A Simple Guide to Salpingitis

A Simple Guide to Salpingitis
------------------------------

What is Salpingitis?
----------------------

Salpingitis is an acute or chronic infection of the fallopian tubes in females.

What are the causes of Salpingitis?
---------------------------------------

Acute Salpingitis is usually caused by the following:

Infections:
1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.

2.tuberculosis salpingitis is rare

3.Infection may follow chilbirth or abortion

Mechanical irritants:
intrauterine device may cause acute or chronic Salpingitis

What are the symptoms and signs of Salpingitis?
------------------------------------------------

Persons who has Acute Salpingitis has the following
Symptoms:

1.severe lower abdominal pain

2.purulent vaginal discharge

3.painful or frequency of urination

4.fever

Signs:
1.tenderness in either lower abdominal quadrant

2.discharge can be seen in female vagina

3.vaginal examination - lateral movement of cervix causes pain
- palpation of the fallopian tubes may be very painful

How do you diagnose Salpingitis?
--------------------------------

Diagnosis can usually be made by :
1.History of lower abdominal pain with vaginal discharge

2.Tenderness in lower abdominal region with occasional palpation of tender mass
in the fallopian tube region

3.vaginal examination for tenderness in the tubes region

4.swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

5.Full blood count

6. endoscopy to examine the fallopian tubes

What are thae complications of Salpingitis?
-------------------------------------------

Acute Salpingitis may progress to chronic Salpingitis:

1. tubal infection with abscess formation(pyosalphinx) or cyst formation(hydrosalphinx)

2. Pelvic abscess

3. Ovarian infection

4.Infertility due to tube blockage

5. Peritonitis may occur with rupture of cyst and abscess

What is the treatment of Salpingitis?
-------------------------------------

1.Approprate Antibiotics for infections especially after uterine bacterial culture

2.Bedrest

3.Surgery may be necessary in cases not responding to antibiotics.
Drainage of the abscess may be done and infected tube resected if necessary

What is the prognosis of Salpingitis?
-------------------------------------------------------

Prognosis is usually good with current antibiotics and medication.

Sexual partner may need to be treated.

Recurrence is quite common.

Infertilty may result in blocked or scarred fallopian tubes

A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)

A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)
--------------------------------------------------------------------------

What is a Menorrhagia?
--------------------------

Menorrhagia is a symptom defined as heavy, prolonged and/or irregular menstruation .

What are the causes of Menorrhagia?
-------------------------------------

1.Physiological(hormonal): most common
-----------------------------------
Excessive menstrual bleeding occurs when no ovulation takes place in a menstrual cycle with resultant excess oestrogen stimulation of the endometrium that results in the shedding of the thickened uterine lining and heavy bleeding when the oestrogen drops.

A defective persistent corpus luteum which results from an abnormal ovulation can also cause the shedding of the nedometrium for a longer period resulting in prolonged bleeding.

Other factors that may make heavy menstrual bleeding are:
2.Uterine Pathology:
-----------------------
polyps,
fibroids
endometriosis
infection
carcinoma

3.Systemic Diseases:
-----------------------
Bleeding diseases
Hypothyoidism
liver disease
Pelvic inflammatory Disease(PID)
Polycystic Ovarian syndrome(PCOS)

4.Medical causes:
--------------------
anticoagulants which are preventing clotting of blood
intrauterine device for contraception

How to establish a diagnosis of Menorrhagia?
---------------------------------------------

History:
--------------
Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea

Contraception:
use of IUD
contraceptive pills

Symptoms suggesting underlying pathology:
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome

Bleeding disorders:
easy bruising
anticoagulants

Pelvic inflammatory Disease:
pelvic pain especially during intercourse
vaginal discharge
dysmenorrhea

Endometriosis:
pelvic pain
dysmenorrhea

Physical Examination:
-----------------------------
Signs of underlying diseases:
bruising
hypothyroid features
pallour(anaemia)
PCOS features(hirsutism,acne,overweight)

Abdominal examination:
tenderness,
palpable uterine or ovarian masses

Pelvic examination:
vulval and vaginal examination
bimanual palpation for masses
cervical smear

Investigation:
------------------
Full blood count including hemoglobin(to exclude anemia from loss of blood) and platelets(low platelets can cause bleeding)

Transvaginal ultrasound to exclude uterine fibroids and polyps -postmenstrual scans is best when the endometrium is at its thinest.

Endometrial hysteroscopy and biopsy in women over 40 to exclude uterine cancer

What is the Treatment of Menorrhagia?
-------------------------------------------
Medications:
-------------

1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding

2.Combined oral contraceptives - prevent proliferation of the endometrium, reduces blood flow. Side effects are fluid retention, nausea, headache,deep vein thrombosis, mood changes, breast tenderness

3.oral progesterone - also prevent proliferation of the endometrium-usually less side effects bloating, headache, mood changes, breast tenderness

4. Injected progesterone -also prevent proliferation of the endometrium -similar side effects as oral progesterone. One additional side effect is the possibility of bone density loss. Evaluation of bone density should be done.

5. Levonorgestrel-releasing intrauterine system(LNG-IUS)
-also prevent proliferation of the endometrium
-side effects includes irregular bleeding up to 6 month, amenorrhea(no menses),
breast tenderness, and headache.

Surgery
-------------

1.Endometrial ablation
may be done only
a.if medications has failed
b.if no desire to coceive
c.if the uterus is normal

Usually involve the removal of the endometrium through the cervical opening.
There are forms of endometrial ablation:
a.First generation:
hysteroscopy with general anaesthesia
-Rollerball ablation
-Transcervical resection of the endometrium

b.Second Generation:
non-hysteroscopy, no general anaethesia, day surgery,fast recovery
-Impedance-controlled bipolar radiofrequency ablation
-balloon thermal ablation
-microwave ablation
-free fluid thermal ablation

2. Hysterectomy
used only as a last resort in treatment of menorrhagia
if other treatment are contraindicated
there is a desire for amenorrhea
there is no desire to retain uterus and fertility

Treatment of Underlying causes:
----------------------------------
hypothyroidism with thyroxine tablets

intrauterine device removal

reduce anticoagulant treatment if possible

treat any bleeding disease with platelets or blood factor deficient infusion

treatment of endometriosis,

antibiotic treatment of pelvic inflammatory idsease

treatment of uterine carcinoma

surgical removal of fibroids and polyps

A Simple Guide to Paronychia

A Simple Guide to Paronychia
-----------------------------------

What are Paronychia?
--------------------------

Paronychia is acute or chronic infection of the tissue surrounding the nails of fingers or feet.

What are the Causes of Paronychia?
---------------------------------------------

There are two main causes of Acute Paronychia:
1.Bacteria-pseudomonas, Proteus,staphylococus

2.Fungal- candida

Chronic Paronychia:
1.Fungal- candida

2.Bacterial-pseudomonas

Micro-organisms usually enter through injured or damaged tissues from a ingrowing nail or sharp nail.

Tissues around the base of the cuticles becomes infected and inflammed, usually on one side of the nail.

Pus may form and oozes from the infected tissues.

What are the Symptoms of Paronychia?
----------------------------------------------

1.Acute paronychia:
----------------------

1.swollen

2.painful

3.red nail fold

4.may dicharge pus

2.Chronic paronychia
-----------------------

1.recurrent

2.painful

3.swollen tissues at base of nail

4.pus may be present

5.nail plate may rigid, distorted or invaded by micro-organism

What are the investigations for Paronychia?
----------------------------------------------

Swab for culture and sensitvity to antibiotics

Exclude Diabetes

What is the Treatment of Paronychia?
----------------------------------------------

Acute Paronychia:
-----------------------

1.Systemic antibiotics

2.Incision and drainage of pus

3.Surgical excision of part of the cuticle causing tissue damage(Ingrowing toenails) and the removal of infected lateral nail folds

Chronic Paronychia:
---------------------

1.Keep hands dry and use protective gloves

2.Apply anti fungal lotions and creams such as clotrimazole, nystatin

3.Systemic anti fungals such as griseofulvin or ketoconazole

4.Treat secondary bacterial infections with antibiotics

What are the Prevention measures in Paronychia?
---------------------------------------------------------

1.Avoid pressure on the lateral folds of the nails

2.Footwear should not be too tight

3.Avoid biting of nails

4.Avoid constant contact with water and soaking in water

5.Cutting of nails should not be too deep

6.Good personal hygience

A Simple Guide to Diverticulosis

A Simple Guide to Diverticulosis
----------------------------------------------------

What is Diverticulosis?
---------------------------------------

Diverticulosis is a disorder of the colon or large intestine where there are one or more sac-like pouches(called diverticula) in the walls of the colon.

It is more common in the descending and sigmoid colon.

Who is affected by Diverticulosis?
---------------------------------------------------

Diverticulosis becomes more obvious with age.
50% of people over the age 0f 60 years have Diverticulosis.

What is the Cause of Diverticulosis?
-----------------------------------------------------

The exact cause of Diverticulosis is not known.

It has been suggested that a low-fiber diet is the main cause of diverticular disease.

Diverticulosis is common in developed countries where low-fiber diets are common whereas it is rare in Asia and Africa where people eat high-fiber vegetable diets.

Fiber prevents constipation which can make the muscles strain and increase pressure in the colon.

This increased pressure makes the weak spots in the colon lining to bulge out like pouches and become diverticula.

What are the Symptoms of Diverticulosis?
-----------------------------------------------------------

Most cases of Diverticulosis have no or little symptoms.

In the more severe cases, the main symptoms of Diverticulosis are:

1.Abdominal pain or cramps-usually over the left side or over the lower abdomen

2.Bloating

3.constipation

The symptoms can range from mild to severe.

How do you make the Diagnosis of Diverticulosis?
------------------------------------------------------------

1.A history of abdominal pain especially on the left lower abdomen, bloating and constipation

2.The physical exam consists of
a.palpation of the left abdomen for tenderness or masses
b.digital rectal exam to detect tenderness or blood.

3.stool may be tested for blood

4.blood tests(WBC,ESR,bood culture) are done for evidence of infection.

5.Xrays of the abdomen and barium enema may be done to show evidence of pouches in the colon

6.Colonoscopy is also done to confirm evidence of diverticulosis and exclude malignant tumours.

What are the complications of Diverticulosis?
---------------------------------------------------

1.Diverticulitis
Diverticulitis occurs when diverticula become infected with bacteria, viruses or become inflamed.
Bacteria are caught in the pouches and develops into diverticulitis suddenly.

The symptoms and signs of diverticulitis are:
1.abdominal pain usually continuous in the lower left abdomen with tenderness

2.fever due to infection,

3.nausea, vomiting,

4.cramping,

5.constipation

6.rectal tenderness

Diverticulitis can lead to:

1.Bleeding,
rare.
Bleeding can be severe caused by a small blood vessel in a diverticulum that weakens and finally bursts.
Surgery may be needed to stop bleeding if bleeding continues.

2.Abscess, Perforation, and Peritonitis
Often a few days of treatment with antibiotics will cure the diverticulitis.
If the infection gets worse, an abscess which is an infected area with pus may form in the colon.

Small abscesses usually clear up with antibiotics.

More severe abscesses may require drainage of the pus using a catheter.

If pus leaks from perforations in the lining of the colon, then it can cause infection in the abdominal cavity and results in peritonitis.

This is an emergency and requires immediate surgery to clean up the pus in the abdominal cavity and removal of the damaged part of the colon.

3.Intestinal Obstruction
The infection of the diverticula can cause scarring of the lining of the colon resulting in partial or total blockage of the large intestine.

If the obstruction blocks the intestine completely, emergency surgery is required to allow faecal matter to pass through.

A temporary colostomy may be necessary.

4.Fistula
occurs as an abnormal connection between two organs or between an organ and the skin.

It results from the damaged tissues coming together and an opening is left between the two tissues.

Usually the bladder, small intestine, vagina, and skin are the organs involved.

The most common fistula occurs between the bladder and the colon especially in men. This can cause a long-lasting infection of the urinary tract.

Surgery may be necessary to remove the fistula as well as the damaged part of the colon.

5.Urinary tract infections occurs frequently due to the fistula and proximity of the bladder to the infected colon.

6.Discarge of faecal material may occur through a fistula between the colon and vagina in some women.

What is the treatment of Diverticulosis?
-------------------------------------------------

Medication:
1.pain medications will relieve any pain symptoms.

2.Antispasmotic mediacation for spams of the colon

3.Antibiotics may be needed in diverticulitis and complications such as urinary infection and peritonitis.

Diet:
1.high-fiber diet

a.whole grain breads and cereals;
b.fruit like apples and peaches;
c.vegetables like carrots, broccoli, spinach, carrots, cabbage, beans.

2.fiber product such as Metamucil once a day.

3.Avoid nuts, popcorn, pumpkin, and sesame seeds or any food which can cause discomfort in the abdomen

Diverticulitis
1.Antibiotics to treat the infection and inflammation,

2.resting the colon by bed rest, nasogastric suction and a liquid diet

3.hospital stay to prevent complications such as abscess.

4.surgery if the attacks are severe or there are complications.
The surgeon resects the affected part of the colon and then joins the remaining sections.

Surgery is also done for complications such as a fistula or intestinal obstruction.

Emergency surgery may be done for a large abscess, perforation, peritonitis, or continued bleeding.

What is the prognosis of Diverticulosis?
------------------------------------------------------

About 1% develop diverticulitis.
70% of patients with acute attacks of diverticulitis can be treated with medical management and have no further attacks

A Simple Guide to Pancreatic Cancer

A Simple Guide to Pancreatic Cancer
----------------------------------------

What is Pancreatic Cancer?
------------------------------

Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.

What are the causes of Pancreatic Cancer?
-----------------------------------------

1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells

2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells

3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer

4.Chronic pancreatitis has been found to have some causal effect

5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer

6.Occupational exposure to certain chemicals including insecticides

7.Family history -there is a family history in 5-10% of pancreatic cancer patients

8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract

What are the symptoms and signs of Pancreatic Cancer?
-------------------------------------------------------

Symptoms - non-specific and varied.

1.pain in the upper abdomen that typically radiates to the back

2.pain relieved by leaning forward

3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)

4.depression is sometimes associated with pancreatic cancer


Signs:

1.tenderness in upper abdomen

2.mass in the abdomen

3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.


How do you diagnose Pancreatic Cancer?
----------------------------------------------

Diagnosis can usually be made by :

History
-----------

1.pain in upper abdomen radiating straight to the back, worse on eating

2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.

3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later

4.onset of atypical diabetes mellitus

5.unexplained recent thrombophlebitis

6.past history of pancreatitis

Location of cancer
-----------------------

1.Tumors in the pancreatic body or tail usually present with pain and weight loss

2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.

Courvoisier sign
-----------------

presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer

Liver function tests
---------------------

may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).

CA19-9 (carbohydrate antigen 19.9)
----------------------------------

is a tumor marker that is frequently elevated in pancreatic cancer.

Ultrasound or abdominal CT
------------------------------

may be used to identify tumors.

Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

What is the treatment of Pancreatic Cancer?
------------------------------------------------

Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.

Surgery
--------------

1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.

2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy

3.localized tumors of the pancreas have been surgically removed using laparoscopy.

4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.

5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.

Chemotherapy
-----------------

is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life

Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer

Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.

Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.

Radiation therapy
--------------------

The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.

What is the Prognosis of pancreatic cancer?
-------------------------------------------------

The prognosis of pancreatic cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 3-4 months;

3.5-year survival is lower than 5%.

4.Pancreatic cancer has the highest mortality of all the cancers.

5.Pancreatic cancer may sometimes cause diabetes.

How to prevent Pancreatic Cancer?
----------------------------------------

1.a healthy lifesyle

2.increase consumption of fruits, vegetables

3.reduce red meat intake

4.Vitamin D can reduce the risk of pancreatic cancer

5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer

6.Avoid smoking and drinking of alcohol

A Simple Guide to Pancreatitis

A Simple Guide to Pancreatitis
------------------------------

What is Pancreatitis?
----------------------

Pancreatitis is an acute or chronic inflammation of the pancreas.

What are the causes of Pancreatitis?
-----------------------------------------

Pancreatitis is usually caused by the following:

1. Alcoholism and diseases of the biliary tract

2. bacterial infections from salmonella typhi and streptococcus

3. viral infection especially mumps, coxsackie virus, cytomegalovirus

4. trauma

Chronic disease follows attacks of acute infection.

What are the symptoms and signs of Pancreatitis?
-------------------------------------------------------

Persons who has Acute Pancreatitis has the following symptoms:

1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.

2.Pain usually very severe occuring a large meal or drinking bout

3.Pain is worse lying supine, therefore patients sit or lean forward

4.mild fever and bodyaches

5.nausea and vomitting

6.hypotension followed by clinical shock

Signs:

1.Tenderness at the epigastrium with muscle spasm

2.Distension and diminished bowel sounds

3.Pleural effusion 10%,abdominal mass 20%, ascites 20%

4. Acute renal failure, respiratory failure following shock.

Chronic Pancreatitis
---------------------
Symptoms:

1.repeated attacks of epigastric abdominal pain

2.Pain worse after eating, radiates to the back

3.weight loss

4.Fever

Signs:

1.abdominal tenderness

2.abdominal mass may suggest swelling and pseudocysts

3.tender subcutaneous masses seen indicating fat necrosis

How do you diagnose Pancreatitis?
--------------------------------

Diagnosis can usually be made by :

1.Physical examination with tenderness in the epigastrium

2.Serum and urine amylase very high after 6 hours

3.White blood cell count high

4.Serum lipase high in 50% patients

5.Blood calcium may be low

6.Blood glucose tolerance test for diabetes

7.Ultrasound may show up the presence of pseudocyst in pancreas

8.CAT scan and MRI may show swelling and pseudocysts in pancreas

What is the complications of Pancreatitis?
-------------------------------------

1.Pseudocysts from damage to pancreatic tissues

2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas

3.peritonitis from rupture of pseudocysts and bleeding

4.diabetes mellitus from damage to the glands in the pancreas producing insulin

What is the treatment of Pancreatitis?
-------------------------------------

Acute Pancreatitis:
----------------------
Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Treat biliary tract diseases and alcoholism

surgical drainage of pseudocysts after acute episode.

Chronic Pancreatitis:
-----------------------

Pancreatic extracts and enzymes together with meals

Sodium bicarbonate and cimetidine to prevent enzymes breakdown

Analgesic or antispasmodic medicine usually by injection

Surgical procedures usually unsuccessful

What is the prognosis of Pancreatitis?
----------------------------------------

Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.

Hemorhagic Pancreatitis has high mortality of 50-90%

Most trauma cases has complete resolution

Some alcoholic pancreatitis may go on to chronic pancreatitis.

Chronic pancreatitis relapses frequently

Rupture of pseudocysts may result in death

How do you prevent Pancreatitis?
------------------------------------------------

Avoid alcohol and oily food

Take precautions during mumps and other viral infection

Avoid injury to the abdomen especially the mid section below the sternum

A Simple Guide to Allergies

A Simple Guide to Allergies
------------------------------

What are Allergies?
----------------------

Allergies are the immune system's reaction to a harmless substance foreign to the body.

In some people this reaction causes a uncomfortable symptom like rashes or swelling of the eyelids.

In severe cases it can even cause peeling of the skin or kidney damage.

What are the Common causes of Allergies?
----------------------------------------------

The most common causes of allergies are pollen and dust mites.

Besides these, there are a wide range of substances that can trigger an allergic response.

Pollen:
---------
Pollen is the seeds or spores released by flowers or plants during pollination phase of plants and usually is higher in summer. Some countries shows the daily pollen index in the media during summer to warm allergen sufferers the risks of allergy during this peroid.
Pollens irritate the sensitive mucusal lining of the nose and the epithelium of the skin causing inflammation and swelling.

Dust mites:
---------------
Dust mites are microscopic parasites who live on the skin flakes shed by the human body every day. They can found just about everywhere on the floor, carpets, on mattresses, pillows, bed covers, clothes and upholstery.
The faeces from the dust mite is the main substance which causes sneezing and wheezing.

House dust like dander from animals, cockroach faeces, bacteria, moulds, fungus spores and dust mites are the main cause of allergies in any family.

Moulds
-------------
Moulds are microscopic fungi with spores floating in the air like pollen.
They are usually found in damp areas indoors such as the basement or bathroom, as well as outdoors in grass, leaves, hay, or under plants.


Animal proteins
------------------
Proteins found in an animal's skin and saliva can cause allergy to skin, nose and lungs in some people.

Food allergens
------------------
Certain foods especially eggs, milk, nuts, and seafood, induce intestinal and skin reactions frequently in children who often outgrow it after puberty.

What are the Symptoms of Allergies?
--------------------------------------------
Allergic symptoms include:

1.itchy, watery nose and eyes,

2.asthma, wheezing and coughing

3.Hives or skin rahes

What is the Treatment of Allergies?
-------------------------------------------

Treatment depends on the severity of symptoms.

In severe cases of allergy:

1.adrenaline injection is used in life-threatening situations to reduce acute swelling of the airways.

2.Antihistamines can help relieve symptoms such as sneezing and running nose.

3.Bronchodilators (theophylline and beta-agonists e.g. salbutamol) are used in cases of asthma to open the airways, relieve coughing, wheezing, shortness of breath and difficulty in breathing.

4.Corticosteroids such as dexamethasone may be given to relieve symptoms.
They also reduce the immune reaction to the allergens.

How to prevent allergies?
------------------------
The best prevention is to avoid the allergens:

1.Avoid dustmites, pollen.

2.Cover all pillows, mattress,beds etc with special dust mite covers,

3.Avoid food like eggs, milk, nuts, and seafood

4.Desensitisation to Allergens
---------------------------------

Desensitisation to Allergens is by giving small doses of allergen until the body itself become insensitise to allergens.

A Simple Guide to Coughing

A Simple Guide to Coughing
------------------------------

What is Coughing?
----------------------

Coughing is the reflex mechanism in which the body tries to get rid of excessive mucus and phlegm accumulated in the lining membranes of the respiratory tract.

The secretions from the lining of the respiratory tract trap and then flush out the viruses, bacteria and other particles like smoke, haze particles.

It prevents serious infections from entering the lungs and bronchial tubes.

What are the common causes of cough?
---------------------------------------

Coughing is usually caused by the following:

Infections:
1.bacterial or viral infection of the nose and throat such as the common cold or influenza.(yellow or green phlegm)

2.anaerobic infections of the mouth,

3.Infection of the tonsils, nose and sinuses(postnasal drip)

4.Bacterial infection of the bronchial tubes and lungs(bronchiectasis, bronchitis, pneumonia, sinusitis, or tracheitis).
This often comes with rusty or green mucus.

Dry mouth:
1.Insufficient drinking of water

2.medications especially ACE inhibitors(eg. enapril) can cause dry persistent coughs

Allergies:
1.Certain plants, pollens, chemicals, cosmetics can cause allergic reactions in the throat and bronchial causing cough. (white clear phlegm)

2.Asthma - narrowing of the bronchial tubes due to allergic and other causes usually results in white sticky clear productive phlegm

Smoking:
Cigarettes smokes contains 40 over chemicals which irritates the cells in the lining of the bronchial tubes causing a chronic cough

Stress:
Stress can cause cough due to dryness of mouth during stress or anxiety, causing the saliva to dry up and producing dry unproductive cough.
The cough in stress usually disappears during sleep.

Gastric problems or indigetions
1. Indigestion of food in the stomach can cause the undigested food in the stomach to produce gas in the stomach which goes upwards to the throat drying saliva which then become irritating phlegm in the throat.

2.gastroesophageal reflux of food can also cause the acid and undigested food to travel to the mouth and produce mucus secretions.

Systemic diseases:
1.Congestive heart failure

2.Lower respiratory tract infections

3.Chronic Obstructive Lung Disease

4.Carcinoma lung.

What investigations are needed for cough?
------------------------------------------

1.chest X-ray

2.sputum culture

3.pulmonary function tests

What is the treatment of Coughing?
-------------------------------------

Medications
1.Approprate Antibiotics, antifungal for infections of throat and bonchial tubes

2.Antihistamines for allregic cough

3.Bronchodilators for asthma and Chronic Obstructive Lung Disease

4.cough mixtures - expectorants helps to expel out the phlegm
- suppresant suppress the cough -especially for dry cough and at night to stop the cough

5.Antacids and antiflatulent agents to get rid of gas in stomach and prevent reflux

6.Diuretics for treatment of congestive heart failure especially in the elderly

Healthy Lifestyle:
1.drinking several glasses of water a day prevents dryness of mouth

2.Avoid cold, acidic, spicy and oily food which irritates the throat

3.Proper oral hygience after eating: brushing of teeth and flossing.

4.Gargle mouth after every meal.

4.Avoid smoking

6.Avoid frequent usage of the voice and throat - do not talk too much

6.Treat underlying condition such as asthma, diabetes, liver, kidney and other conditions.

A Simple Guide to Halitosis

A Simple Guide to Halitosis(Bad Breath)
--------------------------------------

What is Halitosis?
----------------------

Halitosis is the condition when a person suffers from chronic bad breath.

What are the causes of Halitosis?
---------------------------------------

Halitosis is usually caused by the following:

Infections:
1.bacterial infection of the gums, dental cavities.(600 types of bacteria
present in mouth)

2.anaerobic infections of the mouth,

3.Infection of the tonsils, nose and sinuses(postnasal drip)

Gastric problems and indigestion:
1. Indigestion of food in the stomach can cause the undigested food in the stomach to emit an offensive smell through the mouth

2.gastroesophageal reflux of food can also cause the smell of acid and undigested food in the mouth

Certain food:
1.garlic and onions which has odious suphur compounds can give rise to foul smell from the mouth

2.fish

3.cheese

4.alcohol

Smoking:
Cigarettes smokes contains 40 over chemicals which cause bad mouth smell

Dry mouth:
1.Insufficient drinking of water

2.medications can cause dry mouth and produces a smell from the mouth

Systemic diseases:
1.liver failure.

2.Lower respiratory tract infections

3.Renal infections and renal failure.

4.Carcinoma.

5.Trimethylaminuria ("fish odor syndrome").

6.Diabetes mellitus.

What are the symptoms and signs of Halitosis?
------------------------------------------------

Persons who has Halitosis has the following
Symptoms:
1.Bad breath

2.Dry mouth

Signs:
1.discharge from nose or tonsils

2.furry tongue

How do you diagnose Halitosis?
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Diagnosis can usually be made by :
1.History of bad breath

2.lick the back of the wrist, let the saliva dry for a minute, and smell the dried saliva.

3.scrape the posterior back of the tongue with a plastic disposable spoon and smell the drying residue.

4. Halimeter: a portable sulfide monitor to test for levels of sulfur emissions (especially hydrogen sulfide) from the mouth.

5.BANA test: find the salivary levels of an enzyme which shows the presence of certain halitosis-related bacteria

5.ß-galactosidase test: the presence of this enzyme in the saliva indicates presence of bad breath

What is the treatment of Halitosis?
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1.Approprate Antibiotics, antifungal for infections of mouth

2.drinking several glasses of water a day prevents dryness of mouth

3.Eating a healthy breakfast helps clean the back of the tongue

4.Proper oral hygience after eating: brushing of teeth and flossing. Dentures should be removed at bedtime and soaked overnight in antibacterial solutions.

5.Avoid smoking

6.Gargle mouth after every meal.
Avoid the use of alcohol based mouth wahes.
Use instead oil based mouth washes.

7.Chewing sugarless gums helps to stimulate production of saliva and hence less bad breath

8.Treat underlying condition such as diabetes, liver, kidney and other conditions.

What is the prognosis of Halitosis?
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Prognosis is usually good with proper oral hygiene.

Recurrence is quite common.