A Simple Guide to Alcoholism
-------------------------------------------
What is Alcoholism?
---------------------------
Alcoholism is a chronic disease manifested by a pattern of pathological alcohol usage with inability to stop drinking more than temporary resulting in physical, psychological and social consequences.
Who is at risk of getting Alcoholism?
-------------------------------------------
1.Familial
2.Cultural factors especially alcohol drinking friends
3.Social pressure and Stress
4.Depression may be a cause of Alcoholism
What are the Symptoms and signs of Alcoholism?
-----------------------------------------------
Common symptoms of Alcoholism are:
1.Need for daily use of alcohol
2.Binge drinking
3.Inability to stop drinking more than a temporary phase
4.Impairment of social and occupational function
5.Blackouts and amnesia
6.Violent behavior when intoxicated with arguments with friends and family
7.Absence from work or loss of job
8.Legal problems such as arrests for drink driving or traffic accidents
9.Evidence of tolerance for more alcohol to achieve sense of comfort
10.Development of alcohol withdrawal (tremors on awakening, insomnia, hallucinations)
How is the diagnosis of Alcoholism made?
-----------------------------------------------------
1. level of blood alcohol above the permitted limit.
2.Liver function tests are abnormal:
a.Aminotransferases - AST and ALT are moderately elevated, with AST > ALT.
b.Alkaline phosphatase - usually slightly elevated.
c.GGT - correlates with AP levels- much higher in chronic liver disease from alcohol.
3. ECG and EEG
What are the complications of Alcoholism?
-----------------------------------------------------
Complications may develop with progression of the alcoholism.
1.Delirium tremors
2.Acute alcohol delusional states
3.Untidy appearance
a.neglect of personal appearance,
b.unresponsiveness,
c.forgetfulness,
d.trouble concentrating,
e.changes in sleep habits.
5.Alcoholic hepatitis and cirrhosis
6.Wernicke's encephalopathy
7.Alcoholic cerebellar degeneration
8.Pellagra
What is the treatment of Alcoholism?
-----------------------------------------------------
In all cases of Alcoholism, assessment of the patient's alcoholism and complications are needed.
1. Detoxification in special centers
2. treatment of complications
3.Alcohol withdrawal with the help of transquillizers and vitamin supplements
4.Antabuse therapy to cure alcohol dependence
5.Psychological therapy and Alcoholic Anonymous
What is the prognosis for Alcoholism?
---------------------------------------------------
Prognosis is dependent on initial severity and the patient's motivation to return to sobriety
Alcoholism is a serious chronic disease which can be controlled but seldom cured.
What is the best prevention for Alcoholism?
---------------------------------------------------
1. No drinking of any form of alcohol
2. Family support and psychotherapy and self help groups
Thursday, January 27, 2011
Tuesday, January 25, 2011
A Simple Guide to Coeliac Disease
A Simple Guide to Coeliac Disease
---------------------------------------------
What is Coeliac Disease?
--------------------------------
Coeliac Disease(Gluten Enteropathy) is a chronic disease of the small intestine which affects the lining of the small intestine to develop abnormalities on contact with gluten.
The small bowel mucosa shows
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes and plasma cells
Who is affected by Coeliac Disease?
---------------------------------------------------
Coeliac Disease is more common in people with certain HLA antigens and blood group O.
There is a possibility of enzyme deficiency and abnormal immunological response.
Coeliac Disease can be found in all ages but are more common in the 10-30 years age group.
What is the Cause of Coeliac Disease?
-----------------------------------------------------
The exact cause of Coeliac Disease is not known.
It has been suggested that an autoimmune disease is the main cause of Coeliac Disease.
A protein produced by the immune system, called HLA antigen may be a possible cause of the body's reaction in the lining of the small intestinal tract resulting in inflammation.
What are the Symptoms and signs of Coeliac Disease?
---------------------------------------------------------------------
Symptoms varies from mild to severe:
1.severe abdominal pain, bloating
2.diarrhea and steatorrhea
3.Weight loss despite good appetite and intake
4.edema
5.glossitis
6.apthous ulcers
7.finger clubbing
8.hypotension
9.Polyneuritis
10.psychiatric symptoms
In children there may be:
1.failure of weight gain
2.irritability
3.general malaise
How do you make the Diagnosis of Coeliac Disease?
-------------------------------------------------------------------
1.A history of abdominal pain , diarrhea and weight loss
2.small bowels radiology
3.D-xylose absorption study
4.fecal fat assessment
5.Jejunal biopsy
What are the complications of Coeliac Disease?
------------------------------------------------------------
1.weight loss
2.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Coeliac Disease?
---------------------------------------------------
Treatment is :
Control of Diet
1.gluten free diet especially wheat, oats, barley, rye
use rice corn potato in place
2.avoid beer, ale, whisky, vodka which contains a lot of gluten
3.Special diet for gluten sensitive patients
4.Question diet and review diagnosis if no response
Medication
1.Antispasmotic medication for abdominal pain
2.Oral corticosteroids may help in patients not responding after 3 months of careful adherence to diet
Start with high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.
3.Correction of anemia and nutritional deficiencies is important to enhance the immune system
What is the prognosis of Coeliac Disease?
-----------------------------------------
The prognosis depends on the conition of the disease
Improvement occurs within 1-3 days following institution of diet seen in 30% of patients.
80% will respond within a month.
the remaining 20%may take up to 2 years for symptoms control.
There may be recurrence if therapy is stopped.
What are preventive measures in Coeliac Disease?
------------------------------------------------------------------
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
A gluten free diet will prevent recurrence
---------------------------------------------
What is Coeliac Disease?
--------------------------------
Coeliac Disease(Gluten Enteropathy) is a chronic disease of the small intestine which affects the lining of the small intestine to develop abnormalities on contact with gluten.
The small bowel mucosa shows
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes and plasma cells
Who is affected by Coeliac Disease?
---------------------------------------------------
Coeliac Disease is more common in people with certain HLA antigens and blood group O.
There is a possibility of enzyme deficiency and abnormal immunological response.
Coeliac Disease can be found in all ages but are more common in the 10-30 years age group.
What is the Cause of Coeliac Disease?
-----------------------------------------------------
The exact cause of Coeliac Disease is not known.
It has been suggested that an autoimmune disease is the main cause of Coeliac Disease.
A protein produced by the immune system, called HLA antigen may be a possible cause of the body's reaction in the lining of the small intestinal tract resulting in inflammation.
What are the Symptoms and signs of Coeliac Disease?
---------------------------------------------------------------------
Symptoms varies from mild to severe:
1.severe abdominal pain, bloating
2.diarrhea and steatorrhea
3.Weight loss despite good appetite and intake
4.edema
5.glossitis
6.apthous ulcers
7.finger clubbing
8.hypotension
9.Polyneuritis
10.psychiatric symptoms
In children there may be:
1.failure of weight gain
2.irritability
3.general malaise
How do you make the Diagnosis of Coeliac Disease?
-------------------------------------------------------------------
1.A history of abdominal pain , diarrhea and weight loss
2.small bowels radiology
3.D-xylose absorption study
4.fecal fat assessment
5.Jejunal biopsy
What are the complications of Coeliac Disease?
------------------------------------------------------------
1.weight loss
2.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Coeliac Disease?
---------------------------------------------------
Treatment is :
Control of Diet
1.gluten free diet especially wheat, oats, barley, rye
use rice corn potato in place
2.avoid beer, ale, whisky, vodka which contains a lot of gluten
3.Special diet for gluten sensitive patients
4.Question diet and review diagnosis if no response
Medication
1.Antispasmotic medication for abdominal pain
2.Oral corticosteroids may help in patients not responding after 3 months of careful adherence to diet
Start with high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.
3.Correction of anemia and nutritional deficiencies is important to enhance the immune system
What is the prognosis of Coeliac Disease?
-----------------------------------------
The prognosis depends on the conition of the disease
Improvement occurs within 1-3 days following institution of diet seen in 30% of patients.
80% will respond within a month.
the remaining 20%may take up to 2 years for symptoms control.
There may be recurrence if therapy is stopped.
What are preventive measures in Coeliac Disease?
------------------------------------------------------------------
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
A gluten free diet will prevent recurrence
Friday, January 21, 2011
A Simple guide to Raynaud's Disease
A Simple Guide to Raynaud's Disease
------------------------------------------------
What is Raynaud's Disease?
------------------------------------
Raynaud's Disease is a transient vasospasm of small arteries of the hand precipitated by cold.
There is typical whiteness and blueness of fingers.
Causes are:
1.classically cold precipitated, more common in winter
2.Emotional factors such as fear and anxiety
It may secondary to other conditions such as:
1.auto immune disease such as SLE
2.arterial compression syndrome from cervical ribs
3.hypothyroidism
4.pulmonary hypertension
5.medicines such as ergotamine
6.vinyl chloride exposure
7.low immune patients such as cancer
It occurs more commonly in women and usually rare in men
What are the Signs and Symptoms of Raynaud's Disease?
-----------------------------------------------------------------------
Symptoms start off with:
cold extremities with at least 2 of the following changes for diagnosis:
1.blanching and numbness of fingers spreading up to the rest of hand
2.blanching and whiteness of fingers then blue mottling followed by red as circulation returns
3.pain during color changes common
4.skin shiny or wax like
5.feet may be involved, also nose and tongue
6.gangrene of finger tips
How to diagnose Raynaud's Disease?
-------------------------------------------------------------
1.Symptoms and signs as above
2.skin capillary microscopy
3.hand films may show terminal tuft atrophy in vinyl chloride exposure
What are the complications of Raynaud's Disease?
---------------------------------------------
The complications are:
gangrene of the fingers
What is the Treatment of Raynaud's Disease?
--------------------------------------------
1.Avoid of cold temperature
2.Avoid emotional upset and stress
3.Keep body and environment warm
4.treat underlying cause
5.calcium channel blockers
reserpine
methyl dopa
6.sympathectomy
What is the Prevention for Raynaud's Disease?
-----------------------------------------------------------
Avoiding cold temperature and stress
Prognosis of Raynaud's Disease
----------------------------------------------
depends on cause and response to therapy
------------------------------------------------
What is Raynaud's Disease?
------------------------------------
Raynaud's Disease is a transient vasospasm of small arteries of the hand precipitated by cold.
There is typical whiteness and blueness of fingers.
Causes are:
1.classically cold precipitated, more common in winter
2.Emotional factors such as fear and anxiety
It may secondary to other conditions such as:
1.auto immune disease such as SLE
2.arterial compression syndrome from cervical ribs
3.hypothyroidism
4.pulmonary hypertension
5.medicines such as ergotamine
6.vinyl chloride exposure
7.low immune patients such as cancer
It occurs more commonly in women and usually rare in men
What are the Signs and Symptoms of Raynaud's Disease?
-----------------------------------------------------------------------
Symptoms start off with:
cold extremities with at least 2 of the following changes for diagnosis:
1.blanching and numbness of fingers spreading up to the rest of hand
2.blanching and whiteness of fingers then blue mottling followed by red as circulation returns
3.pain during color changes common
4.skin shiny or wax like
5.feet may be involved, also nose and tongue
6.gangrene of finger tips
How to diagnose Raynaud's Disease?
-------------------------------------------------------------
1.Symptoms and signs as above
2.skin capillary microscopy
3.hand films may show terminal tuft atrophy in vinyl chloride exposure
What are the complications of Raynaud's Disease?
---------------------------------------------
The complications are:
gangrene of the fingers
What is the Treatment of Raynaud's Disease?
--------------------------------------------
1.Avoid of cold temperature
2.Avoid emotional upset and stress
3.Keep body and environment warm
4.treat underlying cause
5.calcium channel blockers
reserpine
methyl dopa
6.sympathectomy
What is the Prevention for Raynaud's Disease?
-----------------------------------------------------------
Avoiding cold temperature and stress
Prognosis of Raynaud's Disease
----------------------------------------------
depends on cause and response to therapy
Wednesday, January 19, 2011
A Simple guide to Legionnaire's Disease
A Simple guide to Legionnaire's Disease
----------------------------------------------------
What is Legionnaire's Disease?
-------------------------------------------
Legionnaire's Disease is an acute, infectious disease of the respiratory tract caused by the bacillus Legionella pneumophilia, a Gram negative, non-sporulating aerobic micro-organism..
The bacteria is found mostly in soil and water.
How is Legionnaire's Disease transmitted?
---------------------------------
Legionnaire's Disease is transmitted through the air or in dust associated with movement of soil or contaminated air from air conditioner units.
It is highly infectious.
Incubation period is 10-20 days.
The organism enters the blood and then enter the cells of the lower respiratory tract
The infections occur in persons of all ages but peak incidence is 50-60 years. Males are affected twice as often as females.
Predisposing factors are:
pre-existing lung disease
heavy smoking
low immune patients such as cancer
What are the Signs and Symptoms of Legionnaire's Disease?
------------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of malaise
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. headache
5. dry cough
6. diarrhea
7. upper and lower gastrointestinal bleeding
8. difficult breathing
9. slow heart rate
10. confusion and dilirium
How to diagnose Legionnaire's Disease?
-------------------------------------------------------------
1.Symptoms of
a.prodromal viral like disease (myalgia, malaise, headache)
b.dry cough, confusion, diarrhea
c.lymphopenia without neutropenia
d.hyponatremia
2.ESR raised very high somtimes > 80
3.moderate leucocytosis with lymphopenia
4.low blood sodium
5.low blood calcium
6.abnormal liver function tests with albumin and raised SGOT
7.Urine shows protein and blood
8.Chest x-ray show patchy consolidation usually confined to one lobe
9.Indirect legionna bacterial antibody higher than 1.256
10.symptoms of renal failure
What are the complications of Legionnaire's Disease?
---------------------------------------------
The complications are:
1.pneumonia
2.liver dysfunction
3.renal failure
What is the Treatment of Legionnaire's Disease?
--------------------------------------------
Isolation in hospital is unnecessary.
1.Antibiotics (erythromycin or rifampicin) are used in the treatment of Legionnaire's Disease.
2.Tetracycline can be given
3.pulmonary care -nebulizer, oxygen, deep breathing exercises may be necessary if there is breathing difficulty
Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change
What is the Prevention for Legionnaire's Disease?
-----------------------------------------
Avoiding dust
Proper cleaning of air conditioners and ventilation system
Prognosis of Legionnaire's Disease
---------------------------------------------
Early therapy with antibiotics produce good results
low mortality rates as early cases are detected
Rarely pulmonary fibrosis develops as remnant from disease.
----------------------------------------------------
What is Legionnaire's Disease?
-------------------------------------------
Legionnaire's Disease is an acute, infectious disease of the respiratory tract caused by the bacillus Legionella pneumophilia, a Gram negative, non-sporulating aerobic micro-organism..
The bacteria is found mostly in soil and water.
How is Legionnaire's Disease transmitted?
---------------------------------
Legionnaire's Disease is transmitted through the air or in dust associated with movement of soil or contaminated air from air conditioner units.
It is highly infectious.
Incubation period is 10-20 days.
The organism enters the blood and then enter the cells of the lower respiratory tract
The infections occur in persons of all ages but peak incidence is 50-60 years. Males are affected twice as often as females.
Predisposing factors are:
pre-existing lung disease
heavy smoking
low immune patients such as cancer
What are the Signs and Symptoms of Legionnaire's Disease?
------------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of malaise
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. headache
5. dry cough
6. diarrhea
7. upper and lower gastrointestinal bleeding
8. difficult breathing
9. slow heart rate
10. confusion and dilirium
How to diagnose Legionnaire's Disease?
-------------------------------------------------------------
1.Symptoms of
a.prodromal viral like disease (myalgia, malaise, headache)
b.dry cough, confusion, diarrhea
c.lymphopenia without neutropenia
d.hyponatremia
2.ESR raised very high somtimes > 80
3.moderate leucocytosis with lymphopenia
4.low blood sodium
5.low blood calcium
6.abnormal liver function tests with albumin and raised SGOT
7.Urine shows protein and blood
8.Chest x-ray show patchy consolidation usually confined to one lobe
9.Indirect legionna bacterial antibody higher than 1.256
10.symptoms of renal failure
What are the complications of Legionnaire's Disease?
---------------------------------------------
The complications are:
1.pneumonia
2.liver dysfunction
3.renal failure
What is the Treatment of Legionnaire's Disease?
--------------------------------------------
Isolation in hospital is unnecessary.
1.Antibiotics (erythromycin or rifampicin) are used in the treatment of Legionnaire's Disease.
2.Tetracycline can be given
3.pulmonary care -nebulizer, oxygen, deep breathing exercises may be necessary if there is breathing difficulty
Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change
What is the Prevention for Legionnaire's Disease?
-----------------------------------------
Avoiding dust
Proper cleaning of air conditioners and ventilation system
Prognosis of Legionnaire's Disease
---------------------------------------------
Early therapy with antibiotics produce good results
low mortality rates as early cases are detected
Rarely pulmonary fibrosis develops as remnant from disease.
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