User-agent: Google Allow: A Simple Guide to Medical Conditions: February 2011

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Saturday, February 26, 2011

A Simple Guide to Amoebiasis

A Simple Guide to Amoebiasis
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What is Amoebiasis?
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Amoebiasis is an acute infectious illness caused by the  parasite Entoamoeba histolytica.

What is the cause of Amoebiasis?
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The bacteria which causes Amoebiasis is the Entmoeba histytica which is an extremely hardy parasite able to live in  polluted water, contaminated food and soiled clothes.

Amebic infections occur most common in the cacum and rectosigmoid region of the colon.

Initial infections are small ulcers, usually discrete erosions whhich may extend more deeply ,coalescing to form bigger lesions resulting in extensive mucosal loss.

Penetration through the muscle lining may occur causing peritonitis.

Liver involvement may occur with the ameba traveling through the portal vein.

Liver abscesses consists of necrotic liver tissue. 

Secondary bacterial infection are rare.

Most liver abscesses are solitary, rarely multiple and occur long after clinically evident bowel ulceration.

Single and multiple liver abscesses may occur shortly after a bout of amebic dysentry.

Abscesses of the brain and lung may occur.

Ulcers heal rapidly after treatment and permanent scarring is rare.

What are symptoms of Amoebiasis?
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The main symptoms of Amoebiasis are
1. Many people with E.histolytica in stools are passive carrier

2. Invasive bowel disease begins 1-6 months after infection sometimes later

3. abdominal pain especially at the sides

4. altered bowel habit

5.diarrhea with blood or mucus in stools

6.foul stools

7.adominal bloating or gas

8.tenderness on palpation at caecum or sigmoid colon regions

Severe cases may have:
1.more severe symptoms as above

2.bloody stools

3.fever

4.weight loss

5.liver enlargement and tenderness on palpation

6.dehydration and its effects such as delirium and disorientation

7. lassitude and tiredness

8. convulsions

9.tender abdominal mass with obstruction

How is the diagnosis of Amoebiasis made?
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Doctors generally diagnose Amoebiasis based on:
1. stool cultures.

2.blood tests

3.colonoscopy

4.liver scan and ultrasound

What are the complications of Amoebiasis?
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Amoebiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses

2.Severe hemorrhage uncommon but can cause death

3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction

4.irritable bowel syndrome may persist for some months

5.Lung and pericardial involvement rare but can pose danger

6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration

7.Liver infection can cause damage to liver and result in cirrhosis

8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis

9.Amebic brain abscess are rare but can occur.

How is Amoebiasis treated?
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Amoebiasis is an infectious disease which can spread to other people through contaminated food and water.

1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.

2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis

3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery

4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.

5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier

Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache

2.antispasmodic drug to stop abdominal cramps

3.medicine to harden the stools such as kaolin

4.slow down the intestinal movement (lomotil or loperamide).

Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.

Get plenty of rest.

How is Amoebiasis prevented?
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Prevention of Amoebiasis can be by:
1.boil drinking and cooking water for 5 minutes

2.Proper filtration of water

3.Examination of stools of food handlers

4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies

5.Good food hygience and hand washing

What is the prognosis of Amoebiasis?
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Prognosis depends on the stage of disease

It is excellent with prompt treatment of amebic infection.

Luminal disease or dysentery usually respond well to treatment.

In refractory cases chloroquine may be added to metronidazole.

Surgery is rarely necessary.

Wednesday, February 23, 2011

A Simple guide to Reye's Syndrome

A Simple Guide to Reye's Syndrome
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What is Reye's Syndrome?
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Reye's Syndrome is an acute hepatitis and metabolic encephalopathy occurring in children.

1.Liver usually shows microvesicular fatty infiltration

2. The brain shows cerebral edema with herniation

Causes are not completely known but:
1.Aspirin and salicylate has been suspected as an aggravating cause

2.A number of fatty acids has been postulated as toxic agents

What are the Signs and Symptoms of Reye's Syndrome
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Symptoms:
1.mild prodromal illness like influenza
Mild cases occur without progression to coma.

2.acute onset with:
a.vomiting
b.delirium
c.lethargy
d.stupor
e.coma within 24-48 hours

Signs:
1.Liver enzymes markedly elevated with normal alkaline phosphatase

2.Increased serum ammonia

3.Raised prothrombin time

4.Low blood glucose especially in younger children

5.Intracranial pressure markedly increased

6.Cerebrospinal fluid normal except for increased protein.

7.Respiratory alkalosis with metabolic alkalosis may occur

Clinical progression with marked cerebral edema occurs with improving liver function.

Outcome depends on reversibility and control of intracranial hypertension

Worse case scenerio will be rapid progression to coma and death.

What are the complications of Reye's Syndrome?
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The complications are:
1.liver damage

2.brain damage

What is the Treatment of Reye's Syndrome?
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Treatment is urgent:
1.Hospitalization with intensive care management

2.Respiratory support

3.Intravenous fluid and glucose to maintain blood glucose

4.Immediate treatment of intracranial pressure important

5.In coma cases, intracranial pressure monitoring with treatment of pressure over 30mm mercury with mannitol, hyper ventilation and removal of CSF if necessary through spinal tap

6. No protein given by mouth because of liver condition

7.Vitamin K as well as fresh blood platelets transfusion to control coagulation problems

Other treatments include:
1.exchange blood transfusion

2.dialysis

3.plasmapheresis

4.Glucose plus insulin

5.citrulline

Prognosis:
Mortality is 50% if inital ammonia is more than 300micrograms per dl and coma present on admission

Outcome depends on management of intra cranial pressure

Subclinal cases are more common than previously thought

Sunday, February 20, 2011

A Simple guide to Buerger's Disease

A Simple guide to Buerger's Disease
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What is Buerger's Disease?
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Buerger's Disease is an uncommon form of arterial obstructive disease of the large and medium sized peripheral arteries of legs in men under age 40 giving rise to intermittent claudication.

Occasionally the arteries of the arms and the veins may be involved.

Causes of Buerger's Disease are:
1.heavy smoking

2.arterial lesions are inflammatory rather than degenerative.

3.The appearrance is non-suppurative(no pus) panvasculitis

4.arterial obstructions in the legs are often associated with obstructive arterial lesion elsewhereExample:angina pectoris

5.Diabetes and high lipid patterns are aggravating factors.

What are the Signs and Symptoms of Buerger's Disease
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Symptoms:

1.onset is sudden
2.classic symptom of heavy aching pain in the legs when walking(intermittent claudication)
3.loss of arterial pilses
4.leg pallor and coldness
5.Raynaud's phenomenon
6.Other arterial diseases:
a.retinopathy
b.coronary ischemia
c.renal ischemia
7.evidence of peripheral ischemia or gangrene

How to diagnose Buerger's Disease?
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1.Symptoms and signs as above
2.pallor on raising legs
3.angiography to determine site of lesion

What are the complications of Buerger's Disease?
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The complications are:
gangrene of the legs

What is the Treatment of Buerger's Disease?
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1.stop smoking
2.general measures:
a.graded exercise
b.physical training
c.weight loss
3.avoid injury from
a.heat
b.cold
c.trauma
d.infections

Medicines:
vasodilator drugs like persantin, nitrates

Surgery:
reconstructive surgery for localized blockage but may not work

Amputation is preferable with gangrene in elderly

What is the Prevention for Buerger's Disease?
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Avoiding smoking

Prognosis of Buerger's Disease
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disease is often progressive and amputation may be necessary.

Wednesday, February 16, 2011

A Simple Guide to Syncope

A Simple guide to Syncope
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What is Syncope?
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Syncope is a temporary loss of consciousness resulting from inadequate cerebral blood supply.

Causes:
A.Vasomotor:
1.Vagal slowing of heart and reduction of blood pressure from fear, severe pain or psychogenic disturbance

2.Hemorrhage or circulatory fluid loss from burns

3.Postural hypotension  - blood pressure drops from sleeping or sitting position to upright position

4.Vasoactive drugs such as anti-hypertensive (prazosin, methyl dopa) and heart medicines(nitites, adrenergic blockers)

5.Carotid sinus compression

B.Cardiac:
1.Asystole or heart blockage

2.Sudden arrhythmias with high ventricular rate

3.Heart valve prosthesis

4.Aortic stenosis with exertion

5.Cardiogenic shock following myocardial infarction

6.Sudden cardiac compression

What are the Signs and Symptoms of Syncope
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A.Vasomotor:
Symptoms:
1.cold sweats, pallor, yawning,

2.Urge to urinate or defecate

3.low blood pressure

4.dilated pupils

5.Drug therapy such as adrenagenic blockers

B.Cardiac:
1.ECG evidence of arrhythmia, heart block, asystile, or myocardial infarction

2.history of valve prosthesis, aortic stenosis or chest injury

What are the complications of Syncope?
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The complications are:
1.head injury

2.fractures

What is the Treatment of Syncope?
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1. Patients with postural or psychogenic syncope recover in recumbent position

2.Cardiac syncope from myocardial infarction needs the patient to be hospitalized and managed in cardiac care unit

3. heart blocks or asystole may need pacemaker implantation

4.Tachycardia with arrhythmia must be treated with special medicies to slow the heart

5.review drug therapy abd dosage of potentially causative medicines such as adrenergenic blocking drugs, beta blockers or vasodilators such as nitrates



Prognosis:
1.depends on cause -vasomotor are less serious than cardiac.

2.it may present as a life threatening condition requiring immediate treatment in cardiac syncope

Friday, February 11, 2011

A Simple Guide to Anorectal Abscess

A Simple guide to Anorectal abscess
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What is Anorectal abscess?
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Anorectal abscess is a pocket of pus in the anal region below the anal sphincter muscles.

Perianal abscess lies within the external anal sphincter.

Ischiorectal abscess is situated above the anal sphincter and in the ischiorectal fossa.

How is Anorectal abscess caused?
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Anorectal abscess is caused by infection in the anal glands of the anal mucosa and becomes abscesses or pockets of pus.

1.Trauma or injury causes cell damage and infection

2.Small mucosal tears from hard fecesmay lead to infection

3.Anal fissures, hemorrhoids or colis can also lead to abscess

Most infections are E.coli infections less often staphylococcus

What are the Signs and Symptoms of Anorectal abscess?
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Symptoms start off with:
1. throbbing pain around

2. sitting walking defecation painful

3.Fever, malaise

4.Abscess seen on inspection or rectal exam

How to diagnose Anorectal abscess?
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1.Symptoms of
a.anal swelling pain

b.proctoscopy

c.swab & culture
2.ESR raised very high somtimes > 80
3.moderate leucytosis with lymphopenia

What are the complications of Anorectal abscess?
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The complications are:
1.colitis
What is the Treatment of Anorectal abscess?
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Incision & drainage.
1.Antibiotics

What is the Prevention for Anorectal abscess?
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Avoiding infection
Prognosis of Anorectal abscess
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Early therapy with antibiotics produce good results

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