A Simple Guide to Crohn's Disease
----------------------------------------------------
What is Crohn's Disease?
---------------------------------------
Crohn's Disease(Regional Enteritis) is a chronic inflammatory disease of the gastrointestinal tract which affects the layers of the lining of the whole gastrointestinal tract from mouth to anus.
It was originally called regional ileitis because the ileum was typically affected but has been extended to regional enteritis because the whole layer of the lining of the gastrointestinal tract can be affected from the mouth to anus.
Who is affected by Crohn's Disease?
---------------------------------------------------
Crohn's Disease is more common in Jews than non-Jews and in whites than non-whites
It occurs equally in men and women and can be found in families.
Crohn's Disease can be found in all ages but are more common in the 20-30 years age group.
What is the Cause of Crohn's Disease?
-----------------------------------------------------
The exact cause of Crohn's Disease is not known.
It has been suggested that an autoimmune disease is the main cause of Crohn's Disease.
A protein produced by the immune system, called anti-tumor necrosis factor (TNF) may be a possible cause of the body's reaction in the lining of the gastrointestinal tract resulting in inflammation.
Infectious causes has also been blamed.
What are the Symptoms and signs of Crohn's Disease?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.severe abdominal pain, especially in the right iliac fossa
2.diarrhea
3.Rectal Bleeding
4.fever
5.weight loss
6.loss of appetite
7.joint pain
Signs:
1.Abdominal distension and tenderness
Abdominal mass may be felt in the right iliac fossa
2.Rectal examination may show blood in the stool
3.pallor due to anemia
4.skin lesions
How do you make the Diagnosis of Crohn's Disease?
------------------------------------------------------------
1.A history of abdominal pain , diarrhea and bloody stools
2.The physical exam consists of
a.palpation of the abdomen for tenderness and right iliac fossa mass
b.digital rectal exam to detect blood.
3.stool may be tested for blood
4.blood tests(Hb, WBC, ESR, blood culture) are done for evidence of infection.
5.X-rays of the abdomen, barium meal and barium enema may be done to show evidence of extent of inflammation and narrowing of segment of intestine
6.Colonoscopy is also done to confirm extent of colon involvement.
A biopsy of inflamed lining may be done for microscopic examination.
7.A small camera which can be swallowed and passed out in the stools can take photos of the entire gastrointestinal tract.
What are the complications of Crohn's Disease?
---------------------------------------------------
Bowel complications:
1.Strictures of intestine leading to blockage
2.Fistula especially in the rectal region
3.Fissures in the anal region
4.hemorrhage
Non-bowel complications:
1.Bones: arthritis, sacroiliatis
osteoporosis
2.Eyes: uveitis, iritis
3.mouth ulcers
4.Skin: eczema
5.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Ulcerative Colitis?
---------------------------------------------------
Treatment is symptomatic to relieve discomfort, correct nutritional deficiencies, and control inflammation of the gastrointestinal tract.
Medications:
1.Anti-diarheal and bulk forming agents
2.Anti-spasmotic medication for spasm of the colon
3.Anti-inflammation drugs like Sulfasalazine (immunosuppressant) given indefintely.
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.
4.Oral corticosteroids in high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.
5.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system
6.Infliximab (Remicade). This drug helps by blocking the body's inflammation response
7.Antibiotics like ampicillin, septrim, flagyl, cephalosporin, tetracycline helps to treat bacterial infections in strictures, fistulas.
8.Correction of anemia and nutritional deficiencies is important to enhance the immune system
9.Replacement of fluids and electrolytes are important in cases of dehydration especially in children.
10.Regular hemoglobin, blood counts and liver function tests
Surgery:
Surgery is required:
1.if medications cannot control the symptoms or progression of the disease
2.to treat complications such as blockage, perforation, abscess, or bleeding in the intestine.
Resection of the inflammed segment of the intestine is removed and may relieve symptoms but is not a cure.
There has been instances where recurrence occur in the the segment next to the resected intestine.
In more severe cases a total colectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done.
Emergency surgery may be done for perforation, peritonitis, or continued bleeding.
What is the prognosis of Crohn's Disease?
-----------------------------------------
The prognosis depends on the severity of the disease
Three quarters of patients with Crohn's Disease will require surgery sooner or later.
There will be temporary relief of symptoms but recurrences are common.
In many cases with proper treatment, patients are able to lead a normal life.
What are preventive measures in Crohn's Disease?
-----------------------------------------------------
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
Certain foods such as spicy food, milk products and alcohol which may spark off an attack of abdominal discomfort and diarrhea should be avoided.
Stress can also trigger off episodes of Crohn's disease.
A healthy lifestyle with meditation and mild exercise can always help to prevent triggering off an attack of Crohn's Disease.
Showing posts with label abdominal pain. Show all posts
Showing posts with label abdominal pain. Show all posts
Wednesday, July 30, 2008
Tuesday, July 29, 2008
A Simple Guide to Ulcerative Colitis
A Simple Guide to Ulcerative Colitis
----------------------------------------------------
What is Ulcerative Colitis?
---------------------------------------
Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.
Who is affected by Ulcerative Colitis?
---------------------------------------------------
Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites
Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.
Those above the age of 60 years have more severe symptoms and signs.
It occurs equally in men and women and can be found in families.
What is the Cause of Ulcerative Colitis?
-----------------------------------------------------
The exact cause of Ulcerative Colitis is not known.
It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.
Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.
What are the Symptoms and signs of Ulcerative Colitis?
-----------------------------------------------------------
Symptoms:
The symptoms can range from mild to severe.
Mild cases (about 50%)usually have:
1.an insidious onset
2.lower abdominal pain
3.Slight blood stained diarrhea
4.malaise
In the more severe cases, the main symptoms may be:
1.abrupt onset
2.severe diffuse abdominal pain
3.Bloody diarrhea
4.fever
5.shock
6.fatigue
7.weight loss
8.loss of appetite
9.loss of body fluids and nutrients
10.joint pain
Signs:
1.Abdominal distension and tenderness
2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter
3.pallor due to anemia
4.Wasting of muscles
5.skin lesions
How do you make the Diagnosis of Ulcerative Colitis?
------------------------------------------------------------
1.A history of lower abdominal pain , bloating and bloody diarrhea
2.The physical exam consists of
a.palpation of the abdomen for tenderness
b.digital rectal exam to detect tenesmus or blood.
3.stool may be tested for blood
4.blood tests( HB, WBC, ESR, blood culture) are done for evidence of infection.
5.Xrays of the abdomen and barium enema may be done to show evidence of extent of ulcers in the colon
6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.
What are the complications of Ulcerative Colitis?
---------------------------------------------------
Bowel complications:
1.Strictures of colon
2.Fistula
3.Toxic dilatation(toxic megacolon)
4.Perforation of the colon
5.hemorrhage
6.shock
7.rarely carcinoma(5%)
Non-bowel complications:
1.Bones: arthritis, sacroiliatis
osteoporosis
2.Eyes: uveitis, iritis
3.Skin: eczema
What is the treatment of Ulcerative Colitis?
----------------------------------------------------------------
Mild Cases:
Medications:
1.Antidiarrheal and bulk forming agents
2.Antispasmotic medication for spasm of the colon
3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.
4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.
5.Correction of anemia
6.Regular hemoglobin, blood counts and liver function tests
Severe cases:
1.Hospitalisation with bed rest, fluids, electrolyte replacement and blood transfusion if necessary
2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.
3.Sulphasalazine (immuno-suppressant) given indefinitely
4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system
5.Antibiotics in toxic megacolon syndrome
5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.
In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.
Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.
Emergency surgery may be done for perforation, peritonitis, or continued bleeding.
What is the prognosis of Ulcerative Colitis?
-----------------------------------------
The prognosis depends on the severity of the disease
Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.
5% will die within the first year.
75% will have recurrence for the rest of their life.
Only 10% will have remissions lasting 15 years.
----------------------------------------------------
What is Ulcerative Colitis?
---------------------------------------
Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.
Who is affected by Ulcerative Colitis?
---------------------------------------------------
Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites
Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.
Those above the age of 60 years have more severe symptoms and signs.
It occurs equally in men and women and can be found in families.
What is the Cause of Ulcerative Colitis?
-----------------------------------------------------
The exact cause of Ulcerative Colitis is not known.
It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.
Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.
What are the Symptoms and signs of Ulcerative Colitis?
-----------------------------------------------------------
Symptoms:
The symptoms can range from mild to severe.
Mild cases (about 50%)usually have:
1.an insidious onset
2.lower abdominal pain
3.Slight blood stained diarrhea
4.malaise
In the more severe cases, the main symptoms may be:
1.abrupt onset
2.severe diffuse abdominal pain
3.Bloody diarrhea
4.fever
5.shock
6.fatigue
7.weight loss
8.loss of appetite
9.loss of body fluids and nutrients
10.joint pain
Signs:
1.Abdominal distension and tenderness
2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter
3.pallor due to anemia
4.Wasting of muscles
5.skin lesions
How do you make the Diagnosis of Ulcerative Colitis?
------------------------------------------------------------
1.A history of lower abdominal pain , bloating and bloody diarrhea
2.The physical exam consists of
a.palpation of the abdomen for tenderness
b.digital rectal exam to detect tenesmus or blood.
3.stool may be tested for blood
4.blood tests( HB, WBC, ESR, blood culture) are done for evidence of infection.
5.Xrays of the abdomen and barium enema may be done to show evidence of extent of ulcers in the colon
6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.
What are the complications of Ulcerative Colitis?
---------------------------------------------------
Bowel complications:
1.Strictures of colon
2.Fistula
3.Toxic dilatation(toxic megacolon)
4.Perforation of the colon
5.hemorrhage
6.shock
7.rarely carcinoma(5%)
Non-bowel complications:
1.Bones: arthritis, sacroiliatis
osteoporosis
2.Eyes: uveitis, iritis
3.Skin: eczema
What is the treatment of Ulcerative Colitis?
----------------------------------------------------------------
Mild Cases:
Medications:
1.Antidiarrheal and bulk forming agents
2.Antispasmotic medication for spasm of the colon
3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.
4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.
5.Correction of anemia
6.Regular hemoglobin, blood counts and liver function tests
Severe cases:
1.Hospitalisation with bed rest, fluids, electrolyte replacement and blood transfusion if necessary
2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.
3.Sulphasalazine (immuno-suppressant) given indefinitely
4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system
5.Antibiotics in toxic megacolon syndrome
5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.
In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.
Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.
Emergency surgery may be done for perforation, peritonitis, or continued bleeding.
What is the prognosis of Ulcerative Colitis?
-----------------------------------------
The prognosis depends on the severity of the disease
Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.
5% will die within the first year.
75% will have recurrence for the rest of their life.
Only 10% will have remissions lasting 15 years.
Monday, July 14, 2008
A Simple Guide to Sciatica
A Simple Guide to Sciatica
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
Wednesday, June 25, 2008
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
-----------------------------------
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
Saturday, June 21, 2008
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
----------------------------------------------------
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
Friday, March 21, 2008
A Simple Guide to Gallstones
A Simple Guide to Gallstones
------------------------------
What are gallstones?
----------------------
Gallstones are stones which are found in the gallbladder which is a sac storing bile from the liver.
They are made from cholesterol and other substances in the bile.
What causes gallstones?
-------------------------
Gallstones are formed when cholesterol and other substances like calcium found in bile combine to form stones.
They are more common in
1.overweight people
2.Females more than males
What are the symptoms?
------------------------------
Most people with gallstones do not have symptoms.
Symptomsoccur when a gallstone causes blockage in the bile duct causing obstruction to flow of bile from the liver to the intestine.
The symptoms may be:
1.mild pain in the upper right part of the abdomen and also just below the sternum just like gastritis.
2.Pain in the right upper back or shoulder blade area.
3.Pain is worse when you eat.
4.fever and chills
5.Yellowness of the eyes or skin
6.Dark coloured urine
7.Chest pain occurs when the pain radiates to the chest
How are gallstones diagnosed?
--------------------------------
1.Pain in the right side of the abdomen
2. Murphy's sign positive.
A thumb pressing against the right of the epigastrium causes more pain when the patients breathes in deeply
3.An ultrasound of the right side of the abdomen is the best way to find gallstones.
Most gallstones can be detected from the ultrasound.
4.gallbladder scan. A dye is injected into a vein in your arm.
X-rays are taken as the dye moves through your liver, bile duct, gallbladder.
What are the complications of gallstones?
-------------------------------------------------
A gallsone which is stuck in the bile duct(a tube which leads the bile from the liver to the gallbladder and small intestine) can give rise to:
1.Gallbladder inflmmation or infection(Cholecystitis)
2.Swelling and inflammation of the Pancreas(pancreatitis)
3.Hepatitis due to reflux of the bile back to the liver
4.Peritonitis(inflammation of the inner lining of the abdomen) if the bile duct or gallbladder perfoates or burst.
This is an emergency.
What is the treatment of gallstones?
----------------------------------------
1.If there is no symptoms, treatment is not needed.
2.If there is mild pain, some pain and antispasmodic medicines are given.
Patient is kept for observation.
If the pain goes away, the gallsone may have become unstuck in the bile duct and pass out into the intestine.
3.If there is severe pain or recurrence of another attack of pain, it is advisable to have the gallbladder removed.
a.Normal surgery to remove the gallbladder and the gallstones involve 4 holes in the abdomen and the use of a laparoscopic to cut away the gallbladder followed by stitching.
The surgery is usually very safe and the patient may not need to be hospitalised.
b.In an emergency, such as perforated gallbladder, immediate surgery may be required to remove the gallbladder and cleared the inner abdomen of leaked bile.
What is the prognosis of gallstones?
----------------------------------------------
Most people with gallstones do not have symptoms.
Sometimes gallstones may be detected while having tests for other health problems.
Sometimes an ultrasound done on an woman during pregnancy may show gallstones.
The prognosis for patients after surgery is usually good.
The bile will go straight to the intestine from the liver.
Digestion of oily food may not as good as before and is usually not noticeable.
------------------------------
What are gallstones?
----------------------
Gallstones are stones which are found in the gallbladder which is a sac storing bile from the liver.
They are made from cholesterol and other substances in the bile.
What causes gallstones?
-------------------------
Gallstones are formed when cholesterol and other substances like calcium found in bile combine to form stones.
They are more common in
1.overweight people
2.Females more than males
What are the symptoms?
------------------------------
Most people with gallstones do not have symptoms.
Symptomsoccur when a gallstone causes blockage in the bile duct causing obstruction to flow of bile from the liver to the intestine.
The symptoms may be:
1.mild pain in the upper right part of the abdomen and also just below the sternum just like gastritis.
2.Pain in the right upper back or shoulder blade area.
3.Pain is worse when you eat.
4.fever and chills
5.Yellowness of the eyes or skin
6.Dark coloured urine
7.Chest pain occurs when the pain radiates to the chest
How are gallstones diagnosed?
--------------------------------
1.Pain in the right side of the abdomen
2. Murphy's sign positive.
A thumb pressing against the right of the epigastrium causes more pain when the patients breathes in deeply
3.An ultrasound of the right side of the abdomen is the best way to find gallstones.
Most gallstones can be detected from the ultrasound.
4.gallbladder scan. A dye is injected into a vein in your arm.
X-rays are taken as the dye moves through your liver, bile duct, gallbladder.
What are the complications of gallstones?
-------------------------------------------------
A gallsone which is stuck in the bile duct(a tube which leads the bile from the liver to the gallbladder and small intestine) can give rise to:
1.Gallbladder inflmmation or infection(Cholecystitis)
2.Swelling and inflammation of the Pancreas(pancreatitis)
3.Hepatitis due to reflux of the bile back to the liver
4.Peritonitis(inflammation of the inner lining of the abdomen) if the bile duct or gallbladder perfoates or burst.
This is an emergency.
What is the treatment of gallstones?
----------------------------------------
1.If there is no symptoms, treatment is not needed.
2.If there is mild pain, some pain and antispasmodic medicines are given.
Patient is kept for observation.
If the pain goes away, the gallsone may have become unstuck in the bile duct and pass out into the intestine.
3.If there is severe pain or recurrence of another attack of pain, it is advisable to have the gallbladder removed.
a.Normal surgery to remove the gallbladder and the gallstones involve 4 holes in the abdomen and the use of a laparoscopic to cut away the gallbladder followed by stitching.
The surgery is usually very safe and the patient may not need to be hospitalised.
b.In an emergency, such as perforated gallbladder, immediate surgery may be required to remove the gallbladder and cleared the inner abdomen of leaked bile.
What is the prognosis of gallstones?
----------------------------------------------
Most people with gallstones do not have symptoms.
Sometimes gallstones may be detected while having tests for other health problems.
Sometimes an ultrasound done on an woman during pregnancy may show gallstones.
The prognosis for patients after surgery is usually good.
The bile will go straight to the intestine from the liver.
Digestion of oily food may not as good as before and is usually not noticeable.
Saturday, December 15, 2007
A Simple Guide to Appendicitis
A Simple Guide to Appendicitis
-------------------------------------
What is Appendicitis?
--------------------------
Appendicitis is an infection of the vermiform appendix, a small elongated appendage at the base of the caecum.
What are the causes of Appendicitis?
-------------------------------------------
Appendicitis may occur after:
1.obstruction of the lumen of the appendix by fecalith(small hard faeces), foreign body(eg. seeds), kinking
2.inflammatory oedema of the mucosa
3.infection of the intestine(eg. E. coli) spreading to the appendix
What are the symptoms and signs of Appendicitis?
-------------------------------------------------------------
Symptoms:
1.Pain occurs in the navel region, then moves down to right lower quadrant(McBurney's point-one third from right pelvic protrusion and two thirds from the navel)
2.nausea and vomiting
3.mild fever
4.often a history of constipation, rarely diarrhea
5. loss of appetite
Signs:
1.tenderness,guarding and rebound pain at McBurney's point
2.Positive Psoas and obturator sign in some cases
3.leucocytosis - mainly polymorphs
4.Palpable mass felt at McBurney's point may indicate presence of appendicular
abscess
5.rectal examination may show a palpable tender swelling at the right iliac fossa
What are the complications of Appendicitis?
-------------------------------------------
1.Perforation of the untreated inflammed appendix causes pus to spill into the abdominal cavity
2.Peritonitis(inflammation of the the whole of the internal abdomen) may occur as a result of a ruptured inflammed appendix
3.Septicemia may result from the bacteria entering the blood.
Death may occur in untreated peritonitis and septicemia.
What is the treatment of Appendicitis?
---------------------------------------
All confirmed appenicitis should be treated by surgical removal of the inflammed appendix.
Following surgery, antibiotics are given either intravenously or orally.
What is the prognosis of Appendicitis?
----------------------------------------------
1.Excellent with appropriate surgical intervention
2.Abscesses which developed and are surgical drained and treated with antibiotics recovered rapidly.
3.Peritonitis and septicemia treated early by surgery and antibiotics usually recovered.
Finally there is no such condition such as chronic Appendicitis.
All Appendicitis cases are acute.
-------------------------------------
What is Appendicitis?
--------------------------
Appendicitis is an infection of the vermiform appendix, a small elongated appendage at the base of the caecum.
What are the causes of Appendicitis?
-------------------------------------------
Appendicitis may occur after:
1.obstruction of the lumen of the appendix by fecalith(small hard faeces), foreign body(eg. seeds), kinking
2.inflammatory oedema of the mucosa
3.infection of the intestine(eg. E. coli) spreading to the appendix
What are the symptoms and signs of Appendicitis?
-------------------------------------------------------------
Symptoms:
1.Pain occurs in the navel region, then moves down to right lower quadrant(McBurney's point-one third from right pelvic protrusion and two thirds from the navel)
2.nausea and vomiting
3.mild fever
4.often a history of constipation, rarely diarrhea
5. loss of appetite
Signs:
1.tenderness,guarding and rebound pain at McBurney's point
2.Positive Psoas and obturator sign in some cases
3.leucocytosis - mainly polymorphs
4.Palpable mass felt at McBurney's point may indicate presence of appendicular
abscess
5.rectal examination may show a palpable tender swelling at the right iliac fossa
What are the complications of Appendicitis?
-------------------------------------------
1.Perforation of the untreated inflammed appendix causes pus to spill into the abdominal cavity
2.Peritonitis(inflammation of the the whole of the internal abdomen) may occur as a result of a ruptured inflammed appendix
3.Septicemia may result from the bacteria entering the blood.
Death may occur in untreated peritonitis and septicemia.
What is the treatment of Appendicitis?
---------------------------------------
All confirmed appenicitis should be treated by surgical removal of the inflammed appendix.
Following surgery, antibiotics are given either intravenously or orally.
What is the prognosis of Appendicitis?
----------------------------------------------
1.Excellent with appropriate surgical intervention
2.Abscesses which developed and are surgical drained and treated with antibiotics recovered rapidly.
3.Peritonitis and septicemia treated early by surgery and antibiotics usually recovered.
Finally there is no such condition such as chronic Appendicitis.
All Appendicitis cases are acute.
Monday, September 17, 2007
A Simple Guide to Gastritis
A Simple Guide to Gastritis
----------------
What is Gastritis?
-------------
----------------
What is Gastritis?
-------------
Gastritis is a disease which is caused by inflammation of the stomach lining.
It may presents as gastritis ,peptic gastric ulcer or if it extends to the duodenum(first part of small intestine) duodenal ulcers.
What are the causes of Gastritis?
--------------------------------------
Two main causes are
1.helicobacter pylori infection - this bacteria damages the protective lining of the stomach making the underlying stomach tissue more vulnerable to the acidic gastric juice.
2.excessive production of acidic gastric juice
Excessive production of acidic gastric juice burns into the protective lining of the stomach and cause inflammation of the underlying stomach tissue.
The causes of excessive production of acidic gastric juice are:
1. Most common is stress and anxiety which automatically increase the production of the acid as a result of sympathetic nervous reaction
2.hereditary- some gastric patient has family history of gastric problem. Blood group O tends to have more gastritis while Blood group A has a tendency towards stomach cancer.
3.irregular meals tend to cause more acidic gastric juice to form at regular meal time.
4.alcohol and smoking has been associated with increased acid formation
5.Drugs: prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,
6. diseases, such as pernicious anemia, autoimmune disorders, and chronic bile reflux, can cause gastritis as well.
What are the Symptoms of Gastritis?
--------------------------------------------
The most common symptoms are
1.upper abdominal upset or pain.
Other symptoms are
2.belching, abdominal bloating,
3.nausea, and vomiting
4.indigestion or of burning in the upper abdomen or in the chest(heart burn).
5.Blood in your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.
How do you diagnose Gastritis?
------------------------------------
Gastritis is diagnosed through one or more medical tests:
Medical history - past and family history of gastritis
Physical examination- epigastric bloating or tenderness
Upper gastrointestinal endoscopy.
The doctor eases an gastroscope, a thin tube containing a tiny camera, through your mouth and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may remove a tiny sample of tissue for tests(biopsy).
The biopsy will detect how bad is the inflammation or whether there are underlying cancer cells. In additional if any polyps (benign swelling of the lining of the stomach) are detected, they are removed at the same time and sent for biopsy.
Blood test. The doctor may check your blood for any evidence of H.pylori infection and your red blood cell count to see whether you have anemia, which means that you do not have enough red blood cells. Anemia can be caused by bleeding from the stomach.
Urea breath test can also determine whether you have H.pylori infection
Stool test. This test checks for the presence of blood in your stool, a sign of bleeding. Stool test may also be used to detect the presence of H. pylori in the digestive tract.
What is the Treatment of Gastritis?
------------------------------------------
The main treatment is usually
1.reduce stress
2.reorganisation of work in such a way as to be able to handle the pressure of work better as well as to have regular meals
3.Control of diet - avoid hard foods such as peanuts , tough meat, spicy food, cold food, black coffee, strong tea,citrus fruits and their juices,carbonated beverages, deep fried or oily food.
4. Take more frequent and smaller meals.
5. Avoid alcohol and smoking
6. Avoid drugs such as aspirin, painkillers,steroids which may irritate your stomach and cause increase in acid production
Medical treatment:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)
2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)
3. Antispasmodics: anticholinergic drugs like buscopan, librax reduce the spasm in the stomach and duodenum
4. Antiflatulents - to reduce gas in the abdomen
5.If your gastritis is caused by an infection, that problem may be treated as well. For example, the doctor might prescribe antibiotics to clear up H. pylori infection.
Once the underlying problem disappears, the gastritis usually does too.
Talk to your doctor before stopping any medicine or starting any gastritis treatment on your own.
What are the Complications of untreated Gastritis?
--------------------------------------------------------------
Any untreated gastritis can cause complications such as:
1. peptic ulcers
2. bleeding ulcers
3.perforated stomach and peritonitis
Gastritis or ulcer is not healed overnight. The chances of satisfactory gastric recovery are excellent. However recurrences are always possible so do not stop your medications, good food habits and healthy lifestyle too soon.
It may presents as gastritis ,peptic gastric ulcer or if it extends to the duodenum(first part of small intestine) duodenal ulcers.
What are the causes of Gastritis?
--------------------------------------
Two main causes are
1.helicobacter pylori infection - this bacteria damages the protective lining of the stomach making the underlying stomach tissue more vulnerable to the acidic gastric juice.
2.excessive production of acidic gastric juice
Excessive production of acidic gastric juice burns into the protective lining of the stomach and cause inflammation of the underlying stomach tissue.
The causes of excessive production of acidic gastric juice are:
1. Most common is stress and anxiety which automatically increase the production of the acid as a result of sympathetic nervous reaction
2.hereditary- some gastric patient has family history of gastric problem. Blood group O tends to have more gastritis while Blood group A has a tendency towards stomach cancer.
3.irregular meals tend to cause more acidic gastric juice to form at regular meal time.
4.alcohol and smoking has been associated with increased acid formation
5.Drugs: prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,
6. diseases, such as pernicious anemia, autoimmune disorders, and chronic bile reflux, can cause gastritis as well.
What are the Symptoms of Gastritis?
--------------------------------------------
The most common symptoms are
1.upper abdominal upset or pain.
Other symptoms are
2.belching, abdominal bloating,
3.nausea, and vomiting
4.indigestion or of burning in the upper abdomen or in the chest(heart burn).
5.Blood in your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.
How do you diagnose Gastritis?
------------------------------------
Gastritis is diagnosed through one or more medical tests:
Medical history - past and family history of gastritis
Physical examination- epigastric bloating or tenderness
Upper gastrointestinal endoscopy.
The doctor eases an gastroscope, a thin tube containing a tiny camera, through your mouth and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may remove a tiny sample of tissue for tests(biopsy).
The biopsy will detect how bad is the inflammation or whether there are underlying cancer cells. In additional if any polyps (benign swelling of the lining of the stomach) are detected, they are removed at the same time and sent for biopsy.
Blood test. The doctor may check your blood for any evidence of H.pylori infection and your red blood cell count to see whether you have anemia, which means that you do not have enough red blood cells. Anemia can be caused by bleeding from the stomach.
Urea breath test can also determine whether you have H.pylori infection
Stool test. This test checks for the presence of blood in your stool, a sign of bleeding. Stool test may also be used to detect the presence of H. pylori in the digestive tract.
What is the Treatment of Gastritis?
------------------------------------------
The main treatment is usually
1.reduce stress
2.reorganisation of work in such a way as to be able to handle the pressure of work better as well as to have regular meals
3.Control of diet - avoid hard foods such as peanuts , tough meat, spicy food, cold food, black coffee, strong tea,citrus fruits and their juices,carbonated beverages, deep fried or oily food.
4. Take more frequent and smaller meals.
5. Avoid alcohol and smoking
6. Avoid drugs such as aspirin, painkillers,steroids which may irritate your stomach and cause increase in acid production
Medical treatment:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)
2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)
3. Antispasmodics: anticholinergic drugs like buscopan, librax reduce the spasm in the stomach and duodenum
4. Antiflatulents - to reduce gas in the abdomen
5.If your gastritis is caused by an infection, that problem may be treated as well. For example, the doctor might prescribe antibiotics to clear up H. pylori infection.
Once the underlying problem disappears, the gastritis usually does too.
Talk to your doctor before stopping any medicine or starting any gastritis treatment on your own.
What are the Complications of untreated Gastritis?
--------------------------------------------------------------
Any untreated gastritis can cause complications such as:
1. peptic ulcers
2. bleeding ulcers
3.perforated stomach and peritonitis
Gastritis or ulcer is not healed overnight. The chances of satisfactory gastric recovery are excellent. However recurrences are always possible so do not stop your medications, good food habits and healthy lifestyle too soon.
Friday, September 14, 2007
A Simple Guide to Irritable Bowel Syndrome
A Simple Guide to Irritable Bowel Syndrome
----------------------------------------------
What is Irritable Bowel Syndrome?
------------------------------------------
Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal system. It is characterised by abdominal pain/cramps, bloating or gas, diarrhoea and/or constipation. It is also known as spastic colon.
Who is affected by Irritable Bowel Syndrome?
--------------------------------------------
It occurs in one in five persons and usually between the ages of 20-50.
Women outnumber men by two or three to one.
It can become a chronic condition causing much discomfort and inconvenience to the patient. However, it does not progress to cancer.
What is the Cause of Irritable Bowel Syndrome?
--------------------------------------------------------
The exact cause of IBS is not known.
The muscles of the walls of the intestines in the normal person contract and relax in a co-ordinated rhythm known as peristalsis. This action helps to move food along the intestines during which time absorption takes place.
The nerves and muscles in the bowel appear to be extra sensitive in people with IBS. The contractions are stronger and last longer.
Food is pushed along the intestines at a faster rate, giving rise to abdominal pain, gas and diarrhoea. Sometimes, the opposite occurs. The contractions are weaker causing the passage of food to slow down and constipation results.
Other factors that have been shown to play a part are stress, diet and hormones. These are called triggers.
1.Stress
which may be psychological or physical.
Psychological stresses such as family misunderstanding; bereavement; anxiety; meeting deadlines etc.
Physical stresses such as illnesses, infections, exhaustion etc.
2.Diet
certain foods have been known to cause the onset of symptoms. They include fried or oily food; gas-forming foods e.g.broccoli, beans, cabbage; chocolates; coffee.
3.Hormonal changes
some women experience attacks during or around their menstrual periods.
What are the Symptoms of Irritable Bowel Syndrome?
----------------------------------------------------------------
The main symptoms of IBS are:
1.Abdominal pain or cramps-usually over the left side or over the lower abdomen
2.Bloating and/or gas
3.Diarrhoea, constipation or alternating diarrhoea and constipation.
4.whitish mucus in the stool
The symptoms can range from mild to severe.
In many cases the symptoms are bearable and go off after a bowel movement.
Women with IBS often have more symptoms during their menstrual periods.
How do you make the Diagnosis of Irritable Bowel Syndrome?
------------------------------------------------------------------------
Because the cause is unknown and there is a lack of specific physical signs, diagnosis is arrived at through a process of elimination .
A colonoscopy is usually done to rule out colon cancer, diverticulosis, polyps.
What is the Treatment of Irritable Bowel Syndrome?
--------------------------------------------------------------
There is no real cure for Irritable Bowel Syndrome.
Treatment is mainly symptomatic i.e. it is directed towards the relief of symptoms.
Mild symptoms usually go off on their own.
If symptoms are severe, the doctor may prescribe the following:
Anti-spasmodics for the abdominal pain and cramps,
Anti-flatulents to get rid of gas and relief the bloating,
Anti-diarrhoeals to stop diarrhoea,
Antidepressants, even in lower doses than are used for treating depression, can help people with IBS.
Laxatives to relief constipation.
Foods and drinks that may cause or worsen symptoms include:
fatty foods, like french fries
milk products, like cheese or ice cream
chocolate
alcohol
caffeinated drinks, like coffee
carbonated drinks, like soda
Some foods make IBS better.
Fiber may reduce the constipation associated with IBS because it makes stool soft and easier to pass.
However, some people with IBS who have more sensitive nerves may feel a bit more abdominal discomfort after adding more fiber to their diet. Fiber is found in foods such as breads, cereals, beans, fruits, and vegetables.
Too much fiber at once can cause gas, which can trigger symptoms in a person with IBS.
Eat small meals for example eating four or five small meals a day.
Large meals can cause cramping and diarrhea in people with IBS.
Stress doesn’t cause IBS, but it can make your symptoms worse.
Learning to reduce stress can help with IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.
Meditation, exercise, hypnosis, and counseling may help.
What can be done to prevent Irritable Bowel Syndrome?
------------------------------------------------------------------
Prevention is an important part in the total management of this condition.
They consist of stress management and life-style changes.
Stress management
Avoid unnecessary stress
Learn to relax
Exercise regularly
Dietary changes
Avoid oily, spicy food
Avoid gas-forming foods e.g. cabbage, broccoli, beans
Avoid coffee, chocolates, and alcohol
Avoid large meals
Take more fibre
----------------------------------------------
What is Irritable Bowel Syndrome?
------------------------------------------
Irritable bowel syndrome (IBS) is a common functional disorder of the gastrointestinal system. It is characterised by abdominal pain/cramps, bloating or gas, diarrhoea and/or constipation. It is also known as spastic colon.
Who is affected by Irritable Bowel Syndrome?
--------------------------------------------
It occurs in one in five persons and usually between the ages of 20-50.
Women outnumber men by two or three to one.
It can become a chronic condition causing much discomfort and inconvenience to the patient. However, it does not progress to cancer.
What is the Cause of Irritable Bowel Syndrome?
--------------------------------------------------------
The exact cause of IBS is not known.
The muscles of the walls of the intestines in the normal person contract and relax in a co-ordinated rhythm known as peristalsis. This action helps to move food along the intestines during which time absorption takes place.
The nerves and muscles in the bowel appear to be extra sensitive in people with IBS. The contractions are stronger and last longer.
Food is pushed along the intestines at a faster rate, giving rise to abdominal pain, gas and diarrhoea. Sometimes, the opposite occurs. The contractions are weaker causing the passage of food to slow down and constipation results.
Other factors that have been shown to play a part are stress, diet and hormones. These are called triggers.
1.Stress
which may be psychological or physical.
Psychological stresses such as family misunderstanding; bereavement; anxiety; meeting deadlines etc.
Physical stresses such as illnesses, infections, exhaustion etc.
2.Diet
certain foods have been known to cause the onset of symptoms. They include fried or oily food; gas-forming foods e.g.broccoli, beans, cabbage; chocolates; coffee.
3.Hormonal changes
some women experience attacks during or around their menstrual periods.
What are the Symptoms of Irritable Bowel Syndrome?
----------------------------------------------------------------
The main symptoms of IBS are:
1.Abdominal pain or cramps-usually over the left side or over the lower abdomen
2.Bloating and/or gas
3.Diarrhoea, constipation or alternating diarrhoea and constipation.
4.whitish mucus in the stool
The symptoms can range from mild to severe.
In many cases the symptoms are bearable and go off after a bowel movement.
Women with IBS often have more symptoms during their menstrual periods.
How do you make the Diagnosis of Irritable Bowel Syndrome?
------------------------------------------------------------------------
Because the cause is unknown and there is a lack of specific physical signs, diagnosis is arrived at through a process of elimination .
A colonoscopy is usually done to rule out colon cancer, diverticulosis, polyps.
What is the Treatment of Irritable Bowel Syndrome?
--------------------------------------------------------------
There is no real cure for Irritable Bowel Syndrome.
Treatment is mainly symptomatic i.e. it is directed towards the relief of symptoms.
Mild symptoms usually go off on their own.
If symptoms are severe, the doctor may prescribe the following:
Anti-spasmodics for the abdominal pain and cramps,
Anti-flatulents to get rid of gas and relief the bloating,
Anti-diarrhoeals to stop diarrhoea,
Antidepressants, even in lower doses than are used for treating depression, can help people with IBS.
Laxatives to relief constipation.
Foods and drinks that may cause or worsen symptoms include:
fatty foods, like french fries
milk products, like cheese or ice cream
chocolate
alcohol
caffeinated drinks, like coffee
carbonated drinks, like soda
Some foods make IBS better.
Fiber may reduce the constipation associated with IBS because it makes stool soft and easier to pass.
However, some people with IBS who have more sensitive nerves may feel a bit more abdominal discomfort after adding more fiber to their diet. Fiber is found in foods such as breads, cereals, beans, fruits, and vegetables.
Too much fiber at once can cause gas, which can trigger symptoms in a person with IBS.
Eat small meals for example eating four or five small meals a day.
Large meals can cause cramping and diarrhea in people with IBS.
Stress doesn’t cause IBS, but it can make your symptoms worse.
Learning to reduce stress can help with IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.
Meditation, exercise, hypnosis, and counseling may help.
What can be done to prevent Irritable Bowel Syndrome?
------------------------------------------------------------------
Prevention is an important part in the total management of this condition.
They consist of stress management and life-style changes.
Stress management
Avoid unnecessary stress
Learn to relax
Exercise regularly
Dietary changes
Avoid oily, spicy food
Avoid gas-forming foods e.g. cabbage, broccoli, beans
Avoid coffee, chocolates, and alcohol
Avoid large meals
Take more fibre
Wednesday, August 15, 2007
A Simple Guide to Gastroenteritis
A Simple Guide to Gastroenteritis
-------------------------------------
What is Gastroenteritis?
---------------------------
Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites resulting in leakage of fluid from the cell into the intestine(diarrhea),abdominal pain and vomiting.
What are the causes of Gastroenteritis?
--------------------------------------------
Viral Gastroenteritis:
The most common cause of Gastroenteritis is Viral.
Rota virus is the leading cause among children 3 to 15 months old and the most common cause of diarrhea in children under the age of 5 years.
Adenovirus occurs mainly in children under the age of 2 years.
Caliciviruses especially the norovirus cause infection in people of all ages.
Astrovirus also infects primarily infants, young children, and the elderly.
Bacterial Gastroenteritis:
The most common cause is the E. coli bacteria, usually mild with diarrhea, abdominal pain and occasional vomiting. It rarely cause fever.
Salmonella, Shigella ,Vibrio cholerae, are more serious bacterial infection causing diarrhea and high fever.
Parasitic Gastroenteritis:
Most common is amoebic dysentery,common in India and Africa.
Other parasitic infection are giardiasis and threadworms.
What are symptoms of Gastroenteritis?
----------------------------------------------
The main symptoms of gastroenteritis are
1. watery diarrhea
2. abdominal pain
3. vomiting
4. headache
5. fever.
6.loss of appetite and energy
Symptoms usually appear within 4 to 48 hours after exposure to the germ and last for 1 to 2 days, though symptoms can last as long as 10 days.
How is Gastroenteritis transmitted?
------------------------------------------
Gastroenteritis can be highly contagious. The germs are commonly transmitted by people with unwashed hands.
People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.
Noroviruses in particular, are typically spread to other people by contact with stool or vomit of infected people and through contaminated water or food—especially oysters, prawns, crabs, lobsters, cockleshells from contaminated breeding waters.
How is the diagnosis of Gastroenteritis made?
-----------------------------------------------------
Doctors generally diagnose gastroenteritis based on the symptoms and a physical examination. Your doctor may ask for a stool sample to test for rotavirus or to rule out bacteria or parasites as the cause of your symptoms.
How is Gastroenteritis treated?
-------------------------------------
Most cases of viral gastroenteritis resolve without specific treatment.
Antibiotics are not effective against viral infections.
The primary goal of treatment is to reduce the symptoms which may include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).
Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, vomiting, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.
The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.
The following steps may help relieve the symptoms of gastroenteritis.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes. 4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.
How is Gastroenteritis prevented?
----------------------------------------
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated
-------------------------------------
What is Gastroenteritis?
---------------------------
Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites resulting in leakage of fluid from the cell into the intestine(diarrhea),abdominal pain and vomiting.
What are the causes of Gastroenteritis?
--------------------------------------------
Viral Gastroenteritis:
The most common cause of Gastroenteritis is Viral.
Rota virus is the leading cause among children 3 to 15 months old and the most common cause of diarrhea in children under the age of 5 years.
Adenovirus occurs mainly in children under the age of 2 years.
Caliciviruses especially the norovirus cause infection in people of all ages.
Astrovirus also infects primarily infants, young children, and the elderly.
Bacterial Gastroenteritis:
The most common cause is the E. coli bacteria, usually mild with diarrhea, abdominal pain and occasional vomiting. It rarely cause fever.
Salmonella, Shigella ,Vibrio cholerae, are more serious bacterial infection causing diarrhea and high fever.
Parasitic Gastroenteritis:
Most common is amoebic dysentery,common in India and Africa.
Other parasitic infection are giardiasis and threadworms.
What are symptoms of Gastroenteritis?
----------------------------------------------
The main symptoms of gastroenteritis are
1. watery diarrhea
2. abdominal pain
3. vomiting
4. headache
5. fever.
6.loss of appetite and energy
Symptoms usually appear within 4 to 48 hours after exposure to the germ and last for 1 to 2 days, though symptoms can last as long as 10 days.
How is Gastroenteritis transmitted?
------------------------------------------
Gastroenteritis can be highly contagious. The germs are commonly transmitted by people with unwashed hands.
People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.
Noroviruses in particular, are typically spread to other people by contact with stool or vomit of infected people and through contaminated water or food—especially oysters, prawns, crabs, lobsters, cockleshells from contaminated breeding waters.
How is the diagnosis of Gastroenteritis made?
-----------------------------------------------------
Doctors generally diagnose gastroenteritis based on the symptoms and a physical examination. Your doctor may ask for a stool sample to test for rotavirus or to rule out bacteria or parasites as the cause of your symptoms.
How is Gastroenteritis treated?
-------------------------------------
Most cases of viral gastroenteritis resolve without specific treatment.
Antibiotics are not effective against viral infections.
The primary goal of treatment is to reduce the symptoms which may include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).
Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, vomiting, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.
The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.
The following steps may help relieve the symptoms of gastroenteritis.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes. 4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.
How is Gastroenteritis prevented?
----------------------------------------
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated
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