A Simple Guide to Systemic Lupus Erythematosis

A Simple Guide to Systemic Lupus Erythematosis
----------------------------------------------------

What is Systemic Lupus Erythematosis?
---------------------------------------

Systemic Lupus Erythematosis is a chronic multisystem autoimmune inflammatory disease which attacks the whole body.

It typically has a butterfly erythematous rash on the face.

It is not contagious.

Who is affected by Systemic Lupus Erythematosis?
---------------------------------------------------

Systemic Lupus Erythematosis is more common in women than in men(9:1 ratio)

Most cases begin at the age range of 15-45 years and occurs less frequently between the age of 45-70 years.

It occurs more frequently in blacks than in white people.


What is the Cause of Systemic Lupus Erythematosis?
-----------------------------------------------------

The exact cause of Systemic Lupus Erythematosis is not known.

1.It has been suggested that an autoimmune disease is the main cause of Systemic Lupus Erythematosis disease.

The antibodies produced by the body to fight germs starts to attack the body's own healthy tissue.

2.Psychological problems like stress and anxiety is not a cause of Systemic Lupus Erythematosis but has been known to trigger off the disease.

3.Some cases are induced by medications such as :
hydralazine
procainamide
penicillamine
isoniazid

What are the Symptoms and signs of Systemic Lupus Erythematosis?
-----------------------------------------------------------

The disease may be mild to severe.

There are also periods of remissions and activity.

During the active stage:
Systemic involvement:
-----------------------------

1.fever

2.anorexia

3.weakness

4.weight loss

5.Lymphadenopathy

Skin Mucosa Involvement:
-------------------------------

1.Typical butterfly erythrematous rash on the face

2.pleomorphic erythrematous and maculopapular lesions on the face, neck and extremeties.

3.Vasculitic nail bed and digital pulp lesions

4.Alopecia, petechiae, bullae, and mucous membrane lesions.

Musculoskeletal System:
---------------------------

1.Polyarthritis especially small joints of fingers

2.Arthritis milder and non erosive compared to rheumatoid arthritis

3.morning stiffness

4.muscle atrophy and weakness may occur

Eyes:
-----------

1.Retinal hemorrhages and exudates

2.Cytoid bodies

Lungs and Pleura:
-----------------------

1.Recurrent pleurisy

2.Pleural effusions - small

3.Pulmonary infiltrates

Cardiovascular
-----------------

1.Pericarditis

2.Endocarditis with vegetation on the mitral valve especially

Gastrointestinal
--------------------

1.Non specific nausea

2.Gastrointestinal ulcers, hemorrhage, necrosis

Renal
-------------

1.Focal membranous nephritis

2.Proliferative nephritis - deposit of autoimmune complexes on capillary walls give rise to typical wireloop changes and epithelial crescents in kidneys resulting in proteinuria, hematuria,and renal failure.

Central nervous system:
------------------------------

1.Lesions in the brain can cause mental disorders( dementia, psychosis,epilepsy), chores, cerebrovascular accidents,cranial nerve lesions.

2.Peripheral neuropathy of various types

Others:
-----------------

1.Thrombotic thrombocytopenic purpura

2.Sjogren's syndrome


How do you make the Diagnosis of Systemic Lupus Erythematosis?
------------------------------------------------------------

1.A history of facial butterfly rash, systemic symptoms

2.Blood for ESR, positive ANA(antnuclear Antibodies), LE cells

3.Full blood count for anemia, hemolytic anemia, neutopenia, thrombocytopenia, Coombs' test(usually positive)

4.Renal or skin biopsy

5.X- rays of the chest, abdomen and brain

6.MRI of brain, kidney,

What are the complications of Systemic Lupus Erythematosis?
-----------------------------------------------------------------

1.Severe Dermatitis with discoid lesions (maculopapular in nature)

2.Polyathritis with swelling of joints

3.Anemia

4.Pleural effusions

5.hemorrhage

6.Dementia

7.Renal failure

What is the treatment of Systemic Lupus Erythematosis?
--------------------------------------------------------------

There is no cure for SLE at the present moment.

Treatment is to relieve symptoms and prevent organs from deteriorating.

Patients with mild symptoms may not need any treatment.

Mild Cases:
---------------
1.short course of antiinflammatory medications such as NSAID or corticosteroids.

2.Rest and freedom from stress

Severe cases:
--------------------
Patients with serious illness which has affected their organ may require stronger medications:
1.high doses of corticosteroids intially intravenously, followed by oral medication whose dosage is reduced slowly to the minimum possible.

Corticosteroids are particularly helpful if internal organs are involved.

Side effects of corticosteroids include gastric problems, thinning of the bones, infection, facial puffiness, cataracts.

2.NSAIDs can reduce inflammation and pain especially in the musculoskeletal system.

Examples of NSAIDs include aspirin, ibuprofen, naproxen.

The side effects are stomach upset, abdominal pain, ulcers or GIT bleeding.

To reduce the side effects, NSAIDs are usually taken with food or H2 antagonist like cimetidine, ranitidine.

3.Antimalarial medication such as Hydroxychloroquine has been particularly effective for SLE patients with fatigue, skin, and joint disease.

Side effects include diarrhea, upset stomach, and eye pigment changes.

Eye pigment changes are rare, but require monitoring by an ophthalmologist

Other antimalarial drugs, such as chloroquine or quinacrine, are considered

4.Treatment for severe skin disease skin disease include dapsone and retinoic acid (Retin-A).

5.immunosuppressive medications are used for treating patients with more severe manifestations of SLE with damage to internal organ(s).

Examples of immunosuppressive medications include methotrexate, azathioprine (Imuran), cyclophosphamide, and cyclosporine .

Side effects are depression of blood cell counts and increased risks of infection and bleeding.

6. mycophenolate mofetil (Cellcept) is very effective in lupus with kidney disease.

It has been able to reverse active lupus kidney disease and maintain remission.

It's lower side effects made it more useful than immunosuppresive drugs.

7.plasmapheresis is used to remove antibodies and other immune substances from the blood to suppress immunity.
It has also help to to remove proteins (cryoglobulins) that can lead to vasculitis.
SLE patients with low platelet levels can have severe bleeding.

7.rituximab is an intravenously infused antibody that suppresses a particular white blood cell, the B cell, by reducing the number in the blood stream.
B cells play a central role in lupus activity, and when suppressed, the disease tends toward remission.

8.omega-3 fish oils could help patients with lupus by decreasing disease activity and possibly decreasing heart disease risk.

9.rest during periods of active disease
Poor sleep quality can cause fatigue in patients with SLE.
Sleep quality and the effect of underlying depression, lack of exercise can have an adverse effect on the health of SLE patients.
It is important to maintain muscle tone and range of motion in the joints.

10.Endstage kidney damage from SLE requires dialysis and/or a kidney transplant.


What is the prognosis of Systemic Lupus Erythematosis?
-------------------------------------------------------------

The prognosis depends on the severity of the disease

Severe cases with renal disease has poorer prognosis.


How is SLE prevented?
----------------------------

1.Adequate rest

2. Avoid stress

3. Avoid the sun and use sunscreen.

4.Healthy lifestyle with exercise prevents arthritis

A Simple Guide to Mastitis

A Simple Guide to Mastitis
-----------------------------


What is Mastitis?
--------------------

Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.

What causes Mastitis?
------------------------

The causes of Mastitis are mostly due:

A.Hormonal:
----------------------

1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.

2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.

3.Premenstrual pain and swelling of breasts may occur

B.Infections:
---------------------

Infections of the breasts may occur due to
1.poor skin hygiene

2.Injuries or wounds allowing microganism to enter the wound

3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.

4.Mastitis may occur as a rare complication of mumps.

5.Most common bacteria infection is staphyloccus aures.

6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis

What are the symptoms of Mastitis?
-------------------------------------

The Symptoms of Mastitis are:

1.Pain usually present in all cases except in babies

2.swelling of the breasts or the nipple area

3.Pus discharge from the nipple

Signs:

1.redness of the nipple or areola

2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.

3.Local tenderness of inflammed area

4.Fever and genral malaise

5.Axillary lymph nodes may be swollen and painful

What are the complications of Mastitis?
------------------------------------

1.Abscess formation

2.Cystic formation

3.Chronic mastitis or fibroadenosis

How is diagnosis of Mastitis confirmed?
------------------------------------------

1. clinical features

2. Mammograms to exclude malignant tumors

3. Ultrasound scan of the breasts

What is the treatment of Mastitis?
------------------------------------

1. antibiotics are given to cure the infections.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.

2. Painkillers may be given if there is pain

3.Rest and support of the breasts with soft bras

4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.

5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary

6.Reassurance in hormonal cases of mastitis

What is the Prognosis of Mastitis?
------------------------------------

Most cases of mastitis usually will recover with proper treatment.

What are the Preventive measures for Mastitis?
----------------------------------------------------

Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently

A Simple Guide to Entropion

A Simple Guide to Entropion
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What is Entropion?
---------------------------------------

Entropion is an inversion(rolling inwards) of the eyelid

Who is affected by Entropion?
---------------------------------------------------

Entropion is more common in women than in men.


What is the Cause of Entropion?
-----------------------------------------------------

The causes of Entropion can divided into 2 type:

Spasm of Orbicularis muscle:

1. Degeneration of the peripheral connective tissue of the eye

2. Occurs in old age

3. Occurs also after removal of eyeball

4. Primarily affects the lower eyelid.

Cicatricial:

1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns

2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections

3.Congenital disease

4. May affect either upper or lower eyelid

What are the Symptoms and signs of Entropion?
-----------------------------------------------------------

Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:

1.Irritation of the conjunctiva

2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels

3.Tearing -excess tears from irritation

Signs:

1.Erosions, opacities and vasculisation of the cornea

2.increased dilated blood vessels of conjunctiva present due to irritation

3.The presence of inward turning eyelids and eyelashes


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

The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.

What are the complications of Entropion?
---------------------------------------------------

1.Recurrent corneal ulcers

2.Recurrent irritation and conjunctivitis of eyes.

3.Severe infection of the eye - rare

What is the treatment of Entropion?
---------------------------------------------------

Treatment depends on the type of Entropion:

Spastic:

1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops

2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below

Cicatricial:

Surgery to tighten the eyelid muscle is usually required:

1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.

Recurrence is common.

This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.

2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.

This is usually done on an outpatient basis and under local anesthesia.

Post-operatively the wounds are protected by antibiotic creams and dressings.

Healing usually occurs within 1 week.

Antibiotics are also given for any infections of the conjunctiva and cornea.



What is the prognosis of Entropion?
-----------------------------------------

The prognosis is usually good.

Recurrence is rare but do occur especially due to weakening of eye muscles from age.

A Simple Guide to Corneal Ulcer

A Simple Guide to Corneal Ulcer
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What is Corneal ulcer?
---------------------------------------

Corneal ulcer is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.

Corneal ulcers can be infectious(due to infection) or non infectious(due to injury or autoimmune disease)


Who is affected by corneal ulcer?
---------------------------------------------------

Corneal ulcers may be present more frequently in patients with :
Vitamin A deficiency

autoimmune disease

neurological disorders like facial palsy

What is the Cause of corneal ulcer?
-----------------------------------------------------

The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphhylococci, pneumococci, pseudomonas

2. Viral infections such as herpes simplex, herpes zoster,

3. Fungal infection

Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch

2.autoimmune disease

3.Systemic disease

What are the Symptoms and signs of corneal ulcer?
-----------------------------------------------------------

Symptoms varies from mild to severe:

1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. Non-infectious causes may not give rise to pain.

2.Red eye - increased blood flow through inflamed eye shows up the blood vessels

3.Tearing -excess tears from inflammation

4.Discharge -may be pus discharge from eyes especially in the morning

5.Light sensitivity - sensitive to bright lights

Signs:

1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye

2.increased dilated blood vessels present due to inflammation


How do you make the Diagnosis of corneal ulcer?
------------------------------------------------------------

The presence of a corneal ulcer can be seen using a slit lamp microscope.
Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.

What investigation are necessary in Corneal ulcer?
-----------------------------------------------------

If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.


What are the complications of corneal ulcer?
---------------------------------------------------

The complication is always the risk of :

1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.

2.Scarring of the corneal ulcer resulting in partial loss of vision

What is the treatment of corneal ulcer?
---------------------------------------------------

Treatment depends on the type of corneal ulcer:

Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops (given every 15 minutes)

2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream

3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.

In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain

Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation

2.Antibiotic are also given to prevent infections of the ulcer.

In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.

What is the prognosis of corneal ulcer?
-----------------------------------------

The prognosis depends on the severity of the disease

Most cases can be healed if detected early.

There may be minimum scarring of the cornea with possible loss of some vision.

Rarely the eye may be lost if there is severe infection and no treatment.


What are preventive measures in corneal ulcer?
-----------------------------------------------------

1. A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

2.Avoid the use of infected contact lens lotion

3.A soft lens are more prone to eye infection. Always wash the hands before using any contact lens.

4.Avoid rubbing the eyes with dirty hands or tissues

5.A healthy lifestyle with less stress and mild exercise is always good for the body.

A Simple Guide to Crohn's Disease

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.

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.

A Simple guide to Anal Fistula

A Simple guide to Anal Fistula
-------------------------------------

What is Anal Fistula?
----------------------------

Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.

There may be several external openings but only one internal opening

What is the cause of Anal Fistula?
------------------------------------------

Anal Fistula usually result from :
1.breakdown of anorectal abscesses

2.follows surgery for anal fissure

3.Less common causes are:
lymphogranuloma

carcinoma of rectum

ulcerative colitis,

regional ileitis

tuberculosis

What are the symptoms of Anal Fistula?
------------------------------------------------

1.pain especially on sitting down

2.purulent painless discharge(pus) near the anus

3.Recurrent perianal abscesses(pockets of pus around the anus)

4.pruritis ani(itch in anus)

How are Anal Fistula diagnosed?
-----------------------------------------

1.thorough examination of the perianal region

2.Rectal examination and palpation of the fistula track

3.Pass a probe through the perianal opening to determine the length of the track

4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine

5.Barium enema to exclude any ulcerative colitis and regional ileitis


What is the treatment of Anal Fistula?
------------------------------------------

There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter

2.Low level fistulas are below the levator ani and are more common.

Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)

Treatment of high level fistula:
1.open the track from within the ischiorectal fossa

2.colostomy may be necessary for multiple fistulas or very high internal opening

General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma

2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed

3.toilet and dressing of the wounds, with application of antibiotic creams

4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes

What is the prognosis of Anal Fistula?
----------------------------------------

Good with surgery.

Rarely there may undesirable complication like rectal incontinence.

A Simple Guide to Adenoiditis

A Simple Guide to Adenoiditis
----------------------------------------------

What is Adenoiditis?
-------------------------------

Adenoiditis is inflammation (swelling) of the Adenoids.

The adenoids are lymph nodes in the back of the nose and above the throat.

They normally help to filter out bacteria and other microorganisms to prevent infection in the nose and throat area.

They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing Adenoiditis.

Enlarged adenoids can cause blockage of the eustachian tubes and posterior openings of the nose.

What causes Adenoiditis?
-------------------------------

1.Viral or bacterial infections
---------------------------------

Bacteria cause 15-30 percent of Adenoiditis cases.
Streptococcus pyogenes is the most common bacteria causing acute Adenoiditis.

The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute Adenoiditis.


2.low immunity factors
-----------------------

Unbalanced or insufficient food diet,

Unhygienic lifestyle

Inadequate rest or sleep

3. Allergy
---------------

dustmites,

pollens

Who gets Adenoiditis?
---------------------

Adenoiditis most often occurs in children but rarely occurs in children younger than two years.

It is occasionally found in young adults.

What are the symptoms of Adenoiditis?
-------------------------------------

The Symptoms of Adenoiditis are:

1,Blocked nose

2.mouth breathing

3.nasal speech

4.rhinorhoea(runny nose)

5.Snoring at night

6.Ear blockage(eustachian tube blockage)

7.Ear pain(otitis media)

8.Pain in the cheeks(maxillary sinusitis) or above the eye(frontal sinusitis)

9.Headache

10.Fever, chills

11.Lethargy and malaise are common.

These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.

What are the signs of Adenoiditis?
---------------------------------

An ear nose and throat specialist will be able to put a endoscope through the nasal passage to see the enlarged and inflamed adenoids.

What are the Complications of Adenoiditis?
------------------------------------------

1.Complications of untreated streptococcus Adenoiditis with tonsillitis may be severe:

Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure

2.Ear pain from otitis media

3.Blocked airway from enlarged Adenoids

What is the treatment of Adenoiditis?
------------------------------------

1.If the cause of the Adenoiditis is bacteria such as streptococcus, antibiotics are given to cure the infection.

The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.

2.Rest to allow the body to heal.

3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the nose and throat.

4.Hospitalization may be required in severe cases, particularly when there is airway obstruction.

5.When the condition is chronic or recurrent, a surgical procedure to remove the Adenoids(Adenoidectomy) is often recommended.

What is the Prognosis of Adenoiditis?
------------------------------------

Adenoiditis symptoms usually lessen in 2 or 3 days after treatment starts.

The infection usually is cured by then, but may require more than one course of antibiotics.

Adenoidectomy may be recommended if Adenoiditis is severe, recurrent, or does not respond to antibiotics.

A Simple Guide to Salpingitis

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

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

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

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

Acute Salpingitis is usually caused by the following:

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

2.tuberculosis salpingitis is rare

3.Infection may follow chilbirth or abortion

Mechanical irritants:
intrauterine device may cause acute or chronic Salpingitis

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

Persons who has Acute Salpingitis has the following
Symptoms:

1.severe lower abdominal pain

2.purulent vaginal discharge

3.painful or frequency of urination

4.fever

Signs:
1.tenderness in either lower abdominal quadrant

2.discharge can be seen in female vagina

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

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

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

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

3.vaginal examination for tenderness in the tubes region

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

5.Full blood count

6. endoscopy to examine the fallopian tubes

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

Acute Salpingitis may progress to chronic Salpingitis:

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

2. Pelvic abscess

3. Ovarian infection

4.Infertility due to tube blockage

5. Peritonitis may occur with rupture of cyst and abscess

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

1.Approprate Antibiotics for infections especially after uterine bacterial culture

2.Bedrest

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

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

Prognosis is usually good with current antibiotics and medication.

Sexual partner may need to be treated.

Recurrence is quite common.

Infertilty may result in blocked or scarred fallopian tubes

A Simple Guide to Paronychia

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

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

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

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

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

2.Fungal- candida

Chronic Paronychia:
1.Fungal- candida

2.Bacterial-pseudomonas

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

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

Pus may form and oozes from the infected tissues.

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

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

1.swollen

2.painful

3.red nail fold

4.may dicharge pus

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

1.recurrent

2.painful

3.swollen tissues at base of nail

4.pus may be present

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

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

Swab for culture and sensitvity to antibiotics

Exclude Diabetes

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

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

1.Systemic antibiotics

2.Incision and drainage of pus

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

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

1.Keep hands dry and use protective gloves

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

3.Systemic anti fungals such as griseofulvin or ketoconazole

4.Treat secondary bacterial infections with antibiotics

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

1.Avoid pressure on the lateral folds of the nails

2.Footwear should not be too tight

3.Avoid biting of nails

4.Avoid constant contact with water and soaking in water

5.Cutting of nails should not be too deep

6.Good personal hygience

A Simple Guide to Diverticulosis

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

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

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

It is more common in the descending and sigmoid colon.

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

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

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

The exact cause of Diverticulosis is not known.

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

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

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

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

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

Most cases of Diverticulosis have no or little symptoms.

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

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

2.Bloating

3.constipation

The symptoms can range from mild to severe.

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

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

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

3.stool may be tested for blood

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

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

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

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

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

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

2.fever due to infection,

3.nausea, vomiting,

4.cramping,

5.constipation

6.rectal tenderness

Diverticulitis can lead to:

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

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

Small abscesses usually clear up with antibiotics.

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

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

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

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

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

A temporary colostomy may be necessary.

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

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

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

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

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

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

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

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

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

2.Antispasmotic mediacation for spams of the colon

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

Diet:
1.high-fiber diet

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

2.fiber product such as Metamucil once a day.

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

Diverticulitis
1.Antibiotics to treat the infection and inflammation,

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

3.hospital stay to prevent complications such as abscess.

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

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

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

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

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

A Simple Guide to Halitosis

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

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

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

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

Halitosis is usually caused by the following:

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

2.anaerobic infections of the mouth,

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

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

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

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

2.fish

3.cheese

4.alcohol

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

Dry mouth:
1.Insufficient drinking of water

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

Systemic diseases:
1.liver failure.

2.Lower respiratory tract infections

3.Renal infections and renal failure.

4.Carcinoma.

5.Trimethylaminuria ("fish odor syndrome").

6.Diabetes mellitus.

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

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

2.Dry mouth

Signs:
1.discharge from nose or tonsils

2.furry tongue

How do you diagnose Halitosis?
--------------------------------

Diagnosis can usually be made by :
1.History of bad breath

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

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

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

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

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

What is the treatment of Halitosis?
-------------------------------------

1.Approprate Antibiotics, antifungal for infections of mouth

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

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

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

5.Avoid smoking

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

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

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

What is the prognosis of Halitosis?
----------------------------------------

Prognosis is usually good with proper oral hygiene.

Recurrence is quite common.

A Simple Guide to Vulvitis

A Simple Guide to Vulvitis
------------------------------

What is Vulvitis?
----------------------

Vulvitis is an acute inflammation of the vulva in females.

What are the causes of Vulvitis?
---------------------------------------

Vulvitis is usually caused by the following:

Infections:

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

2.Fungal infection such as candidiasis

3.Herpes simplex in recurrent cases

4.Pediculosis pubis or lice

5.pinworm infection in children

6.Urinary infection such as cystitis

Allergies:

1.Clothings

2.perfumes

3.powders

4.drugs

Chemical irritants:

1.vaginal douche

2.detergents used to wash underwear

Mechanical irritants:

1.ill fitting underwear

2.inadequate sexual lubrication

Postmenopausal:

Atrophic vulvovaginitis after menopausal with dryness and inflammation of the vulval and vaginal lining

Generalised disorders:

Dermatological disorders such as lichen simplex


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

Persons who has Acute Vulvitis has the following
Symptoms:

1.vulval irritation and itch

2.discharge from vagina

3.painful or frequency of urination

4.excoriation of the inner lining of vulva

Signs:

1.discharge can be seen in female vagina

2.redness and inflammation of the vulva

How do you diagnose Vulvitis?
--------------------------------

Diagnosis can usually be made by :

1.History of vulval itch associated frequency of urination, painful urination or discharge from vagina

2.Vulva shows inflammation, excoriation of lining,

3.Vulval and vaginal swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

4. biopsy of the suspicious vulval lesions to exclude other causes of vulval problem such as tumor

What is the treatment of Vulvitis?
-------------------------------------

1.Approprate Antibiotics, antifungal for infections especially after urine bacterial culture

2.Antihistamine medicine for itch

3.Topical oestrogen cream for postmenopausal atrophic vulvovaginitis

4.Proper hygience after urination, sexual intercourse and bathing

5.Avoid strong soaps

6.Use of lubricants during sexual intercourse

7.Weight reduction if obese

8.Treat underlying condition such as diabetes,allergic dermatitis,other skin
conditions.

What is the prognosis of Vulvitis?
----------------------------------------

Prognosis is usually good with medication.

Sexual partner may need to be treated.

Recurrence is quite common.

A Simple Guide to Urethritis

A Simple Guide to Urethritis
------------------------------

What is Urethritis?
----------------------

Urethritis is an acute infection of the urethra(the tube which allows passage of urine from the bladder to the outside).

What are the causes of Urethritis?
---------------------------------------

Urethritis is usually caused by the following:

1.sexually transmitted disease like gonorrhea and chlamydia.

2.Urinary infection such as cystitis

3.In males associated with prostatitis

4.Urinary stone stuck in the urethra may cause urethitis

6.urinary catheterisation

7.Injury to the urethra

8.Important component of Reiter's Syndrome

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

Persons who has Acute Urethritis has the following

Symptoms:
------------------

1.painful urination

2.purulent discharge from penis in males or vagina in females

3.frequency of urination

4.cloudy and unpleasant smelling urine, sometimes blood in the urine

5.fever and chills

6.Polyathritis and conjunctivitis in Reiter's Syndrome

Signs:
------

1. pussy discharge can be seen in male's urethra or in female vagina

2.redness and inflammation of the opening of the urethra

How do you diagnose Urethritis?
--------------------------------

Diagnosis can usually be made by :

1.History of sexual activity followed by frequency of urination, painful urination or pussy discharge from urethra or vagina

2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms

3.Urine culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

4. cystoscopy may be necessary to exclude urinary stones,tumours of the bladder in the case of blood in the urine

What is the complications of Urethritis?
-------------------------------------

Upward infections from the urethra can lead to infections of the bladder and kidneys.

What is the treatment of Urethritis?
-------------------------------------

Analgesic medicine for pain

Approprate Antibiotics for infections especially after urine bacterial culture

Lots of fluids

What is the prognosis of Urethritis?
----------------------------------------

Prognosis is usually good with medication.

Sexual partner may need to be treated.

Recurrence is quite common.

A Simple Guide to Prostatitis

A Simple Guide to Prostatitis
------------------------------

What is Prostatitis?
----------------------

Prostatitis is an acute or chronic infection of the prostate gland.

What are the causes of Prostatitis?
------------------------------

Prostatitis is usually caused by the following:

1.enteric Gram negative organism from intestinal or bladder infection

2.tuberculosis occasionally

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

Persons who has Acute Prostatitis has the following:

Symptoms:

1.frequency of urination and nocturia

2.urgency of urination

3.hematuria(blood in urine)

4.low back pain

5.perineal pain

6.slow initiation of urine

Signs:

Tenderness on palpation of the prostate per rectum

How do you diagnose Prostatitis?
--------------------------------

Diagnosis can usually be made by :

1.History of frequency of urination, urgent urination

2.Tenderness on palpation of the prostate per rectum

3. Culture of the expressed prostatic fluid by prostatic massage

4.Urine and prostatic fluid culture will determine the micro-organism involved and the antibiotic most appropriate for it.

What is the complications of Prostatitis?
-------------------------------------

Infections from the prostate can lead to infections of the bladder and up to the kidney.

What is the treatment of Prostatitis?
-------------------------------------

Analgesic medicine

Antibiotics for infections especially after urine and prostatic fluid bacterial culture

Lots of fluids

What is the prognosis of Prostatitis?
----------------------------------------

Prognosis is usually good with medication.

Recurrence is quite common.

A Simple Guide to Cystitis

A Simple Guide to Cystitis
------------------------------

What is Cystitis?
----------------------

Cystitis is an acute or chronic infection of the urinary bladder.

What are the causes of Cystitis?
------------------------------

Cystitis is usually caused by the following:

1. ascending infection of the urinary bladder from the urethra.

2. in females frequently associated with sexual activity eg. honeymoon cystitis

3.In males with enlargement of the prostate or infection of the prostate

4. In children, the bacteria E.coli of the same type as the child's bowels

5.More frequently present in Diabetic patients

6.procedures such as urinary catheterisation

7.cystitis is more common in the female,especially those on contraceptive pills or with intrauterine contraceptive devices.

8. may be associated with congenital abnormalities of the urinary tract such as bladder neck obstruction,urethral reflux,neurogenic bladder,and urinary incontinence.

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

Persons who has Acute Cystitis has the following symptoms:

1.frequency of urination and nocturia

2.painful urination

3.suprapubic discomfort

4.cloudy and unpleasant smelling urine, sometimes blood in the urine

5.fever and chills especially in children

Signs:
Tenderness on palpation in the suprapubic region

How do you diagnose Cystitis?
--------------------------------

Diagnosis can usually be made by :

1.History of frequency of urination, painful urination

2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms

3.Urine culture will determine the micro-organism involved and the antibiotic most appropriate for it.

4. cystoscopy may be necessary to exclude tumours of the bladder

What are the complications of Cystitis?
-------------------------------------

Upward infections from the bladder can lead to infections of the kidneys and kidney failure.

What is the treatment of Cystitis?
-------------------------------------

Analgesic or antispasmodic medicine

Antibiotics for infections especially after urine bacterial culture

Lots of fluids

What is the prognosis of Cystitis?
----------------------------------------

Prognosis is usually good with medication.

Recurrence is quite common.

cystitis,frequency,painful,nocturia,sexual activity,antibiotics,analgesic, cystoscopy, urine test, bacteria culture,prostate

A Simple guide to Whooping Cough

A Simple guide to Whooping Cough
------------------------------------

What is Whooping Cough?
-----------------------

Whooping cough is an acute infectious childhood disease of the respiratory tract caused by the bacillus Bordetella pertussis.

How is Whooping Cough transmitted?
---------------------------------

Whooping Cough is transmitted by droplets from coughing spells.

It is highly infectious.

The early stage when it appears to be a cold is the most infectious peroid.

Most infections occur in children under six years of age.

One attack usually confers immunity

What are the Signs and Symptoms of Whooping Cough?
---------------------------------------------------

The incubation peroid is usually 10 - 12 days after contact with an infected child.
Symptoms start off with:
1.an ordinary cold (runny nose, sneezing, cough, fever) for 1-2 weeks followed by:

2.uncontrolled coughing that can last 1 - 2 months.

Cough persists and become paroxysmal ending in a noisy inspiration "whoop" sound causing the child to go blue and vomit.

Between the spasms of coughing the child seems relatively well

What are the complications of Whooping Cough?
---------------------------------------------

The worst affected are children below the 1 year old.
Some serious complications are:
1.pneumonia,

2.seizures,

3.brain damage

4.nose bleeds

5.death can occur during the severe coughing stage.

Serious complications are less with older children or adults.

Adults rarely get whooping cough because their immmunity from vaccination usually last 10 years after the last dose.

When adults get whooping cough, a prolonged, irritating cough may be present instead of whooping type of cough.

What is the Treatment of Whooping Cough?
--------------------------------------------

Antibiotics (erythromycin) are used in the treatment of Whooping cough.

Once severe coughing has begun, antibiotics are less effective. They can reduce the duration of the illness and stop the spread to others.

Family members should be treated once there is an infected person.

Tetracycline is used if the patient is allergic to erythromycin but should avoided in children because of the staining of the teeth.

Besides antibiotics, the following will help:
1.Steam inhalation

2.cough mixtures

3.oxygen therapy

4.avoid smokes, dust, dry air,sudden temperature change

What is the Prevention for Whooping Cough?
-----------------------------------------

Vaccination against whooping cough is the best prevention .

Since vaccination began, the worldwide incidence of whooping cough has declined.

Vaccination against diphtheria, pertussis (whooping cough), tetanus (DPT) is usually given to a baby at 3 months of age and repeated at 4 and 5 months of age.

There is a booster vaccination at 18 months.

In very rare cases (1 in 100,000 cases), there has been serious reactions such as seizures to the whooping cough part of the vaccination.

Recently, an improved acellular pertussis vaccine is now available. There are fewer side effects such as high fever and seizureswith this new vaccine.

A Simple Guide to Laryngitis

A Simple Guide to Laryngitis
----------------------------------

What is Laryngitis?
------------------------

Laryngitis is the inflammation of the mucous membranes of the Laryngx which produces the sound of the voice.

What causes the Laryngitis?
---------------------------------

Laryngitis is caused by
1.bacterial or viral infections of the larynx.

2.excessive use of voice

3.inhalation of irritants such as cigarette smoke

Laryngitis is also associated with
1.bronchitis

2.pneumonia

3.whooping cough

4.diphtheria

What are the Symptoms of the Laryngitis?
--------------------------------------------------

Laryngitis produces mild but uncomfortable symptoms:

1.hoarseness of voice

2.loss of voice

3.pain on speaking

4.Fever low grade rare

How is the diagnosis of Laryngitis confirmed?
------------------------------------------------------

1.Symptoms of hoarseness or loss of voice

2.Physical examination of the throat may showed the presence of redness and swelling of the vocal cords with some pus discharge.

The movement of the vocal cords may be impeded.

Sometimes nodules may be found on the vocal cord due to excessive usage of voice.

What are the investigations done in Laryngitis?
-----------------------------------------------------------

1.nasal and throat swabs to determine the type of infection

2.Xray of the chest and neck to determine any pressure of other organs pressing on the larynx

3.A biopsy of the nodules on the vocal cords if present to exclude malignancy

What is the Treatment of Laryngitis?
---------------------------------------------

1.Rest the voice. A rested patient will recover faster.

2.Adequate warm fluids helps to keep the mucus membranes moist

3.Steam inhalations may help

4.Antibiotics if there is suspicion of bacterial infection.

5.Gargles and decongestants may help to soothe the throat and vocal cords

6.Avoid smoking.

What is the prognosis of Laryngitis?
------------------------------------------

Acute laryngitis usually clears up within 10 days.

Very rarely chronic laryngitis may cause hoarseness of voice for months or years.

A Simple Guide to Pelvic Inflammatory Disease

A Simple Guide to Pelvic Inflammatory Disease
--------------------------------------------------------
What is Pelvic Inflammatory Disease?
---------------------------------------------

Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.
These include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.

What is the cause of PID?
------------------------------

It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea.

The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.

Sexually active women in their childbearing years are most likely to get PID.
Women under age 25 are more likely to develop PID than those older than 25.
The cervix of young women is not fully matured, and therefore more prone to be infected by STD.

Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.

Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.

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

Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.

Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).

How is PID diagnosed?
---------------------------

Because the symptoms are often subtle and mild, most cases of PID go undetected.

Diagnosis is usually based on clinical findings:
1.lower abdominal pain

2.abnormal cervical or vaginal mucopurulent discharge

3.oral temperature >101°F (>38.3°C)
together with investigation findings
4.laboratory evidence of gonorrheal or chlamydial infection.

5.A wet specimen of vaginal fluid is able to detect the presence of concomitant infections ( bacterial vaginosis and trichomoniasis)

6. pelvic ultrasound is a helpful procedure for diagnosing PID.It can check the pelvic area to see whether there is an abscess or enlarged fallopian tubes.

7.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end in inserted through a cut in the navel area to view the internal pelvic organs and to take specimens for testing.
Other criteria for diagnosing PID include the following:
8.endometrial biopsy with histopathologic evidence of endometritis;

9.transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex,

10.doppler studies suggesting pelvic infection

What are the complications of PID?
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Prompt and appropriate treatment can help prevent complications of PID.

Without treatment, PID can cause

1. permanent damage to the female reproductive organs.
Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.

2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.

3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow.
As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting in abdominal pain, internal bleeding, and death.

4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.

5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.

6. abscess formation in the reproductive organs or pelvis which can spread to the blood and cause septicemia.

What is the treatment for PID?
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Treatment of PID should be initiated in
1.sexually active young women

2. pelvic or lower abdominal pain,

3. physical examination shows cervical motion tenderness, uterine tenderness or adnexal tenderness.

PID can be treated with several types of antibiotics(eg.clindamycin or metronidazole with doxycycline).
However, antibiotic treatment will not reverse any damage to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is important that she seek care immediately.
Prompt antibiotic treatment can prevent severe damage to reproductive organs.

PID is usually treated with at least two antibiotics given by mouth or by injection.
Even if symptoms go away, the woman should finish taking all of the prescribed medicine.
This will help prevent the infection from returning.

Hospitalization to treat PID may be recommended if the woman
(1) is severely ill with nausea, vomiting, and high fever

(2) is pregnant;

(3) does not respond to or cannot take oral medication and needs intravenous antibiotics;

(4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess).

(5)surgical emergencies (e.g., appendicitis) cannot be excluded;

If symptoms continue or if an abscess does not go away, surgery may be needed.

Complications of PID such as chronic pelvic pain and scarring improve with surgery.

How can PID be prevented?
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1. transmission of STDs can be prevented by abstainance from sexual intercourse,

2. a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected can prevent STD.

3.Latex male condoms, when used consistently and correctly, can reduce the transmission of chlamydia and gonorrhea.

4.chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections especially those with a new sex partner or multiple sex partners

5.Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles suggests a STD infection. Early treatment of STDs can prevent PID.

6. Intrauterine contraceptive devices containing levonorgestrel-and copper-containing devices may cause PID and should be removed if antibiotics does not cure the PID.

A Simple Guide to Anthrax

A Simple Guide to Anthrax

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What is Anthrax?

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Anthrax is a disease caused by a gram positive spore forming bacterium that primarily infects mainly animals but can cause serious illness in humans if one is exposed to these spores.

It can affect the skin, the intestines or the lungs.

What are the different forms of Anthrax?

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1.Cutaneous anthrax is the most common type of anthrax.

It occurs 1-2 days after the skin is scratched and exposed to soil, animal parts or faeces containing the spores of Anthrax.

The affected skin forms an itchy black swelling that becomes a blister that breaks into an ulcer.

The bacteria can then enter the bloodstream and cause septicaemia (blood poisoning). 20% of cases will die if they are not treated promptly.

2.Intestinal anthrax happens 2 to 5 days after one eats contaminated meat containing the spores.

The intestinal lining breaks and bleeding occurs. The victim feels nausea, loss of appetite, vomiting, fever and suffers from severe abdominal pain, bloody vomiting and diarrhoea.

Blood poisoning occurs and the loss of blood can result in shock.

25% to 75% of cases will eventually die.

3.Inhalation anthrax is the least common of the 3 types.

However it is the most serious form of anthrax because the spores are inhaled into the lungs.

Flu-like symptoms occur for 2 to 3 days with fever, cough and then breathlessness starts.

Then the lungs starts to bleed internally like a person drowning in his own blood. Death occurs rapidly most of the time.

This is the type that is used as a biological weapon by terrorists who will send the spores by envelopes to their victims.

What is the treatment of Anthrax?

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The bacterium is easily killed by several antibiotics(penicillin,tetracycline etc), the most effective one being ciprofloxacin given intravenously or directly into the bloodstream.

Oral ciprofloxacin is also effective in less severe cases.

There is no need to take antibiotics to prevent anthrax.

Doing so may cause the bacteria to become resistant to the antibiotic and make it more difficult to treat.

A cell-free vaccine has been developed for people who are at risk of contracting anthrax. This vaccine may be mass produced in the future for common use.

Although anthrax is a much feared disease, it can be prevented and treated with careful and alert practices.

Its use as a biological warfare agent is currently very limited with very effective counter measures in place.