A Simple Guide to Pleural effusion

A Simple Guide to Pleural effusion
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What is Pleural effusion?
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Pleural effusion is excess fluid collection in the pleural space between the parietal and visceral layers of the pleural cavity.

Excessive fluid can limit the expansion of the lungs and cause breathing difficulty.

What the types of Pleural effusions and their causes?
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There are 4 types of pleural effusion which can occur in the pleural space:

1.Serous fluid (hydrothorax)

This is essentially passive collection of extracellular fluid with a specific gravity of <1.015 and protein < 2-3g/dl.

It is translucent in color.

It occur as part of :
a.generalized edema

b.left heart failure

c.liver cirrhosis giving rise to hydrothorax

2.Pus (pyothorax or empyema)

This consists of inflammatory or neoplastic fluid with high protein content.

It is usually yellow or orange in color.

There may be cells or pus or bacteria.

Causes include:
a.bacterial and viral infections such as pneumonia

b.tuberculosis

c.intra-abdominal abscess

d.autoimmune diseases like SLE, rheumatoid arthritis

e.neoplasm(cancer of the lung)

3.Blood (hemothorax)

The exudate is typically blood stained.

Causes are:
a.pulmonary embolism and infarction

b.neoplasm especially with secondaries to lungs

4.Chyle (chylothorax)

Here the exudate arise from the leakage of thoracic duct.

It is milky in appearance.

Causes are:
a.Trauma including chest and heart surgery

b.filariasis in the tropics

What are the symptoms and signs of Pleural effusion?
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Symptoms:
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1.Breathless

2.Side Chest pain

3.dry cough

Signs:
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1.Dullness to percussion

2.Faint or absent breath sounds

3.Decreased movement of the chest

4.Decreased vocal resonance

5.Fremitus

6.pleural friction rub

How do you made a Diagnosis of Pleural effusion?
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Pleural effusion is usually diagnosed on:
1.medical history and physical exam,

2.chest x-ray.
Chest films with the patient lying on their side are more accurate and can show fluid level as low as 50 ml of fluid.

Upright chest films can show fluid level of at least 300ml of pleural effusion

In large effusion there may be tracheal deviation away from the effusion.

3.CT scan of chest showing left sided pleural effusion.

Effusion fluid often settles at the lowest space due to gravity;

4.Pleural tap or thoracentesis.

A needle is inserted through the back of the chest wall in sixth, seventh or eight intercostal space in midaxillary line, into the pleural space.
The fluid may then be evaluated for the following:

Chemical composition including
protein,
lactate dehydrogenase (LDH),
albumin,
amylase,
pH and
glucose

Gram stain and culture to identify possible bacterial infections

Cell count and differential white cell count

Cytology to identify cancer cells

Cytology to identify some infective organisms

Other tests :
lipids,
fungal culture,
viral culture,
specific immunoglobulins

5.Thoracoscopy
If cytology does not show cancer but cancer is still suspected, then a thoracoscopy, or needle biopsy of the pleura may be done to exclude cancer.

What is the Treatment of Pleural Effusion?
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1.Pleural Aspiration is done for relief of chest discomfortand breathlessness.

The Chest Drainage Device is usually connected to an underwater seal below the level of the chest.

Air or pleural fluid is allowed to escape from the pleural space but nothing is allowed to return to the pleural cavity.

Larger effusions may need insertion of an intercostal drain .

2.Treatment depends on the underlying cause of the pleural effusion.

a.Therapeutic aspiration may be sufficient in some cases of trauma and leakage.

b.Installation of antibiotics( eg.bleomycin, tetracycline/doxycycline) in pleural cavity

c.Installation of chemotherapy drugs for cancer into the pleural cavity.

d.treatment of filariasis cases with anti-parasitic drugs

e.surgical pleurodesis- here the parietal and visceral pleural surfaces are made to adhere to each other to prevent accumulation of fluid.

What is the Prognosis of Pleural Effusion?
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Recovery of patient from the pleural effusion after appropriate treatment of the underlying disease is the rule.

Recurrence from returning cancer or infections may be common.

A Simple Guide to Cholecystitis

A Simple Guide to Cholecystitis
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What is Cholecystitis?
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Cholecystitis is an acute or chronic inflammation of the gallbldder.

What are the causes of Cholecystitis?
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Cholecystitis is usually caused by the following:

1. obstruction of the cystic duct by a gallstone -most common cause 80-90% of cases

2. bacterial infection following obstruction in 50% of cases

3. bacterial or viral infection following gastroenteritis-
germs from gut going up the cystic duct into gallbladder.

4. chronic disease follows attacks of acute infection.

Cholecystitis is more common in
the female,
>forty years of age,
fat,
flatulent person.

What are the symptoms and signs of Cholecystitis?
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Persons who has Acute Cholecystitis has the following symptoms:

1.gradual onset of abdominal pain starting from the epigastrium,
moving to the right subcostal area,
may be felt in the back at the subscapular region.

2.nausea and vomiting

3.loss of appetite

4.mild fever and bodyaches

5.slight jaundice

Signs:

1.Tenderness at the right subcostal area with involuntary muscle spasm

2.Murphy Sign positive: sharp increase of tenderness at the subcostal area on palpation with thumbs pressed inwards below the ribs when the patient is asked to breathe deeply

3.Gallbladder may sometimes be felt(palpable)

In chronic Cholecystitis, there may recurrent biliary colic which may be mistaken for signs of gastritis.

How do you diagnose Cholecystitis?
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Diagnosis can usually be made by :
1.Physical examination -a positive Murphy's sign suggest Cholecystitis.

2.Plain X-rays can show the presence of gallstones in 10-15%

3.Oral cholecystogram is 95% accurate if the liver and intestinal functions are normal but may unreliable during the acute attack.

4.Ultrasound is highly reliable in showing up the presence of gallstones

5.Intravenous,transhepatic and endoscopic retrograde cholangiography may be more accurate in diagnosing the gallbladder function and stones

What is the complications of Cholecystitis?
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1.gangrene of the gallbladder due to obstruction of blood supply

2.perforation of the gallbladder due to obstruction of the cystic duct

3.cholangitis - infection of the bile duct which can lead to hepatitis and intestinal infection

What is the treatment of Cholecystitis?
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Acute Cholecystitis:
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Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Cholecystectomy -surgical removal of the gallbladder and stones now usually done through 4 holes in the abdomen.

Chronic Cholecystitis:
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Cholecystectomy

What is the prognosis of Cholecystitis?
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Prognosis is usually good after surgery.

However some pain may persists after surgery due to scar tissue.

A Simple Guide to Cellulitis

A Simple Guide to Cellulitis
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What is a Cellulitis?
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Cellulitis is a condition where bacterial infection and inflammation spread through the skin and subcutaneous tissues.

What are the causes of Cellulitis?
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The bacteria that attack the skin and subcutaneous tissues are usually streptococci and staphylococci.
Rarely the bacteria can be clostridia.

Spread occurs as a result of
1.tissue damage

2.lower body immunity (eg, diabetes,AIDS)

3.virulence of the bacteria

What are the symptoms and signs of Cellulitis?
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1.Red painful hot and swollen skin with ill defined borders

2.Pain and tenderness on palpation

3.In anaerobic infections, crepitation may be present.

4.Pussy discharge may be foul smelling

5.Lymphangitis and lymphadenitis ma be present

What investigations are necessary in Cellulitis?
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Wound swabs may be necessary to determine the bacteria and their resistance to antibiotics

Deep cellulitis may required Xrays and ultrasound scans to see the spread.

What is the treatment of Cellulitis?
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The underlying disease such as diabetes must be treated.

Cool compress may relieve local discomfort.

Analgesics and painkillers may help to relieve pain

Appropriate antibiotics may be taken orally or by skin applications.

Anaerobic infections require systemic antibiotics.

If fascilitis (infection of the fascia of muscles) is present, surgical debridement
(removal of damaged tissues and pus) is necessary.

What is the prognosis of Cellulitis?
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The prognosis of Cellulitis is good with early detection and treatment.

A Simple Guide to Fever

A Simple Guide to Fever
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What is Fever?
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A person's normal body temperature is 37.0 degrees Celsius.
Once above this, it is classified as a fever.
Fever is a symptom not an illness.

What is the cause of Fever?
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A Person's body temperature can be influenced by factors such as
1. infection,

2. metabolic rate and

3.environmental temperature.

When any infection entered the body and localised in a part of the body such as the throat ,intestine, nose, urinary tract etc, it does not cause any fever, only symptoms such as sore throat, diarrhoea, nasal discharge or frequent passing of urine.

However once the germ(whether bacteria,virus or parasite) enter the blood stream from the infected area, the body responses immediately by raising the body temperature.
The raising of the body temperature is the body's way of trying to kill the germ by heating the environment which the germ is trying to survive.

High fevers (above 39 degrees Celsius) however can also damage the body especially the brain.
It can cause seizures in children below the age of five (febrile fits).

Toxins from bacteria and viruses released into the bloodstream can cause chills and shivering in between or sometimes during temperature spikes.

What are the Symptoms of Fever?
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1. Headache

2. Bodyaches

3. Chills

4. Shivering

5. Giddiness

6. Loss of appetite

What is the Treatment of Fever?
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Fever is the body's natural response to a infection, increase in the temperature of the environment and increased metabolic rate.

If the fever is mild (<37.5)and no other problems are present, no medical treatment is necessary.
Just drink more water and rest.

Sponging or bathing in a tub of tepid water can help to reduce the fever. Evaporation of the water cools the skin and thereby reduces body temperature.

Give the person a correct amount of paracetamol which helps to bring down the temperature.

You should see a doctor:
1.If a child of less than 6 months old has a fever.

2.If a fever of more than 39 Degree Celsius cannot be brought down by paracetamol and sponging.

3.If fever lasts for more than 5 days.

4.If there is associated stiff neck and vomiting

5.If there is drowsiness or loss of consciousness

Once the cause of the fever is found and eliminated, the body temperature will reduce spontaneously back to normal.

A Simple Guide to Laceration

A Simple Guide to Laceration
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What is a laceration?
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A laceration is an injury to the skin and its underlying soft tissue when you are cut or hit by something.
A laceration is usually called a cut when the injury is caused by a sharp object breaking the skin. It may a clean cut without bleeding or if it damages the blood vessels in the skin, it can cause visible bleeding.
Lacerations can occur at any part of the body.
Healing time for a laceration depends on where it is on your body.
A laceration usually take longer to heal if it is over a joint such as the knee or elbow.

What are the signs and symptoms of a laceration?
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1.Lacerations may appear in all shapes and sizes.

2.It may look like a cut, tear, or gash.

3.The wound may hurt, bleed, bruise, or swell.

4.Lacerations may bleed a lot in areas of the skin which has a lot of blood vessels such as the scalp.

5.The wound may have edges that are close together, or gaping apart.

6.Sometimes there may be numbness around the wound due to a cut of the nerve endings.

7.Similarly there may be decreased movement in an area below the wound due to loss of nerve endings or tear of muscle fibres.

What are the complications arising from a laceration?
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Even with proper treatment, a laceration can become infected:

1.Increased warmth to the area.

2.Redness or swelling to the area which becomes worse.

3.Pain in the area that increases over time.

4. pus or bad-smelling discharge from the wound.
Pus is milky and may be white, yellow, green, or brown.
It is the result of the white blood cells fighting the bacteria or virus.

Other complications may be:

1.the presence of foreign bodies

2.Injury to the bone( fracture)

3.Injury to the nerve

4.Injury to the blood vessels

5.Injury to muscles

What investigations may be necessary in Laceration?
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If there is suspected foreign objects in your laceration, an x-ray may be required.

Foreign objects include things like metal, gravel, and glass.

If you have many wounds from a car accident, tests may include an ultrasound, a MRI, or a CT scan.

What is the treatment for a laceration?
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The doctor will want to
1.control the bleeding if your wound is bleeding a lot.

2.clean the wound with disinfectant.
This will remove dirt and other small objects and reduce the chance of infection.

3.look in the wound for foreign objects like dust, metal or glass splinters.

4.explore (probe) or close the wound under local anesthesia.
An anesthetic is a medicine which numbs the area so that there is no pain during the probe or surgery.

Closing the wound:
The laceration may need stitches, staples, other treatments to close the wound:
1.if it is deep or bleeds a lot.
2.if your wound is gaping open or
3.if the wound is in an area that moves a lot, such as the hands, feet, and joints.

Stitches also keep the wound from getting infected.
Stitches may decrease the amount of scarring.

If the wound is too old, it can not be stitched.
Some lacerations may heal better without stitches.

Special care:
Some lacerations need special care.
Laceration caused by bites from fish or marine life may need special medicines like antibiotics and antitoxins.
Antibiotics are not needed for most wounds.
Antibiotics are given if your wound has a high risk of infection.

If the laceration injure a bone, nerves, or blood vessels, there may be need for microsurgery to join the torn nerve or blood vessel.
A broken bone may also need to be treated conservatively or with surgery.

Tetanus injection:
Tetanus infection, or "lockjaw," can happen after any deep break in your skin. Tetanus can kill you. It is important for adults to get a tetanus shot at least every 10 years.
After an injury, a tetanus injection may be given if:
1. it has been longer than five years since your last one.
2.any wound that may have dirt or saliva in it.
3.Deep wounds also have a high risk for tetanus infection.

If necessary, tetanus injection should be given as soon as possible (within 72 hours of the injury).

What are the risks in the care of laceration?
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A sharp object which passed through your clothing before cutting your skin may have caused small threads or bits of clothing to be pushed under your skin.
The risk of getting an infection is higher if there are foreign bodies in the wound.
Sometime even with the best care, there may still problems such as infection with your wound.
People who have diabetes have a higher chance of getting a serious infection in a wound.

A Simple Guide to Stye & Chalazion

A Simple Guide to Stye & Chalazion
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What is a Stye?
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A Stye is an infected gland at the edge of the eyelid.

How does a Stye develop?
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A stye develops when a gland supplying wax to eyelash at the edge of the eyelid becomes blocked and infected.
A stye can grow on the inside or outside of the eyelid.
Styes are not harmful to vision.
They can occur at any age.

What are the Symptoms and Signs of Stye?
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A stye starts with pain, redness, tenderness and swelling in the area of the oil gland of the eyelid. Then a small pimple appears. Sometimes just the immediate area is swollen.
At other times the entire eyelid swells.
There may be frequent tearing in the affected eye, a feeling like something is in the eye or increased light sensitivity.

What Causes Styes?
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Most Styes are caused by staphylococcal bacteria.
This bacterium is often found in the nose, and it's easily transferred to the eye by rubbing first your nose, then your eye.
Styes are not normally harmful to vision
They generally heal within a few days.

What is the Treatment for Stye?
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Most styes heal within a few days on their own.
You can apply hot compresses for 10 to 15 minutes, three or four times a day over the course of several days. This will relieve the pain and bring the stye to a head, much like a pimple. The stye ruptures and drains, then heals.

If you have frequent styes, your eye doctor may prescribe a course of antibiotic and ask you to apply an antibiotic eye ointment to kill the bacteria causing the stye.

In most cases, the Styes formed inside the eyelid either disappear completely or rupture on their own. In some cases, the styes become bigger and can be more serious.
These styes may need to be surgically incised and drained by your eye care practitioner.

What is a Chalazion?
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Chalazion is an another type of Eyelid swelling usually inner to the edge of the eyelid.
Often mistaken for a stye, a chalazion is an enlarged, blocked oil gland (tarsal gland)in the inner lining of the eyelid and not at the edge of the eyelid as in the case of a stye.

A chalazion may look like a stye for the first few days, then turns into a hard painless lump in the inner eyelid later on.
Most chalazion develops further from the eyelid edge than stye.

The same treatment is used for the healing of a chalazion.
However in this case, the swelling may linger for one to several months.
If the chalazion remains after several months, your eye doctor may surgically incise and drain it to facilitate healing.