A Simple Guide to Fibromyalgia II
----------------------------------
What are the investigations needed in assessment of Fibromyalgia?
-------------------------------------------------------------------------------------
These criteria for diagnosis of Fibromyalgia:
1.history of widespread pain lasting more than three months-affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
2.Tender points-there are 18 designated tender or trigger points
During diagnosis, four kilograms-force is exerted at each of the 18 points
The patient must feel pain at 11 or more of these points for fibromyalgia to be diagnosed.
3.fibromyalgia patients show sensitivity to pressure, heat, cold, electrical and chemical stimulation.
4.hyperactivity of the sympathetic nervous system
lower heart rate variability,
sympathetic hyperactivity,
5.laboratory blood testing appears normal
6.Cerebrospinal fluid abnormalities
cerebrospinal fluid levels of substance P, a putative nociceptive neurotransmitter, is raised.
Metabolites for monoamine neurotransmitters serotonin, norepinephrine, and dopamine are lower,
Nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is higher
Excitatory amino acid release within cerebrospinal fluid is higher
7.Brain imaging studies
Abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging
decreased blood flow within the thalamus and elements of the basal ganglia and mid-brain.
Hippocampal disruption is shown by reduced brain metabolite ratios
Normal age-related brain atrophy occur with areas of reduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus.
Dopamine synthesis in the brainstem is reduced.
What is the treatment for Fibromyalgia?
-------------------------------------------
There is no cure for fibromyalgia,
B.Medical treatment:
-------------------------
1.corticosteroid seems to help especially to those with adrenal dysfunction and low blood pressure.
Injection of steroids with local anethestics at trigger points or nodules can help relieve pain.
2.Analgesics are able to relieve pain:
a.NSAID medications
b.COX-2 inhibitors,
c.tramadol
3.Muscle relaxants
Muscle relaxants, such as cyclobenzaprine or tizanidine to treat the muscle pain associated with the disorder.
4.Tricyclic antidepressants
Low doses of sedating antidepressants (e.g. amitriptyline and trazodone) help to reduce the sleep disturbances associated with fibromyalgia
Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain.
5.Anti-seizure medication
Anti-seizure drugs are also sometimes used, such as gabapentin and pregabalin
Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved for treatment of fibromyalgia.
6.Dopamine agonists
Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results
7.Combination therapy
A combination of amitriptyline and fluoxetine appeared to be more effective in relieving pain.
8.Central nervous system stimulants
Cognitive dysfunction in fibromyalgia may be treated with low doses of central nervous system (CNS) stimulants such as modafinil, adderall or methylphenidate.
Stimulants may be habit forming and can have other serious side effects
9. Cannabis and cannabinoids
Cannabis is used therapeutically to treat symptoms of the disorder.
Cannabinoid agonists can also help in the treatment of chronic pain conditions
B.Non-drug treatment
------------------------
1. regular floatation tank sessions substantially improves sleep patterns leaving users more optimistic and with reduced nervousness, tension and pain.
Relaxing in a weightless state in the silent warmth of a floatation tank activates the body's own system for recuperation and healing
2..Whirlpool therapy is very beneficial.
C.Psychological therapies
------------------------------
1.Cognitive behavioral therapy has help to improve quality of life
2.Neurofeedback has also shown to provide temporary and long-term relief
3.Biofeedback and self-management techniques such as pacing and stress management can help ,
D. Healthy lifestyle
--------------------------
1. Stop smoking in smokers.
2. Reduce weight in the obese
3. Exercise to improve blood flow can improve symptoms(sleep , pain and fatigue)
4..heat to painful areas.
5. physical therapy, massage, or acupuncture
6. reduce intake of monosodium glutamate
E Surgical treatment:
---------------------------
Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication.
F.Investigational treatments
------------------------------
a.Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI) has help patients in Europe.
b.Dextromethorphan is an over-the-counter cough medicine with activity as an NMDA receptor antagonist.
What is the prognosis for Fibromyalgia?
------------------------------------------------------
Fibromyalgia is not degenerative or fatal,
the chronic pain associated with fibromyalgia is pervasive and persistent.
Fibromyalgia can severely curtail social activity and recreation,
Some with fibromyalgia are unable to maintain full-time employment.
It rarely affects activities of daily living.
How can Fibromyalgia be prevented?
-----------------------------------------------------
1.Stop smoking
2.Reduce weight
3.Exercise
4.Avoid monosodium glutamate in diet
5.Avoid stress and depression
6.Live a healthy lifestyle
Showing posts with label pain. Show all posts
Showing posts with label pain. Show all posts
Friday, November 7, 2008
A Simple Guide to Fibromyalgia I
A Simple Guide to Fibromyalgia I
-----------------------------------------------------
What are Fibromyalgia?
---------------------------------------------
Fibromyalgia is a common nonspecific group of syndrome characterised by diffuse chronic pain, felt in and over muscle masses with focal trigger points or tender points in muscles, joints, tendons and ligaments.
Who is at risk of Fibromyalgia?
-----------------------------------------------------------------
1.genetically predisposed.
2.more females than males, with a ratio of 9:1
3.individuals between the ages of 20 and 50
4.Increased psychosocial stress
5.Excessive physical exertion
6.Lack of slow-wave sleep
7.Changes in humidity and barometric pressure
8.Lack of normal energy
What are the causes of Fibromyalgia?
-------------------------------------------------------
The exact cause of fibromyalgia is unknown.
Fibromyalgia is almost always a combination of several disorders:
1.Genetic predisposition
There is a polygenic predisposition to Fibromyalgia with high aggregation of Fibromyalgia in families
2. Stress
Stress can affect cortisol levels in the body leading to widespread pain.
3.Sleep disturbance
People with fibromyalgia has short wave sleep that do not reach stage four sleep .
4.Dopamine abnormality
Dopamine is a catecholamine neurotransmitter which can cause schizophrenia, Parkinson's disease and addiction.
Abnormality in dopamine cause increased pain perception and analgesia.
5.Serotonin
Serotonin is a neurotransmitter important in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain.
Poor uptake of serotonin can cause pain and poor sleep.
6. Human growth hormone
Stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone during slow-wave sleep.
People with fibromyalgia has low levels of HGH.
Treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep.
7.Chronic fatigue syndrome patients has been known to develop fibromyalgia between onset and the second year of illness
8.Irritable bowel syndrome is found at high frequency in fibromyalgia.
9.Deposition disease
Fibromyalgia is an inherited disorder which cause gradual phosphate build-up in cells but can be accelerated by trauma or illness.
10.Other causes:
a.viral causes such as the Epstein-Barr Virus,
b.disease affecting the hypothalamus gland,
c.immune response to intestinal bacteria
d.neurotransmitter disruptions in the central nervous system
What are the symptoms of Fibromyalgia?
----------------------------------------------
Symptoms can have a slow onset
Many patients have mild symptoms beginning in childhood.
Pain:
1.Onset of pain may be sudden
2.chronic, widespread pain and tenderness to light touch
3.muscle aches(especially lower back, gluteal, neck, chest wall)
4.prolonged muscle spasms,
5.nerve pain,
6.needle-like tingling of the skin,
Fatigue:
7.moderate to severe fatigue,
8.weakness in the limbs,
Psychosomatic disturbances:
9.functional bowel disorders
10.chronic sleep disturbances.
11.cognitive dysfunction
12.impaired concentration,
13.impaired speed of performance,
14.inability to multi-task,
15.diminished attention span
16.anxiety and depressive symptoms
Eye:
17.eye pain,
18.sensitivity to light
19.blurred vision,
20.fluctuating visual clarity,
-----------------------------------------------------
What are Fibromyalgia?
---------------------------------------------
Fibromyalgia is a common nonspecific group of syndrome characterised by diffuse chronic pain, felt in and over muscle masses with focal trigger points or tender points in muscles, joints, tendons and ligaments.
Who is at risk of Fibromyalgia?
-----------------------------------------------------------------
1.genetically predisposed.
2.more females than males, with a ratio of 9:1
3.individuals between the ages of 20 and 50
4.Increased psychosocial stress
5.Excessive physical exertion
6.Lack of slow-wave sleep
7.Changes in humidity and barometric pressure
8.Lack of normal energy
What are the causes of Fibromyalgia?
-------------------------------------------------------
The exact cause of fibromyalgia is unknown.
Fibromyalgia is almost always a combination of several disorders:
1.Genetic predisposition
There is a polygenic predisposition to Fibromyalgia with high aggregation of Fibromyalgia in families
2. Stress
Stress can affect cortisol levels in the body leading to widespread pain.
3.Sleep disturbance
People with fibromyalgia has short wave sleep that do not reach stage four sleep .
4.Dopamine abnormality
Dopamine is a catecholamine neurotransmitter which can cause schizophrenia, Parkinson's disease and addiction.
Abnormality in dopamine cause increased pain perception and analgesia.
5.Serotonin
Serotonin is a neurotransmitter important in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain.
Poor uptake of serotonin can cause pain and poor sleep.
6. Human growth hormone
Stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone during slow-wave sleep.
People with fibromyalgia has low levels of HGH.
Treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep.
7.Chronic fatigue syndrome patients has been known to develop fibromyalgia between onset and the second year of illness
8.Irritable bowel syndrome is found at high frequency in fibromyalgia.
9.Deposition disease
Fibromyalgia is an inherited disorder which cause gradual phosphate build-up in cells but can be accelerated by trauma or illness.
10.Other causes:
a.viral causes such as the Epstein-Barr Virus,
b.disease affecting the hypothalamus gland,
c.immune response to intestinal bacteria
d.neurotransmitter disruptions in the central nervous system
What are the symptoms of Fibromyalgia?
----------------------------------------------
Symptoms can have a slow onset
Many patients have mild symptoms beginning in childhood.
Pain:
1.Onset of pain may be sudden
2.chronic, widespread pain and tenderness to light touch
3.muscle aches(especially lower back, gluteal, neck, chest wall)
4.prolonged muscle spasms,
5.nerve pain,
6.needle-like tingling of the skin,
Fatigue:
7.moderate to severe fatigue,
8.weakness in the limbs,
Psychosomatic disturbances:
9.functional bowel disorders
10.chronic sleep disturbances.
11.cognitive dysfunction
12.impaired concentration,
13.impaired speed of performance,
14.inability to multi-task,
15.diminished attention span
16.anxiety and depressive symptoms
Eye:
17.eye pain,
18.sensitivity to light
19.blurred vision,
20.fluctuating visual clarity,
Friday, October 3, 2008
A Simple Guide to Glossitis
A Simple Guide to Glossitis
-----------------------------------
What is Glossitis?
---------------------------
Glossitis is an acute or chronic inflammatory disease of the tongue which can cause swelling of the tongue and change of colour of the tongue.
The finger like papilla on the surface of the tongue may be lost as a result leading to a smooth tongue.
What are the causes of Glossitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Viral infections:
------------------
Herpes simplex
Non-infectious:
----------------
1.Dryness of the mouth and low saliva in the mouth may allow bacteria to grow more readily.
2.Local dental abnormalities, rough edges of teeth ,ill fitting dental appliances, or other trauma to the tongue
3.Tongue Piercings
4.irritants such as tobacco, alcohol, hot foods, and spicy food.
5.Sensitivity to toothpaste, mouthwash, breath fresheners,and dental material
6.Allergies to dyes in candy or preservatives in food.
7.Drug induced such as anticholinergics (cause dryness of mouth), certain blood-pressure medications (ACE inhibitors).
8.Mouth breathing
Systemic diseases:
--------------------
1.iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies
2.Skin diseases such as oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris,
3.Systemic diseases such as syphilis, and others.
Genetic
---------------
Occasionally Glossitis may be inherited
What are Signs and symptoms of Glossitis?
---------------------------------------------
Symptoms:
1.Swelling of the tongue
2.Tongue color changes often dark red
3.Pale if caused by anemia.
4.Fiery red if due to vitamin B deficiency
5.Sore and tender tongue
6.Smooth tongue
7.Aphthous ulcers of the tongue
8. Swollen tongue resulting in difficulty with chewing, swallowing, or speaking.
This may require emergency treatment especially if breathing is compromised.
How is the diagnosis of Glossitis made?
------------------------------------------
1.Symptoms and signs of red, swollen and inflamed tongue
2.blood tests (complete blood count, ESR and blood culture)
3.Biopsy of the tongue in rare cases.
What are the complications of Glossitis?
-----------------------------------------------
1.difficulty in breathing and swallowing
2.cervical lymphadenitis - swelling of the neck lymph nodes
3.upper respiratory tract infection
What is the treatment of Glossitis?
------------------------------------
The Main treatment is to reduce inflammation.
1.Good oral hygiene
2.Attend to dental problems
3.Antibiotics and antifungal treatment depending on the organism found
4.Corticosteroids may be given to reduce inflammation
5.For mild cases, topical applications of steroid mouth rinses or creams that is not swallowed are used
6.Underlying causes such as Anemia and nutritional deficiencies must be treated, often by changes in diet or vitamin supplements
7.Avoid irritants such as hot or spicy foods, alcohol, and tobacco to minimize the discomfort.
8.hospitalization may be required if unless tongue swelling is is affecting breathing or swallowing.
What is the prognosis of Glossitis ?
------------------------------------------
Usually very good.
Recurrences are common
What are the Preventive measures taken for Glossitis ?
--------------------------------------------------------
1.Avoid smoking
2.Healthy lifestyle with balanced diet and exercise.
3.Regular cleaning of gums and teeth by brushing and flossing
4.Gargling of mouth after meals
5.Regular dental checkups
Thursday, September 25, 2008
A Simple Guide to Impetigo
A Simple Guide to Impetigo
-----------------------------------
What is Impetigo?
---------------------------
Impetigo is a vesiculopustular skin infection occurring mainly at all ages.
What are the causes of Impetigo?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,
What are Signs and symptoms of Impetigo?
---------------------------------------------
Symptoms:
1.vesicles that appears rapidly on the face, hands and knee
2.Yellow liquid or pus discharges from vesicles
3.form crusts
Signs:
1.Vesicles rash present on face, hand and knees
2.yellow crusts appeared and spread to surrounding tissues
3.Neighboring lymph nodes may be enlarged
How is the diagnosis of Impetigo made?
------------------------------------------
1.Symptoms and signs of vesiculopustular lesions of the skin.
2.Culture and sensitivity to antibiotics of the discharge or crusts from skin lesions
What are the complications of Impetigo?
-----------------------------------------------
1.cellulitis
2.abscess
3.carbuncle( a group of abscesses which join together to become a large abscess
4.lymphadenitis
What is the treatment of Impetigo?
------------------------------------
1.Removal of crusts with warm saline or liquid paraffin
2.Strong antibiotic cream applied to skin lesions.
3. Strong systemic antibiotics
a.cephalosporin, penicillin, ampicillin, erythromycin, tetracycline, for most streptococci,
staphalococci,
hemophilus
b.cephalosporins, gentamycin for
pseudomonas
4.surgery to drain abscess and carbuncles may be necessary
What is the prognosis of Impetigo ?
------------------------------------------
Generally excellent with good healing
What are the Preventive measures taken for Impetigo ?
--------------------------------------------------------
1.Avoid touching skin with dirty hands
2.Good hand hygiene
3.Healthy lifestyle with balance diet and adequate sleep.
4.Proper skin care
Wednesday, September 24, 2008
A Simple Guide to Blepharitis
A Simple Guide to Blepharitis
-----------------------------------
What is Blepharitis?
---------------------------
Blepharitis is a disease which causes inflammation and infection of the margins of the eyelids.
What are the causes of Blepharitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,
Parasitic Infections:
----------------------------
Deodex folliculorum rare cause
Non-infectious:
------------------
blocked oil glands of eyelashes
What are the types of Blepharitis?
----------------------------------------
Squamous:
--------------
typically scales on lashes- usually non-infectious
Ulcerative:
----------------
yellow crusts on eyelids which causes small bleeding ulcers when removed -
usually due to infections.
What are Signs and symptoms of Blepharitis?
---------------------------------------------
Symptoms:
1.Irritation and discomfort of eyelids
2.tearing of eyes
3.photophobia (fear of bright lights and sunlight)
4.Yellow discharge or crusts on eyelashes
Signs:
1.White scales on eyelashes in squamous blepharitis
2.yellow crusts on eyelashes in infectious blepharitis
3.small bleeding ulcers on eyelids where crusts have dropped.
4.Conjuctivitis
How is the diagnosis of Blepharitis made?
------------------------------------------
1.Symptoms and signs of scales, yellow crusts on eyelids
2.Culture and sensitivity to antibiotics of the discharge from eyedlids
3.Microscopic examination of eyelashes
What are the complications of Blepharitis?
-----------------------------------------------
1.Stye or chalazion of eyelid
2.Conjuctivitis
3.Scarring of eyelids
What is the treatment of Blepharitis?
------------------------------------
Squamous Blepharitis
-----------------------
1.Treatment of underlying cause such as seborrhoeic dermatitis
2.Application of antiseptic or antibiotic cream to eyelashes
Ulcerative Blepharitis
--------------------------
1.Rest in dark room
2.Painkiller for pain
3.Removal of crusts and diseased eyelashes by washing warm water or saline
4.Strong antibiotic eyedrops and cream applied to eyelashes:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
5.Treat associated conjunctivitis
What is the prognosis of Blepharitis ?
------------------------------------------
Squamous Blepharitis
-----------------------
Generally good.
May vary with response to underlying cause.
Recurrence is common.
Ulcerative Blepharitis
--------------------------
Most cases recovered well.
Rarely there may serious sequalae such as
loss of eyelashes,
scarring of eyelashes
conjuctival ulcers
What are the Preventive measures taken for Blepharitis ?
--------------------------------------------------------
1.Avoid rubbing of eyes with dirty hands
2.Good hand hygiene
3.Healthy lifestyle with balanced diet and adequate sleep.
4.Reducing watching of TV and computer monitors
5.Regular eye checkups
-----------------------------------
What is Blepharitis?
---------------------------
Blepharitis is a disease which causes inflammation and infection of the margins of the eyelids.
What are the causes of Blepharitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,
Parasitic Infections:
----------------------------
Deodex folliculorum rare cause
Non-infectious:
------------------
blocked oil glands of eyelashes
What are the types of Blepharitis?
----------------------------------------
Squamous:
--------------
typically scales on lashes- usually non-infectious
Ulcerative:
----------------
yellow crusts on eyelids which causes small bleeding ulcers when removed -
usually due to infections.
What are Signs and symptoms of Blepharitis?
---------------------------------------------
Symptoms:
1.Irritation and discomfort of eyelids
2.tearing of eyes
3.photophobia (fear of bright lights and sunlight)
4.Yellow discharge or crusts on eyelashes
Signs:
1.White scales on eyelashes in squamous blepharitis
2.yellow crusts on eyelashes in infectious blepharitis
3.small bleeding ulcers on eyelids where crusts have dropped.
4.Conjuctivitis
How is the diagnosis of Blepharitis made?
------------------------------------------
1.Symptoms and signs of scales, yellow crusts on eyelids
2.Culture and sensitivity to antibiotics of the discharge from eyedlids
3.Microscopic examination of eyelashes
What are the complications of Blepharitis?
-----------------------------------------------
1.Stye or chalazion of eyelid
2.Conjuctivitis
3.Scarring of eyelids
What is the treatment of Blepharitis?
------------------------------------
Squamous Blepharitis
-----------------------
1.Treatment of underlying cause such as seborrhoeic dermatitis
2.Application of antiseptic or antibiotic cream to eyelashes
Ulcerative Blepharitis
--------------------------
1.Rest in dark room
2.Painkiller for pain
3.Removal of crusts and diseased eyelashes by washing warm water or saline
4.Strong antibiotic eyedrops and cream applied to eyelashes:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
5.Treat associated conjunctivitis
What is the prognosis of Blepharitis ?
------------------------------------------
Squamous Blepharitis
-----------------------
Generally good.
May vary with response to underlying cause.
Recurrence is common.
Ulcerative Blepharitis
--------------------------
Most cases recovered well.
Rarely there may serious sequalae such as
loss of eyelashes,
scarring of eyelashes
conjuctival ulcers
What are the Preventive measures taken for Blepharitis ?
--------------------------------------------------------
1.Avoid rubbing of eyes with dirty hands
2.Good hand hygiene
3.Healthy lifestyle with balanced diet and adequate sleep.
4.Reducing watching of TV and computer monitors
5.Regular eye checkups
Sunday, September 21, 2008
A Simple Guide to Tenosynovitis
A Simple Guide to Tenosynovitis
----------------------------------------------------
What is Tenosynovitis?
-----------------------------------------
Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.
It can occur together with tendinitis(inflammation of the tendons).
It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).
What are the cause of Tenosynovitis?
-----------------------------------------------
The cause of Tenosynovitis is unknown.
Some possible causes are:
1.Injury or trauma to the tendon
2.Repetitive usage of fingers and wrist joints
3.Arthritis of the joints may predispose to tenosynovitis
4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis
5.Tenosynovitis occurs in families, and
6.It is generally seen more often in males than in females
What are the symptoms and signs of Tenosynovitis?
-------------------------------------------------------------------
Symptoms:
--------------
1.Pain on movement of the tendon
2.Swelling of part of the tendon affected
3.Stenosis of the tendon sheath may be present
4.Stiffness of the tendon - inability to stretch
5.Pain is felt most beneath the bone of involved joints
Signs:
1.swelling over the involved tendon
2.Passive stretching of the tendon is painful.
3.There may be local tenderness of the inflamed tendon.
4.The tendons sheaths are usually swollen and thickened
5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)
6.There may be crepitations felt over the tendon as it moves across the sheaths
What is the complications of Tenosynovitis?
-------------------------------------------------
Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.
What is the Treatment of Tenosynovitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1.rest of the tendon
2.Cold or ice may help reduce inflammation
3.Splints over the hand, wrist and elbow may help to rest the tendons
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the affected sheath or tendon nodule may help to reduce inflammation
7.Surgery :
------------------
Surgical opening of the synovial sheath may be necessary for tendon release.
What is the prognosis of Tenosynovitis?
----------------------------------------------------------
Prognosis is usually good although recurrence may occur after cortisone injection.
Surgery usually give excellent results.
----------------------------------------------------
What is Tenosynovitis?
-----------------------------------------
Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.
It can occur together with tendinitis(inflammation of the tendons).
It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).
What are the cause of Tenosynovitis?
-----------------------------------------------
The cause of Tenosynovitis is unknown.
Some possible causes are:
1.Injury or trauma to the tendon
2.Repetitive usage of fingers and wrist joints
3.Arthritis of the joints may predispose to tenosynovitis
4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis
5.Tenosynovitis occurs in families, and
6.It is generally seen more often in males than in females
What are the symptoms and signs of Tenosynovitis?
-------------------------------------------------------------------
Symptoms:
--------------
1.Pain on movement of the tendon
2.Swelling of part of the tendon affected
3.Stenosis of the tendon sheath may be present
4.Stiffness of the tendon - inability to stretch
5.Pain is felt most beneath the bone of involved joints
Signs:
1.swelling over the involved tendon
2.Passive stretching of the tendon is painful.
3.There may be local tenderness of the inflamed tendon.
4.The tendons sheaths are usually swollen and thickened
5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)
6.There may be crepitations felt over the tendon as it moves across the sheaths
What is the complications of Tenosynovitis?
-------------------------------------------------
Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.
What is the Treatment of Tenosynovitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1.rest of the tendon
2.Cold or ice may help reduce inflammation
3.Splints over the hand, wrist and elbow may help to rest the tendons
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the affected sheath or tendon nodule may help to reduce inflammation
7.Surgery :
------------------
Surgical opening of the synovial sheath may be necessary for tendon release.
What is the prognosis of Tenosynovitis?
----------------------------------------------------------
Prognosis is usually good although recurrence may occur after cortisone injection.
Surgery usually give excellent results.
Thursday, September 11, 2008
A Simple Guide to Gingivitis
A Simple Guide to Gingivitis
-----------------------------------
What is Gingivitis?
---------------------------
Gingivitis is an acute disease which causes inflammation and infection of the gums with redness, swelling and bleeding.
What are the causes of Gingivitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Non-infectious:
------------------
1.malocclusion
2.food impaction
3.dental calculus
4.dental procedures
5.exposure to heavy metals
6.long term phenytoin treatment
7.Oral contraceptive pills
Systemic diseases:
--------------------
1.diabetes mellitus
2.leukemia
3.Debilitating diseases
4.autoimmune diseases
What are Signs and symptoms of Gingivitis?
---------------------------------------------
Symptoms:
1.Pain in the gums
2.Red swollen inflamed gums
3.bleeding in between the gums
4.Fever may be present
Signs:
1.Red swollen inflamed gums around neck of teeth
2.Swelling of papilla between teeth
3.Gum boils or abscess in the gums
4.Gum ulcers
How is the diagnosis of Gingivitis made?
------------------------------------------
1.Symptoms and signs of red, swollen and inflamed gums
2.blood tests (complete blood count, ESR and blood culture)
3.X-rays of teeth
What are the complications of Gingivitis?
-----------------------------------------------
1.damage to root canals
2.cavity in the teeth
3.upper respiratory tract infection
What is the treatment of Gingivitis?
------------------------------------
1.Rest & fluids
2.Painkiller for pain
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
4.Oral application of oral antibiotic cream
What is the prognosis of Gingivitis ?
------------------------------------------
Usually very good.
Surgery for abscess and other gum or tooth problem very rarely needed.
What are the Preventive measures taken for Gingivitis ?
--------------------------------------------------------
1.Avoid smoking
2.Healthy lifestyle with balanced diet and exercise.
3.Regular cleaning of gums and teeth by brushing and flossing
4.Gargling of mouth after meals
5.Regular dental checkups
-----------------------------------
What is Gingivitis?
---------------------------
Gingivitis is an acute disease which causes inflammation and infection of the gums with redness, swelling and bleeding.
What are the causes of Gingivitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Non-infectious:
------------------
1.malocclusion
2.food impaction
3.dental calculus
4.dental procedures
5.exposure to heavy metals
6.long term phenytoin treatment
7.Oral contraceptive pills
Systemic diseases:
--------------------
1.diabetes mellitus
2.leukemia
3.Debilitating diseases
4.autoimmune diseases
What are Signs and symptoms of Gingivitis?
---------------------------------------------
Symptoms:
1.Pain in the gums
2.Red swollen inflamed gums
3.bleeding in between the gums
4.Fever may be present
Signs:
1.Red swollen inflamed gums around neck of teeth
2.Swelling of papilla between teeth
3.Gum boils or abscess in the gums
4.Gum ulcers
How is the diagnosis of Gingivitis made?
------------------------------------------
1.Symptoms and signs of red, swollen and inflamed gums
2.blood tests (complete blood count, ESR and blood culture)
3.X-rays of teeth
What are the complications of Gingivitis?
-----------------------------------------------
1.damage to root canals
2.cavity in the teeth
3.upper respiratory tract infection
What is the treatment of Gingivitis?
------------------------------------
1.Rest & fluids
2.Painkiller for pain
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
4.Oral application of oral antibiotic cream
What is the prognosis of Gingivitis ?
------------------------------------------
Usually very good.
Surgery for abscess and other gum or tooth problem very rarely needed.
What are the Preventive measures taken for Gingivitis ?
--------------------------------------------------------
1.Avoid smoking
2.Healthy lifestyle with balanced diet and exercise.
3.Regular cleaning of gums and teeth by brushing and flossing
4.Gargling of mouth after meals
5.Regular dental checkups
Sunday, August 3, 2008
A Simple Guide to Corneal Ulcer
A Simple Guide to Corneal Ulcer
----------------------------------------------------
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.
----------------------------------------------------
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.
Saturday, July 26, 2008
A Simple Guide to Plantar Fascilitis
A Simple Guide to Plantar Fascilitis
----------------------------------------------------
What is Plantar Fascilitis?
-----------------------------------------
Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.
It is more common in women.
What are the cause of Plantar Fascilitis?
-----------------------------------------------
The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.
In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.
Both heels can be affected.
What are the symptoms and signs of Plantar Fascilitis?
---------------------------------------------------------------------------------
Symptoms:
1.Pain in the heel of one or both feet
2.Pain usually is worse in the morning on getting and stepping on the floor.
3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse
4.Pain is described as constant and aching
5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.
Signs:
1.local tenderness in the calcaneal bone area of the heel.
2. Pain is aggravated by direct pressure.
3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.
4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.
A stress fracture may need to be ruled out in chronic cases.
What is the Treatment of Plantar Fascilitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the heel-avoid jogging or strenous exercises
2.Cold or ice may help reduce inflammation
3.Heel cups, cushions, tapes, pads may help to reduce the pain
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.
7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.
8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.
Mobilisation phase:
Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain
Surgery is usually not indicated in plantar fascilitis.
Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.
What is the prognosis of Plantar Fascilitis?
----------------------------------------------------------
Prognosis is usually good although healing is slow and takes up to 1-2 years.
What is the prevention of Plantar Fascilitis?
-------------------------------------------------
Avoid certain weight bearing exercises like jogging or brisk walking
Use heel cups, cushions, tapes, pads in foot wear
Lose Weight
----------------------------------------------------
What is Plantar Fascilitis?
-----------------------------------------
Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.
It is more common in women.
What are the cause of Plantar Fascilitis?
-----------------------------------------------
The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.
In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.
Both heels can be affected.
What are the symptoms and signs of Plantar Fascilitis?
---------------------------------------------------------------------------------
Symptoms:
1.Pain in the heel of one or both feet
2.Pain usually is worse in the morning on getting and stepping on the floor.
3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse
4.Pain is described as constant and aching
5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.
Signs:
1.local tenderness in the calcaneal bone area of the heel.
2. Pain is aggravated by direct pressure.
3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.
4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.
A stress fracture may need to be ruled out in chronic cases.
What is the Treatment of Plantar Fascilitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the heel-avoid jogging or strenous exercises
2.Cold or ice may help reduce inflammation
3.Heel cups, cushions, tapes, pads may help to reduce the pain
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.
7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.
8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.
Mobilisation phase:
Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain
Surgery is usually not indicated in plantar fascilitis.
Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.
What is the prognosis of Plantar Fascilitis?
----------------------------------------------------------
Prognosis is usually good although healing is slow and takes up to 1-2 years.
What is the prevention of Plantar Fascilitis?
-------------------------------------------------
Avoid certain weight bearing exercises like jogging or brisk walking
Use heel cups, cushions, tapes, pads in foot wear
Lose Weight
Thursday, July 24, 2008
A Simple Guide to Knee cap Dislocation
A Simple Guide to Knee cap Dislocation
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.
What are the causes of Knee cap Dislocation?
----------------------------------------------------------------------
1.Dislocated knee caps most often occur in people with loose joint ligaments.
It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.
2.Dislocation of the knee cap may also occur due to trauma.
A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.
3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.
This condition is usually inherited and are more common in women than in men.
What are the symptoms and signs of Knee cap Dislocation?
-------------------------------------------------------------------
Symptoms:
1.Knee cap is displaced to the lateral position
2.knee swelling and effusion due to displacement of the knee cap.
3.Knee pain and tenderness is present.
4.The knee is usually held in slight flexion.
5.There is difficulty in lifting the leg
6. Patient usually walks with a limp.
Signs:
1.Tenderness and swelling of the knee
2.Knee cap is displaced to the outside or lateral part of the knee
3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.
4.The knee cap can move excessively from right to left.(hypermobile)
How to investigate the cause of Knee cap Dislocation?
-------------------------------------------------------------
1.examination of the knee would confirm presence of the dislocated knee cap.
There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.
2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.
A skyline view of the knee should show the shift of the patella laterally.
3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.
What is the Treatment of Knee cap Dislocation?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.
The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)
Gentle pressure is exerted on the knee cap to place it to its normal position.
The knee is then immobilized for 2-3 weeks.
Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
Surgery is required if:
1.the knee remains unstable
2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.
Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.
What is the prognosis of Knee cap Dislocation?
----------------------------------------------------------
Prognosis using conservative methods is fair.
Recurrences are quite common.
Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.
Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.
What is the Prevention of Knee cap Dislocation?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.
What are the causes of Knee cap Dislocation?
----------------------------------------------------------------------
1.Dislocated knee caps most often occur in people with loose joint ligaments.
It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.
2.Dislocation of the knee cap may also occur due to trauma.
A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.
3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.
This condition is usually inherited and are more common in women than in men.
What are the symptoms and signs of Knee cap Dislocation?
-------------------------------------------------------------------
Symptoms:
1.Knee cap is displaced to the lateral position
2.knee swelling and effusion due to displacement of the knee cap.
3.Knee pain and tenderness is present.
4.The knee is usually held in slight flexion.
5.There is difficulty in lifting the leg
6. Patient usually walks with a limp.
Signs:
1.Tenderness and swelling of the knee
2.Knee cap is displaced to the outside or lateral part of the knee
3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.
4.The knee cap can move excessively from right to left.(hypermobile)
How to investigate the cause of Knee cap Dislocation?
-------------------------------------------------------------
1.examination of the knee would confirm presence of the dislocated knee cap.
There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.
2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.
A skyline view of the knee should show the shift of the patella laterally.
3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.
What is the Treatment of Knee cap Dislocation?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.
The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)
Gentle pressure is exerted on the knee cap to place it to its normal position.
The knee is then immobilized for 2-3 weeks.
Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
Surgery is required if:
1.the knee remains unstable
2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.
Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.
What is the prognosis of Knee cap Dislocation?
----------------------------------------------------------
Prognosis using conservative methods is fair.
Recurrences are quite common.
Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.
Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.
What is the Prevention of Knee cap Dislocation?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
Tuesday, July 22, 2008
A Simple Guide to Frozen Shoulder
A Simple Guide to Frozen Shoulder
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.
It tends to be chronic and full recovery may take several months.
It is more common in women and diabetes.
Incidence is about 2 in a 1000.
What are the causes of Frozen Shoulder?
-----------------------------------------------
The exact cause is unknown but several conditions has been blamed:
1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements
2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement
3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles
4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.
5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.
What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------
Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.
There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.
There is also reduced fluid in the joint further restricting movement.
Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.
This lasts 5 weeks to 9 months.
Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.
This lasts 4 -9 months.
Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.
This lasts 5 -26 months.
What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------
Symptoms:
1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm
2.Pain usually is worse at night especially lying on the affected shoulder
3.Certain movements makes the pain worse
4.Pain is described as constant, dull and aching
5.complaints of stiffness of the shoulder
6.inability to wear a shirt or blouse because of restricted movements
Signs:
1.apprehensive patient who holds the arm protectively
2.Generalised tenderness of rotator cuff and biceps muscles
3.Limited shoulder movement
4.Range of muscle movement is reduced in all directions
5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..
What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder
2.moist heat
3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
4.Muscle relaxant to relax muscles
5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.
Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy
2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder
Maintenance phase:
1.Continual exercises of the shoulder muscles
2.Avoidance of strain on the muscles of the shoulder
Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.
Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.
What is the prognosis of Frozen Shoulder?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.
It tends to be chronic and full recovery may take several months.
It is more common in women and diabetes.
Incidence is about 2 in a 1000.
What are the causes of Frozen Shoulder?
-----------------------------------------------
The exact cause is unknown but several conditions has been blamed:
1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements
2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement
3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles
4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.
5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.
What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------
Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.
There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.
There is also reduced fluid in the joint further restricting movement.
Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.
This lasts 5 weeks to 9 months.
Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.
This lasts 4 -9 months.
Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.
This lasts 5 -26 months.
What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------
Symptoms:
1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm
2.Pain usually is worse at night especially lying on the affected shoulder
3.Certain movements makes the pain worse
4.Pain is described as constant, dull and aching
5.complaints of stiffness of the shoulder
6.inability to wear a shirt or blouse because of restricted movements
Signs:
1.apprehensive patient who holds the arm protectively
2.Generalised tenderness of rotator cuff and biceps muscles
3.Limited shoulder movement
4.Range of muscle movement is reduced in all directions
5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..
What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder
2.moist heat
3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
4.Muscle relaxant to relax muscles
5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.
Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy
2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder
Maintenance phase:
1.Continual exercises of the shoulder muscles
2.Avoidance of strain on the muscles of the shoulder
Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.
Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.
What is the prognosis of Frozen Shoulder?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
Thursday, July 17, 2008
A Simple Guide to Prolapsed Intervertebral Disc
A Simple Guide to Prolapsed Intervertebral Disc
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).
It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.
What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------
1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.
2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.
3.Spinal tumour rarely pushes the disc out of its intervertebral space
What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------
Symptoms:
1.Low Backache with pain in the lumbar region
2.Sciatica or pain shooting down 1 leg
3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing
4.Pain may so bad that the person cannot stand erect.
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Muscle spasm especially spinal extensor muscles
2.Movement of the back and affected led painful and restricted
3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side
4.Straight leg raising test is usually restricted on the affected side.
5.Neurological signs such as paraesthesia commonly present on the affected side.
6.Sensory and motor deficit may be present in the affected side
7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished
L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes
S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished
How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------
1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,
2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test
3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,
4.MRI of spine for slipped disc
5.bone scan for osteoporosis
A definite diagnosis can then be made and the cause of the pain treated.
What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy
Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles
Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain
Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI
Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc
Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.
What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------
Prognosis depends on the underlying cause.
Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.
What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).
It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.
What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------
1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.
2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.
3.Spinal tumour rarely pushes the disc out of its intervertebral space
What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------
Symptoms:
1.Low Backache with pain in the lumbar region
2.Sciatica or pain shooting down 1 leg
3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing
4.Pain may so bad that the person cannot stand erect.
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Muscle spasm especially spinal extensor muscles
2.Movement of the back and affected led painful and restricted
3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side
4.Straight leg raising test is usually restricted on the affected side.
5.Neurological signs such as paraesthesia commonly present on the affected side.
6.Sensory and motor deficit may be present in the affected side
7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished
L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes
S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished
How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------
1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,
2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test
3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,
4.MRI of spine for slipped disc
5.bone scan for osteoporosis
A definite diagnosis can then be made and the cause of the pain treated.
What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy
Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles
Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain
Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI
Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc
Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.
What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------
Prognosis depends on the underlying cause.
Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.
What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
Wednesday, June 18, 2008
A Simple Guide to Pancreatic Cancer
A Simple Guide to Pancreatic Cancer
----------------------------------------
What is Pancreatic Cancer?
------------------------------
Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.
What are the causes of Pancreatic Cancer?
-----------------------------------------
1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells
2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells
3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer
4.Chronic pancreatitis has been found to have some causal effect
5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer
6.Occupational exposure to certain chemicals including insecticides
7.Family history -there is a family history in 5-10% of pancreatic cancer patients
8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract
What are the symptoms and signs of Pancreatic Cancer?
-------------------------------------------------------
Symptoms - non-specific and varied.
1.pain in the upper abdomen that typically radiates to the back
2.pain relieved by leaning forward
3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)
4.depression is sometimes associated with pancreatic cancer
Signs:
1.tenderness in upper abdomen
2.mass in the abdomen
3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.
How do you diagnose Pancreatic Cancer?
----------------------------------------------
Diagnosis can usually be made by :
History
-----------
1.pain in upper abdomen radiating straight to the back, worse on eating
2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.
3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later
4.onset of atypical diabetes mellitus
5.unexplained recent thrombophlebitis
6.past history of pancreatitis
Location of cancer
-----------------------
1.Tumors in the pancreatic body or tail usually present with pain and weight loss
2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.
Courvoisier sign
-----------------
presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer
Liver function tests
---------------------
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).
CA19-9 (carbohydrate antigen 19.9)
----------------------------------
is a tumor marker that is frequently elevated in pancreatic cancer.
Ultrasound or abdominal CT
------------------------------
may be used to identify tumors.
Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.
What is the treatment of Pancreatic Cancer?
------------------------------------------------
Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.
Surgery
--------------
1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.
2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy
3.localized tumors of the pancreas have been surgically removed using laparoscopy.
4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.
5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.
Chemotherapy
-----------------
is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life
Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer
Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.
Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.
Radiation therapy
--------------------
The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.
What is the Prognosis of pancreatic cancer?
-------------------------------------------------
The prognosis of pancreatic cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 3-4 months;
3.5-year survival is lower than 5%.
4.Pancreatic cancer has the highest mortality of all the cancers.
5.Pancreatic cancer may sometimes cause diabetes.
How to prevent Pancreatic Cancer?
----------------------------------------
1.a healthy lifesyle
2.increase consumption of fruits, vegetables
3.reduce red meat intake
4.Vitamin D can reduce the risk of pancreatic cancer
5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer
6.Avoid smoking and drinking of alcohol
----------------------------------------
What is Pancreatic Cancer?
------------------------------
Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.
What are the causes of Pancreatic Cancer?
-----------------------------------------
1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells
2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells
3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer
4.Chronic pancreatitis has been found to have some causal effect
5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer
6.Occupational exposure to certain chemicals including insecticides
7.Family history -there is a family history in 5-10% of pancreatic cancer patients
8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract
What are the symptoms and signs of Pancreatic Cancer?
-------------------------------------------------------
Symptoms - non-specific and varied.
1.pain in the upper abdomen that typically radiates to the back
2.pain relieved by leaning forward
3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)
4.depression is sometimes associated with pancreatic cancer
Signs:
1.tenderness in upper abdomen
2.mass in the abdomen
3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.
How do you diagnose Pancreatic Cancer?
----------------------------------------------
Diagnosis can usually be made by :
History
-----------
1.pain in upper abdomen radiating straight to the back, worse on eating
2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.
3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later
4.onset of atypical diabetes mellitus
5.unexplained recent thrombophlebitis
6.past history of pancreatitis
Location of cancer
-----------------------
1.Tumors in the pancreatic body or tail usually present with pain and weight loss
2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.
Courvoisier sign
-----------------
presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer
Liver function tests
---------------------
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).
CA19-9 (carbohydrate antigen 19.9)
----------------------------------
is a tumor marker that is frequently elevated in pancreatic cancer.
Ultrasound or abdominal CT
------------------------------
may be used to identify tumors.
Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.
What is the treatment of Pancreatic Cancer?
------------------------------------------------
Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.
Surgery
--------------
1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.
2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy
3.localized tumors of the pancreas have been surgically removed using laparoscopy.
4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.
5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.
Chemotherapy
-----------------
is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life
Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer
Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.
Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.
Radiation therapy
--------------------
The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.
What is the Prognosis of pancreatic cancer?
-------------------------------------------------
The prognosis of pancreatic cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 3-4 months;
3.5-year survival is lower than 5%.
4.Pancreatic cancer has the highest mortality of all the cancers.
5.Pancreatic cancer may sometimes cause diabetes.
How to prevent Pancreatic Cancer?
----------------------------------------
1.a healthy lifesyle
2.increase consumption of fruits, vegetables
3.reduce red meat intake
4.Vitamin D can reduce the risk of pancreatic cancer
5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer
6.Avoid smoking and drinking of alcohol
Tuesday, February 12, 2008
A Simple Guide to Cervical Spondylosis
A Simple Guide to Cervical Spondylosis
---------------------------------------------
What is Cervical Spondylosis?
----------------------------------
Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.
Who get Cervical Spondylosis?
-------------------------------------
Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.
What are the causes of Cervical Spondylosis?
-----------------------------------------------
The causes of Cervical Spondylosis are:
1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.
2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.
3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.
What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------
1.The onset is usually gradual with occasional neck pain over weeks or months.
2.There may be a history of trauma to the neck or prolonged neck strain.
3.Early morning neck stiffness and pain may occur,then wears off during the day.
4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.
5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.
6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.
7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.
8.Muscle weakness of the upper and/or lower limb with muscle wasting
Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.
How is Cervical Spondylosis diagnosed?
-----------------------------------------
Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine
How to treat Cervical Spondylosis?
------------------------------------
Not every patient suffer the same degree of symptoms
1. mild requiring only exercises or mild pain killers.
2. more severe require:
a.Neck collars
b.physiotherapy -cervical traction, shortwave diathermy, neck exercises
c.NSAIDs painkillers
d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs
3. All cases require:
protection of neck from muscle strain
avoidance of excessive bending and turning of neck
maintenance of good posture
avoidance of emotional stress
What is the prognosis of Cervical Spondylosis?
------------------------------------------------
Symptoms comes and go.
With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Injury and stress can aggravate the condition.
There is no cure.
---------------------------------------------
What is Cervical Spondylosis?
----------------------------------
Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.
Who get Cervical Spondylosis?
-------------------------------------
Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.
What are the causes of Cervical Spondylosis?
-----------------------------------------------
The causes of Cervical Spondylosis are:
1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.
2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.
3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.
What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------
1.The onset is usually gradual with occasional neck pain over weeks or months.
2.There may be a history of trauma to the neck or prolonged neck strain.
3.Early morning neck stiffness and pain may occur,then wears off during the day.
4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.
5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.
6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.
7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.
8.Muscle weakness of the upper and/or lower limb with muscle wasting
Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.
How is Cervical Spondylosis diagnosed?
-----------------------------------------
Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine
How to treat Cervical Spondylosis?
------------------------------------
Not every patient suffer the same degree of symptoms
1. mild requiring only exercises or mild pain killers.
2. more severe require:
a.Neck collars
b.physiotherapy -cervical traction, shortwave diathermy, neck exercises
c.NSAIDs painkillers
d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs
3. All cases require:
protection of neck from muscle strain
avoidance of excessive bending and turning of neck
maintenance of good posture
avoidance of emotional stress
What is the prognosis of Cervical Spondylosis?
------------------------------------------------
Symptoms comes and go.
With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Injury and stress can aggravate the condition.
There is no cure.
Sunday, December 16, 2007
A Simple Guide to Balanitis
A Simple Guide to Balanitis
----------------------------------
What is Balanitis?
----------------------
Balanitis is an infection of the glans and prepuce of the penis.
What are the causes of Balanitis?
---------------------------------------
It can occur because of:
1. Sexually transmitted bacterial diseases such as gonorrhea, chlamydia, candidiasis.
2. Viral diseases like genital herpes
3. Parasitic infection such as trichomoniasis
4. drug allergy and eruptions
5. Contact dermatitis,psoriasis,lichen planus,seborrheic dermatitis
6. collagen disease (Reiter's syndrome)
7. phimosis
What are the symptoms of Balanitis?
--------------------------------
1. Itchiness of the glans and prepuce with scratch marks
2. Pain and burning sensation on passing urine
3. Subpreputial(below prepuce) discharge 2-3 days after intercourse in venereal disease
4. Oedema of prepuce
5. Ulceration of the glans
6. Blisters or rashes in genital herpes
7. enlarged inguinal lymph nodes
How do you diagnose Balanitis?
--------------------------------------
Physical examination.
Blood tests for venereal disease and glucose
Urine for sugar and leucocytes
What is the treatment of Balanitis?
-----------------------------------------
1. Antibiotic
2. Hygience
3. Treat underlying cause. (eg Diabetes)
4. circumcision
What is the prognosis of Balanitis?
------------------------------------------
Prognosis is good.
Sometimes the disease may recur due to underlying causes.
Circumcision will cure any balanitis due to phimosis
----------------------------------
What is Balanitis?
----------------------
Balanitis is an infection of the glans and prepuce of the penis.
What are the causes of Balanitis?
---------------------------------------
It can occur because of:
1. Sexually transmitted bacterial diseases such as gonorrhea, chlamydia, candidiasis.
2. Viral diseases like genital herpes
3. Parasitic infection such as trichomoniasis
4. drug allergy and eruptions
5. Contact dermatitis,psoriasis,lichen planus,seborrheic dermatitis
6. collagen disease (Reiter's syndrome)
7. phimosis
What are the symptoms of Balanitis?
--------------------------------
1. Itchiness of the glans and prepuce with scratch marks
2. Pain and burning sensation on passing urine
3. Subpreputial(below prepuce) discharge 2-3 days after intercourse in venereal disease
4. Oedema of prepuce
5. Ulceration of the glans
6. Blisters or rashes in genital herpes
7. enlarged inguinal lymph nodes
How do you diagnose Balanitis?
--------------------------------------
Physical examination.
Blood tests for venereal disease and glucose
Urine for sugar and leucocytes
What is the treatment of Balanitis?
-----------------------------------------
1. Antibiotic
2. Hygience
3. Treat underlying cause. (eg Diabetes)
4. circumcision
What is the prognosis of Balanitis?
------------------------------------------
Prognosis is good.
Sometimes the disease may recur due to underlying causes.
Circumcision will cure any balanitis due to phimosis
A Simple Guide to Anal fissure
A Simple Guide to Anal fissure
-------------------------------------
What is Anal fissure?
--------------------------
Anal fissure is a superficial linear tear at the edge of the anus.
What are the causes of Anal fissure?
-------------------------------------------
Anal fissure occur after a tear in the posterior midline of the anus caused by the passage of hard large stools and constipation.
The tear is covered by a sentinel skin tag at the lower end(sentinel pile).
The tear may occur at any age but are more common in young children and pregnant women.
Sometime the tear may occur at the anterior midline of the anus.
What are the symptoms and signs of Anal Fissure?
------------------------------------------------------------
Symptoms:
1.Pain during and after passing motions
2.Serous discharge from tear
3.Itch (pruritis ani)
4.blood streak on stools
Signs:
1.sentinel skin tag covering a posterior midline tear of the anus
2.spasm of the anal sphincter
3.perianal infection
What are the investigations required in Anal fissure?
---------------------------------------------------------------
1.Digital examination of the anus
2.Proctoscopy to exclude piles
3.Sigmoidoscopy may be required in adults.
What is the treatment of Anal fissure?
----------------------------------------------
1.Stool softener
2.low residue diet
3.Avoid constipation -take more fruits and water
4.Give painkiller if necessary
5.Apply anti-itch cream
6.Use antibiotic cream if there is evidence of perianal infection
-------------------------------------
What is Anal fissure?
--------------------------
Anal fissure is a superficial linear tear at the edge of the anus.
What are the causes of Anal fissure?
-------------------------------------------
Anal fissure occur after a tear in the posterior midline of the anus caused by the passage of hard large stools and constipation.
The tear is covered by a sentinel skin tag at the lower end(sentinel pile).
The tear may occur at any age but are more common in young children and pregnant women.
Sometime the tear may occur at the anterior midline of the anus.
What are the symptoms and signs of Anal Fissure?
------------------------------------------------------------
Symptoms:
1.Pain during and after passing motions
2.Serous discharge from tear
3.Itch (pruritis ani)
4.blood streak on stools
Signs:
1.sentinel skin tag covering a posterior midline tear of the anus
2.spasm of the anal sphincter
3.perianal infection
What are the investigations required in Anal fissure?
---------------------------------------------------------------
1.Digital examination of the anus
2.Proctoscopy to exclude piles
3.Sigmoidoscopy may be required in adults.
What is the treatment of Anal fissure?
----------------------------------------------
1.Stool softener
2.low residue diet
3.Avoid constipation -take more fruits and water
4.Give painkiller if necessary
5.Apply anti-itch cream
6.Use antibiotic cream if there is evidence of perianal infection
Saturday, December 8, 2007
A Simple Guide to Beestings
A Simple Guide to Beestings
----------------------------------
What are beestings?
--------------------------
Beestings include stings by different bees, wasps and hornets.
The most common sting is by the common honeybee.
Usually the bee stings the patient skin, leaving its stinger behind and dies.
What are the symptoms of Beestings?
-------------------------------------------
1. stinger left on the skin
2. pain and mild discomfort may last a few hours
3. swelling of the skin at the sting site in sensitive patients reacting to the venom of the sting
4. itch at the site may lasts for a week
The main component of bee venom responsible for pain is the toxin melittin.
Histamine and amines in the beesting contribute to the pain and itching.
Most beesting are acidic in nature.
What is the treatment of Beestings?
------------------------------------------
1.Remove the barbed stinger.
2.Apply cold compress to reduce pain and swelling.
3.Use baking soda solution to conteract the acid.
4.Give paracetamol and antihistmines for pain and itch
For more severe reactions such as allergy and anaphylactic shock to the beestings, emergency treatment may be required:
1.Give adrenaline injection subcutaneously slowly over a minute peroid
followed by
2.antihistamine like diphenhydramine intravenously
3.Treat shock
4.Corticosteroids may be needed to counter allergy
Multiple beestings may cause severe reaction with shock and hemaglobinuria.
This may require hospitalisation.
Multiple beestings have been known to cause the kidneys and vital organs to shut down and should be treated urgently.
----------------------------------
What are beestings?
--------------------------
Beestings include stings by different bees, wasps and hornets.
The most common sting is by the common honeybee.
Usually the bee stings the patient skin, leaving its stinger behind and dies.
What are the symptoms of Beestings?
-------------------------------------------
1. stinger left on the skin
2. pain and mild discomfort may last a few hours
3. swelling of the skin at the sting site in sensitive patients reacting to the venom of the sting
4. itch at the site may lasts for a week
The main component of bee venom responsible for pain is the toxin melittin.
Histamine and amines in the beesting contribute to the pain and itching.
Most beesting are acidic in nature.
What is the treatment of Beestings?
------------------------------------------
1.Remove the barbed stinger.
2.Apply cold compress to reduce pain and swelling.
3.Use baking soda solution to conteract the acid.
4.Give paracetamol and antihistmines for pain and itch
For more severe reactions such as allergy and anaphylactic shock to the beestings, emergency treatment may be required:
1.Give adrenaline injection subcutaneously slowly over a minute peroid
followed by
2.antihistamine like diphenhydramine intravenously
3.Treat shock
4.Corticosteroids may be needed to counter allergy
Multiple beestings may cause severe reaction with shock and hemaglobinuria.
This may require hospitalisation.
Multiple beestings have been known to cause the kidneys and vital organs to shut down and should be treated urgently.
Thursday, October 4, 2007
A Simple Guide to Backache
A Simple Guide to Backache
----------------
What is Backache?
-----------------
Backache is a symptom, not an illness.
It is one of the most common complaints.
The complaint may be:
1.Constant aching, pain or stiffness that occurs anywhere along your spine, from the base of the neck to the hips.
2.Sharp pain in the neck, upper back, or lower back, especially after lifting heavy objects or other strenuous activity.
3.Chronic ache in the middle or lower back, especially after sitting or standing for long period of time.
Who suffer from Backache?
--------------------------------
About 80 per cent of people will experience back pain at some point in their lives.
More men suffer from it than women.
Backache is most common among people in their middle age.
Backache also occurs among young people aged between 16 - 24
Backache can also be hereditary (example: ankylosing spondylosis)
What causes Backache?
----------------------------
Acute Backache
Acute backache may occur due to
1.back strain from the lifting of a heavy object,
2.from a fall,
3.violent jerk as a car suddenly stops.
4.fracture of the spine or the dislocation of a vertebral disc
Chronic Backache
Chronic backache may be caused by
1.Osteoarthritis with degeneration of the spinal column when one vertebra slips forward on the one immediately below it
2. slipped disc. The discs act as cushions between two vertebral bones but due to degeneration in old age, or in cases when the spine has been injured before, a slipped disc may occur.
3.Bad posture can also lead to chronic backache such as sitting for long hours in an incorrect position. The right position is to stand up or sit up straight instead of slouching in a couch when watching TV. If the bad posture is prolonged, backache may occur.
4.sprains in the muscles of the back and
5.gynaecological problems (such as ovarian tumours,fibroids) and pregnancy.
----------------
What is Backache?
-----------------
Backache is a symptom, not an illness.
It is one of the most common complaints.
The complaint may be:
1.Constant aching, pain or stiffness that occurs anywhere along your spine, from the base of the neck to the hips.
2.Sharp pain in the neck, upper back, or lower back, especially after lifting heavy objects or other strenuous activity.
3.Chronic ache in the middle or lower back, especially after sitting or standing for long period of time.
Who suffer from Backache?
--------------------------------
About 80 per cent of people will experience back pain at some point in their lives.
More men suffer from it than women.
Backache is most common among people in their middle age.
Backache also occurs among young people aged between 16 - 24
Backache can also be hereditary (example: ankylosing spondylosis)
What causes Backache?
----------------------------
Acute Backache
Acute backache may occur due to
1.back strain from the lifting of a heavy object,
2.from a fall,
3.violent jerk as a car suddenly stops.
4.fracture of the spine or the dislocation of a vertebral disc
Chronic Backache
Chronic backache may be caused by
1.Osteoarthritis with degeneration of the spinal column when one vertebra slips forward on the one immediately below it
2. slipped disc. The discs act as cushions between two vertebral bones but due to degeneration in old age, or in cases when the spine has been injured before, a slipped disc may occur.
3.Bad posture can also lead to chronic backache such as sitting for long hours in an incorrect position. The right position is to stand up or sit up straight instead of slouching in a couch when watching TV. If the bad posture is prolonged, backache may occur.
4.sprains in the muscles of the back and
5.gynaecological problems (such as ovarian tumours,fibroids) and pregnancy.
6. Chronic infections of spine such as Tuberculosis
7. Cancer of the organs of pelvic region such as bladder or prostate
8. Cancer of the spine from primary bone marrow or secondary spread.
How can Backache be prevented?
--------------------------------------
1.Maintain the correct posture at all times. When standing or sitting, ensure that your back is kept straight instead of a slouched position.
2.support your back and use a cushion when necessary.
3.Correct furniture can also help to prevent the occurrence of backache.
Use chairs of a proper height in relation to the table or desk.
4.Sleep on a firm mattress
5. Do not wear high heels
6. Keep your back straight when carrying heavy item.Keep the item close to the body.
7.Do not bend the back to carry heavy objects. Bend the knees and keep the back straight
8.Exercise is another good way to prevent backache by strengthening the back muscles. However, if you have had back injuries before such as a slipped disc, do be cautious when you exercise.
What to do when Backache occurs?
-----------------------------------------
1. maintain good posture and rest the back.
2.Ice packs can provide relief for backaches. Ice packs will help to reduce the swelling and inflammation.
3.Heat treatment will help improve circulation and reduce stiffness.
4.Painkiller like paracetamol may relieve pain
If pain persists, do consult a doctor.
When should you see a doctor for Backache?
---------------------------------------------------
You should see a doctor under the following conditions:
1. backache is severe and acute.
2.backache starts suddenly and is severe enough to prevent you from work.
3.backache is accompanied with associated pain in legs or weakness and tingling in the legs or back.
4. painkillers and other therapies do not help to relieve pain and your backache is getting worse.
5.pain increases when you cough or bend forward at the waist. This could be a sign of a herniated disk. Try to lie flat with a pillow under your knees.
6.pain follows an injury and is accompanied by sudden loss of bladder or bowel control. If you have difficulty moving any limb, or if you feel numbness, pain, or tingling in a limb, you may have injured your spinal cord.
7.backache is accompanied by nausea, vomiting, fever, muscle weakness, pain down an arm or leg, or bowel or bladder disturbances
8.pain is still present after two to three days of rest.
9.pain lasts longer than 72 hours.
10.pain radiates into the legs,
11.other symptoms such as unexplained weight loss occur,
12.pain is in one side of the small of your back accompanied by a sick feeling and fever. You may have a kidney infection.
13.the pain in your back extends downward along the back of the leg. You may be suffering from sciatica.
14.dull pain in one area of your spine when trying to lie down or getting out of bed, especially if you are over 50 years of age. You may be suffering from osteoarthritis.
15.pain is felt in both thighs when walking. This can be a symptom of spinal stenosis (the narrowing of the lower spinal canal).
16.persistent backache may also be an indication of an undetected cancer of the colon,ovary,bladder or prostate.
How to investigate the cause of Backache?
--------------------------------------------------
1.Full medical history especially of injuries, type of work, onset of pain,radiation to the arms or legs, changes in bowel or bladder habit, loss of weight
2. Full medical examination especially of movement of the back ,any deformity of the spine, abdominal swelling, straight leg raising test
3. X-ray of the Spine: to exclude fracture, osteoarthritis, dislocation,deformity, bone tumour,
4. X-ray of abdomen to exclude any tumours in the abdomen pressing against the spine
5.MRI of spine for slipped disc,tumours,fracture
6.Bone density test to exclude osteoporosis
7.Blood tests for calcium, protein,kidney function,cancer markers, RA factor
8. Urine and stool tests for blood,
A definite diagnosis can then be made and the cause of the pain treated.
What is the Treatment of Backache?
-------------------------------------------
Symptomatic:
Painkillers and muscle relaxants
Ice packs or heat treatment
Physiotherapy to strengthen muscles
Good posture and firm mattress
Avoid aggravating factors like high heels, overstretching muscles,excessive strenous activities
Curative:
The cause must be found and treated. Examples are fractures due to injury.
Causes like cancer and aged related illness(osteoarthritis) may not be cured but may improved with treatment.
Saturday, September 15, 2007
A Simple Guide to Mouth Ulcers
A Simple Guide to Mouth Ulcers
--------------------------------------
What are Mouth Ulcers?
------------------------------
Mouth ulcers are painful open sores or lesions in the mouth. They may appear white or yellow surrouded by red inflamed tissue.
Mouth ulcers occur either singly or in clusters, causing a lot of discomfort or pain.
They usually heal within 7 to 10 days.
What are the Causes of Mouth Ulcers?
--------------------------------------
There are many disorders which can cause mouth ulcers:
1. canker sore (aphthous),
2.leukoplakia,
3.gingivostomatitis,
4.oral cancer,
5.oral lichen planus and
5.oral thrush.
The most common mouth ulcer is Aphthous ulcer.
It is an open sore in the mouth, which appears as a painful white or yellow ulcer surrounded by a bright red area.
Who gets Mouth Ulcers?
---------------------------
Mouth ulcers may occur at any age, but usually first appear between the ages of 10 -40.
Women are more prone than men.
The cause is unknown.
There may be an inherited tendency or an immune system link.
Mouth injury such as dental procedures or aggressive tooth cleaning may cause mouth ulcers.
They may occur at the site of a bite when the tongue or cheek is bitten.
They can also triggered by stress, dietary deficiencies (especially iron, folic acid, or vitamin B12), menstrual periods, hormonal changes, food allergies, and similar situations.
What are the types of Mouth Ulcers?
-------------------------------------------
There are different types of mouth ulcers.
1.A single mouth ulcer is usually caused by damage to the mouth, like biting the cheek, or damage to the gum with a toothbrush or a sharp tooth or filling. They usually go away once the source of the problem is treated.
2.A recurrent ulcer is one that comes and goes, sometimes every few weeks.
Minor ulcers are the most common.
They usually appear inside the cheeks, on the lips, tongue, and gums.
Most of these ulcers are small, round and can sometimes come in clusters(four to six) at any one time.
Large ulcers are more severe, have an irregular border, and can last for 5-10 weeks. They usually appear near the tonsils and can be very painful, especially when swallowing. You usually only get one at a time.
Very rarely,some patients have up to 100 very small painful ulcers (herpetiform type), which last for one to two weeks.
Mouth Ulcers are very common.
About 20% of the population have recurrent mouth ulcers at some time in their lives.
Often they begin in childhood or adolescence.
Most people grow out of them by their late twenties.
What are the Symptoms of Mouth Ulcers?
-------------------------------------------------
Mouth ulcers usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.
They may begin with a tingling or burning sensation, followed by a red spot or bump that ulcerates.
Pain spontaneously decreases in 7 to 10 days, with complete healing in 1 to 3 weeks.
Occasionally, a severe occurrence may be accompanied by fever or lethargy.
Recurrence is common and may continue for years.
Most mouth ulcers are not infectious.
What is theTreatment of Mouth Ulcers?
-----------------------------------------------
The exact treatment will depend on the cause of the ulcer.
Sometimes all that is required is to remove the cause of the ulcer, such as a sharp tooth.
The following measures may help to reduce pain from mouth ulcers:
1.keep your mouth clean at all times,
2.avoid foods that are spicy, acidic, salty or particularly hot or cold, which can make the symptoms worse,
3.eat a healthy diet that includes fresh fruit and vegetables,
4.gargle with warm salt water,
5.use a diluted chlorhexidine mouthwash once a day to help reduce the length of time the ulcers last
6.sprays and rinses are also available for pain relief.
Medical treatment:
The main treatment of the mouth ulcer is application of topical corticosteroids (Kenalog in orabase or Oracorte E), or other soothing preparations.
Dry the area first with a cotton wool bud and then use a wet finger or the back of a spoon to put the cream on the sore area. You can use it up to four times a day after meals.
However, it is most effective to use this cream late at night as it stays there for longer.
What are the Prevention measures in Mouth Ulcers?
-------------------------------------------------------------
Good oral hygiene may help in the prevention of some types of mouth ulcers or complications from mouth ulcers. This includes brushing the teeth at least twice per day, flossing at least daily, and going for regular dental checkup and cleaning.
Healthy life style to avoid getting run down by making sure you eat a balanced diet, take regular exercise and learn to manage stress.
--------------------------------------
What are Mouth Ulcers?
------------------------------
Mouth ulcers are painful open sores or lesions in the mouth. They may appear white or yellow surrouded by red inflamed tissue.
Mouth ulcers occur either singly or in clusters, causing a lot of discomfort or pain.
They usually heal within 7 to 10 days.
What are the Causes of Mouth Ulcers?
--------------------------------------
There are many disorders which can cause mouth ulcers:
1. canker sore (aphthous),
2.leukoplakia,
3.gingivostomatitis,
4.oral cancer,
5.oral lichen planus and
5.oral thrush.
The most common mouth ulcer is Aphthous ulcer.
It is an open sore in the mouth, which appears as a painful white or yellow ulcer surrounded by a bright red area.
Who gets Mouth Ulcers?
---------------------------
Mouth ulcers may occur at any age, but usually first appear between the ages of 10 -40.
Women are more prone than men.
The cause is unknown.
There may be an inherited tendency or an immune system link.
Mouth injury such as dental procedures or aggressive tooth cleaning may cause mouth ulcers.
They may occur at the site of a bite when the tongue or cheek is bitten.
They can also triggered by stress, dietary deficiencies (especially iron, folic acid, or vitamin B12), menstrual periods, hormonal changes, food allergies, and similar situations.
What are the types of Mouth Ulcers?
-------------------------------------------
There are different types of mouth ulcers.
1.A single mouth ulcer is usually caused by damage to the mouth, like biting the cheek, or damage to the gum with a toothbrush or a sharp tooth or filling. They usually go away once the source of the problem is treated.
2.A recurrent ulcer is one that comes and goes, sometimes every few weeks.
Minor ulcers are the most common.
They usually appear inside the cheeks, on the lips, tongue, and gums.
Most of these ulcers are small, round and can sometimes come in clusters(four to six) at any one time.
Large ulcers are more severe, have an irregular border, and can last for 5-10 weeks. They usually appear near the tonsils and can be very painful, especially when swallowing. You usually only get one at a time.
Very rarely,some patients have up to 100 very small painful ulcers (herpetiform type), which last for one to two weeks.
Mouth Ulcers are very common.
About 20% of the population have recurrent mouth ulcers at some time in their lives.
Often they begin in childhood or adolescence.
Most people grow out of them by their late twenties.
What are the Symptoms of Mouth Ulcers?
-------------------------------------------------
Mouth ulcers usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.
They may begin with a tingling or burning sensation, followed by a red spot or bump that ulcerates.
Pain spontaneously decreases in 7 to 10 days, with complete healing in 1 to 3 weeks.
Occasionally, a severe occurrence may be accompanied by fever or lethargy.
Recurrence is common and may continue for years.
Most mouth ulcers are not infectious.
What is theTreatment of Mouth Ulcers?
-----------------------------------------------
The exact treatment will depend on the cause of the ulcer.
Sometimes all that is required is to remove the cause of the ulcer, such as a sharp tooth.
The following measures may help to reduce pain from mouth ulcers:
1.keep your mouth clean at all times,
2.avoid foods that are spicy, acidic, salty or particularly hot or cold, which can make the symptoms worse,
3.eat a healthy diet that includes fresh fruit and vegetables,
4.gargle with warm salt water,
5.use a diluted chlorhexidine mouthwash once a day to help reduce the length of time the ulcers last
6.sprays and rinses are also available for pain relief.
Medical treatment:
The main treatment of the mouth ulcer is application of topical corticosteroids (Kenalog in orabase or Oracorte E), or other soothing preparations.
Dry the area first with a cotton wool bud and then use a wet finger or the back of a spoon to put the cream on the sore area. You can use it up to four times a day after meals.
However, it is most effective to use this cream late at night as it stays there for longer.
What are the Prevention measures in Mouth Ulcers?
-------------------------------------------------------------
Good oral hygiene may help in the prevention of some types of mouth ulcers or complications from mouth ulcers. This includes brushing the teeth at least twice per day, flossing at least daily, and going for regular dental checkup and cleaning.
Healthy life style to avoid getting run down by making sure you eat a balanced diet, take regular exercise and learn to manage stress.
Saturday, August 25, 2007
A Simple Guide to Uveitis
A Simple Guide to Uveitis
-------------------------------
What is Uveitis?
------------------
Uveitis is inflammation of the eye's uvea. The uvea is the eye's middle layer that consists of the iris, ciliary body and choroid.
What are different types of Uveitis?
----------------------------------
Uveitis is classified by the part of the uvea it affects.
1. Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form.
2.Intermediate uveitis refers to inflammation of the ciliary body.
3. Posterior uveitis is inflammation of the choroid.
Diffuse uveitis is inflammation in all areas of the uvea.
What are the dangers of Uveitis?
--------------------------------------
Many cases of uveitis are chronic.
They can produce numerous possible complications, including clouding of the lens (cataract) or cornea, elevated intraocular pressure (IOP), glaucoma, and retinal problems (such as swelling of the retina or retinal detachment).
These complications can lead to loss of vision.
Who are affected by Uveitis?
----------------------------------
Uveitis occurs most frequently in people ages 20 to 50.
It is more common in women and more likely to develop with age.
What are the Complications of Uveitis?
----------------------------------------------
Uveitis complications:
secondary cataracts,
secondary glaucoma,
high intraocular pressure,
retinal detachment
What are the Symptoms and Signs of Uveitis?
-----------------------------------------------------
With anterior uveitis, the symptoms usually affect only one eye.
There may be
mild to strong pain
redness and
light sensitivity.
Your vision may also be blurred.
Eye is tender to palpation
Both intermediate and posterior uveitis are usually painless.
Symptoms are blurred vision and floaters, typically in both eyes.
Diffuse uveitis has a combination of symptoms of all types of uveitis.
What Causes Uveitis?
--------------------------
Uveitis has dozens of causes, including viral, fungal, and bacterial infections.
But, in many cases, the cause is unknown (idiopathic).
Eye doctors can sometimes identify the cause if there has been trauma to the eye, such as from surgery or a blow, or if there is a history of an infectious or immunological systemic disorder.
Some of the many different systemic disorders that can cause uveitis include:
acute posterior multifocal placoid pigment epitheliopathy
ankylosing spondylitis
Behçet's disease
birdshot retinochoroidopathy
brucellosis
herpes simplex
herpes zoster
inflammatory bowel disease
juvenile rheumatoid arthritis
Kawasaki's disease
leptospirosis
Lyme disease
multiple sclerosis
presumed ocular histoplasmosis syndrome
psoriatic arthritis
Reiter's syndrome
sarcoidosis
syphilis
systemic lupus erythematosus
toxocariasis
toxoplasmosis
tuberculosis
Vogt-Koyanagi-Harada syndrome
What is the Treatment of Uveitis?
---------------------------------------
Non-drug:
-------------
warm water
pads to cover eyes for rest and avoid sun
Drugs:
--------
Your doctor will likely prescribe a steroid to reduce the inflammation in your eye.
Whether the steroid is in eye drop, pill, or injection form depends on the type of uveitis you have.
Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops.
Intermediate uveitis can go either way, and
posterior uveitis usually requires tablets or injections.
Steroids and other immunosuppressants can produce many serious side effects:
such as
kidney damage,
high blood sugar,
high blood pressure,
osteoporosis, and
glaucoma.
In April 2005 the drug Retisert was approved by FDA for chronic non-infectious posterior uveitis. Retisert is a drug implant and is the first of its kind for treatment of uveitis. It consists of a drug reservoir that delivers sustained amounts of fluocinolone acetonide, an anti-inflammatory corticosteroid, for about two and a half years. It is implanted into the back of the eye. During clinical trials the incidence of reccurent uveitis fell from 40%-54% to 7%-14%. The most common side effects noted during those studies were cataract progression, increased intraocular pressure, procedural complications, and eye pain.
If you have anterior uveitis, your doctor will likely prescribe, in addition to the steroids, pupil-dilating eye drops to reduce pain.
You may also need eye drops to lower your intraocular pressure if it's elevated.
-------------------------------
What is Uveitis?
------------------
Uveitis is inflammation of the eye's uvea. The uvea is the eye's middle layer that consists of the iris, ciliary body and choroid.
What are different types of Uveitis?
----------------------------------
Uveitis is classified by the part of the uvea it affects.
1. Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form.
2.Intermediate uveitis refers to inflammation of the ciliary body.
3. Posterior uveitis is inflammation of the choroid.
Diffuse uveitis is inflammation in all areas of the uvea.
What are the dangers of Uveitis?
--------------------------------------
Many cases of uveitis are chronic.
They can produce numerous possible complications, including clouding of the lens (cataract) or cornea, elevated intraocular pressure (IOP), glaucoma, and retinal problems (such as swelling of the retina or retinal detachment).
These complications can lead to loss of vision.
Who are affected by Uveitis?
----------------------------------
Uveitis occurs most frequently in people ages 20 to 50.
It is more common in women and more likely to develop with age.
What are the Complications of Uveitis?
----------------------------------------------
Uveitis complications:
secondary cataracts,
secondary glaucoma,
high intraocular pressure,
retinal detachment
What are the Symptoms and Signs of Uveitis?
-----------------------------------------------------
With anterior uveitis, the symptoms usually affect only one eye.
There may be
mild to strong pain
redness and
light sensitivity.
Your vision may also be blurred.
Eye is tender to palpation
Both intermediate and posterior uveitis are usually painless.
Symptoms are blurred vision and floaters, typically in both eyes.
Diffuse uveitis has a combination of symptoms of all types of uveitis.
What Causes Uveitis?
--------------------------
Uveitis has dozens of causes, including viral, fungal, and bacterial infections.
But, in many cases, the cause is unknown (idiopathic).
Eye doctors can sometimes identify the cause if there has been trauma to the eye, such as from surgery or a blow, or if there is a history of an infectious or immunological systemic disorder.
Some of the many different systemic disorders that can cause uveitis include:
acute posterior multifocal placoid pigment epitheliopathy
ankylosing spondylitis
Behçet's disease
birdshot retinochoroidopathy
brucellosis
herpes simplex
herpes zoster
inflammatory bowel disease
juvenile rheumatoid arthritis
Kawasaki's disease
leptospirosis
Lyme disease
multiple sclerosis
presumed ocular histoplasmosis syndrome
psoriatic arthritis
Reiter's syndrome
sarcoidosis
syphilis
systemic lupus erythematosus
toxocariasis
toxoplasmosis
tuberculosis
Vogt-Koyanagi-Harada syndrome
What is the Treatment of Uveitis?
---------------------------------------
Non-drug:
-------------
warm water
pads to cover eyes for rest and avoid sun
Drugs:
--------
Your doctor will likely prescribe a steroid to reduce the inflammation in your eye.
Whether the steroid is in eye drop, pill, or injection form depends on the type of uveitis you have.
Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops.
Intermediate uveitis can go either way, and
posterior uveitis usually requires tablets or injections.
Steroids and other immunosuppressants can produce many serious side effects:
such as
kidney damage,
high blood sugar,
high blood pressure,
osteoporosis, and
glaucoma.
In April 2005 the drug Retisert was approved by FDA for chronic non-infectious posterior uveitis. Retisert is a drug implant and is the first of its kind for treatment of uveitis. It consists of a drug reservoir that delivers sustained amounts of fluocinolone acetonide, an anti-inflammatory corticosteroid, for about two and a half years. It is implanted into the back of the eye. During clinical trials the incidence of reccurent uveitis fell from 40%-54% to 7%-14%. The most common side effects noted during those studies were cataract progression, increased intraocular pressure, procedural complications, and eye pain.
If you have anterior uveitis, your doctor will likely prescribe, in addition to the steroids, pupil-dilating eye drops to reduce pain.
You may also need eye drops to lower your intraocular pressure if it's elevated.
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