A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)

A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)
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What is a Menorrhagia?
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Menorrhagia is a symptom defined as heavy, prolonged and/or irregular menstruation .

What are the causes of Menorrhagia?
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1.Physiological(hormonal): most common
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Excessive menstrual bleeding occurs when no ovulation takes place in a menstrual cycle with resultant excess oestrogen stimulation of the endometrium that results in the shedding of the thickened uterine lining and heavy bleeding when the oestrogen drops.

A defective persistent corpus luteum which results from an abnormal ovulation can also cause the shedding of the nedometrium for a longer period resulting in prolonged bleeding.

Other factors that may make heavy menstrual bleeding are:
2.Uterine Pathology:
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polyps,
fibroids
endometriosis
infection
carcinoma

3.Systemic Diseases:
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Bleeding diseases
Hypothyoidism
liver disease
Pelvic inflammatory Disease(PID)
Polycystic Ovarian syndrome(PCOS)

4.Medical causes:
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anticoagulants which are preventing clotting of blood
intrauterine device for contraception

How to establish a diagnosis of Menorrhagia?
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History:
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Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea

Contraception:
use of IUD
contraceptive pills

Symptoms suggesting underlying pathology:
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome

Bleeding disorders:
easy bruising
anticoagulants

Pelvic inflammatory Disease:
pelvic pain especially during intercourse
vaginal discharge
dysmenorrhea

Endometriosis:
pelvic pain
dysmenorrhea

Physical Examination:
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Signs of underlying diseases:
bruising
hypothyroid features
pallour(anaemia)
PCOS features(hirsutism,acne,overweight)

Abdominal examination:
tenderness,
palpable uterine or ovarian masses

Pelvic examination:
vulval and vaginal examination
bimanual palpation for masses
cervical smear

Investigation:
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Full blood count including hemoglobin(to exclude anemia from loss of blood) and platelets(low platelets can cause bleeding)

Transvaginal ultrasound to exclude uterine fibroids and polyps -postmenstrual scans is best when the endometrium is at its thinest.

Endometrial hysteroscopy and biopsy in women over 40 to exclude uterine cancer

What is the Treatment of Menorrhagia?
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Medications:
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1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding

2.Combined oral contraceptives - prevent proliferation of the endometrium, reduces blood flow. Side effects are fluid retention, nausea, headache,deep vein thrombosis, mood changes, breast tenderness

3.oral progesterone - also prevent proliferation of the endometrium-usually less side effects bloating, headache, mood changes, breast tenderness

4. Injected progesterone -also prevent proliferation of the endometrium -similar side effects as oral progesterone. One additional side effect is the possibility of bone density loss. Evaluation of bone density should be done.

5. Levonorgestrel-releasing intrauterine system(LNG-IUS)
-also prevent proliferation of the endometrium
-side effects includes irregular bleeding up to 6 month, amenorrhea(no menses),
breast tenderness, and headache.

Surgery
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1.Endometrial ablation
may be done only
a.if medications has failed
b.if no desire to coceive
c.if the uterus is normal

Usually involve the removal of the endometrium through the cervical opening.
There are forms of endometrial ablation:
a.First generation:
hysteroscopy with general anaesthesia
-Rollerball ablation
-Transcervical resection of the endometrium

b.Second Generation:
non-hysteroscopy, no general anaethesia, day surgery,fast recovery
-Impedance-controlled bipolar radiofrequency ablation
-balloon thermal ablation
-microwave ablation
-free fluid thermal ablation

2. Hysterectomy
used only as a last resort in treatment of menorrhagia
if other treatment are contraindicated
there is a desire for amenorrhea
there is no desire to retain uterus and fertility

Treatment of Underlying causes:
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hypothyroidism with thyroxine tablets

intrauterine device removal

reduce anticoagulant treatment if possible

treat any bleeding disease with platelets or blood factor deficient infusion

treatment of endometriosis,

antibiotic treatment of pelvic inflammatory idsease

treatment of uterine carcinoma

surgical removal of fibroids and polyps

A Simple Guide to Colorectal Cancer

A Simple Guide to Colorectal Cancer
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What is Colorectal Cancer?
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is one of the commonest cancer among males and females in the world. Colorectal cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). Colorectal cancer can be effectively treated if detected early.

What is the cause of Colorectal Cancer?
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Colorectal cancer occurs when cells from the intestinal wall grow and spread uncontrollably.
It may begin as polyps (growths) in the large intestine and rectum. Polyps should be monitored regularly and removed upon detection to prevent them from developing into cancer.

Who are at risk of Colorectal Cancer?
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As with most cancers, the risk of developing colorectal cancer increases with age.
People at high risk include those with:
1. family history of personal history of endometrial, ovarian or breast cancer
3. personal history or family history of gastrointestinal polyps
4. history of inflammatory bowel disease such as chronic ulcerative colitis or Crohn's disease.
5. Cancer elsewhere in the body
6. Certain genetic syndromes also increase the risk of developing colon cancer.

What you eat may play a role in your risk of colon cancer.
Colon cancer may be associated with a high-fat, low-fiber diet and red meat.
However, some studies found that the risk does not drop if you switch to a high-fiber diet, so the cause of the link is not yet clear.

What are the Symptoms of Colorectal Cancer?
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In its early stages, the cancer usually has no symptoms, which is why regular screening is important to see if it could be present.
The most common symptom of colorectal cancer, especially if it is located in the lower part of the large intestine, is changes in bowel habits. For some, it may be an increase in the number of bowel visits to the toilet, and for others, it may be constipation. Still others may complain of constipation with overflow diarrhoea, i.e., difficulty in passing motion but stools flow out without any control.
Other symptoms include
bloody or black stools from bleeding of the tumour (blood appears black on digestion in the intestines),
fatigue, appetite and weight loss of unknown cause,
Unexplained anemia
abdominal pains, cramps or bloating in the lower abdomen
Intestinal obstruction
Narrow stools
With proper screening, colon cancer can be detected BEFORE the development of symptoms, when it is most curable.

What are the signs of Colorectal Cancer?
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The physical exam rarely shows any problems, although an abdominal mass may be felt in late cases.
A rectal exam may reveal a mass in patients with rectal cancer, but not colon cancer.

How do you Screen for Colorectal Cancer?
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People over the age of 50 years are advised to screen for colorectal cancer, even if they have no symptoms.
A Faecal Occult Blood Test (FOBT>) is recommended once every year.
If the results are positive, other tests like a sigmoidoscopy, barium enema and colonoscopy may be required.
A complete blood count may reveal show signs of anemia with low iron levels.

What is the treatment of Colorectal Cancer?
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Surgery:
is the main treatment.
In surgery, the part of the large intestine containing the cancer is removed.
In some cases, the two ends of the colon can be rejoined.
Sometimes an opening called a stoma has to be left in the abdominal for the removal of waste. This opening may be temporary or permanent.
Radiation Therapy:
destroy the cancer cells with minimal damage to surrounding tissue. It is used to prevent recurrence of the cancer and for pain relief. Side effects include skin irritation,nausea,vomiting and lethargy.
Chemotherapy:
is used to kill the cancer cells in the colon and rectum as well as to prevent a recurrence.
Side effects may be quite severe with loss of hair, weight, appetite, nausea, vomiting, rashes.

Which treatment is used depends on the staging of the cancer using additional tests.
Staging of the Cancer:
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Stage 0: Very early cancer on the innermost layer of the intestine
Stage I: Cancer is in the inner layers of the colon
Stage II: Cancer has spread through the muscle wall of the colon
Stage III: Cancer has spread to the lymph nodes
Stage IV: Cancer that has spread to other organs

Stage 0 colon cancer may be treated by removing the cancer cells, often during a colonoscopy.
For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous.
There is some debate as to whether patients with stage II colorectal cancer should receive chemotherapy after surgery. You should discuss this with your oncologist.
Almost all patients with stage III colorectal cancer should receive chemotherapy after surgery for approximately 6 - 8 months. The chemotherapy drug 5-fluorouracil given has been shown to increase the chance of a cure in certain patients.
Chemotherapy is also used to treat patients with stage IV colon cancer.

Irinotecan, oxaliplatin, and 5-fluorouracil are commonly used drugs. You may receive just one type, or a combination of the drugs. Capecitabine is a chemotherapy drug taken by mouth, and is similar to 5-fluroruracil.

For patients with stage IV disease that has spread to the liver, various treatments directed specifically at the liver can be used. This may include cutting out the cancer, burning it (ablation), or freezing it (cryotherapy). Chemotherapy or radiation can sometimes be delivered directly into the liver.
While radiation therapy is occasionally used in patients with colon cancer, it is usually used in combination with chemotherapy for patients with stage III rectal cancer.

What is the Prognosis(outcome) of Colorectal Cancer?
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How well a patient does depends on many things, including the stage of the cancer.
In general, when treated at an early stage, more than 90% of patients survive at least 5 years after their diagnosis.
However, only about 40% of colorectal cancer is found at an early stage.
The 5-year survival rate drops considerably once the cancer has spread.
If the patient's colon cancer does not come back (recur) within 5 years, it is considered as cured.
Stage I, II, and III cancers are considered potentially curable.
Stage IV cancer is not curable in most cases.

How to prevent Colorectal Cancer?
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Prevention of Colorectal Cancer involve:
1. early and regular screening,
2. lifestyle changes:
Maintain a balanced diet low in animal or saturated fat such as butter, coconut oil, ghee and lard.
Diets high in total fat, protein, calories and meat, and low in calcium are associated with an increased incidence of colorectal cancer.
Increase your intake to at least 2 servings of fruits and vegetables each day. Studies have shown that very low intake of fruits and vegetables is associated with an increased risk of colorectal cancer.
Quit smoking. Cigarette smoke contains many chemicals that promote the development of many types of cancers.
Increase physical activity. Physical activity promotes general health and reduces your risk of colorectal cancer.
Maintain your BMI within the healthy range of 18.5 to 22.9 (kg/m2).

The death rate for colorectal cancer has dropped in the last 15 years.
This may be due to increased awareness and screening by colonoscopy.
Colorectal cancer can almost always be caught in its earliest and most curable stages by colonoscopy.
Almost all men and women age 50 and older should have a colonoscopy.

Other types of colorectal cancer such as lymphoma, carcinoid tumors, melanoma, and sarcomas are rare. The colorectal cancer referred to in this article refers to Colorectal carcinoma.

A Simple Guide to Sinusitis

A Simple Guide to Sinusitis
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What is sinusitis?
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Sinusitis is a condition in which the lining of your sinuses becomes inflamed.

The sinuses are the air chambers in the bone behind your cheeks, eyebrows and jaw.
They produce mucus, a fluid that cleans bacteria and other particles out of the air you breathe. Tiny hairs called cilia sweep mucus out of your sinuses so it can drain out through your nose.
The paranasal sinuses are in direct communication with the nose.
The sinuses are normally sterile.

If the sinus openings may become blocked, the mucus becomes congested in the sinuses, resulting in stagnation of secretion and finally bacterial growth.

What causes sinusitis?
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Anything that causes swelling in your sinuses or keeps the cilia from moving mucus can cause sinusitis.
This can occur because of changes in temperature or air pressure,
Using decongestant nasal sprays too much,
Smoking, and
Swimming or diving.
Some people have growths called polyps that block their sinus passages.
When sinusitis is caused by a bacterial or viral infection, you get a sinus infection.

Sinus infections sometimes occur after you've had a cold.
The cold virus attacks the lining of your sinuses, causing them to swell and become narrow.
Your body responds to the virus by producing more mucus, but it gets blocked in your swollen sinuses.
This built-up mucus makes a good place for bacteria to grow.
The bacteria can cause a sinus infection.

Acute sinusitis is usually bacterial in origin.
Haemophilus influenzae and Streptococcus pneumoniae are the organisms most commonly found in adults.
In children, similar organisms are seen, with the addition of Moraxella catarrhalis.
In older children and young adults, Staphylococcus aureus is an occasional finding.
In systemically impaired hosts, Candida, Aspergillus, and Phycomycetes may be the cause.

Risk factors include the following: diabetes mellitus, cancer, hepatic disease, renal failure, burns, extreme malnutrition, and immunosuppressive diseases.

What are the signs of acute sinusitis?
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Presentation of sinusitis is often nonspecific.

Patients may present with a persistent cold.
A cold that starts to get better and then gets worse may be a sign of acute sinusitis.

Pain or pressure in some areas of the face (forehead, cheeks or between the eyes) is often a sign of blocked sinus drainage and can be a sign of acute sinusitis.

Pain in your forehead that starts when you lean forward can also be a sign.

Other symptoms may include a stuffy nose.

Some patients complain of dental pain or alteration in smell.

Fever is seen in fewer than 2% of individuals with sinusitis.

Facial tenderness to palpation is present.

Complete opacification of sinus on transillumination is present.

An X-ray of the paranasal sinuses usually confirms the presence of sinusitis as opacity in the sinuses.

How is acute sinusitis treated?
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Your doctor may prescribe an antibiotic.
You may take an antibiotic for 10 to 14 days, but you will usually start feeling better a couple of days after you start taking it. It is important to take this medicine exactly as your doctor tells you and to continue taking it until it is gone, even after you're feeling better.

If you have sinus pain or pressure, your doctor may prescribe or recommend a decongestant to help your sinuses drain.

Painkillers may be prescribed if there is severe pain.

How to take care of sinusitis?
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1.Get plenty of rest.

2.Lying down can make your sinuses feel more congested, so try lying on the side that lets you breathe the best.

3.Drink plenty of fluids.

4.Apply moist heat by holding a warm, wet towel against your face or breathing in steam through a cloth or towel.

5.Rinse your sinus passages with a saline solution.

How is chronic sinusitis treated?
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In cases where the acute sinus infection does not cleared or become chronic, a sinus washout may be necessary to remove the mucus stucked in the sinuses.

This involves syringing of antiseptic solution through a hole in the septum separating the maxillary sinuses from the nose.
Sometimes syringing of frontal sinuses can be done through a tube inserted into the sinuses.

In severe case of chronic sinusitis, endoscopy surgery may be done to strip the lining of the maxillary sinuses and clean the cavity of the sinuses.

A new therapy is the use of phage therapy where bacterial viruses are used to cause bacterila lysis in the sinuses.