DOC I HAVE THREADWORMS
Thread worms are parasitic worms (also called pin worms) which are found in the intestines of children in undeveloped countries.
It is rare in developed countries because of the modern sanitary conditions and better hygiene.
Several members of the same household may be infested at the same time so all the family should be treated together.
The cause of Threadworms infection is:
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations.
When the eggs or larvae are swallowed they developed into adult worms in the intestines.
The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.
The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.
The main symptoms of Thread worms are
1. Itch in the anal region especially at night when the worms lay the eggs.
2. Itch in the vulva in girls
3. inflammation of the anus as a result of constant scratching.
4.Rarely tiny white worms can be seen wriggling in the feces.
Doctors generally diagnose Thread worms based on:
1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of thread worms
2.Stool examination and culture
Treatment of thread worm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose
2.Pyrantel pamoate 10mg/kg in a single dose
3.Mebendazole 100mg in a single dose
A single dose will usually cure the patient of thread worms but to prevent re-infection a second dosage is taken 2 weeks later.
All the family members should also be treated.
Prevention of thread worms is through:
1.good personal hygiene and hand washing
2. good food hygiene
Prognosis of thread worms treatment is excellent.
Monday, April 11, 2011
Sunday, April 10, 2011
A Simple Guide to Giardiasis
A Simple Guide to Giardiasis
---------------------------------
What is Giardiasis?
---------------------------
Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
What is the cause of Giardiasis?
----------------------------------
The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
What are symptoms of Giardiasis?
----------------------------------------------
The main symptoms of Giardiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Giardiasis made?
-----------------------------------------------------
Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Giardiasis?
-------------------------------------------
Giardiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Giardiasis treated?
-------------------------------------
Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Giardiasis prevented?
----------------------------------------
Prevention of Giardiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Giardiasis?
-------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
---------------------------------
What is Giardiasis?
---------------------------
Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
What is the cause of Giardiasis?
----------------------------------
The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
What are symptoms of Giardiasis?
----------------------------------------------
The main symptoms of Giardiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Giardiasis made?
-----------------------------------------------------
Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Giardiasis?
-------------------------------------------
Giardiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Giardiasis treated?
-------------------------------------
Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Giardiasis prevented?
----------------------------------------
Prevention of Giardiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Giardiasis?
-------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
Saturday, April 9, 2011
A Family Doctor's Tale - THALASSEMIA
DOC I HAVE THALASSEMIA
Thalassaemia is an inherited condition caused by defects in the genes that produce the hemoglobin (the red pigment which carry the oxygen to the body) of red blood cells of patients from childhood.
Thalassemia can cause the breakup of the red blood cells resulting in severe anemia.
Thalassaemia is more common in people from Asia, African and the Mediterranean region.
There are 2 types of Thalassemia:
1.Thalassemia Major is a major illness which is inherited from both parents with the affected thalassemia gene.
The hemoglobin is low and the red blood cells are small and fragile breaking up easily to give rise to severe anemia.
2.Thalassemia Minor is a minor illness which is inherited if only one parent has the affected thalassemia gene.
There is usually mild anemia.
The red blood cells are smaller than normal.
1.Medical history of thalassemia or anemia
2.Blood tests show a low level of red blood cells.
3.Blood tests can also check on the type of abnormal hemoglobin present
4.Blood test using DNA analysis can diagnose thalassemia through the presence of defective genes.
Possible complications of thalassemia are:
1.Infection - there is a risk of infection because of the low red blood cells and the breakup of the red blood cells affecting the liver
2.Bone deformities are caused by the expansion of the bone marrow especially in the face and skull.
The bones are thin and brittle and therefore prone to fractures.
3.Slowed growth rates are present in more severe thalassemia due to the bone deformities
4.Enlarged spleen can occur due to destruction and breakup of a large number of red blood cells
5.Heart problems especially congestive heart failure and abnormal heart rhythms (arrhythmias) may occur with severe thalassaemia due to low oxygen.
6.Iron overload can occur from frequent blood transfusions especially in the severe thalassemia.
Treatment for Thalassemia is:
For thalassemia minor, no treatment is usually required because there is rarely symptoms
For thalassemia major the patient often require frequent blood transfusions often once a month.
Blood transfusions can lead to high levels of iron in the body which must be removed through iron chelation therapy(desferrioxamine).
In some cases a bone marrow transplant or a stem cell transplant may help.
Prevention of Thalassemia:
Thalassaemia cannot be prevented because it is a genetic disease.
However if a family history of thalassaemia is present, genetic counselling before considering a pregnancy is advised.
Prognosis of Thalassemia:
Thalassaemia is an inherited condition caused by defects in the genes that produce the hemoglobin (the red pigment which carry the oxygen to the body) of red blood cells of patients from childhood.
Thalassemia can cause the breakup of the red blood cells resulting in severe anemia.
Thalassaemia is more common in people from Asia, African and the Mediterranean region.
There are 2 types of Thalassemia:
1.Thalassemia Major is a major illness which is inherited from both parents with the affected thalassemia gene.
The hemoglobin is low and the red blood cells are small and fragile breaking up easily to give rise to severe anemia.
2.Thalassemia Minor is a minor illness which is inherited if only one parent has the affected thalassemia gene.
There is usually mild anemia.
The red blood cells are smaller than normal.
Symptoms of thalassaemia are:
1.Pallor
2.Fatigue
3.Weakness
4.Breathing difficulty
5.Slow growth
6.Jaundice
7.Dark colored urine
8.Bone deformities
Factors that increase the risk of thalassemia are:
1.Family history of thalassemia
2. History of familial Anemia
Diagnosis of Thalassemia is through:
1.Medical history of thalassemia or anemia
2.Blood tests show a low level of red blood cells.
3.Blood tests can also check on the type of abnormal hemoglobin present
4.Blood test using DNA analysis can diagnose thalassemia through the presence of defective genes.
Possible complications of thalassemia are:
1.Infection - there is a risk of infection because of the low red blood cells and the breakup of the red blood cells affecting the liver
2.Bone deformities are caused by the expansion of the bone marrow especially in the face and skull.
The bones are thin and brittle and therefore prone to fractures.
3.Slowed growth rates are present in more severe thalassemia due to the bone deformities
4.Enlarged spleen can occur due to destruction and breakup of a large number of red blood cells
5.Heart problems especially congestive heart failure and abnormal heart rhythms (arrhythmias) may occur with severe thalassaemia due to low oxygen.
6.Iron overload can occur from frequent blood transfusions especially in the severe thalassemia.
Treatment for Thalassemia is:
For thalassemia minor, no treatment is usually required because there is rarely symptoms
For thalassemia major the patient often require frequent blood transfusions often once a month.
Blood transfusions can lead to high levels of iron in the body which must be removed through iron chelation therapy(desferrioxamine).
In some cases a bone marrow transplant or a stem cell transplant may help.
Prevention of Thalassemia:
Thalassaemia cannot be prevented because it is a genetic disease.
However if a family history of thalassaemia is present, genetic counselling before considering a pregnancy is advised.
Prognosis of Thalassemia:
For thalassemia minor, prognosis is very good.
A healthy lifestyle and good diet is important to prevent anemia.
For Thalassemia major, treatment with frequent blood transfusion without excessive iron overload may be able to keep a patient alive up to middle age.
Thursday, April 7, 2011
A Family Doctor's Tale - HENOCH-SCHONLEIN PURPURA
DOC I HAVE HENOCH-SCHONLEIN PURPURA
Henoch-Schonlein Purpura is a bleeding disease where small blood vessels become fragile and allow blood to leak from them.
Bleeding into the skin give rise to a typical rash called purpura like a bruise while bleeding into the joints, kidneys or digestive tract can cause damage to these organs.
People of all ages are affected .
It is more common in children between the age of 2 to 10 years.
The cause is unknown but believed to be an allergic reaction to something or a bacterial infection (suspected streptococcus)
Symptoms of Henoch-Schonlein Purpura are:
1.rash is pink, red or purplish blood filled spots that do not fade
when pressed
2.the rash appears first on the buttocks and the back of arms and body especially around the ankles and elbows then spread to the front of the limbs.
3.joint pain and swelling
4.abdominal pain in many cases with vomiting and diarrhea
5.blood in the stools or urine
Diagnosis of Henoch-Schonlein Purpura is by:
1.The typical rash and its location can suggest the diagnosis of Henoch-Schonlein Purpura
2.Blood and urine tests may be done to rule out other causes and to exclude any kidney inflammation.
Blood and protein in the urine may suggest kidney involvement.
3.Abdominal X-ray may be needed if there is abdominal pain and vomiting
4.Ultrasound of kidney may also be needed for exclusion of serious kidney involvement.
Complications of Henoch-Schonlein Purpura are:
1.inflammation of the kidneys
2.joint arthritis due to bleeding in the joint
Treatment of Henoch-Schonlein Purpura:
No treatment may be needed if the condition or symptoms are mild.
For moderate or severe cases:
1. Bed rest is important
2. paracetamol for pain or fever
3. corticosteroids are needed as treatment for allergy
4. antibiotics are given if there is a bacterial infection.
Prognosis of Henoch-Schonlein Purpura is:
The illness may last a few days to a month during which the symptoms may recur.
Most patients make a full recovery and there is no long term ill effects.
In most cases inflammation of the kidneys disappears in a few days but in some patient recovery from the kidney inflammation may take up to 2 years.
Henoch-Schonlein Purpura is a bleeding disease where small blood vessels become fragile and allow blood to leak from them.
Bleeding into the skin give rise to a typical rash called purpura like a bruise while bleeding into the joints, kidneys or digestive tract can cause damage to these organs.
People of all ages are affected .
It is more common in children between the age of 2 to 10 years.
The cause is unknown but believed to be an allergic reaction to something or a bacterial infection (suspected streptococcus)
Symptoms of Henoch-Schonlein Purpura are:
1.rash is pink, red or purplish blood filled spots that do not fade
when pressed
2.the rash appears first on the buttocks and the back of arms and body especially around the ankles and elbows then spread to the front of the limbs.
3.joint pain and swelling
4.abdominal pain in many cases with vomiting and diarrhea
5.blood in the stools or urine
Diagnosis of Henoch-Schonlein Purpura is by:
1.The typical rash and its location can suggest the diagnosis of Henoch-Schonlein Purpura
2.Blood and urine tests may be done to rule out other causes and to exclude any kidney inflammation.
Blood and protein in the urine may suggest kidney involvement.
3.Abdominal X-ray may be needed if there is abdominal pain and vomiting
4.Ultrasound of kidney may also be needed for exclusion of serious kidney involvement.
Complications of Henoch-Schonlein Purpura are:
1.inflammation of the kidneys
2.joint arthritis due to bleeding in the joint
Treatment of Henoch-Schonlein Purpura:
No treatment may be needed if the condition or symptoms are mild.
For moderate or severe cases:
1. Bed rest is important
2. paracetamol for pain or fever
3. corticosteroids are needed as treatment for allergy
4. antibiotics are given if there is a bacterial infection.
Prognosis of Henoch-Schonlein Purpura is:
The illness may last a few days to a month during which the symptoms may recur.
Most patients make a full recovery and there is no long term ill effects.
In most cases inflammation of the kidneys disappears in a few days but in some patient recovery from the kidney inflammation may take up to 2 years.
Tuesday, April 5, 2011
A Family Doctor's Tale - MOLLUSCUM CONTAGIOSUM
DOC I HAVE MOLLUSCUM CONTAGIOSUM
Molluscum Contagiosum is a mild viral infection which appears as small shiny pimple-like rash on the body.
The virus is of the pox family and can be very infectious.
It is more common in children between 2 to 5 years of age.
It is easily spread either by direct contact or indirectly through infected clothing or towels or in a swimming pool.
The virus can also be spread through sexual contact.
The causative agent is a virus called molluscum contagiosum which is highly infectious.
Secondary infection may occurs from invasion of staphalococcus.
Symptoms of MOLLUSCUM CONTAGIOSUM are:
Pimples appear 2 to 7 weeks after the infection.
1.Occurs mainly on the trunk, face, hands and rarely on palms and soles
2.Small dome shaped with a central pimple
3.pearly white or flesh colored
4.Pimples varies between 2mm and 5mm in diameter
5.appears in groups although they sometimes occur singly
6.usually painless but can itch
Diagnosis of Molluscum contagiosum is based on the:
1.typical appearance of the rash
2.Skin scraping or biopsy for microscopic examination.
Complications of MOLLUSCUM CONTAGIOSUM are:
1.Spread to to other parts of body and causes disfiguring
appearance
2.bacterial infection
Treatment of MOLLUSCUM CONTAGIOSUM is sometimes unnecessary.
The condition will disappear even without treatment and without leaving scars.
However this may take from a few weeks to a year.
If there is disfiguring spots on the face or if the child has low immunity, then treatment may be necessary:
1.apply to the pimples podophyllin paint or salicylic acid cream to dissolve the hard layer of molluscum
2.removal of the pimples by scraping them off (curettage) or freezing them (cryotherapy)
3.surgical removal can cause scarring so it is not recommended
Prognosis of Molluscum contagiosum is:
generally good
Prevention of Molluscum contagiosum is:
1.Avoid contact with any one who has the condition
2.Avoid casual sexual contacts
Molluscum Contagiosum is a mild viral infection which appears as small shiny pimple-like rash on the body.
The virus is of the pox family and can be very infectious.
It is more common in children between 2 to 5 years of age.
It is easily spread either by direct contact or indirectly through infected clothing or towels or in a swimming pool.
The virus can also be spread through sexual contact.
The causative agent is a virus called molluscum contagiosum which is highly infectious.
Secondary infection may occurs from invasion of staphalococcus.
Symptoms of MOLLUSCUM CONTAGIOSUM are:
Pimples appear 2 to 7 weeks after the infection.
1.Occurs mainly on the trunk, face, hands and rarely on palms and soles
2.Small dome shaped with a central pimple
3.pearly white or flesh colored
4.Pimples varies between 2mm and 5mm in diameter
5.appears in groups although they sometimes occur singly
6.usually painless but can itch
Diagnosis of Molluscum contagiosum is based on the:
1.typical appearance of the rash
2.Skin scraping or biopsy for microscopic examination.
Complications of MOLLUSCUM CONTAGIOSUM are:
1.Spread to to other parts of body and causes disfiguring
appearance
2.bacterial infection
Treatment of MOLLUSCUM CONTAGIOSUM is sometimes unnecessary.
The condition will disappear even without treatment and without leaving scars.
However this may take from a few weeks to a year.
If there is disfiguring spots on the face or if the child has low immunity, then treatment may be necessary:
1.apply to the pimples podophyllin paint or salicylic acid cream to dissolve the hard layer of molluscum
2.removal of the pimples by scraping them off (curettage) or freezing them (cryotherapy)
3.surgical removal can cause scarring so it is not recommended
Prognosis of Molluscum contagiosum is:
generally good
Prevention of Molluscum contagiosum is:
1.Avoid contact with any one who has the condition
2.Avoid casual sexual contacts
Sunday, April 3, 2011
A Family Doctor's Tale - GIARDIASIS
DOC I HAVE GIARDIASIS
Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
The main symptoms of Giardiasis are
1. Many people with Giardiasis 75 % do not have any symptoms .
2.Symptoms of Giardiasis in other cases occur only 1-3 days after infection of the parasite
3. abdominal pain especially at the central part of abdomen
4.diarrhea with foul stools
5.abdominal bloating or gas
Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
The complications of Giardiasis are:
Giardiasis is a disease which can cause :
1.dehydration
2.malnutrition
Treatment of Giardiasis is by:
Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
Anti-parasitic medicines like metronidazole three times a day for 10 days should work for mild to moderate disease.
Symptomatic treatment includes:
1.Rehydration salts for dehydration
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.medicines to slow down the intestinal movement (lomotil or loperamide).
5.Get plenty of rest.
Prevention of Giardiasis can be by:
1.Good food hygiene and hand washing
2.Avoid contact with the feces of infected person
3.boil drinking and cooking water for 5 minutes
4.Proper filtration of water
5.proper treatment of swimming pools and filtration systems
6.Avoid raw food and vegetables especially in areas where there is giardiasis
Prognosis of Giardiasis is excellent with prompt treatment .
It is important to treat Giardiasis patients even without symptoms to prevent the spread of Giardiasis.
Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
The main symptoms of Giardiasis are
1. Many people with Giardiasis 75 % do not have any symptoms .
2.Symptoms of Giardiasis in other cases occur only 1-3 days after infection of the parasite
3. abdominal pain especially at the central part of abdomen
4.diarrhea with foul stools
5.abdominal bloating or gas
Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
The complications of Giardiasis are:
Giardiasis is a disease which can cause :
1.dehydration
2.malnutrition
Treatment of Giardiasis is by:
Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
Anti-parasitic medicines like metronidazole three times a day for 10 days should work for mild to moderate disease.
Symptomatic treatment includes:
1.Rehydration salts for dehydration
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.medicines to slow down the intestinal movement (lomotil or loperamide).
5.Get plenty of rest.
Prevention of Giardiasis can be by:
1.Good food hygiene and hand washing
2.Avoid contact with the feces of infected person
3.boil drinking and cooking water for 5 minutes
4.Proper filtration of water
5.proper treatment of swimming pools and filtration systems
6.Avoid raw food and vegetables especially in areas where there is giardiasis
Prognosis of Giardiasis is excellent with prompt treatment .
It is important to treat Giardiasis patients even without symptoms to prevent the spread of Giardiasis.
Friday, April 1, 2011
A Family Doctor's Tale - KAWASAKI DISEASE
DOC I HAVE KAWASAKI DISEASE
Kawasaki Disease is a childhood disease which was first seen in Japan which typically cause fever, swelling of the lymph nodes, and symptoms affecting the skin and mucous membranes.
It occurs mainly in children below 5 years.
One of its notable features other than high fever and skin peeling is the complication of the disease on the arterial system of the heart.
The cause of Kawasaki Disease is believed to be an infection although no causative organism has been found.
An autoimmune disease has been suggested as the cause of the Kawasaki disease.
The triad of symptoms which are common to Kawasaki Disease are:
1.Fever with headache lasting for more than 5 days
2.Swelling of one or more lymph nodes in the neck
3.blotchy red rash over the entire body with typical skin peeling in the second week of illness
Other symptoms are:
4.sore throat with sometimes tonsillar swelling
5.dry cracked and swollen lips
6.conjunctivitis
7.reddening of the palms and soles
8.swelling of the hands and feet
9.skin peeling from the tips of the fingers and toes in the second week of illness
Disease usually lasts for 2-3 weeks.
Diagnosis
1.Classical symptoms and signs as above especially high fever, lymph nodes enlargement, rash and peeling of the skin from the fingers and toes.
2.blood tests (complete blood count, ESR, blood culture).
3.X-rays of chest and neck
4.ECG or electrocardiogram of the heart
5.CT Scan of the heart
Complications of Kawasaki disease:
1.arthritis
2.myocarditis (inflammation of the heart muscles)
3.myocardial infarction (heart attack)
4.coronary artery disease
Treatment of Kawasaki disease:
Suspected cases should be treated as early as possible because of possible heart complications
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
4.Aspirin may be given (in spite of the danger of Reyes Syndrome) to prevent blockage of the coronary artery of the heart.
5.Injections of gamma globulin is the main treatment for Kawasaki disease.
6.corticosteroids is useful to reduce complications such as arthritis and myocarditis
Prognosis of Kawasaki Disease is generally good.
Most children make a full recovery after about 3 weeks.
Myocarditis and arthritis may last for 6 to 8 weeks.
Coronary artery disease improves gradually over 1 year.
In 1-2 per cent of patients serious heart complications may occur.
Kawasaki Disease is a childhood disease which was first seen in Japan which typically cause fever, swelling of the lymph nodes, and symptoms affecting the skin and mucous membranes.
It occurs mainly in children below 5 years.
One of its notable features other than high fever and skin peeling is the complication of the disease on the arterial system of the heart.
The cause of Kawasaki Disease is believed to be an infection although no causative organism has been found.
An autoimmune disease has been suggested as the cause of the Kawasaki disease.
The triad of symptoms which are common to Kawasaki Disease are:
1.Fever with headache lasting for more than 5 days
2.Swelling of one or more lymph nodes in the neck
3.blotchy red rash over the entire body with typical skin peeling in the second week of illness
Other symptoms are:
4.sore throat with sometimes tonsillar swelling
5.dry cracked and swollen lips
6.conjunctivitis
7.reddening of the palms and soles
8.swelling of the hands and feet
9.skin peeling from the tips of the fingers and toes in the second week of illness
Disease usually lasts for 2-3 weeks.
Diagnosis
1.Classical symptoms and signs as above especially high fever, lymph nodes enlargement, rash and peeling of the skin from the fingers and toes.
2.blood tests (complete blood count, ESR, blood culture).
3.X-rays of chest and neck
4.ECG or electrocardiogram of the heart
5.CT Scan of the heart
Complications of Kawasaki disease:
1.arthritis
2.myocarditis (inflammation of the heart muscles)
3.myocardial infarction (heart attack)
4.coronary artery disease
Treatment of Kawasaki disease:
Suspected cases should be treated as early as possible because of possible heart complications
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
4.Aspirin may be given (in spite of the danger of Reyes Syndrome) to prevent blockage of the coronary artery of the heart.
5.Injections of gamma globulin is the main treatment for Kawasaki disease.
6.corticosteroids is useful to reduce complications such as arthritis and myocarditis
Prognosis of Kawasaki Disease is generally good.
Most children make a full recovery after about 3 weeks.
Myocarditis and arthritis may last for 6 to 8 weeks.
Coronary artery disease improves gradually over 1 year.
In 1-2 per cent of patients serious heart complications may occur.
Wednesday, March 30, 2011
A Family Doctor's Tale- LEPTOSPIROSIS
DOC I HAVE LEPTOSPIROSIS
LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.
The bacteria which causes LEPTOSIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occurring in domestic and wild animals.
Humans are accidental hosts.
Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.
The bacteria can affect the liver, kidney, skeletal muscle, heart, spleen, lungs and central nervous system.
Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.
Symptoms and Signs of LEPTOSPIROSIS are:
Incubation period is approximately 10 days.
Illness is typically biphasic.
A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid
2.Abrupt onset of headache, myalgia, high fever and chills
This will last 4-9 days
3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.
B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies
2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.
3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.
Specific Leptospirosis Disease:
Weil's Disease:
is severe leptospirosis with
1.liver involvement with jaundice, hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding, subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis
Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.
2.cerebrospinal tests
3.animal innoculation
4.liver scan and ultrasound
LEPTOSIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis
2.Kidney disease can occur from damage to the kidney
3.Brain damage is rare but can occur from spread to the brain and meninges
4.Severe hemorrhage uncommon but can cause death
Treatment of LEPTOSPIROSIS is :
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.
1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.
2.intravenous drip and blood transfusion if necessary
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to stop vomiting and itch
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Get plenty of rest.
Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals
5.Good food hygiene and hand washing
Prognosis of LEPTOSPIROSIS depends on the virulence of disease and general condition of the patient.
It is excellent with prompt treatment of leptospirosis infection.
Weil's disease is more serious but will respond well to treatment.
Infection of pregnant women may be associated with increased risk of fetal loss.
LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.
The bacteria which causes LEPTOSIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occurring in domestic and wild animals.
Humans are accidental hosts.
Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.
The bacteria can affect the liver, kidney, skeletal muscle, heart, spleen, lungs and central nervous system.
Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.
Symptoms and Signs of LEPTOSPIROSIS are:
Incubation period is approximately 10 days.
Illness is typically biphasic.
A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid
2.Abrupt onset of headache, myalgia, high fever and chills
This will last 4-9 days
3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.
B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies
2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.
3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.
Specific Leptospirosis Disease:
Weil's Disease:
is severe leptospirosis with
1.liver involvement with jaundice, hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding, subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis
Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.
2.cerebrospinal tests
3.animal innoculation
4.liver scan and ultrasound
LEPTOSIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis
2.Kidney disease can occur from damage to the kidney
3.Brain damage is rare but can occur from spread to the brain and meninges
4.Severe hemorrhage uncommon but can cause death
Treatment of LEPTOSPIROSIS is :
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.
1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.
2.intravenous drip and blood transfusion if necessary
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to stop vomiting and itch
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Get plenty of rest.
Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals
5.Good food hygiene and hand washing
Prognosis of LEPTOSPIROSIS depends on the virulence of disease and general condition of the patient.
It is excellent with prompt treatment of leptospirosis infection.
Weil's disease is more serious but will respond well to treatment.
Infection of pregnant women may be associated with increased risk of fetal loss.
Monday, March 28, 2011
A Family Doctor's Tale -NIGHT BLINDNESS
DOC I HAVE Night Blindness
Night Blindness is defective vision in conditions of lowered illumination.
The main causes of Night Blindness is classified into 2 :
1.Congenital Night Blindness:
This is a simple congenital defect of:
a.dominant trait
b.recessive trait
c.recessive sex linked trait
2.Acquired Night Blindness:
This pathological state occurs when the rod function of the retina cells are depressed:
a.Vitamin A deficiency - prolonged deficiency can affect marked degenerative changes in the rods, then cones and subsequently in the neuronal layers of the retina
Causes of Vitamin A deficiency:
inadequate dietary intake
impaired absorption in celiac disease, tropical sprue or liver cirrhosis
b.retinitis pigmentosa - a degenerative disease of the retina affecting the cones and rods starting in the equatorial region and then spreading to the macular region
c.liver disease not associated with vitamin deficiency
d.rare mucopolysaccharidase deficiencies
e.Refsum disease
f.Choroideremia:
progressive atrophy of the choroid -very rare
g.Neuronal ceroid lipofuscinosis
h.Abetalipoproteinuria
Diffuse Night Blindness is inflammation in all areas of the uvea.
Night Blindness affects both eyes and are more common in the elderly:
Symptoms of night blindness:
1.inability to see well at dusk
2.worse after long phases in bright sunlight
Diagnosis of night blindness:
1.History, physical examination and family history eliminates the rarer causes of night blindness.
2.measurement of Vitamin A or carotene levels
3.An early clinical sign of Vitamin A deficiency is conjunctival prexerosis associated with triangular areas of keratinised epithelium at the temporal limbus .
These are called Bitot's spots.
Treatment of night blindness:
1.Most genetic causes of night blindness cannot be cured
2.Vitamin A deficiency:
high doses of Vitamin A of 50,000 to 100,000 units per day up to 14 days.
Longer treatment may cause Vitamin A toxicity and damage the liver.
3.Maintenance dose of 2500 units of Vitamin A(or 750mg) is recommended daily.
Prognosis of night blindness:
depends on the cause -no cure for genetic causes
Poor when due to secondary causes
Excellent in early treatment of Vitamin A deficiency
Prevention of night blindness:
1.knowledge of family history
2. avoid prolonged bright lights
3.Take natural forms of Vitamin A such as carotene in carrots, tomatoes, papaya and other vegetables and natural vitamin A in fish liver oils, liver and meat.
Night Blindness is defective vision in conditions of lowered illumination.
The main causes of Night Blindness is classified into 2 :
1.Congenital Night Blindness:
This is a simple congenital defect of:
a.dominant trait
b.recessive trait
c.recessive sex linked trait
2.Acquired Night Blindness:
This pathological state occurs when the rod function of the retina cells are depressed:
a.Vitamin A deficiency - prolonged deficiency can affect marked degenerative changes in the rods, then cones and subsequently in the neuronal layers of the retina
Causes of Vitamin A deficiency:
inadequate dietary intake
impaired absorption in celiac disease, tropical sprue or liver cirrhosis
b.retinitis pigmentosa - a degenerative disease of the retina affecting the cones and rods starting in the equatorial region and then spreading to the macular region
c.liver disease not associated with vitamin deficiency
d.rare mucopolysaccharidase deficiencies
e.Refsum disease
f.Choroideremia:
progressive atrophy of the choroid -very rare
g.Neuronal ceroid lipofuscinosis
h.Abetalipoproteinuria
Diffuse Night Blindness is inflammation in all areas of the uvea.
Night Blindness affects both eyes and are more common in the elderly:
Symptoms of night blindness:
1.inability to see well at dusk
2.worse after long phases in bright sunlight
Diagnosis of night blindness:
1.History, physical examination and family history eliminates the rarer causes of night blindness.
2.measurement of Vitamin A or carotene levels
3.An early clinical sign of Vitamin A deficiency is conjunctival prexerosis associated with triangular areas of keratinised epithelium at the temporal limbus .
These are called Bitot's spots.
Treatment of night blindness:
1.Most genetic causes of night blindness cannot be cured
2.Vitamin A deficiency:
high doses of Vitamin A of 50,000 to 100,000 units per day up to 14 days.
Longer treatment may cause Vitamin A toxicity and damage the liver.
3.Maintenance dose of 2500 units of Vitamin A(or 750mg) is recommended daily.
Prognosis of night blindness:
depends on the cause -no cure for genetic causes
Poor when due to secondary causes
Excellent in early treatment of Vitamin A deficiency
Prevention of night blindness:
1.knowledge of family history
2. avoid prolonged bright lights
3.Take natural forms of Vitamin A such as carotene in carrots, tomatoes, papaya and other vegetables and natural vitamin A in fish liver oils, liver and meat.
Saturday, March 26, 2011
A Family Doctor's Tale - EYE INJURIES
DOC I HAVE AN EYE INJURY
EYE INJURY is an traumatic accident to the eye which is a delicate organ and cause permanent loss of vision.
The greatest danger of eye injury comes from sharp objects such as pencils, nails, and knife.
Sharp objects injury to the eye can lead to puncture of the eyeball with extrusion of the eye contents and will require surgery.
Scratches and cuts that damage the cornea and the white of the eye are the most common eye injuries.
Causes of EYE INJURIES can be divided into:
1.Superficial injuries that include corneal scratches and superficial cuts even by the edge of a paper,sand ,or grainy dirt particles.
2.Chemical injuries that occur when liquids such as acids or alkali(bleach, thinner, battery acid) enter the eye
3.Blunt injuries to structures of the eye that give rise to swelling of the eyelid or bruising of the tissues around the eye(examples are sports like basketball, football, boxing or martial arts or home repairs where balls, fists or hammer may hit the eye)
4.Penetrating injuries are serious injuries or cuts in the eye which may result in foreign objects including metal bodies being left in the eye. They require urgent medical attention and surgery.
Symptoms varies from mild to severe:
1.Severe pain in the eye or around the eye
2.burning sensation in the eye especially exposed to chemicals
3.blurred vision
4.Discharge -may be due to eye infection
5.Light sensitivity - sensitive to bright lights
6.bruises around the eyelids or cuts
Signs of injury to surface of or area around the eye:
1.bruising of the eyelid and surrounding area usually due to trauma
2.swelling of the eye or eyelid
3.tenderness of the eye
4.blurred vision
5.redness of the eye
6.feeling of something in the eye
Signs of injury to the inside of the eye:
1.blurred vision
2.seeing floating bodies or flashes of light
3.bleeding into the back of the eye(vitreous hemorrhage)
Diagnosis of EYE INJURIES:
1.Mild cases like chemical splash or small dust particles can be treated by a family doctor
2.More severe cases require an eye specialist to examine the eye with a slit lamp microscope to determine the inside of the eye including the retina and cornea.
3.Movements of the eye and testing of the nerves to eye may be needed.
4.X-rays of the may reveal fractures of the eye socket.
5.Ultrasound of the eye may be needed if there is a lot of bleeding in the eye
6.CAT scan or MRI of the eye may be necessary if a penetrating eye injury is suspected or a foreign body may be present.
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 EYE INJURY resulting in partial loss of vision
3.metal from foreign body in the eye can cause loss of vision
Treatment depends on the type and extent of EYE INJURY:
A.Superficial injuries can be diagnosed with a stain called fluorescin.
Abrasions and depth of lacerations can be seen clearly with this. They require antibiotics and an eye patch.
Close follow up is needed when there is infection.
B. Chemical injuries require copious flushing of the eye to remove as much chemicals as possible and to minimize damage to the eye. Follow up is necessary to watch up for late complications such as raised eye pressure.
C.Traumatic Injuries to the eye
Bruises to the eye or eyelid -ice packs can be used to reduce swelling during the first 49 hours followed by warm compression to clear the blood
D. Penetrating injuries to the eye :
when there is vitreous hemorrhage or retinal detachment, a surgical procedure called vitreotomy may be necessary to restore vision.
This is a retina surgery where fine instruments are used to remove blood from the the inside of the eye or repair retinal detachment. An air bubble or silicone oil may be injected at the end of procedure to keep the eye in the normal shape.
Vitreotomy may also be necessary in penetrating injuries to remove any foreign body and repair any cuts or laceration inside the eye.
Foreign bodies that are not removed or untreated can result in severe eye infections and blindness.
The prognosis depends on the severity of the eye injury.
Most cases can be restored to normal if treated early.
Some cases may have 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.
Prevention of Eye Injuries:
1.Take proper safety precautions when dealing with chemicals
and cleaning fluids.
2.Wear goggles when working with sharp instruments or poer tools like drill or saw
3.Avoid rubbing the eyes with hands when handling household cleaning fluids or chemicals of any kind
4. wash the hands thoroughly after handling chemicals or dusts from saws or drills.
EYE INJURY is an traumatic accident to the eye which is a delicate organ and cause permanent loss of vision.
The greatest danger of eye injury comes from sharp objects such as pencils, nails, and knife.
Sharp objects injury to the eye can lead to puncture of the eyeball with extrusion of the eye contents and will require surgery.
Scratches and cuts that damage the cornea and the white of the eye are the most common eye injuries.
Causes of EYE INJURIES can be divided into:
1.Superficial injuries that include corneal scratches and superficial cuts even by the edge of a paper,sand ,or grainy dirt particles.
2.Chemical injuries that occur when liquids such as acids or alkali(bleach, thinner, battery acid) enter the eye
3.Blunt injuries to structures of the eye that give rise to swelling of the eyelid or bruising of the tissues around the eye(examples are sports like basketball, football, boxing or martial arts or home repairs where balls, fists or hammer may hit the eye)
4.Penetrating injuries are serious injuries or cuts in the eye which may result in foreign objects including metal bodies being left in the eye. They require urgent medical attention and surgery.
Symptoms varies from mild to severe:
1.Severe pain in the eye or around the eye
2.burning sensation in the eye especially exposed to chemicals
3.blurred vision
4.Discharge -may be due to eye infection
5.Light sensitivity - sensitive to bright lights
6.bruises around the eyelids or cuts
Signs of injury to surface of or area around the eye:
1.bruising of the eyelid and surrounding area usually due to trauma
2.swelling of the eye or eyelid
3.tenderness of the eye
4.blurred vision
5.redness of the eye
6.feeling of something in the eye
Signs of injury to the inside of the eye:
1.blurred vision
2.seeing floating bodies or flashes of light
3.bleeding into the back of the eye(vitreous hemorrhage)
Diagnosis of EYE INJURIES:
1.Mild cases like chemical splash or small dust particles can be treated by a family doctor
2.More severe cases require an eye specialist to examine the eye with a slit lamp microscope to determine the inside of the eye including the retina and cornea.
3.Movements of the eye and testing of the nerves to eye may be needed.
4.X-rays of the may reveal fractures of the eye socket.
5.Ultrasound of the eye may be needed if there is a lot of bleeding in the eye
6.CAT scan or MRI of the eye may be necessary if a penetrating eye injury is suspected or a foreign body may be present.
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 EYE INJURY resulting in partial loss of vision
3.metal from foreign body in the eye can cause loss of vision
Treatment depends on the type and extent of EYE INJURY:
A.Superficial injuries can be diagnosed with a stain called fluorescin.
Abrasions and depth of lacerations can be seen clearly with this. They require antibiotics and an eye patch.
Close follow up is needed when there is infection.
B. Chemical injuries require copious flushing of the eye to remove as much chemicals as possible and to minimize damage to the eye. Follow up is necessary to watch up for late complications such as raised eye pressure.
C.Traumatic Injuries to the eye
Bruises to the eye or eyelid -ice packs can be used to reduce swelling during the first 49 hours followed by warm compression to clear the blood
D. Penetrating injuries to the eye :
when there is vitreous hemorrhage or retinal detachment, a surgical procedure called vitreotomy may be necessary to restore vision.
This is a retina surgery where fine instruments are used to remove blood from the the inside of the eye or repair retinal detachment. An air bubble or silicone oil may be injected at the end of procedure to keep the eye in the normal shape.
Vitreotomy may also be necessary in penetrating injuries to remove any foreign body and repair any cuts or laceration inside the eye.
Foreign bodies that are not removed or untreated can result in severe eye infections and blindness.
The prognosis depends on the severity of the eye injury.
Most cases can be restored to normal if treated early.
Some cases may have 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.
Prevention of Eye Injuries:
1.Take proper safety precautions when dealing with chemicals
and cleaning fluids.
2.Wear goggles when working with sharp instruments or poer tools like drill or saw
3.Avoid rubbing the eyes with hands when handling household cleaning fluids or chemicals of any kind
4. wash the hands thoroughly after handling chemicals or dusts from saws or drills.
Thursday, March 24, 2011
A Family Doctor's Tale -POSTMENOPAUSAL BLEEDING
DOC I HAVE POSTMENOPAUSAL BLEEDING
Postmenopausal bleeding is a symptom defined as heavy or prolonged occurring one year or more after menopause.
Bleeding can occur from any part of the genital tract.
Causes:
Physiological:
most common 25 per cent show no demonstrable cause
(dysfunctional uterine bleeding)
Iatrogenic:
estrogen replacement therapy
Vulva:
infection
atrophy
granulomatous lesions
carcinoma
Vagina:
atrophy
infection
carcinoma
Cervix:
polyp
carcinoma
Uterus:
polyp
carcinoma
myomas
Others:
tubal or ovarian carcinoma
pelvic inflammatory disease
endometriosis
Diagnosis:
History:
Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea (painful Menstruation)
Symptoms suggesting underlying pathology:
Metabolic disorders:
symptoms of hypothyroidism
Bleeding disorders:
easy bruising
anticoagulants
Pelvic inflammatory Disease:
pelvic pain especially during intercourse
vaginal discharge
dysmenorrhea
Endometriosis:
pelvic pain
dysmenorrhea
Medication:
use of post menopausal estrogen
Physical Examination:
Signs of underlying diseases:
infection of vulva and cervix
hypothyroid features
pallour(anaemia)
Abdominal examination:
palpable uterine or ovarian masses
Pelvic examination:
vulval and vaginal examination
bimanual palpation for masses
cervical smear
Investigation:
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
Laparoscopy if required
Treatment:
Medications:
1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding
2.oral estrogen - prevent proliferation of the endometrium, reduces blood flow. Should be given for 21 days only to assess its effect on menstrual bleeding
3. Injected progesterone -also prevent proliferation of the endometrium, induce uterine atrophy and stop menstruation
4. Levonorgestrel-releasing intrauterine system(LNG-IUS)
-also prevent proliferation of the endometrium
5.Application of estrogen cream for atrophic vulvitis and vaginitis
6.treatment of underlying causes such as bleeding causes, low platelets, hypothyroidism, and cancers
7.treat any anemia caused by post menopausal bleeding
Surgery
1.Endometrial ablation
may be done only if medications has failed
Usually involve the removal of the endometrium through the cervical opening.
There are various forms of endometrial ablation:
First generation:
hysteroscopy with general anaesthesia
-Rollerball ablation
-Transcervical resection of the endometrium
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 Postmenopausal bleeding
if other treatment are contraindicated
there is a desire for amenorrhea
there is no desire to retain uterus
Treatment of Underlying causes:
hypothyroidism with thyroxine tablets
reduce anticoagulant treatment if possible
treat any bleeding disease with platelets or blood factor deficient infusion
treatment of endometriosis,
antibiotic treatment of pelvic inflammatory disease
treatment of uterine carcinoma
surgical removal of fibroids and polyps
Prognosis:
generally good after hysterectomy and removal of ovaries,treatment of underlying causes.
Cancer treatment prognosis depends on severity of cancer.
Postmenopausal bleeding is a symptom defined as heavy or prolonged occurring one year or more after menopause.
Bleeding can occur from any part of the genital tract.
Causes:
Physiological:
most common 25 per cent show no demonstrable cause
(dysfunctional uterine bleeding)
Iatrogenic:
estrogen replacement therapy
Vulva:
infection
atrophy
granulomatous lesions
carcinoma
Vagina:
atrophy
infection
carcinoma
Cervix:
polyp
carcinoma
Uterus:
polyp
carcinoma
myomas
Others:
tubal or ovarian carcinoma
pelvic inflammatory disease
endometriosis
Diagnosis:
History:
Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea (painful Menstruation)
Symptoms suggesting underlying pathology:
Metabolic disorders:
symptoms of hypothyroidism
Bleeding disorders:
easy bruising
anticoagulants
Pelvic inflammatory Disease:
pelvic pain especially during intercourse
vaginal discharge
dysmenorrhea
Endometriosis:
pelvic pain
dysmenorrhea
Medication:
use of post menopausal estrogen
Physical Examination:
Signs of underlying diseases:
infection of vulva and cervix
hypothyroid features
pallour(anaemia)
Abdominal examination:
palpable uterine or ovarian masses
Pelvic examination:
vulval and vaginal examination
bimanual palpation for masses
cervical smear
Investigation:
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
Laparoscopy if required
Treatment:
Medications:
1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding
2.oral estrogen - prevent proliferation of the endometrium, reduces blood flow. Should be given for 21 days only to assess its effect on menstrual bleeding
3. Injected progesterone -also prevent proliferation of the endometrium, induce uterine atrophy and stop menstruation
4. Levonorgestrel-releasing intrauterine system(LNG-IUS)
-also prevent proliferation of the endometrium
5.Application of estrogen cream for atrophic vulvitis and vaginitis
6.treatment of underlying causes such as bleeding causes, low platelets, hypothyroidism, and cancers
7.treat any anemia caused by post menopausal bleeding
Surgery
1.Endometrial ablation
may be done only if medications has failed
Usually involve the removal of the endometrium through the cervical opening.
There are various forms of endometrial ablation:
First generation:
hysteroscopy with general anaesthesia
-Rollerball ablation
-Transcervical resection of the endometrium
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 Postmenopausal bleeding
if other treatment are contraindicated
there is a desire for amenorrhea
there is no desire to retain uterus
Treatment of Underlying causes:
hypothyroidism with thyroxine tablets
reduce anticoagulant treatment if possible
treat any bleeding disease with platelets or blood factor deficient infusion
treatment of endometriosis,
antibiotic treatment of pelvic inflammatory disease
treatment of uterine carcinoma
surgical removal of fibroids and polyps
Prognosis:
generally good after hysterectomy and removal of ovaries,treatment of underlying causes.
Cancer treatment prognosis depends on severity of cancer.
Tuesday, March 22, 2011
A Family Doctor's Tale - SUBARACHNOID HEMORRHAGE
DOC I HAVE SUBARACHNOID HEMORRHAGE
A Subarachnoid Hemorrhage is bleeding into the cerebrospinal fluid filled space between the pial and arachnoid membrane of the brain.
A Subarachnoid Hemorrhage occurs when:
1.Rupture of a congenital arterial aneurym (weak arterial wall) is the most common cause.
2.Rupture of an arterial capillary or venous bleeding from one or multiple sites of origin. This can be from high blood pressure or head injury .
3.Capillary damage leading to hemorrhage can occur in certain form of encephalitis.
4.Hemorrhagic diseases such as dengue fever, hemophilia, thrombocytopenia of unknown origin
5.Intracranial tumors such as angioblastic meningioma, glioma, pituitary adenoma and intracranial metastases are rare but possible causes
6.Anticoagulant therapy especially overdosage of warfarin
7.Smoking has been associated with subarachnoid hemorrhage.
The symptoms and signs of a Subarachnoid Hemorrhage are:
The affected person may have:
1.sudden severe headache with no known cause,initially excruciating, intense, aching pain, later becoming dull and throbbing but still severe.
2.difficulty in speaking or understanding
3.difficulty in swallowing
4.severe neck and back pain
5.Pain on attempted head movement
6.dizziness
7.vomiting
8.confusion and agitation
9.loss of concentration and memory
10.sudden vision loss in one eye
11.loss of consciousness
12.convulsions
13.coma and death
14.Stiff neck usually appears with onset of meningeal inflammatory reaction up to 6 to 12 hours after onset suggesting meningeal stretching and herniation of cerebellum into foramen magnum.
Other neurological signs:
1.Pupils unequal
2.paresis of vertical and medial movements of one eye
3.optic field may have round smooth hemorrhages near optic disc,
usually unilateral which will indicate site of bleeding in the brain.
Special investigations:
1.lumbar puncture:
pressure of cerebrospinal fluid may be raised
red blood cells present for first week
protein content raised
2.MRI or CAT scan with intravenous dyes can determine the source of the bleeding
The treatment of Subarachnoid Hemorrhage:
Subarachnoid Hemorrhage is an emergency.
Purpose of treatment is to:
1. preserve life
2. limit the amount of brain damage
3. lessen the extent of disability and deformity
4. prevent recurrence.
Admission to hospital is necessary to determine
1. the cause of the Subarachnoid Hemorrhage
2. the extent of damage to the brain using MRI of the brain
3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).
4. whether Surgery is necessary to stop bleeding or remove a blood clot
5. risk factors for Subarachnoid Hemorrhage are investigated and treated (diabetes, high blood pressure etc)
During the acute phase of Subarachnoid Hemorrhage:
1. A clear airway must be maintained
2. Sufficient fluid and electrolyte intake must be maintained
3. adequate nutrition in the form of glucose, proteins and calories must be given
4. bed rest with adequate nursing care is provided to prevent bed sores etc
5. Proper medicines are given
Once the Subarachnoid Hemorrhage is stable:
The Subarachnoid Hemorrhage patient is started on a rehabilitation programme.
This will include
a.exercises to strengthen his muscles,
b.speech training for patients with dysphasia (difficulty in talking)
c.training on how to carry out his daily activities.
d.advice about his diet
Immediate care improves the chance of a complete recovery.
A Subarachnoid Hemorrhage can be very devastating and depressing for a patient.
He will feel that part of his body and brain function is incapacitated.
Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends
Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:
Please do:
1.be understanding and patient.
2. keep the patient cheerful and hopeful
3.learn how to help him with the diet, daily exercises and other care necessary for him
4.allow the person more time to do any task
5.encourage and praise the patient to do as much as possible for himself at his own pace.
6.involve the person in family discussions and activities.
7.be encouraging and praise his daily efforts.
Prognosis of subarachnoid hemorrhage:
1.Recurrence may occur
2.Can be life threatening
A Subarachnoid Hemorrhage is bleeding into the cerebrospinal fluid filled space between the pial and arachnoid membrane of the brain.
A Subarachnoid Hemorrhage occurs when:
1.Rupture of a congenital arterial aneurym (weak arterial wall) is the most common cause.
2.Rupture of an arterial capillary or venous bleeding from one or multiple sites of origin. This can be from high blood pressure or head injury .
3.Capillary damage leading to hemorrhage can occur in certain form of encephalitis.
4.Hemorrhagic diseases such as dengue fever, hemophilia, thrombocytopenia of unknown origin
5.Intracranial tumors such as angioblastic meningioma, glioma, pituitary adenoma and intracranial metastases are rare but possible causes
6.Anticoagulant therapy especially overdosage of warfarin
7.Smoking has been associated with subarachnoid hemorrhage.
The symptoms and signs of a Subarachnoid Hemorrhage are:
The affected person may have:
1.sudden severe headache with no known cause,initially excruciating, intense, aching pain, later becoming dull and throbbing but still severe.
2.difficulty in speaking or understanding
3.difficulty in swallowing
4.severe neck and back pain
5.Pain on attempted head movement
6.dizziness
7.vomiting
8.confusion and agitation
9.loss of concentration and memory
10.sudden vision loss in one eye
11.loss of consciousness
12.convulsions
13.coma and death
14.Stiff neck usually appears with onset of meningeal inflammatory reaction up to 6 to 12 hours after onset suggesting meningeal stretching and herniation of cerebellum into foramen magnum.
Other neurological signs:
1.Pupils unequal
2.paresis of vertical and medial movements of one eye
3.optic field may have round smooth hemorrhages near optic disc,
usually unilateral which will indicate site of bleeding in the brain.
Special investigations:
1.lumbar puncture:
pressure of cerebrospinal fluid may be raised
red blood cells present for first week
protein content raised
2.MRI or CAT scan with intravenous dyes can determine the source of the bleeding
The treatment of Subarachnoid Hemorrhage:
Subarachnoid Hemorrhage is an emergency.
Purpose of treatment is to:
1. preserve life
2. limit the amount of brain damage
3. lessen the extent of disability and deformity
4. prevent recurrence.
Admission to hospital is necessary to determine
1. the cause of the Subarachnoid Hemorrhage
2. the extent of damage to the brain using MRI of the brain
3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).
4. whether Surgery is necessary to stop bleeding or remove a blood clot
5. risk factors for Subarachnoid Hemorrhage are investigated and treated (diabetes, high blood pressure etc)
During the acute phase of Subarachnoid Hemorrhage:
1. A clear airway must be maintained
2. Sufficient fluid and electrolyte intake must be maintained
3. adequate nutrition in the form of glucose, proteins and calories must be given
4. bed rest with adequate nursing care is provided to prevent bed sores etc
5. Proper medicines are given
Once the Subarachnoid Hemorrhage is stable:
The Subarachnoid Hemorrhage patient is started on a rehabilitation programme.
This will include
a.exercises to strengthen his muscles,
b.speech training for patients with dysphasia (difficulty in talking)
c.training on how to carry out his daily activities.
d.advice about his diet
Immediate care improves the chance of a complete recovery.
A Subarachnoid Hemorrhage can be very devastating and depressing for a patient.
He will feel that part of his body and brain function is incapacitated.
Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends
Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:
Please do:
1.be understanding and patient.
2. keep the patient cheerful and hopeful
3.learn how to help him with the diet, daily exercises and other care necessary for him
4.allow the person more time to do any task
5.encourage and praise the patient to do as much as possible for himself at his own pace.
6.involve the person in family discussions and activities.
7.be encouraging and praise his daily efforts.
Prognosis of subarachnoid hemorrhage:
1.Recurrence may occur
2.Can be life threatening
Sunday, March 20, 2011
A Simple Guide to LEPTOSPIROSIS
A Simple Guide to LEPTOSPIROSIS
-----------------------------------------
What is LEPTOSPIROSIS?
------------------------------
LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.
What is the cause of LEPTOSPIROSIS?
--------------------------------------------
The bacteria which causes LEPTOSPIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occuring in domestic and wild animals. Humans are accidental hosts.
Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.
The bacteria can affect the liver, kidney, sketal muscle, heart, spleen, lungs and central nervous system.
Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.
What are symptoms of LEPTOSPIROSIS?
----------------------------------------------
Incubation period is approximately 10 days.
Illness is typically biphasic.
A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid
2.Abrupt onset of headache, myalgia, high fever and chills
This will last 4-9 days
3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.
B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies
2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.
3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.
Specific Sterotypes:
Weil's Disease:
is severe leptospirosis with
1.liver involvement withjaundice,hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding,subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis
How is the diagnosis of LEPTOSPIROSIS made?
-----------------------------------------------------
Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.
2.cerebrospinal tests
3.animal innoculation
4.liver scan and ultrasound
What are the complications of LEPTOSPIROSIS?
-------------------------------------------
LEPTOSPIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis
2.Kidney disease can occur from damage to the kidney
3.Brain damage is rare but can occur from spread to the brain and meninges
4.Severe hemorrhage uncommon but can cause death
How is LEPTOSPIROSIS treated?
-------------------------------------
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.
1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.
2.intravenous drip and blood transfusion if necessary
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to stop vomiting and itch
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Get plenty of rest.
How is LEPTOSPIROSIS prevented?
----------------------------------------
Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals
5.Good food hygience and hand washing
What is the prognosis of LEPTOSPIROSIS?
-------------------------------------------------
Prognosis depends on the virulence of disease and general condition of the patient.
It is excellent with prompt treatment of leptospirosis infection.
Weil's disease is more serious but will respond well to treatment.
Infection of pregnant women may be associated with increased risk of fetal loss.
-----------------------------------------
What is LEPTOSPIROSIS?
------------------------------
LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.
What is the cause of LEPTOSPIROSIS?
--------------------------------------------
The bacteria which causes LEPTOSPIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occuring in domestic and wild animals. Humans are accidental hosts.
Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.
The bacteria can affect the liver, kidney, sketal muscle, heart, spleen, lungs and central nervous system.
Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.
What are symptoms of LEPTOSPIROSIS?
----------------------------------------------
Incubation period is approximately 10 days.
Illness is typically biphasic.
A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid
2.Abrupt onset of headache, myalgia, high fever and chills
This will last 4-9 days
3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.
B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies
2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.
3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.
Specific Sterotypes:
Weil's Disease:
is severe leptospirosis with
1.liver involvement withjaundice,hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding,subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis
How is the diagnosis of LEPTOSPIROSIS made?
-----------------------------------------------------
Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.
2.cerebrospinal tests
3.animal innoculation
4.liver scan and ultrasound
What are the complications of LEPTOSPIROSIS?
-------------------------------------------
LEPTOSPIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis
2.Kidney disease can occur from damage to the kidney
3.Brain damage is rare but can occur from spread to the brain and meninges
4.Severe hemorrhage uncommon but can cause death
How is LEPTOSPIROSIS treated?
-------------------------------------
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.
1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.
2.intravenous drip and blood transfusion if necessary
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to stop vomiting and itch
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Get plenty of rest.
How is LEPTOSPIROSIS prevented?
----------------------------------------
Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals
5.Good food hygience and hand washing
What is the prognosis of LEPTOSPIROSIS?
-------------------------------------------------
Prognosis depends on the virulence of disease and general condition of the patient.
It is excellent with prompt treatment of leptospirosis infection.
Weil's disease is more serious but will respond well to treatment.
Infection of pregnant women may be associated with increased risk of fetal loss.
A Family Doctor's Tale - DUPUYTREN'S CONTRACTURE
DOC I HAVE DUPUYTREN'S CONTRACTURE
DUPUYTREN'S CONTRACTURE is the PROGRESSIVE FIBROSIS OF THE PALMA FASCIA LEADING TO PAINLESS contractures of one or mor finger at metacarpophayngeal joints.
At least one or more fingers will be flexed against the palm.
DUPUYTREN'S CONTRACTURE occur as a result of proliferation and thickening of the connective tissues of the palmar fascia.
Nodules of irregular fibroblasts are formed.
Contraction of proliferated fibrous tissues leads to the deformity.
It is inherited as a Mendelian dominant in some cases.
It occurs predominently among Caucasians.
Men are affected 8 times more than women.
It has been associated with:
1.epilepsy
2.diabetes
3.alcoholism
4.as a late result of post myocasrdial infarction shoulder hand syndrome
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple contracture alone to plantar fascial involvement in the foot.
1.minimal flexion deformity in the early stages
2.palmar fascia can be seen puckering the skin
3.thickened or nodular underlying tissue can be felt
4.on or all fingers of either or both hands may be affected especially the ring and little fingers
5.Affected fingers are partly or completely held in fixed flexion and cannot be extended.
Treatment:
1.In mild cases no treatment is required
2.Corticosteroid injection to reduce inflammation at the thickened or nodular underlying tissues may help some patients
3.Surgery may be necessary as last resort to release the palmar fascia by cutting the tightened fascia
Complication:
If left untreated. it can lead to the permanent loss of the hand
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
3.Amputation may be considered if the affected fingers interferes with activities of the hand
DUPUYTREN'S CONTRACTURE is the PROGRESSIVE FIBROSIS OF THE PALMA FASCIA LEADING TO PAINLESS contractures of one or mor finger at metacarpophayngeal joints.
At least one or more fingers will be flexed against the palm.
DUPUYTREN'S CONTRACTURE occur as a result of proliferation and thickening of the connective tissues of the palmar fascia.
Nodules of irregular fibroblasts are formed.
Contraction of proliferated fibrous tissues leads to the deformity.
It is inherited as a Mendelian dominant in some cases.
It occurs predominently among Caucasians.
Men are affected 8 times more than women.
It has been associated with:
1.epilepsy
2.diabetes
3.alcoholism
4.as a late result of post myocasrdial infarction shoulder hand syndrome
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple contracture alone to plantar fascial involvement in the foot.
1.minimal flexion deformity in the early stages
2.palmar fascia can be seen puckering the skin
3.thickened or nodular underlying tissue can be felt
4.on or all fingers of either or both hands may be affected especially the ring and little fingers
5.Affected fingers are partly or completely held in fixed flexion and cannot be extended.
Treatment:
1.In mild cases no treatment is required
2.Corticosteroid injection to reduce inflammation at the thickened or nodular underlying tissues may help some patients
3.Surgery may be necessary as last resort to release the palmar fascia by cutting the tightened fascia
Complication:
If left untreated. it can lead to the permanent loss of the hand
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
3.Amputation may be considered if the affected fingers interferes with activities of the hand
Friday, March 18, 2011
A Family Doctor's Tale - HALLUX VALGUS
DOC I HAVE HALLUX VALGUS
HALLUX VALGUS also known as BUNION deformity is the deformity of the big toe metatarsopharyngeal(MTP) joint in whivh there is medial protrusion and lateral deviation of the great toe.
Shoewear does not cause hallux valgus.
HALLUX VALGUS occur as a result of :
1.heredity
2.flat foot (pes planus)
3.metatarsal primus varus
4.hypermobile first metarsal cuneiform joints
5.abnormal length of first metatarsal
6.joint laxity
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple deviation to severe deviation and deformity.
1.Normal intermetatarsal angle (the angle between the first and second metatarsals is 9 degrees or less.
2.the normal first MTP joint angle is less than 15 degrees.
Any increase of 15 degrees angle is considered as lateral deviation of the first metatarsopharygeal joint.
3.The big toe is turned inwards towards the second causing a medial protrusion of the MTP joint called a bunion.
4.in severe cases the first toe can overlap the second toe or the second toe may cover the inturned big toe.
5.there is pain on walking
6.there is difficulty in wearing shoes
Treatment:
Conservative:
1.In mild cases no treatment is required
2.Shoe wear modifications to increase the width of the toe box will relieve pressure of the MTP joint and help in walking.
3.Pads and splints may also help to relieve symptoms.
Surgery:
The main purpose is to restore the normal anatomical relation of the big toe MTP joint.
1.Osteotomy to realign the first metatarsal
2.Fusion of MTP joint
Prognosis:
90 per cent of patients will have good results after surgery
Conservative treatment can relieve the pain on walking but the deviation may still become worse.
HALLUX VALGUS also known as BUNION deformity is the deformity of the big toe metatarsopharyngeal(MTP) joint in whivh there is medial protrusion and lateral deviation of the great toe.
Shoewear does not cause hallux valgus.
HALLUX VALGUS occur as a result of :
1.heredity
2.flat foot (pes planus)
3.metatarsal primus varus
4.hypermobile first metarsal cuneiform joints
5.abnormal length of first metatarsal
6.joint laxity
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple deviation to severe deviation and deformity.
1.Normal intermetatarsal angle (the angle between the first and second metatarsals is 9 degrees or less.
2.the normal first MTP joint angle is less than 15 degrees.
Any increase of 15 degrees angle is considered as lateral deviation of the first metatarsopharygeal joint.
3.The big toe is turned inwards towards the second causing a medial protrusion of the MTP joint called a bunion.
4.in severe cases the first toe can overlap the second toe or the second toe may cover the inturned big toe.
5.there is pain on walking
6.there is difficulty in wearing shoes
Treatment:
Conservative:
1.In mild cases no treatment is required
2.Shoe wear modifications to increase the width of the toe box will relieve pressure of the MTP joint and help in walking.
3.Pads and splints may also help to relieve symptoms.
Surgery:
The main purpose is to restore the normal anatomical relation of the big toe MTP joint.
1.Osteotomy to realign the first metatarsal
2.Fusion of MTP joint
Prognosis:
90 per cent of patients will have good results after surgery
Conservative treatment can relieve the pain on walking but the deviation may still become worse.
Wednesday, March 16, 2011
A Family Doctor's Tale - TACHYCARDIA
DOC I HAVE TACHYCARDIA
Tachycardia is a symptom defined as heart rate above 100 per minute.
Causes of Tachycardia:
1.Abnormality of the sinus or atrial node in the heart may be continuous or paroxymal in nature
2.Abnormalities of the ventricular conducting system: a.ischemic heart disease b.congenital heart disease
3.Underlying systemic disease:
a.fever
b.anemia
c.thyrotoxicosis
4.Medicines:
a.ephedrine or pseudoephedrine
b.asthmatic drugs like ventolin or bricanyl
c.anticholinergic drugs like atropine, buscopan
5.Psychosomatic like anxiety, emotional upsets, panic attacks
Symptoms:
.palpitations
2.breathlessness
3.fainting
4.polyuria
Signs:
1.heart beat above 100 per minute
2.abnormal heart rhythm
3.ECG will determine
a.location of stimulus of fast heart beat
b.abnormal rhythm -flutter or fibrillation
Treatment of Tachycardia is:
1. Atrial tachycardia can be slowed by carotid sinus massage or Valsalva maneuver
2. Paroxysmal atrial Tachycardia can be terminated by vagal stimulation maneuvers (Valsalva or carotid sinus pressure).
3.Acute atrial attacks if not improved after vagal massage can be treated with: a.digoxin
b.beta blockers such as propanolol or atenolol
c.calcium channel blockers like nefidipine
d.anti-cholinesterase like edrophonium
e.alpha blockers
4.Persistent atrial tachycardia can be treated with a.quinidine, b.beta blockers or c.digoxin or dilatrend
5.Ventricular tachycardia is more dangerous usually associated with coronary heart disease or infarction may be treated with:
a.lidocaine 1-2mg per kg stat followed by infusion of 2-4 mg per kg per min
b.Electo-cardioversion
c.radiofrequency ablation
6. Treat underlying conditions such as thyrotoxicosis
7. No smoking, alcohol or caffiene intake
8.No strenuous exertion or stress
Prognosis:
1.atrial tachycardia may occur in normal young adults and may not indicate heart disease
2.Ventricular tachycardia may herald more serious illness such as life threatening arrthythmia or infarction
Tachycardia is a symptom defined as heart rate above 100 per minute.
Causes of Tachycardia:
1.Abnormality of the sinus or atrial node in the heart may be continuous or paroxymal in nature
2.Abnormalities of the ventricular conducting system: a.ischemic heart disease b.congenital heart disease
3.Underlying systemic disease:
a.fever
b.anemia
c.thyrotoxicosis
4.Medicines:
a.ephedrine or pseudoephedrine
b.asthmatic drugs like ventolin or bricanyl
c.anticholinergic drugs like atropine, buscopan
5.Psychosomatic like anxiety, emotional upsets, panic attacks
Symptoms:
.palpitations
2.breathlessness
3.fainting
4.polyuria
Signs:
1.heart beat above 100 per minute
2.abnormal heart rhythm
3.ECG will determine
a.location of stimulus of fast heart beat
b.abnormal rhythm -flutter or fibrillation
Treatment of Tachycardia is:
1. Atrial tachycardia can be slowed by carotid sinus massage or Valsalva maneuver
2. Paroxysmal atrial Tachycardia can be terminated by vagal stimulation maneuvers (Valsalva or carotid sinus pressure).
3.Acute atrial attacks if not improved after vagal massage can be treated with: a.digoxin
b.beta blockers such as propanolol or atenolol
c.calcium channel blockers like nefidipine
d.anti-cholinesterase like edrophonium
e.alpha blockers
4.Persistent atrial tachycardia can be treated with a.quinidine, b.beta blockers or c.digoxin or dilatrend
5.Ventricular tachycardia is more dangerous usually associated with coronary heart disease or infarction may be treated with:
a.lidocaine 1-2mg per kg stat followed by infusion of 2-4 mg per kg per min
b.Electo-cardioversion
c.radiofrequency ablation
6. Treat underlying conditions such as thyrotoxicosis
7. No smoking, alcohol or caffiene intake
8.No strenuous exertion or stress
Prognosis:
1.atrial tachycardia may occur in normal young adults and may not indicate heart disease
2.Ventricular tachycardia may herald more serious illness such as life threatening arrthythmia or infarction
Monday, March 14, 2011
A Family Doctor's Tale -BRADYCARDIA
DOC I HAVE BRADYCARDIA
Bradycardia is a symptom defined as heart rate below 55 per minute.
Causes of Bradycardia:
1.Bradycardia can occur normally in athletes as a result of training through increased cardiac vagal tone.
2.Abnormalities of the heart conducting system:
a.complete heart block
b.ischemic heart disease
c.congeital heart disease
3.Underlying systemic disease:
a.myxedema
b.increased intracranial disease
4.Medicines:
a.Beta blockers
b.digoxin overdosage
c.reserpine
Symptoms:
1.slow pulse at wrist
2.confirmation with ECG
3.fainting
4.asymptomatic in many cases
Treatment of bradycardia:
1. None if no symptoms and no underlying cause
2. Cardiac bradycardia from heart block may be treated with atropine
3.Sympathommetics such as isoproterenol may be given as temporary measure before treatment of underlying conditions or insertion of pacemaker
4. Treat underlying conditions such as myxedema
5. heart blocks or asystole may need pacemaker implantation
Prognosis:
1.depends on underlying cause -myxedema is less serious than intracranial pressure
2.Patient receiving pacemakers often have an excellent long term survival
Bradycardia is a symptom defined as heart rate below 55 per minute.
Causes of Bradycardia:
1.Bradycardia can occur normally in athletes as a result of training through increased cardiac vagal tone.
2.Abnormalities of the heart conducting system:
a.complete heart block
b.ischemic heart disease
c.congeital heart disease
3.Underlying systemic disease:
a.myxedema
b.increased intracranial disease
4.Medicines:
a.Beta blockers
b.digoxin overdosage
c.reserpine
Symptoms:
1.slow pulse at wrist
2.confirmation with ECG
3.fainting
4.asymptomatic in many cases
Treatment of bradycardia:
1. None if no symptoms and no underlying cause
2. Cardiac bradycardia from heart block may be treated with atropine
3.Sympathommetics such as isoproterenol may be given as temporary measure before treatment of underlying conditions or insertion of pacemaker
4. Treat underlying conditions such as myxedema
5. heart blocks or asystole may need pacemaker implantation
Prognosis:
1.depends on underlying cause -myxedema is less serious than intracranial pressure
2.Patient receiving pacemakers often have an excellent long term survival
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