A Family Doctor's Tale - HIATUS HERNIA

DOC I HAVE HIATUS HERNIA

Hiatus Hernia is a protrusion of part of the stomach through the diaphragmatic hiatus (or hole) into the chest.

Two main causes are
1.Congenital
The Hiatus Hernia occur in newborns as a result of the diaphragm to fuse.
There is a familial history.

2.Acquired
a.Sliding -most common type - occurs when the gastroesophageal junction and part of the stomach above the diaphragm may be associated with a short esophagus secondary to esophagitis and stricture of the esophagus from scarring(due to gastric acid)

b.Paraesopphageal :when the gastroesophageal junction is below the the diaphragm and part of the stomach herniates upwards along the esophagus.

Vomiting of the retained food in the part of the stomach stuck in the diaphragm is a natural progression of the condition.

The Symptoms of Hiatus Hernia are:

Most hiatus hernia are asymptomatic.
The most common symptoms are those of esophageal reflux:
1.heartburn aggravated by bending down, lying down, smoking, alcohol, and heavy meals

2.belching, abdominal bloating,

3.acid reflux to the throat

4.nausea, and vomiting of ingested food

5.fullness and pain after eating may be caused by mechanical obstruction of the pouch of the stomach in paraesophagel type of hiatus hernia

6.Respiratory distress may be present in infants due the pressure of the stomach on the lung space.

7.weight loss

8.bleeding

Hiatus Hernia is diagnosed through one or more medical tests:

1.Upper gastrointestinal endoscopy.
The doctor uses an esophagoscope, a thin tube containing a tiny camera, through your mouth  and down into your stomach to look at the stomach lining for erosions and narrowing of the passage of the upper part of the stomach and esophagus

2.MRI of the upper abdomen usually shows the presence of excess stomach content in the lung area above the diaphragm
and presence of hiatus hernia.

The Treatment of Hiatus Hernia is:
The main treatment is usually medical especially for sliding hernia.

1.correction of fluid and electrolyte deficit by intravenous infusion of saline and glucose

2.Antacids:to reduce stomach acid from gastric reflux and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the esophagus and the upper stomach.)

3.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)

4. Antispasmodics: anticholinergic drugs like buscopan.librax reduce the spasm in the stomach and esophagus

Surgery:
The surgery involves repair of the diaphragmatic hernia and the return of the stomach to below the diaphragm in the paraesophageal cases of hiatus hernia.

1.Surgical treatment may be necessary in cases with persistant esophageal reflux and severe esophagitis.

2.Paraesophageal hernias are less amenable to medical treatment and often require surgical treatment.

3.Emergency surgery is required in cases of strangulation of the esophagus, esophageal obstruction or perforation.

The Complications of untreated Hiatus Hernia are:
1.strangulation of esophagus

2.obstruction of the esophagus

3.perforated esophagus

Prognosis of Hiatus Hernia is :
1. good to excellent if treated surgically to repair the hernia.

2.medical treatment may work but recurrence rate is high.

A Family Doctor's Tale - PYLORIC STENOSIS

DOC I HAVE PYLORIC STENOSIS

Pyloric Stenosis is a stricture at the lower end of the stomach (pylorus)which can obstruct outflow of gastric content to the duodenum.

Two main causes of Pyloric Stenosis are :
1.Congenital
The pyloric stenosis occur in 0.2 per cent of live births with a preponderance ratio of 4 males to 1 female.
There is a familial history.

2.Acquired
a.Scarring - gastric juice burns into the protective lining of the stomach resulting in gastritis or peptic ulcer. The resultant scarring of the stomach lining at the pylorus may cause narrowing or stenosis of the outlet obstructing the outflow of gastric content. Scarring can occur in 5-10 per cent of peptic ulcers especially duodenal ulcers.

b.Spasm of the pyloric muscles due to gastritis or peptic ulcer can also reduce the opening at the outlet of the stomach.

c.mechanical obstruction from a tumor of the stomach

Early cases of pyloric stenosis can be reversed more easily.

Later cases results in gastris dilatation with retention of gastric contents due to obstruction.

Vomiting of the retained food in the stomach is a natural progression of the condition.

The most common symptoms and signs of Pyloric Stenosis are :
1.upper abdominal upset or pain.

2.belching, abdominal bloating, aversion to food

3.nausea, and vomiting of ingested food

4.Protracted copious vomiting due to obstruction at the outflow of the stomach

Signs:
5.gastric splash can be felt and heard on examination

6.weight loss

7.dehydration

Pyloric Stenosis is diagnosed through one or more medical tests:
1.Upper gastrointestinal endoscopy.
In the case of pyloric stenosis, the gastric content (usually large amount) has to be removed by aspiration through a stomach tube 3 hours before any procedure can be done.

The doctor eases an gastroscope, a thin tube containing a tiny camera, through your mouth  and down into your stomach to look at the stomach lining for polyps or tumors blocking the pylorus. If there is no tumor, there may evidence of gastritis or peptic ulcer and narrowing of the passage of the pylorus from scarring or spasm.

2.MRI of the upper abdomen usually shows the presence of excess stomach content and may show evidence of any benign tumor or cancer.

3.Blood tests for electrolytes in cases of dehydration

The main treatment of Pyloric Stenosis is usually
1.correction of fluid and electrolyte deficit by intravenous infusion of saline and glucose

2.removal of stomach content through a nasogastric tube to eliminate distension of stomach and restore tone of stomach muscles

Medications:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)
2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)
3. Antispasmodics: anticholinergic drugs like buscopan.librax reduce the spasm in the stomach and duodenum
4.If the peptic ulceris caused by an infection, that problem may be treated with antibiotics to clear up H. pylori infection.

Surgery:
Surgical treatment may be necessary to remove any tumor or cancerous groth causing blockage.

Any stricture in the pylorus may be dilated or removed for the food to empty out easily to the duodenum.

The Complications of untreated Pyloric Stenosis are

1.dehydration

2.anorexia and loss of weight

3.perforated stomach and peritonitis

Prognosis of Pyloric Stenosis is :
good to excellent if treated early except for cases of cancer of the stomach.

Prevention of Pyloric Stenosis:
avoid gastritis and peptic ulcers

A Family Doctor's Tale - PEPTIC ULCER

DOC I HAVE PEPTIC ULCER

Peptic ulcer is a ulcer or hole in the lining of the stomach or duodenum.

Two main causes of Peptic ulcer are
1..helicobacter pylori infection - this bacteria damages the protective lining of the stomach making the underlying stomach tissue more vulnerable to the acidic gastric juice.

2.excessive production of acidic gastric juice
Excessive production of acidic gastric juice burns into the protective lining of the stomach and cause inflammation of the underlying stomach tissue.

The causes of excessive production of acidic gastric juice are:
1. Most common is stress and anxiety which automatically increase the production of the acid as a result of sympatheic nervous reaction


2.hereditary- some gastric patient has family history of gastric problem. Blood group O tends to have more gastitis while Blood group A has a tendency towards stomach cancer.


3.irregular meals tend to cause more acidic gastric juice to form at regular meal time.


4.alcohol and smoking has been associated with increased acid formation


5.Drugs: prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,

Most gastric ulcers occur on the lining of the lesser curvature of the stomach while dudenal ulcers occur on the first part of the duodenum

What are the Symptoms of Peptic ulcer?
-----------------------------------------
The most common symptoms are
1.upper abdominal upset or pain.

2. belching, abdominal bloating,

3.nausea, and vomiting especially if there is obstruction as pyloric stenosis

4.indigestion or of burning in the upper abdomen or in the chest(heart burn).

5. Blood in your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.

Signs:
6.epigastric tenderness on examination

7.anorexia

6.loss of weight due to poor digestion and absorption

Peptic ulcer is diagnosed through one or more medical tests:
1.Upper gastrointestinal endoscopy.

The doctor eases an gastroscope, a thin tube containing a tiny camera, through the mouth  and down into the stomach to look at the stomach lining.
The doctor will check for inflammation (gastritis) and ulcers and may remove a tiny sample of tissue for tests(biopsy). The biopsy will detect how bad is the inflammation or whether there are underlying cancer cells.
In additional if any polyps (benign swelling of the lining of the stomach) are detected, they are removed at the same time and sent for biopsy.

2.Blood test. The doctor may check your blood for any evidence of H.pylori infection and the red blood cell count to check for anemia (not enough iron in the red blood cells.
Anemia can be caused by bleeding from the stomach.

3.Urea breath test can also determine whether there is H.pylori infection

4.Stool test. This test checks for the presence of blood in the stool, a sign of bleeding. Stool test may also be used to detect the presence of H. pylori in the digestive tract.

The main treatment of Peptic ulcer is usually
1.reduce stress

2.reorganisation of work in such a way as to be able to handle the pressure of work better as well as to have regular meals

3.Control of diet - avoid hard foods such as peanuts , tough meat, spicy food, cold food, black coffee, strong tea,citrus fruits and their juices,carbonated beverages, deep fried or oily food.

4. Take more frequent and smaller meals.

5. Avoid alcohol and smoking

6. Avoid drugs such as aspirin, painkillers,steroids which may irritate your stomach and cause increase in acid production

Medications:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)

2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)

3. Antispasmodics: anticholinergic drugs like buscopan.librax reduce the spasm in the stomach and dudenum

4.If your Peptic ulcer is caused by an infection, antibiotics are given  to clear up H. pylori infection. Once the underlying problem disappears, the Peptic ulcer usually does too.

Surgery:
Surgical treatment is the last resort if the above treatment do not work.

Resection of the ulcers and vagotomy(cutting of the vagal nerve to reduce acid secretion) may be necessary in rare cases.

The Complications of untreated Peptic ulcer are:

1.bleeding

2.pyloric stenosis

3.perforated stomach and peritonitis

Prognosis of Peptic ulcer:
Healing occurs with 6 to 12 weeks .

However recurrence is common.

A Family Doctor's Tale -DYSPEPSIA

DOC I HAVE DYSPEPSIA

Dyspepsia is a symptom of discomfort or indigestion in the upper abdomen often associated with heartburn, nausea, regurgitation and flatulence.

Two main causes are
1. Diseases of the upper digestive system:
a.esophagus-esophagitis, GERD (gastroesophageal reflux disease), hiatus hernia
b.stomach -gastritis, peptic ulcer, stomach cancer
c.duodenum -duodenal ulcer

2.Diseases of the gallbladder, biliary and pancreatic system
a.gallbladder -cholecystitis, gallstone
b.biliary system - obstrion in the bile duct
c.pancreas -pancreatitis, cancer of pancreas

Other causes:
3.Mechanical factors such as overeating, rapid eating,faulty chewing of food

4.Excessive irriation of gastic mucosa such as
a.food - caffiene, alcohol, poorly digested spices, nuts
b.food that relax lower esophageal sphincter such as chocolates
.
5.Psychogenic causes of excessive production of acidic gastric juice such as stress and anxiety which automatically increase the production of the acid as a result of sympatheic nervous reaction

6.Drugs: prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, steroids

7.systemic diseases, such as pernicious anemia,heart failure with ascites, uremia and diabetes

8.hereditary- some gastric patient has family history of gastric problem. Blood group O tends to have more gastitis while Blood group A has a tendency towards stomach cancer.

9.smoking has been associated with increased acid formation
and indigestion

The most common symptoms of dyspepsia are
1.upper abdominal upset or epigastric pain.

2. belching, abdominal bloating,

3.nausea, and vomiting

4.burning sensation in the upper abdomen or in the chest(heart burn).

5.regurgitation

Dyspepsia is diagnosed through one or more medical tests:
1.Upper gastrointestinal endoscopy.
The doctor eases an gastroscope, a thin tube containing a tiny camera, through your mouth  and down into your stomach to look at the stomach lining.
The doctor will check for inflammation and may remove a tiny sample of tissue for tests(biopsy). The biopsy will detect how bad is the inflammation or whether there are underlying cancer cells. In additional if any polyps (benign swelling of the lining of the stomach) are detected, they are removed at the same time and sent for biopsy.

2.X-rays of the stomach -barium meal or
gallbladder-cholecystography

3.Ultrasound scan of liver, pancreas, gallbladder

4.Blood test. The doctor may check your blood for any evidence of H.pylori infection and pancreatic enzymes to exclude pancreatic causes

Urea breath test can also determine whether you have H.pylori infection

The main Treatment of Dyspepsia is usually
1.reduce stress

2.reorganization of work in such a way as to be able to handle the pressure of work better as well as to have regular meals

3.Control of diet - avoid hard foods such as peanuts , tough meat, spicy food, cold food, black coffee, strong tea,citrus fruits and their juices,carbonated beverages, deep fried or oily food.

4. Take more frequent and smaller meals.

5. Avoid alcohol and smoking

6. Avoid drugs such as aspirin, painkillers,steroids which may irritate your stomach and cause increase in acid production

Regulate eating habits  using small meals, sitting up, walking after food

Medications:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)

2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)

3. Antispasmodics: anticholinergic drugs like buscopan,  librax reduce the spasm in the stomach and duodenum

4.If your Dyspepsia is caused by an infection, that problem may be treated as well. For example, the doctor might prescribe antibiotics to clear up H. pylori infection. Once the underlying problem disappears, the Dyspepsia usually does too. Talk to your doctor before stopping any medicine or starting any Dyspepsia treatment on your own.

5.Surgery may be required in cancer of stomach, pancreas, gallstones

The Complications of untreated Dyspepsia are:
gastric ulcers and strictures
bleeding

Prognosis :
good to excellent except for cancer of stomach and pancreas

A Family Doctor's Tale - DYSENTERY

DOC I HAVE DYSENTERY

Dysentery is an acute invasive infection  of the lining of the intestines caused by a micro-organism such as bacteria or paraste resulting in leakage of fluid from the cell into the intestine(diarrhea) sometimes with bloody mucus, abdominal pain or vomiting.

The causes of Dysentery are:
Bacteria:
1.Shigella

2.E.Coli

Parasitic:

amebic

Transnission occurs most often by close personal contact through hands or soiled clothing or fecal-oral contamination.

Stools can contain red blood cells and white blood cells.

There may blood in the stools.

The symptoms of Dysentery are:
1. watery diarrhea with blood and mucus

2. cramping abdominal pain

3. fever

4. headache and bodyaches

5. serious fluid loss especially in children

6. loss of appetite and energy

Dysentery is transmitted through:
Dysentery can be highly contagious.

The germs are commonly transmitted by people with unwashed hands.

People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.

The diagnosis of Dysentery is made by:
1.Doctors generally diagnose Dysentery based on the symptoms and a physical examination.

2.stool sample to test for microscopic examination and stool culture

Microscopic examination shows the presence of red blood cells and polymorphs white blood cells.

Treatment of  Dysentery is by:
1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.

Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.

The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness

Mild dehydration can be treated by drinking liquids.

Severe dehydration may require intravenous fluids and hospitalization.

Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.

2.Antibiotics is necessary,the choice of which depends on the sensitivity of bacteria to the antibiotic.

Anti parasitic drug for amebic dysentery is usually metronidazole

3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).

The following steps may help relieve the symptoms of Dysentery.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.

2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.

3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes.

4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.

5.Avoid dairy products, caffeine, and alcohol until recovery is complete.

6.Get plenty of rest.

Prognosis:
Symptoms usually improve within one to 2 days after the onset of treatment.

Outcome is usually excellent with appropriate treatment.

Prevention of dysentery is by:
1.washing of  hands thoroughly for 20 seconds after using the bathroom or changing diapers

2.washing of  hands thoroughly for 20 seconds before eating

3.disinfecting contaminated surfaces such as counter tops and baby changing stations

4.Avoid eating or drinking foods or liquids that might be contaminated

5.Avoid raw vegetables or meat

A Family Doctor's Tale -CONTACT DERMATITIS

DOC I HAVE CONTACT DERMATITIS


Contact Dermatitis is a common skin condition which presents as a erythematous or vesicular rash on face, neck, hands and other areas in contact with external environmental substances.

The cause of Contact Dermatitis is related to the exposure of the skin to the external environmental substances, chemicals or plants.

There may be a latent interval of days or years between first exposure and development of sensitization.

Virtually any substance can cause sensitivity of the epidermis of the skin.

Some possible triggers are:
1.Metals especially nickel from bracelet, pendants, neck chains, or chrome from watches, etc

2.Dyes from comestics,lipstick, clothes, hair dyes

3.Chemicals from perfumes, soaps, shaving cream, antiseptic creams

4.drugs such as penicillin, sulphonamides, tetracycline, neomycin, aspirin, NSAIDs, ointment bases,

5.Plants such as poison ivy, flowers, pollens, primrose just to name a few can cause skin allergy

6.Animals - the fur from animals can cause contact dermatitis

Contact Dermatitis affects both sexes equally.

Symptoms and signs of Contact Dermatitis are:
Typical features of Contact Dermatitis are:

1.vesicular or bubbles in areas most exposed to the external environmental substance

2.erythrematous or red rashes in areas most exposed to direct contact

3.hives or urticaria from direct contact such as pollens

4.weeping eczema in severe cases

Diagnosis:

skin patch tests

Treatment of an Contact Dermatitis treatment routine is:

1. Avoid exposure to causative substance

2.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.

Hydrocotisone cream and ointment are preferred to prevent side effects such as skin thinning.

3.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).

4.sedative antihistamines are sometimes used to reduce the itch

Prognosis of Contact Dermatitis:

good to excellent in most cases with avoidance of contact substance

Recurrence is always possible due to recontact or new substance allergy

Prevention of Contact Dermatitis is by:
Contact Dermatitis can usually be avoided with some simple precautions.

1.Avoid contact with the causative environmental substance which has been identified

2.Avoid contact with drugs or cosmetics which can trigger off Contact dermatitis

3.Avoid contact with foods having dyes and preservatives

A Family Doctor's Tale - PHOTO DERMATITIS

DOC I HAVE PHOTO DERMATITIS

Photo Dermatitis is a common skin condition which presents as a erythematous or vesicular rash on face, neck, hands and other areas exposed to sunlight.

The cause of Photo Dermatitis is related to the exposure of the skin to the sun.
However some possible triggers are:
1.Genetic

Genes play a part in Photo Dermatitis as the condition runs in families

2.External causes

Photo sensitivity:certain exogenous sensitizers play a part in the development of Photo Dermatitis.

a.drugs such as phenothiazines, thiazides and tetracycline

b.cosmetic such as lipstick, perfumes, soaps, shaving cream, antiseptic creams, even sun screening agents (especially if they contain coal tar)

c.irritating chemicals which exaggerated the photosensitzing effect of the sun

d.sunburn reaciion which aggarvated the skin to react as rashes.

e.Photo allergic rash which persist for years

f. injury by ultraviolet light

g.feeling too hot and/or sweating will cause an outbreak.

h.Stress can also sometimes aggravate an existing flare-up.

Photo Dermatitis affects both sexes equally.

The symptoms and signs of Photo Dermatitis are:
Typical features of Photo Dermatitis are:

1.vesicular or bubbles in areas most exposed to light

2.erythrematous or red rashes in areas most exposed to light

3.some occurs following severe sunburn

4.some are seasonal with recurrance in early spring and summer

5.actinoid reticuloid skin rash affecting the face and hands are also seen in chronic photo dermatitis patients

Photo Dermatitis is  diagnosed by:
1.History and appearance of the rash

2.Photo patch testing

3.Determination of light wavelength causing photo dermatitis

Treatment of an Photo Dermatitis treatment routine is:
1. Avoid ultraviolet light especially long wave ultraviolet light

2. application of lotions or creams to protect the skin against the sun

3.chloroquine sulphate 200mg daily may be useful for some patients over short periods

4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.

Hydrocotisone cream and ointment are preferred to prevent side effects such as skin thinning.

5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).

6.sedative antihistamines are sometimes used to reduce the itch

Prognosis:

1.good to excellent in most cases with phot toxic eruptions

2.good to fair with photo allergic reactions

3.Some patients reacts persistently to light without exposure to an antigen.

Prevention of  Photo Dermatitis is by:
Photo Dermatitis outbreaks can usually be avoided with some simple precautions.

The following suggestions may help to reduce the severity and frequency of flare-ups when exposed to the sun:

1.use sun screen

2.Avoid drugs or cosmetics which can trigger off photo dermatitis

3.Avoid sweating or overheating

4.Reduce stress

5.Avoid harsh soaps, detergents, and solvents

6.Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)

7.Be aware of any foods that may cause an outbreak and avoid those foods

A Family Doctor's Tale - ENCEPHALITIS

DOC I HAVE ENCEPHALITIS

Encephalitis is a serious medical disease which causes inflammation and infection of the brain.

The causes of Encephalitis may be divided into:

Infections:
1.viral infections are the most common
(herpes simplex virus, mumps, measles, rubella, chickenpox, West Nile Encephalitis, Japanese Encephalitis, St Lious Encephalitis).

Of these viruses, herpes simplex virus is the most serious and can cause fatality.

2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus(Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal Encephalitis can cause outbreaks(spread easily).

3.fungi,
Cryptococcus neoformans is the most common cause of fungal Encephalitis

4.Parasitic
Examples are Toxoplasmosis, malaria, amoeba, Lyme Disease

The symptoms which often defines Encephalitis are:

1.Severe headache

2.Fever

3.Irritabilty

4.Confusion

5.Drowsiness and fatigue

Other symptoms are:

6.seizures and convulsions

7.vomiting

8.hallucinations

9.memory problems

10.tremors

11.weakness of the hands and legs

12.incontinence of urinary and bowel movement

The diagnosis of Encephalitis is made by:
1.Typical symptoms of fever, headache, confusion .

2.Physical examination shows confusion ,drowsiness and signs of neck rigidity

3.blood tests (complete blood count, ESR and blood culture)

4.cerebrospinal fluid analysis (CSF) via lumbar puncture is examined for increased white blood cells and protein content,  normal glucose level. Red blood cells may be present if there is bleeding. Sometimes the CSF may show the presence of micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs, or signs of raised ICP).

5.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

The complications of Encephalitis are:
1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome

7.seizures also more in children

8.pneumonia especially in the elderly

The treatment of Encephalitis is:
1.Hospitalisation should be immediate as Encephalitis can be a life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of antifungals may be given for Fungal Encephalitis for a prolonged period of time

3.corticosteroids is useful to reduce swelling and inflammation in the brain

4.Sedatives may be needed for irritabilty and restlessness

5.High-flow oxygen

6.intravenous fluids

The prognosis of Encephalitis is:
This depends on the severity and type of infection.

Viral infections except for herpes simplex usually recover quickly.

Bacterial infections such as meningococcus and pneumonia are more dangerous.

The Preventive measures taken for Encephalitis are:
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis and encephalitis.

Mumps vaccination as part of Measles,mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis and encephalitis

Vaccinations against Japanese Encephalitis is given for travelers going to endemic places with Japanese Encephalitis.

A Family Doctor's Tale - CANCER OF VULVA

DOC I HAVE CANCER OF THE VULVA

Cancer of the vulva is  a rare cancer in women which affects the vulva occurring usually in older women past menopause.

The average age is over 60.

The cancer is usually a squamous carcinoma.

Rare tumors are melanoma, basal cell carcinoma and sarcoma.

The most common site is the labium majus(side wall of the vulva) , followed by the clithoris but it may arise anywhere including the urethral area.

The cancer can spread locally to involve the whole vulva and invade the vagina.

Secondary spread of the cancer is along the lymphatic system.

The symptoms and signs of  cancer of the vulva are:

1.The cancer is usually symptomless until it ulcerates.

2.It can presents as a lump which is cauliflower in appearance or ulcerated or indurated.

3.inguinal lymph nodes may be enlarged in cases of spread.

4.There may be pain with ulceration or long standing itch.

Diagnosis of cancer of the vulva is by:

1.Physical examination may revealed a lump or more in the vulva region.

2.Biopsy of the lump may reveal cancer

3.Ultrasound may be able to detect any spread to the vagina, uterus or lymph gland.

The treatment of Cancer of the vulva is  :

1.Surgery:
If there is no evidence of spread, usually removal of the cancerous lump is sufficient.

If the evidence of spread to the entire vulva region, radical vulvectomy may be done together with removal of the inguinal lymph nodes.

Chemotherapy:
Chemotherapy may help to prevent the spread of the cancer or to prevent a reccurance.

Radiotherapy :
Radiotherapy is not a treatment of choice


Squamous cell carcinoma is relatively resistant to radiotherapy.


The vulval skin is also very sensitive the burning effect of radiotheray.


However in the very old and frail patients, radiotherapy may be considered as an alternative to multilating operation.

Prognosis of cancer of the vulva is:
If the lymph nodes are not involved, there is a chance of 70% 5 year cure rate.

If the superficial lymph nodes are involved, the cure rate drops to 40%.

If the pelvic lymph nodes are involved the cure rate drops to only 20%.

A Family Doctor's Tale - VESICOVAGINAL FISTULA

DOC I HAVE A VESICOVAGINAL FISTULA

Vesicovaginal Fistula is a chronic granulous track which communicate between the bladder base and the vagina.

Vesicovaginal Fistula usually result from :
1.operation through the vagina causing a hole through vaginal wall to bladder wall

2.follows surgery for hysterectomy

3.Pressure necrosis on the vaginal and bladder walls during a
prolonged and difficult labor.

4.Radiation burns during treatment of cancer of cervix

5.untreated cancer of bladder or genital tract in women

6.Chronic illness such as tuberculosis of bladder or genital tract in women

7.Congenital fistula between bladder and vagina

A veiscovaginal fistula have a natural tendency to close by granulation and fibrosis.

Factors interfering with this are:

1.continual flow of urine

2.sepsis

3.persistance of causative factor such as malignancy or radiation necrosis.

However if the urinary stream can be diverted by a cathether and good bladder drainage and if the sepsis is treated, the natural decrease in size will occur.

Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months

Symptoms:
1.incontinence

2.painful urination

3.frequent urination

4.vaginal discharge or wetness

5.painful vagina

Diagnosis:
1.Vaginal examination can show presence of fistula on the roof of vagina

2.Dye instilled into the bladder shows the dye leaking from the roof of vagina

3.Intravenous pyelogram also can show the contrast leaking into the vagina on X-ray.

Treatment of small fistula:
1.The urinary stream can be diverted by a cathether and good bladder drainage

2.The sepsis is treated with antibiotics
Without infection and the constant leakage of urine, the fistula will naturally decrease in size.

Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months

3.If this does not happened, the fistula can be easily stitched up.

Treatment of larger fistula:
The vaginal skin is cut open bigger than the fistula for the fresh edges to be stitched.

The granulated hardened edges of the original fistula will not join together so easily as when fresh new tissues are cut and stitched together.

A catheter is left in the bladder to drain the urine and antibiotics are given to prevent infection.

Painkillers may be given if there is pain after the operation.

General treatment:
1.Treatment of associated diseases like diabetes,  carcinoma

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

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

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

Prognosis is good with surgery.
Rarely there may undesirable complication like urinary incontinence.

A Simple Guide to Encephalitis

A Simple Guide to Encephalitis
-----------------------------------

What is Encephalitis?
---------------------------

Encephalitis is a serious medical disease which causes inflammation and infection of the brain.

What are the causes of Encephalitis?
----------------------------------------

The causes of Encephalitis may be divided into:

Infections:
------------
1.viral infections are the most common
(herpes simplex virus, mumps, measles, rubella, chickenpox, West Nile Encephalitis, Japanese Encephalitis, St Lious Encephalitis).

Of these viruses, herpes simplex virus is the most serious and can cause fatality.

2.bacterial infections such as meningoccocus(Neisseria meningitidis) and pneumococcus(Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal Encephalitis can cause outbreaks(spread easily).

3.fungi,
Cryptococcus neoformans is the most common cause of fungal Encephalitis

4.Parasitic
Examples are Toxoplasmosis, malaria, amoeba, Lyme Disease

What are Signs and symptoms of Encephalitis?
---------------------------------------------

The symptoms which often defines Encephalitis are:

1.Severe headache

2.Fever

3.Irritabilty

4.Confusion

5.Drowsiness and fatigue

Other symptoms are:

6.seizures and convulsions

7.vomiting

8.hallucinations

9.memory problems

10.tremors

11.weakness of the hands and legs

12.incontinence of urinary and bowel movement

How is the diagnosis of Encephalitis made?
------------------------------------------

1.Typical symptoms of fever, headache, confusion .

2.Physical examination shows confusion ,drowsiness and signs of neck rigidity

3.blood tests (complete blood count, ESR and blood culture) 

4.cerebrospinal fluid analysis (CSF) via lumbar puncture is examined for increased white blood cells and protein content,  normal glucose level. Red blood cells may be present if there is bleeding. Sometimes the CSF may show the presence of micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs, or signs of raised ICP).

5.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

What are the complications of Encephalitis?
-----------------------------------------------

1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome 

7.seizures also more in children

8.pneumonia especially in the elderly

What is the treatment of Encephalitis?
------------------------------------

1.Hospitalisation should be immediate as Encephalitis is an life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of antifungals may be given for Fungal Encephalitis for a prolonged period of time

3.corticosteroids is useful to reduce swelling and inflammation in the brain

4.Sedatives may be needed for irritabilty and restlessness

5.High-flow oxygen

6.intravenous fluids

What is the prognosis of Encephalitis?
------------------------------------------

This depends on the severity and type of infection.

Viral infections except for herpes simplex usually recover quickly.

Bacterial infections such as meningococcus and pneumonia are more dangerous.

What are the Preventive measures taken for Encephalitis?
--------------------------------------------------------

Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis and encephalitis.

Mumps vaccination as part of Measles,mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis and encephalitis

A Family Doctor's Tale -UTERINE PROLAPSE

DOC I HAVE UTERINE PROLAPSE

Uterine prolapse occurs when the ligaments and muscles holding the uterus in place has weakened to allow it to drop out of the vagina especially in a squatting position.

Causes of Uterine Prolapse:

1.Pregnancy and childbirth  -the physical trauma of  child birth can strain the pelvic muscles and ligaments to the extent that they are not as strong as before childbirth

2.large fibroids or pelvic tumors can cause pressure on the pelvic muscles downward by gravity

3.age  and menopause can weaken the pelvic muscles and the elasticity of the ligaments

4.Heavy lifting as in manual work can also strain and damage pelvic muscles

5.overweight women are more prone to prolapse

6.Pelvic or spinal surgery may damage nerves and  pelvic muscles increasing the risk of prolapse.

7.Genetic conditions or muscle dystrophy conditions may be responsible for weak muscles

8.Chronic coughing from smoking or the straining due to  constipation, increases the risk of prolapse

Symptoms and signs of uterine prolapse are:

1.Heaviness or protrusion out of the vagina

2.Some thing dropping out of the vaginal area

3.Discomfort or pain in pelvis, abdomen or back

4.Vaginal discharge is excessive or unusual

5.Frequency of urination or urine infection

6.Loss of control of urination(incontinence)

Symptoms may be worse in the evening after prolonged standing or walking

Signs of Uterine prolapse are:

1.Physical examination may show a protrusion of the uterus on squatting.

2.Vaginal examination show the degree of uterine prolapse especially in the standing position:

Stage I   Descent of the uterus to any point in the vagina above the level of the hymen

Stage II Descent to the level of the hymen

Stage III - Descent beyond the hymen

Stage IV - Total prolapse

3.Ultrasound of the pelvis may exclude other conditions than uterine prolapse

Treatment of Uterine Prolapse :

Conservative usually for mild cases of uterine prolapse:

1.Kegel exercises help to strengthen the pelvic floor muscles.

The patient is asked  to tighten the pelvic muscles by tightening the anus for a few seconds and then release many times a day.

2.Vaginal pessary is a rubber or plastic device which is placed around or under the cervix to  support the uterus and hold it in position.

Regular removal and cleaning is important to prevent infection.

It is a temporary measure.

Surgery:

This is the more permanent method of treatment.

1.Colpocleisis involves the removal of a part of anterior and posterior vaginal wall and closing of the margins of the two walls resulting in a small vaginal canal.

The uterus is thus unable to drop out of the smaller vaginal canal.

Success is 90-100%.

2.Sacrospinous fixation is a procedure where the uterosacral ligaments bilaterally is  sutured to the sacrospinous ligaments preventing the prolapse.

3.Sacrohysteropexy make use of a strip of synthetic mesh to hold the uterus in place in an operation done through a 15-cm incision or laparoscopy. One end of the mesh is attached to the cervix and top of the vagina and the other to the sacrum thus supporting the uterus.

4.Vaginal hysterectomy -the uterus is removed through the vagina and the uterosacral and cardinal ligaments are sutured together.

5.Abdominal hysterectomy is done when there is pelvic inflammatory disease or previous intra-abdominal operation when a vaginal hysterectomy is not advisable. The uterus is removed followed by a vaginal anterior and posterior colporrhaphy.

Prognosis of uterine prolapse indicates the treatment in most cases will relieve the symptoms and discomfort.

Prevention of uterine prolapse :

1.Avoid constipation by taking a healthy diet

2.Pelvic muscle exercise (Kegel exercises) should be done regularly

3.Avoid straing of pelvic muscle by using correct lifting techniques

4.Avoid smoking to prevent a chronic cough

A Family Doctor's Tale -ATROPHIC VAGINITIS

DOC I HAVE ATROPHIC VAGINITIS

Vaginal atrophy is the thinning of the vaginal wall of a woman appearing during or after menopause (the end of menstrual cycles).

Menopause in women usually occur between the age of 45 - 55 years old.

The cause of atrophic vaginitis is the decline of estrogens level in the female as she reaches menopause.

The loss of estrogen cause the lining of the vagina to become thinner and dryer.

Symptoms and signs of Atrophic Vaginitis are:

1.Irritation and itchiness from the dryness of the vaginal wall

2.Pain on sexual intercourse ( dyspareunia) as result of the dryness and lack of lubrication

3.Atrophic urethritis (inflammation of the opening of the bladder) -there is discomfort and frequent passing of urine with resultant urinary tract infections

4.Other menopausal symptoms such as hot flushes and night sweats, mood changes and tiredness

5. The vaginal mucosa is dry thin and shiny and bleeds easily.

The vagina is thus prone to infections.

The Pap smear show presence of small blue staining basal and parabasal cells in the mucosa of the vagina and cervix

The treatment of Atrophic Vaginitis is:

If the patient do not show any discomfort from the dryness and thinning of the vaginal wall , no treatment is necessary.

In Patients with symptoms, treatment involves:

1.Oestrogens  is an effective treatment for vaginal atrophy -reducing dryness and discomfort but must be used with precaution as it can cause stroke and thrombosis and endometrial cancer of the uterus.

It can prevent osteoporosis if taken early enough.

It however do not cause breast cancer or heart disease.

Estrogens can be given in the form of oral pills and skin implants.

2.Combined estrogen and progesterone therapy also reduce the effect of menopause such as vaginal atrophy, dryness of the internal lining of the genital tract and the skin and hot flushes.

It has been found that there is an increased risk of heart attack, cancer of the breast , thrombosis, and stroke.

Because of all these risks,  female hormone replacement therapy has fallen out of favor.

Instead of chemical hormones , natural plant female hormones such as primrose, soy, etc are used instead to reduce the symptoms of menopause.

3.Topical estrogen cream can be applied to the lining of the vagina once a week to reduce the dryness and discomfort in the vaginal wall.

4. Other moisturizer such as KY Vaginal moisturizer can also be used to reduce the dryness in atrophic vaginitis.

Prognosis of Atrophic Vaginitis is good if precautions are taken to prevent the dangerous side effects of female hormonal treatment.

 

A Family Doctor's Tale - BARTHOLIN CYST

DOC I HAVE  A BARTHOLIN CYST

Bartholin cyst is an acute cystic inflammation of the Bartholin gland at the vulva region in females.

Bartholin Gland lies behind the bulb of the vestibule which is the erectile tissue of the female.

When stimulated the bartholin gland which is covered by the erectile tissue(the bulb of the vestibule) will produce a mucoid discharge through a 2 cm duct opening in the vaginal orifice lateral to the hymen.

This mucoid discharge act as a lubricant during the sexual act.

Bartholin cyst occurs when the duct is blocked and forms a painless cyst occurring in the lower half of the vulval wall.

Normally only 1 bartholin gland is affected, rarely two at the same time.

If infection is present an acute abscess results.

Bartholin cyst and abscess can be usually caused by the following:

1.when the duct of the Bartholin gland is blocked by dirt or dead cell or injury.

The fluid which is produced by the gland then cause the gland to swell and forms a painless cyst occurring in the lower half of the vulval wall.

2.A Bartholin abscess occurs when a cyst becomes infected by a number of bacteria.

These bacterial organisms may be:

a.sexually transmitted diseases such as  gonorrhea and chlamydia

b.Escherichia coli and other bacteria normally found in the intestinal tract

Many of these abscesses may be infected by more than one micro-organism.

Symptoms of Bartholin cyst or abscess are:
1.swelling of the labia on one side, near the entrance to the vagina.

2.significant pain may indicate an abscess has formed.
Large cysts can be painful because their size may press against the vulva wall and the nerves.

3.Bartholin's abscess forms a swollen area with extremely tender and reddened skin

4.Walking and sitting may be very painful because of the swollen tender abscess may rub against the opposite vulva wall.

5.Vaginal discharge  is present  especially if the infection is caused by a sexually transmitted organism.

Diagnosis of Bartholin's cyst or abscess is usually made by:

1.physical examination :

a. presence of a lump at the lower part of the vulva wall
The vulva may  show inflammation and excoriation of lining

b.A painful swollen and red lump suggests that an abscess has formed.

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

3. biopsy of the suspicious vulva swelling to exclude other causes of vulva problem such as tumor

Treatment of Bartholin cyst or abscess involves the following:

1.Small Bartholin's cyst

sitz baths

2.Recurrent cysts or painful abscesss

antibiotics and sitz baths
Approprate Antibiotics is given  for infections especially after the results of the bacterial culture

3.Bartholin's abscesses and cysts that are large and painful

a.Incision and drainage of the abscess which is pus enclosed within an enclosed space.

Since antibiotics cannot adequately enter the enclosed space, incision of the enclosed bag of pus under local anesthetic followed by drainage of a Bartholin's abscess must be done .

After the infected material is drained, the abscess cavity is packed
with gauze keeping the cavity open and promotes further drainage.

Antibiotics and painkillers can be given to relieve the pain after the anesthetic wears off.


The gauze packing is removed after 24 hours.

b.Another surgery called marsupialization can be carried out for recurrent Bartholin cyst or abscess.

After cutting into the cyst wall, drainage of the fluid from the cyst is done.

Then the lining of the cyst wall is sutured to the overlying skin in such a way as to create a permanent hole which acts as a drain site.

This operation usually prevents recurrence of the cyst.

Prognosis of Bartholin cyst:

Prognosis is usually good with medical treatment and surgery.
Most patients  have relief after the 24 hours of drainage.

Prevention of Bartholin cyst:
1.Proper hygience after urination, sexual intercourse and bathing

2.Use of lubricants during sexual intercourse

3.Prompt treatment with sitz baths can prevent the formation of an abscess.

4.Safe sex practices with a single partner can decrease the spread of sexually transmitted diseases

A Family Doctor's Tale - POLYCYSTIC OVARIAN SYNDROME

DOC I HAVE POLYCYSTIC OVARIAN SYNDROME

Polycystic ovarian syndrome (PCOS) is a hormonal disease that causes women to have a combination of symptoms:

1.Oligomenorrhea -less menses than before

2.Obesity

3.Hirsutism -skin is more hairy

4.Infertility

Most women with PCOS have some small cysts in the ovaries hence the name Polycystic ovarian syndrome.

However cysts in the ovaries can be caused by a number of other illness than PCOS.

It is the characteristic  symptoms rather than the presence of the cysts that is important in the the diagnosis of PCOS.

PCOS occurs in 5% to 10% of women and is present in all races.

It is the main cause of infertility in women.

Symptoms of polycystic ovarian syndrome are:

1.menstrual disturbances  -

a.fewer than normal menstrual periods (oligomenorrhea),

b.the absence of menstruation for more than three months (secondary amenorrhea)

c.heavy bleeding (menorrhagia).

2.excess hair growth on the body (hirsutism),

3.obesity -excess weight gain,

4.infertility - due to  irregular or no release of eggs from the ovaries

5.multiple, small cysts in the ovaries.

Other symptoms are:

1.skin discolorations,

2.high cholesterol levels,

3.elevated blood pressure

4.raised insulin levels

5.raised androgen levels

6.oily skin,

7.dandruff,

The causes of polycystic ovarian syndrome (PCOS) are unknown but could be due to :
1.Genetic - Women with PCOS often have a mother or sister with the condition,

2. environmental factors:

a.exposure to male hormones

b chronic inflammation of the body from childhood illnesses

The diagnosis of PCOS is based on:

1.clinical signs and symptoms as  above

2.Serum male hormones (DHEA and testosterone) are usually raised

3.Blood luteining hormone which is secreted by the pituitary gland in the brain is usually raised

4.Ultrasound can also detect cysts in the ovaries

5.CT scan and MRI  detect cysts but are used mainly to exclude ovarian or adrenal gland tumors

The complications associated with PCOS are:
1. high blood pressure

2.diabetes

3.heart disease

4.cancer of the uterus (endometrial cancer).

5.infertility

6. abnormal levels of LDL ("bad") cholesterol and blood triglycerides

Treatment of PCOS is as follows:

1. Oral contraceptic pill with low androgenic (male hormone) side effects can help to  regulate menses and reduce the risk of cancer of the uterus

2.Oral Progesterone treatment used intermitently can induce regular menses

3.spironolactone (Aldactone)  can reduce water retention and acne

4. clomiphene (Clomid) can be given to infertile women with PCOS to induce ovulation (cause egg production)

5.Metformin used to treat type 2 diabetes reduce the action of insulin and reduce the symptoms and complications of PCOS such as irregular periods, ovulation induction, weight loss, prevention of type 2 diabetes

6.gonadotropin hormones injection can help women who wish to have babies and do not want to be on Clomid treatment which cause multiple pregnancies

7.weight loss in obese females with PCOS can cause menstrual cycles to be normal and increases the possibility of pregnancy.

Weight loss can help reduce or prevent the complications associated with PCOS, including diabetes and heart disease.

8. ovarian drilling (some ovarian tissue is removed bypassing an electric current through a needle inserted into the ovary)can  induce ovulation in women who are not responding  to other treatments

Prognosis is good for patient to regulate menses but not so good for infertility.

A Family Doctor's Tale - MISCARRIAGE

DOC I HAVE A MISCARRIAGE

Miscarriage or spontaneous abortion is defined as the premature expulsion of contents from a pregnant uterus.

About 10-15 per cent of all pregnancies ends in spontaneous abortion.

Spontaneous abortion is most likely to occur between the 6th and 10th week of pregnancy.

Causes of miscarriage:
1.Fetus development:
most common cause is the fetus is unable to develop a heart or brain to sustain living and hence dies on its own with fetus remnants being expelled from the womb

2.Hormonal
low progesterone secretion prevents the the placenta to attach securely to the wall of the womb and hence the the detached fetus is expelled from the womb

3.Iatrogenic:
attempts by pregnant mothers to induce an abortion by taking poisons, ergometrine, hormones, chinese medicines may sometimes be successful

4.Maternal factors:
In later pregnancies, maternal factors like acute illness, hypertension, endocrine disease like diabetes, uterine abnormalities may play a part in spontaneous abortion

Signs and Symptoms:

1.Threatened Abortion:

vaginal bleeding occurs during the first 28 weeks of pregnancy, starting from the uterus with uterine contractions and without dilatation of the cervical os.

2. Inevitable Abortion:

miscarriage is inevitable if uterine contractions are strong and the cervical os is open.

3.Complete Abortion:

This occurs when the products of conception are passed out through the vagina.

It is incomplete abortion if the miscarriage is partial.

4.Missed Abortion:

This happened when the dead embryo and placenta are not passed spontaneously.

If there is incomplete abortion there is a danger of septic abortion.

5.Septic Abortion:

There is fever, rapid heart beat, foul smelling vaginal discharge, tender uterus and leucocytosis  , all symptoms of septicemia.

The cause is usually E. coli or clostridium bacteria.

Habitual abortion :

This occurs when the uterus has cervical incompetance or is bicornuate


Investigations and diagnosis of abortion need to be confirmed by :

1. Vaginal examination

2.Ultrasound scan of the uterus

3. Blood human placenta lactogen and human choriongenic hormones should be helpful to determine the strength of the pregnancy

4.High vaginal swab is important to determine cause of infection

5.Dilation and curretage of missed abortion

Treatment of Miscarriage:

1. Threatened abortion :

Bed rest is very important


Avoid sexual intercourse

2. Incomplete Abortion:

Treatment of shock

Dilation and currettage of the uterus

3.Septic Abortion:

Appropriate antibiotics should be given

4.Missed Abortion:

Dilatation and currettage

5.Habitual Abortion:

a suture should be sewn around the cervical os to tighten the opening and prevent the embryo sac to slip through the os .

A Family Doctor's Tale -G6PD DEFICIENCY

DOC I HAVE G6PD DEFICIENCY

G6PD Deficiency  is an inherited disorder of the Red blood cells which has a lack of the glucose-6-phosphate dehydrogenase enzyme.

This causes the red blood cells to burst (hemolysis) in certain circumstances when certain food, herbs or medicines are taken.

It is a lifelong disease and there is no cure for it.

10 per cent of the world population is believed to have it.


It is  more common in Asians and Africans, less so in Caucasians.

There are 2 types of G6PD Deficiency:
1.G6PD Deficiency major which is a serious illness which occurs as a sex linked genetic disease affecting the males.

2.G6PD Deficiency minor occurs in the females and can also cause red blood cells break up as in the the major form of the disease.

Here the female can pass the gene to the male child(resulting in the major illness) and the female child(resulting in the female child as the carrier of the gene).

Not all mothers with the gene will pass it to the son or daughter.

The  risk of G6PD Deficiency is:
G6PD Deficiency results from a defective gene which provides for the enzyme in the red blood cell which preserve the integrity of the red blood cell.

When the child takes certain food, herbs or chemicals, the absence of the enzyme cause the red blood cell to burst resulting in hemolytic anemia, release of bilirubin and passing of blood through the urine.

If both parents has this faulty gene then the male child will have G6PD Deficiency major and the female child may have the minor illness which allows her to pass the gene to her son.

If the female parent has the faulty gene then the child may have the gene passed to him or her.

If only male parent has the faulty gene then the child will not have the gene passed to him or her.

The red blood cells are normal sized and breaking up easily under certain circumstances to cause a severe anemia.

Triggers which can cause an attack of red blood cells breakup (hemolysis) in G6PD Deficiency are:
1. Certain food - fava beans (also known as broad beans)


2. Chinese herbs especially Huang Lian

3. Medicines
a. Sulphonamides, septrin

b. Antimalaria drugs such as chloroquine, quinine,

c.analgesics such as aspirin,

d.Non-sulphonamide antibiotic such as nalidixic acid, nitrofurantoin, isoniazide, dapsone

4.naphthalene or moth balls

5.some bacterial or viral infections


The symptoms of hemolysis in G6PD Deficiency are:
1.Anemia - pale

2.blood in the urine

3.vomiting

4.abdominal pain

5.Slight jaundice

6.rapid heart beats , lethargy and symptoms of shock


Diagnosis of G6PD Deficiency is often based on
1. blood test for G6PD deficiency - rapid fluorescent spot test detecting the generation of NADPH from NADP

2. microscopic examination of red blood cells(Heinz bodies can be seen in G6PD deficient patients red blood cells)


3. Genetic analysis

The complications of hemolysis in G6PD Deficiency are:

1. Anemia

2. damage to liver

3. shock and death

The treatment of hemolysis in G6PD Deficiency is:
1.Blood transfusion

2.treatment for shock

3.Folic acid to build up the blood


The prognosis of hemolysis in G6PD Deficiency is:

Prognosis is good if treatment is early.

The patient must take care of himself or herself and remembers what are the food, medicines or herbs he cannot take.

Prevention of G6PD Deficiency is by:
1.testing cord blood for G6pd deficiency at birth


2.patient education of his condition and avoidance of certain food or medicines.