DOC I HAVE DEMENTIA
Dementia is a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life.
In Dementia there is a severe and progressive decline in mental function.
It affects a person's ability to:
1.think,remember and reason
2.learn new information and skills
3.solve problems and make judgement
The causes of Dementia are :
There are several different factors which may contribute to its development.
They can be divided into:
1.Irreversible conditions
a.Aging is one important risk factor.
Alzeimer's Disease
b.Stroke
c.Parkinson's disease
2.Reversible conditions
a.Hypothyroidism
b.Vitamin B12 deficiency
c.Alcohol dependence diseases
Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease.
It may be possible treat the cognitive symptoms.
Potentially reversible dementia may be curable.
The Symptoms of Dementia are:
1.Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)
2.Confusion(Disorientation in time and place) ,
3.Trouble with organizing
4.Misplacing things,
5.Difficulty in expressing thoughts,
6.Difficulty performing familiar tasks
7.Difficulty understanding others
8.Poor or decreased judgment
9.Wandering and getting lost in familiar places
10.Changes in mood and behaviour (They may become easily agitated or depressed)
a.Changes in personality
b.paranoia
c.hallucinations
d.agitation
e.anxiety
f.sleep problems
Dementia should be assessed and investigated.
Diagnosis can be based on :
1.History of depression, anxiety, hallucination, paranoia, agitation or sleep problems
2.Various tests may be done to exclude other conditions that may be causing the same problems:
a.blood sugar, thyroid hormone, vitamin B12 level
b.CT Scan or MRI of the brain to exclude tumors or stroke
The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected.
The Management of Dementia is by:
Dementia is quite common in old people.
Referral to a psychiatrist may then be necessary for assessement and advice on management.
Management of dementia usually involve :
1.Treatment of reversible causes and risk factors:
a.treatment of any reversible causes such as hypothyroidism(thyroxine tabs), Vitamin B12 deficiency(injections of Vitamin B12 or B12 oral tablets)
b.reduction of risk facors for stroke such as diabetes, hypertension, high cholesterol
c.Use of blood thinning medicines such aspirin, plavix, ticlid, warfarin to prevent stroke
2.At the present moment there is no cure for non reversible Dementia but there are many ways to reduce the behavioural and psychological symptoms.
These including having
a.a fixed routine daily,
b.making the home and surroundings safe and familiar
c.using memory aids like diaries and calendars.
d.social interactions and contacts with other patients
e.activity programs
3.There are now drugs available to help delay or prevent symptoms from becoming worse:
a.One group of drugs helps improve the ability to think, understand, and remember.(Donepezil, Rivastigmine, Galantamine, Memantine) .
There may be improvement of the symptoms but ultimately they do not prevent the disease from getting worse.
b.Another group of drugs is also to help with behavioural problems associated with Dementia, such as aggressiveness, agitation, depression, and anxiety.(Prozac, Seroxat, Zoloft)
4.Caring for a patient with dementia can be frustrating and stressful.
It gets worse as the disease progresses.
There are now support groups and organisations which can help caregivers providing:.
a.education on dementia and caretaker skills
b.individual and family couseling
c.caretaker support groups
d.dementia day care service
Sunday, July 10, 2011
Friday, July 8, 2011
A Family Doctor's Tale - ROSEOLA INFANTUM
DOC I HAVE ROSEOLA INFANTUM
Roseola Infantum is usually a contagious childhood infection caused by the Roseola Infantum virus.
It is also known as "false measles" because of the appearance of its rashes which appear from the face and spread down to the legs and fever.
It is characterized by typical prodromal symptoms of fever, runny nose , cough, generalised rash and cervical lymphadenopathy
Any one at any age can contract Roseola Infantum but it usually occurs before the age of 2 years old because by that time most of the children has immunity to the virus.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.
There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever
2.coughing,
3.runny nose, stuffy nose,
4.tiredness,
5.red eyes, tearing. ,
6.Roseola Infantum rash usually occurs after the onset of fever.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, palms and soles.
The rash begins to fade in about four days .
There may be a brownish discoloration in areas of affected skin rahes but this is only temporary.
7. enlarged lymph glands may be felt in the neck and groins
8.inflammation of the eyes (conjunctivitis) with tearing may also occurs.
9. diarrhoea and vomiting may occurs in some patients.
Children who have had Roseola Infantum develop a natural immunity and cannot contract it again.
Complications are rare and include:
1.Ear infection (Otitis Media) is a common complication of Roseola Infantum.
2.pneumonia in very young children may be dangerous.
3.encephalitis (brain infection)may occur in rare cases
There is no cure for Roseola Infantum.
Treatment is therefore symptomatic.
1.Fever symptoms are treated with acetaminophen (Paracetamol).
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain
2.Itch may be controlled by antihistamines which can also help to relieve the runny nose.
3.Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia..
4.Cough mixtures may be given to relieve the cough.
5.Plenty of bed rest is necessary.
6.Lots of fluids helps to prevent dehydration.
Most patients recover completely from Roseola Infantum.
Roseola Infantum is usually a contagious childhood infection caused by the Roseola Infantum virus.
It is also known as "false measles" because of the appearance of its rashes which appear from the face and spread down to the legs and fever.
It is characterized by typical prodromal symptoms of fever, runny nose , cough, generalised rash and cervical lymphadenopathy
Any one at any age can contract Roseola Infantum but it usually occurs before the age of 2 years old because by that time most of the children has immunity to the virus.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.
There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever
2.coughing,
3.runny nose, stuffy nose,
4.tiredness,
5.red eyes, tearing. ,
6.Roseola Infantum rash usually occurs after the onset of fever.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, palms and soles.
The rash begins to fade in about four days .
There may be a brownish discoloration in areas of affected skin rahes but this is only temporary.
7. enlarged lymph glands may be felt in the neck and groins
8.inflammation of the eyes (conjunctivitis) with tearing may also occurs.
9. diarrhoea and vomiting may occurs in some patients.
Children who have had Roseola Infantum develop a natural immunity and cannot contract it again.
Complications are rare and include:
1.Ear infection (Otitis Media) is a common complication of Roseola Infantum.
2.pneumonia in very young children may be dangerous.
3.encephalitis (brain infection)may occur in rare cases
There is no cure for Roseola Infantum.
Treatment is therefore symptomatic.
1.Fever symptoms are treated with acetaminophen (Paracetamol).
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain
2.Itch may be controlled by antihistamines which can also help to relieve the runny nose.
3.Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia..
4.Cough mixtures may be given to relieve the cough.
5.Plenty of bed rest is necessary.
6.Lots of fluids helps to prevent dehydration.
Most patients recover completely from Roseola Infantum.
Wednesday, July 6, 2011
A Family Doctor's Tale - SCARLET FEVER
DOC I HAVE SCARLET FEVER
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
The Signs and Symptoms of Scarlet Fever are:
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrades
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever , rash and strawberry tongue
2.ESR raised very high sometimes > 80
3.moderate leucocytosis
4.Throat swab for culture ans sensitivity
The complications of Scarlet Fever are:
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
The Treatment of Scarlet Fever is:
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
The Prevention for Scarlet Fever is by:
Avoiding infected patients
Use a mask in clouded places
General personal hygiene including washing hands after contact with possible contact with mucous discharge from nose, infected items or clothing and after meals
Recently in June 2011 there is an outbreak of new cases of Scarlet Fever in Hong Kong.
Prognosis of Scarlet Fever is good.
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
The Signs and Symptoms of Scarlet Fever are:
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrades
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever , rash and strawberry tongue
2.ESR raised very high sometimes > 80
3.moderate leucocytosis
4.Throat swab for culture ans sensitivity
The complications of Scarlet Fever are:
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
The Treatment of Scarlet Fever is:
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
The Prevention for Scarlet Fever is by:
Avoiding infected patients
Use a mask in clouded places
General personal hygiene including washing hands after contact with possible contact with mucous discharge from nose, infected items or clothing and after meals
Recently in June 2011 there is an outbreak of new cases of Scarlet Fever in Hong Kong.
Prognosis of Scarlet Fever is good.
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
Monday, July 4, 2011
A Family Doctor's Tale - HYPOPARATHYROIDISM
DOC I HAVE HYPOPARATHYROIDISM
Hypoparathyroid disease is a condition when the parathyroid gland produces too little parathyroid hormones resulting in hypocalcemia.
Hypoparathyroid disease is caused by:
Primary
Primary Hypoparathyroid disease is a rare congenital condition which usually occurs in children below the age of sixteen but can persists throughout adult life
Secondary.
Secondary Hypoparathyroid disease is usually related to surgical resection of the thyroid during which partial to total removal of the parthyroid gland occurs.
As a result of better surgical techniques , less permanent loss of the parathyroid glands occurs during throidectomy.
Instead transient deficiency may occur due to injuries to the parathyroid glands during the surgery, temporary reduction of blood supply to the parathyroid gland and hemorrhage during the surgery.
Neither the administration of radfioactive iodine or radiation to the thyroid gland has been known to cause Secondary Hypoparathyroid disease.
Symptoms:
1.tetany from lowered blood calcium
Tetany which appeared in 70 per cent of cases appears as a carpopedal spasm where the stiff hollowed hand with rigid fingers is flexed at the second metacarpal-phalangeal joint, wrist and elbow joints and the legs and feet are extended.
2.epileptic fits and tonic convulsions occurs in 40 per cent of cases
3.laryngeal spasm of muscles (may be dangerous)
4.spasm of the smooth muscle of blood vessel causing numbness due to poor blood circulation
5.diarrhea due to spasm of the smooth muscles of the gastrintestinal tract
6.mental changes including anxiety, depression, psychoses
Signs:
1.neuromuscular excitabilty may show up as contraction of the facial muscles in response to a light tap on the facial nerve in front of the ear(Chvostek's sign)
2.Dorsal flexion and abduction of the foot may occur by a tapping the lateral surface of the fibula just below its heal(Peroneal sign)
3.Inflation of a blood pressure cuff above the systolic pressure may cause the hand the typical position seen in carpopedal spasm(Trousseau's sign)
4.Skin is dry rough and scaly with patchy or generalised erythema
5.Nails may be brittle with transverse ridges
Diagnosis:
1. blood test is done for presence of low parathyroid hormone levels.
2. Blood calcium is low in hypoparathyroidism
3. Blood phosphate is high in primary
Treatment:
1.Hypocalcemia is treated with intravenous injections of calcium gluconate under cardiac monitoring as excess calcium may affect the heart
2.oral Calcium supplements(Calcium Chloride is the most effective) is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
surgery of thyroid gland should be done carefully so as not to remove the parathyroid gland or damage it
Hypoparathyroid disease is a condition when the parathyroid gland produces too little parathyroid hormones resulting in hypocalcemia.
Hypoparathyroid disease is caused by:
Primary
Primary Hypoparathyroid disease is a rare congenital condition which usually occurs in children below the age of sixteen but can persists throughout adult life
Secondary.
Secondary Hypoparathyroid disease is usually related to surgical resection of the thyroid during which partial to total removal of the parthyroid gland occurs.
As a result of better surgical techniques , less permanent loss of the parathyroid glands occurs during throidectomy.
Instead transient deficiency may occur due to injuries to the parathyroid glands during the surgery, temporary reduction of blood supply to the parathyroid gland and hemorrhage during the surgery.
Neither the administration of radfioactive iodine or radiation to the thyroid gland has been known to cause Secondary Hypoparathyroid disease.
Symptoms:
1.tetany from lowered blood calcium
Tetany which appeared in 70 per cent of cases appears as a carpopedal spasm where the stiff hollowed hand with rigid fingers is flexed at the second metacarpal-phalangeal joint, wrist and elbow joints and the legs and feet are extended.
2.epileptic fits and tonic convulsions occurs in 40 per cent of cases
3.laryngeal spasm of muscles (may be dangerous)
4.spasm of the smooth muscle of blood vessel causing numbness due to poor blood circulation
5.diarrhea due to spasm of the smooth muscles of the gastrintestinal tract
6.mental changes including anxiety, depression, psychoses
Signs:
1.neuromuscular excitabilty may show up as contraction of the facial muscles in response to a light tap on the facial nerve in front of the ear(Chvostek's sign)
2.Dorsal flexion and abduction of the foot may occur by a tapping the lateral surface of the fibula just below its heal(Peroneal sign)
3.Inflation of a blood pressure cuff above the systolic pressure may cause the hand the typical position seen in carpopedal spasm(Trousseau's sign)
4.Skin is dry rough and scaly with patchy or generalised erythema
5.Nails may be brittle with transverse ridges
Diagnosis:
1. blood test is done for presence of low parathyroid hormone levels.
2. Blood calcium is low in hypoparathyroidism
3. Blood phosphate is high in primary
Treatment:
1.Hypocalcemia is treated with intravenous injections of calcium gluconate under cardiac monitoring as excess calcium may affect the heart
2.oral Calcium supplements(Calcium Chloride is the most effective) is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
surgery of thyroid gland should be done carefully so as not to remove the parathyroid gland or damage it
Saturday, July 2, 2011
Thursday, June 30, 2011
A Family Doctor's Tale - HYPOCALCEMIA
DOC I HAVE HYPOCALCEMIA
Hypocalcemia is defined as low Calcium (less than 8.4 mg per liter) in the blood.
Normal blood Calcium varies from 8.4 to 10.4 mg per liter.
Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal
Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.
Vitamin D increases the intestinal absorption of calcium and phosphate.
Hypocalcemia or low calcium level in the blood is caused by:
1.Hypoparathyroidism from surgical removal of parathyroid gland during thyroidectomy
2.Idiopathic hypoparathyroidism from genetic causes, sometimes unknown causes
3.Malabsorption of calcium, Vitamin D or phosphates from diet.
4.Hypoalbuminemia
5.Chronic renal failure
5.Osteomalacia -lack of mineralization of the bone matrix
6.Rickets - abnormal condition of the bones caused by low Vitamin D
7. Hyperventilation- calcium is bonded to the carbonate in the blood. If the carbon dioxide level in the blood is low, then less calcium is present because the carbonate in the blood is low.
Symptoms of hypocalcemia:
1.neuromuscular hyperexcitabilty resulting in tetany(a cramp condition of the index finger )
2.convulsions
3.stridor -due to tightening of the muscle of vocal cord
4.smooth muscles tightening
5.diarrhea
Signs:
1.Trousseau's sign - Raising the blood pressure to 200 systolic using the blood pressure cuff on the upper arm can cause the typical sign of tetany or obstretician's finger in hypocalcemia
2.Chvostek's sign - tapping the seventh nerve on the same side of the jaw as the tetany sign can cause the finger to jerk confirming hypocalcemia
Diagnosis:
1.Plasma Calcium levels
2.Blood phosphate level
3.Total serum protein levels
low serum calcium in the presence of low albumin allows a higher free cacium concentration making the patient to be normocalcemic. (normal blood cacium)
4.Bone density test
Treatment:
1.Intravenous calcium carbonate under cardiac monitoring as excessive calcium may affect the heart
2.oral Calcium supplements is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
Hypocalcemia is defined as low Calcium (less than 8.4 mg per liter) in the blood.
Normal blood Calcium varies from 8.4 to 10.4 mg per liter.
Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal
Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.
Vitamin D increases the intestinal absorption of calcium and phosphate.
Hypocalcemia or low calcium level in the blood is caused by:
1.Hypoparathyroidism from surgical removal of parathyroid gland during thyroidectomy
2.Idiopathic hypoparathyroidism from genetic causes, sometimes unknown causes
3.Malabsorption of calcium, Vitamin D or phosphates from diet.
4.Hypoalbuminemia
5.Chronic renal failure
5.Osteomalacia -lack of mineralization of the bone matrix
6.Rickets - abnormal condition of the bones caused by low Vitamin D
7. Hyperventilation- calcium is bonded to the carbonate in the blood. If the carbon dioxide level in the blood is low, then less calcium is present because the carbonate in the blood is low.
Symptoms of hypocalcemia:
1.neuromuscular hyperexcitabilty resulting in tetany(a cramp condition of the index finger )
2.convulsions
3.stridor -due to tightening of the muscle of vocal cord
4.smooth muscles tightening
5.diarrhea
Signs:
1.Trousseau's sign - Raising the blood pressure to 200 systolic using the blood pressure cuff on the upper arm can cause the typical sign of tetany or obstretician's finger in hypocalcemia
2.Chvostek's sign - tapping the seventh nerve on the same side of the jaw as the tetany sign can cause the finger to jerk confirming hypocalcemia
Diagnosis:
1.Plasma Calcium levels
2.Blood phosphate level
3.Total serum protein levels
low serum calcium in the presence of low albumin allows a higher free cacium concentration making the patient to be normocalcemic. (normal blood cacium)
4.Bone density test
Treatment:
1.Intravenous calcium carbonate under cardiac monitoring as excessive calcium may affect the heart
2.oral Calcium supplements is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
Tuesday, June 28, 2011
A Family Doctor's Tale - HYPERCALCEMIA
DOC I HAVE HYPERCALCEMIA
Hypercalcemia is defined as high calcium(above 10.4 md per liter) in the blood.
Normal blood Calcium varies from 8.4 to 10.4 mg per liter.
Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal
Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.
Vitamin D increases the intestinal absorption of calcium and phosphate.
Hypercalcemia occurs with high calcium due to:
1.High parathyroid hormones due to parathyoid adenomas
2.Vitamin D excess
3.Various malignancies including myeloma and leukemia.
4.breast tumors and metastases
5.sarcoidosis
Symptoms of Hypercalcemia:
1.weakness
2.lethargy
3.intractable nausea and vomiting
4.dehydration
5.constipation
6.coma
7.cardiac arrthymia
8.calcification of joint or skin
Diagnosis:
1.Plasma calcium and phosphate levels
2.Blood sodium bicarbonate and gases
3.Blood albumin and proteins
4.Joint Xrays in cases of joint calcification
Complications:
1.Calcification of gouty trophi
2.renal stones
3.Cacific tendonitis
4.Myositis ossificans
5.chondrocalcinosis
6.phosphate arthropathy
Treatment:
Acute hypercalcemia is a medical emergency because of its effect on the heart rhythm.
1.Immediate treatment of intravenous isotonic saline and
2.a powerful diuretic such as frusemide to induce excess calcium to pass out through the urine
3.Phosphate intravenously or orally can also be effective to reduce the calcium from the blood although it may cause diarrhea
4.Corticosteroids are also effective in reducing calcium blood levels.
5.Treat underlying cause.
6.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea
Hypercalcemia is defined as high calcium(above 10.4 md per liter) in the blood.
Normal blood Calcium varies from 8.4 to 10.4 mg per liter.
Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal
Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.
Vitamin D increases the intestinal absorption of calcium and phosphate.
Hypercalcemia occurs with high calcium due to:
1.High parathyroid hormones due to parathyoid adenomas
2.Vitamin D excess
3.Various malignancies including myeloma and leukemia.
4.breast tumors and metastases
5.sarcoidosis
Symptoms of Hypercalcemia:
1.weakness
2.lethargy
3.intractable nausea and vomiting
4.dehydration
5.constipation
6.coma
7.cardiac arrthymia
8.calcification of joint or skin
Diagnosis:
1.Plasma calcium and phosphate levels
2.Blood sodium bicarbonate and gases
3.Blood albumin and proteins
4.Joint Xrays in cases of joint calcification
Complications:
1.Calcification of gouty trophi
2.renal stones
3.Cacific tendonitis
4.Myositis ossificans
5.chondrocalcinosis
6.phosphate arthropathy
Treatment:
Acute hypercalcemia is a medical emergency because of its effect on the heart rhythm.
1.Immediate treatment of intravenous isotonic saline and
2.a powerful diuretic such as frusemide to induce excess calcium to pass out through the urine
3.Phosphate intravenously or orally can also be effective to reduce the calcium from the blood although it may cause diarrhea
4.Corticosteroids are also effective in reducing calcium blood levels.
5.Treat underlying cause.
6.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea
A Simple guide to Scarlet Fever
A Simple guide to Scarlet Fever
-----------------------------------------------
What is Scarlet Fever?
------------------------------------
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
How is Scarlet Fever transmitted?
-----------------------------------------------
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
What are the Signs and Symptoms of Scarlet Fever ?
------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever and rash
2.ESR raised very high somtimes > 80
3.moderate leucytosis
4.Throat swab for culture and sensitivity
What are the complications of Scarlet Fever?
----------------------------------------------------------------
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
What is the Treatment of Scarlet Fever?
------------------------------------------------------------
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
What is the Prevention for Scarlet Fever?
---------------------------------------------------
Avoiding infected patients
Recently there are new cases of Scarlet Fever in Hong Kong.
What is the Prognosis of Scarlet Fever?
-------------------------------------------------
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
-----------------------------------------------
What is Scarlet Fever?
------------------------------------
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
How is Scarlet Fever transmitted?
-----------------------------------------------
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
What are the Signs and Symptoms of Scarlet Fever ?
------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever and rash
2.ESR raised very high somtimes > 80
3.moderate leucytosis
4.Throat swab for culture and sensitivity
What are the complications of Scarlet Fever?
----------------------------------------------------------------
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
What is the Treatment of Scarlet Fever?
------------------------------------------------------------
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
What is the Prevention for Scarlet Fever?
---------------------------------------------------
Avoiding infected patients
Recently there are new cases of Scarlet Fever in Hong Kong.
What is the Prognosis of Scarlet Fever?
-------------------------------------------------
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
Sunday, June 26, 2011
A Family Doctor's Tale - HYPERNATREMIA
DOC I HAVE HYPERNATREMIA
Hypernatremia is defined as high Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinent of intracellular volume of cells and intracellular osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hypernatremia occurs with high sodium due to:
1.dehydration from insufficient water intake or excess water loss
2.impaired renal function cause retention of sodium
3.cardiac disease can cause retention of salt
4.excess intake of salt
Symptoms of Hypernatremia:
1.edema
2.peripheral muscles tetany
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.More intake of water may reduce concentration of sodium
2.diuretic to induce excess sodium to pass out through the urine
3.Infusion of sodium bicarbonate to induce alkalosis
4.Infusion of calcium bicarbonate to induce alkalosis
4.administer Sodium binding resins by mouth
5.Treat underlying cause.
6.Frequent monitoring of progress by blood studies
7.hemodialysis
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea
Hypernatremia is defined as high Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinent of intracellular volume of cells and intracellular osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hypernatremia occurs with high sodium due to:
1.dehydration from insufficient water intake or excess water loss
2.impaired renal function cause retention of sodium
3.cardiac disease can cause retention of salt
4.excess intake of salt
Symptoms of Hypernatremia:
1.edema
2.peripheral muscles tetany
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.More intake of water may reduce concentration of sodium
2.diuretic to induce excess sodium to pass out through the urine
3.Infusion of sodium bicarbonate to induce alkalosis
4.Infusion of calcium bicarbonate to induce alkalosis
4.administer Sodium binding resins by mouth
5.Treat underlying cause.
6.Frequent monitoring of progress by blood studies
7.hemodialysis
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea
Friday, June 24, 2011
A Family Doctor's Tale - HYPONATREMIA
DOC I HAVE HYPONATREMIA
Hyponatremia is defined as low Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinant of intracellular volume of cells and intracellular osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hyponatremia occurs with loss of salt through:
1.gastrointestinal -vomiting and diarrhea
2.urinary loss especially following use of Sodium wasting diuretics
3.sweating
4.fistula
5.diabetes mellitus.
Symptoms of hyponatremia:
1.lethargy
2.generalized fatigue
3.muscle weakness
4.reduced urination
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.oral Sodium chloride (or salt) is given in most cases with improvement of blood Sodium level
2.Intravenous Sodium chloride dextrose solutionis given in emergency cases.
3.Bicarbonate or lactate infusion may help correct acid base disorders depending on underlying cause.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
Hyponatremia is defined as low Sodium in the blood.
Normal blood Sodium varies from 136 to 145 mmol per liter.
Extracellular Sodium level represents only 2 per cent of the total body Sodium.
Sodium is a major determinant of intracellular volume of cells and intracellular osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular Sodium concentrations.
Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.
Hyponatremia occurs with loss of salt through:
1.gastrointestinal -vomiting and diarrhea
2.urinary loss especially following use of Sodium wasting diuretics
3.sweating
4.fistula
5.diabetes mellitus.
Symptoms of hyponatremia:
1.lethargy
2.generalized fatigue
3.muscle weakness
4.reduced urination
Diagnosis:
1.Plasma Sodium levels
2.Blood sodium bicarbonate and gases
3.Urinary electrolytes
Treatment:
1.oral Sodium chloride (or salt) is given in most cases with improvement of blood Sodium level
2.Intravenous Sodium chloride dextrose solutionis given in emergency cases.
3.Bicarbonate or lactate infusion may help correct acid base disorders depending on underlying cause.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
Wednesday, June 22, 2011
A Family Doctor's Tale - DIARRHEA
DOC I HAVE DIARRHEA
Diarrhea is a symptom defined as an increase in the volume, water content and frequency of bowel movements.
Diarrhea is a symptom of many gastrointestinal disorders:
1.Infections:
Bacterial infections such as:
a.Shigella
b.Salmonella and typhoid
c.cholera
Viral infections such as:
a,enterovirus
b.rotavirus
Protozoan infections such as:
a.amoebic
b.giardia
2.Toxins from bacteria in contaminated food:
a.E.coli food poisoning (enterotoxins)
b.staphaloccal food poisoning (preformed toxins)
3.Antibiotic usage:
pseudomembraous enterocolitis
4.Food Intolerance
a.Lactose or sugar intolerance
b.Gluten sensitive enteropathy:
celiac disease, nontropical sprue
5.Inflammatory diseases of the intestine:
a.crohn's disease or regional ileitis
b.ulcerative colitis
6.Malabsorption syndromes
a.malabsorption of bile acids
b.pancreatic steatorrhea
c.ileal resection
7.Cancers:
a.colon
b.rectal cancers
8.Tumors especially hormonal producing tumors:
a,gastrinoma
b.Zollinger-Ellison syndrome
c.glucaglonoma
d.carcinoid tumors
9.Drug induced:
a.excessive use of laxatives
b.magnesium antacids which absorbs water into intestine
c.stimulant cathartics
10.Rapid intestinal movement:
a.Irritable bowel syndrome
b.resection of bowels in tumors or fistula
c.vagotomy
d.other surgery of intestine
rhea with blood and mucus
Diarrhea is investigated by:
1.full investigation of the possible underlying causes
2.Macroscopic and microscopic examination of the stools:
e.g rice water is typical of cholera
3.culture and sensitivity to antibiotic of the stools
4.Full blood count and electrolytes
Treatment of Diarrhea 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 light headedness
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.Specific treatment if available for underling conditions eg.antibiotic the choice of which depends on the sensitivity of bacteria to the antibiotic.
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 Diarrhea.
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 of diarrhea depends on the cause:
Usual outcome of acute diarrhea is excellent if treated early.
For chronic diarrhea, the underlying cause must be treated.
Outcome is usually excellent with appropriate treatment.
Prevention of Infections causing Diarrhea is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your 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
Diarrhea is a symptom defined as an increase in the volume, water content and frequency of bowel movements.
Diarrhea is a symptom of many gastrointestinal disorders:
1.Infections:
Bacterial infections such as:
a.Shigella
b.Salmonella and typhoid
c.cholera
Viral infections such as:
a,enterovirus
b.rotavirus
Protozoan infections such as:
a.amoebic
b.giardia
2.Toxins from bacteria in contaminated food:
a.E.coli food poisoning (enterotoxins)
b.staphaloccal food poisoning (preformed toxins)
3.Antibiotic usage:
pseudomembraous enterocolitis
4.Food Intolerance
a.Lactose or sugar intolerance
b.Gluten sensitive enteropathy:
celiac disease, nontropical sprue
5.Inflammatory diseases of the intestine:
a.crohn's disease or regional ileitis
b.ulcerative colitis
6.Malabsorption syndromes
a.malabsorption of bile acids
b.pancreatic steatorrhea
c.ileal resection
7.Cancers:
a.colon
b.rectal cancers
8.Tumors especially hormonal producing tumors:
a,gastrinoma
b.Zollinger-Ellison syndrome
c.glucaglonoma
d.carcinoid tumors
9.Drug induced:
a.excessive use of laxatives
b.magnesium antacids which absorbs water into intestine
c.stimulant cathartics
10.Rapid intestinal movement:
a.Irritable bowel syndrome
b.resection of bowels in tumors or fistula
c.vagotomy
d.other surgery of intestine
rhea with blood and mucus
Diarrhea is investigated by:
1.full investigation of the possible underlying causes
2.Macroscopic and microscopic examination of the stools:
e.g rice water is typical of cholera
3.culture and sensitivity to antibiotic of the stools
4.Full blood count and electrolytes
Treatment of Diarrhea 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 light headedness
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.Specific treatment if available for underling conditions eg.antibiotic the choice of which depends on the sensitivity of bacteria to the antibiotic.
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 Diarrhea.
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 of diarrhea depends on the cause:
Usual outcome of acute diarrhea is excellent if treated early.
For chronic diarrhea, the underlying cause must be treated.
Outcome is usually excellent with appropriate treatment.
Prevention of Infections causing Diarrhea is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your 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
Monday, June 20, 2011
A Family Doctor's Tale - SHIGELLA DYSENTERY
DOC I HAVE SHIGELLA DYSENTERY
Shigella Dysentery is an acute invasive infection of the lining of the intestines caused by a bacteria of the genus Shigella resulting in leakage of fluid from the cell into the intestine(diarrhea), abdominal pain and vomiting.
The causes of Shigella Dysentery are:
4 subspecies of Shigella has been recognised as causative agents:
1.Group A :Shigella dysenteriae
2.Group B :Shigella flexneri
3.Group C :Shigella boydii
4.Group D :Shigella sonnei (most common in North America, Europe and Japan
Humans are the only known reservoir of Shigella infection.
Transnission occurs most often by close personal contact through hands or soiled clothing or fecal-oral contamination.
The bacteria pass through the gastric acid barrier relatively easily and proliferate in lower ileum and colon.
Multiplication of bacteria occurs within the epithelial cells followed by micro-abscesses on the villi of intestine.
Stools can contain red blood cells and white blood cells.
There may blood in the stools.
Since the infection is superficial, bacteremia is rare and perforation of the colon seldom occurs.
The symptoms of Shigella Dysentery are:
Incubation period is one to two days.
In the early phases lasting one to three days, the main symptoms of Shigella Dysentery are:
1. watery diarrhea with blood and mucus
2. cramping abdominal pain
3. fever up to 40 degrees centigrade
4. headache and bodyaches
5. serious fluid loss especially in children
6. loss of appetite and energy
In the later stages:
1.bowel movements quantity decreases but still contain blood and mucus
2.fever has subsided
3.decreased appetite and energy
4.weight loss
5.convulsions may occur in children
Shigella Dysentery can be transmitted by:
Shigella 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.
Doctors generally diagnose Shigella Dysentery based on
1.the symptoms and a physical examination.
2.stool sample to test for shigella and microscopic examination.
Microscopic examination shows the presence of red blood cells and polymorphs white blood cells.
Treatment of Shigella 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.
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 Shigella 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 of Shigella Dysentery is:
50% of Shigella dysentery develop full blown symptoms as above
25% will only have watery diarrhea
Symptoms usually improve within one to 2 days after the onset of treatment.
Outcome is usually excellent with appropriate treatment.
Prevention of Shigella Dysentery is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your 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
Shigella Dysentery is an acute invasive infection of the lining of the intestines caused by a bacteria of the genus Shigella resulting in leakage of fluid from the cell into the intestine(diarrhea), abdominal pain and vomiting.
The causes of Shigella Dysentery are:
4 subspecies of Shigella has been recognised as causative agents:
1.Group A :Shigella dysenteriae
2.Group B :Shigella flexneri
3.Group C :Shigella boydii
4.Group D :Shigella sonnei (most common in North America, Europe and Japan
Humans are the only known reservoir of Shigella infection.
Transnission occurs most often by close personal contact through hands or soiled clothing or fecal-oral contamination.
The bacteria pass through the gastric acid barrier relatively easily and proliferate in lower ileum and colon.
Multiplication of bacteria occurs within the epithelial cells followed by micro-abscesses on the villi of intestine.
Stools can contain red blood cells and white blood cells.
There may blood in the stools.
Since the infection is superficial, bacteremia is rare and perforation of the colon seldom occurs.
The symptoms of Shigella Dysentery are:
Incubation period is one to two days.
In the early phases lasting one to three days, the main symptoms of Shigella Dysentery are:
1. watery diarrhea with blood and mucus
2. cramping abdominal pain
3. fever up to 40 degrees centigrade
4. headache and bodyaches
5. serious fluid loss especially in children
6. loss of appetite and energy
In the later stages:
1.bowel movements quantity decreases but still contain blood and mucus
2.fever has subsided
3.decreased appetite and energy
4.weight loss
5.convulsions may occur in children
Shigella Dysentery can be transmitted by:
Shigella 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.
Doctors generally diagnose Shigella Dysentery based on
1.the symptoms and a physical examination.
2.stool sample to test for shigella and microscopic examination.
Microscopic examination shows the presence of red blood cells and polymorphs white blood cells.
Treatment of Shigella 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.
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 Shigella 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 of Shigella Dysentery is:
50% of Shigella dysentery develop full blown symptoms as above
25% will only have watery diarrhea
Symptoms usually improve within one to 2 days after the onset of treatment.
Outcome is usually excellent with appropriate treatment.
Prevention of Shigella Dysentery is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your 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
Saturday, June 18, 2011
A Family Doctor's Tale - MEGACOLON
DOC I HAVE MEGACOLON
Megacolon is the dilatation and often hypertrophy of part or all the colon associated with constipation.
There is predominance of occurrence of 8 males to 1 female.
There is a familial history.
Two main causes of Megacolon are
1.Congenital(also known as Hirsprung Disease)
The Congenital Megacolon occur in newborns due to the absence of autonomic ganglia from the distal segment of the colonic wall, varying in length(about 1 to 2 cm from rectosigmoid junction to entire colon).
Aganglionic colon provides a functional block to defecation, thus the colon proximal to the affected portion becomes grossly dilated and hypertrophied.
2.Acquired
a.Sliding megacolon:
The acquired idiopathic form is a functional disturbance of the colon in older children or adults resulting from persistent failure or inadequate rectal evacuation.
b.Paraesopphageal :
when the gastroesophageal junction is below the the diaphragm and part of the stomach herniates upwards along the esophagus.
The most common symptoms of Megacolon are :
Congenital:
1.gross abdominal distension in severe cases
2.Constipation alternating with diarrhea due to bacterial overgrowth in milder cases
3.Respiratory distress may be present in infants due the pressure of the abdomen on the lung space.
4.weight loss
5.Rectum is usually empty on examination
Acquired:
1.Onset is slower with constipation
2.gross abdominal distension
3.Rectal examination shows a lax sphincter and full rectum
The Diagnosis of Megacolon is:
Megacolon is diagnosed through one or more medical tests:
Congenital:
1.lower gastrointestinal endoscopy.
Colonoscopy show presence of narrowed distal segment and transition to dilated part of colon.
2.colon biopsy showed neuronal lesion.
3.Rectosphincteric manometric studies show absence of anal sphincter response
Acquired:
1.colonoscopy showed gross rectal dilatation but no narrowed segment
2.colonic biopsy is normal
The Treatment of Megacolon is by:
The main treatment is :
Congenital:
1.colostomy may be required as a life saving measure
2.This is followed by later surgical resection of short segment or longer segment of the colon
Acquired:
1.Evacuation of impacted stools
2.suppositories or microenema to clear rectal feces daily
3.mild laxatives to help induce passing of stools
4.Retraining of toilet habits
The Complications of untreated Megacolon are:
1.dehydration in infants during severe gastroenteritis episodes
2.obstruction of the intestines
3.toxic megacolon
Prognosis of Megacolon is :
1. good to excellent in acquired form if treated medically
2.surgery is needed in the congenital form
Prevention in acquired megacolon is to
1.have good toilet and bowel habits .
2.Avoid constipation by taking more fruits and vegetables and fibre.
3.Enough physical exercise to help the intestine move easier.
Megacolon is the dilatation and often hypertrophy of part or all the colon associated with constipation.
There is predominance of occurrence of 8 males to 1 female.
There is a familial history.
Two main causes of Megacolon are
1.Congenital(also known as Hirsprung Disease)
The Congenital Megacolon occur in newborns due to the absence of autonomic ganglia from the distal segment of the colonic wall, varying in length(about 1 to 2 cm from rectosigmoid junction to entire colon).
Aganglionic colon provides a functional block to defecation, thus the colon proximal to the affected portion becomes grossly dilated and hypertrophied.
2.Acquired
a.Sliding megacolon:
The acquired idiopathic form is a functional disturbance of the colon in older children or adults resulting from persistent failure or inadequate rectal evacuation.
b.Paraesopphageal :
when the gastroesophageal junction is below the the diaphragm and part of the stomach herniates upwards along the esophagus.
The most common symptoms of Megacolon are :
Congenital:
1.gross abdominal distension in severe cases
2.Constipation alternating with diarrhea due to bacterial overgrowth in milder cases
3.Respiratory distress may be present in infants due the pressure of the abdomen on the lung space.
4.weight loss
5.Rectum is usually empty on examination
Acquired:
1.Onset is slower with constipation
2.gross abdominal distension
3.Rectal examination shows a lax sphincter and full rectum
The Diagnosis of Megacolon is:
Megacolon is diagnosed through one or more medical tests:
Congenital:
1.lower gastrointestinal endoscopy.
Colonoscopy show presence of narrowed distal segment and transition to dilated part of colon.
2.colon biopsy showed neuronal lesion.
3.Rectosphincteric manometric studies show absence of anal sphincter response
Acquired:
1.colonoscopy showed gross rectal dilatation but no narrowed segment
2.colonic biopsy is normal
The Treatment of Megacolon is by:
The main treatment is :
Congenital:
1.colostomy may be required as a life saving measure
2.This is followed by later surgical resection of short segment or longer segment of the colon
Acquired:
1.Evacuation of impacted stools
2.suppositories or microenema to clear rectal feces daily
3.mild laxatives to help induce passing of stools
4.Retraining of toilet habits
The Complications of untreated Megacolon are:
1.dehydration in infants during severe gastroenteritis episodes
2.obstruction of the intestines
3.toxic megacolon
Prognosis of Megacolon is :
1. good to excellent in acquired form if treated medically
2.surgery is needed in the congenital form
Prevention in acquired megacolon is to
1.have good toilet and bowel habits .
2.Avoid constipation by taking more fruits and vegetables and fibre.
3.Enough physical exercise to help the intestine move easier.
Thursday, June 16, 2011
A Family Doctor's Tale - PSEUDOMEMBRANOUS ENTEROCOLITIS
DOC I HAVE PSEUDOMEMBRANOUS ENTEROCOLITIS
Pseudomembranous Enterocolitis is an inflammatory disease of the small and large intestine often associated with antibiotic use and with serious illnesses requiring chemotherapy or postoperative conditions.
The causes of Pseudomembranous Enterocolitis are:
The illness is believed to be due to the eradication of normal bowel flora from excessive use of antibiotics resulting in exposure to Clostridium difficile and its toxins.
The involved bowel mucosa is friable(thin) and has yellow green plagues which coalesce and form a thin membrane on the mucous lining.
The membrane consists of fibrin, mucus, and inflammatory cells.
The submucosa is edematous and necrotic in the advanced stage.
Besides clostridium, staphalococcus aureus has been isolated in cases of Pseudomembranous Enterocolitis.
The symptoms and signs of Pseudomembranous Enterocolitis are:
The disease may be suspected from the clinical picture of abdominal discomfort especially a history of prolonged antibiotic usage.
The main symptoms of Pseudomembranous Enterocolitis are:
1. watery diarrhea with blood,pus and mucus
2. cramping abdominal pain and distension
3. fever up to 39 degrees centigrade
4. headache and bodyaches
5. serious fluid loss and dehydration
6. metabolic acidosis
Signs:
Typical pseudomembrane seen on sigmoidoscopy</p>
The diagnosis of Pseudomembranous Enterocolitis is made by :
1.Doctors generally diagnose Pseudomembranous Enterocolitis based on the symptoms and history
3.typical pseudomembrane seen on sigmoidoscopy
The treatment of Pseudomembranous Enterocolitis is:
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.Stop all antibiotics if still administered
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).
4.Get plenty of rest.
5.surgery may be necessary if perforation of intestine has occurred.
Prognosis of Pseudomembranous Enterocolitis:
Outcome is usually excellent with early diagnosis and appropriate treatment.
Prevention of Pseudomembranous Enterocolitis is by:
No prolonged antibiotics.
Tuesday, June 14, 2011
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.
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.
Sunday, June 12, 2011
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
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
Friday, June 10, 2011
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.
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.
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