A Simple Guide to Uterine Fibroids

A Simple Guide to Uterine Fibroids
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What are Uterine Fibroids ?
-------------------------------------

Uterine Fibroids are solid benign tumours(non-cancerous) of the smooth muscles and fibrous tissues of the uterine cavity.

The name fibroid is derived by the fibrous tissue present in the tumour.

They are the commonest tumours (25%)found in women especially after the age of 35.

What are the different types of Uterine Fibroids?
----------------------------------------------------------------

They are classified according to their location.

1.intramurally(inside the cavity of the uterus(70%)

2.subserous(on the outer wall of the uterus) on the external wall(20%)

3.Submucous (in the lining of the uterus) 10%

4.pendunculated subserous(like a polyp outside the uterus)

5.cervical(at the cervix or beginning of the uterus)

What are the Causes of Uterine Fibroids?
-----------------------------------------------------------

The cause of Uterine Fibroids is still not known.

It is believed that oestrogen has a part to play in the formation since fibroids are not present before puberty and sometimes shrinks after menopause.

Generally it is believed that during the thickening and shedding of the endometrium of the menstrual cycle, some uterine muscles and connective tive tissues overgrow and form a swelling in the wall of the uterus.

Fibroids are generally relatively avascular and may degenerate forming cysts and becoming calcified.

What are the Symptoms of Uterine Fibroids?
------------------------------------------------------------------

Most women with fibroids are asysptomatic.

Symptoms and signs varies with the size and location of the fibroid.

Common symptoms include:

1.Heavy menstrual flow sometimes with blood clots

2.Irregular menstrual periods

3.Painful menses

4.Backache

5.Painful and frequent urination

6.Bloating

7.Constipation

8.Fatigue

Signs:
1.Enlarged uterine mass on abdominal palpation

2.Anaemia and pallour due to blood loss

How do you made the Diagnosis of Uterine Fibroids?
--------------------------------------------------------

Pelvic examination may show enlarged uterine swellings

Ultrasound scan showed presence of fibroids

Colposcopy may show the location of the fibroid.

What are the complications of Uterine Fibroids?
-------------------------------------------------

1.sarcoma

2.degeneration

3.necrobiosis

4.cystic degeneration

5.torsion of pendunculated fibroid

What is the Treatment for Uterine Fibroids?
----------------------------------------------------------

If small no treatment is required.

If larger,then treatment depends on the
1.size,
2.extent of the lesions,
3.age of the patient and
4.the desire for pregnancy.

Surgery
---------------
is required if
1.extremely heavy bleeding occurs during the menstrual cycle

2.anemia follows heavy menses

3.pain has become intolerable

4.discomfort due to the pressure of the fibroids on another organ

a.Myomectomy is the surgical removal of the fibroid without damage to the uterus thus allowing a woman to be pregnant.
However recurrence of fibroids is quite common after myomectomy

b.Hysterectomy is preferred for fibroid tumors

1.when a women has severe symptoms,

2.has completed her family

3.excessively large fibroid tumors;

4.severe abnormal bleeding is present

5.fibroids are causing problems with the bladder and bowels.

Non surgical treatment:
------------------------

a.uterine artery embalization is a non-surgical procedure.
Polyvinyl particles are allowed to flow into the uterine artery and clog the nexis of vessels spread out into the uterine tissue.
The fibroids are unable to receive the constant blood supply and thus shrink over time.

b.Lupron is a drug which shrinks fibroids in most women.
Unfortunately the fibroids will grow back when Lupron treatment is stopped.

A Simple Guide to Salpingitis

A Simple Guide to Salpingitis
------------------------------

What is Salpingitis?
----------------------

Salpingitis is an acute or chronic infection of the fallopian tubes in females.

What are the causes of Salpingitis?
---------------------------------------

Acute Salpingitis is usually caused by the following:

Infections:
1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.

2.tuberculosis salpingitis is rare

3.Infection may follow chilbirth or abortion

Mechanical irritants:
intrauterine device may cause acute or chronic Salpingitis

What are the symptoms and signs of Salpingitis?
------------------------------------------------

Persons who has Acute Salpingitis has the following
Symptoms:

1.severe lower abdominal pain

2.purulent vaginal discharge

3.painful or frequency of urination

4.fever

Signs:
1.tenderness in either lower abdominal quadrant

2.discharge can be seen in female vagina

3.vaginal examination - lateral movement of cervix causes pain
- palpation of the fallopian tubes may be very painful

How do you diagnose Salpingitis?
--------------------------------

Diagnosis can usually be made by :
1.History of lower abdominal pain with vaginal discharge

2.Tenderness in lower abdominal region with occasional palpation of tender mass
in the fallopian tube region

3.vaginal examination for tenderness in the tubes region

4.swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

5.Full blood count

6. endoscopy to examine the fallopian tubes

What are thae complications of Salpingitis?
-------------------------------------------

Acute Salpingitis may progress to chronic Salpingitis:

1. tubal infection with abscess formation(pyosalphinx) or cyst formation(hydrosalphinx)

2. Pelvic abscess

3. Ovarian infection

4.Infertility due to tube blockage

5. Peritonitis may occur with rupture of cyst and abscess

What is the treatment of Salpingitis?
-------------------------------------

1.Approprate Antibiotics for infections especially after uterine bacterial culture

2.Bedrest

3.Surgery may be necessary in cases not responding to antibiotics.
Drainage of the abscess may be done and infected tube resected if necessary

What is the prognosis of Salpingitis?
-------------------------------------------------------

Prognosis is usually good with current antibiotics and medication.

Sexual partner may need to be treated.

Recurrence is quite common.

Infertilty may result in blocked or scarred fallopian tubes

A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)

A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)
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What is a Menorrhagia?
--------------------------

Menorrhagia is a symptom defined as heavy, prolonged and/or irregular menstruation .

What are the causes of Menorrhagia?
-------------------------------------

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

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

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

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

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

How to establish a diagnosis of Menorrhagia?
---------------------------------------------

History:
--------------
Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea

Contraception:
use of IUD
contraceptive pills

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

Bleeding disorders:
easy bruising
anticoagulants

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

Endometriosis:
pelvic pain
dysmenorrhea

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

Abdominal examination:
tenderness,
palpable uterine or ovarian masses

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

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

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

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

What is the Treatment of Menorrhagia?
-------------------------------------------
Medications:
-------------

1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding

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

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

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

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

Surgery
-------------

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

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

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

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

Treatment of Underlying causes:
----------------------------------
hypothyroidism with thyroxine tablets

intrauterine device removal

reduce anticoagulant treatment if possible

treat any bleeding disease with platelets or blood factor deficient infusion

treatment of endometriosis,

antibiotic treatment of pelvic inflammatory idsease

treatment of uterine carcinoma

surgical removal of fibroids and polyps

A Simple Guide to Paronychia

A Simple Guide to Paronychia
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What are Paronychia?
--------------------------

Paronychia is acute or chronic infection of the tissue surrounding the nails of fingers or feet.

What are the Causes of Paronychia?
---------------------------------------------

There are two main causes of Acute Paronychia:
1.Bacteria-pseudomonas, Proteus,staphylococus

2.Fungal- candida

Chronic Paronychia:
1.Fungal- candida

2.Bacterial-pseudomonas

Micro-organisms usually enter through injured or damaged tissues from a ingrowing nail or sharp nail.

Tissues around the base of the cuticles becomes infected and inflammed, usually on one side of the nail.

Pus may form and oozes from the infected tissues.

What are the Symptoms of Paronychia?
----------------------------------------------

1.Acute paronychia:
----------------------

1.swollen

2.painful

3.red nail fold

4.may dicharge pus

2.Chronic paronychia
-----------------------

1.recurrent

2.painful

3.swollen tissues at base of nail

4.pus may be present

5.nail plate may rigid, distorted or invaded by micro-organism

What are the investigations for Paronychia?
----------------------------------------------

Swab for culture and sensitvity to antibiotics

Exclude Diabetes

What is the Treatment of Paronychia?
----------------------------------------------

Acute Paronychia:
-----------------------

1.Systemic antibiotics

2.Incision and drainage of pus

3.Surgical excision of part of the cuticle causing tissue damage(Ingrowing toenails) and the removal of infected lateral nail folds

Chronic Paronychia:
---------------------

1.Keep hands dry and use protective gloves

2.Apply anti fungal lotions and creams such as clotrimazole, nystatin

3.Systemic anti fungals such as griseofulvin or ketoconazole

4.Treat secondary bacterial infections with antibiotics

What are the Prevention measures in Paronychia?
---------------------------------------------------------

1.Avoid pressure on the lateral folds of the nails

2.Footwear should not be too tight

3.Avoid biting of nails

4.Avoid constant contact with water and soaking in water

5.Cutting of nails should not be too deep

6.Good personal hygience

A Simple Guide to Diverticulosis

A Simple Guide to Diverticulosis
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What is Diverticulosis?
---------------------------------------

Diverticulosis is a disorder of the colon or large intestine where there are one or more sac-like pouches(called diverticula) in the walls of the colon.

It is more common in the descending and sigmoid colon.

Who is affected by Diverticulosis?
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Diverticulosis becomes more obvious with age.
50% of people over the age 0f 60 years have Diverticulosis.

What is the Cause of Diverticulosis?
-----------------------------------------------------

The exact cause of Diverticulosis is not known.

It has been suggested that a low-fiber diet is the main cause of diverticular disease.

Diverticulosis is common in developed countries where low-fiber diets are common whereas it is rare in Asia and Africa where people eat high-fiber vegetable diets.

Fiber prevents constipation which can make the muscles strain and increase pressure in the colon.

This increased pressure makes the weak spots in the colon lining to bulge out like pouches and become diverticula.

What are the Symptoms of Diverticulosis?
-----------------------------------------------------------

Most cases of Diverticulosis have no or little symptoms.

In the more severe cases, the main symptoms of Diverticulosis are:

1.Abdominal pain or cramps-usually over the left side or over the lower abdomen

2.Bloating

3.constipation

The symptoms can range from mild to severe.

How do you make the Diagnosis of Diverticulosis?
------------------------------------------------------------

1.A history of abdominal pain especially on the left lower abdomen, bloating and constipation

2.The physical exam consists of
a.palpation of the left abdomen for tenderness or masses
b.digital rectal exam to detect tenderness or blood.

3.stool may be tested for blood

4.blood tests(WBC,ESR,bood culture) are done for evidence of infection.

5.Xrays of the abdomen and barium enema may be done to show evidence of pouches in the colon

6.Colonoscopy is also done to confirm evidence of diverticulosis and exclude malignant tumours.

What are the complications of Diverticulosis?
---------------------------------------------------

1.Diverticulitis
Diverticulitis occurs when diverticula become infected with bacteria, viruses or become inflamed.
Bacteria are caught in the pouches and develops into diverticulitis suddenly.

The symptoms and signs of diverticulitis are:
1.abdominal pain usually continuous in the lower left abdomen with tenderness

2.fever due to infection,

3.nausea, vomiting,

4.cramping,

5.constipation

6.rectal tenderness

Diverticulitis can lead to:

1.Bleeding,
rare.
Bleeding can be severe caused by a small blood vessel in a diverticulum that weakens and finally bursts.
Surgery may be needed to stop bleeding if bleeding continues.

2.Abscess, Perforation, and Peritonitis
Often a few days of treatment with antibiotics will cure the diverticulitis.
If the infection gets worse, an abscess which is an infected area with pus may form in the colon.

Small abscesses usually clear up with antibiotics.

More severe abscesses may require drainage of the pus using a catheter.

If pus leaks from perforations in the lining of the colon, then it can cause infection in the abdominal cavity and results in peritonitis.

This is an emergency and requires immediate surgery to clean up the pus in the abdominal cavity and removal of the damaged part of the colon.

3.Intestinal Obstruction
The infection of the diverticula can cause scarring of the lining of the colon resulting in partial or total blockage of the large intestine.

If the obstruction blocks the intestine completely, emergency surgery is required to allow faecal matter to pass through.

A temporary colostomy may be necessary.

4.Fistula
occurs as an abnormal connection between two organs or between an organ and the skin.

It results from the damaged tissues coming together and an opening is left between the two tissues.

Usually the bladder, small intestine, vagina, and skin are the organs involved.

The most common fistula occurs between the bladder and the colon especially in men. This can cause a long-lasting infection of the urinary tract.

Surgery may be necessary to remove the fistula as well as the damaged part of the colon.

5.Urinary tract infections occurs frequently due to the fistula and proximity of the bladder to the infected colon.

6.Discarge of faecal material may occur through a fistula between the colon and vagina in some women.

What is the treatment of Diverticulosis?
-------------------------------------------------

Medication:
1.pain medications will relieve any pain symptoms.

2.Antispasmotic mediacation for spams of the colon

3.Antibiotics may be needed in diverticulitis and complications such as urinary infection and peritonitis.

Diet:
1.high-fiber diet

a.whole grain breads and cereals;
b.fruit like apples and peaches;
c.vegetables like carrots, broccoli, spinach, carrots, cabbage, beans.

2.fiber product such as Metamucil once a day.

3.Avoid nuts, popcorn, pumpkin, and sesame seeds or any food which can cause discomfort in the abdomen

Diverticulitis
1.Antibiotics to treat the infection and inflammation,

2.resting the colon by bed rest, nasogastric suction and a liquid diet

3.hospital stay to prevent complications such as abscess.

4.surgery if the attacks are severe or there are complications.
The surgeon resects the affected part of the colon and then joins the remaining sections.

Surgery is also done for complications such as a fistula or intestinal obstruction.

Emergency surgery may be done for a large abscess, perforation, peritonitis, or continued bleeding.

What is the prognosis of Diverticulosis?
------------------------------------------------------

About 1% develop diverticulitis.
70% of patients with acute attacks of diverticulitis can be treated with medical management and have no further attacks

A Simple Guide to Pancreatic Cancer

A Simple Guide to Pancreatic Cancer
----------------------------------------

What is Pancreatic Cancer?
------------------------------

Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.

What are the causes of Pancreatic Cancer?
-----------------------------------------

1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells

2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells

3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer

4.Chronic pancreatitis has been found to have some causal effect

5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer

6.Occupational exposure to certain chemicals including insecticides

7.Family history -there is a family history in 5-10% of pancreatic cancer patients

8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract

What are the symptoms and signs of Pancreatic Cancer?
-------------------------------------------------------

Symptoms - non-specific and varied.

1.pain in the upper abdomen that typically radiates to the back

2.pain relieved by leaning forward

3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)

4.depression is sometimes associated with pancreatic cancer


Signs:

1.tenderness in upper abdomen

2.mass in the abdomen

3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.


How do you diagnose Pancreatic Cancer?
----------------------------------------------

Diagnosis can usually be made by :

History
-----------

1.pain in upper abdomen radiating straight to the back, worse on eating

2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.

3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later

4.onset of atypical diabetes mellitus

5.unexplained recent thrombophlebitis

6.past history of pancreatitis

Location of cancer
-----------------------

1.Tumors in the pancreatic body or tail usually present with pain and weight loss

2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.

Courvoisier sign
-----------------

presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer

Liver function tests
---------------------

may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).

CA19-9 (carbohydrate antigen 19.9)
----------------------------------

is a tumor marker that is frequently elevated in pancreatic cancer.

Ultrasound or abdominal CT
------------------------------

may be used to identify tumors.

Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

What is the treatment of Pancreatic Cancer?
------------------------------------------------

Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.

Surgery
--------------

1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.

2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy

3.localized tumors of the pancreas have been surgically removed using laparoscopy.

4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.

5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.

Chemotherapy
-----------------

is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life

Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer

Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.

Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.

Radiation therapy
--------------------

The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.

What is the Prognosis of pancreatic cancer?
-------------------------------------------------

The prognosis of pancreatic cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 3-4 months;

3.5-year survival is lower than 5%.

4.Pancreatic cancer has the highest mortality of all the cancers.

5.Pancreatic cancer may sometimes cause diabetes.

How to prevent Pancreatic Cancer?
----------------------------------------

1.a healthy lifesyle

2.increase consumption of fruits, vegetables

3.reduce red meat intake

4.Vitamin D can reduce the risk of pancreatic cancer

5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer

6.Avoid smoking and drinking of alcohol

A Simple Guide to Pancreatitis

A Simple Guide to Pancreatitis
------------------------------

What is Pancreatitis?
----------------------

Pancreatitis is an acute or chronic inflammation of the pancreas.

What are the causes of Pancreatitis?
-----------------------------------------

Pancreatitis is usually caused by the following:

1. Alcoholism and diseases of the biliary tract

2. bacterial infections from salmonella typhi and streptococcus

3. viral infection especially mumps, coxsackie virus, cytomegalovirus

4. trauma

Chronic disease follows attacks of acute infection.

What are the symptoms and signs of Pancreatitis?
-------------------------------------------------------

Persons who has Acute Pancreatitis has the following symptoms:

1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.

2.Pain usually very severe occuring a large meal or drinking bout

3.Pain is worse lying supine, therefore patients sit or lean forward

4.mild fever and bodyaches

5.nausea and vomitting

6.hypotension followed by clinical shock

Signs:

1.Tenderness at the epigastrium with muscle spasm

2.Distension and diminished bowel sounds

3.Pleural effusion 10%,abdominal mass 20%, ascites 20%

4. Acute renal failure, respiratory failure following shock.

Chronic Pancreatitis
---------------------
Symptoms:

1.repeated attacks of epigastric abdominal pain

2.Pain worse after eating, radiates to the back

3.weight loss

4.Fever

Signs:

1.abdominal tenderness

2.abdominal mass may suggest swelling and pseudocysts

3.tender subcutaneous masses seen indicating fat necrosis

How do you diagnose Pancreatitis?
--------------------------------

Diagnosis can usually be made by :

1.Physical examination with tenderness in the epigastrium

2.Serum and urine amylase very high after 6 hours

3.White blood cell count high

4.Serum lipase high in 50% patients

5.Blood calcium may be low

6.Blood glucose tolerance test for diabetes

7.Ultrasound may show up the presence of pseudocyst in pancreas

8.CAT scan and MRI may show swelling and pseudocysts in pancreas

What is the complications of Pancreatitis?
-------------------------------------

1.Pseudocysts from damage to pancreatic tissues

2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas

3.peritonitis from rupture of pseudocysts and bleeding

4.diabetes mellitus from damage to the glands in the pancreas producing insulin

What is the treatment of Pancreatitis?
-------------------------------------

Acute Pancreatitis:
----------------------
Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Treat biliary tract diseases and alcoholism

surgical drainage of pseudocysts after acute episode.

Chronic Pancreatitis:
-----------------------

Pancreatic extracts and enzymes together with meals

Sodium bicarbonate and cimetidine to prevent enzymes breakdown

Analgesic or antispasmodic medicine usually by injection

Surgical procedures usually unsuccessful

What is the prognosis of Pancreatitis?
----------------------------------------

Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.

Hemorhagic Pancreatitis has high mortality of 50-90%

Most trauma cases has complete resolution

Some alcoholic pancreatitis may go on to chronic pancreatitis.

Chronic pancreatitis relapses frequently

Rupture of pseudocysts may result in death

How do you prevent Pancreatitis?
------------------------------------------------

Avoid alcohol and oily food

Take precautions during mumps and other viral infection

Avoid injury to the abdomen especially the mid section below the sternum

A Simple Guide to Allergies

A Simple Guide to Allergies
------------------------------

What are Allergies?
----------------------

Allergies are the immune system's reaction to a harmless substance foreign to the body.

In some people this reaction causes a uncomfortable symptom like rashes or swelling of the eyelids.

In severe cases it can even cause peeling of the skin or kidney damage.

What are the Common causes of Allergies?
----------------------------------------------

The most common causes of allergies are pollen and dust mites.

Besides these, there are a wide range of substances that can trigger an allergic response.

Pollen:
---------
Pollen is the seeds or spores released by flowers or plants during pollination phase of plants and usually is higher in summer. Some countries shows the daily pollen index in the media during summer to warm allergen sufferers the risks of allergy during this peroid.
Pollens irritate the sensitive mucusal lining of the nose and the epithelium of the skin causing inflammation and swelling.

Dust mites:
---------------
Dust mites are microscopic parasites who live on the skin flakes shed by the human body every day. They can found just about everywhere on the floor, carpets, on mattresses, pillows, bed covers, clothes and upholstery.
The faeces from the dust mite is the main substance which causes sneezing and wheezing.

House dust like dander from animals, cockroach faeces, bacteria, moulds, fungus spores and dust mites are the main cause of allergies in any family.

Moulds
-------------
Moulds are microscopic fungi with spores floating in the air like pollen.
They are usually found in damp areas indoors such as the basement or bathroom, as well as outdoors in grass, leaves, hay, or under plants.


Animal proteins
------------------
Proteins found in an animal's skin and saliva can cause allergy to skin, nose and lungs in some people.

Food allergens
------------------
Certain foods especially eggs, milk, nuts, and seafood, induce intestinal and skin reactions frequently in children who often outgrow it after puberty.

What are the Symptoms of Allergies?
--------------------------------------------
Allergic symptoms include:

1.itchy, watery nose and eyes,

2.asthma, wheezing and coughing

3.Hives or skin rahes

What is the Treatment of Allergies?
-------------------------------------------

Treatment depends on the severity of symptoms.

In severe cases of allergy:

1.adrenaline injection is used in life-threatening situations to reduce acute swelling of the airways.

2.Antihistamines can help relieve symptoms such as sneezing and running nose.

3.Bronchodilators (theophylline and beta-agonists e.g. salbutamol) are used in cases of asthma to open the airways, relieve coughing, wheezing, shortness of breath and difficulty in breathing.

4.Corticosteroids such as dexamethasone may be given to relieve symptoms.
They also reduce the immune reaction to the allergens.

How to prevent allergies?
------------------------
The best prevention is to avoid the allergens:

1.Avoid dustmites, pollen.

2.Cover all pillows, mattress,beds etc with special dust mite covers,

3.Avoid food like eggs, milk, nuts, and seafood

4.Desensitisation to Allergens
---------------------------------

Desensitisation to Allergens is by giving small doses of allergen until the body itself become insensitise to allergens.

A Simple Guide to Coughing

A Simple Guide to Coughing
------------------------------

What is Coughing?
----------------------

Coughing is the reflex mechanism in which the body tries to get rid of excessive mucus and phlegm accumulated in the lining membranes of the respiratory tract.

The secretions from the lining of the respiratory tract trap and then flush out the viruses, bacteria and other particles like smoke, haze particles.

It prevents serious infections from entering the lungs and bronchial tubes.

What are the common causes of cough?
---------------------------------------

Coughing is usually caused by the following:

Infections:
1.bacterial or viral infection of the nose and throat such as the common cold or influenza.(yellow or green phlegm)

2.anaerobic infections of the mouth,

3.Infection of the tonsils, nose and sinuses(postnasal drip)

4.Bacterial infection of the bronchial tubes and lungs(bronchiectasis, bronchitis, pneumonia, sinusitis, or tracheitis).
This often comes with rusty or green mucus.

Dry mouth:
1.Insufficient drinking of water

2.medications especially ACE inhibitors(eg. enapril) can cause dry persistent coughs

Allergies:
1.Certain plants, pollens, chemicals, cosmetics can cause allergic reactions in the throat and bronchial causing cough. (white clear phlegm)

2.Asthma - narrowing of the bronchial tubes due to allergic and other causes usually results in white sticky clear productive phlegm

Smoking:
Cigarettes smokes contains 40 over chemicals which irritates the cells in the lining of the bronchial tubes causing a chronic cough

Stress:
Stress can cause cough due to dryness of mouth during stress or anxiety, causing the saliva to dry up and producing dry unproductive cough.
The cough in stress usually disappears during sleep.

Gastric problems or indigetions
1. Indigestion of food in the stomach can cause the undigested food in the stomach to produce gas in the stomach which goes upwards to the throat drying saliva which then become irritating phlegm in the throat.

2.gastroesophageal reflux of food can also cause the acid and undigested food to travel to the mouth and produce mucus secretions.

Systemic diseases:
1.Congestive heart failure

2.Lower respiratory tract infections

3.Chronic Obstructive Lung Disease

4.Carcinoma lung.

What investigations are needed for cough?
------------------------------------------

1.chest X-ray

2.sputum culture

3.pulmonary function tests

What is the treatment of Coughing?
-------------------------------------

Medications
1.Approprate Antibiotics, antifungal for infections of throat and bonchial tubes

2.Antihistamines for allregic cough

3.Bronchodilators for asthma and Chronic Obstructive Lung Disease

4.cough mixtures - expectorants helps to expel out the phlegm
- suppresant suppress the cough -especially for dry cough and at night to stop the cough

5.Antacids and antiflatulent agents to get rid of gas in stomach and prevent reflux

6.Diuretics for treatment of congestive heart failure especially in the elderly

Healthy Lifestyle:
1.drinking several glasses of water a day prevents dryness of mouth

2.Avoid cold, acidic, spicy and oily food which irritates the throat

3.Proper oral hygience after eating: brushing of teeth and flossing.

4.Gargle mouth after every meal.

4.Avoid smoking

6.Avoid frequent usage of the voice and throat - do not talk too much

6.Treat underlying condition such as asthma, diabetes, liver, kidney and other conditions.

A Simple Guide to Halitosis

A Simple Guide to Halitosis(Bad Breath)
--------------------------------------

What is Halitosis?
----------------------

Halitosis is the condition when a person suffers from chronic bad breath.

What are the causes of Halitosis?
---------------------------------------

Halitosis is usually caused by the following:

Infections:
1.bacterial infection of the gums, dental cavities.(600 types of bacteria
present in mouth)

2.anaerobic infections of the mouth,

3.Infection of the tonsils, nose and sinuses(postnasal drip)

Gastric problems and indigestion:
1. Indigestion of food in the stomach can cause the undigested food in the stomach to emit an offensive smell through the mouth

2.gastroesophageal reflux of food can also cause the smell of acid and undigested food in the mouth

Certain food:
1.garlic and onions which has odious suphur compounds can give rise to foul smell from the mouth

2.fish

3.cheese

4.alcohol

Smoking:
Cigarettes smokes contains 40 over chemicals which cause bad mouth smell

Dry mouth:
1.Insufficient drinking of water

2.medications can cause dry mouth and produces a smell from the mouth

Systemic diseases:
1.liver failure.

2.Lower respiratory tract infections

3.Renal infections and renal failure.

4.Carcinoma.

5.Trimethylaminuria ("fish odor syndrome").

6.Diabetes mellitus.

What are the symptoms and signs of Halitosis?
------------------------------------------------

Persons who has Halitosis has the following
Symptoms:
1.Bad breath

2.Dry mouth

Signs:
1.discharge from nose or tonsils

2.furry tongue

How do you diagnose Halitosis?
--------------------------------

Diagnosis can usually be made by :
1.History of bad breath

2.lick the back of the wrist, let the saliva dry for a minute, and smell the dried saliva.

3.scrape the posterior back of the tongue with a plastic disposable spoon and smell the drying residue.

4. Halimeter: a portable sulfide monitor to test for levels of sulfur emissions (especially hydrogen sulfide) from the mouth.

5.BANA test: find the salivary levels of an enzyme which shows the presence of certain halitosis-related bacteria

5.ß-galactosidase test: the presence of this enzyme in the saliva indicates presence of bad breath

What is the treatment of Halitosis?
-------------------------------------

1.Approprate Antibiotics, antifungal for infections of mouth

2.drinking several glasses of water a day prevents dryness of mouth

3.Eating a healthy breakfast helps clean the back of the tongue

4.Proper oral hygience after eating: brushing of teeth and flossing. Dentures should be removed at bedtime and soaked overnight in antibacterial solutions.

5.Avoid smoking

6.Gargle mouth after every meal.
Avoid the use of alcohol based mouth wahes.
Use instead oil based mouth washes.

7.Chewing sugarless gums helps to stimulate production of saliva and hence less bad breath

8.Treat underlying condition such as diabetes, liver, kidney and other conditions.

What is the prognosis of Halitosis?
----------------------------------------

Prognosis is usually good with proper oral hygiene.

Recurrence is quite common.

A Simple Guide to Urinary Incontinence

A Simple Guide to Urinary Incontinence
------------------------------------------------

What is Urinary Incontinence?
----------------------------------------

Urinary incontinence is a symptom and means the the uncontrollable leakage of urine.
It can cause a lot social discomfort to patients having this problem.
Men are more prone to it than women.

What are the Causes of Urinary Incontinence?
------------------------------------------------

Urinary Incontinence is a medical condition which may be temporary or permanent.

There are many causes of urinary incontinence:
Temporary urinary incontinence
------------------------------

1.Drinking too much tea, coffee or carbonated drinks can irritate the bladder and cause or contribute to incontinence.
Coffee and other drinks containing caffeine can be a particular problem as caffeine is a diuretic, i.e. it increases the urge to pass urine.

2.Excessive alcohol. Alcohol is also a diuretic. Because it has deppresant effect on the the brain, it may affect the person's judgement temporarily, hence resulting in accidental leakage of urine.

3.Some medications like diuretic pills, heart medications and antidepressants can cause or contribute to incontinence.

4.Urinary Tract Infection may cause sufficient irritation to the bladder to stimulate incontinence.

5.Constipation result in impaction of the stools in the rectum. This irritates the nerves to the bladder resulting in incontinence.

Permanent urinary incontinence
-------------------------------
In both sexes there are many conditions which can cause or contribute to chronic or persistent urinary incontinence:

1.Aging
With age there is a decrease in the bladder capacity to store urine.

2.Enlarged prostate in men
BPH or benign prostatic hypertrophy is associated with aging and can obstruct the urethra and block urinary flow resulting in urge or overflow incontinence.

3.Prostate Cancer in men
Prostate cancer can cause incontinence if untreated. However the incontinence in prostate cancer patients may be a side effect of treatment e.g. surgery, radiation therapy.

4.Prostatitis in men
Inflammation of the prostate gland sometimes can cause constriction of the urinary flow and incontinence.

5.Gynecological problems such as prolapsed uterus, enlarged utrue due to fiboids, ovarian cysts or tumours can pulled on the muscles of the perineum causing weakness of the muscles and poor constriction of the bladder opening

5.Surgery involving the organs near the bladder
Any operations involving organs such as the ovary, uterus, prostate, rectum can cause inadvertent damage to muscles or nerves of the urinary tract, resulting in incontinence.

6.Urinary tract obstruction
Any enlarged tumours along the urinary tract can obstruct the normal flow of urine and cause incontinence. Bladder stones can do the same.

7.Neurological conditions
Stroke, Parkinson's disease, tumours in the brain or spinal cord and injury to the nerves in pelvis or spinal cord can can affect the nerves to the bladder and weakening of the bladder opening muscles.

What are the Types of urinary incontinence?
-----------------------------------------------

Urinary incontinence may be categorised into 4 main types. It is possible however to have more than one type of urinary incontinence

1.Stress incontinence
Leakage of urine occurs because of weakness of the pelvic floor muscles. When there is pressure exerted on the bladder - e.g. from laughing, sneezing, coughing, exercising or heavy lifting, pregnancy, the muscles at the opening of the bladder comes under stress and opens to allow leaking of urine.


2.Urge incontinence
There is an uncontrollable leakage of urine while suddenly feeling the urge to urinate.

3.Overflow incontinence
There is a constant dribbling of urine even after finishing urination. There is an inability to completely empty the bladder.

4.Functional incontinence
There is physical or mental impairment resulting in the failure to realise the need to urinate.As a result the person fail to get to the toilet in time and pass out the urine. Examples are people who suffer from dementia, parkinson or is incapacitated by poor physical movement.

Other types of urinary incontinence include enuresis(bed wetting ) which is common in chilldren,
Transient incontinence which is temporary and sometimes caused by medications.

What are the symptoms of urinary incontinence?
------------------------------------------------

The main symptom of urinary incontinence is leakage of urine. This leakage may be frequent and heavy, or it may be small and rare.
Some other symptoms of urinary incontinence include:

Urgency - a strong desire to urinate even when the bladder is not full together with pelvic discomfort or pressure

Frequency - urinating more than once in a two-hour period or more than seven times a day

Nocturia - the need to wake up and urinate at least twice during sleep

Dysuria - painful urination

Enuresis - bed-wetting or urinating while sleeping

How do you make the Diagnosis of urinary incontinence?
----------------------------------------------------------

1. history taking is important especially the pattern of urine leakage. Other history include symptoms of straining and discomfort, use of drugs, surgery, and illness.

2. physical examination will look for signs of medical conditions causing incontinence, such as pelvic tumors, stool impaction, and poor reflexes or sensations.

3. measurement of bladder capacity and residual urine for signs of poor functioning bladder muscles.

4.Stress test - the patient coughs vigorously as the doctor watches for loss of urine.

5.Urinalysis - urine is tested for infection, urinary stones.

6.Blood tests - for PSA( in case of Cancer of prostate) or alphafoetoprotein (in case of cancer of the ovaries)

5.Ultrasound -to visualize the kidneys, ureters, bladder, and urethra.

6.Cystoscopy - a thin lighted tube is used to see the inside of the urethra and bladder.

7.Urodynamics - measurement of pressure in the bladder and the flow of urine.

What is the Treatment of urinary incontinence?
-----------------------------------------------

Elderly patient tend to believe that the only way to prevent embarrassment is to wear absorbent pads or padded undergarments like adult Pampers. However the wetness may lead to rashes, sores, or infections.

Treatment involves:
A. making certain lifestyle changes.

1.Timed Voiding
Timed voiding (urinating) means writing a chart of your urination and leakage patterns for several days. This will then tell you which times of day you normally need to empty your bladder before leakage may occur.

2.Bladder training
This involves training your bladder to control the urge to urinate.

3.Changing Fluid Intake
Restricting your fluid intake, or changing the timing of fluid intake will help you to gain more control over the bladder. Restriction of alcohol, tea, coffee and other caffeinated beverages can reduce the amount of urine from your body

4.Exercises
Exercising the muscles of the pelvis(Kegel exercises) may strengthen the muscles of the affected area.

5.Vaginal cone therapy
This exercise for women involves the use of a set of five small vaginal cones of increasing weight. The patient simply places the small plastic cone within her vagina and hold it in by a mild reflex contraction of the pelvic floor muscles. This exercise is done twice a day for fifteen to twenty minutes.As the pelvic floor muscles becomes stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually.

6.Electrical stimulation
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles and strenthen the pelvic muscles.
This can reduce stress and urge incontinence.

7.Biofeedback
Using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can slowly control movement of these muscles.

B.Treating the cause of the incontinence:

1.Medications:
drugs may be given to treat urinary tract infections or inhibit contractions of an overactive bladder.

2,Pessaries
A pessary is a ring shaped medical device that is inserted into the vagina. It compresses the urethra against the pubic bone and elevates the bladder neck.

3.Surgery
Surgery to reduce the size of your prostate gland ( transurethral resection of the prostate or TURP) helps to reduce urinary incontinence in men.

Bladder repositioning
In older women incontinence results from the bladder dropping down toward the vagina. Surgery involves pulling the bladder up to a more normal position. Using an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

Marshall-Marchetti-Krantz
This procedure also known as retropubic suspension or bladder neck suspension surgery, is performed using an incision across the abdomen. Stitches are placed in these tissues near the bladder neck and the urethra is then lifted, and the stitches are attached to the pubic bone or to tissue behind the pubic bone. The bladder neck is supported helping the patient to control the urine flow.

Slings
The sling procedure uses synthetic mesh material in the shape of a narrow ribbon that is placed under the urethra through one vaginal incision and two small abdominal incisions. The purpose is to provide support under the urethra. There are the Transobturator Tape Sling, the Tension-free Transvaginal Sling, and the Minisling.

Artificial urinary sphincter
Rarely the surgeon implants an artificial urinary sphincter a doughnut-shaped sac surrounding the urethra. To close the urethra A fluid fills and expands the sac. Pressing a valve implanted under the skin, the artificial sphincter can be deflated allowing urine from the bladder to pass.

4.Catheterization
A catheter may be inserted to drain the urine if your bladder never empties completely or if your bladder cannot empty because of poor muscle tone, post surgery or spinal cord injury. This can be done on a if required basis.Prolonged catherisation may lead to infection of the urinary tract.

5. Botox injections
Botox injection has been tried to reduce the sensitivity of the nerves at the opening of the bladder. It appears more successful for women than in men.

How do you prevent urinary incontinence?
----------------------------------------

Reduce your risk of urinary incontinence:

1.Maintain a healthy weight.

2.Obesity can lead to urinary incontinence.

3.Avoid constipation by drinking sufficient amounts of fibre and fluids in your diet.

4.Avoid drinks which can irritate your bladder such as coffee, tea, carbonated drinks and alcohol.

A Simple Guide to Benign Prostatic Hyperplasia

A Simple Guide to Benign Prostatic Hyperplasia
-------------------------------------------------------------------

What is Benign Prostatic Hyperplasia?
--------------------------------------------------------

Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.

What are the Causes of Benign Prostatic Hyperplasia?
------------------------------------------------------------

The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.

It is a walnut size gland encircling the lower urinary outlet of the bladder.

With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.

The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.

What are the symptoms and signs of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------

The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.

Symptoms:
1. difficulty in starting urination

2. straining at urination to produce a weak flow of urine

3. dribbling of the urine after urination

4. feeling of incomplete emptying of bladder even after urination.

5. nocturia -getting up at night more frequently to pass urine

6. frequency of urination

7. interrupted urine flow

8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)

Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate

2.urine examination to exclude infections

3.blood tests to check on kidney function

4.an ultrasound to have a better look at the prostate and also any damage to kidneys

5.a urine flow test(Uroflow) to see how fast you can pass urine

6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer

7. Cystoscopy - a ligted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine

8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)

What are the complications of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------

Prolonged blockage of the urine by BPH can cause serious complications:

1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain

2. Urine leakage or incontinence

3. recurring urine infections

4. bladder stone formation

5. blood in the urine

What is the treatment of Benign Prostatic Hyperplasia?
----------------------------------------------------------------

BPH sufferers may be referred to an Urologist for review. As lonas Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.

In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by :
1.adjustment of fluid intake

2.regular exercise,

3.proper diet with less red meat , more vegetables and fruits.

In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as :

4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.

In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,

5.catherisation and drainage of the urine may be necessary in acute retention of the urine

6.Surgery may be necessary.
This operation called TURP or transUrethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract.
Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfuction problems.

7. Antibiotics may be given for urinary infections

What are the preventive measures taken in Benign Prostatic Hyperplasia?
--------------------------------------------------------------------

1.Changing Fluid Intake

You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.

2.Bladder training & periuretharal muscle exercises
This involves training your bladder to control the urge to void.

3.Maintain a healthy weight.

4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.

What is the prognosis of Benign Prostatic Hyperplasia?
---------------------------------------------------------------

Very good after treatment.

A Simple Guide to Erectile Dysfunction

A Simple Guide to Erectile Dysfunction
-------------------------------------------

What is erectile dysfunction (ED)?
----------------------------------------

Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"

The WHO sponsered Consultation recommend" a minimum of three months of erectile difficulty qualified foe a diagnosis of Erectile Dysfunction."

What is the incidence of ED?
-----------------------------------

The incidence of ED is unknown:
ED is currently underdiagnosed and undertreated.
More than 50% of all men 40-70 years old are likely to experience it.

What are the Causes of ED?
----------------------------

Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.

Medical causes:
------------------

1.vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)

high blood pressure

high cholesterol

heart disease

stroke

All these conditions affects the blood flowing and out of the penis.

2.diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED

3.nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis

4.hormonal problems-
low levels of testosterone(male hormone) can cause ED

5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.

6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.

7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillisers) may reduce the blood flow to the penis

8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.

Lifestyle causes:
----------------------

1.alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.

2.Smoking-
The incidence of ED in smokers are hiher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.

3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.

4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation

Psychosocial Causes:
-----------------------

1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause

3. Depresssion

4. Relationship Problems- marital problems and tensions may affect sexual relationship

5. fatigue.

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

1.medical hisory especially about diabetes, hypertension, medications, alcohol adrug abuse,smoking.

2.medical examination including genitals and prostate

3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)

What is the treatment of ED?
------------------------------

Successful treatment of erectile dysfunction includes:

1. Lifestyle modifications:
exercising

dieting

quitting smoking

reducing alcohol/drug abuse

counselling to manage anxiety/stress/marital problems

2.treatment of underlying medical conditions such as diabetes

3.change of medications

4.medication for treatment of ED.

There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors
e.g. Viagra, Cialis, Levitra.

There is no instant erections when the medicine is taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.

Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.

6.Other treatments for erectile dysfunction

a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity

b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.

c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis

d:surgery for blocked blood vessels

e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse.
This surgery is offered when all other options failed.

How to cope with ED?
-----------------------

Erectile dysfunction can cause a lot of stress on one’s marital relationship.

Communication and honesty with the spouse is important in ED.so that she understands the problem and that she is not the cause of the problem.

In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.

A Simple Guide to Urinary Stones

A Simple Guide to Urinary Stones
----------------------------------

What are Urinary Stones?
----------------------------

Urinary Stones are small, solid stones which occur when salts or minerals in the urine become solid crystals inside the kidney.

How are Urinary Stones formed?
----------------------------------------

Urinary Stones are formed usually because of the accumulation of salts and minerals especially calcium in the urine.

Usually the stones may be so small that they pass out through the urine without the knowledge of the patient.

Some however become bigger due to accumulation of the salts and minerals and the concentration of the urine.

The bigger stones may remain in the tubes of the kidney and are called renal stones.

Some smaller stones may move out of the kidney and passes through the ureters which are the the tubes bringing urine from the kidney to your bladder.
These are called ureteric stones.

If a ureteric stone gets stuck in the ureter, this can cause blockage of the urine and severe pain.(ureteric colic)

What are the types of Urinary Stones?
------------------------------------------

Different kinds of Urinary stones form from different salts in the urine.

1.Calcium stones forms about 80% of the urinary stones.
50% are made up of calcium oxalate and the rest are calcium phosphate.
They are spiky or large and smooth


2.Uric acid stones are caused by accumulation of excess amounts of uric acid which can be due to eating a lot of meat.
They are smooth, brown and soft

3.Struvite stones (infection stones) are produced when there is too much ammonia in the urine occuring especially in urinary tract infection.
The bacteria that cause these urinary infections can generate ammonia.
They are usually large and have a horn-like shape
This kind of kidney stone is most often found in women.

4.Cystine stones occurs when there is high levels of cystine in the urine. A hereditary disorder called cystinuria is the source of high cystine in the urine.
They are yellow and crystalline

Who is at risk of Urinary stones formation?
--------------------------------------------

Risk factors include:

1.Men get urinary stone more commonly than women

2.a previous history of kidney stone - 50% will develop another one within five years.

3.a family history of kidney stones

4.Age between 20 and 40

5.Not drinking enough water

6.eating a diet high in protein

7.taking certain medicines such as diuretics (water tablets), antacids and thyroid medications

8.having only one kidney, or an abnormally shaped kidney

What causes Urinary Stones?
---------------------------

Urinary Stones are caused by 4 main factors:

1.Insuffient water in the urine leading to concentration and stagnation of urine flow:
a.insufficient intake of water
b.intake of alcohol causing concentration of the blood volume

2.Excess Urinary Constituents:
a. Calcium:
High calcium intake (includes calcium tablets and high calcium milk)

Primary Hyperparathyroidism leading to high blood calcium

high Vitamin D intake cause high adsorption of calcium

medical conditions such as cancer, some kidney diseases, or sarcoidosis are more likely to develop calcium stones.


b. Oxalates:
high oxalate intake (cabbage,spinach,tomatoes, chocolates) in diet leads to high concentration of oxalates in urine

c. Uric Acid:
Gout or High Uric Acid can form crystals which may lead to stones

Treatments such as chemotherapy can also increase the risk of getting uric acid stones.

d: Cystine:
Hereditary cystinuria leads to high cystine in the urine and formation of cystine stones

About one in a hundred urinary stones is due to this illness.

Cystine stones tend to appear earlier in life between the ages of 10 and 30 years.

3. Infection of urine:
clumps of bacteria can form the nucleus of the stone.

Bacteria also produce ammonia which can promote formation of stones

4. Congenital deformity of the kidney and urinary tract:

these block the passage of concentrated urine and causes formation of stones.

What are the symptoms of Urinary Stones?
------------------------------------------

Many Urinary stones do not cause any symptoms.
Once an urinary stone enters the ureter and blocks the passage of urine flow, it may cause the following symptoms:

1.severe pain or aching in the back on one or both sides

2.sudden spasms of excruciating pain which usually starts in the upper back below the ribs, radiates around the flanks of the abdomen, down to the pubes, groin and genitalia.

3.Urine is bloody, cloudy or smelly

4.frequent urge to urinate, or a burning sensation during urination

5.fever and chills

6.nausea and vomiting

Urinary stones can be passed out of the body within 48 hours.

Sometimes attacks of pain from urinary stones may last for over 30 days.

How are Urinary Stones diagnosed?
---------------------------------

1.History of ureteric colic symptoms and physical examination showing tenderness of abdomen and flanks

Other tests may be done to confirm the diagnosis and to reveal the size, location and type of stone:

2.blood tests - to identify excess amounts of certain chemicals (calcium, uric acid, oxalates, cystines) related to the formation of stones

3.urine analysis - to look for signs of infection and presence of crystals

4.X-ray of abdomen - stones that contain calcium (80%) usually appears white on X-rays

5.Intravenous urogram (IVU) - an injection of a special dye that shows up the whole urinary system on X-ray images, revealing stones that can't usually be seen

6.ultrasound scan - can detect stones in kidneys and solid internal organs

7.non-contrast helical computerised tomography - X-ray images taken at different angles - can diagnose kidney stones, and is probable the most accurate diagnostic test

How are Urinary Stones treated?
---------------------------------

Treatment depends on the
1.type and
2.cause of the stone.

Most stones can be treated without surgery:
1.Drinking lots of water (two and a half to three litres per day)

2.staying physically active are often enough to move stones smaller than about 5mm out of the urinary tract.

3.paracetamol or codeine may be given to reduce the pain.

4.Infections can be treated with antibiotics.

Stones that are stuck can be removed in several ways:

1.Extracorporeal shock wave lithotripsy (ESWL)
Location of the urinary stone is dtermined using X-ray imaging or ultrasound scanning.
The patient lies in a side position while a machine called a lithotriptor sends targeted shock waves to break up the kidney stone.
There may be some pain as the stone breaks up, so the procedure is usually performed under local anaesthesia.

2.Ureteroscopic stone removal
A narrow, flexible instrument called a cystoscope can be passed up through the urethra and bladder and up the ureter where the stone is stuck. The stone is captured and removed.It can also be broken up with a laser beam or shock waves generated by a device attached at the end of the cytoscope. This procedure is usually done under general anaesthesia.

3.Percutaneous nephrolithotomy (PCNL)
Large stones can be surgically removed from the kidney.
The surgeon makes a small opening at the back and uses a telescopic instrument called a nephroscope to pull the stone out or break it up with shock waves or a laser.
This procedure is performed under general anesthesia.

How to prevent Urinary Stones?
---------------------------------

1.drink more fluid at least three litres every 24 hours.

2.reducing the amount of calcium in the diet to a normal level(not excessively high)

3.For calcium oxalate stones, reduce intake of high levels of oxalate - chocolate, tea, cooked spinach and asparagus.

4.For uric acid stones, less meat, fish, poultry, organs, peanuts and soya beans should be taken. Daily intake of allopurinol medicine can help reduce the level of uric acid in the urine.

5.For cystine stones, medicines can be given to reduce formation of the stones.

6.For struvite or "infection" stones,long term antibiotics may prevent chronic urinary infection.


Added 4th October 2008
-------------------------------------

Urinary stone:
--------------------

Melamine a chemical used for hardening plastic has found illegally in milk products in China in September 2008.

This causes urinary stones in babies.

A Simple Guide to Gallstones

A Simple Guide to Gallstones
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What are gallstones?
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Gallstones are stones which are found in the gallbladder which is a sac storing bile from the liver.
They are made from cholesterol and other substances in the bile.


What causes gallstones?
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Gallstones are formed when cholesterol and other substances like calcium found in bile combine to form stones.

They are more common in
1.overweight people

2.Females more than males

What are the symptoms?
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Most people with gallstones do not have symptoms.

Symptomsoccur when a gallstone causes blockage in the bile duct causing obstruction to flow of bile from the liver to the intestine.

The symptoms may be:

1.mild pain in the upper right part of the abdomen and also just below the sternum just like gastritis.

2.Pain in the right upper back or shoulder blade area.

3.Pain is worse when you eat.

4.fever and chills

5.Yellowness of the eyes or skin

6.Dark coloured urine

7.Chest pain occurs when the pain radiates to the chest

How are gallstones diagnosed?
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1.Pain in the right side of the abdomen

2. Murphy's sign positive.
A thumb pressing against the right of the epigastrium causes more pain when the patients breathes in deeply

3.An ultrasound of the right side of the abdomen is the best way to find gallstones.
Most gallstones can be detected from the ultrasound.

4.gallbladder scan. A dye is injected into a vein in your arm.
X-rays are taken as the dye moves through your liver, bile duct, gallbladder.

What are the complications of gallstones?
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A gallsone which is stuck in the bile duct(a tube which leads the bile from the liver to the gallbladder and small intestine) can give rise to:
1.Gallbladder inflmmation or infection(Cholecystitis)

2.Swelling and inflammation of the Pancreas(pancreatitis)

3.Hepatitis due to reflux of the bile back to the liver

4.Peritonitis(inflammation of the inner lining of the abdomen) if the bile duct or gallbladder perfoates or burst.
This is an emergency.

What is the treatment of gallstones?
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1.If there is no symptoms, treatment is not needed.

2.If there is mild pain, some pain and antispasmodic medicines are given.
Patient is kept for observation.
If the pain goes away, the gallsone may have become unstuck in the bile duct and pass out into the intestine.

3.If there is severe pain or recurrence of another attack of pain, it is advisable to have the gallbladder removed.

a.Normal surgery to remove the gallbladder and the gallstones involve 4 holes in the abdomen and the use of a laparoscopic to cut away the gallbladder followed by stitching.
The surgery is usually very safe and the patient may not need to be hospitalised.

b.In an emergency, such as perforated gallbladder, immediate surgery may be required to remove the gallbladder and cleared the inner abdomen of leaked bile.

What is the prognosis of gallstones?
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Most people with gallstones do not have symptoms.

Sometimes gallstones may be detected while having tests for other health problems.

Sometimes an ultrasound done on an woman during pregnancy may show gallstones.

The prognosis for patients after surgery is usually good.

The bile will go straight to the intestine from the liver.
Digestion of oily food may not as good as before and is usually not noticeable.

A Simple Guide to Vulvitis

A Simple Guide to Vulvitis
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What is Vulvitis?
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Vulvitis is an acute inflammation of the vulva in females.

What are the causes of Vulvitis?
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Vulvitis is usually caused by the following:

Infections:

1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.

2.Fungal infection such as candidiasis

3.Herpes simplex in recurrent cases

4.Pediculosis pubis or lice

5.pinworm infection in children

6.Urinary infection such as cystitis

Allergies:

1.Clothings

2.perfumes

3.powders

4.drugs

Chemical irritants:

1.vaginal douche

2.detergents used to wash underwear

Mechanical irritants:

1.ill fitting underwear

2.inadequate sexual lubrication

Postmenopausal:

Atrophic vulvovaginitis after menopausal with dryness and inflammation of the vulval and vaginal lining

Generalised disorders:

Dermatological disorders such as lichen simplex


What are the symptoms and signs of Vulvitis?
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Persons who has Acute Vulvitis has the following
Symptoms:

1.vulval irritation and itch

2.discharge from vagina

3.painful or frequency of urination

4.excoriation of the inner lining of vulva

Signs:

1.discharge can be seen in female vagina

2.redness and inflammation of the vulva

How do you diagnose Vulvitis?
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Diagnosis can usually be made by :

1.History of vulval itch associated frequency of urination, painful urination or discharge from vagina

2.Vulva shows inflammation, excoriation of lining,

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

4. biopsy of the suspicious vulval lesions to exclude other causes of vulval problem such as tumor

What is the treatment of Vulvitis?
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1.Approprate Antibiotics, antifungal for infections especially after urine bacterial culture

2.Antihistamine medicine for itch

3.Topical oestrogen cream for postmenopausal atrophic vulvovaginitis

4.Proper hygience after urination, sexual intercourse and bathing

5.Avoid strong soaps

6.Use of lubricants during sexual intercourse

7.Weight reduction if obese

8.Treat underlying condition such as diabetes,allergic dermatitis,other skin
conditions.

What is the prognosis of Vulvitis?
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Prognosis is usually good with medication.

Sexual partner may need to be treated.

Recurrence is quite common.

A Simple Guide to Urethritis

A Simple Guide to Urethritis
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What is Urethritis?
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Urethritis is an acute infection of the urethra(the tube which allows passage of urine from the bladder to the outside).

What are the causes of Urethritis?
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Urethritis is usually caused by the following:

1.sexually transmitted disease like gonorrhea and chlamydia.

2.Urinary infection such as cystitis

3.In males associated with prostatitis

4.Urinary stone stuck in the urethra may cause urethitis

6.urinary catheterisation

7.Injury to the urethra

8.Important component of Reiter's Syndrome

What are the symptoms and signs of Urethritis?
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Persons who has Acute Urethritis has the following

Symptoms:
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1.painful urination

2.purulent discharge from penis in males or vagina in females

3.frequency of urination

4.cloudy and unpleasant smelling urine, sometimes blood in the urine

5.fever and chills

6.Polyathritis and conjunctivitis in Reiter's Syndrome

Signs:
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1. pussy discharge can be seen in male's urethra or in female vagina

2.redness and inflammation of the opening of the urethra

How do you diagnose Urethritis?
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Diagnosis can usually be made by :

1.History of sexual activity followed by frequency of urination, painful urination or pussy discharge from urethra or vagina

2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms

3.Urine culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

4. cystoscopy may be necessary to exclude urinary stones,tumours of the bladder in the case of blood in the urine

What is the complications of Urethritis?
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Upward infections from the urethra can lead to infections of the bladder and kidneys.

What is the treatment of Urethritis?
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Analgesic medicine for pain

Approprate Antibiotics for infections especially after urine bacterial culture

Lots of fluids

What is the prognosis of Urethritis?
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Prognosis is usually good with medication.

Sexual partner may need to be treated.

Recurrence is quite common.

A Simple Guide to Prostatitis

A Simple Guide to Prostatitis
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What is Prostatitis?
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Prostatitis is an acute or chronic infection of the prostate gland.

What are the causes of Prostatitis?
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Prostatitis is usually caused by the following:

1.enteric Gram negative organism from intestinal or bladder infection

2.tuberculosis occasionally

What are the symptoms and signs of Prostatitis?
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Persons who has Acute Prostatitis has the following:

Symptoms:

1.frequency of urination and nocturia

2.urgency of urination

3.hematuria(blood in urine)

4.low back pain

5.perineal pain

6.slow initiation of urine

Signs:

Tenderness on palpation of the prostate per rectum

How do you diagnose Prostatitis?
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Diagnosis can usually be made by :

1.History of frequency of urination, urgent urination

2.Tenderness on palpation of the prostate per rectum

3. Culture of the expressed prostatic fluid by prostatic massage

4.Urine and prostatic fluid culture will determine the micro-organism involved and the antibiotic most appropriate for it.

What is the complications of Prostatitis?
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Infections from the prostate can lead to infections of the bladder and up to the kidney.

What is the treatment of Prostatitis?
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Analgesic medicine

Antibiotics for infections especially after urine and prostatic fluid bacterial culture

Lots of fluids

What is the prognosis of Prostatitis?
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Prognosis is usually good with medication.

Recurrence is quite common.

A Simple Guide to PECOMA Cancer

A Simple Guide to PECOMA Cancer
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What are PECOMA Cancer?
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Perivascular epithelioid cell tumor (PEComa) is a neoplasm composed chiefly of HMB-45-positive(a marker which is relatively specific for melanoma) epithelioid cells with clear to granular cytoplasm and a perivascular distribution.
Such tumors have been reported in different organs

Although rare, only 20 + cases worldwide, PEC tumors (PEComas) should be regarded as a tumor of uncertain malignant potential.

Who is at risk of getting PECOMA Cancers?
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The median patient age was 46 years (range, 15-97 years).

There is a marked female predominance (22 females, 4 males).

Sites of involvement included

1.the omentum or mesentery (6 cases),

2.uterus (4 cases),

3.pelvic soft tissues (3 cases),

4.abdominal wall (2 cases),

5.uterine cervix (2 cases),

6.vagina,(1 case).

7.retroperitoneum,(1 case).

8.thigh,(1 case).

9.falciform ligament,(1 case).

10.scalp,(1 case).

11.broad ligament,(1 case).

12.forearm, (1 case).

13.shoulder,(1 case).

14.neck (1 case).

The tumors ranged from 1.6 to 29 cm in size (median, 7.8 cm).

Tumors were
1.epithelioid (N = 9),

2.spindled (N = 7), or

3.mixed (N = 10).

What are the Symptoms of Pecoma Cancer?
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Among the common warning signs are:

1.weight loss,

2.pain in the bones

3.swelling of lymph nodes

4.Persistent fever

5.loss of appetite

6.generalised weakness and pallour

What are the Causes of Pecoma Cancer?
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Unknown.

Certain genetic abnormalities may be present.

They are more common in women.

How do you diagnose Pecoma Cancer?
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1.HMB-45-positive(a marker which is relatively specific for melanoma)is present in all cases

2.Perivascular epithelioid cell present on biopsy

What is the Treatment of Pecoma Cancer?
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The onset of PEComa Cancer has been known to be very rapid.

Because of its vascular origin, it can spread very fast.

Surgery will be useful if detected at the early stage.

Chemotherapy and radiation therapy are the main treatment for Pecoma cancer.

Besides these treatments, stem cells infusion also give patients and their families another source for a cure.

What are the Prognosis for Pecoma Cancer?
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Generally poor because onset is fast and spread diffuse.

A Simple Guide to Chikungunya Fever

A Simple Guide to Chikungunya Fever
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What is Chikungunya Fever?
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Chikungunya fever is an acute illness caused by the chikungunya virus transmitted to humans by the bite of an infected Aedes mosquito.

How is the Chikungunya Fever transmitted?
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Chikungunya virus is transmitted to humans by the bite of infected Aedes mosquito.

Monkeys and other wild animals may be possible source of the virus.

Infected mosquitoes will spread the virus to other humans when they bite their skin.

The condition was first detected in Eastern Africa in the 1950 and recently has also outbreaks in India, Africa, Indonesia and Malaysia.

What are the Symptoms of chikungunya fever?
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The incubation period in mosquito is 3-5 days and 1-12 days in humans.

Symptoms usually last 3-10 days.

Symptoms may be the same as denque fever:

1.fever of sudden onset

2.severe and prolonged joint pains with or without swelling

3.muscle pain

4.headache

5.chills

6.rash -no petechiae, more of a maculopaular rash

7.fatigue

8.nausea

9.vomiting.

The most severe symptom is the severe and prolonged joint pains which can even last up to 1 month.

Unlike dengue fever,there has been no documented cases of hemorrhagic (bleeding) or shock syndrome reported in chikungunya infection.

The chikungunya virus also does not affect the nervous system.

How do you diagnose chikungunya fever?
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Diagnosis is made on the basis of :

1.high fever

2.severe and prolonged joint pain

3.blood tests for chikungunya fever

What is the treatment for chikungunya fever?
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There is at present no specific medication or vaccine to treat chikungunya fever.

TREATMENT IS THEREFORE SYMPTOMATIC:

1.rest,

2.plenty of fluids and

3.pain medication such as paracetamol may relieve symptoms of joint pain, body aches and fever.
Aspirin and NSAIDs should be avoided if possible.

What is the prognosis of chikungunya fever?
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The illness is usually self-limiting.

Most symptoms lasts for 3-10 days and the joint pain may last for weeks to months.

Rarely does it cause death(through high fever and dehydration).

How can you prevent being infected with the chikungunya virus?
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The best way to prevent chikungunya infection is to avoid bites from the Aedes Mosquito.

Preventive measures are the same as dengue fever such as getting rid of mosquito breeding places.