A Simple Guide to Meningitis
-----------------------------------
What is Meningitis?
---------------------------
Meningitis is a serious medical disease which causes inflammation and infection of the meninges which are the protective lining of the spinal cord and brain.
What are the causes of Meningitis?
----------------------------------------
The causes of Meningitis may be divided into:
Infections:
------------
1.viral infections are the most common and are usually mild
(enterovirus, herpes simplex virus 2 and mumps) except for Hand mouth and foot disease(enterovirus EV7)which can cause fatality in children
2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae) can be serious and fatal in some cases.
Meningococcal meningitis can cause outbreaks(spread easily).
E.coli, Group B streptococus and Pseudomonas infection are common in neonates.
Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae are common in infants and children
Streptococcus pneumoniae, N. meningitidis, Mycobacteria are more common in adults.
Mycobacterium tuberculosis meningitis are more common in developing countries and in people whose immune systems are impaired(eg. AIDS) and are preceded by active tuberculosis infections elsewhere.
3.fungi
Cryptococcus neoformans is the most common cause of fungal meningitis
Non-infectious:
------------------
Non infectious causes usually irritates the meninges through inflammation and auto immune reactions:
1.cancers,
2.systemic lupus erythematosus
3.drugs.
4.head injury
5.post neurosurgical procedures
What are Signs and symptoms of Meningitis?
---------------------------------------------
The triad of symptoms which often defines meningitis are:
1.Severe headache
2.Neck rigidity (unable to flex the neck forward),
A positive Kernig's sign means that the neck will painful when one hip is flexed to 90 degrees and the knee flexed to 90 degrees in a patient lying supine.
3.vomiting
Other symptoms are:
4.high fever
5.mental confusion.
6.Malaise
7.photo-phobia (inability to tolerate bright light),
8.phono-phobia (inability to tolerate loud noises),
9.irritability especially in small children
10.seizures .
11.swelling of the fontanelle may be present in infants
12.rash with numerous small, irregular red spots on the body, lower legs, soles of feet, palms
13.ulcers of the mouth (present in hand,mouth and foot disease).
How is the diagnosis of Meningitis made?
------------------------------------------
1.Classical symptoms and signs as above especially neck rigidity
2.blood tests (complete blood count, ESR and blood culture)
3.X-rays of chest and brain
4.cerebrospinal fluid (CSF) analysis via lumbar puncture is examined for white blood cells, red blood cells, protein content, glucose level and micro-organisms.
This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs)
A pressure of over 180 mm suggests bacterial meningitis.
5.CSF glucose is low,protein high and cells high in bacterial meningitis,
CSF glucose is normal,protein normal and cells high in viral meningitis
CSF glucose is low,protein high and cells high in fungal meningitis
6.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.
What are the complications of Meningitis?
-----------------------------------------------
1.Neurological deficits
2.deafness
3.learning disorders in children
4.brain infarction,
5.septic shock,
6.adult respiratory distress syndrome
7.seizures also more in children
8.pneumonia especially in the elderly
What is the treatment of Meningitis?
------------------------------------
1.Hospitalization should be immediate as meningitis is an life threatening condition.
2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.
Acyclovir may be given for herpes virus infection
High dosages of anti-fungals may be given for Fungal meningitis for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of Meningitis?
------------------------------------------
This depends on the severity and type of infection.
Viral infections except for enterovirus EV7 usually recover quickly.
Bacterial infections such as meningococcus and pneumococcus are more dangerous.
What are the Preventive measures taken for Meningitis?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis.
Vaccines against type A and C Neisseria meningitidis are used to prevent these types of meningitis especially in those who travel abroad.
Vaccines against type B Neisseria meningitidis have yet to be produced athough a drug company is doing research on the production of this vaccine.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumococcal meningitis.
Mumps vaccination as part of Measles, mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis
Friday, August 15, 2008
Wednesday, August 13, 2008
A Simple Guide to Mastitis
A Simple Guide to Mastitis
-----------------------------
What is Mastitis?
--------------------
Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.
What causes Mastitis?
------------------------
The causes of Mastitis are mostly due:
A.Hormonal:
----------------------
1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.
2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.
3.Premenstrual pain and swelling of breasts may occur
B.Infections:
---------------------
Infections of the breasts may occur due to
1.poor skin hygiene
2.Injuries or wounds allowing microganism to enter the wound
3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.
4.Mastitis may occur as a rare complication of mumps.
5.Most common bacteria infection is staphyloccus aures.
6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis
What are the symptoms of Mastitis?
-------------------------------------
The Symptoms of Mastitis are:
1.Pain usually present in all cases except in babies
2.swelling of the breasts or the nipple area
3.Pus discharge from the nipple
Signs:
1.redness of the nipple or areola
2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.
3.Local tenderness of inflammed area
4.Fever and genral malaise
5.Axillary lymph nodes may be swollen and painful
What are the complications of Mastitis?
------------------------------------
1.Abscess formation
2.Cystic formation
3.Chronic mastitis or fibroadenosis
How is diagnosis of Mastitis confirmed?
------------------------------------------
1. clinical features
2. Mammograms to exclude malignant tumors
3. Ultrasound scan of the breasts
What is the treatment of Mastitis?
------------------------------------
1. antibiotics are given to cure the infections.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2. Painkillers may be given if there is pain
3.Rest and support of the breasts with soft bras
4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.
5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary
6.Reassurance in hormonal cases of mastitis
What is the Prognosis of Mastitis?
------------------------------------
Most cases of mastitis usually will recover with proper treatment.
What are the Preventive measures for Mastitis?
----------------------------------------------------
Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently
-----------------------------
What is Mastitis?
--------------------
Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.
What causes Mastitis?
------------------------
The causes of Mastitis are mostly due:
A.Hormonal:
----------------------
1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.
2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.
3.Premenstrual pain and swelling of breasts may occur
B.Infections:
---------------------
Infections of the breasts may occur due to
1.poor skin hygiene
2.Injuries or wounds allowing microganism to enter the wound
3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.
4.Mastitis may occur as a rare complication of mumps.
5.Most common bacteria infection is staphyloccus aures.
6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis
What are the symptoms of Mastitis?
-------------------------------------
The Symptoms of Mastitis are:
1.Pain usually present in all cases except in babies
2.swelling of the breasts or the nipple area
3.Pus discharge from the nipple
Signs:
1.redness of the nipple or areola
2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.
3.Local tenderness of inflammed area
4.Fever and genral malaise
5.Axillary lymph nodes may be swollen and painful
What are the complications of Mastitis?
------------------------------------
1.Abscess formation
2.Cystic formation
3.Chronic mastitis or fibroadenosis
How is diagnosis of Mastitis confirmed?
------------------------------------------
1. clinical features
2. Mammograms to exclude malignant tumors
3. Ultrasound scan of the breasts
What is the treatment of Mastitis?
------------------------------------
1. antibiotics are given to cure the infections.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2. Painkillers may be given if there is pain
3.Rest and support of the breasts with soft bras
4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.
5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary
6.Reassurance in hormonal cases of mastitis
What is the Prognosis of Mastitis?
------------------------------------
Most cases of mastitis usually will recover with proper treatment.
What are the Preventive measures for Mastitis?
----------------------------------------------------
Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently
Tuesday, August 12, 2008
A Simple Guide to Hypothyroidism
A Simple Guide to Hypothyroidism
-----------------------------------
What is Hypothyroidism (Underactive Thyroid) ?
------------------------------------------------
Hypothyroidism is a condition caused by insufficient production of the thyroid hormones, usually more common in females.
What are the causes of Hypothyroidism?
-------------------------------------------
Primary causes:
1.Congenital:
Aplasia(no thyroid), Hypoplasia(small thyroid), ectopic(not at normal site) thyroid gland
2.Autoimmune Thyroiditis(hashimoto thyroiditis):
inflammation cause insuffient production of thyroid hormones
3.Iodine deficiency can cause less production of thyroxine
Secondary Causes:
1.Radioactive iodine reduces production of thyroid hormones
2.Excess removal of thyroid gland causes reduced production of thyroid hormones.
3.Hypothyroidism during or after pregnancy.
These women develop antibodies to their own thyroid gland resulting in underproduction of thyroid hormones.
Other rarer causes include
4. radiation treatment for cancers of the head and neck,
5.pituitary problems
What are the symptoms and signs of Hypothyroidism?
-------------------------------------------------------
Symptoms
Congenital Hypothyroidism:
---------------------------
1.puffy face
2.enlarged protruberant tongue
3.hypotonia
4.sluggish reflexes
5.enlarged fontanelle
6.retardation of development
Adult Hypothyroidism:
------------------------
1.Slowness of movement
2.slowness of thought
3.unexplained weight gain
4.cold intolerance
5.dry coarse skin
6.hair loss
7.puffy face
8.menorrhagia
9.constipation
10.depression
11.husky voice
12.bradycardia(slow heart beats)
How is the diagnosis of Hypothyroidism made?
-----------------------------------------------
1.blood test is done for TSH (thyroid stimulating hormone) levels.
TSH is usually high for Hypothyroidism
2.blood test for T4 and T3 levels.
Low levels of T4 and T3 usually means HYpothyroidism
3.Thyroid ultrasound scan for ectopic and congenital hyothyroids
What is the Treatment of Hypothyroidism?
-------------------------------------------
1.Hormone replacement with daily doses of synthetic thyroxine
2.Blood is taken regularly to test the level of TSH.
3.thyroxine dosage is adjusted until there is a normal TSH level.
4.Life long treatment of patients with thyroid hormones
What is the Prognosis of Hypothyroidism?
-------------------------------------------
Dramatic response and very good reaction to treatment occurs in most cases.
Mental retardation and slow physical development occurs in congenital hypothyroidism
-----------------------------------
What is Hypothyroidism (Underactive Thyroid) ?
------------------------------------------------
Hypothyroidism is a condition caused by insufficient production of the thyroid hormones, usually more common in females.
What are the causes of Hypothyroidism?
-------------------------------------------
Primary causes:
1.Congenital:
Aplasia(no thyroid), Hypoplasia(small thyroid), ectopic(not at normal site) thyroid gland
2.Autoimmune Thyroiditis(hashimoto thyroiditis):
inflammation cause insuffient production of thyroid hormones
3.Iodine deficiency can cause less production of thyroxine
Secondary Causes:
1.Radioactive iodine reduces production of thyroid hormones
2.Excess removal of thyroid gland causes reduced production of thyroid hormones.
3.Hypothyroidism during or after pregnancy.
These women develop antibodies to their own thyroid gland resulting in underproduction of thyroid hormones.
Other rarer causes include
4. radiation treatment for cancers of the head and neck,
5.pituitary problems
What are the symptoms and signs of Hypothyroidism?
-------------------------------------------------------
Symptoms
Congenital Hypothyroidism:
---------------------------
1.puffy face
2.enlarged protruberant tongue
3.hypotonia
4.sluggish reflexes
5.enlarged fontanelle
6.retardation of development
Adult Hypothyroidism:
------------------------
1.Slowness of movement
2.slowness of thought
3.unexplained weight gain
4.cold intolerance
5.dry coarse skin
6.hair loss
7.puffy face
8.menorrhagia
9.constipation
10.depression
11.husky voice
12.bradycardia(slow heart beats)
How is the diagnosis of Hypothyroidism made?
-----------------------------------------------
1.blood test is done for TSH (thyroid stimulating hormone) levels.
TSH is usually high for Hypothyroidism
2.blood test for T4 and T3 levels.
Low levels of T4 and T3 usually means HYpothyroidism
3.Thyroid ultrasound scan for ectopic and congenital hyothyroids
What is the Treatment of Hypothyroidism?
-------------------------------------------
1.Hormone replacement with daily doses of synthetic thyroxine
2.Blood is taken regularly to test the level of TSH.
3.thyroxine dosage is adjusted until there is a normal TSH level.
4.Life long treatment of patients with thyroid hormones
What is the Prognosis of Hypothyroidism?
-------------------------------------------
Dramatic response and very good reaction to treatment occurs in most cases.
Mental retardation and slow physical development occurs in congenital hypothyroidism
Monday, August 11, 2008
A Simple Guide to Hyperthyroid Disease
A Simple Guide to Hyperthyroid Disease
------------------------------------------
What is Hyperthyroid Disease?
---------------------------------
Hyperthyroid disease is a condition when the thyroid gland produces too much thyroid hormones resulting in all the symptoms of excessive metabolism.
What is the cause of Hyperthyroid Disease ?
---------------------------------------------------
Hyperthyroid disease is caused by conditions that increases the output of thyroid hormones:
too much thyroid hormone.
1.Graves' disease - diffuse goiter(enlarged thyroid) caused by autoimmune antibodies stimulation of the thyroid gland to produce more thyroid hormones.
Graves' disease is more common in young women.
2.Plummer's Disease (Toxic nodular thyroid)
Hyperactive thyroid nodules produce excess thyroid hormones especially in older women.
3.Hashimoto's Disease (Thyroiditis) inflammation of the thyroid gland causes production of excess thyroid hormones.
4.Idiopathic Hyperthyroid Disease is caused by ingestion of too much thyroid hormones.
What are the Symptoms of Hyperthyroid Disease?
------------------------------------------------------------
Symptoms:
1.anxiety, shaking, feeling nervous or irritated
2.fast heartbeat or palpitations
3.feeling hot all the time
4.Excess sweating
5.increased appetite
6.loss of weight
7.fatigue, exhaustion
8.increased frequency of bowel movements
9.changes in menstrual periods
10.eye irritation
11.bulging of the eyes
12.double vision
13.blurred vision
Signs:
1. Enlarged thyroid gland -diffuse or nodular
2. Bruit or blood flow sounds may be heard over the thyroid
3. Skin warm and sweaty
4. fine brittle nails
5. fine hair
6. Tachycardia -heart beat may be above 100/min , wide difference between systolic and diastolic pressure
7. Fine tremors of hands
8. Eye : bulging, peri-orbital edema, lid lag
How is diagnosis of Hyperthyroidism made?
-------------------------------------------------------
1. blood test is done for presence of high thyroid hormones(T3 and T4) and low TSH (thyroid stimulating hormone) levels.
2. Blood for thyroid antibodies(thyroiditis)
3. Ultrasound of the thyroid gland
What is the Treatment of Hyperthyroidism?
--------------------------------------------------
1.Anti-thyroid drugs
-------------------------
reduce the production of excess thyroid hormones
The drugs of choice are carbimazole and propylthiouracil initially on high doses then reducing down to a maintenance dose which has to be taken for 1-2 years depending on the severity of the condition.
Symptoms usually improve after 2 months but blood tests are needed to monitor the effect of the drugs.
Side effects include lowering of white cell count and concomitant infection of the throat.
Relapse after 1-2 years treatment are quite common.
2.Radioactive iodine therapy
--------------------------------
is more suitable for older patients and those who do not respond to anti-thyroid drugs and women who do not intend to have pregnancy.
The side effect of radioactive iodine is often radiation side effects which may lead to cancer of the bones 20 years down the road.
The other danger is the destruction of the thyroid producing cells which lead to hypothyroid disease later on.
The patient will then be required to take thyroxine for the rest of her life.
3.Surgery
may be required if the hyperthyroid condition did not improve with anti-thyroid
drugs or if there is frequent recurrences.
It is also done for women who do not wish to go for radioactive iodine therapy and who wishes to have a child later on.
A subtotal thyroidectomy is done.
Usually three quarters of the glands are removed.
Dangers of surgery and anesthesia are as usual rare however there may be removal of too much thyroid gland resulting in hypothyroidism or removal of parathyroid glands resulting in low calcium.
Patient will then need to take thyroxine and calcium replacement tablets for life.
4. Supportive treatment:
a.Propanolol and other beta blockers can slow down the fast heart beats caused by the excess thyroid hormones
b.tranquillizers such as ativan, xanax can help soothe the anxiety or stress in a person with hyperthyroid disease.
Most hyperthyroid disease patients have their excessive thyroid hormones production triggered off by stress and anxiety.
c.rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
What is the prognosis of Hyperthyroid Disease?
---------------------------------------------------
Most cases of patients treated with surgery and radioactive iodine recovered quite well although many can developed hypothyroidism later on in life when the thyroid hormones production is reduced.
Many cases on anti-thyroid medication usually have recurrence especially if the basic cause of stress and anxiety remains in their work or home life.
What are the prevention measures for hyperthyroid Disease?
--------------------------------------------------------------
Rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
Avoid stress and anxiety.
------------------------------------------
What is Hyperthyroid Disease?
---------------------------------
Hyperthyroid disease is a condition when the thyroid gland produces too much thyroid hormones resulting in all the symptoms of excessive metabolism.
What is the cause of Hyperthyroid Disease ?
---------------------------------------------------
Hyperthyroid disease is caused by conditions that increases the output of thyroid hormones:
too much thyroid hormone.
1.Graves' disease - diffuse goiter(enlarged thyroid) caused by autoimmune antibodies stimulation of the thyroid gland to produce more thyroid hormones.
Graves' disease is more common in young women.
2.Plummer's Disease (Toxic nodular thyroid)
Hyperactive thyroid nodules produce excess thyroid hormones especially in older women.
3.Hashimoto's Disease (Thyroiditis) inflammation of the thyroid gland causes production of excess thyroid hormones.
4.Idiopathic Hyperthyroid Disease is caused by ingestion of too much thyroid hormones.
What are the Symptoms of Hyperthyroid Disease?
------------------------------------------------------------
Symptoms:
1.anxiety, shaking, feeling nervous or irritated
2.fast heartbeat or palpitations
3.feeling hot all the time
4.Excess sweating
5.increased appetite
6.loss of weight
7.fatigue, exhaustion
8.increased frequency of bowel movements
9.changes in menstrual periods
10.eye irritation
11.bulging of the eyes
12.double vision
13.blurred vision
Signs:
1. Enlarged thyroid gland -diffuse or nodular
2. Bruit or blood flow sounds may be heard over the thyroid
3. Skin warm and sweaty
4. fine brittle nails
5. fine hair
6. Tachycardia -heart beat may be above 100/min , wide difference between systolic and diastolic pressure
7. Fine tremors of hands
8. Eye : bulging, peri-orbital edema, lid lag
How is diagnosis of Hyperthyroidism made?
-------------------------------------------------------
1. blood test is done for presence of high thyroid hormones(T3 and T4) and low TSH (thyroid stimulating hormone) levels.
2. Blood for thyroid antibodies(thyroiditis)
3. Ultrasound of the thyroid gland
What is the Treatment of Hyperthyroidism?
--------------------------------------------------
1.Anti-thyroid drugs
-------------------------
reduce the production of excess thyroid hormones
The drugs of choice are carbimazole and propylthiouracil initially on high doses then reducing down to a maintenance dose which has to be taken for 1-2 years depending on the severity of the condition.
Symptoms usually improve after 2 months but blood tests are needed to monitor the effect of the drugs.
Side effects include lowering of white cell count and concomitant infection of the throat.
Relapse after 1-2 years treatment are quite common.
2.Radioactive iodine therapy
--------------------------------
is more suitable for older patients and those who do not respond to anti-thyroid drugs and women who do not intend to have pregnancy.
The side effect of radioactive iodine is often radiation side effects which may lead to cancer of the bones 20 years down the road.
The other danger is the destruction of the thyroid producing cells which lead to hypothyroid disease later on.
The patient will then be required to take thyroxine for the rest of her life.
3.Surgery
may be required if the hyperthyroid condition did not improve with anti-thyroid
drugs or if there is frequent recurrences.
It is also done for women who do not wish to go for radioactive iodine therapy and who wishes to have a child later on.
A subtotal thyroidectomy is done.
Usually three quarters of the glands are removed.
Dangers of surgery and anesthesia are as usual rare however there may be removal of too much thyroid gland resulting in hypothyroidism or removal of parathyroid glands resulting in low calcium.
Patient will then need to take thyroxine and calcium replacement tablets for life.
4. Supportive treatment:
a.Propanolol and other beta blockers can slow down the fast heart beats caused by the excess thyroid hormones
b.tranquillizers such as ativan, xanax can help soothe the anxiety or stress in a person with hyperthyroid disease.
Most hyperthyroid disease patients have their excessive thyroid hormones production triggered off by stress and anxiety.
c.rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
What is the prognosis of Hyperthyroid Disease?
---------------------------------------------------
Most cases of patients treated with surgery and radioactive iodine recovered quite well although many can developed hypothyroidism later on in life when the thyroid hormones production is reduced.
Many cases on anti-thyroid medication usually have recurrence especially if the basic cause of stress and anxiety remains in their work or home life.
What are the prevention measures for hyperthyroid Disease?
--------------------------------------------------------------
Rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
Avoid stress and anxiety.
Wednesday, August 6, 2008
A Simple Guide to Pterygium
A Simple Guide to Pterygium
----------------------------------------------------
What is Pterygium?
---------------------------------------
Pterygium is a fleshy tissue that grows in on the inner corner of the eye
towards the pupil.
It may also appear on the outer corner.
It is usually triangular in shape.
Who is affected by Pterygium?
---------------------------------------------------
Pterygium is more common in people who spend time outdoors than indoor
What is the Cause of Pterygium?
-----------------------------------------------------
The exact cause of Pterygium is not known.
1. Long-term exposure to sunlight, especially ultraviolet (UV) rays
2. chronic eye irritation
3. dusty conditions
4. dry eye may contribute to pterygium as well.
What are the Symptoms and signs of Pterygium?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.discomfort in the eye
2.Conjunctival congestion
3.Tearing -excess tears from irritation
Signs:
1.fleshy growth on the conjunctiva on inner side of eye growing towards pupils
2.increased dilated blood vessels in the fleshy growth
How do you make the Diagnosis of Pterygium?
------------------------------------------------------------
The presence of fleshy growth with blood vessels on the conjunctiva on inner side of eye growing towards pupils
What are the complications of Pterygium?
---------------------------------------------------
1.Partial blindness if the pterygium covers the cornea
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Pterygium?
---------------------------------------------------
Treatment depends on the severity:
1.Mild:
Eye drops with anti congestion and anti-inflammatory properties may shrink the blood vessels which provide nourishment for the growth of the pterygium.
2.Severe:
Once the pterygium reaches the cornea and may cover the cornea, surgical resection of the pterygium may be necessary otherwise the eye sight may be compromised.
Surgical resection may also be done if the pterygium is unsightly.
What is the prognosis of Pterygium?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur due to regrowth of the blood vessel supplying the pterygium.
This occurs more in younger people.
How is pterygium prevented?
---------------------------------
Wearing UV protective sunglasses
Avoid dry and dusty conditions
Use of artificial tear eye drops
----------------------------------------------------
What is Pterygium?
---------------------------------------
Pterygium is a fleshy tissue that grows in on the inner corner of the eye
towards the pupil.
It may also appear on the outer corner.
It is usually triangular in shape.
Who is affected by Pterygium?
---------------------------------------------------
Pterygium is more common in people who spend time outdoors than indoor
What is the Cause of Pterygium?
-----------------------------------------------------
The exact cause of Pterygium is not known.
1. Long-term exposure to sunlight, especially ultraviolet (UV) rays
2. chronic eye irritation
3. dusty conditions
4. dry eye may contribute to pterygium as well.
What are the Symptoms and signs of Pterygium?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.discomfort in the eye
2.Conjunctival congestion
3.Tearing -excess tears from irritation
Signs:
1.fleshy growth on the conjunctiva on inner side of eye growing towards pupils
2.increased dilated blood vessels in the fleshy growth
How do you make the Diagnosis of Pterygium?
------------------------------------------------------------
The presence of fleshy growth with blood vessels on the conjunctiva on inner side of eye growing towards pupils
What are the complications of Pterygium?
---------------------------------------------------
1.Partial blindness if the pterygium covers the cornea
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Pterygium?
---------------------------------------------------
Treatment depends on the severity:
1.Mild:
Eye drops with anti congestion and anti-inflammatory properties may shrink the blood vessels which provide nourishment for the growth of the pterygium.
2.Severe:
Once the pterygium reaches the cornea and may cover the cornea, surgical resection of the pterygium may be necessary otherwise the eye sight may be compromised.
Surgical resection may also be done if the pterygium is unsightly.
What is the prognosis of Pterygium?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur due to regrowth of the blood vessel supplying the pterygium.
This occurs more in younger people.
How is pterygium prevented?
---------------------------------
Wearing UV protective sunglasses
Avoid dry and dusty conditions
Use of artificial tear eye drops
Tuesday, August 5, 2008
A Simple Guide to Entropion
A Simple Guide to Entropion
----------------------------------------------------
What is Entropion?
---------------------------------------
Entropion is an inversion(rolling inwards) of the eyelid
Who is affected by Entropion?
---------------------------------------------------
Entropion is more common in women than in men.
What is the Cause of Entropion?
-----------------------------------------------------
The causes of Entropion can divided into 2 type:
Spasm of Orbicularis muscle:
1. Degeneration of the peripheral connective tissue of the eye
2. Occurs in old age
3. Occurs also after removal of eyeball
4. Primarily affects the lower eyelid.
Cicatricial:
1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns
2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections
3.Congenital disease
4. May affect either upper or lower eyelid
What are the Symptoms and signs of Entropion?
-----------------------------------------------------------
Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:
1.Irritation of the conjunctiva
2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels
3.Tearing -excess tears from irritation
Signs:
1.Erosions, opacities and vasculisation of the cornea
2.increased dilated blood vessels of conjunctiva present due to irritation
3.The presence of inward turning eyelids and eyelashes
How do you make the Diagnosis of Entropion?
------------------------------------------------------------
The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.
What are the complications of Entropion?
---------------------------------------------------
1.Recurrent corneal ulcers
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Entropion?
---------------------------------------------------
Treatment depends on the type of Entropion:
Spastic:
1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops
2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below
Cicatricial:
Surgery to tighten the eyelid muscle is usually required:
1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.
Recurrence is common.
This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.
2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.
This is usually done on an outpatient basis and under local anesthesia.
Post-operatively the wounds are protected by antibiotic creams and dressings.
Healing usually occurs within 1 week.
Antibiotics are also given for any infections of the conjunctiva and cornea.
What is the prognosis of Entropion?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur especially due to weakening of eye muscles from age.
----------------------------------------------------
What is Entropion?
---------------------------------------
Entropion is an inversion(rolling inwards) of the eyelid
Who is affected by Entropion?
---------------------------------------------------
Entropion is more common in women than in men.
What is the Cause of Entropion?
-----------------------------------------------------
The causes of Entropion can divided into 2 type:
Spasm of Orbicularis muscle:
1. Degeneration of the peripheral connective tissue of the eye
2. Occurs in old age
3. Occurs also after removal of eyeball
4. Primarily affects the lower eyelid.
Cicatricial:
1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns
2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections
3.Congenital disease
4. May affect either upper or lower eyelid
What are the Symptoms and signs of Entropion?
-----------------------------------------------------------
Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:
1.Irritation of the conjunctiva
2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels
3.Tearing -excess tears from irritation
Signs:
1.Erosions, opacities and vasculisation of the cornea
2.increased dilated blood vessels of conjunctiva present due to irritation
3.The presence of inward turning eyelids and eyelashes
How do you make the Diagnosis of Entropion?
------------------------------------------------------------
The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.
What are the complications of Entropion?
---------------------------------------------------
1.Recurrent corneal ulcers
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Entropion?
---------------------------------------------------
Treatment depends on the type of Entropion:
Spastic:
1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops
2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below
Cicatricial:
Surgery to tighten the eyelid muscle is usually required:
1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.
Recurrence is common.
This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.
2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.
This is usually done on an outpatient basis and under local anesthesia.
Post-operatively the wounds are protected by antibiotic creams and dressings.
Healing usually occurs within 1 week.
Antibiotics are also given for any infections of the conjunctiva and cornea.
What is the prognosis of Entropion?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur especially due to weakening of eye muscles from age.
Sunday, August 3, 2008
A Simple Guide to Corneal Ulcer
A Simple Guide to Corneal Ulcer
----------------------------------------------------
What is Corneal ulcer?
---------------------------------------
Corneal ulcer is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.
Corneal ulcers can be infectious(due to infection) or non infectious(due to injury or autoimmune disease)
Who is affected by corneal ulcer?
---------------------------------------------------
Corneal ulcers may be present more frequently in patients with :
Vitamin A deficiency
autoimmune disease
neurological disorders like facial palsy
What is the Cause of corneal ulcer?
-----------------------------------------------------
The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphhylococci, pneumococci, pseudomonas
2. Viral infections such as herpes simplex, herpes zoster,
3. Fungal infection
Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch
2.autoimmune disease
3.Systemic disease
What are the Symptoms and signs of corneal ulcer?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. Non-infectious causes may not give rise to pain.
2.Red eye - increased blood flow through inflamed eye shows up the blood vessels
3.Tearing -excess tears from inflammation
4.Discharge -may be pus discharge from eyes especially in the morning
5.Light sensitivity - sensitive to bright lights
Signs:
1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye
2.increased dilated blood vessels present due to inflammation
How do you make the Diagnosis of corneal ulcer?
------------------------------------------------------------
The presence of a corneal ulcer can be seen using a slit lamp microscope.
Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.
What investigation are necessary in Corneal ulcer?
-----------------------------------------------------
If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.
What are the complications of corneal ulcer?
---------------------------------------------------
The complication is always the risk of :
1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.
2.Scarring of the corneal ulcer resulting in partial loss of vision
What is the treatment of corneal ulcer?
---------------------------------------------------
Treatment depends on the type of corneal ulcer:
Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops (given every 15 minutes)
2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream
3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.
In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain
Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation
2.Antibiotic are also given to prevent infections of the ulcer.
In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.
What is the prognosis of corneal ulcer?
-----------------------------------------
The prognosis depends on the severity of the disease
Most cases can be healed if detected early.
There may be minimum scarring of the cornea with possible loss of some vision.
Rarely the eye may be lost if there is severe infection and no treatment.
What are preventive measures in corneal ulcer?
-----------------------------------------------------
1. A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
2.Avoid the use of infected contact lens lotion
3.A soft lens are more prone to eye infection. Always wash the hands before using any contact lens.
4.Avoid rubbing the eyes with dirty hands or tissues
5.A healthy lifestyle with less stress and mild exercise is always good for the body.
----------------------------------------------------
What is Corneal ulcer?
---------------------------------------
Corneal ulcer is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.
Corneal ulcers can be infectious(due to infection) or non infectious(due to injury or autoimmune disease)
Who is affected by corneal ulcer?
---------------------------------------------------
Corneal ulcers may be present more frequently in patients with :
Vitamin A deficiency
autoimmune disease
neurological disorders like facial palsy
What is the Cause of corneal ulcer?
-----------------------------------------------------
The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphhylococci, pneumococci, pseudomonas
2. Viral infections such as herpes simplex, herpes zoster,
3. Fungal infection
Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch
2.autoimmune disease
3.Systemic disease
What are the Symptoms and signs of corneal ulcer?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. Non-infectious causes may not give rise to pain.
2.Red eye - increased blood flow through inflamed eye shows up the blood vessels
3.Tearing -excess tears from inflammation
4.Discharge -may be pus discharge from eyes especially in the morning
5.Light sensitivity - sensitive to bright lights
Signs:
1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye
2.increased dilated blood vessels present due to inflammation
How do you make the Diagnosis of corneal ulcer?
------------------------------------------------------------
The presence of a corneal ulcer can be seen using a slit lamp microscope.
Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.
What investigation are necessary in Corneal ulcer?
-----------------------------------------------------
If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.
What are the complications of corneal ulcer?
---------------------------------------------------
The complication is always the risk of :
1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.
2.Scarring of the corneal ulcer resulting in partial loss of vision
What is the treatment of corneal ulcer?
---------------------------------------------------
Treatment depends on the type of corneal ulcer:
Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops (given every 15 minutes)
2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream
3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.
In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain
Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation
2.Antibiotic are also given to prevent infections of the ulcer.
In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.
What is the prognosis of corneal ulcer?
-----------------------------------------
The prognosis depends on the severity of the disease
Most cases can be healed if detected early.
There may be minimum scarring of the cornea with possible loss of some vision.
Rarely the eye may be lost if there is severe infection and no treatment.
What are preventive measures in corneal ulcer?
-----------------------------------------------------
1. A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
2.Avoid the use of infected contact lens lotion
3.A soft lens are more prone to eye infection. Always wash the hands before using any contact lens.
4.Avoid rubbing the eyes with dirty hands or tissues
5.A healthy lifestyle with less stress and mild exercise is always good for the body.
Wednesday, July 30, 2008
A Simple Guide to Crohn's Disease
A Simple Guide to Crohn's Disease
----------------------------------------------------
What is Crohn's Disease?
---------------------------------------
Crohn's Disease(Regional Enteritis) is a chronic inflammatory disease of the gastrointestinal tract which affects the layers of the lining of the whole gastrointestinal tract from mouth to anus.
It was originally called regional ileitis because the ileum was typically affected but has been extended to regional enteritis because the whole layer of the lining of the gastrointestinal tract can be affected from the mouth to anus.
Who is affected by Crohn's Disease?
---------------------------------------------------
Crohn's Disease is more common in Jews than non-Jews and in whites than non-whites
It occurs equally in men and women and can be found in families.
Crohn's Disease can be found in all ages but are more common in the 20-30 years age group.
What is the Cause of Crohn's Disease?
-----------------------------------------------------
The exact cause of Crohn's Disease is not known.
It has been suggested that an autoimmune disease is the main cause of Crohn's Disease.
A protein produced by the immune system, called anti-tumor necrosis factor (TNF) may be a possible cause of the body's reaction in the lining of the gastrointestinal tract resulting in inflammation.
Infectious causes has also been blamed.
What are the Symptoms and signs of Crohn's Disease?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.severe abdominal pain, especially in the right iliac fossa
2.diarrhea
3.Rectal Bleeding
4.fever
5.weight loss
6.loss of appetite
7.joint pain
Signs:
1.Abdominal distension and tenderness
Abdominal mass may be felt in the right iliac fossa
2.Rectal examination may show blood in the stool
3.pallor due to anemia
4.skin lesions
How do you make the Diagnosis of Crohn's Disease?
------------------------------------------------------------
1.A history of abdominal pain , diarrhea and bloody stools
2.The physical exam consists of
a.palpation of the abdomen for tenderness and right iliac fossa mass
b.digital rectal exam to detect blood.
3.stool may be tested for blood
4.blood tests(Hb, WBC, ESR, blood culture) are done for evidence of infection.
5.X-rays of the abdomen, barium meal and barium enema may be done to show evidence of extent of inflammation and narrowing of segment of intestine
6.Colonoscopy is also done to confirm extent of colon involvement.
A biopsy of inflamed lining may be done for microscopic examination.
7.A small camera which can be swallowed and passed out in the stools can take photos of the entire gastrointestinal tract.
What are the complications of Crohn's Disease?
---------------------------------------------------
Bowel complications:
1.Strictures of intestine leading to blockage
2.Fistula especially in the rectal region
3.Fissures in the anal region
4.hemorrhage
Non-bowel complications:
1.Bones: arthritis, sacroiliatis
osteoporosis
2.Eyes: uveitis, iritis
3.mouth ulcers
4.Skin: eczema
5.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Ulcerative Colitis?
---------------------------------------------------
Treatment is symptomatic to relieve discomfort, correct nutritional deficiencies, and control inflammation of the gastrointestinal tract.
Medications:
1.Anti-diarheal and bulk forming agents
2.Anti-spasmotic medication for spasm of the colon
3.Anti-inflammation drugs like Sulfasalazine (immunosuppressant) given indefintely.
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.
4.Oral corticosteroids in high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.
5.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system
6.Infliximab (Remicade). This drug helps by blocking the body's inflammation response
7.Antibiotics like ampicillin, septrim, flagyl, cephalosporin, tetracycline helps to treat bacterial infections in strictures, fistulas.
8.Correction of anemia and nutritional deficiencies is important to enhance the immune system
9.Replacement of fluids and electrolytes are important in cases of dehydration especially in children.
10.Regular hemoglobin, blood counts and liver function tests
Surgery:
Surgery is required:
1.if medications cannot control the symptoms or progression of the disease
2.to treat complications such as blockage, perforation, abscess, or bleeding in the intestine.
Resection of the inflammed segment of the intestine is removed and may relieve symptoms but is not a cure.
There has been instances where recurrence occur in the the segment next to the resected intestine.
In more severe cases a total colectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done.
Emergency surgery may be done for perforation, peritonitis, or continued bleeding.
What is the prognosis of Crohn's Disease?
-----------------------------------------
The prognosis depends on the severity of the disease
Three quarters of patients with Crohn's Disease will require surgery sooner or later.
There will be temporary relief of symptoms but recurrences are common.
In many cases with proper treatment, patients are able to lead a normal life.
What are preventive measures in Crohn's Disease?
-----------------------------------------------------
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
Certain foods such as spicy food, milk products and alcohol which may spark off an attack of abdominal discomfort and diarrhea should be avoided.
Stress can also trigger off episodes of Crohn's disease.
A healthy lifestyle with meditation and mild exercise can always help to prevent triggering off an attack of Crohn's Disease.
----------------------------------------------------
What is Crohn's Disease?
---------------------------------------
Crohn's Disease(Regional Enteritis) is a chronic inflammatory disease of the gastrointestinal tract which affects the layers of the lining of the whole gastrointestinal tract from mouth to anus.
It was originally called regional ileitis because the ileum was typically affected but has been extended to regional enteritis because the whole layer of the lining of the gastrointestinal tract can be affected from the mouth to anus.
Who is affected by Crohn's Disease?
---------------------------------------------------
Crohn's Disease is more common in Jews than non-Jews and in whites than non-whites
It occurs equally in men and women and can be found in families.
Crohn's Disease can be found in all ages but are more common in the 20-30 years age group.
What is the Cause of Crohn's Disease?
-----------------------------------------------------
The exact cause of Crohn's Disease is not known.
It has been suggested that an autoimmune disease is the main cause of Crohn's Disease.
A protein produced by the immune system, called anti-tumor necrosis factor (TNF) may be a possible cause of the body's reaction in the lining of the gastrointestinal tract resulting in inflammation.
Infectious causes has also been blamed.
What are the Symptoms and signs of Crohn's Disease?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.severe abdominal pain, especially in the right iliac fossa
2.diarrhea
3.Rectal Bleeding
4.fever
5.weight loss
6.loss of appetite
7.joint pain
Signs:
1.Abdominal distension and tenderness
Abdominal mass may be felt in the right iliac fossa
2.Rectal examination may show blood in the stool
3.pallor due to anemia
4.skin lesions
How do you make the Diagnosis of Crohn's Disease?
------------------------------------------------------------
1.A history of abdominal pain , diarrhea and bloody stools
2.The physical exam consists of
a.palpation of the abdomen for tenderness and right iliac fossa mass
b.digital rectal exam to detect blood.
3.stool may be tested for blood
4.blood tests(Hb, WBC, ESR, blood culture) are done for evidence of infection.
5.X-rays of the abdomen, barium meal and barium enema may be done to show evidence of extent of inflammation and narrowing of segment of intestine
6.Colonoscopy is also done to confirm extent of colon involvement.
A biopsy of inflamed lining may be done for microscopic examination.
7.A small camera which can be swallowed and passed out in the stools can take photos of the entire gastrointestinal tract.
What are the complications of Crohn's Disease?
---------------------------------------------------
Bowel complications:
1.Strictures of intestine leading to blockage
2.Fistula especially in the rectal region
3.Fissures in the anal region
4.hemorrhage
Non-bowel complications:
1.Bones: arthritis, sacroiliatis
osteoporosis
2.Eyes: uveitis, iritis
3.mouth ulcers
4.Skin: eczema
5.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Ulcerative Colitis?
---------------------------------------------------
Treatment is symptomatic to relieve discomfort, correct nutritional deficiencies, and control inflammation of the gastrointestinal tract.
Medications:
1.Anti-diarheal and bulk forming agents
2.Anti-spasmotic medication for spasm of the colon
3.Anti-inflammation drugs like Sulfasalazine (immunosuppressant) given indefintely.
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.
4.Oral corticosteroids in high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.
5.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system
6.Infliximab (Remicade). This drug helps by blocking the body's inflammation response
7.Antibiotics like ampicillin, septrim, flagyl, cephalosporin, tetracycline helps to treat bacterial infections in strictures, fistulas.
8.Correction of anemia and nutritional deficiencies is important to enhance the immune system
9.Replacement of fluids and electrolytes are important in cases of dehydration especially in children.
10.Regular hemoglobin, blood counts and liver function tests
Surgery:
Surgery is required:
1.if medications cannot control the symptoms or progression of the disease
2.to treat complications such as blockage, perforation, abscess, or bleeding in the intestine.
Resection of the inflammed segment of the intestine is removed and may relieve symptoms but is not a cure.
There has been instances where recurrence occur in the the segment next to the resected intestine.
In more severe cases a total colectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done.
Emergency surgery may be done for perforation, peritonitis, or continued bleeding.
What is the prognosis of Crohn's Disease?
-----------------------------------------
The prognosis depends on the severity of the disease
Three quarters of patients with Crohn's Disease will require surgery sooner or later.
There will be temporary relief of symptoms but recurrences are common.
In many cases with proper treatment, patients are able to lead a normal life.
What are preventive measures in Crohn's Disease?
-----------------------------------------------------
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
Certain foods such as spicy food, milk products and alcohol which may spark off an attack of abdominal discomfort and diarrhea should be avoided.
Stress can also trigger off episodes of Crohn's disease.
A healthy lifestyle with meditation and mild exercise can always help to prevent triggering off an attack of Crohn's Disease.
Tuesday, July 29, 2008
A Simple Guide to Ulcerative Colitis
A Simple Guide to Ulcerative Colitis
----------------------------------------------------
What is Ulcerative Colitis?
---------------------------------------
Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.
Who is affected by Ulcerative Colitis?
---------------------------------------------------
Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites
Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.
Those above the age of 60 years have more severe symptoms and signs.
It occurs equally in men and women and can be found in families.
What is the Cause of Ulcerative Colitis?
-----------------------------------------------------
The exact cause of Ulcerative Colitis is not known.
It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.
Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.
What are the Symptoms and signs of Ulcerative Colitis?
-----------------------------------------------------------
Symptoms:
The symptoms can range from mild to severe.
Mild cases (about 50%)usually have:
1.an insidious onset
2.lower abdominal pain
3.Slight blood stained diarrhea
4.malaise
In the more severe cases, the main symptoms may be:
1.abrupt onset
2.severe diffuse abdominal pain
3.Bloody diarrhea
4.fever
5.shock
6.fatigue
7.weight loss
8.loss of appetite
9.loss of body fluids and nutrients
10.joint pain
Signs:
1.Abdominal distension and tenderness
2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter
3.pallor due to anemia
4.Wasting of muscles
5.skin lesions
How do you make the Diagnosis of Ulcerative Colitis?
------------------------------------------------------------
1.A history of lower abdominal pain , bloating and bloody diarrhea
2.The physical exam consists of
a.palpation of the abdomen for tenderness
b.digital rectal exam to detect tenesmus or blood.
3.stool may be tested for blood
4.blood tests( HB, WBC, ESR, blood culture) are done for evidence of infection.
5.Xrays of the abdomen and barium enema may be done to show evidence of extent of ulcers in the colon
6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.
What are the complications of Ulcerative Colitis?
---------------------------------------------------
Bowel complications:
1.Strictures of colon
2.Fistula
3.Toxic dilatation(toxic megacolon)
4.Perforation of the colon
5.hemorrhage
6.shock
7.rarely carcinoma(5%)
Non-bowel complications:
1.Bones: arthritis, sacroiliatis
osteoporosis
2.Eyes: uveitis, iritis
3.Skin: eczema
What is the treatment of Ulcerative Colitis?
----------------------------------------------------------------
Mild Cases:
Medications:
1.Antidiarrheal and bulk forming agents
2.Antispasmotic medication for spasm of the colon
3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.
4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.
5.Correction of anemia
6.Regular hemoglobin, blood counts and liver function tests
Severe cases:
1.Hospitalisation with bed rest, fluids, electrolyte replacement and blood transfusion if necessary
2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.
3.Sulphasalazine (immuno-suppressant) given indefinitely
4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system
5.Antibiotics in toxic megacolon syndrome
5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.
In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.
Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.
Emergency surgery may be done for perforation, peritonitis, or continued bleeding.
What is the prognosis of Ulcerative Colitis?
-----------------------------------------
The prognosis depends on the severity of the disease
Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.
5% will die within the first year.
75% will have recurrence for the rest of their life.
Only 10% will have remissions lasting 15 years.
----------------------------------------------------
What is Ulcerative Colitis?
---------------------------------------
Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.
Who is affected by Ulcerative Colitis?
---------------------------------------------------
Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites
Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.
Those above the age of 60 years have more severe symptoms and signs.
It occurs equally in men and women and can be found in families.
What is the Cause of Ulcerative Colitis?
-----------------------------------------------------
The exact cause of Ulcerative Colitis is not known.
It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.
Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.
What are the Symptoms and signs of Ulcerative Colitis?
-----------------------------------------------------------
Symptoms:
The symptoms can range from mild to severe.
Mild cases (about 50%)usually have:
1.an insidious onset
2.lower abdominal pain
3.Slight blood stained diarrhea
4.malaise
In the more severe cases, the main symptoms may be:
1.abrupt onset
2.severe diffuse abdominal pain
3.Bloody diarrhea
4.fever
5.shock
6.fatigue
7.weight loss
8.loss of appetite
9.loss of body fluids and nutrients
10.joint pain
Signs:
1.Abdominal distension and tenderness
2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter
3.pallor due to anemia
4.Wasting of muscles
5.skin lesions
How do you make the Diagnosis of Ulcerative Colitis?
------------------------------------------------------------
1.A history of lower abdominal pain , bloating and bloody diarrhea
2.The physical exam consists of
a.palpation of the abdomen for tenderness
b.digital rectal exam to detect tenesmus or blood.
3.stool may be tested for blood
4.blood tests( HB, WBC, ESR, blood culture) are done for evidence of infection.
5.Xrays of the abdomen and barium enema may be done to show evidence of extent of ulcers in the colon
6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.
What are the complications of Ulcerative Colitis?
---------------------------------------------------
Bowel complications:
1.Strictures of colon
2.Fistula
3.Toxic dilatation(toxic megacolon)
4.Perforation of the colon
5.hemorrhage
6.shock
7.rarely carcinoma(5%)
Non-bowel complications:
1.Bones: arthritis, sacroiliatis
osteoporosis
2.Eyes: uveitis, iritis
3.Skin: eczema
What is the treatment of Ulcerative Colitis?
----------------------------------------------------------------
Mild Cases:
Medications:
1.Antidiarrheal and bulk forming agents
2.Antispasmotic medication for spasm of the colon
3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.
4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.
5.Correction of anemia
6.Regular hemoglobin, blood counts and liver function tests
Severe cases:
1.Hospitalisation with bed rest, fluids, electrolyte replacement and blood transfusion if necessary
2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.
3.Sulphasalazine (immuno-suppressant) given indefinitely
4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system
5.Antibiotics in toxic megacolon syndrome
5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.
In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.
Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.
Emergency surgery may be done for perforation, peritonitis, or continued bleeding.
What is the prognosis of Ulcerative Colitis?
-----------------------------------------
The prognosis depends on the severity of the disease
Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.
5% will die within the first year.
75% will have recurrence for the rest of their life.
Only 10% will have remissions lasting 15 years.
Monday, July 28, 2008
A Simple Guide to Foot Care
A Simple Guide to Foot Care
-------------------------------
What is Foot Care?
------------------------------------
Typically the foot is furthest from the heart and therefore more easily plagued with problems like poor blood circulation or neurological deficit.
Therefore taking care of the foot is very important especially in diabetic patients.
Foot care is an important tool in prevention of foot problems at all ages.
What is important in Foot care?
--------------------------------------
Footwear:
1.Shoes should fit comfortably.
2.Soft shoes like canvas or soft leather is preferred because they cause less
pressure points.
Foam rubber shoes cause fewer planter calluses
3.The toe box should be wide and high enough to accomodate any exostosis or contractures.
4.Shoes should have anterior as well as a posterior heel.
This protects the metatarsal heads from coming under stress.
5.Wearing sport shoes which are comfortable and has air bubbles at the front and back of the shoes will prevent friction in sports like jogging and brisk walking.
6.Woman's shoes should not have high heels as these increase increased pressure
on the planter surface and the metatarsal bones.
A low heel lace shoe is more comfortable because of the bigger toe box.
7.Specially constructed shoes may be necessary for patients with deformities of the foot.
8. Full length soft molded inlays can be used when pressure sores or painful calluses are present.
Socks:
1.Socks or stocking should fit comfortably and kept dry at all times
2.Tight constricting stocking should not be worn.
3.Loose stockings which can wrinkle should also be avoided
Foot:
1.Inspect and clean foot daily.
2.wash feet daily with bland soap and lukewarm water.
Pat dry gently and thoroughly especially between the toes after wash.
Do not rub the foot vigorously.
3.keep your toe nails short,trimming them straight across to avoid ingrowing toenails
4.moisturise feet daily to prevent dryness and cracking of skin
5.web spaces should be kept dry with powder or small pieces of cotton wool in between toes.
6.examine feet daily for scratches, cuts, blisters and corn
7.use a mirror to check the sole of your feet
8.Avoid going barefoot
9.Seek prompt treatment for cuts and sores
10.annual review for foot ulcers, risk of neuropathy(poor sensation), blood circulation( palpable pulses)
General Measures:
1.Smoking should be avoided as it causes constriction of the blood vessels
2.Avoid extreme temperatures such as excessive heat or cold
3.Home surgery should avoided in diabetes and those with vascular disease.
Avoid cutting calluses or corns yourself.
Also avoid applying strong chemicals to calluses or corn.
Instead try changing the weight bearing stresses on the foot.
4.When ulcers do appear they are most commonly on the weight bearing surface of the foot.
Vigorous local care such as removal of infected tissues and control of infections with antibiotics and antibiotic creams are indicated.
If the foot is warm and the blood flow good(feel pulse), healing of ulcers
usually will occur.
Raise the foot and exercise the foot to improve blood circulation.
5.Any injuries or cuts in the foot should be treated instantly to prevent any complication such as infection
6.Good balanced diet and a healthy lifestyle is important.
-------------------------------
What is Foot Care?
------------------------------------
Typically the foot is furthest from the heart and therefore more easily plagued with problems like poor blood circulation or neurological deficit.
Therefore taking care of the foot is very important especially in diabetic patients.
Foot care is an important tool in prevention of foot problems at all ages.
What is important in Foot care?
--------------------------------------
Footwear:
1.Shoes should fit comfortably.
2.Soft shoes like canvas or soft leather is preferred because they cause less
pressure points.
Foam rubber shoes cause fewer planter calluses
3.The toe box should be wide and high enough to accomodate any exostosis or contractures.
4.Shoes should have anterior as well as a posterior heel.
This protects the metatarsal heads from coming under stress.
5.Wearing sport shoes which are comfortable and has air bubbles at the front and back of the shoes will prevent friction in sports like jogging and brisk walking.
6.Woman's shoes should not have high heels as these increase increased pressure
on the planter surface and the metatarsal bones.
A low heel lace shoe is more comfortable because of the bigger toe box.
7.Specially constructed shoes may be necessary for patients with deformities of the foot.
8. Full length soft molded inlays can be used when pressure sores or painful calluses are present.
Socks:
1.Socks or stocking should fit comfortably and kept dry at all times
2.Tight constricting stocking should not be worn.
3.Loose stockings which can wrinkle should also be avoided
Foot:
1.Inspect and clean foot daily.
2.wash feet daily with bland soap and lukewarm water.
Pat dry gently and thoroughly especially between the toes after wash.
Do not rub the foot vigorously.
3.keep your toe nails short,trimming them straight across to avoid ingrowing toenails
4.moisturise feet daily to prevent dryness and cracking of skin
5.web spaces should be kept dry with powder or small pieces of cotton wool in between toes.
6.examine feet daily for scratches, cuts, blisters and corn
7.use a mirror to check the sole of your feet
8.Avoid going barefoot
9.Seek prompt treatment for cuts and sores
10.annual review for foot ulcers, risk of neuropathy(poor sensation), blood circulation( palpable pulses)
General Measures:
1.Smoking should be avoided as it causes constriction of the blood vessels
2.Avoid extreme temperatures such as excessive heat or cold
3.Home surgery should avoided in diabetes and those with vascular disease.
Avoid cutting calluses or corns yourself.
Also avoid applying strong chemicals to calluses or corn.
Instead try changing the weight bearing stresses on the foot.
4.When ulcers do appear they are most commonly on the weight bearing surface of the foot.
Vigorous local care such as removal of infected tissues and control of infections with antibiotics and antibiotic creams are indicated.
If the foot is warm and the blood flow good(feel pulse), healing of ulcers
usually will occur.
Raise the foot and exercise the foot to improve blood circulation.
5.Any injuries or cuts in the foot should be treated instantly to prevent any complication such as infection
6.Good balanced diet and a healthy lifestyle is important.
Saturday, July 26, 2008
A Simple Guide to Plantar Fascilitis
A Simple Guide to Plantar Fascilitis
----------------------------------------------------
What is Plantar Fascilitis?
-----------------------------------------
Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.
It is more common in women.
What are the cause of Plantar Fascilitis?
-----------------------------------------------
The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.
In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.
Both heels can be affected.
What are the symptoms and signs of Plantar Fascilitis?
---------------------------------------------------------------------------------
Symptoms:
1.Pain in the heel of one or both feet
2.Pain usually is worse in the morning on getting and stepping on the floor.
3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse
4.Pain is described as constant and aching
5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.
Signs:
1.local tenderness in the calcaneal bone area of the heel.
2. Pain is aggravated by direct pressure.
3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.
4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.
A stress fracture may need to be ruled out in chronic cases.
What is the Treatment of Plantar Fascilitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the heel-avoid jogging or strenous exercises
2.Cold or ice may help reduce inflammation
3.Heel cups, cushions, tapes, pads may help to reduce the pain
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.
7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.
8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.
Mobilisation phase:
Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain
Surgery is usually not indicated in plantar fascilitis.
Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.
What is the prognosis of Plantar Fascilitis?
----------------------------------------------------------
Prognosis is usually good although healing is slow and takes up to 1-2 years.
What is the prevention of Plantar Fascilitis?
-------------------------------------------------
Avoid certain weight bearing exercises like jogging or brisk walking
Use heel cups, cushions, tapes, pads in foot wear
Lose Weight
----------------------------------------------------
What is Plantar Fascilitis?
-----------------------------------------
Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.
It is more common in women.
What are the cause of Plantar Fascilitis?
-----------------------------------------------
The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.
In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.
Both heels can be affected.
What are the symptoms and signs of Plantar Fascilitis?
---------------------------------------------------------------------------------
Symptoms:
1.Pain in the heel of one or both feet
2.Pain usually is worse in the morning on getting and stepping on the floor.
3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse
4.Pain is described as constant and aching
5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.
Signs:
1.local tenderness in the calcaneal bone area of the heel.
2. Pain is aggravated by direct pressure.
3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.
4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.
A stress fracture may need to be ruled out in chronic cases.
What is the Treatment of Plantar Fascilitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the heel-avoid jogging or strenous exercises
2.Cold or ice may help reduce inflammation
3.Heel cups, cushions, tapes, pads may help to reduce the pain
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.
7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.
8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.
Mobilisation phase:
Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain
Surgery is usually not indicated in plantar fascilitis.
Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.
What is the prognosis of Plantar Fascilitis?
----------------------------------------------------------
Prognosis is usually good although healing is slow and takes up to 1-2 years.
What is the prevention of Plantar Fascilitis?
-------------------------------------------------
Avoid certain weight bearing exercises like jogging or brisk walking
Use heel cups, cushions, tapes, pads in foot wear
Lose Weight
Thursday, July 24, 2008
A Simple Guide to Knee cap Dislocation
A Simple Guide to Knee cap Dislocation
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.
What are the causes of Knee cap Dislocation?
----------------------------------------------------------------------
1.Dislocated knee caps most often occur in people with loose joint ligaments.
It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.
2.Dislocation of the knee cap may also occur due to trauma.
A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.
3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.
This condition is usually inherited and are more common in women than in men.
What are the symptoms and signs of Knee cap Dislocation?
-------------------------------------------------------------------
Symptoms:
1.Knee cap is displaced to the lateral position
2.knee swelling and effusion due to displacement of the knee cap.
3.Knee pain and tenderness is present.
4.The knee is usually held in slight flexion.
5.There is difficulty in lifting the leg
6. Patient usually walks with a limp.
Signs:
1.Tenderness and swelling of the knee
2.Knee cap is displaced to the outside or lateral part of the knee
3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.
4.The knee cap can move excessively from right to left.(hypermobile)
How to investigate the cause of Knee cap Dislocation?
-------------------------------------------------------------
1.examination of the knee would confirm presence of the dislocated knee cap.
There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.
2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.
A skyline view of the knee should show the shift of the patella laterally.
3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.
What is the Treatment of Knee cap Dislocation?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.
The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)
Gentle pressure is exerted on the knee cap to place it to its normal position.
The knee is then immobilized for 2-3 weeks.
Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
Surgery is required if:
1.the knee remains unstable
2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.
Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.
What is the prognosis of Knee cap Dislocation?
----------------------------------------------------------
Prognosis using conservative methods is fair.
Recurrences are quite common.
Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.
Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.
What is the Prevention of Knee cap Dislocation?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.
What are the causes of Knee cap Dislocation?
----------------------------------------------------------------------
1.Dislocated knee caps most often occur in people with loose joint ligaments.
It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.
2.Dislocation of the knee cap may also occur due to trauma.
A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.
3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.
This condition is usually inherited and are more common in women than in men.
What are the symptoms and signs of Knee cap Dislocation?
-------------------------------------------------------------------
Symptoms:
1.Knee cap is displaced to the lateral position
2.knee swelling and effusion due to displacement of the knee cap.
3.Knee pain and tenderness is present.
4.The knee is usually held in slight flexion.
5.There is difficulty in lifting the leg
6. Patient usually walks with a limp.
Signs:
1.Tenderness and swelling of the knee
2.Knee cap is displaced to the outside or lateral part of the knee
3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.
4.The knee cap can move excessively from right to left.(hypermobile)
How to investigate the cause of Knee cap Dislocation?
-------------------------------------------------------------
1.examination of the knee would confirm presence of the dislocated knee cap.
There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.
2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.
A skyline view of the knee should show the shift of the patella laterally.
3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.
What is the Treatment of Knee cap Dislocation?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.
The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)
Gentle pressure is exerted on the knee cap to place it to its normal position.
The knee is then immobilized for 2-3 weeks.
Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
Surgery is required if:
1.the knee remains unstable
2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.
Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.
What is the prognosis of Knee cap Dislocation?
----------------------------------------------------------
Prognosis using conservative methods is fair.
Recurrences are quite common.
Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.
Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.
What is the Prevention of Knee cap Dislocation?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
Tuesday, July 22, 2008
A Simple Guide to Frozen Shoulder
A Simple Guide to Frozen Shoulder
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.
It tends to be chronic and full recovery may take several months.
It is more common in women and diabetes.
Incidence is about 2 in a 1000.
What are the causes of Frozen Shoulder?
-----------------------------------------------
The exact cause is unknown but several conditions has been blamed:
1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements
2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement
3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles
4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.
5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.
What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------
Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.
There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.
There is also reduced fluid in the joint further restricting movement.
Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.
This lasts 5 weeks to 9 months.
Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.
This lasts 4 -9 months.
Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.
This lasts 5 -26 months.
What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------
Symptoms:
1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm
2.Pain usually is worse at night especially lying on the affected shoulder
3.Certain movements makes the pain worse
4.Pain is described as constant, dull and aching
5.complaints of stiffness of the shoulder
6.inability to wear a shirt or blouse because of restricted movements
Signs:
1.apprehensive patient who holds the arm protectively
2.Generalised tenderness of rotator cuff and biceps muscles
3.Limited shoulder movement
4.Range of muscle movement is reduced in all directions
5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..
What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder
2.moist heat
3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
4.Muscle relaxant to relax muscles
5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.
Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy
2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder
Maintenance phase:
1.Continual exercises of the shoulder muscles
2.Avoidance of strain on the muscles of the shoulder
Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.
Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.
What is the prognosis of Frozen Shoulder?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.
It tends to be chronic and full recovery may take several months.
It is more common in women and diabetes.
Incidence is about 2 in a 1000.
What are the causes of Frozen Shoulder?
-----------------------------------------------
The exact cause is unknown but several conditions has been blamed:
1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements
2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement
3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles
4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.
5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.
What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------
Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.
There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.
There is also reduced fluid in the joint further restricting movement.
Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.
This lasts 5 weeks to 9 months.
Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.
This lasts 4 -9 months.
Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.
This lasts 5 -26 months.
What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------
Symptoms:
1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm
2.Pain usually is worse at night especially lying on the affected shoulder
3.Certain movements makes the pain worse
4.Pain is described as constant, dull and aching
5.complaints of stiffness of the shoulder
6.inability to wear a shirt or blouse because of restricted movements
Signs:
1.apprehensive patient who holds the arm protectively
2.Generalised tenderness of rotator cuff and biceps muscles
3.Limited shoulder movement
4.Range of muscle movement is reduced in all directions
5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..
What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder
2.moist heat
3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
4.Muscle relaxant to relax muscles
5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.
Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy
2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder
Maintenance phase:
1.Continual exercises of the shoulder muscles
2.Avoidance of strain on the muscles of the shoulder
Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.
Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.
What is the prognosis of Frozen Shoulder?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
Monday, July 21, 2008
A Simple Guide to Dandruff
A Simple Guide to Dandruff
--------------------------------
What is Dandruff?
------------------------
Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.
As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.
What are the Causes of Dandruff?
----------------------------------
The cause of Dandruff is not completely known but are related to three possible factors:
1.Excessive sebaceous or oil gland secretions from the skin
2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.
3. allergic reaction to chemicals in hair oils, cream or gel
Certain oily foods may trigger the production of dandruff
Stress has been known to trigger off dandruff
What are the symptoms of Dandruff?
-------------------------------------
Onset is usually gradual.
Symptoms:
1.Flaking of scales from the scalp.
2.Itchiness of the scalp
3.Redness of the skin on scalp, forehead and eyebrows
Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.
2.The surface consists of dry scales which can be rubbed off
3.Sometimes the lesions can become crusted
4.Some lesions may become purulent with yellow exudate.
What is the Treatment of Dandruff?
-----------------------------------------
1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.
2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.
3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.
4.General hair hygiene -
shampoo hair daily
Avoid too strong hair cream or gels
What is the prognosis of Dandruff?
------------------------------------
Generally good with treatment.
However recurrences are not uncommon.
General hair hygiene is important.
--------------------------------
What is Dandruff?
------------------------
Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.
As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.
What are the Causes of Dandruff?
----------------------------------
The cause of Dandruff is not completely known but are related to three possible factors:
1.Excessive sebaceous or oil gland secretions from the skin
2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.
3. allergic reaction to chemicals in hair oils, cream or gel
Certain oily foods may trigger the production of dandruff
Stress has been known to trigger off dandruff
What are the symptoms of Dandruff?
-------------------------------------
Onset is usually gradual.
Symptoms:
1.Flaking of scales from the scalp.
2.Itchiness of the scalp
3.Redness of the skin on scalp, forehead and eyebrows
Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.
2.The surface consists of dry scales which can be rubbed off
3.Sometimes the lesions can become crusted
4.Some lesions may become purulent with yellow exudate.
What is the Treatment of Dandruff?
-----------------------------------------
1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.
2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.
3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.
4.General hair hygiene -
shampoo hair daily
Avoid too strong hair cream or gels
What is the prognosis of Dandruff?
------------------------------------
Generally good with treatment.
However recurrences are not uncommon.
General hair hygiene is important.
Friday, July 18, 2008
A Simple Guide to Hyperhidrosis
A Simple Guide to Hyperhidrosis
---------------------------------
What is Hyperhidrosis?
----------------------
Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.
This may cause a social problem in people who need to shake hands or write with sweaty palms.
Excess perspiration with foul odor may also be offensive to people around the patient
What are the causes of Hyperhidrosis?
---------------------------------------
The cause of Hyperhidrosis is usually unknown.
It has been linked to :
1.excessive sweat glands
2.psychogenic excess production of sweats under stress and nervous conditions
3.Endocrine disorder such as hyperthyroidism
4.Skin diseases with increased hydration of skin such as in weeping eczema
5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis
6.diseases of the nervous system
7.Tuberculosis-night sweats are a typical feature of tuberculosis
8.diabetes mellitus and pituitary disorders
9.Certain medicines such as aspirin, paracetamol may provoke excess sweating
10.alcohol, caffiene, and certain food(spices) may stimulate the sweat glands
What are the symptoms and signs of Hyperhidrosis?
-------------------------------------------------------
Persons who has Hyperhidrosis has the following:
Symptoms:
1.Genralised sweating
2.localised sweating of palms, soles, axilla and groins
3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection
Signs:
1.Skin may become thickened, fissured or scaly
2.Nail deformities may occur
3.Secondary bacterial and fungal infections may be present
How do you diagnose Hyperhidrosis?
-------------------------------------------
Diagnosis can usually be made by :
1.Sweaty palms or soles
2.thickened, fissured skin with nail deformities
What is the treatment of Hyperhidrosis?
------------------------------------------------
1.Treat the underlying cause such as hyperthyroidism, diabetes
2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.
3.Wear cotton socks and underwear and change daily.
4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea.
Some side effects may be allergic dermatitis or staining of skin
5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing
6.Surgery in severe cases may be required such as sympathectomy (for palms).
Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating
7.Iontophoresis: may help but may be painful
8.Botox injection may disable the sympathetic nerves to the sweat glands amy lasts for 6-9 months
9.Hypnosis, relaxation and meditation has help to certain extent
10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.
What is the prognosis of Hyperhidrosis?
----------------------------------------
Prognosis is usually palliative as the sweat glands and nerve cells may grow back.
Recurrence is quite common.
---------------------------------
What is Hyperhidrosis?
----------------------
Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.
This may cause a social problem in people who need to shake hands or write with sweaty palms.
Excess perspiration with foul odor may also be offensive to people around the patient
What are the causes of Hyperhidrosis?
---------------------------------------
The cause of Hyperhidrosis is usually unknown.
It has been linked to :
1.excessive sweat glands
2.psychogenic excess production of sweats under stress and nervous conditions
3.Endocrine disorder such as hyperthyroidism
4.Skin diseases with increased hydration of skin such as in weeping eczema
5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis
6.diseases of the nervous system
7.Tuberculosis-night sweats are a typical feature of tuberculosis
8.diabetes mellitus and pituitary disorders
9.Certain medicines such as aspirin, paracetamol may provoke excess sweating
10.alcohol, caffiene, and certain food(spices) may stimulate the sweat glands
What are the symptoms and signs of Hyperhidrosis?
-------------------------------------------------------
Persons who has Hyperhidrosis has the following:
Symptoms:
1.Genralised sweating
2.localised sweating of palms, soles, axilla and groins
3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection
Signs:
1.Skin may become thickened, fissured or scaly
2.Nail deformities may occur
3.Secondary bacterial and fungal infections may be present
How do you diagnose Hyperhidrosis?
-------------------------------------------
Diagnosis can usually be made by :
1.Sweaty palms or soles
2.thickened, fissured skin with nail deformities
What is the treatment of Hyperhidrosis?
------------------------------------------------
1.Treat the underlying cause such as hyperthyroidism, diabetes
2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.
3.Wear cotton socks and underwear and change daily.
4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea.
Some side effects may be allergic dermatitis or staining of skin
5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing
6.Surgery in severe cases may be required such as sympathectomy (for palms).
Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating
7.Iontophoresis: may help but may be painful
8.Botox injection may disable the sympathetic nerves to the sweat glands amy lasts for 6-9 months
9.Hypnosis, relaxation and meditation has help to certain extent
10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.
What is the prognosis of Hyperhidrosis?
----------------------------------------
Prognosis is usually palliative as the sweat glands and nerve cells may grow back.
Recurrence is quite common.
Thursday, July 17, 2008
A Simple Guide to Prolapsed Intervertebral Disc
A Simple Guide to Prolapsed Intervertebral Disc
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).
It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.
What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------
1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.
2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.
3.Spinal tumour rarely pushes the disc out of its intervertebral space
What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------
Symptoms:
1.Low Backache with pain in the lumbar region
2.Sciatica or pain shooting down 1 leg
3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing
4.Pain may so bad that the person cannot stand erect.
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Muscle spasm especially spinal extensor muscles
2.Movement of the back and affected led painful and restricted
3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side
4.Straight leg raising test is usually restricted on the affected side.
5.Neurological signs such as paraesthesia commonly present on the affected side.
6.Sensory and motor deficit may be present in the affected side
7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished
L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes
S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished
How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------
1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,
2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test
3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,
4.MRI of spine for slipped disc
5.bone scan for osteoporosis
A definite diagnosis can then be made and the cause of the pain treated.
What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy
Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles
Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain
Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI
Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc
Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.
What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------
Prognosis depends on the underlying cause.
Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.
What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).
It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.
What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------
1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.
2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.
3.Spinal tumour rarely pushes the disc out of its intervertebral space
What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------
Symptoms:
1.Low Backache with pain in the lumbar region
2.Sciatica or pain shooting down 1 leg
3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing
4.Pain may so bad that the person cannot stand erect.
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Muscle spasm especially spinal extensor muscles
2.Movement of the back and affected led painful and restricted
3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side
4.Straight leg raising test is usually restricted on the affected side.
5.Neurological signs such as paraesthesia commonly present on the affected side.
6.Sensory and motor deficit may be present in the affected side
7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished
L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes
S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished
How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------
1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,
2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test
3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,
4.MRI of spine for slipped disc
5.bone scan for osteoporosis
A definite diagnosis can then be made and the cause of the pain treated.
What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy
Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles
Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain
Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI
Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc
Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.
What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------
Prognosis depends on the underlying cause.
Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.
What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
Tuesday, July 15, 2008
A Simple guide to Anal Fistula
A Simple guide to Anal Fistula
-------------------------------------
What is Anal Fistula?
----------------------------
Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.
There may be several external openings but only one internal opening
What is the cause of Anal Fistula?
------------------------------------------
Anal Fistula usually result from :
1.breakdown of anorectal abscesses
2.follows surgery for anal fissure
3.Less common causes are:
lymphogranuloma
carcinoma of rectum
ulcerative colitis,
regional ileitis
tuberculosis
What are the symptoms of Anal Fistula?
------------------------------------------------
1.pain especially on sitting down
2.purulent painless discharge(pus) near the anus
3.Recurrent perianal abscesses(pockets of pus around the anus)
4.pruritis ani(itch in anus)
How are Anal Fistula diagnosed?
-----------------------------------------
1.thorough examination of the perianal region
2.Rectal examination and palpation of the fistula track
3.Pass a probe through the perianal opening to determine the length of the track
4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine
5.Barium enema to exclude any ulcerative colitis and regional ileitis
What is the treatment of Anal Fistula?
------------------------------------------
There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter
2.Low level fistulas are below the levator ani and are more common.
Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)
Treatment of high level fistula:
1.open the track from within the ischiorectal fossa
2.colostomy may be necessary for multiple fistulas or very high internal opening
General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes
What is the prognosis of Anal Fistula?
----------------------------------------
Good with surgery.
Rarely there may undesirable complication like rectal incontinence.
-------------------------------------
What is Anal Fistula?
----------------------------
Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.
There may be several external openings but only one internal opening
What is the cause of Anal Fistula?
------------------------------------------
Anal Fistula usually result from :
1.breakdown of anorectal abscesses
2.follows surgery for anal fissure
3.Less common causes are:
lymphogranuloma
carcinoma of rectum
ulcerative colitis,
regional ileitis
tuberculosis
What are the symptoms of Anal Fistula?
------------------------------------------------
1.pain especially on sitting down
2.purulent painless discharge(pus) near the anus
3.Recurrent perianal abscesses(pockets of pus around the anus)
4.pruritis ani(itch in anus)
How are Anal Fistula diagnosed?
-----------------------------------------
1.thorough examination of the perianal region
2.Rectal examination and palpation of the fistula track
3.Pass a probe through the perianal opening to determine the length of the track
4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine
5.Barium enema to exclude any ulcerative colitis and regional ileitis
What is the treatment of Anal Fistula?
------------------------------------------
There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter
2.Low level fistulas are below the levator ani and are more common.
Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)
Treatment of high level fistula:
1.open the track from within the ischiorectal fossa
2.colostomy may be necessary for multiple fistulas or very high internal opening
General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes
What is the prognosis of Anal Fistula?
----------------------------------------
Good with surgery.
Rarely there may undesirable complication like rectal incontinence.
Monday, July 14, 2008
A Simple Guide to Sciatica
A Simple Guide to Sciatica
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
Friday, July 11, 2008
A Simple Guide to Trigeminal Neuralgia
A Simple Guide to Trigeminal Neuralgia
-----------------------------------------------
What is Trigeminal Neuralgia?
--------------------------------------
Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.
It is a rare codition affecting more women than men.
It is more common at the age of 60 years and above.
What are the causes of Trigeminal Neuralgia?
----------------------------------------------------
Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)
2.Trauma- injury to the trigeminal nerve
3.Tumours- compressing the trigeminal nerve
4.Infections-meningeal inflammation of the trigeminal nerve
5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.
6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.
What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------
Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.
There may be recurrent stabs of pain or spontaneous exacerbations of pain.
It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).
Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.
Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.
Pain is unilateral (rarely bilateral).
Pain may occur several times a day.
It rarely occurs at night.
There are certain triggers which can spark off an attack:
-----------------------------------------------------------
Light touch at the trigger zone such as the lips is the most provocative.
Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing
Pain causes brief muscle spasm of the facial muscles, inducing the tic.
Signs:
---------
Physical examination findings are normal.
A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.
A careful examination of the cranial nerves must be done, including the corneal reflex.
Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.
What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------
1.Blood for infections such as meningitis,
2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.
What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------
Medications:
----------------
1.Carbamazepine is the most effective medical treatment.
2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.
3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.
4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.
They can depress the sensitivity of the nerve and relax the muscle.
Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.
Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.
2.anesthetic blocks of the trigeminal ganglion.
3.decompression of trigeminal root entry of impinging vascular structures.
4.Surgical division of the affected branch of the nerve.
What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------
80% of patients respond well to carbamazepine but recurrences and exacerbations are common.
Surgery is usually effective but may leave permanent neurological deficit.
Trigeminal Neuralgia is not life threatening.
-----------------------------------------------
What is Trigeminal Neuralgia?
--------------------------------------
Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.
It is a rare codition affecting more women than men.
It is more common at the age of 60 years and above.
What are the causes of Trigeminal Neuralgia?
----------------------------------------------------
Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)
2.Trauma- injury to the trigeminal nerve
3.Tumours- compressing the trigeminal nerve
4.Infections-meningeal inflammation of the trigeminal nerve
5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.
6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.
What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------
Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.
There may be recurrent stabs of pain or spontaneous exacerbations of pain.
It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).
Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.
Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.
Pain is unilateral (rarely bilateral).
Pain may occur several times a day.
It rarely occurs at night.
There are certain triggers which can spark off an attack:
-----------------------------------------------------------
Light touch at the trigger zone such as the lips is the most provocative.
Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing
Pain causes brief muscle spasm of the facial muscles, inducing the tic.
Signs:
---------
Physical examination findings are normal.
A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.
A careful examination of the cranial nerves must be done, including the corneal reflex.
Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.
What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------
1.Blood for infections such as meningitis,
2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.
What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------
Medications:
----------------
1.Carbamazepine is the most effective medical treatment.
2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.
3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.
4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.
They can depress the sensitivity of the nerve and relax the muscle.
Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.
Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.
2.anesthetic blocks of the trigeminal ganglion.
3.decompression of trigeminal root entry of impinging vascular structures.
4.Surgical division of the affected branch of the nerve.
What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------
80% of patients respond well to carbamazepine but recurrences and exacerbations are common.
Surgery is usually effective but may leave permanent neurological deficit.
Trigeminal Neuralgia is not life threatening.
Wednesday, July 9, 2008
A Simple Guide to Facial Palsy
A Simple Guide to Facial Palsy
-----------------------------------------
What is Facial Palsy?
----------------------------------
Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.
It is usually temporary.
What are the causes of Facial Palsy?
------------------------------------------------
Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:
Supranuclear(within the Brain)
1.Cerebral vascular lesions
2.Cerebral tumours
Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.
2.Trauma- Birth injury,fractured temporal bone, surgery of the ear
3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease
5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,
6.Multiple sclerosis
What are the symptoms and signs of Facial Palsy?
------------------------------------------------------------
The onset of facial palsy is usually very sudden.
The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.
Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations
2.Depressed taste ( lesion above chorda tympani)
3.hyperacusis ( lesion above nerve to stapedius)
Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.
2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.
3.dribbling of saliva
4.difficulty in speaking
5.loss of taste at the front of the tongue
6.dryness or watering of the affected eye
7.eyeball rolled up and inward on attempted closure of affected eye
8.ectropion or turned out lower eyelid
9.sharp hearing on the affected side
10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.
What are the investigations required in Facial Palsy?
-----------------------------------------------------------
1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)
b.test closing of the eye - to test weakness of eyelid muscles
c.ask patient to smile - to check for weakness of the cheek muscles
2.Investigations:
a.Blood for infections, HIV, Lyme's disease
b.MRI of brain to exclude tumours
c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Facial Palsy?
-----------------------------------------------------
1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.
The steroid usually reduce swelling of the nerve.
2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus
3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.
Use artificial eyedrops during the day to keep the eye moist.
Tape the eye at night to keep it closed.
4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.
5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.
Plastic surgery may improve permanent facial drooping
What is the prognosis of Facial Palsy?
----------------------------------------
80-90% of patient with facial palsy recover spontaneously and completely within three weeks.
The remainder usually takes up to six months to recover.
Very rarely do you get permanent paralysis of the facial nerve.
-----------------------------------------
What is Facial Palsy?
----------------------------------
Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.
It is usually temporary.
What are the causes of Facial Palsy?
------------------------------------------------
Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:
Supranuclear(within the Brain)
1.Cerebral vascular lesions
2.Cerebral tumours
Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.
2.Trauma- Birth injury,fractured temporal bone, surgery of the ear
3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease
5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,
6.Multiple sclerosis
What are the symptoms and signs of Facial Palsy?
------------------------------------------------------------
The onset of facial palsy is usually very sudden.
The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.
Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations
2.Depressed taste ( lesion above chorda tympani)
3.hyperacusis ( lesion above nerve to stapedius)
Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.
2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.
3.dribbling of saliva
4.difficulty in speaking
5.loss of taste at the front of the tongue
6.dryness or watering of the affected eye
7.eyeball rolled up and inward on attempted closure of affected eye
8.ectropion or turned out lower eyelid
9.sharp hearing on the affected side
10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.
What are the investigations required in Facial Palsy?
-----------------------------------------------------------
1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)
b.test closing of the eye - to test weakness of eyelid muscles
c.ask patient to smile - to check for weakness of the cheek muscles
2.Investigations:
a.Blood for infections, HIV, Lyme's disease
b.MRI of brain to exclude tumours
c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Facial Palsy?
-----------------------------------------------------
1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.
The steroid usually reduce swelling of the nerve.
2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus
3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.
Use artificial eyedrops during the day to keep the eye moist.
Tape the eye at night to keep it closed.
4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.
5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.
Plastic surgery may improve permanent facial drooping
What is the prognosis of Facial Palsy?
----------------------------------------
80-90% of patient with facial palsy recover spontaneously and completely within three weeks.
The remainder usually takes up to six months to recover.
Very rarely do you get permanent paralysis of the facial nerve.
Sunday, July 6, 2008
A Simple Guide to Adenoiditis
A Simple Guide to Adenoiditis
----------------------------------------------
What is Adenoiditis?
-------------------------------
Adenoiditis is inflammation (swelling) of the Adenoids.
The adenoids are lymph nodes in the back of the nose and above the throat.
They normally help to filter out bacteria and other microorganisms to prevent infection in the nose and throat area.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing Adenoiditis.
Enlarged adenoids can cause blockage of the eustachian tubes and posterior openings of the nose.
What causes Adenoiditis?
-------------------------------
1.Viral or bacterial infections
---------------------------------
Bacteria cause 15-30 percent of Adenoiditis cases.
Streptococcus pyogenes is the most common bacteria causing acute Adenoiditis.
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute Adenoiditis.
2.low immunity factors
-----------------------
Unbalanced or insufficient food diet,
Unhygienic lifestyle
Inadequate rest or sleep
3. Allergy
---------------
dustmites,
pollens
Who gets Adenoiditis?
---------------------
Adenoiditis most often occurs in children but rarely occurs in children younger than two years.
It is occasionally found in young adults.
What are the symptoms of Adenoiditis?
-------------------------------------
The Symptoms of Adenoiditis are:
1,Blocked nose
2.mouth breathing
3.nasal speech
4.rhinorhoea(runny nose)
5.Snoring at night
6.Ear blockage(eustachian tube blockage)
7.Ear pain(otitis media)
8.Pain in the cheeks(maxillary sinusitis) or above the eye(frontal sinusitis)
9.Headache
10.Fever, chills
11.Lethargy and malaise are common.
These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.
What are the signs of Adenoiditis?
---------------------------------
An ear nose and throat specialist will be able to put a endoscope through the nasal passage to see the enlarged and inflamed adenoids.
What are the Complications of Adenoiditis?
------------------------------------------
1.Complications of untreated streptococcus Adenoiditis with tonsillitis may be severe:
Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure
2.Ear pain from otitis media
3.Blocked airway from enlarged Adenoids
What is the treatment of Adenoiditis?
------------------------------------
1.If the cause of the Adenoiditis is bacteria such as streptococcus, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2.Rest to allow the body to heal.
3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the nose and throat.
4.Hospitalization may be required in severe cases, particularly when there is airway obstruction.
5.When the condition is chronic or recurrent, a surgical procedure to remove the Adenoids(Adenoidectomy) is often recommended.
What is the Prognosis of Adenoiditis?
------------------------------------
Adenoiditis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
Adenoidectomy may be recommended if Adenoiditis is severe, recurrent, or does not respond to antibiotics.
----------------------------------------------
What is Adenoiditis?
-------------------------------
Adenoiditis is inflammation (swelling) of the Adenoids.
The adenoids are lymph nodes in the back of the nose and above the throat.
They normally help to filter out bacteria and other microorganisms to prevent infection in the nose and throat area.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing Adenoiditis.
Enlarged adenoids can cause blockage of the eustachian tubes and posterior openings of the nose.
What causes Adenoiditis?
-------------------------------
1.Viral or bacterial infections
---------------------------------
Bacteria cause 15-30 percent of Adenoiditis cases.
Streptococcus pyogenes is the most common bacteria causing acute Adenoiditis.
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute Adenoiditis.
2.low immunity factors
-----------------------
Unbalanced or insufficient food diet,
Unhygienic lifestyle
Inadequate rest or sleep
3. Allergy
---------------
dustmites,
pollens
Who gets Adenoiditis?
---------------------
Adenoiditis most often occurs in children but rarely occurs in children younger than two years.
It is occasionally found in young adults.
What are the symptoms of Adenoiditis?
-------------------------------------
The Symptoms of Adenoiditis are:
1,Blocked nose
2.mouth breathing
3.nasal speech
4.rhinorhoea(runny nose)
5.Snoring at night
6.Ear blockage(eustachian tube blockage)
7.Ear pain(otitis media)
8.Pain in the cheeks(maxillary sinusitis) or above the eye(frontal sinusitis)
9.Headache
10.Fever, chills
11.Lethargy and malaise are common.
These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.
What are the signs of Adenoiditis?
---------------------------------
An ear nose and throat specialist will be able to put a endoscope through the nasal passage to see the enlarged and inflamed adenoids.
What are the Complications of Adenoiditis?
------------------------------------------
1.Complications of untreated streptococcus Adenoiditis with tonsillitis may be severe:
Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure
2.Ear pain from otitis media
3.Blocked airway from enlarged Adenoids
What is the treatment of Adenoiditis?
------------------------------------
1.If the cause of the Adenoiditis is bacteria such as streptococcus, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2.Rest to allow the body to heal.
3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the nose and throat.
4.Hospitalization may be required in severe cases, particularly when there is airway obstruction.
5.When the condition is chronic or recurrent, a surgical procedure to remove the Adenoids(Adenoidectomy) is often recommended.
What is the Prognosis of Adenoiditis?
------------------------------------
Adenoiditis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
Adenoidectomy may be recommended if Adenoiditis is severe, recurrent, or does not respond to antibiotics.
Thursday, July 3, 2008
A Simple Guide to Amenorrhea
A Simple Guide to Amenorrhea
---------------------------------
What is Amenorrhea?
--------------------------
Amenorrhea is a symptom defined as absence of menstruation.
What are the types of Amenorrhea?
------------------------------------
1.Primary Amenorrhea
----------------------
is defined as the absence of onset of menstruation (menarche) in a girl who has reached the age of 18 years.
2.Secondary Amenorrhea
-----------------------
is defined as the absence of menstruation for a peroid of at least 6 months in a girl who has previously experienced normal menstruation and is not pregnant.
What are the causes of Amenorrhea?
-------------------------------------
1.Physiological(hormonal):
------------------------------
pregnancy hormones - pregnancy is the still the most common cause of secondary amenorrhea.
Growth hormone deficiency
Abnormal production of testosterone
2.Genetic Causes:
------------------
abnormal formation of genital tract causing cryptomenorrhea -obstruction to the flow of menstrual blood such as imperforate hymen
Chromosonal abnormalities:
Turner syndrome
Ovarian agenesis
3.Uterine Pathology:
------------------------
adhesions from previous operation
endometriosis
tuberculosis infection
radiation
4.Ovarian:
------------------
Agenesis(no ovaries)
Abnormal ovaries(again congenital)
Polycystic Ovaries
Granulosa-thca tumours of ovaries
radiation of ovaries
5.Pituitary:
----------------
Pituitary tumours
Hypopituitarism
Hypothalamic abnormalities
6.Psychological:
------------------
Depression
Anorexia nervosa,
starvation
7.Systemic Diseases:
------------------------
Hypothyoidism
Cushing syndrome
8.Medical causes:
----------------------
Chemotherapy
oral cotraceptive
corticosteroids
hypotensive drugs
How to establish a diagnosis of Amenorrhea
-------------------------------------------
History:
1.Primary Amenorrhea
------------------------
Genetic disorders:
failure to develop female sex characteristics
anatomic abnormalities due to chromosonal defects such as Turner syndrome
hirsutism-excessive male hormones
2.Secondary Amenorrhea
--------------------------
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Obesity
Pyschologic disorders:
depression
anorexia nervosa
Pelvic examination:
---------------------
vulval and vaginal examination for cryptomenorrhea,
bimanual palpation for ovarian masses like polystic ovaries
abnormal uterus or ovaries
Investigations:
--------------------
Pregnancy test
blood for follicle stimulating hormones, luteinising hormones, prolactin
Progesterone withdrawal bleeding test
Luteinizing hormone releasing tests
Serum testesterone and androsterones
Transvaginal ultrasound to check on the uterus and ovaries
X-ray Skull, Brain CAT or MRI scans to exclude pituitary tumours
What is the Treatment of Amenorrhea?
----------------------------------------------
Medications:
-------------
Specific treatment for amenorrhea depends on:
1.age,
2.overall health,
3.cause of the condition (primary or secondary)
4.the preference of the patient
Treatment for amenorrhea may include:
1.Pregnancy - no treatment if the patient wish to continue with pregnancy. Usually a referral to an obstetrician may be necessary
2.hormonal replacement(oestrogen and progesterone supplements ) in genetic cases and androgen producing tumours.
3.Cyproterone acetate is an anti-androgen which counters the effects of male hormones. It is usually given with a small dose of oestrogen.
4.Hyperprolactinaemia -treatment with bromocriptine which acts by stimulating the prolactin Inhibiting factor in the hypothalamus.
5.Polycystic ovary Disease -clomiphene and gonadatrophins may be given to improve menstruation and help fertility
6.Adrenal dysfunction due to deficiency of the enzyme 21-hydroxylase (androgegenital syndrome) results in excess ACTH and excessive production of androgens-treatment is with corticosteroids such as prednisolone
Other Treatments:
----------------------
1.Treatment of underlying systemic disease like thyroxine for hypothyroidism,
2.dietary changes to include increased caloric and fat intake especially in cases of low fat due to self induced dieting, anorexia nervosa
3.Pyschiatric treatment for women with depression, anorexia nervosa, or genetic dysfunction.
4.Healthy lifestyle for those who are obese
---------------------------------
What is Amenorrhea?
--------------------------
Amenorrhea is a symptom defined as absence of menstruation.
What are the types of Amenorrhea?
------------------------------------
1.Primary Amenorrhea
----------------------
is defined as the absence of onset of menstruation (menarche) in a girl who has reached the age of 18 years.
2.Secondary Amenorrhea
-----------------------
is defined as the absence of menstruation for a peroid of at least 6 months in a girl who has previously experienced normal menstruation and is not pregnant.
What are the causes of Amenorrhea?
-------------------------------------
1.Physiological(hormonal):
------------------------------
pregnancy hormones - pregnancy is the still the most common cause of secondary amenorrhea.
Growth hormone deficiency
Abnormal production of testosterone
2.Genetic Causes:
------------------
abnormal formation of genital tract causing cryptomenorrhea -obstruction to the flow of menstrual blood such as imperforate hymen
Chromosonal abnormalities:
Turner syndrome
Ovarian agenesis
3.Uterine Pathology:
------------------------
adhesions from previous operation
endometriosis
tuberculosis infection
radiation
4.Ovarian:
------------------
Agenesis(no ovaries)
Abnormal ovaries(again congenital)
Polycystic Ovaries
Granulosa-thca tumours of ovaries
radiation of ovaries
5.Pituitary:
----------------
Pituitary tumours
Hypopituitarism
Hypothalamic abnormalities
6.Psychological:
------------------
Depression
Anorexia nervosa,
starvation
7.Systemic Diseases:
------------------------
Hypothyoidism
Cushing syndrome
8.Medical causes:
----------------------
Chemotherapy
oral cotraceptive
corticosteroids
hypotensive drugs
How to establish a diagnosis of Amenorrhea
-------------------------------------------
History:
1.Primary Amenorrhea
------------------------
Genetic disorders:
failure to develop female sex characteristics
anatomic abnormalities due to chromosonal defects such as Turner syndrome
hirsutism-excessive male hormones
2.Secondary Amenorrhea
--------------------------
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Obesity
Pyschologic disorders:
depression
anorexia nervosa
Pelvic examination:
---------------------
vulval and vaginal examination for cryptomenorrhea,
bimanual palpation for ovarian masses like polystic ovaries
abnormal uterus or ovaries
Investigations:
--------------------
Pregnancy test
blood for follicle stimulating hormones, luteinising hormones, prolactin
Progesterone withdrawal bleeding test
Luteinizing hormone releasing tests
Serum testesterone and androsterones
Transvaginal ultrasound to check on the uterus and ovaries
X-ray Skull, Brain CAT or MRI scans to exclude pituitary tumours
What is the Treatment of Amenorrhea?
----------------------------------------------
Medications:
-------------
Specific treatment for amenorrhea depends on:
1.age,
2.overall health,
3.cause of the condition (primary or secondary)
4.the preference of the patient
Treatment for amenorrhea may include:
1.Pregnancy - no treatment if the patient wish to continue with pregnancy. Usually a referral to an obstetrician may be necessary
2.hormonal replacement(oestrogen and progesterone supplements ) in genetic cases and androgen producing tumours.
3.Cyproterone acetate is an anti-androgen which counters the effects of male hormones. It is usually given with a small dose of oestrogen.
4.Hyperprolactinaemia -treatment with bromocriptine which acts by stimulating the prolactin Inhibiting factor in the hypothalamus.
5.Polycystic ovary Disease -clomiphene and gonadatrophins may be given to improve menstruation and help fertility
6.Adrenal dysfunction due to deficiency of the enzyme 21-hydroxylase (androgegenital syndrome) results in excess ACTH and excessive production of androgens-treatment is with corticosteroids such as prednisolone
Other Treatments:
----------------------
1.Treatment of underlying systemic disease like thyroxine for hypothyroidism,
2.dietary changes to include increased caloric and fat intake especially in cases of low fat due to self induced dieting, anorexia nervosa
3.Pyschiatric treatment for women with depression, anorexia nervosa, or genetic dysfunction.
4.Healthy lifestyle for those who are obese
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