A Simple Guide To Atrial Fibrillation II
--------------------------------------------------------
What is the Complications of Atrial Fibrillation?
------------------------------------------------------
1.fibrosis of the atria
2.Enlarged atria and heart
3.Thrombosis to the brain(stroke),
intestines(ischemia),
fingers and toe(ischemia or gangrene)
What is the Treatment of Atrial Fibrillation?
------------------------------------------------------
The treatment of atrial fibrillation is aimed at
1.regulating the heart beat and rhythm- digoxin, dilatrend, betablockers
2.preventing blood clots to be thrown out in the blood stream -anticoagulants
3.In cases of uncontrolled tachycardia, immediate cardioversion may be done.
Regulating the heart beat:
----------------------------
a.rate control
Rate control is by drugs to reduce the heart rate to 60 to 100 bpm without changing to a regular rhythm.
The medications work by blocking the AV node reducing the electrical impulses to the ventricles.
1.Beta blockers such as metoprolol, atenolol, bisoprolol
2.Cardiac glycosides ( digoxin)
3.Calcium channel blockers (i.e. diltiazem or verapamil)
4.amiodarone has AV node blocking effects which can be used when other agents are contraindicated (eg.hypotension).
b.rhythm control
Rhythm control work to restore the regular heart rhythm and maintain it with drugs.
The anti-arrhythmic medications makes the heart tissue less excitable.
These medications are often used in concert with electrical cardioversion.
Prevention of blood clots in blood stream:
--------------------------------------------
Anticoagulation with drugs as below reduce the risk of blood clots being thrown out from the heart and blocking the passage of blood in the arteries of the heart or brain
1.aspirin
2.clopidogrel in those who are allergic to aspirin
3.warfarin or similar drugs.
4.heparin intravenously prevents blood clotting in urgent cases.
Cardioversion
---------------------
Cardioversion is the conversion of an abnormal heartbeat to a normal heartbeat using electrical or chemical means
1.Electrical cardioversion restores the heart rhythm by appying a DC electrical shock to the heart.
2.Chemical cardioversion uses medicine such as amiodarone, dronedarone, procainamide, ibutilide, propafenone or flecainide.
Cardioversion should not be done unless adequate anticoagulation has been given to patients for 48 hours.
There is a relapse rate of 1% following cardioversion.
3.Catheter ablation
It is possible to destroy the bundle of cells connecting the upper and lower chambers of the heart - the atrioventricular node - which regulates heart rate, and to implant a pacemaker Another method involves ablating groups of cells near the pulmonary veins where atrial fibrillation is thought to originate.This method do not need a pacemaker.
4. Radiofrequency ablation uses radiofrequency energy to remove abnormal electrical pathways in heart tissue.
5. laser, cryothermy and high intensity ultrasound has been use to eliminate the responsible heart tissue causing the irregular heart beats.
Surgical Maze procedure
----------------------------
A series of incisions is made in the atriain a maze-like pattern.
This block abnormal electrical circuits that AF requires.
Minimaze surgery is a minimally invasive cardiac surgery that do not require a median sternotomy or cardiopulmonary bypass.
Laser, cryothermy, radiofrequency, or acoustic energy are used to destroy atrial tissue near the pulmonary veins and and other ablations to mimic the maze.
What is the prognosis of Atrial Fibrillation?
---------------------------------------------------
Most cases of patients treated with rate control and cardioversion with ablation has excellent prognosis, usually better than those with rhthym control.
Recurrence may recur especially if there is an underlying condition which cannot be cured.
What are the prevention measures for Atrial Fibrillation?
--------------------------------------------------------------
Rest and a healthy lifestyle may help to prevent an onset or recurrence of atrial fibrillation.
Avoid stress and anxiety.
Wednesday, October 15, 2008
Monday, October 13, 2008
A Simple Guide to Atrial Fibrillation I
A Simple Guide to Atrial Fibrillation I
------------------------------------------------
What is Atrial Fibrillation?
---------------------------------
Atrial Fibrillation is a heart condition where the disordered electrical impulses of the atrial muscle leads to irregular electrical impulses to the ventricular heart muscles resulting in irregular heart beats.
Who is at risk of Atrial Fibrillation?
-----------------------------------------
1.Age: 8% of people over 80 has AF
2.family history of AF increases risk by 30%.
What is the cause of Atrial Fibrillation?
---------------------------------------------------
Atrial Fibrillation is caused by underlying heart conditions such as:
1.Primary heart diseases:
a.coronary artery disease
b.mitral stenosis
c.mitral regurgitation
d.hypertrophic cardiomyopathy
e.pericarditis
f.congenital heart disease
g.previous heart surgery
2.Hypertension (High blood pressure)
3.Lung diseases such as
a.pneumonia,
b.lung cancer,
c.pulmonary embolism,
d.sarcoidosis
4.Excessive alcohol consumption
5.Hyperthyroidism
What are the Symptoms of Atrial Fibrillation?
------------------------------------------------------------
Atrial fibrillation often do not present with symptoms.
When they do the symptoms are generally non -life threatening:
Symptoms:
-----------
1.fast heartbeat or palpitations
2.Breathlessness
3.fainting
4.chest pain
Signs:
--------------
1.Pulse is fast and irregular in rhythm and strength
2.Angina pectoris(pain over heart area)
3.Congestive cardiac failure with ankle swelling and breathlessness
4.exercise intolerance
5.Abnormal ECG reading with absent P waves and irregular rhythm
6.Underlying heart disease such as hypertension, pericarditis, valvular disease of heart,
7.Underlying systemic disease such as hyperthyroidism, diabetes, stroke
How is diagnosis of Atrial Fibrillation made?
-------------------------------------------------------
1. History and physical examination
Palpitations, atrial fibrillation episodes
2. Blood tests:
renal function and electrolytes,
thyroid hormones, thyroid-stimulating hormone,
blood count.
Where there is chest pain,
blood cardiac enzymes and
coagulation tests are also done
3.Electrocardiogram
a.absence of P waves,
b.irregularity of R-R interval due to irregular conduction of impulses
4.Echocardiography
transthoracic echocardiogram is done in newly diagnosed AF to detect
valvular heart disease ,
left and right atrial size,
left ventricular size and function,
peak right ventricular pressure ,
presence of left ventricular hypertrophy
pericardial disease
5. Chest X-ray
chest X-ray is generally only performed if a pulmonary cause of atrial fibrillation is suggested,
6.Transesophageal echocardiogram
transesophageal echocardiogram (TEE) is done to detect thrombus formation
7.Ambulatory holter monitoring
A holter monitor is a heart monitor which can be worn by the patient to check the heart rate and heart rhythm for 24 hours.
It can detect presence of AF.
8.Exercise stress testing
A threadmill test can gauge the heart rate in response to exertion.
------------------------------------------------
What is Atrial Fibrillation?
---------------------------------
Atrial Fibrillation is a heart condition where the disordered electrical impulses of the atrial muscle leads to irregular electrical impulses to the ventricular heart muscles resulting in irregular heart beats.
Who is at risk of Atrial Fibrillation?
-----------------------------------------
1.Age: 8% of people over 80 has AF
2.family history of AF increases risk by 30%.
What is the cause of Atrial Fibrillation?
---------------------------------------------------
Atrial Fibrillation is caused by underlying heart conditions such as:
1.Primary heart diseases:
a.coronary artery disease
b.mitral stenosis
c.mitral regurgitation
d.hypertrophic cardiomyopathy
e.pericarditis
f.congenital heart disease
g.previous heart surgery
2.Hypertension (High blood pressure)
3.Lung diseases such as
a.pneumonia,
b.lung cancer,
c.pulmonary embolism,
d.sarcoidosis
4.Excessive alcohol consumption
5.Hyperthyroidism
What are the Symptoms of Atrial Fibrillation?
------------------------------------------------------------
Atrial fibrillation often do not present with symptoms.
When they do the symptoms are generally non -life threatening:
Symptoms:
-----------
1.fast heartbeat or palpitations
2.Breathlessness
3.fainting
4.chest pain
Signs:
--------------
1.Pulse is fast and irregular in rhythm and strength
2.Angina pectoris(pain over heart area)
3.Congestive cardiac failure with ankle swelling and breathlessness
4.exercise intolerance
5.Abnormal ECG reading with absent P waves and irregular rhythm
6.Underlying heart disease such as hypertension, pericarditis, valvular disease of heart,
7.Underlying systemic disease such as hyperthyroidism, diabetes, stroke
How is diagnosis of Atrial Fibrillation made?
-------------------------------------------------------
1. History and physical examination
Palpitations, atrial fibrillation episodes
2. Blood tests:
renal function and electrolytes,
thyroid hormones, thyroid-stimulating hormone,
blood count.
Where there is chest pain,
blood cardiac enzymes and
coagulation tests are also done
3.Electrocardiogram
a.absence of P waves,
b.irregularity of R-R interval due to irregular conduction of impulses
4.Echocardiography
transthoracic echocardiogram is done in newly diagnosed AF to detect
valvular heart disease ,
left and right atrial size,
left ventricular size and function,
peak right ventricular pressure ,
presence of left ventricular hypertrophy
pericardial disease
5. Chest X-ray
chest X-ray is generally only performed if a pulmonary cause of atrial fibrillation is suggested,
6.Transesophageal echocardiogram
transesophageal echocardiogram (TEE) is done to detect thrombus formation
7.Ambulatory holter monitoring
A holter monitor is a heart monitor which can be worn by the patient to check the heart rate and heart rhythm for 24 hours.
It can detect presence of AF.
8.Exercise stress testing
A threadmill test can gauge the heart rate in response to exertion.
Thursday, October 9, 2008
A Simple Guide to Osteomyelitis
A Simple Guide to Osteomyelitis
--------------------------------------
What is Osteomyelitis?
----------------------------
Osteomyelitis is an infection of the bone substance by pyogenic bacteria and fungus.
What causes Osteomyelitis?
----------------------------------
The most causes of Osteomyelitis is
1.Staphylococcus aureus bacteria(80%).
Other bacteria involved are:
2.Streptococci Group A & B
3.Enterobacter species including E.Coli
4.Haemophilus influenzae
5.Pneumococci
6.Serratia marcescens
Systemic mycotic (fungal) infections may also cause osteomyelitis.
1.Blastomyces dermatitidis
2.Coccidioides immitis.
In children,
-------------------
1.the long bones are usually affected in children.
2.Spread of bacteria occurs from the bloodstream from a skin boil, dental abscess, direct injury to the bone.
3.Acute osteomyelitis almost invariably occurs in children.
In adults
---------------
1.injury to the bone is the most common cause.
The bone injury is exposed to local infection in the skin or environment.
Staphylococcus aureus is the most common bacteria in osteomyelitis resulting from bone injury and infection.
Other bacteria such as Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common.
2.The vertebrae and the pelvis are the bones most commonly affected in adults.
For osteomyelitis of the vertebral bodies,
50% are due to Staphylococcus aureus,
and the remaining 50%f are due to tuberculosis usually from the lungs.
3.Bone infection in adults are usually due to their lower resistance from
debilitation,
intravenous drug abuse,
infectious root-canal teeth,
other disease or drugs (e.g. immunosuppressive therapy).
What are the symptoms of Osteomyelitis?
-------------------------------------------------
Symptoms:
---------------
1.pain and swelling of the bone
2.fever
3.toxemia
Signs:
-----------
1.Hot tender bones
2.Throbbing pain of bones
3.Abscess and swelling
How do you made the diagnosis of Osteomyelitis?
-------------------------------------------------
Diagnosis of osteomyelitis is often based on:
1.radiologic results showing a translucent center with a ring of sclerosis(hardened bones)
2.Blood and bone cultures are normally required to identify the specific pathogen
What are the complications of Osteomyelitis?
-------------------------------------------------------
The complications of Osteomyelitis are:
1.fractures of the bone
2.amyloidosis
3.endocarditis
4.septicemia
What is the treatment of Osteomyelitis?
----------------------------------------
1.antibiotic therapy - usually as prolonged treatment lasting a matter of weeks or months.
2.Hyperbaric oxygen therapy has helped in the treatment of refractory osteomyelitis.
3.Immobilization of the bone affected(bed rest, plaster casts,splints)
4.Osteomyelitis may also need surgical debridement to remove pus and damaged bone tissues.
5.Severe cases may lead to the loss of a limb.
What is the prognosis of Osteomyelitis?
----------------------------------------
Prognosis depends on the rapidity of onset of treatment.
The faster the treatment the faster thee cure.
Otherwise the condition may become a chronic illness requiring multiple surgical procedures.
--------------------------------------
What is Osteomyelitis?
----------------------------
Osteomyelitis is an infection of the bone substance by pyogenic bacteria and fungus.
What causes Osteomyelitis?
----------------------------------
The most causes of Osteomyelitis is
1.Staphylococcus aureus bacteria(80%).
Other bacteria involved are:
2.Streptococci Group A & B
3.Enterobacter species including E.Coli
4.Haemophilus influenzae
5.Pneumococci
6.Serratia marcescens
Systemic mycotic (fungal) infections may also cause osteomyelitis.
1.Blastomyces dermatitidis
2.Coccidioides immitis.
In children,
-------------------
1.the long bones are usually affected in children.
2.Spread of bacteria occurs from the bloodstream from a skin boil, dental abscess, direct injury to the bone.
3.Acute osteomyelitis almost invariably occurs in children.
In adults
---------------
1.injury to the bone is the most common cause.
The bone injury is exposed to local infection in the skin or environment.
Staphylococcus aureus is the most common bacteria in osteomyelitis resulting from bone injury and infection.
Other bacteria such as Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common.
2.The vertebrae and the pelvis are the bones most commonly affected in adults.
For osteomyelitis of the vertebral bodies,
50% are due to Staphylococcus aureus,
and the remaining 50%f are due to tuberculosis usually from the lungs.
3.Bone infection in adults are usually due to their lower resistance from
debilitation,
intravenous drug abuse,
infectious root-canal teeth,
other disease or drugs (e.g. immunosuppressive therapy).
What are the symptoms of Osteomyelitis?
-------------------------------------------------
Symptoms:
---------------
1.pain and swelling of the bone
2.fever
3.toxemia
Signs:
-----------
1.Hot tender bones
2.Throbbing pain of bones
3.Abscess and swelling
How do you made the diagnosis of Osteomyelitis?
-------------------------------------------------
Diagnosis of osteomyelitis is often based on:
1.radiologic results showing a translucent center with a ring of sclerosis(hardened bones)
2.Blood and bone cultures are normally required to identify the specific pathogen
What are the complications of Osteomyelitis?
-------------------------------------------------------
The complications of Osteomyelitis are:
1.fractures of the bone
2.amyloidosis
3.endocarditis
4.septicemia
What is the treatment of Osteomyelitis?
----------------------------------------
1.antibiotic therapy - usually as prolonged treatment lasting a matter of weeks or months.
2.Hyperbaric oxygen therapy has helped in the treatment of refractory osteomyelitis.
3.Immobilization of the bone affected(bed rest, plaster casts,splints)
4.Osteomyelitis may also need surgical debridement to remove pus and damaged bone tissues.
5.Severe cases may lead to the loss of a limb.
What is the prognosis of Osteomyelitis?
----------------------------------------
Prognosis depends on the rapidity of onset of treatment.
The faster the treatment the faster thee cure.
Otherwise the condition may become a chronic illness requiring multiple surgical procedures.
Monday, October 6, 2008
A Simple Guide to Systemic Lupus Erythematosis
A Simple Guide to Systemic Lupus Erythematosis
----------------------------------------------------
What is Systemic Lupus Erythematosis?
---------------------------------------
Systemic Lupus Erythematosis is a chronic multisystem autoimmune inflammatory disease which attacks the whole body.
It typically has a butterfly erythematous rash on the face.
It is not contagious.
Who is affected by Systemic Lupus Erythematosis?
---------------------------------------------------
Systemic Lupus Erythematosis is more common in women than in men(9:1 ratio)
Most cases begin at the age range of 15-45 years and occurs less frequently between the age of 45-70 years.
It occurs more frequently in blacks than in white people.
What is the Cause of Systemic Lupus Erythematosis?
-----------------------------------------------------
The exact cause of Systemic Lupus Erythematosis is not known.
1.It has been suggested that an autoimmune disease is the main cause of Systemic Lupus Erythematosis disease.
The antibodies produced by the body to fight germs starts to attack the body's own healthy tissue.
2.Psychological problems like stress and anxiety is not a cause of Systemic Lupus Erythematosis but has been known to trigger off the disease.
3.Some cases are induced by medications such as :
hydralazine
procainamide
penicillamine
isoniazid
What are the Symptoms and signs of Systemic Lupus Erythematosis?
-----------------------------------------------------------
The disease may be mild to severe.
There are also periods of remissions and activity.
During the active stage:
Systemic involvement:
-----------------------------
1.fever
2.anorexia
3.weakness
4.weight loss
5.Lymphadenopathy
Skin Mucosa Involvement:
-------------------------------
1.Typical butterfly erythrematous rash on the face
2.pleomorphic erythrematous and maculopapular lesions on the face, neck and extremeties.
3.Vasculitic nail bed and digital pulp lesions
4.Alopecia, petechiae, bullae, and mucous membrane lesions.
Musculoskeletal System:
---------------------------
1.Polyarthritis especially small joints of fingers
2.Arthritis milder and non erosive compared to rheumatoid arthritis
3.morning stiffness
4.muscle atrophy and weakness may occur
Eyes:
-----------
1.Retinal hemorrhages and exudates
2.Cytoid bodies
Lungs and Pleura:
-----------------------
1.Recurrent pleurisy
2.Pleural effusions - small
3.Pulmonary infiltrates
Cardiovascular
-----------------
1.Pericarditis
2.Endocarditis with vegetation on the mitral valve especially
Gastrointestinal
--------------------
1.Non specific nausea
2.Gastrointestinal ulcers, hemorrhage, necrosis
Renal
-------------
1.Focal membranous nephritis
2.Proliferative nephritis - deposit of autoimmune complexes on capillary walls give rise to typical wireloop changes and epithelial crescents in kidneys resulting in proteinuria, hematuria,and renal failure.
Central nervous system:
------------------------------
1.Lesions in the brain can cause mental disorders( dementia, psychosis,epilepsy), chores, cerebrovascular accidents,cranial nerve lesions.
2.Peripheral neuropathy of various types
Others:
-----------------
1.Thrombotic thrombocytopenic purpura
2.Sjogren's syndrome
How do you make the Diagnosis of Systemic Lupus Erythematosis?
------------------------------------------------------------
1.A history of facial butterfly rash, systemic symptoms
2.Blood for ESR, positive ANA(antnuclear Antibodies), LE cells
3.Full blood count for anemia, hemolytic anemia, neutopenia, thrombocytopenia, Coombs' test(usually positive)
4.Renal or skin biopsy
5.X- rays of the chest, abdomen and brain
6.MRI of brain, kidney,
What are the complications of Systemic Lupus Erythematosis?
-----------------------------------------------------------------
1.Severe Dermatitis with discoid lesions (maculopapular in nature)
2.Polyathritis with swelling of joints
3.Anemia
4.Pleural effusions
5.hemorrhage
6.Dementia
7.Renal failure
What is the treatment of Systemic Lupus Erythematosis?
--------------------------------------------------------------
There is no cure for SLE at the present moment.
Treatment is to relieve symptoms and prevent organs from deteriorating.
Patients with mild symptoms may not need any treatment.
Mild Cases:
---------------
1.short course of antiinflammatory medications such as NSAID or corticosteroids.
2.Rest and freedom from stress
Severe cases:
--------------------
Patients with serious illness which has affected their organ may require stronger medications:
1.high doses of corticosteroids intially intravenously, followed by oral medication whose dosage is reduced slowly to the minimum possible.
Corticosteroids are particularly helpful if internal organs are involved.
Side effects of corticosteroids include gastric problems, thinning of the bones, infection, facial puffiness, cataracts.
2.NSAIDs can reduce inflammation and pain especially in the musculoskeletal system.
Examples of NSAIDs include aspirin, ibuprofen, naproxen.
The side effects are stomach upset, abdominal pain, ulcers or GIT bleeding.
To reduce the side effects, NSAIDs are usually taken with food or H2 antagonist like cimetidine, ranitidine.
3.Antimalarial medication such as Hydroxychloroquine has been particularly effective for SLE patients with fatigue, skin, and joint disease.
Side effects include diarrhea, upset stomach, and eye pigment changes.
Eye pigment changes are rare, but require monitoring by an ophthalmologist
Other antimalarial drugs, such as chloroquine or quinacrine, are considered
4.Treatment for severe skin disease skin disease include dapsone and retinoic acid (Retin-A).
5.immunosuppressive medications are used for treating patients with more severe manifestations of SLE with damage to internal organ(s).
Examples of immunosuppressive medications include methotrexate, azathioprine (Imuran), cyclophosphamide, and cyclosporine .
Side effects are depression of blood cell counts and increased risks of infection and bleeding.
6. mycophenolate mofetil (Cellcept) is very effective in lupus with kidney disease.
It has been able to reverse active lupus kidney disease and maintain remission.
It's lower side effects made it more useful than immunosuppresive drugs.
7.plasmapheresis is used to remove antibodies and other immune substances from the blood to suppress immunity.
It has also help to to remove proteins (cryoglobulins) that can lead to vasculitis.
SLE patients with low platelet levels can have severe bleeding.
7.rituximab is an intravenously infused antibody that suppresses a particular white blood cell, the B cell, by reducing the number in the blood stream.
B cells play a central role in lupus activity, and when suppressed, the disease tends toward remission.
8.omega-3 fish oils could help patients with lupus by decreasing disease activity and possibly decreasing heart disease risk.
9.rest during periods of active disease
Poor sleep quality can cause fatigue in patients with SLE.
Sleep quality and the effect of underlying depression, lack of exercise can have an adverse effect on the health of SLE patients.
It is important to maintain muscle tone and range of motion in the joints.
10.Endstage kidney damage from SLE requires dialysis and/or a kidney transplant.
What is the prognosis of Systemic Lupus Erythematosis?
-------------------------------------------------------------
The prognosis depends on the severity of the disease
Severe cases with renal disease has poorer prognosis.
How is SLE prevented?
----------------------------
1.Adequate rest
2. Avoid stress
3. Avoid the sun and use sunscreen.
4.Healthy lifestyle with exercise prevents arthritis
----------------------------------------------------
What is Systemic Lupus Erythematosis?
---------------------------------------
Systemic Lupus Erythematosis is a chronic multisystem autoimmune inflammatory disease which attacks the whole body.
It typically has a butterfly erythematous rash on the face.
It is not contagious.
Who is affected by Systemic Lupus Erythematosis?
---------------------------------------------------
Systemic Lupus Erythematosis is more common in women than in men(9:1 ratio)
Most cases begin at the age range of 15-45 years and occurs less frequently between the age of 45-70 years.
It occurs more frequently in blacks than in white people.
What is the Cause of Systemic Lupus Erythematosis?
-----------------------------------------------------
The exact cause of Systemic Lupus Erythematosis is not known.
1.It has been suggested that an autoimmune disease is the main cause of Systemic Lupus Erythematosis disease.
The antibodies produced by the body to fight germs starts to attack the body's own healthy tissue.
2.Psychological problems like stress and anxiety is not a cause of Systemic Lupus Erythematosis but has been known to trigger off the disease.
3.Some cases are induced by medications such as :
hydralazine
procainamide
penicillamine
isoniazid
What are the Symptoms and signs of Systemic Lupus Erythematosis?
-----------------------------------------------------------
The disease may be mild to severe.
There are also periods of remissions and activity.
During the active stage:
Systemic involvement:
-----------------------------
1.fever
2.anorexia
3.weakness
4.weight loss
5.Lymphadenopathy
Skin Mucosa Involvement:
-------------------------------
1.Typical butterfly erythrematous rash on the face
2.pleomorphic erythrematous and maculopapular lesions on the face, neck and extremeties.
3.Vasculitic nail bed and digital pulp lesions
4.Alopecia, petechiae, bullae, and mucous membrane lesions.
Musculoskeletal System:
---------------------------
1.Polyarthritis especially small joints of fingers
2.Arthritis milder and non erosive compared to rheumatoid arthritis
3.morning stiffness
4.muscle atrophy and weakness may occur
Eyes:
-----------
1.Retinal hemorrhages and exudates
2.Cytoid bodies
Lungs and Pleura:
-----------------------
1.Recurrent pleurisy
2.Pleural effusions - small
3.Pulmonary infiltrates
Cardiovascular
-----------------
1.Pericarditis
2.Endocarditis with vegetation on the mitral valve especially
Gastrointestinal
--------------------
1.Non specific nausea
2.Gastrointestinal ulcers, hemorrhage, necrosis
Renal
-------------
1.Focal membranous nephritis
2.Proliferative nephritis - deposit of autoimmune complexes on capillary walls give rise to typical wireloop changes and epithelial crescents in kidneys resulting in proteinuria, hematuria,and renal failure.
Central nervous system:
------------------------------
1.Lesions in the brain can cause mental disorders( dementia, psychosis,epilepsy), chores, cerebrovascular accidents,cranial nerve lesions.
2.Peripheral neuropathy of various types
Others:
-----------------
1.Thrombotic thrombocytopenic purpura
2.Sjogren's syndrome
How do you make the Diagnosis of Systemic Lupus Erythematosis?
------------------------------------------------------------
1.A history of facial butterfly rash, systemic symptoms
2.Blood for ESR, positive ANA(antnuclear Antibodies), LE cells
3.Full blood count for anemia, hemolytic anemia, neutopenia, thrombocytopenia, Coombs' test(usually positive)
4.Renal or skin biopsy
5.X- rays of the chest, abdomen and brain
6.MRI of brain, kidney,
What are the complications of Systemic Lupus Erythematosis?
-----------------------------------------------------------------
1.Severe Dermatitis with discoid lesions (maculopapular in nature)
2.Polyathritis with swelling of joints
3.Anemia
4.Pleural effusions
5.hemorrhage
6.Dementia
7.Renal failure
What is the treatment of Systemic Lupus Erythematosis?
--------------------------------------------------------------
There is no cure for SLE at the present moment.
Treatment is to relieve symptoms and prevent organs from deteriorating.
Patients with mild symptoms may not need any treatment.
Mild Cases:
---------------
1.short course of antiinflammatory medications such as NSAID or corticosteroids.
2.Rest and freedom from stress
Severe cases:
--------------------
Patients with serious illness which has affected their organ may require stronger medications:
1.high doses of corticosteroids intially intravenously, followed by oral medication whose dosage is reduced slowly to the minimum possible.
Corticosteroids are particularly helpful if internal organs are involved.
Side effects of corticosteroids include gastric problems, thinning of the bones, infection, facial puffiness, cataracts.
2.NSAIDs can reduce inflammation and pain especially in the musculoskeletal system.
Examples of NSAIDs include aspirin, ibuprofen, naproxen.
The side effects are stomach upset, abdominal pain, ulcers or GIT bleeding.
To reduce the side effects, NSAIDs are usually taken with food or H2 antagonist like cimetidine, ranitidine.
3.Antimalarial medication such as Hydroxychloroquine has been particularly effective for SLE patients with fatigue, skin, and joint disease.
Side effects include diarrhea, upset stomach, and eye pigment changes.
Eye pigment changes are rare, but require monitoring by an ophthalmologist
Other antimalarial drugs, such as chloroquine or quinacrine, are considered
4.Treatment for severe skin disease skin disease include dapsone and retinoic acid (Retin-A).
5.immunosuppressive medications are used for treating patients with more severe manifestations of SLE with damage to internal organ(s).
Examples of immunosuppressive medications include methotrexate, azathioprine (Imuran), cyclophosphamide, and cyclosporine .
Side effects are depression of blood cell counts and increased risks of infection and bleeding.
6. mycophenolate mofetil (Cellcept) is very effective in lupus with kidney disease.
It has been able to reverse active lupus kidney disease and maintain remission.
It's lower side effects made it more useful than immunosuppresive drugs.
7.plasmapheresis is used to remove antibodies and other immune substances from the blood to suppress immunity.
It has also help to to remove proteins (cryoglobulins) that can lead to vasculitis.
SLE patients with low platelet levels can have severe bleeding.
7.rituximab is an intravenously infused antibody that suppresses a particular white blood cell, the B cell, by reducing the number in the blood stream.
B cells play a central role in lupus activity, and when suppressed, the disease tends toward remission.
8.omega-3 fish oils could help patients with lupus by decreasing disease activity and possibly decreasing heart disease risk.
9.rest during periods of active disease
Poor sleep quality can cause fatigue in patients with SLE.
Sleep quality and the effect of underlying depression, lack of exercise can have an adverse effect on the health of SLE patients.
It is important to maintain muscle tone and range of motion in the joints.
10.Endstage kidney damage from SLE requires dialysis and/or a kidney transplant.
What is the prognosis of Systemic Lupus Erythematosis?
-------------------------------------------------------------
The prognosis depends on the severity of the disease
Severe cases with renal disease has poorer prognosis.
How is SLE prevented?
----------------------------
1.Adequate rest
2. Avoid stress
3. Avoid the sun and use sunscreen.
4.Healthy lifestyle with exercise prevents arthritis
A Simple Guide to Acoustic neuroma
A Simple Guide to Acoustic neuroma
---------------------------------------------------
What are Acoustic neuroma ?
------------------------------------------------
Acoustic neuroma is a neurofibroma of the eight nerve.
Who are at risk of Acoustic neuroma?
-------------------------------------
1.Both sexes are equally affected.
2.Acoustic neuroma occurs more in the 50- 60 age group.
3.It forms 5-10% of the intracranial tumors in adults.
What are the different types of Acoustic neuroma?
--------------------------------------------------------
1.Neurofibroma I -
a. Unilateral acoustic neuroma usually
Bilateral acoustic neuromas are not common.
b. occurs in adult life,
c. the tumor involve the 8th nerve,
d. can involve any other cranial nerve or the spinal root.
e.Incidence is usually 90-95%
2.Neurofibroma II -
a. bilateral acoustic neuromas are common
b. occurs before the age of 21.
c. affects the entire nerve
d. autosomal dominant inheritance.
e. Incidence is about 5 to 10%.
What are the Causes of Acoustic neuroma?
------------------------------------------------------
Acoustic neuroma in the adult begins in the Schwann's cells of the vestibular portion of the 8th nerve inside the internal auditory canal.
The tumor grows slowly and can extend into the posterior fossa to occupy the space between the cerebellum and the pons.
Because of its location, it can also compress the 5th, 7th, and less often, the 9th and 10th cranial nerves.
If it grows larger, it may also compress the pons and lateral medulla of the brain, causing blockage of the cerebrospinal fluid and increased intracranial pressure.
What are the symptoms and signs of Acoustic neuroma?
-------------------------------------------------------
Symptoms:
--------------
1.unilateral hearing loss
2.tinnitus with unilateral high-pitched ringing sound
3.loss of sense of balance
4.vertigo
5.nausea and vomiting
6.altered gait
7.pressure in the ear
8.rarely headache and altered consciousness.
Signs:
-------------
1.unilateral facial weakness.
2.sensory impairment of the nerve
3.impairment of glandular secretions
4.loss of taste
5.loss of sensation in one side of the face and mouth
6.rarely altered gag or swallowing reflexes.
How are diagnosis of Acoustic neuroma made?
------------------------------------------------------------
1.Contrast-enhanced CT will detect almost all acoustic neuromas that are greater than 2.0 cm in diameter
2.MRI with gadolinium enhancement may show even smaller tumors
3.Audiology and vestibular tests are done to check for Nerve versus conduction hearing loss.
What is the Treatment of Acoustic neuroma?
-------------------------------------------
Treatment of acoustic neuroma is usually by surgery and radiotherapy.
Conservative treatment
--------------------------
In some cases because the neuroma grow so slowly, the tumor is monitored by annual MRI to see its growth.
This method is common among patients over 70 years old.
In rare cases, acoustical neuroma have been known to disappear spontaneously.
Acoustic neuroma may result in gradual hearing loss and tinnitus.
Surgery
-----------------
Surgical removal of acoustic neuroma usually involve microsurgery to remove the tumor.
The superior and inferior vestibular nerves are removed at surgery.
This effectively restores balance in the patient.
Radiation treatment
-----------------------
Radiotherapy using gamma knife radiosurgery or fractionated stereotactic radiotherapy does not remove the tumor but is able to slow or stop its growth.
What is the Prognosis of Acoustic neuroma?
-------------------------------------------
Prognosis is good in all early diagnosis and small tumors.
Large tumors may give rise to residual neurolgical damage even afer removal.
---------------------------------------------------
What are Acoustic neuroma ?
------------------------------------------------
Acoustic neuroma is a neurofibroma of the eight nerve.
Who are at risk of Acoustic neuroma?
-------------------------------------
1.Both sexes are equally affected.
2.Acoustic neuroma occurs more in the 50- 60 age group.
3.It forms 5-10% of the intracranial tumors in adults.
What are the different types of Acoustic neuroma?
--------------------------------------------------------
1.Neurofibroma I -
a. Unilateral acoustic neuroma usually
Bilateral acoustic neuromas are not common.
b. occurs in adult life,
c. the tumor involve the 8th nerve,
d. can involve any other cranial nerve or the spinal root.
e.Incidence is usually 90-95%
2.Neurofibroma II -
a. bilateral acoustic neuromas are common
b. occurs before the age of 21.
c. affects the entire nerve
d. autosomal dominant inheritance.
e. Incidence is about 5 to 10%.
What are the Causes of Acoustic neuroma?
------------------------------------------------------
Acoustic neuroma in the adult begins in the Schwann's cells of the vestibular portion of the 8th nerve inside the internal auditory canal.
The tumor grows slowly and can extend into the posterior fossa to occupy the space between the cerebellum and the pons.
Because of its location, it can also compress the 5th, 7th, and less often, the 9th and 10th cranial nerves.
If it grows larger, it may also compress the pons and lateral medulla of the brain, causing blockage of the cerebrospinal fluid and increased intracranial pressure.
What are the symptoms and signs of Acoustic neuroma?
-------------------------------------------------------
Symptoms:
--------------
1.unilateral hearing loss
2.tinnitus with unilateral high-pitched ringing sound
3.loss of sense of balance
4.vertigo
5.nausea and vomiting
6.altered gait
7.pressure in the ear
8.rarely headache and altered consciousness.
Signs:
-------------
1.unilateral facial weakness.
2.sensory impairment of the nerve
3.impairment of glandular secretions
4.loss of taste
5.loss of sensation in one side of the face and mouth
6.rarely altered gag or swallowing reflexes.
How are diagnosis of Acoustic neuroma made?
------------------------------------------------------------
1.Contrast-enhanced CT will detect almost all acoustic neuromas that are greater than 2.0 cm in diameter
2.MRI with gadolinium enhancement may show even smaller tumors
3.Audiology and vestibular tests are done to check for Nerve versus conduction hearing loss.
What is the Treatment of Acoustic neuroma?
-------------------------------------------
Treatment of acoustic neuroma is usually by surgery and radiotherapy.
Conservative treatment
--------------------------
In some cases because the neuroma grow so slowly, the tumor is monitored by annual MRI to see its growth.
This method is common among patients over 70 years old.
In rare cases, acoustical neuroma have been known to disappear spontaneously.
Acoustic neuroma may result in gradual hearing loss and tinnitus.
Surgery
-----------------
Surgical removal of acoustic neuroma usually involve microsurgery to remove the tumor.
The superior and inferior vestibular nerves are removed at surgery.
This effectively restores balance in the patient.
Radiation treatment
-----------------------
Radiotherapy using gamma knife radiosurgery or fractionated stereotactic radiotherapy does not remove the tumor but is able to slow or stop its growth.
What is the Prognosis of Acoustic neuroma?
-------------------------------------------
Prognosis is good in all early diagnosis and small tumors.
Large tumors may give rise to residual neurolgical damage even afer removal.
Friday, October 3, 2008
A Simple Guide to Glossitis
A Simple Guide to Glossitis
-----------------------------------
What is Glossitis?
---------------------------
Glossitis is an acute or chronic inflammatory disease of the tongue which can cause swelling of the tongue and change of colour of the tongue.
The finger like papilla on the surface of the tongue may be lost as a result leading to a smooth tongue.
What are the causes of Glossitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Viral infections:
------------------
Herpes simplex
Non-infectious:
----------------
1.Dryness of the mouth and low saliva in the mouth may allow bacteria to grow more readily.
2.Local dental abnormalities, rough edges of teeth ,ill fitting dental appliances, or other trauma to the tongue
3.Tongue Piercings
4.irritants such as tobacco, alcohol, hot foods, and spicy food.
5.Sensitivity to toothpaste, mouthwash, breath fresheners,and dental material
6.Allergies to dyes in candy or preservatives in food.
7.Drug induced such as anticholinergics (cause dryness of mouth), certain blood-pressure medications (ACE inhibitors).
8.Mouth breathing
Systemic diseases:
--------------------
1.iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies
2.Skin diseases such as oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris,
3.Systemic diseases such as syphilis, and others.
Genetic
---------------
Occasionally Glossitis may be inherited
What are Signs and symptoms of Glossitis?
---------------------------------------------
Symptoms:
1.Swelling of the tongue
2.Tongue color changes often dark red
3.Pale if caused by anemia.
4.Fiery red if due to vitamin B deficiency
5.Sore and tender tongue
6.Smooth tongue
7.Aphthous ulcers of the tongue
8. Swollen tongue resulting in difficulty with chewing, swallowing, or speaking.
This may require emergency treatment especially if breathing is compromised.
How is the diagnosis of Glossitis made?
------------------------------------------
1.Symptoms and signs of red, swollen and inflamed tongue
2.blood tests (complete blood count, ESR and blood culture)
3.Biopsy of the tongue in rare cases.
What are the complications of Glossitis?
-----------------------------------------------
1.difficulty in breathing and swallowing
2.cervical lymphadenitis - swelling of the neck lymph nodes
3.upper respiratory tract infection
What is the treatment of Glossitis?
------------------------------------
The Main treatment is to reduce inflammation.
1.Good oral hygiene
2.Attend to dental problems
3.Antibiotics and antifungal treatment depending on the organism found
4.Corticosteroids may be given to reduce inflammation
5.For mild cases, topical applications of steroid mouth rinses or creams that is not swallowed are used
6.Underlying causes such as Anemia and nutritional deficiencies must be treated, often by changes in diet or vitamin supplements
7.Avoid irritants such as hot or spicy foods, alcohol, and tobacco to minimize the discomfort.
8.hospitalization may be required if unless tongue swelling is is affecting breathing or swallowing.
What is the prognosis of Glossitis ?
------------------------------------------
Usually very good.
Recurrences are common
What are the Preventive measures taken for Glossitis ?
--------------------------------------------------------
1.Avoid smoking
2.Healthy lifestyle with balanced diet and exercise.
3.Regular cleaning of gums and teeth by brushing and flossing
4.Gargling of mouth after meals
5.Regular dental checkups
Thursday, October 2, 2008
A Simple Guide to Ichthyosis
A Simple Guide to Ichthyosis
----------------------------------------------
What is Ichthyosis?
------------------------------------
Ichthyosis is a rare non contagious disease of the keratin of the skin where there is reduction of sweat and sebaceous secretions.
The word Ichthus means fish.
So Ichthyosis means fish like appearance of the skin.
Who is at risk of Ichthyosis?
----------------------------------------------
a family history of ichthyosis
What are the causes of Ichthyosis?
--------------------------------------------------
Most forms of ichthyosis are due to:
A.genetic conditions:
------------------------
1.Ichthyosis vulgaris 95% -autosomal dominant
2.X-linked ichthyosis -sex linked recessive
3.Ichthyosis lamellaris - autosomal recessive usually in newborns
4.Harlequins Ichthyosis -autosomal recessive
5.Bullous Ichthyosis - autosomal dominant
B.Acquired Ichthyosis
----------------------
6.Ichthyosis acquisita occur in :
leprosy,
hypothyroidism,
lymphoma,
sarcoidosis,
Hodgkin disease
7.Xeroderma - is a mild form of ichthyosis, occurs in middle aged and older patients.
What are Signs and symptoms of Ichthyosis?
---------------------------------------------
Symptoms:
1.extensor surface of limbs covered with dry scales(rarely the whole body is covered).
2.axilla and antecubal fossa (elbows,armpits,groins,back of knee)not affected
3.Usually symptoms present in childhood but improve during puberty to becoming worst again in later life.
4.Rashes can be extremely itchy in xeroderma
5.The condition is worse in colder weather.
6.Hair may be thin and dry.
7.Nails are brittle and dry.
How is the diagnosis of Ichthyosis made?
--------------------------------------------------------
1.Appearance of the skin
2.Family history of Ichthyosis
2.Skin biopsy for microscopic examination.
What are the complications of Ichthyosis?
-----------------------------------------------
1.keratisis with corneal and ocular surface disease
2.Ectropion of eyelids due to dehydration
3.Deafness in a Keratitis-Ichthyosis-Deafness (KID)Disease
What is the treatment of Ichthyosis?
------------------------------------
There is no cure for Ichthyosis.
1.Symptomatic treatment with emolient creams such as petroleum jelly my help to hydrate the skin.
2.Itch may be controlled with antihistamines
3.Hydration with propylene glycol solution will help
4.Urea in emulsion creams has also help the dry skin
5.Topical or oral retinoic acid has brought some improvement to the skin.
6.Exposure to the sun may improve or worsen the condition.
What is the prognosis of Ichthyosis ?
------------------------------------------
It is a lifelong condition and need continuous treatment.
What are the Preventive measures taken for Ichthyosis ?
--------------------------------------------------------
There is no known preventive measure for ichthyosis
----------------------------------------------
What is Ichthyosis?
------------------------------------
Ichthyosis is a rare non contagious disease of the keratin of the skin where there is reduction of sweat and sebaceous secretions.
The word Ichthus means fish.
So Ichthyosis means fish like appearance of the skin.
Who is at risk of Ichthyosis?
----------------------------------------------
a family history of ichthyosis
What are the causes of Ichthyosis?
--------------------------------------------------
Most forms of ichthyosis are due to:
A.genetic conditions:
------------------------
1.Ichthyosis vulgaris 95% -autosomal dominant
2.X-linked ichthyosis -sex linked recessive
3.Ichthyosis lamellaris - autosomal recessive usually in newborns
4.Harlequins Ichthyosis -autosomal recessive
5.Bullous Ichthyosis - autosomal dominant
B.Acquired Ichthyosis
----------------------
6.Ichthyosis acquisita occur in :
leprosy,
hypothyroidism,
lymphoma,
sarcoidosis,
Hodgkin disease
7.Xeroderma - is a mild form of ichthyosis, occurs in middle aged and older patients.
What are Signs and symptoms of Ichthyosis?
---------------------------------------------
Symptoms:
1.extensor surface of limbs covered with dry scales(rarely the whole body is covered).
2.axilla and antecubal fossa (elbows,armpits,groins,back of knee)not affected
3.Usually symptoms present in childhood but improve during puberty to becoming worst again in later life.
4.Rashes can be extremely itchy in xeroderma
5.The condition is worse in colder weather.
6.Hair may be thin and dry.
7.Nails are brittle and dry.
How is the diagnosis of Ichthyosis made?
--------------------------------------------------------
1.Appearance of the skin
2.Family history of Ichthyosis
2.Skin biopsy for microscopic examination.
What are the complications of Ichthyosis?
-----------------------------------------------
1.keratisis with corneal and ocular surface disease
2.Ectropion of eyelids due to dehydration
3.Deafness in a Keratitis-Ichthyosis-Deafness (KID)Disease
What is the treatment of Ichthyosis?
------------------------------------
There is no cure for Ichthyosis.
1.Symptomatic treatment with emolient creams such as petroleum jelly my help to hydrate the skin.
2.Itch may be controlled with antihistamines
3.Hydration with propylene glycol solution will help
4.Urea in emulsion creams has also help the dry skin
5.Topical or oral retinoic acid has brought some improvement to the skin.
6.Exposure to the sun may improve or worsen the condition.
What is the prognosis of Ichthyosis ?
------------------------------------------
It is a lifelong condition and need continuous treatment.
What are the Preventive measures taken for Ichthyosis ?
--------------------------------------------------------
There is no known preventive measure for ichthyosis
Wednesday, October 1, 2008
A Simple Guide to Pityriasis Rosea
A Simple Guide to Pityriasis Rosea
----------------------------------------------
What is Pityriasis Rosea?
------------------------------------
Pityriasis Rosea is a common non contagious disease which appears as numerous patches of red rash on the trunk of the body.
Who is at risk of Pityriasis Rosea?
----------------------------------------------
All ages and both sex are affected but occurs more between 10 -35 years of age.
What are the causes of Pityriasis Rosea?
--------------------------------------------------
The cause is unknown but a viral infection is suspected to cause it.
What are Signs and symptoms of Pityriasis Rosea?
---------------------------------------------
Symptoms:
1.A single red large patch of rashes or herald patch usually occur 1-20 days on the body before the onset of numerous small patches.
2.sore throat may occur before the onset of rashes
3.Numerous Large patches of red oval-shaped rash on the body may occur on the chest, back and neck.
4. As the rashes subside on the body, they may spread to the groin and extremities like the legs and arms
5.Rashes can be extremely itchy
6.breathlessness
7.low-grade fever
8.headache
9.nausea
10.fatigue.
How is the diagnosis of Pityriasis Rosea made?
--------------------------------------------------------
1.Symptoms and signs of typical herald patch followed by other patches of rashes
2.Skin scraping for microscopic examination.
What are the complications of Pityriasis Rosea?
-----------------------------------------------
1.Fungal infection
2.bacterial infection
What is the treatment of Pityriasis Rosea?
------------------------------------
1.No treatment may be necessary as the illness is self limiting
2.Itch may be controlled with antihistamines
3.Corticosteroid (oral or cream) may help reduce severe itching and inflammation
4.Soap should be avoided because it irritate the skin.
5.Moisturizer is better because of the dry skin
6.UV therapy sometimes help
7.Antibiotics may be given if there is secondary infection.
What is the prognosis of Pityriasis Rosea ?
------------------------------------------
Generally excellent but may recur.
What are the Preventive measures taken for Pityriasis Rosea ?
--------------------------------------------------------
1.Good skin hygiene
2.Healthy lifestyle with balanced diet and adequate sleep.
3.Proper skin care of the body.
Tuesday, September 30, 2008
A Simple Guide to Guillain-Barre Syndrome
A Simple Guide to Guillain-Barre Syndrome
---------------------------------------------------
What is Guillain-Barre Syndrome?
----------------------------------------
Guillain-Barre Syndrome is a rare autoimmune progressive disease with relatively symmetrical weakness of 2 or more limbs due to neuropathy, areflexia and mild sensory symptoms of not more than 4 weeks duration.
The Guillain-Barre Syndrome is a condition also called acute inflammatory demyelinating polyneuropathy (AIDP).
What causes Guillain-Barre Syndrome?
-------------------------------------------
In Guillain-Barre Syndrome, antibodies produced by the body's immune system attacks the gangliosides of cranial, spinal and peripheral nerve usually after:
1.a nonspecific respiratory or gastrointestinal viral illness
2.infectious mononucleosis
3.Campylobacter jejuni , cytomegalovirus infection
4.vaccination
5.extreme exposure to cold
The result of the antibodies attack on the peripheral nerves is inflammation of myelin and blockage of nerve conduction, resulting in muscle paralysis with sensory or autonomic deficits.
Who is at risk of Guillain-Barre Syndrome?
----------------------------------------------------
Guillain-Barre Syndrome occurs at any age usually at age 30-40.
It occurs more in men than in women.
What are the symptoms of Guillain-Barre Syndrome?
-------------------------------------------------------
The typical feature of Guillain-Barre Syndrome is
1.acute onset of symmetrical muscle weakness in both lower limbs with
ascending progression of the weakness upwards to the arms and face usually within hours or days.
2.the lower cranial nerves can also be affected leading to bulbar weakness, (dysphagia or difficulty with swallowing) and respiratory difficulties. If this happens , hospitalisation is a must.
3.Sensory loss is usually minor with loss of position, numbness or tingling sensation.
4.areflexia or complete loss of deep tendon reflexes is always present.
5.Loss of pain and temperature sensation may be present but mild.
6.pain is a common symptom with deep aching pain usually in the weakened muscles.
7.Autonomic dysfunction such as tachycardia, diarrhea, bladder dysfunction may occur but are usually transient.
8.absence of fever is one of the sign of Guillian Barre Syndrome.
If there is fever, another cause should be suspected.
Recovery usually begins 2-4 weeks after progression of disease stops.
How is the diagnosis of Guillain-Barre Syndrome made?
----------------------------------------------------------------
The diagnosis of Guillain-Barre Syndrome involve
1.History of a rapid onset and progression of ascending motor weakness, areflexia and the absence of fever.
2.physical and neurological examinations for peripheral neurological deficit.
3.cerebrospinal fluid examination-
typical CSF findings show albumino-cytological dissociation,
a. an elevated protein level (100 - 1000 mg/dL)
b. absent pleocytosis (increased cell count)unlike infectious causes.
4.Electromyographic studies and nerve conduction studies may show prolonged distal latencies, conduction slowing, nerve conduction blockage suggestive of demyelination.
5.Computed tomography or MRI may show actual demyelination of the nerve.
What are the complications for Guillain-Barre Syndrome ?
--------------------------------------------------------
1.Progression of nerve involvement to whole body
2.Paralysis of respiratory muscles and swallowing can be life threatening
What is the treatment for Guillain-Barre Syndrome ?
---------------------------------------------------------
Treatment for Guillain-Barre Syndrome may be urgent especially in cases of respiratory distress:
1.Hospitalisation and early intubation with a respirator on standby in case of difficulty in respiration
2.treatment of the underlying cause is started as soon as possible:
a. High dose intravenous immune globulin, which temporarily modifies the immune system and provides the body with normal antibodies from donated blood or
b.plasmapheresis in which abnormal antibodies are removed from the blood.
3.rehabilitation is atrted after the patient is stable and will focus on improving activities of daily living functions such as brushing teeth, washing and getting dressed.
4.physiotherapy to strengthen muscles
5.Speech therapy for speech and awallowing
6. Corticosteroids have no part to play in the treatment of Guillian Barre Syndrome.
What is the prognosis of Guillian-Barre Syndrome?
------------------------------------------------------------
1.With all these new treatments the prognosis for most patients with Guillain-Barre Syndrome is good with 80% recovery within 1 year
2.Some of them may have persistant minor neurological deficits such as areflexia.
3.Some 5% recover but with severe disability involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.
4.About 10% of patients have relapses and are as classified as having chronic inflammatory demyelinating polyneuropathy
5.Death is rare(5%) and may be due to severe paralysis, autonomic dysfunction and other severe pulmonary complications.
---------------------------------------------------
What is Guillain-Barre Syndrome?
----------------------------------------
Guillain-Barre Syndrome is a rare autoimmune progressive disease with relatively symmetrical weakness of 2 or more limbs due to neuropathy, areflexia and mild sensory symptoms of not more than 4 weeks duration.
The Guillain-Barre Syndrome is a condition also called acute inflammatory demyelinating polyneuropathy (AIDP).
What causes Guillain-Barre Syndrome?
-------------------------------------------
In Guillain-Barre Syndrome, antibodies produced by the body's immune system attacks the gangliosides of cranial, spinal and peripheral nerve usually after:
1.a nonspecific respiratory or gastrointestinal viral illness
2.infectious mononucleosis
3.Campylobacter jejuni , cytomegalovirus infection
4.vaccination
5.extreme exposure to cold
The result of the antibodies attack on the peripheral nerves is inflammation of myelin and blockage of nerve conduction, resulting in muscle paralysis with sensory or autonomic deficits.
Who is at risk of Guillain-Barre Syndrome?
----------------------------------------------------
Guillain-Barre Syndrome occurs at any age usually at age 30-40.
It occurs more in men than in women.
What are the symptoms of Guillain-Barre Syndrome?
-------------------------------------------------------
The typical feature of Guillain-Barre Syndrome is
1.acute onset of symmetrical muscle weakness in both lower limbs with
ascending progression of the weakness upwards to the arms and face usually within hours or days.
2.the lower cranial nerves can also be affected leading to bulbar weakness, (dysphagia or difficulty with swallowing) and respiratory difficulties. If this happens , hospitalisation is a must.
3.Sensory loss is usually minor with loss of position, numbness or tingling sensation.
4.areflexia or complete loss of deep tendon reflexes is always present.
5.Loss of pain and temperature sensation may be present but mild.
6.pain is a common symptom with deep aching pain usually in the weakened muscles.
7.Autonomic dysfunction such as tachycardia, diarrhea, bladder dysfunction may occur but are usually transient.
8.absence of fever is one of the sign of Guillian Barre Syndrome.
If there is fever, another cause should be suspected.
Recovery usually begins 2-4 weeks after progression of disease stops.
How is the diagnosis of Guillain-Barre Syndrome made?
----------------------------------------------------------------
The diagnosis of Guillain-Barre Syndrome involve
1.History of a rapid onset and progression of ascending motor weakness, areflexia and the absence of fever.
2.physical and neurological examinations for peripheral neurological deficit.
3.cerebrospinal fluid examination-
typical CSF findings show albumino-cytological dissociation,
a. an elevated protein level (100 - 1000 mg/dL)
b. absent pleocytosis (increased cell count)unlike infectious causes.
4.Electromyographic studies and nerve conduction studies may show prolonged distal latencies, conduction slowing, nerve conduction blockage suggestive of demyelination.
5.Computed tomography or MRI may show actual demyelination of the nerve.
What are the complications for Guillain-Barre Syndrome ?
--------------------------------------------------------
1.Progression of nerve involvement to whole body
2.Paralysis of respiratory muscles and swallowing can be life threatening
What is the treatment for Guillain-Barre Syndrome ?
---------------------------------------------------------
Treatment for Guillain-Barre Syndrome may be urgent especially in cases of respiratory distress:
1.Hospitalisation and early intubation with a respirator on standby in case of difficulty in respiration
2.treatment of the underlying cause is started as soon as possible:
a. High dose intravenous immune globulin, which temporarily modifies the immune system and provides the body with normal antibodies from donated blood or
b.plasmapheresis in which abnormal antibodies are removed from the blood.
3.rehabilitation is atrted after the patient is stable and will focus on improving activities of daily living functions such as brushing teeth, washing and getting dressed.
4.physiotherapy to strengthen muscles
5.Speech therapy for speech and awallowing
6. Corticosteroids have no part to play in the treatment of Guillian Barre Syndrome.
What is the prognosis of Guillian-Barre Syndrome?
------------------------------------------------------------
1.With all these new treatments the prognosis for most patients with Guillain-Barre Syndrome is good with 80% recovery within 1 year
2.Some of them may have persistant minor neurological deficits such as areflexia.
3.Some 5% recover but with severe disability involving severe proximal motor and sensory axonal damage with inability of axonal regeneration.
4.About 10% of patients have relapses and are as classified as having chronic inflammatory demyelinating polyneuropathy
5.Death is rare(5%) and may be due to severe paralysis, autonomic dysfunction and other severe pulmonary complications.
Monday, September 29, 2008
A Simple Guide to Gastroesophageal reflux disease
A Simple Guide to Gastroesophageal reflux disease II
----------------------------------------------------------------
What are the Complications of untreated Gastroesophageal reflux disease?
-------------------------------------------------------------------------
GERD complications include
1.stricture formation,
2.Barrett's esophagus,
3.esophageal spasms,
4.esophageal ulcers,
5.esophageal cancer, especially in adults over 60 years old.
What is the treatment of Gastroesophageal reflux disease?
-------------------------------------------------------------------
Treatment is aimed at
A. prevention of reflux:
---------------------------
1.weight loss for the Obese
2.Positional therapy
a.Sleeping on the left side has been shown to drastically reduce nighttime reflux episodes in patients
b.Elevating the head of the bed is also effective.
The head of the bed can be raised by wooden bed risers that support bed posts or legs.
Elevation must be at least 6 to 8 inches (15 to 20 cm) to be able to prevent the backflow of gastric fluids.
c.a bed wedge pillow will also help to raise the patient's body higher
3.Certain foods should be avoided to prevent gastroesophageal reflux:
a.Coffee,
b.alcohol,
c.Acidic foods, such as oranges,tomatoes and excess amounts of Vitamin C
d.Antacids based on calcium carbonate actually increase the acidity of the stomach.
e.Foods high in fats -delay stomach emptying
f.Carbonated soft drinks with or without sugar.
g.Chocolate and peppermint.
h.Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.
i.Milk and milk-based products containing calcium and fat,
j.Eating within 2 hours before bedtime.
k.Large meals- smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.
4.Smoking reduce lower esophageal sphincter competence, and should be avoided
5. Posture and GERD
Slouching causes a kink between the stomach and esophagus.
The esophageal muscles become twisted in a spasm.
Gas and acid get trapped in the spasm,causing irritation to the throat and the windpipe resulting in cough and asthmatic symptoms.
6.Avoid stress.
Learn to relax or meditate.
Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.
B. Neutralizing the Gastric Acid Reflux
-----------------------------------------------
1. Drug treatment
a.Proton pump inhibitors are the best drugs used in reducing gastric acid secretion. (eg Nexium, Losec)
b.Antacids taken before meals half hourly after symptoms begin can reduce gastric acidity (liquid antacid are more useful than tablets)
c.Alginic acid (Gaviscon) protects the mucosa as well as increase pH and decrease reflux.
d.Gastric H2 receptor blockers such as ranitidine or famotidine decrease gastric secretion of acid.
e.Sucralfate (Carafate) is used to help heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two hours apart from meals and medications.
2. Surgical treatment
The standard surgical treatment, done laparoscopically, is the Nissen fundoplication.
The upper part of the stomach is wrapped around the Lower Esophageal Sphincter(LES) to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.
3.New treatments
Eight years ago some new endoscopic devices to treat chronic heartburn were approved:
a.The Endocinch apply stitches in the LES to help strengthen the muscle.
b.The Stretta Procedure uses electrodes to use radio frequency energy to strengthen the LES.
c.The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fix the fold using a suture-based implant.
What is the prognosis of Gastroesophageal reflux disease?
------------------------------------------------------------
It is a chronic disease so treatment is lifelong and recurrences are common.
How is Gastroesophageal reflux disease prevented?
-------------------------------------------------------
1.Prevent heartburn by limiting acidic foods, such as grapefruit, oranges, tomatoes, or vinegar
2.Spicy foods - Cut down on pepper or chilies.
3.Avoid lying down for two to three hours after meals.
When you are sitting up, gravity helps drain food and stomach acid into your stomach.
4.Eat lean meats and non-fatty foods.
Greasy foods (like French fries and cheeseburgers) can trigger heartburn.
5.Avoid GERD symptom triggers- chocolate, mint, citrus, tomatoes, pepper, vinegar, catsup, and mustard.
6.Avoid drinks that can trigger reflux, such as alcohol, drinks with caffeine, and carbonated drinks.
7.Eat smaller meals to avoid triggering GERD symptoms.
8.Avoid stress.
Learn to relax or meditate.
Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.
----------------------------------------------------------------
What are the Complications of untreated Gastroesophageal reflux disease?
-------------------------------------------------------------------------
GERD complications include
1.stricture formation,
2.Barrett's esophagus,
3.esophageal spasms,
4.esophageal ulcers,
5.esophageal cancer, especially in adults over 60 years old.
What is the treatment of Gastroesophageal reflux disease?
-------------------------------------------------------------------
Treatment is aimed at
A. prevention of reflux:
---------------------------
1.weight loss for the Obese
2.Positional therapy
a.Sleeping on the left side has been shown to drastically reduce nighttime reflux episodes in patients
b.Elevating the head of the bed is also effective.
The head of the bed can be raised by wooden bed risers that support bed posts or legs.
Elevation must be at least 6 to 8 inches (15 to 20 cm) to be able to prevent the backflow of gastric fluids.
c.a bed wedge pillow will also help to raise the patient's body higher
3.Certain foods should be avoided to prevent gastroesophageal reflux:
a.Coffee,
b.alcohol,
c.Acidic foods, such as oranges,tomatoes and excess amounts of Vitamin C
d.Antacids based on calcium carbonate actually increase the acidity of the stomach.
e.Foods high in fats -delay stomach emptying
f.Carbonated soft drinks with or without sugar.
g.Chocolate and peppermint.
h.Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.
i.Milk and milk-based products containing calcium and fat,
j.Eating within 2 hours before bedtime.
k.Large meals- smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.
4.Smoking reduce lower esophageal sphincter competence, and should be avoided
5. Posture and GERD
Slouching causes a kink between the stomach and esophagus.
The esophageal muscles become twisted in a spasm.
Gas and acid get trapped in the spasm,causing irritation to the throat and the windpipe resulting in cough and asthmatic symptoms.
6.Avoid stress.
Learn to relax or meditate.
Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.
B. Neutralizing the Gastric Acid Reflux
-----------------------------------------------
1. Drug treatment
a.Proton pump inhibitors are the best drugs used in reducing gastric acid secretion. (eg Nexium, Losec)
b.Antacids taken before meals half hourly after symptoms begin can reduce gastric acidity (liquid antacid are more useful than tablets)
c.Alginic acid (Gaviscon) protects the mucosa as well as increase pH and decrease reflux.
d.Gastric H2 receptor blockers such as ranitidine or famotidine decrease gastric secretion of acid.
e.Sucralfate (Carafate) is used to help heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two hours apart from meals and medications.
2. Surgical treatment
The standard surgical treatment, done laparoscopically, is the Nissen fundoplication.
The upper part of the stomach is wrapped around the Lower Esophageal Sphincter(LES) to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.
3.New treatments
Eight years ago some new endoscopic devices to treat chronic heartburn were approved:
a.The Endocinch apply stitches in the LES to help strengthen the muscle.
b.The Stretta Procedure uses electrodes to use radio frequency energy to strengthen the LES.
c.The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fix the fold using a suture-based implant.
What is the prognosis of Gastroesophageal reflux disease?
------------------------------------------------------------
It is a chronic disease so treatment is lifelong and recurrences are common.
How is Gastroesophageal reflux disease prevented?
-------------------------------------------------------
1.Prevent heartburn by limiting acidic foods, such as grapefruit, oranges, tomatoes, or vinegar
2.Spicy foods - Cut down on pepper or chilies.
3.Avoid lying down for two to three hours after meals.
When you are sitting up, gravity helps drain food and stomach acid into your stomach.
4.Eat lean meats and non-fatty foods.
Greasy foods (like French fries and cheeseburgers) can trigger heartburn.
5.Avoid GERD symptom triggers- chocolate, mint, citrus, tomatoes, pepper, vinegar, catsup, and mustard.
6.Avoid drinks that can trigger reflux, such as alcohol, drinks with caffeine, and carbonated drinks.
7.Eat smaller meals to avoid triggering GERD symptoms.
8.Avoid stress.
Learn to relax or meditate.
Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.
Sunday, September 28, 2008
A Simple Guide to Gastroesophageal reflux disease
A Simple Guide to Gastroesophageal reflux disease I
------------------------------------------------------------
What is Gastroesophageal reflux disease?
--------------------------------------------------------
Gastroesophageal reflux disease (GERD) is a chronic disease of the esophagus whose mucosa is damaged by abnormal reflux of gastric acid from the stomach to the esophagus.
What are the risk factors in Gastroesophageal reflux disease?
---------------------------------------------------------------------------
1.Incompetant Lower Esophageal Sphincter(LES) allow the acid and gastric juice to reflux up the esophagus
2.Hiatus hernia - hole in diaphragm separating esophagus from stomach is enlarged allowing the easier flow of acid up the esophagus
3.Obesity and pregnancy: increased body weight cause pressure in the abdomen to push gastric contents upwards towards esophagus
4.Zollinger-Ellison syndrome- this condition typically increase gastric acid
5.Hypercalcemia, increase gastrin production, leading to increased acidity
6.Corticosteroids like prednisolone - can irritate the stomach mucosa and increase gastric acid
7.Scleroderma and Multiple sclerosis with esophageal involvement
Factors which has been associated with GERD :
8.Obstructive sleep apnea
9.Gallstones which can impede the flow of bile and digestion of fats
What are the causes of Gastroesophageal reflux disease?
------------------------------------------------------------------
1.incompetence of the cardia(junction between the stomach and esophagus),
2.transient cardia relaxation,
3.impaired expulsion of gastric reflux from the esophagus
4.hiatus hernia.
What are the Symptoms of Gastroesophageal reflux disease?
----------------------------------------------------------------------
The most common symptoms are
1.Heartburn - there is a burning discomfort behind the breastbone due to acid flow up the esophagus
2.difficulty swallowing (dysphagia)- due to narrowing of the esophagus (persistent implies stricture while intermittent implies spasm)
3.chronic chest pain - pain is behind the central sternum as a result of acid in the esophagus
4.cough - the acid flow up the esophagus can irritate the larynx and spark off the cough reflex
5.hoarseness- due to inflammation of the vocal cords from the acid reflux
6.voice changes- as above
7.chronic ear ache- inflammation of the throat from acid relux an also affect the eustachian tube of the middle ear resulting in pain
8.burning chest pains- again due to the gastric acid in esophagus
9.nausea and belching- too much acid to the throat can cause the nausea and expulsion of air effect
10.sinusitis - acid can also find its way up the throat and into the sinuses.
11.esophagitis (reflux esophagitis)- acid low up the esophagus causing pain
worse on lying down
12.strictures are narrowing of the esophagus resulting from acid in the esophagus
If the reflux affects the throat and larynx, it is called laryngopharyngeal reflux disease.
How do you diagnose Gastroesophageal reflux disease?
---------------------------------------------------------------
A detailed history of acid reflux into the esophagus.
Useful investigations may include
1.barium swallow X-rays,
2.esophageal manometry - measures the pressure in the esophagus
3.24-hour esophageal pH monitoring - measures the acidity of the esophagus
4.Esophagogastroduodenoscopy (EGD) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach in order to assess the internal surfaces of the esophagus, stomach, and duodenum.
In general, an EGD is done when:
1.the patient does not respond well to treatment,
2.has danger symptoms including:
dysphagia,
anemia,
blood in the stool (detected chemically),
wheezing,
weight loss,
voice changes.
Esophagogastroduodenoscopy can show peptic stricture, or narrowing of the esophagus near the junction with the stomach.
This can cause dysphagia or difficulty in swallowing
Biopsies done during gastroscopy may show:
1.Edema and basal hyperplasia (non-specific)
2.Lymphocytic inflammation (non-specific)
3.Neutrophilic inflammation (usually due to reflux or Helicobacter Gastroesophageal reflux disease)
4.Eosinophilic inflammation (usually due to reflux)
5.Goblet cell intestinal metaplasia or Barretts esophagus.
6.Elongation of the papillae
7.Thinning of the squamous cell layer
8.Dysplasia or pre-cancer.
9.Carcinoma.
10.Reflux changes may be non-erosive in nature, leading to the non-erosive reflux disease.
Saturday, September 27, 2008
A Simple Guide to Acne Rosacea
A Simple Guide to Acne Rosacea
-----------------------------------------------
What is Acne Rosacea?
----------------------------------
Acne Rosacea is a chronic inflammatory disease of the skin which typically redness of the cheeks with maculopapular rashes.
Who Gets Acne Rosacea?
-----------------------
Acne Rosacea occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Acne Rosacea?
-------------------------------------
The cause of Acne Rosacea is unknown.
Some possible causes are:
1.menopause with flushing of the face due to hormonal
2.Excessive sebum production in the sebaceous glands
3.stress aggravate the condition
4.Alcohol and certain foods(seafood with its high histamine content, spicy food) can cause flushing
What are the symptoms of Acne Rosacea?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of Acne Rosacea is well-defined :
1.red (rosy cheek)
2.small blood vessel seen in rashes
3.hypertrophic sebaceous glands without blockage of ducts
4.papular rash.
5.Typically on forehead, cheeks, nose, chin or center of face
6.Associated seborrheic dermatitis of the scalp(dandruff)and eyelids (blepharitis)
7.Eye lesions may include:
tearing of eyes
photophobia
visual disturbances
corneal infections
conjunctivitis
How does Acne Rosacea affects the Patient?
-----------------------------------------
All types of Acne Rosacea can affect a person’s quality of life.
1.Appearance of face
2.Blood vessel on nose
3.papular rashes on the face
What is the Treatment of Acne Rosacea?
-----------------------------------
Treatment depends on the severity and type of Acne Rosacea.
1.mild cases may not require any treatment
2.Avoid food that can cause flushing such as alcohol, spicy foods, hot drinks
3.Avoid stress and tension
Treatments:
1.Topical Medicines include:
sulphur containing creams and shampoo to dry the oil from the skin
2.Systemic antibiotics like tetracycline or erythromycin
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A radiation)
4.Avoid corticosteroids which usually make the condition worse
5.Surgical treatment of rhinophyma and laser treatment of dilated blood vessels
At the present moment there is no known cure for Acne Rosacea.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
What is the Prognosis of Acne Rosacea?
-----------------------------------------------
There is generally no cure for Acne Rosacea.
Treatment is good with prolonged antibiotic therapy.
Lifelong treatment may be necessary to control signs and symptoms.
-----------------------------------------------
What is Acne Rosacea?
----------------------------------
Acne Rosacea is a chronic inflammatory disease of the skin which typically redness of the cheeks with maculopapular rashes.
Who Gets Acne Rosacea?
-----------------------
Acne Rosacea occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Acne Rosacea?
-------------------------------------
The cause of Acne Rosacea is unknown.
Some possible causes are:
1.menopause with flushing of the face due to hormonal
2.Excessive sebum production in the sebaceous glands
3.stress aggravate the condition
4.Alcohol and certain foods(seafood with its high histamine content, spicy food) can cause flushing
What are the symptoms of Acne Rosacea?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of Acne Rosacea is well-defined :
1.red (rosy cheek)
2.small blood vessel seen in rashes
3.hypertrophic sebaceous glands without blockage of ducts
4.papular rash.
5.Typically on forehead, cheeks, nose, chin or center of face
6.Associated seborrheic dermatitis of the scalp(dandruff)and eyelids (blepharitis)
7.Eye lesions may include:
tearing of eyes
photophobia
visual disturbances
corneal infections
conjunctivitis
How does Acne Rosacea affects the Patient?
-----------------------------------------
All types of Acne Rosacea can affect a person’s quality of life.
1.Appearance of face
2.Blood vessel on nose
3.papular rashes on the face
What is the Treatment of Acne Rosacea?
-----------------------------------
Treatment depends on the severity and type of Acne Rosacea.
1.mild cases may not require any treatment
2.Avoid food that can cause flushing such as alcohol, spicy foods, hot drinks
3.Avoid stress and tension
Treatments:
1.Topical Medicines include:
sulphur containing creams and shampoo to dry the oil from the skin
2.Systemic antibiotics like tetracycline or erythromycin
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A radiation)
4.Avoid corticosteroids which usually make the condition worse
5.Surgical treatment of rhinophyma and laser treatment of dilated blood vessels
At the present moment there is no known cure for Acne Rosacea.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
What is the Prognosis of Acne Rosacea?
-----------------------------------------------
There is generally no cure for Acne Rosacea.
Treatment is good with prolonged antibiotic therapy.
Lifelong treatment may be necessary to control signs and symptoms.
A Simple Guide to Intertrigo
A Simple Guide to Intertrigo
-----------------------------------
What is Intertrigo?
---------------------------
Intertrigo is a moist red seborrheic (oil gland) skin rash affecting body clefts such as armpits and groins.
What are the causes of Intertrigo?
----------------------------------------
The seborrheic glands (oil glands) in the skin secretes excessive sebum(oil) especially in areas which tends to rubs against each other such as armpits, groins, skin under the breasts, and navel.
Because of the irritation of the skin and secretion of sebum, a red moist form of rash appears.
What are Signs and symptoms of Intertrigo?
---------------------------------------------
Symptoms:
1.moist rash
2.red skin
3.may be oily
Signs:
1.Typical red moist macular rash
2.may have sebum present
3.appears mainly at axilla, groin, submammary skin
How is the diagnosis of Intertrigo made?
------------------------------------------
1.Symptoms and signs of moist red seborrheic type of rash
2.Skin scraping to exclude fungal infection.
What are the complications of Intertrigo?
-----------------------------------------------
1.Fungal infection
2.bacterial infection
What is the treatment of Intertrigo?
------------------------------------
1.Control of dandruff and other seborrheic conditions
2.Anifungal and antibiotic cream applied to skin lesions.
3.Corticosteroid cream may help reduce inflammation
What is the prognosis of Intertrigo ?
------------------------------------------
Generally excellent but may recur.
What are the Preventive measures taken for Intertrigo ?
--------------------------------------------------------
1.Lose weight in obese patient(less friction)
2.Good skin hygiene
3.Healthy lifestyle with balanced diet and adequate sleep.
4.Proper skin care of the axilla, groins, submammary ares, navel
-----------------------------------
What is Intertrigo?
---------------------------
Intertrigo is a moist red seborrheic (oil gland) skin rash affecting body clefts such as armpits and groins.
What are the causes of Intertrigo?
----------------------------------------
The seborrheic glands (oil glands) in the skin secretes excessive sebum(oil) especially in areas which tends to rubs against each other such as armpits, groins, skin under the breasts, and navel.
Because of the irritation of the skin and secretion of sebum, a red moist form of rash appears.
What are Signs and symptoms of Intertrigo?
---------------------------------------------
Symptoms:
1.moist rash
2.red skin
3.may be oily
Signs:
1.Typical red moist macular rash
2.may have sebum present
3.appears mainly at axilla, groin, submammary skin
How is the diagnosis of Intertrigo made?
------------------------------------------
1.Symptoms and signs of moist red seborrheic type of rash
2.Skin scraping to exclude fungal infection.
What are the complications of Intertrigo?
-----------------------------------------------
1.Fungal infection
2.bacterial infection
What is the treatment of Intertrigo?
------------------------------------
1.Control of dandruff and other seborrheic conditions
2.Anifungal and antibiotic cream applied to skin lesions.
3.Corticosteroid cream may help reduce inflammation
What is the prognosis of Intertrigo ?
------------------------------------------
Generally excellent but may recur.
What are the Preventive measures taken for Intertrigo ?
--------------------------------------------------------
1.Lose weight in obese patient(less friction)
2.Good skin hygiene
3.Healthy lifestyle with balanced diet and adequate sleep.
4.Proper skin care of the axilla, groins, submammary ares, navel
Thursday, September 25, 2008
A Simple Guide to Impetigo
A Simple Guide to Impetigo
-----------------------------------
What is Impetigo?
---------------------------
Impetigo is a vesiculopustular skin infection occurring mainly at all ages.
What are the causes of Impetigo?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,
What are Signs and symptoms of Impetigo?
---------------------------------------------
Symptoms:
1.vesicles that appears rapidly on the face, hands and knee
2.Yellow liquid or pus discharges from vesicles
3.form crusts
Signs:
1.Vesicles rash present on face, hand and knees
2.yellow crusts appeared and spread to surrounding tissues
3.Neighboring lymph nodes may be enlarged
How is the diagnosis of Impetigo made?
------------------------------------------
1.Symptoms and signs of vesiculopustular lesions of the skin.
2.Culture and sensitivity to antibiotics of the discharge or crusts from skin lesions
What are the complications of Impetigo?
-----------------------------------------------
1.cellulitis
2.abscess
3.carbuncle( a group of abscesses which join together to become a large abscess
4.lymphadenitis
What is the treatment of Impetigo?
------------------------------------
1.Removal of crusts with warm saline or liquid paraffin
2.Strong antibiotic cream applied to skin lesions.
3. Strong systemic antibiotics
a.cephalosporin, penicillin, ampicillin, erythromycin, tetracycline, for most streptococci,
staphalococci,
hemophilus
b.cephalosporins, gentamycin for
pseudomonas
4.surgery to drain abscess and carbuncles may be necessary
What is the prognosis of Impetigo ?
------------------------------------------
Generally excellent with good healing
What are the Preventive measures taken for Impetigo ?
--------------------------------------------------------
1.Avoid touching skin with dirty hands
2.Good hand hygiene
3.Healthy lifestyle with balance diet and adequate sleep.
4.Proper skin care
Wednesday, September 24, 2008
A Simple Guide to Blepharitis
A Simple Guide to Blepharitis
-----------------------------------
What is Blepharitis?
---------------------------
Blepharitis is a disease which causes inflammation and infection of the margins of the eyelids.
What are the causes of Blepharitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,
Parasitic Infections:
----------------------------
Deodex folliculorum rare cause
Non-infectious:
------------------
blocked oil glands of eyelashes
What are the types of Blepharitis?
----------------------------------------
Squamous:
--------------
typically scales on lashes- usually non-infectious
Ulcerative:
----------------
yellow crusts on eyelids which causes small bleeding ulcers when removed -
usually due to infections.
What are Signs and symptoms of Blepharitis?
---------------------------------------------
Symptoms:
1.Irritation and discomfort of eyelids
2.tearing of eyes
3.photophobia (fear of bright lights and sunlight)
4.Yellow discharge or crusts on eyelashes
Signs:
1.White scales on eyelashes in squamous blepharitis
2.yellow crusts on eyelashes in infectious blepharitis
3.small bleeding ulcers on eyelids where crusts have dropped.
4.Conjuctivitis
How is the diagnosis of Blepharitis made?
------------------------------------------
1.Symptoms and signs of scales, yellow crusts on eyelids
2.Culture and sensitivity to antibiotics of the discharge from eyedlids
3.Microscopic examination of eyelashes
What are the complications of Blepharitis?
-----------------------------------------------
1.Stye or chalazion of eyelid
2.Conjuctivitis
3.Scarring of eyelids
What is the treatment of Blepharitis?
------------------------------------
Squamous Blepharitis
-----------------------
1.Treatment of underlying cause such as seborrhoeic dermatitis
2.Application of antiseptic or antibiotic cream to eyelashes
Ulcerative Blepharitis
--------------------------
1.Rest in dark room
2.Painkiller for pain
3.Removal of crusts and diseased eyelashes by washing warm water or saline
4.Strong antibiotic eyedrops and cream applied to eyelashes:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
5.Treat associated conjunctivitis
What is the prognosis of Blepharitis ?
------------------------------------------
Squamous Blepharitis
-----------------------
Generally good.
May vary with response to underlying cause.
Recurrence is common.
Ulcerative Blepharitis
--------------------------
Most cases recovered well.
Rarely there may serious sequalae such as
loss of eyelashes,
scarring of eyelashes
conjuctival ulcers
What are the Preventive measures taken for Blepharitis ?
--------------------------------------------------------
1.Avoid rubbing of eyes with dirty hands
2.Good hand hygiene
3.Healthy lifestyle with balanced diet and adequate sleep.
4.Reducing watching of TV and computer monitors
5.Regular eye checkups
-----------------------------------
What is Blepharitis?
---------------------------
Blepharitis is a disease which causes inflammation and infection of the margins of the eyelids.
What are the causes of Blepharitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,
Parasitic Infections:
----------------------------
Deodex folliculorum rare cause
Non-infectious:
------------------
blocked oil glands of eyelashes
What are the types of Blepharitis?
----------------------------------------
Squamous:
--------------
typically scales on lashes- usually non-infectious
Ulcerative:
----------------
yellow crusts on eyelids which causes small bleeding ulcers when removed -
usually due to infections.
What are Signs and symptoms of Blepharitis?
---------------------------------------------
Symptoms:
1.Irritation and discomfort of eyelids
2.tearing of eyes
3.photophobia (fear of bright lights and sunlight)
4.Yellow discharge or crusts on eyelashes
Signs:
1.White scales on eyelashes in squamous blepharitis
2.yellow crusts on eyelashes in infectious blepharitis
3.small bleeding ulcers on eyelids where crusts have dropped.
4.Conjuctivitis
How is the diagnosis of Blepharitis made?
------------------------------------------
1.Symptoms and signs of scales, yellow crusts on eyelids
2.Culture and sensitivity to antibiotics of the discharge from eyedlids
3.Microscopic examination of eyelashes
What are the complications of Blepharitis?
-----------------------------------------------
1.Stye or chalazion of eyelid
2.Conjuctivitis
3.Scarring of eyelids
What is the treatment of Blepharitis?
------------------------------------
Squamous Blepharitis
-----------------------
1.Treatment of underlying cause such as seborrhoeic dermatitis
2.Application of antiseptic or antibiotic cream to eyelashes
Ulcerative Blepharitis
--------------------------
1.Rest in dark room
2.Painkiller for pain
3.Removal of crusts and diseased eyelashes by washing warm water or saline
4.Strong antibiotic eyedrops and cream applied to eyelashes:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
5.Treat associated conjunctivitis
What is the prognosis of Blepharitis ?
------------------------------------------
Squamous Blepharitis
-----------------------
Generally good.
May vary with response to underlying cause.
Recurrence is common.
Ulcerative Blepharitis
--------------------------
Most cases recovered well.
Rarely there may serious sequalae such as
loss of eyelashes,
scarring of eyelashes
conjuctival ulcers
What are the Preventive measures taken for Blepharitis ?
--------------------------------------------------------
1.Avoid rubbing of eyes with dirty hands
2.Good hand hygiene
3.Healthy lifestyle with balanced diet and adequate sleep.
4.Reducing watching of TV and computer monitors
5.Regular eye checkups
Tuesday, September 23, 2008
A Simple Guide to Cytomegalovirus
A Simple Guide to Cytomegalovirus
-----------------------------------
What is Cytomegalovirus?
---------------------------
Cytomegalovirus is an acute viral disease of all ages which can be transmitted to the fetus before birth.
It affects people at all ages but seldom causes any symptoms in adults.
What are the causes of Cytomegalovirus?
----------------------------------------
Cytomegalovirus is a virus of the herpes group characterised by its ability to stay dormant in the body over a long period.
It is transmited in body fluid (urine, saliva ,blood, semen, tears and breast milk)
What are Signs and symptoms of Cytomegalovirus?
---------------------------------------------
Adult and children Cytomegalovirus infection do not normally give rise to symptoms except for mild fever and a mononucleosis-like illness.
Congenital Cytomegalovirus infections presents itself at birth:
1.Microcephaly
2.Hepatosplenomegaly with jaundice
3.Hearing impairment
4.Blindness
5.Chorioretinitis
6.Hemolytic anemia with petechiae
7.Seizures
8.Respiratory distress
How is the diagnosis of Cytomegalovirus made?
------------------------------------------
1.blood tests for igG or igM for Cytomegalovirus are positive within 3 weeks of birth
2.Usually appears normal at birth
3.Ultrasound during pregnancy to dentify any brain abnormalities .
4.Saliva , urine may be taken to test if there is presence of the Cytomegalovirus.
What are the complications of Cytomegalovirus?
-----------------------------------------------
1.Respiratory distress
2.Mental retardation
3.Hemolytic anemia
4.Blindness
5.Deafness
What is the treatment of Cytomegalovirus?
--------------------------------------------------
There is no effective treatment of Cytomegalovirus at the present moment.
A antiviral drug ganciclovir which is used to treat AIDS may help babies with Cytomegalovirus infection.
A vacine is also being developed for prevention.
What is the prognosis of Cytomegalovirus ?
------------------------------------------
Prognosis for congenital Cytomegalovirus infection is poor.
Adult Cytomegalovirus infection do not have any problem.
What are the Preventive measures taken for Cytomegalovirus ?
------------------------------------------------------------------
There is no vaccine at the present moment for Cytomegalovirus.
Transmission of Cytomegalovirus infection is always preventable because it is transmitted through body fluid from hand,nose and mouth of a suseceptible person.
People who interacts with children and pregnant mothers shuold practice good safe hygiene methods such as washing of hand and wearing of clothes when changing diapers.
Pregnant women are also advised to practice safe hygiene methods and to seek advice in the presence of a mononucleosis-like illness.
-----------------------------------
What is Cytomegalovirus?
---------------------------
Cytomegalovirus is an acute viral disease of all ages which can be transmitted to the fetus before birth.
It affects people at all ages but seldom causes any symptoms in adults.
What are the causes of Cytomegalovirus?
----------------------------------------
Cytomegalovirus is a virus of the herpes group characterised by its ability to stay dormant in the body over a long period.
It is transmited in body fluid (urine, saliva ,blood, semen, tears and breast milk)
What are Signs and symptoms of Cytomegalovirus?
---------------------------------------------
Adult and children Cytomegalovirus infection do not normally give rise to symptoms except for mild fever and a mononucleosis-like illness.
Congenital Cytomegalovirus infections presents itself at birth:
1.Microcephaly
2.Hepatosplenomegaly with jaundice
3.Hearing impairment
4.Blindness
5.Chorioretinitis
6.Hemolytic anemia with petechiae
7.Seizures
8.Respiratory distress
How is the diagnosis of Cytomegalovirus made?
------------------------------------------
1.blood tests for igG or igM for Cytomegalovirus are positive within 3 weeks of birth
2.Usually appears normal at birth
3.Ultrasound during pregnancy to dentify any brain abnormalities .
4.Saliva , urine may be taken to test if there is presence of the Cytomegalovirus.
What are the complications of Cytomegalovirus?
-----------------------------------------------
1.Respiratory distress
2.Mental retardation
3.Hemolytic anemia
4.Blindness
5.Deafness
What is the treatment of Cytomegalovirus?
--------------------------------------------------
There is no effective treatment of Cytomegalovirus at the present moment.
A antiviral drug ganciclovir which is used to treat AIDS may help babies with Cytomegalovirus infection.
A vacine is also being developed for prevention.
What is the prognosis of Cytomegalovirus ?
------------------------------------------
Prognosis for congenital Cytomegalovirus infection is poor.
Adult Cytomegalovirus infection do not have any problem.
What are the Preventive measures taken for Cytomegalovirus ?
------------------------------------------------------------------
There is no vaccine at the present moment for Cytomegalovirus.
Transmission of Cytomegalovirus infection is always preventable because it is transmitted through body fluid from hand,nose and mouth of a suseceptible person.
People who interacts with children and pregnant mothers shuold practice good safe hygiene methods such as washing of hand and wearing of clothes when changing diapers.
Pregnant women are also advised to practice safe hygiene methods and to seek advice in the presence of a mononucleosis-like illness.
Monday, September 22, 2008
A Simple Guide to Polycystic kidney disease
A Simple Guide to Polycystic kidney disease
---------------------------------------------------------
What are Polycystic kidney disease ?
-----------------------------------------------
Polycystic kidney disease is a progressive genetic condition of the kidneys in which multiple cysts (polycystic)are present in both kidneys.
The disease can produce cysts in the liver, pancreas, and rarely, the heart and brain.
Who is at risk of Polycystic kidney disease formation?
------------------------------------------------------------------
Any one with a family history of polycystic kidneys.
What causes Polycystic kidney disease ?
-------------------------------------------------------
There are 2 main causes of polycystic kidney disease.
Both are determined by their genetic inheritance:
1.Autosomal dominant
----------------------
It is generally a late-onset disease with progressive cyst development.
The kidneys are bilaterally enlarged and have multiple cysts.
There may be kidney dysfunction resulting in hypertension and kidney failure by the age of 60 years.
Beside this there are also cysts in other organs such as the liver, spleen, pancreas, and arachnoid mater.
Other abnormalities includes intracranial aneurysms, dissection of the aorta, mitral valve prolapse.
2.Autosomal recessive
-----------------------------
This disease is less common than the above.
Most cases died during the pregnancy or in the first month of birth.
Early manifestations of the disease is apparent at birth or in early infancy.
What are the symptoms of Polycystic kidney disease ?
------------------------------------------------------------
Many Polycystic kidney patients do not have any symptoms.
In some cases there may be:
1.hypertension,
2.Abdominal colic due to urinary stones
3.back or flank pain
4.urinary tract infections with hematuria and proteinuria
5.Palpable large kidneys
6.Abdominal swelling
7.fatigue
The condition eventually ends in chronic renal failure with loss of kidney function.
How are Polycystic kidney disease diagnosed?
---------------------------------------------------------------
1.X-rays of the kidneys on routine checkup
2.Ultrasound of the kidneys
3.MRI of the kidneys
4.genetic testing
Genetic counseling may help families at risk for polycystic kidney disease.
How are Polycystic kidney disease treated?
--------------------------------------------------------
There is no cure for Polycystic kidney disease.
Although a cure for Polycystic kidney disease is not possible, treatment can ease the symptoms and prolong life.
1.Back Pain:
Mild pain killers such as paracetamol can relieve pain.
2.Urinary tract infections:
urinary tract infections can be treated with antibiotics.
Any urinary infection can spread from the urinary tract to the kidney cysts so early treatment is important.
Once the infection enter the cyst, treatment is difficult because many antibiotics cannot enter the walls of the cysts.
3.High blood pressure:
All hypertension cases due to Polycystic kidney disease must be kept under control with medications and lifestyle changes such as exercise, distressing, low salt and fats
4.Renal disease:
Eventually in all cases the kidney function will fail and chronic real failure develop.
Treatment will then be by dialysis or kidney transplant.
5.Surgery:
Surgery is rarely needed except to remove large cysts. Even then the kidney disease is progressive and will still end in chronic renal failure.
What is the prognosis of Polycystic kidney disease?
----------------------------------------------------------
Generally poor after the age of 60 when renal disease may set in.
How to prevent Polycystic kidney disease ?
-----------------------------------------------------------------
There is no prevention for Polycystic kidney disease.
---------------------------------------------------------
What are Polycystic kidney disease ?
-----------------------------------------------
Polycystic kidney disease is a progressive genetic condition of the kidneys in which multiple cysts (polycystic)are present in both kidneys.
The disease can produce cysts in the liver, pancreas, and rarely, the heart and brain.
Who is at risk of Polycystic kidney disease formation?
------------------------------------------------------------------
Any one with a family history of polycystic kidneys.
What causes Polycystic kidney disease ?
-------------------------------------------------------
There are 2 main causes of polycystic kidney disease.
Both are determined by their genetic inheritance:
1.Autosomal dominant
----------------------
It is generally a late-onset disease with progressive cyst development.
The kidneys are bilaterally enlarged and have multiple cysts.
There may be kidney dysfunction resulting in hypertension and kidney failure by the age of 60 years.
Beside this there are also cysts in other organs such as the liver, spleen, pancreas, and arachnoid mater.
Other abnormalities includes intracranial aneurysms, dissection of the aorta, mitral valve prolapse.
2.Autosomal recessive
-----------------------------
This disease is less common than the above.
Most cases died during the pregnancy or in the first month of birth.
Early manifestations of the disease is apparent at birth or in early infancy.
What are the symptoms of Polycystic kidney disease ?
------------------------------------------------------------
Many Polycystic kidney patients do not have any symptoms.
In some cases there may be:
1.hypertension,
2.Abdominal colic due to urinary stones
3.back or flank pain
4.urinary tract infections with hematuria and proteinuria
5.Palpable large kidneys
6.Abdominal swelling
7.fatigue
The condition eventually ends in chronic renal failure with loss of kidney function.
How are Polycystic kidney disease diagnosed?
---------------------------------------------------------------
1.X-rays of the kidneys on routine checkup
2.Ultrasound of the kidneys
3.MRI of the kidneys
4.genetic testing
Genetic counseling may help families at risk for polycystic kidney disease.
How are Polycystic kidney disease treated?
--------------------------------------------------------
There is no cure for Polycystic kidney disease.
Although a cure for Polycystic kidney disease is not possible, treatment can ease the symptoms and prolong life.
1.Back Pain:
Mild pain killers such as paracetamol can relieve pain.
2.Urinary tract infections:
urinary tract infections can be treated with antibiotics.
Any urinary infection can spread from the urinary tract to the kidney cysts so early treatment is important.
Once the infection enter the cyst, treatment is difficult because many antibiotics cannot enter the walls of the cysts.
3.High blood pressure:
All hypertension cases due to Polycystic kidney disease must be kept under control with medications and lifestyle changes such as exercise, distressing, low salt and fats
4.Renal disease:
Eventually in all cases the kidney function will fail and chronic real failure develop.
Treatment will then be by dialysis or kidney transplant.
5.Surgery:
Surgery is rarely needed except to remove large cysts. Even then the kidney disease is progressive and will still end in chronic renal failure.
What is the prognosis of Polycystic kidney disease?
----------------------------------------------------------
Generally poor after the age of 60 when renal disease may set in.
How to prevent Polycystic kidney disease ?
-----------------------------------------------------------------
There is no prevention for Polycystic kidney disease.
Sunday, September 21, 2008
A Simple Guide to Tenosynovitis
A Simple Guide to Tenosynovitis
----------------------------------------------------
What is Tenosynovitis?
-----------------------------------------
Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.
It can occur together with tendinitis(inflammation of the tendons).
It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).
What are the cause of Tenosynovitis?
-----------------------------------------------
The cause of Tenosynovitis is unknown.
Some possible causes are:
1.Injury or trauma to the tendon
2.Repetitive usage of fingers and wrist joints
3.Arthritis of the joints may predispose to tenosynovitis
4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis
5.Tenosynovitis occurs in families, and
6.It is generally seen more often in males than in females
What are the symptoms and signs of Tenosynovitis?
-------------------------------------------------------------------
Symptoms:
--------------
1.Pain on movement of the tendon
2.Swelling of part of the tendon affected
3.Stenosis of the tendon sheath may be present
4.Stiffness of the tendon - inability to stretch
5.Pain is felt most beneath the bone of involved joints
Signs:
1.swelling over the involved tendon
2.Passive stretching of the tendon is painful.
3.There may be local tenderness of the inflamed tendon.
4.The tendons sheaths are usually swollen and thickened
5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)
6.There may be crepitations felt over the tendon as it moves across the sheaths
What is the complications of Tenosynovitis?
-------------------------------------------------
Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.
What is the Treatment of Tenosynovitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1.rest of the tendon
2.Cold or ice may help reduce inflammation
3.Splints over the hand, wrist and elbow may help to rest the tendons
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 affected sheath or tendon nodule may help to reduce inflammation
7.Surgery :
------------------
Surgical opening of the synovial sheath may be necessary for tendon release.
What is the prognosis of Tenosynovitis?
----------------------------------------------------------
Prognosis is usually good although recurrence may occur after cortisone injection.
Surgery usually give excellent results.
----------------------------------------------------
What is Tenosynovitis?
-----------------------------------------
Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.
It can occur together with tendinitis(inflammation of the tendons).
It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).
What are the cause of Tenosynovitis?
-----------------------------------------------
The cause of Tenosynovitis is unknown.
Some possible causes are:
1.Injury or trauma to the tendon
2.Repetitive usage of fingers and wrist joints
3.Arthritis of the joints may predispose to tenosynovitis
4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis
5.Tenosynovitis occurs in families, and
6.It is generally seen more often in males than in females
What are the symptoms and signs of Tenosynovitis?
-------------------------------------------------------------------
Symptoms:
--------------
1.Pain on movement of the tendon
2.Swelling of part of the tendon affected
3.Stenosis of the tendon sheath may be present
4.Stiffness of the tendon - inability to stretch
5.Pain is felt most beneath the bone of involved joints
Signs:
1.swelling over the involved tendon
2.Passive stretching of the tendon is painful.
3.There may be local tenderness of the inflamed tendon.
4.The tendons sheaths are usually swollen and thickened
5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)
6.There may be crepitations felt over the tendon as it moves across the sheaths
What is the complications of Tenosynovitis?
-------------------------------------------------
Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.
What is the Treatment of Tenosynovitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1.rest of the tendon
2.Cold or ice may help reduce inflammation
3.Splints over the hand, wrist and elbow may help to rest the tendons
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 affected sheath or tendon nodule may help to reduce inflammation
7.Surgery :
------------------
Surgical opening of the synovial sheath may be necessary for tendon release.
What is the prognosis of Tenosynovitis?
----------------------------------------------------------
Prognosis is usually good although recurrence may occur after cortisone injection.
Surgery usually give excellent results.
Saturday, September 20, 2008
A Simple Guide to Ovarian torsion
A Simple Guide to Ovarian torsion
----------------------------------------------------
What is a Ovarian torsion?
---------------------------------------
Ovarian torsion is the twisting of the Ovary either spontaneously or due to another medical condition.
Ovarian torsion occurs usually in only one Ovary at a time.
Both normal or enlarged ovaries can be affected.
Rarely both ovaries may be affected.
It is a medical emergency as gangrene of Ovary may occur.
Who is at risk of Ovarian torsion?
----------------------------------------
Women of all ages can develop this rare condition.
Most cases occur in women under 30 years old.
One fifth of all cases occur in pregnant women.
What is the Cause of Ovarian torsion?
-----------------------------------------------------
Ovarian torsion is caused by
1.congenital and developmental abnormalities
Longer than normal tubes or a missing mesosalpinx will cause ovarian torsion.
2.disease that affects the tube or Ovary resulting in the twisting of the ovarian axis.
a.Spasms or changes in the blood vessels in the mesosalpinx can cause the blood vessels to the ovaries to be congested resulting in torsion of the ovaries.
b.Ovarian cysts or fibromas,
c.tumor of the Ovaries or tubes,
d.Injury to either the ovaries or the tubes
What are the Symptoms and signs of Ovarian torsion?
-----------------------------------------------------------
Symptoms :
--------------
1.sudden onset of extreme lower abdominal pain that radiates to the back, side and thigh.
2.Nausea, vomiting,
3.diarrhea, or constipation
4.fever
5.tachycardia.
Signs:
-------------
1.tenderness of the lower abdomen
2.tenderness of the Ovarian region on vaginal palpation
How do you make the Diagnosis of Ovarian torsion?
------------------------------------------------------------
1.suddenness of lower abdominal pain.
2.pregnancy test.
3. ultrasound and CT scan (computed tomography) can help to visualise the ovarian structures
4.laparoscopy.
What are the complications of Ovarian torsion?
---------------------------------------------------
Damage to the Ovary with gangrene formation due to loss of blood flow.
What is the treatment of Ovarian torsion?
---------------------------------------------------
Surgical repair of the ovarian torsion must done urgently.
For less severe cases laparoscopic surgery can release the torsion
Pain killers such as NSAIDs are given to control pain.
What is the prognosis of Ovarian torsion?
-----------------------------------------
The prognosis is usually good if the ovarian trosion is detected early and treated.
If however the treatment is delayed there is a danger of arterial blood flow into and venous blood flow out of the Ovarian may be compromised resulting in necrosis (death) of the ovarian tissue.
Infertility may be a result of ovarian torsion.
----------------------------------------------------
What is a Ovarian torsion?
---------------------------------------
Ovarian torsion is the twisting of the Ovary either spontaneously or due to another medical condition.
Ovarian torsion occurs usually in only one Ovary at a time.
Both normal or enlarged ovaries can be affected.
Rarely both ovaries may be affected.
It is a medical emergency as gangrene of Ovary may occur.
Who is at risk of Ovarian torsion?
----------------------------------------
Women of all ages can develop this rare condition.
Most cases occur in women under 30 years old.
One fifth of all cases occur in pregnant women.
What is the Cause of Ovarian torsion?
-----------------------------------------------------
Ovarian torsion is caused by
1.congenital and developmental abnormalities
Longer than normal tubes or a missing mesosalpinx will cause ovarian torsion.
2.disease that affects the tube or Ovary resulting in the twisting of the ovarian axis.
a.Spasms or changes in the blood vessels in the mesosalpinx can cause the blood vessels to the ovaries to be congested resulting in torsion of the ovaries.
b.Ovarian cysts or fibromas,
c.tumor of the Ovaries or tubes,
d.Injury to either the ovaries or the tubes
What are the Symptoms and signs of Ovarian torsion?
-----------------------------------------------------------
Symptoms :
--------------
1.sudden onset of extreme lower abdominal pain that radiates to the back, side and thigh.
2.Nausea, vomiting,
3.diarrhea, or constipation
4.fever
5.tachycardia.
Signs:
-------------
1.tenderness of the lower abdomen
2.tenderness of the Ovarian region on vaginal palpation
How do you make the Diagnosis of Ovarian torsion?
------------------------------------------------------------
1.suddenness of lower abdominal pain.
2.pregnancy test.
3. ultrasound and CT scan (computed tomography) can help to visualise the ovarian structures
4.laparoscopy.
What are the complications of Ovarian torsion?
---------------------------------------------------
Damage to the Ovary with gangrene formation due to loss of blood flow.
What is the treatment of Ovarian torsion?
---------------------------------------------------
Surgical repair of the ovarian torsion must done urgently.
For less severe cases laparoscopic surgery can release the torsion
Pain killers such as NSAIDs are given to control pain.
What is the prognosis of Ovarian torsion?
-----------------------------------------
The prognosis is usually good if the ovarian trosion is detected early and treated.
If however the treatment is delayed there is a danger of arterial blood flow into and venous blood flow out of the Ovarian may be compromised resulting in necrosis (death) of the ovarian tissue.
Infertility may be a result of ovarian torsion.
Friday, September 19, 2008
A Simple Guide to Croup
A Simple Guide to Croup
-----------------------------------
What is Croup?
---------------------------
Croup is an acute viral disease of the upper and lower respiratory tract associated with inspiratory stridor ( whistling obstructive sound during inhalation) and respiratory distress in severe cases.
It typically affects infants and children below 6 years old.
It causes a typically barking type of cough and hoarseness of the voice due to obstruction at the vocal box.
What are the causes of Croup?
----------------------------------------
Viral infections:
--------------------
1.parainfluenza virus, primarily types 1 and 2
2.Other viral infections such as adenorhinovirnese, enterovirus and mycoplasma pneumoniae
Genetic predisposition:
------------------------
Some families are more prone than others to get the disease.
It is also more common in males than females.
What are Signs and symptoms of Croup?
---------------------------------------------
Symptoms:
1.harsh barking cough
2.sneeze
3.inspiratory stridor (a high-pitched whistling sound during inspiration),
4.nausea and vomiting
5.fever.
6.Hoarseness -usually present
7.respiratory distress due to airway obstruction
8.lethargy
Signs:
1.Reduced breath sounds - air movement is reduced in the lungs
2.Prolonged inspiration on auscultation with laryngeal stridor
3.Chest retraction
4.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
How is the diagnosis of Croup made?
------------------------------------------
1.Symptoms and signs of fever, laryngeal stridor and barking cough
2.blood tests (complete blood count, ESR and blood culture)
5.frontal X-ray of the C-spine
the presence of the the steeple sign confirms the diagnosis of croup.
What are the complications of Croup?
-----------------------------------------------
1.Respiratory distress
2.Bacterial tracheitis
What is the treatment of Croup?
------------------------------------
1.Rest, fluids and oxygen
2.Humidifiers and steam inhalations
3.Corticosteroids especially dexamethasone are the most commonly used agent as it reduces inflammation
4.Antibiotics are not useful because the cause is viral. If there is bacterial tracheitis, antibiotics may be needed
5.Bronchodilators such as theophylline, epinephrine, ventolin, bricanyl are all helpful to open the airways
6.Intubation and tracheostomy may be needed in severe cases.
What is the prognosis of Croup ?
------------------------------------------
This depends on the severity and type of infection.
Most cases, if treated early and correctly, recovered completely with return of normal lung function within 7 days.
What are the Preventive measures taken for Croup ?
--------------------------------------------------------
Vaccination against the influenza virus may help.
Thursday, September 18, 2008
A Simple Guide to Obstructive Sleep Apnea
A Simple Guide to Obstructive Sleep Apnea
----------------------------------------------------
What is Obstructive Sleep Apnea?
--------------------------------------
Obstructive Sleep Apnea (OSA) is the absence of respiratory airflow (for 10 seconds or more) during sleep despite respiratory effort due to upper airway obstruction.
Patients with OSA do not have adequate sleep and may have problem staying awake during the day posing problems in their employment during the day and keeping their family awake at night.
What are the causes of Obstructive Sleep Apnea?
-----------------------------------------------------
Obstruction causes:
----------------------------
1.Inadequate muscle tone of the palate, tongue and pharynx leads to airway collapse during inspiration during the deep stage sleep.
2.bulky tissue in the upper respiratory airway(adenoids and tonsillar hypertrophy, cysts and tumors)
3.excessive soft palatial tissue or long uvula
4.receding chin resulting in a backward prolapsing tongue
5.anatomical abnormalities in the nose(deviated nasal septum, hypertrophied inferior turbinates) or congested nasal passages (allergies, sinusitis, nasal polyps)
Systemic disorders:
-------------------------
1.Hypothyroidism
2.Acromegaly
3.Alcohol
4.Sedatives
5.Obesity
What are Signs and symptoms of Obstructive Sleep Apnea?
-------------------------------------------------------------
Symptoms:
1.snoring present in 20% of men and 5% of women at age 30-35 years.
At age 60years or more, 60% of men and 40% of women snore habitually
2.unrefreshed sleep
3.daytime sleepiness
4.poor concentration
5.forgetfulness
6.morning headaches
7.dryness of mouth in the morning
8.irritability
9.depression
10.sexual dysfunction
Signs:
1.Enlarged nasal turbinates, polyps , and nasal blockage
2.Enlarged tonsils and adenoids
3.Long uvula
4.large protruding tongue
How is the diagnosis of Obstructive Sleep Apnea made?
--------------------------------------------------------------
A.Symptoms of snoring, nasal congestion and inadequate sleep
B.observation of airway obstruction during sleep
C.Sleep study using monitoring devices such as
1.electroencephalogram(EEG)- brain waves
2 electro-oculogram(EOG) - ocular or eye muscle movement
3.Electro-myogram (EMG) - chin and leg movement
4.Electrocardiogram(ECG) - electrical activity of the heart
5.Blood oxygen studies
6.Body position
7.Nasal and oral airflow
8.Thoracic movement
9.abdominal movement
10.Snoring sounds
What are the complications of Obstructive Sleep Apnea?
-----------------------------------------------
1.higher risk of hypertension
2.cardiovascular disease
3.Congestive heart failure
4.cardiac arrhythmias
5.cerebrovascular accidents
What is the treatment of Obstructive Sleep Apnea?
------------------------------------
Non Surgical treatment:
--------------------------
1.Continuous Positive Airway Pressure(CPAP)
CPAP administered by mask through the nose is the single most effective and least invasive treatment for OSA.
It can improve all the bad effects of OSA.
2.Oral appliances which pushes the mandible forward and prevent it from falling open during sleep
3.Nasal Congestion treatment:
Patients with nasal congestion and blockage should be treated with antihistamine and decongestant
4. Weight reduction:
Any obese patients should have at least 10% of his weight reduced over a 6 months period
Surgical Treatments:
--------------------------
1.Surgery on the upper pharyngeal airway (uvula and palate)
a.Radiofrequency reduction is indicated in simple snorer or mild OSA.
b.Uvulopalatopharyngeal (UPPP) surgery includes uvulectomy, palatal releasing and shortening incisions.
2.Surgery of the Tongue base:
Radiofrequency reduction is done for mild cases.
Advancement of the tongue, hyoid suspension is done under general anesthesia. All these enlarge the posterior airway space.
3.Maxillomandibular Advancement:
This is the most effective surgical procedure for treatment of OSA.
It causes enlargement of the pharyngeal and hypopharyngeal airway by physically expanding the skeletal framework.
What is the prognosis of Obstructive Sleep Apnea ?
--------------------------------------------------------
This depends on the severity of the condition but is generally good.
What are the Preventive measures taken for Obstructive Sleep Apnea ?
---------------------------------------------------------------------
1.Lose weight in obese individual with OSA
2.Healthy lifestyle with balanced diet and exercise.
3.Neck elevation
4.Avoid alcohol
----------------------------------------------------
What is Obstructive Sleep Apnea?
--------------------------------------
Obstructive Sleep Apnea (OSA) is the absence of respiratory airflow (for 10 seconds or more) during sleep despite respiratory effort due to upper airway obstruction.
Patients with OSA do not have adequate sleep and may have problem staying awake during the day posing problems in their employment during the day and keeping their family awake at night.
What are the causes of Obstructive Sleep Apnea?
-----------------------------------------------------
Obstruction causes:
----------------------------
1.Inadequate muscle tone of the palate, tongue and pharynx leads to airway collapse during inspiration during the deep stage sleep.
2.bulky tissue in the upper respiratory airway(adenoids and tonsillar hypertrophy, cysts and tumors)
3.excessive soft palatial tissue or long uvula
4.receding chin resulting in a backward prolapsing tongue
5.anatomical abnormalities in the nose(deviated nasal septum, hypertrophied inferior turbinates) or congested nasal passages (allergies, sinusitis, nasal polyps)
Systemic disorders:
-------------------------
1.Hypothyroidism
2.Acromegaly
3.Alcohol
4.Sedatives
5.Obesity
What are Signs and symptoms of Obstructive Sleep Apnea?
-------------------------------------------------------------
Symptoms:
1.snoring present in 20% of men and 5% of women at age 30-35 years.
At age 60years or more, 60% of men and 40% of women snore habitually
2.unrefreshed sleep
3.daytime sleepiness
4.poor concentration
5.forgetfulness
6.morning headaches
7.dryness of mouth in the morning
8.irritability
9.depression
10.sexual dysfunction
Signs:
1.Enlarged nasal turbinates, polyps , and nasal blockage
2.Enlarged tonsils and adenoids
3.Long uvula
4.large protruding tongue
How is the diagnosis of Obstructive Sleep Apnea made?
--------------------------------------------------------------
A.Symptoms of snoring, nasal congestion and inadequate sleep
B.observation of airway obstruction during sleep
C.Sleep study using monitoring devices such as
1.electroencephalogram(EEG)- brain waves
2 electro-oculogram(EOG) - ocular or eye muscle movement
3.Electro-myogram (EMG) - chin and leg movement
4.Electrocardiogram(ECG) - electrical activity of the heart
5.Blood oxygen studies
6.Body position
7.Nasal and oral airflow
8.Thoracic movement
9.abdominal movement
10.Snoring sounds
What are the complications of Obstructive Sleep Apnea?
-----------------------------------------------
1.higher risk of hypertension
2.cardiovascular disease
3.Congestive heart failure
4.cardiac arrhythmias
5.cerebrovascular accidents
What is the treatment of Obstructive Sleep Apnea?
------------------------------------
Non Surgical treatment:
--------------------------
1.Continuous Positive Airway Pressure(CPAP)
CPAP administered by mask through the nose is the single most effective and least invasive treatment for OSA.
It can improve all the bad effects of OSA.
2.Oral appliances which pushes the mandible forward and prevent it from falling open during sleep
3.Nasal Congestion treatment:
Patients with nasal congestion and blockage should be treated with antihistamine and decongestant
4. Weight reduction:
Any obese patients should have at least 10% of his weight reduced over a 6 months period
Surgical Treatments:
--------------------------
1.Surgery on the upper pharyngeal airway (uvula and palate)
a.Radiofrequency reduction is indicated in simple snorer or mild OSA.
b.Uvulopalatopharyngeal (UPPP) surgery includes uvulectomy, palatal releasing and shortening incisions.
2.Surgery of the Tongue base:
Radiofrequency reduction is done for mild cases.
Advancement of the tongue, hyoid suspension is done under general anesthesia. All these enlarge the posterior airway space.
3.Maxillomandibular Advancement:
This is the most effective surgical procedure for treatment of OSA.
It causes enlargement of the pharyngeal and hypopharyngeal airway by physically expanding the skeletal framework.
What is the prognosis of Obstructive Sleep Apnea ?
--------------------------------------------------------
This depends on the severity of the condition but is generally good.
What are the Preventive measures taken for Obstructive Sleep Apnea ?
---------------------------------------------------------------------
1.Lose weight in obese individual with OSA
2.Healthy lifestyle with balanced diet and exercise.
3.Neck elevation
4.Avoid alcohol
Wednesday, September 17, 2008
A Simple Guide to Cervicitis
A Simple Guide to Cervicitis
----------------------------------------------------
What is Cervicitis?
---------------------------------------
Cervicitis is non-specific infection of the cervix.
It is most common on the posterior cervix but may be anterior or concentric.
Who is affected by Cervicitis?
---------------------------------------------------
1.Congeital cervical erosions or cervicitis can occur in virgins.
2.sexually active females
3.dilatation in labor or during abortion
What are the types of Cervicitis?
-------------------------------------------
1.Simple:
Erosion surface is smooth
2.Papillary:
Erosion surface is rough
3.Follicular:
Erosion surface is cystic
What are the Causes of Cervicitis?
-----------------------------------------------------
Bacterial infections:
---------------------------
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
--------------------------
1.Genital herpes
2.Human Papilloma Virus
Other causes:
--------------------
1.Cervical cap
2.Device to support the uterus (pessary)
3.Diaphragm
4.allergy to spermicides
5.Exposure to a chemical
What are the complications of Cervicitis?
---------------------------------------------------
1.Pelvic inflammatory disease
2.Urethritis and cystitis
3.rarely malignant changes in cervix
4.inguinal lymphadenitis
5.Cervical cancer
What are the Symptoms and signs of Cervicitis?
-----------------------------------------------------------
1.Mucopurulent vaginal discharge (Gray, white, or yellow color) with odor
2.Blood in the vaginal discharge
a.After intercourse
b.After menopause
c.Between periods
3.Urinary infection symptoms - frequency and pain
3.hematuria (blood in the urine)
4.Pelvic pain
5.Backache
6.Painful sexual intercourse
7.Pain in the vagina
8.Pressure or heaviness in the pelvis
Signs:
1.reddened area of cervix
2.erosion of cervical wall
3.Vaginal surface of cervix may be affected
4.pus discharge from the cervix
5.Swelling (inflammation) of the walls of the vagina
How is diagnosis of Cervicitis made?
-----------------------------------------------
1.Vaginal examination with Pap's smear of cervical cells
2.Cervical swab for culture and sensitivity to antibiotics
3.Blood tests( white cell count , blood culture, chlamydia, gonorrhea)
4.Biopsy of cervical erosions.
What is the treatment of Cervicitis?
---------------------------------------------------
1. Antibiotics is given according to the sensitivity of bacteria in the culture.
2.Pelvic pain and backache may be treated with paracetamol
3.Local application of sulphonamide, tetracycline or other antibiotic cream to affected cervical area
4.Electro-Cauterisation of the affected cervical area
5.Cryosurgery of cervical erosions
6.Cone biopsy if necessary of affected cervix area.
7.Hormonal therapy (especially in postmenopausal women)
8.Laser therapy of cervical erosions
What is the prognosis of Cervicitis?
-------------------------------------------------------------
Prognosis with appropriate treatment and antibiotics is generally good.
Recurrence is common.
Cervicitis may last for months to years.
Cervicitis may lead to pain with intercourse (dyspareunia).
What are Preventive measures for Cervicitis?
-------------------------------------------------------------------
Avoid sexual intercourse with multiple partners.
Use condoms during sexual intercourse.
Vaccination against human papilloma virus
Avoid chemical irritants such as douches and deodorant tampons.
Avoid using spermicidal contraceptives
Make sure that any foreign objects that inserted into the vagina is clean or sterile
----------------------------------------------------
What is Cervicitis?
---------------------------------------
Cervicitis is non-specific infection of the cervix.
It is most common on the posterior cervix but may be anterior or concentric.
Who is affected by Cervicitis?
---------------------------------------------------
1.Congeital cervical erosions or cervicitis can occur in virgins.
2.sexually active females
3.dilatation in labor or during abortion
What are the types of Cervicitis?
-------------------------------------------
1.Simple:
Erosion surface is smooth
2.Papillary:
Erosion surface is rough
3.Follicular:
Erosion surface is cystic
What are the Causes of Cervicitis?
-----------------------------------------------------
Bacterial infections:
---------------------------
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
--------------------------
1.Genital herpes
2.Human Papilloma Virus
Other causes:
--------------------
1.Cervical cap
2.Device to support the uterus (pessary)
3.Diaphragm
4.allergy to spermicides
5.Exposure to a chemical
What are the complications of Cervicitis?
---------------------------------------------------
1.Pelvic inflammatory disease
2.Urethritis and cystitis
3.rarely malignant changes in cervix
4.inguinal lymphadenitis
5.Cervical cancer
What are the Symptoms and signs of Cervicitis?
-----------------------------------------------------------
1.Mucopurulent vaginal discharge (Gray, white, or yellow color) with odor
2.Blood in the vaginal discharge
a.After intercourse
b.After menopause
c.Between periods
3.Urinary infection symptoms - frequency and pain
3.hematuria (blood in the urine)
4.Pelvic pain
5.Backache
6.Painful sexual intercourse
7.Pain in the vagina
8.Pressure or heaviness in the pelvis
Signs:
1.reddened area of cervix
2.erosion of cervical wall
3.Vaginal surface of cervix may be affected
4.pus discharge from the cervix
5.Swelling (inflammation) of the walls of the vagina
How is diagnosis of Cervicitis made?
-----------------------------------------------
1.Vaginal examination with Pap's smear of cervical cells
2.Cervical swab for culture and sensitivity to antibiotics
3.Blood tests( white cell count , blood culture, chlamydia, gonorrhea)
4.Biopsy of cervical erosions.
What is the treatment of Cervicitis?
---------------------------------------------------
1. Antibiotics is given according to the sensitivity of bacteria in the culture.
2.Pelvic pain and backache may be treated with paracetamol
3.Local application of sulphonamide, tetracycline or other antibiotic cream to affected cervical area
4.Electro-Cauterisation of the affected cervical area
5.Cryosurgery of cervical erosions
6.Cone biopsy if necessary of affected cervix area.
7.Hormonal therapy (especially in postmenopausal women)
8.Laser therapy of cervical erosions
What is the prognosis of Cervicitis?
-------------------------------------------------------------
Prognosis with appropriate treatment and antibiotics is generally good.
Recurrence is common.
Cervicitis may last for months to years.
Cervicitis may lead to pain with intercourse (dyspareunia).
What are Preventive measures for Cervicitis?
-------------------------------------------------------------------
Avoid sexual intercourse with multiple partners.
Use condoms during sexual intercourse.
Vaccination against human papilloma virus
Avoid chemical irritants such as douches and deodorant tampons.
Avoid using spermicidal contraceptives
Make sure that any foreign objects that inserted into the vagina is clean or sterile
Tuesday, September 16, 2008
A Simple Guide to Epididymitis and Orchitis
A Simple Guide to Epididymitis and Orchitis
----------------------------------------------------
What is Epididymitis and Orchitis?
---------------------------------------
Epididymitis and orchitis is acute bacterial or viral infection of the epididymis and testis.
The epididymis is the small organ on top of the testis.
Who is affected by Epididymitis and Orchitis?
---------------------------------------------------
1.childhood, usually related to mumps infection
2.sexually active males
3.Epididymitis is more common than Orchitis
What are the Causes of Epididymitis and Orchitis?
-----------------------------------------------------
Bacterial infections:
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.mumps in childhood
2.measles
What are the complications of Epididymitis and Orchitis?
---------------------------------------------------
1.Orchitis or infection of the testis following epididymitis
2.Abscess formation of the epididymis
3.gangrene of the testis if blood flow is affected.
4.inguinal lymphadenitis
What are the Symptoms and signs of Epididymitis and Orchitis?
-----------------------------------------------------------
1.Pain in scrotum
2.ejaculation of blood
3.hematuria (blood in the urine)
4.Fever
Signs:
1.Scrotal swelling
2.Induration of scrotum wall
3.tenderness of epididymis
4.tenderness of the testis if orchitis is present
How is diagnosis of Epididymitis and Orchitis made?
-----------------------------------------------
1.pain and tenderness of the epididymis and testis
2.Mid stream urine for culture
3.Blood tests( white cell count , blood culture)
4.Ultrasound of the testis
What is the treatment of Epididymitis and Orchitis?
---------------------------------------------------
Acute Epididymitis and Orchitis
1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.
2.Fever and pain may be treated with paracetamol
3.Scrotal support
4.Ice packs for scrotum
5.Bed rest and Fluids
6.Surgical drainage if there is abscess formation.
What is the prognosis of Epididymitis and Orchitis?
-------------------------------------------------------------
Prognosis with appropriate treatment and antibiotics is generally good.
There is a risk of sterility and decreased male hormone production if treatment is inadequate.
What are Preventive measures for Epididymitis and Orchitis?
-------------------------------------------------------------------
Avoid sexual partners with multiple partners.
Use condoms during sexual intercourse.
----------------------------------------------------
What is Epididymitis and Orchitis?
---------------------------------------
Epididymitis and orchitis is acute bacterial or viral infection of the epididymis and testis.
The epididymis is the small organ on top of the testis.
Who is affected by Epididymitis and Orchitis?
---------------------------------------------------
1.childhood, usually related to mumps infection
2.sexually active males
3.Epididymitis is more common than Orchitis
What are the Causes of Epididymitis and Orchitis?
-----------------------------------------------------
Bacterial infections:
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.mumps in childhood
2.measles
What are the complications of Epididymitis and Orchitis?
---------------------------------------------------
1.Orchitis or infection of the testis following epididymitis
2.Abscess formation of the epididymis
3.gangrene of the testis if blood flow is affected.
4.inguinal lymphadenitis
What are the Symptoms and signs of Epididymitis and Orchitis?
-----------------------------------------------------------
1.Pain in scrotum
2.ejaculation of blood
3.hematuria (blood in the urine)
4.Fever
Signs:
1.Scrotal swelling
2.Induration of scrotum wall
3.tenderness of epididymis
4.tenderness of the testis if orchitis is present
How is diagnosis of Epididymitis and Orchitis made?
-----------------------------------------------
1.pain and tenderness of the epididymis and testis
2.Mid stream urine for culture
3.Blood tests( white cell count , blood culture)
4.Ultrasound of the testis
What is the treatment of Epididymitis and Orchitis?
---------------------------------------------------
Acute Epididymitis and Orchitis
1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.
2.Fever and pain may be treated with paracetamol
3.Scrotal support
4.Ice packs for scrotum
5.Bed rest and Fluids
6.Surgical drainage if there is abscess formation.
What is the prognosis of Epididymitis and Orchitis?
-------------------------------------------------------------
Prognosis with appropriate treatment and antibiotics is generally good.
There is a risk of sterility and decreased male hormone production if treatment is inadequate.
What are Preventive measures for Epididymitis and Orchitis?
-------------------------------------------------------------------
Avoid sexual partners with multiple partners.
Use condoms during sexual intercourse.
Monday, September 15, 2008
A Simple Guide to Testicular torsion
A Simple Guide to Testicular torsion
----------------------------------------------------
What is a Testicular torsion?
---------------------------------------
Testicular torsion is the twisting of the testis on its cord either spontaneously or following strenuous activity.
It is a medical emergency as gangrene of testis may occur.
What is the Cause of Testicular torsion?
-----------------------------------------------------
Testicular torsion is caused by
1.incomplete fixation of the epididymis to the testis
2.inadequate attachment of the mesorchium.(testicular body)
3.loose ligaments holding the testis to its cord .
Because of the loose attachment sudden movement of the testis on its cord may cause the testis to be twisted resulting in sudden reduction of blood flow to the testis leading to gangrene of the testis.
What are the Symptoms and signs of Testicular torsion?
-----------------------------------------------------------
Symptoms :
1.Severe pain in the testis
2.nausea and vomiting
3.fever
Signs:
1.scrotal swelling and edema
2.tenderness of the testis on palpation
3.redness and inflammation of the scrotal pouch
4.enlarged scrotal pouch
How do you make the Diagnosis of Testicular torsion?
------------------------------------------------------------
1.Characteristic appearance of the testis
2.Ultrasound examination can detect the obvious torsion
What are the complications of Testicular torsion?
---------------------------------------------------
Damage to the testis with gangrene formation
What is the treatment of Testicular torsion?
---------------------------------------------------
The only treatment is surgical treatment to untangle the torsion and fasten the testis tightly to its attachment.
Removal of the testis (orchidectomy) may be necessary if there is gangrene.
What is the prognosis of Testicular torsion?
----------------------------------------------
The prognosis is usually excellent if treated early.
Gangrenous testis must be removed.
How can Testicular Torsion be prevented?
---------------------------------------------
Avoid strenuous activities
Wear loose underwear
----------------------------------------------------
What is a Testicular torsion?
---------------------------------------
Testicular torsion is the twisting of the testis on its cord either spontaneously or following strenuous activity.
It is a medical emergency as gangrene of testis may occur.
What is the Cause of Testicular torsion?
-----------------------------------------------------
Testicular torsion is caused by
1.incomplete fixation of the epididymis to the testis
2.inadequate attachment of the mesorchium.(testicular body)
3.loose ligaments holding the testis to its cord .
Because of the loose attachment sudden movement of the testis on its cord may cause the testis to be twisted resulting in sudden reduction of blood flow to the testis leading to gangrene of the testis.
What are the Symptoms and signs of Testicular torsion?
-----------------------------------------------------------
Symptoms :
1.Severe pain in the testis
2.nausea and vomiting
3.fever
Signs:
1.scrotal swelling and edema
2.tenderness of the testis on palpation
3.redness and inflammation of the scrotal pouch
4.enlarged scrotal pouch
How do you make the Diagnosis of Testicular torsion?
------------------------------------------------------------
1.Characteristic appearance of the testis
2.Ultrasound examination can detect the obvious torsion
What are the complications of Testicular torsion?
---------------------------------------------------
Damage to the testis with gangrene formation
What is the treatment of Testicular torsion?
---------------------------------------------------
The only treatment is surgical treatment to untangle the torsion and fasten the testis tightly to its attachment.
Removal of the testis (orchidectomy) may be necessary if there is gangrene.
What is the prognosis of Testicular torsion?
----------------------------------------------
The prognosis is usually excellent if treated early.
Gangrenous testis must be removed.
How can Testicular Torsion be prevented?
---------------------------------------------
Avoid strenuous activities
Wear loose underwear
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