DOC I HAVE THYROID NODULES
Thyroid nodules are abnormal swellings in the thyroid gland which occurs when the thyroid tissues starts to proliferate in one part of the thyroid gland.
People who are at risk of thyroid nodule are:
1.Thyroid nodules are more common in females than in male.
2.However the thyroid nodule in males are more prone to malignancy than in females
3.Thyroid nodules occurs more in the 30- 60 age group.
The types of Thyroid Nodules are:
1.solid - solid thyroid nodules which may or not feel hard
2.cystic - the nodules is filled with fluid.
3.benign - non malignant
4.malignant - cancerous
Symptoms and signs of Thyroid Nodules:
In mild cases there is usually no obvious symptoms.
In moderate or severe cases of thyroid nodules:
Symptoms:
1.Obvious swelling in the thyroid gland
2.Neck swelling suggest presence of spread to the lymph node
3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord
4.Dyspnea or breathlessness if there is pressure on the trachea
5.Dysphagia or difficulty in swallowing due to pressure on the esophagus
Signs:
1.Thyroid nodules are felt only if they are more than 1.5 to 2cm in diameter.
2.Cystic nodules may feel hard while solid nodules may be soft to firm.
3. The vocal cords should always be examined to exclude lesions in the vocal cords causing hoarseness.
4.Malignant thyroid nodules present similarly to benign nodules but can spread to other parts of the body.
Diagnosis of Thyroid Nodules are made by:
1.blood test for thyroxine and TSH levels
2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.
The biopsied material is then sent to the lab for tests to look for any malignant cells.
3.ultrasound scans are done to differentiate between solid and cystic nodules,
4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.
5.CT Scan or MRI are not routine to thyroid nodules investigation except where there is suspected compression of teachea.
The Treatment of Thyroid Nodules is:
Benign lumps can be monitored by doctors at regular intervals.
If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.
Patients who has symptoms of hyperthyroidism are advised to go for radioactive iodine treatment or surgery.
The Prognosis of Thyroid Nodules:
Prognosis is good in all benign cases.
Malignant thyroid nodules will depend on any spread to other organs.
Monday, May 9, 2011
Saturday, May 7, 2011
A Family Doctor's Tale - URTICARIA
DOC I HAVE URTICARIA
Urticaria is an itchy rash that occurs rapidly anywhere on the body.
The rash may occur often simultaneously at multiple sites.
It is usually temporary disappearing after 24 hours although new rashes may occur at other sites.
Urticaria is usually due to known mast cell stimulants although in the majority of cases the cause is unknown.
Urticaria is not contagious and for most patients the condition may be managed well with treatment and avoidance of mast cell stimulants:
1. Certain foods: eggs, nuts, fruits,shellfish, fish, chocolates
2. Certain drugs: antibiotics, NSAIDs
3. Physical stimulants: pressure, sweating, cold temperature, sunlight
4. Infections: viral, bacteria
5. Others: flowers, pollen, beestings, animal furs, soaps
The symptoms and signs of Urticaria are:
1.The rash is typically itchy and appear rapidly as localised red swelling on the skin measuring a few mm to more than 10 cm in size in different shapes.
2.The swelling can also occur on eyelids, lips, palms and soles.
3.Urticaria is usually harmless and disappear within a few days or week.
4.However because it can involve very extensive areas of the body, it can cause a lot of irritation and a lot of anxiety.
5.Very rarely the urticaria can lasts months to years causing disruption to work and social life.
In people with Urticaria, the mast cell stimulant can cause histamine release from mast cells.
The histamine is the predominant chemical which is responsible for the inflammatory response which leads to changes of the blood vessels of the skin.
This leads to more blood flow to the affected skin and excessive fluid moving into the surrounding tissues , causing itching and swelling.
Treatment of Urticaria:
1.One of the most important part of treatment is to to try to identify the substance or underlying medical condtion which may cause the Urticaria.
2.Avoidance of the causative substance or treatment of the underlying medical conditions such as infections will lead to the resolution of the urticaria.
3.One of the most important components of an Urticaria treatment routine is to prevent scratching.
4.Cold compresses applied directly to itchy skin can also help relieve itching.
5.Antihistamine tablets will usually relieve the itch and suppress the eruption of the rash.
The antihistamine need to be taken regularly for long as the urticaria is active.
6.If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce itch.
7.Corticosteroid tablets may be prescribed if necessary.
Prevention of Urticaria is by:
1.Find the causative agent and avoid it.
2.Avoid sudden changes in temperature or humidity
3.Avoid sweating or overheating
4.Avoid certain foods (e.g.,eggs, nuts, seafood, chocolates)
5.Avoid harsh soaps, detergents, and solvents
6.Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
Urticaria is an itchy rash that occurs rapidly anywhere on the body.
The rash may occur often simultaneously at multiple sites.
It is usually temporary disappearing after 24 hours although new rashes may occur at other sites.
Urticaria is usually due to known mast cell stimulants although in the majority of cases the cause is unknown.
Urticaria is not contagious and for most patients the condition may be managed well with treatment and avoidance of mast cell stimulants:
1. Certain foods: eggs, nuts, fruits,shellfish, fish, chocolates
2. Certain drugs: antibiotics, NSAIDs
3. Physical stimulants: pressure, sweating, cold temperature, sunlight
4. Infections: viral, bacteria
5. Others: flowers, pollen, beestings, animal furs, soaps
The symptoms and signs of Urticaria are:
1.The rash is typically itchy and appear rapidly as localised red swelling on the skin measuring a few mm to more than 10 cm in size in different shapes.
2.The swelling can also occur on eyelids, lips, palms and soles.
3.Urticaria is usually harmless and disappear within a few days or week.
4.However because it can involve very extensive areas of the body, it can cause a lot of irritation and a lot of anxiety.
5.Very rarely the urticaria can lasts months to years causing disruption to work and social life.
In people with Urticaria, the mast cell stimulant can cause histamine release from mast cells.
The histamine is the predominant chemical which is responsible for the inflammatory response which leads to changes of the blood vessels of the skin.
This leads to more blood flow to the affected skin and excessive fluid moving into the surrounding tissues , causing itching and swelling.
Treatment of Urticaria:
1.One of the most important part of treatment is to to try to identify the substance or underlying medical condtion which may cause the Urticaria.
2.Avoidance of the causative substance or treatment of the underlying medical conditions such as infections will lead to the resolution of the urticaria.
3.One of the most important components of an Urticaria treatment routine is to prevent scratching.
4.Cold compresses applied directly to itchy skin can also help relieve itching.
5.Antihistamine tablets will usually relieve the itch and suppress the eruption of the rash.
The antihistamine need to be taken regularly for long as the urticaria is active.
6.If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce itch.
7.Corticosteroid tablets may be prescribed if necessary.
Prevention of Urticaria is by:
1.Find the causative agent and avoid it.
2.Avoid sudden changes in temperature or humidity
3.Avoid sweating or overheating
4.Avoid certain foods (e.g.,eggs, nuts, seafood, chocolates)
5.Avoid harsh soaps, detergents, and solvents
6.Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
Friday, May 6, 2011
A Family Doctor's Tale - INTUSSUSCEPTION
DOC I HAVE INTUSSUSCEPTION
Intussusception is the telescoping of one part of the intestine into the distal(lower) part of the intestine.
Intussusception is most common in children between 3 months and 1 years of age.
Boys are affected 2 times more than girls.
It seldom occurs in children under 3 months of age or in older children.
It rarely occurs in adults.
The process of intussusception involves a part of intestine (called the intussusceptum) telescopes into a more distal part (called the intussuscipiens) and pulls the accompanying mesentery, vessels, and nerves together into the intussuscipiens.
As a result the compression of the veins and swelling of the region results in blockage of the lumen of the intestine and reduce the blood flow to the affected part of the intestine.
Most cases affect the junction where the small intestine meets the large intestine.
Intussusception because of its obstruction effect on the intestine requires urgent attention and treatment.
The causes of of intussusception are not fully known although some viral and bacterial infections of the intestine may be a possible cause.
In older children and adults possible causes of intussusception may be due to polyps or tumors.
Typical Symptoms of intussusception are:
1.abdominal pain or cramps often with the baby drawing up its knees
when crying
2.vomiting episodes together with the abdominal pain.
The vomiting is not associated with food and may be like bile in
color(yellow-green).
3.bloody and mucous stool(also called black currant jelly stools)may be present
Others symptoms are:
1.paleness,
2.lethargy,
3.fever
4.shock
Intussusception is diagnosed by:
1.history of abdominal pain, vomiting and black currant stools may suggest the diagnosis of intussusception.
2.On examination an abdominal "sausage-shaped" mass (the intussusception itself) can sometimes be felt on palpation of the abdomen.
Diminished bowel sounds may suggest obstruction.
3.abdominal X-rays can show signs of an intestinal obstruction, with air-fluid levels, decreased gas, and unexplained masses, usually seen in the right lower region of the abdomen.
4.Ultrasound and CT scans are not necessary to make the diagnosis.
Early diagnosis and treatment of intussusception is essential in
order to prevent complications such as :
1.injury to the intestine from blockage
2.perforation of the bowel,
3.sepsis
4.death.
The treatment of intussusception may not require surgery.
1.In some cases, the intestinal obstruction can be reversed using a barium enema.
The barium liquid enters the large intestine and pushes its way up to the small intestine. The pressure of the flow of the enema may push the telescoped small intestine out of its receptor and reverse the process of telescoping.
There is a risk of intestinal rupture.
2.If the above procedure is unsuccessful, surgery is necessary to reverse the intussusception and relieve the obstruction.
Any part of the intestine which has become gangrenous must be removed.
Intravenous feeding and fluids after surgery are continued until normal bowel movements returns.
The prognosis for intussusception is usually good with early diagnosis and treatment.
Intussusception is the telescoping of one part of the intestine into the distal(lower) part of the intestine.
Intussusception is most common in children between 3 months and 1 years of age.
Boys are affected 2 times more than girls.
It seldom occurs in children under 3 months of age or in older children.
It rarely occurs in adults.
The process of intussusception involves a part of intestine (called the intussusceptum) telescopes into a more distal part (called the intussuscipiens) and pulls the accompanying mesentery, vessels, and nerves together into the intussuscipiens.
As a result the compression of the veins and swelling of the region results in blockage of the lumen of the intestine and reduce the blood flow to the affected part of the intestine.
Most cases affect the junction where the small intestine meets the large intestine.
Intussusception because of its obstruction effect on the intestine requires urgent attention and treatment.
The causes of of intussusception are not fully known although some viral and bacterial infections of the intestine may be a possible cause.
In older children and adults possible causes of intussusception may be due to polyps or tumors.
Typical Symptoms of intussusception are:
1.abdominal pain or cramps often with the baby drawing up its knees
when crying
2.vomiting episodes together with the abdominal pain.
The vomiting is not associated with food and may be like bile in
color(yellow-green).
3.bloody and mucous stool(also called black currant jelly stools)may be present
Others symptoms are:
1.paleness,
2.lethargy,
3.fever
4.shock
Intussusception is diagnosed by:
1.history of abdominal pain, vomiting and black currant stools may suggest the diagnosis of intussusception.
2.On examination an abdominal "sausage-shaped" mass (the intussusception itself) can sometimes be felt on palpation of the abdomen.
Diminished bowel sounds may suggest obstruction.
3.abdominal X-rays can show signs of an intestinal obstruction, with air-fluid levels, decreased gas, and unexplained masses, usually seen in the right lower region of the abdomen.
4.Ultrasound and CT scans are not necessary to make the diagnosis.
Early diagnosis and treatment of intussusception is essential in
order to prevent complications such as :
1.injury to the intestine from blockage
2.perforation of the bowel,
3.sepsis
4.death.
The treatment of intussusception may not require surgery.
1.In some cases, the intestinal obstruction can be reversed using a barium enema.
The barium liquid enters the large intestine and pushes its way up to the small intestine. The pressure of the flow of the enema may push the telescoped small intestine out of its receptor and reverse the process of telescoping.
There is a risk of intestinal rupture.
2.If the above procedure is unsuccessful, surgery is necessary to reverse the intussusception and relieve the obstruction.
Any part of the intestine which has become gangrenous must be removed.
Intravenous feeding and fluids after surgery are continued until normal bowel movements returns.
The prognosis for intussusception is usually good with early diagnosis and treatment.
Sunday, May 1, 2011
A Family Doctor's Tale - BED SORES
DOC I HAVE BEDSORES
A bed sores is skin which is damaged most commonly by
ischemic necrosis(lack of blood supply leading to breakdown of tissue cells) and ulceration of tissues overlying a bony prominence that has been subjected to prolonged pressure against an external object.
This typically occurs in a incapacitated person lying over a prolonged periods in bed hence the term bed sores.
Blood supply is impaired as a result of constant pressure on the blood vessel resulting in localized gangrene(death of tissue due to lack of blood supply)
The following are considered when determining the severity of the bed sores:
1.Degree of bed sores
2.Extent of the bed sores
3.Age of patient
4.Location of bed sores
5.Other illnesses and injuries
There are 6 stages of a bed sores:
First stage bed sores:
superficial redness of the skin
Second stage bed sores:
The skin is red, hot, swollen with induration. blister formation and desquamation(dropping of skin layer).
There may be some pain
Third stage bed sores:
The full thickness of the skin is damaged with ulceration.
Fouth stage bed sores:
The skin damage extends to the muscle often causing pain because of impingement on the nerve
Fifth stage bed sores:
The necrosis of skin tissue affects the muscles and fat tissue
Sixth stage bed sores:
There is associated bone destruction , bone or joint infection and septicemia(infection of the blood)
Illnesses such as those below can aggravate the severity of the bed soress and affect the healing:
1.Respiratory diseases
2.Diabetes
3.Heart disease
4.Injuries like fractures
Complications of bed sores are:
1.Septicemia or blood infection
2.Cellulitis or abscess formation
Treatment of bed sores:
In the early stage such as redness of the skin, prevention is the best treatment:
1.Encourage regular movement of the body every 2 hours
2.In cases of paralyzed or unconscious patients change position of the patients every 2 hours.
3.apply talcum powder or soothing cream or lotion on the skin
4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.
5.Painkillers may be necessary for pain.
6.Regular inspection of the skin for cleanliness and dryness.
7. Use of water beds, ripple mattress, inflatable rings, protective padding and Stryker frame for those with spinal cord paralysis all help to prevent bed sores.
More severe cases may need to be treated in a hospital:
1.the bed sores gets infected(fever, pus formation and increasing pain, redness and swelling).
2.Appropriate antibiotics to treat infection
3.Hydrophilic beads of dextronomer may be useful to clean oozing lesions and promote granulation and recovery
4.Regular debridement(removal of infected tissues) with enzymatic digestive agents
5.In severe cases surgical debridement and skin grafts may be necessary.
6.Underlying medical illnesses such as diabetes, heart attack and stroke should be treated
Prognosis:
In early stage the prognosis is good with preventive measures.
Once ulcers are formed the prognosis is fair.
A bed sores is skin which is damaged most commonly by
ischemic necrosis(lack of blood supply leading to breakdown of tissue cells) and ulceration of tissues overlying a bony prominence that has been subjected to prolonged pressure against an external object.
This typically occurs in a incapacitated person lying over a prolonged periods in bed hence the term bed sores.
Blood supply is impaired as a result of constant pressure on the blood vessel resulting in localized gangrene(death of tissue due to lack of blood supply)
The following are considered when determining the severity of the bed sores:
1.Degree of bed sores
2.Extent of the bed sores
3.Age of patient
4.Location of bed sores
5.Other illnesses and injuries
There are 6 stages of a bed sores:
First stage bed sores:
superficial redness of the skin
Second stage bed sores:
The skin is red, hot, swollen with induration. blister formation and desquamation(dropping of skin layer).
There may be some pain
Third stage bed sores:
The full thickness of the skin is damaged with ulceration.
Fouth stage bed sores:
The skin damage extends to the muscle often causing pain because of impingement on the nerve
Fifth stage bed sores:
The necrosis of skin tissue affects the muscles and fat tissue
Sixth stage bed sores:
There is associated bone destruction , bone or joint infection and septicemia(infection of the blood)
Illnesses such as those below can aggravate the severity of the bed soress and affect the healing:
1.Respiratory diseases
2.Diabetes
3.Heart disease
4.Injuries like fractures
Complications of bed sores are:
1.Septicemia or blood infection
2.Cellulitis or abscess formation
Treatment of bed sores:
In the early stage such as redness of the skin, prevention is the best treatment:
1.Encourage regular movement of the body every 2 hours
2.In cases of paralyzed or unconscious patients change position of the patients every 2 hours.
3.apply talcum powder or soothing cream or lotion on the skin
4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.
5.Painkillers may be necessary for pain.
6.Regular inspection of the skin for cleanliness and dryness.
7. Use of water beds, ripple mattress, inflatable rings, protective padding and Stryker frame for those with spinal cord paralysis all help to prevent bed sores.
More severe cases may need to be treated in a hospital:
1.the bed sores gets infected(fever, pus formation and increasing pain, redness and swelling).
2.Appropriate antibiotics to treat infection
3.Hydrophilic beads of dextronomer may be useful to clean oozing lesions and promote granulation and recovery
4.Regular debridement(removal of infected tissues) with enzymatic digestive agents
5.In severe cases surgical debridement and skin grafts may be necessary.
6.Underlying medical illnesses such as diabetes, heart attack and stroke should be treated
Prognosis:
In early stage the prognosis is good with preventive measures.
Once ulcers are formed the prognosis is fair.
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