A Simple Guide to Trigeminal Neuralgia
-----------------------------------------------
What is Trigeminal Neuralgia?
--------------------------------------
Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.
It is a rare codition affecting more women than men.
It is more common at the age of 60 years and above.
What are the causes of Trigeminal Neuralgia?
----------------------------------------------------
Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)
2.Trauma- injury to the trigeminal nerve
3.Tumours- compressing the trigeminal nerve
4.Infections-meningeal inflammation of the trigeminal nerve
5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.
6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.
What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------
Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.
There may be recurrent stabs of pain or spontaneous exacerbations of pain.
It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).
Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.
Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.
Pain is unilateral (rarely bilateral).
Pain may occur several times a day.
It rarely occurs at night.
There are certain triggers which can spark off an attack:
-----------------------------------------------------------
Light touch at the trigger zone such as the lips is the most provocative.
Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing
Pain causes brief muscle spasm of the facial muscles, inducing the tic.
Signs:
---------
Physical examination findings are normal.
A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.
A careful examination of the cranial nerves must be done, including the corneal reflex.
Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.
What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------
1.Blood for infections such as meningitis,
2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.
What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------
Medications:
----------------
1.Carbamazepine is the most effective medical treatment.
2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.
3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.
4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.
They can depress the sensitivity of the nerve and relax the muscle.
Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.
Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.
2.anesthetic blocks of the trigeminal ganglion.
3.decompression of trigeminal root entry of impinging vascular structures.
4.Surgical division of the affected branch of the nerve.
What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------
80% of patients respond well to carbamazepine but recurrences and exacerbations are common.
Surgery is usually effective but may leave permanent neurological deficit.
Trigeminal Neuralgia is not life threatening.
Friday, July 11, 2008
Wednesday, July 9, 2008
A Simple Guide to Facial Palsy
A Simple Guide to Facial Palsy
-----------------------------------------
What is Facial Palsy?
----------------------------------
Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.
It is usually temporary.
What are the causes of Facial Palsy?
------------------------------------------------
Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:
Supranuclear(within the Brain)
1.Cerebral vascular lesions
2.Cerebral tumours
Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.
2.Trauma- Birth injury,fractured temporal bone, surgery of the ear
3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease
5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,
6.Multiple sclerosis
What are the symptoms and signs of Facial Palsy?
------------------------------------------------------------
The onset of facial palsy is usually very sudden.
The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.
Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations
2.Depressed taste ( lesion above chorda tympani)
3.hyperacusis ( lesion above nerve to stapedius)
Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.
2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.
3.dribbling of saliva
4.difficulty in speaking
5.loss of taste at the front of the tongue
6.dryness or watering of the affected eye
7.eyeball rolled up and inward on attempted closure of affected eye
8.ectropion or turned out lower eyelid
9.sharp hearing on the affected side
10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.
What are the investigations required in Facial Palsy?
-----------------------------------------------------------
1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)
b.test closing of the eye - to test weakness of eyelid muscles
c.ask patient to smile - to check for weakness of the cheek muscles
2.Investigations:
a.Blood for infections, HIV, Lyme's disease
b.MRI of brain to exclude tumours
c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Facial Palsy?
-----------------------------------------------------
1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.
The steroid usually reduce swelling of the nerve.
2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus
3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.
Use artificial eyedrops during the day to keep the eye moist.
Tape the eye at night to keep it closed.
4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.
5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.
Plastic surgery may improve permanent facial drooping
What is the prognosis of Facial Palsy?
----------------------------------------
80-90% of patient with facial palsy recover spontaneously and completely within three weeks.
The remainder usually takes up to six months to recover.
Very rarely do you get permanent paralysis of the facial nerve.
-----------------------------------------
What is Facial Palsy?
----------------------------------
Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.
It is usually temporary.
What are the causes of Facial Palsy?
------------------------------------------------
Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:
Supranuclear(within the Brain)
1.Cerebral vascular lesions
2.Cerebral tumours
Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.
2.Trauma- Birth injury,fractured temporal bone, surgery of the ear
3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease
5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,
6.Multiple sclerosis
What are the symptoms and signs of Facial Palsy?
------------------------------------------------------------
The onset of facial palsy is usually very sudden.
The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.
Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations
2.Depressed taste ( lesion above chorda tympani)
3.hyperacusis ( lesion above nerve to stapedius)
Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.
2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.
3.dribbling of saliva
4.difficulty in speaking
5.loss of taste at the front of the tongue
6.dryness or watering of the affected eye
7.eyeball rolled up and inward on attempted closure of affected eye
8.ectropion or turned out lower eyelid
9.sharp hearing on the affected side
10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.
What are the investigations required in Facial Palsy?
-----------------------------------------------------------
1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)
b.test closing of the eye - to test weakness of eyelid muscles
c.ask patient to smile - to check for weakness of the cheek muscles
2.Investigations:
a.Blood for infections, HIV, Lyme's disease
b.MRI of brain to exclude tumours
c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Facial Palsy?
-----------------------------------------------------
1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.
The steroid usually reduce swelling of the nerve.
2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus
3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.
Use artificial eyedrops during the day to keep the eye moist.
Tape the eye at night to keep it closed.
4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.
5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.
Plastic surgery may improve permanent facial drooping
What is the prognosis of Facial Palsy?
----------------------------------------
80-90% of patient with facial palsy recover spontaneously and completely within three weeks.
The remainder usually takes up to six months to recover.
Very rarely do you get permanent paralysis of the facial nerve.
Sunday, July 6, 2008
A Simple Guide to Adenoiditis
A Simple Guide to Adenoiditis
----------------------------------------------
What is Adenoiditis?
-------------------------------
Adenoiditis is inflammation (swelling) of the Adenoids.
The adenoids are lymph nodes in the back of the nose and above the throat.
They normally help to filter out bacteria and other microorganisms to prevent infection in the nose and throat area.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing Adenoiditis.
Enlarged adenoids can cause blockage of the eustachian tubes and posterior openings of the nose.
What causes Adenoiditis?
-------------------------------
1.Viral or bacterial infections
---------------------------------
Bacteria cause 15-30 percent of Adenoiditis cases.
Streptococcus pyogenes is the most common bacteria causing acute Adenoiditis.
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute Adenoiditis.
2.low immunity factors
-----------------------
Unbalanced or insufficient food diet,
Unhygienic lifestyle
Inadequate rest or sleep
3. Allergy
---------------
dustmites,
pollens
Who gets Adenoiditis?
---------------------
Adenoiditis most often occurs in children but rarely occurs in children younger than two years.
It is occasionally found in young adults.
What are the symptoms of Adenoiditis?
-------------------------------------
The Symptoms of Adenoiditis are:
1,Blocked nose
2.mouth breathing
3.nasal speech
4.rhinorhoea(runny nose)
5.Snoring at night
6.Ear blockage(eustachian tube blockage)
7.Ear pain(otitis media)
8.Pain in the cheeks(maxillary sinusitis) or above the eye(frontal sinusitis)
9.Headache
10.Fever, chills
11.Lethargy and malaise are common.
These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.
What are the signs of Adenoiditis?
---------------------------------
An ear nose and throat specialist will be able to put a endoscope through the nasal passage to see the enlarged and inflamed adenoids.
What are the Complications of Adenoiditis?
------------------------------------------
1.Complications of untreated streptococcus Adenoiditis with tonsillitis may be severe:
Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure
2.Ear pain from otitis media
3.Blocked airway from enlarged Adenoids
What is the treatment of Adenoiditis?
------------------------------------
1.If the cause of the Adenoiditis is bacteria such as streptococcus, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2.Rest to allow the body to heal.
3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the nose and throat.
4.Hospitalization may be required in severe cases, particularly when there is airway obstruction.
5.When the condition is chronic or recurrent, a surgical procedure to remove the Adenoids(Adenoidectomy) is often recommended.
What is the Prognosis of Adenoiditis?
------------------------------------
Adenoiditis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
Adenoidectomy may be recommended if Adenoiditis is severe, recurrent, or does not respond to antibiotics.
----------------------------------------------
What is Adenoiditis?
-------------------------------
Adenoiditis is inflammation (swelling) of the Adenoids.
The adenoids are lymph nodes in the back of the nose and above the throat.
They normally help to filter out bacteria and other microorganisms to prevent infection in the nose and throat area.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing Adenoiditis.
Enlarged adenoids can cause blockage of the eustachian tubes and posterior openings of the nose.
What causes Adenoiditis?
-------------------------------
1.Viral or bacterial infections
---------------------------------
Bacteria cause 15-30 percent of Adenoiditis cases.
Streptococcus pyogenes is the most common bacteria causing acute Adenoiditis.
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute Adenoiditis.
2.low immunity factors
-----------------------
Unbalanced or insufficient food diet,
Unhygienic lifestyle
Inadequate rest or sleep
3. Allergy
---------------
dustmites,
pollens
Who gets Adenoiditis?
---------------------
Adenoiditis most often occurs in children but rarely occurs in children younger than two years.
It is occasionally found in young adults.
What are the symptoms of Adenoiditis?
-------------------------------------
The Symptoms of Adenoiditis are:
1,Blocked nose
2.mouth breathing
3.nasal speech
4.rhinorhoea(runny nose)
5.Snoring at night
6.Ear blockage(eustachian tube blockage)
7.Ear pain(otitis media)
8.Pain in the cheeks(maxillary sinusitis) or above the eye(frontal sinusitis)
9.Headache
10.Fever, chills
11.Lethargy and malaise are common.
These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.
What are the signs of Adenoiditis?
---------------------------------
An ear nose and throat specialist will be able to put a endoscope through the nasal passage to see the enlarged and inflamed adenoids.
What are the Complications of Adenoiditis?
------------------------------------------
1.Complications of untreated streptococcus Adenoiditis with tonsillitis may be severe:
Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure
2.Ear pain from otitis media
3.Blocked airway from enlarged Adenoids
What is the treatment of Adenoiditis?
------------------------------------
1.If the cause of the Adenoiditis is bacteria such as streptococcus, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2.Rest to allow the body to heal.
3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the nose and throat.
4.Hospitalization may be required in severe cases, particularly when there is airway obstruction.
5.When the condition is chronic or recurrent, a surgical procedure to remove the Adenoids(Adenoidectomy) is often recommended.
What is the Prognosis of Adenoiditis?
------------------------------------
Adenoiditis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
Adenoidectomy may be recommended if Adenoiditis is severe, recurrent, or does not respond to antibiotics.
Thursday, July 3, 2008
A Simple Guide to Amenorrhea
A Simple Guide to Amenorrhea
---------------------------------
What is Amenorrhea?
--------------------------
Amenorrhea is a symptom defined as absence of menstruation.
What are the types of Amenorrhea?
------------------------------------
1.Primary Amenorrhea
----------------------
is defined as the absence of onset of menstruation (menarche) in a girl who has reached the age of 18 years.
2.Secondary Amenorrhea
-----------------------
is defined as the absence of menstruation for a peroid of at least 6 months in a girl who has previously experienced normal menstruation and is not pregnant.
What are the causes of Amenorrhea?
-------------------------------------
1.Physiological(hormonal):
------------------------------
pregnancy hormones - pregnancy is the still the most common cause of secondary amenorrhea.
Growth hormone deficiency
Abnormal production of testosterone
2.Genetic Causes:
------------------
abnormal formation of genital tract causing cryptomenorrhea -obstruction to the flow of menstrual blood such as imperforate hymen
Chromosonal abnormalities:
Turner syndrome
Ovarian agenesis
3.Uterine Pathology:
------------------------
adhesions from previous operation
endometriosis
tuberculosis infection
radiation
4.Ovarian:
------------------
Agenesis(no ovaries)
Abnormal ovaries(again congenital)
Polycystic Ovaries
Granulosa-thca tumours of ovaries
radiation of ovaries
5.Pituitary:
----------------
Pituitary tumours
Hypopituitarism
Hypothalamic abnormalities
6.Psychological:
------------------
Depression
Anorexia nervosa,
starvation
7.Systemic Diseases:
------------------------
Hypothyoidism
Cushing syndrome
8.Medical causes:
----------------------
Chemotherapy
oral cotraceptive
corticosteroids
hypotensive drugs
How to establish a diagnosis of Amenorrhea
-------------------------------------------
History:
1.Primary Amenorrhea
------------------------
Genetic disorders:
failure to develop female sex characteristics
anatomic abnormalities due to chromosonal defects such as Turner syndrome
hirsutism-excessive male hormones
2.Secondary Amenorrhea
--------------------------
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Obesity
Pyschologic disorders:
depression
anorexia nervosa
Pelvic examination:
---------------------
vulval and vaginal examination for cryptomenorrhea,
bimanual palpation for ovarian masses like polystic ovaries
abnormal uterus or ovaries
Investigations:
--------------------
Pregnancy test
blood for follicle stimulating hormones, luteinising hormones, prolactin
Progesterone withdrawal bleeding test
Luteinizing hormone releasing tests
Serum testesterone and androsterones
Transvaginal ultrasound to check on the uterus and ovaries
X-ray Skull, Brain CAT or MRI scans to exclude pituitary tumours
What is the Treatment of Amenorrhea?
----------------------------------------------
Medications:
-------------
Specific treatment for amenorrhea depends on:
1.age,
2.overall health,
3.cause of the condition (primary or secondary)
4.the preference of the patient
Treatment for amenorrhea may include:
1.Pregnancy - no treatment if the patient wish to continue with pregnancy. Usually a referral to an obstetrician may be necessary
2.hormonal replacement(oestrogen and progesterone supplements ) in genetic cases and androgen producing tumours.
3.Cyproterone acetate is an anti-androgen which counters the effects of male hormones. It is usually given with a small dose of oestrogen.
4.Hyperprolactinaemia -treatment with bromocriptine which acts by stimulating the prolactin Inhibiting factor in the hypothalamus.
5.Polycystic ovary Disease -clomiphene and gonadatrophins may be given to improve menstruation and help fertility
6.Adrenal dysfunction due to deficiency of the enzyme 21-hydroxylase (androgegenital syndrome) results in excess ACTH and excessive production of androgens-treatment is with corticosteroids such as prednisolone
Other Treatments:
----------------------
1.Treatment of underlying systemic disease like thyroxine for hypothyroidism,
2.dietary changes to include increased caloric and fat intake especially in cases of low fat due to self induced dieting, anorexia nervosa
3.Pyschiatric treatment for women with depression, anorexia nervosa, or genetic dysfunction.
4.Healthy lifestyle for those who are obese
---------------------------------
What is Amenorrhea?
--------------------------
Amenorrhea is a symptom defined as absence of menstruation.
What are the types of Amenorrhea?
------------------------------------
1.Primary Amenorrhea
----------------------
is defined as the absence of onset of menstruation (menarche) in a girl who has reached the age of 18 years.
2.Secondary Amenorrhea
-----------------------
is defined as the absence of menstruation for a peroid of at least 6 months in a girl who has previously experienced normal menstruation and is not pregnant.
What are the causes of Amenorrhea?
-------------------------------------
1.Physiological(hormonal):
------------------------------
pregnancy hormones - pregnancy is the still the most common cause of secondary amenorrhea.
Growth hormone deficiency
Abnormal production of testosterone
2.Genetic Causes:
------------------
abnormal formation of genital tract causing cryptomenorrhea -obstruction to the flow of menstrual blood such as imperforate hymen
Chromosonal abnormalities:
Turner syndrome
Ovarian agenesis
3.Uterine Pathology:
------------------------
adhesions from previous operation
endometriosis
tuberculosis infection
radiation
4.Ovarian:
------------------
Agenesis(no ovaries)
Abnormal ovaries(again congenital)
Polycystic Ovaries
Granulosa-thca tumours of ovaries
radiation of ovaries
5.Pituitary:
----------------
Pituitary tumours
Hypopituitarism
Hypothalamic abnormalities
6.Psychological:
------------------
Depression
Anorexia nervosa,
starvation
7.Systemic Diseases:
------------------------
Hypothyoidism
Cushing syndrome
8.Medical causes:
----------------------
Chemotherapy
oral cotraceptive
corticosteroids
hypotensive drugs
How to establish a diagnosis of Amenorrhea
-------------------------------------------
History:
1.Primary Amenorrhea
------------------------
Genetic disorders:
failure to develop female sex characteristics
anatomic abnormalities due to chromosonal defects such as Turner syndrome
hirsutism-excessive male hormones
2.Secondary Amenorrhea
--------------------------
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Obesity
Pyschologic disorders:
depression
anorexia nervosa
Pelvic examination:
---------------------
vulval and vaginal examination for cryptomenorrhea,
bimanual palpation for ovarian masses like polystic ovaries
abnormal uterus or ovaries
Investigations:
--------------------
Pregnancy test
blood for follicle stimulating hormones, luteinising hormones, prolactin
Progesterone withdrawal bleeding test
Luteinizing hormone releasing tests
Serum testesterone and androsterones
Transvaginal ultrasound to check on the uterus and ovaries
X-ray Skull, Brain CAT or MRI scans to exclude pituitary tumours
What is the Treatment of Amenorrhea?
----------------------------------------------
Medications:
-------------
Specific treatment for amenorrhea depends on:
1.age,
2.overall health,
3.cause of the condition (primary or secondary)
4.the preference of the patient
Treatment for amenorrhea may include:
1.Pregnancy - no treatment if the patient wish to continue with pregnancy. Usually a referral to an obstetrician may be necessary
2.hormonal replacement(oestrogen and progesterone supplements ) in genetic cases and androgen producing tumours.
3.Cyproterone acetate is an anti-androgen which counters the effects of male hormones. It is usually given with a small dose of oestrogen.
4.Hyperprolactinaemia -treatment with bromocriptine which acts by stimulating the prolactin Inhibiting factor in the hypothalamus.
5.Polycystic ovary Disease -clomiphene and gonadatrophins may be given to improve menstruation and help fertility
6.Adrenal dysfunction due to deficiency of the enzyme 21-hydroxylase (androgegenital syndrome) results in excess ACTH and excessive production of androgens-treatment is with corticosteroids such as prednisolone
Other Treatments:
----------------------
1.Treatment of underlying systemic disease like thyroxine for hypothyroidism,
2.dietary changes to include increased caloric and fat intake especially in cases of low fat due to self induced dieting, anorexia nervosa
3.Pyschiatric treatment for women with depression, anorexia nervosa, or genetic dysfunction.
4.Healthy lifestyle for those who are obese
Wednesday, July 2, 2008
A Simple Guide to Uterine Fibroids
A Simple Guide to Uterine Fibroids
------------------------------------------
What are Uterine Fibroids ?
-------------------------------------
Uterine Fibroids are solid benign tumours(non-cancerous) of the smooth muscles and fibrous tissues of the uterine cavity.
The name fibroid is derived by the fibrous tissue present in the tumour.
They are the commonest tumours (25%)found in women especially after the age of 35.
What are the different types of Uterine Fibroids?
----------------------------------------------------------------
They are classified according to their location.
1.intramurally(inside the cavity of the uterus(70%)
2.subserous(on the outer wall of the uterus) on the external wall(20%)
3.Submucous (in the lining of the uterus) 10%
4.pendunculated subserous(like a polyp outside the uterus)
5.cervical(at the cervix or beginning of the uterus)
What are the Causes of Uterine Fibroids?
-----------------------------------------------------------
The cause of Uterine Fibroids is still not known.
It is believed that oestrogen has a part to play in the formation since fibroids are not present before puberty and sometimes shrinks after menopause.
Generally it is believed that during the thickening and shedding of the endometrium of the menstrual cycle, some uterine muscles and connective tive tissues overgrow and form a swelling in the wall of the uterus.
Fibroids are generally relatively avascular and may degenerate forming cysts and becoming calcified.
What are the Symptoms of Uterine Fibroids?
------------------------------------------------------------------
Most women with fibroids are asysptomatic.
Symptoms and signs varies with the size and location of the fibroid.
Common symptoms include:
1.Heavy menstrual flow sometimes with blood clots
2.Irregular menstrual periods
3.Painful menses
4.Backache
5.Painful and frequent urination
6.Bloating
7.Constipation
8.Fatigue
Signs:
1.Enlarged uterine mass on abdominal palpation
2.Anaemia and pallour due to blood loss
How do you made the Diagnosis of Uterine Fibroids?
--------------------------------------------------------
Pelvic examination may show enlarged uterine swellings
Ultrasound scan showed presence of fibroids
Colposcopy may show the location of the fibroid.
What are the complications of Uterine Fibroids?
-------------------------------------------------
1.sarcoma
2.degeneration
3.necrobiosis
4.cystic degeneration
5.torsion of pendunculated fibroid
What is the Treatment for Uterine Fibroids?
----------------------------------------------------------
If small no treatment is required.
If larger,then treatment depends on the
1.size,
2.extent of the lesions,
3.age of the patient and
4.the desire for pregnancy.
Surgery
---------------
is required if
1.extremely heavy bleeding occurs during the menstrual cycle
2.anemia follows heavy menses
3.pain has become intolerable
4.discomfort due to the pressure of the fibroids on another organ
a.Myomectomy is the surgical removal of the fibroid without damage to the uterus thus allowing a woman to be pregnant.
However recurrence of fibroids is quite common after myomectomy
b.Hysterectomy is preferred for fibroid tumors
1.when a women has severe symptoms,
2.has completed her family
3.excessively large fibroid tumors;
4.severe abnormal bleeding is present
5.fibroids are causing problems with the bladder and bowels.
Non surgical treatment:
------------------------
a.uterine artery embalization is a non-surgical procedure.
Polyvinyl particles are allowed to flow into the uterine artery and clog the nexis of vessels spread out into the uterine tissue.
The fibroids are unable to receive the constant blood supply and thus shrink over time.
b.Lupron is a drug which shrinks fibroids in most women.
Unfortunately the fibroids will grow back when Lupron treatment is stopped.
------------------------------------------
What are Uterine Fibroids ?
-------------------------------------
Uterine Fibroids are solid benign tumours(non-cancerous) of the smooth muscles and fibrous tissues of the uterine cavity.
The name fibroid is derived by the fibrous tissue present in the tumour.
They are the commonest tumours (25%)found in women especially after the age of 35.
What are the different types of Uterine Fibroids?
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They are classified according to their location.
1.intramurally(inside the cavity of the uterus(70%)
2.subserous(on the outer wall of the uterus) on the external wall(20%)
3.Submucous (in the lining of the uterus) 10%
4.pendunculated subserous(like a polyp outside the uterus)
5.cervical(at the cervix or beginning of the uterus)
What are the Causes of Uterine Fibroids?
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The cause of Uterine Fibroids is still not known.
It is believed that oestrogen has a part to play in the formation since fibroids are not present before puberty and sometimes shrinks after menopause.
Generally it is believed that during the thickening and shedding of the endometrium of the menstrual cycle, some uterine muscles and connective tive tissues overgrow and form a swelling in the wall of the uterus.
Fibroids are generally relatively avascular and may degenerate forming cysts and becoming calcified.
What are the Symptoms of Uterine Fibroids?
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Most women with fibroids are asysptomatic.
Symptoms and signs varies with the size and location of the fibroid.
Common symptoms include:
1.Heavy menstrual flow sometimes with blood clots
2.Irregular menstrual periods
3.Painful menses
4.Backache
5.Painful and frequent urination
6.Bloating
7.Constipation
8.Fatigue
Signs:
1.Enlarged uterine mass on abdominal palpation
2.Anaemia and pallour due to blood loss
How do you made the Diagnosis of Uterine Fibroids?
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Pelvic examination may show enlarged uterine swellings
Ultrasound scan showed presence of fibroids
Colposcopy may show the location of the fibroid.
What are the complications of Uterine Fibroids?
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1.sarcoma
2.degeneration
3.necrobiosis
4.cystic degeneration
5.torsion of pendunculated fibroid
What is the Treatment for Uterine Fibroids?
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If small no treatment is required.
If larger,then treatment depends on the
1.size,
2.extent of the lesions,
3.age of the patient and
4.the desire for pregnancy.
Surgery
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is required if
1.extremely heavy bleeding occurs during the menstrual cycle
2.anemia follows heavy menses
3.pain has become intolerable
4.discomfort due to the pressure of the fibroids on another organ
a.Myomectomy is the surgical removal of the fibroid without damage to the uterus thus allowing a woman to be pregnant.
However recurrence of fibroids is quite common after myomectomy
b.Hysterectomy is preferred for fibroid tumors
1.when a women has severe symptoms,
2.has completed her family
3.excessively large fibroid tumors;
4.severe abnormal bleeding is present
5.fibroids are causing problems with the bladder and bowels.
Non surgical treatment:
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a.uterine artery embalization is a non-surgical procedure.
Polyvinyl particles are allowed to flow into the uterine artery and clog the nexis of vessels spread out into the uterine tissue.
The fibroids are unable to receive the constant blood supply and thus shrink over time.
b.Lupron is a drug which shrinks fibroids in most women.
Unfortunately the fibroids will grow back when Lupron treatment is stopped.
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