A Simple Guide to Ulcerative Colitis

A Simple Guide to Ulcerative Colitis
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What is Ulcerative Colitis?
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Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.


Who is affected by Ulcerative Colitis?
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Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites

Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.

Those above the age of 60 years have more severe symptoms and signs.

It occurs equally in men and women and can be found in families.

What is the Cause of Ulcerative Colitis?
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The exact cause of Ulcerative Colitis is not known.

It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.

Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.


What are the Symptoms and signs of Ulcerative Colitis?
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Symptoms:
The symptoms can range from mild to severe.

Mild cases (about 50%)usually have:

1.an insidious onset

2.lower abdominal pain

3.Slight blood stained diarrhea

4.malaise

In the more severe cases, the main symptoms may be:

1.abrupt onset

2.severe diffuse abdominal pain

3.Bloody diarrhea

4.fever

5.shock

6.fatigue

7.weight loss

8.loss of appetite

9.loss of body fluids and nutrients

10.joint pain

Signs:
1.Abdominal distension and tenderness

2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter

3.pallor due to anemia

4.Wasting of muscles

5.skin lesions

How do you make the Diagnosis of Ulcerative Colitis?
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1.A history of lower abdominal pain , bloating and bloody diarrhea

2.The physical exam consists of
a.palpation of the abdomen for tenderness

b.digital rectal exam to detect tenesmus or blood.

3.stool may be tested for blood

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

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

6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.

What are the complications of Ulcerative Colitis?
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Bowel complications:

1.Strictures of colon

2.Fistula

3.Toxic dilatation(toxic megacolon)

4.Perforation of the colon

5.hemorrhage

6.shock

7.rarely carcinoma(5%)

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.Skin: eczema


What is the treatment of Ulcerative Colitis?
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Mild Cases:
Medications:

1.Antidiarrheal and bulk forming agents

2.Antispasmotic medication for spasm of the colon

3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.

5.Correction of anemia

6.Regular hemoglobin, blood counts and liver function tests

Severe cases:

1.Hospitalisation with bed rest, fluids, electrolyte replacement and blood transfusion if necessary

2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.

3.Sulphasalazine (immuno-suppressant) given indefinitely

4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

5.Antibiotics in toxic megacolon syndrome

5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.

In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.

Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.

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


What is the prognosis of Ulcerative Colitis?
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The prognosis depends on the severity of the disease

Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.

5% will die within the first year.

75% will have recurrence for the rest of their life.

Only 10% will have remissions lasting 15 years.

A Simple Guide to Foot Care

A Simple Guide to Foot Care
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What is Foot Care?
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Typically the foot is furthest from the heart and therefore more easily plagued with problems like poor blood circulation or neurological deficit.

Therefore taking care of the foot is very important especially in diabetic patients.

Foot care is an important tool in prevention of foot problems at all ages.


What is important in Foot care?
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Footwear:

1.Shoes should fit comfortably.

2.Soft shoes like canvas or soft leather is preferred because they cause less
pressure points.
Foam rubber shoes cause fewer planter calluses

3.The toe box should be wide and high enough to accomodate any exostosis or contractures.

4.Shoes should have anterior as well as a posterior heel.
This protects the metatarsal heads from coming under stress.

5.Wearing sport shoes which are comfortable and has air bubbles at the front and back of the shoes will prevent friction in sports like jogging and brisk walking.

6.Woman's shoes should not have high heels as these increase increased pressure
on the planter surface and the metatarsal bones.
A low heel lace shoe is more comfortable because of the bigger toe box.

7.Specially constructed shoes may be necessary for patients with deformities of the foot.

8. Full length soft molded inlays can be used when pressure sores or painful calluses are present.

Socks:

1.Socks or stocking should fit comfortably and kept dry at all times

2.Tight constricting stocking should not be worn.

3.Loose stockings which can wrinkle should also be avoided

Foot:

1.Inspect and clean foot daily.

2.wash feet daily with bland soap and lukewarm water.

Pat dry gently and thoroughly especially between the toes after wash.

Do not rub the foot vigorously.

3.keep your toe nails short,trimming them straight across to avoid ingrowing toenails

4.moisturise feet daily to prevent dryness and cracking of skin

5.web spaces should be kept dry with powder or small pieces of cotton wool in between toes.

6.examine feet daily for scratches, cuts, blisters and corn

7.use a mirror to check the sole of your feet

8.Avoid going barefoot

9.Seek prompt treatment for cuts and sores

10.annual review for foot ulcers, risk of neuropathy(poor sensation), blood circulation( palpable pulses)

General Measures:

1.Smoking should be avoided as it causes constriction of the blood vessels

2.Avoid extreme temperatures such as excessive heat or cold

3.Home surgery should avoided in diabetes and those with vascular disease.

Avoid cutting calluses or corns yourself.

Also avoid applying strong chemicals to calluses or corn.

Instead try changing the weight bearing stresses on the foot.

4.When ulcers do appear they are most commonly on the weight bearing surface of the foot.

Vigorous local care such as removal of infected tissues and control of infections with antibiotics and antibiotic creams are indicated.

If the foot is warm and the blood flow good(feel pulse), healing of ulcers
usually will occur.

Raise the foot and exercise the foot to improve blood circulation.

5.Any injuries or cuts in the foot should be treated instantly to prevent any complication such as infection

6.Good balanced diet and a healthy lifestyle is important.

A Simple Guide to Plantar Fascilitis

A Simple Guide to Plantar Fascilitis
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What is Plantar Fascilitis?
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Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.

It is more common in women.

What are the cause of Plantar Fascilitis?
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The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.

In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.

Both heels can be affected.

What are the symptoms and signs of Plantar Fascilitis?
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Symptoms:

1.Pain in the heel of one or both feet

2.Pain usually is worse in the morning on getting and stepping on the floor.

3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse

4.Pain is described as constant and aching

5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.

Signs:

1.local tenderness in the calcaneal bone area of the heel.

2. Pain is aggravated by direct pressure.

3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.

4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.

A stress fracture may need to be ruled out in chronic cases.


What is the Treatment of Plantar Fascilitis?
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Conservative treatment:
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Initial phase:

1.rest of the heel-avoid jogging or strenous exercises

2.Cold or ice may help reduce inflammation

3.Heel cups, cushions, tapes, pads may help to reduce the pain

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.

7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.

8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.

Mobilisation phase:

Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain

Surgery is usually not indicated in plantar fascilitis.

Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.


What is the prognosis of Plantar Fascilitis?
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Prognosis is usually good although healing is slow and takes up to 1-2 years.


What is the prevention of Plantar Fascilitis?
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Avoid certain weight bearing exercises like jogging or brisk walking

Use heel cups, cushions, tapes, pads in foot wear

Lose Weight

A Simple Guide to Knee cap Dislocation

A Simple Guide to Knee cap Dislocation
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What is Knee cap Dislocation?
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Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.


What are the causes of Knee cap Dislocation?
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1.Dislocated knee caps most often occur in people with loose joint ligaments.

It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.

2.Dislocation of the knee cap may also occur due to trauma.

A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.

3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.

This condition is usually inherited and are more common in women than in men.


What are the symptoms and signs of Knee cap Dislocation?
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Symptoms:

1.Knee cap is displaced to the lateral position

2.knee swelling and effusion due to displacement of the knee cap.

3.Knee pain and tenderness is present.

4.The knee is usually held in slight flexion.

5.There is difficulty in lifting the leg

6. Patient usually walks with a limp.

Signs:

1.Tenderness and swelling of the knee

2.Knee cap is displaced to the outside or lateral part of the knee

3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.

4.The knee cap can move excessively from right to left.(hypermobile)

How to investigate the cause of Knee cap Dislocation?
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1.examination of the knee would confirm presence of the dislocated knee cap.

There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.

2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.

A skyline view of the knee should show the shift of the patella laterally.

3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.


What is the Treatment of Knee cap Dislocation?
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Conservative treatment:
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1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.

The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)

Gentle pressure is exerted on the knee cap to place it to its normal position.

The knee is then immobilized for 2-3 weeks.

Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

2.Muscle relaxant to relax muscles

Surgery:
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Surgery is required if:

1.the knee remains unstable

2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.

Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.


What is the prognosis of Knee cap Dislocation?
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Prognosis using conservative methods is fair.

Recurrences are quite common.

Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.

Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.


What is the Prevention of Knee cap Dislocation?
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1.proper technique when exercising.

2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.

3.Wearing a knee guard

A Simple Guide to Frozen Shoulder

A Simple Guide to Frozen Shoulder
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What is Frozen Shoulder?
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Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.

It tends to be chronic and full recovery may take several months.

It is more common in women and diabetes.

Incidence is about 2 in a 1000.

What are the causes of Frozen Shoulder?
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The exact cause is unknown but several conditions has been blamed:

1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements

2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement

3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles

4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.

5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.

What is the natural progression of frozen shoulder in most cases?
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Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.

There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.

There is also reduced fluid in the joint further restricting movement.

Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.

This lasts 5 weeks to 9 months.

Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.

This lasts 4 -9 months.

Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.

This lasts 5 -26 months.

What are the symptoms and signs of Frozen Shoulder?
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Symptoms:

1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm

2.Pain usually is worse at night especially lying on the affected shoulder

3.Certain movements makes the pain worse

4.Pain is described as constant, dull and aching

5.complaints of stiffness of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:

1.apprehensive patient who holds the arm protectively

2.Generalised tenderness of rotator cuff and biceps muscles

3.Limited shoulder movement

4.Range of muscle movement is reduced in all directions

5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..

What is the Treatment of Frozen Shoulder?
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Conservative treatment:
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Initial phase:
1.rest of the shoulder

2.moist heat

3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

4.Muscle relaxant to relax muscles

5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy

2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder

Maintenance phase:
1.Continual exercises of the shoulder muscles

2.Avoidance of strain on the muscles of the shoulder

Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.

Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.

What is the prognosis of Frozen Shoulder?
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Prognosis depends on the underlying cause.

In most cases frozen shoulder may resolve itself with time