A Simple Guide to Thyroid Nodules

A Simple Guide to Thyroid Nodules
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What are Thyroid Nodules ?
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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.


Who are at risk of thyroid nodule?
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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.


What are the different types of Thyroid Nodules?
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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


What are the symptoms and signs of Thyroid Nodules?
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In mild cases there is usually no obvious symptoms.

In moderate or severe cases of thyroid nodules:

Symptoms:
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1.Obvious swelling in the thyroid gland

2.Neck swelling -suuggest 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 difficuly in swallowing due to pressure on the oesophagus


Signs:
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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.


How are diagnosis of Thyroid Nodules made?
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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.


What is the Treatment of Thyroid Nodules?
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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.


What is the Prognosis of Thyroid Nodules?
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Prognosis is good in all benign cases.

Malignant thyroid nodules will depend on any spread to other organs.

A Simple Guide to Otitis media

A Simple Guide to Otitis media
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What is Otitis media?
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Otitis media is acute or chronic inflammation of the middle ear.

Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube.

Who is affected by Otitis media?
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1.childhood, usually related to viral upper respiratory tract infection

2.family history of middle ear disease.

What are the Causes of Otitis media?
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Bacterial infections:

1.Streptococcus pneumoniae

2.Haemophilus influenzae

3.staphylococcus aureus

4.Moraxella catarrhalis, a gram-negative diplococcus.

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.common cold.

2.measles

What is the Types of Otitis Media?
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1. Acute otitis media

Acute otitis media ia an acute infection of the middle ear which usually occurs as a result of viral upper respiratory tract infection that can occur at least twice a year

2.Chronic otitis media

Chronic otitis media occurs following acute otitis media with chronic infection of the middle ear and ear perforation.

3.Otitis media with effusion:

Otitis media with effusion occurs when fluid occurs in the middle ear due to blockage of the eustachian tube.

What are the complications of Otitis media?
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1.mastoiditis

2.labrynthitis

3.facial nerve palsy

4.meningitis,

5.brain abscess,

6.febrile seizures.

7.death if a severe infection goes untreated long enough


What are the Symptoms and signs of Otitis media?
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1. cold: stuffy nose

2. earache - The pain lasts a day or two.

3. high fever - may cause seizures if very high

4. discharging pus from the ruptured eardrum
Usually the ruptured drum will usually heal spontaneously

5.Eustachian tube becomes blocked resulting in hearing loss

Signs:

1.Ear drum (tympanic membrane) inflamed and bulging with loss of normal outline

2.Decreased or displaced light reflex of ear drum

3.perforation of ear drum

4.mucopurulent discharge from ear after perforation

How is diagnosis of Otitis media made?
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1.Inflamed ear drum with loss of normal outline, decreased light reflex, bulging and perforation and purulent discharge.

2.Culture and sensitivity of pus swab

3.Nasal and pharyngeal swabs my also be done

4.X-rays or MRI of the mastoid air cells

5.Audiogram for hearing loss

What is the treatment of Otitis media?
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Acute otitis media

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.Antihistamines may be given for rhinitis or runny nose.

4.Decogestants may be necessary for blockage of eustachian tube

5.Bed rest and Fluids

6.Myringoplasty -Puncture of bulging ear drum if painful and aspiration of pus or fluid in the middle ear.

7.Tympanoplasty for eardrum whose perforation does not heal.

8.Mastoidectomy to remove cholesteatoma(growing of skin into middle ear cavity) in chronic otitis media with mastoiditis.


What is the prognosis of Otitis media?
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Prognosis with appropriate treatment is generally good.

Ear drum perforation usually heal spontaneously in most cases.

What are Preventive measures for Otitis media?
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Avoid swimming and diving.

Proper ear hygiene.

A Simple Guide to Skin warts

A Simple Guide to Skin warts
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What are Skin warts?
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Skin warts are benign epithelial hyperplasia raised swellings on the skin caused by one of the human papilloma viruses.

They are infectious by direct contact or indirect contact through contaminated surfaces from one person to the other.

It is the one of the common skin condition.

It is never life threatening.

Who is affected by Skin warts?
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Skin warts is more common in :

1.children than in adults

2.contact with a person with warts

3.families with a patient having warts

What is the Cause of Skin warts?
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The human papilloma virus is the cause of skin warts.

There are 100 types of HPV which has been identified as causing skin or mucosal infections.

What are the types of Skin warts?
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Common wart:
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Common warts are benign swellings in the skin that are caused by human papillomavirus (HPV) infection.

1.Periungual wart

Periungual warts are common warts around or under the fingernail and toenail.

2.Plantar warts

Plantar warts are found on the pressure areas of the foot.

The presure causes inward growth.

They can be single, seedling or mosaic.

3.Mosaic warts

Mosaic warts are plagues of closely set plantar warts

4.Plane warts

Plane warts are flat-topped smooth papules, light brown or skin flesh in color present on the face, legs, and hands often occuring in large numbers.

5.Filiform warts

Filiform warts appear as a single long narrow growth often on the eyelid or face

What are the Symptoms and signs of Skin warts?
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Skin warts can present as:

1.round or irregular raised swelling

2.Color may be like normal skin or light brown.

3.Surface is rough(may look like califlower) or smooth

4.Border is sharply demarcated

5.Size varies from 2-10mm in diameter.

5.They are usually found on the fingers, elbows, knees, feet, scalp and face.

How do you make the Diagnosis of Skin warts?
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1.Skin biopsy under local anesthesia

2.small lesions can be totally removed

3.larger ones are biopsied first and surgically removed later on


What are the complications of Skin warts?
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If skin warts are transmitted to the genital area, there is a risk of genital warts which can cause cervical cancer in women

What is the treatment of Skin warts?
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Many warts resolve spontaneously.

For those that persists or grow bigger, other treatments may be used:

1.Surgery:

Skin warts are removed by surgical excision.

2.Chemical treatment:

a.local therapy with Salicylic-acid preparations which dissolves the protein forming most of both the wart and the thick layer of dead skin above it.

b. 5-fluorouracil(a chemotherapy agent)

3.Cautery:

Electrotherapy by cautery of the warts kills the virus and destroy the tisues underneath which allow them to grow.

4.Cryosurgery:

Aerosol wart treatments freeze warts at a temperature of minus 57 C.

This can kill the virus.

Dermatologists use liquid nitrogen which is considerably colderminus 196 C.

What is the prognosis of Skin warts?
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Prognosis of majority of cases is good if there is complete removal.

Recurrences are common

What are the preventive measures for Skin warts?
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Avoid direct or indirect contact through contaminated surfaces with people having warts

A Simple Guide to Lichen Planus

A Simple Guide to Lichen Planus
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What is Lichen Planus?
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Lichen Planus is a chronic inflammatory disease of the skin which typically consists of red small papules that joined together to from rough scaly patches.

It is often associated with lesions of the mucosal membranes.

What are the types of Lichen Planus?
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There are 2 main types:

1.Skin Lichen Planus is the most common type of Lichen Planus.
About 80% of people have red small papules that joined together to from rough scaly patches.

The skin usually grows very more quickly and are thicker than usual.

2.Mucosal Lichen Planus (small, red papular lesion of the mouth and mucous membranes)

Who Gets Lichen Planus?
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Lichen Planus occurs more in females than in males.

It is also more common in the middle ages.

It is rare in children

What causes Lichen Planus?
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The cause of Lichen Planus is unknown.

1.allergic reactions to medications for high blood pressure(methyl dopa) and arthritis (chloroquine and salicylates),arsenic, gold.

2.chronic hepatitis C virus infection

3.stress aggravate the condition

4.Allergic reactions to amalgam and gold filling can cause oral lesions


What are the symptoms of Lichen Planus?
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Onset is sudden or gradual.

They may last weeks or months and be recurrent.

Frequently they become chronic.

The typical rash of lichen planus is well-defined :
1.pruritic,
2.planar,
3.purple,
4.polygonal
5.papules.

When seen under the microscope the papules have characteristic network of white lines(Wickham's striae)

Lesions are symmetrical, usually on flexor surfaces of the arm near the wrist and the ankle.

Nails are frequently involved with pitting and thinning of the nail plate.

Oral lichen planus occurs in 50% of patients:

1. reticular form - most common rash, occurs as white streaks on the mucosa (known as Wickham's striae) or papules with small raised area .

The lesions are present on the gums, the tongue, palate and lips.

The lesions are present on both sides of the mouth

2. bullous form - fluid-filled vesicles

3. erosive form - erythematous (red) areas which are ulcerated.
This form may become malignant.

Microscopic appearance is typical of lichen planus:

1.Hyperparakeratosis or thickening of the granular cell layer
There is a typical saw-tooth appearance of the rete pegs

2.Degenerated basal cell layer

3.Inflammatory cells present in subepithelial layer of connective tissue

Lichen planus may involve the glan penis and vulvovaginal mucosa

Lichen planus rarely involve the eosophagus where it can cause erosive esophagitis and stricturing.

How does Lichen Planus affects the Patient?
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All types of Lichen Planus can affect a person’s quality of life.

Itching, soreness, and ulcers of the mouth are common.

What is the Treatment of Lichen Planus?
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Treatment depends on the severity and type of Lichen Planus.

1. mild cases may not require any treatment

2.severe Lichen Planus have lesions that affects most of the body and hospitalization is required.

3.Most cases of Lichen Planus lie in between.

Treatments:
1.Topical Medicines include:

topical steroids.
tar lotions, ointments, creams, and shampoo

2.Systemic therapy (oral drugs that affect the whole body system):

cyclosporins, methotrexate
immunosuppressant medications
Oral retinoids
Oral corticosteroids
hydroxychloroquine
tacrolimus
dapsone

3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)

4.Combined therapy are frequently used.

5.new therapies such as the biologic agents has improved the condition

At the present moment there is no known cure for lichen planus.

Medicines have been able to reduce the severity of inflammation and improve the quality of life.

Other medicines are used to treat symptoms:

1.Antihistamines for itch

2.Oral topical steroids for mouth ulcers


What is the Prognosis of Lichen Planus?
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There is generally no cure for lichen planus.

Lichen planus may become dormant after being treated.

Recurrences are common even years after being dormant.

Lifelong treatment may be necessary to control signs and symptoms.

A Simple Guide to Keloid

A Simple Guide to Keloid
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What is a Keloid?
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Keloid is an overgrowth of fibroplastic tissue which occurs in an area of injured skin.

Sometimes it may occur spontaneously.


Who is affected by Keloid?
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Keloid usually occur in black skin people than in white skin.

Keloid is more common in women than in men.

Keloid may occur after skin injury especially burns.


What is the Cause of keloid?
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Keloid are dense fibrous tissue which forms scars as a result:

1.Skin injury -cuts and lacerations, even superficial abrasions

2.Burns - from injury to the skin

3.Chemical damage to the skin - cosmetics, sulphuric acid burns,

4.Infections of the skin -acne, abscess, ulcers

5.Surgery - incision scars after operations

6.Postvaccination scarring such a keloids over BCG vaccination

What are the Symptoms and signs of keloid?
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Symptoms :

1.raised red fleshy looking irregular swelling of the skin at site of injury

2.smooth and shiny surface

3.Usually painless, mainly itchy

4.may grow bigger

5.multiple swellings may also be present.

Signs:

1.swelling is red, fleshy looking with blood vessels present

2.irregular appearance with shiny smooth surface

3.May occur anywhere on the body

4.Swelling quite hard on palpation

How do you make the Diagnosis of keloid?
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1.Characteristic appearance at site of injury or surgery

2.Microscopic examination shows the presence of a fibroplastic cells with blood vessels and nerve endings.


What are the complications of keloid?
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The keloid can be irritated by shaving, clothing or jewellery.

There can be :

1. bleeding

2. infection especially in diabetes

What is the treatment of keloid?
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The only treatment is removal of the keloid.

This can be done by :

1.Injection of corticosteroids into the base of keloids

2.Excision followed by corticosteroid injections.

3.Cryosurgery (freezing with liquid nitrogen)

4.Taping of keloid with pressure adhesive tape to prevent growth and flattening of keloids.

Some keloids may resolve spontaneously.

What is the prognosis of keloid?
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The prognosis is usually excellent.

Recurrence at the same spot is common due to regrowth of the blood vessel supplying the keloid.