A Simple guide to Buerger's Disease

A Simple guide to Buerger's Disease
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What is Buerger's Disease?
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Buerger's Disease is an uncommon form of arterial obstructive disease of the large and medium sized peripheral arteries of legs in men under age 40 giving rise to intermittent claudication.

Occasionally the arteries of the arms and the veins may be involved.

Causes of Buerger's Disease are:
1.heavy smoking

2.arterial lesions are inflammatory rather than degenerative.

3.The appearrance is non-suppurative(no pus) panvasculitis

4.arterial obstructions in the legs are often associated with obstructive arterial lesion elsewhereExample:angina pectoris

5.Diabetes and high lipid patterns are aggravating factors.

What are the Signs and Symptoms of Buerger's Disease
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Symptoms:

1.onset is sudden
2.classic symptom of heavy aching pain in the legs when walking(intermittent claudication)
3.loss of arterial pilses
4.leg pallor and coldness
5.Raynaud's phenomenon
6.Other arterial diseases:
a.retinopathy
b.coronary ischemia
c.renal ischemia
7.evidence of peripheral ischemia or gangrene

How to diagnose Buerger's Disease?
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1.Symptoms and signs as above
2.pallor on raising legs
3.angiography to determine site of lesion

What are the complications of Buerger's Disease?
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The complications are:
gangrene of the legs

What is the Treatment of Buerger's Disease?
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1.stop smoking
2.general measures:
a.graded exercise
b.physical training
c.weight loss
3.avoid injury from
a.heat
b.cold
c.trauma
d.infections

Medicines:
vasodilator drugs like persantin, nitrates

Surgery:
reconstructive surgery for localized blockage but may not work

Amputation is preferable with gangrene in elderly

What is the Prevention for Buerger's Disease?
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Avoiding smoking

Prognosis of Buerger's Disease
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disease is often progressive and amputation may be necessary.

A Simple Guide to Syncope

A Simple guide to Syncope
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What is Syncope?
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Syncope is a temporary loss of consciousness resulting from inadequate cerebral blood supply.

Causes:
A.Vasomotor:
1.Vagal slowing of heart and reduction of blood pressure from fear, severe pain or psychogenic disturbance

2.Hemorrhage or circulatory fluid loss from burns

3.Postural hypotension  - blood pressure drops from sleeping or sitting position to upright position

4.Vasoactive drugs such as anti-hypertensive (prazosin, methyl dopa) and heart medicines(nitites, adrenergic blockers)

5.Carotid sinus compression

B.Cardiac:
1.Asystole or heart blockage

2.Sudden arrhythmias with high ventricular rate

3.Heart valve prosthesis

4.Aortic stenosis with exertion

5.Cardiogenic shock following myocardial infarction

6.Sudden cardiac compression

What are the Signs and Symptoms of Syncope
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A.Vasomotor:
Symptoms:
1.cold sweats, pallor, yawning,

2.Urge to urinate or defecate

3.low blood pressure

4.dilated pupils

5.Drug therapy such as adrenagenic blockers

B.Cardiac:
1.ECG evidence of arrhythmia, heart block, asystile, or myocardial infarction

2.history of valve prosthesis, aortic stenosis or chest injury

What are the complications of Syncope?
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The complications are:
1.head injury

2.fractures

What is the Treatment of Syncope?
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1. Patients with postural or psychogenic syncope recover in recumbent position

2.Cardiac syncope from myocardial infarction needs the patient to be hospitalized and managed in cardiac care unit

3. heart blocks or asystole may need pacemaker implantation

4.Tachycardia with arrhythmia must be treated with special medicies to slow the heart

5.review drug therapy abd dosage of potentially causative medicines such as adrenergenic blocking drugs, beta blockers or vasodilators such as nitrates



Prognosis:
1.depends on cause -vasomotor are less serious than cardiac.

2.it may present as a life threatening condition requiring immediate treatment in cardiac syncope

A Simple Guide to Anorectal Abscess

A Simple guide to Anorectal abscess
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What is Anorectal abscess?
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Anorectal abscess is a pocket of pus in the anal region below the anal sphincter muscles.

Perianal abscess lies within the external anal sphincter.

Ischiorectal abscess is situated above the anal sphincter and in the ischiorectal fossa.

How is Anorectal abscess caused?
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Anorectal abscess is caused by infection in the anal glands of the anal mucosa and becomes abscesses or pockets of pus.

1.Trauma or injury causes cell damage and infection

2.Small mucosal tears from hard fecesmay lead to infection

3.Anal fissures, hemorrhoids or colis can also lead to abscess

Most infections are E.coli infections less often staphylococcus

What are the Signs and Symptoms of Anorectal abscess?
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Symptoms start off with:
1. throbbing pain around

2. sitting walking defecation painful

3.Fever, malaise

4.Abscess seen on inspection or rectal exam

How to diagnose Anorectal abscess?
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1.Symptoms of
a.anal swelling pain

b.proctoscopy

c.swab & culture
2.ESR raised very high somtimes > 80
3.moderate leucytosis with lymphopenia

What are the complications of Anorectal abscess?
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The complications are:
1.colitis
What is the Treatment of Anorectal abscess?
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Incision & drainage.
1.Antibiotics

What is the Prevention for Anorectal abscess?
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Avoiding infection
Prognosis of Anorectal abscess
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Early therapy with antibiotics produce good results

A Simple Guide to Alcoholism

A Simple Guide to Alcoholism
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What is Alcoholism?
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Alcoholism is a chronic disease manifested by a pattern of pathological alcohol usage with inability to stop drinking more than temporary resulting in physical, psychological and social consequences.

Who is at risk of getting Alcoholism?
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1.Familial

2.Cultural factors especially alcohol drinking friends

3.Social pressure and Stress

4.Depression may be a cause of Alcoholism

What are the Symptoms and signs of Alcoholism?
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Common symptoms of Alcoholism are:

1.Need for daily use of alcohol

2.Binge drinking

3.Inability to stop drinking more than a temporary phase

4.Impairment of social and occupational function

5.Blackouts and amnesia

6.Violent behavior when intoxicated with arguments with friends and family

7.Absence from work or loss of job

8.Legal problems such as arrests for drink driving or traffic accidents

9.Evidence of tolerance for more alcohol to achieve sense of comfort

10.Development of alcohol withdrawal (tremors on awakening, insomnia, hallucinations)

How is the diagnosis of Alcoholism made?
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1. level of blood alcohol above the permitted limit.

2.Liver function tests are abnormal:
a.Aminotransferases  - AST and ALT are moderately elevated, with AST > ALT.
b.Alkaline phosphatase  - usually slightly elevated.
c.GGT  - correlates with AP levels- much higher in chronic liver disease from alcohol.

3. ECG and EEG

What are the complications of Alcoholism?
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Complications may develop with progression of the alcoholism.

1.Delirium tremors

2.Acute alcohol delusional states

3.Untidy appearance
a.neglect of personal appearance,
b.unresponsiveness,
c.forgetfulness,
d.trouble concentrating,
e.changes in sleep habits.

5.Alcoholic hepatitis and cirrhosis

6.Wernicke's encephalopathy

7.Alcoholic cerebellar degeneration

8.Pellagra

What is the treatment of Alcoholism?
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In all cases of Alcoholism,  assessment of the patient's alcoholism and complications are needed.
1. Detoxification in special centers

2. treatment of complications

3.Alcohol withdrawal with the help of transquillizers and vitamin supplements

4.Antabuse therapy to cure alcohol dependence

5.Psychological therapy and Alcoholic Anonymous

What is the prognosis for Alcoholism?
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Prognosis is dependent on initial severity and the patient's motivation to return to sobriety

Alcoholism is a serious chronic disease which can be controlled but seldom cured.

What is the best prevention for Alcoholism?
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1. No drinking of any form of alcohol

2. Family support and psychotherapy and self help groups

A Simple Guide to Coeliac Disease

A Simple Guide to Coeliac Disease
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What is Coeliac Disease?
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Coeliac Disease(Gluten Enteropathy) is a chronic disease of the small intestine which affects the lining of the small intestine to develop abnormalities on contact with gluten.

The small bowel mucosa shows
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes and plasma cells

Who is affected by Coeliac Disease?
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Coeliac Disease is more common in people with certain HLA antigens and blood group O.

There is a possibility of enzyme deficiency and abnormal immunological response.

Coeliac Disease can be found in all ages but are more common in the 10-30 years age group.

What is the Cause of Coeliac Disease?
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The exact cause of Coeliac Disease is not known.

It has been suggested that an autoimmune disease is the main cause of Coeliac Disease.

A protein produced by the immune system, called HLA antigen may be a possible cause of the body's reaction in the lining of the  small intestinal tract resulting in inflammation.

What are the Symptoms and signs of Coeliac Disease?
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Symptoms varies from mild to severe:

1.severe abdominal pain, bloating

2.diarrhea and steatorrhea

3.Weight loss despite good appetite and intake

4.edema

5.glossitis

6.apthous ulcers

7.finger clubbing

8.hypotension

9.Polyneuritis

10.psychiatric symptoms

In children there may be:
1.failure of weight gain
2.irritability
3.general malaise

How do you make the Diagnosis of Coeliac Disease?
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1.A history of abdominal pain , diarrhea and weight loss

2.small bowels radiology

3.D-xylose absorption study

4.fecal fat assessment

5.Jejunal biopsy 

What are the complications of Coeliac Disease?
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1.weight loss

2.Nutrition: malabsorption and vitamin deficiency

What is the treatment of Coeliac Disease?
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Treatment is :
Control of Diet
1.gluten free diet especially wheat, oats, barley, rye
use rice corn potato in place
2.avoid beer, ale, whisky, vodka which contains a lot of gluten
3.Special diet for gluten sensitive patients
4.Question diet and review diagnosis if no response

Medication

1.Antispasmotic medication for abdominal pain

2.Oral corticosteroids may help in patients not responding after 3 months of careful adherence to diet
Start with high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.

3.Correction of anemia and nutritional deficiencies is important to enhance the immune system

What is the prognosis of Coeliac Disease?
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The prognosis depends on the conition of the disease

Improvement occurs within 1-3 days following institution of diet seen in 30% of patients.
80% will respond within a month.
the remaining 20%may take up to 2 years for symptoms control.

There may be recurrence if therapy is stopped.

What are preventive measures in Coeliac Disease?
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A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
A gluten free diet will prevent recurrence