A Simple Guide to Pancreatic Cancer

A Simple Guide to Pancreatic Cancer
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What is Pancreatic Cancer?
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Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.

What are the causes of Pancreatic Cancer?
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1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells

2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells

3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer

4.Chronic pancreatitis has been found to have some causal effect

5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer

6.Occupational exposure to certain chemicals including insecticides

7.Family history -there is a family history in 5-10% of pancreatic cancer patients

8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract

What are the symptoms and signs of Pancreatic Cancer?
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Symptoms - non-specific and varied.

1.pain in the upper abdomen that typically radiates to the back

2.pain relieved by leaning forward

3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)

4.depression is sometimes associated with pancreatic cancer


Signs:

1.tenderness in upper abdomen

2.mass in the abdomen

3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.


How do you diagnose Pancreatic Cancer?
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Diagnosis can usually be made by :

History
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1.pain in upper abdomen radiating straight to the back, worse on eating

2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.

3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later

4.onset of atypical diabetes mellitus

5.unexplained recent thrombophlebitis

6.past history of pancreatitis

Location of cancer
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1.Tumors in the pancreatic body or tail usually present with pain and weight loss

2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.

Courvoisier sign
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presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer

Liver function tests
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may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).

CA19-9 (carbohydrate antigen 19.9)
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is a tumor marker that is frequently elevated in pancreatic cancer.

Ultrasound or abdominal CT
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may be used to identify tumors.

Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

What is the treatment of Pancreatic Cancer?
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Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.

Surgery
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1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.

2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy

3.localized tumors of the pancreas have been surgically removed using laparoscopy.

4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.

5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.

Chemotherapy
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is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life

Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer

Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.

Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.

Radiation therapy
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The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.

What is the Prognosis of pancreatic cancer?
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The prognosis of pancreatic cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 3-4 months;

3.5-year survival is lower than 5%.

4.Pancreatic cancer has the highest mortality of all the cancers.

5.Pancreatic cancer may sometimes cause diabetes.

How to prevent Pancreatic Cancer?
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1.a healthy lifesyle

2.increase consumption of fruits, vegetables

3.reduce red meat intake

4.Vitamin D can reduce the risk of pancreatic cancer

5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer

6.Avoid smoking and drinking of alcohol

A Simple Guide to Pancreatitis

A Simple Guide to Pancreatitis
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What is Pancreatitis?
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Pancreatitis is an acute or chronic inflammation of the pancreas.

What are the causes of Pancreatitis?
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Pancreatitis is usually caused by the following:

1. Alcoholism and diseases of the biliary tract

2. bacterial infections from salmonella typhi and streptococcus

3. viral infection especially mumps, coxsackie virus, cytomegalovirus

4. trauma

Chronic disease follows attacks of acute infection.

What are the symptoms and signs of Pancreatitis?
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Persons who has Acute Pancreatitis has the following symptoms:

1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.

2.Pain usually very severe occuring a large meal or drinking bout

3.Pain is worse lying supine, therefore patients sit or lean forward

4.mild fever and bodyaches

5.nausea and vomitting

6.hypotension followed by clinical shock

Signs:

1.Tenderness at the epigastrium with muscle spasm

2.Distension and diminished bowel sounds

3.Pleural effusion 10%,abdominal mass 20%, ascites 20%

4. Acute renal failure, respiratory failure following shock.

Chronic Pancreatitis
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Symptoms:

1.repeated attacks of epigastric abdominal pain

2.Pain worse after eating, radiates to the back

3.weight loss

4.Fever

Signs:

1.abdominal tenderness

2.abdominal mass may suggest swelling and pseudocysts

3.tender subcutaneous masses seen indicating fat necrosis

How do you diagnose Pancreatitis?
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Diagnosis can usually be made by :

1.Physical examination with tenderness in the epigastrium

2.Serum and urine amylase very high after 6 hours

3.White blood cell count high

4.Serum lipase high in 50% patients

5.Blood calcium may be low

6.Blood glucose tolerance test for diabetes

7.Ultrasound may show up the presence of pseudocyst in pancreas

8.CAT scan and MRI may show swelling and pseudocysts in pancreas

What is the complications of Pancreatitis?
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1.Pseudocysts from damage to pancreatic tissues

2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas

3.peritonitis from rupture of pseudocysts and bleeding

4.diabetes mellitus from damage to the glands in the pancreas producing insulin

What is the treatment of Pancreatitis?
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Acute Pancreatitis:
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Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Treat biliary tract diseases and alcoholism

surgical drainage of pseudocysts after acute episode.

Chronic Pancreatitis:
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Pancreatic extracts and enzymes together with meals

Sodium bicarbonate and cimetidine to prevent enzymes breakdown

Analgesic or antispasmodic medicine usually by injection

Surgical procedures usually unsuccessful

What is the prognosis of Pancreatitis?
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Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.

Hemorhagic Pancreatitis has high mortality of 50-90%

Most trauma cases has complete resolution

Some alcoholic pancreatitis may go on to chronic pancreatitis.

Chronic pancreatitis relapses frequently

Rupture of pseudocysts may result in death

How do you prevent Pancreatitis?
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Avoid alcohol and oily food

Take precautions during mumps and other viral infection

Avoid injury to the abdomen especially the mid section below the sternum

A Simple Guide to Allergies

A Simple Guide to Allergies
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What are Allergies?
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Allergies are the immune system's reaction to a harmless substance foreign to the body.

In some people this reaction causes a uncomfortable symptom like rashes or swelling of the eyelids.

In severe cases it can even cause peeling of the skin or kidney damage.

What are the Common causes of Allergies?
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The most common causes of allergies are pollen and dust mites.

Besides these, there are a wide range of substances that can trigger an allergic response.

Pollen:
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Pollen is the seeds or spores released by flowers or plants during pollination phase of plants and usually is higher in summer. Some countries shows the daily pollen index in the media during summer to warm allergen sufferers the risks of allergy during this peroid.
Pollens irritate the sensitive mucusal lining of the nose and the epithelium of the skin causing inflammation and swelling.

Dust mites:
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Dust mites are microscopic parasites who live on the skin flakes shed by the human body every day. They can found just about everywhere on the floor, carpets, on mattresses, pillows, bed covers, clothes and upholstery.
The faeces from the dust mite is the main substance which causes sneezing and wheezing.

House dust like dander from animals, cockroach faeces, bacteria, moulds, fungus spores and dust mites are the main cause of allergies in any family.

Moulds
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Moulds are microscopic fungi with spores floating in the air like pollen.
They are usually found in damp areas indoors such as the basement or bathroom, as well as outdoors in grass, leaves, hay, or under plants.


Animal proteins
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Proteins found in an animal's skin and saliva can cause allergy to skin, nose and lungs in some people.

Food allergens
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Certain foods especially eggs, milk, nuts, and seafood, induce intestinal and skin reactions frequently in children who often outgrow it after puberty.

What are the Symptoms of Allergies?
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Allergic symptoms include:

1.itchy, watery nose and eyes,

2.asthma, wheezing and coughing

3.Hives or skin rahes

What is the Treatment of Allergies?
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Treatment depends on the severity of symptoms.

In severe cases of allergy:

1.adrenaline injection is used in life-threatening situations to reduce acute swelling of the airways.

2.Antihistamines can help relieve symptoms such as sneezing and running nose.

3.Bronchodilators (theophylline and beta-agonists e.g. salbutamol) are used in cases of asthma to open the airways, relieve coughing, wheezing, shortness of breath and difficulty in breathing.

4.Corticosteroids such as dexamethasone may be given to relieve symptoms.
They also reduce the immune reaction to the allergens.

How to prevent allergies?
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The best prevention is to avoid the allergens:

1.Avoid dustmites, pollen.

2.Cover all pillows, mattress,beds etc with special dust mite covers,

3.Avoid food like eggs, milk, nuts, and seafood

4.Desensitisation to Allergens
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Desensitisation to Allergens is by giving small doses of allergen until the body itself become insensitise to allergens.

A Simple Guide to Coughing

A Simple Guide to Coughing
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What is Coughing?
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Coughing is the reflex mechanism in which the body tries to get rid of excessive mucus and phlegm accumulated in the lining membranes of the respiratory tract.

The secretions from the lining of the respiratory tract trap and then flush out the viruses, bacteria and other particles like smoke, haze particles.

It prevents serious infections from entering the lungs and bronchial tubes.

What are the common causes of cough?
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Coughing is usually caused by the following:

Infections:
1.bacterial or viral infection of the nose and throat such as the common cold or influenza.(yellow or green phlegm)

2.anaerobic infections of the mouth,

3.Infection of the tonsils, nose and sinuses(postnasal drip)

4.Bacterial infection of the bronchial tubes and lungs(bronchiectasis, bronchitis, pneumonia, sinusitis, or tracheitis).
This often comes with rusty or green mucus.

Dry mouth:
1.Insufficient drinking of water

2.medications especially ACE inhibitors(eg. enapril) can cause dry persistent coughs

Allergies:
1.Certain plants, pollens, chemicals, cosmetics can cause allergic reactions in the throat and bronchial causing cough. (white clear phlegm)

2.Asthma - narrowing of the bronchial tubes due to allergic and other causes usually results in white sticky clear productive phlegm

Smoking:
Cigarettes smokes contains 40 over chemicals which irritates the cells in the lining of the bronchial tubes causing a chronic cough

Stress:
Stress can cause cough due to dryness of mouth during stress or anxiety, causing the saliva to dry up and producing dry unproductive cough.
The cough in stress usually disappears during sleep.

Gastric problems or indigetions
1. Indigestion of food in the stomach can cause the undigested food in the stomach to produce gas in the stomach which goes upwards to the throat drying saliva which then become irritating phlegm in the throat.

2.gastroesophageal reflux of food can also cause the acid and undigested food to travel to the mouth and produce mucus secretions.

Systemic diseases:
1.Congestive heart failure

2.Lower respiratory tract infections

3.Chronic Obstructive Lung Disease

4.Carcinoma lung.

What investigations are needed for cough?
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1.chest X-ray

2.sputum culture

3.pulmonary function tests

What is the treatment of Coughing?
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Medications
1.Approprate Antibiotics, antifungal for infections of throat and bonchial tubes

2.Antihistamines for allregic cough

3.Bronchodilators for asthma and Chronic Obstructive Lung Disease

4.cough mixtures - expectorants helps to expel out the phlegm
- suppresant suppress the cough -especially for dry cough and at night to stop the cough

5.Antacids and antiflatulent agents to get rid of gas in stomach and prevent reflux

6.Diuretics for treatment of congestive heart failure especially in the elderly

Healthy Lifestyle:
1.drinking several glasses of water a day prevents dryness of mouth

2.Avoid cold, acidic, spicy and oily food which irritates the throat

3.Proper oral hygience after eating: brushing of teeth and flossing.

4.Gargle mouth after every meal.

4.Avoid smoking

6.Avoid frequent usage of the voice and throat - do not talk too much

6.Treat underlying condition such as asthma, diabetes, liver, kidney and other conditions.

A Simple Guide to Halitosis

A Simple Guide to Halitosis(Bad Breath)
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What is Halitosis?
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Halitosis is the condition when a person suffers from chronic bad breath.

What are the causes of Halitosis?
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Halitosis is usually caused by the following:

Infections:
1.bacterial infection of the gums, dental cavities.(600 types of bacteria
present in mouth)

2.anaerobic infections of the mouth,

3.Infection of the tonsils, nose and sinuses(postnasal drip)

Gastric problems and indigestion:
1. Indigestion of food in the stomach can cause the undigested food in the stomach to emit an offensive smell through the mouth

2.gastroesophageal reflux of food can also cause the smell of acid and undigested food in the mouth

Certain food:
1.garlic and onions which has odious suphur compounds can give rise to foul smell from the mouth

2.fish

3.cheese

4.alcohol

Smoking:
Cigarettes smokes contains 40 over chemicals which cause bad mouth smell

Dry mouth:
1.Insufficient drinking of water

2.medications can cause dry mouth and produces a smell from the mouth

Systemic diseases:
1.liver failure.

2.Lower respiratory tract infections

3.Renal infections and renal failure.

4.Carcinoma.

5.Trimethylaminuria ("fish odor syndrome").

6.Diabetes mellitus.

What are the symptoms and signs of Halitosis?
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Persons who has Halitosis has the following
Symptoms:
1.Bad breath

2.Dry mouth

Signs:
1.discharge from nose or tonsils

2.furry tongue

How do you diagnose Halitosis?
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Diagnosis can usually be made by :
1.History of bad breath

2.lick the back of the wrist, let the saliva dry for a minute, and smell the dried saliva.

3.scrape the posterior back of the tongue with a plastic disposable spoon and smell the drying residue.

4. Halimeter: a portable sulfide monitor to test for levels of sulfur emissions (especially hydrogen sulfide) from the mouth.

5.BANA test: find the salivary levels of an enzyme which shows the presence of certain halitosis-related bacteria

5.ß-galactosidase test: the presence of this enzyme in the saliva indicates presence of bad breath

What is the treatment of Halitosis?
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1.Approprate Antibiotics, antifungal for infections of mouth

2.drinking several glasses of water a day prevents dryness of mouth

3.Eating a healthy breakfast helps clean the back of the tongue

4.Proper oral hygience after eating: brushing of teeth and flossing. Dentures should be removed at bedtime and soaked overnight in antibacterial solutions.

5.Avoid smoking

6.Gargle mouth after every meal.
Avoid the use of alcohol based mouth wahes.
Use instead oil based mouth washes.

7.Chewing sugarless gums helps to stimulate production of saliva and hence less bad breath

8.Treat underlying condition such as diabetes, liver, kidney and other conditions.

What is the prognosis of Halitosis?
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Prognosis is usually good with proper oral hygiene.

Recurrence is quite common.

A Simple Guide to Urinary Incontinence

A Simple Guide to Urinary Incontinence
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What is Urinary Incontinence?
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Urinary incontinence is a symptom and means the the uncontrollable leakage of urine.
It can cause a lot social discomfort to patients having this problem.
Men are more prone to it than women.

What are the Causes of Urinary Incontinence?
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Urinary Incontinence is a medical condition which may be temporary or permanent.

There are many causes of urinary incontinence:
Temporary urinary incontinence
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1.Drinking too much tea, coffee or carbonated drinks can irritate the bladder and cause or contribute to incontinence.
Coffee and other drinks containing caffeine can be a particular problem as caffeine is a diuretic, i.e. it increases the urge to pass urine.

2.Excessive alcohol. Alcohol is also a diuretic. Because it has deppresant effect on the the brain, it may affect the person's judgement temporarily, hence resulting in accidental leakage of urine.

3.Some medications like diuretic pills, heart medications and antidepressants can cause or contribute to incontinence.

4.Urinary Tract Infection may cause sufficient irritation to the bladder to stimulate incontinence.

5.Constipation result in impaction of the stools in the rectum. This irritates the nerves to the bladder resulting in incontinence.

Permanent urinary incontinence
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In both sexes there are many conditions which can cause or contribute to chronic or persistent urinary incontinence:

1.Aging
With age there is a decrease in the bladder capacity to store urine.

2.Enlarged prostate in men
BPH or benign prostatic hypertrophy is associated with aging and can obstruct the urethra and block urinary flow resulting in urge or overflow incontinence.

3.Prostate Cancer in men
Prostate cancer can cause incontinence if untreated. However the incontinence in prostate cancer patients may be a side effect of treatment e.g. surgery, radiation therapy.

4.Prostatitis in men
Inflammation of the prostate gland sometimes can cause constriction of the urinary flow and incontinence.

5.Gynecological problems such as prolapsed uterus, enlarged utrue due to fiboids, ovarian cysts or tumours can pulled on the muscles of the perineum causing weakness of the muscles and poor constriction of the bladder opening

5.Surgery involving the organs near the bladder
Any operations involving organs such as the ovary, uterus, prostate, rectum can cause inadvertent damage to muscles or nerves of the urinary tract, resulting in incontinence.

6.Urinary tract obstruction
Any enlarged tumours along the urinary tract can obstruct the normal flow of urine and cause incontinence. Bladder stones can do the same.

7.Neurological conditions
Stroke, Parkinson's disease, tumours in the brain or spinal cord and injury to the nerves in pelvis or spinal cord can can affect the nerves to the bladder and weakening of the bladder opening muscles.

What are the Types of urinary incontinence?
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Urinary incontinence may be categorised into 4 main types. It is possible however to have more than one type of urinary incontinence

1.Stress incontinence
Leakage of urine occurs because of weakness of the pelvic floor muscles. When there is pressure exerted on the bladder - e.g. from laughing, sneezing, coughing, exercising or heavy lifting, pregnancy, the muscles at the opening of the bladder comes under stress and opens to allow leaking of urine.


2.Urge incontinence
There is an uncontrollable leakage of urine while suddenly feeling the urge to urinate.

3.Overflow incontinence
There is a constant dribbling of urine even after finishing urination. There is an inability to completely empty the bladder.

4.Functional incontinence
There is physical or mental impairment resulting in the failure to realise the need to urinate.As a result the person fail to get to the toilet in time and pass out the urine. Examples are people who suffer from dementia, parkinson or is incapacitated by poor physical movement.

Other types of urinary incontinence include enuresis(bed wetting ) which is common in chilldren,
Transient incontinence which is temporary and sometimes caused by medications.

What are the symptoms of urinary incontinence?
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The main symptom of urinary incontinence is leakage of urine. This leakage may be frequent and heavy, or it may be small and rare.
Some other symptoms of urinary incontinence include:

Urgency - a strong desire to urinate even when the bladder is not full together with pelvic discomfort or pressure

Frequency - urinating more than once in a two-hour period or more than seven times a day

Nocturia - the need to wake up and urinate at least twice during sleep

Dysuria - painful urination

Enuresis - bed-wetting or urinating while sleeping

How do you make the Diagnosis of urinary incontinence?
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1. history taking is important especially the pattern of urine leakage. Other history include symptoms of straining and discomfort, use of drugs, surgery, and illness.

2. physical examination will look for signs of medical conditions causing incontinence, such as pelvic tumors, stool impaction, and poor reflexes or sensations.

3. measurement of bladder capacity and residual urine for signs of poor functioning bladder muscles.

4.Stress test - the patient coughs vigorously as the doctor watches for loss of urine.

5.Urinalysis - urine is tested for infection, urinary stones.

6.Blood tests - for PSA( in case of Cancer of prostate) or alphafoetoprotein (in case of cancer of the ovaries)

5.Ultrasound -to visualize the kidneys, ureters, bladder, and urethra.

6.Cystoscopy - a thin lighted tube is used to see the inside of the urethra and bladder.

7.Urodynamics - measurement of pressure in the bladder and the flow of urine.

What is the Treatment of urinary incontinence?
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Elderly patient tend to believe that the only way to prevent embarrassment is to wear absorbent pads or padded undergarments like adult Pampers. However the wetness may lead to rashes, sores, or infections.

Treatment involves:
A. making certain lifestyle changes.

1.Timed Voiding
Timed voiding (urinating) means writing a chart of your urination and leakage patterns for several days. This will then tell you which times of day you normally need to empty your bladder before leakage may occur.

2.Bladder training
This involves training your bladder to control the urge to urinate.

3.Changing Fluid Intake
Restricting your fluid intake, or changing the timing of fluid intake will help you to gain more control over the bladder. Restriction of alcohol, tea, coffee and other caffeinated beverages can reduce the amount of urine from your body

4.Exercises
Exercising the muscles of the pelvis(Kegel exercises) may strengthen the muscles of the affected area.

5.Vaginal cone therapy
This exercise for women involves the use of a set of five small vaginal cones of increasing weight. The patient simply places the small plastic cone within her vagina and hold it in by a mild reflex contraction of the pelvic floor muscles. This exercise is done twice a day for fifteen to twenty minutes.As the pelvic floor muscles becomes stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually.

6.Electrical stimulation
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles and strenthen the pelvic muscles.
This can reduce stress and urge incontinence.

7.Biofeedback
Using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can slowly control movement of these muscles.

B.Treating the cause of the incontinence:

1.Medications:
drugs may be given to treat urinary tract infections or inhibit contractions of an overactive bladder.

2,Pessaries
A pessary is a ring shaped medical device that is inserted into the vagina. It compresses the urethra against the pubic bone and elevates the bladder neck.

3.Surgery
Surgery to reduce the size of your prostate gland ( transurethral resection of the prostate or TURP) helps to reduce urinary incontinence in men.

Bladder repositioning
In older women incontinence results from the bladder dropping down toward the vagina. Surgery involves pulling the bladder up to a more normal position. Using an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

Marshall-Marchetti-Krantz
This procedure also known as retropubic suspension or bladder neck suspension surgery, is performed using an incision across the abdomen. Stitches are placed in these tissues near the bladder neck and the urethra is then lifted, and the stitches are attached to the pubic bone or to tissue behind the pubic bone. The bladder neck is supported helping the patient to control the urine flow.

Slings
The sling procedure uses synthetic mesh material in the shape of a narrow ribbon that is placed under the urethra through one vaginal incision and two small abdominal incisions. The purpose is to provide support under the urethra. There are the Transobturator Tape Sling, the Tension-free Transvaginal Sling, and the Minisling.

Artificial urinary sphincter
Rarely the surgeon implants an artificial urinary sphincter a doughnut-shaped sac surrounding the urethra. To close the urethra A fluid fills and expands the sac. Pressing a valve implanted under the skin, the artificial sphincter can be deflated allowing urine from the bladder to pass.

4.Catheterization
A catheter may be inserted to drain the urine if your bladder never empties completely or if your bladder cannot empty because of poor muscle tone, post surgery or spinal cord injury. This can be done on a if required basis.Prolonged catherisation may lead to infection of the urinary tract.

5. Botox injections
Botox injection has been tried to reduce the sensitivity of the nerves at the opening of the bladder. It appears more successful for women than in men.

How do you prevent urinary incontinence?
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Reduce your risk of urinary incontinence:

1.Maintain a healthy weight.

2.Obesity can lead to urinary incontinence.

3.Avoid constipation by drinking sufficient amounts of fibre and fluids in your diet.

4.Avoid drinks which can irritate your bladder such as coffee, tea, carbonated drinks and alcohol.

A Simple Guide to Benign Prostatic Hyperplasia

A Simple Guide to Benign Prostatic Hyperplasia
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What is Benign Prostatic Hyperplasia?
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Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.

What are the Causes of Benign Prostatic Hyperplasia?
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The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.

It is a walnut size gland encircling the lower urinary outlet of the bladder.

With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.

The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.

What are the symptoms and signs of Benign Prostatic Hyperplasia?
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The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.

Symptoms:
1. difficulty in starting urination

2. straining at urination to produce a weak flow of urine

3. dribbling of the urine after urination

4. feeling of incomplete emptying of bladder even after urination.

5. nocturia -getting up at night more frequently to pass urine

6. frequency of urination

7. interrupted urine flow

8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)

Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate

2.urine examination to exclude infections

3.blood tests to check on kidney function

4.an ultrasound to have a better look at the prostate and also any damage to kidneys

5.a urine flow test(Uroflow) to see how fast you can pass urine

6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer

7. Cystoscopy - a ligted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine

8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)

What are the complications of Benign Prostatic Hyperplasia?
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Prolonged blockage of the urine by BPH can cause serious complications:

1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain

2. Urine leakage or incontinence

3. recurring urine infections

4. bladder stone formation

5. blood in the urine

What is the treatment of Benign Prostatic Hyperplasia?
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BPH sufferers may be referred to an Urologist for review. As lonas Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.

In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by :
1.adjustment of fluid intake

2.regular exercise,

3.proper diet with less red meat , more vegetables and fruits.

In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as :

4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.

In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,

5.catherisation and drainage of the urine may be necessary in acute retention of the urine

6.Surgery may be necessary.
This operation called TURP or transUrethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract.
Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfuction problems.

7. Antibiotics may be given for urinary infections

What are the preventive measures taken in Benign Prostatic Hyperplasia?
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1.Changing Fluid Intake

You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.

2.Bladder training & periuretharal muscle exercises
This involves training your bladder to control the urge to void.

3.Maintain a healthy weight.

4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.

What is the prognosis of Benign Prostatic Hyperplasia?
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Very good after treatment.

A Simple Guide to Erectile Dysfunction

A Simple Guide to Erectile Dysfunction
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What is erectile dysfunction (ED)?
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Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"

The WHO sponsered Consultation recommend" a minimum of three months of erectile difficulty qualified foe a diagnosis of Erectile Dysfunction."

What is the incidence of ED?
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The incidence of ED is unknown:
ED is currently underdiagnosed and undertreated.
More than 50% of all men 40-70 years old are likely to experience it.

What are the Causes of ED?
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Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.

Medical causes:
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1.vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)

high blood pressure

high cholesterol

heart disease

stroke

All these conditions affects the blood flowing and out of the penis.

2.diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED

3.nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis

4.hormonal problems-
low levels of testosterone(male hormone) can cause ED

5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.

6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.

7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillisers) may reduce the blood flow to the penis

8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.

Lifestyle causes:
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1.alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.

2.Smoking-
The incidence of ED in smokers are hiher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.

3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.

4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation

Psychosocial Causes:
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1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause

3. Depresssion

4. Relationship Problems- marital problems and tensions may affect sexual relationship

5. fatigue.

How is the diagnosis of ED made?
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1.medical hisory especially about diabetes, hypertension, medications, alcohol adrug abuse,smoking.

2.medical examination including genitals and prostate

3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)

What is the treatment of ED?
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Successful treatment of erectile dysfunction includes:

1. Lifestyle modifications:
exercising

dieting

quitting smoking

reducing alcohol/drug abuse

counselling to manage anxiety/stress/marital problems

2.treatment of underlying medical conditions such as diabetes

3.change of medications

4.medication for treatment of ED.

There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors
e.g. Viagra, Cialis, Levitra.

There is no instant erections when the medicine is taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.

Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.

6.Other treatments for erectile dysfunction

a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity

b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.

c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis

d:surgery for blocked blood vessels

e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse.
This surgery is offered when all other options failed.

How to cope with ED?
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Erectile dysfunction can cause a lot of stress on one’s marital relationship.

Communication and honesty with the spouse is important in ED.so that she understands the problem and that she is not the cause of the problem.

In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.