A Simple Guide to Facial Palsy

A Simple Guide to Facial Palsy
-----------------------------------------

What is Facial Palsy?
----------------------------------

Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.

It is usually temporary.

What are the causes of Facial Palsy?
------------------------------------------------

Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:

Supranuclear(within the Brain)
1.Cerebral vascular lesions

2.Cerebral tumours

Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.

2.Trauma- Birth injury,fractured temporal bone, surgery of the ear

3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease

5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,

6.Multiple sclerosis

What are the symptoms and signs of Facial Palsy?
------------------------------------------------------------

The onset of facial palsy is usually very sudden.

The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.

Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations

2.Depressed taste ( lesion above chorda tympani)

3.hyperacusis ( lesion above nerve to stapedius)


Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.

2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.

3.dribbling of saliva

4.difficulty in speaking

5.loss of taste at the front of the tongue

6.dryness or watering of the affected eye

7.eyeball rolled up and inward on attempted closure of affected eye

8.ectropion or turned out lower eyelid

9.sharp hearing on the affected side

10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.

What are the investigations required in Facial Palsy?
-----------------------------------------------------------

1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)

b.test closing of the eye - to test weakness of eyelid muscles

c.ask patient to smile - to check for weakness of the cheek muscles

2.Investigations:
a.Blood for infections, HIV, Lyme's disease

b.MRI of brain to exclude tumours

c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis

What is the treatment of Facial Palsy?
-----------------------------------------------------

1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.

The steroid usually reduce swelling of the nerve.

2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus

3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.

Use artificial eyedrops during the day to keep the eye moist.

Tape the eye at night to keep it closed.

4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.

5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.

Plastic surgery may improve permanent facial drooping

What is the prognosis of Facial Palsy?
----------------------------------------

80-90% of patient with facial palsy recover spontaneously and completely within three weeks.

The remainder usually takes up to six months to recover.

Very rarely do you get permanent paralysis of the facial nerve.

A Simple Guide to Adenoiditis

A Simple Guide to Adenoiditis
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What is Adenoiditis?
-------------------------------

Adenoiditis is inflammation (swelling) of the Adenoids.

The adenoids are lymph nodes in the back of the nose and above the throat.

They normally help to filter out bacteria and other microorganisms to prevent infection in the nose and throat area.

They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing Adenoiditis.

Enlarged adenoids can cause blockage of the eustachian tubes and posterior openings of the nose.

What causes Adenoiditis?
-------------------------------

1.Viral or bacterial infections
---------------------------------

Bacteria cause 15-30 percent of Adenoiditis cases.
Streptococcus pyogenes is the most common bacteria causing acute Adenoiditis.

The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute Adenoiditis.


2.low immunity factors
-----------------------

Unbalanced or insufficient food diet,

Unhygienic lifestyle

Inadequate rest or sleep

3. Allergy
---------------

dustmites,

pollens

Who gets Adenoiditis?
---------------------

Adenoiditis most often occurs in children but rarely occurs in children younger than two years.

It is occasionally found in young adults.

What are the symptoms of Adenoiditis?
-------------------------------------

The Symptoms of Adenoiditis are:

1,Blocked nose

2.mouth breathing

3.nasal speech

4.rhinorhoea(runny nose)

5.Snoring at night

6.Ear blockage(eustachian tube blockage)

7.Ear pain(otitis media)

8.Pain in the cheeks(maxillary sinusitis) or above the eye(frontal sinusitis)

9.Headache

10.Fever, chills

11.Lethargy and malaise are common.

These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.

What are the signs of Adenoiditis?
---------------------------------

An ear nose and throat specialist will be able to put a endoscope through the nasal passage to see the enlarged and inflamed adenoids.

What are the Complications of Adenoiditis?
------------------------------------------

1.Complications of untreated streptococcus Adenoiditis with tonsillitis may be severe:

Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure

2.Ear pain from otitis media

3.Blocked airway from enlarged Adenoids

What is the treatment of Adenoiditis?
------------------------------------

1.If the cause of the Adenoiditis is bacteria such as streptococcus, antibiotics are given to cure the infection.

The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.

2.Rest to allow the body to heal.

3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the nose and throat.

4.Hospitalization may be required in severe cases, particularly when there is airway obstruction.

5.When the condition is chronic or recurrent, a surgical procedure to remove the Adenoids(Adenoidectomy) is often recommended.

What is the Prognosis of Adenoiditis?
------------------------------------

Adenoiditis symptoms usually lessen in 2 or 3 days after treatment starts.

The infection usually is cured by then, but may require more than one course of antibiotics.

Adenoidectomy may be recommended if Adenoiditis is severe, recurrent, or does not respond to antibiotics.

A Simple Guide to Amenorrhea

A Simple Guide to Amenorrhea
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What is Amenorrhea?
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Amenorrhea is a symptom defined as absence of menstruation.

What are the types of Amenorrhea?
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1.Primary Amenorrhea
----------------------
is defined as the absence of onset of menstruation (menarche) in a girl who has reached the age of 18 years.

2.Secondary Amenorrhea
-----------------------
is defined as the absence of menstruation for a peroid of at least 6 months in a girl who has previously experienced normal menstruation and is not pregnant.

What are the causes of Amenorrhea?
-------------------------------------

1.Physiological(hormonal):
------------------------------

pregnancy hormones - pregnancy is the still the most common cause of secondary amenorrhea.
Growth hormone deficiency
Abnormal production of testosterone

2.Genetic Causes:
------------------

abnormal formation of genital tract causing cryptomenorrhea -obstruction to the flow of menstrual blood such as imperforate hymen
Chromosonal abnormalities:
Turner syndrome
Ovarian agenesis

3.Uterine Pathology:
------------------------

adhesions from previous operation
endometriosis
tuberculosis infection
radiation

4.Ovarian:
------------------

Agenesis(no ovaries)
Abnormal ovaries(again congenital)
Polycystic Ovaries
Granulosa-thca tumours of ovaries
radiation of ovaries

5.Pituitary:
----------------

Pituitary tumours
Hypopituitarism
Hypothalamic abnormalities

6.Psychological:
------------------

Depression
Anorexia nervosa,
starvation

7.Systemic Diseases:
------------------------

Hypothyoidism
Cushing syndrome

8.Medical causes:
----------------------

Chemotherapy
oral cotraceptive
corticosteroids
hypotensive drugs

How to establish a diagnosis of Amenorrhea
-------------------------------------------

History:
1.Primary Amenorrhea
------------------------
Genetic disorders:
failure to develop female sex characteristics
anatomic abnormalities due to chromosonal defects such as Turner syndrome
hirsutism-excessive male hormones

2.Secondary Amenorrhea
--------------------------

Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Obesity

Pyschologic disorders:
depression
anorexia nervosa

Pelvic examination:
---------------------

vulval and vaginal examination for cryptomenorrhea,
bimanual palpation for ovarian masses like polystic ovaries
abnormal uterus or ovaries

Investigations:
--------------------

Pregnancy test

blood for follicle stimulating hormones, luteinising hormones, prolactin

Progesterone withdrawal bleeding test
Luteinizing hormone releasing tests

Serum testesterone and androsterones

Transvaginal ultrasound to check on the uterus and ovaries
X-ray Skull, Brain CAT or MRI scans to exclude pituitary tumours

What is the Treatment of Amenorrhea?
----------------------------------------------

Medications:
-------------

Specific treatment for amenorrhea depends on:

1.age,
2.overall health,
3.cause of the condition (primary or secondary)
4.the preference of the patient

Treatment for amenorrhea may include:
1.Pregnancy - no treatment if the patient wish to continue with pregnancy. Usually a referral to an obstetrician may be necessary

2.hormonal replacement(oestrogen and progesterone supplements ) in genetic cases and androgen producing tumours.

3.Cyproterone acetate is an anti-androgen which counters the effects of male hormones. It is usually given with a small dose of oestrogen.

4.Hyperprolactinaemia -treatment with bromocriptine which acts by stimulating the prolactin Inhibiting factor in the hypothalamus.

5.Polycystic ovary Disease -clomiphene and gonadatrophins may be given to improve menstruation and help fertility

6.Adrenal dysfunction due to deficiency of the enzyme 21-hydroxylase (androgegenital syndrome) results in excess ACTH and excessive production of androgens-treatment is with corticosteroids such as prednisolone

Other Treatments:
----------------------

1.Treatment of underlying systemic disease like thyroxine for hypothyroidism,

2.dietary changes to include increased caloric and fat intake especially in cases of low fat due to self induced dieting, anorexia nervosa

3.Pyschiatric treatment for women with depression, anorexia nervosa, or genetic dysfunction.

4.Healthy lifestyle for those who are obese

A Simple Guide to Uterine Fibroids

A Simple Guide to Uterine Fibroids
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What are Uterine Fibroids ?
-------------------------------------

Uterine Fibroids are solid benign tumours(non-cancerous) of the smooth muscles and fibrous tissues of the uterine cavity.

The name fibroid is derived by the fibrous tissue present in the tumour.

They are the commonest tumours (25%)found in women especially after the age of 35.

What are the different types of Uterine Fibroids?
----------------------------------------------------------------

They are classified according to their location.

1.intramurally(inside the cavity of the uterus(70%)

2.subserous(on the outer wall of the uterus) on the external wall(20%)

3.Submucous (in the lining of the uterus) 10%

4.pendunculated subserous(like a polyp outside the uterus)

5.cervical(at the cervix or beginning of the uterus)

What are the Causes of Uterine Fibroids?
-----------------------------------------------------------

The cause of Uterine Fibroids is still not known.

It is believed that oestrogen has a part to play in the formation since fibroids are not present before puberty and sometimes shrinks after menopause.

Generally it is believed that during the thickening and shedding of the endometrium of the menstrual cycle, some uterine muscles and connective tive tissues overgrow and form a swelling in the wall of the uterus.

Fibroids are generally relatively avascular and may degenerate forming cysts and becoming calcified.

What are the Symptoms of Uterine Fibroids?
------------------------------------------------------------------

Most women with fibroids are asysptomatic.

Symptoms and signs varies with the size and location of the fibroid.

Common symptoms include:

1.Heavy menstrual flow sometimes with blood clots

2.Irregular menstrual periods

3.Painful menses

4.Backache

5.Painful and frequent urination

6.Bloating

7.Constipation

8.Fatigue

Signs:
1.Enlarged uterine mass on abdominal palpation

2.Anaemia and pallour due to blood loss

How do you made the Diagnosis of Uterine Fibroids?
--------------------------------------------------------

Pelvic examination may show enlarged uterine swellings

Ultrasound scan showed presence of fibroids

Colposcopy may show the location of the fibroid.

What are the complications of Uterine Fibroids?
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1.sarcoma

2.degeneration

3.necrobiosis

4.cystic degeneration

5.torsion of pendunculated fibroid

What is the Treatment for Uterine Fibroids?
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If small no treatment is required.

If larger,then treatment depends on the
1.size,
2.extent of the lesions,
3.age of the patient and
4.the desire for pregnancy.

Surgery
---------------
is required if
1.extremely heavy bleeding occurs during the menstrual cycle

2.anemia follows heavy menses

3.pain has become intolerable

4.discomfort due to the pressure of the fibroids on another organ

a.Myomectomy is the surgical removal of the fibroid without damage to the uterus thus allowing a woman to be pregnant.
However recurrence of fibroids is quite common after myomectomy

b.Hysterectomy is preferred for fibroid tumors

1.when a women has severe symptoms,

2.has completed her family

3.excessively large fibroid tumors;

4.severe abnormal bleeding is present

5.fibroids are causing problems with the bladder and bowels.

Non surgical treatment:
------------------------

a.uterine artery embalization is a non-surgical procedure.
Polyvinyl particles are allowed to flow into the uterine artery and clog the nexis of vessels spread out into the uterine tissue.
The fibroids are unable to receive the constant blood supply and thus shrink over time.

b.Lupron is a drug which shrinks fibroids in most women.
Unfortunately the fibroids will grow back when Lupron treatment is stopped.

A Simple Guide to Salpingitis

A Simple Guide to Salpingitis
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What is Salpingitis?
----------------------

Salpingitis is an acute or chronic infection of the fallopian tubes in females.

What are the causes of Salpingitis?
---------------------------------------

Acute Salpingitis is usually caused by the following:

Infections:
1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.

2.tuberculosis salpingitis is rare

3.Infection may follow chilbirth or abortion

Mechanical irritants:
intrauterine device may cause acute or chronic Salpingitis

What are the symptoms and signs of Salpingitis?
------------------------------------------------

Persons who has Acute Salpingitis has the following
Symptoms:

1.severe lower abdominal pain

2.purulent vaginal discharge

3.painful or frequency of urination

4.fever

Signs:
1.tenderness in either lower abdominal quadrant

2.discharge can be seen in female vagina

3.vaginal examination - lateral movement of cervix causes pain
- palpation of the fallopian tubes may be very painful

How do you diagnose Salpingitis?
--------------------------------

Diagnosis can usually be made by :
1.History of lower abdominal pain with vaginal discharge

2.Tenderness in lower abdominal region with occasional palpation of tender mass
in the fallopian tube region

3.vaginal examination for tenderness in the tubes region

4.swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

5.Full blood count

6. endoscopy to examine the fallopian tubes

What are thae complications of Salpingitis?
-------------------------------------------

Acute Salpingitis may progress to chronic Salpingitis:

1. tubal infection with abscess formation(pyosalphinx) or cyst formation(hydrosalphinx)

2. Pelvic abscess

3. Ovarian infection

4.Infertility due to tube blockage

5. Peritonitis may occur with rupture of cyst and abscess

What is the treatment of Salpingitis?
-------------------------------------

1.Approprate Antibiotics for infections especially after uterine bacterial culture

2.Bedrest

3.Surgery may be necessary in cases not responding to antibiotics.
Drainage of the abscess may be done and infected tube resected if necessary

What is the prognosis of Salpingitis?
-------------------------------------------------------

Prognosis is usually good with current antibiotics and medication.

Sexual partner may need to be treated.

Recurrence is quite common.

Infertilty may result in blocked or scarred fallopian tubes

A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)

A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)
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What is a Menorrhagia?
--------------------------

Menorrhagia is a symptom defined as heavy, prolonged and/or irregular menstruation .

What are the causes of Menorrhagia?
-------------------------------------

1.Physiological(hormonal): most common
-----------------------------------
Excessive menstrual bleeding occurs when no ovulation takes place in a menstrual cycle with resultant excess oestrogen stimulation of the endometrium that results in the shedding of the thickened uterine lining and heavy bleeding when the oestrogen drops.

A defective persistent corpus luteum which results from an abnormal ovulation can also cause the shedding of the nedometrium for a longer period resulting in prolonged bleeding.

Other factors that may make heavy menstrual bleeding are:
2.Uterine Pathology:
-----------------------
polyps,
fibroids
endometriosis
infection
carcinoma

3.Systemic Diseases:
-----------------------
Bleeding diseases
Hypothyoidism
liver disease
Pelvic inflammatory Disease(PID)
Polycystic Ovarian syndrome(PCOS)

4.Medical causes:
--------------------
anticoagulants which are preventing clotting of blood
intrauterine device for contraception

How to establish a diagnosis of Menorrhagia?
---------------------------------------------

History:
--------------
Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea

Contraception:
use of IUD
contraceptive pills

Symptoms suggesting underlying pathology:
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome

Bleeding disorders:
easy bruising
anticoagulants

Pelvic inflammatory Disease:
pelvic pain especially during intercourse
vaginal discharge
dysmenorrhea

Endometriosis:
pelvic pain
dysmenorrhea

Physical Examination:
-----------------------------
Signs of underlying diseases:
bruising
hypothyroid features
pallour(anaemia)
PCOS features(hirsutism,acne,overweight)

Abdominal examination:
tenderness,
palpable uterine or ovarian masses

Pelvic examination:
vulval and vaginal examination
bimanual palpation for masses
cervical smear

Investigation:
------------------
Full blood count including hemoglobin(to exclude anemia from loss of blood) and platelets(low platelets can cause bleeding)

Transvaginal ultrasound to exclude uterine fibroids and polyps -postmenstrual scans is best when the endometrium is at its thinest.

Endometrial hysteroscopy and biopsy in women over 40 to exclude uterine cancer

What is the Treatment of Menorrhagia?
-------------------------------------------
Medications:
-------------

1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding

2.Combined oral contraceptives - prevent proliferation of the endometrium, reduces blood flow. Side effects are fluid retention, nausea, headache,deep vein thrombosis, mood changes, breast tenderness

3.oral progesterone - also prevent proliferation of the endometrium-usually less side effects bloating, headache, mood changes, breast tenderness

4. Injected progesterone -also prevent proliferation of the endometrium -similar side effects as oral progesterone. One additional side effect is the possibility of bone density loss. Evaluation of bone density should be done.

5. Levonorgestrel-releasing intrauterine system(LNG-IUS)
-also prevent proliferation of the endometrium
-side effects includes irregular bleeding up to 6 month, amenorrhea(no menses),
breast tenderness, and headache.

Surgery
-------------

1.Endometrial ablation
may be done only
a.if medications has failed
b.if no desire to coceive
c.if the uterus is normal

Usually involve the removal of the endometrium through the cervical opening.
There are forms of endometrial ablation:
a.First generation:
hysteroscopy with general anaesthesia
-Rollerball ablation
-Transcervical resection of the endometrium

b.Second Generation:
non-hysteroscopy, no general anaethesia, day surgery,fast recovery
-Impedance-controlled bipolar radiofrequency ablation
-balloon thermal ablation
-microwave ablation
-free fluid thermal ablation

2. Hysterectomy
used only as a last resort in treatment of menorrhagia
if other treatment are contraindicated
there is a desire for amenorrhea
there is no desire to retain uterus and fertility

Treatment of Underlying causes:
----------------------------------
hypothyroidism with thyroxine tablets

intrauterine device removal

reduce anticoagulant treatment if possible

treat any bleeding disease with platelets or blood factor deficient infusion

treatment of endometriosis,

antibiotic treatment of pelvic inflammatory idsease

treatment of uterine carcinoma

surgical removal of fibroids and polyps

A Simple Guide to Paronychia

A Simple Guide to Paronychia
-----------------------------------

What are Paronychia?
--------------------------

Paronychia is acute or chronic infection of the tissue surrounding the nails of fingers or feet.

What are the Causes of Paronychia?
---------------------------------------------

There are two main causes of Acute Paronychia:
1.Bacteria-pseudomonas, Proteus,staphylococus

2.Fungal- candida

Chronic Paronychia:
1.Fungal- candida

2.Bacterial-pseudomonas

Micro-organisms usually enter through injured or damaged tissues from a ingrowing nail or sharp nail.

Tissues around the base of the cuticles becomes infected and inflammed, usually on one side of the nail.

Pus may form and oozes from the infected tissues.

What are the Symptoms of Paronychia?
----------------------------------------------

1.Acute paronychia:
----------------------

1.swollen

2.painful

3.red nail fold

4.may dicharge pus

2.Chronic paronychia
-----------------------

1.recurrent

2.painful

3.swollen tissues at base of nail

4.pus may be present

5.nail plate may rigid, distorted or invaded by micro-organism

What are the investigations for Paronychia?
----------------------------------------------

Swab for culture and sensitvity to antibiotics

Exclude Diabetes

What is the Treatment of Paronychia?
----------------------------------------------

Acute Paronychia:
-----------------------

1.Systemic antibiotics

2.Incision and drainage of pus

3.Surgical excision of part of the cuticle causing tissue damage(Ingrowing toenails) and the removal of infected lateral nail folds

Chronic Paronychia:
---------------------

1.Keep hands dry and use protective gloves

2.Apply anti fungal lotions and creams such as clotrimazole, nystatin

3.Systemic anti fungals such as griseofulvin or ketoconazole

4.Treat secondary bacterial infections with antibiotics

What are the Prevention measures in Paronychia?
---------------------------------------------------------

1.Avoid pressure on the lateral folds of the nails

2.Footwear should not be too tight

3.Avoid biting of nails

4.Avoid constant contact with water and soaking in water

5.Cutting of nails should not be too deep

6.Good personal hygience

A Simple Guide to Diverticulosis

A Simple Guide to Diverticulosis
----------------------------------------------------

What is Diverticulosis?
---------------------------------------

Diverticulosis is a disorder of the colon or large intestine where there are one or more sac-like pouches(called diverticula) in the walls of the colon.

It is more common in the descending and sigmoid colon.

Who is affected by Diverticulosis?
---------------------------------------------------

Diverticulosis becomes more obvious with age.
50% of people over the age 0f 60 years have Diverticulosis.

What is the Cause of Diverticulosis?
-----------------------------------------------------

The exact cause of Diverticulosis is not known.

It has been suggested that a low-fiber diet is the main cause of diverticular disease.

Diverticulosis is common in developed countries where low-fiber diets are common whereas it is rare in Asia and Africa where people eat high-fiber vegetable diets.

Fiber prevents constipation which can make the muscles strain and increase pressure in the colon.

This increased pressure makes the weak spots in the colon lining to bulge out like pouches and become diverticula.

What are the Symptoms of Diverticulosis?
-----------------------------------------------------------

Most cases of Diverticulosis have no or little symptoms.

In the more severe cases, the main symptoms of Diverticulosis are:

1.Abdominal pain or cramps-usually over the left side or over the lower abdomen

2.Bloating

3.constipation

The symptoms can range from mild to severe.

How do you make the Diagnosis of Diverticulosis?
------------------------------------------------------------

1.A history of abdominal pain especially on the left lower abdomen, bloating and constipation

2.The physical exam consists of
a.palpation of the left abdomen for tenderness or masses
b.digital rectal exam to detect tenderness or blood.

3.stool may be tested for blood

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

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

6.Colonoscopy is also done to confirm evidence of diverticulosis and exclude malignant tumours.

What are the complications of Diverticulosis?
---------------------------------------------------

1.Diverticulitis
Diverticulitis occurs when diverticula become infected with bacteria, viruses or become inflamed.
Bacteria are caught in the pouches and develops into diverticulitis suddenly.

The symptoms and signs of diverticulitis are:
1.abdominal pain usually continuous in the lower left abdomen with tenderness

2.fever due to infection,

3.nausea, vomiting,

4.cramping,

5.constipation

6.rectal tenderness

Diverticulitis can lead to:

1.Bleeding,
rare.
Bleeding can be severe caused by a small blood vessel in a diverticulum that weakens and finally bursts.
Surgery may be needed to stop bleeding if bleeding continues.

2.Abscess, Perforation, and Peritonitis
Often a few days of treatment with antibiotics will cure the diverticulitis.
If the infection gets worse, an abscess which is an infected area with pus may form in the colon.

Small abscesses usually clear up with antibiotics.

More severe abscesses may require drainage of the pus using a catheter.

If pus leaks from perforations in the lining of the colon, then it can cause infection in the abdominal cavity and results in peritonitis.

This is an emergency and requires immediate surgery to clean up the pus in the abdominal cavity and removal of the damaged part of the colon.

3.Intestinal Obstruction
The infection of the diverticula can cause scarring of the lining of the colon resulting in partial or total blockage of the large intestine.

If the obstruction blocks the intestine completely, emergency surgery is required to allow faecal matter to pass through.

A temporary colostomy may be necessary.

4.Fistula
occurs as an abnormal connection between two organs or between an organ and the skin.

It results from the damaged tissues coming together and an opening is left between the two tissues.

Usually the bladder, small intestine, vagina, and skin are the organs involved.

The most common fistula occurs between the bladder and the colon especially in men. This can cause a long-lasting infection of the urinary tract.

Surgery may be necessary to remove the fistula as well as the damaged part of the colon.

5.Urinary tract infections occurs frequently due to the fistula and proximity of the bladder to the infected colon.

6.Discarge of faecal material may occur through a fistula between the colon and vagina in some women.

What is the treatment of Diverticulosis?
-------------------------------------------------

Medication:
1.pain medications will relieve any pain symptoms.

2.Antispasmotic mediacation for spams of the colon

3.Antibiotics may be needed in diverticulitis and complications such as urinary infection and peritonitis.

Diet:
1.high-fiber diet

a.whole grain breads and cereals;
b.fruit like apples and peaches;
c.vegetables like carrots, broccoli, spinach, carrots, cabbage, beans.

2.fiber product such as Metamucil once a day.

3.Avoid nuts, popcorn, pumpkin, and sesame seeds or any food which can cause discomfort in the abdomen

Diverticulitis
1.Antibiotics to treat the infection and inflammation,

2.resting the colon by bed rest, nasogastric suction and a liquid diet

3.hospital stay to prevent complications such as abscess.

4.surgery if the attacks are severe or there are complications.
The surgeon resects the affected part of the colon and then joins the remaining sections.

Surgery is also done for complications such as a fistula or intestinal obstruction.

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

What is the prognosis of Diverticulosis?
------------------------------------------------------

About 1% develop diverticulitis.
70% of patients with acute attacks of diverticulitis can be treated with medical management and have no further attacks