A Simple Guide to Gastroesophageal reflux disease

A Simple Guide to Gastroesophageal reflux disease II
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What are the Complications of untreated Gastroesophageal reflux disease?
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GERD complications include

1.stricture formation,

2.Barrett's esophagus,

3.esophageal spasms,

4.esophageal ulcers,

5.esophageal cancer, especially in adults over 60 years old.


What is the treatment of Gastroesophageal reflux disease?
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Treatment is aimed at
A. prevention of reflux:
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1.weight loss for the Obese

2.Positional therapy

a.Sleeping on the left side has been shown to drastically reduce nighttime reflux episodes in patients

b.Elevating the head of the bed is also effective.

The head of the bed can be raised by wooden bed risers that support bed posts or legs.

Elevation must be at least 6 to 8 inches (15 to 20 cm) to be able to prevent the backflow of gastric fluids.

c.a bed wedge pillow will also help to raise the patient's body higher

3.Certain foods should be avoided to prevent gastroesophageal reflux:

a.Coffee,

b.alcohol,

c.Acidic foods, such as oranges,tomatoes and excess amounts of Vitamin C

d.Antacids based on calcium carbonate actually increase the acidity of the stomach.

e.Foods high in fats -delay stomach emptying

f.Carbonated soft drinks with or without sugar.

g.Chocolate and peppermint.

h.Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.

i.Milk and milk-based products containing calcium and fat,

j.Eating within 2 hours before bedtime.

k.Large meals- smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.

4.Smoking reduce lower esophageal sphincter competence, and should be avoided

5. Posture and GERD
Slouching causes a kink between the stomach and esophagus.

The esophageal muscles become twisted in a spasm.

Gas and acid get trapped in the spasm,causing irritation to the throat and the windpipe resulting in cough and asthmatic symptoms.

6.Avoid stress.

Learn to relax or meditate.

Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.

B. Neutralizing the Gastric Acid Reflux
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1. Drug treatment

a.Proton pump inhibitors are the best drugs used in reducing gastric acid secretion. (eg Nexium, Losec)

b.Antacids taken before meals half hourly after symptoms begin can reduce gastric acidity (liquid antacid are more useful than tablets)

c.Alginic acid (Gaviscon) protects the mucosa as well as increase pH and decrease reflux.

d.Gastric H2 receptor blockers such as ranitidine or famotidine decrease gastric secretion of acid.

e.Sucralfate (Carafate) is used to help heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two hours apart from meals and medications.

2. Surgical treatment
The standard surgical treatment, done laparoscopically, is the Nissen fundoplication.

The upper part of the stomach is wrapped around the Lower Esophageal Sphincter(LES) to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

3.New treatments
Eight years ago some new endoscopic devices to treat chronic heartburn were approved:

a.The Endocinch apply stitches in the LES to help strengthen the muscle.

b.The Stretta Procedure uses electrodes to use radio frequency energy to strengthen the LES.

c.The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fix the fold using a suture-based implant.


What is the prognosis of Gastroesophageal reflux disease?
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It is a chronic disease so treatment is lifelong and recurrences are common.


How is Gastroesophageal reflux disease prevented?
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1.Prevent heartburn by limiting acidic foods, such as grapefruit, oranges, tomatoes, or vinegar

2.Spicy foods - Cut down on pepper or chilies.

3.Avoid lying down for two to three hours after meals.

When you are sitting up, gravity helps drain food and stomach acid into your stomach.

4.Eat lean meats and non-fatty foods.
Greasy foods (like French fries and cheeseburgers) can trigger heartburn.

5.Avoid GERD symptom triggers- chocolate, mint, citrus, tomatoes, pepper, vinegar, catsup, and mustard.

6.Avoid drinks that can trigger reflux, such as alcohol, drinks with caffeine, and carbonated drinks.

7.Eat smaller meals to avoid triggering GERD symptoms.

8.Avoid stress.

Learn to relax or meditate.

Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.

A Simple Guide to Gastroesophageal reflux disease

A Simple Guide to Gastroesophageal reflux disease I
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What is Gastroesophageal reflux disease?
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Gastroesophageal reflux disease (GERD) is a chronic disease of the esophagus whose mucosa is damaged by abnormal reflux of gastric acid from the stomach to the esophagus.


What are the risk factors in Gastroesophageal reflux disease?
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1.Incompetant Lower Esophageal Sphincter(LES) allow the acid and gastric juice to reflux up the esophagus

2.Hiatus hernia - hole in diaphragm separating esophagus from stomach is enlarged allowing the easier flow of acid up the esophagus

3.Obesity and pregnancy: increased body weight cause pressure in the abdomen to push gastric contents upwards towards esophagus

4.Zollinger-Ellison syndrome- this condition typically increase gastric acid

5.Hypercalcemia, increase gastrin production, leading to increased acidity

6.Corticosteroids like prednisolone - can irritate the stomach mucosa and increase gastric acid

7.Scleroderma and Multiple sclerosis with esophageal involvement

Factors which has been associated with GERD :

8.Obstructive sleep apnea

9.Gallstones which can impede the flow of bile and digestion of fats


What are the causes of Gastroesophageal reflux disease?
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1.incompetence of the cardia(junction between the stomach and esophagus),

2.transient cardia relaxation,

3.impaired expulsion of gastric reflux from the esophagus

4.hiatus hernia.


What are the Symptoms of Gastroesophageal reflux disease?
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The most common symptoms are

1.Heartburn - there is a burning discomfort behind the breastbone due to acid flow up the esophagus

2.difficulty swallowing (dysphagia)- due to narrowing of the esophagus (persistent implies stricture while intermittent implies spasm)

3.chronic chest pain - pain is behind the central sternum as a result of acid in the esophagus

4.cough - the acid flow up the esophagus can irritate the larynx and spark off the cough reflex

5.hoarseness- due to inflammation of the vocal cords from the acid reflux

6.voice changes- as above

7.chronic ear ache- inflammation of the throat from acid relux an also affect the eustachian tube of the middle ear resulting in pain

8.burning chest pains- again due to the gastric acid in esophagus

9.nausea and belching- too much acid to the throat can cause the nausea and expulsion of air effect

10.sinusitis - acid can also find its way up the throat and into the sinuses.

11.esophagitis (reflux esophagitis)- acid low up the esophagus causing pain
worse on lying down

12.strictures are narrowing of the esophagus resulting from acid in the esophagus

If the reflux affects the throat and larynx, it is called laryngopharyngeal reflux disease.


How do you diagnose Gastroesophageal reflux disease?
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A detailed history of acid reflux into the esophagus.

Useful investigations may include

1.barium swallow X-rays,

2.esophageal manometry - measures the pressure in the esophagus

3.24-hour esophageal pH monitoring - measures the acidity of the esophagus

4.Esophagogastroduodenoscopy (EGD) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach in order to assess the internal surfaces of the esophagus, stomach, and duodenum.

In general, an EGD is done when:
1.the patient does not respond well to treatment,

2.has danger symptoms including:
dysphagia,

anemia,

blood in the stool (detected chemically),

wheezing,

weight loss,

voice changes.

Esophagogastroduodenoscopy can show peptic stricture, or narrowing of the esophagus near the junction with the stomach.
This can cause dysphagia or difficulty in swallowing

Biopsies done during gastroscopy may show:

1.Edema and basal hyperplasia (non-specific)
2.Lymphocytic inflammation (non-specific)
3.Neutrophilic inflammation (usually due to reflux or Helicobacter Gastroesophageal reflux disease)
4.Eosinophilic inflammation (usually due to reflux)
5.Goblet cell intestinal metaplasia or Barretts esophagus.
6.Elongation of the papillae
7.Thinning of the squamous cell layer
8.Dysplasia or pre-cancer.
9.Carcinoma.
10.Reflux changes may be non-erosive in nature, leading to the non-erosive reflux disease.

A Simple Guide to Acne Rosacea

A Simple Guide to Acne Rosacea
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What is Acne Rosacea?
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Acne Rosacea is a chronic inflammatory disease of the skin which typically redness of the cheeks with maculopapular rashes.


Who Gets Acne Rosacea?
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Acne Rosacea occurs more in females than in males.

It is also more common in the middle ages.

It is rare in children


What causes Acne Rosacea?
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The cause of Acne Rosacea is unknown.

Some possible causes are:

1.menopause with flushing of the face due to hormonal

2.Excessive sebum production in the sebaceous glands

3.stress aggravate the condition

4.Alcohol and certain foods(seafood with its high histamine content, spicy food) can cause flushing


What are the symptoms of Acne Rosacea?
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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 Acne Rosacea is well-defined :

1.red (rosy cheek)

2.small blood vessel seen in rashes

3.hypertrophic sebaceous glands without blockage of ducts

4.papular rash.

5.Typically on forehead, cheeks, nose, chin or center of face

6.Associated seborrheic dermatitis of the scalp(dandruff)and eyelids (blepharitis)

7.Eye lesions may include:
tearing of eyes

photophobia

visual disturbances

corneal infections

conjunctivitis


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


1.Appearance of face

2.Blood vessel on nose

3.papular rashes on the face


What is the Treatment of Acne Rosacea?
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Treatment depends on the severity and type of Acne Rosacea.

1.mild cases may not require any treatment

2.Avoid food that can cause flushing such as alcohol, spicy foods, hot drinks

3.Avoid stress and tension

Treatments:

1.Topical Medicines include:

sulphur containing creams and shampoo to dry the oil from the skin

2.Systemic antibiotics like tetracycline or erythromycin

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

4.Avoid corticosteroids which usually make the condition worse

5.Surgical treatment of rhinophyma and laser treatment of dilated blood vessels

At the present moment there is no known cure for Acne Rosacea.

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


What is the Prognosis of Acne Rosacea?
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There is generally no cure for Acne Rosacea.

Treatment is good with prolonged antibiotic therapy.

Lifelong treatment may be necessary to control signs and symptoms.

A Simple Guide to Intertrigo

A Simple Guide to Intertrigo
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What is Intertrigo?
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Intertrigo is a moist red seborrheic (oil gland) skin rash affecting body clefts such as armpits and groins.


What are the causes of Intertrigo?
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The seborrheic glands (oil glands) in the skin secretes excessive sebum(oil) especially in areas which tends to rubs against each other such as armpits, groins, skin under the breasts, and navel.

Because of the irritation of the skin and secretion of sebum, a red moist form of rash appears.


What are Signs and symptoms of Intertrigo?
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Symptoms:

1.moist rash

2.red skin

3.may be oily


Signs:

1.Typical red moist macular rash

2.may have sebum present

3.appears mainly at axilla, groin, submammary skin


How is the diagnosis of Intertrigo made?
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1.Symptoms and signs of moist red seborrheic type of rash

2.Skin scraping to exclude fungal infection.



What are the complications of Intertrigo?
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1.Fungal infection

2.bacterial infection


What is the treatment of Intertrigo?
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1.Control of dandruff and other seborrheic conditions

2.Anifungal and antibiotic cream applied to skin lesions.

3.Corticosteroid cream may help reduce inflammation


What is the prognosis of Intertrigo ?
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Generally excellent but may recur.


What are the Preventive measures taken for Intertrigo ?
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1.Lose weight in obese patient(less friction)

2.Good skin hygiene

3.Healthy lifestyle with balanced diet and adequate sleep.

4.Proper skin care of the axilla, groins, submammary ares, navel

A Simple Guide to Impetigo

A Simple Guide to Impetigo
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What is Impetigo?
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Impetigo is a vesiculopustular skin infection occurring mainly at all ages.


What are the causes of Impetigo?
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Bacterial Infections:
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1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,


What are Signs and symptoms of Impetigo?
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Symptoms:

1.vesicles that appears rapidly on the face, hands and knee

2.Yellow liquid or pus discharges from vesicles

3.form crusts

Signs:

1.Vesicles rash present on face, hand and knees

2.yellow crusts appeared and spread to surrounding tissues

3.Neighboring lymph nodes may be enlarged


How is the diagnosis of Impetigo made?
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1.Symptoms and signs of vesiculopustular lesions of the skin.

2.Culture and sensitivity to antibiotics of the discharge or crusts from skin lesions



What are the complications of Impetigo?
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1.cellulitis

2.abscess

3.carbuncle( a group of abscesses which join together to become a large abscess

4.lymphadenitis


What is the treatment of Impetigo?
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1.Removal of crusts with warm saline or liquid paraffin

2.Strong antibiotic cream applied to skin lesions.

3. Strong systemic antibiotics

a.cephalosporin, penicillin, ampicillin, erythromycin, tetracycline, for most streptococci,
staphalococci,
hemophilus

b.cephalosporins, gentamycin for
pseudomonas

4.surgery to drain abscess and carbuncles may be necessary


What is the prognosis of Impetigo ?
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Generally excellent with good healing


What are the Preventive measures taken for Impetigo ?
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1.Avoid touching skin with dirty hands

2.Good hand hygiene

3.Healthy lifestyle with balance diet and adequate sleep.

4.Proper skin care

A Simple Guide to Blepharitis

A Simple Guide to Blepharitis
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What is Blepharitis?
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Blepharitis is a disease which causes inflammation and infection of the margins of the eyelids.


What are the causes of Blepharitis?
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Bacterial Infections:
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1.Gram positive bacteria such as Streptococcus and Staphphylococcus are common

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas,

Parasitic Infections:
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Deodex folliculorum rare cause

Non-infectious:
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blocked oil glands of eyelashes


What are the types of Blepharitis?
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Squamous:
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typically scales on lashes- usually non-infectious

Ulcerative:
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yellow crusts on eyelids which causes small bleeding ulcers when removed -
usually due to infections.


What are Signs and symptoms of Blepharitis?
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Symptoms:

1.Irritation and discomfort of eyelids

2.tearing of eyes

3.photophobia (fear of bright lights and sunlight)

4.Yellow discharge or crusts on eyelashes

Signs:

1.White scales on eyelashes in squamous blepharitis

2.yellow crusts on eyelashes in infectious blepharitis

3.small bleeding ulcers on eyelids where crusts have dropped.

4.Conjuctivitis


How is the diagnosis of Blepharitis made?
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1.Symptoms and signs of scales, yellow crusts on eyelids

2.Culture and sensitivity to antibiotics of the discharge from eyedlids

3.Microscopic examination of eyelashes

What are the complications of Blepharitis?
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1.Stye or chalazion of eyelid

2.Conjuctivitis

3.Scarring of eyelids


What is the treatment of Blepharitis?
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Squamous Blepharitis
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1.Treatment of underlying cause such as seborrhoeic dermatitis

2.Application of antiseptic or antibiotic cream to eyelashes

Ulcerative Blepharitis
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1.Rest in dark room

2.Painkiller for pain

3.Removal of crusts and diseased eyelashes by washing warm water or saline

4.Strong antibiotic eyedrops and cream applied to eyelashes:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

5.Treat associated conjunctivitis

What is the prognosis of Blepharitis ?
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Squamous Blepharitis
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Generally good.

May vary with response to underlying cause.

Recurrence is common.

Ulcerative Blepharitis
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Most cases recovered well.

Rarely there may serious sequalae such as
loss of eyelashes,
scarring of eyelashes
conjuctival ulcers


What are the Preventive measures taken for Blepharitis ?
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1.Avoid rubbing of eyes with dirty hands

2.Good hand hygiene

3.Healthy lifestyle with balanced diet and adequate sleep.

4.Reducing watching of TV and computer monitors

5.Regular eye checkups

A Simple Guide to Cytomegalovirus

A Simple Guide to Cytomegalovirus
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What is Cytomegalovirus?
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Cytomegalovirus is an acute viral disease of all ages which can be transmitted to the fetus before birth.

It affects people at all ages but seldom causes any symptoms in adults.


What are the causes of Cytomegalovirus?
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Cytomegalovirus is a virus of the herpes group characterised by its ability to stay dormant in the body over a long period.

It is transmited in body fluid (urine, saliva ,blood, semen, tears and breast milk)


What are Signs and symptoms of Cytomegalovirus?
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Adult and children Cytomegalovirus infection do not normally give rise to symptoms except for mild fever and a mononucleosis-like illness.

Congenital Cytomegalovirus infections presents itself at birth:

1.Microcephaly

2.Hepatosplenomegaly with jaundice

3.Hearing impairment

4.Blindness

5.Chorioretinitis

6.Hemolytic anemia with petechiae

7.Seizures

8.Respiratory distress


How is the diagnosis of Cytomegalovirus made?
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1.blood tests for igG or igM for Cytomegalovirus are positive within 3 weeks of birth

2.Usually appears normal at birth

3.Ultrasound during pregnancy to dentify any brain abnormalities .

4.Saliva , urine may be taken to test if there is presence of the Cytomegalovirus.


What are the complications of Cytomegalovirus?
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1.Respiratory distress

2.Mental retardation

3.Hemolytic anemia

4.Blindness

5.Deafness


What is the treatment of Cytomegalovirus?
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There is no effective treatment of Cytomegalovirus at the present moment.

A antiviral drug ganciclovir which is used to treat AIDS may help babies with Cytomegalovirus infection.

A vacine is also being developed for prevention.


What is the prognosis of Cytomegalovirus ?
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Prognosis for congenital Cytomegalovirus infection is poor.

Adult Cytomegalovirus infection do not have any problem.


What are the Preventive measures taken for Cytomegalovirus ?
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There is no vaccine at the present moment for Cytomegalovirus.

Transmission of Cytomegalovirus infection is always preventable because it is transmitted through body fluid from hand,nose and mouth of a suseceptible person.

People who interacts with children and pregnant mothers shuold practice good safe hygiene methods such as washing of hand and wearing of clothes when changing diapers.

Pregnant women are also advised to practice safe hygiene methods and to seek advice in the presence of a mononucleosis-like illness.

A Simple Guide to Polycystic kidney disease

A Simple Guide to Polycystic kidney disease
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What are Polycystic kidney disease ?
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Polycystic kidney disease is a progressive genetic condition of the kidneys in which multiple cysts (polycystic)are present in both kidneys.

The disease can produce cysts in the liver, pancreas, and rarely, the heart and brain.


Who is at risk of Polycystic kidney disease formation?
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Any one with a family history of polycystic kidneys.


What causes Polycystic kidney disease ?
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There are 2 main causes of polycystic kidney disease.

Both are determined by their genetic inheritance:

1.Autosomal dominant
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It is generally a late-onset disease with progressive cyst development.

The kidneys are bilaterally enlarged and have multiple cysts.

There may be kidney dysfunction resulting in hypertension and kidney failure by the age of 60 years.

Beside this there are also cysts in other organs such as the liver, spleen, pancreas, and arachnoid mater.

Other abnormalities includes intracranial aneurysms, dissection of the aorta, mitral valve prolapse.


2.Autosomal recessive
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This disease is less common than the above.

Most cases died during the pregnancy or in the first month of birth.

Early manifestations of the disease is apparent at birth or in early infancy.


What are the symptoms of Polycystic kidney disease ?
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Many Polycystic kidney patients do not have any symptoms.
In some cases there may be:

1.hypertension,

2.Abdominal colic due to urinary stones

3.back or flank pain

4.urinary tract infections with hematuria and proteinuria

5.Palpable large kidneys

6.Abdominal swelling

7.fatigue

The condition eventually ends in chronic renal failure with loss of kidney function.


How are Polycystic kidney disease diagnosed?
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1.X-rays of the kidneys on routine checkup

2.Ultrasound of the kidneys

3.MRI of the kidneys

4.genetic testing

Genetic counseling may help families at risk for polycystic kidney disease.


How are Polycystic kidney disease treated?
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There is no cure for Polycystic kidney disease.

Although a cure for Polycystic kidney disease is not possible, treatment can ease the symptoms and prolong life.

1.Back Pain:
Mild pain killers such as paracetamol can relieve pain.

2.Urinary tract infections:
urinary tract infections can be treated with antibiotics.

Any urinary infection can spread from the urinary tract to the kidney cysts so early treatment is important.

Once the infection enter the cyst, treatment is difficult because many antibiotics cannot enter the walls of the cysts.

3.High blood pressure:
All hypertension cases due to Polycystic kidney disease must be kept under control with medications and lifestyle changes such as exercise, distressing, low salt and fats

4.Renal disease:
Eventually in all cases the kidney function will fail and chronic real failure develop.
Treatment will then be by dialysis or kidney transplant.

5.Surgery:
Surgery is rarely needed except to remove large cysts. Even then the kidney disease is progressive and will still end in chronic renal failure.


What is the prognosis of Polycystic kidney disease?
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Generally poor after the age of 60 when renal disease may set in.


How to prevent Polycystic kidney disease ?
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There is no prevention for Polycystic kidney disease.