A Family Doctor's Tale - CHRONIC FATIGUE

DOC I HAVE CHRONIC FATIGUE 

Chronic Fatigue is a collection of symptoms with the predominance of severe fatigue(tiredness) which can last for months or years.

There are 2 main causes of Chronic Fatigue 

1.Pathological Chronic Fatigue :
Viral Infections may be a trigger
Others are:
Anemia
Dehydration and electrolyte disturbance
Diabetes
Fibromyalgia
Heart disease
Hypothyroidism
Narcotics
Paraneoplastic syndrome
Pulmonary disease
Renal disease
Chemotherapy

2.Psychological Chronic Fatigue :
Anxiety
Depression
sedentary lifestyle
Sleep disorders

Symptoms are:
1.Severe fatigue that prevents the patient from getting up of bed

2.weakness in the limbs

3.Pain in the head, abdomen, or muscles of the limbs

4.Poor appetite

5.reluctance to take part in social activities

6.Tired after any physical or mental exercise

7.difficulty in concentration

Diagnosis is by:
1.Blood tests to exclude anemia and infections

2.Tests to exclude diabetes, low thyroid hormones, endocrine disease

3.Psychological evaluation

Treatment is by :
1. No specific treatment eexcept for rest

2.Counseling in cases of psychological causes

3.Gradual return to work or school

4.Treat underlying causes such as diabetes, hypothyroidism

Prognosis:
usually good

P.S (on 22nd April 2011)

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I was advised by my expert readers that what I was writing about is Chronic Fatigue and not Chronic Fatigue Syndrome. Having gone through all their comments and their links, they are all correct and this post is all about Chronic Fatigue.

I am grateful for all these experts for their comments.

Please send me more comments.

A Simple Guide to Photo Dermatitis

A Simple Guide to Photo Dermatitis
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What is Photo Dermatitis?
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Photo Dermatitis is a common skin condition which presents as a erythematous or vesicular rash on face, neck, hands and other areas exposed to sunlight.


What causes Photo Dermatitis?
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The cause of Photo Dermatitis is related to the exposure of the skin to the sun.
However some possible triggers are:
1.Genetic

Genes play a part in Photo Dermatitis as the condition runs in families

2.External causes

Photo sensitivity:certain exogenous sensitizers play a part in the development of Photo Dermatitis.

a.drugs such as phenothiazines, thiazides and tetracycline

b.cosmetic such as lipstick, perfumes, soaps, shaving cream, antiseptic creams, even sun screening agents (especially if they contain coal tar)

c.irritating chemicals which exaggerated the photosensitzing effect of the sun

d.sunburn reaciion which aggarvated the skin to react as rashes.

e.Photo allergic rash which persist for years

f. injury by ultraviolet light

g.feeling too hot and/or sweating will cause an outbreak.

h.Stress can also sometimes aggravate an existing flare-up.

Photo Dermatitis affects both sexes equally.

What are the symptoms and signs of Photo Dermatitis?
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Typical features of Photo Dermatitis are:

1.vesicular or bubbles in areas most exposed to light

2.erythrematous or red rashes in areas most exposed to light

3.some occurs following severe sunburn

4.some are seasonal with recurrance in early spring and summer

5.actinoid reticuloid skin rash affecting the face and hands are also seen in chronic photo dermatitis patients

How is Photo Dermatitis diagnosed?
-------------------------------------------

1.History and appearance of the rash

2.Photo patch testing

3.Determination of light wavelength causing photo dermatitis

How can Photo Dermatitis be treated?
------------------------------------------

Treatment of an Photo Dermatitis treatment routine is:

1. Avoid ultraviolet light especially long wave ultraviolet light

2. application of lotions or creams to protect the skin against the sun

3.chloroquine sulphate 200mg daily may be useful for some patients over short periods

4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.

Hydrocotisone cream and ointment are preferred to prevent side effects such as skin thinning.

5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).

6.sedative antihistamines are sometimes used to reduce the itch

Prognosis:

1.good to excellent in most cases with phot toxic eruptions

2.good to fair with photo allergic reactions

3.Some patients reacts persistently to light without exposure to an antigen.

How can Photo Dermatitis be prevented?
---------------------------------------------

Photo Dermatitis outbreaks can usually be avoided with some simple precautions.

The following suggestions may help to reduce the severity and frequency of flare-ups when exposed to the sun:

1.use sun screen

2.Avoid drugs or cosmetics which can trigger off photo dermatitis

3.Avoid sweating or overheating

4.Reduce stress

5.Avoid harsh soaps, detergents, and solvents

6.Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)

7.Be aware of any foods that may cause an outbreak and avoid those foods

A Family Doctor's Tale - ADDISON DISEASE

DOC I HAVE ADDISON DISEASE

Addison Disease is a  disease which is caused by the deficiency of  circulating glucocorticoids steroids and mineralocorticoids (aldosterone) hormones as a result of disease of the adrenal glands.

The causes are believed to be:
1. Auto-immune disease of the adrenals with destruction of the adrenal parenchyma is associated with circulating antibodies and decreased production of glucocorticosteroids.

2.Tuberculosis of the adrenal glands

3.Adrenal tumors which may be benign or malignant can reduce production of corticosteroids.

4.Rare causes are metastatic carcinoma, amyloidosis and hemachromatosis

5.Iatrogenic -sudden cessation of chronic corticosteroids or failure to increase therapy in corticosteroid dependent patients undergoing stress, surgery or infection.

Symptoms of Addison Disease are:

A.Acute Addison Crisis
The symptoms are :
1.vomiting


2.abdominal pain


3.back and extremity pain


4.extreme muscle weakness


5.dehydration leading to hypotension


6.shock


7.confusion


8.coma


Addison crisis is fortunately rare

B.Chronic Addison disease:
1.Chronic adrenal hypofunction begins gradually

2.fatique

3.loss of appetite and weight

4.abdominal pain.

5.vomiting

6.dizziness

7.craving for salty food

8.increased pigmentation especially palmar flexures, nipples, genitalia, mouth lining, scars and exposed areas.

9.postural hypotension is common with giddiness

10.occasionally hypoglycemic symptoms may occur in early morning or when a meal is missed

Diagnosis of Addison Disease:
1.The increased pigmentation and loss of weight can suggest the diagnosis of Addison Disease

2.Electrolytes especially sodium is low, potassium and urea nitrogen is high

3.ACTH stimulation test with impaired corticol response is required to confirm diagnosis

4.Plasma adrenal antibodies may be present

5.Chest and abdominal X-rays for tuberculosis

Complications of Addison Disease:
1.coma from Addison's crisis

2.Hypotension

Treatment of Addison Disease:
1.Addison crisis is treated by intravenous normal saline and hydrocortisone 100mg every eight hours
Treatment must be done before laboratory confirmation of
diagnosis because of the danger of coma

2.Chronic Addison disease requires replacement of glucocorticoid:
a.hydrocortisone 30mg daily or
b.cortisone acetate 37.5 mg daily or
c.fludrocortisone 0.05 to 0.2 mg daily

Prognosis of Addison Disease:
The prognosis of Addison Disease is usually very good.

Addison crisis patients have excellent recovery with appropriate treatment

Chronic Addison disease patients also recovered well with replacement therapy.

Care is needed when there is trauma, infection and surgery.

A Family Doctor's Tale - CUSHING SYNDROME

DOC I HAVE CUSHING SYNDROME

Cushing Syndrome is a  disease which is caused by the exposure of the body to excessive quantities of glucocorticoids steroids.

People of all ages are affected but more are seen in females between 30 to 50 years of age.

The causes are believed to be:
1. Cushing Disease -excessive production of adrenocorticotrophin hormone(ACTH) by the pituary gland causes bilateral adrenal(gland above kidney)hyperplasia(overgrowth of gland tissue).The enlarged adrenal gland will produce excessive corticosteroids.
A pituitary basophil or chromphobe adenoma may be present.

2.Adrenal tumors which may be benign or malinant can produce excessive corticosteroids

3.Ectopic ACTH syndrome
Production of ACTH by a tumor such as cancer of the lungd leads to adrenal hyperplasia

4.Iatrogenic -patients receiving excessive doses of corticosteroids may present as Cushing syndrome

Symptoms of Cushing Syndrome:
1.Obesity predominally truncal often with pad of fat between shoulders(buffalo hump)

2.Round flat plethoric(red) face (moon face)

3.Skin is thin and bruises easily

4.Purole striae on abdomen, thighs, and shoulders.

5.Proximal myopathy leads to difficulty in getting out of chairs and walking upstairs

6.Excessive adrenal androgen secretions leads to hirsutism, amenorrhea and acne

7.Osteoporis can lead to back pain

8.Hypertension and glycosuria(glucose in urine) are common

9.Depression and other psychiatric disturbance common

10.In children there may stunting of growth

Diagnosis of Cushing Syndrome:
1.The typical moon face and buffalo hump can suggest the diagnosis of Cushing Syndrome

2.24 hour urine cortisol tests

3.Overnight dexamethasone suppression test

4.Plasma ACTH level

5.Chest X-ray to exclude lung cancer

6.X-ray of pituitary fossa to exclde pituitary tumors

7.Ultrasound of adrenal glands for enlargement

Complications of Cushing Syndrome:
1.Hypertension

2.fractures from osteoporosis

3.stunted growth in children

Treatment of Cushing Syndrome:
1.Anti-sdrenal drug such as aminogluthemide

2.bilateral adrenalectomy

3.Surgery to remove pituitary tumor

4.surgery to remove primary neoplasm in lungs or pancreas

Prognosis of Cushing Syndrome:
The prognosis of Cushing Syndrome varies with cause.

The response is often excellent in cases of pituitary tumor removal. However recurrence of tumor or increase in size of the tumor will affect the prognosis.

Benign adrenal tumors have excellent response to treatment.

Iatrogenic Cushing syndrome often responds well to decreasing doses of corticosteroids.

In cases of lung cancer, treatment may have poor response.

A Family Doctor's Tale - NEPHROTIC SYNDROME

DOC I HAVE NEPHROTIC SYNDROME

Nephrotic Syndrome is a rare disease characterized by the edema(accumulation of fluid in the body) and hypo-albumemia (low blood protein due to protein loss through the kidneys).

The cause is the increased capillary permeability of the glomeruli to plasma protein  due to the inflammation and allows loss of blood and protein in the urine and retention of salt, water and nitrogen.

Loss of negative charges on the filtering membrane allows negatively charged molecules including albumin to enter the urinary tract.

Reduced protein in the blood leads to edema.

There are 3 types of Nephrotic Syndrome:
1.Minimal Change Nephropathy (MCN) occurs in children with very little microscopic changes in the glomerular tissues of the kidney.

2.Focal glomerulonephritis has appearance of MCN above but develop sclerosis of the glomeruli later.

3.Diffuse proliferative glomerulonephritis and membranous nephropathy are more common in adults and be secondary to other diseases such as:


a.SLE and other connective tissues
b.diabetes
c.allergies to drugs such as penicillinamine, tolbutamide, probenecid
d.certain infections
e.cancer (carcinomas and lymhomas)

Symptoms:
1.Urine may show the presence of protein at least 3.5g/day

2.low protein in blood causes decreased plasma mass pressure resulting in retention of water and salts

3.swelling of the face and ankle occurs as a result

4.edema ranges from puffiness of eyes, ascites (water in abdominal cavity), pleural effusions(water in the lungs) to generalized edema

5.With increasing edema and nitrogen retention, headaches, nausea and vomiting may occur.

6.high blood pressure may occur in one third of patients

7.The blood in nephrotic syndrome tend to clot easily and the patient may develop blood clots in his leg veins.

8.Lipids may be raised in the blood especially triglicerides and cholesterol

9.Symptoms and signs of underlying diseases such as diabetes, SLE etc may be present

Diagnosis:
1.A history of recent kidney infection followed by swelling of face ang legs

2.Urinary protein loss of 15g per day

3.Full examination of fresh urine for red blood cells and casts(indicating glomerulonephritis) and lipid

4.Full blood count and tests for kidney function

5.Ultrasound of kidneys

6.Biopsy of kidney and histology of specimen

Complications:
1.Renal failure

2.hemolytic uremic stndrome

Treatment should be in hospital:
1.Minimal change nephropathy in children are treated with high doses of corticosteroids up to 1mg prednisolone per kg per day.
In most cases within 10 days there should be reduction of fluid in the body with increased urinary passage of urine.
Relapses may occur and should be treated with more corticosteroids or cyclophosphamide

2.In adults treatment with corticosteroids should help to treat the edema.

3.In addition thiazide diuretics or frusemide to reduce edema.
Spironolactone and amiloride may also help

4.Hypertension may require anti hypertensive. The use of corticosteroids may aggravate hypertension.

5.Diet with low salt and protein

6.Intake of fluids are restricted
These 2 measures will reduce the strain on the kidneys and prevent accumulation of fluids

Prognosis:
1.In most cases of MCN the illness will clear up with proper treatment.

Some may have relapses.

After 3 years of remission 99% of MCN will not have relapses
MCN cases seldom progress to renal failure.

2.In focal glomerulonephritis cases nephrotic syndrome may develop into chronic renal failure.

3.In Membranous nephropathy
25% complete remission
25% improves in renal function
25% have persistent nephrotic syndrome
25% will have chronic renal failure

A Family Doctor's Tale -GLOMERULONEPHRITIS

DOC I HAVE GLOMERULONEPHRITIS

Glomerulonephritis is a disease characterized by the inflammation of the glomeruli, the filtering units of the kidneys.

The glomeruli are unable to function properly due to the inflammation and allows loss of blood and protein in the urine and retention of salt, water and nitrogen.

Both kidneys are affected usually.

It is not contagious.

The exact cause of Glomerulonephritis is not known.

1.It has been suggested that an autoimmune disease is the main cause of Glomerulonephritis disease.

The antibodies produced by the body to fight germs starts to attack the body's own healthy kidney tissue.

2.Sometimes Glomerulonephritis disease may follow an infection by the streptococcus bacteria or by viruses.

Symptoms of Glomerulonephritis disease:
1.Urine may show the presence of protein, red blood cells, casts.

2.less urine is passed than normal

3.swelling of the face and legs is quite common

4.high blood pressure may occur in rare cases

5.With increasing edema and nitrogen retention, headaches, nausea and vomiting may occur.

Diagnosis of Glomerulonephritis disease is made by:

1.A history of recent infection followed by swelling of face and legs

2.Urine test for blood, protein and casts

3.Full blood count and tests for kidney function

4.Blood Tests for raised ESR,  anti-streptolysin titer, C reactive protein

5.Ultrasound of kidneys

6.Biopsy of kidney if required

Complications of Glomerulonephritis disease are:
1.Nephrotic syndrome

2.hemolytic uremic syndrome

3.renal failure

Treatment of Glomerulonephritis disease is by:
1.Diet with low salt and protein

2.Intake of fluids are restricted
These 2 measures will reduce the strain on the kidneys and prevent accumulation of fluids

3. antibiotics are given if the glomerulonephritis is suspected to be caused by a bacteria

4.hypertension is usually controlled with drugs until the blood pressure returns to normal

5.Corticosteroids and cytotoxic drugs have not been found to be effective against glomerulonephritis

Prognosis of Glomerulonephritis disease:
In most cases the illness will clear up with proper treatment.

In rare cases nephrotic syndrome may develop with ensuing chronic renal failure.

A Family Doctor's Tale - THREADWORMS

DOC I HAVE THREADWORMS


Thread worms are parasitic worms (also called pin worms) which are found in the intestines of children in undeveloped countries.

It is rare in developed countries because of the modern sanitary conditions and better hygiene.

Several members of the same household may be infested at the same time so all the family should be treated together.

The cause of Threadworms infection is:
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations.

When the eggs or larvae are swallowed  they developed into adult worms in the intestines.

The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.


The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.

The main symptoms of Thread worms are
1. Itch in the anal region especially at night when the worms lay the eggs.

2. Itch in the vulva in girls

3. inflammation of the anus as a result of constant scratching.

4.Rarely tiny white worms can be seen wriggling in the feces.

Doctors generally diagnose Thread worms based on:

1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of thread worms

2.Stool examination and culture

Treatment of thread worm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose

2.Pyrantel pamoate 10mg/kg in a single dose

3.Mebendazole 100mg in a single dose

A single dose will usually cure the patient of thread worms but to prevent re-infection a second dosage is taken 2 weeks later.

All the family members should also be treated.

Prevention of thread worms is through:
1.good personal hygiene and hand washing

2. good food hygiene

Prognosis of thread worms treatment is excellent.

A Simple Guide to Giardiasis

A Simple Guide to Giardiasis
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What is Giardiasis?
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Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
What is the cause of Giardiasis?
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The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in  polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
What are symptoms of Giardiasis?
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The main symptoms of Giardiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Giardiasis made?
-----------------------------------------------------
Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Giardiasis?
-------------------------------------------
Giardiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Giardiasis treated?
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Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Giardiasis prevented?
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Prevention of Giardiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Giardiasis?
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Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.