A Simple Guide to Pneumothorax

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

Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.

What are the types of pneumothorax?
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Tension pneumothorax:
-----------------------------

This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.

Non-tension pneumothorax:
-----------------------------

A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.

Hemopneumothorax:
----------------------

When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.

What is the causes of pneumothorax?
---------------------------------------------------

It is most commonly due to:

Spontaneous pneumothorax
-----------------------------

This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:

1.tall young males and in Marfan syndrome

2.Tuberculosis

3.Bronchial obstruction

4.Cancer

Non-spontaneous pneumothorax
--------------------------------

1.penetrating chest wound

2.surgical trauma

3.pleural effusion tap

What are the Signs and symptoms of Pneumothorax?
----------------------------------------------------

Symptoms:
---------------

1.Sudden onset of chest pain, back

2.shortness of breath,

3.dry coughs,

4.cyanosis (turning blue)

5.coma

Signs:
--------------

1.Pale or cyanotic

2.Percussion show resonance at normal lung while none at the pneumothorax lung area

3.Auscultation reveals breath sounds on the normal side but none at the pneumothoracic lung

4.There may be a characteristic clicking sound with respiration.

5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .

6.The flopping sound of the punctured lung can sometimes be heard

How is the Diagnosis of Pneumothorax made?
---------------------------------------------------

Physical examination:
a. absence of audible breath sounds through a stethoscope

b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.

c.Two coins when tapped on the affected side results in a tinkling resonant sound

Chest X-ray reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.

Medistinal shifts can be seen on inspiratory and expiratory films

CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.

What is the complication of Pneumothorax?
------------------------------------------------

Respiratory failure with circulatory collapse

What is the treatment of Pneumothorax?
--------------------------------------------

All pneumothorax patients are to be admitted to hospital for treatment.

1. Small spontaneous pneumothorax
-------------------------------------

A small spontaneous pneumothorax can be left alone to reabsorb on its own.

The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.

2.Tension Pneumothorax
-----------------------------

Tension Pneumothorax is a medical emergency.

Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.

Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.

The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.

The lung should re-expand in the thoracic cavity nad the result is monitored by frequent x-rays

Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.


Penetrating wounds:
---------------------

A chest drain is inserted first before any treatment of the wounds is done.

Supprtive treatment:
------------------------

Oxygen therapy
Rest
Antibiotics for infections
Painkillers for pain


Recurrent pneumothorax
------------------------------

1.pleurodesis may be required in recurrent pneumothorax.

2.bullectomy (the removal or stapling of bullae).

3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.

4.Mechanical pleurodesis The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues

5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery

What is the prognosis of Pneumothorax?
----------------------------------------------

It is usually good following treatment.

However treatment is always needed to address the cause of the underlying diseases causing the pneumothorax.

A Simple Guide to Infectious Mononucleosis

A Simple Guide to Infectious Mononucleosis
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What is Infectious Mononucleosis?
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Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.

What is the cause of Infectious Mononucleosis?
-------------------------------------------------------

The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.

It is more common in young adults.

The incubation period (from contact to illness) is 10-15 days.

It is usually sporadic but may be epidemic.


What are Signs and symptoms of Infectious Mononucleosis?
------------------------------------------------------------------

The triad of symptoms which are common to Infectious Mononucleosis are:

1.Neck and axillary lymph nodes are enlarged

2.Fever with headache

3.sore throat with sometimes extensive tonsillar exudates and swelling

Other symptoms are:

4.fatigue

5.bodyaches

6.jaundice(rare)

Signs:

1.Throat is red and inflamed with enlarged tonsils

2.Pinpoint petechiae at junction of hard and soft palate

3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region

4.Swelling of lacrimal glands and eyelids

5.Spleen is enlarged in 50% of cases

6.Generalized maculopapular rash may occur

Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.

Disease usually lasts for 2-3 weeks.

How is the diagnosis of Infectious Mononucleosis made?
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1.Classical symptoms and signs as above especially lymph nodes enlargement.

2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.

3.Blood for Epstein Barr antibody

3.X-rays of chest and abdomen

4.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.

What are the complications of Infectious Mononucleosis?
---------------------------------------------------------------

1.Obstruction to airway from enlarged lymph nodes

2.thrombopenic purpura

3.myocarditis

4.pericarditis

5.lymphocytic meningitis

6.encephalitis

7.polyneuritis

8.hepatitis

What is the treatment of Infectious Mononucleosis?
------------------------------------------------------------

1.Bed rest in isolation ward

2.Adequate fluids

3.Antipyretic medicines such as paracetamol for fever

3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis

4.High-flow oxygen and tracheostomy in airway obstruction

What is the prognosis of Infectious Mononucleosis?
-----------------------------------------------------------

Prognosis of Infectious Mononucleosis is generally good.

Epstein Barr infections has been associated with nasopharyngeal cancer.

What are the Preventive measures taken for Infectious Mononucleosis?
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Isolation of cases at home or in hospital.

Avoid contacts.

A Simple Guide to Pneumonia

A Simple Guide to Pneumonia
-----------------------------------

What is Pneumonia?
---------------------------

Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.

The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.

Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .

It is one of the top causes of death in the world.


What are the causes of Pneumonia?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.

Viral infections:
--------------------

Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus

Fungal infections:
-----------------------

Cryptococcus neoformans

Non-infectious:
------------------

1.chemicals such as asbestos can damage the lungs and cause pneumonia

2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs

3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.

This occurs in comatose patients and people having seizures or stroke.

What are Signs and symptoms of pneumonia?
---------------------------------------------

Symptoms:

1.cold or runny nose is usually the first symptom

2.Fever is usually high

3.cough with productive purulent sputum which can yellow, green or bloody

4.Breathlessness due to congestion of the lungs

5.chest pain especially the sides of the chest due to coughing and fever

6.Myalgia (bodyaches) and headache which may be related to the fever

7.abdominal discomfort

8.lethargy especially in small children

Signs:

1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs

2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs

3.Reduced breath sounds - air movement is reduced in the lungs

4.Hyporesonance on percussion of the lungs

5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.

This will considered as a medical emergency.

Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness

How is the diagnosis of Pneumonia made?
------------------------------------------

1.Symptoms and signs of fever, breathless and productive cough

2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease

3.Sputum culture to determine the type of micro-organism

4.Chest X-rays to establish site and character of the lung infection

5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.

6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.

What are the complications of Pneumonia?
-----------------------------------------------

1.Pleural effusion

2.septic shock,

3.adult respiratory distress syndrome

4.seizures also more in children

5.Emphysema

6.Pericarditis

What is the treatment of pneumonia?
------------------------------------

1.Hospitalization should be immediate as pneumonia can be a life threatening condition.

2.Antibiotics depending on the organism found:

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

b.cephalosporins, gentamycin for pseudomonas

c.Tetracycline or erythromycin for mycoplasma and chlamydia

d.Erythromycin and rifampicin for Legionaire's disease.

3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection

4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time

3.corticosteroids is useful to reduce complications

4.High-flow oxygen

5.intravenous fluids

What is the prognosis of pneumonia ?
------------------------------------------

This depends on the severity and type of infection.

Most cases if treated early and correctly recovered completely.

The elderly, babies and bedridden has a higher mortality.

What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------

Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.

Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.

Vaccinations are recommended in:

Adults age 65 or older

Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys

2. health problems like diabetes, alcoholism, AIDS

3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy

Normal Pressure Hydrocephalus

A Simple Guide to Normal Pressure Hydrocephalus
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What is Normal Pressure Hydrocephalus?
--------------------------------------------

Normal Pressure Hydrocephalus(NPH) is an abnormal accumulation of cerebrospinal fluid in the cavities of the brain.

Who is at risk of getting Normal Pressure Hydrocephalus?
-------------------------------------------------------------

Normal Pressure Hydrocephalus occurs in adults of 55 years old and above.

The accumulation of cerebrospinal fluid is gradual leading to enlargement of the cavities in the brain called ventricles.

This in turn stretches the nerve tissues of the brain giving rise to 3 main neurological disturbances in the brain which is characteristic of NPH.

What are the causes of Normal Pressure Hydrocephalus?
------------------------------------------------------------

In most cases the cause is unknown.

In the remaining cases, the secondary causes can be found:

1. Brain infection can cause damage to brain tissues and the resulting cell damage can increase fluid in the brain

2. Stroke may damage brain cells resulting in damaged brain tissues and increase fluid in the brain

3. Trauma and head injury may damage brain cells similar to above

4. Brain tumors are another cause of increased fluid in the brain


What are the Symptoms of Normal Pressure Hydrocephalus?
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Onset is slow and gradual but typically the following symptoms are present:

Gait disturbance
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Difficulty in walking or balancing

Cognitive impairment
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mild dementia

Urinary Incontinence
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Problems with bladder control and hence incontinence

How is the diagnosis of Normal Pressure Hydrocephalus confirmed?
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1.History of the above 3 symptoms

2.Physical examination shows the neurological deficits:
difficulty in walking

mild dementia

urinary incontinence

3.MRI of brain shows the presence of enlarged ventricles in the brain

What is the Treatment of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------

NPH cannot be cured but its symptoms can be controlled.

Treatment is by surgery using a shunt to divert the excessive fluid in the brain to the peritoneal cavity.

What are the complications of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------

1. Dementia

2. Disabilty

3. Disturbed urinary and bowel function.

What is the prognosis of Normal Pressure Hydrocephalus?
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With early diagnosis and treatment, symptoms can be partially or fully reversed leading to resumption of a normal life.

With the use of the shunt, symptoms may disappear within days or at most a few months.

There is dramatic improvement in the first week in mild cases.

Some adjustments of the valve are often needed before the correct setting is obtained for the individual.

A Simple Guide to Meningitis

A Simple Guide to Meningitis
-----------------------------------

What is Meningitis?
---------------------------

Meningitis is a serious medical disease which causes inflammation and infection of the meninges which are the protective lining of the spinal cord and brain.

What are the causes of Meningitis?
----------------------------------------

The causes of Meningitis may be divided into:

Infections:
------------
1.viral infections are the most common and are usually mild
(enterovirus, herpes simplex virus 2 and mumps) except for Hand mouth and foot disease(enterovirus EV7)which can cause fatality in children

2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal meningitis can cause outbreaks(spread easily).

E.coli, Group B streptococus and Pseudomonas infection are common in neonates.

Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae are common in infants and children

Streptococcus pneumoniae, N. meningitidis, Mycobacteria are more common in adults.

Mycobacterium tuberculosis meningitis are more common in developing countries and in people whose immune systems are impaired(eg. AIDS) and are preceded by active tuberculosis infections elsewhere.

3.fungi
Cryptococcus neoformans is the most common cause of fungal meningitis

Non-infectious:
------------------

Non infectious causes usually irritates the meninges through inflammation and auto immune reactions:

1.cancers,

2.systemic lupus erythematosus

3.drugs.

4.head injury

5.post neurosurgical procedures


What are Signs and symptoms of Meningitis?
---------------------------------------------

The triad of symptoms which often defines meningitis are:

1.Severe headache

2.Neck rigidity (unable to flex the neck forward),
A positive Kernig's sign means that the neck will painful when one hip is flexed to 90 degrees and the knee flexed to 90 degrees in a patient lying supine.

3.vomiting

Other symptoms are:

4.high fever

5.mental confusion.

6.Malaise

7.photo-phobia (inability to tolerate bright light),

8.phono-phobia (inability to tolerate loud noises),

9.irritability especially in small children

10.seizures .

11.swelling of the fontanelle may be present in infants

12.rash with numerous small, irregular red spots on the body, lower legs, soles of feet, palms

13.ulcers of the mouth (present in hand,mouth and foot disease).

How is the diagnosis of Meningitis made?
------------------------------------------

1.Classical symptoms and signs as above especially neck rigidity

2.blood tests (complete blood count, ESR and blood culture)

3.X-rays of chest and brain

4.cerebrospinal fluid (CSF) analysis via lumbar puncture is examined for white blood cells, red blood cells, protein content, glucose level and micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs)

A pressure of over 180 mm suggests bacterial meningitis.

5.CSF glucose is low,protein high and cells high in bacterial meningitis,
CSF glucose is normal,protein normal and cells high in viral meningitis
CSF glucose is low,protein high and cells high in fungal meningitis

6.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

What are the complications of Meningitis?
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1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome

7.seizures also more in children

8.pneumonia especially in the elderly

What is the treatment of Meningitis?
------------------------------------

1.Hospitalization should be immediate as meningitis is an life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of anti-fungals may be given for Fungal meningitis for a prolonged period of time

3.corticosteroids is useful to reduce complications

4.High-flow oxygen

5.intravenous fluids

What is the prognosis of Meningitis?
------------------------------------------

This depends on the severity and type of infection.

Viral infections except for enterovirus EV7 usually recover quickly.

Bacterial infections such as meningococcus and pneumococcus are more dangerous.

What are the Preventive measures taken for Meningitis?
--------------------------------------------------------

Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis.

Vaccines against type A and C Neisseria meningitidis are used to prevent these types of meningitis especially in those who travel abroad.

Vaccines against type B Neisseria meningitidis have yet to be produced athough a drug company is doing research on the production of this vaccine.

Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumococcal meningitis.

Mumps vaccination as part of Measles, mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis

A Simple Guide to Mastitis

A Simple Guide to Mastitis
-----------------------------


What is Mastitis?
--------------------

Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.

What causes Mastitis?
------------------------

The causes of Mastitis are mostly due:

A.Hormonal:
----------------------

1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.

2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.

3.Premenstrual pain and swelling of breasts may occur

B.Infections:
---------------------

Infections of the breasts may occur due to
1.poor skin hygiene

2.Injuries or wounds allowing microganism to enter the wound

3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.

4.Mastitis may occur as a rare complication of mumps.

5.Most common bacteria infection is staphyloccus aures.

6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis

What are the symptoms of Mastitis?
-------------------------------------

The Symptoms of Mastitis are:

1.Pain usually present in all cases except in babies

2.swelling of the breasts or the nipple area

3.Pus discharge from the nipple

Signs:

1.redness of the nipple or areola

2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.

3.Local tenderness of inflammed area

4.Fever and genral malaise

5.Axillary lymph nodes may be swollen and painful

What are the complications of Mastitis?
------------------------------------

1.Abscess formation

2.Cystic formation

3.Chronic mastitis or fibroadenosis

How is diagnosis of Mastitis confirmed?
------------------------------------------

1. clinical features

2. Mammograms to exclude malignant tumors

3. Ultrasound scan of the breasts

What is the treatment of Mastitis?
------------------------------------

1. antibiotics are given to cure the infections.
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. Painkillers may be given if there is pain

3.Rest and support of the breasts with soft bras

4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.

5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary

6.Reassurance in hormonal cases of mastitis

What is the Prognosis of Mastitis?
------------------------------------

Most cases of mastitis usually will recover with proper treatment.

What are the Preventive measures for Mastitis?
----------------------------------------------------

Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently

A Simple Guide to Hypothyroidism

A Simple Guide to Hypothyroidism
-----------------------------------

What is Hypothyroidism (Underactive Thyroid) ?
------------------------------------------------

Hypothyroidism is a condition caused by insufficient production of the thyroid hormones, usually more common in females.

What are the causes of Hypothyroidism?
-------------------------------------------

Primary causes:
1.Congenital:
Aplasia(no thyroid), Hypoplasia(small thyroid), ectopic(not at normal site) thyroid gland

2.Autoimmune Thyroiditis(hashimoto thyroiditis):
inflammation cause insuffient production of thyroid hormones

3.Iodine deficiency can cause less production of thyroxine

Secondary Causes:
1.Radioactive iodine reduces production of thyroid hormones

2.Excess removal of thyroid gland causes reduced production of thyroid hormones.

3.Hypothyroidism during or after pregnancy.
These women develop antibodies to their own thyroid gland resulting in underproduction of thyroid hormones.

Other rarer causes include
4. radiation treatment for cancers of the head and neck,

5.pituitary problems

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

Symptoms

Congenital Hypothyroidism:
---------------------------

1.puffy face

2.enlarged protruberant tongue

3.hypotonia

4.sluggish reflexes

5.enlarged fontanelle

6.retardation of development

Adult Hypothyroidism:
------------------------

1.Slowness of movement

2.slowness of thought

3.unexplained weight gain

4.cold intolerance

5.dry coarse skin

6.hair loss

7.puffy face

8.menorrhagia

9.constipation

10.depression

11.husky voice

12.bradycardia(slow heart beats)

How is the diagnosis of Hypothyroidism made?
-----------------------------------------------

1.blood test is done for TSH (thyroid stimulating hormone) levels.
TSH is usually high for Hypothyroidism

2.blood test for T4 and T3 levels.
Low levels of T4 and T3 usually means HYpothyroidism

3.Thyroid ultrasound scan for ectopic and congenital hyothyroids

What is the Treatment of Hypothyroidism?
-------------------------------------------

1.Hormone replacement with daily doses of synthetic thyroxine

2.Blood is taken regularly to test the level of TSH.

3.thyroxine dosage is adjusted until there is a normal TSH level.

4.Life long treatment of patients with thyroid hormones

What is the Prognosis of Hypothyroidism?
-------------------------------------------

Dramatic response and very good reaction to treatment occurs in most cases.

Mental retardation and slow physical development occurs in congenital hypothyroidism

A Simple Guide to Hyperthyroid Disease

A Simple Guide to Hyperthyroid Disease
------------------------------------------

What is Hyperthyroid Disease?
---------------------------------

Hyperthyroid disease is a condition when the thyroid gland produces too much thyroid hormones resulting in all the symptoms of excessive metabolism.


What is the cause of Hyperthyroid Disease ?
---------------------------------------------------

Hyperthyroid disease is caused by conditions that increases the output of thyroid hormones:
too much thyroid hormone.

1.Graves' disease - diffuse goiter(enlarged thyroid) caused by autoimmune antibodies stimulation of the thyroid gland to produce more thyroid hormones.
Graves' disease is more common in young women.

2.Plummer's Disease (Toxic nodular thyroid)
Hyperactive thyroid nodules produce excess thyroid hormones especially in older women.

3.Hashimoto's Disease (Thyroiditis) inflammation of the thyroid gland causes production of excess thyroid hormones.

4.Idiopathic Hyperthyroid Disease is caused by ingestion of too much thyroid hormones.


What are the Symptoms of Hyperthyroid Disease?
------------------------------------------------------------

Symptoms:

1.anxiety, shaking, feeling nervous or irritated

2.fast heartbeat or palpitations

3.feeling hot all the time

4.Excess sweating

5.increased appetite

6.loss of weight

7.fatigue, exhaustion

8.increased frequency of bowel movements

9.changes in menstrual periods

10.eye irritation

11.bulging of the eyes

12.double vision

13.blurred vision

Signs:

1. Enlarged thyroid gland -diffuse or nodular

2. Bruit or blood flow sounds may be heard over the thyroid

3. Skin warm and sweaty

4. fine brittle nails

5. fine hair

6. Tachycardia -heart beat may be above 100/min , wide difference between systolic and diastolic pressure

7. Fine tremors of hands

8. Eye : bulging, peri-orbital edema, lid lag


How is diagnosis of Hyperthyroidism made?
-------------------------------------------------------

1. blood test is done for presence of high thyroid hormones(T3 and T4) and low TSH (thyroid stimulating hormone) levels.

2. Blood for thyroid antibodies(thyroiditis)

3. Ultrasound of the thyroid gland

What is the Treatment of Hyperthyroidism?
--------------------------------------------------

1.Anti-thyroid drugs
-------------------------
reduce the production of excess thyroid hormones

The drugs of choice are carbimazole and propylthiouracil initially on high doses then reducing down to a maintenance dose which has to be taken for 1-2 years depending on the severity of the condition.
Symptoms usually improve after 2 months but blood tests are needed to monitor the effect of the drugs.
Side effects include lowering of white cell count and concomitant infection of the throat.
Relapse after 1-2 years treatment are quite common.

2.Radioactive iodine therapy
--------------------------------
is more suitable for older patients and those who do not respond to anti-thyroid drugs and women who do not intend to have pregnancy.

The side effect of radioactive iodine is often radiation side effects which may lead to cancer of the bones 20 years down the road.
The other danger is the destruction of the thyroid producing cells which lead to hypothyroid disease later on.
The patient will then be required to take thyroxine for the rest of her life.

3.Surgery
may be required if the hyperthyroid condition did not improve with anti-thyroid
drugs or if there is frequent recurrences.
It is also done for women who do not wish to go for radioactive iodine therapy and who wishes to have a child later on.

A subtotal thyroidectomy is done.
Usually three quarters of the glands are removed.
Dangers of surgery and anesthesia are as usual rare however there may be removal of too much thyroid gland resulting in hypothyroidism or removal of parathyroid glands resulting in low calcium.
Patient will then need to take thyroxine and calcium replacement tablets for life.

4. Supportive treatment:
a.Propanolol and other beta blockers can slow down the fast heart beats caused by the excess thyroid hormones

b.tranquillizers such as ativan, xanax can help soothe the anxiety or stress in a person with hyperthyroid disease.
Most hyperthyroid disease patients have their excessive thyroid hormones production triggered off by stress and anxiety.

c.rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.


What is the prognosis of Hyperthyroid Disease?
---------------------------------------------------

Most cases of patients treated with surgery and radioactive iodine recovered quite well although many can developed hypothyroidism later on in life when the thyroid hormones production is reduced.

Many cases on anti-thyroid medication usually have recurrence especially if the basic cause of stress and anxiety remains in their work or home life.

What are the prevention measures for hyperthyroid Disease?
--------------------------------------------------------------

Rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.

Avoid stress and anxiety.

A Simple Guide to Pterygium

A Simple Guide to Pterygium
----------------------------------------------------

What is Pterygium?
---------------------------------------

Pterygium is a fleshy tissue that grows in on the inner corner of the eye
towards the pupil.

It may also appear on the outer corner.

It is usually triangular in shape.


Who is affected by Pterygium?
---------------------------------------------------

Pterygium is more common in people who spend time outdoors than indoor

What is the Cause of Pterygium?
-----------------------------------------------------

The exact cause of Pterygium is not known.

1. Long-term exposure to sunlight, especially ultraviolet (UV) rays

2. chronic eye irritation

3. dusty conditions

4. dry eye may contribute to pterygium as well.



What are the Symptoms and signs of Pterygium?
-----------------------------------------------------------

Symptoms varies from mild to severe:

1.discomfort in the eye

2.Conjunctival congestion

3.Tearing -excess tears from irritation

Signs:

1.fleshy growth on the conjunctiva on inner side of eye growing towards pupils

2.increased dilated blood vessels in the fleshy growth


How do you make the Diagnosis of Pterygium?
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The presence of fleshy growth with blood vessels on the conjunctiva on inner side of eye growing towards pupils


What are the complications of Pterygium?
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1.Partial blindness if the pterygium covers the cornea

2.Recurrent irritation and conjunctivitis of eyes.

3.Severe infection of the eye - rare

What is the treatment of Pterygium?
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Treatment depends on the severity:

1.Mild:

Eye drops with anti congestion and anti-inflammatory properties may shrink the blood vessels which provide nourishment for the growth of the pterygium.

2.Severe:

Once the pterygium reaches the cornea and may cover the cornea, surgical resection of the pterygium may be necessary otherwise the eye sight may be compromised.

Surgical resection may also be done if the pterygium is unsightly.

What is the prognosis of Pterygium?
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The prognosis is usually good.

Recurrence is rare but do occur due to regrowth of the blood vessel supplying the pterygium.

This occurs more in younger people.

How is pterygium prevented?
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Wearing UV protective sunglasses

Avoid dry and dusty conditions

Use of artificial tear eye drops