A Simple Guide to Plantar Fascilitis
----------------------------------------------------
What is Plantar Fascilitis?
-----------------------------------------
Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.
It is more common in women.
What are the cause of Plantar Fascilitis?
-----------------------------------------------
The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.
In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.
Both heels can be affected.
What are the symptoms and signs of Plantar Fascilitis?
---------------------------------------------------------------------------------
Symptoms:
1.Pain in the heel of one or both feet
2.Pain usually is worse in the morning on getting and stepping on the floor.
3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse
4.Pain is described as constant and aching
5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.
Signs:
1.local tenderness in the calcaneal bone area of the heel.
2. Pain is aggravated by direct pressure.
3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.
4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.
A stress fracture may need to be ruled out in chronic cases.
What is the Treatment of Plantar Fascilitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the heel-avoid jogging or strenous exercises
2.Cold or ice may help reduce inflammation
3.Heel cups, cushions, tapes, pads may help to reduce the pain
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.
7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.
8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.
Mobilisation phase:
Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain
Surgery is usually not indicated in plantar fascilitis.
Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.
What is the prognosis of Plantar Fascilitis?
----------------------------------------------------------
Prognosis is usually good although healing is slow and takes up to 1-2 years.
What is the prevention of Plantar Fascilitis?
-------------------------------------------------
Avoid certain weight bearing exercises like jogging or brisk walking
Use heel cups, cushions, tapes, pads in foot wear
Lose Weight
Saturday, July 26, 2008
Thursday, July 24, 2008
A Simple Guide to Knee cap Dislocation
A Simple Guide to Knee cap Dislocation
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.
What are the causes of Knee cap Dislocation?
----------------------------------------------------------------------
1.Dislocated knee caps most often occur in people with loose joint ligaments.
It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.
2.Dislocation of the knee cap may also occur due to trauma.
A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.
3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.
This condition is usually inherited and are more common in women than in men.
What are the symptoms and signs of Knee cap Dislocation?
-------------------------------------------------------------------
Symptoms:
1.Knee cap is displaced to the lateral position
2.knee swelling and effusion due to displacement of the knee cap.
3.Knee pain and tenderness is present.
4.The knee is usually held in slight flexion.
5.There is difficulty in lifting the leg
6. Patient usually walks with a limp.
Signs:
1.Tenderness and swelling of the knee
2.Knee cap is displaced to the outside or lateral part of the knee
3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.
4.The knee cap can move excessively from right to left.(hypermobile)
How to investigate the cause of Knee cap Dislocation?
-------------------------------------------------------------
1.examination of the knee would confirm presence of the dislocated knee cap.
There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.
2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.
A skyline view of the knee should show the shift of the patella laterally.
3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.
What is the Treatment of Knee cap Dislocation?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.
The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)
Gentle pressure is exerted on the knee cap to place it to its normal position.
The knee is then immobilized for 2-3 weeks.
Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
Surgery is required if:
1.the knee remains unstable
2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.
Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.
What is the prognosis of Knee cap Dislocation?
----------------------------------------------------------
Prognosis using conservative methods is fair.
Recurrences are quite common.
Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.
Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.
What is the Prevention of Knee cap Dislocation?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.
What are the causes of Knee cap Dislocation?
----------------------------------------------------------------------
1.Dislocated knee caps most often occur in people with loose joint ligaments.
It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.
2.Dislocation of the knee cap may also occur due to trauma.
A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.
3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.
This condition is usually inherited and are more common in women than in men.
What are the symptoms and signs of Knee cap Dislocation?
-------------------------------------------------------------------
Symptoms:
1.Knee cap is displaced to the lateral position
2.knee swelling and effusion due to displacement of the knee cap.
3.Knee pain and tenderness is present.
4.The knee is usually held in slight flexion.
5.There is difficulty in lifting the leg
6. Patient usually walks with a limp.
Signs:
1.Tenderness and swelling of the knee
2.Knee cap is displaced to the outside or lateral part of the knee
3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.
4.The knee cap can move excessively from right to left.(hypermobile)
How to investigate the cause of Knee cap Dislocation?
-------------------------------------------------------------
1.examination of the knee would confirm presence of the dislocated knee cap.
There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.
2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.
A skyline view of the knee should show the shift of the patella laterally.
3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.
What is the Treatment of Knee cap Dislocation?
----------------------------------------------------------------
Conservative treatment:
-----------------------
1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.
The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)
Gentle pressure is exerted on the knee cap to place it to its normal position.
The knee is then immobilized for 2-3 weeks.
Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
Surgery is required if:
1.the knee remains unstable
2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.
Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.
What is the prognosis of Knee cap Dislocation?
----------------------------------------------------------
Prognosis using conservative methods is fair.
Recurrences are quite common.
Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.
Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.
What is the Prevention of Knee cap Dislocation?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
Tuesday, July 22, 2008
A Simple Guide to Frozen Shoulder
A Simple Guide to Frozen Shoulder
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.
It tends to be chronic and full recovery may take several months.
It is more common in women and diabetes.
Incidence is about 2 in a 1000.
What are the causes of Frozen Shoulder?
-----------------------------------------------
The exact cause is unknown but several conditions has been blamed:
1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements
2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement
3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles
4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.
5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.
What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------
Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.
There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.
There is also reduced fluid in the joint further restricting movement.
Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.
This lasts 5 weeks to 9 months.
Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.
This lasts 4 -9 months.
Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.
This lasts 5 -26 months.
What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------
Symptoms:
1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm
2.Pain usually is worse at night especially lying on the affected shoulder
3.Certain movements makes the pain worse
4.Pain is described as constant, dull and aching
5.complaints of stiffness of the shoulder
6.inability to wear a shirt or blouse because of restricted movements
Signs:
1.apprehensive patient who holds the arm protectively
2.Generalised tenderness of rotator cuff and biceps muscles
3.Limited shoulder movement
4.Range of muscle movement is reduced in all directions
5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..
What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder
2.moist heat
3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
4.Muscle relaxant to relax muscles
5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.
Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy
2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder
Maintenance phase:
1.Continual exercises of the shoulder muscles
2.Avoidance of strain on the muscles of the shoulder
Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.
Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.
What is the prognosis of Frozen Shoulder?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.
It tends to be chronic and full recovery may take several months.
It is more common in women and diabetes.
Incidence is about 2 in a 1000.
What are the causes of Frozen Shoulder?
-----------------------------------------------
The exact cause is unknown but several conditions has been blamed:
1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements
2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement
3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles
4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.
5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.
What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------
Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.
There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.
There is also reduced fluid in the joint further restricting movement.
Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.
This lasts 5 weeks to 9 months.
Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.
This lasts 4 -9 months.
Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.
This lasts 5 -26 months.
What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------
Symptoms:
1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm
2.Pain usually is worse at night especially lying on the affected shoulder
3.Certain movements makes the pain worse
4.Pain is described as constant, dull and aching
5.complaints of stiffness of the shoulder
6.inability to wear a shirt or blouse because of restricted movements
Signs:
1.apprehensive patient who holds the arm protectively
2.Generalised tenderness of rotator cuff and biceps muscles
3.Limited shoulder movement
4.Range of muscle movement is reduced in all directions
5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..
What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder
2.moist heat
3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
4.Muscle relaxant to relax muscles
5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.
Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy
2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder
Maintenance phase:
1.Continual exercises of the shoulder muscles
2.Avoidance of strain on the muscles of the shoulder
Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.
Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.
What is the prognosis of Frozen Shoulder?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
Monday, July 21, 2008
A Simple Guide to Dandruff
A Simple Guide to Dandruff
--------------------------------
What is Dandruff?
------------------------
Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.
As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.
What are the Causes of Dandruff?
----------------------------------
The cause of Dandruff is not completely known but are related to three possible factors:
1.Excessive sebaceous or oil gland secretions from the skin
2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.
3. allergic reaction to chemicals in hair oils, cream or gel
Certain oily foods may trigger the production of dandruff
Stress has been known to trigger off dandruff
What are the symptoms of Dandruff?
-------------------------------------
Onset is usually gradual.
Symptoms:
1.Flaking of scales from the scalp.
2.Itchiness of the scalp
3.Redness of the skin on scalp, forehead and eyebrows
Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.
2.The surface consists of dry scales which can be rubbed off
3.Sometimes the lesions can become crusted
4.Some lesions may become purulent with yellow exudate.
What is the Treatment of Dandruff?
-----------------------------------------
1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.
2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.
3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.
4.General hair hygiene -
shampoo hair daily
Avoid too strong hair cream or gels
What is the prognosis of Dandruff?
------------------------------------
Generally good with treatment.
However recurrences are not uncommon.
General hair hygiene is important.
--------------------------------
What is Dandruff?
------------------------
Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.
As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.
What are the Causes of Dandruff?
----------------------------------
The cause of Dandruff is not completely known but are related to three possible factors:
1.Excessive sebaceous or oil gland secretions from the skin
2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.
3. allergic reaction to chemicals in hair oils, cream or gel
Certain oily foods may trigger the production of dandruff
Stress has been known to trigger off dandruff
What are the symptoms of Dandruff?
-------------------------------------
Onset is usually gradual.
Symptoms:
1.Flaking of scales from the scalp.
2.Itchiness of the scalp
3.Redness of the skin on scalp, forehead and eyebrows
Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.
2.The surface consists of dry scales which can be rubbed off
3.Sometimes the lesions can become crusted
4.Some lesions may become purulent with yellow exudate.
What is the Treatment of Dandruff?
-----------------------------------------
1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.
2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.
3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.
4.General hair hygiene -
shampoo hair daily
Avoid too strong hair cream or gels
What is the prognosis of Dandruff?
------------------------------------
Generally good with treatment.
However recurrences are not uncommon.
General hair hygiene is important.
Friday, July 18, 2008
A Simple Guide to Hyperhidrosis
A Simple Guide to Hyperhidrosis
---------------------------------
What is Hyperhidrosis?
----------------------
Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.
This may cause a social problem in people who need to shake hands or write with sweaty palms.
Excess perspiration with foul odor may also be offensive to people around the patient
What are the causes of Hyperhidrosis?
---------------------------------------
The cause of Hyperhidrosis is usually unknown.
It has been linked to :
1.excessive sweat glands
2.psychogenic excess production of sweats under stress and nervous conditions
3.Endocrine disorder such as hyperthyroidism
4.Skin diseases with increased hydration of skin such as in weeping eczema
5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis
6.diseases of the nervous system
7.Tuberculosis-night sweats are a typical feature of tuberculosis
8.diabetes mellitus and pituitary disorders
9.Certain medicines such as aspirin, paracetamol may provoke excess sweating
10.alcohol, caffiene, and certain food(spices) may stimulate the sweat glands
What are the symptoms and signs of Hyperhidrosis?
-------------------------------------------------------
Persons who has Hyperhidrosis has the following:
Symptoms:
1.Genralised sweating
2.localised sweating of palms, soles, axilla and groins
3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection
Signs:
1.Skin may become thickened, fissured or scaly
2.Nail deformities may occur
3.Secondary bacterial and fungal infections may be present
How do you diagnose Hyperhidrosis?
-------------------------------------------
Diagnosis can usually be made by :
1.Sweaty palms or soles
2.thickened, fissured skin with nail deformities
What is the treatment of Hyperhidrosis?
------------------------------------------------
1.Treat the underlying cause such as hyperthyroidism, diabetes
2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.
3.Wear cotton socks and underwear and change daily.
4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea.
Some side effects may be allergic dermatitis or staining of skin
5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing
6.Surgery in severe cases may be required such as sympathectomy (for palms).
Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating
7.Iontophoresis: may help but may be painful
8.Botox injection may disable the sympathetic nerves to the sweat glands amy lasts for 6-9 months
9.Hypnosis, relaxation and meditation has help to certain extent
10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.
What is the prognosis of Hyperhidrosis?
----------------------------------------
Prognosis is usually palliative as the sweat glands and nerve cells may grow back.
Recurrence is quite common.
---------------------------------
What is Hyperhidrosis?
----------------------
Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.
This may cause a social problem in people who need to shake hands or write with sweaty palms.
Excess perspiration with foul odor may also be offensive to people around the patient
What are the causes of Hyperhidrosis?
---------------------------------------
The cause of Hyperhidrosis is usually unknown.
It has been linked to :
1.excessive sweat glands
2.psychogenic excess production of sweats under stress and nervous conditions
3.Endocrine disorder such as hyperthyroidism
4.Skin diseases with increased hydration of skin such as in weeping eczema
5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis
6.diseases of the nervous system
7.Tuberculosis-night sweats are a typical feature of tuberculosis
8.diabetes mellitus and pituitary disorders
9.Certain medicines such as aspirin, paracetamol may provoke excess sweating
10.alcohol, caffiene, and certain food(spices) may stimulate the sweat glands
What are the symptoms and signs of Hyperhidrosis?
-------------------------------------------------------
Persons who has Hyperhidrosis has the following:
Symptoms:
1.Genralised sweating
2.localised sweating of palms, soles, axilla and groins
3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection
Signs:
1.Skin may become thickened, fissured or scaly
2.Nail deformities may occur
3.Secondary bacterial and fungal infections may be present
How do you diagnose Hyperhidrosis?
-------------------------------------------
Diagnosis can usually be made by :
1.Sweaty palms or soles
2.thickened, fissured skin with nail deformities
What is the treatment of Hyperhidrosis?
------------------------------------------------
1.Treat the underlying cause such as hyperthyroidism, diabetes
2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.
3.Wear cotton socks and underwear and change daily.
4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea.
Some side effects may be allergic dermatitis or staining of skin
5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing
6.Surgery in severe cases may be required such as sympathectomy (for palms).
Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating
7.Iontophoresis: may help but may be painful
8.Botox injection may disable the sympathetic nerves to the sweat glands amy lasts for 6-9 months
9.Hypnosis, relaxation and meditation has help to certain extent
10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.
What is the prognosis of Hyperhidrosis?
----------------------------------------
Prognosis is usually palliative as the sweat glands and nerve cells may grow back.
Recurrence is quite common.
Thursday, July 17, 2008
A Simple Guide to Prolapsed Intervertebral Disc
A Simple Guide to Prolapsed Intervertebral Disc
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).
It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.
What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------
1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.
2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.
3.Spinal tumour rarely pushes the disc out of its intervertebral space
What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------
Symptoms:
1.Low Backache with pain in the lumbar region
2.Sciatica or pain shooting down 1 leg
3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing
4.Pain may so bad that the person cannot stand erect.
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Muscle spasm especially spinal extensor muscles
2.Movement of the back and affected led painful and restricted
3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side
4.Straight leg raising test is usually restricted on the affected side.
5.Neurological signs such as paraesthesia commonly present on the affected side.
6.Sensory and motor deficit may be present in the affected side
7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished
L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes
S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished
How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------
1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,
2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test
3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,
4.MRI of spine for slipped disc
5.bone scan for osteoporosis
A definite diagnosis can then be made and the cause of the pain treated.
What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy
Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles
Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain
Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI
Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc
Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.
What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------
Prognosis depends on the underlying cause.
Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.
What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).
It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.
What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------
1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.
2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.
3.Spinal tumour rarely pushes the disc out of its intervertebral space
What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------
Symptoms:
1.Low Backache with pain in the lumbar region
2.Sciatica or pain shooting down 1 leg
3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing
4.Pain may so bad that the person cannot stand erect.
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Muscle spasm especially spinal extensor muscles
2.Movement of the back and affected led painful and restricted
3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side
4.Straight leg raising test is usually restricted on the affected side.
5.Neurological signs such as paraesthesia commonly present on the affected side.
6.Sensory and motor deficit may be present in the affected side
7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished
L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes
S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished
How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------
1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,
2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test
3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,
4.MRI of spine for slipped disc
5.bone scan for osteoporosis
A definite diagnosis can then be made and the cause of the pain treated.
What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy
Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles
Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back
Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain
Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI
Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc
Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.
What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------
Prognosis depends on the underlying cause.
Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.
What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
Tuesday, July 15, 2008
A Simple guide to Anal Fistula
A Simple guide to Anal Fistula
-------------------------------------
What is Anal Fistula?
----------------------------
Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.
There may be several external openings but only one internal opening
What is the cause of Anal Fistula?
------------------------------------------
Anal Fistula usually result from :
1.breakdown of anorectal abscesses
2.follows surgery for anal fissure
3.Less common causes are:
lymphogranuloma
carcinoma of rectum
ulcerative colitis,
regional ileitis
tuberculosis
What are the symptoms of Anal Fistula?
------------------------------------------------
1.pain especially on sitting down
2.purulent painless discharge(pus) near the anus
3.Recurrent perianal abscesses(pockets of pus around the anus)
4.pruritis ani(itch in anus)
How are Anal Fistula diagnosed?
-----------------------------------------
1.thorough examination of the perianal region
2.Rectal examination and palpation of the fistula track
3.Pass a probe through the perianal opening to determine the length of the track
4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine
5.Barium enema to exclude any ulcerative colitis and regional ileitis
What is the treatment of Anal Fistula?
------------------------------------------
There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter
2.Low level fistulas are below the levator ani and are more common.
Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)
Treatment of high level fistula:
1.open the track from within the ischiorectal fossa
2.colostomy may be necessary for multiple fistulas or very high internal opening
General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes
What is the prognosis of Anal Fistula?
----------------------------------------
Good with surgery.
Rarely there may undesirable complication like rectal incontinence.
-------------------------------------
What is Anal Fistula?
----------------------------
Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.
There may be several external openings but only one internal opening
What is the cause of Anal Fistula?
------------------------------------------
Anal Fistula usually result from :
1.breakdown of anorectal abscesses
2.follows surgery for anal fissure
3.Less common causes are:
lymphogranuloma
carcinoma of rectum
ulcerative colitis,
regional ileitis
tuberculosis
What are the symptoms of Anal Fistula?
------------------------------------------------
1.pain especially on sitting down
2.purulent painless discharge(pus) near the anus
3.Recurrent perianal abscesses(pockets of pus around the anus)
4.pruritis ani(itch in anus)
How are Anal Fistula diagnosed?
-----------------------------------------
1.thorough examination of the perianal region
2.Rectal examination and palpation of the fistula track
3.Pass a probe through the perianal opening to determine the length of the track
4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine
5.Barium enema to exclude any ulcerative colitis and regional ileitis
What is the treatment of Anal Fistula?
------------------------------------------
There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter
2.Low level fistulas are below the levator ani and are more common.
Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)
Treatment of high level fistula:
1.open the track from within the ischiorectal fossa
2.colostomy may be necessary for multiple fistulas or very high internal opening
General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes
What is the prognosis of Anal Fistula?
----------------------------------------
Good with surgery.
Rarely there may undesirable complication like rectal incontinence.
Monday, July 14, 2008
A Simple Guide to Sciatica
A Simple Guide to Sciatica
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.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 Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.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 Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
Friday, July 11, 2008
A Simple Guide to Trigeminal Neuralgia
A Simple Guide to Trigeminal Neuralgia
-----------------------------------------------
What is Trigeminal Neuralgia?
--------------------------------------
Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.
It is a rare codition affecting more women than men.
It is more common at the age of 60 years and above.
What are the causes of Trigeminal Neuralgia?
----------------------------------------------------
Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)
2.Trauma- injury to the trigeminal nerve
3.Tumours- compressing the trigeminal nerve
4.Infections-meningeal inflammation of the trigeminal nerve
5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.
6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.
What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------
Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.
There may be recurrent stabs of pain or spontaneous exacerbations of pain.
It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).
Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.
Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.
Pain is unilateral (rarely bilateral).
Pain may occur several times a day.
It rarely occurs at night.
There are certain triggers which can spark off an attack:
-----------------------------------------------------------
Light touch at the trigger zone such as the lips is the most provocative.
Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing
Pain causes brief muscle spasm of the facial muscles, inducing the tic.
Signs:
---------
Physical examination findings are normal.
A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.
A careful examination of the cranial nerves must be done, including the corneal reflex.
Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.
What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------
1.Blood for infections such as meningitis,
2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.
What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------
Medications:
----------------
1.Carbamazepine is the most effective medical treatment.
2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.
3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.
4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.
They can depress the sensitivity of the nerve and relax the muscle.
Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.
Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.
2.anesthetic blocks of the trigeminal ganglion.
3.decompression of trigeminal root entry of impinging vascular structures.
4.Surgical division of the affected branch of the nerve.
What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------
80% of patients respond well to carbamazepine but recurrences and exacerbations are common.
Surgery is usually effective but may leave permanent neurological deficit.
Trigeminal Neuralgia is not life threatening.
-----------------------------------------------
What is Trigeminal Neuralgia?
--------------------------------------
Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.
It is a rare codition affecting more women than men.
It is more common at the age of 60 years and above.
What are the causes of Trigeminal Neuralgia?
----------------------------------------------------
Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)
2.Trauma- injury to the trigeminal nerve
3.Tumours- compressing the trigeminal nerve
4.Infections-meningeal inflammation of the trigeminal nerve
5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.
6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.
What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------
Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.
There may be recurrent stabs of pain or spontaneous exacerbations of pain.
It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).
Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.
Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.
Pain is unilateral (rarely bilateral).
Pain may occur several times a day.
It rarely occurs at night.
There are certain triggers which can spark off an attack:
-----------------------------------------------------------
Light touch at the trigger zone such as the lips is the most provocative.
Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing
Pain causes brief muscle spasm of the facial muscles, inducing the tic.
Signs:
---------
Physical examination findings are normal.
A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.
A careful examination of the cranial nerves must be done, including the corneal reflex.
Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.
What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------
1.Blood for infections such as meningitis,
2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.
What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------
Medications:
----------------
1.Carbamazepine is the most effective medical treatment.
2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.
3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.
4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.
They can depress the sensitivity of the nerve and relax the muscle.
Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.
Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.
2.anesthetic blocks of the trigeminal ganglion.
3.decompression of trigeminal root entry of impinging vascular structures.
4.Surgical division of the affected branch of the nerve.
What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------
80% of patients respond well to carbamazepine but recurrences and exacerbations are common.
Surgery is usually effective but may leave permanent neurological deficit.
Trigeminal Neuralgia is not life threatening.
Wednesday, July 9, 2008
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.
-----------------------------------------
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.
Sunday, July 6, 2008
A Simple Guide to Adenoiditis
A Simple Guide to Adenoiditis
----------------------------------------------
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.
----------------------------------------------
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.
Thursday, July 3, 2008
A Simple Guide to Amenorrhea
A Simple Guide to Amenorrhea
---------------------------------
What is Amenorrhea?
--------------------------
Amenorrhea is a symptom defined as absence of menstruation.
What are the types of Amenorrhea?
------------------------------------
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
---------------------------------
What is Amenorrhea?
--------------------------
Amenorrhea is a symptom defined as absence of menstruation.
What are the types of Amenorrhea?
------------------------------------
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
Wednesday, July 2, 2008
A Simple Guide to Uterine Fibroids
A Simple Guide to Uterine Fibroids
------------------------------------------
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?
-------------------------------------------------
1.sarcoma
2.degeneration
3.necrobiosis
4.cystic degeneration
5.torsion of pendunculated fibroid
What is the Treatment for Uterine Fibroids?
----------------------------------------------------------
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.
------------------------------------------
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?
-------------------------------------------------
1.sarcoma
2.degeneration
3.necrobiosis
4.cystic degeneration
5.torsion of pendunculated fibroid
What is the Treatment for Uterine Fibroids?
----------------------------------------------------------
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.
Monday, June 30, 2008
A Simple Guide to Salpingitis
A Simple Guide to Salpingitis
------------------------------
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
------------------------------
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
Sunday, June 29, 2008
A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)
A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)
--------------------------------------------------------------------------
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
--------------------------------------------------------------------------
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
Wednesday, June 25, 2008
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
-----------------------------------
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
Saturday, June 21, 2008
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
----------------------------------------------------
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
Wednesday, June 18, 2008
A Simple Guide to Pancreatic Cancer
A Simple Guide to Pancreatic Cancer
----------------------------------------
What is Pancreatic Cancer?
------------------------------
Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.
What are the causes of Pancreatic Cancer?
-----------------------------------------
1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells
2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells
3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer
4.Chronic pancreatitis has been found to have some causal effect
5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer
6.Occupational exposure to certain chemicals including insecticides
7.Family history -there is a family history in 5-10% of pancreatic cancer patients
8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract
What are the symptoms and signs of Pancreatic Cancer?
-------------------------------------------------------
Symptoms - non-specific and varied.
1.pain in the upper abdomen that typically radiates to the back
2.pain relieved by leaning forward
3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)
4.depression is sometimes associated with pancreatic cancer
Signs:
1.tenderness in upper abdomen
2.mass in the abdomen
3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.
How do you diagnose Pancreatic Cancer?
----------------------------------------------
Diagnosis can usually be made by :
History
-----------
1.pain in upper abdomen radiating straight to the back, worse on eating
2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.
3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later
4.onset of atypical diabetes mellitus
5.unexplained recent thrombophlebitis
6.past history of pancreatitis
Location of cancer
-----------------------
1.Tumors in the pancreatic body or tail usually present with pain and weight loss
2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.
Courvoisier sign
-----------------
presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer
Liver function tests
---------------------
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).
CA19-9 (carbohydrate antigen 19.9)
----------------------------------
is a tumor marker that is frequently elevated in pancreatic cancer.
Ultrasound or abdominal CT
------------------------------
may be used to identify tumors.
Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.
What is the treatment of Pancreatic Cancer?
------------------------------------------------
Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.
Surgery
--------------
1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.
2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy
3.localized tumors of the pancreas have been surgically removed using laparoscopy.
4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.
5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.
Chemotherapy
-----------------
is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life
Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer
Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.
Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.
Radiation therapy
--------------------
The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.
What is the Prognosis of pancreatic cancer?
-------------------------------------------------
The prognosis of pancreatic cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 3-4 months;
3.5-year survival is lower than 5%.
4.Pancreatic cancer has the highest mortality of all the cancers.
5.Pancreatic cancer may sometimes cause diabetes.
How to prevent Pancreatic Cancer?
----------------------------------------
1.a healthy lifesyle
2.increase consumption of fruits, vegetables
3.reduce red meat intake
4.Vitamin D can reduce the risk of pancreatic cancer
5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer
6.Avoid smoking and drinking of alcohol
----------------------------------------
What is Pancreatic Cancer?
------------------------------
Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.
What are the causes of Pancreatic Cancer?
-----------------------------------------
1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells
2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells
3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer
4.Chronic pancreatitis has been found to have some causal effect
5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer
6.Occupational exposure to certain chemicals including insecticides
7.Family history -there is a family history in 5-10% of pancreatic cancer patients
8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract
What are the symptoms and signs of Pancreatic Cancer?
-------------------------------------------------------
Symptoms - non-specific and varied.
1.pain in the upper abdomen that typically radiates to the back
2.pain relieved by leaning forward
3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)
4.depression is sometimes associated with pancreatic cancer
Signs:
1.tenderness in upper abdomen
2.mass in the abdomen
3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.
How do you diagnose Pancreatic Cancer?
----------------------------------------------
Diagnosis can usually be made by :
History
-----------
1.pain in upper abdomen radiating straight to the back, worse on eating
2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.
3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later
4.onset of atypical diabetes mellitus
5.unexplained recent thrombophlebitis
6.past history of pancreatitis
Location of cancer
-----------------------
1.Tumors in the pancreatic body or tail usually present with pain and weight loss
2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.
Courvoisier sign
-----------------
presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer
Liver function tests
---------------------
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).
CA19-9 (carbohydrate antigen 19.9)
----------------------------------
is a tumor marker that is frequently elevated in pancreatic cancer.
Ultrasound or abdominal CT
------------------------------
may be used to identify tumors.
Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.
What is the treatment of Pancreatic Cancer?
------------------------------------------------
Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.
Surgery
--------------
1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.
2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy
3.localized tumors of the pancreas have been surgically removed using laparoscopy.
4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.
5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.
Chemotherapy
-----------------
is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life
Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer
Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.
Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.
Radiation therapy
--------------------
The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.
What is the Prognosis of pancreatic cancer?
-------------------------------------------------
The prognosis of pancreatic cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 3-4 months;
3.5-year survival is lower than 5%.
4.Pancreatic cancer has the highest mortality of all the cancers.
5.Pancreatic cancer may sometimes cause diabetes.
How to prevent Pancreatic Cancer?
----------------------------------------
1.a healthy lifesyle
2.increase consumption of fruits, vegetables
3.reduce red meat intake
4.Vitamin D can reduce the risk of pancreatic cancer
5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer
6.Avoid smoking and drinking of alcohol
Sunday, June 15, 2008
A Simple Guide to Pancreatitis
A Simple Guide to Pancreatitis
------------------------------
What is Pancreatitis?
----------------------
Pancreatitis is an acute or chronic inflammation of the pancreas.
What are the causes of Pancreatitis?
-----------------------------------------
Pancreatitis is usually caused by the following:
1. Alcoholism and diseases of the biliary tract
2. bacterial infections from salmonella typhi and streptococcus
3. viral infection especially mumps, coxsackie virus, cytomegalovirus
4. trauma
Chronic disease follows attacks of acute infection.
What are the symptoms and signs of Pancreatitis?
-------------------------------------------------------
Persons who has Acute Pancreatitis has the following symptoms:
1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.
2.Pain usually very severe occuring a large meal or drinking bout
3.Pain is worse lying supine, therefore patients sit or lean forward
4.mild fever and bodyaches
5.nausea and vomitting
6.hypotension followed by clinical shock
Signs:
1.Tenderness at the epigastrium with muscle spasm
2.Distension and diminished bowel sounds
3.Pleural effusion 10%,abdominal mass 20%, ascites 20%
4. Acute renal failure, respiratory failure following shock.
Chronic Pancreatitis
---------------------
Symptoms:
1.repeated attacks of epigastric abdominal pain
2.Pain worse after eating, radiates to the back
3.weight loss
4.Fever
Signs:
1.abdominal tenderness
2.abdominal mass may suggest swelling and pseudocysts
3.tender subcutaneous masses seen indicating fat necrosis
How do you diagnose Pancreatitis?
--------------------------------
Diagnosis can usually be made by :
1.Physical examination with tenderness in the epigastrium
2.Serum and urine amylase very high after 6 hours
3.White blood cell count high
4.Serum lipase high in 50% patients
5.Blood calcium may be low
6.Blood glucose tolerance test for diabetes
7.Ultrasound may show up the presence of pseudocyst in pancreas
8.CAT scan and MRI may show swelling and pseudocysts in pancreas
What is the complications of Pancreatitis?
-------------------------------------
1.Pseudocysts from damage to pancreatic tissues
2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas
3.peritonitis from rupture of pseudocysts and bleeding
4.diabetes mellitus from damage to the glands in the pancreas producing insulin
What is the treatment of Pancreatitis?
-------------------------------------
Acute Pancreatitis:
----------------------
Admission to hospital
Gastric suction and fluid replacement
Analgesic or antispasmodic medicine usually by injection
Antibiotics for infections
Treat biliary tract diseases and alcoholism
surgical drainage of pseudocysts after acute episode.
Chronic Pancreatitis:
-----------------------
Pancreatic extracts and enzymes together with meals
Sodium bicarbonate and cimetidine to prevent enzymes breakdown
Analgesic or antispasmodic medicine usually by injection
Surgical procedures usually unsuccessful
What is the prognosis of Pancreatitis?
----------------------------------------
Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.
Hemorhagic Pancreatitis has high mortality of 50-90%
Most trauma cases has complete resolution
Some alcoholic pancreatitis may go on to chronic pancreatitis.
Chronic pancreatitis relapses frequently
Rupture of pseudocysts may result in death
How do you prevent Pancreatitis?
------------------------------------------------
Avoid alcohol and oily food
Take precautions during mumps and other viral infection
Avoid injury to the abdomen especially the mid section below the sternum
------------------------------
What is Pancreatitis?
----------------------
Pancreatitis is an acute or chronic inflammation of the pancreas.
What are the causes of Pancreatitis?
-----------------------------------------
Pancreatitis is usually caused by the following:
1. Alcoholism and diseases of the biliary tract
2. bacterial infections from salmonella typhi and streptococcus
3. viral infection especially mumps, coxsackie virus, cytomegalovirus
4. trauma
Chronic disease follows attacks of acute infection.
What are the symptoms and signs of Pancreatitis?
-------------------------------------------------------
Persons who has Acute Pancreatitis has the following symptoms:
1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.
2.Pain usually very severe occuring a large meal or drinking bout
3.Pain is worse lying supine, therefore patients sit or lean forward
4.mild fever and bodyaches
5.nausea and vomitting
6.hypotension followed by clinical shock
Signs:
1.Tenderness at the epigastrium with muscle spasm
2.Distension and diminished bowel sounds
3.Pleural effusion 10%,abdominal mass 20%, ascites 20%
4. Acute renal failure, respiratory failure following shock.
Chronic Pancreatitis
---------------------
Symptoms:
1.repeated attacks of epigastric abdominal pain
2.Pain worse after eating, radiates to the back
3.weight loss
4.Fever
Signs:
1.abdominal tenderness
2.abdominal mass may suggest swelling and pseudocysts
3.tender subcutaneous masses seen indicating fat necrosis
How do you diagnose Pancreatitis?
--------------------------------
Diagnosis can usually be made by :
1.Physical examination with tenderness in the epigastrium
2.Serum and urine amylase very high after 6 hours
3.White blood cell count high
4.Serum lipase high in 50% patients
5.Blood calcium may be low
6.Blood glucose tolerance test for diabetes
7.Ultrasound may show up the presence of pseudocyst in pancreas
8.CAT scan and MRI may show swelling and pseudocysts in pancreas
What is the complications of Pancreatitis?
-------------------------------------
1.Pseudocysts from damage to pancreatic tissues
2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas
3.peritonitis from rupture of pseudocysts and bleeding
4.diabetes mellitus from damage to the glands in the pancreas producing insulin
What is the treatment of Pancreatitis?
-------------------------------------
Acute Pancreatitis:
----------------------
Admission to hospital
Gastric suction and fluid replacement
Analgesic or antispasmodic medicine usually by injection
Antibiotics for infections
Treat biliary tract diseases and alcoholism
surgical drainage of pseudocysts after acute episode.
Chronic Pancreatitis:
-----------------------
Pancreatic extracts and enzymes together with meals
Sodium bicarbonate and cimetidine to prevent enzymes breakdown
Analgesic or antispasmodic medicine usually by injection
Surgical procedures usually unsuccessful
What is the prognosis of Pancreatitis?
----------------------------------------
Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.
Hemorhagic Pancreatitis has high mortality of 50-90%
Most trauma cases has complete resolution
Some alcoholic pancreatitis may go on to chronic pancreatitis.
Chronic pancreatitis relapses frequently
Rupture of pseudocysts may result in death
How do you prevent Pancreatitis?
------------------------------------------------
Avoid alcohol and oily food
Take precautions during mumps and other viral infection
Avoid injury to the abdomen especially the mid section below the sternum
Wednesday, June 11, 2008
A Simple Guide to Allergies
A Simple Guide to Allergies
------------------------------
What are Allergies?
----------------------
Allergies are the immune system's reaction to a harmless substance foreign to the body.
In some people this reaction causes a uncomfortable symptom like rashes or swelling of the eyelids.
In severe cases it can even cause peeling of the skin or kidney damage.
What are the Common causes of Allergies?
----------------------------------------------
The most common causes of allergies are pollen and dust mites.
Besides these, there are a wide range of substances that can trigger an allergic response.
Pollen:
---------
Pollen is the seeds or spores released by flowers or plants during pollination phase of plants and usually is higher in summer. Some countries shows the daily pollen index in the media during summer to warm allergen sufferers the risks of allergy during this peroid.
Pollens irritate the sensitive mucusal lining of the nose and the epithelium of the skin causing inflammation and swelling.
Dust mites:
---------------
Dust mites are microscopic parasites who live on the skin flakes shed by the human body every day. They can found just about everywhere on the floor, carpets, on mattresses, pillows, bed covers, clothes and upholstery.
The faeces from the dust mite is the main substance which causes sneezing and wheezing.
House dust like dander from animals, cockroach faeces, bacteria, moulds, fungus spores and dust mites are the main cause of allergies in any family.
Moulds
-------------
Moulds are microscopic fungi with spores floating in the air like pollen.
They are usually found in damp areas indoors such as the basement or bathroom, as well as outdoors in grass, leaves, hay, or under plants.
Animal proteins
------------------
Proteins found in an animal's skin and saliva can cause allergy to skin, nose and lungs in some people.
Food allergens
------------------
Certain foods especially eggs, milk, nuts, and seafood, induce intestinal and skin reactions frequently in children who often outgrow it after puberty.
What are the Symptoms of Allergies?
--------------------------------------------
Allergic symptoms include:
1.itchy, watery nose and eyes,
2.asthma, wheezing and coughing
3.Hives or skin rahes
What is the Treatment of Allergies?
-------------------------------------------
Treatment depends on the severity of symptoms.
In severe cases of allergy:
1.adrenaline injection is used in life-threatening situations to reduce acute swelling of the airways.
2.Antihistamines can help relieve symptoms such as sneezing and running nose.
3.Bronchodilators (theophylline and beta-agonists e.g. salbutamol) are used in cases of asthma to open the airways, relieve coughing, wheezing, shortness of breath and difficulty in breathing.
4.Corticosteroids such as dexamethasone may be given to relieve symptoms.
They also reduce the immune reaction to the allergens.
How to prevent allergies?
------------------------
The best prevention is to avoid the allergens:
1.Avoid dustmites, pollen.
2.Cover all pillows, mattress,beds etc with special dust mite covers,
3.Avoid food like eggs, milk, nuts, and seafood
4.Desensitisation to Allergens
---------------------------------
Desensitisation to Allergens is by giving small doses of allergen until the body itself become insensitise to allergens.
------------------------------
What are Allergies?
----------------------
Allergies are the immune system's reaction to a harmless substance foreign to the body.
In some people this reaction causes a uncomfortable symptom like rashes or swelling of the eyelids.
In severe cases it can even cause peeling of the skin or kidney damage.
What are the Common causes of Allergies?
----------------------------------------------
The most common causes of allergies are pollen and dust mites.
Besides these, there are a wide range of substances that can trigger an allergic response.
Pollen:
---------
Pollen is the seeds or spores released by flowers or plants during pollination phase of plants and usually is higher in summer. Some countries shows the daily pollen index in the media during summer to warm allergen sufferers the risks of allergy during this peroid.
Pollens irritate the sensitive mucusal lining of the nose and the epithelium of the skin causing inflammation and swelling.
Dust mites:
---------------
Dust mites are microscopic parasites who live on the skin flakes shed by the human body every day. They can found just about everywhere on the floor, carpets, on mattresses, pillows, bed covers, clothes and upholstery.
The faeces from the dust mite is the main substance which causes sneezing and wheezing.
House dust like dander from animals, cockroach faeces, bacteria, moulds, fungus spores and dust mites are the main cause of allergies in any family.
Moulds
-------------
Moulds are microscopic fungi with spores floating in the air like pollen.
They are usually found in damp areas indoors such as the basement or bathroom, as well as outdoors in grass, leaves, hay, or under plants.
Animal proteins
------------------
Proteins found in an animal's skin and saliva can cause allergy to skin, nose and lungs in some people.
Food allergens
------------------
Certain foods especially eggs, milk, nuts, and seafood, induce intestinal and skin reactions frequently in children who often outgrow it after puberty.
What are the Symptoms of Allergies?
--------------------------------------------
Allergic symptoms include:
1.itchy, watery nose and eyes,
2.asthma, wheezing and coughing
3.Hives or skin rahes
What is the Treatment of Allergies?
-------------------------------------------
Treatment depends on the severity of symptoms.
In severe cases of allergy:
1.adrenaline injection is used in life-threatening situations to reduce acute swelling of the airways.
2.Antihistamines can help relieve symptoms such as sneezing and running nose.
3.Bronchodilators (theophylline and beta-agonists e.g. salbutamol) are used in cases of asthma to open the airways, relieve coughing, wheezing, shortness of breath and difficulty in breathing.
4.Corticosteroids such as dexamethasone may be given to relieve symptoms.
They also reduce the immune reaction to the allergens.
How to prevent allergies?
------------------------
The best prevention is to avoid the allergens:
1.Avoid dustmites, pollen.
2.Cover all pillows, mattress,beds etc with special dust mite covers,
3.Avoid food like eggs, milk, nuts, and seafood
4.Desensitisation to Allergens
---------------------------------
Desensitisation to Allergens is by giving small doses of allergen until the body itself become insensitise to allergens.
Monday, June 9, 2008
A Simple Guide to Coughing
A Simple Guide to Coughing
------------------------------
What is Coughing?
----------------------
Coughing is the reflex mechanism in which the body tries to get rid of excessive mucus and phlegm accumulated in the lining membranes of the respiratory tract.
The secretions from the lining of the respiratory tract trap and then flush out the viruses, bacteria and other particles like smoke, haze particles.
It prevents serious infections from entering the lungs and bronchial tubes.
What are the common causes of cough?
---------------------------------------
Coughing is usually caused by the following:
Infections:
1.bacterial or viral infection of the nose and throat such as the common cold or influenza.(yellow or green phlegm)
2.anaerobic infections of the mouth,
3.Infection of the tonsils, nose and sinuses(postnasal drip)
4.Bacterial infection of the bronchial tubes and lungs(bronchiectasis, bronchitis, pneumonia, sinusitis, or tracheitis).
This often comes with rusty or green mucus.
Dry mouth:
1.Insufficient drinking of water
2.medications especially ACE inhibitors(eg. enapril) can cause dry persistent coughs
Allergies:
1.Certain plants, pollens, chemicals, cosmetics can cause allergic reactions in the throat and bronchial causing cough. (white clear phlegm)
2.Asthma - narrowing of the bronchial tubes due to allergic and other causes usually results in white sticky clear productive phlegm
Smoking:
Cigarettes smokes contains 40 over chemicals which irritates the cells in the lining of the bronchial tubes causing a chronic cough
Stress:
Stress can cause cough due to dryness of mouth during stress or anxiety, causing the saliva to dry up and producing dry unproductive cough.
The cough in stress usually disappears during sleep.
Gastric problems or indigetions
1. Indigestion of food in the stomach can cause the undigested food in the stomach to produce gas in the stomach which goes upwards to the throat drying saliva which then become irritating phlegm in the throat.
2.gastroesophageal reflux of food can also cause the acid and undigested food to travel to the mouth and produce mucus secretions.
Systemic diseases:
1.Congestive heart failure
2.Lower respiratory tract infections
3.Chronic Obstructive Lung Disease
4.Carcinoma lung.
What investigations are needed for cough?
------------------------------------------
1.chest X-ray
2.sputum culture
3.pulmonary function tests
What is the treatment of Coughing?
-------------------------------------
Medications
1.Approprate Antibiotics, antifungal for infections of throat and bonchial tubes
2.Antihistamines for allregic cough
3.Bronchodilators for asthma and Chronic Obstructive Lung Disease
4.cough mixtures - expectorants helps to expel out the phlegm
- suppresant suppress the cough -especially for dry cough and at night to stop the cough
5.Antacids and antiflatulent agents to get rid of gas in stomach and prevent reflux
6.Diuretics for treatment of congestive heart failure especially in the elderly
Healthy Lifestyle:
1.drinking several glasses of water a day prevents dryness of mouth
2.Avoid cold, acidic, spicy and oily food which irritates the throat
3.Proper oral hygience after eating: brushing of teeth and flossing.
4.Gargle mouth after every meal.
4.Avoid smoking
6.Avoid frequent usage of the voice and throat - do not talk too much
6.Treat underlying condition such as asthma, diabetes, liver, kidney and other conditions.
------------------------------
What is Coughing?
----------------------
Coughing is the reflex mechanism in which the body tries to get rid of excessive mucus and phlegm accumulated in the lining membranes of the respiratory tract.
The secretions from the lining of the respiratory tract trap and then flush out the viruses, bacteria and other particles like smoke, haze particles.
It prevents serious infections from entering the lungs and bronchial tubes.
What are the common causes of cough?
---------------------------------------
Coughing is usually caused by the following:
Infections:
1.bacterial or viral infection of the nose and throat such as the common cold or influenza.(yellow or green phlegm)
2.anaerobic infections of the mouth,
3.Infection of the tonsils, nose and sinuses(postnasal drip)
4.Bacterial infection of the bronchial tubes and lungs(bronchiectasis, bronchitis, pneumonia, sinusitis, or tracheitis).
This often comes with rusty or green mucus.
Dry mouth:
1.Insufficient drinking of water
2.medications especially ACE inhibitors(eg. enapril) can cause dry persistent coughs
Allergies:
1.Certain plants, pollens, chemicals, cosmetics can cause allergic reactions in the throat and bronchial causing cough. (white clear phlegm)
2.Asthma - narrowing of the bronchial tubes due to allergic and other causes usually results in white sticky clear productive phlegm
Smoking:
Cigarettes smokes contains 40 over chemicals which irritates the cells in the lining of the bronchial tubes causing a chronic cough
Stress:
Stress can cause cough due to dryness of mouth during stress or anxiety, causing the saliva to dry up and producing dry unproductive cough.
The cough in stress usually disappears during sleep.
Gastric problems or indigetions
1. Indigestion of food in the stomach can cause the undigested food in the stomach to produce gas in the stomach which goes upwards to the throat drying saliva which then become irritating phlegm in the throat.
2.gastroesophageal reflux of food can also cause the acid and undigested food to travel to the mouth and produce mucus secretions.
Systemic diseases:
1.Congestive heart failure
2.Lower respiratory tract infections
3.Chronic Obstructive Lung Disease
4.Carcinoma lung.
What investigations are needed for cough?
------------------------------------------
1.chest X-ray
2.sputum culture
3.pulmonary function tests
What is the treatment of Coughing?
-------------------------------------
Medications
1.Approprate Antibiotics, antifungal for infections of throat and bonchial tubes
2.Antihistamines for allregic cough
3.Bronchodilators for asthma and Chronic Obstructive Lung Disease
4.cough mixtures - expectorants helps to expel out the phlegm
- suppresant suppress the cough -especially for dry cough and at night to stop the cough
5.Antacids and antiflatulent agents to get rid of gas in stomach and prevent reflux
6.Diuretics for treatment of congestive heart failure especially in the elderly
Healthy Lifestyle:
1.drinking several glasses of water a day prevents dryness of mouth
2.Avoid cold, acidic, spicy and oily food which irritates the throat
3.Proper oral hygience after eating: brushing of teeth and flossing.
4.Gargle mouth after every meal.
4.Avoid smoking
6.Avoid frequent usage of the voice and throat - do not talk too much
6.Treat underlying condition such as asthma, diabetes, liver, kidney and other conditions.
Friday, June 6, 2008
A Simple Guide to Halitosis
A Simple Guide to Halitosis(Bad Breath)
--------------------------------------
What is Halitosis?
----------------------
Halitosis is the condition when a person suffers from chronic bad breath.
What are the causes of Halitosis?
---------------------------------------
Halitosis is usually caused by the following:
Infections:
1.bacterial infection of the gums, dental cavities.(600 types of bacteria
present in mouth)
2.anaerobic infections of the mouth,
3.Infection of the tonsils, nose and sinuses(postnasal drip)
Gastric problems and indigestion:
1. Indigestion of food in the stomach can cause the undigested food in the stomach to emit an offensive smell through the mouth
2.gastroesophageal reflux of food can also cause the smell of acid and undigested food in the mouth
Certain food:
1.garlic and onions which has odious suphur compounds can give rise to foul smell from the mouth
2.fish
3.cheese
4.alcohol
Smoking:
Cigarettes smokes contains 40 over chemicals which cause bad mouth smell
Dry mouth:
1.Insufficient drinking of water
2.medications can cause dry mouth and produces a smell from the mouth
Systemic diseases:
1.liver failure.
2.Lower respiratory tract infections
3.Renal infections and renal failure.
4.Carcinoma.
5.Trimethylaminuria ("fish odor syndrome").
6.Diabetes mellitus.
What are the symptoms and signs of Halitosis?
------------------------------------------------
Persons who has Halitosis has the following
Symptoms:
1.Bad breath
2.Dry mouth
Signs:
1.discharge from nose or tonsils
2.furry tongue
How do you diagnose Halitosis?
--------------------------------
Diagnosis can usually be made by :
1.History of bad breath
2.lick the back of the wrist, let the saliva dry for a minute, and smell the dried saliva.
3.scrape the posterior back of the tongue with a plastic disposable spoon and smell the drying residue.
4. Halimeter: a portable sulfide monitor to test for levels of sulfur emissions (especially hydrogen sulfide) from the mouth.
5.BANA test: find the salivary levels of an enzyme which shows the presence of certain halitosis-related bacteria
5.ß-galactosidase test: the presence of this enzyme in the saliva indicates presence of bad breath
What is the treatment of Halitosis?
-------------------------------------
1.Approprate Antibiotics, antifungal for infections of mouth
2.drinking several glasses of water a day prevents dryness of mouth
3.Eating a healthy breakfast helps clean the back of the tongue
4.Proper oral hygience after eating: brushing of teeth and flossing. Dentures should be removed at bedtime and soaked overnight in antibacterial solutions.
5.Avoid smoking
6.Gargle mouth after every meal.
Avoid the use of alcohol based mouth wahes.
Use instead oil based mouth washes.
7.Chewing sugarless gums helps to stimulate production of saliva and hence less bad breath
8.Treat underlying condition such as diabetes, liver, kidney and other conditions.
What is the prognosis of Halitosis?
----------------------------------------
Prognosis is usually good with proper oral hygiene.
Recurrence is quite common.
--------------------------------------
What is Halitosis?
----------------------
Halitosis is the condition when a person suffers from chronic bad breath.
What are the causes of Halitosis?
---------------------------------------
Halitosis is usually caused by the following:
Infections:
1.bacterial infection of the gums, dental cavities.(600 types of bacteria
present in mouth)
2.anaerobic infections of the mouth,
3.Infection of the tonsils, nose and sinuses(postnasal drip)
Gastric problems and indigestion:
1. Indigestion of food in the stomach can cause the undigested food in the stomach to emit an offensive smell through the mouth
2.gastroesophageal reflux of food can also cause the smell of acid and undigested food in the mouth
Certain food:
1.garlic and onions which has odious suphur compounds can give rise to foul smell from the mouth
2.fish
3.cheese
4.alcohol
Smoking:
Cigarettes smokes contains 40 over chemicals which cause bad mouth smell
Dry mouth:
1.Insufficient drinking of water
2.medications can cause dry mouth and produces a smell from the mouth
Systemic diseases:
1.liver failure.
2.Lower respiratory tract infections
3.Renal infections and renal failure.
4.Carcinoma.
5.Trimethylaminuria ("fish odor syndrome").
6.Diabetes mellitus.
What are the symptoms and signs of Halitosis?
------------------------------------------------
Persons who has Halitosis has the following
Symptoms:
1.Bad breath
2.Dry mouth
Signs:
1.discharge from nose or tonsils
2.furry tongue
How do you diagnose Halitosis?
--------------------------------
Diagnosis can usually be made by :
1.History of bad breath
2.lick the back of the wrist, let the saliva dry for a minute, and smell the dried saliva.
3.scrape the posterior back of the tongue with a plastic disposable spoon and smell the drying residue.
4. Halimeter: a portable sulfide monitor to test for levels of sulfur emissions (especially hydrogen sulfide) from the mouth.
5.BANA test: find the salivary levels of an enzyme which shows the presence of certain halitosis-related bacteria
5.ß-galactosidase test: the presence of this enzyme in the saliva indicates presence of bad breath
What is the treatment of Halitosis?
-------------------------------------
1.Approprate Antibiotics, antifungal for infections of mouth
2.drinking several glasses of water a day prevents dryness of mouth
3.Eating a healthy breakfast helps clean the back of the tongue
4.Proper oral hygience after eating: brushing of teeth and flossing. Dentures should be removed at bedtime and soaked overnight in antibacterial solutions.
5.Avoid smoking
6.Gargle mouth after every meal.
Avoid the use of alcohol based mouth wahes.
Use instead oil based mouth washes.
7.Chewing sugarless gums helps to stimulate production of saliva and hence less bad breath
8.Treat underlying condition such as diabetes, liver, kidney and other conditions.
What is the prognosis of Halitosis?
----------------------------------------
Prognosis is usually good with proper oral hygiene.
Recurrence is quite common.
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