HOT SITE CLICK HERE 2008 | Healthy Our Priority
Breaking News
Loading...

Miscellaneous




Recent Post

Sunday, December 7, 2008
no image

Angioneurotic Edema


ALSO KNOWN AS
Angioedema

DESCRIPTION
* This is a syndrome of swelling in the deep layers of the skin. Lip swelling is usually prominent. It is often associated with Urticaria (hives).
* Angioedema is often caused by an allergic type reaction (i.e., the body's defense system mistakenly goes off, initiating reactions in the body). This occurs because histamine released from mast cells starts a cascade of events that result in allergy and Angioedema.



SYMPTOMS
* Lip swelling
* Eyelid swelling
* Tongue swelling
* Hives
* Nausea/vomiting
* Intermittent sharp abdominal pain
* History of sudden onset of shortness of breath

CAUSE
* Allergic sensitivities

1. Pollens
2. Foods (i.e., shellfish, eggs, nuts, chocolate, tomatoes, milk, and berries)
3. Medications
4. Molds
5. Bee stings
6. Venom
7. Dermographism (a form of Urticaria)
8. Cold
9. Light
10. Exercise
11. Inherited forms (genetic) hereditary Angioedema or HEA
12. Complement mediated (an immune pathway)
13. Medications (nonallergic, but direct cause, such as ACE inhibitors)
14. Aspirin
15. Other anti-inflammatories
16. Dyes
17. Chemicals
18. Emotional stress
19. Unknown

HOW THE DIAGNOSIS IS MADE
* Examination:

1. Swelling of lips, eyelid or tongue -- usually resolves within 72 hours.
2. There is very little aching.
3. Hives may or may not be present.
4. Stridor (wheezing in neck area)

* Laboratory findings may include:

1. Abnormal complement levels (i.e., C4, C1 assay may help in diagnosing HAE)
2. Vasculitis workup may be done (ANA, RA, CBC, ESR) if no other etiology for Angioedema is found.
3. Rarely, skin biopsy is needed.

TREATMENT
* Medications

1. Antihistamines (e.g., Hydroxyzine for acute attacks)
2. Doxepin (an older antidepressant) helps with chronic (continuous) form
3. Calcium channel blockers
4. Terbutaline
5. Colchicine
6. Danazol

* Plasmapheresis (exchange of plasma in blood) used for rare unresponsive chronic forms

IF YOU SUSPECT THIS CONDITION
* Angioedema can be life threatening. Seek emergency medical treatment.

PREVENTIONS
* Identify and eliminate causative agents. Special diets may be prescribed.

SIMILAR CONDITIONS
* Hives
* Allergic reactions

MISCELLANEOUS
* Note

- Angioedema often involves complicated immune chemical pathways. Often your primary care physician will need to refer you to allergy specialists in order to properly treat your condition.



no image

Angioedema



ALSO KNOWN AS
Angioneurotic edema

DESCRIPTION
* This is a syndrome of swelling in the deep layers of the skin. Lip swelling is usually prominent. It is often associated with Urticaria (hives).
* Angioedema is often caused by an allergic type reaction (i.e., the body's defense system mistakenly goes off, initiating reactions in the body). This occurs because histamine released from mast cells starts a cascade of events that result in allergy and angioedema.



ALSO KNOWN AS
Angioneurotic edema

DESCRIPTION
* This is a syndrome of swelling in the deep layers of the skin. Lip swelling is usually prominent. It is often associated with Urticaria (hives).
* Angioedema is often caused by an allergic type reaction (i.e., the body's defense system mistakenly goes off, initiating reactions in the body). This occurs because histamine released from mast cells starts a cascade of events that result in allergy and angioedema.

SYMPTOMS
* Lip swelling
* Eyelid swelling
* Tongue swelling
* Hives
* Nausea/vomiting
* Intermittent sharp abdominal pain
* History of sudden onset of shortness of breath

CAUSE
* Allergic sensitivities

1. Pollens
2. Foods (i.e., shellfish, eggs, nuts, chocolate, tomatoes, milk, and berries)
3. Medications
4. Molds
5. Bee stings
6. Venom
7. Dermographism (a form of Urticaria)
8. Cold
9. Light
10. Exercise
11. Inherited forms (genetic): hereditary angioedema or HEA
12. Complement mediated (an immune pathway)
13. Medications (nonallergic, but direct cause, such as ACE inhibitors)
14. Aspirin
15. Other anti-inflammatories
16. Dyes
17. Chemicals
18. Emotional stress
19. Unknown

HOW THE DIAGNOSIS IS MADE
* Examination:

1. Swelling of lips, eyelid or tongue -- usually resolves within 72 hours.
2. There is itching, but very little aching.
3. Hives may or may not be present.
4. Stridor (wheezing in neck area)

* Laboratory findings may include:

1. Abnormal complement levels (i.e., C4, C1 assay may help in diagnosing HAE)
2. Vasculitis workup may be done (ANA, RA, CBC, ESR) if no other etiology for angioedema is found.
3. Rarely, skin biopsy is needed.

TREATMENT
* Medications
* Antihistamines (e.g., Hydroxyzine for acute attacks)
* Doxepin (an older antidepressant) helps with chronic (continuous) form
* Calcium channel blockers
* Terbutaline
* Colchicine
* Danazol
* Plasmapheresis (exchange of plasma in blood) used for rare unresponsive chronic forms

IF YOU SUSPECT THIS CONDITION
* Angioedema can be life threatening. Seek emergency medical treatment.

PREVENTION
* Identify and eliminate causative agents. Special diets may be prescribed.

SIMILAR CONDITIONS
* Hives
* Allergic reactions

MISCELLANEOUS
* Note

- Angioedema often involves complicated immune chemical pathways. Often your primary care physician will need to refer you to allergy specialists in order to properly treat your condition.



no image

Angiodysplasia



ALSO KNOWN AS
Vascular ectasias

DESCRIPTION
* It is theorized that veins in the colon become damaged over time. This causes capillaries to dilate (capillaries are blood vessels that connect the artery side of the circulatory system to the venous side). These dilated capillaries no longer function properly, causing the body to compensate by forming direct connections between the arterial and venous sides-called angiodysplastic lesions. These abnormal blood vessel connections have a tendency to bleed, especially in the elderly.



SYMPTOMS
* Usually occurs after age 70 but can be seen after age 50
* Usually painless
* Bleeding may be in tiny amounts and lead to fatigue, weakness, and shortness of breath secondary to anemia.
* Bright red blood passed from rectum (bleeding may be massive)
* Tarry black stool (melena)
* Vomiting blood or coffee-ground material

CAUSE
* Damaged veins as above
* Congenital (born with these abnormal vessel connections)
* Hereditary hemorrhagic telangiectasia (a rare genetic disease)
* Autoimmune diseases such as Scleroderma

HOW THE DIAGNOIS IS MADE
* Rectal examination positive for blood
* Complete blood count may show anemia
* Colonoscopy (scope passed from rectum to colon)
* Endoscopy (scope passed from throat into stomach)
* Special push enteroscope (scope to view small intestines)
* Nuclear red blood cell scan

TREATMENT
* If slow bleeding over time:

1. Iron supplementation
2. Specific hormone therapy (estrogen-progesterone)

* Rapid or massive bleeding:

1. Cautery (heater probe) or laser treatment
2. Angiography (dye injected and X-Rays taken) to localize bleeding area. Then vasopressin (constricts blood vessel) is injected into the area to stop bleeding, or the area is embolized (an artificial blockage of the angiodysplastic lesion is made).
3. Right hemicolectomy (partial removal of colon) if bleeding is uncontrollable, recurrent, and in right colon
4. Surgical sewing in other areas of uncontrollable or recurrent bleeding

SIMILAR CONDITIONS
* Colorectal Cancer
* Rectal Cancer
* Anus cancer
* Colon Polyps
* Hemorrhoids
* Esophageal Varices
* Ulcer Disease
* Ischemic Colitis



no image

Anemias



DESCRIPTION
* Oxygen is carried to the body's tissues predominantly by red blood cells. There is a near-constant level of blood cells that make up the blood. Red blood cells live approximately 120 days, and new ones are constantly being made in the bone marrow to replace lost ones. The red blood cell (RBC) count is determined by two equivalent methods: (1) by measuring the hematocrit, i.e., the volume occupied by red blood cells; and (2) by measuring the hemoglobin, i.e., the quantity of oxygen-carrying protein in the blood. Normal hematocrit is approximately 38 to 44, while normal hemoglobin is approximately 12.5 to 14.5. Anemia is defined in terms of hematocrit or hemoglobin measurements below these norms.
* Anemia occurs either because there are insufficient blood cells being made in the bone marrow, or because blood cells are destroyed and are not being adequately replaced. Another cause may be that blood cells are lost due to bleeding.



CAUSE
* Blood loss, especially from bleeding in the gastrointestinal tract
* Rapid loss occurs in bleeding ulcers or slow loss in colon cancer.
* Decreased bone marrow production due to problems with manufacturing cells in the bone marrow
* Cancers such as Lymphoma
* Aplastic Anemia
* Myeloplastic anemia
* Bone marrow damaged by toxins and radiation, or invasion by cancers, fibrosis, and other tumors
* Decreased bone marrow production due to deficiencies
* Vitamin B12 Deficiency
* Folic Acid Deficiency
* Iron deficiency
* Thalassemias -- genetic problems with the hemoglobin molecule structure
* Hypothyroidism
* Kidney disease -- because of decreased level of hormone erythropoietin
* Hemolytic anemias -- cells are destroyed
* Red blood cells are also destroyed in Sickle Cell Anemia, hereditary diseases, spherocytosis, thrombocyopenic purpura, hemolytic-uremic syndrome, and G6PD deficiency
* Drug induced hemolytic anemia

TREATMENT
* Treat the appropriate disorder listed above.



no image

Anaplastic Thyroid Cancer



DESCRIPTION
* Anaplastic thyroid carcinoma is the least common type of Thyroid Cancer of the ones that begin in the gland itself. This is a very aggressive cancer, and often spreads quickly to surrounding tissues, as well as to distant sites. It is often seen in those over age 60, and the only risk factor may be previous surgery for cancer of the thyroid, in which only part of the gland was removed (i.e., partial thyroidectomy). This arises out a multinodular goiter -- usually, a quickly enlarging mass that compresses the surrounding tissues.
* Anaplastic thyroid carcinoma does not pick up iodine, making scanning with radioiodine of little use. Treatment involves surgical removal of the (entire) thyroid gland. As with scanning, because the cancer does not take up iodine, radioactive destruction of the cancer is not an option either.



SYMPTOMS
* Most people with Thyroid Cancer usually have painless swelling of the thyroid gland.
* The thyroid gland may be swollen all over, but most often only one area of the gland is affected. Often, there is a nodule (or lump) present, which is firm, painless, and does not move freely.
* Most Thyroid Cancers do not produce any thyroid hormone. Therefore, most people with Thyroid Cancer do not have symptoms of hyperthyroidism.
* Lymph nodes in the front part of the neck may be enlarged, but are usually not tender to touch.
* Growing very rapidly, this type of cancer can put pressure on some of the other structures in the neck and lead to trouble swallowing, difficulty breathing, or hoarse voice. It depends on its size, rate of growth, and location.

CAUSE
* It is not known what causes Thyroid Cancer.
* Anaplastic Thyroid Cancer spreads very early to the surrounding tissues, as well as to distant ones.

HOW THE DIAGNOSIS IS MADE
* The history, symptoms, and examination can help point the doctor in the right direction.
* However, the most effective method of diagnosis involves removing a piece of the thyroid and examining it under the microscope to see if cancer is present. This is usually done via a process known as FNA (fine needle aspiration), in which a needle is used to remove a sample of the lump.
* As stated above, in most cases of Thyroid Cancer, the tumor does not produce any thyroid hormone. Therefore, most people with Thyroid Cancer have normal thyroid tests.
* An Ultrasound of the neck is also helpful in determining the size of the cancer and to see if it has spread to other areas within the neck.
* Radioiodine scanning is not helpful (for reasons given above).
* Chest X-Ray, CT scan, MRI, or PET scan can also be helpful in detecting any metastatic disease.
* Laryngoscopy may be done if paralysis of vocal cords is suspected.

TREATMENT
* Treatment for almost all Thyroid Cancers begins with surgical removal of the thyroid -- usually the entire gland. In a few cases, only part is removed. The best surgical option should be discussed with your doctors.
* Surgery, if done by a skilled physician, is usually safe. There are potential complications and you should discuss these with your surgeon.
* However, one of the most common complications is accidental removal of the parathyroid gland because it is located very close to the thyroid. If this happens, it is generally not life threatening if detected early.
* Immediately after surgical removal of the thyroid gland, thyroid hormone replacement will be initiated, and will continue for the rest of the patient's life.
* Radioiodine scans and treatment with radioactive iodine are not options for those with anaplastic Thyroid Cancer because these cancers do not take up iodine.
* If Thyroid Cancer has spread to the bone, then radiation therapy may be needed.
* If the cancer has spread to the brain, then gamma knife radiation (a special type of radiation treatment) will be needed.
* After one has been treated for this condition, he will need to be followed very closely with periodic physicals, neck exams, and chest X-Rays. Monitoring for the correct amount of thyroid hormone replacement is requisite.
* The long-term outlook (or prognosis) is guarded for this type of cancer. The one-year survival is about 10% and the 5-year survival is only about 5%.

SIMILAR CONDITIONS
* Lymphocytic Thyroiditis
* Multinodular goiter
* Colloid nodules
* Benign follicular adenoma
* Metastatic Cancer

MISCELLANEOUS
* Special Information

1. Iodine is used by the thyroid gland to make thyroid hormone. Doctors can use this fact to their advantage by ordering a nuclear medicine scan using radioiodine when a problem with the thyroid is suspected. The patient is given radioiodine and if the gland is active, it will take up the radioiodine and use it to make thyroid hormone. A scan is performed to see what areas of the body are taking up the radioiodine. Radioactive iodine (131I) can then be used to destroy the cancer. Therefore, whether or not the cancer takes up iodine is very important in both the diagnosis and treatment of thyroid diseases.
2. Radioactive iodine is generally safe. However, depending on the dose and individual response to the medicine, it can cause side effects, including stomach inflammation, temporary low sperm count, low blood count, and, very rarely, leukemia.
3. To summarize -- if a lump is detected in the thyroid gland, first determine whether or not it is cancer. If cancer is present, then blood tests and X-Rays will be needed, followed by surgery to remove the cancer. In certain types of Thyroid Cancers, an iodine scan is administered to determine if the cancer has spread -- and radioactive iodine is used to destroy any Metastatic Cancer. (Anaplastic Thyroid Cancer, however, does not take up iodine, making this approach inapplicable in such cases). After surgery, in addition to receiving thyroid hormone replacement, survivors of this virulent cancer will have to be closely followed to make sure that the cancer does not come back.



no image

Anaphylaxis



DESCRIPTION
* Anaphylaxis is a severe generalized allergic reaction characterized by widespread dilation of the blood vessels of the body, resulting in a marked drop in blood pressure. It is caused by an IgE (a type of an antibody) mediated reaction to an allergen.



SYMPTOMS
* Severe drop in blood pressure -- lightheadedness and fainting are common
* Respiratory distress -- severe wheezing in the lungs or spasm in the larynx (throat feels like it is closing off). Stridor (whistling sound) may be heard coming from the throat.
* Gastrointestinal tract muscles contract (spasm)
* Uterine muscles contract (spasm)
* Hives
* Lip swelling
* Tongue swelling
* Tryptase (a substance found in mast cells) is elevated 60-90 minutes after an attack.

CAUSE
* Medications
* Insect stings or bites, e.g., bee stings
* Certain foods, e.g., peanuts
* Latex (gloves)

TREATMENT
* Aqueous epinephrine 1:1000, 0.2 to 0.5 ml subcutaneously, or via intramuscular injection. May be repeated every 15 to 30 minutes.
* Rapid infusion of large volumes of intravenous fluids, such as normal saline, lactated Ringer's solution, plasma, colloid solutions, or plasma expanders
* Other vasopressive drugs, if not responsive to epinephrine, e.g., dopamine, norepinephrine, phenylephrine
* If airway obstruction occurs (or is impending), endotracheal intubation or tracheostomy will be needed.
* Beta 2 agonist inhaled (e.g., Albuterol) can help with bronchospasm.
* Intravenous theophylline may also be helpful with bronchospasm.
* Antihistamines H1 (e.g., Atarax, Benadryl) and H2 (Ranitidine) are adjunct therapies.
* Patients chronically on beta blockers (used for blood pressure, heart problems, and migraine prevention) may be refractory to epinepherine and may require higher doses of adrenergic drugs or intravenous Glucagon.
* Warning: 6 -12 hours after an anaphylactic reaction there may be a late phase response (a recurrence of symptoms), requiring monitoring (in a hospital) for 24 hours after an attack.

IF YOU SUSPECT THIS CONDITION
* If you have an Epi Pen, use it immediately as directed by your physician. Seek immediate emergency medical treatment as quickly as possible (in the United States dial 911). This condition is often fatal if not treated immediately.

PREVENTION
* There is no reliable way to truly prevent an attack, once exposed to the allergen (it can be treated afterwards).
* The best prevention is avoidance of inciting allergens. Allergy skin testing and RAST (radioallergosorbent test) testing can identify allergens (substances) to be avoided.
* Long term antihistamine and corticosteroid oral therapy may decrease the occurrence of attacks.
* Persons with a history of anaphylaxis should carry an Epi Pen with them at all times. This is self-injection epinephrine kit for emergencies.

SIMILAR CONDITIONS
* Angioedema
* Urticaria


Saturday, December 6, 2008
no image

Anal Fissures

ABNORMAL
NORMAL


DESCRIPTIONS
* This is a cut (ulcer or Laceration) inside the anus. The usual cause is trauma to the anus because of a strained bowel movement, hard bowel movement, or high internal sphincter tone (the area that allows stool to pass stays tense, obstructing proper passage).



SYMPTOMS
* Severe tearing pain during a bowel movement
* Throbbing pain in anus following a bowel movement
* Blood on toilet paper or around the bowel movement

CAUSE
* Constipation
* Constant irritation from stool in diapers of babies or constant wiping in all others
* Scratching due to infections (e.g., pinworm) or skin conditions (e.g., dry skin, Eczema)
* Straining
* High internal sphincter tone (explained above)

HOW THE DIAGNOSIS IS MADE
* Visual inspection by physician

TREATMENT
* Sitz baths
* Fiber supplements
* Stool softeners
* Topical anesthetics (Mesalamine suppositories)
* Topical nitroglycerin Ointment (this is at 10% the strength used for angina) -- relaxes the internal sphincter
* Botulism toxin injection -- also relaxes the internal sphincter
* Partial lateral internal sphincterotomy -- the sphincter is partially cut in order to relax it

SIMILAR CONDITIONS
* Thrombosed external hemorrhoid
* Solitary rectal fissure
* Cancer of the Anus

MISCELLANEOUS
* Tests That May Be Done

1. Anoscope
2. Flexible Sigmoidoscopy



no image

Anal Fissure



DESCRIPTION
* This is a cut (ulcer or laceration) inside the anus. The usual cause is Trauma to the anus because of a strained bowel movement, a hard bowel movement, or high internal sphincter tone (the area that allows stool to pass stays too tense to allow proper passage).



SYMPTOMS
* Severe tearing pain during a bowel movement
* Throbbing pain in anus following a bowel movement
* Blood on toilet paper or around the bowel movement

CAUSE
* Constipation
* Straining
* High internal sphincter tone (explained above)

HOW THE DIAGNOSIS IS MADE
* Visual inspection by physician
* Tests:

1. Anoscope
2. Flexible sigmoidoscopy

TREATMENT
* Sitz baths (baths in a warm tub of water)
* Fiber supplements
* Stool softeners
* Topical anesthetics (Mesalamine suppositories)
* Topical nitroglycerin ointment (at 10% of the strength used for angina) -- relaxes the internal sphincter
* Partial lateral internal sphincterotomy or excision of the fissure

SIMILAR CONDITIONS
* Thrombosed external hemorrhoid
* Solitary rectal fissure
* Cancer of the anus



no image

Anal Cancer

ABNORMAL

NORMAL

DESCRIPTION
* This is a tumor in the anal canal, specifically, squamous cell (a specific cellular type) carcinoma of the anus. These tumors often invade the anal sphincter (controls release of stool) and spread upwards toward the rectum.



SYMPTOMS
* Bleeding from rectum
* Rectal pain

CAUSE
* Unknown
* Acquired Immune Deficiency Syndrome (AIDS)

HOW THE DIAGNOSIS IS MADE
* Mass may be felt on examination
* Biopsy

TREATMENT
* Abdominoperineal resection (extensive surgical resection from anus extending upward)
* Very small tumors may only need surgical removal.
* Radiation treatment for inoperable disease (disease has spread too much)
* If metastatic, spreads to lymph nodes (glands) in the groin and these glands may be resected.

SIMILAR CODITIONS
* Thrombosed external hemorrhoid
* Solitary Rectal Ulcer Syndrome
* Anal fissure
* Perianal Abscess
* Anorectal infection


no image

Anal Abscess



ALSO KNOWN AS
Anorectal abscess, perianal abscess, or rectal abscess

DESCRIPTION
* Stool formed in the colon or large intestine empties into the rectum and the anal canal then exits through the anus. Perianal refers to the structures around the anus (skin) and within the anal canal. The walls of the anal canal above the anus contain anal glands that secrete lubricants. Stool contains waste material and many bacteria. If there is a cut or scratch in the skin around the anus or the walls of the anal canal, bacteria can enter and cause an infection. The infection then causes local swelling, irritation, tissue damage, and pus buildup (abscess).



SYMPTOMS
* Unable to sit comfortably
* Difficulty or pain with passing stool
* Redness or pain around anus
* Abscess felt around anus or within anal canal
* Peri-rectal swelling
* Pain may be throbbing, sharp, or dull
* Fever may be seen in severe case
* Bleeding or discharge if abscess is drained or accidentally ruptures.
* In elderly there maybe no fever only lower abdominal pain
* If the abscess ruptures and leaves a fissure that opens into the anal canal, a fistula is formed.

CAUSE
* Bacteria:

1. Staphylococcus
2. E.coli
3. Streptococci

* Proteus vulgaris
* Pseudomonas aeruginosa
* Bacteroides
* Usually a mixture of above

HOW THE DIAGNOSIS IS MADE
* Need examination by a doctor
* If abscess is in the canal, the doctor may need to insert his index finger in the canal (digital rectal exam) and feel for it.
* If fever is present and the patient appears sick, blood samples may be taken to assess the severity of infection.
* Barium Enema -- an enema used to pour a chalky substance called barium through the anus into the rectum for X-raying. This will help if the abscess cannot be felt, or if a fistula is present.
* Sigmoidoscopy -- a rigid tube inserted into the rectum allows the doctor to look inside.

RISK FACTORS
* Cuts:

1. From food such as egg shell and fish bone
2. Swallowed objects, such as rings, coins, paperclips

* Penetrating injuries:

1. Constipation
2. Enema
3. Vibrators
4. Anal sex
5. Light bulbs
6. Bottles
7. Surgical injection of hemorrhoids

* Diseases:

1. Hemorrhoids (hang out from the anus opening)
2. Inflammatory Bowel Disease
3. Granulomatous diseases such as Sarcoidosis
4. Weakened immune system (body's defenses) -- cancer (specially of blood), AIDS, etc.

TREATMENT
* May need admission to the hospital if very sick, elderly, have other diseases or need surgery.
* Pain medication -- Tylenol, Motrin, Codeine.
* Stool softeners or laxatives to prevent Constipation.
* Good diet with high fiber diet-adequate amount of oil, fruits, vegetables, and fruits.
* Avoid enemas and rectal temperature.
* Antibiotics may be administered intravenously (through veins).
* Surgery:

1. Local small abscesses can be cut and drained on an outpatient basis.
2. Deeper abscess and fistulas need to be opened, drained, and removed in the hospital under general anesthesia.
3. The wound is then packed with gauze soaked in Iodoform, an anti-bacterial agent for 24-48 hours.
4. Sitz baths are recommended every 2-4 hours to remove debris.
5. Warm compresses help with pain.

IF YOU SUSPECT THIS CONDITION
* See your doctor for a digital rectal exam.

SIMILAR CONDITIONS
* Crohn's Disease
* Rectal tumors or cancers
* Infections:
* Syphilis lesions or ulcers
* Tuberculous ulceration


no image

Anaerobic Pneumonia

ALSO KNOWN AS
Lung abscess

ABNORMAL
NORMAL

DESCRIPTION
* Anaerobes are bacteria that live where there is no oxygen. A lung Abscess is a collection of pus in the lungs. Anaerobic bacterial infections may cause lung Abscess when bacteria are aspirated into the lungs.
* Aspiration into the lungs may be due to impaired normal swallowing mechanisms, esophageal disorders (e.g., acid Reflux), altered consciousness levels, or absent gag reflex.
* Patients with Alcoholism, dental/gum disease, Seizures, swallowing disorders, or who are under anesthesia or have tracheal or nasogastric tubes are at higher risk.



SYMPTOMS
* Fever
* Cough with foul smelling sputum
* Shortness of breath
* Wheezing
* Weight loss
* Fatigue
* Poor dental hygiene is common

HOW THE DIAGNOSIS IS MADE
* Chest X-Ray
* Chest CT Scan
* Thoracentesis (scope passed into lungs) or needle biopsy, if diagnosis is unclear

TREATMNT
* Medications:

1. Penicillin intravenously
2. Clindamycin intravenously
3. Unasyn intravenously
4. Others also effective

SIMILAR CONDITIONS
* Tuberculosis
* Lung Cancer


no image

Anaerobic Infections



ALSO KNOWN AS
Gas gangrene, clostridial myonecrosis, or necrotizing infections

DESCRIPTION
* This disease is caused when the bacteria in the family of Clostridium (e.g., Clostridium perfringens) infects the body tissue. Clostridium bacteria of this type can only live where there is little or no oxygen (i.e., anaerobic conditions). This occurs in damaged or injured tissues where the oxygen supply is low. It is called "gas" gangrene because the Clostridium bacteria release gas that causes swelling in the surrounding tissue.
* Trauma, Diabetes Mellitus, old age, poor circulation, malignancies of blood cell line, poor nutrition, decrease in number of neutrophils (a type of white blood cell), diseases of the large intestine, and chemotherapy are some of the predisposing risks and causes of gangrene.



SYMPTOMS
* Sudden onset of pain in affected area
* Heart racing
* Drop in blood pressure
* Fever
* Later as the infection progresses:
* Feel severely ill
* Confusion
* Delirium
* Coma

HOW THE DIAGNOSIS IS MADE
* Examination:

1. Wound is foul smelling with a brown/clear, blood-tinged discharge
2. Wound swells and surrounding skin is pale
3. Skin eventually changes from pale to dusky to dark and discolored, containing blood-filled blisters
4. Gas may be felt in the tissues
5. Skin and eyes may turn yellow

* Laboratory findings:

1. Blood cells may hemolyze (burst)
2. Increase in white blood cells
3. Levels of muscle enzyme Creatine Kinase are often elevated with destruction of muscle tissue in gangrene.
4. Anemia in severe cases
5. X-Rays may show gas

* Anaerobic culture will confirm diagnosis (takes too long to come back, so treatment is initiated immediately)

TREATMENT
* Penicillin intravenously
* If allergic to penicillin -- Clindamycin, Tetracycline, Flagyl, Cefoxitin, and Chloramphenicol. All are theoretically (in vitro) active against these Clostridia.
* Surgical debridement (removal of contaminated tissue) of affected area (stops continued spread)
* Other treatment options:

1. Hyperbaric oxygen -- oxygen forced into tissues in an oxygen chamber
2. Polyvalent Gas Gangrene anti-toxin

IF YOU SUSPECT THIS CONDITION
* This is a life-threatening emergency that can lead to rapid death. Seek emergency medical treatment immediately.

SIMILAR CONDITIONS
* Other bacterial infections, such as E. coli, enterobacter, and other anaerobic organisms


Friday, December 5, 2008
no image

Amyloidosis



DESCRIPTION
* Amyloidosis is a condition in which amyloids, i.e., protein fibrils (minute fibers) not normally present in the body, become deposited in one or more sites, damaging the organs where they collect. Virtually any organ in the body may be affected. Symptoms are determined by the location of the buildup, and vary from mild to severe and life threatening.
* There are two forms of this condition: primary and secondary. In primary amyloidosis (called AL) the protein fibrils are made up of the light chain portions of antibodies. Typical sites of fibril pooling are the heart, lungs, skin, tongue, blood vessels, kidney, liver, and thyroid gland. The cause of this form is not known.



* In secondary amyloidosis (called AA) fibrils are derived from acute phase reactant apolipoprotein precursors (i.e., molecules that are signs of infection in the body). Typical sites of collection are the adrenals, lymph nodes, liver, spleen, and kidneys. In this form of the disease, amyloidosis is secondary to another disease.
* Still other protein fibril forms exist, such as those associated with aging, heart disease, and Alzheimer's.

SYMPTOMS
* Directly related to the organ affected. Examples below:

1. Heart -- congestive Heart Failure (shortness of breath, leg swelling, crackles on lung exam, Heart Failure on chest X-Ray)
2. Respiratory system -- cough, shortness of breath, sinus problems
3. Kidney -- protein in the urine, water retention (edema), elevated BUN and Creatinine
4. Liver -- enlarged liver, mild elevation in liver function tests
5. Gastrointestinal tract -- obstructive symptoms (nausea, vomiting, abdominal distention, Constipation), blood in bowel movements, weight loss, malabsorption (greasy stools), and Malnutrition
6. Nervous system -- peripheral Neuropathy (pain, numbness, weakness, or loss of sensation, especially in legs and feet), hoarseness, postural Hypotension (blood pressure drops on standing, causing lightheadedness or fainting), inability to sweat, inability to control bladder or bowels. Carpal Tunnel Syndrome may also occur. Senile plaques and neurofibrillary tangles in the brain may occur. The cranial nerves are usually not affected.
7. Endocrine -- may infiltrate endocrine glands such as the thyroid, but rarely causes a problem in function
8. Joints -- can infiltrate joints and cause pain and stiffness (i.e., symptoms of arthritis)

HOW THE DIAGNOSIS IS MADE
* Abdominal subcutaneous fat pad biopsy and rectal biopsies are good first places to test (with appropriate staining techniques) if the diagnosis is suspected. Other areas of high yield are the gingiva (gums) and bone marrow.
* If the above techniques fail or cannot be performed, tissue from the affected organ must be biopsied and examined using the specified stains.

TREATMENT
* None specifically for amyloidosis
* Treat the underlying disease (e.g., Multiple Myeloma) or specific manifestations (e.g., hemodialysis for renal amyloid)
* Surgical excision of amyloid tumors
* Unfortunately, systemic forms (i.e., affecting many organs in the body) slowly progress and death often occurs in 1-3 years.

MISCELLANEOUS
* Classification System
(Protein fibril type is in parenthesis.)

1. Primary (AL) -- no other condition present
2. Amyloidosis associated with Multiple Myeloma (AL)
3. Secondary or reactive amyloidosis associated with chronic infections (e.g., Tuberculosis) or chronic diseases (e.g., Rheumatoid Arthritis) (AA)
4. Heredofamilial amyloidosis -- neuropathic, cardiovascular, renal, and others, plus those associated with Mediterranean fever (AA). This is a genetically transmitted form of amyloidosis.
5. Local amyloidosis -- tumorlike deposits in isolated organs
6. Amyloidosis associated with aging
7. Amyloidosis associated with hemodialysis (kidney dialysis)


no image

Amphetamine-cocaine Abuse




ALSO KNOWN AS
* Some of the common street names for cocaine include "big C", "blow", "nose candy", "coke", "flake", "snow", "lady", "rock", "ice", and "crack".
* "Cat", "crystal", "speed", "bennies", "ups", "jollies", "uppers", and "dexies" are some of the street names for amphetamine.



DESCRIPTION
* When cocaine (in the hydrochloride form) is treated with Ammonia or baking soda it is called "crack". Medically, cocaine is used at low doses as a topical anesthetic in some procedures, while forms of amphetamine (e.g., Ritalin, now being abused as well) are use to treat Attention Deficit Disorder (ADD). These drugs can be inhaled, snorted, injected, smoked, or swallowed.
* Cocaine and amphetamines are stimulant type drugs. In general, they cause euphoric emotions. Medically, they affect the part of the nervous system that "revs up" the body similar to adrenaline. They are psychologically addictive (intensely craved), but are not physically addictive like narcotics, such as heroin (physical addiction means, an individual becomes ill when he attempts to discontinue a drug).

SYMPTOMS
* Sweating
* Heart racing
* Dilated eyes
* High Blood Pressure
* Hyperactivity
* Confusion
* Paranoid delusions
* Depression after quitting or prolonged use.
* Malnutrition due to suppression of appetite (especially with amphetamines)

HOW THE DIAGNOSIS IS MADE
* Urine test is best.
* Blood test not usually sensitive enough to find these drugs

TREATMENT
* Addiction:

1. Bromocriptine may help craving
2. Addiction treatment programs
3. If addicted to these drugs, never stop them suddenly without medical or psychiatric help.
4. Do not take these drugs (at all) if you have a medical condition or you are taking other drugs or medications.

* Overdose:

1. Maintain airway
2. Mechanical ventilation if necessary
3. Treat Coma, heart attacks, or Seizures as they occur
4. Diazepam or Midazolam for agitation or psychosis
5. If overdose by mouth, gastric lavage (pump stomach) and charcoal -- do not induce vomiting.
6. Phentolamine, Nifedipine, or Labetalol for elevated blood pressure (do not use pure beta-blockers by themselves for elevated blood pressure due to amphetamine abuse)
7. Esmolol for rapid heart race/rapid heart arrythmias (this is a pure beta-blocker so another agent must be used to treat elevated blood pressure if this is occurring)

COMPLICATIONS
* Heart attacks
* Strokes
* Seizures
* Aortic Dissection
* Psychosis
* Lung damage
* Hyperthermia (elevated body temperature)
* Fetal abnormalities
* Placental abruption
* Premature births



no image

Amphetamine Abuse



ALSO KNOWN AS
"Cat", "crystal", "speed", "bennies", "ups", "jollies", "uppers", and "dexies" are some of the street names for amphetamine.

DESCRIPTION
* Medically, forms of amphetamine (e.g., Dexedrine) are used to treat Attention Deficit Disorder (ADD). In the 60s and 70s it was the diet pill of choice, often dispensed by doctors like candy, without any understanding of the damaging psychological and physical side effects it induced.




* The illegal street version of amphetamine, i.e., speed, is often "cooked up" in a dangerously explosive, "homemade" laboratory, to produce a powdered substance that can be inhaled, snorted, injected, smoked, or swallowed.
* Speed is a stimulant. In general, it causes euphoria, although repeated, excessive use can result in Anxiety, panic attacks, hallucinations, and other forms of mental and extreme emotional distress. Medically, amphetamine affects the part of the nervous system that "revs up" the body similar to adrenaline.
* It is extremely psychologically addictive (intensely craved), but it is not physically addictive like narcotics, such as heroin (physical addiction means, an individual becomes ill when he attempts to discontinue a drug).
* Nevertheless, it tends to have a devastating, negative impact on one's lifestyle, health, and work.

SYMPTOMS
* Sweating
* Heart racing
* Dilated eyes
* High Blood Pressure
* Hyperactivity
* Confusion
* Paranoid delusions
* Depression after quitting or prolonged use.
* Malnutrition due to suppression of appetite (especially with amphetamines)

HOE THE DIAGNOSIS IS MADE
* Urine test is best.
* Blood test not usually sensitive enough to find these drugs

TREATMENT
* Addiction:

1. Bromocriptine may help craving
2. Addiction treatment programs
3. If addicted, never stop suddenly without medical or psychiatric help.
4. Do not take speed (at all) if you have a medical condition or you are taking other drugs or medications.

* Overdose:

1. Maintain airway
2. Mechanical ventilation if necessary
3. Treat coma, heart attacks, or Seizures as they occur
4. Diazepam or Midazolam for agitation or psychosis
5. If overdose by mouth, gastric lavage (pump stomach) and charcoal -- do not induce vomiting.
6. Phentolamine, nifedipine, or labetalol for elevated blood pressure (do not use pure beta-blockers by themselves for elevated blood pressure due to Amphetamine Abuse)
7. Esmolol for rapid heart race/rapid heart arrhythmias (this is a pure beta-blocker so another agent must be used to treat elevated blood pressure if this is occurring)

COMPLICATIONS
* Heart attacks
* Strokes
* Seizures
* Aortic Dissection
* Psychosis
* Lung damage
* Hyperthermia (elevated body temperature)
* Fetal abnormalities
* Placental abruption
* Premature births


no image

Amebic Liver Abscess

ALSO KNOWN AS
Hepatic amebiasis

NORMAL
ABNORMAL

DESCRIPTION
* This is an Abscess (walled area of infection/pus) in the liver that is caused by the organism Entamoeba histolytica. It is common in tropical and subtropical areas (southeast Asia, Africa, India, Latin America). In the U.S., it is most common in young Hispanic adults. It is also seen in those with recent travels to tropical areas, homosexuals, and among the inhabitants of institutions for the mentally ill.



SYMPTOMS
* Right upper abdominal pain
* Right sided chest pain worse on a deep breath
* Diarrhea precedes infection in 20% of patients
* Weight loss, malaise, and jaundice may occur.

CAUSE
* Travel to endemic areas (as above), where the cysts of the parasite may be ingested by consuming water or food contaminated by fecal matter.

HOW THE DIAGNOSIS IS MADE
* Examination

1. Ill-appearance
2. Fever
3. Tender right upper abdomen
4. Palpable liver (liver can be felt) whereas the liver is not easily felt
5. Tenderness in chest wall of right chest

* Laboratory tests

1. Anemia
2. Elevated white blood cell count
3. Hemagglutination test
4. If needle aspiration is done, culture is sent to laboratory

* Imaging:

1. Chest X-Ray shows elevated right diaphragm
2. Ultrasound
3. CT scan 20 days after successful treatment to eradicate ameba cysts
4. MRI

TREATMENT
* Metronidazole (Flagyl) orally
* Percutaneous needle drainage of the Abscess in severely ill patients
* Iodoquinal is taken for ameba remaining in the intestines (treating the Abscess only would not clear infection in the intestines).

COMPLICATIONS
* Amebic Abscess may rupture and cause the infection to spread.

PREVENTION
* Amebic infection is caused by the ingestion of contaminated food or water. Therefore, use careful sanitation, avoid unpeeled fruits and vegetables, and use bottled water when traveling in areas known to have amebiasis.

SIMILAR CONDITIONS
* Hepatic vein obstruction
* Cholecystitis
* Choledocholithiasis/cholangitis
* Hepatocellular carcinoma
* Pyogenic Abscess
* Cancer of the biliary tract
* Pancreatic Cancer



no image

Amaurosis Fugax



ALSO KNOWN AS
Fleeting blindness

DESCRIPTION
* Emboli (blood clots) travel from the carotid artery (near the heart) to the retinal arteries, thereby blocking the blood supply to the part of the eye known as the retina, and resulting in vision loss. In young patients, spasm of the retinal arteries blocks the blood supply.



SYMPTOMS
* A "curtain" appears to pass down over the visual field, causing complete loss of vision in the affected eye that lasts a few minutes.

CAUSE
* Atherosclerosis (cholesterol plaques) form in the carotid arteries, causing the narrowing of the arteries. Emboli made of blood or cholesterol may then be released, blocking the retinal arteries.
* Blood clots from heart valves or the heart itself due to underlying heart disease
* Retinal vascular spasm in younger individuals

HOW THE DIAGNOSIS IS MADE
* Examination by ophthalmologist
* Tests:

1. Doppler or ultrasound of carotid arteries
2. MRA (similar to MRI but evaluates carotid arteries)
3. Carotid angiography (dye test of the carotid arteries)
4. Echocardiography (ultrasound of the heart)

TREATMENT
* Immediate evaluation by an ophthalmologist
* Treatment of underlying causes which -- if due to carotid artery disease -- may include anti-platelet medications (e.g., aspirin, Plavix) or carotid endarterectomy (surgically removing cholesterol plaque in the carotid artery).
* If due to heart disease, treatment will depend on the specific cause.

SIMILAR CONDITIONS
* Stroke
* Transient ischemic attack
* Retinal detachment
* Central & branch retinal artery occlusion
* Temporal arteritis
* Retinal vein occlusion
* Vitreous hemorrhage

MISCELLANEOUS
* Special Considerations

- Amaurosis Fugax may be a warning sign for an impending stroke, or may be a sign of underlying heart disease. It therefore needs careful evaluation by an ophthalmologist and your primary care physician.




no image

Alveolar Hemorrhage Syndromes



DESCRIPTION
* Alveoli are the tiny air sacs in the lung where oxygen is brought into the blood and carbon dioxide is released. Many diseases (fortunately all rare) may cause bleeding in the alveoli.



SYMPTOMS
* Cough with blood
* Shortness of breath
* Goodpasture's syndrome usually affects the lungs and kidneys.
* Wegener's Granulomatosis also can affect the sinuses and kidneys.

CAUSE
* Goodpasture's syndrome
* Wegener's Granulomatosis
* Systemic Lupus Erythematosus
* Systemic necrotizing vasculitis
* Rapidly progressing Glomerulonephritis
* Mitral Stenosis (a heart valve problem)
* Coagulopathy (blood is too thin)
* Pulmonary infections (severe)
* Toxins
* Drugs (penicillamine)
* Hemosiderosis

HOW THE DIAGNOSIS IS MADE
* General

1. X-Ray shows diffuse lung infiltrates.
2. Blood gas shows low oxygen level.
3. Anemia due to blood loss may be present.

* Wegener's Granulomatosis

- C-ANCA blood level is elevated

* Systemic Lupus Erythematosus

- Elevated ANA, double stranded-DNA

* Goodpasture's syndrome

- Kidney biopsy shows IgG deposits

TREATMENT
* Treat the appropriate disorder listed above
* Corticosteroids
* Cyclophosphamide for Wegener's Granulomatosis



Thursday, December 4, 2008
no image

Alport's Syndrome



DESCRIPTION
* Alport's syndrome is a common cause of hematuria (blood in the urine). It is responsible for about 15% of childhood cases of hematuria.



SYMPTOMS
* Microscopic hematuria: Blood cells in the urine visible only under the microscope, are usually first noticed on routine checks during a routine physical examination.
* Gross hematuria: Red blood cells in the urine are visible with the naked eye when the child has a viral illness, such as a cold or sore throat.
* Slow development of deafness
* Decreases in vision
* High blood pressure
* Swelling of the eyes, especially in the mornings

CAUSE
* Alport's syndrome is caused by a genetic mutation that affects the formation of collagen. Collagen is one of the proteins that helps "hold us together" and is in connective tissue.
* Alport's syndrome is much more common in males than in females.

HOW THE DIAGNOSIS IS MADE
* Initial diagnosis can be made on the history and physical findings, but confirmation requires a biopsy of the kidney.

TREATMENT
* Treatment of Alport's syndrome is supportive, aimed mainly at slowing the progression of the symptoms. The only "cure" is a renal transplant, which is usually undertaken only when a patient's own kidneys have stopped working.
* A low-protein diet is usually recommended to help slow damage to the kidneys.
* High blood pressure is controlled with various medications.
* Unfortunately, there is no therapy available to prevent or slow the development of blindness and deafness.
* In the future, gene therapy may allow doctors to replace the defective gene and reverse some aspects of the disease.

no image

Alopecia Areata



DESCRIPTION
* Alopecia areata causes development of bald patches on the scalp. Although it is a relatively uncommon cause of hair loss in children, about half of the people who do develop alopecia areata do so before their 20th birthday.
* A less common form of the disease, "alopecia totalis," results in loss of all the hair on the head.



SYMPTOMS
* Hair loss, usually in patchy, localized areas
* Scalp in the areas of hair loss is smooth, without irritation, itching, or rash.
* Sudden development of hair loss, without slow spreading of the affected area
* Hairs that do grow in the affected area are shaped like "exclamation points" (narrow at the base and wider at the tips).

CAUSE
* The cause of alopecia areata is not known. It is thought to be an "autoimmune" disease. This means that the body confuses the hair follicle with an infecting or foreign object, and begins to attack it, much like it would fight an infection.

RISK FACTORS
* People with family members with the disease are at a higher risk of developing alopecia areata, leading many to conclude there is an unidentified gene that makes certain people more likely to develop the disease.

TREATMENT
* Because of the complexity of the therapy, most children with this disorder are treated by a dermatologist, who helps select the most appropriate therapy.
* There are several therapies for alopecia areata, but none are effective for all patients. Some of these treatments include:

1. Local injections of steroid medications, to decrease the immune response in the affected area
2. Use of topical medications that increase hair growth, such as Minoxidil
3. Use of topical anti-immune agents

* In more severe cases, use of oral steroids might be considered.
* Psychological counseling is also appropriate, since the hair loss can be very traumatic and embarrassing for children and (especially) teenagers.
* In most cases, alopecia areata will resolve itself, if given enough time. This can take several years to occur, and is less likely in children than in adults.

IF YOU SUSPECT THIS CONDITION
* See your pediatrician for more information.


no image

Allergies to Drugs



DESCRIPTION
* When the body's immune system reacts adversely to medication, it can exhibit an allergic (rejection) reaction. Any medication can cause an allergic reaction. The reasons are individual, varying from patient to patient. Such reactions may range from mild to severe and life threatening.



SYMPTOMS
* Hives
* Skin rash
* Swelling of lips, gums, and tongue
* Tightness in the throat
* Stridor (wheezing/whistling) sound in the neck
* Shortness of breath
* Wheezing in the chest
* Circulatory collapse (very Low Blood Pressure)
* Late reactions may include fever, joint pain/stiffness, and edema (swelling in the legs and arms).

HOW THE DIAGNOSIS IS MADE
* Often made from a history of taking certain medications that cause symptoms described above
* Laboratory:
* Allergy testing -- skin "prick" allergy testing
* Provocation testing -- direct challenge of the potential allergic agent under controlled conditions
* Bronchoprovocation testing -- an aerosolized solution of the potential allergic medication is given under controlled conditions. Lung function is measured before and after.
* Oral challenge -- medicine is given by mouth in a controlled environment.

TREATMENT
* Rapid desensitization -- the individual is given minute doses of the very medications he is allergic to, followed by gradual increase to full strength over a period of hours. This has been especially effective in treating Penicillin and Insulin allergies.

MISCELLANEOUS
* Cross Reactivity

- If one medication causes an allergic medication, other closely related medications are also likely to cause an allergic reaction. This is especially true with antibiotics. For example, patients who are allergic to the Penicillin family (e.g., Penicillin, Amoxicillin, Dicloxacillin) have up to a 10% chance of reacting to the Cephalosporin family of antibiotics (e.g. Keflex, Ceftin, Cefaclor).


no image

Allergies to Air Conditioners



DESCRIPTION
* Some people notice increased allergy problems in air-conditioned environments. The most likely cause is that the air filter in the air conditioner needs to be cleaned or replaced. Air filters trap allergens, like dust and pollen. When the filters do not work properly, allergens may be released into the air, causing typical allergy symptoms, such as watery eyes, runny nose, and wheezing.






no image

Allergic Tubulointerstitial Nephritis




DESCRIPTION
* The kidney tissue becomes inflamed due to an allergic reaction. This allergic reaction can occur from medications, infections, or the cause may be unknown.



SYMPTOMS
* Fever
* Rash
* Flank pain
* Blood in urine
* Low or high urine output
* Swelling due to fluid overload can occur in any area of the body (i.e., face, legs, abdomen)
* Lethargy, confusion, or even Coma can occur

CAUSE
* Drug reactions -- the most common cause:

1. Antibiotics (e.g., penicillin, sulfonamides, etc.) -- are the most prevalent cause
2. Thiazide diuretics
3. Furosemide
4. Allopurinol
5. Cimetidine (Tagamet)
6. Phenytoin (Dilantin)
7. Anti-inflammatories (such as ibuprofen)

* Bacterial infections
* Viral infections
* Mycoplasma
* Toxoplasma
* Idiopathic (unknown causes)

HOW THE DIAGNOSIS IS MADE
* Laboratory Tests:

1. Elevated blood eosinophils
2. Urinalysis may show red blood cells, white blood cells, white blood cell casts, protein, and eosinophils.

* Imaging

1. Ultrasound of kidneys
2. Gallium scanning

* Kidney biopsy may be considered if diagnosis is unclear.

TREATMENT
* Discontinuance of an offending medication
* Treatment of an underlying infection
* Kidney dialysis may be required in a severe case.
* Corticosteroid medications may be considered.

SIMILAR CONDITIONS
* Kidney Cancer
* Kidney Stones
* Pyelonephritis
* Post-streptococcal Glomerulonephritis
* Glomerulonephritis -- general
* Schistosomiasis
* Bladder Cancer


no image

Allergic Rhinitis



ALSO KNOWN AS
Hay fever

DESCRIPTION
* Inhaled allergens (materials that are foreign to the body) such as pollens, molds, or dust trigger an abnormal response by the body's immune system (protective cells and proteins known as antibodies that attack foreign invaders), specifically, IgE antibodies, which attach to mast cells. Mast cells are specialized cells that release inflammatory products. These inflammatory products produce the symptoms that occur with allergic rhinitis. Symptoms occur seasonally or year-round, depending on the allergen.
* Some patients will find that their symptoms wax and wane over the course of a year as various plants are in season.
* Children, who are reacting to other things in the environment, such as stuffed animals and pets, may find that their symptoms are constant.




SYMPTOMS
* Nasal congestion
* Sneezing
* Watery eyes
* Eye irritation
* Eye itching
* Headaches
* Pressure in the cheeks
* Wheezing
* Impaired sense of smell
* Sore throat and coughing may occur
* Wrinkles under the eyes
* Wrinkles across the nose

CAUSE
* Pollens
* House dust
* Dust mites
* Mold spores
* Grasses
* Ragweed
* Animal products -- urine, saliva, hair, skin debris

HOW THE DIAGNOSIS IS MADE
* Possible findings on examination:

1. Swollen and pale or purple turbinates (inside the nasal cavity)
2. Nasal polyps
3. Tenderness above eyes near bridge of nose or over cheeks.
4. Wheezing in chest

* Tests:

1. Complete blood count
2. Skin allergy testing
3. Serum RAST testing

TREATMENT
* Avoid allergens: Several therapies are available, depending upon the age of the child and the symptoms causing the most problems. This may require removal of pets, carpets, and stuffed animals from the home.
* For children under 2 years of age, the main medication is oral antihistamine such as diphenhydramine (Benadryl).
* For older children, several other therapies are available:

1. Prescription antihistamines cause less drowsiness, and can be taken less frequently, than their over-the-counter equivalents. They are best for patients in whom the main problem is a runny nose and postnasal drip.
2. Inhaled steroids, given by a nasal spray, are useful in children who can cooperate with their use. They are best for patients in whom the main problem is itchy and watery eyes, headaches, and congestion. There is some concern that inhaled steroids may decrease the rate of growth in children, but they do not appear to affect the final height they attain.

* If your child suffers environmental allergens, keep him/her indoors and use air conditioners or air filters.
* If caused by animals, keep pets out of the bedroom or remove animal from the home.
* If caused by mold spores, keep bathroom areas clean of mold and repair all leaks.
* Use flooring in place of carpets, dust frequently, and using dust-proof material, furniture, and bedding can reduce house dust/house mites.
* Medications:

1. Antihistamines -- over the counter such as Benadryl are effective, but tend to cause drowsiness. Newer prescription medications such as Claritin and Allegra are less likely to cause drowsiness, but are more expensive.
2. Nasal corticosteroid sprays
3. Cromolyn sodium nasal sprays
4. Antihistamine nasal sprays
5. Decongestants such as pseudoephedrine
6. Ibuprofen may help with associated headaches.
7. Prednisone in a tapered dose
8. Medrol dose pack
9. Kenalog (Triamcinolone injection) -- corticosteroid injection gives 4-6 weeks of relief, but can have long-term side effects if given too frequently

* Desensitization therapy also known as "Allergy Shots" -- very small amounts of allergen are injected, slowly increasing the dose over time in order to desensitize the body.

PREVENTION
* Although there is no way to prevent the development of allergic rhinitis, many of the symptoms can be prevented by controlling the environment.
* The most common things that aggravate allergic rhinitis:

1. Perfumes and dyes in new clothing; new clothes should always be washed prior to first use to decrease exposure.
2. Perfumes in clothing soaps: Always use "hypoallergenic" detergents, and do not use fabric softeners.
3. Stuffed animals
4. Pet dander
5. Cigarette smoke, either in the air, or on the clothes of those that smoke
6. Smog and other airborne pollutants

SIMILAR CONDITIONS
* Acute Sinusitis
* Chronic Sinusitis
* Common Cold
* Asthma
* Contact Dermatitis
* Allergic eye disease




Wednesday, December 3, 2008
no image

Allergic Rhinitis

ALSO KNOWN AS
Hay fever

DESCRIPTION
* Inhaled allergens (materials that are foreign to the body) such as pollens, molds, or dust trigger an abnormal response by the body's immune system (protective cells and Proteins known as antibodies that attack foreign invaders), specifically, allergins trigger IgE antibodies, which attach to mast cells. Mast Cells are specialized cells that release inflammatory products. These inflammatory products produce the symptoms that occur with allergic rhinitis. Symptoms occur seasonally or year-round, depending on the allergen.

ABNORMAL
NORMAL




SYMPTOMS
* Nasal Congestion
* Sneezing
* Watery eyes
* Eye irritation
* Eye itching
* Headaches
* Pressure in the cheeks
* Wheezing
* Impaired sense of smell
* Sore throat and coughing may occur

CAUSE
* Pollens
* House dust
* Dust mites
* Mold spores
* Grasses
* Ragweed
* Animal products -- urine, saliva, hair, skin debris

HOW THE DIAGNOSIS IS MADE
* Possible findings on examination:

1. Swollen and pale or purple turbinates (inside the nasal cavity)
2. nasal polyps
3. Tenderness above eyes near bridge of nose or over cheeks.
4. Wheezing in chest

* Tests:

1. Complete blood count
2. Skin allergy testing
3. Serum RAST testing

TREATMENT
* Avoidance of allergen is best:

1. If you are suffering from an environmental allergen -- stay indoors, use air conditioners or air filters.
2. If caused by animals, keep pets out of bedroom or remove animal from the home.
3. If caused by mold spores, keep bathroom areas clean of mold and repair all leaks.
4. Use flooring in place of carpets, dust frequently, and using dust-proof material, furniture, and bedding can reduce house dust/house mites.

* Medications:

1. Antihistamines -- over the counter such as Benadryl are effective, but tend to cause drowsiness. Newer prescription medications such as Claritin and Allegra are less likely to cause drowsiness, but are more expensive.
2. Nasal corticosteroid sprays
3. Cromolyn Sodium nasal sprays
4. Antihistamine nasal sprays
5. Decongestants such as Pseudoephedrine
6. Ibuprofen may help with associated headaches.
7. Prednisone in a tapered dose
8. Medrol dose pack
9. Kenalog (Triamcinolone injection) -- corticosteroid injection gives 4-6 weeks of relief, but can have long term side effects if given too frequently

* Desensitization therapy also known as "Allergy Shots" -- very small amounts of allergen are injected, slowly increasing the dose over time in order to desensitize the body.

SIMILAR CONDITIONS
* Acute Sinusitis
* Chronic Sinusitis
* Common Cold
* Asthma
* Contact Dermatitis
* Allergic eye disease


no image

Allergic Reaction



DESCRIPTION
* Allergic reactions can occur in response to many foods, cosmetics, drugs, and environmental triggers.
* Reactions can occur within a few minutes or often after a second exposure.



SYMPTOMS
* Red, itchy rash or Hives are the most obvious symptoms.
* Swelling around the eyes and lips are also common.
* Flushing, headache, abdominal cramps, runny nose, and congestion.
* Worse symptoms may include difficulty breathing, wheezing, cough, fever, swollen tongue, sloughing of skin, and blood in urine.
* Severe reactions can lower blood pressure and cause fainting.

HOW THE DIAGNOSIS IS MADE
* Onset of reaction often related to use of new product.
* Previous history of similar reaction.
* Rashes on a single area or over the entire body.

TREATMENT
* Most cases resolve when the cause is removed.
* Over-the-counter antihistamines will help with the itching and swelling.
* Physicians in severe cases can give adrenaline. Severe reactions should be treated in the emergency room.
* Steroid creams or oral medications may also help treat the symptoms.

PREVENTION
* Check the ingredients of foods, cosmetics and drugs. If your child has experienced a severe allergic reaction to any specific irritant, he/she should wear a bracelet indicating the previous allergic history.


no image

Allergic Dermatitis



DESCRIPTIONS
* A condition characterized by dry itchy skin
* Likely a genetic relationship
* Multiple environmental factors (i.e., food, clothing, soap, bacterial, dust-mites, climate)
* Emotional stress also worsens
* More common in infants; 50% are clear by age 10
* 50% retain the condition to adulthood
* Associated with Asthma in 50%



SYMPTOMS
* Dry, scaly rash. Common areas in infants are scalp, cheeks, and elbows.
* In children and adults, common areas are eyelids, neck, elbow creases, and back of knees
* Rarely, total body involvement may occur
* Prolonged episodes may lead to thickening, facial wrinkles, increased pigmentation.

TREATMENT
* Changing of formula (lactose to soy) may benefit some children
* Avoidance of environmental irritants and triggers
* Mild soaps, moisturizers, topical and oral antihistamines
* Restrict bathing to twice weekly; oatmeal baths may help, followed by moisturizers
* Scalp may benefit from antifungal shampoos and creams
* Severe cases may benefit from patch testing by a dermatologist
* Severe cases may require oral steroids and ultra-violet light therapy
* High-strength steroids may thin skin, cause acne, affect growth, and will require monitoring by a physician.

COMPLICATIONS
* Scratching can cause scarring, infection, increased pigmentation, and thickening of the skin.

PREVENTION
* Avoidance of irritants and triggers



no image

Allergic Contact Dermatitis



ALSO KNOWN AS
Contact dermatitis

DESCRIPTIONS
* This is an allergic reaction of the skin. It is caused by contact of the skin with substances such as chemicals that induce an allergic reaction.



SYMPTOMS
* Tiny blisters that may crust
* Scaling, red, thickened skin
* Itching, burning, stinging
* Large blisters occur
* Blisters may follow a line

CAUSE
* Soaps
* Detergents
* Organic solvents
* Poison ivy
* Poison oak
* Neomycin
* Hair dyes
* Latex
* Adhesive tape
* Nickel in jewelry
* Preservatives

TREATMENT
* Wet compresses
* Calamine or starch
* Topical corticosteroids such as Temovate
* Tar therapy
* Oral Prednisone for severe cases for 12-21 days
* Course of contact dermatitis -- usually takes two to three weeks to resolve

PREVENTION
* Washing allergic substance as quickly as possible. Sometimes isopropyl (rubbing) alcohol is used to wash off organic solvents. Iodoquinal may help with nickel allergy. The best prevention, of course, is to avoid substances that induce this reaction.

SIMILAR CONDITIONS
* Impetigo
* Scabies
* Atopic Dermatitis
* Eczema

no image

Allergic Conjunctivitis



ALSO KNOWN AS
Pink eye, red eye, or conjunctivitis

DESCRIPTION
* Conjunctivitis is a condition in which the white part of the eye becomes inflamed, red, and irritated. Anything that irritates or infects the white part of the eye can cause Conjunctivitis. Viral and allergic causes tend to have clear or "white eye discharge." Bacterial causes, e.g., Staphylococcus, tend to have yellow or green eye discharge.




SYMPTOMS
* White of eye is red
* Eye itching
* Watery eye discharge
* White eye discharge
* Yellow or green eye discharge

CAUSE
* Allergies
* Dry eyes

HOW THE DIAGNOSIS IS MADE
* Clear discharge, sudden onset -- usually Viral Conjunctivitis ("Pink Eye")
* Clear discharge, seasonal, or related to environment -- allergic
* Colored discharge -- usually bacterial (can still occasionally be viral) -- cultures may be done
* Sicca (dry) Eyes -- diagnosed by Schirmer's test

TREATMENT
* Viral (pink eye) -- none, but wash hands cautiously and avoid touching eye, as it is very contagious
* Gonorrhea -- Ceftriaxone by injection
* Chlamydia -- Doxycycline, Erythromycin, Azithromycin
* Bacterial causes -- antibiotic eye drops, e.g., Polytrim
* Allergic Eye -- topical lodoxamide, Naphcon A eye drops, other allergy eye drops
* Dry Eyes -- artificial tear drops
* Treatment precaution:

- Some antibiotic eye drop preparations contain corticosteroids. Corticosteroids can be helpful in some infections, but can make others worse. In most instances, drops containing corticosteroids should only be prescribed by an ophthalmologist (medical doctor who specializes in eye diseases).

MISCELLANEOUS
* Contact Lenses

- Contact lens use increases the risk of bacterial Conjunctivitis. Extended wear contacts have the highest risk. Use proper sterile techniques when handling your lenses. Follow instructions on how to clean your lenses carefully.


no image

Alcoholism


DESCRIPTION
* Alcoholism can have three components. The primary one is alcohol addiction (inability to discontinue drinking). The second is "problem drinking," in which alcohol interferes with the activities of daily living. The third is the use of alcoholic beverages to alleviate stress or emotional problems.




SYPTOMS
* Tolerance to the effects of alcohol
* Withdrawal symptoms when alcohol intake is interrupted
* Impairment in social and occupational function
* Depression
* Blackouts
* Frequent unexplained accidents (e.g., falls and injuries)

CAUSE
* Partial genetic Predisposition -- higher rate in twins and adopted children with alcoholic birth parents
* Abnormalities in the brain neurotransmitters or chemical enzymes may play a role.
* Depression
* Anxiety
* Addictive personality

HOW THE DIAGNOSIS IS MADE
* Alcohol on breath
* Red bulbous nose
* Red Eyes
* Memory difficulties
* Signs of alcoholic liver disease:
* Yellow eyes or skin
* Ascites (swollen abdomen)
* Palmar erythema (pink/red hands)
* Tremor
* Laboratory tests:

1. Elevated liver function tests, especially AST twice ALT value
2. Elevated mean corpuscular volume
3. Elevated Uric acid
4. Elevated triglycerides
5. Toxicology screen (ethanol level)

* Psychological screening tests such as Michigan Alcohol Screening Test (MAST), or Short MAST are sometimes used.

TREATMENT
* Alcohol recovery programs
* Alcoholics anonymous
* Religious/spiritual support
* Treatment of Depression, if present:

1. Psychotherapy
2. Antidepressants

* Disulfiram (Antabuse) -- an aversion medication that causes nausea/vomiting if one drinks alcoholic beverages
* Naltrexone -- a medication that helps with alcohol craving
* Ondansetron -- a medication that helps with alcohol craving
* Treatment of alcohol withdrawal if it occurs
* Treating Depression and social problems
* Treatment goal

- Complete Abstinence (and not "controlled drinking")

SIMILAR CONDITIONS
* Alcoholic Hepatitis
* Cirrhosis
* Drug addiction
* Alcohol withdrawal
* Wernicke's Encephalopathy
* Korsakoff's Psychosis
* Depression

MISCELLANEOUS
* Social Implications of Alcoholism

1. Major factor in rape, sexual abuse, assault, and murder
2. Higher rate of suicide
3. Major cause of automobile fatalities
4. Dysfunctional homes
5. Major cause of missed work



Tuesday, December 2, 2008
no image

Alcoholic Liver Disease


ALSO KNOWN AS
Alcoholic Hepatitis

DESCRIPTION
* This occurs after periods of long-term Consumption of ethanol (alcohol), an agent toxic to the liver, which inflames and injures the liver. This condition is reversible, but commonly is a precursor to liver Cirrhosis (permanent damage and scarring of the liver).



SYMPTOMS
* Loss of Appetite
* Nausea
* Abdominal pain
* Fever
* Confusion
* Coma

CAUSE
* Excessive alcohol Consumption (this level may be less than the level for drunkenness)

HOW THE DIAGNOSIS IS MADE
* Possible findings on examination:

1. Jaundice (yellow skin or eyes)
2. Ascites (fluid in abdomen)
3. Hepatomegaly (enlarged liver)

* Tests that may be performed:

1. Blood tests
2. CBC, which may show anemia and elevated white blood cell count
3. Liver function tests show a moderately elevated AST that is usually double the ALT level, elevated GGTP, and elevated Bilirubin level.
4. Decreased albumin (protein level) and increased gamma globulin level
5. Liver biopsy
6. Ultrasound of liver
7. CT scan
8. MRI

TREATMENT
* Discontinuance of all alcoholic beverages
* Nutritional supplementation
* Vitamin supplementation with Folic Acid and Thiamin usually needed
* Methylprednisolone may be considered by your physician.

PREVENTION
* An alcoholic dependency treatment program, counseling, or Alcoholic Anonymous (AA) should strongly be considered.

SIMILAR CONDITIONS
* Cholecystitis
* Cholelithiasis
* Cirrhosis
* Alcoholism
* Drug & toxin-induced liver disease
* Hepatitis A
* Hepatitis B
* Hepatitis C



no image

Alcoholic Hepatitis

ALSO KNOWN AS
Alcoholic liver disease

DESCRIPTION
* This occurs after periods of long-term Consumption of ethanol (alcohol), an agent toxic to the liver, which inflames and injures the liver. This condition is reversible, but commonly is a precursor to liver Cirrhosis (permanent damage and scarring of the liver).

ABNORMAL

NORMAL



SYMPTOMS
* Loss of Appetite
* Nausea
* Abdominal pain
* Fever
* Confusion
* Coma

CAUSE
* Excessive alcohol Consumption (this level may be less than the level for drunkenness)

HOW THE DIAGNOSIS IS MADE
* Possible findings on examination:

1. Jaundice (yellow skin or eyes)
2. Ascites (fluid in abdomen)
3. Hepatomegaly (enlarged liver)

* Tests that may be performed:

1. Blood tests
2. CBC, which may show anemia and elevated white blood cell count
3. Liver function tests show a moderately elevated AST that is usually double the ALT level, elevated GGTP, and elevated Bilirubin level.
4. Decreased albumin (protein level) and increased gamma globulin level
5. Liver biopsy
6. Ultrasound of liver
7. CT scan
8. MRI

TREATMENT
* Discontinuance of all alcoholic beverages
* Nutritional supplementation
* Vitamin supplementation with Folic Acid and Thiamin usually needed
* Methylprednisolone may be considered by your physician.

PREVENTION
* An alcoholic dependency treatment program, counseling, or Alcoholic Anonymous (AA) should strongly be considered.

SIMILAR CONDITIONS
* Cholecystitis
* Cholelithiasis
* Cirrhosis
* Alcoholism
* Drug & toxin-induced liver disease
* Hepatitis A
* Hepatitis B
* Hepatitis C


Followers

Copyright © 2013 Healthy Our Priority All Right Reserved