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Sunday, August 30, 2009
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Appendicitis

Abnormal

Normal

Description
* The appendix is a collection of lymphatic tissue (tissue that is part of the body's immune/defense system). The appendix, connected to the colon, is a few inches in length and has a lumen (a hollow portion). Appendicitis is thought to occur when this lumen becomes obstructed.



Symptoms
* Child refuses to run or jump because of abdominal pain
* Flank, pelvic, or rectal pain may occur
* Pain usually begins near belly button
* Pain then localizes to the right lower abdomen
* Nausea/vomiting (occurs after pain starts and not before)
* Loss of appetite
* Urinary pain/frequency may occur

Cause
* Fecal obstruction
* Parasitic worm obstruction
* Tumor obstruction
* Viral infection of appendix
* Barium obstruction (from a medical test)

How The Diagnosis Is Made
* Examination:

1. Fever
2. Fast heart rate
3. Rebound tenderness in right lower abdomen (pain is worse when doctor releases hand from abdomen)
4. Flank, rectal, or pelvic pain if appendix is in unusual position
5. Rigid or diffuse abdominal tenderness if appendix perforates

* If the diagnosis is still unclear after all the tests and procedures are done, many doctors will admit a child to the hospital for observation and repeated physical exams over a period of 12 to 24 hours.
* Laboratory:

1. Laboratory tests may be unreliable in some (e.g., older patients with certain drugs/medications).
2. Elevated white blood cell count
3. Urinalysis to check for other causes

* Imaging:

1. Abdominal X-ray (KUB), ultrasound, or barium enemas may help in certain cases but are not diagnostic.
2. Spiral CT scan is now very sensitive in detecting appendicitis


Treatment
* Surgical removal of the appendix (appendectomy) as soon as possible, unless the doctor feels a mass on the outside.
* The surgery, called an "appendectomy," can be done through a small incision in the abdomen or with a laparoscope, a small device with a camera that lets the surgeon operate remotely. The decision about what kind of procedure is needed depends upon each patient's circumstances.
* Because the complications of an untreated appendix infection are serious, children often have an appendectomy even if the diagnosis is not entirely certain. In cases where the surgeon finds that the appendix is not infected, it is usually removed anyway, so that there is not question of a possible infection in the future.
* If mass is felt on the outside, patients are treated with IV antibiotics and fluids, and appendectomy is done when the patient is more stable.

Miscellaneous
* Special Considerations:

1. There may be unusual presentations, such as pain in rectum only and no abdominal pain, if the appendix is pointed backwards. Therefore, appendicitis must be considered as a possible diagnosis in all types of pelvic, rectal, and back pain, as well as with abdominal pain.
2. In infants with fever, Diarrhea, vomiting, and abdominal pain appendicitis should always be considered.
3. In pregnant women, appendicitis occurs in 1 in every 1000 pregnancies, and the enlarged uterus may push appendix to the right upper abdomen, causing pain in this area.
4. If an infected appendix is not removed in time, it may break open, or "rupture." This is a serious and potentially life-threatening complication. Children with a ruptured appendix will usually require a week or more of IV antibiotics.


* Seek emergency medical care immediately.

Similar Conditions
* Mesenteric adenitis
* Severe constipation
* Urinary tract infection
* Pneumonia
* Acute gastroenteritis
* Meckel's diverticulitis
* Intussusception
* Ovarian lesions



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Aplastic Anemia


Also known as
Hypoplastic anemia, refractory anemia or pan-myelo-phthisis

Description
* Of the many components that make up the cells --e.g., red blood cells (carry oxygen), platelets (stop bleeding), white blood cells (fight infection) -- all are made in the bone marrow. The bone marrow is contained in the long and pelvic bones of the body. When the bone marrow is damaged or destroyed, the result is a lack of production of the cellular productions of blood -- resulting in aplastic anemia. Toxins, radiation, cancer chemotherapy, and medications are the main causes of this condition.



Symptoms
* Weakness
* Fatigue
* Shortness of breath
* Infections
* Nosebleeds
* Occult blood loss from the rectum
* Gastrointestinal bleeding
* Heavy menstrual bleeding
* Bleeding in gums
* Bleeding under skin

Cause
* Idiopathic (probably autoimmune -- the body mistakenly attacks the bone marrow)
* Diseases:

1. Systemic Lupus Erythematosus
2. Post-hepatitis
3. Congenital (Fanconi's anemia)
4. Paroxysmal nocturnal hemoglobinuria
5. AIDS
6. Viral hepatitis

* Toxins:

1. Benzene
2. Toluene
3. Insecticides

* Medications:

1. Chloramphenicol
2. Phenylbutazone
3. Gold Salts
4. Sulfonamides
5. Phenytoin (Dilantin)
6. Carbamazepine (Tegretol)
7. Quinacrine
8. Tolbutamide

* Cancer Chemotherapy
* Radiation therapy
* Pregnancy
* Some forms may be associated with thymomas (the types that only affect red blood cells)



How The Diagnosis Is Made
* Examination:

1. Pale
2. Red/purple blotchy rash
3. Fine "red dot" rash
4. Enlarged liver
5. Enlarged spleen
6. Swollen lymph glands
7. Bone tenderness

* Laboratories:

1. Complete blood count shows anemia, decreased white blood cell count, decreased platelets
2. There may be blood in stool or urinalysis.
3. HLA testing -- a genetic marker is evident

* Tests:

- Bone marrow biopsy

Treatment
* Supportive therapy such as oxygen may be needed
* Blood Transfusions
* Platelet Transfusions
* Bone Marrow Transplantation
* Antithymocyte Globulin (suppresses immune system to treat autoimmune cause, i.e., stops the body from mistakenly attacking the bone marrow).
* Cyclosporin (used with Antithymocyte Globulin)
* Cyclophosphamide and predisone are also used in some cases.
* G-CSF & GM-CSF (stimulate white blood cell production)
* Androgens (only works in a few cases)

If You Suspect This Condition
* You must seek immediate medical attention. If not treated, there is an 80% death rate in 3 months.

Similar Conditions
* Myelodysplasia
* Acute Leukemia
* Myelofibrosis
* Lymphoma
* Multiple Myeloma
* Hairy cell leukemia
* B12 deficiency
* Folic Acid Deficiency


Friday, August 7, 2009
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Aphthous Ulcer



Also Known As
Ulcerative stomatitis or canker sore


Description
* These are small sores or painful swellings on the inside of the mouth and on the tongue that appear without apparent reason, and disappear by themselves usually within ten days, leaving no scar. They maybe caused by stress, spicy foods, or acid-alkaline imbalance.



Symptoms
* Small (usually a few millimeters and rarely up to a few centimeters), painful ulcerations -- they usually have a yellow-gray center surrounded by a red halo
* Usually painful for 7-10 days
* Usually resolve in 7-21 days


Cause
* Unknown, but probably viral



Treatment
* Topical corticosteroids in an adhesive base e.g. Triamcinolone acetonide 0.1% with Orabase Palin
* Tapered 7-day course of prednisone in severe cases


Similar Condition
* Herpes Simplex
* Behcet's syndrome
* Drug allergic reaction
* Erythema Multiforme
* Pemphigus
* Bullous lichen planus
* Squamous cell carcinoma







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Aphasia



Also Known As
Language impairment

Description
* Aphasia is an impairment of the ability to use or comprehend (and express) language (i.e. words). Aphasia makes it difficult to speak, read, write, or understand speech, but has no effect on an individual's intelligence. Aphasia can affect anyone of any age, race, or gender.
* Aphasia is often the result of damage to the language areas of the brain located in the left hemisphere. It is usually acquired as a result of a Stroke or other brain injury (e.g., cerebral tumor, head injury, etc.).
* A type of aphasia known as Broca's aphasia (non-fluent aphasia) results from damage to an area in the left frontal lobe of the brain known as the Broca's area. Individuals with this condition are able to understand the speech of others normally, but are unable to properly form words. Consequently, their speech is slow and slurred, and they speak in short phrases produced with great effort.
* Another important language area in the brain is Wernicke's area, which normally communicates with Broca's area via a bundle of nerves known as the arcuate fasciculus. When the arcuate fasciculus is damaged, it may cause a condition known as conduction aphasia, in which patients understand language normally, but are unable to repeat words. Their speech does not make sense.
* People with damage to Wernicke's area specifically (i.e., Wernicke's aphasia or fluent aphasia) can speak clearly, but their words make no sense (i.e., "word salad"). They also may add unnecessary words or even create new ones. They have great difficulty in understanding the speech of other people.
* Transient aphasia refers to a temporary condition involving problems with communication, whereas global aphasia describes a condition in which extensive portions of the brain have been damaged, resulting in severe and permanent communication difficulties.




Treatment
* Is aimed at the underlying cause, and may involve rehabilitation by a speech therapist.



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Aortic Stenosis



Description

* The heart pumps blood from its left ventricle (left lower chamber) to the rest of the body by way of a large blood vessel known as the aorta. The aortic valve, located between the left ventricle and the aorta, opens when the ventricle pumps blood to the aorta, and closes (passively) when at rest (i.e., between heartbeats). Normally, the aortic valve has three leaflets.
* If the valve becomes narrowed, it causes Aortic Stenosis, interfering with the heart's ability to pump blood to the rest of the body. (Think of a hose blasting water through a crimped opening).
* Aortic valvular stenosis is due to the progressive buildup of Calcium on the valve leaflets, or when the valve leaflets suffer damage. (Note: severe Aortic Stenosis is defined as a valve area of 0.7 square centimeters or less.)



Symptoms
* Shortness of breath
* Lightheadedness especially on exertion
* Fainting on standing or exertion
* Chest pain
* Rarely, sudden death

Cause
* Congenital bicuspid valve -- the aortic valve has two leaflets instead of the normal three, causing Calcium buildup and progressive valve constriction.
* Rheumatic heart disease -- caused by untreated "strep throat" infections usually from childhood
* Elderly individuals (without specific cause)

How The Diagnosis Is Made
* Examination --

1. Carotid -- delayed and diminished carotid upstroke
2. Heart in mild to moderate cases will reveal a systolic eject murmur in the aortic area that radiates to the neck and apex
3. In severe cases -- reversed splitting of the second heart sound or weak/absent aortic sound. Signs of left ventricular hypertrophy may be present, such as left ventricular heave or thrill.
4. Lungs -- signs of Heart Failure may occur in severe Aortic Stenosis (e.g., crackles)

* Tests --

1. Electrocardiogram may show left ventricular hypertrophy, repolarization changes, or may be normal
2. Chest X-Ray may show a calcified aortic valve and cardiomegaly
3. Echocardiogram can evaluate the valve and the degree of stenosis (when done with a Doppler)
4. Cardiac catheterization gives the definitive measurements of stenosis.



Treatment
* Aortic Stenosis is treated by surgical valve replacement when it causes symptoms, or when stenosis (narrowing) becomes severe.
* The valve may be replaced with a mechanical (artificial valve) or porcine (pig) valve. Mechanical valves may be more durable, but require anticoagulation with the blood thinner Coumadin. A new procedure involves transplanting the patient's own pulmonary valve to the aortic area, and replacing the pulmonary valve instead. (Since the aortic valve is the one under greater pressure, a transplant as described above will lower the risk of rejection and decrease the need for repeat replacement surgery.) Prior to surgery, the patient is placed on a low Sodium diet, diuretics ("water pills"), and Digoxin.
* Balloon angioplasty (opening a balloon device in the stenotic valve to open it) is used primarily in patients for whom surgery is not an option, or as an alternative to surgery.

If You Suspect This Condition

* See your physician as soon as possible. If you have symptoms such as chest pain, shortness of breath, or fainting seek immediate emergency medical treatment.

Similar Condition
* Aortic Regurgitation
* Mitral Stenosis
* Hypertrophic cardiomyopathy

Miscellaneous
* Special Consideration

- Patients with Aortic Stenosis or those who have had valve replacement should be placed on antibiotic prophylaxis to prevent infective endocarditis. This includes dental, respiratory, esophageal, gastrointestinal, and genitourinary procedures.








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Aortic Regurgitation


Also Known As

Aortic insufficiency

Description

* The heart pumps blood from the left ventricle (chamber) of the heart to the rest of the body by way of a large blood vessel known as the aorta. The aortic valve, located between the left ventricle and the aorta, opens when the ventricle pumps blood to the aorta, and closes (passively) when at rest (i.e., between heartbeats). If the valve leaflets are damaged or fail to close properly, blood leaks back from the aorta into the left ventricle between heartbeats. This is known as aortic regurgitation.



Symptoms

* Usually none until age 40-50
* Fatigue
* Shortness of breath on exertion
* Shortness of breath while resting prone
* Chest pain
* Lightheadedness

Cause

* Congenital bicuspid aortic valve (person is born with only two aortic valve leaflets, instead of the normal three)
* Rheumatic heart disease (caused by untreated "strep throat" in childhood)
* Hypertension
* Infective endocarditis
* Marfan's Syndrome
* Ankylosing Spondylitis
* Reiter's Syndrome
* Aortic Dissection
* Syphilis

How The Diagnosis Is Made

* Chronic (slow onset) aortic regurgitation, e.g., rheumatic heart disease --

1. Decreased diastolic blood pressure
2. Wide pulse pressure (large difference between systolic and diastolic)
3. Pulse has a rapid rise and fall (known as a Corrigan's pulse)
4. Diastolic murmur over a partially compressed femoral artery
5. Nail bed capillaries show pulsations
6. Apical heart impulse is prominent
7. Heart reveals a high-pitched decrescendo diastolic murmur in the aortic area. An Austin Flint murmur may be present (low-pitched, mid or late diastolic murmur).
8. Electrocardiogram shows left ventricular hypertrophy
9. Chest X-Rays shows an enlarged heart (cardiomegaly)

* Acute aortic regurgitation, e.g., infective endocarditis --

1. Sudden onset of aortic regurgitation murmur
2. Lungs may reveal crackles of Pulmonary Edema
3. Echocardiogram -- reveals the valve abnormality, and Doppler studies show the degree of regurgitation.
4. Scintigraphic studies can asses left ventricular function
5. Cardiac catheterization is often helpful


Treatment

* Chronic --

1. Vasodilator medications such as ACE inhibitors, hydralazine, and nifedipine can decrease the severity of the regurgitation.
2. Beta-blocker medications may slow progression in those with Marfan's Syndrome.
3. Surgical valve replacement in those with symptoms or significant left ventricular dysfunction

* Acute --

- Usually caused by infective endocarditis -- surgical replacement of the valve is usually needed. Vasodilators may temporarily stabilize the condition.

if u suspect this condition
* Acute aortic regurgitation -- this is a life-threatening medical condition. Seek immediate emergency medical treatment.
* Chronic aortic regurgitation -- this condition needs to be followed carefully by your physician. A cardiologist is often consulted.

Miscellanous

* Special Consideration

- Persons with aortic regurgitation should have antibiotic prophylaxis to prevent infective endocarditis. This includes dental, respiratory, esophageal, gastrointestinal, and genitourinary procedures.




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Aortic Insufficiency



Also Known As
Aortic regurgitation

Description
* The heart pumps blood from the left ventricle (left lower chamber) of the heart to the rest of the body by way of a large blood vessel known as the aorta. The aortic valve, located between the left ventricle and the aorta, opens when the ventricle pumps blood to the aorta, and closes (passively) when at rest (i.e., between heartbeats). If the valve leaflets are damaged or fail to close properly, blood leaks back from the aorta into the left ventricle between heartbeats. This is known as aortic regurgitation.




Symptoms

* Usually none until age 40-50
* Fatigue
* Shortness of breath on exertion
* Shortness of breath while resting prone
* Chest pain
* Lightheadedness

Cause

* Congenital bicuspid aortic valve (person is born with only two aortic valve leaflets, instead of the normal three)
* Rheumatic heart disease (caused by untreated "strep throat" in childhood)
* Hypertension
* Infective endocarditis
* Marfan's Syndrome
* Ankylosing Spondylitis
* Reiter's Syndrome
* Aortic Dissection
* Syphilis



How The Diagnosis Is Made

* Chronic (slow onset) aortic regurgitation, e.g., rheumatic heart disease --

1. Decreased diastolic blood pressure
2. Wide pulse pressure (large difference between systolic and diastolic)
3. Pulse has a rapid rise and fall (known as a Corrigan's pulse)
4. Diastolic murmur over a partially compressed femoral artery
5. Nail bed capillaries show pulsations
6. Apical heart impulse is prominent
7. Heart reveals a high-pitched decrescendo (decreasing in loudness) diastolic murmur in the aortic area. An Austin Flint murmur may be present (low-pitched, mid or late diastolic murmur).
8. Electrocardiogram shows left ventricular hypertrophy
9. Chest X-Rays shows an enlarged heart (cardiomegaly)

* Acute aortic regurgitation, e.g., infective endocarditis --

1. Sudden onset of aortic regurgitation murmur
2. Lungs may reveal crackles of Pulmonary Edema

* Echocardiogram -- reveals the valve abnormality, and Doppler studies show the degree of regurgitation.
* Scintigraphic studies can asses left ventricular function
* Cardiac catheterization is often helpful
treatment

* Chronic --

1. Vasodilator medications such as ACE inhibitors, hydralazine, and nifedipine can decrease the severity of the regurgitation.
2. Beta-blocker medications may slow progression in those with Marfan's Syndrome.
3. Surgical valve replacement in those with symptoms or significant left ventricular dysfunction
* Acute --

- Usually caused by infective endocarditis -- surgical replacement of the valve is usually needed. Vasodilators may temporarily stabilize the condition.

If You Suspect This Condition

* Acute aortic regurgitation -- this is a life-threatening medical condition. Seek immediate emergency medical treatment.
* Chronic aortic regurgitation -- this condition needs to be followed carefully by your physician. A cardiologist is often consulted.

Miscellanous

* Special Consideration

- Persons with aortic regurgitation should have antibiotic prophylaxis to prevent infective endocarditis. This includes dental, respiratory, esophageal, gastrointestinal, and genitourinary procedures.


Sunday, June 7, 2009
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Aortic Insufficiency




ALSO KNOWN AS

Aortic regurgitation

DESCRIPTION

* The heart pumps blood from the left ventricle (left lower chamber) of the heart to the rest of the body by way of a large blood vessel known as the aorta. The aortic valve, located between the left ventricle and the aorta, opens when the ventricle pumps blood to the aorta, and closes (passively) when at rest (i.e., between heartbeats). If the valve leaflets are damaged or fail to close properly, blood leaks back from the aorta into the left ventricle between heartbeats. This is known as aortic regurgitation.



SYMPTOMS

* Usually none until age 40-50
* Fatigue
* Shortness of breath on exertion
* Shortness of breath while resting prone
* Chest pain
* Lightheadedness



CAUSE

* Congenital bicuspid aortic valve (person is born with only two aortic valve leaflets, instead of the normal three)
* Rheumatic heart disease (caused by untreated "strep throat" in childhood)
* Hypertension
* Infective endocarditis
* Marfan's Syndrome
* Ankylosing Spondylitis
* Reiter's Syndrome
* Aortic Dissection
* Syphilis

>

HOW THE DIAGNOSIS IS MADE

* Chronic (slow onset) aortic regurgitation, e.g., rheumatic heart disease --

1. Decreased diastolic blood pressure
2. Wide pulse pressure (large difference between systolic and diastolic)
3. Pulse has a rapid rise and fall (known as a Corrigan's pulse)
4. Diastolic murmur over a partially compressed femoral artery
5. Nail bed capillaries show pulsations
6. Apical heart impulse is prominent
7. Heart reveals a high-pitched decrescendo (decreasing in loudness) diastolic murmur in the aortic area. An Austin Flint murmur may be present (low-pitched, mid or late diastolic murmur).
8. Electrocardiogram shows left ventricular hypertrophy
9. Chest X-Rays shows an enlarged heart (cardiomegaly)

* Acute aortic regurgitation, e.g., infective endocarditis --

1. Sudden onset of aortic regurgitation murmur
2. Lungs may reveal crackles of Pulmonary Edema

* Echocardiogram -- reveals the valve abnormality, and Doppler studies show the degree of regurgitation.
* Scintigraphic studies can asses left ventricular function
* Cardiac catheterization is often helpful

TREATMENT

* Chronic --

1. Vasodilator medications such as ACE inhibitors, hydralazine, and nifedipine can decrease the severity of the regurgitation.
2. Beta-blocker medications may slow progression in those with Marfan's Syndrome.
3. Surgical valve replacement in those with symptoms or significant left ventricular dysfunction

* Acute --

- Usually caused by infective endocarditis -- surgical replacement of the valve is usually needed. Vasodilators may temporarily stabilize the condition.

IF YOU SUSPECT THIS CONDITION

* Acute aortic regurgitation -- this is a life-threatening medical condition. Seek immediate emergency medical treatment.
* Chronic aortic regurgitation -- this condition needs to be followed carefully by your physician. A cardiologist is often consulted.

MISCELLANEOUS

* Special Consideration

- Persons with aortic regurgitation should have antibiotic prophylaxis to prevent infective endocarditis. This includes dental, respiratory, esophageal, gastrointestinal, and genitourinary procedures.


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Aortic Dissection


Abnormal
Normal

DESCRIPTION

* The aorta is the large artery that carries blood from the heart to the rest of the body. Anatomically, it arches over the heart, down the back of the chest cavity, into the abdomen. Though the wall of the aorta is thick, a tear may occur in the wall. Tears generally start from the inside and burrow downward. A tear in the aorta is called an aortic dissection. Aortic dissections are classified into two types, based on the location of the tear: If the tear is high in the aorta (ascending aorta and the arch) it is called Type A; lower (descending aorta), it is called Type B.




SYMPTOMS

* Sudden onset of severe chest pain
* Pain radiates down arms or into neck
* Sweating
* Loss of consciousness
* Shortness of breath
* Weakness
* Ripping/tearing pain in the back or chest


CAUSE

* A tear in the internal layer of the aorta that extends down the wall, creating a false lumen.
* Possibly, injuries during catheterization

HOW THE DIAGNOSIS IS MADE

* Examination:

1. Diminished pulses in wrists and/or legs/feet
2. Wide pulse pressure
3. Low or High Blood Pressure
4. Heart murmur
5. Lung crackles

* Electrocardiogram may show left ventricular hypertrophy. It may show myocardial ischemia (decreased blood to heart) if dissection extends into coronary blood vessels.
* Imaging:

1. Chest X-Rays show abnormal aortic contour or widened mediastinum (center cavity of chest) -- a widened area where the aorta is normally narrower
2. CT scan
3. MRI
4. Angiography (dye is injected into the aorta and X-Rays taken)
5. Transesophageal Echocardiography (ultrasound of heart done by passing a scope into the esophagus)



RISK FACTORS

* Long-standing High Blood Pressure
* Age
* Bicuspid aortic valve
* Aortic coarctation
* Pregnancy
* Marfan's Syndrome (a genetic disorder that results in a defect in components that make up wall structure of the aorta)
* Ehlers-Danlos syndrome
* Cardiac surgery
* Trauma to the chest
* Cocaine abuse

TREATMENT

* Medications:

1. Intravenous beta blockers decrease shear force and blood pressure
2. Intravenous nitroprusside to lower blood pressure

* Surgery:

Replacement of torn aorta with an artificial graft

* Note: Type A dissections nearly always need surgery, whereas Type B is generally managed with medications.

IF YOU SUSPECT THIS CONDITION

* You need emergency medical treatment. The death rate for untreated aortic dissection is 20% in the first day, and 90% over 3 months.

PREVENTION

* One of the major causes of aortic dissection is untreated High Blood Pressure. Proper monitoring and use of blood pressure medications will prevent aortic dissection in most cases.

SIMILAR CONDITIONS

* Myocardial Infarction
* Angina pectoris
* Aortic aneurysm
* Pulmonary Embolism
* Marfan's Syndrome


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Anxiety

DESCRIPTION

* Generalized anxiety is very common. Most people experience periods of anxiety in their lives. Others have general anxiety most of the time. The latter condition generally begins between 20-35 years of age, and is somewhat more common in women.



SYMPTOMS

* Apprehension
* Worry
* Dizziness
* Sweating
* Trembling
* Tense feeling
* Vigilance
* Irritability
* Other body systems may be involved, with the resulting possible symptoms:



1. Headaches, including migraines
2. Heart racing
3. Tightness or pressure in the chest
4. Increased blood pressure
5. Stomach pain and acid feeling
6. Indigestion
7. Hyperventilation or rapid, shallow breathing
8. Choking sensation
9. Tingling sensation

CAUSE

* Genetic predisposition, psychological stressors (e.g., social, cultural, and major significant events), neurochemical abnormalities, e.g., serotonin, GABA (gamma aminobutyric acid), and other brain chemicals may all play a role.

HOW THW DIAGNOSIS IS MADE

* Rule out other causes, such as thyroid problems, e.g., Pheochromocytoma

TREATMENT

* Biofeedback
* Regular exercise/ meditation and stress reduction techniques (e.g., deep breathing).
* Psychotherapy counseling
* Medications:

1. Buspar
2. Paxil and other calming anti-depressants
3. Benzodiazepines such as Xanax, used cautiously due to addicting potential

SIMILAR CONDITIONS

* Post traumatic stress disorder
* Social phobia
* Use of or withdrawal from drugs such as caffeine, amphetamines, cocaine, and alcohol
* Asthma and other lung problems
* Metabolic and hormonal problems such as Hyperthyroidism, Cushing's disease, Pheochromocytoma, and hypoglycemia.
* Neurological problems, such as essential tremors
* Panic Disorder
* Depression
* Obsessive-compulsive disorder
* Hyperthyroidism





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Anosmia

ALSO KNOWN AS

Smelling difficulties

DESCRIPTION

* Smelling problems occur either because of obstruction or injury of nasal passages, or due to problems with neurological processing. There are multiple causes, as listed below.



CAUSE

* Aging
* Nasal Obstruction
* Allergies
* Sinusitis
* Viral Rhinitis (Cold)
* nasal polyps
* Nasal tumors
* Brain/Head tumors
* Head trauma
* Diabetes Mellitus
* Hypothyroidism
* Cushing's Syndrome
* Nutritional problems
* Anxiety disorders
* Lead Poisoning
* Prolonged use of nasal decongestants
* Medications e.g. estrogen, phenothiazines
* Drugs such as amphetamines (speed)
* Cocaine abuse (nasally inhaled)
* Parkinson's Disease
* Alzheimer's disease
* Korsakoff's Psychosis
* Vitamin B12 Deficiency
* Zinc deficiency
* Kallmann's syndrome



TREATMENT

* Treat the underlying cause
* For sudden neurosensory loss (neurosensory system is not working properly for unknown reason) -- Zinc and Vitamin A replacement may be tried




Thursday, May 7, 2009
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Anorexia Nervosa


ALSO KNOWN AS

Eating disorder

DESCRIPTION

* In this condition, the individual has a distorted body image of normal weight. He/she may also have a fear of becoming fat. The individual uses starvation and/or exercise in order to achieve abnormally low weight.



SYMPTOMS

* Loss of sexual interest
* Extensive exercise habits
* Elaborate eating rituals
* Decline in cognitive functions, exemplified by learning difficulties in school
* Social isolation
* Blotchy skin
* Refusal to maintain body weight
* 25% or more weight loss
* Distorted body image
* Cold intolerance
* Constipation

CAUSE

* Distorted body image
* Fear of weight gain
* Fear of loss of control over food intake
* Depression
* Models/actresses as the standard for "normal" (who themselves are often anorexic)


HOW THE DIAGNOSIS IS MADE

* Dental cavities
* Depression may be identified
* Body weight 15% below expected
* Emaciation
* In females, absence of three consecutive menstrual cycles
* Low heart rate
* Low basal body temperature
* Loss of body fat
* Dry Scaly Skin
* Increased lanugo (fine "baby" hair)
* Enlargement of glands in front of ears (parotid gland enlargement)
* Leg swelling
* Laboratory work up may include a Complete blood count with differential (may show white blood cells and a low CD4/CD8 ratio and anemia), chemistry panel (may show abnormal liver enzymes and high cholesterol), hormone levels (Low T3, low FSH, low LH, low leptin, high growth hormone, high vasopressin and Cortisol levels), urine analysis, and EKG (prolonged Q-T interval).

TREATMENT

* Psychiatric/behavioral team experienced with anorexia
* Hospitalization may be necessary.
* Antidepressants may be considered.
* Intravenous nutritional support if Malnutrition is severe

SIMILAR CONDITIONS

* Bulimia Nervosa
* Addison's Disease
* Hyperthyroidism
* Diabetes Mellitus
* Celiac Sprue
* Crohn's Disease
* Lymphoma
* Tuberculosis
* Pituitary disorder

MISCELLANEOUS

* Social Considerations

1. Current societal admiration for thinness as a sign of beauty/attractiveness has contributed to the problems of distorted body image held by many anorexic women. Thirty years ago, most of the actresses/models of today would be considered "tomboyish" and "masculine."
2. The phenomenon of anorexia (and bulimia) is a strong indication of the need to empower individuals not to have their bodies and souls controlled by fluctuating and illogical standards, as dictated and fostered by the media.


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Anorectal Infections


DESCRIPTION

* These are infections of the anal and rectal tissues, causing the tissues in these areas to become inflamed. It is usually sexually transmitted, with the highest risk from anal intercourse.



SYMPTOMS

* Anorectal pain
* Severe rectal pain after a bowel movement
* Rectal discharge
* Constipation
* Anorectal itching/burning

CAUSE

* Neisseria gonorrhoeae (Gonorrhea)
* Treponema pallidum (syphilis)
* Chlamydia trachomatis (Chlamydia)
* Herpes Simplex virus
* Human papillomavirus

HOW THE DIAGNOSIS IS MADE

* Examination -- findings that may be present:


1. Redness of anal area
2. Pus expressed from crypts in anus
3. Chancre (painless ulcer) present in syphilis
4. Condylomata lata (moist warty patches) present in syphilis
5. Genital ulcers
6. Enlarged lymph nodes in groin
7. Blister lesions in anal or genital area
8. Warty areas (hard and thickened)

* Laboratory Tests:

1. Swab and culture of anal canal
2. Urethral or cervical cultures may be helpful
3. Dark-field microscopy (test for syphilis)
4. VDRL or RPR blood test for syphilis
5. Rectal biopsy
6. Viral culture or antigen detection of herpes lesions

TREATMENT

* Gonorrhea -- Ceftriaxone, ciprofloxacin
* Syphilis -- Penicillin G (injection), tetracycline, azithromycin
* Chlamydia -- Tetracycline, erythromycin, trimethoprim-sulfamethoxazole, azithromycin
* Herpes Simplex -- Acyclovir, Valtrex, Famvir
* Venereal Warts (human papillomavirus) -- topical Podophyllum resin, laser surgery, cryosurgery (freezing)

SIMILAR CONDITIONS

* Perianal Abscess
* Ulcerative Colitis
* Crohn's Disease


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Anorectal Abscess



ALSO KNOWN AS

Perianal abscess, anal 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 fluid 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
* Pseudemonas aeruginosa
* Bacterides
* 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:

1. Syphilis lesions or ulcers
2. Tuberculous ulceration


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Ankylosing Spondylitis



ALSO KNOWN AS

Marie-Strumpell disease or rheumatoid spondylitis

DESCRIPTION

* Ankylosing spondylitis is a chronic inflammatory disease of the joints of the spine and those connecting to the spine, such as the sacroiliac joint. This is an arthritic condition involving stiffness in joints, with resultant pain and stiffness in the back and hips, and difficulty taking deep breaths, due to rib connection to spine. The underlying cause is thought to involve the autoimmune response (the body's immune system mistakenly attacks these joints). The age of onset is usually late teens or early 20's, with a male predominance.



SYMPTOMS

* Morning stiffness
* Hip and shoulder pain
* Stiffness improves with activity
* Intermittent bouts of lower back pain (that may radiate to thighs)
* Progressive limitation of back motion
* Difficulty with chest expansion ("taking a deep breath") -- pleuritic chest pain is common
* Arthritis (stiffness and/or pain) in other joints such as hips, shoulders, and knees
* Uveitis (blurred vision, tearing, and light causes eye pain)
* Rarely, heart and lungs may be affected.
* Aortic root dilation
* Aortic Regurgitation


CAUSE

* Probable autoimmune (explained above)
* Genetic predisposition in those who carry the HLA-B27 gene

HOW THE DIAGNOSIS IS MADE

* Laboratory Tests:

1. Elevated Erythrocyte sedimentation rate (ESR)
2. Mild Anemia
3. HLA-B27 positive in 90% of cases
4. Absent Rheumatoid factor

* Imaging

1. Sacroiliac joint (spine connection to pelvic bone) is abnormal on X-Ray and CT scan
2. Spine X-Rays are abnormal ("bamboo spine" appearance)

TREATMENT

* Educational/emotional support
* Physical and occupational therapy
* Nonsteroidal anti-inflammatories, especially indomethacin
* Sulfasalazine


SIMILAR CONDITIONS

* Reiter's Syndrome
* Rheumatoid Arthritis
* Osteoporosis
* Herniated disc(s) of spine
* Back Injury
* Lumbar Spinal Stenosis


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Ankle Sprain and Ankle Fracture



DESCRIPTION

* Ligaments are like ropes that connect the bones. When the ligaments in the bones of the ankle are injured, this is called an ankle sprain. The Injury is usually a tear in a ligament. An ankle sprain usually occurs on the outside of ankle joints.
* An ankle Fracture occurs when the bones in the ankle are broken or cracked. Fractures account for about 10%-15% of injuries in children.



SYMPTOMS

* Sensation that ankle gave way
* Ankle pain
* Painful to bear weight on the ankle
* Ankle is bruised or swollen
* Tenderness of the ankle

CAUSE

* Sprain: Stretched or torn ligament caused by a twist Injury of the ankle, in which the foot is twisted underneath the ankle.
* Fracture:

1. A fall
2. Child Abuse
3. Bone disease


HOW THE DIAGNOSIS IS MADE

* X-ray, if Fracture is suspected

TREATMENT

* Rest
* Compression and elevation
* Ice first 24-48 hours
* Wrap for support
* If the sprain is moderate-severe, use crutches to avoid bearing weight.
* Pain medications
* If Fracture is present, immobilization and orthopedic evaluation are needed.


COMPLICATIONS

* Growth arrest
* Residual deformities
* Progressive deformities

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Ankle Injury



DESCRIPTION

* Including ankle sprains and fractures:

1. Ligaments are like ropes that connect bones together. When the ligaments in the bones of the ankle are injured, this is called an ankle sprain. The injury is usually a tear in the ligament. This commonly occurs after a twist injury of the ankle, in which the foot is inverted underneath the ankle.
2. An ankle fracture occurs when the bones in the ankle are broken (or cracked).




SYMPTOMS

* Lessening of sensation in the ankle
* Ankle pain
* Painful to bear weight on the ankle
* Ankle is bruised or swollen
* Tenderness of the ankle


HOW THE DIAGNOSIS IS MADE

* X-Ray check if fracture is suspected


TREATMENT

* Ice for first 24-48 hours
* Ace wrap for support
* If moderate-to-severe, use crutches to avoid bearing weight
* Pain medications
* If fracture is present, immobilization and orthopedic evaluation is needed



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Animal Bites


ALSO KNOWN AS

Also see Rabies

DESCRIPTION

* An infection that affects the central nervous system (brain, spinal cord, and cranial nerves) of animals and humans




SYMPTOMS

* Symptoms may develop 30-50 days after the bite.
* Often there is only pain and local swelling at the bite site.
* Fever
* Headache
* Numbness or tingling at the bite site
* Swallowing difficulty
* Anxiety and restlessness
* Declining mental function
* Sore throat
* Nausea
* Muscle stiffness
* Excessive salivation (not real foaming at the mouth, but increased saliva)
* Itching at the site of the bite
* Muscle Cramps
* Tingling and numbness of the skin in other parts of the body
* Paralysis of muscles including respiratory muscles (breathing)
* In severe cases:

1. Hydrophobia -- fear of water because liquids can cause spasm in the throat and make swallowing difficult
2. Aerophobia -- in some, air can also trigger spasm in the respiratory (breathing) muscles
3. Excitement and agitation followed by periods of calm
4. Drooling
5. Gasping for air
6. Convulsions, Seizures, Coma, and death
7. Death occurs due to heart or respiratory failure
8. Only 7 people worldwide have been known to survive untreated Rabies (i.e., did not receive the series vaccination for Rabies after being bitten or exposed to a rabid animal).

>CAUSE

* Virus -- RNA virus is transmitted via the saliva of the infected animal.
* The virus in the saliva enters a wound (after a bite) or skin cut, and travels via the nerves to the central nervous system, where it can multiply in the gray matter of the brain. Then the virus spreads out along certain nerves to infect many other tissues.

* The time between the bite and the onset of symptoms (incubation period) may range from days to years, but in most cases it is between 3-12 weeks.

HOW THE DIAGNOSIS IS MADE

* History of the bite, occupation, illnesses, travels, allergies, surgeries, habits, and vaccination history of the patient (i.e., Rabies, Tetanus, etc.) and his pets are helpful.
* Medical exam will reveal:

1. Bite mark
2. Fever
3. Agitation
4. Numbness
5. Paralysis

* Tests:

1. The virus needs to be found in the saliva or brain tissues, including the spinal fluid (CSF).
2. Fluorescent antibody (protein associated with Rabies) test will be positive in the infected animal.
3. The rabid animal should be captured if possible, terminated, and tested for the virus.

RISK FACTORS

* Animal bite from wild or unvaccinated pets
* All warm-blooded animals (Mammals) can carry the virus.
* Bats (most common in the US), dogs, cats, foxes, raccoons, and skunks
* Veterinarians
* Laboratory workers
* Animal handlers
* Travel to areas with high rate of Rabies in animals

TREATMENT

* Clean the wound
* Support the blood pressure, breathing, and heart if affected
* Immunoglobulins (HRIG) are protective Proteins that are given right away to fight the infection.
* The patient receives a vaccine to develop his or her own protective immunoglobulins down the road. Vaccines can be any of the following (HDCV, RVA, and PCEC).
* Report to the doctor if you have allergies, especially to eggs.
* In those who have been vaccinated prior to exposure, two booster shots (to provide more protection) of the vaccine are recommended.
* Tetanus vaccine, if not updated, is often given.

IF YOU SUSPECT THIS CONDITION

* Get to your doctor as soon as you can. If there is difficulty breathing, Seizures, confusion, or Coma -- call 911.

PREVENTION

* Vaccinate your pets -- dogs need Rabies vaccinations every 2 years, especially in areas with wild animals.
* Avoid contact with wild animals
(e. g., feeding, petting, etc.).
* If bitten, wash the site with soap and water and contact your physician and local health department immediately. Delay in treatment can result in death. Treatment after the bite from an animal with Rabies is with the Rabies vaccination series, which must begin soon after the rabid bite.
* Vector control and contact your doctor
* If traveling to an area known for Rabies, you must receive a vaccine (HDCV, RVA, and PCEC) before leaving. Vaccination is important for high-risk occupations.

SIMILAR CONDITIONS

* Other Infections:

1. Encephalitis
2. Tetanus
3. Guillain-Barre Syndrome


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