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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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