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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.


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