Healthy Our Priority

Argyria

2009-08-30T13:30:00.001+08:00

Description
* This is a skin condition in which the skin turns a bluish color. It is due to the ingestion of silver. Silver was once used in some medications, and people who took them on a long-term basis developed argyria.

Appendicitis

2009-08-30T13:14:00.002+08:00

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

Aplastic Anemia

2009-08-30T13:08:00.002+08:00

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

Aphthous Ulcer

2009-08-07T17:18:00.002+08:00

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

Aphasia

2009-08-07T17:15:00.002+08:00

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.

Aortic Stenosis

2009-08-07T17:09:00.003+08:00

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.

Aortic Regurgitation

2009-08-07T17:02:00.002+08:00

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.

Aortic Insufficiency

2009-08-07T16:55:00.002+08:00

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.

Aortic Insufficiency

2009-06-07T20:06:00.002+08:00

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.

Aortic Dissection

2009-06-07T19:54:00.003+08:00

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

Anxiety

2009-06-07T19:49:00.001+08:00

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

Anosmia

2009-06-07T19:43:00.002+08:00

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

Anorexia Nervosa

2009-05-07T02:16:00.002+08:00

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.

Anorectal Infections

2009-05-07T02:09:00.002+08:00

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

Anorectal Abscess

2009-05-07T02:02:00.002+08:00

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

Ankylosing Spondylitis

2009-05-07T01:54:00.002+08:00

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

Ankle Sprain and Ankle Fracture

2009-05-07T01:48:00.002+08:00

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

Ankle Injury

2009-05-07T01:44:00.003+08:00

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

Animal Bites

2009-05-07T01:33:00.002+08:00

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

Angioneurotic Edema

2008-12-07T10:46:00.001+08:00

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.

Angioedema

2008-12-07T10:40:00.002+08:00

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.

Angiodysplasia

2008-12-07T10:34:00.002+08:00

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

Anemias

2008-12-07T10:29:00.001+08:00

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.

Anaplastic Thyroid Cancer

2008-12-07T10:25:00.002+08:00

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.

Anaphylaxis

2008-12-07T10:10:00.002+08:00

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

Anal Fissures

2008-12-06T10:59:00.003+08:00

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

Anal Fissure

2008-12-06T10:55:00.002+08:00

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

Anal Cancer

2008-12-06T10:51:00.002+08:00

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

Anal Abscess

2008-12-06T10:47:00.002+08:00

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

Anaerobic Pneumonia

2008-12-06T10:43:00.002+08:00

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

Anaerobic Infections

2008-12-06T10:38:00.002+08:00

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

Amyloidosis

2008-12-05T01:53:00.002+08:00

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)

Amphetamine-cocaine Abuse

2008-12-05T01:50:00.001+08:00

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

Amphetamine Abuse

2008-12-05T01:44:00.002+08:00

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

Amebic Liver Abscess

2008-12-05T01:38:00.001+08:00

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

Amaurosis Fugax

2008-12-05T01:33:00.002+08:00

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.

Alveolar Hemorrhage Syndromes

2008-12-05T01:22:00.003+08:00

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

Alport's Syndrome

2008-12-04T02:35:00.002+08:00

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.

Alopecia Areata

2008-12-04T02:30:00.002+08:00

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.

Allergies to Drugs

2008-12-04T02:26:00.002+08:00

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).

Allergies to Air Conditioners

2008-12-04T02:24:00.002+08:00

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.

Allergic Tubulointerstitial Nephritis

2008-12-04T02:20:00.003+08:00

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

Allergic Rhinitis

2008-12-04T02:10:00.002+08:00

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

Allergic Rhinitis

2008-12-03T07:39:00.002+08:00

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

Allergic Reaction

2008-12-03T07:36:00.002+08:00

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.

Allergic Dermatitis

2008-12-03T07:32:00.002+08:00

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

Allergic Contact Dermatitis

2008-12-03T07:28:00.002+08:00

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

Allergic Conjunctivitis

2008-12-03T07:25:00.002+08:00

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.

Alcoholism

2008-12-03T07:20:00.002+08:00

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

Alcoholic Liver Disease

2008-12-02T01:29:00.001+08:00

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

Alcoholic Hepatitis

2008-12-02T01:24:00.002+08:00

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

Alcohol-induced Red Nose

2008-12-02T01:22:00.001+08:00

DESCRIPTION
* Alcohol use and abuse affects many organs in the body. On the skin, alcohol causes dilation of surface capillaries (tiny blood vessels), resulting in facial flushing and a pinkish-red hue to the cheeks. With chronic use of alcohol, the face and nose will sustain flushing and appear red. Please see Alcoholism for further details.

Alcohol-induced Red Face

2008-12-02T01:19:00.002+08:00

Alcohol Withdrawal Seizures

2008-12-02T01:14:00.002+08:00

ALSO KNOWN AS
* See alcoholism, Seizures and delirium tremens

DESCRIPTION
* In a person who is an alcoholic, complete cessation of drinking or sudden reduction in the amount normally consumed without medical guidance and monitoring, may lead to serious problems, including some of the following.

SYMPTOMS
* Can occur within 36 hours of cessation of drinking alcohol
* Intense craving for alcohol or another drug to substitute for alcohol if none can be found.
* Profuse sweating
* Increased body temperature
* Unstable blood pressure
* Dehydration
* Cramps and muscle pain
* Anxiety
* Aggressive and agitated behavior
* Confusion and disorientation
* Paranoia and suspicions
* Severe tremor or "the shakes "
* Frightening hallucinations
* Seizures -- tonic clonic seizures that may occur once or 3-4 times
* Coma
* Death

TREATMENT
* Alcoholics are at risk of brain injuries from falling and may have Epilepsy (Seizures due to brain injuries). These conditions must be distinguished from Alcohol Withdrawal Seizures, because alcoholics with Epilepsy and brain injuries require maintenance treatment for these specific conditions, while those with Alcoholism alone do not.
* Since some problems are more common in alcoholics (i.e., electrolyte imbalances, Dehydration, Hypoglycemia, liver damage and subsequent hepatic encephalopathy, head injury such as subdural hematoma, and infections like Meningitis), appropriate workups need to be done to rule out these conditions as well as others (e.g., Stroke) as the source of the Seizures, and treat them appropriately.
* Emergency care is required since Seizures can be fatal if not treated. Intravenous fluids, thiamine, Electrolytes, glucose, and oxygen may all be administered until the patient is stabilized. Benzodiazepines and anticonvulsants (e.g., Dilantin, etc.) are effective in stopping the seizure activity.

Alcohol Overdose

2008-12-02T01:09:00.001+08:00

ALSO KNOWN AS
See Alcoholism and other alcohol related topics

DESCRIPTION
* Alcohol (e.g., beer, wine, whisky, etc.), like any other drug when consumed in excess amounts, can lead to a serious overdose syndrome.
* When a person drinks alcohol at a rate faster than his liver can metabolize it, the alcohol accumulates in the bloodstream, subsequently affecting judgment and coordination, and possibly leading to loss of consciousness.
* When dealing with alcohol overdose, keep in mind that since the effects of the alcohol depend upon a variety of factors, such as body weight, number of drinks per hour, and individual metabolic rates, some (e.g., females, elderly) may develop toxicity (even death) at lower levels than others.

SYMPTOMS
* Signs of overdose include declining heart, lung, and neurological functions (i.e., low pulse rate, decreased respiratory rate, Low Blood Pressure, and alteration in mental status and consciousness).
* These signs may precede circulatory collapse and death. Since blood alcohol levels are only a rough guide to severity of intoxication, doctors need to treat the patient and not his level, as blood alcohol levels as low as 0.25 have been associated with death.
* Others with a high tolerance may demonstrate little impairment at this level.
* BAC (blood alcohol concentration) charts do not take into account gender differences, body composition differences, use of medication, mood changes, or one's personal metabolic rate -- and physicians must take care when utilizing these values (see below) in treating alcohol overdoses.
* The body breaks down alcohol at a constant rate, with the liver's detoxifying approximately one-half ounce of alcohol per hour (less in some people, particularly women). One-half ounce is roughly the amount in a 12-ounce can of domestic beer, one ounce of 100 Proof liquor, or a 5-ounce glass of wine.

HOW THE DIAGNOSIS IS MADE
* Since intoxicated people tend to be non-cooperative and poor historians, an interview with anyone accompanying him or her may be helpful, to collect information about his or her medication and drug history, past medical and surgical history, allergies, and habits.
* A full physical exam is requisite, keeping in mind that taking alcohol with other drugs may have a depressant effect. Heroin, methadone, and some prescribed medicines like diazepam or Valium, and antihistamines increase the potential for overdose and death. Thus, as full a medical history as possible is important.
* In addition to alcohol level measurements, laboratory tests should include a chemistry panel and drug screen (to look for other possible drugs such as heroin, etc.).

TREATMENT
* Careful monitoring of Arterial blood gases, oxygen saturation, and vital signs is necessary. These patients may need intravenous hydration and/or respiratory support with mechanical ventilator.

MISCELLANEOUS
* The following is a generalized alcohol effect chart based on a 150-pound person, metabolizing 0.5 ounce of alcohol per hour, on a full stomach.
* The elderly and women are often affected by alcohol at lower dosages than healthy, 150-lbs males.
* BCA's Effect on the body:

1. 0.02 Slight alterations in mood
2. 0.06 Lowered inhibition (more likely to partake in risky behavior, e.g., unsafe sex), impairment of judgment, decreased rational decision-making abilities.
3. 0.08 Legally drunk -- decreased reaction time and control.
4. 0.15 Impaired balance, movement, and coordination; difficulty standing, walking, talking; at risk of falling.
5. 0.20 Decreased pain and sensation. Lability (wide swings) of emotions.
6. 0.30 Diminished reflexes. Semi-consciousness.
7. 0.40 Loss of consciousness. Very limited reflexes. Anesthetic effects.
8. 0.50 Death

IF YOU SUSPECT THIS CONDITION
* In short when you observe someone with slow respiration, clammy cold skin (may be bluish skin), and lack of consciousness and you suspect alcohol overdose call 911 immediately. Alcohol poisoning is a medical emergency and may lead to death.

SIMILAR CONDITIONS
* Signs and symptoms of other drugs, including street drugs, other-the-counter medications, and pharmaceuticals, may mimic those of alcohol overdose; or may be a complicating factor.

Airway Burns

2008-11-12T03:48:00.002+08:00

NORMAL

ABNORMAL

DESCRIPTION
* Airway Burns occur when an individual is trapped in a poorly ventilated space and inhales smoke, steam, superheated air, or toxic fumes.

* At risk are those caught in fires, fire fighters, explosives experts, toxic chemical cleaning crews, miners, and factory workers working with chemicals or steam.
* Exposure may result in charred mouth; burned lips; burns on the face, head, and neck; singed eyebrows and hair (nose, scalp); burns on other parts of the skin and clothing; cough productive of black or tar-stained mucus; difficulty breathing; wheezing or coughing.
* Exposure victims must be immediately attended to, the nature of the fumes identified, and appropriate measures taken to assure that their airways are open (for normal breathing) and that they are hemodynamically stable.

TREATMENT
* Requires emergency treatment

Air in the Lungs

2008-11-12T03:45:00.002+08:00

ALSO KNOWN AS
Pneumothorax, air in the chest, collapsed lung or collapsed chest

DESCRIPTION
* The lungs are covered by a saclike membrane known as the pleura, which separates the lungs from the chest wall (ribs). The pleurae have two layers: one covers the lungs (visceral), the other is attached to the inside of the chest cavity (parietal). Between the two layers there is a thin film of fluid that lubricates the lungs, allowing them to move smoothly during respiration (breathing). Under normal conditions, there should be no air between the lungs and the chest cavity. The introduction of air into this cavity will cause the lung to collapse, and compromise breathing.

* The air may leak from a cut or hole in the visceral pleura (i.e., lung problem) or in the parietal pleura (i.e., bullet or knife wound). When air enters the chest cavity, the condition is known as Pneumothorax (p.).

SYMPTOMS
* Depends on the size of p.
* Chest pain:

1. Sudden
2. Sharp or stabbing
3. Chest tightness
4. Made worse by breathing or coughing

* Shortness of breath
* Cyanosis or bluish color to the skin and lips due to hypoxia (low oxygen level)
* Rapid rate of breathing
* Fatigue
* Wheezing
* Anxiety
* Patient may be in Shock or unconscious, especially with trauma or tension p.

CAUSE
* Primary p. -- in healthy individuals this occurs without any underlying diseases
* Secondary -- complication of underlying lung disease
* Spontaneous p. -- often occurs after the rupture of a bulla (a.k.a bleb) or blister (not found in normal lungs), which are small air-filled sacs in the lungs of individuals with certain risk factors. Could be primary or secondary.

HOW THE DIAGNOSIS IS MADE
* History:

1. Symptoms
2. Injuries
3. Procedures or surgeries
4. Illnesses
5. Medications
6. Habits
7. Occupation
8. Allergies

* Medical exam:

1. Skin may show the site of trauma
2. Low Blood Pressure
3. Fever may be present
4. Cyanosis
5. Air can leak under the skin (subcutaneous Emphysema) and has a spongy feel
6. Pallor -- pale skin
7. Rapid heart and respiration rate
8. The chest movements are not symmetrical
9. The trachea (major airway -- located in the center of the neck) may be shifted in tension p.
10. When the doctor listens to the heart or the lungs, the normal sounds may be diminished or absent.

* Tests:

1. Chest X-Ray will show the abnormal air pocket, and Collapsed Lung or structures that have been pushed to one side.
2. CAT scan, using computer imaging, shows detailed views of the chest and lungs.
3. Blood tests may show low oxygen levels (<80 acidosis =" pH">30%:

1. Objective is to remove the air.
2. General physician may consult with a surgeon or a pulmonologist (lung doctor).
3. A needle may be used to remove the air.
4. Aspiration involves inserting a catheter (Teflon tube) into the chest cavity (between the ribs) and attaching to a simple bottle (vacuum inside with no air). This may be enough to expand the Collapsed Lung.
5. A plastic chest tube is inserted through an incision in the chest (between the ribs) and then connected to suction. This method may take few days to drain the trapped air and expand the Collapsed Lung.

* Multiple episodes of Pneumothorax may require surgery or injection of medicines (talc or Doxycycline) into the pleural space.

IF YOU SUSPECT THIS CONDITION
* Contact 911 and seek immediate medical attention. If you've had previous episodes, Quit Smoking and talk to your doctor before high altitude climbing, flying, or scuba diving.

SIMILAR CONDITION
* Pericarditis -- inflammation of the sac covering the heart
* Pleurisy -- inflammation of the pleura
* Pulmonary Embolism -- blood clot in the lungs
* Myocardial Infarction -- heart attack

Air in the Chest

2008-11-12T03:31:00.002+08:00

ALSO KNOWN AS
Pneumothorax, collapsed lung, or collapsed chest

DESCRIPTION
* The lungs are covered by a saclike membrane known as the pleura, which separates the lungs from the chest wall (ribs). The pleurae have two layers: one covers the lungs (visceral), the other is attached to the inside of the chest cavity (parietal). Between the two layers there is a thin film of fluid that lubricates the lungs, allowing them to move smoothly during respiration (breathing). Under normal conditions, there should be no air between the lungs and the chest cavity. The introduction of air into this cavity will cause the lung to collapse, and compromise breathing.

* The air may leak from a cut or hole in the visceral pleura (i.e., lung problem) or in the parietal pleura (i.e., bullet or knife wound). When air enters the chest cavity, the condition is known as Pneumothorax (p.).

NORMAL

ABNORMAL

SYMPTOMS
* Depends on the size of p.
* Chest pain:

1. Sudden
2. Sharp or stabbing
3. Chest tightness
4. Made worse by breathing or coughing

* Shortness of breath
* Cyanosis or bluish color to the skin and lips due to hypoxia (low oxygen level)
* Rapid rate of breathing
* Fatigue
* Wheezing
* Anxiety
* Patient may be in Shock or unconscious, especially with trauma or tension p.

CAUSE
* Primary p. -- in healthy individuals this occurs without any underlying diseases
* Secondary -- complication of underlying lung disease
* Spontaneous p. -- often occurs after the rupture of a bulla (a.k.a bleb) or blister (not found in normal lungs), which are small air-filled sacs in the lungs of individuals with certain risk factors. Could be primary or secondary.

HOW THE DIAGNOSIS IS MADE
* History:

1. Symptoms
2. Injuries
3. Procedures or surgeries
4. Illnesses
5. Medications
6. Habits
7. Occupation
8. Allergies

* Medical exam:

1. Skin may show the site of trauma
2. Low Blood Pressure
3. Fever may be present
4. Cyanosis
5. Air can leak under the skin (subcutaneous Emphysema) and has a spongy feel
6. Pallor -- pale skin
7. Rapid heart and respiration rate
8. The chest movements are not symmetrical
9. The trachea (major airway -- located in the center of the neck) may be shifted in tension p.
10. When the doctor listens to the heart or the lungs, the normal sounds may be diminished or absent.

* Tests:

1. Chest X-Ray will show the abnormal air pocket, and Collapsed Lung or structures that have been pushed to one side.
2. CAT scan, using computer imaging, shows detailed views of the chest and lungs.
3. Blood tests may show low oxygen levels (<80 acidosis =" pH">30%:

1. Objective is to remove the air.
2. General physician may consult with a surgeon or a pulmonologist (lung doctor).
3. A needle may be used to remove the air.
4. Aspiration involves inserting a catheter (Teflon tube) into the chest cavity (between the ribs) and attaching to a simple bottle (vacuum inside with no air). This may be enough to expand the Collapsed Lung.
5. A plastic chest tube is inserted through an incision in the chest (between the ribs) and then connected to suction. This method may take few days to drain the trapped air and expand the Collapsed Lung.

* Multiple episodes of Pneumothorax may require surgery or injection of medicines (talc or Doxycycline) into the pleural space.

IF YOU SUSPECT THIS CONDITION
* Contact 911 and seek immediate medical attention. If you've had previous episodes, Quit Smoking and talk to your doctor before high altitude climbing, flying, or scuba diving.

SIMILAR CONDITIONS
* Pericarditis -- inflammation of the sac covering the heart
* Pleurisy -- inflammation of the pleura
* Pulmonary Embolism -- blood clot in the lungs
* Myocardial Infarction -- heart attack

Aging Eyes

2008-11-12T03:27:00.002+08:00

ALSO KNOWN AS
Presbyopia or old eyes

DESCRIPTION
* This is a condition that affects most people as they age. It is due to the loss of the normal elasticity (ability to bounce back to it's normal shape) of the lens of the eye. Over time, Presbyopia results in the inability to see close objects, as when reading a newspaper.

CAUSE
* Age -- affects most people over the age 45

SYMPTOMS
* Headache when reading
* Eyes get tired when reading
* Difficulty reading in dim light
* Letters on a page may appear fuzzy

HOW THE DIAGNOSIS IS MADE
* A doctor or an optometrist can diagnose the problem.
* History of symptoms
* Exam will include a vision test with an eye chart (visual acuity).
* Optometrist will have equipment to do other tests, such as a slit lamp exam using a special microscope to look inside the eye, or a refraction test for those with blurred vision.

RISK FACTORS
* Age -- may start as early as age 30

TREATMENT
* Glasses and contact lenses are the best treatment.
* Improve lighting when reading
* Rest the eyes often between readings.
* Consult with an ophthalmologist (eye doctor) to see if new treatments or surgeries are for you.
* At the present time, laser surgery is not effective for Presbyopia, but new techniques are being investigated.

IF YOU SUSPECT THIS CONDITION
* Contact your optometrist or your doctor.

SIMILAR CONDITIONS
* Farsightedness

African Trypanosomiasis

2008-11-12T03:23:00.002+08:00

ALSO KNOWN AS
Sleeping sickness

DESCRIPTION
* This disease is caused by the parasites Trypanosoma brucei rhodesiense or Trypanosma brucei gambeinse. They are transmitted to humans by the bites of tsetse flies, found in the moist climate regions in Africa.

SYMPTOMS
* Stage 1: The area of the bite causes an itching pain and swollen glands that lasts 2-4 weeks.
* Stage 2: Occurs 3-10 days after stage 1. The infection goes into the bloodstream and lymph system. Symptoms include high fever, severe headache, joint pains, lack of energy, and rashes. Weight loss may also occur. Symptoms may temporarily disappear for two weeks at a time, only to return for a second go around.
* Stage 3: "Sleeping Sickness Stage" occurs from 6 months to years after the original infection. Symptoms may include Insomnia (instead of sleepiness), loss of appetite, personality changes, lack of energy, and headaches. Severe sleepiness occurs late. This is followed by severe weight loss and coma. Death occurs from infections from other diseases.

HOW THE DIAGNOSIS IS MADE
* Stage 1: Examination may show inflammation of the bite site and swollen lymph glands nearby.
* Stage 2: Examination may show mild enlargement of the liver and spleen, lower extremity edema, Ascites (fluid in the abdomen), pleural effusions (fluid in the lungs) and enlarged rubbery lymph nodes. Cardiac involvement (myocarditis) may occur.
* Stage 3: Examination may reveal tremors, Speech Problems, gait disturbances, and abnormal reflexes.
* Laboratory:

1. Wet films after Giemsa staining from bite lesion, lymph node aspirates, bone marrow, or CSF
2. Blood specimens need to be examined daily for 15 days because the number of trypanosomes in the blood can vary.
3. Cerebrospinal fluid shows increased lymphocytes and protein. A centrifuge of CSF may be needed to find the parasites.
4. Serologic (blood) testing for IgM and IgG antibodies may be performed
5. Other findings may include increased sedimentation rates, anemia, decreased platelets, decreased total serum protein, and increased serum globulin.

TREATMENT
* Suramin for both parasites (rhodesiense and gambiense)
* Eflornithine (DMFO) is a drug of choice for gambiense. An alternative is Pentamidine.
* A third choice for both parasites is Melarsoprol, but it has a severe amount of toxicity.
* Late stage diseases with Central Nervous System Involvement: Melarsoprol for both parasites or Eflornithine for gambeinse, are the leading drugs of choice. Alternative drugs for gambiense are Eflornithine or Tryparsamide plus Suramin.

IF YOU SUSPECT THIS CONDITION
* Seek treatment as soon as possible. This disease is often fatal if untreated.

PREVENTION
* Wear long sleeves and trousers and avoid dark clothing.
* Use mosquito nets while sleeping because repellents have no effect.
* Pentamidine may be used for gambiense type.

SIMILIAR CONDITIONS
* Malaria
* Pneumonia
* Influenza
* Mononucleosis
* Lymphoma
* Leukemia
* Viral Encephalitis
* Cerebral Tumor
* Psychiatric Diseases

Affective Disease

2008-11-12T03:19:00.002+08:00

ALSO KNOWN AS
Bipolar disorder, mood disorder or manic depression

DESCRIPTION
* A Bipolar disorder is a psychiatric disease characterized by episodes of extreme mood swings of both Depression and mania. Mania is characterized by elation, fast moving ideas, little need for sleep, and grandiose thoughts and behavior.

* Depression in the patient is defined by feelings of hopelessness, low energy, and no desire or interest in everyday activities. He may become suicidal, or he may develop mania, characterized by excess activity to the point of exhaustion, euphoria, aggressiveness, and at times, a feeling of being super human. Examples of manic behavior might be suddenly quitting your job and going to Hollywood to become an actor (even though you have no previous acting history or interest); or deciding to run for president of the United States, even though you have no previous political experience. An individual in a manic phase may suddenly go on a massive shopping spree, buying items that are not really needed.
* Hypomania is a less severe form of mania that can occur with bipolar disorders. The disorder can affect any age, but it is often triggered between ages of 25-44. Both men and women are equally affected.

SYMPTOMS
* Depression

1. Sadness
2. Low self-esteem
3. Lack of interest in work, sex, family, or other interests
4. Excessive sleep or Insomnia
5. Difficulty with focus
6. Inability to concentrate
7. Thoughts of suicide or dying
8. Feelings of worthlessness
9. Changes in appetite
10. There may be unexplained pains or aches

* Mania

1. Boundless energy
2. Grandiose thoughts
3. Thinking that one is important and powerful
4. Irrational, fearless behavior
5. Fast moving thoughts
6. Difficulty concentrating
7. Speaking too fast
8. Going on spending sprees
9. Drug or alcohol abuse
10. Going long periods without sleep
11. Loss of self-control and good judgment with a desire to engage in risky behavior.

CAUSE
* Unknown -- however, chemical imbalances in the brain may be the cause.
* There may be a genetic component. Having a parent with bipolar disorder may increase the chance of having children with the condition.
* See Depression and mania sections.

TREATMENT
* The goal of treatment is to stabilize mood and restore one's normal (prior to manic Depression) state.
* The two medications most commonly used to stabilize the mood swings in manic Depression are Depakote and Lithium. Other medications may be added or used, some of which are listed below. All treatments are administered under the supervision of a psychiatrist, and are part of an organized treatment plan. Psychotherapy can be added to the treatment, and is very helpful.
* Depression:

1. Antidepressants -- Prozac, Paxil, Effexor, Wellbutrin, Zoloft.
2. Psychotherapy

* Mania:

1. Acute treatment
2. Haldol
3. Clonazepam

* Chronic (long-term prevention)

1. Lithium
2. Depakote
3. Tegretol

SIMILIAR CONDITIONS
* Depression
* Schizophrenia
* Cyclothymic disorder

Adult RF

2008-11-08T02:50:00.002+08:00

ALSO KNOW AS
Rheumatic fever or RF

DESCRIPTION
* Rheumatic Fever is an inflammation that may follow an infectious episode of the group Streptococcus bacteria -- usually of the throat. In RF there may be heart (carditis) and multiple joint (polyarthritis) damage. RF also may affect the skin (rash, nodules) and the nervous system (e.g., abnormal involuntary movements).

SYMPTOMS
* Joint swelling and tenderness
* May involve many joints
* Fever
* Skin rash (erythema marginatum) and nodules (painless, hard swellings under the skin and overlying bones)
* Nose bleeds (epistaxis)
* Symptoms of RF often occur within 7-35 days after infection.
* In some, symptoms of RF may last 3 months or longer.
* Vomiting
* Abdominal pain
* Sydenham's chorea -- jerky, involuntary, purposeless movements (of legs and arms), muscle weakness, Speech Problems, and emotional instability

CAUSE
* Throat infection with the group A Streptococcus (pharyngitis, scarlet fever) may start an
autoimmune reaction in which the body's defenses, in the process of attacking the bacteria (using Proteins known as antibodies), may damage or cause inflammation -- swelling, irritation, and pain -- to certain body parts, such as the skin, heart valves, joints, and brain.
* The autoimmune response leads to RF.

HOW THE DIAGNOSIS IS MADE
* History of symptoms, illnesses, recent infections, allergies, surgeries, habits
* Medical exam:

1. Fever
2. Rash or nodules
3. Swollen tender joints
4. Chorea may be present
5. Using a stethoscope, the doctor may hear an abnormal flow of blood (murmur) across a damaged heart valve (endocarditis).
6. If the sac that covers the heart is inflamed (pericarditis) there may be chest pain with each breath (pleuritic chest pain), shortness of breath, and a characteristic friction rub may be heard (with a stethoscope) over the chest.

* Tests:

1. Throat (swabbed sample of the throat) cultures may reveal the bacteria early in the disease.
2. Blood tests -- C-reactive protein and ESR indicate ongoing inflammation. ASO (antistreptolysin O) and DNase indicate infection with group A streptococcus.
3. Anemias (low red blood cell count) may be present.
4. Electrocardiogram -- measures the electrical activity of the heart -- may show changes indicating damage to the electrical pathways inside the heart (prolonged P-R interval).
5. Echocardiography -- using sound waves may show fluid around the heart and show the diseased valves.

RISK FACTORS
* Children between ages of 5 -15
* Crowded places like schools, work
* Untreated strepthroat
* Rheumatic Fever

TREATMENT
* Bed rest
* Penicillin is the antibiotic of choice and is given to all patients except those with allergy to penicillin, who receive alternative drugs.
* NSAIDs (such as aspirin) may reduce inflammation of the joints and relieve pain and fever.
* Irregular heart rhythms can be corrected with medications.
* Steroids, such as Prednisone, are used if there is a severe form of carditis (heart inflammation).
* Chorea can be treated with medications such as Haldol.
* Patients often receive penicillin (monthly injections) until adulthood or up to 5 years after an attack of RF.
* Some experts recommend treatment with antibiotics for life, especially if there is severe valve damage.
* The patient with a damaged heart valve may need to take antibiotics before dental and other major procedures.

IF YOU SUSPECT THIS CONDITION
* Contact your physician as soon as you can. If there is high fever, chorea, chest pain, fainting, or shortness of breath, contact 911.

SIMILAR CONDITIONS
* Viral myocarditis
* Kawasaki's syndrome
* Lyme disease
* Infectious arthritis
* Endocarditis or murmurs from other causes

Adenocarcinoma of the Kidney

2008-10-25T05:24:00.002+08:00

ALSO KNOWN AS
Kidney cancer, Renal Cell Carcinoma, or Hypernephroma

DESCRIPTION
* The cause of Kidney Cancer is unknown. Cigarette smoking certainly does increase the risk. Rarely, certain genetic (inherited) syndromes increase the risk as well (specifically von Hippel-Lindau syndrome). Those on long-term dialysis may also have increased risk of developing Renal Cell Carcinoma.

SYMPTOMS
* Flank pain
* Flank mass
* Blood in the Urine

HOW THE DIAGNOSIS IS MADE
* Urinanalysis may show microscopic blood
* Intravenous pyelogam (IVP) -- X-Rays taken after the dye is injected
* Ultrasound or CT scan can detect tumors or further delineate tumors
* Chest X-Ray to check for lung metastases
* Bone scans to check for bone metastases
* MRI ordoppler Ultrasound to check for tumor thrombus in realigning the vein and inferior vena cava

TREATMENT
* Surgical removal of the affected kidney (if the tumor is only in the kidney, there is a 90-100% chance of a 5-year survival rate).
* Chemotherapy may be tried in more advanced diseases. Vinblastine, alpha interferon, or inteleukin-2 may be considered.
* If you suspect this condition, seek medical treatment very soon. If this disease is caught early, there is more of a chance for recovery then if it is detected late.

SIMILAR CONDITIONS
* Bladder Cancer
* Angiomyolipomas
* Transitional cell cancers of the renal pelvis
* Adrenal tumors
* Oncocytomas
* Renal abscesses

Addison's Disease

2008-10-25T05:19:00.001+08:00

ALSO KNOWN AS
Chronic adrenocortical insufficiency

DESCRIPTION
* Addison's disease is caused by the destruction of the central part of the adrenal glands. This area makes the following hormones: Cortisol (which responds to stress and affects the immune system, inflammation, and blood sugar), aldosterone (regulates kidneys and blood pressure), and androgens (sex hormones though not their primary source).

SYMPTOMS
* Weakness
* Fatigue
* Lightheadedness
* Faintness
* Weight loss
* Muscle aches
* Joint aches
* Loss of appetite
* Nausea/vomiting
* Anxiety/irritability
* Emotional lability
* Chronic Diarrhea
* Salt craving
* Depression

CAUSE
* Autoimmune destruction is the most common cause -- i.e., the body's immune system mistakenly attacks the adrenal glands.
* Tuberculosis bacterium may infect the gland (now a rare cause in the USA).
* Hemorrhage (bleeding) into the adrenal glands generally occurs in patients on anticoagulants (blood thinners) during open-heart surgery and after trauma.
* Many other disorders, such as Metastatic Cancer (lung, breast, kidney, or colon), side effects of drugs (e.g., Ketoconazole), radiation therapy, surgical removal of adrenals, Sarcoidosis, Amyloidosis, and infections (e.g., Histoplasmosis, meningococcemia, etc.) may very rarely cause Addison's disease.

HOW THE DIAGNOSIS IS MADE
* Findings that may present on examination:

1. Low Blood Pressure
2. Increased heart rate
3. Dilated pupils
4. Confusion or memory problems
5. Tremors
6. Mouth -- may have pigmented areas inside the cheeks
7. Skin becomes darker (''appears tanned")
8. Multiple new freckles
9. Darkening of the skin of the elbows, knuckles, and knees.
10. Darkening of the skin of the back of the neck, palm creases, and nail beds.
11. Nipples and areolas (pigmented areas of the breast) become darker
12. Vitiligo (areas of skin lose all color)
13. Seizures
14. Hallucinations
15. Coma

* Blood tests:

1. White blood cell proportions in blood are altered
2. Blood sugar is often low
3. Sodium level is low
4. Potassium level is high
5. Calcium level may be high
6. High levels of very long chain fatty acids (VLCFAs)
7. Low morning plasma Cortisol
8. ACTH level is elevated
9. Cosyntropin stimulation test
10. Anti-adrenal antibodies

* Imaging Tests:

1. Chest X-Ray to look for cancer, Tuberculosis, infection
2. Abdominal X-Ray may show calcification (Calcium deposits) in the adrenals.
3. CT scan of abdomen to evaluate the adrenal glands

TREATMENT
* Replacement therapy for hormones no longer being manufactured by the adrenal gland

1. Hydrocortisone or Prednisone
2. Fludrocortisone acetate
3. Extra salt (NaCl) in diet
4. Appropriate amounts of Potassium and water in the diet.

SIMILIAR CONDITIONS
* AIDS
* Tuberculosis
* Metastatic Cancer
* Vitiligo
* Hemochromatosis
* Amyloid disease
* Scleroderma

MISCELLANEOUS
* Special considerations

- The dose of Hydrocortisone or Prednisone must be increased when the body is under stress, such as with an infection or around the time of surgery. This is very important and can be life threatening if not properly monitored by a physician.

Acute Subdural Hematoma

2008-10-24T19:21:00.003+08:00

ALSO KNOWN AS
Subacute subdural hematoma

DESCRIPTION
* The brain is covered by a membrane (layer of tissue) called the dura. If the veins located below the dura (subdural area) leak blood, then pressure in this area may build up and injure the brain. Head injuries may injure these veins, causing them to be torn and leak. This blood collects into a mass called a hematoma. Hence the name, Subdural Hematoma. For an acute hematoma, symptoms generally occur in the first 24 hours, while for a subacute Hematoma, they occur in the first 2-10 days after a head injury.

NORMAL

ABNORMAL

SYMPTOMS
* Head injury (may be severe or a minor)
* Nausea
* Headache
* Personality changes
* Confusion
* Decreased level of consciousness
* Impaired vision
* Eye droop
* Speech difficulties
* Paralysis
* Numbness or decreased sensation in a limb
* Seizures
* Coma
* Other neurological problems
* Symptoms may initially improve, but then dramatically worsen

HOW THE DIAGNOSIS IS MADE
* Neurological exam by a physician
* Complete blood count, Chemistry panels, a PT, and a PTT should be performed
* CT scan of the head

RISK FACTORS
* Very young (infants) or the elderly
* Use of blood thinners such as aspirin or Coumadin
* Alcoholism
* Diseases that increase the risk of falls such as Alzheimer's disease or narcolepsy.

TREATMENT
* Goal is to reduce pressure on the brain
* Circulation support (intravenous fluids and medications to maintain blood pressure)
* Respiratory support (oxygen and mechanical ventilation if necessary)
* Dexamethasone (a corticosteroid medication) may be used to decrease the inflammation of the brain
* Mannitol (a diuretic) may be used to decrease the swelling of the brain
* Dilantin (a seizure medication) may be used to prevent or control Seizures
* Reversal of blood thinning agents such as Coumadin or Heparin
* Emergency Surgery may be needed to drain the hematoma (blood clot), and relieve the pressure on the brain. The hematoma is outside the brain, but still puts pressure on it. Therefore, the surgery involves drilling small holes in the skull and evacuating the blood. Occasionally, if the hematoma is very large or has solidified, a large opening in skull may be needed (this is called a craniotomy).

IF YOU SUSPECT THIS CONDITION
* The individual needs immediate emergency medical treatment. Untreated, this condition often leads to death.

SIMILIAR CONDITIONS
* Meningitis
* Encephalitis
* Subarachnoid Hemorrhage
* Chronic Subdural Hematoma
* Stroke

Life and death 2: the brain (subdural hematoma surgery)

Acute Sinusitis

2008-10-24T19:14:00.003+08:00

DESCRIPTION
* Sinuses are open cavities. An infected sinus is known as sinusitis. The maxillary and frontal sinuses are the two main sinuses that become infected. The maxillary sinuses are located on the inside cheeks of both sides of the nose. The maxillary sinuses drain through the nose. In addition, the ears drain fluid into the maxillary sinuses by way of the eustachian tube. The eustachian tube may become blocked or inflamed from a sinus infection, resulting in pressure, pain, or fullness in the ears. The frontal sinuses are located in the lower part of the forehead just above the bridge of nose.
* Sinusitis usually occurs either after a viral infection (cold/runny nose) or after allergy symptoms begin. This occurs because of swelling in the nasal tract tissue, which drains the sinuses, causing them to become swollen. The sinuses accumulate fluid and mucous, allowing bacteria to grow in the sinuses, which causes the sinusitis.

ABNORMAL

NORMAL

SYMPTOMS
* Pain/pressure over the sinuses
* Occasional upper tooth pain
* Pain and tenderness over the forehead
* Ear pressure
* If symptoms do note resolve in three weeks, or do not respond to antibiotics, this may represent Chronic Sinusitis. Please see the section on Chronic Sinusitis for more details.

CAUSE
* Streptococcus pneumoniae
* Hemophilus Influenza
* Moraxella catarrhalis
* Staphylococcus aureus

HOW THE DIAGNOSIS IS MADE
* Transilluminator may show a fluid collection
* Sinus X-Rays
* A CT scan of the sinuses is more accurate than an X-Ray
* Cultures are not helpful unless done by a needle placed into the sinuses (and this is not done unless the case is extreme)

TREATMENT
* Oral antibiotics are usually administered for 10 to 14 days. Commonly used antibiotics include Ceftin, augmentin, or cipro.
* Older antibiotics, such as Amoxicillin and Erythromycin may be prescribed, but you should be aware that they do not provide the same scope of coverage that Ceftin, augmentin, or cipro. They have poor coverage when dealing with Haemophilus Influenza as well.
* Oral Decongestants, such as Sudafed, and nasal sprays such as Afrin, for the first 3 days may be helpful (after 3 days a "rebound" may occur, and the decongestants may no longer be effective).
* Take a warm shower twice a day, and blow out your excessive mucous.
* Saline nasal sprays may be used multiple times during the day to loosen nasal secretions.

SIMILIAR CONDITIONS
* Tooth Abscess
* Mucormycosis
* Sinus cancer

MISCELLANEOUS
* Predisposing Causes

1. Viral Rhinitis (Cold)
2. Allergies
3. Dental problems
4. nasal polyps

Acute Poststreptococcal Glomerulonephritis

2008-10-24T19:08:00.002+08:00

ALSO KNOWN AS
APSGN

DESCRIPTION
* This is the most common form of glomerulonephritis, a disorder marked by inflammation of the kidneys' glomeruli.

SYMPTOMS
* Dark brown urine
* Periorbital swelling
* Shortness of Breath
* Rapid breathing
* Pallor
* High blood pressure
* Diarrhea
* Decreased urine output
* Seizures

CAUSE
* Streptococcal infection (nephritogenic strain)
* Pharyngitis -- M type 12
* Skin Infection: M type 49

HOW THE DIAGNOSIS IS MADE
* Streptococcal infection evidence
* Laboratory tests:

1. Manual blood count shows anemia
2. Elevated blood urea nitrogen (BUN) level
3. Elevated creatinine (Cr) level
4. Streptococcus serologic tests (ASO, antihyaluronidase, antideoxyribonuclease) level
5. Decreased complement 3 level
Microscopic urine examine shows protein, RBC, WBC in urine

TREATMENT
* Penicillin for 10 days
* For kidney failure:

1. Restrict fluid
2. Maintain calories
3. Correction of electrolyte disturbance

* For high blood pressure:

1. Hospitalization
2. Diazoxide for pulmonary edema

COMPLICATIONS
* Acute renal failure
* Hypertensive encephalopathy
* Heart failure

PROGNOSIS
* Ninety-five percent of patients recover completely.

IF YOU SUSPECT THIS CONDITION
* Your child needs to be hospitalized if he/she has high blood pressure.

SIMILAR CONDITIONS
* Lupus nephritis
* Membranoproliferative glomerulonephritis (MPGN)
* Nephritis due to bacterial endocarditis
* Shunt nephritis

Acute Peritonitis

2008-10-24T19:06:00.002+08:00

DESCRIPTIONS
* Acute peritonitis is an inflammatory process within the abdominal cavity. It is usually due to a bacterial infection and is treated with antibiotics.
* In some cases, the infection occurs independent of outside infection, and is known as Spontaneous Bacterial Peritonitis (SBP). SBP usually occurs in patients who have Ascites (fluid in the abdominal cavity) from some other cause. Most people normally have only a very small amount of fluid in the stomach cavity. However, certain diseases can lead to the accumulation of fluid within the abdomen. This fluid can get infected, in turn, and cause peritonitis.
* About 20 to 30% of patients with Ascites will develop SBP. In other cases, peritonitis is caused by some other condition, and this is known as secondary bacterial peritonitis.
* In a few cases, the condition may be due to less common causes, such as Tuberculosis, cancer, or other processes. In cases of bacterial peritonitis, treatment is with antibiotics. In other cases, the underlying condition has to be treated.

SYMPTOMS
* Most patients with peritonitis will have abdominal pain and a fever.
* Also, they usually already have Ascites (a build-up of fluid within their stomach) and a distended stomach. Peritonitis may or may not cause the stomach to be more distended than normal.
* Some patients will have nausea, vomiting, loss of appetite, and weight loss. Which of these symptoms are present depends on the cause of the problem.
* Many patients with Ascites also have liver problems. When these patients develop peritonitis, they often experience deterioration in mental status because of the build-up of toxic substances in their blood.
* Patients with tuberculous peritonitis have low-grade fever, loss of appetite, and weight loss. Often, their Ascites will develop slowly.
* In patients with cancer, the cancer can spread to the peritoneum (the abdominal cavity). If this happens, it triggers a reaction and causes the accumulation of fluid. This can cause an abnormal increase in the size of the abdomen, loss of appetite, and lack of energy.
* If there is a large amount of fluid within the stomach cavity, the patient may have trouble breathing because the lungs cannot expand normally. Also, fluid may block the intestine and not allow food to pass through.
* Examination by a doctor usually reveals tenderness of the abdomen, and fever.

CAUSE
* As stated above, there are many factors that cause peritonitis.
* Secondary bacterial peritonitis is usually caused by an infection somewhere in the abdomen. For example, Diverticulitis, Appendicitis, pancreatitis, intestinal perforation, etc., all can cause this problem. Most abdominal infections stay within the infected organ. When the infection spreads out of the organ and into the abdominal cavity, it causes peritonitis. This is known as secondary bacterial peritonitis. Also, any type of trauma that introduces bacteria into the abdominal cavity can lead to peritonitis.
* Spontaneous Bacterial Peritonitis occurs when the fluid within the abdominal cavity becomes infected on its own. This process almost always occurs in patients who already have Ascites. It is called spontaneous because the bacteria enter the abdominal cavity on their own by moving through the wall of the intestine. There is no outside source for the infection, such as in secondary bacterial peritonitis.
* The risk of Spontaneous Bacterial Peritonitis (SBP) is higher in patients who have liver disease and who have a low amount of protein in their Ascites fluid.
* Another cause of peritonitis is Tuberculosis infection of the abdominal cavity.
* Cancer can also spread to the abdominal cavity and cause the development of Ascites. The most common tumors that spread to the abdominal cavity include cancer from the ovaries, uterus, pancreas, stomach, colon, lungs, and breasts.
* A disease called familial Mediterranean fever also can cause peritonitis.

HOW THE DIAGNOSIS IS MADE
* The symptoms and doctor's examination may suggest the presence of peritonitis, or peritonitis might be diagnosed during abdominal surgery.
* However, the only way to be sure is to remove some of the fluid and send it to the lab. This is done by a process known as paracentesis. In a paracentesis, a needle is inserted into the abdomen and a sample of the fluid is removed. The fluid is then sent to the lab where it is analyzed.
* Once, the test results are back, decisions regarding treatment can be made.
* This test will only tell you whether or not an infection is present. It will not necessarily tell you the source of the infection.
* Once the diagnosis of an infection (peritonitis) is made, then it has to be determined whether this is spontaneous or secondary bacterial peritonitis.
* Spontaneous Bacterial Peritonitis usually responds to antibiotic therapy within 24 to 48 hours.
* If the patient is placed on antibiotics and is not improving after 1 to 2 days, the doctor may need to repeat the paracentesis to recheck the fluid. The doctor has to take into consideration that the lack of improvement may be due to secondary bacterial peritonitis or some other disease.
* If secondary bacterial peritonitis is felt to be present, the doctor will have to do more testing to see what is causing the problem. Tests may include Ultrasound, CAT scan, and special X-Rays (such as an upper gastrointestinal series or a gastrograffin enema). The most appropriate test will be determined by your doctor.
* Tuberculous peritonitis is often very hard to diagnose. Often, the fluid collected from the abdomen will not give a specific diagnosis. In such cases, the patient may need a biopsy to see if the infection is due to Tuberculosis. The biopsy can be done by laparoscopic surgery, in which a camera is inserted into the abdomen via 2 or 3 small incisions. The doctor can then look around and perform a biopsy.
* In patients with peritonitis due to cancer, the fluid can be collected and analyzed in the laboratory to see if any cancer cells are present. If this does not give a final diagnosis, then laparoscopic surgery can be done (as described above) to obtain a biopsy.
* In patients with familial Mediterranean fever, they can undergo genetic testing to see if they have this disease.

RISK FACTORS
* Risk factors for developing peritonitis include the presence of Ascites. Therefore, any condition that leads to the formation of Ascites can also be considered a risk factor for peritonitis.
* Also, a low amount of protein (less than 1 gram per deciliter) in the Ascites fluid is a risk factor for developing peritonitis.
* Any other abdominal infection such as Appendicitis, Diverticulitis, perforation, etc can lead to peritonitis.
* Having had peritonitis previously is a risk factor for developing peritonitis again.

TREATMENT
* Treatment depends on the cause of the peritonitis.
* In general, patients who have Ascites are placed on diuretics. A diuretic is a type of medication that increases urine output and helps remove excess fluid from the body. It is often also known as a "water pill."
* Treatment for secondary peritonitis is addressed at taking care of the underlying infection or problem. The person will need to be placed on antibiotics. However, the most appropriate treatment depends on the cause of the problem.
* Treatment for SBP is with antibiotics. Usually the person is treated with an antibiotic such as cefotaxime. If needed, another antibiotic called ampicillin can be also be used. Antibiotics are usually continued for 1-2 weeks.
* In certain special circumstances (for example those who do peritoneal dialysis), they may need different antibiotics. Therefore, the doctor treating the person will help decide which antibiotic is most appropriate.
* Patients with Ascites due to cancer usually do not require antibiotics. They also usually do not respond to medicines that increase urine output (diuretics). These individuals usually require a procedure known as large volume paracentesis. This procedure is the same as that described above (in the diagnosis section). However, instead of removing just a small sample for analysis, a large amount of the fluid is removed to help reduce the person's symptoms.
* Patients with familial Mediterranean fever sometimes can be treated with a medicine called Colchicine (which is often used in patients with gout) to help reduce the frequency and severity of symptoms. However, no specific cure for this condition is currently available.

COMPLICATIONS
* Usually, most cases of peritonitis due to an infection respond to antibiotics.
* If the infection does not respond, the infection may get worse or spread to other parts of the body.
* Other complications include Intestinal Obstruction, shortness of breath, or development of fluid build-up around the lungs (called a pleural effusion).

IF YOU SUSPECT THIS CONDITION
* If you suspect this condition, please seek medical attention as soon as possible.

PREVENTION
* Things such as fluid collections due to cancer cannot really be prevented.
* Peritonitis due to other causes (secondary bacterial peritonitis) can potentially be prevented if those conditions are diagnosed and treated quickly.
* Tuberculous peritonitis can sometimes be prevented if the infection is detected elsewhere in the body and treatment is started early.
* Spontaneous Bacterial Peritonitis has a high rate of occurring again in patients who have already had it once. Therefore, antibiotics are often given to these patients to prevent repeat infections. These antibiotics are also given to patients with very low amounts of protein in their Ascites (remember a low protein level greatly increases the risk of developing SBP).
* The antibiotics most often used are ciprofloxacin (750 milligrams once a week), Norfloxacin (400 milligrams once a day), or Trimethoprim-sulfamethoxazole (one double-strength tablet a day).
* These antibiotics, though not a 100% effective, do greatly reduce the risk of developing an infection.

SIMILIAR CONDITIONS
* Diverticulitis
* Pancreatitis
* Cholecystitis
* Cholangitis
* Pancreatitis
* Chylous, pancreatic, or bile Ascites
* Bowel obstruction
* Appendicitis

Acute Nonsuppurative Pericarditis

2008-10-24T18:34:00.002+08:00

ALSO KNOWN AS
Pericarditis, ANP, Constrictive Pericarditis, CP, or pericardial tamponade

DESCRIPTION
* The heart and the blood vessels emerging from it are covered by a sac called the pericardium. This sac has an outer and inner layer normally separated by a small amount of lubricating fluid. Conditions that irritate the pericardium cause a localized and protective body response known as inflammation. This may result in an increase in the amount of fluid (pericardial effusion) between the outer and inner layers that may compress the heart and restrict its pumping action.
* In constrictive Pericarditis there is a thickening of the pericardium and attachment to the heart that may restrict its normal movements.
* In pericardial or Cardiac Tamponade (PT), blood or fluid can also collect in the pericardium and cause heart problems. PT can result with any type of Pericarditis.
* Pericarditis may be acute (less than 6 weeks) or chronic (>6 weeks).

SYMPTOMS
* Chest pain:

1. Sharp or stabbing
2. Sudden
3. Worse on breathing in or with movement
4. Radiating to neck, back, shoulders, or abdomen
5. Reduced by sitting up or leaning forward

* Difficulty breathing:

1. Worse with lying down
Better when standing, sitting, or bent forward
2. Racing Heart
3. Pounding in the Chest
4. Fever
5. Cough
6. Sweating
7. Dizziness
8. Fatigue
9. Loss of appetite

* With constrictive Pericarditis and Pericardial Tamponade, there is pressure on the heart from thick fibrous material or fluids (>120cc) that compromises the heart's ability to pump, and fluids may build up in the abdomen, ankles, and feet (right-sided Heart Failure).

CAUSE
*
Idiopathic -- i.e., no cause is identified. This is the most common type.
*
Infections:

1.
Viruses -- Coxsackie B (especially children), adenovirus (especially children), Mumps , Epstein-Barr, echo virus, Herpes Simplex
2. Bacteria -- Staphylococcus, Haemophilus (especially children), pneumococcus,
Salmonella, Lyme Disease, meningococcus, mycoplasma
3. Acute Rheumatic Fever
4. Mycobacterium -- M.Tuberculosis
5. Fungi -- candida, nocardi, Histoplasmosis
6.
Parasites

* Drugs:

1. Phenytoin
2. Procainamide
3. Hydralazine
4. Minoxidil

* Others:

1. Cancers:
2. Lung
3. Breast
4. Lymphoma
5. Mesothelioma -- tumors caused by exposure to asbestos

* Connective tissue diseases:

1. Rheumatoid Arthritis
2. SLE ( Systemic Lupus Erythematosus )

* Diseases and other conditions:

1. Pancreatitis
2. Uremia -- kidney failure
3. Sarcoidosis
4. AIDS
5. Aortic Dissection -- aorta (major artery) can rupture
6. Chylopericardium (milky fluid inside the pericardium)
7. Myxedema -- severe thyroid disease
8. Dressler's syndrome -- Pericarditis long after a heart attack
9. Radiation of any cause -- constrictive Pericarditis
10. Radiation therapy
11. Acute Pericarditis can result in Pericardial Tamponade and can lead to chronic or constrictive Pericarditis.

HOW THE DIAGNOSIS IS MADE
* Examination and history
* Physician may consult with a heart specialist (cardiologist)
* History:

1. Symptoms
2. Medications
3. Illnesses
4. Surgeries
5. Habits
6. Job
7. Family
8. Travel
9. Allergies

*
Exam:

o Acute Pericarditis:

1. Patient is in pain and anxious.
2. Patient is leaning forward and unable to lie flat.
3. Rapid shallow breathing may be present.
4. Doctor may hear a friction rub -- (using a stethoscope) a scratchy noise is heard over the chest, as the two layers of the pericardium rub against each other.
5. Listening to the lower back, the doctor may hear Fluid in the Lungs (rales).
6. Pulse rate may speed up and then normalize.
7. Fever may be detected.

* Pericardial Tamponade:

1. All the same signs or symptoms as with acute Pericarditis
2. Patient is pale or with bluish lips (cyanosis)
3. Weak or absent pulse
4. Rapid, thready pulse rate
5. Low or no blood pressure (BP)
6. There may be >10 mm Hg drop in systolic BP (the number on top when BP is measured) when the patient breaths in (pulsus paradoxus).
7. Putting his hands over the heart, the doctor may feel little activity.
8. Lungs may be clear when listened to.
9. There may be friction rub.
10. There may be muffled or distant heart sounds, Low BP, and distended neck veins (jugular veins) known as Beck's triad.

* Constrictive Pericarditis:

1. Often a history of acute Pericarditis or viral illness
2. Shortness of breath (dyspnea)
3. Fatigue.
4. Listening to the lungs one may hear rales.
5. Listening to the heart, one may hear an abnormal sound known as a knock.
6. Swollen ankles, legs, arms, and abdomen
7. Distended jugular veins
8. Kussmaul's sign -- upon inspiration, the pressure in the jugular veins increase and distend the veins.

o Tests:

1. Blood samples -- show an increase in white blood cells and ESR, due to inflammation.
2. Heart chemicals (enzymes) can also be elevated (i.e., CK, LDH) in the blood. Liver enzymes may be elevated if there is right-sided Heart Failure.
3. Electrocardiogram or EKG -- (recording of electrical activities of the heart) in Pericarditis has a characteristic pattern.
4. Echocardiograph (echo) - uses sound waves to show a picture of the heart and pericardium. Echo can show if fluid is present. Using echo, a cardiologist can insert a needle in between the pericardial layers, and draw out a small amount of fluid (percardiocentesis), or take a small piece of pericardium (pericardial biopsy). The fluid or sample is then sent to a laboratory, where its contents and source are identified.
5. Cardiac catheterization (CC) -- uses a long wire inserted through the thigh vein and guided to the heart, in order to measure pressure changes inside the heart.
6. CC is useful when constrictive or tamponade Pericarditis is compressing the heart.
7. Chest CAT scan and MRI can provide detailed and clear pictures of the heart, such as the presence of a thick and calcified (Calcium deposits) pericardium in the case of chronic or constrictive Pericarditis.

RISK FACTORS
* See causes
* Chest Trauma -- open-heart surgery (postpericardiotomy) and stabbing may cause constrictive Pericarditis
* Men > Women
* Age -- adolescents and young men
* Upper respiratory infections -- colds

TREATMENT
* Mild cases -- outpatient treatment:

1. Rest
2. Aspirin or other nonsteroidal anti-inflammatory drugs (i.e., NSAIDS such as Motrin, Indocin, etc.) for 2 weeks. Side effects include stomach upset, bleeding, and others.
3. Prednisone pills for 2-4 weeks can also be used to reduce inflammation of the pericardium. Side effects include stomach ulcers and infections. This medicine cannot be stopped suddenly, but must be tapered.
4. Azothioprine and Phenylbutazone are also used in some cases, but have many side effects.

* In-patient therapy is recommended if there are signs of heart problems (shock, Low Blood Pressure, very irregular or rapid heart beat):

1. Monitor patient with serial EKG
2. Drain fluids as soon as possible

* If medication and fluid drainage is not effective, or in cases of severe constrictive Pericarditis with Heart Failure, a cardiac surgeon may be called in to remove the pericardium (pericardiectomy).

IF YOU SUSPECT THIS CONDITION
* See a doctor immediately. Call 911 if there is any pressure or pain in the chest, sweating or shortness of breath.

SIMILIAR CONDITIONS
* Heart attack
* Pneumonia -- lung infection
* Pleurisy -- inflammation of the sac covering the lung
* Pancreatitis -- inflammation of the pancreas
* Pulmonary Emboli -- blood clot in the lung
* Cholecystitis -- inflammation of the gallbladder

Acute Necrotizing Gingivitis

2008-10-24T18:29:00.002+08:00

ALSO KNOWN AS
Vincent's infection or trench mouth

DESCRIPTION
* This condition is due to a severe bacterial infection (Treponema vincenti) of the gums and is most often caused by stress. It used to be very common during wars when soldiers in trenches fought under extremely stressful conditions, and would develop gum infections -- thus the derivation of the name trench mouth.

SYMPTOMS
* Symptoms include painful, severely inflamed gums. Also, patients with this condition often have enlarged and tender lymph nodes in the neck, Bad Breath, fever, and bleeding gums.

CAUSE
* It is due to a bacterial infection of the gums (i.e., Treponema vincenti).
* It is usually seen in people who are under extreme stress.
* Patients with severe medical illness often develop trench mouth.

HOW THE DIAGNOSIS IS MADE
* Examination of the mouth by a doctor is usually sufficient to make the diagnosis.

TREATMENT
* Treatment is with antibiotics such as penicillin, for 10 days.
* If possible, ideally eliminate stress.
* Eat a healthy diet.
* Half-strength peroxide can be used to rinse the mouth 3 to 4 times a day.
* If these remedies fail, see your dentist for more treatment.

Acute Leukemia

2008-10-24T18:20:00.002+08:00

ALSO KNOWN AS
Leukemia

DESCRIPTION
* Leukemia is a life-threatening cancer of the white blood cells in the bone marrow. White blood cells normally function to fight infections. There are two major types of white blood cells -- neutrophils and lymphocytes -- allowing for two types of acute Leukemias: myelocytic (also known as AML, i.e., acute myelocytic Leukemia) and lymphocytic (also known as ALL, i.e., acute lymphocytic Leukemia).
* Both forms of acute Leukemia inhibit the bone marrow's production of needed blood components, including red blood cells and platelets (structures involved in clotting blood).
* ALL is the most common cause of cancer in children, generally occurring between ages 3 and 5, but it can also affect adolescents and, occasionally, adults.
* AML affects people of all ages but is more common in adults. It is a life-threatening cancer that rapidly replaces the normal cells in the bone marrow.

SYMPTOMS
* Bleeding in gums
* Bleeding under the skin, such as bruises or spots
* Nosebleeds
* Increased menstrual bleeding
* Thickened and swollen gums
* Bone pain
* Joint pain
* Weight loss
* Fatigue
* Enlarged lymph nodes
* Shortness of breath
* Severe infections are rare.

CAUSE
* Usually unknown
* Radiation
* Benzene
* Cancer chemotherapy

HOW THE DISGNOSIS IS MADE
* Examination:

1. Skin is pale
2. Rash with red dots on the skin called petechiae
3. Enlarged liver
4. Enlarged spleen
5. Enlarged lymph nodes
6. Bone tenderness

* Laboratory Findings:

1. Manual Complete blood count shows diffuse decrease in all blood records with the presence of blast cells (immature white blood cells).
2. Acute lymphocytic Leukemia (ALL) will have granules in blast cells. A special cell marker called TdT is present in 95 percent of cases. It is subtyped to either B-cell or T-cell type.
3. Genetic testing on the cells is performed.
4. Acute myelogenous Leukemia (AML) shows Auer rods in the blast cells. Special stains may also be done.
5. Genetic testing is performed and t (8,21), t (15,17), and inv16q have a more favorable prognosis.
6. A bone marrow biopsy showing 30 percent or more blast forms, confirming the diagnosis
7. Other lab findings may include disseminated intravascular coagulation (DIC), which is a severe depletion of clotting factors in the blood.
8. Uric acid level may be elevated.
9. Lumbar puncture (spinal tap) will show blasts if meningeal Leukemia is present.

TREATMENT
* Intensive chemotherapy is recommended. During this period, there is a high risk of infection. Transfusion of blood products may be needed.
* Drug agents prescribed for AML include daunorubicin (antibiotic) and cytarabine.
* Drug agents prescribed for ALL include Daunorubicin, Vincristine, Prednisone, and Asparaginase.
* After initial therapy, intense chemotherapy, high dose chemotherapy, and radiation with bone marrow transplant may be recommended to cure the disease.

IF YOU SUSPECT THIS CONDITION
* You need immediate medical treatment. This is a curable disease. In AML, nearly 80 percent of adults younger than 60 years of age can be cured. 50 percent of patients older than 60 years may also be cured. In ALL, usually 80 percent of adults and 95 percent of children are cured.

SIMILIAR CONDITIONS
* Lymphoma
* Chronic Myelogenous Leukemia
* Myelodysplastic Syndromes
* Chronic Lymphocytic Leukemia
* Hairy cell Leukemia
* Mononucleosis

MISCELLANEOUS
* Blast Crisis

- This is a severe elevation of the white blood cell count to greater than 200,000/ml. Normal levels of white blood cells are 10,0000/ml. The high level of white bloods cells interferes with the circulation of red blood cells, which carry oxygen. Confusion, headaches, and shortness of breath are some of the symptoms. This is a life-threatening emergency. Blood must be filtered in a process called leukapheresis, and chemotherapy administered immediately.

Women and Smoking

2008-10-22T02:22:00.001+08:00

Description

# Smoking is an addiction. Tobacco smoke contains nicotine, a drug that is addictive and can make it very hard, but not impossible, to quit. If you smoke, your body is exposed to chemicals that cause cancer, coronary heart disease, stroke, and respiratory conditions such as emphysema and chronic bronchitis. Smoking is also linked to a variety of disorders and conditions including infertility and the slow healing of wounds.

# We all have heard the warnings: Cigarettes can cause cancer and increase the risk of heart disease. But the sad fact is that approximately 23 million women in the United States (23% of the female population) smoke. Smoking is the most preventable cause of death in this country; yet more than 140,000 women die each year from smoking-related causes. Approximately one fifth of all deaths in the United States can be blamed on smoking.
# Smoking harms not just the smoker, but also family members, co-workers, and others who breathe the smoker's cigarette smoke (second-hand smoke).
# Among infants 18 months of age and younger, second-hand smoke is associated with nearly 300,000 cases of bronchitis and pneumonia annually.
# Second-hand smoke increases a child's risk for middle ear problems, causes coughing and wheezing, and worsens asthma.
# If both parents smoke, a teenager is more than twice as likely to smoke than a young person whose parents are both non-smokers. In households where one parent smokes, young people are also more likely to start smoking.

Women smokers

# Twenty-seven percent of women smokers are between ages 25 and 44.
# Women smokers suffer all the consequences of smoking that men do, such as increased risk of respiratory diseases and various cancers (lung, mouth, larynx, pharynx, esophagus, kidney, pancreas, kidney, and bladder).
# In general, women smokers experience more illness and chronic conditions than women who have never smoked. According to the American Cancer Society, women who smoke heavily have nearly 3-fold more bronchitis and emphysema, 75% more chronic sinusitis, and 50% more peptic ulcers than non-smokers. The incidence of illness, such as influenza, is 20% higher for women smokers than women who are non-smokers. Currently, employed women smokers report more days lost from work due to illness and injury than do working women who do not smoke. In addition, women smokers younger than 65 years of age have more limited physical activity than those who have never smoked.

Pregnancy and Smoking

# Pregnant women who smoke are more likely to deliver low birth-weight babies. If all women quit smoking during pregnancy, approximately 4,000 additional babies would live each year.
# Chemicals in tobacco are passed from pregnant mothers through the bloodstream to the fetus. These toxic chemicals present serious risks to the unborn child, as well as the mother. According to Our Bodies, Ourselves for the New Century, by the Boston Women's Health Book Collective, 'Smoking during pregnancy is associated with preterm delivery, low birth-weight, premature rupture of membranes, placenta previa, miscarriage, and neonatal death. Newborns whose mothers smoked during pregnancy have the same nicotine levels in their bloodstreams as adults who smoke, and they go through withdrawal during their first days of life.'
# Children born to mothers who smoke experience more colds, earaches, respiratory problems, and illnesses requiring visits to the pediatrician than children born to non-smokers
# Is a baby part of your future plans? Many women today delay childbirth until they are in their 30s or even 40s, which can cause fertility problems even for non-smoking women. But women who smoke and delay childbirth are putting themselves at a substantially greater risk of future infertility than non-smokers.
# Increasingly, studies are showing that decreased ovulatory response, as well as the fertilization and implantation of the zygote, may be impaired in women who smoke. Chemicals in tobacco are suspected of altering the cervical fluid, making it toxic to sperm, and making pregnancy to be difficult to achieve.
# We cannot leave the men out on this one, either. Male smokers are 50% more likely to become impotent. Some of the toxic chemicals found in cigarettes may result in gene mutations that can cause miscarriage, birth defects, cancer, and other health problems in children.

Smoking cessation

# Research suggests that smoking cessation should be a gradual process because withdrawal symptoms are less severe in those who quit gradually than in those who quit all at once. Relapse rates are highest in the first few weeks and months and diminish considerably after 3 months.
Studies have shown that pharmacological treatment combined with psychological treatment, including psychological support and skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates.
Nicotine chewing gum is one medication approved by the Food and Drug Administration (FDA) for the treatment of nicotine dependence. Nicotine gum acts as a nicotine replacement.
# The success rates for smoking cessation treatment with nicotine chewing gum vary considerably across studies, but evidence suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision.
# Another approach to smoking cessation is the nicotine transdermal patch, a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. A research team at NIDA Division of Intramural Research studied the safety, mechanism of action, and abuse liability of the FDA-approved patch. Both nicotine gum and the nicotine patch, as well as other nicotine replacements such as sprays and inhalers, are used to help people quit smoking by reducing withdrawal symptoms and preventing relapse while undergoing behavioral treatment.
# Another tool in treating nicotine addiction is Zyban. This is not a nicotine replacement, as are the gum and patch. Rather, this works on other areas of the brain, and its effectiveness is in helping to control nicotine craving or thoughts in people trying to quit.
# In the future, a nicotine vaccine may be an effective method for preventing and treating tobacco addiction. The vaccine would prevent nicotine from reaching the brain, so as to reduce its effects and help keep people from becoming addicted

Vaginal Infection

2008-10-22T02:21:00.001+08:00

Description

# Vaginitis is an inflammatory condition of the vagina. It is the most common problem found in women of all ages. It causes distress and discomfort in women. It can be transmitted through sexual contact, sexually transmitted disease, most commonly trichomoniasis.

# Most men with trichomoniasis may not have any symptoms, so the infection cannot be diagnosed in either partner until the woman has symptoms of vaginitis. One of the most common types of vaginitis is yeast infection, usually called candidiasis. Various microorganisms normally populate the vagina and prevent infection. If a woman takes antibiotics to treat an infection, even if it is not for vaginitis, the antibiotics can kill both the bad and the good microorganisms, ultimately creating various imbalances in the body, including yeast infections.

Causes

# Bacteria (bacterial vaginosis)
# Protozoa (trichomoniasis)
# Yeast infection (candidiasis)

Symptoms

# Non-bloody vaginal discharge (leukorrhea)
# Vaginal odors
# Vulva irritation

Diagnosis

Examine a sample of vaginal secretion through a microscope, either stained or in special lighting, for evidence of infection forms.

Treatment

Various effective drugs are available for treating vaginal infections and accompanying vaginitis.
# Bacterial vaginitis: metronidazole, clindamycin
# Trichomoniasis: metronidazole. Candidiasis: Antifungal creams, tablets, or suppositories (i.e., Butoconazole, Biconazole, Clotrimazole, and Tioconazole)

Uterine Fibroids

2008-10-22T02:19:00.001+08:00

Description

# Uterine fibroids are benign smooth muscle tumors known as leiomyoma.
# About 20% of women develop uterine fibroids by age 40.
# They develop within the wall of the uterus as nodules of smooth muscle cells and fibrous connective tissue. The uterus becomes large and irregular in shape. It is an extremely common disease. There can be one or many fibroid tumors on the uterus.
# It is the second most common indication for major surgery in women after cesarean section.
# It can develop as a single nodule or many fibroid tumors that may range in size from 1 mm to more than 20 cm (8 inches) in diameter. They can grow within the uterine wall and may protrude toward the outer uterine surface and the pelvic cavity.

Causes

# The etiology is not clear. Most likely, they develop from uterine smooth muscle cells.

Symptoms

# Many women do not have any symptoms.
# Heavy, prolonged, unusual monthly menstrual bleeding is the most common symptom.
# An increase in menstrual cramps and pelvic pain
# Pain in the back, flank, or legs, as the fibroids press on nerves that supply the pelvis and legs
# Pain during sexual intercourse
# Pressure on the urinary system, increased frequency of urination
# Pressure on the bowel, leading to constipation and bloating
# Abnormally enlarged (distended) abdomen

Diagnosis

# Pelvic exam
# Ultrasound
# MRI
# If necessary, a hysteroscopy (in which a camera is used to look into the uterus) or hysterography (in which a dye is injected into the uterus and x-rays are taken) can be done.

Similar conditions

# Pregnancy
# Leiomyosarcoma
# Ovarian cancer
# Adenomyosis

Treatment

# No treatment is necessary, just follow-up every 6 months, if the woman does not have symptoms.
# If the fibroid's blood supply is cut off, then the woman will have a lot of pain. This is an emergency and needs immediate medical attention.
# If bleeding is heavy, medroxyprogesterone or estrogen can help decrease the bleeding.
# If the woman is severely anemic (low blood count), this needs to be treated before any surgery is attempted. Surgical removal of the fibroid is required if the uterus is getting bigger very quickly, if it is causing symptoms, or bleeding is excessive.
# The smaller the fibroids, the less risky the surgery. Therefore, when possible, women are given medicines such as Leuprolide or Nafarelin for 2 to 3 months before surgery to shrink the fibroids.
# Surgery to remove either the individual fibroids or the entire uterus is the main treatment.
# If a woman desires pregnancy, the fibroids can be surgically removed and the uterus is left intact.
# If a woman does not desire pregnancy, the entire uterus is removed. This can be done through the stomach (abdominal hysterectomy), through the vagina (vaginal hysterectomy), or by laparoscopy-assisted vaginal hysterectomy (a camera-assisted surgery).
# Women can still become pregnant if the uterus is left in place, but they may have to have a C-section.

Uterine Atony

2008-10-22T02:17:00.001+08:00

Also known as

The failure of the uterus to contract maximally after the delivery of the baby and placenta, resulting in heavy uterine bleeding.

Description

# Uterine atony is the most common cause of postpartum hemorrhage and the most common indication for postpartum hysterectomy or blood transfusion.
# Normally, bleeding after delivery is stopped by uterine contractions and compression of the vessels. If uterine contractions are not adequate, bleeding can continue. At times, the uterus is prevented from contracting effectively by fragments of placenta that remain in the uterus after delivery or by benign growths of uterine muscle within the uterine wall (fibroids). In these cases, the term 'atony' usually is not applied. In most cases, the uterine muscle simply fails to contract adequately.

Causes

# Multiple gestation, high parity
# Fetal macrosomia
# Polyhydramnios
# General anesthetics
# Prolonged labor, precipitous labor, augmented labor
# Infection (chorioamnionitis)

Symptoms

# Excessive bleeding at the time of delivery

Diagnosis

# The presenting signs are a soft uterus with vaginal bleeding.
# After delivery, uterine atony is detected when there is excessive bleeding and a large, relaxed uterus. Your doctor may perform an examination to be certain that there are no tears of the cervix or the vagina and that all fragments of placenta have been removed from the uterus.
# Alternate sources of bleeding, such as vaginal or cervical lacerations or retained placental fragments, must be excluded.

Treatment

# Initial treatment consists of bimanual compression, uterine massage.
# Uterine contraction medications: Oxytocin, Methylergonovine, and Prostaglandins
# Surgery: uterine vessel ligation or hysterectomy (the latter is rarely used)
# Blood and fluids must be replaced as needed.

Uterine Anomalies

2008-10-22T02:16:00.001+08:00

Description

Uterine anomalies occur in 0.1 to 0.5% of women, depending on the population. Uterine anomalies that are large enough to decrease the size of the uterine cavity (womb) are a major cause of recurring abortions, premature labor and/or abnormal presentation of the fetus during labor. Uterine anomalies are detected in 15% to 25% of women with recurrent pregnancy loss. Unfortunately, uterine anomalies are usually not diagnosed until a woman becomes pregnant.

Causes

# The cause of most congenital uterine anomalies is unknown.
# In the past, pregnant women were sometimes given diethylstilbestrol (DES) to prevent miscarriage. Female offspring of these women had a higher frequency than usual of uterine anomalies, as well as an increase in cancers of the female reproductive tract.
# A genetic cause has not been found.
# Environmental factors, as yet undetermined, may affect uterine development.

Symptoms

# Recurrent miscarriages (spontaneous abortions)
# Premature delivery
# Intrauterine fetal growth retardation
# Abnormal fetal presentation (defined as any part of the fetus that presents other than the top (vertex) of the fetal head facing the cervix towards the floor)
# Pelvic examination reveals two vaginas and/or two cervix (associated with uterine anomalies) or sometimes two horns are felt on the uterus.
# Usually there is no sign of a uterine anomaly on a routine pelvic examination.

Diagnosis

# History of pregnancy losses or prenatal exposure to DES
# Pelvic examination
# Ultrasound
# Magnetic resonance imaging (MRI)
# Hysterosalpingogram
# Hysteroscopy
# Laparoscopy

Treatment

# Aggressive obstetrical, nonsurgical management of patients with prior reproductive failure.
# Surgery to redesign the uterus is a highly successful procedure. Postoperative success rates (i.e., term pregnancy) generally range from 70% to 80%, with premature delivery rates less than 10%.

Urinary Incontinence

2008-10-22T02:14:00.001+08:00

Description

Urinary incontinence is the involuntary loss of urine, sufficient enough to cause a social or cleanliness problem.

By age 65, 1 in 10 women experiences urinary incontinence. It is most commonly seen in women who have had one or more vaginal deliveries, which cause a change in the anatomy of the uterus, vagina, and supporting structures of the bladder, urethra, and rectum. Changes may be temporary, mild, or very significant.

If you suffer from urinary incontinence, there are many new products and surgical methods available to treat this condition.

Causes

Urinary incontinence is often caused by a combination of the following:

* Pregnancy, particularly vaginal delivery.
* Weakened or damaged pelvic muscles that support the bladder.
* Lack of estrogen, e.g., menopause.
* Medical problems that affect the bladder function, e.g., diabetes mellitus.
* Urinary tract infections.
* Constipation causing straining.
* Repeated coughing, e.g., smoker's cough.
* Certain prescription and nonprescription medications.

Symptoms

Symptoms vary depending on the type of incontinence:

Stress incontinence is the loss of urine when there is a sudden increase in pressure in the abdomen caused by laughing, coughing, sneezing, exercising, or lifting something heavy.

Urge incontinence is the most common type of incontinence. It occurs when someone suddenly feels as though they need to use the toilet, but is unable to reach it in time. Urge incontinence has many causes.

Mixed incontinence is a combination of stress and urge incontinence.

Overflow incontinence occurs when the bladder cannot empty properly. A person makes frequent trips to the toilet, letting out small amounts of urine each time. Because the bladder never empties completely, it may feel full again very quickly. Some people may have periodic leaking without any sensation of fullness.

Functional incontinence is not caused by problems with the bladder. Accidents occur because it may be difficult for a person to get to the toilet due to illness, arthritis, or lack of available facilities.

Diagnosis

* Review of medical history.
* Physical exam, including pelvic examination.
* Laboratory tests, including urinalysis and urine culture to rule out a urinary tract infection; blood sugars to rule out diabetes mellitus.
* Urodynamic studies where the physician tests the function of bladder and urethra by measuring bladder pressure and urine flow.
* Cystoscopy, which involves the direct visualization of the urinary bladder and urethra from inside by inserting an endoscopic tube through the urethra. Please see cystoscopy for more information.
* Cystogram to show abnormal anatomy and functions that may be causing incontinence. For a cystography or voiding cystourethrography, the bladder is filled with iodine containing X-Ray dye, and an X-Ray is taken of the bladder and urethra when filled, during urination, and immediately after urination.

Treatment

Treatment depends on the type of incontinence and may require one or more of the following:

* Estrogen creams, if estrogen deficiency (from menopause) is suspected.
* Antibiotics to treat a urinary tract infection.
* Medication to help regulate the bladder and urethra.
* Surgery to support the bladder and correct the pelvic anatomy.
* Kegel exercises to strengthen the pelvic muscles.
* Bladder training to help a person control the urgent need to urinate.
* Vaginal pessaries to support a partially prolapsed bladder.

Secondary Dysmenorrhea

2008-10-22T02:12:00.001+08:00

Also known as

# Secondary dysmenorrhea is also known as painful or difficult menstruation.

Description

# Secondary dysmenorrhea is related to the presence of pelvic lesions secondary to organic pelvic disease such as endometriosis, salpingitis, PID (pelvic inflammatory disease), postsurgical adhesions, etc. Secondary dysmenorrhea begins a few days before menstruation and lasts several days after the onset of flow. Often, it is lateralized to one side, and it does not characteristically peak and diminish as clearly or quickly as primary dysmenorrhea. Its onset is later in life, in women who have not had primary dysmenorrhea; however, it can be superimposed onto a pre-existing case of primary dysmenorrhea. An intrauterine device (IUD) may cause secondary dysmenorrhea.

Causes

# Endometriosis
# Pelvic inflammation
# Adenomyosis
# Uterine myoma
# Ovarian cyst
# Pelvic congestion
# IUD
# Uterine polyp
# Uterine malformation
# Cervical stenosis

Symptoms

# Pain may be continuous or intermittent
# Pelvic tenderness
# Nausea and/or vomiting
# Sweating, headaches, rapid heartbeat
# Diarrhea
# Tremulousness

Diagnosis

History and physical examination by the health care provider will differentiate between functional dysmenorrhea and those rare cases associated with a medical condition. Younger adolescents who have not become sexually active usually do not require a pelvic examination.

Treatment

Treatment of underlying disease:
# Pain relievers: aspirin, ibuprofen, naproxen, acetaminophen
# Birth control pills
# Surgery is not usually helpful in alleviating pain

Primary Amenorrhea

2008-10-22T02:11:00.001+08:00

Description

Amenorrhea means a woman is not menstruating. A female who has not had her first period by age 16 has primary amenorrhea. This should be distinguished from infrequent or light menstrual cycles (oligomenorrhea), which are very common and usually normal in teenagers, particularly in the first couple of years after menses begin, a time called menarche. If a woman starts her periods, but then stops having periods for at least 3 cycles (90 days), she is said to have secondary amenorrhea.

Causes

# Imperforate hymen (the opening to the vagina is covered by skin)
# Cervical stenosis (the cervix is closed)
# Eating disorders: sudden weight reduction, obesity, anorexia nervosa, fad dieting
# Intense exercise
# Stress
# Malnutrition
# Chronic disease, e.g., diabetes, anemia, congenital heart disease, thyroid disease
# Pituitary or hypothalamic failure
# Chromosomal anomaly, e.g., Turner's syndrome
# Congenital adrenal hyperplasia
# Ovarian dysfunction
# Absence or abnormality of one or more of the female reproductive organs

Diagnosis

# Medical history
# Physical examination including pelvic and bimanual examination
# Laboratory tests for levels of luteinizing hormone, follicle-stimulating hormone, thyroid hormone, prolactin, etc.
# Ultrasound
# CT
# MRI
# Chromosomal testing
# Laparoscopy

Treatment

Varies, depending on the cause, and may include:
# Hormonal replacement therapy and/or other medications
# Surgery minor and/or major
# Psychosocial counseling
# Long-term follow-up by an internist or other medical specialist

Painful Menstruation

2008-10-22T02:09:00.001+08:00

Description

Dysmenorrhea, or painful menstruation, is experienced by approximately 50% of woman; it is severe or disabling in 10%, causing a loss of workdays and poor performance at school. Dysmenorrhea is caused by the production of prostaglandins during menstruation. Prostaglandins enhance uterine contractions, causing pelvic pain. Primary dysmenorrhea is caused by normal uterine muscle contractions and affects more than half of menstruating women. Secondary dysmenorrhea is menstrual-related pain that is caused by abnormal medical conditions, such as endometriosis. The pain begins with the onset of menstrual flow and lasts 2-3 days. It is characterized by crampy, lower abdominal pain that radiates to the back region or inner thigh region. Nausea, headache, or fatigue may accompany the pain.

Causes

# Prostaglandins. These are chemicals that occur naturally in the body. Certain prostaglandins cause uterine muscles to spasm.

Symptoms

# Lower abdominal, crampy pain that occurs before the beginning of the menstrual period and lasts 1 or 2 days into the period.
# Nausea, vomiting, diarrhea, constipation

Treatment

# Common pain relievers: aspirin, ibuprofen, naproxen, acetaminophen
# Birth control pills

Self-Care Procedures

# Drink a hot cup of regular tea, chamomile or mint tea.
# Place heating pad or hot-water bottle on the abdomen.
# Take a warm bath.
# Gently massage your abdomen.
# Mild exercises
# Drink a glass of wine or other alcoholic beverage. Alcohol slows down uterine contractions.
# Rest
# Birth control pills

Ovarian Cancer

2008-10-22T02:08:00.001+08:00

Description

There are many types of ovarian cancer, and cure and treatment success depends on how early ovarian cancer is detected. Ninety-five percent of women will live longer than five years, if ovarian cancer is detected before it has spread beyond the ovaries. Presently, only 25% of ovarian cancer cases in the U.S. are diagnosed in the early stages, because there is no simple screening test for ovarian cancer. Also, once symptoms develop and a woman seeks medical care, the cancer is often advanced. In advanced stages, 5-year survival rates drop to 28%. Ovarian cancer is the fifth leading cause of cancer deaths among women.

Symptoms

# None in the early stages
# Family history of ovarian cancer should alert a woman that she should be followed closely.
# Abdominal pressure or bloating
# Changes in bowel or bladder patterns
# Nausea, feeling full early when eating, constipation, and gas
# Excessive fatigue
# Weight loss
# Bowel obstruction

Diagnosis

# Pelvic examination reveals an enlarged ovary
# Ultrasound
# Computed tomography (CT)
# Magnetic resonance imaging (MRI)
# Blood tests (CA-125, CEA)
# Laparoscopy
# Exploratory laparotomy

Treatment

# Surgery to remove all visible cancer and involved structures
# Chemotherapy
# Radiation therapy
# Supportive care

Osteoporosis

2008-10-22T02:06:00.002+08:00

Description

# Osteoporosis is a disease of progressive bone loss associated with an increased risk of fractures. It literally means 'porous bone.' The disease often develops unnoticed over many years, with no symptoms or discomfort, until a fracture occurs. Osteoporosis often causes a loss of height and dowager's hump (a severely rounded upper back region).

# Osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women. In the U.S. today, 10 million individuals already have osteoporosis and 18 million more have low bone mass, placing them at increased risk for this disease. One out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime
# More than 2 million American men suffer from osteoporosis, and millions more are at risk. Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites.

Causes

Doctors do not know the exact medical causes of osteoporosis, but they do know many of the major factors that can lead to the disease.
# Aging. Everyone loses bone with age. After age 35, the body builds less new bone to replace losses of old bone. In general, the older you are, the lower your total bone mass and the greater your risk for osteoporosis.
# Heredity. A family history of fractures; a small, slender body build; fair skin; and a Caucasian or Asian background can increase the risk for osteoporosis. Heredity also may help explain why some people develop osteoporosis early in life.
# Nutrition and lifestyle. Poor nutrition, including a low calcium diet, low body weight and a sedentary lifestyle has been linked to osteoporosis, as have smoking and excessive alcohol use.
# Medications and other illnesses. Osteoporosis has been linked to some medications, including steroids, and to other illnesses, including some thyroid problems.

Diagnosis

# The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests. If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia (a vitamin D deficiency) or hyperparathyroidism (overactivity of the parathyroid glands).
# Bone densitometry is a safe, painless x-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at its highest.
# It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam X-ray absorptiometry (DXA) is one of the most accurate methods, but other techniques can also identify osteoporosis, including single photon absorptiometry (SPA), quantitative computed tomography (QCT), radiographic absorptometry and ultrasound. Your doctor can determine which method would be best suited for you.

Treatment

# Because lost bone cannot be replaced, treatment for osteoporosis focuses on the prevention of further bone loss. Treatment is often a team effort involving a family physician or internist, orthopedist, gynecologist, and endocrinologist.
# While exercise and nutrition therapy are often key components of a treatment plan for osteoporosis, there are other treatments as well.
# Estrogen replacement therapy (ERT) is often recommended for women at high risk for osteoporosis to prevent bone loss and reduce fracture risk. A measurement of bone density when menopause begins may help you decide whether ERT is for you. Hormones also prevent heart disease, improve cognitive functioning, and improve urinary function. It should be discussed with your doctor.
# New anti-estrogens known as SERMs have been introduced. They increase bone mass, decrease the risk of spine fractures, and lower the risk of breast cancer.
# Calcitonin is another medication used to decrease bone loss. A nasal spray form of this medication increases bone mass, limits spine fractures, and may offer some pain relief. Bisphosphonates, including Alendronate, markedly increase bone mass and prevent both spine and hip fractures. HRT, Alendronate, SERMs, and calcitonin all offer the osteoporosis patient an opportunity to not only increase bone mass, but also to significantly reduce fracture risk. Prevention is preferable to waiting until treatment is necessary.

Prevention

There is a lot you can do throughout your life to prevent osteoporosis, slow its progression, and protect yourself from fractures.
Include adequate amounts of calcium and vitamin D in your diet.
# Calcium. During the growing years, your body needs calcium to build strong bones and to create a supply of calcium reserves. Building bone mass when you are young is a good investment for your future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life.
Whatever your age or health status, you need calcium to keep your bones healthy. Calcium continues to be an essential nutrient after growth because the body loses calcium every day. Although calcium cannot prevent gradual bone loss after menopause, it plays an essential role in maintaining bone quality. Even if you have gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fracture.
How much calcium you need will vary depending on your age and other factors. The National Academy of Sciences makes the following recommendations regarding daily intake of calcium:
Males and females 9 to 18 years: 1300 mg per day
Women and men 19 to 50 years: 1000 mg per day
Pregnant or nursing women up to age 18: 1300 mg per day
Pregnant or nursing women 19 to 50 years: 1000 mg per day
Women and men over 50: 1500 mg per day
Dairy products, including yogurt and cheese, are excellent sources of calcium. An eight-ounce glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones, and green leafy vegetables, including broccoli and collard greens.
If your diet does not contain enough calcium, dietary supplements can help. Talk to your doctor before taking a calcium supplement.
# Vitamin D. Vitamin D helps your body absorb calcium. The recommendation for vitamin D is 400 IU daily for adults and 800 IU daily for the elderly. Supplemented dairy products are an excellent source of vitamin D. (A cup of milk contains 100 IU. A multivitamin contains 400 IU of vitamin D.) Vitamin supplements can be taken if your diet does not contain enough of this nutrient. Again, consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic.
# Exercise regularly. Like muscles, bones need exercise to stay strong. No matter what your age, exercise can help you minimize bone loss while providing many additional health benefits. Doctors believe that a program of moderate, regular exercise (3 to 4 times a week) is effective for the prevention and management of osteoporosis. Weight-bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting are probably best. Falls account for 50% of fractures, therefore, even if you have low bone density you can prevent fractures if you avoid falls. Programs that emphasize balance training, especially, Tai Chi, should be emphasized. Consult your doctor before beginning any exercise program.

Menstruation

2008-10-22T01:45:00.002+08:00

Description

# Menstruation is the periodic discharge of blood, mucus, and tissue from the uterus due to the change of the uterine lining (endometrium).
# From the pubertal stage, (which begins around age 11-12) first menstruation (menarche) cycle can be irregular for 2-3 years because of unbalanced hormonal secretion with or without ovulation.
# It then becomes more regular during the mid- to late teen years.
# Menstruation then continues throughout a women's life until she reaches menopause.

Causes

# The mechanism that regulates the sloughing of the uterine lining is controlled by changing levels of female hormones. It begins every month when follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are released from the pituitary gland, which is located at the base of the brain. Once FSH and LH are released, they influence the ovaries.
# During each cycle, FSH and LH cause one follicle to grow, and normally one egg is released from the follicle for possible fertilization. After this process, the follicle begins to produce estrogen and progesterone. Estrogen levels peak during the first half of the cycle as the newly released egg is maturing. Progesterone levels peak after midcycle when ovulation has occurred. Ovulation refers to the production of a mature egg.
# Estrogen and progesterone stimulate the lining of the uterus. During the first 2 weeks following menstruation, estrogen causes the uterine lining to grow gradually and the lining thickens by increasing the number of blood vessels.
# By midcycle, the inner lining of the uterus (endometrium) has increased 3 times in thickness and has a greatly increased blood supply.
# After midcycle, usually 14 days before menstruation, the egg is received by the fallopian tube.
# If the egg is fertilized, a large ovarian follicle, now called a corpus luteum cyst, secretes progesterone.
# If fertilization does not occur, the follicle begins to deteriorate and the progesterone levels decrease. The abrupt decrease in progesterone levels causes the lining of the uterus break down and menstruation begins.

Symptoms

# Bloody uterine discharge exits the vagina.
# Normal menstrual cycle: 21-25 days
# Menstruation period: 2-7 days
# Normal menstrual blood, 25-80 cc

Management

# Tampons
# Sanitary napkins
# Sanitary towel
# Sanitary briefs

Polycystic Ovary Syndrome

2008-10-21T02:55:00.001+08:00

Also known as

# Polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, polycystic ovarian disease, or hyperandrogenic chronic anovulation, is an endocrine disorder that occurs in 5%-10% women. It can cause a myriad of symptoms that appear, on the surface, to be unrelated

Description

# Polycystic ovary syndrome (PCOS) is a condition in which the ovaries accumulate tiny cysts, actually little follicles, 2 to 5 millimeters in diameter, each containing an egg. Instead of growing and going on to ovulate, the cysts stall and secrete male hormones into the blood. Ovulation is rare without the help of medications. In some women, there will be a long history of irregular periods and, perhaps, an increase in facial and body hair. Approximately 20% of women have mild polycystic ovaries (PCO).
# PCOS is a major cause of infertility.

Causes

# Unknown
# Genetic
# Insulin resistance, an abnormal response to oral glucose and/or elevated insulin levels in the blood disorder, may cause abnormal hormone responses in the ovaries.

Symptoms

# Irregular or absent periods secondary to a lack of ovulation
# Infertility
# Weight gain, particularly around the waist (the 'apple' shape as opposed to the 'pear' or 'hourglass' shape which is more typical for women)
# Hirsutism (excess body hair) that tends to worsen over time
# Insulin resistance, as measured by a person's abnormal response to oral glucose and/or elevated insulin levels in the blood
# Syndrome X: Insulin resistance is associated with high blood pressure, high triglyceride levels, and a decrease in HDL (the good cholesterol) and obesity.
# Acne, male-pattern baldness
# Multiple small cysts on the ovaries
# Acanthosis nigricans (darkening of the skin under the arms, breasts and back of neck)

Diagnosis

# History
# Physical examination, including pelvic examination
# Ultrasound
# Blood tests to test the level of different hormones: High androgen levels (particularly free testosterone), high levels of luteinizing hormone (LH), or an elevated LH to follicle stimulating hormone ratio are characteristic of PCOS.

Treatment

# In mild cases, treatment is not administered until a woman wants to become pregnant.
# Medication to induce ovulation when infertility is caused by anovulation:
a. Clomiphene citrate (Clomid or Serophene) is generally taken daily from days 3-7 of a cycle. Ovarian follicle development is usually monitored with a combination of home urinary LH testing and office ultrasound examination. Additional endometrial support may be promoted with the use of progesterone or HCG injections. There is an increased rate of multiple pregnancies with Clomiphene (6-7%), but no increased risk of birth defects. The majority of women who conceive on Clomiphene will do so in the first 4 cycles.
b. Gonadotropins are prescribed if Clomiphene fails to successfully induce ovulation.
# Medications are available to reverse hirsutism, regulate menstrual cycles, and control acne.
# Watch for development of diabetes mellitus, high blood pressure, high cholesterol and/or high triglyceride levels, and treat aggressively, if present, with diet and medication.

Genital Fistula

2008-10-21T02:51:00.002+08:00

Description

Genital fistula is a condition in which the genital tract and the urinary and intestinal tract become connected (usually in the vagina) by a leak in the system. It usually occurs as a result of a difficult delivery, when the vagina and the urinary bladder may become swollen or damaged due to excessive pressure during labor.

Symptoms

Urine leaks into the vagina in amounts proportional to the size of the hole. When the urine settles in the pubic area, a very strong odor may be noticed. If the rectum and the vagina are connected by a fistula, excretion through the vagina is also possible.

Causes

The most common cause of genital fistula is childbirth complications. Other possible causes are obstetrics/gynecologic surgeries, x-rays, tumors, and necrosis due to the use of a pessary.

Diagnosis

In the case of a urethral fistula, the diagnosis can be relatively simple. If leakage continues to occur when there does not appear to be a fistula, an over relaxed sphincter muscle may be the problem. For small urethral fistulas, a color pigment can be introduced into the urinary bladder to check to see if leakage occurs into the vagina. Or, cystoscopy (urinary bladder examination) can be performed to determine the location of the fistula in relation to the ureter. Depending on the situation, delicate urologic examination, or in rare cases, intravenous or retrograde pyelography can be used for diagnosis. For rectum-vaginal fistulas, a substance called barium is introduced into the intestinal canal, and an x-ray is taken to determine the whereabouts of the fistula.

Complications

Psychological problems, such as an avoidance of social contact, oversensitivity, insomnia, and depression may limit social activity.

Treatment

Most small fissures that are not a result of major diseases (i.e., cancer) heal themselves, and, thus, surgery may not be necessary. However, most people tend to prefer the immediate results of surgery. The standard treatment is to undergo reconstructive surgery after 4-6 months the injury. The waiting period is necessary in order to allow the swelling and hardening to subside before operating.

Fetal Alcohol Syndrome

2008-10-21T02:49:00.002+08:00

Description

# Fetal Alcohol Syndrome (FAS) is a pattern of mental and physical defects that develop in some unborn babies when the mother drinks too much alcohol during pregnancy.
# It includes mental retardation, growth deficiencies, central nervous system dysfunction, craniofacial abnormalities, and behavioral problems.

# A baby born with FAS may be seriously handicapped and require a lifetime of special care.
# The fetus is most vulnerable to various types of injuries depending on the stage of development in which alcohol is encountered. A safe amount of drinking during pregnancy has not been determined, and all major authorities agree that women should not drink at all during pregnancy. Unfortunately, women sometimes wait until a pregnancy is confirmed before they stop drinking. By then, the embryo/fetus has gone through several weeks of critical development, a period during which exposure to alcohol can be very damaging. Therefore, the Division of Alcohol and Drug Abuse urges women who are pregnant or anticipating a pregnancy to abstain from drinking alcoholic beverages. The incidence of FAS can conservatively be estimated at 0.33 cases per 1000 live births.

Causes

# Alcohol in a pregnant woman's bloodstream reaches the fetus by crossing the placenta. There, the alcohol interferes with the ability of the fetus to receive sufficient oxygen and nourishment for normal cell development in the brain and other body organs.
# Timing of alcohol use during pregnancy is important. Alcohol use during the first trimester is more damaging than during the second trimester, which is, in turn, more damaging than use in the third trimester.

Symptoms

The manifestations of specific growth, mental, and physical birth defects associated with the alcohol exposure during pregnancy
# Small birth weight, small head circumference
# Epicanthal folds, small, widely spaced eyes, flat mid-face
# Short, upturned nose, smooth, wide philtrum, thin upper lip
# Underdeveloped jaw
# Irritable, difficulty eating or sleeping, hypersensitivity to any form of stimulation

Neurological manifestations of FAS
# Attention deficits, memory deficits, hyperactive
# Difficulty with abstract concepts (math, time, money)
# Poor problem-solving skills, difficulty learning from consequences
# Poor judgment, immature behavior, poor impulse control

Treatment

# There is no cure for FAS. Once the damage is done, it cannot be undone. However, FAS is completely preventable.

Prevention

# FAS and FAE (Fetal Alcohol Effects) are 100% preventable when a pregnant woman abstains from alcohol. Communities, schools, and concerned individuals can help to prevent FAS/FAE, through education and intervention.

Female Urinary Tract Infection

2008-10-21T02:47:00.001+08:00

Description

# The urinary tract can be infected from above (by bacteria entering the kidneys from the bloodstream and traveling downward) or from below (bacteria entering the urethra and traveling upward). Most often, infections begin in the urethra and move up the urinary tract to the kidneys. Since a woman's urethra is shorter than a man's, women are more prone to urinary tract infections (UTIs) than men or children. One woman in five develops a UTI during her lifetime. UTIs in men, while not as common, can be very serious when they do occur

Causes

# Bacteria cause most UTIs.
# Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally live in the colon. Chlamydia and mycoplasma may also cause UTIs in both women and men, but these infections tend to remain limited to the urethra and reproductive system. Unlike E. coli, chlamydia and mycoplasma may be sexually transmitted, and these infections require treatment of both partners.

Symptoms

The symptoms depend on how old the person is and the location of the UTI infection.
# Pressure in the lower pelvis, burning, painful sensation while urinating
# Frequent need to urinate (frequency), urge to urinate (urgency)
# Need to urinate at night, cloudy, bloody, or abnormal-colored urine
# Blood in the urine (hematuria), abnormal odor to the urine
# Fever, chills, nausea or vomiting

Diagnosis

# Urinalysis test: The urine is examined for white and red blood cells and bacteria.
# Bacterial culture and sensitivity test to see which drug best treats the bacteria

Treatment

# If you are a healthy adult woman who is not pregnant, or a man, a 3-day course of antibiotic pills will usually cure your UTI. Tell your doctor if you have symptoms such as back pain and fever (a fever over 101°F could indicate that the infection has spread to your kidneys).
# The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin.
Preventative steps that a woman can take to avoid a UTI:
# Drink plenty of water every day. Some doctors suggest drinking cranberry juice, which in large amounts inhibits the growth of some bacteria by acidifying the urine. Vitamin C (ascorbic acid) supplements have the same effect.
# Urinate when you feel the need, i.e., do not resist the urge to urinate.
# Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.
# Take showers instead of tub baths.
# Cleanse the genital area before sexual intercourse.
# Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.

Female Sexual Dysfunction

2008-10-21T02:45:00.003+08:00

Description

The following is a discussion of the physical aspects of female sexual dysfunction, and some of the possible remedies and aids.

Orgasmic dysfunction

The most troublesome sexual problem for women is the inability to orgasm. Orgasmic dysfunction can be largely divided into two categories: Primary dysfunction, which is the inability to orgasm through any means, usually due to inherent causes; secondary dysfunction, which is the inability to orgasm due to factors arising after having previous orgasms via masturbation or intercourse. Ordinarily, the inability to orgasm in women is referred to as frigidity. However, some specialists consider this to be too strong a word and tend to be cautious with its usage, especially since some of the women who cannot orgasm, still have the inherent ability to orgasm, but just have a higher threshold. Orgasmic dysfunction is not only a result of insufficient clitoral stimulation. Sexual satisfaction, in general, depends not only on the physical stimulation but also on the person's attitude toward sex. The best treatment for orgasmic dysfunction is self-exploration through masturbation. In the event of masturbating for the first time, careful observation of the body's response should be noted. Then, with a partner, the ability to focus on one's sensual pleasures is practiced without being afraid or concerned of the result. After many practice sessions, the male partner then sits behind the woman and proceeds to stimulate the woman's genitals. Some specialists recommend that the woman first stand in front of the male partner and stimulate her own genitals. Then finally, direct intercourse is commenced with the women in the superior position. This sexual position has the advantage in that it allows the woman more control of her sexual response by allowing her to move in the direction of her sensitive areas. Also, in this position, the chances of attaining an orgasm is enhanced because it is possible for the woman to stimulate her clitoris with her hand, or rub it against the man's pubic bone during intercourse. However, it should be kept in mind that a woman's sexual satisfaction is not dependent totally on orgasm alone, but can be enhanced by psychological factors and emotional exchange during intercourse. In other words, the frequency of sexual encounters or the number of orgasms is less important than the closeness of the personal relationship. In conclusion, the most effective treatment for sexual problems is establishing a close emotional relationship with one's partner.

Vaginismus

Vaginismus is the spasmodic contractions of the vagina near its entrance or in the levator ani muscle due to localized oversensitivity in the region. The vaginal muscle contracts involuntarily and, thus, intercourse can be painful. Also, spasms can occur when trying to insert a finger or tampon into the vagina. For these women, pelvic examinations can be difficult and all attempts for a normal sexual life are likely to fail. About 2% of all women experience vaginismus, and most causes are psychological. Treatment involves reducing the anxiety about intercourse by developing sensual concentration, and gradual enlargement of the vagina with the insertion of fingers or enlargement devices. If the devices are applied in a relaxing and pressure-free setting, gradual enlargement can be achieved as the women becomes accustomed to objects being inserted into the vagina. As the couple's relationship becomes more intimate, the sexual satisfaction improves. In conclusion, as we stated earlier, the most effective way to treat sexual problems is to establish a close relationship with one's partner and build on the emotional satisfaction gained through such a relationship. During sexual arousal, the vaginal wall becomes wet with secretions that serve as lubrication. This type of secretion becomes more and more pronounced with increasing visual, aural, and tactile stimulations, and in the case of a fast response, no more than 30 seconds is needed for arousal. The added moisture and lubrication is in preparation for receiving the penis during intercourse. Vaginal dryness is a condition in which there is not enough or no secretion of lubrication. This can cause painful intercourse, and subsequent avoidance of intercourse altogether. If however, sexual activity is continued, in spite of the dryness, the vaginal wall and the urethra may become irritated and the urinary bladder could become inflamed. Again, the end result is that intercourse will be avoided, and in serious cases, sexual difficulty that parallels impotence in men will be experienced.

Vaginal tightening surgery

The vaginal opening can be tightened with surgery by removing a part of the mucous membrane and then suturing the remaining membrane together. At this point, it is important that the rear muscles (levator ani muscle) and the mucous membrane be sutured together in order to prevent any further relaxation of the vagina. During the procedure however, care should be taken not to damage the rectum or the anal sphincter.

Exercise

This is a method of exercising the muscles near the anus. It is used to strengthen the muscles of the pubic and tailbones in order to overcome problems with urination or orgasms. While keeping a normal breathing rate, the anus is contracted and held for 1 to 10 seconds and then relaxed, and then contracted again, repeating the process over and over again. At moments of leisure, this exercise should be repeated about 200 times daily. If the muscles can not be properly contracted, electrical stimulation or biofeedback techniques may help resolve the problem. The muscles of the pubic bone and tailbone surround the urethra and the vagina and play a big part in vaginal orgasms. Women with weak pubic and tailbone muscles have difficulty experiencing vaginal orgasms, but women with strong ones experience vaginal orgasms easily. This method of exercising the muscles near the anus is also helpful in preventing incontinence of urine, which usually happens after childbirth.

Exercise procedure
1.Familiarize yourself with the pubococcygeal muscle by first urinating with legs apart for a moment, and then trying to hold the urine back. When holding, make sure that you inhale while the pubococcygeal muscle is being contracted.
2.Then urinate again while exhaling.
3.Repeat steps 1 and 2 until all urine has passed.
4.Once you have mastered steps 1 to 3, practice with a finger in the vagina, contracting it 10 times for a duration of 3 seconds. Do this 3 times daily.

The above method will take some time to get used to. Only after constant repetition and practice will there be a difference.

Female Reproductive System

2008-10-21T02:42:00.002+08:00

Description

# The female reproductive organs consist of the vagina, cervix, the uterus, ovaries, and fallopian tubes. The uterus is a pear-shaped hollow, thick-walled muscular organ located in the lower abdomen between the bladder and the rectum.
# The narrow end of the uterus is the cervix.

When a woman is pregnant, the fetus grows in the uterus until birth

# The vagina extends from the labia to the uterus, and is located behind the bladder and in front of the rectum.
# At the top and on each side of the uterus are the fallopian tubes and ovaries.
Ovaries are two glands that produce various hormones and contain follicles. An ovary is about the size of an almond. Fallopian tubes are two tubular structures that connect the ovaries with the uterus. Fringe-like projections
called fimbriae (located at the opening of the fallopian tubes) sweep an egg released from an ovary into the tube.

Reproductive system

# The ovaries are the main source of female hormone: estrogen and progesterone. These hormones control the development of female body characteristics from puberty onward. They also regulate the menstrual cycle and pregnancy.
# Estrogen stimulates the inner surface of the uterus to grow thick in preparation for pregnancy. Progesterone stops the thickening process and causes the glands to mature so they can nourish the new pregnancy; in most tissues it blocks the stimulating effect of estrogen.
# The process of fertilization starts with the union of an egg and a sperm. Sperm enter the uterus via the cervix during sexual intercourse. After penetrating the cervix, they travel upward through the uterus into the fallopian tubes. In the outer one third of the fallopian tubes, a sperm may reach and penetrate an egg that has matured and been released from an ovary. This is called fertilization. The fertilized egg travels down the fallopian tube and implants in the inner lining of the uterus.
# After implantation, the embryo continues to grow; from the 8th week until birth, it is referred to as the fetus.

Female Infertility

2008-10-20T04:50:00.001+08:00

Description
Infertility is defined as the inability to become pregnant after trying for 1 year with the same person without using contraception of any sort. The condition affects about 5.3 million Americans or 9% of the reproductive-age population, according to the American Society for Reproductive Medicine (ASRM). Conventional therapies, such as medication to induce ovulation or surgery to open blocked fallopian tubes, are used to treat 85% to 90% of infertility cases, according to ASRM. Infertility affects males and females in roughly equal numbers. Doctors generally diagnose infertility and initiate diagnostic testing after 1 year of unsuccessful, well-timed attempts at getting pregnant.

Causes
# Contraceptives
# Decreased libido/sexual activity
# Sexual technique problems
# Sex not timed with ovulation
# History of miscarriages
# Mother's use of DES
# Tobacco use
# Excess alcohol consumption
# Recreational drugs
# Prescription drugs (that decrease male potency)
# History of pelvic inflammatory disease
# Thyroid problems
# Excessive exercise

Testing

Basic Testing
# General physical examination for both partners
# Both partners should be checked for sexually transmitted diseases such as chlamydia, syphilis, and gonorrhea.
# Basal body temperature monitoring for women (see below)
# Post sexual intercourse testing on day 12 or 13 of cycle: Cervical mucous should be abundant, clear, and elastic. Also mucous is examined under the microscope.
# Serum progesterone blood level on day 21 of the cycle
# Thyroid function testing

More Advanced Testing
# Hystero-salpingography: Oil dye is injected into uterus and uterus and tubes are evaluated for blockage with x-rays.
# Measure luteinizing hormone and follicle-stimulating hormone levels to determine ovarian function.
# Measure prolactin levels, as abnormal levels may indicate a problem or lack of ovulation.
# Endometrial biopsy to evaluate the lining of the uterus
# Laparoscopy: A scope is passed through belly button to evaluate for endometriosis or tubal adhesions.

Treatment

Specific Causes:
# Timing: Use a basal temperature testing or ovulation predictor kit to predict ideal time to have sexual relations, usually 24 to 48 hours before ovulation.
# Treat cervicitis with antibiotics.
# Treat thyroid problems appropriately.
# Excess exercise: decrease exercise
# Surgical treatment of ovarian tumors, tubal obstruction, tubal adhesions, or endometriosis
# Low progesterone level is an indication the woman is not ovulating on a monthly basis.

General treatments:
# Clomiphene citrate to induce ovulation (5% of pregnancies will result in twins, and rarely multiple births)
# Bromocriptine: treatment for elevated prolactin levels
# In vitro fertilization: Egg and sperm are brought together in the laboratory and then implanted in the uterus. This method is much more expensive than medications such as Clomiphene citrate.

Female Gonorrhea

2008-10-20T04:48:00.002+08:00

Description

Gonorrhea is a curable disease, primarily spread by sexual contact. Gonorrhea is a major cause of pelvic inflammatory disease (PID), infertility, and tubal (ectopic) pregnancy. Gonorrhea may also spread through the blood stream and cause life-threatening illness, or blindness in a newborn that acquires the infection during vaginal delivery. In children, gonorrhea may be the first sign of sexual abuse.

Causes

The Neisseria gonorrhea (N. gonorrhea) bacteria cause gonorrhea. These bacteria grow and multiply quickly in the mucous membranes of the male and female genital tract, the mouth, and the rectum. The cervix and the penile urethra are the most common sites of initial infection. However, throat and rectal infection can occur during oral sex and rectal intercourse, allowing N. gonorrhea to spread to many different tissues.

Symptoms

# Cervicitis (infection of the cervix)
a. Vaginal discharge may or may not be present.
b. Bleeding associated with vaginal intercourse
c. Urinary symptoms, usually more severe in males (see Urethritis below)
# Pelvic inflammatory disease, an infection in the uterus, fallopian tube, ovaries or other areas in the pelvis, that causes severe pelvic pain and tenderness and may lead to permanent scarring of the fallopian tubes and surrounding structures.
# Urethritis
a. Initially: burning on urination, clear or milky penile discharge
b. 2-3 days later: pain in the urethra (tube where urine exits), yellow, creamy penile discharge
# Prostatitis (infection of the prostate)
# Epididymitis (infection of the tubes above the testicles)
# Proctitis (infection of the rectum), sometimes associated with a rectal discharge. Most common in male homosexuals.
# Sore throat from throat infections
# Septicemia (blood infection) leading to disseminated disease (disease in the rest of the body), joint pain and swelling, fever, chills, and a diffuse rash. Meningitis (infection of membranes that surround the brain) may occur.
# Conjunctivitis, an infection of the mucous membrane covering the eyes, is associated with eye pain, redness, and discharge. It occurs when a person with gonorrhea rubs his/her eyes after touching infected body fluids, or in the newborn that has passed through an infected cervix.

Diagnosis

Microscopic examination of the discharge from the male urethra and cervix (females) reveals Gram-negative rod-shaped bacteria inside white blood cells.
DNA probes of urethral or cervical discharge
Culture of throat, rectum, urethra, blood, and joint fluid may grow N. gonorrhea.

Treatment

# Uncomplicated: In many areas, N. gonorrhea is resistant to penicillin, which previously was the drug of choice, so depending on the local sensitivity of N. gonorrhea in your area, one of the following medications will be used:
# Ceftriaxone 250 mg-one injection only
# Oral ciprofloxacin: Some strains of bacteria are resistant to this drug.
# Spectinomycin injection
# Pelvic inflammatory disease: Many treatments are available, for example:
# Cefoxitin
# Clindamycin+gentamicin
# Cefoxitin+ doxycycline
# Chlamydia infections often co-exist with gonorrhea, so treat by adding another antibiotic such as Doxycycline, Erythromycin and/or Azithromycin.
# Check for other sexually transmitted diseases, such as syphilis, hepatitis, and HIV-1 and HIV-2, the viruses associated with AIDS, at time of treatment and 1 and 6 months later, or earlier if sick, since these diseases may take weeks after infection to detect.
# All sexual partners must be located and treated.
# Screen for N. gonorrhea in pregnant women.
# Use of eye drops in the newborn is effective in preventing most N. gonorrhea infections.

Female Genital Prolapse

2008-10-20T04:45:00.002+08:00

Description

# Genital prolapse is an extrusion or herniation of genital mass through the vagina.
# This creates discomfort in walking, as well as causing a feeling of pressure, and sometimes a loss of urine.

# There are three types of female genital hernias: cystocele, rectocele, and enterocele. A cystocele occurs where the bladder wall pushes into the vagina (also known as a dropped bladder). A rectocele occurs when the rectum pushes into the vagina. An enterocele occurs when the small intestine pushes into the vagina. Additionally, an enterocele may be associated with prolapse of the uterus (the uterus pushes down into the vagina). A woman can experience more than one type simultaneously. Women who have had multiple children are at higher risk for developing any or all of these conditions.
# There are three degrees of uterine prolapse. In first-degree prolapse, the cervix remains within the vagina. In second-degree prolapse, the cervix is at or near the introitus. Finally, in third-degree prolapse (procidentia uteri), most or all the uterus lies outside the vaginal opening. Uterine prolapse is always accompanied by some degree of vaginal-wall prolapse.

Causes

# Obstetrical trauma (multiparity, infant weight)
# Congenital weakness of pelvis
# Decreased estrogen levels (e.g., menopause)
# Increased intra-abdominal pressure (e.g., obesity, chronic lung disease, asthma)

Symptoms

# Pelvic pain, heaviness or pressure (experienced in more than 90% of cases)
# Protrusion of tissue (experienced in more than 90% of cases)
# Difficult or painful intercourse
# Lower back pain
# Nausea, constipation
# Difficulty walking
# Urinary difficulty, frequency, urgency, incontinence

Treatment

# High-fiber diet
# Weight reduction
# Pessaries-devices placed inside the vagina to help push herniated (prolapsed) organ back into place
# Corrective surgery