Diabetes Mellitus

Diabetes mellitus is the name given to a group of conditions linked by the patient's inability to produce and/or utilize insulin. A chronic disease of absolute or relative insulin deficiency or resistance, diabetes mellitus is characterized by disturbances in carbohydrate, protein, and fat metabolism. This condition occurs in two forms: type 1, characterized by absolute insulin insufficiency, and type 2, characterized by insulin resistance with varying degrees of insulin secretory defects. Onset of type 1 usually occurs before age 30 (although it may occur at any age); the patient is usually thin and requires exogenous insulin and dietary management to achieve control. Conversely, type 2 usually occurs in obese adults after age 40, although it's commonly seen in North American youths. It's most often treated with diet and exercise (in combination with antidiabetic drugs), although treatment may include insulin therapy. Diabetes mellitus is estimated to affect nearly 8% of the population of the United States (16 million people), about half of whom are undiagnosed. Incidence is equal in men and women and rises with age. Nearly two-thirds of people with diabetes will die of cardiovascular disease. It's also the leading cause of renal failure and new blindness.

Causes
The effects of diabetes mellitus result from insulin deficiency. Insulin transports glucose into the cell for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage. Insulin deficiency compromises the body tissues' access to essential nutrients for fuel and storage. The etiology of both type 1 and type 2 diabetes remains unknown. Genetic factors may playa part in development of all types; autoimmune disease and viral infections may be risk factors in type 1. Other risk factors include the following:
y y

y y

Obesity contributes to the resistance to endogenous insulin. Physiologic or emotional stress can cause prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon, and growth hormone). This raises blood glucose levels, which, in turn, places increased demands on the pancreas. Pregnancy causes weight gain and increases levels of estrogen and placental hormones, which antagonize insulin. Some medications can antagonize the effects of insulin, including thiazide diuretics, adrenal corticosteroids, and oral contraceptives.

Signs and symptoms

Type 1 Symptoms for Type I don't really show up until the destruction of the beta cells is almost complete. The symptoms start to show when the insulin production is almost done, and then they appear rather suddenly. Symptoms include frequent urination, excessive thirst, especially for sweet drinks, extreme hunger along with sudden weight loss, weakness, extreme fatigue, visual changes especially blurred vision, and irritability. Severe cases may have no symptoms, then be diagnosed by a sudden onset of a diabetic coma caused by the extremely high levels of blood sugar. Type II Type II diabetes have very similar symptoms including the frequent urination, unusual thirst, fatigue, blurred vision and weight loss, but they tend to appear more slowly than with Type I. Women may also have frequent vaginal yeast infections, and fungal infections are common in the groin area or under the breasts. Diagnosis The fasting plasma glucose test is the standard and preferred way to diagnose diabetes. Normal fasting plasma glucose levels are less than 110 milligrams per deciliter (mg/dl). If the overnight fasting blood glucose is greater than 126 mg/dl on two different tests on different days, the diagnosis of diabetes mellitus is made. Random blood glucose alone is seldom used because it is not reliable. Other diagnostic and monitoring tests include urinalysis for acetone and blood testing for glycosylated hemoglobin, which reflects glucose control over the past 2 to 3 months.

Treatment
Effective treatment for both types of diabetes normalizes blood glucose and decreases complications. Type 1 diabetes Treatment includes insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multipledose regimens may use an insulin pump. Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente), or a combination of rapid-acting and intermediate-acting (70/30 or 50/50 of NPH and Regular) mixed together. Type 2 diabetes

Patients may require oral anti-diabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis,and delay GI absorption of carbohydrates. Both types Treatment of both types of diabetes requires a diet planned to meet nutritional needs, to control blood glucose levels, and to reach and maintain appropriate body weight. For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently and meals eaten at regular times.
Prevention

Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.

Acute Respiratory Distress Syndrome (ARDS)

Alternative names :- Non-cardiogenic pulmonary edema; Increased-permeability pulmonary edema; Stiff lung; Shock lung; Adult respiratory distress syndrome; Acute respiratory distress syndrome A form of pulmonary edema that causes acute respiratory failure, adult respiratory distress syndrome (ARDS, shock lung, stiff lung) results from increased permeability of the alveolocapillary membrane. Fluid accumulates in the lung interstitium, alveolar spaces, and small airways, causing the lung to stiffen. Effective ventilation is thus impaired, prohibiting adequate oxygenation of pulmonary capillary blood. Severe ARDS can cause intractable and fatal hypoxemia; however, patients who recover may have little or no permanent lung damage.

Causes
ARDS results from a variety of respiratory and nonrespiratory insults, such as:y y y y

aspiration of gastric contents sepsis (primarily gram-negative), trauma (lung contusion, head injury, long bone fracture with fat emboli), or oxygen toxicity. viral, bacterial, or fungal pneumonia or microemboli (fat or air emboli or disseminated intravascular coagulation) drug overdose (barbiturates, glutethimide, narcotics) or blood transfusion

y y y y

smoke or chemical inhalation (nitrous oxide, chlorine, ammonia). hydrocarbon and paraquat ingestion pancreatitis, uremia, or miliary tuberculosis (rare) neardrowning.

Altered permeability of the alveolocapillary membranes causes fluid to accumulate in the interstitial space. If the pulmonary lymphatics can't remove this fluid, interstitial edema develops. The fluid collects in the peribronchial and peribronchiolar spaces, producing bronchiolar narrowing. Hypoxemia occurs as a result of fluid accumulation in alveoli and subsequent alveolar collapse, causing the shunting of blood through nonventilated lung regions. In addition, regional differences in compliance and airway narrowing cause regions of low ventilation and inadequate perfusion, which also contribute to hypoxemia.

Signs and symptoms

y y y

Shortness of breath Labored, rapid breathing Low blood pressure or shock (low blood pressure accompanied by organ failure)

Often, persons affected by ARDS are so sick they are unable to complain of symptoms. Diagnosis On room air, arterial blood gas (ABG) analysis initially shows a decreased (Pao2) - < 60 mm Hg - and a decreased partial pressure of arterial carbon dioxide (Paco2)- < 35 mm Hg. The resulting pH usually reflects respiratory alkalosis. As ARDS becomes more severe, ABG values indicate respiratory acidosis (a Paco2 > 45 mm Hg) and metabolic acidosis (a bicarbonate level < 22 mEq/L) as well as a decreasing Pao2 despite oxygen therapy.
y

Pulmonary artery (PA) catheterization helps identify the cause of pulmonary edema by evaluating PA wedge pressure (PAWP); allows collection of PA blood, which shows decreased oxygen saturation, reflecting tissue hypoxia; measures PA pressure; and measures cardiac output by thermodilution techniques. Serial chest X-rays initially show bilateral infiltrates; in later stages, groundglass appearance and, eventually (as hypoxemia becomes irreversible), "whiteouts" of both lung fields.

A differential diagnosis must rule out cardiogenic pulmonary edema, pulmonary vasculitis, and diffuse pulmonary hemorrhage. To establish the cause, laboratory work should include a sputum Gram stain, culture and sensitivity tests, and blood cultures to detect infections; a toxicology screen for drug ingestion; and, when pancreatitis is a consideration, a serum amylase determination.

Treatment

When possible, treatment is designed to correct the underlying cause of ARDS and to prevent progression and potentially fatal complications of hypoxemia and respiratory acidosis. Supportive medical care consists of administering humidified oxygen by a tight-fitting mask, which allows for the use of continuous positive airway pressure. Hypoxemia that doesn't respond adequately to these measures requires ventilatory support with intubation, volume ventilation, and positive end-expiratory pressure (PEEP). Other supportive measures include fluid restriction, diuretics, and the correction of electrolyte and acidbase abnormalities.
Special considerations y

y y y y y

Frequently assess the patient's respiratory status. Be alert for retractions on inspiration. Note rate, rhythm, and depth of respirations, and watch for dyspnea and the use of accessory muscles of respiration. On auscultation, listen for adventitious or diminished breath sounds. Check for clear, frothy sputum that may indicate pulmonary edema. Observe and document the hypoxemic patient's neurologic status (level of consciousness, mental sluggishness). Maintain a patent airway by suctioning, using sterile, nontraumatic technique. Ensure adequate humidification to help liquefy tenacious secretions. Closely monitor heart rate and blood pressure. Watch for arrhythmias that may result from hypoxemia, acid-base disturbances, or electrolyte imbalance. Reposition the patient often and note any increase in secretions, temperature, or hypotension that may indicate a deteriorating condition. Perform passive range-of-motion exercises, or help the patient perform active exercises, if possible. Provide meticulous skin care. Allow periods of uninterrupted sleep.

Expectations (prognosis) The death rate in ARDS is approximately 20-30%. Although survivors may recover normal lung function, many individuals suffer permanent lung damage, which can range from mild to severe. Many people who survive ARDS suffer memory loss or other problems with thinking after they recover. This is related to brain damage caused by reduced access to oxygen while the lungs were malfunctioning.

Anemia Related To Exercise

A decreased number of circulating red blood cells, or insufficient hemoglobin in the cells, caused from participation in exercise. Anemia is also a symptom of other disorders, and may interfere with athletic performance. For proper treatment, the cause must be found.

Causes

y y y y y y y

Participation in exercise such as prolonged, walking, running or cross- country skiing. The forces exerted on the red blood cells in the capillaries of the feet may rupture the blood cells and lead to anemia. Other heavy physical exercise and exertion. Heavy menstrual bleeding. Pregnancy. Malabsorption of iron from food. Profuse sweating. Age over 60. Recent illness with bleeding, such as an ulcer, diverticulitis, colitis, hemorrhoids or gastrointestinal tumor.

Signs and symptoms

Sign of pronounced anemia:
y y y

Decreased performance in maximum-effort activities. Tiredness and weakness. Paleness, especially in the hands and lining of the lower eyelids.

Less common signs:

y y y y y

Tongue Inflammation. Fainting. Breathlessness. Excessively rapid heartbeat with exercise. Appetite loss.

Diagnosis
y y y

Your own observation of symptoms. Medical history and exam by a doctor. Laboratory blood studies every 2 months while involved in vigorous physical activity. Test should include studies of hemoglobin (see, Glossary), hemoglobin and red-bloodcell counts. X-rays of the gastrointestinal tract.

Treatment
Your doctor may prescribe iron supplements:
y y y

Take iron on an empty stomach (at least 1/2 hour before meals) for best absorption. If it upsets your stomach, you may take it with a small amount of food (except milk). If you take other medications, wait at least 2 hours after taking iron before taking them. Antacids and tetracycline especially interfere with iron absorption. Continue iron supplements until 2 to 3 months after blood tests return to normal.

Too much iron is dangerous. A bottle of iron tablets can poison a child. Keep iron supplements out of the reach of children.

Prevention y

Maintain an adequate iron intake by eating a well-balanced diet or taking iron supplements.

Alzheimer's Disease - Causes, Symptoms And Treatment

Also known as primary degenerative dementia, Alzheimer's disease accounts for over half of all dementia's. An estimated 5% of people over age 65 have a severe form of this disease, and 12% suffer from mild to moderate dementia. Because this is a primary progressive dementia, the prognosis for a patient with this disease is poor.

Causes
Alzheimer's disease is thought to be related to several causal factors. They include neurochemical factors, such as deficiencies in acetylcholine (a neurotransmitter), somatostatin, substance P, and norepinephrine; environmental factors, such as aluminum and manganese; viral factors, such as slow-growing central nervous system viruses; trauma; and genetic immunologic factors. The brain tissue of patients with Alzheimer's disease has three hallmark features: neurofibrillary tangles, neuritic plaques, and granulovascular degeneration.

Signs and symptoms

Onset is insidious. Initially, the patient experiences almost imperceptible changes, such as forgetfulness, recent memory loss, difficulty learning and remembering new information, deterioration in personal hygiene and appearance, and an inability to concentrate. Gradually, tasks that require abstract thinking and activities that require judgment become more difficult. Progressive and severe deterioration in memory, language, and motor function results in a loss of coordination and an inability to write or speak. Personality changes (restlessness, irritability) and nocturnal awakenings are common. Eventually, the patient becomes disoriented, and emotional liability and physical and intellectual disability progress. The patient becomes very susceptible to infection and accidents. Secondary to loss of the cough reflex, pulmonary diseases such as pneumonia may result in death.

Diagnosis Early diagnosis of Alzheimer's disease is difficult because the patient's signs and symptoms are subtle. A positive diagnosis is based on an accurate history from a reliable family member, mental status and neurologic examinations, and psychometric testing. A positron emission tomography scan measures the metabolic activity of the cerebral cortex and may help in reaching an early diagnosis. An EEG and a computed tomography scan may help in later diagnosis. Currently, the disease is diagnosed by exclusion: Various tests are performed to rule out other disorders. It can't be confirmed until death, when an autopsy reveals pathologic findings. CLINICAL TIP Many researchers believe that the aluminum and silicon found in neurofibrillary tangles and neuritic plaques occurs as a result of damage and isn't a cause.

Treatment
Cerebral vasodilators, such as ergoloid mesylates, isoxsuprine, and cyclandelate, are prescribed to enhance the brain's circulation; hyperbaric oxygen, to increase oxygenation to the brain; psychostimulators such as methylphenidate, to enhance the patient's mood; and antidepressants, if depression seems to exacerbate the patient's dementia. Tacrine, a centrally acting anticholinesterase agent, is given to treat memory deficits. Most drug therapies currently being used are experimental. These include choline salts, lecithin, physostigmine, deanol, enkephalins, and naloxone, which may slow the disease process. Another approach to treatment includes avoiding the use of antacids containing aluminum, aluminum cooking utensils, and aluminumcontaining deodorants to help decrease aluminum intake.
Special considerations y y y

Focus on supporting the patient's abilities and compensating for those abilities he has lost. Establish an effective communication system with the patient and his family to help them adjust to the patient's altered cognitive abilities. Offer emotional support to the patient and his family. Teach them about the disease, and refer them to social service and community resources for legal and financial advice and support. Provide the patient with a safe environment. Encourage him to exercise to help maintain mobility.

Asthma

Asthma is a very common disorder with an estimated four to five percent of the population being affected. It is perhaps the only common treatable condition that is increasing in terms of prevalence, severity and mortality, especially in children. Asthma is a chronic inflammatory condition of the airways. In susceptible individuals this inflammation causes recurrent episodes of coughing, wheezing, chest tightness, and difficult breathing. Inflammation makes the airways sensitive to stimuli such as, chemical irritant, tobacco smoke, cold air, or exercise. When exposed to these stimuli, the airways may become swollen, constricted, filled with mucus, and hypersensitive to stimuli. The inflammation causes associated increase in existing airway hyper responsiveness to variety of cold air and virus. Exposure of patients to these stimuli provokes a variety of changes in airways including broncho constriction, airway oedema, chronic mucus plug formation and airway remodelling. The recurrent episodes of wheezing, breathlessness, chest tightness and coughing experienced by patient with asthma, particularly at night and in early morning, is usually associated with airflow obstruction. Asthma attacks all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day. This condition is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs. Asthma, technically called bronchial asthma, is a disease of the bronchial tubes that lead from the windpipe, or trachea, into the lungs. The bronchial tubes ordinarily do not furnish any marked resistance to the entrance or exit of air. However, in asthmatic attacks, the bronchial tubes tend to close down, causing asthmatic wheezing. In severe attack, the sufferer seems almost to be suffocating. He apparently uses all his strength just trying to breathe. He becomes pale and bluish and often perspires. Fortunately, most attacks are mild and do not last long. Many of them can be prevented or stopped by medical treatment. Bronchial asthma is a chronic illness marked by these attacks. In severe cases, the bronchial tubes become swollen and ofter greater resistance to treatment. Plugs of clinging mucus may form in the tubes and cause chronic irritation and coughing. They are dislodged and brought up as sputum. If the attacks are frequent, prolonged, and severe, the lung tissue is damaged. This puts a strain on the heart. The average case of asthma is mild and more of a recurrent nuisance than a threat to health. It is always essential to get and follow competent medical advice, especially in the cases of young persons, before asthma can damage the heart or lungs. The resulting airflow limitation is reversible, either spontaneously or with treatment; when asthma therapy is adequate, inflammation can be reduced over the long term, symptoms can usually be controlled, and most asthma related problems prevented.

Asthma & Exercise-Induced Bronchospasm (Eib)

A chronic breathing disorder characterized by recurrent attacks of wheezing and shortness of breath. It affects many people who exercise regularly. Exercise-induced bronchospasm (also called EIB) happens when the airways in your lungs shrink (get smaller) while you are exercising. If you have EIB, it can be hard for you to exercise for more than 30 minutes at a time.

Causes
Spasm of air passages (bronchi and bronchioles) followed by swelling of the passages and thickening of lung secretions (sputum). This decreases or closes off air to the lungs. These changes are caused by:
y y y

y y y y y

Allergens, such as some medications, pollen, dust, animal dander, molds and some foods. Air irritants, such as smoke, smog and odors. Exercise, especially exercise in smoggy or cold air. Bronchospasm can occur within minutes while exercising in cool air. Warm, humid air seldom triggers exercise-induced bronchospasm. Lung infections such as bronchitis. Stress. Family history of asthma or allergies Smoking. Use of drugs to which you are allergic, such as aspirin.

Signs and symptoms

y y y y y

Chest tightness and shortness of breath. Wheezing when exhaling. Coughing, especially at night, with little sputum. Rapid, shallow breathing that is easier with sitting up. Breathing difficulty- neck muscles tighten.

Severe late symptoms:

y y y y y

Bluish skin. Exhaustion. Grunting respiration. Inability to speak. Mental changes, including restlessness, confusion or delirium.

Diagnosis
y y y y

Your own observation of symptoms. Medical history and exam by a doctor. Laboratory blood studies and pulmonary-function test. Chest X-rays.

Treatment
Medical Treatment
y y y

Emergency- room care and hospitalization for severe attacks. Psychotherapy or counseling, if asthma stress-related. A short-acting bronchodilator, such as albuterol (some brand names: AccuNeb, Proventil, Ventolin), pirbuterol (brand name: Maxair) and terbutaline (one brand name: Brethine). These medications are usually taken 15 minutes before exercise and last 4 to 6 hours. Your doctor will tell you how to take your medicine. It is important to follow your doctor's instructions carefully to make sure your medicine is effective.

Home Treatment
y y y y

Eliminate allergens and irritants at home and at work, if possible. Keep regular medications with you at all times. Ask your doctor about having emergency drugs available. Sit upright during attacks. Avoiding exercise in extremely cold temperatures or when pollen levels are high may also help reduce your symptoms.

Medication Your doctor may prescribe:

y y y y

Expectorants to loosen sputum. Bronchodilators to open air passages. Corticosteroid drugs by nebulizer, which have fewer adverse reactions than oral forms. Cromolyn sodium by nebulizer. This is a preventive drug.

Prevention y y y y

Avoid known allergens and air pollutants. Take prescribed preventive medicines regularly-don't omit them when you feel well. Reduce activity level (sometimes). Exercise indoors on smoggy or cold days.

Cardiac Arrhythmias
Abnormal electrical conduction or automaticity changes heart rate and rhythm in cardiac arrhythmias, also called cardiac dysrhythmias. Cardiac dysrhythmia is technically more correct, as arrhythmia would imply that there is "no rhythm," but this term is not used frequently. Arrhythmias vary in severity, from those that are mild, asymptomatic, and require no treatment (such as sinus arrhythmia, in which the heart rate increases and decreases with respirations) to catastrophic ventricular fibrillation, which necessitates immediate resuscitation. Arrhythmias are generally classified according to their origin (ventricular or supraventricular). Their effect on cardiac output and blood pressure, partially influenced by the site of origin, determines their clinical significance.

Causes
Arrhythmias may be congenital or they may result from one of several factors, including myocardial ischemia, myocardial infarction, and organic heart disease. Drug toxicity or degeneration of the conductive tissue necessary to maintain normal heart rhythm (sick sinus syndrome) sometimes can also precipitate arrhythmias.

Signs and symptoms

Most arrhythmia does not result in symptoms, but people may experience anxiety , lightheadedness, dizziness, fainting, unusual awareness of the heartbeat, and sensations of fluttering or pounding in the chest.

Diagnosis
Cardiac dysrhythmias are often first detected by simple but nonspecific means: auscultation of the heartbeat with a stethoscope , or feeling for peripheral pulses . These cannot usually diagnose specific dysrhythmias, but can give a general indication of the heart rate and whether it is regular or irregular. Not all the electrical impulses of the heart produce audible or palpable beats; in many cardiac arrhythmias, the premature or abnormal beats do not produce an effective pumping action and are experienced as "skipped" beats. The simplest specific diagnostic test for assessment of heart rhythm is the electrocardiogram (abbreviated ECG or EKG ). A Holter monitor is an ECG recorded over a 24-hour period, to detect dysrhythmias that may happen briefly and unpredictably throughout the day.

Types of cardiac arrhythmias

Following are the different types of cardiac arrhythmias:

1. Atrial fibrillation: The heart beats too fast and irregularly. This type of arrhythmia requires treatment and can increase risk of stroke. 2. Paroxysmal atrial tachycardia: The heart has episodes when it beats fast, but regularly. This type of arrhythmia may be unpleasant but is usually not dangerous. 3. Ectopic beats: The heart has an extra beat. Treatment usually is not needed unless you have several extra beats in row and/or other problems with your heart - such as heart disease or congenital heart failure. 4. Ventricular tachycardia: The heart beats too fast and may not pump enough blood. These types of arrhythmias are very dangerous and need immediate treatment. 5. Bradycardia: It is defined as a slow heart rhythm. It is generally divided into 2 categories, sick sinus syndrome or heart block. These slow heart rhythms are usually treated by the implantation of a permanent pacemaker, which takes over the work of the hearts normal pacemaker.

Treatment for cardiac arrhythmia

The pharmacological treatments consist of agents that interfere with sodium, pottasium, and calcium pump systems, which are used by the heart to control heart rate. These agents tend to result in longer times between each impulse, by prolonging repolarisation (the heart cells pump Na+ across their membranes during a contraction, and then pump Na+ back in ready for another contraction, this is called repolarisation). Surgery: Can correct certain types of arrhythmias. For example, arrhythmias caused by coronary artery disease may be controlled by bypass surgery. When an cardiac arrhythmia is causes by a certain area of the heart, sometimes that part of the heart can be destroyed or removed. Electrical "shock" (defibrillation or cardioversion), the implantation of a temporary pacemaker to interrupt the arrhythmia, or antiarrhythmic drugs may be used.
Prevention y y y y y

Maintaining a healthy weight. Avoiding or limiting the intake of caffeine, alcohol, and other substances that may contribute to arrhythmias or heart disease. Having regular check ups. Avoiding unnecessary stress, such as anger, anxiety or fear, and finding ways to manage or control stressful situations that cannot be avoided. Exercising regularly and eating a healthy, low-fat diet with plenty of vegetables, fruits, and other vitamin-rich foods are the cornerstones of "heart healthy" living.

Chronic Constipation
Also known as lazy colon, colonic stasis, colonic inertia, and atonic constipation, chronic constipation may lead to fecal impaction if left untreated. It's common in elderly and disabled people because of their inactivity and is often relieved with diet and exercise. Constipation is a symptom, not a disease. Almost everyone experiences constipation at some point in their life, and a poor diet typically is the cause. Most constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

Causes
Chronic constipation usually results from some deficiency in the three elements necessary for normal bowel activity: dietary bulk, fluid intake, and exercise. Other possible causes can include habitual disregard of the impulse to defecate, emotional conflicts, chronic use of laxatives, or prolonged dependence on enemas, which dull rectal sensitivity to the presence of stool.

Signs and symptoms

The symptoms of constipation include:
y y y y y y y

Needing to open the bowels less often than usual Hard, dry stools that may be painful to pass Straining to pass the motion Having to sit on the toilet for much longer than usual The sensation afterwards that the bowel hasn't fully emptied Bloated abdomen Abdominal cramps.

Diagnosis A patient history of dry, hard stool and infrequent bowel movements suggests chronic constipation due to inactive colon. A digital rectal examination reveals stool in the lower portion of the rectum and a palpable colon.

Analoscopy may show an unusually small colon lumen, prominent veins, and an abnormal amount of mucus. Diagnostic tests to rule out other causes include an upper GI series, barium enema, and examination of stool for occult blood from neoplasms. Colonoscopy may be performed for inactive colon. Manometric studies may also be done to exclude Hirschsprung's disease as well as evaluation of internal and external sphincters.

Treatment
Effective treatment varies with the patient's age and condition. A diet higher in fiber, sufficient exercise, and increased fluid intake often relieve constipation. Treatment for severe constipation may include bulkforming laxatives, such as psyllium, or well-lubricated glycerin suppositories; for fecal impaction, manual removal of stool is necessary. Administration of an oilretention enema usually precedes stool removal; an enema is also necessary afterward. For lasting relief of constipation, the patient with inactive colon must modify his bowel habits. Dietary changes Increasing the amount of fibre in the daily diet. Good sources of fibre include wholegrain cereals, fruits, vegetables and legumes. The intake of foods such as milk, cheese, white rice, white flour and red meat should be restricted, because they tend to contribute to constipation.
Prevention y y

y y

A well-balanced diet high in fibre , including bran, fruits and vegetables, is often helpful. Drinking at least 8 to 10 glasses of water a day. Hot beverages, such as coffee, tea or hot water may stimulate bowel movements. Regular exercise improves digestion and reduces stress . Eat a normal breakfast

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) - also called chronic obstructive lung disease results from emphysema, chronic bronchitis, asthma, or any combination of these disorders. Usually, more than one of these underlying conditions coexist; most often, bronchitis and emphysema occur together. About 14 million people in the United States have COPD. The disease develops over many years. It is almost always caused by cigarette smoking. The best way prevent or keep COPD from getting worse is to quit smoking.

Causes
Predisposing factors include cigarette smoking, recurrent or chronic respiratory tract infections, air pollution, and allergies. Familial and hereditary factors (for example, deficiency of alphalantitrypsin) may also predispose a person to COPD. Smoking is by far the most important of these factors; it impairs ciliary action and macrophage function and causes inflammation in airways, increased mucus production, destruction of alveolar septae, and peribronchiolar fibrosis. Early inflammatory changes may reverse if the patient stops smoking before lung destruction is extensive.

Signs and symptoms

y y y y

Shortness of breath ( dyspnea ) persisting for months to years Wheezing Decreased exercise tolerance Cough with or without phlegm

Diagnosis The diagnostic process for COPD includes a thorough medical history as well as one or more of the following diagnostic procedures.
y y y y y

Pulmonary Function Tests Oximetry Radiological Procedures Arterial Blood Gases Alpha-1-Antitrypsin Level

Treatment

The main goal of treatment is to relieve symptoms and prevent complications. Bronchodilators can help alleviate bronchospasm and enhance mucociliary clearance of secretions. Effective coughing, postural drainage, and chest physiotherapy can help mobilize secretions. Administration of low concentrations of oxygen helps relieve symptoms; arterial blood gas analysis determines oxygen need and helps avoid carbon dioxide narcosis. Antibiotics allow treatment of respiratory tract infections. Pneumococcal vaccination and annual influenza vaccinations are important preventive measures.
Prevention

Avoidance of smoking prevents COPD. Early recognition and treatment of small airway disease in people who smoke, combined with smoking cessation, may prevent progression of the disease. Sound nutrition, including vitamin supplementation, may help to prevent emphysema. Special attention should be given to the intake of antioxidants to prevent the breakdown of functional lung tissue by free radicals. Regular aerobic exercise builds up lung capacity and helps cleanse the lungs of stale air. Walking is an excellent choice, if one avoids polluted areas. Unproven preventive measures often recommended by doctors include yearly pneumonia and influenza vaccinations.

Colon, Irritable
An irritative and inflammatory disorder involving the large and small intestines. It is not contagious, inherited or cancerous-but it probably is stress-related. Flare-ups may be triggered by approaching competitive events.

Causes
y y y y y y y y y y

Stress and emotional conflict prior to athletic competition, resulting in anxiety or depression. Obsessive worry about everyday problems or about self-image. Concern about performance. Marital tension. Fear of loss of a beloved person or object. Death of a loved one. Improper diet. Symptoms may be triggered by eating, though no specific food has been identified as responsible. Smoking. Excess alcohol consumption. Use of drugs.

y y

Fatigue or overwork. Poor physical fitness.

Signs and symptoms

The following symptoms usually begin in early adult life. Episodes may last for days, weeks or months:
y y y y y y y y y

Cramp like pain in the middle or to one side of the lower abdomen. Pain is usually relieved with a bowel movement. Nausea. Bloating and gas. Occasional appetite loss that may lead to weight loss. Diarrhea or constipation, usually alternating. Fatigue. Depression. Anxiety. Concentration difficulty.

Diagnosis
y y y y

Your own observation of symptoms. Medical history and physical exam by a doctor. Laboratory studies, including stool studies, to exclude other disorders such as lactose intolerance, ulcers, parasites, enzyme deficiency and ulcerative colitis. X-ray of the colon (barium enema).

Treatment
Medical Treatmenty y y y y

Medication. Counseling with a trained therapist to define, confront and solve conflicts in day-to-day living. Anxiety-reducing measures, such as regular exercise Low-dose antidepressants Anti-diarrheal medications

Home Treatment
y y

Diet changes. Adequate rest.

Medication

y y y

Medication can help symptoms, but it cannot cure this disorder. Your doctor may prescribe: Antispasmodics to relieve severe abdominal cramps. Tranquilizers to reduce anxiety.

Prevention

Reduce stress or try to modify your response to it. An exercise program without competition may protect against flare-ups because it reduces stress.

Colorectal Cancer
Colorectal cancer , also called colon cancer or bowel cancer , includes cancerous growths in the colon , rectum and appendix . It is the third most common form of cancer and in the United States and Europe, colorectal cancer is the second most common visceral neoplasm. Incidence is equally distributed between men and women. Colorectal malignant tumors are almost always adenocarcinomas. About half of these are sessile lesions of the rectosigmoid area; the rest are polypoid lesions. Many colorectal cancers are thought to arise from adenomatous polyps in the colon. These mushroom-like growths are usually benign, but some may develop into cancer over time. The majority of the time, the diagnosis of localized colon cancer is through colonoscopy. Therapy is usually through surgery, which in many cases is followed by chemotherapy .

Causes
The exact cause of colorectal cancer is unknown, but studies showing concentration in areas of higher economic development suggest a relation to diet (excess animal fat, particularly beef, and low fiber). Other factors that magnify the risk of developing colorectal cancer include:
y y y y

other diseases of the digestive tract . age (over 40) . history of ulcerative colitis (the average interval before onset of cancer is 11 to 17 years) . familial polyposis (cancer almost always develops by age 50).

Signs and symptoms

With proper screening, colon cancer should be detected BEFORE the development of symptoms, when it is most curable.

Most cases of colon cancer have no symptoms. The following symptoms, however, may indicate colon cancer:
y y y y y y y

Diarrhea , constipation, or other change in bowel habits that does not resolve Blood in the stool Unexplained anemia (anemia in any adult who is not a menstruating woman should almost always be evaluated by a colonoscopy) Abdominal pain and tenderness in the lower abdomen Intestinal obstruction Weight loss with no known reason Stools narrower than usual

Diagnosis Only a tumor biopsy can verify colorectal cancer, but the following tests help detect it:
y y y y y y

Digital examination can detect almost 15% of colorectal cancers. Hemoccult test (guaiac) can detect blood in stool. Proctoscopy or sigmoidoscopy can detect up to 66% of colorectal cancers. Colonoscopy permits visual inspection (and photographs) of the colon up to the ileocecal valve and gives access for polypectomies and biopsies of suspected lesions. Computed tomography scan helps to detect areas affected by metastasis. Barium X-ray, utilizing a dual contrast with air, can locate lesions that are undetectable manually or visually. Barium examination should follow endoscopy or excretory urography because the barium sulfate interferes with these tests. Carcinoembryonic antigen, although not specific or sensitive enough for an early diagnosis, is helpful in monitoring patients before and after treatment to detect metastasis or recurrence.

Treatment
The most effective treatment for colorectal cancer is surgery to remove the malignant tumor and adjacent tissues as well as any lymph nodes that may contain cancer cells. The type of surgery depends on the location of the tumor:
y

y y y

Cecum and ascending colon: A right hemicolectomy (for advanced disease) is performed. It may include resection of the terminal segment of the ileum, cecum, ascending colon, and the right half of the transverse colon with corresponding mesentery. Proximal and middle transverse colon: A right colectomy is performed that includes the transverse colon and mesentery corresponding to midcolic vessels or segmental resection of the transverse colon and associated midcolic vessels. Sigmoid colon: Surgery is typically limited to the sigmoid colon and mesentery. Upper rectum: Anterior or low anterior resection is performed. A newer method, using a stapler, allows for resections much lower than were previously possible. Lower rectum: Abdominoperineal resection and permanent sigmoid colostomy is performed.

Chemotherapy is indicated for patients with metastasis, residual disease, or a recurrent inoperable tumor. Drugs used in such treatment commonly include fluorouracil with levamisole, leucovorin, methotrexate, or streptozocin. Patients whose tumor has extended to regional lymph nodes may receive fluorouracil and levamisole for 1 year postoperatively. Radiation therapy induces tumor regression and may be used before or after surgery or combined with chemotherapy, especially fluorouracil.
Prevention

Unfortunately, colon cancers can be well advanced before they are detected. The most effective prevention of colon cancer is early detection and removal of precancerous colon polyps before they turn cancerous. If you are over age 50 talk to your doctor about your risks of colorectal cancer, and about what screening tests are appropriate. If screening tests do find polyps, have them removed promptly, to reduce the risk of cancer. Dietary and lifestyle modifications are important. Some evidence suggests that low-fat and highfiber diets may reduce your risk of colon cancer. However, even patients who follow strict diets can develop this disease and require colonoscopy.

Allergic, Bacterial & Viral Conjunctivitis Treatment

Conjunctivitis is one of the most common and treatable eye infections in children and adults. Often called "pink eye," it is an inflammation of the conjunctiva, the tissue that lines the inside of the eyelid. This tissue helps keep the eyelid and eyeball moist. Hyperemia of the conjunctiva from infection, allergy, or chemical reactions characterizes conjunctivitis. Bacterial and viral conjunctivitis are highly contagious but are also self-limiting after two weeks duration. Chronic conjunctivitis may result in degenerative changes to the eyelids. In the Western hemisphere, conjunctivitis is probably the most common eye disorder.

Causes
Conjunctivitis may be triggered by a virus, bacteria, an allergic reaction (to dust, pollen, smoke, fumes or chemicals) or, in the case of giant papillary conjunctivitis, a foreign body on the eye, typically a contact lens. Bacterial and viral systemic infections also may induce conjunctivitis.

Signs and symptoms

y y y y y y

Redness in the white of the eye or inner eyelid Crusts that form on the eyelid overnight Gritty feeling in the eyes Increased tearing Blurred vision Thick yellow discharge that crusts over the eyelashes, especially after sleep (in conjunctivitis caused by bacteria)

Diagnosis Physical examination reveals injection of the bulbar conjunctival vessels. In children, possible systemic symptoms include sore throat and fever. Monocytes are predominant in stained smears of conjunctival scrapings if conjunctivitis is caused by a virus. Polymorphonuclear cells (neutrophils) predominate if conjunctivitis stems from bacteria; eosinophils, if it's allergy related. Culture and sensitivity tests identify the causative bacterial organism and indicate appropriate antibiotic therapy.

Treatment
The cause of conjunctivitis dictates the treatment. Bacterial conjunctivitis requires topical application of the appropriate antibiotic or sulfonamide. Although viral conjunctivitis resists treatment, broad-spectrum antibiotic eye drops may prevent secondary infection. Herpes simplex infection generally responds to treatment with trifluridine drops, vidarabine ointment, or oral acyclovir, but the infection may persist for 2 to 3 weeks. Treatment of vernal (allergic) conjunctivitis includes administration of corticosteroid drops followed by lodoxamide tromethamine (Alomide), a histamine -antagonist, cold compresses to relieve itching and, occasionally, oral antihistamines. Instillation of a one-time dose of erythromycin into the eyes of newborns prevents gonococcal and chlamydial conjunctivitis.
Prevention y

y y

Teach proper hand-washing technique because some forms of conjunctivitis are highly contagious. Stress the risk of spreading infection to family members by sharing washcloths, towels, and pillows. Warn against rubbing the infected eye, which can spread the infection to the other eye and to other persons. Don't touch or rub the infected eye(s). Apply warm compresses and therapeutic ointment or drops. Don't irrigate the eye; this will only spread infection. Have the patient wash his hands before he uses the medication, and use clean washcloths or towels frequently so he doesn't infect his other eye. Wash your hands after applying the eye drops or ointment to your eye or your child's eye.

y y y

Avoid wearing eye makeup. Wear glasses instead of contact lenses. Throw away disposable lenses or be sure to clean extended wear lenses and all eyewear cases. Do not share towels or handkerchiefs.

Coronary Artery Disease (CAD)

Coronary artery disease (CAD) is one of the most common forms of heart disease and a leading cause of death of both men and women in Canada. The dominant effect of coronary artery disease (CAD) is the loss of oxygen and nutrients to myocardial tissue because of diminished coronary blood flow. This disease is near epidemic in the Western world. CAD occurs more often in men than in women, in whites, and in middle-aged and elderly people. In the past, this disorder rarely affected women who were premenopausal; however, that's no longer the case, perhaps because many women now take oral contraceptives, smoke cigarettes, and are employed in stressful jobs that used to be held exclusively

Causes
Both men and women can get CAD. It can be hereditary (run in your family). It might also develop as you get older and plaque builds up in your arteries over the years. You may get CAD if you are overweight or if you have high blood pressure or diabetes. High cholesterol may also lead to CAD . CAD can stem from making unhealthy choices such as smoking, eating a high-fat diet and not exercising enough. Uncommon causes of reduced coronary artery blood flow include dissecting aneurysms, infectious vasculitis, syphilis, and congenital defects in the coronary vascular system. Coronary artery spasms may also impede blood flow.

Signs and symptoms

The classic symptom of CAD is angina, the direct result of inadequate flow of oxygen to the myocardium. It's usually described as a burning, squeezing, or tight feeling in the substernal or precordial chest that may radiate to the left arm, neck, jaw, or shoulder blade. Typically, the patient clenches his fist over his chest or rubs his left arm when describing the pain, which may be accompanied by nausea, vomiting, fainting, sweating, and cool extremities. Anginal episodes most often follow physical exertion but may also follow emotional excitement, exposure to cold, or a large meal. Angina has three major forms:

y y y

Stable angina causes pain that's predictable in frequency and duration and can be relieved with nitrates and rest. Unstable angina causes pain that increases in frequency and duration. It's more easily induced. Prinzmetal's angina causes unpredictable coronary artery spasm.

Severe and prolonged anginal pain generally suggests MI, with potentially fatal arrhythmias and mechanical failure. Diagnosis The patient history - including the frequency and duration of angina and the presence of associated risk factors-is crucial in evaluating CAD. Additional diagnostic measures include the following:
y

y y y

Electrocardiography (ECG) during angina may show ischemia or may be normal; it may also show arrhythmias, such as premature ventricular contractions. The ECG is apt to be normal when the patient is pain-free. Treadmill or bicycle exercise test may provoke chest pain and ECG signs of myocardial ischemia (ST-segment depression). Coronary angiography reveals narrowing or occlusion of the coronary artery, with possible collateral circulation. Myocardial perfusion imaging with thallium-201 or cardiolite during treadmill exercise detects ischemic areas of the myocardium, visualized as "cold spots."

Treatment
The goal of treatment in patients with angina is to either reduce myocardial oxygen demand or increase oxygen supply. Therapy consists primarily of nitrates, such as nitroglycerin (given sublingually, orally, transdermally, or topically in ointment form), isosorbide dinitrate (given sublingually or orally), beta-adrenergic blockers (given orally), or calcium channel blockers (given orally). Obstructive lesions may necessitate coronary artery bypass surgery and the use of vein grafts. Angioplasty may be performed during cardiac catheterization to compress fatty deposits and relieve occlusion in patients with no calcification and partial occlusion. A certain risk is associated with this procedure, but its morbidity is lower than that for surgery. Percutaneous transluminal coronary angioplasty may be done in combination with coronary stenting. Stents provide a framework to hold an artery open by securing flaps of tunica media and intima against the artery wall. Lifestyle changes Although great advances have been made in treating coronary artery disease, changing your habits remains the single most effective way to stop the disease from progressing. Here are the most beneficial changes you can make:

y y y

Don't smoke. Smoking is a major risk factor for coronary artery disease. Quitting smoking dramatically lowers your risk of a first or second heart attack. Exercise regularly. Eating less fat should also help you lose weight. If you're overweight, losing weight can help you further lower blood cholesterol. Eating a diet rich in fruits and vegetables and having at least one to two servings of fish a week also can reduce your risk of a heart attack.

Prevention

Because CAD is so widespread, prevention is of incalculable importance. Dietary restrictions aimed at reducing intake of calories (in obesity) and of dietary fats and cholesterol serve to minimize the risk, especially when supplemented with regular exercise. Abstention from smoking and reduction of stress are also beneficial. Other preventive actions include control of hypertension (with sympathetic blocking agents, such as methyldopa and propranolol, or diuretics, such as hydrochlorothiazide), control of elevated serum cholesterol or triglyceride levels (with antilipemics, such as HMG-reductase inhibitors like cerivastatin sodium (Baycol), atorvastatin calcium (Lipitor), pravastatin sodium (Pravachol), or simvastatin (Zocor), and measures to minimize platelet aggregation and the danger of blood clots (with aspirin).

Home :: Dehydration

Dehydration - Symptoms & Treatment

Dehydration can be defined as "the excessive loss of water from the body." Diseases of the gastrointestinal tract can lead to dehydration in various ways. Often, dehydration becomes the major problem in an otherwise self-limited illness. Fluid loss may even be severe enough to become life-threatening. Loss of water and essential body salts due to excessive sweating during exercise, particularly in hot, humid weather. Dehydration can occur at any age, but it is most dangerous for babies, small children, and older adults.

Causes
y y y y y y y

Heavy sweating. Persistent vomiting or diarrhea from any cause. Use of drugs that deplete fluids and electrolytes, such as diuretics ("water pills"). Overexposure to sun or heat. Age over 60. Recent illness with high fever. Chronic kidney disease.

Signs and symptoms

y y y y y y y y y y y y

Dry mouth Excessive thirst Decreased or absent urination Sunken eyes Headache Wrinkled skin Confusion Low blood pressure Coma Fever Lack of sweating Muscle weakness

Diagnosis
y y y y

Your own observation of symptoms. Medical history and physical exam by a doctor. Laboratory blood studies, including blood counts and electrolyte measurement. If it's not obvious why you're dehydrated, your doctor may order additional tests to check for diabetes and for liver or kidney problems.

Treatment
Drinking fluids is usually sufficient for mild dehydration. It is better to have frequent, small amounts of fluid (using a teaspoon or syringe for an infant or child) rather than trying to force large amounts of fluid at one time. Drinking too much fluid at once can bring on more vomiting. Electrolyte solutions or freezer pops are especially effective. These are available at pharmacies. Sport drinks contain a lot of sugar and can cause or worsen diarrhea. In infants and children, avoid using water as the primary replacement fluid. Intravenous fluids and hospitalization may be necessary for moderate to severe dehydration. The doctor will try to identify and then treat the cause of the dehydration. Home Treatmenty y y

Weight at the same time each day on an accurate home scale and record the weight so you can be aware of fluid loss. If you have vomiting or diarrhea, keep a record of the number of episodes so you can estimate your fluid loss. For minor dehydration, take frequent small amounts of clear liquids. Large amounts may trigger vomiting.

Prevention

y y y y

Drink water frequently in small quantities during exercise that causes excessive sweating. If you are vomiting or have diarrhea, take small amounts of liquid with non-prescription electrolyte supplements-or drinks such as Gatorade- every 30 to 60 minutes. If you use diuretics, weigh daily. Report to your doctor a weight loss of more than 3 pounds in 1 day or 5 pounds in 1 week. Weigh in before and after practice sessions. Skip workouts if a weight loss of 2% or more has not been regained.

Crohn's Disease Medication - Symptoms And Treatment

Crohn's disease is an inflammation of the alimentary tract. It can affect any portion of the tract from the mouth to the anus. In 50% of cases, the disease involves the colon and small bowel. About 33% of cases involve the terminal ileum, and 10% to 20% of cases involve only the colon. The disease can extend through all layers of the intestinal wall and may also involve regional lymph nodes and the mesentery. Crohn's disease is most prevalent in adults ages 20 to 40. It's two to three times more common in people of Jewish ancestry and least common in blacks.

Causes
There is now evidence of a genetic link as Crohn's frequently shows up in a family group. In addition, there is evidence that the normal bacteria that grow in the lower gut may, in some manner, act to promote inflammation. The body's immune system, which protects it against many different infections, is known to be a factor. There are still a number of unknowns about the cause of the disease. Fortunately, a great deal is known about the disease and especially its treatment.

Signs and symptoms

The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth. The range and severity of symptoms varies. Diagnosis Upper GI series with small-bowel follow-through may demonstrate ulcerations, stricture, and fistulas.

Laboratory findings often indicate increased white blood cell count and erythrocyte sedimentation rate, hypokalemia, hypocalcemia, hypomagnesemia, and decreased hemoglobin level related to anemia from chronic inflammation, blood loss from the mucosa, and iron deficiency. Leukocytosis can be related to corticosteroid therapies, inflammation, or abscess formation. Sedimentation rate is increased in patients with active inflammation. Hypoglobulinemia may result from intestinal protein loss. A barium enema showing the string sign (segments of stricture separated by normal bowel) supports the diagnosis. Flexible sigmoidoscopy and colonoscopy may show patchy areas of inflammation, ulcers, strictures, and granulomas, thus helping to rule out ulcerative colitis. However, a definitive diagnosis is possible only after a biopsy.

Treatment
No cure for Crohn's disease exists; treatment is symptomatic. In debilitated patients, therapy includes I. V. hyperalimentation to maintain nutrition while resting the bowel. Medication can in many cases control the inflammation, keep the symptoms down, and reduce the probability of relapse. Promising results have been obtained with the use of budesonide (Entocort), a corticosteroid with high topical anti-inflammatory activity and low systemic activity (because of extensive hepatic metabolism). This medication , though costly, can reduce the intestinal inflammation while minimizing the side effects that would commonly be experienced with prednisone. Effective treatment requires important changes in lifestyle: physical rest, low-residue diet, and elimination of dairy products for lactose intolerance. Surgery may be necessary on poor response to medical therapy to correct bowel perforation, massive hemorrhage, intra-abdominal abscess, stricture, fistulas, or acute intestinal obstruction. Colectomy with ileostomy is often necessary in patients with extensive disease of the large intestine and rectum.

Diet for crohn's disease

Paying close attention to diet can help reduce the number and severity of flare-ups for many sufferers. Patients are encouraged to follow a nutritious diet and limit any foods that seem to worsen symptoms. Individual reactions vary. Some foods commonly avoided by Crohn's patients are:
y y y y

Foods associated with inflammation (alcohol, hot spices, and caffeine). Simple sugars. Dried fruits or high-sugar fruits, such as grapes, watermelon, or pineapple. Products containing corn or gluten (those made from wheat, oats, barley, or triticale).

The patient is advised to eat a well-balanced diet, with adequate protein and calories. A multivitamin and iron supplement may be recommended by the physician. Stress, anxiety, and extreme emotions may aggravate symptoms of the disorder, but are not believed to cause it or make it worse. Any chronic disease can produce a serious emotional reaction, which can usually be handled through discussion with the physician.