Med Help

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  • Depression

    Depression: a morbid sadness, dejection, or melancholy.

    Depression affects twice as many women as men, major depression is
    characterized by at least one 2 week episode of depressed mood.  Incidence
    is also high among patients hospitalized with medical illness.

    There is multiple cause of depression and not all are completely understood,
    most are controversial.  Research suggests possible genetic, familial,
    biochemical, physical, psychological, and social causes.  Studies
    shows that with many patients, the history identifies a specific personal
    loss or severe stress that probably interacts with a person’s predisposition
    to major depression.

    Symptoms:

    Major depression is a relatively persistent and prominent dysphoric
    mood, with loss of interest in usual activities and pastimes, which may
    shift periodically to anger or anxiety.

    • Appetite disturbance – weight loss without dieting, or significant appetite
      or weight gain
    • Sleep disturbance – insomnia or hypersomnia
    • Fatigue – energy loss
    • Psychomotor agitation – hyperactive or slow inactive behavior
    • Loss of interest – possible decreased sex drive, or loss of pleasure in
      activities
    • Feelings of worthlessness – excessive guilt and self reproach
    • Difficulty in concentration, decision making, or thinking
    • Recurrent suicidal thoughts, suicide attempts, or wishing death over life

    Treatment:

    Psychotherapy drugs and or Antidepressant therapy (combination of the
    two has been known to work well together)

    Somatic therapy – aim to relieve depressive symptoms

    Sedative – if patient has insomnia

    Electroconvulsive therapy (ECT) or Electric shock treatment – use for
    severely depressed or suicidal patients who do not respond to other treatments.

    Depression is very difficult to treat, especially in children, adolescents,
    elderly, and those with a history of chronic disease, but treatment has
    become more effective.

  • Goiter

    Goiter:  enlargement of the thyroid gland, causing a
    swelling in the front part of the neck.

    Hyperthyroidism: excessive
    thyroid gland activity, marked by increased metabolic rate, goiter, and
    disturbances in the autonomic nervous system and in creatine metabolism;
    sometimes used to refer to Graves’ disease.

    This metabolic imbalance results from Excessive thyroid Hormone. 
    The most common form of hyperthyroidism is Graves’ disease, which increases
    T 4 production, enlarges the thyroid gland (goiter), and causes multisystemic
    changes.  An acute exacerbation of hyperthyroidism is called thyrotoxicosis,
    and
    is a medical emergency that may lead to cardiac failure.

    Cause:  Believe to be an autoimmune disease.  Antibodies
    to thyroglobulin or to thyroid microsomes occur in most patients with this
    disorder.

    Symptoms:

    Enlarged thyroid

    Nervousness

    Heat intolerance

    Weight loss (despite increased appetite)

    Sweating

    Diarrhea

    Tremor

    Palpitation

    Exophthalmos (abnormal protrusion of the eye)

    Thyrotoxicosis symptoms:  may include – irritability,
    hypertension, tachycardia, vomiting, temperature up to 106 degrees F.,
    delirium, and coma

    Other sings and symptoms include:

    CNS:  difficulty concentrating, excitability, nervousness,
    fine tremor, shaky handwriting, clumsiness, and mood swings.

    Cardiovascular system:  tachycardia, full – bounding
    pulse, wide pulse pressure, increased cardiac output and blood volume,
    cardiomegaly, paroxysmal supraventricular tachycardia and atrial fibrillation
    (more so in elderly patients), 

    Eyes:  exophthalmos, inflammation of conjunctivae,
    corneas, or eye muscles; increased tearing, lid retraction, the perception
    of two images of a single object (diplopia)

    GI system:  increased appetite, but occasional anorexia,
    increased defecation, soft stools or, with severe disease – diarrhea, and
    liver enlargement..

    Musculoskeletal system:  weakness, fatigue, and muscle
    atrophy.  generalized or localized paralysis associated with hypokalemia;
    soft tissue swelling

    Reproductive system:  in females – oligomenorrhea
    (abnormal infrequent menstrual cycle) or amenorrhea (absent or abnormal
    stoppage of menstrual cycle); decreased fertility; higher incidence of
    spontaneous abortions. 

    In males:  gynecomastia (excessive development of the male mammary
    glands, even to the functional state.)

    Both sexes:  diminished libido

    Respiratory system:  dyspnea (difficulty breathing)
    on exertion and at rest rest

    Skin, hair, and nails:  smooth, warm, paper thin, flashed
    skin;  accentuated hair follicles; raised red patches of skin that
    are itchy and sometimes painful, with occasional nodule formation; fine,
    soft hair: premature graying and increased hair loss in both sexes; friable
    nails and distal nail separated from the bed (onycholysis)

    Treatment:

    Treatment depends on the size of the goiter, the causes, the patient’s
    age and parity, and how long surgery (if needed) will be delayed.

    Antithyroid drugs

    I, beta-adrenergic blockers

    Surgery (if needed) 

  • Glomerulonephritis

    Glomerulonephritis: is inflammation of the glomerulus. 
    Inflammation is the body’s response to an intruder, such as bacteria. The
    body’s defense system is very complex and difficult to understand and at
    this time beyond the scope of our library.  Briefly,
    our immune system walls off the area that is infected (caused by bacteria)
    in an attempt to keep the intruder from spreading to other areas of the
    body.  It is usually very effective at this, but at times becomes
    overwhelmed, and antibiotics are required.  As the area is walled
    off, warriors come to the area to fight the bacteria.  There are numerous
    types of warriors and they use different means to accomplish the task of
    killing the intruders.  Now that you have some idea what inflammation
    is (I hope) let’s talk about the

    glomerulus.  The glomerulus is within bowmans capsule located
    in the kidney.  It is located at the beginning of the nephron and
    it’s function is filtration. It consists of a membrane ( a thin, soft,
    pliable tissue) that is permeable to water, but does not allow larger particles
    such as proteins to pass. 

    This too is a very simplified version of what is taking place in the
    kidney.  The kidney’s function is to save things the body needs and
    to excrete things it does not need. 

    Causes- The most frequent cause is abnormalities of the immune
    system, although other causes include drugs, toxins, and vascular disorders. 

    Types

    Acute glomerulonephritis- is frequently associated with streptococcal
    infection (bacteria) of the throat or skin.  From 7 to 10days after
    the bacterial infection there is a sudden onset of the disease.  Symptoms
    occur 10 to 21 days after the initial infection.  They include: blood,
    protein, and casts from red blood cells in the urine. There is usually
    a marked decrease of urine output.  Edema, usually around the eyes
    and high blood pressure. 

    Treatment- there is no specific treatment for this type of glomerulonephritis. 
    Most people, especially children recover without significant loss of function
    of the glomerulus.

  • Glaucoma

    Glaucoma:  A group of disorders characterized by
    abnormally high IOP (Intraocular pressure).  Glaucoma is an increase
    in IOP causing changes in the optic disk (nerve).  It occurs in three
    primary forms: 1.) chronic open-angle (primary), 2.) acute closed-angle,
    3.) congenital.  It may also be secondary to other causes. In the
    united States approximately 12%  over the age of 40 accounts for new
    cases of blindness.  Prognosis is good with early treatment.

    Cause:  Chronic open -angle glaucoma results from over production
    of aqueous humor or obstruction of its outflow through the trabecular meshwork
    or the canal of Schlemm.  Most common glaucoma affecting 90% of all
    patients.

    Acute closed -angle glaucoma, also called narrow-angle glaucoma, results
    from obstruction to the outflow of aqueous humor from anatomically narrow
    angles between the anterior iris and the posterior corneal surface. 
    It also results from shallow anterior chambers, a thickened iris that causes
    angle closure on pupil dilation, or a bulging iris that presses on the
    trabeculae, closing the angle – peripheral anterior synechiae

    Congenital glaucoma is inherited as an autosomal recessive trait. 
    Secondary glaucoma can result from uveitis, trauma, or drugs such as corticosteroids. 
    Vein occlusion or diabetes can cause neovascularization in the angle.

    Symptoms:

    Mild aching in the eyes

    Gradual loss of peripheral vision

    Seeing halos around lights

    Reduced visual acuity (especially at night, that is not correctable
    with glasses)

    The onset of acute closed-angel glaucoma is typically rapid, constituting
    an ophthalmic emergency.  If not treated promptly, this glaucoma produces
    blindness in the affected eye in 3 to 5 days.  Symptoms may include:

    Unilateral inflammation and pain

    Pressure over the eye

    Moderate pupil dilation that’s nonreactive to light

    Cloudy cornea

    Blurring and decreased visual acuity

    Photophobia

    Seeing halos around lights

    Nausea and or Vomiting

    Treatment:

    For chronic open-angle glaucoma:  to decrease IOP through administration
    of beta-blockers, such as timolol or betaxolol, epinephrine, or diuretics,
    such as acetazolamide.

    Drug treatment may also include:  miotic eyedrops – to facilitate
    outflow of aqueous humor

    Argon laser trabeculoplasty or surgical filtering procedure called trabeculectomy
    – which creates an opening for aqueous outflow.  (This may be done
    if drug therapy does not work)

    For treating acute closed-angle glaucoma as an emergency, drug therapy
    may lower IOP.  If pressure does not decrease, laser iridotomy or
    surgical peripheral iridectomy must be performed immediately to save the
    patient’s vision.

    Iridectomy relieves pressure by excising part of the iris to reestablish
    aqueous humor outflow.  A prophylactic iridectomy is performed a few
    days later on the normal eye.

    Narcotic analgesics may be needed for pain.

  • Gastroenteritis

    Gastroenteritis: inflammation of the stomach and intestine.

    This inflammatory condition of the stomach and intestines
    accompanies numerous GI disorders (Gastrointestinal).  It occurs in
    persons of
    all ages and is a major cause of morbidity and mortality in under
    developed nations. It can be lie- threatening in elderly and
    debilitated persons.

    Gastroenteritis has many possible causes such as:
    Bacteria (responsible for acute food poisoning) – Staphylococcus aureus, Salmonella, Shigella, Clostridium
    botulinum, C. perfringens, and Escherichia coli
    Parasites – Ascaris, Enterobius, and Trichinella spiralis
    Amoebae
    Viruses (may be responsible for traveler’s diarrhea)
    Toxins – ingestion of plants or toadstools
    Drug reactions
    Enzyme deficiencies
    Food allergens

    Symptoms:

    Symptoms varies depending on the causative organism and on the level
    of the GI tract involved.

    Diarrhea

    Abdominal discomfort – cramping and pain

    Nausea

    Vomiting

    Possible fever

    Malaise

    Borborygmus (a rumbling noise caused by propulsion of gas through the
    intestines)

    Treatments:

    Treatment is usually supportive and consists of bed rest, nutritional
    support, and increased fluid intake

    Severe gastroenteritis – treatment may require hospitalization (especially
    in the young, elderly, and debilitated person)

    Specific antimicrobials

    I.V. fluids and electrolyte replacement may be needed

    Bismuth – containing compounds, such as Pepto-Bismol

    Antiemetics

  • Home Birth

    Today, many expecting mothers decide against a hospital delivery and choose to have their babies at home. A home birth is becoming more and more common. The ideal of going through labor and delivery is familiar surroundings appeals to many families. At home, family members and friends can attend the birth of your baby. Bringing a new life into the world is an exciting time, and loved ones want to share the moment. Since hospital delivery rooms are very small, and the number of birth attendees is limited, some expecting couples plan a home birth and invite the entire family.

    Before deciding on a home birth, seriously consider the risks. Some women do not want to deliver their baby at home because the risks of complications are very high. Although midwives carefully examine the mother and can usually perceive problems early, there is no way to guarantee an uncomplicated delivery. For example, the baby could change its position, which makes vaginal delivery impossible. Additionally, the cervix may fail to dilate 10 centimeters, which also makes a vaginal delivery difficult. In both cases, a caesarean section is necessary. Since a midwife is not prepared to perform a surgical procedure, the expecting mother would need to complete the delivery at a hospital.

    For the most part, giving birth at home is safe. Each year thousands of women participate in a home birth and experience little or no complications. For some women, the risk of complications is high, and doctors may discourage a home birth. Women with a history of birth complications and those who have had a previous C-section should plan on a hospital delivery. Some families choose a home birth because the cost is considerably less than having the baby at a hospital. A few insurance companies cover the cost of a home birth. The best way to ensure a safe process is to choose a certified midwife with plenty of experience. In the event of an emergency, create a backup plan.

  • Gastritis

    Gastritis:  inflammation of the stomach.  This
    inflammatory disorder of the gastric mucosa may be acute or chronic. 
    Acute gastritis is the most common stomach disorder.  In a patient
    with epigastric discomfort or other GI symptoms (particularly bleeding),
    a history suggesting exposure to a GI irritant suggests gastritis. 
    Gastritis usually accompanies pernicious anemia (as chronic atrophic gastritis). 
    Gastritis is more prevalent in the elderly, but can occur at any age.

    Cause:  Acute gastritis may be caused by:

    Chronic ingestion of irritating foods or an allergic reaction to them.

    Alcohol or drugs, such as aspirin

    Poisons, such as: DDT, ammonia, mercury, and carbon tetrachloride

    Hepatic disorders, such as: portal hypertension

    Gi disorders, such as: spure

    Infectious disorders

    Curling’s ulcer (after a burn)

    Cushing’s ulcer

    Gi injury may be thermal such as:  ingesting a hot fluid, or mechanical
    – such as: swallowing a foreign object.

    Corrosive gastritis may be caused by ingestion of strong
    acids or alkalies.

    Acute phlegmonous gastritis may be caused by a rare bacterial
    infection of the stomach wall (usually streptococcal)

    Symptoms:

    GI bleeding

    Mild epigastric discomfort

    Treatment:

    Symptoms are usually relieved by eliminating the gastric irritant or
    other cause.

    Corrosive gastritis:  to neutralize with the appropriate antidote
    (emetics are contraindicated).

    Gastritis cause by poisons:  emetics, anticholinergics such as
    methantheline bromide

    GI distress:  histamine anatagonists such as cimetidine, and antacids

    When gastritis causes massive bleeding, treatment includes blood replacement;
    iced saline lavage, possibly with norepinephrine; angiography with vasopressin
    infused in normal saline solution; and surgery.

    Bacterial gastritis:  antibiotic therapy, bland diet, and antiemetic.

    Acute phlegnonous gastritis:  Vigorous antibiotic therapy followed
    by surgical repair.

    NOTE:  with all medication use as directed by your doctor.

  • Hospital Birth

    Some women make a conscious decision to have their children at home with the use of a midwife. Still others choose to have a hospital birth, where they are under the care of medical professionals. There are some pros and cons to having a hospital birth, although a large percentage of mothers choose to have one. Some of the major perks of a hospital birth are the standard things like having pain medication and knowing you are in safe hands in the unlikely event of an emergency. Most women who become pregnant develop a close relationship with their doctors and then the doctor is present at the birth. This can give a real peace of mind and make you feel like you are safe and in good hands. The help of professionals can give new mothers a sense that their childbirth will be painless and easy.

    Still, some mothers opt not to have a hospital birth. Many people find hospitals to be a bit daunting and intimidating. A lot of people feel like the hospital is too cold and impersonal. Some people prefer not to use pain medication, or to induce labor, but would rather have an all natural childbirth. This is really a matter of preference. It should also be noted that participating in a hospital birth can also be rather expensive. Some people also claim that it’s difficult to get any sleep in a maternity ward since there are so many people on the floor and so much activity going on. There are perks to a hospital birth, like being able to control your medication and having the advice of a doctor nearby. Overall it is really the mother’s choice when it comes to having her child in her home or in the hospital. New parents should weigh both pros and cons before making the final decision.

  • Gall Stones and Gall Bladder Disorders

    Gallstone:  a calculus formed in the gallbladder
    or bile duct.

    Gallbladder and biliary tract disorders:  includes
    Cholecystitis,
    cholelithiasis,
    choledocholithiasis    , cholangitis, and gallstone ileus

    Gallbladder and biliary tract disorders are common and frequently painful
    conditions that usually require surgery and may be life-threatening. 
    Usually they often accompany calculus deposition and inflammation. 
    Gallbladder and duct diseases usually occur in middle age.  They are
    more common in women, but incidence in both sexes becomes equal after age
    50.

    Cholecystitis:  acute
    or chronic inflammation of the gallbladder is usually associated with a
    gallstone impacted in the cystic duct, causing painful distention of the
    gallbladder.  Prognosis is good with treatment.  The acute form
    is most common during middle age; the chronic form, among the elderly.

    Cholangitis:  infection
    of the bile duct.  It is commonly associated with choledocholithiasis
    (calculi in the common bile duct) and may follow percutaneous (performed
    through the skin) transhepatic cholangiography (radiography of the bile
    ducts).  Widespread inflammation may cause fibrosis and stenosis of
    the common bile duct and biliary radicles.  Prognosis for the rare
    condition is poor- stenosing or primary sclerosing cholangitis is almost
    always fatal.

    Cholelithiasis:  stones
    or calculi in the gallbladder (gallstones), results from changes in bile
    components.  It is the leading biliary tract disease, affecting over
    20 million Americans, and accounts for the third most common surgical procedure
    performed in the United States.  (Cholecystectomy)

    Choledocholithiasis: 
    occurs when gallstones passed out of the gallbladder lodge in the common
    bile duct, causing partial or complete biliary obstruction.  Prognosis
    is good unless infection develops.

    Gallstone ileus: 
    involves small bowel obstruction by a gallstone.  Usually, the gallstone
    travels through a fistula between the gallbladder and small bowel and lodges
    at the ileocecal valve.  Prognosis is good with surgery. Gallstone
    ileus is most common in the elderly.

    Cause:  The exact cause of gallstone formation is unknown,
    but abnormal metabolism of cholesterol and bile salts is a likely cause.

    Risk factors include:

    –A high calorie, high cholesterol diet, associated with obesity

    –Elevated estrogen levels from oral contraceptives, postmenopausal
    therapy, and pregnancy.

    –Diabetes mellitus, ileal disease, hemolytic disorders, liver disease,
    or pancreatitis.

    How gallstones form:  Bile is made continuosly by the liver
    and is concentrated and stored in the gallbladder until needed by the duodenum
    to help digest fat.  Changes in the composition of bile or in the
    absorptive ability of the gallbladder epithelium allow gallstones to form.

    Symptoms:

    In acute cholecystitis, acute cholelithiasis, and choledocholithiasis:

    –a classic attack with severe midepigastric or right upper quadrant
    pain radiating to the back or referred to the right scapula, frequently
    after meal rich in fats.

    –recurring fat intolerance

    –belching that leaves a sour taste in the mouth

    –flatulence

    –indigestion

    –diaphoresis (profuse perspiration)

    –nausea

    –chills and low-grade fever

    –possible jaundice and clay colored stools with common duct obstruction.

    In cholangitis:

    –weakness and fatigue

    –abdominal pain

    –possible jaundice and related itching

    –high fever and chills

    In gallstone ileus:

    –absent bowel sounds (in complete bowel obstruction)

    –intermittent colicky pain over several days

    –nausea and vomiting

    –abdominal distention

    Treatment:

    Surgery, usually elective, is the treatment of choice for gallbladder
    and duct disease.

    Low-fat diet

    Vitamin K

    A nonsurgical treatment for choledocholithiasis involves insertion of
    a flexible catheter, formed around a T tube, through the sinus tract into
    the common bile duct.  Guided by fluoroscopy, the doctor directs the
    catheter toward the stone.  The doctor then threads a Dormia basket
    through the catheter, opens and twirls it to entrap the calculi, then closes
    and withdraws the basket.

    Chenodiol, a drug that dissolves radiolucent calculi,, provides an alternative
    for patients who are poor surgical risks or who refuse surgery.  The
    use of chenodiol is limited by the need for prolonged treatment, the high
    incidence of adverse effects, and the frequency of calculi re-formation
    after treatment is stopped.

    Lithotripsy:  is the breakup of gallstones through ultrasonic waves,
    is an investigational procedure with good results in many cases.

  • how to get pregnant

    Many women find it difficult to get pregnant, even though they try very hard to conceive. You may be asking yourself how to pregnant and what you can do to help increase the odds. There are some surprising things you can do to help make your dream of becoming a mother come true. Perhaps the best way to help you get pregnant is to find out when you are most fertile. You can do this by tracking your cycle on a calendar, and track the number of days between each period so you know when ovulation begins. While this method is simple and easy, it is not always 100% accurate, but it can help you increase the odds. There are also many wonderful, informative books on how to get pregnant that can help guide you through the ovulation tracking process. Another method is to keep track of your basal body temperature. This is the temperature of your body when fully at rest. The higher your basal temperature, the better the odds you will begin ovulation a day or two afterwards.

    If you’re wondering about how to get pregnant without all of the tracking, the most obvious way is for you and your partner to keep trying. Sometimes the body is just not ready and other times it is, so it really depends on a number of different factors. Many doctors will help with preconception planning and show you some great tips on diet and other lifestyle adjustments you can make to help maximize your chances of becoming pregnant. If you wondering how to get pregnant and you’ve brainstormed, remember it isn’t always what you do but what you don’t do. Don’t smoke, don’t eat too much junk food, don’t miss out on sleep, and don’t take any medications without checking with your doctor first.