2011 February » Family Medicine Help

Brief Summary of Headaches

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Feb 192011

The most common patient complaint, headache usually occurs as a symptom of an underlying disorder. Ninety percent of all headaches are vascular, muscle contraction, or a combination; 10% are due to underlying intracranial, systemic, or psychological disorders.

Migraine headaches, probably the most intensively studied, are throbbing, vascular headaches that usually begin to appear in childhood or adolescence and recur throughout adulthood. Affecting up to 10% of Americans, they’re more common in females and have a strong familial incidence.

Causes

Most chronic headaches result from tension—muscle contraction—that may be caused by emotional stress, fatigue, menstruation, or environmental stimuli (such as noise, crowds, and bright lights).

Other possible causes include glaucoma; inflammation of the eyes or mucosa of the nasal or paranasal sinuses; diseases of the scalp, teeth, extracranial arteries, or external or middle ear; and muscle spasms of the face, neck, or shoulders.

In addition, headaches may be caused by vasodilators (such as nitrates, alcohol, and histamines), systemic disease, hypoxia, hypertension, head trauma and tumor, intracranial bleeding, abscess, and aneurysm.

Migraine headache

The cause of migraine headache is unknown, but a genetic link has been identified. These headaches are associated with constriction and dilation of intracranial and extracranial arteries initiated by neurons in the brainstem. Certain biochemical abnormalities are thought to occur during a migraine attack. They include local leakage of a vasodilator polypeptide called neurokinin through the dilated arteries as an inflammatory response and a decrease in the plasma level of serotonin.

Foods associated with migraine headache include aged or processed cheese and meats, alcoholic beverages (particularly red wine), food additives (such as monosodium glutamate), chocolate- and caffeine-containing foods, and nuts. Changes in the weather pattern, menstrual cycle fluctuations, sleep pattern changes, and too much or too little exercise as well as glaring lights and fatigue can also trigger a migraine headache. In addition, one of the more common causes of a recurring headache is the rebound effect that occurs when the original treatment used to get rid of the headache triggers the next episode (as with narcotics).

Headache pain

Pain may emanate from the pain-sensitive structures of the skin, scalp, muscles, arteries, and Continue reading »

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Brief Summary of Ascariasis

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Feb 142011

Also known as roundworm infection, ascariasis is caused by the parasitic worm Ascaris lumbricoides. It occurs worldwide but is most common in tropical areas with poor sanitation and in Asia, where farmers use human stool as fertilizer. In the United States, it’s more prevalent in the South, particularly among younger children.

Causes

A. lumbricoides is a large roundworm resembling an earthworm. It’s transmitted to humans by ingestion of soil contaminated with human stool that harbors A. lumbricoides ova. Such ingestion may occur directly (by eating contaminated soil) or indirectly (by eating poorly washed raw vegetables grown in contaminated soil).

Ascariasis never passes directly from person to person. After ingestion, A. lumbricoides ova hatch and release larvae, which penetrate the intestinal wall and reach the lungs through the bloodstream. After about 10 days in pulmonary capillaries and alveoli, the larvae migrate to the bronchioles, bronchi, trachea, and epiglottis. There they’re swallowed and return to the intestine to mature into worms.

Signs and symptoms

Mild intestinal ascariasis may cause only vague stomach discomfort. The first clue may be vomiting a worm or passing a worm in the stool. In established infection, adult worms usually cause no symptoms. Severe disease, however, causes stomach pain, vomiting, restlessness, disturbed sleep and, in extreme cases, intestinal obstruction. Larvae migrating by the lymphatic and the circulatory systems cause various symptoms—for example, when they invade the lungs, pneumonitis may result.

Diagnosis

Microscopic identification of ova in the stool or observation of adult worms, which may be passed rectally or by mouth, confirms the diagnosis. When migrating larvae invade the alveoli, other conclusive tests include X-rays that show characteristic bronchovascular markings: infiltrates, Continue reading »

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Introduction to Fatty liver

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Feb 102011

Steatosis, or fatty liver, is the accumulation of triglycerides and other fats in liver cells. In severe fatty liver, fat constitutes as much as 40% of the liver’s weight (as opposed to 5% in a normal liver); the liver’s weight may increase from 3.3 lb (1.5 kg) to as much as 11 lb (5 kg).

Minimal fatty changes are temporary and asymptomatic; severe or persistent changes may cause liver dysfunction. Fatty liver is usually reversible by simply eliminating the cause. This disorder may result in recurrent infection or sudden death from fat emboli in the lungs.

Causes

The most common cause of fatty liver in the United States and Europe is chronic alcoholism, with the severity of liver disease directly related to the amount of alcohol consumed. Other common, non-alcohol-related causes include acquired immunodeficiency syndrome, drug toxicity, and pregnancy.

Other causes include malnutrition (especially protein deficiency), obesity, diabetes mellitus, jejunoileal bypass surgery, Cushing’s syndrome, Reye’s syndrome, carbon tetrachloride intoxication, prolonged total parenteral nutrition (TPN), and DDT poisoning.

Whatever the cause, fatty infiltration of the liver probably results from mobilization of fatty acids from adipose tissues or from altered fat metabolism.

Signs and symptoms

Clinical features of fatty liver vary with the degree of lipid infiltration, and many patients are asymptomatic. The most typical sign is a large, tender liver (hepatomegaly). Common symptoms include right upper quadrant pain (with massive or rapid infiltration), ascites, edema, jaundice, Continue reading »

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