Brief Summary of Gastroenteritis

Also called intestinal flu, traveler’s diarrhea, viral enteritis, and food poisoning, gastroenteritis is a self-limiting disorder characterized by diarrhea, nausea, vomiting, and abdominal cramping. It occurs in all age-groups and is a major cause of morbidity and mortality in underdeveloped nations.
It can also be life-threatening in elderly and debilitated people.
Causes
Gastroenteritis has many possible causes, including the following:
  • bacteria (responsible for acute food poisoning)—Staphylococcus aureus, Salmonella, Shigella, Clostridium botulinum, Escherichia coli, Clostridium perfringens
  • amoebae—especially Entamoeba histolytica
  • parasites—Ascaris, Enterobius, Trichinella spiralis
  • viruses (may be responsible for traveler’s diarrhea)—adenovirus, echovirus, or coxsackievirus
  • ingestion of toxins—plants or toadstools (mushrooms)
  • drug reactions—antibiotics
  • enzyme deficiencies
  • food allergens.
The bowel reacts to any of these enterotoxins with hypermotility, producing severe diarrhea and secondary depletion of intracellular fluid.

Signs and symptoms
Clinical manifestations vary, depending on the pathologic organism and the level of GI tract involved. Gastroenteritis produces symptoms such as diarrhea, abdominal discomfort (ranging from cramping to pain), nausea, and vomiting. Other possible symptoms include fever, malaise Continue reading “Brief Summary of Gastroenteritis”

Brief Summary of Somatization disorder

When multiple recurrent signs and symptoms of several years’ duration suggest that physical disorders exist without a verifiable disease or pathophysiologic condition to account for them, somatization disorder is present.
The typical patient with somatization disorder usually undergoes repeated medical examinations and diagnostic testing that—unlike the symptoms themselves—can be potentially dangerous or debilitating. However, unlike the hypochondriac, she isn’t preoccupied with the belief that she has a specific disease.
Somatization disorder usually is chronic, with exacerbations during times of stress.
Signs and symptoms usually begin in adolescence; rarely, when the patient is in her 20s. This disorder primarily affects women; it’s seldom diagnosed in men.
Causes
Both genetic and environmental factors contribute to the development of somatization disorder.
Signs and symptoms
A patient with somatization disorder presents physical complaints in a dramatic, vague, or exaggerated way, often as part of a complicated medical history in which many medical diagnoses have been considered.
An important clue to this disorder is a history of multiple medical evaluations by different physicians at different institutions—sometimes simultaneously—without significant findings. The patient usually appears anxious and depressed.
Common physical complaints include:
  • conversion or pseudoneurologic signs and symptoms (for example, paralysis or blindness)
  • GI discomfort (abdominal pain, nausea, or vomiting)
  • female reproductive difficulties (such as painful menstruation) or male reproductive difficulties (such as erectile dysfunction)
  • psychosexual problems (such as sexual indifference)
  • chronic pain (such as back pain)
  • cardiopulmonary symptoms (chest pain, dizziness, or palpitations).
The patient typically relates her current complaints and previous evaluations in great detail. She may be quite knowledgeable about tests, procedures, and medical jargon.
Attempts to explore areas other than her medical history may cause noticeable anxiety. She tends to disparage previous health care professionals and previous treatments, often with the comment, “Everyone thinks I’m imagining these things.”
Ongoing assessment should focus on new signs or symptoms or any change in old ones to avoid Continue reading “Brief Summary of Somatization disorder”

Introduction to Influenza

Also called the grippe or the flu, influenza is an acute, highly contagious infection of the respiratory tract that results from three types of Myxovirus influenzae. It occurs sporadically or in epidemics (usually during the colder months). Epidemics tend to peak within 2 to 3 weeks after initial cases and subside within 1 month.
Although influenza affects all age-groups, its incidence is highest in schoolchildren. Its severity is greatest in the very young, the elderly, and those with chronic disease. In these groups, influenza may even lead to death.
Causes
Transmission of influenza occurs through inhalation of a respiratory droplet from an infected person or by indirect contact such as using a contaminated drinking glass. The virus then invades the epithelium of the respiratory tract, causing inflammation and desquamation.
One remarkable feature of the influenza virus is its capacity for antigenic variation. Such variation leads to infection by strains of the virus to which little or no immunologic resistance is present in the population at risk. Antigenic variation is characterized as antigenic drift (minor changes that occur yearly or every few years) and antigenic shift (major changes that lead to pandemics).
Influenza viruses are classified into three groups:
  • Type A, the most prevalent, strikes every year, with new serotypes causing epidemics every 3 years.
  • Type B also strikes annually, but only causes epidemics every 4 to 6 years.
  • Type C is endemic and causes only sporadic cases.
Signs and symptoms
After an incubation period of 24 to 48 hours, signs and symptoms appear: the sudden onset of chills, a temperature of 101° to 104° F (38.3° to 40° C), headache, malaise, myalgia (particularly in the back and limbs), a nonproductive cough and, occasionally, laryngitis, hoarseness, conjunctivitis, rhinitis, and rhinorrhea.
These signs and symptoms usually subside in 3 to 5 days, but cough and weakness may persist. Fever is usually higher in children than in adults. Also, cervical adenopathy and croup are likely to be associated with influenza in children. In some patients (especially elderly ones), lack of Continue reading “Introduction to Influenza”

Amyotrophic lateral sclerosis

Commonly called Lou Gehrig disease, after the New York Yankee first baseman who died of this disorder, amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease causing muscular atrophy. Other motor neuron diseases include progressive muscular atrophy and progressive bulbar palsy. Onset occurs between ages 40 and 70. A chronic, progressively debilitating disease, ALS is rapidly fatal.

Causes

The disease is progressive, with death resulting from respiratory paralysis (the median survival is 3 to 5 years), and it’s three times more common in men than in women. The exact cause of ALS is unknown, but 5% to 10% of ALS cases have a genetic component. In these cases, it’s an autosomal dominant trait that affects men and women equally.
ALS and other motor neuron diseases may result from:
  • a slow-acting virus
  • nutritional deficiency related to a disturbance in enzyme metabolism
  • metabolic interference in nucleic acid production by the nerve fibers
  • an autoimmune disorder that affects immune complexes in the renal glomerulus and basement membrane.
Precipitating factors for acute deterioration include trauma, viral infections, and physical exhaustion.
Signs and symptoms
Patients with ALS develop fasciculations, accompanied by atrophy and weakness, especially in the muscles of the forearms and the hands. Other signs include impaired speech; difficulty chewing, swallowing, and breathing, particularly if the brain stem is affected; and, occasionally, choking and excessive drooling.
Mental deterioration doesn’t usually occur, but patients may become depressed as a result of the disease. Progressive bulbar palsy may cause crying spells or inappropriate laughter. Continue reading “Amyotrophic lateral sclerosis”

Testicular cancer

Testicular cancerMalignant testicular tumors, which rank first in cancer deaths among men ages 20 to 35, primarily affect young to middle-aged men; they are the most common solid tumor in this group. (In children, testicular tumors are rare.) Most testicular tumors originate in gonadal cells. About 40% are seminomas— uniform, undifferentiated cells resembling primitive gonadal cells. The rest are nonseminomas—tumor cells showing various degrees of differentiation.
The prognosis varies with the cell type and disease stage. When treated with surgery and radiation, almost all patients with localized disease survive beyond 5 years.
Causes
The cause of testicular cancer isn’t known, but incidence (which peaks between ages 20 and 40) is higher in men with cryptorchidism (even when surgically corrected) and in men whose mothers used diethylstilbestrol during pregnancy. Exposure to certain chemicals, infection with human immunodeficiency virus, and a family history of testicular cancer increase risk. (Testicular cancer accounts for 1% of all cancers in men.)
Testicular cancer spreads through the lymphatic system to the para-aortic, iliac, and mediastinal lymph nodes and may metastasize to the lungs, liver, viscera, and bone.
Signs and symptoms
The first sign is usually a firm, painless, smooth testicular mass, varying in size and sometimes producing a sense of testicular heaviness. When such a tumor causes chorionic gonadotropin or estrogen production, gynecomastia and nipple tenderness may result.
In advanced stages, signs and symptoms include ureteral obstruction, abdominal mass, cough, hemoptysis, shortness of breath, weight loss, fatigue, pallor, and lethargy.
Diagnosis
  • Two effective means of detecting a testicular tumor are regular self-examinations and testicular palpation during a routine physical examination.
  • Transillumination can distinguish between a tumor (which doesn’t transilluminate) and a hydrocele or spermatocele (which does). Follow-up measures should include an examination for gynecomastia and abdominal masses.
  • Diagnostic tests include excretory urography to detect ureteral deviation resulting from para-aortic node involvement, urinary or serum luteinizing hormone levels, ultrasound, and abdominal computed tomography scan. Continue reading “Testicular cancer”