Friday, December 21, 2007
Thursday, November 15, 2007
What is diarrhea?
Stools that are loose and watery, usually occuring more frequently than the usual bowel movements.
What causes diarrhea?
Most cases of diarrhea are caused by an infection of the gastrointestinal pathway, either viral, bacterial or parasitic. Other less common causes are as follows:
- Eating foods that upset the digestive system
- Allergies to certain foods
- Radiation therapy
- Diseases of the intestines (Crohn’s disease, ulcerative colitis)
- Malabsorption (where the body is unable to adequately absorb certain nutrients from the diet)
- Some cancers
- Laxative abuse
- Alcohol abuse
- Digestive tract surgery
What needs to be done?
The mainstay of treatment is the prevention of dehydration and electrolyte losses. Make sure the patient is given adequate fluids. The best choice would be ORS (oral rehydrating solution), which contains adequate concentrations of electrolytes.
In mild cases of dehydration, water, soups, juices, sports drinks and other fluids may be used in the meantime if ORS is not immediately available.
If the patient has difficulty drinking fluids, intravenous fluids may be given instead.
Moderate dehydration requires ORS to be given more frequently.
Severe dehydration requires hospitalization for IV rehydration and observation.
Some cases of diarrhea may require antibiotic treatment. The majority of cases are, however, viral and do not require antibiotic therapy.
What should we watch out for in diarrhea?
We have to watch out for dehydration. The signs of dehydration may include the following:
- Dark urine
- Small amount of urine (less number of diaper changes in small children)
- Rapid heart rate
- Dry skin
- Dry mouth and tongue
- Sunken eyes or cheeks
- No or decreased tear production
- Irritability or listlessness
- Skin that stays pinched instead of flattening out after being pinched
Other signs to watch out for are: fever, blood, undigested food or mucus in the stool and weight loss.
All the above conditions require medical attention.
We must especially be wary of diarrhea in very young or very old patients, or if the diarrhea lasts for weeks.
How to prevent diarrhea?
Most gastrointestinal infections are transmitted via the fecal oral route. Handwashing with water and soap before eating, before and after food preparation and after defecating would prevent trasmission of the microbes that could cause diarrhea.
All water intended for drinking should be adequately disinfected. A simple and effective way is by boiling the water for at least 15 minutes.
Hygiene should always be observed during food preparation.
Monday, November 12, 2007
A blighted ovum, or anembryonic pregnancy occurs when a fertilized egg never develops an embryo after attaching itself to the uterine wall. The gestational sac, however, continues to develop until a spontaneous miscarriage occurs or a dilatation and curettage is done.
Signs and symptoms:
The usual signs of early pregnancy may be present (missed period, nausea, vomiting, etc.). A urine pregnancy test shows a positive result.
Transvaginal ultrasound (TVS) is usually requested to check for viability of an early pregnancy. There should be a gestational sac of adequate size (mean diameter of 13 mm and above) but with no visible yolk sac and embyonic pole on TVS in order to make a diagnosis of a blighted ovum.
It must be noted that a very early pregnancy with a small gestational sac (less than 13 mm diameter) may not show visible signs of either a yolk sac or embryonic pole yet, therefore a diagnosis of blighted ovum cannot be made yet. Repeat TVS should show an enlarging gestational sac and appearance of yolk sac and embryonic pole when the gestational sac is large enough in order to judge for viability of the pregnancy.
Majority of blighted ova occur because of the presence of chromosomal abnormalities.
In some cases, the blighted ovum may spontaneously be aborted. However, some doctors and patients would prefer a D&C for physical and psychological closure.
Saturday, November 10, 2007
Hydatidiform mole is a relatively complication of pregnancy. Incidence is about 1 in 1000 pregnancies in the United States and other western countries, but in the Philippines as well as other Asian countries, the incidence is much higher, closer to about 1 in 100 pregnancies.
Hydatidiform moles are usually classified as complete or partial moles. These are usually benign uterine masses, but they do have a slight chance of converting to malignancy.
In a complete mole, there is no identifiable fetal tissue, unlike in a partial mole, wherein there may be an abnomal fetus or other elements like placental tissue.
Other gestational trophoblastic diseases which must be differentiated are invasive moles and choriocarcinoma.
Etiology and Risk factors:
The etiology of this condition is not completely understood.
Potential risk factors may include the following:
- defects in the egg
- abnormalities within the uterus
- nutritional deficiencies: diets low in protein, folic acid and carotene
- age: Women under 20 or over 40 years of age have a higher risk.
Signs and Symptoms:
The most common complaint of patients with H. mole is painless vaginal bleeding. The patient may also experience nausea and vomiting, as well as other signs of pregnancy. The uterus may also be noted to enlarge, mimicking a normal pregnancy. There may also be symptoms of hyperthyroidism, since large amounts of Beta HCG in the blood may mimic thyroid stimulating hormones (TSH).
A urine pregnancy test may turn out to be positive because of the high levels of circulating human chorionic gonadotrophin (HCG) hormone, although there may also be cases wherein a false negative pregnancy test may also appear. A more accurate baseline would be a serum (blood) determination of the beta component of HCG (Beta HCG). Levels of Beta HCG are higher than what would be expected for a normal pregnancy of equal duration. This test, although highly suggestive of a gestational trophoblastic disease (GTD), is not definitive for any of GTDs.
A transvaginal ultrasound is usually ordered by the obstetrician gynecologist to check for the presence and characteristic of the uterine mass. The definitive diagnosis, however is via a biopsy.
Chest x-rays and abdominal ultrasounds are usually done to check for any metastasis of villous tissue, as this would affect both the diagnosis (H mole vs. invasive mole vs. choriocarcinoma) and the treatment. Blood exams are usually done prior to treatment to check for liver and kidney functions in preparation for possible chemotherapy treatment. A complete blood count, blood typing, and platelet count is usually done in preparation for blood transfusion.
Suction curettage is the treatment of choice to remove a hydatidiform mole. Since blood loss is expected during the surgery, compatible blood is usually prepared beforehand, typed and crossmatched, so that a transfusion may be done before, during or after surgery, as dictated by the findings.
Specimens obtained during the procedure are sent to the histopathology lab for a the definitive histopathologic diagnosis (Biopsy).
Depending on the associated finding, the gynecologist may also decide to give a course of chemotherapy with low dose Methotrexate (or other chemotherpeutic agents) as prophylaxis against malignant conversion or invasion.
It is important for the attending gynecologist to have a high index of suspicion regarding the mass. The levels of the serum beta HCG and the ultrasound findings would give a strong suggestion of the type of GTD, whether it is an H. mole, an invasive mole or a choriocarcinoma. This is because the treatment protocols of each disease in the spectrum is different.
Serum Beta HCG levels are monitored biweekly after suction curettage until the level reaches undetectable levels. If the beta HCG levels remain high or spikes after it has already decreased, additional therapy may be required.
Patient is advised not to get pregnant within 1 year because of the following reasons:
- Pregnancy increases HCG levels, which would make monitoring of any recurrence difficult.
- A new pregnancy episode may trigger a recurrence of H. mole.
Prognosis for H mole is usually very good. 80% do not result in malignant conversion. Of the 20% who do develop malignancy, chemotherapy usually works in most cases.
Chance of recurrence is about 1%.
A previous H mole does not affect the chances for a future normal pregnancy. The normal risk factors still apply, though.
Disclaimer: Contents of this blog is only intended as a simplified guide. It is still best to consult an obstetrician-gynecologist if you suspect or are diagnosed with this problem.
Thursday, April 19, 2007
Glaucoma may be acute or chronic.
In acute glaucoma, there is a sudden increase in intraocular pressure (the pressure inside the eyeball), causing severe eye pain, headache, nausea, vomiting, blurring of vision and iridescent vision (seeing rainbows around lights). This is considered as a relative ophthalmologic emergency, and it is imperative to see an ophthalmologist at this point so that management of the glaucoma can be instituted immediately.
In chronic glaucoma, there is no sudden increase in intraocular pressure, hence, the signs and symptoms are a lot more subtle. There may be occasional headaches or eye pain, but generally the patient does not really feel a pressing need to see a doctor because these symptoms are not that severe or get relieved with minor measures like over the counter medications. Or they may not even feel any symptoms at all. The tragedy of chronic glaucoma is that patients do not know that they have this disease until they have already lost a significant amount of peripheral vision.
It is important to remember that since the optic nerve gradually loses axons in this disease, any vision loss is considered permanent. That's why an early diagnosis is important so that early intervention can be done and the progression of the disease can be minimized.
Current recommendations for people less than 45 years old and without risk factors for glaucoma to have an eye check at least every 4 years, and those above 45, at least every 2 years. If you have known risk factors for glaucoma, it's recommended that an eye exam should be done at least every 2 years if you're under 45 and every year if you're above 45. The following are considered as risk factors: Family history, myopia (nearsightedness), previous eye injury, low blood pressure, African descent, diabetes, long exposure to cortisone. (Previous info from The Glaucoma Foundation, website www.glaucomafoundation.org .)
It is also important to note that glaucoma is a disease that is controlled, not cured. That means that patients should visit their eye doctors at periodic intervals so that the treatment regimen can be reassessed accordingly.
How is diagnosis made? The ophthalmologist screens for glaucoma by looking at the optic nerve through an ophthalmoscope or through a special lens and a slit lamp. He also measures the intraocular pressure using a tonometer. Then gonioscopy, which allows him to see the "angles" of the eye is done to determine if it's an open angle or an angle closure type of glaucoma. This is important because the type of treatment is dictated by the type of glaucoma. Perimetry is then done to assess the peripheral visual function.
There are 3 basic treatment options available for glaucoma. These include medical treatment - with use of eyedrops and sometimes oral or IV medications, laser treatment and surgical treatment. The type of treatment is dependent upon the stage and the type of glaucoma.
It is important that patients undergoing glaucoma treatment understand that a careful and periodic monitoring of their disease by a qualified ophthalmolgist is a must in order that treatment plans are reevaluated and updated as needed, for maximum suppression of disease progression.
Should you have further questions, please do not hesitate to leave a comment and an email.
Saturday, April 14, 2007
Acute viral conjunctivitis also shows the following symptoms: tearing, discharge, slight pain, slight swelling of the eyelids, itchiness. This is a contagious condition, spread by direct contact.
What to do:
- HANDWASHING especially when you have touched your eyes. This would greatly cut down on the spread of conjunctivitis. You don't want to start an epidemic of conjunctivitis.
- Use tissue to wipe off any tearing, and throw the tissue afterwards.
- Use sterile or boiled water to clean off any crusting or discharge.
- it's best to just stay home, especially for children, in order to avoid spreading the infection.
What NOT to do:
- use just any eyedrop without a doctor's prescription. For that matter, don't just put anything into the eye, especially unclean water, urine, plant extracts etc. You might just be worsening the situation.
When you must ABSOLUTELY see an eye doctor (ophthalmologist)
- There was trauma involved, or a chemical substance has been introduced prior to the symptoms.
- When the redness has not subsided in 3 days
- There is very copious discharge.
- There is blurring of vision noted.
- Eyes are very swollen.
- There is eye pain, headache, dizziness or other symptoms.
- There is accompanying fever.
- The patient is either very young or very old.
Other possible cause of red eyes: Acute onset glaucoma, corneal abrasions, blepharitis, bacterial conjunctivitis, keratitis (bacterial or herpes), chemical burns or injury, etc.
Also published in http://blogchex.com/theworkingmom and http://hubpages.com/hub/The_Red_Eye by the same author.
I am a doctor with a specialty in ophthalmology and a subspecialty in glaucoma. I am also mom to an active toddler. I believe that who I am gives me an edge as I've been on both sides of the health care relationship more times than I could count.
I hope that, in some way, I would be able to help people out.