Indigestion

Indigestion

Definition:


Indigestion — also called dyspepsia or an upset stomach — is a general term that describes discomfort in your upper abdomen. Indigestion is not a disease, but rather a collection of symptoms you experience, including bloating, belching and nausea. Although indigestion is common, how you experience indigestion may differ from other people. Symptoms of indigestion might be felt occasionally or as often as daily.
Fortunately, you may be able to prevent or treat the symptoms of indigestion.

Symptoms:

Most people with indigestion have one or more of the following symptoms:

• Early fullness during a meal. You haven't eaten much of your meal, but you already feel full and may not be able to finish eating.
• Uncomfortable fullness after a meal. Fullness lasts longer than it should.
• Pain in the upper abdomen. You feel a mild to severe pain in the area between the bottom of your breastbone (sternum) and your navel.
• Burning in the upper abdomen. You feel an uncomfortable heat or burning sensation between the bottom of the breastbone and navel.

Less frequent symptoms that may come along with indigestion include:

• Nausea. You feel like you are about to vomit.
• Bloating. Your stomach feels swollen, tight and uncomfortable.

Sometimes people with indigestion also experience heartburn, but heartburn and indigestion are two separate conditions. Heartburn is a pain or burning feeling in the center of your chest that may radiate into your neck or back after or during eating.
When to see a doctor
Mild indigestion is usually nothing to worry about. Consult your doctor if discomfort persists for more than two weeks. Contact your doctor right away if pain is severe or accompanied by:

• Unintentional weight loss or loss of appetite
• Repeated vomiting or vomiting with blood
• Black, tarry stools
• Yellow coloring in the skin and eyes (jaundice)
• Trouble swallowing that gets progressively worse

Seek immediate medical attention if you have:

• Shortness of breath, sweating or chest pain radiating to the jaw, neck or arm
• Chest pain on exertion or with stress

Causes:

There are many possible causes of indigestion. Some are related to lifestyle and what you're eating and drinking. Indigestion can also be caused by other digestive conditions.
Common causes include:

• Overeating
• Eating too quickly
• Fatty or greasy foods
• Spicy foods
• Too much caffeine
• Too much alcohol
• Too much chocolate
• Too many carbonated beverages
• Smoking
• Nervousness
• Emotional trauma
• Medications, including antibiotics, and some pain relievers
• Pancreas inflammation (pancreatitis)
• Peptic ulcers
• Gallstones
• Stomach cancer

When a cause for indigestion can't be found after a thorough evaluation, a person may have functional dyspepsia. Functional dyspepsia is a type of indigestion that occurs because of an impairment in the stomach's ability to accept and digest food and then pass that food to the small intestine.

Complications:

Although indigestion doesn't usually have serious complications, it can affect your quality of life by making you feel uncomfortable and causing you to eat less. When indigestion is caused by an underlying condition, that condition could come with complications of its own.

Treatments and drugs:

If lifestyle changes — especially avoiding offending foods — don't help your indigestion, there also are over-the-counter and prescription medications that may help. Most are designed to reduce stomach acid or help move food from the stomach to the small intestine.
Types of indigestion medications include:

• Antacids. Alka-Seltzer, Maalox, Mylanta, Tums, and others are available over-the-counter and work by neutralizing stomach acid. Side effects include diarrhea and constipation. These are often the first medications doctors recommend.

• H-2-receptor antagonists (H2RAs). These medications don't begin working as quickly as antacids do, but they work for a longer period of time. Examples of these drugs include Axid, Tagamet, Pepcid and Zantac, which are available over-the-counter or by prescription. Possible side effects that can occur include headache, nausea, vomiting, constipation, diarrhea, and bruising or bleeding.

• Proton pump inhibitors (PPIs). Aciphex, Nexium, Prevacid, Prilosec, Protonix and Zegerid are most effective for people who also have gastroesophageal reflux disease (GERD). These medications reduce stomach acid more effectively than H2RAs. They're available by prescription, although Prilosec and Prevacid also come in over-the-counter strength. Possible side effects include back pain, aching, cough, headache, dizziness, abdominal pain, gas, nausea, vomiting, constipation and diarrhea. Long-term use has, rarely, been associated with bone fractures.

• Prokinetics. Medications, such as Reglan, can be helpful if your stomach empties slowly. People taking this prescription medication frequently experience side effects, such as fatigue, sleepiness, depression, anxiety and involuntary muscle spasms.

• Antibiotics. If the bacteria that causes peptic ulcer disease (Helicobacter pylori) is causing your indigestion, your doctor may prescribe an antibiotic.

• Antidepressants. If a thorough evaluation doesn't reveal a cause for your symptoms and the conventional treatments listed above don't work, your doctor may recommend an antidepressant medication. These prescription medications may improve the discomfort from indigestion by decreasing your sensation of pain.

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Angina

Angina

Definition:

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. Angina (an-JI-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Many people with angina say it feels like someone is standing on their chest.

Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.
Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Symptoms:

Angina symptoms include:

• Chest pain or discomfort
• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Anxiety
• Sweating
• Dizziness

The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest, or feeling like a heavy weight has been placed on their chest.
The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest pain. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

Stable angina is the most common form of angina and typically occurs with exertion and goes away with rest. If chest pain is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.
Characteristics of stable angina

• Develops when your heart works harder, such as when you exercise or climb stairs
• Can usually be predicted and the pain is usually similar to previous types of chest pain you've had
• Lasts a short time, perhaps five minutes or less
• Disappears sooner if you rest or use your angina medication
• Could feel like indigestion
• Might spread to your arms, back or other areas
• Can be triggered by mental or emotional stress

Characteristics of unstable angina (a medical emergency)

• Occurs even at rest
• Is a change in your usual pattern of angina
• Is unexpected
• Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes
• May not disappear with rest or use of angina medication
• Might signal a heart attack

Characteristics of variant angina (Prinzmetal's angina)

• Usually happens when you're resting
• Is often severe
• May be relieved by angina medication

Prinzmetal's angina is rare — only about 2 percent of angina cases are Prinzmetal's angina. This type of angina is caused by a spasm in your heart's arteries that temporarily reduces blood flow.

Angina in women
A woman's angina symptoms can be different from the classic angina symptoms. For example, a woman may have chest pain that feels like a stabbing, pulsating or sharp form of chest pain rather than the more typical vise-like pressure. Women are also more likely to experience symptoms, such as nausea, shortness of breath or abdominal pain. These differences may lead to delays in seeking treatment.

When to see a doctor
If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.

Causes:

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.
The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.

This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow ithout triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

• Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.

• Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by conditions such as severe anemia, especially if you already have narrowed coronary arteries.
  Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.
   
  
• Variant angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily  narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina accounts for about 2 percent of angina cases.

Complications:

The chest pain that can occur with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack.
Common symptoms of a heart attack include:

• Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Impending sense of doom
• Fainting
• Nausea and vomiting

If you have any of these symptoms, seek emergency medical attention immediately.

Treatments and drugs:


There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of heart attack and death.
However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.
Lifestyle changes
If your angina is mild, lifestyle changes may be all you need to do. Even if your angina is severe, making lifestyle changes can still help. Changes include:

• If you smoke, stop smoking. Avoid exposure to secondhand smoke.
• If you're overweight, talk to your doctor about weight-loss options.
• If you have diabetes make sure that it is well controlled and that you are following an optimal diet and exercise plan.
• Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
• Avoid large meals.
• Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
• Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
• Talk to your doctor about starting a safe exercise plan.

Medications
If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

• Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.

• Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, which allows more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion), or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue.

• Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.

• Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.

• Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.

• Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system in numerous ways, including narrowing your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder.

• Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. Unlike some other angina medications, Ranexa can be used if you're taking oral erectile dysfunction medications.

Medical procedures and surgery
Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery are also used to treat angina.

• Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.

• Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.

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Undescended testicle (cryptorchidism)

Undescended testicle (cryptorchidism)

Definition:

Undescended testicle (cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging behind the penis (scrotum) prior to the birth of a baby boy. Usually just one testicle is affected, but in some cases both testes may be undescended.

An undescended testicle is more common among baby boys born prematurely or before 37 weeks.
For most boys born with one or two undescended testicles, the problem corrects itself within the first few months of life. If your infant has an undescended testicle that doesn't correct itself, surgery can usually be used to relocate it into the scrotum.

Symptoms:

Testicles form in the abdomen during fetal development. During the last couple of months of normal fetal development, the testicles gradually leave the abdomen, pass through a tube-like passageway in the groin (inguinal canal) and descend into the scrotum.

If your son has an undescended testicle, that process was stopped or delayed in some stage of development. Therefore, you won't see or feel a testicle where you would expect it to be in the scrotum.

When to see a doctor
An undescended testicle is typically detected when your baby is examined shortly after birth. If your son has an undescended testicle, ask the doctor how often your son will need to be examined. If the testicle hasn't moved into the scrotum by the time your son is 4 months old, the problem probably won't correct itself.

Treating undescended testicle when your son is still a baby may lower the risk of complications later in life, such as infertility and testicular cancer.
Older boys — from infants to pre-adolescent boys — who have normally descended testicles at birth may appear to be "missing" a testicle later. This condition may indicate:

• A retractile testicle, which moves back and forth between the scrotum and the groin and may be easily guided by hand into the scrotum during a physical examination
• An ascending testicle, or acquired undescended testicle, which has "returned" to the groin and cannot be easily guided by hand into the scrotum

If you notice any changes in your son's genitals or are concerned about his development, talk to your doctor.

Causes:

 The exact cause of an undescended testicle isn't known. A combination of genetics, maternal health and other environmental factors may disrupt the hormones, physical changes and nerve activity that influence the development of the testicles.

Complications:


In order for testicles to develop and function normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment. Until a boy is 3 or 4 years old, the testicles continue to undergo changes that affect how well they function later.
An undescended testicle isn't in a cooler environment. This might increase the risk of complications later in life. These complications include:

• Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who've had an undescended testicle have an increased risk of testicular cancer. Surgically correcting an undescended testicle before age 15 months may decrease, but not eliminate, the risk of future testicular cancer.
• Fertility problems. Low sperm counts, poor sperm quality and decreased fertility are more likely to occur among men who have had an undescended testicle.

Other complications related to the abnormal location of the undescended testicle include:

• Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle. If not treated promptly, it may result in the loss of the testicle. An undescended testicle increases the risk of testicular torsion.
• Trauma. If a testicle is located in the groin, it may be damaged from pressure against the pubic bone.
• Inguinal hernia. An undescended testicle may be associated with an inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.

Treatments and drugs:


The goal of treatment is to move the undescended testicle to its proper location in the scrotum. Early treatment may lower the risk of complications of an undescended testicle, such as the risk of infertility and testicular cancer.

Surgery
An undescended testicle is usually corrected with surgery. The surgeon carefully manipulates the testicle into the scrotum and stitches it into place. This procedure usually requires relatively small incisions and may be performed with laparoscopic devices.

When your son has surgery will depend on a number of factors, such as your son's health and how difficult the procedure might be. Your surgeon will likely recommend doing the surgery after your son is 3 to 6 months old and before he is 15 months old. Early surgical treatment appears to lower the risk of later complications.

In some cases, the testicle may be poorly developed, abnormal or dead tissue. The surgeon will remove this testicular tissue.

If your son also has an inguinal hernia associated with the undescended testicle, the hernia is repaired during the surgery.

After surgery, the surgeon will monitor the testicle to see that it continues to develop, function properly and stay in place. Monitoring may include:

• Physical exam
• Ultrasound examination of the scrotum
• Tests of hormone levels

Hormone treatment
Hormone treatment involves the injection of human chorionic gonadotropin (HCG). This hormone could cause the testicle to move to your son's scrotum, but hormone treatment is usually less effective than surgery is. There's some evidence that hormone treatment may contribute to early onset of puberty (precocious puberty).

Other treatments
If your son doesn't have one or both testicles — either missing or didn't survive after surgery — you may consider saline testicular implants for the scrotum that can be implanted during late childhood or adolescence. These implants — testicle-shaped nodules filled with a fluid — result in the "appearance" of two testicles in the scrotum.

If your son doesn't have at least one healthy testicle, your doctor will refer you to a hormone specialist (endocrinologist) to discuss future hormone treatments that would be necessary to bring about puberty and physical

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Hypothyroidism (underactive thyroid)

Hypothyroidism (underactive thyroid)

Definition :

Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain important hormones. Women, especially those older than age 60, are more likely to have hypothyroidism.

Hypothyroidism upsets the normal balance of chemical reactions in your body. It seldom causes symptoms in the early stages, but, over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease. The good news is that accurate thyroid function tests are available to diagnose hypothyroidism, and treatment of hypothyroidism with synthetic thyroid hormone is usually simple, safe and effective once you and your doctor find the right dose for you.

Symptoms:

The signs and symptoms of hypothyroidism vary, depending on the severity of the hormone deficiency. But in general, any problems you have tend to develop slowly, often over a number of years.
At first, you may barely notice the symptoms of hypothyroidism, such as fatigue and weight gain, or you may simply attribute them to getting older. But as your metabolism continues to slow, you may develop more obvious signs and symptoms. Hypothyroidism signs and symptom may include:

• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Unexplained weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory

When hypothyroidism isn't treated, signs and symptoms can gradually become more severe. Constant stimulation of your thyroid gland to release more hormones may lead to an enlarged thyroid (goiter). In addition, you may become more forgetful, your thought processes may slow, or you may feel depressed.
Advanced hypothyroidism, known as myxedema, is rare, but when it occurs it can be life-threatening. Signs and symptoms include low blood pressure, decreased breathing, decreased body temperature, unresponsiveness and even coma. In extreme cases, myxedema can be fatal.

Hypothyroidism in infants
Although hypothyroidism most often affects middle-aged and older women, anyone can develop the condition, including infants. Initially, babies born without a thyroid gland or with a gland that doesn't work properly may have few signs and symptoms. When newborns do have problems with hypothyroidism, they may include:

• Yellowing of the skin and whites of the eyes (jaundice). In most cases, this occurs when a baby's liver can't metabolize a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells.
• Frequent choking.
• A large, protruding tongue.
• A puffy appearance to the face.

As the disease progresses, infants are likely to have trouble feeding and may fail to grow and develop normally. They may also have:

• Constipation
• Poor muscle tone
• Excessive sleepiness

When hypothyroidism in infants isn't treated, even mild cases can lead to severe physical and mental retardation.
Hypothyroidism in children and teens
In general, children and teens who develop hypothyroidism have the same signs and symptoms as adults do, but they may also experience:

• Poor growth, resulting in short stature
• Delayed development of permanent teeth
• Delayed puberty
• Poor mental development

When to see a doctor
See your doctor if you're feeling tired for no reason or have any of the other signs or symptoms of hypothyroidism, such as dry skin, a pale, puffy face, constipation or a hoarse voice.
You'll also need to see your doctor for periodic testing of your thyroid function if you've had previous thyroid surgery; treatment with radioactive iodine or anti-thyroid medications; or radiation therapy to your head, neck or upper chest. However, it may take years or even decades before any of these therapies or procedures result in hypothyroidism.

If you have high blood cholesterol, talk to your doctor about whether hypothyroidism may be a cause. And if you're receiving hormone therapy for hypothyroidism, schedule follow-up visits as often as your doctor recommends. Initially, it's important to make sure you're receiving the correct dose of medicine. And over time, the dose you need may change.

Causes:

When your thyroid doesn't produce enough hormones, the balance of chemical reactions in your body can be upset. There can be a number of causes, including autoimmune disease, treatment for hyperthyroidism, radiation therapy, thyroid surgery and certain medications.
Your thyroid is a small, butterfly-shaped gland situated at the base of the front of your neck, just below your Adam's apple.

Hormones produced by the thyroid gland — triiodothyronine (T3) and thyroxine (T4) — have an enormous impact on your health, affecting all aspects of your metabolism.  They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins.
Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may be due to a number of factors, including:

• Autoimmune disease. People who develop a particular inflammatory disorder known as Hashimoto's thyroiditis suffer from the most common cause of hypothyroidism. Autoimmune disorders occur when your immune system produces antibodies that attack your own tissues. Sometimes this process involves your thyroid gland. Scientists aren't sure why the body produces antibodies against itself. Some think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved. Most likely, autoimmune diseases result from more than one factor. But however it happens, these antibodies affect the thyroid's ability to produce hormones.

• Treatment for hyperthyroidism. People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications to reduce and normalize their thyroid function. However, in some cases, treatment of hyperthyroidism can result in permanent hypothyroidism.

• Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that case, you'll need to take thyroid hormone for life.
• Radiation therapy. Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidisi

• Medications. A number of medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric disorders. If you're taking medication, ask your doctor about its effect on your thyroid gland.

Less often, hypothyroidism may result from one of the following:

• Congenital disease. Some babies are born with a defective thyroid gland or no thyroid gland. In most cases, the thyroid gland didn't develop normally for unknown reasons, but some children have an inherited form of the disorder. Often, infants with congenital hypothyroidism appear normal at birth. That's one reason why most states now require newborn thyroid screening.

• Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign tumor of the pituitary gland.

• Pregnancy. Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid gland. Left untreated, hypothyroidism increases the risk of miscarriage, premature delivery and preeclampsia — a condition that causes a significant rise in a woman's blood pressure during the last three months of pregnancy. It can also seriously affect the developing fetus.

• Iodine deficiency. The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt — is essential for the production of thyroid hormones. In some parts of the world, iodine deficiency is common, but the addition of iodine to table salt has virtually eliminated this problem in the United States. Conversely, taking in too much iodine can cause hypothyroidism. 

Complications:

 Untreated hypothyroidism can lead to a number of health problems:

• Goiter. Constant stimulation of your thyroid to release more hormones may cause the gland to become larger — a condition known as a goiter. Hashimoto thyroiditis is one of the most common causes of a goiter. Although generally not uncomfortable, a large goiter can affect your appearance and may interfere with swallowing or breathing.

• Heart problems. Hypothyroidism may also be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — can occur in people with an underactive thyroid. Even subclinical hypothyroidism, a more benign condition than true hypothyroidism, can cause an increase in total cholesterol levels and impair the pumping ability of your heart. Hypothyroidism can also lead to an enlarged heart and heart failure.

• Mental health issues. Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning.

• Peripheral neuropathy. Long-term uncontrolled hypothyroidism can cause damage to your peripheral nerves — the nerves that carry information from your brain and spinal cord to the rest of your body, for example your arms and legs. Signs and symptoms of peripheral neuropathy may include pain, numbness and tingling in the area affected by the nerve damage. It may also cause muscle weakness or loss of muscle control.

• Myxedema. This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by sedatives, infection or other stress on your body. If you have signs or symptoms of myxedema, you need immediate emergency medical treatment.

• Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs fertility. In addition, some of the causes of hypothyroidism — such as autoimmune disorder — also impair fertility. Treating hypothyroidism with thyroid hormone replacement therapy may not fully restore fertility. Other interventions may be needed, as well.

• Birth defects. Babies born to women with untreated thyroid disease may have a higher risk of birth defects than may babies born to healthy mothers. These children are also more prone to serious intellectual and developmental problems. Infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development. But if this condition is diagnosed within the first few months of life, the chances of normal development are excellent.

Treatments and drugs:

Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levothroid, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism.
One to two weeks after starting treatment, you'll notice that you're feeling less fatigued. The medication also gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain. Treatment with levothyroxine is usually lifelong, but because the dosage you need may change, your doctor is likely to check your TSH level every year.

Determining proper dosage may take time
To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after two to three months. Excessive amounts of the hormone can cause side effects, such as:

• Increased appetite
• Insomnia
• Heart palpitations
• Shakiness

If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism.
Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage. Also, don't skip doses or stop taking the drug because you're feeling better. If you do, the symptoms of hypothyroidism will gradually return.
Proper absorption of levothyroxine
Certain medications, supplements and even some foods may affect your ability to absorb levothyroxine. Talk to your doctor if you eat large amounts of soy products or a high-fiber diet or you take other medications, such as:

• Iron supplements
• Cholestyramine
• Aluminum hydroxide, which is found in some antacids
• Calcium supplements

If you have subclinical hypothyroidism, discuss treatment with your doctor. For a relatively mild increase in TSH, you probably won't benefit from thyroid hormone therapy, and treatment could even be harmful. On the other hand, for a higher TSH level, thyroid hormones may improve your cholesterol level, the pumping ability of your heart and your energy level.

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Bags under eyes

Bags under eyes

Definition:

Bags under eyes — mild swelling or puffiness under the eyes — are common as you age. With aging, the tissues around your eyes, including some of the muscles supporting your eyelids, weaken. Normal fat that helps support the eyes can then migrate forward into the lower eyelids, causing the lids to appear puffy. Fluid also may accumulate in the space below your eyes, adding to a swollen appearance.

Bags under eyes are usually a cosmetic concern and rarely a sign of a serious underlying medical condition. At-home remedies, such as cold compresses, can help improve the appearance of bags under eyes. For persistent or bothersome under-eye puffiness, cosmetic treatments are available.

Symptoms:

Bags under eyes can include:

• Mild swelling
• Saggy or loose skin
• Dark circles

When to see a doctor
You may not like the way they look, but bags under eyes are usually harmless and don't require medical care. However, see your doctor if the swelling:

• Is severe and persistent
• Is accompanied by redness, itching or pain
• Affects other parts of your body, such as your legs

Your doctor will want to rule out other possible causes that can contribute to the swelling, such as kidney or thyroid problems, infection, or an allergy.

Causes:

As you age, the tissue structures and muscles supporting your eyelids weaken. The skin may start to sag, and fat that is normally confined to the area around the eye (orbit) can migrate forward below your eyes. Also, the space below your eyes can accumulate fluid, making the under-eye area appear puffy or swollen. Several factors can lead to this, including:

• Fluid retention due to changes in weather (for example, hot, humid days), hormone levels or eating salty foods
• Sleeping flat on your back
• Not getting enough sleep
• Allergies or dermatitis, especially if puffiness is accompanied by redness and itching
• Heredity

Treatments and drugs :

Bags under eyes are usually a cosmetic concern and don't require specific treatment. Depending on the cause of the swelling, home and lifestyle treatments, such as applying cold compresses or sleeping with your head raised, can help reduce or eliminate puffy eyes.
Medical and surgical treatments are available if you're concerned about the appearance of under-eye swelling. Treatment may not be covered by medical insurance if it's done solely to improve your appearance.

Skin treatments
Skin treatments traditionally done to treat wrinkles, such as laser resurfacing or chemical peels, may improve skin tone and tighten the skin. This may lessen the appearance of under-eye swelling and improve any discoloration.

Eyelid surgery
Eyelid surgery (blepharoplasty) is an option to remove bags under eyes. During blepharoplasty, the surgeon cuts just below the lashes in your eye's natural crease or inside the lower lid. The surgeon removes excess fat and sagging skin. Depending on where the initial incisions are made, stitches may follow the lower lid's natural crease or be placed inside the lower eyelid.
In addition to correcting bags under eyes, blepharoplasty can also repair:

• Baggy or puffy upper eyelids
• Excess skin of the upper eyelid that interferes with your vision
• Droopy lower eyelids, which may cause white to show below the iris — the colored part of the eye
• Excess skin on lower eyelids

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Umbilical hernia

Umbilical hernia

Definition:

An umbilical hernia occurs when part of the intestine protrudes through an opening in the abdominal muscles. Umbilical hernia is a common and typically harmless condition. Umbilical hernias are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries, causing the baby's bellybutton to protrude. This is a classic sign of an umbilical hernia.

Many umbilical hernias close on their own by age 1, though some take longer to heal. To prevent complications, umbilical hernias that don't disappear by age 3 or those that appear during adulthood may need surgical repair.

Symptoms:

An umbilical hernia creates a soft swelling or bulge near the navel (umbilicus). If your baby has an umbilical hernia, you may notice the bulge only when he or she cries, coughs or strains. The bulge may disappear when your baby is calm or lies on his or her back.
Umbilical hernias in children are usually painless. Umbilical hernias that appear during adulthood may cause abdominal discomfort.
When to see a doctor
If you suspect that your baby has an umbilical hernia, talk with your child's pediatrician. Seek emergency care if your baby has an umbilical hernia and:

• Your baby appears to be in pain
• Your baby begins to vomit
• The bulge becomes tender, swollen or discolored

Similar guidelines apply to adults. Talk with your doctor if you have a bulge near your navel. Seek emergency care if the bulge becomes painful or tender. Prompt diagnosis and treatment can help prevent complications.

Causes:

During pregnancy, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life.
In adults, too much abdominal pressure can cause an umbilical hernia. Possible causes in adults include:

• Obesity
• Multiple pregnancies
• Fluid in the abdominal cavity (ascites)
• Previous abdominal surgery

Complications:

For children, complications of an umbilical hernia are rare. Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to umbilical pain and tissue damage. If the trapped portion of intestine is completely cut off from the blood supply (strangulated hernia), tissue death (gangrene) may occur. Infection may spread throughout the abdominal cavity, causing a life-threatening situation.
Adults with umbilical hernia are somewhat more likely to experience incarceration or obstruction of the intestines. Emergency surgery is typically required to treat these complications.

Treatments and drugs:

Most umbilical hernias in babies close on their own by 18 months. Your doctor may even be able to push the bulge back into the abdomen during a physical exam. Don't try this on your own, however. Although some people claim a hernia can be fixed by taping a coin down over the bulge, this "fix" doesn't help and germs may accumulate under the tape, causing infection.
For children, surgery is typically reserved for umbilical hernias that:

• Are painful
• Are bigger than 1.5 centimeters in diameter (slightly larger than a 1/2 inch)
• Don't decrease in size after six to 12 months
• Don't disappear by age 3
• Become trapped or block the intestines

For adults, surgery is typically recommended to avoid possible complications — especially if the umbilical hernia gets bigger or becomes painful.
During surgery, a small incision is made at the base of the bellybutton. The herniated tissue is returned to the abdominal cavity, and the opening in the abdominal wall is stitched closed. In adults, surgeons often use mesh to help strengthen the abdominal wall. Recurrences are unlikely.

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Ulcerative colitis

Ulcerative colitis

Definition  :

Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes long-lasting inflammation in part of your digestive tract.
Like Crohn's disease, another common IBD, ulcerative colitis can be debilitating and sometimes can lead to life-threatening complications. Because ulcerative colitis is a chronic condition, symptoms usually develop over time, rather than suddenly.

Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon, unlike Crohn's disease, which occurs anywhere in the digestive tract and often spreads deeply into the affected tissues.
There's no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.

Symptoms:

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. For these reasons, doctors often classify ulcerative colitis according to its location.
Here are the signs and symptoms that may accompany ulcerative colitis, depending on its classification:

• Ulcerative proctitis. In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people, rectal bleeding may be the only sign of the disease. Others may have rectal pain and a feeling of urgency. This form of ulcerative colitis tends to be the mildest.
• Proctosigmoiditis. This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease.
• Left-sided colitis. As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
• Pancolitis. Affecting more than the left colon and often the entire colon, pancolitis causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
• Fulminant colitis. This rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly expand.

The course of ulcerative colitis varies, with periods of acute illness often alternating with periods of remission. But over time, the severity of the disease usually remains the same. Most people with a milder condition, such as ulcerative proctitis, won't go on to develop more-severe signs and symptoms.
When to see a doctor
See your doctor if you experience a persistent change in your bowel habits or if you have any of the signs and symptoms of ulcerative colitis, such as:

• Abdominal pain
• Blood in your stool
• Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications
• An unexplained fever lasting more than a day or two

Although ulcerative colitis usually isn't fatal, it's a serious disease that, in some cases, may cause life-threatening complications.

Causes:

Like Crohn's disease, ulcerative colitis causes inflammation and ulcers in your intestine. But unlike Crohn's, which can affect the colon in various, separate sections, ulcerative colitis usually affects one continuous section of the inner lining of the colon beginning with the rectum.
No one is quite sure what triggers ulcerative colitis, but there's a consensus as to what doesn't. Researchers no longer believe that stress is the main cause, although stress can often aggravate symptoms. Instead, current thinking focuses on the following possibilities:

• Immune system. Some scientists think a virus or bacterium may trigger ulcerative colitis. The digestive tract becomes inflamed when your immune system tries to fight off the invading microorganism (pathogen). It's also possible that inflammation may stem from an autoimmune reaction in which your body mounts an immune response even though no pathogen is present.
• Heredity. Because you're more likely to develop ulcerative colitis if you have a parent or sibling with the disease, scientists suspect that genetic makeup may play a contributing role. However, most people who have ulcerative colitis don't have a family history of this disorder

Complications:

Possible complications of ulcerative colitis include:

• Severe bleeding
• A hole in the colon (perforated colon)
• Severe dehydration
• Liver disease (rare)
• Kidney stones
• Osteoporosis
• Inflammation of your skin, joints and eyes
• An increased risk of colon cancer
• A rapidly swelling colon (toxic megacolon)

Treatments and drugs:


The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Ulcerative colitis treatment usually involves either drug therapy or surgery.

Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you'll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

• Sulfasalazine (Azulfidine). Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including nausea, vomiting, diarrhea, heartburn and headache. Don't take this medication if you're allergic to sulfa medications.

• Mesalamine (Asacol, Lialda, others), balsalazide (Colazal) and olsalazine (Dipentum). These medications are available in oral forms and also in topical forms, such as enemas and suppositories. Which form you take depends on the area of your colon that's affected by ulcerative colitis. These medications tend to have fewer side effects than sulfasalazine and are generally very well tolerated. Your doctor may prescribe a combination of two different forms, such as an oral medication and an enema or suppository. Mesalamine can relieve signs and symptoms in more than 90 percent of people with mild ulcerative colitis. People with proctitis tend to respond better to combination therapy with oral mesalamine and suppositories. For left-sided colitis, a combination of oral mesalamine and mesalamine enemas seems to work better than either agent alone if symptoms are mild to moderate. Rare side effects include headache, kidney problems and pancreas problems (pancreatitis).

• Corticosteroids. Corticosteroids can help reduce inflammation, but they have numerous side effects, including weight gain, excessive facial hair, mood swings, high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn't respond to other treatments. Corticosteroids aren't for long-term use, and the dose is usually tapered down over two to three months.

They may also be used in conjunction with other medications as a means to induce remission. For example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission. Occasionally, your doctor may also prescribe short-term use of steroid enemas to treat disease in your lower colon or rectum.

Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because immune suppressors can be effective in treating ulcerative colitis, scientists theorize that damage to digestive tissues is caused by your body's immune response to an invading virus or bacterium or even to your own tissue. By suppressing this response, inflammation is also reduced. Immunosuppressant drugs include:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol). Because azathioprine and mercaptopurine act slowly — taking three months or longer to start working — they're sometimes initially combined with a corticosteroid, but in time, they seem to produce benefits on their own and the steroids can be tapered off.
  Side effects can include allergic reactions, bone marrow suppression, infections, and inflammation of the liver and pancreas. There also is a small risk of development of cancer with these medications. If you're taking either of these medications, you'll need to follow up closely with your doctor and have your blood checked regularly to look for side effects. If you've had cancer, discuss this with your doctor before starting these medications.
  
  
• Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug is normally reserved for people who don't respond well to other medications or who face possible surgery because of severe ulcerative colitis. In some cases, cyclosporine may be used to delay surgery until you're strong enough to undergo the procedure. In others, it's used to control signs and symptoms until less toxic drugs start working. Cyclosporine begins working in one to two weeks, but because it has the potential for severe side effects, including kidney damage, seizures and fatal infections, talk to your doctor about the risks and benefits of treatment. There's also a small risk of cancer with these medications, so let your doctor know if you've previously had cancer.

• Infliximab (Remicade). This drug is specifically for those with moderate to severe ulcerative colitis who don't respond to or can't tolerate other treatments. It works quickly to bring on remission, especially for people who haven't responded well to corticosteroids. This drug can sometimes prevent surgery for some people. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.
  Some people with heart failure, people with multiple sclerosis, and people with cancer or a history of cancer can't take infliximab. The drug has been linked to an increased risk of infection, especially tuberculosis and reactivation of viral hepatitis, and may increase your risk of blood problems and cancer. You'll need to have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab.
  Also, because infliximab contains mouse protein, it can cause serious allergic reactions in some people — reactions that may be delayed for days to weeks after starting treatment. Once started, infliximab is generally continued as long-term therapy, although its effectiveness may decrease over time.
  
  
• Adalimumab (Humira) is an alternative to inflixmab for people whose ulcerative colitis has not been helped by other medications such as azathioprine or 6 mercaptopurine. It may also be considered for people who initially improve with infliximab but then improvement stops; but its benefit in this situation remains unproven. Adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. Before taking adalimumab, you should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose and upper respiratory infection.

Other medications
In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your ulcerative colitis, your doctor may recommend one or more of the following:

• Antibiotics. People with ulcerative colitis who run fevers will likely be given antibiotics to help prevent or control infection.
• Anti-diarrheals. For severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution, however, because they increase the risk of toxic megacolon.
• Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Don't use ibuprofen (Advil, Motrin, others), naproxen (Aleve) or aspirin. These are likely to make your symptoms worse.
• Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished.

Surgery
If diet and lifestyle changes, drug therapy, or other treatments don't relieve your signs and symptoms, your doctor may recommend surgery.
Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy). In the past, after this surgery you would wear a small bag over an opening in your abdomen (ileal stoma) to collect stool. But a procedure called ileoanal anastomosis eliminates the need to wear a bag. Instead, your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus. This allows you to expel waste more normally, although you may have more-frequent bowel movements that are soft or watery because you no longer have your colon to absorb water.

Pregnancy
Women with ulcerative colitis can usually have successful pregnancies, especially if they can keep the disease in remission during pregnancy. Ideally, you'll become pregnant when your disease is in remission. Some medications may not be indicated for use in pregnancy, especially during the first trimester, and the effects of certain medications may linger after you stop them. Talk with your doctor about the best way to manage your illness before you conceive. If you stop certain medications, their effects may linger. It's estimated that the risk of passing ulcerative colitis to your unborn child if your partner doesn't have ulcerative colitis is less than 10 percent.

Cancer surveillance
Screening for colon cancer often needs to be done more frequently because people who have ulcerative colitis have an increased risk of colon cancer. It's recommended that people with pancolitis begin colon cancer screening with a colonoscopy eight years after diagnosis. For those who have left-sided colitis, screening with colonoscopy is recommended beginning 10 years after diagnosis. People with proctitis can follow the usual colon cancer screening guidelines that call for a colonoscopy every 10 years beginning at age 50.

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Solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome

Definition:

Solitary rectal ulcer syndrome is a condition that occurs when a sore (ulcer) develops in the rectum. The rectum is a muscular tube that's connected to the end of your colon. Stool passes through the rectum on its way out of the body.

Solitary rectal ulcer syndrome is a rare and poorly understood disorder that occurs in people with chronic constipation. Solitary rectal ulcer syndrome can cause rectal bleeding and straining during bowel movements. Despite its name, sometimes more than one rectal ulcer occurs in solitary rectal ulcer syndrome.
Treatments for solitary rectal ulcer syndrome range from changing your diet and fluid intake to surgery.

Symptoms:

Signs and symptoms of solitary rectal ulcer syndrome include:

• Constipation
• A feeling of incomplete passing of stool
• Pain or a feeling of fullness in your pelvis
• Passing mucus from your rectum
• Fecal incontinence
• Rectal pain or anal sphincter spasms
• Rectal bleeding
• Straining during bowel movements

However, some people with solitary rectal ulcer syndrome may experience no symptoms.

When to see a doctor 
Make an appointment with your doctor if you notice any signs or symptoms that worry you.
Other diseases and conditions may cause signs and symptoms similar to those of solitary rectal ulcer syndrome. At your appointment, your doctor may recommend tests and procedures to rule out other causes of your signs and symptoms.

Causes:

It's not always clear what causes solitary rectal ulcer syndrome. Doctors believe stress or injury to the rectum may cause rectal ulcers to form.
Examples of situations that could injure the rectum include:

• Attempts to manually remove impacted stool
• Constipation or impacted stool
• Anal intercourse
• Intussusception, which occurs when part of the intestine slides inside another part
• Radiation therapy used to treat cancer in the abdomen or pelvis
• Rectal prolapse, which occurs when the rectum protrudes from the anus
• Straining during bowel movements
• Use of ergotamine suppositories, an anti-migraine treatment
• Uncoordinated tightening of the pelvic floor muscles that slows blood flow to the rectum

Treatments and drugs:

Treatment for solitary rectal ulcer syndrome depends on the severity of your condition. People with mild signs and symptoms may find relief through lifestyle changes, while people with more severe signs and symptoms may require treatment.
Behavior therapy to stop straining during bowel movements
Some people strain during bowel movements out of habit. Behavior therapy can help you learn to relax your pelvic muscles during bowel movements. In one technique called biofeedback, a specialist teaches you to control certain involuntary body responses, such as tightening of your anus or pelvic floor muscles during defecation. Biofeedback may make you more aware of your straining and help you to control it.
Medications
Treatments such as topical steroids, sulfasalazine enemas and botulinum toxin (Botox) may help ease your rectal ulcer symptoms. However, these treatments don't work for everyone, and some are still considered experimental.
Surgery
Surgical procedures used to treat rectal ulcer include:

• Rectal prolapse surgery. If you have a rectal prolapse that's causing rectal ulcer, your doctor may recommend a rectopexy procedure. Rectopexy secures the rectum in its anatomically correct position with stitches.
• Surgery to remove the rectum. An operation to remove the rectum may be an option for people with severe rectal ulcer signs and symptoms who haven't been helped by other treatments. The surgeon may connect the colon to an opening in the abdomen for waste to leave the body (colostomy). If you have a colostomy, a pouch or bag is then attached to your abdomen to collect waste.

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Bedsores (pressure sores)

Definition:

Bedsores — also called pressure sores or pressure ulcers — are injuries to skin and underlying tissues that result from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heel, ankles, hips or buttocks.

People most at risk of bedsores are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for prolonged periods.
Bedsores can develop quickly and are often difficult to treat. Several care strategies can help prevent some bedsores and promote healing

Symptoms:

Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, has defined each stage as follows.
Stage I
The beginning stage of a pressure sore has the following characteristics:

• The skin is intact.
• The skin appears red on people with lighter skin color, and the skin doesn't briefly lighten (blanch) when touched.
• On people with darker skin, there may be no change in the color of the skin, and the skin doesn't blanch when touched. Or the skin may appear ashen, bluish or purple.
• The site may be painful, firm, soft, warmer or cooler compared with the surrounding skin.

Stage II
The stage II ulcer is an open wound:

• The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
• The pressure ulcer may appear as a shallow, pinkish-red, basin-like wound.
• It may also appear as an intact or ruptured fluid-filled blister.

Stage III
At this stage, the ulcer is a deep wound:

• The loss of skin usually exposes some amount of fat.
• The ulcer has a crater-like appearance.
• The bottom of the wound may have some yellowish dead tissue (slough).
• The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV
A stage IV ulcer exhibits large-scale loss of tissue:

• The wound may expose muscle, bone and tendons.
• The bottom of the wound likely contains slough or dark, crusty dead tissue (eschar).
• The damage often extends beyond the primary wound below layers of healthy skin.

Common sites of pressure sores
For people who use a wheelchair, pressure sores often occur on skin over the following sites:

• Tailbone or buttocks
• Shoulder blades and spine
• Backs of arms and legs where they rest against the chair

For people who are confined to a bed, common sites include the following:

• Back or sides of the head
• Rim of the ears
• Shoulders or shoulder blades
• Hip, lower back or tailbone
• Heels, ankles and skin behind the knees

When to see a doctor
Inspection of the skin should be a part of routine nursing or home care for anyone who is confined for a long time to a wheelchair or bed or for anyone who has limited ability to reposition himself or herself. Contact your doctor right away if you notice any signs or symptoms of a pressure ulcer. Get immediate medical care if a person under your care shows signs of infection, such as fever, drainage or foul odor from a sore, or increased heat and redness in the surrounding skin.

Causes:

Pressure sores are caused by pressure against the skin that inhibits an adequate supply of blood to skin and underlying tissues. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores. There are three primary contributing factors:

• Sustained pressure. When your skin and the underlying tissues are trapped between bone and a surface such as a wheelchair or bed, the pressure may be greater than the pressure of the blood flowing in the tiny vessels (capillaries) that deliver oxygen and other nutrients to tissues. Deprived of these essential nutrients, cells of the skin and other tissues are damaged and may eventually die. This kind of pressure tends to happen in areas that aren't well padded with muscle or fat and that lie just over a bone, such as your spine, tailbone (coccyx), shoulder blades, hips, heels and elbows.
• Friction. Friction is the resistance to motion. When a person changes position or is handled by care providers, friction may occur when the skin is dragged across a surface. The resistance to motion may be even greater if the skin is moist. Friction between skin and another surface may make fragile skin more vulnerable to injury.
• Shear. Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, a person can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may damage tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.

Complications:

Complications of pressure ulcers include:

• Sepsis. Sepsis occurs when bacteria enters your bloodstream through the broken skin and spreads throughout your body — a rapidly progressing, life-threatening condition that can cause organ failure.
• Cellulitis. This acute infection of your skin's connective tissue causes pain, redness and swelling, all of which can be severe. Cellulitis can also lead to life-threatening complications, including sepsis and meningitis — an infection of the membrane and fluid surrounding your brain and spinal cord.
• Bone and joint infections. These develop when the infection from a pressure sore burrows deep into your joints and bones. Joint infections (septic or infectious arthritis) can damage cartilage and tissue, and bone infections (osteomyelitis) may reduce the function of your joints and limbs.
• Cancer. Another complication is the development of a type of squamous cell carcinoma that develops in chronic, nonhealing wounds (Marjolin ulcer). This type of cancer is aggressive and usually requires surgical treatment.

Treatments and drugs:

Stage I and stage II pressure sores usually heal within several weeks to months with conservative care of the wound and with ongoing, appropriate general care that manages risk factors for pressure sores. Stage III and IV pressure sores are more difficult to treat. In a person who has a terminal illness or multiple chronic medical conditions, pressure sore treatment may focus primarily on managing pain rather than complete healing of a wound.

Treatment team
Addressing the many aspects of wound care usually requires a multidisciplinary approach. Members of a care team may include:

• A primary care physician who oversees the treatment plan
• A physician specializing in wound care
• Nurses or medical assistants who provide both care and education for managing wounds
• A social worker who helps a person or family access appropriate resources and addresses emotional concerns related to long-term recovery
• A physical therapist who helps with improving mobility
• A dietitian who assesses nutritional needs and recommends an appropriate diet
• A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on whether surgery is required and what type of surgery is needed

Relieving pressure
The first step in treating a sore at any stage is relieving the pressure that caused it. Strategies to reduce pressure include the following:

• Repositioning. A person with pressure sores needs to be repositioned regularly and placed in correct positions. People using a wheelchair should change position as much as possible on their own every 15 minutes and should have assistance with changes in position every hour. People confined to a bed should change positions every two hours. Lifting devices are often used to avoid friction during repositioning.
• Support surfaces. Special cushions, pads, mattresses and beds can help a person lie in an appropriate position, relieve pressure on an existing sore and protect vulnerable skin from damage. A variety of foam, air-filled or water-filled devices provide cushion for those sitting in wheelchairs. The type of devices used will depend on a person's condition, body type and mobility.

Removing damaged tissue
To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing these tissues (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals. Options include:

• Surgical debridement involves cutting away dead tissues.
• Mechanical debridement uses one of a number of methods to loosen and remove wound debris, such as a pressurized irrigation device, a whirlpool water bath or specialized dressings.
• Autolytic debridement, the body's natural process of recruiting enzymes to break down dead tissue, can be enhanced with an appropriate dressing that keeps the wound moist and clean.
• Enzymatic debridement is the use of chemical enzymes and appropriate dressings to break down dead tissues.

Cleaning and dressing wounds
Care that promotes healing of the wound includes the following:

• Cleaning. It's essential to keep wounds clean to prevent infection. A stage I wound can be gently washed with water and mild soap, but open sores are cleaned with a saltwater (saline) solution each time the dressing is changed.
• Dressings. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. A variety of dressings are available, including films, gauzes, gels, foams and various treated coverings. A combination of dressings may be used. Your doctor selects an appropriate dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of application and removal.

Other interventions
Other interventions that may be used are:

• Pain management. Interventions that may reduce pain include the use of nonsteroidal anti-inflammatory drugs — such as ibuprofen (Motrin, Advil, others) and naproxen (Aleve, others) — particularly before and after repositioning, debridement procedures and dressing changes. Topical pain medications, such as a combination of lidocaine and prilocaine, also may be used during debridement and dressing changes.
• Antibiotics. Pressure sores that are infected and don't respond to other interventions may be treated with topical or oral antibiotics.
• Healthy diet. Appropriate nutrition and hydration promote wound healing. Your doctor may recommend an increase in calories and fluids, a high protein diet, and an increase in foods rich in vitamins and minerals. Your doctor may also prescribe dietary supplements, such as vitamin C and zinc.
• Muscle spasm relief. Muscle relaxants — such as diazepam (Valium), tizanidine (Zanaflex), dantrolene (Dantrium) and baclofen — may inhibit muscle spasms and enable the healing of sores that may have been caused or worsened by spasm-related friction or shearing.

Surgical repair
Pressure sores that fail to heal may require surgical intervention. The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer.

The type of reconstruction that's best in any particular case depends mainly on the location of the wound and whether there's scar tissue from a previous operation. In general, though, most pressure wounds are repaired using a pad of the person's own muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).

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Peptic ulcer

Peptic ulcer

Definition:

Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain.
Peptic ulcers that occur on the inside of the stomach are called gastric ulcers.
 Peptic ulcers that occur inside the hollow tube (esophagus) where food travels from your throat to your stomach are called esophageal ulcers.

Peptic ulcers that affect the inside of the upper portion of your small intestine (duodenum) are called duodenal ulcers.
It's a myth that spicy foods or a stressful job can cause peptic ulcers. Doctors now know that a bacterial infection or some medications — not stress or diet — cause most peptic ulcers.

Symptoms :

Pain is the most common symptom
Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:

• Be felt anywhere from your navel up to your breastbone
• Be worse when your stomach is empty
• Flare at night
• Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication
• Disappear and then return for a few days or weeks

Other signs and symptoms
Less often, ulcers may cause severe signs or symptoms such as:

• The vomiting of blood — which may appear red or black
• Dark blood in stools or stools that are black or tarry
• Nausea or vomiting
• Unexplained weight loss
• Appetite changes

When to see a doctor
See your doctor if you have persistent signs and symptoms that worry you. Over-the-counter antacids and acid blockers may relieve the gnawing pain, but the relief is short-lived. If your pain persists, see your doctor.

Causes:

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the esophagus, stomach or small intestine. The acid can create a painful open sore that may bleed.
Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Causes include:

• A bacterium. A common cause of ulcers is the corkscrew-shaped bacterium Helicobacter pylori. H. pylori bacteria commonly live and multiply within the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the mucous layer and inflame the lining of your stomach or duodenum, producing an ulcer. It's not clear how H. pylori spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.
• Regular use of pain relievers. Certain over-the-counter and prescription pain medications can irritate or inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve, Anaprox, others), ketoprofen and others. Peptic ulcers are more common in older adults who take pain medications frequently, such as might be common in people with osteoarthritis. To help avoid digestive upset, take pain relievers with meals. If you have been diagnosed with an ulcer, make sure your doctor knows this when prescribing any pain reliever. The pain reliever acetaminophen (Tylenol, others) doesn't cause peptic ulcers. 
• Other medications. Other prescription medications that can also lead to ulcers include medications used to treat osteoporosis called bisphosphonates (Actonel, Fosamax, others).

Complications:

Left untreated, peptic ulcers can result in:

• Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion.
• Infection. Peptic ulcers can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
• Scar tissue. Peptic ulcers can also produce scar tissue that can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight.

Treatments and drugs:
 
Treatment for peptic ulcers typically involves antibiotics to kill the H. pylori bacterium and other medications to reduce the level of acid in your digestive system to relieve pain and encourage healing. You may take antibiotics for two weeks and acid-reducing medications for about two months.
If your peptic ulcer isn't caused by H. pylori, you won't need antibiotics. Instead, your doctor may recommend treatments for your specific situation. For instance, if pain relievers caused your ulcer, your doctor may recommend a different pain reliever or a different dose. Your doctor may also recommend acid-reducing medications to allow your ulcer to heal. You may take these medications for two months or more.
Treatments for peptic ulcer can include:

• Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. Antibiotic regimens are different throughout the world. In the United States, antibiotics prescribed for treatment of H. pylori include amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline. You'll likely need to take antibiotics for two weeks.
• Medications that block acid production and promote healing. Proton pump inhibitors reduce acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.
• Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of acid released into your digestive tract, which relieves ulcer pain and encourages healing. Available by prescription or over-the-counter (OTC), acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid).
• Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.
• Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol).

Follow-up after initial treatment
Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms. If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment.

Ulcers that fail to heal
Peptic ulcers that don't heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal. These reasons may include:

• Not taking medications according to directions.
• The fact that some types of H. pylori are resistant to antibiotics.
• Regular use of tobacco.
• Regular use of pain relievers that increase the risk of ulcers.

Less often, refractory ulcers may be a result of:

• Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome
• An infection other than H. pylori
• Stomach cancer
• Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn's disease

Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics.

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Canker sore

Canker sore

Definition:

Canker sores, also called aphthous ulcers, are small, shallow lesions that develop on the soft tissues in your mouth or at the base of your gums. Unlike cold sores, canker sores don't occur on the surface of your lips and aren't contagious. They can be painful, however, and can make eating and talking difficult.
Most canker sores go away on their own in a week or two. Check with your doctor or dentist if you have unusually large or painful canker sores or canker sores that don't seem to heal.

Symptoms:

Most canker sores are round or oval with a white or yellow center and a red border. They form inside your mouth — on or under your tongue, inside your cheeks or lips, at the base of your gums, or on your soft palate. You might notice a tingling or burning sensation a day or two before the sores actually appear.
There are several types of canker sores, including minor, major and herpetiform sores.
Minor canker sores
These most common canker sores:

• Are usually small
• Are oval shaped
• Heal without scarring in one to two weeks

Major canker sores
These less common sores:

• Are larger and deeper than minor canker sores
• Have irregular edges
• May take up to six weeks to heal and can leave extensive scarring

Herpetiform canker sores
These canker sores, which usually develop later in life:

• Are pinpoint size
• Often occur in clusters of 10 to 100 sores
• Have irregular edges
• Heal without scarring in one to two weeks

When to see a doctor
Consult your doctor if you experience:

• Unusually large canker sores
• Recurring sores, with new ones developing before old ones heal
• Persistent sores, lasting three weeks or more
• Sores that extend into the lips themselves (vermilion border)
• Pain that you can't control with self-care measures
• Extreme difficulty eating or drinking
• High fever along with canker sores

See your dentist if you have sharp tooth surfaces or dental appliances that seem to trigger the sores.

Causes:

The precise cause of canker sores remains unclear, though researchers suspect that a combination of several factors contributes to outbreaks, even in the same person.
Possible triggers for canker sores include:

• A minor injury to your mouth from dental work, overzealous brushing, sports mishaps, spicy or acidic foods, or an accidental cheek bite
• Toothpastes and mouth rinses containing sodium lauryl sulfate
• Food sensitivities, particularly to chocolate, coffee, strawberries, eggs, nuts, cheese and highly acidic foods, such as pineapple
• A diet lacking in vitamin B-12, zinc, folate (folic acid) or iron
• An allergic response to certain bacteria in your mouth
• Helicobacter pylori, the same bacteria that cause peptic ulcers
• Hormonal shifts during menstruation
• Emotional stress

Canker sores may also occur because of certain conditions and diseases, such as:

• Celiac disease, a serious intestinal disorder caused by a sensitivity to gluten, a protein found in most grains
• Inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis
• Behcet's disease, a rare disorder that causes inflammation throughout the body, including the mouth
• A faulty immune system that attacks healthy cells in your mouth instead of pathogens, such as viruses and bacteria
• HIV/AIDS, which suppresses the immune system

Unlike cold sores, canker sores are not associated with herpes virus infections.

Treatments and drugs:

Treatment usually isn't necessary for minor canker sores, which tend to clear on their own in a week or two. But large, persistent or unusually painful sores often need medical care. A number of treatment options exist, ranging from mouth rinses and topical ointments to systemic corticosteroids for the most-severe cases.

• Mouth rinses. If you have several canker sores, your doctor may prescribe a mouth rinse containing the steroid dexamethasone (dek-suh-METH-uh-sown) to reduce pain and inflammation. Oral suspensions of the antibiotic tetracycline also can reduce pain and cut healing time, but tetracycline has drawbacks. It can make you more susceptible to oral thrush, a fungal infection that causes painful mouth sores, and it can permanently discolor children's teeth.
• Topical pastes. Over-the-counter and prescription pastes with active ingredients such as benzocaine (Anbesol), amlexanox (Aphthasol) and fluocinonide (Lidex, Vanos) can help relieve pain and speed healing if applied to individual sores as soon as they appear. Your doctor may recommend applying the paste to the sore two to four times a day until it heals.
• Oral medications. Medications not intended specifically for canker sore treatment, such as the heartburn drug cimetidine (Tagamet) and colchicine, which is normally used to treat gout, may be helpful for canker sores. Your doctor may prescribe oral steroid medications when severe canker sores don't respond to other treatments, but because of serious side effects, they're usually considered a last resort.
• Cautery of sores. During cautery, an instrument or chemical substance is used to burn, sear or destroy tissue. Debacterol is a topical solution designed to treat canker sores and gum problems. By chemically cauterizing canker sores, this medication may reduce healing time to about a week. Silver nitrate — another option for chemical cautery of canker sores — hasn't been shown to speed healing, but it may help relieve canker sore pain.
• Nutritional supplements. Your doctor may prescribe a nutritional supplement if you consume low amounts of important nutrients, such as folate (folic acid), vitamin B-6, vitamin B-12 or zinc.

If your canker sores relate to a more serious health problem, your doctor will treat the underlying condition.

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