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Diabetes

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

There are three types of diabetes:

1) Type 1 Diabetes

Type 1 diabetes is an autoimmune disease - the person's body has destroyed his/her own insulin-producing beta cells in the pancreas.
People with Diabetes Type 1 are unable to produce insulin. Most patients with Diabetes Type 1 developed the condition before the age of 40. Approximately 15% of all people with diabetes have Type 1.

Type 1 diabetes is fatal unless the patient regularly takes exogenous insulin. Some patients have had their beta cells replaced through a pancreas transplant and have managed to produce their own insulin again.

Type 1 diabetes is also known as juvenile diabetes or childhood diabetes. Although a large number of diabetes Type 1 patients become so during childhood, it can also develop after the age of 18. Developing Type 1 after the age of 40 is extremely rare.

Type 1, unlike Type 2, is not preventable. The majority of people who develop Type 1 are of normal weight and are otherwise healthy during onset. Exercise and diet cannot reverse Type 1. Quite simply, the person has lost his/her insulin-producing beta cells. Several clinical trials have attempted to find ways of preventing or slowing down the progress of Type 1, but so far with no proven success.

Dia T13 Dia T12

2) Type 2 Diabetes

A person with diabetes type 2 either:

- Does not produce enough insulin. Or

- Suffers from 'insulin resistance'. This means that the insulin is not working properly.

The majority of people with Type 2 have developed the condition because they are overweight. Type 2 generally appears later on in life, compared to Type 1. Type 2 is the most common form of diabetes.

In the case of insulin resistance, the body is producing the insulin, but insulin sensitivity is reduced and it does not do the job as well as it should do. The glucose is not entering the body's cells properly, causing two problems:

- A build-up of glucose in the blood.

- The cells are not getting the glucose they need for energy and growth.

In the early stages of Type 2 insulin sensitivity is the main abnormality - also there are elevated levels of insulin in the blood. There are medications which can improve insulin sensitivity and reduce glucose production by the liver.

As the disease progresses the production of insulin is undermined, and the patient will often need to be given replacement insulin.

Approximately 90% of all cases of diabetes worldwide are of this type.

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3) Gestational Diabetes

This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose.

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Insulin:

Insulin is a hormone. It makes our body's cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy.

When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells. When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body systems, such as amino acid uptake by body cells. Insulin is not identical in all animals - their levels of strength vary.

The pancreas:

The pancreas is part of the digestive system. It is located high up in your abdomen and lies across your body where the ribs meet at the bottom. It is shaped like a leaf and is about six inches long. The wide end is called the head while the narrower end is called the tail, the mid-part is called the body.

The pancreas has two principal functions:

It produces pancreatic digestive juices.
It produces insulin and other digestive hormones.

pancreas large

Causes of Diabetes:

Diabetes causes vary depending on your genetic makeup, family history, ethnicity, health and environmental factors.

Type 1 diabetes causes:

Type 1 diabetes is caused by the immune system destroying the cells in the pancreas that make insulin. This causes diabetes by leaving the body without enough insulin to function normally.

This is called an autoimmune reaction, or autoimmune cause, because the body is attacking itself.

There is no specific diabetes causes, but the following triggers may be involved:

- Viral or bacterial infection

- Chemical toxins within food

- Unidentified component causing autoimmune reaction

Underlying genetic disposition may also be a type 1 diabetes cause.

Type 2 diabetes causes:

Type 2 diabetes causes are usually multifactorial - more than one diabetes cause is involved. Often, the most overwhelming factor is a family history of type 2 diabetes.

This is the most likely type 2 diabetes cause.

There are a variety of risk factors for type 2 diabetes, any or all of which increase the chances of developing the condition.

These include:

- Obesity

- Living a sedentary lifestyle

- Increasing age

- Bad diet

Other type 2 diabetes causes such as pregnancy or illness can be type 2 diabetes risk factors.

Gestational diabetes causes:

The causes of diabetes in pregnancy also known as gestational diabetes remain unknown. However, there are a number of risk factors that increase the chances of developing this condition:

- Family history of gestational diabetes

- Overweight or obese

- Suffer from polycystic ovary syndrome

- Have had a large baby weighing over 9lb

Causes of gestational diabetes may also be related to ethnicity - some ethnic groups have a higher risk of gestational diabetes.

Other diabetes causes:

There are a variety of other potential diabetes causes. These include the following:

- Pancreatitis or pancreatectomy as a cause of diabetes. Pancreatitis is known to increase the risk of developing diabetes, as is a pancreatectomy.

- Polycystic Ovary Syndrome (PCOS). One of the root causes of PCOS is obesity-linked insulin resistance, which may also increase the risk of pre-diabetes and type 2 diabetes.

- Cushing’s syndrome. This syndrome increases production of the cortisol hormone, which serves to increased blood glucose levels. An over-abundance of cortisol can cause diabetes.

- Glucagonoma. Patients with glucagonoma may experience diabetes because of a lack of equilibrium between levels of insulin production and glucagon production.

- Steroid induced diabetes (steroid diabetes) is a rare form of diabetes that occurs due to prolonged use of glucocorticoid therapy.

Symptoms of Diabetes:

People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided.

Here is a list of the most common diabetes symptoms:

- Frequent urination                                        - Disproportionate thirst

- Intense hunger                                               - Unusual weight loss

- Increased fatigue                                           - Irritability

- Blurred vision                                               - Cuts and bruises don't heal properly or quickly

- More skin and/or yeast infections                - Itchy skin

- Gums are red and/or swollen - Gums pull away from teeth

- Sexual dysfunction among men                   - Numbness or tingling, especially in your feet and hands

symptoms-of-diabetes

Complications of diabetes:

People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.

complications of diabetic

Diabetes prevention:

5 tips for taking control:

Tip 1: Get more physical activity

There are many benefits to regular physical activity. Exercise can help you:

-         Lose weight

-         Lower your blood sugar

Boost your sensitivity to insulin — which helps keep your blood sugar within a normal range

Tip 2: Get plenty of fiber

It's rough, it's tough — and it may help you:

-         Reduce your risk of diabetes by improving your blood sugar control

-         Lower your risk of heart disease

-         Promote weight loss by helping you feel full

-         Foods high in fiber include fruits, vegetables, beans, whole grains, nuts and seeds.

Tip 3: Go for whole grains

Although it's not clear why, whole grains may reduce your risk of diabetes and help maintain blood sugar levels. Try to make at least half your grains whole grains. Many foods made from whole grains come ready to eat, including various breads, pasta products and many cereals. Look for the word "whole" on the package and among the first few items in the ingredient list.

Tip 4: Lose extra weight

If you're overweight, diabetes prevention may hinge on weight loss. Every pound you lose can improve your health, and you may be surprised by how much. Participants in one large study who lost a modest amount of weight — around 7 percent of initial body weight — and exercised regularly reduced the risk of developing diabetes by almost 60 percent.

Tip 5: Skip fad diets and just make healthier choices

Low-carb diets, the glycemic index diet or other fad diets may help you lose weight at first, but their effectiveness at preventing diabetes isn't known nor are their long-term effects. And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients. Instead, think variety and portion control as part of an overall healthy-eating plan.

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High blood pressure (Hypertension)

High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

PULMONARY HYPERTENSION

Symptoms

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms usually don't occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

You'll likely have your blood pressure taken as part of a routine doctor's appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age 18. Blood pressure should be checked in both arms to determine if there is a difference. Your doctor will likely recommend more frequent readings if you've already been diagnosed with high blood pressure or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups.

If you don't regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free, but these machines can give you inaccurate results.

Causes

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

Kidney problems
Adrenal gland tumors

Thyroid problems

Certain defects in blood vessels you're born with (congenital)

Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs

Illegal drugs, such as cocaine and amphetamines

Alcohol abuse or chronic alcohol use

Obstructive sleep apnea

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to:

Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm.
Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure.
To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
Weakened and narrowed blood vessels in your kidneys.
This can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes.
This can result in vision loss.
Metabolic syndrome.
This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL); or "good," cholesterol; high blood pressure; and high insulin levels.
If you have high blood pressure, you're more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.

Trouble with memory or understanding.
Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.

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Disc & Disc Prolapse

Disc

The spine is made up of the vertebrae (the bones making up the spine), which have cartilage discs between them.

The discs consist of a circle of connective tissue with a central gel-like core. This makes the spine flexible and at the same time acts as a protective buffer.

In the centre of this column of vertebrae and discs is the spinal canal, which contains the spinal cord stretching from the brain-stem down to the first or second lumbar vertebra.

It continues as a bundle of nerve fibres called the cauda equina stretching down towards the sacrum, which is the extension of the spine.

Between each vertebra, the spinal cord has nerve root connections to other parts of the body.

The spine is divided into three parts:

- neck (cervical vertebrae)

- chest (thoracic vertebrae)

- the lower back (lumbar vertebrae).

The spine is connected to the ribs at the chest.

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Cervical Vertebrae

The cervical spine is comprised of seven vertebrae - C1, C2, C3, C4, C5, C6, C7 (often noted as C1-C7) - that begin at the base of the skull and extend down to the thoracic spine. The cervical vertebrae are composed of cylindrical bones (vertebral bodies) that lie in front of the spinal cord, and work with the muscles, joints, ligaments and tendons to provide support, structure and stabilization to the neck.

The first cervical vertebra is unique in that it is a ring that rotates around the second vertebral body (the odontoid). The cervical vertebrae closest to the skull are the smallest. All of the cervical vertebrae are smaller than the vertebrae in the thoracic spine (upper back) and the lumbar spine (lower back).

250px-Cervical vertebrae lateral2 Cervical vertebra

cervel spine

Thoracic vertebrae

In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebrae and they are intermediate in size between the cervical and lumbar vertebrae; they increase in size going towards the lumbar vertebrae, with the lower ones being a lot larger than the upper. They are distinguished by the presence of facets on the sides of the bodies for articulation with the heads of the ribs, and facets on the transverse processes of all, except the eleventh and twelfth, for articulation with the tubercles of the ribs. By convention, the human thoracic vertebrae are numbered T1-T12, with the first one (T1) located closest to the skull and the others going down the spine towards the lumbar region.

250px-Thoracic vertebrae back3 500px-Thoracic vertebrae

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lumbar vertebrae

In human anatomy, the lumbar vertebrae are the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse process (as it is only found in the cervical region), and by the absence of facets on the sides of the body. They are designated L1 to L5, starting at the top. The lumbar vertebrae help support the weight of the body, and permit movement.

250px-Lumbar vertebrae anterior 800px-Lumbar vertebrae

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Slipped Disc (Disc Prolapse)

A slipped disc is when the soft part of the disc bulges through the circle of connective tissue.

This prolapse may push on the spinal cord or on the nerve roots. However, it is worth noting that 20 per cent of the population have slipped discs without experiencing any noticeable symptoms.

The term 'slipped disc' does not really describe the process properly – the disc does not actually slip out of place, but bulges out towards the spinal cord.

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Causes of a slipped disc

What is the A slipped disc occurs due to the breaking down of the circle of connective tissue with advancing age. This causes a weakness allowing the soft part to swell.

Slipped discs most often affect the lower back and are relatively rare in the chest part of the spine.

It is possible that hard physical labour can increase the likelihood of a slipped disc. They are also occasionally seen following trauma such as an injury from a fall or a road traffic accident.

At what age can a slipped disc occur?

A slipped disc in the lower back is most often seen between the ages of 30 and 50. In the cervical vertebrae around the neck, slipped discs are most often seen between the ages of 40 and 60.

Symptoms of a slipped disc

A slipped disc can be symptom free. If it causes pain, it is primarily due to the pressure on the nerve roots, the spinal cord or the cauda equina.

Symptoms of nerve root pressure

Paralysis of single muscles, possibly with pain radiating to the arms or legs. There may also be a disturbance of feeling in the limbs.

Symptoms of pressure on the spinal cord

Disturbance of feeling, muscle spasms or paralysis in the part of the body below the spinal cord pressure. For example, pressure on the spinal cord in the chest area will cause spasms in the legs but not in the arms.

Pressure on the spinal cord may cause problems with control of the bladder.

Symptoms of pressure on the cauda equina

The symptoms can include loss of control of the bowel and/or bladder function, disturbance of feeling in the rectum and the saddle region; sometimes including the inside of the thighs and at worst, paralysis of both legs.

These are clearly very serious symptoms and anyone developing them should contact a doctor immediately. (They are so-called 'red flag' symptoms.)

How does the doctor make a diagnosis?

It is possible to make a diagnosis from the patient's history and the doctor's physical examination.

In many cases it is possible to determine which disc is affected. This can usually be confirmed either by a CT scan or MRI scan.

A myelogram may be used to find the cause of pain should MRI or CT scanning prove unsuccessful. Myelography is a radiographic technique involving an injection of contrast medium into the spinal cord canal, followed by as series of x-rays; and has now been largely superseded by MRI and CT imaging.

The doctor will decide which examination is necessary.

An ordinary X-ray of the spine is requested infrequently as it is not as helpful diagnostically compared to a scan or myelogram.

It is important to make a correct diagnosis because several other diseases have similar symptoms. Any 'red flag' symptoms must be acted upon without delay.

Complications of a slipped disc

Your spinal cord doesn't extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse's tail. Rarely, disk herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.

Seek emergency medical attention if you have:

- Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.

- Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.

- Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle - the inner thighs, back of legs and the area around the rectum.

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Arthritis

What is arthritis?

The US National Library of Medicine1 says that if you have trouble moving around or feel pain and stiffness in your body, you could have arthritis. In the majority of cases arthritis causes pain and swelling in the joints.

Eventually a swollen joint can suffer severe damage. In some cases, arthritis can cause problems in the patient's eye, skin or other organs.

Arthritis is not a single disease - it is a term that covers over 100 medical conditions. Osteoarthritis (OA) is the most common form of arthritis and generally affects elderly patients. Some forms of arthritis can affect people at a very early age.

causes arthritis

What causes arthritis?

In order to better understand what is going on when a person suffers from some form of arthritis, let us look at how a joint works.

Basically, a joint is where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move.

Cartilage covers the bone surface to stop the two bones from rubbing directly against each other. The covering of cartilage allows the joint to work smoothly and painlessly.

A capsule surrounds the joint. The space within the joint - the joint cavity - has synovial fluid. Synovial fluid nourishes the joint and the cartilage. The synovial fluid is produced by the synovium (synovial membrane) which lines the joint cavity.

If you have arthritis something goes wrong with the joint(s). What goes wrong depends on what type of arthritis you have. It could be that the cartilage is wearing away, a lack of fluid, autoimmunity (your body attacking itself), infection, or a combination of many factors.

Arthritis Research UK3 says that most types of arthritis are caused by a combination of several factors working together. The following factors may contribute towards a higher arthritis risk:

Your genetic makeup.

A physically demanding job, especially one with repetitive movements.

A previous injury.

Some infections or allergic reactions may cause short-term arthritis. When it is caused by an infection it is known as "reactive arthritis"

For a number of people certain foods can either bring on arthritis symptoms, or make existing ones worse.

Obesity, which places extra strain on joints.

Arthritis may also be caused by autoimmune disease.

Types of arthritis

There are over 100 types of arthritis. Here is a description of some common ones, together with the causes:

Osteoarthritis

With osteoarthritis, the cartilage loses its elasticity. If the cartilage is stiff it becomes damaged more easily. The cartilage, which acts as a shock absorber, will gradually wear away in some areas. As the cartilage becomes damaged tendons and ligaments become stretched, causing pain. Eventually the bones may rub against each other causing very severe pain.

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Rheumatoid arthritis

This is an inflammatory form of arthritis. The synovial membrane (synovium) is attacked, resulting in swelling and pain. If left untreated the arthritis can lead to deformity.

Rheumatoid arthritis is significantly more common in women than men and generally strikes when the patient is aged between 40 and 60. However, children and much older people may also be affected.

During the first ten years after diagnosis, patients with rheumatoid arthritis have a higher risk of blood clots.

rheumatoid arthritis

Infectious arthritis (septic arthritic)

Infectious arthritis is an infection in the synovial fluid and tissues of a joint. It is usually caused by bacteria, but could also be caused by fungi or viruses.

Bacteria, fungi or viruses may spread through the bloodstream from infected tissue nearby, and infect a joint.

Most susceptible people are those who already have some form of arthritis and develop an infection that travels in the bloodstream.

septic

Juvenile rheumatoid arthritis (JRA)

Juvenile rheumatoid arthritis is a type of arthritis that affects a person aged 16 or less. JRA can be various forms of arthritis; it basically means that a child has it.

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There are three main types:

  1. Pauciarticular JRA, the most common and mildest. The child experiences pain in up to 4 joints.
  2. Polyarticular JRA affects more joints and is more severe. As time goes by it tends to get worse.
  3. Systemic JRA is the least common. Pain is experienced in many joints. It can spread to organs. This can be the most serious JRA.

Signs and symptoms

Signs and symptoms

The symptoms of arthritis depend on the type, for example:

Osteoarthritis

The symptoms of osteoarthritis develop slowly and get worse as time goes by. There is pain in a joint, either during or after use, or after a period of inactivity. There will be tenderness when pressure is applied to the joint. The joint will be stiff, especially first thing in the morning.

The patient may find it harder to use the joint - it loses its flexibility. Some patients experience a grating sensation when they use the joint. Hard lumps, or bone spurs may appear around the joint. In some cases the joint might swell.

The most commonly affected joints are in the hips, hands, knees and spine.

Rheumatoid arthritis

The patient often finds the same joints in each side of the body are painfully swollen, inflamed, and stiff. The fingers, arms, legs and wrists are most commonly affected.

Symptoms are usually worst on waking up in the morning and the stiffness can last for 30 minutes at this time. The joint is tender when touched. Hands may be red and puffy. There may be rheumatoid nodules (bumps of tissue under the skin of the patient's arms).

Many patients with rheumatoid arthritis feel tired most of the time. Weight loss is common.

The smaller joints are usually noticeably affected first. Experts say patients with rheumatoid arthritis have problems with several joints at the same time.

As the arthritis progresses it spreads from the smaller joints in your hands, wrists, ankles and feet to your elbows, knees, hips, neck, shoulders and jaw.

Infectious arthritis

The patient commonly has a fever, joint inflammation and swelling with infectious arthritis. They will feel tenderness and/or a sharp pain. Often these symptoms are linked to an injury or another illness.

Most commonly affected areas are the knee, shoulder, elbow, wrist and finger. In the majority of cases just one joint is affected.

Juvenile rheumatoid arthritis

The patient is a child and will experience intermittent fevers which tend to peak in the evening and then suddenly disappear. Appetite will be poor and weight may be lost.

There may be blotchy rashes on arms and legs. Anemia is also common. The child may limp or have a sore wrist, finger, or knee. A joint may suddenly swell and stay larger than it usually is. The child may experience a stiff neck, hips or some other joint.

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Female Infertility

Infertility means that couples have been trying to get pregnant with frequent intercourse for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples in the United States. An estimated 10 to 15 percent of couples have trouble getting pregnant or getting to a successful delivery.

Infertility results from female infertility factors about one-third of the time and male infertility factors about one-third of the time. In the rest, the cause is either unknown or a combination of male and female factors.

The cause of female infertility can be difficult to diagnose, but many treatments are available. Treatment options depend on the underlying problem. Treatment isn't always necessary — many infertile couples will go on to conceive a child spontaneously.

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Symptoms

The main symptom of infertility is the inability of a couple to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can be a sign of lack of ovulation, which can be associated with female infertility. There may be no other outward signs or symptoms.

When to see a doctor

When to seek help depends, in part, on your age.

- If you're in your early 30s or younger, most doctors recommend trying to get pregnant for at least a year before having any testing or treatment.

- If you're between 35 and 40, discuss your concerns with your doctor after six months of trying.

- If you're older than 40, your doctor may want to begin testing or treatment right away.

Your doctor also may want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis.

Causes

To become pregnant, each of these factors is essential:

-    You need to ovulate. Achieving pregnancy requires that your ovaries produce and release an egg, a process known as ovulation. Your doctor can help evaluate your menstrual cycles and confirm ovulation.

-    Your partner needs sperm. For most couples, this isn't a problem unless your partner has a history of illness or surgery. Your doctor can run some simple tests to evaluate the health of your partner's sperm.

-    You need to have regular intercourse. You need to have regular sexual intercourse during your fertile time. Your doctor can help you better understand when you're most fertile during your cycle.

-    You need to have open fallopian tubes and a normal uterus. The egg and sperm meet in the fallopian tubes, and the pregnancy needs a healthy place to grow.

For pregnancy to occur, every part of the complex human reproduction process has to take place just right. The steps in this process are as follows:

- One of the two ovaries releases a mature egg.

- The egg is picked up by the fallopian tube.

- Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.

- The fertilized egg travels down the fallopian tube to the uterus.

- The fertilized egg implants and grows in the uterus.

In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of these factors.

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Ovulation disorders

Ovulation disorders, meaning you ovulate infrequently or not at all, account for infertility in about 25 percent of infertile couples. These can be caused by flaws in the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or by problems in the ovary itself.

  • Polycystic ovary syndrome (PCOS). In PCOS, complex changes occur in the hypothalamus, pituitary gland and ovaries, resulting in a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.
  • Hypothalamic dysfunction. The two hormones responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — are produced by the pituitary gland in a specific pattern during the menstrual cycle. Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt this pattern and affect ovulation. The main sign of this problem is irregular or absent periods.
  • Premature ovarian insufficiency. This disorder is usually caused by an autoimmune response where your body mistakenly attacks ovarian tissues or by premature loss of eggs from your ovary due to genetic problems or environmental insults such as chemotherapy. It results in the loss of the ability to produce eggs by the ovary, as well as a decreased estrogen production under the age of 40.
  • Too much prolactin. Less commonly, the pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Most commonly this is due to a problem in the pituitary gland, but it can also be related to medications you're taking for another disease.

Damage to fallopian tubes (tubal infertility)

When fallopian tubes become damaged or blocked, they keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

  • Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
  • Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg becomes implanted and starts to develop in a fallopian tube instead of the uterus
  • Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in the United States

Endometriosis

Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may obstruct the tube and keep the egg and sperm from uniting. It can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Uterine or cervical causes

Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage.

  • Benign polyps or tumors (fibroids or myomas) are common in the uterus, and some types can impair fertility by blocking the fallopian tubes or by disrupting implantation. However, many women who have fibroids or polyps can become pregnant.
  • Endometriosis scarring or inflammation within the uterus can disrupt implantation.
  • Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
  • Cervical stenosis, a cervical narrowing, can be caused by an inherited malformation or damage to the cervix.
  • Sometimes the cervix can't produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Unexplained infertility

In some instances, a cause for infertility is never found. It's possible that a combination of several minor factors in both partners underlie these unexplained fertility problems. Although it's frustrating to not get a specific answer, this problem may correct itself with time.

Polycystic ovaries تكيس المبايض  fallopian image

 fshfibroids-faqs

Prevention

If you're a woman thinking about getting pregnant soon or in the future, you may improve your chances of having normal fertility if you:

  • Maintain a normal weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than seven hours a week has been associated with decreased ovulation.
  • Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
  • Avoid alcohol. Heavy alcohol use may lead to decreased fertility. And any alcohol use can affect the health of a developing fetus. If you're planning to become pregnant, avoid alcohol, and don't drink alcohol while you're pregnant.
  • Reduce stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. If you can, find a way to reduce stress in your life before trying to become pregnant.
  • Limit caffeine. Some physicians suggest limiting caffeine intake to less than 200 to 300 milligrams a day.

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Premature Ejaculation

Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it's not cause for concern.

However, you may meet the diagnostic criteria for premature ejaculation if you:

-      Always or nearly always ejaculate within one minute of penetration

-      Are unable to delay ejaculation during intercourse all or nearly all of the time

-      Feel distressed and frustrated, and tend to avoid sexual intimacy as a result

Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.

premature ejaculation 1 definition en

Symptoms

The primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.

Premature ejaculation can be classified as lifelong (primary) or acquired (secondary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you've had previous sexual experiences without ejaculatory problems.

Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these may have natural variable premature ejaculation, which is characterized by periods of rapid ejaculation as well as periods of normal ejaculation.

When to see a doctor

Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.

For some men, a conversation with their doctor may help alleviate concerns about premature ejaculation. For example, it may be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.

Causes

The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of psychological and biological factors.

Psychological causes

Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

- Situations in which you may have hurried to reach climax in order to avoid being discovered

-  Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role in causing premature ejaculation include:

- Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.

- Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.

- Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes

A number of biological factors may contribute to premature ejaculation, including:

-      Abnormal hormone levels

-      Abnormal levels of brain chemicals called neurotransmitters

-      Abnormal reflex activity of the ejaculatory system

-      Certain thyroid problems

-      Inflammation and infection of the prostate or urethra

-      Inherited traits

-      Nerve damage from surgery or trauma (rare)

Complications

While premature ejaculation alone doesn't increase your risk of health problems, it can cause significant problems in your personal life, including:

- Stress and relationship problems. A common complication of premature ejaculation is relationship stress.

- Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to have a baby.

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Impotence {Erectile Dysfunction (ED)}

Impotence is a common problem among men and is characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. Erectile dysfunction can vary. It can involve a total inability to achieve an erection or ejaculation, an inconsistent ability to do so, or a tendency to sustain only very brief erections.

The risk of impotence increases with age. It is fourfold higher in men in their 60s compared with those in their 40s according to a study published in the Journal of Urology. Men with less education are also more likely to experience impotence, perhaps because they tend to have less healthy lifestyles, eat a less healthy diet, drink more, and exercise less.

Causes of impotence are many and include blood vessel diseases (such as peripheral vascular disease and others), systemic disease, hormonal imbalance, and medications (such as blood pressure and heart medications).

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Symptoms

Being unable to have or keep an erection adequate for sexual activity is the defining mark of erectile dysfunction. The problem may manifest itself in several ways. If the dysfunction:

-   Is transient or appearing only occasionally, the problem is not likely to be serious; all men experience problems with erections at some time in their lives.

-   Develops gradually and persistently, there is probably a physical cause; this is generally the case with chronic impotence.

-  Develops abruptly but you still have early-morning erections and are able to have an erection while masturbating, the problem is likely to have a psychological component, perhaps with an underlying physical factor.

Causes

Common psychological causes include:

-      nerves – especially about performing

-      guilt – notably if you're trying to have sex with somebody else's wife

-      relationship problems – especially if you're no longer keen on your partner

-      latent gayness – for instance, if you’re a basically gay guy, trying to have sex with a woman

-      depression

-      exhaustion.

In a lot of cases, ED turns out to be due to a mixture of psychological and physical causes.

Common physical causes include:

-      deterioration of the arteries – this is a physical change which is common in older men, including those with high blood pressure

-      diabetes

-      smoking

-      excessive drinking (hence the phrase 'Brewer's droop')

-      being obese and out-of-condition

-      side-effects of certain drugs, notably ones for blood pressure and depression

-      effects of recreational drugs, like cocaine

-      major surgery in the abdomen – particularly on the prostate gland.

Less common physical causes include:

-      excessive drainage of blood from the veins of the penis (venous leak(

-      diseases of the nervous system

-      injury to the spinal cord or brain

-      hormone problems , including excess production of a pituitary hormone called prolactin (this is rare)

erectile-dysfunction

Complications

-      An unsatisfactory sex life

-      Stress or anxiety

-      Embarrassment or low self-esteem

-      Marital or relationship problems

-     The inability to get your partner pregnant

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health problems you have. Here are some things you can do:

- Work with your doctor to manage diabetes, heart disease or other chronic health problems.

- See your doctor for regular checkups and medical screening tests.

- Stop smoking, limit or avoid alcohol, and don't use street drugs.

- Exercise regularly.

- Take steps to reduce stress.

- Get help for anxiety or depression.

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penis

The penis is the male sex organ, reaching its full size during puberty. In addition to its sexual function, the penis acts as a conduit for urine to leave the body.

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The penis is made of several parts:

• Glans (head) of the penis: In uncircumcised men, the glans is covered with pink, moist tissue called mucosa. Covering the glans is the foreskin (prepuce). In circumcised men, the foreskin is surgically removed and the mucosa on the glans transforms into dry skin.

• Corpus cavernosum: Two columns of tissue running along the sides of the penis. Blood fills this tissue to cause an erection.

• Corpus spongiosum: A column of sponge-like tissue running along the front of the penis and ending at the glans penis; it fills with blood during an erection, keeping the urethra -- which runs through it -- open.

• The urethra runs through the corpus spongiosum, conducting urine out of the body.

An erection results from changes in blood flow in the penis. When a man becomes sexually aroused, nerves cause penis blood vessels to expand. More blood flows in and less flows out of the penis, hardening the tissue in the corpus cavernosum.

penis

The average penis size

I say there are only two types of penises: ‘grow-ers’ and ‘show-ers’. Grow-ers are those men with short flaccid penises. As their penises becomes erect, the shaft grows much longer. The difference between their penis size soft and hard can be several inches. Show-ers are those whose penises tend to hang long, even when flaccid. When their penises go from soft to hard, their length may hardly change. The penis simply fills with blood and becomes stiff, rather than longer. Never judge a softie! As far as size of the erect penis, the general range is between 5-6 inches, with a wider range of self reporting men stating sizes between 4.8 inches to 7 inches (12-17.5 cms). Circumference of an erect penis is between 3-5 inches (7.5-12.5 cms).

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Sperm

Sperm is the male reproductive cell in vertebrates. The term is derived from the Greek word "sperma" meaning "seed". Sperm were first observed under a microscope in 1677 by Antonie van Leeuwenhoek who described them as little animals or animalcules.

The cellular biology of a sperm

Each human cell contains 23 pairs of chromosomes. These undergo division in a process called mitosis. Mitosis produces daughter cells that contain 23 pairs of chromosomes, one one half of which is inherited from the mother and the other from the father.

sperm 640

Structure of the sperm

When the sperm has the usual single flagellum (or "tail"), it is called a spermatozoon and may be described as uniflagellate. The flagellum moves in a whip-like manner, propelling the the sperm towards the egg and uniflagellated sperm are also termed motile sperm.

A non-motile sperm that lacks a flagellum is called a spermatium. A sperm may contain an X chromosome and produce female off spring after fertilizing the ovum or it may have a Y chromosome, in which case fertilization will lead to the development of male offspring.

The sperm consists of a head that is about 5 µm by 3 µm in size and a flagellum of around 50 μm in length. There is little cytoplasm in sperm and the "head" is densely packed with DNA. Sperm is released from the male in a fluid called semen. Semen is alkaline and does not allow the sperm to be completely motile until they reach the female reproductive tract or the vagina which is acidic in pH.

structure of sperm

Sperm Production

Sperm are produced, stored, and delivered by the male reproductive system. The male reproductive system includes the testes, urethra, vas deferens, prostate gland, seminal vesicle, and penis.

The testes contain coiled structures called seminiferous tubules, which are the sites of sperm production. They produce over 12 billion sperm per month. The epididymis lies on top of the seminiferous tubules. Immature sperm migrate from the seminiferous tubules to the epididymis to mature and be stored.

Sperm Production

low-sperm-count:

Low sperm count means that the fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal. A low sperm count is also called oligospermia (ol-ih-go-SPUR-me-uh). A complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per milliliter of semen.

Having a low sperm count decreases the odds that one of your sperm will fertilize your partner's egg, resulting in pregnancy. Nonetheless, many men who have a low sperm count are still able to father a child.

low-sperm-count

Symptoms

The main sign of low sperm count is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, an underlying problem such as an inherited hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms. Low sperm count symptoms may include:

  • Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling or a lump in the testicle area
  • Decreased facial or body hair or other signs of a chromosome or hormone abnormality

Causes

Medical causes

Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:

- Varicocele. A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It's a common cause of male infertility.

- Infection. Some infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, such as chlamydia and gonorrhea; inflammation of the prostate (prostatitis); inflamed testicles; and other infections of the urinary tract or reproductive organs.

- Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also may result in retrograde ejaculation, such as blood pressure medications known as alpha blockers. Some men with spinal cord injuries or certain diseases can't ejaculate semen at all, though they still can produce sperm.

- Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, or can affect the glands that release hormones related to reproduction (such as the pituitary gland). Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.

- Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.

- Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal, may impair sperm production.

- Sperm duct defects. The tubes that carry sperm can be damaged by illness or injury. Some men are born with a blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one of the tubes that carry sperm out of the testicles (vas deferens). Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.

- Chromosome defects. Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann's syndrome and Kartagener syndrome.

- Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.

- Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications and some other medications can impair sperm production and decrease male fertility.

Environmental causes

Overexposure to certain environmental elements can affect sperm production or function. Specific causes include:

-      Industrial chemicals.

-      Heavy metal exposure.

-      Radiation or X-rays.

-   Overheating the testicles. Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or using a laptop on your lap for long periods of time also may increase the temperature in your scrotum and reduce sperm production.

Health, lifestyle and other causes

Other causes of low sperm count include:

-      Illegal drug use.

-      Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.

-      Tobacco smoking.

-      Emotional stress.

-      Weight.

The Semen Analysis

What are they looking for?

Sperm count.

Ability of sperm to swim (motility).

Velocity or forward progression of the sperm.

Size and shape of the sperm (morphology).

Total semen volume.

The liquefaction of the semen (the ability to go from normal gel-like state at ejaculation to a liquid state).

semen analysis

If the results of the analysis are as follows:
- Size: about 3 mL (2-6).
- Number: 20 million sperm per milliliter or more.
- Movement: 50% of the sperm are still active after moving two hours.
- At least 60% of the sperm in the sample appears to be normal is distorted or dead.
This means that the results are normal.

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Ulcers

There is no clear evidence to suggest that the stress of modern life or a steady diet of fast food causes ulcers in the stomach and small intestine, but they are nonetheless common in our society.

Peptic ulcers are holes or breaks in the protective lining of the duodenum (the upper part of the small intestine) or the stomach - areas that come into contact with stomach acids and enzymes. Duodenal ulcers are more common than stomach ulcers. Comparatively rare are esophageal ulcers, which form in the esophagus - or swallowing tube - and are often a result of alcohol abuse.

Until the mid-1980s, the conventional wisdom was that ulcers form as a result of stress, a genetic predisposition to excessive stomach acid secretion, and poor lifestyle habits (including overindulging in rich and fatty foods, alcohol, caffeine, and tobacco). It was believed that such influences contribute to a buildup of stomach acids that erode the protective lining of the stomach, duodenum, or esophagus.

While excessive stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers. Indeed, research conducted since the mid-1980s has persuasively demonstrated that the bacterium Helicobacter pylori (H. pylori) is present in more than 90% of duodenal ulcers and about 80% of stomach ulcers.

Other factors also seem to contribute to ulcer formation. Overuse of over-the-counter painkillers (such as aspirin, ibuprofen, and naproxen), heavy alcohol use, and smoking exacerbate and may promote the development of ulcers. Research indicates that heavy smokers are more prone to developing duodenal ulcers than are nonsmokers, that people who drink alcohol are more susceptible to esophageal ulcers, and that those who take aspirin frequently for a long period of time are more likely to develop stomach ulcers than those who don't.

Peptic-ulcers-lg-enlg image001

Causes

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:

-  Infection with a type of bacteria called Helicobacter pylori (H. pylori).

- Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even safety-coated aspirin and aspirin in powered form can frequently cause ulcers.

- Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output.

Symptoms

The following are the most common symptoms of ulcers. However, each individual may experience symptoms differently.

Although ulcers do not always cause symptoms, the most common ulcer symptom is a gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in the early hours of the morning. It may last from a few minutes to a few hours. Less common ulcer symptoms may include:

-      Belching

-      Nausea

-      Vomiting

-      Poor appetite

-      Loss of weight

-      Feeling tired and weak

The symptoms of stomach and duodenal ulcers may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Complications

People with ulcers may experience serious complications if they do not seek appropriate treatment. The most common problems include the following:

- Bleeding. As an ulcer eats into the muscles of the stomach or duodenal wall, blood vessels may become damaged, causing bleeding.

- Perforation. Sometimes, an ulcer eats a hole in the wall of the stomach or duodenum, and bacteria and partially digested food can spill through the opening into the sterile abdominal cavity (known as the peritoneum) and cause peritonitis, severe inflammation of the abdominal cavity and wall.

- Narrowing and obstruction. Ulcers located at the end of the stomach, where the duodenum is attached, can cause swelling and scarring, which can narrow or close the intestinal opening. This obstruction can prevent food from leaving the stomach and entering the small intestine, resulting in vomiting the contents of the stomach.

Diagnosis

Because protocols vary for different types of ulcers, it is important to diagnose the underlying cause of ulcer disease properly before starting treatment. For example, for an NSAID-induced ulcer, treatment is quite different from the treatment for a person diagnosed with an ulcer caused by the bacterium, H. pylori.

There are a number of options available for diagnosing ulcers, and for testing for the H. pylori bacterium. These diagnostic procedures include:

- Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

- Esophagogastroduodenoscopy (also called EGD or upper endoscopy). An EGD (upper endoscopy) is aprocedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

- Blood, breath, and stomach tissue tests. These tests are performed to detect the presence of H. pylori. Although some of the tests for H. pylori may occasionally give false-positive results, or may give false-negative results in people who have recently taken antibiotics, omeprazole, or bismuth, research shows these tests can be helpful in detecting the bacteria and guiding treatment.

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Stones of Kidney - Ureter - Bladder - Gallbladder

kindy ueter bladder

h9991361 002

Kidney and Uretral Stones

Stone disease is among the most painful and prevalent urological disorders. More than a million kidney stone cases are diagnosed each year with an estimated 10 percent of Americans destined to suffer from kidney stones at some point in their lives.

The incidence of urolithiasis, or stone disease, is about 12% by age 70 for males and 5-6% for females in the United States. Additionally, the gender gap may be decreasing as more women are being diagnosed and treated for kidney stones. The reason for the change is of the dietary and climate changes in our population. The debilitating effects of kidney stones is quite substantial, with patients incurring billions of dollars in treatment costs each year.

Fortunately, most stones pass out of the body without any intervention. If you are not so lucky, the following information should help you and your doctor address the causes, symptoms and possible complications created by your kidney stone disease.

What are stones and the difference between kidney stones and ureteral stones?

Normally, urine contains many dissolved substances. At times, some materials may become concentrated in the urine and form solid crystals. These crystals can lead to the development of stones when materials continue to build up around them, much as a pearl is formed in an oyster.

Stones formed in the kidney are called kidney stones. Ureteral stone is a kidney stone that has left the kidney and moved down into the ureter.

The majority of stones contain calcium, with most of it being comprised of a material called calcium oxalate. Other types of stones include substances such as calcium phosphate, uric acid, cystine and struvite.

Stones form when there is an imbalance between certain chemical urinary components such as calcium, oxalate and phosphate. These chemical components either promote crystallization while others inhibit it.

The most common stones contain calcium in combination with oxalate and/or phosphate.

A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Much less common are the pure uric acid stones. Much rarer is the hereditary type of stones called cystine stones and even more rare are those linked to other hereditary disorders.

kidney stone ureteric stone

Symptoms

A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, these signs and symptoms may occur:

-      Severe pain in the side and back, below the ribs

-      Pain that spreads to the lower abdomen and groin

-      Pain that comes in waves and fluctuates in intensity

-      Pain on urination

-      Pink, red or brown urine

-      Cloudy or foul-smelling urine

-      Nausea and vomiting

-      Persistent urge to urinate

-      Urinating more often than usual

-      Fever and chills if an infection is present

Pain caused by a kidney stone may change - for instance, shifting to a different location or increasing in intensity - as the stone moves through your urinary tract.

Causes

Kidney stones often have no definite, single cause, although several factors may increase your risk.

Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid - than the fluid in your urine can dilute. At the same time, your urine may lack substances that keep crystals from sticking together, creating an ideal environment for kidney stones to form.

Types of kidney stones

Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. Types of kidney stones include:

  • Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. Your liver also produces oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones may also occur in the form of calcium phosphate.
  • Struvite stones. Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
  • Uric acid stones. Uric acid stones can form in people who don't drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.
  • Cystine stones. These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).
  • Other stones. Other, rarer types of kidney stones can occur.

Bladder stones

Bladder stones are hard masses of minerals in your bladder. Bladder stones develop when urine in your bladder becomes concentrated, causing minerals in your urine to crystallize. Concentrated, stagnant urine is often the result of not being able to completely empty your bladder.

Bladder stones don't always cause signs or symptoms and may be discovered during tests for other problems. When symptoms do occur, they can range from abdominal pain to blood in your urine.

Small bladder stones sometimes pass on their own, but you may need to have others removed by your doctor. Left untreated, bladder stones can cause infections and other complications.

bladder stone

Symptoms

Some people with bladder stones have no problems — even when their stones are large. But if a stone irritates the bladder wall or blocks the flow of urine, signs and symptoms can develop. These include:

  • Lower abdominal pain
  • In men, pain or discomfort in the penis
  • Painful urination
  • Frequent urination
  • Difficulty urinating or interruption of urine flow
  • Blood in your urine
  • Cloudy or abnormally dark-colored urine

Causes

Bladder stones generally begin when your bladder doesn't empty completely. The urine that's left in your bladder can form crystals that eventually become bladder stones. In most cases, an underlying condition affects your bladder's ability to empty completely.

The most common conditions that cause bladder stones include:

  • Prostate gland enlargement. An enlarged prostate, or benign prostatic hyperplasia (BPH), can cause bladder stones in men. As the prostate enlarges, it can compress the urethra and interrupt urine flow, causing urine to remain in your bladder.
  • Damaged nerves (neurogenic bladder). Normally, nerves carry messages from your brain to your bladder muscles, directing your bladder muscles to tighten or release. If these nerves are damaged — from a stroke, spinal cord injury or other health problem — your bladder may not empty completely.

Other conditions that can cause bladder stones include:

  • Bladder stones can develop if your bladder becomes inflamed. Urinary tract infections and radiation therapy to your pelvic area can both cause bladder inflammation.
  • Medical devices. Occasionally, bladder catheters — slender tubes inserted through the urethra to help urine drain from your bladder — can cause bladder stones. So can objects that accidentally migrate to your bladder, such as a contraceptive device or stent. Mineral crystals, which later become stones, tend to form on the surface of these devices.
  • Kidney stones. Stones that form in your kidneys are not the same as bladder stones. They develop in different ways and often for different reasons. But small kidney stones occasionally travel down the ureters into your bladder and, if not expelled, can grow into bladder stones.

Gall Stones

Gallstones form in the gallbladder, a small organ located under the liver. The gallbladder aids in the digestive process by storing bile and secreting it into the small intestine when food enters. Bile is a fluid produced by the liver and is made up of several substances, including cholesterol, bilirubin, and bile salts.

What Are Gallstones?

Gallstones are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.

The two main types of gallstones are:

- Cholesterol stones: Usually yellow-green in color, approximately 80% of gallstones are cholesterol stones.

- Pigment stones: These stones are smaller and darker and are made up of bilirubin.

gall

Causes

Several factors may come together to create gallstones, including:

  • Genetics
  • Body weight
  • Decreased motility (movement) of the gallbladder
  • Diet

Gallstones can form when there is an imbalance in the substances that make up bile. For instance, cholesterol stones may develop as a result of too much cholesterol in the bile. Another cause may be the inability of the gallbladder to empty properly.

Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease in which scar tissue replaces healthy liver tissue) or blood diseases such as sickle cell anemia.

Symptoms

Gallstones often don't cause symptoms. Those that don't are called "silent stones." A person usually learns he or she has gallstones while being examined for another illness.

When symptoms do appear, they may include:

  • Pain in the upper abdomen and upper back. The pain may last for several hours.
  • Nausea
  • Vomiting
  • Other gastrointestinal problems, including bloating, indigestion and heartburn, and gas

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Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a functional gastrointestinal (GI) disorder, meaning symptoms are caused by changes in how the GI tract works. People with a functional GI disorder have frequent symptoms; however, the GI tract does not become damaged. IBS is a group of symptoms that occur together, not a disease. In the past, IBS was called colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel. The name was changed to reflect the understanding that the disorder has both physical and mental causes and is not a product of a person’s imagination.

IBS is diagnosed when a person has had abdominal pain or discomfort at least three times a month for the last 3 months without other disease or injury that could explain the pain. The pain or discomfort of IBS may occur with a change in stool frequency or consistency or be relieved by a bowel movement.

IBS is often classified into four subtypes based on a person’s usual stool consistency. These subtypes are important because they affect the types of treatment that are most likely to improve the person’s symptoms.

ibs

The four subtypes of IBS are

  • IBS with constipation (IBS-C)

-hard or lumpy stools at least 25 percent of the time

-loose or watery stools less than 25 percent of the time

  • IBS with diarrhea (IBS-D)

-loose or watery stools at least 25 percent of the time

-hard or lumpy stools less than 25 percent of the time

  • Mixed IBS (IBS-M)

-hard or lumpy stools at least 25 percent of the time

-loose or watery stools at least 25 percent of the time

  • Unsubtyped IBS (IBS-U)

-hard or lumpy stools less than 25 percent of the time

-loose or watery stools less than 25 percent of the time

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What is the GI tract?

The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus—the opening through which stool leaves the body. Food is digested by the movement of muscles in the GI tract, along with the release of hormones and enzymes. Organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine—which includes the appendix, cecum, colon, and rectum—and anus. The intestines are sometimes called the bowel. The last part of the GI tract—called the lower GI tract—consists of the large intestine and anus.

The large intestine absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is located between the last part of the colon—called the sigmoid colon—and the anus. The rectum stores stool prior to a bowel movement. During a bowel movement, stool moves from the rectum to the anus.

GI Tract IBS

Symptoms

The most common symptoms of IBS are abdominal pain or discomfort, often reported as cramping, along with changes in bowel habits. To meet the definition of IBS, the pain or discomfort will be associated with at least two of the following three symptoms:

  • bowel movements that occur more or less often than usual
  • stool that appears less solid and more watery, or harder and more lumpy, than usual
  • bowel movements that improve the discomfort

Other symptoms of IBS may include

  • diarrhea—having loose, watery stools three or more times a day and feeling urgency to have a bowel movement.
  • constipation—having fewer than three bowel movements a week. During a bowel movement, stools can be hard, dry, and small, making them difficult to pass. Some people find it painful and often have to strain to have a bowel movement.
  • feeling that a bowel movement is incomplete.
  • passing mucus—a clear liquid made by the intestines that coats and protects tissues in the GI tract.
  • abdominal bloating.

Symptoms may often occur after eating a meal. To meet the definition of IBS, symptoms must occur at least three times a month.

Causes

It's not known exactly what causes irritable bowel syndrome, but a variety of factors play a role. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal, causing gas, bloating and diarrhea. Or the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools.

Abnormalities in your gastrointestinal nervous system also may play a role, causing you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhea or constipation.

Triggers vary from person to person

Stimuli that don't bother other people can trigger symptoms in people with IBS — but not all people with the condition react to the same stimuli. Common triggers include:

  • The role of food allergy or intolerance in irritable bowel syndrome is not yet clearly understood, but many people have more severe symptoms when they eat certain things. A wide range of foods has been implicated — chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol to name a few.
  • Most people with IBS find that their signs and symptoms are worse or more frequent during periods of increased stress, such as finals week or the first weeks on a new job. But while stress may aggravate symptoms, it doesn't cause them.
  • Because women are twice as likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.
  • Other illnesses. Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) or too many bacteria in the intestines (bacterial overgrowth), can trigger IBS.

Diagnosis

To diagnose IBS, a health care provider will conduct a physical exam and take a complete medical history. The medical history will include questions about symptoms, family history of GI disorders, recent infections, medications, and stressful events related to the onset of symptoms. An IBS diagnosis requires that symptoms started at least 6 months prior and occurred at least three times a month for the previous 3 months. Further testing is not usually needed, though the health care provider may perform a blood test to screen for other problems. Additional diagnostic tests may be needed based on the results of the screening blood test and for people who also have signs such as:

- fever, rectal bleeding, weight loss

- anemia—too few red blood cells in the body, which prevents the body from getting enough oxygen

- family history of colon cancer

- family history of inflammatory bowel disease—long-lasting disorders that cause irritation and ulcers, or sores, in the GI tract

Additional diagnostic tests may include a stool test, lower GI series, and flexible sigmoidoscopy or colonoscopy. Colonoscopy may also be recommended for people who are older than age 50 to screen for colon cancer.

Complications

Diarrhea and constipation, both signs of irritable bowel syndrome, can aggravate hemorrhoids. In addition, if you avoid certain foods, you may not get enough of the nutrients you need, leading to malnourishment.

But the condition's impact on your overall quality of life may be the most significant complication. These effects of IBS may cause you to feel you're not living life to the fullest, leading to discouragement or depression.

IBD-shutterstock 14214397

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Psoriasis

Psoriasis is a common skin condition that changes the life cycle of skin cells. Psoriasis causes cells to build up rapidly on the surface of the skin. The extra skin cells form thick, silvery scales and itchy, dry, red patches that are sometimes painful.

Psoriasis is a persistent, long-lasting (chronic) disease. There may be times when your psoriasis symptoms get better alternating with times your psoriasis worsens.

The primary goal of treatment is to stop the skin cells from growing so quickly. While there isn't a cure, psoriasis treatments may offer significant relief. Lifestyle measures, such as using a nonprescription cortisone cream and exposing your skin to small amounts of natural sunlight, also may improve your psoriasis symptoms.

psoriasis-skin-deep

Symptoms

Psoriasis signs and symptoms can vary from person to person but may include one or more of the following:

  • Red patches of skin covered with silvery scales
  • Small scaling spots (commonly seen in children)
  • Dry, cracked skin that may bleed
  • Itching, burning or soreness
  • Thickened, pitted or ridged nails
  • Swollen and stiff joints

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

Several types of psoriasis exist. These include:

  • Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body, including your genitals and the soft tissue inside your mouth. You may have just a few plaques or many.
  • plaque-psoriasis-pictures
  • Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
  • Nail-psoriasis
  • Scalp psoriasis. Psoriasis on the scalp appears as red, itchy areas with silvery-white scales. The red or scaly areas often extend beyond the hairline. You may notice flakes of dead skin in your hair or on your shoulders, especially after scratching your scalp.
  • scalp-psoriasis-e1344517065278
  • Guttate psoriasis. This primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, water-drop-shaped sores on your trunk, arms, legs and scalp. The sores are covered by a fine scale and aren't as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.
  • cut por
  • Inverse psoriasis. Mainly affecting the skin in the armpits, in the groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It's worsened by friction and sweating. Fungal infections may trigger this type of psoriasis.
  • psoriasis inverse
  • Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.
  • pustular psoriasis
  • Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.
  • psoriasis-erythrodermic-29
  • Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually isn't as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.

Psoriatic arthritis2010

Causes

The cause of psoriasis isn't fully known, but it's thought to be related to an immune system problem with cells in your body. More specifically, one key cell is a type of white blood cell called a T lymphocyte or T cell. Normally, T cells travel throughout the body to detect and fight off foreign substances, such as viruses or bacteria. If you have psoriasis, however, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells trigger other immune responses. The effects include dilation of blood vessels in the skin around the plaques and an increase in other white blood cells that can enter the outer layer of skin. These changes result in an increased production of both healthy skin cells and more T cells and other white blood cells. This causes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Dead skin and white blood cells can't slough off quickly enough and build up in thick, scaly patches on the skin's surface. This usually doesn't stop unless treatment interrupts the cycle.

Just what causes T cells to malfunction in people with psoriasis isn't entirely clear. Researchers have found genes that are linked to the development of psoriasis, but environmental factors also play a role.

Psoriasis triggers

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

  • Infections, such as strep throat or skin infections
  • Injury to the skin, such as a cut or scrape, bug bite, or a severe sunburn
  • Stress
  • Cold weather
  • Smoking
  • Heavy alcohol consumption
  • Certain medications — including lithium, which is prescribed for bipolar disorder; high blood pressure medications such as beta blockers; antimalarial drugs; and iodides.

Complications

If you have psoriasis, you're at greater risk of developing certain diseases. These include:

  • Psoriatic arthritis. This complication of psoriasis can cause joint damage and a loss of function in some joints, which can be debilitating.
  • Eye conditions. Certain eye disorders — such as conjunctivitis, blepharitis and uveitis — are more common in people with psoriasis.
  • People with psoriasis, especially those with more severe disease, are more likely to be obese. It's not clear how these diseases are linked, however. The inflammation linked to obesity may play a role in the development of psoriasis. Or it may be that people with psoriasis are more likely to gain weight, possibly because they're less active because of their psoriasis.
  • Type 2 diabetes. The risk of type 2 diabetes is upped in people with psoriasis. The more severe the psoriasis, the greater the likelihood of type 2 diabetes.
  • High blood pressure. The odds of having high blood pressure are higher for people with psoriasis.
  • Cardiovascular disease. For people with psoriasis, the risk of heart attack is almost three times greater than for those without the disease. The risk of irregular heartbeats and stroke is also higher in those with psoriasis. This could be due to excess inflammation or to an increased risk of obesity and other risk factors for cardiovascular disease. Some psoriasis treatments may cause abnormal cholesterol levels and increase the risk of hardened arteries.
  • Metabolic syndrome. This is a cluster of conditions — including high blood pressure, elevated insulin levels and abnormal cholesterol levels — that increases your risk of heart disease. People with psoriasis have a higher risk of metabolic syndrome.
  • Other autoimmune diseases. Celiac disease, sclerosis and the inflammatory bowel disease called Crohn's disease are more likely to strike people with psoriasis.
  • Parkinson's disease. This chronic neurological condition is more likely to occur in people with psoriasis.
  • Kidney disease. Moderate to severe psoriasis has been linked to a higher risk of kidney disease.

Psoriasis can also affect your quality of life by increasing your risk of:

  • Low self-esteem
  • Depression
  • Social isolation
  • Problems at work, which can lead to a lower income

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Vitiligo

Vitiligo (vit-ih-LIE-go) is a disease that causes the loss of skin color in blotches. The extent and rate of color loss from vitiligo is unpredictable. It can affect the skin on any part of your body. It may also affect hair, the inside of the mouth and even the eyes.

Normally, the color of hair, skin and eyes is determined by melanin. Vitiligo occurs when the cells that produce melanin die or stop functioning.

Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself.

vitiligo T vitiligo 3 030116

Symptoms

The main sign of vitiligo is color (pigment) loss that produces light or white patches on your skin. Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face and lips.

Vitiligo signs include:

- Skin discoloration

- Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard (usually before age 35)

- Loss of color in the tissues that line the inside of your mouth and nose (mucous membranes)

Loss of or change in color of the inner layer of the eyeball (retina)

- Discolored patches around the armpits, navel, genitals and rectum

- Vitiligo can start at any age, but most often appears before age 20.

Depending on the type of vitiligo you have, the discolored patches may cover:

- Many parts of your body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).

- Only one side or part of your body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.

- One or only a few areas of your body. This type is called localized (focal) vitiligo.

It's difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Rarely, the skin gets its color back.

Causes

Vitiligo occurs when melanin-forming cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair and eyes color. The involved patches of skin become lighter or white. Doctors don't know why the cells fail or die. It may be related to:

A disorder in which your immune system attacks and destroys the melanocytes in the skin

- Family history (heredity)

A trigger event, such as sunburn, stress or exposure to industrial chemicals

Complications

People with vitiligo may be at increased risk of:

- Social or psychological distress

- Sunburn and skin cancer

- Eye problems, such as inflammation of the iris (iritis)

- Hearing loss

- Side effects due to treatment, such as dry skin and itching

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Eczema

Eczema is "a general term for any superficial inflammatory process involving the epidermis primarily, marked early by redness, itching, minute papules and vesicles, weeping, oozing and crusting, and later by scaling, lichenification and often pigmentation" It is also used specifically to refer to the condition atopic dermatitis.

The word eczema comes from the Greek word ekzein meaning "to boil out"; the Greek word ek means "out" while the Greek word zema means "boiling"

The term 'eczema' is used in two different ways. It can be used widely to describe any rash-like skin conditions. It is usually used specifically to refer to the most common type of these skin conditions: atopic dermatitis.

Atopic dermatitis is a chronic skin condition that commonly starts during infancy and continues through into childhood. Some people outgrow the condition while some people will continue to have it into adulthood.

page5 1

The word 'atopic' refers to a collection of diseases for which there is an inherited tendency to develop, including dermatitis, asthma and hay fever. 'Dermatitis' means inflammation of the skin.

There are many different types of eczema. This article will predominantly focus on atopic dermatitis. Other variants include:

-Allergic contact eczema (dermatitis) - a reaction where the skin has come into contact with a substance that the immune system recognizes as foreign

e1

-Contact eczema - a localized reaction where the skin has come into contact with an allergen

e2

-Dyshidriotic eczema - irritation of skin on palms of hands and soles of feet, characterized by blisters

e3

-Neurodermatitis - scaly patches of skin on head, forearms, wrists, lower legs caused by localized itch such as an insect bite

e4

-Nummular eczema - circular patches of irritated skin that can be crusted, scaling and itchy

e5

-Seborrheic eczema - oily, scaly yellowish patches of skin, usually on scalp and face

e6

-Stasis dermatitis - skin irritation on lower legs, usually related to circulatory problems.

e7

Symptoms

Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:

-Itching, which may be severe, especially at night

-Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and, in infants, the face and scalp

-Small, raised bumps, which may leak fluid and crust over when scratched

-Thickened, cracked, dry, scaly skin

-Raw, sensitive, swollen skin from scratching

Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.

Factors that worsen atopic dermatitis

Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin. This in turn may worsen symptoms, particularly in young children.

Factors that can worsen atopic dermatitis signs and symptoms include:

-Dry skin, which can result from long, hot baths or showers

-Scratching, which causes further skin damage

-Bacteria and viruses

-Stress

-Sweat

-Changes in heat and humidity

-Solvents, cleaners, soaps and detergents

-Wool in clothing, blankets and carpets

-Dust and pollen

-Tobacco smoke and air pollution

-Eggs, milk, peanuts, soybeans, fish and wheat, in infants and children

Atopic dermatitis is related to allergies. But eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition.

Causes

The exact cause of atopic dermatitis (eczema) is unknown. Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is likely related to a mix of factors:

-Dry, irritable skin, which reduces the skin's ability to be an effective barrier

-A gene variation that affects the skin's barrier function

-Immune system dysfunction

-Bacteria, such as Staphylococcus aureus, on the skin that creates a film that blocks sweat glands

-Environmental conditions

Complications

Complications of atopic dermatitis (eczema) include:

  • Asthma and hayfever. Eczema sometimes precedes these conditions.
  • Chronic itchy, scaly skin. A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. You scratch the area, which makes it even itchier. Eventually, you may scratch simply out of habit. This condition can cause the affected skin to become discolored, thick and leathery.
  • Skin infections. Repeated scratching that breaks the skin can cause open sores and cracks. These increase your risk of infection from bacteria and viruses, including the herpes simplex virus.
  • Eye problems. Signs and symptoms of eye complications include severe itching around the eyelids, eye watering, inflammation of the eyelid (blepharitis) and inflammation of the eyelid (conjunctivitis).
  • Irritant hand dermatitis. This especially affects people whose work requires that their hands are often wet and exposed to harsh soaps, detergents and disinfectants.
  • Allergic contact dermatitis. This condition is common in patients with atopic dermatitis. Many substances can cause an allergic skin reaction, including corticosteroids, drugs often used to treat people with atopic dermatitis.
  • Sleep problems. The itch-scratch cycle can cause you to awaken repeatedly and decrease the quality of your sleep.
  • Behavioral problems. Studies show a link between atopic dermatitis and attention-deficit/hyperactivity disorder, especially if a child is also losing sleep.

Prevention

The following tips may help prevent bouts of dermatitis (flares) and minimize the drying effects of bathing:

-Try to identify and avoid triggers that worsen the inflammation. Reduce your exposure to your unique triggers.

-Take shorter baths or showers. Limit your baths and showers to 10 to 15 minutes. And use warm, rather than hot, water. Bath oil also may be helpful.

-Use only gentle soaps. Choose mild soaps that clean without removing too many natural oils. Deodorant and antibacterial soaps may be more drying to your skin. Use soap only on your face, underarms, genital areas, hands and feet. Use clear water elsewhere.

-Dry yourself carefully. After bathing, brush your skin rapidly with the palms of your hands, or gently pat your skin dry with a soft towel and apply moisturizer.

-Moisturize your skin at least twice a day. Creams or lotions seal in moisture. Thicker moisturizers work best — such as Cetaphil, Nutraderm and Eucerin. You may also want to use cosmetics that contain moisturizers. If your skin is extremely dry, try applying baby oil or a similar product while your skin is still moist. Oil has more staying power than moisturizers do.

The difference between Eczema and Psoriasis

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