What is Tumor Lysis Syndrome?

Tumor Lysis Syndrome is a condition that tends to be precipitated after a cancer treatment. This condition is a group of symptoms and a complication from cancer treatment. Tumor lysis syndrome shouldn’t be taken lightly for it can provide grave effects. This is a medical emergency as this is life-threatening.

The incidence of this condition is not very clear today. But reported cases from all over the world suggests or provide evidence of tumor lysis syndrome is about 42% in occurrence to cancer treated patients. This condition does not choose a certain age group of people to affect. All age groups are affected from the condition. But it has been noted that advancing age or increasing age can precipitate the condition.

The condition can be diagnosed with laboratory examinations. Blood tests such as those that identify the levels of serum potassium, phosphate, calcium and uric acid levels shall help in the diagnosis of tumor lysis syndrome. If there is an increase in the potassium level, then it can cause for an alarm. The effects of increased potassium level, or hyperkalemia, are life-threatening. About an increase of 5mmol/dL from the normal level would indicate for hyperkalemia. Hyperphosphatemia or increased levels of serum phosphate is an indication of tumor lysis syndrome. Levels of BUN and creatinine should also be taken in order to assess if tumor lysis syndrome is an impending condition. Checking the patient’s urine pH is essential in order to identify for increase of uric acid in the body, this shall be identified or supported with excessive acidic urine. ECG is essential in order to watch out for changes in the cardiac status.

Symptoms

A person experiencing tumor lysis syndrome would experience the following symptoms:

• Nausea and vomiting
• Weakness or lethargy
• Edema, generalized or peripheral edema
• Congestive heart failure
• Cardiac symptoms such as arrhythmias
• Seizures
• Shortness of breath
• Muscle cramps or tetany
• Laboratory tests would show for hyperkalemia or increased serum potassium levels. The patient shall manifest weakness and parethesia. As the condition goes uncontrolled, hypocalcemia develops causing for tetany. Uremia or urine in the blood also develops. The patient shall experience difficulty in concentrating, restlessness and irritability. Uric acid levels would also increase causing for arthritis and renal colic.
• Complications include: life-threatening heart failure and metabolic acidosis.

Causes

The condition is believed to be a condition that is a result from cancer treatments such as radiotherapy and chemotherapy. Those patients who are treated for acute leukemia are quite at risk for the condition. As for those with related hematologic problems, this condition can place you in harm. It has been known that people who are sensitive to their treatments would also develop such syndrome. There are also rare cases wherein a patient who was under general anesthesia developed tumor lysis syndrome. Once a person is taking the following, they are prone to the development of tumor lysis syndrome:

• Radiotherapy
• Corticosteroids
• Hormonal agents
• Monoclonal antibodies

Treatment

The goal of treatment for tumor lysis syndrome lies to supportive care. This is done in order to avoid complications that are a great possibility of the condition. In order to avoid complications when a patient is under treatment for cancer, he or she should be closely monitored. Here are the following supportive cares for tumor lysis syndrome:

Frequent blood tests

This intervention helps in the assessment process. As this condition assist in the monitoring of patient’s serum levels, such as those significant in the patient’s health.

Frequent ECG tests

This is to monitor for abnormalities in the potassium levels. As hyperkalemia can provide a grave effect to the patient’s heart.

Dialysis

There are instances where the client is in need for cleansing his or her blood. This can be attained by hemodialysis, a procedure that involves ultra-filtration of the unhealthy contents in the blood.

Hydrate the client

This is aimed to supplement the client from increased water depletion. As this can also assist the client in expanding his or her fluid volume as well as intravascular volume.

Medications

These are the following medications provided for clients who are at risk for developing tumor lysis syndrome:

Allopurinol – This drug is of help in the avoidance of tumor lysis syndrome. As a person is at great risk for the development of increased uric acid levels, allopurinol can reduce that occurrence. Another form of medication for hyperuricemia is rasburicase. This new therapy can lower the uric acid levels in the blood. These are uricosurics, known agents that control serum uric acid levels.

Calcium supplements – These can be provided through medications or in diet modification. If a person has a decreased amount of calcium in the blood, this can result to muscle tetany, cramps, and seizures.

Kayexalate – This is administered in order to reduce the increased potassium levels. Along with that, foods rich in potassium are restricted.

Sodium bicarbonate – This is provided to clients in order to attain an alkaline serum. This is also good in stabilizing the pH levels of the blood.

Diuretics – Furosemide or mannitol is provided to clients to decrease uric acid levels in the system or renal tubules.

Electrolytes – The patient should be treated with electrolytes, to treat and restore one’s electrolyte balance.

As a patient is treated for cancer, it is important that he or she should be watched out carefully. This can be done by proper assessment and monitoring of the client. Frequent laboratory exams should be done in order to treat immediately cases of impending tumor lysis syndrome.

What is Premenstrual Syndrome?

Premenstrual syndrome or simplified as PMS is a condition that only occurs to women. This involves physical and psychological changes, making the affected feel burdened when experiencing such syndrome. This is basically rooted from women’s hormonal levels and changes. Premenstrual means symptoms or a group of symptoms occur before the onset of a woman’s menstrual flow.

PMS is a very common condition as reported. According to statistical reports, 80% of women who are menstruating experience premenstrual syndrome. The condition varies from one woman to another. It is noted that the condition occurs with different levels of intensity. Others even experience a more severe form of PMS which is called premenstrual dysphoric disorder, garnering about 2% to 6% of women.

According to the National Institute of Mental Health, the condition can be qualified as premenstrual syndrome when the woman experiences the symptoms of PMS 6 days prior to menstrual flow or even during the menstrual period. Criteria for PMS includes that it should affect two aspects of the person, these are the emotional and physical aspects.

Symptoms

A person suffering from premenstrual syndrome is expected to experience the following symptoms:

Pain

Basically, discomfort or pain is the main complaint of a woman experiencing premenstrual syndrome. It has been noted that a person shall become physically affected. As this occurs, accompanying symptoms occur because of pain or menstrual crapms; fatigue, fluid retention is equal to weight gain, breast tenderness, acne flare ups, insomnia, and food cravings. Others would tend to have no appetite for food. Sometimes, because of the pain, they tend to experience nausea and vomiting. Others also may experience bowel symptoms. Diarrhea is sometimes accompanied by premenstrual syndrome.

Emotional changes

This is referred as mood-related changes and symptoms. The person affected would usually have mood changes such as abrupt angriness and irritability. This is expected as one is experiencing excruciating pain, making them uncomfortable. Women would also tend to become anxious, tensed, depressed, sensitive and moody. All these changes become exaggerated at some point.

The condition is readily diagnosed through a thorough physical assessment. No laboratory assessment would assist us in the diagnosis of the problem. This is highly attained and easily attained. Here are the clinical features of premenstrual syndrome:

• Changes in mood. Women who tend to have increase in tension and mood swing could point out the occurrence of premenstrual syndrome.
• Before a menstrual cycle, the woman would experience the above symptoms.
• As this occurs, sometimes abruptly, the condition shall even affect the person’s day to day living. Making them unable to do their usual task as the condition can lead to an excruciating discomfort to the woman.

Causes

The primary and root cause for premenstrual syndrome is yet being understood. This condition is linked to a woman’s hormonal levels. Some studies even indicate a significant probability that twins are affected, meaning a woman from one of the twins are affected of PMS while the other is not. Hormonal levels are indeed being pointed out as the real cause of the condition. It has also been noted that a women’s cycle is affecting or triggering PMS symptoms. Normally, a woman has a complete 28 day cycle of menstrual period, these includes all the phases of menstruation including the 3 to 5 days menstrual flow and ovulation phase. It is noted that 28 to 35 days of menstrual cycle is the normal duration of the period, but once the person experiences a longer menstrual cycle, more than 40 days cycle, this then predisposes her to experience premenstrual syndrome. It is also believed that a woman experiences PMS during luteal phase, a phase where the woman’s uterus starts to slowly grow. Estrogen levels are also believed to precipitate in causing premenstrual syndrome. A theory has been presented that a person may experience premenstrual syndrome when increased prostaglandins are noted.

Premenstrual syndrome affects women effectively, that their day to day living is affected. This is because of their practices and as other factors precipitate for such condition. These risk factors include:

• Before the menstrual period, women taking high dosage of caffeine can induce PMS. Taking caffeine can make one’s smooth muscles constricted. The uterus of women are noted to be a smooth muscle, thus impending premenstrual syndrome is a possibility if a person usually take coffee especially before a menstrual flow.
• Increased stress or depression. It has been noted that women who are prone to depression and stress are at high risk for the condition. It has been linked to the patient’s level of serotonin, which is a chemical that is responsible for the person’s mood and sensation to pain.
• History in the family. The condition is believed to be linked to the family history of PMS. This has not been entirely supported, but is found according to some reports.
• Low or unhealthy nutrition. Nutrition is essential in triggering premenstrual syndrome. This is believed to take affect when a person has low blood sugar levels. When a person is also low in contents of vitamin A, B6, and E in the diet, she is believed to be prone to premenstrual syndrome.
• Other related conditions of premenstrual syndrome are:
• Anemia
• Hypothyroidism
• Substance abuse

Treatment

The goal of the treatment for premenstrual syndrome is to decrease or alleviate the discomfort that one is feeling. This condition is believed to be hard to manage because there is no direct treatment for PMS. But one can only assist the client in order to alleviate the discomfort. Here are the following remedies for premenstrual syndrome:

• Undergo exercise. Make it a habit so that one shall attain good health and a smooth menstrual cycle. As this can relieve the pain and discomfort that a person experiences during PMS. The mechanism of exercise helps in releasing endorphins, chemical that involves in the perception of pain. This intervention is believed to take effect on a person in a placebo manner.
• Reduce taking of coffee during or before menstrual flow.
• Avoid smoking. Cigarettes are known as vasoconstrictors, making a person prone to the condition.
• Avoid taking alcoholic beverages.
• Reduce intake of salt and sugar.
• When pain is not controlled properly, application of hot compress on the pelvic area of the woman can assist the patient to pain alleviation.

Medications

The proposed medications for premenstrual syndrome are the following:

Diuretics – These are helpful in decreasing the fluids that has been retained in the patient. Spironolactone is recommended mostly for treating edema as an effect of premenstrual syndrome.

Pain killers – As menstrual cramps or pain is the common complaint of a client experiencing PMS, she is provided with analgesics. NSAIDs are the common drugs prescribed to patients.

Oral contraceptive pills – These can help in balancing a person’s hormonal levels. This is believed to reduce the occurrence of PMS. But take note, this should not be taken when a person has a family history of breast cancer.

Antidepressants – These have been known to be quite effective in treating a person from experiencing mood changes and depression. Prozac is recommended but should only be taken with the doctor’s prescription.

Natural remedies

Having a healthy diet such as those with increase intake of foods rich in vitamins such as B6, E, calcium and magnesium.

One should take note that there is no exact cure for PMS. It is important we consult the doctor as this condition is believed to be occurring. We may never know that an underlying condition is present.

What is Patella Femoral Syndrome?

Patella femoral syndrome is also referred as Chrondomalacia Patella. This condition is characterized by an abnormal softening of the patients’ cartilage of the kneecap or the patella. Patella femoral syndrome is a result of the degeneration of a person’s cartilage. This is rooted from an underlying condition, and it states sliding of the bone structure ineffectively. This phenomenon is described as the patella sliding over the lower ends of the femur or knows as the thigh bone.

The condition is the most common cause of knee pain, as the person affected would usually complain of. PFS is said to be aggravated by activities such as running, prolonged sitting, hopping or jumping, and climbing the stairs. The condition is quite common according to epidemiological studies. Patella femoral syndrome is considered common among people who are physically active. Those who are still in school are quite affected of the condition, garnering about 20% of all cases are students. This is influenced by the prevalence of students to be physically active, as this is required of them. Reports have shown that women are quite affected of this condition compared to men. This is due to the fact that women are more prone to having bone density problems, especially when one ages.

The condition can be diagnosed through some tests. These tests would include imaging studies such as nuclear scans, CT scans, and MRI. These tests are not that necessary, but are done in order to rule out other possible conditions. The most common procedure done in order to confirm for the condition is arthroscopy. This test is done to directly visualize the cartilage affected. This can assess the joint structures of the patient and provide guidance to the doctor in the hopes for the surgical intervention.

Symptoms

The patient would usually complain of knee pain, the phatognomonic sign of patella femoral syndrome. The pain is characterized by the following:

The location of the pain is found behind the patella. It would usually be aggravated by activities such as running, jumping and those that require a person to flex the knees. The pain would then worsen as the patient does an action repeatedly. As the affected person continuously stays in one position such as sitting, it can aggravate the pain too.

Causes

The root cause of patella femoral syndrome is still in the works. But according to studies, this condition is believed to be associated with over usage, overloading and misuse of the patella femoral joint. The condition can be triggered by a person’s profession. Athletes are quite prone to such syndrome. Women are prone for they tend to be at risk for bone problems.

The process of patella femoral syndrome is by the pulling of the patella bones making and inflicting shear forces on the joints. This then results to bones becoming brittle. Because of this, people who have a medical history of having brittle bones would make them prone to such condition. Precipitating factors include fractures, osteoarthritis, and bone tumors.

Treatment

The treatment for patella femoral syndrome includes the following:

Provide rest

Because of the overuse of the patella-femoral joints, the patient would need adequate rest. Do not concentrate in one sitting position. It is advisable that one would ambulate from time to time. When a person is into contact or aggressive sports, one should avoid or stop this kind of activity for some time.

Ice

Application of ice on the affected joint can reduce the swelling or local pain. This can also be done in alternate with hot compress, whatever the patient prefers. Taking of NSAIDs is done in order to reduce the pain felt by the patient and to decrease the inflammatory process. Celebrex is provided to patients.

Brace

There are cases where the patient is required to have an applied brace. This can be a help facilitate in avoiding for further damage to the area.

Surgical Intervention

Surgical interventions are done in cases where the damage cannot be treated with simple exercises and medications. Lateral facetectomy is done when arthritis is involved. Cartilage transplantation is also performed. As routine procedure is done in order to correct the defect of the bones, arthroscopic drilling.

Prevention

Prevention is done by knowing the facts. Patient education is essential in order to avoid complications and to make sure that the condition is treated. It is important that a person takes good care of his or her health. In order to have strong bones, drinking of milk is recommended. Taking of foods rich in calcium is advised. When a patient is progressively active and is usually using his or her legs, rest should be provided accordingly. A patient can attain full recovery once he submits himself to treatment and follows the regimen accordingly.

Exercises

This condition should not be taken lightly, as what others commonly do. They think this is an ordinary knee or joint pain, that it lets them consider that the odds of the condition are not important. Exercise is an essential part in the treatment course. Here are the following exercises for patella femoral syndrome:

• Walking backwards – This would provide a new pattern of movement to the joints and muscles. This can help a person work on the difficulties of having patella femoral syndrome.
• Leg-extension exercise – This is one effective mode of exercise. This can assist the client in attaining a full leg extension, where a person affected is incapable when experiencing the syndrome. Gradually, as this is being practiced, the person affected then can include simple workouts of the lower extremities.
• Back-pedaling exercise – This is done by running backwards and using the thigh muscles effectively. This then can assist a person in managing the knees to become stress-free. Frequent, correct use of the legs can reduce damage, but should be controlled in order to avoid stress.
• Adjust and correct ones foot placement. Walking with the feet forward is the correct position and placement of the feet. This would help in managing a person’s calves and knee muscles to a stress-free condition.

What is Cyclic Vomiting Syndrome?

Cyclic vomiting syndrome or CVS is a condition that involves repeated or cyclic episodes of nausea and vomiting. This condition takes places or occurs for hours and unfortunately, even for days.

Remember that this condition is not particularly affecting a specific age group. In general, all of us are affected but it is noted to greatly affect the children. The prevalence of this condition is estimated about 4 to two thousand among 100, 000 children in the world. In order to diagnose the condition, there is a need for the medical practitioner to acquire the patient’s medical history and by assessing the patient’s physical status. Laboratory tests are only done to support the diagnosis, as changes in the electrolytes level would suggest problems of fluid balance.

Phases

There are four phases of cyclic vomiting syndrome. Here are the said phases:

1. Symptom-free interval – The phase includes asymptomatic stage. The patient would manifest no symptoms at all.
2. Prodrome – The stage would signal out that an impending episode of nausea and vomiting shall take place. The phase can even last for minutes to an hour of feeling nauseated. A simple remedy such as taking anti-emetics can alleviate the condition.
3. Vomiting – This phase is where a person would start vomiting. They are unable to take foods per orem or by mouth. Because of this, they become weak and exhausted.
4. Recovery – Simply, the patient attains recovery from the stress of vomiting persistently.

Symptoms

The symptoms of CVS or cyclic vomiting syndrome are long lasting. It can be chronic for it can at least last for three whole months. The patient would experience episodes of vomiting, reaching to 12 times in just an hour, which is also accompanied by nausea. Because of this, the affected may lose his or her energy, making them weak and lethargic. The patient would feel weaker because the main symptoms can last for hours and days. Aside from the presenting symptoms, here are the following symptoms of cyclic vomiting syndrome:

• Pale skin (may be a sign of dehydration)
• Abdominal pain
• Diarrhea
• Headache – These headaches can be varying in episode. This is sometime described as severe that it can cause nausea and eventually vomiting.
• Photophobia

Complications

The following are the possible complications of cyclic vomiting syndrome:

• Persistent vomiting can lead to dehydration and electrolyte imbalance. Body fluids can make a person lose most of the patient’s water in the body. This condition shouldn’t be taken lightly for its effects can be very demanding and could cause grave harm to the patient.
• As the patient is persistently vomiting, he or she may develop peptic esophagitis. The esophagus can be irritated and injured from the stomach contents that are being taken out from the patient. The contents are composed of acid that is very corrosive to our mucous membranes.
• The patient may later develop bleeding in the upper digestive tract. This is due to vomiting the gastric contents persistently, that would eventually damage the person’s upper digestive tract. Vomiting blood or coughing out blood is called hematemesis.
• There is a possibility of tearing the patient’s lower end of the esophagus. This damage is called the Mallory-Weiss tear.
• As one is persistently vomiting, this can also provide an effect to the patient’s set of teeth. High acidic content can lead to corrosion of the teeth enamel.

Causes

The direct cause of this condition is not made known today. But it has been determined that the condition is influenced by varying factors such as those believed to be contributory. It is also noted that cyclic vomiting syndrome is caused by migraine, as much as this is connected to the condition. Other studies suggest that the condition is caused by the genetic makeup that one person is basically composed of. Another collective study gained about cyclic vomiting syndrome, the condition is believed to be inherited. This has no clear significance, but it is thought of that those with related factors of medical history such as migraines running in the family to be a possible cause of the disease process.

The condition has a lot of triggering factors. An episode can be triggered by the following:

• Stress
• Infectious process
• Anxiety
• Allergies
• Certain foods
• Draft
• Motion sickness

Treatment

The exact cure for cyclic vomiting syndrome has not been identified but instead, a treatment has been provided for in order to resolve the presenting symptoms and support the client from preventing complications. These are the following ways to treat the client from cyclic vomiting syndrome:

Hydration

The patient is needed to be hydrated as he or she is prone to develop dehydration. Hydration is done by providing oral fluid intakes, but not in or during episodes of nausea or vomiting. Oral hydration is provided in between episodes of vomiting. Severe dehydration is treated with intravenous hydration.

Anti-emetics

These drugs are very helpful in treating or relieving the patient from the grave effects of persistent vomiting. The drugs recommended for patients with cyclic vomiting syndrome are ondansetron, dronabinol and dextromethorphan. Plasil is also provided for patients.

Provide rest

Patients are expected to experience generalized weakness as the condition can be exhausting. Provide the client with complete bed rest in order to regain his or her strength.

Diet

As a patient is diagnosed with cyclic vomiting syndrome, he or she may be initially recommended to nothing per orem diet. This is to avoid triggering the patient from vomiting and feeling nausea. As the patient is in his or her recovery phase, the patient is provided or recommended with foods rich in minerals or components that a person is supposed to lack after CVS. As the laboratory results would suggest that a person lack certain electrolytes, they are advised to eat certain foods rich in those particular components.

Cyclic Vomiting Syndrome in Children

It has been noted in the past that a number of children are affected of cyclic vomiting syndrome. According to reports, children of ages 6 to 8 are diagnosed with the condition. Fortunately, these cases are not that severe for they gain resolution after weeks from suffering the condition. As the condition has become prevalent in children, it has been quoted as a common cause for children to miss there academics.

Infants are not spared from this disease process. Those as young as six days can be affected of the condition. In contrast to that, extremes of the age are also a factor. The old are also affected of the condition. Mortality cases for the condition are not well supported. The condition is only grave when it is not properly cared for, especially in children. Children are fragile people that need immediate care so to avoid the grave effects of cyclic vomiting syndrome. As a child is affected of the condition, it is important that prompt care is provided for. This can be more intense compared to adults, because their health is much stronger compared to children. Dehydration can really put the child’s life at risk. This can even result for the child to become undernourished, thus resulting to increased mortality.

What is Foreign Accent Syndrome?

The said condition, foreign accent syndrome, is considered as rare for which it involves speech changes. The condition is indeed rare for there has been few cases reported for this condition. Accounts of foreign accent syndrome have been noted minimal and have caused great interest among medical practitioners. This is also famous for it has come out to the news and is considered as a speech disorder. This has also become a feast in the media because there are cases where a person with an American-accent acquires a British or German accent. This condition has been a question to all medical practitioners, because clear explanation of the disease process has not been provided and given. This is such a medical mystery that still waits for a concrete answer to all the questions.

Symptoms

Foreign accent syndrome is primarily described as a condition that involves change in a person’s accent. The affected tends to speak a foreign tongue accent but wouldn’t have the slightest idea why the process has been changed. This is not intentional but a condition that starts from changes in the pitch pattern, intonation, timing and spoken accent. Because of this, a native-tongued individual shall unmistakingly acquire a foreign-accent. The following are the specific description of the manifestations of foreign accent syndrome:

• Changes in tone of speech
• Changes in the movement of one’s tongue and jaw activity while speaking
• Using of words that one is not commonly using. Inappropriate words may be used, that would seem to signify that they are truly from a foreign country.
• Sentence construction seemed to be distorted for the native language has become the foreign one.

Causes

The condition is indeed considered rare in occurrence. According to studies, the problem is primarily cause by brain damage. Stroke, in most cases, is believed to cause the condition. As the brain is damaged, the effect would be changes in one’s rhythm of speech and melody. Possible causes of the condition include:

• Cerebrovascular accident or stroke. This may cause brain hemorrhage.
• Head trauma, blunt or sharp trauma to the patient’s skull. This may cause a concussion.
• Multiple sclerosis

Those at risk of the condition are those prone from stroke. If a person has suffered from stroke, he or she may be at risk for another attack thus leading to this phenomenon, foreign accent syndrome.

Diagnosis

The condition can be diagnosed in various ways. There is a need for the patient to provide his or her complete medical history in order to assist in the attainment of a proper diagnosis:

• There would be a need for a psych consult. This is indicated to rule out other conditions such as those that would suggest for psychiatric problems.
• Assessment of the patient’s language skills, especially in speaking is necessary. Knowing the patient’s native tongue accent would assist us in identifying the occurrence of the problem.
• Electroencephalogram – This test would assess the patient’s brain activity by assessing one’s brain electrical currents.
• Imaging tests – This would include MRI and CT scan. The MRI would take pictures of the patient’s brain structures with the use of magnetic waves. While CT scan is like an x-ray that would visualize the structures of the brain.

Treatment

Once this has been identified by a patient, consulting one’s doctor is necessary. This would pave way for the proper treatment of the disease process and the identification of the possible root of the syndrome. Treatment if provided to patients with the following:

Speech therapy

This can help regain the patient’s ability to speak in the same manner he or she used to.

Counseling

This is needed in order to provide patient emotional assistance or support. The condition can be a root of social stigma or can provoke others, and then rejection may take place. Counseling is needed in order to not affect the patient’s emotional aspect.

Consult

One should consult a speech-language pathologist in order to attain treatment. A psychologist may be necessary to identify or rule out other conditions and so that referral may be done in order to attain wellness.

Prevention

This is attained by avoiding the risks of experiencing stroke. This can be done by doing a usual exercise regimen, having a healthy diet – avoid foods that can increase the blood pressure, and avoid or quit smoking.

What is Hepatorenal Syndrome?

Hepatorenal syndrome is a condition that involves a progressive form of kidney disease, common process is kidney failure. This would persist and can provide a grave effect on the person’s life by complications. As described and known in the medical profession, the hallmark or pathognomonic sign for hepatorenal syndrome is renal vasoconstriction. This condition is found to be common in the United States. Statistical reports show that about 10% of cases who are suffering from cirrhosis and ascites has hepatorenal syndrome. It is believed that this condition is a result of uncompensated cirrhosis. In the world, the cases of hepatorenal syndrome are similarly increasing as just like in the United States. Those at risk for this condition are people with medical history of chronic liver disease or those who are suffering from liver disease. Men and women are equally affected with this syndrome. Increasing age is a factor for this condition. Those who are at their 4th to 8th decade of life are at most risk for acquiring hepatorenal syndrome.

Diagnosis

Diagnostic tests for this condition include the following:

1. Physical assessment can help in the diagnosis of the condition. Identification of the probable signs of hepatorenal is done. These signs include mental confusion, ascites, skin discoloration, bruits, gynecomastia and lesions on the skin. Accumulated data such as the abrupt decrease or loss of urine output would indicate presence of the disease process.
2. Blood tests – Tests such as those that can identify the levels of BUN and creatinine levels of the patient are necessary. A low serum sodium level or concentration is another sign of the disease. Changes in the prothrombin time of the patient would help suggest liver problems. The ammonia levels are significantly higher than the usual levels.

Symptoms

Hepatorenal syndrome is reported to have no specific signs or symptoms. It is however, common to patients who suffer from chronic liver diseases, such as cirrhosis. The following are the typical presentations of hepatorenal syndrome as basically influenced by cirrhosis:

• Changes in the levels of consciousness or mental alertness. Patients tend to be confused, experience delirium and eventually dementia.
• Palmar erythema (redness).
• Asterixis or also known as liver flap, a tremor observed on the patient’s wrist when it is dorsiflexed (extended).
• Muscle wasting and clubbing of hands
• Fetor hepaticus – This is known as severe bad breath among patients with hepatorenal syndrome. It is widely referred as breath of the dead because of the smell an affected emits from their mouths can be compared to a dead corpse.
• Gynecomastia – Men are most affected of the problem. There is an increase in the breast size or chest area of men.
• Ascites – There is accumulation of fluid in the peritoneal cavity of the patient. It is a very common presentation of liver problems. This can also cause for an increase in one’s weight.
• Peripheral edema
• Bruits – A sound that is heard when one uses a stethoscope over the heart. Sometimes, the sound that it emits is confused with a heart murmur.
• Caput medusa – This is characterized by the distention of the umbilical or abdominal veins. It may also be engorged in appearance.
• Hernia
• Loss of pubic hair
• Dark colored urine – This indicates for kidney malfunction.
• Jaundice -Yellow discoloration of the skin.

Possible complications include hemorrhage, organ/s failure, congestive heart disease leading to failure and secondary infections.

Causes

Hepatorenal syndrome is a condition that is basically caused by an underlying chronic liver problem. Those who are at risk of this condition are patients who suffer from liver cirrhosis. If there is a decrease in the normal functioning of the kidney, then it can also precipitate those who suffer from liver disease to develop hepatorenal syndrome. Others that are at risk of the condition are those who have alcohol hepatitis and liver failure.

Treatment

The most recommended treatment or intervention for hepatorenal syndrome is liver transplantation. As this is done, patients would readily attain a success from the treatment process provided for them. But other studies have shown that this can only be a limited intervention. Other surgical interventions are the following:

• PVS or peritoneovenous shunting. This is done to improve one’s circulatory functioning.
• Surgical shunting.
• Medications that are unnecessary are halted, so to avoid placing harm in one’s kidneys. The taking of antibiotics, NSAIDS and diuretics are contraindicated in cases of hepatorenal syndrome. Vasopressin is indicated to improve one’s circulatory functioning. The sympathomimetic agents are prescribed I order to improve the patient’s renal artery perfusion. In order to avoid bleeding, plasma volume expanders are provided.
• Renal replacement may be indicated. This is also known as renal dialysis.
• Patients are provided with albumin and dopamine in order to improve the patient’s kidney function.
• Prevention of complications. It is very important that one would comply with the treatment regimen provided by the doctor. Once a liver and kidney condition has been diagnosed, we can avoid the effects of hepatorenal syndrome if we comply and maintain a healthy lifestyle.

Prognosis

As reported in most or a number of cases with hepatorenal syndrome, the disease process can be very fatal and even cause death. Once a person is diagnosed with the condition, it is believed that the condition’s prognosis is poor. This is entirely because of its wide affectation and effect of the disease condition. Death is believed attained when the patient has acquired a secondary infection. Patients with hepatorenal syndrome are also immunocompromised, making them susceptible to other diseases. Another probable outcome from hepatorenal syndrome is hemorrhage, making this another cause of death among patients.

What is General Adaptation Syndrome?

The General Adaptation Syndrome or simplified as GAS is a response to stress which is composed of three stages. This was first described by a Canadian endocrinologist, Dr. Hans Selye – Austrian-born. He accordingly described this process as GAS, as to the effects of stressors to the body in general is manifested by a group of symptoms or specific symptoms that guarantees influence to a person. Dr. Hans Selye explained that general adaptation syndrome typically involves our nervous and endocrine systems. Endocrine system is responsible in releasing hormones responsible for the output of reactions.

General adaptation syndrome is noted to be a person’s short- and long-term reaction to stress (response to the demands that the environment requires of us). This syndrome is composed of a number of symptoms as it is also influenced by a number of factors. These are believed to be stressors, which may include physical, emotional and environmental.

The condition can be diagnosed descriptively from a person’s presenting symptoms. Once a person is adapting stress in a manner that is out of the normal context, it may be necessary to dive into the possible underlying conditions. Blood tests may be recommended in order to measure a person’s cortisol level, or the increase of their hormones triggered by stress. As it is also possible, others are recommended to be seen by psychiatrists so to assess a person’s adaptive levels from stress.

Symptoms

The symptoms of general adaptation syndrome entirely depend in each person’s adaptive skills. As common as it is, a person shall manifest these symptoms:

• Increase in vital signs or decrease in the normal levels of vital signs.
• Others would have bowel reactions. They tend to experience irritable bowel syndrome.
• Headache
• Fatigue
• Changes in concentration or there is difficulty in concentrating.
• Insomnia
• Hair loss or alopecia

Stages

The stages of the general adaptation syndrome are the following:

Alarm/ fight or flight response

This is the immediate response to a stressor that would result to increase in one’s heart rate, blood pressure and respirations. In a situation wherein there is an increase of demand of a response, such as instances that one has an adrenaline rush. The increase in the person’s vital signs is a point that takes in stressors with the accompanying reaction. Simply, the person’s sympathetic nervous system is stimulated, one that acts in our fight and flight responses. A person and another may have a different reaction from a stimulator. It is possible that a person shall experience the opposite reaction, where the parasympathetic nervous system acts. Instead of an increase in ones vital signs, a person may have a lowered blood pressure, respirations, and decreased heart rate.

This stage of the general adaptation syndrome is influenced by the secretion of our adrenaline. This would then serve as a stimulator with accompanying physiological changes and reactions. When a person is at threat, normally a person would react immediately from the stressor that can change a person’s normal capacity into a higher level. But once an abnormality has been found in a person’s system, a reaction may be altered that would then complicate to things such as shock and mental disturbances.

Adaptation

This is also referred as resistance. Right after the alarm/ fight or flight response, a person can attain his or her relation phase. The pituitary shall then act to stop the secretion of hormones responsible for the alarm response. This would also entirely depend if a person is still exposed to the stressor responsible for starting the first stage. As the first reaction takes place, a person shall then slowly adapt to the stressor. This stage is also influenced by a factor. As a person ages, he may have a depleting adaptation reaction. A person can adapt differently from other people. In this stage, a person can take control of the situation right after the first response or take control of the given situation as required of them.

Exhaustion

This is the stage wherein a person has exhausted all his or her efforts from the reaction he has given from a stressor. Usually, a person will have a depleted strength right after a stressor. Worst case scenarios come when great stressors have taken place which would usually end to death. Increased exposure to stress can provide a negative result to a person.

Causes

The primary cause of the general adaptation syndrome is stress. Basically the stress unrelieved in time can result to GAS. Factors that influences general adaptation syndrome includes that those of a person’s health, nutrition, sex, ages, race, socioeconomic status, and genetics. These are factors that are either can precipitate for a different reaction, while others are modifiable and unmodifiable traits. A person can vary from another in terms of their responses, it may be due to some underlying conditions or it may be rooted from a maladaptive disorder.

Treatment

The treatment for this condition is basically aimed in order to reduce the given stress one has attained. There are strategies provided in order to reduce the stress levels of a person. In order to attain equilibrium, these given strategies and categories are done:

• Knowing the signs of stress in order to avoid them. These signs include nausea, increase sweating, headache, indigestion, increased irritability, poor concentration and anxiety.
• Avoiding the known or given stressors.
• Changing a person’s reaction to stressors.
• Stress relief. This can be attained by music therapy, aromatherapy, and massage or exercising. Deep breathing exercises, attending yoga sessions and exercises are helpful in relieving stress.

What is Horner’s Syndrome?

Horner’s syndrome is a medical condition that is considered rare and basically affects a person’s eye and face, specifically the person’s nervous system. It is considered as a syndrome for it includes several or a collection of symptoms. The condition is characterized by the sinking of one’s eyeballs into the orbital cavity and anisocoria (unequal size of pupils). Horner’s syndrome is also referred as Bernard-Horner syndrome and oculosympathetic palsy. The condition is named or coined after the person who first described the disease, Dr. Johann Friedrich Horner. Horner’s syndrome would then indicate for an underlying problem of the sympathetic nervous system. According to some statistical reports, the condition is commonly found in men than in women. The male-to-female ratio is 5:1 according to studies. This condition does not choose people specifically their age, but it has been found equally distributed in the general population of all age group.

Diagnosis

The condition, again considered rare, can be diagnosed through several tests. The tests would include:

Cocaine drop test

This is done by using cocaine eyedrops. The eyedrops can take effect by dilating the patient’s pupils. As the patient is left to no dilation of one of the pupils, application of the eyedrops can help confirm for the presence of the disease process. When the patient reacts from the instilled medication after several minutes (pupils dilate for more than 0.8 mm) then it would suggest for Horner’s syndrome.

Paredrine test

The test includes the use of amphetamine to cause for dilation of the pupils. When instillation of the solution has no effect on the pupils, it indicates that Horner’s syndrome is present.

Neurological examination

This is necessary to identify areas of the which part of human system is affected of the condition. Significantly, cranial nerve III is affected for to cause Horner’s syndrome.

Imaging tests

MRI, CT scan and X-ray can also assist in the diagnosis of this condition.

Horner’s Syndrome Symptoms

The person affected of this condition can present the following symptoms in general:

• Ptosis – medical term for drooping of the eyelid/s.
• Miosis – medical terminology for increased constriction of the pupils. A particular eye is affected.
• The affected side of the face will have a decrease in sweating or medically known as anhidrosis.
• Sinking of the eyeballs into the face or the orbital area.
• Reddish conjunctiva or also referred as bloodshot conjunctiva.
• Swelling of the lower eyelid may be noted.
• Decreased tear production on the affected eye.
• Rarely causes heterochromia, different eye or iris colors.

Horner’s Syndrome Causes

The condition is caused primarily by the interruption and destruction of the nerve fibers pathway that run from the hypothalamus (part of the brain stem) to the face. This explains why the face is greatly affected by this condition. Other predisposing factors and conditions cause for this condition to occur:

• Lesion or injury to the cervical chain, which can affect a specific side of a person’s body.
• Trauma to the neck. Severe whiplash can cause for this condition, too.
• Infection – can be referring to middle ear infections
• Tumor found on top of the lung. Lung cancer is also found connected with this condition. This is believed as one of the common causes of Horner’s syndrome. About 35% of cases with Horner’s syndrome are caused by tumors affecting the lungs and thyroid.
• Migraine or headaches that can be in a form of clusters.
• Stroke or cerebrovascular accident. Aneurysm is also believed to cause this condition. Vascular problems are also commonly pointed out as a root of this condition.

The condition can be differentially identified by the pathway of affectation. The condition is accordingly caused by the following:

• First neuron – There is an occlusion of the arterial passage at the postero-inferior area of the brain stem, thus resulting to the occlusion and interruption of the blood supply to one’s brain.
• Second neuron – This is primarily caused by tumors. This includes lung tumors, thoracic tumors, thyroid tumors, and neck trauma or injury.
• Third neuron – The upper neck is affected. Ear infections and viral agents (Herpes zoster) may have caused the condition.

Other precipitating factors for this condition includes taking of drugs such as those with effects similar to Horner’s syndrome. Common drugs found are diacetylmorphine, levodopa, methotrimeprazine, prilocaine, procaine, and reserpine. These drugs are widely used and can have similar effects as the presentation of Horner’s syndrome.

Horner’s Syndrome Treatment

Specific treatment for this condition is entirely aimed in the avoidance of complications. There is no direct treatment for the condition but it is rooted to treat the presenting symptoms. The etiological history of the patient would assist us in the treatment of Horner’s syndrome.

As the etiology of the condition has been found or identified, treatment is aimed to correct that. If the pathology includes, stroke or aneurysm, correction is done by surgical intervention. When certain drugs have caused for the symptoms of the condition, we need to consult our doctor and report for the unusuality. Avoid neck injury, so to avoid the hazards of acquiring Horner’s syndrome. Have or practice a healthy diet and lifestyle. By this we can avoid the predisposing factors of the disease condition. As these are done, good prognosis can be attained by a person affected because early or abrupt treatment has been provided. It is important that a person would consult his or her ophthalmologist as the symptoms have been identified.

Horner’s Syndrome Pictures

Photos, Images and Pictures of Horner’s Syndrome…

Horner’s Syndrome Pictures

source: eyeplastics.com

Horner’s Syndrome Photos

source: mrcophth.com

Horner’s Syndrome Images

source: mrcophth.com

What is Boerhaave Syndrome?

This is a syndrome that is also referred to as “Spontaneous esophageal rupture”. It is a very rare – only accounting for sixteen (16) % of all ruptures that are traumatic to the esophagus. This is a very serious condition. This syndrome is categorized by a total rupture thru the entire wall of the esophagus caused by vomiting that is forceful – causing barogenic trauma.

Vomiting that is uncoordinated with diaphragmatic contraction as well as pyloric closure against a contracted cricopharyngeal muscle causes a rise in intraluminal pressure and is believed to be the underlying cause of this syndrome. The most common rupture site is the left posterolateral wall of the lower third of the esophagus which is believed to be the point of the esophagus that is weakest.

Symptoms

Individuals with the hole in the mid portion or lower portion of the esophagus can have the following symptoms:

• Swallowing difficulties
• Difficulty breathing
• Chest pain

Other signs can include:

• Fever
• Fast breathing
• Blood pressure is low
• Rapid heart rate

Individuals with the tear in the top portion of the esophagus might have:

• Stiffness or pain in the neck
• Bubbles of air beneath the skin

An X-ray of the chest will expose air in the chest’s soft tissues, leaks of fluid from the esophagus into spaces surrounding the lungs, or a lung collapse might be revealed.

A CT scan of the chest might expose in the chest an abscess or cancer of the esophageal. X-rays that are taken after the individual drinks a dye that is non-harmful might help locate the exact site of the tear.

Beside severe chest pain other common symptoms of this syndrome can include:

• Pain that travels to the back
• Severe abdominal pain
• Upper back pain
• Upper abdominal pain
• Nausea and vomiting
• Voice that is hoarse
• Choking
• Hiccups

Causes

A hole or tear in the esophagus can let contents of the esophagus pass into the mediastinum which is the surrounding area in the chest. This frequently causes infection of the mediastinum referred to as mediastinitis.

Boerhaave syndrome is most often caused by an injury during a medical procedure. But, since more flexible instruments are used now this occurs rarely.

The esophagus can also become perforated due to:

• A tumor
• Gastric reflux accompanied by ulceration
• Previous esophagus surgery
• Swallowing foreign objects or chemicals that cause corrosion, such as household cleansers, disk batteries or battery acid
• Injury or trauma to the esophagus or chest
• Vomiting that is violent

Some causes that occur less frequently include:

• Injuries or blunt trauma to the esophagus area
• Injury to the esophagus during an operation on another organ nearby

Treatment

Management that is ideal involves combining a conservative as well as a surgical approach.

Mainstays of therapy include:

• Administering IV broad spectrum antibiotics
• Administering fluids thru IV
• Draining any fluid that collects around the lung using a chest tube
• Surgical intervention that is prompt

If very little or no fluid has leaked, placing a stent in the esophagus may help to avoid surgery.

Often a perforation that is in the upper neck region, part of the esophagus can heal by itself if the individual does not eat or drink for a certain time period. Nutrition can be supplied thru a stomach tube for feeding.

The decision to use medical intervention only or an aggressive approach of medical as well as surgical intervention usually depends on the below factors:

• Time between individual seeking medical attention and diagnosis
• Perforation extent
• Overall condition medically of the individual

Surgery

The majority of physicians believe that surgical intervention is the standard of care particularly in cases where the diagnosis is made within the first 24 hours.

Repair of the rupture that is direct with acceptable drainage of the pleural and mediastinum cavity offers the best rates of survival.

The favored surgical method is a left thoracotomy, although laparotomy might be needed if the rupture or tear spreads into the lower esophagus.

• Various techniques, such as the use of an omental flap, can be used to support the closure that is primary.
• Gastrostomy and jejunostomy tubes frequently are placed to help in drainage and for providing nutrition.

The strength of the tissue surrounding the tear is a factor that is important in choosing the surgical method to use.

• For individuals who have had a diagnosis delay – more than 24 hours, the primary repair might not be possible.
• After 24 hours, the edges of the wound often are still, edematous and friable.

But many substitutions to primary repair are accessible.

• The more common substitution consists of creating of an esophageal deviation by use of end-cervical or a loop esophagostomy. This lets the wound heal by secondary means.
• The use of T-tubes has also been described. T-tubes cause a creation of a well-ordered fistula and a route of drainage for secretion of the esophageal as well as gastric materials that is refluxed.
• There is one study that noted that the option of using primary repair may still be considered for perforations as old as 72 hours.

There are also newer procedures that involve using plastic-covered metallic stents that are self-expanding.

• These are acceptable alternatives only when every other involvement choice has been exhausted.
• The use of stents in this syndrome is advised for cases that have had extreme delays in diagnosis or a failure of conservative management.
• The continuing effects of placement of these stents in Boerhaave syndrome has not been evaluated adequately.

Complications

Possible complications consist of:

• Destruction of the esophagus that is lasting
• Formation of abscess around and in the esophagus
• Infection around or in the lungs

This condition may progress to shock and even death if not treated.

For individuals with a diagnosis that is early – 24 hours or less, the prognosis is good. Survival rate is approximately 90% when surgery occurs within 24 hours. But, this rate drops to about 50% when treatment is delayed.