Anemia, most common at all. This is common to make some handles all anemia by giving iron compounds, and this may lead to severe damage kidney or heart failure).>
Reasons
Lack of set:
1 - lack of food contained (most common) and constitutes 50-70% of reasons.
2 - gastrectomy leads to a lack of HCl.
3 - bowel resection.
4 - diseases of malabsorption (eg celiac disease).
5 - poor absorption of iron.
6 - hinder absorption materials, such as drinking tea and coffee.
7 - eat dirt (in the deviations of appetite).
8 - Turansvirin deficiency (a genetic disorder).
Increase the need for:
1 - baby
2 - Pregnancy
3 - puberty (due to the rapid increase in weight and menstrual haemorrhage in females)
Increase in waste:
1 - hemorrhages (bleeding such as gastrointestinal bleeding and Women).
2 - frequent blood donation.
3 - psychological problems (which makes a person withdraw amounts from the blood and delivered).
4 - intravascular hemolysis and leading to albuminuria or Imosiderenah Khaddabih
The most important food that is available in iron are:
1 - red meat, and peanuts, hazelnuts, almonds, apricots, spinach and Swiss chard (milk food excellent, but it does not contain iron).
2 - poor absorption of iron is a very rare disease, its incidence of about 1 to two million people only, in which there is poor absorption of iron only (ie no mal-absorption of the year).
3 - in these cases must be taken twice daily need of iron.
4 - should be given to the infant iron compounds after the sixth month, and the reason is the increasing need for rapid growth during the first year.
5 - may be prima facie may be hidden (as in inflammation of the stomach and Alshadji diaphragmatic hernia, and some tumors of the colon).
Clinical demonstrations:
First - public demonstrations: the demonstrations of anemia in general.
II - special events:
1 - glossitis
2 - concave and spoon nails
3 - hair loss
4 - severe vulvar itching
5 - very severe dysphagia in Plummer Vinson syndrome
6 - splenomegaly in 10% of cases.
7 - deviation of appetite.
Diagnosis:
1 - a film screening of blood and Blood Picture shows a small-sized cells lacking pigment, a difference in the shapes and sizes of red blood cells (cells appear ring - Qlmah ...). (Ham), increasing the number of platelets (up to 400-500 A / mm 3).
2 - fresh examination: no longer used in the diagnosis: overactive note the chain-generating red and free of atoms Alimosideren dye after it was painted Pearl.
3 - Laboratory Tests: We note the following:
A - Low serum iron
- Increasing Turanseverin (total capacity Association)
C - the proportion of low-saturation:
Percentage of saturation = serum iron × 100
Binding capacity (Turanseverin)
D - Fartin low serum Ferritin is the most important.
4 - x-ray surveys are not important and no longer used.
Measure of iron deficiency anemia:
And depends on:
1 - find the cause and treatment: such as adjust the menstrual cycle, treat the cause of gastrointestinal bleeding.
Note: If the causative agent and a clear turn to the investigation of occult blood in the stool:
2 - prosthetic treatment:
The best way is to give iron by mouth, but there are special cases where we can not resort to this method (such as malabsorption), then we resort to the intramuscular route.
Special case: in iron-deficiency anemia in severe atrophy of intestinal villi in this case we resort to give the rate of iron compounds IM Hbabh / day for 10 days then turn to the oral compounds.
Important Notes:
There is no difference in the speed of recovery between the oral route and the intramuscular route.
Almalux may not be given (and the other antacids) with iron compounds at all.
If the cause of oral administration of iron digestive problems (Akieouat - abdominal pain ...) resort to the intramuscular route.
3 - can be addressed Vitc (increases iron absorption), access to food rich in iron (red meat).
Duration of treatment:
Must continue to compensatory treatment for two months after the access to natural blood values (in order to dictate the stores).
Warning: Very Good
Is an involuntary muscle Nfdhat occur in the transition from waking to sleep, he describes the people who suffer from it as similar to the sense of falling from a high place or as an electric shock can cause the movement of the body on the bed. It was noted that this Alinvdhat repeated frequently higher in the night when people who suffer from sleep problems at night as Alinvdhat that this could be the result of worry or depression or fatigue and exhaustion.
Hypotheses Ahtzazat sleep onset:
1 - when the body enters the stage of sleep it is subject to a number of changes in multiple systems as a system, temperature, breathing and muscle relaxation ... the latter can be the cause of vibrations for sleep onset.
The brain interprets the signs of muscle relaxation as signs similar to the case of a fall from a high and sends signals to the parties, causing muscle contraction and the occurrence of sudden waking. For this reason, Alinvdhat get. This is often the case with for people who feel they fall or they see themselves when they fall asleep.
2 - The second assumption: You say that Ahtzazat sleep onset occur during stage movements, rapid eye sleep (or aspiring REM or sleep contradictory). It is known that dreams occur during REM sleep, as well as the other muscle movements Urdu-stop during this phase with the decline in full in muscle tension. Some people suffer from the vibration intensity light in the eye or ear during REM sleep and this is also another reason Nfdhat at the time of sleep onset.
Sleep onset vibrations occur once or twice a night when the majority of people,. Alinvdhat this can be repeated frequency is higher among those people who find difficulties in sleeping.
In severe cases, this Alinvdhat can be repeated every 30 seconds and the aspiring movement disorder, periodic parties.
Body reacts with the state to enter into sleep in the same way that rise up the body at death and therefore can be considered as vibrations of sleep onset as a reflex helps the body to maintain his career.
Recorded case of the brain into sleep as a state in which the body needs to be capable of alerting or arousal.
This Alinvdhat can rarely get when you wake up. Is a rare condition - as we said - affecting the muscular and auditory nerves.
At the beginning of sleep, waking up the audio of sleep is associated with the voice of refraction of very strong or crash as it seems like a sound coming from the head.
Get a lot of people Bnfdhat sleep onset but not be strong enough to wake them from sleep and therefore they can not be aware of.
10% of people suffering from these Alinvdhat a night, while 80% get it sometimes but the remaining 10% do not catch it only rarely.
Sleep when someone is near you and feel that it rose up suddenly without any reason can you say about this case, it shakes sleep onset.
In the case of periodic movement disorder parties there is no light jerk but a series of Alinvdhat that can last for hours. Your partner in bed can be observed symptoms.
If you suffer from a series of Alinvdhat This situation was causing you problems, then you should consult a healthcare provider to tell you why and guides you to how to deal with this situation.. If you are suffering from Nfdhat physiological normal, there is no need to worry from this case because these vibrations do not cause any damage to the body and does not constitute any danger to your physical health.
Most people get an allergic inflammation of the conjunctiva (allergic) when the eyes come into contact with the allergenic substance (the substance that makes the body's immune system responds strongly), then the eye become inflamed and occasionally ulcerate and become painful.
Symptoms arise from an immune response that causes histamine release and other materials that are liberated from mast cells, and this is what is causing the expansion and Aaúaa irritates nerve endings, leading to increased secretion of tears.
The definition of Medilexicon's contains: allergic conjunctivitis is the immune response in the conjunctiva Ttoasitha Alglupulinat immune (E) and associated with itching, redness, Damaa ones and this inflammation is usually seasonal caused by an allergic (rather than a septic), and it is linked to other features of the reactions of allergic and affects more than 10% of population.
Allergens is considered one of the following substances to more allergic conjunctivitis:
• pollen (hay fever)
• fur animals
• eye drops
• Makeup
• mites and dust.
Allergic conjunctivitis is classified into different categories and with some of the following cite:
1 - seasonal allergic conjunctivitis (inflammation of allergic conjunctivitis and nasal allergic rhinoconjunctivitis):
The pollen of the most common allergens which cause allergic conjunctivitis, especially in countries with cold winter (far from the equator).
If you are suffering from conjunctivitis caused by pollen often you have symptoms of hay fever, which include: sneezing, runny or stuffy nose, itchy nose, itching and runny eyes.
(Of course when these symptoms accompany the condition called seasonal allergic conjunctivitis, because it only occurs during the spring and summer when the flowers and herbs and trees in the process of pollination).
Of course, these symptoms may appear in early autumn, when some people.
2 - plea conjunctivitis (inflammation of conjunctivitis and contact dermatitis Contact dermatoconjunctivtis):
And is usually caused by cosmetics, eye drops and other chemicals that irritate the conjunctiva in some people, what is causing the allergic response is different to different people and scalability Thsshm of these materials.
In this case symptoms develop within two days to 4 days after contact with the material eye.
3 - Aertal papillary conjunctivitis Giant papillary conjunctivitis: and is caused by contact lenses which is preceded by a feeling of satisfaction it can get worse and worse, causing severe redness in the eye.
Can also be for this type of conjunctivitis that occurs after eye surgery when the patient is put to hard contact lenses.
Also, some say that the lack of attention to hygiene when dealing with contact lenses and solutions may participate in eye injury Ballantnat.
4 - conjunctivitis Holi Perennial (extended throughout the year):
As the name implies, this type of conjunctivitis throughout the year and continues to be the main cause sensitivity to house dust mites and domestic.
The sensitivity of the domestic mite is an immune response to specific proteins found in the mites cause other problems as well as conjunctivitis or its flow Cansdad nose, sneezing and asthma.
It can also be caused by animal dander (small scales from animal skin or hair or bird feathers), which cause allergic reactions in some people
What are the symptoms of allergic conjunctivitis?
Most people with allergic conjunctivitis have problems with both eyes. Symptoms may appear rapidly, immediately after eye contact with the allergen material.
In other cases, as in some eye drops, symptoms may take two to four days to appear.
The following symptoms are more typical for allergic conjunctivitis:
• redness of eyes, pink eye: The most common symptom to some extent, and the eyes become Mthajtan because telangiectasia (small blood vessels) in the conjunctiva.
• Pain: Some people suffer from pain in one or both eyes. If the eyes are very red and painful, it is necessary to visit the doctor.
Any patient with red eyes and painful and has become sensitive to light (photophobia Photophobia) and felt that his vision had been affected, he must see a doctor immediately.
• Itching: Since they are irritated eyes may be itchy. (Pruritus may be exacerbated if the patient Pferkha).
• swelling of the eyelids: eyelids may swell when the conjunctiva becomes inflamed or if the patient Pferkha much.
• lesion: inflammation may make the entire region and ulcerated Mamadh. Some people say that the soreness feeling like a burn.
People with seasonal allergic conjunctivitis infection will suffer from symptoms at certain times during the year usually from the beginning of spring, summer, and also to the fall.
People with arthritis and allergic conjunctivitis lasting vulnerable at any time of the year. There may be specific times during the day gets worse the symptoms more than other times.
If the eyelids red and chapped or dry it is a sign that the patient often has a tangential conjunctivitis.
Conjunctivitis and conjunctivitis plea papillomavirus Aertal are not seasonal Symptoms may occur at any time of the year.
How is the diagnosis of allergic conjunctivitis?
Skilled therapist (general practitioner and a physical therapist) must be able to diagnose allergic conjunctivitis after examining the patient by assessing the signs and symptoms.
Tags are a pathological phenomena detected by the doctor of his own (red eyes) The symptoms are the phenomena that the patient tells the doctor (as pain) and the doctor will ask about other symptoms Kattas, runny nose or Ansdadeh.
Here on the processor to exclude cases that share some with conjunctivitis symptoms.
If you have the following symptoms should see a doctor immediately and could face other symptoms more severe than indicated:
- Did not my eyes.
- Sensitivity to light (light phobia).
- Visual problems.
- Severe redness in the eyes.
The following conditions (other than the allergic conjunctivitis) can cause redness of eyes:
- Septic conjunctivitis: caused by bacteria, viruses or sexually transmitted diseases.
- Acute glaucoma: an uncommon form of glaucoma which causes a rise of pressure in the eye, symptoms may appear quickly and acute untreated glaucoma can lead to loss of sight is reversible (non-treatment).
- Inflammation of the cornea: the cornea becomes inflamed and ulcerate in some cases may progress to scarring of the cornea and scarring that may cause loss of sight temporarily.
- Inflammation of the iris: If not treated it will stick to the iris lenses proof of the displaced fluid dynamic iris, and the result may be irreversible destruction of the eye.
The doctor makes sure if there was a latent or other material behind Kohadab eye irritation, for example.
Severe cases: If the symptoms are severe or very bad For the processor to switch the patient to a specialist Balaanah.
Previous surgery:
- Any person who has previous eye surgery and has evolved to the case of papillary conjunctivitis will be transferred to a specialist Balaanah by his doctor.
- It is important to control the eyes and make sure the effectiveness of treatment.
- Most of the therapists sent the patient to a doctor in kind if infection is suspected, skin and conjunctiva purpose here is to confirm the diagnosis.
What is the treatment of allergic conjunctivitis?
Whatever the cause of inflammation, the following procedures, may be useful:
1. Should not be wearing contact lenses before the final disappearance of symptoms, and should not be wearing contact lenses before the lapse of 24 hours of use of any medication on the eyes.
2. Stop rubbing the eyes and rub as this can lead to worsening of the situation in spite of feeling the need for friction or rubbing the eyes.
3. Eye wash or clean wet towel moistened with cold water, while others recommend immersing the face with warm water and open the eyes and believe that an interest rate, while others opposed this move strongly.
4. Avoid allergens such as pollen and by closing the windows and close the distance between the solar glasses or by a piece of cloth when you exit.
It also should not use pillows that contain feathers and replace them with other materials is the elimination of allergens and mites in order to eliminate sensor dust mites.
Antihistamines:
Antihistamines provide quick benefit for patients and eliminate the symptoms quickly, in case of conjunctivitis Althssse doctors prescribe antihistamines by mouth or drops in kind.
These class of drugs to reverse the effect of histamine produced by the immune system response to foreign objects, in short make these drugs less aggressive immune system.
More commonly used antihistamines are Ssiterazin, fexofenadine, loratadine, which is described Yumiaan single dose by mouth.
The most commonly used eye drops and it Azelactin Aimidastin Alkitovan and which is applied topically to the eye twice a day.
Antihistamines are very useful in allergic conjunctivitis is also useful in Althssse rhinitis or runny nose or blocked nose, nose or sneezing Alhak.
Since some antihistamines cause drowsiness, the cases of people who eat for the first time should be wary of driving and working on heavy machinery in order to avoid side effects of the drug.
Mast cell stabilizers:
Mast cell stabilizers, and take much longer to begin to show any beneficial effects - compared with anti-histamines - but when you start work, the effect lasts longer.
Some patients are given anti-histamine and mast cell stabilizers at the same time as the antihistamines the alleviation of symptoms before starting mast cell stabilizers work.
Months of the mast cell stabilizers: Aeodoxamed and nedocromil. Are given in the form of eye drops.
Mast cell stabilizers are a row of drugs not Alstroidah ballasts, which reduce the release of chemical compounds that cause inflammation of the mast cells
Calcium channel blockade is necessary to remove the mast cell degranulation, install the cell; and thus prevent the release of histamine.
Alstroidat corticosteroids:
And is described only if the symptoms are particularly severe. Are rarely described.
Corticoid: steroid hormone produced from the adrenal cortex.
Alstraaidat corticosteroids are produced synthetically and just like the medicine is reduce the swelling and reduce the body's immune response.
Alstroidat work well, but should not be given for a long time because of potential side effects
Complications of allergic conjunctivitis:
Complications of allergic conjunctivitis Holi (year round) or seasonal very rare. The incidence of symptoms is frustrating for the patient more than the expected complications. Also to feel that people with pollen from throughout the year may suffer from discomfort.
Allergic conjunctivitis case of trouble, and can disrupt the patient's daily life. And can be affected by concentration of the patient, especially if the symptoms within the eye - (Information is crucial for visual focus).
Experts say that allergic conjunctivitis should not affect long on the health of the patient.
Complications of conjunctivitis, contact dermatitis and conjunctivitis complications papillomavirus Aertal:
There is a greater likelihood of complications in these types of conjunctivitis. In spite of that the most likely, but remains small
There is risk of corneal inflammation (keratitis). Inflammation of the cornea that can cause blisters to form on the cornea and significantly increase the risk of scarring and thus can cause permanent visual impairment.
Symptoms include inflammation of the cornea:
• severe pain in the eye
• the direction of light sensitivity (photophobia)
• blurry vision
• a sense of something is in the eye
• tearing of the eye
Ethanol is metabolized in the liver in two ways and the resulting increase in the ratio NADH / NAD. Oxidation and latency of the return variable causes an increase manufacturing fatty acids with lower hepatic oxidized, cumin oxidation and return the variable causes an increase manufacture of fatty acids with lower hepatic oxidized, both incidents would lead towards an accumulation of fatty acids in the liver and therefore fatty acid esterification to Glesiredat. Change in oxidation and return also weakens the metabolism of carbohydrates and proteins and is the cause of necrosis in the center of hepatic lobule Anbh where necrosis is considered a model for alcoholic injury. Alosat aldehyde is formed from the oxidation of ethanol and proteins affect the liver and can therefore be considered as a factor for incidence of liver.The exact mechanism for the inflammation of the liver alcohol and cirrhosis alcohol is not known, but since that 10-20% only of people who consume alcohol excessively will develop cirrhosis of the liver, so it has been shown that the inheritance of a role in susceptibility Balchma, and the mechanism of immune has been brought up also .
can enhance the toxic effects of alcohol from the products of metabolism of drugs (such as paracetamol) on the liver, also incites metabolic Almkroa by a Almkroa ethanol oxidation (MEOS)
Pathogenesis:
Alcohol can cause a wide spectrum of liver diseases ranging from infections to changes in fatty liver and hepatic cirrhosis.
1 - fatty change Fatty Changes:
Permanent result of alcohol metabolism in the liver to the formation of fat, particularly in Zone 3. These changes may be few if the amount of alcohol consumed is small, but larger quantities cause swelling of cells and fullness of guys (steatosis). I talk to hepatocellular injury, and these changes are irreversible when you stop alcohol consumption. Fatty degeneration may occur for reasons other than alcohol.
In some cases, collagen is located around the hepatic central veins (cirrhosis of the veins) Vtaatriqy to cirrhosis of the liver, even if it were not preceded by inflammation of the liver. Toxicity of the alcohol directly on the astrocytes, transforms into the cells of fibroblastic collagen-producing muscle.
2 - alcoholic hepatitis Alcoholic hepatitis
In this case changes occur in addition to fatty infiltration of the multi-core white cells and necrosis of liver cells, particularly in Zone 3. We find the contents of Sitoblasmih dense objects called Mallory Mallory bodies are sometimes seen within the liver cells in addition to the presence of giant mitochondria. Mallory's bodies are a manifestation indicative of liver injury, but not qualitatively, they might see in other liver diseases such as Wilson's disease and initial biliary cirrhosis.
Develop alcoholic hepatitis to cirrhosis if the consumption of alcohol.
3 - Alcoholic liver cirrhosis Alcoholic cirrhosis
Alcoholic cirrhosis usually have a small nodule of the style, but can also see a sample mixed with the conjugated fatty changes, we may find evidence of a former alcoholic hepatitis.
Clinical Features
In fatty liver:
In most cases there are no symptoms or signs. But may show some symptoms of digestive Allanoaah resulting from the general effects of alcohol on the gastrointestinal tract (nausea, vomiting, diarrhea).
Hepatomegaly may appear (may be severe at times) to accompany the demonstrations of other chronic liver disease.
Alcoholic hepatitis:
The clinical manifestations ranging between:
- Patient normally complain of mild symptoms and inflammation of the liver only pretending to liver biopsy with changes seen in the greasiness.
- Symptoms of mild to moderate severity of the disease is sometimes associated with mild jaundice
Tags: with all the signs seen in chronic liver disease.
Chemical analysis is useful in diagnosis, which depends mainly on the study of the liver and tissue biopsy.
- In the severe stage of the disease characterized by the occurrence of alcoholic cirrhosis.
Pretend to: jaundice, ascites, abdominal pain frequently in addition to the facilities to raise the caloric hepatic necrosis.
Clinical examination: we find severe jaundice, Hepatomegaly, sometimes splenomegaly, ascites and ankle edema in addition to signs of chronic liver disease.
Alcoholic cirrhosis:
Represents the final stage of liver disease caused by alcohol. However, the patient may be in good health and show mild symptoms. Clinical examination found signs of chronic liver disease.
Diagnosis is confirmed by liver biopsy. Disease usually manifests one of the complications of cirrhosis, has appeared in many cases the features of alcohol dependence as well as injuries to other devices such as multi-neuropathy polyneuropathy.
Surveys:
In fatty liver:
Note a rise in corpuscular volume MCV, which often refers to the excessive consumption of alcohol. Chemical analysis of the liver.
Show slight changes with the rise in the level of enzymes Alaminotransferraz (carriers of the Secretary) and serum gamma-glutamine is trans-peptidase Gamma-GT sensitive test to determine if the patient could still be using alcohol or stop eating.
In the event of severe fatty infiltration of the liver can show significant changes in the values of all the chemical analysis of the liver.
Ultrasound or CT scan CT shows histological changes in liver lipid infiltration and the extent of it.
And can be used Alelastograve elastography as a way to estimate the degree of hepatic fibrosis.
Alcoholic hepatitis:
Surveys show leukocytosis with marked changes in the chemical analysis of the liver, where the high note:
• serum bilirubin.
• ALT and AST serum
• alkaline phosphatase.
• prothrombin time.
Is possible to see a decrease in the level of serum albumin, and rarely see excessive fat in the blood with the dissolution of blood (Zieve syndrome). Zieve's syndrome
The liver biopsy in case they are needed through the jugular vein for fear of bleeding disorders because of the high prothrombin time.
Cirrhosis of the liver:
The same surveys cirrhosis in general.
Measure and warning of the disease:
General measure:
Should be directed to the patient's abstinence from alcohol. Is treated delirium tremens (View the withdrawal) by diazepam diazepam
And thiamin thiamine should be given intravenously for the prevention of encephalopathy and Urnqh - Korsakov and provide the patient and giving him vitamins and high protein meal in addition to clinical comfort.
A meal containing protein are rarely identified due to encephalopathy. Patients should be directed to participate in programs to refrain from alcohol, and the patient's ability to refrain from alcohol depends on several factors, especially social and family factors
In fatty liver:
After excluding the patient's consumption of alcohol, the fat will disappear and chemical analysis will return to normal.
Alcoholic hepatitis:
In severe cases, requires the acceptance of patients in the hospital. Must be maintained on the patient's diet and provide vitamins may require enteral feeding. Balstroidat treatment improves outcome and, in more severe cases and followed the process according to the following sports: Discriminant function (DF).
DF prothrombin time above control = (4.6. In seconds) + bilirubin (mg dL
The situation would be severe if the value is greater than 32
Should prevent or treat sepsis immediately, and must use preventive medicine antifungal and start treating Alhabn and encephalopathy. The patient must refrain from alcohol for life, because alcohol would undoubtedly risk of cirrhosis of the liver. Warning of the disease is variable, and regardless of abstinence from alcohol, the liver disease is a progressive disease in many patients. The mortality rate in severe cases, at least 50%, but at higher time Albrootermben of the weakness of time and natural progression encephalopathy and renal failure, the mortality rate rises to 90%
Cirrhosis:
As mentioned previously, the consumption of alcohol will undoubtedly lead to cirrhosis of the liver, and to refrain from alcohol consumption will improve the promotion cirrhosis, where the survival rate for 5 years is estimated at 90%, and when abstinence from alcohol, but when the continuation of alcohol intake, this ratio drops to 60%.
When progression of the disease (ie, in the event of jaundice, ascites, dissolution of blood), the survival rate for 5 years reduced to 35%, as most deaths occur during the first year of cirrhosis.
Liver transplantation will lead to good survival rate, although the return of cirrhosis as a result of relapse are rare. Often, patients sign a contract with their doctor refers to abstaining from alcohol before and after the transplant.
The start to refrain from alcohol in order to test the improvement of liver to be mandatory, and should not be denied a liver transplant if the patient's condition continued to deteriorate, and follow-up is recommended especially for patients with regard to alcohol consumption.
HCC is one of the complications of cirrhosis especially in men.
Acute pancreatitis is a relapsing inflammatory effectiveness may include in some cases, tissue around the pancreas and other organs.
- Acute pancreatitis is a widespread condition in Western societies at 11_40 cases per 100,000 people and an estimated fatality rate of 7-8%.
- Warning of acute pancreatitis is strongly linked to degree of tissue necrosis in the pancreas, although most cases tend to heal it automatically in about 15% of patients severe necrosis occurs and dangerous in the pancreas and other organs.
- Patients who have inflammation of the pancreas with an injury and lack of other members of the pancreatic necrosis ratio of approximately 30_50% of the gland tissue with high mortality.
- About 80% of cases of acute pancreatitis due to channel University of pebbles and excessive alcohol consumption.
- 10% of cases of unknown cause and the rest are caused by obstructions or drugs or metabolic, genetic or septic, or due to diseases of the blood.
Clinical manifestations and diagnosis
Patients complain of acute pancreatitis acute epigastric pain and sudden, sometimes spreads to the back, these symptoms may be associated with nausea, vomiting, fever and accelerate the pulse,
Clinical examination, we find reluctantly and tenderness in the epigastric region with abdominal distension and poor intestinal sounds with occasional fever.
Put the diagnosis with certainty based on laboratory tests that show high concentration of serum amylase and lipase three times the normal limit, at least, and the high degree of enzyme does not bear any indication of the degree of necrosis.
It is also the serological tests low sensitivity, because about a third of the patients happen to have a height of pancreatic enzymes, but less than three times the normal limit, and high amylase blood may be a reason beyond the pancreas being produced in the salivary glands and the horn tubes and rises if the ulcer perforated or intestinal infarction, or renal failure.
Therefore, serum lipase is considered to be more accurate but may be high in some patients asymptomatic.
Although the imaging and x-ray tests are not required but it is always useful in determining the severity of inflammation and the reasons sometimes.
CT imaging is considered the most accurate and useful in terms of the quality of discrimination between pancreatic Almtozm and interstitial inflammation and necrotizing inflammation.
More assets are seen on the CT scan is the magnitude of the pancreas and uneven edges and inflammation of tissue around the pancreas and concentration of liquids (see figure).
MRI is magnetic is very useful in patients sensitive to contrast radiography.
Also, the ultrasound in the detection of stones in the event of doubt reg inflammation of origin.
Warning criteria in acute pancreatitis:
Most episodes of acute pancreatitis are of moderate interstitial form, and nearly all mortality occurs in patients with necrotizing form of acute pancreatitis, which ranges in which the mortality rate between 30% and 10_ specifically, septic pancreatic necrosis.
And use a variety of systems, calculating the points for the definition of degree of seriousness of the patient's condition and determine the warning, and these systems standards Ranson, Glasgow system, and evaluation of Apache 2.
Ranson criteria and remains the most widely used, while the Apache system is more complex, and should not replace any test subject clinical trial minute for each patient individually.
And increase serum concentration of the reactive protein in conjunction with the severity of acute pancreatitis, but it is not a name and a sensitive and early on the severity of the disease.
As the disease is more severe in the case of obesity (body mass index above the 30).
Measure
Often heals acute pancreatitis from the mild form in the interstitial space of a few days without causing Bakabil functional. The measure consists mainly of supportive measures, including bowel rest (absolute oral diet), intravenous fluid, and pain control using appropriate analgesics.
Patients who suffer from severe acute pancreatitis should be performed, CT is supported to assess the degree of necrosis caused and the severity.
According to the preventive treatment with antibiotics only patients with pancreatitis Altnchri, has been found that both Alemippinim, cephalosporins and fluoroquinolones has led to the low rate of morbidity and mortality.
Shall be subject to pancreatitis patients Altnchri of fine needle aspiration through the skin and for the transplant and dye grams in order to assess the presence of inflammation of the pancreas Tnchri, which should be addressed Baltnder surgery.
Patients with acute pancreatitis often spend a long time in the hospital with their inability to take food or fluids orally. And recent evidence suggests that early use of the feeding tube through the nasal tract
Specific (nasal jejunoileal) may reduce the rate of morbidity, especially septic complications, compared to intravenous nutrition.
And advised to use imaging technology, and ductal pancreatic bile reflux endoscopically for patients who have signs of inflammation of the pancreas Bhsaat bitterness and suspicion biliary obstruction. Embolism is suspected in the case of biliary bile Althsa channel counts or university, and we find a widening of the bile duct in this case and a rise in liver enzymes. Alaminotransferraz concentration rises first in the inflammation of the pancreas Bhsaat bitterness, followed by a rise in alkaline phosphatase and bilirubin if the blockage.
Has shown an endoscopic technique with a few mill previous decline in the proportion of morbidity and mortality in those patients, and significantly reduced the rate of cholangitis and biliary infection.
Complications:
False pancreatic cysts: is the mixing of the most common acute pancreatitis (which is about cysts of the pancreatic juice with a fibrous lining is present on the epithelial gland).
These cysts need at least 4 weeks to form and often break down spontaneously, without symptoms, but may cause pain or blockage of pressure on other organs.
The cysts occasional false address Balenzh through the skin Oalenzh endoscopic or surgical through the stomach or duodenum.
Patient with septic Pkissat false (pancreatic abscess) is suffering from deteriorating abdominal pain, fever and a high rate of leukocytes. Balenzh treatment is surgical or through the skin and antibiotics.
Less common complications of acute pancreatitis is the holes or channels, pancreatic fistulas, which are associated with Alhabn pancreatic origin. Treatment and resting during bowel endoscopy or surgery.
Inflammation of the pancreas may lead to splenic vein thrombosis with gastric varices and subsequent hemorrhages.
Some patients with severe pancreatitis and those with significant necrosis may develop with diabetes.
Headaches (headaches), forms, symptoms, diagnosis, and treatment. (Comprehensive article)
Headache is a common problem occur for many reasons and many making the identification and classification difficult. Chronic headaches
Common occurrence in cases of:
• sister
• effort and tension (anxiety)
• Stress
But it could also be linked to:
• intracranial lesions
• head injuries
• ankylosing spondylitis
• dental disease or in-kind
• work disorder TMJ lower
• sinusitis
• High blood pressure
• a wide range of disorders that affect the membership and cause medical problems.
- Although most patients who suffer from headaches do not have lesions structural, saying only that, although it must keep in mind the possibility of a background of structural and behind the headaches complained of by the patient; For example, a third of patients with cancers of the brain demonstrating Initially filed a complaint of headaches.
- The unit and the nature and location of pain in addition to other things, the most important bout for headaches and the presence of accompanying neurological symptoms, all of this gives us the key to solve the mystery of the underlying cause of headache, which affects the patient.
Headache that occurs because of migraine or tension often described as throbbing or flapped, and the sense described by the patient as feeling Btadhaq vessel head or feeling the pulse of the head vessels are also associated with headaches caused by tension.
Headache associated with pain pike acute suggests a reason relates to inflammation of the nerves; Kalasb kind or nerve around the orbits, where there is pain - described as the pain hit ax ice - a companion of migraine or cluster headache, while the headache associated with pain dim light or constant constant suggests mainly the presence of the scourge of intracranial in mass.
Pain on the kind or kind suggests the existence of pest-related eye; when the pain is "bar", it is commonly associated with tension headache, while the pain is often accompanied by collateral deposited with migraine or cluster headache.
In patients with inflammation of the sinuses, in addition to the presence of headache, there is tenderness in the skin and bone deposited over the area of the infected pocket.
If the headaches caused by lesions in mass within the skull - the trajectory a nerve - we can Nsnfe to a position and a generalized, for example if a patient has pain of the trigeminal nerve or glossopharyngeal neuralgia, this pain will be the subject of a branch of the trigeminal or in the pharynx and external auditory meatus (respectively).
When questioning the patient should be asked for headaches:
genetic factors
inflammation of the pockets of recent
injury hay fever
dental surgery
injury to the head
symptoms of systemic viral infection may be indicative of a possible underlying reason behind the presence of headache
For migraine headaches aggravated in cases of:
emotional stress
fatigue and fatigue
eating materials containing nitrite or tyramine
menstrual cycle [menstrual]
** The alcohol may be due Balubal the owner and has developed a type of severe headache is the "cluster headaches".
- The work of the disorder of TMJ pain and cause the lower Aghia type of headache or be predisposed chewing trigeminal neuralgia or glossopharyngeal nerve may also cause pain as well be predisposed to chewing chewing or ten so called stopped chewing] that sometimes occurs in conjunction with inflammation artery giant cell (temporal arteritis).
- Cough-induced headache is happening in the case of structural lesions of the hole background, but in many cases can not find a clear reason for this type of cough.
In a patient with headaches, learn the timing of symptoms and headache episode is important because headache is bad when the alarm awakens the patient is already inflamed sinuses or intracranial mass.
Cluster headaches usually occur in the same time every day or typically occurs at night, but for tension headache and fatigue effort it is getting worse and worse at the end of the day.
- The incidence of Sudden headache severe suggests an association with lesions and disorders of intracranial Kalnsv subarachnoid or meningitis, especially if this happens when a healthy person without a history of satisfactory, but to be a chronic headache was the proposal against the backdrop of turmoil within the skull when a healthy person before this probability is relatively rare.
For additional surveys, we we request depending on the principled clinical evaluation of the patient, for example, in cases of:
• severe headache, progressive
• New onset of headache in the middle or late life
• headache that haunts the sleeping
• headache tension and stress
• headache associated with neurological symptoms in general or the subject of a nervous disorder
All of these cases require a magnetic resonance MRI of the cranium or photography class a pivotal head CT in order to deny the existence of intracranial lesion with mass.
But when there are signs of meningeal irritation or deterioration in consciousness, it also requires a CT scan, MRI and examination of cerebrospinal fluid so as to exclude subarachnoid hemorrhage or infection of the meninges.
The diagnosis and treatment of neurological disorders associated with primary headache is not uniform and varied and all have a special type of a particular neurological disorder.
The types of headaches are studying:
1 - Stress and tension headaches:
Patients often complain of poor concentration with vague non-specific symptoms of the other, in addition to the continuous daily headache as Alhadh Court on the head like a vice, this iron is exacerbated headache severity or emotional fatigue or excessive fuss or staring with something dazzling to the eye.
Headache is usually generalized, but be as strong as possible within the scope of Agafoh neck and head, and not associated with neurological symptoms placement.
Treatment:
- Start simple palliatives of pain, if did not work then we resort to drugs of anti-sister and that would be the effect worthwhile.
- Are technologies that provide comfort is also helpful in alleviating the pain of headaches, these techniques include:
massages
hot baths
Self-feedback technology (a technology through which the controlled person and involuntary body functions Kalnd, pressure and other functions that are normally controlled voluntarily, using specific devices).
- Survey of the main reasons for the chronic state of anxiety is usually a useful and appropriate for the development of appropriate treatment.
- Injection of the toxin type A Albotulini sometimes helpful, with possession of a few systemic side effects, but given protocol must be irregular.
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2 - headache depression:
In this type of headache is repeated every day is a pain episode is the worst of its kind and which are in the early morning, in addition to this headache may be associated with other symptoms of depression.
It is said that depression is causing the headaches, but on the other extreme is said that the headache occurs first and is the focus is causing depression or activated the device Aldilala (placebo), physical, and therefore may be both the cause of headaches or depression of another.
In this case the benefit is usually antidepressants, also serve as medical and psychological counseling.
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3 - sister:
Basics of diagnosis:
Headache is often throbbing, associated symptoms include nausea and vomiting as well as phobias and optical audio.
May precede the attack of some neurological symptoms (especially visual) may also occur without the presence of people (and a certain sense of aura felt by the patient before an attack).
General ideas:
Studies have shown that the neurotransmitter "serotonin" may play an important role in the pathogenesis of migraine.
That in the case of migraine headaches may be due to release peptides act as vectors in the nerve branches of the trigeminal nerve, leading to an inflammatory process and there is another theory says that the headache could be due to induction of dorsal nucleus Alrvaúah.
Clinical findings:
Classical migraine headache is unilateral nature vibrant frequently occurs periodically after the first episode that may occur in adolescence or early adult and with that not every headache is diagnosed with a vibrant nature of the sister that in addition to many types of headaches do not match the form mentioned above, although the characteristics and response to drugs because of its sister show the same pathogenicity.
And consequently, migraine headaches may be unilateral or bilateral (generalized) with the nature of a vibrant or dullness is often accompanied by anorexia, nausea and vomiting and light and sound phobia disorder, and (confusion) optical.
Symptoms begin gradually and last for several hours or more have been observed in facilities for these symptoms and the presence of over-expansion and an increase in the external carotid artery pulse.
May be preceded or accompanied by headache, focal disturbances in the work of the central nervous system and due to the presence of narrowing in the carotid artery branches.
Visual disturbances are common and include visual field disturbances or visual hallucinations and bright, which may take different forms are in the form of stars or sparks, or specific geometric shapes or ripples and may not take a particular form and can include visual disturbances both visual field disturbance and hallucinations.
May occur as focal disorders such as aphasia, numbness, tingling, weakness in specific muscles in the body, movements are inaccurate (lout).
There is often a family history of migraine injury
Factor is induced mental stress or physical deficiency or increased sleep, missed meals, specific foods (chocolate), alcoholic beverages, the menstrual cycle, take oral contraceptives.
Of cases (variations) is common:
Sister of basilar artery, which is characterized by the loss or disturbance of vision in both fields visual accompanied or followed by dysarthria (difficulty word), upset the balance, tinnitus, numbness around the mouth and in remote areas, disturbance (loss of cross-awareness) or a state of confusion my mind, followed by headache, pulsatile especially in the occipital region, accompanied by nausea and vomiting.
In migraine associated with paralysis kind there is pain telescopic building maintenance around the eye with nausea and vomiting, and diplopia (double vision) due to a partial paralysis in the muscles of the external eye as a result of paralysis of third nerve, which may be accompanied sometimes paralysis of the sixth nerve and can continue to be paralyzed for several days after the occurrence of pain, and could include ophthalmic branch of the trigeminal nerve.
The migraine associated with paralysis of the eye is rare.
Of the most common causes of painful ophthalmoplegia maternal blood in the carotid artery disease and diabetes.
In some rare cases may be physical or neurological disorders demonstrate only diagnosed the attack.
Migraine may lead in very rare cases the injury of nerve permanently.
Treatment:
The management of migraine includes avoiding provocative factors in addition to the preventive treatment of the symptoms of drug or existing, and when necessary.
1 - Symptomatic treatment:
Many of the patients during the acute attack and found the benefit of rest and relaxation in a quiet room is dark until the symptoms disappear, and pain relievers simple (such as aspirin, aspirin - paracetamol acetaminophen - ibuprofen ibuprofen - naproxen, naproxen), when given directly Oharthm comfortable, as well as the HANDLE of blood outside the brain and other medicines are sometimes necessary.
Kavirgot: Cafergot is a combination of tartrate ergotamine ergotamine tartrate (1 mg) with caffeine caffeine (100 mg), a product with a clear benefit, especially when dealing with a disk or two disks at the start of headache or when symptoms warning of the occurrence onslaught of pain followed by a disk every half hour, and if needed we can increase the number of disks to 6 tablets during the acute attack and 10 during the week.
May fail oral treatment sometimes be useful because of the absorption of the weak and Alakieouat occurring during the acute attack and in such cases, the Kavirgot can be given via the rectum Kthamil anal (suppository every half hour containing 2mg of ergotamine) or we can give Dai Hydro ergotamine Messelat dihydroergotamine mesylate (0.5 - 1 mg intravenous) or (1 - 2 mg subcutaneously or intramuscularly) in addition to that given prochlorperazine prochlorperazine through the rectum (25 mg) or intravenous (10 mg), and we must not forget that ergotamine affects the pregnant uterus and therefore should be avoided. give during pregnancy.
Sumaatrepettan Sumatriptan: have a familiar high serotonin receptors -1, a factor effectively and promptly to stop the acute attack when given by subcutaneous self-injection device, and can be given as nasal absorption, but limited, and the eating is orally available.
Zulma triptans: Zolmitriptan stimulant selective for serotonin receptors -1 and has the availability of a dynamic high after taking orally is effective in the treatment of acute attack of migraine, the initial dose ideal of it is (5 mg) and relaxes the patient, usually after hours, and there is a product I deny my own and developed the start of its effect quickly, We can also use some other drugs from a group including triptans Triptans (Rizzatreptan rizatriptan - Naratreptan naratriptan - Olmutreptan almotriptan - Afrovathriptan frovatriptan), which has a longer half-life which is worthwhile for the treatment of patients with long attacks (more than 7.5 mg in 24 hours). We should avoid triptans during pregnancy, and that this group is one of Contraindications in people who have the disease in the coronary or peripheral vessels, and may also cause nausea and vomiting.
droperidol: droperidol antipsychotic and is also useful to stop the acute attack.
Pain relievers, which has affected a drug may be necessary in some special cases such as Mberden meperidine (100 mg intramuscularly) and tartrate Baotovanol butorphanol tartrate by nasal spray (1 mg / spray in each nostril, and repeated after 3-4 hours if necessary), and propofol propofol for intravenously in doses given under anesthesia could be beneficial in cases resistant to treatment.
2 - preventive treatment:
The preventive treatment is necessary if the headaches caused by migraine get frequent 2-3 times a month and that the most common drugs used for this purpose are summarized below, and the way it works is not clear it affects all of education outside the brain in addition to their effects brain; such as installing transport of the nervous system serotonin.
Drugs:
Aspirin
propranolol (and other β-receptor blockers are also useful)
Amitriptyline
Amapramen
sertraline
ergonovine maleate
cyproheptadine
Clonidine
verapamil (and other calcium channel blockers are also useful)
Many of the drugs should be tried sequentially until the headache and control a counter attack as soon as we find the panacea we must continue to take him for a few months and if the patient felt that he get rid of the headaches we can reduce the dose gradually we eventually withdraw the drug.
Albotulini toxin A effective in the prevention of migraine in some patients in the event of localized injections of the scalp, but it has some side effects and only needs to give him at intervals during several months.
The use of antimicrobial agents is also useful anticonvulsant drugs used:
valproic acid (500 - 1500 mg) with a note not to use it during pregnancy.
Gababintin (900 - 2400 mg)
Topeeramat (50 - 1100 mg)
Drugs blocking the calcium channels can reduce the recurrence of attacks after several weeks, but the severity and duration of attacks will not be affected, and we should not we use with beta blockers.
The receptor blockers, angiotensin-converting enzyme (Candy Sartian candesartan) and that have been evaluated, may be useful and effective.
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4 - cluster headache (neuralgia Alhqiqi Migrainous Neuralgia):
This type of headache generally affects men in middle age. Its causes are not yet known but it may be associated with headache caused by vascular disorders or disorder mechanisms of action of serotonin.
- Seen in this type of headache to activate the cells of the hypothalamus in the same side as there is a pain.
- Often happens this type of headache without family history of headache or migraine.
Occur bouts of severe unilateral pain localized around the pilgrims on a daily basis for several weeks and is often associated with one or more of the following:
• nasal congestion that occurs in the same side where the pain
• runny nose
• runny lacrimal
• red eyes
• Horner's syndrome
Seizures often occur at night Moukzh the patient from his sleep and continue per attack less than two hours and then place spontaneous remissions lasting weeks or months where the patient is in good health before they have converged from heart attack later.
During the attack a number of alcohol patients accuse of inciting a heart pain, and others accuse the intensity, or very bright light, or eating certain foods is working on the induction of heart pain.
In some patients, repeated episodes of pain and accompanying symptoms without the period of remission, and this disparity in the protocol of a pain due to the presence of chronic cluster headache.
Drugs which are useful for the prevention of migraine important in the treatment have been mentioned at the top .....
Examination shows the absence of any appearance is abnormal only in Horner's syndrome, which occurs either on a temporary basis during the attack, or that already exists Kaadz permanent and continuous rest between the attacks.
Treatment of single attack of oral pain medications are often not completely satisfied with the result of the use of medicines, injections under the skin it is often useful drugs used are:
Somaterbtin (6 mg)
de Hydro ergotamine (1 - 2 mg)
It may also benefit from the inhalation of 100% oxygen to give 7L \ min for 15 min.
Ttrut Albotorvnol - a synthetic opiate anti-cough - may also be useful when used Kboukhakh my nose and dose (1 mg) one puff in each nostril, and repeated every 60 - 90 min if needed.
Ttrut ergotamine effective in the prevention of attacks if given in anal suppositories dose (0.5 - 1 mg) at night or twice a day, but if given orally Valjrah (2 mg) per day, and if I give the injections under the skin Valjrah (0.25 mg) three times daily for 5 days each week.
Preventive medicines that have been found effective in patients are:
Alvalbrooat
cyproheptadine
lithium carbonate (must be used when the monitor lithium concentration in plasma)
prednisone (20 - 40 mg) daily or a reciprocal system of sequential doses for two weeks followed by a gradual withdrawal of the drug
verapamil (240 - 480 mg) per day
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5 - headaches following trauma:
A wide range of symptoms Allanoaah can track the closed head injury, regardless of whether he had lost consciousness or not. Headaches often have a clear profile.
- Some authorities believe that psychological factors could be important because there is no link between the severity of the infection and neurological signs.
Headache disappears within days after self-injury, may get worse in the ensuing weeks and then gradually disappears. It is often constant pain deaf and overlay, and pulsed with pain or be subject, or generalized side is sometimes accompanied by nausea or vomiting, scotomata, or blinking.
Imbalance may occur associated with the composite rotary (dizziness compound) is also often increases with position changes or movements of the head.
Memory ailing (sick), poor communication, emotional instability and high irritability (irritability), all previous complaints might be common, and sometimes the views only of the disease syndrome.
Duration of symptoms associated with tongs as to the severity of the original injury and even minor injuries can be followed by symptoms may last for months.
Surveys are usually not assist, EEG power EEG can show small changes of unknown cause, while the proposed planning nystagmus electricity in some cases, either in morbidity vestibular ocular peripheral or central, CT and MRI magnetic head appears free of the assets is not natural.
- Treatment is difficult, but optimism and encouragement and the gradual rehabilitation based on the occupations appropriate to the conditions recommended.
Headaches often respond to simple analgesics, but severe headaches requiring treatment by using:
Amitriptyline
Propranolol
derivatives clavus scalenus
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6 - Saala headaches:
May cause coughing, severe pain in the head as this may result in pain, fatigue and also for the effort, sneezing, laughing, but fortunately only lasts for several minutes or a few less than that even.
Mechanism of physiological disease of the complaint is not accurately known yet often does not have a structural lesion considerable potential beyond the pain, but the lesions are intracranial usually in the posterior fossa in particular (malformation Arnold - Kiara [prolonged and flat bulb and cerebellum) are present in approximately 10% of cases, and brain tumors or lesions of the worker into the manifest also in the same way.
