AtoZ Diseases

What do doctors call these conditions?

Hypochloremia, hyperchloremia

What are these conditions?

Chloride imbalance refers to too little or too much chloride in the blood. Too little chloride is called hypochloremia; too much, hyperchloremia.

Chloride is secreted by the stomach lining as hydrochloric acid to help with digestion and to activate needed enzymes. Chloride also helps the body maintain its chemical (acid-base) balance and body water balance and plays a role in the exchange of oxygen and carbon dioxide in red blood cells. It also helps activate chemicals in the saliva, which in turn starts the digestive process.

What causes chloride deficiency?

Too little chloride may be caused by:

• poorly absorbed or insufficient sodium in the person’s diet, potassium deficiency, or metabolic alkalosis (an imbalance caused by too little acid)

•  prolonged use of certain diuretics

• intravenous administration of dextrose without electrolytes (chlorides or other dissolved salts)

• excessive chloride loss, which is caused by prolonged diarrhea or sweating

• loss of chloride in stomach acid through vomiting, gastric suctioning, or gastric surgery.

What causes chloride excess?

Too much chloride may be caused by:

• eating or absorbing too much ammonium chloride, or the bowel’s reabsorbing too much chloride

• dehydration, which raises the proportion of chloride to other fluids in the blood

• the body’s compensating for other metabolic abnormalities.

What are the symptoms of chloride deficiency?

The person with a chloride deficit usually has muscle weakness and twitching, which is also characteristic of sodium imbalance. However, if the deficit results from loss of stomach acids (and sodium imbalance isn’t part of the problem), typical symptoms are muscle tension or spasm and shallow, depressed breathing.

What are the symptoms of chloride excess?

Too much chloride usually causes agitation, fluid volume excess, rapid heartbeat, high blood pressure, swelling, and difficulty breathing. If excessive chloride comes from metabolic acidosis, the symptoms are deep, rapid breathing; weakness; confusion; and, ultimately, coma.

How chloride imbalances are diagnosed?

The doctor may check chloride levels through blood tests to confirm chloride imbalances.

How is chloride deficiency treated?

In chloride deficit, the doctor will try to correct the cause and give an oral chloride replacement, such as salty broth. If the person can’t drink or eat or if the imbalance causes an emergency, the doctor may prescribe normal saline solution intravenously. The doctor may also prescribe chloride-containing drugs, such as ammonium chloride to increase blood chloride levels and potassium chloride to treat metabolic alkalosis.

How is chloride excess treated?

For severe hyperchloremic acidosis, the doctor will prescribe intravenous sodium bicarbonate to aid chloride excretion. In either kind of chloride imbalance, treatment must correct the underlying disorder.

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What is this condition?

Corneal abrasion is a scratch on the surface lining of the cornea ­the transparent, convex, front portion of the eye. The most common eye injury, corneal abrasion has a good prognosis if properly treated
What causes it?

Corneal abrasion usually occurs when a foreign body, such as a bit of dust or dirt, lodges under the eyelid. Even if the particle is washed out by tears, it may still injure the cornea. For instance, a tiny piece of metal that gets in the eye of a worker who neglects to wear protective eyewear quickly forms a rust ring on the cornea and abrades it. Corneal abrasions are also common in people who fall asleep wearing hard contact lenses.

A corneal scratch from a fingernail, a piece of paper, or another organic substance may cause a persistent wound. The lining doesn’t always heal properly, and recurrent corneal erosion may develop, with delayed effects that are more severe than the original injury.
What are the symptoms?

Typically, corneal abrasion causes redness, pain, increased tearing, and a sensation of something in the eye, even after the offending particle falls out. A corneal abrasion may also affect vision. Because the cornea is richly endowed with nerve endings, symptoms are more severe than the size of the injury would suggest.
How is it diagnosed?

Diagnosis is based on typical symptoms and a history of eye injury or prolonged wearing of contact lenses. The doctor will examine the eye with a penlight to reveal a foreign body on the cornea; to check for a foreign body embedded under the lid, he or she will gently turn the eyelid inside out. To confirm the diagnosis, the doctor may stain the cornea with fluorescein, a dye that makes the injured area look green when examined with a penlight.
How is it treated?

To remove a deeply embedded foreign body, the doctor uses a spadelike device after applying a topical anesthetic. To remove a rust ring on the cornea, the doctor uses an ophthalmic burr, an abrasive device. When only partial removal is possible, healing of the epithelium lifts the ring to the surface and allows complete removal the next day.

After the foreign body is removed, antibiotic eyedrops must be instilled in the affected eye every 3 to 4 hours. Applying a pressure patch prevents further corneal irritation when the person blinks, except where abrasion is caused by contact lenses.

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What is this condition?

This type of cancer attacks the esophagus - the canal extending from the throat to the stomach. The tumor is usually infiltrating. There’s no known cure yet.
What causes it?

The cause is unknown, but predisposing factors include chronic irritation caused by heavy smoking and excessive alcohol use, stasis-induced inflammation, and nutritional deficiency
What are its symptoms?

Swallowing difficulty and weight loss are the most common initial symptoms. Swallowing difficulty is mild and intermittent at first bur soon becomes constant. Pain, hoarseness, coughing, and esophageal obstruction follow. Physical wasting and malnutrition may develop.
How is it diagnosed?

X-rays of the esophagus, with barium swallow and motility studies, reveal structural and filling defects and reduced peristalsis. An endoscopic examination of the esophagus, biopsies, and cytologic tests confirm esophageal tumors.
How Esophageal Cancer is treated?

Whenever possible, treatment includes surgical removal of the tumor to maintain a passageway for food. This may require radical surgery. Some people can undergo only palliative surgery, which relieves some symptoms but doesn’t cure the disease. Other therapies may consist of radiation, chemotherapy with cisplatin, or insertion of prosthetic tubes to bridge the tumor and alleviate swallowing difficulty. Treatment complications may be severe.

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What is this condition?

Kaposi’s sarcoma is a type of cancer affecting the walls of certain lymphatic cells. Until the 1980s, doctors viewed it as a rare sarcoma (soft­tissue cancer) of the blood vessels, occurring mostly in elderly Italian and Jewish men. But the incidence of Kaposi’s sarcoma has risen dramatically along with the incidence of AIDS. Currently, it’s the most common AIDS-related cancer.

Kaposi’s sarcoma causes both structural and functional damage. When associated with AIDS, it has an aggressive course, involving the lymph nodes, internal organs, and possibly the digestive tract.

What causes Kaposi’s Sarcoma?

The exact cause of Kaposi’s sarcoma is unknown, but the disease may be related to suppression of the immune system. Genetic or hereditary predisposition is also suspected.

What are its symptoms?

The first sign of Kaposi’s sarcoma is one or more obvious skin lesions. These lesions vary in shape and size, and their color may range from red-brown to dark purple. They are most common on the skin, inside of the cheek or mouth, lips, gums, tongue, tonsils, eyes, and eyelids. Besides the skin, Kaposi’s sarcoma may affect the lungs, gastrointestinal tract, and other areas.

When the disease advances, the lesions may join, becoming one large plaque, or patch. Untreated lesions may look like large, craterlike masses. Other signs and symptoms include:

• pain (if the sarcoma advances beyond the early stages or if a lesion breaks down or presses on nerves or organs)
• swelling caused by clogged lymphatic channels
• shortness of breath or difficulty breathing (if the disease affects respiratory structures), wheezing, slow and shallow breathing, and respiratory distress
• digestive problems.

How is it diagnosed?

The doctor performs a tissue biopsy (removal and analysis of tissue from the lesion) to identity the type and stage of the lesion. Then the person may undergo a computed tomography scan (commonly called a CAT scan) to detect and evaluate possible disease spread.

How is it treated?

Treatment isn’t indicated for all cases of Kaposi’s sarcoma. But if the disease is progressing quickly and the lesions are cosmetically offensive or painful or if they’re blocking vital functions, the person should get treatment.

Treatment options include radiation therapy, chemotherapy, and biotherapy (administration of drugs called biological response modifiers). Radiation therapy eases symptoms, including pain from obstructing lesions in the mouth, throat, arms, or legs and swelling caused by lymphatic blockage. It may also be used to improve the person’s appearance.

Chemotherapy includes combinations of the drugs doxorubicin, vinblastine, vincristine, and etoposide (VP-16).

Biotherapy with interferon alfa-2b may be prescribed for AIDS­related Kaposi’s sarcoma. This treatment reduces the number of skin lesions but isn’t effective in advanced disease.

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What is this condition?

Metabolic acidosis is a combination of excess acid accumulation and insufficient base compounds in the person’s system. This acid-base imbalance is usually brought on by a medical disorder.

This imbalance of body chemicals depresses the central nervous system. Left untreated, metabolic acidosis can lead to dangerous changes in heart rate and rhythm, cardiac arrest, and coma. The prognosis improves if the underlying cause is identified quickly and the body’s normal acid-base balance is promptly restored.

Metabolic acidosis is more common in children than in adults.
What causes it?

Metabolic acidosis is commonly caused by excessive burning of fats in the absence of usable carbohydrates. This can be caused by diabetes, chronic alcoholism, malnutrition, or a low-carbohydrate, high­fat diet - all of which produce more acids than the body can handle. Other causes include:

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too little oxygen to burn carbohydrates (as occurs after a heart attack) and a corresponding rise in lactic acid level
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kidney insufficiency and failure (the kidneys may fail to secrete sufficient acid)
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diarrhoea and intestinal malabsorption, which cause loss of sodium bicarbonate
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aspirin overdose (less frequently) or some other poisoning
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Addison’s disease.

What are the symptoms of Metabolic Acidosis?

Metabolic acidosis typically causes a headache and lethargy, progressing to drowsiness, central nervous system depression, and rapid breathing (as the lungs try to compensate by “blowing off” carbon dioxide), and stupor. If the condition is severe and goes untreated, the person may suffer a coma and die.

The person usually has stomach problems that produce appetite loss, as well as nausea, vomiting, and diarrhea, which may lead to dehydration. If the person has diabetes, he or she may have fruity­smelling breath.
How is it diagnosed?

After he asks about symptoms, the doctor will order blood tests to confirm metabolic acidosis and determine its severity. The key test for detecting metabolic acidosis is called arterial blood gas analysis.
How is it treated?

If severe metabolic acidosis is diagnosed, treatment begins with intravenous sodium bicarbonate, which helps to neutralize body acids. The doctor evaluates and corrects other electrolyte imbalances - for example, a person with metabolic acidosis may also need treatment for excessive potassium.

Other treatments may include mechanical ventilation to ensure adequate breathing, replacement of fluids, and antibiotics to treat infection. Ultimately, the doctor must correct the underlying cause. For example, in diabetic ketoacidosis, a low-dose continuous, intravenous infusion of insulin is recommended.

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What is this condition?

A cataract is a clouding of the lens of the eye, which is normally transparent. This clouding makes vision fuzzy. A common cause of vision loss, cataracts usually affect both eyes - except for traumatic cataracts, which usually occur in just one eye.

A disorder of aging, cataracts are most common in people over age 70. The prognosis is generally good; surgery improves vision in 95% of people with the disorder.

What causes cataracts?

Cataracts have various causes:

• Senile cataracts develop in the elderly, probably from chemical changes in the lens of the eye .

• Congenital cataracts occur in newborns as genetic defects or may result from German measles contracted by the mother during the first trimester of pregnancy .

• Traumatic cataracts develop after a foreign body injures the lens with enough force to allow eye fluids to enter the lens capsule.

• Complicated cataracts result from other eye disorders (such as inflammation of the uveal tract in the eye, glaucoma, or a detached retina) or from a systemic disease such as diabetes, underactive parathyroid glands, or a skin inflammation called atopic dermatitis.

These cataracts can also result from exposure to ionizing radiation or infrared rays.

• Toxic cataracts result from toxicity from certain drugs (such as Or­asone, ergot alkaloids, and phenothiazines) or certain chemicals (such as dinitrophenol and naphthalene).

What are its symptoms?

Typically, a cataract causes painless, gradual blurring of vision and vision loss. As it progresses, the normally black pupil turns milky white. Other symptoms include blinding glare from headlights when driving at night, poor reading vision, and an unpleasant glare and poor vision in bright sunlight. If the central part of the lens is cloudy, vision is better in dim light than in bright light.

How is it diagnosed?

Shining a penlight into the eye reveals the white area of an advanced cataract behind the pupil. To confirm the diagnosis, the doctor performs ophthalmoscopic and slit-lamp exams.

cataract surgery

• To restore sight, the cataract must be removedby means of surgery. Usually, this is done in one of the following same-day surgical procedures:
• Extracapsular cataract extraction removes the front lens capsule, leaving the rear lens capsule intact. Then an intraocular lens is implanted where the person’s own lens used to be. This procedure can be done in people of all ages.
• Phacoemulsification fragments the cloudy lens with ultrasonic vibrations; lens debris is removed by suction.
• Discission and aspiration can still be used for children with soft cataracts but the procedure is obsolete.
• A person with an intraocular lens implant has clear distance vision once the eye patch is removed but needs corrective reading glasses or contact lenses for reading. Glasses or lenses are fitted 4 to 8 weeks after surgery.

After surgery, the person must care for the eye properly.

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Cerebral” means braincentered, and “palsy,” paralysis. This is a condition present in children after birth, and affects brain centers having to do with muscular control. There is a considerable range in severity and nature of symptoms. Some afflicted persons walk with scissoring, floundering movements, awk­ward armflinging and head tossing and speak with difficult guttural sounds if at all. Some who are mildly afflicted do not appear to be conspicuously strange.

The cause or causes of cerebral palsy are not too clearly established. Some cases are due to brain injury during diffi. cult childbirth, but many babies born with difficulty do not have cerebral palsy. Some cases are thought to be due to infections suffered by the mother or to toxic substances in her blood that reach and damage the brain of the fetus during its early developmental stages. Rh· factor incompatibilities are sometimes implicated.

The afflicted person may show chiefly one or a combination of symptoms such as chorea (involuntary jerking move· ments of different muscle groups), athetosis (a slow, writhing type of constant movement, chiefly in the fingers), poor sense of balance, tremor, and spastic muscles. Frequently, though by no means always. there is mild to severe impair:ment of intelligence; sometimes a normal may be hidden behind difficulties of communication.

There are no preventive measures of celebral palsy, other than careful prenantal and obstetrical care which maycorrect recognized abnormalities. Physical.and speech therapy may overcome handcaps to some degree, and braces and other supportive measures may be helpful in individual cases.

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What is this condition?

Chronic glomerulonephritis is a slowly progressive disease, marked by inflammation of the kidneys. The inflammation leads to hardening and scarring of tissue and eventual kidney failure.

People with this condition usually don’t develop symptoms until the disease is advanced. By this time, the person with chronic glomerulonephritis usually cannot be cured and must rely on dialysis or a kidney transplant.

What causes it?

Common causes of chronic glomerulonephritis include a long list of preexisting kidney disorders, and it may be linked to some other diseases such as strep, lupus, and Goodpasture’s syndrome.

What are its symptoms?

Since it develops slowly and silently, people with chronic glomerulonephritis may not have symptoms for many years. At any time, however, it may suddenly worsen, producing high blood pressure and protein and blood in the urine, possibly followed by symptoms of uremic poisoning, such as nausea, vomiting, itchy skin, difficult breathing, and fatigue. Mild to severe swelling and anemia may accompany these symptoms. When the disease involves the heart or leads to kidney failure, the person will require dialysis or a kidney transplant.

How is it diagnosed?

Because the doctor usually can’t detect glomerulonephritis with a physical exam or questions, he or she will order urinalysis, which may show blood, protein, and debris from the damaged kidneys. The doctor may use blood tests and X-ray or ultrasound to learn more, and then a kidney biopsy to identify the exact cause and gather data to plan the persons therapy.

How is it treated?

The doctor first works to reduce the person’s symptoms and to control high blood pressure with drugs and a low-potassium diet.

The doctor may restrict and guide the person’s fluid consumption and prescribe diuretics to prevent congestive heart failure. Treatment may also include antibiotics (for urinary tract infections) and, eventually, dialysis or transplantation.

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Dizziness is almost as common a complaint, especially among older people, as headache. Dizziness is the lay equivalent the medical term, veTtigo. Dizziness is often loosely applied to include giddiness. giddiness refers to a mild form of dizziness frequently seen among elderly people in which there is a momentary sensation of clouding of the mind and reeling or unsteadiness when they suddenly change position, as from a reclining to a sitting or standing position, or “hen they suddenly bend to pick up an object. It is believed to be due to hardening of the brain arteries, in which a sharp mange in posture leads to a momentary flooding of the brain with blood, or the emptying of blood from the brain. Giddiness may prove frightening to some patients, but does not lead to any serious consequences and most patients learn to avoid making sudden postural changes.

Dizziness refers to a slightly more disturbing situation than giddiness that may last a few minutes to a half hour, inuring which there is some unsteadiness in walking and a slight reeling sensation, perhaps nausea, but rarely vomiting. It is usually due to a temporary impoverishment of brain circulation, caused by hardening of the brain arteries, by poor heart heart function, or by a drug that suddenly lowers the blood pressure. The patient will generally seek a sitting position for a few minutes until the unpleasant sensation passes.

Meniere’s disease or syndrome is characterized by attacks that commence suddenly with violent dizziness, ringing in the ear, vomiting, a reeling sensation and unsteadiness of body equilibrium so severe that if the person does not lie down, he would fall to the floor. During the course of a severe attack, the patient is confined to bed and cannot move his head from one side to the other without experiencing disturbing sensations that the floor, bed, and chairs are turning around him. Such a bout may last several weeks before there is complete recovery.

Milder attacks may last a half hour to several hours. The attacks may recur at irregular i

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In this condition, endometrial tissue occurs outside of its customary location: the lining of the uterine cavity. Called ectopic tissue, it’s generally confined to the pelvic area, but it can appear anywhere in the body. This ectopic endometrial tissue responds to normal stimulation in the same way that the endometrium does. During menstruation, the ectopic tissue bleeds, which causes inflammation of the surrounding tissues. This inflammation causes fibrosis, leading to adhesions that produce pain and infertility.

Active endometriosis usually occurs between ages 30 and 40, especially in women who postpone childbearing; it’s uncommon before age 20. Severe symptoms of endometriosis may develop rapidly or may develop over many years. This disorder usually becomes progressively severe during the menstrual years; after menopause, it tends to subside.
What causes it?

Although there are several theories to explain this disorder, its precise cause remains unknown.
What are the symptoms of endometriosis?

The painful menstruation is one of the main endometriosis symptoms which may produce constant pain in the lower abdomen and in the vagina, posterior pelvis, and back. This pain usually begins from 5 to 7 days before a period reaches its peak and lasts for 2 to 3 days.

Other clinical features depend on the location of the ectopic tissue:

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ovaries and oviducts: infertility and heavy menstrual flow
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ovaries or cul-de-sac: deep-thrust dyspareunia (painful intercourse)
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bladder: suprapubic pain, dysuria, and hematuria
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recto vaginal septum and colon: painful defecation, rectal bleeding with a menstrual period, and pain in the coccyx or sacrum (base of the spine)
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small bowel and appendix: nausea and vomiting, which worsen before menses, and abdominal cramps
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cervix, vagina, and perineum: bleeding from endometrial deposits in these areas during a menstrual period.

How is it diagnosed?

The doctor will perform a pelvic exam to detect endometriosis. He or she may be able to feel multiple tender nodules on the uterosacral ligaments or between the rectum and vagina or detect ovarian enlargement. Laparoscopy must confirm the diagnosis and determine the stage of the disease before treatment begins.
How endometriosis is treated?

Treatment varies according to the stage of the disease and the woman’s age and desire to have children .Conservative therapy for young women who want to have children includes androgens, such as Danocrine, which produce a temporary remission. Progestins and oral contraceptives also relieve symptoms. Gonadotropin-releasing hormone agonists, which work by inducing false menopause, are commonly used to provide a remission of disease. When ovarian masses are present, surgery must be performed to rule out cancer. Conservative surgery is possible, bur the treatment of choice for women who don’t want to bear children or for extensive disease is total removal of the uterus, fallopian tubes, and ovaries.

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