About the gastrointestinal tract

The gastrointestinal (GI or digestive) tract includes the:

• Esophagus
• Stomach
• Gallbladder and bile ducts
• Liver
• Pancreas
• Small intestine
• Colon
• Rectum
• Anus
• Lining of the gut

The GI tract plays a central role in digesting food and liquid and in processing waste.  When you swallow food, it is pushed down a muscular tube called the esophagus and enters the stomach. The muscles in the stomach mix the food and release gastric juices that help break down and digest the food.

The food then moves into the small intestine, or small bowel, for further digestion before entering the large intestine. The large intestine helps remove waste from the body. The colon makes up the first 5 to 6 feet of the large intestine. The rectum makes up the last 6 inches, ending at the anus.

About gastrointestinal stromal tumor (GIST)

A tumor begins when healthy cells change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. A tumor can start in any part of the GI tract. There are several different types of GI tumors, including gastrointestinal stromal tumor (GIST).

GISTs are different from more common types of GI tumors because of the type of tissue in which they start. GISTs belong to a group of cancers called soft-tissue sarcomas. Soft-tissue sarcomas develop in the tissues that support and connect the body. The sarcoma cells resemble the cells that hold the body together, including fat cells, muscles, nerves, tendons, joints, blood vessels, and lymph vessels.

Doctors used to think that GISTs were muscle or nerve tumors. However, research shows that GIST begins in “pacemaker” cells found in the walls of the GI tract. These pacemaker cells are called interstitial cells of Cajal (ICCs), and they send signals to the GI tract to help move food and liquid through the digestive system.

  

Symptoms :

People with GIST often do not experience any specific symptoms or signs. When symptoms do occur, they may be vague. Or, the cause of a symptom may be a different medical condition that is not a tumor.

• Pain or discomfort in the abdomen
• A mass in the abdomen that you can feel with your hand
• Bowel obstruction
• Nausea and vomiting
• Vomiting blood
• Blood in the stool
• Fatigue due to anemia, which is a low red blood cell count and is often caused by bleeding in the GI tract.

Stages:

For other types of GI tumors, the most common staging tool used is called the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). However, the use of the TNM system for GIST is not required. Instead, doctors look at different factors to determine a patient’s prognosis and the specific risk of how aggressive an individual tumor will be. Specifically, doctors want to figure out how quickly the GIST may grow and the chance the tumor will come back, or recur, after surgery.

Doctors commonly use the factors listed below to determine how aggressive a GIST that has been removed could be:

• The size of the tumor
• The mitotic count, which describes the number of dividing cells
• The location where the tumor started

A GIST that has spread to distant areas of the body is considered higher risk because it has a greater likelihood of coming back, called recurrent GIST.

 

The major salivary glands are on each side of the face and below the tongue. Several important nerves and other structures run through or near salivary glands and can be affected by salivary tumors.

Possible signs and symptoms of salivary gland cancer include:

• A lump or swelling in your mouth, cheek, jaw, or neck
• Pain in your mouth, cheek, jaw, ear, or neck that does not go away
• A difference between the size and/or shape of the left and right sides of your face or neck
• Numbness in part of your face
• Weakness of the muscles on one side of your face
• Trouble opening your mouth widely
• Fluid draining from an ear
• Trouble swallowing

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many risk factors, does not mean that you will get the disease. And many people who get the disease may have few or no known risk factors.

A few risk factors are known to make a person more likely to develop salivary gland cancer.

Older age

The risk of salivary gland goes up as people get older.

Male gender

Salivary gland cancers are more common in men than in women.

Radiation exposure

Radiation treatment to the head and neck area for other medical reasons increases your risk of salivary gland cancer.

Workplace exposure to certain radioactive substances may also increase the risk of salivary gland cancer.

Family history

Very rarely, members of some families seem to have a higher than usual risk of developing salivary gland cancers. But most people who get salivary gland cancer do not have a family history of this disease.

Other possible risk factors

Certain workplace exposures

Some studies have suggested that people who work with certain metals (nickel alloy dust) or minerals (silica dust), and people who work in asbestos mining, plumbing, rubber products manufacturing, and some types of woodworking may be at increased risk for salivary gland cancer, but these links are not certain. The rarity of these cancers makes this hard to study.

Tobacco and alcohol use

Tobacco and alcohol can increase the risk for several cancers of the head and neck area, but they have not been strongly linked to salivary gland cancers in most studies.

Diet

Some studies have found that a diet low in vegetables and high in animal fat may increase the risk of salivary gland cancer, but more research is needed to confirm this possible link.

Cell phone use

One study has suggested an increased risk of parotid gland tumors among heavy cell phone users. In this study, most of the tumors seen were benign (not cancer). Other studies looking at this issue have not found such a link. Research in this area is still in progress.

If you’ve been diagnosed with salivary gland cancer, your cancer care team will discuss your treatment options with you. It’s important to weigh the benefits of each treatment option against the possible risks and side effects.

Which treatments are used for salivary gland cancer?

Common treatment options for salivary gland cancer include:

• Surgery
• Radiation therapy
• Chemotherapy

Vulvodynia is a burning, stinging but often unexplained pain affecting the skin around the vagina, or the vulva.

Although the condition is persistent and without an obvious cause, there are steps which can be taken to help relieve the discomfort.

Vulvodynia that is always present or comes on without a trigger is called unprovoked vulvodynia. If the pain starts when the vulva is touched, such as during sex or when changing a tampon, doctors call this provoked vulvodynia.

Vulvodynia cannot be transmitted during sex and is not a sign of a more serious condition, such as cancer.

Vestibulodynia is a related condition where pain affects the vestibule, which is the entrance to the vagina.

Types of vulvodynia

Vulvodynia affects the vulva which is the external female genital organs. This includes the labia, clitoris and vaginal opening.

The two main types of vulvodynia are:

• Generalised vulvodynia which is pain in different areas of the vulva which occurs at different times. Vulvar pain may be constant or occasional. It may or may not be prompted by touch or pressure but this may make the pain worse.
• Vestibulodynia is pain in the vestibule which is the entrance to the vagina. Often a burning sensation, this type of vulvar pain comes on during or after touch or pressure such as during sexual intercourse.

Possible causes of vulvodynia

Doctors do not know what causes vulvodynia. There is no evidence that infections, such as sexually transmitted infections, cause it.

Researchers are trying to find the causes of vulvodynia. These may include:

• Nerve injury or irritation
• Abnormal response in vulvar cells to an infection or trauma
• Genetic factors that make the vulva respond poorly to chronic inflammation
• Hypersensitivity to yeast infections
• Muscle spasms
• Allergies or irritation to chemicals or other substances
• Hormonal changes
• History of sexual abuse
• Frequent antibiotic use

What is carpal tunnel syndrome?

Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure on the median nerve in your wrist.

The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel . The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).

What causes carpal tunnel syndrome?

Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:

• Illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes.
• Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
• Pregnancy.

Causes

Carpal tunnel syndrome is caused by pressure on the median nerve.

The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

There is no single cause in many cases. It may be that a combination of risk factors contributes to the development of the condition.

Risk factors

A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:

• Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.
• Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
• Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
• Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.
• Obesity. Being obese is a significant risk factor for carpal tunnel syndrome.
• Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.
• Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome.
• Workplace factors. It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.However, the scientific evidence is conflicting and these factors haven’t been established as direct causes of carpal tunnel syndrome.Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

Prevention

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists with these methods:

• Reduce your force and relax your grip. If your work involves a cash register or keyboard, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
• Take frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force.
• Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.
• Improve your posture. Incorrect posture rolls shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands.
• Change your computer mouse. Make sure that your computer mouse is comfortable and doesn’t strain your wrist.
• Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.

Within the body, several sensitive nerves branch away from the spinal column through foraminal canals before travelling to peripheral regions of the body. These nerves relay sensory information to and from the central nervous system and enable us to interact with the world around us. Sometimes, however, nerves can begin to operate ineffectively or improperly relay information because they are being compressed and damaged as they exit the spine. The medical term for this painful condition is known as “radiculopathy.”

When radiculopathy is experienced, one or more nerves becomes diseased or aggravated as the result of abnormal pressure, which generally develops in or near the foraminal canals. Nerves can become irritated or pinched in any section of the spine, but radiculopathy is most frequently seen in the lumbar (lower back) and cervical (neck) regions of the back. These two regions are most susceptible to injury because the lower back bears much of the upper body’s weight and because the upper spine is sensitive and almost constantly in motion. Radiculopathy can usually be treated through a combination of conservative methods, although surgery may be recommended in extreme cases.

Radiculopathy Causes

There is a diverse array of causes for radiculopathy, usually discovered in conjunction with an injury or other spinal condition. Some of the most common factors that may contribute to nerve compression include:

• Frequent, improper movements, including those that might occur in heavy lifting, highly physical or manual labor and contact sports
• Degenerative, age-related diseases
• Genetic predisposition, congenital spine difficulties or a family history of radiculopathy
• Overly thickened ligaments
• Other spinal conditions, such as scoliosis, bone spurs and disc herniation
• Other health issues, including diabetes, tumors and infection
• Inflammation or displaced materials that may result from a sudden injury like a traumatic fall, motor vehicle accident or sports incident

All of these elements may also narrow the foraminal canals, leading to restricted nerves and debilitating symptoms. To care for your spine and the nerves that surround it, avoid activities that overly strain the backbone and seek prompt, professional medical attention if an issue is suspected.

Radiculopathy Symptoms

Symptoms of this condition are often shared with the other, underlying issues causing the radiculopathy to occur in the first place.

• Pain, numbness and tingling in the back, arms or legs
• Sciatica (discomfort that radiates through the lower back and limbs)
• A hypersensitivity to light touch and tenderness in the region in question
• Weakness in the affected area and associated extremities
• An inability to perform everyday activities or movements

Because any of the nerves leaving the spinal canal may suffer from radiculopathy, symptoms vary widely depending on the location of the affected region. If you are unsure where your pain is stemming from, we offer advanced pain-mapping procedures to pinpoint the precise site of your hurting nerve.

If you or a loved one encounter incontinence of the bladder or bowels in tandem with back pain, These symptoms are indicators of a life-threatening ailment known as “cauda equina syndrome”.

Treatments:

Taking the first step toward relief is as simple as scheduling a consultation at our state-of-the-art-facilities. During this appointment, one of our spine experts will carefully and compassionately evaluate your medical history, physical state and symptoms. To confirm a diagnosis of radiculopathy, imaging tests like a C.T. scan, MRI or X-ray may be requested, as well as a pain-mapping procedure. Once the location and severity of your compressed nerve has been ascertained, we will work with you to design a treatment plan that meets your unique needs and goals.

Whenever possible, we encourage patients to consider conservative, non-invasive treatment options before resorting to surgical intervention. Some of the non-surgical methods of care commonly implemented to treat radiculopathy include:

• Physical Therapy and Specialized Exercises: Oftentimes, physical therapists are able to strengthen the spine and reduce pressure on certain nerves by guiding the body through therapeutic movements.
• Pain-Relieving and Anti-Inflammatory Medication: When used temporarily, certain medications can reduce the amount of pain experienced by a patient and allow them to take up other treatment modalities, such as physical therapy, without being extremely uncomfortable.
• Injections: Localized injections can sometimes eliminate a patient’s pain for as long as 6 months at a time, often allowing compressed nerves to recover and thus reducing the need for surgery.
• Limited activity for a set period of time
• Heating and cooling treatments to maximize blood flow and the transmission of nutrients
• Spinal decompression therapy

Typically, radiculopathy will clear up when conservative treatment methods are dedicatedly employed. In severe cases, however, minimally invasive surgery may be needed to obtain full pain relief. Our expert spine surgeons can oftentimes treat radiculopathy with a posterolateral lumbar fusion or other advanced minimally invasive technique.

Because we offer some of the most state-of-the-art surgical options available, patients realize many benefits when compared to traditional open surgery. Some of these benefits include:

• Tiny incisions
• Less blood loss and scarring
• Minimal trauma to surrounding muscles and tissue
• Quicker recovery times that allow patients to return to work, school and other daily activities sooner
• Faster pain relief

A boil is a skin infection that starts in a hair follicle or oil gland. At first, the skin turns red in the area of the infection, and a tender lump develops. After four to seven days, the lump starts turning white as pus collects under the skin.

• The most common places for boils to appear are on the face, neck, armpits, shoulders, and buttocks. When one forms on the eyelid, it is called a sty.
• If several boils appear in a group, this is a more serious type of infection called a carbuncle.

Causes of Boils

Most boils are caused by a germ (staphylococcal bacteria). This germ enters the body through tiny nicks or cuts in the skin or can travel down the hair to the follicle.

These health problems make people more susceptible to skin infections:

• Diabetes
• Problems with the immune system
• Poor nutrition
• Poor hygiene
• Exposure to harsh chemicals that irritate the skin

Symptoms of Boils

A boil starts as a hard, red, painful lump usually about half an inch in size. Over the next few days, the lump becomes softer, larger, and more painful. Soon a pocket of pus forms on the top of the boil. These are the signs of a severe infection:

• The skin around the boil becomes infected. It turns red, painful, warm, and swollen.
• More boils may appear around the original one.
• A fever may develop.
• Lymph nodes may become swollen.

When to Seek Medical Care

• You start running a fever.
• You have swollen lymph nodes.
• The skin around the boil turns red or red streaks appear.
• The pain becomes severe.
• The boil does not drain.
• A second boil appears.
• You have a heart murmur, diabetes, any problem with your immune system, or use immune suppressing drugs (for example, corticosteroids or chemotherapy) and you develop a boil.
• Boils usually do not need immediate emergency attention. However, if you are in poor health and you develop high fever and chills along with the infection, a trip to a hospital’s emergency room is needed.

Medical Treatment for Boils

If there are concerns about the seriousness of the infection, additional bloodtests will be performed. The doctor may prescribe antibiotics if the infection is severe. If the boil is drained, a culture may be done to determine the type of bacteria causing the infection and to assess if an appropriate antibiotic was given.

Next Steps — Follow-up

Whether the boil is drained at home or is lanced by a doctor, you will need to clean the infected area two to three times a day until the wound is healed. Apply an antibiotic ointment after washing and cover with a bandage. If the area turns red or looks as if it is getting infected again, contact your doctor.

The hip joint can withstand repeated motion and a fair amount of wear and tear. This ball-and-socket joint — the body’s largest — fits together in a way that allows for fluid movement.

Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket.

Despite its durability, the hip joint isn’t indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. Bones in the hip can break during a fall or other injury. Any of these conditions can lead to hip pain.

If your hips are sore, here is a rundown of what might be causing your discomfort and how to get hip pain relief.

Hip fractures. With age, the bones can become weak and brittle. Weakened bones are more likely to break during a fall.

Bursitis. Bursae are sacs of liquid found between tissues such as bone, muscles, and tendons. They ease the friction from these tissues rubbing together. When bursae get inflamed, they can cause pain. Inflammation of bursae is usually due to repetitive activities that overwork or irritate the hip joint.

Tendinitis. Tendons are the thick bands of tissue that attach bones to muscles. Tendinitis is inflammation or irritation of the tendons. It’s usually caused by repetitive stress from overuse.

Muscle or tendon strain. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When they become inflamed due to overuse, they can cause pain and prevent the hip from working normally.

Hip labral tear. This is a rip in the ring of cartilage (called the labrum) that follows the outside rim of the socket of your hip joint. Along with cushioning your hip joint, your labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket. Athletes and people who perform repetitive twisting movements are at higher risk of developing this problem.

Cancers. Tumors that start in the bone or that spread to the bone can cause pain in the hips, as well as in other bones of the body.

Avascular necrosis (also called osteonecrosis). This condition happens when blood flow to the hip bone slows and the bone tissue dies. Although it can affect other bones, avascular necrosis most often happens in the hip. It can be caused by a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), among other causes.

Symptoms of Hip Pain

Depending on the condition that’s causing your hip pain, you might feel the discomfort in your:

• Thigh
• Inside of the hip joint
• Groin
• Outside of the hip joint
• Buttocks

Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.

You might notice that your pain gets worse with activity, especially if it’s caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.

Hip Pain Relief :

If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication such as Tylenol or a nonsteroidal anti-inflammatory drug such as Motrin or Aleve.

Rheumatoid arthritis treatments also include prescription anti-inflammatory medications such as corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and sulfasalazine, and biologics, which target the immune system.

Another way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better. You may also try heating the area. A warm bath or shower can help ready your muscle for stretching exercises that can lessen pain.

If you have arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion.

When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement(arthroplasty) may be a consideration. People who fracture their hip sometimes need surgery to fix the fracture or replace the hip.

Get medical help right away if:

• The hip pain came on suddenly.
• A fall or other injury triggered the hip pain.
• Your joint looks deformed or is bleeding.
• You heard a popping noise in the joint when you injured it.
• The pain is intense.
• You can’t put any weight on your hip.
• You can’t move your leg or hip.

Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia.

The hiatus is an opening in the diaphragm — the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia(also called hiatus hernia) the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become “strangled,” or have its blood supply shut off.

Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

People with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. That’s why it’s so important to undergo testing and get properly diagnosed.

What Causes a Hiatal Hernia?

Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from pregnancy, obesity, coughing, or straining during bowel movements may also play a role.

Who Is at Risk for Hiatal Hernia?

Hiatal hernias occur more often in women, people who are overweight, and people older than 50.

How Is a Hiatal Hernia Diagnosed?

A hiatal hernia can be diagnosed with a specialized X-ray (using a barium swallow) that allows a doctor to see the esophagus or with endoscopy.

How Are Hiatal Hernias Treated?

Most people do not experience any symptoms of their hiatal hernia so no treatment is necessary. However, the paraesophageal hernia (when part of the stomach squeezes through the hiatus) can sometimes cause the stomach to be strangled, so surgery is sometimes recommended. Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated.Symptoms of GERD, such asheartburn, should be treated.

When Is Hiatal Hernia Surgery Necessary?

If the hiatal hernia is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.

Hiatal hernia surgery can often be performed as a laparoscopic, or “minimally invasive,” procedure. During this type of surgery, a few small (5 to 10 millimeter) incisions are made in the abdomen. The laparoscope that allows the surgeon to see inside the abdomen and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs to a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.

What Is Gout?

Gout is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid and crystallization of these compounds in joints can cause attacks of painful arthritis, kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history.

Symptoms of Gout

Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. The small joint at the base of the big toe is the most common site for an attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. In some people, the acute pain is so intense that even a bed sheet touching the toe causes severe pain. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most people with gout will experience repeated bouts over the years.

 

Risk Factors for Gout

Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

How Are Gout Attacks Prevented?

Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.

Treating Gout with Medications

Certain medications reduce the pain and inflammation of gout attacks, such as anti-inflammatory drugs (ibuprofen and others), colchicine, and corticosteroids. Other medications decrease the level of uric acid in the blood and prevent the deposit of uric acid in joints (gouty arthritis), the kidneys (stones), and in tissue (tophi), helping to prevent further attacks and complications. These drugs include allopurinol, febuxostat, lesinurad, and probenicid.

Schizophrenia most commonly strikes between the ages of 16 and 30, and males tend to show symptoms at a slightly younger age than females. In many cases, the disorder develops so slowly that the individual does not know that they have had it for many years. However, in other cases, it can strike suddenly and develop quickly.

Schizophrenia affects approximately 1 percentof all adults, globally. Experts say schizophrenia is probably many illnesses masquerading as one.

Some research suggests that schizophrenia may be the result of faulty neuronal development in the brain of the fetus, which later in life emerges as a full-blown illness.

Individuals with schizophrenia may hear voices that are not there. Some may be convinced that others are reading their minds, controlling how they think, or plotting against them. This can distress patients severely and persistently, making them withdrawn and, at times, frantic.

Symptoms of schizophrenia

A sizable proportion of people with schizophrenia have to rely on others because they are unable to hold a job or care for themselves. Many may also resist treatment, arguing that there is nothing wrong with them.

Some patients may present clear symptoms, but on other occasions, they may seem fine until they start explaining what they are truly thinking. The effects of schizophrenia reach far beyond the patient – families, friends, and society are affected too.

Symptoms and signs of schizophrenia will vary, depending on the individual.

The symptoms are classified into four categories:

• Positive symptoms – also known as psychotic symptoms. For example, delusions and hallucinations.
• Negative symptoms – these refer to elements that are taken away from the individual. For example, absence of facial expressions or lack of motivation.
• Cognitive symptoms – these affect the person’s thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
• Emotional symptoms – these are usually negative symptoms, such as blunted emotions.

Below is a list of the major symptoms:

• Delusions – the patient displays false beliefs, which can take many forms, such as delusions of persecution, or delusions of grandeur. They may feel others are attempting to control them remotely. Or, they may think they have extraordinary powers and abilities.
• Hallucinations – hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, however, people with schizophrenia may experience a wide range of hallucinations.
• Thought disorder – the person may jump from one subject to another for no logical reason. The speaker may be hard to follow or erratic.

Other symptoms may include:

• Lack of motivation (avolition) – the patient loses their drive. Everyday actions, such as washing and cooking, are neglected.
• Poor expression of emotions – responses to happy or sad occasions may be lacking, or inappropriate.
• Social withdrawal – when a patient with schizophrenia withdraws socially, it is often because they believe somebody is going to harm them.
• Unawareness of illness – as the hallucinations and delusions seem so real for patients, many of them may not believe they are ill. They may refuse to take medication for fear of side effects, or for fear that the medication may be poison, for example.
• Cognitive difficulties – the patient’s ability to concentrate, recall things, plan ahead, and to organize their life are affected. Communication becomes more difficult.

What are the causes schizophrenia?

fig: looks images in both sides of eye becomes more dark

Experts believe several factors are generally involved in contributing to the onset of schizophrenia.

Evidence suggests that genetic and environmental factors act together to bring about schizophrenia. The condition has an inherited element, but environmental triggers also significantly influence it.

Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:

Genetic inheritance

If there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent. However, that risk rises to 10 percent if a parent was diagnosed.

Chemical imbalance in the brain

Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. Other neurotransmitters, such as serotonin, may also be involved.

Family relationships

There is no evidence to prove or even indicate that family relationships might cause schizophrenia, however, some patients with the illness believe family tension triggers relapses.

Environmental factors

Although there is no definite proof, many suspect trauma before birth and viral infections may contribute to the development of the disease.

Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocused. This can trigger relationship problems, divorce, and unemployment.

These factors are often blamed for the onset of the disease, when really it was the other way round – the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.

Drug induced schizophrenia

Marijuana and LSD are known to cause schizophrenia relapses. Additionally, for people with a predisposition to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode.

Some researchers believe that certain prescription drugs, such as steroids and stimulants, can cause psychosis.

Treatments for schizophrenia

With proper treatment, patients can lead productive lives. Treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life.

Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of:

• medication
• psychological counseling
• self-help resources

Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in a hospital.

The most common schizophrenia medications are:

• Risperidone (Risperdal) - less sedating than other atypical antipsychotics. Weight gain and diabetes are possible side effects, but are less likely to happen, compared with Clozapine or Olanzapine.
• Olanzapine (Zyprexa) – may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
• Quetiapine (Seroquel) – risk of weight gain and diabetes, however, the risk is lower than Clozapine or Olanzapine.
• Ziprasidone (Geodon) – the risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia.
• Clozapine (Clozaril) – effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors in patients with schizophrenia. The risk of weight gain and diabetes is significant.
• Haloperidol – an antipsychotic used to treat schizophrenia. It has a long-lasting effect (weeks).

The primary schizophrenia treatment is medication. Sadly, compliance (following the medication regimen) is a major problem. People with schizophrenia often come off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them.

The patient must continue taking medication even when symptoms are gone. Otherwise they will come back.

The first time a person experiences schizophrenia symptoms, it can be very unpleasant. They may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a person living with schizophrenia receives the full support of their family, friends, and community services when onset appears for the first time.