Saturday, June 2, 2012


Appendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the beginning of your large intestine.

Causes, incidence, and risk factors:

Appendicitis is one of the most common causes of emergency abdominal surgery in the United States. It usually occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor.


The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, the elderly, and women of childbearing age.

The first symptom is often pain around your belly button. (See: Abdominal pain) The pain may be minor at first, but it becomes more sharp and severe. Your appetite will be reduced, and you may have nausea, vomiting, and a low fever.
As the swelling in the appendix increases, the pain tends to move into your right lower abdomen. It focuses right above the appendix at a place called McBurney's point. This most often occurs 12 to 24 hours after the illness starts.
If your appendix breaks open (ruptures), you may have less pain for a short time and you may feel better. However, once the lining of your abdominal cavity becomes swollen and infected (a condition called peritonitis), the pain gets worse and you become sicker.
Your pain may be worse when you walk or cough. You may prefer to lie still because sudden movement causes pain.
                                                      Later symptoms include
 Signs and tests:
             If you have appendicitis, your pain will increase when the doctor gently presses on your lower right belly area. If you have peritonitis, touching the belly area may cause a spasm of the muscles.
A rectal exam may find tenderness on the right side of your rectum.
Doctors can usually diagnose appendicitis by:
  • Your description of the symptoms
  • The physical exam
  • Lab tests
In some cases, other tests may be needed, including:
                a. Abdominal CT scan
                 b.Abdominal ultrasound


                      If you do not have complications, a surgeon will usually remove your appendix soon after your doctor thinks you might have the condition. For information on this type of surgery, see: Appendectomy.
Because the tests used to diagnose appendicitis are not perfect, sometimes the operation will show that your appendix is normal. In that case, the surgeon will remove your appendix and explore the rest of your abdomen for other causes of your pain.
If a CT scan shows that you have an abscess from a ruptured appendix, you may be treated for infection. You will have your appendix removed after the infection and swelling have gone away.
1. Abnormal connections between abdominal organs or between these organs and    the skin surface (fistula)

2. Abscess
3. Blockage of the intestine
4.Infection inside the abdomen (peritonitis)
5. Infection of the surgical wound

calling your Health care provider :
Call your health care provider if you have abdominal pain in the lower-right portion of your belly, or any other symptoms of appendicitis. Also call your doctor if:
  • Your pain is severe, sudden, or sharp
  • You have a fever along with your pain
  • You are vomiting blood or have bloody diarrhea
  • You have a hard abdomen that is tender to touch
  • You are unable to pass stool, especially if you are also vomiting
  • You have chest, neck, or shoulder pain
  • You are dizzy or light-headed
  • You have nausea and a lack of appetite with your pain
  • You are losing weight that you did not mean to lose
  • You have yellowing of your eyes or skin
  • You have bloating for more than 2 days
  • You have diarrhea for more than 5 days, or your infant or child has had diarrhea for 2 days or vomiting for 12 hours (call right away if a baby younger than 3 months has diarrhea or vomiting)
  • You have had abdominal pain for more than 1 week
  • You have burning with urination or you are urinating more often than usual
  • You have pain and may be pregnant
  • Your pain gets worse when you take antacids or eat something

Attention Deficit Disorder (ADD)

Life can be a balancing act for any adult, but if you find yourself constantly late, disorganized, forgetful, and overwhelmed by your responsibilities, you may have ADD/ADHD. Attention deficit disorder affects many adults, and its wide variety of frustrating symptoms can hinder everything from your relationships to your career. But help is available—and learning about ADD/ADHD is the first step. Once you understand the challenges, you can learn to compensate for areas of weakness and start taking advantage of your strengths.


Understanding ADD In Adults :


                                       Attention deficit disorder is not just a problem in children. If you were diagnosed with childhood ADD/ADHD, chances are, you’ve carried at least some of the symptoms into adulthood. But even if you were never diagnosed with ADD/ADHD as a child, that doesn’t mean you can’t be affected by it as an adult.

Attention deficit disorder often goes unrecognized throughout childhood. This was especially common in the past, when very few people were aware of ADD/ADHD. Instead of recognizing your symptoms and identifying the real issue, your family, teachers, or other parents may have labeled you a dreamer, a goof-off, a slacker, a troublemaker, or just a bad student.
Alternately, you may have been able to compensate for the symptoms of ADD/ADHD when you were young, only to run into problems as your responsibilities increase. The more balls you’re trying to keep in the air—pursuing a career, raising a family, running a household—the greater the demand on your abilities to organize, focus, and remain calm. This can be challenging for anyone, but if you have ADD/ADHD, it can feel downright impossible.
The good news is that, no matter how it feels, the challenges of attention deficit disorder are beatable. With education, support, and a little creativity, you can learn to manage the symptoms of adult ADD/ADHD—even turning some of your weaknesses into strengths. It’s never too late to turn the difficulties of adult ADD/ADHD around and start succeeding on your own terms.
                       Signs and Symptoms of ADD 

In adults, attention deficit disorder often looks quite different than it does in children—and its symptoms are unique for each individual. The following categories highlight common symptoms of adult ADD/ADHD. Do your best to identify the areas where you experience difficulty. Once you pinpoint your most problematic symptoms, you can start to work on strategies for dealing with them.

1.Trouble concentrating and staying focused :


                 Adults with ADD/ADHD often have difficulty staying focused and attending to daily, mundane tasks. For example, you may be easily distracted by irrelevant sights and sounds, quickly bounce from one activity to another, or become bored quickly. Symptoms in this category are sometimes overlooked because they are less outwardly disruptive than the ADD/ADHD symptoms of hyperactivity and impulsivity—but they can be every bit as troublesome. The symptoms of inattention and concentration difficulties include:
  • “zoning out” without realizing it, even in the middle of a conversation.
  • extreme distractibility; wandering attention makes it hard to stay on track.
  • difficulty paying attention or focusing, such as when reading or listening to others.
  • struggling to complete tasks, even ones that seem simple.
  • tendency to overlook details, leading to errors or incomplete work.
  • poor listening skills; hard time remembering conversations and following directions.
2. Hyperfocus :


               While you’re probably aware that people with ADD/ADHD have trouble focusing on tasks that aren’t interesting to them, you may not know that there’s another side: a tendency to become absorbed in tasks that are stimulating and rewarding. This paradoxical symptom is called hyperfocus.
Hyperfocus is actually a coping mechanism for distraction—a way of tuning out the chaos. It can be so strong that you become oblivious to everything going on around you. For example, you may be so engrossed in a book, a TV show, or your computer that you completely lose track of time and neglect the things you’re supposed to be doing. Hyperfocus can be an asset when channeled into productive activities, but it can also lead to work and relationship problems if left unchecked.

3.Disorganization and forgetfulness:


                  When you have adult ADD/ADHD, life often seems chaotic and out of control. Staying organized and on top of things can be extremely challenging—as is sorting out what information is relevant for the task at hand, prioritizing the things you need to do, keeping track of tasks and responsibilities, and managing your time. Common symptoms of disorganization and forgetfulness include:
  • poor organizational skills (home, office, desk, or car is extremely messy and cluttered)
  • tendency to procrastinate
  • trouble starting and finishing projects
  • chronic lateness
  • frequently forgetting appointments, commitments, and deadlines
  • constantly losing or misplacing things (keys, wallet, phone, documents, bills)
  • underestimating the time it will take you to complete tasks

4. Impulsivity:


                   If you suffer from symptoms in this category, you may have trouble inhibiting your behaviors, comments, and responses. You might act before thinking, or react without considering consequences. You may find yourself interrupting others, blurting out comments, and rushing through tasks without reading instructions. If you have impulse problems, being patient is extremely difficult. For better or for worse, you may go headlong into situations and find yourself in potentially risky circumstances. You may struggle with controlling impulses if you:
  • frequently interrupt others or talk over them
  • have poor self-control
  • blurt out thoughts that are rude or inappropriate without thinking
  • have addictive tendencies
  • act recklessly or spontaneously without regard for consequences
  • have trouble behaving in socially appropriate ways (such as sitting still during a long meeting)

5.Emotional difficulties:


              Many adults with ADD/ADHD have a hard time managing their feelings, especially when it comes to emotions like anger or frustration. Common emotional symptoms of adult ADD/ADHD include:
  • sense of underachievement
  • doesn’t deal well with frustration
  • easily flustered and stressed out
  • irritability or mood swings
  • trouble staying motivated
  • hypersensitivity to criticism
  • short, often explosive, temper
  • low self-esteem and sense of insecurity


  • feelings of inner restlessness, agitation
  • tendency to take risks
  • getting bored easily
  • racing thoughts
  • trouble sitting still; constant fidgeting
  • craving for excitement
  • talking excessively
  • doing a million things at once

Saturday, May 19, 2012

High Blood Pressure(Hypertension)

High Blood Pressure Overview

(A silent killer)

                The heart pumps blood into the arteries with enough force to push blood to the far reaches of each organ from the top of the head to the bottom of the feet. Blood pressure can be defined as the pressure of blood on the walls of the arteries as it circulates through the body. Blood pressure is highest as its leaves the heart through the aorta and gradually decreases as it enters smaller and smaller blood vessels (arteries, arterioles, and capillaries). Blood returns in the veins leading to the heart, aided by gravity and muscle contraction.
                      Picture of the blood pressure and circulatory system
Hypertension is the medical term for high blood pressure. It is known as the "silent killer" since it has no initial symptoms but can lead to long-term disease and complications..
  • Many people have high blood pressure and don't know it.
  • Important complications of uncontrolled or poorly treated high blood pressure include heart attackcongestive heart failurestrokekidney failureperipheral artery disease, and aortic aneurysms (weakening of the wall of the aorta, leading to widening or ballooning of the aorta).
  • Public awareness of these dangers has increased. High blood pressure has become the second most common reason for medical office visits in the United States.
How is blood pressure measured?
Blood pressure is measured with a blood pressure cuff and recorded as two numbers, for example, 120/80 mm Hg (millimeters of mercury). Blood pressure measurements are usually taken at the upper arm over the brachial artery.
  • The top, larger number is called the systolic pressure. This measures the pressure generated when the heart contracts (pumps). It reflects the pressure of the blood against arterial walls.
  • The bottom, smaller number is called the diastolic pressure. This reflects the pressure in the arteries while the heart is filling and resting between heartbeats.
                                    Picture of diastolic and systolic blood pressure
The American Heart Association has recommended guidelines to define normal and high blood pressure.
  • Normal blood pressure less than 120/80
  • Pre-hypertension 120-139/ 80-89
  • High blood pressure (stage 1) 140-159/90-99
  • High blood pressure (stage 2) higher than 160/100
As many as 60 million Americans have high blood pressure.
  • Uncontrolled high blood pressure may be responsible for many cases of death and disability resulting from heart attack, stroke, and kidney failure.
  • According to research studies, the risk of dying of a heart attack is directly linked to high blood pressure, particularly systolic hypertension. The higher your blood pressure, the higher the risk. Maintaining lifelong control of hypertension decreases the future risk of complications such as heart attack and stroke.

High Blood Pressure Causes

In 90% of people with hypertension, the cause of high blood pressure is not known and is referred to as primary or essential hypertension. While the specific cause is unknown, there are risk factors that can contribute to developing high blood pressure.
Factors that can not be changed
  • Age:   The older a person is, the greater the likelihood that he or she will develop high blood pressure, especially elevated systolic readings. This is largely due to arteriosclerosis, or "hardening of the arteries."

  • Race:   African Americans develop high blood pressure more often than Caucasians. They develop high blood pressure at a younger age and develop more severe complications sooner in life. 

  • Socioeconomic status:    High blood pressure is found more commonly among the less educated and lower socioeconomic groups. Residents of the southeastern United States, both Caucasian and African American, are more likely to have high blood pressure than residents of other regions.
  • Family history (heredity):    The tendency to have high blood pressure appears to run in families. 
  • Gender:              Generally men have a greater likelihood of developing high blood pressure than women. This likelihood varies according to age and among various ethnic groups.

Factors that can be changed

  • Obesity:                   

 As body weight increases, the blood pressure rises. Obesity is defined as having a body mass index (BMI) greater than 30 kg/m. A BMI of 25-30 kg/m is considered overweight (BMI=weight in pounds x 703/ height in inches ) Being overweight increases the risk of high blood pressure. Health care practitioners recommend that all 
obese people with high blood pressure lose weight until they are within 15% of their healthy body weight.

  • Obese people are two to six times more likely to develop high blood pressure than people whose weight is within a healthy range.
  • Not only the degree of obesity is important, but also the manner in which the body accumulates extra fat. Some people gain weight around their belly (central obesity or "apple-shaped" people), while others store fat around their hips and thighs ("pear-shaped" people). "Apple-shaped" people tend to have greater health risks for high blood pressure than "pear-shaped" people.

  • Sodium (salt) sensitivity:         
                                 Some people have high sensitivity to sodium (salt), and their blood pressure increases if they use salt. Reducing sodium intake tends to lower their blood pressure. Americans consume 10-15 times more sodium than they need. Fast foods and processed foods contain particularly high amounts of sodium. Many over-the-counter medicines also contain large amounts of sodium. Read food labels and learn about salt content in foods and other products as a healthy first step to reducing salt intake. Fast food restaurants also make the salt and calorie content of their food available to consumers at their restaurants,

  • Alcohol use:                       
Drinking more than one to two drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol. 

  • Birth control pills (oral contraceptive use): 

Some women who take birth control pills develop high blood pressure. 

  • Lack of exercise (physical inactivity):      

A sedentary lifestyle contributes to the development of obesity and high blood pressure. 

  • Medications:             
Certain drugs, such as amphetamines (stimulants), diet pills, and some medications used for cold and allergy symptoms such aspseudoephedrine, tend to raise blood pressure.

High Blood Pressure Symptoms

           High blood pressure usually causes no symptoms and high blood pressure often is labeled "the silent killer." People who have high blood pressure typically don't know it until their blood pressure is measured.
Sometimes people with markedly elevated blood pressure may develop:





Blurred vision

Nausea and vomiting 

chest pain and shortness of breath.

People often do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure. The following types of organ damage are commonly seen in chronic high blood pressure:
  • Heart attack
  • Heart failure
  • Stroke or transient ischemic attack (TIA)
  • Kidney failure
  • Eye damage with progressive vision loss
  • Peripheral arterial disease causing leg pain with walking (claudication)
  • Outpouchings of the aorta, called aneurysms
About 1% of people with high blood pressure do not seek medical care until the high blood pressure is very severe, a condition known as malignant hypertension.
  • In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg.
  • Malignant hypertension may be associated with headache, lightheadedness, nausea, vomiting, and stroke like symptoms
  • Malignant hypertension requires emergency intervention and lowering of blood pressure to prevent brain hemorrhage or stroke.
It is of utmost importance to realize that high blood pressure can be unrecognized for years, causing no symptoms but causing progressive damage to the heart, other organs, and blood vessels.

High Blood Pressure Diagnosis


Blood pressure is measured with a blood pressure cuff (sphygmomanometer). This may be done using a stethoscope and a cuff and gauge or by an automatic machine. It is a routine part of the physical examination and one of the vital signs often recorded for a patient visit. Other vital signs include pulse rate, respiratory rate (breathing rate), temperature, and weight.
When discussing blood pressure issues, the health care practitioner may ask questions about past medical history, family history, and medication use, including prescriptions, over-the-counter medications, herbal remedies, and food additives. Other questions may include lifestyle habits, including activity levels,smoking, alcohol consumption, and illegal drug use.
Physical examination may include listening to the heart and lungs, feeling for pulse in the wrist and ankles, and feeling and listening to the abdomen looking for signs of an enlarged aorta. Eye examination with an ophthalmoscope may be helpful by looking at the small blood vessels on the retina in the back of the eyeball.
  • Normal Blood Pressure

    • Systolic less than 120 mm Hg; diastolic less than 80 mm Hg
  • Prehypertension

    • Systolic 120-139 or diastolic 80-89 mm Hg

  • High Blood Pressure
    • Stage 1: Systolic 140-159; diastolic 90-99 mm Hg
    • Stage 2: Systolic more than 160; diastolic more than 100 mm Hg
Blood tests may be considered to assess risk factors for heart disease and stroke as well as looking for complications of hypertension. These include complete blood count (CBC), electrolytes, BUN (blood urea nitrogen), and creatinine and GFR (glomerular filtration rate) to measure kidney function. A fasting lipid profile will measure cholesterol and triglyceride levels in the blood. If appropriate, blood tests may be considered to look for an underlying cause of high blood pressure includingabnormal thyroid or adrenal gland function.
Ultrasound of the kidneys, CT scan of the abdomen, or both may be done to assess damage or enlargement of the kidneys and adrenal glands.
Other studies may be considered depending upon the individual patient's needs
  • Electrocardiogram (ECG) may help evaluate heart rate and rhythm. It is a screening test to help assess heart muscle thickness. If hypertension is long-standing, the heart muscle has to hypertrophy, or get larger, to push blood against the increased pressure within the arteries of the body.  
  • Echocardiogram is an ultrasound examination of the heart It is used to evaluate the anatomy and the function of the heart. A cardiologist is required to interpret this test and can evaluate the heart muscle and determine how thick it is, whether it moves appropriately, and how efficiently it can push blood out to the rest of the body. The echocardiogram can also assess heart valves, looking for narrowing (stenosis) and leaking (insufficiency or regurgitation). A chest X-ray may be used as a screening test to look for heart size, the shape of the aorta, and to assess the lungs.

  • Doppler ultrasound is used to check blood flow through arteries at pulse points in your arms, legs, hands, and feet. This is an accurate way to detectperipheral vascular disease, which can be associated with high blood pressure. It also can measure blood flow in the arteries to both kidneys and sometimes depicts narrowings that can lead to high blood pressure in a minority of patients.