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Colorectal cancer ( CRC )

Colorectal cancer ( CRC ) or Bowel cancer – cancer arising from the epithelium
 of the colon or rectum

 

Third most deadly and 4th most commonly diagnosed cancer worldwide 4th most common cancer in UK accounting for 11 % of all new cancer cases in 2017 Slightly ↑ common in men More common in the developed than developing world Incidence ↑ es with age ( except familial colorectal cancer ) in the UK during 2015-17 on average each year more than 4 in 10 new cases were in people aged 75 and over Highest rate are in 85-89 age group Incidence increasing worldwide and mortality decreasing ( Western way of life ) Almost always adenocarcinoma

 

Neuropathic pain

Neuropathic pain ( NP ) develops as a result of lesions or disease affecting the 
somatosensory nervous system either in the periphery or centrally

 

NEUROPATHIC PAIN –Disease process leads to a dysfunctional and abnormal 
somatosensory system

 

Nociceptive -Noxious perception from cellular damage Also called inflammatory Proportionate to magnitude of tissue damage →release of inflammatory mediators nociceptive pain can be somatic ,

Constipation – Adults

Constipation is used to describe symptoms that relate to difficulties in defecation. These include infrequent bowel movements , hard lumpy stools , excessive straining , sensation of incomplete evacuation.

 

Common gastrointestinal problem which affects all ages It is estimated that the overall prevalence worldwide is 16 % Data from N America report a prevalence of 12 % to 19 % NICE reports that rates of reported constipation of between 4 % and 20 % in the UK NICE also reports that constipation affects twice as many women as men and older people are 5 times more likely than younger adults to suffer with constipation Maria et el ( 2011 ) in the Canadian J of Gastroenterology report that chronic constipation increases with increasing age particularly after 65 yrs with a prevalence of self reported constipation between 12.5 % and 30 % Chronic constipation is one of the 5 most common symptoms seen by a gastroenterologist Seen more commonly in people with low socioeconomic status ,

Laxatives- overview

A review of laxatives commonly used to treat constipation.

Osmotic laxatives-Soluble non absorbable compounds →enter stool →exert osmotic pressure ↑ fluid content of stools→ softening & ↑ ed bulk –> stimulation of peristalsis They increase the amount of water in the large bowel ( can draw fluid into the large bowel or retain the fluid that they are administered with ) Macrogols and lactulose also act as stool softeners First line osmotic laxatives are macrogols –

Haemoptysis ( coughing up blood )

Haemoptysis is expectoration of blood from the lower respiratory tract below the glottis.

 

In primary care the common causes of haemoptysis are acute and chronic bronchiectasis , TB , lung cancer , pneumonia and bronchiectasis ( BMJ best practice )

 

Infections – common cause in up to 60-70 % cases Pulmonary tuberculosis Pneumonia Bronchiectasis Chronic bronchitis Periodontal disease Sinusitis Tracheitis Lung abscess Fungal infections HIV.

Allergic rhinitis

Rhinitis is an inflammation of the nasal mucosa

 

Allergic rhinitis -Seasonal -> hay fever Perennial Occupational

Also known as ” allergic rhinoconjunctivitis” ( when conjunctivae are also involved ) or “hay fever ” ( seasonal AR )

 

Non allergic rhinitis -Infectious Vasomotor Hormonal Drug induced Structural Occupational Rhinitis medicamentosa Non-allergic rhinitis with eosinophilia syndrome.

Helicobacter pylori infection

Helicobacter pylori is a major human pathogen that infects the stomach and produces inflammation that is responsible for various gastrointestinal diseases ( Yamaoka 2012 )

 

How common-H.pylori is a small curved highly motile gram negative microaerophilic bacterium that colonises the mucus layer of the human stomach Found in 1982 ( Warren and Marshall ) Very common bacterium and about 50 % of the world population is estimated to be
infected ( extremely successful huma pathogen ) Prevalence is highly variable –

Prostatitis

Prostatitis describes a combination of infectious diseases
 ( acute or bacterial prostatitis ) chronic pelvic pain syndrome and asymptomatic inflammation 
( Krieger et al 2008 )

 

Prevalence is high , comparable to rates of IHD and diabetes Third most important condition of the prostate AAFP reports prevalence of 8.2 % ( range from 2.2 to 9.7 % ) Rosebud et al quote a prevalence of 5 % to 9 % among unselected men in the community The lifetime probability of a man being diagnosed as prostatitis exceeds 25 % and prostatitis accounts for about ~ 25 % of men seeking medical attention for genitourinary complaints.

Long COVID

Long Covid describes a longer , more complex course of illness than that emerging from initial formal reports from Wuhan ( The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team 2020 ; WHO , 2020a )

It must be noted that this is a new subject which is likely to change and evolve as 
more studies are done and what we know is derived from reports which are currently available ie long term data is missing
 No international consensus about the definition and lot of uncertainties persist Various terms are used in literature to describe the condition as
○ long haulers
○ long term effects of COVID 19
○ post-COVID syndrome &

Obesity ( Adults )

Overweight and obesity are defined as abnormal or excessive fat accumulation
 that presents a risk to health ( WHO )

 

Major health hazard in the 21st century – a serious global epidemic ( Globesity ) Relatively rare before the 1960s Worldwide obesity has nearly tripled since 1975 WHO reports that
○ in 2016 nearly 1.6 billion adults ,

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