Laceration Repair (Cuts and grazes)
Posted by on Thursday, 13th June 2013
Introduction
Cuts and grazes are a common type of injury and, in most cases, do not pose a threat to health.
Treating minor cuts and grazes
Most cuts and grazes are minor and can be easily treated at home.
Cleaning them thoroughly and covering them with a plaster or dressing is all that is needed.
Stopping the bleeding
If your cut or graze is bleeding heavily or is on a particularly delicate area of your body, such as the palm of your hand, you should stop the bleeding before applying any kind of dressing.
Apply pressure to the area using a bandage or a towel. If the cut is to your hand or arm, raise it above your head. If the injury is to a lower limb, lie down and raise the affected area above the level of your heart so the bleeding slows down and stops.
Dressing
To dress a cut or graze at home:
Wash and dry your hands thoroughly
Clean the wound under running tap water but do not use antiseptic because it may damage the tissue and slow down healing
Pat the area dry with a clean towel
Apply a sterile, adhesive dressing, such as a plaster
Keep the dressing clean by changing it as often as necessary and keep the wound dry by using waterproof dressings, which will allow you to take showers.
Painkillers
The wound should heal by itself in a few days. If the wound is painful, you can take painkillers, such as paracetamol or ibuprofen.
When to see Dr. B C Shah
You only need to see Dr. B C Shah if there is a risk of a cut or graze becoming infected or you think it already has become infected.
You are more at risk of the wound becoming infected if:
It has been contaminated with soil, pus, bodily fluids or faeces (stools)
There was something in the wound before it was cleaned, such as a tooth or a shard of glass
The wound has a jagged edge
The wound is longer than 5cm (1.9 inches)
You should also contact Dr. B C Shah if your skin has been bitten (either by an animal or a person), as bites are prone to infection.
Signs that a wound has become infected include:
Swelling of the affected area
Pus forming in the affected area
Redness spreading from the cut or graze
Increasing pain in the wound
Feeling generally unwell
A high temperature (fever) of 38°C (100.4°F) or above
Swollen glands
An infected wound can usually be successfully treated with a short course of antibiotics (usually around seven days).
When to seek emergency help
Some cuts and grazes can be more serious and will require an emergency treatment.
It is recommended that you visit Dr. B C Shah if:
You are bleeding from a cut artery. Blood from an artery comes out in spurts (with each beat of the heart), is bright red and is usually hard to control.
You cannot stop the bleeding.
You experience loss of sensation near the wound or you are having trouble moving body parts. If this is the case you may have damaged underlying nerves.
There is severe pain, extensive bruising and you are having trouble moving body parts. If this is the case you may have damaged one of your tendons.
You have received a cut to the face. You may require urgent treatment to prevent scarring.
You have received a cut to the palm of your hand and the cut looks infected. These types of infection can spread quickly.
There is a possibility that a foreign body is still inside the wound.
The cut is extensive, complex or has caused a lot of tissue damage.
Your cut will be examined to determine whether or not there is any risk of infection. If there was glass inside your cut, you may need an X-ray to ensure it has been removed.
What happens if there is no risk of infection
If there is no risk of infection, your cut will be cleaned using water or a sterile saline solution before it’s closed. This may be done using stitches, tissue adhesive or skin-closure strips.
Stitches (sutures). These are usually used to close cuts that are more than 5cm long, or wounds that are particularly deep. A sterile surgical thread is used for stitches, which is flexible and allows the wound to move.
Tissue adhesive (glue). This may be used to close less severe cuts that are less than 5cm long. The tissue adhesive is painted onto your skin, over your cut, while the edges are held together. The paste then dries, forming a flexible layer that keeps the cut closed.
Skin-closure strips. These may be used as an alternative to tissue adhesive, for cuts that are less than 5cm long, where there is a risk of infection. The strips are sticky and can be placed over the edges of the cut to hold them together. They are easier to remove than tissue adhesive.
Once your cut is closed, it may be covered with a protective dressing to ensure that your stitches, tissue adhesive or skin-closure strips stay in place.
If you have stitches or strips, you will need to return to Dr. B C Shah to have them removed.
Stitches or strips on the head are removed after three to five days
Stitches over joints are removed after 10-14 days
Stitches or strips at other sites are removed after 7-10 days
You should never try to remove stitches yourself. They should only be removed by Dr. B C Shah
.
Tissue adhesive comes off by itself after a week or so.
To prevent tetanus (a serious bacterial infection), you may be given a tetanus booster injection. If it’s suspected that you are at risk of developing tetanus, you may be referred for specialist treatment.
If there is risk of infection, or your cut is already infected
If there is risk of infection or your cut is already infected, Dr. B C Shah may take a sample for analysis using a swab, before cleaning it as usual.
However, they will not yet be able to close your cut because this may trap any infection inside it, making it more likely to spread. Instead, the cut will be packed with a non-sticky dressing so that it cannot close, before it is covered with a protective dressing. You may also be given antibiotics to fight the infection.
You will need to return Dr. B C Shah after three to five days to see if any infection has cleared up. If so, your cut will be closed using stitches or skin-closure strips.
If your infection has not cleared up, a change of antibiotics may be required.
Skin grafts
If your graze is very severe and you have lost a lot of skin, you may need to have a skin graft.
Dr. B C Shah will take some skin from another part of your body and put it over the wound. After a while, it will heal and look normal.
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Rectal Cancer (Bowel Cancer)
Posted by on Monday, 10th June 2013
Introduction
Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer or rectal cancer.
Symptoms of bowel cancer include blood in your stools (faeces), an unexplained change in your bowel habits, such as prolonged diarrhoea or constipation, and unexplained weight loss.
Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.
Who is affected by bowel cancer?
Bbowel cancer is the third most common type of cancer.
Approximately 72% of bowel cancer cases develop in people who are 65 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum.
Who's at risk?
Things that increase your risk of getting bowel cancer include:
Age – around 72% of people diagnosed with bowel cancer are over 65
Diet – a diet high in fibre and low in saturated fat could reduce your bowel cancer risk, a diet high in red or processed meats can increase your risk
Healthy weight – leaner people are less likely to develop bowel cancer than obese people
Exercise – being inactive increases the risk of getting bowel cancer
Alcohol and smoking – high alcohol intake and smoking may increase your chances of getting bowel cancer
Family history and inherited conditions – aving a close relative with bowel cancer puts you at much greater risk of developing the disease.
Related conditions – having certain bowel conditions can put you more at risk of getting bowel cancer
Bowel cancer screening
Currently, everyone between the ages of 60 and 69 should go for bowel cancer screening every two years.
Screening is carried out by taking a small stool sample and testing it for the presence of blood (faecal occult blood test).
In addition, an extra screening test is being introduced over the next three years for all people at age 55. This test involves a camera examination of the lower bowel called a flexible sigmoidoscopy.
Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance it can be cured completely.
Treatment and outlook
Bowel cancer can be treated using a combination of surgery, chemotherapy, radiotherapy and, in some cases, biological therapy. As with most types of cancer, the chance of a complete cure depends on how far the cancer has advanced by the time it is diagnosed.
If bowel cancer is diagnosed in its earliest stages, the chance of surviving a further five years is 90%, and a complete cure is usually possible. However, bowel cancer diagnosed in its most advanced stage only has a five-year survival rate of 6% and a complete cure is unlikely.
Signs and symptoms of bowel cancer
Early bowel cancer may have no symptoms and some symptoms of later bowel cancer can also occur in people with less serious medical problems, such as haemorrhoids(piles).
See Dr. B C Shah if you notice any of the symptoms below.
The initial symptoms of bowel cancer include:
Blood in your stools (faeces) or bleeding from your rectum
A change to your normal bowel habits that persists for more than three weeks, such as diarrhoea, constipation or passing stools more frequently than usual
Abdominal pain
Unexplained weight loss
As bowel cancer progresses, it can sometimes cause bleeding inside the bowel. Eventually, this can lead to your body not having enough red blood cells. This is known as anaemia.
Symptoms of anaemia include:
Fatigue
Breathlessness
In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms of a bowel obstruction include:
A feeling of bloating, usually around the belly button
Abdominal pain
Constipation
Vomiting
When to seek medical advice
Visit Dr. B C Shah if you have any of the symptoms above. While the symptoms are unlikely to be the result of bowel cancer, these types of symptoms always need to be investigated further.
Causes of bowel cancer
Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.
Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean you will get bowel cancer.
Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it.
Family history
There is evidence that bowel cancer can run in families. Around 20% of people who develop bowel cancer have a close relative (mother, father, brother or sister) or a second-degree relative (grandparent, uncle or aunt) who have also had bowel cancer.
It is estimated that if you have one close relative with a history of bowel cancer, your risk of getting bowel cancer is doubled. If you have two close relatives with a history of bowel cancer, your risk increases four-fold.
Diet
A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams.
There is also good evidence that a diet high in fibre and low in saturated fat could help reduce your bowel cancer risk. Cancer experts think this is because this type of diet encourages regular bowel movements.
Smoking
People who smoke cigarettes are 25% more likely to develop bowel cancer, other types of cancer and heart disease than people who do not smoke.
Alcohol
A major study, called the EPIC study, showed alcohol was associated with bowel cancer risk. Even small amounts of alcohol can put you at higher risk of getting bowel cancer. The EPIC study found that for every two units of alcohol a person drinks each day, their risk of bowel cancer goes up by 8%.
Obesity
Obesity is linked to an increased risk of bowel cancer. Obese men are 50% more likely to develop bowel cancer than people with a healthy weight. Morbidly obese men, who have a body mass index (BMI) of over 40, are twice as likely to develop bowel cancer.
Obese women have a small increased risk of developing the condition, and morbidly obese women are 50% more likely to develop bowel cancer than women with a healthy weight.
Inactivity
People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Your risk could be cut by up to one-fifth if you do an hour of vigorous exercise every day or two hours of moderate exercise (such as vacuum cleaning or brisk walking).
Digestive disorders
Some conditions may put you at a higher risk of developing bowel cancer. People with Crohn’s disease are 2-3 times more likely to develop bowel cancer. The risk of developing bowel cancer is much higher in people with ulcerative colitis, and as many as 1 in 20 of these people will go on to develop it.
Genetic conditions
There are two rare inherited conditions that can cause bowel cancer. They are:
Familial adenomatous polyposis (FAP)
Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome
FAP affects 1 in 10,000 people. The condition triggers the growth of non-cancerous polyps inside the bowel. Although the polyps are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Almost all people with FAP will have bowel cancer by the time they are 50 years of age.
People with FAP have such a high risk of getting bowel cancer, they are often advised to have their large bowel removed by surgery before they reach the age of 25. Families affected can find support and advice from the FAP registry at St Mark’s Hospital, London.
HNPCC is a type of bowel cancer caused by a mutated gene. An estimated 2-5% of all cases of bowel cancer are due to HNPCC. Around 90% of men and 70% of women with the
As with FAP, removing the bowel as a precautionary measure is usually recommended in people with HNPCC.
Diagnosing bowel cancer
When you first see Dr. B C Shah he will ask about your symptoms and whether you have a family history of bowel cancer.
Dr. B C Shah will then carry out a physical examination known as a digital rectal examination (DRE). A DRE involves Dr. B C Shah gently placing a finger into your anus, and then up into your rectum.
A DRE is a useful way of checking whether there is a noticeable lump inside your rectum. This is found in an estimated 40-80% of cases of rectal cancer.
A DRE is not painful, but some people may find it a little embarrassing.
If your symptoms suggest you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital for further examination.
Further examination
Two tests are commonly used to confirm a diagnosis of bowel cancer:
A sigmoidoscopy is an examination of your rectum and some of your large bowel.
A colonoscopy is an examination of all of your large bowel.
Sigmoidoscopy
A sigmoidoscopy uses a device called a sigmoidoscope, which is a thin, flexible tube attached to a small camera and light.
The sigmoidoscope is inserted into your rectum and then up into your bowel. The camera relays images to a monitor. This allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer.
A sigmoidoscopy can also be used to remove small samples of suspected cancerous tissue so they can be tested in the lab. This is known as a biopsy.
A sigmoidoscopy is not usually painful, but can feel uncomfortable. Most people go home after the examination has been completed.
Colonoscopy
A colonoscopy is similar to a sigmoidoscopy except a longer tube, called a colonoscope, is used to examine your entire bowel.
Your bowel needs to be empty when a colonoscopy is performed, so you will be given a special diet to eat for a few days before the examination and a laxative (medication to help empty your bowel) on the morning of the examination.
You will be given a sedative to help you relax, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. As with a sigmoidoscope, the colonoscope can be used to obtain a biopsy, as well as relaying images of any abnormal areas.
A colonoscopy usually takes about one hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so arrange for someone to accompany you home.
Further testing
If a diagnosis of bowel cancer is confirmed, further testing is usually carried out for two reasons:
to check if the cancer has spread from the bowel to other parts of the body
to help decide on the most effective treatment for you
These tests can include:
A computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan to provide a detailed image of your bowel and other organs
Ultrasound scans, which can be used to look inside other organs, such as your liver, to see if the cancer has spread there
Chest X-rays, which can be used to assess the state of your heart and lungs
Blood tests to detect a special protein, known as a tumour marker, released by the cancerous cells in some cases of bowel cancer
Staging and grading
Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive and likely to spread your cancer is.
Stage 1 – the cancer is still contained within the lining of the bowel or rectum
Stage 2 – the cancer has spread into the layer of muscle surrounding the bowel
Stage 3 – the cancer has spread into nearby lymph nodes
Stage 4 – the cancer has spread into another part of the body, such as the liver
This is a simplified guide. Stage 2 is divided into further categories called A and B and stage 3 is divided into A, B and C.
There are three grades of bowel cancer:
Grade 1 is a cancer that grows slowly and has a low chance of spreading beyond the bowel
Grade 2 is a cancer that grows moderately and has a medium chance of spreading beyond the bowel
Grade 3 is a cancer that grows rapidly and has a high chance of spreading beyond the bowel
If you are not sure what stage or grade of cancer you have, ask your doctor.
Treating bowel cancer
People with bowel cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best treatment and care.
The team often consists of a Dr. B C Shah, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist, and you may have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
The type and size of the cancer
Your general health
Whether the cancer has spread to other parts of your body
What grade it is
There are several treatments for bowel cancer, including:
Surgery
Chemotherapy
Radiotherapy
Biological therapy
Surgery is usually the main treatment for bowel cancer, but in about one in five cases, the cancer is too advanced to be removed by surgery. If you have surgery, you may also need chemotherapy, radiotherapy or biological therapy, depending on your particular case.
Your treatment plan
Your recommended treatment plan will depend on the stage and location of your bowel cancer.
If the cancer is confined to your rectum, radiotherapy will usually be used to shrink the tumour, then surgery may be used to remove the tumour. Sometimes, radiotherapy is combined with chemotherapy, which is known as chemoradiation.
If you have stage 1 bowel cancer, it should be possible to surgically remove the cancer and no further treatment will be required.
If you have stage 2 or 3 bowel cancer, surgery may be used to remove the cancer and, in some cases, nearby lymph nodes. Surgery is usually followed by a course of chemotherapy to stop the cancer returning.
It is not usually possible to cure stage 4 (advanced) cancer. However, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and biological therapy where appropriate.
Preventing bowel cancer
There are several ways to reduce your risk of developing bowel cancer.
Diet
Research suggests a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains can help reduce your risk of getting bowel cancer. It can also reduce your risk of developing other types of cancer and heart disease.
It is recommended you do not eat a lot of processed meat and red meat. The Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams. .
Exercise
There is strong evidence to suggest regular exercise can lower the risk of developing bowel and other cancers.
It is recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week.
Healthy weight
Try to maintain a healthy weight. Changes to your diet and an increase in physical activities will help keep your weight under control. Find out if you are a healthy weight with the Healthy weight calculator.
Smoking
If you smoke, giving up will reduce your risk of developing bowel and other cancers.
Dr. B C Shah can also provide help, support and advice if you want to give up smoking.
How screening for bowel cancer works
Bowel cancer can be present for a long time before any symptoms appear. If bowel cancer is detected before symptoms appear, it is easier to treat and there is a better chance of surviving the disease.
Screening for bowel cancer called an FOBt (faecal occult blood test) is done at a pathology Lab. A tiny stool samples on a special card. The card is then checked at the laboratory for traces of blood.
Results
There are three types of result:
Normal: no blood was found in the samples. Screening will be offered again in two years’ time.
Unclear: there were possible traces of blood that could be caused by factors other than cancer, such as haemorrhoids (piles) or stomach ulcers. If you have an unclear result, you will be asked to repeat the test kit up to twice more.
Abnormal: blood was definitely found in the samples. Again, this could be from piles or bowel polyps(small growths not usually cancerous). If you have an abnormal result, you will be offered an appointment with Dr. B C Shah to discuss having an examination of the bowel, called a colonoscopy.
Colonoscopy
A colonoscopy is an investigation of the lining of the large bowel (colon). A thin flexible tube with a tiny camera on the end is passed into your bottom and guided around the bowel. Only around 2 in every 100 people completing the FOBt kit will have an abnormal result and will be offered a colonoscopy. Of those who have a colonoscopy, only about one in 10 will have cancer.
New screening test
As well as the FOBt described above, an additional screening test is being rolled out by 2016. This involves inviting people at age 55 to have a one-off flexible sigmoidoscopy test to examine the lower bowel with a camera.
If the flexible sigmoidoscopy shows polyps, the person will then be offered a full colonoscopy . Both FOBt and flexible sigmoidoscopy screening tests have been shown to reduce the risk of dying of bowel cancer.
Living with bowel cancer
Being diagnosed with cancer is a tough challenge for most people. There are several ways to find support to help you cope.
Not all of them work for everybody. but one or more should be helpful:
Talk to your friends and family. They can be a powerful support system.
Get in touch with others in the same situation as you
Learn about your condition
Don't try to do too much at once
Make time for yourself.
Talk to others
Dr. B C Shah may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist . Dr. B C Shah will have information on these.
Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.
Recovering from colon or rectal surgery
Surgeons and anaesthetists have found that using an “enhanced recovery programme” after bowel cancer surgery helps patients recover more quickly.
Most hospitals now use this programme. It involves giving you more information before the operation about what to expect, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy.
During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.
Most people will be able to eat a light diet the day after their operation.
To reduce the risk of deep vein thrombosis (blood clots in the legs), you may be given special compression stockings that help prevent blood clots, or a regular injection with heparin until you are fully mobile.
A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home again within a few days.
With the enhanced recovery programme, most people are well enough to go home within five to six days of their operation. The timing depends on when you and Dr. B C Shah agree you are well enough to go home.
Coping with colostomy
If you need a colostomy, you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma (including stoma care, stoma products and ‘stoma-friendly’ diets) is available via the ileostomy and colostomy topics.
Diet after bowel surgery
If you have had part of your colon removed, it is likely that your stools (faeces) will be looser because one of the functions of the colon is to absorb water from the stools. This may mean that you experience repeated episodes of diarrhoea
You should inform Dr. B C Shah if diarrhoea becomes a problem because medication is available to help control symptoms.
You may find some foods upset your bowels, particularly during the first few months after your operation.
Different foods can upset different people, but food and drink that is commonly known to cause problems include:
Rich and fatty food
Fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas
Fizzy drinks, such as cola and beer
You may find it useful to keep a food diary to record the effects of different foods on your bowel.
If you find that you are having continual problems with your bowels as a result of your diet, and/or you are finding it difficult to maintain a healthy diet, you should contact Dr. B C Shah. You may need to be referred to a dietitian for further advice.
Sex and bowel cancers
Having cancer and its treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, if you have had a colostomy you may feel self-conscious or uncomfortable.
Talking about how you feel with your partner may help you both to support each other. Or you may feel you’d like to talk to someone else about your feelings. Dr. B C Shah will be able to help.
Financial concerns
A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you.
Dealing with dying
If you are told there is nothing more that can be done to treat your bowel cancer, Dr. B C Shah will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.
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Dental Abscess
Posted by on Friday, 7th June 2013
Introduction
A dental abscess is a collection of pus that forms in your teeth or gums as a result of a bacterial infection.
The main symptom of a dental abscess is a severe, throbbing pain at the site of the abscess. The pain usually comes on suddenly and then gets gradually worse over a few hours or a few days.
ypes and causes of dental abscesses
There are two types of dental abscess:
periapical abscess – where bacteria infect the inside of the tooth (this is the most common type of dental abscess)
periodontal abscess – where bacteria infect the gums
Both types of dental abscess are caused when bacteria builds up inside your mouth. This usually occurs due to a combination of:
poor dental hygiene – not cleaning your teeth and gums properly and regularly (find out how to brush and floss your teeth)
consuming lots of sugary or starchy food and drink – the carbohydrates in these types of food and drink encourage bacteria to grow
Treating dental abscesses
You should make an appointment with Dr. B C Shah as soon as possible if you think you may have a dental abscess.
He will be able to drain away the pus from the abscess and, if necessary, remove any teeth that have been damaged by the infection.
This type of treatment should not be too painful because local anaesthetic will be used to numb the affected area of your mouth.
Unlike some other types of infection, a dental abscess will not get better on its own and must be treated immediately. With appropriate treatment, the bacterial infection that causes a dental abscess can usually be successfully cured.
Complications of dental abscesses
It is rare for complications to develop as a result of a dental abscess, but they can be serious if they do occur. For example, the infection may spread to nearby bone (osteomyelitis).
Emergency treatment
If you have severe pain, you may need emergency dental treatment. Depending on your individual circumstances, you may need to contact Dr. B C Shah for your treatment.
Symptoms of dental abscess
The main symptom of a dental abscess is an intense, throbbing pain in your affected tooth or area of gum.
The pain usually comes on suddenly and may gradually get worse over a few hours to a few days.
Sometimes, the pain may spread to your ear, lower jaw and neck on the same side as the affected tooth.
Other symptoms
Other symptoms of a dental abscess can include:
Tenderness of your tooth and surrounding area
Sensitivity to very hot or cold food and drink
An unpleasant taste in your mouth
A general feeling of being unwell
Difficulty opening your mouth
Dysphagia (difficulty swallowing)
Disturbed sleep
When to seek immediate medical help
The following symptoms can be a sign of the infection spreading to other parts of your body:
Swelling in your face
A high temperature (fever) of 38°C (100.4°F) or above
Severe pain that does not respond to treatment with painkillers
Breathing difficulties
If you develop any of these symptoms you will need to contact Dr. B C Shah immediately.
Causes of dental abscess
A dental abscess occurs when bacteria infect and spread inside a tooth or your gums.
Your mouth is full of bacteria, which combine with small particles of food and saliva to form a sticky film called plaque, which builds up on your teeth.
Eating and drinking food and drink high in carbohydrates (sugary or starchy) causes the bacteria in plaque to turn the carbohydrates into the energy they need to reproduce. Acid is also produced.
The combination of bacteria and excess acid can lead to the formation of a dental abscess. This can either occur when bacteria spread into:
The centre of a tooth (the pulp) through tiny holes in the tooth (dental caries) that are caused by the excess amount of acid – this is known as a periapical abscess and it is the most common type of dental abscess
An area of your gums underneath a tooth – this is known as a periodontal abscess
Periapical abscesses
When a periapical abscess develops, plaque bacteria infect your tooth as a result of dental caries (tiny holes caused by tooth decay) that form in the hard outer layer of your tooth (the enamel).
Dental caries break down the enamel and the softer layer of tissue underneath (dentine) and eventually reach the centre of your tooth (pulp). This is known as pulpitis. The dental pulp in the middle of the tooth dies and the pulp chamber becomes infected.
The bacteria continue to infect the pulp until it reaches the bone that surrounds and supports your tooth (alveolar bone), where the periapical abscess forms.
Periodontal abscesses
A periodontal abscess occurs when plaque bacteria affect your gums, causing severe gum disease (also known as periodontitis).
Periodontitis causes inflammation (redness and swelling) in your gums, which can make the tissue surrounding the root of your tooth separate from the base of your tooth.
The separation creates a tiny gap called a periodontal pocket, which allows bacteria to enter and spread and can be very difficult to keep clean.
The periodontal abscess is formed by the build-up of bacteria in the periodontal pocket. A periodontal abscess may also occur as a result of:
Dental procedures that create accidental periodontal pockets
The use of antibiotics in untreated periodontitis, which can mask the beginnings of an abscess
Gum damage, even if you do not have periodontitis
Risk factors
Risk factors for a dental abscess include:
Poor oral hygiene – if you do not brush your teeth and floss between them regularly, your risk of developing a dental abscess is increased
Having a diet high in sweet and sticky food and drink – such as chocolate, sweets, sugar and fizzy drinks and/or starchy foods, such as crisps, white bread, pretzels and biscuits
Having a weakened immune system – this may be due to having an underlying health condition, such as diabetes, or the side effects of treatments such as steroid medication (corticosteroids) or chemotherapy
Diagnosing a dental abscess
If you think that you may have a dental abscess, you must see Dr. B C Shah as soon as possible.
Dr. B C Shah will carry out some tests to determine whether your symptoms are being caused by a dental abscess. For example, they may:
Tap on the affected tooth or area of gum – if infection is present, your tooth or gum will be sensitive to any pressure
Examine your gums – an infection will usually cause an area of your gums to become red and swollen
Take an X-ray of the affected area to help assess the spread of infection
In some cases, he may be able to confirm a diagnosis by simply asking you about your symptoms.
Referral
Dr. B C Shah may refer you for treatment in hospital if you have a dental abscess and you:
Are feeling unwell with a high temperature, a rapid pulse rate or low blood pressure (hypotension) and rapid breathing
Are in severe pain despite taking painkillers
Have a spreading facial infection
Have a weakened immune system (for example, because you are having treatment such as chemotherapy)
Treating a dental abscess
The only way to cure a dental abscess is with dental treatment.
Dr. B C Shah will treat your abscess using dental procedures and, in some cases, surgery .
Painkillers
A dental abscess can be very painful, but you can use over-the-counter painkillers from your local pharmacy to control the pain while you are waiting for dental treatment.
Ibuprofen is the preferred painkiller for dental abscesses, but if you are unable to take ibuprofen for medical reasons, you can take paracetamol instead.
If one painkiller fails to relieve the pain, taking both paracetamol and ibuprofen at the same time can often be effective (this is safe for adults, but not for children under 16 years of age).
However, you should make sure you leave six hours before taking another combined dose.
Also, always read and follow the information on the packet about how much to take and how often, and do not exceed the maximum stated dose.
Accidental overdoses have been reported in people who take too many painkillers when trying to relieve the pain of a dental abscess.
Painkillers cannot treat or cure a dental abscess, so they should not be used to delay dental treatment.
Follow the advice below to take painkillers safely:
Do not take ibuprofen if you are asthmatic or if you have a stomach ulcer, or you have had one in the past
Do not take more than one painkiller at the same time without first checking with Dr. B C Shah as this can be dangerous because many over-the-counter products contain similar painkillers and it is possible to overdose when combining products
Ibuprofen and paracetamol are both available as liquid preparations for children
Aspirin is not suitable for children under 16 years of age
If you are pregnant or breastfeeding, you should take paracetamol
Self care
Other self care techniques that can help include:
Avoid anything that makes the pain worse, such as hot or cold foods or cold air
Holding cooled water or crushed ice around the tooth can sometimes ease the pain
The pain can often feel worse when you are lying flat, so lying propped up may help ease pain
Dental treatment
The first and most important step in treating a dental abscess is to cut out the abscess and drain away the pus containing the infectious bacteria.
Dr. B C Shah will carry this out under local anaesthetic. This means you will be awake throughout the procedure, but the affected area will be numb so you will feel little to no pain.
If the abscess is inside one of your teeth (a periapical abscess), root canal treatment will usually be recommended. This involves drilling into the affected tooth to release the pus and removing any damaged tissue from the centre (pulp). A filling will then be inserted into the space to prevent further infection.
If there is a pocket of pus inside an area of gum (a periodontal abscess), Dr. B C Shah will drain the pus and clean out the pocket. They will then smooth out the surfaces of the root of your tooth by filing below your gum line to help your tooth heal and prevent further infection.
Antibiotics
Antibiotics are not routinely prescribed to treat dental abscess because:
Draining the abscess is a more effective treatment
Using antibiotics to treat non-serious infections makes them less effective at treating more serious infections (this is known as antibiotic resistance)
Antibiotics are usually only required if:
There are signs that the infection is spreading, such as swelling of your face or neck
You have a weakened immune system
If antibiotics are required, an antibiotic called amoxicillin is usually recommended. If you are allergic to amoxicillin, which is a type of penicillin, metronidazole can usually be prescribed as a precaution.
Reoccurring infection
If you have a periapical abscess and your infection reoccurs, you may need to undergo a surgery to remove any further diseased tissue.
If you have a periodontal abscess and your infection reoccurs, Dr. B C Shah will surgically be able to reshape your gum tissue to permanently remove the periodontal pocket.
In some cases, a dental abscess infection can reoccur even after dental and surgical procedures. If this happens, or if your tooth is severely broken down, it may need to be removed altogether (extracted).
Complications of a dental abscess
With appropriate dental treatment, a dental abscess can usually be easily cured. However, in rare cases, complications can occur.
Most complications arise due to the spread of the bacterial infection when an abscess is left untreated. Some possible complications are outlined below.
Dental cysts
If a dental abscess is left untreated, a fluid-filled cavity may develop at the bottom of the root of your tooth. This is known as a dental cyst.
If a cyst becomes infected, treatment with antibiotics may be needed. A dental cyst can be surgically removed under local anaesthetic (where the affected area is numbed).
Osteomyelitis
Osteomyelitis is an infection of the bone. It is caused by the bacteria in a dental abscess spreading through your bloodstream.
Osteomyelitis can cause symptoms such as fever, nausea (feeling sick) and severe pain in the affected bone, which can often be in the area surrounding a dental abscess.
However, as the infection is spread through your blood, it is possible for it to affect any bone in your body. Osteomyelitis can be treated by taking oral antibiotics or injecting them into a vein.
Sinusitis
Sinusitis is an infection of the small air-filled cavities inside your skull.
It is usually the cavities behind your cheekbones that can become infected as a complication of a dental abscess. These are known as the maxillary sinuses.
Symptoms of sinusitis include:
A blocked or runny nose
Facial pain and tenderness
A high temperature (fever) of 38°C (100.4°F) or above
Sinusitis often clears up without treatment but, if necessary, antibiotics may be prescribed.
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Brain Abscess
Posted by on Tuesday, 4th June 2013
Introduction
A brain abscess is a pus-filled swelling in the brain caused by an infection. It is a rare and life threatening condition.
It happens when bacteria or fungi enter the brain tissue.
Symptoms of a brain abscess include:
Headache – which is often severe and cannot be relieved by taking painkillers
Changes in mental state such as appearing very confused
Weakness or paralysis on one side of the body
A high temperature (fever) of or above 38C (100.4F)
Seizures (fits)
What causes a brain abscess?
There are three main ways that a brain abscess can develop:
An infection in another part of the skull, such as an ear infection, sinusitis or dental abscess, spreads directly into the brain
An infection in another part of the body, such as the lung infection pneumonia, spreads into the brain via the blood
Trauma, such as a severe head injury, that cracks open the skull allowing bacteria or fungi to enter the brain
Although in around 1 in 7 cases the source of the infection remains unknown.
Treating a brain abscess
A brain abscess is regarded as a medical emergency. This is because the swelling caused by the abscess can disrupt the blood and oxygen supply to the brain. There is also a risk that the abscess may burst (rupture). If left untreated, a brain abscess can cause permanent brain damage and can be fatal.
A brain abscess is usually treated using a combination of antibiotics (or in some cases, antifungals) and surgery. Dr. B C Shah will usually open the skull and drain the pus from the abscess or remove the abscess entirely.
The sooner the condition is diagnosed and treated the lower the chance a person has of developing long-term complications.
Complications
Any damage to the tissue of the brain can result in long-term complications, such as:
Brain damage – which can range from mild to severe
Epilepsy – where a person has repeated seizures (fits)
Who is affected
Brain abscesses tend to only be significant problem in parts of the world where access to antibiotics is limited.
Brain abscesses can occur at any age, but most cases are reported in people aged 40 or younger. They are more common in men than women. It is not clear why this should be the case.
Outlook
Because of advances in diagnostic and surgical techniques, the outlook for people with brain abscesses has improved dramatically. Nowadays, deaths only occur in an estimated 1 in 10 of cases. Many people make a full recovery.
Symptoms of a brain abscess
The symptoms of a brain abscess can develop quickly or slowly.
In around two-thirds of people, symptoms are present for two weeks or less before they escalate to the point where the person needs to be admitted to hospital.
Common symptoms include:
Headache - the headache is often severe, located in a single section of the head and cannot be relieved with painkillers
Changes in mental state, such as confusion or irritability
Problems with nerve function, such as muscle weakness, slurred speech or paralysis on one side of the body
A high temperature (fever) of or above 38C (100.4F)
Seizures (fits)
Nausea and vomiting
Stiff neck
Changes in vision, such as blurring, greying of vision or double vision (because of the abscess putting pressure on the optic nerve)
When to seek medical advice
Any symptoms that suggest a problem with the brain and nervous system, such as slurred speech, muscle weakness or paralysis, or seizures occurring in a person who had no previous history of seizures should be treated as a medical emergency.
Any symptoms that suggest a worsening infection, such as fever and vomiting, should be reported to Dr. B C Shah immediately.
Causes of a brain abscess
An abscess is a pus-filled swelling caused by infection with either bacteria or fungi.
The abscess is created by your immune system as a defence mechanism. If the immune system is unable to kill an infection, it will try to limit its spread. Your immune system will use healthy tissue to form a wall around the source of infection to stop the pus infecting other tissue.
The routes for brain infection
Infections of the brain are rare because the body has evolved a number of defences to protect this vital organ. One of these is the blood-brain barrier, which is a thick membrane that filters out impurities from blood before allowing it into your brain.
However, in some people, for reasons not always entirely clear, germs can get through these defences and infect the brain.
The three most common routes for germs to enter the brain are:
Germs have already infected one of the nearby cavities in the skull (such as the ears or nose) and go on to infect the brain.
Germs have already infected another part of the body, get into the bloodstream, bypass the blood-brain barrier and then infect the brain.
Germs pass through the skull and enter the brain after the skull is damaged, for example after being hit by a blunt object or after a gunshot wound.
Though in around 1 in 7 cases no obvious cause for the infection can be found.
The causes of a brain abscess are explained in more detail below.
Germs from another infection in the skull
In up to a half of cases, the brain abscess occurs as a complication of a nearby infection in the skull, such as:
A persistent middle ear infection (otitis media)
Sinusitis (an infection of the sinuses, which are the air-filled cavities inside the cheekbones and forehead)
Mastoiditis (an infection of the bone behind the eye)
This used to be a major cause of brain abscesses, but because of improved treatments for infections, a brain abscess is now a rare complication of these kinds of infection.
Germs invading the brain through the bloodstream
Infections spread through the blood are thought to account for around 1 in 4 cases of brain abscesses.
People with a weakened immune system have a higher risk of developing a brain abscess from a blood-borne infection. This is because their immune system may not be capable of fighting off the initial infection.
You may have a weakened immune system if you:
Have a medical condition that weakens your immune system, such as HIV or AIDS
Receive medical treatment known to weaken the immune system, such as chemotherapy
Have an organ transplant and take immunosuppressant drugs to prevent your body rejecting the new organ
The most commonly reported infections and health conditions that may cause a brain abscess are:
Cyanotic heart disease, a type of congenital heart disease (a heart defect present at birth) where the heart is unable to carry enough oxygen around the body (this lack of a regular oxygen supply makes the body more vulnerable to infection)
Pulmonary arteriovenous fistula – a rare condition in which abnormal connections develop between blood vessels inside the lungs; this can allow bacteria to get into the blood and then into the brain,
Lung infections, such as pneumonia or bronchiectasis
Infections of the heart, such as endocarditis
Skin infections
Infections of the abdomen, such as peritonitis (an infection of the lining of the bowel)
Pelvic infections such as infection of the lining of the bladder (cystitis)
Germs invading the brain after a head injury
Direct trauma to the skull can also lead to a brain abscess and is thought responsible for 1 in 10 cases.
The most commonly reported causes include:
Skull fracture caused by penetrating injury to the head
Gunshot or shrapnel wound
In rare cases, a brain abscess can develop as a complication of surgery.
Diagnosing a brain abscess
An initial assessment will be made based on your physical symptoms and medical history, such as whether you have had a recent infection or a weakened immune system.
Blood tests
Blood tests will be carried out to check for the presence of infection. A high level of white blood cells in your blood indicates the presence of a serious infection.
Scans
If a brain abscess is suspected, the diagnosis can be confirmed using a brain scan.
Computerised tomography (CT) scan
A computerised tomography (CT) scan involves a series of X-rays taken of your body at different angles. This produces a detailed image of the inside of your body.
A CT scan can often detect the presence of the abscess and any associated swelling inside the brain.
Magnetic resonance imaging (MRI) scan
A magnetic resonance imaging (MRI) scan uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body.
A MRI scan can provide a more detailed image than a CT scan so is sometimes used if the results of the CT scan are inconclusive.
CT-guided aspiration
If an abscess is found, Dr. B C Shah can use a CT scan to guide a needle to the site of the abscess and remove a sample of pus for further testing. This is known as CT-guided aspiration. The sample of pus should indicate the type of germ causing the abscess.
Treatment with broad-spectrum antibiotics will usually begin as soon as possible, even before a CT-guided aspiration is carried out, because it can be dangerous to wait for the results.
Broad-spectrum antibiotics can be used against a wide range of bacteria. They will be used before a specific diagnosis is made because there is a high chance they will be effective if the infection is caused by bacteria.
If the test reveals the abscess is caused by a fungus, the treatment plan can be changed and antifungal medication given.
Treating a brain abscess
Treatment for a brain abscess will depend on the size and number of brain abscesses present. A brain abscess is a medical emergency, so you will need treatment in hospital and will stay there until your condition is stable.
Medication
Surgery will be avoided if thought too risky or if an abscess is small and could be treated by medication alone.
Medication is recommended over surgery if you have:
Several abscesses
A small abscess (less than 2cm)
An abscess deep inside the brain
Meningitis (an infection of the protective membranes that surround the brain) as well as an abscess
Hydrocephalus (a build-up of fluid on the brain)
You will normally be given antibiotics or antifungal medication through a drip (directly into a vein). Dr. B C Shah will aim to treat the abscess and the original infection that caused it.
Surgery
If the abscess is larger than 2cm, it is usually necessary to drain the pus out of the abscess.
There are two surgical techniques for treating a brain abscess:
Simple aspiration
Craniotomy
Simple aspiration involves using a CT scan to locate the abscess and then drills a small hole known as a burr hole into the skull. The pus is then drained through the hole and the hole sealed.
A simple aspiration takes around one hour to complete.
Open aspiration and excisions are usually carried out using a surgical procedure known as a craniotomy.
Craniotomy
A craniotomy may be recommended if an abscess does not respond to aspiration or reoccurs at a later date.
During a craniotomy, Dr. B C Shah will shave a small section of your hair and then remove a small piece of your skull bone (a bone flap) to gain access to your brain.
The abscess will then be drained of pus or totally removed. A CT-guided localisation system may be used during the operation, which allows Dr. B C Shah to more accurately locate the exact position of the abscess.
Once the abscess has been treated, the bone is replaced. The operation usually takes around three hours which includes recovery from the general anaesthetic (where you are put to sleep).
Complications of a craniotomy
As with all surgery, a craniotomy carries risks, but serious complications are uncommon.
Possible complications of a craniotomy are:
Swelling and bruising around your face, which is common after a craniotomy. This will die down after the operation.
Headaches. These are common after a craniotomy and may last several months, but should eventually settle down.
A blood clot in the brain (further surgery may be required to remove it).
Stiff jaw. During a craniotomy, Dr. B C Shah may need to make a small cut to a muscle that helps with chewing. The muscle does heal, but can become stiff for a few months, causing your jaw to feel stiff. Exercising the muscle by regularly chewing sugar-free gum should help relieve the stiffness.
Movement of the bone flap. The bone flap in your skull may feel like it moves and you may experience a clicking sensation. This can feel strange, but it is normal and not dangerous. It will stop as the skull heals.
The site of the cut (incision) in your skull can become infected, although this is uncommon. You are usually given antibiotics around the time of your operation to prevent infection.
Recovering from surgery
Once your brain abscess has been treated, you will probably stay in hospital for several weeks so your body can be supported while you recover.
You will also receive a number of CT scans, to make sure the brain abscess has been completely removed.
Most people will then need a further 6 to 12 weeks rest at home before they are fit enough to return to work or full-time education.
After treatment for a brain abscess, avoid any contact sport where there is a risk of injury to the skull, such as boxing, rugby or football.
Complications of a brain abscess
Possible complications of a brain abscess are outlined below.
Brain damage
Brain damage can range from mild through moderate to severe.
Mild brain damage can result in:
Headaches
Memory problems
Moderate brain damage can result in:
Changes in mood such as feeling restless or agitated
Problems with tasks that require high-level thinking such as planning and decision making
Difficulties with balance and coordination – the medical term for this is ataxia
Severe brain damage can result in:
Weakness in certain parts of the body
And in the most serious of cases – coma or persistent vegetative state
Mild to moderate brain damage often improves with time. Severe brain damage is likely to be permanent.
Brain damage is more of a risk when the diagnosis of a brain abscess was delayed and treatment did not begin quickly enough. Brain abscesses can now be diagnosed very easily with a CT or MRI scan, so the risk of serious brain damage is now low.
Epilepsy
A common complication of brain abscesses is epilepsy, a condition that causes repeated fits or seizures. Epilepsy is a long-term condition and symptoms can usually be controlled using medication..
Meningitis
In some cases, especially those involving children, a brain abscess can develop into bacterial meningitis, a life-threatening infection of the protective membranes that surround the brain.
Symptoms of meningitis include:
Severe headache
Vomiting
High temperature (fever) of 38ºC (100.4ºF) or over
Stiff neck
Someone with bacterial meningitis will require urgent treatment in hospital; usually an intensive care unit (ICU).
Antibiotics will be used to treat the underlying infection. These will be given intravenously (through a vein in the arm).
At the same time a person may also be given:
Oxygen
Intravenous fluids (through a vein)
Steroids or other medication to help reduce the inflammation (swelling) around the brain
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Breast Biopsy (Excision)
Posted by on Friday, 31st May 2013
What is the test?
In an excisional biopsy of the breast, Dr. B C Shah makes an incision in the skin and removes all or part of the abnormal tissue for examination under a microscope. Unlike needle biopsies, a surgical biopsy leaves a visible scar on the breast and sometimes causes a noticeable change in the breast’s shape. It’s a good idea to discuss the placement and length of the incision with your surgeon beforehand. Also ask Dr. B C Shah about scarring and the possibility of changes to your breast shape and size after healing, as well as the choice between local anesthesia and general anesthesia.
How do I prepare for the test?
You’ll undergo a breast exam and possibly a mammogram before the biopsy to determine where the lump is located. If you are having a sedative with local anesthesia, or if you are having general anesthesia, you’ll be asked not to eat anything after midnight on the day before the surgery
Tell Dr. B C Shah if you’re taking insulin, NSAIDs, or any medicine that can affect blood clotting. You might have to stop or adjust the dose of these medicines before your test.
What happens when the test is performed?
A surgical biopsy is done in an operating room. An IV line is placed in your arm so that you can receive medicines through it. Dr. B C Shah may use local anesthesia with sedation to help you relax during the procedure, or general anesthesia. Surgical biopsies take about an hour, and the recovery period is less than two hours.
An open biopsy that removes only part of a lump of suspicious tissue is called an incisional biopsy; one that removes the entire lump is called an excisional biopsy. An incisional biopsy is usually done when the lump is quite large, since removing a larger lump completely can alter the appearance of the breast. This procedure is appropriate for larger lumps in order to secure a diagnosis while minimizing the effect on the breast’s appearance. If the tissue proves to be cancerous, the remaining portion of the lump will be removed surgically, usually during a second surgical procedure that may be more extensive and involve removal of lymph nodes to determine whether the cancer has spread.
When a breast mass or an area of calcification cannot be felt, Dr. B C Shah may choose to use a procedure called wire localization to help identify the tissue for later surgical biopsy. The first part of this procedure is a mammogram. After applying a local anesthetic, he inserts a hollow needle into the breast and, guided by ultrasound or mammography, places the tip of the needle in the suspicious area. He then inserts a thin wire with a hook on the end through the hollow needle and into the breast alongside the suspicious area. Dr. B C Shah will then removes the needle, leaving the wire in place to serve as a guide to help him find the area of breast tissue to be removed later.
Must I do anything special after the test is over?
Dr. B C Shah will monitor you for a few hours after your surgery to make sure that you’re recovering well and not having any adverse reactions to anesthesia. Contact him if you develop a fever, strong pain at the incision site, or bleeding from the incision. You may need a follow-up visit so that Dr. B C Shah can remove stitches and make sure you are recovering well.
How long is it before the result of the test is known?
A preliminary report from the pathologist might be available when your surgery is over. A final report typically takes three to four days.
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