Medical Topics

Cellulitis

 

Skin integrity Immunity VasculatureCellulitis is a spreading bacterial infection of the dermis and subcutaneous tissues ( CREST 2005 )

It is a bacterial skin and soft tissue infection Generally affects the lower limbs Erysipelas – Greek erythros (red) + pella (skin ) is considered a subtype
Evidence suggests a large overlap between the two conditions Seen and managed frequently by different specialists as GPs,

UTI ( Catheter ) antibiotics

NICE has published a guideline on management of UTIs in people with a urinary catheter. 

This was published in November 2018 and NICE has reviewed current evidence / experience on this topic and produced this very useful guidance. An easy to use visual is produced here for quick reference

Catheter-associated urinary tract infection 
( UTI ) -symptomatic infection of the bladder or kidneys in a person with a urinary catheter
 NICE guidance suggests that longer the catheter is in place –

Bronchiectasis- antibiotics

Bronchiectasis ( non-cystic ) -acute exacerbation antibiotic prescribing

Send sputum for M/C Offer an antibiotic-NICE suggests to offer some general and safety-netting advice
 SEs of antibiotics particularly diarrhoea
 To seek further medical help if
○ symptoms worsen rapidly at any time or
○ person becomes systemically unwell

When sputum culture result becomes available
 review choice only change antibiotic if
○ bacteria are resistant and
○ symptoms are not already improving
○ using marrow spectrum antibiotics when possible

NICE advices to reassess the situation at any time if symptoms worsen rapidly or significantly- taking into account
 other possible diagnosis as pneumonia symptoms or signs of something more serious ,

Gallstones

Gallstone disease occurs when hard fatty or mineral deposits 
( gallstones ) form in the gall bladder

Epidemiology-Very common – 5-30 % of adults in W Europe
UK around 10-15 % Most people are asymptomatic ( ~ 90 % unaware carriers )
Majority of gallstones are cholesterol – main component Substantial economic burden to health-care systems globally Most common GI disease that requires hospitalization


Cause –Gallstone formation is multifactorial including a complex interplay pf sex-specific ,

Insulin chart

A chart describing the types of insulin, manufacturers, devices and duration of action. This chart has been reproduced unedited. It provides information which can be useful when dealing with patients on insulin for the non-experts.

Rapid-acting insulins Insulin Aspart , Insulin Lispro , Insulin Glulisine

Short-acting insulins- Insulin-soluble/ neutral

Intermediate-acting insulins-Isophane insulin

Long-acting analogue insulins -Insulin Detemir,

LUTS in men

Lower urinary tract symptoms ( LUTS ) in men- storage , voiding and post-micturition symptoms

LUTS can happen due to many causes such as
abnormalities or abnormal function of 

◘ prostate eg prostatitis , cancer
◘ urethra- stricture , foreign body, stone
◘ sphincters -detrusor muscle weakness or overactivity

UTIs and neurological diseases eg neurogenic bladder dysfunction
Foreign body in bladder or urethra
Meatal stenosis or phimosis
Calculus in bladder ,

Diverticular disease

Diverticula are herniations or small pouches in the mucosal lining of the colon , most commonly affecting the descending and sigmoid colon
 ( Amerine , 2007 ; Marrs 2006 )

protrusion occurs in weak areas of the bowel through which blood vessels can penetrate ( see figure ) diverticula generally are multiple typically 5-10 mm in dia but can occasionally be up to 20 mm most common site is sigmoid colon ( 90 % ) ,

Epistaxis (Nosebleeds )

Epistaxis ( nosebleeds ) is bleeding from the nasal cavity.

How common- Most common ENT emergency presentation in primary care Up to 60 % of the population will suffer from epistaxis atleast once in their lifetime
But -only 6 % will require medical attention Bimodal age distribution ( ↑ ed prevalence in children and aged )
Most cases in age group 2-10 and 50-70 yrs
Rare below age 2 and may indicate serious illness like leukaemia or injury More common in winter No racial or gender predilection Allergic rhinitis and use of nasal medications can be risk factors

Classified as Anterior or Posterior- division lies at the piriform aperture

Anterior – 

Tennis elbow

Tennis elbow – Tennis elbow is a tendinopathy of the common extensor origin
 of the lateral elbow ( John Orchard BMJ 2011 ). First described
 by Runge et al in 1873 when it was called ” writers cramp “

Tennis elbow is very common Peaks age 35-55 Dominant arm involved in majority of ( ~ 75 % ) cases Equal gender incidence Prevalence 1-3 % ( higher in manual workers ) Tennis players make only 10 % of tennis elbow cases
but 50 % of tennis players develop elbow pain and tennis elbow is responsible for 75 % of those Occurs more frequently in non-athletes Most common cause of persistent elbow pain in general practice

Etiology multifactorial Overuse injury of extensor carpi radialis brevis insertion at the lateral epicondyle of humerus Several contributory factors as
○ force
○ repetition ( forearm and elbow )
○ posture Repetitive overuse –>

Upper gastrointestinal tract cancers

oesophageal cancer – Types
○ adenocarcinoma ( commonest now )
○ squamous cell cancer
○ undifferentiated cancers
○ rare types eg melanoma , lymphoma , sarcomas Over 8000 diagnosed /year in UK Men more likely to be affected Five year survival rate is ~ 15 %. Risk factors
○ male sex
○ low socioeconomic status
○ smoking
○ excessive alcohol
○ GORD
○ Barrett’s oesophagus
○ obesity
○ family hx of oesophageal ,

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