TB

Tuberculosis
From Wikipedia, the free encyclopedia.
Tuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) but can also affect the central nervous system (meningitis), lymphatic system, circulatory system (miliary TB), genitourinary system, bones and joints.
Tuberculosis is the most common major infectious disease today, infecting two billion people or one-third of the world's population, with nine million new cases of active disease annually, resulting in two million deaths, mostly in developing countries.
Most of those infected (90 percent) have asymptomatic latent TB infection (LTBI). There is a 10 percent lifetime chance that LTBI will progress to active TB disease which, if left untreated, will kill more than 50 percent of its victims. TB is one of the top three infectious killing diseases in the world: HIV/AIDS kills 3 million people each year, TB kills 2 million, and malaria kills 1 million.
The neglect of TB control programs, HIV/AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) are emerging. The World Health Organization declared TB a global health emergency in 1993.

Other names for the disease
TB (short for tuberculosis and also for Tubercle Bacillus)
Consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor, and long relentless wasting)
Wasting disease
White plague (TB sufferers appeared markedly pale)
Phthisis (Greek for consumption) and phthisis pulmonalis
Scrofula (swollen neck glands)
King's evil (so called because it was believed that a king's touch would heal scrofula)
Pott's disease of the spine
Miliary TB (x-ray lesions look like millet seeds)
Tabes mesenterica (TB of the abdomen)
Lupus vulgaris (the common wolf - TB of the skin)
Prosector's wart, also a kind of TB of the skin, transmitted by contact with contaminated cadavers to anatomists, pathologists, veterinarians, surgeons, butchers, etc.

The bacterium

Acid-fast bacilli (AFB) (shown in red) are tubercle bacilli Mycobacterium tuberculosis.
The cause of tuberculosis, Mycobacterium tuberculosis (MTB), is a slow-growing aerobic bacterium that divides every 16 to 20 hours. This is extremely slow compared to other bacteria, which tend to have division times measured in minutes (among the fastest growing bacteria is a strain of E. coli that can divide roughly every 20 minutes). It is not classified as either Gram-positive or Gram-negative because it does not have the chemical characteristics of either, although it contains peptidoglycan in their cell wall. If a Gram stain is performed, it stains very weakly Gram-positive or not at all. It is a small rod-like bacillus which can withstand weak disinfectants and can survive in a dry state for weeks but, spontaneously, can only grow within a host organism (in vitro culture of M. tuberculosis took a long time to be achieved, but is nowadays a normal laboratory procedure).
MTB is identified microscopically by its staining characteristics: it retains certain stains after being treated with acidic solution, and is thus classified as an "acid-fast bacillus" or "AFB". In the most common staining technique, the Ziehl-Neelsen stain, AFB are stained a bright red which stands out clearly against a blue background. Acid-fast bacilli can also be visualized by fluorescent microscopy, and by auramine-rhodamine stain.
The M. tuberculosis complex includes 3 other mycobacteria which can cause tuberculosis: M. bovis, M. africanum, and M. microti. The first two are very rare causes of disease and the last one does not cause human disease.
Nontuberculous mycobacteria (NTM) are other mycobacteria (besides M. leprae which causes leprosy) which may cause pulmonary disease resembling TB, lymphadenitis, skin disease, or disseminated disease. These include Mycobacterium avium, M. kansasii, and others.

The disease
Transmission
TB is spread through aerosol droplets which are expelled when persons with active TB disease cough, sneeze, speak, or spit. Close contacts (people with prolonged, frequent, or intense contact) are at highest risk of becoming infected (typically 22 percent infection rate but everything is possible, even up to 100%). A person with untreated, active tuberculosis can infect an estimated 20 other people per year. Others at risk include foreign-born from areas where TB is common, immunocompromised patients (eg. HIV/AIDS), residents and employees of high-risk congregate settings, health care workers who serve high-risk clients, medically underserved, low-income populations, high-risk racial or ethnic minority populations, children exposed to adults in high-risk categories, and people who inject illicit drugs.
Transmission can only occur from people with active TB disease (not latent TB infection).
The probability of transmission depends upon infectiousness of the person with TB (quantity expelled), environment of exposure, duration of exposure, and virulence of the organism.
The chain of transmission can be stopped by isolating patients with active disease and starting effective anti-tuberculous therapy.

Pathogenesis
While only 10 percent of TB infection progresses to TB disease, if untreated the death rate is 51 percent.
TB infection begins when MTB bacilli reach the pulmonary alveoli, infecting alveolar macrophages, where the mycobacteria replicate exponentially. Bacteria are picked up by dendritic cells, which can transport bacilli to local (mediastinal) lymph nodes, and then through the bloodstream to the more distant tissues and organs where TB disease could potentially develop: lung apices, peripheral lymph nodes, kidneys, brain, and bone.
Tuberculosis is classed as one of the granulomatous inflammatory conditions. Macrophages, T lymphocytes, B lymphocytes and fibroblasts are among the cells that aggregate to form a granuloma, with lymphocytes surrounding infected macrophages. The granuloma functions not only to prevent dissemination of the mycobacteria, but also provides a local environment for communication of cells of the immune system. Within the granuloma, T lymphocytes secrete cytokine such as interferon gamma, which activates macrophages and make them better able to fight infection. T lymphocytes can also directly kill infected cells.
Importantly, bacteria are not eliminated with the granuloma, but can become dormant, resulting in a latent infection. Latent infection can be diagnosed only by tuberculin skin test, which yields a delayed hypertype sensitivity response to purified protein derivatives of M. tuberculosis in an infected person.
Another feature of the granulomas of human tuberculosis is the development of cell death, also called necrosis, in the center of tubercles. To the naked eye this has the texture of soft white cheese and was termed caseous necrosis.
If TB bacteria gain entry to the blood stream from an area of tissue damage they spread through the body and set up myriad foci of infection, all appearing as tiny white tubercles in the tissues. This is called miliary tuberculosis and has a high case fatality.
In many patients the infection waxes and wanes. Tissue destruction and necrosis are balanced by healing and fibrosis. Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material. During active disease, some of these cavities are in continuity with the air passages bronchi. This material may therefore be coughed up. It contains living bacteria and can pass on infection.
Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Affected areas are eventually replaced by scar tissue.

Progression
In those people in whom TB bacilli overcome the immune system defenses and begin to multiply, there is progression from TB infection to TB disease. This may occur soon after infection (primary TB disease – 1 to 5 percent) or many years after infection (post primary TB, secondary TB, reactivation TB disease of dormant bacilli – 5 to 9 percent). The risk of reactivation increases with immune compromise, such as that caused by infection with HIV. In patients co-infected with M. tuberculosis and HIV, the risk of reactivation increases to 10 percent per year, while in immune competent individuals, the risk is between 5 and 10 percent in a lifetime.
About five percent of infected persons will develop TB disease in the first two years, and another five percent will develop disease later in life. In all, about 10 percent of infected persons with normal immune systems will develop TB disease in their lifetime.
Some medical conditions increase the risk of progression to TB disease. In HIV infected persons with TB infection, the risk increases to 10 percent each year instead of 10 percent over a lifetime. Other such conditions include drug injection (mainly because of the life style of IV Drug users), substance abuse, recent TB infection (within two years) or history of inadequately treated TB, chest X-ray suggestive of previous TB (fibrotic lesions and nodules), diabetes mellitus, silicosis, prolonged corticosteroid therapy and other immunosuppressive therapy, head and neck cancers, hematologic and reticuloendothelial diseases (leukemia and Hodgkin's disease), end-stage renal disease, intestinal bypass or gastrectomy, chronic malabsorption syndromes, or low body weight (10 percent or more below the ideal).
Some drugs, including rheumatoid arthritis drugs that work by blocking tumor necrosis factor-alpha (an inflammation-causing cytokine), raise the risk of causing a latent infection to become active due to the importance of this cytokine in the immune defense against TB.
TB disease most commonly affects the lungs (75 percent or more), where it is called pulmonary TB. Symptoms include a productive, prolonged cough of more than three weeks duration, chest pain, and hemoptysis. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, and easy fatigability. The term consumption arose because sufferers appeared as if they were "consumed" from within by the disease. People from Asian and African descent may have more often lymph node TB than Caucasians.
Extrapulmonary sites include the pleura, central nervous system (meningitis), lymphatic system (scrofula of the neck), genitourinary system, and bones and joints (Pott's disease of the spine). An especially serious form is "disseminated", or "miliary" TB, so named because the lung lesions so-formed resemble millet seeds on x-ray. These are more common in immunosuppressed persons and in young children. Pulmonary TB may co-exist with extrapulmonary TB.

Drug resistance
Drug-resistant TB is transmitted in the same way as drug-susceptible TB. Primary resistance develops in persons initially infected with resistant organisms. Secondary resistance (acquired resistance) may develop during TB therapy due to inadequate treatment regimen, not taking

Diagnosis
A complete medical evaluation for TB includes a medical history, a physical examination, a tuberculin skin test, a serological test, a chest X-ray, and microbiologic smears and cultures. The measurement of a positive skin test depends upon the person's risk factors for progression of TB infection to TB disease.
See: tuberculosis diagnosis, tuberculosis radiology

Treatment
Persons with TB infection (class 2 or class 4 TB), but who do not have TB disease (class 3 or class 5 TB), cannot spread the infection to other people. TB infection in a person who does not have TB disease is not considered a case of TB and is often referred to as latent TB infection (LTBI). This distinction is important because treatment options will be different for a person who has LTBI instead of active TB disease.
See: tuberculosis treatment

Prevention
Prevention and control efforts include three priority strategies:
identifying and treating all persons who have TB disease
finding and evaluating persons who have been in contact with TB patients to determine whether they have TB infection or disease, and treating them appropriately, and
testing high-risk groups for TB infection to identify candidates for treatment of latent infection and to ensure the completion of treatment.
In tropical areas where the incidence of atypical mycobacteria is high, exposure to nontuberculous mycobacteria gives some protection against TB.

BCG vaccine
Many countries use BCG vaccine as part of their TB control programs, especially for infants. The protective efficacy of BCG for preventing serious forms of TB (e.g. meningitis) in children is high (greater than 80 percent). However, the protective efficacy for preventing pulmonary TB in adolescents and adults is variable, from 0 to 80 percent. In the United Kingdom, children aged 10-14 were typically immunized during school until 2005. (Routine BCG vaccination was stopped as it was no longer cost-effective. The incidence of TB in people born in the UK, and with parents and grandparents who were born in the UK, was at an all time low, and falling. Others continue to be offered BCG vaccination.)
The effectiveness of BCG is much lower than in areas where mycobacteria are much less prevalent. In the USA, BCG vaccine is not routinely recommended except for selected persons who meet specific criteria:
Infants or children with negative skin-test result who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to multidrug-resistant TB.
Healthcare workers considered on individual basis in settings in which high percentage of MDR-TB patients has been found, transmission of MDR-TB is likely, and TB control precautions have been implemented and not successful.

Tuberculosis vaccine
The first recombinant tuberculosis vaccine entered clinical trials in the United States in 2004 sponsored by the National Institute of Allergy and Infectious Diseases (NIAID). [1]
A 2005 study showed that a DNA TB vaccine given with conventional chemotherapy can accelerate the disappearance of bacteria as well as protecting against re-infection in mice; it may take four to five years to be available in humans. PMID 15690060.
Because of the limitations of current vaccines, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and advance market commitments.

Animals
Tuberculosis can be carried by many mammals. Domesticated species, such as cats and dogs, are generally free of tuberculosis, but wild animals may be carriers. As a result, many places have regulations restricting the ownership of novelty pets, possibly including such partially domesticated species as pet skunks; for example, the American state of California forbids the ownership of pet gerbils. The strictness of such restrictions generally depends on the public health policies adopted for fighting tuberculosis.
An effort to eradicate bovine tuberculosis from the cattle and deer herds of New Zealand is underway. It has been found that herd infection is more likely in areas where infected vector species such as Australian brush-tailed possums come into contact with domestic livestock at farm/bush borders. Controlling the vectors through possum eradication and monitoring the level of disease in livestock herds through regular surveillance are seen as a "two-pronged" approach to ridding New Zealand of the disease.
In both the Republic of Ireland and Northern Ireland, badgers have been identified as a vector species for the transmission of bovine tuberculosis. As a result, the government in both regions has mounted an active campaign of eradication of the species in an effort to reduce the incidence of the disease. Badgers have been culled primarily by snaring and gassing. It remains a contentious issue, with proponents and opponents of the scheme citing their own studies to support their position.

Pain Pain Go Away

Ovulation pain

Ovulation is a phase of the female menstrual cycle, which involves the release of an egg (ovum) from one of the ovaries. For most women, ovulation occurs about once every month until menopause, apart from episodes of pregnancy and breastfeeding. About one in five women experience pain and discomfort during ovulation. The duration of the pain varies from one woman to the next, but ranges from a few minutes to 48 hours. In most cases, ovulation pain doesn't mean that anything is wrong. However, severe pain may sometimes be symptomatic of gynaecological conditions including endometriosis. See your doctor if your ovulation pain lasts longer than three days or is associated with other unusual menstrual symptoms, such as heavy bleeding. Ovulation pain is also known as mid-cycle pain and mittelschmerz (German for 'middle pain').

Symptoms
The symptoms of ovulation pain can include:
Pain in the lower abdomen, just inside the hip bone.
The pain typically occurs about two weeks before the menstrual period is due.
The pain is felt on the right or left side, depending on which ovary is releasing an egg.
The pain may switch from one side to the other from one cycle to the next, or remain on one side for a few cycles.
The pain sensation varies between individuals - for example, it could feel like uncomfortable pressure, twinges, sharp pains or cramps.
The duration of pain ranges anywhere from minutes to 48 hours.

Theories on possible causes
The exact cause of ovulation pain is not clear, but theories include:

• Emerging follicle - hormones prompt the ovaries to produce around 20 follicles. Each follicle contains an immature egg (ovum) but only one follicle usually survives to maturity. It is supposed that ovulation pain is caused by the expanding follicle stretching the membrane of the ovary.
• Ruptured follicle - when the egg is mature, it bursts from the follicle. This may cause slight bleeding. The peritoneum (abdominal lining) could be irritated by the blood or fluids from the ruptured follicle, and this may trigger the pain.

Underlying medical problems

In most cases, ovulation pain is harmless. However, severe and prolonged ovulation pain, or other pains felt in the lower abdomen, can be symptomatic of various medical conditions including:

• Salpingitis - inflammation of the fallopian tubes following an infection.
• Chronic pelvic inflammatory disease - inflammation following an infection.
• Endometriosis - the lining of the womb (endometrium) grows in other locations, such as the bowel. Other symptoms include painful periods and painful sex.
• Ovarian cyst - an abnormal pocket of fluid that develops on the ovary.
• Ectopic pregnancy - a pregnancy that develops outside of the womb, most commonly in one of the fallopian tubes. Symptoms include cramping, abdominal pain and vaginal bleeding. Seek urgent medical help.
• Appendicitis - inflammation of the appendix can sometimes be confused with ovulation pain. Seek urgent medical help if the pain is on the right side of your abdomen and you are experiencing nausea and vomiting.
• Other gastrointestinal problems - lower abdominal pain can be symptomatic of a range of gastrointestinal problems, including perforated ulcer, gastroenteritis and inflammatory bowel disease.

Diagnosis methods

Tests that help determine whether ovulation pain is harmless or caused by infection or disease may include:
Medical history
Physical examination, including an internal pelvic examination
Blood tests
Cervical cultures
Abdominal ultrasound
Vaginal ultrasound
Exploratory surgery (laparoscopy or 'keyhole' surgery).Taking care of yourselfConsult with your doctor to make sure that your ovulation pain isn't caused by any underlying medical problem.

Suggestions on taking care of benign ovulation pain yourself include:
Relax. If the pain is particularly bothersome, rest in bed whenever you can.
Use pain-killing medication.
Warmth on the lower abdomen may help. Use heat packs, hot water bottles or warm baths.
Take anti-inflammatory drugs. See your doctor or pharmacist for recommendations.
The Pill and other forms of hormonal contraceptive can prevent ovulation pain because they stop ovulation. Talk over this option with your doctor.

See your doctor if you experience ovulation pain that lasts longer than three days, or if you have other symptoms such as heavy bleeding or discharge.

Family planning

Chances of conception are high if a couple have sex in the days before, during and after ovulation. Some women rely on ovulation pain to help them plan a pregnancy. However, it is unwise to rely on ovulation pain alone if you're trying to avoid pregnancy. Always use other methods of birth control.

Where to get help
Your doctor
Gynaecologist
Women's health clinic
Family Planning Victoria Tel. (03) 9257 0100
Women's Health Victoria Tel. (03) 9662 3755
Women's Health Information Centre Information line Tel. (03) 9344 2007, TTY (03) 9344 2849, Country callers Tel. 1800 442 007

Things to remember
About one in five women experience pain during ovulation that can last from a few minutes to 48 hours.
Ovulation pain is usually harmless, but can sometimes indicate various medical conditions such as endometriosis.
See your doctor if your ovulation pain lasts longer than three days or is associated with other unusual menstrual symptoms, such as heavy bleeding.

Ringworm -- pag nahawa talaga ako uupakan kita...

What you don't know wont hurt you...>>This is so wrong! Especially with individuals who know little or nothing...

Ringworm

Ringworm is a contagious fungus infection that can affect the scalp, the body, the feet (athlete's foot), or the nails.
People can get Ringworm from:
1) direct skin-to-skin contact with an infected person or pet,
2) indirect contact with an object or surface that an infected person or pet has touched, or
3) rarely, by contact with soil.

Ringworm can be treated with fungus-killing medicine.
To prevent Ringworm,
1) make sure all infected persons and pets get appropriate treatment,
2) avoid contact with infected persons and pets,
3) do not share personal items, and 4) keep common-use areas clean.

What is Ringworm?
Ringworm is a contagious fungus infection that can affect the scalp, the body (particularly the groin), the feet, and the nails. Despite its name, it has nothing to do with worms. The name comes from the characteristic red ring that can appear on an infected person's skin. Ringworm is also called Tinea.

What is the infectious agent that causes Ringworm?
Ringworm is caused by several different fungus organisms that all belong to a group called "Dermatophytes." Different Dermatophytes affect different parts of the body and cause the various types of Ringworm:
Ringworm of the scalp
Ringworm of the body
Ringworm of the foot (athlete's foot)
Ringworm of the nails

Where is Ringworm found?
Ringworm is widespread around the world and in the United States. The fungus that causes scalp Ringworm lives in humans and animals. The fungus that causes Ringworm of the body lives in humans, animals, and soil. The fungi that cause Ringworm of the foot and Ringworm of the nails live only in humans.

How do people get Ringworm?
Ringworm is spread by either direct or indirect contact. People can get Ringworm by direct skin-to-skin contact with an infected person or pet. People can also get Ringworm indirectly by contact with objects or surfaces that an infected person or pet has touched, such as hats, combs, brushes, bed linens, stuffed animals, telephones, gym mats, and shower stalls. In rare cases Ringworm can be spread by contact with soil.

What are the signs and symptoms of Ringworm?
Ringworm of the scalp usually begins as a small pimple that becomes larger, leaving scaly patches of temporary baldness. Infected hairs become brittle and break off easily. Yellowish crusty areas sometimes develop.
Ringworm of the body shows up as a flat, round patch anywhere on the skin except for the scalp and feet. The groin is a common area of infection (groin Ringworm). As the rash gradually expands, its center clears to produce a ring. More than one patch might appear, and the patches can overlap. The area is sometimes itchy.
Ringworm of the foot is also called athlete's foot. It appears as a scaling or cracking of the skin, especially between the toes.
Ringworm of the nails causes the affected nails to become thicker, discolored, and brittle, or to become chalky and disintegrate.

How soon after exposure do symptoms appear?
Scalp Ringworm usually appears 10 to 14 days after contact, and Ringworm of the skin 4 to 10 days after contact. The time between exposure and symptoms isnot known for the other types of Ringworm.

How is Ringworm diagnosed?
A health-care provider can diagnose Ringworm by examining the site of infection with special tests.

Who is at risk for Ringworm?
Anyone can get Ringworm. Scalp Ringworm often strikes young children; outbreaks have been recognized in schools, day-care centers, and infant nurseries. School athletes are at risk for scalp Ringworm, Ringworm of the body, and foot Ringworm; there have been outbreaks among high school wrestling teams. Children with young pets are at increased risk for Ringworm of the body.

What is the treatment for Ringworm?
Ringworm can be treated with fungus-killing medicine. The medicine can be in taken in tablet or liquid form by mouth or as a cream applied directly to the affected area.

What complications can result from Ringworm?
Lack of or inadequate treatment can result in an infection that will not clear up.

Is Ringworm an emerging infection?
Although Ringworm is not tracked by health authorities, infections appear to be increasing steadily, especially among pre-school and school-age children. Early recognition and treatment are needed to slow the spread of infection and to prevent re-infection.

How can Ringworm be prevented?
Ringworm is difficult to prevent. The fungus is very common, and it is contagious even before symptoms appear.
Steps to prevent infection include the following:
Educate the public, especially parents, about the risk of Ringworm from infected persons and pets.
Keep common-use areas clean, especially in schools, day-care centers, gyms, and locker rooms. Disinfect sleeping mats and gym mats after each use.
Do not share clothing, towels, hair brushes, or other personal items.

Infected persons should follow these steps to keep the infection from spreading:
Complete treatment as instructed, even after symptoms disappear.
Do not share towels, hats, clothing, or other personal items with others.
Minimize close contact with others until treated.
Make sure the person or animal that was the source of infection gets treated.

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have any questions about the disease described above or think that you might have a fungus infection, consult a health-care provider.

My Tummy hurts...

What is a peptic ulcer?
A peptic ulcer is a sore in the lining of your stomach or duodenum.

* The duodenum is the first part of your small intestine. If peptic ulcers are found in the stomach, they're called gastric ulcers. If they're found in the duodenum, they're called duodenal ulcers. You can have more than one ulcer.

Many people have peptic ulcers. Peptic ulcers can be treated successfully. Seeing your doctor is the first step.

Peptic ulcers occur in the wall of the stomach and duodenum.

What are the symptoms of peptic ulcers?
A burning pain in the gut is the most common symptom. The pain feels like a dull ache that comes and goes for a few days or weeks starts 2 to 3 hours after a meal comes in the middle of the night when your stomach is empty usually goes away after you eat

Other symptoms are:
losing weight
not feeling like eating
having pain while eating
feeling sick to your stomach
vomiting

Some people with peptic ulcers have mild symptoms. If you have any of these symptoms, you may have a peptic ulcer and should see your doctor.

What causes peptic ulcers?
Peptic ulcers are caused by bacteria called Helicobacter pylori, or H. pylori for short
nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen
other diseases

Nonsteroidal anti-inflammatory drugs can cause peptic ulcers.

Your body makes strong acids that digest food. A lining protects the inside of your stomach and duodenum from these acids. If the lining breaks down, the acids can damage the walls. Both H. pylori and NSAIDs weaken the lining so acid can reach the stomach or duodenal wall.
H. pylori causes almost two-thirds of all ulcers. Many people have H. pylori infections. But not everyone who has an infection will develop a peptic ulcer.

Most other ulcers are caused by NSAIDs. Only rarely do other diseases cause ulcers.

Do stress or spicy foods cause peptic ulcers?
No, neither stress nor spicy foods cause ulcers. But they can make ulcers worse. Drinking alcohol or smoking can make ulcers worse, too.

What increases my risk of getting peptic ulcers?
You're more likely to develop a peptic ulcer if you have an H. pylori infection, use NSAIDs often
smoke cigarettes, drink alcohol, have relatives who have peptic ulcers, are 50 years old or older
Having relatives with peptic ulcers puts you at risk of having them too.

Can peptic ulcers get worse?
Peptic ulcers will get worse if they aren't treated. Call your doctor right away if you have any of these symptoms:
sudden sharp pain that doesn't go away
black or bloody stools
bloody vomit or vomit that looks like coffee grounds
Call your doctor if the pain gets worse.

These could be signs that
the ulcer has gone through, or perforated, the stomach or duodenal wall
the ulcer has broken a blood vessel
the ulcer has stopped food from moving from the stomach into the duodenum

These symptoms must be treated quickly. You may need surgery.

How can I find out whether I have peptic ulcers?
If you have symptoms, see your doctor. Your doctor may
Peptic ulcers can show up on x rays.
take x rays of your stomach and duodenum, called an upper GI series. You'll drink a liquid called barium to make your stomach and duodenum show up clearly on the x rays.
use a thin lighted tube with a tiny camera on the end to look at the inside of your stomach and duodenum. This procedure is called an endoscopy. You'll take some medicine to relax you so your doctor can pass the thin tube through your mouth to your stomach and duodenum. Your doctor may also remove a tiny piece of your stomach to view under a microscope. This procedure is called a biopsy.

If you do have a peptic ulcer, your doctor may test your breath, blood, or tissue to see whether bacteria caused the ulcer.

How are peptic ulcers treated?
Peptic ulcers can be cured. Medicines for peptic ulcers are
proton pump inhibitors or histamine receptor blockers to stop your stomach from making acids
antibiotics to kill the bacteria

Depending on your symptoms, you may take one or more of these medicines for a few weeks. They'll stop the pain and help heal your stomach or duodenum.
Ulcers take time to heal. Take your medicines even if the pain goes away. If these medicines make you feel sick or dizzy, or cause diarrhea or headaches, your doctor can change your medicines.

If NSAIDs caused your peptic ulcer, you'll need to stop taking them. If you smoke, quit. Smoking slows healing of ulcers.

Can I use antacids?
Yes. If you have a peptic ulcer, taking antacids will stop the acids from working and reduce the pain, help ulcers heal

You can buy antacids at any grocery store or drugstore. But you must take them several times a day. Also, antacids don't kill the bacteria, so your ulcer could come back even if the pain goes away.

Can peptic ulcers come back?
Yes. If you stop taking your antibiotic too soon, not all the bacteria will be gone and not all the sores will be healed. If you still smoke or take NSAIDs, your ulcers may come back.[Top]
What happens if peptic ulcers don't heal? Will I need surgery?

In many cases, medicine heals ulcers. You may need surgery if your ulcers
don't heal keep coming back perforate, bleed, or obstruct the stomach orduodenum
Surgery can remove the ulcers reduce the amount of acid your stomach makes[Top]

What can I do to prevent peptic ulcers?
Stop using NSAIDs. Talk with your doctor about other pain relievers. [Top]
What can I do to lower my risk of getting peptic ulcers?
Don't smoke.
Don't drink alcohol.

Tummy...

Dysmenorrhea
Also found under: Menstrual Disorders

What is it?
The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Dysmenorrhea is the term used to describe painful menstrual periods. There are two types of dysmenorrhea. Primary dysmenorrhea has no underlying cause. Secondary dysmenorrhea is caused by an underlying gynecological disorder.

Who gets it?
Primary dysmenorrhea affects more than 50 percent of all women who have a menstrual period. Approximately 5 to 15 percent of these women have severe pain that interferes with daily activities. Only about one-fourth of all women with dysmenorrhea have secondary dysmenorrhea, meaning there is an underlying cause of their symptoms. Dysmenorrhea usually begins during adolescence.

What causes it?
To understand dysmenorrhea, it's important to understand how the menstrual cycle works. Each month, the lining of the uterus, the endometrium, thickens to prepare for the egg that is released by the fallopian tubes. If the woman does not become pregnant during that cycle, then most of the endometrium is shed and bleeding occurs. The blood flows from the uterus, through the cervical canal, and out through the vagina. Primary dysmenorrhea occurs when the uterus contracts because the blood supply to the endometrium is reduced. This pain occurs only during a menstrual cycle where an egg is released. If the cervical canal is narrow, the pain may be worse as the endometrial tissue passes through the cervix. Pain can also be caused by a uterus that tilts backward instead of forward, low levels of physical activity, and emotional stress. Secondary dysmenorrhea can be caused by the growth of uterine tissue outside the uterus, called endometriosis; non-cancerous growths of muscle and fibrous tissue in the uterus, called fibroid tumors; the non-cancerous growth of the uterine lining in the muscular wall of the uterus, called adenomyosis; inflammation of the fallopian tubes; and the growth of scar tissue, or adhesions, between organs.

What are the symptoms?
Shortly before or in the beginning of the menstrual period, a woman with dysmenorrhea experiences cramps in the lower abdomen. The pain can be continuous, or may come and go, and may extend to the lower back and legs. The pain can be accompanied by headache, nausea, diarrhea or constipation, and the need to urinate frequently. In severe cases, dysmennorhea also causes vomiting and makes it difficult for the woman to participate in her normal activities. Symptoms are usually at their worst 24 hours after beginning, and stop after 2 days. Women with dysmenorrhea are more likely to pass blood clots from the lining of the uterus, which causes more pain.

How is it diagnosed?
To diagnose dysmenorrhea, your doctor will take a complete medical history and will perform a physical examination, including a pelvic, or internal, exam. This doctor would most likely be your gynecologist, a doctor who specializes in women's reproductive health. He or she will ask questions about your lifestyle, diet, sexual activity, and any medications you are taking. Fibroid tumors can usually be felt during a pelvic exam, but may need to be confirmed by an ultrasound scan of the abdomen. To make sure any growths are non-cancerous, your doctor may look inside the uterus using a hysteroscope, a small tube with a light that is inserted through the vagina and cervix and into the uterus. He or she may also look for abnormalities in the uterine tissue by removing a tiny sample of tissue from the inside of the uterus, called a biopsy, for examination under a microscope. Endometriosis is usually diagnosed through a combination of biopsy and laparoscopy. With laparoscopy, the doctor makes a small cut in the navel through which he or she inserts a small instrument called a laparoscope. With the laparoscope, the doctor can examine the uterus and other female organs, such as the fallopian tubes, in the pelvic area.

What is the treatment?
The treatment of dysmenorrhea depends on the cause of the problem. In most cases, symptoms are relieved by nonprescription anti-inflammatory drugs such as ibuprofren, naproxen, and mefanamic acid. If you know you have a history of dysmenorrhea, your doctor may recommend taking these medications up to two days before your menstrual period begins, and continuing them for one to two days after it begins. It's important to continue to get plenty of rest, follow a good diet, and exercise during your period. Women with primary dysmenorrhea that is so severe it interferes with daily activities may benefit from a low-dose birth control pill. Because birth control pills prevent an egg from being released each month, the menstrual period is generally lighter and lasts for a shorter time. Secondary dysmenorrhea is relieved by treating the cause. For example, fibroid tumors can be shrunk with hormone therapy, or may be surgically removed. Where fibroids are extremely large or cause severe pain, the entire uterus may need to be surgically removed. This procedure is called a hysterectomy, and is also used to treat severe endometriosis. A woman who has had a hysterectomy can no longer conceive a child. Inflammation of the fallopian tubes is treated with antibiotics.

Self-care tips
See your doctor if you have a pattern of severe pain at the beginning of and during your menstrual period. A thorough exam will help determine if your pain is caused by some underlying condition that may need immediate treatment. Remember, rest, diet, and exercise play an important role in your overall health, and may help relieve premenstrual and menstrual symptoms.

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

**http://www.hmc.psu.edu/healthinfo/d/dysmenorrhea.htm