Endometriosis

Endometriosis

Definition:

Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium
— grows outside your uterus.

Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.

In endometriosis, displaced endometrial tissue continues to act as it normally would: It thickens, breaks down and bleeds with each menstrual cycle. And because this displaced tissue has no way to exit your body, it becomes trapped. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions
— abnormal tissue that binds organs together.

This process can cause pain
— sometimes severe
— especially during your period.

Fertility problems also may develop. Fortunately, effective treatments are available.

Symptoms:

The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that's far worse than usual. They also tend to report that the pain has increased over time.

Common signs and symptoms of endometriosis may include:

• Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period and may include lower back and abdominal pain.
• Pain with intercourse. Pain during or after sex is common with endometriosis.
• Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
• Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
• Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
• Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little pain or even no pain at all.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

When to see a doctor
See your doctor if you have signs and symptoms that may indicate endometriosis. The cause of chronic or severe pelvic pain may be difficult to pinpoint. But discovering the problem early may help you avoid unnecessary complications and pain.


Causes:

A process called retrograde menstruation is a likely explanation for endometriosis. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of the menstrual cycle.

Retrograde menstruation alone may not cause endometriosis, though. Instead, the condition may develop when one or more small areas of the abdominal lining turns into endometrial tissue. This is possible because the cells lining the abdominal and pelvic cavities are descended from embryonic cells with the potential to specialize and take on the structure and function of endometrial cells. What activates that potential remains unknown.


Complications:

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women who have endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting, but the condition also seems to affect fertility in less-direct ways.

Even so, many women with mild to moderate endometriosis are still able to conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time. The longer you have endometriosis, the greater your chance of becoming infertile.



Treatments and drugs:

Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.
Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.

Pain medications
Your doctor may recommend that you take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin, others), to help ease painful menstrual cramps. However, if you find that taking the maximum dose doesn't provide full relief, you may need to try another treatment approach to manage your signs and symptoms.

Hormone therapy
Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. That's because the rise and fall of hormones during a woman's menstrual cycle causes endometrial implants to thicken, break down and bleed.
Hormonal therapies used to treat endometriosis include:

• Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — can reduce or eliminate the pain of mild to moderate endometriosis.
  
• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones. This action prevents menstruation and dramatically lowers estrogen levels, causing endometrial implants to shrink. Gn-RH agonists and antagonists can force endometriosis into remission during the time of treatment and sometimes for months or years afterward. These drugs create an artificial menopause that can sometimes lead to troublesome side effects, such as hot flashes and vaginal dryness. Taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease such side effects. If Gn-RH agonists don't relieve your pain, it's unlikely that endometriosis is responsible for your symptoms.
  
• Danazol. Another drug that blocks the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis, is danazol. In addition, it suppresses the growth of the endometrium. However, danazol may not be the first choice because it can cause unwanted side effects, such as acne and facial hair.
  
• Medroxyprogesterone (Depo-Provera). This injectable drug is effective in halting menstruation and the growth of endometrial implants, thereby relieving the signs and symptoms of endometriosis. Its side effects can include weight gain, decreased bone production and depressed mood.
  
• Aromatase inhibitors. Although not specifically approved for the treatment of endometriosis, studies suggest that aromatase inhibitors may significantly reduce endometriosis-related pain. Aromatase inhibitors work by blocking the conversion of hormones such as androstenedione and testosterone into estrogen and by blocking the production of estrogen from endometrial implants themselves. This deprives endometriosis of the estrogen it needs to grow. To reduce the risk of side effects, such as bone loss and follicular cysts, aromatase inhibitors must be taken in combination with a Gn-RH agonist or an oral estrogen-progestin contraceptive.

Hormonal therapies aren't a permanent fix for endometriosis. It's possible that you could experience a recurrence of your symptoms after stopping treatment.

Conservative surgery
If you have endometriosis and are trying to become pregnant, surgery to remove endometrial implants may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery.

Conservative surgery removes endometrial growths, scar tissue and adhesions without removing your reproductive organs. Your doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases. In laparoscopic surgery, a slender viewing instrument (laparoscope) is inserted through a small incision near your navel. Guided by the laparoscope, your doctor inserts other instruments through another small incision to remove endometrial implants. Such instruments might include a laser, small surgical instruments or a cautery — an instrument that destroys tissue with heat.

Assisted reproductive technologies to help you become pregnant are sometimes preferable to conservative surgery, and doctors often suggest these approaches if conservative surgery is ineffective.

Hysterectomy
In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. Hysterectomy alone is not effective — the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. Surgery is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy.

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Endocarditis

Endocarditis


Definition:

Endocarditis is an infection of the inner lining of your heart (endocardium).

Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Left untreated, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in severe cases, surgery.

Endocarditis is uncommon in people with healthy hearts. People at greatest risk of endocarditis have a damaged heart valve, an artificial heart valve or other heart defects.

Symptoms:


Endocarditis may develop slowly or suddenly — depending on what's causing the infection and whether you have any underlying heart problems. The infection can infect different people differently, so signs and symptoms vary. They may include:

• Fever
• Chills
• A new or changed heart murmur — abnormal heart sounds made by blood rushing through your heart
• Fatigue
• Aching joints and muscles
• Night sweats
• Shortness of breath
• Paleness
• Persistent cough
• Swelling in your feet, legs or abdomen
• Unexplained weight loss
• Blood in your urine (either visible or found in a doctor's viewing of your urine under a microscope)
• Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage
• Osler's nodes — red, tender spots under the skin of your fingers
• Petechiae (puh-TEE-key-e) — tiny purple or red spots on the skin, whites of your eyes or inside your mouth

When to see a doctor
If you develop signs or symptoms of endocarditis, see your doctor right away — especially if you have risk factors for this serious infection, such as a heart defect or a previous case of endocarditis.
Although less serious conditions can cause similar signs and symptoms, you won't know for sure until you're evaluated.

Causes:

Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Bacteria cause most cases, but fungi or other microorganisms also may be responsible.
Sometimes the culprit is one of many common bacteria that live in your mouth, throat or other parts of your body. The offending organism may enter your bloodstream through:

• Everyday oral activities. Activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream — especially if your teeth and gums are in poor condition.
  
• An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted disease or an intestinal disorder — such as inflammatory bowel disease — also may give bacteria the opportunity to enter your bloodstream.
  
• Catheters or needles. Bacteria can enter your body through a catheter — a thin tube that doctors sometimes use to inject or remove fluid from the body. The bacteria that can cause endocarditis can also enter your bloodstream through the needles used for tattooing or body piercing. Contaminated needles and syringes are a concern for people who use intravenous (IV) drugs.
  
• Certain dental procedures. Some dental procedures that can cut your gums may allow bacteria to enter your bloodstream.

Typically, your immune system destroys bacteria that make it into your bloodstream. Even if bacteria reach your heart, they may pass through without causing an infection.
Most people who develop endocarditis have a diseased or damaged heart valve — an ideal spot for bacteria to settle. This damaged tissue in the endocardium provides bacteria with the roughened surface they need to attach and multiply.


Complications:


Endocarditis can cause several major complications:

• Stroke and organ damage. In endocarditis, clumps of bacteria and cell fragments (vegetations) form in your heart at the site of the infection. These clumps can break loose and travel to your brain, lungs, abdominal organs, kidneys or extremities. This may cause various problems, including stroke or damage to other organs or tissues.
  
• Infections in other parts of your body. Endocarditis can cause you to develop pockets of collected pus (abscesses) in other parts of your body, including the brain, kidneys, spleen or liver. An abscess may develop in the heart muscle itself as well, causing an abnormal heartbeat. Severe abscesses may require surgery to treat them.
  
• Heart failure. Left untreated, endocarditis can damage your heart valves and permanently destroy your heart's inner lining. This can cause your heart to work harder to pump blood, eventually causing heart failure — a chronic condition in which your heart is unable to pump enough blood to meet your body's needs. If the infection progresses untreated, it's usually fatal.

Treatments and drugs:


The first line of treatment for endocarditis is antibiotics. Sometimes, if your heart valve is damaged by your infection, surgery is necessary.

Antibiotics
If you have endocarditis, you may need high doses of intravenous (IV) antibiotics in the hospital. Blood tests may help identify the type of microorganism that's infecting your heart. This information will help your doctor choose the best antibiotic or combination of antibiotics to fight the infection.

You will usually need to take antibiotics for four to six weeks or longer to clear up the infection. Once your fever and the worst of your signs and symptoms have passed, you may be able to leave the hospital and continue IV antibiotic therapy with visits to your doctor's office or at home with home-based care. You'll need to see your doctor regularly to make sure your treatment is working.
Report to your doctor any signs or symptoms that your infection is getting worse, such as:

• Fever
• Chills
• Headaches
• Joint pain
• Shortness of breath

Diarrhea, a rash, itching or joint pain may indicate a reaction to an antibiotic — another reason to call your doctor.
See your doctor immediately if you experience shortness of breath or swelling in your legs, ankles or feet. These signs and symptoms may indicate heart failure.

Surgery
If the infection damages your heart valves, you may have symptoms and complications for years after treatment. Sometimes surgery is needed to treat persistent infections or to replace a damaged valve. Surgery is also sometimes needed to treat endocarditis that's caused by a fungal infection.
Depending on your condition, your doctor may recommend either repairing your damaged valve or replacing it with an artificial valve made of animal tissue or man-made materials.

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Encopresis

Encopresis

Definition:

Encopresis occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool and out of the anus, staining your child's underwear. Encopresis may also be called stool holding.

Encopresis usually occurs after age 4, when your child has already learned to use a toilet. In most cases, encopresis is a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues.

Encopresis can be frustrating for you — and embarrassing for your child. However, with patience and positive reinforcement, treatment for encopresis is usually successful.

Symptoms:

Signs and symptoms of encopresis may include:

• Leakage of stool or liquid stool on your child's underwear. If the amount of leakage is large, you may misinterpret it as diarrhea.
• Constipation with dry, hard stool.
• Passage of large stool that clogs or almost clogs the toilet.
• Avoidance of bowel movements.
• Long periods of time between bowel movements, possibly as long as a week.
• Lack of appetite.
• Abdominal pain.
• Repeated urinary tract infections.

When to see a doctor
Call your doctor if your child, who is older than age 4 and already toilet trained, begins exhibiting one or more of the symptoms listed above.

Causes:

There are several causes of encopresis. The most common are:

• Constipation. Most cases of encopresis are the result of chronic constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet — making the problem worse. The longer the stool remains in the colon, the more difficult it is for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out.
  
  Common causes of constipation include eating too little fiber, not drinking enough fluids or consuming an excess of dairy products. Sometimes, a child with a cow's milk intolerance may experience constipation, although milk intolerance causes diarrhea more often than constipation.
  
  
• Emotional issues. Emotional stress also may trigger encopresis. A child may experience stress from premature toilet training or an important life change — for instance, the divorce of a parent or the birth of a sibling.

Complications:

 A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or chastised by adults, he or she may feel depressed or have low self-esteem.

Early treatment, including spending time with a mental health professional, can help prevent the social and emotional impact of encopresis.

Treatments and drugs:

Generally, the earlier treatment begins for encopresis, the better. The first step in treatment focuses on clearing the colon of retained, impacted stool. After that, treatment includes encouraging healthy bowel movements. This includes training your child to go to the toilet as soon as reasonably able when the urge to defecate occurs.
There are several methods for clearing the colon and relieving constipation. Your child's doctor will likely recommend one or more of the following:

• Stool softeners, such as lactulose
• Colon lubricants, such as mineral oil
• Rectal suppositories
• Enemas
• More oral fluids

Your child's doctor may recommend abdominal X-rays to check the progress of the colon clearing.
Once the colon has been cleared, it's important to encourage your child to have regular bowel movements. In addition to recommending self-care measures such as a high-fiber diet, your child's doctor may recommend the use of stool softeners for six months or more.

Psychotherapy
If your child feels shame, guilt, depression or low self-esteem related to encopresis, psychotherapy can be helpful. A psychologist can help your child deal with these feelings and may also give you techniques for teaching your child not to hold stool. Ask your child's doctor for a recommendation.

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Erectile dysfunction

Erectile dysfunction

Definition:

Erectile dysfunction (impotence) occurs when a man can no longer get or keep an erection firm enough for sexual intercourse. Having erection trouble from time to time isn't necessarily a cause for concern. But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect your self-confidence.

Even though it may seem awkward to talk with your doctor about erectile dysfunction, go in for an evaluation. Problems getting or keeping an erection can be a sign of a health condition that needs treatment, such as heart disease or poorly controlled diabetes. Treating an underlying problem may be enough to reverse your erectile dysfunction.

If treating an underlying condition doesn't help your erectile dysfunction, medications or other direct treatments may work.

Causes:

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health problems can cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues causes erectile dysfunction.

For instance, a minor physical problem that slows your sexual response may cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction
In most cases, erectile dysfunction is caused by something physical. Common causes include:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Metabolic syndrome, a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• Parkinson's disease
• Multiple sclerosis
• Low testosterone
• Peyronie's disease, development of scar tissue inside the penis
• Certain prescription medications
• Tobacco use
• Alcoholism and other forms of substance abuse
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

• Depression, anxiety or other mental health conditions
• Stress
• Relationship problems due to stress, poor communication or other concerns

 Symptoms:

Erectile dysfunction symptoms may include persistent:

• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire

When to see a doctor
A family doctor is a good place to start when you have erectile problems. See your doctor if:

• Erectile or other sexual problems are an issue for you or your partner
• You have diabetes, heart disease or another known health problem that may be linked to erectile dysfunction
• You have other symptoms along with erectile dysfunction that may not seem related

Complications:

Complications resulting from erectile dysfunction can include:

• An unsatisfactory sex life
• Stress or anxiety
• Embarrassment or low self-esteem
• Marital or relationship problems
• The inability to get your partner pregnan

Treatments and drugs:

The first thing your doctor will do is to make sure you're getting the right treatment for any health problems that could be causing or worsening your erectile dysfunction.

A variety of options exist for treating erectile dysfunction. The cause and severity of your condition, and underlying health problems, are important factors in your doctor's recommending the best treatment or treatments for you. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also may play a role in treatment choices.

Oral medications
Oral medications are a successful erectile dysfunction treatment for many men. They include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)

All three medications work in much the same way. These drugs enhance the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation. These medications vary in dosage, how long they work and their side effects. Your doctor will take into account your particular situation to determine which medication may work best.

Possible side effects include flushing, nasal congestion, headache, visual changes and stomach upset.
These medications may not fix your erectile dysfunction immediately. You may need to work with your doctor to find the right medication and dose for you.

Before taking any prescription erectile dysfunction medication (including over-the-counter supplements or herbal remedies), get your doctor's OK. Although these medications can help many people, not all men should take them to treat erectile dysfunction. These medications may not work or may be dangerous for you if you:

• Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Bid, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Imdur, Monoket) and isosorbide dinitrate (Dilatrate, Isordil)
• Take a blood-thinning (anticoagulant) medication, alpha blockers for enlarged prostate (benign prostatic hyperplasia) or high blood pressure medications
• Have heart disease or heart failure
• Have had a stroke
• Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
• Have uncontrolled diabetes

Other medications
Other medications for erectile dysfunction include:

• Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Each injection generally produces an erection that lasts about an hour. Because the needle used is very fine, pain from the injection site is usually minor. Side effects can include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site.
  
• Alprostadil penis suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra. The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra, and formation of fibrous tissue inside your penis.
  
• Testosterone replacement. Some men have erectile dysfunction caused by low levels of the hormone testosterone, and may need testosterone replacement therapy.

Penis pumps, surgery and implants
Medications may not work or may not be a good choice for you. If this is the case, your doctor may recommend a different treatment. Other treatments include:

• Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation may not be as forceful. If a penis pump is a good treatment choice for you, your doctor may recommend or prescribe a specific model. That way you can be sure it suits your needs and that it's made by a reputable manufacturer. Penis pumps available in magazines and sex ads may not be safe or effective.
  
• Penile implants. This treatment involves surgically placing devices into the two sides of the penis. These implants consist of either inflatable or semirigid rods. The inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep the penis firm but bendable. This treatment is usually not recommended until other methods have been tried first. As with any surgery, there is a risk of complications such as infection.
  
• Blood vessel surgery. In rare cases, leaking or obstructed blood vessels can cause erectile dysfunction and surgery is necessary to repair them.

Psychological counseling
If your erectile dysfunction is caused by stress, anxiety or depression, your doctor may suggest that you, or you and your partner, visit a psychologist or counselor. Even if it is caused by something physical, erectile dysfunction can create stress and relationship tension.

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Encephalitis

Encephalitis

Definition:

Encephalitis (en-sef-uh-LI-tis) is inflammation of the brain. Viral infections are the most common cause of the condition.

Encephalitis can cause flu-like symptoms, such as a fever or severe headache, as well as confused thinking, seizures, or problems with senses or movement. Many cases of encephalitis may go unnoticed because they result in only mild flu-like symptoms or even no symptoms. Severe cases of encephalitis, while relatively rare, can be life-threatening.

Because the course of any single case of encephalitis is relatively unpredictable, it's important to get a timely diagnosis and treatment.

Symptoms:

Most people with viral encephalitis have either no symptoms or mild flu-like symptoms, such as the following:

• Headache
• Fever
• Aches in muscles or joints
• Fatigue or weakness

More-serious cases require prompt medical care. Signs and symptoms may include the following:

• Severe headache
• Fever
• Altered consciousness
• Confusion or agitation
• Personality changes
• Seizures
• Loss of sensation or paralysis in certain areas of the body
• Muscle weakness
• Hallucinations
• Double vision
• Perception of foul smells
• Problems with speech or hearing
• Loss of consciousness

Signs and symptoms in infants and young children may also include:

• Bulging in the soft spots (fontanels) of the skull in infants
• Nausea and vomiting
• Body stiffness
• Constant, inconsolable crying
• Crying that worsens when the child is picked up
• Poor feeding

When to see a doctor
Get immediate care if you or someone you know is experiencing any of the symptoms associated with more-severe cases of encephalitis. Severe headache, fever and altered consciousness — almost always present with encephalitis in older children and adults — require urgent care.
Infants and young children with any signs or symptoms of encephalitis should receive urgent care.

Causes:

The cause of encephalitis is often unknown, but the most commonly diagnosed cause is a viral infection. Known causes of encephalitis may include:

• Viruses
• Bacteria
• Fungi
• Parasites

An infection may result in one of two conditions affecting the brain:

• Primary encephalitis occurs when a virus or other infectious agent directly infects the brain. The infection may be concentrated in one area or widespread. A primary infection may be a reactivation of a virus that had been inactive (latent) after a previous illness.
  
• Secondary (post-infectious) encephalitis is a faulty immune system reaction in response to an infection elsewhere in the body. This likely occurs when disease-fighting proteins enlisted to fight an infection mistakenly attack molecules in the brain. Secondary encephalitis often occurs two to three weeks after the initial infection. Rarely, secondary encephalitis occurs as a complication of vaccination against a viral infection.

Common viral causes
Common causes of encephalitis include:

• Herpes simplex virus. There are two types of herpes simplex virus (HSV). HSV type 1 (HSV-1) more commonly causes cold sores or fever blisters around your mouth, and HSV type 2 (HSV-2) more commonly causes genital herpes. While HSV-1 encephalitis is rare, it has the potential to cause significant brain damage or death.
  
• Other herpes viruses. Other herpes viruses that may cause encephalitis include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.
  
• Enteroviruses. These viruses include the poliovirus and the coxsackievirus, which usually causes an illness with flu-like symptoms, eye inflammation and abdominal pain.
  
• Mosquito-borne viruses. Arboviruses, or arthropod-borne viruses, are transmitted by mosquitoes or other blood-sucking insects. Mosquito-borne viruses can cause infections that include West Nile, La Crosse, St. Louis, western equine and eastern equine encephalitis. Mosquitoes transfer the virus from a nonhuman host — such as a bird, chipmunk or horse — to humans. Symptoms of an infection may appear within a few days to a couple of weeks after exposure to an arbovirus.
  
• Tick-borne viruses. In the United States, the only known tick-transmitted virus that causes encephalitis is Powassan virus. Symptoms usually appear about a week after exposure to the virus.
  
• Rabies virus. Infection with the rabies virus, which is usually transmitted by a bite from an infected animal, causes a rapid progression to encephalitis once symptoms begin. The disease causes death if the infection isn't treated before it reaches the spinal cord and brain.
  
• Childhood infections. Common childhood infections — such as measles (rubeola), mumps, and German measles (rubella) — used to be fairly common causes of secondary encephalitis. These causes are now rare because of the availability of vaccinations for these diseases

Complications:

The complications resulting from encephalitis depend on several factors, including age, the cause of the infection, the severity of the initial illness and the time from disease onset to treatment.
In most cases, people with relatively mild illness recover within a few weeks with no long-term complications.

Complications of severe illness
Injury to the brain from inflammation can result in a number of problems. The most severe cases can result in:

• Respiratory arrest
• Coma
• Death

Other complications — varying greatly in severity — may persist for many months or be permanent:

• Fatigue
• Weakness
• Mood disorders
• Personality changes
• Memory problems
• Intellectual disabilities
• Lack of muscle coordination
• Paralysis
• Hearing or vision defects
• Speech impairments

Treatments and drugs:

Treatment for mild cases mainly consists of:

• Bed rest
• Plenty of fluids
• Anti-inflammatory drugs — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — to relieve headaches and fever.

Antiviral drugs
More-serious cases of encephalitis usually require aggressive antiviral treatments. Antiviral drugs commonly used to treat encephalitis include:

• Acyclovir (Zovirax)
• Ganciclovir (Cytovene)

Some viruses, such as insect-borne viruses, don't respond to these treatments. However, because the specific virus causing the infection may not be identified immediately or at all, treatment with acyclovir is often begun immediately. This drug can be effective against the herpes simplex virus, which can result in significant complications or death when not treated promptly.

Side effects of the antiviral drugs may include nausea, vomiting, diarrhea, loss of appetite, and muscle or joint soreness or pain. Rare serious problems may include abnormalities in kidney or liver function or suppression of bone marrow activity. Appropriate tests are used to monitor for serious adverse effects.

Supportive care
Additional supportive care also is needed in the hospital for people with severe encephalitis. The care may include:

• Breathing assistance, as well as careful monitoring of breathing and heart function
• Intravenous fluids to ensure proper hydration and appropriate levels of essential minerals
• Anti-inflammatory drugs, such as corticosteroids, to help reduce swelling and pressure within the skull
• Anticonvulsant medications, such as phenytoin (Dilantin), to stop or prevent seizures.

Follow-up therapy
After the initial illness, it may be necessary to receive additional therapy depending on the type and severity of complications. This therapy may include:

• Physical therapy to improve strength, flexibility, balance, motor coordination and mobility
• Occupational therapy to develop everyday skills and to use adaptive products that help with everyday activities
• Speech therapy to relearn muscle control and coordination to produce speech
• Psychotherapy to learn coping strategies and new behavioral skills to improve mood disorders or address personality changes — with medication management if necessary.

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Emphysema

Emphysema

Definition:

Emphysema occurs when the air sacs in your lungs are gradually destroyed, making you progressively more short of breath. Emphysema is one of several diseases known collectively as chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of emphysema.

As it worsens, emphysema turns the spherical air sacs — clustered like bunches of grapes — into large, irregular pockets with gaping holes in their inner walls. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

Emphysema also slowly destroys the elastic fibers that hold open the small airways leading to the air sacs. This allows these airways to collapse when you breathe out, so the air in your lungs can't escape. Treatment may slow the progression of emphysema, but it can't reverse the damage.

Symptoms:

You can have emphysema for many years without noticing any signs or symptoms. The main symptom of emphysema is shortness of breath, which usually begins gradually. You may start avoiding activities that cause you to be short of breath, so the symptom doesn't become a problem until it starts interfering with daily tasks. Emphysema eventually causes shortness of breath even while you're at rest.

When to see a doctor
See your doctor if you've had shortness of breath for several months, especially if it's getting worse or it's interfering with your daily activities. Don't try to attribute it to your deconditioning or age or weight. Seek immediate medical attention if:

• You're so short of breath, you can't talk
• Your lips or fingernails turn blue or gray
• You're not mentally alert
• Your heartbeat is very fast

Causes:

The main cause of emphysema is long-term exposure to airborne irritants, including:

• Tobacco smoke
• Marijuana smoke
• Air pollution
• Manufacturing fumes
• Coal and silica dust

Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the lungs. It is called Alpha-1 antitrypsin deficiency emphysema.

 Complications:

People who have emphysema are also more likely to develop:

• Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised.
  
• Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.
  
• Large holes in the lungs (giant bullae). Some people with emphysema develop empty spaces in the lungs called bullae. Giant bullae can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can become infected and are more prone to causing a collapsed lung (pneumothorax).

Treatments and drugs:

Emphysema can't be cured, but treatments can help relieve symptoms and slow the progression of the disease.
Medications

• Smoking cessation drugs. Prescription medications, such as bupropion hydrochloride (Zyban) and varenicline (Chantix), can help you quit smoking.
  
• Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis.
  
• Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath. But prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
  
• Antibiotics. If you develop a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.

Therapy

• Pulmonary rehabilitation. A pulmonary rehabilitation program can teach you breathing exercises and techniques that may help reduce your breathlessness and improve your ability to exercise. You'll also receive advice about proper nutrition. In the early stages of emphysema, many people need to lose weight, while people with late-stage emphysema often need to gain weight.
  
• Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. It's usually administered via narrow tubing that fits into your nostrils.

Surgery
Depending on the severity of your emphysema, your doctor may suggest one or more different types of surgery, including:

• Lung volume reduction. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue work more efficiently and helps improve breathing.
  
• Lung transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.

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Eisenmenger syndrome

Eisenmenger syndrome

Definition:

Eisenmenger (I-sun-meng-uhr) syndrome is a complication of a heart defect that you're born with (congenital). A heart defect that causes a hole (shunt) to develop between two chambers of your heart is the most common cause of Eisenmenger syndrome.

This hole causes blood to circulate abnormally in your heart and lungs. Increased blood flow returns to your lungs instead of going to the rest of your body. The blood vessels in your lung arteries become stiff and narrow, increasing the pressure in your lung's arteries. This permanently damages the blood vessels in your lungs.

Eisenmenger syndrome occurs when the increased pressure of the blood flow in the lung becomes so great that the direction of blood flow through the shunt reverses. Oxygen-poor (blue) blood from the right side of the heart flows into the left ventricle and is pumped to your body, making it so that you don't receive enough oxygen to all your organs and tissues. Eisenmenger syndrome is a life-threatening condition requiring careful medical monitoring. Medications can improve symptoms and prognosis.

Symptoms:

Eisenmenger syndrome signs and symptoms include:

• Bluish or grayish skin color (cyanosis)
• Large, rounded fingernails or toenails (clubbing)
• Easily tiring and shortness of breath with activity
• Shortness of breath while at rest
• Chest pain or tightness
• Skipped or racing heartbeats (palpitations)
• Fainting (syncope)
• Dizziness
• Numbness or tingling in the fingers or toes
• Headaches

When to see a doctor
If you have any signs or symptoms of Eisenmenger syndrome, make an appointment to see your doctor. Even if you haven't previously been diagnosed with a heart defect, symptoms such as cyanosis and shortness of breath are signals that you have a health problem that needs medical attention.


Causes:


Eisenmenger syndrome develops most often due to a hole between the chambers of your heart. To understand how Eisenmenger syndrome affects your heart and lungs, it's helpful to know how your heart works.

How the heart works
Your heart is divided into four chambers, two on the right and two on the left. In performing its basic job — pumping blood throughout your body — your heart uses its left and right sides for different tasks. The right side moves blood into vessels that lead to your lungs. In your lungs, oxygen enriches your blood, which circulates to your heart's left side.

The left side of your heart pumps blood into a large vessel called the aorta, which circulates blood to the rest of your body. Valves control the flow of blood into and out of the chambers of your heart. These valves open to allow blood to move to the next chamber or to one of the arteries, and they close to keep blood from flowing backward.

How Eisenmenger syndrome develops
For most people who have Eisenmenger syndrome, the cause of their condition is due to a hole (shunt) between the main blood vessels or chambers of your heart. This shunt is a heart defect you're born with (congenital). Heart defects that can cause Eisenmenger syndrome include:

• Ventricular septal defect. This shunt in the wall of tissue that divides the right and left sides of your heart's main pumping chambers (ventricles) is the most common cause of Eisenmenger syndrome.
  
• Atrial septal defect. An atrial septal defect is a shunt in the wall of tissue that divides the right and left sides of the upper chambers of your heart (atria).
  
• Patent ductus arteriosus. This heart defect is an opening between the pulmonary artery that carries oxygen-poor blood to the lungs and the artery that carries oxygen-rich blood to the rest of your body (aorta).
  
• Atrioventricular canal defect. In this heart defect, there's a large hole in the center of the heart where the walls between the upper chambers (atria) and lower chambers (ventricles) meet. Some of the valves in your heart also may not function properly.

For each of these defects, the increased pressure of blood flowing through the shunt increases the pressure in your pulmonary artery. Over time, this increased pressure damages the smaller blood vessels in your lungs.

The damaged blood vessel walls make it difficult for the red blood cells to take up oxygen. Eisenmenger syndrome occurs when blood flows backward through the shunt, causing oxygen-rich and oxygen-poor blood to mix. This lowers the oxygen level in your blood (cyanosis), and your red blood cell count increases to try and make up for the lack of oxygen.

Complications:


Without proper treatment and monitoring, you can develop complications of Eisenmenger syndrome, including:

• Low oxygen levels in your blood (cyanosis). The reversed blood flow through your heart lowers the amount of oxygen your body's tissues and organs receive. This causes you to have a lower tolerance for physical activity and your skin to have a bluish or a grayish color. Cyanosis will worsen over time.
  
• High red blood cell count (erythrocytosis). Because you aren't getting enough oxygen-rich blood circulating throughout your body, your kidneys release a hormone that increases your number of red blood cells, the cells that carry oxygen throughout the body. Having too many red blood cells can reduce the blood flow to other organs and increase your risk of developing blood clots.
  
• Arrhythmias. Enlargement and thickening of the walls in the heart, along with low oxygen levels may cause an irregular heart rhythm (arrhythmia). Some types of arrhythmias can cause blood to pool in your heart's chambers where it can clot. If the clot travels out of your heart and blocks an artery, you can have a heart attack or stroke.
  
• Sudden cardiac arrest. If you develop an arrhythmia as a complication of Eisenmenger syndrome, it's possible the arrhythmia could suddenly stop your heartbeat. Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Without immediate medical attention, you can die of sudden cardiac arrest in minutes. You can also go into cardiac arrest during surgical procedures, usually related to changes in blood pressure caused by anesthesia.
  
• Heart failure. The increased pressure in your heart can cause your heart muscles to weaken, decreasing its pumping effectiveness. Eventually, this can lead to heart failure.
  
• Coughing up blood (hemoptysis). Increased pressure in the lungs and problems with your blood caused by Eisenmenger syndrome can cause life-threatening bleeding into your lungs and airways, causing you to cough up blood and further lowering your blood oxygen level. Bleeding can also occur in other parts of the body.
  
• Stroke. Stoke can occur when a blood clot travels from the right to left side of the heart without being filtered out by your lungs. This blood clot may then block a blood vessel in the brain, leading to a stroke. The high levels of red blood cells in Eisenmenger syndrome also increase your risk of blood clots and stroke.
  
• Kidney problems. Low oxygen levels in your blood may lead to problems with your kidneys. This can also increase your risk of developing gout.
  
• Pregnancy risks. Due to the demands pregnancy puts on a mother's heart and lungs, women who have Eisenmenger syndrome shouldn't become pregnant. Pregnancy for a woman who has Eisenmenger syndrome poses a high risk of death for both the mother and baby.

Eisenmenger syndrome is a life-threatening condition. The prognosis for people diagnosed with Eisenmenger syndrome depends on the type of congenital heart defect and other medical conditions. People who are diagnosed with Eisenmenger syndrome can survive as long as age 50 to 60 and sometimes longer.

Treatments and drugs:


Eisenmenger syndrome treatment is aimed at controlling your or your child's symptoms and managing the condition. Although there's no cure, medications may help you feel better, improve your quality of life and prevent serious complications. Doctors don't recommend surgery to repair the hole in your heart once Eisenmenger syndrome has developed, and any surgery may be life-threatening. It's important that you're treated by a doctor who has expertise in Eisenmenger syndrome.

Observation and monitoring
You'll be monitored through regular visits with a congenital heart disease cardiologist. You should have an appointment with your cardiologist at least once a year. A typical evaluation generally includes a thorough review of complaints and symptoms, a physical exam, and blood tests.

Medications
Medications are the primary treatment option for Eisenmenger syndrome. You'll need to be monitored closely by a doctor when taking medications for any changes in blood pressure, fluid volume or pulse rate.
Medications for Eisenmenger syndrome include:

• Medications to control arrhythmias. If you have an arrhythmia, you may receive medications to control your heart rhythms.
  
• Iron supplements. Your doctor may prescribe iron supplements if he or she finds your iron level is too low. Don't start taking iron supplements without talking to your doctor first.
  
• Aspirin or other blood-thinning medications. If you have had a stroke, blood clot or certain types of irregular heart rhythms, your doctor may recommend aspirin or other blood thinners such as warfarin (Coumadin, Jantoven). However, people who have Eisenmenger syndrome are also at increased risk of bleeding when taking these medications, so don't take any blood thinners unless your doctor tells you to do so. You shouldn't take over-the-counter pain medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve), without talking to your doctor first.
  
• Endothelin receptor antagonists. These medications reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow. One of these medications, bosentan (Tracleer), may improve your energy level and symptoms by lowering the resistance in your lung arteries. If you take bosentan, you'll need monthly liver monitoring because the drug can damage your liver.
  
• Sildenafil and tadalafil. Sildenafil (Revatio, Viagra) and tadalafil (Cialis, Adcirca) are sometimes used to treat high blood pressure in your pulmonary arteries caused by Eisenmenger syndrome. These drugs work by opening the blood vessels in the lungs to allow blood to flow through more easily. Side effects include upset stomach, dizziness and vision problems.
  
• Antibiotics. Depending on your condition, you may need to take antibiotics before having certain dental and medical procedures. These procedures may allow bacteria to enter your bloodstream. Antibiotics taken before these procedures can help destroy or control the harmful bacteria that may lead to an infection of your heart's tissues (endocarditis). Antibiotics are recommended only before certain dental procedures (those that cut your gum tissue or part of the teeth) and procedures involving the respiratory tract, infected skin or tissue that connects muscle to bone.

Blood drawing (phlebotomy)
If your red blood cell count becomes too high, your doctor may recommend having blood drawn to help normalize your blood cell counts. You should also receive intravenous (IV) fluids when having blood drawn to help replace the lost fluids.

Heart-lung transplantation
Some people who have Eisenmenger syndrome may eventually need a heart and lung transplant or a lung transplant with repair of the hole in the heart if no other treatments prove effective.

Birth control and pregnancy
If you have Eisenmenger syndrome, becoming pregnant poses serious health risks — and can be fatal — for the mother and baby. It's critical that women who have Eisenmenger syndrome avoid becoming pregnant.

Your doctor may recommend nonreversible birth control, such as Essure. Essure is a metal coil inserted through the vagina to the fallopian tubes that causes scar tissue to develop. This blocks the fallopian tubes. Having your fallopian tubes tied (tubal ligation) is less often recommended due to the risks of having even minor surgery.

Birth control pills containing estrogen aren't recommended for women who have Eisenmenger syndrome. Estrogen increases your risk of developing blood clots that could potentially block an artery to your heart, brain or lungs. Using only barrier methods, such as condoms or diaphragms, isn't recommended due to the risk of those methods failing.

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