Crystals in urine

Crystals in urine

Diagnosis: 

History of recurrent renal colic - Painful micturition - Urine analysis.

Treatment: 

According to type of crystals.

Ca Oxalate crystals by Mg Citrate drugs:

As Mg Citrate + Calcium Oxalate  = Mg Oxalate which is soluble salt secreted in urine.

e.g.

-Epimag eff.

-Xinomag eff.

-Citro mag eff.

-Citrocid Mg eff.

One sachet dissolved in half glass of water 3 times daily after meals.

Ca Urate crystals:

Treatment by

1-Colchicine containing effervescent.

2-Alkalinazation of urine.

Effervescent e.g.

Urosolvin eff.

Colisolvin eff.

Ur - aid eff.

Solvinal eff.

One sachet dissolved in half glass of water 3 times daily after meals.

Alkalinazation of urine drugs e.g.

Coliurinal eff. Bottle (teaspoonful or tablespoonful on half glass of water 3 times daily after meals).

Uricol eff. One sachet dissolved in half glass of water 3 times daily after meals.

Phosphate crystals:

Treatment by

1-Proximol effervescent.

2-Acidification of urine.

For proximal → Proximol tab. One tablet 3 times daily after meals.

                     → Proximol bottle as one tablespoonful on half glass of water 3 times daily after meals.

For acidification (vitamin C) → Vit – C tab. 1×1.

                                           → Vit – C SR cap. 1×1.

                                           → Cevarol tab. 1×1.

Renal Colic

Renal Colic

The most common causes of renal colic:

-Crystals in urine.

-Urinary stones.

-Pyelonephritis.

Renal colic: 

-Is intermittent, severe attacks of pain in loin, usually radiate to back and may radiate to testicles or vulva and may be associated with nausea or vomiting.

-Urinary symptoms may be present as burning, difficulty in micturition and haematuria.

-Sometimes pain radiate to umbilicus.

Diagnosis:

-Clinical picture: see above.

-Investigation:

- Urine analysis → crystals - pus - RBCs….

- Abdominal sonar → stones…..

- CT and MRI.

Treatment: according to diagnosis.

Iron Deficiency Anemia

Iron Deficiency Anemia

Diagnosis:

Easy fatigability.

Sense of weakness.

Decreased concentration.

Dyspnea.

Palpitation.

Headache.

Blurring of vision.

Gastric upset, anorexia and dyspepsia.

By examination:

Hypotension.

Haemic murmur.

Pallor.

Increased neck arterial and capillary pulsations.

Water hammer pulse (rare).

Investigation:

 HB% - E.S.R - CBC → microcytic hypochromic anemia.

Treatment:

- Iron capsules 1×1 after lunch.

- Vit.B complex tablets.

Iron: Haematon cap, - Fefol cap. – Haematron tab. – Haema caps cap.

Vit B: vit B complex tab. – Neuroton tab.

Fer in sol drops in iron deficiency in children:

10 drops → < 2 years → 3 times daily.

15 drops → 2 years - 6 years → 3 times daily.

20 drops → 6 years -12 years → 3 times daily.

Hiatus Hernia

Hiatus Hernia

Diagnosis:

Heart burn increased by lying down and decreased in upright position.

History of dyspepsia and heart burn.

Investigation:

Barium swallow in Trendlenberg position.

Manometric studies to assess lower esophageal sphincter.

Treatment:

1- Antacids. (see gastritis)

2- Drugs of peptic ulcer. (see gastritis)

3- Drugs to assess motility of stomach (prokinetics).

- Domperidone tab. 1×3 before meals.

- Motinorm tab. = Motilium  tab.

- Farcotilium cap. = Dompidone tab.

4- Instructions → decrease body weight, avoiding cigarette, spicy food and heavy meals before sleeping.

Indications of surgery:

- Sliding hernia (small or large).

- Large paraoesophageal hernia.

- Complications (anemia).

Angular Stomatitis

Angular Stomatitis

Diagnosis:

Inflammation at angels of lips usually due to deficiency of vitamin B complex and iron. (may be other vitamin deficiency)

Treatment:

Iron → Haemacaps cap. → adults.

            Ferronil syr.        → children.

Folic acid → Folic acid 5 mg tab. 1-3×1 → children.

                                                    2-4×1 → adults.

Vit. B → Becozym syr. 1×3 → children.

               Beco C syr. 1×3 → children.

               Vit. B complex tab. 1×3 →adults.

Ulcerative Colitis

Ulcerative Colitis

Diagnosis:

Pain → lower abdominal pain or discomfort.-

-Diarrhea → bloody ± mucus.

-Fever → may be (high in acute cases).

-Periods of remission and exacerbations.

Investigations:

-High E.S.R - high C.R.P.

-α1 Globulins – α1 glycoprotiens.

-Stool analysis → blood and may be pus.

-Barium enema → loss of haustration.
Treatment:

Mild cases: bed rest +

Valpam (diazepam) tab. 1×3 +

Lomotil (anti-motility drug to stop diarrhea) tab 1×3 +

Cefotax vial 1×2 or Quinolone antibiotic oral 1×2 or Ciprofloxacin 250 or 500 tab. 1×2.

Moderate cases: (Antidiarrheal drug + cortisone)

Colopyrine tab. Or Salazopyrine tab. As 2 tab. 4 times daily for 3 weeks with meals then 1 tab. 3 times daily for 6 monthes.

Prednisolone tab. As 1 tab. 4 times daily with lowering the dose gradually.

And best thing is to do a mixture which consists of Hydrocortisone 100 mg in 60 ml isotonic saline + Methylcellulose and give it per rectum daily for 7 days with lifting the lower limbs to make it easy for the mixture to be given then give the mixture day after day for another 7 days then stop gradually.

Severe cases: (Antidiarrheal drug + corticosteroid + cytotoxic immune suppressant drug)

Colopyrine tab. As before.

Hostacortine H = prednisolone tab. by the following method (3×3 for 1 month then 1×2 for 1 week then 1×1 for 1 week).

Imuran 50 mg tab. (1-3 mg/kg/day) = Azarin 50 mg tab.

Pancreatitis (acute)

Diagnosis:

pain: - Very very severe.

- In upper abdomen and radiating to back.

- Pain is increased by movement and respiration.

- Pain is relieved by sitting and waist flexion.

Fever (37.5° - 39°) is common.

Nausea and vomiting.

Shock may be present in severe cases.

By examination:

Rigidity and guarding.

Rebound tenderness may be present.

Cullen sign → bluish coloration around umbilicus is seen after 2 hours from acute attack.

Grey-turner sign → as Cullen but in flanks.

Investigations:

Serum amylase and lipase.

Urine amylase.

U.S and C.T scan.

NB. → Serum amylase is elevated only in first day and falls due to clearance. So serum lipase is more specific. U.S and C.T is the best.

NB. → Acute pancreatitis is usually idiopathic but in 50% of cases the cause may be ascending gall stone biliary disease – alcoholism.

Treatment:

1-     Emergency treatment (the most important).

2-     Symptomatic treatment (colic – vomiting - ….).

3-     If hyperglycemia → insulin by blood glucose.

4-     Surgical interference.

5-     Instructions.

Emergenic treatment:

 Hospitalization – nasogastric suction – ryle – to reduce pain – correction of shock, dehydration, hypokalaemia by K amp. , hypoxia by O2 and hypocalcemia by calcium gluconate 10% solution (10 – 20 ml I.V – can be repeated every 4 hours).

Symptomatic treatment:

Vomiting      - plasil amp. Primperan amp.

-         Motinorm tab. 1x3.

-         Motilium tab. 1x3.

Pain – diclophenac sodium as olfen = oflam = voltaren 50 tab. 1x3 or amp. Or

 Pethidine.

NB. Morphine is avoided as it may cause spasm of sphincter of oddi.

Surgical interference:

-         Pancreatic abscess.

-         Pseudocyst.

-         Damaged part of pancreas (surgical resection).

Instructions:

-         Bed rest.

-         Oral feeding is started when -Normal serum amylase and lipase.

                                                -No pain or tenderness. 

Acute cholecystitis

Acute cholecystitis

Diagnosis:

Main complaint of patient is pain over right hypochondrium area or may be in epigastrium.

pain is sudden severe colicky pain referring to tip of right shoulder and right scapula.

nausea and vomiting may be present (ask about past history of biliary colic).

by examination → tender gall bladder funds and positive Murphy sign (i.e. →

patient hold breath with pressure on tip of 9^th intercostal space)

NB. → chronic cholecystitis = gall bladder stones = surgical interference.

Investigartion done:

-Sonar → 75% stones.

-X rays upper abdomen → 20%.

-CBC → leucocytosis.

-Minor ↑ in plasma transaminases and amylase.

-May be minor ↑ in serum bilirubin.

-Cholecystography → cystic duct obstruction.

NB. → in 20% only of patients.

Treatment:

1.    Antibiotics (quinolone group)

2.    Drugs for stones

3.    Symptomatic treatment for pain, vomiting, …………

Antibiotics:

-Ciprofar tab.

-Ciprocin tab.

-Rancif tab.

-Tavanic tab.

Drugs for stones:

-Ursochol cap.

-Ursogall cap., susp.

-Rwachol.

Maldigestion and distention

Maldigestion and distention

Diagnosis:

Several  motions in morning and after meals alternative with constipation and passage of small dry hard pallets.

Abdominal pain before defecation felt on left iliac region.

Tender sigmoid colon.

Treatment:

-Digestant drugs.

-For intestinal flora → flagyl

-Symptomatic treatment

Digestant drugs as:

Zymogen tab.

Spasmodigestin tab.

Spasmoamrase tab.

Spasmocanulase tab.

Di-ease  syrup.

Neo-digestin syrup.

Mandorex

Malabsorption syndrome

Malabsorption syndrome

Diagnosis :

Is a syndrome resulting from impaired nutrition from small bowel due to many causes as chronic pancreatitis, billiary cirrhosis, cancer pancrease, zolinger Ellison syndrome,  small bowel resection, ……

Characterized by : diarrhea , may be steatorrhea  (bulky-pale-soft-stool), abdominal distension, flatulence (gas production) and features of nutritional deficiencies

Treatment:

1.    Treat the cause (specific treatment).

2.    Supportive treatment.

3.    Symptomatic treatment.

Supportive treatment:

-Theragran H tab. 1x1.

-Folic acid tab. 1x3.

-Neurobin amp. (vit. B) one amp. Every week.

In severe cases –Hostacortin H. (prednisolone) tab. 1x3 daily then decrease the dose gradually till half tablet then stop.

Irritable bowel (spastic colon)

Irritable bowel 

spastic colon

Diagnosis : 

.usually young adult anxious tense

.Female more than male

.Usually abdominal distension with diarrhea and several loose motions related to meals

May be alternative with constipation.

Usually tenderness and colic over sigmoid colon especially before defecation.

Some cases may show only painless persistent diarrhea.

No other data are found.

Treatment :

1 symptomatic treatment.

2 to regulate colon peristalsis.

3 other drugs.

4 instructions.

1- symptomatic treatment

As diarrhea   constipation  distention

2- to regulate colon peristalsis

Gast-reg  tab.  Susp. Supp. Amp.  

G-regular  tab.  Susp.

One tab. 3 times daily half an hour before meal.

3- Other drugs.

Bran tab.  (contains bran and cellulose→natural fibers good regulate GIT motility) 2x1 before sleep.

Cloxide tab. 1x3 before meals.

Librax tab. (is anxiolytic drug used only for a short period as it causes potential habituation) 1x3.

4-instructions.

- frequent small meals.

- avoid eating foods causing gases as fish, onion, falafel, lentil and eggplants.

- decrease nervousness as much as bossible.