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G6PD Deficiency
Definition:
G6PD Deficiency is a hereditary abnormality in the activity of an enzyme called glucose-6-phosphate dehydrogenase (G-6-PD). Normally this enzyme protects the red blood cells against chemical injuries. Patients deficient in the enzyme are prone to sudden destruction of red blood cells. This may happen after intake of certain drugs, herbs, food stuff or exposure to chemicals.
Who is at risk?
G6PD Deficiency is common in South East Asia. In Hong Kong, the incidence rate is around 4.5% in males and 0.5% in females. It is also prevalent in Africa and Mediterranean countries.
The disease is more common in males because the gene is located in the X chromosome. Females have 2 copies of X chromosome and thus 2 copies of G6PD genes. A female with a defective gene may still have a normal gene doing the job. Not so in a male carrying a defective gene in his only X chromosome. The enzyme activity would be invariably low.
Symptoms:
Patients do not have any symptoms. They lead a normal life and have a normal life span. However, after exposure to the offending substance, they may become acutely ill with:
- Sudden rise of body temperature
- Dark urine
- Abdominal pain
- Yellow coloring of skin and mucous membrane
- Pallor, fatigue, general deterioration of physical conditions
- Heavy, fast breathing and weak, rapid pulse
Newborns may become severely jaundiced.
Treatment:
The condition is inherited. No treatment is necessary unless there is an acute attack, which is usually taken care of in hospital with intravenous fluids and perhaps transfusion.
Prevention:
All newborn babies are tested for the condition at birth. If it is found to be G6PD deficient, parents would be given a note with a list of drugs, herbs, food and chemicals to avoid.
Gallstones
Definition:
Gallstones are small stones made from cholesterol, bile pigment and calcium salts, usually as a mixture that forms in the gall bladder. In most cases, gallstones don't cause any problems. However, prompt treatment may be necessary if stones block ducts and cause complications, such as infections or inflammation of the pancreas. There are three main types of gallstones, including:
- Cholesterol stones - comprised mainly of cholesterol. Cholesterol stones can grow to significant sizes, large enough to block bile ducts.
- Pigment stones - bile is greenish-brown in color, typically small but numerous.
- Mixed stones - commonest type comprised of cholesterol and salts.
Who is at risk?
Heredity, age, and diet are probably all important factors in developing gallstones.
Losing weight very rapidly produces stones in some people.
People traditionally considered at an increased risk of gallstone are people who are the 5 F's:
- Female;
- Fat (obesity);
- Fair (Caucasian): Asian and African people have a low incidence of gallstones while certain American Indian tribes have almost a 100 percent incidence in females by middle age;
- Forty (middle-aged);
- Fertile (the risk is increased in pregnancy).
Symptoms:
- Colic: Gallstones can lodge in the outlet neck of the gallbladder or even in the main bile duct to the intestine. This would cause intermittent severe pain, which is experienced in the upper-middle or right side of the upper abdomen lasting from a few minutes to several hours.
- Gallbladder Inflammation: Stones irritate the gallbladder and acute inflammation (cholecystitis) results. This condition produces steady, dull, and usually severe pain in the upper-right abdomen often with fever.
- Jaundice: Gallstone becomes permanently lodged in the main bile duct and bile backs up in the liver and spills into the blood. The skin turns yellow, the urine dark and, perhaps, the stool white, since it is bile that colors the stool brown.
- Other Symptoms -- Gallstones are frequently blamed for causing indigestion, nausea, and intolerance to fatty foods. However, it has been found that persons without gallstones experience these symptoms as frequently as those with stones.
Treatment:
Gallstones that present no symptoms generally do not require any medical intervention. Treatment depends on the size and location of the gallstones, but may include:
- Dietary modifications: Limiting or eliminating fatty foods and dairy products.
- Surgery: Remove the gall bladder or stones from bile ducts (laparoscopic or conventional abdominal incision).
- Lithotripsy: Machine generates sound waves to shatter stones. This treatment is used for those people with small and soft stones.
- Medications: There are drugs available that can dissolve gallstones, but this treatment is only rarely given, due to side effects and a variable success rate.
Prevention:
- Achieve and maintain ideal body weight but do not lose more than 3 lbs per week, especially using the super low-calorie liquid fasting diets.
- Increased fiber in the diet, vitamin C and caffeinated coffee may be helpful. Additionally, regular recreational and physical activity such as vigorous walking and aerobics seem to have protective value.
Gastric and Duodenal Ulcer (Peptic Ulcer)
Definition:
Gastric and duodenal ulcers or Peptic ulcers are sores in the lining of the stomach or the first part of the small intestine (called the duodenum). Most peptic ulcers are caused by the bacteria Helicobacter pylori (H. pylori) or by using non-steroidal anti-inflammatory drugs (NSAIDs). Other causes include Zollinger-Ellison syndrome (meaning: a disease that causes an increase in acid production) and radiation therapy.
Who is at risk?
- Age: 60 or older;
- Family history of ulcer disease;
- People taking aspirin and non-steroidal anti-inflammatory medications;
- Prior peptic ulcer disease;
- Cigarette smoking;
- Alcohol abuse;
- Stress;
- People taking steroids;
- Type O blood;
- People sharing food (and saliva) with their chopsticks.
Symptoms:
- Gnawing pain in the epigastric area (meaning: upper central region of the abdomen between the costal margins and a line drawn horizontally across the lower costal margins) that
- May awaken you from sleep
- May sometimes improve when you eat
- May associate with unusually strong feeling of hunger
- Nausea and vomiting
- Loss of appetite
- Gastric bloating
- Burping and belching
- Bleeding ulcer with black, tarry stools or vomiting up "coffee ground" materials
- Anaemia (from bleeding ulcer)
- Loss of weight (scar tissue that narrows the outlet of the stomach to the intestines affect the food in digestion)
Treatment:
Gastric ulcers may take longer to heal than duodenal ulcers.
- Medication
- Antacids and Bismuth-containing drug (provide some relief from heartburn).
- Histamine 2 blockers such as famotidine, ranitidine and cimetidine (decrease stomach acid production).
- Proton pump inhibitors such as omerprazole, lansoprazole and rabeprazole (decrease stomach acid production).
- Antibiotics (to treat helicobacter pyloric infection).
- Medication to protectively coat ulcer such as sucralfate.
- Medication to protect stomach against NSAID damage such as misoprostol.
- Surgery
Surgery may be necessary if you have bleeding, a perforation, or an obstruction.- Endoscopic surgery - May be done to stop bleeding by injecting "glueing medication" over the bleeding area.
- Vagotomy and drainage - Cutting the vagus nerve can greatly reduce acid production and also interfere the stomach's ability to empty itself. Drainage can be created by widening of the opening between the stomach and duodenum or creating a new opening with connection to the duodenum and jejunum.
- Highly elective vagotomy - Cuts only part of the vagus nerve. This type of surgery does not require extra means of drainage.
- Vagotomy with antrectomy - Cutting of the vagus nerve combined with removal of the lower part of the stomach (antrum) that normally produces a chemical that promotes acid production.
- Eliminating risk factors:
- If you smoke, quit. Smoking interferes with ulcer healing.
- Do not drink alcoholic beverages.
- Avoid non-steroidal anti-inflammatory medication such as aspirin, ibuprofen and diclofenac.
- If spicy or fatty foods increase symptoms, you can temporarily stop eating them. Keep in mind they did not cause the ulcer and probably do not affect ulcer healing.
- If stress increases ulcer pain, learn and practice stress-management techniques.
Prevention:
Avoid drinking too much coffee and alcohol and moderate consumption is recommended, though without conclusive evidence, as coffee can stimulate gastric acid secretion and cause gastritis (Meaning: inflammation of the stomach).
Gastritis
Definition:
Gastritis means the inflammation of the stomach. The lining of the stomach often looks red, irritated and swollen, and may have raw areas that bleed.
Gastritis can be caused by infections from bacteria such as H. pylori, or viruses such as the Norwalk virus. These microorganisms can spread through contaminated food, water, saliva or digestive fluids. Irritants such as alcohol and cigarettes can also damage the stomach lining and cause gastritis.
Who is at risk?
People over the age of 60 and smokers have higher risk of developing gastritis. Heavy drinkers and those who are on aspirin or similar pain-killers are also vulnerable. Gastritis can result from sudden stress to the body, such as after major surgery, traumatic injury, burns, or severe infections. People with pernicious anaemia (an anaemia resulting from deficiency of vitamin B12) are also prone to gastritis.
Symptoms:
The most common symptoms of gastritis are abdominal upset or pain. Other symptoms are fever, loss of appetite, belching, fatigue, abdominal cramps, nausea, diarrhea, and vomiting or a feeling of fullness or of burning in the upper abdomen. Vomiting out blood or passing dark black stools may be a sign of bleeding in the stomach. This requires immediate medical attention.
Treatment:
Treatment usually involves medicine to reduce stomach acid. Patients should also avoid certain medicines (such as pain-killers and steroids). Certain foods and beverages such as alcohol, coffee, spicy dishes, should be avoided. If your gastritis is caused by an infection with H. pylori, it can be cured by a course of antibiotics.
Prevention:
- Stop smoking
- Eat regularly
- Avoid food that can't be digested easily, including those that are greasy, spicy or very acidic.
- Stay away from alcohol, caffeine and drugs such as pain-killers that can irritate your stomach.
Gastroenteritis
Definition:
Gastroenteritis is an inflammation of the stomach and intestines, most commonly caused by viruses and bacteria introduced from the mouth to the gastrointestinal tract.
Who is at risk?
Gastroenteritis can affect anybody because many different microorganisms can cause the disease. Locally, gastroenteritis is frequently caused by the consumption of contaminated food, such as raw seafood. It can cause outbreaks in children day care centers and elderly homes. The disease is common in travelers, especially to tropical countries.
Symptoms:
Characteristic signs and symptoms include:
- Nausea or vomiting
- Diarrhea
- Abdominal cramps
- Bloating
- Fever
Treatment:
The patient would need to rest. If the patient has been vomiting, rest the stomach for 30 to 60 minutes. To replenish the loss in fluid and electrolytes, the patient needs to take in small amount of an oral rehydration solution at frequent intervals. Drug stores have different types of preparations available, some in powder form and some come in bottles. Plain water is not well absorbed and would not adequately replace glucose and electrolytes.
When vomiting has stopped, introduce bland, easy-to-digest foods, such as congee and soft rice. Avoid dairy products and sugary foods, such as ice cream, sodas and candy. These can make diarrhea worse. Do not give anti-diarrhea drugs to children.
Get medical help if the patient:
- Is a young infant.
- Keeps on vomiting and cannot take in any fluid for more than 8 hours.
- Becomes unusually drowsy.
- Vomited blood or has bloody diarrhea.
- Shows signs of dehydration, such as dry mouth, sunken eyes or poor urine output.
- Has high fever and shaking chills.
Prevention:
- Wash your hands and your children's hands thoroughly.
- Avoid undercooked meat and fish. Trust only reputable restaurants when eating out.
- Take precautions when traveling. Drink only bottled water.
- Avoid raw food - including peeled fruits, raw vegetables and salads - that has been touched by human hands.
- Use separate personal items at home.
Glaucoma
Definition:
The eye is like a ping-pong ball filled with fluid. This fluid is constantly being produced and absorbed. Pressure in the eye can increase when too much fluid is being produced, or when the fluid is not draining properly. Glaucoma is the condition in which the nerve supplying the eye (the optic nerve) is harmed by abnormally high eye pressure.
There can be many different types of glaucoma. In general, acute glaucoma presents suddenly with severe symptoms. Chronic glaucoma, which is far more common, is usually clinically silent. Glaucoma can also be congenital and occur in children.
Who is at risk?
- Old age
- Family history of glaucoma;
- Diabetic patients;
- Extreme nearsighted people;
- Previous eye surgery or eye injuries;
- Patients who have been on long term corticosteroids.
Symptoms:
Acute glaucoma presents suddenly eye pain, headaches, haloes around lights, dilated pupils, vision loss, red eyes, nausea and vomiting.
Patients with chronic glaucoma do not experience symptoms. When visual loss appears it is often too late. This starts in the periphery, so that the patient would have a narrow field of vision (tunnel vision), which progresses to blindness.
Treatment:
To release high eye pressure in glaucoma, doctors may prescribe eye drops to lower eye pressure. If uncontrolled, patients may need laser or open surgery to prevent continuing deterioration.
Prevention:
Chronic glaucoma can take away your vision silently. The best way to stop the disease from causing blindness is early diagnosis and treatment. The elderly should have their eyes examined by ophthalmologists once every one or two years. Ophthalmologists have special apparatus to measure the eye pressure. People at high risk should be examined more frequently.
Acute glaucoma is a medical emergency. If the high pressure is not reduced within hours, it can permanently damage vision. Anyone who experiences its symptoms should immediately seek consultation with an ophthalmologist.
Gonorrhoea
Definition:
Gonorrhea is a sexually transmitted disease (STD). A person can become infected when the bacteria enter any opening in the body, including the penis in the male, vagina or cervix in the female. Gonorrhea can also infect the rectum, anus, throat, pelvic organs, and rarely, the conjunctiva, which is the membrane that lines the eyelid and eye surface.
Who is at risk?
Risk factors for getting gonorrhea include:
- Having multiple sex partners;
- Having high-risk sex partner(s), such as those in the sex trade;
- Having unprotected sexual contact (not using condoms).
Symptoms:
A male patient would notice symptoms early, usually 2 to 5 days after exposure. There is pain and burning sensation while urinating with frequent urges to pass urine. A yellow, white or green discharge appears from the tip of the penis, and would stain the underwear.
In women, symptoms are much less specific. Many may not have symptoms at all. They harbor bacteria in their vagina and cervix, and can spread the disease to sex partners.
Symptoms in a woman that can be caused by gonorrhea include:
- Painful or frequent urination.
- Anal itching, pain, bleeding, or discharge.
- Abnormal vaginal discharge.
- Abnormal vaginal bleeding during or after sex or between periods.
- Genital itching.
- Irregular menstrual bleeding.
- Lower abdominal pain.
- Painful sexual intercourse.
- Fever and general tiredness.
- Swollen and painful glands at the opening of the vagina.
Treatment:
Gonorrhea can be effectively treated with antibiotics. The incidence of antibiotic resistance is rapidly increasing, and treatment should be supervised by doctors. Both oral and injection preparations are available. Single treatment can sometimes eradicate an uncomplicated disease found early.
If you are treated for gonorrhea and your sex partner is not, you will probably become infected again. Make sure that your partner is also treated for gonorrhea, although he or she may not have any symptoms. Otherwise use a condom.
Prevention:
Don't have more than one sexual relationship at a time. Avoid casual sex. Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Practice safe sex by using a condom.
Gout
Definition:
Gout is a kind of arthritis caused by uric acid depositing in the joints. Uric acid normally dissolves in your blood and is excreted in the urine. In gout, the chemical builds up and forms crystals in and around the affected joint, causing intense pain and swelling.
Who is at risk?
Uric acid comes from a group of substances called purines from the diet. People indulged in a diet rich in purines are vulnerable. Purines are the building blocks of nucleic acids and are found in all foods rich in protein.
Gout often runs in families. First attacks of gout tend to occur in men between the ages of 40 and 50. Women are less susceptible, unless after menopause. Gout is also more common in the obese, in diabetic patients, and in those with high cholesterol levels. Excess consumption of alcohol is a risk factor. Certain drugs, such as diuretics (a drug that help you get rid of excess fluid) can increase uric levels and increase the risk of gout.
Symptoms:
Gout usually affects the large joint of the big toe. The pain is typically acute and intense, appearing without warning. The affected joint becomes red, hot swollen and painful to touch. Gout can also affect other joints in the feet, ankles, knees, hands and wrists.
Treatment:
Acute attacks of gout are often treated with nonsteroidal anti-inflammatory drugs (NSAIDs), which are drugs with properties similar to aspirin and can stop pain and inflammation. The patient should rest with the limb raised during an acute attack. Putting an ice pack on the joint may ease the pain.
Prevention:
Stay away from alcohol and foods that are high in purines. Doctors and dieticians would give you a list of high purine foods, amongst them offal, seafood, and meat. Patients should lose weight and drink plenty of water.
Those with more than two to three attacks a year may need to be on drugs to help them excrete uric acid in the urine.
