What is Cat Scratch Disease?

It is a disease that is caused by the infection of Bartonella bacteria which is transmitted by cat bites and scratches. It is abbreviated as CSD and it is otherwise known as Cat scratch fever or Bartonellosis. The bacteria live in the cat’s saliva and may have the tendency to carry if for a couple of months or so until it spreads to others via physical contact. The person, who has the disease condition, usually complains of having a history of being bitten or scratched by a cat, most often a kitten. Studies show that young cats, specifically kittens, are often the ones to carry such bacteria compared to older cats. Also, household kittens are the high rates of acquiring the infection. The rate becomes higher if the cats have a presence of fleas. It is self limited and common syndrome. It may otherwise be due to lick, bite or scratch of the cats. Children are often the targeted persons or the persons who often have this kind of disease condition.

Cat scratch disease commonly results from a cat scratch or bite

Cat Scratch Disease Symptoms

Persons who are known to have this kind of disease condition are known to manifest the following symptoms:

• Fatigue
• Headache
• Body malaise or discomfort all over
• Tender regional Lymphadenopathy or swelling of the lymph nodes which develops around 1-2 weeks after the scratch or being bitten by a cat or kitten
• Low Grade Fever
• Pustule or blister
• Enlarged spleen or spleenomegaly
• Papule or bump which is otherwise known as inoculation lesion
• Weight loss which is unexplained
• Sore throat
• Losing of appetite
• Rashes
• Crusting of the pustule may also occur
• Anorexia
• Nausea

When the following symptoms occurs:

• Seizure
• High fever
• Mental status changes
• Level of consciousness changes

It may indicate a condition which is life threatening and there is a need to seek medical help immediately to prevent further complications.

Cat Scratch Disease Diagnosis

Most often the persons who have cat scratch disease do not recall their experience of being bitten or scratched by a cat or a kitten. Hence, it is important that they undergo test to be able to confirm the suspected diagnosis, which is cat scratch disease. Such examinations that one must undergo are as follows:

• Physical examination which may reveal that their spleen is enlarged
• Bartonella Henselae IFA test is an accurate and confirmatory diagnosis of this kind of disease condition
• Lymph node biopsy and Blood culture is done to be able to rule out the other etiology of the swelling of the person’s glands
• Microscopic Exam from the affected swollen lymph node may also be done

These are the common diagnostic test that is associated with the confirmation of this disease condition.

Cat Scratch Disease Treatment

Actually persons who are diagnosed with Cat Scratch disease does not entirely need treatment whatsoever unless the person has symptoms that are systemic in nature or there is a presence of adenopathy. The common treatments used for this kind of disease condition include:

• Pharmacological Medication

Antibiotics are the medications often given to eradicate the bacteria that cause this disease condition. Antibiotics may vary depending on the individual’s reaction to such. The following are the suggested antibiotics used for persons who have cat scratch disease:

• Azithromycin
• Rifampin
• Ciprofloxacin
• Doxycycline
• Gentamicin
• Erythromycin
• Clarithromycin
• Sulfamethoxazole
• Trimethoprim

Aside from antibiotics, one can take pain relievers such as ibuprofen and acetaminophen. One should take note that, aspirin should be avoided especially with children.

• Moist Compress

It can be given to a child or the patient to be able to ease the soreness of the nodes.

• Lymph node Aspiration

It may only be required when there is a presence of suppuration. The use of aspiration may be considered to be as a therapeutic as well as a diagnostic approach. When a person reports of recurrent pain and pus reaccumulation, there may be a need for repetition of aspiration procedure.

• Surgical Excision

It is done especially if the person has already a presence of an enlarge nodule which may be indicated when there is a continuous repetition of aspiration and still fail to relieve the pain that the person reports to have. The physician may suggest excising a persistent granuloma.

Cat Scratch Disease Prevention

This kind of disease condition happens rarely. Since the cause of this disease are mainly because of physical contact with cats, the main prevention of such is to avoid dealing with cats specially those that are stray and those that has fleas on it. If you are keeping a pet cat in your house, there is a need for you to be responsible enough to have regular visits to the veterinary and to make sure, as much as possible, that they do not acquire fleas by keeping them clean. You need to have an open communication with your veterinarian so that you will be guided to the right treatment or product to use for your pet cats. Also, in addition to that, is that children are the often the common victim of this kind of disease condition. Hence, as young as they are, they must be taught to handle their pet cats gently and appropriately to prevent such disease to occur. The child should not in any way provoke or tease the cat so as to prevent the cat from biting or scratching them. They can do by telling them to wash thoroughly their hands after touching or playing with any cats. If in any instance, the child had been bitten or scratched by a kitten, there is a need to consult a trusted physician to help deal with such matter on hand. Also, the first aid to do, when a child or a person is scratched or bitten by a cat, is that you need to wash it off by the use of running water and soap.

Cat Scratch Disease Pictures

Papule or bump which is otherwise known as inoculation lesion

Pustule or blister in cat scratch disease

Swollen lymph nodes as commonly seen in CSD

What is Prolapsed Uterus?

The uterus is a pear shaped, hollow, muscular organ of tghe female reproductive system. It is about 7.6 cm or 3 inches long and in which the fetus develops during pregnancy; the other term used for uterus is womb. The fertilized ovum enters the uterus where implantation happens. The uterus also gives nourishment to the growing fetus from blood vessels. It is located inside the pelvic cavity, near the urinary bladder and upwards toward the rectum.

A prolpased uterus is a condition in which the uterus falls out into the vagina from its original location. Most of the time, a prolapsed uterus is accompanied by a cystocele (Prolapsed Bladder) and/or Rectocele (anterior displacement of the rectum into the vagina).

The extent of the prolapse varies; it can be a slight sagging of the uterus, but in more complex cases, it can be a complete downward displacement of the uterus to the vagina. It can be classified as the following:

First degree

The cervix can be seen when labia is spread without straining or traction.

Second degree

The cervix protrudes out to the level of the perineum.

Third degree

Most of the uterus or the entire part of it protrudes out of the vagina and into the perineum.

Studies shows that 50% of all women who have symptoms of uterine prolapse are those above 50 years of age due to weakening and less elasticity of the pelvic muscles. It is more common among Hispanic women. Next are Asians and blacks.

The other names of a prolapsed uterus are uterine prolapse, pelvic relaxation, or pelvic relaxation.

Image Source: www.2womenshealth.com

Pathophysiology

The uterus placed inside the pelvic cavity, near the bladder and towards to the rectum. It is divided into four sections: the fundus, internal OS, corpus, and the cervix.

It is supported by muscles and ligaments. Uterine prolapse happens if this supporting structure is weakened. The uterus may slip down the vaginal canal and even extend outside the vaginal orifice. When the uterus falls down, it may also pull the other nearby organs like vaginal walls, bladder, and rectum.

Signs and Symptoms

• Lower back pain
• Abdominal pain
• Presence of tissue protrusion from the vagina
• Heaviness on the Pelvic area
• Vaginal Discharge
• Constipation
• Fecal incontinence
• Urinary incontinence
• Urinary retention
• Painful sexual intercourse or Dyspareunia
• Protrusion of the cervix during examination

Causes and risk factors

Vaginal childbirth

Damage to the muscles supporting the uterus is likely because of compression and increased pressure from the fetal head and maternal forces during delivery. It causes stretching and tearing in the muscles. Obstetric trauma to the muscles also occur during vaginal delivery.

Multiple pregnancy

Uterine prolapse is more common among women with more children.

In addition to this, other risk factors include:

• Increased age
• Menopausal period
• Because of a decrease in estrogen after menopause, the muscle loses its strength and is weakened.

Obesity

Due to increased strain on the muscles that support the uterus.

• Chronic constipation
• Smoking
• Prolong standing
• Heavy lifting – because of intra-abdominal pressure
• Other diseases like COPD and chronic cough.

Diagnosis

Complete pelvic examination

The doctor will conduct a pelvic examination to look for a protruding uterus. This is done while lying down and standing up. To assess for the degree of the prolapse, you will be asked to bear down like you’re doing bowel movement.

Pelvic ultrasound

This is done to further assess the degree of the prolapse.

Magnetic resonance imaging (MRI)

It is not commonly done but can be an option in determining the stage of prolapse.

Treatment

Treatment depends on the degree of the prolapse. For a mild prolapse, usually no treatment is needed. For more severe degrees or symptoms, there are available treatments both non-surgical and surgical.

Pessary

A vaginal pessary is inserted into the vagina to support the uterus and prevent it from falling down. Minimal discomfort and irritation can be felt since it presses the vaginal muscle. Prolonged usage of pessary may lead to necrosis and ulceration. Pessary should be cleaned frequently and removed every one to two months.

Surgery treatment includes:

Total Hysterectomy

The complete removal of the uterus is performed for severe degrees of uterine prolapse.

Vaginal Hysterectomy

A surgical procedure used to correct sagging of the supporting muscle of the pelvis. Ligament are preserved so they may continue their functions as support of the pelvic muscle and help improve muscle tone.

Sacrospinous fixation

This operation involves attaching the vaginal vault to firmer tissue and muscle within the pelvis to lift it back into place. It is done through the vagina, so there is no need to make an incision (wound) on the abdomen. Two non-dissolvable stitches are sewn into the sacrospinous (pelvic) ligaments and muscle which are then passed through the top of the vagina. The stitches are tightened against the muscle so the vagina is pulled back into place. Dissolvable stitches are then used to close the vaginal wall.

Kegels Exercise

This exercise strengthens the pubococcygeus muscle of the pelvis. To do this, women will sit on a toilet and she will contract the pelvic muscle for few seconds and relax slowly after. It is suggested that patients practice this when they have a full bladder and repeat the exercise for at least ten minutes.

Estrogen Replacement
During menopause, women will lose estrogen that helps strengthen the pelvic muscle. Taking estrogen replacement may help maintain muscle tone and prevent weakness that may lead to uterine prolapse.

Complications

Uterine prolapse, if left untreated, will progress to more complicated cases like other Pelvic Organ prolapse. Cystocele, or prolapsed bladder, and Rectocele, a prolapsed rectum, are known complication of uterine prolapsed.

Urinary tract infection, ulcers, and constipation may also occur in severe cases of pelvic organ prolapse.

Prevention

To decrease the possibility of having uterine prolapse, practice the following preventive measures:

• Maintain your ideal weight
• Do kegels exercise
• Maintain daily movement to prevent constipation
• Stop smoking

Prolapsed Uterus Pictures

What is Underactive Thyroid?

Underactive thyroid or medically known as hypothyroidism is a condition wherein the thyroid glands do not produce enough thyroid hormones for the body’s use. Thyroid hormones such as triiodothyronine (T3) and thyroxine (T4) are essential in the regulation of the body’s metabolism. Limited amounts of thyroid hormones lead to slowing down of the metabolism and body processes.

infant with Underactive Thyroid Symptoms

Source – clivir.com

Underactive Thyroid Symptoms and Signs

Hypothyroidism causes symptoms that are a result of the slowing down of body processes; hence there is affectation of all body processes. Hypothyroidism symptoms appear gradually and some patients may not even notice its occurrence. This condition is known as subclinical hypothyroidism. Most of the symptoms of underactive thyroid include:

Common Symptoms

• Cold sensitivity – The slow metabolism leads to poor heat production and causes the patient to feel cold easily.
• Fatigue and drowsiness -Slowing of body processes also makes the person sleepy most of the time with feelings of fatigue because of low energy production.
• Drying of the skin – Drying of the skin may be related to decrease in sweating hence, lack of skin moisture is experienced.
• Paleness – Patients may also have delayed formation of red blood cells leading to anemia. Anemia shows as paleness and weakness.
• Brittle hair and nails, thinning of hair – The formation of a strong matrix in the hair and nails is also impaired because of slowed body metabolism.
• Change in facial expression – Facial expression is also affected because of affectation of the face such as the appearance of moon face due to water retention.
• Slowed movements, sore muscles and weakness – Decreased metabolic rate means decreased energy production. As a result, the patient may have weakness and slowing of body movements.
• Constipation – The digestive system is also affected leading to slowing of the peristaltic activity. This further leads to constipation.
• Weight gain – Poor metabolism allows the body to store food rather than utilizing it for energy production. The patient experiences severe weight gaining over a short period. Weight gaining may also be caused by water retention because of the decreased formation of urine by the kidneys.
• Bradycardia – Low thyroid hormones do not stimulate the contraction of the heart leading to slowed heart rate. Bradycardia is more evident at night when the body is at rest. Patients should be monitored for heart failures.
• Elevated cholesterol levels – Lipids are also not metabolized and used by the body thereby there is elevation of cholesterol levels.

Late symptoms

• Goiter or the enlargement of the thyroid gland
• Hoarse voice due to goiter
• Decreased basal body temperature
• Depression

Other symptoms related to slowed brain functioning may also arise. These include:

• Impaired memory
• Inattentiveness
• Slow reflexes

Symptoms in women

Certain symptoms may also be specific to women such as:

1. Increased risk for abortion or miscarriage – When metabolism is slow, fetal development is also affected due to poor nutrition to the fetus.
2. Fertility problems – The ovaries may not be able to produce egg cells regularly because of impaired body functioning.
3. Prolonged, heavy and irregular menstrual period – Thyroid hormones are responsible in regulating the menstruation. Absence or lack of hormones may lead to heavy menstruation.
4. Galactorrhea – Similar to the mechanism in menstruation, there is increased production of prolactin that stimulates the cells to produce milk despite being not pregnant or not nursing a baby.

Symptoms in men

Symptoms in men may include:

• Fertility problems – The testosterone levels in the body are also reduced leading to difficulties in spermatogenesis.
• Decreased libido – The affectation of the testosterone also reduces the sexual functioning in men.
• Gynecomastia – Gynecomastia is the development of enlarged breast tissue in men as a result of increased estrogen levels.

Causes of Underactive thyroid

Specific causes of underactive thyroid are related to the destruction of the thyroid gland as well as problems on the pituitary gland or hypothalamus, which regulates thyroid function. These include:

• Hashimoto thyroiditis – This is an autoimmune disease that leads to the destruction of the thyroid gland by the body’s own immune cells.
• Congenital anomalies – Women exposed to teratogens may have baby with congenital hypothyroidism that will be present indefinitely.
• Pituitary tumors – The presence of problems in the pituitary gland leads to a reduction in the thyroid stimulating hormone, which stimulates the thyroid glands to produce T3 and T4.
• Iodine deficiency – Lack of iodine in the diet predisposes to decreased production of thyroid hormones because iodine is the basic component of thyroid hormones.

Treatments for hyperthyroidism – Medications and surgery to treat overactive thyroid may accidentally reduce its functioning thereby leading to underactive thyroid.

Medications – Medications such as amiodarone (anti-arrhythmic) and lithium carbonate (anti-manic drug) may also affect the thyroid glands and cause decreased production of hormones.

Diagnosis of Underactive Thyroid

Diagnosis of underactive thyroid is done by assessing the TSH and thyroid hormone levels. A high level of TSH with low T4 may indicate underactive thyroid that originates from the thyroid itself. A low level of TSH together with T4 signifies problems on the pituitary gland or hypothalamus. Circulating antibodies may also be assessed to determine autoimmune diseases.

Treatment

Treatment of hypothyroidism is based on medical approaches. Surgery is not a treatment of choice because it cannot reverse the damage to the thyroid gland. Medical therapy involves:

Synthetic Thyroid Hormone Administration – Synthetic hormones are usually given to supply the body with thyroid hormones that are needed to undergo normal metabolism. An example of this drug is Synthroid or levothyroxine. These medications can improve symptoms and may reverse cold sensitivity, weight gaining, weakness, fatigue, dry skin and hair loss. Thyroid hormones are administered daily 30 minutes to one hour before breakfast to maximize absorption. Calcium and caffeine should be avoided because these inhibit the absorption of thyroid hormones. Thyroid hormone levels are also monitored to prevent sudden increase and too much thyroid hormone that may lead to overactive thyroid.

Thyroid replacement therapy may take one of these combinations:
1. T3 and T4 combination
2. Levothyroxine only
3. Desiccated Thyroid extract (an animal-based thyroid extract, which comes from porcine sources).

Thyroid replacement therapy is usually increased pregnancy.

Diet and Natural Remedies

Some patients with hypothyroidism may not require medications and can be managed with proper diet and home remedies. Before taking any home remedies, it is best to consult a physician.

Diet

Diet is an important factor for the prevention and treatment of hypothyroidism. An increase in goitrogens or foods that cause low levels of thyroid hormone plays as role in the development of underactive thyroid. These foods include cauliflower, cabbage, radish, broccoli, soy, millet, kale, and Brussels sprouts. Management of hypothyroidism includes avoiding these foods and substituting it for iodine rich foods such as sea foods and the use of iodized salt.

Other home remedies include:

• Increase selenium intake – Selenium is very important in the management of underactive thyroid. Selenium serves as a stimulant in the conversion of T4 to T3. Selenium can be found in salmon, snapper, halibut, tuna, cod, shrimp, and mushrooms.
• Consume tyrosine rich foods – Tyrosine is responsible for manufacturing thyroid hormones from iodine. It is found in lean meat, fish, wheat, dairy products and oats.
• Consider using herbs – Herbs such as ginseng, black cohosh and spirulina are beneficial for people with underactive thyroid.
• Consume small frequent meals – Instead of taking three big meals, substitute it with six small meals because small meals with good quality improves metabolism.
• Engage in exercise – Exercise allows the body to hasten metabolism and also helps people with hypothyroidism to lose weight and increase immunity.

Underactive Thyroid Problems and Side effects

Complications of hypothyroidism include those that results from slowed body metabolism such as cardiomyopathy, heart failure and myxedema coma. Myxedema coma is a life-threatening condition arising from underactive thyroid.

What is Ocular Rosacea?

Rosacea is a chronic skin condition where there is formation of papules on the face as well as appearance of thin blood vessels under the skin. Rosacea affects 5% of the world population with increased risk for people in the middle adulthood stage. Women and fair-skinned people also have a higher risk for developing it.

Rosacea is sometimes linked to the occurrence of acne; however, acne and rosacea are different. Rosacea often involves the eruptions of tiny papules on the skin, especially on the face. Causes of rosacea include skin mites, Pitorosporum ovale and other fungal and bacterial infections. Connective tissue problems, gastric secretions and genetics also play a role in the development of rosacea.

Symptoms of rosacea include the appearance of a rash on the nose and face, frequent blushing, telangiectasia or appearance of small capillaries on the face, firm acne nodules, and pustules on the face.

When rosacea is not managed accurately and promptly, it usually leads to complications. Ocular rosacea is one complication of a rosacea disorder when the condition is left untreated. It affects 20% of those having facial rosacea. It involves the affectation of the eyes and eyelids and may cause a burning sensation in the area. It is similar to seborrheic dermatitis, affecting the eyes because it leads to a chronic inflammation of the eyelids with resultant crusts and scales. Some also experience the occurrence of rhinophyma or a bulbous nose as a result of rosacea.

Symptoms and Signs of Ocular Rosacea

Ocular rosacea produces symptoms such as:

1. Redness of eyes or blood shut eyes
2. Irritation
3. Burning sensation
4. Feeling of having an eyelash on the eye
5. Gritty feeling on the eye
6. Swollen eyelids
7. Small bumps on the eyelids
8. Falling of eyelashes
9. Photophobia
10. Pain on the eyes
11. Dryness of the eyes
12. Blurred vision
13. Appearance of stye
14. Evident small blood vessels on the sclera or the white portion of the eyes

The symptoms of ocular rosacea are usually distinct from the severity of skin rosacea. Other complications include the following eye conditions:

1. Conjunctivitis or the inflammation of the bulbar conjunctiva
2. Blepharitis or inflammation of the eyelids
3. Iritis or the inflammation of the iris
4. Keratitis or the inflammation of the cornea
5. Iridocyclitis
6. Hypopyoniritis

Causes of Ocular Rosacea

The exact cause of ocular rosacea is unknown, but several factors contribute to its development. The focus of the risk factors includes becoming dehydrated and eye irritation as a cause of ocular rosacea. Causes of ocular rosacea are synonymous to the causes of facial rosacea which include:

1. Consuming high amounts of beverages containing caffeine
2. Drinking alcoholic beverages
3. Eating spicy foods
4. Exposure to extreme temperatures
5. Prolonged exposure to the sun
6. Stress
7. Strenuous exercise
8. Frequent hot baths or sauna baths
9. Some antihypertensive medications
10. Corticosteroid therapy.
11. Family history of rosacea and being fair-skinned also contribute to the occurrence of ocular rosacea.

Treatment of Ocular Rosacea

The management of rosacea is focused on alleviating the symptoms and eradicating the causative factors. Managements include:

Warm compress. Warm compresses may be placed on the eyelids and eyes to relieve pain and irritation. A warm compress also liquifies the thick secretions in the meibomian gland, located on the eyelids, which enhances excretion.

Washing eyes with warm water. Good eye care is essential in removing the crusts and allowing the area around the eyes to be moisturized. Other mild cleansers may be used to clean the eyelids. Gentle pressure on the eyelids may also help in expressing the thick secretions.

Artificial Tears. Artificial tears aid to relieve dryness in the eyes. Non-preserved artificial tears are used during the day and lubricating ointment may also be applied at night.

Antibiotics. These drugs are used to counteract and prevent eye infection. Antibiotics are in the form of tetracyclines, erythromycin or doxycycline. Metronidazole may also be given to aid in the management of ocular rosacea through its anti-inflammatory property. Antibiotics should be taken as prescribed to prevent drug resistance. Patients with asymptomatic ocular rosacea who do not manifest severe ocular rosacea should not be given antibiotics.

Steroids. Topical corticosteroids are used for acute exacerbation of the condition. This relieves inflammation associated with keratitis and other inflammatory conditions of the eyes. However, the use of topical steroids should be monitored because it can lead to corneal melting after prolonged use.

Retinoids. Retinoids or Vitamin A derivatives can be used to reduce inflammation in the eyes associated with ocular rosacea. It is very helpful in the prevention of over-secretion of sebum by reducing the size of sebaceous glands. The most commonly used retinoids are tretinoin and isotretinoin. However, these compounds should not be used during pregnancy because they cause teratogenic effects to the fetus, leading to congenital anomalies.

Immunomodulators. Immunomodulators such as cyclosporine are used for anti-inflammatory action that reduces secretions in the eyelids.

Anti-ulcer drugs. The use of anti-ulcer drugs is necessary for the treatment of ocular rosacea because the occurrence of ulcer has been linked to the development of rosacea.

Dietary Restrictions. Dietary restrictions are also essential, especially in the treatment of mild forms of rosacea. This includes avoidance of irritating foods such as alcohol, spicy foods, hot beverages, and caffeine. Diet is one of the causes of rosacea; thereby, restricting a person’s intake of these foods is very important.

Sun protection. When going out, patients with ocular rosacea should protect the eyes from the sun by using sunglasses, an umbrella or a cap to reduce the harsh effects of the sun.

Surgery. More severe cases of ocular rosacea require surgery to correct the condition. Punctual occlusions may be helpful to prevent excessive secretions. Amniotic membrane may also be used to reconstruct the damaged cornea in cases of corneal ulceration or epithelial defect. Keratoplasty and limbal system transplant is also done for corneal ulceration and limbal system deficiency.

Prevention of Rosacea

Once facial rosacea has occurred, it is difficult to prevent rosacea. However, early management of facial rosacea is very essential to prevent its development. Other measures that can be done include:

1. Comply with the treatment plan even if symptoms of facial rosacea have already resolved.
2. Avoid things that potentially trigger the development of ocular rosacea such as preventing extremes of temperature, irritating foods, caffeine, exposure to the sun, and alcohol consumption.
3. Avoid using contact lenses for the moment until facial rosacea has been treated completely.

Pictures

Picture 1 – Four forms of rosacea

Image source – gstatic.com

Picture 5 – Ocular, Eyelid involvement in Ocular rosacea

Picture 6 – Excessive pannus and corneal thinning in ocular rosacea

There could be a number of causes associated with persons reporting to having pain on the left rib cage of their body.

Pain under Left Rib Cage Causes

This may either be due to severe illness, injuries or:

Spleen Irritation

The spleen being irritated or ruptured can cause disquiet and pain under the left rib cage.

Gas in the Colon

Splenic flexure syndrome is another name for this kind of disease condition. It is when excessive amount of gas is trapped in the colon which leads to causation of pain under the rib cage. The consumption of gas forming food causes the indigestion which leads to such accumulation of gasses in the colon and leading to the symptoms of pain under the left rib cage.

Heartburn or Reflux of Acid

A common reported case associated with the pain under the left rib cage symptom is when the person experience heart burn or acid reflux. This is due to over consumption of acid rich food or drinks that leads to heartburn. The pain felt is sharp that is sometimes misdiagnosed as chest pain. Others experience a bloated feeling because of the deficiency of acid of the stomach to break down the food inside the stomach.

Costochondritis

It is a result from an infection in the cartilage that binds the ribs with the breastbone. It is caused by a viral infection. There is unbearable pain felt near the breastbone during breathing or whenever the person breathes. It is also has a symptom of pain under the left rib cage. This condition is otherwise known as costosternal syndrome.

Broken Ribs

Injury in the left rib cage can cause pain under the left rib cage. The pain is felt or experience upon normal breathing episodes.

Stomach Ulcer

When a person has stomach ulcer, there is a sharp pain felt under the left rib cage. This ulcer causes pain the moves up to the shoulder blade area. The pain usually last to a few minutes or it recurs in an interval period.

Pneumothorax

This is when the lungs collapse or the so call known as atelectasis because there is a rupture of the lung membrane and the air will leak out to the cavity in between the lungs and the rib cage which lead to pain felt under the rib cage areas. This condition needs an immediate medical attention.

IBS or Irritable Bowel Syndrome

There is a pain in the abdomen, cramps and bloating which is manifested by a person diagnosed with this medical condition. Along with that there are sharp pains under the rib cage area which leads to cramps in the person’s intestines.

Pinch Nerve in the Thoracic Spine

Osteoporosis, rheumatoid arthritis, bulging or herniated disc or spondylitis can result to this disease condition. It leads to the innervations of the muscles and skin of the chest wall. The person having this disease condition will manifest pain under left rib cage.

Herpes Zoster or Shingles

The shingles is caused by an inflammation of the spinal nerves due to the infection called Herpes Zoster or varicella virus. It causes burning pain under the left rib cage and itchy rashes.

Pancreatitis and Pancreatic Cancer

It may also be due to pancreatitis or inflammation of the pancreas or there is tumor in the pancreas that results to pain under the left rib cage.

Spleen Disorders and Enlarged Spleen

Spleen disorders such as systemic lupus erythematosus or SLE, spleen rupture, spleen infarct, infectious mononucleosis, malaria, lymphoma, sickle cell anemia, leukemia, and other genetic metabolic disorder can cause the symptom of pain under the left rib cage to be manifested.

Angina

Angina will lead to pain under the left rib cage because of the fact that there is decreased blood flow going to the heart.

Other possible etiology of why there is pain under the left rib cage may include: Pericarditis, Aneurysm, Henoch Schonlein Purpura, Kidney disease, Gastric Ulcer, Chest or Abdominal Trauma, or stretched or torn muscle or a possibility of muscle spasm in either in the chest or abdominal wall.

Pain under Left Rib Cage in Different Conditions

Pain under Left Rib Cage after Eating

When a person experiences pain under the left rib cage after eating it may be due to:

Food Poisoning – It is caused by consumption of contaminated food that leads to vomiting, fever and severe pain under the left rib cage.

Heartburn or acid Reflux – There is heartburn associated when eating and then lying flat after eating. The lower esophageal sphincter is weak and causes the reflux of the acid from the stomach towards the esophagus to the mouth hence causing heartburn.

Hernia – It is when part of the bowel projects out of the abnormal opening of the wall of the stomach which leads to pain under the left rib cage after eating

Indigestion – After a heavy meal, there is excessive burping and pain is felt under the left rib cage. This occurrence is commonly associated with indigestion.

Pain under Left Rib Cage After Drinking

When a person drinks too much alcoholic beverages it is sometimes associates with gastritis. Persons with gastritis experiences pain in the left side under the rib cage which makes bowel movement painful and difficult for them. It could also be due to a cramp or appendix. When the pain persist, you should visit a physician.

Pain under Left Rib Cage while Pregnant

Anatomically speaking, your pancreas is located at the left anatomical area of your body and your stomach is located in the middle and ballooned towards the left. Both organs are located at the left region. Pregnant women often experiences heartburn or acid reflux from their stomach. This will lead to having pain felt under their left rib cage, where, as mentioned, the two organs are located.

Pain under Left Rib Cage when Breathing

Usually and the only reason when a person has a certain hypertrophied organ such as stomach or spleen, liver or perhaps a malignant and growing tumor may lead to compression of the diaphragm which may lead to pain felt under the left rib cage when a person normally breathes. When this occurs, you need to consult and go to the nearest hospital for further evaluation and for the condition to not get anymore worst.

Pain under Left Rib Cage Treatment

You need to treat pain under the left rib cage as soon as possible in order for the underlying condition to not flourish into an aggravating and serious condition. Persons reporting to have pain felt under the left rib cage may or may not be directly caused or related to a serious medical condition but it can’t be totally taken for granted because it may lead to a worst health condition. The treatment usually will depend on the etiology and the severity of the pain that the person is experiencing. Such treatment can be:

• Anti inflammatory medication
• NSAIDs or non steroidal medications
• Steroid injections
• TCA or Tricyclic Antidepressants
• Local Anesthesia
• Rest
• Self care
• Avoiding strenuous activities

Aspermia is a condition wherein the males do not produce semen. This is different from azoospermia, which is the absence of sperm cells in the male semen. Aspermia is widely associated with male infertility. In this condition, males usually reach orgasm and experience the sensation of ejaculation, but do not actually ejaculate semen, meaning there is no semen released from the body. Normally, in males who are fertile, there is constant production of sperm cells by the testes. These cells then are stored in the epididymis and released every time the male reaches orgasm and experiences ejaculation. During this process, a volume of sperm cells released by the epididymis moves across the vas deferens, which acts as a bridge between the testicles and the prostate gland. Inside the prostate gland, the sperm cells are incorporated with secretions coming from the prostate gland, the semininal vesicles and from the Cowper’s gland, which becomes the semen that is released during periods of ejaculation from the penis.

Aspermia Causes

There are two noted causes of aspermia: retrograde ejaculation and ejaculatory duct obstruction.

Retrograde ejaculation

In this condition, the semen streams into the bladder rather than outside the body via the urethra and out of the body by the penis. This condition is a result of bladder sphincter malfunction which results from weak muscles and impaired nerve supply in the sphincter muscles.

Aspermia caused by retrograde ejaculation usually occur as a result of:

1. Prostate or testicular surgery
2. Damaged nerve as a result of a disease
3. May also be correlated to diseases such as diabetes, spinal cord injury, and multiple sclerosis.
4. It can also result from regular intake of medications like tamsulosin which is used to treat prostate tumors, antihypertensive drugs, antidepressants and antipsychotic drugs.

Ejaculatory duct obstruction

This is the other leading cause of aspermia. The following are probable causes of this condition contributing to aspermia:

1. Congenital cyst found inside the ejaculatory ducts.
2. Conditions such as inflammation of the prostate gland, or tuberculosis of the prostate gland may also cause ejaculatory duct obstruction.
3. Infection with a sexually transmitted disease like Chlamydia is also a likely cause.

Aspermia Symptoms

Aspermia is rare compared to other conditions causing male infertility. There are only few, but they are very apparent signs and symptoms of this condition. The following are the noted symptoms of aspermia:

1. Absence of semen upon ejaculation, usually referred to as dry orgasms
2. Hazy urine after reaching the peak of intercourse. This is the result of leakage of semen in the bladder possibly due to an obstruction.
3. Pelvic pain after ejaculation
4. Oligospermia or the very little amount of semen is released
5. Unable to father a child or male infertility because there is no semen entering the vagina during intercourse.

Diagnosis

The diagnosis of aspermia is dependent on the factors that leads to the disorder. Upon consultation, the doctor will advise the patient to take the following tests to confirm aspermia to provide adequate and proper treatment procedures.

1. Patient history: An elaborate patient history is very important in understanding the conditions underlying the disorder.
2. Physical Examination: This procedure involves the evaluation of the genitalia and testicles to ensure that all of the important parts are present especially the tubules or the vas deferens.
3. Post-ejaculate urine analysis: This is done to check if semen is present in the urine, which confirms retrograde ejaculation as the cause of aspermia.
4. Blood tests: This includes tests for a follicle-stimulating hormone and testosterone. A decreased in the level of testosterone results in very low amounts of semen.
5. Radioimmunoassay (RIA): This test is utilized to check levels of sexual hormones in the blood. In aspermia, results show that testosterone and follicle-stimulating hormone levels are decreased and there is an apparent increase in the level of luteinizing hormone.
6. Wright-Giemma stain: This test is done to check sperm morphology among aspermia patients.
7. Microscopic examination of the sperm: This is important in the diagnosis of aspermia.
8. Chemical analysis of the semen: This test will show that there is a decrease in the concentration of fructose in the semen and that the pH is also low.
9. Imaging studies: This includes a transrectal ultrasound and magnetic resonance imaging. This is done to see if there are damages in the structure of the prostate gland and the seminal vesicles.

Aspermia Treatment

The treatment of aspermia is the aimed at the eradication of the causes of the disorder. Conservative therapy is given, but if this does not correct the problem, operation may be recommended.

If the cause of the condition is drug-related, medications causing the problem should be stopped.

Oral therapy

This helps the bladder neck to constrict during ejaculation, thereby allowing semen to flow directly into the urethra. These drugs will help restore the function of the damaged nerve that causes the condition. These include:

1. Pseudoephedrine (Sudafed plus): 120mg taken before ejaculation
2. Imipramine (Tofranil): 25-50 mg taken daily for the span of one month
3. Phenylephrine (Neo-Synephrine): Nasally sprayed 1-2 hours before ejaculation
4. Ephedrine (Ventolin): 30-60 mg taken 1-2 hours prior to ejaculation
5. Inhalers (Apulent and Proventil): taken 1-2 hours prior to ejaculation
6. Chlorpheniramine (Atarax): taken 2x daily for the span of 1 month
7. Bromopheniramine (Vistaril): taken 2x daily for the span of 1 month

Assisted reproduction

This procedure is done when the affected males want to father a child. There are several ways achieve this procedure. This includes the following:

1. Intrauterine insemination: Semen collected in the urinary bladder is introduced in the partner’s uterus. This procedure has been successful in most patients.
2. In Vitro fertilization: This procedure is done if the sperm has decreased motility and decreased numbers of sperm.
3. Bladder sperm harvest: This procedure is done when urine pH does not go up despite the use of medications to increase the pH since exposure of sperm cells to urine results in death of sperm cells.

Surgery

Surgical procedure is done if, and only if, the condition cannot be treated with medications and other adjunctive therapy.

1. Transurethral resection of the ejaculatory duct (TURED): This invasive procedure is done to correct ejaculatory duct obstruction if this is the one causing aspermia. This procedure leads to normal pregnancies but causes several complications. This can cause damage to the valves found in the orifice of the ejaculatory ducts and lead to the urethra causing urine to retreat inside the seminal vesicles.
2. Recanalization of ejaculatory ducts: This is another procedure done to correct aspermia caused by ejaculatory duct obstruction. This is done by transrectal or transurethral insertion of balloon catheter. The balloon catheter will dilate the obstructed ejaculatory duct to allow semen to flow freely. The rate of success for this procedure is not yet known and it also causes complications.

Aspermia Complications

Aspermia, once treated and detected early, will not result in any complications. Early detection and treatment of underlying causes is the key to prevent complications.

The most notable complication of aspermia is male infertility. Despite infertility, affected males can still father a child and live normally since their semen can be collected and stored in a sperm bank for future use via assisted reproduction.