Menstrual Cramps Or Painful Menstruation (Dysmenorrhea) : Symptom, Cause, Diagnosis, Treatment, And Drug

Dysmenorrhea (Menstrual Cramps) is pain during menstruation.Painful menstruation usually begins around the time that menstruation starts.Symptoms of dysmenorrhea often begin immediately following ovulation. They can last until the end of menstruation because dymenorrhea is associated with changes in hormonal levels in the body that occur with ovulation.During menstrual period the uterus contracts to expel its lining.Hormone-like substances prostaglandins involve in pain and inflammation trigger the uterine muscle contractions.Higher levels of prostaglandins are associated with more severe menstrual cramps.Primary dysmenorrhea has also been attributed to behavioral and psychological factors.In primary dysmenorrhea, there is a highly complex interplay between hormones and mediators, basal body temperature, sleep patterns, and the central nervous system (CNS), the extent of which is not completely understood.

Dysmenorrhea can be classified based on the absence or presence of an underlying cause :

• Primary dysmenorrhea is menstrual painthat is not associated with macroscopic  pelvic pathology.It occurs in the absence of pelvic pathology.
• Secondary dysmenorrhea is menstrual pain resulting from anatomic or macroscopic  pelvic pathology.It results from identifiable organic disease.

Clinical features of primary dysmenorrhea include

• Onset shortly after menarche (6 months or up)
• Usual duration of 48-72 hours often starting several hours before or just after the menstrual flow.
• Cramping or laborlike pain.
• Background or constant lower abdominal pain, back or thighs pain.
• Unremarkable pelvic examination findings.

Clinical features of secondary dysmenorrhea include

• Dysmenorrhea begins in the 20s or 30s, after previous relatively painless cycles.
• Heavy menstrual flow or irregular bleeding.
• Dysmenorrhea occuring during the first or second cycles after menarche.
• Pelvic abnormality with physical examination.
• Poor response to non-steroidal anti-inflammatory drugs or oral contraceptives (OCs).
• Infertility
• Vaginal discharge

The Symptoms of Dysmenorrhea

• Nausea
• Vomiting
• Diarrhea or constipation
• Headache
• Dizziness
• Fainting
• Fatigue
• Disorientation
• Hypersensitivity to sound, light, smell, and touch
• Pain in the lower abdomen or pelvis
• Pain in the lower back and thighs

The Cause of  Primary Dysmenorrhea

• Endometriosis is the presence of endometrium like tissue found outside of the uterus, most commonly in ovaries.
• Uterine Fibroids are non-cancerous growths in the wall of the uterus and may be cause the pain.
• Adenomyosis is an invasion of myometrium by uterine adrenal glands.
• Pelvic Inflammatory Disease (PID) is an infection of the uterus and fallopian tubes, with or without ovarian or parametrial involvement.
• Cervical stenosis is the opening of the cervix  may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.

The Common Causes of Secondary Dysmenorrhea

• Uterine Leiomyomata are benign tumors of the uterine musculature that are common cause of dymenorrhea because they enlarge when stimulated by estrogen.
• Adenomyosis is an invasion of myometrium by uterine adrenal glands
• Tubo-Ovarian abscess is a loculated infection within the fallopian tubes or ovaries, usually occuring as a sequela of pelvic inflammatory disease.
• Ovarian Torsion involves twisting of the adnexal structures, which lead to ischemia and ultimately necrosis if the process is not reversed in time.
• Pelvic Inflammatory Disease (PID) is an infection of the uterus and fallopian tubes, with or without ovarian or parametrial involvement.
• Endometriosis is the presence of endometrium like tissue found outside of the uterus, most commonly in ovaries.
• Premenstrual Dysphoric Disorder may have bloating, migraine, body aches, breast tenderness, headache, and emotional complaints.
• Intrauterine Contraceptive Devices (IUCDs) may cause bladder or uterine perforation.

The Risk factors for Primary Dysmenorrhea :

• Earlier age at menarche or before twelve years olds
• Long menstrual periods
• Heavy menstrual flow
• Smoking
• Family history
• Obesity
• Nulliparity

Risk factors of Secondary Dysmenorrhea

• Leiomyomata (Fibroids)
• PID
• Tubo-Ovarian abscess
• Ovarian torsion
• Endometriosis

Diagnosis

Dysmenorrhea diagnosis is made on a medical history of menstrual pain that interferes with daily activity.There is no standard technique for qualifying the severity of painful menstruation.

• Menstrual symptometrics are tthe quantification models to estimate the severity of the menstrual pain as well as correlate them with pain in other parts of the body, menstrual bleeding and degree of interference with daily activities.

Secondary dysmenorrhea is diagnosed by laboratory tests to identify or exclude organic causes of secondary dysmenorrhea

• Complete blood count with differential.
• Gonococcal and Chlamidial cultures, enzyme immunoassay, and DNA probe testing.
• Quantitative human chorionic gonadotropin level.
• Erythrocyte sedimentation rate
• Urinalysis
• Stool guaiac
• Cancer antingen 125 assay

Imaging Studies are used to diagnose if the pelvic pathology is suspected :

• Abdominal or transvaginal ultrasonography
• Hysterosalpingography
• Intravenous pyelography
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Laparoscopy
• Hysteroscopy
• Dilatation and Curettage

Treatment of Dysmenorrhea

1. Pharmacotherapy is to relieve dysmenorrhea effectively.Secondary dysmenorrhea treatment involves correction of the underlying organic cause.
2. Medications approved by FDA (Food and Drug Administration), including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
3. The Intraurine System (Mirena IUD) is to reduce dysmenorrhea symptoms.
4. The supplements are proved effectively to treat dysmenorrhea :

• Omega-3 fatty acids
• Thiamine (Vitamin B1)
• Pyridoxine (Vitamin B6)
• Magnesium
• Vitamin E

5. Physical Activities or exercises are to treat or relieve dysmenorrhea

• Yoga
• Acupuncture
• Homeopathy
• Massage

Drugs for Dysmenorrhea

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.NSAIDs are approved by FDA as follow :

• Diclofenac
• Ibuprofen
• Ketoprofen
• Meclofenamate
• Mefenamic acid
• Naproxen

Other Non-Steroidal Anti-Inflammatory Drugs and Analgesics that have been used :

• Aspirin
• Acetaminophen
• COX-2 Inhibitors
• Montelukast

Oral Contraceptives (OCs) are used for treating dysmenorrhea eventhough these drugs are not approved by FDA (Food and Drug Administration) as below :

• Depot medroxyprogesterone acetate
• Ethynil estradiol with progestin or drospirenone (Combination OCs)
• Levonorgestrel Intrauterine device
• Norplant
• Depo-provera

Caution :
You have to see a doctor if menstrual cramps

• Interfere with the every day life every month
• Get increasingly worse
• Last more than two or three days
• Start after age twenty five
• Accompanied by bleeding, fever, or foul smelling discharge

Obesity : Classification, Risk Factor, Diagnosis, Treatment, and Drug

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health.It can be defined as having a body mass index (BMI) of 30 or more.Body mass index (BMI) is a measurement that takes a person's weight and height into account.BMI is usually expressed in kilograms for square metre, resulting when weight is measured in kilograms and height in metres.Obesity is commonly caused by a combination of excessive food intake, lack of physical activity, and genetic susceptibility.BMI is defined as the subject's weight divided by the square of their height and is calculated as follows :

Where m and h are the subject's weight and height respectively


The Classification of Obesity

• Under weight   : 18.5 kg/m2
• Normal weight : from 18.5 kg/m2 up to 25.0 kg/m2
• Over weight      : from 25.0 kg/m2 up to 30.0 kg/m2
• Class I obesity  : from 30.0 kg/m2 up to 35.0 kg/m2
• Class II obesity (Severe obesity) : from 35.0 kg/m2 up to 40.0 kg/m2
• Class III obesity (Morbid obesity) : 40.0 kg/ m2
• Super obesity   : 45.0 kg/m2 up to 50.0 kg/m2

Ten possible contributors to the recent increase of obesity :

1. Insufficient sleep.
2. Endocrine disruptors is environtmental pollutants that interfere with lipid metabolism.
3. Decreased variability in ambient temperature.
4. Decreased rates of smoking. Smoking suppresses appetite.
5. Increased use of medications that can cause weight gain (Atypical antipsychotics).
6. Porpotional increases in ethnic and age groups that tend to heavier.
7. Pregnacy at later age which may cause susceptibility to obesity in children.
8. Epigenetic risk factors.
9. Natural selection for higher body mass index.
10. Assortative mating leading to increase concentration of obesity risk factors

Risk factors of obesity

1. Genetics
2. Sedentary lifestyle
3. Psychological factors
4. Environment and community
5. Certain medications, including thiazolidinediones, steroids, certain antidepressants, insulin, sulfonylureas, atypical antipsychotics, certain anticonvulsants ( phenytoin and valproate ), pizotifen, and some of hormonal contraceptive.
6. Medical illness increases obesity risk include genetic syndrome, some congenital or acquired conditions, such as Cushing's syndrome, hypothyroidism, growth hormone deficiency, and the eating disorders (binge eating disorder and night eating syndrome).

Complications of Obesity

• Cardiovascular disease
• Asthma
• Diabetes mellitus type 2
• Obstructive sleep apnea
• Osteoarthritis
• Certain types of cancer, such as colon, endrometrial, breast
• Stroke
• High blood pressure
• Heart disease
• Infertility
• High cholesterol

Diagnosis

Obesity is diagnosed by certain tests :

• Accurate measures of body fat and body fat distribution include skinfold thickness, waist-to-hip comparisons.
• Screening tests, such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) scans.
• Blood tests are to examine cholesterol and glucose levels.
• Liver function tests.
• Diabetes screen.
• Thyroid tests.
• Heart tests, such as an electrocardiogram.

The Treatment of Obesity

1. Dieting and physical exercise
2. Lifestyle and behaviour changes.
3. Certain prescription weight loss medications
4. Weight loss surgery (Bariatric Surgery) is not a quick fix.It is a major surgery that can have serious risk.Surgical options include :

• Gastric by pass surgery creates a small pouch at the top of the stomach that connects directly to the small intestine.Food and liquids go through the pouch and into the intestine by passing most of the stomach.
• Laparoscopic Adjustable Gastric Banding (LAGB) separates the stomach into two pouches using a band.
• Gastric Sleeve removes part of the stomach.
• Biliopancreatic Diversion with duodenal switch removes most of the stomach.

Drugs for Obesity

• Orlistat (Xenical) 
• Lorcaserin (Belviq)
• A combination of Phentermine and Topiramate (Qsymia)

Weight loss with Orlistat is modest, an average of 2.9 kilograms (6.4 lb) at 1 to 4 years.It's use has side effectd that are associated with high rates of gastrointestinal and kidney.

Lorcaserin results an average of 3.1 kilograms weight loss (3% of body weight).The side effect of lorcaserin can increase heart valve problems.

Prevention of Obesity

• Doing Physical activities or exercises, such as walking, biking, and swimming for twenty or thirty minutes daily.
• Eating high fat, high calorie foods in moderation.
• Consuming nutrious foods like fruits, vegetables, lean protein, and whole grains.
• Consuming dietary fiber.

Halitosis (Bad Breath) : Symptom, Cause, Diagnosis Approach, Treatment, And Prevention

Halitosis (Bad Breath) is a symptom in which a noticeably unpleasant odor is present on exhaled breath.The foul oral odor is usually caused by a group of anaerobic, sulfur-producing bacteria that breed beneath the surface of the tongue and often in the throat and tonsil area.The term anaerobic literally means living without oxygen.The bacteria occur naturally in the oral environment.They are essential because they assist in digestion by breaking down proteins into amino acids.

The symptoms of Halitosis

• Post-nasal drip
• A bitter metallic taste
• A white coating on the tongue
• Thick saliva

The Author suggested that halitosis can be divided according to the character of the odor into three groups :

• Sulfurous or fecal caused by volate sulfur compounds (VSC), most notably methyl mercaptan, hydrogen sulfide, and dimethyl sulfide.
• Fruity caused by acetone, present in diabetes.
• Urine-like ammoniacal caused by ammonia, dimethyl amine, trimethylamine (TMA), present in trimethylaminuria and uremia.

An Etiologic classification of halitosis has been proposed :

• Type 0 : Physiologic
• Type I : Oral
• Type II : Airway
• Type III : Gastroesophageal
• Type IV : Blood-borne
• Type V : Subjective

The causes of Halitosis

1. Mouth is exposed to less oxygen and is inactive at the night, the odor is usually worse upon awakening.Dry mouth can cause the growth of bacteria.
2. Tongue.Large quantities of naturally-occuring bacteria are found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity.This part of the tongue is relatively dry and poorly cleansed, and the convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, wgich flourish under a continually-forming tongue coating of food debris, dead epithelial cells, postnasal drip, and overlying bacteria, living and dead.
3. Nose and sinuses.Nasal odor may  be due to sinus infections.
4. Gums.Waste products from anaerobic bacteria growing below the gumline  (subgingival) have a foul smell and have been clinically demonstrated to produce a very intense bad breath.
5. Tonsils are the most significant cause of halitosis after the mouth.
6. Esophagus.A Zenker's diverticulum may result in halitosis due to aging food retained in the esophagus.
7. Stomach is considered as a very uncommon source of bad breath.
8. Halitophobia is bad breath suffer from a highly exaggerated concern of having bad breath.
9. Systemic disease  may cause foul breath odor 

• Fetor hepaticus
• Lower respiratory tract infections, such as lung and bronchial infections
• Diabetes mellitus
• Renal infection and renal failure
• Carcinoma
• Trimethylaminuria (fish odor syndrome)
• Metabolic conditions

10. Other potential can cause oral malador

• Deep carious lesions (dental decay) cause localized food and stagnation.
• Recent dental extraction sockets provide an ideal habitat for bacterial proliferation.
• Interdental food packing.
• Acrylic dentures (plastic false teeth).
• Oral infection.
• Oral ulceration.
• Fasting.
• Stress and anxiety.
• Menstrual cycle.At mid cycle and during menstruation can increase volate sulfur compound.
• Smoking.
• Alcohol.
• Volatile foodstuffs, such as garlic, onion, durian, cauliflower, radish  and cabbage.
• Medications can cause dry mouth that increases the growth of bacteria.

Diagnostic Approach

1. Self Diagnosis is not easy because of preconceived notions of how bad someone think it should be.One popular home method to determine the presence of bad breath is to lick the back of the wrist, let the saliva dry for a minute or two minutes and smell the result.This test results in overestimation.Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds and tongue swabs are available.
2. Professional Diagnosis is to use several laboratory methods for diagnosis of bad breath :

• Halimeter is a portable sulfide monitor used to test for levels of sulfur emissions (hydrogen sulfide) in the mouth air.It can be very effective at determining levels of certain volate sulfur compound-producing bacteria if the device is used properly.
• Gas chromatography is portable machines, such as OralChroma that is designed to digitally measure molecular levels of the three major volate sulfur compounds in a sample of mouth air, including hydrogen sulfide, methyl mercaptan, and dimethyl sulfide.
• Bana Test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
• Beta-Galactosidase Test is to find salivary levels of this enzyme to be correlated with oral malador.

Treatment of Halitosis

The treatment of halitosis effectively is not easy to find.There are some strategies to treat halitosis or bad breath :

• Gently cleaning the tongue surface in twice a day.
• Eating a healthy breakfast with rough foods that helps in cleaning the very back of the tongue.
• Chewing gum aids in provision of saliva, which washes away oral bacteria.It has antibacterial properties and promotes mechanical activity which help in cleansing  the mouth.Some chewing gums contain special anti-odor ingredients, such as mastic gum, cinnamon sticks, fennel seeds, and fresh parsley.
• Gargling right before bedtime with an effective mouthwash.Mouthwashes often contain antibacterial agents, such as cetylpyridinium chloride, chlorhexidine, zinc gluconate, hydrogen peroxide, chlorine dioxide, and essential oils.
• Maintaining proper oral hygiene, including daily tongue cleaning, brushing, flossing, and periodic visits to desntists and hygienists.
• Probiotic treatment by specifically Streptococcus salivarius K12 is to suppress maladorous bacteria growth.
• Brushing teeth occasionally with baking soda can neutralize excess acids found in the oral cavity.

Prevention of Halitosis

• Avoid drying medication or avoid using antidepressant, diuretics, antihisthamines unless it is medically necessary because these drugs inhibits saliva flow and can cause  chronic dry mouth.
• Stop smoking.Smoking can develop periodontal disease and dry mouth.
• Keep the mouth moist by drinking plenty of water.
• Breathe through the nose instead of the mouth.
• Eliminate dairy products from your diet.
• Clean dentures at least once a day.
• Avoid products with sodium lauryl, sulfate and alcohol.
• Clean the mouth after eating meat, fish, and dairy products.
• Drink green and black teas that contain polyphenols to eliminate sulfur compounds and reduce oral bacteria.
• Eat food with high fibers and avoid eating heavily processed foods that contain refined carbohydrate, such as ice creams, cookies, and cakes.

The Normal and Abnormal Symptoms In A Newborn Baby Or An Infant

A Newborn is an infant who is only hours, days, or up to a few weeks old.In medical context, newborn or neonate refers to an infant in the first twenty eight days after birth.

The characteristics of normal Symptoms in Nerwborn baby or infant :

• A newborn's head is very large in proportion to the body and the cranium is enormous relative to his or her face.
• The soft spots on baby's head is known as the fontanels.It is not brain.The soft spots exist in order to safely negotiate the narrow birth canal, a baby's skull is flexible.
• There is a Baby's pulse in his or her fontanels.Because the fontanels cover areas of the skull that have not yet fused together.They are soft that make veins and arteries visible.
• Some newborns have a fine, downy body hair called lanugo.
• A newborn's skin is often grayish,  to dusky blue in color after birth.The colour of the skin reaches its normal tone within a minute or two minute after beginning to  breathe.
• After birth, A newborn has the rash that develops shortly.It consists of  red blotches in a random distribution all over the infant.Most blotches have a central yellow-white pimple.The rash comes, goes and changes frequently.It lasts about two up to three weeks or disappers spontaneously.
• A newborn may have mongolian spots, various other birthmarks, or peeling skin, particularly on the wrists, hands, ankles, and feet.
• A newborn's shoulders and hips are wide, the abdomen protrudes slightly.
• A newborn's arms and legs are relatively long with respect to the rest of the body.
• A newborn's genitals are enlarged and reddened, with male infants having unusual large scrotum.
• The breasts of female infants and male infants may be enlarged.This is caused by naturally occuring maternal hormones.It is a temporary condition.Females and males may actually discharge milk from their nipples called witch's milk.
• Menstrual period in newborn female baby lasts about one week.Some baby girls experience one or two days and other  do not experience it at all.During pregnancy the infant comes in contact with reproductive hormones.Maternal hormones crossing the placenta stimulate growth in the infants uterine lining.
• Infant's urine may contain significant amounts of uric acid.These uric acid crystals get trapped in the diaper liner and appear like red brick dust.So these cause the urine appearance like blood.
• Baby sneezes all the time because the newborn has just emerged from his watery home in the uterus.It is likely to have at least a little congestion which may cause quite a few sneezes.Unless his sneezing is accompanied by thick, yellow mucus, which indicates a cold.
• Baby has soft and squishy poops after every feeding.Breasfed baby may poop after each feeding because breast milk is so quickly digested.As far as the squishy issue is concerned, most newborn poops are soft simply because they are on an all-liquid diet.
• The average of birth weight is typically in the range of 2,7 up to 4,6 kilograms.The average of a full-term newborn birth weight is approximately 3,4 kilograms.
• A newborn may need to comfort himself or herself  by suckling his or her thumb or a pacifier.
• The umbilical cord of a newborn is bluish-white in colour.After birth, the umbilical cord is normally cut, leaving a 1-2 inch stub.
• The cry of a newborn is as a form of basic instinctive communication.It is to express various feeling, such as hunger, discomfort, boredom, overstimulation, loneliness, and wanting something.
• A newborn hiccup constantly.Some say that it is due to miscommunication between the brain and diaphragm, the abdominal muscle that controls breathing.Regardless of the cause, hiccups are a harmless part of babyhood.
• Normal blood pressure of a newborn is 75-100 mmHg of Systolic, 50-70 mmHg of Diastolic.
• Normal heart rate (BPM) of a newborn is 120-160.
• Normal respiratory rate of a newborn is 30-60.

The abnormal symptoms in the newborn baby or infant

• Baby's lips are turning blue or mucus membranes in his/her mouth or tongue turn blue because it is a sign that he/she is not getting enough oxygen.This condition is known as cyanosis.
• All babies grunt and groan from time to time.But if their breathing is consistently hard and fast.They are using their chest muscles more than they should be and that their nostrils flare out.It may be a sign of respiratory distress.
• Baby is not making wet diapers.It is a sign of dehydration.One diaper for every day old up to six days of age and then six wet diapers a day going forward.At the least, that means two diapers for two days-olds, three diapers for three days-olds and so on.The other signs of severe dehydration include dry mouth, sunken eyes and lethargy.
• The babies throw up greenish bile.It is serious because green bile can  indicate that the intestines are blocked, which needs immediate attention.Vomit looks like coffee grounds.It is serious because it is a sign of internal bleeding.Vomiting after head injury will also require evaluation because it can be a sign of a concussion or of bleeding inside the cranium.Head injuries with or without vomiting should be evaluated by a doctor.
• An infant  is less than three months and has a raectal temperature  greater than 100.4 F or 38 C .It can be anything from a cold to meningitis.Fever in an infant is very non-spesific.Fever in the newborn should be treated seriously.
• A newborn  is getting yellower and yellower after birth, she or he may have worsening jaundice.Bilirubin is produced by the liver.The liver in the baby is like a furnace that it takes a while to get it going.It is ok.When the baby is born if his/her liver is not up to speed, bilirubin can build up in the body and cause the skin to turn a yellowish colour.Not all jaundice is dangerous.Some is normal and will go away on its own but if it is increasing as opposed to going away, it may need an evaluation.If bilirubin levels skyrocket, they can affect the brain, causing seizures and permanent damage.

The Bleeding of The Newborn Girl's Genital Or Menstrual Period In The Newborn Baby

The newborn daughter at the age of two or three days may have a little bit of bleeding from her vagina.It is caused by the withdrawal of the hormones she was exposed in the womb.It is normal and common for baby girl.The womb (uterus) is a hollow, pear-shaped organ located in a woman's slower abdomen between the bladder and the rectum.Vaginal bleeding is blood flow from the uterus.During pregnancy, a surge in maternal estrogen levels can stimulate a female fetus' uterus.Maternal hormones crossing the placenta stimulate growth in the infants uterine lining.This hormone stimulation is abruptly terminated at the birth and causes sloughing of hyperdeveloped uterine lining of the baby.

The newborn girl's genital has been exposed to many hormones in the uterus.It is caused by :

• These hormones may have caused a thick, milky discharge in the vagina.
• These hormones made the outside of the vagina (labia majora and the clitoris) a little swollen and prominent.

After birth,  babies still have hormones in their body left over from their nine months stay in the womb.This can lead to engorged genitals, swollen breast buds and small amounts of bleeding and discharge in both girls and boys, as the hormones slowly leave their body.When a women breastfeeds she passes her hormones to baby.During pregnancy the infant also comes in contact  with reproductive hormones.According to Medical professionals state that Breastfeeding is not a precursor to what is often called false menstruation.These increased hormones can cause small lumps to form in the breasts for both boy and girl babies.The baby girl may experience a menstrual cycle about one week.Some baby girls only experience the bleeding for a day or two days and others do not experience it at all.

A Study of 350 newborn girls revealed vaginal (Uterine) bleeding in 25,4 %, mostly demonstrable only by chemical-micro methods, but also macroscopically visible in 3,3%.This kind of bleeding appears always in the first week, with its highest frequency on the fifth day of life and must be regarded as a physiologic event.Analogues histologic and cytologic controls comfirmed these observations, pointing toward the fact that, as a rule no menstrual withdrawal bleeding, but degenerative regressional changes upon the endometrium occur.Due to the rapid withdrawal of maternal hormones, nutritive disorders may lead also to diapedesis bleeding.But if any genital bleeding lasts longer than one week or appears for the first time after that period, further diagnostic procedures are essential as a possible pathologic condition may be assumed.

The Way to Clean the Baby

Spread labia and wash out the creases gently that are not needed to go any deeper.The inside of baby vagina is cleaned with warm water only without soaps.It is sensitive tissue.Both the penis and vagina of babies are self cleaning.A baby girl's vulva should never be forcibly cleaned or any cleaning products inserted, as this can throw off the natural bacterial balance and cleaning process.A baby boy's foreskin should never be retracted.Do not come away with a wipe and just leave it if the vagina has any discharge .Do not attemp to remove it because it will come away by itself in a few days.As long as this area is cleaned gently at each diaper change to remove any leftover poop or urine.The body of baby will do what it is designed to do.

Dyspepsia (Indigestion) : Symptom, Cause, Diagnosis, Treatment, And Drug

Dyspepsia (Indigestion) is a condition of impaired digestion, such as upper gut.The upper gut include esophagus, stomach and duodenum. The gastrointestinal tract (gut) is the tube that transfers food to the digestion organs and expells waste.It extends from the mouth to anus.It is divided into upper tract and lower tract.


The Symptoms of Dyspepsia

• Upper abdominal pain or belching
• Nausea
• Heartburn (a burning sensation felt in the lower chest area)
• Feeling full earlier than expected when eating
• Upper abdominal fullness
• Bloating
• Vomiting
• Bitter-tasting liquid coming up into the back of the throat ( water brash)
• Depression
• Increased anxiety
• Black stools (severe)
• Trouble swelling (severe)
• Unexplained weight loss (severe)
• Bloody vomiting like coffee grounds (severe dyspepsi)

The Common Causes involve Dyspepsia

• Peptic ulcer disease is an ulcer of the stomach or duodenum.
• Non -ulcer dyspepsia (functional dyspepsia) is indigestion without evidence of an organic disease that is likely to explain the symptoms.
• Gastroesophageal reflux  disease (GERD), including gastritis, gastroparesis, inflammatory bowel disease, coeliac disease.
• Medications, such as aspirin, ibuprofen, antibiotics (metronidazole, macrolides), diabetes drugs (metformin, alpha-glucosidase inhibitor, amylin analogs, GLP-1 receptor antagonists), antihypertensive medications (angiotensin converting enzyme inhibitor, angiotensin II receptor antagonists), cholesterol-lowering agents (niacin, fibrates).
• Liver and pancreas disease, such as chronic pancreatitis, cholelithiasis.
• Helicobacter pylori infection.
• Systemic diseases, such as coronary disease, congestive heart failure, diabetes mellitus.

Diagnosis

Some procedures, tests and causes are diagnosed.

• Medical history
• Eating habits
• Physical Examination
• X-rays images of abdomen
• Endoscopic Examination
• Biopsy
• Blood Test
• Test of gallbladder or pancreas

The tests for diagnosing bacteria Helicobacter pylori

• A Breath Test is to confirm for having of a current bacteria Helicobacter pylori infection.
• An Alternative Test is the stool antingent test.It is to give a pea-sized sample of the tools (faeces) which is tested for helicobacter pylori.
• A Blood Test is to detect antibodies to bacteria Helicobacter pylori.
• A small sample (Biopsy) of the stomach lining

Treatment for Dyspepsia

• H2 Receptor Antagonist (H2RAs), including Zantac and Pepcid are to work in reducing stomach acid.Side effects of these medications are nausea, vomiting, diarrhea, rash or itching, constipation, headache, bleeding and bruising.
• Proton Pump inhibitors (PPIs), such as Prilosec are to reduce stomach acid.They are stronger than H2 Receptor Antagonists.The side effect of these medications include nausea, vomiting, constipation, diarrhea, cough, headache, backache, dizziness, and abdominal pain.
• Prokinetics, including prescription medications ; Reglan, Motilium are to improve the muscle action (motility) of digestive tract.The side effect of these medications are depression, anxiety, involuntary movements or spasms, and fatigue.
• Over-the-counter antacids, including Maalox, Mylanta are to neutralize acid in the stomach.The side effect of these medications may cause diarrhea and constipation.
• The changes of lifestyle and home care include avoiding spicy, fatty foodd that can trigger heartburn, reducing the consuming of the amount of coffeee, soft drinks and alcohol, Eating slowly, stopping smoke, eating smaller meals throughout the day, getting plenty of rest, losing excess body weight, stop taking aspirin, NSAIDs medicines that irritate the lining of stomach, and for posture lying down or bending forward alot during the day thar encourages reflux, sitting hunched up.

Drugs for Dyspepsia

To treat peptic ulcer by reducing stomach acid :

• Zantac
• Pepcid
• Prilosec

To treat bacteria Helicobacter pylori by using combination with antibiotics

• Clarithromycin
• Amoxicillin

To neutralize stomach acid by using antacids (alkali liquids or tablets)

• Maalox
• Mylanta

To reduce acid in the stomach

• Omeprazole
• Lansoprazole
• Pantoprazole
• Rabeprazole
• Esomeprazole
• Cimetidine
• Nizatidine
• Ranitidine
• Famotidine

Alternative Medicine

To treat non-ulcer dyspepsia as anti-dyspeptic effect by using herbal products found tn the several herbs, such as peppermint and caraway.

Kidney Stone : Type, Symptom, Risk Factor, Diagnosis, Treatment, Drug, And Prevention

Kidney stone (Renal Calculus or Nephrolith) is a solid piece of material which is formed in the kidneys from minerals in urine.Kidneys are a pair of organs located in the back of the abdomen.Each kidney is about four or five inches long (about the size of a fist).They sit opposite each other on either size of the spine.Kidneys' function are to filter the blood.They remove wastes, control the body's fluid balance, and regulate the balance of electrolytes.Kidney stone typically leave the body in the urine stream and a small stone may pass without causing symptoms.The size of stones at least 3 millimeters can cause the blockage of the ureter.Calcium is the electrolyte that influences the formation of kidney stones.Potassium is an inhibitor of calcium crystal formation that promotes the urinary excretion of citrate.Magnesium inhibits stone formation.Pain is typically the first sign of a kidney stone known as renal colic, the pain usually begins when a stone moves from where it has formed into the urinary tract.

There are four main Types of Kidney Stone

• Stones formed from calcium combined with oxalate or phosphate.

• Struvite stones are caused by a urine infection and are often horn-shaped and quite large.

• Uric acid stones are often softer than other form of kidney stone.

• Cystine stone are rare and hereditary and look more like crystals than stones.

The Classification of Urinary stones based on their location :

• The Kidney (Nephrolithiasis)

• The Ureter (Ureterolithiasis)

• The Bladder (Cystolithiasis)

The symptoms of  Kidney Stone

• Blood in the urine
• Painful urination
• Vomiting
• Nausea
• Fever
• Pus in the urine
• Shivering
• Sweating
• Cloudy or bad smelling of urine

Risk Factors of Kidney Stone

• Dehydration from low fluid intake.
• High dietary intake of animal protein, sodium, refined sugars, fructose, and high fructose corn syrup, oxalate, grapefruit juice, and apple juice.
• Dietary supplement of calcium intake.
• Drinking fluoridated tap water.
• Low urinary citrate excretion (Hypocitraturia).
• Excessive vitamin D supplementation.
• Certain behaviours associated with frequent and binge drinking.
• Soft drinks containing phosphoric acid (Colas)

Diagnosis

Diagnosis of kidney stone is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies.

1. Physical examination is to reveal fever and tenderness at the costrovertebral angel on the affected side.
2. Clinical diagnosis is made on the basis of the location  and severity of the pain, which is typically colicky in nature (comes and goes in spasmodic waves).
3. Laboratory tests include

• Microscopic examination of the urine is to show red blood cells,  bacteria, leukocytes, urinary casts, and crystals.
• Urine culture is to identify any infecting organisms present in the urinary tract and sensitivity to determine the susceptibility of these organisms to specific antibiotics.
• Complete blood count is look for neutrophilia (increased neutrophil granulocyte count) suggestive of  bacterial infection, as seen in the setting of struvite stones.
• Renal function tests are to look for high blood calcium blood levels abnormally.
• 24 hour urine collecttion is to measure total daily urinary volume, magnesium, sodium, uric acid, calcium, citrate, oxalate, and phosphate.
• Chemical analysis of collected stones can establish their composition, which in turn can help to guide future preventive and therapeutic managements.A Simple Tea Strainer or a Stone Screen Kidney Stone collection cup are to collect stones through urinating.
• Ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes.
• Computed Tomography (CT) scan is a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles

Treatments of Kidney Stone

• Extracorporeal Shock Wave Lithotripsy is a procedure that shatter stones into small fragments.It is used for severe cases.
• Surgery is to remove the stone.
• Endoscope Removal is an instrument that is inserted into the urethra, passed into the bladder, then to where the stone is located.It is to remove the stone or break it up.
• Percutaneous Nephrolithotomy is a small incision that is made in the back.It is used to remove kidney stone.

Drugs for Kidney stone

• Allopurinol is the drug to reduce kidney stone recurrences.
• Acetazolamide (Diamox) is a drug to alkalinizes the urine.
• Chlorthalidone and Indapamide are drugs to inhibit the formation of calcium-containing stones by reducing urinary calcium excretion.
• Drug for anti-inflammatory.

Preventation of Kidney Stone

• Increasing total fluid intake to more than two liters per day of urine output.
• Increasing citric acid intake, such as lemon or lime juice.
• Moderating calcium intake.
• Limiting sodium intake.
• Avoidance of large doses of supplemental vitamin C.
• Limiting consumption of soft drinks like cola.
• Limiting animal protein intake to no more than two meals daily.
• Sufficient dietary intake of magnesium and citrate.

Hypertension : Classification, Symptom, Cause, Diagnosis, Medication, And Prevention

Hypertension (High Blood Pressure) is a long term medical condition in which the blood pressure in the arteries is persistenly elevated.It usually does not cause symptoms.Normal blood pressure at rest is within the range of 100 - 140 millimeters mercury (mmHg) systolic and the range of  60 - 90 millimeters mercury (mmHg) diastolic.For adults, hypertension is present if the resting blood pressure persistenly at or above 140/90 mmHg.Hypertension can cause headache, failure to thrive, blurred vision, nosebleeds, and facial paralysis in older infant and children.

There are two measurements of blood pressure :

• The Systolic Pressure occurs when the left ventricle is most contracted.
• The Diastolic Pressure occurs when the left ventricle is most relaxed prior to the next contraction.

Hypertension (HT) can be classified into two :

• Primary Hypertension is high pressure without obvious underlying cause.
• Secondary Hypertension is hypertension due to an identifiable cause, such as chronic kidney disease, kidney arteries, an endocrine disorder.

The Signs and Symptoms of Hypertension

• Headache at the back of the head and in the morning
• Lightheadedness
• Vertigo
• Buzzing or hissing in the ears (Tinnitus)
• Altered vision or fainting episodes
• Anxiety
• Fatigue
• Dizziness
• Blood spot in the eyes
• Facial flushing
• Shortness breath

The Causes of Primary Hypertension

• Family history of hypertension
• High salt intake
• Obesity
• Stress
• Depression
• Lack of exercise
• Caffeine consumption
• Vitamin D deficiency
• Maternal smoking
• Low birth weight
• Lack of breastfeeding

The Causes of Secondary Hypertension

• Obesity
• Coarctation of the aorta
• Pregnancy
• Sleep apnea
• The consumption of liquorice excessively
• Herbal remedies
• Certain prescription medicines, and certain medications such as birth control pills, cold remedies, decongestants
• Illegal drugs, such as cocaine, amphetamines.
• Arsenic exposure through drinking water
• Alcohol abuse or chronic alcohol use

Diagnosis

Hypertension is diagnosed on the basis of a high blood pressure persistenly.Typical tests are performed :

• Kidney system uses tests, such as microscopic urinalysis, protein in the urine, BUN and/or creatinine.
• Endocrine system uses tests, including serum sodium, potassium, calcium, TSH.
• Metabolic system uses tests, such as  fasting blood glucose, HDL, LDL, and total cholesterol, triglycerides.
• The other can be used tests , such as hematocrit, electrocardiogram, and chest radiograph.

The clasification of blood pressure for adult

I. Normal 

• Systolic   : 90 - 119 mmHg
• Diastolic : 60  -   79 mmHg

II. High Normal (Prehypertension)

• Systolic   : 120 - 139 mmHg
• Diastolic :   80 -  89  mmHg

III. Stage I Hypertension

• Systolic   : 140 - 159 mmHg
• Diastolic :   90 -  99  mmHg

IV. Stage II Hypertension

• Systolic   : 160 - 179 mmHg
• Diastolic :  100 - 109  mmHg

V. Stage III Hypertension (Hypertensive Emergency)

• Systolic   : 180 mmHg or over
• Diastolic :  110 mmHg or over

VI. Isolated systolic Hypertension

• Systolic   : 140 mmHg or over
• Diastolic :  90 mmHg or over

Medications for Hypertension (High Blood Pressure)

1. Beta Blockers are to reduce the workload on the heart and open blood vessels, causing the heart to beat slower and with less force.

Beta Blockers include :

• Acebutolol (Sectral)
• Atenolol (Tenormin)

2. Thiazide Diuretecs act on the kidneys to help the body in eliminating sodium and water and reducing blood volume.

Thiazide Diuretics include :

• Hydrochlorothiazide (Microzide)
• Chlorthalidone

3. Angiotensin-converting Enzyme (ACE) Inhibitors help in relaxing blood vessels by blocking the formation of a natural chemical that narrows blood vessels.

These medications include :

• Benazepril (Lotensin)
• Lisinopril (Zestril)
• Captopril (Capoten)

4. Angiotensin II Receptor Blockers (ARBs) help in relaxing blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels.

These medications include :

• Losartan (Cozaar)
• Candesartan (Atacand)

5. Calcium Channel Blockers help in relaxing the muscle of blood vessels.

These medications include :

• Amlodipine (Norvasc)
• Diltiazem (Cardizem)
• Tiazac

6. Renin inhibitors are to slow down the production of renin, an enzyme produced by kidneys that starts a chain of chemical steps that increase blood pressure.

Renin inhibitors include :

• Aliskiren (Tekturna)

Additional Medications for treating Hypertension

1. Alpha Blockers reduces nerve impulses to blood vessels.

Alpha Blockers include :

• Prazosin (Minipress)
• Dosazosin (Cardura)

2. Alpha-Beta Blockers slow the heartbeat to refuce the amount of blood that must be pumped through vessels.

Alpha-Beta Blockers include :

• Labetalol (Trandate)
• Carvedilol (Coreg)

3. Central-Acting Agents prevent brain from signaling nervous system to increase the heart rate and narrow the blood vessels.

Central -Acting Agents include :

• Clonidine (Catapres, Kapvay)
• Guanfacine (Intuniv, Tenex)
• Methyldopa

4. Vasodilators prevent the muscles from tightening and arteries from narrowing.

Vasodilators include ;

• Hydralazine
• Minoxidil

5. Aldosterone Antagonists block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.

These medications include :

• Spironolactone (Aldactone)
• Eplerenone (Inspra)

Primary Prevention of Hypertension

• Maintaining normal body weight for adult.
• Reducing dietary sodium intake to 2, 4 g of sodium per day.
• Limiting alcohol consumption to no more than two units per day in women and three units per day in men.
• Consuming a diet rich in fruit and vegetables at least five portions per day.
• Enganging in regular aerobic physical activity.

Anemia : Type, Symptom, Causes, Diagnosis, And Treatment

Anemia is a decrease in the amount of red blood cells or hemoglobin in the blood or a lowered ability of the blood to carry oxygen.Red blood cells carry hemoglobin, an iron-rich protein that attach to oxygen in the lungs and carry it to tissues throughout the body.Diagnosing in men is based on a hemoglobin of less than 130 to 140 g/L (13 to 14 g/dL), while in women is less than 120 to 130 g/L (12 to 13 g/dL).Sickle cell anemia is an inherited hemolytic anemia in which the hemoglobin protein is abnormal, causing the red blood cells to be rigid and clog the circulation because they are unable to flow through small blood vessels.Hydroxyurea (Droxia and Hydrea) drug is used to treat sickle cell anemia.

The Types of Anemia

• Anemia due to blood loss includes Trauma and Gastrointestinal Bleeding.
• Anemia due to decreased red blood cell production includes Iron Deficiency, a Lack of Vitamin B12, Thalassemia, and a number of neoplasms of the bone marrow.
• Anemia due to increased red blood cell (RBC) breakdown includes a number of genetic conditions, such as Sickle Cell Anemia, Infections like Malaria, and some Autoimmune diseases.

The Causes of Anemia may be classified :

1. Anemia of Impaired red blood cells production.

• Disturbance of proliferation and differentiation of stem cells : pure red cell aplasia, aplastic anemia, anemia of renal failure by insuffecient erythropoietin production, anemia of endocrine disorders.
• Disturbance of proliferation and  maturation of erythroblasts : pernicious anemia, anemia of prematurity, anemia of folic acid deficiency, congenital dyserythropoietic anemias.

2. Hemolytic Anemias are anemia of increased red blood cells (RBCs) destruction.

• Intrinsic (intracorpuscular) abnormalities : hereditary spherocytosis, hereditary elliptocytosis, abetalipoproteinemia, hemoglobinopathies, paroxysmal nocturnal hemoglobinuria.
• Extrinsic (extracorpuscular) abnormalities : antibody-mediated, mechanical trauma to red cells.

3. Hypervolemia is anemia of blood loss and fluid overload.

Blood loss :

• Trauma or surgery
• Gastrointestinal tract lesions
• Gynecologic disturbances
• Infections by intestinal nematodes feeding on blood, such as hookworms.
• Menstrution in young women and older women with fibroids.

Fluid overload causes decreased hemoglobin concentration :

• Excessive sodium or fluid intake, sodium or water retention and fluid shift into the intravascular space.
• Anemia with pregnancy is induced by blood volume expansion experienced in pregnancy.

The classification of Anemia based on the size of red blood cells :

1. Microcytic Anemia is primarily a result of hemoglobin synthesis failure/insufficiency, which could be caused by several etiologies :

• Heme synthesis defect : iron deficiency anemia.
• Globin synthesis defect : Alpha-thalassemia and beta-thalassemia, HbE syndrome, HbC syndrome.
• Sideroblastic defect : hereditary sideroblastic anemia, aquired sideroblastic anemia (lead toxicity), reversible sideroblastic anemia.

2. Macrocytic is if the cells are large.It can be caused by removal of the functional portion of the stomach, such as during gastric bypass surgery, leading to reduce vitamin B12 or folate absorption.

• Megaloblastic anemia is due to a deficiency of either vitamin B12 of folic acid or both.
• Hypothyroidism
• Alcoholism
• Drugs like Methotrexate, Zidovudine, and other substances may inhibit DNA replication, such as heavy metals.

3. Normocytic occurs when the overall hemoglobin levels are decreased, but the red blood size (corpuscular volume) remains normal.Its causes include :

• Acute blood loss
• Anemia of chronic disease
• Aplastic anemia (the failure of bone marrow)
• Hemolytic anemia

4. Dimorphic. A dimorphic appearance on a peripheral blood smear occurs when there are two simultaneous populations of red blood cells, typically of different size and hemoglobin content (this last feature affecting the color of the red blood cells on a stained peripheral blood smear.

5. Heinz Body Anemia forms in the cytoplasm of red blood cells and appears as small dark dots under the microscope.

6. Hyperanemia is a severe form of anemia, in which the hematocrit is below ten percent.

7. Refractory Anemia is an anemia which does not respond to treatment.

The Symptoms of Anemia

• Loss of conciousness
• Weakness
• Feeling tired
• Shortness of breath
• Increased thirst
• Pale or yellow skin
• General malaise
• Poor concentration
• Palpitations
• Bone deformities
• Chest pain
• Headache
• Dizziness
• Cold hands or feet
• Pounding or whoosing in ears
• Fast or irregular heartbeat

Diagnosis

Anemia is diagnosed on a complete blood count.

• Flow cytometry is an important tool in distinguishing between the causes of anemia.
• Examination of a stained blood smear using a microscope.
• Parameters, such as Red Blood Count, Hemoglobin Concentration, MCV, RDW, Hematocrit, MCH, and MCHC.
• If the cause is not obvious, the clinicians use some tests, including ESR, Ferritin, Serum Iron, Transferrin, Red Blood Cell (RBC) Folate Level, Serum Vitamin B12, Hemoglobin Electrophoresis,  and Renal Function Test (Serum Creatine).
• If diagnose remains difficult, A bone Marrow Examination allows direct examination of the precursors to red cells.It is reserved for cases where severe pathology needs to be determined or excluded.

Treatment Of Anemia

Treatments for anemia depend on cause and severity of disease.

• Vitamin supplements, such as folic acid or vitamin B12 are given orally or vitamin B12 is given intramuscularly that will replace specific deficiency.
• Oral Iron supplementation with ferrous sulfate, ferrous fumarate, or ferrous gluconate can treat mild to moderate iron-deficiency anemia.
• Injectable iron or Parenteral iron.Parenteral iron can be used where iron absorption is impeded or in cases of inflammation.
• Blood Transfusions should be undertaken in cardiovascular instability cases.People with coronary artery disease are recommended to transfusion if the hemoglobin is below 70 to 80 g/L (7 to 8 g/dL).
• Erythropoiesis-Stimulating Agent (ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the individual person needs.It should not be used for mild or moderate anemia.People with chronic kidney disease are not recommended unless hemoglobin levels less than 10 g/dL or they have anemia symptoms.It is used in severe anemia.
• Hyperbaric Oxygen (HBO) is used to indicate when oxygen delivery to tissue is not sufficient in patients who cannot be given transfusions for medical or religious reasons.It may be used for medical reasons when threat of blood production incompatibility or concern for the factors of transmissible disease.Hyperbaric Oxygen is used in severe anemia.
• Thalassemia can be treated with blood transfusions, folic acid supplements, medications, and removal of the spleen (Splenectomy) or a blood or bone marrow stem cell transplant.

Stomach Cancer : Type, Symptom, Risk Factor, Diagnosis, Stage, Treatment, And Drug

Stomach Cancer (Gastric Cancer) is cancer that develops from the lining of the stomach.Stomach is a muscular organ located on the left side of the upper abdomen.Cardia, fundus, and corpus are called the proximal stomach.Antrum and pylorus are called the distal stomach.Stomach cancer tends to develop slowly.Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the stomach.

Parts of Stomach :

• Cardia is the first portion (closest to the esophagus)
• Fundus is the upper part of stomach next to the cardia.
• Body (Corpus) is the main part of the stomach , between the upper and the lower parts.
• Antrum is the lower portion (near the intestine), where the food is mixed with gastric juice.
• Pylorus is the last part of the stomach, which acts as a valve to control emptying of the stomach contents into the small intestine.

The Types of Stomach Cancer :

• Adenocarcinoma develps from the cells that form the innermost lining of the stomach (mucosa).
• Lymphoma is found in the wall of the stomach.
• Gastrointestinal Stromal Tumor (GIST) starts in very early forms of cells in the wall of the stomach called interstitial cells of cajal.
• Carcinoid tumor starts in hormone-making cells of the stomach.

The Signs or Symptoms of Stomach Cancer

• Loss of appetite
• Fatigue
• Unexplained weight loss
• Nausea
• Vomiting with or without blood
• Abdominal (belly) pain 
• Yellow skin and white eyes
• Difficulty of swallowing
• Blood in the stools among others
• Heartburn or indigestion
• Swelling or fluid build-up in the abdomen
• Feeling of fullness
• Vague discomfort in the abdomen, usually above the navel
• Low red blood cell count (anemia)
• Weakness
• Diarrhea
• Constipation
• Bloating of the stomach after meals

The Risk Factors of Stomach Cancer

• Family history of stomach cancer
• Gender
• Age
• Ethnicity
• Helicobacter pylori infection
• Inherited cancer syndromes
• Geography
• Obesity
• Diet
• The use of tobacco smoking
• Type A blood
• Stomach lympoma
• Pernicious anemia
• Menetrier disease
• Previous stomach surgery
• Heriditary non-polyposis colorectal cancer
• Diabetes

Diagnosis

To find the cause of stomach cancer symptoms, the doctor will ask the medical history and physical exam.The tests are to diagnose the stomach cancer as follow :

• Upper Endoscopy (Esophagogastroduodenoscopy or EGD) is to find stomach cancer.
• Endoscopic Ultrasound uses sound waves to produce images of organs, such as the stomach.
• Biopsy is to check for stomach cancer.
• Testing Biopsy Samples is to check if samples contain cancer by looking at under a microscope.The biopsy samples may be tested in two different ways, such as Immunohistochemistry (IHC) is the test by special antibodies that stick to the HER2/ neu protein applied to the sample, which cause cells to change color if many copies are present and Fluorescent In Situ Hybridization (FISH) is the test that uses fluorescent pieces of DNA  specifically to stick the copies of the HER2/neu gene in cells, which can then be counted under special microscope.
• Imaging tests use x-rays, magnetic field, sound waves, or radioactive substances to create pictures of the inside of body.
• Upper Gastrointestina (GI) Series are an x-ray test to look at the inner lining of esophagus, stomach, and first part of the small intestine.
• Computed Tomagraphy (CT) scan is an x-ray test that produces detailed cross-sectional images of the body.
• CT-Guided Needle Biopsy is to guide a biopsy needle into a suspected area of cancer spread.
• Magnetic Resonance Imaging (MRI) scan uses radio waves and strong magnetic instead of x-rays.
• Positron Emission Tomography (PET) scan shows if the cancer has spread beyond the stomach to other parts of the body.
• Chest X-Ray is to find out if cancer has spread to the lungs.
• Laparoscopy is to confirm a stomach cancer that is still only in the stomach and can be removed completely with surgery.
• Lab Test uses blood test to look for anemia which could be caused by the cancer bleeding into the stomach.

The Stage of Stomach Cancer

• The Stage 0 (Carcinoma in situ) : The cancer has not spead to any lymph nodes or anywhere else.
• The Stage IA : The cancer has grown beneath the top layer of cells in the mucosa into tissue below, such as the connective tissue (lamina propria), the thin muscle layer (muscularis mucosa) or the submucosa.The cancer has not spead to any lymph nodes or anywhere else.

• The Stage IB : The cancer has grown into the layer of connective tissue (lamina propria), and may have grown into the thin muscle layer (muscularis mucosa) beneath it or deeper into the submucosa.Cancer has also spread to 1 or 2 lymph nodes near the stomach, but not to any distant tissues and organs.
• The Stage IIA : Cancer has grown beneath the top layer of cells in the mucosa into the layer of connective tissue (lamina propria), thin muscle layer (muscularis mucosa) or the submucosa.It has spread to 3 to 6 nearby lymph nodes.It has no spread to distant sites.

• The Stage IIB : Cancer has grown beneath the top layer of cells in the mucosa into the layer of connective tissue (lamina propria), thin muscle layer (muscularis mucosa) or the submucosa.It has spread to 7 or more nearby lymph nodes.It has no spread to distant tissues or organs.
• The Stage IIIA : The cancer has grown into the main muscle layer (muscularis mucosa).It has spread to 7 or more nearby lymph nodes.It has no spread to distant tissues or organs.

• The Stage IIIB : The cancer has grown into the subserosa layer but not through all the layers to the outside of the stomach.It has spread to 7 or more nearby lymph nodes, but it has no spread to distant sites.
• The Stage IIIC : The cancer has grown completely to all the layer of the stomach wall into the serosa, but it has not grown into nearby organs or tissues.It has spread to 7 or more nearby lymph nodes.It has no spread to distant tissues or organs.
• The Stage IV : The cancer has spread to distant organs, such as the liver, lungs, brain, or bones.

The Treatment of Stomach Cancer

I.The Treatments of Stage I  include

• Chemotherapy (5-Fluorouracil)
• Radiation therapy

II.The Treatments of Stage II include

• Chemotherapy (5-Fluorouracil)
• Radiation Therapy
• Neoadjuvant Chemotherapy

III. The Treatments of Stage III include

• Chemotherapy (5-Fluorouracil)
• Radiation Therapy
• Neoadjuvant Chemotherapy

IV. The Treatments of Stage IV include

• Laser treatment
• Surgery
• Chemotherapy by drugs, such as 5-Fluorouracil, cisplatin, epirubicin, docetaxel, etoposide, oxaliplatin, capecitabine, or irinotecan.

Drugs for Stomach Cancer

• 5-Fluorouracil
• Fluorouracil injection
• Docetaxel
• Cisplatin
• Cyramza (Ramucirumab)
• Irinotecan
• Etoposide
• Capecitabine
• Herceptin (Trastuzumab)
• Doxorubicin Hydrochloride
• Oxaliplatin
• Mitomycin C
• Mitozytrex (Mitomycin C)
• Mutamycin (Mitomycin C)
• Epirubicin
• Ramucirumab
• Taxotere (Docetaxel)
• Trastuzumab

Drugs combinations used in Stomach Cancer

• FU-LV
• TPF
• Xeliri