LISP
L
e s p e c i a l l y i n s o m e o n e w h o i s a l s o t a k i n g a
d i u r e t i c
;
a p e r s o n s h o u l d l i e d o w n f o r a
c o u p l e o f h o u r s a f t e r t a k i n g i t . T h e d r u g
m a y
a l s o
p r o d u c e
v a r i o u s
m i n o r
s i d e
e f f e c t s , s u c h a s a p e r s i s t e n t d r y c o u g h
o r a d i s t u r b a n c e i n t a s t e s e n s a t i o n .
lis p
A
c o m
m o n
s p e e c h
d i s o r d e r
c a u s e d
b y
p r o t r u s i o n
o f t h e
t o n g u e
b e t w e e n
t h e
t e e t h s o t h a t t h e “ s ” s o u n d i s r e p l a c e d
b y “ t h ” . I n m o s t c a s e s , t h e r e i s n o p h y s -
i c a l c a u s e , b u t s o m e t i m e s i t i s d u e t o a
c l e f t p a l a t e ( s e e
c l e f t l i p a n d p a l a t e
).
U n l e s s t h e r e i s a n u n d e r l y i n g c a u s e ,
l i s p i n g u s u a l l y d i s a p p e a r s b y t h e a g e o f
a b o u t
f o u r .
I f i t
p e r s i s t s
b e y o n d
t h i s
t i m e , s p e e c h t h e r a p y m a y b e n e e d e d .
lis t e r io s is
A n i n f e c t i o n t h a t i s c o m
m
o n i n a n i m a l s
a n d a l s o a f f e c t s h u m a n s .
CAUSE
L i s t e r i o s i s
i s
c a u s e d
b y t h e
b a c t e r i u m
L i s t e r i a
m o n o c y t o g e n e s ,
w h i c h
i s
w i d e -
s p r e a d i n t h e e n v i r o n m e n t , e s p e c i a l l y i n
s o i l . P o s s i b l e s o u r c e s
o f h u m a n i n f e c -
t i o n w i t h l i s t e r i o s i s i n c l u d e s o f t c h e e s e ,
r e a d y - p r e p a r e d c o l e s l a w a n d s a l a d s , a n d
i m p r o p e r l y c o o k e d m e a t .
SYMPTOMS
I n m o s t
o t h e r w i s e
h e a l t h y
a d u l t s ,
t h e
o n l y
s y m p t o m s
m a y
b e
f e v e r ,
a c h i n g
m u s c l e s , d i a r r h o e a , a n d a b d o m i n a l p a i n .
H o w e v e r , i n e l d e r l y p e o p l e , t h o s e w i t h
r e d u c e d i m m u n i t y , a n d n e w b o r n b a b i e s ,
l i s t e r i o s i s c a n b e l i f e - t h r e a t e n i n g .
P n e u -
m o n i a
,
s e p t i c a e m i a
( b l o o d
p o i s o n i n g ) ,
a n d
m e n i n g i t i s
( i n f l a m m a t i o n
o f
t h e
m e m b r a n e s c o v e r i n g t h e b r a i n ) m a y d e -
v e l o p .
I n
p r e g n a n t
w o m e n ,
i n f e c t i o n
m a y c a u s e a m i s c a r r i a g e o r s t i l l b i r t h .
DIAGNOSIS AND TREATMENT
T h e
c o n d i t i o n
i s
d i a g n o s e d
b y
b l o o d
t e s t s
a n d a n a l y s i s o f o t h e r b o d y f l u i d s ,
s u c h a s c e r e b r o s p i n a l f l u i d . T r e a t m e n t i s
w i t h
a n t i b i o t i c d r u g s
s u c h
a s
a m p i c i l l i n
a n d
g e n t a m i c i n
.
lith iu m
A
m o o d - s t a b i l i z i n g
d r u g
u s e d
i n
t h e
l o n g - t e r m t r e a t m e n t o f
m a n i a
a n d
m a n i c -
d e p r e s s i v e i l l n e s s
,
a n d
t o
h e l p
p r e v e n t
r e c u r r e n c e
o f s e v e r e
d e p r e s s i o n .
S i d e
e f f e c t s i n c l u d e n a u s e a , v o m i t i n g , t r e m o r ,
a n d e x c e s s i v e t h i r s t . T h e d o s a g e m u s t b e
m o n i t o r e d b y r e g u l a r b l o o d t e s t s t o p r e -
v e n t s e r i o u s a d v e r s e e f f e c t s . H i g h l e v e l s
o f l i t h i u m
m a y
c a u s e
b l u r r e d
v i s i o n ,
d r o w s i n e s s , r a s h , a n d p o s s i b l y
h y p o t h y -
r o i d i s m
a n d
k i d n e y d a m a g e . S i d e e f f e c t s
s h o u l d b e r e p o r t e d p r o m p t l y t o a d o c t o r .
lith o to m y
S u r g i c a l
r e m o v a l
o f a
c a l c u l u s
( s t o n e )
f r o m t h e
u r i n a r y t r a c t
.
T h e p r o c e d u r e i s
p e r f o r m e d o n l y f o r l a r g e s t o n e s ; s m a l l e r
s t o n e s a r e u s u a l l y c r u s h e d a n d r e m o v e d
u s i n g
c y s t o s c o p y
,
o r p u l v e r i z e d u l t r a s o n -
i c a l l y b y
l i t h o t r i p s y
.
lith o to m y p o sitio n
A p o s i t i o n i n w h i c h a p a t i e n t l i e s o n h i s
o r
h e r b a c k w i t h t h e
h i p s
a n d
k n e e s
b e n t a n d t h e l e g s w i d e a p a r t ; t h e f e e t
m a y b e s u p p o r t e d o n f i r m s u r f a c e s o r
i n
s t i r r u p s .
O n c e
u s e d
f o r
l i t h o t o m y
( r e m o v a l o f b l a d d e r s t o n e s ) , t h e p o s i -
t i o n
i s
n o w
w i d e l y
u s e d
f o r
p e l v i c
e x a m i n a t i o n s
a n d s o m e t y p e s o f s u r g e r y .
lith o t rip s y
T h e u s e
o f h i g h l y c o n c e n t r a t e d
s h o c k
w a v e s o r u l t r a s o n i c w a v e s t o b r e a k u p
c a l c u l i
( s t o n e s ) i n s i d e t h e k i d n e y s , u p p e r
u r e t e r s
,
a n d
g a l l b l a d d e r
s o t h a t t h e y c a n
b e c o m f o r t a b l y e x c r e t e d .
T h e m o s t c o m
m
o n t y p e i s e x t r a c o r -
p o r e a l s h o c k - w a v e l i t h o t r i p s y
( E S W
L ) ,
w h i c h i s p e r f o r m e d t o b r e a k u p s m a l l
s t o n e s .
E S W L u s e s a m
a c h i n e c a l l e d a
l i t h o t r i p t e r
,
w h i c h p r o d u c e s s h o c k w a v e s
t h a t
a r e
t r a n s m i t t e d
i n t o
t h e
b o d y
t h r o u g h a w a t e r - o r g e l - f i l l e d c u s h i o n
p l a c e d o v e r t h e o r g a n b e i n g t r e a t e d .
U r e t e r i c c o l i c
( s e v e r e
s p a s m o d i c p a i n
i n t h e s i d e ,
o c c u r r i n g i f t h e u r e t e r i s
o b s t r u c t e d b y s m a l l f r a g m e n t s o f s t o n e )
LITHOTRIPSY
Calculi (stones) can sometimes be broken up by lithotripsy, a procedure that uses
ultrasonic or shockwaves. In extracorporeal shock-wave lithotripsy (ESWL), the
most common form of the treatment, no major surgery is needed. If the stones are
in the kidney or ureter, fragments of the stones are passed in the urine.
EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY (ESWL)
L e a d a p r o n
X -r a y r e c e i v e r
X - r a y b e a m
W a te r - o r g e l -
f i l l e d c u s h i o n
S h o c k - w a v e g e n e r a t o r
X - r a y s o u r c e
S h o c k w a v e s
S t a g h o r n
c a l c u l u s
Patient receiving ESWL
The patient is given a general or epidural
anaesthetic. The lithotripter produces shock
waves that are focused on the stone. The
image intensifier (X-ray equipment) allows the
operator to locate the stones and adjust the
lithotripter to ensure thatthe shockwaves
target the stones accurately. Nearly all the
energy is dissipated in the stone, shattering
it. The patient then drinks liberallyto flush
out stone fragments. There may be some
blood in the urine and abdominal bruising,
but serious complications are uncommon.
Kidney stone
This X-ray shows a
staghorn calculus
(stone) in the left
kidney (on the right
in the X-ray). With
lithotripsy, stones
such as these can be
removed without the
need for surgery.
470
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