OLECRANON BURSITIS
DISORDERS OF THE OESOPHAGUS
Several disorders affect the oesophagus,
many of which cause
s w a l l o w i n g
d i f f i c u l t i e s
and/or chest pain.
Infection and inflammation
Infections of the oesophagus are rare
but may occur in immunosuppressed
patients whose defences are weakened.
The most common are
h e r p e s s i m p l e x
and
c a n d i d i a s i s
(thrush) spreading
downwards from the mouth. Both
cause pain on swallowing.
O e s o p h a g i t i s
(inflammation of the oesophagus) is
usually due to reflux of stomach
contents, causing heartburn. A more
severe form, corrosive oesophagitis, can
occur as a result of swallowing caustic
chemicals. Both types may cause an
o e s o p h a g e a l s t r i c t u r e
(narrowing of
the oesophagus) with difficulty in
swallowing.
B a r r e t t ' s o e s o p h a g u s
is a
complication of long-term reflux
oesophagitis; it may lead to cancer.
Congenital defects
O e s o p h a g e a l a t r e s i a
(the congenital
absence of a section of the oesophagus,
with the remaining sections ending in
dead ends) requires urgent surgical
treatment. Babies are occasionally also
born with weblike constrictions of the
oesophagus. These are rarely serious
enough to require treatment, but they
can be broken down with a dilator.
Tumours
Tumours of the oesophagus are
relatively common. The initial symptom
is usually difficulty in swallowing. The
majority of oesophageal tumours are
cancerous (see
o e s o p h a g u s , c a n c e r o f ) .
Injury
Severe vomiting and retching can tear
the oesophageal lining and, in extreme
cases, lead to rupture. A swallowed
f o r e i g n b o d y
can also cause injury, even
perforation, if it penetrates the
oesophageal wall.
Other disorders
O e s o p h a g e a l v a r i c e s
(dilated blood
vessels) at the junction of the stomach
and oesophagus may be associated
with
c i r r h o s i s . A n o e s o p h a g e a l
d i v e r t i c u l u m
is a protruding sac in
which food may collect, causing
difficulty in swallowing. In
o e s o p h a g e a l
s p a s m ,
the oesophageal muscles
contract uncontrollably. In
a c h a l a s i a
,
the sphincter at the junction between
the oesophagus and stomach fails to
relax to allow the passage of food,
causing pain on swallowing and
sometimes regurgitation of food.
INVESTIGATION
Disorders of the oesophagus are
investigated by barium swallow (see
b a r i u m X - r a y e x a m i n a t i o n s )
and by
endoscopy during which a biopsy
(tissue sample) can be taken for
microscopic examination.
o e s tra d io l
S e e
e s t r a d i o l .
o e s trio l
S e e
e s t r i o l .
o e stro g e n d ru g s
COMMON DRUGS
• Conjugated oestrogens •Diethylstilbestrol
• Estradiol •Estriol •Estrone •Estropipate
• Ethinylestradiol •Mestranol
A
g r o u p
o f
s y n t h e t i c a l l y
p r o d u c e d
d r u g s t h a t a r e u s e d i n
o r a l c o n t r a c e p t i v e s
a n d a d d i t i o n a l l y t o s u p p l e m e n t o r r e -
p l a c e
t h e
b o d y ’s
o w n
o e s t r o g e n
h o r -
m o n e s
i n
h o r m o n e
r e p l a c e m e n t t h e r a p y
( H R T )
.
O e s t r o g e n d r u g s a r e o f t e n u s e d
w i t h
p r o g e s t o g e n d r u g s
.
WHY THEY ARE USED
O e s t r o g e n s s u p p r e s s t h e p r o d u c t i o n o f
g o n a d o t r o p h i n
h o r m o n e s
,
w h i c h
s t i m u -
l a t e c e l l a c t i v i t y i n t h e
o v a r i e s
.
T h e y a r e
u s e d i n H R T t o t r e a t , o r s o m e t i m e s t o
p r e v e n t ,
m e n o p a u s a l
s y m p t o m s
a n d
d i s o r d e r s . O e s t r o g e n s m a y a l s o b e u s e d
t o
t r e a t
f e m a l e
h y p o g o n a d i s m
( u n d e r -
a c t i v i t y
o f
t h e
o v a r i e s ) ,
a b n o r m a l
m e n s t r u a l b l e e d i n g , a n d p r o s t a t i c c a n -
c e r ( s e e
p r o s t a t e , c a n c e r o f
) .
POSSIBLE ADVERSE EFFECTS
O e s t r o g e n s m a y c a u s e b r e a s t t e n d e r n e s s
a n d e n l a r g e m e n t , b l o a t i n g , w e i g h t g a i n ,
n a u s e a , r e d u c e d s e x d r i v e ,
d e p r e s s i o n ,
m i g r a i n e ,
a n d
b l e e d i n g
b e t w e e n
p e r -
i o d s .
M o s t
o f t h e
s i d e
e f f e c t s s u b s i d e
a f t e r t w o o r t h r e e m o n t h s . O e s t r o g e n s
c a n a l s o i n c r e a s e t h e r i s k o f a b n o r m a l
b l o o d
c l o t t i n g
a n d
s u s c e p t i b i l i t y
t o
h y p e r t e n s i o n
( h i g h b l o o d p r e s s u r e ) .
O e s t r o g e n d r u g s s h o u l d n o t b e t a k e n
d u r i n g
p r e g n a n c y
b e c a u s e
t h e y
m a y
a d v e r s e l y a f f e c t t h e f e t u s .
o e stro g e n h o rm o n e s
A g r o u p o f
h o r m o n e s
t h a t a r e e s s e n t i a l f o r
n o r m a l f e m a l e s e x u a l d e v e l o p m e n t a n d
h e a l t h y f u n c t i o n i n g o f t h e r e p r o d u c t i v e
s y s t e m . I n w o m e n , t h e y a r e p r o d u c e d
m a i n l y i n t h e
o v a r i e s
a n d a l s o i n t h e
p l a -
c e n t a
i n p r e g n a n c y . S m a l l a m o u n t s a r e
p r o d u c e d i n t h e
a d r e n a l g l a n d s
i n b o t h
m e n a n d w o m e n , b u t o e s t r o g e n s h a v e
n o s p e c i f i c f u n c t i o n i n m e n . W
h e n l e v -
e l s a r e l o w , o e s t r o g e n h o r m o n e s c a n b e
r e p l a c e d w i t h
o e s t r o g e n d r u g s
.
o e s tr o g e n -p r o g e s to g e n p ill
A n a l t e r n a t i v e n a m e f o r t h e c o m
b i n e d
p i l l ( s e e
o r a l c o n t r a c e p t i v e s
) .
o e stro n e
S e e
e s t r o n e
.
o flo x a c in
A
q u i n o l o n e
a n t i b i o t i c u s e d t o t r e a t s k i n ,
s o f t
t i s s u e ,
a n d
l o w e r
r e s p i r a t o r y t r a c t
a n d
u r i n a r y t r a c t i n f e c t i o n s
.
I t i s
u s u a l l y
t a k e n i n t a b l e t f o r m t o t r e a t i n f e c t i o n s
t h a t h a v e n o t r e s p o n d e d t o o t h e r d r u g s
b u t i s a l s o g i v e n b y i n t r a v e n o u s i n f u -
s i o n f o r s e v e r e
s y s t e m i c
i n f e c t i o n s . S i d e
e f f e c t s
m a y
i n c l u d e
n a u s e a ,
v o m i t i n g ,
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 .
o ils
S e e
f a t s a n d o i l s .
o in tm e n t
A g r e a s y p r e p a r a t i o n t h a t i s u s e d a s a
v e h i c l e t o a p p l y d r u g s i n d r y s k i n c o n -
d i t i o n s s u c h a s
e c z e m a
o r t o p r o t e c t o r
l u b r i c a t e t h e s k i n .
o la n z a p in e
A n
a n t i p s y c h o t i c d r u g
u s e d f o r t h e t r e a t -
m
e n t o f
s c h i z o p h r e n i a
.
o le c ra n o n
T h e b o n y p r o j e c t i o n a t t h e u p p e r e n d o f
t h e
u l n a
( t h e i n n e r b o n e
o f t h e f o r e -
a r m ) t h a t f o r m s t h e p o i n t o f t h e e l b o w
o le c ra n o n b u rs itis
I n f l a m m a t i o n o f t h e s m a l l ,
f l u i d - f i l l e d
p a d t h a t c u s h i o n s t h e
o l e c r a n o n
a t t h e
t i p o f t h e e l b o w . T h e c o n d i t i o n c a u s e s
p a i n a n d s w e l l i n g b u t u s u a l l y c l e a r s u p
a f t e r
a f e w
d a y s
o f r e s t a n d a v o i d i n g
p r e s s u r e o n t h e j o i n t . ( S e e a l s o
b u r s i t i s
.)
O
561
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