I
AORTIC INCOMPETENCE
DISORDERSOFTHE ANUS
Most anal disorders are minor but
may cause considerable discomfort
and concern. Many are aggravated by
constipation and may be helped by
regular toilet habits, an increased intake
of fluids, wholemeal products, fruits,
and vegetables to soften the faeces, and
the use of glycerine suppositories,
if necessary.
Congenitaldefects
Imperforate anus is an uncommon
birth defect in which the anus is sealed
(see
anus, imperforate).
In
anal stenosis,
the anus is too
narrow to allow the normal passage of
faeces.This is sometimes a congenital
abnormality, but it can also result from
scarring following surgery to treat
another disorder.
Injury
Anal fissures
originate from small
tears in the lining of the anus, usually
as a result of straining to pass hard,
dry faeces.
Tumours
Cancer of the skin around the anus is
rare (see
anus, cancer of).
Other disorders
Haemorrhoids
are enlarged blood vessels
under the lining of the anus and may
cause bleeding during defaecation,
itching, and pain.
An
anal fistula
is an abnormal tunnel
connecting the inside of the anal canal
with the skin surrounding the anus.
These fistulas usually result from an
abscess in the wall of the anus.
Itching
of the anus (pruritus ani) may
be a direct result of another disorder,
such as an anal fistula, haemorrhoids or
threadworm
infestation.
Anal warts (see
warts, genital)
are
transmitted by sexual contact and are
caused by a papillomavirus.
INVESTIGATION
Investigation of anal disorders is
usually by visual inspection,
sometimes involving
proctoscopy
(use of a rigid internal viewing tube)
and digital examination (feeling
with a finger). Sometimes a
biopsy
(small sample o f tissue removed for
microscopic analysis) or
swab
may
be taken for bacteriological culture.
include lightheadedness, sweating, pal-
lor, blushing, and a frequent need to
urinate or defaecate.
People with anxiety may have a con-
stant feeling that something bad is
going to happen. They may fear illness
or worry about the health and safety of
family and friends. Fear of losing con-
trol is also common.Anxiety often leads
to increasing dependence on others,
irritability, a sense of fatigue, and frus-
tration. Inability to relax may lead to
difficulty in sleeping.
TREATMENT
People suffering from anxiety may be
helped by
counselling
or
psychotherapy.
If there is an underlying disorder, such
as depression, treatment with
antidepres-
sant drugs
can help. Antianxiety drugs
are used for short-term control of symp-
toms but are avoided for long-term
treatment because they are addictive.
anxiety disorders
A group of mental illnesses, including
several specific syndromes, in which
symptoms of
anxiety
are the principal
feature. Anxiety disorders are common
and mainly affect young adults.
TYPES
In
generalized anxiety disorder,
the affec-
ted individual suffers from persistent
tension and apprehension that has no
specific focus or cause, together with
physical or psychological symptoms
that disrupt normal activity.
Panic disor-
der
is characterized by sudden and
recurrent attacks of extreme, unreason-
able
fear
and
anxiety.
Phobias
are
irrational fears, such as the fear of open
spaces or of spiders, that lead to avoid-
ance of certain situations or objects.
Post-traumatic stress disorder
is a form of
anxiety
that
develops
following
a
stressful or traumatic event and
obses-
sive-compulsive disorder
is a condition
in which a person’s obsessions and
fears lead them to carry out repetitive,
ritualized acts.
TREATMENT
Counselling,
psychotherapy,
and group
or individual
cognitive-behavioural ther-
apy
are used to treat anxiety disorders.
Antidepressant drugs
are often used, and
antianxiety drugs
(especially
benzodiaz-
epine drugs
) may be used for short-
term treatment but are addictive.
anxiolytics
See
antianxiety drugs.
aorta
The main
artery
of the body, which sup-
plies oxygenated blood to all other parts.
The aorta arises from the left ventricle
(the main pumping chamber of the
heart
) and arches up over the heart
before descending, behind it, through the
chest cavity. It terminates in the abdo-
men by dividing into the two common
iliac arteries of the legs. The aorta is
thick-walled and has a large diameter to
cope with the high pressure and large
volume of blood passing through it.
DISORDERS
The aorta, like other arteries, can become
narrowed as a result of
atherosclerosis
(fat deposits on its walls), which may
cause
hypertension
(high blood pres-
sure).
Coarctation of the aorta
(in which
the aorta is abnormally narrow at birth)
and
aortitis
(inflammation of the aorta
wall) are examples of aorta-specific dis-
orders. Both aortitis and atherosclerosis
may result in an aortic
aneurysm
(bal-
looning of the aorta wall), which may
require surgery. (See also
arteries
,
disor-
ders of; circulatory system.)
aortic incompetence
Leakage of blood through the aortic
valve (one of the
heart valves),
resulting
in a backflow of blood from the aorta
into the left ventricle (the heart’s main
pumping chamber).
CAUSES
Failure of the aortic valve to close pro-
perly may be due to a
congenital
(present
from birth) abnormality in which the
valve has two leaflets (flaps) rather than
three. The valve leaflets can be destroyed
by infective
endocarditis
(inflammation
of the membrane lining the heart).
Long-term
hypertension
can sometimes
cause the root of the aorta to stretch so
that the valve does not close properly.
Aortic incompetence is also associated
with
ankylosing spondylitis
(a disorder that
affects the spine), and
Marfan syndrome,
a congenital disorder of connective tis-
sues.
Rheumatic fever,
which is now rare,
may damage the valve, causing a combi-
nation of
aortic stenosis
(narrowing of
the aortic valve) and incompetence. In
addition,
aortic
incompetence
may
occur in untreated
syphilis.
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