Multiple neuritis, peripheral neuritis, peripheral neuropathy, polyneuritis

What is this condition?

This disorder involves degeneration of peripheral nerves supplying the distal muscles of the extremities. It results in muscle weakness with sensory loss and atrophy as well as decreased or absent deep tendon reflexes. Although peripheral nerve degeneration can occur at any age, incidence is highest in men between ages 30 and 50. Because onset is usually subtle, a person may compensate by overusing unaffected muscles; however, the disease may begin rapidly with severe infection and chronic alcohol intoxication. If the cause can be identified and eliminated, the prognosis is good.

What causes it?

Causes of peripheral nerve degeneration include:

• chronic intoxication (with ethyl alcohol, arsenic, lead, carbon disulfide, benzene, phosphorus, and sulfonamides)

• infectious diseases (meningitis, diphtheria, syphilis, tuberculosis, pneumonia, and mumps)

• metabolic and inflammatory disorders (gout, diabetes, rheumatoid arthritis, polyarteritis nodosa, and lupus)

• nutritional disorders (beriberi and other vitamin deficiencies, and malnourishment) .

What are its symptoms?

The signs and symptoms of peripheral nerve degeneration develop slowly, and the disease usually affects the motor and sensory nerve fibers. The condition typically produces flaccid paralysis, wasting, loss of reflexes, pain of varying intensity, loss of ability to perceive vibratory sensations, and numbness, tingling, increased sensitivity to pain or touch, or anesthesia in the hands and feet. Deep-tendon reflexes are diminished or absent, and atrophied muscles are tender or hypersensitive to pressure or palpation. Footdrop may also be present. Skin manifestations include glossy red skin and decreased sweating. Many people with the disease have a history of clumsiness and complain of frequent vague sensations.

How is it diagnosed?

The person’s history and physical exam reveal characteristic distribution of motor and sensory deficits. Electromyography may show a delayed action potential if peripheral nerve degeneration impairs motor nerve function.

How is it treated?

Effective treatment consists of supportive measures to relieve pain, adequate bed rest, and physical therapy, as needed. Most important, however, the underlying cause must be identified and corrected. For instance, it’s essential to identify and remove the toxic agent, correct nutritional and vitamin deficiencies (the person needs a high-calorie diet rich in vitamins, especially the B-complex group), or counsel the person to avoid alcohol.
What can a person with peripheral nerve degeneration do?

• Rest frequently and avoid using the affected arm or leg. To avoid bed sores, use a foot cradle. To prevent contractures, use splints, boards, braces, or other orthopedic appliances

• After the pain subsides, passive range-of-motion exercises or massage may be beneficial. The doctor may recommend electrotherapy for nerve and muscle stimulation.

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What is this Condition?

Irritable bowel syndrome is a common condition marked by chronic or occasional diarrhea, alternating with constipation and accompanied by straining and abdominal cramps. Most people can control or eliminate this condition by avoiding the foods and activities that cause it.

What Causes it?

This problem with the way the digestive tract works is often linked to psychological stress. However, irritable bowel may be caused by disease, abuse of laxatives, food poisoning, colon cancer or, most probably, eating and drinking things that a person can’t tolerate.

What are its Symptoms?

Irritable bowel syndrome usually produces lower abdominal pain (often relieved by a bowel movement or passage of gas) and diarrhea during the day. These symptoms alternate with constipation or normal bowel function. Stools are often small and contain visible mucus. The person may have indigestion and bloating too.

How is it Diagnosed?

The doctor will ask about recent events in the person’s life, such as a stressful change that may interfere with his or her digestion. The doctor will also rule out other disorders, such as infections, colon cancer, and lactose intolerance. The exam may include using a scope to see into the intestine, a barium enema X-ray, rectal biopsy, and stool analysis for blood, parasites, and bacteria.

How is it Treated?

The doctor may recommend counseling if the person needs to learn about the relationship between stress and illness. Strict dietary restrictions aren’t necessary, but the person can pinpoint foods that are irritating and avoid them.

Rest and heat applied to the abdomen are helpful, as is judicious use of sedatives, such as Barbita, and antispasmodics. However, with continued use, a person could become dependent on these drugs. If the cause of irritable bowel syndrome is chronic laxative abuse, the individual can learn other methods to achieve regularity.

What can a Person with Irritable Bowel Syndrome do?

While you work on discovering what foods to avoid, investigate the value of increased bulk in your diet to avoid laxatives. Getting help with the stress in your life may be the best way to avoid dependence on sedatives or antispasmodics.

Finally, even though you may solve your immediate problem, get regular checkups because irritable bowel syndrome is associated with a higher-than-normal chance of diverticulitis and colon cancer. If you are over age 40, get an annual sigmoidoscopy and rectal exam to be safe .

What is this Condition?

Crohn’s disease is an inflammation of any part of the digestive tract. The inflammation extends through the intestinal wall. Swelling caused by a blockage in the intestinal wall leads to inflammation, sores, narrowing of passages and, possibly, abscesses and fistulas (abnormal passages between body cavities).

The most common site is the end of the small intestine. It may affect nearby lymph nodes as well as the membrane that holds the small intestines. Mild cases are relieved by changes in diet and life­style.

What Causes it?

Crohn’s disease is most common in adults ages 20 to 40 and may run in families. Its exact cause is unknown. Some experts suspect allergies and other immune disorders or infection; others are investigating possible genetic links.

What are its Symptoms?

Symptoms depend on the location and size of the inflammation. The mild, yet persistent symptoms of chronic Crohn’s disease are most common and include diarrhea, pain in the lower right abdomen, excessive fat in the stools, weight loss, occasionally fatigue and, rarely, clubbing of the fingers. In a flare-up of Crohn’s disease, symptoms mimic those of appendicitis: steady, colicky, pain in the lower right abdomen, cramping, tenderness, release of gas, nausea, fever, diarrhea and, possibly, bloody stools. Complications can include intestinal obstruction, bowel-bladder fistulas, abscesses in the abdomen and around the anus or rectum, and perforation.

How is it Diagnosed?

Lab tests will show an increase in white blood cells and other imbalances. A barium enema X-ray and other X-ray studies may be used to check changes in the shape of the bowel. Also, the doctor may use a special scope to inspect for patchy areas of inflammation to rule out ulcerative colitis. However, biopsy (obtaining a tissue specimen for study) is the only way to confirm a diagnosis.

How is it Treated?

Initial treatment involves easing symptoms. For example, if the person is very sick, the doctor will order intravenous liquids and nutrients to rest the gastrointestinal tract and prescribe drugs to reduce inflammation, subdue the body’s immune system, and fight bacterial infection. Serious side effects may necessitate surgery to correct bowel perforation or massive bleeding. Only in the most severe cases is the diseased colon surgically removed.

What can a Person with Crohn’s Disease do?

The most helpful steps you can take involve making lifestyle changes: get more rest, restrict dietary fiber (no fruit or vegetables), and eliminate dairy products (for lactose intolerance). If stress is clearly an aggravating factor, consider getting counseling.

Gout is a metabolic disease marked by localized deposits of uric acid salts that are normally excreted through the kidneys. The deposits cause painfully arthritic joints. Gout usually strikes the feet and legs of men over age 30 and women past menopause. In elderly people, it is linked to other diseases.

Though gout may disappear for years between attacks, it can lead to disability or crippling. Fortunately, most people get better with treatment.

What Causes Gout?

Although the exact cause is unknown, gout seems linked to a genetic defect in metabolism, which causes overproduction and retention of uric acid. Too much uric acid leads to urate deposits in the joints or tissues, causing local damage. Secondary gout, linked to other conditions (such as obesity, diabetes, high blood pressure, sickle cell anemia, and kidney disease) or to drug therapy, produces similar harmful substances.

Another condition, called pseudogout, or chondrocalcinosis, causes arthritic pain too, but for different reasons.

What are its Symptoms?

Gout develops in four stages (asymptomatic, acute, intercritical, and chronic) that produce the following findings:

• In asymptomatic gout, urate levels rise in the blood but produce no symptoms. Later, gout may cause high blood pressure or show up in severe back pain.

• The first acute attack strikes suddenly and peaks quickly, causing extreme pain in one or only a few joints. Affected joints feel hot, tender, inflamed, and look dusky red or bruised. The joint of the big toe usually becomes inflamed first, then the instep, ankle, heel, knee, or wrist joints. Some attacks pass quickly and then come back at irregular intervals. Severe attacks may last for days or weeks.

• Intercritical periods are the symptom-free intervals between gout attacks. Most people have a second attack within 6 months to 2 years, but others are symptom-free for 5 to 10 years. Those delayed attacks can strike untreated people with longer-lasting, severe pain in several joints, sometimes all at once and sometimes in one joint after another.

• Eventually, chronic gaur sets in. This final, continuous stage shows up in persistently painful joints, with large urate deposits in the cartilage, membranes between the bones, tendons, and soft tissue. Deposits form primarily in arms and legs and, rarely, in organs, such as the kidneys and heart lining.

The skin over the deposits may develop sores and release a chalky, white material or pus. Chronic inflammation and urate deposition progress to further restrict movement and harm the person’s general health, possibly including formation of kidney stones.

How is it diagnosed?

The doctor can find evidence of gout in fluid taken from an inflamed joint or a deposit and by checking the level of uric acid in the blood. In chronic gout, X-rays show damage to the cartilage and bones.

How is it Treated?

The doctor first tries to stop the pain and prevent complications by suggesting bed rest and protection for the painful joints. Hot or cold packs and pain relievers may help with mild attacks. For more severe attacks and chronic gour, treatment may include the following:

• drugs to reduce inflammation, including Colsalide, Butazolidin, and Indocin, and injections of corticosteroids or corticotropin

• slower-acting drugs to reduce the uric acid level in the blood, including Zyloprim, Colsalide, Benemid, and Anturane

• diet changes, primarily to avoid alcohol and some rich foods; obese people should try to lose weight because the extra weight puts more stress on painful joints.

• surgery to improve joint function or correct deformities. Deposits must be opened and drained if they become infected or ulcerated. Deposits can also be cut out to prevent ulceration, improve the joint’s appearance, or make it easier to wear shoes or gloves.

This condition involves an abnormal twisting of the spermatic cord caused by rotation of a testicle or the mesorchium (a fold in the area

between the testicle and epididymis), which causes strangulation and, if untreated, eventual infarction (tissue death) in the testicle. This twisting almost always occurs only on one side.

Testicular twisting is most common between ages 12 and 18, but it may occur at any age. The prognosis is good with early detection and prompt treatment.

What Causes it?

Normally, the tunica vaginalis (internal pouch) envelops the testicle and attaches to the epididymis and spermatic cord. Testicular twisting may result from an abnormality of the tunica, in which the testicle is abnormally positioned, or from a narrowing of supporting tissues. In newborns, loose attachment of the tunica vaginalis to the scrotal lining may cause spermatic cord rotation above the testicle. A sudden forceful contraction of the cremaster muscle may precipitate this condition.

What are its Symptoms?

Twisting produces excruciating pain in the affected testicle.

How is it Diagnosed?

A physical exam reveals tense, tender swelling in the scrotum or inguinal canal and hyperemia of the overlying skin. Ultrasound helps distinguish testicular twisting from strangulated hernia, undescended testicles, or epididymitis.

How is it Treated?

Treatment consists of immediate surgical repair by orchiopexy (fixation of a viable testicle to the scrotum) or orchiectomy (excision of a nonviable testicle).

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