The condition largely affects young adolescent women, with between 15 and 19 years old
About 70% of young females are not satisfied with the shape - and size - of their bodies.
One in 10 young urban female college students is prone to eating disorders in their quest for a perfect body shape
Primary anorexia nervosa appears to be a very rare condition in Malaysia, especially amongst Malays compared to Chinese and Indians.
Prevalence of eating disorders in Asian countries was comparable to that in the West, where between 1% and 4% of girls aged between 14 and 18 have an eating disorder.
In Singapore, a National University of Singapore’s (NUS) study of 4,400 female students in 2005 also showed that 7% of them were found to be at high risk of disorders like anorexia and bulimia.
Penang Hospital’s child and adolescent psychiatrist Dr Lai Fong Hwa said there was a six-fold increase in the incidence of eating disorders in Singapore in the last 10 years.
In November 2006, Brazilian model Ana Carolina Reston, 21, was reported to have died of anorexia nervosa. She was 1.74m tall and weighed only 40kg when she died.
Countries where eating disorders are common include Japan, South Korea, Thailand, China, Taiwan, Hong Kong, Singapore, India, Pakistan, Egypt and Israel, she added.
Eating disorders are more common among females than males. For every 10 to 20 females with eating disorders, there would be one male with similar problem.
In a population of 60 patients suffering from obsessive-compulsive disorders, the authors find 5 patients (8.3% of the whole group), all female (13.1% of the whole female subgroup) with an anorexia nervosa among their antecedents
Review found more bulimia sufferers than anorexia sufferers in all countries
Students majoring in ballet, arts, medicine, and nursing in the United Kingdom had high EAT-26 scores; EAT is eating attitude test.
source:
http://thestar.com.my/news/story.asp?file=/2007/6/24/nation/17817717&sec=nation
http://www.ncbi.nlm.nih.gov/pubmed/8641163
http://www.medscape.com/viewarticle/487413_3
Thursday, September 30, 2010
MSE PCL 11
Appearance
Observe the person's self-care, grooming, general physical health and dress. For example, a man who is depressed may neglect his self-care. A person with schizophrenia may dress bizarrely. A person with obsessive - compulsive personality traits may dress with excessive conformity, while one with histrionic traits may dress flamboyantly.
Behaviour
Note how the person acts during the interview. A depressed person may exhibit psychomotor agitation or retardation. An anxious person may sweat, have a tremor and startle easily.
Conversation
Document the volume and rate of speech, and the command of grammar and vocabulary.
Mood/affect
Mood refers to the sustained emotional tone that is reported by the individual. Some words commonly used to describe mood include euthymic, depressed, angry, elated, elevated, irritable or anxious. Affect refers to the varying emotional response witnessed during the interview. Some terms used to describe this include appropriate, inappropriate, fatuous, blunted, restricted, flat or labile.
Thought process
Record the patient's thought process information. The process of thoughts can be described with the following terms: looseness of association (irrelevance), flight of ideas (change topics), racing (rapid thoughts), tangential (departure from topic with no return), circumstantial (being vague, ie, "beating around the bush"), word salad (nonsensical responses, ie, jabberwocky), derailment (extreme irrelevance), neologism (creating new words), clanging (rhyming words), punning (talking in riddles), thought blocking (speech is halted), and poverty (limited content).
Cognition
Involves several areas of thinking such as level of consciousness, orientation, concentration and attention span, as well as memory.
Judgment
Estimate the patient's judgment based on the history or on an imaginary scenario. To elicit responses that evaluate a patient's judgment adequately, ask the following question. "What would you do if you smelled smoke in a crowded theater?" (good response is "call 911" or "get help"; poor response is "do nothing" or "light a cigarette").
Insight
Assess the patients' understanding of the illness. To assess patients' insight to their illness, the interviewer may ask patients if they need help or if they believe their feelings or conditions are normal.
Observe the person's self-care, grooming, general physical health and dress. For example, a man who is depressed may neglect his self-care. A person with schizophrenia may dress bizarrely. A person with obsessive - compulsive personality traits may dress with excessive conformity, while one with histrionic traits may dress flamboyantly.
Behaviour
Note how the person acts during the interview. A depressed person may exhibit psychomotor agitation or retardation. An anxious person may sweat, have a tremor and startle easily.
Conversation
Document the volume and rate of speech, and the command of grammar and vocabulary.
Mood/affect
Mood refers to the sustained emotional tone that is reported by the individual. Some words commonly used to describe mood include euthymic, depressed, angry, elated, elevated, irritable or anxious. Affect refers to the varying emotional response witnessed during the interview. Some terms used to describe this include appropriate, inappropriate, fatuous, blunted, restricted, flat or labile.
Thought process
Record the patient's thought process information. The process of thoughts can be described with the following terms: looseness of association (irrelevance), flight of ideas (change topics), racing (rapid thoughts), tangential (departure from topic with no return), circumstantial (being vague, ie, "beating around the bush"), word salad (nonsensical responses, ie, jabberwocky), derailment (extreme irrelevance), neologism (creating new words), clanging (rhyming words), punning (talking in riddles), thought blocking (speech is halted), and poverty (limited content).
Cognition
Involves several areas of thinking such as level of consciousness, orientation, concentration and attention span, as well as memory.
Judgment
Estimate the patient's judgment based on the history or on an imaginary scenario. To elicit responses that evaluate a patient's judgment adequately, ask the following question. "What would you do if you smelled smoke in a crowded theater?" (good response is "call 911" or "get help"; poor response is "do nothing" or "light a cigarette").
Insight
Assess the patients' understanding of the illness. To assess patients' insight to their illness, the interviewer may ask patients if they need help or if they believe their feelings or conditions are normal.
What are the signs and symptoms of anorexia (psychological and behavioral)?
Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other family members as well.
•The individual can become seriously underweight, which can lead to depression and social withdrawal.
•The individual can become irritable and easily upset and have difficulty interacting with others.
•Sleep can become disrupted and lead to fatigue during the day.
•Attention and concentration can decrease.
•Most individuals with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about eating rituals. They may collect recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other people, or hoard food. Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic criteria for an obsessive compulsive disorder.
•Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders.
•Generally, individuals with anorexia are compliant in every other aspect of their life except for their relationship with food. Sometimes, they are overly compliant, to the extent that they lack adequate self-perception. They are eager to please and strive for perfection. They usually do well in school and may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to them. Performance in other areas is stressed as well, and they are often high achievers.
•While control and perfection are critical issues for individuals with anorexia, aspects of their life other than their eating habits are often found to be out of control as well. Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework, and shopping are not uncommon. In particular, people with anorexia often exercise compulsively to speed the weight-loss process.
All of these features can negatively affect one's daily activities. Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder.
PHYSICAL SIGNS AND SYMPTOMS
Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the progressive deterioration brought about by anorexia.
•Heart and circulatory system: Although not life-threatening, an abnormally slow heart rate (bradycardia) and unusually low blood pressure (hypotension) are frequent manifestations of starvation and are commonly associated with anorexia. Of greater significance are disturbances in the heart rhythm (arrhythmia). A reduction in the work capacity of the heart is associated with severe weight loss and starvation.
•Gastrointestinal complications are also associated with anorexia. Constipation and abdominal pain are the most common symptoms. The rate at which food is absorbed into the body is slowed down. Starvation and overuse of laxatives can seriously disrupt the body's normal functions involved in the elimination process. While liver function is generally found to be normal, there is evidence of changes in enzyme levels and overall damage to the liver.
•The glandular (endocrine) system in the body is profoundly affected by anorexia. The complex physical and chemical processes involved in the maintenance of life can be disrupted, with serious consequences. Disturbances in the menstrual cycle are frequent, and secondary amenorrhea (absence of menstrual periods) affects about 90% of adolescent girls with anorexia. Menstrual periods typically return with weight gain and successful treatment. Hormonal imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.
•Kidney (renal) function may appear normal. However, there are significant changes in kidney function in many people with anorexia, resulting in increased or decreased urination or potentially fatal potassium deficiency.
•Bone density loss (osteopenia or thinning of the bones) is a significant complication of anorexia, since women acquire 40%-60% of their bone mass during adolescence. Studies have shown that bone loss can occur fairly rapidly in girls with anorexia. While some studies have shown that bone density may be restored if overall health improves and anorexia is successfully treated, other studies suggest that an increased risk for fracture may persist later in life.
•Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences.
•Anemia is frequently found in anorexic patients. In addition to having fewer red blood cells, people with anorexia tend to have lower numbers of white blood cells, which play a major role in protecting the body from developing infections. Suppressed immunity and a high risk for infection are suspected but not clinically proven.
•Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause a lower body temperature as well as dry, flaky skin that takes on a yellow tinge. Fine, downy hair grows on the face, back, arms, and legs. Despite this new hair growth, loss of hair on the head is not uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel and eventually lead to tooth loss.
Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other family members as well.
•The individual can become seriously underweight, which can lead to depression and social withdrawal.
•The individual can become irritable and easily upset and have difficulty interacting with others.
•Sleep can become disrupted and lead to fatigue during the day.
•Attention and concentration can decrease.
•Most individuals with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about eating rituals. They may collect recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other people, or hoard food. Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic criteria for an obsessive compulsive disorder.
•Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders.
•Generally, individuals with anorexia are compliant in every other aspect of their life except for their relationship with food. Sometimes, they are overly compliant, to the extent that they lack adequate self-perception. They are eager to please and strive for perfection. They usually do well in school and may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to them. Performance in other areas is stressed as well, and they are often high achievers.
•While control and perfection are critical issues for individuals with anorexia, aspects of their life other than their eating habits are often found to be out of control as well. Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework, and shopping are not uncommon. In particular, people with anorexia often exercise compulsively to speed the weight-loss process.
All of these features can negatively affect one's daily activities. Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder.
PHYSICAL SIGNS AND SYMPTOMS
Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the progressive deterioration brought about by anorexia.
•Heart and circulatory system: Although not life-threatening, an abnormally slow heart rate (bradycardia) and unusually low blood pressure (hypotension) are frequent manifestations of starvation and are commonly associated with anorexia. Of greater significance are disturbances in the heart rhythm (arrhythmia). A reduction in the work capacity of the heart is associated with severe weight loss and starvation.
•Gastrointestinal complications are also associated with anorexia. Constipation and abdominal pain are the most common symptoms. The rate at which food is absorbed into the body is slowed down. Starvation and overuse of laxatives can seriously disrupt the body's normal functions involved in the elimination process. While liver function is generally found to be normal, there is evidence of changes in enzyme levels and overall damage to the liver.
•The glandular (endocrine) system in the body is profoundly affected by anorexia. The complex physical and chemical processes involved in the maintenance of life can be disrupted, with serious consequences. Disturbances in the menstrual cycle are frequent, and secondary amenorrhea (absence of menstrual periods) affects about 90% of adolescent girls with anorexia. Menstrual periods typically return with weight gain and successful treatment. Hormonal imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.
•Kidney (renal) function may appear normal. However, there are significant changes in kidney function in many people with anorexia, resulting in increased or decreased urination or potentially fatal potassium deficiency.
•Bone density loss (osteopenia or thinning of the bones) is a significant complication of anorexia, since women acquire 40%-60% of their bone mass during adolescence. Studies have shown that bone loss can occur fairly rapidly in girls with anorexia. While some studies have shown that bone density may be restored if overall health improves and anorexia is successfully treated, other studies suggest that an increased risk for fracture may persist later in life.
•Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences.
•Anemia is frequently found in anorexic patients. In addition to having fewer red blood cells, people with anorexia tend to have lower numbers of white blood cells, which play a major role in protecting the body from developing infections. Suppressed immunity and a high risk for infection are suspected but not clinically proven.
•Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause a lower body temperature as well as dry, flaky skin that takes on a yellow tinge. Fine, downy hair grows on the face, back, arms, and legs. Despite this new hair growth, loss of hair on the head is not uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel and eventually lead to tooth loss.
Differential Diagnosis
- There are other medical conditions that mimic the signs and symptoms of anorexia nervosa. For instance, a characteristic sign is weight loss which can also be due to type 1 diabetes, primary and secondary hypothyroidism, neoplasias, superior mesenteric artery syndrome and malnutrition.
- During diagnosis, it is essential to rule out mental disorders such as body dysmorphic disorders and body perception alteration.
- There are isolated cases of phagophobia (fear of food), social phobia (inability to eat in public), and globus hystericus (a foreign body feeling in the pharynx that prevents swallowing.
- To rule out bullimia nervosa, consider any gastrointestinal or systemic conditions that include:
- Repeated vomiting
- Polyuria (excessive urination)
- Diarrhea
- Patients are frequently seen by a physician involuntarily and this makes it difficult to obtain data for a precise diagnosis.
- The key is that purgative behaviours in bullimia are caused by the patient.
- Relatives should be questioned regarding behaviours associated with vomiting (going to restroom after eating) and whether diuretics and laxatives have been found in patient's belongings without prescription.
- Physical marks that may indicate bullimia instead of anorexia
- Parotid hypertrophy from chronic vomiting
- Destruction of tooth enamel
Other conditions that may be confused with aneroxia because they all lead to weight loss as well:
- Addison's disease- a rare disorder of the adrenal cortex which results in hypocorticolism leading to weight loss
- Emetophobia- anxiety disorder characterized by intense fear of vomiting. Patients withdraw from situations which in their perception make them feel nauseous such as not touching food with hands.
- Body dysmorphic disorder- a somatoform disorder whereby the patient excessively ruminates over an actual or perceived physical flaw. The patient becomes obsessed over her body image and yearns for a perfect body.
Risk Factors of Anorexia - Jon
Sex
- Being female and having a sibling with Anorexia – 10 to 20 times more likely than the general population
Genetics
- Researchers have found an area on chromosome 1 that appears to be linked to an increased risk of anorexia nervosa
Media and society
- Television, fashion magazines of supermodels and slim bodies and how the media portrays them as the perfect people.
Social pressures
- Cultural pressures to be thin such as ballet, gymnastics, or modeling.
- Parents who pressure their children where they put a lot of emphasis on looks and diets themselves.
Stress
- Onset of puberty
- A breakup
- Leaving schools/migrating
Weight changes
- Classical conditioning where losing weight unintentionally/intentionally brings about good response from people and they continue to do so hoping for continued good response.
- Opposite can happen if they gain weight and bad comments are received
- Being female and having a sibling with Anorexia – 10 to 20 times more likely than the general population
Genetics
- Researchers have found an area on chromosome 1 that appears to be linked to an increased risk of anorexia nervosa
Media and society
- Television, fashion magazines of supermodels and slim bodies and how the media portrays them as the perfect people.
Social pressures
- Cultural pressures to be thin such as ballet, gymnastics, or modeling.
- Parents who pressure their children where they put a lot of emphasis on looks and diets themselves.
Stress
- Onset of puberty
- A breakup
- Leaving schools/migrating
Weight changes
- Classical conditioning where losing weight unintentionally/intentionally brings about good response from people and they continue to do so hoping for continued good response.
- Opposite can happen if they gain weight and bad comments are received
Wednesday, September 29, 2010
PCL 11 Support Group - JinLi
A. Malaysia
1.The Malaysian Mental Health Association (MMHA)
- A NGO under the Department of Social Welfare
They have Family Group Support (for family members)
- provides education through public talks and forums on the nature, treatment and management of different types of mental disorders.
- Illness Management and Recovery (IMR) Programme (Rehabilitation Programme)
- help people to reduce susceptibility to their illness and better manage their symptoms.
- Recovery occurs when people with mental illness discover or rediscover their ability to set and achieve personal goals.
-organizes forums, workshops, seminars, dissemination (create awarenes)
Compared to Australia, there are many eating disorders organizations.
B)Eating Disorders Victoria (EDV) provide comprehensive support and information service on all aspects of eating disorders
- via hotlines, helplines, chatrooms, message boards, events,etc.Family and Friends Support Groups
- only for family members, partners and friends of somebody experiencing an eating disorder.
- a place where family members and friends may express their emotions in a confidential and supportive environment
- provides the opportunity for people to share their stories, learn coping strategies and discover they are not alone.
C)Recovery Support Groups
- for people with an eating disorder who have already taken the first steps towards recovery, are in the midst of the recovery process or are maintaining their recovery.
- not a therapy group, but a support group for sharing experiences and discussing relevant topics of concern.
1.The Malaysian Mental Health Association (MMHA)
- A NGO under the Department of Social Welfare
They have Family Group Support (for family members)
- provides education through public talks and forums on the nature, treatment and management of different types of mental disorders.
- Illness Management and Recovery (IMR) Programme (Rehabilitation Programme)
- help people to reduce susceptibility to their illness and better manage their symptoms.
- Recovery occurs when people with mental illness discover or rediscover their ability to set and achieve personal goals.
-organizes forums, workshops, seminars, dissemination (create awarenes)
Compared to Australia, there are many eating disorders organizations.
B)Eating Disorders Victoria (EDV) provide comprehensive support and information service on all aspects of eating disorders
- via hotlines, helplines, chatrooms, message boards, events,etc.Family and Friends Support Groups
- only for family members, partners and friends of somebody experiencing an eating disorder.
- a place where family members and friends may express their emotions in a confidential and supportive environment
- provides the opportunity for people to share their stories, learn coping strategies and discover they are not alone.
C)Recovery Support Groups
- for people with an eating disorder who have already taken the first steps towards recovery, are in the midst of the recovery process or are maintaining their recovery.
- not a therapy group, but a support group for sharing experiences and discussing relevant topics of concern.
Tuesday, September 28, 2010
PCL 11 - Causes
Cultural Pressures
- being extremely thin = standard of beauty for women and represents success, happiness, and self-control
- messages from the media that they must diet to meet this standard
- however, this idealized ultra-thin body shape is almost impossible to achieve since it does not fit with the biological and inherited factors that determine natural body weight
- women very dissatisfied with their body weight and shape.
- More recently, pressure has also increased on men to be lean and muscular. In addition, in certain occupations (such as dancing, modeling, and sports like gymnastics, figure skating, running, and wrestling), the pressure to maintain a specific weight and appearance is especially strong.
Psychological Issues
Psychological characteristics that can make a person more likely to develop anorexia nervosa include:
- Low self-esteem
- Feelings of ineffectiveness
- Poor body image
- Depression
- Difficulty expressing feelings
- Rigid thinking patterns
- Need for control
- Perfectionism
- Physical or sexual abuse
- Avoidance of conflict with others
- Need to feel special or unique
People with anorexia nervosa often appear emotionally driven not only toward weight loss, but also in other areas of their life, such as schoolwork, physical fitness, or career. It has also been suggested that in some cases of anorexia nervosa, self-starvation may be a way to avoid the sexual and social demands associated with adolescence.
One of the problems in determining which traits may cause anorexia nervosa is that the weight loss itself causes certain psychological disturbances to develop. These may include depression, anxiety, irritability, mood swings, obsessive thinking, feelings of inadequacy, social withdrawal, and personality changes. Thus, some of the traits that occur in anorexia nervosa may be a result, rather than a cause, of the disorder.
Family Environment
- Overprotective
- Rigid
- Suffocating in their closeness
--> anorexia nervosa develops as a struggle for independence and individuality
Other characteristics of families:
- Overvaluing appearance and thinness
- Criticizing a child's weight or shape
- Being physically or sexually abusive
Genetic Factors
- eight times more often in people who have relatives with the disorder.
- However, experts do not know exactly what the inherited factor may be.
- In addition, anorexia nervosa occurs more often in families with a history of depression or alcohol abuse.
Life Transitions
Life transitions can often trigger anorexia nervosa in someone who is already vulnerable because of the factors described above. Examples include:
- Beginning of adolescence
- Beginning or failing in school or at work
- Breakup of a relationship
- Death of a loved one
Dieting and losing weight can also set off anorexia nervosa.
Perpetuating Factors
Once anorexia nervosa has developed, several factors can perpetuate the disorder. These factors include:
- Symptoms of starvation
- Other people's reactions to the weight loss
- Emotional needs filled by feelings of self-control, virtue, and power from controlling one's weight
The resulting cycle makes it more difficult to stop the disorder and become healthy again.
Monday, September 27, 2010
PCL 11- Siti's Dieting
SitiNoorhazlina:
-lower six(STPM)
-volleybal player
-top scorer
- tall, fit appearance,
- love fashion magazine and compare herself with the models
-started to eat light, kopi-o and a peice of fruit during lunchtime
-skipping meals, instead working out in the gym
-she thinks she has huge legs, she thinks she's fat
-indication of weight loss: 'old jeans are too big"
-she's secretive about her eating
probable reasons:
-anorexia nervosa; a psychological problem, wrong perception
-peer pressure
-bulimia nervosa?
-high metabolism
-dysphagia? problem in swollowing
-drug abuse? chemo drugs, amphetemine, etc
Few other causes of weight loss:
- intentional loss
-unintentional loss: anorexia, depression, bulimia *related to psychological state
-manifestation of diseases: cancer, tumour
features of modern lifestyle:
sedentary lifestyle, media, binge eating, type of food, stress, and depress, more modern people skip breakfast.
eating disorders:
bulimia and anorexia
Anorexia: heritable?
Things we need to know/ask :
Perception on food, what do the subject feel about eating, ask the person's target, family history, social history
Learning issues:
1.What is anorexia nervosa?- Reza
2.Causes of anorexia nervosa? - charlene
3.Signs and symptoms - dev
4.Risk factors - Jon
5.Epidemiology - Teh
6.Pathophysiology of weight loss - nicole
7.Diffrential diagnosis(compare with other eating disorders) - valerie
8. Proper Diet and unhealthy diet & BMI - Deena
9. Nutritional deficiency disorders - Sharvin
10. MSE - gurki
11. Investigations - lincoln
12. Treatment and management- revathy
13.Proper Diet and unhealthy diet & BMI - Deena
14. Support Group - jin li & amlah
-lower six(STPM)
-volleybal player
-top scorer
- tall, fit appearance,
- love fashion magazine and compare herself with the models
-started to eat light, kopi-o and a peice of fruit during lunchtime
-skipping meals, instead working out in the gym
-she thinks she has huge legs, she thinks she's fat
-indication of weight loss: 'old jeans are too big"
-she's secretive about her eating
probable reasons:
-anorexia nervosa; a psychological problem, wrong perception
-peer pressure
-bulimia nervosa?
-high metabolism
-dysphagia? problem in swollowing
-drug abuse? chemo drugs, amphetemine, etc
Few other causes of weight loss:
- intentional loss
-unintentional loss: anorexia, depression, bulimia *related to psychological state
-manifestation of diseases: cancer, tumour
features of modern lifestyle:
sedentary lifestyle, media, binge eating, type of food, stress, and depress, more modern people skip breakfast.
eating disorders:
bulimia and anorexia
Anorexia: heritable?
Things we need to know/ask :
Perception on food, what do the subject feel about eating, ask the person's target, family history, social history
Learning issues:
1.What is anorexia nervosa?- Reza
2.Causes of anorexia nervosa? - charlene
3.Signs and symptoms - dev
4.Risk factors - Jon
5.Epidemiology - Teh
6.Pathophysiology of weight loss - nicole
7.Diffrential diagnosis(compare with other eating disorders) - valerie
8. Proper Diet and unhealthy diet & BMI - Deena
9. Nutritional deficiency disorders - Sharvin
10. MSE - gurki
11. Investigations - lincoln
12. Treatment and management- revathy
13.Proper Diet and unhealthy diet & BMI - Deena
14. Support Group - jin li & amlah
Sunday, September 26, 2010
PCL 10 - Reading between the lines
Hey Guys :)
i've just posted the basic stuff, i'll go into more depth during our PCL session alright :)
Causes of Cataract
Cataracts are caused by changes in the lens protein of the eye, which makes them cloudy. Cataract may be caused due to:
- Diabetes
- An injury to the eye or Previous eye inflammation
- Exposure to ultraviolet light from sunlight
- Medication use, such as long-term use of steroids
- Smoking
- Crystallin’s loss of function
- A family history of cataracts
- Exposure to lead
Saturday, September 25, 2010
Investigations
Investigations
Full Blood Count
- shows red blood cell count , total haemoglobin , haematocrit , white blood cell count ,platelet count
Haemoglobin - normal range : 13.5-17.5 g/dl (male )
: 11.5-15.5 g/dl (female )
Has oxygen carrying capacity. Hence, if person has low haemoglobin count, might cause anemia in patients, post operatively.
Anaemia - condition where r.b.c or r.b.c carrying capacity drops below normal levels.
- symptoms : tiredness, lethargy, shortness of breath , palpitations
- signs : palor , smooth tongue ( abnormal ) , painful ulcers
White Blood Cell Count
- doesn’t have much significance in prevalence of unexpected abnormalities postoperatively. ( only 1 % )
- patient management also not altered.
- usually indicated by myeloproliferative disorders, high risk of leukopenia from drugs/disease
Platelet Count
- important function in blood clotting .*
- normal range : ( 150- 400K /microlitre )
- reduced level could cause problems during cataract surgery. ( invasive )
Coagulation Tests
- Related to platelet function
- Eg: Thrombin Time - thrombin added to plasma and time taken to form a clot is
- recorded. ( should be <>
- extended period of time could suggests drug use ( aspirin ) , haemophilia.
Fasting Blood Glucose
range : -
- done by asking patient to cease eating any food for about 8 hours, then blood glucose tested with glucometer.
- important to make sure patient is not diabetic.
Super sorry for the late upload. forgot to do upload =.= . sorry deeenaaaa
History
Careful history taking is essential in determining the progression and functional impairment in vision resulting from the cataract and in identifying other possible causes for the lens opacity. A patient with cataract often presents with a history of gradual progressive deterioration and disturbance in vision. Such visual aberrations are varied depending on the type of cataract present in the patient.
* Decreased visual acuity
o Decreased visual acuity is the most common complaint of patients with senile cataract. The cataract is considered clinically relevant if visual acuity is affected significantly. Furthermore, different types of cataracts produce different effects on visual acuity.
o For example, a mild degree of posterior subcapsular cataract can produce a severe reduction in visual acuity with near acuity affected more than distance vision, presumably as a result of accommodative miosis. However, nuclear sclerotic cataracts often are associated with decreased distance acuity and good near vision.
o A cortical cataract generally is not clinically relevant until late in its progression when cortical spokes compromise the visual axis. However, instances exist when a solitary cortical spoke occasionally results in significant involvement of the visual axis.
* Glare
o Increased glare is another common complaint of patients with senile cataracts. This complaint may include an entire spectrum from a decrease in contrast sensitivity in brightly lit environments or disabling glare during the day to glare with oncoming headlights at night.
o Such visual disturbances are prominent particularly with posterior subcapsular cataracts and, to a lesser degree, with cortical cataracts. It is associated less frequently with nuclear sclerosis. Many patients may tolerate moderate levels of glare without much difficulty, and, as such, glare by itself does not require surgical management.
* Myopic shift
o The progression of cataracts may frequently increase the diopteric power of the lens resulting in a mild-to-moderate degree of myopia or myopic shift. Consequently, presbyopic patients report an increase in their near vision and less need for reading glasses as they experience the so-called second sight. However, such occurrence is temporary, and, as the optical quality of the lens deteriorates, the second sight is eventually lost.
o Typically, myopic shift and second sight are not seen in cortical and posterior subcapsular cataracts. Furthermore, asymmetric development of the lens-induced myopia may result in significant symptomatic anisometropia that may require surgical management.
* Monocular diplopia
o At times, the nuclear changes are concentrated in the inner layers of the lens, resulting in a refractile area in the center of the lens, which often is seen best within the red reflex by retinoscopy or direct ophthalmoscopy.
o Such a phenomenon may lead to monocular diplopia that is not corrected with spectacles, prisms, or contact lenses.
Physical
After a thorough history is taken, careful physical examination must be performed. The entire body habitus is checked for abnormalities that may point out systemic illnesses that affect the eye and cataract development.
* A complete ocular examination must be performed beginning with visual acuity for both near and far distances. When the patient complains of glare, visual acuity should be tested in a brightly lit room. Contrast sensitivity also must be checked, especially if the history points to a possible problem.
* Examination of the ocular adnexa and intraocular structures may provide clues to the patient's disease and eventual visual prognosis.
o A very important test is the swinging flashlight test which detects for a Marcus Gunn pupil or a relative afferent pupillary defect (RAPD) indicative of optic nerve lesions or diffuse macular involvement. A patient with RAPD and a cataract is expected to have a very guarded visual prognosis after cataract extraction.
o A patient with long-standing ptosis since childhood may have occlusion amblyopia, which may account more for the decreased visual acuity rather than the cataract. Similarly, checking for problems in ocular motility at all directions of gaze is important to rule out any other causes for the patient's visual symptoms.
* Slit lamp examination should not only concentrate on evaluating the lens opacity but the other ocular structures as well (eg, conjunctiva, cornea, iris, anterior chamber).
o Corneal thickness and the presence of corneal opacities, such as corneal guttata, must be checked carefully.
o Appearance of the lens must be noted meticulously before and after pupillary dilation.
o The visual significance of oil droplet nuclear cataracts and small posterior subcapsular cataracts is evaluated best with a normal-sized pupil to determine if the visual axis is obscured. However, exfoliation syndrome is appreciated with the pupil dilated, revealing exfoliative material on the anterior lens capsule.
o After dilation, nuclear size and brunescence as indicators of cataract density can be determined prior to phacoemulsification surgery. The lens position and integrity of the zonular fibers also should be checked because lens subluxation may indicate previous eye trauma, metabolic disorders, or hypermature cataracts.
* The importance of direct and indirect ophthalmoscopy in evaluating the integrity of the posterior pole must be underscored. Optic nerve and retinal problems may account for the visual disturbance experienced by the patient. Furthermore, the prognosis after lens extraction is affected significantly by detection of pathologies in the posterior pole preoperatively (eg, macular edema, age-related macular degeneration).
Careful history taking is essential in determining the progression and functional impairment in vision resulting from the cataract and in identifying other possible causes for the lens opacity. A patient with cataract often presents with a history of gradual progressive deterioration and disturbance in vision. Such visual aberrations are varied depending on the type of cataract present in the patient.
* Decreased visual acuity
o Decreased visual acuity is the most common complaint of patients with senile cataract. The cataract is considered clinically relevant if visual acuity is affected significantly. Furthermore, different types of cataracts produce different effects on visual acuity.
o For example, a mild degree of posterior subcapsular cataract can produce a severe reduction in visual acuity with near acuity affected more than distance vision, presumably as a result of accommodative miosis. However, nuclear sclerotic cataracts often are associated with decreased distance acuity and good near vision.
o A cortical cataract generally is not clinically relevant until late in its progression when cortical spokes compromise the visual axis. However, instances exist when a solitary cortical spoke occasionally results in significant involvement of the visual axis.
* Glare
o Increased glare is another common complaint of patients with senile cataracts. This complaint may include an entire spectrum from a decrease in contrast sensitivity in brightly lit environments or disabling glare during the day to glare with oncoming headlights at night.
o Such visual disturbances are prominent particularly with posterior subcapsular cataracts and, to a lesser degree, with cortical cataracts. It is associated less frequently with nuclear sclerosis. Many patients may tolerate moderate levels of glare without much difficulty, and, as such, glare by itself does not require surgical management.
* Myopic shift
o The progression of cataracts may frequently increase the diopteric power of the lens resulting in a mild-to-moderate degree of myopia or myopic shift. Consequently, presbyopic patients report an increase in their near vision and less need for reading glasses as they experience the so-called second sight. However, such occurrence is temporary, and, as the optical quality of the lens deteriorates, the second sight is eventually lost.
o Typically, myopic shift and second sight are not seen in cortical and posterior subcapsular cataracts. Furthermore, asymmetric development of the lens-induced myopia may result in significant symptomatic anisometropia that may require surgical management.
* Monocular diplopia
o At times, the nuclear changes are concentrated in the inner layers of the lens, resulting in a refractile area in the center of the lens, which often is seen best within the red reflex by retinoscopy or direct ophthalmoscopy.
o Such a phenomenon may lead to monocular diplopia that is not corrected with spectacles, prisms, or contact lenses.
Physical
After a thorough history is taken, careful physical examination must be performed. The entire body habitus is checked for abnormalities that may point out systemic illnesses that affect the eye and cataract development.
* A complete ocular examination must be performed beginning with visual acuity for both near and far distances. When the patient complains of glare, visual acuity should be tested in a brightly lit room. Contrast sensitivity also must be checked, especially if the history points to a possible problem.
* Examination of the ocular adnexa and intraocular structures may provide clues to the patient's disease and eventual visual prognosis.
o A very important test is the swinging flashlight test which detects for a Marcus Gunn pupil or a relative afferent pupillary defect (RAPD) indicative of optic nerve lesions or diffuse macular involvement. A patient with RAPD and a cataract is expected to have a very guarded visual prognosis after cataract extraction.
o A patient with long-standing ptosis since childhood may have occlusion amblyopia, which may account more for the decreased visual acuity rather than the cataract. Similarly, checking for problems in ocular motility at all directions of gaze is important to rule out any other causes for the patient's visual symptoms.
* Slit lamp examination should not only concentrate on evaluating the lens opacity but the other ocular structures as well (eg, conjunctiva, cornea, iris, anterior chamber).
o Corneal thickness and the presence of corneal opacities, such as corneal guttata, must be checked carefully.
o Appearance of the lens must be noted meticulously before and after pupillary dilation.
o The visual significance of oil droplet nuclear cataracts and small posterior subcapsular cataracts is evaluated best with a normal-sized pupil to determine if the visual axis is obscured. However, exfoliation syndrome is appreciated with the pupil dilated, revealing exfoliative material on the anterior lens capsule.
o After dilation, nuclear size and brunescence as indicators of cataract density can be determined prior to phacoemulsification surgery. The lens position and integrity of the zonular fibers also should be checked because lens subluxation may indicate previous eye trauma, metabolic disorders, or hypermature cataracts.
* The importance of direct and indirect ophthalmoscopy in evaluating the integrity of the posterior pole must be underscored. Optic nerve and retinal problems may account for the visual disturbance experienced by the patient. Furthermore, the prognosis after lens extraction is affected significantly by detection of pathologies in the posterior pole preoperatively (eg, macular edema, age-related macular degeneration).
PCL 10- pathophysiology of cataracts
CATARACTS
Most cataracts develop when aging or injury changes the tissue that makes up your eye's lens. Some cataracts are caused by inherited genetic disorders that cause other health problems and increase your risk of cataracts.
How a cataract forms...
The lens, where cataracts form, is positioned behind the colored part of your eye (iris). The lens focuses light that passes into your eye, producing clear, sharp images on the retina — the light-sensitive membrane on the back inside wall of your eyeball that functions like the film of a camera. A cataract scatters the light as it passes through the lens, preventing a sharply defined image from reaching your retina. As a result, your vision becomes blurred.
As you age, the lenses in your eyes become less flexible, less transparent and thicker. Aging-related changes to the lens cause tissues to break down and to clump together, clouding small areas of the lens. As the cataract continues to develop, the clouding becomes denser and involves a greater part of the lens.
Types of cataract :
Nuclear Cataract Formation
A nuclear cataract may at first cause you to become more nearsighted or even experience a temporary improvement in your reading vision. But with time, the lens gradually turns more densely yellow and further clouds your vision. Nuclear cataracts sometimes cause you to see double or multiple images. As the cataract progresses, the lens may even turn brown. Advanced yellowing or browning of the lens can lead to difficulty distinguishing between shades of color.
Cataract formation, especially in nuclear cataracts, is caused by oxidative stress that occurs in all biological systems and particularly the lens. Oxidative stress and generation of free radicals results from normal activity of mitochondria and other metabolic processes. Oxidation is controlled by an environment of reducing agents. Reducing agents produced in the mitochondria neutralize free radicals.
Production of reducing agents requires energy output, a challenge for the deeper lens fiber cells that lack mitochondria. The enzyme systems in deeper cells are less active because they were synthesized decades earlier. These central lens fiber cells are delicate balanced between being damaged by oxidation of membrane lipids and cytoplasmic protein, and being protected by reducing agents transported from epithelial cells and immature lens fiber cells near the surface. Transport of reducing agents is difficult because there is little space between lens fiber cells. Movement is by diffusion.50
Another challenge is maintenance of protein stability for many decades. Once a lens is formed, proteins are synthesized in outer fiber cells close to the surface. Proteins deeper in the lens generated during embryogenesis have to last a hundred years or more. Accumulated damage to these proteins reduces enzymatic activity and increases protein aggregation, a component of cataract formation.
Cortical Cataract Formation
A cortical cataract begins as whitish, wedge-shaped opacities or streaks on the outer edge of the lens cortex. As it slowly progresses, the streaks extend to the center and interfere with light passing through the center of the lens. Problems with glare are common for people with this type of cataract.
Unlike nuclear cataracts, cortical cataracts show disorganization of fiber cell structure. Causes of cortical cataracts include loss of calcium balance, protein breakdown and aggregation, and diminished antioxidant protection (from glutathione). There is evidence for a genetic cause of cataract formation. There is no overall explanation why initial damage is restricted to the center of affected cells or why the preferred location of cortical cataracts is the lower half of the lens.
Posterior Subcapsular Cataract Formation
A posterior subcapsular cataract starts as a small, opaque area that usually forms near the back of the lens, right in the path of light on its way to the retina. A subcapsular cataract often interferes with your reading vision, reduces your vision in bright light and causes glare or halos around lights at night.
Posterior subcapsular cataracts are less common and occur with the other two types. A “pure” posterior subcapsular cataract is uncommon, occurring in only 10% of cases.
An important risk factor in posterior subcapsular cataract development (and cortical cataracts) is exposure to excessive X-ray or gamma-radiation. Mechanisms that initiate cellular or molecular dysfunction are poorly understood.
Congenital Cataract Formation
Cataracts you're born with (congenital cataracts). Some people are born with cataracts or develop them during childhood. Such cataracts may be the result of the mother having contracted an infection during pregnancy. They may also be due to certain inherited syndromes, such as Alport's syndrome, Fabry's disease and galactosemia. Congenital cataracts, as they're called, don't always affect vision, but if they do they're usually removed soon after detection.
Physiology and Visual Pathway of The Eye
How the eye works
- First, light rays are reflected off an object and enters the eyes through the cornea, a transparent outer coat of the eye.
- The cornea refracts light and together with the lens, focuses light onto the retina. Contrary to popular belief, the cornea instead of the lens, provides more refractive power (two thirds) due to its highly curved surface and high refractive index.
- As the light rays pass through the pupil, the iris changes the size of the pupil via sphincter (parasympathetic) and dilator muscles (sympathetic) to regulate the amount of light passing through. For example, in bright light, the sphincter muscles contract and dilator muscles relax to decrease the diameter of the pupil. The opposite action happens in dim light.
- The retina is a highly complex structure comprising photoreceptors (rods and cones) and neurones, some of which give rise to the optic nerve fibres. It converts light into electrical signals.
- Photoreceptors in the retina which are the rods and cones are responsible for detecting light with light-receptive pigments. Transformation of light energy into nerve impulses depend on alteration of visual pigments contained in these photoreceptors.
- Cones are responsible for daylight vision. Subgroups of cones respond to different wavelengths of light (blue, green and red). They are concentrated at the fovea (macula) which is responsible for detailed vision. (reading fine print). In bright conditions, cones provide clear, sharp, central vision.
- Rods are responsible for night vision. They do not signal wavelength info. They form the large majority of photoreceptors in the remaining retina. Rods provide peripheral vision, allowing eyes to detect motion.
- On the retina, the image formed is real, inverted and smaller. As the light passes through the lens, its trajectory changes. Thus the image is upside down on retina.
Accomodation, or how the eye sees images at different distances.
- In order to produce a focussed image, the zonular fibres supporting the lens transmit changes to the ciliary body. This allows the lens to change its shape and refractive power.
- In the normal resting state:
- our ciliary muscle is relaxed
- the elastic lens tends to become thick
- aqueous & vitreous humour push outward on the sclerotic coat
- ligaments become taut / tensed
- lens pulled into a thin shape
- short focal length
- When a near object is brought to our eye:
- sphincter-like action of circular muscle fibres + contraction of longitudinal muscle fibres
- contraction of ciliary muscle
- distance between edges of ciliary body decreases
- relaxation of suspensory ligament
- lens becomes thicker
- focal length shortens
- light rays converge earlier; image formed on retina
Transduction
- Besides rods and cones, other cells found in the retina are bipolar, horizontal, amacrine and ganglion cells.
- The light activates the photoreceptor cells (turns them "on") and they in turn convert the light signal into a neural signal. This is done through the action of protein molecules on the outer segment of the rods and cones known as photopigments.
- The absorption of light by the photopigments then produces a chemical reaction that changes the rate of neurotransmitter release at the receptor’s synapse with the bipolar cells. The greater the change in transmitter release, the stronger the signal that is then passed on to the bipolar cells.
- The neural impulses from the bipolar cells then activate the ganglion cells. The axons of the ganglion cells make up the optic nerve, which then conveys the information to the brain for further processing.
• All information from the right half of the visual field projects to the left half of the brain, and vice-versa.
• The axons of ganglion cells in the nasal part of the retina (i.e. near the nose) cross in the optic chiasm. They convey information about the visual field periphery
(lightly shaded colours).
• The axons of ganglion cells in the temporal part of the retina do
not cross in the optic chiasm.
Location and structure of the lateral geniculate nucleus
• The LGN on each side of the brain receives projections from ganglion cells
located in the contralateral nasal retina and ipsilateral temporal retina.
• The LGN is formed by layers which receive projections from different classes of
ganglion cells.
• The Magnocellular (M) layers receive projections from the retinal Y cells, and the
Parvocellular (P) layers from the retinal X cells.
• The projection from the lateral geniculate nucleus to the cortex forms the
optic radiation, which is one of the most distinctive fibre tracts in the human
brain.
• The optic radiation is topographically organised. For example, information
from the upper half of the visual field (which projects to the lower retina) is
conveyed by the most ventral axons, and terminate in the lower bank of the
calcarine sulcus.
Receptive Field Mapping
• The visual receptive field of a cell is a small “window” of the visual field.
Presentation of a stimulus within the receptive field can modify the
neuron’s activity.
• By moving the spot (stimulus) on the screen, the experimenter defines
the receptive field.
• By changing the stimulus characteristics, the neuron’s selectivity for
stimulus features is determined.
• The receptive field is the “window” of the visual field that the neurone is
analysing.
• Only stimuli presented within the receptive field can change the
electrical activity of the neurone.
• The inteconnections between the retina, thalamus and cortex are TOPOGRAPHIC: adjacent cells of the retina connect to adjacent cells in the cortex.
• This creates a map-like representation of the visual scene in our visual cortices. There is one map in each visual area
Responses of retinal cells
• Retinal ganglion cells are maximally excited by a spot of light that fills the
receptive field.
• Because of the inhibitory surrounds, they respond poorly to uniform
illumination.
• Different ganglion cells will be maximally excited by light of different
colours.
• Similar to small photometers; each “reads” the amount and type of light
coming from a point of the scene.
Orientation
• In the visual cortex, cells are no longer “spot readers”. They code for the
presence of oriented boundaries.
• In this example, the neurone responds only to a boundary between light and
dark, of a specific orientation
• There are weak or no electrical responses to uniform light within the
receptive field, or to different orientations.
Friday, September 24, 2010
Anatomy of the EYE O_O
FIGURE 3
FIGURE 2
FIGURE 1Ladies and Gentlemen,
I bid all of you a beautiful Saturday morning and hope the day does go splendid for all of you.
For this PCL posting, I would be doing a brief summary of the anatomy of the eye but further details would be definitely be gone through during PCL this coming Monday. As usual, physiology must go hand in hand with anatomy and I believe the physiologists would be discussing together with the anatomists to bring a wholesome picture for you guys.
Gross anatomy is very dry and is just plain memory work, however, the most important thing about anatomy would be clinical relevance, so of course we would be discussing this in clinical relevance. I would just type out the pointers and everyone should go do a brief read up about the conditions. =)
For holistic sake and the non-excludability of anatomy, I would firstly be discussing about the orbit, the bones forming the orbital fossa in your skull that houses your eye. FIGURE 1
It is important to know those major bones in your skull and more importantly where glands are housed, nerves run. Like the lesser and greater wings of the sphenoid along with the floor of the maxilla and the palatine give rise to the superior orbital fissure and inferior orbital fissure. Those fissures are where some of your nerves run. The lacrimal has a fossa for the lacrimal sac and at the superior lateral aspect of your frontal bone roof has another fossa for lacrimal glands.
Clinical relevance: Blowout fracture. The medial and inferior walls of the orbit are thin and a blow may fracture the orbital walls while the margin remains intact. Orbital fractures often result in intraorbital bleeding, which exerts pressure on the eyeball, causing exopthalmos.
Lacrimal glands secrete your tears, ducts convey the tears from glands to conjunctival sac, lacrimal canaliculi each commencing at a punctum on the lacrimal papilla near the medial angle of the eye convey the lacrimal fluid from the lacrimal lake to sac, the dilated superior part of the nasolacrimal duct
Nasolacrimal duct conveys lacrimal fluid to the nasal cavity.
Production of the lacrimal fluid is by parasymp impulses from CN VII
Now we will talk about the eyelids or palpebrae (L.). When closed tit covers the eyeball anteriorly and protects it from injury or excessive light. They also help in the moisture maintenance of the eye. The eyeids are covered externally but thin skin and internally by a transparent mucous membrane called the palpebral conjunctiva. The palpebral conjunctiva is reflected onto the eyeball and continuous with the bulbar conjunctiva which is adherent to the periphery of the cornea.
The junction linking the bulbar and palpebral is known as the fornix (superior n inferior). The conjunctiva sac is the area or space bound by both palpebrae and bulbar, it allows the eyelids to move freely over the surface of the eyeball as they open and close.
The eyelashes (cilia) are in the margins of the eyelids, the large sebaceous glands associated with the eyelashes are the ciliary glands. The junctions of the superior and inferior eyelids make up the medial and lateral palpbral commissures, defining the angles of the eyes.
Do take note of the anatomy of the upper eyelids, figure 2. The tarsal glands are the ones that secrete lipids to keep the lacrimal fluid in the eye, making it moist. However when the lacrimal fluid is in too much quantity then it goes past this lipid layer and flows out as tears (when crying) cool huh!
Clinical relevance:
1. Lesion to CN III would result in ptosis.
2. Lesion to CN VII involves paralysis of the orbicularis oculi, preventing eyelids from closing fully.Loss of tonus of lower eyelid, drying up of cornea.
3.Inflammation of palpebral glands: sty and cysts
Now we will talk about the eyeball, which has 3 layers, a fibrous layer, vascular layer and a neural layer. The fibrous layer consists of the cornea and the sclera. The vascular or uvea contains iris, ciliary bodies and choroid. Neural layer consists of the retina (cones and rods).
All of these would be discussed in greater detail during the PCL.
Iris is controlled by parasymp. sphnicter pupillae and symp. dilator pupillae.
Posterior part of the eye is the fundus (hence fundoscopy)
Clinical relevance:
1.Detached retina. Seepage of fluid betwen the neual and pigmented layers of the retina, patients may complain of specks of light in front of their eye.
2.Papilledema is increase in CSF pressure slows venous return and can be seen as the swelling of the optic disc.
Remember the 4 rectus muscles, the superior and inferior oblique muscles and their movements also, what we have learnt in last semester.
Okay thats all from me for now =D Peace out people. :)))
Social limitations of Impaired vision
-There is a difference on the social effects when a child is born blind and when someone loses his/her vision and becomes blind.
- Extensive care is needed
- Mobility needs
- Need training, adaptation and learning of new skills
- Many skills would be lost such as driving and reading.
- Would need a caregiver at periods throughout the day
- Period of training can last up to 2 years
- Moving to new environments would cause difficulties as the patient has to learn the place again
- Skills learnt would help make adaptation easier in the future
- Need help during travelling
- Tend to be more skilful in other sensory areas such as hearing and smell.
PCL 10 - Treatment and Management for cataracts
Treatment
How is a cataract treated?
The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.
A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.
Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.
If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.
If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.
Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma.
What are the different types of cataract surgery?
There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:
Phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called "small incision cataract surgery."
Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.
After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.
Some people cannot have an IOL. They may have another eye disease or have problems during surgery. For these patients, a soft contact lens, or glasses that provide high magnification, may be suggested.
What are my lens choices?
The artificial replacement lens used to replace your cataracts is called an intraocular lens or IOL for short. These IOLs are very small and are highly advanced medical devices that are designed to mimic your natural crystalline lens.
Different types of implantable lenses are designed to meet individual eye health and lifestyle needs, so be sure to talk to your doctor about which lens is right for you.
Monofocal lens: This traditional lens will give you good vision for seeing objects in the distance, such as when you’re driving. For near vision, such as reading or surfing the Internet, you will typically need to wear glasses. There are many types of monofocal lenses that you can choose.
Multifocal lens: These types of lenses are designed to be able to provide patients the ability to see objects clearly at different distances without glasses—near, far, and everywhere in between. The lens material distributes light to different distances, which the eye can focus on for sharper vision. For people who are active and find wearing glasses inconvenient, the multifocal lens can be the optimal choice.
What are the risks of cataract surgery?
As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.
Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes, see an eye care professional immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Your eye must be examined by an eye surgeon as soon as possible. A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.
Is cataract surgery effective?
Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision afterward.
What happens before surgery?
A week or two before surgery, your doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of your eye. This information helps your doctor choose the right type of IOL.
You may be asked not to eat or drink anything 12 hours before your surgery.
What happens during surgery?
At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The area around your eye will be washed and cleansed.
The operation usually lasts less than one hour and is almost painless. Many people choose to stay awake during surgery. Others may need to be put to sleep for a short time.
If you are awake, you will have an anesthetic to numb the nerves in and around your eye.
After the operation, a patch may be placed over your eye. You will rest for a while. Your medical team will watch for any problems, such as bleeding. Most people who have cataract surgery can go home the same day. You will need someone to drive you home.
What happens after surgery?
Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. Your eye may be sensitive to light and touch. If you have discomfort, your doctor can suggest treatment. After one or two days, moderate discomfort should disappear.
For a few days after surgery, your doctor may ask you to use eyedrops to help healing and decrease the risk of infection. Ask your doctor about how to use your eyedrops, how often to use them, and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye.
When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.
Can problems develop after surgery?
Problems after surgery are rare, but they can occur. These problems can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully.
Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery.
An after-cataract is treated with a laser. Your doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems. As a precaution, your doctor may give you eyedrops to lower your eye pressure before or after the procedure.
When will my vision be normal again?
You can return quickly to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.
If you received an IOL, you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved color vision. Also, when your eye heals, you may need new glasses or contact lenses.
What can I do if I already have lost some vision from cataract?
If you have lost some sight from cataract or cataract surgery, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision
services.
Complementary Medicine
Other forms of natural therapies, although not backed by human studies, include Ayurveda, imagery, juice therapy and reflexology.
The common therapy if using Ayurveda to treat cataracts is to bathe the eye with an eye wash made of triphala tea which can be found in most Indian pharmacies and some natural health stores. The tea is composed of a powder of three Indian tree fruits. The recommendation is to wash the affected eye in the steeped, cooled tea up to three times a day.
In imagery therapy, there are many images which may help to heal the cataracts. An image should appeal to each individual in order to work successfully. Different imagery sessions can be found in books, on tapes or by seeking the expertise of a professional who works with imagery therapy.
Juice therapy is based on the body's need for additional antioxidants, vitamins and minerals with which it can fight the free radicals and damaging molecules that are attacking the protein of the lenses. However, most juicing experts agree that juicing therapy will only slow down the progression, not reverse the condition.
Reflexology has been used in some cases of cataracts therapy. The points used in reflexology hone in on the "eye, ear, neck, cervical spine, kidney and all of the points on the tops and bottoms of the toes, with emphasis on the pituitary and thyroid gland." Foot reflexology charts and reflexology books are available to help locate the points which should be stimulated for cataracts treatment.
Finally, some acupuncturists claim that they are able to help in the treatment of cataracts by unblocking stagnant energy (Chi) within the meridians of the body. This increases the circulation of the blood throughout the entire body, possibly increasing the amount of nutrients that reach the area of the eye in need of extra antioxidants, vitamins and minerals. There is the possibility that with an experienced and licensed acupuncturist plus diet changes, cataracts may be reduced or at least the progression slowed or halted altogether.
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