Deformities of The Vertebral Column With Causes

The vertebral column in a normal upright position has two antero-posterior curves-one with a concavity forwards in the upper dorsal region and the other with a slight convexity forwards in the dorsolumbar region. Normally, there is no lateral curvature. The vertebral column should be examined for any abnormality, angular deformity, swelling or tenderness.

Normally the vertebral column has both anterior as well as lateral mobility. This can be tested by asking the patient to bend forwards, backwards and sideways. Limitation of movements and pain, if any, should be looked for.

I. Scoliosis: Scoliosis is an abnormal lateral curvature of the spine.

Causes:

1. Congenital
2. Postural: Carrying heavy weight in one arm.
3. Compensatory: Reduced length of one lower limb.
4. Reflex: To relieve pain as in sciatica or renal colic.
5. Neurological: Poliomyelitis, syringomyelia, muscular dystrophy, hereditary ataxia.
6. Rickets
7. Functional

II. Kyphosis: Kyphosis is an abnormal anterio-posterior curvature of the spine with forward concavity and dorsal prominence.

Causes:

1. Congenital: Wedge shaped vertebra
2. Postural: Carrying weights on the back
3. Disease of bone and joints: Tuberculosis (Pott’s spine), rheumatoid arthritis, rickets, osteoarthritis, osteitis deformans, fracture of the vertebral body, new growth of the spine.
4. Neurological: Muscular dystrophy, hereditary spastic paraplegia, Friedreich’s ataxia, sryingomyelia, poliomyelitis, cerebral palsy, neurofibroma, etc.

III. Lordosis: Lordosis is an abnormal anterior-posterior curvature of the spine with forward convexity.

Causes:

1. Physiological: Pregnancy
2. Secondary to hip disease and congenital
3. Muscular dystrophy
4. Large abdominal tumors

Examination of Skin For manifestation of Systemic Disease

Examination of skin often gives important clues to local or systemic diseases. The following features should be noted:

Color: It may be pale, flushed, cyanosed, yellow, etc.

Pigmentation: Pigmentation may occur in several diseases. Some common medical conditions associates with pigmentation are:

• Endocrine: Addison’s disease, Cushing’s disease, thyrotoxicosis.
• Deficiency: Pellagra, Kwashiorkor.
• Infections: Kala azar, chronic malaria, secondary syphilis, tuberculosis, leprosy, etc.
• Metabolic: Hemochromatosis.
• Skin disease: Neurofibromatosis, lichen planus, acanthosis nigricans, etc.
• Miscellaneous: Malignancy, pernicious anemia, exposure to sun rays or radiations.

Hypopigmentation: Hypopigmented patches may occur in leprosy, leukoderma, albinism, fungal infections of skin, etc.

Eruptions: Various types of eruptions may occur as follows:

• Macules: (Not raised above the skin). This may occur in typhoid, syphilis and purpura. If they are not generalized they are called roseollar.
• Papules: (Raised tiny nodules): This may occur in measles, chicken-pox, smallpox, and following drugs like sulfonamides.
• Pustules: These are papules containing pus.
• Nodules: (Large papules solitary projection from the skin). This may occur in erythema nodosum, leprosy, tuberculosis, secondary syphilis.
• Vesicles: (Small blisters). This may occur in herpes, chicken-pox and smallpox..
• Wheat: (Elevated patches on the skin with center paler than the periphery), Allergy.
• Café-Au-Lait patches: Dark brown patches resembling coffee in milk. They are considered significant if they are more than 5 in number. They are seen in:
  • Neurofibromatosis (regular outline without deep indentations).
  • Albright’s syndrome (irregular outline with deep indentations).

Hemorrhagic: Hemorrhage under the skin is classified as follows:

• Petechiae: Tiny hemorrhage less than 1 mm in diameter.
• Purpura: Hemorrhage 2-5 mm in diameter.
• Ecchymosis: Hemorrhage more than 5 cm in diameter.
• Hematoma: Hemorrhage large enough to produce elevation of skin.

Causes of hemorrhage under the skin:

• Deficiency: Vitamin deficiency, scurvy.
• Infection: Meningococcal meningitis, SBE, HIV.
• Hematological: Thrombocytopenia, acute leukemia, chronic lymphatic leukemia, chronic myeloid leukemia (in terminal phase) platelet dysfunction and aplastic anemia.

Type of Skin

• Dry skin: This is seen in myxedema and dehydration.
• Moist skin: This occurs when there is profuse perspiration as in shock, following myocardial infarction, crisis of pneumonia and thyrotoxicosis.
• Thick skin: This occurs in Myxedema, acromegaly and scleroderma.
• Thin skin: This occurs in old people and following wasting diseases.
• Pinched skin: suggests dehydration.

Hair: Changes in hair that occurs in some of the diseases are as follows:

• Falling of hair: Following infectious fevers e.g. typhoid.
• Patchy hair loss: Alopecia areata, syphilis.
• Loss of outer third of the eyebrows: Leprosy, Myxedema.
• Absence of axillary, pubic and facial hair: Hypopituitarism, hypogonadism.
• Excessive hair growth in women: Cushing’s syndrome, adrenocortical syndrome.

Common Digestive Problems-Flatulence, Heart Burns, Eructations, Indigestion

Flatulence

• Gastric Causes:

Aerophagy

Neurosis

Hiatus hernia

Pyloric stenosis

Biliary dyspepsia

Following vagotomy

• Food intake
  • Cabbage
  • Cauliflower
  • Peas
  • Beans
• Intestinal
  • Steatorrhea
  • Intestinal obstruction
  • Malignancy, etc.
• Systemic diseases
  • Cardiac failure
  • Cirrhosis

Heart Burns

• Organic lesions
  • Reflux oesophagitis
  • Hiatus hernia
  • Peptic ulcer
• Functional
  • Faulty dietary habits
  • Addictions
• Psychogenic
  • Neurosis
  • Repressed emotion

Eructation

• Faulty dietary habits
  • Aerated water
  • Chewing gum
  • Mouth breathing
• Addiction

• • Smoking
  • Alcohol
  • Betel nut
  • Paan

• Gastrointestinal

• • Gastritis
  • Peptic ulcer
  • Hiatus hernia
  • Cholecystitis
  • Stones
  • Irritable bowel syndrome.

• Psychogenic
  • Anxiety
  • Depression

Indigestion

• Upper gastrointestinal tract
  • Alcohol
  • Heavy meals
  • Aerophagia
  • Hiatus hernia
  • Gastroesophageal reflux
  • Peptic ulcer disease
  • Ggastritis
  • Drugs
• Lower gastrointestinal tract
  • Parasites
  • Food intolerance
  • Irritable bowel syndrome
  • Increased intraluminal gas
• Hepatobiliary
  • Cholecystitis
  • Stones
  • Pancreatitis
  • Splenic flexure syndrome
• Systemic diseases
  • Uremia,
  • Cardiac failure
  • Tuberculosis
  • Malignancy.
• Functional

6 Deadly Causes of Anorexia

Anoexia is a symptom that could be of serious concern. Technically anorexia is loss of appetite. Occasional loss of appetite is fine but prolonged loss of appetite is a serious issue. Following diseases must be considered when anorexia is pressent.

• Hepatitis
• Tuberculosis
• Malignancies
• Endocrine disorders
• Chronic wasting diseases: Uremia, cirrhosis of liver, chronic alcoholism, chronic smoking etc.
• Drugs: Digitalis, quinine, metronidazole, etc.