Insulinoma Insulinoma Home I Overview Insulinomas are tumours found in the pancreas that produce excessive amounts of insulin, leading to dangerously low levels of blood sugar. The pancreas typically regulates blood sugar by producing insulin, but in the case of insulinomas, the amount produced exceeds the body’s needs. These tumours are rare and usually remain localised, without spreading to other areas. The exact cause of insulinomas is not well understood. Symptoms ConfusionWeaknessSweatingRapid heartbeatBlurred visionWeight gain Diagnosis Typically confirmed through low plasma glucose levels alongside elevated insulin levels Treatment Most insulinomas are benign and can be surgically removed. This procedure is often performed laparoscopically, where the surgeon makes small incisions and uses specialised instruments to excise the tumour. Read more about Insulinoma Filter Alphabet I
Intercostal Drainage Intercostal Drainage Home I Overview Intercostal drainage, also known as chest tube insertion, is a procedure used to remove air, fluid or pus from the pleural space, which is the space between the lungs and chest wall. Indications Pneumothorax: Presence of air in the space between the chest and lungs, which causes lung collapsePleural Effusion: Presence of fluid in the pleural spaceHaemothorax: Presence of blood in the pleural spaceEmpyema: Presence of pus in the pleural space due to infectionPost-Surgical Drainage: Drainage after thoracic surgeries to prevent fluid/blood accumulation Procedure Preparation: The patient is positioned, usually sitting up or lying on the side. Local anaesthesia is administered to numb the area.Insertion: A small incision is made between the ribs, and a chest tube is inserted into the pleural space. The tube is then connected to a drainage system to allow the continuous removal of air, fluid, or pus.Positioning: The tube is often secured to the skin with sutures and covered with a sterile dressing.Monitoring: The patient is monitored to ensure proper drainage. The tube remains in place until the underlying issue is resolved, which is confirmed via imaging (e.g., chest X-ray). Removal The chest tube is removed once it is no longer needed (typically when drainage decreases and imaging shows resolution of the underlying problem). Complications InfectionBleedingTube displacementOrgan Injury (lung, liver or diaphragm) Read more about Intercostal Drainage Filter Alphabet I
Impulse Oscillometry Impulse Oscillometry Home I Overview Impulse Oscillometry (IOS) is a non-invasive technique used for assessing lung function. It measures respiratory impedance, which includes both resistance and reactance in the airways, by applying small pressure oscillations to the respiratory system during normal breathing. This technique provides detailed information about the mechanical properties of the lungs and airways, making it particularly useful in diagnosing and monitoring conditions, such as asthma, COPD and other respiratory disorders. It is an excellent method to diagnose small airway obstruction, which can be missed by spirometry. Small airways are less than 2 mm in diameter and are usually affected first in obstructive airway disease; hence, IOS can be used to detect these diseases earlier (than by spirometry). IOS is non-invasive, easy to perform and requires minimal patient cooperation; therefore, it is suitable for a wide range of patients, including young children and older patients. Measurement Principle IOS uses sound waves or pressure impulses to create small oscillations in the airway. The patient's response to these oscillations is measured to determine respiratory impedance. Components of Impedance Resistance (R): Reflects the ease with which air flows through the airways. Increased resistance can indicate obstruction or narrowing of the airways.Reactance (X): Represents the elastic and inertive properties of the respiratory system. Changes in reactance can provide information about the stiffness or compliance of the lungs and chest wall. Clinical Applications Diagnosing and monitoring asthma, COPD and other obstructive lung diseases.Evaluating the effectiveness of bronchodilator therapy.Assessing respiratory function in patients with neuromuscular diseases or other conditions affecting breathing mechanics. Read more about Impulse Oscillometry Filter Alphabet I
Indwelling Pleural Catheter Indwelling Pleural Catheter Home I Overview Indwelling pleural catheter (IPCs) are flexible tubes that are inserted into the pleural space (the space between the lungs and chest wall) to drain excess fluid. They are typically used for patients who have recurrent pleural effusions due to conditions such as cancer, heart failure or infections. The catheter allows the patients to manage fluid build-up at home, reducing the need for repeated hospital visits for thoracentesis (a procedure to remove fluid from the pleural space). The use of IPCs can reduce symptoms, such as shortness of breath, and enhance the quality of life for patients with chronic pleural effusion. Insertion Procedure Preparation: The patient is usually given local anaesthesia to numb the area. Sedation may also be provided to help the patient relax.Insertion: A small incision is made in the chest wall. Using ultrasound guidance, the catheter is inserted into the pleural space. The catheter is then tunnelled under the skin to help reduce the risk of infection and is secured in place.Securing the Catheter: The external end of the catheter is connected to a drainage bag or bottle. The catheter is secured with sutures and covered with a sterile dressing.Post-Insertion Care: The patient is monitored for a short period to ensure there are no immediate complications, such as bleeding or pneumothorax (collapsed lung). Care and Maintenance Regular Drainage: Fluid is typically drained every few days, or as needed, to manage symptoms. The patient or a caregiver is trained to perform the drainage at home.Site Care: The catheter site must be kept clean and dry to prevent infection. Dressings should be changed regularly according to the healthcare provider’s instructions.Monitoring for Complications: Patients should watch for signs of infection (e.g., redness, swelling, fever) or catheter malfunction and contact their healthcare provider if any issues arise. Complications Infection: The most common complication is an infection at the catheter site or within the pleural space.Catheter blockage: The catheter can become blocked, preventing proper drainage.Pain: Some patients may experience pain or discomfort at the insertion site.Pneumothorax: Although rare, the insertion procedure can sometimes cause a pneumothorax.Bleeding: There is a risk of bleeding during or after the insertion of the catheter.Tumour seeding: In cases of malignant pleural effusion, there is a risk that cancer cells might spread along the catheter track.Proper care and monitoring are crucial to minimise risks and complications. Always follow the healthcare provider's instructions and report any concerns promptly. Read more about Indwelling Pleural Catheter Filter Alphabet I
Interventional Pulmonology Interventional Pulmonology Home I Overview Interventional pulmonology is a sub-specialty of Pulmonary Medicine, which involves minimally invasive and percutaneous techniques for advanced diagnostic and therapeutic management of various lung disorders. This field has evolved dramatically over the years.The primary application of interventional pulmonology is in the diagnosis, staging and palliative treatment (a medical approach that helps patients with serious illness live better) of patients with lung cancer. Dilatation of tracheo-bronchial strictures, stenting of the airways, removal of foreign bodies, management of unclassified pleural disorders and temporary percutaneous tracheotomies for chronic airway management also fall under the realm of interventional pulmonology. Types of Interventions Flexible bronchoscopy: Bronchoscopy is the most common interventional pulmonology procedure. During bronchoscopy, a pulmonologist advances a flexible endoscope (bronchoscope) through a person’s mouth or nose into the windpipe. The doctor pushes the bronchoscope forward through the airways in each lung, to inspect for any abnormality and patency of the airways. Images from inside the lung are displayed on a video screen.BAL: In this procedure, sterile water is injected through the bronchoscope into a segment of the lung. The fluid is then suctioned back and sent for tests. BAL helps in the diagnosis of infection, cancer, bleeding, and other conditions.Endobronchial lung biopsy (EBLB): In this procedure, small pieces of tissue are collected from the bronchial wall or mucosa to diagnose various conditions like cancer, tuberculosis or sarcoidosis.Transbronchial lung biopsy (TBLB): In this procedure, a small forceps is pushed down through the bronchoscope to remove small pieces of tissue from the lung periphery. TBLB is generally used to detect acute rejection in case of lung transplantation. Additionally, it can also be used to diagnose many pulmonary disorders, such as lung cancer, ILD, pulmonary infection and pneumonitis.Brush biopsy: In this method, a small brush is used to take sample from the abnormal airway mucosa. Cryobiopsy: In this method, a cryoprobe is introduced into the airway through a bronchoscope, following which, compressed gas is shot from the probe tip to freeze the surrounding tissues. The biopsy samples obtained in this manner are larger and better preserved. Cryobiopsy is used to treat ILDs. Read more about Interventional Pulmonology Filter Alphabet I
Insulin Injection Insulin Injection Home I Overview Insulin injections are a common treatment option for diabetes, particularly for type 1 diabetes and advanced type 2 diabetes. Insulin allows glucose to enter cells for energy, thus helping to regulate blood sugar levels.There are different insulin types, including rapid-acting, short-acting, intermediate-acting, and long-acting insulin, each with specific timing and duration. Proper technique and timing are crucial for effective management.Patients need to regularly evaluate blood sugar levels and accordingly adjust insulin doses. Education on injection techniques, insulin types, and managing blood sugar levels is essential for individuals using insulin pump therapy to maintain good health and prevent complications.Using insulin can be challenging for some people, but it is an effective way to lower your blood sugar levels. If you are having trouble with your insulin routine, talk to your healthcare team.If your at-home blood sugar tests show very low or high levels, get help immediately. Your insulin or other medicines might need to be altered. With time, you can figure out a routine that works well for you and fits your lifestyle. Read more about Insulin Injection Filter Alphabet I
Interstitial Lung Disease Interstitial Lung Disease Home I Overview Interstitial lung diseases (ILDs), also known as Diffuse Parenchymal Lung Diseases (DPLDs) or Pulmonary Fibrosis, are a diverse group of disorders characterised by inflammation and scarring of the interstitium, which is the tissue surrounding the air sacs (alveoli) in the lungs. This leads to thickening of the interstitium and affects the ability of the lung to transfer oxygen to the bloodstream. ILDs can be acute or chronic and may have various causes and clinical presentations. Most ILDs cause irreversible damage to the lung, and the most serious ILDs are progressive, where the patient’s condition continues to worsen with time. Causes and Risk Factors ILDs can be triggered by a multitude of factors:Autoimmune Diseases: Autoimmune diseases, such as rheumatoid arthritis, systemic sclerosis (scleroderma) and systemic lupus erythematosus can cause ILDs.Exposure to Environmental Factors: Long-term exposure to factors, such as asbestos fibres, silica dust, environmental toxins, grain dust, bird and animal droppings and indoor hot tubs has been reported to cause ILD.Medication: Many drugs, such as chemotherapy drugs (Otrexup, Trexall), some heart medications used to treat irregular heartbeats (Nexterone, Pacerone, Inderal, Innopran), some antibiotics (Macrobid, Macrodantin, Myambutol), and certain anti-inflammatory drugs (Rituxan, Azulfidine), can cause lung damage.Infections: Some viral, bacterial, and fungal infections can lead to ILDs.However, in many cases, the cause remains unknown (idiopathic interstitial pneumonias). Symptoms The clinical presentation of ILDs can vary widely depending on the specific type and stage of the disease. Common symptoms include shortness of breath, dry cough, weight loss and fatigue. Diagnosis Diagnosing ILDs typically involves a combination of:Clinical evaluation, including a detailed medical history and physical examination.Imaging-based Techniques, such as HRCT Chest, which can reveal characteristic patterns of lung involvement.PFTs to assess lung function, including measures of lung volumes and diffusion capacity.Biopsy is needed sometimes to confirm the specific type of ILD and guide treatment. Treatment Treatment of ILDs depends on the underlying cause and severity of the disease. It may include:Medications: Corticosteroids, immunosuppressants or antifibrotic agents.Oxygen Therapy: To improve oxygenation in advanced cases.Pulmonary Rehabilitation: Includes exercise programmes and education to manage symptoms.Lung Transplant: This is the treatment of choice in severe cases, when other treatments are ineffective.Overall, ILDs are a complex group of disorders that require careful evaluation and management by pulmonologists and other specialists to optimise outcomes and improve quality of life of the affected individuals. Read more about Interstitial Lung Disease Filter Alphabet I
Insomnia Insomnia Home I Overview Insomnia refers to a sleep-related disorder characterized by challenges in initiation or maintenance of sleep leading to inadequate sleep quality and/or duration. Causes Stress and anxietyPoor sleep habits (stimulants such as coffee, and use of electronic gadgets before bed)Medical conditions (chronic pain, sleep apnoea, or restless leg syndrome)Medications (used to treat depression, ADHD, or high blood pressure)Lifestyle factors (working late shifts, traveling across time zones) Risk factors Lifestyle: change in routine, traveling to different time zones, or working shift workMental health: stress, anxiety, depression, or other mental health conditionsMedical conditions: diabetes, high blood pressure, or other physical health conditionsSleep environment: noise, light, or an uncomfortable bedSubstances: consuming caffeine, nicotine, alcohol, or recreational drugs before bedtimeAge: Insomnia is more common in people over 60 years of age and health.Sex: Hormonal changes during menstruation and menopause can make it more likely for women to experience insomniaGenetics: 31% to 58% of a person's likelihood of experiencing insomnia is due to geneticsSafety: People who do not feel safe in their homes, such as those experiencing repeated violence or abuse Symptoms Difficulty falling asleepWaking up too early in the morningWaking up frequently at nightFeeling tired or groggy upon wakingDifficulty concentrating or paying attentionMood disturbances, such as irritability or anxietyReduced productivity and performance Treatment Cognitive behavioural therapy for insomnia (CBT-I)Sleep hygiene practices (e.g., consistent sleep schedule, relaxing bedtime routine)Sleep aids (e.g., melatonin, prescription sleep medications)Addressing underlying medical conditions or lifestyle factorsRelaxation techniques (e.g., deep breathing, progressive muscle relaxation) Read more about Insomnia Filter Alphabet I
Inflammatory Myopathies (IM) Inflammatory Myopathies (IM) Home I Overview IM are a collection of uncommon autoimmune disorders affecting the skeletal muscles. These conditions may also present with extramuscular symptoms such as skin rash, joint inflammation, interstitial lung disease (ILD), and heart-related complications. IM are of following type: Dermatomyositis (associated with characteristic skin rash- heliotrope rash, V sign, shawl sign, occasional dysphagia)Overlap myositis (related to connective tissue disorders)Antisynthetase syndrome (ASyS) (presents with multisystem involvement, including arthritis, ILD, and myocarditis)Immune-mediated necrotizing myopathy (IMNM) (muscle predominant)Sporadic inclusion body myositis (sIBM) (muscle predominant)Earlier polymyositis was also recognized as a subtype but now the terminology has been discarded for the above-mentioned classification. Cause It is an autoimmune disease with unknown cause. Risk factors Genetic factors: The HLA 8.1 ancestral haplotype is an important risk factor in some populations.Environmental factors: These include:Exposure to ultraviolet (UV) lightSmokingInfectionsVitamin D deficiencyExposure to certain pollutantsExposure to medicationsExposure to inhaled particlesExposure to chemical agentsExposure during pregnancy and infancyOther factors: Statins can increase HMGCR expression in muscle, which may worsen autoimmunity against muscle tissue Symptoms Muscle pain or crampsMuscle weaknessFatigueDifficulty swallowing/ breathingSkin rashJoint pain and swelling Specialist to approach Neurologist Diagnosis Clinical examinationBlood tests to determine serum enzymes levels using Myositis panel which includes the auto-antibodies responsible for muscle inflammation and weakness.ElectromyographyMuscle biopsy featuresMuscle MRI patterns Treatment Corticosteroids to reduce inflammationImmunosuppressive medicationsPhysiotherapy/ speech therapyManagement of associated systemic featuresEarly diagnosis and treatment are necessary to prevent severe weakness Read more about Inflammatory Myopathies (IM) Filter Alphabet I
Idiopathic Intracranial Hypertension (IIH) Idiopathic Intracranial Hypertension (IIH) Home I Overview Idiopathic intracranial hypertension (referred to as benign intracranial hypertension, pseudotumor cerebri) is typically seen in middle-aged obese females. It is precipitated by hormonal therapies, PCOS, excessive vitamin A intake or some medications like tetracyclines. Causes Caused due to raised cerebrospinal fluid pressure. Symptoms Early morning headache that worsens on lying downBlurring of visionDouble visionRinging of earsNausea and vomitingOccasional confusion, disorientation Specialist to approach Neurologist Diagnosis CSF manometry to check CSF pressure. Value above 18 cm of water is suggestive of IIHFundus examination may show papilloedemaMRI brain may show flattening of optic nerve head, empty sella, tortuosity of optic nerve Treatment Medications to reduce CSF formation and pressureCSF drainageVentriculoperitoneal shunt in medication refractory casesStenting of venous sinuses if venous sinus thrombosis is the cause of increased CSF pressureOptic nerve fenestration of excessive CSF pressure around optic nerve is causing vision loss Read more about Idiopathic Intracranial Hypertension (IIH) Filter Alphabet I