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Interstitial Nephritis

Management Team

Interstitial Nephritis

Overview

Acute interstitial nephritis (AIN) is a condition in which there is inflammation and damage to the kidney tubules and interstitium (inner part of the kidney). This may be a reaction to a drug or infection or kidney transplant rejection.

Common causes of AIN include certain medications such as antibiotics, non-steroidal anti-inflammatory drugs, infections and in some cases, autoimmune conditions or reactions to kidney transplants. If the condition is related to a drug, discontinuation of the medication is essential.

In some cases, acute interstitial nephritis may be asymptomatic. Patients may have a normal urine output, but renal function tests will show a concerning increasing trend., indicating kidney dysfunction. Haematuria (blood in the urine) and proteinuria (protein in the urine) may also be present, depending on the severity.

To properly manage this condition, a kidney specialist (nephrologist) should be consulted.

Diagnosis often involves urine tests, blood tests to evaluate renal function, and imaging tests such as ultrasound KUB (Kidney, Ureter, and Bladder). In some cases, the diagnosis is confirmed through a USG-guided Kidney Biopsy to examine tissue samples from the kidney.

If the condition is drug-induced, discontinuing the offending medication is crucial. Treatment may include a short course of steroids to reduce inflammation and improve kidney function. If infection is the cause, appropriate antibiotic therapy will be necessary.

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Intimate Aesthetic Concerns

Management Team

Intimate Aesthetic Concerns

Overview

Intimate aesthetic concerns refer to aesthetic and functional changes in the genital area, such as loss of elasticity or dryness.

  • Elasticity-related concerns: Loss of elasticity and firmness in the vaginal area.
  • Moisture-related concerns: Dryness and discomfort due to hormonal changes.
  • Aesthetic concerns: Changes in appearance that may affect confidence such as hyperpigmentation.

  • Loss of elasticity
  • Dryness
  • Discomfort
  • Aesthetic concerns

  • Aging
  • Childbirth
  • Hormonal changes
  • Lifestyle factors

Physical examination and patient consultation.

  •  Vaginal rejuvenation
  • Forma V (radiofrequency treatment)
  • PRP therapy
  • Laser treatments
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Infective Colitis

Management Team

Infective Colitis

Overview

Infective colitis refers to inflammation of the colon (large intestine) caused by an infection, typically resulting from bacterial, viral, or parasitic pathogens. It is a common cause of diarrhoea and abdominal discomfort, and it can vary in severity from mild to severe, depending on the underlying infection and the patient's overall health.

Infective colitis can be caused by a variety of pathogens, including:

  • Bacterial infections: Common bacterial causes include:
    • Escherichia coli (E. coli): Particularly E. coli O157:H7, which produces toxins that can lead to severe gastrointestinal symptoms.
    • Salmonella spp: Often contracted from contaminated food or water.
    • Campylobacter jejuni: A leading cause of bacterial diarrhoea worldwide.
    • Shigella spp: Highly contagious bacteria that cause severe diarrhoea and abdominal cramping.
    • Clostridium difficile (C. diff): Typically arises after antibiotic use, leading to an overgrowth of the bacteria in the colon and causing severe colitis.
  • Viral infections:
    • Norovirus: A highly contagious virus that causes gastroenteritis.
    • Rotavirus: A common cause of gastroenteritis in children.
    • Adenovirus: Can also lead to gastroenteritis, particularly in children.
  • Parasitic infections:
    • Entamoeba histolytica: A parasitic infection that can cause amoebic dysentery.
    • Giardia lamblia: A protozoan parasite that can cause watery diarrhoea.
    • Cryptosporidium spp: Often contracted through contaminated water sources.

The symptoms of infective colitis vary based on the causative pathogen but generally include:

  • Diarrhoea: Can be watery, bloody, or mucoid, depending on the pathogen.
  • Abdominal pain and cramping
  • Fever (especially with bacterial infections like Salmonella or Shigella)
  • Nausea and vomiting (more common with viral infections)
  • Fatigue
  • Dehydration (from severe diarrhoea)

In severe cases, the infection can lead to complications such as:

  • Sepsis
  • Toxic megacolon
  • Intestinal perforation
  • Haemorrhage

Diagnosis is typically made through:

  • Stool cultures: To identify the specific pathogen, especially for bacterial and parasitic infections.
  • Polymerase chain reaction (PCR): For detecting specific viral or bacterial pathogens.
  • Blood tests: To check for signs of infection, dehydration, and systemic involvement (e.g., elevated white blood cell count).
  • Endoscopy/Colonoscopy: In some cases, to directly visualise the colon and take biopsy samples for further testing.

The treatment of infective colitis depends on the causative organism and the severity of symptoms:

  • Supportive care:
    • Hydration: Oral rehydration solutions or intravenous fluids for dehydration.
    • Electrolyte replacement: Especially if diarrhoea is severe or prolonged.
  • Antibiotics:
    • For bacterial infections: Specific antibiotics (e.g., ciprofloxacin for Salmonella, metronidazole for C. diff, or azithromycin for Campylobacter).
    • C. difficile colitis: Treated with oral vancomycin or fidaxomicin.
    • Antibiotics for parasitic infections (e.g., metronidazole for Giardia or Entamoeba histolytica).
  • Antiviral treatment: For certain viral infections, antiviral medications may be considered, but most viral infections (like norovirus or rotavirus) are self-limiting.
  • Avoiding antibiotics for self-limited infections: In some cases, such as with Shigella or Salmonella infection, antibiotics may not be needed and can even cause harm (e.g., in the case of non-typhoidal Salmonella).
  • Probiotics: In some cases, probiotics may be recommended to help restore the normal gut flora, especially after treatment with antibiotics, although their role is still debated.

Prevention strategies for infective colitis include:

  • Hand hygiene: Thorough handwashing, especially before eating and after using the restroom.
  • Food safety: Proper food handling, cooking, and storage to prevent bacterial contamination.
  • Water safety: Ensuring access to clean water and avoiding untreated water sources.
  • Vaccination: Vaccines for rotavirus can prevent viral gastroenteritis in children.
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Irregular Pigmentation

Management Team

Irregular Pigmentation

Overview

Pigmentation involves skin darkening caused by excessive melanin production.

  • Hypopigmentation: It is marked by a lighter skin tone in the affected area.
  • Hyperpigmentation: It is marked by a darker skin tone in the affected area.

Dark or lighter patches or spots on the skin.

  • Sun exposure
  • Hormonal changes
  • Certain diseases
  • Inflammation

Skin examination and medical history by a dermatologist.

  • Topical agents
  • Chemical peels
  • Laser therapy
  • PRP therapy, depending on the condition and underlying cause
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Intestinal Bowel Disease (IBD)

Management Team

Intestinal Bowel Disease (IBD)

Overview

IBD is a general term for two chronic conditions that cause inflammation in the digestive tract: Crohn's disease and ulcerative colitis. Both conditions fall under the category of inflammatory bowel diseases (IBD), though they have distinct characteristics, symptoms, and patterns of inflammation.

Crohn's disease is a chronic, inflammatory bowel disease (IBD) that primarily affects the gastrointestinal (GI) tract. It causes inflammation, ulcers, and damage to various parts of the digestive system, most commonly the small intestine and the colon. Crohn’s disease can affect all parts of the GI tract, from the mouth to the anus, but it typically involves the ileum (last portion of the small intestine) and the colon.

The exact cause of Crohn's disease is not well understood, but it is thought to result from a combination of genetic, environmental, and immune factors:

  • Genetic factors:
    • Family history: People with a family history of Crohn's disease or other forms of IBD (ulcerative colitis) are at a higher risk. About 15-20% of people with Crohn’s disease have a first-degree relative (parent or sibling) with the disease.
    • Specific genes, like those involved in the immune system (e.g., NOD2 gene), have been linked to an increased risk of developing Crohn's disease.
  • Immune system dysfunction: Crohn's disease is considered an autoimmune disease. The immune system attacks the body’s own tissues in the GI tract, mistaking normal gut bacteria for harmful invaders. This results in chronic inflammation. The immune system’s response is thought to be triggered by an environmental factor, such as an infection, but it ultimately results in an overactive immune response.
  • Environmental factors:
    • Diet: Though not directly causing Crohn’s disease, certain diets high in fat and sugar may contribute to flare-ups. However, no specific diet has been definitively linked to Crohn's onset.
    • Smoking: Smoking increases the risk of developing Crohn's disease and can worsen the course of the disease.
    • Geography: Crohn's disease is more common in developed countries, particularly in North America, Europe, and parts of Australia. It is less common in rural areas and in developing countries, though its incidence is rising in these regions.
  • Infections: Some studies suggest infections might trigger the onset or exacerbate the disease, although they are not a direct cause.
  • Age: Crohn's disease is often diagnosed in young adults, typically between the ages of 15 and 35. However, it can occur at any age.

Symptoms can vary greatly depending on the severity of inflammation and the specific part of the GI tract involved. The most common symptoms include:

  • Abdominal pain: Often felt in the lower right quadrant of the abdomen, especially if the ileum is affected. Pain may be crampy and comes and goes.
  • Diarrhoea: Chronic, watery diarrhoea is a hallmark symptom. This may be accompanied by blood or mucus, particularly during flare-ups.
  • Weight loss: Due to malabsorption of nutrients and a reduced appetite during flare-ups, weight loss is common, even if food intake is normal.
  • Fatigue: People with Crohn's disease often experience chronic fatigue, which may be related to inflammation, anaemia, or malnutrition.
  • Blood in stools: Rectal bleeding or passing blood in the stool is more common when the colon is involved, although it can occur if other areas are affected.
  • Fever: During active flare-ups, fever may be present, especially if there is significant inflammation or infection.
  • Nausea and vomiting: This can occur, particularly if there is a blockage or stricture in the intestines.
  • Extra-intestinal symptoms: Joint pain, skin rashes, and eye inflammation (such as iritis or uveitis) may occur due to the systemic nature of Crohn’s disease.
  • Liver and bile duct problems: (e.g., primary sclerosing cholangitis) are also associated with Crohn's in some cases.

Diagnosing Crohn's disease involves a combination of clinical evaluation, laboratory tests, imaging, and endoscopic procedures:

  • Clinical history and physical examination: A thorough medical history is taken, including symptom duration, pattern of symptoms (diarrhoea, pain, weight loss), and family history of IBD. Physical examination may reveal tenderness in the abdomen, particularly in the right lower quadrant.
  • Laboratory tests:
    • Blood tests: These can show signs of inflammation (e.g., elevated C-reactive protein [CRP] or erythrocyte sedimentation rate [ESR]), anaemia, or nutritional deficiencies.
    • Stool tests: These help exclude infections that may mimic Crohn’s disease, such as bacterial or parasitic infections.
  • Endoscopy:
    • Colonoscopy with biopsy: is a key diagnostic tool. It allows visualisation of the colon and terminal ileum, which are most commonly affected in Crohn’s disease. Biopsy samples may be taken to confirm the diagnosis and rule out other conditions.
    • Upper endoscopy (esophagogastroduodenoscopy, or EGD) may be performed if the upper GI tract is involved.
  • Imaging:
    • CT or MRI: These imaging studies are useful in evaluating the extent of the disease, detecting complications such as fistulas, abscesses, and strictures, and for assessing the bowel wall.
    • MRI enterography and CT enterography: are particularly helpful in imaging the small intestine and detecting inflammation or strictures.
    • Capsule endoscopy: A small pill with a camera that you swallow to capture images of the small intestine. It can be particularly useful when the disease is suspected to affect areas of the small intestine that are difficult to reach with traditional endoscopy.
  • Radiological signs: On imaging, signs of Crohn's disease may include thickening of the bowel wall, strictures, fistulas, or abscesses.

There is currently no cure for Crohn’s disease, but the goal of treatment is to control inflammation, induce remission, and maintain long-term remission. Treatment options include medications, lifestyle changes, and sometimes surgery.

  • Medications:
    • Anti-inflammatory medications: Aminosalicylates (e.g., sulfasalazine, mesalamine) may be used for mild cases to reduce inflammation in the bowel.
    • Corticosteroids: Prednisone or other corticosteroids are used for flare-ups to quickly reduce inflammation. However, these are typically used for short-term management due to long-term side effects.
    • Immunosuppressive drugs: Thiopurines (e.g., azathioprine, mercaptopurine) and methotrexate suppress the immune response to reduce inflammation. Cyclosporine may be used in severe cases.
    • Biologics: TNF inhibitors (e.g., infliximab, adalimumab), integrin inhibitors (e.g., vedolizumab), and IL-12/23 inhibitors (e.g., ustekinumab) are used to target specific immune pathways involved in inflammation and are typically used for moderate-to-severe disease or when other treatments fail. These biologics can be administered as injections or infusions.
    • Antibiotics: Antibiotics (e.g., metronidazole, ciprofloxacin) may be used to treat or prevent infections such as abscesses or fistulas.
    • Probiotics and nutritional support: Probiotics may help with managing symptoms of Crohn’s, though evidence is mixed. Nutritional support, including enteral nutrition (liquid diets), may be used to help heal the intestines and improve symptoms, especially in children.
  • Surgery: Surgery is not a cure but may be necessary for complications or when medications fail. Surgical options include:
    • Resection: Removal of the diseased part of the bowel. This is most common for strictures or fistulas.
    • Bowel resection and anastomosis: Involves cutting out damaged parts and rejoining the healthy sections.
    • Stoma creation: In severe cases, a colostomy or ileostomy is needed.
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Intestinal Obstruction

Management Team

Intestinal Obstruction

Overview

Intestinal obstruction refers to a blockage that prevents the normal movement of contents through the intestines. This condition can be partial or complete and can occur in the small intestine or large intestine (colon). Intestinal obstruction is a medical emergency, as it can lead to complications such as bowel ischaemia (decreased blood flow), perforation, and infection.

  • Mechanical obstruction: This occurs when something physically blocks the intestines. Causes include:
    • Adhesions: Scar tissue from previous surgeries that can form between the intestines and other abdominal organs.
    • Hernias: Parts of the intestine protrude through a weak spot in the abdominal wall.
    • Tumours: Cancer or benign tumours can obstruct the intestine.
    • Volvulus: Twisting of the intestines that can lead to obstruction.
    • Intussusception: One segment of the intestine "telescopes" into an adjacent segment.
    • Foreign Bodies: Ingested objects or material that obstruct the intestinal passage.
  • Functional obstruction (Ileus): This type is not caused by a physical blockage but rather by a disruption in the normal function of the intestines. Causes include:
    • Post-surgical Ileus: A temporary paralysis of the bowel after surgery.
    • Electrolyte imbalances: Changes in blood levels of sodium, potassium, or calcium.
    • Infections: Certain infections, such as peritonitis, can interfere with normal bowel function.

  • Abdominal pain: Often crampy or colicky, and it may come and go.
  • Distension: The abdomen may become swollen or bloated due to the buildup of gas and fluids.
  • Nausea and vomiting: Typically, vomiting occurs after the development of abdominal pain. The content may become feculent in severe cases.
  • Constipation: Incomplete obstruction may still allow some gas or stool to pass, but full obstruction will prevent any passage.
  • Inability to pass gas: Often an important sign of obstruction.

  • Physical examination: The healthcare provider may listen to bowel sounds with a stethoscope. Increased or absent bowel sounds can help identify the nature of the obstruction.
  • Imaging studies:
    • X-ray: An abdominal X-ray can show signs of obstruction (such as dilated loops of intestine or air-fluid levels).
    • CT scan: A more detailed imaging method that can help identify the cause and location of the obstruction.
    • Ultrasound: Particularly useful in diagnosing intussusception (more common in children).
  • Laboratory tests: Blood tests may reveal electrolyte imbalances, dehydration, or signs of infection.

Treatment depends on the type and severity of the obstruction:

  • Conservative management:
    • Nasogastric Tube (NGT) Decompression: A tube inserted through the nose into the stomach can help remove fluids and air, relieving pressure and discomfort.
    • Fluid resuscitation: Patients often need intravenous fluids to address dehydration and electrolyte imbalances.
    • Monitoring: In less severe cases or with partial obstructions, close observation with supportive care may be sufficient.
  • Surgical intervention:
    • Exploratory Surgery: If the obstruction is caused by a mechanical issue such as a hernia, volvulus, or tumour, surgery may be required to remove or correct the blockage.
    • Resection: In cases of bowel ischaemia or necrosis (tissue death), part of the intestine may need to be removed.
    • Laparoscopy: A minimally invasive approach may be used in some cases to relieve adhesions or other blockages.
    • Endoscopic Procedures: In certain cases, endoscopy (using a flexible tube with a camera) can be used to remove objects or treat conditions such as a volvulus.

While not all causes of intestinal obstruction can be prevented, some measures can reduce the risk:

  • Surgical care: Proper management of adhesions following surgery.
  • Healthy diet: Adequate fibre intake to prevent constipation.
  • Early detection: Regular screenings for colon cancer in high-risk populations.
  • Prompt treatment of abdominal issues: Seeking medical attention at the first signs of severe abdominal pain, vomiting, or constipation can prevent the escalation of symptoms.
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Impacted Tooth

Management Team

Impacted Tooth

Overview

An impacted tooth is one that remains trapped within the gums or jawbone (instead of erupting normally). While impaction usually affects wisdom teeth and canines (cuspids), other teeth may also be affected. Impaction is classified into three main types:

  • Soft-tissue impaction: The tooth erupts through the jawbone but does not break through the gums.
  • Partial bony impaction: Only a part of the tooth erupts through the jawbone; the tooth does not break through the gums.
  • Full bony impaction: The tooth remains completely trapped within the jawbone. 

The main causes of an impacted tooth are as follows: 

  • Twisted/crooked teeth that erupt sideways.
  • Overcrowding: this prevents the teeth from erupting normally.
  • Insufficient space in the jawbone: this may happen when the jaw is small or in the presence of extra (supernumerary) teeth.

The symptoms of impacted teeth may come and go or be persistent. These include the following:

  • Red, swollen, or bleeding gums
  • Pain and stiffness in the jaw (difficulty in opening the mouth)
  • Halitosis or dysgeusia
  • Headaches
  • Swollen lymph nodes in the neck

In some cases, impacted teeth can lead to one or more of the following oral health complications:

  • Tooth decay (cavity formation)
  • Tooth abscesses
  • Gum disease
  • Formation of cysts (fluid-filled sacs) under the gums
  • Pericoronitis
  • Malocclusion (bad bite)
  • Mandibular nerve damage (this is a large nerve in the lower jaw that controls important functions such as mastication and swallowing)

The diagnosis of impacted tooth usually involves the following:

  • Oral examination: Examination of the oral cavity for signs of inflammation, pericoronitis, swelling, or pus formation.
  • Dental X-ray: X-ray imaging to determine the location of the impacted teeth. Sometimes, cone beam CT is also used for determining the actual position of the impacted teeth and its proximity to vital nerves and vessels.

Patients with impacted teeth may not always experience symptoms; moreover, treatment is not always needed. However, if patients notice sudden and unexplained pain in the teeth or gums, they are advised to schedule a dental consultation. The severity and cause of the condition may reflect whether the symptoms will get better or worse; however, without proper care, the teeth will not heal and pain may persist.

Based on the symptoms, presentation, and severity of the condition, dentists decide whether treatment is required or not, and if it is, recommend the following treatments:

  • The “wait and see” approach: If an impacted tooth is detected but no symptoms are present, dentists may recommend that the affected region be monitored without further action (unless required), i.e., the tooth is frequently examined during routine dental checkups or cleaning sessions to ensure that it is healthy and does not cause any complications.
  • Impacted tooth removal: In cases where the impacted tooth causes oral health issues, such as pain, swelling, or infection, tooth extraction is recommended. This is an outpatient procedure performed under local anaesthesia or sedation.
  • Eruption aids: When a tooth does not erupt on its own, an eruption aid is applied to accelerate eruption. This treatment quite frequently performed among young patients (children and teenagers) with impacted canine teeth.
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