Roth’s Spots Pictures, Definition, Symptoms, Causes, Treatment

A disease in which there is a hemorrhage on the retina with white or pale centers is termed as Roth’s spots. The disease was discovered and explained by a Swiss pathologist “Mortiz Roth” and hence it is named after his name. It is originally associated with a bacterial infection of heart, in which its wall “endocardium” gets swelled. Roth’s spots may also be formed in leukemia, diabetes, collagen-vascular diseases, and other conditions that predispose to hemorrhage in the retina. These spots are believed to be composed of coagulated fibrinogens which may include platelets or neoplastic cells.

Roth’s Spots Pictures


Roth’s Spots Pictures, Definition, Symptoms, Causes, Treatment

Roth’s Spots Pictures, Definition, Symptoms, Causes, Treatment



Roth’s Spots Symptoms



  • Extreme tiredness, typically resulting from mental or physical exertion or illness.
  • Repeated episodes of extreme perspiration that may soak your nightclothes or bedding this condition is called as night sweats.
  • Having temperature more than the normal body temperature this condition is termed as pyrexia or simply fever.
  • Loss of weight that causes weakness.
  • Roth’s spot due to hypertension include following
  • Pain in forehead.
  • Difficulties in breathing
  • Problems in vision.
  • Redness of eyes is also an important symptom of Roth’s spots disease.


Roth’s Spots Causes

     
The disease can be caused by following major reasons:

  • Swelling of blood vessels mediated due to immune complex resulting from bacterial infection of heart in which endocardium gets swelled.
  • Abnormal mass of blood cells those are dangerous to health.
  • Abnormal increase in growth of blood cells, the leukocytes.
  • Abnormally high sugar level in blood.
  • Sub acute bacterial endocarditis.
  • Retinal loss of vision due to human immunodeficiency virus.
  • Loss of red blood cells.
  • Deficiency of vitamin B12.
  • Restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism, to keep tissue alive.
  • Damage to the retina and retinal circulation due to high blood pressure.


Roth’s Spots Treatment

Treatment of roth's spots depends upon underlying cause e.g if endocarditis is main reason of roth's spots then treatment of infection is primary goal to removal all associated complications. Similarly, viral infection, diabetes, leukemia etc may also act as triggering factor in pathogenesis of roth's spots. It is always recommended to consult you health care provider for proper diagnosis of disease and its root cause before initiating any kind of therapeutic treatment.
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Janeway lesion Pictures, Definition, Symptoms, Causes, Treatment

The janeway  lesion is described as collection of pus that has built up within the tissues of the body with marked localized death of living tissue and inflammatory filtrate not involving the epidermis. These macules are only few millimeters in diameter. Janeway lesions are distal, flat, ecchymotic (the escape of blood into the tissues from ruptured blood vessels) and painless. Janeway lesions are named after Edward Janeway (1841–1911). He was a prominent American physician and pathologist who initially described the lesions and after brief research it is named Janeway Lesions.


Janeway lesion Pictures






Janeway lesion Symptoms



  • There are small areas of bleeding under the nails which is also called splinter hemorrhages.
  • There are red colored and painless skin spots on the flat,expanded concave part of the palms of hands between the bases of the fingers and the wrist and soles.
  • There are red colored, painful nodes when touched in the pads of the fingers and toes and these are similar to osler’s nodes.
  • There is very high shortness of breathing during light or hard activity or during exercise.
  • Swelling  and inflammation of feet, legs and the dorsal side of abdomen.
  • Irregular flat,injured and diseased spot on the skin of  hands and feet
  • These are painless skin spot but painful in osler’s nodes. 
  • The color of skin lesions may change from reddish to purplish.

Janeway lesions and Osler's nodes


According to research which is related to pathology janeway lesion is also just similar to osler’s nodes but osler’s nodes is painful when touched with finger tip or simply exerting pressure on it.


Janeway lesions Causes


  • They are caused by infected and contaminated particles circulating in the blood and deposition of  bacteria, forming a painful area of inflamed tissue that is filled with pus.
  • Janeway's lesions are caused by bacteria that have spread from an infection of the lining of the heart 
  • Janeway lessions and Osler’s nodes are may occur due to cutaneous immune-complex mediated by vasculitis, only present in around 25% of patients with inflammation of the linning of heart and its valves.
  • Janeway lesions occurs in endocarditis caused by staphylococcus aureus.
  • Janeway lesions are caused by septic emboli. 
  • Osler's nodes result from the depositing of immune complexes. 
  • The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions.
  • Serious and deadly infections if not treated became aggressive and can even result in death.

Janeway lesions Treatment

Treatment mainly depends upon the causative agent. If it happen due to infection then broad spectrum anti-biotics like aminoglycosides, fluoroquinolones, macrolides etc should be used to eradicate infection completely. It is assumed that neem oil and eucalyptus oil are very effective in the treatment of janeway lesions but it is not proved by any health authority.
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Mcburney's point Location, Tenderness, Test

Mcburney's point was named after a surgeon who first described it in 1800's. This is very useful test to identify various abdominal pains associated with diseases like appendicitis, peritonitis, inflammatory abdominal disease or pain due to some abdominal infection.

Mcburey's point lies in right lower quadrant of abdomen at the junction of spinoumbilical line. It has about one third distance from anterior superior iliac spine to umbilicus. Clinically, this area is important because pain of certain acute infections can be felt at this point upon putting mild to moderate pressure on this point.

Mcburney's point and Mcburney's sign are related terms used in same conditions. For example if patient feels pain or tenderness at Mcburney's point then it means he/she has some kind of acute infection and this tenderness will be termed as Mcburney's sign.

This area is also important from surgery point of view because surgeon mark incision right at this point (spinoumbilical line) to remove inflamed appendix (appendicitis). This surgical procedure is termed as appendectomy. Clinically, this point has strong correlation with appendix pain most commonly adopted by surgeon and physicians to rule out appendicitis pain. Further confirmation is done via lower abdominal ultrasound which reveals out the inflammatory process clearly if there is any.

Mcburney's point Location, Tenderness, Test

Mcburney's point Location


Mcburney's point (marked with blue arrow in the picture) is located at the junction of spinoumbilical line. It is about 5cm above the anterior superior spine of ilium and between the umbilicus and spine where patient feels pain and tenderness upon exerting mild to moderate pressure via finger tip.

Mcburney's point Tenderness


Mcburney's point tenderness is also termed as Mcburney's sign or simply positive Mcburney's test. During this procedure when doctor exerts pressure via finger tip on Mcburney's point that gives a sensation of deep tenderness or pain to patient is ususally known as Mcburney's point tenderness or Mcburney's sign.

Mcburney's point Test


To perform Mcburney's test ask patient to lie in spine position with relaxed abdominal muscles and slightly flexed the knees. Now, put pressure slowly but deeply in the right lower quadrant of abdomen at 5 cm away from anterior superior spine of ilium and between the umbilicus and spine. If this procedure gives a pain sensation or deep tenderness to a patient then Mcburney's point test will be consider positive and more likely to indicate acute infection like appendicitis.
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Bell Clapper Deformity Pictures, Test, Symptoms, Causes, Treatment

Bell Clapper Deformity is a congenital anatomical disorder in which there is an innate lack of gubernaculum, the back fixation of the tunica vaginalis to the scrotum. With bell clapper deformity, testicles are poorly connected to the scrotum and able to move freely in the scrotal sack and bend around the axis of the blood vessels. Bell clapper deformity is usually bilateral in about 60% to 70% of such cases.

Bell clapper deformity leaves testicles  to rotate and swing within tunica vaginalis just like clapper inside of a bell. This condition may lead to testicular torsion around the axis of the seminal cord that is termed as spermatic cord torsion.

Deformation itself is difficult to detect from radiographic images. However, there are some specific findings in case of MRI for example an abnormal direction of the longitudinal axis of the testicles and irregular pattern of fluid collection inside the cavity of tunica vaginalis.

About 40% to 60% cases of Bell clapper deformity lead towards testicular torsion while rest of the cases does not cause torsion and ischemia. Torsion usually occurs when mesorchium becomes abnormally long and allows testicles to bend and twist around its own axis. Possible causes of bell clapper deformity and testicular torsion are forceful contraction of cremasteric muscle, trauma, sexual intercourse and strenuous activity.

 Bell Clapper Deformity Pictures



Bell Clapper Deformity Tests

It is difficult to diagnose bell clapper deformity via physical examination because it is cannot be observed with naked eye. For this purpose you healthcare provide may ask you you to perform some radiographic as well as sonographic test for clear diagnosis. Lower abdominal ultrasound with special focus to testicular region is beneficial in this regard. However, sometimes it is necessary to perform MRI if ultrasound does not provide adequate results.

Bell Clapper Deformity Symptoms

Symptoms of bell clapper deformity are not so much obvious unlike other testicular abnormalities. However, following signs must be kept in consideration as far as bell calpper deformity is concerned.
  • Presence of blood in semen
  • Nausea
  • Vomiting
  • Lumps in the scrotal region
  • Swelling in the scrotum
  • Lower abdominal pain
  • Painful urination

Bell clapper deformity Causes 

Bell calpper deformity may occur at any age with or without obvious cause. Some commonly known factors that results in bell clapper deformity are trauma, accidental injury to testes, birth defect, strenuous activity, cremasteric muscle stretchiness, cold temperature and aggressive testicle growth during puberty.

Bell clapper deformity Treatment

There is no therapeutic treatment for bell clapper deformity. Surgery is the mainstay for such problem. In this surgeon will make a small incision in your scrotum, untwist your spermatic cord and then stitch one or both testicles. Only 2-5% of the cases require removal of testicles due to secondary complications.
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Pneumaturia ICD-10, Definition, Symptoms, Causes, Treatment

Pneumaturia is the passage of gas into the urine. In patients who did not have a recent urinary tract procedure or urethral catheterization, it is almost always due to the fistula between the intestine and the bladder. Common causes include diverticulitis, colon carcinoma, regional enteritis (Crohn's disease). In rare cases, diabetic patients may have gas infections due carbon dioxide formation from fermentation of high urinary sugar concentrations.

First of all, there may be a rectovesical fistula. In these cases, there are usually presence of fecal matter in urine. Usually, it results from ruptured diverticulitis, ruptured appendix, or tumor that forms pelvic abscess gradually and spreads into the walls of bladder. Second, there may be a urinary tract infection with gas generating micro-organisms e.g E. coli.

Pus formation and bloody discharge is common is both types so further diagnosis is much necessary to make it confirm. The fistula can be diagnosed by intravenous pyelogram, cystoscopy or barium enema. Urine culture can show presence of micro-organisms in cases there is no fistula.

Though, it is a rare kind of disorder in clinical practice but it may lead to irreversible complications so, prompt treatment is much necessary to avoid secondary problems and in some cases surgical intervention is the only option left behind.

Pneumaturia ICD-10, Definition, Symptoms, Causes, Treatment

Pneumaturia Symptoms


Symptoms of pneumaturia are not same in all cases but following symptoms should be kept under consideration as far as pneumaturia is concerned.
  • Pus like discharge
  • Pain during urination
  • Presence of fecal matter in urine
  • Presence of air or bubbles in urine
  • Changes in the color of urine
  • Presence of blood in the urine
  • Bladder pain

Pneumaturia Causes


There are number of causes of pneumaturia that must be ruled out before starting any kind of therapeutic treatment. Fistula between the intestine and the bladder is at the top of the list in pneumaturia. Other causes that might be the main the main culprit are colon carcinoma, ruptured diverticulitis, diabetes, E.coli infection, and accidental injury or trauma.

Pneumaturia Treatment


Treatment of pneumaturia is depends upon the root cause. If patient is having such disorder due to infection then therapy of broad spectrum antibiotics is the mainstay to resolve this problem. Most commonly used antibiotics in UTI are quinolones, macrolides and cephalosporins.

Similarly, if it is happening due to any structural defect associated with trauma, injury etc then surgical intervention is mainstay to eradicate it completely. This options has some limitations as well e.g in case carcinoma cancer staging is very critical point. Early diagnosis makes it more possible to eliminate completely while later stages become resistant and chances of survival are less.

Pneumaturia ICD-10


Following code is used for Pneumaturia in ICD-10

R39.89--Other symptoms and signs involving the genitourinary system--Billable
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Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes are small red tender nodules located in the fingertip and at the proximal end and the lateral edge of the nails. They grow over a period of several days to weeks. Janeway lesions are little different from from osler's nodes because they often appeared as non-tender hemorrhagic or nodular lesions on the palms and feet. Clinically both are cardinal manifestations of subacute bacterial endocarditis.

At the beginning of these nodes, patients might feel nerve pain or neurological pain. Although these nodes originally considered to be derived via immune system response. It is proposed that the microembolization along with micro-abscess is occurred due to vasculitis triggered by immunomodified hypersensitivity. Osler's nodes may appear at any time during subacute cutaneous lupus erythematosus and may take several hours to a few days to settle down. They may also be due to infective endocarditis.

Osler's nodes usually ranges from 0.5cm to 1cm and appear as painful brownish or reddish subcutaneous papules on feet, finger tips, toes and palms. Many researchers are still trying to find out exact underlying pathophysiology that triggers such kinds of nodes. However, current clinical data suggests that these nodes are occurred due to immune system hypersensitivity.

Osler's nodes Pictures


Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment


Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes Symptoms


Physically, osler's nodes are quite similar to janeway lesions so, it is difficult to differentiate them without examining further via microscopical or histological examination. However, some commonly observed features of osler's nodes during clinical practice are

  • Nodules like appearance at finger tips, palms, toes and feet
  • Reddish brown in color
  • Painful
  • Itching
  • Feeling of tenderness
  • Slightly raised with pale surface

Osler's nodes Causes


Exact etiological factors that drive the whole process are still not fully understood but many immunologist believe that infective endocarditis, subacute cutaneous lupus erythematosus and gonococcal infection are strongly associated with such kind of nodes and lesions. Hypersensitive immune system is another factor that triggers such phenomenon.

Osler's nodes Treatment


Osler's nodes usually last several hours to a few days to settle down. However, root cause treatment is necessary otherwise they might appear again at some point. If osler's nodes appear due to infective process then then primary problem should be treated accordingly to avoid further progression. Similarly, if immune system is main culprit then anti-allergic drugs should be used to reduce hypersensitivity of immune system.
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Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaques are cholesterol emboli found at the bifurcation of the retinal arteries. The source of these emboli is generally the heart or carotid arteries. They are usually unilateral and occur in elderly patients with advanced atherosclerosis. Symptoms of fugitive alteration of vision may accompany these emboli.

Light yellow deposit usually stick to the peripheral artery at the bifurcation of a peripheral arteriole due to which they cause occlusion of branch retinal artery. This often appears larger than the artery where it is and sometimes you can even see it during migrating down. Migration can be facilitated by lightly massaging the eyeball. It is an arterial cholesterol embolism from an atheromatous plaque ulcer in a proximal artery, usually the internal carotid artery.

Usually embolism associated with retinal artery are often termed as hollenhorst plaque. Due to insignificant symptoms they often diagnosed during routine checkups but appearance of several emboli over time in the arterial tree gives temporary vision loss for seconds at a time. Loss of vision occurs because a temporary artery occlusion occurs, followed by a break of embolism, the components are taken down into the fine capillary system. Larger embolism can be lodged in a vessel permanently and cause massive ischemia in the part of the retina, with permanent loss. In some cases, larger emboli settle down in retinal artery with no obvious symptom in general. This is usually due to the blood flowing around the embolus and continuing retinal tissue supply.

Hollenhorst plaque Images


Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Symptoms


Usually patient remains asymptomatic in case of small emboli. It is often diagnosed during routing examination of eye. If the large sized emboli deposit in retinal artery then sudden vision loss just for few second or blurry vision for few seconds might be a major symptom of Hollenhorst plaque. Usually white color deposits occur due to deposition of calcium while yellowish appearance reveals the deposition of cholesterol.

Hollenhorst plaqueCauses


There number of causes that trigger hollenhorst plaque. These are diabetes mellitus, atherosclerosis, hypercholesterolemia, blood thickening, geriatric patients. However, about 60% cases of hollenhorst plaque are mainly due to diabetes mellitus so, patients having diabetes are more prone get hollenhorst plaque.

Hollenhorst plaque Treatment


Hollenhorst plaque is alarming condition because patient is at high risk to have hemorrhage, stroke, myocardial infarction, circulatory disorder etc. A prompt strategy to minimize such problems is usage of blood thinning agents like aspirin, low molecular weight heparin and anti-clotting agents.  Similarly, if patient is diabetic he must control his/her diabetes by using insulin or other anti-diabetic agents like metformin etc.

Hollenhorst plaque ICD-10


Following code is used for Hollenhorst plaque in ICD-10

H34.219--Partial retinal artery occlusion, unspecified eye--Billable
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