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Hypercortisolism Definition, Symptoms, Causes, Treatment

Cardinal manifestation of prolonged hypercortisolism is cushing's syndrome, which may include not only obesity but also connected with hypertension, hyperglycemia, osteoporosis and female hirsutism.

Hypercortisolism has a number of effects on bone metabolism, and there is suppression of osteoblast activity with increased bone matrix protein resorption. Increased renal excretion of calcium combined with decreased absorption of calcium from intestinal results in hypocalcemia. This hypocalcemia is offset by slightly increased secretion of PTH. At the same time, PTH increases the activity of osteoclasts.

The overall effect is marked osteopenia. Since hypercortisolism reduces growth hormone and IGF-1 secretion, over time, marked linear growth retardation. Thinning of the skin and the formation of purple strips on the abdomen, thighs, buttocks are associated with a hypercortisol effect on the collagen metabolism. Hypercortisolism increases gastric acid secretion, which is considered to be associated with a high incidence of peptic ulcers.

Primary hypercortisolism, where cortisol hyper-secretion is autonomous and usually depends on ACTH. This is due to either adenoma or rarely, adrenal gland cancer. Circulating plasma cortisol inhibits the release of the ACTH, so that the levels of the trophic hormone are low. Tumor usually develops unilaterally and the contralateral gland atrophies are due to the lack of ACTH.

Secondary hypercortisolism results in hyperplasia of gland dependent on pituitary secretion. Secondary hypercortisolism may be associated with a small anterior pituitary adenoma (about 15% of cases, a Nelson syndrome) or derangement in the mechanism controlling ACTH release, which may include hypothalamus CRF and factors that control it. However, ACTH production is not independent because it can still be inhibited by high doses of glucocorticoid.

Hypercortisolism Definition, Symptoms, Causes, Treatment

Hypercortisolism Symptoms

Some commonly reported symptoms of Hypercortisolism are given below

  • Central Obesity
  • Hypertension
  • Memory Problems
  • Weakness
  • Loss of energy
  • Redness on skin
  • Fat depots around neck and shoulders
  • Difficulty in focusing
  • Delayed healing
  • Depression
  • Hair loss
  • Swelling around feet and legs

Hypercortisolism Causes

Exact underlying cause of hypercortisolism depends upon number of factors. However, in many cases tumor of adrenal gland is main cause which leads increase secretion of cortisol. Similarly, administration of high doses of exogenous corticosteroids result in exogenous hypercotisolism. Conditions in which high doses of corticosteroids are administered include arthritis, asthma and some autoimmune diseases.

Hypercortisolism Treatment

Treatment of hypercortisolism highly depends upon root cause treatment. e.g if hypercortisolism occurs due to high dose corticosteroids then their use must discontinue or dose should be adjusted to make it tolerable for body. Similarly, if cortisol is overproducing then cortisol inhibitory drugs would be mainstay. Tumor induce hypercortisolism can managed via cytotoxic drugs.  
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Hemopneumothorax Definition, Symptms, Causes, Treatment

When a fracture of the rib breaks through the lungs, the blood of the affected lung also accumulates in the pleural space this is called hemopneumothorax because the pleural space contains both blood and air. The amount of blood that accumulates in the pleural space depends on the size and extent of lung damage. In some cases, the accumulation of blood is minimal in other cases, it is significant. As blood and air continue to accumulate in the pleural space, the pressure on the lungs shrinks through the mediastinum to the healthy lung.

A pneumothorax is a hemopneumothorax with bleeding in the pleural space. This is usually due to a penetrating trauma, such as a shot or a knife. Initial trauma allows air to enter pleural space and create pneumothorax. Bleeding caused by trauma allows the blood to collect in the pleural space with air, creating hemopneumothorax.

Bleeding may originate from damaged blood vessels, pulmonary bruising, or even rapid deceleration. History and physical results of hemopneumothorax are similar to hemothorax, including dyspnoea, tachypnea and tachycardia. Patients can also obviously represent chest trauma, possibly hypotension and shock. Physical exploration can reveal possible segments of ulcers, subcutaneous emphysema or hematoma. Lung exudation reveals reduced or absent breathing sounds of affected lungs and hyperresonance on percussion.

Hemopneumothorax Definition, Symptms, Causes, Treatment

Hemopneumothorax Symtoms

Some commonly reported symptoms of pneumothorax are given below

  • Chest Pain
  • Shortness of breath
  • Tachypnea
  • Tachycardia
  • Hypoxia
  • Decreased breath sounds
  • Subcutaneous Emphysema
  • Palipitation
  • Feeling of Heavy chest

Hemopneumothorax Causes

Exact underlying cause of hemopneumothorax can only be done via radiological findings. However, some injuries that have strong correlation with hemopneumothorax are blunt chest taruma, penetrating chest injury, fractured ribs and aspiration of hemothorax. Important radiological findings during scanning are obliteration of costophrenic angle, fluid level with air shadow above, collapsed lung border.

Hemopneumothorax Treatment

Treatment of hemopneumothorax mainly depends on invasive procedure. Patient having severe form of hemopenumothorax should be decompressed via chest tube before starting any procedure. In case of tension penumothorax emergent needle decompression with large gauge needle placed in the second intercostal space at midclavicular line. To minimize chances of infection you health care provider may prescribe you antibiotics as well. 
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Enthesophyte ICD-10, Treatment, Symptoms, Causes

Enthesophyte, can be defined as abnormal development of bony prominence at the end of the normal bone contour, that can be observed in two perpendicular planes, either with acoustic shadow or with out it.

Enthesophyte formation is a new bone to the site of attaching tendons, ligaments or the capsule of the joint. Enthesophyte reflects the response of bone to stress applied through these structures such as ligamentous or capsular tearing. Enthesophyte formations take several weeks to months to develop and may or may not be associated with clinical signs. Indentifying tendons, ligaments and capsule insertions is essential to determine which structure of soft tissues may be damaged. In some places, such as the hock, the differentiation between enthesophyte formation and osteophytes is not easy.

Development of enthesophyte is a new bone at the site of ligament or tendon. Newborn Entheseous bones reflect the response to stress applied through the following structures, such as tear connections or capsular tension. Like osteophytes, enthesophytes development take several weeks to months and may or may not be associated with clinical signs.

Knowing the anatomy of ligamnet, tendons and capsule insertions is essential to determine which structure of soft tissues may have been damaged. In some places, such as the hock joint, the distinction between entesophyte development and osteophytes is not easy. Cranialis tibialis, dorsal tarsal ligament and fibularis tertius are close to the general boundary of tarsometatarsal joint and the differentiation between new bone and bony prominence of osteophyte can be difficult.

Enthesophyte ICD-10, Treatment, Symptoms, Causes

Enthesophyte Symptoms

Some commonly reported symptoms of enthesophyte are given below

  • Problem in joint mobility
  • Narrowing of joint space
  • Swelling
  • Deep and intense pain
  • Joint stiffness
  • Feeling of grating
  • Bone spur

Enthesophyte Causes

Though exact mechanism by which enthesophytes are formed is not fully understood. However, many orthopedic surgeons believe that putting excessive stress over bony structure may cause abnormalities in normal bone development in the form of enthesophytes. Some other diseases that have strong correlation with enthesophytes are tennis elbow, postman's heel, plantar fasciitis, golfers elbow and spondylitis.

Enthesophyte Treatment

Treatment mainly depends upon severity of symptoms. If patient feels only mild to moderate pain then pain killers are mainstay for such problem. Most commonly used pain killers are diclofenac sodium and naproxen sodium. If patient feels intense pain along swelling around affected area and mobility of joint is compromised then surgery would be preferred because at this stage medicines may become useless to decrease the severity of symptoms.

Enthesophyte ICD-10

Following code is used for Enthesophyte in ICD-10

M77.9--Enthesopathy, unspecified--Billable.
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Hypoproteinemia - ICD-10, Symptoms, Causes, Treatment

Hypoproteinemia is the reduction in total protein concentration in plasma or serum that is lower than expected according to age, gender, physiological. Hypoproteinemia may result from a decrease in albumin and globulin concentration or a decrease in both albumin or globulin concentrations. Some basic types of  hypoproteinemia include

  • Panhypoproteinemia: It includes reduction in both types of proteins e.g hypoalbuminemia and hypoglobulinemia 
  • Hypoproteinemia: It includes reduction in one type of protein e.g hypoalbuminemia and normal globulin concentration 
  • Hypoproteinemia: It includes reduction in one type of protein e.g hypoglobulinemia and normal albumin.
Hypoproteinemia may be caused by protein synthesis reduction and seen in malnutrition and chronic liver disease. Protein malnutrition deprives the hepatic system for production of plasma proteins and is a common problem in hospitalized patients. In chronic liver disease, the protein synthesis machine is impaired, which means hypoproteinemia. Protein increased catabolism is observed in various inflammatory and neoplastic conditions. 

Excessive loss of protein may occur in the kidneys, the gastrointestinal tract, or the skin. Examples include nephrotic syndrome, inflammatory bowel disease, extensive burns, and any severe exudative process. The most serious loss can be seen in nephrotic syndrome where number of plasma proteins, in particular albumin, is passed through the glomeruli into the urine. Changes in total serum protein may cause changes in albumin, globulin, or both. For this reason, it may be useful to determine the ratio of the concentration of albumin to the concentration of globulin. 

Hypoproteinemia - ICD-10, Symptoms, Causes, Treatment

Hypoproteinemia Symptoms

Sign and Symptoms associated with hypoproteinemia may vary depending upon underlying cause. However, some commonly reported symptoms of hypoproteinemia are edema, tachycardia, asthenia, weight loss, diarrhea and polyuria. Some patients may also feel melena, ascites, rashes on body, swelling in extremities and tingling.

Hypoproteinemia Causes

Some common causes that are associated with Hypoproteinemia are as follows

  • Vasculitis
  • Hepatic impairment
  • Protein losing enteropathy
  • Ulcerative colitis
  • Enteritis
  • Granulomatosis
  • Severe infections
  • Drug induced Hypoproteinemia
  • Pyelonephritis
  • peritonitis
  • Pleuritis
  • Chronic heart failure

Hypoproteinemia Treatment

Treatment of hypoproteinemia is mainly consist of bolus infusion of protein in case of severe protein loss especially seen in chronic kidney disease patients. However, it is important treatment underlying cause along with bolus protein infusion to limit its further loss. If you have mild hypoproteinemia then your health care provider might recommend you tablets that increases protein synthesis in the body like ketosteril etc. 

Diet plan may also provides beneficial results e.g eating products that are rich in amino acids improve protein synthesis. Examples of such diet include protein shakes, milk, egg white, dates, red meat etc.

Hypoproteinemia ICD-10

Following code is used for Hypoproteinemia in ICD-10

E88.09--Other disorders of plasma-protein metabolism, not elsewhere classified--Billable
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What are schistocytes - Defintion, Symptoms, Causes, Diagnosis

Schistocytes (schistocytes) are fragments of erythrocytes that are small and irregular in shape. Since these cells are produced as a result of rupturing of the red blood cell (RBC's) apart, the schistocyte is about half the size of normal erythrocytes and may have a deeper red appearance. An increase in schistocytes can be seen in hemolytic anemia associated with burns and prosthetic implants and rejection of kidney transplants.

Basically, schistocytes are fragments of red blood cells (RBC's) formed by fragmentation of abnormal cells, for example, in pyropoikilocytosis associated with some genetic defect or mechanical injury, toxin or heat-induced change of pre-normal cells. When as a result of mechanical damage, schistocytes often coexist with keratocytes.

Many Schistocytes spiculated. Others have been left too little for their membrane cytoplasmic volume and therefore form microspherocytes (spheroschistocytes). In patients with burns schistocytes can be obeserved as microdiscocytes and microspherocytes. A rare form of red blood cell fragment, linear or filamentous structure is observed in sickle cell anemia. The most common causes of schistocytes are hemolytic anemia and microangiopathy. Schistocytes may be a characteristic of myelodysplastic syndrome which is common in erythroleukemias patients.

What are schistocytes - Defintion, Symptoms, Causes, Diagnosis

Schistocytes Symptoms

Physically it is difficult evaluate symptoms associated with schistocytes because it might be an outcome of any hemolytic disease or kidney disease.  It can only be confirmed via differential cell count or morphological assessment of blood. Many doctors recommend routine screening of blood 2-3 times in year to rule any hemolytic disease.

Schistocytes Causes

Schistocytes exhibit micro-enteropathic haemolytic anemia and are associated with various non-infectious diseases, particularly disseminated intravascular coagulation (DIC). Schistocytes are present with DIC whether caused by non-infectious disorder, for example, malignant tumor,  or underlying infectious disease for example, meningococcemia. Spherocytes are characteristic of gas gangrene, but can be found in various other diseases, including autoimmune hemolytic anemia, cirrhosis, transfusion reactions and severe burns.

Schistocytes Diagnosis

Schistocytes  are usually obtained from direct physical damage to red blood cells secondary to vascular abnormalities or turbulent blood flow. The shape of the fragments may vary from acute or triangular spiculated. Microangiopathic granulation has been reported in several different disorders, including disseminated intravascular coagulation (DIC), glomerulonephritis (GN). Hemangio sarcoma, myeloflbrosis, dyserythropoiesis and Chronic Toxic inoculation with doxorubicin. Schistocytes have also been identified as a common characteristic of disseminated intravascular coagulation.
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Pseudarthrosis ICD-10, Symptoms, Causes, Treatment

Pseudarthrosis ( non-union) of the tibia results from a pathological fracture that may occur before or after birth. It can be preceded by the anterolateral bend of the tibia and sometimes associated with neurofibromatosis. The pseudarthrosis encounter in the distal tibial diaphysis can be assessed by severity.

When pseudarthrosis develop, it is not necessary to require a surgical correction. pseudarthrosis can not be considered as the main cause of ongoing symptoms. In fact, many pseudarthrosis are asymptomatic and in some degenerative conditions, the preferred treatment is observation. However, in cases where the inability to achieve a stable anhrodesis can lead to the development of deformation, consider surgery, even in the absence of pain.

Progression of kyphosis and the development of osteophytes neurocompressive led to reports of isolated cases at the end of paraparesis and even torn aortic pseudo-aneurysm. When pseudarthrosis is accompanied by pain or other symptoms, a careful reassessment of the patient should be performed to establish a causal relationship between the pseudarthrosis and the symptoms. In general, symptomatic lumbar pseudarthrosis causes back pain as the most important feature. Pain is usually close to the level of the pseudarthrosis and is axial in one place.

Indications for surgical repair of pseudarthroses include myelopathy, structural instability, deformity or irreversible back pain. Surgical repairs of pseudarthroses might be helpful in improving overall clinical outcome. However, patients and physicians should be aware that for symptomatic pseudarthrosis repeated surgery is associated with higher rates of recurrent pseudanhrosis and clinical failure.

Pseudarthrosis ICD-10, Symptoms, Causes, Treatment

Pseudarthrosis Symptoms

Many patients with pseudarthrosis show no special symptoms, and for these patients additional treatment and evaluation are not always needed. If necessary, x-rays and computer tomography of the spine can be used to determine whether there is a spinal fusion occurred or not. Moreover, precise physical examination provides valuable information to rule out pseudarthrosis suspect.

Pseudarthrosis Causes

The exact underlying cause of pseudarthrosis is still not fully understood but many researchers believed that genetic predisposition is very important in this disease. Some other factors that might have some correlation with this disease are

  • Hyperthyroidism
  • Bone Demineralization
  • Distraction
  • Infection
  • Skeletal muscle rupture
  • Nutritional deficiency
  • Bone fragility

Pseudarthrosis Treatment

Treatment of pseudarthroses in asymptomatic individuals is non-operative, and up to 30% does not  require surgical intervention. Surgical treatment is required for people with unstable or defective structure and suitable for those patients who remain symptomatic despite conservative measures. Treatment of the back pseudarthroses can be complicated in the context of pre-decompression because there is an increased risk of accidental durotomy during surgical dissection. In these cases, anterior cervical fusion is preferred.

A non-surgical treatment can be considered as management for delayed fusion in the absence of neurological compromise or progression of deformity. Treatment strategies include bracing, restricted activity, and careful monitoring. When non surgical treatment does not provide adequate response then surgical intervention will be required.

Pseudarthrosis ICD-10

Following code is used for pseudarthrosis in ICD-10

M96.0--Pseudarthrosis after fusion or arthrodesis--billable
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Monocytosis ICD-10, Symptoms, Causes, Treatment

Monocytosis is defined as an increase in peripheral blood monocytes greater than 0.8 X 109 / L and is predominantly associated with inflammatory and immune disorders. It is difficult to connect elevated levels of monocytosis with some specific diseases, unlike neutrophils. One of the classical monocytosis associations is tuberculosis infection.

However, other infections such as subacute bacterial endocarditis, salmonellosis, listeriosis, syphilis, leprosy and brucellosis may also be associated with monocytosis. The monocytosis often occurs during the recovery phase of acute infection or after removal of the bone marrow. Monocytosis may also be associated with haematological malignancies such as myelodysplastic syndrome and certain types of acute and chronic leukemias. Interestingly, 25% of patients with Hodgkin's disease have been reported to have monocytosis.

Monocytosis may also accompany many non-hematopoietic malignancies and some vascular diseases of collagen. Thus, the detection of a monocytosis is relatively non-specific and can be associated with various haematological disorders that might be benign or malignant in natures. The mononuclear phagocytic system is also the major cell system affected in several storage disorders. These storage disorders are usually inherited disorders or enzyme deficiencies that are necessary for the storage and processing of lipids. Macrophages become the most obvious morphological anomalies in these diseases as they are filled with lipid materials that can not  be further digested.

Monocytosis ICD-10, Symptoms, Causes, Treatment

Monocytosis Symptoms

Monocytosis  is associated with inflammatory response in case of any infection, pathological disorder or autoimmune disease. Symptoms are not so obvious to distinguish it clearly from other disorders. However, some commonly reported symptoms are swelling around body especially in extremities, joints pain due to inflammatory response, fever like condition. These symptoms may vary from patient to patient depending upon the underlying cause.

Monocytosis Causes

Monocytosis is an unusual finding in children. Infection with intracellular micro-organisms or parasites is the most common cause of monocytosis. Infections include malaria, trypanosomiasis, Rickettsia disease and Listeria monacytogertes. Persistent monocytosis with unusual forms may precede various lymphoproliferative disorders and histopathological disorders such as hodgkin's disease and juvenile myelomonocytic leukemia. Some other possible causes include ulcerative colitis, regional neuritis, lipid storage disorders, neutrophil suppression, collagen vascular disease etc.

Monocytosis Treatment

Monocytosis itself does not require any treatment because it is always a manifestation of disease. So, it is important to rule underlying cause of monocytosis before treatment. If monocytosis is associated is with infection like brucellosis or tuberculosis then antibacterial therapy is much effective to bring this condition at normal level. However, if it is associated with auto immune disorder then steroidal therapy and immunosuppressant might be required.

Monocytosis ICD-10

Following code is used for monocytosis in ICD-10

D72.821--Monocytosis (symptomatic)--billable
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Arthrography Pain, Types, Uses, Complications or Side effects

First Knee arthography were carried out by Robinson and Werndorff in 1905 after insufflation of oxygen in the knee joint. Arthrography using gas as a negative contrast agent has remained only a method used for several decades. Common Indications for all arthrographic procedures are first visualized internally that can not be properly identified on conventional X-rays. This includes the capsule, synovium, cartilage structures and internal joint and collateral tendons. Secondly, it is often necessary to obtain synovial fluid for its assessment in diagnostic laboratories. The arthrographic contraindications other side are superficial skin infections and severe allergic reactions for administration of contrast.

Magnetic resonance imaging (MRI) replaces arthrography in most cases for displaying soft tissues of the temporomandibular joint (TMJ). Arthrography can still provide valuable information which is not available from any other imaging technique. It's just an imaging technique that shows disk perforations in real time as the operator can see the dye escape from the inferior to the superior joint space during the initial injection. The usual technique involves injection of water-soluble, iodized contrast media in the lower joint space under fluoroscopy. Visual arthrofluoroscopy can clearly show the various stages of disk displacement  with or without reduction, but fails to show internal or lateral displacement of the disc. Potential complications of arthrography include allergic reaction to contrast, infection and pain and swelling due to invasive technique used during the procedure.

Arthrography consists of two basic types mainly used for evaluation of internal structures of joint. CT arthrogrpahy in which 2-3ml of contrast media is used followed by incorporating 5-10ml of gas usually oxygen or carbon dioxide depending upon patient tolerability. After this procudre a double contrast athrogram is obtained. This technique is called as Ct arthrograpy. Similarly, MR arthrography has many advantages over conventional MRI especially in case of collateral ligaments, synovial and capsular pathology, articular cartilage and osteochoral injuries. In this type of arthrograpy about 8-15ml of saline followed by incorporation of gadolininium  DPTA into joint directly.

Pain major undesirable phenomenon during this procedure especially when your health care provide is performing procedural arthrography. In case of case severe pain local or general anesthesia might require to inhibit pain sensation. A major drawback associated with arthrography is that is invasive procedure that may cause severe pain or allergic reaction to contrast medium used for enhanced imaging.

Arthrography Pain, Types, Uses, Complications or Side effects

Arthrography Complications or Side effects

Some commonly reported complications associated with arthrography are listed below

  • High risk of infection 
  • Deep vein thrombosis
  • Complex regional pain syndrome
  • Iatrogenic injury
  • Neurological or nerve injury
  • Anesthesia associated complications
  • Compartment syndrome
  • Vascular Injury
  • Extravasation
  • Broken cartilage
  • Scuffing
In current practice though it has been largely replaced by some non-invasive techniques but some orthopedic surgeons still prefer arthrography especially when the problem is associated ligament or osteochondral area.

Arthrography Uses/Indications

Arthrography is mainly performed to investigate areas such as 

  • Collateral ligaments
  • Synovial
  • Capsular pathology 
  • Articular cartilage 
  • Osteochoral injuries
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