Inflammatory diseases

Inflammatory Diseases
By
Dr. Laraib Jameel Rph
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Gangrene
• Definition: Gangrene is a medical term used to
describe the death of an area of the body. It
develops when the blood supply is cut off to the
affected part as a result of various processes,
such as infection, vascular (pertaining to blood
vessels) disease, or trauma.
• Area mostly affects: Gangrene usually affects
your extremities — the areas farthest from your
heart, such as your toes and fingers. However, it
can affect other parts of your body as well.
Gangrene can even affect your internal organs.

• Causes:
• Lack of blood supply: Blood plays a very important role in your
health. Not only does it transport oxygen and nutrients throughout
your body to feed cells, it delivers disease-fighting antibodies that
protect your body from infection. When blood cannot travel freely
throughout the body, your cells cannot survive, infection can
develop, and tissue can die from gangrene. Any condition that
affects blood flow increases your risk of gangrene, Such as:
• Infection. If bacteria thrive unchecked for long, infection can take
over and cause your tissue to die, causing gangrene.
• Trauma. Wounds that are traumatic, such as gunshot wounds or
crushing injuries from car crashes, crush injury, a severe burn,
or frostbite (injury of finger, toes, nose as a result of freezing)can
cause bacteria to invade tissues deep within the body. When such
tissues are infected, gangrene can occur.

Dry forms can also result from:
• Vascular problems: Most commonly due to the poor health of
arteries and veins in the legs and toes. This usually develops over
time due to conditions such as diabetes, peripheral arterial disease,
and high blood pressure.
• Severe burns, scalds, and cold: Heat, chemical agents, and extreme
cold, including frostbite, can all lead to dry gangrene. Wet gangrene
may develop later.
• Raynaud's disease: There is impaired circulation to the ends of
fingers and toes, especially in cold weather. Raynaud's is implicated
in some cases of gangrene.
• Diabetes: Imbalanced blood sugar levels can damage blood vessels
and nerves, reducing the oxygen supply to extremities.

Wet forms can develop from:
• Injury: Deep, crushing, or penetrating wounds that are sustained in
conditions that allow bacterial infection can lead to gangrene.
Examples are war zones and railway, machinery, and street
accidents, if lacerated and bruised tissues are contaminated.
• Dry gangrene: If the area is infected with bacteria.
• Embolism: The sudden blockage of an artery can lead to dry
gangrene, but it also increases the risk of infection, and therefore
wet gangrene.
• Immune deficiency: If an immune system is weakened, for example
by HIV, diabetes, long-time alcohol or drug abuse, or
recent chemotherapy or radiotherapy, minor infections escalate
more quickly and can become gangrenous.

Gangrene
• TYPES OF GANGRENE
• Dry gangrene is caused by a reduction of blood flow through the
arteries. It appears gradually and progresses slowly. In most people,
the affected part does not become infected. In this type of
gangrene, the tissue becomes cold and black, begins to dry, and
eventually sloughs off.
• Dry gangrene is commonly seen in people with blockage of arteries
(arteriosclerosis) resulting from increased cholesterol
levels, diabetes, cigarette smoking( constrict blood vessels and
reduces blood flow), and genetic and other factors.
• Dry gangrene is sometimes called mummification. It starts more
slowly than wet gangrene,

• Wet gangrene: Unlike dry gangrene, wet gangrene almost always
involves an infection.
• Injury from burns or trauma where a body part is crushed or
squeezed can rapidly cut off blood supply to the affected area,
causing tissue death and increased risk of infection.
• The tissue swells and blisters and is called "wet" because of pus.
Infection from wet gangrene can spread quickly throughout the
body, making wet gangrene a very serious and potentially life-
threatening condition if not treated quickly.
• wet or moist gangrene develops as a complication of an untreated
infected wound. Swelling resulting from the bacterial infection
causes a sudden stoppage of blood flow. Cessation of blood flow
facilitates invasion of the muscles by the bacteria and multiplication
of the bacteria because disease-fighting cells (white blood cells)
cannot reach the affected part.

Types of wet gangrene include:
1- Internal gangrene: If gangrene occurs inside the body due to blocked
blood flow to an internal organ, then it is referred to as internal gangrene.
This is usually related to an infected organ such as the colon- Large bowel
volvulus ( due to: pregnancy, post operative adhesions, internal herniations)
• This type of gangrene occurs when blood flow to an internal organ is
blocked — for example, when your intestines bulge through a weakened
area of muscle in your abdomen (hernia) and become twisted.
• hernia is the abnormal exit of tissue or an organ, such as the bowel,
through the wall of the cavity in which it normally resides, hiatal hernia:
diaphragm &stomach
2- Gas gangrene: Gas gangrene, also called clostridial myonecrosis, is a
particularly highly infectious form of wet gangrene. Gas gangrene is most
commonly caused by infection with the bacterium Clostridium perfringens,
which develops in an injury or surgical wound that's depleted of blood supply

• Gas gangrene is rare but dangerous. It occurs when infection develops
deep inside the body, such as inside muscles or organs, usually as a result
of trauma. The bacteria that causes gas gangrene, called clostridia, release
dangerous toxins or poisons that causes widespread throughout the body,
along with gas which can be trapped within body tissue. As the condition
progresses, the skin may become pale and gray, and make a crackling
sound when pressed, due to the gas within the tissue. Gas gangrene
warrants immediate medical treatment. Without treatment, death can
occur within 48 hours.
• Fournier's gangrene: Also a rare condition, Fournier's gangrene is caused
by an infection in the genital area. Men are affected more often than
women. Fournier's gangrene usually arises due to an infection in the
genital area or urinary tract and causes genital pain, tenderness, redness
and swelling.
• If the infection gets into the bloodstream, a condition called sepsis, it can
be life-threatening.

Symptoms of gangrene
• Dry gangrene:
– The affected area becomes cold and numb.
– Initially, the affected area becomes red.
– Then, it develops a brown discoloration.
– Finally, it becomes black and wrinkled.
• Wet or moist gangrene:
– The affected area becomes swollen and decays.
– It is extremely painful.
– Local oozing occurs.
– It produces a foul-smelling odor.
– It becomes black.
– The affected person develops a fever.
• Gas gangrene:
– The wound is infected.
– A brown-red or bloody discharge may ooze from the affected tissues.
– Gas produced by Clostridia may produce a crackling sensation when the affected area is pressed.
– It becomes swollen, and blisters may develop.
– Pain in the affected area is severe.
– The affected person develops fever, increased heart rate, and rapid breathing if the toxins spread into the
bloodstream.

• RISK FACTORS TO DEVELOP GANGRENE
• Diabetes. If you have diabetes, your body doesn't produce enough of the
hormone insulin (which helps your cells take up blood sugar) or is resistant
to the effects of insulin. High blood sugar levels can eventually damage
blood vessels, decreasing or interrupting blood flow to a part of your body.
• Blood vessel disease. Hardened and narrowed arteries (atherosclerosis)
and blood clots also can block blood flow to an area of your body.
• Severe injury or surgery. Any process that causes trauma to your skin and
underlying tissue, including an injury or frostbite, increases your risk of
developing gangrene, especially if you have an underlying condition that
affects blood flow to the injured area.
• Smoking. People who smoke have a higher risk of gangrene.
• Obesity. Obesity often accompanies diabetes and vascular disease, but
the stress of extra weight alone can also compress arteries, leading to
reduced blood flow and increasing your risk of infection and poor wound
healing.

• Immunosuppression. If you have an infection with the
human immunodeficiency virus (HIV) or if you're
undergoing chemotherapy or radiation therapy, your
body's ability to fight off an infection is impaired.
• Medications or drugs that are injected. In rare
instances, certain medications and illegal drugs that are
injected have been shown to cause infection with
bacteria that cause gangrene.
• intravenous drug use
• Rarely, gangrene is linked to use of the anticoagulant
drug, warfarin.

• Diagnosis: The diagnosis of gangrene is based on history, physical
examination, blood tests, and other exams.
• The health-care provider asks the person about any history of injury,
chronic diseases (such as diabetes), surgery, cigarette smoking, and
exposure to extreme cold.
• Physical examination of the affected area is performed to look for signs of
gangrene.
• Blood test results show an increase in the number of white blood cells in
persons with wet gangrene or infection.
• A sample of the drainage from the wound is examined to identify the
bacteria causing the infection.
• An X-ray film may be performed to examine the affected tissue for the
presence of gas bubbles or for bone involvement or osteomyelitis.
• Imaging studies, including a CT scan and/or MRI, can help determine the
extent of damage to the tissues and the amount of gas present.

• In people with dry gangrene, an arteriogram/ angiography may be
performed to visualize any obstruction in the artery which supplies
blood to the affected part.
• PROCEDURE: During the procedure, you will sit or lie down. Your
doctor will insert a catheter into an artery, typically in your leg. Your
doctor will guide this catheter through your blood vessels to reach
the correct area. Then contrast material will be injected into the
catheter, and this dye will flow into the surrounding arteries.
• Your doctor will use X-ray images to follow the path of the dye
through your arteries. This helps to reveal any blockages. The
procedure can also reveal arterial damage or narrowing.

• Treatment
• Treatment for gangrene involves removing the dead tissue, treating
and preventing the spread of infection, and treating the condition
that caused gangrene to develop. The sooner you receive
treatment, the better your chance of recovery. Depending on the
type of gangrene, treatment may include:
• Treatment depends on the type, location, and extent of diseased
tissue.
• Treatment may involve the following emergency measures:
• intravenous antibiotics
• surgical removal of dead tissue (debridement), including
amputation(surgical removal) of an extremity or a limb to halt the
wider spread

• Maggot therapy. Believe it or not, maggots still play a role in
modern medicine. Maggots provide a non-surgical way to remove
dead tissue. When used to treat gangrene, maggots from fly larvae
(specially bred in a laboratory so they are sterile) are placed on the
wound, where they consume the dead and infected tissue without
harming healthy tissue. They also help fight infection and speed up
healing by releasing substances that kill bacteria.
• Oxygen therapy. Hyperbaric (high pressure) oxygen therapy may be
used in some cases of wet gangrene or ulcers related to diabetes
or peripheral artery disease. During treatment, the patient is put in
a specially designed chamber filled with oxygen at a higher pressure
than oxygen found in the outside air. The theory is that this high
level of oxygen saturates the blood and encourages healing of the
dying tissue. Oxygen therapy may also reduce the growth of
bacteria that cannot thrive in an oxygen-rich environment.

• In order to prevent gangrene from occurring again, the
cause of any blood supply blockage must be determined so
that the underlying condition can be treated. Often
vascular surgery, such as bypass surgery or angioplasty, is
needed to restore blood flow. Medication to prevent blood
clots may be used in some cases.
• Medications include:
• Antibiotics are usually administered intravenously to
control the infection.
• Pain relievers are administered as necessary.
• Anticoagulants are administered to prevent blood clotting.
• Intravenous fluids are administered to
replenish electrolytes.

Erysipelas ‫مرض‬ ‫جلدی‬ ‫ترخبادہ‬
• Definition: Erysipelas is a bacterial skin infection
involving the upper dermis that characteristically
extends into the superficial cutaneous
lymphatics.
• It is a form of cellulitis,
but unlike cellulitis,
which affects deeper/lower
layers, erysipelas only
affects the upper layers
of the skin.

• Causes: Erysipelas is usually caused by the Group A Streptococcus
bacterium, the same bacterium that causes strep throat. The infection
results in large, raised red patches on the skin. Streptococci involve are:
• group A (or rarely group C or G) beta-hemolytic streptococci and occurs
most frequently on the legs and face.
• Group A Streptococcus bacteria penetrate the outer barrier of your skin.
These bacteria normally live on your skin and other surfaces without
causing any harm. However, they can enter your skin through a cut or a
sore and cause an infection. Conditions that cause breaks in the skin, such
as athlete’s foot and eczema, can sometimes lead to erysipelas.
• Staphylococcus aureus (including methicillin-resistant S.
aureus[MRSA]), Klebsiella pneumoniae,Haemophilus
influenzae,Escherichia coli,S. warneri,Streptococcus pneumoniae,S.
pyogenes, and Moraxellasp. MRSA is more common in facial erysipelas
than in lower-extremity erysipelas.

• Pathomechanism: Erysipelas develops when bacteria enter the skin through cuts or sores.
• Skin injuries that increase the chances of developing erysipelas include:
• cuts to the skin, ulcers, or bed sores
• insect or animal bites
• wounds from surgery
• Pre-existing skin conditions that break the surface of the skin also increase the chances of getting
erysipelas.
• These conditions include:
• eczema
• Impetigo (bacterial infection forming pustules + yellow crusty sores)
• fungal infections, such as athlete's foot
• Some medications can weaken the immune system and lead to erysipelas. These medications
include some cancer drugs and medication commonly used after organ transplants.
• Anyone can get erysipelas, but it most commonly affects infants and adults over the age of 60.
• Erysipelas is not hereditary or contagious.

• Symptoms:
• Skin becomes swollen and shiny
• redness
• warm and tender to the touch
• When erysipelas affects the face, the swollen area usually
includes the nose and both cheeks.
• blisters in severe cases
• sharp edges between the affected area and unaffected skin
• red streaks above the affected area
• can turn purple or black in severe cases
• These signs and symptoms are often quite abrupt and can
develop in just a few hours or days.

• Diagnosis:
• a doctor will be able to diagnose erysipelas by the
appearance and symptoms of the affected area.
• The person's medical history, highlighting previous
injuries or surgery, will often suggest the possible
cause as well.
• Further testing is not usually needed.
• Doctors may carry out a blood test if there are any
signs of systemic infection, such as bacteria in the
blood (bacteremia). However, the identification of
bacteria is not always possible, even in a laboratory.

• Tests can also help to reveal:
• raised levels of white blood cells, which can be caused
by tissue damage and bacterial infection
• elevated levels of C-reactive protein, which is
produced by the liver in increased amounts
when inflammation occurs
• positive blood culture indicating a bacterial infection
• the presence of a specific infection, caused by an
animal bite, for example
• In some cases of deep infection, a magnetic resonance
imaging (MRI) or computed tomography (CT) scan is
necessary.

• Treatment: Erysipelas is curable. It is important to start treatment as early as
possible to limit the chance of further complications.
• Antibiotics treat erysipelas. The exact type will depend on what germ is causing
the problem, but it will often contain penicillin
• It is therefore essential that anyone who is allergic to penicillin tell their doctor
before starting treatment so that they can prescribe other medications, such as
erythromycin or cephalexin.
• Other treatment which aids in healing are:
• keeping the infected area elevated, although still ensuring movement to try and
prevent clotting
• cooling packs placed on the skin
• lotions to stop the skin getting dry and cracking
• anti-inflammatory painkillers, such as ibuprofen
• compression stockings once the infection has settled
• treatment for any breaks in the skin, often with a prescribed cream that is applied
directly

• Who Is at Risk for Erysipelas?
• Young children (especially 2 to 6 years old)
and adults over age 60 are more likely to
develop erysipelas. Older adults who have
weak immune systems or who have problems
with fluid buildup after surgery are at the
highest risk.

• Herbal treatment:
• Aloe vera
A. vera (Xanthorrhoeaceae) is an herbaceous, succulent
plant, which grows up to 1 m high, and is probably of
African origin. It has thick, succulent leaves attached to a
short stem.It is a medicinal plant with different properties,
being ascribed to the inner colorless gel and to the
exudates from the outer layers. A. vera is a natural cleaner
that has the power to penetrate in the tissues. The species
has strong antibiotic, virucidal, fungicidal, and anti-
inflammatory properties, presenting an absorption by the
skin greater than the water and chemical constituents
with an action on the immune system.

• Sambucus nigra L.
S. nigra (Adoxaceae) is large shrub or tree of 3–4 m in height and presents an
irregular and many-branched canopy, with tortuous trunk and fissured bark, native
of South America. Phytochemical studies of the aerial parts of the plant showed
compounds, such as glycosides, flavonoids (rutin and quercetin), tannins, essential
oils, triterpene acids, and reducing sugars.
Pharmacological studies have shown evidence of the following properties for S.
nigra: anti-inflammatory, anti-Helicobacter pylori, and antioxidant.
• Antioxidant=prevent damage of cell cause by free radicals(are waste substances
produce by body processes)
The presence of these chemical compounds imparts anti-inflammatory,
antioxidant, and expectorant properties in the species. Studies showed the power
of the fruits of S. nigra L. in lower of the inflammatory response. This action is
related to the presence of immune modulating components, including
anthocyanins, flavonols, and phenolic acids

Herpes
• Definition: Herpes is a super-common infection cause by common virus
that causes sores on your mouth and/or genitals.
• Virus: HSV (herpes simplex virus)
• Scientific name: Human herpesvirus 1
• Higher classification: Simplexvirus
• Also known as Human Alphaherpesvirus 1
• There are two types of herpes simplex viruses: HSV-1 (herpes type 1, or
oral herpes) 50% present in America and
• HSV-2 (herpes type 2, or genital herpes).
• each strain prefers to live on its favorite area But it’s totally possible for
both types of herpes simplex to infect either area.
• Note: Both kinds can make sores pop up on and around your vulva(from
where u pee), vagina, cervix(lower end of uterus), anus, penis, scrotum
(bag which contain testicles), butt, inner thighs, lips, mouth, throat, and
rarely, your eyes.

• Types of herpes:
• Genital herpes: When you get either HSV-1 or
HSV-2 on or around your genitals
(vulva, vagina, cervix, anus, penis, scrotum, butt,
inner thighs), it’s called genital herpes.
• Oral herpes: When you get either HSV-1 or HSV-2
in or around your lips, mouth, and throat, it’s
called oral herpes. Oral herpes sores are
sometimes called cold sores or fever blisters.

• Spread/transmission of disease:
• Herpes easily spreads from skin-to-skin contact with someone who has the virus.
You can get it when your genitals and/or mouth touch their genitals and/or mouth
— usually during oral, anal, and vaginal sex.
• You can also get herpes from kissing someone who has oral herpes.
• Other areas of skin may get infected if there’s a way for the herpes virus to get in,
like through a cut, burn, rash, or other sores.
• A mother can pass genital herpes to a baby during vaginal childbirth, but that’s
pretty rare.
• You can spread herpes to other parts of your body if you touch a herpes sore and
then touch your mouth, genitals, or eyes without washing your hands first. You
can also pass herpes to someone else this way.
• Herpes is most contagious when sores are open and wet, because fluid from
herpes blisters easily spreads the virus. But herpes can also “shed” and get passed
to others when there are no sores and your skin looks totally normal.
• Because the virus dies quickly outside the body, you can’t get herpes from
hugging, holding hands, coughing, sneezing, or sitting on toilet seats.

• What Triggers an Outbreak?
• Outbreak: when symptom shows up.
• The herpes virus stays in your body forever, even if you have no
symptoms. You may have an outbreak when you're sick, after
you’ve been out in the sun- ( blister), or when you’re stressed out
or tired. If you’re a woman, you could get one when you start your
period.
• How to Avoid Herpes
• As long as you're sexually active, there's a chance you could get
herpes. You'll make it a lot less likely if you use a latex or
polyurethane condom or dental dam every time, for every
activity. The dam or condom only protects the area it covers. If you
don’t have herpes, you and your partner should get tested for STDs
before sex. If you’re both disease-free and aren’t having sex with
other people, you should be safe

• Cause: HSV-1 & HSV-2
• When HSV is present on the surface of the skin of an infected
person, it can easily be passed on to someone else through the
moist skin that lines the mouth, anus, and genitals. The virus may
also spread to another individual through other areas of skin, as
well as the eyes. HSV can also spread to the eyes, causing a
condition called herpes keratitis (inflammation of cornea). This can
cause symptoms such as eye pain, discharge, and a gritty feeling in
the eye.
• Symptoms: Most people do not experience symptoms for months
or years after becoming infected. Those who do have symptoms
during the initial period will usually notice them about 4 days after
exposure (the average range is 2-12 days).

• Symptoms include:
• Tingling, itching, or burning: Before the blisters appear, the skin may tingle, itch,
or burn for a day or so.
• Sores: One or more painful, fluid-filled blisters may appear. Blisters break open
and often ooze fluid and form a crust, before healing. The first time sores appear,
they will show up between 2 and 20 days after a person has contact with an
infected person. The sores can last from 7 to 10 days.
• Flu-like symptoms. Fever, muscle aches, or swollen lymph nodes (glands) in the
neck (oral herpes) or groin (genital herpes) are possible.
• Problems urinating. People (most often women) with genital herpes may have
trouble urinating or have a burning feeling while urinating.
• An eye infection (herpes keratitis). Sometimes the herpes simplex virus can
spread to one or both eyes. If this happens, you can have pain, light sensitivity,
discharge, and a gritty feeling in the eye. Without prompt treatment, scarring of
the eye may result. Scarring can lead to cloudy vision and even loss of vision.

• Diagnosis: This type of virus is generally diagnosed
with a physical exam. Your doctor may check your
body for sores and ask you about some of your
symptoms.
• Your doctor may also request HSV testing. This is
known as a herpes culture. It will confirm the diagnosis
if you have sores on your genitals. During this test, your
doctor will take a swab sample of fluid from the sore
and then send it to a laboratory for testing.
• Blood tests for antibodies to HSV-1 and HSV-2 can also
help diagnose these infections. This is especially
helpful when there are no sores present.

• Treatment:
• There is currently no cure for this virus. Treatment focuses on getting rid of sores
and limiting outbreaks (symptoms).
• It’s possible that your sores will go away without treatment. However, your doctor
may determine you need one or more of the following medications:
• acyclovir
• famciclovir
• valacyclovir
• These medications can help people infected with the virus reduce the risk of
transmitting it to others. The medications also help to lower the intensity and
frequency of outbreaks.
• These medications may come in oral (pill) form, or may be applied as a cream. For
severe outbreaks, these medications may also be administered by injection.
• taking painkillers, such as acetaminophen or ibuprofen
• If urinating is painful, apply some cream or lotion to the urethra, for
example, lidocaine

• Preventions & home remedies:
• bathing in lightly salted water helps relieve symptoms
• (believed to help remove toxins from the body to improve your
health, relieve stress, treat constipation, and assist with weight loss)
• soaking in a warm sitz bath
• applying petroleum jelly to the affected area
• avoiding tight clothing around the affected area
• washing hands thoroughly, especially after touching the affected
area
• refraining from sexual activity until symptoms have gone
• Some people find that using ice packs can help. Never apply ice
directly to the skin, always wrap it in a cloth or towel first.

Orchitis
• Definition: Orchitis is an inflammatory
condition of one or both testicles in males,
generally caused by a viral or bacterial
infection.

• Cause:
• Orchitis caused by a bacterial infection most commonly develops from the
progression of epididymitis, an infection of the tube that carries semen out of the
testicles. This is called epididymo-orchitis.
• Epididymitis usually is caused by an infection of the urethra or bladder that
spreads to the epididymis. either from a sexually transmitted disease (STD) or
from a prostate gland/urinary tract infection
• Bacteria that can cause orchitis from prostate gland/urinary tract
infections include
• Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa,
and Staphylococcus and Streptococcus species.
• Bacteria that cause sexually transmitted diseases, such as gonorrhea, chlamydia,
and syphilis, can cause orchitis in sexually active men, typically between the ages
of 19-35 years
• Function of epididymis: It transports and stores sperm cells that are produced in
the testes. It also is the job of the epididymis to bring the sperm to maturity, since
the sperm that emerge from the testes are immature and incapable of fertilization.
During sexual arousal, contractions force the sperm into the vas deferens

• 2nd cause:
• The majority of cases of mumps orchitis occur in prepubertal (less
than 10 years old) males Orchitis in children most commonly occurs
as a result of a viral infection.
• The mumps virus usually causes viral orchitis. Nearly one-third of
males who contract the mumps after puberty develop orchitis,
usually four to seven days after onset of the mumps
• Viral orchitis related to the mumps develops anywhere from four to
10 days after the salivary glands swell. Salivary gland swelling is a
symptom of the mumps.
• It is most common in young boys
• Other less common viral organisms which can cause orchitis
include:
• varicella, coxsackievirus, echovirus, and cytomegalovirus
(associated with infectious mononucleosis)

• 3rd cause: Individuals may be at risk for non-
sexually transmitted orchitis if they have not
been immunized against mumps,
• 4th cause: if they get frequent urinary tract
infections, if older than 45 years of age, or if they
frequently have a catheter placed into their
bladder.
• 5th cause: Other causes of infection can be
related to having been born with abnormalities
in your urinary tract

• Symptoms:
• The symptoms associated with orchitis may range from mild to severe, and the inflammation may
involve one or both testicles.
• Symptoms of orchitis may include the following:
• Testicular swelling
• Testicular redness
• Testicular pain and tenderness
• Fever and chills
• Nausea (viral infection)
• Malaise and fatigue
• Body aches
• Pain with urination
• painful ejaculation (UTI + PROSTATE PROBLEMS)
• a swollen scrotum
• blood in the semen
• abnormal discharge
• an enlarged prostate
• swollen lymph nodes in the groin(It is located where your abdomen ends and your legs begin).

• In epididymo-orchitis, the symptoms may come
on and progress more gradually.
• Epididymitis initially causes a localized area of
pain and swelling on the back of the testicle for
several days.
• Later, the infection increases and spreads to
involve the whole testicle.
• Possible pain or burning before or after urination
and penile discharge may also be seen.

• Risk factors for nonsexually transmitted orchitis include:
• Not being immunized against mumps
• Having recurring urinary tract infections
• Having surgery that involves the genitals or urinary tract
• Being born with an abnormality in the urinary tract
• Sexual behaviors that can lead to STIs put you at risk of
sexually transmitted orchitis. Those behaviors include
having:
• Multiple sexual partners
• Sex with a partner who has an STI
• Sex without a condom
• A personal history of an STI

• Diagnosis:
• our doctor will ask you questions about your medical history and your symptoms.
• They’ll perform a physical examination to determine the extent of the
inflammation.
• You may need a prostate examination to see if your prostate is inflamed. This
involves your doctor inserting a finger into your rectum to physically examine the
prostate.
• Doctors use the digital rectal exam (DRE) as a relatively simple test to check
the prostate. Because the prostate is an internal organ, your doctor cannot look
at it directly. But because the prostate lies in front of the rectum, he or she can
feel it by inserting a gloved, lubricated finger into the rectum
• With a rectal exam, a health care practitioner can check the prostate gland for
infection. This test is necessary because antibiotic treatment will be used for a
longer period of time if the infection involves the prostate gland.
• Your doctor may ask for a urine sample and swab any discharge for lab analysis.
This can determine if you have STIs or other infections.

• A sample of discharge taken from the urethra, the tube that forms
the opening at the end of the penis, may be obtained to identify
which bacteria are responsible for the infection if a sexually
transmitted disease is suspected.
• Blood is drawn to test for HIV and syphilis if a sexually transmitted
disease is suspected.
• Ultrasound imaging can rule out testicular
torsion(TWISTING). Testicular torsions another condition that
causes extreme pain in the testicles and groin area, and the
symptoms are often confused with those of orchitis. Testicular
torsion is the twisting of the spermatic cord — a network of nerves
and blood vessels that runs into each testicle. It can threaten your
fertility if it interrupts blood flow to your testicles. Therefore, you
should see a physician immediately.

• Treatment:
• People with bacterial orchitis or bacterial epididymo-orchitis require
antibiotic treatment. Antibiotic therapy is necessary to cure the infection.
• Antibiotics prescribed will depend on the patient age and underlying
cause of the bacterial infection. Antibiotics commonly used may
include ceftriaxone (Rocephin), doxycycline(Vibramycin, Doryx), azithromy
cin (Zithromax) or ciprofloxacin (Cipro).
• If the cause of orchitis is determined to be viral in origin, antibiotics will
not be prescribed. Mumps orchitis will generally improve over a 1-2
week period. Patients should treat symptoms with the home care
treatments.
• Over-the-counter nonsteroidal anti-inflammatory drugs such
as ibuprofen (Advil or Motrin, for example) or naproxen (Aleve)
and acetaminophen (Tylenol) may help with pain.

• Home remedies:
• Elevating your scrotum with snug-fitting briefs
(UNDER GARMENT) or an athletic supporter can
increase comfort.
• Apply ice packs.
– Ice should not be directly applied to the skin because
this may cause burns from freezing. Rather, the ice
should be wrapped in a thin cloth and then applied to
the scrotum.
– The ice packs may be applied for 15-20 minutes at a
time, several times a day for the first day or two. This
will help keep down the swelling (and pain).

• Complications:
• For some of the men who have orchitis, the
affected testicle will shrink and lose its
function. The longer you delay getting
treatment, the more likely the testicle will
have long-term damage. Untreated orchitis
can result in infertility, loss of one or both
testicles, and severe illness or death.

• Preventions:
• Certain measures can be taken to reduce the risk
of developing orchitis.
• Immunization against mumps can prevent
mumps orchitis.
• Choose not to have intercourse in high-risk
situations where individuals may be exposed
to sexually transmitted diseases.
• Men older than 50 years of age should have their
prostate gland examined during their yearly
physical exams.

Scrotal hernia
• Definition: an inguinal hernia that has descended into the scrotum. Or
Complete inguinal (pertaining to groin) hernia, located in the scrotum.
• Inguinal hernia:
(indirect) Part of the intestine bulges into the inguinal canal
• (direct) part of intestine bulges near the opening
• (the channel through which testes drop into the scrotum before birth.)
• Hernia
• A hernia is a common condition that occurs when part of an internal organ or
tissue bulges through a muscle. Hernias can occur around the belly button,
through a surgical scar, in the diaphragm, or in the groin (the area between the
abdomen and the thigh on both sides of the body).
• In this condition, a weak spot or other abnormal opening in a body wall permits
part of the organ to bulge through.
• hernia may develop in various parts of the body; most commonly in the region of
the abdomen.
• A layman's term for hernia is rupture. A hernia is either acquired or congenital.

• inguinal hernia hernia occurring in the groin, or inguen, where the abdominal fold
of flesh meet the thighs. It is often the
result of increased pressure within the abdomen, whether due to lifting, coughin
g, straining, or accident. Inguinal hernia
accounts for about 75 per cent of all hernias.
Appearance: A sac formed from the peritoneum and containing a portion of the
intestine or omentum (two folds of peritoneum), or both, pushes either directly
outward through the weakest point in the abdominal wall (direct hernia)
Indirect
or downward at an angle into the inguinal canal(indirect hernia). Indirect inguinal hern
ia (the common form) occurs more often in males because it follows the tract that
develops when the testes descend into the scrotum before birth, and the hernia itself
may descend into the scrotum.
In the female, the hernia follows the course of the round ligament of the uterus.
(The round ligament exits the pelvis via the deep inguinal ring passes through
the inguinal canal and continues on to the labia majora (female genital organ)
(large compound bone structure at the base of spine which supports legs)

• Function of inguinal canal:
• Inguinal canal is an oblique passage through the lower part of
anterior abdominal wall. Inguinal canal is about 1.5 inches long in
adults. It is present in both males and females.
• In males, the inguinal canal allows structures of the spermatic cord
to pass to and from the testis to the abdomen. This allows the
testes to leave the abdominal cavity. The importance of this
phenomenon can be appreciated by reminding the fact that
spermatogenesis takes place only if the testes leave the abdominal
cavity to go to a cooler environment in the scrotum.
• In females, it allows the passage of round ligament (a band of tissue
which connects one bone with another bone)of uterus from the
uterus to labium majus. In addition to the above primary structures,
it transmits the ilio inguinal nerve in both males and females.

• Two types of inguinal hernias are
• indirect inguinal hernias, which are caused by a
defect in the abdominal wall that is congenital, or
present at birth
• direct inguinal hernias, which usually occur only
in male adults and are caused by a weakness in
the muscles of the abdominal wall that develops
over time

• What is the inguinal canal?
• The inguinal canal is a passage through the lower abdominal wall. People
have two inguinal canals—one on each side of the lower abdomen.
• In males, the spermatic cords pass through the inguinal canals and
connect to the testicles in the scrotum—the sac around the testicles. The
spermatic cords contain blood vessels, nerves, and a duct, called the
spermatic duct, that carries sperm from the testicles to the penis.
• spermatic-cord: cord-like structure in males formed by the vas deferens
(ducts deferens) and surrounding tissue that runs from the deep inguinal
ring down to each testicle
• In females, the round ligaments, which support the uterus, pass through
the inguinal canals.

• Causes of inguinal hernia:
• The cause of inguinal hernias depends on the type of inguinal hernia.
• Indirect inguinal hernias. A defect in the abdominal wall that is present at
birth causes an indirect inguinal hernia.
• During the development of the fetus in the womb, the lining of the
abdominal cavity forms and extends into the inguinal canal. In males, the
spermatic cord and testicles descend out from inside the abdomen and
through the abdominal lining to the scrotum through the inguinal canal.
Next, the abdominal lining usually closes off the entrance to the inguinal
canal a few weeks before or after birth. In females, the ovaries do not
descend out from inside the abdomen, and the abdominal lining usually
closes a couple of months before birth.
• Sometimes the lining of the abdomen does not close as it should, leaving
an opening in the abdominal wall at the upper part of the inguinal canal.
Fat or part of the small intestine may slide into the inguinal canal through
this opening, causing a hernia. In females, the ovaries may also slide into
the inguinal canal and cause a hernia.

• Direct inguinal hernias. Direct inguinal hernias usually
occur only in male adults as aging and stress or strain
weaken the abdominal muscles around the inguinal canal.
Previous surgery in the lower abdomen can also weaken
the abdominal muscles.
• Why women does not suffers?
• Females rarely form this type of inguinal hernia. In females,
the broad ligament of the uterus acts as an additional
barrier behind the muscle layer of the lower abdominal
wall. The broad ligament of the uterus is a sheet of tissue
that supports the uterus and other reproductive organs.

• Who is more prone to develop an inguinal hernia:
• Males are much more likely to develop inguinal hernias than females. About 25
percent of males and about 2 percent of females will develop an inguinal hernia in
their lifetimes.
• Some people who have an inguinal hernia on one side will have or will develop a
hernia on the other side.
• People of any age can develop inguinal hernias. Indirect hernias can appear before
age 1 and often appear before age 30; however, they may appear later in life.
• Premature infants have a higher chance of developing an indirect inguinal hernia.
• Direct hernias, which usually only occur in male adults, are much more common in
men older than age 40 because the muscles of the abdominal wall weaken with
age.
• People with a family history of inguinal hernias are more likely to develop inguinal
hernias. Studies also suggest that people who smoke have an increased risk of
inguinal hernias.5
•

• Chronic cough, such as from smoking.
• Chronic constipation. Constipation causes
straining during bowel movements.
• Pregnancy. Being pregnant can weaken the
abdominal muscles and cause increased pressure
inside your abdomen.
• Premature birth and low birth weight.
• Previous inguinal hernia or hernia repair. Even if
your previous hernia occurred in childhood,
you're at higher risk of developing another
inguinal hernia.

• Reason for developing inguinal hernia less
commonly in female:
• Smoking
• Lifting heavy objects
• Because of the stress of childbearing, the
transversalis fascia is stronger in the floor of
the inguinal canal and hence has protective
effect, so direct hernia in females is unusual

• Symptoms:
• The first sign of an inguinal hernia is a small bulge on one or, rarely, on
both sides of the groin—the area just above the groin crease between the
lower abdomen and the thigh. The bulge may increase in size over time
and usually disappears when lying down.
• Other signs and symptoms can include
• discomfort or pain in the groin—especially when straining, lifting,
coughing, or exercising—that improves when resting
• feelings such as weakness, heaviness, burning, or aching in the groin
• a swollen or an enlarged scrotum in men or boys
• Indirect and direct inguinal hernias may slide in and out of the abdomen
into the inguinal canal. A health care provider can often move them back
into the abdomen with gentle massage.

• Complications:
• Inguinal hernias can cause the following complications:
• Incarceration. An incarcerated hernia happens when part of the fat or
small intestine from inside the abdomen becomes stuck in the groin or
scrotum and cannot go back into the abdomen. A health care provider is
unable to massage the hernia back into the abdomen.
• Strangulation. When an incarcerated hernia is not treated, the blood
supply to the small intestine may become obstructed, causing
“strangulation” (constriction) of the small intestine. This lack of blood
supply is an emergency situation and can cause the section of the
intestine to die.
• If you aren't able to push the hernia in, the contents of the hernia may be
trapped (incarcerated) in the abdominal wall. An incarcerated hernia can
become strangulated, which cuts off the blood flow to the tissue that's
trapped. A strangulated hernia can be life-threatening if it isn't treated.

• Signs and symptoms of a strangulated hernia
include:
• Nausea, vomiting or both
• Fever
• Sudden pain that quickly intensifies
• A hernia bulge that turns red, purple or dark
• Inability to move your bowels or pass gas

• Preventions:
• Maintain a healthy weight. Talk to your doctor about
the best exercise and diet plan for you.
• Emphasize high-fiber foods. Fruits, vegetables and
whole grains contain fiber that can help prevent
constipation and straining.
• Lift heavy objects carefully or avoid heavy lifting. If
you must lift something heavy, always bend from your
knees — not your waist.
• Stop smoking. Besides its role in many serious
diseases, smoking often causes a chronic cough that
can lead to or aggravate an inguinal hernia.

• Diagnosis:
• Your doctor can usually diagnose an inguinal hernia during
a physical exam. During the exam, your doctor will ask you
to cough while standing so they can check the hernia when
it’s most noticeable.
• When it’s reducible, you or your doctor should be able to
easily push an inguinal hernia back into your abdomen
when you’re lying down on your back. However, if this is
unsuccessful, you may have an incarcerated or strangulated
inguinal hernia.
• If the diagnosis isn't readily apparent, your doctor might
order an imaging test, such as an abdominal ultrasound, CT
scan or MRI.

• Treatment:
• If your hernia is small and isn't bothering you, your
doctor might recommend watchful waiting.
Sometimes, wearing a supportive truss may help
relieve symptoms, but check with your doctor first
because it's important that the truss fits properly. In
children, the doctor might try applying manual
pressure to reduce the bulge before considering
surgery.
• Enlarging or painful hernias usually require surgery to
relieve discomfort and prevent serious complications.

Single & double sided truss to aid
hernia

• There are two general types of hernia operations
— open hernia repair and laparoscopic repair.
• Open surgery — Most inguinal hernias are
repaired by open surgery with the patient under
general or local anesthesia. After the surgeon
makes an incision in the groin, he or she pushes
the herniated tissue back into place and repairs
the hernia opening with stitches. In many cases, a
small piece of synthetic mesh material is used to
reinforce the area to prevent another hernia.

• Laparoscopic surgery — In laparoscopic hernia repair, a surgeon makes
three small incisions in the abdominal wall and then inflates the abdomen
with a harmless gas. The surgeon then inserts a laparoscope through the
incisions. A laparoscope is a tube-like instrument with a small video
camera and surgical instruments. While viewing the internal scene on a
monitor, the surgeon pushes the herniated intestine back into place and
repairs the hernia opening with surgical staples. Although this surgery
seems attractive to many people, the long-term success rate is lower
compared to open surgery. Laparoscopic surgery often causes less
discomfort, and lets the person return to activities more quickly.
• However, hernia recurrence may be more likely with laparoscopic repair
than with open surgery. Having a surgeon who is very experienced in the
laparoscopic procedure may reduce this risk.
• Laparoscopy allows the surgeon to avoid scar tissue from an earlier
hernia repair, so it might be a good choice for people whose hernias
recur after open hernia surgery. It also might be a good choice for people
with hernias on both sides of the body (bilateral).

Hydrocele or ‫آب‬‫نزول‬
• Definition: A hydrocele is a type of swelling in the scrotum that
occurs when fluid collects in the thin sheath (tunica
vaginalis) surrounding a testicle.
• Fluid can surround one or both testicles, causing swelling in the
scrotum.
• Hydrocele is common in newborns and usually disappears without
treatment by age 1. Older boys and adult men can develop a
hydrocele due to inflammation or injury within the scrotum.
• A hydrocele usually isn't painful or harmful and might not need any
treatment. But if you have scrotal swelling, then treatment should
be taken.
• About 10% of newborn male infants have a hydrocele, which often
clears up without any particular treatment within the first year of
life. Hydroceles occur in only about 1% of adult men, and will often
disappear on their own within the first 6 months.

‫نزول‬ ‫آب‬
NUZOOL ALMAE
‫الما‬ ‫نزول‬
• Causes:
• Before birth, the testicles develop near the kidneys. By the time of birth, the
testicles normally drop from their position inside the abdomen into the scrotum
through a tunnel of muscles called the inguinal canal. If the peritoneal sac in the
canal is reopened, fluid may leak from the belly into the scrotum and cause a
hydrocele. If there is some inflammation in the cell linings of the sac surrounding
the testicles, a hydrocele can result.
• Normally: During development of baby before birth, each testicle has a naturally
occurring sac around it that contains fluid. Normally, this sac closes itself and the
body absorbs the fluid inside during the baby’s first year. However, this doesn’t
happen for babies with a hydrocele. Babies born prematurely are at a higher risk
for hydrocele, Other causes of hydrocele include:
• Blockage in the spermatic cord.
• Inguinal hernia surgery.
• Infection of the scrotum or a testicle.

• Blockage in spermatic cord:
• spermatic cords pass
through the inguinal
canals and connect to
the testicles in the
scrotum—the sac
around the testicles.
The spermatic cords
contain blood vessels,
nerves, and a duct, called the spermatic duct, function:
carries sperm from the testicles to the penis.

• Hydroceles can also form later in life, mostly in men
over 40. This usually occurs if the channel through
which the testicles descend hadn’t closed all the way
and fluid now enters, or the channel reopens. This can
cause fluid to move from the abdomen into the
scrotum. Hydroceles can also be caused by
inflammation or injury in the scrotum or along the
channel.
• The inflammation may be caused by an infection
(epididymitis) or another condition.
• It is coiled tube (epididymis) at the back of the testicle
that stores and carries sperm.

• Types of hydroceles
• The two types of hydroceles are noncommunicating
and communicating.
• Noncommunicating
• A noncommunicating hydrocele occurs when the sac
closes, but your body doesn’t absorb the fluid. The
remaining fluid is typically absorbed into the body
within a year.
• Communicating
• A communicating hydrocele occurs when the sac
surrounding your testicle (tunica viginalis) doesn’t
close all the way. This allows fluid to flow in and out.

• Symptoms:
• Hydroceles usually don’t cause any pain. Usually, the only symptom
is a swollen scrotum.
• In adult men, there may be a feeling of heaviness in the scrotum.
In some cases, the swelling might be worse in the morning than in
the evening. It is not usually very painful.
• CAUTION: Seek medical treatment if you or your child has sudden
or severe pain in their scrotum. This could be the sign of another
condition called testicular torsion. Testicular torsion occurs when
the testicles become twisted, typically due to an injury or accident.
Testicular torsion isn’t common, but it’s a medical emergency
because it can lead to blocked blood supply to the testicle and
ultimately infertility if untreated.

• Diagnosis:
• Checking for tenderness in an enlarged scrotum.
• Applying pressure to the abdomen and scrotum to check for inguinal
hernia.
• Shining a light through the scrotum (transillumination). If you or your child
has a hydrocele, transillumination will show clear fluid surrounding the
testicle.
• Transillumination: It allows your doctor to determine if there’s fluid in the
scrotum. If fluid is present, the scrotum will allow light transmission and
the scrotum will appear to light up with the light passing through.
However, if scrotal swelling is due to a solid mass (cancer), then the light
will not shine through the scrotum. This test does not provide a definite
diagnosis but can be very helpful.
• She’ll also check to make sure that do you have a hernia.
• You may also have a blood test and an ultrasound to make sure nothing
else is causing the swelling.

• Treatment:
• A hydrocele usually goes away on its own before a boy’s first
birthday. If it doesn’t, or if it gets bigger, or if it cause pain, his
doctor will refer him to a specialist called a urologist.
• If you have a communicating hydrocele, the pediatrician will
usually recommend surgery without waiting for it to go away.
• The doctor can remove a hydrocele in a brief operation called a
hydrocelectomy.
• [ECTOMY= REMOVAL]
• baby will get medicine to numb his body or to put him under
completely. Then, a surgeon makes a cut in his scrotum or lower
belly. The surgeon then drains the fluid and sews the sac closed.
Once it’s finished, baby can go home the same day. (out-patient
surgery)
• In the days after surgery, you’ll need to keep the area clean and dry.

• Needle aspiration (ASPIRE= TRY TO REACH)
• Another option for hydrocele treatment is to drain it with a long needle. The
needle is inserted into the sac to draw out the fluid.
• In some cases, a drug may be injected to prevent the sac from filling again.
• Ex- Sclerosant solution Polidocanol = sclerosing agent
• Sclerosing agents are used in sclerotherapy of varicose veins, where the irritant
solution is injected into the blood vessels. Sclerosing agents are used to treat
varicose veins. Here is purpose could be in blockage of spermatic cord.
• Other drugs include sodium tetradecyl sulfate, ethanolamine oleate
• Needle aspiration is commonly performed on men who are at high risk for
complications during surgery.
• The most common side effects of needle aspiration are temporary pain in your
scrotum and risk of infection.
• Vericose veins: spider veins, common in elders, Hemorrhoid are a type of
varicose vein. veins have one-way valves that help keep blood flowing toward
your heart. If the valves are weak or damaged, blood can back up and pool in
your veins. This causes the veins to swell, which can lead to varicose veins. they
usually occur in the legs, but also can form in other parts of the body

• Complications:
• A hydrocele typically isn't dangerous and usually
doesn't affect fertility. But a hydrocele might be
associated with an underlying testicular condition
that can cause serious complications, including:
• Infection or tumor. Either might reduce sperm
production or function.
• Inguinal hernia. The loop of intestine trapped in
the abdominal wall can lead to life-threatening
complications.

Varicose veins
• Definition: Varicose veins are enlarged, swollen, and
twisting veins, often appearing blue or dark purple.
• Any superficial vein may become varicosed, but the veins
most commonly affected are those in your legs and feet
(That's because standing and walking upright increases the
pressure in the veins of your lower body.)
• The veins furthest from the heart are most often affected,
such as those in the legs. This is because gravity makes it
harder for blood to flow back to the heart.
• Any condition that puts pressure on the abdomen has the
potential to cause varicose veins; for instance,
pregnancy, constipation and, in rare cases, tumors.

• Pathology: Arteries carry blood from your heart to the rest
of your tissues, and veins return blood from the rest of your
body to your heart, so the blood can be recirculated. To
return blood to your heart, the veins in your legs must work
against gravity.
• Muscle contractions in your lower legs act as pumps, and
elastic vein walls help blood return to your heart. Tiny
valves in your veins open as blood flows toward your heart
then close to stop blood from flowing backward. If these
valves are weak or damaged, blood can flow backward and
pool in the vein, causing the veins to stretch or twist.
• More than 23 % of all adults are thought to be affected by
varicose veins. Approximately 1 in 4 adults in the United
States is affected by varicose veins.

• Risk factors:
• The following risk factors are linked to a higher risk of having varicose
veins:
• Gender: Varicose veins affect women more often than males. It may be
that female hormones relax veins. If so, taking birth control pills or
hormone therapy (HT) might contribute. (Estrogen & Progesteron)
• Theses 2 hormones dilates veins
• Hormonal changes during, pre-menstruation or menopause may be a
factor because female hormones tend to relax vein walls.
• Genetics: Varicose veins often run in families.
• Obesity: Being overweight or obese increases the risk of varicose veins.
• Age: The risk increases with age, due to wear and tear on vein valves.
• Some jobs: An individual who has to spend a long time standing at work
may have a higher chance of varicose veins.

• Risk factors:
• Pregnancy and varicose veins
• Women are much more likely to develop varicose veins during their
pregnancy than at any other time in their lives. Pregnant women have
much more blood in their body; this places extra pressure on the
circulatory system.
• Additionally, changes in hormone levels can lead to a relaxation of the
blood vessel walls. Both these factors raise the risk of having varicose
veins.
• As the uterus (womb) grows, there is more pressure on the veins in the
mother's pelvic area. In the majority of cases, the varicose veins go away
after the pregnancy is over; this is not always the case, and sometimes,
even if the varicose veins improve, there may be some left visible.
• Being sedentary (not moving) also may contribute to varicosity, because
muscles that are out of condition offer poor blood-pumping action.

• Types of varicose veins
• There are several types of varicose veins, such as:
• trunk varicose veins – these are near to the surface of the
skin and are thick and knobbly; they're often long and can
look unpleasant (trunk= tree b/w roots & branches )
• reticular varicose veins – these are red and sometimes
grouped close together in a network.(Reticulum= network )
• telangiectasia varicose veins – also known as thread veins
or spider veins, these are small clusters of blue or red veins
that sometimes appear on your face or legs; they're
harmless and, unlike trunk varicose veins, don't bulge
underneath the surface of the skin

• Symptoms:
• Varicose veins may not cause any pain. Signs you may have
varicose veins include:
• Veins that are dark purple or blue in color
• Veins that appear twisted and bulging; they are often like cords on
your legs
• When painful signs and symptoms occur, they may include:
• An achy or heavy feeling in your legs
• Burning, throbbing, muscle cramping and swelling in your lower
legs
• Worsened pain after sitting or standing for a long time
• Itching around one or more of your veins
• Skin discoloration around a varicose vein

• Diagnosis:
1- patient history:
• having a family history of varicose veins
• being pregnant
• whether you have a healthy body mass index
(BMI)
• having deep vein thrombosis (a blood clot in one
of the deep veins of the body)
• a history of leg injury (for example, having
previously broken a bone in your leg)

2- duplex ultrasound scan
• This is a type of scan that uses high-frequency
sound waves to produce a picture of the veins in
your legs.
• The picture shows the blood flow and helps the
vascular specialist locate any damaged valves that
might be causing your varicose veins.
• Doppler test: An ultrasound scan to check the
direction of blood flow in the veins. This test also
checks for blood clots or obstructions in the
veins.

4- Transducer: You also may need an ultrasound test to see if
the valves in your veins are functioning normally or if there's
any evidence of a blood clot. In this noninvasive test, a
technician runs a small hand-held device (transducer), about
the size of a bar of soap, against your skin over the area of
your body being examined. The transducer transmits images
of the veins in your legs to a monitor, so a technician and your
doctor can see them.
3- Venogram:
• Depending on the location, a venogram may be done to
further assess your veins. During this test, your doctor
injects a special dye into your legs and takes X-rays of the
area. The dye appears on the X-rays, giving your doctor a
better view of how your blood is flowing.

• Preventions:
Lifestyle changes
• The following changes may help prevent varicose veins from
forming or becoming worse:
• Avoid standing for extended periods of time.
• Lose weight or maintain a healthy weight.
• Exercise to improve your circulation.
• Eating a high-fiber, low-salt diet
• Avoiding high heels and tight hosiery
• Elevating your legs
• Use compression socks or stockings: These place enough pressure
on your legs so that blood can flow more easily to your heart. They
also decrease swelling.

• Treatment:
• treatments for more-severe varicose veins
• If you don't respond to self-care or compression stockings, or if
your condition is more severe, your doctor may suggest one of
these varicose vein treatments:
• Sclerotherapy. In this procedure, your doctor injects small- and
medium-sized varicose veins with a solution or foam that scars and
closes those veins. In a few weeks, treated varicose veins should
fade.
• Although the same vein may need to be injected more than once,
sclerotherapy is effective if done correctly. Sclerotherapy doesn't
require anesthesia and can be done in your doctor's office.
• Foam sclerotherapy of large veins. Injection of a large vein with a
foam solution is also a possible treatment to close a vein and seal it.

• Laser treatment. Doctors are using new technology in laser
treatments to close off smaller varicose veins and spider veins.
Laser treatment works by sending strong bursts of light onto the
vein, which makes the vein slowly fade and disappear. No incisions
or needles are used.
• Radiofrequency ablation
• A small incision is made either above or below the knee, and with
the help of an ultrasound scan; a narrow tube (catheter) is threaded
into the vein.
• The doctor inserts a probe into the catheter, which emits
radiofrequency energy. The radiofrequency energy heats up the
vein, causing its walls to collapse, effectively closing it and sealing it
shut. This procedure is preferred for larger varicose veins.
Radiofrequency ablation is usually done with a local anesthetic.

• High ligation (tye) and vein stripping. This procedure involves tying
off a vein before it joins a deep vein and removing the vein through
small incisions. This is an outpatient procedure for most people.
Removing the vein won't adversely affect circulation in your leg
because veins deeper in the leg take care of the larger volumes of
blood.
• Procedure: Two incisions are made, one near the patient's groin at
the top of the target vein, and the other is made further down the
leg, either at the ankle or knee. The top of the vein is tied up and
sealed. A thin, flexible wire is threaded through the bottom of the
vein and then pulled out, taking the vein with it.
• Ambulatory phlebectomy (fluh-BEK-tuh-me). Your doctor removes
smaller varicose veins through a series of tiny skin punctures. Only
the parts of your leg that are being pricked are numbed in this
outpatient procedure. Scarring is generally minimal.

• Transilluminated powered phlebectomy
• An endoscopic transilluminator (special light)
is threaded through an incision under the skin
so that the doctor can see which veins need to
be taken out. The target veins are cut and
removed with a suction device through the
incision.
• A general or local anesthetic may be used for
this procedure

• Complications:
• Blood clots. Occasionally, veins deep within the
legs become enlarged. In such cases, the affected
leg may become painful and swell. Any persistent
leg pain or swelling warrants medical attention
because it may indicate a blood clot — a
condition known medically as thrombophlebitis.
• Bleeding. Occasionally, veins very close to the
skin may burst. This usually causes only minor
bleeding. But any bleeding requires medical
attention.

• Herbal treatment:
• Though they haven't been well-studied, a number of
alternative therapies claim to be helpful treatments for
chronic venous insufficiency(due lo lack of blood supply
which contains nutrients, oxygen due to poor blood flow to
travel against gravity), a condition associated with varicose
veins in which leg veins have problems returning blood to
the heart. These therapies include:
• Horse chestnut
• Butcher's broom
• Grape (leaves, sap, seed and fruit)
• Sweet clover

• Horse chest net: Horse chestnut, or Aesculus hippocastanum, is a
tree native to the Balkan Peninsula.
• Extract from the horse chestnut seed is a popular dietary
supplement commonly used to improve vein health and reduce
inflammation.
• The main active component in horse chestnut extract is aescin,
which has been studied for its many health benefits.
• The compound aescin in horse chestnut has multiple medicinal
properties that could make it useful for treating CVI. For example, it
may increase blood flow in your veins, possibly improving
symptoms
• In fact, one study noted that horse chestnut extract was as
effective as compression therapy at reducing swelling and leg
volume

Inflammatory diseases

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