BIOSOFT HELP FILES

The experience of impairment, disability, distress, and handicap by the patient

Impairment – Any loss or abnormality of psychological, physiological, or anatomical structure or function. ( WHO: International Classification of Impairments, disabilities, and Handicaps.  Geneva, Switzerland, World Health Organization, 1980)

Get to a quiet and comfortable place.  Think of a place you have been like for instance a scenery of a river in a forest during a holiday.  Then try to recall in as much detail as possible all that you felt at that time.  Try to hear the sounds of birds and beasts you heard.  Try recalling in the mind the things you saw in detail with colors, contrasts, and shades.  Try and recall the smell.  Try and recall the breeze and how you felt it brushing against your body. Relive the whole experience as you enjoyed it then.

1)      Metatarsus adducts of foot – in-toeing gait, the foot looks curved and there is metatarsus adducts of the forefoot, usually mild and flexible and can also be severe and rigid, spontaneous correction is usual

2)      Tibial torsion – in-toeing gait, the tibia is internally rotated, usually by 5 yrs corrects itself, if not surgery is done at the age of 8-10 yrs to correct the deformity

3)      Femoral torsion – in-toeing gait, characteristic sitting posture – when sitting on the floor they keep the legs and thighs in a “W” shape – leg and thigh of each side form the 2 sides of the “W” – while most of the time corrects itself if not surgery is done at the age of 8-10 yrs, particularly if the gait is very unsightly or frequent falls.

1)      Rigid and gross metatarsus adductus

2)      Gross tibial torsion

3)      Gross femoral torsion with frequent falls

(American Academy of Orthopedic Surgeons website accessed on 30-mar-2007)

1)      Randima – age 20 yrs, since menarche menses cannot be predicted, long perids of amenorrhea, usually exceeding 2 months, flow 3 days, adolescent anovular bleeding,

1)      Irritable Bowel Syndrome – Manning criteria: onset of abdominal pain associated with more frequent bowel movements, onset of abdominal pain associated with loser bowel movements, pain relieved by defecation, visible distension, subjective sensation of incomplete rectal evacuation most of the time, mucus passage most of the time. Rome III criteria: recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months AND 2 or more of the following – abdominal pain improvement with defecation, abdominal pain onset associated with a change in frequency of stools, abdominal pain onset associated with a change in the appearance of stools.  Other common symptoms seen in IBS but not part of the criteria list include constipation (< 3 bowel movements/week), diarrhea (> 3 bowel movements/day, lumpy-hard-lose-watery stools, defecation straining, urgency, sense of incomplete evacuation of the rectum, mucus passage, bloating).  In the presence of a typical history and Rome – III criteria and in the absence of red flags, no further testing is necessary. Tx – PCT, management of illness fears and concerns, worries and fears, management of psychosocial triggers, management of associated anxiety, depression or any other psychiatric syndromes, symptomatic management, drug therapy – loperamide for diarrhea 2 mg after each stool up to a maximum of 16 mg/day, TCAs for chronic pain therapy with amitriptyline 10-150 mg daily, desipramine 10-150 mg daily, doxepin 10-200 mg daily, imipramine 10-150 mg daily, trazodone 25-50 mg daily basically lower doses than for depression. 

1)      Onset in Middle Ages or above

2)      Acute onset illness

3)      Progressive symptoms

4)      Night-time symptoms

5)      Anorexia and/or weight loss

6)      Fever

7)      Bleeding PR

8)      Painless diarrhea

9)      Steatorrhea

10)    Lactose intolerance

11)    Gluten intolerance

12)    Anemia

13)    Abdominal mass or rectal mass

14)    Family history of IBD

15)    Family history of GIT Cancers

16)    Clinical or biochemical evidence of malnutrition

17)    Osteoporosis, stress fracture

18)    Fecal occult blood

19)    Persistent diarrhea

20)    Severe constipation

21)    Recent antibiotic use

(Longstretch et.al 2006 – Rome III criteria)