What are these Conditions?

Extraocular motor nerve palsies are dysfunctions of the third, fourth, and sixth cranial nerves, which are involved with movement and focusing of the eyes.

What Causes them?

The most common causes of extraocular motor nerve palsies are diabetic neuropathy and pressure from an aneurysm or a brain tumor. Other causes vary, depending on which cranial nerve is involved.

What are their Symptoms?

The most characteristic symptom is double vision of recent onset. Typically, the person with third nerve palsy exhibits drooping eyelid. an eye that looks outward, dilated pupils, and an inability to adjust to light.

The person with fourth nerve palsy has double vision and cannot rotate the eye downward or upward; wryneck may develop from repeatedly tilting the head to the affected side to compensate for double vision.

Sixth nerve palsy causes one eye to turn; the eye cannot abduct beyond the midline. To compensate for double vision, the person turns the head to the unaffected side and develops wryneck.

How are they Diagnosed?

The doctor will perform a complete neuro-ophthalmologic exam and obtain a thorough history. Differential diagnosis of third, fourth, or sixth nerve palsy depends on the specific motor defect. For all extraocular motor nerve palsies, skull X-rays and a computed tomography scan (called a CAT scan) rule out tumors. The person is also evaluated for an aneurysm or diabetes. If sixth nerve palsy results from infection, cultures identifY the causative organism and determine the choice of an antibiotic.

How are they Treated?

Treatment depends on the underlying cause. Neurosurgery is necessary if the cause is a brain tumor or an aneurysm. For infection, massive doses of antibiotics may be appropriate. After treatment of the primary condition, the person may need to perform exercises that stretch the neck muscles.

What is this Condition?

Gallbladder cancer is rare, accounting for fewer than 1 % of all cancers. The disease occurs mostly in women over age 60. It progresses rapidly and has a poor prognosis because it’s usually diagnosed late.

Bile duct cancer accounts for approximately 3% of all cancer deaths in the United States. It occurs in both men and women between ages 60 and 70. Typically, the cancer spreads to local lymph nodes as well as the liver, lungs, and peritoneum.

What Causes it?

Many doctors consider gallbladder cancer a complication of gallstones, although this theory is based on circumstantial evidence ­ 60% to 90% of people with gallbladder cancer also have gallstones.

At diagnosis, the doctor often finds that the cancer has spread to the lymph nodes. Direct spread to the liver is common, and direct spread to both the cystic and common bile ducts, stomach, colon, duodenum, and jejunum also occurs, causing blockages. The cancer also spreads to the peritoneum, ovaries, and lower lung lobes.

The cause of bile duct cancer isn’t known; however, statistics show an unexplained increased incidence of this cancer in people with ulcerative colitis. This link may result from a common cause - perhaps an immune mechanism or chronic use of certain drugs by people with colitis.

What are its Symptoms?

The symptoms of gallbladder cancer are almost indistinguishable from those of gallbladder inflammation: pain in the upper middle or upper right part of the abdomen, weight loss, loss of appetite, nausea. vomiting, and jaundice. However, chronic, progressively severe pain in someone without a fever suggests cancer. In people with simple gallstones, pain is sporadic. Another telling clue to cancer is a palpable gallbladder with obstructive jaundice. Some people may also have an enlarged liver and spleen.

Progressive profound jaundice is commonly the first sign of obstruction due to extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the upper middle or upper right part of the abdomen, radiating to the back. Other common symptoms include itching, skin problems, loss of appetite, weight loss, chills. and fever.

How is it Diagnosed?

No one test can diagnose gallbladder cancer. However, lab tests support this diagnosis when they suggest liver problems and extrahepatic biliary obstruction.

How is it Treated?

Surgery relieves symptoms but doesn’t cure the disease. It includes various procedures, such as gallbladder removal, common bile due exploration, tube drainage, and wedge excision of liver tissue. Surgery should normally be performed to relieve obstruction and jaundice that result from extrahepatic bile duct cancer.

Other measures to help relieve symptoms include radiation, radiation implants (mostly used for local and incisional recurrences), and chemotherapy (with combinations of fluorouracil, doxorubicin, and lomustine). All of these treatment measures have limited effects.

What can a Person Undergoing Surgery do?

• After biliary surgery, you’ll probably want to take shallow breath. To improve your breathing, you may receive pain relievers and be instructed to splint your abdomen with a pillow or an abdominal binder.
• Be aware that you’ll have a nasogastric tube in place for 24 to 72 hours after surgery to relieve distention, as well as a T tube.