Source: Wikipedia, some random lecture, and some random websites
Definition
Alcoholism is the consumption of or preoccupation with alcoholic beverages to the extent that this behavior interferes with the alcoholic's normal personal, family, social, or work life.
Consequence
The chronic alcohol consumption caused by alcoholism can result in psychological and physiological disorders. Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country's GDP.
Alcohol Levels
One standard drink = 10 grams alcohol.
1 standard drink = pot of beer, alcoholic shot, port/sherry, restaurant wine = 0.8 S.D.
1.5 standard drinks = sparkling wine, champagne
Bottle of wine = 7 Standard Drinks
Bottle of spirits = 22 SDs (which is why you take only a nip)
Drinking and driving legal limits: 0.05 (0.05 grams per 100 ml blood = one more drink than the number of hours for men, and drinks equal the number of hours for women). For taxi, bus, heavy vehicle, learner and P plate drivers, the limit is 0.02 grams per 100 ml. At 0.05, the risk of an accident is doubled than that of someone who has not consumed alcohol. At 0.10, the risk is 7 times higher.
Low-risk drinking guidelines
Men: No more than 2 standard drinks in the first hour, and one per hour after that. No more than 4 standard drinks a day on average (never more than 6) and at least one or two alcohol-free days per week.
Women: No more than 1 standard drink per hour. No more than 2 standard drinks per day (on average) and never more than four and one or two alcohol-free days per week.
4 L’s of Alcohol’s harmful effects:
· Liver (injuries, brain disease)
· Lover (domestic violence)
· Livelihood (poor performance)
· Law (drinking and driving, assault)
Almost 100,000 deaths per year in USA are attributable to alcohol.
Alcohol Addiction
While alcohol use is required to trigger alcoholism, the biological mechanism of alcoholism is uncertain. For most people, moderate alcohol consumption poses little danger of addiction. Other factors must exist for alcohol use to develop into alcoholism. These factors may include a person's social environment, emotional health and genetic predisposition. In addition, an alcoholic can develop multiple forms of addiction to alcohol simultaneously such as psychological, metabolic, and neurochemical. Each type of addiction must be treated individually for an alcoholic to fully recover.
Alcohol Screening
The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.
Two "yes" responses indicate that the respondent should be investigated further. The questionnaire asks the following questions:
Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Diagnosis of Alcohol Levels
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC).
Alcohol content in blood can be directly measured by a hospital laboratory. More commonly in law enforcement investigations, BAC is estimated from breath alcohol concentration (BrAC) measured with a machine commonly referred to as a Breathalyzer.
Showing posts with label Diagnostics. Show all posts
Showing posts with label Diagnostics. Show all posts
1/13/07
1/7/07
Sickle Cell Disease
Source: Wikipedia and University of Maryland's "Sickle Cell Anemia"
Sickle-cell disease, is a general term to describe a variety of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S) to red blood cells. In sickle cells, there is a single amino acid mutation (at position 6 Glutamate becomes Valine). This is a substantial change in terms of the properties of the amino acids (because Glutamate is hydrophillic and Valine is hydrophobic, a hydrophobic patch on the surface of the protein is exposed).
In many forms of the disease the red blood cell changes form into a crescent-shape, or a sickle shape. The danger lies in the tendency for the sickle-shaped red blood cells to clog together and get stuck in vessels. This deprives the downstream tissues of oxygen and causes ischemia (reduction of blood flow to an organ, thus damaging tissues) or infarction (necrosis caused by arterial deprivation).
*It is important to note that "sickle-cell anemia" is the proper name of a specific type of "sickle-cell disease", and that "sickle-cell disease" is a non-specific term.
Sickle cell anemia: The person has most or all of the normal hemoglobin (HbA) replaced with the sickle hemoglobin (HbS). This is referred to as HbSS. It is the most common and most severe form of the sickle cell variations. These persons suffer from a variety of complications due to the shape and thickness of the sickled cells. Severe and chronic anemia is also a common characteristic for children with HbSS.
The allele responsible for sickle cell anemia is autosomal recessive. A person who receives the defective gene from both father and mother develops the disease; a person who receives one defective and one healthy allele remains healthy, but can pass on the disease and is known as a carrier. If two parents who are carriers have a child, there is a 1-in-4 chance of their child developing the illness and a 1-in-2 chance of their child just being a carrier.
Sickle cell RBC's contain long fibres of protein which give rise to the strange shapes of the cell. Since there are fewer cells and the cells that exist have abnormalities, the gas carrying capacity of the cells is greatly altered.
Symptoms
Patients with sickle cell anemia have a part varies in severity, with typical hemoglobin levels of 6-9 g/dl. Reticulocyte counts are elevated, reflecting new red blood cells replacing the rapidly destroyed older cells - red blood cell life span is markedly reduced in this disease. Often, the white blood cell and platelet counts are elevated, and these cells may contribute to vaso-occlusion.
The following is a list of symptoms and complications associated with sickle cell disease. However, each individual may experience symptoms differently. Symptoms and complications may include, but are not limited to, the following:
anemia - the most common symptom of all the sickle cell diseases. In sickle cell disease, red blood cells are produced but then become deformed into the sickle shape, which causes red blood cells to lose their oxygen carrying capacity. The body subsequently becomes dehydrated, or with a fever. This sickle shape makes the cells stiff and sticky causing them to become stuck in the vessels, destroyed by the spleen, or simply die because of their abnormal function. The decrease in red blood cells causes anemia. Severe anemia can make a person pale and tired, and makes the person's ability to carry oxygen to the tissues more difficult. Healing and normal growth and development may be delayed because of chronic anemia.
pain crisis, or sickle crisis - when the flow of blood is blocked to an area because the sickled cells have become stuck in the blood vessel. These are also called "vasoocclusive crises." The pain can occur anywhere, but most often occurs in the chest, arms, and legs. Painful swelling of the fingers and toes, called dactylitis, can occur in infants and children under 3 years of age. Priapism is a painful sickling that occurs in the penis. Any interruption in blood flow to the body can result in pain, swelling, and possible death of the surrounding tissue not receiving adequate blood and oxygen.
acute chest syndrome - when sickling is in the chest. This can be a life-threatening complication of sickle cell disease. It often occurs suddenly, when the body is under stress from infection, fever, or dehydration. The sickled cells stick together and block the flow of oxygen in the tiny vessels in the lungs. It resembles pneumonia and can include fever, pain, and a violent cough. Multiple episodes of acute chest syndrome can cause permanent lung damage.
splenic sequestration (pooling) - crises are a result of sickle cells pooling in the spleen. This can cause a sudden drop in hemoglobin and can be life threatening if not treated promptly. The spleen can also become enlarged and painful from the increase in blood volume. After repeated episodes of splenic sequestration, the spleen becomes scarred, and permanently damaged. Most children, by the age of 8 years old, do not have a functioning spleen either from surgical removal, or from repeated episodes of splenic sequestration. The risk of infection is a major concern of children without a functioning spleen. Infection is the major cause of death in children under the age of 5 years in this population.
stroke - another sudden and severe complication of persons with sickle cell disease. The misshapen cells can block the major blood vessels that supply the brain with oxygen. Any interruption in the flow of blood and oxygen to the brain can result in devastating neurological impairment. Having had one stroke, a person is 60 percent more likely to have a second and third stroke.
jaundice, or yellowing of the skin, eyes, and mouth - a common sign and symptom of sickle disease. Sickle cells do not live as long as normal red blood cells and, therefore they are dying more rapidly than the liver can filter them out. Bilirubin (which causes the yellow color) from these broken down cells builds up in the system causing jaundice.
Any and all major organs are affected by sickle cell disease. The liver, heart, kidneys, gallstone, eyes, bones, and joints can suffer damage from the abnormal function of the sickle cells and their inability to flow through the small blood vessels correctly. Problems may include the following:
- increased infections
- leg ulcers
- bone damage
- early gallstones
- kidney damage and loss of body water in the urine
- eye damage
The symptoms of sickle cell disease may resemble other blood disorders or medical problems. Always consult your physician for a diagnosis.
How is sickle cell disease diagnosed?
Treatment
Most patients with sickle cell disease have intensely painful episodes called vaso-occlusive crises. The frequency, severity, and duration of these crises vary tremendously, however. Painful crises are treated symptomatically with analgesics; pain management requires opioid administration at regular intervals until the crisis has settled. For milder crises a subgroup of patients manage on NSAIDs (such as diclofenac or naproxen). For more severe crises most patients require inpatient management for intravenous opioids; patient-controlled analgesia (PCA) devices are commonly used in this setting. Diphenhydramine is effective for the itching associated with the opioid use. Gene therapy is under investigation.
Other treatments offered:
- drinking plenty of water daily (eight to 10 glasses) or receiving fluid intravenously (to prevent and treat pain crises)
- blood transfusions: for anemia and to prevent stroke, blood transfusions may be used. Transfusions are also used to dilute the HbS with normal hemoglobin to treat chronic pain, acute chest syndrome, splenic sequestration, and other emergencies.
- penicillin (to prevent infections)
- folic acid (to help prevent severe anemia)
- hydroxyurea: Hydroxyurea is a medication that has recently been developed that may help reduce the frequency of pain crises and acute chest syndrome. It may also help decrease the need for frequent blood transfusions. The long-term effects of the medication, however, are unknown.
- bone marrow transplant: Bone marrow transplant has been effective in curing some persons with sickle cell disease; the decision to undergo this procedure is based on the severity of the disease and ability to find a suitable bone marrow donor. These decisions need to be discussed with your physician.
Sickle-cell disease, is a general term to describe a variety of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S) to red blood cells. In sickle cells, there is a single amino acid mutation (at position 6 Glutamate becomes Valine). This is a substantial change in terms of the properties of the amino acids (because Glutamate is hydrophillic and Valine is hydrophobic, a hydrophobic patch on the surface of the protein is exposed).
In many forms of the disease the red blood cell changes form into a crescent-shape, or a sickle shape. The danger lies in the tendency for the sickle-shaped red blood cells to clog together and get stuck in vessels. This deprives the downstream tissues of oxygen and causes ischemia (reduction of blood flow to an organ, thus damaging tissues) or infarction (necrosis caused by arterial deprivation).
*It is important to note that "sickle-cell anemia" is the proper name of a specific type of "sickle-cell disease", and that "sickle-cell disease" is a non-specific term.
Sickle cell anemia: The person has most or all of the normal hemoglobin (HbA) replaced with the sickle hemoglobin (HbS). This is referred to as HbSS. It is the most common and most severe form of the sickle cell variations. These persons suffer from a variety of complications due to the shape and thickness of the sickled cells. Severe and chronic anemia is also a common characteristic for children with HbSS.
The allele responsible for sickle cell anemia is autosomal recessive. A person who receives the defective gene from both father and mother develops the disease; a person who receives one defective and one healthy allele remains healthy, but can pass on the disease and is known as a carrier. If two parents who are carriers have a child, there is a 1-in-4 chance of their child developing the illness and a 1-in-2 chance of their child just being a carrier.
Sickle cell RBC's contain long fibres of protein which give rise to the strange shapes of the cell. Since there are fewer cells and the cells that exist have abnormalities, the gas carrying capacity of the cells is greatly altered.
Symptoms
Patients with sickle cell anemia have a part varies in severity, with typical hemoglobin levels of 6-9 g/dl. Reticulocyte counts are elevated, reflecting new red blood cells replacing the rapidly destroyed older cells - red blood cell life span is markedly reduced in this disease. Often, the white blood cell and platelet counts are elevated, and these cells may contribute to vaso-occlusion.
The following is a list of symptoms and complications associated with sickle cell disease. However, each individual may experience symptoms differently. Symptoms and complications may include, but are not limited to, the following:
anemia - the most common symptom of all the sickle cell diseases. In sickle cell disease, red blood cells are produced but then become deformed into the sickle shape, which causes red blood cells to lose their oxygen carrying capacity. The body subsequently becomes dehydrated, or with a fever. This sickle shape makes the cells stiff and sticky causing them to become stuck in the vessels, destroyed by the spleen, or simply die because of their abnormal function. The decrease in red blood cells causes anemia. Severe anemia can make a person pale and tired, and makes the person's ability to carry oxygen to the tissues more difficult. Healing and normal growth and development may be delayed because of chronic anemia.
pain crisis, or sickle crisis - when the flow of blood is blocked to an area because the sickled cells have become stuck in the blood vessel. These are also called "vasoocclusive crises." The pain can occur anywhere, but most often occurs in the chest, arms, and legs. Painful swelling of the fingers and toes, called dactylitis, can occur in infants and children under 3 years of age. Priapism is a painful sickling that occurs in the penis. Any interruption in blood flow to the body can result in pain, swelling, and possible death of the surrounding tissue not receiving adequate blood and oxygen.
acute chest syndrome - when sickling is in the chest. This can be a life-threatening complication of sickle cell disease. It often occurs suddenly, when the body is under stress from infection, fever, or dehydration. The sickled cells stick together and block the flow of oxygen in the tiny vessels in the lungs. It resembles pneumonia and can include fever, pain, and a violent cough. Multiple episodes of acute chest syndrome can cause permanent lung damage.
splenic sequestration (pooling) - crises are a result of sickle cells pooling in the spleen. This can cause a sudden drop in hemoglobin and can be life threatening if not treated promptly. The spleen can also become enlarged and painful from the increase in blood volume. After repeated episodes of splenic sequestration, the spleen becomes scarred, and permanently damaged. Most children, by the age of 8 years old, do not have a functioning spleen either from surgical removal, or from repeated episodes of splenic sequestration. The risk of infection is a major concern of children without a functioning spleen. Infection is the major cause of death in children under the age of 5 years in this population.
stroke - another sudden and severe complication of persons with sickle cell disease. The misshapen cells can block the major blood vessels that supply the brain with oxygen. Any interruption in the flow of blood and oxygen to the brain can result in devastating neurological impairment. Having had one stroke, a person is 60 percent more likely to have a second and third stroke.
jaundice, or yellowing of the skin, eyes, and mouth - a common sign and symptom of sickle disease. Sickle cells do not live as long as normal red blood cells and, therefore they are dying more rapidly than the liver can filter them out. Bilirubin (which causes the yellow color) from these broken down cells builds up in the system causing jaundice.
Any and all major organs are affected by sickle cell disease. The liver, heart, kidneys, gallstone, eyes, bones, and joints can suffer damage from the abnormal function of the sickle cells and their inability to flow through the small blood vessels correctly. Problems may include the following:
- increased infections
- leg ulcers
- bone damage
- early gallstones
- kidney damage and loss of body water in the urine
- eye damage
The symptoms of sickle cell disease may resemble other blood disorders or medical problems. Always consult your physician for a diagnosis.
How is sickle cell disease diagnosed?
Treatment
Most patients with sickle cell disease have intensely painful episodes called vaso-occlusive crises. The frequency, severity, and duration of these crises vary tremendously, however. Painful crises are treated symptomatically with analgesics; pain management requires opioid administration at regular intervals until the crisis has settled. For milder crises a subgroup of patients manage on NSAIDs (such as diclofenac or naproxen). For more severe crises most patients require inpatient management for intravenous opioids; patient-controlled analgesia (PCA) devices are commonly used in this setting. Diphenhydramine is effective for the itching associated with the opioid use. Gene therapy is under investigation.
Other treatments offered:
- drinking plenty of water daily (eight to 10 glasses) or receiving fluid intravenously (to prevent and treat pain crises)
- blood transfusions: for anemia and to prevent stroke, blood transfusions may be used. Transfusions are also used to dilute the HbS with normal hemoglobin to treat chronic pain, acute chest syndrome, splenic sequestration, and other emergencies.
- penicillin (to prevent infections)
- folic acid (to help prevent severe anemia)
- hydroxyurea: Hydroxyurea is a medication that has recently been developed that may help reduce the frequency of pain crises and acute chest syndrome. It may also help decrease the need for frequent blood transfusions. The long-term effects of the medication, however, are unknown.
- bone marrow transplant: Bone marrow transplant has been effective in curing some persons with sickle cell disease; the decision to undergo this procedure is based on the severity of the disease and ability to find a suitable bone marrow donor. These decisions need to be discussed with your physician.
1/4/07
Gastroenteritis
Main source: eMedicine Health's "Gastroenteritis"
Definition
Gastroenteritis is a bowel infection causing diarrhea and sometimes vomiting. Vomiting may settle quickly, but diarrhea may last up to 10 days. In most cases medicine is not needed, however babies can become sick very quickly because they lose fluids. Gastroenteritis is often also called "food poisoning", "gastro" or "stomach flu".
Cause
Gastroenteritis may be caused by many pathogens, but is most often caused by either viruses or bacteria. Viruses and bacteria are very contagious and can spread through food or water. In upto 50% of diarrhoea cases, no specific agent is found. Not washing your hands after defecating can spread the disease from person to person.
Gastroenteritis caused by viruses can last 1-2 days. Gastroenteritis caused by bacteria can last one week or more.
Bacteria:
- Escherichia coli - Traveler’s diarrhea, food poisoning, dysentery, colitis, or uremic syndrome
- Salmonella - Typhoid Fever; handling poultry or reptiles such as turtles that carry the germs
- Campylobacter - Undercooked meat, unpasteurized milk
- Shigella - Dysentery
Virus:
Viral outbreaks (30-40% of cases in children) can spread rapidly through close contact among children in day care and schools. Poor handwashing habits can spread viruses. Common viral causes include the following:
- Adenoviruses
- Rotaviruses: Rotaviruses are the most common cause of severe diarrhoea in children, killing about 600,000 children in developing countries (as of 2005). However, new vaccines have proven to be safe and effective.
- Caliciviruses
- Astroviruses
- Norovirus (formerly called Norwalk-like virus or NLV) and Norwalk virus. Norovirus was attributed to 9 out of the 21 outbreaks of acute gastroenteritis on cruise ships reported to the CDC’s Vessel Sanitation Program from January 1, 2002, to December 2, 2002. Noroviruses cause about 23 million cases of acute gastroenteritis each year and are the leading cause of outbreaks. It is transmitted fecal-orally. It is estimated that Norwalk viruses are responsible for about 1/3 of the gastroenteritis cases not involving the 6-to-24-month age group.
Parasites and Protozoans:
These tiny organisms are less frequently responsible for intestinal irritation. You may pick up one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. Common parasites include:
Giardia - The most frequent cause of waterborne diarrhea causing giardiasis
Cryptosporidium - Affects mostly people with weakened immune systems, causes watery diarrhea
Other Causes:
Chemical toxins most often found in seafood, food allergies, heavy metals, antibiotics, and other medications also may be responsible for bouts of gastroenteritis that are not infectious to others.
- Medications (Aspirin, Nonsteroidal anti-inflammatory medicines such as Motrin or Advil, Antibiotics, Caffeine, Steroids - Excessive use or a sudden change in frequency or dosage, Laxatives,
- Inability to tolerate the sugar lactose in milk and milk products such as cheese and ice cream
- Exposure to heavy metals sometimes present in drinking water (Arsenic, Lead, Mercury)
Symptoms
Gastroenteritis may affect both the stomach and the intestines, resulting in one or more of the following symptoms:
Common symptoms:
- Low grade fever (99°F)
- Nausea with or without vomiting
- Mild-to-moderate diarrhea: May range from 2-4 loose stools per day for adolescents and adults to stools that run out of the diaper in infants.
- Crampy painful bloating
- Vomiting: May or may not accompany diarrhea. If you do vomit, your dehydration rate will increase. Either together or alone, diarrhea and vomiting result not only in loss of significant amounts of fluid, leading to dehydration and possibly shock, but also loss of potassium, sodium, and bicarbonate.
More serious symptoms
Blood in vomit or stool
Vomiting more than 48 hours
Fever higher than 101°F
Swollen abdomen or abdominal pain coming from the right lower side
Dehydration - Little to no urination, extreme thirst, lack of tears, and dry mouth (dry diapers in infants)
In general, symptoms caused by bacteria or their toxins will become apparent after the following amount of time:
- Staphylococcus aureus in 3-6 hours
- Clostridium 8-10 hours
- Salmonella in 12-72 hours
Going to the Doctor
If a patient with gastroenteritis is losing too much fluid from vomiting and diarrhoea and is unable to keep liquids in, they should consult a doctor. If there is blood in the feces, vomiting that lasts more than 48 hours, a very high fever, swollen stomach or dehydration (little urination, extreme thirst, lack of tears, dry mouth), then they must consult the Emergency Department.
A doctor first will determine if your symptoms are acute (lasting less than 2 weeks) or chronic (longer lasting). A long-lasting illness suggests an inflammation or immune disorder, which should be checked after infection has been ruled out. Sudden onset of illness may indicate changes in diet or medication.
A doctor will then try to make out whether it is a virus or a bacteria causing the symptoms.
Signs for bacterial infection: rapidly developing fever, abdominal pain, bloody stool and presence of white blood cells (leukocytes).
Signs for viral infection: watery stools without blood or leukocytes are more typical of viral- or toxin-induced diarrhea.
The doctor will then:
- Ask typical questions (how long? what type? alleviating/aggrevating factors? weight loss?)
- Check for an outbreak (any other family members/friends affected?)
- Check for inflammation (of appendix, gallbladder, pancreas)
- Lab tests (check feces for blood, mucus or odor, maybe even for parasites and their eggs)
- Travel history (Mexico = E coli)
- Exposure to poisons or irritants (contaminated water = Giardia)
- Diet change
- Medication (antibiotic irritation perhaps)
Treatment
Because dehydration is the big problem with gastro, patients should get adequate amounts of fluid. Children and infants, in particular, are prone to lose a lot of fluid very fast so they must be given a careful watch (for infants, breastfeeding is the best solution to dehydration).
First line of treatment is to provide proper hydration. It is not just water that has been lost, but also important electrolytes such as potassium and sodium. Drinking water will not be enough (in fact it may just dilute the electrolytes). Tea, fruit juices and soft drinks are no-no's. There's a common myth that soft drinks such as lemonade will heal dehydration, but those drinks contain too much sugar and not enought electrolytes. An appropriate choice of drink would be an Oral Rehydration Solution (such as Pedialyte, Rehydrate, Resol, and Rice-Lyte) available at any pharmacy. After a liquid diet, move on to solid foods.
*ORS (oral rehydration solution): simple, cheap and effective for diarrhea-related dehydration, due to cholera or rotavirus. Consists of salts and other substances – glucose, sucrose, citrates. 90 mm Glucose, 60 mm Sodium, and amounts of potassium, chloride and citrate. Soft drinks like lemonade are bad myths for dehydration (although best one is sprite, but still bad. Dilute if must, takes away sugar. Pepsi is horrible).
*You can also make your own oral rehydration solution at home. The World Health Organization has established a field recipe for fluid rehydration: Mix 2 tablespoons of sugar (or honey) with ¼ teaspoon of table salt and ¼ teaspoon of baking soda. (Baking soda may be substituted with ¼ teaspoon of table salt.) Mix in 1 liter (1 qt) of clean or previously boiled water.
Medical line of treatment: Upon seeking medical attention, if you cannot take fluids by mouth because of vomiting, the doctor may insert an IV to put fluid back into your body (rehydration). With severe symptoms, a surgeon, toxicologist, gastroenterologist, or other specialist may see you.
Pathogenic line of treatment: But what about the pathogen! Aren't we making the classic mistake of "treating the symptoms and not the disease"? Well, in gastro- cases, usually the body's defence system is able to fight the disease quicker than doctors can specify it. Therefore, supplying hydration is really all that's necessary.
Doctors usually don’t give antibiotics until bacteria have been identified. Antibiotics may be given for certain bacteria, specifically Campylobacter, Shigella, and Vibrio cholerae, if properly identified through laboratory testing. Otherwise, using any antibiotic or the wrong antibiotic can worsen some infections or make them last longer.
For adults, the doctor may give medications to stop vomiting (which are called antiemetics. Doctors usually do not recommend antiemetics for children. A single dose of Compazine may be prescribed, however, for children older than 2 years. Doctors generally avoid antidiarrheal medications for all age groups.
Final Words
Diarrhea is one of the leading causes of infant sickness. Worldwide, diarrhea accounts for 3-5 million deaths for all age groups. In general, most adults and children recover after they are appropriately rehydrated.
Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have been developed, but doctors generally give them out based on your medical and travel history. If you are travelling to a third world country, then maybe consider one.
Definition
Gastroenteritis is a bowel infection causing diarrhea and sometimes vomiting. Vomiting may settle quickly, but diarrhea may last up to 10 days. In most cases medicine is not needed, however babies can become sick very quickly because they lose fluids. Gastroenteritis is often also called "food poisoning", "gastro" or "stomach flu".
Cause
Gastroenteritis may be caused by many pathogens, but is most often caused by either viruses or bacteria. Viruses and bacteria are very contagious and can spread through food or water. In upto 50% of diarrhoea cases, no specific agent is found. Not washing your hands after defecating can spread the disease from person to person.
Gastroenteritis caused by viruses can last 1-2 days. Gastroenteritis caused by bacteria can last one week or more.
Bacteria:
- Escherichia coli - Traveler’s diarrhea, food poisoning, dysentery, colitis, or uremic syndrome
- Salmonella - Typhoid Fever; handling poultry or reptiles such as turtles that carry the germs
- Campylobacter - Undercooked meat, unpasteurized milk
- Shigella - Dysentery
Virus:
Viral outbreaks (30-40% of cases in children) can spread rapidly through close contact among children in day care and schools. Poor handwashing habits can spread viruses. Common viral causes include the following:
- Adenoviruses
- Rotaviruses: Rotaviruses are the most common cause of severe diarrhoea in children, killing about 600,000 children in developing countries (as of 2005). However, new vaccines have proven to be safe and effective.
- Caliciviruses
- Astroviruses
- Norovirus (formerly called Norwalk-like virus or NLV) and Norwalk virus. Norovirus was attributed to 9 out of the 21 outbreaks of acute gastroenteritis on cruise ships reported to the CDC’s Vessel Sanitation Program from January 1, 2002, to December 2, 2002. Noroviruses cause about 23 million cases of acute gastroenteritis each year and are the leading cause of outbreaks. It is transmitted fecal-orally. It is estimated that Norwalk viruses are responsible for about 1/3 of the gastroenteritis cases not involving the 6-to-24-month age group.
Parasites and Protozoans:
These tiny organisms are less frequently responsible for intestinal irritation. You may pick up one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. Common parasites include:
Giardia - The most frequent cause of waterborne diarrhea causing giardiasis
Cryptosporidium - Affects mostly people with weakened immune systems, causes watery diarrhea
Other Causes:
Chemical toxins most often found in seafood, food allergies, heavy metals, antibiotics, and other medications also may be responsible for bouts of gastroenteritis that are not infectious to others.
- Medications (Aspirin, Nonsteroidal anti-inflammatory medicines such as Motrin or Advil, Antibiotics, Caffeine, Steroids - Excessive use or a sudden change in frequency or dosage, Laxatives,
- Inability to tolerate the sugar lactose in milk and milk products such as cheese and ice cream
- Exposure to heavy metals sometimes present in drinking water (Arsenic, Lead, Mercury)
Symptoms
Gastroenteritis may affect both the stomach and the intestines, resulting in one or more of the following symptoms:
Common symptoms:
- Low grade fever (99°F)
- Nausea with or without vomiting
- Mild-to-moderate diarrhea: May range from 2-4 loose stools per day for adolescents and adults to stools that run out of the diaper in infants.
- Crampy painful bloating
- Vomiting: May or may not accompany diarrhea. If you do vomit, your dehydration rate will increase. Either together or alone, diarrhea and vomiting result not only in loss of significant amounts of fluid, leading to dehydration and possibly shock, but also loss of potassium, sodium, and bicarbonate.
More serious symptoms
Blood in vomit or stool
Vomiting more than 48 hours
Fever higher than 101°F
Swollen abdomen or abdominal pain coming from the right lower side
Dehydration - Little to no urination, extreme thirst, lack of tears, and dry mouth (dry diapers in infants)
In general, symptoms caused by bacteria or their toxins will become apparent after the following amount of time:
- Staphylococcus aureus in 3-6 hours
- Clostridium 8-10 hours
- Salmonella in 12-72 hours
Going to the Doctor
If a patient with gastroenteritis is losing too much fluid from vomiting and diarrhoea and is unable to keep liquids in, they should consult a doctor. If there is blood in the feces, vomiting that lasts more than 48 hours, a very high fever, swollen stomach or dehydration (little urination, extreme thirst, lack of tears, dry mouth), then they must consult the Emergency Department.
A doctor first will determine if your symptoms are acute (lasting less than 2 weeks) or chronic (longer lasting). A long-lasting illness suggests an inflammation or immune disorder, which should be checked after infection has been ruled out. Sudden onset of illness may indicate changes in diet or medication.
A doctor will then try to make out whether it is a virus or a bacteria causing the symptoms.
Signs for bacterial infection: rapidly developing fever, abdominal pain, bloody stool and presence of white blood cells (leukocytes).
Signs for viral infection: watery stools without blood or leukocytes are more typical of viral- or toxin-induced diarrhea.
The doctor will then:
- Ask typical questions (how long? what type? alleviating/aggrevating factors? weight loss?)
- Check for an outbreak (any other family members/friends affected?)
- Check for inflammation (of appendix, gallbladder, pancreas)
- Lab tests (check feces for blood, mucus or odor, maybe even for parasites and their eggs)
- Travel history (Mexico = E coli)
- Exposure to poisons or irritants (contaminated water = Giardia)
- Diet change
- Medication (antibiotic irritation perhaps)
Treatment
Because dehydration is the big problem with gastro, patients should get adequate amounts of fluid. Children and infants, in particular, are prone to lose a lot of fluid very fast so they must be given a careful watch (for infants, breastfeeding is the best solution to dehydration).
First line of treatment is to provide proper hydration. It is not just water that has been lost, but also important electrolytes such as potassium and sodium. Drinking water will not be enough (in fact it may just dilute the electrolytes). Tea, fruit juices and soft drinks are no-no's. There's a common myth that soft drinks such as lemonade will heal dehydration, but those drinks contain too much sugar and not enought electrolytes. An appropriate choice of drink would be an Oral Rehydration Solution (such as Pedialyte, Rehydrate, Resol, and Rice-Lyte) available at any pharmacy. After a liquid diet, move on to solid foods.
*ORS (oral rehydration solution): simple, cheap and effective for diarrhea-related dehydration, due to cholera or rotavirus. Consists of salts and other substances – glucose, sucrose, citrates. 90 mm Glucose, 60 mm Sodium, and amounts of potassium, chloride and citrate. Soft drinks like lemonade are bad myths for dehydration (although best one is sprite, but still bad. Dilute if must, takes away sugar. Pepsi is horrible).
*You can also make your own oral rehydration solution at home. The World Health Organization has established a field recipe for fluid rehydration: Mix 2 tablespoons of sugar (or honey) with ¼ teaspoon of table salt and ¼ teaspoon of baking soda. (Baking soda may be substituted with ¼ teaspoon of table salt.) Mix in 1 liter (1 qt) of clean or previously boiled water.
Medical line of treatment: Upon seeking medical attention, if you cannot take fluids by mouth because of vomiting, the doctor may insert an IV to put fluid back into your body (rehydration). With severe symptoms, a surgeon, toxicologist, gastroenterologist, or other specialist may see you.
Pathogenic line of treatment: But what about the pathogen! Aren't we making the classic mistake of "treating the symptoms and not the disease"? Well, in gastro- cases, usually the body's defence system is able to fight the disease quicker than doctors can specify it. Therefore, supplying hydration is really all that's necessary.
Doctors usually don’t give antibiotics until bacteria have been identified. Antibiotics may be given for certain bacteria, specifically Campylobacter, Shigella, and Vibrio cholerae, if properly identified through laboratory testing. Otherwise, using any antibiotic or the wrong antibiotic can worsen some infections or make them last longer.
For adults, the doctor may give medications to stop vomiting (which are called antiemetics. Doctors usually do not recommend antiemetics for children. A single dose of Compazine may be prescribed, however, for children older than 2 years. Doctors generally avoid antidiarrheal medications for all age groups.
Final Words
Diarrhea is one of the leading causes of infant sickness. Worldwide, diarrhea accounts for 3-5 million deaths for all age groups. In general, most adults and children recover after they are appropriately rehydrated.
Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have been developed, but doctors generally give them out based on your medical and travel history. If you are travelling to a third world country, then maybe consider one.
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