FAQ's on Internal Medicine

Q- What Is Acute Gastroenteritis?

Ans- Acute gastroenteritis

Acute diarrhea or gastroenteritis is the passage of loose stools more frequently than what is normal often associated with, abdominal cramps and bloating.

Causes

·         Diarrhea is mainly caused by bacterial and viral infections and food poisoning and can also be caused by bacteria or viruses that have been transmitted from person to person. For this reason, it is important to wash your hands with soap and water after using the toilet.

·         Diarrhea occurs when the micro-organisms irritate the mucous membrane of the small or large intestine resulting in an abnormally large quantity of water in the motions. The irritated gut becomes very active, contracting excessively and irregularly (colic). This can be accompanied by nausea, vomiting, and cold sweats. In some cases the motions may include some blood.

·         Food poisoning - Certain bacteria (usually staphylococci) irritate the digestive tract by producing toxins which affect the mucous membrane much sooner, a few hours after consumption, compared with bacterial infection.

·         Many people suffer diarrhea after the antibiotic course has finished because the antibiotic alters the intestinal bacterial environment. It is not an allergic reaction.

Chronic diarrhea ( If the diarrhea lasts for more than three weeks). Chronic diarrhea can be a symptom of many disorders such as--irritable bowel syndrome, acute, recurrent or chronic intestinal infections, chronic intestinal inflammation (ulcerative colitis and Crohn's disease),chronic pancreatitis, which produces fatty stools, laxatives, lactose intolerance, improper diet (consumption of too much alcohol, coffee or sweets), metabolic disorders such as diabetes and thyrotoxicosis and intolerance to gluten (wheat protein).

Symptoms

Frequent, watery motions, loss of appetite, nausea,vomiting, stomach pain, fever, dehydration

WHAT ARE THE WARNING SIGNS?

·         Blood in the motions.

·         Pus in the motions (yellow mucus).

·         Inability to drink liquids because of vomiting.

·         Dehydration - symptoms include excreting small amounts of dark urine, drowsiness, dry mucous membranes and thirst. Dehydration as a result of diarrhea is a particular risk for young children and the elderly.

·         Pronounced drowsiness due to dehydration or intoxication.

·         Acute diarrhea in infants.

·         Acute diarrhea in very old people.

What can be done at home?

·         In cases of acute diarrhea it would be wise to drink more fluids (3-4 liters a day), preferably containing sugar and salts. Ready made ORS sachets can be bought from the pharmacist. A sufficient intake has been obtained when the urine becomes light yellow in color.

·         Maintain good standards of hygiene.

·         Eat normally as soon as your appetite returns but if you have suffered an acute attack of diarrhea; avoid foods containing milk for a couple of days.

When should the doctor be consulted?

·         When one of the warning signs outlined above is present.

·         When the diarrhea has occurred during or following a trip abroad - travellers' diarrhea.

·         When the diarrhea has lasted more than one to two weeks.

Treatment

·         Diarrhea can usually be treated safely 'at home' and normally goes away by itself within a week. Treatment with antibiotics is therefore rarely needed, and may cause side effects, such as chronic diarrhea.

·         Antidiarrhoeal agents, such as loperamide (eg Imodium), may be used, except in cases where there is blood or pus in the motions or if the diarrhea is accompanied by high fever.

·         During visits abroad, boil all drinking water, or drink water from sealed bottles only. In addition, you should only eat vegetables that have been boiled or peeled and avoid ice-cream and salads (which may have been washed with unclean water).

Prevention

·         Since most cases of acute watery diarrhea are infectious, the majority of such illnesses can be prevented by drinking water or eating foods that are not contaminated with infectious agents

·         Washing hands frequently with water, when caring for a patient with diarrhea as also always before eating is important.

Proper storage of food and water is also important to prevent harmful bacteria from contaminating them.

Q- What Is Dengue Fever?

Ans- Dengue Fever

Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with headache, fever, exhaustion, severe joint and muscle pain, swollen glands and rash. Dengue strikes people with low levels of immunity.

Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening or even fatal.

Signs and Symptoms

·         After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear.

·         This infectious disease is manifested by a sudden onset of fever, with severe headache, muscle and joint pains and rashes. The dengue rash is characteristically bright red petechia and usually appears first on the lower limbs and the chest - in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting or diarrhea. The glands (lymph nodes) in the neck and groin are often swollen.

·         Some cases develop much milder symptoms which can, when no rash is present, be misdiagnosed as influenza or other viral infection. Patients with dengue can only pass on the infection through mosquitoes or blood products while they are still febrile.

·         The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the disease (the so-called "biphasic pattern"). Clinically, the platelet count will drop until the patient's temperature is normal.

·         Cases of DHF also show higher fever, haemorrhagic phenomena, thrombocytopenia & haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate.

Diagnosis

·         The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with thrombocytopenia and relative leukopenia.

·         For dengue haemorrhagic fever, all four criteria must be fulfilled:

1.       Fever

2.       Haemorrhagic tendency (spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)

3.       Thrombocytopaenia (< 100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)

4.       Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinaemia)

·         Dengue shock syndrome is defined as dengue haemorrhagic fever plus:

1.       Weak rapid pulse,

2.       Narrow pulse pressure (less than 20 mm Hg)

3.       Cold, clammy skin and restlessness.

Serology and PCR (polymerase chain reaction) studies are available to confirm the diagnosis of dengue if clinically indicated.

How is dengue contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito (which feeds during the day) that has previously bitten an infected person. One mosquito bite can inflict the disease. The virus is not contagious and cannot be spread directly from person to person. There must be a person-tomosquito- toanother- person pathway.

Prevention

·         The transmission of the virus to mosquitoes must be interrupted to prevent the illness. Patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious.

·         The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue.

·         Wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic.

·         Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours before sunrise and sunset will help.

·         There is currently no vaccine available for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective.

Treatment

·         The mainstay of treatment is supportive therapy. Increased oral fluid intake is recommended to prevent dehydration. Supplementation with intravenous fluids may be necessary to prevent dehydration and significant concentration of the blood if the patient is unable to maintain oral intake.

·         A platelet transfusion is indicated in rare cases if the platelet level drops significantly (below 20,000) or if there is significant bleeding. The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion.

It is very important to avoid aspirin and non-steroidal antiinflammatory medications. These drugs are often used to treat pain and fever though in this case they may actually aggravate the bleeding tendency associated with some of these infections. Patients should receive, instead acetaminophen preparations to deal with these symptoms if dengue is suspected.