COUGH

 COUGH is a sudden,protective and repetitively occuriong reflex movement that helps in clearing the airway from various irritants.

                                           

CLASSIFICATION:
           cough is classified into either acute(<3 weeks),subacute(3 to 8 weeks),chronic(>8 weeks) or acute cough i.e, lasting
<3 weeks or persistent cough lasting > 3 weeks.

cough may vary from simple cough to coughing up sputum or blood and sometimes may be associated with other symptoms like sore throat,
wheezing and difficulty in breathing.


CAUSES FOR ACUTE COUGH:
           In most of the healthy adults the cause of acute cough syndrome is mostly viral upper respiratory tract infection like
common cold and other bacterial infections of the nose,
2.Psychogenic,
3.Acute pulmonary oedema i.e, associated with pink,frothy oedema.
4.Pulmonary embolus,
5.Use of ACE inhibitors(used to treat hypertension) and other beta blockers


CAUSES FOR CHRONIC COUGH:
           1.Bronchitis(infection of the air passages leading to lungs),
           2.Asthma
           3.Croup(barking cough more commom in children between 6 months and 3 years)
           4.GERD(Heartburn)
           5.chronic lung disease(Bronchitis or Emphysema)
           6.lung tumour
           7.pulmonary tuberculosis
           8.Whooping cough(Pertussis)


DIAGNOSIS:
     
              *Age
              *Cough
              *Dyspnoea(Atrest or with exertion)
              *Constitutional symptoms
              *Tobacco use history
              *Vital signs(heart rate,respiratory rate,body temperature)
              *chest examination
              *chest radiograph

       These are the essential requirements to make a diagnosis of cause of cough.


TREATMENT:
           1. Treatment depends upon the cause of cough.Natural remedies like some fruits(oranges),hot water bath may treat the acute cough by thinning the mucus in the throat.
 

           2.Drink plenty of fluids

           3. HOME CARE:
          Cough due to common cold and postnasal drip can be treated by some cough syrups like                     Phensedyl(pseudoephedrine,promethazine).
     Should not be used in children below 6 years.
 
          4.Consult your doctor if the cough persists and it is associated with constitutional symptoms.


PREVENTION:


       1.Quit smoking and stay away from second hand smoke and air pollution.
       2.If you have seasonal allergies or any allergies,take preventive measures like staying indoors,using medication etc.

DROWSINESS

   DROWSINESS is nothing but feeling abnormally sleepy during the day.it has got many reasons.main reasons behind drowsiness include somnolence,abnormal thyrotoxic profile,sleep apnoea,depression,stress,grief and some psychological disorders.Medications like tranquilizers,sleeping pills and first genearation antihistamines may also cause drowsiness.

COMMON COLD

rhinitis:inflammation in the nose..sneezing,snuffy and running nose,watery eyes,postnasal drip.
              diagnosis :cap. amoxycillin 250 mg tid for 5 days...tab cetrizine or tab.pseudoephedrine is the commom treatment                                      used now a days

ABDOMINAL PAIN(CHILD)

Cholecystitis:(unlikely in children) Gallstones, Fever, right upper abdomi-
                       nal pain, sometimes pain in right shoulder, nausea,vomiting, chills, sometimes jaundice,dark
                        urine



Pancreatitis:(unlikely in children) Inflammation of the pancreas,the organ that produces insulin,glucose regulating hormone,associated with gall stones. Pain in the upper abdomen,sometimes in  the back,nausea, vomiting sometimes weakness and rapid heart rate
                                             

Ulcerative colitis: Inflammation of the rectum and colon. Low-grade fever (less than
 101 degrees F), some pain  in lower abdomen, blood may appear in stools,sometimes weight loss



Crohn’s disease:(unlikely in children) Inflammation of the entire gastrointestinal tract. Low-grade fever
                               less than 101 F,pain in the lower right part of the abdomen that is often relieved by
                               defecation of stools that are soft and not well formed

Sickle-cell disease: Painful “crises” caused by misshapen red blood cells,an inherited disease foubd most often in african americans. Severe pain in abdomen and joints,sweating,sometimes fever
 

Worms: Infection by Ascaris,hookworm, Taenia,Strongyloides species. Worms and eggs in stool,
, mild pain, weight loss and diarrhoea


Lead poisoning :Caused by exposure to lead, most often in lead paint in older houses.Diffuse abdominal pain,in the long term lead to mental retardation


Bowel obstruction:A blockage in theintestine. Nausea, vomiting, sometimes constipation
                               distended belly, extreme discomfort

Intussusception: common between ages of 5 months and 2 years.“Telescoping” of tubes of intestine into
                            one another. Slight fever, acute sudden pain,vomiting,often decreased bowel movements.

Ulcer: Severe irritation of the stomach or intestinal lining.Burning upper abdominal
                 pain that is worse when lying down,sometimes relieved by antacids,made worse by  aspirin or
                 ibuprofen

Henoch schonlein purpura:inflammation of the blood vessels that often follow respiratory     
                                       infections.joint pain,vomiting,distended belly,bruising occurs later
Kidney disease: Congenital kidney problems... Severity of pain varies, but
                            generally over the flank
Hepatitis: Infection or inflammation of the liver caused by viruses.Weakness, fatigue, right
                   upper abdominal pain,jaundice (skin taking on a yellowish appearance)

ABDOMINAL PAIN(CHILD)

 These are the most common causes of abdominal pain in a child

Gastroenteritis( Infection of the stomach) Nausea, vomiting, diarrhea, cramping, muscle

                              aches, slight fever

Unclear cause (Alternating diarrhea and constipation)Attention-seeking behavior,cramping,diarrhoea,

                            constipation with minimal pain,no fever

                                                                                                          

 Colic: Crying spells seen between the ages of  2 weeks and 4 months probably due to

              abdominal pain..Crying spells, usually  resolves on its own by age of 4 months

Constipation: Constipation, Diffuse pain

Appendicitis:Infection or inflammation  of the appendix,a small pouch of the large intestine                                                                                         Pain in the lower right part of the abdomen,low grade fever(<101 degrees)

Pharyngitis:Sore throat, can lead to abdominal pain. Fever, enlarged “glands,”

                    sore throat, redness in throat

Pneumonia: Lung infection, can lead to abdominal pain because of coughing. Fever, cough are the main 

                    symptoms          

Mumps: Infection that causes the area around the cheeks to swell, now prevented in large part by MMR

                vaccination.swollen cheeks and  fever are seen

Lactose intolerance: Reaction to lactose, a  sugar found in milk and cheese. Bloating, cramping pain are the main symptoms

ABDOMINAL PAIN(ADULT)

                 These are the most commom causes for abdominal pain leading to emergency in an adult.


                                               ABDOMINAL PAIN(ADULT)


cause              :what is it?                                     typical symptoms


Gastroenteritis  : Infection of the stomach or intestines. Nausea, vomiting,diarrhea, cramping, muscle aches, slight fever.
                                                                                       
                                                                                                          

Heartburn  : Also known as GERD(Gastroesophagealreflux disease),the movement of acid up into and through the oesophaus,which connects the throat upright to the stomach,can lead to ulcer.Burning upper abdominal pain,worse when lying flat or bending over,particularly soon after meals,releived by antacids or sitting.                              

Irritable bowel syndrome: Alternating diarrhea and  constipation, sometimes  occurring during periods of anxiety.abdominal  Cramping, diarrhea,constipation, with minimal pain,no fever.
                                                         
                                                                   
                                              

Ulcer:  Severe irritation of the stomach or intestinal lining.Burning upper abdominal pain that is worse when lying down,sometimes releived by lying down,antacids and made worse by aspirin or drugs such as ibuprofen.
                                                                         
                                                                                                 
                                                                                                         

Appendicitis:   Infection or inflammation  of the appendix, a small pouch of the large intestine.                     Pain in the lower right part of the abdomen, low grade fever (less than 101 degrees F)
                                                        
                                                                         
                                                                                                        

Hepatitis : Infection or inflammation of the liver,can be caused by viruses or by heavy long-term drinking.                  Weakness, fatigue, right upper abdominal pain, jaundice (skin taking on a yellowish appearence)

                                                                               ,
                                                                    
                                                                 


Diverticulitis: Infection of pockets of  the large intestine..Fever, pain in lower left part of the abdomen,constipation, nausea, vomiting,sometimes blood in the stool

                                                                            ,
                                                                                                     ,
                                                                                                    
                                                                                                    

Cholecystitis :Gallstones. Fever, right upper abdominal pain, sometimes pain  in right shoulder, nausea
                   vomiting, chills, sometimes  jaundice, dark urine                                                                                
                                                                                                    ,
                                                                                                    
                                                                                                 
                                                                                                   

Pancreatitis: Inflammation of the pancreas  with history of heavy drinking or gallstones.Pain in the upper
                 abdomen, sometimes in the back, nausea, vomiting sometimes weakness and  rapid heart rate                          
                   
                                                         
                                             

Ureteral stone: Passing of a kidney stone into one of the ureters ..Pain usually begins in side, accompanied by painful urination and blood in the urine can lead to fever
                                                              

Ectopic pregnancy: Presence of a growing fetus outside the uterus(in women) usually in the fallopian tubes. Missed menstrual period, severe lower abdominal pain that appears suddenly
                              ,                 
                                            

Pelvic inflammatory dsease: Inflammation of the reproductive tract that results from past sexually (in women) transmitted diseases, Severe pain in the lower abdomen, fever, chills,vaginal discharge, painful sexual intercourse
                                                  
                                                    

Ulcerative colitis Inflammation of the rectum and colon. Low-grade fever (less than 101 degrees F), some pain in lower abdomen, blood  may appear in stools, sometimes weight loss
                                                            
                                                                                                    
                                                                                                   
                                                                                                   



Crohn’s disease: Inflammation of the entire gastrointestinal system (can occur from  mouth to rectum)                             Low-grade fever (less than 101 degrees F), pain in lower right part of the abdomen that is often
              relieved by defecation of stools that are soft and not well formed.                                                
                                                               
                                                                       
                                                                                                   
                                                                                                   
                                                                                                   

Abdominal aortic aneurysm rupture: A tear of the aorta, the largest blood vessel in the body.                        Acute pain anywher ebetween the chest and lower abdomen, weakness,rapid heartbeat, sometimes,a pulsing mass can be felt
                                                                                      
                                                                                                  

Bowel infarction:  Failure of blood to get to part of the intestine leading to death of part of the intestine,often                 associated with a history of abdominal surgery.Weakness, rapid heartbeat, distended belly, pain is                  all over the abdomen.surgery is necessary                                        
                           ,                       
                                       
                                        

Peritonitis:  An infection of the lining of the abdomen. Severe pain that worsens with movement, fever,rigidity
                                                                          
                                                                                                

Bowel obstruction: A blockage in theintestines. Nausea, vomiting, sometimes constipation,distended belly
                              extreme discomfort                                  
                                                                                                                                                            

Heart attack : Blockage in one of the arteries feeding the heart,leading to death of part of the heart muscle                       Pain is very severe in the chest or very high in the abdomen, possibly in the jaw or left shoulder and
                 elbow, sweating