FAQs 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.

 

 

Q- What Is Diabetes Mellitus?

Ans- Diabetes Mellitus

Diabetes is a condition in which the body doesn't produce or properly use insulin or both. This causes sugars to build up too high in your blood.

types of diabetes

Type 1 diabetes usually occurs in children and young adults. In this the pancreas makes little or no insulin.

Type 2 diabetes is the most common form in adults. It develops when the body doesn’t make enough insulin and doesn’t efficiently use the insulin it makes (insulin resistance).

Symptoms

Frequent urination, excessive thirst, extreme hunger ,unusual weight loss, increased fatigue, irritability and blurring of vision.

Q- What Is Malarial Fever?

Ans- Malarial Fever

Malaria is a vector-borne infectious disease caused by protozoan parasites.

Cause

The disease is caused by protozoan parasites of the genus Plasmodium. The most serious forms of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species (Plasmodium ovale, Plasmodium malariae, and sometimes Plasmodium knowlesi) can also infect humans. This group of humanpathogenic Plasmodium species is usually referred to as malaria parasites.

Transmission

·         Malaria parasites are transmitted by female Anopheles mosquitoes.

·         The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death. Infection begins with a bite from an infected mosquito.

·         he parasite travels from the mosquito to your liver, where the parasite begins to reproduce. If another mosquito bites an infected person, that mosquito can then carry the infection to someone else.

 

 

 

Q- What Is Pneumonia?

Ans- Pneumonia

Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi and contracted by breathing in small droplets that contain the organisms that can cause pneumonia. These droplets get into the air when a person infected with these germs coughs or sneezes. People with recent viral infections, lung disease, heart disease, and swallowing problems, as well as alcoholics, drug users, and those who have suffered a stroke or seizure are at higher risk for developing pneumonia than the general population. Once organisms enter the lungs, they usually settle in the air sacs of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus as the body attempts to fight off the infection.

Symptoms

Most people who develop pneumonia initially have symptoms of a cold which are then followed by a high fever (sometimes as high as 104 degrees Fahrenheit), shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody. Patients may become short of breath. Chest pain may develop if the outer aspects of the lung are involved. This pain is usually sharp and worsens when taking a deep breath. At times, the individual's skin color may change and become dusky or purplish (a condition known as "cyanosis") due to their blood being poorly oxygenated. Children and babies who develop pneumonia often do not have any specific signs of a chest infection, but develop a fever, appear quite ill, and can become lethargic. Elderly people may also have few symptoms with pneumonia.

 

 

Q- What Is Tuberculosis (TB)?

Ans- Tuberculosis (TB)

Tuberculosis (TB) is an infectious disease caused by bacteria Mycobacterium tuberculosis. TB most commonly affects the lungs but also can involve almost any organ of the body. Today, tuberculosis usually can be treated successfully. There is also a group of organisms referred to as atypical tuberculosis which do not cause disease and are referred to as "colonizers," because they simply live alongside other bacteria in our bodies without causing damage. At times, these bacteria can cause an infection that sometimes appears as typical tuberculosis.

How does a person get tb?

A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. The bacteria get into the air when someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits (which is common in some cultures). People who are nearby can then possibly breathe the bacteria into their lungs. You don't get TB by just touching the clothes or shaking the hands of someone who is infected. Tuberculosis is spread (transmitted) primarily from person to person by breathing infected air during close contact. There is a form of tuberculosis, however, that is transmitted by drinking unpasteurized milk caused by Mycobacterium bovis. Previously, this bacterium was a major cause of TB in children, but it rarely causes TB now since most milk is pasteurized (a heating process that kills the bacteria).

 

 

Q- What Is Typhoid (Enteric) Fever?

Ans- Typhoid (Enteric) Fever

Typhoid Fever is an acute illness associated with diarrhea, systemic disease, fever and rash caused by the Salmonellae typhi bacteria.

Causes

·         Typhoid Fever is contracted by the ingestion of the bacteria in contaminated food or water. Patients with acute illness can contaminate the surrounding water supply through the stool, which contains a high concentration of the bacteria. The bacteria multiply in the gallbladder, bile ducts, or liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewage. Following ingestion, the bacteria spread from the intestine via the bloodstream to the intestinal lymph nodes, liver, and spleen via the blood where they multiply.

·         Salmonella may directly infect the gallbladder through the hepatic duct or spread to other areas of the body through the bloodstream.

·         A few people can become carriers of S. typhi and continue to shed the bacteria in their feces

Symptoms

·         The incubation period is usually 1-2 weeks and the duration of the illness is about 4-6 weeks.

·         Early symptoms are generalized and include fever, malaise and abdominal pain. As the disease progresses, the fever becomes higher (greater than 103 degrees Fahrenheit), and diarrhea becomes prominent. Weakness, profound fatigue, delirium, and an acutely ill appearance develop.

·         A rash, characteristic only of typhoid and called "rose spots," appears in some cases of typhoid. Rose spots are small (1/4 inch) red spots that appear most often on the abdomen and chest.Chest congestion, abdominal pain and discomfort are common. The fever becomes constant.

·         Improvement occurs in the third and fourth week in those without complications. There is a chance of recurrent symptoms (relapse) after feeling better for one to two weeks. Relapses are actually more common in individuals treated with antibiotics.Typically, children have milder disease and fewer complications than adults.