Govand S.

Jawher
1
 Contents
Section 1…….3
Section 2…….10
Section 3…….15
Section 4…….20
Section 5…….30
Section 6…….37
Section 7…….40
Section 8…….44
Section 9…….49
Section 10…...53
Section 11……61
Section 12…..68
Section 13…..73
Section 14…..81
Section 15…..89

2
3
ABDOMINAL PAIN
SECTION ONE

-major organ situated in the abdominal region

include:

• Small intestine
• Large intestine
• Gallbladder
• Kidneys
• Appendix
• Spleen
• Stomach
• Pancreas
• Liver
If those organs are affected by inflammation or diseases
, result in abdominal pain ( stomache). Also, viral ,
bacterial , or parasite infection may also cause abdominal
pain, when they affect stomach and intestines.
Abdominal pain can be crampy , achy , dull , intermittent
or sharp.

What causes abdominal pain?

Abdominal pain can occur by many conditions.

Nevertheless, the main causes are infections , abnormal
4
growth , inflammation , obstruction , intestinal
disorders.

Abdominal pain can be caused by bacteria , when it

comes from throat , intestines and blood. These
infections can change in digestion , such as diarrhea or
constipation.

Other common cause of abdominal pain , include:

• Constipation
• Diarrhea
• Acid reflux
• Vomiting
• Stress
• Gastroenteritis ( stomach flu)

Diseases that cause chronic abdominal pain , include:

• Gastroesophageal reflux disease (GERD):-is a

digestive disorder that occurs when acidic
stomach juices , or food and fluids back up from
the stomach into esophagus.
• Irritable bowel syndrome:- is a group of
symptoms-including abdominal pain and
changes in the pattern of bowel movements
without any evidence of underlying damage
• Crohn’s disease:-is an inflammatory bowel
disease. It causes inflammation of digestive tract
, which can lead to abdominal pain , severe
diarrhea ,fatigue , weight loss and malnutrition

5
 • Lactose intolerance:- is common digestive
problem where the body is unable to digest
lactose , a type of sugar mainly found in milk
and dairy products

Cause of severe abdominal pain , include:

• Organ rupture or near rupture
• Gallbladder stones ( gallstone)
• Kidney stones
• Kidney infection

Types of abdominal pain

Abdominal pain can be described as localized , cramp-

like , or colicky

Localized pain:- is limited to one area of abdomen. The

most common cause of localized pain id stomach ulcer.

Cramp-like pain:- may be associated with diarrhea ,

constipation , bloating or flatulence. In women, it can be
associated with menstruation , miscarriage or
complication in the female reproductive system.
Colicky pain:- is a symptom of ore severe conditions ,
such as gallstones or kidney stones. This pain occurs
suddenly and may feel like a severe muscle spasm.

Location of pain within the abdomen

Pain that is generalized throughout the abdomen

6
 • Appendicitis
• Crohn’s disease
• Traumatic injuru
• Irritable bowel syndrome
• Urinary tract infection
• The flu

Pain that is focused in lower abdomen

• Appendicitis
• Intestinal obstruction
• ectopic pregnancy

in women, pain in the reproductive organs of the lower

abdomen
• severe menstrual pain ( dysmenorrheal)
• ovarian cysts
• miscarriage
• fibroids
• endometriosis
• pelvic inflammatory disease
• ectopic pregnancy

upper abdominal pain

• gallstones
• heart attack
• hepatitis
• pneumonia

7
pain in the centre of abdomen
• appendicitis NOTE:
Gastroenteritis, also known as
• gastroenteritis infectious diarrhea, is inflammation
of the gastrointestinal tract—the

• injury stomach and small intestine

• uremia

lower left abdominal pain

• crohn’s disease
• cancer
• kidney infection
• ovarian cyst
• appendicitis

upper left abdominal pain

• enlarged spleen
NOTE:
• fecal impaction Fecal impaction is a

• injury severe bowel condition in which a

hard, dry mass of stoolbecomes

• kidney infection
stuck in the colon or rectum

• heart attack
• cancer

lower right abdominal pain

• appendicitis
NOTE:
• hernia A hernia is the abnormal exit of

• kidney infection
tissue or an organ, such as the
bowel, through the wall of the

• cancer
cavity in which it normally resides.

• flu

8
 upper right abdominal pain
NOTE: • hepatitis
Pneumonia is an infection in one or
both lungs. Bacteria, viruses, and • injury
fungi cause it. The infection causes
inflammation in the air sacs in your • pneumonia
lungs, which are called alveoli. The
alveoli fill with fluid or pus, making it • appendicitis
difficult to breathe

Treatment of abdominal pain

medication that are used for the treatment of underlying

cause(S) of the pain are the medications of choice.
Medications are not needed for gastroenteritis , while
surgery and / or chemotherapy may be the best
approach to treat certain cancer other causes may
require

antispasmodics , anti-microbial , H2-blocker , or even

nitrates or morphine.

A few causes can only be treated by surgery , such as

incarcerated hernia , abdominal adhesion from previous
surgeries and certain abdominal injuries

9
10
ALTERED LEVEL OF CONSCIOUSNESS
SECTION TWO

Altered level of consciousness ( ALOC) means that you

are not awake , alert , or able to understand or react as
you are normally. ALOC can be caused by a head injury ,
medicines , alcohol or drugs , dehydration or some
diseases , such as diabetes.

Different levels of ALOS

Confusion:- marked by the absence of the clear thinking

and may result in poor decision-making.

Disorientation:- inability to understand how you relate to

people , place , objects , and time

Delirium:- thoughts are confused and illogical. People

who are delirious are often disoriented.

Lethargic:- means you are drowsy and less aware or less

interested in your surroundings.

Stupor:- deeper level of impaired consciousness in which

it is difficult for you to respond to the stimulus , except
for pain.

11
Coma:- deepest level of the impaired consciousness. You
are unable to respond to he stimulus , not even pain.

Symptoms of decreased consciousness

• seizures
• loss of bowel or bladder function
• falling
• lightheadedness
• low blood pressure
• difficulty walking
• irregular heartbeat
• sweating
• poor balance
• fainting
• rapid pulse
• fever
• loss
• weakness in the face , arms , or legs

common underlying causes decreased consciousness

common causes , include:

• drugs
• alcohol
• epilepsy
• stroke
• substance abuse
• certain medications
• low blood sugar
• low of oxygen to the brain
12
 other underlying causes , include:
• cerebral hemorrhage
• dementia
• head trauma
• brain tumor
• heart disease
• heart stroke
• liver diseases
• uremia
• shock

what to expect when you see the doctor?

Diagnosis and treatment of decreased consciousness

starts with a complete medical history and physical
examination.

In addition to your complete history and physical , the

doctor may order to the following test:

• Compete blood count (CBC):- is a blood

test used to evaluate your overall health and
detect a wide range of disorders, including
anemia, infection and leukemia. A complete
blood count test measures several components
and features of your blood, including:
Red blood cells, which carry oxygen
• Toxicology screen:- is a test that determines
the approximate amount and type of legal or
illegal drugs that you've taken. It may be used
13
 to screen for drug abuse, to monitor a substance
abuse problem, or to evaluate drug intoxication
or overdose.
• Electrolyte panel:- is a blood test that
measures levels of the body's main electrolytes:
Sodium, which helps control the amount of fluid
of
in the body. It also helps your nerves and
muscles work properly. Chloride, which also
helps control the amount of fluid in the body.
• Liver function test:- are groups of blood
tests that provide information about the state of
a patient's liver. These tests include
prothrombin time (PT/INR), activated Partial
Thromboplastin Time (aPTT), albumin, bilirubin
(direct and indirect), and others.
• electroencephalogram (EEG)
• electrocardiogram ( EKG)
• chest X-ray
• CT scan of the head
• MRI of the head

Treatment of decreased consciousness

Treatment is selected due to the level of decrease in

consciousness and its underlying causes. Initial treatment
often includes the administration of dextrose , if the
blood sugar is low as well as the administration of oxygen
, naloxone and thiamine.

14
15
 BACK PAIN
SECTION THREE

Back pain can be uncomfortable and debilitating.

Back pain can affect people of any ages due to different

causes. As we get older , the risk of being affected by
back pain increases. Because of previous occupation and
degenerative disc diseases

Lower back pain may be related to the bony lumbar

spine , discs between the vertebrae , ligaments around
the spine and discs , spinal cord and nerves , lower back
pain muscle , abdominal and pelvic , internal organs , and
the skin around the lumbar area.

Pain in the upper back may be due to disorder of the

aorta , tumors in the chest , and spine inflammation.

Causes

 Strain
NOTE:
• Strained muscle and ligaments Strain is An injury to a tendon or

•
muscle (stretch or tear)
A muscle spasm resulting from overuse or trauma.

• Muscle tension
• Damaged discs
16
 • Injuries , fractures , or falling
 Activities that can lead to strain, include:
• Lifting something improperly
• Lifting something that is too heavy
• Making an abrupt and awkward
movement

 Structural problems
• Ruptured discs:- if the disc ruptures ,
there will be more pressure on a nerve.
• Bulging discs:- bulging discs put more
pressure on nerve
• Sciatica :- a sharp and shooting pain
travels through buttock and down the
back of the leg. Resulted from bulging
or herniated disc pressing on nerve
• Arthritis :- osteoarthritis causes a
spinal stenosis, which is a narrowing of
the space around the spine , which can
put pressure on the nerves.
• Abnormal curvature of the spine
• Osteoporosis:- vertebrae become
brittle and porous making compression
• Kidney problems

 Movements and posture

• Twisting
• Coughing and sneezing
• Over-stretching
17
 • Bending awkwardly or for a long period

 Other causes NOTE:

• Cauda equina syndrome Cauda equina syndrome (CES) is a
condition that occurs when the

• Cancer of the spine bundle of nerves below the end of

the spinal cord known as the cauda

• Infection of the spine

equina is damaged

• Other infection:- pelvic inflammatory

Shingles is a viral infection that
causes a painful rash.
Although shingles can occur
disease , bladder or kidney infection anywhere on your body, it most
often appears as a single stripe of
• Sleep disorder blisters that wraps around either the
left or the right side of your torso.
• Shingles

Risk factors

The following factors are under higher risk of developing

back pain

1. Occupational activities
2. Pregnancy
3. A sedentary lifestyle
4. Poor physical fitness
5. Older ages
6. Obesity
7. Smoking

Diagnosis

A doctor will usually able to diagnose back pain after

medical history and physical examinations. The doctor

18
 may order and X-ray, MRI, CT, to obtain more
information and be acquainted with the causes

Other types of diagnosis

1. A chiropractor
2. An osteopath
3. A physical therapist

Treatment

Back pain usually doesn’t need a treatment for cure. It

only needs a rest and home remedies. But sometimes
medical treatment is necessary

Home treatment

Over the counter (OTC) pain relief medications are

optimum options , usually Non-steroidal anti-
inflammatory drugs (NSAIDs) , such as Ibuprofen.
However, we can apply a hot compress or an ice-pack to
relieve the pain.

Medical treatment

If home treatment don’t suffice, a doctor may

NOTE:
Hydrocodone is an antitussive recommend the following medication:-
(cough suppressant) and
narcotic analgesic agent for
the treatment of moderate pain
 Prescription NSAIDs
Amitriptyline is a tricyclic
antidepressant. Amitriptyline  Narcotics ( Codeine or Hydrocodone)
 Anti-depressants ( Amitriptyline)
affects chemicals in the brain
that may be unbalanced in
people with
depression. Amitriptyline is
used to treat symptoms of
depression 19
20
CHEST PAIN
SECTION FOUR

Chest pain appears in many forms, ranging from a sharp

stab to a dull ache. Sometimes chest pain feels crushing
or burning. In serious cases, the pain travels up the neck,
into the jaw, and then radiates to the back or down one
or both arms.

Many different factors can cause chest pain. The most

life-threatening causes involve the heart or lungs.
Because chest pain can indicate a serious problem, it's
important to seek immediate medical help.

Heart-related chest pain

Although chest pain is often related to heart disease,

many people with heart disease say they experience a
vague discomfort that isn't necessarily identified as pain.
In general, chest discomfort related to a heart attack or
another heart problem may be described by or
associated with one or more of the following:

• Pressure, fullness, burning or tightness in your

chest

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 • Crushing or searing pain that radiates to your
back, neck, jaw, shoulders, and one or both
arms

• Pain that lasts more than a few minutes, gets

worse with activity, goes away and comes back,
or varies in intensity

• Shortness of breath

• Cold sweats

• Dizziness or weakness

• Nausea or vomiting

Other types of chest pain

It can be difficult to differentiate heart-related chest

pain from other types of chest pain. Nevertheless , chest
pain that is less likely result from a heart problem is
more often associated with:

• A sour taste or a sensation of food re-entering

your mouth

• Trouble swallowing

• Pain that gets better or worse when you change

your body position

• Pain that intensifies when you breathe deeply or

cough

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 • Tenderness when you push on your chest

• Pain that is persistently present for many hours

The classic symptoms of heartburn — a painful, burning

sensation behind your breastbone — can be caused by
problems with your heart or your stomach.

Causes

Heart-related causes
Examples of heart-related causes of chest pain include:
• Heart attack. A heart attack results from
blockage of blood flow, often from a blood clot,
to your heart muscle.
• Angina. Angina is the term for chest pain caused
by insufficient blood flow to the heart. This is
often caused by the buildup of thick plaques on
the inner walls of the arteries that carry blood
to your heart. These plaques narrow the arteries
and restrict the heart's blood supply, particularly
during exertion.

• Aortic dissection. This life-threatening condition

involves the main artery leading from your heart
(aorta). If the inner layers of this blood vessel
isolate , blood is forced between the layers and
can cause the aorta to rupture.

• Pericarditis. This is the inflammation of the sac

surrounding your heart. It usually causes sharp

23
 pain that gets worse when you breathe in or
when you lie down.

Digestive causes
Chest pain can be caused by disorders of the digestive
system, including:
• Heartburn. This painful, burning sensation in
your chest or throat occurs when stomach acid
backs up into your esophagus
• Swallowing disorders. Disorders of the
esophagus can make swallowing difficult and
even painful.

• Gallbladder or pancreas problems. Gallstones

or inflammation of your gallbladder or pancreas
can cause abdominal pain that radiates to your
chest.

Muscle and bone causes

Some sorts of chest pain are associated with injuries and

other problems affecting the structures that make up the
chest wall, including:

• Costochondritis. Is an inflammation of the

junctions where the upper ribs join with the
cartilage that holds them to the breastbone , or
sternum.

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 • Sore muscles. Chronic pain syndromes, such as
fibromyalgia, can produce persistent muscle-
related chest pain.

• Injured ribs. A bruised or broken rib can cause

chest pain.

Lung-related causes

Many lung disorders can cause chest pain,

including:

• Pulmonary embolism(PE):- is a sudden

blockage in a lung artery. It usually happens
when a blood clot breaks loose and travels
through the bloodstream

• Pleurisy. Is due to inflammation of the pleura

next to lung. It is most often caused by infection
a germ ( a viral infection ).

• Collapsed lung. The chest pain associated

with a collapsed lung typically starts suddenly
and can last for hours, and is generally
associated with shortness of breath (SOB). A
collapsed lung occurs when air leaks into the
space between the lung and the ribs.

25
• Pulmonary hypertension. This condition
occurs when you have high blood pressure in
the arteries carrying blood to the lungs, which
can produce chest pain.

Diagnosis

Chest pain doesn't always signal a heart attack. But that's

what emergency room doctors will test for first because
it's potentially the most immediate threat to your life.
They may also check for life-threatening lung conditions
— such as a collapsed lung or a clot in your lung.

Immediate tests

Some of the first tests your doctor may order include:

• Electrocardiogram (ECG). This test records the

electrical activity of your heart through
electrodes attached to your skin. Because
injured heart muscle doesn't conduct electrical
impulses normally, the ECG may show that you
have had or are having a heart attack.

• Blood tests. Your doctor may order blood tests

to check for increased levels of certain proteins
or enzymes normally found in heart muscle.
Damage to heart cells from a heart attack may
allow these proteins or enzymes to leak, over a
period of hours, into your blood.
26
 • Chest X-ray. An X-ray of your chest allows
doctors to check the condition of your lungs and
the size and shape of your heart and major
blood vessels. A chest X-ray can also reveal lung
problems such as pneumonia or a collapsed
lung.

• Computerized tomography (CT scan). CT scans

can spot a blood clot in your lung (pulmonary
embolism) or make sure you're not having aortic
dissection

Treatment

Treatment varies depending on what's causing your chest

pain.

Medications

Drugs used to treat some of the most common causes of

chest pain include:

• Artery relaxers. Nitroglycerin — usually taken as

a tablet under the tongue — relaxes heart
arteries, so blood can flow more easily through
the narrowed spaces. Some blood pressure
medicines also relax and widen blood vessels.

• Aspirin. If doctors suspect that your chest pain

is related to your heart, you'll likely be given
aspirin.
27
 • Thrombolytic drugs. If you are having a heart
attack, you may receive these clot-busting
drugs. These work to dissolve the clot that is
blocking blood from reaching your heart muscle.

• Blood thinners. If you have a clot in an artery

feeding your heart or lungs, you'll be given
drugs that inhibit blood clotting to prevent the
formation of more clots.

• Acid-suppressing medications. If your chest

pain is caused by stomach acid splashing into
your esophagus, the doctor may suggest
medications that reduce the amount of acid in
your stomach.

• Antidepressants. If you're experiencing panic

attacks, your doctor may prescribe
antidepressants to help control your symptoms.
Psychological therapy, such as cognitive
behavioral therapy, also might be
recommended

Surgical and other procedures

Procedures to treat some of the most dangerous causes

of chest pain include:

• Angioplasty and stent placement. If your chest

pain is caused by a blockage in an artery feeding

28
 your heart, your doctor will insert a catheter
with a balloon on the end into a large blood
vessel in your groin, and thread it up to the
blockage. Your doctor will inflate the balloon tip
to widen the artery, then deflate and remove
the catheter. In most cases, a small wire mesh
tube (stent) is placed on the outside of the
balloon tip of the catheter. When expanded, the
stent locks into place to keep the artery open.

• Bypass surgery. During this procedure, surgeons

take a blood vessel from another part of your
body and use it to create an alternative route
for blood to go around the blocked artery.

• Dissection repair. You may need emergency

surgery to repair an aortic dissection — a life-
threatening condition in which the artery that
carries blood from your heart to the rest of your
body ruptures.

• Lung reinflation. If you have a collapsed lung,

doctors may insert a tube in your chest to
reinflate the lung.

29
30
CONSTIPATION
SECTION FIVE

Constipation occurs when bowel movements become

less frequent and stools become difficult to pass. It
happens most often due to changes in diet or routine, or
due to inadequate intake of fiber.

Can constipation cause internal damage or lead to other

health problems?
There are a few complications that could happen if you
don’t have soft, regular bowel movements. Some
complications include:
• Swollen, inflamed veins in your rectum (a
condition called hemorrhoids).
• Tears in the lining of your anus from hardened
stool trying to pass through (called anal
fissures).
• An infection in pouches that sometimes form off
the colon wall from stool that has become
trapped and infected (a condition
called diverticulitis)
• A pile-up of too much stool/poop in the rectum
and anus (a condition called fecal impaction).
• Damage to your pelvic floor muscles from
straining to move your bowels. These muscles
help control your bladder. Too much staining for
31
 too long a period of time may cause urine to
leak from the bladder (a condition called stress
urinary incontinence).

Causes

Constipation most commonly occurs when waste or stool

moves too slowly through the digestive tract or cannot
be eliminated effectively from the rectum, which may
cause the stool to become hard and dry. Chronic
constipation has many possible causes.

Blockages in the colon or rectum

Blockages in the colon or rectum may slow or stop stool
movement. Causes include:
• Tiny tears in the skin around the anus (anal
fissure)
• A blockage in the intestines (bowel obstruction)
• Colon cancer
• Narrowing of the colon (bowel stricture)
• Other abdominal cancer that presses on the
colon
• Rectal cancer
• Rectum bulge through the back wall of the
vagina (rectocele)

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause

muscles in the colon and rectum to contract and move
stool through the intestines. Causes include:

32
 • Damage to the nerves that control bodily
NOTE: functions (autonomic neuropathy)
Multiple sclerosis (MS) is a potentially
disabling disease of the brain and spinal
cord (central nervous system). In MS ,
• Multiple sclerosis
• Parkinson's disease
the immune system attacks the
protective sheath (myelin) that covers
nerve fibers and causes communication
problems between your brain and the • Spinal cord injury
rest of your body.
• Stroke
Parkinson's disease is a progressive
nervous system disorder that affects
movement. Symptoms start gradually,
sometimes starting with a barely
noticeable tremor in just one hand. Difficulty with the muscles involved in elimination
Problems with the pelvic muscles involved in having a
Tremors are common, but the disorder
also commonly causes stiffness or

bowel movement may cause chronic constipation. These

slowing of movement

problems may include:

• The inability to relax the pelvic muscles to allow

for a bowel movement (anismus)
• Pelvic muscles that don't coordinate relaxation
and contraction correctly (dyssynergia)
• Weakened pelvic muscles
•
Conditions that affect hormones in the body
Hormones help balance fluids in your body. Diseases and
conditions that upset the balance of hormones may lead
to constipation, including:

• Diabetes
• Overactive parathyroid gland
(hyperparathyroidism)
• Pregnancy
• Underactive thyroid (hypothyroidism)

Prevention

33
The following can help you avoid developing chronic
constipation.

• Include plenty of high-fiber foods in your diet,

including beans, vegetables, fruits, whole grain
cereals and bran.
• Eat fewer foods with low amounts of fiber such
as processed foods, and dairy and meat
products.
• Drink plenty of fluids.
• Stay as active as possible and try to get regular
exercise.
• Try to manage stress.
• Don't ignore the urge to pass stool.
• Try to create a regular schedule for bowel
movements, especially after a meal.
• Make sure children who begin to eat solid foods
get plenty of fiber in their diets

Treatment

Treatment for chronic constipation usually begins with

diet and lifestyle changes meant to increase the speed at
which stool moves through your intestines. If those
changes don't help, your doctor may recommend
medications or surgery.

Diet and lifestyle changes

Your doctor may recommend the following changes to

relieve your constipation:

34
 • Increase your fiber intake. Adding fiber to your
diet increases the weight of your stool and
speeds its passage through your intestines.
Slowly begin to eat more fresh fruits and
vegetables each day. Choose whole-grain breads
and cereals.

Your doctor may recommend a specific number of grams

of fiber to consume each day. In general, aim for 14
grams of fiber for every 1,000 calories in your daily diet.

A sudden increase in the amount of fiber you eat can

cause bloating and gas, so start slowly and work your
way up to your goal over a few weeks.

• Exercise most days of the week. Physical

activity increases muscle activity in your
intestines. Try to fit in exercise most days of the
week. If you do not already exercise, talk to your
doctor about whether you are healthy enough
to start an exercise program.
• Don't ignore the urge to have a bowel
movement. Take your time in the bathroom,
allowing yourself enough time to have a bowel
movement without distractions and without
feeling rushed.
Laxatives
Several types of laxatives exist. Each works somewhat
differently to make it easier to have a bowel movement.
The following are available over the counter:

• Fiber supplements. Fiber supplements add bulk

to your stool. Bulky stools are softer and easier

35
 to pass. Fiber supplements include psyllium
(Metamucil, Konsyl, others), calcium
polycarbophil (FiberCon, Equalactin, others) and
methylcellulose (Citrucel).

• Stimulants. Stimulants including bisacodyl

(Correctol, Dulcolax, others) and sennosides
(Senokot, Ex-Lax, Perdiem) cause your intestines
to contract.

• Osmotics. Osmotic laxatives help stool move

through the colon by increasing secretion of
fluid from the intestines and helping to
stimulate bowel movements. Examples include
oral magnesium hydroxide (Phillips' Milk of
Magnesia, Dulcolax Milk of Magnesia, others),
magnesium citrate, lactulose (Cholac, Constilac,
others), polyethylene glycol (Miralax, Glycolax).

• Lubricants. Lubricants such as mineral oil enable

stool to move through your colon more easily.

• Stool softeners. Stool softeners such as

docusate sodium (Colace) and docusate calcium
(Surfak) moisten the stool by drawing water
from the intestines.

• Enemas and suppositories. Tap water enemas

with or without soapsuds can be useful to
soften stool and produce a bowel movement.
Glycerin or bisacodyl suppositories also aid in
moving stool out of the body by providing
lubrication and stimulation.

36
37
 DIARRHEA
SECTION SIX

Diarrhea is loose, watery stools (bowel movements). You

have diarrhea if you have loose stools three or more
times in one day. Acute diarrhea is diarrhea that lasts a
short time. It is a common problem. It usually lasts about
one or two days, but it may last longer. Then it goes away
on its own.

What causes diarrhea?

The most common causes of diarrhea include

• Bacteria from contaminated food or water NOTE:

• Viruses such as the flu, norovirus, or rotavirus .
Rotavirus is the most common cause of acute Norovirus is a very contagious
virus that causes vomiting and

diarrhea in children. diarrhea. Anyone can get infected

and sick with norovirus.

• Parasites, which are tiny organisms found in

Rotavirus commonly causes
contaminated food or water severe, watery diarrhea and
vomiting in infants and young
• Medicines such as antibiotics, cancer drugs, and children. Children may become
dehydrated and need to be
antacids that contain magnesium hospitalized and can even die.
Protect your child with
• Food intolerances and sensitivities, which are rotavirus vaccine.

problems digesting certain ingredients or foods.

An example is lactose intolerance.

38
 • Diseases that affect the stomach, small
intestine, or colon, such as Crohn's disease
• Problems with how the colon functions, such
as irritable bowel syndrome

What are the treatments for diarrhea?

Diarrhea is treated by replacing lost fluids and

electrolytes to prevent dehydration. Depending on the
cause of the problem, you may need medicines to stop
the diarrhea or treat an infection.

Adults with diarrhea should drink water, fruit juices,

sports drinks, sodas without caffeine, and salty broths. As
your symptoms improve, you can eat soft, bland food.

Children with diarrhea should be given oral rehydration

solutions to replace lost fluids and electrolytes.

39
40
DIZZINESS
SECTION SEVEN

Dizziness is the feeling of being lightheaded, woozy, or

unbalanced. It affects the sensory organs, specifically the
eyes and ears, so it can sometimes cause fainting.
Dizziness isn’t a disease, but rather a symptom of various
disorders.

Causes of dizziness

Common causes of dizziness include a migraine,

medications, and alcohol. It can also be caused by a
problem in the inner ear, where balance is regulated.

Dizziness is often a result of vertigo as well. The most

common cause of vertigo and vertigo-related dizziness
is benign positional vertigo (BPV). This causes short-term
dizziness when someone changes positions quickly, such
as sitting up in bed after lying down.

Dizziness and vertigo can also be triggered by Meniere’s

disease. This causes fluid to build up in the ear with
associated ear fullness, hearing loss, and tinnitus.
Another possible cause for dizziness and vertigo is an
acoustic neuroma. This is a noncancerous tumor that
forms on the nerve that connects the inner ear to the
brain.
41
Some other possible causes of dizziness include:

• sudden drop in blood pressure

• heart muscle disease
• decrease in blood volume
• anxiety disorders
• anemia (low iron)
• hypoglycemia (low blood sugar)

Symptoms of dizziness

People experiencing dizziness may feel various

sensations, including:

• lightheadedness or feeling faint

• a false sense of spinning
• unsteadiness
• loss of balance
• feeling of floating or swimming
Sometimes, dizziness is accompanied by nausea,
vomiting, or fainting. Seek emergency medical help if you
have these symptoms for extended periods.

Treatments for dizziness

Treatment for dizziness focuses on the underlying cause.

In most cases, home remedies and medical treatments
can control the cause of dizziness. For example:

• Inner-ear issues may be managed

with medications and at-home exercises that
can help control balance.

42
 • BPV can be resolved with maneuvers that can
NOTE: help alleviate symptoms. Surgery is an option
Meniere's disease is a disorder
of the inner ear that can lead to
dizzy spells (vertigo) and
for patients whose BPV is not otherwise
hearing loss. In most
cases, Meniere's
controlled.
• Meniere’s disease is treated with a healthful
diseaseaffects only one ear

low-salt diet, occasional injections, or ear

A migraine can cause severe
throbbing pain or a pulsing
sensation, usually on one side
of the head. It's often
accompanied by nausea,
vomiting, and extreme
sensitivity to light and sound
surgery.
• Migraines are treated with medications and
lifestyle changes, such as learning to identify
and avoid migraine triggers.
• Medication and anxiety-reducing techniques can
help with anxiety disorders.
• Drinking plenty of fluids can help when dizziness
is caused by excessive exercise, heat, or
dehydration.

43
44
DYSPNEA
SECTION EIGHT

If you’ve ever felt you couldn’t breathe in enough air,

you’ve experienced a condition known medically as
dyspnea. Shortness of breath can be a symptom of
health problems, often related to heart or lung disease.
But you can also experience temporary dyspnea after an
intense workout.

Symptoms

The main symptom of dyspnea is labored breathing. It

may last for a minute or two after strenuous activity. Or
it could be a chronic problem. You may have the
sensation of just not getting quite enough air into your
lungs all the time. In serious cases, you may feel as
though you’re suffocating. Bouts of dyspnea may also
bring on chest tightness.

Dyspnea that occurs after strenuous exercise is

understandable. However, seek medical attention if any
of the following occurs:

• You’re short of breath sooner than you used to

be after physical activity.

45
 • You’re breathless after activity that you used to
handle without a problem.
• You start to experience dyspnea without any
explanation.

Causes

If you’ve ever run or swam a race, you know that it may

take a few minutes to catch your breath. You may have
trouble breathing in enough oxygen to meet your body’s
increased demand. If you’re healthy, your breathing will
ease soon. You’ll be breathing normally within a few
minutes.

Exercise is usually a trigger for short-term dyspnea. If

you’re at a higher elevation and you’re not used to
having less oxygen available, you may also experience
temporary dyspnea. At extremely high elevations, such
as mountaintops, the “thinner” air can be a real health
hazard. Be sure to consult with a climbing expert before
making an ambitious high-elevation trek.

Dyspnea caused by medical conditions covers a wide

range of health concerns. While they should all be
evaluated by a doctor, conditions that bring on sudden
breathlessness should be treated as emergencies. These
include:

• heart failure
• low blood pressure
• pneumonia

46
 • pulmonary embolism (a blood clot in the lungs)

• carbon monoxide poisoning

• stress or anxiety

Treatment options

Treating dyspnea usually means treating its

underlying cause.

Diet and exercise

If obesity and a poor fitness level are the cause of

dyspnea you may be experiencing, eat healthier
meals and exercise frequently. If it’s been a long
time or you have a medical condition that limits your
activity level, talk with your doctor about how to
begin a safe exercise routine.

Pulmonary rehabilitation

COPD and other lung problems require the care of a

pulmonologist, a doctor who specializes in the
health of your lungs and respiratory system. You
may need supplemental oxygen in a portable tank to
help keep you from feeling out of breath. Pulmonary
rehabilitation may also be helpful. This is a program
of supervised exercise and education about
breathing techniques to help you overcome lung
disease.

Cardiac rehabilitation

47
 Heart-related causes are treated by a cardiologist, a
doctor specializing in heart disorders. If you have
heart failure, it means your heart is too weak to
pump enough oxygenated blood to meet your
body’s requirements. Dyspnea is one of several
symptoms of heart failure. Cardiac rehabilitation can
help you manage heart failure and other heart-
related conditions. In serious cases of heart failure,
an artificial pump may be needed to take over the
blood pumping duties of a weakened heart.

48
49
 FEVER
SECTION NINE

Fever is also known as hyperthermia, pyrexia, or

elevated temperature. It describes a body
temperature that’s higher than normal. Fever can
affect children and adults.

A short-term increase in body temperature can help

your body fight off illness. However, a severe fever
can be a symptom of a serious condition that
requires immediate medical attention.

What usually causes a fever?

Fever occurs when a part of the brain called

the hypothalamus shifts the set point of your normal
body temperature upward. When this happens, you
may feel chilled and add layers of clothing, or you
may start shivering to generate more body heat. This
eventually results in a higher body temperature.

There are numerous different conditions that can

trigger a fever. Some possible causes include:

• infections, including the flu and pneumonia

50
 • some immunizations, such as diphtheria or
NOTE:
Diphtheria is an infection caused tetanus (in children)
• teething (in infants)
by the bacterium Corynebacterium
diphtheriae.Diphtheria causes a
thick covering in the back of the
throat • some inflammatory diseases,
Tetanus, also called lockjaw, is a
serious infection caused by
including rheumatoid arthritis (RA) and Crohn’s
Clostridium tetani. This bacterium
produces a toxin that affects the
disease
brain and nervous system, leading
to stiffness in the muscles.
• blood clots
• extreme sunburn
• food poisoning
• some medications, including antibiotics

Depending on the cause of the fever, additional

symptoms may include:
• sweating
• shivering
• headache
• muscle aches
• loss of appetite
• dehydration
• general weakness

How to treat a fever at home

Care for a fever depends on its severity. A low-grade

fever with no other symptoms doesn’t typically
require medical treatment. Drinking fluids and
resting in bed are usually enough to fight off a fever.

51
 When a fever is accompanied by mild symptoms,
such as general discomfort or dehydration, it can be
helpful to treat elevated body temperature by:

• making sure the room temperature where the

person is resting is comfortable
• taking a regular bath or a sponge bath using
lukewarm water
• taking acetaminophen (Tylenol) or ibuprofen
(Advil)
• drinking plenty of fluids

52
53
 HEADACHE
SECTION TEN

A headache is a very common condition that causes

pain and discomfort in the head, scalp, or neck. It’s
estimated that 7 in 10 people have at least one
headache each year.

Headaches can sometimes be mild, but in many

cases, they can cause severe pain that makes it
difficult to concentrate at work and perform other
daily activities. In fact, approximately 45
million Americans frequently have severe headaches
that can be disabling. Luckily, most headaches can
be managed with medication and lifestyle changes.

Primary causes of headaches

Doctors have identified several different causes of

headaches.

Primary causes of headaches are causes that aren’t

related to separate medical conditions. These
headaches are the result of an underlying process in
the brain. Examples of common primary headaches
include migraine, cluster, and tension headaches.

54
 Secondary causes of headaches

Secondary headaches are those that are due to an

underlying medical condition. Examples of secondary
headache causes include:

Brain tumor or brain aneurysm

The presence of a brain tumor or brain

NOTE:
An aneurysm refers to a weakening of
aneurysm (brain bleed) can lead to headache. This is
an artery wall that creates a bulge, or
distention, of the artery. because there is only so much room in the skull.
When the skull starts to build up with blood or extra
Most aneurysms do not show
symptoms and are not dangerous.

tissue, the compression on the brain can cause a

However, at their most severe stage,
some can rupture, leading to life-
threatening internal bleeding.
headache.

Cervicogenic headaches

Cervicogenic headaches occur when discs start to

degenerate and press on the spinal column. The
result can be significant neck pain as well as
headaches.

Medication overuse headaches

If a person takes a significant amount of pain

medications daily and starts to taper them or
discontinue them altogether, a headache can result.
Examples of these medications include
hydrocodone.

Meningitis-related headache

Meningitis is an infection of the meninges, which are

the membranes that line the skull and enclose the
spinal cord and brain.
55
 Post-traumatic headache

Sometimes a person will experience headaches after

trauma to the head, sustained during an event like a
fall, car accident, or skiing accident.

Sinus headaches

Inflammation in the normally air-filled sinus cavities

in the face can cause pressure and pain that leads to
a sinus headache.

Spinal headache

A spinal headache can occur due to a slow leak of

cerebrospinal fluid, usually after a person has an
epidural, spinal tap, or spinal block for anesthesia.

Headache types

Several different headache types exist. Examples of

these headache types include:

Tension headaches

Tension headaches are the most common type of

headache and occur most frequently in women over
age 20. These headaches are often described as
feeling like a tight band around the head. They are
caused by a tightening of the muscles in the neck
and scalp. Poor posture and stress are contributing
factors.

56
Tension headaches usually last for several minutes,
but in some cases, they can last for several days.
They also tend to be recurrent.

Cluster headaches

Cluster headaches are non-throbbing headaches that

cause excruciating, burning pain on one side of the
head or behind the eye. They usually cause the eyes
to tear up and produce nasal congestion or
rhinorrhea (runny nose). These headaches can last
for extended periods of time, known as the cluster
period. The cluster period can be as long as six
weeks.

Cluster headaches may occur every day and more

than once a day. The cause is unknown; however,
this type headache is rare and generally affects men
age 20 to 40.

Migraine headaches

Migraine headaches are severe headaches that can

cause throbbing, pounding pain, usually on one side
of the head. Several different types of migraine
headache exist. This includes chronic migraines,
which are migraines that occur 15 or more days a
month.

Hemiplegic migraines are those with symptoms

resembling that of a stroke. A person can even
experience migraines without head pain, which
means they have migraine symptoms such as

57
 nausea, visual disturbances, and dizziness, but
without head pain.

Rebound headaches

Rebound headaches are those that occur after a

person stops taking medications they used regularly
to treat headaches. A person is more likely to
experience rebound headaches if they take
medications such as acetaminophen, triptans
(Zomig, Imitrex), ergotamine (Ergomar), and
painkillers (like Tylenol with codeine).

Thunderclap headaches

Thunderclap headaches are abrupt, severe

headaches that often come on very quickly. They will
usually appear without warning and last up to five
minutes. These headache types can signal an
underlying problem with blood vessels in the brain
and often require prompt medical attention. A
significant number of headache types exist. Learn
more about 10 of the most common headache
types.

Headache treatment

Treatment for headaches varies according to the

cause. If headaches are being caused by an illness,
then it’s likely that the headaches will go away once
the underlying condition is treated. However, most
58
headaches aren’t symptoms of serious medical
conditions and can be successfully treated with over-
the-counter medications, such as aspirin,
acetaminophen (Tylenol), or ibuprofen (Advil).

If medications aren’t working, there are several

other remedies that can help treat headaches:

• Biofeedback is a relaxation technique that helps

with pain management.

• Stress management classes can teach you how

to cope with stress and how to relieve tension.

• Cognitive behavioral therapy is a type of talk

therapy that shows you how to recognize
situations that make you feel stressed and
anxious.

• Acupuncture is an alternative therapy that may

reduce stress and tension by applying fine
needles to specific areas of your body.

• Mild to moderate exercise can help increase

the production of certain brain chemicals that
make you feel happier and more relaxed.

• Cold or hot therapy involves applying a heating

pad or ice pack to your head for 5 to 10 minutes
multiple times a day.

• Taking a hot bath or shower can help relax

tense muscles.

59
 Preventive treatment is used when headaches occur
three or more times per month. Sumatriptan is a
drug that’s commonly prescribed for the control of
migraine headaches. Other medications that can be
used to treat or prevent chronic migraine or cluster
headaches are:

• beta blockers (propranolol, atenolol)

• verapamil (calcium channel blocker)
• methysergide maleate (helps to reduce blood
vessel constriction)
• amitriptyline (antidepressant)
• valproic acid (anti-seizure medication)
• dihydroergotamine
• lithium
• topiramate

60
61
 NAUSEA and VOMITING
SECTION ELEVEN

Vomiting is an uncontrollable reflex that expels the

contents of the stomach through the mouth. It’s also
called “being sick” or “throwing up.” Nausea is a term
that describes the feeling that you might vomit, but
aren’t actually vomiting.

Both nausea and vomiting are very common symptoms

and can be caused by a wide range of factors. They occur
in both children and adults, although they’re probably
most common in pregnant women and people
undergoing cancer treatments

What causes nausea and vomiting?

Nausea and vomiting may occur together or separately.

They can be caused by a number of physical and
psychological conditions.

Nausea

The most common causes of nausea are intense pain —

usually from an injury or illness — and the first trimester

62
of pregnancy. There are also a number of other relatively
common causes, including:

• motion sickness
• emotional stress
• indigestion
• food poisoning
• viruses
• exposure to chemical toxins
If you have gallstones, you’re also likely to feel
nauseated.
You may find that certain smells bring on the feeling of
nausea. This is a very common symptom during the first
trimester of pregnancy, although it can also occur in
people who aren’t pregnant. Pregnancy-induced nausea
usually goes away by the second or third trimester.

Vomiting in children

The most common causes of vomiting in children are

viral infections and food poisoning. However, vomiting
can also be caused by:

• severe motion sickness

• coughing
• high fevers
• overeating
In very young infants, blocked intestines can also cause
persistent vomiting. The intestines may become blocked
by abnormal muscular thickening, hernia, gallstones, or
tumors. This is uncommon, but should be investigated if
unexplained vomiting occurs in an infant.

63
Vomiting in adults

Most adults rarely vomit. When it does occur, a bacterial

or viral infection or a type of food poisoning usually
causes vomiting. In some cases, vomiting can also be the
result of other illnesses, especially if they lead to
a headache or high fever.

Chronic stomach conditions

Chronic, or long-term, stomach conditions can often

cause nausea and vomiting. These conditions can come
along with other symptoms, such
as diarrhea, constipation, and stomach pain. These
chronic conditions include food intolerances, such
as celiac disease and dairy protein and lactose
intolerance.

Irritable bowel syndrome (IBS) is a common stomach

condition that causes bloating, nausea, vomiting,
heartburn, fatigue, and cramping. It occurs when parts of
the gut become overactive. Doctors usually diagnose IBS
by identifying symptoms and ruling out other stomach
and bowel conditions.

Crohn’s disease is an inflammatory bowel disease that

commonly affects the intestines, though it can occur
anywhere in the digestive tract. Crohn’s disease is an
autoimmune condition in which the body attacks its own
healthy gut tissue, causing inflammation, nausea,
vomiting, and pain.

Doctors usually diagnose Crohn’s disease using

a colonoscopy, a procedure that uses a small camera to

64
explore the colon. Sometimes they also need a stool
sample to help diagnose the condition.

Lifestyle choices

Certain lifestyle choices can increase your chance of

experiencing nausea and vomiting.

Consuming a large amount of alcohol can cause damage

to the lining of the gut. Alcohol can also react with
stomach acid. Both of these will cause nausea and
vomiting. In some cases, excessive alcohol consumption
can also cause bleeding in the digestive tract.

Eating disorders

An eating disorder is when a person adjusts their eating

habits and behaviors based on an unhealthy body image.
It can cause nausea and vomiting.

Bulimia is an eating disorder in which a person induces

vomiting deliberately to purge the stomach of any
consumed food. People with anorexia may also feel
nausea due to starvation and excess stomach acid.

Serious conditions

Though rare, vomiting can sometimes occur as a

symptom of a more serious condition, including:

• meningitis
• appendicitis
• concussion
• a brain tumor
• migraines
65
Treating nausea and vomiting

You can use a number of methods to relieve nausea and

vomiting, including home remedies and medications.

Self-treatment for nausea

To treat nausea at home:

• Consume only light, plain foods, such as bread

and crackers.
• Avoid any foods that have strong flavors, are
very sweet, or are greasy or fried.
• Drink cold liquids.
• Avoid any activity after eating.
• Drink a cup of ginger tea.

Self-treatment for vomiting

• Eat smaller, more frequent meals.
• Drink a large amount of clear fluids to remain
hydrated, but consume it in small sips at a time.
• Avoid solid foods of any kind until vomiting
stops.
• Rest.
• Avoid using medications that may upset your
stomach, such as nonsteroidal anti-
inflammatory drugs or corticosteroids.
• Use an oral rehydration solution to replace lost
electrolytes.

66
Medical care

Before prescribing medication, you doctor will ask you

questions about when the nausea and vomiting began
and when it’s at its worst. They may also ask you about
your eating habits and whether anything makes the
vomiting and nausea better or worse.

A number of prescription medications can control nausea

and vomiting, including medications you can use during
pregnancy. These include promethazine (Phenergan),
diphenhydramine (Benadryl), trimethobenzamide
(Tigan), and ondansetron (Zofran).

67
68
EPIPESY and SEIZURES
SECTION TWELVE

A seizure, formally known as an epileptic seizure, is a

period of symptoms due to abnormally excessive
or synchronous neuronal activity in the brain

Major Types of Seizures

Seizures are classified into two groups.

1. Generalized seizures affect both sides of the

brain.
• Absence seizures, sometimes called petit mal
seizures, can cause rapid blinking or a few
seconds of staring into space.
• Tonic-clonic seizures, also called grand mal
seizures, can make a person
o Cry out.
o Lose consciousness.
o Fall to the ground.
o Have muscle jerks or spasms.
The person may feel tired after a tonic-clonic seizure.

69
 2. Focal seizures are located in just one area of the
brain. These seizures are also called partial
seizures.
• Simple focal seizures affect a small part of the
brain. These seizures can cause twitching or a
change in sensation, such as a strange taste or
smell.
• Complex focal seizures can make a person with
epilepsy confused or dazed. The person will be
unable to respond to questions or direction for
up to a few minutes.
• Secondary generalized seizures begin in one
part of the brain, but then spread to both sides
of the brain. In other words, the person first has
a focal seizure, followed by a generalized
seizure.
Seizures may last as long as a few minutes.

What causes seizures?

Seizures can stem from a number of health conditions.

Anything that affects the body also may disturb the brain
and lead to a seizure. Some examples include:

• alcohol withdrawal
NOTE:
• a brain infection, such as meningitis Alcohol withdrawal syndrome

a brain injury during childbirth

(AWS) is the name for the symptoms
• that occur when a heavy
drinker suddenly stops or significantly
• a brain defect present at birth reduces their alcohol intake.

• choking
• drug abuse
• drug withdrawal

70
How are seizures diagnosed?

Doctors can have a difficult time diagnosing seizure

types. Your doctor may recommend certain tests to
diagnose a seizure accurately and to help ensure that the
treatments they recommend will be effective.

Your doctor will consider your full medical history and

the events leading up to the seizure. For example,
conditions such as migraine headaches, sleep disorders,
and extreme psychological stress can cause seizure-like
symptoms.

Lab tests may help your doctor rule out other conditions
that can cause seizure-like activity. The tests may
include:

• blood testing to check for electrolyte imbalances

• a spinal tap to rule out infection
• a toxicology screening to test for drugs, poisons,
or toxins
An electroencephalogram (EEG) can help your doctor
diagnose a seizure. This test measures your brain waves.
Viewing brain waves during a seizure can help your
doctor diagnose the type of seizure.
Imaging scans such as a CT scan or MRI scan also can help
by providing a clear picture of the brain. These scans
allow your doctor to see abnormalities like blocked blood
flow or a tumor.

How are seizures treated?

71
Treatments for seizures depend on the cause. By treating
the cause of the seizures, you may be able to prevent
future seizures from occurring. The treatment for
seizures due to epilepsy include:

• medications
• surgery to correct brain abnormalities
• nerve stimulation
• a special diet, known as a ketogenic diet
With regular treatment, you can reduce or stop seizure
symptoms.

72
73
 SORE THROAT
SECTION THIRTEEN

A sore throat is pain, scratchiness or irritation of the

throat that often worsens when you swallow. The most
common cause of a sore throat (pharyngitis) is a viral
infection, such as a cold or the flu. A sore throat caused
by a virus resolves on its own.

Strep throat (streptococcal infection), a less common

type of sore throat caused by bacteria, requires
treatment with antibiotics to prevent complications.
Other less common causes of sore throat might require
more complex treatment.

Symptoms

Symptoms of a sore throat can vary depending on the

cause. Signs and symptoms might include:

• Pain or a scratchy sensation in the throat

• Pain that worsens with swallowing or talking
• Difficulty swallowing
• Sore, swollen glands in your neck or jaw
• Swollen, red tonsils
• White patches or pus on your tonsils
74
 • A hoarse or muffled voice

Infections causing a sore throat might result in other

signs and symptoms, including:

• Fever
• Cough
• Runny nose
• Sneezing
• Body aches
• Headache
• Nausea or vomiting

Causes

Viruses that cause the common cold and the flu also
cause most sore throats. Less often, bacterial infections
cause sore throats.

Viral infections

Viral illnesses that cause a sore throat include:

• Common cold
• Flu (influenza)
• Mono (mononucleosis)
• Measles
• Chickenpox
• Croup — a common childhood illness
characterized by a harsh, barking cough

75
Bacterial infections

A number of bacterial infections can cause a sore throat.

The most common is Streptococcus pyogenes (group A
streptococcus) which causes strep throat.

Other causes

Other causes of a sore throat include:

• Allergies. Allergies to pet dander, molds, dust

and pollen can cause a sore throat. The problem
may be complicated by postnasal drip, which
can irritate and inflame the throat.
• Dryness. Dry indoor air can make your throat
feel rough and scratchy. Breathing through your
mouth — often because of chronic nasal
congestion — also can cause a dry, sore throat.
• Irritants. Outdoor air pollution and indoor
pollution such as tobacco smoke or chemicals
can cause a chronic sore throat. Chewing
tobacco, drinking alcohol and eating spicy foods
also can irritate your throat.
• Muscle strain. You can strain muscles in your
throat by yelling, talking loudly or talking for
long periods without rest.
• Gastroesophageal reflux disease (GERD). GERD
is a digestive system disorder in which stomach
acids back up in the food pipe (esophagus).
Other signs or symptoms may include heartburn,
hoarseness, regurgitation of stomach contents and the
sensation of a lump in your throat.

76
 • HIV infection. A sore throat and other flu-like
symptoms sometimes appear early after
someone is infected with HIV.

Also, someone who is HIV-positive might have a chronic

or recurring sore throat due to a fungal infection called
oral thrush or due to a viral infection called
cytomegalovirus (CMV), which can be serious in people
with compromised immune systems.

• Tumors. Cancerous tumors of the throat,

tongue or voice box (larynx) can cause a sore
throat. Other signs or symptoms may include
hoarseness, difficulty swallowing, noisy
breathing, a lump in the neck, and blood in
saliva or phlegm.

Rarely, an infected area of tissue (abscess) in the throat

or swelling of the small cartilage "lid" that covers the
windpipe (epiglottitis) can cause a sore throat. Both can
block the airway, creating a medical emergency.

Risk factors

Although anyone can get a sore throat, some factors

make you more susceptible, including:

• Age. Children and teens are most likely to

develop sore throats. Children ages 3 to 15 are
also more likely to have strep throat, the most

77
 common bacterial infection associated with a
sore throat.

• Exposure to tobacco smoke. Smoking and

secondhand smoke can irritate the throat. The
use of tobacco products also increases the risk
of cancers of the mouth, throat and voice box.
• Allergies. Seasonal allergies or ongoing allergic
reactions to dust, molds or pet dander make
developing a sore throat more likely.
• Exposure to chemical irritants. Particles in the
air from burning fossil fuels and common
household chemicals can cause throat irritation.
• Chronic or frequent sinus infections. Drainage
from your nose can irritate your throat or
spread infection.
• Close quarters. Viral and bacterial infections
spread easily anywhere people gather, whether
in child care centers, classrooms, offices or
airplanes.
• Weakened immunity. You're more susceptible
to infections in general if your resistance is low.
Common causes of lowered immunity include
HIV, diabetes, treatment with steroids or
chemotherapy drugs, stress, fatigue, and poor
diet.

Treatment

A sore throat caused by a viral infection usually lasts five

to seven days and doesn't require medical treatment.
78
To ease pain and fever, many people turn to
acetaminophen (Tylenol, others) or other mild pain
relievers.

Consider giving your child over-the-counter pain

medications designed for infants or children, such as
acetaminophen (Children's Tylenol, FeverAll, others) or
ibuprofen (Children's Advil, Children's Motrin, others), to
ease symptoms.

Never give aspirin to children or teenagers because it has

been linked to Reye's syndrome, a rare but potentially
life-threatening condition that causes swelling in the liver
and brain.

Treating bacterial infections

If your or your child's sore throat is caused by a bacterial

infection, your doctor or pediatrician will prescribe
antibiotics.

You or your child must take the full course of antibiotics

as prescribed even if the symptoms are gone. Failure to
take all of the medication as directed can result in the
infection worsening or spreading to other parts of the
body.

Not completing the full course of antibiotics to treat

strep throat can increase a child's risk of rheumatic fever
or serious kidney inflammation.

Talk to your doctor or pharmacist about what to do if you

forget a dose.

Other treatments
79
If a sore throat is a symptom of a condition other than a
viral or bacterial infection, other treatments will likely be
considered depending on the diagnosis.

80
81
 SYNCOPE
SECTION FOURTEEN

Syncope is a temporary loss of consciousness usually

related to insufficient blood flow to the brain. It's also
called fainting or "passing out."

It most often occurs when blood pressure is too

low (hypotension) and the heart doesn't pump enough
oxygen to the brain. It can be benign or a symptom of an
underlying medical condition.

What causes syncope?

Syncope is a symptom that can be due to several causes,

ranging from benign to life-threatening conditions. Many
non life-threatening factors, such as overheating,
dehydration, heavy sweating, exhaustion or the pooling
of blood in the legs due to sudden changes in body
position, can trigger syncope. It's important to determine
the cause of syncope and any underlying conditions.

However, several serious heart conditions, such

as bradycardia, tachycardia or blood flow obstruction,
can also cause syncope.

82
What are the risk factors?

Syncope is common, but adults over age 80 are at

greater risk of hospitalization and death.

Younger people without cardiac disease but who've

experienced syncope while standing or have specific
stress or situational triggers aren't as likely to experience
cardiac syncope.

Cardiac syncope is a higher risk in: people older than age

60; men; presence of known heart disease; brief
palpitations or sudden loss of consciousness; fainting
during exertion; fainting while supine; an abnormal
cardiac exam; or family history of inheritable conditions.
Other existing conditions and medications used are
particularly important in older patients.

Different types of syncope

There are several types of syncope, each with a different

cause.

Sometimes, though, the cause of fainting can’t be

determined. It’s estimated that 10 to 40 percent of
fainting cases have an unknown cause.

Let’s take a closer look at some of the most common

types of syncope, or fainting episodes.

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Reflex syncope

Reflex syncope, also known as neurally mediated

syncope, is the most common type of fainting. It happens
when certain reflexes are not properly regulated.

This can cause your heart to slow down and a drop in

blood pressure. In turn, this can decrease the flow of
blood to your brain.

There are three kinds of reflex syncope:

• Vasovagal: This happens when your body

overreacts to a trigger. There are many types of
triggers, which can include things like intense
pain, distress, or standing too long. Vasovagal
syncope accounts for 50 percentTrusted
Source of all cases of fainting.

• Situational: This type of fainting happens when

you perform certain actions, such as laughing,
coughing, or swallowing.

• Carotid sinus: This type of fainting happens

when pressure is placed on your carotid artery,
located in your neck. Fainting can occur due to
certain neck motions, wearing shirts with a tight
collar, or shaving.

In people with reflex syncope, fainting is often preceded

by symptoms such as:
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 • lightheadedness

• nausea
• feelings of warmth
• tunnel vision
• visual blackout or “grayout”

Cardiac syncope
Cardiac syncope is fainting caused by a problem with
your heart. When your heart isn’t working quite as it
should, your brain receives less blood. It’s estimated that
cardiac syncope causes about 15 percentTrusted
Source of fainting episodes.

Several factors can cause cardiac syncope, including:

• structural problems with your heart, such

as ischemic cardiomyopathy, heart valve
disorders, and dilated cardiomyopathy
• electrical problems with your heart, such
as arrhythmias and conditions like Brugada
syndrome
• other conditions, such as a pulmonary
embolism or aortic dissection

Common characteristics of cardiac syncope include:

• experiencing chest pain or heart palpitations
before fainting
• having fainting symptoms while exercising or
exerting yourself
• fainting while you’re lying down

Risk factors for cardiac syncope include:

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 • being older than 60

• being male
• having heart disease
• having a family history of heart conditions or
fainting

Orthostatic syncope
Orthostatic syncope happens due to a drop in blood
pressure when you stand up. The drop in blood pressure
occurs due to the effects of gravity.

Normally, your brain works to stabilize this. But in

orthostatic syncope this doesn’t happen. As a result, it
can lead to fainting.

There are many possible causes for this type of fainting.

They can include:

• dehydration, due to not drinking enough fluids,

or from conditions like vomiting or diarrhea
• blood loss
• medications, such as some blood pressure
medications, antidepressants, and diabetes
drugs
• alcohol use
• underlying health conditions, such
as diabetes, Parkinson’s disease, or multiple
sclerosis
Symptoms are usually consistent with the warning signs
that are commonly experienced before a fainting
episode. However, orthostatic syncope may also happen
suddenly, without warning.

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Cerebrovascular syncope

This type of syncope happens due to a problem with the

blood vessels in and around the brain that can prevent
the brain from getting enough blood.

There are a variety of factors that can cause this type of

fainting, but they aren’t common causes of syncope.
They can include:

• injury from cerebrovascular disease, which can

include things like stroke, carotid stenosis,
and aneurysms
• basilar artery disease, which is a condition that
can reduce the blood flow through the basilar
arteries in your brain
• steal syndrome, which is a reversal of blood flow
in the subclavian arteries that supply blood to
your arms
Some symptoms that may occur with cerebrovascular
causes of fainting include:
• feeling dizzy or lightheaded
• headache
• uncoordinated movements
• trouble hearing
• confusion
Risk factors for this type of fainting may include:
• older age
• cardiovascular disease, such
as atherosclerosis, high blood pressure, or high
cholesterol

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 • cerebrovascular disease

Are there ways to prevent fainting?

There are a number of steps you can take that may help
prevent fainting:

• Don’t skip meals. You may want to eat smaller,

more frequent meals throughout the day.
• Drink plenty of fluids. This may help prevent
fainting due to dehydration.
• Understand if there are external factors or
triggers that may cause you to faint. This could
include the sight of blood, getting an injection,
or intense pain. If possible, try to avoid
situations that may trigger a fainting episode.
• Take your time when standing up. Standing up
too quickly can cause a drop in blood pressure
and prevent enough blood from flowing to your
brain.
• Avoid shirts with tight collars. This can help
prevent carotid sinus syncope.

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89
 VERTIGO
SECTION FIFTEEN

Vertigo is a symptom, rather than a condition itself. It's

the sensation that you, or the environment around you,
is moving or spinning.

This feeling may be barely noticeable, or it may be so

severe that you find it difficult to keep your balance and
do everyday tasks.

Attacks of vertigo can develop suddenly and last for a

few seconds, or they may last much longer. If you have
severe vertigo, your symptoms may be constant and last
for several days, making normal life very difficult.

Other symptoms associated with vertigo may include:

• loss of balance – which can make it difficult to

stand or walk

• feeling sick or being sick

• dizziness

What causes vertigo?

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Vertigo is commonly caused by a problem with the way
balance works in the inner ear, although it can also be
caused by problems in certain parts of the brain.

Causes of vertigo may include:

• benign paroxysmal positional vertigo (BPPV) –

where certain head movements trigger vertigo

• migraines – severe headaches

• labyrinthitis – an inner ear infection

• vestibular neuronitis – inflammation of the

vestibular nerve, which runs into the inner ear
and sends messages to the brain that help to
control balance

Depending on the condition causing vertigo, you may

experience additional symptoms, such as a high
temperature, ringing in your ears (tinnitus) and hearing
loss.

Read more about the causes of vertigo

How is vertigo treated?

Some cases of vertigo improve over time, without

treatment. However, some people have repeated
episodes for many months, or even years, such as those
with Ménière's disease.

There are specific treatments for some causes of vertigo.

A series of simple head movements (known as the Epley
manoeuvre) is used to treat BPPV.

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Medicines, such as prochlorperazine and some
antihistamines, can help in the early stages or most cases
of vertigo.

Many people with vertigo also benefit from vestibular

rehabilitation training (VRT), which is a series of exercises
for people with dizziness and balance problems.

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93
 References

1.www.healthline.com
2.www.medicinnet.com
3. hhma.org
4.www.medicalnewstoday.com
5.www.mayoclinic.com
6.www.cdc.gov
7.www.webmd.com
8. medlineplus.gov
9. patient.info
10.www.aaaai.org
11. en.m.wikipedia.org
12.www.heart.org
13. my.clevelandclinic.org

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