Health Awareness blog

Gastroenteritis is the infection of the small intestine.

     Gastroenteritis in children always concerns the parents. It will cause vomiting and diarrhea. Most of the time, it only happened in a mild form and often settles within 48 hours of onset. However, more serious form of gastroenteritis can occur especially in babies and young children. The main danger from small intestine infection is dehydration and electrolyte imbalance that cause by persistent of watery stool and vomiting. Dehydration occurs when fluids lost from the body are not replaced. So, the treatment is mainly to replace the fluids quick enough before the children develop dehydration.

SIGNS OF DEHYDRATION
1.   Passing less urine. Dry nappies may be noted.
2.   Dry mouth and coated tongue
3.   Sunken eyes and no tears
4.   Drowsiness and irritability
5.   The child will appear lethargy, less active and refuse to playShould any of these signs present, the child will need urgent medical attention. Worldwide, diarrhea alone kills more than 3 000 000 children per year.

CAUSES 
    Rotavirus is the most common noted organism. Others include small round structured virus and astrovirus.There is often associated otitis media or upper respiratory tract infection.

TESTS AND INVESTIGATIONS
- Stools for pathogens (including ova, cyst and parasites)TREATMENTS

• Fluid replacement – encourage your child to drink plenty of water. Oral rehydration solution is the fluid of choice.
• Stop bottle milk. It can be restarted after 24 hours (or sooner if the child recovers and feels hungry).
• Children who have diarrhea but not dehydrated should continue their normal feed if they wish. Do not starve your child to reduce severity of diarrhea. Early use of full strength feed is safe even in small babies.
• If your child is breast feed, it should be continued through out the duration of the illness.
• Antibiotics and antidiarrhoeals should used. Many of these agents have potential to cause more harm than good especially when use in infants and young children.
• If your child is moderate to severe dehydrated, he or she may be need admission to hospital. Intravenous fluid will be given to replace the fluid.
• Monitor the temperature because a raised temperature will make the baby irritable and will cause more fluid loss by evaporation. In this case, paracetomol and tepid sponging will be a great help.

COMPLICATIONS
·    Dehydration.
·    Malnutrition.
·    Temporary sugar intolerance after persistent diarrhea and vomiting with explosive watery acid stools. (Rare)   

References:
1.     Oxford Handbook of Clinical Specialties. 4th edition. 2001.
2.     Fact sheet by Health Promotion Unit, Ireland.  

     Coronary artery disease (CAD) is a condition where the blood supply of the heart is affected. This condition occurs due to narrowing and hardening of the coronary arteries. Coronary arteries are blood vessels that carrying oxygen to the heart and supply nutrition to the heart so the heart can functioning normally.

     CAD gives rise to a wide variety of clinical presentations from stable angina (chest pain that occur only during exertion) to acute coronary syndromes like myocardial infarction and unstable angina (chest pain at rest - also known as heart attacks).

     CAD is caused by atherosclerosis. Atherosclerosis is a complex process characterized by the accumulation of lipid, cholesterol and other substances in arteries in the form of plaques.

EFFECTS OF ATHEROSCLEROSIS

• The plaques will narrow the blood vessels hence reduce the oxygen and nutrients supply to the heart.

• Blockage of arteries supplying the heart will lead to myocardial ischemia. It means the imbalance between supplies of oxygen to the demand by the heart muscle.

• Myocardial ischemia will cause angina (chest pain).

RISK FACTORS FOR CORONARY DISEASE  
A. Non modifiable

• Age – risk of CAD increases with age

• Family history

• Male sex – Risk for coronary artery disease is higher for men compared to premenopausal women.

• Deletion polymorphism in the ACE (angiotensin converting enzyme) gene (DD)

B. Modifiable (potentially changeable with treatment) 
      Strong association

• High blood cholesterol

• High blood pressure (hypertension)

• Cigarettes smoking

• Diabetes Mellitus

      Weak association

• Obesity (overweight)

• Sedentary lifestyle

• Stress

• Personality

• Gout

• Soft water

• Lack of exercise

• Contraceptive pill

• Heavy alcohol consumption

LIFETSYLE CHANGES

• Healthy diet

• Reduce weight

• Quit smoking

• Exercise and maintain an active lifestyle

• Reduce stress

• Reduce alcohol intake

• Control blood pressure and blood sugar level

Symptoms of heart attack

• Chest pain or chest discomfort (angina)

• Shortness of breath

• Pain in one or both arms, left shoulder, jaw, neck ad back

Treatment
1. Lifestyle changes
2. Medication
  - Aspirin or ticlopidine (unless contraindicated)
  - Lipid lowering agents (to reduce cholesterol)
  - Sub lingual Glyceryl trinitrate (to relief the chest pain)
  - Other drugs like ?-blockers, calcium channel blocker (to reduce heart rate and reduce oxygen demand to the heart muscle)3. Surgery
  - Percutaneous Transiluminal Coronary Angioplasty (PTCA) - to dilate the affected coronary artery using a ballon.
  - Coronary artery bypass grafting (CABG) – this is where a vein graft (blood vessel from somewhere else in the body) is use to bypass the coronary artery obstruction.