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Viral Meningitis

What is meningitis? —

Meningitis is a condition that can cause a fever, headache, and stiff neck. Meningitis happens when the lining that covers the brain and spinal cord (called the “meninges”) gets inflamed or infected.

An infection of the meninges can cause meningitis. This can happen after a person gets an infection in another part of the body. The germs can travel through the blood to the lining of the brain and spinal cord.

There are 2 main types of meningitis:

●Bacterial meningitis ●Aseptic meningitis Bacterial meningitis is caused by bacteria. Aseptic meningitis is not. It’s important for doctors to find out which kind of meningitis a person has, because bacterial meningitis is a medical emergency. It can lead to brain problems or even death.

Aseptic meningitis is serious, but not usually as serious as bacterial meningitis. People usually recover from aseptic meningitis without any long-term problems.

Both aseptic and bacterial meningitis can have the same symptoms. So the only way a doctor can know for sure which type of meningitis someone has is to do tests in the hospital.

This article discusses aseptic meningitis.

What causes aseptic meningitis? — Viruses cause most cases of aseptic meningitis. But other things can also cause aseptic meningitis, including:

●Germs that are not bacteria or viruses ●Medicines – Aseptic meningitis can be a rare side effect of certain medicines. Also, people who have advanced cancer can get aseptic meningitis if their cancer spreads to their meninges.

What are the symptoms of aseptic meningitis? — Common symptoms include:

●Fever ●Headache ●Nausea or vomiting ●Stiff neck – This is most often seen in children and adults. Babies might not get a stiff neck. ●Having light bother a person’s eyes Babies can also have other symptoms, including:

●Not feeding well ●Being more sleepy or fussy than usual ●A bulging soft spot on the skull People can have other symptoms, too, depending on what’s causing the infection. For example, people whose aseptic meningitis is caused by a virus can also have a rash, diarrhea, runny nose, or sore throat. A rash can also happen with bacterial meningitis.

Should I see a doctor or nurse? — Yes. If you have a fever, headache, and stiff neck, go to the emergency room right away. If you think your child has meningitis, bring him or her to the emergency room right away.

It’s very important to go to the hospital if you think you or your child has meningitis. That’s because the only way a doctor can tell for sure that someone has aseptic meningitis — and not life-threatening bacterial meningitis — is to do tests in the hospital.

Will I need tests? — Yes. The doctor or nurse will learn about your symptoms and do an exam. He or she will do tests to look for the cause of your meningitis. These tests can include 1 or more of the following:

●Blood tests ●A lumbar puncture (sometimes called a “spinal tap”) – During this procedure, a doctor puts a thin needle into your lower back and takes out a small amount of spinal fluid. Spinal fluid is the fluid that surrounds the brain and spinal cord. He or she will do lab tests on the spinal fluid. ●A CT scan of the brain – This is an imaging test that creates pictures of the brain. ●Other tests – For example, the doctor can use a cotton swab to collect a sample from the back of the throat. Then he or she can do lab tests on the sample. How is aseptic meningitis treated? — Treatment for aseptic meningitis usually includes:

●Resting ●Drinking fluids or getting fluids into your vein through a tube called an “IV” ●Taking an over-the-counter medicine to treat a fever or headache Aseptic meningitis is NOT treated with antibiotic medicines. That’s because antibiotics only treat infections caused by bacteria.

Your doctor might recommend other treatments, depending on what’s causing the meningitis. Certain viruses and other germs can be treated with medicines.

This content was written by

Dr. Carlo Oller

Board Certified Emergency Physician

Dr. Oller Transparent copySmall.png  

Bacterial Meningitis

What is meningitis? 

— Meningitis is a condition that can cause a fever, headache, and stiff neck. It happens when the lining that covers the brain and spinal cord (called the “meninges”) gets inflamed or infected.

There are 2 main types of meningitis, depending on which germs are causing the infection. Bacteria cause bacterial meningitis. Viruses cause viral meningitis. Both types of meningitis can cause similar symptoms. It is very important that doctors figure out what kind of meningitis a person has. That’s because bacterial meningitis is a medical emergency. If it is not treated quickly, it can lead to brain problems such as hearing loss or learning problems. It can also lead to death.

This article discusses bacterial meningitis.

What are the symptoms of bacterial meningitis? — Symptoms of bacterial meningitis usually come on suddenly, so people can get very sick over a short period of time. Common symptoms include:

Fever – But some people have a temperature that is lower than normal instead of a fever.

Headache

Stiff neck – This happens most often in adults and children. Babies might not get a stiff neck.

Nausea or vomiting

Acting confused, or being hard to wake up

Having light bother a person’s eyes

A rash that looks like red or purple spots on the skin that do not go away when touched

Seizures – Seizures are waves of abnormal electrical activity in the brain. They can make people pass out, or move or behave strangely.

Babies can also have other symptoms, including:

Being more sleepy or fussy than usual

Not feeding well

A bulging soft spot on the skull

Should I see the doctor or nurse? — Yes. If you have a fever, headache, and stiff neck, go to the emergency room right away. If you think your child has meningitis, bring him or her to the emergency room right away.

Will I have tests? — Yes. Your doctor will learn about your symptoms and do an exam. He or she will do tests to see if you have meningitis and find out what type of bacteria is causing the infection. The tests can include:

Blood tests

A lumbar puncture (sometimes called a “spinal tap”) – During this procedure, a doctor puts a thin needle into your lower back and removes a small amount of spinal fluid. Spinal fluid is the fluid that surrounds the brain and spinal cord. He or she will do lab tests on the spinal fluid.

A CT scan of the brain – This is an imaging test that creates pictures of the brain.

How is bacterial meningitis treated? — People are treated in the hospital with:

Antibiotic medicines that go into a vein through a tube called an “IV” – The antibiotics used depend on the type of bacteria causing the infection.

Fluids and other medicines that go into a vein – These medicines sometimes include “steroids.” The steroids help protect your brain from the effects of the bacterial meningitis. They are different from the steroids athletes take to build muscle.

Can bacterial meningitis be spread from 1 person to another? — Sometimes. It depends on the type of bacteria that’s causing the infection. Some types of bacteria can be spread from 1 person to another.

Can bacterial meningitis be prevented? — Sometimes. Certain vaccines can help prevent bacterial meningitis. Vaccines are treatments that can prevent certain serious infections.

To help prevent bacterial meningitis, make sure that you and your children have had all of the vaccines you need to prevent the following infections:

Meningococcus

Pneumococcus

Haemophilus influenzae type b, called “Hib” (for babies and young children)

If someone in your home has bacterial meningitis, ask your doctor or nurse if you should take antibiotics. Sometimes, other people at home need to take antibiotics to keep from getting the infection. Plus, you can help avoid getting sick by washing your hands well before eating, and not sharing cups or silverware.

Bursitis

Basic Patient education

What is bursitis? — Bursitis is a condition that can cause pain or swelling next to a joint. Most of the time, bursitis happens around the shoulder, elbow, hip, or knee. It can also happen around other joints in the body.

A “bursa” is a small fluid-filled sac that sits near a bone. It cushions and protects nearby tissues when they rub on or slide over bones. These sacs, called “bursae,” are found in many places throughout the body. Bursitis happens when a bursa gets irritated and swollen. This can happen when a person:

Moves a joint over and over again in the same way, over a short period of time

Sits on a hard surface or stays in a position that presses on the bursa for a long time

Has certain kinds of arthritis, such as gout or rheumatoid arthritis, that can affect their joints and bursae

Gets hurt near a bursa

Has an infection that spreads to a bursa

What are the symptoms of bursitis? — Symptoms of bursitis can include:

Pain or tenderness

Swelling

Trouble moving the joint

A bursa can get infected if a person gets a cut on the skin nearby. An infected bursa can cause a fever and the area around the bursa to be:

Red

Swollen

Warm

Painful

If you have any of the symptoms of an infected bursa, let your doctor or nurse know as soon as possible.

Is there a test for bursitis? — Yes. Your doctor or nurse will ask about your symptoms and do an exam.

If you have symptoms of an infected bursa, your doctor might use a needle to remove some fluid from the bursa. Then he or she can do lab tests on the fluid to find out what is causing the bursitis, and if you need antibiotics. He or she might also order imaging tests, such as an MRI scan or ultrasound. Imaging tests can create pictures of the inside of the body.

What can I do to treat my bursitis? 

— To treat your bursitis, you can:

Rest, cushion, and protect the area – Try not to irritate the area that hurts. For example, people with very painful shoulder bursitis might need to avoid lifting or carrying heavy things for a while. They might also need to wear an arm sling. People with bursitis behind the heel might need to use a thick heel pad. This can raise the heel so that it does not rub against the back of the shoe.

Avoid positions that put pressure on the area – For example, people with bursitis in the front of the knee should avoid kneeling.

Put ice on the area to reduce pain – Use a frozen bag of peas or a cold gel pack a few times a day for 20 minutes each time.

Put heat on the area to reduce pain and stiffness – Do not use heat for more than 20 minutes at a time. Also, do not use anything too hot that could burn your skin.

What other treatments might I have? — Your doctor or nurse might use other treatments, depending on your symptoms and where your bursitis is. Treatments can include:

Pain-relieving medicines called “nonsteroidal antiinflammatory drugs” or “NSAIDs” – NSAIDs include ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand name: Aleve). These medicines can reduce pain and prevent the bursae from getting swollen and painful.

Steroid injections – Steroid medicines help reduce inflammation. These medicines are different from the steroids athletes use to build muscle. Doctors can inject steroids into the area of the bursitis to help reduce symptoms.

Exercises and stretches – Your doctor or nurse might recommend that you work with a physical therapist. A physical therapist can teach you stretches and exercises to help reduce your symptoms.

Surgery – A doctor can do surgery if other treatments do not work and you have had symptoms for a long time.

People with an infected bursa might also have treatment that includes:

Antibiotics

Having the fluid in the bursa drained – A doctor can drain the fluid using a needle and syringe, or by doing surgery.

Can bursitis be prevented? — Yes. To help reduce the chance that you get bursitis, you can:

Use cushions or pads to avoid putting too much pressure on joints – For example, people who garden can kneel on a kneeling pad. People who sit for a long time can sit on a cushioned chair.

Take breaks, if you are using a certain joint too much

Stop an activity or change the way you are doing it, if you feel pain

Exercise

Lose weight, if you are overweight

Use good posture

BURSITIS OVERVIEW — Advanced Patient Education 

— Bursitis is an inflammation or irritation of the bursae (plural of “bursa”). The bursae are fluid-filled sacs in the joints that decrease friction and provide a cushion between bones, muscles, and skin.

Bursitis can be acute (often as a result of an injury or infection) or chronic (for example, following a long period of repetitive use or motion). It can affect almost any joint in the body, although some are more commonly affected than others.

BURSITIS CAUSES 

— Causes of bursitis include:

Injury, such as from a fall or hit

Prolonged pressure, which can result from kneeling, sitting, or leaning on a particular joint for a long period

Strain or overuse from repeating the same motion many times

Joint stress from an abnormal gait; for example, walking unevenly because one leg is shorter than the other

Gout or other crystal diseases

Certain types of arthritis, like rheumatoid arthritis or psoriatic arthritis

Infection resulting from bacteria entering the body through a cut or scrape in the skin

BURSITIS SYMPTOMS 

— Common symptoms of bursitis include pain and swelling in the affected joint. Visible swelling is more common in bursae that are closer to the surface of the skin (such as those around the elbows, kneecaps, and heels), and less common in deeper areas (such as the shoulders, hips, and inner knees).

In acute bursitis, there is often pain directly over the affected bursa; active motion (when the patient moves or bends the joint) also causes pain. People with chronic bursitis are more likely to have swelling, often with minimal pain. They may have limited range of motion due to avoiding moving the joint and surrounding muscles. Bursitis caused by an infection is called “septic bursitis.” Symptoms may include pain, swelling, warmth, and redness around the affected joint. Fever may also be present. This is a potentially serious condition, since infection can spread to nearby joints or the blood. Specific symptoms vary depending on the area that is affected. (See ‘Types of bursitis’ below.)

BURSITIS DIAGNOSIS 

— Diagnosing bursitis involves a physical examination, a review of your symptoms, and sometimes tests.

If infection or crystal disease (for example, gout) is suspected, your doctor may use a syringe and needle to remove a sample of fluid from the affected bursa. This is called “aspiration.” The fluid can then be examined under a microscope for crystals, bacteria, and white blood cells. Imaging (such as radiograph, MRI, or ultrasound) is not usually needed to diagnose bursitis. However, it can help in some situations, such as when other problems (for example, a tear in the cartilage or ligament) need to be ruled out quickly. It can also be useful if your doctor needs to remove fluid from a bursa near other areas that could be injured, such as nerves or blood vessels. Imaging can allow the doctor to see where the needle is going.

TYPES OF BURSITIS 

— Bursitis can affect many different areas of the body. The exact symptoms and preferred treatments depend on the location as well as the cause.

Shoulder (subacromial bursitis) — Shoulder bursitis causes pain in the shoulder and outside of the upper arm (figure 1). Pain is often present at rest but increases with movement of the arm, especially with lifting the arms above the head; it also often interrupts sleep. It can be difficult to differentiate shoulder bursitis from other issues such as a rotator cuff tear or tendinitis.

Upper back (scapulothoracic bursitis) — Upper back bursitis affects the space between the scapula (shoulder blade) and ribs, and can cause pain or a popping sensation. Reaching the arms overhead or doing pushups can make pain worse.

Elbow (olecranon bursitis) — Elbow bursitis usually causes a visible swelling at the tip of the elbow, like a golf ball. It can result from injury, infection, crystals (gout), or rheumatoid arthritis. It usually causes pain when the elbow is flexed, but not extended. The elbow often extends fully without discomfort.

Pelvis (ischial bursitis) — Pelvic bursitis has also been referred to as “weaver’s bottom” or “tailor’s bottom,” since it is often caused by prolonged sitting on hard surfaces. It causes pain in the lower buttocks that is aggravated by sitting (figure 2); pain may disappear when the person stands.

Hip

Greater trochanteric pain syndrome (formerly called trochanteric bursitis) — The greater trochanteric bursa is located in the upper outer part of the femur (thigh bone) (figure 2). Bursitis in this area is usually associated with inflammation of nearby tendons and can cause pain while lying or sleeping on the affected side of the body. People with greater trochanteric pain syndrome also tend to have pain when extending the leg to walk, but not while standing still. Symptoms can be aggravated by an abnormal gait, due to uneven stress on the hips. There are many contributing factors, including chronic back pain, contralateral knee pain (knee pain on the opposite side of the body from the bursitis), different leg lengths, and being overweight.

Iliopsoas bursitis — The iliopsoas bursa is deep in the front of the hip. This type of bursitis causes pain in the groin area, particularly when the hip is flexed against resistance. It can result from arthritis in the area, overuse (for example, excessive running), or injury. Because symptoms are similar to those of other hip problems (for example, problems with the bone or cartilage), imaging tests are often required to confirm the diagnosis. Infection in the psoas muscle (psoas abscess) can have similar symptoms. (The psoas muscle runs from the spine to the femur, and is used to flex the hip.)

Knee

Prepatellar and infrapatellar bursitis — The prepatellar bursa is located at the front of the knee, on top of the patella (kneecap) (figure 3); the infrapatellar bursa is below this. Bursitis in these areas can result from recurrent injury to the knee, and is often seen in people who frequently kneel (prepatellar bursitis has been referred to as “housemaid’s knee” or “nun’s knee”). It can also happen as a result of infection, gout, or rheumatoid arthritis. Swelling occurs within the bursa, not in the knee joint itself. People with prepatellar and infrapatellar bursitis usually feel more comfortable lying down with the knee extended, while people with swelling within the true knee joint tend to feel better lying down with the knee bent.

MCL bursitis — The medial collateral ligament (MCL) is located on the inner side of the knee, and connects the femur (thigh bone) to the tibia (shin bone) (figure 4). Bursitis in this area can cause pain and tenderness, but doesn’t usually involve swelling. It must be differentiated from an injury or tear to the MCL or meniscus (the cartilage in the knee).

Pes anserinus pain syndrome — The anserine bursa is located about two inches below the top of the tibia (shin bone), on the inner side of the knee. Pes anserinus pain syndrome (formerly referred to as anserine bursitis) causes pain on the inner side of the knee, which tends to come on abruptly, often during the night. It is common in people with arthritis of the knee; it can also result from an uneven gait (for example, walking with a limp or while favoring one leg over time), or from flat feet.

Heel (retrocalcaneal bursitis) — The retrocalcaneal bursa is between the heel bone and the Achilles tendon, which connects the heel to the calf muscle. It normally serves as a cushion to absorb impact when walking. Retrocalcaneal bursitis can cause pain and swelling in the area. It can be easily confused with tendinitis (inflammation of the Achilles tendon).

BURSITIS TREATMENT 

— Bursitis treatment focuses on relieving inflammation and pain, treating infection (if present), and preventing complications and future recurrence.

Medication — In most cases, nonsteroidal antiinflammatory drugs (NSAIDs) can help relieve pain and inflammation. NSAIDs include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve); other NSAIDs, as well as higher doses, are also available by prescription. (See “Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)”.)

A glucocorticoid (steroid) injection can also help with inflammation. This is more often used when the affected area is deep under the skin (see ‘Shoulder (subacromial bursitis)’ above and ‘Greater trochanteric pain syndrome (formerly called trochanteric bursitis)’ above and ‘MCL bursitis’ above and ‘Pes anserinus pain syndrome’ above). It is not usually helpful for more superficial types of bursitis, for example, in the olecranon bursa of the elbow, prepatellar bursa of the knee, or retrocalcaneal bursa of the heel. Septic bursitis requires drainage of the infected fluid and antibiotics to treat the underlying infection. (See ‘Treating infection’ below.)

Protecting the joints — It is important to protect the affected joints in order to help the bursae to heal, and to prevent the bursitis from getting worse or recurring. Examples of joint protection include:

Avoiding or modifying activities that cause pain

The use of pads or cushions for people who have to kneel or sit frequently

Modifying footwear to reduce pressure on the back of the heel (eg, cutting a “V”-shaped groove into the back of a shoe; using a pad inside the shoe to lift the heel)

Custom-fitted devices worn over the elbows to protect them and prevent fluid from building up again

Other measures 

— Ice can help relieve pain, particularly for bursitis affecting superficial areas like the elbow, kneecap, and heel. Heat (eg, a heating pad) may be more effective for deeper forms of bursitis, such as the hip, shoulder, or inner knee.

In many cases, physical therapy can help treat symptoms of bursitis and prevent future recurrence. The optimal exercises depend on the type and severity of bursitis, but may involve stretching, strengthening, or working to improve (and maintain) range of motion. Rarely, surgery is required to remove all or part of the affected bursa.

Treating infection — Septic bursitis is treated with antibiotics. The choice of which antibiotic to use, and for how long, is based on the type and severity of infection. For mild cases, a few weeks of oral antibiotics may be enough; for more severe infection, intravenous (IV) antibiotics (given in the hospital) may be required.

It is also often necessary to drain infected fluid using a needle. This is done in a doctor’s office, usually several times, until the infection has resolved.

WHERE TO GET MORE INFORMATION 

— Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

Stomach Ache

What happens when you have a stomach ache? 

— When you have a stomach ache, you have pain or discomfort in your belly. Sometimes that’s the only symptom you have. Other times, you can have other symptoms such as:

Burning in your chest known as heartburn

Burping

Bloating (feeling as though your belly is filled with air)

Feeling full too quickly when you start eating

Should I see a doctor or nurse about my stomach ache? — Most people do not need to see a doctor or nurse for a stomach ache. But you should see your doctor or nurse if:

You have bloody bowel movements, diarrhea, or vomiting

Your pain is severe and lasts more than an hour or comes and goes for more than 24 hours

You cannot eat or drink for hours

You have a fever higher than 102°F (39°C)

You lose a lot of weight without trying to, or lose interest in food

What causes stomach aches? 

— In some cases, stomach aches are caused by a specific problem, such as a stomach ulcer (a sore on the inside of the stomach) or a condition called “diverticulitis,” in which small pouches in your large intestine get infected. But in some cases, doctors and nurses do not know what causes stomach aches or the other symptoms that happen with them. Even so, doctors and nurses can usually treat the symptoms of stomach ache.

What treatments help with stomach symptoms? 

— If your symptoms are caused by a specific problem, such as an ulcer, treatments for that problem will likely relieve your symptoms. But if your doctor or nurse does not know what is causing your pain, he or she might recommend medicines that reduce the amount of acid in your stomach. These medicines often relieve stomach ache and the symptoms that come with it. Some of these medicines are available without a prescription.

Can I do anything on my own to prevent stomach ache? — Yes, the foods you eat and the way you eat them can have a big effect on whether or not you feel pain.

To lower your chances of getting a stomach ache:

Avoid fatty foods, such as red meat, butter, fried foods, and cheese

Eat a bunch of small meals each day, rather than two or three big meals

Stay away from foods that seem to make your symptoms worse

Avoid taking over-the-counter medicines that seem to make your symptoms worse – Examples include aspirin or ibuprofen (sample brand names: Advil, Motrin).

Some people – especially kids – sometimes get a stomach ache after drinking milk or eating cheese, ice cream, or other foods that have milk in them. They have a problem called “lactose intolerance,” which means that they cannot fully break down foods that have milk in them. People with lactose intolerance can avoid problems caused by milk if they take a medicine called lactase. Lactase (sample brand name: Lactaid), helps your body break down milk. Some foods come with it already added. If your stomach ache seems to be related to constipation, meaning that you do not have enough bowel movements, you might need more fiber or a medicine called a laxative. (Laxatives are medicines that increase the number of bowel movements you have.) Taking in a lot of fiber helps to increase the number of bowel movements you have. You can get more fiber by:

Eating plenty of fruits, vegetables, and whole grains

Taking fiber pills, powders, or wafers

Is a stomach ache the same for children as it is for adults? — In general, yes. Children get stomach aches for the same reasons that adults do. As with adults, doctors and nurses often do not know what causes stomach pain in children. But in children, stomach pain is often triggered by stress or anxiety. For them, it’s especially important to pay attention to psychological or emotional problems that might be making pain worse.

     

Appendicitis

What is the appendix? — The appendix is a long, thin pouch that is shaped like a finger. It hangs down from the large intestine, which is also called the colon (figure 1).

What is appendicitis? — Appendicitis is the term doctors use when the appendix gets infected and swells. When that happens, the appendix can sometimes burst. A burst appendix can be serious, because it can cause a bad infection.

Appendicitis can happen in children and adults. When it happens in children, it is more likely to affect older children and teens than babies or younger children.

What are the symptoms of appendicitis? — Symptoms can be different, depending on a child’s age. The most common symptoms are:

Belly pain – In older children and teens, belly pain is usually the first symptom. The pain might start around the belly button and then move to the right side of the lower belly. Children can also have belly pain that gets worse with coughing or hopping.

Vomiting

Fever – Fever often starts after 1 to 2 days.

Loss of appetite

Should my child see a doctor or nurse? — Yes. Call your child’s doctor or nurse if your child has the symptoms listed above. If your child does have appendicitis, it’s important to get treatment as soon as possible.

Will my child need tests? — Maybe. Your child’s doctor or nurse will first ask about the symptoms and do an exam. The doctor or nurse might be able to tell if your child has appendicitis without doing any tests.

If the doctor or nurse can’t tell for sure if your child has appendicitis, he or she might do one or more of the following tests:

Blood tests

Urine tests

An imaging test such as an ultrasound or CT scan – Imaging tests create pictures of the inside of the body.

No test can say for sure if a child has appendicitis. But the doctor or nurse can use the test results, symptoms, and exam to figure out how likely it is that your child has appendicitis.

How is appendicitis treated? — The main treatment for appendicitis is surgery to remove the appendix. This surgery can be done in 2 ways:

Open surgery – During open surgery, the doctor makes a cut in the belly near the appendix. Then he or she removes the appendix through that opening.

Laparoscopic surgery – During laparoscopic surgery, the doctor makes a few cuts in the belly that are much smaller than cuts for open surgery. He or she puts long, thin tools into the belly through these openings. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to know where to cut and what to remove. Then he or she uses the tools to do the surgery.

If your child’s appendix has burst, the doctor will do surgery to remove the appendix. During the surgery, he or she will also clean out the area in the belly around the appendix to wash away the material that spilled out of the burst appendix. This surgery can be more complicated than the surgery that is done if the appendix has not burst. If it has been more than a few days since your child’s appendix burst, your child might not have surgery right away. That’s because the body sometimes forms a wall inside the belly, to block off the area that became infected when the appendix burst. In cases like these, the doctor will first treat your child with antibiotics and watch him or her. He or she might take the appendix out once the antibiotics have made your child feel better, or stick a needle in the walled-off area to drain the infected fluid. This treatment is usually done at the same time as an imaging test, so that the doctor can see where to put the needle. After the doctor treats the infection, he or she might recommend that your child have surgery later on.

Appendicitis in Children

What is the appendix? — The appendix is a long, thin pouch that is shaped like a finger. It hangs down from the large intestine, which is also called the colon (figure 1).

What is appendicitis? — Appendicitis is the term doctors use when the appendix gets infected and swells. When that happens, the appendix can sometimes burst. A burst appendix can be serious, because it can cause a bad infection.

Appendicitis can happen in children and adults. When it happens in children, it is more likely to affect older children and teens than babies or younger children.

What are the symptoms of appendicitis? — Symptoms can be different, depending on a child’s age. The most common symptoms are:

Belly pain – In older children and teens, belly pain is usually the first symptom. The pain might start around the belly button and then move to the right side of the lower belly. Children can also have belly pain that gets worse with coughing or hopping.

Vomiting

Fever – Fever often starts after 1 to 2 days.

Loss of appetite

Should my child see a doctor or nurse? — Yes. Call your child’s doctor or nurse if your child has the symptoms listed above. If your child does have appendicitis, it’s important to get treatment as soon as possible.

Will my child need tests? — Maybe. Your child’s doctor or nurse will first ask about the symptoms and do an exam. The doctor or nurse might be able to tell if your child has appendicitis without doing any tests.

If the doctor or nurse can’t tell for sure if your child has appendicitis, he or she might do one or more of the following tests:

Blood tests

Urine tests

An imaging test such as an ultrasound or CT scan – Imaging tests create pictures of the inside of the body.

No test can say for sure if a child has appendicitis. But the doctor or nurse can use the test results, symptoms, and exam to figure out how likely it is that your child has appendicitis.

How is appendicitis treated? — The main treatment for appendicitis is surgery to remove the appendix. This surgery can be done in 2 ways:

Open surgery – During open surgery, the doctor makes a cut in the belly near the appendix. Then he or she removes the appendix through that opening.

Laparoscopic surgery – During laparoscopic surgery, the doctor makes a few cuts in the belly that are much smaller than cuts for open surgery. He or she puts long, thin tools into the belly through these openings. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to know where to cut and what to remove. Then he or she uses the tools to do the surgery.

If your child’s appendix has burst, the doctor will do surgery to remove the appendix. During the surgery, he or she will also clean out the area in the belly around the appendix to wash away the material that spilled out of the burst appendix. This surgery can be more complicated than the surgery that is done if the appendix has not burst. If it has been more than a few days since your child’s appendix burst, your child might not have surgery right away. That’s because the body sometimes forms a wall inside the belly, to block off the area that became infected when the appendix burst. In cases like these, the doctor will first treat your child with antibiotics and watch him or her. He or she might take the appendix out once the antibiotics have made your child feel better, or stick a needle in the walled-off area to drain the infected fluid. This treatment is usually done at the same time as an imaging test, so that the doctor can see where to put the needle. After the doctor treats the infection, he or she might recommend that your child have surgery later on.

Hypertrophic Cardiomyopathy – HCM

What is hypertrophic cardiomyopathy? — Hypertrophic cardiomyopathy is a condition that causes the muscle in the heart to get too bulky (figure 1). When this happens, the heart can have trouble pumping blood as well as it should. This can lead to symptoms, such as trouble breathing, chest pain, and fainting. Hypertrophic cardiomyopathy is caused by a genetic problem that runs in families.

What are the symptoms of hypertrophic cardiomyopathy? — Most people with hypertrophic cardiomyopathy have no symptoms. When symptoms do occur, they can start during childhood, the teenage years, or adulthood.

Symptoms can include:

Trouble breathing, especially during exercise

Trouble breathing that gets worse when you lie down and gets better if you sit up or stand

Chest pain, which sometimes gets worse with activity

Fainting or feeling like you might faint

Feeling as though your heart is beating very fast or skipping beats

Swelling in the feet, ankles, or legs

Is there a test for cardiomyopathy? — Yes. If your doctor or nurse suspects you have cardiomyopathy, he or she will probably order an “electrocardiogram” (also called an “ECG” or “EKG”) (figure 2). This test measures the electrical activity in your heart. It can show if your heart beats in a normal pattern and rhythm.

Your doctor might also order an “echocardiogram” (or “echo” for short) (figure 3). An echo uses sound waves to create an image of the heart. This test allows doctors to measure the thickness of the walls of the heart, measure the size of the spaces inside the heart — called chambers — and see how the heart pumps. Depending on your situation, you might also need other tests. Since hypertrophic cardiomyopathy runs in families, your doctor or nurse might suggest testing your family members for the disorder, too.

What problems can hypertrophic cardiomyopathy cause? — In many cases the condition causes no problems. But in some cases it can lead to:

Heart failure, a condition in which the heart does not pump as well as it should

Heart rhythm disorders

Heart block, a problem that keeps electrical signals from moving through the heart as they should

Stroke

Infection of a heart valve

Death

How is hypertrophic cardiomyopathy treated? — Many people with hypertrophic cardiomyopathy do not need treatment. Those who do need treatment can get different kinds depending on what symptoms they have and how severe their condition is.

Treatments can include:

Medicines to relieve chest pain or trouble breathing

Medicines to control the heart’s rhythm

Surgery to implant a device called an “implantable cardioverter-defibrillator,” or “ICD.” (This device keeps the heart beating normally.)

Surgery or other treatments to remove parts of the heart muscle. (This is done only when medicines do not work.)

What if I want to get pregnant? — Talk to your doctor before you start trying to get pregnant. Most women with hypertrophic cardiomyopathy are able to have normal pregnancies. But some need to change their medicines before they start trying to have a baby.

Is there anything I can do on my own to protect my heart and my health? — Yes. You should be careful to always drink enough water. People with hypertrophic cardiomyopathy sometimes have problems, such as fainting, when they do not get enough fluids. On the other hand, some people with hypertrophic cardiomyopathy have to be careful if they have too much salt and water. Ask your doctor about how much salt is OK to have in your diet.

It’s also important that you ask your doctor what types of physical activity are safe for you. In many cases, people with hypertrophic cardiomyopathy need to avoid some kinds of activity.

Jet Lag

What is jet lag? — Jet lag is a condition that causes sleep problems, tiredness, and other symptoms. It happens in people who fly across several time zones, especially when they fly east. The more time zones a person crosses, the more likely he or she is to get jet lag.

Jet lag gets better on its own as a person adjusts to the new time zone. But this can take several days. The farther from home a person is, the longer it takes to get over jet lag.

What are the symptoms of jet lag? — The symptoms include:

Sleep problems, such as problems falling or staying asleep

Feeling tired or sleepy in the daytime

Having trouble thinking, concentrating, or doing normal activities

Stomach problems, such as constipation

Feeling sick or having less energy than normal

Should I see a doctor or nurse? — If you think you had jet lag in the past, talk to your doctor or nurse before going on a long airline flight. He or she can help you figure out ways to avoid jet lag.

How can I prevent jet lag? — Here are a few things you can try:

Stay awake and sleep at certain times. This can help your body adjust to the new time zone. For example, you can:

Stay up until it’s dark if you fly west – Only go to sleep when it gets dark. If you go sightseeing, try to do it during the day.

Avoid bright morning light if you fly east – Go outside as much as possible in the afternoon. If you go sightseeing outdoors, try to do it in the afternoon until your body adjusts to the new time zone.

Eat meals at mealtime in the new time zone – For example, if you normally eat lunch at noon, eat at noon in the new time zone (not noon at home).

Get some exercise, but not right before you are supposed to go to sleep.

Can supplements or medicines help with jet lag? — Yes. A supplement called “melatonin” can help with sleep problems from jet lag when you fly east. Melatonin is a hormone that is naturally made by a gland in the brain. Taking extra melatonin can help your body adjust to a new time zone. You can buy melatonin pills in a store or pharmacy without a prescription. The usual dose is 5 milligrams after dark each night, about half an hour before you want to go to sleep.

If you want to try melatonin, tell your doctor or nurse. He or she can tell you if it is safe for you. If you take warfarin (brand names: Coumadin, Jantoven) or medicine to help with epilepsy, melatonin might not be safe for you. Tell your doctor or nurse about all medicines and supplements you take, including over-the-counter medicines. You should start taking melatonin the night you arrive, at bedtime. You can take melatonin for up to 5 nights in the new time zone. After that, you are not likely to need it. Only adults should take melatonin. Doctors don’t know if it helps with jet lag in children. Avoid drinking alcohol while you are taking melatonin.

Does melatonin cause side effects? — Some people have side effects from melatonin. These can include:

Feeling sleepy in the daytime

Dizziness or confusion

Headache

Loss of appetite, nausea, and other stomach problems

But these side effects are very similar to jet lag. So doctors are not sure if they are really side effects of melatonin or just jet lag symptoms.

Heart Block

What is heart block? — Heart block is a condition that affects the electrical system that controls the heartbeat. Mild types of heart block can cause your heart to beat more slowly than normal or to skip beats. More serious types can cause your heart to stop beating. Without emergency treatment, serious heart block can be fatal.

What causes heart block? — Heart block happens when the electrical signals that tell the heart to beat either get slowed down or stopped. Most people with heart block get it from a disease, surgery, or medicine that damaged their heart. In rare cases, people are born with heart block.

What are the symptoms of heart block? — The symptoms depend on the type of heart block a person has. There are 3 types of heart block:

First degree – This is the mildest type of heart block. Often, people with this type have no symptoms.

Second degree – This type is more serious than first degree. Symptoms include:

Fainting

Feeling dizzy

Feeling tired

Trouble breathing

Chest pain

Third degree – This is the most serious type of heart block. It can cause the same symptoms as second degree, but they will be more severe. In some cases, third degree heart block can be life threatening.

Is there a test for heart block? — Yes. Your doctor or nurse will probably do a test called an electrocardiogram (also called an “ECG” or “EKG”). This test measures the electrical activity in your heart (figure 1).

You might also need other tests to see if another condition is causing your slow heartbeat.

Should I see a doctor or nurse? — If you have trouble breathing or have chest pain that lasts for more than a few minutes, call for an ambulance (in the US and Canada, dial 9-1-1).

If you do not have these problems, but you often notice your heart beating slowly or skipping beats, talk to your doctor or nurse.

How is heart block treated? — The treatment depends on the type of heart block you have. Often, people who have first degree heart block do not need treatment. But people who have third degree heart block and some people who have second degree heart block need a pacemaker. A pacemaker is a device that goes under the skin near a person’s heart. It sends electrical signals to the heart that help it beat at a normal rate.

Can heart block be prevented? — People who have heart disease are more likely to get heart block. Doing things that keep your heart healthy can help prevent heart disease. This includes:

Eating a healthy diet. This involves eating lots of fruits and vegetables and low-fat dairy products, but not a lot of meat or fatty foods.

Walking or doing a physical activity on most days of the week.

Losing weight, if you are overweight.

   

DKA – Diabetic Ketoacidosis

What is diabetic ketoacidosis? — Diabetic ketoacidosis is a serious problem that happens to people with diabetes when chemicals called “ketones” build up in their blood. It can happen to people with either type 1 or type 2 diabetes, but it is more likely to affect people with type 1. That’s because people with type 1 make little or no insulin, a hormone that allows the body to use sugar as a source of energy. Normally, the body breaks down sugar as a source of energy. But in people with diabetes who do not make any insulin, the body is unable to use sugar. When the body can’t use sugar, it burns fat as a source of energy. But burning fat can cause the body to make too many ketones. When ketones build up in the blood, they can be toxic. What causes diabetic ketoacidosis? — People can get diabetic ketoacidosis for a few reasons: ●They are not getting treated for diabetes (possibly because they don’t know they have it) and so their body is breaking down fat. ●They have a major illness or health problem, such a heart attack or infection. ●They take certain medicines or illegal drugs. ●They don’t take their insulin as directed. ●Their insulin pump does not work correctly. What are the symptoms of diabetic ketoacidosis? — The symptoms can include: ●Feeling very thirsty and drinking a lot ●Urinating a lot, including at night ●Nausea or vomiting ●Belly pain ●Feeling tired or having trouble thinking clearly ●Having breath that smells sweet or fruity ●Weight loss Should I see a doctor or nurse? — See your doctor or nurse right away if you have the symptoms listed above. Also, see your doctor or nurse if your blood sugar levels keep being higher than they should be. Is there a test for diabetic ketoacidosis? — Yes. If the doctor or nurse thinks you have diabetic ketoacidosis, he or she will order several blood tests, including tests to check your blood sugar and ketone levels. He or she will also check your urine for ketones. These tests can show whether you have diabetic ketoacidosis. Because diabetic ketoacidosis can cause problems with the heart, you might also need an electrocardiogram. That is a test to measure the electrical activity in the heart. How is diabetic ketoacidosis treated? — Treatment is done at the hospital and can include: ●Fluids and electrolytes – When dealing with diabetic ketoacidosis, the body loses a lot of fluids. It also loses electrolytes, chemicals such as sodium and potassium, that keep cells working normally. As part of treatment for the condition, doctors must replace lost fluids and electrolytes. ●Insulin – When the body has enough insulin, it can use sugar as fuel and it does not need to break down fat. Can diabetic ketoacidosis be prevented? — You can reduce your chances of getting diabetic ketoacidosis by:●Taking your insulin exactly as directed ●Taking your insulin exactly as directed ●Measuring your blood sugar often to make sure it is not too high or too low    

Paracentesis – procedure to remove fluid inside the abdomen.

https://youtu.be/F1ZLWR_mYy8Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites . Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.

Why It Is Done

Paracentesis may be done to:
  • Find the cause of fluid buildup in the belly.
  • Diagnose an infection in the peritoneal fluid.
  • Check for certain types of cancer, such as liver cancer.
  • Remove a large amount of fluid that is causing pain or trouble breathing or that is affecting how the kidneys or the intestines (bowel) are working.
  • Check for damage after a belly injury.

How To Prepare

Before you have paracentesis done, tell your doctor if you: Other blood tests may be done before a paracentesis to make sure that you do not have any bleeding or clotting problems. You will empty your bladder before the procedure. You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

How It Is Done

This procedure may be done in your doctor’s office, an emergency room, or the X-ray department of a hospital, or at your bedside in the hospital.
If a large amount of fluid is going to be taken out during the procedure, you may lie on your back with your head raised. People who have less fluid taken out may sit up. The site where your doctor will put the needle is cleaned with a special soap and draped with sterile towels.Your doctor puts a numbing medicine into your belly. Once the area is numb, your doctor will gently and slowly put the paracentesis needle in where the extra fluid is likely to be. Your doctor will be careful to not poke any blood vessels or the intestines. If your test is done in the X-ray department, an ultrasound may be used to show where the fluid is in your belly. If a large amount of fluid is present, the paracentesis needle may be hooked by a small tube to a vacuum bottle for the fluid to drain into it. Generally, up to 4 L (1 gal) of fluid is taken out. If your doctor needs to remove a larger amount of fluid, you may be given fluids through an intravenous line (IV) in a vein in your arm. This fluid is needed to prevent low blood pressure or shock. It is important that you lie completely still during the procedure unless you are asked to change positions to help drain the fluid. When the fluid has drained, the needle is taken out and a bandage is placed over the site. After the test, your pulse, blood pressure, and temperature are watched for about an hour. You may be weighed and the distance around your belly may be measured before and after the test. Paracentesis takes about 20 to 30 minutes. It will take longer if a large amount of fluid is taken out. You can do your normal activities after the test unless your doctor tells you not to.

How It Feels

You may feel a brief, sharp sting when the numbing medicine is given. When the paracentesis needle is put into your belly, you may feel a temporary sharp pain or pressure.
You may feel dizzy or lightheaded if a large amount of fluid is taken out. Tell your doctor if you do not feel well during the test.After the procedure, you may have some clear fluid draining from the site, especially if a large amount of fluid was taken out. The drainage will get less in 1 to 2 days. A small gauze pad and bandage may be needed. Ask your doctor how much drainage to expect.

Risks

There is a very small chance that the paracentesis needle may poke the bladder, bowel, or a blood vessel in the belly. If cancer cells are present in the peritoneal fluid, there is a small chance that the cancer cells may be spread in the belly. If a large amount of fluid is removed, there is a small chance that your blood pressure could drop to a low level. This could lead to shock. If you go into shock, IV fluids or medicines, or both, may be given to help return your blood pressure to normal. There is also a small chance that removing the peritoneal fluid may affect how your kidneys work. If this is a concern, IV fluids may be given during the paracentesis.

After the test Call your doctor immediately if you have:

  • A fever higher than 100°F (38°C).
  • Severe belly pain.
  • More redness or tenderness in your belly.
  • Blood in your urine.
  • Bleeding or a lot of drainage from the site.

Results

Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites . The fluid taken from your belly will be sent to a lab to be studied and looked at under a microscope. Results will be ready in a few hours.
Paracentesis
Normal: No infection, cancer, or abnormal values are found.
Abnormal: Several tests may be done on the fluid.
  • Cell counts. A high number of white blood cells (WBCs) in the fluid may mean inflammation, infection (peritonitis), or cancer is present. A high WBC count and a high count of WBCs called polymorphonuclear leukocytes (PMNs) may mean there is an infection inside the belly called spontaneous bacterial peritonitis (SBP).
  • Serum-ascites albumin gradient (SAAG). The SAAG compares the level of protein in the fluid to the level of protein in the blood. High protein levels in the fluid may mean cancer,tuberculosisnephrotic syndrome, orpancreatitis. Low protein levels in the fluid may mean cirrhosis or clots in veins of the liver are present.
  • Culture. A culture can be done on the fluid to see whether bacteria or other infectious organisms are present.
  • Lactate dehydrogenase (LDH). High levels of the enzyme LDH may mean infection or cancer is present.
  • Cytology. Abnormal cells in the fluid may mean cancer is present.
  • Amylase. High levels of amylase may mean pancreatitis or that there is a hole in the intestine.
  • Glucose. Low levels of glucose may mean infection.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:
  • Using blood thinners (anticoagulants) or aspirin, which can increase the chance of bleeding.
  • Having blood, bile, urine, or feces in the fluid sample.
  • Not being able to stay still during the test.
  • Being obese.
  • Having scars inside the belly (adhesions) from any belly surgery in the past.

What To Think About

Sometimes doctors use fluids put into the belly to check for injuries. This is called peritoneal lavage. During this procedure, a doctor uses a paracentesis needle to put a salt (saline) fluid into the belly. The fluid is then taken out through the same needle. If the fluid that comes out is bloody, the bleeding is probably being caused by an injury inside the belly.