Diarrhea

Diarrhea

Frequent loose bowel movements (4 to 6/day) may occur in normal infants; they are of no concern unless anorexia, vomiting, weight loss, failure to gain weight, or passage of blood also occurs. Breastfed infants tend to have frequent bowel movements, especially if they are not receiving solid food. The significance of diarrhea in a child at any age differs if it is acute (< 2 wk) or chronic (> 2 wk).

Etiology

Acute diarrhea is most likely infectious, especially if onset is sudden or accompanied by vomiting, bloody stools, fever, anorexia, or listlessness. Diagnosis is clinical, and treatment is supportive until the condition resolves spontaneously.

Chronic diarrhea is usually more significant. Causes include gluten-induced enteropathy, cystic fibrosis, sugar malabsorption, and allergic gastroenteropathy. Inflammatory bowel disease and some infections (eg, with Giardia) can also cause chronic diarrhea.

With gluten-induced enteropathy (celiac sprue), the gluten fraction of wheat protein causes intestinal mucosal damage and malabsorption of dietary fats, resulting in malnutrition, anorexia, and bulky, foul-smelling stools. The change in stools starts when wheat and other gluten-containing foods are added.

With cystic fibrosis, pancreatic insufficiency results in trypsin and lipase deficits, causing high fecal losses of protein and fats with consequent malnutrition and growth retardation. The stool is voluminous and often foul-smelling. Children who have cystic fibrosis often have respiratory problems and growth failure.

With sugar malabsorption, intestinal mucosal enzymes, such as lactase, which splits lactose to galactose and glucose, may be congenitally absent or temporarily deficient secondary to GI infection. Improvement after eliminating lactose (or other carbohydrates) from the diet or after substituting a lactose-free formula strongly suggests the diagnosis.

With allergic gastroenteropathy, cow's milk protein may cause diarrhea, often with vomiting and blood in the stools, but intolerance to the carbohydrate fraction of the ingested food should be suspected also. Symptoms often abate promptly when soy formula is substituted for cow's milk and return if cow's milk is reintroduced. Some infants intolerant of cow's milk are also intolerant of soy, so a formula that has had the protein pre-digested and does not contain the offending disaccharide may be needed. Spontaneous improvement usually occurs toward the end of the 1st yr.

Treatment

Supportive care for acute diarrhea consists primarily of providing adequate oral (or rarely IV) rehydration. Antimotility agents (eg, loperamide: IMODIUM) are generally not recommended for infants and young children.

For chronic diarrhea, adequate nutrition must be maintained, particularly of fat-soluble vitamins. Specific treatments are indicated for certain causes (eg, gluten-free diet for those with celiac disease).

Sleeping

Sleeping

Sleep behaviors are culturally determined, and problems tend to be defined as behaviors that vary from accepted customs or norms. In cultures where children sleep separately from their parents in the same house, sleep problems are among the most common that parents and children face. Infants generally adapt to a day-night sleep schedule between 4 and 6 mo. Sleep problems beyond these ages take many forms, including difficulty falling asleep at night, frequent nighttime awakening, atypical daytime napping, and dependence on feeding or being held for sleep. These problems are related to parental expectations, the child's temperament and biologic rhythms, and child-parent interactions. Inborn biologic patterns are central to an infant's sleep patterns, whereas emotional factors and established habits become more important in the toddler and older child. In addition, sleep disturbances become common at 9 mo and again around 18 mo, when separation anxiety, increasing ability of the child to move independently and control his environment, long late-afternoon naps, overstimulating play before bedtime, and nightmares tend to become more common.

Treatment

The clinician's role in treatment is to present explanations and options to parents, who must implement changes to get the child on an acceptable sleep schedule. Approaches vary with age and circumstances. Infants are often comforted by swaddling, ambient noise, and movement. However, always rocking the infant to sleep does not allow the infant to learn how to fall asleep on his own, which is an important developmental task. As a substitute for rocking, the parent can sit quietly by the crib until the infant falls asleep, and the infant eventually learns to be comforted and to fall asleep without being held. All children awaken during the night, but children who have been taught to fall asleep by themselves will usually settle themselves back to sleep. When a child is unable to get back to sleep, parents can check on the child to reassure themselves of the child's safety and to reassure the child, but the child should then be allowed to settle himself back to sleep.

In older children, a period of "winding down" with quiet activities such as reading at bedtime facilitates sleep. A consistent bedtime is important, and a fixed ritual is helpful for young children. Asking a fully verbal child to recount the events of the day often eliminates nightmares and waking. Encouraging exercise in the daytime, avoiding scary television programs and movies, and refusing to allow bedtime to become an element of manipulation also help prevent sleep problems. Stressful events (eg, moving, illness) may cause acute sleep problems in older children; reassurance and encouragement are always ultimately effective. Allowing the child to sleep in the parents' bed in such instances almost always prolongs rather than resolves the problem.

Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome
  
Definition/Description
 
Acute respiratory distress syndrome (ARDS) is breathing failure that can occur in critically ill persons with underlying illnesses. When one develops ARDS, severe fluid buildup occurs in both lungs and prevents the lungs from transfering oxygen from air into the body and carbon dioxide out of the body into the air. Noncardiogenic pulmonary edema; increased-permeability pulmonary edema; stiff lung; shock lung; and acute lung injury are its alternative names.
 
Causes
  
ARDS can be caused by any major swelling (inflammation) or injury to the lung. Some common causes include:
 
◆　Aspiration)
 
◆　Pneumonia
 
◆　Septic shock
 
◆　Trauma

ARDS leads to a buildup of fluid in the alveoli, which prevents enough oxygen from passing into the bloodstream.
 
The fluid buildup also makes the lungs heavy and stiff, and decreases the lungs' ability to expand. The level of oxygen in the blood can stay dangerously low, even if the person receives oxygen from mechanical ventilator through endotracheal tube.
 
ARDS often occurs along with the failure of other organ systems, such as the liver or the kidneys. Cigarette smoking and heavy alcohol use may be risk factors.
 
Symptoms/Signs

Symptoms usually develop within 24 to 48 hours of the initial injury or illness. Often, people with ARDS are so sick they are unable to complain of symptoms. However, the major signs and symptoms are:
 
◆ Dyspnea, tachypnea
 
◆ Hypotention and organ failure

◆ Cyanosis
 
Examinations/Tests
 
Listening to the chest with a stethoscope (auscultation) reveals abnormal breath sounds, such as crackles that suggest fluid in the lungs. Often the blood pressure is low. Cyanosis (blue skin, lips, and nails caused by lack of oxygen to the tissues) is often seen.

Tests used to diagnose ARDS include:

◆ Arterial blood gas

◆ Bronchoscopy

◆ CBC and blood chemistries

◆ Chest x-ray

◆ Sputum cultures and analysis

◆ Tests for possible infections

Occasionally an echocardiogram or Swan-Ganz catheterization may need to be done to rule out congestive heart failure, which can look similar to ARDS on a chest x-ray.

Treatment

Typically persons with ARDS need to be in an intensive care unit (ICU). The goal of treatment is to provide breathing support and treat the underlying cause of ARDS. This may involve medications to treat infections, reduce inflammation, and remove fluid from the lungs.

A breathing machine is used to deliver high doses of oxygen and a continuous level of pressure called PEEP (positive end-expiratory pressure) to the damaged lungs. Patients often need to be deeply sedated with medications when using this equipment.

Many different kinds of medicines are used to treat ARDS patients. Some kinds of medicines often used include:

◆ Antibiotics to fight infection

◆ Pain relievers

◆ Drugs to relieve anxiety and keep the patient calm

◆ Drugs to raise blood pressure or stimulate the heart

◆ Muscle relaxers to prevent movement and reduce the body's demand for oxygen

Complications

Common complications in ARDS patients are infections with hospital-acquired bacteria and leaks of air out of the lungs into other body spaces. These include:

◆ Lung damage (such as pneumothorax) due to use of high settings on the breathing machine needed to treat the disease

◆ Multiple organ system failure

◆ Pulmonary fibrosis

◆ Ventilator-associated pneumonia

Prognosis

About a third of people with ARDS die from the disease. Survivors usually get back normal lung function, but many people have permanent, usually mild, lung damage.

Many people who survive ARDS have memory loss or other problems with thinking after they recover. This is due to brain damage that occurred when the lungs weren't working properly and the brain wasn't getting enough oxygen.
 

Terms Commonly Used in TCM

中国医药学　Traditional Chinese Medicine		治未病　prevention of disease
中医基础理论　Basic theory of traditional Chinese medicine		脏腑　zang-organs and fu-organs, viscera
临床经验　clinical experience		功能活动　functional activities
辨证论治　treatment based on syndrome differentiation		形神统一　unity of the body and spirit
本草　materia medica, herbs		阴阳失调　imbalance of yin and yang
中药　Chinese materia medica, Chinese medicinal herbs		条达舒畅　free development
四气五味　four properties and five tastes		延年益寿　prolonging life, promising longevity
针灸　acupuncture and moxibustion, acumox		养生防病　cultivating health to prevent disease
各家学说　theories of different schools		正气　healthy qi, vital qi
汗法　diaphoresis, sweating therapy		病邪　pathogenic factor
下法　purgative therapy, purgation		整体观念　concept of holism
吐法　emetic therapy, vomiting therapy		疾病的本质与现象　nature and manifestations of disease
补土派　school of invigorating the earth		阴阳的相对平衡　relative balance between yin and yang
病因学说　etiology		疾病的发生与发展　occurrence and development of disease
养生　health-cultivation,		同病异治　treating the same disease with different therapies
医疗实践　medical practice		异病同治　treating different diseases with the same therapy
治疗原则　therapeutic principles		五脏　five zang-organs, five zang-viscera
寒凉药物　herbs of cold and cool nature, cold-natured herbs		六腑　six fu-organs, six fu-viscera
滋阴降火　nourishing yin to lower/reduce fire		经络系统　system of meridians and collaterals
滋水涵木　enriching water to nourish wood		余热未尽　incomplete abatement of heat
瘀血致泻　disease caused by blood stasis		有机整体　organic wholeness/integrity
先天之精　congenital essence		表里关系　exterior and interior relation
形与神俱　inseparability of the body and spirit		开窍　opening into
开胃　promoting appetite		自然现象　natural phenomena
脉象　pulse conditions, pulse pattern		哲学概念　philosophical concept
邪正关系　states of pathogenic factors and healthy qi		对立统一　unity of opposites
发热恶寒　fever and aversion to cold		相互消长　mutual waning and waxing
头身疼痛　headache and body pain		相互转化　mutual transformation
久痢脱肛　proctoptosis due to prolonged dysentery		阴阳属性　nature of yin and yang
养阴清热　nourishing yin and clearing away heat		相互联系　interrelation
清肺热　clear away lung-heat		相互制约　mutual restraint, mutual restriction/interaction
湿邪犯肺　pathogenic dampness invading the lung		动态平衡　dynamic equilibrium
清热泻火　clearing away heat and reducing fire		阴平阳秘　yin and yang in equilibrium
腠理　muscular interstices, striae, interstitial space		阴阳的互根互用　interdependence of yin and yang
水湿停滞　retention of water and dampness, water retention		相互依存　interdependence
癃闭　retention of urine		阴阳离绝　separation of yin and yang
气血运行　circulation/flow of qi and blood		相反相成　opposite and supplementary to each
阴阳转化　transformation between yin and yang		生理功能　physiological functions
阳消阴长　yang waning and yin waxing		病理变化　pathological changes
阴胜则阳病　predominance of yin leading to disorder of yang		临床诊断　clinical diagnosis
阴胜则阳病　an excess of yin leads to deficiency of yang		阳胜生外热　exuberance of yang leading to exterior heat
阳胜则热　predominance of yang generating heat		阳中求阴　obtaining yang from yin
寒极生热　extreme cold generating heat		绝对偏盛　absolute predominance
热极生寒　extreme heat generating cold		阳虚则寒　yang deficiency leading to cold
阳损及阴　impairment of yang involving yin		阴阳俱损　simultaneous consumption of yin and yang
阴液不足　insufficiency of yin-fluid		阴阳两虚　simultaneous deficiency of both yin and yang
病机总纲　general principle of pathogenesis		阳虚发热　fever due to yang deficiency
病机　pathomechanism, pathological mechanism		阴阳自和　natural harmony between yin and yang
阴阳胜复　alternative predominance of yin and yang		木乘土　the wood over-restrains the earth
虚寒证　deficiency-cold syndrome		木火刑金　wood-fire impairs the metal
扶阳退阴　strengthening yang to reduce yin		金水相生　generation between the metal and water
祛风散寒　expelling/eliminating wind to dispersing cold		生克制化　interrelationship between generation and restriction
消导积滞　promoting digestion and removing food retention		制则生化　restriction ensuring generation
潜阳熄风　suppressing yang to quench wind		母病及子　disease of the mother-organ affecting the child-organ
五行学说　theory of five elements		传变　transmission of disease, progress of disease
运动变化　motion and variation		子病犯母　disease of the child-organ affecting the mother-organ
正邪相争　struggle/combat between healthy qi and pathogenic factors		肝肾精血不足　insufficiency of liver and kidney essence and blood
相生相克　mutual generation and restriction		肝阳上亢　hyperactivity of liver yang
生我，我生　to be generated and to generate		心肝血虚　asthenia / deficiency of heart and liver blood
克我，我克　to be restricted and to restrict		心肝火旺　exuberance of heart and liver fire
生中有制　restriction within generation		心火亢盛　hyperactivity/exuberance of heart fire
克中有生　generation within restriction		滋肾养肝　nourishing the kidney and liver
木曰曲直　wood is characterized by growing freely and peripherally		方位配五行　correspondence of the directions to the five elements
火曰炎上　fire is characterized by flaming up		温肾健脾　warming the kidney and strengthening the spleen
土爰稼穑　earth is characterized by cultivation and reaping		肾阳式微　declination of kidney yang
金曰从革　metal is characterized by change		脾阳不振　inactivation of spleen yang
病缓起　gradual onset of disease		脾胃虚弱　hypofunction/weakness of the spleen and stomach
肝阴不足　insufficiency of liver yin		地道不通　menopause
相乘相侮　over-restriction and reverse restriction		平肝和胃　soothing the liver and harmonizing the stomach
水湿停聚　retention of water-dampness		水火不济　discordance between water and fire
肾阴不足　insufficiency of kidney yin		藏象学说　theory of visceral manifestations
心肾不交　disharmony between the heart and kidney		奇恒之腑　extraordinary fu-organs
宣通水道　dredging water passage		水谷精微　cereal nutrients, essence of water and food
通调水道　dredging and regulating water passage		传化水谷　transmission and transformation of food
行气利水　activating qi to excrete water		贮藏精气　storage of essence
水液停滞　retention of fluid		治疗效果　curative / therapeutic effect
后天之本　postnatal / acquired base of life		藏而不泻　storage without excretion
调畅气机　regulating qi activity		泻而不藏　excretion without storage
肝气上逆　upward flow of liver qi		表热里寒　exterior heat and interior cold
水曰润下　water is characterized by moistening and downward flowing		肝旺脾虚　hyperfunction of the liver and weakness of the spleen
脾主运化　the spleen governing transportation and transformation		大肉陷下　obvious emaciation and muscular atrophy, extreme emaciation
肝气郁结　stagnation of liver qi		面色红润　ruddy complexion, rosy cheeks
胆虚证　gallbladder deficiency syndrome		胆虚不得眠　insomnia due to gallbladder asthenia
腐熟水谷　digesting food		导便法　laxation
食欲不振　poor appetite		跌打损伤　traumatic injury
脘腹胀闷　epigastric distension and depression		动静结合　integration of motion and quietness/stillness
嗳气酸腐　eructation with fetid odor		定喘　relieving asthma
泌别清浊　separating the clear from the turbid		心主血脉　the heart controlling blood and vessels
食物残渣　residue of food		心气充沛　abundance of heart qi
大肠主传导　the large intestine governing transmission and transportation		防御外邪入侵　preventing the invasion of exogenous pathogenic factor
癃闭　dysuria, retention of urine, anuria and dysuria		血液充盈　plenty of blood
面黄肌瘦　emaciation with sallow complexion		脉道不利　unsmoothness of vessels
止珠偏斜　strabismus, squint, ocular deviation		面色无华　lusterless complexion
调节水液　regulation of water		脉象细弱　thin and weak pulse
排泄糟粕　excretion of waste material		面色萎黄　sallow complexion
髓海不足　insufficiency of marrow-sea		汗血同源　sweat and blood sharing the same origin
精神委靡　dispiritedness, listlessness, lower spirit		升降出入　ascending, descending, coming in and going out
月经不调　irregular menstruation		气为血帅　qi serves as the commander of the blood
冲任不固　weakness of thoroughfare and conception vessels		气血凝滞　stagnation of qi and blood
经期延长　prolonged menstruation		血瘀　blood stasis
小肠实热　sthenia-heat in the small intestine		气滞腰痛　lumbago due to qi stagnation
气机调畅　smooth activity of qi		气虚滑胎　habitual abortion due to qi asthenia