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Sepsis

Alternative Names: Systemic inflammatory response syndrome (SIRS),blood poisoning or septicaemia.

Definition:
Sepsis is a bacterial infection of the blood.It is a severe illness in which the bloodstream is overwhelmed by bacteria.While sepsis can happen to anyone, it’s most common and most dangerous in people who are elderly or who have weakened immune systems.

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Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammation throughout the body. This inflammation creates microscopic blood clots that can block nutrients and oxygen from reaching organs, causing them to fail. If sepsis progresses to septic shock, blood pressure drops dramatically and the person may die.

Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival.

Symptoms:
In addition to symptoms related to the provoking infection, sepsis is characterized by presence of acute inflammation present throughout the entire body, and is, therefore, frequently associated with fever and elevated white blood cell count (leukocytosis) or low white blood cell count and lower-than-average temperature, and vomiting. The modern concept of sepsis is that the host’s immune response to the infection causes most of the symptoms of sepsis, resulting in hemodynamic consequences and damage to organs. This host response has been termed systemic inflammatory response syndrome (SIRS) and is characterized by an elevated heart rate (above 90 beats per minute), high respiratory rate (above 20 breaths per minute or a partial pressure of carbon dioxide in the blood of less than 32), abnormal white blood cell count (above 12,000, lower than 4,000, or greater than 10% band forms) and elevated or lowered body temperature, i.e. under 36 °C (97 °F) or over 38 °C (100 °F). Sepsis is differentiated from SIRS by the presence of a known or suspected pathogen. For example SIRS and a positive blood culture for a pathogen indicates the presence of sepsis. However, in many cases of sepsis no specific pathogen is identified.

This immunological response causes widespread activation of acute-phase proteins, affecting the complement system and the coagulation pathways, which then cause damage to the vasculature as well as to the organs. Various neuroendocrine counter-regulatory systems are then activated as well, often compounding the problem. Even with immediate and aggressive treatment, this may progress to multiple organ dysfunction syndrome and eventually death.

Causes:
Sepsis is often a complication of another infection, such as of the lungs or kidneys, and occurs when the bacteria escape that part of the body and get into the bloodstream.

This bacteria can also come from burns, infected wounds, boils and tooth abscesses. Sometimes it isn’t obvious how it has got into your blood.

Anyone can develop sepsis. The people most at risk are those with weakened immune systems, because of an existing illness, for example, or medication.

Older people, children and intravenous drug users are also more susceptible.

In children, sepsis may accompany infection of the bone (osteomyelitis). In hospitalized patients, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as bedsores (decubitus ulcers).

Risk Factors:
Sepsis is more common and more dangerous in people who:

*Are very young or very old
*Have compromised immune systems
*Are already very sick, often in a hospital’s intensive care unit
*Have invasive devices, such as intravenous catheters or breathing tubes

Complication:
As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis can also cause blood clots to form in your organs and in your arms, legs, fingers and toes — leading to varying degrees of organ failure and tissue death (gangrene).

Most people recover from mild sepsis, but the mortality rate for severe sepsis or septic shock is close to 50 percent.

Diagnosis:
The infection is often confirmed by a blood test. However, a blood test may not reveal infection in people who have been receiving antibiotics.

Other tests that may be done include:
•Blood gases
•Kidney function tests
•Platelet count
•White blood cell count
•Blood differential
•Fibrin degradation products
•Peripheral smear

Treatment;
Early, aggressive treatment boosts your chances of surviving sepsis. People with severe sepsis require close monitoring and treatment in a hospital intensive care unit. If one has severe sepsis or septic shock, lifesaving measures may be needed to stabilize breathing and heart function.

Medications
A number of different types of medications are used in treating sepsis. They include:

*Antibiotics. Treatment with antibiotics begins immediately — even before the infectious agent is identified. Initially you’ll receive broad-spectrum antibiotics, which are effective against a variety of bacteria. The antibiotics are administered intravenously (IV). After learning the results of blood tests, your doctor may switch to a different antibiotic that’s more appropriate against the particular bacteria causing the infection.

*Vasopressors. If your blood pressure remains too low even after receiving intravenous fluids, you may be given a vasopressor medication, which constricts blood vessels and helps to increase blood pressure.

*Others. Other medications you may receive include low doses of corticosteroids, insulin to help maintain stable blood sugar levels, drugs that modify the immune system responses, and painkillers or sedatives.Therapy

People with severe sepsis usually receive supportive care including oxygen and large amounts of intravenous fluids. Depending on your condition, you may need to have a machine help you breathe or dialysis for kidney failure.

Surgery
Surgery may be needed to remove sources of infection, such as collections of pus (abscesses).

Prognosis:
This section requires expansion.

Prognosis can be estimated with the Mortality in Emergency Department Sepsis (MEDS) score.  Approximately 20–35% of patients with severe sepsis and 40–60% of patients with septic shock die within 30 days. Others die within the ensuing 6 months. Late deaths often result from poorly controlled infection, immunosuppression, complications of intensive care, failure of multiple organs, or the patient’s underlying disease.

Prognostic stratification systems such as APACHE II indicate that factoring in the patient’s age, underlying condition, and various physiologic variables can yield estimates of the risk of dying of severe sepsis. Of the individual covariates, the severity of underlying disease most strongly influences the risk of death. Septic shock is also a strong predictor of short- and long-term mortality. Case-fatality rates are similar for culture-positive and culture-negative severe sepsis.

Some patients may experience severe long-term cognitive decline following an episode of severe sepsis, but the absence of baseline neuropsychological data in most sepsis patients makes the incidence of this difficult to quantify or to study. A preliminary study of nine patients with septic shock showed abnormalities in seven patients by MRI.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.mayoclinic.com/health/sepsis/DS01004
http://www.nlm.nih.gov/medlineplus/ency/article/000666.htm
http://en.wikipedia.org/wiki/Sepsis
http://www.bbc.co.uk/health/physical_health/conditions/sepsis.shtml
http://www.humenhealth.com/sepsis/sepsis.asp
http://images.emedicinehealth.com/images/4453/4453-4482-12996-21147.jpg

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Osteomyelitis

Definition:
Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone, myelo- meaning marrow, and -itis meaning inflammation) simply means an infection of the bone or bone marrow. It can be usefully subclassified on the basis of the causative organism (pyogenic bacteria or mycobacteria), the route, duration and anatomic location of the infection.

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It is  is an acute or chronic bone infection and the same can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs.

In children, osteomyelitis most commonly affects the long bones of the legs and upper arm, while adults are more likely to develop osteomyelitis in the bones that make up the spine (vertebrae). People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Once considered an incurable condition, osteomyelitis can be successfully treated today. Most people require surgery to remove parts of the bone that have died — followed by strong antibiotics, often delivered intravenously, typically for at least six weeks.

Symptoms:
Signs and symptoms of osteomyelitis include:

*Fever or chills

*Bone pain

*General discomfort, uneasiness, or ill-feeling (malaise)

*Local swelling, redness, and warmth

*Irritability or lethargy in young children

*Pain in the area of the infection

*Swelling, warmth and redness over the area of the infection

*Excessive sweating

*Low back pain

Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems.

Causes:
Most cases of osteomyelitis are caused by staphylococcus bacteria (more common) or fungi (less common), a type of germ commonly found on the skin or in the nose of even healthy individuals.

*Infection may spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).

*The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.

*A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones are usually affected. In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.

Risk Factors
*Diabetes

*Hemodialysis

*Injected drug use

*Poor blood supply

*Recent trauma

People who have had their spleen removed are also at higher risk for osteomyelitis.

Complications:
When the bone is infected, pus is produced in the bone, which may result in an abscess. The abscess steals the bone’s blood supply. The lost blood supply can result in a complication called chronic osteomyelitis. This chronic infection can cause symptoms that come and go for years.

Other complications include:
*Need for amputation

*Reduced limb or joint function

*Spread of infection to surrounding tissues or the bloodstream

*Septic arthritis. In some cases, infection within bones can spread into a nearby joint

*Impaired growth. In children, the most common location for osteomyelitis is in the softer areas, called growth plates, at either end of the long bones of the arms and legs. Normal growth may be interrupted in infected bones.

*Skin cancer. If your osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer.

Diagnosis:
A physical examination shows bone tenderness and possibly swelling and redness.

Tests may include:

*Blood cultures

*Bone biopsy (which is then cultured)

*Bone scan

*Bone x-ray

*Complete blood count (CBC)

*C-reactive protein (CRP)

*Erythrocyte sedimentation rate (ESR)

*MRI of the bone

*Needle aspiration of the area around affected bones

Treatment:
Osteomyelitis often requires prolonged antibiotic therapy, with a course lasting a matter of weeks or months. A PICC line or central venous catheter is often placed for this purpose. Osteomyelitis also may require surgical debridement. Severe cases may lead to the loss of a limb. Initial first-line antibiotic choice is determined by the patient’s history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities.  Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes.

In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting titled The Gross Clinic.

Prior to the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.

Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.

Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization  can be done

Prognosis
With treatment, the outcome for acute osteomyelitis is usually good.

The outlook is worse for those with long-term (chronic) osteomyelitis, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation.

The outlook for those with an infection of an orthopedic prosthesis depends, in part, on:

*The patient’s health

*The type of infection

*Whether the infected prosthesis can be safely removed

Prevention:
Prompt and complete treatment of infections is helpful. People who are at high risk or who have a compromised immune system should see a health care provider promptly if they have signs of an infection anywhere in the body.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000437.htm
http://en.wikipedia.org/wiki/Osteomyelitis
http://www.bbc.co.uk/health/physical_health/conditions/osteomyelitis2.shtml
http://www.mayoclinic.com/health/osteomyelitis/DS00759
http://www.medicalook.com/Joint_pain/Osteomyelitis.html
http://www.orthopediatrics.com/docs/Guides/back_pain.html

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Ailmemts & Remedies Pediatric

Infant jaundice

Definition:
Infant jaundice is a yellow discoloration in a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow-colored pigment of red blood cells. Jaundice isn’t a disease itself but the name given to the yellow appearance of skin and the conjunctiva (whites) of the eyes.

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Infant jaundice is a common condition, particularly in babies born before 38 weeks gestation (preterm babies) and breast-fed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some cases, an underlying disease may cause jaundice.

Infant jaundice can be concerning as although the majority of causes are easily treated, some rarer causes are very serious. Also, high levels of unconjugated bilirubin can cause brain damage. This is virtually never seen now due to treatment with UVB light, but it means that it is very important that the baby receives proper treatment.

Types of Infant jaundice:
The most common types of jaundice are:

Physiological (normal) jaundice: occurring in most newborns, this mild jaundice is due to the immaturity of the baby’s liver, which leads to a slow processing of bilirubin. It generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age.

Jaundice of prematurity: occurs frequently in premature babies since they are even less ready to excrete bilirubin effectively. Jaundice in premature babies needs to be treated at a lower bilirubin level than in full term babies in order to avoid complications.

Breastfeeding jaundice: jaundice can occur when a breastfeeding baby is not getting enough breast milk because of difficulty with breastfeeding or because the mother’s milk isn’t in yet. This is not caused by a problem with the breast milk itself, but by the baby not getting enough to drink.

Breast milk jaundice: in 1% to 2% of breastfed babies, jaundice may be caused by substances produced in their mother’s breast milk that can cause the bilirubin level to rise. These can prevent the excretion of bilirubin through the intestines. It starts after the first 3 to 5 days and slowly improves over 3 to 12 weeks.

Symptoms:
The main symptom of jaundice is yellow colouring of the skin and conjunctiva of the eyes. Jaundice can also make babies sleepy which can lead to poor feeding. Poor feeding can make jaundice worse as the baby can become dehydrated.

If a baby has conjugated jaundice, it may have white chalky stool (poo) and urine that is darker than normal. (The bilirubin that normally colours the stool is excreted in the urine.)

Medical advise should be sought urgently if:
•Jaundice is present in the first 24 hours of life
•Jaundice is present when the baby is 10 days old
•The baby has problems feeding or is very sleepy
•The stools are pale or the urine is very dark

Causes:
The main cause of jaundice is:
Excess bilirubin (hyperbilirubinemia). Bilirubin is the substance that causes the yellow color of jaundice. It’s a normal part of the waste produced when “used” red blood cells are broken down. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. Before birth, a mother’s liver removes bilirubin from the baby’s blood. The liver of a newborn is immature and often can’t remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.Other causes

A baby may have an underlying disorder that is causing jaundice. In these cases, jaundice often appears much earlier or much later than physiologic jaundice.

Diseases or conditions that can cause jaundice include:
*Internal bleeding (hemorrhage)
*An infection in your baby’s blood (sepsis)
*Other viral or bacterial infections
*An incompatibility between the mother’s blood and the baby’s blood
*A liver malfunction
*An enzyme deficiency
*An abnormality of your baby’s red blood cells

Risk Factors:
Problems with the blood may lead to a rapid breakdown of cells (haemolysis) – if the mother’s blood type isn’t compatible with her baby’s. For example, she may make antibodies that attack and destroy her baby’s red blood cells.

Hormone deficiencies such as low levels of thyroid hormone (hypothyroidism) or pituitary gland hormones (hypopituitarism) can trigger jaundice.

There may be inherited genetic problems with the enzymes that convert or break down bilirubin – these include rare conditions such as Crigler-Najjar syndrome, Gilbert’s syndrome, galactosaemia and tyrosinaemia.

There may be problems with the liver, such as biliary atresia, in which the tubes that drain bile from the liver are blocked. If spotted early, an operation can prevent long-term damage (which is why it is important to investigate jaundice that is still there at 10 days).

Diagnosis:
Doctors, nurses, and family members will watch for signs of jaundice at the hospital, and after the newborn goes home.

Any infant who appears jaundiced should have bilirubin levels measured right away. This can be done with a blood test.

Many hospitals check total bilirubin levels on all babies at about 24 hours of age. Hospitals use probes that can estimate the bilirubin level just by touching the skin. High readings need to be confirmed with blood tests.

Tests that will likely be done include:
•Complete blood count
•Coomb’s test
•Reticulocyte count
Further testing may be needed for babies who need treatment or whose total bilirubin levels are rising more quickly than expected.

Treatment:
Treatment is usually not needed.

When determining treatment, the doctor must consider:

•The baby’s bilirubin level
•How fast the level has been rising
•Whether the baby was born early (babies born early are more likely to be treated at lower bilirubin levels)
•How old the baby is now
Your child will need treatment if the bilirubin level is too high or is rising too quickly.

Keep the baby well hydrated with breast milk or formula. Frequent feedings (up to 12 times a day) encourage frequent bowel movements, which help remove bilirubin through the stools. Ask your doctor before giving your newborn extra formula.

Some newborns need to be treated before they leave the hospital. Others may need to go back to the hospital when they are a few days old. Treatment in the hospital usually lasts 1 to 2 days.

Sometimes special blue lights are used on infants whose levels are very high. This is called phototherapy. These lights work by helping to break down bilirubin in the skin.

The infant is placed under artificial light in a warm, enclosed bed to maintain constant temperature. The baby will wear only a diaper and special eye shades to protect the eyes. The American Academy of Pediatrics recommends that breastfeeding be continued through phototherapy, if possible. Rarely, the baby may have an intravenous (IV) line to deliver fluids.

If the bilirubin level is not too high or is not rising quickly, you can do phototherapy at home with a fiberoptic blanket, which has tiny bright lights in it. You may also use a bed that shines light up from the mattress.

•You must keep the light therapy on your child’s skin and feed your child every 2 to 3 hours (10 to 12 times a day).
•A nurse will come to your home to teach you how to use the blanket or bed, and to check on your child.
•The nurse will return daily to check your child’s weight, feedings, skin, and bilirubin levels.
•You will be asked to count the number of wet and dirty diapers.
In the most severe cases of jaundice, an exchange transfusion is required. In this procedure, the baby’s blood is replaced with fresh blood. Treating severely jaundiced babies with intravenous immunoglobulin may also be very effective at reducing bilirubin levels.

Prognosis:
Usually newborn jaundice is not harmful. For most babies, jaundice usually gets better without treatment within 1 to 2 weeks.

Very high levels of bilirubin can damage the brain. This is called kernicterus. However, the condition is almost always diagnosed before levels become high enough to cause this damage.

For babies who need treatment, the treatment is usually effective

Possible Complications:–
Rare, but serious, complications from high bilirubin levels include:

•Cerebral palsy
•Deafness
•Kernicterus — brain damage from very high bilirubin levels

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm
http://www.mayoclinic.com/health/infant-jaundice/DS00107
http://www.bbc.co.uk/health/physical_health/conditions/jaundice2.shtml

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Acute Cholecystitis

Alternative Names: Cholecystitis – acute

Definition: Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.

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You may Click  See also: Chronic cholecystitis

Causes :-
In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness, alcohol abuse and, rarely, tumors of the gallbladder may also cause cholecystitis.

Acute cholecystitis causes bile to become trapped in the gallbladder. The build up of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ.

Gallstones occur more frequently in women than men. Gallstones become more common with age in both sexes. Native Americans have a higher rate of gallstones.

Symptoms :-

The main symptom is abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:

*Be sharp, cramping, or dull
*Come and go
*Spread to the back or below the right shoulder blade
*Be worse after eating fatty or greasy foods
*Occur within minutes of a meal
*Shortness of breath due to pain when inhaling

Other symptoms that may occur include:–
*Abdominal fullness
*Clay-colored stools
*Excess gas
*Fever
*Heartburn
*Indigestion
*Nausea and vomiting
*Yellowing of skin and whites of the eyes (jaundice)
*Stiff abdomen muscles, specially on the right side
*Chills

Diagnosis:
Because the symptoms of acute cholecystitis can resembles symptoms of other illness, it is sometimes difficult to diagnose. If doctor suspects Cholecystitis after a carefull physical examination, he or she may perform some of the following tests:-

Blood Test:-
*Amylase and lipase
*Bilirubin
*Complete blood count ( CBC) — may show a higher-than-normal white blood cell count
*Liver function tests

Imaging tests that can show gallstones or inflammation include:
*Abdominal ultrasound
*Abdominal CT scan
*Abdominal x-ray
*Oral cholecystogram
*Gallbladder radionuclide scan
.

Treatment:-
Seek immediate medical attention for severe abdominal pain.

In the emergency room, patients with acute cholecystitis are given fluids through a vein and antibiotics to fight infection.

Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when inflammation continues or recurs. Surgery is usually done as soon as possible, however some patients will not need surgery right away.

Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can be tolerated).

Emergency surgery may be necessary if gangrene (tissue death), perforation, pancreatitis, or inflammation of the common bile duct occurs.

Occasionally, in very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.

For Alternative Medication  you may click to see:->
*Cholecystitis as related to Herbal Medicine :
*An alternative approach to acute cholecystitis :
*Acute cholecystitis – Traditional Chinese Medicine, Nature therapy :

Prognosis:-Patients who have surgery to remove the gallbladder are usually do very well.

Possible Complications:-
*Empyema (pus in the gallbladder)
*Gangrene (tissue death) of the gallbladder
*Injury to the bile ducts draining the liver (a rare complication of cholecystectomy)
*Pancreatitis
*Peritonitis (inflammation of the lining of the abdomen)

When to Contact a Medical Professional:

*Call your health care provider if severe abdominal pain persists.
*Call for an appointment with your health care provider if symptoms of cholecystitis recur after an acute episode.

Prevention :
Removal of the gallbladder and gallstones will prevent further attacks. Follow a low-fat diet if you are prone to gallstone attacks.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000264.htm

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