Symptoms of Child abuse
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Alcohol-related disorder:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Because the person with alcohol dependence may hide or deny his addiction, and may temporarily manage to maintain a functional life, assessing for alcohol-related disorder can be difficult. Note physical and psychosocial symptoms that suggest alcohol-related disorder. For example, the patient’s history may suggest a need for daily or episodic alcohol use to maintain adequate functioning, an inability to discontinue or reduce alcohol intake, episodes of anesthesia or amnesia (blackouts) during intoxication, episodes of violence during intoxication, and interference with social and familial relationships and occupational responsibilities. Many minor complaints may be alcohol-related. The patient may report malaise, dyspepsia, mood swings or depression, and an increased incidence of infection. Observe the patient for poor personal hygiene and untreated injuries, such as cigarette burns, fractures, and bruises, that he can’t fully explain. Note any evidence of an unusually high tolerance of sedatives and opioids.
Although each person abusing alcohol may present in his own unique way, secretive or manipulative behavior may be a manifestation of the patient’s denial of the severity of his addiction. Suspect alcohol-related disorder if the patient uses inordinate amounts of aftershave or mouthwash. When confronted, the patient may deny or rationalize the problem. Alternatively, he may be guarded or hostile in his response and may even sign out of the hospital against medical advice. He also may project his anger or feelings of guilt or inadequacy onto others to avoid confronting his illness.
Chronic alcohol abuse brings with it an array of physical complications, including malnutrition, cirrhosis of the liver, peripheral neuropathy, brain damage, and cardiomyopathy. Assess for these complications in a patient with alcohol-related disorder. (See Complications of alcohol use.)
After abstinence or reduction of alcohol intake, signs and symptoms of withdrawal — which begin shortly after drinking has stopped and last for 5 to 7 days — may vary. The patient initially experiences anorexia, nausea, anxiety, fever, insomnia, diaphoresis, and tremor, progressing to severe tremulousness, agitation and, possibly, hallucinations and violent behavior. Major motor seizures (alcohol withdrawal seizures) can occur during withdrawal. Suspect alcohol-related disorder in any patient with unexplained seizures. (See Signs and symptoms of alcohol withdrawal.)
ELDER TIP Remember to consider the possibility of alcohol abuse when evaluating older patients. Research suggests that alcoholism affects 2% to 10% of adults older than age 60. More than half of all elderly hospital admissions are due to alcohol-related problems.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Substance abuse and induced disorders:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
The signs and symptoms of acute intoxication vary, depending on the drug. The drug user seldom seeks treatment specifically for his drug problem. Instead, he may seek emergency treatment for drug-related injuries or complications, such as a motor vehicle accident, burns from freebasing, an overdose, physical deterioration from illness or malnutrition, or symptoms of withdrawal. Friends, family members, or law enforcement officials may bring the patient to the hospital because of respiratory depression, unconsciousness, acute injury, or a psychiatric crisis.
Examine the patient for signs and symptoms of drug use or drug-related complications as well as for clues to the type of drug ingested. For example, fever can result from stimulant or hallucinogen intoxication, from withdrawal, or from infection caused by I.V. drug use.
Inspect the eyes for lacrimation from opiate withdrawal, nystagmus from central nervous system (CNS) depressants or phencyclidine intoxication, and drooping eyelids from opiate or CNS depressant use. Constricted pupils occur with opiate use or withdrawal; dilated pupils, with the use of hallucinogens or amphetamines.
Examine the nose for rhinorrhea from opiate withdrawal and the oral and nasal mucosa for signs of drug-induced irritation. Drug sniffing can result in inflammation, atrophy, or perforation of the nasal mucosa. Dental conditions commonly result from the poor oral hygiene associated with chronic drug use. Also inspect under the tongue for evidence of I.V. drug injection.
Inspect the skin. Sweating, a common sign of intoxication with opiates or CNS stimulants, also accompanies most drug withdrawal syndromes. Drug use sometimes induces a sensation of bugs crawling on the skin, known as formication; as a result, the patient’s skin may be excoriated from scratching.
Needle marks or tracks are an obvious sign of I.V. drug abuse. Keep in mind that the patient may attempt to conceal or disguise injection sites with tattoos or by selecting an inconspicuous site such as under the nails. In addition, self-injection can sometimes cause cellulitis or abscesses, especially in the patient who also is a chronic alcoholic. Puffy hands can be a late sign of thrombophlebitis or of fascial infection due to self-injection on the hands or arms.
Auscultation may disclose bilateral crackles and rhonchi caused by smoking and inhaling drugs or by opiate overdose. Other cardiopulmonary signs of overdose include pulmonary edema, respiratory depression, aspiration pneumonia, and hypotension. CNS stimulants and some hallucinogens may precipitate refractory acute-onset hypertension or cardiac arrhythmias. Withdrawal from opiates or depressants also can provoke arrhythmias and, occasionally, hypotension.
During opiate withdrawal, the patient may report abdominal pain, nausea, or vomiting. He may also complain of hemorrhoids, a consequence of the constipating effects of these drugs. Palpation of an enlarged liver, with or without tenderness, may indicate hepatitis.
Neurologic symptoms of drug abuse include tremors, hyperreflexia, hyporeflexia, and seizures. Abrupt withdrawal may precipitate signs of CNS depression (ranging from lethargy to coma), hallucinations, or signs of overstimulation, including euphoria and violent behavior.
Carefully review the patient’s medical history. Suspect drug abuse if he reports a painful injury or chronic illness but refuses a diagnostic workup. In his attempt to obtain drugs, the dependent patient may feign illnesses, such as migraine headaches, myocardial infarction, and renal colic; claim an allergy to over-the-counter analgesics; or even request a specific medication. Also be alert for a history of overdose or a high tolerance for potentially addictive drugs. An I.V. drug user may have a history of hepatitis or human immunodeficiency virus (HIV) infection from sharing dirty needles. A female drug user may report a history of amenorrhea.
A patient who abuses drugs may give you a fictitious name and address, be reluctant to discuss previous hospitalizations, or seek treatment at a medical facility across town rather than in his own neighborhood. If possible, interview family members to verify his responses.
If the patient admits to drug use, try to determine the extent to which this behavior interferes with his normal functioning. Note whether he expresses a desire to overcome his dependence on drugs. If possible, obtain a drug history consisting of substances ingested, amount, frequency, and last dose. Expect incomplete or inaccurate responses. Drug-induced amnesia, a depressed level of consciousness, or ignorance may distort the patient’s recollection of the facts; he also may fabricate answers to avoid arrest or to conceal a suicide attempt.
The hospitalized drug abuser is likely to be uncooperative, disruptive, or even violent. He may experience mood swings, anxiety, impaired memory, sleep disturbances, flashbacks, slurred speech, depression, and thought disorders. He may resort to plays on sympathy, bribery, or threats to obtain drugs, or he may try to pit one caregiver against another.
Psychoactive substances may be used in cultural practices. For instance, some Native Americans use hallucinatory drugs to help achieve spiritual experiences. Therefore, use and abuse must be carefully distinguished.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Child abuse as a Cause of Symptoms or Medical Conditions
When considering symptoms of Child abuse, it is also important to consider Child abuse as a possible cause of other medical conditions.
The Disease Database lists the following medical conditions that Child abuse may cause:
- (Source - Diseases Database)
Medical articles and books on symptoms:
These general reference articles may be of interest
in relation to medical signs and symptoms of disease in general:
Full list of premium articles on symptoms and diagnosis
About signs and symptoms of Child abuse:
The symptom information on this page
attempts to provide a list of some possible signs and symptoms of Child abuse.
This signs and symptoms information for Child abuse has been gathered from various sources,
may not be fully accurate,
and may not be the full list of Child abuse signs or Child abuse symptoms.
Furthermore, signs and symptoms of Child abuse may vary on an individual basis for each patient.
Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they
are indeed Child abuse symptoms.
As three- or four-year-olds get faster and smarter, parents have to be faster and smarter about keeping them out of trouble. From the bathroom to the...
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» Next page: Diagnostic Tests for Child abuse
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