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.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Cholelithiasis and related disorders:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Although gallbladder disease may produce no symptoms, acute cholelithiasis, acute cholecystitis, choledocholithiasis, and cholesterolosis produce the symptoms of a classic gallbladder attack. Attacks usually follow meals rich in fats or may occur at night, suddenly awakening the patient. They begin with acute abdominal pain in the right upper quadrant that may radiate to the back, between the shoulders, or to the front of the chest; the pain may be so severe that the patient seeks emergency department care. Other features may include recurring fat intolerance, biliary colic, belching, flatulence, indigestion, diaphoresis, nausea, vomiting, chills, low-grade fever, jaundice (if a stone obstructs the common bile duct), and clay-colored stools (with choledocholithiasis).
Clinical features of cholangitis include a rise in eosinophils, jaundice, abdominal pain, high fever, and chills; biliary cirrhosis may produce jaundice, related itching, weakness, fatigue, slight weight loss, and abdominal pain. Gallstone ileus produces signs and symptoms of small-bowel obstruction — nausea, vomiting, abdominal distention, and absent bowel sounds if the bowel is completely obstructed. Its most telling symptom is intermittent recurrence of colicky pain over several days.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Alcoholism:
Signs and symptoms
(Handbook of Diseases)
Because people with alcohol dependence may hide or deny their addiction and may temporarily manage to maintain a functional life, assessing a patient for alcoholism can be difficult. However, there are various physical and psychosocial symptoms that can facilitate assessment.
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, or interference with social and familial relationships and occupational responsibilities.
Many minor complaints that the patient may have may also be alcohol related. He may mention malaise, dyspepsia, mood swings, depression, or more infections. Note any evidence of an unusually high tolerance for sedatives and narcotics.
Secretive behavior is another indication. When confronted, the patient may deny or rationalize his problem with alcohol. Alternatively, he may be guarded or hostile in his response. He also may project his anger or feelings of guilt or inadequacy onto others to avoid confronting his illness.
With chronic alcohol abuse, the patient may experience malnutrition, cirrhosis of the liver, peripheral neuropathy, brain damage, or cardiomyopathy.
After abstaining from alcohol or significantly reducing his intake, the patient may experience signs and symptoms of withdrawal, and they may last for 5 to 7 days. The patient initially experiences anorexia, nausea, anxiety, fever, insomnia, diaphoresis, and tremor, progressing to severe tremulousness, agitation and, possibly, hallucinations and violent behavior. Major tonic-clonic seizures (known as rum fits) can occur during withdrawal. Suspect alcoholism in any patient with unexplained seizures.
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Source: Handbook of Diseases, 2003
Cholelithiasis, cholecystitis, and related disorders:
Signs and symptoms
(Handbook of Diseases)
Although gallbladder disease may produce no symptoms, acute cholelithiasis, acute cholecystitis, choledocholithiasis, and cholesterolosis all produce the symptoms of a classic gallbladder attack. Such attacks commonly follow meals rich in fats or may occur at night, suddenly awakening the patient.
A gallbladder attack may begin with acute abdominal pain in the right upper quadrant that may radiate to the back, between the shoulders, or to the front of the chest. The pain may be so severe that the patient seeks emergency care.
Other signs and symptoms include recurring fat intolerance, biliary colic, belching, flatulence, indigestion, diaphoresis, nausea, vomiting, chills, low-grade fever, jaundice (if a stone obstructs the common bile duct), and clay-colored stool (with choledocholithiasis).
Signs and symptoms of cholangitis include a rise in eosinophils, jaundice, abdominal pain, high fever, and chills. Biliary cirrhosis may produce jaundice, related itching, weakness, fatigue, slight weight loss, and abdominal pain. Gallstone ileus produces signs and symptoms of small-bowel obstruction —nausea, vomiting, abdominal distention, and absent bowel sounds if the bowel is completely obstructed. Its most telling sign is intermittent recurrence of colicky pain over several days.
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Source: Handbook of Diseases, 2003
Fetal Alcohol Syndrome:
Fetal Alcohol Syndrome - signs & symptoms
(The 5-Minute Pediatric Consult)
- Facial anomalies (at least 2):
- Short palpebral fissures (≤10th percentile)
- Thin vermilion border upper lip (score of 4 or 5 on the lip/philtrum guide [Astley, 2000])
- Ptosis and short, upturned nose are not mentioned in IOM criteria, but are commonly seen in children with FAS.
- Growth retardation, pre- or postnatal onset:
- Height or weight ≤10th percentile
- CNS neurodevelopmental abnormalities (at least 1 for diagnosis):
- Microcephaly at birth OFC <10th percentile
- Structural brain abnormalities (e.g., agenesis of corpus callosum, cerebellar hypoplasia)
- Unexplained behavior or cognitive abnormalities:
- Learning difficulties
- Poor school performance
- Poor impulse control
- Problems in social perception
- Deficits in higher level receptive and expressive language
- Poor abstract reasoning
- Poor math skills
- Impaired memory, attention, or judgment
- Birth defects—for ARBD, must have at least 1 of the following:
- Cardiac (30%): Atrial septal defect, ventricular septal defect (most common), aberrant great vessels, conotruncal defects
- Skeletal (18%): Radioulnar synostosis, vertebral defects
- Renal: Hydronephrosis, renal agenesis, hypoplastic, dysplastic, or horseshoe kidneys
- Ocular: Strabismus, ptosis, retinal vascular anomalies, optic nerve hypoplasia
- Auditory: Hearing loss (conductive—75% of children with FAS; neurosensory—less common)
- Minor anomalies (would need 2 if none of the above): Nail hypoplasia, clinodactyly, camptodactyly, “hockey stick” palmar creases, “railroad track” ears, pectus excavatum
>
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Source: The 5-Minute Pediatric Consult, 2008
Toxic Alcohols:
Toxic Alcohols - signs & symptoms
(The 5-Minute Pediatric Consult)
- Inebriation may occur after exposure.
- Isopropyl alcohol may cause severe GI irritation or hemorrhage.
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Source: The 5-Minute Pediatric Consult, 2008
Article Excerpts About Symptoms of Fetal alcohol syndrome:
Fetal Alcohol Syndrome: NWHIC (Excerpt)
FAS describes a "pattern of abnormalities observed in children born
to alcoholic mothers." FAS may result in various birth defects: prenatal
and/or postnatal growth retardation (weight and/or length below the 10th
percentile); central nervous system involvement, including neurological
abnormalities, developmental delays, behavioral dysfunction, intellectual
impairment, and skull or brain malformations; and a characteristic face
with short palpebral fissures (eye openings), a thin upper lip, and an
elongated, flattened midface and philtrum (the groove in the middle of the
upper lip). Mental handicaps and hyperactivity are probably the most
debilitating aspects of FAS, and prenatal alcohol exposure is one of the
leading known causes of mental retardation in the Western World. Problems
with learning, attention, memory, and problem solving are common, along
with in coordination, impulsiveness, and speech and hearing impairment.
Deficits in learning skills persist even into adolescence and adulthood.
Prenatal alcohol exposure may also cause a more subtle pattern of physical
and cognitive deficits, making diagnosis more difficult. Deficits in
learning skills persist into adolescence and adulthood. (Source: excerpt from Fetal Alcohol Syndrome: NWHIC)
Alcohol What You Don't Know Can Harm You: NIAAA (Excerpt)
Children born with alcohol-related
birth defects can have lifelong learning and behavior problems. Those born
with FAS have physical abnormalities, mental impairment, and behavior
problems. (Source: excerpt from Alcohol What You Don't Know Can Harm You: NIAAA)
Drinking and Your Pregnancy: NIAAA (Excerpt)
Children with Fetal
Alcohol Syndrome May:
• Be
born small.
•
Have problems eating and sleeping.
•
Have problems seeing and hearing.
•
Have trouble following directions and learning how to do simple
things.
•
Have trouble paying attention and learning in school.
•
Have trouble getting along with others and controlling their
behavior.
•
Need medical care all their lives.
•
Need special teachers and schools. (Source: excerpt from Drinking and Your Pregnancy: NIAAA)
Fetal alcohol syndrome as a Cause of Symptoms or Medical Conditions
When considering symptoms of Fetal alcohol syndrome, it is also important to consider Fetal alcohol syndrome as a possible cause of other medical conditions.
The Disease Database lists the following medical conditions that Fetal alcohol syndrome may cause:
- (Source - Diseases Database)
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