Treatments for Fetal alcohol syndrome
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Alcohol-related disorder:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce good long-term results.
Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.
Treatment of chronic alcohol abuse requires a varied approach that may include medications to deter alcohol use and treat effects of withdrawal; psychotherapy, consisting of behavior modification techniques, group therapy, and family therapy; and appropriate measures to relieve associated physical problems.
Aversion, or deterrent, therapy involves a daily oral dose of disulfiram to prevent compulsive drinking. This drug interferes with alcohol metabolism and allows toxic levels of acetaldehyde to accumulate in the patient’s blood, producing immediate and potentially fatal distress in the event he consumes alcohol up to 2 weeks after taking it. Disulfiram is contraindicated during pregnancy and in the patient with diabetes, heart disease, severe hepatic disease, or any disorder in which such a reaction could be especially dangerous. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic.
The first drug approved by the U.S. Food and Drug Administration for the treatment of alcohol-related disorder since disulfiram is naltrexone, an opiate antagonist that effectively reduces the amount of intake, severity of craving, and relapse incidence. It’s believed to work by preventing the effects of increased endorphins produced as a product of increased alcohol intake.
For long-term success, the recovering individual must learn to fill the place alcohol once occupied in his life with something constructive. Therapy using disulfiram or naltrexone may only substitute one drug dependence for another, so it should be used prudently.
Benzodiazepine isn’t recommended during rehabilitation due to its addictive nature and the potential for reinforcing the substance abuse behavior.
ELDER TIP Because the older patient may be more sensitive to these drugs, withdrawal may take longer (weeks or months) and be more severe than in a younger adult.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are helpful. In AA, a self-help group with more than 1 million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA’s members stay sober as long as 5 years, and 30% stay sober longer than 5 years.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cesarean birth:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The most common type of cesarean birth is the lower segment cesarean, in which a transverse incision across the lower abdomen opens the visceral peritoneum over the uterus. The lower anterior uterine wall is then incised (transversely or longitudinally) behind the bladder.
The classic cesarean — in which a longitudinal incision is made into the body of the uterus, extending into the fundus and opening the top of the uterus — is rarely performed because it exaggerates the risk of infection and of uterine rupture in subsequent pregnancies. Cesarean hysterectomy removes the entire uterus and is reserved for such cases as malignant tumors, severe infection, and placenta accreta.
Patients may have general or regional anesthetic for surgery, depending on the extent of maternal or fetal distress. Possible maternal complications of cesarean delivery include respiratory tract infection, wound dehiscence, thromboembolism, paralytic ileus, hemorrhage, and genitourinary tract infection.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cholelithiasis and related disorders:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Surgery, usually elective, is the treatment of choice for gallbladder and bile duct diseases and may include open or laparoscopic cholecystectomy, cholecystectomy with operative cholangiography, and possibly exploration of the common bile duct. Electrohydraulic shock wave lithotripsy can be used to fragment gallstones if they’re few in number; it may be used with ursodeoxycholic acid to improve dissolution. Other treatments include a low-fat diet to prevent attacks and vitamin K for itching, jaundice, and bleeding tendencies due to vitamin K deficiency. Treatment during an acute attack may include insertion of a nasogastric tube and an I.V. line and, possibly, antibiotic administration.
A nonsurgical treatment for choledocholithiasis involves placement of a catheter through the percutaneous transhepatic cholangiographic route. Guided by fluoroscopy, the catheter is directed toward the stone. A basket is threaded through the catheter, opened, twirled to entrap the stone, closed, and withdrawn. This procedure can be performed endoscopically.
Chenodeoxycholic acid, which dissolves radiolucent stones, provides an alternative for patients who are poor surgical risks or who refuse surgery.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Alcoholism:
Treatment
(Handbook of Diseases)
Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous, may produce good long-term results.
Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding. Acute withdrawal is also treated with oral multiple B vitamins, including thiamine. Administer fluids as needed, but avoid overhydrating the patient.
CLINICAL TIP: The possibility of intoxication with other drugs should be considered and a blood or urine sample sent for toxicology as appropriate.
Treatment of chronic alcoholism involves counseling, education, and cognitive techniques; psychotherapy (consisting of behavior modification techniques, group therapy, and family therapy); and appropriate measures to relieve associated physical problems.
Aversion, or deterrent, therapy may involve a daily oral dose of disulfiram to prevent compulsive drinking. (See Avoiding the risks of disulfiram therapy.)
UNDER STUDY: The opioid-antagonist drug naltrexone has been shown to reduce the ability to return to drinking and shorten periods of relapse. Longer-term trials are needed.
Tranquilizers, particularly the benzodiazepines, are used to decrease withdrawal symptoms of the central nervous system and are administered routinely to decrease risk of seizures. These drugs are administered and decreased over 3 to 5 days. Status epilepticus should be treated aggressively; initial treatment with lorazepam I.V. is effective.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are also helpful.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cholelithiasis, cholecystitis, and related disorders:
Treatment
(Handbook of Diseases)
Surgery, usually elective, is the treatment of choice for gallbladder and bile duct diseases. Surgery may include open or laparoscopic cholecystectomy, cholecystectomy with operative cholangiography and, possibly, exploration of the common bile duct.
Other treatment includes a low-fat diet to prevent attacks and vitamin K for itching, jaundice, and bleeding tendencies resulting from vitamin K deficiency. Treatment during an acute attack may include insertion of a nasogastric tube and an I.V. line and, possibly, administration of an antibiotic.
A nonsurgical treatment for choledocholithiasis involves insertion of a flexible catheter, formed around a biliary tube (T tube), through a sinus tract into the common bile duct. Guided by fluoroscopy, the catheter is directed toward the stone. A Dormia basket is threaded through the catheter, opened, twirled to entrap the stone, closed, and withdrawn.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Fetal Alcohol Syndrome:
Fetal Alcohol Syndrome - TREATMENT
(The 5-Minute Pediatric Consult)
The role of the pediatrician is early identification (with help from specialists), resulting in early intervention and appropriate referrals:
- To social and educational resources in the community to support family and child
- For comprehensive neuropsychologic evaluation (IQ, achievement, executive function, memory, adaptive function, language, reasoning and judgment, behavior)
- For ophthalmologic exam (consider routine screening prior to school, then every 2 years)
- For hearing test (consider brainstem auditory evoked response [BAER] at 6–12 months)
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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