Niemann-Pick disease

DEFINITION

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

SYMPTOMS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

CAUSES

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

RISK FACTORS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

COMPLICATIONS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

PREPARING FOR YOUR APPOINTMENT

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

TESTS AND DIAGNOSIS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

TREATMENTS AND DRUGS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

LIFESTYLE AND HOME REMEDIES

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

TRYPOPHOBIA | Fear Of Holes

Definition 

TRYPOPHOBIA is a pathological fear of holes, particular those that are clustered together in a pattern. Trypophobia was coined in 2005 and derives its name from the Greek τρύπα (trýpa) “hole” and φόβος (phóbos) “fear”. According to Cole and Wilkins (2015) trypophobia is a “fear of holes” in which “Sufferers report aversion to visual stimuli comprising particular configuration of holes. The stimuli are usually clusters of holes of any variety that are almost always innocuous and seemingly pose no threat” . The phobia itself claims many sufferers although not currently recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), or any other scientific literature. 

Kleptomania | Impulse control disorder

DEFINITION

Kleptomania is the irresistible urge to steal items that you generally don't really need and that usually have little value. Kleptomania (klep-toe-MAY-knee-uh) is a serious mental health disorder that can cause much emotional pain to you and your loved ones if not treated.

Kleptomania is a type of impulse control disorder — a disorder in which you can't resist the temptation or drive to perform an act that's harmful to you or someone else. 

Many people with kleptomania live lives of secret shame because they're afraid to seek mental health treatment. Although there's no cure for kleptomania, treatment with medication or psychotherapy may be able to help end the cycle of compulsive stealing.

SYMPTOMS

Kleptomania symptoms may include:

• Powerful urges to steal items that you don't need 
• Feeling increased tension leading up to the theft 
• Feeling pleasure or gratification while stealing 
• Feeling terrible guilt or shame after the theft 

A powerful urge

Unlike typical shoplifters, people with kleptomania don't compulsively steal for personal gain. Nor do they steal as a way to exact revenge. They steal simply because the urge is so powerful that they can't resist it. This urge makes them feel uncomfortably anxious, tense or aroused. To soothe these feelings, they steal.

During the theft, they feel relief and gratification. Afterward, though, they may feel enormous guilt, remorse, self-loathing and fear of arrest. But the urge comes back, and the kleptomania cycle repeats itself.

Spontaneous occurrences and public places
Episodes of kleptomania generally occur spontaneously, without planning. Most people with kleptomania steal from public places, such as stores and supermarkets. Some may steal from friends or acquaintances, such as at a party. Often, the stolen items have no value to the person with kleptomania. The stolen items are usually stashed away, never to be used. Items may also be donated, given away to family or friends, or even secretly returned to the place from which they were stolen. 

When to see a doctor

If you can't stop shoplifting or stealing, seek medical advice. Many people who may have kleptomania don't want to seek treatment because they're afraid they'll be arrested or jailed. A mental health provider doesn't have to report your thefts to authorities, however. Getting treatment may help you gain control over your kleptomania.

If a loved one has kleptomania

If you suspect a close friend or family member may have kleptomania, gently raise your concerns with your loved one. Keep in mind that kleptomania is a mental health condition, not a character flaw, and approach your loved one without blame or accusation.

It may be helpful to emphasize the following points:

• You're concerned because you care about your loved one's health and well-being. 
• You're worried about the risks of compulsive stealing, such as being arrested, losing a job or damaging a valued relationship. 
• You understand that, with kleptomania, the urge to steal may be too strong to resist just by \"putting your mind to it.\" 
• Effective treatments are available to minimize the urge to steal and help your loved one live without addiction and shame. 

If you need help preparing for this conversation, talk with your doctor. He or she may refer you to a mental health provider who can help you plan a way of raising your concerns without making your loved one feel defensive or threatened.

CAUSES

The cause of kleptomania isn't known. There are several theories that suggest that changes in the brain may be at the root of kleptomania. Kleptomania may be linked to problems with a naturally occurring brain chemical (neurotransmitter) called serotonin. Serotonin helps regulate moods and emotions. Low levels of serotonin are common in people prone to impulsive behaviors.

Kleptomania also may be related to addictive disorders, and stealing may cause the release of dopamine (another neurotransmitter). Dopamine causes pleasurable feelings, and some people seek this rewarding feeling again and again.

Other research has found that kleptomania can occur after someone sustains a head injury. More research is needed to better understand all of these possible causes of kleptomania.

RISK FACTORS

Kleptomania is considered uncommon. However because many people with kleptomania never seek treatment, or they're simply jailed after repeated thefts, many cases of kleptomania may never be diagnosed. It's thought that fewer than 5 percent of shoplifters have kleptomania. Kleptomania often begins during adolescence or in young adulthood, but in rare cases it begins after 50 years of age.

Kleptomania risk factors may include:

• Family history. Having a first-degree blood relative, such as a parent or sibling, with kleptomania or obsessive-compulsive disorder may increase your risk of kleptomania. 
• Being female. Approximately two-thirds of people with known kleptomania are women. 
• Having another mental illness. People with kleptomania often have other mental illnesses, such as bipolar disorder, anxiety disorder, eating disorders, substance abuse or personality disorders. 
• Head trauma or brain injuries. People who've experienced a head trauma may develop kleptomania. 

COMPLICATIONS

Left untreated, kleptomania can result in severe emotional, legal and financial problems. For example, many people with known kleptomania have been arrested for shoplifting. Because you know stealing is wrong but you feel powerless to resist the impulse, you may be wracked by guilt, shame, self-loathing and humiliation. You may otherwise lead a moral, upstanding life and be confused and upset by your compulsive stealing.

Complications that kleptomania may cause or be associated with include:

• Arrest 
• Imprisonment 
• Depression 
• Alcohol and substance abuse 
• Eating disorders 
• Anxiety 
• Compulsive gambling or shopping 
• Suicidal thoughts or behavior 
• Social isolation 

PREPARING FOR YOUR APPOINTMENT

If you struggle with an irresistible urge to steal, call your doctor. Making that call will undoubtedly be scary, but trust that your doctor is interested in caring for your health, not in judging you. Your doctor may refer you to a mental health provider, such as a psychiatrist, with experience diagnosing and treating kleptomania.

Use the information below to prepare for your first appointment and learn what to expect from the mental health provider.

What you can do:

• Write down any symptoms you're experiencing, and for how long. It will help the mental health provider to know what kinds of events seem to trigger your urge to steal. 
• Write down key personal information,including traumatic events in your past and any current, major stressors. 
• Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications or supplements you're taking. 
• Take a trusted family member or friend along, if possible. It can be difficult to remember everything your mental health provider says, and a loved one can help remember the details. In addition, someone who has known you for a long time may be able to ask questions or share information with the mental health provider that you don't remember to bring up. 
• Write down questions to ask your mental health provider in advance so that you can make the most of your appointment. 

For kleptomania, some basic questions to ask your mental health provider include:

• Why can't I stop stealing? 
• What treatments are available? 
• What treatments are most likely to work for me? 
• How quickly will I stop stealing? 
• Will I still feel the urge to steal? 
• How often do I need therapy sessions, and for how long? 
• Would family therapy be helpful in my case? 
• Are there medications that can help? 
• What are the possible side effects of these medications? 
• I have these other health conditions. How can I best manage these conditions together? 
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting? 

What to expect from your mental health provider

The mental health provider will likely ask you a number of questions to better understand your symptoms and how they're affecting your life. The mental health provider may ask:

• At what age did you first experience an irresistible urge to steal? 
• How often do you experience the urge to steal? 
• Have you ever been caught or arrested for stealing? 
• How would you describe your feelings before, during and after you steal something? 
• What kinds of items do you steal? Are they things you need? 
• From whom do you steal? 
• What do you do with the items you steal? 
• Does anything in particular seem to trigger your urge to steal? 
• How would you say your urge to steal is affecting your life, including school, work and personal relationships? 
• Have any of your close relatives had a problem with compulsive stealing, or with other mental health conditions such as depression, addiction or obsessive-compulsive disorder? 
• Have you been treated for any other mental health problems, including eating disorders? If yes, what treatments were most effective? 
• Do you use alcohol or illegal drugs? How often? 
• Are you currently being treated for any other medical conditions? 

TESTS AND DIAGNOSIS

When you decide to seek treatment for symptoms of possible kleptomania, you may have both a physical and psychological evaluation. The physical exam can determine if there may be any physical causes triggering your symptoms.

There's no laboratory test to diagnose kleptomania. Instead, kleptomania is diagnosed based on your signs and symptoms. Kleptomania is a type of impulse control disorder. In addition to asking questions about your impulses and how they make you feel, your doctor may review a list of situations to see if they trigger kleptomania episodes. You may also fill out psychological questionnaires or self-assessments to help pinpoint a diagnosis.

To be diagnosed with kleptomania, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment. Criteria for a kleptomania diagnosis include:

• You have an inability to resist urges to steal objects that aren't needed for personal use or monetary value 
• You feel increasing tension leading up to the theft 
• You sense feelings of pleasure, relief or gratification during the act of stealing 
• The theft isn't committed as a way to exact revenge or to express anger, and isn't done while hallucinating or delusional 
• The stealing isn't related to manic episodes of bipolar disorder or other mental health disorders, such as antisocial personality disorder 

TREATMENTS AND DRUGS

Although fear, humiliation or embarrassment may make it difficult for you to seek treatment for kleptomania, it's important to get help. Kleptomania is difficult to overcome on your own. Treatment of kleptomania typically involves medications and psychotherapy, perhaps along with self-help groups. However, there's no standard kleptomania treatment, and researchers are still trying to understand what may work best. You may have to try several types of kleptomania treatment to find something that works well for your situation.

Medications

There's little solid scientific research about using psychiatric medications to treat kleptomania. However, certain medications may be helpful. Which medication is best for you depends on your overall situation and other conditions you may have, such as depression or obsessive-compulsive disorder. You may benefit from taking a combination of medications. Medications to consider include:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat kleptomania. These include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR), fluvoxamine (Luvox, Luvox CR) and others. 
• Mood stabilizers. These medications are meant to even out your mood so that you don't have rapid or uneven changes that may trigger urges to steal. One mood stabilizer used to treat kleptomania is lithium (Lithobid). 
• Anti-seizure medications. Although originally intended for seizure disorders, these medications have shown benefits in certain mental health disorders, possibly including kleptomania. Examples include topiramate (Topamax) and valproic acid (Depakene, Stavzor). 
• Addiction medications. Naltrexone (Revia, Vivitrol), known technically as an opioid antagonist, blocks the part of your brain that feels pleasure with certain addictive behaviors. It may reduce the urges and pleasure associated with stealing. 

You may have to try several different medications or combinations of medications to see what works best for you with the fewest side effects. Keep in mind that it may take several weeks to notice full benefits. Talk to your doctor or mental health provider if you're bothered by side effects. Under his or her guidance, you may be able to switch medications or change your dosage. Many side effects eventually go away.

Psychotherapy

Cognitive behavioral therapy has become the psychotherapy of choice for kleptomania. In general, cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Cognitive behavioral therapy may include these techniques to help you overcome kleptomania urges:

• Covert sensitization, in which you picture yourself stealing and then facing negative consequences, such as being caught 
• Aversion therapy, in which you practice mildly painful techniques, such as holding your breath until you become uncomfortable, when you get an urge to steal 
• Systematic desensitization, in which you practice relaxation techniques and picture yourself controlling urges to steal 

Other forms of therapy, such as psychodynamic therapy, family therapy or marriage counseling, also may be helpful.

Avoiding relapses

It's not unusual to have relapses of kleptomania. To help avoid relapses, be sure to stick to your treatment plan. If you feel urges to steal, contact your mental health provider or reach out to a trusted support group.

LIFESTYLE AND HOME REMEDIES

Kleptomania is the irresistible urge to steal items that you generally don't really need and that usually have little value. Kleptomania (klep-toe-MAY-knee-uh) is a serious mental health disorder that can cause much emotional pain to you and your loved ones if not treated.

Kleptomania is a type of impulse control disorder — a disorder in which you can't resist the temptation or drive to perform an act that's harmful to you or someone else.

Many people with kleptomania live lives of secret shame because they're afraid to seek mental health treatment. Although there's no cure for kleptomania, treatment with medication or psychotherapy may be able to help end the cycle of compulsive stealing.

Intussusception

DEFINITION

Intussusception (in-tuh-suh-SEP-shun) is a serious disorder in which part of the intestine slides into an adjacent part of the intestine. This \"telescoping\" often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected. Intussusception can lead to a tear in the bowel (perforation), infection and death of bowel tissue. 

Intussusception is the most common cause of intestinal obstruction in children younger than 3. Intussusception is rare in adults. Most cases of adult intussusception are the result of an underlying medical condition, such as a tumor. In contrast, the cause of most cases of intussusception in children is unknown.

In children, the intestines can usually be pushed back into position with an X-ray procedure. In adults, surgery is often required to correct the problem.

SYMPTOMS

The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain. Infants who have abdominal pain may pull their knees to their chests when they cry. The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and happen more often as time passes.

Other frequent signs and symptoms of intussusception include:

• Stool mixed with blood and mucus (sometimes referred to as \"currant jelly\" stool because of its appearance) 
• Vomiting 
• A lump in the abdomen 
• Lethargy 

Less common signs and symptoms include:

• Diarrhea 
• Fever 
• Constipation 

Some infants have no obvious pain, don't pass blood or have a lump in the abdomen. Some older children have pain but no other symptoms.

Adults

Because intussusception is rare in adults and symptoms of the disorder are often nonspecific, it is more challenging to identify. Abdominal pain is the most common symptom, followed by nausea and vomiting and diarrhea. A significant percentage of people have no signs and symptoms.

When to see a doctor

Intussusception requires emergency medical care. If you or your child develops the signs or symptoms listed above, seek medical help right away.

In infants, remember that signs of abdominal pain may include recurrent bouts of pulling the knees to the chest and crying.

CAUSES

Your intestine is shaped like a long tube. In intussusception, one part of your intestine — usually the small intestine — slides inside an adjacent part. This is sometimes called telescoping because it's similar to the way a collapsible telescope folds together.

In some cases, the telescoping is caused by an abnormal growth in the intestine, such as a polyp or a tumor (called a lead point). The normal wave-like contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be identified for intussusception.

Children

In the vast majority of cases of intussusception in children, the cause is unknown. Because intussusception seems to occur more often in the fall and winter and because many children with the problem also have flu-like symptoms, some suspect a virus may play a role in the condition. In a few instances, a lead point is identified as the cause of the condition — most frequently Meckel's diverticulum (a pouch in the lining of the small intestine).

Adults

In adults, intussusception is usually the result of a medical condition, such as:

• A tumor 
• Scar-like tissue in the intestine (adhesions) 
• Surgical scars in the small intestine or colon 
• Hematoma 
• Inflammation, such as from Crohn's disease 

RISK FACTORS

Risk factors for intussusception include:

• Age. Children are much more likely to develop intussusception than adults are. It's the most common cause of bowel obstruction in children between the ages of 6 months and 3 years. 
• Sex. Intussusception more often affects boys. 
• Abnormal intestinal formation at birth. A condition present at birth (congenital) in which the intestine doesn't develop correctly (malrotation) also is a risk factor for intussusception. 
• A prior history of intussusception.Once you've had intussusception, you're at increased risk to develop it again. 
• AIDS. There is some evidence of an increased incidence of intussusception in people with acquired immune deficiency syndrome. 

COMPLICATIONS

Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. Tissue death can lead to a tear (perforation) in the intestinal wall, which can cause an infection of the lining of the abdominal cavity (peritonitis).

Peritonitis is a life-threatening condition that requires immediate medical attention. Signs and symptoms of peritonitis include:

• Abdominal pain 
• Abdominal swelling 
• Fever 
• Thirst 
• Low urine output 

Peritonitis may cause your child to go into shock. Signs and symptoms of shock include:

• Cool, clammy skin that may be pale or gray 
• A weak and rapid pulse 
• Abnormal breathing that may be either slow and shallow or very rapid 
• Lackluster eyes that seem to stare blankly 
• Profound listlessness 

A child who is in shock may be conscious or unconscious. If you suspect your child is in shock, seek emergency medical care right away.

PREPARING FOR YOUR APPOINTMENT

Emergency medical care is required to treat intussusception. You may not have much time to prepare for an appointment.

What to expect from your doctor

Your child's doctor is likely to ask you a number of questions, including:

• When did your child begin experiencing abdominal pain or other symptoms? 
• Does your child's pain appear to be continuous — or is it occurring off and on? 
• Does the pain begin and end suddenly? 
• Has your child experienced nausea, vomiting or diarrhea? 
• Have you noticed any blood in your child's stool? 
• Have you noticed any swelling or a lump in your child's abdomen? 

What you can do in the meantime

Don't give your child any over-the-counter medications to treat symptoms before the appointment.

TESTS AND DIAGNOSIS

Your or your child's doctor will start by getting a history of the symptoms of the problem. He or she may be able to feel a sausage-shaped lump in the abdomen. To confirm the diagnosis, your doctor may order:

• Ultrasound or other abdominal imaging. An ultrasound, X-ray or computerized tomography (CT) scan may reveal intestinal obstruction caused by intussusception. Imaging will typically show a \"bull's eye,\" representing the intestine coiled within the intestine. Abdominal imaging also can show if the intestine has been torn (perforated). 
• Air or barium enema. An air or barium enema is basically a colon X-ray. During the procedure, the doctor will insert air (the preferred choice in most cases) or liquid barium into the colon through the rectum. This makes the images on the X-ray clearer. An air or barium enema will fix intussusception 90 percent of the time in children, and no further treatment is needed. A barium enema can't be used if the intestine is torn. 

TREATMENTS AND DRUGS

Treatment of intussusception typically happens as a medical emergency. Emergency medical care is required to avoid severe dehydration and shock, as well as prevent infection that can occur when a portion of intestine dies due to lack of blood.

Initial care

When your child arrives at the hospital, the doctors will first stabilize his or her medical condition. This includes:

• Giving your child fluids through an intravenous (IV) line 
• Helping the intestines decompress by putting a tube through the child's nose and into the stomach (nasogastric tube) 

Correcting the intussusception

To treat the problem, your doctor may recommend:

• A barium or air enema. This is both a diagnostic procedure and a treatment. If an enema works, further treatment is usually not necessary. This treatment is highly effective in children, but rarely used in adults. Intussusception recurs as often as 15 to 20 percent of the time and the treatment will have to be repeated. 
• Surgery. If the intestine is torn, if an enema is unsuccessful in correcting the problem or if a lead point is the cause, surgery is necessary. The surgeon will free the portion of the intestine that is trapped, clear the obstruction and, if necessary, remove any of the intestinal tissue that has died. Surgery is the main treatment for adults and for people who are acutely ill. 

In some cases, intussusception may be temporary and go away without treatment.

LIFESTYLE AND HOME REMEDIES

Intussusception (in-tuh-suh-SEP-shun) is a serious disorder in which part of the intestine slides into an adjacent part of the intestine. This \"telescoping\" often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected. Intussusception can lead to a tear in the bowel (perforation), infection and death of bowel tissue.

Intussusception is the most common cause of intestinal obstruction in children younger than 3. Intussusception is rare in adults. Most cases of adult intussusception are the result of an underlying medical condition, such as a tumor. In contrast, the cause of most cases of intussusception in children is unknown.

In children, the intestines can usually be pushed back into position with an X-ray procedure. In adults, surgery is often required to correct the problem.

Ichthyosis vulgaris | skin disorder

DEFINITION

Ichthyosis vulgaris (ik-thee-O-sis vul-GAY-ris) is an inherited skin disorder in which dead skin cells accumulate in thick, dry scales on your skin's surface.

The scales of ichthyosis vulgaris, sometimes called fish scale disease or fish skin disease, can be present at birth, but usually first appear during early childhood. Sometimes, mild cases of ichthyosis vulgaris go undiagnosed because they're mistaken for extremely dry skin. 

Most cases of ichthyosis vulgaris are mild, but some are severe. Sometimes other skin diseases, such as the allergic skin condition eczema, are associated with ichthyosis vulgaris. No cure has been found for ichthyosis vulgaris, and treatments focus on controlling the condition.

SYMPTOMS

Ichthyosis vulgaris slows your skin's natural shedding process. This causes chronic, excessive buildup of the protein in the upper layer of the skin (keratin). Symptoms include:

• Dry, scaly skin 
• Tile-like, small scales 
• Scales colored white, dirty gray or brown — with darker colored scales typically on darker skin 
• Flaky scalp 
• Deep, painful cracks in your skin 

The scales usually appear on your elbows and lower legs and may be especially thick and dark over your shins. Most cases of ichthyosis vulgaris are mild, but some can be severe. The severity of symptoms may vary widely among family members who have the condition.

Symptoms usually worsen or are more pronounced in cold, dry environments and tend to improve or even resolve in warm, humid environments.

When to see a doctor

If you suspect you or your child has ichthyosis, talk to your family doctor or a dermatologist. He or she can diagnose the condition by examining the characteristic scales. Also, be sure to seek medical advice if the symptoms worsen or don't improve with self-care measures. You may need stronger medication to manage the condition.

CAUSES

Ichthyosis vulgaris is commonly caused by a genetic mutation that's inherited from one or both parents. Children who inherit a defective gene from just one parent have a milder form of the disease, while those who inherit two defective genes have a more severe form of ichthyosis vulgaris. Children with the inherited form of the disorder usually have normal skin at birth, but develop scaling and roughness during the first few years of life.

If genetic abnormalities aren't responsible for ichthyosis, it's referred to as acquired ichthyosis. This rare type often begins in adulthood. It's usually associated with other diseases, such as cancer, thyroid disease or HIV/AIDS.

RISK FACTORS

Ichthyosis vulgaris (ik-thee-O-sis vul-GAY-ris) is an inherited skin disorder in which dead skin cells accumulate in thick, dry scales on your skin's surface.

The scales of ichthyosis vulgaris, sometimes called fish scale disease or fish skin disease, can be present at birth, but usually first appear during early childhood. Sometimes, mild cases of ichthyosis vulgaris go undiagnosed because they're mistaken for extremely dry skin.

Most cases of ichthyosis vulgaris are mild, but some are severe. Sometimes other skin diseases, such as the allergic skin condition eczema, are associated with ichthyosis vulgaris. No cure has been found for ichthyosis vulgaris, and treatments focus on controlling the condition.

COMPLICATIONS

Some people with ichthyosis may experience:

• Overheating. In rare cases, the skin thickness and scales of ichthyosis can interfere with sweating. This can inhibit cooling. 
• Secondary infection. Skin splitting and cracking may lead to infections. 

PREPARING FOR YOUR APPOINTMENT

If the appointment is for your child, you're likely to start by seeing your child's pediatrician. If the appointment is for you, you're likely to start by seeing your primary care doctor. He or she may refer you or your child to a specialist in skin conditions (dermatologist).

Here's some information to help you prepare for the appointment.

What you can do

• Write down any symptoms your child or you are experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. 
• Write down key personal information,including any major stresses or recent life changes. 
• Make a list of all medications, vitamins or supplements you or your child is taking. 
• Write down questions to ask your doctor. 

Preparing a list of questions for your doctor will help you make the most of your time together. List your questions from most important to least important. For ichthyosis vulgaris, some basic questions to ask your doctor include:

• What's the most likely cause of these symptoms? 
• Are there other possible causes? 
• What kinds of tests do I or my child need? 
• Is the condition likely temporary or long lasting? 
• What treatments are available and which do you recommend? 
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend? 

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did your symptoms first appear? 
• Have the symptoms been continuous or do they come and go? 
• What, if anything, seems to improve the symptoms? 
• What, if anything, appears to worsen the symptoms? 
• Does anyone in your immediate or extended family have similar skin changes? 

What you can do in the meantime

To help soothe your or your child's skin:

• Wash only with mild soaps that have added oils and fats. Avoid strongly scented and antibacterial soaps, which are especially harsh on dry skin. 
• Apply moisturizer or lubricating cream while your or your child's skin is still moist from bathing. Choose a moisturizer that contains urea or propylene glycol — chemicals that help keep your skin moist. Petroleum jelly is another good choice. Cover the treated areas with plastic wrap to keep the petroleum jelly from staining clothes and furniture. 

TESTS AND DIAGNOSIS

A doctor can often make a diagnosis by examining your skin and the characteristic scales. If there's any doubt, he or she may perform other tests, such as a skin biopsy. This may be necessary to rule out other causes of dry, scaly skin.

TREATMENTS AND DRUGS

There's no known cure for ichthyosis, so the goal of treatment is to manage the condition.

Medications

Treatments may include:

• Alpha hydroxy acids, such as lactic acid and glycolic acid. Treatment can include prescription creams and ointments that contain acids that help control scaling and increase skin moisture. 
• Retinoids. Your doctor may prescribe these vitamin A-derived medications in severe cases. They reduce the production of skin cells. Side effects from the medication may include eye and lip inflammation, bone spurs and hair loss. Retinoids may cause birth defects. Women considering retinoid therapy should be sure they are not pregnant before starting the medication — and use effective birth control while taking retinoids. 

LIFESTYLE AND HOME REMEDIES

Although self-help measures won't cure ichthyosis, they may help improve the appearance and feel of damaged skin. Consider these measures to help:

• Take long soaking baths to soften the skin. Then use a rough-textured sponge, such as a loofa sponge, to remove the thickened scales. 
• Choose mild soaps that have added oils and fats. Avoid strongly scented and antibacterial soaps, which are especially harsh on dry skin. 
• After showering or bathing, gently pat or blot your skin dry with a towel so that some moisture remains on the skin. 
• Apply moisturizer or lubricating cream while your skin is still moist from bathing. Choose a moisturizer that contains urea or propylene glycol — chemicals that help keep your skin moist. Petroleum jelly is another good choice. Cover the treated areas with plastic wrap to keep the petroleum jelly from staining clothes and furniture. 
• Apply an over-the-counter product that contains urea, lactic acid or a low concentration of salicylic acid twice daily. Mild acidic compounds help your skin shed its dead skin cells. Urea helps bind moisture to your skin. 
• Use a portable home humidifier or one attached to your furnace to add moisture to the air inside your home.

Which of the following do these programs prioritize?

Ans: D

Feedback:
Organized self-care education programs emphasize health promotion, disease
prevention, management of illness, self-care, and judicious use of the professional
health care system. Prenatal care, lobbying, and Internet activities are secondary.

What is one characteristic the nurse would cite as necessary to possess to be an effective nurse

Ans: A

Feedback:
To promote an effective nurse-patient relationship and positive outcomes of care,
nursing care must be culturally competent, appropriate, and sensitive to cultural
differences. Team-focused nursing and strict adherence to routine are not
characteristics needed to be an effective nurse. The ability to handle criticism is
important, but to a lesser degree than cultural competence.

Hand-foot-and-mouth disease | viral infection

DEFINITION

Hand-foot-and-mouth disease — a mild, contagious viral infection common in young children — is characterized by sores in the mouth and a rash on the hands and feet. Hand-foot-and-mouth disease is most commonly caused by a coxsackievirus. 

There's no specific treatment for hand-foot-and-mouth disease. You can reduce your risk of infection from hand-foot-and-mouth disease by practicing good hygiene, such as washing your hands often and thoroughly.

SYMPTOMS

Hand-foot-and-mouth disease may cause some or all of the following signs and symptoms:

• Fever 
• Sore throat 
• Feeling of being unwell (malaise) 
• Painful, red, blister-like lesions on the tongue, gums and inside of the cheeks 
• A red rash, without itching but sometimes with blistering, on the palms, soles and sometimes the buttocks 
• Irritability in infants and toddlers 
• Loss of appetite 

The usual period from initial infection to the onset of signs and symptoms (incubation period) is three to seven days. A fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and malaise. One or two days after the fever begins, painful sores may develop in the mouth or throat. A rash on the hands and feet and possibly on the buttocks can follow within one or two days.

When to see a doctor

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. Contact your doctor, however, if mouth sores or a sore throat keep your child from drinking fluids. Contact your doctor also if after a few days, your child's signs and symptoms worsen.

CAUSES

The most common cause of hand-foot-and-mouth disease is infection with the coxsackievirus A16. The coxsackievirus belongs to a group of viruses called nonpolio enteroviruses. Other enteroviruses sometimes cause hand-foot-and-mouth disease.

Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with an infected person's:

• Nasal secretions or throat discharge 
• Saliva 
• Fluid from blisters 
• Stool 
• Respiratory droplets sprayed into the air after a cough or sneeze 

Common in child care setting

Hand-foot-and-mouth disease is most common in children in child care settings because of frequent diaper changes and potty training, and because little children often put their hands in their mouths.

Although your child is most contagious with hand-foot-and-mouth disease during the first week of the illness, the virus can remain in his or her body for weeks after the signs and symptoms are gone. That means your child still can infect others.

Some people, particularly adults, can pass the virus without showing any signs or symptoms of the disease.

Outbreaks of the disease are more common in summer and autumn in the United States and other temperate climates. In tropical climates, outbreaks occur year-round.

Different from foot-and-mouth disease

Hand-foot-and-mouth disease isn't related to foot-and-mouth disease (sometimes called hoof-and-mouth disease), which is an infectious viral disease found in farm animals. You can't contract hand-foot-and-mouth disease from pets or other animals, and you can't transmit it to them.

RISK FACTORS

Hand-foot-and-mouth disease primarily affects children younger than age 10. Children in child care centers are especially susceptible to outbreaks of hand-foot-and-mouth disease because the infection spreads by person-to-person contact, and young children are the most susceptible.

Children usually develop immunity to hand-foot-and-mouth disease as they get older by building antibodies after exposure to the virus that causes the disease. However, it's possible for adolescents and adults to get the disease.

COMPLICATIONS

The most common complication of hand-foot-and-mouth disease is dehydration. The illness can cause sores in the mouth and throat, making swallowing painful and difficult. Watch closely to make sure your child frequently sips fluid during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary.

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, a rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications:

• Viral meningitis. This is an infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Viral meningitis is usually mild and often clears on its own. 
• Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare. 

PREPARING FOR YOUR APPOINTMENT

If you take your child to a doctor, make the most of your time by writing down information the doctor will need before you go, including:

• Any signs and symptoms your child is experiencing 
• How long your child has been having signs and symptoms 
• Whether your child has been in child care or other environments where the disease might be spread 
• Any questions you have 

Some questions you might want to ask your doctor include:

• What's the likely cause of the symptoms? 
• Are there other possible causes? 
• Will my child need to undergo any tests? 
• What's the best treatment approach? 
• Is there a need to take medicine? 
• What can I do at home to make my child more comfortable? 

What to expect from your doctor

Some questions the doctor may ask include:

• When did symptoms first begin? 
• How severe are the symptoms? 
• Has your child recently been exposed to anyone who was sick? 
• Have you heard of any illnesses at your child's school or day care? 
• Does anything seem to improve the symptoms? 
• Does anything appear to worsen the symptoms? 

What you can do in the meantime

To help lessen discomfort, doctors often recommend:

• Getting rest 
• Drinking fluids — milk-based fluids may be easier to tolerate than acidic liquids, such as juice or soda 
• Taking over-the-counter pain relievers other than aspirin, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), if needed, but they're not necessary for low-grade fevers 
• Using mouthwash or oral spray to numb pain 

TESTS AND DIAGNOSIS

Your doctor will likely be able to distinguish hand-foot-and-mouth disease from other types of viral infections by evaluating:

• The age of the affected person 
• The pattern of signs and symptoms 
• The appearance of the rash or sores 

A throat swab or stool specimen may be taken and sent to the laboratory to determine which virus caused the illness. However, your doctor probably won't need this type of testing to diagnose hand-foot-and-mouth disease.

TREATMENTS AND DRUGS

There's no specific treatment for hand-foot-and-mouth disease. Signs and symptoms of hand-foot-and-mouth disease usually clear up in seven to 10 days.

A topical oral anesthetic may help relieve the pain of mouth sores. Over-the-counter pain medications other than aspirin, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), may help relieve general discomfort.

LIFESTYLE AND HOME REMEDIES

Certain foods and beverages may irritate blisters on the tongue or in the mouth or throat. Try these tips to help make blister soreness less bothersome and eating and drinking more tolerable:

• Suck on ice pops or ice chips 
• Eat ice cream or sherbet 
• Drink cold beverages, such as milk or ice water 
• Avoid acidic foods and beverages, such as citrus fruits, fruit drinks and soda 
• Avoid salty or spicy foods 
• Eat soft foods that don't require much chewing 
• Rinse your mouth with warm water after meals 

If your child is able to rinse without swallowing, swishing the inside of his or her mouth with warm salt water may be soothing. Mix 1/2 teaspoon (2.5 milliliters) of salt with 1 cup (237 milliliters) of warm water. Have your child rinse with this solution several times a day, or as often as needed to help reduce the pain and inflammation of mouth and throat sores caused by hand-foot-and-mouth disease.

The public health nurse is presenting a health promotion class to a group of new mothers. How should the nurse best define health?

Ans: D
Feedback:
The World Health Organization (WHO) defines health in the preamble to its
constitution as a “state of complete physical, mental, and social well-being and not
merely the absence of disease and infirmity.“ The other answers are incorrect because
they are not congruent with the WHO definition of health.

Henoch-Schonlein purpura | disorder that causes inflammation and bleeding

DEFINITION

Henoch-Schonlein purpura (HEN-awk SHURN-line PUR-pu-ruh) is a disorder that causes inflammation and bleeding in the small blood vessels in your skin, joints, intestines and kidneys. 
The most striking feature of Henoch-Schonlein purura is a purplish rash, typically on the lower legs and buttocks. Henoch-Schonlein purpura can also cause abdominal pain and aching joints. Rarely serious kidney damage can occur.
Although Henoch-Schonlein purpura can affect anyone, it's most common in children between the ages of 2 and 6. Henoch-Schonlein purpura usually improves on its own. Medical care is generally needed if the disorder affects the kidneys.

SYMPTOMS

There are four main characteristics of Henoch-Schonlein purpura, although not everyone with the disease develops all four. They include:

• Rash (purpura). Reddish-purple spots, which look like bruises, are the most distinctive and universal sign of Henoch-Schonlein purpura. The rash develops mainly on the buttocks, legs and feet, but it can also appear on the arms, face and trunk and may be worse in areas of pressure, such as the sock line and waistline. 
• Swollen, sore joints (arthritis). People with Henoch-Schonlein purpura often have painful, swollen joints — mainly in the knees and ankles. Joint pain sometimes precedes the classical rash by one or two days. These symptoms subside when the disease clears and leave no lasting damage. 
• Gastrointestinal symptoms. Many children with Henoch-Schonlein purpura develop gastrointestinal symptoms, such as abdominal pain, nausea, vomiting or bloody stools. These symptoms sometimes occur before the rash appears. 
• Kidney involvement. Henoch-Schonlein purpura can also affect the kidneys. In most cases, this shows up as protein or blood in the urine, which you may not even know is there unless you have a urine test done. Usually this goes away once the illness passes, but in a few cases, kidney disease may develop and even persist. 

When to see a doctor

In some cases, Henoch-Schonlein purpura causes serious problems of the bowel or kidneys. See your doctor as soon as possible if you or your child develops the distinctive rash associated with Henoch-Schonlein purpura.

CAUSES

In Henoch-Schonlein purpura, some of the body's small blood vessels become inflamed, which can cause bleeding in the skin, joints, abdomen and kidneys. Why this initial inflammation develops isn't clear, although it may be the result of an overzealous immune system responding inappropriately to certain triggers.
Nearly half the people who have Henoch-Schonlein purpura developed the disease after an upper respiratory infection, such as a cold. Infectious triggers may include chickenpox, strep throat, measles and hepatitis. Other triggers may include certain medications, food, insect bites or exposure to cold weather.

RISK FACTORS

Factors that may increase the risk of developing Henoch-Schonlein purpura include:

• Age. The disease affects primarily children and young adults with the majority of cases occurring in children between 2 and 6 years of age. 
• Sex. Henoch-Schonlein purpura is slightly more common in boys than girls. 
• Race. White and Asian children are more likely to develop Henoch-Schonlein purpura than black children are. 
• Time of year. Henoch-Schonlein purpura strikes mainly in autumn, winter and spring but rarely in summer. 

COMPLICATIONS

For most people, symptoms improve within a month, leaving no lasting problems. Recurrences are fairly common, however.
Complications associated with Henoch-Schonlein purpura include:

• Kidney damage. The most serious complication of Henoch-Schonlein purpura is kidney damage. Occasionally the damage is severe enough that dialysis or a kidney transplant may be needed. 
• Bowel obstruction. In rare cases, Henoch-Schonlein purpura can cause intussusception — a condition in which a section of the bowel folds into itself like a telescope, which prevents matter from moving through the bowel. 

PREPARING FOR YOUR APPOINTMENT

You'll likely see your family doctor or your child's pediatrician for this condition, although you may be referred to a kidney specialist (nephrologist) if kidney complications develop. Here's some information that may help you get ready for your appointment and what to expect from your doctor.
Before your appointment, you may want to write a list of answers to the following questions:

• When did the symptoms begin? 
• Did they come on suddenly or gradually? 
• Were you or was your child sick before the rash started? 
• What medications and supplements do you or your child take regularly? 

Questions you may want to ask your doctor include:

• What might be causing these symptoms? 
• What tests are needed to confirm the diagnosis? 
• Is this condition temporary or chronic? 
• How will I know if there's kidney damage? What if it turns up later on? 
• How is Henoch-Schonlein purpura treated? 
• What are the side effects of treatment? 
• Do you have any literature on this condition? Is there a website you can recommend where I can learn more? 

What to expect from your doctor

Your doctor is likely to ask a number of questions, such as:

• What did the rash look like when it first started? 
• Is the rash painful? Does it itch? 
• Do you or does your child have other symptoms, such as stomach pain or joint aches? 

TESTS AND DIAGNOSIS

A diagnosis of Henoch-Schonlein purpura is fairly easy to make if the classic rash, joint pain and gastrointestinal symptoms are present. If some of these signs and symptoms are missing, your doctor may suggest one or more of the following tests.

Lab tests

Although no single test can confirm Henoch-Schonlein purpura, certain tests can help rule out other diseases and make a diagnosis of Henoch-Schonlein seem likely. They may include:

• Blood tests. People who have Henoch-Schonlein purpura often have abnormal levels of a particular type of antibody in their blood. 
• Urine tests. Your urine may be tested for evidence of blood and to determine if your kidneys are still working properly. 

Biopsies

If there are doubts about the rash or if other tests are inconclusive, your doctor may take a small sample of skin to be examined under a microscope. In cases of severe kidney involvement, your doctor may suggest a kidney biopsy to help guide treatment decisions.

Imaging tests

Your doctor may recommend an ultrasound to rule out other causes of abdominal pain and to check for possible complications, such as a bowel obstruction.

TREATMENTS AND DRUGS

Henoch-Schonlein purpura usually improves on its own within a month with no lasting ill effects. Bed rest, plenty of fluids and over-the-counter pain relievers may help.

Medications

The use of powerful corticosteroids, such as prednisone, in treating or preventing complications of Henoch-Schonlein purpura is controversial. They're most often used to treat severe gastrointestinal symptoms. Because these drugs can have serious side effects and their usefulness isn't clear, be sure to discuss the risks and benefits with your doctor.

Surgery

If a section of the bowel has folded in upon itself or ruptured, surgical repair will be necessary.

LIFESTYLE AND HOME REMEDIES

Children and adults with mild Henoch-Schonlein purpura should be kept comfortable while the disease runs its course. Bed rest, plenty of fluids and over-the-counter pain relievers may help.