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Medical Encyclopedia




1. Acrodermatitis
2. Acrodysostosis
3. Acromegaly
4. ACTH (cosyntropin) stimulation test
5. ACTH blood test
6. Actinic keratosis
7. Actinomycosis
8. Acute
9. Acute adrenal crisis
10. Acute arterial occlusion - kidney
11. Acute cerebellar ataxia
12. Acute cholecystitis
13. Acute cytomegalovirus (CMV) infection
14. Acute kidney failure
15. Acute lymphoblastic leukemia (ALL)
16. Acute mountain sickness
17. Acute myeloid leukemia
18. Acute nephritic syndrome
19. Acute pancreatitis
20. Acute respiratory distress syndrome


01. Acrodermatitis

Acrodermatitis is a childhood skin condition that may be accompanied by mild symptoms of fever and malaise. It may also be associated with hepatitis B and other viral infections.

Causes

The cause of acrodermatitis is poorly understood, but its link with other infections is well-documented.
In Italian children, acrodermatitis is seen frequently with hepatitis B, but this link is rarely seen in the United States. Epstein-Barr virus (EBV, mononucleosis) is the virus most often associated with acrodermatitis. Other associated viruses include cytomegalovirus, coxsackie viruses, parainfluenza virus, respiratory syncytial virus (RSV), and some live virus vaccines.
A rare, genetic form of acrodermatitis is acrodermatitis enteropathica. In this disorder, zinc is poorly absorbed from the diet. Adding zinc supplements to the diet improves the condition. This form of the disorder can be associated with other abnormalities and development delays.

Symptoms

• Rash or patch on skin
• Brownish-red or copper-colored patch that is firm and flat on top
• String of bumps may appear in a line
• Generally not itchy
• Rash looks the same on both sides of the body
• Rash may appear on the palms and soles -- it does not occur on the back, chest, or belly area (this is one of the ways it is identified -- by the absence of the rash from the trunk of the body)
Other symptoms that may appear include:
• Swollen abdomen
• Swollen lymph nodes
• Tender lymph nodes

Exams and Tests

Your doctor can diagnose this condition by looking at the skin and rash. The liver, spleen, and lymph nodes may be swollen.
The following tests may be done to confirm the diagnosis or rule out other conditions:
• Bilirubin level
• Hepatitis virus serology or hepatitis B surface antigen
• Liver enzymes (liver function tests)
• Screening for EBV antibodies
• Serum zinc level may be tested in acrodermatitis enteropathica
• Skin biopsy

Treatment

Acrodermatitis by itself is not treated. Infections associated with this condition, such as hepatitis B and Epstein-Barr, are treated. Cortisone creams may help with itching and irritation.
Acrodermatitis enteropathica improves when the zinc levels in the body is returned to normal.

Outlook (Prognosis)

Acrodermatitis usually disappears on its own without treatment or complication. Associated conditions must be watched carefully.

Possible Complications

Complications occur as a result of associated conditions, rather than as a result of acrodermatitis.

When to Contact a Medical Professional

Call your health care provider if your child has signs of this condition.

Alternative Names

Papular acrodermatitis of childhood; Gianotti-Crosti syndrome; Acrodermatitis - infantile lichenoid; Acrodermatitis - papular infantile; Papulovesicular acro-located syndrome; Acrodermatitis enteropathica

References

Mancini AJ, Shani-Adir A. Other viral diseases. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds.Dermatology
Morelli JG. Nutritional dermatoses. In: Kliegman RM, Stanton BF, St. Geme, JW III, et al., eds.Nelson Textbook of Pediatrics

Update Date 5/15/2013

Updated by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

02. Acrodysostosis

Acrodysostosis is an extremely rare disorder that is present at birth (congenital). It leads to problems with the bones of the hands, feet, and nose, and intellectual disability.

Causes

Most people with acrodysostosis have no family history of the disease. However, sometimes the condition is passed down from parent to child. Parents with the condition have a 1 in 2 chance of passing the disorder to their children.
There is a slightly greater risk with fathers who are older.

Symptoms

Symptoms of this disorder include:
• Frequent middle ear infections
• Growth problems, short arms and legs
• Hearing problems
• Mental deficiency
• The body being resistant to certain hormones, even though hormone levels are normal
• Unusual looking face

Exams and Tests

Your health care provider can usually diagnose this condition with a physical exam. This may show:
• Advanced bone age
• Bone deformities in hands and feet
• Delays in growth
• Problems with the skin, genitals, teeth, and skeleton
• Short arms and legs with small hands and feet
• Short head, measured front to back
• Short height
• Small, upturned broad nose with flat bridge
• Unusual features of the face (short nose, open mouth, jaw that sticks out)
• Unusual head
• Wide-spaced eyes, sometimes with extra skin fold at corner of eye
In the first months of life, x-rays may show spotty calcium deposits, called stippling, in bones (especially the nose). Infants may also have:
• Abnormally short fingers and toes
• Early growth of bones in the hands and feet
• Short bones
• Shortening of the forearm bones near the wrist
Two genes have been linked with this condition, and genetic testing may be done.

Treatment

Treatment depends on the symptoms.
Orthopedic care, early intervention, and special education are recommended.

Outlook (Prognosis)

Problems depend on the degree of skeletal involvement and intellectual disability. In general, people do relatively well.

Possible Complications

Acrodysostosis may lead to:
• Arthritis
• Carpal tunnel syndrome
• Worsening range of movement in the spine, elbows, and hands

When to Contact a Medical Professional

Call your health care provider if your infant or child does not seem to be growing or developing properly.

Prevention

Genetic counseling may be helpful.

Alternative Names

Arkless-Graham; Acrodysplasia; Maroteaux-Malamut

References

Linglart, A., Menguy, C., Couvineau, A., et al. Recurrent PRKAR1A mutation in acrodysostosis with hormone resistance.New Eng. J. Med

03. Acromegaly

Acromegaly is a condition in which there is too much growth hormone in the body.

Causes

Acromegaly is a rare condition. It is caused when the pituitary gland makes too much growth hormone. The pituitary gland is a pea-sized endocrine gland located at the base of the brain. It controls, makes, and releases several hormones, including growth hormone.
Usually a noncancerous (benign) tumor of the pituitary gland causes the gland to release too much growth hormone.
In children, too much growth hormone causes gigantism rather than acromegaly.

Symptoms

Symptoms of acromegaly may include any of the following:
• Body odor
• Carpal tunnel syndrome
• Decreased muscle strength (weakness)
• Decreased peripheral vision
• Easy fatigue
• Excessive height (when excess growth hormone production begins in childhood)
• Excessive sweating
• Headache
• Hoarseness
• Joint pain, limited joint movement, swelling of the bony areas around a joint
• Large bones of the face
• Large feet (change in shoe size), large hands (change in ring or glove size)
• Large glands in the skin (sebaceous glands)
• Large jaw (prognathism) and tongue (macroglossia)
• Sleep apnea
• Thickening of the skin, skin tags
• Widely spaced teeth
• Widened fingers or toes, with swelling, redness, and pain
Other symptoms that may occur with this disease:
• Colon polyps
• Excess hair growth in females (hirsutism)
• Type 2 diabetes
• Weight gain (unintentional)

Exams and Tests

The health care provider will perform a physical exam and ask about your symptoms.
The following tests may be ordered to confirm diagnosis of acromegaly:
• Blood glucose
• Growth hormone
• High insulin-like growth factor 1 (IGF-1) level
• Spine x-ray
• MRI of the brain, including the pituitary gland
• Echocardiogram
• Prolactin

Treatment

Surgery to remove the pituitary tumor that is causing this condition often corrects the abnormal growth hormone. Sometimes the tumor is too large to remove completely. People who do not respond to surgery may have radiation of the pituitary gland.
Medications are used after surgery. Some patients are treated with medicines instead of surgery.
After treatment, you will need to see your health care provider regularly to make sure that the pituitary gland is working normally. Yearly evaluations are recommended.

Outlook (Prognosis)

Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon.
Without treatment, the symptoms will get worse. Conditions such as high blood pressure, diabetes, and heart disease may result.

When to Contact a Medical Professional

Call your health care provider if:
• You have symptoms of acromegaly
• Your symptoms do not improve with treatment

Prevention

Acromegaly cannot be prevented. Early treatment may prevent complications of the disease from getting worse.

Alternative Names

Somatotroph adenoma; Growth hormone excess; Pituitary giant (in childhood)

References

Katznelson L, Atkinson JLD, Cook DM, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly - 2011 update. Endocr Pract.
Melmed S, Kleinberg D. Pituitary masses and tumors. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology

04. ACTH (cosyntropin) stimulation test

The ACTH stimulation test measures how well the adrenal glands respond to adrenocorticotropic hormone (ACTH). ACTH is a hormone produced in the pituitary gland that stimulates the adrenal glands to release a hormone called cortisol. The man-made form of ACTH is called cosyntropin.

How the Test is Performed

The test is done the following way:
• Your blood is drawn.
• The lab then checks the cortisol level in the blood sample.
• You then receive a shot (injection) of cosyntropin.
• After either 30 minutes or 60 minutes, depending on how much cosyntropin you receive, your blood is drawn again.
• The lab rechecks the cortisol level in the second blood sample.
Along with the blood tests, you may also have a urine cortisol test or urine 17-ketosteroids test, which involves collecting the urine over a 24-hour period.

How to Prepare for the Test

You may need to limit activities and eat foods that are high in carbohydrates 12 to 24 hours before the test. You may be asked to fast for 6 hours before the test. Sometimes, no special preparation is needed.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away.

Why the Test is Performed

This test can help determine whether your adrenal and pituitary glands are normal. It is most often used when the doctor thinks you have an adrenal gland problem, such as Addison disease or pituitary insufficiency.

Normal Results

An increase in cortisol after stimulation by ACTH is normal. Cortisol level after ACTH stimulation should be higher than 18 to 20 micrograms per deciliter (mcg/dL), depending on the dose of cosyntropin used.
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

This test is helpful in finding out if you have:
• Acute adrenal crisis
• Addison disease (adrenal glands do not produce enough cortisol)
• Hypopituitarism (pituitary gland is not producing enough hormones such as ACTH)
• Pituitary tumor

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

Tests of adrenal reserve; Cortrosyn stimulation test

References

Guber HA, Farag AF. Evaluation of endocrine function. In: McPherson RA, Pincus MR, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods
Schroeder E, Wang CCL. Adrenal insufficiency. In: McDermott MT, ed.Endocrine Secrets.
Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology.

05. ACTH blood test

The ACTH test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone released from the pituitary gland in the brain.

How the Test is Performed

A blood sample is needed.

How to Prepare for the Test

Your doctor will likely ask you to have the test be done early in the morning. This is important, because cortisol level varies throughout the day.
You may also be told to stop taking medicines that can affect the test results. These medicines include glucocorticoids such as prednisone, hydrocortisone, or dexamethasone.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away.

Why the Test is Performed

The main function of ACTH is to regulate the steroid hormone cortisol. Cortisol is released by the adrenal gland. It regulates blood pressure and blood sugar.
This test can help find the causes of certain hormone problems.

Normal Results

Normal values for a blood sample taken early in the morning are 9 to 52 picograms per milliliter (pg/mL).
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

A higher-than-normal level of ACTH may indicate:
• Adrenal glands not producing enough cortisol (Addison disease)
• Adrenal glands not producing enough hormones (congenital adrenal hyperplasia)
• One or more of the endocrine glands are overactive or have formed a tumor (multiple endocrine neoplasia type I)
• Pituitary is making too much ACTH (Cushing disease), which is usually caused by a non-cancerous tumor of the pituitary gland
• Rare type of tumor (lung, thyroid, or pancreas) making too much ACTH (ectopic Cushing syndrome)
A lower-than-normal level of ACTH may indicate:
• Pituitary gland not producing enough hormones, such as ACTH (hypopituitarism)
• Tumor of the adrenal gland that produces too much cortisol
• Glucocorticoid medicines are suppressing ACTH production
Other conditions under which the test may be performed:
• Multiple endocrine neoplasia (MEN) I

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

Serum adrenocorticotropic hormone; Adrenocorticotropic hormone; Highly-sensitive ACTH

References

Guber HA, Farag AF. Evaluation of endocrine function. In: McPherson RA, Pincus MR, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods
Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology.
Melmed S, Kleinberg D. Pituitary masses and tumors. Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology.

06. Actinic keratosis

Actinic keratosis is a small, rough, raised area found on areas of your skin that have often been exposed to the sun for a long period of time.
Some actinic keratoses may develop into a type of skin cancer.

Causes

Actinic keratosis is caused by exposure to sunlight.
You are more likely to develop this if you:
• Have fair skin, blue or green eyes, or blond or red hair
• Had a kidney or other transplant
• Take medicines that suppress the immune system
• Spend a lot of time each day in the sun (for example, if you work outdoors)
• Had many, severe sunburns early in life
• Are older

Symptoms

Actinic keratosis is usually found on the face, scalp, back of the hands, chest, or places that are often in the sun.
• The skin changes begin as flat and scaly areas. They often have a white or yellow crusty "scale" on top.
• The growths may be gray, pink, red, or the same color as the skin. Later they may become hard and wart-like or gritty and rough.
• The areas may be easier to feel than see.

Exams and Tests

Your doctor or nurse will look at your skin to diagnose this condition. A skin biopsy may be done to see if it is cancer.

Treatment

Some actinic keratoses become squamous cell skin cancer. Have all skin growths looked at by a doctor as soon as you find them. Your doctor will tell you how to treat it.
Growths may be removed by:
• Burning (electrical cautery)
• Scraping away the lesion and using electricity to kill any remaining cells (called curettage and electrodesiccation)
• Cutting the tumor out and using stitches to place the skin back together (called excision)
• Freezing (cryotherapy, which freezes and kills the cells)
If you have many of these skin growths, your doctor may recommend:
• A laser treatment called photodynamic therapy
• Chemical peels
• Skin creams such as 5-fluorouracil (5-FU) and imiquimod

Outlook (Prognosis)

A small number of these skin growths turn a type of skin cancer called squamous cell carcinoma.

When to Contact a Medical Professional

Call your health care provider if you see or feel a rough or scaly spot on your skin, or if you notice any other skin changes.

Prevention

The best way to lower your risk of actinic keratosis and skin cancer is to learn how to protect your skin from sun and ultraviolet (UV) light.
Things you can do to lower your exposure to sunlight include:
• Wear clothing such as hats, long-sleeved shirts, long skirts, or pants.
• Try to avoid being in the sun during midday, when ultraviolet light is most intense.
• Use high-quality sunscreens, preferably with a sun protection factor (SPF) rating of at least 15. Pick a sunscreen that blocks both UVA and UVB light.
• Apply sunscreen before going out into the sun, and reapply often.
• Use sunscreen year-round, including in the winter.
• Avoid sun lamps, tanning beds, and tanning salons.
Other things to know about sun exposure:
• Sun exposure is stronger in or near surfaces that reflect light, such as water, sand, concrete, and areas painted white.
• Sun exposure is more intense at the beginning of the summer.
• Skin burns faster at higher altitudes.

Alternative Names

Solar keratosis; Sun-induced skin changes - keratosis; Keratosis - actinic (solar)

References

Habif TP, ed.Clinical Dermatology
Soyer PH, Rigel DS, Wurm E MT: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds.Dermatology

07. Actinomycosis

Actinomycosis is a long-term (chronic) bacterial infection that commonly affects the face and neck.

Causes

Actinomycosis is usually caused by bacterium called Actinomyces israelii. This is a common and organism found in the nose and throat. It normally does not cause disease.
Because of the bacteria's normal location in the nose and throat, actinomycosis most commonly affects the face and neck. The infection can sometimes occur in the chest (pulmonary actinomycosis), abdomen, pelvis, or other areas of the body. The infection is not contagious. This means it does not spread to other persons.
Symptoms occur when the bacteria enter the tissues of the face after trauma, surgery, or infection. Common triggers include dental abscess or oral surgery. The infection can also affect certain women who have had an intrauterine device (IUD) to prevent pregnancy.
Once in the tissue, the bacteria causes an abscess, producing a hard, red to reddish-purple lump, often on the jaw, from which comes the condition's common name, "lumpy jaw."
Eventually, the abscess breaks through the skin surface to produce a draining sinus tract.

Symptoms

• Draining sores in the skin, especially on the chest wall from lung infection with Actinomyces
• Fever
• Minimal or no pain
• Swelling or a hard, red to reddish-purple lump on the face or upper neck
• Weight loss

Exams and Tests

The health care provider will perform a physical exam and ask questions about your symptoms.
Tests that may be done to check for presence of the bacteria include:
• Culture of the tissue or fluid
• Examination of drained fluid under a microscope

Treatment

Treatment of actinomycosis usually requires antibiotics for several months to a year. Surgical drainage or removal of the affected area (lesion) may be needed. If the condition is related to an IUD, the device must be removed.

Outlook (Prognosis)

Full recovery can be expected with treatment.

Possible Complications

In rare cases, meningitis can develop from actinomycosis.

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of this infection. Beginning treatment promptly helps quicken the recovery.

Prevention

Good oral hygiene and regular dentist visits may help prevent some forms of actinomycosis.

Alternative Names

Lumpy jaw

References

Brook I. Actinomycosis. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Russo TA. Agents of actinomycosis. In: Mandell GL, Bennett JE, Dolin R, eds.Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

08. Acute

Acute means sudden or severe. Acute symptoms appear, change, or worsen rapidly. It is the opposite of chronic.

09. Acute adrenal crisis

Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal glands.

Causes

The adrenal glands are located just above the kidneys. The adrenal gland consists of two parts. The outer portion, called the cortex, produces cortisol. This is an important hormone for controlling blood pressure. The inner portion, called the medulla, produces the hormone adrenaline (also called epinephrine). Both cortisol and adrenaline are released in response to stress.
Cortisol production is regulated by the pituitary gland. This is a small gland behind the nose and under the brain. The pituitary gland releases adrenocorticotropic hormone (ACTH). This is a hormone that causes the adrenal glands to release cortisol.
Adrenaline production is regulated by nerves coming from the brain and spinal cord and by circulating hormones.
Adrenal crisis occurs when:
• The adrenal gland is damaged due to, for example, Addison disease or other adrenal gland disease, surgery
• The pituitary gland is injured and cannot release ACTH
• Adrenal insufficiency is not properly treated
Risk factors for adrenal crisis include:
• Dehydration
• Infection and other physical stress
• Injury to the adrenal or pituitary gland
• Stopping treatment too suddenly with glucocorticoid medications such as prednisone or hydrocortisone
• Surgery
• Trauma

Symptoms

Symptoms of adrenal crisis can include any of the following:
• Abdominal pain
• Confusion or coma
• Dehydration
• Dizziness or light-headedness
• Fatigue
• Flank pain
• Headache
• High fever
• Loss of appetite
• Loss of consciousness
• Low blood pressure
• Nausea
• Profound weakness
• Rapid heart rate
• Rapid respiratory rate (see tachypnea)
• Slow, sluggish movement
• Unusual and excessive sweating on face or palms
• Vomiting

Exams and Tests

Tests that may be ordered to help diagnose acute adrenal crisis include:
• ACTH (cosyntropin) stimulation test
• Cortisol level
• Blood sugar
• Serum potassium
• Serum sodium
• Serum pH

Treatment

In adrenal crisis, patients need an immediate injection of hydrocortisone through a vein (intravenous) or muscle (intramuscular). You may receive intravenous fluids if you have low blood pressure.
You will need to go to the hospital for treatment and monitoring. If infection or another medical problem caused the crisis, you may need additional treatment.

Outlook (Prognosis)

Shock may occur if treatment is not provided early, and it can be life-threatening.

Possible Complications

• Coma
• Seizures
• Shock
• Hypoglycemia

When to Contact a Medical Professional

Call your health care provider if you have Addison disease and are unable to take your glucocorticoid medicine for any reason.
Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of acute adrenal crisis.
If you have Addison disease, you may be told to increase the dosage of your glucocorticoid medicine if you are very ill or before having surgery.

Prevention

If you have Addison disease, learn to recognize signs of potential stress that may cause an acute adrenal crisis. If you have been instructed by your doctor, be prepared to give yourself an emergency shot of glucocorticoid or to increase your dosage of oral glucocorticoid medication in times of stress.
Always carry medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency.
Never miss taking your medicines.

Alternative Names

Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency

References

Chaker AJ, Vaidya B. Addison disease in adults: diagnosis and management. Am J Med
Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology

10. Acute arterial occlusion - kidney

Acute arterial occlusion of the kidney is a sudden, severe blockage of the artery that supplies blood to the kidney.

Causes

The kidneys need a good blood supply. The main artery to the kidney is called the renal artery. Reduced blood flow through the renal artery can hurt kidney function. A complete blockage of blood flow to the kidney can often result in permanent kidney failure.
Acute arterial occlusion of the renal artery can occur after injury or trauma to the abdomen, side, or back. Blood clots that travel through the bloodstream (emboli) can lodge in the renal artery. Pieces of plaque from the walls of the arteries can come loose (on their own or during a procedure). This debris can block the main kidney artery one or one of the smaller vessels.
The risk of renal artery blockages increases in people who have certain heart disorders which make them likely to form blood clots. These include mitral stenosis and atrial fibrillation.
A narrowing of the renal artery is called renal artery stenosis. This condition increases the risk of a sudden blockage.

Symptoms

You may not have symptoms when one kidney does not function because the second kidney can filter the blood. However, high blood pressure (hypertension) may come on suddenly and be difficult to control.
If your other kidney is not working fully, blockage of the renal artery may cause symptoms of acute kidney failure. Other symptoms of acute arterial occlusion of the renal artery include:
• Abdominal pain
• Abrupt decrease in urine output
• Back pain
• Blood in the urine
• Flank pain or pain in the side
• Symptoms of high blood pressure such as headache, change in vision, and swelling
Note: There may be no pain. Pain, if it is present, usually develops suddenly.

Exams and Tests

The doctor will not be able to identify the problem with just an exam unless you have developed kidney failure.
Tests you may need include:
• Duplex Doppler ultrasound exam of the renal arteries to test blood flow
• MRI of the kidney arteries, which can show a lack of blood flow to the affected kidney
• Renal arteriography shows the exact location of the blockage
• Renal nuclear scan shows a lack of blood flow to the affected kidney
• Ultrasound of the kidney to check kidney size

Treatment

Often, patients do not need treatment. Blood clots may get better on their own over time.
You may have treatment to open the artery if the blockage is discovered quickly or it is affecting the only working kidney. Treatment to open the artery may include:
• Clot-dissolving medicines (thrombolytics)
• Medicines that prevent the blood from clotting (anticoagulants), such as warfarin (Coumadin)
• Surgical repair of the renal artery
• Insertion of a tube (catheter) into the renal artery to open the blockage
You may need temporary dialysis to treat acute kidney failure. Medicines to lower cholesterol may be needed if the blockage is due to clots from plaque buildup in the arteries.

Outlook (Prognosis)

Damage caused by arterial occlusion may go away. However, in most cases it is permanent.
If only one kidney is affected, the healthy kidney may take over filtering the blood and producing urine. If you have only one working kidney, arterial occlusion leads to acute kidney failure. This can develop into chronic kidney failure.

Possible Complications

• Acute kidney failure
• Chronic kidney disease
• High blood pressure
• Malignant hypertension

When to Contact a Medical Professional

Call your health care provider if:
• You stop producing urine
• You feel sudden, severe pain in the back, flank, or abdomen.
Get emergency medical help right away if you have symptoms of arterial occlusion and have only one working kidney.

Prevention

In many cases, the disorder is not preventable. The most important way to reduce your risk is to stop smoking.
People at risk for developing blood clots may need to take anti-clotting medicines. Taking steps to control diseases related to atherosclerosis (hardening of the arteries) may reduce your risk.

Alternative Names

Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery

References

DuBose TD Jr, Santos RM. Vascular disorders of the kidney. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Scolari F, Ravani P. Atheroembolic renal disease. Lancet
Ruggenenti P, Cravede P, Remuzzi G. Microvascular and macrovascular diseases of the kidney. In: Taal MW, Chertow GM, Marsden PA, et al, eds.Brenner and Rector's The Kidney

11. Acute cerebellar ataxia

Acute cerebellar ataxia is sudden, uncoordinated muscle movement due to disease or injury to the cerebellum in the brain.

Causes

Acute cerebellar ataxia in children, especially younger than age 3, may occur several weeks after an illness caused by a virus.
Viral infections that may cause this include chickenpox, Coxsackie disease, Epstein-Barr, and echovirus.
Other causes of acute cerebellar ataxia include:
• Abscess of the cerebellum
• Alcohol, medications, and insecticides
• Bleeding into the cerebellum
• Multiple sclerosis
• Strokes of the cerebellum
• Vaccination

Symptoms

Ataxia may affect movement of the middle part of the body from the neck to the hip area (the trunk) or the arms and legs (limbs).
When the person is sitting, the body may move side-to-side, back-to-front, or both. Then the body quickly moves back to an upright position.
When a person with ataxia of the arms reaches for an object, the hand may sway back and forth.
Common symptoms of ataxia include:
• Clumsy speech pattern (dysarthria)
• Repetitive eye movements (nystagmus)
• Uncoordinated eye movements
• Walking problems (unsteady gait)

Exams and Tests

The doctor will ask if the person has recently been sick and will try to rule out any other causes of the problem. Brain and nervous system examination will be done to identify the areas of the nervous system that are most affected.
The following tests may be ordered:
• CT scan of the head
• MRI scan of the head
• Spinal tap

Treatment

Treatment depends on the cause:
• If the acute cerebellar ataxia is due to bleeding, surgery may be needed.
• For a stroke, medicine to thin the blood can be given.
• Infections may need to be treated with antibiotics or antivirals.
• Steroids may be needed for swelling (inflammation) of the cerebellum (such as from multiple sclerosis)
• Cerebellar ataxia caused by a recent viral infection may not need treatment.

Outlook (Prognosis)

People whose condition was caused by a recent viral infection should make a full recovery without treatment in a few months. Strokes, bleeding, or infections may cause permanent symptoms.

Possible Complications

In rare cases, movement or behavioral disorders may persist.

When to Contact a Medical Professional

Call your health care provider if any symptoms of ataxia appear.

Alternative Names

Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA

References

Marcdante KJ, Kliegman RM. Ataxia and movement disorders. In: Marcdante KJ, Kliegman RM.Nelson Essentials of Pediatrics
Steinlin M. The continuum of parainfectious reactions of the cerebellum in childhood.Neuropediatricswww.ncbi.nlm.nih.gov/pubmed/23065745
Subramony SH, Xia G. Disorders of the cerebellum, including the degenerative ataxias. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC.Bradley's Neurology in Clinical Practice

12. Acute cholecystitis

Acute cholecystitis is a sudden swelling and irritation of the gallbladder. It causes severe belly pain.
See also: Chronic cholecystitis

Causes

The gallbladder is an organ that sits below the liver. It stores bile, which your body uses to digest fats in the small intestine.
Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because a gallstone blocks the cystic duct. This is the tube that bile travels into and out of the gallbladder. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection.
Other causes include:
• Serious illnesses such as HIV or diabetes
• Tumors of the gallbladder (rare)
Some people are more at risk for gallstones. Risk factors include:
• Being female
• Pregnancy
• Hormone therapy
• Older age
• Being Native American or Hispanic
• Obesity
• Losing or gaining weight rapidly
• Diabetes
Sometimes the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead to chronic cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It also does not store and release bile as well.

Symptoms

The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. You may feel:
• Sharp, cramping, or dull pain
• Steady pain
• Pain that spreads to your back or below your right shoulder blade
Other symptoms that may occur include:
• Clay-colored stools
• Fever
• Nausea and vomiting
• Yellowing of skin and whites of the eyes (jaundice)

Exams and Tests

A physical exam will show that it hurts to touch your belly.
Your doctor may order the following blood tests:
• Amylase and lipase
• Bilirubin
• Complete blood count (CBC)
• Liver function tests
Imaging tests can show gallstones or inflammation. You may have one of these tests:
• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan

Treatment

If you have severe belly pain, seek medical attention right away.
In the emergency room, you'll be given fluids through a vein. You also may be given antibiotics to fight infection.
Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder.
Nonsurgical treatment includes:
• Antibiotics to fight infection
• Low-fat diet (if you are able to eat)
• Pain medicines
You may need emergency surgery if you have complications such as:
• Gangrene (tissue death)
• Perforation (a hole that forms in the wall of the gallbladder)
• Pancreatitis (inflamed pancreas)
• Persistent bile duct blockage
• Inflammation of the common bile duct
If you are very ill, a tube may be placed in your gallbladder and through your skin to drain it. Then, once you are feeling better, you may have surgery.

Outlook (Prognosis)

Most people who have surgery to remove their gallbladder recover completely.

Possible Complications

• Empyema (pus in the gallbladder)
• Gangrene
• Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
• Pancreatitis
• Perforation
• Peritonitis (inflammation of the lining of the abdomen)

When to Contact a Medical Professional

Call your health care provider if:
• Severe belly pain does not go away
• Symptoms of cholecystitis return

Prevention

Removing the gallbladder and gallstones will prevent further attacks.

Alternative Names

Cholecystitis - acute

References

Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease
Jackson P, Evans S. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery.
Siddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg
Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease

13. Acute cytomegalovirus (CMV) infection

Acute cytomegalovirus (CMV) infection is a condition caused by a member of the herpesvirus family.

Causes

Infection with cytomegalovirus (CMV) is very common. The infection is spread by:
• Blood transfusions
• Organ transplants
• Respiratory droplets
• Saliva
• Sexual contact
• Urine
Most people come into contact with CMV in their lifetime. Typically only people with a weakened immune system become ill from CMV infection. Some otherwise healthy people with acute CMV infection develop a mononucleosis-like syndrome.
In the United States, CMV infection most commonly develops between ages 10 and 35. Many people are exposed to CMV early in life but do not realize it because they have no symptoms, or they have mild symptoms that resemble the common cold. People with a compromised immune system can have a more severe form of the disease.
CMV is a type of herpes virus. The virus remains in your body for the rest of your life. If your immune system becomes weakened in the future, this virus may have the chance to reactivate, causing symptoms.

Symptoms

• Enlarged lymph nodes, especially in the neck
• Fever
• Fatigue
• Loss of appetite
• Malaise
• Muscle aches
• Rash
• Sore throat
Less common symptoms include:
• Chest pain
• Cough
• Headache
• Hives
• Irregular heartbeat
• Jaundice
• Neck stiffness
• Rapid heart rate
• Sensitivity to light
• Shortness of breath
• Swollen spleen and liver

Exams and Tests

Your health care provider will perform a physical exam and feel your belly area. Your liver and spleen may be tender when they are gently pressed (palpated). You may have a skin rash.
Special lab tests such as a CMV DNA serum PCR test may be done to check for substances in your blood that are produced by CMV. Other tests such as a CMV antibody test may be done to check your body’s response to the CMV infection.
Other tests include:
• Blood tests for platelets and white blood cells
• Chemistry panel
• Liver function tests
• Monospot test

Treatment

Most patients recover in 4 to 6 weeks without medication. Rest is needed, sometimes for a month or longer to regain full activity levels. Painkillers and warm salt-water gargles can help relieve symptoms.
Antiviral medications are usually not used in people with normal immune function.

Outlook (Prognosis)

Fever usually goes away in 10 days, and swollen lymph glands and spleen return to normal in 4 weeks. Fatigue may linger for 2 to 3 months.

Possible Complications

Throat infection is the most common complication. Rare complications include:
• Colitis
• Guillain-Barre syndrome
• Nervous system (neurologic) complications
• Pericarditis or myocarditis
• Pneumonia
• Rupture of spleen

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of acute CMV infection.
Go to the emergency room or call the local emergency number (such as 911) if you have sharp, severe sudden pain in your left upper abdomen. This could be a sign of a ruptured spleen, which may require emergency surgery.

Prevention

CMV infection can be contagious if the infected person comes in close or intimate contact with another person. You should avoid kissing and sexual contact with an infected person.
The virus may also spread among young children in day care settings.
When planning blood transfusions or organ transplants, the CMV status of the donor can be checked to avoid passing CMV to a recipient who has not had CMV infection.

Alternative Names

CMV mononucleosis; Cytomegalovirus (CMV)

References

Crumpacker CS II, Zhang JL. Cytomegalovirus. In: Mandell GL, Bennett JE, Dolin R, eds.Principles and Practice of Infectious Diseases
Drew WL. Cytomegalovirus. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

14. Acute kidney failure

Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your body.

Causes

There are many possible causes of kidney damage. They include:
• Acute tubular necrosis (ATN)
• Autoimmune kidney disease
• Blood clot from cholesterol (cholesterol emboli)
• Decreased blood flow due to very low blood pressure, which can result from burns, dehydration, hemorrhage, injury, septic shock, serious illness, or surgery
• Disorders that cause clotting within the kidney blood vessels
• Infections that directly injure the kidney, such as acute pyelonephritis or septicemia
• Pregnancy complications, including placenta abruption or placenta previa
• Urinary tract blockage

Symptoms

Symptoms of acute kidney failure may include any of the following:
• Bloody stools
• Breath odor and metallic taste in the mouth
• Bruising easily
• Changes in mental status or mood
• Decreased appetite
• Decreased sensation, especially in the hands or feet
• Fatigue
• Flank pain (between the ribs and hips)
• Hand tremor
• High blood pressure
• Nausea or vomiting, may last for days
• Nosebleeds
• Persistent hiccups
• Prolonged bleeding
• Seizures
• Shortness of breath
• Slow, sluggish movements
• Swelling due to the body keeping in fluid (may be seen in the legs, ankles, and feet)
• Urination changes, such as little or no urine, excessive urination at night, or urination that stops completely

Exams and Tests

The doctor or nurse will examine you. Many patients with kidney disease have body swelling caused by fluid retention. The doctor may hear a heart murmur, crackles in the lungs, or other abnormal sounds when listening to the heart and lungs with a stethoscope.
The results of laboratory tests may change suddenly (within a few days to 2 weeks). Such tests may include:
• BUN
• Creatinine clearance
• Serum creatinine
• Serum potassium
• Urinalysis
A kidney or abdominal ultrasound is the preferred test for diagnosing a blockage in the urinary tract. X-ray, CT scan, or MRI of the abdomen can also tell if there is a blockage.
Blood tests may help reveal the underlying cause of kidney failure. Arterial blood gas and blood chemistries may show metabolic acidosis.

Treatment

Once the cause is found, the goal of treatment is to help your kidneys work again and prevent fluid and waste from building up in your body while they heal. Usually, you will have to stay overnight in the hospital for treatment.
The amount of liquid you drink will be limited to the amount of urine you can produce. You will be told what you may and may not eat to reduce the buildup of toxins that the kidneys would normally remove. Your diet may need to be high in carbohydrates and low in protein, salt, and potassium.
You may need antibiotics to treat or prevent infection. Diuretics (water pills) may be used to help remove fluid from your body.
Medicines will be given through a vein to help control your blood potassium level.
You may need dialysis. This is a treatment that does what healthy kidneys normally do -- rid the body of harmful wastes, extra salt, and water. Dialysis can save your life if your potassium levels are dangerously high. Dialysis will also be used if:
• Your mental status changes
• You stop urinating
• You develop pericarditis
• You retain too much fluid
• You cannot remove nitrogen waste products from your body
Dialysis will most often be short term. In rare cases, the kidney damage is so great that dialysis is needed permanently.

When to Contact a Medical Professional

Call your health care provider if your urine output slows or stops or you have other symptoms of acute kidney failure.

Prevention

Treating disorders such as high blood pressure can help prevent acute kidney failure.

Alternative Names

Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute

References

Molitoris BA. Acute kidney injury. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Sharfuddin AA, Weisbord SD, Palevsky PM, Molitoris BA. Acute kidney injury. In: Taal MW, Chertow GM, et al, eds.Brenner & Rector's The Kidney

15. Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cell called a lymphoblast.
ALL occurs when the bone marrow produces a large number of immature lymphoblasts. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. The abnormal lymphoblasts grow quickly and replace normal cells in the bone marrow. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur as normal blood counts drop.

Causes

Most of the time, no clear cause can be found for ALL.
The following factors may play a role in the development of all types of leukemia:
• Certain chromosome problems
• Exposure to radiation, including x-rays before birth
• Past treatment with chemotherapy drugs
• Receiving a bone marrow transplant
• Toxins, such as benzene
The following factors are known to increase the risk of ALL:
• Down syndrome or other genetic disorders
• A brother or sister with leukemia
This type of leukemia usually affects children ages 3 to 7. ALL is the most common childhood cancer, but it can also occur in adults.

Symptoms

ALL makes a person more likely to bleed and develop infections. Symptoms include:
• Bone and joint pain
• Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods)
• Feeling weak or tired
• Fever
• Loss of appetite and weight loss
• Paleness
• Pain or feeling of fullness below the ribs
• Pinpoint red spots on the skin (petechiae)
• Swollen glands (lymphadenopathy) in the neck, under arms, and groin
• Night sweats
These symptoms can occur with other conditions. Talk to the doctor about the meaning of specific symptoms.

Exams and Tests

A physical exam may reveal the following:
• Bruising
• Enlarged liver, lymph nodes, and spleen
• Signs of bleeding (petechiae, purpura)
Blood tests may include:
• Complete blood count (CBC), including white blood cell (WBC) count
• Platelet count
• Bone marrow biopsy
• Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid
Tests are also done to look for changes in the DNA inside the abnormal white cells. Certain DNA changes may determine how well a person does (prognosis), and what kind of treatment is recommended.

Treatment

The first goal of treatment is to get blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.
Chemotherapy is the first treatment tried with the goal of achieving a remission.
• The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the patient goes home afterward.
• Chemotherapy is given into the veins (by IV) and sometimes into the fluid around the brain (the spinal fluid).
After a remission is achieved, more treatment is given to achieve a cure. This treatment can include more IV chemotherapy or radiation to the brain. Stem cell or bone marrow transplant from another person may also be done. Further treatment depends on:
• Age and health of the person
• Genetic changes in the leukemia cells
• How many courses of chemotherapy it took to achieve remission
• If abnormal cells are still detected under the microscope
• Availability of donors for stem cell transplant

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

Those who respond to treatment right away tend to do better. Most children with ALL can be cured. Children often have a better outcome than adults.

Possible Complications

Both leukemia itself and the treatment can lead to many problems such as bleeding, weight loss, and infections.

When to Contact a Medical Professional

Call your health care provider if you or your child develops symptoms of ALL.

Prevention

The risk of developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.

Alternative Names

ALL; Acute lymphoblastic leukemia; Acute lymphoid leukemia; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)

References

Jeha S, Pui CH. Clinical manifestations and treatment of acute lymphoblastic leukemia in children. In: Hoffman R, Benz EJ Jr, Silberstein LE, Weitz JI, Anastasi J, eds.Hematology: Basic Principles and Practice.
National Cancer Institute: PDQ Adult Acute Lymphoblastic Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified January 13, 2015. Available at: www.cancer.gov/cancertopics/pdq/treatment/adultALL/HealthProfessional. Accessed: February 26, 2015.
National Cancer Institute: PDQ Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified January 28, 2015. Available at: cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional. Accessed: February 26, 2015.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. Version 2.2014. Available at: /www.nccn.org/professionals/physician_gls/pdf/all.pdf. Accessed: February 26, 2015.

16. Acute mountain sickness

Acute mountain sickness is an illness that can affect mountain climbers, hikers, skiers, or travelers at high altitudes, usually above 8,000 feet (2,400 meters).

Causes

Acute mountain sickness is caused by reduced air pressure and lower oxygen levels at high altitudes.
The faster you climb to a high altitude, the more likely you will get acute mountain sickness.
You are at higher risk for acute mountain sickness if:
• You live at or near sea level and travel to a high altitude
• You have had the illness before

Symptoms

Your symptoms will also depend on the speed of your climb and how hard you push (exert) yourself. Symptoms range from mild to life-threatening. They can affect the nervous system, lungs, muscles, and heart.
In most cases, symptoms are mild. Symptoms of mild to moderate acute mountain sickness may include:
• Difficulty sleeping
• Dizziness or light-headedness
• Fatigue
• Headache
• Loss of appetite
• Nausea or vomiting
• Rapid pulse (heart rate)
• Shortness of breath with exertion
Symptoms that may occur with more severe acute mountain sickness include:
• Blue color to the skin (cyanosis)
• Chest tightness or congestion
• Confusion
• Cough
• Coughing up blood
• Decreased consciousness or withdrawal from social interaction
• Gray or pale complexion
• Cannot walk in a straight line, or walk at all
• Shortness of breath at rest

Exams and Tests

The doctor or nurse will examine you and listen to your chest with a stethoscope. This may reveal sounds called crackles (rales) in the lung. Rales may be a sign of fluid in the lungs.
Tests that may be done include:
• Blood tests
• Brain CT scan
• Chest x-ray
• Electrocardiogram (ECG)

Treatment

Early diagnosis is important. Acute mountain sickness is easier to treat in the early stages.
The main treatment for all forms of mountain sickness is to climb down (descend) to a lower altitude as rapidly and safely as possible. You should not continue climbing if you develop symptoms.
Extra oxygen should be given, if available.
People with severe mountain sickness may need to be admitted to a hospital.
Acetazolamide (Diamox) may be given to help you breathe better. It can help reduce mild symptoms. This medicine can make you urinate more often. Make sure you drink plenty of fluids and avoid alcohol when taking this drug. This medication works best when taken before reaching a high altitude.
If you have fluid in your lungs (pulmonary edema), treatment may include:
• Oxygen
• A high blood pressure medicine called nifedipine
• Beta agonist inhalers to open the airways
• Breathing machine in severe cases
• Medicine to increase blood flow to the lungs called phosphodiesterase inhibitor (such as sildenafil)
Dexamethasone (Decadron) may help reduce swelling in the brain (cerebral edema).
Portable hyperbaric chambers allow hikers to simulate conditions at lower altitudes without actually moving from their location on the mountain. These devices are very helpful if bad weather or other factors make climbing down the mountain impossible.

Outlook (Prognosis)

Most cases are mild. Symptoms improve quickly when you climb down the mountain to a lower altitude.
Severe cases may result in death due to lung problems or brain swelling, called cerebral edema.
In remote locations, emergency evacuation may not be possible, or treatment may be delayed. This can have a negative affect on your outcome.

Possible Complications

• Coma
• Fluid in the lungs (pulmonary edema)
• Swelling of the brain (cerebral edema), which can lead to seizures, mental changes, or permanent damage to the nervous system

When to Contact a Medical Professional

Call your health care provider if you have or had symptoms of acute mountain sickness, even if you felt better when you returned to a lower altitude.
Call 911 or your local emergency number if you or another climber have any of the following symptoms:
• Severe breathing problems
• Altered level of alertness
• Coughing up blood
Climb down the mountain immediately and as safely as possible.

Prevention

Keys to preventing acute mountain sickness include:
• Climb the mountain gradually
• Stop for a day or two of rest for every 2,000 feet (600 meters) above 8,000 feet (2,400 meters)
• Sleep at a lower altitude when possible
• Learn how to recognize early symptoms of mountain sickness
If you are traveling above 9,840 feet (3,000 meters), you should carry enough oxygen for several days.
If you plan on quickly climbing to a high altitude, ask your doctor about a medication called acetazolamide (Diamox). This drug helps your body get used to higher altitudes more quickly, and reduces minor symptoms. It should be taken the day before you climb, and then for the next 1 to 2 days.
If you are at risk for a low red blood cell count (anemia), ask your doctor if an iron supplement is right for you. Anemia lowers the amount of oxygen in your blood. This makes you more likely to have mountain sickness.
While climbing:
• Drink plenty of fluids
• Avoid alcohol
• Eat regular meals, high in carbohydrates
You should avoid high altitudes if you have heart or lung disease.

Alternative Names

High altitude cerebral edema; Altitude anoxia; Altitude sickness; Mountain sickness; High altitude pulmonary edema

References

Hackett PH, Roach RC. High-altitude medicine. In: Auerbach PS, ed.Wilderness Medicine
Schoene RB, Swenson ER. High Altitude. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA, eds.Textbook of Respiratory Medicine
Wright A, Brearey S, Imray C. High hopes at high altitudes: pharmacotherapy for acute mountain sickness and high-altitude cerebral and pulmonary oedema. Expert Opin Pharmacother
Yaron, M, Honigman, B. High- Altitude Medicine. In: Marx JA, Hockberger RS, Walls RM, et al., eds.Rosen's Emergency Medicine: Concepts and Clinical Practice

17. Acute myeloid leukemia

Acute myeloid leukemia (AML) is cancer that starts inside bone marrow. This is the soft tissue in the center of bones that helps form all blood cells. The cancer grows from cells that would normally turn into white blood cells.
Acute means the disease develops quickly and usually has an aggressive course.

Causes

Acute myeloid leukemia (AML) is one of the most common types of leukemia among adults. This type of cancer is rare under age 40.
AML is more common in men than women.
Persons with this type of cancer have an abundance of abnormal immature cells inside their bone marrow. The cells grow very quickly, and replace healthy blood cells. The bone marrow, which helps the body fight infections and makes other blood components, eventually stops working correctly. Persons with AML are more likely to have infections and have an increased risk of bleeding as the numbers of healthy blood cells decrease.
Most of the time, a doctor cannot tell you what caused AML. However, the following things can lead to some types of leukemia, including AML:
• Blood disorders, including polycythemia vera, thrombocythemia, and myelodysplasia
• Certain chemicals (for example, benzene)
• Certain chemotherapy drugs, including etoposide and drugs known as alkylating agents
• Exposure to certain chemicals and harmful substances
• Radiation
• Weakened immune system due to an organ transplant
Problems with your genes may also play a role in the development of AML.

Symptoms

Symptoms of AML may include any of the following:
• Bleeding from the nose
• Bleeding gums
• Bruising
• Bone pain or tenderness
• Fatigue
• Fever
• Heavy menstrual periods
• Pallor
• Shortness of breath (gets worse with exercise)
• Skin rash or lesion
• Swollen gums (rare)
• Weight loss

Exams and Tests

The doctor will perform a physical exam. There may be signs of a swollen spleen, liver, or lymph nodes.
A complete blood count (CBC) may show anemia and a low number of platelets. A white blood cell count (WBC) can be high, low, or normal.
Bone marrow aspiration and biopsy will show if there are any leukemia cells.
If your doctor learns you do have this type of leukemia, further tests will be done to determine the specific type of AML. Subtypes are based on specific genetic changes or mutations and how the leukemia cells appear under the microscope.

Treatment

Treatment involves using medicines (chemotherapy) to kill the cancer cells. Most types of AML are treated the same way in the beginning, with more than one chemotherapy drug.
Chemotherapy kills normal cells, too. This may cause side effects such as:
• Increased risk of bleeding
• Increased risk of infection (your doctor may want to keep you away from other people to prevent infection)
• Weight loss (you will need to eat extra calories)
• Mouth sores
Other supportive treatments for AML may include:
• Antibiotics to treat infection
• Red blood cell transfusions to fight anemia
• Transfusions of platelets to control bleeding
A bone marrow (stem cell) transplant will likely be done after your first or second round of chemotherapy. This decision is determined by several factors, including:
• Your age and overall health
• How high your white blood cell count was
• Certain genetic changes in the leukemia cells
• The availability of donors

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

When a bone marrow biopsy shows no evidence of AML, you are said to be in remission. Complete remission occurs in most patients. How well you do depends on your overall health and the genetic subtype of the AML cells.
Remission is not the same as a cure. More therapy is usually needed, either in the form of more chemotherapy or a bone marrow transplant.
With treatment, younger patients with AML tend to do better than those who develop the disease at an older age. The 5-year survival rate is much lower in older adults than younger persons. Experts say this is partly due to the fact that younger people are better able to tolerate strong chemotherapy medicines. Also, leukemia in older people tends to be more resistant to current treatments.
If the cancer does not come back (relapse) within 5 years of the diagnosis, you are likely cured.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you develop symptoms of AML.
Call your health care provider if you have AML and have a fever that will not go away or other signs of infection.

Prevention

If you work around radiation or chemicals linked to leukemia, you should always wear protective gear.

Alternative Names

Acute myelogenous leukemia; AML; Acute granulocytic leukemia; Acute nonlymphocytic leukemia (ANLL); Leukemia - acute myeloid (AML); Leukemia - acute granulocytic; Leukemia - nonlymphocytic (ANLL)

References

Appelbaum FR. Acute leukemias in adults. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds.Abeloff's Clinical Oncology
National Cancer Institute: PDQ Adult Acute Myeloid Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified 03/28/2014. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/healthprofessional.Accessed May 29, 2014.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Acute Myeloid Leukemia. Version 2.2014. Available at: http://www.nccn.org/professionals/physician_gls/pdf/aml.pdf.Accessed May 29, 2014.

18. Acute nephritic syndrome

Acute nephritic syndrome is a group of symptoms that occur with some disorders that cause glomerulonephritis, or swelling and inflammation of the glomeruli in the kidney.

Causes

Acute nephritic syndrome is often caused by an immune response triggered by an infection or other disease.
Common causes in children and adolescents include:
• Hemolytic uremic syndrome
• Henoch-Schonlein purpura
• IgA nephropathy
• Post-streptococcal glomerulonephritis
Common causes in adults include:
• Abdominal abscesses
• Goodpasture syndrome
• Hepatitis B or C
• Infective endocarditis
• Membranoproliferative GN I
• Membranoproliferative GN II
• Rapidly progressive (crescentic) glomerulonephritis
• SLE or lupus nephritis
• Vasculitis
• Viral diseases such as mononucleosis, measles, mumps
The inflammation affects the function of the glomerulus -- the part of the kidney that filters blood to make urine and remove waste. As a result, blood and protein appear in the urine, and excess fluid builds up in the body.
Swelling of the body occurs when the blood loses a protein called albumin. (Albumin keeps fluid in the blood vessels. When it is lost, fluid collects in the body tissues). Blood loss from the damaged kidney structures leads to blood in the urine.
Acute nephritic syndrome may be related to:
• Acute kidney failure
• High blood pressure

Symptoms

Common symptoms of nephritic syndrome are:
• Blood in the urine (urine appears dark, tea-colored, or cloudy)
• Decreased urine output (little or no urine may be produced)
• Swelling of the face, eye socket, legs, arms, hands, feet, abdomen, or other areas
Other symptoms that may occur include:
• Blurred vision
• Cough containing mucus or pink, frothy material
• Decreased alertness, drowsiness, confusion
• General aches and pains (joint pain, muscle aches)
• General ill feeling (malaise)
• Headache
• Shortness of breath
• Slow, sluggish, lethargic movement
Patients may develop symptoms of acute kidney failure or chronic kidney disease.

Exams and Tests

During an examination, your health care provider may find the following signs:
• Abnormal heart and lung sounds
• Enlarged liver
• Enlarged neck veins from increased pressure
• General swelling
• High blood pressure
• Signs of acute kidney failure
• Signs of fluid overload (in the abdomen)
Tests that may be done include:
• Blood electrolytes
• Blood urea nitrogen (BUN)
• Creatinine - blood
• Creatinine clearance
• Potassium test
• Protein in the urine
• Urinalysis
• Urine appearance and color
A kidney biopsy will show inflammation of the glomeruli, which may indicate the cause of the condition.
Tests to find the cause of acute nephritic syndrome may include:
• ANA titer (lupus)
• Anti-glomerular basement membrane antibody
• Antineutrophil cytoplasmic antibody for vasculitis (ANCA)
• Blood culture
• Culture of the throat or skin
• Serum complement (C3 and C4)

Treatment

The goal of treatment is to reduce inflammation in the kidney and control high blood pressure. You may need to stay in a hospital to be diagnosed and treated. Treatment may include antibiotics or other medications or therapies.
Your doctor may recommend bedrest. You may need to limit salt, fluids, and potassium in your diet. Your health care provider may prescribe medications to control high blood pressure. Corticosteroids or other anti-inflammatory medications may be used to reduce inflammation.
You may also need other treatments for acute kidney failure.

Support Groups

For information and support, see kidney disease support groups.

Outlook (Prognosis)

The outlook depends on the disease that is causing the nephritis. When the condition improves, symptoms of fluid retention (such as swelling and cough) and high blood pressure may go away in 1 or 2 weeks. However, urine tests may take months to return to normal.
Children tend to do better than adults and usually recover completely. Only rarely do they develop complications or progress to chronic glomerulonephritis and chronic kidney disease.
Adults do not recover as well or as quickly as children. Although it is unusual for the disease to return, at least one-third of adults whose disease does return will develop end-stage kidney disease and may need dialysis or a kidney transplant.

Possible Complications

• Chronic glomerulonephritis
• Congestive heart failure
• Nephrotic syndrome
• Pulmonary edema

When to Contact a Medical Professional

Call your health care provider if you have symptoms of acute nephritic syndrome.

Prevention

Many times, the disorder cannot be prevented, although treatment of illness and infection may help to reduce the risk.

Alternative Names

Glomerulonephritis - acute; Acute glomerulonephritis; Nephritis syndrome - acute

References

Appel GB. Glomerular disorders and nephrotic syndromes. In: Goldman L, Ausiello D, eds.Cecil Medicine
Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Brenner BM, ed.Brenner & Rector's The Kidney

19. Acute pancreatitis

Acute pancreatitis is sudden swelling and inflammation of the pancreas.

Causes

The pancreas is an organ located behind the stomach that produces chemicals called enzymes, which are needed to digest food. It also produces the hormones insulin and glucagon. Most of the time, the enzymes are only active after they reach the small intestine.
When these enzymes become active inside the pancreas, they digest the tissue of the pancreas. This causes swelling, bleeding (hemorrhage), and damage to the organ and its blood vessels. This condition is called acute pancreatitis.
Acute pancreatitis affects men more often than women. Certain diseases, surgeries, and habits make you more likely to develop this condition. The two most common causes of pancreatitis in the United States are heavy alcohol use and gallstones.
Alcohol use is responsible for up to 70% of cases in the United States. Acute pancreatitis typically requires 5 to 8 drinks per day for 5 or more years. Gallstones are the next most common cause. The condition develops when the gallstones travel out of the gallbladder into the bile ducts, where they block the opening that drains the common bile duct and pancreatic duct (ampulla). Genetics may be a factor in some cases. Sometimes, the cause is not known.
Other conditions that have been linked to pancreatitis are:
• Autoimmune problems (when the immune system attacks the body)
• Damage to the ducts or pancreas during surgery
• High blood levels of a fat called triglycerides (hypertriglyceridemia) usually above 1000 mg/dL
• Injury to the pancreas from an accident
Other causes include:
• Complications of cystic fibrosis
• Hemolytic uremic syndrome
• Hyperparathyroidism
• Kawasaki disease
• Reye syndrome
• Use of certain medications (especially estrogens, corticosteroids, sulfonamides, thiazides and azathioprine)
• Viral infections, including mumps, coxsackie B, mycoplasma pneumonia, and campylobacter
• Injury to the pancreas after a procedure such as an ERCP (endoscopic retrograde cholangiopancreatography) or EUS (endoscopic ultrasound) with FNA (fine needle aspirate)

Symptoms

The main symptom of pancreatitis is pain felt in the upper left side or middle of the abdomen. The abdominal pain:
• May be worse within minutes after eating or drinking at first, especially if foods have a high fat content
• Becomes constant and more severe, lasting for several days
• May be worse when lying flat on the back
• May spread (radiate) to the back or below the left shoulder blade
People with acute pancreatitis often look ill and have a fever, nausea, vomiting, and sweating.
Other symptoms that may occur with this disease include:
• Clay-colored stools
• Gaseous abdominal fullness
• Hiccups
• Indigestion
• Mild yellowing of the skin and whites of the eyes (jaundice)
• Swollen abdomen

Exams and Tests

The doctor will do a physical exam, which may show:
• Abdominal tenderness or lump (mass)
• Fever
• Low blood pressure
• Rapid heart rate
• Rapid breathing (respiratory) rate
Lab tests that show the release of pancreatic enzymes will be done. These include:
• Increased blood amylase level
• Increased serum blood lipase level
• Increased urine amylase level
Other blood tests that can help diagnose pancreatitis or its complications include:
• Complete blood count (CBC)
• Comprehensive metabolic panel
Imaging tests that can show inflammation of the pancreas include:
• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound

Treatment

Treatment often requires a stay in the hospital. It may involve:
• Pain medicines
• Fluids given through a vein (IV)
• Stopping food or fluid by mouth to limit the activity of the pancreas
A tube may be inserted through the nose or mouth to remove the contents of the stomach (nasogastric suctioning). This may be done if vomiting and severe pain do not improve, or if a paralyzed bowel (paralytic ileus) develops. The tube will stay in for 1 - 2 days to 1 - 2 weeks.
Treating the condition that caused the problem can prevent repeated attacks.
In some cases, therapy is needed to:
• Drain fluid that has collected in or around the pancreas
• Remove gallstones
• Relieve blockages of the pancreatic duct
In the most severe cases, surgery is needed to remove damaged, dead or infected pancreatic tissue.
Avoid smoking, alcoholic drinks, and fatty foods after the attack has improved.

Outlook (Prognosis)

Most cases go away in a week. However, some cases develop into a life-threatening illness.
The death rate is high with:
• Hemorrhagic pancreatitis
• Liver, heart, or kidney impairment
• Necrotizing pancreatitis

Possible Complications

Pancreatitis can return. The chances of it returning depend on the cause, and how well it can be treated. Complications of acute pancreatitis may include:
• Acute kidney failure
• Acute respiratory distress syndrome (ARDS)
• Buildup of fluid in the abdomen (ascites)
• Cysts or abscesses in the pancreas
• Heart failure
• Low blood pressure
Repeat episodes of acute pancreatitis can lead to chronic pancreatitis.

When to Contact a Medical Professional

Call your health care provider if:
• You have intense, constant abdominal pain
• You develop other symptoms of acute pancreatitis

Prevention

You may lower your risk of new or repeat episodes of pancreatitis by taking steps to prevent the medical conditions that can lead to the disease:
• Avoid aspirin when treating a fever in children, especially if they may have a viral illness, to reduce the risk of Reye syndrome.
• Do NOT drink too much alcohol.
• Make sure children receive vaccines to protect them against mumps and other childhood illnesses.
• Treat medical conditions that contribute to hypertriglyceridemia.

References

Forsmark CE. Pancreatitis. In: Goldman L, Shafer AI, eds.Goldman's Cecil Medicine
Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology Guideline: Management of Acute Pancreatitis. Am J Gastroenterol.
Tenner S, Steinbert WM. Acute pancreatitis. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease.

20. Acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood. Infants can also have respiratory distress syndrome.

Causes

ARDS can be caused by any major direct or indirect injury to the lung. Common causes include:
• Breathing vomit into the lungs (aspiration)
• Inhaling chemicals
• Lung transplant
• Pneumonia
• Septic shock (infection throughout the body)
• Trauma
ARDS leads to a buildup of fluid in the air sacs (alveoli). This fluid prevents enough oxygen from passing into the bloodstream.
The fluid buildup also makes the lungs heavy and stiff, which decreases the lungs' ability to expand. The level of oxygen in the blood can stay dangerously low, even if the person receives oxygen from a breathing machine (ventilator) through a breathing tube (endotracheal tube).
ARDS often occurs along with the failure of other organ systems, such as the liver or kidneys. Cigarette smoking and heavy alcohol use may be risk factors.

Symptoms

Symptoms usually develop within 24 to 48 hours of the injury or illness. Often, people with ARDS are so sick they cannot complain of symptoms. Symptoms can include any of the following:
• Difficulty breathing
• Low blood pressure and organ failure
• Rapid breathing
• Shortness of breath

Exams and Tests

Listening to the chest with a stethoscope (auscultation) reveals abnormal breath sounds, such as crackles, which may be signs of fluid in the lungs. Often, blood pressure is low. Cyanosis (blue skin, lips, and nails caused by lack of oxygen to the tissues) is often seen.
Tests used to diagnose ARDS include:
• Arterial blood gas
• Blood tests, including CBC and blood chemistries
• Blood and urine cultures
• Bronchoscopy
• Chest x-ray
• Sputum cultures and analysis
• Tests for possible infections
An echocardiogram or Swan-Ganz catheterization may be needed to rule out congestive heart failure, which can look similar to ARDS on a chest x-ray.

Treatment

ARDS often needs to be treated in an intensive care unit (ICU).
The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve medicines to treat infections, reduce inflammation, and remove fluid from the lungs.
A ventilator is used to deliver high doses of oxygen and continued pressure (positive end-expiratory pressure, or PEEP) to the damaged lungs. Patients often need to be deeply sedated with medicines. During treatment, doctors and nurses make every effort to protect the lungs from further damage.

Support Groups

Many family members of people with ARDS are under extreme stress. Often they can relieve this stress by joining support groups where members share common experiences and problems.

Outlook (Prognosis)

About a third of people with ARDS die of the disease. Those who live usually get back most of their normal lung function, but many people have permanent (usually mild) lung damage.
Many people who survive ARDS have memory loss or other quality-of-life problems after they recover. This is due to brain damage that occurred when the lungs were not working properly and the brain was not getting enough oxygen.

Possible Complications

• Failure of many organ systems
• Lung damage (such as a collapsed lung--also called pneumothorax) due to injury from the breathing machine needed to treat the disease
• Pulmonary fibrosis (scarring of the lung)
• Ventilator-associated pneumonia

When to Contact a Medical Professional

Usually, ARDS occurs during another illness, for which the patient is already in the hospital. In some cases, a healthy person has severe pneumonia that gets worse and becomes ARDS. If you have trouble breathing, call your local emergency number (such as 911) or go to the emergency room.

Alternative Names

Noncardiogenic pulmonary edema; Increased-permeability pulmonary edema; ARDS; Acute lung injury

References

Herridge MS. Recovery and long-term outcome in acute respiratory distress syndrome. Crit Care Clin
Lee WL, Slutsky AS. Acute respiratory distress syndrome. In: Mason RJ, Murray JF, Broaddus VC, et al., eds.Murray and Nadel's Textbook of Respiratory Medicine
Published for educational purposes from the website: MedlinePlus
Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

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