Pregnancy Care

Definition

Adolescent pregnancy is pregnancy in girls age 19 or younger.

Symptoms

Pregnancy symptoms include

Abdominal distention

Breast enlargement and breast tenderness

Fatigue

Light-headedness or actual fainting

Missed period

Nausea/vomiting

Frequent urination

Abdomen - swollen

Definition

A swollen abdomen is when your belly area is bigger than usual.

Considerations

Abdominal swelling, or distention, is a common condition, which usually results from over-eating, rather than from a serious illness. Simple weight gain,premenstrual syndrome (PMS), pregnancy, or the unconscious swallowing of air can lead to this problem.

Abdominal distention is often due to gas in the intestines. This may result from eating fibrous foods such as fruits and vegetables. Beans are common sources of intestinal gas. Dairy foods can lead to abdominal swelling if you are lactose intolerant.

Abdominal swelling may also occasionally result from the accumulation of fluid in the abdomen, which can be a sign of serious medical problems. There are usually other symptoms in this case.

Home Care

A swollen abdomen that results from eating a heavy meal will go away when the food is digested. Eating in moderation will help prevent swelling.

For a swollen abdomen caused by swallowing air, awareness often leads to self-control. Eat slowly, avoid carbonated beverages, avoid chewing gum or sucking on candies, avoid drinking through a straw, or sipping the surface of a hot beverage.

For swollen abdomen caused by malabsorption, try changing diets and reducing milk consumption. Consult your doctor.

For irritable bowel syndrome, increase dietary fiber, decrease emotional stress, and consult your doctor.

For swollen abdomen resulting from other causes, follow prescribed therapy to treat the underlying cause.

Call your health care provider if

Call your health care provider if:

• The abdominal swelling is getting worse and does not go away
• The swelling occurs with other unexplained symptoms
• Your abdomen is tender to the touch

What to expect at your health care provider's office

Your health care provider perform a physical exam and ask questions about your medical history, such as:

• Time pattern
  • When did the abdominal swelling begin?
  • Does it occur after meals or after eating specific foods?
• What other symptoms occur at the same time? For example, have you had:
  • Absent menstrual period
  • Diarrhea
  • Excessive fatigue
  • Excessive gas or belching
  • Irritability
  • Vomiting
  • Weight gain

Tests that may be done include:

• Abdominal CT scan
• Abdominal ultrasound
• Blood tests
• Colonoscopy
• Esophagogastroduodenoscopy (EGD)
• Paracentesis
• Sigmoidoscopy
• Stool analysis
• X-rays of the abdomen

Breast - premenstrual tenderness and swelling

Definition

Premenstrual swelling and tenderness of both breasts occurs during the second half of the menstrual cycle.

Alternative Names

Premenstrual tenderness and swelling of the breasts

Considerations

Symptoms of premenstrual breast tenderness may range from mild to severe. Symptoms typically peak just before each menstrual period and improve immediately after or during the menstrual period.

Breast tissue may have dense, rough, "cobblestone" feel to the fingers -- usually more marked in the outer areas. There may also be an intermittent or persistent sense of breast fullness with dull, heavy pain, and tenderness.

During the menstrual cycle, estrogen production increases and peaks just prior to midcycle. This causes enlargement of the breast ducts. Premenstrually, progesterone peaks near the 21st day (in a 28-day cycle) and causes growth of the breast lobules (milk glands).

Premenstrual swelling and tenderness of the breasts is commonly associated withpremenstrual syndrome (PMS) and fibrocystic breast disease (benign breast changes). Fibrocystic breast changes are not completely understood, but are believed to hormone related since the condition usually gets better with menopause.

Premenstrual breast tenderness and swelling probably occur to some degree in nearly all women. Symptoms severe enough to cause concern or limit function may occur in many women during their childbearing years. The rate may be lower in women taking birth control pills. Risk factors may include family history, a high fat diet, and too much caffeine.

Common Causes

• Menstrual cycle
• Estrogen medications
• Adolescent pregnancy
• Early pregnancy

Home Care

Self-care tips include:

• Eating a lower fat diet
• Avoiding caffeine
• Avoiding salt 1-2 weeks before your period starts
• Getting vigorous exercise every day

You should perform a breast self-examination every month.

A well-fitting bra should be worn day and night to provide good breast support.

The effectiveness of vitamin E, vitamin B6, and herbal preparations such asevening primrose oil are somewhat controversial and should be discussed with your health care provider.

Birth control pills may be prescribed to decrease symptoms.

Diuretics (water pills) taken in the premenstrual phase may reduce breast swelling and tenderness.

A prescription medicine called Depo-Provera is available for those who experience premenstrual breast swelling and tenderness. This drug relieves symptoms by eliminating menstrual periods.

Danazol, a synthetic androgen (male hormone), may be used in severe cases when the potential benefit is thought to outweigh the possible bad side effects. If Danazol does not work for you, bromocriptine or tamoxifen may be prescribed.

Call your health care provider if

Call your health care provider if:

• You have new, unusual, or changing lumps in breast tissue.
• You have one-sided (unilateral) lumps in breast tissue.
• You do not know how to properly perform a breast self-examination.
• You are a woman, age 40 or older, and have never had a screening mammogram.
• You have discharge from your nipple, especially if it is a bloody or brown discharge.
• Your symptoms are interfering with your ability to sleep and diet changes and exercise have not helped.

What to expect at your health care provider's office

The medical history will be obtained and a physical examination performed. Medical history questions documenting premenstrual breast tenderness may include:

• Does the tenderness occur with every menstrual period?
• Do you know how to do breast self-examination?
• Have you noticed any breast lumps?
• What other symptoms are also present?

Your health care provider will check for breast lumps, and note the qualities of the lump (firm or soft, smooth or bumpy, and so on).

Diagnostic tests:

A mammogram or breast ultrasound may be performed to evaluate any abnormalities found in a breast exam. If a lump is found that is not clearly benign, abreast biopsy may be necessary.

Fatigue

Definition

Fatigue is a feeling of weariness, tiredness, or lack of energy.

Alternative Names

Tiredness; Weariness; Exhaustion; Lethargy

Considerations

Fatigue is different from drowsiness. In general, drowsiness is feeling the need tosleep, while fatigue is a lack of energy and motivation. Drowsiness and apathy (a feeling of indifference or not caring about what happens) can be symptoms that go along with fatigue.

Fatigue can be a normal and important response to physical exertion, emotional stress, boredom, or lack of sleep. However, it can also be a nonspecific sign of a more serious psychological or physical disorder. When fatigue is not relieved by enough sleep, good nutrition, or a low-stress environment, it should be evaluated by your doctor. Fatigue is a common symptom, and is usually not due to a serious disease.

The pattern of fatigue may help your doctor determine its underlying cause. For example, if you wake up in the morning rested but rapidly develop fatigue with activity, you may have an ongoing physical condition like an underactive thyroid. On the other hand, if you wake up with a low level of energy and have fatigue that lasts throughout the day, you may be depressed

Common Causes

There are many possible physical and psychological causes of fatigue. Some of the more common are:

• An allergy that leads to hay fever or asthma
• Anemia (including iron deficiency anemia)
• Depression or grief
• Persistent pain
• Sleep disorders such as ongoing insomnia, obstructive sleep apnea, ornarcolepsy
• Underactive or overactive thyroid gland
• Use of alcohol or drugs such as cocaine or narcotics, especially with regular use

Fatigue can also accompany the following illnesses:

• Addison's disease
• Anorexia or other eating disorders
• Arthritis, including juvenile rheumatoid arthritis
• Autoimmune diseases such as systemic lupus erythematosus
• Cancer
• Congestive heart failure
• Diabetes
• Infection, especially one that takes a long time to recover from or treat such as bacterial endocarditis (infection of the heart muscle or valves), parasitic infections, AIDS, tuberculosis, and mononucleosis
• Kidney disease
• Liver disease
• Malnutrition

Certain medications may also cause drowsiness or fatigue, including antihistamines for allergies, blood pressure medicines, sleeping pills, steroids, and diuretics.

Chronic fatigue syndrome (CFS) is a condition that starts with flu-like symptoms and lasts for 6 months or more. All other possible causes of fatigue are eliminated before this diagnosis is made. Most people with CFS do not get much relief from rest.

.Home Care

Here are some tips for reducing fatigue:

• Get adequate, regular, and consistent amounts of sleep each night.
• Eat a healthy, well-balanced diet and drink plenty of water throughout the day.
• Exercise regularly.
• Learn better ways to relax. Try yoga or meditation.
• Maintain a reasonable work and personal schedule.
• Change your stressful circumstances, if possible. For example, switch jobs, take a vacation, and deal directly with problems in a relationship.
• Take a multivitamin. Talk to your doctor about what is best for you.
• Avoid alcohol, nicotine, and drug use.

If you have chronic pain or depression, treating either often helps the fatigue. However, some antidepressant medications may cause or worsen fatigue. Your medication may have to be adjusted to avoid this problem. DO NOT stop or change any medications without instruction from your doctor.

Stimulants (including caffeine) are NOT effective treatments for fatigue, and can actually make the problem worse when the drugs are stopped. Sedatives also tend to worsen fatigue in the long run.

Call your health care provider if

Call your doctor right away if:

• You are confused or dizzy
• You have blurred vision
• You have little to no urine, or recent swelling and weight gain

Call your doctor if:

• You have ongoing, unexplained weakness or fatigue, especially if accompanied by fever or unintentional weight loss
• You have constipation, dry skin, weight gain, or intolerance to cold
• You wake up and fall back to sleep multiple times through the night
• You have headaches
• You are taking any medications, prescription or non-prescription, or using drugs that may cause fatigue or drowsiness
• You feel sad or depressed
• You have insomnia

What to expect at your health care provider's office

Your doctor will perform a complete physical examination, paying special attention to your heart, lymph nodes, thyroid, and nervous system. You will be asked questions about your medical history, symptoms, and your lifestyle, habits, and feelings.

Questions may include:

• How long have you had fatigue? Did it develop recently or awhile ago?
• Have you had fatigue in the past? If so, does it tend to occur in regular cycles?
• How many hours do you sleep each night?
• Do you have trouble falling asleep? Do you awaken during the night?
• Do you awaken feeling rested or fatigued?
• Do you snore or does someone who sleeps nearby tell you that you snore?
• Has anyone noticed that you stop breathing for short periods of time during sleep?
• Do you feel fatigued or tired throughout the day? Does it tend to get worse as the day goes on or stay about the same?
• Do you feel bored, stressed, unhappy, or disappointed?
• How are your relationships?
• Has anyone in your life recently passed away?
• Have you had more activity (mental or physical) lately?
• What is your diet like?
• Do you get regular exercise?
• Do you have any other symptoms like pain, headaches, or nausea?
• Have you had any recent change in appetite (up or down) or weight (up or down)?
• Do you take any prescription or non-prescription medications? Which ones?

Tests that may be performed include the following:

• Blood tests to check for anemia, diabetes, and possible infection.
• Thyroid, kidney, and liver function tests
• Urinalysis

Fainting

Definition

Fainting is a temporary loss of consciousness due to a drop in blood flow to the brain. The episode is brief (lasting less than a couple of minutes) and is followed by rapid and complete recovery. You may feel light-headed or dizzy before fainting.

A longer, deeper state of unconsciousness is often called a coma.

Alternative Names

Passed out; Light-headedness - fainting; Syncope; Vasovagal episode

Considerations

When you faint, you not only experience loss of consciousness, but also loss of muscle tone and paling of color in your face (pallor). You may also feel weak or nauseated just prior to fainting, and you may have the sense that surrounding noises are fading into the background.

Common Causes

Fainting may occur while you are urinating, having a bowel movement (especially if straining), coughing very hard, or when you have been standing in one place too long. Fainting can also be related to fear, severe pain, or emotional distress.

A sudden drop in blood pressure can cause you to faint. Your blood pressure may drop suddenly if you are bleeding or severely dehydrated. It can also happen if you stand up very suddenly from a lying position.

Certain medications may lead to fainting by causing a drop in your blood pressure or for another reason. Common drugs that contribute to fainting include those used for anxiety, high blood pressure, nasal congestion, and allergies.

Other reasons you may faint include hyperventilation, drug or alcohol use, and low blood sugar.

Less common but more serious reasons for fainting include heart disease (such as abnormal heart rhythm or heart attack) and stroke. These conditions are more likely in persons over age 65 and less likely in those younger than 40.

Home Care

If you have a history of fainting and have been seen by a medical professional, follow your doctor's instructions for how to prevent fainting episodes. For example, if you know the situations that cause you to faint, avoid or change them. Avoid sudden changes in posture. Get up from a lying or seated position slowly. If having blood drawn makes you faint, tell your health care provider before having a blood test and make sure that you are lying down when the test is done.

You can take immediate treatment steps when someone has fainted:

• Check the person's airway and breathing. If necessary, call 911 and begin rescue breathing and CPR.
• Loosen tight clothing around the neck.
• Raise the person's feet above the level of the heart (about 12 inches).
• If vomiting has occurred, turn the person onto their side to prevent choking.
• Keep the person lying down for at least 10 - 15 minutes, preferably in a cool and quiet space. If this is not possible, sit the person forward and place their head between their knees.

Call your health care provider if

Call 911 if the person who fainted:

• Fell from a height, especially if injured or bleeding
• Does not become alert quickly (within a couple of minutes)
• Is pregnant
• Is over age 50
• Has diabetes (check for medical identification bracelets)
• Feels chest pain, pressure, or discomfort
• Has a pounding or irregular heartbeat
• Has a loss of speech, visual disturbances, or inability to move one or more limbs
• Has convulsions, tongue injury, or loss of bladder or bowel control

Even if it's not an emergency situation, people should be seen by a doctor if they have never fainted before, if they are fainting frequently, or if they have new symptoms associated with fainting. Call for an appointment to be seen as soon as possible.

What to expect at your health care provider's office

When you see your doctor, the focus of the questions will be to determine whether you simply fainted, or if something else happened (like a seizure or heart rhythm disturbance), and to figure out the cause of the fainting episode.

The questions will include:

• Is this the first time you have fainted?
• When did you faint? What were you doing before it occurred? For example, were you going to the bathroom, coughing, or standing for a long time?
• How would you describe the dizziness that you felt before fainting? Did you feel light-headed, off-balance, or like the room was spinning?
• Was the faint associated with convulsions (jerking muscle movements), tongue trauma, or loss of control of your bowels?
• When you regained consciousness were you aware of your surroundings or were you confused?
• Did you experience chest pain or heart palpitations before you fainted?
• Does fainting occur when you change positions -- for example, go from lying to standing?

The physical examination will focus on your heart, lungs, and nervous system. Your blood pressure may be measured in several different positions.

Tests that may be performed include:

• ECG
• Holter monitor
• X-ray of the chest
• Echocardiogram
• EEG
• Blood tests for anemia or body chemical imbalances

Nausea and vomiting

Definition

Nausea is the sensation of having an urge to vomit. Vomiting is forcing the contents of the stomach up through the esophagus and out of the mouth.

Alternative Names

Emesis; Vomiting; Stomach upset; Upset stomach

Considerations

Your body has a few main ways to respond to an ever-changing, wide variety of invaders and irritants. Sneezing ejects the intruders from the nose, coughing from the lungs and throat, diarrhea from the intestines, and vomiting from the stomach.

Vomiting is a forceful action accomplished by a fierce, downward contraction of the diaphragm muscle. At the same time, the abdominal muscles tighten against a relaxed stomach with an open gastroesophageal sphincter. The contents of the stomach are propelled up and out.

As part of a bodily reflex, you may produce more saliva just before vomiting.

Vomiting is a complex, coordinated reflex orchestrated by the vomiting center of the brain. It responds to signals coming from:

• The mouth, stomach, and intestines
• The bloodstream, which may contain medicines or infections
• The balancing systems in the ear (motion sickness)
• The brain itself, including unsettling sights, smells, or thoughts

An amazing variety of stimuli can trigger vomiting, from migraines to kidney stones. Sometimes, just seeing someone else vomit will start you vomiting, in your body's effort to protect you from possible exposure to the same danger.

Vomiting is common. Almost all children will vomit several times during their childhood. In most cases, it is due to a viral gastrointestinal infection.

Spitting up, the gentle sloshing of stomach contents up and out of the mouth, sometimes with a burp, is an entirely different process. Some spitting up is normal for babies, and usually gets gradually better over time. If spitting up worsens or is more frequent, it might be reflux disease. Discuss this with your child's doctor.

Most of the time, nausea and vomiting do not require urgent medical attention. However, if the symptoms continue for days, they are severe, or you cannot keep down any food or fluids, you may have a more serious condition.

Dehydration is the main concern with most vomiting. How fast you become dehydrated depends on your size, frequency of vomiting, and whether you also have diarrhea.

Common Causes

The following are possible causes of vomiting:

• Viral infections
• Medications
• Seasickness or motion sickness
• Migraine headaches
• Morning sickness during pregnancy
• Food poisoning
• Food allergies
• Brain tumors
• Chemotherapy in cancer patients
• Bulimia
• Alcoholism
• Peptic ulcer in the stomach outlet (pylorus)

These are possible causes of vomiting in infants (0 - 6 months):

• Congenital pyloric stenosis, a constriction in the outlet from the stomach (the infant vomits forcefully after each feeding but otherwise appears to be healthy)
• Food allergies or milk intolerance
• Gastroenteritis (infection of the digestive tract that usually causes vomiting with diarrhea)
• Gastroesophageal reflux
• An inborn error of metabolism
• Hole in the bottle nipple may be wrong size, leading to overfeeding
• Infection, often accompanied by fever or runny nose
• Intestinal obstruction, evidenced by recurring attacks of vomiting and crying or screaming as if in great pain
• Accidentally ingesting a drug or poison

Call the doctor immediately or take the child to an emergency care facility if you suspect poisoning or drug ingestion!

Home Care

It is important to stay hydrated. Try frequent, small amounts of clear liquids, such as electrolyte solutions. Other clear liquids -- such as water, ginger ale, or fruit juices -- also work unless the vomiting is severe or it is a baby who is vomiting.

For breast-fed babies, breast milk is usually best. Formula-fed babies usually need clear liquids.

Don't drink too much at one time. Stretching the stomach can make nausea and vomiting worse. Avoid solid foods until there has been no vomiting for six hours, and then work slowly back to a normal diet.

An over-the-counter bismuth stomach remedy like Pepto-Bismol is effective for upset stomach, nausea, indigestion, and diarrhea. Because it contains aspirin-like salicylates, it should NOT be used in children or teenagers who might have (or recently had) chickenpox or the flu.

Most vomiting comes from mild viral or food-related illnesses. Nevertheless, if you suspect the vomiting is from something serious, the person may need to be seen immediately by a medical professional.

If you have morning sickness during pregnancy, ask your doctor about the many possible treatments.

The following may help treat motion sickness:

• Lying down
• Over-the-counter antihistamines (such as Dramamine)
• Scopolamine prescription skin patches (such as Transderm Scop) are useful for extended trips, such as an ocean voyage. Place the patch 4 - 12 hours before setting sail. Scopolamine is effective but may produce dry mouth, blurred vision, and some drowsiness. Scopolamine is for adults only. It should NOT be given to children.

Call your health care provider if

Call 911 or go to an emergency room if you think vomiting is from poisoning or a child has taken aspirin.

Call a health care provider if the person has:

• Been vomiting for longer than 24 hours
• Blood or bile in the vomit
• Severe abdominal pain
• Headache and stiff neck
• Signs of dehydration

Signs of dehydration include:

• Increased thirst
• Infrequent urination or dark yellow urine
• Dry mouth
• Eyes that appear sunken
• Crying without tears
• Loss of normal skin elasticity (if you touch or squeeze the skin, it doesn't bounce back the way it usually does)

You should also call if:

• A young child is lethargic or has marked irritability.
• An infant vomits repeatedly.
• A child is unable to retain any fluids for 8 hours or more.
• Vomiting is recurrent.
• An adult is unable to retain any fluids for 12 hours or more.
• There is a decrease in urination (including a baby who is not wetting the normal amount of diapers).
• Nausea persists for a prolonged period of time (in a person who is not pregnant).

What to expect at your health care provider's office

Your health care provider will perform a physical examination, particularly to look for signs of dehydration.

To help diagnose the cause of the nausea or vomiting, your health care provider will ask medical history questions, such as:

• When did the vomiting begin? How long has it lasted?
• Does it occur several hours after meals?
• What other symptoms are present -- abdominal pain, fever, diarrhea, poor skin turgor, other signs of dehydration, abdominal swelling, headaches?
• Are you vomiting fresh blood? Do you have repeated episodes of vomiting blood?
• Are you vomiting material that looks like coffee grounds?
• Are you vomiting undigested food?
• Are you vomiting greenish material?
• Is the nausea or vomiting severe enough to cause unintentional weight loss?
• Is the vomiting self-induced?
• Have you been traveling? Where?
• What medications do you take?
• Did other people that ate at the same location as you have the same symptoms?
• Are you pregnant or could you be pregnant?

The following diagnostic tests may be performed:

• Blood tests (such as CBC with differential, blood electrolyte levels, and liver function tests)
• Urinalysis
• X-rays of the abdomen

If dehydration is severe, you may need intravenous fluids. This may require hospitalization, although it can often be done in a doctor's office. Antivomiting drugs (anti-emetics) may be helpful but they should be used only when the potential benefits outweigh the risks.