Encyclopedia of Family Medicine

Chapter 48 Prevention of Common Diseases (9)
Sinusitis

1.acute sinusitis
Whole body discomfort, sleepiness, poor appetite, chills and fever, etc.Children have severe systemic symptoms, mostly manifested as upper flu symptoms.Local symptoms include persistent nasal congestion, a large amount of mucopurulent or purulent secretions, and olfactory disturbance; headache and local pain.Acute maxillary sinusitis, frontal pain is mild in the morning and worse in the afternoon; sometimes accompanied by distending pain in the ipsilateral cheek or upper tooth pain, tenderness in the canine fossa and cheek, and sometimes percussion pain in the upper tooth.Acute frontal sinusitis is also the frontal pain, the pain gradually in the morning, the worst at noon, relieved in the afternoon, disappeared in the evening, and reappeared the next day.Tenderness in frontal sinus area or medial upper orbit.In acute ethmoid sinusitis, pain in the inner part or the root of the nose can radiate to the top of the head, but it is mild. The ethmoid sinusitis in the former group gets worse in the morning and becomes lighter in the afternoon;Acute sphenoid sinusitis usually causes pain in the deep part of the skull and behind the eyeballs, can radiate to the top of the skull, accompanied by dizziness, and can also cause occipital pain that is mild in the morning and severe in the afternoon.

General treatment with acute rhinitis.Sufficient amount of sulfa drugs or antibiotics was given at the same time.After the systemic symptoms subside and the local inflammation is basically controlled, the maxillary sinus can be punctured and washed, and antibiotics can be injected.In the case of odontogenic maxillary sinusitis, toothache should be treated at the same time.

2.Chronic sinusitis: mostly the result of recurrent acute sinusitis and improper treatment.

Lack of energy, fatigue, dizziness, headache, memory loss, etc.Long-term discharge of yellow mucus purulent or purulent nasal discharge, accompanied by stench, and odontogenic ones have a putrefactive smell.Nasal congestion, decreased sense of smell, dull pain or heavy pressure in the head.

Eliminate the cause of the disease and improve the body's resistance.Oral Huodan Pills, Biyuanshu Oral Liquid, etc.Ephedrine nasal drops are available topically.Physical therapy can be added to improve local blood circulation.Replacement therapy and maxillary sinus irrigation can cure some patients.If long-term conservative treatment fails, functional sinus surgery may be considered.

Throat disease
1.Acute epiglottitis
It is cellulitis of the epiglottis and aryepiglottic folds, sometimes it can invade the ventricular zone, also known as supraglottic laryngitis.

Sudden onset, severe sore throat, difficulty swallowing, drooling, and slurred speech.In severe cases, dyspnea may occur, choking of drinking water, and obvious symptoms of systemic poisoning.The disease can deteriorate rapidly and can cause death due to airway obstruction in a short period of time.

He was hospitalized for observation, paid close attention to the development of the disease, and was given sufficient antibiotics and hormone therapy in time.Pay attention to correct dehydration and electrolyte imbalance.After the abscess is formed, it can be cut and drained under the laryngoscope.In case of progressive aggravation of dyspnea, tracheotomy should be done in time.

2.acute laryngitis

Acute inflammation of the laryngeal mucosa.Happens in winter and spring.Acute laryngitis in young children can easily lead to laryngeal obstruction and laryngospasm, resulting in dyspnea.

Adult acute laryngitis is mainly manifested as hoarseness, laborious speech, and aphonia in severe cases.At the same time, the throat is dry and itchy, there is a foreign body sensation, and paroxysmal cough, sometimes sore throat.In addition to the above-mentioned manifestations of acute laryngitis in children, the symptoms are often aggravated suddenly at night, mainly laryngospasm, inspiratory dyspnea, inspiratory stridor and barking cough.When dyspnea worsens, irritability, sweating, and bruising may appear.If the breathing rate is fast and shallow, it usually indicates the deterioration of the condition, and should pay close attention to timely treatment, otherwise it may cause death due to suffocation.

Acute laryngitis in adults should be silenced to rest the throat. Steam inhalation or atomized inhalation therapy is effective for dry, itchy and hoarse throat.In severe cases, antibiotics and hormone therapy can be given.Acute laryngitis in children with dyspnea should be hospitalized.Adequate systemic antibiotics combined with larger doses of corticosteroids often relieve dyspnea within hours.Antibiotics, hormones and 1% ephedrine saline atomized inhalation can eliminate laryngeal mucosal edema.If the laryngeal obstruction is severe and treatment fails, a tracheotomy should be performed in time.

3.chronic laryngitis

It is a chronic nonspecific inflammation of the laryngeal mucosa that can occur at any age.Recurrent episodes of acute laryngitis, long-term stimulation by alcohol, tobacco, and physical and chemical factors, and voice abuse are common.

The main symptom is hoarseness, which worsens after using the voice, accompanied by throat discomfort, foreign body sensation, dry cough, seldom pain, and occasionally aphonia.

Remove adjacent lesions, quit smoking and drinking habits, and rest without sound.Physiotherapy and mist inhalation can help the inflammation absorb and subside.Antibiotics are not effective.Vocal cord polyps and larger vocal cord nodules can be surgically removed.After a period of silence and rest after the operation, vocalization training will be carried out again.

Periodontal disease

Periodontal disease is also called periodontal tissue disease. Periodontal tissue includes gingiva, periodontal ligament, and alveolar bone. Therefore, periodontal disease is mainly gingivitis and periodontitis.

Periodontal disease is one of the common diseases in stomatology. The early symptoms are not obvious and easy to be ignored. When the disease is severe and the symptoms are prominent, it is often difficult to cure completely. Some teeth lose the opportunity for treatment and can only be extracted.

1. Gingivitis

(1) Gum congestion, redness, softness, and deep gingival sulcus.

(2) The gums tend to bleed when brushing your teeth.

(3) The mouth often has peculiar smell.

(4) No loose teeth.

Treatment options are:
(1) Cleaning: Commonly known as "tooth washing" is the key measure for the treatment of this disease.

(2) gargle with 1%~3% hydrogen peroxide, chlorhexidine, Koutai, etc.

(3) Apply iodine glycerin locally.

(4) Oral tetracycline, spiramycin, metronidazole, etc.

2.Periodontitis
(1) The gums are hyperemia, edema, and easy to bleed.

(2) Periodontal pocket formation or gingival recession.

(3) loose teeth.

Treatment options are:
(1) Cleansing is the basic treatment for this disease.

(2) Periodontal surgery.

(3) Loose tooth fixation.

(4) Extract the affected tooth.

(5) Drug treatment is the same as gingivitis.

Periodontal disease prevention common sense:

1.Master the correct way of brushing your teeth, insist on brushing your teeth every day, rinse your mouth after meals, and develop good oral hygiene habits.

2.Actively treat dental caries, gingivitis, misaligned teeth, etc.

3.Correct the habit of chewing on one side.

4.Adhere to gum massage, tap teeth and so on.

Oral lichen planus
Lichen planus is an exogenous chronic inflammation that often occurs in the mouth or skin.The etiology of this disease is unknown, and it is currently believed that the onset is related to mental and nervous disorders, viral infections, and autoimmunity.

1.Oral lesions were more common in bilateral cheeks and dorsum of the tongue, and were mostly distributed asymmetrically.

2.The lesions are mostly white plaques with striations.

3.There is a burning sensation, which is aggravated by eating irritating foods.

4.There are different degrees of inflammatory reactions in the mucosa of the lesion area.

Treatment options are:
1.Treatment of systemic diseases: such as hepatitis, diabetes.

2.Eliminate local irritants, such as removing residual crowns and roots, and removing bad restorations.

3.Drug treatment: Oral Kunming Shanhaitang or tripterygium glycosides, vitamin B6, vitamin E, oral or oral chloroquine.

4.Local use of gargles: such as Koutai, chlorhexidine, 3% hydrogen peroxide.

eczema
Eczema is a common inflammation of the epidermis.The etiology is more complicated, and it is generally believed that it is closely related to allergies.The disease is characterized by severe itching, pleomorphic skin lesions mainly papules and herpes, which are symmetrically distributed, may have a tendency to ooze, recur, and tend to become chronic.

According to the priority of its onset, it can be divided into acute, subacute and chronic eczema.

1.Acute eczema: The skin lesions are pleomorphic. In the early stage, they are mostly dense erythema, papules, and papules. The hyperemia at the base quickly turns into small blisters. After ulceration, erosions and scabs are formed. The skin lesions are easy to spread to the surrounding area. , scattered in the periphery of small papules herpes, resulting in unclear boundaries of damage.Conscious itching and burning sensation, scratching or scalding will aggravate the symptoms.Exposed parts such as the head, face, and limbs are more common.

2.Subacute eczema: evolved from acute eczema, or due to improper treatment, dark red plaques are formed, with scabs and scales on them, and a small amount of papules and exudates in between.The itching is still severe.

3.Chronic eczema: The eczema condition persists and becomes chronic.The skin of the affected area is thickened, with rough surface, lichenification, pigmentation and mild desquamation.

Eczema in different parts has its own characteristics: hand eczema is easily affected by the climate, severe in winter and light in summer, and aggravated by excessive washing or being affected by soap and detergent.Auricle and external auditory canal eczema are more itchy, and corticosteroid cream is contraindicated for external auditory canal eczema.Breast eczema is seen in breastfeeding women, which can cause itching and pain, and it is easy to recover after stopping breastfeeding.Eczema of the vulva and scrotum has severe itching, and excessive scratching can cause skin erosion, hypertrophy, and rubbery swelling-like changes.

Note that acute eczema must be differentiated from contact dermatitis, chronic eczema should be differentiated from neurodermatitis, hand and foot eczema should be differentiated from hand and foot tinea.

General care for eczema includes:

1.Eliminate all suspicious causes, avoid contact with external stimuli, and avoid irritating or allergenic foods, such as chili, wine, seafood, etc.Keep your skin clean.Patients should undergo systematic examination to remove lesions and treat systemic diseases.

2.Avoid hot water scalding, hot water scalding feels comfortable, and it will aggravate the condition afterwards.

3.Local rash can be rubbed with Fuqingsong and Triamcinolone ointment.

Seborrheic Dermatitis

Seborrheic dermatitis is a chronic, superficial, inflammatory skin disease that occurs at the site of seborrhea.The etiology is not yet fully understood, and it may be related to genetics, mental factors, vitamin B deficiency, eating habits, etc.; or due to increased sebum secretion, the normal flora on the skin surface is out of balance, causing dermatitis.

Most adult patients have oily skin.Skin lesions tend to occur on the head, eyebrows, eyelids, nasolabial folds, behind the ears, chest area, and scapular area. In severe cases, it can invade the armpits, under the breasts, umbilical cord, vulva, and anus.Skin lesions are dark yellow-red papules or patches with clear edges, covered with greasy scales or scabs, and desquamation is obvious.Often accompanied by varying degrees of itching or hair loss.

Infant seborrheic dermatitis often occurs within 1 to 3 months after birth, and the skin lesions are mostly on the scalp, forehead, cheeks, and between the eyebrows, showing exudative red plaques with greasy yellow crusts.

This disease should be distinguished from psoriasis, psoriasis, pityriasis alba and eczema.

Prevention methods are:
1.General principles: Regular life, avoid polysaccharide, fatty and irritating food, pay attention to hygiene, avoid scratching.Mild patients are mainly treated with external medicine.

2.Systemic treatment: take complex vitamin B, B2, B6, C and sedative and antipruritic agents.When the scope of dermatitis is large, short-term corticosteroids, such as prednisone 10mg, 1 times a day, generally not more than 3 weeks.Exudation is obvious, when there is infection, oral or intramuscular injection of effective antibiotics can be used.

3.Local treatment: based on the principle of reducing sebum, sterilizing, anti-inflammatory and relieving itching.Commonly used drugs are corticosteroid cream, compound sulfur lotion, fish gypsum cream, etc. Antibiotics can be added when infection is accompanied.At present, it is believed that seborrheic dermatitis is related to Pityrosporum ovale, and the treatment effect is better with antifungal drugs. Commonly used drugs include compound miconazole cream, ketoconazole and clotrimazole cream.Potassium permanganate, wheat bran bath, etc. are feasible for the whole body.

Urticaria

Urticaria, commonly known as "wheal", is a vascular reactive skin disease.Appears as bright red or pale wheals that develop and resolve quickly, with itching and burning.Food, drugs, infection, physical stimulation, insect bites, etc. can all be induced, and can also be the accompanying symptoms of certain diseases, but most of them have unknown etiology.

Generally divided into acute and chronic categories.

1.Acute urticaria: rapid onset, sudden itching of the skin, and soon appear bright red wheals of different sizes, mostly isolated and scattered, or merged into pieces, a single wheal usually lasts for several minutes to several hours, and does not stay after subsiding Traces, but one after another, can be repeated.A small number of patients are accompanied by fever, joint swelling, headache, vomiting, and even abdominal pain, diarrhea, chest tightness, and dyspnea.It usually recovers in a few days or 1 to 2 weeks after treatment or getting rid of the inducement.

2.Chronic urticaria: recurring urticaria that lasts more than 6 to 8 weeks.Most of them can't find a cause.Treatment is more difficult.

See also some specific types of hives, such as:
1.Cutaneous scratches: Also known as artificial urticaria, after scratching or scratching the skin with a blunt instrument, strip-like swellings occur along the scratches, accompanied by itching, which subsides soon.Can occur alone or accompanied by urticaria.

2.Angioedema: Also known as giant urticaria, it is more common in areas with loose tissues, such as eyelids, lips, and external genitalia.Sudden localized edema with unclear borders, normal or light red, shiny surface skin, elastic feeling to the touch, and subsides by itself after 1-3 days.Most of them are solitary, but they can also occur repeatedly at the same site.If the throat is involved, it can cause breathing difficulties and even death by suffocation.

3.Cold urticaria: It can be divided into two types: one is hereditary cold urticaria, which is relatively rare and usually occurs shortly after birth and lasts for life.In addition to general welt after encountering cold.May be accompanied by fever, headache, arthralgia and other symptoms, neutrophil increase.The other is acquired cold urticaria, which is more common in young women.Often when the cold stimulus warms up, a wheal is formed on the exposed or contacted part, which is consciously itchy and lasts for about half an hour to 1 hour.After several days to several years, the cold allergy can disappear by itself.

Urticaria needs to be differentiated from papular urticaria and erythema multiforme.Those with abdominal pain or diarrhea should be differentiated from acute abdomen and gastroenteritis.

General care for urticaria includes:

The key is to find out the cause and rule out the pathogenic factors.If the etiology is unknown, it can be treated symptomatically, mainly systemic treatment, with the purpose of relieving itching and reducing the attack, and calamine lotion is applied locally or no medicine is used.

Avoid various predisposing factors.For those who have a clear cause and cannot avoid it, they can take preventive medication, such as applying antihistamines 1 hour before possible induction.It is best not to swim for patients with cold urticaria, so as not to cause urticaria after the whole body is immersed in cold water.

Tinea capitis
Tinea capitis is a superficial fungal infection of the scalp and hair.It is more common in children and is highly contagious. It is mainly transmitted indirectly through hairdressing tools, hats, combs, pillow covers, etc., or directly from animals.Tinea capitis is divided into three types: tinea capitis, tinea alba, and tinea black spot. Among them, tinea capitis can easily cause cicatrix and permanent alopecia, which is more harmful.

1. Yellow tinea, commonly known as "bald sore" or "little dysentery head".Typical yellow tinea has three characteristics: yellow ringworm scab, atrophic scar and hair loss.It starts as an inflammatory papule of the follicular stomatitis, and then forms small pustules, which dry and form a yellow crust, such as a dish.Remove the yellow scab, and underneath it is a bright red moist eroded surface with a rat odor.There are a lot of fungi in the yellow scab. If the treatment is not timely, it can destroy the hair follicles, form atrophic scars, and cause permanent baldness.

2.Tinea versicolor, also known as tinea versicolor, is more common in school-aged children.At first, one to several gray-white scaly spots appeared on the scalp hair, which gradually expanded to form circular spots. The hairs on the spots lost their luster and were surrounded by white bacterial sheaths, which were mostly broken at 3-8 mm from the scalp.Lesions often have a "satellite" distribution.It tends to heal itself by puberty.

3.Tinea nigra: Both children and adults can be infected.The skin lesions are similar to tinea versicolor, and are mostly white scaly patches the size of the nails, but the lesions break off as soon as they appear on the surface of the scalp, and the remaining broken hair piles form black spots, hence the name.The course of the disease is generally longer, and it may not heal for several years, and scarring and hair loss may occur after healing.

Tinea capitis must be differentiated from scalp pityriasis, seborrheic dermatitis, and psoriasis.

General protective measures for tinea capitis include:

1.Pay attention to personal hygiene and public health. If you find a patient, you should actively treat it and pay attention to isolation. The patient's washbasin, towel, comb, hat, etc. should be used exclusively and sterilized regularly.If there are sick animals, they should be actively dealt with.

2.Haircut is an important transmission route of tinea capitis, so the onset and desquamation should be burned intensively.Contaminated utensils should be disinfected.

Scabies
Scabies is a contagious skin disease caused by the scabies mites, which tends to spread in families and groups.Scabies mites, commonly known as scabies, are a variety of intradermal parasites.Human scabies are mainly caused by human scabies mites, and occasionally by animal scabies mites, but the disease course is short and the symptoms are mild.The scabies mites dig tunnels in the epidermis and devour the stratum corneum tissue, live and multiply, and their feces, egg shells, dead insects and burrows can cause skin damage and itching.The adult lifespan is about 2 months, and it can survive for 2 to 3 days without the human body. It often infects others through close contact or clothing.

Scabies mites often invade the thin and tender parts of the skin, so the damage occurs in the finger joints, elbow fossa, armpits, breasts, waist around the umbilicus, lower abdomen, inner thighs, external genitalia, etc. The rash is mainly papules, blisters, tunnels and nodules .The papules are about the size of a miliary, light red or normal skin tone, scattered or in dense clusters.Blisters are more common between the fingers.The tunnel is the trace of the scabies mites drilling, with a gray-brown irregular curve, about 3~15mm in length.The nodules occur in the scrotum, penis, labia, inner thigh, etc., are pea-sized, light red wheal-like, and persist for a long time.Consciously severe itching, even worse at night, scratches, scabs, eczema-like changes, or broken hair infections, pustules, boils, folliculitis, lymphadenitis, etc. occur due to scratching.

Note that this disease is differentiated from prurigo, eczema, and pediculosis.

Usually pay attention to personal hygiene.If the patient is found, he should be treated in isolation immediately, completely cured the patient, eliminate scabies mites, prevent complications, select insecticides and antipruritic drugs, and require family and collective patients to be treated at the same time.The medicine should be applied from the neck down (including the head and face in children), all over the body. Do not take a bath or change clothes during the medicine period. Take a bath with hot water and soap before treatment and the next day after the course of treatment. At the same time, clothes should be scalded and disinfected.Contact with others, including shaking hands, should be avoided until it is cured.

Alopecia areata
Alopecia areata, commonly known as "ghost shaving", is a sudden onset of patchy baldness.The etiology is unknown, but may be related to mental stress, genetic factors, autoimmune or endocrine dysfunction.

The disease is more common in young adults.It is a sudden round or oval patchy hair loss on the head with clear borders, mostly without symptoms, and is often discovered accidentally.The skin in the bald area is normal and the pores are clearly visible.The hair that falls out is thick at the top and thin at the bottom, in the shape of an "exclamation mark".In the advanced stage of the disease, the hair around the damage becomes loose and easy to fall off.In mild cases, there is only one or several alopecia areas, while in severe cases, the hair loss continues to develop and merge with each other, and the whole head will be stripped in a short period of time, which is called alopecia totalis; in severe cases, eyebrows, beards, pubic hair, vellus hair, etc. can all fall off, which is called alopecia universalis.The course of alopecia areata lasts for several months to several years, has no effect on health, and most of them can heal themselves.Most of the new hair is thin and soft, in the shape of off-white vellus hair, which gradually becomes thicker, turns black, and finally returns to normal.But there are also those who have recurrent attacks or side long side off.

Eliminate possible triggering factors and enhance confidence in healing.Some patients may have hair regrowth after a few weeks without any treatment.Mild patients can try fresh ginger slices or garlic for external application, and eat more fruits and vegetables rich in vitamin B family.

Vitiligo

Vitiligo is a skin disease caused by acquired depigmentation.The etiology is not yet fully understood, and may be related to genetic, autoimmune dysfunction, and imbalance of melanocyte self-destroying neurochemical factors. In addition, the lack of copper ions has a certain relationship with the disease.

The disease is more common in young people.The skin lesions are local depigmentation spots, which are milky white, and the hair inside them can be white or normal, but the skin has no changes such as atrophy, hardening, and desquamation, and generally has no subjective symptoms.Sun exposure can cause burning pain, erythema, or blisters.Lesions can occur in any part of the skin, unilateral or symmetrical distribution.The course of the disease is chronic and sustainable for life, but it also disappears by itself.The disease is generally not difficult to diagnose, but it should be differentiated from pityriasis simplex, light spots of leprosy, and old skin lesions of tinea versicolor.

Vitiligo treatments include:
1.The etiology of this disease is unknown, although there are many treatment methods, the curative effect is not good enough.Systemic or topical photochemotherapy is most commonly used.Local intradermal injection of atropine or triamcinolone suspension is effective for small lesions.

2.Fresh fig leaves are collected, soaked in 75% alcohol for 1 week and then applied externally, which is effective for some patients (it is better to submerge the fig leaves with alcohol).

(End of this chapter)