DOCSLIB.ORG

Failure to Void in Labour: Postnatal Urinary and Anal Incontinence by Linda Birch, Patrick M Doyle, Roger Ellis and Elaine Hogard

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Failure to Void in Labour: Postnatal Urinary and Anal Incontinence by Linda Birch, Patrick M Doyle, Roger Ellis and Elaine Hogard TRAUMA IN CHILDBIRTH Failure to void in labour: postnatal urinary and anal incontinence By Linda Birch, Patrick M Doyle, Roger Ellis and Elaine Hogard 2.8% (Arya et al, 2001) to 77% (Sampselle et al, 1996). This Abstract wide variation may be explained by differing research meth- ods. Some studies use urodynamic assessment; others use a The objectives was to identify the impact of intrapartum voiding self-reported questionnaire. Some include multiparous and on postnatal urinary and anal incontinence. A longitudinal, primiparous women while others, such as this one, focus on prospective, repeated measures, cohort study design was used. primiparous women only. The time that the patient is asked The study was set in one of the biggest and busiest acute NHS about their symptoms can vary from a few days postnatally to university teaching hospitals in the North West of England, which several years, so it is difficult to compare studies. provides maternity care to over 4000 women each year. Persistent postnatal urinary incontinence is often attrib- Primiparous women with no pre-existing disease (n=516) uted to pathophysiological changes consequential to labour participated and were recruited after a normal 20-week gestation and delivery. In addition to trauma to the bladder, urethra obstetric ultrasound scan. and supporting structures, denervation of the pelvic floor and Data was collected using validated questionnaires during the perineal muscle injury are thought to directly contribute to last trimester of pregnancy and postnatally at six weeks, six postnatal urinary incontinence. months and finally at one year. Obstetric and demographic data During vaginal delivery, the endopelvic fascia and leva- was extracted from case notes. This included age, body mass tor ani muscles may become traumatised. In addition, the index, gestation, duration of labour, analgesia, birth weight, nerve supply to the levator musculature, i.e. the pudendal mode of delivery and perineal trauma. Statistical analysis was nerve, may suffer stretch injury leading to denervation. The undertaken using Statistics Package for Social Sciences (SPSS result may lead to stress incontinence (Freeman, 2002). version 13.0). MRI scanning (Tunn et al, 1999; Kearney et al, 2006) and The main outcome measures were urinary incontinence electromyography (EMG) studies (Weidner et al, 2006) symptoms and anal incontinence symptoms. Prolonged periods of have both confirmed levator defects in primiparae following time in labour without emptying the bladder was associated with vaginal delivery. increased rates of postnatal urinary incontinence (OR 2.36) and This has led to the assertion that a caesarean section will may also contribute to anal incontinence. have a protective effect. Data identifying obstetric risk fac- Postnatal urinary incontinence may be reduced if intrapartum tors and consequential perineal and nerve damage remain bladder care policies reflect frequent emptying. This preliminary contradictory. The pathophysiology of urinary inconti- data supports large-scale exploration of the association between nence remains unclear but pregnancy itself seems to be a postnatal anal incontinence and bladder emptying in labour. considerable risk factor. The autonomic innervation of the bladder and urethra can degenerate during pregnancy and the regeneration after each delivery appears to be incom- regnancy and childbirth are established risk fac- plete (Owman 1981; Grandadam et al, 1999; Bakircioglu tors for the development of urinary incontinence. et al, 2000). Traumatic stretching and compression of the PIncontinence during the initial few weeks after deliv- peripheral nerve supply to the pelvic floor is associated ery is frequently transient and often destined to subside with pregnancy, labour and delivery and may result in par- as hormonal and pressure effects resolve. Within the first tial denervation of the striated muscle in and around the postnatal year, rates of urinary incontinence range from urethra, leading to urinary dysfunction and incontinence (Handa et al, 1996). Linda Birch is Head of Midwifery and Gynaecology, Women’s and Results of many epidemiologic studies (Jolleys, 1988; Children’s Division; Patrick M Doyle is Consultant Obstetrician Persson et al, 2000; Farrell et al, 2001; Goldberg et al, 2005; & Urogynaecologist, Wirral University Teaching Hospital NHS Van Brummen et al, 2007) and pathophysiological studies Foundation Trust, Wirral; Professor Roger Ellis is Professor of (Snooks et al, 1990; King and Freeman 1998) assessing Social and Health Sciences, Director of Research Policy and risk factors for incontinence have been largely inconclusive, Associate Dean Research and Development, Chester University, often presenting contradictory conclusions. However, from Chester; Professor Elaine Hogard is Reader in Evaluation the evidence available, some risk factors for the develop- Research and Leader of Social and Health Evaluation Unit, Social ment of urinary incontinence in an obstetric population can and Health Evaluation Unit, Chester University, Chester be identified, for example, raised body mass index (BMI), Email: [email protected] vaginal delivery, and instrumental delivery. Other risk fac- tors remain controversial. These include smoking, age, diet, 562 BRITISH JOURNAL OF MIDWIFERY, SEPTEMBER 2009, VOL 17, NO 9 TRAUMA IN CHILDBIRTH increased parity, total labour duration, length of second stage of labour, fetal size, and genital tract trauma. Further respondents who did not potential risk factors, such as voiding in labour, have not been explored. empty their bladder for more Prevalence of anal incontinence among postnatal women than four hours prior to varies between 1% and 21% (Johanson and Lafferty 1996; ‘ Boreham et al, 2005). As with studies looking at urinary beginning the second stage symptoms, there are problems with definition, method, clas- sification and sample selection. Higher rates were recorded by of labour were ... more studies using longer term follow-up; with 22–30.5% report- ing anal incontinence at one-year postnatal (Fynes et al, 1999; likely to report any urinary Van Brummen et al, 2006). incontinence ... Anal sphincter damage is a recognized risk factor for postnatal anal incontinence. Recent studies have found evidence of postnatal occult anal sphincter damage in 7–28% of primiparous women (Abramowitz et al, 2000; regarding the care received and progress of labour. This Faltin et al, 2000; Andrews et al, 2005; Nichols et al, included age, gestation, BMI, onset,’ progress and duration 2006) with one study demonstrating 19% of primiparous of labour, analgesia, birth weight, mode of delivery and women who were classed as having a first- or second- perineal trauma. degree tear having an anal sphincter defect on endo-anal scan (Nichols et al, 2006). Analysis Statistical analysis was undertaken using Statistics Package for Method Social Science (SPSS version 13.0). Variables were analysed as This longitudinal prospective study collected data from continuous scales, incremental scales and percentile groups of primiparous patients during the last trimester of pregnancy, approximately equal size. and also postnatally at six weeks, six months and one year, using the Kings Health Incontinence Questionnaire (Kelleher Ethical approval et al, 1997). The Kings Health Questionnaire is a validated Ethical approval was granted by the Local Research Ethics tool used to assess urinary incontinence and its impact on Committee for Wirral. quality of life. It explores perception of general health and the perceived impact of incontinence on aspects of life. This Results is followed by a symptom index where patients are asked to Following exclusions owing to severe maternal or fetal illness indicate how often they are experiencing urinary symptoms 1023 women offered full participation. A total of 862 women on a three-point scale (a little; moderately; a lot). The remain- (84.1%) agreed to participate in the study. ing items explore the impact of urinary incontinence on Of the 862 women recruited (59.9%) 516 returned at quality of life. Finally, questions are included which explore least 2 of the 3 postnatal questionnaires and are included in behaviour undertaken to address the continence problem, postnatal data analysis. Women only returning 1 postnatal such as wearing pads, alteration to diet and embarrassment. questionnaire (n=237; 27.5%) were excluded from data This section forms a severity score. Given that the same ques- analysis due to incompleteness. Of the 516 postnatal data sets tionnaire was given to the same patients, on three occasions analysed, 404 (78.3%) women completed the questionnaire over the course of the postnatal year, it was also possible to determine if incontinence was progressive—getting worse, or Table 1. Symptoms reported regressive—getting better. At one-year postnatal, participants were also asked to Antenatal 6 weeks 6 months 1 year report anal incontinence symptoms using the Manchester % (n=466) % (n=404) % (n=397) % (n=336) Health Questionnaire (Bugg et al, 2001). This mirrors the Kings Health Questionnaire but explores anal incontinence Frequency of micturition 72.3 34.6 36.6 23.8 symptoms. Nocturia 76.2 35.6 35.1 21.7 In order to reduce obstetric and social variables, the research only recruited women who had no previous children Urgency 37.3 22.8 23.6 20.2 and were not suffering from any medical condition that may Urge incontinence 23.5 21.2 21.4 16.4 predispose them to continence problems. Stress incontinence
Load more

Recommended publications
  • Guidelines for Management of Acute Renal Failure (Acute Kidney Injury)
    Guidelines for management of Acute Renal Failure (Acute Kidney Injury) Children’s Kidney Centre University Hospital of Wales Cardiff CF14 4XW DISCLAIMER: These guidelines were produced in good faith by the author(s) reviewing available evidence/opinion. They were designed for use by paediatric nephrologists at the University Hospital of Wales, Cardiff for children under their care. They are neither policies nor protocols but are intended to serve only as guidelines. They are not intended to replace clinical judgment or dictate care of individual patients. Responsibility and decision-making (including checking drug doses) for a specific patient lie with the physician and staff caring for that particular patient. Version 1, S. Hegde/Feb 2009 Guidelines on management of Acute Renal Failure (Acute Kidney Injury) Definition of ARF (now referred to as AKI) • Acute renal failure is a sudden decline in glomerular filtration rate (usually marked by rise in serum creatinine & urea) which is potentially reversible with or without oliguria. • Oliguria defined as urine output <300ml/m²/day or < 0.5 ml/kg/h (<1 ml/kg/h in neonates). • Acute on chronic renal failure suggested by poor growth, history of polyuria and polydipsia, and evidence of renal osteodystrophy However, immediately after a kidney injury, serum creatinine & urea levels may be normal, and the only sign of a kidney injury may be decreased urine production. A rise in the creatinine level can result from medications (e.g., cimetidine, trimethoprim) that inhibit the kidney’s tubular secretion. A rise in the serum urea level can occur without renal injury, such as in GI or mucosal bleeding, steroid use, or protein loading.
    [Show full text]
  • Current Current
    CP_0406_Cases.final 3/17/06 2:57 PM Page 67 Current p SYCHIATRY CASES THAT TEST YOUR SKILLS Chronic enuresis has destroyed 12-year-old Jimmy’s emotional and social functioning. The challenge: restore his self-esteem by finding out why can’t he stop wetting his bed. The boy who longed for a ‘dry spell’ Tanvir Singh, MD Kristi Williams, MD Fellow, child® Dowdenpsychiatry ResidencyHealth training Media director, psychiatry Medical University of Ohio, Toledo CopyrightFor personal use only HISTORY ‘I CAN’T FACE MYSELF’ during regular checkups and refer to a psychia- immy, age 12, is referred to us by his pediatri- trist only if the child has an emotional problem J cian, who is concerned about his “frequent secondary to enuresis or a comorbid psychiatric nighttime accidents.” His parents report that he wets disorder. his bed 5 to 6 times weekly and has never stayed con- Once identified, enuresis requires a thorough sistently dry for more than a few days. assessment—including its emotional conse- The accidents occur only at night, his parents quences, which for Jimmy are significant. In its say. Numerous interventions have failed, including practice parameter for treating enuresis, the restricting fluids after dinner and awakening the boy American Academy of Child and Adolescent overnight to make him go to the bathroom. Psychiatry (AACAP)1 suggests that you: Jimmy, a sixth-grader, wonders if he will ever Take an extensive developmental and family stop wetting his bed. He refuses to go to summer history. Find out if the child was toilet trained and camp or stay overnight at a friend’s house, fearful started walking, talking, or running at an appro- that other kids will make fun of him after an acci- priate age.
    [Show full text]
  • Urinary System Diseases and Disorders
    URINARY SYSTEM DISEASES AND DISORDERS BERRYHILL & CASHION HS1 2017-2018 - CYSTITIS INFLAMMATION OF THE BLADDER CAUSE=PATHOGENS ENTERING THE URINARY MEATUS CYSTITIS • MORE COMMON IN FEMALES DUE TO SHORT URETHRA • SYMPTOMS=FREQUENT URINATION, HEMATURIA, LOWER BACK PAIN, BLADDER SPASM, FEVER • TREATMENT=ANTIBIOTICS, INCREASE FLUID INTAKE GLOMERULONEPHRITIS • AKA NEPHRITIS • INFLAMMATION OF THE GLOMERULUS • CAN BE ACUTE OR CHRONIC ACUTE GLOMERULONEPHRITIS • USUALLY FOLLOWS A STREPTOCOCCAL INFECTION LIKE STREP THROAT, SCARLET FEVER, RHEUMATIC FEVER • SYMPTOMS=CHILLS, FEVER, FATIGUE, EDEMA, OLIGURIA, HEMATURIA, ALBUMINURIA ACUTE GLOMERULONEPHRITIS • TREATMENT=REST, SALT RESTRICTION, MAINTAIN FLUID & ELECTROLYTE BALANCE, ANTIPYRETICS, DIURETICS, ANTIBIOTICS • WITH TREATMENT, KIDNEY FUNCTION IS USUALLY RESTORED, & PROGNOSIS IS GOOD CHRONIC GLOMERULONEPHRITIS • REPEATED CASES OF ACUTE NEPHRITIS CAN CAUSE CHRONIC NEPHRITIS • PROGRESSIVE, CAUSES SCARRING & SCLEROSING OF GLOMERULI • EARLY SYMPTOMS=HEMATURIA, ALBUMINURIA, HTN • WITH DISEASE PROGRESSION MORE GLOMERULI ARE DESTROYED CHRONIC GLOMERULONEPHRITIS • LATER SYMPTOMS=EDEMA, FATIGUE, ANEMIA, HTN, ANOREXIA, WEIGHT LOSS, CHF, PYURIA, RENAL FAILURE, DEATH • TREATMENT=LOW NA DIET, ANTIHYPERTENSIVE MEDS, MAINTAIN FLUIDS & ELECTROLYTES, HEMODIALYSIS, KIDNEY TRANSPLANT WHEN BOTH KIDNEYS ARE SEVERELY DAMAGED PYELONEPHRITIS • INFLAMMATION OF THE KIDNEY & RENAL PELVIS • CAUSE=PYOGENIC (PUS-FORMING) BACTERIA • SYMPTOMS=CHILLS, FEVER, BACK PAIN, FATIGUE, DYSURIA, HEMATURIA, PYURIA • TREATMENT=ANTIBIOTICS,
    [Show full text]
  • Case Report Jun 2013; Vol 23 (No 3), Pp: 360-362
    Iran J Pediatr Case Report Jun 2013; Vol 23 (No 3), Pp: 360-362 Spontaneous Rupture of Kidney Due to Posterior Urethral Valve– Diagnostic Difficulties Katarzyna Kiliś-Pstrusińska1 ,MD,PhD; Agnieszka Pukajło-Marczyk1,MD; Dariusz Patkowski2 ,MD,PhD; Urszula Zalewska-Dorobisz3 ,MD,PhD; Danuta Zwolińska1 ,MD,PhD 1. Department of Paediatric Nephrology, Wroclaw Medical University, Wrocław, Poland 2. Department of Paediatric Surgery and Urology, Wroclaw Medical University, Wrocław, Poland 3. Department of Radiology, Wroclaw Medical University, Wrocław, Poland Received: Jan 18, 2012; Accepted: Aug 04, 2012; First Online Available: Nov 22, 2012 Abstract Background: Spontaneous kidney rupture could develop in the course of posterior urethral valve (PUV), the most common cause of outflow urinary tract obstruction in male infants. However, urinary extravasation is a rare complication among this group of children. Case Presentation: Our case report presents diagnostic difficulties connected with spontaneous kidney rupture due to PUV in a 6 week-old infant. Due to not equivocal images, thundery course of disease and rapid deterioration in the infant`s condition, the patient required an urgent laparatomy. Conclusion: This case showed that the investigation of renal abnormalities during early neonatal period, is very important specifically in PUV that can lead to kidney rupture. Iranian Journal of Pediatrics, Volume 23 (Number 3), June 2013, Pages: 360-362 Key Words: Urinoma; Kidney Rupture; Urinary Extravasation; Posterior Urethral Valve Introduction rare complication among this group of children. The clinical manifestation is often nonspecific. Kidney rupture in developmental age most often Our report presents diagnostic difficulties takes place in the aftermath of multiorgan trauma, connected with spontaneous kidney rupture due especially when urinary abnormalities or to PUV in a 6-week old male.
    [Show full text]
  • History & Physical Format
    History & Physical Format SUBJECTIVE (History) Identification name, address, tel.#, DOB, informant, referring provider CC (chief complaint) list of symptoms & duration. reason for seeking care HPI (history of present illness) - PQRST Provocative/palliative - precipitating/relieving Quality/quantity - character Region - location/radiation Severity - constant/intermittent Timing - onset/frequency/duration PMH (past medical /surgical history) general health, weight loss, hepatitis, rheumatic fever, mono, flu, arthritis, Ca, gout, asthma/COPD, pneumonia, thyroid dx, blood dyscrasias, ASCVD, HTN, UTIs, DM, seizures, operations, injuries, PUD/GERD, hospitalizations, psych hx Allergies Meds (Rx & OTC) SH (social history) birthplace, residence, education, occupation, marital status, ETOH, smoking, drugs, etc., sexual activity - MEN, WOMEN or BOTH CAGE Review Ever Feel Need to CUT DOWN Ever Felt ANNOYED by criticism of drinking Ever Had GUILTY Feelings Ever Taken Morning EYE OPENER FH (family history) age & cause of death of relatives' family diseases (CAD, CA, DM, psych) SUBJECTIVE (Review of Systems) skin, hair, nails - lesions, rashes, pruritis, changes in moles; change in distribution; lymph nodes - enlargement, pain bones , joints muscles - fractures, pain, stiffness, weakness, atrophy blood - anemia, bruising head - H/A, trauma, vertigo, syncope, seizures, memory eyes- visual loss, diplopia, trauma, inflammation glasses ears - deafness, tinnitis, discharge, pain nose - discharge, obstruction, epistaxis mouth - sores, gingival bleeding, teeth,
    [Show full text]
  • Signs and Symptoms of Urinary System Diseases
    SIGNS AND SYMPTOMS OF URINARY SYSTEM DISEASES LECTURE IN INTERNAL MEDICINE PROPAEDEUTICS M. Yabluchansky, L. Bogun, L.Martymianova, O. Bychkova, N. Lysenko, N. Makienko, E. Tomina, E. Golubkina V.N. Karazin National University Medical School’ Internal Medicine Dept. http://kottke.org/tag/infoviz Plan of the lecture • The importance(value) of a human kidney • Reminder – how do kidneys work – the primary function – purpose • History-taking • Patient’s examination – clinical – laboratory – instrumental • Spectrum of urinary system diseases • Urinary system diseases’ symptoms and syndromes – symptoms – urinary syndrome – nephrotic syndrome – nephritic syndrome – urinary tract obstruction syndrome – hypertensive syndrome • Glossary of urinary pathology’ terms http://images.emedicinehealth.com/images/illustrations/urinary_structures.jpg The price of a human kidney The human kidney is the body’s filter. It cleans 180 liters of liquid per day, retaining the good stuff and expelling the bad. Most fortuitously, humans are born with two kidneys. If one of them becomes damaged, the other one can pick up the slack. If both your kidneys fail, however, your body will be filled with harmful toxins. Without medical intervention, such patients will die within several weeks Reminder: how kidneys work https://www.youtube.com/watch?v=aj-gbnOB4jM http://venturebeat.com/wp-content/uploads/2012/08/kidneys.jpg Reminder: the primary urinary system functions • maintain homeostasis • regulate fluids and electrolytes • eliminate waste products • maintain blood pressure (BP) • involved with red blood cell (RBC) production • involved with bone metabolism Reminder: purpose • General evaluation of health • Diagnosis of disease or disorders of the kidneys or urinary tract • Diagnosis of other systemic diseases that affect kidney function • Monitoring of patients with diabetes • Screening for drug toxicity (eg.
    [Show full text]
  • URINARY TRACT DISORDERS in HORSES- Advances in Diagnostics and Treatments Thomas J
    URINARY TRACT DISORDERS IN HORSES- Advances in Diagnostics and Treatments Thomas J. Divers, DVM, DACVIM, DAVECC College of Veterinary Medicine Cornell University, Ithaca, New York USA Introduction- Drs. Lisle George and Robert Whitlock in 1976 during my residency encouraged me to develop and interest in studying urinary tract diseases in large animals. I am grateful to him for encouraging me to do so. In these notes, I will give a brief overview of equine urinary tract disorders pointing out some of the discoveries or observations made over the last 45 years. Acute Renal failure/ Acute Kidney Injury In most of the recent literature the term acute renal failure (ARF) has been replaced by acute kidney injury (AKI). One commonly used definition of AKI is an acute increase in serum creatinine of 0.3 mg/dl or greater and oliguria. The switch in terms from ARF to AKI is semantic and in my mind has not improved our understanding or management of the disease. Uremia is the clinical condition caused by renal failure and accumulation of harmful products in the blood associated with decline in kidney function. AKI leading to renal failure and uremia can result from either intrinsic (kidney) disease/dysfunction or obstruction/rupture of the urinary tract. Acute renal failure is more common in large animals than chronic renal failure (CRF) and we can often reverse the disease process in ARF. Intrinsic causes of acute renal failure (ARF/AKI) include those disorders that cause significant functional decreases in glomerular filtration rate (GFR), mostly due to abnormal glomerular filtration pressures (common with septic shock), or morphologic nephron damage (common with nephrotoxins) or both.
    [Show full text]
  • ACS/ASE Medical Student Core Curriculum Postoperative Care
    ACS/ASE Medical Student Core Curriculum Postoperative Care POSTOPERATIVE CARE Prompt assessment and treatment of postoperative complications is critical for the comprehensive care of surgical patients. The goal of the postoperative assessment is to ensure proper healing as well as rule out the presence of complications, which can affect the patient from head to toe, including the neurologic, cardiovascular, pulmonary, renal, gastrointestinal, hematologic, endocrine and infectious systems. Several of the most common complications after surgery are discussed below, including their risk factors, presentation, as well as a practical guide to evaluation and treatment. Of note, fluids and electrolyte shifts are normal after surgery, and their management is very important for healing and progression. Please see the module on Fluids and Electrolytes for further discussion. Epidemiology/Pathophysiology I. Wound Complications Proper wound healing relies on sufficient oxygen delivery to the wound, lack of bacterial and necrotic contamination, and adequate nutritional status. Factors that can impair wound healing and lead to complications include bacterial infection (>106 CFUs/cm2), necrotic tissue, foreign bodies, diabetes, smoking, malignancy, malnutrition, poor blood supply, global hypotension, hypothermia, immunosuppression (including steroids), emergency surgery, ascites, severe cardiopulmonary disease, and intraoperative contamination. Of note, when reapproximating tissue during surgery, whether one is closing skin or performing a bowel anastomosis, tension on the wound edges is an important factor that contributes to proper healing. If there is too much tension on the wound, there will be local ischemia within the microcirculation, which will compromise healing. Common wound complications include infection, dehiscence, and incisional hernia. Wound infections, or surgical site infections (SSI), can occur in the surgical field from deep organ spaces to superficial skin and are due to bacterial contamination.
    [Show full text]
  • Abnormalities of Urine
    Appendix A Abnormalities of urine Urine testing by the use of observation and dipstick tests is a procedure carried out on an almost daily basis by nursing staff. Since this procedure is frequently used as a primary screening technique it is important that nurses have a knowledge of the meaning of the test results and what constitute abnormal readings. Correct interpretation and reporting of the results may not only lead to an earlier diagnosis and hence treat­ ment for the patient but also to a financial saving, since it may obviate the need for further analysis of the urine in the laboratory. Observation of the urine is a comparatively straight­ forward but nonetheless important activity. The exact nature and the range of substances which can be detected using test strips vary from manufacturer to manufacturer and this section will give an outline of the substances most commonly tested for, and how their presence in urine may be interpreted. It is important to stress that accurate testing using this method relies on following the manufacturers' instructions particularly in relation to reading the results at specific times which may be necessary for quantitative analysis . Fresh urine should always be used for the test. OBSERVATION OF THE URINE Colour The colour of normal urine varies between a very light yellow to a dark amber. Normally this is dependent on the concen­ tration of the urine and diet. Certain diseases mayaiso have an effect on this. Consistently light coloured urine may be the result of excessive urine production, as would occur in diabetes mellitus and diabetes insipidus, whereas production of very Observation of the urine 161 dark urine may be indicative of some form of hepatic or biliary disease and the presence of large amounts of urobilinogen.
    [Show full text]
  • Appendix 2: Characteristic Signs and Symptoms for Several Pesticide Active Ingredients and Classes of Pesticides
    Appendix 2: Characteristic Signs and Symptoms for Several Pesticide Active Ingredients and Classes of Pesticides PESTICIDE SIGNS AND SYMPTOMS Acrolein Conjunctivitis (irritation of mucous membranes, tearing) Skin irritation, rash, blistering, or erosion (without sensitization) Pulmonary edema Tearing Upper respiratory tract irritation: rhinitis, scratchy throat, cough Acrylonitrile Seizures/convulsions (tonic-clonic), sometimes leading to coma Upper respiratory tract irritation: rhinitis, scratchy throat, cough Aminopyridine Behavioral-mood disturbances (confusion, excitement, mania, disorientation, emotional lability ) Salivation Sweating (diaphoresis) Thirst ANTU Dyspnea Upper respiratory tract irritation: rhinitis, scratchy throat, cough Arsenicals (inorganic) Anemia Abdominal pain Behavioral-mood disturbances (confusion, excitement, mania, disorientation, emotional lability ) Bloody diarrhea Keratoses, brown discoloration Kidney (proteinuria, hematuria, sometimes leading to oliguria, acute renal failure with azotemia Leukopenia, thrombocytopenia Metallic taste in mouth Paralysis, paresis (muscle weakness) Paresthesia of extremities Runny nose Stomatitis Thirst Arsine Anemia Chills Hemoglobinuria Hemolysis Hyperkalemia Kidney (proteinuria, hematuria, sometimes leading to oliguria, acute renal failure with azotemia PESTICIDE SIGNS AND SYMPTOMS Borate Abdominal pain Beefy red palms, soles Diarrhea Hypotension, shock Kidney (proteinuria, hematuria, sometimes leading to oliguria, acute renal failure with azotemia Nervous system depression
    [Show full text]
  • Department of Neurology
    Department of Neurology ® Follow Up FIRST NAME: LAST NAME: DATE OF BIRTH: PRIMARY CARE PROVIDER & CLINIC: ® PREVIOUS NEUROLOGIST: REVIEW OF SYSTEMS: (please mark all that apply) 1. Head, Eyes, Ears, Nose, Throat, Lymph Nodes: — Headaches — Neck swelling — Glaucoma — Double vision — Pain and/or drainage from ears — Teethe grinding / clenching — Hoarseness of voice — Nasal and/or sinus congestion — Headaches — Tinnitus (buzzing or humming) — Visual loss or change — Hearing problems — Photophobia (light bothers eyes) — Nose bleeds — Vision problems — Swollen and/or painful lymph nodes — Neck stiffness — Dental problems — Head trauma — Sneezing — Sinus problems — Deafness — Sore throat 2. Respiratory System: — Shortness of breath — Cough — Sputum/secretion production — Hemoptysis — Wheezing — Breathing difficulty 3. Cardiovascular System: — Chest pain, discomfort, heaviness, tightness — Orthopnea (sleeping on two or more pillows) — Palpitations — Shortness of breath with exertion — Leg swelling — Chest pain — PND (waking up short of breath) — High blood pressure — Heartburn 1 of 2 Please complete all pages Neurology Locations The Portland Clinic - South The Portland Clinic - Downtown THEPORTLANDCLINIC.COM [11009 8/14] 6640 SW Redwood Lane 800 SW 13th Ave Portland, OR 97224 Portland, OR 97205 (503) 620-7358 (503) 221-0161 4. Gastrointestinal System: — Anorexia (poor appetite) — Hematochezia (red blood in bowel movements) — Dysphagia (difficulty swollowing) — Nausea and/or vomiting — Melena (black bowel movements) — Stomach pain — Constipation or diarrhea — Jaundice — Weight change: loss ____ lbs , gain____lbs — Weight loss or gain — Abdominal pain 5. Genitourinary System: — Hematuria — Nocturia (urination at night) — Symptoms of menopause — Oliguria (infrequent urination) — Frequency (frequent urination) — Irregular periods — Incontinence — Pyuria (cloudy urine) — PMS — Heavy menstrual flow — Urgency (sensation to urinate) — Bladder problems — Polyuria (urination of large volumes of urnie) — Sexual dysfunction — Excessive urination or thirst 6.
    [Show full text]
  • Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 Published: November 27, 2017
    Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 Published: November 27, 2017 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Publish Date: November 27, 2017 Introduction Grades Grade 5 The NCI Common Terminology Criteria for Grade refers to the severity of the AE. The CTCAE Grade 5 (Death) is not appropriate for some AEs Adverse Events is a descriptive terminology which displays Grades 1 through 5 with unique clinical and therefore is not an option. can be utilized for Adverse Event (AE) reporting. A descriptions of severity for each AE based on this grading (severity) scale is provided for each AE general guideline: Definitions term. A brief Definition is provided to clarify the Grade 1 Mild; asymptomatic or mild meaning of each AE term. A single dash (-) symptoms; clinical or diagnostic indicates a Definition is not available. SOC observations only; intervention System Organ Class (SOC), the highest level of the not indicated. 1 MedDRA hierarchy, is identified by anatomical or Grade 2 Moderate; minimal, local or Navigational Notes physiological system, etiology, or purpose (e.g., noninvasive intervention A Navigational Note is used to assist the reporter SOC Investigations for laboratory test results). indicated; limiting age- in choosing a correct AE. It may list other AEs that CTCAE terms are grouped by MedDRA Primary appropriate instrumental ADL*. should be considered in addition to or in place of SOCs. Within each SOC, AEs are listed and Grade 3 Severe or medically significant but not the AE in question. A single dash (-) indicates a accompanied by descriptions of severity (Grade).
    [Show full text]