Common Diagnoses & Interventions

1. Include (Interventions to consider in parenthesis):

   1. Headache, Tension-Type/Chronic Daily Hydration, Paracetamol, Amytriptyline for sleep
   2. GERD/Gastritis H2B or PPI, behavioral/diet counseling, r/o H pylori
   3. Depression/Anxiety Amytriptyline preferred due to cost; Fluoxetine an option
   4. Malnutrition/Vitamin Deficiences (Iron-Deficiency Anemia, Iodine Deficiency Disease, Protein-Energy Malnutrition) FeSO4, BComplex, Folate, Iodized Salt
   5. Intestinal Parasites (Roundworm, Hookworm) Albendazole 400 preferred for most (better hookworm coverage than Mebendazole), schools often deworm kids age 5-12 q 6months
   6. Intestinal Protozoa (Giardia, Amoeba) Tinidazole/Metronidazole, etc.
   7. Hypertension low salt, wt loss, Hydrochlorothiazide and Atenolol cheapest
   8. Diabetes diet/exercise, Metformin preferred first line, then sulfonylureas
   9. Rheumatic Heart Disease Echocardiogram at Calmette (see CHF)
   10. Allergic Rhinitis education (dust mites, mold), chlorpheniramine cheapest, loratidine/cetirizine cheap and convenient, nasal saline via syringe as adjunct, nasal steroid spray available at cost ($4/month)
   11. Asthma/COPD education, albuterol ($4/month) with homemade spacer (250cc plastic bottle); oral salbutamol tabs available (caution CV side effect); low dose oral prednisone may be good option for COPD patients
   12. Cancers (especially infection-linked: gastric, HCC, etc) make diagnosis/biopsy, then steer management with help from oncology center (Dr Eav Sokha) as needed and other specialists
   13. Back pain behavior/lifting, PT referral, paracetamol/ibuprofen preferred, piroxicam available, consider PPI with chronic NSAID
   14. Stroke eval and treat causes, PT referral, teach post-stroke management
   15. Ischemic Heart Disease control HTN, DM, etc, Low dose Aspirin
   16. Congestive Heart Failure ACEI, Bblockers, CaCB, Thiazides/Loops, ASA available; Spironolactone available but costly
   17. Chronic Liver Disease (Hepatitis B and C, cirrhosis, liver failure, HCC) follow AST/ALT q6-12 months, consider ARV, consider loop +/- spironolactone (costly) for ESLD, consider paracentesis for tense ascites with resp distress
   18. Arsenicosis Arsenic is common in water sources along the Mekong; dermopathies and anemia or aplastic anemia should prompt consideration of this diagnosis.

2. See specific Patient Care Protocol pages for further information