Coeliac disease
of stomach liver and gastrointestinal tract, coeliac disease

Coeliac disease is a common autoimmune condition where the immune system in a person’s intestine (gut) reacts when they eat gluten. This causes chronic inflammation.

Symptoms

Coeliac disease can cause a wide range of symptoms in the digestive system and rest of the body.

Symptoms can develop at any age, but coeliac disease is most commonly diagnosed between the ages of 40 and 60 years.

More about the symptoms of coeliac disease or what is coeliac disease?


Symptoms of coeliac disease vary from person to person and can range from mild to severe.

Some people may have no symptoms at all.

Sometimes the symptoms of coeliac disease are mistaken for:

irritable bowel syndrome (IBS) wheat intolerance stress just getting older


Some common symptoms of coeliac disease include:

severe diarrhoea, excessive wind and/or constipation persistent or unexplained gastrointestinal symptoms, such as nausea and vomiting recurrent stomach pain, cramping or bloating iron, vitamin B12 or folic acid deficiency anaemia tiredness sudden or unexpected weight loss (but not in all cases) mouth ulcers skin rash (dermatitis herpetiformis) depression repeated miscarriages neurological (nerve) problems such as ataxia (loss of coordination, poor balance) and peripheral neuropathy (numbness and tingling in the hands and feet)

If you’ve any of these symptoms, speak to your GP. You must continue eating gluten as part of your diet until you’ve been diagnosed.

You can also take Coeliac UK’s online assessment.

Symptoms in children

Children with coeliac disease might also not grow at the expected rate, or be late to reach puberty.

Causes

Coeliac disease is more common in people with certain conditions and in relatives of people with coeliac disease. It’s unknown exactly why people develop the condition.

More about the causes of coeliac disease


It’s not known exactly why people develop coeliac disease or why some have mild symptoms while others have severe symptoms. It could be that a person’s genetics and the environment play a part in why this condition develops.

Diagnoses

Most people with coeliac disease have antibodies in their blood. The first stage in diagnosis is a simple blood test. The second stage might result in a biopsy, if necessary.

More about how coeliac disease is diagnosed


Coeliac disease can be diagnosed at any age, and both children and adults can show symptoms

Delayed diagnosis is common. It can take an average of 13 years to diagnose.


Most people with coeliac disease have antibodies that show up in their blood. The first stage in diagnosis can be a blood test.

Who’ll have a blood test

A blood test should be offered if you’ve any of the following:

type 1 diabetes autoimmune thyroid disease dermatitis herpetiformis irritable bowel syndrome (IBS) anaemia without an obvious cause certain symptoms related to your digestive system – such as frequent diarrhoea, abdominal pain or vomiting, nausea or sudden weight loss close relatives (parents, siblings or children) with coeliac disease

A blood test might also be offered if:

you feel tired all the time a child is not growing as fast as expected you’ve other symptoms or conditions that sometimes occur in people with coeliac disease – such as mouth ulcers, particular types of problems with your bones or liver, Down’s syndrome, Turner syndrome or persistent constipation

Blood tests for coeliac disease are not recommended for infants who’ve not started to eat foods containing gluten.

Before a blood test

Before a blood test is taken, it’s important that you eat gluten-containing foods in more than one meal every day for at least 6 weeks before the test.

Remember to eat a normal gluten diet for 6 weeks before any tests. This means eating more than one meal a day that includes gluten-based foods.

What’s involved in a blood test?

A blood test for coeliac disease involves taking a blood sample and testing it for antibodies in the blood.

You must have been eating gluten-containing food in more than 1 meal for at least 6 weeks before the test, for it to be successful.

Blood tests are 95% accurate at diagnosing coeliac disease.

Positive result

If the coeliac antibodies are found in your blood, further investigation will be needed. This’ll be discussed with you.

Your GP will refer you to your local coeliac service for confirmation of the diagnosis. You should remain on a normal diet until all investigations are complete.

Negative result

It’s sometimes possible to have coeliac disease and not have antibodies in your blood.

If you continue to have coeliac disease-like symptoms your GP may still refer you for a biopsy of your gut.


You should continue to eat gluten-containing foods every day until a diagnosis has been confirmed.

A biopsy will only show coeliac disease if the person being tested has been eating gluten-containing foods regularly.

Only after coeliac disease is confirmed can you start a gluten-free diet.

If you’re already on a gluten-free diet and find it hard to eat gluten again, your GP should refer you to a specialist. You may not be able to get gluten-free foods on prescription if you do not have coeliac disease confirmed by a biopsy.

Read further information:

Diet advice when being tested for Coeliac Disease NICE guidelines – coeliac disease recognition, assessment and management BSG guidelines on the diagnosis and management of adult coeliac disease Lynsey’s diagnosis story

Tests after diagnosis

If you’ve been diagnosed with coeliac disease, you may also have other tests to assess how the condition has affected you so far.

Additional blood tests

You may have further blood tests to check levels of iron and other vitamins and minerals in your blood. This’ll help check for anaemia.

Dual energy X-ray (DEXA) scan (adults only)

In coeliac disease, a lack of nutrients caused by poor absorption can make bones weak and brittle (osteoporosis).

A DEXA scan is a type of very low dose X-ray that measures bone density. This may be required if your risk score (FRAX/Qfracture) is high. This will be calculated as part of your assessment.

Over-the-counter tests

You can buy over-the-counter tests for coeliac disease at pharmacies. There isn’t enough evidence that these tests are reliable.

If you’ve used one, it’s important that you talk to your GP about the result.

Before a diagnosis can be confirmed, you’ll still need to have a blood test and biopsy.

Treatments

Coeliac disease can be effectively treated with a gluten-free diet. By adopting a gluten-free diet and lifestyle, you can manage your condition and improve your quality of life.

More about how coeliac disease is treated


The only treatment for confirmed coeliac disease is a lifelong gluten-free diet.


Symptoms should improve within weeks of starting a gluten-free diet. However, it may take up to 2 years for the digestive system to heal completely.

Complications

If coeliac disease isn’t treated, you’re at greater risk of conditions like osteoporosis and cancer in later life.

More about the complications of coeliac disease


Complications of coeliac disease only tend to affect people that continue to eat gluten, or in people that have taken a long time to diagnose.

Possible complications of coeliac disease include:

lactose intolerance nutritional deficiencies osteoporosis cancer


Less common complications of coeliac disease include low birth weight in newborn babies and in rare cases, hyposplenia.

Cold sore
of mouth

Cold sores are small blisters that develop on the lips or around the mouth. They’re caused by the herpes simplex virus and usually clear up without treatment within 7 to 10 days.

You may not have any symptoms when you first become infected with the herpes simplex virus. An outbreak of cold sores may happen some time later.

Cold sores often start with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then appear, usually on the edges of your lower lip.

Read more about the symptoms of cold sores.

Symptoms

You won’t usually have any symptoms when you first become infected with the herpes simplex virus (the primary infection).

An outbreak of cold sores may occur some time later and keep coming back (recurrent infection).

However, if the primary infection does cause symptoms, they can be quite severe.

Causes

The strain of herpes simplex virus usually responsible for cold sores is known as HSV-1.

In rare cases, cold sores can also be caused by the herpes simplex virus type 2 (HSV-2). This can be the result of having oral sex with someone who has genital herpes.

Read more about the causes of cold sores.


Cold sores are usually caused by the herpes simplex virus type 1 (HSV-1).

In most cases the virus is passed on in early childhood – for example, when a child is kissed by a family member or friend with a cold sore.

The virus passes through the skin and travels up the nerves, where it lies inactive (dormant) until it’s triggered at a later date.

Treatments

 

Pharmacy First Scotland: Cold sore treatment from your pharmacyIf you have cold sores you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you

Cold sores aren’t usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required.

If you’ve had outbreaks of cold sores before, it’s likely that you’ll know what they are if they return.

You only need to visit your pharmacist if you’re unsure whether it’s a cold sore or if it’s severe and spreading further than just the lip. See your pharmacist if a cold sore hasn’t healed after 7 to 10 days.


Cold sores usually clear up by themselves without treatment within 7 to 10 days.

However, antiviral creams are available over the counter from pharmacies without a prescription. If used correctly, these can help ease your symptoms and speed up the healing time.

To be effective, these treatments should be applied as soon as the first signs of a cold sore appear – when you feel a tingling, itching or burning sensation around your mouth. Using an antiviral cream after this initial period is unlikely to have much of an effect.

Cold sore patches are also available that contain hydrocolloid gel, which is an effective treatment for skin wounds. The patch is placed over the cold sore while it heals.

Antiviral tablets may be prescribed for severe cases.

Read more about treating cold sores.


Cold sores usually clear up without treatment within 7 to 10 days. Antiviral tablets or cream can be used to ease your symptoms and speed up the healing time.

If you develop a cold sore, some general advice to follow includes:

drink plenty of fluids to avoid dehydration avoid acidic or salty foods and eat cool, soft foods if brushing your teeth is painful, use an antiseptic mouthwash dab creams on to sores rather than rubbing them in wash your hands using soap and water before and after applying cold sore creams avoid touching your cold sores, other than to apply cream, and don’t share your cold sore cream with others


Several non-antiviral creams are also available over the counter from pharmacies without the need for a prescription.

These creams aren’t specifically designed to treat cold sores and won’t help them heal faster, but they may help ease any pain or irritation. Ask your pharmacist to recommend a suitable treatment for you.

Pain can also be treated with painkillers such as ibuprofen or  paracetamol  – both are available in liquid form for young children.

However, don’t take ibuprofen if you have asthma or stomach ulcers, or you’ve had them in the past.

Children under the age of 16 shouldn’t be given aspirin.

Speak to your pharmacist if you have cold sores and you’re pregnant.


If your cold sores are particularly severe or your immune system is damaged – for example, if you have HIV or you’re having chemotherapy treatment – you may be at risk of developing serious complications.

For example, your risk of developing encephalitis or the infection spreading to other parts of your body, such as your eyes, is increased.

Speak to your GP if you’re at risk. They may prescribe antiviral tablets and refer you for specialist treatment.

The type of treatment recommended will depend on the severity of your cold sore symptoms and the complication that’s causing problems.

For example, if you develop herpetic keratoconjunctivitis – a secondary eye infection – you may need to see an ophthalmologist, a specialist eye doctor.

Preventions

It’s not possible to prevent infection with the herpes simplex virus or prevent outbreaks of cold sores, but you can take steps to minimise the spread of infection.

Cold sores are at their most contagious when they burst (rupture), but remain contagious until they’re completely healed. Avoid close contact with others until your cold sore has completely healed and disappeared.

However, there’s no need to stay away from work or miss school if you or your child have a cold sore.

You can help minimise the risk of the cold sore virus spreading and cold sores recurring by following the advice below:

avoid touching cold sores unless you’re applying cold sore cream – creams should be dabbed on gently rather than rubbed in, as this can damage your skin further always wash your hands before and after applying cold sore cream and after touching the affected area do not share cold sore creams or medication with other people as this can cause the infection to spread do not share items that come into contact with the affected area, such as lipsticks or cutlery avoid kissing and oral sex until your cold sores have completely healed be particularly careful around newborn babies, pregnant women and people with a low immune system, such as those with HIV  or those having chemotherapy if you know what usually triggers your cold sores, try to avoid the triggers – for example, a sun block lip balm (SPF 15 or higher) may help prevent cold sores triggered by bright sunlight

Complications

Cold sores are usually mild, but may cause complications in rare cases. People with weak immune systems caused by illness or treatments such as chemotherapy are particularly at risk of complications.

Dehydration sometimes occurs if drinking fluids becomes painful. Young children are particularly at risk of becoming dehydrated.

The herpes simplex virus can also spread to other parts of your body. Examples of when this can occur include:

skin infections – these often occur if the virus comes into contact with broken skin, such as a cut or graze, or a skin condition such as eczema herpetic whitlow (whitlow finger) – this causes painful sores and blisters to appear on and around your fingers herpetic keratoconjunctivitis – this causes swelling and irritation (inflammation) of your eye area and sores to develop on your eyelids

Left untreated, herpetic keratoconjunctivitis can cause the cornea, the transparent layer at the front of your eye, to become infected, which can eventually lead to blindness.

It’s therefore important not to touch your eyes if you have an unhealed cold sore. If you must touch your eyes – for example, to remove contact lenses – wash your hands thoroughly first.

In very rare cases, encephalitis, a condition where the brain becomes inflamed and swollen, can be caused by the cold sore virus spreading to the brain. It can be treated with intravenous injections of antiviral medications, such as aciclovir.


If your cold sores are particularly severe or your immune system is damaged – for example, if you have HIV or you’re having chemotherapy treatment – you may be at risk of developing serious complications.

For example, your risk of developing encephalitis or the infection spreading to other parts of your body, such as your eyes, is increased.

Speak to your GP if you’re at risk. They may prescribe antiviral tablets and refer you for specialist treatment.

The type of treatment recommended will depend on the severity of your cold sore symptoms and the complication that’s causing problems.

For example, if you develop herpetic keratoconjunctivitis – a secondary eye infection – you may need to see an ophthalmologist, a specialist eye doctor.

Coma
of brain nerves and spinal cord

It can result from injury to the brain, such as a severe head injury or stroke. A coma can also be caused by severe alcohol poisoning or a brain infection (encephalitis).

People with diabetes could fall into a coma if their blood glucose levels suddenly became very low (hypoglycaemia) or very high (hyperglycaemia). 


People with diabetes could fall into a coma if their blood glucose levels suddenly became very low (hypoglycaemia) or very high (hyperglycaemia). 

Common cold
of infections and poisoning

A cold is a mild viral infection of the nose, throat, sinuses and upper airways. It’s very common and usually clears up on its own within a week or two.

The main symptoms of a cold include:

a sore throat a blocked or runny nose sneezing a cough

More severe symptoms, including a high temperature (fever), headache and aching muscles can also occur, although these tend to be associated more with flu.

Read more about the symptoms of a cold

Symptoms

The symptoms of a cold usually develop within a few days of becoming infected.

The main symptoms include:

a sore throat a blocked or runny nose sneezing a cough a hoarse voice generally feeling unwell

Less common symptoms of a cold include:

a high temperature (fever) – this is usually about 37-39C (98.6-102.2F) a headache earache – severe earache may be a sign of a middle ear infection muscle pain loss of taste and smell mild irritation of your eyes a feeling of pressure in your ears and face  

The symptoms are usually at their worst during the first two to three days, before they gradually start to improve. In adults and older children, they usually last about 7 to 10 days, but can last longer. A cough in particular can last for two or three weeks.

Colds tend to last longer in younger children who are under five, typically lasting around 10 to 14 days. Read more about colds in children.

Causes

Antibiotics are used to treat infections caused by bacteria. Colds are caused by viruses, so do not respond to antibiotics.

The overuse of antibiotics can lead to antibiotic resistance, where bacterial infections become less easily treatable.

Your doctor is likely to prescribe antibiotics only if your child has developed a bacterial infection in addition to their cold.

Treatments

Pharmacy First Scotland: Cold treatment from your pharmacyIf you have a cold or the symptoms of a cold, you get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you

If you or your child has a cold, there’s usually no need to see your GP as it should clear within a week or two.

You only really need to contact your GP if:

your symptoms persist for more than three weeks your symptoms get suddenly worse you have breathing difficulties you develop complications of a cold, such as chest pain or coughing up bloodstained mucus

It might also be a good idea to get advice from a GP if you’re concerned about your baby or an elderly person, or if you have a long-term illness such as a lung condition. You can also phone NHS 24’s 111 service for advice.


You can manage cold symptoms yourself by following some simple advice. You’ll normally start to feel better within 7 to 10 days.


The following treatments aren’t usually recommended to treat colds because there isn’t strong evidence to suggest they’re effective, and they may cause unpleasant side effects:

antihistamines cough treatments or syrups antibiotics – these are only effective against bacteria (colds are caused by viruses) complementary and alternative medicine (CAM) treatments such as echinacea and Chinese herbal medicines


You should seek medical advice if:

your child is under three months old and has a temperature of 38C (100.4F) or above, or is between three and six months old and has a temperature of 39C (102.2F) or above their symptoms last more than three weeks they seem to be getting worse rather than better they have chest pain or are coughing up bloodstained phlegm – this could be a sign of a bacterial chest infection that needs treatment with antibiotics they’re finding it difficult to breathe – seek medical help immediately from your GP surgery or local hospital they have, or seem to have, severe earache (babies with earache often rub their ears and seem irritable) as they could have an ear infection that may need antibiotic treatment they have a persistent or severely sore throat – they may have bacterial tonsillitis, which needs antibiotic treatment they develop any other worrying symptoms

Complications

Colds usually clear up without causing any further problems. However, the infection can sometimes spread to your chest, ears or sinuses.

Common heart conditions
of heart and blood vessels, conditions

It’s always best to discuss your heart condition with your health professional or heart specialist who can advise you on the correct diagnosis and name of your condition and treatment plan.

Heart disease and different conditions affect the heart’s ability to work efficiently.

It can be worrying and confusing to be diagnosed with a heart condition, but there’s a lot of information and support available to you. Sometimes understanding what is happening can help you worry less.


Heart disease and different conditions affect the heart’s ability to work efficiently.

It can be worrying and confusing to be diagnosed with a heart condition, but there’s a lot of information and support available to you. Sometimes understanding what is happening can help you worry less.


It can be worrying and confusing to be diagnosed with a heart condition, but there’s a lot of information and support available to you. Sometimes understanding what is happening can help you worry less.

Symptoms

Angina is your heart’s way of telling you it’s not getting enough oxygen when you’re doing something strenuous or you’re feeling under stress. Many people learn to recognise how much activity will bring on an angina attack – this is called stable angina.

If you have unexplained chest pain, seek urgent medical advice – you will need an assessment of your overall health.


Read more about heart failure


shortness of breath swollen ankles fatigue chest pain (angina or palpitations) dizziness or fainting

Read about heart valve problems on the Chest Heart & Stroke Scotland website

Congenital heart disease
of heart and blood vessels, conditions

Congenital heart disease is a general term used to refer to a series of birth defects that affect the heart.

Symptoms

As stated in the introduction, the two main types of congenital heart disease are:

cyanotic heart disease acyanotic heart disease


The symptoms of cyanotic heart disease include:

a blue coloured tinge to the lips, fingers and toes (cyanosis) palpitations fainting fatigue chest pains breathing problems

Children with cyanotic heart disease have lower levels of oxygen in their blood, this is known as hypoxia.

Sometimes, their oxygen levels can fall further and cause additional symptoms such as anxiety and confusion or disorientation.


The symptoms of acyanotic heart disease include:

severe tiredness palpitations chest pain shortness of breath (particularly during activities such as climbing the stairs)


There are some symptoms that are present in both cyanotic and acyanotic heart disease.

These include:

poor appetite and feeding difficulties sweating, particularly when a baby is feeding delayed growth

Children with acyanotic heart disease are usually underweight, and children with cyanotic heart disease are usually underweight and small for their age.

Causes

To understand how congenital heart disease can affect your child’s heart and general health, it’s useful to first understand how a healthy heart works.

Find out how your heart works, on the British Heart Foundation website.

Congenital heart disease develops when abnormalities in the heart’s structure prevent it from working as it should.

As outlined in the introduction, the two main types of congenital heart disease are:

cyanotic heart disease acyanotic heart disease

Find common causes of each below.

Diagnoses

An increasing number of cases of congenital heart disease are now diagnosed by carrying out a foetal echocardiograph before a baby is born.

A foetal echocardiograph is made possible by using a type of ultrasound scanner that has been specially designed to build a picture of the unborn baby’s heart. It should be carried out during routine antenatal examinations, usually sometime between the 18th and 20th week of pregnancy.

It is not always possible to detect heart defects (particularly mild ones) using a foetal echocardiography.


If a baby is born with cyanotic heart disease, a diagnosis can usually be made quickly and confidently due to the distinctive blue colour of their skin.

If your baby is born with acyanotic heart disease, their symptoms may not become immediately apparent for several months, or possibly years, after birth. 

Possible signs that your child may have a cyanotic heart disease include:

problems feeding slow growth shortness of breath after exercising tiredness after exercising swelling of their hands, feet and ankles

You should contact your GP if your child has any of the above symptoms. Further testing can confirm or disprove a diagnosis of congenital heart disease.


Echocardiogram

An echocardiogram may be used to check your child’s heart. Sometimes, underlying problems with the heart, which were missed during a foetal echocardiogram, can be detected as a child grows up.

Find out more about an echocardiogram on the British Heart Foundation website.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a test that measures the electrical activity of the child’s heart. Electrodes are placed on the skin across the chest, arms and legs, and then connected to an ECG machine. The machine analyses the electrical signals produced by the heart in order to assess the heart rhythm.

Find out more about an ECG on the British Heart Foundation website.

Chest X-ray

A chest X-ray of the heart and lungs can check whether there are any abnormalities in the lungs, or whether the heart is larger than normal. Both of these can be signs of congenital heart disease.

Find out more about a chest x-ray on the British Heart Foundation website.

Pulse oximetry

Pulse oximetry is a test that measures how much oxygen is present in the blood. 

The test involves placing a special sensor on your child’s fingertip, ear or toe. The sensor sends out light waves. A computer that is connected to the sensor measures how the light waves are being absorbed, and gives a percentage reading. 

A healthy person should have a reading of 94% or above. It is common for those with cyanotic heart defects to have readings below this value.

Cardiac catheterisation

Cardiac catheterisation is a useful way of finding out more information about exactly how the blood is pumping through the child’s heart.

During a cardiac catheterisation, a small flexible tube, known as a catheter, will be inserted into one of the child’s blood vessels, usually in the groin or arm. The tube is moved up into the heart, using X-rays to help guide it.

A contrast dye that shows up on X-rays can be injected into the tube. The dye can then be studied as it moves through the heart, enabling medical staff to see how well each chamber of the heart is working. Blood pressure readings in different parts of the heart can also be taken; this will help with diagnosis and treatment planning.

Cardiac catheterisation is usually performed under a local anaesthetic and is a relatively painless procedure.

Treatments

There are a number of different surgical techniques that can be used to treat congenital heart disease. Some of these are explained below.


Specific treatments for the most common types of congenital heart disease are described below.

Septal defects

If your child is diagnosed with a ventricular septal defect (VSD) or an atrial septal defect (ASD), the recommended treatment will depend on the size of the defect.

If the defect is small, a policy of ‘watchful waiting’ may be recommended, where your child receives no immediate treatment but their health is carefully monitored. This is because 90% of small defects will close as the child grows older.

In cases of mild to medium-sized defects, it may be possible to seal the defect using a catheter. The catheter is guided to the site of the hole, and a specially designed mesh is passed through the catheter to seal the defect.

In cases of medium to large-sized defects, open-heart surgery may be required. This involves a patch being stitched directly over the defect.

Stenosis

If your child is diagnosed with a stenosis (a narrowing one of their valves) the treatment that is recommended will depend on the extent of the stenosis and if they are symptomatic.

In mild cases, a policy of ‘watchful waiting’ may be recommended. Medication that lowers blood pressure may also be recommended to reduce the strain on your child’s heart and lungs.

In more serious cases of stenosis, a catheter can be used to widen the valve. A small balloon is passed up through the catheter and then inflated to widen the affected valve. This is known as a balloon angioplasty. Once the valve has been widened, the balloon is removed. Sometimes, a metal coil (stent) is used to keep the valve widened.

In more serious cases of stenosis, it’s sometimes necessary to replace the valve using open heart surgery. Replacement valves can be obtained from human donors, or made from artificial materials, such as titanium, or taken from pigs and modified for human use. Pigs are used because their hearts are the most similar to the human heart.

For people who are too ill or weak to withstand the effects of open heart surgery, a catheter approach can be used. The catheter is passed through a blood vessel in the groin and up into the heart. A replacement valve is passed through the catheter and into position.

Patent ductus ateriosus (PDA)

Many cases of patent ductus ateriosus (PDA) can be treated shortly after birth, using medication.

Two types of medication – indomethacin and a special type of ibuprofen – have been shown to effectively stimulate the closure of the duct that is responsible for PDA.

If a PDA does not respond to medication, a catheter can be used to seal the duct with a metal coil or plug.

Tetralogy of Fallot (TOF)

Babies born with Tetralogy of Fallot (TOF) who are experiencing severe symptoms of breathlessness may require emergency surgery such as a Blalock-Taussig shunt (a BT shunt).

During a BT shunt, an artery is diverted (or shunted) into the lungs so that a supply of oxygen-rich blood becomes available. Further open-heart surgery is then recommended when the baby is old enough to withstand the after-effects of surgery. During open-heart surgery, the defect between the ventricles is sealed and the pulmonary valve is widened.

Transposition of the great arteries (TGA)

Transposition of the great arteries (TGA) will require open-heart surgery, which is usually done shortly after your baby is born.

A surgical technique, known as an arterial switch, is usually used to treat cases of TGA. During an arterial switch, the affected arteries are cut and reattached to their correct position on the other side of the heart.

Complications

Many children with congenital heart disease will experience delays in their development, and may take longer to reach certain stages in their development, such as walking or talking.

Some children with congenital heart disease also have associated learning difficulties and require specialised educational and psychological assistance.

If your child has congenital heart disease, your local educational authority should draw up an individual education plan (IEP). The IEP makes an assessment of your child’s current and future needs, and provides access to any specialised services that your child needs, such as speech and language therapy or an educational psychologist.

The IEP will take into account what level of physical activity is safe for your child. Children with congenital heart disease should be encouraged to be as active as possible, but certain activities, such as contact sports, may have to be avoided.

Conjunctivitis
of eyes

inflammation redness itching a burning or gritty feeling watering pus that sticks to the eyelashes


The 3 most common causes of this inflammation are:

infection (infective conjunctivitis) an allergic reaction (allergic conjunctivitis) something irritating the conjunctiva, like a loose eyelash (irritant conjunctivitis)

Symptoms

Conjunctivitis usually causes symptoms in both eyes like:

inflammation redness itching a burning or gritty feeling watering pus that sticks to the eyelashes

Causes

Conjunctivitis happens when the conjunctiva becomes inflamed. This is a thin layer of cells covering the front of your eyes.

The 3 most common causes of this inflammation are:

infection (infective conjunctivitis) an allergic reaction (allergic conjunctivitis) something irritating the conjunctiva, like a loose eyelash (irritant conjunctivitis)

Treatments

Do boil water and let it cool down before you gently wipe your eyelashes to clean off crusts with a clean cotton wool pad (1 piece for each eye) hold a cold towel over your eyes for a few minutes wash your hands regularly – this is particularly important after touching your eyes use lubricant eye drops – these are available at pharmacies or they may be prescribed for you

Don’t do not rub your eyes do not wear contact lenses until the symptoms have cleared up don’t re-use old lenses after the infection has gone – they could cause re-infection do not not share pillows or towels

You don’t need to take time off school or work if you have conjunctivitis unless you’re feeling very unwell.


Treatment for conjunctivitis will depend on what’s causing it.

You may be prescribed antibiotics to treat a bacterial infection. But these won’t work if the symptoms are caused by a virus or an allergy.

Allergic conjunctivitis can usually be treated with antihistamines. If possible, you should also try to avoid the substance that triggered the allergy.

Irritant conjunctivitis will ease when whatever is causing the symptoms is removed.

Some sexually transmitted infections (STIs) can cause conjunctivitis. This type takes longer to get better.

Preventions

Do boil water and let it cool down before you gently wipe your eyelashes to clean off crusts with a clean cotton wool pad (1 piece for each eye) hold a cold towel over your eyes for a few minutes wash your hands regularly – this is particularly important after touching your eyes use lubricant eye drops – these are available at pharmacies or they may be prescribed for you

Don’t do not rub your eyes do not wear contact lenses until the symptoms have cleared up don’t re-use old lenses after the infection has gone – they could cause re-infection do not not share pillows or towels

You don’t need to take time off school or work if you have conjunctivitis unless you’re feeling very unwell.

Constipation
of stomach liver and gastrointestinal tract

Constipation is a common condition that affects people of all ages. It can mean that you’re not passing stools regularly or you’re unable to completely empty your bowel.

Constipation can also cause your stools to be hard and lumpy, as well as unusually large or small.

The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life.

Read more about the symptoms of constipation.

Symptoms

When you’re constipated, passing stools becomes more difficult and less frequent than usual.

Normal bowel habits vary from person to person. Some adults go to the toilet more than once a day, whereas others may only go every 3 or 4 days. Similarly, some infants pass stools several times a day, while others only pass them a few times a week.

If you or your child pass stools less than usual, it could be a sign of constipation.

It may also be more difficult to pass stools and you may feel unable to empty your bowel completely. Your stools may appear dry, hard and lumpy, as well as abnormally large or small.

Other symptoms of constipation can include:

stomach ache and cramps  feeling bloated feeling sick loss of appetite

Causes

It’s often difficult to identify the exact cause of constipation. However, there are a number of things that contribute to the condition, including:

not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits ignoring the urge to pass stools side effects of certain medications not drinking enough fluids anxiety or depression

In children, poor diet, fear about using the toilet and problems toilet training can all lead to constipation.

Read more about the causes of constipation.


Constipation usually occurs when stools remain in the colon (large intestine) for too long, and the colon absorbs too much water from the stools, causing them to become hard and dry.

Most cases of constipation aren’t caused by a specific condition and it may be difficult to identify the exact cause. However, several factors can increase your chances of having constipation, including:

not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits having limited privacy when using the toilet ignoring the urge to pass stools immobility or lack of exercise not drinking enough fluids having a high temperature (fever) being underweight or overweight anxiety or depression psychiatric problems, such as those brought on by sexual abuse, violence or trauma

Diagnoses

Constipation is a very common condition. Your pharmacist won’t usually need to carry out any tests or procedures, but will confirm a diagnosis based on your symptoms and medical history.

Your pharmacist will ask you some questions about your bowel habits. Don’t feel embarrassed about discussing this with your pharmacist. It’s important they’re aware of all of your symptoms, so they can make the correct diagnosis.

Your pharmacist may also ask questions about your diet, level of exercise and whether there have been any recent changes to your routines.

Constipation can be defined in a number of ways:

opening the bowels less than 3 times a week needing to strain to open your bowels on more than a quarter of occasions passing a hard or pellet-like stool on more than a quarter of occasions


If you’re experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions.

Other tests you may have include:

an abdominal X-ray – where X-ray radiation is used to produce images of the inside of your abdomen transit study examination – where you take a short course of special capsules that show up on X-rays; one or more X-rays are taken later on to see how long it takes for the capsules to pass through your digestive system anorectal manometry – where a small device with a balloon at one end is inserted into your rectum and attached to a machine that measures pressure readings from the balloon as you squeeze, relax and push your rectum muscles; this gives an idea of how well the muscles and nerves in and around your rectum are working

As there’s an increased risk of bowel cancer in older adults, your doctor may also request tests to rule out a diagnosis of cancer, including a computerised tomography (CT) scan or colonoscopy.

Treatments

Pharmacy First Scotland: Constipation treatment from your pharmacyIf you have constipation you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you

Constipation isn’t usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required.

Also speak to your pharmacist if you think your child might be constipated. Laxatives are often recommended for children alongside diet and lifestyle changes.

You may be able to treat constipation yourself by making simple changes to your diet and lifestyle (see below). If these changes don’t help and the problem continues, you should see your pharmacist.

However, you should see your GP for advice if:

you notice any rectal bleeding you notice any unexplained weight loss you have persistent tiredness your constipation lasts longer than 14 days without improvement


Diet and lifestyle changes are usually recommended as the first treatment for constipation.

This includes gradually increasing your daily intake of fibre, making sure you drink plenty of fluids, and trying to get more exercise.

If these aren’t effective, your pharmacist may recommend an oral laxative medication that can help you empty your bowels.

Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established.

Read more about treating constipation.


Treatment for constipation depends on the cause, how long you’ve had it and how severe your symptoms are.

In many cases, it’s possible to relieve the symptoms by making dietary and lifestyle changes.


Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.

Sometimes as a result of impaction, overflow diarrhoea may occur (where loose stools leak around the obstruction). You may have difficulty controlling this.

If you have faecal impaction, you’ll initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using macrogol, you may also have to start taking a stimulant laxative.

If you don’t respond to these laxatives, and/or if you have overflow diarrhoea, you may need one of the following medications.

Suppository – this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl is an example of a medication that can be given in suppository form.

Mini enema – where a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.

Preventions

Making the diet and lifestyle changes mentioned above can also help to reduce your risk of developing constipation in the first place.

Giving yourself enough time and privacy to pass stools comfortably may also help, and you should try not to ignore the urge to go to the toilet.

Read more about preventing constipation.


There are a number of things you can do to prevent constipation, including making diet and lifestyle changes.

Complications

For most people constipation rarely causes complications, but people with long-term constipation can develop:

haemorrhoids (piles) faecal impaction (where dry, hard stools collect in the rectum) bowel incontinence (the leakage of liquid stools)

Read more about the complications of constipation.


Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if it’s started promptly.

However, if you have long-term (chronic) constipation, you may be more at risk of experiencing complications.

Coronavirus (COVID-19)
of infections and poisoning, coronavirus covid 19

Coronavirus, and other respiratory infections such as flu, can spread easily and cause serious illness in some people. Vaccinations are very effective at preventing serious illness from coronavirus. But there’s still a chance you might catch coronavirus, or another respiratory infection, and pass it on to other people.



have a high temperature or do not feel well enough to go to work or carry out normal activities

Try to do this until you no longer have a high temperature (if you had one) or until you feel better.

Symptoms of coronavirus include:

continuous cough high temperature, fever or chills loss of, or change in, your normal sense of taste or smell shortness of breath unexplained tiredness, lack of energy muscle aches or pains that are not due to exercise not wanting to eat or not feeling hungry headache that’s unusual or longer lasting than usual sore throat, stuffy or runny nose diarrhoea feeling sick or being sick

How to help your symptoms

Do drink fluids like water to keep yourself hydratedget plenty of restwear loose, comfortable clothing – don’t try to make yourself too coldtake over-the-counter medications like paracetamol – always follow the manufacturer’s instructions

Antibiotics will not relieve your symptoms or speed up your recovery.

You might continue to have a cough or feel tired after your other symptoms have improved. This does not mean that you’re still infectious.

Phone 999 or to go A&E if: You or your child: seems very unwell, is getting worse or you think there’s something seriously wrong – children and babies in particular can get unwell very quickly gets sudden chest pain is so breathless they’re unable to say short sentences when resting, or breathing suddenly gets worse – in babies their stomach may suck under their ribs starts coughing up blood collapses, faints, or has a seizure or fit for the first time has a rash that does not fade when you roll a glass over it, the same as meningitis

Speak to your GP if: your symptoms worsen you’re concerned about your symptoms you have symptoms that you can no longer manage at home you’re worried about your child, especially if they’re under 2 years If your GP is closed, phone 111. In an emergency phone 999.

It’s particularly important to get help if you’re at increased risk of becoming more unwell from coronavirus such as if you’re pregnant, aged 60 or over, or have a weakened immune system.

Symptoms

To prevent the spread of coronavirus, try to stay at home and avoid contact with other people if you have symptoms of a respiratory infection such as coronavirus and you:

have a high temperature or do not feel well enough to go to work or carry out normal activities

Try to do this until you no longer have a high temperature (if you had one) or until you feel better.

Symptoms of coronavirus include:

continuous cough high temperature, fever or chills loss of, or change in, your normal sense of taste or smell shortness of breath unexplained tiredness, lack of energy muscle aches or pains that are not due to exercise not wanting to eat or not feeling hungry headache that’s unusual or longer lasting than usual sore throat, stuffy or runny nose diarrhoea feeling sick or being sick

How to help your symptoms

Do drink fluids like water to keep yourself hydratedget plenty of restwear loose, comfortable clothing – don’t try to make yourself too coldtake over-the-counter medications like paracetamol – always follow the manufacturer’s instructions

Antibiotics will not relieve your symptoms or speed up your recovery.

You might continue to have a cough or feel tired after your other symptoms have improved. This does not mean that you’re still infectious.

Phone 999 or to go A&E if: You or your child: seems very unwell, is getting worse or you think there’s something seriously wrong – children and babies in particular can get unwell very quickly gets sudden chest pain is so breathless they’re unable to say short sentences when resting, or breathing suddenly gets worse – in babies their stomach may suck under their ribs starts coughing up blood collapses, faints, or has a seizure or fit for the first time has a rash that does not fade when you roll a glass over it, the same as meningitis

Speak to your GP if: your symptoms worsen you’re concerned about your symptoms you have symptoms that you can no longer manage at home you’re worried about your child, especially if they’re under 2 years If your GP is closed, phone 111. In an emergency phone 999.

It’s particularly important to get help if you’re at increased risk of becoming more unwell from coronavirus such as if you’re pregnant, aged 60 or over, or have a weakened immune system.

Diagnoses

Most people in Scotland no longer need to test for coronavirus.

Who can still access free NHS testing?

You can still access testing if you have a health condition which means you’re eligible for coronavirus treatments.

Order tests online if you’re eligible

Your test is not complete until you report your result.

Testing helpline

If you’re eligible for free NHS tests and you cannot place an order online, phone 0800 008 6587. The helpline is free from mobiles and landlines. Lines are open Monday to Friday from 9am to 5pm and on Saturdays from 9am to 1pm. Lines are closed on Sundays and bank holidays.

They have a translation service. SignVideo (a free online British Sign Language interpreter service) is also available.

Everyone else

Unless you have a health condition which means you’re eligible for coronavirus treatments, you’re not eligible for free NHS testing. You should not order online or phone for a test. You will not be able to get one this way.

You can buy tests from some pharmacies and shops, in person and online.

Cough
of lungs and airways

Most coughs clear up within 3 weeks and don’t require any treatment.

A dry cough means it’s tickly and doesn’t produce any phlegm (thick mucus). A chesty cough means phlegm is produced to help clear your airways.


A dry cough means it’s tickly and doesn’t produce any phlegm (thick mucus). A chesty cough means phlegm is produced to help clear your airways.

Symptoms

Speak to a pharmacist for: advice about coughs cough treatments Find your local pharmacy

Speak to a GP if: you’ve had a cough for more than 3 weeks your cough is particularly severe you cough up blood  you experience shortness of breath, breathing difficulties or chest pain you have any other worrying symptoms, such as unexplained weight loss, a persistent change in your voice, or lumps or swellings in your neck If your GP is unsure what’s causing your cough, they may refer you to a hospital specialist for an assessment. They may also request some tests, such as a chest X-ray, allergy tests, breathing tests, and an analysis of a sample of your phlegm to check for infection.

If you’re concerned about coronavirus (COVID-19): visit our coronavirus page.

Treatments

Treatment isn’t always necessary for short-term coughs because it’s likely to be a viral infection that will get better on its own within a few weeks.

Do restdrink plenty of fluidstake painkillers such as paracetamol or ibuprofen

Cough medicines and remedies

Although some people find them helpful, medicines that claim to suppress your cough or stop you bringing up phlegm are not usually recommended. This is because there’s little evidence to suggest they’re any better than simple home remedies, and they’re not suitable for everyone.

The Medicines and Healthcare products Regulatory Agency (MHRA) recommends that over-the-counter cough and cold medicines shouldn’t be given to children under the age of six. Children aged 6 to 12 should only use them on the advice of a pharmacist or doctor.

A homemade remedy containing honey and lemon is likely to be just as useful and safer to take. Honey shouldn’t be given to babies under the age of one because of the risk of infant botulism.

Treating the underlying cause

If your cough has a specific cause, treating this may help. For example:

asthma can be treated with inhaled steroids to reduce inflammation in your airways allergies can be treated by avoiding things you’re allergic to and taking antihistamines to dampen down your allergic reactions bacterial infections can be treated with antibiotics GORD can be treated with antacids to neutralise your stomach acid and medication to reduce the amount of acid your stomach produces COPD can be treated with bronchodilators to widen your airways

If you smoke, quitting is also likely to help improve your cough. Read more about stopping smoking.

Contact your GP or, if your GP’s closed, phone 111 if your child: is under 3 months old and has a temperature of 38°C or above is older than 3 months and has a temperature of 39°C or above has fewer wet nappies or nappies that seem drier than usual or has a dry nappy for over 12 hours isn’t getting better after a few days is taking less than half their usual amount during their last 2 or 3 feeds If you’re very concerned about your child trust your instincts and phone your GP or 111 for advice, or phone 999 in an emergency.