February 7, 2017

Hepatopulmonary syndrome (HPS) is considered present when the following triad exists  –

  • Liver disease
  • Impaired oxygenation
  • Intrapulmonary vascular abnormalities, referred to as intrapulmonary vascular dilatations (IPVDs)

The unique pathological feature of hepatopulmonary syndrome (visualized by autopsy) is gross dilatation of the pulmonary precapillary and capillary vessels, as well as an absolute increase in the number of dilated vessels. A few pleural and pulmonary arteriovenous shunts and portopulmonary anastomoses may also be seen.

The hepatopulmonary syndrome results from the formation of microscopic intrapulmonary arteriovenous dilations in patients with chronic liver disease. The mechanism is unknown but is thought to be due to increased hepatic production or decreased hepatic clearance of vasodilators. The vascular dilations cause overperfusion relative to ventilation, leading to hypoxemia, particularly because patients have an increased cardiac output resulting from systemic vasodilation. Because the lesions frequently are more numerous at the lung bases, the hepatopulmonary syndrome can cause platypnea (dyspnea) and orthodeoxia (hypoxemia), which occur when the patient is seated or standing and are relieved by recumbency. Most patients also have characteristic findings of chronic liver disease, such as spider angiomas. About 20% of patients present with pulmonary symptoms alone.

The condition is said to be in two forms:

  • Type I – The condition involves the right to left shunting of the lungs. This is known as the most common type of hepatopulmonary syndrome which basically involves dilatation of the capillaries during the exchange of oxygen. As a result, there is less oxygen containment in the alveoli- where gas exchange is the primary role, and the ventilation process is altered.
  • Type II – This accumulates about 10% of hepatopulmonary syndrome cases. The oxygen exchange is yet again not attained normally, as arteriovenous shunts in the circulatory system have not attained its purpose. The anatomic shunts place the ineffective oxygen exchange, making this type of the syndrome as very grave one.

Causes

Presence of an arteriovenous shunt – This shunt is basically a product from a surgical intervention that provides a vessel indicated to provide a pathway for blood exchange between an artery and vein. This is highly indicated for patients for hemodiaysis.

Impaired function of the alveolocapillary in maintaining the diffusion-perfusion process – The pulmonary vessels are quite affected when a vasodilator takes place and acts in desaturating the oxygen. Making the erythrocytes incapable of providing adequate oxygenated blood.

Ventilation and perfusion process is uneven – When there is an underlying lung condition, it is expected that one will suffer from perfusion problems. In cases of liver cirrhosis, there shall be adecrease in perfusion in specific lung areas as ventilation is poor.

Others – Portal hypertension is considered a significant cause of hepatopulmonary syndrome. The chronic use of substances for vasodilatation can induce the syndrome.

Symptom

Those with hepatopulmonary syndrome are expected to present pulmonary symptoms as well as liver problem manifestations. The following present the characteristics of the disease –

  • Hypoxemia is a prominent presentation. This is most recognizable especially when a person is suffering from liver cirrhosis.
  • Cyanosis is noted among patients. This is described as the bluish or purple discoloration of our skin. The inside membranes or tissues of our body is also affected of the discoloration and is primary caused by a deficient flow of oxygenated blood.
  • Digital clubbing (a known manifestation of hypoxemia and is described as the fingers’ tips are enlarged) is observed. This is due to the lack of oxygenation.
  • Plethora of spider nevi is noted. This is identified as spider angioma where there are small angiomata on the skin. This is the spider-like appearance of the vessels visible on the skin. This is basically a manifestation of a hepatic problem.
  • Platypnea is noted or simply known as dyspnea upon standing.
  • Orthodeoxia is a manifestation. This is the sudden fall of the partial oxygen of the patient while in standing position.
  • Increased Nitric oxide levels. This is noted due to its vasodilator component.
  • Esophageal varices might develop. These are dilated veins found in the esophagus.
  • Increased heart rate is noted as a sign of compensation from hypoxemia.

Treatment

Supplemental O 2 – The main treatment is supplemental O 2 for symptoms. Other therapies, such as somatostatin to inhibit vasodilation, are of modest benefit in only some patients. Coil embolization is virtually impossible because of the number and size of the lesions. Inhaled nitric oxide synthesis inhibitors may be a future treatment option. Hepatopulmonary syndrome may regress after liver transplantation or if the underlying liver disease subsides. Prognosis is poor without treatment.

Nitrous oxide inhibitor is provided. Even though there has been less support with this treatment, it has been found to reverse vasodilatation.

Control of the  hypertension. Providing the suitable treatment for the client is a great help in managing the disease.

Orthotopic liver transplantation. This is considered as a treatment of choice when no other interventions seem to work. This is simply known as liver transplant.

Studies show that there is about 24 months to 5 years of survival rate among the reported cases of HPS. When surgical intervention such as liver transplant has not been performed, the survival rate shall be lower than expected.

 

Reference –

http://www.hindawi.com/journals/bmri/2013/670139/

http://www.atsjournals.org/doi/full/10.1164/rccm.201302-0245LE#.VrHI8_l97IU

http://lifeinthefastlane.com/ccc/hepatopulmonary-syndrome/

http://www.nature.com/nrgastro/journal/v9/n9/pdf/nrgastro.2012.123.pdf%3FWT.ec_id%3DNRGASTRO-201209

http://ehjcimaging.oxfordjournals.org/content/8/5/408

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673604161072.pdf

https://www.msdmanuals.com/professional/pulmonary-disorders/pulmonary-hypertension/hepatopulmonary-syndrome

Posted in ORGAN SYSTEM
February 7, 2017

Hepatitis is a term used to describe inflammation (swelling) of the liver. It can occur as the result of a viral infection or because the liver is exposed to harmful substances such as alcohol. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

Liver is the largest organ inside the body. It helps the body digest food, store energy, and remove poisons. It performs following jobs –

  • Bile production that’s essential to digestion
  • Filtering of toxins from the body
  • excretion of bilirubin, cholesterol, hormones, and drugs
  • Metabolism of carbohydrates, fats, and proteins
  • Activation of enzymes, which are specialized proteins essential to metabolic functions
  • Storage of glycogen, minerals, and vitamins (A, D, E, and K)
  • Synthesis of plasma proteins, such as albumin
  • Synthesis of clotting factor

There are 5 main hepatitis viruses, mainly, types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer. In the United States, the most common types of viral hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Types of Hepatitis

  • Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.
  • Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV.
  • Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.
  • Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.
  • Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Causes                                                  

Hepatitis can be caused by:

  • Immune cells in the body attacking the liver
  • Infections from viruses (such as hepatitis A, hepatitis B, or hepatitis C), bacteria, or parasites
  • Liver damage from alcohol or poison
  • Medicines, such as an overdose of acetaminophen
  • Liver disease can also be caused by inherited disorders such as cystic fibrosis or hemochromatosis, a condition that involves having too much iron in your body.

Other causes include Wilson’s disease, a disorder in which the body retains too much copper.

Symptoms

Common symptoms:

  • Fatigue
  • General feeling of ill-health
  • Lack of energy
  • Tendency to tire easily
  • Inability to finish a full days work
  • The need to have more sleep
  • Joint pains (arthralgia) which are an indirect effect of chronic hepatitis and are usually mild and intermittent, noted mostly in the mornings.

Less common symptoms may be:

  • Nausea
  • Decreased appetite
  • Weight loss
  • Abdominal pain or bloating
  • Indigestion
  • Jaundice
  • Abnormal blood vessels on the skin on the face, arms and chest
  • Bruising

If the disease is very active or advanced, jaundice (yellowing of the skin and whites of the eyes and darkening of the urine) may occur.

If cirrhosis develops as a result of chronic AIH there may be muscle wasting, weight loss, ascites (swelling of the abdomen with fluid) and vomiting blood. In many cases the condition develops almost secretly, with no factor pointing to the liver as a cause of ill-health.

Treatment

Medications – Hepatitis hepatitis is usually treated first with a glucocorticoid (such as prednisone).

  • Glucocorticoids – Glucocorticoids such as prednisone control the inflammation in the liver, thereby preventing further scarring. The main drawback of prednisone is side effects, which can include weight gain, acne, bone loss, elevated blood glucose levels (potentially leading to diabetes), an increased risk of infections, cataracts, high blood pressure, and mood and sleep disturbance, among others. People who require long-term prednisone are monitored carefully for these side effects. To minimize the risks of side effects, the lowest possible dose of prednisone is used.
  • Azathioprine or 6-mercaptopurine – A second medication, such as azathioprine {Azasan; Imuran} or 6-mercaptopurine (Purinethol) and, less commonly, methotrexate or mycophenolate mofetil, may be recommended in addition to prednisone. The benefit of adding a second medication is that it may be possible to reduce or eliminate prednisone, helping to minimize the potential side effects of prednisone.
  • Budesonide – Budesonide, another medication that may be substituted for prednisone, continues to be studied, but is not yet widely used.
  • Castor Oil – Castor oil that is absorbed through the skin over the liver and spleen is of benefit during times of severe inflammation. A person will need to first determine where these organs are to accomplish this. A rag should be soaked in pure, cold-pressed castor oil beforehand. The excess oil should be squeezed out just prior to use.

Liver Transplantation – Transplantation is indicated in patients with fulminant liver failure due to acute Hepatitis, or more commonly, decompensated cirrhosis secondary to it.

Alternative Treatment

  • Milk Thistle – It is an herb that has properties that promote liver health. It may be sold as Silybum marianum, or as silymarin. Side effects may include nausea, diarrhea, and abdominal bloating. Still, it is well tolerated by most people. Silymarin is the most widespread supplement taken for liver disease.
  • Zinc – Zinc supplements are sometimes touted as a good therapy for hepatitis . There is no evidence to suggest that zinc can halt its progression.
  • Colloidal silver – It is used to treat hepatitis. Serious side effects include argyria. Argyria can cause permanent, grayish discoloration of the skin.
  • Probiotics – Probiotics are live microscopic organisms (bacteria) much like the ones that are already in the your body. These good bacteria may benefit the overall health. Most people can tolerate supplementing with probiotics without harmful side effects.
  • Others – Other supplements that have been studied include glycyrrhizin (from licorice root), lactoferrin (a protein found in milk), SAMe (a chemical naturally found in your body), TJ-108 (herbs used in Japanese Kampo medicine), schisandra (the berries of the plant), oxymatrine (extract of sophora root), and thymus extract (from the glands of cows).
  • Curcumin – This is a chemical in turmeric, the spice that gives many curries their flavor and yellow hue. It can help the body fight inflammation, viruses, and bacteria, which can be helpful to people with hepatitis.
  • Vitamins – It’s best to get the vitamins and minerals from the diet, one that includes plenty of fruits, vegetables, whole grains, and healthy fats. some Studies show that certain vitamins may help people with hepatitis. Vitamins B12 and D, for example, may make some standard hepatitis drugs work better.

Accupuncture – Acupuncture is a form of traditional Chinese medicine. Very thin needles are inserted through the skin at specific points to stimulate ther blood flow. It is generally used to treat pain and nausea. There are no published studies regarding the use of acupuncture to treat hepatitis.

Posted in ORGAN SYSTEM
February 7, 2017

Hepatitis is an inflammation of the liver. Hepatitis C is a contagious disease that can range in severity and be classified as either acute or chronic. If you are diagnosed with hepatitis C, is because you are infected with the hepatitis C virus.

Acute hepatitis is a short-term illness that lasts for approximately 6 months after being exposed to the virus. Most people who start out with an acute infection will eventually get chronic hepatitis C.

Chronic hepatitis is a long-term illness that remains within the body. It can last a lifetime and lead to a variety of liver problems, including cirrhosis as well as liver cancer. Approximately 3,000,000 people in the United States suffer from a chronic hepatitis C infection. Many people have no idea that they are infected because they do not look or feel sick. This can lead to more infections because people are not aware of the infection.

Hepatitis C is spread via blood. The most common way of being infected is by sharing needles, as well as other equipment that is used to inject drugs. Prior to screening blood supply, hepatitis C was also spread via blood transfusions and even organ transplants, but this is no longer such a concern. People who share needles and syringes are more likely to become infected with hepatitis C as well as needle stick injuries within a healthcare setting. If someone is born to a mother with hepatitis C, there is a significant likelihood that they will have hepatitis C as well. In less common instances, a person may also be infected by sharing personal care items, such as razors and toothbrushes. It is also possible to be infected with the hepatitis C virus through sexual contact. This likelihood is very low, however.

Causes

Hepatitis C infection is caused by the hepatitis C virus (HCV).

People can catch hepatitis C if the blood of someone who has hepatitis C enters their body. Exposure may occur –

  • After a needle stick or sharps injury
  • If blood from someone who has hepatitis C contacts a cut on the skin or contacts the eyes or mouth

People at risk of hepatitis C are those who –

  • Inject street drugs or share a needle with someone who has hepatitis C
  • Have been on long-term kidney dialysis
  • Have regular contact with blood at work (such as a health care worker)
  • Have unprotected sexual contact with a person who has hepatitis C
  • Were born to a mother who had hepatitis C
  • Received a tattoo or acupuncture with needles that were not disinfected properly after being used on another person (risk is very low with practitioners who have a tattoo license or permit or an acupuncture license)
  • Received an organ transplant from a donor who has hepatitis C
  • Share personal items, such as toothbrushes and razors, with someone who has hepatitis C (less common)
  • Received a blood transfusion (rare in the United States since blood screening became available in 1992)

Risk Factors

People are at risk of hepatitis C infection if they-

  • Are a health care worker who has been exposed to infected blood, such as may happen if an infected needle pierces the skin
  • Have ever injected or inhaled illicit drugs
  • Have HIV
  • Received a piercing or tattoo in an unclean environment using unsterile equipment
  • Received a blood transfusion or organ transplant before 1992
  • Received clotting factor concentrates before 1987
  • Received hemodialysis treatments for a long period of time
  • Were born to a woman with a hepatitis C infection
  • Were ever in prison
  • Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection

Symptoms

Most people do not have any symptoms until the hepatitis C virus causes liver damage, which can take 10 or more years to happen. Others may have one or more of the following symptoms –

  • Feeling tired
  • Muscle soreness
  • Upset stomach
  • Stomach pain
  • Fever
  • Loss of appetite
  • Diarrhea
  • Dark-yellow urine
  • Light-colored stools
  • Yellowish eyes and skin, called jaundice

When symptoms of hepatitis C occur, they can begin 1 to 3 months after coming into contact with the virus. See a doctor right away if you or a child in your care has symptoms of hepatitis C.

Complications

Hepatitis C infection that continues over many years can cause significant complications, such as –

  • Scarring of the liver tissue (cirrhosis) – After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in the liver makes it difficult for the liver to function.
  • Liver cancer – A small number of people with hepatitis C infection may develop liver cancer.
  • Liver failure – A liver that is severely damaged by hepatitis C may be unable to function adequately.

Treatment

New combination treatments (pegylated interferon and ribarivin) have greatly improved the outcomes for people with hepatitis C. These treatments help decrease inflammation in the liver and can clear the virus in 30 to 65 per cent of cases.

There are some side effects related to hepatitis C medicines. It is important to talk with your doctor about treatment options.

In general, people who have hepatitis C will feel better if they –

  • Avoid drinking alcohol.
  • Eat a well-balanced, low-fat diet.
  • Do regular exercise (although always rest when tired).
  • Consult their doctor regularly.

Some people who have hepatitis C have used complementary or natural therapies to manage the symptoms of hepatitis C and the side effects of combination treatment.

Alternative Treatment

Alpha lipoic acid boosts levels of glutathione, a detoxifying antioxidant that is particularly protective of the liver.

Silymarin, an herbal extract derived from milk thistle, also increases glutathione levels, plus it curbs inflammation and rejuvenates the liver by stimulating the production of new hepatic cells.

Selenium, a trace mineral, slows the replication of the hepatitis C virus—I like to think of it as “viral birth control.”

Milk thistle – This plant has been used for liver, bile duct, and gallbladder health for thousands of years, according to the National Institutes of Health. Milk thistle and its active ingredient, silymarin, are probably the most well-studied of the alternative hepatitis C treatments.

Vitamin D – Studies found that patients who took vitamin D had lower amounts of substances associated with liver injury in their blood.

Green tea and green tea extract – Many natural-health websites extol the compounds in green tea as a treatment for various conditions, including hepatitis C.

Yoga and meditation – While mind-body practices can’t treat hepatitis C, they can help you stay well while you have the virus, Hashemi says. Regular meditation, for example, could help you feel less stressed.

Flushes, cleanses, detoxes – As with green tea, many websites recommend special “cleansing diets” to rid the liver of toxins and remove hepatitis C virus from the body.

 

Reference-

http://www.epidemic.org/

http://www.medicalnewstoday.com/articles/294705.php

http://www.sfcdcp.org/hepatitisc.html

http://www.hepcassoc.org/

http://www.hepatitisaustralia.com/hepatitis-c-facts/about-hep-c

http://www.hepatitisc.org.au/

http://www.mayoclinic.org/diseases-conditions/hepatitis-c/basics/definition/con-20030618

http://hepc.liverfoundation.org/

http://patient.info/health/hepatitis-c-leaflet

http://www.liver.ca/liver-disease/types/viral_hepatitis/Hepatitis_C.aspx

http://www.nhs.uk/Conditions/Hepatitis-C/Pages/Introduction.aspx

 

Posted in ORGAN SYSTEM
February 7, 2017

Hepatitis B is an infectious liver disease. It is caused by the hepatitis B virus (HBV). Infections of hepatitis B occur only if the virus is able to enter the blood stream and reach the liver. Once in the liver, the virus reproduces and releases large numbers of new viruses into the bloodstream. Hepatitis B is a vaccine-preventable bloodborne infection.

Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, drinking too much alcohol, various drugs and chemicals, and also several different germs (viruses) can cause hepatitis. One virus that causes hepatitis is called the hepatitis B virus. This leaflet is only about hepatitis B. See separate leaflets called Hepatitis A and Hepatitis C, which are caused by different viruses. Hepatitis B is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver.

Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. When first infected, a person can develop an “acute” infection, which can range in severity from a very mild illness with few or no symptoms to a serious condition requiring hospitalization. Acute Hepatitis B refers to the first 6 months after someone is exposed to the Hepatitis B virus. Some people are able to fight the infection and clear the virus. For others, the infection remains and leads to a “chronic,” or lifelong, illness. Chronic Hepatitis B refers to the illness that occurs when the Hepatitis B virus remains in a person’s body. Over time, the infection can cause serious health problems.

Hepatitis B is highly infectious. An estimated 700,000 to 1.4 million people in the United States have the virus, and most of them acquired it in childhood.

Causes

The virus is found in the blood or certain body fluids and is spread when blood or body fluid from an infected person enters the body of a person who is not infected. This can occur in a variety of ways including:

  • Unprotected sexual contact
  • Sharing drugs, needles, or “works” when using drugs
  • Poor infection control practices in medical settings, particularly with equipment to test blood sugar
  • Needle sticks or sharps exposures on the job
  • From mother to baby during birth
  • Contact with wounds or skin sores
  • When an infected person bites another person
  • Pre-chewing food for babies
  • Sharing personal-care items, such as razors or toothbrushes

Hepatitis B virus particles can be found on objects, even in the absence of visible blood. The virus can remain infectious and capable of spreading infection for at least seven days outside the human body.

Hepatitis B is not spread through food or water, sharing eating utensils, hugging, kissing, coughing, and sneezing or by casual contact, such as in an office or factory setting.

Risk Factors

Hepatitis B spreads through contact with blood, semen or other body fluids from an infected person. People are at risk of hepatitis B infection increases if they –

  • Have unprotected sex with multiple sex partners or with someone who’s infected with HBV
  • Share needles during intravenous (IV) drug use
  • Are a man who has sex with other men
  • Live with someone who has a chronic HBV infection
  • Are an infant born to an infected mother
  • Have a job that exposes them to human blood
  • Travel to regions with high infection rates of HBV, such as Africa, Central and Southeast Asia, and Eastern Europe

Symptoms

The symptoms of hepatitis B depend on whether a person has acute or chronic hepatitis B infection.

Symptoms of Acute Hepatitis B

Symptoms resulting from acute hepatitis B infection among adults are common, with jaundice occurring approximately 12 weeks after initial infection.

The symptoms of acute hepatitis B include –

  • Loss of appetite
  • Nausea and vomiting
  • Tiredness
  • Abdominal pain
  • Muscle and joint pain
  • Jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces/poo).

Many people with acute hepatitis B have no symptoms and never realise they had the infection. A very small percentage of people with acute hepatitis B become very sick in a short period of time. This happens if there is massive damage to the liver and it stops working. This is called ‘fulminant hepatitis’.

Symptoms of Chronic Hepatitis B

Most people with chronic hepatitis B do not have any symptoms of infection which means they may feel healthy and not be aware they are infected. However, other people may experience symptoms which are similar to those experienced with other forms of viral hepatitis. These can include –

  • Tiredness, depression and irritability
  • Pain in the liver (upper, right side of abdomen)
  • Nausea and vomiting
  • Loss of appetite
  • joint aches and pains.

Complications

Having a chronic HBV infection can lead to serious complications, such as –

  • Scarring of the liver (cirrhosis) – The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver’s ability to function.
  • Liver cancer – People with chronic hepatitis B infection have an increased risk of liver cancer.
  • Liver failure – Acute liver failure is a condition in which the vital functions of the liver shut down. When that occurs, a liver transplant is necessary to sustain life.
  • Other conditions – People with chronic hepatitis B may have kidney disease, inflammation of blood vessels or anemia.

Treatment

Treatment for the short-term (acute) phase

No treatment can clear the germ (virus) from the body. If the patient develops symptoms when first infected, treatment aims to help ease symptoms until they go – for example, drinking plenty of water to avoid lack of fluid in the body (dehydration). Rarely, a severe hepatitis develops which may need hospital care. No treatment can prevent acute hepatitis B from becoming persistent (chronic).

Treatment for chronic infection

Treatment for hepatitis B does not cure hepatitis B but works to delay or even to prevent complications from developing, like liver damage and scarring of the liver (cirrhosis). People with chronic hepatitis B usually need treatment to stop or to reduce the activity of the virus, so limiting liver damage. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given –

Interferon – This medicine is similar to a substance produced in your body, which is also called interferon. It works to fight infections by boosting the immune system. Interferon is usually given as an injection each week.

Antiviral medicines – These work by stopping the hepatitis B virus from multiplying in the body. They include lamivudine, adefovir, tenofovir, and entecavir. The doctor will discuss these in more detail with the patient, as the medicine used can vary between people. A combination of antiviral medicines is sometimes used.

Treatment with medicines is usually continued for many years.

Liver transplant – For some people with advanced scarring of the liver (cirrhosis), liver transplantation may be an option. Although this is a major operation, the outlook following a liver transplant can be very good. However, the new liver may also eventually become damaged by the persisting (chronic) hepatitis B infection.

Diet and alcohol – Most people with chronic hepatitis B will be advised to eat a normal healthy balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol. If a person already has liver inflammation, alcohol increases the risk and speed of developing scarring of the liver (cirrhosis).

Self Help

  • Avoid sharing needles/syringes, spoons, drug solutions or water, filters, cookers, pipes, straws used for snorting drugs, and other drug related equipment. Cleaning with bleach may not kill HBV;
  • Practice safer sex. Use condoms/dental dams to reduce the risk of acquiring sexually transmitted and blood borne infections (STBBIs) including HBV;
  • Avoid dental, medical or cosmetic procedures that penetrate the skin (e.g., transfusions, acupuncture, piercing or tattooing) unless you are certain that the needles, materials and equipment are sterile;
  • Wear latex gloves if you are likely to be in contact with someone else’s blood or bodily fluids;
  • Don’t share personal items like razors, scissors, nail clippers or toothbrushes; and
  • Be especially careful when travelling abroad in countries where HBV is widespread.

Alternative Treatment

  • Healthy diet emphasizing lots of fruits, vegetables, berries, and nuts.
  • Sunlight
  • Neem
  • Milk thistle
  • Mega-dose of vitamin C
  • Selenium
  • Flax seed oil mixed with yogurt
  • Turmeric or curcumin
  • Get some light exercise every day
  • Arginine
  • Licorice root
  • Dandelion
  • Sea salt
  • Iodine
  • Zinc supplements
  • American ginseng
  • Sophora root

Optional Supplements

  • Glutathione
  • Quercetin
  • CoQ10
  • Green tea
  • DHEA
  • N-acetyl cysteine

Optional for hepatitis mental issues with anxiety, insomnia, and etc –

  • Skullcap
  • Chamomile (may cause drowsiness and avoid if there are ragweed allergies)
  • John’s Wort (unless there is a chance of pregnancy)

 

Reference –

https://umm.edu/health/medical/ency/articles/hepatitis-b

http://www.hopkinsmedicine.org/gastroenterology_hepatology/diseases_conditions/faqs/hepatitis_B_C.html

http://www.hepatitisaustralia.com/hepatitis-b-facts/about-hep-b

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-b

http://www.hepfi.org/HEPATITIS/Hepatitis-B.html

http://www.babycenter.com/0_the-hepatitis-b-vaccine_1561.bc

http://www.healthline.com/health/hepatitis-b

http://www.britishlivertrust.org.uk/liver-information/liver-conditions/hepatitis-b/

https://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test/

http://www.phac-aspc.gc.ca/hcai-iamss/bbp-pts/hepatitis/hep_b-eng.php

https://www.aasld.org/sites/default/files/guideline_documents/ChronicHepatitisB2009.pdf

https://www.ccohs.ca/oshanswers/diseases/hepatitis_b.html

http://www.vaccineinformation.org/hepatitis-b/

http://www.itmonline.org/arts/hepb.htm

http://emedicine.medscape.com/article/177632-treatment

http://www.who.int/mediacentre/factsheets/fs204/en/

Posted in ORGAN SYSTEM
February 7, 2017

Hepatitis is inflammation of the liver that sometimes causes permanent damage. It is caused by viruses, bacteria, certain medications, or alcohol. It may also be caused by certain diseases, such as autoimmune diseases, metabolic diseases, and congenital (present at birth) abnormalities, such as biliary atresia and Wilson disease. Generally, symptoms of hepatitis include fever, jaundice (yellowing of the skin and eyes), and an enlarged liver. There are several types of hepatitis.

Hepatitis A, sometimes called hep A or HAV, is a liver disease caused by the hepatitis A virus. (A virus is a tiny particle that needs to infect and control the cells of your body in order to live and reproduce). Hepatitis A is an acute infectious disease of the liver caused by the hepatitis A virus, a small, non-enveloped hepatotropic virus classified in the genus Hepatovirus within the family Picornaviridae.

The disease is highly transmissible through faecal-oral route. Hepatitis A is often asymptomatic or mild, particularly in children below five years of age, but the severity increases with age. Up to 90% of hepatitis A infections in children present no symptoms. In adults, the onset of illness is usually abrupt with fever, loss of appetite, nausea and vomiting. Jaundice is the predominant symptom. Symptoms may last between 1 to 2 weeks, or up to months. About 15% of patients have prolonged or relapsing symptoms over a 6–9-month period.

People usually get hepatitis A by having close contact with a person who is infected, from food or drinks prepared by someone who is infected, or by eating shellfish harvested from sewage-contaminated water.  After the virus enters the body, there is an incubation period lasting 2 to 7 weeks until illness begins.

Hepatitis A still occurs in the United States, although not as frequently as it once did. Over the last several decades, there has been more than a 90% decrease in Hepatitis A cases. New cases are now estimated to be around 3,000 each year. Many experts believe this decline is a result of the vaccination of children and people at risk for Hepatitis A. Many of the new cases, however, are from American travelers who got infected while traveling to parts of the world where Hepatitis A is common.

Causes

Hepatitis A is usually spread when a person ingests fecal matter—even in microscopic amounts—from contact with objects, food, or drinks contaminated by feces or stool from an infected person. Hepatitis A can be spread when:

  • An infected person does not wash his/her hands properly after going to the bathroom and then touches objects or food
  • A caregiver does not properly wash his or her hands after changing diapers or cleaning up the stool of an infected person
  • Someone engages in sexual activities with an infected person Hepatitis A also can be spread through contaminated food or water. Contamination of food can happen at any point: growing, harvesting, processing, handling, and even after cooking. This most often occurs in countries where Hepatitis A is common.

Risk Factors

Risk Factors include –

Children, teens, and adults who may be at high risk of hepatitis A include the following:

  • People traveling to areas of where hepatitis A is prevalent, including, but not limited to: Africa, Asia (except Japan), the Mediterranean basin, Eastern Europe, the Middle East, Central and South America, Mexico, and parts of the Caribbean
  • People living in or relocating to any community in the U.S. or abroad with one or more recorded hepatitis A outbreaks within the past five years
  • Military personnel
  • People who engage in high-risk sexual activity
  • Users of illegal intravenous (IV) drugs
  • Hemophiliacs and other recipients of therapeutic blood products
  • Employees of day-care centers
  • Institutional care workers
  • Laboratory workers who handle live hepatitis A virus
  • People who handle primate animals that may be carrying the hepatitis A virus

Hepatitis A is sometimes called a traveler’s disease because it is the most frequently occurring, vaccine-preventable infection in travelers. However, it is possible to become infected with hepatitis A virus without ever leaving the United States. Some cases reported in the United States have occurred in people with no identifiable risk factors.

Symptoms

Symptoms of hepatitis A include –

  • fever
  • weakness
  • fatigue
  • loss of appetite
  • nausea
  • joint aches and pains
  • vomiting
  • jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces)

The duration of the illness varies but most people feel better and their Liver Function Tests (LFTs) begin to normalise a month after the onset of infection. Hepatitis A infection never causes a chronic (long-term) infection.

Death because of hepatitis A infection is very rare. The likelihood of severe disease or death resulting from hepatitis A infection is much greater in people with pre-existing liver damage, including people with chronic liver disease due to hepatitis B or C, and people over 50 years of age.

Complications

In rare cases, hepatitis A can cause loss of liver function that occurs suddenly, especially in older adults or people with chronic liver diseases. Acute liver failure requires hospitalization for monitoring and treatment. Some people with acute liver failure may require a liver transplant.

Treatment

Hepatitis A usually clears up on its own and does not require treatment. Patients should make sure to get plenty of rest and avoid drinking any alcohol until they are fully recovered.

In addition to avoiding risky behaviors, there are two methods for prevention of hepatitis A:

  • Immune globulin – A preparation of antibodies that is given both before anticipated exposure to the hepatitis A virus and soon after exposure.
  • Hepatitis A vaccine – The vaccine consists of killed hepatitis A virus that stimulates the body’s natural immune system. After the vaccine is given, the body makes antibodies that protect a person against the virus. Please consult your doctor if you have any questions about its use

Self Help –

Vccination for –

  • Children at age 1 year (12 – 23 months)
  • Travelers to countries where hepatitis A is prevalent; they should receive the hepatitis A vaccine at least 2 weeks prior to departure.
  • Men who have sex with other men
  • Users of illegal drugs, especially those who inject drugs
  • People with chronic liver diseases, such as hepatitis B or C

Others who may benefit include –

  • People who have chronic liver disease
  • People who receive clotting factor concentrate to treat hemophilia or other clotting disorders
  • Military personnel
  • Employees of child day-care centers
  • People who care for institutionalized patients

Frequent handwashing after using the bathroom or changing diapers is important for preventing transmission of hepatitis A. International travelers to developing countries should use bottled or boiled water for brushing teeth and drinking, and avoid ice cubes. It is best to eat only well-cooked heated food and to peel raw fruits and vegetables.

Alternative Treatment

Reishi mushroom herbal remedy has shown favorable results in the natural treatment of Hepatitis A.

Milk Thistle – An important natural treatment for Hepatitis A is the use of a herbal remedy known as Milk Thistle. Silymarin health supplement found in milk thistles protects the liver by preventing toxins from entering the cells. They are strong antioxidants and reduce damage to liver cells.

Licorice – Hepatitis patients are known to experience relief with the use of liquorice root as part of natural treatment for Hepatitis A.

Flavonoids – Some studies reveal that one particular herb, Uncaria gambier, containing a flavonoid known as catechin, can be an effective diet supplement for Hepatitis A.

 Natural antibiotics, colloidal silver, and olive leaf capsules, are considered beneficial in cases of Hepatitis.

Zell oxygen natural health supplements for Hepatitis A are known to strengthen the immune system.

Dietary supplements with Zinc (30-50mg), vitamin C (1000 mg), and vitamin E (800 mg) are also recommended as natural remedies for Hepatitis.

Sterols and sterolins health supplements for Hepatitis A are prescribed to strengthen the immune system.

Black Seed Oil improves liver function and associated digestive problems. The warming and bitter qualities seem to penetrate into blockages in the body and rapidly instigate normalisation.  Black Seed has an unprecedented strengthening effect upon the immune system, and works in a host of other ways to promote optimum health and well being.

Body Cleansing

  • Bowel cleanse with parasite cleanse
  • Dental cleanup (if you can afford it)
  • Kidney Cleanse and
  • Liver cleanse

Psychotherapy and Spiritual Therapy

 

Reference –

https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/hepatitis-a

http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/hepatitisa/

http://travel.gc.ca/travelling/health-safety/diseases/hepatitis-a

http://www.about-hepatitis.com/

http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hepatitis

http://www.liver.ca/liver-disease/types/viral_hepatitis/Hepatitis_A.aspx

http://www.about-hepatitis.com/

http://www.sfcdcp.org/hepatitisa.html

http://www.emedicinehealth.com/hepatitis_a/article_em.htm

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-a

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-a

http://www.immunize.org/catg.d/p4075.pdf

http://www.mayoclinic.org/diseases-conditions/hepatitis-a/basics/definition/con-20022163

http://www.cdc.gov/hepatitis/hav/

Posted in ORGAN SYSTEM
February 7, 2017

Hemolytic Uremic Syndrome (HUS), commonly referred to as “Hamburger Disease”, is a disease that affects the kidneys and other organs. It poses a substantial threat to Canadian children as one of the leading causes of both acute and chronic kidney failure.

HUS is considered a syndrome because it is a combination of findings that may have different causes. In most cases, HUS occurs after a severe bowel infection with certain toxic strains of the bacteria called E. coli. It may also occur in response to certain medicines, but this is rare. Even more rarely, HUS occurs for unknown reasons. This fact sheet primarily focuses on the type of HUS that occurs in infants and children as a result of an E. coli infection.

It is a condition that affects the blood and blood vessels. It results in the destruction of blood platelets (cells involved in clotting), a low red blood cell count (anemia) and kidney failure due to damage to the very small blood vessels of the kidneys. Other organs, such as the brain or heart, may also be affected by damage to very small blood vessels.

HUS is a kidney condition that happens when red blood cells are destroyed and block the kidneys’ filtering system. Red blood cells contain hemoglobin—an iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body. When the kidneys and glomeruli—the tiny units within the kidneys where blood is filtered—become clogged with the damaged red blood cells, they are unable to do their jobs. If the kidneys stop functioning, a child can develop acute kidney injury—the sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children.

Though hemolytic uremic syndrome is a serious condition, getting timely and appropriate treatment leads to a full recovery for most people, especially young children.

Causes

HUS develops when Escherichia coli (E. coli) bacteria lodged in the digestive tract make toxins that enter the bloodstream and start to destroy red blood cells. Most cases of HUS occur after an infection of the digestive tract by the E. coli bacterium, which is found in foods like meat, dairy products, and juice when they are contaminated. Some people have contracted HUS after swimming in pools or lakes contaminated with feces.

Infection of the digestive tract is called gastroenteritis and may cause a child to vomit and have stomach cramps and bloody diarrhea. Most children who have gastroenteritis recover fully in 2 or 3 days and do not develop HUS.

E.coli O157:H7 can be found in –

  • Undercooked meat, most often ground beef
  • Unpasteurized, or raw, milk
  • Unwashed, contaminated raw fruits and vegetables
  • Contaminated juice
  • Contaminated swimming pools or lakes

Less common causes, sometimes called atypical hemolytic uremic syndrome, can include –

  • Taking certain medications, such as chemotherapy
  • Having other viral or bacterial infections
  • Inheriting a certain type of hemolytic uremicsyndrome that runs in families

More information about foodborne illnesses and the digestive system is provided in the NIDDK health topic, foodborne illnesses.

Risk Factors

Those most at risk of developing hemolytic uremic syndrome are –

  • Children under 5 years of age
  • People who have certain genetic changes that make them more susceptible

Young children and elderly adults are the most likely to be seriously ill from hemolytic uremic syndrome.

Symptoms

HUS often begins with vomiting and diarrhea, which may be bloody. Within a week, the person may become weak and irritable. Persons with this condition may urinate less than normal. Urine output may almost stop.

Red blood cell destruction leads to symptoms of anemia.

Early symptoms –

  • Blood in the stools
  • Irritability
  • Fever
  • Lethargy
  • Vomiting
  • diarrhea
  • Weakness

Later symptoms –

  • Bruising
  • Decreased consciousness
  • Low urine output
  • No urine output
  • Pallor
  • Seizures — rare
  • Skin rash that looks like fine red spots (petechiae)
  • Yellow skin (jaundice)

Complications

  • Blood clotting problems
  • Hemolytic anemia
  • Kidney failure
  • Nervous system problems
  • Too few platelets (thrombocytopenia)
  • Uremia

Treatment

  • Fluid replacement – Lost fluid and electrolytes need to be carefully replaced because the kidneys aren’t removing fluids and waste as efficiently as normal.
  • Red blood cell transfusions – If patients don’t have enough red blood cells, they may feel chilled, fatigued and short of breath. They may have a rapid heart rate, yellow skin and dark urine. Red blood cell transfusions, given through an intravenous (IV) needle, may help reverse these signs and symptoms.
  • Platelet transfusions – If the patient is bleeding or bruising easily, platelet transfusions can help your blood clot more normally. Like red blood cell transfusions, platelet transfusions are given through an IV needle.
  • Plasma exchange – Plasma is the part of blood that supports the circulation of blood cells and platelets. Sometimes a machine is used to clear the blood of its own plasma and replace it with fresh or frozen donor plasma. This process is called plasmapheresis.
  • Kidney dialysis – Sometimes dialysis is needed to filter waste and excess fluid from the blood. Dialysis is usually a temporary treatment until the kidneys begin functioning adequately again. If the kidney damage is significant, however, permanent kidney failure — requiring long-term dialysis or a kidney transplant — is possible.

Alternative Treatment

 

Reference –

https://www.nlm.nih.gov/medlineplus/ency/article/000510.htm

http://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/thrombotic-thrombocytopenic-purpura-(ttp)-and-hemolytic-uremic-syndrome-(hus)

http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/hemolytic-uremic-syndrome-in-children-hus/Pages/facts.aspx

http://patient.info/doctor/Haemolytic-Uraemic-Syndrome.htm

http://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/thrombotic-thrombocytopenic-purpura-(ttp)-and-hemolytic-uremic-syndrome-(hus)

http://medicalxpress.com/news/2015-11-hemolytic-uremic-syndrome-treatment-regimen.html

http://medind.nic.in/ibv/t09/i12/ibvt09i12p1075.pdf

http://www.nejm.org/doi/full/10.1056/NEJMra0902814

http://www.aafp.org/afp/2006/0915/p991.html

http://library.med.utah.edu/ed/ahus.html

http://www.uptodate.com/contents/overview-of-hemolytic-uremic-syndrome-in-children

https://www.rareconnect.org/en/community/atypical-hemolytic-uremic-syn

Posted in ORGAN SYSTEM
February 7, 2017

Hemochromatosis (HH) is a disease that results from excessive amounts of iron in the body (iron overload).

Hereditary (genetic) hemochromatosis (HHC) an inherited disorder of abnormal iron metabolism. Individuals with hereditary hemochromatosis absorb too much dietary iron. Once absorbed, the body does not have an efficient way of excreting iron excesses.  Over time, these excesses build to a condition of iron overload, which is a toxic to cells. Glands and organs, including the liver, heart, pituitary, thyroid, pancreas, synovium (joints) and bone marrow burdened with excess iron cannot function properly.  Symptoms develop and disease progresses.

As many as 1 in 200 Americans are believed to carry both copies of the gene for hemochromatosis, and it is estimated that about half of them will eventually develop complications. That puts it roughly on a par with type 1 diabetes for prevalence. Like type 2 diabetes, it is severely underdiagnosed.

Types of Hemochromatosis

Hemochromatosis is classified by type depending on the age of onset and other factors such as genetic cause and mode of inheritance.

Hemochromatosis type 1, the most common form of the disorder, and type 4 (also called ferroportin disease) are adult-onset disorders. Men with type 1 or type 4 hemochromatosis typically develop symptoms between the ages of 40 and 60, and women usually develop symptoms after menopause

Type 2 hemochromatosis is a juvenile-onset disorder. Iron accumulation begins early in life, and symptoms may begin to appear in childhood. By age 20, decreased or absent secretion of sex hormones is evident. Females usually begin menstruation in a normal manner, but menses stop after a few years. Males may experience delayed puberty or sex hormone deficiency symptoms such as impotence. If the disorder is untreated, heart disease is evident by age 30.

Onset of type 3 hemochromatosis is usually intermediate between types 1 and 2. Symptoms generally begin before age 30.generally begin before age 30.

In rare cases, iron overload begins before birth. These cases are called neonatal hemochromatosis. This type of hemochromatosis progresses rapidly and is characterized by liver damage that is apparent at birth or in the first day of life. The neonatal form causes rapid iron buildup in a baby’s liver that can lead to death.

Causes

Hemochromatosis is a hereditary disorder, which means it is passed down from parents to children through their genes. Hemochromatosis is mainly caused by a defect in the HFE gene. It is also known as primary hemochromatosis.

Some people get a copy of the HFE gene defect from just one parent. They are called “carriers” because they carry the defective gene and can pass it on to their children. Carriers usually do not get sick. People who get the HFE gene defect from both parents have a greater chance of getting the disease.

There are other types of hemochromatosis that are not caused by the HFE gene defect — including secondary, juvenile, and neonatal hemochromatosis – but they are less common than the primary form. Secondary hemochromatosis can be caused by disorders such as thalassemia, anemia, chronic alcoholism, and other conditions. Juvenile and neonatal hemochromatosis are caused by other types of gene defects.

Risk Factors

The known risk factors for hemochromatosis are:

Possessing two copies of a mutated HFE gene – the greatest risk factor for hereditary hemochromatosis. The person inherits one copy of the mutated HFE gene from each parent.

Family history – anybody who has a close relative (parent, offspring, brother or sister) with hemochromatosis is significantly more likely to develop it compared to other people.

Ancestry – people of British, Scandinavian Dutch, German, Irish and French ancestry have a higher risk of developing hemochromatosis compared to others. Their risk of having the HFE gene mutation is greater.

Gender – men are significantly more likely to develop hemochromatosis compared to women. Signs and symptoms tend to appear earlier on in life in males than females. This is because women lose iron during menstruation and pregnancy. A woman’s risk increases after the menopause or a hysterectomy. The male-to-female ratio is 1.8:1 (out of every 28 people with hemochromatosis, 18 are male and 10 are female).

Symptoms

A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, a headache may be a symptom while a rash may be a sign.

As signs and symptoms may be mild and could also be indications of other illnesses and conditions, identifying hemochromatosis is often not straightforward.

  • The main symptoms include:
  • Abdominal pain
  • Females may stop menstruating
  • High blood sugar levels
  • Hypothyroidism (low thyroid function)
  • Loss of libido (sex drive) and male impotence
  • Pain in the joints
  • Reduction in size of testicles
  • Skin becomes bronzed (has a tanned look)
  • Tiredness (fatigue)
  • Weakness
  • Weight loss

Complications

As the disorder progresses, the following conditions may develop:

  • Enlarged liver
  • Cirrhosis (scarring of the liver)
  • Liver cancer
  • Liver failure
  • Arthritis
  • Osteoporosis
  • Diabetes (from damage to the pancreas)
  • Irregular heartbeat
  • Enlarged heart
  • Congestive heart failure
  • Impotence
  • Early menopause
  • Hypothyroidism
  • Damage to adrenal glands
  • Enlarged spleen

Treatment

  • Venesection (phlebotomy) – iron-rich blood is removed from the body regularly, just as if the patient were donating blood. In this case the aim is to bring iron levels down to normal. How much blood is taken and how often depends on the patient’s age, overall health and the severity of the iron overload. In most cases blood is removed weekly until levels are back to normal. When iron levels build up again the patient will need venesection treatment again.

Although venesection cannot reverse the symptoms of cirrhosis, it can improve symptoms such as nausea, abdominal pain and fatigue.

  • Medication – the patient may be given a drug that binds iron, which is then excreted from the body.

If hemochromatosis is diagnosed and treated early, before too much excessive iron accumulates, the patient should have a normal lifespan, experts say.

Alternative Treatment

Excess iron and treatment – Getting iron levels down is very important to the outcome of hemochromatosis. A therapeutic phlebotomy or blood transfusion are usually accomplished this. Blood donations are done every eight weeks; sever conditions may require up to eight donations per month. Some medications may help also. The goal is to get iron levels down.

Herbal Therapy – Here are some herbal therapies that have been known to be useful in treating iron overload.

  • Dandelion—reduces constipation caused by excess iron conditions.
  • Wild Hyssop—regulates blood sugar, reduces pain and inflammation surrounding nerve tissues needing iron supply to vital organs needing nutrients.
  • Milk Thistle—reduces the iron storage in the body and lowers blood sugar levels.

Chelation Therapy – Chelating therapy removes excess minerals, and toxic materials from the body through the use of drugs; making it easier for them to tolerate phlebotomy.

EDTA Chelation Therapy – EDTA is used to remove heavy metals from the body, with IV therapy; given under supervision of medical supervision.

Calcium – Taking 300 mg of calcium per day with a meal is a simple way to block the absorbed iron, and reduce it about 40%. Some people do build up a tolerance to calcium, so regular blood tests are needed.

Vitamins and minerals

  • Vitamin B6—blocks absorption of iron, especially when taking vitamin C.
  • Avoid Vitamin C—limit taking vitamin c supplements over 500mg, eat more fresh vegetables and fruit containing vitamin C instead.
  • Vitamin E—antioxidant used as a blood thinner (400-800IU)
  • Manganese—protects against damage from excess iron.

Black Tea – Drinking black tea may reduce iron absorption, and reduces amount of frequent phlebotomies patients may have. Green tea is also powerful as a chelator to remove iron.

 

Reference –

http://www.lifeextension.com/protocols/metabolic-health/hemochromatosis/Page-01

https://my.clevelandclinic.org/health/diseases_conditions/hic_hemochromatosis

http://familydoctor.org/familydoctor/en/diseases-conditions/hereditary-hemochromatosis.html

https://www.aasld.org/sites/default/files/guideline_documents/Hemochromatosis2011.pdf

https://www.genome.gov/10001214

http://www.hopkinschildrens.org/hemochromatosis.aspx

http://www.aafp.org/afp/2013/0201/p183.html

http://www.yourgenesyourhealth.org/hc/whatisit.htm

http://www.hemochromatosisdna.com/about-the-disease/signs-and-symptoms

http://www.liver.ca/liver-disease/types/hemochromatosis.aspx

http://www.healthline.com/health/hemochromatosis

http://www.diabetes.org/living-with-diabetes/complications/related-conditions/hemochromatosis.html?referrer=https://www.google.co.in/

Posted in ORGAN SYSTEM
February 7, 2017

Gilbert’s syndrome is a fairly common, mild liver disorder that is caused by an inherited deficiency of an enzyme involved in the metabolism of bilirubin. In people with Gilbert’s syndrome, the bilirubin is typically mildly elevated and often fluctuates. At times, it may be within the normal range whereas at other times, the level may be higher than normal, but not dangerously so.

The medical name for this is ‘unconjugated hyperbilirubinemia’. It is also sometimes called familial nonhaemolytic bilirubinaemia or constitutional hepatic dysfunction. These long names may not sound promising but GS is in fact a harmless condition. It is not a disease and it is possible that you may not even know you have it.

What is Bilirubin?

Small amounts of bilirubin are normally present in the blood. Bilirubin is produced from the natural breakdown of hemoglobin (the red pigment of red blood cells) in bone marrow, the spleen, and other organs. It is carried to the liver in the blood where it undergoes a series of chemical changes and is excreted into the bile. It undergoes further chemical changes within the intestine, and from there passes out of the body. However, when red blood cells break down excessively (called hemolysis) or there is interference in the normal processes for bilirubin metabolism or bile excretion, the amount of bilirubin increases. High levels of bilirubin in the blood may produce jaundice (a yellow discoloration of the skin and/or eyes), and in the urine may produce a tea-coloured appearance.

Men are at higher risk than women, and tend to develop Gilbert’s syndrome between their late teens and early 30s. Usually, the disorder is diagnosed by chance during the investigation of unrelated illnesses. Some people with Gilbert syndrome also experience abdominal discomfort or tiredness. However, approximately 30 percent of people with Gilbert syndrome have no signs or symptoms of the condition and are discovered only when routine blood tests reveal elevated unconjugated bilirubin levels.

Causes

Gilbert’s syndrome is caused by decreased hepatic levels of the enzyme glucuronosyltransferase. As this enzyme is responsible for the glucuronidation (conjugation) of bilirubin in the liver, reduced activity of this enzyme leads to an accumulation of unconjugated bilirubin in the circulation.

The genetic defect has been identified as the presence of two additional nucleotides in the promoter region of the gene leading to reduced gene expression and therefore reduced enzyme activity. In affected individuals the enzyme is usually functioning at about 25% of normal levels. Of interest the syndrome may be passed to recipients of liver transplantation if the donor was affected. A mutation is a permanent change in the code of the DNA making up a gene or chromosome. This can alter the way a physical characteristic is expressed or cause some function in the body to occur differently. Sometimes the word ‘variant’ is used instead of mutation as many changes do not cause any disorder.

Although hemolysis is not part of the syndrome, many patients who consult physicians may have a high bilirubin load because of a slightly reduced erythrocyte life span. Fasting may also increase the bilirubin load, and the resulting hyperbilirubinemia may be exaggerated in patients with Gilbert’s syndrome because of the reduced expression of the glucuronidating enzyme.

Alcohol is the most common chemical responsible for toxic damage to the liver, causing fatty liver, alcoholic hepatitis, Gilbert’s Syndrome and, potentially, cirrhosis of the liver . Exposure to industrial chemicals may harm the liver. Many prescription medications may damage the liver as well, including cholesterol-lowering drugs in the statin family and high-dose niacin (also used to reduce cholesterol levels.) The over-the-counter drug acetaminophen (Tylenol) is highly toxic to the liver when taken to excess. Finally, numerous natural herbs and supplements contain chemicals that may cause or accelerate harm to the liver.

Symptoms

  • Frequently Reported – fatigue, tiredness, brain fog, headaches, poor memory, dizziness, depression, irritability, anxiety, nausea, loss of appetite, irritable bowel syndrome (IBS), stomach pain & cramping, liver/gallbladder pain, abdominal pain, tremors, itchiness, jaundice.
  • Commonly Reported – insomnia, difficulty concentrating, panic attacks, hypoglycemic reaction to foods, intolerance to carbs, food intolerances, alcohol intolerance, loose stools / diarrhea, abdominal bloating or swelling, breathlessness or labored breathing, heart palpitations, aching muscles / body ache, joint pain, numbness & tingling, weakness, chemical sensitivity, weight loss, lump in the throat, feeling constantly sick.
  • Sometimes Reported – difficulty finding the right words, feeling drunk, vomiting, intolerance to fatty foods, strong hangovers, acid reflux, excessive thirst, chest pain, muscle twitches, cold hands and feet, environmental allergies, swollen lymph nodes, toxic feeling, bitter or metallic taste in the mouth, eye pain.
  • Occasionally Reported – waking panic attack, mood swings, feeling antisocial, intolerance to drugs, constipation, pale stools, indigestion, back pain, dry skin, feeling cold, low body temperature, pale skin, low weight, night sweats, excessive sweating, poor immune system, sore or dry throat, light sensitivity, bloodshot eyes.

However, these problems are not thought to be directly related to increased bilirubin levels, and could mean you have another condition other than Gilbert’s syndrome.

Diseases Associated with Gilbert’s Syndrome

  • Acute inflammation of the liver – may impair the ability of the liver to conjugate and secrete bilirubin.
  • Inflammation of the bile duct – may prevent the secretion of bile and removal of bilirubin.
  • Obstruction of the bile duct – prevents the liver from disposing of bilirubin.
  • Hemolytic anemia – bilirubin production increases when lots of erythrocytes are broken down.
  • Cholestasis – the flow of bile from the liver is interrupted. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
  • Crigler-Najjar syndrome – an inherited condition that impairs the specific enzyme responsible for processing bilirubin, resulting in an excess of bilirubin.
  • Dubin-Johnson syndrome – an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted out of the liver’s cells.
  • Pseudojaundice – a harmless form of jaundice in which the yellowing of the skin results from an excess of beta-carotene, not from an excess of bilirubin; usually from eating lots of carrots, pumpkin, or melon.

Treatment

Conventional Treatment – No treatment is needed for majority of patients. There is no health problems associated with this condition and thus most patients do not need any therapy.

Patients with Gilbert’s syndrome have a normal life expectancy and do not have a raised risk of other liver ailments.

Patients who find the jaundice symptoms too unsettling may benefit from Phenobarbital, a medication which lowers bilirubin levels. Phenobarbital may cause sedation and light-headedness. It is important for the patient to realize that in this case the medication is not being taken for health reasons.

Alternative Treatment

  • Zinc – Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Zinc sulfate supplementation seemed to decrease serum unconjugated bilirubin levels in limited available study. Well-designed clinical trials are needed to better understand the potential role of zinc in Gilbert’s syndrome.
  • SAMe: SAMe (S-adenosyl-L-methionine) is a natural substance that is found inside all cells in the body. Early laboratory evidence suggests that SAMe may reduce bilirubin levels in patients with Gilbert’s syndrome. SAMe may improve the transport of bilirubin, which is impaired in people with Gilbert’s syndrome. However, until studies are performed in humans, it remains unclear if SAMe supplements are a safe and effective therapy for this condition.
  • Milk thistle is also used in a vague condition known as minor hepatic insufficiency, or sluggish liver and Glibert’s syndrome.
  • Probiotics have been studied as possible treatment for liver disease.
  • Peppermint is commonly used to flavor foods, candy and other consumable products. When used medicinally, peppermint may help soothe certain digestive orders as well as headaches associated with Gilbert’s disease.
  • Chamomile is an herb that is commonly used as a calming and relaxing herb.
  • Numerous other herbs and supplements have shown a bit of promise in test tube studies for protecting the liver, including –
    • Andrographis
    • Artichoke leaf
    • Beet leaf
    • Choline
    • Dandelion
    • Inositol
    • Lecithin
    • Licorice
    • Lipoic acid
    • Liver extracts,
    • Picrorhiza kurroa
    • Schisandra
    • Taurine
    • Thymus extract
    • Turmeric

To be noted

  • Many natural products have the capacity to harm the liver. Furthermore, due to the generally inadequate regulation of dietary supplements that exists at the time of this writing, there are real risks that herbal products, at least, may contain liver-toxic contaminants even if the actual herbs listed on the label are safe.
  • High doses of the supplements beta-carotene and vitamin A are thought to accelerate the progression of alcoholic liver disease in people who abuse alcohol
  • All forms of vitamin B3, including niacin, niacinamide (nicotinamide), and inositol hexaniacinate, may damage the liver when taken in high doses.
  • A great many herbs and supplements have known or suspected liver-toxic properties, including but not limited to: chaparral , coltsfoot , corydalis , comfrey , germander , germanium (a mineral), greater celandine , green tea extracts (despite its proposed benefits), kava , kombucha , mistletoe , noni , pennyroyal , pokeroot , sassafras , and various herbs and minerals used in traditional Chinese herbal medicine .

 

Reference –

http://www.news-medical.net/health/Gilberte28099s-Syndrome-Treatment.aspx

http://www.medicalnewstoday.com/articles/166971.php

http://www.medicinenet.com/gilbert_syndrome/article.htm#what_is_the_treatment_for_gilbert_syndrome

http://patient.info/health/gilberts-syndrome-leaflet

http://www.hse.ie/eng/health/az/G/Gilbert’s-syndrome/Causes-of-Gilbert’s-syndrome.html#Causes-of-Gilbert’s-syndrome

http://www.nhs.uk/conditions/Gilbertssyndrome/Pages/Introduction.aspx

http://growyouthful.com/ailment/gilberts-syndrome.php

Posted in ORGAN SYSTEM
February 7, 2017

Chronic Kidney Disease (CKD) is a long-term condition characterized by gradual loss of kidney function over time. CKD is a worldwide public health problem. There is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost in the United States. There is an even higher prevalence of earlier stages of chronic kidney disease. The outcomes of CKD are adverse, and include, s kidney failure, cardiovascular disease, and premature death, and to prevent these outcomes, it becomes necessary to understand the function of the Kidney and Chronic Kidney Disease.

How does our Kidney function?

The function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals. The critical regulation of the body’s salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism. Kidney also helps to produce a substance called erythropoietin, which stimulates production of red blood cells.

The kidneys are powerful chemical factories that perform the following functions:

  • remove waste products from the body
  • remove drugs from the body
  • balance the body’s fluids
  • release hormones that regulate blood pressure
  • produce an active form of vitamin D that promotes strong, healthy bones
  • control the production of red blood cells

What is Chronic Kidney Disease (CKD)?

CKD includes conditions that damage the kidney and decreases its ability to keep the body healthy by doing its usual job. CKD is usually asymptomatic, but it is detectable, and tests for CKD are simple and freely available. When the kidneys do not work properly, they leave behind waste in the blood. The waste can build up and make the person feel sick. It can cause problems with the heart and can increase the risk of bone loss, broken bones, anemia (a low number of red blood cells, which carry oxygen throughout the body), complete kidney failure, and other serious problems. It can also lead to death. Chronic kidney disease is also called chronic renal failure or chronic renal insufficiency.

One way to measure how well the kidneys are working is to figure out the glomerular filtration rate (GFR). The GFR is usually calculated using results from the blood creatinine test. Then the stage of kidney disease is figured out using the GFR. There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.

How is GFR calculated? Doctor can estimate the GFR from the results of a simple blood test for creatinine. Creatinine is a waste product of the body’s muscle activity. Kidneys usually keep the level of creatinine just right. The creatinine result is used in a math formula with the age, race and gender to determine your GFR.

A GFR of 90 or above is considered normal. Even with a normal GFR, you may be at increased risk for developing CKD if you have diabetes, high blood pressure, or a family history of kidney disease. The risk increases with age: People over 65 are more than twice as likely to develop CKD as people between the ages of 45 and 65. The 5 stages are:

StageGFRDescription
 

1

 

90+

Normal kidney function but urine findings or structural abnormalities or genetic trait point to kidney disease.
 

2

 

60-89

Mildly reduced kidney function, and symptoms as stage 1
345-59

30-44

Moderately reduced kidney function
415-29Severely reduced kidney function
 

5

 

<15 or on dialysis

Very severe, or end stage kidney failure (sometimes call established renal failure

 

Causes of CKD

CKD is usually caused by conditions that put strain on the kidneys. The two main causes are:

  • Diabetes – Diabetes is a condition in which the body produces no – or too little – insulin (type 1 diabetes) or has become unable to make effective use of insulin (type 2 diabetes). If diabetes is poorly controlled, too much glucose can build up in your blood. The glucose can damage the tiny filters in the kidneys, which affects the ability of your kidneys to filter out waste products and fluids. The first sign of diabetic kidney disease is the appearance of low levels of protein in the urine.
  • High Blood Pressure – High blood pressure puts more stress on blood vessels throughout the body, including the kidneys filters called the nephrons. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other causes are:

  • Overuse of pain killers and allergic reactions to antibiotics – Heavy use of painkillers containing ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol) have been linked to interstitial nephritis, a kidney inflammation that can lead to kidney failure. Allergic reactions to or side effects of antibiotics like penicillin and vancomycin may also result in CKD.
  • Drug Abuse – Use of certain non-prescribed drugs, such as heroin or cocaine, can damage the kidney.
  • Inflammation – Glomerulonephritis, a group of diseases that cause inflammation and causes damage to the kidney’s filtering units. Some glomerulonephritis is inherited, and some may be an immune response to infections like strep throat. Sometimes, these are enough to cause CKD.
  • Environmental Toxins – Exposure to various toxic agents and conditions in the natural and occupational environment such as heavy metals, industrial chemicals, elevated ambient temperatures, and infections can lead to CKD. Various toxins are derived from gut micro biota, and an imbalance of gut micro biota or dysbiosis is related to renal failure. However, the pathophysiologic mechanisms underlying the relationship between the gut micro biota and renal failure are still obscure. Toxics include –
    • Cadmium
    • Fluoride in drinking water
    • Combination of fluoride in drinking water and aluminum vessel
    • Arsenic
    • Hard Water
    • Cyanobacterial toxins
    • Bioaccumulation – pesticide residues, heavy metals and toxins in the plants and aquatic animals
    • Liquor – Illicit liquor is another probable cause
    • Pesticides
    • Lead
  • Blockages – Infections or a malformed lower urinary tract system (birth defect) can force urine to back up into the kidney and damage it. Blood clots or plaques of cholesterol that block the kidney’s blood vessels can reduce blood flow to the kidney and cause damage. Repeated kidney stones can block the flow of urine from the kidney and are another kind of obstruction that can damage the kidneys.
  • Family History – The person having one or more family members with CKD or on dialysis or kidney transplant may be at high risk of getting this condition. One inherited disease, polycystic kidney disease, causes large, fluid-filled cysts that eventually crowd out normal kidney tissue. Diabetes and high blood pressure can also run in families.
  • Premature Birth – About one in five very premature infants (less than 32 weeks gestation) may have calcium deposits in parts of the kidney called nephrons. This is termed nephrocacinosis. Sometimes, individuals with this condition may go on to develop kidney problems later in life.
  • Certain Diseases – Having certain diseases puts people at higher risk for kidney disease. These diseases include systemic lupus erythematosus (a connective tissue disease), sickle cell anemia, cancer, AIDS, hepatitis C, and congestive heart failure.

Symptoms

Many people who have chronic kidney disease don’t know it, because the early signs can be very subtle. It can take many years to go from chronic kidney disease (CKD) to kidney failure. Some people with CKD live out their lives without ever reaching kidney failure.

Symptoms include –

  • Change in urination – Kidneys are responsible for making urine, hence, the when kidneys fail to function properly, the urine may change (color, difficulty in urinating, urine may be foamy or bubbly, increased need to urinate, especially at night)
  • Swelling in the legs, ankles, feet, face and/or hands – Failing kidneys don’t remove extra fluid, which builds up in the body.
  • Fatigue – Healthy kidneys make a hormone called erythropoietin that tells the body to make oxygen-carrying red blood cells. As the kidneys fail, they make less erythropoietin. With fewer red blood cells to carry oxygen, the muscles and brain become tired very quickly. This condition is called anemia, and it can be treated.
  • Skin Rash – Kidney cleans the body by removing wastes from the body. When it fails in performing its functions, the waste called uremia, accumulates in the blood and causes severe itching.
  • Ammonia Breath – The accumulation of waste in the blood can make the food taste different and cause foul breath.
  • Nausea & Vomiting – A severe build-up of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.
  • Shortness of breath – Due to extra fluid in the body and anemia
  • Feeling Cold – Due to anemia

 Treatment

 Conventional Medicines

  • Angiotensin receptor blockers (ARBs) – ARBs are drugs that block the action of angiotensin 2 on its receptors. These drugs, like ACE-I, have a protective effect on the kidneys and slow the progression of kidney failure. Drugs included in this category include losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), candesartan (Atacand) and olmesartan (Benicar).
  • Angiotensin converting enzyme inhibitors (ACE-Is) – ACE-Is are drugs commonly used in the treatment of hypertension. The drugs include captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), ramipril (Altace), quinapril (Accupril), benazepril (Lotensin) and trandolapril (Mavik). These drugs decrease blood pressure by reducing production of angiotensin-II (a hormone that causes blood vessels to constrict) and aldosterone (a hormone that causes sodium retention).
  • Diuretics – The doctor may prescribe diuretics (water pills) to control edema (swelling), blood pressure and/or potassium levels. There are several classes of diuretics, including loop diuretics (furosemide, ethacrynic acid, bumetanide, torsemide), thiazides (hydrochlorothiazide, chlorthalidone, indapamide), and potassium-sparing diuretics (spironolactone, eplerenone, amiloride, triamterene). Diuretics differ in their potential to eliminate salt and water.
  • Erythropoiesis-stimulating agents (ESAs) – Patients with chronic kidney disease often develop anemia due to a lack of erythropoietin produced by the kidneys. Anemia is a condition with too few red cells and is characterized by fatigue and tiredness. After excluding other causes of anemia, the doctor may prescribe erythropoiesis-stimulating agents (ESAs). This includes Procrit (erythropoietin), Aranesp (darbepoetin), or Omontys (peginesatide). ESAs also stimulate the bone marrow to produce red cells and reduce the need for blood transfusions.
  • Phosphate binders – Binders are divided into large classes, including calcium-based binders such as Tums (calcium carbonate) and PhosLo (calcium acetate) and non-calcium based binders like Fosrenol (lanthanum carbonate), Renagel (sevelamer hydrochloride) and Renvela (sevelamer carbonate).
  • Vitamin D -Vitamin D deficiency is very common in patients with chronic kidney disease. The first step in treating metabolic bone disease is to ensure that there are adequate reserves of vitamin D in the body.

Others

  • Dialysis – removes Dialysis helps to maintain your body’s balance by removing waste and extra fluid from the blood, keeping the blood’s chemical balance at a safe level and assisting with blood pressure control. Dialysis is a useful and important treatment.
    • Haemodialysis – Uses machine acting as an artificial kidney cleans the blood. Requires good access to your bloodstream, which may be an issue if you have diabetes. If you have heart problems, changes in blood pressure and waste levels associated with haemodialysis can cause problems.
    • Peritoneal Dialysis – Allows the blood to be cleaned inside the body and is usually done at home. PD may not be possible if you’ve had major abdominal surgery causing scarring. It may also be difficult to obtain the right amount of dialysis with PD if you are tall and muscular, or overweight.
  • Transplantation – If you start dialysis you will also be assessed for your suitability for transplantation. Health issues may prevent this option.
  • Conservative or Supportive Care – If you decide that dialysis or transplant is not for you, then your health-care team will support you to stay as healthy as possible without dialysis. Your life-span however will be limited.

Alternative Medicine

Environmental Medicine focuses on finding the causes of an illness rather than just treating the effects.

  • Biodetoxification Prgramme – Safe, intensive treatment for the reduction of the body’s burden of toxic chemicals. Biodetoxification Program utilizes clinical procedures that safely reduce the body’s burden of toxic chemicals, including chemicals stored following occupational, accidental, and/or chronic airborne exposures. Chemicals bind to human tissues on the basis of their lipophilic properties — meaning literally “attracted to fats.” When our bodies absorb lipophilic toxins, they are deposited in the fat stores and released whenever those fatty tissues are broken down to provide energy. Thus, although a patient may initially be poisoned by an extrinsic (outside) source of toxicants, the patient may continue to be poisoned over a prolonged period of time by our own intrinsic (inside) body stores of those poisons.
  • Fish Oils – Fish oils affect the progression of CKD. In one meta-analysis some studies indicate a negative effect on the progression of CKD
  • Vitamin and mineral supplements – Replacement of certain vitamins and minerals that that the patient does not get in the diet or that are lost during dialysis.
  • Avoiding IV Dye – Avoiding X-ray tests that require IV dye (contrast material), such as an angiogram, an intravenous pyelogram (IVP), and some CT scans. IV dye can cause more kidney damage.
  • Diet – This may include – Avoid products with added salt, lower potassium foods, limited amount of protein in the diet.
  • Chinese Herbal Medicine – Acupuncture, Lei Gong Teng, Micro-Chinese Medicine Osmotherapy are the natural alternative treatments for kidney failure which is used externally.
  • Ayurveda – Gokshura and Mutrakrichantak Churna which contains herbs like Punarnava, Varuna, Shigru, Apamarg etc. maintain effective kidney functioning by promoting proper urination, reducing kidney discomforts and removing stones and helps to reduce accompanying fluid accumulation and kidney tissue inflammation.
  • Herbal treatment – Cornsilk, dandelion, astragalus, basil etc. helps to cleanse and strengthen the kidney.
Posted in ORGAN SYSTEM
February 7, 2017

Berger’s disease, commonly known as Ig A Neuropathy (short for Immunoglobulin A), is a kidney disease, which affects the glomerulus. Glomeruli are the tiny blood filters where urine is made.

In this condition, IgA settles in the kidney and causes scarring and inflammation within the kidney, which can only be seen clearly under the microscope. Therefore it is normally only diagnosed after a biopsy test of the kidney. What is seen under the microscope is that the “glomeruli”, which are the tiny structures which filter the blood to make urine, are damaged by deposits of IgA.

After diabetes and high blood pressure, IgA nephropathy is the third leading cause of chronic kidney disease (CKD) in the United States.

Antibodies are produced when there is a virus, bacterium or toxin, threatening the body. Normally, these antibodies will help fight the thing that is invading the body. For reasons that are unknown, IgA can get into the kidney, causing inflammation. This condition can eventually lead to blood and protein in the urine, high blood pressure, swollen hands and feet and other signs of CKD.

Berger’s disease usually progresses slowly over many years, but the course of the disease in each person is uncertain. Some people leak blood in their urine without developing problems, some eventually achieve complete remission, and others develop end-stage kidney failure.

Causes

The disease seems to cluster in certain families and in certain areas of the world. It rarely occurs in people of African heritage. These facts suggest that genetic influences may play a role in the development of the disease.

IgA is a protein called an antibody that helps the body fight infections. Berger’s disease occurs when too much of this protein is deposited in the kidneys. IgA builds up inside the small blood vessels of the kidney. Structures in the kidney called glomeruli become inflamed and damaged. Berger’s disease is a form of mesangial proliferative nephritis.

The disorder can appear suddenly (acute), or get worse slowly over many years (chronic glomerulonephritis).

Who is at Risk?

Factors that increase may your chance of IgA nephropathy include –

gastrointestinal such as cirrhosis, celiac disease, inflammatory bowel disease infectious disease such as HIV, tuberculosis, hepatitis pulmonary disease such as bronchiolitis obliterans, small cell lung cancer lymphoma dermatitis herpetiformis seronegative arthritis.

  • Family history
  • Gastrointestinal disorders, such as inflammatory bowel disease or celiac disease
  • Cirrhosis of the liver
  • Henoch schoenlein purpura

Symptoms

Symptoms for IgA nephropathy don’t occur at the beginning stages of the disease. Instead, it’s a progressive condition that can take decades to produce symptoms. Sometimes, during a routine screening your doctor may detect signs of IgA nephropathy, which include: –

  • Cola or tea-colored urine, due to blood in the urine (hematuria)
  • Periodic pain in the loins, abdomen, sides or flanks
  • Foam after urination caused by protein in the urine (known as proteinuria)
  • Fatigue
  • Flu and cold-like symptoms
  • High blood pressure
  • Swelling of the hands and feet (edema)
  • Mood swings
  • Becoming more susceptible to allergies
  • Lack of response to cold temperatures (mainly in children)
  • Urinary tract infections (UTIs, mainly in young girls)

Treatment

Medications

Depending on the symptoms and overall health –

  • Medications to help control blood pressure and decrease protein loss in the urine
  • Cholesterol lowering medication
  • Corticosteroids to decrease inflammation in the body
  • Medications to suppress the immune system

Surgery

Dialysis takes over the job of the kidneys if they are not able to work well. It cannot cure the kidney damage, but it will help you feel better and decrease symptoms like high blood pressure.

A kidney transplant may be needed when illness has progressed and the kidneys have failed.

Lifestyle Changes

  • Exercise can help with overall health. It can also help manage cholesterol and blood pressure.
  • Don’t smoke

Alternative Treatment

Vitamins – Vitamin C can strengthen the immune system so as to help fight against aliments such as cold and infection. These aliments may cause blood urine and speed up kidney failure for Berger’s patients. IgA Nephropathy patients may also need vitamin D, vitamin E, vitamin K and some other vitamins

Low-antigen diet – A low-antigen diet, which consists of restricting dietary gluten and avoiding meats and dairy products, has been recommended to decrease mucosal antigen exposure.

Low-protein diets have been recommended to slow the rate of progression of many nephropathies.

Omega-3 fish oil provides essential fatty acids that cannot be made by our bodies but must be supplied by our diet. These include linoleic and linolenic acids, which are found in black currant, borage, primrose and flax oils as well as fish, EPA (eicosapentaenoic acid), and DHA (docosahexanenoic acid). Omega-3 fatty acids affect the production of eicosanoids, cytokines, and thromboxane A2, all of which are believed to have a role in injuring the glomeruli.

Blueberry contains antioxidant phytonutrients and manganese, which can keep the bones healthy.

Vitamin D – Deficiency of vitamin D is present early in the course of CKD, and correction may prevent activation of key pathogenic mechanisms in cardiovascular disease (eg, inflammation, myocardial cell hypertrophy and proliferation, and the renin-angiotensin system).

 

Reference

http://www.igan.net/iga.html

http://www.nejm.org/doi/pdf/10.1056/NEJMra1206793

http://cjasn.asnjournals.org/content/2/5/1054.long

https://www.med.nyu.edu/medicine/nephrology/sites/default/files/nephrology/IGA%20Nephropathy.pdf

http://jasn.asnjournals.org/content/16/7/2088.full.pdf

http://www.worldscientific.com/worldscibooks/10.1142/7064

http://bestpractice.bmj.com/best-practice/monograph/480.html

Posted in ORGAN SYSTEM
February 7, 2017

Amyloidosis is defined as a group of diseases in which one or more organ systems in the body accumulate amyloid proteins. It is a condition in which too much of amyloid protein  collects in the organs, so that they are not able to work normally. Amyloidosis can affect the heart, kidneys, liver, spleen, nervous system, stomach or intestines. The condition is rare (affecting fewer than 4,000 people in the United States each year), but it can be fatal.

Amyloidosis is a rare and serious protein deposition disease. It is caused by an abnormal protein called amyloid that builds up in tissues or organs.  These abnormal protein deposits (or amyloid) are relatively insoluble and therefore cannot be easily broken down by the body. As the amount of amyloid protein deposits increase in a tissue or organ, they interfere with the tissue or organ’s healthy function. Eventually, the amyloid protein deposits cause symptoms and organ failure.

Types of Amyloidosis –

Light chain (AL) amyloidosis -This is the most common type of amyloidosis in the United States. The amyloid proteins that build up in the tissues in this condition are known as light chains. They can either be kappa or lambda light chains. AL amyloidosis is a disorder of the plasma cells. Plasma cells are a type of white blood cell responsible for the production of immunoglobulins or antibodies, a type of protein that fights infection. In AL amyloidosis, these proteins are misshapen and produced in excess. They deposit in tissues, causing organ damage. AL amyloidosis can affect one or more organs. The heart, kidneys, nerves, and gastrointestinal system are the most common organs affected. Because AL amyloidosis is associated with the overproduction of plasma cell proteins, it is linked to multiple myeloma.

Autoimmune (AA) amyloidosis – In this condition, the amyloid protein that builds up in the tissues is called the A protein. AA amyloidosis is associated with some chronic diseases, such as diabetes, tuberculosis, rheumatoid arthritis, or inflammatory bowel disease. It may also be linked to aging. AA amyloidosis can affect the spleen, liver, kidneys, adrenal glands, and lymph nodes. Lymph nodes are tiny, bean-shaped organs that fight infection.

Hereditary or familial (AF) amyloidosis – Hereditary amyloidosis is rare. It is a specific type of amyloidosis that can be passed down from generation to generation within a family. It may cause issues relating to the central nervous system, carpal tunnel syndrome, and eye abnormalities. The most common subtypes involve a protein called transthyretin (TTR).

Causes

No one knows what causes amyloidosis. There may be more than one cause. Hereditary amyloidosis results from genetic changes that cause the body to make abnormal proteins. Researchers think that as we get older, damage builds up in the body and triggers the disease. This kind of damage may come from the body’s use of oxygen (oxidation) and from free radicals (harmful byproducts formed when cells use energy). Amyloid is also more likely to form in people who have immune system problems. Once amyloid deposits start, they seem to continue building up in the same locations. The heart, kidneys, nervous system, and GI tract are the most commonly affected.

Who is at Risk?

  • Men – two thirds of people with AL are men.
  • People over age 50 – even in people with hereditary forms, doctors usually detect amyloid deposits severe enough to cause problems later in life.
  • Disease affecting the antibody-producing plasma cells in the blood (such as multiple myeloma, malignant lymphoma, benign monoclonal gammopathy, or Waldenström’s macroglobulinemia)
  • Chronic infectious or inflammatory disease (such as rheumatoid arthritis, inflammatory bowel disease, familial Mediterranean fever, or ankylosing spondylitis)
  • Long-term dialysis
  • Inherited genetic changes that affect proteins in the body

Symptoms

Signs and symptoms of amyloidosis may include –

  • Swelling of your ankles and legs
  • Severe fatigue and weakness
  • Shortness of breath
  • Numbness, tingling or pain in your hands or feet, especially pain in your wrist (carpal tunnel syndrome)
  • Diarrhea, possibly with blood, or constipation
  • Feeling full quickly when eating, and significant weight loss
  • An enlarged tongue
  • Skin changes, such as thickening or easy bruising, and purplish patches around the eyes
  • An irregular heartbeat
  • Difficulty swallowing

Other Complications –

  • Heart – Because amyloid protein deposits can limit the heart’s ability to fill with blood between beats, even the slightest exertion can cause shortness of breath. If the heart’s electrical system is affected, the heart’s rhythm may become erratic. The heart may also be enlarged and heart murmurs may be present. Congestive heart failure may result.
  • Kidneys – The feet, ankles, and calves swell when amyloidosis damages the kidneys. The kidneys become small and hard, and kidney failure may result. It is not unusual for a patient to lose 20-25 pounds and develop a distaste for meat, eggs, and other protein-rich foods. Cholesterol elevations that don’t respond to medication and protein in the urine (proteinuria) are common.
  • Nervous system – Nervous system symptoms often appear in patients with familial amyloidosis. Inflammation and degeneration of the peripheral nerves (peripheral neuropathy) may be present. One of four patients with amyloidosis has carpal tunnel syndrome, a painful disorder that causes numbness or tingling in response to pressure on nerves around the wrist. Amyloidosis that affects nerves to the feet can cause burning or numbness in the toes and soles and eventually weaken the legs. If nerves controlling bowel function are involved, bouts of diarrhea alternate with periods of constipation. If the disease affects nerves that regulate blood pressure, patients may feel dizzy or faint when they stand up suddenly.
  • Liver and spleen – The most common symptoms are enlargement of these organs. Liver function is not usually affected until quite late in the course of the disease. Protein accumulation in the spleen can increase the risk of rupture of this organ due to trauma.
  • Gastrointestinal system – The tongue may be inflammed, enlarged, and stiff. Intestinal movement (motility) may be reduced. Absorption of food and other nutrients may be impaired (and may lead to malnutrition), and there may also be bleeding, abdominal pain, constipation, and diarrhea.
  • Skin – Skin symptoms occur in about half of all cases of primary and secondary amyloidosis and in all cases where there is inflammation or degeneration of the peripheral nerves. Waxy-looking raised bumps (papules) may appear on the face and neck, in the groin, armpits, or anal area, and on the tongue or in the ear canals. Swelling, hemorrhage beneath the skin (purpura), hair loss, and dry mouth may also occur.
  • Respiratory system – Airways may be obstructed by amyloid deposits in the nasal sinus, larynx and traches (windpipe).

Treatment

  • Diuretics to relieve swelling caused by fluid retention
  • Anti-arrhythmics to control heart rhythm
  • Metoclopramide to help empty food from the stomach
  • Antibiotics to control bacteria that may cause diarrhea or prevent the body from absorbing nutrients
  • Anti-inflammatory/immune suppressive therapy to reduce amyloid precursor load
  • Dialysis, if the kidneys are failing
  • Peripheral blood stem cell transplantation – During peripheral blood stem cell transplantation, high-dose chemotherapy is administered along with transfusion of stem cells (immature blood cells) to replace damaged bone marrow. These stem cells may come from the patient (autologous transplant) or from a donor (allogeneic transplant). Autologous transplant is the preferred method.
  • Anti-cancer medication (“antineoplastics”) – Melphalan (Alkeran®), an agent used to treat certain types of cancer, has been prescribed to amyloidosis patients as well. Other types of chemotherapy treatments, like melphalan with high-dose dexamethasone or VAD (vincristine, adriamycin and dexamethasone), are being tested for safety and efficacy in the treatment of amyloidosis. Other medications, including thalidomide, a drug used to treat multiple myeloma, are also being tested for their ability to inhibit the disease.
  • Corticosteroids -Corticosteroids like prednisone have been prescribed to amyloidosis patients because of their anti-inflammatory effects.
  • Liver transplantation – For hereditary amyloidosis, one possible therapy may be liver transplantation because the protein that causes this form of amyloidosis is produced in the liver.

Alternative Treatment

DMSO (dimethyl sulfoxide) –  DMSO may change the course of amyloidosis if treatment is started early. However, there is not much scientific support for this claim.

Germanium – Studies suggests that germanium compounds may prevent amyloidosis. Results can only be considered preliminary at this time.

Resveratrol – Preliminary data suggests that resveratrol may play a role in the prevention of amyloidosis. High quality clinical research is needed to better understand this relationship.

Omega-3s – These are also essential dietary elements when suffering from amyloidosis. Commonly found in many types of meat, these beneficial fatty acids, particularly the type found in fish oil, can significantly protect your heart and vascular system, ensuring that your circulatory system remains healthy and functioning properly, while also reducing the chances of coronary heart disease and atherosclerosis, which can quicken the complications of amyloidosis in the cardiovascular system.

Vitamin C – Study suggested that high doses of vitamin C may help the body break down amyloid and prevent amyloidosis from worsening, but there is no evidence this works in humans.

Bromelain – An enzyme derived from pineapple, fights inflammation and may help break down amyloid deposits in kidney tissue, though evidence is slight. Bromelain is often combined with turmeric, which strengthens its effects. Bromelain can interact with certain medications including some antibiotics.

Glutathione is an antioxidant produced by the body. Low levels may be associated with higher levels of beta2-microglobulin in people on dialysis with or without amyloidosis.

Quercetin is an antioxidant with anti-inflammatory properties. It has not been studied for amyloidosis.

Gingko extract also contains flavonoids. It has been suggested as a treatment for Alzheimer’s disease.

 

Reference –

http://www-sop.inria.fr/axis/cost282/kelsi04/Brito/Brito1.pdf

http://rstb.royalsocietypublishing.org/content/356/1406/203

https://www.ucl.ac.uk/amyloidosis/nac/amyloidosis-overview

http://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/amyloidosis/amyloidosis

https://my.clevelandclinic.org/health/diseases_conditions/hic-amyloidosis

http://patient.info/doctor/amyloidosis-pro

http://www.amyloidosissupport.org/AmyloidAware_Booklet.pdf

http://www.amyloidosissupport.org/AmyloidAware_Booklet.pdf

http://www.webmd.com/a-to-z-guides/amyloidosis-symptoms-causes-treatments

http://www.cancer.net/cancer-types/amyloidosis

http://emedicine.medscape.com/article/335414-overview

Posted in ORGAN SYSTEM