Tag Archives: Alagille syndrome

Cholangitis

Definition:
Cholangitis is an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines. Bile is a liquid made by the liver that helps digest food.

CLICK & SEE

Cholangitis can be life-threatening, and is regarded as a medical emergency. Characteristic symptoms include yellow discoloration of the skin or whites of the eyes, fever, abdominal pain, and in severe cases, low blood pressure and confusion. Initial treatment is with intravenous fluids and antibiotics, but there is often an underlying problem (such as gallstones or narrowing in the bile duct) for which further tests and treatments may be necessary, usually in the form of endoscopy to relieve obstruction of the bile duct.
Symptoms:
The following symptoms may occur:

*Pain on the upper right side or upper middle part of the abdomen. It may also be felt in the back or below the right shoulder blade. The pain may come and go and feel sharp, cramp-like, or dull.

*Fever and chills

*Dark urine and clay-colored stools

*Nausea and vomiting

*Yellowing of the skin (jaundice), which may come and go
Physical examination findings typically include jaundice and right upper quadrant tenderness.Charcot’s triad is a set of three common findings in cholangitis: abdominal pain, jaundice, and fever. This was assumed in the past to be present in 50–70% of cases, although more recently the frequency has been reported as 15–20%.Reynolds’ pentad includes the findings of Charcot’s triad with the presence of septic shock and mental confusion. This combination of symptoms indicates worsening of the condition and the development of sepsis, and is seen less commonly still.

In the elderly, the presentation may be atypical; they may directly collapse due to septicemia without first showing typical features. Those with an indwelling stent in the bile duct (see below) may not develop jaundice.

Causes:
Cholangitis is most often caused by a bacterial infection. This can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver.

Bile duct obstruction, which is usually present in acute cholangitis, is generally due to gallstones. 10–30% of cases, however, are due to other causes such as benign stricturing (narrowing of the bile duct without an underlying tumor), postoperative damage or an altered structure of the bile ducts such as narrowing at the site of an anastomosis (surgical connection), various tumors (cancer of the bile duct, gallbladder cancer, cancer of the ampulla of Vater, pancreatic cancer, cancer of the duodenum), anaerobic organisms such as Clostridium and Bacteroides (especially in the elderly and those who have undergone previous surgery of the biliary system). Parasites which may infect the liver and bile ducts may cause cholangitis; these include the roundworm Ascaris lumbricoides and the liver flukes Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus. In people with AIDS, a large number of opportunistic organisms has been known to cause AIDS cholangiopathy, but the risk has rapidly diminished since the introduction of effective AIDS treatment. Cholangitis may also complicate medical procedures involving the bile duct, especially ERCP. To prevent this, it is recommended that those undergoing ERCP for any indication receive prophylactic (preventative) antibiotics.

The presence of a permanent biliary stent (e.g. in pancreatic cancer) slightly increases the risk of cholangitis, but stents of this type are often needed to keep the bile duct patent under outside pressure

Diagnosis:
Routine blood tests show features of acute inflammation (raised white blood cell count and elevated C-reactive protein level), and usually abnormal liver function tests (LFTs). In most cases the LFTs will be consistent with obstruction: raised bilirubin, alkaline phosphatase and ?-glutamyl transpeptidase. In the early stages, however, pressure on the liver cells may be the main feature and the tests will resemble those in hepatitis, with elevations in alanine transaminase and aspartate transaminase.

Blood cultures are often performed in people with fever and evidence of acute infection. These yield the bacteria causing the infection in 36% of cases, usually after 24–48 hours of incubation. Bile, too, may be sent for culture during ERCP (see below). The most common bacteria linked to ascending cholangitis are gram-negative bacilli: Escherichia coli (25–50%), Klebsiella (15–20%) and Enterobacter (5–10%). Of the gram-positive cocci, Enterococcus causes 10–20%.

You may have the following tests to look for blockages:

*Abdominal ultrasound

*Endoscopic retrograde cholangiopancreatography (ERCP)

*Magnetic resonance cholangiopancreatography (MRCP)

*Percutaneous transhepatic cholangiogram (PTCA)

*You may also have the following blood tests:

#Bilirubin level
#Liver enzyme levels
#Liver function tests
#White blood count (WBC)
Treatment:
Quick diagnosis and treatment are very important.Antibiotics to cure infection is the first treatment done in most cases. ERCP or other surgical procedure is done when the patient is stable.Patients who are very ill or are quickly getting worse may need surgery right away.

Cholangitis requires admission to hospital. Intravenous fluids are administered, especially if the blood pressure is low, and antibiotics are commenced. Empirical treatment with broad-spectrum antibiotics is usually necessary until it is known for certain which pathogen is causing the infection, and to which antibiotics it is sensitive. Combinations of penicillins and aminoglycosides are widely used, although ciprofloxacin has been shown to be effective in most cases, and may be preferred to aminoglycosides because of fewer side effects. Metronidazole is often added to specifically treat the anaerobic pathogens, especially in those who are very ill or at risk of anaerobic infections. Antibiotics are continued for 7–10 days. Drugs that increase the blood pressure (vasopressors) may also be required to counter the low blood pressure.
Prognosis:
Acute cholangitis carries a significant risk of death, the leading cause being irreversible shock with multiple organ failure (a possible complication of severe infections). Improvements in diagnosis and treatment have led to a reduction in mortality: before 1980, the mortality rate was greater than 50%, but after 1980 it was 10–30%. Patients with signs of multiple organ failure are likely to die unless they undergo early biliary drainage and treatment with systemic antibiotics. Other causes of death following severe cholangitis include heart failure and pneumonia.

Risk Factors:
Risk factors include a previous history of gallstones, sclerosing cholangitis, HIV, narrowing of the common bile duct, and, rarely, travel to countries where you might catch a worm or parasite infection.

Risk factors indicating an increased risk of death include older age, female gender, a history of liver cirrhosis, biliary narrowing due to cancer, acute renal failure and the presence of liver abscesses. Complications following severe cholangitis include renal failure, respiratory failure (inability of the respiratory system to oxygenate blood and/or eliminate carbon dioxide), cardiac arrhythmia, wound infection, pneumonia, gastrointestinal bleeding and myocardial ischemia (lack of blood flow to the heart, leading to heart attacks).

Prevention:
Treatment of gallstones, tumors, and infestations of parasites may reduce the risk for some people. A metal or plastic stent that is placed in the bile system may be needed to prevent the infection from returning.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000290.htm
http://en.wikipedia.org/wiki/Ascending_cholangitis

Advertisements

Hepatitis

Knowing the ABCs of this liver disorder can save your life. Though some hepatitis viruses cause an acute but temporary flulike illness, others can produce a chronic, festering liver infection. Natural therapies are designed to protect the liver and boost your immune system.
Symptoms:-

Fatigue.
Fever.
Loss of appetite.
Nausea and vomiting.
Aching muscles or joints.
Abdominal discomfort, pain, or swelling.
Jaundice (yellowish tinge of skin and whites of eyes).
Dark urine and pale stools.

When to Call Your Doctor :
If you think you have been exposed to hepatitis, either through contaminated food or water or by sexual contact with an infected person.
If you develop lingering flulike symptoms. During its acute phase, viral hepatitis so closely resembles the flu that it is frequently misdiagnosed.
If you develop jaundice or other symptoms of hepatitis.
Reminder: If you have a medical condition, talk to your doctor before taking supplements.

What It Is :
Hepatitis is an inflammation of the liver. Of the two forms — acute and chronic — the first is the easier to treat. Hepatitis can be caused by any of six viruses, called A, B, C, D, E, and G. Hepatitis A, the most common, is highly contagious; it produces acute flulike symptoms but usually no long-lasting damage. Hepatitis B and C, on the other hand, can linger for years, often causing few or no symptoms but in some cases leading to irreversible liver scarring (cirrhosis) or liver cancer. Types D, E, and G are rare. All forms of hepatitis attack the liver, impairing its ability to process sugars and carbohydrates, to secrete fat-digesting bile, and to rid the body of toxins and waste. But the chronic forms are the most dangerous because they may ultimately lead to liver failure.

What Causes It:
Whether contracted through contaminated food or water (type A), or through blood transfusions, infected hypodermic needles, or sexual intercourse (types B and C), hepatitis is most often caused by a viral infection. Certain medications, toxic chemicals, or years of alcohol abuse can also result in hepatitis. Rarely, an autoimmune dysfunction — in which the immune system attacks the body’s own tissues — is to blame. And sometimes, no cause can be determined.

How Supplements Can Help :
Conventional medicines have achieved only limited success in treating hepatitis, particularly the more dangerous chronic form. The natural therapies listed in the chart are designed to protect and strengthen the liver and boost general immunity. They should be used together, along with conventional drugs, until symptoms of acute hepatitis subside. Benefits may be noticed within a week. For chronic disease, take them long term.

What Else You Can Do :
Watch what you eat and drink when traveling in areas where sanitation is poor and disease rates high. Have only bottled water and cooked foods.
Refrain from alcohol, especially during and for a month after an acute illness, or until your doctor says your liver function tests are normal.
Make sure disposable or sterilized needles are used during acupuncture, body piercing, tattooing, and similar procedures.
Vaccines against both hepatitis A and hepatitis B are available. Ask your doctor if you should have one or both.

Supplement Recommendations:-

Vitamin C
Vitamin E
Milk Thistle
Licorice
Lipotropic Combination
Alpha-lipoic Acid
Dandelion Root

Vitamin C
Dosage: 1,000 mg 3 times a day.
Comments: Reduce dose if diarrhea develops.

Vitamin E
Dosage: 400 IU a day.
Comments: Check with your doctor if taking anticoagulant drugs.

Milk Thistle
Dosage: 150 mg 3 times a day.
Comments: Standardized to contain at least 70% silymarin.

Licorice
Dosage: 200 mg 3 times a day for a maximum of 10 days.
Comments: Standardized to contain 22% glycyrrhizin or glycyrrhizinic acid; can raise blood pressure. Don’t use DGL form.

Lipotropic Combination
Dosage: 2 pills twice a day.
Comments: Should contain milk thistle, choline, inositol, and other ingredients.

Alpha-lipoic Acid
Dosage: 200 mg 3 times a day.
Comments: Can be taken with or without food.

Dandelion Root
Dosage: 500 mg standardized extract twice a day.
Comments: May be contained in lipotropic combination formulas.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Source:Your Guide to Vitamins, Minerals, and Herbs (Reader’s Digest)

First aid In Fever

Fever is one of your body’s reactions to infection. What’s normal for you may be a little higher or lower than the average temperature of 98.6 F (37 C). That’s why it’s hard to say just what a fever is. But a “significant” fever is usually defined as an oral or ear temperature of 102 F or a rectal temperature of 103 F. For very young children and infants, however, even slightly elevated temperatures may indicate a serious infection. In newborns, a subnormal temperature   rather than a fever   also may be a sign of serious illness.

Don’t treat fevers below 101 F with any medications unless advised to do so by your doctor. If you have a fever of 101 F or higher, your doctor may suggest taking over-the-counter medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Adults may also use aspirin. But don’t give aspirin to children. It may trigger a rare, but potentially fatal, disorder known as   Reye’s syndrome.

How to take a temperature
You can choose from several types of thermometers. Today most have digital readouts. Some take the temperature quickly from the ear canal and can be especially useful for young children and older adults. Other thermometers can be used rectally, orally or under the arm. If you use a digital thermometer, be sure to read the instructions, so you know what the beeps mean and when to read the thermometer. Under normal circumstances, temperatures tend to be highest around 4 p.m. and lowest around 4 a.m.

Because of the potential for mercury exposure or ingestion, glass mercury thermometers have been phased out and are no longer recommended.

Rectally (for infants)
To take your child’s temperature rectally:

* Place a dab of petroleum jelly or other lubricant on the bulb.
* Lay your child on his or her stomach.
* Carefully insert the bulb one-half inch to one inch into the rectum.
* Hold the bulb and child still for three minutes. To avoid injury, don’t let go of the thermometer while it’s inside your child.
* Remove and read the temperature as recommended by the manufacturer.
* A rectal temperature reading is generally 1 degree F higher than an oral reading.

Orally
To take your temperature orally:

* Place the bulb under your tongue.
* Close your mouth for the recommended amount of time, usually three minutes.
* If you’re using a nondigital thermometer, remove it from your mouth and rotate it slowly until you can read the temperature accurately.

Under the arm (axillary)
Although it’s not the most accurate way to take a temperature, you can also use an oral thermometer for an armpit reading:

* Place the thermometer under your arm with your arm down.
* Hold your arms across your chest.
* Wait five minutes or as recommended by your thermometer’s manufacturer. Then remove the thermometer and read the temperature.
* An axillary reading is generally 1 degree F less than an oral reading

Get medical help for a fever in these cases:

* If a baby is younger than 2 months of age and has a rectal temperature of 100.4 F or higher. Even if your baby doesn’t have other signs or symptoms, call your doctor just to be safe.
* If a baby is older than 2 months of age and has a temperature of 102 F or higher.
* If a newborn has a lower-than-normal temperature — less than 95 F rectally.
* If a child younger than age 2 has a fever for longer than one day, or a child age 2 or older has a fever for longer than three days. If your child has a fever after being left in a very hot car, seek medical care immediately.
* If an adult has a temperature of more than 104 F or has had a fever for more than three days.

Call your doctor immediately if any of these signs or symptoms accompanies a fever:

* A severe headache
* Severe swelling of the throat
* Unusual skin rash
* Unusual eye sensitivity to bright light
* A stiff neck and pain when the head is bent forward
* Mental confusion
* Persistent vomiting
* Difficulty breathing or chest pain
* Extreme listlessness or irritability
* Abdominal pain or pain when urinating
* Any other unexplained symptoms

Source:MayoClinic.Com