Tag Archives: Bile

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.

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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

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Jaundice

 

Definition:
Jaundice, also known as icterus (attributive adjective: “icteric”), is yellowish discoloration of the skin, sclerae (whites of the eyes) and mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood). This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluids. Typically, the concentration of bilirubin in the plasma must exceed 1.5 mg/dL, three times the usual value of approximately 0.5mg/dL, for the coloration to be easily visible. Jaundice comes from the French word jaune, meaning yellow.

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Jaundice is not a disease but rather a sign that can occur in many different diseases. Jaundice is the yellowish staining of the skin and sclerae (the whites of the eyes) that is caused by high levels in blood of the chemical bilirubin. The color of the skin and sclerae vary depending on the level of bilirubin. When the bilirubin level is mildly elevated, they are yellowish. When the bilirubin level is high, they tend to be brown.

Normal Physiology
In order to understand how jaundice results, it is important to understand where the pathological processes that cause jaundice take their effect. It is also important to further recognize that jaundice itself is not a disease, but rather a symptom of an underlying pathological process that occurs at some point along the normal physiological pathway of the metabolism of bilirubin.

Pre-hepatic events
When red blood cells have completed their life span of approximately 120 days, or when they are damaged, their membranes become fragile and prone to rupture. As the cell traverses through the reticuloendothelial system, their cell membranes rupture and the contents of the red blood cell is released into the blood. The component of the red blood cell that is involved in jaundice is hemoglobin. The hemoglobin released into the blood is phagocytosed by macrophages, and split into its heme and globin portions. The globin portion, being protein, is degraded into amino acids and plays no further role in jaundice. Two reactions then take place to the heme molecule. The first reaction is the oxidation of heme to form biliverdin.This reaction is catalyzed by microsomal enzyme heme oxygenase and it results in biliverdin (green color pigment), iron and carbon monoxide. Next step is reduction of biliverdin to yellow color tetrapyrol pigment bilirubin by cytosolic enzyme biliverdin reductase. This bilirubin is known as “unconjugated”, “free” or “indirect” bilirubin. Approximately 4 mg per kg of bilirubin is produced each day. The majority of this bilirubin comes from the breakdown of heme from expired red blood cells in the process just described. However approximately 20 per cent comes from other heme sources, including ineffective erythropoiesis, breakdown of other heme-containing proteins, such as muscle myoglobin and cytochromes.

Hepatic events
The unconjugated bilirubin then travels to the liver through the bloodstream. Because this bilirubin is not soluble, however, it is transported through the blood bound to serum albumin. Once it arrives at the liver, it is conjugated with glucuronic acid (to form bilirubin diglucuronide, or just “conjugated bilirubin”) to become more water soluble. The reaction is catalyzed by the enzyme UDP-glucuronide transferase.

Post-hepatic events
This conjugated bilirubin is excreted from the liver into the biliary and cystic ducts as part of bile. Intestinal bacteria convert the bilirubin into urobilinogen. From here the urobilinogen can take two pathways. It can either be further converted into stercobilinogen, which is then oxidized to stercobilin and passed out in the faeces, or it can be reabsorbed by the intestinal cells, transported in the blood to the kidneys, and passed out in the urine as the oxidised product urobilin. Stercobilin and urobilin are the products responsible for the coloration of faeces and urine, respectively.

Symptoms:-
In jaundice, the skin and whites of the eyes appear yellow. Urine is often dark because excess bilirubin is excreted through the kidneys. People may have itching, light-colored stools, or other symptoms, depending on the cause of jaundice. For example, acute inflammation of the liver (acute hepatitis) may cause loss of appetite, nausea, vomiting, and fever. Blockage of bile may result in abdominal pain and fever.
Causes:

Bilirubin comes from red blood cells. When red blood cells get old, they are destroyed. Hemoglobin, the iron-containing chemical in red blood cells that carries oxygen, is released from the destroyed red blood cells after the iron it contains is removed. The chemical that remains in the blood after the iron is removed becomes bilirubin.

The liver has many functions. One of the liver’s functions is to produce and secrete bile into the intestines to help digest dietary fat. Another is to remove toxic chemicals or waste products from the blood, and bilirubin is a waste product. The liver removes bilirubin from the blood. After the bilirubin has entered the liver cells, the cells conjugate (attaching other chemicals, primarily glucuronic acid) to the bilirubin, and then secrete the bilirubin/glucuronic acid complex into bile. The complex that is secreted in bile is called conjugated bilirubin. The conjugated bilirubin is eliminated in the feces. (Bilirubin is what gives feces its brown color.) Conjugated bilirubin is distinguished from the bilirubin that is released from the red blood cells and not yet removed from the blood which is termed unconjugated bilirubin.

Jaundice occurs when there is 1) too much bilirubin being produced for the liver to remove from the blood. (For example, patients with hemolytic anemia have an abnormally rapid rate of destruction of their red blood cells that releases large amounts of bilirubin into the blood), 2) a defect in the liver that prevents bilirubin from being removed from the blood, converted to bilirubin/glucuronic acid (conjugated) or secreted in bile, or 3) blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines. (For example, the bile ducts can be blocked by cancers, gallstones, or inflammation of the bile ducts). The decreased conjugation, secretion, or flow of bile that can result in jaundice is referred to as cholestasis: however, cholestasis does not always result in jaundice.
When a pathological process interferes with the normal functioning of the metabolism and excretion of bilirubin just described, jaundice may be the result. Jaundice is classified into three categories, depending on which part of the physiological mechanism the pathology affects.

The three categories are:

*Pre-hepatic: The pathology is occurring prior the liver

*Hepatic: The pathology is located within the liver

*Post-Hepatic: The pathology is located after the conjugation of bilirubin in the liver

Pre-hepatic
Pre-hepatic jaundice is caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells). In tropical countries, malaria can cause jaundice in this manner. Certain genetic diseases, such as sickle cell anemia, spherocytosis and glucose 6-phosphate dehydrogenase deficiency can lead to increased red cell lysis and therefore hemolytic jaundice. Commonly, diseases of the kidney, such as hemolytic uremic syndrome, can also lead to coloration. Defects in bilirubin metabolism also present as jaundice. Jaundice usually comes with high fevers.

Laboratory findings include:
*Urine: no bilirubin present, urobilirubin > 2 units (except in infants where gut flora has not developed).

*Serum: increased unconjugated bilirubin.

Hepatic
Hepatic jaundice causes include acute hepatitis, hepatotoxicity and alcoholic liver disease, whereby cell necrosis reduces the liver’s ability to metabolise and excrete bilirubin leading to a buildup in the blood. Less common causes include primary biliary cirrhosis, Gilbert’s syndrome (a genetic disorder of bilirubin metabolism which can result in mild jaundice, which is found in about 5% of the population), Crigler-Najjar syndrome, metastatic carcinoma and Niemann Pick Type C disease. Jaundice seen in the newborn, known as neonatal jaundice, is common, occurring in almost every newborn as hepatic machinery for the conjugation and excretion of bilirubin does not fully mature until approximately two weeks of age.

Laboratory Findings include:
Urine: Conjugated bilirubin present, Urobilirubin > 2 units but variable (Except in children)

Post-hepatic
Post-hepatic jaundice, also called obstructive jaundice, is caused by an interruption to the drainage of bile in the biliary system. The most common causes are gallstones in the common bile duct, and pancreatic cancer in the head of the pancreas. Also, a group of parasites known as “liver flukes” live in the common bile duct, causing obstructive jaundice. Other causes include strictures of the common bile duct, biliary atresia, ductal carcinoma, pancreatitis and pancreatic pseudocysts. A rare cause of obstructive jaundice is Mirizzi’s syndrome.

The presence of pale stools and dark urine suggests an obstructive or post-hepatic cause as normal feces get their color from bile pigments.

Patients also can present with elevated serum cholesterol, and often complain of severe itching or “pruritus”.

Laboratory Tests
No one test can differentiate between various classifications of jaundice. A combinations of liver function tests is essential to arrive at a diagnosis.

Neonatal jaundice(jaundice in newborn infants)
Neonatal jaundice is usually harmless: this condition is often seen in infants around the second day after birth, lasting until day 8 in normal births, or to around day 14 in premature births. Serum bilirubin normally drops to a low level without any intervention required: the jaundice is presumably a consequence of metabolic and physiological adjustments after birth. In extreme cases, a brain-damaging condition known as kernicterus can occur; there are concerns that this condition has been rising in recent years due to inadequate detection and treatment of neonatal hyperbilirubinemia. Neonatal jaundice is a risk factor for hearing loss.

Click to see as per Ayurveda-> Yellow Jaundice, Newborn Jaundice, Causes & Symptoms

Jaundiced eye
It was once believed persons suffering from the medical condition jaundice saw everything as yellow. By extension, the jaundiced eye came to mean a prejudiced view, usually rather negative or critical. Alexander Pope, in ‘An Essay on Criticism’ (1711), wrote: “All seems infected that the infected spy, As all looks yellow to the jaundiced eye.” Similarly in the mid 19th century the English poet Lord Alfred Tennyson wrote in the poem ‘Locksley Hall’: “So I triumphe’d ere my passion sweeping thro’ me left me dry, left me with the palsied heart, and left me with a jaundiced eye.”

Problems Jaundice Cause :

Jaundice or cholestasis, by themselves, causes few problems (except in the newborn, and jaundice in the newborn is different than most other types of jaundice, as discussed later.) Jaundice can turn the skin and sclerae yellow. In addition, stool can become light in color, even clay-colored because of the absence of bilirubin that normally gives stool its brown color. The urine may turn dark or brownish in color. This occurs when the bilirubin that is building up in the blood begins to be excreted from the body in the urine. Just as in feces, the bilirubin turns the urine brown.

Besides the cosmetic issues of looking yellow and having dark urine and light stools, the symptom that is associated most frequently associated with jaundice or cholestasis is itching, medically known as pruritus. The itching associated with jaundice and cholestasis can sometimes be so severe that it causes patients to scratch their skin “raw,” have trouble sleeping, and, rarely, even to commit suicide.

It is the disease causing the jaundice that causes most problems associated with jaundice. Specifically, if the jaundice is due to liver disease, the patient may have symptoms or signs of liver disease or cirrhosis. (Cirrhosis represents advanced liver disease.) The symptoms and signs of liver disease and cirrhosis include fatigue, swelling of the ankles, muscle wasting, ascites (fluid accumulation in the abdominal cavity), mental confusion or coma, and bleeding into the intestines.

If the jaundice is caused by blockage of the bile ducts, no bile enters the intestine. Bile is necessary for digesting fat in the intestine and releasing vitamins from within it so that the vitamins can be absorbed into the body. Therefore, blockage of the flow of bile can lead to deficiencies of certain vitamins. For example, there may be a deficiency of vitamin K that prevents proteins that are needed for normal clotting of blood to be made by the liver, and, as a result, uncontrolled bleeding may occur.

Diseases cause jaundice:-
Increased production of bilirubin
There are several uncommon conditions that give rise to over-production of bilirubin. The bilirubin in the blood in these conditions usually is only mildly elevated, and the resultant jaundice usually is mild and difficult to detect. These conditions include: 1) rapid destruction of red blood cells (referred to as hemolysis), 2) a defect in the formation of red blood cells that leads to the over-production of hemoglobin in the bone marrow (called ineffective erythropoiesis), or 3) absorption of large amounts of hemoglobin when there has been much bleeding into tissues (e.g., from hematomas, collections of blood in the tissues).

Acute inflammation of the liver
Any condition in which the liver becomes inflamed can reduce the ability of the liver to conjugate (attach glucuronic acid to) and secrete bilirubin. Common examples include acute viral hepatitis, alcoholic hepatitis, and Tylenol-induced liver toxicity.

Chronic liver diseases
Chronic inflammation of the liver can lead to scarring and cirrhosis, and can ultimately result in jaundice. Common examples include chronic hepatitis B and C, alcoholic liver disease with cirrhosis, and autoimmune hepatitis.

Infiltrative diseases of the liver
Infiltrative diseases of the liver refer to diseases in which the liver is filled with cells or substances that don’t belong there. The most common example would be metastatic cancer to the liver, usually from cancers within the abdomen. Uncommon causes include a few diseases in which substances accumulate within the liver cells, for example, iron (hemochromatosis), alpha-one antitrypsin (alpha-one antitrypsin deficiency), and copper (Wilson’s disease).

Inflammation of the bile ducts
Diseases causing inflammation of the bile ducts, for example, primary biliary cirrhosis or sclerosing cholangitis and some drugs, can stop the flow of bile and elimination of bilirubin and lead to jaundice.

Blockage of the bile ducts
The most common causes of blockage of the bile ducts are gallstones and pancreatic cancer. Less common causes include cancers of the liver and bile ducts.

Drugs:-
Many drugs can cause jaundice and/or cholestasis. Some drugs can cause liver inflammation (hepatitis) similar to viral hepatitis. Other drugs can cause inflammation of the bile ducts, resulting in cholestasis and/or jaundice. Drugs also may interfere directly with the chemical processes within the cells of the liver and bile ducts that are responsible for the formation and secretion of bile to the intestine. As a result, the constituents of bile, including bilirubin, are retained in the body. The best example of a drug that causes this latter type of cholestasis and jaundice is estrogen. The primary treatment for jaundice caused by drugs is discontinuation of the drug. Almost always the bilirubin levels will return to normal within a few weeks, though in a few cases it may take several months.

Genetic disorders:-
There are several rare genetic disorders present from birth that give rise to jaundice. Crigler-Najjar syndrome is caused by a defect in the conjugation of bilirubin in the liver due to a reduction or absence of the enzyme responsible for conjugating the glucuronic acid to bilirubin. Dubin-Johnson and Rotor’s syndromes are caused by abnormal secretion of bilirubin into bile.

The only common genetic disorder that may cause jaundice is Gilbert’s syndrome which affects approximately 7% of the population. Gilbert’s syndrome is caused by a mild reduction in the activity of the enzyme responsible for conjugating the glucuronic acid to bilirubin. The increase in bilirubin in the blood usually is mild and infrequently reaches levels that cause jaundice. Gilbert’s syndrome is a benign condition that does not cause health problems.

Developmental abnormalities of bile ducts:-
There are rare instances in which the bile ducts do not develop normally and the flow of bile is interrupted. Jaundice frequently occurs. These diseases usually are present from birth though some of them may first be recognized in childhood or even adulthood. Cysts of the bile duct (choledochal cysts) are an example of such a developmental abnormality. Another example is Caroli’s disease.

Jaundice of pregnancy :-

Most of the diseases discussed previously can affect women during pregnancy, but there are some additional causes of jaundice that are unique to pregnancy.

Cholestasis of pregnancy. Cholestasis of pregnancy is an uncommon condition that occurs in pregnant women during the third trimester. The cholestasis is often accompanied by itching but infrequently causes jaundice. The itching can be severe, but there is treatment (ursodeoxycholic acid or ursodiol). Pregnant women with cholestasis usually do well although they may be at greater risk for developing gallstones. More importantly, there appears to be an increased risk to the fetus for developmental abnormalities. Cholestasis of pregnancy is more common in certain groups, particularly in Scandinavia and Chile, and tends to occur with each additional pregnancy. There also is an association between cholestasis of pregnancy and cholestasis caused by oral estrogens, and it has been hypothesized that it is the increased estrogens during pregnancy that are responsible for the cholestasis of pregnancy.

Pre-eclampsia. Pre-eclampsia, previously called toxemia of pregnancy, is a disease that occurs during the second half of pregnancy and involves several systems within the body, including the liver. It may result in high blood pressure, fluid retention, and damage to the kidneys as well as anemia and reduced numbers of platelets due to destruction of red blood cells and platelets. It often causes problems for the fetus. Although the bilirubin level in the blood is elevated in pre-eclampsia, it usually is mildly elevated, and jaundice is uncommon. Treatment of pre-eclampsia usually involves delivery of the fetus as soon as possible if the fetus is mature.

Acute fatty liver of pregnancy. Acute fatty liver of pregnancy (AFLP) is a very serious complication of pregnancy of unclear cause that often is associated with pre-eclampsia. It occurs late in pregnancy and results in failure of the liver. It can almost always be reversed by immediate delivery of the fetus. There is an increased risk of infant death. Jaundice is common, but not always present in AFLP. Treatment usually involves delivery of the fetus as soon as possible.

Diagnosis:-
Many tests are available for determining the cause of jaundice, but the history and physical examination are important as well.

History
The history can suggest possible reasons for the jaundice. For example, heavy use of alcohol suggests alcoholic liver disease, whereas use of illegal, injectable drugs suggests viral hepatitis. Recent initiation of a new drug suggests drug-induced jaundice. Episodes of abdominal pain associated with jaundice suggests blockage of the bile ducts usually by gallstones.

Physical examination
The most important part of the physical examination in a patient who is jaundiced is examination of the abdomen. Masses (tumors) in the abdomen suggest cancer infiltrating the liver (metastatic cancer) as the cause of the jaundice. An enlarged, firm liver suggests cirrhosis. A rock-hard, nodular liver suggests cancer within the liver.

Blood tests
Measurement of bilirubin can be helpful in determining the causes of jaundice. Markedly greater elevations of unconjugated bilirubin relative to elevations of conjugated bilirubin in the blood suggest hemolysis (destruction of red blood cells). Marked elevations of liver tests (aspartate amino transferase or AST and alanine amino transferase or ALT) suggest inflammation of the liver (such as viral hepatitis). Elevations of other liver tests, e.g., alkaline phosphatase, suggest diseases or obstruction of the bile ducts.

Ultrasonography
Ultrasonography is a simple, safe, and readily-available test that uses sound waves to examine the organs within the abdomen. Ultrasound examination of the abdomen may disclose gallstones, tumors in the liver or the pancreas, and dilated bile ducts due to obstruction (by gallstones or tumor).

Computerized tomography (CT or CAT scans)
Computerized tomography or CT scans are scans that use x-rays to examine the soft tissues of the abdomen. They are particularly good for identifying tumors in the liver and the pancreas and dilated bile ducts, though they are not as good as ultrasonography for identifying gallstones.

Magnetic resonance imaging (MRI)
Magnetic Resonance Imaging scans are scans that utilize magnetization of the body to examine the soft tissues of the abdomen. Like CT scans, they are good for identifying tumors and studying bile ducts. MRI scans can be modified to visualize the bile ducts better than CT scans (a procedure referred to as MR cholangiography), and, therefore, are better than CT for identifying the cause and location of bile duct obstruction.

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound
Endoscopic retrograde cholangiopancreatography (ERCP) provides the best means for examining the bile duct. For ERCP an endoscope is swallowed by the patient after he or she has been sedated. The endoscope is a flexible, fiberoptic tube approximately four feet in length with a light and camera on its tip. The tip of the endoscope is passed down the esophagus, through the stomach, and into the duodenum where the main bile duct enters the intestine. A thin tube then is passed through the endoscope and into the bile duct, and the duct is filled with x-ray contrast solution. An x-ray is taken that clearly demonstrates the contrast-filled bile ducts. ERCP is particularly good at demonstrating the cause and location of obstruction within the bile ducts. A major advantage of ERCP is that diagnostic and therapeutic procedures can be done at the same time as the x-rays. For example, if gallstones are found in the bile ducts, they can be removed. Stents can be placed in the bile ducts to relieve the obstruction caused by scarring or tumors. Biopsies of tumors can be obtained.

Ultrasonography can be combined with ERCP by using a specialized endoscope capable of doing ultrasound scanning. Endoscopic ultrasound is excellent for diagnosing small gallstones in the gallbladder and bile ducts that can be missed by other diagnostic methods such as ultrasound, CT, and MRI. It also is the best means of examining the pancreas for tumors and can facilitate biopsy through the endoscope of tumors within the pancreas.

Liver biopsy
Biopsy of the liver provides a small piece of tissue from the liver for examination under the microscope. The biopsy most commonly is done with a long needle after local injection of the skin of the abdomen overlying the liver with anesthetic. The needle passes through the skin and into the liver, cutting off a small piece of liver tissue. When the needle is withdrawn, the piece of liver comes with it. Liver biopsy is particularly good for diagnosing inflammation of the liver and bile ducts, cirrhosis, cancer, and fatty liver.

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Treatment:

A doctor uses laboratory tests and imaging studies to determine the cause of the jaundice. If the problem is a disease of the liver, such as acute viral hepatitis, the jaundice usually disappears gradually as the condition of the liver improves. If the problem is blockage of a bile duct, surgery or surgical endoscopy (using a flexible viewing tube with surgical instruments attached: Endoscopy) is usually performed as soon as possible to reopen the affected bile duct. Itching caused by jaundice can be treated with cholestyramine Some Trade Names QUESTRAN taken by mouth. Usually, the itching gradually disappears as the liver’s condition improves.

With the exception of the treatments for specific causes of jaundice mentioned previously, the treatment of jaundice usually requires a diagnosis of the specific cause of the jaundice and treatment directed at the specific cause, e.g., removal of a gallstone blocking the bile duct.

You may click to see:->Natural & Herbal Remedies of Jaundice

Liver Care – Dietary And Ayurvedic Treatment, Home Remedies

Jaundice Treatment With Ayurvedic and Home Remedies

Herbal Supliment of Jaundice

Homeopathic Treatment for LIVER DISEASES Liver Enlargement, Hypertrophy, Jaundice, Hepatitis

HOMEOPATHY FOR JAUNDICE

Homeopathic jaundice remedies

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://en.wikipedia.org/wiki/Jaundice
http://www.medicinenet.com/jaundice/page2.htm
http://merck.com/mmhe/au/sec10/ch135/ch135b.html

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Beetroot

Botanical Name::Beta vulgaris
Family: Amaranthaceae
Subfamily:Betoideae
Genus: Beta
Species: B. vulgaris
Kingdom: Plantae
Order: Caryophyllales

Synonyms: Spinach Beet. Sea Beet. Garden Beet. White Beet. Mangel Wurzel.
Parts Used: Leaves, root.
Habitat:Coasts of Europe, North Africa and Asia, as far as India, and is found in muddy maritime marshes in many parts of England,

Description: Beta vulgaris (Linn.) is a native of South Europe, extensively cultivated as an article of food and especially for the production of sugar, and presents many varieties.The plant is a tall & succulent plant, about 2 feet high, with large, fleshy, glossy leaves, angular stems and numerous leafy spikes of green flowers.foot.

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It is derived from the Sea Beet (B. maritima, Linn.), which grows wild on the coasts of Europe, North Africa and Asia, as far as India, and is found in muddy maritime marshes in many parts of England, a tall, succulent plant, about 2 feet high, with large, fleshy, glossy leaves, angular stems and numerous leafy spikes of green flowers, much like those of the Stinking Goosefoot.

The lower leaves, when boiled, are quite equal in taste to Spinach, and the leaf-stalks and midrib of a cultivated form, the Spinach Beet (B. vulgaris, var. cicla), are sometimes stewed, under the name of Swiss Chard (being the Poirée à Carde of the French, with whom it is served as Sea Kale or Asparagus). This white-rooted Beet is also cultivated for its leaves, which are put into soups, or used as spinach, and in France are often mixed with sorrel, to lessen its acidity. It is also largely used as a decorative plant for its large handsome leaves, blood red or variegated in colour. Its root, thoughcontaining almost as much sugar as the red Garden Beet, neither looks so appetizing nor tastes so well.

The Mangel Wurzel, or Mangold, also a variety of the Beet, too coarse for table use, is good for cattle, who thrive excellently upon this diet, both its leaves and roots affording an abundance of valuable and nutritious food.

In its uncultivated form, the root of the Sea Beet is coarse and unfit for food, nor has any use been made of the plant medicinally, but the Garden Beet has been cultivated from very remote times as a salad plant and for general use as a vegetable. It was so appreciated by the ancients, that it is recorded that it was offered on silver to Apollo in his temple at Delphi.

Click to learn more about —> Beetroot

Constituents:Contains Sodium benzoate, methylparaben, sorbic acid. The root contains about a tenth portion of pure sugar, which is one of the glucoses or fruit sugars and is very wholesome. It is softer than cane sugar and does not crystallize as well as the latter. There is a treacle principle in it, but this renders it all the more nutritious. Canesugar has to be converted by the digestive juices into fruit sugar, before the body can absorb it, but the sugar present in the Beetroot is already in the more easily assimilated form, thus making the Beet a valuable food. Its sugar is a force-giver and an energy creator, a source of vitality to the human body. Besides its tenth portion of pure sugar, Beetroot has as much as a third of its weight in starch and gum.

The Beet makes an appetizing vegetable, plain boiled, stewed, or baked and a good pickle, and in Russia forms an appetizing soup – called Bortsch – the red root in this case being made to exude all its juice into a rich, white stock.

A pleasant wine can be made from the roots and an equally good domestic ale has also been brewed from Mangolds. A considerable amount of alcohol can be obtained by distillation.

Although modern medicine disregards the Beet, of old it was considered to have distinct remedial properties.

Benefits of Beet Root:

*Beetroot provides a good source of anthocyanadins, a natural antioxidant that contributes to its deep red colour

*Extract is a natural source of vitamins and minerals

*Beetroot is used traditionally as a blood building food

*Beetroot may aid the natural process of elimination and support detoxification processes

*Beetroot has liver, spleen, gall bladder and kidney cleansing properties

*Beetroot is particularly rich in Vitamin C, calcium, phosphorus and iron

*The iron contained in beetroot is organic and non-irritating and will not cause constipation

*Beetroot is useful in acidosis due to it being rich in alkaline elements

Click to see -> Beet juice and benefit of beet

Medicinal Action and Uses: The juice of the White Beet was stated to be ‘of a cleansing, digestive quality,’ to open obstructions of the liver and spleen, and, says Culpepper, ‘good for the headache and swimmings therein and all affections of the brain.’ Also,’effectual against all venomous creatures and applied upon the temples, it stayeth inflammations in the eyes, it helpeth burnings, being used without oil and with a little alum put to it is good for St. Anthonys Fire. It is good for all weals, pushes, blisters and blains in the skin: the decoction in water and vinegar healeth the itch if bathed therewith and cleanseth the head of dandriff, scurf and dry scabs and relieves running sores and ulcers and is much commended against baldness and shedding the hair.’
The juice of the Red Beetroot was recommended ‘to stay the bloody flux’ and ‘to help the yellow jaundice,’ also the juice ‘put into the nostrils, purgeth the head, helpeth the noise in the ears and the toothache.’

The Sugar Beet, or White Beet, is a selected form of the ordinary red-rooted Garden Beet and is now the chief source of our sugar; as food for animals, it has been preferred to turnips and carrots.

The root contains about a 10% fructose and about 30% by weight of starch and gum. The juice of the red beetroot was traditionally used for its astringent and antiseptic properties.

Primary chemical constituents of Beet Root include saponiside, phytosterol, betaine, leucine, tyrosine, betacyanin, beta carotene, manganese, potassium, and iron.
Beet Root powder is a very popular colouring agent for use in soaps and cosmetic products. The colour is due to Betanin.

Click to see->Beetroot Cut Blood Pressure “

Augaherb Beetroot AG:
In addition to its use as a colouring agent the rich antioxidant and silicon content of beetroot helps strengthen connective tissue and supports overall skin health.
Carrier: Monopropylene glycol/ water.

About 1760, the Berlin apothecary Marggraff obtained in his laboratory by means of alcohol, 6.2 per cent. of sugar from a white variety of Beet and 4.5 per cent. from a red variety. At the present day, as a result of careful study of many years, improvement of cultivation, careful selection of seed and suitable manuring, especially with nitrate of soda, the average Beet worked up contains 7 per cent. of fibre and 92 per cent. of juice. The average yield of its weight in sugar was stated in 1910 to be 12.79 per cent. in Germany and 11.6 per cent. in France.

Resources:

https://en.wikipedia.org/wiki/Beetroot

http://botanical.com/botanical/mgmh/b/beetro28.html
http://www.augustus-oils.ltd.uk/products/herb%20monographs.htm

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Bladder Stones (Gallstone)

Definition:
Gallstones (commonly misspelled gall stones or gall stone) are solid particles that form from bile in the gallbladder.

•The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.

•The gallbladder is part of the biliary system, which includes the liver and the pancreas.

•The biliary system, among other functions, produces bile and digestive enzymes.
Bile is a fluid made by the liver to help in the digestion of fats.

•It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.

•Bile is stored in the gallbladder until needed.

•When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct. The bile then assists in the digestive process

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here are two types of gallstones: 1) cholesterol stones and 2) pigment stones.

1.Patients with cholesterol stones are more common in the United States; cholesterol stones make  up approximately 80% of all gallstones. They form when there is too much cholesterol in the bile.

2.Pigment stones form when there is excess bilirubin in the bile.
Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

•Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.

•If stones are very small, they may form a sludge or slurry.

•Whether gallstones cause symptoms depends partly on their size and their number, although no combination of number and size can predict whether symptoms will occur or the severity of the symptoms.
Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they move out of the gallbladder.

•If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.

•Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.

•This can cause inflammation and ultimately severe pain, infection, and organ damage.

•If these conditions go untreated, they can even cause death.
Up to 20% of adults in the United States may have gallstones, yet only 1% to 3% develop symptoms.

•Hispanics, Native Americans, and Caucasians of Northern European descent are most likely to be at risk for gallstones. African Americans are at lower risk.

Stones can form in the bladder if waste products in the urine crystallize. About 8 in 10 stones consist of calcium, which comes from excessive salts in the urine. Most are between 1/16 in (2 mm) and ¾ in (2 cm) in diameter, but some grow much larger. bladder stones are about three times more common in men than in women and are much more common in people over 45 years old.

The condition may develop if urine stagnates in the bladder as a result of incomplete emptying. It is also more likely to develop in people who have recurrent or chronic urinary tract infections. In addition, metabolic disorders, such as gout, can give rise to increased levels of waste products in the urine and encourage the formation of bladder stones.

Symptoms:

Often gallstones don’t cause symptoms, but if one partially or completely blocks the normal flow of bile it may cause an attack of biliary colic, with upper abdominal pain, nausea and vomiting.

These episodes are normally brief and typically follow a fatty meal, which causes the gall bladder to contract.

Stones that continue to block the drainage of bile can cause inflammation or infection of the gall bladder and bile ducts, jaundice and acute pancreatitis

A small bladder stone may not cause any symptoms. however, as a stone increases in size, it may start to irritate the bladder lining, causing some or all of the following symptoms:

· painful and difficult urination.
· frequent and sometimes urgent need to urinate.
· blood in the urine.

If you develop any of these symptoms, you should consult your doctor without delay. Left untreated, a stone may irritate the muscles in the bladder wall and cause urge incontinence. A stone that blocks the bladder outlet can cause urinary retention or cystitis, which may be intensively painful.

Causes:
Gallstones occur when bile forms solid particles (stones) in the gallbladder.
•The stones form when the amount of cholesterol or bilirubin in the bile is high.
•Other substances in the bile may promote the formation of stones.
•Pigment stones form most often in people with liver disease or blood disease, who have high levels of bilirubin.
•Poor muscle tone may keep the gallbladder from emptying completely. The presence of residual bile may promote the formation of gallstones.
Risk factors for the formation of cholesterol gallstones include the following:
•female gender,
•being overweight,
•losing a lot of weight quickly on a “crash” or starvation diet, or
•taking certain medications such as birth control pills or cholesterol lowering drugs.

Gallstones are the most common cause of gallbladder disease.

•As the stones mix with liquid bile, they can block the outflow of bile from the gallbladder. They can also block the outflow of digestive enzymes from the pancreas.

•If the blockage persists, these organs can become inflamed. Inflammation of the gallbladder is called cholecystitis. Inflammation of the pancreas is called pancreatitis.

•Contraction of the blocked gallbladder causes increased pressure, swelling, and, at times, infection of the gallbladder.
When the gallbladder or gallbladder ducts become inflamed or infected as the result of stones, the pancreas frequently becomes inflamed too.

•This inflammation can cause destruction of the pancreas, resulting in severe abdominal pain.

•Untreated gallstone disease can become life-threatening, particularly if the gallbladder becomes infected or if the pancreas becomes severely inflamed.

•Gallstones are most common among overweight, middle-aged women, but the elderly and men are more likely to experience more serious complications from gallstones.

•Women who have been pregnant are more likely to develop gallstones. The same is true for women taking birth control pills or on hormone/estrogen therapy as this can mimic pregnancy in terms of hormone levels.

Diagnosis:
Choledocholithiasis (stones in common bile duct) is one of the complications of cholelithiasis (gallstones), so the initial step is to confirm the diagnosis of cholelithiasis. Patients with cholelithiasis typically present with pain in the right-upper quadrant of the abdomen with the associated symptoms of nausea and vomiting, especially after a fatty meal. The physician can confirm the diagnosis of cholelithiasis with an abdominal ultrasound that shows the ultrasonic shadows of the stones in the gallbladder.

The diagnosis of choledocholithiasis is suggested when the liver function blood test shows an elevation in bilirubin. The diagnosis is confirmed with either an Magnetic resonance cholangiopancreatography (MRCP), an ERCP, or an intraoperative cholangiogram. If the patient must have the gallbladder removed for gallstones, the surgeon may choose to proceed with the surgery, and obtain a cholangiogram during the surgery. If the cholangiogram shows a stone in the bile duct, the surgeon may attempt to treat the problem by flushing the stone into the intestine or retrieve the stone back through the cystic duct.

On a different pathway, the physician may choose to proceed with ERCP before surgery. The benefit of ERCP is that it can be utilized not just to diagnose, but also to treat the problem. During ERCP the endoscopist may surgically widen the opening into the bile duct and remove the stone through that opening. ERCP, however, is an invasive procedure and has its own potential complications. Thus, if the suspicion is low, the physician may choose to confirm the diagnosis with MRCP, a non-invasive imaging technique, before proceeding with ERCP or surgery.

Treatment:
Eating a low-fat diet and maintaining an ideal weight may help to prevent the formation of gallstones.

Occasionally they pass out into the intestines on their own, especially if they’re small. Treatment is only needed if gallstones are causing problems.

Complementary therapies may be tried to help remove gallstones, but there’s little evidence they do any good.

Medical (non-surgical) treatments include a drug to dissolve the gallstones (ursodeoxycholic acid) and ultrasonic shockwaves, called lithotripsy, to break down the stones within the body so they can pass out on their own. These are suitable for about one in five patients, but there may be side-effects and the stones may simply form again.

There are various different surgical options:
•Operating through an endoscope, a telescope into the gut. The stones may be broken down within the gall bladder and removed
•Removal of stones and gall bladder (cholecystectomy) – this is the most reliable treatment. As with all operations, there are risks and complications, but these are steadily reducing as techniques improve
Cholecystectomy may be done as an open operation through a cut in the abdomen, or a closed or minimally invasive operation via an endoscope put through a tiny cut in the abdominal wall. There used to be concern about the safety of this type of surgery, but in skilled hands it’s now as safe as open surgery and is how most cholecystectomies are done in the UK.

Bladder stones often recur. About 3 in 5 of the people successfully treated for bladder stones develop the condition again within 7 years.

After gall bladder surgery:
It used to be thought people adapted quickly to the loss of a gall bladder, but there may be problems. Some patients still have symptoms, albeit much milder. Others have problems with bile refluxing into the stomach and gullet, causing severe indigestion.

There may also be reduced absorption of fat resulting in diarrhoea. This usually – but not always – settles.

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Modern Bladder Stone Treatment

Bladder Stone Herbal Treatment

Homeopathic treatment………………(A)…………….(B).……..(C)

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

Resources:

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

http://en.wikipedia.org/wiki/Gallstone

http://www.bbc.co.uk/health/physical_health/conditions/gallstones1.shtml

http://www.charak.com/DiseasePage.asp?thx=1&id=235

Few Health Questions & Answers

Jog past the pain:

 Conditioning of muscles before exercise reduces pain.

Q: I want to exercise, but when I jog my leg starts paining. The pain disappears after taking some rest. I do not smoke or drink. What is wrong with me?

A: This is a typical case of shin splints. This occurs owing to the entrapment of the shin muscles under the non-yielding ligament near the ankle. Exercise makes the muscle expand and since it’s held down firmly, it hurts. As the expansion subsides with rest, the pain disappears. Conditioning of the muscles prior to exercise with warm ups and stretches prevents this. Also, if you persist with the exercise this pain will disappear. You have to jog past the pain….CLICK & SEE

 



Gall stones

Q: I had a laparoscopic cholecystectomy two months back for a gallstone problem. The doctor told me that the gall bladder had been removed with multiple stones and advised me to eat a normal diet. Is it possible for the stones to form again? Some of my friends got stones after a year or two of being operated. Can I eat tomatoes? What type of diet should I have?

A: Once the gall bladder has been successfully removed you cannot develop gallstones again, as there is no gall bladder for the stones to form in. Perhaps your friends developed stones in the kidney the second time. Kidney stones can recur. You can eat tomatoes, but should cut down on oily food. Small frequent meals are best for you.

Fungal infection

Q: I have itching in my groin area. After I scratch it becomes black and ugly. Please advise.

A: This is typically described as dhobis itch. It is a superficial fungal infection. It sets in as the groin area perspires and the sweat can’t evaporate because of tight synthetic pants. You should bathe twice a day with Neko soap. Wear a dhothi and no underclothes at night while sleeping. Apply a fungicidal ointment without steroids twice a day. This has to be continued for at least one and a half months.

Healthy diet

Q: I have gout. What diet should I follow?

A: Avoid foods high in purines like livers, brains, kidneys and mackerel. Limit animal protein in your diet to not more than six ounces of lean meat, poultry or fish a day. Alcohol, especially binge drinking, should be avoided.

Digestion trouble

Q: I am 20 years old. I have to go to the toilet twice before I leave for work. I also suffer from bloating. On having rich food, I have to go to the toilet more frequently. Please advise.

A: Many people have trouble in digesting rich food, wheat, pulses and milk products. Small quantities can be digested, but large amounts often overload the enzyme system in the intestines. Fermentation of these foods causes bloating, intestinal hurry, frequent visits to the toilet and discharge of foul smelling gas. Cut down on such food and you can also take enzyme capsules for better digestion. Exercise helps to regulate bowel habits. Aerobics, walking or running for 40 minutes a day will help. Do stomach crunches — about 20 a day. A well-toned abdomen prevents bloating and helps the intestines function efficiently.

Lump in breast

Q: My wife had developed a lump in her left breast two years ago. We went to a doctor who wanted to poke it with a needle. We refused and went for homeopathic treatment. The lump is bigger now, but it does not pain. There is now another lump in her armpit. She is 42 years old. We do not have any children. What should we do now?

A: The doctor wanted to do a FNAC (Fine Needle Aspiration Cytology). That is a non-invasive way of getting tissue to arrive at a pathological diagnosis. Breast lumps have to be taken seriously for all age groups but particularly so in older women. The lack of any pain is a sinister sign. You need to get the lump evaluated immediately by a surgeon. You need to follow the doctor’s advice. After all, doctors can only tell you the diagnosis and recommend a line of treatment. They can not always tell you what you want to hear.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Source:The Telegraph (Kolkata,India)