Hepatitis
Hepatitis:
Hepatitis (plural hepatitides) is an inflammation of the liver characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar (ἧπαρ), the root being hepat- (ἡπατ-), meaning liver, and suffix -itis, meaning “inflammation” (c. 1727).[1] The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis.
Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide, but it can also be due to toxins (notably alcohol, certain medications and plants), other infections and autoimmune diseases.
Signs and symptoms
[edit] Acute
Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort. Physical findings are usually minimal, apart from jaundice in a third and tender hepatomegaly (swelling of the liver) in about 10%. Some exhibit lymphadenopathy (enlarged lymph nodes, in 5%) or splenomegaly (enlargement of the spleen, in 5%).[2]
Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks.[3]
A small proportion of people with acute hepatitis progress to acute liver failure, in which the liver is unable to clear harmful substances from the circulation (leading to confusion and coma due to hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding). This may become life-threatening and occasionally requires a liver transplant.
[edit] Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise, tiredness and weakness, and often leads to no symptoms at all. It is commonly identified on blood tests performed either for screening or to evaluate nonspecific symptoms. The occurrence of jaundice indicates advanced liver damage. On physical examination there may be enlargement of the liver.[4]
Extensive damage and scarring of liver (i.e. cirrhosis) leads to weight loss, easy bruising and bleeding tendencies, peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the abdominal cavity). Eventually, cirrhosis may lead to various complications: esophageal varices (enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction).
Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.[4]
Alcoholic hepatitis
Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset.
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C.[citation needed] The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis.
Non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease (NAFLD) is the occurrence of fatty liver in people who have no history of alcohol use. It is most commonly associated with obesity (80% of all obese people have fatty liver). It is more common in women. Severe NAFLD leads to inflammation, a state referred to as non-alcoholic steatohepatitis (NASH), which on biopsy of the liver resembles alcoholic hepatitis (with fat droplets and inflammatory cells, but usually no Mallory bodies).
The diagnosis depends on medical history, physical exam, blood tests, radiological imaging and sometimes a liver biopsy. The initial evaluation to identify the presence of fatty infiltration of the liver is medical imaging, including such ultrasound, computed tomography (CT), or magnetic resonance (MRI). However, imaging cannot readily identify inflammation in the liver. Therefore, the differentiation between steatosis and NASH often requires a liver biopsy. It can also be difficult to distinguish NASH from alcoholic hepatitis when the patient has a history of alcohol consumption. Sometimes in such cases a trial of abstinence from alcohol along with follow-up blood tests and a repeated liver biopsy are required.
NASH is becoming recognized as the most important cause of liver disease second only to hepatitis C in numbers of patients going on to cirrhosis.[citation needed]
Ischemic hepatitis
Ischemic hepatitis is caused by decreased circulation to the liver cells. Usually this is due to decreased blood pressure (or shock), leading to the equivalent term “shock liver”. Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver (such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells). Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT), which may exceed 1000 U/L. The elevation in these blood tests is usually transient (lasting 7 to 10 days). It is rare that liver function will be affected by ischemic hepatitis.
See also
References
- ^ Online Etymology Dictionary
- ^ Ryder S, Beckingham I (2001). “ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis”. BMJ 322 (7279): 151–153. doi:10.1136/bmj.322.7279.151. PMID 11159575.
- ^ a b V.G. Bain and M. Ma, Acute Viral Hepatitis, Chapter 14, First principle of gastroenterology (an online text book)
- ^ a b Chronic hepatitis at Merck Manual of Diagnosis and Therapy Home Edition
- ^ Figure 7.12 (Some causes of acute parenchymal damage), Parveen, M.D.
Pneumonia
PNEUMONIA:
Pneumonia is an inflammatory condition of the lung.[1] It is often characterized as including inflammation of the parenchyma of the lung (that is, the alveoli) and abnormal alveolar filling with fluid (consolidation and exudation).[2]
The alveoli are microscopic air filled sacs in the lungs responsible for gas exchange. Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. Its cause may also be officially described as unknown when infectious causes have been excluded.
Typical symptoms associated with pneumonia include cough, chest pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum. Treatment depends on the cause of pneumonia; bacterial pneumonia is treated with antibiotics.
Pneumonia is common, occurring in all age groups, and is a leading cause of death among the young, the old, and the chronically ill.[3] Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the treatment, any complications, and the person’s underlying health.
Pneumonia can be caused by microorganisms, irritants and unknown causes. When pneumonias are grouped this way, infectious causes are the most common type. The symptoms of infectious pneumonia are caused by the invasion of the lungs by microorganisms and by the immune system‘s response to the infection. Although more than one hundred strains of microorganism can cause pneumonia, only a few are responsible for most cases. The most common causes of pneumonia are viruses and bacteria. Less common causes of infectious pneumonia are fungi and parasites.
Signs and symptoms
Pneumonia fills the lung’s alveoli with fluid, keeping oxygen from reaching the bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of fluid from pneumonia.
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People with infectious pneumonia often have a cough producing greenish or yellow sputum, or phlegm and a high fever that may be accompanied by shaking chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either experienced during deep breaths or coughs or worsened by them. People with pneumonia may cough up blood, experience headaches, or develop sweaty and clammy skin. Other possible symptoms are loss of appetite, fatigue, blueness of the skin, nausea, vomiting, mood swings, and joint pains or muscle aches. Less common forms of pneumonia can cause other symptoms; for instance, pneumonia caused by Legionella may cause abdominal pain and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and night sweats. In elderly people, manifestations of pneumonia are seldom typical. They may develop a new or worsening confusion (delirium) or may experience unsteadiness, leading to falls. Infants with pneumonia may have many of the symptoms above, but in many cases they are simply sleepy or have a decreased appetite.[9]
See also
References
- ^ pneumonia at eMedicine Dictionary
- ^ pneumonia at Dorland’s Medical Dictionary
- ^ “Causes of death in neonates and children under five in the world (2004)”. World Health Organization.. 2008. http://www.who.int/entity/child_adolescent_health/media/causes_death_u5_neonates_2004.pdf.
- ^ a b c d Table 13-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7.
- ^ “UpToDate Inc.”. http://www.uptodate.com/online/content/topic.do?topicKey=pedi_id/18313&selectedTitle=1~1&source=search_result.
- ^ Krause DC, Balish MF (February 2004). “Cellular engineering in a minimal microbe: structure and assembly of the terminal organelle of Mycoplasma pneumoniae”. Mol. Microbiol. 51 (4): 917–24. doi:10.1046/j.1365-2958.2003.03899.x. PMID 14763969.
- ^ Girard TD, Bernard GR (March 2007). “Mechanical ventilation in ARDS: a state-of-the-art review”. Chest 131 (3): 921–9. doi:10.1378/chest.06-1515. PMID 17356115.
Health – Lowering Blood Pressure
Ten ways to go beyond low-sodium.
You can’t see it, you can’t feel it, and unless you get checked, you won’t even know you have it. That makes high blood pressure, or hypertension, a quiet killer, one that slowly damages your blood vessels, heart, and eyes while simultaneously increasing your risk of heart disease, stroke, dementia, and kidney disease. High blood pressure results in stiff, inflexible arteries that are virtual magnets for cholesterol and other blood components that form the gunk known as plaque. If you already have this gunk, blood rushing past at high force is just what it takes to nick the “cap” off mounds of plaque, setting the dominoes in motion for a heart attack.
One in five Americans have high blood pressure, and nearly a third don’t know they have it. Many of the rest of us are at risk, as blood pressure slowly creeps up with age. Regardless of where your blood pressure lies along the spectrum, the following tips will help lower it if it’s high, and keep it from rising if it’s where it should be–guaranteed.
1. Every morning, take a brisk 15-minute walk.
Amazingly, you don’t need a lot of exercise to make a difference in your blood pressure. When Japanese researchers asked 168 inactive volunteers with high blood pressure to exercise at a health club for different amounts of time each week for eight weeks, blood pressure dropped almost as much in those who exercised 30-90 minutes a week as in those who exercised more than 90 minutes a week.
2. Write “take medication” on your calendar every day.
Twenty-five percent of the time, when your blood pressure hasn’t dropped after you’ve started medication, the reason is that you forgot to take your pills.
3. Buy a home blood pressure kit.
A study in the Journal of the American Medical Association found that home blood pressure testing provides a better overall picture of blood pressure than measurement in a doctor’s office. In the study, office measurement failed to identify 13 percent of patients who had high blood pressure only in the office but not at home (called “white-coat hypertension”). It also failed to identify 9 percent of people who had high blood pressure at home but not in the doctor’s office. Another study, this one presented at the 2004 European Society of Hypertension meeting, found that people who monitored their blood pressure at home had lower overall blood pressure than those who only had their pressure taken at the doctor’s office. A good home blood pressure kit costs under $100, a small price to pay for peace of mind.
4. Sprinkle 2 tablespoons flaxseed over your yogurt in the morning
and mix 2 tablespoons into your ice cream, spaghetti sauce, or other food later in the day. One small study found that adding 4 tablespoons of the crunchy stuff significantly lowered systolic blood pressure (a strong predictor of heart disease) in postmenopausal women with a history of heart disease. Flaxseed is rich in many nutrients and in fiber. Its effects on blood pressure are likely due to its high content of omega-3 fatty acids.
5. Substitute tea for your morning (and afternoon and evening) coffee.
An Australian study found that every one-cup increase in daily tea consumption decreased systolic blood pressure (the top number) two points and diastolic pressure one point. The benefits ended after four cups, however.
6. Dip your chips into guacamole.
Why? Avocados have more bloodpressure-lowering potassium than any other fruit or vegetable, including bananas. We should get about 4.7 grams a day of potassium, but most Americans get just half this amount.
7. Turn to dark chocolate when your sweet tooth asserts itself.
Unlike milk chocolate, dark chocolate is rich in flavonoids that keep your arteries flexible, preventing the increases in pressure that come with stiffer blood vessels. That’s thought to be one reason for the normal blood pressure of a tribe of Panamanian Indians who eat a high-salt diet but also consume massive amounts of cocoa. In addition, a study published in the Journal of the American Medical Association found that three ounces of dark chocolate a day helped to lower blood pressure in older people with isolated systolic hypertension (a type of high blood pressure in which only the upper number of a pressure reading is high). Other good sources of flavonoids include tea and wine, as well as many fruits and vegetables.
8. Snack on roasted soybeans.
These make a crunchy, nutrient-packed munch that’s as yummy as any bag of chips. Studies show that people with high blood pressure can lower their systolic readings by an average of 10 points by eating one ounce of roasted soybeans (also called soy nuts) a day for two weeks. The beans are available at some supermarkets, as well as specialty and health food stores. Just look for unsalted beans.
9. Flavor your food with lots of ground pepper.
Why? Pepper is a strong, dominant flavor that can help you reduce your interest in salt. In fact, your tongue is easily trained away from its salt addiction. When you switch to low-salt foods, your meals may taste bland for a couple of days. Bring in the pepper. And if that doesn’t appeal to you, try garlic, lemon, ginger, basil, or other big-punch flavors you like. After a week, your old favorite foods will taste dreadfully oversalted and your blood pressure will be singing your praises.
10. Eat a banana or a quarter of a cantaloupe at each breakfast.
That’s because both are rich in potassium. Potassium is sometimes called the “un-salt” because if you don’t get enough of it, your blood pressure is likely to rise. It’s easy to slide potassium into your diet. Other high-potassium foods include spinach, lima beans, sweet potatoes, and the aforementioned avocados.
Source: Reader’s Digest
My Heart & Yours, Protect it!
