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The Surgical Treatment For Portal Hypertension!

The Surgical Treatment For Portal Hypertension!

There are veins which carry blood from the various digestive organs to the liver. When there is an obstruction in the free flow of blood in the liver, it increases the pressure and is known as portal hypertension. This increased blood pressure stresses the blood vessels in the esophagus, stomach, and other digestive organs and results in internal bleeding.

What causes portal hypertension?
Cirrhosis is the most common cause of portal hypertension. The cirrhosis could be a result of excessive consumption of alcohol, chronic hepatitis, or thrombosis in the liver vessels. Blood clots in the portal vein are schistosomiasis ( a parasitic infection) are some other causes of portal hypertension. It is also important to know that in some cases, the causes of this condition remain unknown.

What are the symptoms?
Although, the symptoms of portal hypertension may not be very evident until you identify that there is some damage in the liver. the chances of developing a portal hypertension are increased if you suffer from a liver disease.

  • Ascites, which is fluid accumulation in the abdominal cavity
  • Bleeding in the abdominal vessels
  • Blood in the stools and/or vomitus (black tarry stools or blood in the vomitus)
  • Reduced platelet count
  • Encephalopathy, fluid accumulation in the brain, which can lead to confusion and other issues

How can it be managed?
Once diagnosed, treatment of portal hypertension is at two levels.
At the first level, dietary and lifestyle changes and medical treatment should suffice.

  1. Alcohol, a street drug, and tobacco use should be completely stopped. Sodium and protein intake should be reduced.
  2. Avoid taking any over-the-counter medications without consulting a medical personnel.
  3. Have a good, balanced nutrition
  4. Medications like propranolol are given to control blood pressure
  5. Medications are also given to prevent internal bleeding
  6. If there is encephalopathy, then lactulose is given to clear confusion
  7. The ends of the bleeding vessels are tied and cut off (ligated) endoscopically, and this is known as sclerotherapy. Alternately, bands may be applied to the cut vessels to prevent further bleeding. This is known as banding.

If this first line does not work, then the next level of interventional therapy is initiated.

  • TIPS, which is a transjugular intrahepatic portosystemic shunt, which is a shunt that is placed into the liver to reduce pressure.
  • Distal splenorenal shunt (DRSR) is when a shunt or link is created between the splenic vein and the left kidney vein. This also helps control variceal pressure and bleeding.
  • Both these shunts are widely performed and require follow up once in 6 months to ensure they are performing well and without any blockages.

Other options:

  • In cases where a shunt is not possible, then devascularization is done. This involves removal of the bleeding varices.
  • The fluid in the abdomen may be removed surgically by paracentesis.
  • As a last option, a liver transplant surgery may also be considered.

So, while portal hypertension definitely is a serious medical condition, there are different levels of treatment. The important thing is to alert yourself once any symptoms set in. Early intervention always ensures minimal intervention and good prognosis.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2540 people found this helpful

Try Surgery For Portal Hypertension!

Try Surgery For Portal Hypertension!

There are veins which carry blood from the various digestive organs to the liver. When there is an obstruction in the free flow of blood in the liver, it increases the pressure and is known as portal hypertension. This increased blood pressure stresses the blood vessels in the esophagus, stomach, and other digestive organs and results in internal bleeding.

What causes portal hypertension?
Cirrhosis is the most common cause of portal hypertension. The cirrhosis could be a result of excessive consumption of alcohol, chronic hepatitis, or thrombosis in the liver vessels. Blood clots in the portal vein are schistosomiasis ( a parasitic infection) are some other causes of portal hypertension. It is also important to know that in some cases, the causes of this condition remain unknown.

What are the symptoms?
Although, the symptoms of portal hypertension may not be very evident until you identify that there is some damage in the liver. the chances of developing a portal hypertension are increased if you suffer from a liver disease.

  • Ascites, which is fluid accumulation in the abdominal cavity
  • Bleeding in the abdominal vessels
  • Blood in the stools and/or vomitus (black tarry stools or blood in the vomitus)
  • Reduced platelet count
  • Encephalopathy, fluid accumulation in the brain, which can lead to confusion and other issues

How can it be managed?
Once diagnosed, treatment of portal hypertension is at two levels.
At the first level, dietary and lifestyle changes and medical treatment should suffice.

  1. Alcohol, a street drug, and tobacco use should be completely stopped. Sodium and protein intake should be reduced.
  2. Avoid taking any over-the-counter medications without consulting a medical personnel.
  3. Have a good, balanced nutrition
  4. Medications like propranolol are given to control blood pressure
  5. Medications are also given to prevent internal bleeding
  6. If there is encephalopathy, then lactulose is given to clear confusion
  7. The ends of the bleeding vessels are tied and cut off (ligated) endoscopically, and this is known as sclerotherapy. Alternately, bands may be applied to the cut vessels to prevent further bleeding. This is known as banding.

If this first line does not work, then the next level of interventional therapy is initiated.

  • TIPS, which is a transjugular intrahepatic portosystemic shunt, which is a shunt that is placed into the liver to reduce pressure.
  • Distal splenorenal shunt (DRSR) is when a shunt or link is created between the splenic vein and the left kidney vein. This also helps control variceal pressure and bleeding.
  • Both these shunts are widely performed and require follow up once in 6 months to ensure they are performing well and without any blockages.

Other options:

  • In cases where a shunt is not possible, then devascularization is done. This involves removal of the bleeding varices.
  • The fluid in the abdomen may be removed surgically by paracentesis.
  • As a last option, a liver transplant surgery may also be considered.

So, while portal hypertension definitely is a serious medical condition, there are different levels of treatment. The important thing is to alert yourself once any symptoms set in. Early intervention always ensures minimal intervention and good prognosis.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2709 people found this helpful

Treatment of Encopresis!

Treatment of Encopresis!

Treatment of Encopresis

Homeopathic Treatment of Encopresis
Acupuncture & Acupressure Treatment of Encopresis
Psychotherapy Treatment of Encopresis
Conventional / Allopathic Treatment of Encopresis
Surgical Treatment of Encopresis
Dietary & Herbal Treatment of Encopresis
Other Treatment of Encopresis
What is Encopresis
Symptoms of Encopresis
Causes of Encopresis
Risk factors of Encopresis
Complications of Encopresis
Lab Investigations and Diagnosis of Encopresis
Precautions & Prevention of Encopresis
Treatment of Encopresis

Homeopathic Treatment of Encopresis

Homeopathic Treatment of Encopresis works to regulate bowel movement. It also calms down emotional state of child. Some of the homeopathic remedies for encopresis are:

Bryonia
Causticum
Calcarea carbonica
Lyco
Nux V
Graph

Psychotherapy and Hypnotherapy Treatment of Encopresis

Psychotherapy and Hypnotherapy Treatment of Encopresis gives you techniques for teaching your child not to hold stool. It may be used to help the child cope with the shame, guilt or loss of self-esteem associated with the disorder.

Conventional / Allopathic Treatment of Encopresis

The allopathic Treatment of Encopresis includes the following medications:

Stool softeners, such as lactulose
Colon lubricants, such as mineral oil
Rectal suppositories
Enemas
More oral fluids

Dietary & Herbal Treatment of Encopresis

Eat high fiber food

Drink lot of fluids

What is Encopresis?

Encopresis occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child’s colon is full of impacted stool, liquid stool can start to leak around the hard, dry, impacted stool, soiling a child’s clothing.

Symptoms of Encopresis

Leakage of stool on your child’s underwear
Avoidance of bowel movement
Lack of appetite
Abdominal pain
Constipation
Long periods of time between bowel movements, possibly as long as a week

Causes of Encopresis

Constipation
Emotional issues

Risk factors of Encopresis

More common in boys
Chronic constipation
Not drinking enough fluids
 

Complications of Encopresis

Low self-esteem
Embarrassment and frustration
Depression 

Diagnosis of Encopresis

Diagnosis of Encopresis involves the following tests:

Physical examination
Abdominal X-ray

Precautions & Prevention of Encopresis

Encourage your child to drink plenty of water
Provide your child a diet

high in fiber
Encourage your child to have regular bowel movements

1 person found this helpful

Treatment of Encopresis!

Treatment of Encopresis!

Treatment of Encopresis

Homeopathic Treatment of Encopresis
Acupuncture & Acupressure Treatment of Encopresis
Psychotherapy Treatment of Encopresis
Conventional / Allopathic Treatment of Encopresis
Surgical Treatment of Encopresis
Dietary & Herbal Treatment of Encopresis
Other Treatment of Encopresis
What is Encopresis
Symptoms of Encopresis
Causes of Encopresis
Risk factors of Encopresis
Complications of Encopresis
Lab Investigations and Diagnosis of Encopresis
Precautions & Prevention of Encopresis
Treatment of Encopresis

Homeopathic Treatment of Encopresis

Homeopathic Treatment of Encopresis works to regulate bowel movement. It also calms down emotional state of child. Some of the homeopathic remedies for encopresis are:

Bryonia
Causticum
Calcarea carbonica
Lyco
Nux V
Graph

Psychotherapy and Hypnotherapy Treatment of Encopresis

Psychotherapy and Hypnotherapy Treatment of Encopresis gives you techniques for teaching your child not to hold stool. It may be used to help the child cope with the shame, guilt or loss of self-esteem associated with the disorder.

Conventional / Allopathic Treatment of Encopresis

The allopathic Treatment of Encopresis includes the following medications:

Stool softeners, such as lactulose
Colon lubricants, such as mineral oil
Rectal suppositories
Enemas
More oral fluids

Dietary & Herbal Treatment of Encopresis

Eat high fiber food

Drink lot of fluids
What is Encopresis

Encopresis occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child’s colon is full of impacted stool, liquid stool can start to leak around the hard, dry, impacted stool, soiling a child’s clothing.

Symptoms of Encopresis

Leakage of stool on your child’s underwear
Avoidance of bowel movement
Lack of appetite
Abdominal pain
Constipation
Long periods of time between bowel movements, possibly as long as a week

Causes of Encopresis

Constipation
Emotional issues
Risk factors of Encopresis

More common in boys
Chronic constipation
Not drinking enough fluids

Complications of Encopresis

Low self-esteem
Embarrassment and frustration
Depression 

Diagnosis of Encopresis

Diagnosis of Encopresis involves the following tests:

Physical examination
Abdominal X-ray

Precautions & Prevention of Encopresis

Encourage your child to drink plenty of water
Provide your child a diet high in fiber
Encourage your child to have regular bowel movements

A Guide to Living Healthy: Preventing Cirrhosis of the Liver!

A Guide to Living Healthy: Preventing Cirrhosis of the Liver!

Cirrhosis of liver is slow and gradual replacement of normal healthy liver tissue with scar tissue which results in poor liver function and blockage of flow of blood through liver which comes from intestines. As more scar tissue replaces normal healthy liver, liver begins to fail.

What causes cirrhosis?

  1. Alcohol: Amount of alcohol which can cause liver damage varies from person to person, however those who consume alcohol for long in significant amount are more prone to develop liver damage.
  2. Hepatitis B or hepatitis C: Caused by hepatitis B and C viruses, respectively, which are acquired by contact with contaminated blood (like needlestick injury, blood transfusion, injection drug abuser), sexual contact with infected person and from mother to child during childbirth.
  3. Non-alcoholic fatty liver disease (NAFLD): Caused by presence of extra fat in liver (after excluding significant alcohol intake) which causes inflammation and scarring leading to cirrhosis. Usually seen in patients who are overweight or obese, having diabetes, high fat in blood, high blood pressure or metabolic syndrome.
  4. Drugs causing liver injury.
  5. Others: Autoimmune hepatitis (body`s own immunity acting against liver), Wilson disease (build up of copper in body), hemochromatosis (excess of iron in body), certain bile duct disorders, etc.

What are the symptoms of cirrhosis?

  1. Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
  2. Advanced disease can present with fluid accumulation in legs (edema) or abdomen (ascites), facial puffiness, yellowish discoloration of eyes or urine (jaundice), redness of palm (palmer erythema), decrease urine output, small red lesions on skin, easy bleeding following trauma, blood coming out of mouth/anus/other body site, black colored feaces, mental confusion, flapping tremors of hand, etc. In men it can cause impotence, breast enlargement and shrinking of testis.

What are the complication of cirrhosis?

Portal hypertension: It is a common complication of cirrhosis which is due to increased pressure in portal vein. Portal vein is main blood vessel which carries blood to liver from stomach, intestines, spleen, gallbladder and pancreas. Because of scar formation in liver the normal flow of blood from these organs to liver is hampered. As a result of blockage of blood flow to liver there are few complications which can arise like accumulation of fluid in abdomen (ascites) and legs (edema), formation of enlarged veins (varices) in food pipe (esophagus), stomach, etc., enlargement of spleen (splenomegaly), mental confusion/altered behavior/altered sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

  1. Increase risk of infection because of immune system dysfunction.
  2. Development of liver cancer (Hepatocellular carcinoma)
  3. Easy brusibility or bleeding following light trauma.
  4. Gall bladder stone formation
  5. Metabolic bone disease

What are the stages of cirrhosis?

  1. Compensated cirrhosis: Liver damage is damaged but no abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
  2. Decompensated cirrhosis: Presence of abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

How cirrhosis is diagnosed?

  1. Your doctor will take good history and do proper physical examination. If there is suspicion of cirrhosis then he will subject you to some blood test, ultrasound abdomen, fibroscan/elastography, upper GI endoscopy and if needed CT scan or MRI of abdomen or liver biopsy.

  2. Ultrasound of abdomen in cirrhosis may shows coarse liver echotexture, nodular liver surface, dilated portal vein or collateral, enlarged spleen or abdominal fluid (ascites).

How to prevent cirrhosis?

Best way to avoid development of cirrhosis from predisposing stage of liver illness is to recognize and treat early. Few advices to keep liver healthy are:

  1. Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
  2. Lifestyle modification: Maintain healthy body weight. Avoid being overweight or obese. Aerobic exercise (like brisk walk 30-45min/day atleast 5days/week) regularly helps to lower liver fat.
  3. Avoid: Avoid use of contaminated needles, sharing of items of personal hygiene (like shaving razors, toothbrush, nail clippers, etc), use of illicit drugs, self medication with over the counter drugs or using drugs beyond doctor`s advice.
    1. Practice safe protected sex
    2. Alcohol
  4. Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
  5. Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
  6. Vaccination: For hepatitis A or hepatitis B, if you are not vaccinated or not already infected or unsafe antibody titre. Transmission rate of hepatitis B from mother to child at birth can be reduced with vaccination and immunization of newborn starting within 12 hours of birth as well as by using antiviral drugs (if indicated).

Prevent others from getting infected from you if you harbor virus causing liver damage.

How to treat cirrhosis?

Treatment of cirrhosis is based on cause of cirrhosis and complication of cirrhosis. Main aim of treatment in early stage of cirrhosis is to slow the progression of cirrhosis and prevent complications development

  1. Stop alcohol, antiviral drugs for hepatitis b or hepatitis C, proper sugar level if diabetes, steroid or other medications for autoimmune hepatitis, medications to reduce copper from body in patients with Wilson`s disease, etc.
  2. Drugs to lower portal pressure (beta-blocker or nitrates), drugs to remove fluid from body (diuretics), drugs to lower ammonia level for encephalopathy (lactulose and others), drugs to improve kidney function (albumin, terlipressin and others).
  3. Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
  4. Low salt high protein diet
  5. Stop alcohol intake even if you have other cause of cirrhosis.
  6. Stop smoking
  7. Avoid over the counter drugs (especially pain killers)
  8. Vaccinate if not done already or infected

In case you have a concern or query you can always consult an expert & get answers to your questions!

3279 people found this helpful

Cirrhosis Of Liver - A Complete Guide!

Cirrhosis Of Liver - A Complete Guide!

Cirrhosis of liver is slow and gradual replacement of normal healthy liver tissue with scar tissue which results in poor liver function and blockage of flow of blood through liver which comes from intestines. As more scar tissue replaces normal healthy liver, liver begins to fail.

What causes cirrhosis?

  1. Alcohol: Amount of alcohol which can cause liver damage varies from person to person, however those who consume alcohol for long in significant amount are more prone to develop liver damage.
  2. Hepatitis B or hepatitis C: Caused by hepatitis B and C viruses, respectively, which are acquired by contact with contaminated blood (like needlestick injury, blood transfusion, injection drug abuser), sexual contact with infected person and from mother to child during childbirth.
  3. Non-alcoholic fatty liver disease (NAFLD): Caused by presence of extra fat in liver (after excluding significant alcohol intake) which causes inflammation and scarring leading to cirrhosis. Usually seen in patients who are overweight or obese, having diabetes, high fat in blood, high blood pressure or metabolic syndrome.
  4. Drugs causing liver injury.
  5. Others: Autoimmune hepatitis (body`s own immunity acting against liver), Wilson disease (build up of copper in body), hemochromatosis (excess of iron in body), certain bile duct disorders, etc.

What are the symptoms of cirrhosis?

  1. Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
  2. Advanced disease can present with fluid accumulation in legs (edema) or abdomen (ascites), facial puffiness, yellowish discoloration of eyes or urine (jaundice), redness of palm (palmer erythema), decrease urine output, small red lesions on skin, easy bleeding following trauma, blood coming out of mouth/anus/other body site, black colored feaces, mental confusion, flapping tremors of hand, etc. In men it can cause impotence, breast enlargement and shrinking of testis.

What are the complication of cirrhosis?

Portal hypertension: It is a common complication of cirrhosis which is due to increased pressure in portal vein. Portal vein is main blood vessel which carries blood to liver from stomach, intestines, spleen, gallbladder and pancreas. Because of scar formation in liver the normal flow of blood from these organs to liver is hampered. As a result of blockage of blood flow to liver there are few complications which can arise like accumulation of fluid in abdomen (ascites) and legs (edema), formation of enlarged veins (varices) in food pipe (esophagus), stomach, etc., enlargement of spleen (splenomegaly), mental confusion/altered behavior/altered sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

  1. Increase risk of infection because of immune system dysfunction.
  2. Development of liver cancer (Hepatocellular carcinoma)
  3. Easy brusibility or bleeding following light trauma.
  4. Gall bladder stone formation
  5. Metabolic bone disease

What are the stages of cirrhosis?

  1. Compensated cirrhosis: Liver damage is damaged but no abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
  2. Decompensated cirrhosis: Presence of abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

How cirrhosis is diagnosed?

  1. Your doctor will take good history and do proper physical examination. If there is suspicion of cirrhosis then he will subject you to some blood test, ultrasound abdomen, fibroscan/elastography, upper GI endoscopy and if needed CT scan or MRI of abdomen or liver biopsy.

  2. Ultrasound of abdomen in cirrhosis may shows coarse liver echotexture, nodular liver surface, dilated portal vein or collateral, enlarged spleen or abdominal fluid (ascites).

How to prevent cirrhosis?

Best way to avoid development of cirrhosis from predisposing stage of liver illness is to recognize and treat early. Few advices to keep liver healthy are:

  1. Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
  2. Lifestyle modification: Maintain healthy body weight. Avoid being overweight or obese. Aerobic exercise (like brisk walk 30-45min/day atleast 5days/week) regularly helps to lower liver fat.
  3. Avoid: Avoid use of contaminated needles, sharing of items of personal hygiene (like shaving razors, toothbrush, nail clippers, etc), use of illicit drugs, self medication with over the counter drugs or using drugs beyond doctor`s advice.
    1. Practice safe protected sex
    2. Alcohol
  4. Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
  5. Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
  6. Vaccination: For hepatitis A or hepatitis B, if you are not vaccinated or not already infected or unsafe antibody titre. Transmission rate of hepatitis B from mother to child at birth can be reduced with vaccination and immunization of newborn starting within 12 hours of birth as well as by using antiviral drugs (if indicated).

Prevent others from getting infected from you if you harbor virus causing liver damage.

How to treat cirrhosis?

Treatment of cirrhosis is based on cause of cirrhosis and complication of cirrhosis. Main aim of treatment in early stage of cirrhosis is to slow the progression of cirrhosis and prevent complications development

  1. Stop alcohol, antiviral drugs for hepatitis b or hepatitis C, proper sugar level if diabetes, steroid or other medications for autoimmune hepatitis, medications to reduce copper from body in patients with Wilson's disease, etc.
  2. Drugs to lower portal pressure (beta-blocker or nitrates), drugs to remove fluid from body (diuretics), drugs to lower ammonia level for encephalopathy (lactulose and others), drugs to improve kidney function (albumin, terlipressin and others).
  3. Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
  4. Low salt high protein diet
  5. Stop alcohol intake even if you have other cause of cirrhosis.
  6. Stop smoking
  7. Avoid over the counter drugs (especially pain killers)
  8. Vaccinate if not done already or infected

    If you wish to discuss about any specific problem, you can consult a gastroenterologist.

3014 people found this helpful

How To Prevent Cirrhosis Of Liver?

How To Prevent Cirrhosis Of Liver?

Cirrhosis of liver is slow and gradual replacement of normal healthy liver tissue with scar tissue which results in poor liver function and blockage of flow of blood through liver which comes from intestines. As more scar tissue replaces normal healthy liver, liver begins to fail.

What causes cirrhosis?

  1. Alcohol: Amount of alcohol which can cause liver damage varies from person to person, however those who consume alcohol for long in significant amount are more prone to develop liver damage.
  2. Hepatitis B or hepatitis C: Caused by hepatitis B and C viruses, respectively, which are acquired by contact with contaminated blood (like needlestick injury, blood transfusion, injection drug abuser), sexual contact with infected person and from mother to child during childbirth.
  3. Non-alcoholic fatty liver disease (NAFLD): Caused by presence of extra fat in liver (after excluding significant alcohol intake) which causes inflammation and scarring leading to cirrhosis. Usually seen in patients who are overweight or obese, having diabetes, high fat in blood, high blood pressure or metabolic syndrome.
  4. Drugs causing liver injury.
  5. Others: Autoimmune hepatitis (body`s own immunity acting against liver), Wilson disease (build up of copper in body), hemochromatosis (excess of iron in body), certain bile duct disorders, etc.

What are the symptoms of cirrhosis?

  1. Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
  2. Advanced disease can present with fluid accumulation in legs (edema) or abdomen (ascites), facial puffiness, yellowish discoloration of eyes or urine (jaundice), redness of palm (palmer erythema), decrease urine output, small red lesions on skin, easy bleeding following trauma, blood coming out of mouth/anus/other body site, black colored feaces, mental confusion, flapping tremors of hand, etc. In men it can cause impotence, breast enlargement and shrinking of testis.

What are the complication of cirrhosis?

Portal hypertension: It is a common complication of cirrhosis which is due to increased pressure in portal vein. Portal vein is main blood vessel which carries blood to liver from stomach, intestines, spleen, gallbladder and pancreas. Because of scar formation in liver the normal flow of blood from these organs to liver is hampered. As a result of blockage of blood flow to liver there are few complications which can arise like accumulation of fluid in abdomen (ascites) and legs (edema), formation of enlarged veins (varices) in food pipe (esophagus), stomach, etc., enlargement of spleen (splenomegaly), mental confusion/altered behavior/altered sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

  1. Increase risk of infection because of immune system dysfunction.
  2. Development of liver cancer (Hepatocellular carcinoma)
  3. Easy brusibility or bleeding following light trauma.
  4. Gall bladder stone formation
  5. Metabolic bone disease

What are the stages of cirrhosis?

  1. Compensated cirrhosis: Liver is damaged or cirrhotic but there is no no abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
  2. Decompensated cirrhosis: Presence of abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).

How cirrhosis is diagnosed?

  1. Your doctor will take good history and do proper physical examination. If there is suspicion of cirrhosis then he will subject you to some blood test, ultrasound abdomen, fibroscan/elastography, upper GI endoscopy and if needed CT scan or MRI of abdomen or liver biopsy.

  2. Ultrasound of abdomen in cirrhosis may shows coarse liver echotexture, nodular liver surface, dilated portal vein or collateral, enlarged spleen or abdominal fluid (ascites).

What are the stages of cirrhosis How to prevent cirrhosis?

Best way to avoid development of cirrhosis from predisposing stage of liver illness is to recognize and treat early. Few advices to keep liver healthy are:

  1. Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
  2. Lifestyle modification: Maintain healthy body weight. Avoid being overweight or obese. Aerobic exercise (like brisk walk 30-45min/day atleast 5days/week) regularly helps to lower liver fat.
  3. Avoid: Avoid use of contaminated needles, sharing of items of personal hygiene (like shaving razors, toothbrush, nail clippers, etc), use of illicit drugs, self medication with over the counter drugs or using drugs beyond doctor`s advice.
    1. Practice safe protected sex
    2. Alcohol
  4. Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
  5. Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
  6. Vaccination: For hepatitis A or hepatitis B, if you are not vaccinated or not already infected or unsafe antibody titer. Transmission rate of hepatitis B from mother to child at birth can be reduced with vaccination and immunization of newborn starting within 12 hours of birth as well as by using antiviral drugs (if indicated).

Prevent others from getting infected from you if you harbor virus causing liver damage.

How to treat cirrhosis?

Treatment of cirrhosis is based on cause of cirrhosis and complication of cirrhosis. Main aim of treatment in early stage of cirrhosis is to slow the progression of cirrhosis and prevent complications development

  1. Stop alcohol, antiviral drugs for hepatitis b or hepatitis C, proper sugar level if diabetes, steroid or other medications for autoimmune hepatitis, medications to reduce copper from body in patients with Wilson`s disease, etc.
  2. Drugs to lower portal pressure (beta-blocker or nitrates), drugs to remove fluid from body (diuretics), drugs to lower ammonia level for encephalopathy (lactulose and others), drugs to improve kidney function (albumin, terlipressin and others).
  3. Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
  4. Low salt high protein diet
  5. Stop alcohol intake even if you have other cause of cirrhosis.
  6. Stop smoking
  7. Avoid over the counter drugs (especially pain killers)
  8. Vaccinate if not done already or infected
2114 people found this helpful

Understanding Jaundice (Kamala)

Understanding Jaundice (Kamala)

Jaundice (also known as icterus) is a yellowish pigmentation of the skin, the conjunctival membranes over the sclera (whites of the eyes), and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood). This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid. Concentration of bilirubin in blood plasma does not normally exceed 1 mg/dl (gt 17 x00b5 mol/l). A concentration higher than 1.8 mg/dl (gt 30 x00b5 mol/l) leads to jaundice. This is a brief presentation on jaundice and its ayurvedic management.

Jaundice, also known as icterus is a disease caused due to the dysfunction of the liver. It is the most common of all liver disorders that results from an obstruction in the bile duct or the loss of the bile producing liver cells. Jaundice refers to the yellowing of skin and whites of the eyes caused by the high level of pigment bilirubin in the body. Bile is a vital digestive fluid that is essential for proper nutrition. It is unable to function properly and filtering and elimination of toxins from your system is affected.

Jaundice is caused mainly by the dysfunctional liver or other liver diseases. In tropical countries jaundice is more likely to happen because of the extreme nature of summer heat and digestive difficulties that it causes. Chronic digestive disorders like bowels inflammatory syndromes, gastric problems also play bigger roles in causing the disease. In relation to these internal causes jaundice can be of various types. Apart from this hepatitis virus can cause some major types of jaundice which can be potential life threats. Obstructive jaundice is another type of jaundice which is caused by obstruction caused in the liver function to relieve the bilirubin from the body. Pregnancy related jaundice and jaundice at child birth are other types of jaundice which is more common in pregnant women. Before introducing some of the major types of jaundice, for a better clinical understanding of the disease let us take a look at the basic process which causes jaundice.

Causes, incidence, and risk factors:
Every day, a small number of red blood cells in your body die, and are replaced by new ones. The liver removes the old blood cells, forming bilirubin. The liver helps break down bilirubin so that it can be removed by the body in the stool. This waste product is called bilirubin and when liver cannot perform its assigned function of relieving this waste product from our organic process the higher amount of presence of this chemical substance in the blood is felt and this is how the jaundice occurs. All major types of jaundice can have different areas of reasoning for the malfunction of the production process and relieving process of bilirubin, but the basic facts related with the bilirubin and its effects are all same in all minor or major types of jaundice

When too much bilirubin builds up in the body, jaundice may result.

Jaundice is caused due to following causes:
Obstruction of the bile ducts (by infection, tumor or gallstones)
Viral hepatitis (hepatitis a, hepatitis b, hepatitis c, hepatitis d, and hepatitis e)
Drug-induced cholestasis (bile pools in the gallbladder because of the effects of drugs)
Drug-induced hepatitis (hepatitis triggered by medications, including erythromycin sulfa drugs, antidepressants, anti-cancer drugs, aldomet, rifampin, steroids, chlorpropamide, tolbutamide, oral contraceptives, testosterone, propylthiouracil)
Biliary stricture
Alcoholic liver disease (alcoholic cirrhosis)
Pancreatic carcinoma (cancer of the pancreas)
Primary biliary cirrhosis
Ischemic hepatocellular jaundice (jaundice caused by inadequate oxygen or inadequate blood flow to the liver)
Intrahepatic cholestasis of pregnancy (bile pools in the gallbladder because of the pressure in the abdomen with pregnancy)
Haemolytic anemia
Congenital disorders of bilirubin metabolism (gilbert’s syndrome, dubin-johnson syndrome, rotor’s syndrome)
Chronic active hepatitis
Autoimmune hepatitis
Malaria


Jaundice is often a sign of a problem with the liver, gallbladder, or pancreas. Infections, use of certain drugs, cancer, blood disorders, gallstones, birth defects and a number of other medical conditions can lead to jaundice.

Clinical symptoms:
Jaundice may appear suddenly or develop slowly over time. Common symptoms of jaundice commonly include:


Yellow skin and the white part of the eyes (sclera) -- when jaundice is more severe, these areas may look brown 
Yellow color inside the mouth
Dark or brown-colored urine
Pale or clay-colored stools

Other symptoms depend on the disorder causing the jaundice:
Cancers may produce no symptoms, or there may be fatigue, weight loss, or other symptoms

Hepatitis may produce nausea, vomiting, fatigue, or other symptoms.

Differential diagnosis:
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.

Pre-hepatic jaundice: it is caused by anything which causes an increased rate of hemolysis (breakdown of red blood cells).

Laboratory findings include:
Urine: no bilirubin present, urobilinogen gt; 2 units (i.e. hemolytic anemia causes increased heme metabolism; exception: infants where gut flora has not developed).
Serum: increased unconjugated bilirubin.
Kernicterus is associated with increased unconjugated bilirubin.

Hepatocellular jaundice: it can be caused by acute or chronic hepatitis, hepatotoxicity, cirrhosis, drug induced hepatitis and alcoholic liver disease.

Laboratory findings depend on the cause of jaundice, include:
Urine: conjugated bilirubin present, urobilirubin gt; 2 units but variable (except in children). Kernicterus is a condition not associated with increased conjugated bilirubin.
Plasma protein show characteristic changes.
Plasma albumin level is low but plasma globulins are raised due to an increased formation of antibodies.

Post-hepatic jaundice: it is 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" can live in the common bile duct, causing obstructive jaundice.

The presence of pale stools and dark urine suggests an obstructive or post-hepatic cause as normal feces get their color from bile pigments. However, although pale stools and dark urine is a feature of biliary obstruction, they can occur in many intra-hepatic illnesses and are therefore not a reliable clinical feature to distinguish obstruction from hepatic causes of jaundice. Patients also can present with elevated serum cholesterol, and often complain of severe itching or" pruritus" because of the deposition of bile salts.

Signs and tests:
No single test can differentiate between various classifications of jaundice. A combination of liver function tests is essential to arrive at a diagnosis.

Other tests vary, but may include:
Hepatitis virus panel to look for infection of the liver
Liver function tests to determine how well the liver is working
Complete blood count to check for low blood count or anemia
Abdominal ultrasound
Abdominal ct scan
Endoscopic retrograde cholangiopancreatography (ercp)
Percutaneous transhepatic cholangiogram (ptca)
Liver biopsy
Cholesterol level
Prothrombin time


Ayurvedic approach:
In the ayurvedic perspectrive jaundice (kamala) is a complaint of the pitta region of the body, which denotes a build up of toxins in an intestinal area that is causing an in-balance in the overall dosha. You need to expel such toxins to rebalance the immune system and yourself. All the great indian laureates viz. Acharaya charaka, sushruta and vagbhatta have described the yakrita roga (liver diseases). Acharaya charaka has mentioned a detailed description of kamala roga in connection with liver disease. He has given details of nidan, samprapti, rupa, bheda, sadhyasadhayata and chikitsa karma. The concept of kamala in ayurveda kayam malyati iti kamala. i.e. The whole body becomes dirty because of accumulation of pitta in the body which refers to accumulation of bilirubin in this context. Kamala produces various signs and symptoms as haridra netra (yellow discoloration of conjunctiva), haridra twaka (yellow colour of skin), haridra nakha (yellow nails), bheka varna (frog like body color), daha (burning sensation), ajirna (indigestion), daurbalaya (weakness), kshudhanasha (anorexia) etc.

Management:
Since liver is the largest organ and main site of metabolism and detoxification, the diet should be easily digestible during this condition. So ayurvedic treatment contains such medicines which will facilitate removal of waste substances from the gut and kidney.

The treatment of kamala (jaundice) must start with purgation. The basic theory is that no burden be placed on the liver and for that, a daily purgative is recommended. A diuretic may also be administered to encourage the flow of urine, which will expel most of the bile from the system this helps to remove the toxins accumulated in the liver and the rest of the body. Strong purgatives are avoided. Oral medicines and rasayana treatments are also given to the patient. Strong purgatives are avoided.

Ayurvedic treatments for jaundice will aim to rectify the pitta imbalance and eliminate the toxins accumulated in the human system. Elimination of toxins is done through the panchakarma treatments that begin with an oil massage followed by mild emesis and purgation with bitter herbs.

Medicines used:
Regular intake of avipattikar churna about one- teaspoonful twice a day with hot water.
Arogyavardhani vati 2-2 tablets regularly with hot water twice a day.
Punarnava mandoor, 1 tab thice daily for 2 to 3 weeks.
Navrayas loh can also be given in the dose of 125mg thrice daily.
Daily consumption of triphala powder (10gm) soaked in water overnight. (equivalent to lactulose)
Regular intake of guduchi juice 10gm twice or thrice a day.
Daily intake of neem juice is also useful for jaundice
Rohitakyadi, punarnava, phalatrikyadi kwath, dhatri lauha etc. May also be used.

Some routine home remedies:
Mix 1 teaspoon of roasted barley powder to 1 cup of water. Add 1 teaspoon of honey to it and have this twice a day.
Add 1 teaspoon paste of basil leaves to a cup of radish juice. Have this juice twice a day for 15-20 days.
Have a cup of sugarcane juice with teaspoon of basil leaves paste twice a day. Juice should be prepared in hygienic conditions so as to avoid contamination from dust or other substances


Pathya-apathya (do's don'ts):
Avoid non-vegetarian foods at least till the effects of the jaundice last on the skin. Do not take even heavy vegetarian foods. The reason is that the liver needs to produce more bile to digest these heavy foodstuffs and this could alleviate the pigmentation of the skin.

Completely restrict your intake of junk food such as chocolate, cakes, pastries, potato chips, ice-creams, colas and other aerated drinks, etc.
Always drink water that is filtered or boiled. Do not drink raw milk.
Do not eat sea foods especially oysters, unless you are sure they have come from a reliable source.
Take simple food for the first three days of the jaundice affliction. Have a meal of porridge, especially rice gruel (kanji). You can flavor it with jaggery syrup or honey.
There must be a complete abstinence of salt as it is a mineral and requires a difficult digestion process.
Do not give cereals and pulses to the patient as they cause inflammation in the liver. Grapes, black soya beans, nuts, sweet potatoes are the fruits that are beneficial in jaundice.
Vegetable salad of tomato, carrot, radish and its leaves, and two-three slices of lemon are very good for health and very effective in curing jaundice in a natural way.
It is advised for the patient suffering with jaundice to take proper rest and drink fruit juices.
Bitter vegetables like bitter gourd and the bitter variety of drumsticks are beneficial to the jaundice patient.
Alcohol is very harmful to the jaundice patient. It can complicate the disease with fatal consequences. Hence say a strict no to alcohol.

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