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[ { "from": "human", "value": "What is (are) Diabetic Kidney Disease?" }, { "from": "gpt", "value": "The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine.\nWhen the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short.\nKidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final product becomes urine." } ]

[ { "from": "human", "value": "What is (are) Diabetic Kidney Disease?" }, { "from": "gpt", "value": "Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.\nDiabetes is a disorder of metabolism the way the body uses digested food for energy. The digestive tract breaks down carbohydratessugars and starches found in many foodsinto glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, cells throughout the body absorb glucose and use it for energy.\nInsulin is made in the pancreas, an organ located behind the stomach and below the liver. As blood glucose levels rise after a meal, the pancreas is triggered to release insulin. The pancreas contains clusters of cells called pancreatic islets. Beta cells within the pancreatic islets make insulin and release it into the blood.\nDiabetes develops when the body doesnt make enough insulin, is not able to use insulin effectively, or both. As a result, glucose builds up in the blood instead of being absorbed by cells in the body. The bodys cells are then starved of energy despite high blood glucose levels." } ]

[ { "from": "human", "value": "What are the symptoms of Diabetic Kidney Disease?" }, { "from": "gpt", "value": "People with diabetic kidney disease do not have symptoms in the early stages. As kidney disease progresses, a person can develop edema, or swelling. Edema happens when the kidneys cannot get rid of the extra fluid and salt in the body. Edema can occur in the legs, feet, or ankles and less often in the hands or face. Once kidney function decreases further, symptoms may include\n- appetite loss\n- nausea\n- vomiting\n- drowsiness, or feeling tired\n- trouble concentrating\n- sleep problems\n- increased or decreased urination\n- generalized itching or numbness\n- dry skin\n- headaches\n- weight loss\n- darkened skin\n- muscle cramps\n- shortness of breath\n- chest pain" } ]

[ { "from": "human", "value": "How to diagnose Diabetic Kidney Disease?" }, { "from": "gpt", "value": "A health care provider diagnoses diabetic kidney disease based on\n- a medical and family history\n- a physical exam\n- urine tests\n- a blood test\nMedical and Family History\nTaking a medical and family history is one of the first things a health care provider may do to help diagnose diabetic kidney disease. He or she will ask about the symptoms and the patients diabetes history.\nPhysical Exam\nAfter taking a medical and family history, a health care provider will perform a physical exam. During a physical exam, a health care provider usually\n- examines the patients body to check for changes in skin color\n- taps on specific areas of the patients body, checking for swelling of the feet, ankles, or lower legs\nUrine Tests\nDipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. A patient collects the urine sample in a special container in a health care providers office or a commercial facility. The office or facility tests the sample onsite or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when blood or protein is present in urine.\nUrine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The patient collects a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed into the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine. A urine albumin-to-creatinine ratio above 30 mg/g may be a sign of kidney disease.\nBlood Test\nA blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate (eGFR). The results of the test indicate the following:\n- eGFR of 60 or above is in the normal range\n- eGFR below 60 may indicate kidney damage\n- eGFR of 15 or below may indicate kidney failure" } ]

[ { "from": "human", "value": "How to diagnose Diabetic Kidney Disease?" }, { "from": "gpt", "value": "People with diabetes should get regular screenings for kidney disease. The National Kidney Disease Education Program recommends the following:\n- urine albumin-to-creatinine ratio measured at least once a year in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more\n- eGFR calculated at least once a year in all people with type 1 or type 2 diabetes" } ]

[ { "from": "human", "value": "How to prevent Diabetic Kidney Disease?" }, { "from": "gpt", "value": "People can prevent or slow the progression of diabetic kidney disease by\n- taking medications to control high blood pressure\n- managing blood glucose levels\n- making changes in their eating, diet, and nutrition\n- losing weight if they are overweight or obese\n- getting regular physical activity\nPeople with diabetes should see a health care provider who will help them learn to manage their diabetes and monitor their diabetes control. Most people with diabetes get care from primary care providers, including internists, family practice doctors, or pediatricians. However, having a team of health care providers can often improve diabetes care. In addition to a primary care provider, the team can include\n- an endocrinologista doctor with special training in diabetes\n- a nephrologista doctor who specializes in treating people who have kidney problems or related conditions\n- diabetes educators such as a nurse or dietitian\n- a podiatrista doctor who specializes in foot care\n- an ophthalmologist or optometrist for eye care\n- a pharmacist\n- a dentist\n- a mental health counselor for emotional support and access to community resources\nThe team can also include other health care providers and specialists.\nBlood Pressure Medications\nMedications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensinconverting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown to slow the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care provider may prescribe a diuretica medication that helps the kidneys remove fluid from the blood. A person may also need beta-blockers, calcium channel blockers, and other blood pressure medications.\nPeople should talk with their health care provider about their individual blood pressure goals and how often they should have their blood pressure checked.\nManaging Blood Glucose Levels\nPeople manage blood glucose levels by\n- testing blood glucose throughout the day\n- following a diet and physical activity plan\n- taking insulin throughout the day based on food and liquid intake and physical activity\nPeople with diabetes need to talk with their health care team regularly and follow their directions closely. The goal is to keep blood glucose levels within the normal range or within a range set by the persons health care team. More information about diabetes is provided in the NIDDK health topics:\n- National Diabetes Statistics Report, 2014\n- Diagnosis of Diabetes and Prediabetes\nEating, Diet, and Nutrition\nFollowing a healthy eating plan can help lower blood pressure and control blood sugar. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan\n- is low in fat and cholesterol\n- features fat-free or low-fat milk and dairy products, fish, poultry, and nuts\n- suggests less red meat, and fewer sweets, added sugars, and sugarcontaining beverages\n- is rich in nutrients, protein, and fiber\nRead more about DASH at www.nhlbi.nih.gov/health/health-topics/topics/dash.\nPeople with diabetic kidney disease may need to limit sodium and salt intake to help reduce edema and lower blood pressure. A dietitian may also recommend a diet low in saturated fat and cholesterol to help control high levels of lipids, or fats, in the blood.\nHealth care providers may recommend that people with CKD eat moderate or reduced amounts of protein, though the benefits of reducing protein in a persons diet are still being researched. Proteins break down into waste products the kidneys must filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. More information about diabetes and diet is provided in the NIDDK health topics:\n- What I need to know about Eating and Diabetes and What I need to know about Carbohydrate Counting and Diabetes\n- Make the Kidney Connection: Food Tips and Healthy Eating Ideas and Eating Right for Kidney Health: Tips for People with Chronic Kidney Disease.\nWeight Loss and Physical Activity\nHealth care providers recommend that people who are overweight or obese lose weight to improve their bodies ability to use insulin properly and lower their risk for health problems related to high blood pressure. Overweight is defined as a body mass index (BMI)a measurement of weight in relation to heightof 25 to 29. A BMI of 30 or higher is considered obese. People should aim to keep their BMI lower than 25.4\nExperts recommend physical activity as an important part of losing weight, keeping sensitivity to insulin, and treating high blood pressure. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house. More information is provided in the NIDDK health topic, What I need to know about Physical Activity and Diabetes." } ]

[ { "from": "human", "value": "What are the treatments for Diabetic Kidney Disease?" }, { "from": "gpt", "value": "A health care provider may treat kidney failure due to diabetic kidney disease with dialysis or a kidney transplant. In some cases, people with diabetic kidney disease receive kidney and pancreas transplants.\nIn most cases, people with diabetic kidney disease start dialysis earlier than people with kidney failure who do not have diabetes. People with diabetic end-stage kidney disease who receive a kidney transplant have a much better survival rate than those people on dialysis, although survival rates for those on dialysis have increasingly improved over time. However, people who receive a kidney transplant and do not have diabetes have a higher survival rate than people with diabetic kidney disease who receive a transplant.5\nMore information about treatment options for kidney failure is provided in the NIDDK health topics:\n- Treatment Methods for Kidney Failure: Hemodialysis\n- Treatment Methods for Kidney Failure: Peritoneal Dialysis\n- Treatment Methods for Kidney Failure: Transplantation" } ]

[ { "from": "human", "value": "What are the treatments for Diabetic Kidney Disease?" }, { "from": "gpt", "value": "People with diabetes should work with their health care team to prevent or manage CKD through the following steps:\n- measure A1C levelsa blood test that provides information about a persons average blood glucose levels for the previous 3 months at least twice a year and keep A1C levels below 7 percent\n- learn about insulin injections, diabetes medications, meal planning, physical activity, and blood glucose monitoring\n- find out whether protein, salt, or liquid should be limited in the diet\n- see a registered dietitian to help with meal planning\n- check blood pressure every visit with a health care provider or at least two to four times a year\n- learn about possible benefits from taking an ACE inhibitor or an ARB if a person has high blood pressure\n- measure eGFR at least once a year to check kidney function\n- get the amount of protein in the urine tested at least once a year to check for kidney damage" } ]

[ { "from": "human", "value": "What to do for Diabetic Kidney Disease?" }, { "from": "gpt", "value": "- Diabetic kidney disease, also called diabetic nephropathy, is kidney disease caused by diabetes.\n- People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.\n- At the onset of diabetes, blood flow into the kidneys increases, which may strain the glomeruli and lessen their ability to filter blood.\n- Higher levels of blood glucose lead to the buildup of extra material in the glomeruli, which increases the force of the blood moving through the kidneys and creates stress in the glomeruli.\n- Many people with diabetes can develop high blood pressure, another factor in the development of kidney disease. High blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the entire body.\n- Diabetic kidney disease takes many years to develop.\n- People with diabetic kidney disease do not have any symptoms in the early stages. As kidney disease progresses, a person can develop edema, or swelling. Edema happens when the kidneys cannot get rid of the extra fluid and salt in the body. Edema can occur in the legs, feet, or ankles and less often in the hands or face.\n- Once kidney function decreases further, symptoms may include- appetite loss- nausea- vomiting- drowsiness, or feeling tired- trouble concentrating- sleep problems- increased or decreased urination- generalized itching or numbness- dry skin- headaches- weight loss- darkened skin- muscle cramps- shortness of breath- chest pain- People can prevent or slow the progression of diabetic kidney disease by- taking medication to control high blood pressure- managing blood glucose levels- making changes in their eating, diet, and nutrition- losing weight if they are overweight or obese- getting regular physical activity" } ]

[ { "from": "human", "value": "What is (are) Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system. Red blood cells contain hemoglobinan iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body.\nWhen the kidneys and glomerulithe tiny units within the kidneys where blood is filteredbecome clogged with the damaged red blood cells, they are unable to do their jobs. If the kidneys stop functioning, a child can develop acute kidney injurythe sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children." } ]

[ { "from": "human", "value": "What is (are) Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder." } ]

[ { "from": "human", "value": "What causes Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system. The digestive system is made up of the gastrointestinal, or GI, tracta series of hollow organs joined in a long, twisting tube from the mouth to the anusand other organs that help the body break down and absorb food.\nNormally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream. The toxins travel through the bloodstream and can destroy the red blood cells. E.coli O157:H7 can be found in\n- undercooked meat, most often ground beef\n- unpasteurized, or raw, milk\n- unwashed, contaminated raw fruits and vegetables\n- contaminated juice\n- contaminated swimming pools or lakes\nLess common causes, sometimes called atypical hemolytic uremic syndrome, can include\n- taking certain medications, such as chemotherapy\n- having other viral or bacterial infections\n- inheriting a certain type of hemolytic uremicsyndrome that runs in families\nMore information about foodborne illnesses and the digestive system is provided in the NIDDK health topic, foodborne illnesses." } ]

[ { "from": "human", "value": "What are the symptoms of Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritisan inflammation of the lining of the stomach, small intestine, and large intestine such as\n- vomiting\n- bloody diarrhea\n- abdominal pain\n- fever and chills\n- headache\nAs the infection progresses, the toxins released in the intestine begin to destroy red blood cells. When the red blood cells are destroyed, the child may experience the signs and symptoms of anemiaa condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen.\nSigns and symptoms of anemia may include\n- fatigue, or feeling tired\n- weakness\n- fainting\n- paleness\nAs the damaged red blood cells clog the glomeruli, the kidneys may become damaged and make less urine. When damaged, the kidneys work harder to remove wastes and extra fluid from the blood, sometimes leading to acute kidney injury.\nOther signs and symptoms of hemolytic uremic syndrome may include bruising and seizures.\nWhen hemolytic uremic syndrome causes acute kidney injury, a child may have the following signs and symptoms:\n- edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face\n- albuminuriawhen a child's urine has high levels of albumin, the main protein in the blood\n- decreased urine output\n- hypoalbuminemiawhen a child's blood has low levels of albumin\n- blood in the urine\nSeek Immediate Care Parents or caretakers should seek immediate care for a child experiencing any urgent symptoms, such as\n- unusual bleeding\n- swelling\n- extreme fatigue\n- decreased urine output\n- unexplained bruises" } ]

[ { "from": "human", "value": "How to diagnose Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "A health care provider diagnoses hemolytic uremic syndrome with\n- a medical and family history\n- a physical exam\n- urine tests\n- a blood test\n- a stool test\n- kidney biopsy\nMedical and Family History\nTaking a medical and family history is one of the first things a health care provider may do to help diagnose hemolytic uremic syndrome.\nPhysical Exam\nA physical exam may help diagnose hemolytic uremic syndrome. During a physical exam, a health care provider most often\n- examines a child's body\n- taps on specific areas of the child's body\nUrine Tests\nA health care provider may order the following urine tests to help determine if a child has kidney damage from hemolytic uremic syndrome.\nDipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine, which could mean kidney damage. The child or caretaker collects a urine sample in a special container in a health care provider's office or a commercial facility. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the child's urine sample. Patches on the dipstick change color when albumin is present in the urine.\nUrine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The child provides a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed in the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine.\nBlood Test\nA blood test involves drawing blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. A health care provider will test the blood sample to\n- estimate how much blood the kidneys filter eachminute, called the estimated glomerular filtrationrate, or eGFR. The test results help the healthcare provider determine the amount of kidneydamage from hemolytic uremic syndrome.\n- check red blood cell and platelet levels.\n- check for liver and kidney function.\n- assess protein levels in the blood.\nStool Test\nA stool test is the analysis of a sample of stool. The health care provider will give the child's parent or caretaker a container for catching and storing the stool. The parent or caretaker returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Stool tests can show the presence of E. coli O157:H7.\nKidney Biopsy\nBiopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The health care provider will give the child light sedation and local anesthetic; however, in some cases, the child will require general anesthesia. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab. The pathologist looks for signs of kidney disease and infection. The test can help diagnose hemolytic uremic syndrome." } ]

[ { "from": "human", "value": "What are the complications of Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health.1\nHowever, children with hemolytic uremic syndrome may have serious and sometimes life-threatening complications, including\n- acute kidney injury\n- high blood pressure\n- blood-clotting problems that can lead to bleeding\n- seizures\n- heart problems\n- chronic, or long lasting, kidney disease\n- stroke\n- coma" } ]

[ { "from": "human", "value": "What are the treatments for Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "A health care provider will treat a child with hemolytic uremic syndrome by addressing\n- urgent symptoms and preventing complications\n- acute kidney injury\n- chronic kidney disease (CKD)\nIn most cases, health care providers do not treat children with hemolytic uremic syndrome with antibiotics unless they have infections in other areas of the body. With proper management, most children recover without long-term health problems.2\nTreating Urgent Symptoms and Preventing Complications\nA health care provider will treat a child's urgent symptoms and try to prevent complications by\n- observing the child closely in the hospital\n- replacing minerals, such as potassium and salt, and fluids through an intravenous (IV) tube\n- giving the child red blood cells and platelets cells in the blood that help with clottingthrough an IV\n- giving the child IV nutrition\n- treating high blood pressure with medications\nTreating Acute Kidney Injury\nIf necessary, a health care provider will treat acute kidney injury with dialysisthe process of filtering wastes and extra fluid from the body with an artificial kidney. The two forms of dialysis are hemodialysis and peritoneal dialysis. Most children with acute kidney injury need dialysis for a short time only.\nTreating Chronic Kidney Disease\nSome children may sustain significant kidney damage that slowly develops into CKD. Children who develop CKD must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation.\nIn most cases, health care providers treat CKD with a kidney transplant. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a person's body to take over the job of the failing kidney. Though some children receive a kidney transplant before their kidneys fail completely, many children begin with dialysis to stay healthy until they can have a transplant.\nMore information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children." } ]

[ { "from": "human", "value": "How to prevent Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by\n- avoiding unclean swimming areas\n- avoiding unpasteurized milk, juice, and cider\n- cleaning utensils and food surfaces often\n- cooking meat to an internal temperature of at least 160 F\n- defrosting meat in the microwave or refrigerator\n- keeping children out of pools if they have had diarrhea\n- keeping raw foods separate\n- washing hands before eating\n- washing hands well after using the restroom and after changing diapers\nWhen a child is taking medications that may cause hemolytic uremic syndrome, it is important that the parent or caretaker watch for symptoms and report any changes in the child's condition to the health care provider as soon as possible." } ]

[ { "from": "human", "value": "What to do for Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "At the beginning of the illness, children with hemolytic uremic syndrome may need IV nutrition or supplements to help maintain fluid balance in the body. Some children may need to follow a low-salt diet to help prevent swelling and high blood pressure.\nHealth care providers will encourage children with hemolytic uremic syndrome to eat when they are hungry. Most children who completely recover and do not have permanent kidney damage can return to their usual diet." } ]

[ { "from": "human", "value": "What to do for Hemolytic Uremic Syndrome in Children?" }, { "from": "gpt", "value": "- Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system.\n- The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system.\n- Normally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream.\n- A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritis, an inflammation of the lining of the stomach, small intestine, and large intestine.\n- Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health.\n- Some children may sustain significant kidney damage that slowly develops into chronic kidney disease (CKD).\n- Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by- avoiding unclean swimming areas- avoiding unpasteurized milk, juice, and cider- cleaning utensils and food surfaces often- cooking meat to an internal temperature of at least 160 F- defrosting meat in the microwave or refrigerator- keeping children out of pools if they have had diarrhea- keeping raw foods separate- washing hands before eating- washing hands well after using the restroom and after changing diapers" } ]

[ { "from": "human", "value": "What is (are) Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum. The tumors, called gastrinomas, release large amounts of gastrin that cause the stomach to produce large amounts of acid. Normally, the body releases small amounts of gastrin after eating, which triggers the stomach to make gastric acid that helps break down food and liquid in the stomach. The extra acid causes peptic ulcers to form in the duodenum and elsewhere in the upper intestine.\nThe tumors seen with Zollinger-Ellison syndrome are sometimes cancerous and may spread to other areas of the body." } ]

[ { "from": "human", "value": "What is (are) Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "The stomach, duodenum, and pancreas are digestive organs that break down food and liquid.\n- The stomach stores swallowed food and liquid. The muscle action of the lower part of the stomach mixes the food and liquid with digestive juice. Partially digested food and liquid slowly move into the duodenum and are further broken down.\n- The duodenum is the first part of the small intestinethe tube-shaped organ between the stomach and the large intestinewhere digestion of the food and liquid continues.\n- The pancreas is an organ that makes the hormone insulin and enzymes for digestion. A hormone is a natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Insulin helps cells throughout the body remove glucose, also called sugar, from blood and use it for energy. The pancreas is located behind the stomach and close to the duodenum." } ]

[ { "from": "human", "value": "What causes Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "Experts do not know the exact cause of Zollinger-Ellison syndrome. About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1).1 MEN1 causes hormone-releasing tumors in the endocrine glands and the duodenum. Symptoms of MEN1 include increased hormone levels in the blood, kidney stones, diabetes, muscle weakness, weakened bones, and fractures.\nMore information about MEN1 is provided in the NIDDK health topic, Multiple Endocrine Neoplasia Type 1." } ]

[ { "from": "human", "value": "How many people are affected by Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "Zollinger-Ellison syndrome is rare and only occurs in about one in every 1 million people.1 Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old. A child who has a parent with MEN1 is also at increased risk for Zollinger-Ellison syndrome.2" } ]

[ { "from": "human", "value": "What are the symptoms of Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers. A dull or burning pain felt anywhere between the navel and midchest is the most common symptom of a peptic ulcer. This discomfort usually\n- occurs when the stomach is emptybetween meals or during the nightand may be briefly relieved by eating food\n- lasts for minutes to hours\n- comes and goes for several days, weeks, or months\nOther symptoms include\n- diarrhea\n- bloating\n- burping\n- nausea\n- vomiting\n- weight loss\n- poor appetite\nSome people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER), which occurs when stomach contents flow back up into the esophagusa muscular tube that carries food and liquids to the stomach. In addition to nausea and vomiting, reflux symptoms include a painful, burning feeling in the midchest. More information about GER is provided in the NIDDK health topic, Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults." } ]

[ { "from": "human", "value": "What are the symptoms of Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "A person who has any of the following emergency symptoms should call or see a health care provider right away:\n- chest pain\n- sharp, sudden, persistent, and severe stomach pain\n- red blood in stool or black stools\n- red blood in vomit or vomit that looks like coffee grounds\nThese symptoms could be signs of a serious problem, such as\n- internal bleedingwhen gastric acid or a peptic ulcer breaks a blood vessel\n- perforationwhen a peptic ulcer forms a hole in the duodenal wall\n- obstructionwhen a peptic ulcer blocks the path of food trying to leave the stomach" } ]

[ { "from": "human", "value": "How to diagnose Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "A health care provider diagnoses Zollinger-Ellison syndrome based on the following:\n- medical history\n- physical exam\n- signs and symptoms\n- blood tests\n- upper gastrointestinal (GI) endoscopy\n- imaging tests to look for gastrinomas\n- measurement of stomach acid\nMedical History\nTaking a medical and family history is one of the first things a health care provider may do to help diagnose Zollinger-Ellison syndrome. The health care provider may ask about family cases of MEN1 in particular.\nPhysical Exam\nA physical exam may help diagnose Zollinger-Ellison syndrome. During a physical exam, a health care provider usually\n- examines a persons body\n- uses a stethoscope to listen to bodily sounds\n- taps on specific areas of the persons body\nSigns and Symptoms\nA health care provider may suspect Zollinger-Ellison syndrome if\n- diarrhea accompanies peptic ulcer symptoms or if peptic ulcer treatment fails.\n- a person has peptic ulcers without the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen or a bacterial Helicobacter pylori (H. pylori) infection. NSAID use and H. pylori infection may cause peptic ulcers.\n- a person has severe ulcers that bleed or cause holes in the duodenum or stomach.\n- a health care provider diagnoses a person or the persons family member with MEN1 or a person has symptoms of MEN1.\nBlood Tests\nThe health care provider may use blood tests to check for an elevated gastrin level. A technician or nurse draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. A health care provider will ask the person to fast for several hours prior to the test and may ask the person to stop acid-reducing medications for a period of time before the test. A gastrin level that is 10 times higher than normal suggests Zollinger-Ellison syndrome.2\nA health care provider may also check for an elevated gastrin level after an infusion of secretin. Secretin is a hormone that causes gastrinomas to release more gastrin. A technician or nurse places an intravenous (IV) needle in a vein in the arm to give an infusion of secretin. A health care provider may suspect Zollinger-Ellison syndrome if blood drawn after the infusion shows an elevated gastrin level.\nUpper Gastrointestinal Endoscopy\nThe health care provider uses an upper GI endoscopy to check the esophagus, stomach, and duodenum for ulcers and esophagitisa general term used to describe irritation and swelling of the esophagus. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenum. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A technician or nurse inserts an IV needle in a vein in the arm if anesthesia is given.\nImaging Tests\nTo help find gastrinomas, a health care provider may order one or more of the following imaging tests:\n- Computerized tomography (CT) scan. A CT scan is an x ray that produces pictures of the body. A CT scan may include the injection of a special dye, called contrast medium. CT scans use a combination of x rays and computer technology to create images. CT scans require the person to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes x rays. A computer puts the different views together to create a model of the pancreas, stomach, and duodenum. The x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. The person does not need anesthesia. CT scans can show tumors and ulcers.\n- Magnetic resonance imaging (MRI). MRI is a test that takes pictures of the bodys internal organs and soft tissues without using x rays. A specially trained technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The person does not need anesthesia, though people with a fear of confined spaces may receive light sedation, taken by mouth. An MRI may include the injection of contrast medium. With most MRI machines, the person will lie on a table that slides into a tunnel-shaped device that may be open ended or closed at one end. Some machines allow the person to lie in a more open space. During an MRI, the person, although usually awake, remains perfectly still while the technician takes the images, which usually takes only a few minutes. The technician will take a sequence of images from different angles to create a detailed picture of the upper GI tract. During sequencing, the person will hear loud mechanical knocking and humming noises.\n- Endoscopic ultrasound. This procedure involves using a special endoscope called an endoechoscope to perform ultrasound of the pancreas. The endoechoscope has a built-in miniature ultrasound probe that bounces safe, painless sound waves off organs to create an image of their structure. A gastroenterologist performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The gastroenterologist carefully feeds the endoechoscope down the esophagus, through the stomach and duodenum, until it is near the pancreas. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A sedative helps the person stay relaxed and comfortable. The images can show gastrinomas in the pancreas.\n- Angiogram. An angiogram is a special kind of x ray in which an interventional radiologista specially trained radiologistthreads a thin, flexible tube called a catheter through the large arteries, often from the groin, to the artery of interest. The radiologist injects contrast medium through the catheter so the images show up more clearly on the x ray. The interventional radiologist performs the procedure and interprets the images in a hospital or an outpatient center. A person does not need anesthesia, though a light sedative may help reduce a persons anxiety during the procedure. This test can show gastrinomas in the pancreas.\n- Somatostatin receptor scintigraphy. An x-ray technician performs this test, also called OctreoScan, at a hospital or an outpatient center, and a radiologist interprets the images. A person does not need anesthesia. A radioactive compound called a radiotracer, when injected into the bloodstream, selectively labels tumor cells. The labeled cells light up when scanned with a device called a gamma camera. The test can show gastrinomas in the duodenum, pancreas, and other parts of the body.\nSmall gastrinomas may be hard to see; therefore, health care providers may order several types of imaging tests to find gastrinomas.\nStomach-acid Measurement\nUsing a sample of stomach juices for analysis, a health care provider may measure the amount of stomach acid a person produces. During the exam, a health care provider puts in a nasogastric tubea tiny tube inserted through the nose and throat that reaches into the stomach. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. Once the tube is placed, a health care provider takes samples of the stomach acid. High acid levels in the stomach indicate Zollinger-Ellison syndrome." } ]

[ { "from": "human", "value": "What are the treatments for Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery.\nMedications\nA class of medications called proton pump inhibitors (PPIs) includes\n- esomeprazole (Nexium)\n- lansoprazole (Prevacid)\n- pantoprazole (Protonix)\n- omeprazole (Prilosec or Zegerid)\n- dexlansoprazole (Dexilant)\nPPIs stop the mechanism that pumps acid into the stomach, helping to relieve peptic ulcer pain and promote healing. A health care provider may prescribe people who have Zollinger-Ellison syndrome higher-than-normal doses of PPIs to control the acid production. Studies show that PPIs may increase the risk of hip, wrist, and spine fractures when a person takes them long term or in high doses, so its important for people to discuss risks versus benefits with their health care provider.\nSurgery\nSurgical removal of gastrinomas is the only cure for Zollinger-Ellison syndrome. Some gastrinomas spread to other parts of the body, especially the liver and bones. Finding and removing all gastrinomas before they spread is often challenging because many of the tumors are small.\nChemotherapy\nHealth care providers sometimes use chemotherapy drugs to treat gastrinomas that cannot be surgically removed, including\n- streptozotocin (Zanosar)\n- 5-fluorouracil (Adrucil)\n- doxorubicin (Doxil)" } ]

[ { "from": "human", "value": "What to do for Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Zollinger-Ellison syndrome." } ]

[ { "from": "human", "value": "What to do for Zollinger-Ellison Syndrome?" }, { "from": "gpt", "value": "- Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum.\n- Experts do not know the exact cause of Zollinger-Ellison syndrome.\n- About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1).\n- Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old.\n- Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers.\n- Some people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER).\n- A health care provider diagnoses Zollinger-Ellison syndrome based on the following:- medical history- physical exam- signs and symptoms- blood tests- upper gastrointestinal (GI) endoscopy- imaging tests to look for gastrinomas- measurement of stomach acid- A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery." } ]

[ { "from": "human", "value": "What is (are) Cystocele?" }, { "from": "gpt", "value": "A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder into the vagina. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. During urination, also called voiding, the bladder empties through the urethra, located at the bottom of the bladder. The urethra is the tube that carries urine outside of the body. The vagina is the tube in a womans body that runs beside the urethra and connects the womb, or uterus, to the outside of the body." } ]

[ { "from": "human", "value": "What causes Cystocele?" }, { "from": "gpt", "value": "A cystocele occurs when the muscles and supportive tissues between a womans bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening. In a cystocele, the bladder tissue remains covered by the vaginal skin. A cystocele may result from damage to the muscles and tissues that hold the pelvic organs up inside the pelvis. A womans pelvic organs include the vagina, cervix, uterus, bladder, urethra, and small intestine. Damage to or weakening of the pelvic muscles and supportive tissues may occur after vaginal childbirth and with conditions that repeatedly strain or increase pressure in the pelvic area, such as\n- repetitive straining for bowel movements\n- constipation\n- chronic or violent coughing\n- heavy lifting\n- being overweight or obese\nA womans chances of developing a cystocele increase with age, possibly because of weakening muscles and supportive tissues from aging. Whether menopause increases a womans chances of developing a cystocele is unclear." } ]

[ { "from": "human", "value": "What are the symptoms of Cystocele?" }, { "from": "gpt", "value": "The symptoms of a cystocele may include\n- a vaginal bulge\n- the feeling that something is falling out of the vagina\n- the sensation of pelvic heaviness or fullness\n- difficulty starting a urine stream\n- a feeling of incomplete urination\n- frequent or urgent urination\nWomen who have a cystocele may also leak some urine as a result of movements that put pressure on the bladder, called stress urinary incontinence. These movements can include coughing, sneezing, laughing, or physical activity, such as walking. Urinary retentionthe inability to empty the bladder completelymay occur with more severe cystoceles if the cystocele creates a kink in the womans urethra and blocks urine flow.\nWomen with mild cystoceles often do not have any symptoms." } ]

[ { "from": "human", "value": "How to diagnose Cystocele?" }, { "from": "gpt", "value": "Diagnosing a cystocele requires medical tests and a physical exam of the vagina. Medical tests take place in a health care providers office, an outpatient center, or a hospital. The health care provider will ask about symptoms and medical history. A health care provider uses a grading system to determine the severity of a womans cystocele. A cystocele receives one of three grades depending on how far a womans bladder has dropped into her vagina:\n- grade 1mild, when the bladder drops only a short way into the vagina\n- grade 2moderate, when the bladder drops far enough to reach the opening of the vagina\n- grade 3most advanced, when the bladder bulges out through the opening of the vagina\nIf a woman has difficulty emptying her bladder, a health care provider may measure the amount of urine left in the womans bladder after she urinates. The remaining urine is called the postvoid residual. A health care provider can measure postvoid residual with a bladder ultrasound. A bladder ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off the bladder to create an image and show the amount of remaining urine. A specially trained technician performs the procedure, and a radiologista doctor who specializes in medical imaginginterprets the images. A woman does not need anesthesia.\nA health care provider can also use a cathetera thin, flexible tubeto measure a womans postvoid residual. The health care provider inserts the catheter through the womans urethra into her bladder to remove and measure the amount of remaining urine after the woman has urinated. A postvoid residual of 100 mL or more is a sign that the woman is not completely emptying her bladder. A woman receives local anesthesia.\nA health care provider may use a voiding cystourethrograman x-ray exam of the bladderto diagnose a cystocele as well. A woman gets a voiding cystourethrogram while urinating. The x-ray images show the shape of the womans bladder and let the health care provider see any problems that might block normal urine flow. An x-ray technician performs a voiding cystourethrogram, and a radiologist interprets the images. A woman does not need anesthesia; however, some women may receive sedation. A health care provider may order additional tests to rule out problems in other parts of a womans urinary tract." } ]

[ { "from": "human", "value": "What are the treatments for Cystocele?" }, { "from": "gpt", "value": "Cystocele treatment depends on the severity of the cystocele and whether a woman has symptoms. If a womans cystocele does not bother her, a health care provider may recommend only that she avoid heavy lifting or straining, which could worsen her cystocele. If a woman has symptoms that bother her and wants treatment, the health care provider may recommend pelvic muscle exercises, a vaginal pessary, or surgery.\nPelvic floor, or Kegel, exercises involve strengthening pelvic floor muscles. Strong pelvic floor muscles more effectively hold pelvic organs in place. A woman does not need special equipment for Kegel exercises.\nThe exercises involve tightening and relaxing the muscles that support pelvic organs. A health care provider can help a woman learn proper technique.\nMore information about pelvic muscle exercises is provided in the NIDDK health topic, Kegel Exercise Tips.\nA vaginal pessary is a small, silicone medical device placed in the vagina that supports the vaginal wall and holds the bladder in place. Pessaries come in a number of shapes and sizes. A health care provider has many options to choose from to find the most comfortable pessary for a woman.\nA heath care provider may recommend surgery to repair the vaginal wall support and reposition the womans bladder to its normal position. The most common cystocele repair is an anterior vaginal repairor anterior colporrhaphy. The surgeon makes an incision in the wall of the womans vagina and repairs the defect by folding over and sewing together extra supportive tissue between the vagina and bladder. The repair tightens the layers of tissue that separate the organs, creating more support for the bladder. A surgeon who specializes in the urinary tract or female reproductive system performs an anterior vaginal repair in a hospital. The woman receives either regional or general anesthesia. The woman may stay overnight in the hospital, and full recovery may take up to 4 to 6 weeks." } ]

[ { "from": "human", "value": "What to do for Cystocele?" }, { "from": "gpt", "value": "Researchers have not found that eating, diet, and nutrition play a role in causing or preventing a cystocele." } ]

[ { "from": "human", "value": "What to do for Cystocele?" }, { "from": "gpt", "value": "- A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder into the vagina.\n- A cystocele occurs when the muscles and supportive tissues between a womans bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening.\n- Diagnosing a cystocele requires medical tests and a physical exam of the vagina.\n- Cystocele treatment depends on the severity of the cystocele and whether a woman has symptoms." } ]

[ { "from": "human", "value": "What is (are) Inguinal Hernia?" }, { "from": "gpt", "value": "An inguinal hernia happens when contents of the abdomenusually fat or part of the small intestinebulge through a weak area in the lower abdominal wall. The abdomen is the area between the chest and the hips. The area of the lower abdominal wall is also called the inguinal or groin region.\nTwo types of inguinal hernias are\n- indirect inguinal hernias, which are caused by a defect in the abdominal wall that is congenital, or present at birth\n- direct inguinal hernias, which usually occur only in male adults and are caused by a weakness in the muscles of the abdominal wall that develops over time\nInguinal hernias occur at the inguinal canal in the groin region." } ]

[ { "from": "human", "value": "What is (are) Inguinal Hernia?" }, { "from": "gpt", "value": "The inguinal canal is a passage through the lower abdominal wall. People have two inguinal canalsone on each side of the lower abdomen. In males, the spermatic cords pass through the inguinal canals and connect to the testicles in the scrotumthe sac around the testicles. The spermatic cords contain blood vessels, nerves, and a duct, called the spermatic duct, that carries sperm from the testicles to the penis. In females, the round ligaments, which support the uterus, pass through the inguinal canals." } ]

[ { "from": "human", "value": "What causes Inguinal Hernia?" }, { "from": "gpt", "value": "The cause of inguinal hernias depends on the type of inguinal hernia.\nIndirect inguinal hernias. A defect in the abdominal wall that is present at birth causes an indirect inguinal hernia.\nDuring the development of the fetus in the womb, the lining of the abdominal cavity forms and extends into the inguinal canal. In males, the spermatic cord and testicles descend out from inside the abdomen and through the abdominal lining to the scrotum through the inguinal canal. Next, the abdominal lining usually closes off the entrance to the inguinal canal a few weeks before or after birth. In females, the ovaries do not descend out from inside the abdomen, and the abdominal lining usually closes a couple of months before birth.1\nSometimes the lining of the abdomen does not close as it should, leaving an opening in the abdominal wall at the upper part of the inguinal canal. Fat or part of the small intestine may slide into the inguinal canal through this opening, causing a hernia. In females, the ovaries may also slide into the inguinal canal and cause a hernia.\nIndirect hernias are the most common type of inguinal hernia.2 Indirect inguinal hernias may appear in 2 to 3 percent of male children; however, they are much less common in female children, occurring in less than 1 percent.3\nDirect inguinal hernias. Direct inguinal hernias usually occur only in male adults as aging and stress or strain weaken the abdominal muscles around the inguinal canal. Previous surgery in the lower abdomen can also weaken the abdominal muscles.\nFemales rarely form this type of inguinal hernia. In females, the broad ligament of the uterus acts as an additional barrier behind the muscle layer of the lower abdominal wall. The broad ligament of the uterus is a sheet of tissue that supports the uterus and other reproductive organs." } ]

[ { "from": "human", "value": "What are the symptoms of Inguinal Hernia?" }, { "from": "gpt", "value": "The first sign of an inguinal hernia is a small bulge on one or, rarely, on both sides of the grointhe area just above the groin crease between the lower abdomen and the thigh. The bulge may increase in size over time and usually disappears when lying down.\nOther signs and symptoms can include\n- discomfort or pain in the groinespecially when straining, lifting, coughing, or exercisingthat improves when resting\n- feelings such as weakness, heaviness, burning, or aching in the groin\n- a swollen or an enlarged scrotum in men or boys\nIndirect and direct inguinal hernias may slide in and out of the abdomen into the inguinal canal. A health care provider can often move them back into the abdomen with gentle massage." } ]

[ { "from": "human", "value": "What are the complications of Inguinal Hernia?" }, { "from": "gpt", "value": "Inguinal hernias can cause the following complications:\n- Incarceration. An incarcerated hernia happens when part of the fat or small intestine from inside the abdomen becomes stuck in the groin or scrotum and cannot go back into the abdomen. A health care provider is unable to massage the hernia back into the abdomen.\n- Strangulation. When an incarcerated hernia is not treated, the blood supply to the small intestine may become obstructed, causing strangulation of the small intestine. This lack of blood supply is an emergency situation and can cause the section of the intestine to die.\nSeek Immediate Care People who have symptoms of an incarcerated or a strangulated hernia should seek emergency medical help immediately. A strangulated hernia is a life-threatening condition. Symptoms of an incarcerated or a strangulated hernia include\n- extreme tenderness or painful redness in the area of the bulge in the groin\n- sudden pain that worsens quickly and does not go away\n- the inability to have a bowel movement and pass gas\n- nausea and vomiting\n- fever" } ]

[ { "from": "human", "value": "How to diagnose Inguinal Hernia?" }, { "from": "gpt", "value": "A health care provider diagnoses an inguinal hernia with\n- a medical and family history\n- a physical exam\n- imaging tests, including x rays\nMedical and family history. Taking a medical and family history may help a health care provider diagnose an inguinal hernia. Often the symptoms that the patient describes will be signs of an inguinal hernia.\nPhysical exam. A physical exam may help diagnose an inguinal hernia. During a physical exam, a health care provider usually examines the patients body. The health care provider may ask the patient to stand and cough or strain so the health care provider can feel for a bulge caused by the hernia as it moves into the groin or scrotum. The health care provider may gently try to massage the hernia back into its proper position in the abdomen.\nImaging tests. A health care provider does not usually use imaging tests, including x rays, to diagnose an inguinal hernia unless he or she\n- is trying to diagnose a strangulation or an incarceration\n- cannot feel the inguinal hernia during a physical exam, especially in patients who are overweight\n- is uncertain if the hernia or another condition is causing the swelling in the groin or other symptoms\nSpecially trained technicians perform imaging tests at a health care providers office, an outpatient center, or a hospital.\nA radiologista doctor who specializes in medical imaginginterprets the images. A patient does not usually need anesthesia.\nTests may include the following:\n- Abdominal x ray. An x ray is a picture recorded on film or on a computer using a small amount of radiation. The patient will lie on a table or stand during the x ray. The technician positions the x-ray machine over the abdominal area. The patient will hold his or her breath as the technician takes the picture so that the picture will not be blurry. The technician may ask the patient to change position for additional pictures.\n- Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create images. For a CT scan, the technician may give the patient a solution to drink and an injection of a special dye, called contrast medium. A health care provider injects the contrast medium into a vein, and the injection will make the patient feel warm all over for a minute or two. The contrast medium allows the health care provider to see the blood vessels and blood flow on the x rays. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the technician takes the x rays. A health care provider may give children a sedative to help them fall asleep for the test.\n- Abdominal ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure." } ]

[ { "from": "human", "value": "What are the treatments for Inguinal Hernia?" }, { "from": "gpt", "value": "Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incarceration and strangulation. Health care providers recommend surgery for most people with inguinal hernias and especially for people with hernias that cause symptoms. Research suggests that men with hernias that cause few or no symptoms may be able to safely delay surgery until their symptoms increase.3,6 Men who delay surgery should watch for symptoms and see a health care provider regularly. Health care providers usually recommend surgery for infants and children to prevent incarceration.1 Emergent, or immediate, surgery is necessary for incarcerated or strangulated hernias.\nA general surgeona doctor who specializes in abdominal surgeryperforms hernia surgery at a hospital or surgery center, usually on an outpatient basis. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the person.\nHernia surgery is also called herniorrhaphy. The two main types of surgery for hernias are\n- Open hernia repair. During an open hernia repair, a health care provider usually gives a patient local anesthesia in the abdomen with sedation; however, some patients may have- sedation with a spinal block, in which a health care provider injects anesthetics around the nerves in the spine, making the body numb from the waist down- general anesthesia\n- The surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the abdominal wall with stitches. Usually the surgeon also reinforces the weak area with a synthetic mesh or screen to provide additional support.\n- Laparoscopic hernia repair. A surgeon performs laparoscopic hernia repair with the patient under general anesthesia. The surgeon makes several small, half-inch incisions in the lower abdomen and inserts a laparoscopea thin tube with a tiny video camera attached. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While watching the monitor, the surgeon repairs the hernia using synthetic mesh or screen.\nPeople who undergo laparoscopic hernia repair generally experience a shorter recovery time than those who have an open hernia repair. However, the surgeon may determine that laparoscopy is not the best option if the hernia is large or if the person has had previous pelvic surgery.\nMost adults experience discomfort and require pain medication after either an open hernia repair or a laparoscopic hernia repair. Intense activity and heavy lifting are restricted for several weeks. The surgeon will discuss when a person may safely return to work. Infants and children also experience some discomfort; however, they usually resume normal activities after several days.\nSurgery to repair an inguinal hernia is quite safe, and complications are uncommon. People should contact their health care provider if any of the following symptoms appear:\n- redness around or drainage from the incision\n- fever\n- bleeding from the incision\n- pain that is not relieved by medication or pain that suddenly worsens\nPossible long-term complications include\n- long-lasting pain in the groin\n- recurrence of the hernia, requiring a second surgery\n- damage to nerves near the hernia" } ]

[ { "from": "human", "value": "How to prevent Inguinal Hernia?" }, { "from": "gpt", "value": "People cannot prevent the weakness in the abdominal wall that causes indirect inguinal hernias. However, people may be able to prevent direct inguinal hernias by maintaining a healthy weight and not smoking.\nPeople can keep inguinal hernias from getting worse or keep inguinal hernias from recurring after surgery by\n- avoiding heavy lifting\n- using the legs, not the back, when lifting objects\n- preventing constipation and straining during bowel movements\n- maintaining a healthy weight\n- not smoking" } ]

[ { "from": "human", "value": "What to do for Inguinal Hernia?" }, { "from": "gpt", "value": "Researchers have not found that eating, diet, and nutrition play a role in causing inguinal hernias. A person with an inguinal hernia may be able to prevent symptoms by eating high-fiber foods. Fresh fruits, vegetables, and whole grains are high in fiber and may help prevent the constipation and straining that cause some of the painful symptoms of a hernia.\nThe surgeon will provide instructions on eating, diet, and nutrition after inguinal hernia surgery. Most people drink liquids and eat a light diet the day of the operation and then resume their usual diet the next day." } ]

[ { "from": "human", "value": "What to do for Inguinal Hernia?" }, { "from": "gpt", "value": "- An inguinal hernia happens when contents of the abdomenusually fat or part of the small intestinebulge through a weak area in the lower abdominal wall.\n- A defect in the abdominal wall that is present at birth causes an indirect inguinal hernia.\n- Direct inguinal hernias usually occur only in male adults as aging and stress or strain weaken the abdominal muscles around the inguinal canal. Females rarely form this type of inguinal hernia.\n- The first sign of an inguinal hernia is a small bulge on one or, rarely, on both sides of the grointhe area just above the groin crease between the lower abdomen and the thigh.\n- An incarcerated hernia happens when part of the fat or small intestine from inside the abdomen becomes stuck in the groin or scrotum and cannot go back into the abdomen.\n- When an incarcerated hernia is not treated, the blood supply to the small intestine may become obstructed, causing strangulation of the small intestine.\n- People who have symptoms of an incarcerated or a strangulated hernia should seek emergency medical help immediately. A strangulated hernia is a life-threatening condition.\n- Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incarceration and strangulation." } ]

[ { "from": "human", "value": "What are the treatments for What I need to know about Living with Kidney Failure?" }, { "from": "gpt", "value": "Kidney failure means your kidneys no longer work well enough to do their job. You need treatment to replace the work your damaged kidneys have stopped doing. The treatments for kidney failure are\n- hemodialysis\n- peritoneal dialysis\n- a kidney transplant\nYour kidneys filter wastes and extra fluid from your blood to keep you healthy. The wastes and extra fluid become urine that is stored in your bladder until you urinate. When your kidneys fail, dialysis can take over a small part of the work your damaged kidneys can no longer do. You can make treatments work better by\n- sticking to your treatment schedule\n- taking all medicines your doctor prescribes\n- following a special diet that keeps wastes from building up in your blood\n- being active most days of the week\nHemodialysis\nHemodialysis is a treatment for kidney failure. Hemodialysis uses a machine to filter your blood outside your body. First, a dialysis nurse places two needles into your arm. A pump on the hemodialysis machine draws your blood through one of the needles into a tube. The tube takes the blood to a filter, called a dialyzer. Inside the dialyzer, your blood flows through thin fibers that are like straws. The wastes and extra fluid leave the blood through tiny holes in the fibers. Then, a different tube carries the filtered blood back to your body through the second needle.\nMore information is provided in the NIDDK health topics, Treatment Methods for Kidney Failure: Hemodialysis and Home Hemodialysis.\nPeritoneal Dialysis\ncatheter\nTreatment Methods for Kidney Failure: Peritoneal Dialysis\nKidney Transplant\nA kidney transplant places a healthy kidney from another person into your body. The kidney may come from someone who has just died. Your doctor will place your name on a waiting list for a kidney. A family member or friend might be able to give you a kidney. Then you dont have to wait.\nThe new kidney takes over filtering your blood. The damaged kidneys usually stay where they are. The new kidney is placed in the front lower abdomen, on one side of the bladder. Your body normally attacks anything that shouldnt be there, such as bacteria. Your body will think the new kidney shouldnt be there. You will take medicines called immunosuppressants to keep your body from attacking the new kidney.\nMore information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Transplantation.\n*See the Pronunciation Guide for tips on how to say the the words in bold type." } ]

[ { "from": "human", "value": "What are the treatments for What I need to know about Living with Kidney Failure?" }, { "from": "gpt", "value": "Learning about different treatments for kidney failure will help you choose the one that best fits your lifestyle. Talk with your doctor and people on hemodialysis or peritoneal dialysis to learn about the pros and cons of each treatment. Ask your doctor about the transplant waiting list and about medicines required after a transplant. Talk with people who have had kidney transplants and ask how it has changed their lives.\nIf you plan to keep working, think about which treatment can help make that easier. If spending time with family and friends means a lot to you, learn about which treatment may give you the most free time. Find out which treatment will give you the best chance to be healthy and live longer.\nTalking with your doctor ahead of time about your options can help you take control of your care. Understanding the treatment you choose and getting used to the idea that you will be receiving this treatment takes time. If you choose one type of dialysis treatment and find it is not a good fit for your life, talk with your doctor about selecting another type of dialysis treatment that better meets your needs.\nWhile kidney failure can make your life harder, treatments can help improve your life." } ]

[ { "from": "human", "value": "What to do for What I need to know about Living with Kidney Failure?" }, { "from": "gpt", "value": "Eating the right foods can help you feel better when you are on dialysis or have a kidney transplant. Staying healthy with kidney failure requires watching how much of these elements are included in your diet:\n- Protein is in many foods you eat. Protein is in foods from animals and plants. Most diets include both types of protein. Protein provides the building blocks that maintain and repair muscles, organs, and other parts of the body. Too much protein can cause waste to build up in your blood, making your kidneys work harder. However, if you are on hemodialysis or peritoneal dialysis, you need lots of protein to replace the protein that dialysis removes.\n- Phosphorus is a mineral that keeps your bones healthy. Phosphorus also keeps blood vessels and muscles working. This mineral is found naturally in foods rich in protein, such as meat, poultry, fish, nuts, beans, and dairy products. Phosphorus is also added to many processed foods. You need phosphorus to turn food into energy; however, too much can cause your bones to weaken.\n- Water is in drinks and in foods such as fruits, vegetables, ice cream, gelatin, soup, and popsicles. Your body needs water; however, too much can cause fluid to build up in your body and make your heart work harder.\n- Sodium is a part of salt. You can find sodium in many canned, packaged, and fast foods and in seasonings and meats. You need sodium to help control the amount of fluid in your body; however, too much can cause high blood pressure.\n- Potassium is a mineral that helps your nerves and muscles work the right way. Potassium is found in fruits and vegetables such as oranges, bananas, tomatoes, and potatoes. You need potassium for healthy nerves and brain cells; however, too much can make your heartbeat irregular.\n- Calories are found in all foods and are especially high in oils and sugary foods. You need calories for energy; however, too many can cause weight gain and high blood sugar.\nTalk with your clinics renal dietitian to find a meal plan that works for you. Each treatment requires a different diet. If you are on hemodialysis, you have to stay away from foods such as potatoes and oranges because they have lots of potassium. If you are on peritoneal dialysis, eating potassium is fine. Instead, you may need to watch your calories. Your food needs will also depend on your weight and activity level.\nChanging your diet may be hard at first. Eating the right foods will help you feel better. You will have more strength and energy. Having more energy will help you live a fuller, healthier life. More information is provided in the NIDDK health topic, Eat Right to Feel Right on Hemodialysis." } ]

[ { "from": "human", "value": "What to do for What I need to know about Living with Kidney Failure?" }, { "from": "gpt", "value": "- Kidney failure means your kidneys no longer work well enough to do their job.\n- Learning about treatments for kidney failure will help you choose the one that best fits your lifestyle.\n- Many people with kidney failure continue to work.\n- Physical activity is an important part of staying healthy when you have kidney failure.\n- You can help prevent relatives from having kidney failure by talking with them about their risk.\n- Eating the right foods can help you feel better when you are on dialysis or have a kidney transplant." } ]

[ { "from": "human", "value": "What is (are) What I need to know about Diarrhea?" }, { "from": "gpt", "value": "Diarrhea is frequent, loose, and watery bowel movements. Bowel movements, also called stools, are body wastes passed through the rectum and anus. Stools contain what is left after your digestive system absorbs nutrients and fluids from what you eat and drink. If your body does not absorb the fluids, or if your digestive system produces extra fluids, stools will be loose and watery. Loose stools contain more water, salts, and minerals and weigh more than solid stools.\nDiarrhea that lasts a short time is called acute diarrhea. Acute diarrhea is a common problem and usually lasts only 1 or 2 days, but it may last longer. Diarrhea that lasts for at least 4 weeks is called chronic diarrhea. Chronic diarrhea symptoms may be continual or they may come and go.\n*See the Pronunciation Guide for tips on how to say the words in bold type." } ]

[ { "from": "human", "value": "What causes What I need to know about Diarrhea?" }, { "from": "gpt", "value": "Causes of diarrhea include\n- bacteria from contaminated food or water\n- viruses that cause illnesses such as the flu\n- parasites, which are tiny organisms found in contaminated food or water\n- medicines such as antibiotics\n- problems digesting certain foods\n- diseases that affect the stomach, small intestine, or colon, such as Crohns disease\n- problems with how the colon functions, caused by disorders such as irritable bowel syndrome\nSometimes no cause can be found. As long as diarrhea goes away within 1 to 2 days, finding the cause is not usually necessary." } ]

[ { "from": "human", "value": "What are the symptoms of What I need to know about Diarrhea?" }, { "from": "gpt", "value": "In addition to passing frequent, loose stools, other possible symptoms include\n- cramps or pain in the abdomenthe area between the chest and hips\n- an urgent need to use the bathroom\n- loss of bowel control\nYou may feel sick to your stomach or become dehydrated. If a virus or bacteria is the cause of your diarrhea, you may have fever and chills and bloody stools.\nDehydration\nBeing dehydrated means your body does not have enough fluid to work properly. Every time you have a bowel movement, you lose fluids. Diarrhea causes you to lose even more fluids. You also lose salts and minerals such as sodium, chloride, and potassium. These salts and minerals affect the amount of water that stays in your body.\nDehydration can be serious, especially for children, older adults, and people with weakened immune systems.\nSigns of dehydration in adults are\n- being thirsty\n- urinating less often than usual\n- having dark-colored urine\n- having dry skin\n- feeling tired\n- feeling dizzy or fainting\nSigns of dehydration in babies and young children are\n- having a dry mouth and tongue\n- crying without tears\n- having no wet diapers for 3 hours or more\n- having sunken eyes, cheeks, or soft spot in the skull\n- having a high fever\n- being more cranky or drowsy than usual\nAlso, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released." } ]

[ { "from": "human", "value": "How to diagnose What I need to know about Diarrhea?" }, { "from": "gpt", "value": "To find the cause of diarrhea, the health care provider may\n- perform a physical exam\n- ask about any medicines you are taking\n- test your stool or blood to look for bacteria, parasites, or other signs of disease or infection\n- ask you to stop eating certain foods to see whether your diarrhea goes away\nIf you have chronic diarrhea, your health care provider may perform other tests to look for signs of disease." } ]

[ { "from": "human", "value": "What are the treatments for What I need to know about Diarrhea?" }, { "from": "gpt", "value": "Diarrhea is treated by replacing lost fluids, salts, and minerals to prevent dehydration.\nTaking medicine to stop diarrhea can be helpful in some cases. Medicines you can buy over the counter without a prescription include loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate). Stop taking these medicines if symptoms get worse or if the diarrhea lasts more than 2 days. If you have bloody diarrhea, you should not use over-the-counter diarrhea medicines. These medicines may make diarrhea last longer. The health care provider will usually prescribe antibiotics instead.\nOver-the-counter medicines for diarrhea may be dangerous for babies and children. Talk with the health care provider before giving your child these medicines." } ]

[ { "from": "human", "value": "What to do for What I need to know about Diarrhea?" }, { "from": "gpt", "value": "To prevent dehydration when you have diarrhea, it is important to drink plenty of water, but you also need to drink fluids that contain sodium, chloride, and potassium.\n- Adults should drink water, fruit juices, sports drinks, sodas without caffeine, and salty broths.\n- Children should drink oral rehydration solutionsspecial drinks that contain salts and minerals to prevent dehydration. These drinks include Pedialyte, Naturalyte, Infalyte, and CeraLyte. These drinks are sold in most grocery stores and drugstores.\n- bananas\n- plain rice\n- boiled potatoes\n- toast\n- crackers\n- cooked carrots\n- baked chicken without the skin or fat\nIf a certain food is the cause of diarrhea, try to avoid it.\n- drinks with caffeine, such as coffee and cola\n- high-fat or greasy foods, such as fried foods\n- foods with a lot of fiber, such as citrus fruits\n- sweet foods, such as cakes and cookies\nDuring or after an episode of diarrhea, some people have trouble digesting lactose, the sugar in milk and milk products. However, you may be able to digest yogurt. Eating yogurt with active, live bacterial cultures may even help you feel better faster.\nWhen babies have diarrhea, continue breastfeeding or formula feeding as usual.\nAfter you have had diarrhea caused by a virus, problems digesting lactose may last up to 4 to 6 weeks. You may have diarrhea for a short time after you eat or drink milk or milk products." } ]

[ { "from": "human", "value": "How to prevent What I need to know about Diarrhea?" }, { "from": "gpt", "value": "Two types of diarrhea can be preventedrotavirus diarrhea and travelers diarrhea.\nRotavirus Diarrhea\nTwo vaccines, RotaTeq and Rotarix, protect against rotavirusa common virus that causes diarrhea in babies and children. RotaTeq is given to babies in three doses at 2, 4, and 6 months of age. Rotarix is given in two doses. The first dose is given when the baby is 6 weeks old, and the second is given at least 4 weeks later but before the baby is 24 weeks old. To learn more about rotavirus vaccines, talk with your childs health care provider. You can also find more information at the Centers for Disease Control and Prevention rotavirus vaccination webpage at www.cdc.gov/vaccines/vpd-vac/rotavirus.\nRotaTeq and Rotarix only prevent diarrhea caused by rotavirus. Children who have been vaccinated may still get diarrhea from another cause.\nTravelers Diarrhea\nPeople may develop travelers diarrhea while visiting developing areas of the world such as Latin America, Africa, and southern Asia. Travelers diarrhea is caused by eating food or drinking water that contains harmful bacteria, viruses, or parasites.\nYou can prevent travelers diarrhea by being careful:\n- Do not drink tap water, use tap water to brush your teeth, or use ice cubes made from tap water.\n- Do not eat or drink unpasteurized milk or milk products.\n- Do not eat raw fruits and vegetables unless they can be peeled and you peel them yourself.\n- Do not eat raw or rare meat and fish.\n- Do not eat meat or shellfish that is not hot when served to you.\n- Do not eat food sold by street vendors.\nYou can drink bottled water, carbonated soft drinks, and hot drinks such as coffee and tea.\nBefore traveling outside the United States, talk with your health care provider. Your health care provider may suggest taking medicine with you. In some cases, taking antibiotics before traveling can help prevent travelers diarrhea. And early treatment with antibiotics can shorten an episode of travelers diarrhea." } ]

[ { "from": "human", "value": "What to do for What I need to know about Diarrhea?" }, { "from": "gpt", "value": "- Diarrhea is frequent, loose, and watery bowel movements.\n- Acute diarrhea is a common problem. It usually lasts only 1 or 2 days, but it may last longer.\n- Being dehydrated means your body does not have enough fluid to work properly. Dehydration can be serious, especially for children, older adults, and people with weakened immune systems.\n- Diarrhea is treated by replacing lost fluids, salts, and minerals.\n- See your health care provider if you have signs of dehydration, diarrhea for more than 2 days, severe pain in your abdomen or rectum, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry.\n- Take your child to a health care provider right away if your child has signs of dehydration, diarrhea for more than 24 hours, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry.\n- Two types of diarrhea can be prevented rotavirus diarrhea and travelers diarrhea." } ]

[ { "from": "human", "value": "What is (are) Viral Hepatitis: A through E and Beyond?" }, { "from": "gpt", "value": "Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.\nAll of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.\nResearchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus." } ]

[ { "from": "human", "value": "What are the symptoms of Viral Hepatitis: A through E and Beyond?" }, { "from": "gpt", "value": "Symptoms include\n- jaundice, which causes a yellowing of the skin and eyes\n- fatigue\n- abdominal pain\n- loss of appetite\n- nausea\n- vomiting\n- diarrhea\n- low grade fever\n- headache\nHowever, some people do not have symptoms." } ]

[ { "from": "human", "value": "What to do for Viral Hepatitis: A through E and Beyond?" }, { "from": "gpt", "value": "- Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.\n- Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.\n- Vaccines offer protection from hepatitis A and hepatitis B.\n- No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.\n- Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis." } ]

[ { "from": "human", "value": "What causes Viral Hepatitis: A through E and Beyond?" }, { "from": "gpt", "value": "Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus. These cases are called non-AE hepatitis. Scientists continue to study the causes of non-AE hepatitis." } ]

[ { "from": "human", "value": "What is (are) Cushing's Syndrome?" }, { "from": "gpt", "value": "Cushing's syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. Sometimes called hypercortisolism, Cushing's syndrome is relatively rare and most commonly affects adults aged 20 to 50. People who are obese and have type 2 diabetes, along with poorly controlled blood glucose-also called blood sugar-and high blood pressure, have an increased risk of developing the disorder." } ]

[ { "from": "human", "value": "What are the symptoms of Cushing's Syndrome?" }, { "from": "gpt", "value": "Signs and symptoms of Cushing's syndrome vary, but most people with the disorder have upper body obesity, a rounded face, increased fat around the neck, and relatively slender arms and legs. Children tend to be obese with slowed growth rates.\nOther signs appear in the skin, which becomes fragile and thin, bruises easily, and heals poorly. Purple or pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts. The bones are weakened, and routine activities such as bending, lifting, or rising from a chair may lead to backaches and rib or spinal column fractures.\nWomen with Cushing's syndrome usually have excess hair growth on their face, neck, chest, abdomen, and thighs. Their menstrual periods may become irregular or stop. Men may have decreased fertility with diminished or absent desire for sex and, sometimes, erectile dysfunction.\nOther common signs and symptoms include\n- severe fatigue\n- weak muscles\n- high blood pressure\n- high blood glucose\n- increased thirst and urination\n- irritability, anxiety, or depression\n- a fatty hump between the shoulders\nSometimes other conditions have many of the same signs as Cushing's syndrome, even though people with these disorders do not have abnormally elevated cortisol levels. For example, polycystic ovary syndrome can cause menstrual disturbances, weight gain beginning in adolescence, excess hair growth, and impaired insulin action and diabetes. Metabolic syndrome-a combination of problems that includes excess weight around the waist, high blood pressure, abnormal levels of cholesterol and triglycerides in the blood, and insulin resistance-also mimics the symptoms of Cushing's syndrome." } ]

[ { "from": "human", "value": "What causes Cushing's Syndrome?" }, { "from": "gpt", "value": "Cushing's syndrome occurs when the body's tissues are exposed to high levels of cortisol for too long. Many people develop Cushing's syndrome because they take glucocorticoids-steroid hormones that are chemically similar to naturally produced cortisolsuch as prednisone for asthma, rheumatoid arthritis, lupus, and other inflammatory diseases. Glucocorticoids are also used to suppress the immune system after transplantation to keep the body from rejecting the new organ or tissue.\nOther people develop Cushing's syndrome because their bodies produce too much cortisol. Normally, the production of cortisol follows a precise chain of events. First, the hypothalamus, a part of the brain about the size of a small sugar cube, sends corticotropin-releasing hormone (CRH) to the pituitary gland. CRH causes the pituitary to secrete adrenocorticotropin hormone (ACTH), which stimulates the adrenal glands. When the adrenals, which are located just above the kidneys, receive the ACTH, they respond by releasing cortisol into the bloodstream.\nCortisol performs vital tasks in the body including\n- helping maintain blood pressure and cardiovascular function\n- reducing the immune system's inflammatory response\n- balancing the effects of insulin, which breaks down glucose for energy\n- regulating the metabolism of proteins, carbohydrates, and fats\nOne of cortisol's most important jobs is to help the body respond to stress. For this reason, women in their last 3 months of pregnancy and highly trained athletes normally have high levels of the hormone. People suffering from depression, alcoholism, malnutrition, or panic disorders also have increased cortisol levels.\nWhen the amount of cortisol in the blood is adequate, the hypothalamus and pituitary release less CRH and ACTH. This process ensures the amount of cortisol released by the adrenal glands is precisely balanced to meet the bodys daily needs. However, if something goes wrong with the adrenals or the regulating switches in the pituitary gland or hypothalamus, cortisol production can go awry.\nPituitary Adenomas\nPituitary adenomas cause 70 percent of Cushing's syndrome cases,1 excluding those caused by glucocorticoid use. These benign, or noncancerous, tumors of the pituitary gland secrete extra ACTH. Most people with the disorder have a single adenoma. This form of the syndrome, known as Cushing's disease, affects women five times more often than men.\nEctopic ACTH Syndrome\nSome benign or, more often, cancerous tumors that arise outside the pituitary can produce ACTH. This condition is known as ectopic ACTH syndrome. Lung tumors cause more than half of these cases, and men are affected three times more often than women. The most common forms of ACTH-producing tumors are small cell lung cancer, which accounts for about 13 percent of all lung cancer cases,2 and carcinoid tumors-small, slow-growing tumors that arise from hormone-producing cells in various parts of the body. Other less common types of tumors that can produce ACTH are thymomas, pancreatic islet cell tumors, and medullary carcinomas of the thyroid.\nAdrenal Tumors\nIn rare cases, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing's syndrome. Adrenal tumors are four to five times more common in women than men, and the average age of onset is about 40. Most of these cases involve noncancerous tumors of adrenal tissue called adrenal adenomas, which release excess cortisol into the blood.\nAdrenocortical carcinomas-adrenal cancers-are the least common cause of Cushing's syndrome. With adrenocortical carcinomas, cancer cells secrete excess levels of several adrenocortical hormones, including cortisol and adrenal androgens, a type of male hormone. Adrenocortical carcinomas usually cause very high hormone levels and rapid development of symptoms.\nFamilial Cushing's Syndrome\nMost cases of Cushing's syndrome are not inherited. Rarely, however, Cushing's syndrome results from an inherited tendency to develop tumors of one or more endocrine glands. Endocrine glands release hormones into the bloodstream. With primary pigmented micronodular adrenal disease, children or young adults develop small cortisol-producing tumors of the adrenal glands. With multiple endocrine neoplasia type 1 (MEN1), hormone-secreting tumors of the parathyroid glands, pancreas, and pituitary develop; Cushing's syndrome in MEN1 may be due to pituitary, ectopic, or adrenal tumors." } ]

[ { "from": "human", "value": "How to diagnose Cushing's Syndrome?" }, { "from": "gpt", "value": "Diagnosis is based on a review of a person's medical history, a physical examination, and laboratory tests. X rays of the adrenal or pituitary glands can be useful in locating tumors.\nTests to Diagnose Cushing's Syndrome\nNo single lab test is perfect and usually several are needed. The three most common tests used to diagnose Cushing's syndrome are the 24-hour urinary free cortisol test, measurement of midnight plasma cortisol or late-night salivary cortisol, and the low-dose dexamethasone suppression test. Another test, the dexamethasone-corticotropin-releasing hormone test, may be needed to distinguish Cushing's syndrome from other causes of excess cortisol.\n- 24-hour urinary free cortisol level. In this test, a person's urine is collected several times over a 24-hour period and tested for cortisol. Levels higher than 50 to 100 micrograms a day for an adult suggest Cushing's syndrome. The normal upper limit varies in different laboratories, depending on which measurement technique is used.\n- Midnight plasma cortisol and late-night salivary cortisol measurements. The midnight plasma cortisol test measures cortisol concentrations in the blood. Cortisol production is normally suppressed at night, but in Cushing's syndrome, this suppression doesn't occur. If the cortisol level is more than 50 nanomoles per liter (nmol/L), Cushing's syndrome is suspected. The test generally requires a 48-hour hospital stay to avoid falsely elevated cortisol levels due to stress. However, a late-night or bedtime saliva sample can be obtained at home, then tested to determine the cortisol level. Diagnostic ranges vary, depending on the measurement technique used.\n- Low-dose dexamethasone suppression test (LDDST). In the LDDST, a person is given a low dose of dexamethasone, a synthetic glucocorticoid, by mouth every 6 hours for 2 days. Urine is collected before dexamethasone is administered and several times on each day of the test. A modified LDDST uses a onetime overnight dose. Cortisol and other glucocorticoids signal the pituitary to release less ACTH, so the normal response after taking dexamethasone is a drop in blood and urine cortisol levels. If cortisol levels do not drop, Cushing's syndrome is suspected. The LDDST may not show a drop in cortisol levels in people with depression, alcoholism, high estrogen levels, acute illness, or stress, falsely indicating Cushing's syndrome. On the other hand, drugs such as phenytoin and phenobarbital may cause cortisol levels to drop, falsely indicating that Cushings is not present in people who actually have the syndrome. For this reason, physicians usually advise their patients to stop taking these drugs at least 1 week before the test.\n- Dexamethasone-corticotropin-releasing hormone (CRH) test. Some people have high cortisol levels but do not develop the progressive effects of Cushing's syndrome, such as muscle weakness, fractures, and thinning of the skin. These people may have pseudo-Cushing's syndrome, a condition sometimes found in people who have depression or anxiety disorders, drink excess alcohol, have poorly controlled diabetes, or are severely obese. Pseudo-Cushings does not have the same long-term effects on health as Cushing's syndrome and does not require treatment directed at the endocrine glands. The dexamethasone-CRH test rapidly distinguishes pseudo-Cushing's from mild cases of Cushing's. This test combines the LDDST and a CRH stimulation test. In the CRH stimulation test, an injection of CRH causes the pituitary to secrete ACTH. Pretreatment with dexamethasone prevents CRH from causing an increase in cortisol in people with pseudo-Cushing's. Elevations of cortisol during this test suggest Cushing's syndrome.\nTests to Find the Cause of Cushing's Syndrome\nOnce Cushing's syndrome has been diagnosed, other tests are used to find the exact location of the abnormality that leads to excess cortisol production. The choice of test depends, in part, on the preference of the endocrinologist or the center where the test is performed.\n- CRH stimulation test. The CRH test, without pretreatment with dexamethasone, helps separate people with pituitary adenomas from those with ectopic ACTH syndrome or adrenal tumors. As a result of the CRH injection, people with pituitary adenomas usually experience a rise in blood levels of ACTH and cortisol because CRH acts directly on the pituitary. This response is rarely seen in people with ectopic ACTH syndrome and practically never in those with adrenal tumors.\n- high-dose dexamethasone suppression test (HDDST). The HDDST is the same as the LDDST, except it uses higher doses of dexamethasone. This test helps separate people with excess production of ACTH due to pituitary adenomas from those with ectopic ACTH-producing tumors. High doses of dexamethasone usually suppress cortisol levels in people with pituitary adenomas but not in those with ectopic ACTH-producing tumors.\n- Radiologic imaging: direct visualization of the endocrine glands. Imaging tests reveal the size and shape of the pituitary and adrenal glands and help determine if a tumor is present. The most common imaging tests are the computerized tomography (CT) scan and magnetic resonance imaging (MRI). A CT scan produces a series of x-ray pictures giving a cross-sectional image of a body part. MRI also produces images of internal organs but without exposing patients to ionizing radiation. Imaging procedures are used to find a tumor after a diagnosis has been made. Imaging is not used to make the diagnosis of Cushing's syndrome because benign tumors are commonly found in the pituitary and adrenal glands. These tumors, sometimes called incidentalomas, do not produce hormones in quantities that are harmful. They are not removed unless blood tests show they are a cause of symptoms or they are unusually large. Conversely, pituitary tumors may not be detectable by imaging in almost half of people who ultimately need pituitary surgery for Cushing's syndrome.\n- Petrosal sinus sampling. This test is not always required, but in many cases, it is the best way to distinguish pituitary from ectopic causes of Cushing's syndrome. Samples of blood are drawn from the petrosal sinuses-veins that drain the pituitary-by inserting tiny tubes through a vein in the upper thigh or groin region. A local anesthetic and mild sedation are given, and x rays are taken to confirm the correct position of the tubes. Often CRH, the hormone that causes the pituitary to release ACTH, is given during this test to improve diagnostic accuracy. Levels of ACTH in the petrosal sinuses are measured and compared with ACTH levels in a forearm vein. Higher levels of ACTH in the sinuses than in the forearm vein indicate a pituitary adenoma. Similar levels of ACTH in the petrosal sinuses and the forearm suggest ectopic ACTH syndrome." } ]

[ { "from": "human", "value": "What are the treatments for Cushing's Syndrome?" }, { "from": "gpt", "value": "Treatment depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs. If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects. In some cases, noncorticosteroid drugs can be prescribed.\nPituitary Adenomas\nSeveral therapies are available to treat the ACTH-secreting pituitary adenomas of Cushing's disease. The most widely used treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and fine instruments, the surgeon approaches the pituitary gland through a nostril or an opening made below the upper lip. Because this procedure is extremely delicate, patients are often referred to centers specializing in this type of surgery. The success, or cure, rate of this procedure is more than 80 percent when performed by a surgeon with extensive experience. If surgery fails or only produces a temporary cure, surgery can be repeated, often with good results.\nAfter curative pituitary surgery, the production of ACTH drops two levels below normal. This drop is natural and temporary, and patients are given a synthetic form of cortisol such as hydrocortisone or prednisone to compensate. Most people can stop this replacement therapy in less than 1 or 2 years, but some must be on it for life.\nIf transsphenoidal surgery fails or a patient is not a suitable candidate for surgery, radiation therapy is another possible treatment. Radiation to the pituitary gland is given over a 6-week period, with improvement occurring in 40 to 50 percent of adults and up to 85 percent of children. Another technique, called stereotactic radiosurgery or gamma knife radiation, can be given in a single high-dose treatment. It may take several months or years before people feel better from radiation treatment alone. Combining radiation with cortisol-inhibiting drugs can help speed recovery.\nDrugs used alone or in combination to control the production of excess cortisol are ketoconazole, mitotane, aminoglutethimide, and metyrapone. Each drug has its own side effects that doctors consider when prescribing medical therapy for individual patients.\nEctopic ACTH Syndrome\nTo cure the overproduction of cortisol caused by ectopic ACTH syndrome, all of the cancerous tissue that is secreting ACTH must be eliminated. The choice of cancer treatment-surgery, radiation, chemotherapy, immunotherapy, or a combination of these treatmentsdepends on the type of cancer and how far it has spread. Because ACTH-secreting tumors may be small or widespread at the time of diagnosis, making them difficult to locate and treat directly, cortisol-inhibiting drugs are an important part of treatment. In some cases, if other treatments fail, surgical removal of the adrenal glands, called bilateral adrenalectomy, may replace drug therapy.\nAdrenal Tumors\nSurgery is the mainstay of treatment for benign and cancerous tumors of the adrenal glands. Primary pigmented micronodular adrenal disease and the inherited Carney complex-primary tumors of the heart that can lead to endocrine overactivity and Cushing's syndrome-require surgical removal of the adrenal glands." } ]

[ { "from": "human", "value": "What to do for Cushing's Syndrome?" }, { "from": "gpt", "value": "- Cushing's syndrome is a disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol.\n- Typical signs and symptoms of Cushing's syndrome include upper body obesity, a rounded face, skin that bruises easily and heals poorly, weakened bones, excess body hair growth and menstrual irregularities in women, and decreased fertility in men.\n- Cushing's syndrome is caused by exposure to glucocorticoids, which are used to treat inflammatory diseases, or by the body's overproduction of cortisol, most often due to tumors of the pituitary gland or lung.\n- Several tests are usually needed to diagnosis Cushing's syndrome, including urine, blood, and saliva tests. Other tests help find the cause of the syndrome.\n- Treatment depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs." } ]

[ { "from": "human", "value": "How to diagnose Nonalcoholic Steatohepatitis?" }, { "from": "gpt", "value": "NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH and separating it from simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or scans can reliably provide this information." } ]

[ { "from": "human", "value": "What are the symptoms of Nonalcoholic Steatohepatitis?" }, { "from": "gpt", "value": "NASH is usually a silent disease with few or no symptoms. Patients generally feel well in the early stages and only begin to have symptomssuch as fatigue, weight loss, and weaknessonce the disease is more advanced or cirrhosis develops. The progression of NASH can take years, even decades. The process can stop and, in some cases, reverse on its own without specific therapy. Or NASH can slowly worsen, causing scarring or fibrosis to appear and accumulate in the liver. As fibrosis worsens, cirrhosis develops; the liver becomes seriously scarred, hardened, and unable to function normally. Not every person with NASH develops cirrhosis, but once serious scarring or cirrhosis is present, few treatments can halt the progression. A person with cirrhosis experiences fluid retention, muscle wasting, bleeding from the intestines, and liver failure. Liver transplantation is the only treatment for advanced cirrhosis with liver failure, and transplantation is increasingly performed in people with NASH. NASH ranks as one of the major causes of cirrhosis in America, behind hepatitis C and alcoholic liver disease." } ]

[ { "from": "human", "value": "What causes Nonalcoholic Steatohepatitis?" }, { "from": "gpt", "value": "Although NASH has become more common, its underlying cause is still not clear. It most often occurs in persons who are middle-aged and overweight or obese. Many patients with NASH have elevated blood lipids, such as cholesterol and triglycerides, and many have diabetes or prediabetes, but not every obese person or every patient with diabetes has NASH. Furthermore, some patients with NASH are not obese, do not have diabetes, and have normal blood cholesterol and lipids. NASH can occur without any apparent risk factor and can even occur in children. Thus, NASH is not simply obesity that affects the liver.\nWhile the underlying reason for the liver injury that causes NASH is not known, several factors are possible candidates:\n- insulin resistance\n- release of toxic inflammatory proteins by fat cells (cytokines)\n- oxidative stress (deterioration of cells) inside liver cells" } ]

[ { "from": "human", "value": "What are the treatments for Nonalcoholic Steatohepatitis?" }, { "from": "gpt", "value": "Currently, no specific therapies for NASH exist. The most important recommendations given to persons with this disease are to\n- reduce their weight (if obese or overweight)\n- follow a balanced and healthy diet\n- increase physical activity\n- avoid alcohol\n- avoid unnecessary medications\nThese are standard recommendations, but they can make a difference. They are also helpful for other conditions, such as heart disease, diabetes, and high cholesterol.\nA major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease to some extent. Research at present is focusing on how much weight loss improves the liver in patients with NASH and whether this improvement lasts over a period of time.\nPeople with NASH often have other medical conditions, such as diabetes, high blood pressure, or elevated cholesterol. These conditions should be treated with medication and adequately controlled; having NASH or elevated liver enzymes should not lead people to avoid treating these other conditions.\nExperimental approaches under evaluation in patients with NASH include antioxidants, such as vitamin E, selenium, and betaine. These medications act by reducing the oxidative stress that appears to increase inside the liver in patients with NASH. Whether these substances actually help treat the disease is not known, but the results of clinical trials should become available in the next few years.\nAnother experimental approach to treating NASH is the use of newer antidiabetic medicationseven in persons without diabetes. Most patients with NASH have insulin resistance, meaning that the insulin normally present in the bloodstream is less effective for them in controlling blood glucose and fatty acids in the blood than it is for people who do not have NASH. The newer antidiabetic medications make the body more sensitive to insulin and may help reduce liver injury in patients with NASH. Studies of these medicationsincluding metformin, rosiglitazone, and pioglitazoneare being sponsored by the National Institutes of Health and should answer the question of whether these medications are beneficial in NASH." } ]

[ { "from": "human", "value": "What to do for Nonalcoholic Steatohepatitis?" }, { "from": "gpt", "value": "- Nonalcoholic steatohepatitis (NASH) is fat in the liver, with inflammation and damage.\n- NASH occurs in people who drink little or no alcohol and affects 2 to 5 percent of Americans, especially people who are middle-aged and overweight or obese.\n- NASH can occur in children.\n- People who have NASH may feel well and may not know that they have a liver disease.\n- NASH can lead to cirrhosis, a condition in which the liver is permanently damaged and cannot work properly.\n- Fatigue can occur at any stage of NASH.\n- Weight loss and weakness may begin once the disease is advanced or cirrhosis is present.\n- NASH may be suspected if blood tests show high levels of liver enzymes or if scans show fatty liver.\n- NASH is diagnosed by examining a small piece of the liver taken through a needle, a procedure called biopsy.\n- People who have NASH should reduce their weight, eat a balanced diet, engage in physical activity, and avoid alcohol and unnecessary medications.\n- No specific therapies for NASH exist. Experimental therapies being studied include antioxidants and antidiabetes medications." } ]

[ { "from": "human", "value": "How to diagnose Your Diabetes Care Records?" }, { "from": "gpt", "value": "TestInstructionsResults or DatesA1C test- Have this blood test at least twice a year. Your result will tell you what your average blood glucose level was for the past 2 to 3 months.Date: __________ A1C: __________ Next test: __________Blood lipid (fats) lab tests- Get a blood test to check your- total cholesterolaim for below 200- LDL, or bad, cholesterolaim for below 100- HDL, or good, cholesterolmen: aim for above 40; women: aim for above 50- triglyceridesaim for below 150Date: __________ Total cholesterol: __________ LDL: __________ HDL: __________ Triglycerides: __________ Next test: __________Kidney function tests- Once a year, get a urine test to check for protein.\n- At least once a year, get a blood test to check for creatinine.Date: __________ Urine protein: __________ Creatinine: __________ Next test: __________Dilated eye exam- See an eye doctor once a year for a complete eye exam that includes using drops in your eyes to dilate your pupils.\n- If you are pregnant, have a complete eye exam in your first 3 months of pregnancy. Have another complete eye exam 1 year after your baby is born.Date: __________ Result: __________ Next test: __________Dental exam- See your dentist twice a year for a cleaning and checkup.Date: __________ Result: __________ Next test: __________Pneumonia vaccine (recommended by the Centers for Disease Control and Prevention [CDC])- Get the vaccine if you are younger than 64.\n- If youre older than 64 and your shot was more than 5 years ago, get another vaccine.Date received: __________Flu vaccine (recommended by the CDC)- Get a flu shot each year.Date received: __________Hepatitis B vaccine (recommended by the CDC)- Get this vaccine if you are age 19 to 59 and have not had this vaccine.\n- Consider getting this vaccine if you are 60 or older and have not had this vaccine.Date of 1st dose: __________ Date of 2nd dose: __________ Date of 3rd dose: __________\nPDF Version (PDF, 40 KB)" } ]

[ { "from": "human", "value": "What is (are) Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "Henoch-Schnlein purpura is a disease that causes small blood vessels in the body to become inflamed and leak. The primary symptom is a rash that looks like many small raised bruises. HSP can also affect the kidneys, digestive tract, and joints. HSP can occur any time in life, but it is most common in children between 2 and 6 years of age.1 Most people recover from HSP completely, though kidney damage is the most likely long-term complication. In adults, HSP can lead to chronic kidney disease (CKD) and kidney failure, described as end-stage renal disease when treated with blood-filtering treatments called dialysis or a kidney transplant." } ]

[ { "from": "human", "value": "What causes Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "Henoch-Schnlein purpura is caused by an abnormal immune system response in which the bodys immune system attacks the bodys own cells and organs. Usually, the immune system makes antibodies, or proteins, to protect the body from foreign substances such as bacteria or viruses. In HSP, these antibodies attack the blood vessels. The factors that cause this immune system response are not known. However, in 30 to 50 percent of cases, people have an upper respiratory tract infection, such as a cold, before getting HSP.2 HSP has also been associated with\n- infectious agents such as chickenpox, measles, hepatitis, and HIV viruses\n- medications\n- foods\n- insect bites\n- exposure to cold weather\n- trauma\nGenetics may increase the risk of HSP, as it has occurred in different members of the same family, including in twins." } ]

[ { "from": "human", "value": "What are the symptoms of Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "The symptoms of HSP include the following:\n- Rash. Leaking blood vessels in the skin cause a rash that looks like bruises or small red dots on the legs, arms, and buttocks. The rash may first look like hives and then change to look like bruises, and it may spread to the chest, back, and face. The rash does not disappear or turn pale when pressed.\n- Digestive tract problems. HSP can cause vomiting and abdominal pain, which can range from mild to severe. Blood may also appear in the stool, though severe bleeding is rare.\n- Arthritis. Pain and swelling can occur in the joints, usually in the knees and ankles and less frequently in the elbows and wrists.\n- Kidney involvement. Hematuria blood in the urineis a common sign that HSP has affected the kidneys. Proteinurialarge amounts of protein in the urineor development of high blood pressure suggests more severe kidney problems.\n- Other symptoms. In some cases, boys with HSP develop swelling of the testicles. Symptoms affecting the central nervous system, such as seizures, and lungs, such as pneumonia, have been seen in rare cases.\nThough the rash affects all people with HSP, pain in the joints or abdomen precedes the rash in about one-third of cases by as many as 14 days.1" } ]

[ { "from": "human", "value": "What are the complications of Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "In children, the risk of kidney damage leading to long-term problems may be as high as 15 percent, but kidney failure affects only about 1 percent of children with HSP.1 Up to 40 percent of adults with HSP will have CKD or kidney failure within 15 years after diagnosis.3\nA rare complication of HSP is intussusception of the bowel, which includes the small and large intestines. With this condition, a section of the bowel folds into itself like a telescope, causing the bowel to become blocked.\nWomen with a history of HSP who become pregnant are at higher risk for high blood pressure and proteinuria during pregnancy." } ]

[ { "from": "human", "value": "How to diagnose Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "A diagnosis of HSP is suspected when a person has the characteristic rash and one of the following:\n- abdominal pain\n- joint pain\n- antibody deposits on the skin\n- hematuria or proteinuria\nAntibody deposits on the skin can confirm the diagnosis of HSP. These deposits can be detected using a skin biopsy, a procedure that involves taking a piece of skin tissue for examination with a microscope. A skin biopsy is performed by a health care provider in a hospital with little or no sedation and local anesthetic. The skin tissue is examined in a lab by a pathologista doctor who specializes in diagnosing diseases.\nA kidney biopsy may also be needed. A kidney biopsy is performed by a health care provider in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the organ. The kidney tissue is examined in a lab by a pathologist. The test can confirm diagnosis and be used to determine the extent of kidney involvement, which will help guide treatment decisions.\nHematuria and proteinuria are detected using urinalysis, which is testing of a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine sample. Patches on the dipstick change color when blood or protein are present in urine." } ]

[ { "from": "human", "value": "What are the treatments for Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "No specific treatment for HSP exists. The main goal of treatment is to relieve symptoms such as joint pain, abdominal pain, and swelling. People with kidney involvement may receive treatment aimed at preventing long-term kidney disease.\nTreatment is rarely required for the rash. Joint pain is often treated with nonsteroidal anti-inflammatory medications, such as aspirin or ibuprofen. Recent research has shown corticosteroidsmedications that decrease swelling and reduce the activity of the immune systemto be even more effective in treating joint pain. Corticosteroids are also used to treat abdominal pain.\nThough rare, surgery may be needed to treat intussusception or to determine the cause of swollen testicles.\nHSP that affects the kidneys may be treated with corticosteroid and immunosuppressive medications. Immunosuppressive medications prevent the body from making antibodies. Adults with severe, acute kidney failure are treated with high-dose corticosteroids and the immunosuppressive cyclophosphamide (Cytoxan).\nPeople with HSP that is causing high blood pressure may need to take medications thatwhen taken as prescribed by their health care providerlower their blood pressure and can also significantly slow the progression of kidney disease. Two types of blood pressure lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretica medication that helps the kidneys remove fluid from the bloodmay be prescribed. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed.\nBlood and urine tests are used to check the kidney function of people with HSP for at least 6 months after the main symptoms disappear." } ]

[ { "from": "human", "value": "What to do for Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "Eating, diet, and nutrition have not been shown to play a role in causing or preventing HSP." } ]

[ { "from": "human", "value": "What to do for Henoch-Schnlein Purpura?" }, { "from": "gpt", "value": "- Henoch-Schnlein purpura (HSP) is a disease that causes small blood vessels in the body to become inflamed and leak.\n- HSP is caused by an abnormal immune system response in which the bodys immune system attacks the bodys own cells and organs. The factors that cause this immune system response are not known.\n- The symptoms of HSP include the following:- rash- digestive tract problems- arthritis- kidney involvement- In children, the risk of kidney damage leading to long-term problems may be as high as 15 percent, but kidney failure affects only about 1 percent of children with HSP. Up to 40 percent of adults with HSP will have CKD or kidney failure within 15 years after diagnosis.\n- A diagnosis of HSP is suspected when a person has the characteristic rash and one of the following:- abdominal pain- joint pain- antibody deposits on the skin- hematuria or proteinuria- Antibody deposits on the skin can confirm the diagnosis of HSP.\n- No specific treatment for HSP exists. The main goal of treatment is to relieve symptoms such as joint pain, abdominal pain, and swelling. People with kidney involvement may receive treatment aimed at preventing long-term kidney disease." } ]

[ { "from": "human", "value": "What is (are) Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "Childhood nephrotic syndrome is not a disease in itself; rather, it is a group of symptoms that\n- indicate kidney damageparticularly damage to the glomeruli, the tiny units within the kidney where blood is filtered\n- result in the release of too much protein from the body into the urine\nWhen the kidneys are damaged, the protein albumin, normally found in the blood, will leak into the urine. Proteins are large, complex molecules that perform a number of important functions in the body.\nThe two types of childhood nephrotic syndrome are\n- primarythe most common type of childhood nephrotic syndrome, which begins in the kidneys and affects only the kidneys\n- secondarythe syndrome is caused by other diseases\nA health care provider may refer a child with nephrotic syndrome to a nephrologista doctor who specializes in treating kidney disease. A child should see a pediatric nephrologist, who has special training to take care of kidney problems in children, if possible. However, in many parts of the country, pediatric nephrologists are in short supply, so the child may need to travel. If traveling is not possible, some nephrologists who treat adults can also treat children." } ]

[ { "from": "human", "value": "What is (are) Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder.\nKidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes." } ]

[ { "from": "human", "value": "What causes Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "While idiopathic, or unknown, diseases are the most common cause of primary childhood nephrotic syndrome, researchers have linked certain diseases and some specific genetic changes that damage the kidneys with primary childhood nephrotic syndrome.\nThe cause of secondary childhood nephrotic syndrome is an underlying disease or infection. Called a primary illness, its this underlying disease or infection that causes changes in the kidney function that can result in secondary childhood nephrotic syndrome.\nCongenital diseasesdiseases that are present at birthcan also cause childhood nephrotic syndrome.\nPrimary Childhood Nephrotic Syndrome\nThe following diseases are different types of idiopathic childhood nephrotic syndrome:\n- Minimal change disease involves damage to the glomeruli that can be seen only with an electron microscope. This type of microscope shows tiny details better than any other microscope. Scientists do not know the exact cause of minimal change disease. Minimal change disease is the most common cause of idiopathic childhood nephrotic syndrome.1\n- Focal segmental glomerulosclerosis is scarring in scattered regions of the kidney:- Focal means that only some of the glomeruli become scarred.\n- Segmental means damage affects only part of an individual glomerulus.\n- Membranoproliferative glomerulonephritis is a group of disorders involving deposits of antibodies that build up in the glomeruli, causing thickening and damage. Antibodies are proteins made by the immune system to protect the body from foreign substances such as bacteria or viruses.\nSecondary Childhood Nephrotic Syndrome\nSome common diseases that can cause secondary childhood nephrotic syndrome include\n- diabetes, a condition that occurs when the body cannot use glucosea type of sugarnormally\n- Henoch-Schnlein purpura, a disease that causes small blood vessels in the body to become inflamed and leak\n- hepatitis, inflammation of the liver caused by a virus\n- human immunodeficiency virus (HIV), a virus that alters the immune system\n- lupus, an autoimmune disease that occurs when the body attacks its own immune system\n- malaria, a disease of the blood that is spread by mosquitos\n- streptococcal infection, an infection that results when the bacteria that causes strep throat or a skin infection is left untreated\nOther causes of secondary childhood nephrotic syndrome can include certain medications, such as aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs, and exposure to chemicals, such as mercury and lithium.\nCongenital Diseases and Childhood Nephrotic Syndrome\nCongenital nephrotic syndrome is rare and affects infants in the first 3 months of life.2 This type of nephrotic syndrome, sometimes called infantile nephrotic syndrome, can be caused by\n- inherited genetic defects, which are problems passed from parent to child through genes\n- infections at the time of birth\nMore information about underlying diseases or infections that cause changes in kidney function is provided in the NIDDK health topic, Glomerular Diseases." } ]

[ { "from": "human", "value": "What are the symptoms of Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "The signs and symptoms of childhood nephrotic syndrome may include\n- edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face\n- albuminuriawhen a childs urine has high levels of albumin\n- hypoalbuminemiawhen a childs blood has low levels of albumin\n- hyperlipidemiawhen a childs blood cholesterol and fat levels are higher than normal\nIn addition, some children with nephrotic syndrome may have\n- blood in their urine\n- symptoms of infection, such as fever, lethargy, irritability, or abdominal pain\n- loss of appetite\n- diarrhea\n- high blood pressure" } ]

[ { "from": "human", "value": "What are the complications of Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "The complications of childhood nephrotic syndrome may include\n- infection. When the kidneys are damaged, a child is more likely to develop infections because the body loses proteins that normally protect against infection. Health care providers will prescribe medications to treat infections. Children with childhood nephrotic syndrome should receive the pneumococcal vaccine and yearly flu shots to prevent those infections. Children should also receive age-appropriate vaccinations, although a health care provider may delay certain live vaccines while a child is taking certain medications.\n- blood clots. Blood clots can block the flow of blood and oxygen through a blood vessel anywhere in the body. A child is more likely to develop clots when he or she loses proteins through the urine. The health care provider will treat blood clots with blood-thinning medications.\n- high blood cholesterol. When albumin leaks into the urine, the albumin levels in the blood drop. The liver makes more albumin to make up for the low levels in the blood. At the same time, the liver makes more cholesterol. Sometimes children may need treatment with medications to lower blood cholesterol levels." } ]

[ { "from": "human", "value": "How to diagnose Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "A health care provider diagnoses childhood nephrotic syndrome with\n- a medical and family history\n- a physical exam\n- urine tests\n- a blood test\n- ultrasound of the kidney\n- kidney biopsy\nMedical and Family History\nTaking a medical and family history is one of the first things a health care provider may do to help diagnose childhood nephrotic syndrome.\nPhysical Exam\nA physical exam may help diagnose childhood nephrotic syndrome. During a physical exam, a health care provider most often\n- examines a childs body\n- taps on specific areas of the childs body\nUrine Tests\nA health care provider may order the following urine tests to help determine if a child has kidney damage from childhood nephrotic syndrome.\nDipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine, which could mean kidney damage. The child or a caretaker collects a urine sample in a special container. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the childs urine sample. Patches on the dipstick change color when albumin is present in urine.\nUrine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The child provides a urine sample during an appointment with the health care provider. Creatinine is a waste product filtered in the kidneys and passed in the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine.\nBlood Test\nA blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. The lab tests the sample to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate, or eGFR. The test results help the health care provider determine the amount of kidney damage. Health care providers may also order other blood tests to help determine the underlying disease that may be causing childhood nephrotic syndrome.\nUltrasound of the Kidney\nUltrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital. A radiologista doctor who specializes in medical imaginginterprets the images to see if the kidneys look normal; a child does not need anesthesia.\nKidney Biopsy\nBiopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The health care provider will give the child light sedation and local anesthetic; however, in some cases, the child will require general anesthesia. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab. The test can help diagnose childhood nephrotic syndrome.\nWhen the health care provider suspects a child has minimal change disease, he or she often starts treatment with medications without performing a biopsy. If the medication is effective, the child does not need a biopsy. In most cases, a health care provider does not perform a biopsy on children younger than age 12 unless he or she thinks that another disease is the cause." } ]

[ { "from": "human", "value": "What are the treatments for Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "Health care providers will decide how to treat childhood nephrotic syndrome based on the type:\n- primary childhood nephrotic syndrome: medications\n- secondary childhood nephrotic syndrome: treat the underlying illness or disease\n- congenital nephrotic syndrome: medications, surgery to remove one or both kidneys, and transplantation\nPrimary Childhood Nephrotic Syndrome\nHealth care providers treat idiopathic childhood nephrotic syndrome with several types of medications that control the immune system, remove extra fluid, and lower blood pressure.\n- Control the immune system. Corticosteroids are a group of medications that reduce the activity of the immune system, decrease the amount of albumin lost in the urine, and decrease swelling. Health care providers commonly use prednisone or a related corticosteroid to treat idiopathic childhood nephrotic syndrome. About 90 percent of children achieve remission with daily corticosteroids for 6 weeks and then a slightly smaller dose every other day for 6 weeks.2 Remission is a period when the child is symptom-free. Many children relapse after initial therapy, and health care providers treat them with a shorter course of corticosteroids until the disease goes into remission again. Children may have multiple relapses; however, they most often recover without long-term kidney damage. When a child has frequent relapses or does not respond to treatment, a health care provider may prescribe other medications that reduce the activity of the immune system. These medications prevent the body from making antibodies that can damage kidney tissues. They include- cyclophosphamide- mycophenolate (CellCept, Myfortic)- cyclosporine- tacrolimus (Hecoria, Prograf) A health care provider may use these other immune system medications with corticosteroids or in place of corticosteroids.\n- Remove extra fluid. A health care provider may prescribe a diuretic, a medication that helps the kidneys remove extra fluid from the blood. Removing the extra fluid can often help to lower blood pressure.\n- Lower blood pressure. Some children with childhood nephrotic syndrome develop high blood pressure and may need to take additional medications to lower their blood pressure. Two types of blood pressure-lowering medications, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have the additional benefit of slowing the progression of kidney disease. Many children with nephrotic syndrome require two or more medications to control their blood pressure.\nSecondary Childhood Nephrotic Syndrome\nHealth care providers treat secondary childhood nephrotic syndrome by treating the underlying cause of the primary illness. For example, a health care provider may treat children by\n- prescribing antibiotics for an infection\n- adjusting medications to treat lupus, HIV, or diabetes\n- changing or stopping medications that are known to cause secondary childhood nephrotic syndrome\nWhile treating the underlying cause, the health care provider will also treat the child to improve or restore kidney function with the same medications used to treat primary childhood nephrotic syndrome.\nCaretakers should make sure that children take all prescribed medications and follow the treatment plan recommended by their health care provider.\nMore information about specific treatments for secondary childhood nephrotic syndrome is provided in the NIDDK health topic, Glomerular Diseases.\nCongenital Nephrotic Syndrome\nResearchers have found that medications are not effective in treating congenital nephrotic syndrome, and that most children will need a kidney transplant by the time they are 2 or 3 years old. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a persons body to take over the job of the failing kidney. To keep the child healthy until the transplant, the health care provider may recommend the following:\n- albumin injections to make up for the albumin lost in urine\n- diuretics to help remove extra fluid that causes swelling\n- antibiotics to treat the first signs of infection\n- growth hormones to promote growth and help bones mature\n- removal of one or both kidneys to decrease the loss of albumin in the urine\n- dialysis to artificially filter wastes from the blood if the kidneys fail\nMore information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children." } ]

[ { "from": "human", "value": "How to prevent Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "Researchers have not found a way to prevent childhood nephrotic syndrome when the cause is idiopathic or congenital." } ]

[ { "from": "human", "value": "What to do for Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "Children who have nephrotic syndrome may need to make changes to their diet, such as\n- limiting the amount of sodium, often from salt, they take in each day\n- reducing the amount of liquids they drink each day\n- eating a diet low in saturated fat and cholesterol to help control elevated cholesterol levels\nParents or caretakers should talk with the childs health care provider before making any changes to the childs diet.\nMore information is provided in the NIDDK health topic, Nutrition for Chronic Kidney Disease in Children." } ]

[ { "from": "human", "value": "What to do for Childhood Nephrotic Syndrome?" }, { "from": "gpt", "value": "- Childhood nephrotic syndrome is not a disease in itself; rather, it is a group of symptoms that- indicate kidney damageparticularly damage to the glomeruli, the tiny units within the kidney where blood is filtered- result in the release of too much protein from the body into the urine- The two types of childhood nephrotic syndrome are- primarythe most common type of childhood nephrotic syndrome, which begins in the kidneys and affects only the kidneys- secondarythe syndrome is caused by other diseases- The signs and symptoms of childhood nephrotic syndrome may include- edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face- albuminuriawhen a childs urine has high levels of albumin- hypoalbuminemiawhen a childs blood has low levels of albumin- hyperlipidemiawhen a childs blood cholesterol and fat levels are higher than normal- A health care provider may order urine tests to help determine if a child has kidney damage from childhood nephrotic syndrome.\n- Health care providers will decide how to treat childhood nephrotic syndrome based on the type:- primary childhood nephrotic syndrome: medications- secondary childhood nephrotic syndrome: treat the underlying illness or disease- congenital nephrotic syndrome: medications, surgery to remove one or both kidneys, or transplantation" } ]

[ { "from": "human", "value": "What is (are) Mntriers Disease?" }, { "from": "gpt", "value": "Mntriers disease causes the ridges along the inside of the stomach wallcalled rugaeto enlarge, forming giant folds in the stomach lining. The rugae enlarge because of an overgrowth of mucous cells in the stomach wall.\nIn a normal stomach, mucous cells in the rugae release protein-containing mucus. The mucous cells in enlarged rugae release too much mucus, causing proteins to leak from the blood into the stomach. This shortage of protein in the blood is known as hypoproteinemia. Mntriers disease also reduces the number of acid-producing cells in the stomach, which decreases stomach acid.\nMntriers disease is also called Mntrier disease or hypoproteinemic hypertrophic gastropathy." } ]

[ { "from": "human", "value": "What causes Mntriers Disease?" }, { "from": "gpt", "value": "Scientists are unsure about what causes Mntriers disease; however, researchers think that most people acquire, rather than inherit, the disease. In extremely rare cases, siblings have developed Mntriers disease as children, suggesting a genetic link.\nStudies suggest that people with Mntriers disease have stomachs that make abnormally high amounts of a protein called transforming growth factor-alpha (TGF-).\nTGF- binds to and activates a receptor called epidermal growth factor receptor. Growth factors are proteins in the body that tell cells what to do, such as grow larger, change shape, or divide to make more cells. Researchers have not yet found a cause for the overproduction of TGF-.\nSome studies have found cases of people with Mntriers disease who also had Helicobacter pylori (H. pylori) infection. H. pylori is a bacterium that is a cause of peptic ulcers, or sores on the lining of the stomach or the duodenum, the first part of the small intestine. In these cases, treatment for H. pylori reversed and improved the symptoms of Mntriers disease.1\nResearchers have linked some cases of Mntriers disease in children to infection with cytomegalovirus (CMV). CMV is one of the herpes viruses. This group of viruses includes the herpes simplex viruses, which cause chickenpox, shingles, and infectious mononucleosis, also known as mono. Most healthy children and adults infected with CMV have no symptoms and may not even know they have an infection. However, in people with a weakened immune system, CMV can cause serious disease, such as retinitis, which can lead to blindness.\nResearchers are not sure how H. pylori and CMV infections contribute to the development of Mntriers disease." } ]

[ { "from": "human", "value": "Who is at risk for Mntriers Disease??" }, { "from": "gpt", "value": "Mntriers disease is rare. The disease is more common in men than in women. The average age at diagnosis is 55.2" } ]

[ { "from": "human", "value": "What are the symptoms of Mntriers Disease?" }, { "from": "gpt", "value": "The most common symptom of Mntriers disease is pain in the upper middle part of the abdomen. The abdomen is the area between the chest and hips.\nOther signs and symptoms of Mntriers disease may include\n- nausea and frequent vomiting\n- diarrhea\n- loss of appetite\n- extreme weight loss\n- malnutrition\n- low levels of protein in the blood\n- swelling of the face, abdomen, limbs, and feet due to low levels of protein in the blood\n- anemiatoo few red blood cells in the body, which prevents the body from getting enough oxygendue to bleeding in the stomach\nPeople with Mntriers disease have a higher chance of developing stomach cancer, also called gastric cancer." } ]

[ { "from": "human", "value": "How to diagnose Mntriers Disease?" }, { "from": "gpt", "value": "Health care providers base the diagnosis of Mntriers disease on a combination of symptoms, lab findings, findings on upper gastrointestinal (GI) endoscopy, and stomach biopsy results. A health care provider will begin the diagnosis of Mntriers disease by taking a patients medical and family history and performing a physical exam. However, a health care provider will confirm the diagnosis of Mntriers disease through a computerized tomography (CT) scan, an upper GI endoscopy, and a biopsy of stomach tissue. A health care provider also may order blood tests to check for infection with H. pylori or CMV.\nMedical and family history. Taking a medical and family history is one of the first things a health care provider may do to help diagnose Mntriers disease. He or she will ask the patient to provide a medical and family history.\nPhysical exam. A physical exam may help diagnose Mntriers disease. During a physical exam, a health care provider usually\n- examines a patients body\n- uses a stethoscope to listen to bodily sounds\n- taps on specific areas of the patients body\nCT scan. CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes x rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologista doctor who specializes in medical imaginginterprets them. The patient does not need anesthesia. CT scans can show enlarged folds in the stomach wall.\nUpper GI endoscopy. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenum. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the stomach lining. The gastroenterologist also can take a biopsy of the stomach tissue during the endoscopy. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patients throat. A health care provider will place an intravenous (IV) needle in a vein in the arm to administer sedation. Sedatives help patients stay relaxed and comfortable. The test can show enlarged folds in the stomach wall.\nBiopsy. Biopsy is a procedure that involves taking a piece of stomach tissue for examination with a microscope. A gastroenterologist performs the biopsy at the time of upper GI endoscopy. A pathologista doctor who specializes in diagnosing diseasesexamines the stomach tissue in a lab. The test can diagnose Mntriers disease by showing changes in the stomachs mucous cells and acid-producing cells.\nBlood test. A health care provider will take a blood sample that can show the presence of infection with H. pylori or CMV. A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis." } ]

[ { "from": "human", "value": "What are the treatments for Mntriers Disease?" }, { "from": "gpt", "value": "Treatment may include medications, IV protein, blood transfusions, and surgery.\nMedications\nHealth care providers may prescribe the anticancer medication cetuximab (Erbitux) to treat Mntriers disease. Studies have shown that cetuximab blocks the activity of epidermal growth factor receptor and can significantly improve a persons symptoms, as well as decrease the thickness of the stomach wall from the overgrowth of mucous cells. A person receives cetuximab by IV in a health care providers office or an outpatient center. Studies to assess the effectiveness of cetuximab to treat Mntriers disease are ongoing. A health care provider also may prescribe medications to relieve nausea and abdominal pain.\nIn people with Mntriers disease who also have H. pylori or CMV infection, treatment of the infection may improve symptoms. Health care providers prescribe antibiotics to kill H. pylori. Antibiotic regimens may differ throughout the world because some strains of H. pylori have become resistant to certain antibioticsmeaning that an antibiotic that once destroyed the bacterium is no longer effective. Health care providers use antiviral medications to treat CMV infection in a person with a weakened immune system in order to prevent a serious disease from developing as a result of CMV. Antiviral medications cannot kill CMV; however, they can slow down the virus reproduction.\nIntravenous Protein and Blood Transfusions\nA health care provider may recommend an IV treatment of protein and a blood transfusion to a person who is malnourished or anemic because of Mntriers disease. In most cases of children with Mntriers disease who also have had CMV infection, treatment with protein and a blood transfusion led to a full recovery.\nSurgery\nIf a person has severe Mntriers disease with significant protein loss, a surgeon may need to remove part or all of the stomach in a surgery called gastrectomy.\nSurgeons perform gastrectomy in a hospital. The patient will require general anesthesia. Some surgeons perform a gastrectomy through laparoscopic surgery rather than through a wide incision in the abdomen. In laparoscopic surgery, the surgeon uses several smaller incisions and feeds special surgical tools through the incisions to remove the diseased part of the stomach. After gastrectomy, the surgeon may reconstruct the changed portions of the GI tract so that it may continue to function. Usually the surgeon attaches the small intestine to any remaining portion of the stomach or to the esophagus if he or she removed the entire stomach." } ]

[ { "from": "human", "value": "What to do for Mntriers Disease?" }, { "from": "gpt", "value": "Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Mntriers disease. In some cases, a health care provider may prescribe a high-protein diet to offset the loss of protein due to Mntriers disease. Some people with severe malnutrition may require IV nutrition, which is called total parenteral nutrition (TPN). TPN is a method of providing an IV liquid food mixture through a special tube in the chest." } ]

[ { "from": "human", "value": "What to do for Mntriers Disease?" }, { "from": "gpt", "value": "- Mntriers disease causes the ridges along the inside of the stomach wallcalled rugaeto enlarge, forming giant folds in the stomach lining. The rugae enlarge because of an overgrowth of mucous cells in the stomach wall.\n- Scientists are unsure about what causes Mntriers disease; however, researchers think that most people acquire, rather than inherit, the disease.\n- Mntriers disease is rare. The disease is more common in men than in women.\n- The most common symptom of Mntriers disease is pain in the upper middle part of the abdomen.\n- Health care providers base the diagnosis of Mntriers disease on a combination of symptoms, lab findings, findings on upper gastrointestinal (GI) endoscopy, and stomach biopsy results.\n- Treatment may include medications, intravenous (IV) protein, blood transfusions, and surgery." } ]