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Most patients have had prior attacks of biliary colic or acute cholecystitis. The pain of cholecystitis is similar in quality and location to biliary colic but lasts longer (ie, > 6 h) and is more severe. Vomiting is common, as is right subcostal tenderness. Within a few hours, the Murphy sign (deep inspiration exacerbates the pain during palpation of the right upper quadrant and halts inspiration) develops along with involuntary guarding of upper abdominal muscles on the right side. Fever, usually low grade, is common. In the elderly, the first or only symptoms may be systemic and nonspecific (eg, anorexia, vomiting, malaise, weakness, fever). Sometimes fever does not develop. Acute cholecystitis begins to subside in 2 to 3 days and resolves within 1 wk in 85% of patients even without treatment. Complications Without treatment, 10% of patients develop localized perforation, and 1% develop free perforation and peritonitis. Increasing abdominal pain, high fever, and rigors with rebound tenderness or ileus suggest empyema (pus) in the gallbladder, gangrene, or perforation. When acute cholecystitis is accompanied by jaundice or cholestasis, partial common duct obstruction is likely, usually due to stones or inflammation. Other complications include the following: Mirizzi syndrome: Rarely, a gallstone becomes impacted in the cystic duct and compresses and obstructs the common bile duct, causing cholestasis. Gallstone pancreatitis: Gallstones pass from the gallbladder into the biliary tract and block the pancreatic duct. Cholecystoenteric fistula: Infrequently, a large stone erodes the gallbladder wall, creating a fistula into the small bowel (or elsewhere in the abdominal cavity); the stone may pass freely or obstruct the small bowel (gallstone ileus).
19 Nov 2017
268
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Supportive care (hydration, analgesics, antibiotics) Cholecystectomy Management includes hospital admission, IV fluids, and analgesics, such as an NSAID (ketorolac) or opioid. Nothing is given orally, and nasogastric suction is instituted if vomiting or an ileus is present. Parenteral antibiotics are usually initiated to treat possible infection, but evidence of benefit is lacking. Empiric coverage, directed at gram-negative enteric organisms, involves IV regimens such as ceftriaxone 2 g q 24 h plus metronidazole 500 mg q 8 h, piperacillin/tazobactam 4 g q 6 h, or ticarcillin/clavulanate 4 g q 6 h. Cholecystectomy cures acute cholecystitis and relieves biliary pain. Early cholecystectomy is generally preferred, best done during the first 24 to 48 h in the following situations: The diagnosis is clear and patients are at low surgical risk. Patients are elderly or have diabetes and are thus at higher risk of infectious complications. Patients have empyema, gangrene, perforation, or acalculous cholecystitis. Surgery may be delayed when patients have an underlying severe chronic disorder (eg, cardiopulmonary) that increases the surgical risks. In such patients, cholecystectomy is deferred until medical therapy stabilizes the comorbid disorders or until cholecystitis resolves. If cholecystitis resolves, cholecystectomy may be done ≥ 6 wk later. Delayed surgery carries the risk of recurrent biliary complications. Percutaneous cholecystostomy is an alternative to cholecystectomy for patients at very high surgical risk, such as the elderly, those with acalculous cholecystitis, and those in an ICU because of burns, trauma, or respiratory failure.
29 Nov 2017
125
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Biliary colic and cholecystitis are in the spectrum of biliary tract disease. This spectrum ranges from asymptomatic gallstones to biliary colic, cholecystitis, choledocholithiasis, and cholangitis. Gallstones can be divided into 2 categories: Cholesterol stones (80%) and pigment stones (20%). Most patients with gallstones are asymptomatic. Stones may temporarily obstruct the cystic duct or pass through into the common bile duct, leading to symptomatic biliary colic, which develops in 1-4% of patients with gallstones annually. Cholecystitis occurs when obstruction at the cystic duct is prolonged (usually several hours) resulting in inflammation of the gallbladder wall. Acute cholecystitis develops in approximately 20% of patients with biliary colic if they are left untreated. However, the incidence of acute cholecystitis is falling, likely due to increased acceptance by patients of laparoscopic cholecystectomy as a treatment of symptomatic gallstones. Choledocholithiasis occurs when the stone becomes lodged in the common bile duct, with the potential sequelae of cholangitis and ascending infections. Biliary sludge is a reversible suspension of precipitated particulate matter in bile in a viscous mucous liquid phase. The most common precipitates are cholesterol monohydrate crystals and various calcium-based crystals, granules, and salts. A portion of biliary sludge contains comparatively large particles (1-3 mm) called microliths, the formation of which is an intermediate step in the formation of gallstones (about 12.5%). For patient education information, see the Digestive Disorders Center and Gallstones.
3 Dec 2017
261
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The kidneys are our organs that filter out toxins and waste from the bloodstream. Because toxins can affect your entire body, there is no question that supporting your kidneys is crucial for keeping your overall health in check. Without a balanced diet, purified drinking water, and body cleansing, toxins can build up and affect the function of the kidneys, liver, and neighboring organs… and may even lead to kidney stones and other problems. Cleansing the Kidneys With a Few Sips Cleansing the kidneys is a simple process and most cleanses don’t require an exhaustive supply of tools or ingredients to work. In fact, just drinking plenty of purified water is the first step toward an effective flush. Water, however, only provides hydration. The following 5 kidney-cleansing drinks may provide that extra cleansing boost. 1. Cranberry Juice Cranberry juice has been touted for years as support for the urinary tract. Research shows that cranberries can help fight against urinary tract infections, possibly by decreasing the adhesion of bacteria to the bladder and urethra. Cranberries may also be helpful for cleansing the kidneys of excess calcium oxalate, one of the main contributors to kidney stones. When purchasing cranberry juice, always choose varieties that are certified organic and free of added sugars, preservatives, or artificial flavors; or, get a juicer and make your own. 2. Beet Juice Beets and beet juice contain betaine, a very beneficial phytochemical. It has antioxidant qualities and increases the acidity of urine. This can help clear calcium phosphate and struvite buildup from the kidneys. The removal of calcium in the kidneys not only promotes kidney function, but decreases the likelihood of kidney stones. 3. Lemon Juice Naturally acidic, lemon juice has been shown to increase citrate levels in urine, a factor that discourages kidney stones from forming. For a quick lemon kidney cleanse, squeeze 4-5 lemons into a quart of cold water and drink up.
10 Dec 2017
265
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A gallbladder attack happens because of inflammation and irritation of the gallbladder. Called cholecystitis, gallbladder attacks occur because of the presence of an infection or gallstones in the gallbladder or from damage to the bile ducts that drain the gallbladdder. Cholecystitis may become an acute condition with a sudden onset or it can become a chronic health problem. Remedies for gallbladder attacks involve diet and lifestyle modifications, medications and surgery. Low Fat Diet According to the National Institute of Diabetes and Digestive and Kidney Diseases, NIDDK, an important remedy for gallbladder attacks is a low fat diet. The consumption of fat causes an increase in the production of bile which, in a diseased gallbladder, increases biliary spasm and pain symptoms. Donna D. Ignatavicius, MS RN, and M. Linda Workman, PhD, authors of "Medical-Surgical Nursing: Critical Thinking for Collaborative Care", emphasize the importance of sufficient protein intake along with adherence to a low fat diet. Adequate protein prevents the formation of certain gallstones. Gallstones are a frequent cause of gallbladder attacks. People with gallbladder disease should confer with a physician or nutritionist to establish an appropriate diet that meets individual needs. Weight Control The NIDDK report that a direct link exists between obesity and cholecystitis. One possible reason for this connection purports that in overweight people the amount of bile salts in bile is reduced, leading to elevated cholesterol levels. High cholesterol slows gallbladder emptying and increases gallstone formation. A low fat diet and regular exercise help control weight and cholesterol levels. Control Cholesterol Donna D. Ignatavicius, MS RN, and M. Linda Workman, PhD, further explain why individuals with high cholesterol have an increased risk of gallbladder attacks. Often, people with high cholesterol take cholesterol lowering medications.
12 Dec 2017
136
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High cholesterol in the bile causes 80 percent of gallstones, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Gallstones cause cholecystitis or inflammation of the gallbladder, which can result in severe abdominal pain, nausea and vomiting. In order to digest fat, the liver makes bile, which is subsequently stored in the gallbladder. When bile hardens, gallstones are formed. Eating a proper diet can keep the gallbladder healthy and prevent gallbladder attacks. Healthy Fats While high doses of saturated fats can increase circulating cholesterol and the risk of gallstones, cutting fat completely from your diet is unnecessary. Choosing healthy fats can keep the body healthy and the gallbladder happy. Try to cut back on meats that are high in saturated fats such as red meat and organ meats. Eating salmon or other meat that is high in omega-3 fatty acids can not only keep your gallbladder healthy but decrease your cholesterol as well. Remember, some fat in the diet is necessary to help control cravings and to maintain your brain power and healthy skin. Fruits and Vegetables In a 2006 "American Journal of Medicine," article, researchers from the University of Kentucky Medical Center reported that after examining the diets of 77,000 women, they found that women who had higher intakes of fruits and vegetables were less likely to have gallbladder attacks and subsequent removal of their gallbladders. Green leafy vegetables, citrus fruits and cruciferous vegetables were associated with lower risk of cholecystectomy or gallbladder removal. Whole Grains Whole grain foods have been shown to lower the risk of many chronic diseases, according to the Whole Grains Council. Eating foods such as whole wheat pasta, whole grain breads, quinoa and oats can reduce the risk of stroke and heart disease by lowering blood cholesterol. Lowering blood cholesterol reduces the risk of gallbladder stones. Eat 2 to 3 servings of whole grains daily.
21 Dec 2017
249
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Liver disease is any disturbance of liver function that causes illness. The liver is responsible for many critical functions within the body and should it become diseased or injured, the loss of those functions can cause significant damage to the body. Liver disease is also referred to as hepatic disease. Liver disease is a broad term that covers all the potential problems that cause the liver to fail to perform its designated functions. Usually, more than 75% or three quarters of liver tissue needs to be affected before a decrease in function occurs. The liver is the largest solid organ in the body; and is also considered a gland because among its many functions, it makes and secretes bile. The liver is located in the upper right portion of the abdomen protected by the rib cage. It has two main lobes that are made up of tiny lobules. The liver cells have two different sources of blood supply. The hepatic artery supplies oxygen rich blood that is pumped from the heart, while the portal vein supplies nutrients from the intestine and the spleen. Normally, veins return blood from the body to the heart, but the portal vein allows nutrients and chemicals from the digestive tract to enter the liver for processing and filtering prior to entering the general circulation. The portal vein also efficiently delivers the chemicals and proteins that liver cells need to produce the proteins, cholesterol, and glycogen required for normal body activities. As part of its function, the liver makes bile, a fluid that contains among other substances, water, chemicals, and bile acids (made from stored cholesterol in the liver). Bile is stored in the gallbladder and when food enters the duodenum (the first part of the small intestine), bile is secreted into the duodenum, to aid in the digestion of food.
25 Dec 2017
224
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The liver can be damaged in a variety of ways. Cells can become inflamed, for example, hepatitis. Bile flow can be obstructed, for example, cholestasis). Cholesterol ortriglycerides can accumulate, for example, steatosis). Blood flow to the liver may be compromised. Liver tissue can be damaged by chemicals and minerals, or infiltrated by abnormal cells, like cancer cells. Alcohol abuse Alcohol abuse is the most common cause of liver disease in North America. Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic hepatitis. In chronic alcohol abuse, fat accumulation occurs in liver cells affecting their ability to function. Cirrhosis Cirrhosis is a late-stage of liver disease. Scarring of the liver and loss of functioning liver cells cause the liver to fail. Significant amounts of liver cells need to be damaged before the hole organ fails to function.
27 Dec 2017
287
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Drug-induced liver disease Liver cells may become temporarily inflamed or permanently damaged by exposure to medications or drugs. Some medications or drugs require an overdose to cause liver injury while others may cause the damage even when taken in the appropriately prescribed dosage. Taking excess amounts of acetaminophen (Tylenol, Panadol) can cause liver failure. This is the reason that warning labels exist on many over-the-counter medications that contain acetaminophen and why prescription narcotic-acetaminophen combination medications (for example, Vicodin, Lortab, Norco, Tylenol #3) limit the numbers of tablets to be taken in a day. For patients with underlying liver disease or those who abuse alcohol, that daily limit is lower and acetaminophen may be contra-indicated in those individuals. Statins are drugs commonly prescribed to control elevated blood levels of cholesterol. Even when taken in the appropriately prescribed dose, liver inflammation may occur. This inflammation can be detected by blood tests that measure liver enzymes. Stopping the medication usually results in return of the liver function to normal. Niacin is another medication used to control elevated blood levels of cholesterol, but liver inflammation with this medication is related to the dose taken. Similarly, patients with underlying liver disease may be at higher risk of developing liver disease due to medications such as niacin. Recent studies have found that niacin may not be as effective as previously thought in controlling high cholesterol. Patients who take niacin may want to see their health care professional to determine if other treatment options may be appropriate. There are numerous other medications that may cause liver inflammation, most of which will resolve when the medication is stopped.
30 Dec 2017
327
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Infectious hepatitis The term "hepatitis" means inflammation, and liver cells can become inflamed because of infection. Hepatitis A is a viral infection that is spread primarily through the fecal-oral route when small amounts of infected fecal matter are inadvertently ingested. Hepatitis A causes an acute inflammation of the liver which generally resolves spontaneously. The hepatitis A vaccine can prevent this infection. Thorough hand washing, especially when preparing food is the best way to prevent the spread of hepatitis A. This is especially important for workers who work in the food and restaurant industries. Hepatitis B is spread by exposure to body fluids (needles from drug abusers, contaminated blood, and sexual contact) and can cause an acute infection, but can also progress to cause chronic inflammation (chronic hepatitis) that can lead to cirrhosis and liver cancer. The hepatitis B vaccine can prevent this infection. Hepatitis C causes chronic hepatitis. An infected individual may not recall any acute illness. Hepatitis C is spread by exposure to body fluids (needles from drug abusers, contaminated blood, and some forms of sexual contact). Chronic hepatitis C may lead to cirrhosis and liver cancer. At present, there is no vaccine against this virus. There is a recommendation to test all people born between 1945 and 1965 for Hepatitis C antibody to identify people who do not know that they have contracted the disease. Newer medications are now available to treat and potentially cure Hepatitis C. Hepatitis D is a virus that requires concomitant infection with hepatitis B to survive, and is spread via body fluid exposure (needles from drug abusers, contaminated blood, and sexual contact). Hepatitis E is a virus that is spread via exposure to contaminated food and water.
6 Jan 2018
232
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The precise diagnosis of liver disease involves a history and physical examination performed by a health care professional. Understanding the symptoms and the patient's risk factors for liver disease will help guide any diagnostic tests that may be considered. Sometimes history is difficult, especially in patients who abuse alcohol. These patients tend to minimize their consumption, and it is often family members who are able to provide the correct information. Liver disease can have physical findings that affect almost all body systems including the heart, lungs, abdomen, skin, brain and cognitive function, and other parts of the nervous system. The physical examination often requires evaluation of the entire body. Blood tests are helpful in assessing liver inflammation and function. Specific liver function blood tests include: AST and ALT ( transaminase chemicals released with liver cell inflammation); GGT and alkaline phosphatase (chemicals released by cells lining the bile ducts); bilirubin; and protein and albumin levels.
16 Jan 2018
122
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Your liver is one of the largest internal organs with a fully loaded to-do list. It is the production house of bile which is responsible for digesting your food and absorbing nutrition. Your liver also regulates the amount of fats, proteins and sugars in your blood. It is the hero of the metabolic process so it works tirelessly to remove wastes and toxins from your system. With so many things to look after, it is but natural that it is also prone to malfunction just like any other machine. The three most common liver diseases are: Fatty liver Hepatitis A, B, C, D and E (jaundice) Cirrhosis While there are others, our article will provide you with herbal remedies to cure these three conditions. If you observe liver disease symptoms outlined below follow these natural remedies for liver disease.
22 Jan 2018
217
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A gallbladder attack happens because of inflammation and irritation of the gallbladder. Called cholecystitis, gallbladder attacks occur because of the presence of an infection or gallstones in the gallbladder or from damage to the bile ducts that drain the gallbladdder. Cholecystitis may become an acute condition with a sudden onset or it can become a chronic health problem. Remedies for gallbladder attacks involve diet and lifestyle modifications, medications and surgery. Low Fat Diet According to the National Institute of Diabetes and Digestive and Kidney Diseases, NIDDK, an important remedy for gallbladder attacks is a low fat diet. The consumption of fat causes an increase in the production of bile which, in a diseased gallbladder, increases biliary spasm and pain symptoms. Donna D. Ignatavicius, MS RN, and M. Linda Workman, PhD, authors of “Medical-Surgical Nursing: Critical Thinking for Collaborative Care”, emphasize the importance of sufficient protein intake along with adherence to a low fat diet. Adequate protein prevents the formation of certain gallstones. Gallstones are a frequent cause of gallbladder attacks. People with gallbladder disease should confer with a physician or nutritionist to establish an appropriate diet that meets individual needs. Weight Control The NIDDK report that a direct link exists between obesity and cholecystitis. One possible reason for this connection purports that in overweight people the amount of bile salts in bile is reduced, leading to elevated cholesterol levels. High cholesterol slows gallbladder emptying and increases gallstone formation. A low fat diet and regular exercise help control weight and cholesterol levels.
16 Apr 2018
164
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