ACUTE LIVER FAILURE

DEFINITION

Acute liver failure is loss of liver function that occurs rapidly in days or weeks, usually in a person who has no pre-existing liver disease. Acute liver failure is less common than chronic liver failure, which develops more slowly.

Acute liver failure, also known as fulminant hepatic failure, can cause serious complications, including excessive bleeding and increasing pressure in the brain. It’s a medical emergency that requires hospitalization.

Depending on the cause, acute liver failure can sometimes be reversed with treatment. In many situations, though, a liver transplant may be the only cure.

SYMPTOMS

Signs and symptoms of acute liver failure may include:

  • Yellowing of your skin and eyeballs (jaundice).
  • Pain in your upper right abdomen.
  • Abdominal swelling.
  • Nausea.
  • Vomiting.
  • A general sense of feeling unwell (malaise).
  • Disorientation or confusion.
  • Sleepiness.

CAUSES

Acute liver failure occurs when liver cells are damaged significantly and are no longer able to function. Potential causes include:

  • Acetaminophen overdose: Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Acute liver failure can occur after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.
    If you suspect that you or someone you know has taken an overdose of acetaminophen, seek medical attention as quickly as possible. Do not wait for the signs of liver failure.
  • Prescription medications: Some prescription medications, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, can cause acute liver failure.
  • Herbal supplements: Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure.
  • Hepatitis And other viruses: Hepatitis A, Hepatitis B and Hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include cytomegalovirus and herpes simplex virus.
  • Toxins: Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for edible species.
  • Autoimmune disease: Liver failure can be caused by autoimmune hepatitis- a disease in which your immune system attacks liver cells, causing inflammation and injury.
  • Diseases of the veins in the liver: Vascular diseases, such as Budd-Chiari syndrome, can cause blockages in the veins of the liver, leading to acute liver failure.
  • Metabolic disease: Rare metabolic diseases, such as Wilson’s disease and acute fatty liver of pregnancy, infrequently cause acute liver failure.
  • Cancer: Cancer that either begins in or spreads to your liver can cause your liver to fail.

TREATMENTS AND DRUGS

People with acute liver failure are often treated in the intensive care unit of a hospital and when possible, in a facility that can perform a liver transplant if necessary. Your doctor may try to treat the liver damage itself, but in many cases, treatment involves controlling complications and giving your liver time to heal.

Treatments for acute liver failure

Acute liver failure treatments may include:

  • Medications to reverse poisoning: Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin and may reduce liver damage.
  • Liver transplant: When acute liver failure can’t be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor.

Treatments for complications

Your doctor will work to control signs and symptoms you’re experiencing and try to prevent complications caused by acute liver failure. This care may include:

  • Relieving pressure caused by excess Fluid in the brain: Cerebral Edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the Fluid buildup in your brain.
  • Screening for infections: Your medical team will take periodic samples of your blood and urine to be tested for infection. If your doctor suspects that you have an infection, you’ll receive medications to treat the infection.
  • Preventing severe bleeding: Your doctor can give you medications to reduce the risk of bleeding. If you lose a lot of blood, your doctor may perform tests to find the source of the blood loss, and you may require blood transfusions.

PREVENTION OF ACUTE LIVER FAILURE

Reduce your risk of acute liver failure by taking care of your liver.

  • Follow instructions on medications: If you take acetaminophen or other medications, check the package insert for the recommended dosage, and don’t take more than that. If you already have liver disease, ask your doctor if it is safe to take any amount of acetaminophen.
  • Tell your doctor about all your medicines: Even over-the-counter and herbal medicines can interfere with prescription drugs you’re taking.
  • Drink alcohol in moderation, if at all: Limit the amount of alcohol you drink to no more than one drink a day for women of all ages and men older than 65 and no more than two drinks a day for younger men.
  • Avoid risky behavior: Get help if you use illicit intravenous drugs. Don’t share needles. Use condoms during sex. If you get tattoos or body piercings, make sure the shop you choose is clean and safe. Don’t smoke.
  • Get vaccinated: If you have chronic liver disease, a history of any type of hepatitis infection or an increased risk of hepatitis, talk to your doctor about getting the hepatitis B vaccine. A vaccine also is available for hepatitis A.
  • Avoid contact with other people’s blood and body fluids: Accidental needle sticks or improper cleanup of blood or body fluids can spread hepatitis viruses. Sharing razor blades or toothbrushes also can spread infection.
  • Don’t eat wild mushrooms: It can be difficult to tell the difference between a poisonous mushroom and one that is safe to eat.
  • Take care with aerosol sprays: When you use an aerosol cleaner, make sure the room is ventilated, or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals. Follow product instructions carefully.
  • Watch what gets on your skin: When using insecticides and other toxic chemicals, cover your skin with gloves, long sleeves, a hat and a mask.
  • Maintain a healthy weight: Obesity can cause a condition called nonalcoholic fatty liver disease, which may include fatty liver, hepatitis and cirrhosis.

ACUTE KIDNEY FAILURE

DEFINITION

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate and your blood’s chemical makeup may get out of balance.

Acute kidney failure is also called acute renal failure or acute kidney injury which develops rapidly over a few hours or a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.

Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you’re otherwise in good health, you may recover normal or nearly normal kidney function.

SYMPTOMS

Signs and symptoms of acute kidney failure may include:

  • Decreased urine output, although occasionally urine output remains normal.
  • Fluid retention, causing swelling in your legs, ankles or feet.
  • Drowsiness.
  • Shortness of breath.
  • Fatigue.
  • Confusion.
  • Nausea.
  • Seizures or Coma in severe cases.
  • Chest pain or pressure.

Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.

CAUSES

Acute kidney failure can occur when:

  • You have a condition that slows blood flow to your kidneys.
  • You experience direct damage to your kidneys.
  • Your kidneys’ urine drainage tubes (ureters) become blocked and wastes can’t leave your body through your urine.

Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the kidneys and lead to kidney failure include:

  • Blood or Fluid loss.
  • Blood pressure medications.
  • Heart attack.
  • Heart disease.
  • Infection.
  • Liver failure.
  • Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) or related drugs.
  • Severe allergic reaction (Anaphylaxis).
  • Severe burns.
  • Severe dehydration.

Damage to the kidneys

These diseases, conditions and agents may damage the kidneys and lead to acute kidney failure:

  • Blood clots in the veins and arteries in and around the kidneys.
  • Cholesterol deposits that block blood flow in the kidneys.
  • Glomerulonephritis is an inflammation of the tiny filters in the kidneys (glomeruli).
  • Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells
  • Infection..
  • Lupus is an immune system disorder causing glomerulonephritis.
  • Medications, such as certain chemotherapy drugs, antibiotics, dyes used during imaging tests and zoledronic acid (Reclast, Zometa), used to treat Osteoporosis and high blood calcium levels (Hypercalcemia).
  • Scleroderma is a group of rare diseases affecting the skin and connective tissues.
  • Toxins, such as alcohol, heavy metals and cocaine.
  • Vasculitis is an inflammation of blood vessels.

Urine blockage in the kidneys

Diseases and conditions that block the passage of urine out of the body (urinary obstructions) and can lead to acute kidney failure include:

  • Bladder Cancer.
  • Blood clots in the urinary tract.
  • Cervical cancer.
  • Colon cancer.
  • Enlarged prostate.
  • Kidney stones.
  • Nerve damage involving the nerves that control the bladder.
  • Prostate cancer.

TREATMENTS AND DRUGS

Treatment for acute kidney failure typically requires a hospital stay. Most people with acute kidney failure are already hospitalized. How long you’ll stay in the hospital depends on the reason for your acute kidney failure and how quickly your kidneys recover.

In some cases, you may be able to recover at home.

Treating the underlying cause of your kidney failure:

Treatment for acute kidney failure involves identifying the illness or injury that originally damaged your kidneys. Your treatment options depend on what’s causing your kidney failure.

Treating complications until your kidneys recover:

Your doctor will also work to prevent complications and allow your kidneys time to heal. Treatments that help prevent complications include:

  • Treatments to balance the amount of Fluids in your blood: If your acute kidney failure is caused by a lack of fluids in your blood, your doctor may recommend intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have too much fluid, leading to swelling in your arms and legs. In these cases, your doctor may recommend medications (diuretics) to cause your body to expel extra Fluids.
  • Medications to control blood potassium: If your kidneys aren’t properly filtering potassium from your blood, your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate to prevent the accumulation of high levels of potassium in your blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias) and muscle weakness.
  • Medications to restore blood calcium levels: If the levels of calcium in your blood drop too low, your doctor may recommend an infusion of calcium.
  • Dialysis to remove toxins from your blood: If toxins build up in your blood, you may need temporary hemodialysis often referred to simply as dialysis, to help remove toxins and excess fluids from your body while your kidneys heal. Dialysis may also help remove excess potassium from your body. During dialysis, a machine pumps blood out of your body through an artificial kidney (dialyzer) that filters out waste. The blood is then returned to your body.

PREVENTION

Because AKI(Acute kidney Injury) happens suddenly, it can be hard to predict or prevent it. But taking good care of your kidneys can help prevent AKI, chromic kidney disease(CKD) and kidney failure.

Follow these general rules to keep your kidneys as healthy as possible:

  • Work with your doctor to manage diabetes and high blood pressure.
  • Live healthy! Eat a diet low in salt and fat, exercise for 30 minutes at least five days per week, limit alcohol and take all prescription medicines as your doctor tells you to.
  • If you take over-the-counter pain medicines, such as aspirin or ibuprofen, do not take more than is recommended on the package. Taking too much of these medicines can hurt your kidneys and can cause AKI.

ACNE

DEFINITION

Acne also called pimples is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne usually appears on your face, neck, chest, back and shoulders. Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.

Acne is most common among teenagers, with a reported prevalence of 70 to 87 percent. Increasingly, younger children are getting acne as well.

Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of lasting physical and emotional damage.

SYMPTOMS

Acne signs and symptoms vary depending on the severity of your condition:

  • Whiteheads (closed plugged pores).
  • Blackheads (open plugged pores, the oil turns brown when it is exposed to air).
  • Small red, tender bumps (papules).
  • Pimples (pustules), which are papules with pus at their tips.
  • Large, solid, painful lumps beneath the surface of the skin (nodules).
  • Painful, pus-filled lumps beneath the surface of the skin (cystic lesions).

CAUSES

Four main factors that causes acne;

  • Oil production
  • Dead skin cells
  • Clogged pores
  • Bacteria

Acne typically appears on your face, neck, chest, back and shoulders. These areas of skin have the most oil (sebaceous) glands. Acne occurs when hair follicles become plugged with oil and dead skin cells.

Hair follicles are connected to oil glands. These glands secrete an oily substance (sebum) to lubricate your hair and skin. Sebum normally travels along the hair shafts and through the openings of the hair follicles onto the surface of your skin.

When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles. They form a soft plug, creating an environment where bacteria can thrive. If the clogged pore becomes infected with bacteria, inflammation results.

The plugged pore may cause the follicle wall to bulge and produce a whitehead. The plug may be open to the surface and may darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it’s exposed to the air.

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce cyst-like lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren’t usually involved in Acne.

FACTORS THAT MAY WORSEN ACNE

These factors can trigger an existing case of Acne:

  • Hormones: Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. Low amounts of androgens circulate in the blood of women and can worsen acne.
  • Certain medications: Drugs containing corticosteroids, androgens or lithium can worsen acne.
  • Diet: Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods; such as bread, bagels and chips, may trigger acne. Chocolate has long been suspected of making acne worse. A recent study of 14 men with acne showed that eating chocolate was related to an increase in acne. Further study is needed to examine why this happens or whether acne patients need to follow specific dietary restrictions.
  • Stress: Stress can make acne worse.

TREATMENTS AND DRUGS

If over-the-counter (nonprescription) products haven’t cleared up your Acne, your doctor can prescribe stronger medications or other therapies. A dermatologist can help you:

  • Control your acne.
  • Avoid scarring or other damage to your skin.
  • Make scars less noticeable.

Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation, which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your Acne to clear up completely.

The drug your doctor recommends depends on the type and severity of your acne. It might be something you apply to your skin (topical medication) or take by mouth (oral medication). Often, drugs are used in combination. Pregnant women will not be able to use oral prescription medications for acne.

TREATING ACNE SCARS

Procedures used to diminish scars left by Acne include the following:

  • Soft tissue fillers: Injecting soft tissue fillers, such as collagen or fat, under the skin and into indented scars can fill out or stretch the skin. This makes the scars less noticeable. Results are temporary, so you would need to repeat the injections periodically. Side effects include temporary swelling, redness and bruising.
  • Chemical peels: High-potency acid is applied to your skin to remove the top layer and minimize deeper scars.
  • Dermabrasion: This procedure is usually reserved for more severe scarring. It involves sanding (planing) the surface layer of skin with a rotating brush. This helps blend acne scars into the surrounding skin.
  • Laser resurfacing: This is a skin resurfacing procedure that uses a laser to improve the appearance of your skin.
  • Light therapy: Certain lasers, pulsed light sources and radio frequency devices that don’t injure the epidermis can be used to treat scars. These treatments heat the dermis and cause new skin to form. After several treatments, acne scars may appear less noticeable. This treatment has shorter recovery times than some other methods. But you may need to repeat the procedure more often and results are subtle.
  • Skin surgery: Using a minor procedure called punch excision, your doctor cuts out individual acne scars and repairs the hole at the scar site with stitches or a skin graft.

PREVENTION

  • Properly wash your face: To help prevent pimples, it’s important to remove excess oil, dirt and sweat daily. Washing your face more than twice a day may make acne worse. Don’t wash your face with harsh cleansers that dry skin but rather an alcohol-free cleanser.
  • Know your skin type: Knowing your skin type will help you choose the right skin care products.
  • Stay hydrated: If you are dehydrated, your body may signal your skin’s oil glands to produce more oil. Dehydration gives your skin a dull appearance and promotes inflammation and redness. To keep your body well-hydrated, drink at least eight ounce glasses of water each day.
  • Use tea tree oil: Tea tree oil is a popular remedy for pimples. According to the Mayo Clinic, it may reduce the number of inflamed and non-inflamed lesions. To use tea tree oil for pimples, apply a couple of drops to the inflamed area. You can also add a few drops to your daily cleanser or moisturizer.

Amenorrhea

DEFINITION

Amenorrhea is the absence of menstruation thus one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who haven’t begun menstruation by age 15.

The most common cause of amenorrhea is pregnancy. Other causes of amenorrhea include problems with the reproductive organs or with the glands that help regulate hormone levels. Treatment of the underlying condition often resolves amenorrhea.

Primary Amenorrhea means you never start your periods or menses.Secondary Amenorrhea means you have had periods and then it has stopped for more than three months.

SYMPTOMS

The main sign of amenorrhea is the absence of menstrual periods. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as:

  • Milky nipple discharge
  • Hair loss
  • Headache
  • Vision changes
  • Excess facial hair
  • Pelvic pain
  • Acne

CAUSES

Amenorrhea can occur for a variety of reasons. Some are normal during the course of a woman’s life, while others may be a side effect of medication or a sign of a medical problem.

Natural amenorrhea

During the normal course of your life, you may experience amenorrhea for natural reasons, such as:

  • Pregnancy
  • Breast-feeding
  • Menopause

Contraceptives

Some women who take birth control pills may not have periods. Even after stopping oral contraceptives, it may take some time before regular ovulation and menstruation return. Contraceptives that are injected or implanted also may cause amenorrhea, as can some types of intrauterine devices.

Medications

Certain medications can cause menstrual periods to stop, including some types of:

  • Antipsychotics
  • Cancer chemotherapy
  • Antidepressants
  • Blood pressure drugs
  • Allergy medication

TREATMENTS AND DRUGS

Treatment depends on the underlying cause of your amenorrhea. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a Tumor or structural blockage is causing the problem, surgery may be necessary.

PREVENTION

The best way to prevent secondary amenorrhea is to maintain a healthy life. Stay at a healthy, stay up to date with your pelvic exam and pap smear.

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