Hyperthyroidism

Hyperthyroidism (the overactivity of the thyroid gland) occurs when the thyroid gland produces and releases too much thyroxine. Excess thyroxine accelerates the body’s metabolism. Women tend to be more likely to be affected by hyperthyroidism than men. Although it can occur at any age, hyperthyroidism is more common in young adults and middle aged patients. There are several conditions that can make the thyroid release too much hormones. The most common cause is an autoimmune disease called Basedow-Graves. Other causes can be the inflammation of the gland (thyroiditis) and the emergence of thyroid nodules (bumps).

Hyperthyroidism

Hyperthyroidism Signs And Symptoms

The most common signs of hyperthyroidism are weight loss despite having an increased appetite; rapid or irregular heartbeat and/or palpitations; sweating; swelling located at the neck (goiter); frequent stools, sometimes diarrhea; fatigue and muscle weakness; increased sensitivity to heat; in women, menstrual cycle changes may occur; sleep disturbance; fever; fast pulse; agitation and delirium.

How Serious Is Hyperthyroidism?

Hyperthyroidism can have serious consequences if it left untreated. Complications include heart problems such as a high heart rate, irregular heartbeat (atrial fibrillation) or heart failure. Untreated hyperthyroidism can cause osteoporosis. If you have a thyroid disorder characterized by hyperactivity, you also have a risk of developing thyrotoxicosis. This is a sudden increase of signs and symptoms that leads to fever and even delirium. This requires immediate medical attention. Common manifestations of hyperthyroidism also include the acceleration of the metabolism due to increased appetite, feeling hot when others are cold and having trembling hands. Your heart can beat at a high, upsetting, frequency and can sometimes present a irregular rythm. Sleep disorders are also common in patients that suffer from hyperthyroidism. Your thyroid may be enlarged, but often it’s so little that it’s not even observable.

Hyperthyroidism Diagnosis

Hyperthyroidism is usually diagnosed based on medical history, physical examination and blood tests. During the examination, the doctor can detect a slight tremor of the fingers when you hold them stretched out. You may be asked about changes, stool frequency or about any sensitivity to temperature. Your doctor may also ask you to swallow as he examines the thyroid, a procedure which makes the thyroid easily palpable. Blood tests can detect an increase in thyroxine concentration. They can demonstrate the low value or absence of the thyroid stimulating hormone (TSH), which is produced by the pituitary gland and is suppressed when there are too many thyroid hormones. These results may help diagnose hyperthyroidism.

However, these tests can only indicate the hyperfunction of the thyroid, whilst not revealing the cause. The doctor may use a method of radioiodine capturing to help facilitate diagnosis and treatment planning. In this test, you are given a small amount of radioactive iodine. Over time, iodine accumulates in the thyroid, where it is absorbed and used to manufacture thyroxine. The doctor will make determinations after 2, 6 or 24 hours, or sometimes all three moments to determine how much iodine your thyroid has absorbed. A high intake of iodine indicates that the thyroid produces too much thyroxine, which occurs in the Basedow-Graves disease and hyperfunctional thyroid nodules. If the capture is low, then the most likely cause is thyroiditis. In this inflammatory disease of the thyroid, captured iodine is locked, but the thyroid gland hormones are released in excess. Your doctor may also get a picture of the thyroid gland (thyroid tomography) to help determine the cause and establish a possible treatment.

Hyperthyroidism Treatment

Hyperthyroidism treatment depends on the cause, the patients’ physical condition, age and disease severity. Treatment includes radioactive iodine, antithyroid drugs, beta blockers and surgical treatment.

Dandruff

Dandruff represents the desquamation of the scalp skin (the scalp skin flakes off). Everyone has a certain degree of desquamation from the scalp level due to the normal process of removing and renewal of the external skin layer cells.

What Is Dandruff?

Dandruff

Dandruff has to do with the renewal of the scalp cells and is caused by a fungus called Malassezia Oval (formerly known as Pityrosporum ovale). This organism is naturally found on the scalp, but in some cases there is an excessive multiplication of this fungus. Thus, by its action, Malassezia determines an excess of epidermal peeling of the scalp and it also irritates it. Approximately 50% of people face this condition at some point in their lives. A healthy scalp removes dead cells and at the same time produces new ones at a steady rate. The grouping of several dead cells form dandruff.

There are two types of dandruff:

• Dry dandruff – caused by an acceleration of the scalp cell regeneration, it is dry, very smooth and easily comes off;
• Fatty dandruff – caused by an excess of sebum, it is found in patients with oily hair and is easily recognizable because it is yellow and “glued” to the scalp.

 Dandruff Causes

Malassezia Ovale

In addition to the fungus Malassezia Oval, there are a number of factors which are considered causes of dandruff. Thus, hormonal imbalances, an incorect nutritional regime and stress can also cause the appearance of dandruff. Also, intolerance to a hair care product (whether it is shampoo, conditioner, styling products or dye) or temperature change may favor the appearance of dandruff. Sometimes food deficiencies such as zinc deficiency can lead to the formation of dandruff. Therefore many shampoos use zinc derivates. However, the positive effects of these shampoos are amplified if we have a diet rich in zinc, being often even more effective than external treatments which might not be absorbed very well. Drastic diets can cause an imbalance in the organism, dandruff is one of the ways the body warns us that something is wrong.

Dandruff Treatment

Treatment against dandruff varies according to its abundance and the causes that led to its appearance. There are many products, that can be obtained withoutprescription, available to treat dandruff. Anti-dandruff shampoos can treat the problem successfully, because they contain active ingredients such as zinc pyrithione, ketoconazole or climbazole. Wash your head regularly whilst massaging it in a slow and gentle movement. This will activate blood circulation to the scalp and exfoliate dead cells from the surface.

Also, applying hydrocortisone creams or solutions and ketoconazole creams can help relieve dandruff. You must however take into account several factors. For example, washing too often with a hair shampoo designed for oily hair can only worsen the situation because it excites the sebaceous glands, causing them to secrete even more sebum. It is indicated for these conditions to alternate shampoos designed for oily hair with some softer types of shampoos. Also, people who have dry hair should avoid washing it too often during winter. Sometimes dandruff might be a symptom of a far more serious disease. If dandruff persists or if you have high portions of skin peeling off, redness and peeling around the nose, ears or chest, it can be a severe form of dandruff or even scalp psoriasis. If the dandruff particles are yellow and have a fatty consistency then it could be seborrheic dermatitis. In these cases you should urgently consult a dermatologist.

The scalp should be taken care of by adopting a healthy diet and using delicate shampoos. It is not advisable to dye your hair or get a permanent wave whilst using the anti-dandruff treatment. Chemical elements found in the composition of these products will further irritate the scalp. When you dry your hair, you should make sure that the air is not too hot. The best is however to leave your hair to dry freely. If you doubt the seriousness of disease, ask your doctor or dermatologist.

New Study Shows How Viruses Use Unharmful Bacteria To Elude The Immune System

A new study, showed how certain viruses can evade the immune system using bacteria which are normally present in the human intestine. Sharon Kuss, study leader from the University of Texas, proved with this research how viruses can attach to molecules of bacteria (considered non-threatening by the immune system) to travel through the intestine. These molecules, which are components of the cell wall of bacteria (lipopolysaccharides), trigger the production of interleukin 10, a compound that transmits to the the immune system cells that the bacteria is not dangerous.

It is well known, that the mouth and the intestine are filled with bacteria and most of them do not represent a risk for health. Some of this bacteria even inhibit the growth of other types of bacteria, which are potentially harmful. The most populated part of the body  populated with bacteria are the stomach and intestine, where bacteria helps in digestion and form vitamin K in the colon, vitamin which is needed for blood clotting and bone strengthening.

New Study

Between commensal bacteria and humans a symbiotic relationship is etablished from which both sides have onlyto gain (the bacteria receive nutrients, and humans are shielded from possible infection, benefiting in the same time from certain chemical compounds which are released by the bacteria metabolism).

To demonstrate how a virus uses a bacterium to elucidate the immune system, the researchers have injected large amounts of antibiotics in the intestine of experimental animals to kill all the present bacteria, then they tested animal’s susceptibility to viral infection. Researchers have shown that viruses are more able to cause an infection when they are using the bacteria from the intestine for transportation. Also, experimental animals that were born with sterile intestines are more resistant to viral infection. When the intestine was repopulated with bacteria, the susceptibility to viral infection has returned.

This study shows that there is still much to discover about the bacterial flora that lives inside us and about its relationship with external factors such as the polio virus. A course of antibiotics, which was considered until now harmless to viruses, could kill “the transporter”, and protect us from a possible infection in consequence.

Raynaud’s Syndrome

In 1862 Raynaud described the condition for the first time. This disease looks pretty spectacular at first sight, due to the fact that the patient notices the skin color change of the affected limbs. Initially, the skin is pale and cold due to arteriolar spasm, then the limbs become cyanotic and cold because vein dilation is added and the skin turns into blue. Finally it becomes red and hot due to reactive vasodilatation of the arterioles.

Raynaud’s syndrome is divided into:

• Primary disease, which bears the same name and whose cause is unknown.

• Raynaud’s phenomenon, which is more common than Raynaud’s disease and is secondary to a local or a systemic disease.

Raynaud’s Syndrome

It seems that the most affected are women, especially in the second and third decade of life. It has a progressive evolution, the disease is symmetrically affecting fingers from both hands. Over time the spasms are becoming more frequent and prolonged. The diagnosis of Raynaud’s syndrome is established when the phenomenon persists for more than three years, without a cause which can be highlighted.

The cause of Raynaud’s syndrome is represented by an excessive response of the arterioles to vasospastic stimuli, especially in conditions of  cold or emotional stress. The disease can occur both in the upper and lower limbs, nose, ears and chin. In rare cases ischemia can lead to necrosis.

Raynaud’s Phenomenon

It is more common than Raynaud’s syndrome and has a equal frequency to both women and men. It appears secondary to the following conditions:

Autoimmune Diseases:

1. Scleroderma;
2. Lupus erythematosus;
3. Dermatomyositis and polymyositis;
4. Rheumatoid arthritis;
5. Sjogren’s syndrome;
6. Vasculitis;
7. Primary pulmonary hypertension.

Infectious Diseases:

1. Hepatitis B or C;
2. Mycoplasma infections.

Neoplastic disease:

1. Lymphoma;
2. Leukemia;
3. Myeloma;
4. Waldenstrom macroglobulinaemia;
5. Polycythemia;
6. Type 1 cryoglobulinemia;
7. Lung adenocarcinoma;
8. Other paraneoplastic syndromes.

Metabolic And Endocrine Diseases:

1. Acromegaly;
2. Myxedema;
3. Diabetes mellitus;
4. Pheochromocytoma.

Hematological Diseases:

1. Paroxysmal nocturnal hemoglobinuria;
2. Polycythemia;
3. Cryofibrinogenaemia.

Occupational Diseases:

1. Vibration;
2. Polyvinyl chloride exposure;
3. Frostbites;
4. Exposure to arsenic
5. Exposure to lead.

Adverse reaction to drugs:

1. Oral contraceptives;
2. Ergot alkaloids;
3. Bromocriptine;
4. Beta adrenergic;
5. Cyclosporine;
6. Alpha-interferon.

Raynaud’s Syndrome Diagnosis:

The clinical examination will insist on the following:

• If you have numbness, pain or swelling in the affected area;
• If the affected area has at least two colors: white, due to ischemia caused by vasospasm, blue due to cyanosis or red due to hyperemia. Skin color can changed in this order, although it is not mandatory;
• How many fingers are affected during a crisis, because in the early attacks of Raynaud’s phenomenon can be affected only 1 or 2 fingers. As the disease progresses all fingers will be affected. The thumb is rarely affected;
• If crises occur in conditions of cold or emotional stress;
• If tactile sensitivity is reduced;
• If in the affected area is a loss of function;
• If the patient suffer from other disorders that could explain the association with Raynaud’s phenomenon;
• If symptoms are unilateral, then Raynaud’s phenomenon is suspected, while in case of bilateral and symmetrical symptoms, Raynaud’s syndrome is suspected;
• The number of daily crises, in serious damage may appear multiple attacks per day, with a longer duration (from several minutes to hours);
• What profession has the patient.

Raynaud’s Disease

Raynaud’s Syndrome Treatment:

Treatment consists of:

• General measures:

1. Protection from the cold;
2. To avoid trauma to the affected area;
3. To use moisturizing creams and lotions;
4. Stop smoking;
5. Avoid emotional stress;
6. Consumption of fish, rich in omega 3 fatty acids;
7. To treat promptly any lesion to the affected limb.

• Medications:

1. Calcium channel blockers, to achieve vasodilation;
2. Inhibitors of angiotensin converting enzyme, may decrease the severity and frequency of the attacks;
3. Angiotensin II antagonist.

• Surgical:

1. Sympathectomy is performed when the disease interferes with daily activity of the patient, or trophic changes occur or medication treatment failed
2. Cervical and thoracic sympathectomy provide a temporary relief, but lumbar sympathectomy  is preferred as it is providing a more complete relief with a longer duration.

Halitosis

Everyone has bad breath from time to time, especially in the morning. This can happen when you’re hungry, when you are fasting or after ingesting a type of food with a strong odor such as garlic, onions or pastrami.

Bad Breath Causes

There can be many causes for bad breath. A major cause is the decrease of salivary secretion. Saliva has a cleaning action that helps reduce or eliminate bad breath. When saliva levels decrease, bacteria can grow, causing bad breath.

The main health problems associated with bad breath are:

1. Periodontal (gum) disease. Periodontal disease is caused by plaque buildup on the teeth. Bacteria found in the transparent and sticky substance can irritate the gums. If not treated on time, periodontal disease can destroy gum tissue and bone structure supporting the teeth.
2. Oral trush
3. Dental decay
4. Xerostomia (dry mouth). Saliva is necessary to clean your mouth of food from debris, eliminate dead cells from the tongue, gums and cheeks, and  neutralize acids in the mouth. If these cells are not removed, they decompose inside the mouth, causing bad breath.
5. Side effects of certain drugs.
6. Salivary glands disorders.
7. Some diseases and conditions such as severe respiratory tract infections (pneumonia or bronchitis), chronic sinus infection, diabetes, chronic esophageal reflux disease.

Bad breath cause by decreased salivary secretion can be detected in particular:

• In the morning: saliva flow almost stops during sleep. Thus, bacteria can multiply and cause bad breath;
• When you’re hungry: Bad breath is more common in people who skip meals or are dieting. Chewing increases the amount of mouth saliva. When you’re not eating, mouth saliva production decreases and bacteria growth increases, causing bad breath;
• When you are dehydrated: when dehydrated, saliva production decreases. The cleansing action of saliva is thus diminished;
• Disease that affects the salivary glands, such as Sjogren’s syndrome or scleroderma, can also cause bad breath;
• A decrease in saliva levels cause by certain medications;
• After drinking;

Bad Breath

Other causes of causing bad breath include:

• Eating foods with a strong odor such as garlic, onions, or pastrami;
• Smoking, chewing or sniffing tobacco;
• Plaque and tartar that forms from food left between the teeth or dentures.

Mouth and throat problems that can cause bad breath include:

• Strep throat or other mouth or throat infections;
• Cavities and other dental problems;
• Gum diseases such as periodontitis, which can give a metallic breath odor;
• Tonsils with deep crypts, where particles of food can get stuck;
• Cancers of the mouth or throat.

Problems in other areas of the body that can cause bad breath include:

• Nose problems such as a sinus infection, nasal polyps or the presence of a foreign body in the nasal cavity;
• Diabetes; a symptom of high blood sugar is a strong odor, fruity (similar to the odor of acetone) breath;
• Digestive system problems such as gastroesophageal reflux disease, bowel problems or cancer;
• HIV (Human Immunodeficiency Virus);
• Liver disease;
• Lung problems such as an infection or cancer.

Treatment and prevention

To help you have a more pleasant breath:

• Gargle with mouthwash;
• Brush your teeth, tongue, palate and gums at least twice a day with toothpaste;
• Floss at least once a day;
• Adopt a diet low in fat and rich in fruits and vegetables;
• Eat less meat;
• Do not smoke or use other tobacco products such as snuff or chewing tobacco;
• Avoid food and drinks that cause bad breath such as garlic and alcohol;
• Eat at regular intervals. Dieting or missing meals can decrease saliva and cause bad breath;
• Chew sugarless gum, suck sugarless mint candy, drink water, especially if you have a dry mouth;
• Try mint bars that contain ingredients also found in mouthwash and that dissolve in your mouth;
• Remove mobile dentures, partial dentures or braces and wash them once a day or as directed by your dentist. Bacteria and food parts can collect on them, causing bad breath;
• Use mouthwash in order to temporarily remove bad breath. Rinse for about 30 seconds before spitting it out;
• Make regular dental checks;
• Make an appointment with a specialist in Otolaryngology (investigates the ear, nose and throat) if you have frequent problems with bad breath.

Gout

The condition known as hyperuricemia or gout is a constitutional disease, often hereditary, characterized by inflammatory joint attacks. Pain is felt most often in the big toe and recurs more nights in a row. Gout may be appear in other joints (knees, fingers, elbow) as well. A sodium urate solidification called tophus is formed at joint levels. The crisis is accompanied by fever and may last 5-10 days.

Gout

Causes

One of the main causes of gout is an unbalanced diet, especially rich in meat (sausages, red meat, pork), in shellfish and crustaceans which cause the formation of uric acid. The blood uric acid is the main cause of gout. It can sometimes alter renal function leading to kidney stones (renal lithiasis). Patients should worry about the occurrence of gout every time blood levels of uric acid are increased (normal level: 30-58 mg per liter).

Treatment

The first step in treating gout is to start a diet. Patients should change the way they eat and radically reorganize their lifestyle. Even when on vacation or travelling, they should have sufficient medication in order to ensure continued treatment and to avoid an unexpected crisis. Also, if patients should have to undergo surgery of any kind, they must be sure to inform the doctor about their condition. It is recommended to drink plenty of mineral water during the day, between 1.5 and 2 liters (alkaline water is recommended). Avoid foods high in purine – meat and meat products such as anchovies, sardines, liver, etc. and becomes uric acid in the body. A calorie restriction is sufficient for most patients. Alcohol consumption should be reduced to a minimum.

Gout Diet

Recommended Diet

• Beef, chicken, lamb and rabbit meat should be eaten with moderation. White fish, warm-sea fish, such as common bream, turbot, rudd, hake, pike, caviar and oysters can be eaten with moderation;
• Vegetables such as carrots, tomatoes, cabbage, spinach, lettuce and green beans are allowed (50-70mg/100 g or uric acid);
• Pasta, potatoes, rice and bread are recommended.
• Dairy products like milk, whole or skimmed, egg yolk, yogurt and cheese are also permitted;
• Fresh fruit, olives, peanuts and pistachios can be consumed without exaggeration;
• Desserts such as pastries and ice creams can be consumed with moderation;
• Drinks such as coffee, tea and alkaline mineral water are highly recommended;
• It is strictly prohibited to consume lentil, asparagus and peas;
• Shellfish clams, sardines, fish paste, herring and lobster are prohibited (360-465 uric acid content mg/100 g);
• Pork, sheep, geese, game, organ sausages are forbidden;
• Chocolate should be eliminated from everyday diet.

What is vitamin D?

Vitamin D is produced by the body through diet and in the skin, synthesis possible only under the influence of sunlight. This vitamin determines a harmonious development of the skeleton. For this reason, during winter, when sunlight is less intense, it is recommended to supplement the intake of vitamin D. People who have significant deficiencies of vitamin D have a 60% higher risk of suffering from type II diabetes compared with people who fall within the limits recommended by doctors. Behind the lack of vitamin D factors such as obesity or inactivity, the main causes of type II diabetes, can be found researchers say. Previous studies have shown that vitamin D maintains blood sugar at a normal level and regulates the production of insulin. The main cause of type II diabetes, the most common form of diabetes is an inability to produce enough insulin to control blood sugar.

Vitamin D food

Optimal dose of vitamin D

The recommended daily amount of vitamin D for adults is 200-400 units (higher in those over 50 years). In children, things are different, and could exceed 1,000 units per day during the cold period of year for kids under the age of two. Vitamin D can be produced by the body when it is exposed to direct sunlight (10 minutes of exposure per day are enough). Most experts recommend about 200 international units (IU) per day for adults aged between 19 and 50. This recommendation also applies to pregnant or nursing women. Those over 50 need 400 IU per day. Parents are advised to feed their babies two cups of milk per day (a cup of milk equals 100 IU of vitamin D).

Vitamin D sources

Vitamin D is synthesized by the body through the effect of sunlight, but it is also found in eggs, salmon, cod and some dairy. The most effective way to obtain vitamin D is through supplements. Studies have shown that during winter, a healthy adult who eats fish once a week, takes a daily multivitamin supplement and drinks milk, has a minimum vitamin D level. It was also discovered that it is a myth that cod oil serves as a source of vitamin D. Given how hard it is to procure this vitamin from food, most doctors recommended supplements. There are of two kinds of supplements, called ergocalciferol and cholecalciferol. Of these, according to experts, the only one who benefits the human organism is the second one.

Benefits of vitamin D for pregnant women

Use of vitamin D by pregnant women without health problems is beneficial. Even in larger quantities than the normal dose, it was found that there are no adverse effects on the pregnant woman or fetus. There are still voices that question the effectiveness of this vitamin in the body during pregnancy. However, the authors of a recent study at the Medical University of South Carolina have shown otherwise. Specialists say that a daily dose of 200 units of vitamin D can only have beneficial effects on mother and fetus. The team led by Dr. Gilbert Forbes monitored 350 women in weeks 12-16 of pregnancy, women which were divided into three groups. One group received 400 units of vitamin D daily, while the second group received 2,000 units of vitamin D each day. The third group of women received a daily dose of 4,000 units of vitamin D. At the end of the study it was found that there were no reported adverse effects from any of three groups.

Gynecomastia

Gynecomastia is a benign proliferation of glandular tissue in men, manifested by concentric growth of one or both breasts. The condition is common in the neonatal period, at adolescence and at old age. Asymptomatic gynecomastia among infants is estimated at 60-90%. According to studies, approximately 50-60% of boys aged between 10 and 16 years are prone to gynecomastia. Moreover, it is considered that gynecomastia is an event that occurs in the midst of puberty and is more common among boys with pubic hair. The last peak in the incidence of this disease is in men aged between 50 and 85 years, taken it is up to 70%. In such cases, the most common form is bilateral gynecomastia (both breasts).

Gynecomastia

Causes

Gynecomastia is a complex process resulting from several changes in body hormones. The pathology of this disease is given by the lack of balance between estrogen and androgen action on the breast tissue. Estrogens strongly stimulate the tissue, while androgens inhibit breast growth. Estrogens are known to bind less on the sex hormone-binding protein (SHBG) than androgens like testosterone. Several hypotheses try to explain the etiology of gynecomastia include increased levels of estrogen, too little free testosterone or the sensitivity of breast tissue, but for many patients, the etiology remains unclear.

The main causes of gynecomastia can be either idiopathic (adrenocortical tumors), age related, obesity, hyperthyroidism, liver disease, Klinefelter syndrome, testicular tumors, oral ingestion of testosterone, the use of estrogen creams, medication such as Spironolactone and Ketoconazole, cirrhosis, HIV, chronic diseases and lavender oil. Drugs that are involved in gynecomastia development are those containing hormones (anabolic steroids, growth hormones, etc.), anti-androgens (Flutamide, Duasteride), antibiotics (Isoniazid, Ketoconazole, Metronidazole), anti-ulcers (Cimetidine, Ranitidine), Metoclopramide , drugs prescribed for HIV, drug and alcohol abuse (marijuana, amphetamines, heroin).

Patient evolution

The first steps in the clinical evaluation of gynecomastia is the elimination of pseudogynecomastia and carcinoma. Laboratory and imaging tests will identify the cause of the disease. Tests for assessing liver function tests, kidney and thyroid function, blood testosterone, Luteinizing hormone (LH), Human chorionic gonadotropin (hCG) and estrogen levels respectively will be taken into account.
Puberty occurring gynecomastia disappears spontaneously for most teenagers in less than three years, but the patients should be kept under observation. Unfortunately, puberty occurring gynecomastia has a negative impact on personal image of adolescents and may lead to depression.
In adults with asymptomatic gynecomastia, no treatment is required. Men who experience pain or soreness need short-term treatment. If it turns out that gynecomastia is caused by the use of any drug, improvement in the situation can be seen in more than a month after the patient stops the use of that certain drug. Once diagnosed with gynecomastia, it is essential to maintain patient history and physical examinations in order to determine any changes that may occur.
For chronic gynecomastia, it is unlikely for the disease to be treated, either spontaneously cured or by the use of treatment. In these cases, subcutaneous mastectomy or liposuction can be considered. Liposuction alone may be sufficient in cases where breast enlargement pseudogynecomastia is caused by excess fatty tissue. In these cases of chronic gynecomastia, drug therapy is the most useful.
Anti-androgen therapies used for prostate cancer have an increased incidence for gynecomastia. One of the drugs used to treat gynecomastia is Tamoxifen – a dose of 20 mg per day (taken orally) for a period of up to 3 months. It has good results in normal cases, but can also be effective in painful gynecomastia cases.

Cirrhosis

Cirrhosis is a disease that can be life threatening and occurs when fibrosis develops. Fibrotic tissue replaces healthy liver tissue and prevents it from functioning normally. Cirrhosis occurs after many years of liver tissue inflammation. As the cirrhosis develops, fibrotic tissue surrounds the normal liver cells, causing nodular aspect. Nodular liver tissue can block or inflame the bile ducts, causing bile reflux in the liver and bloodstream. Fibrotic tissue can also block bloodstream from the intestines to the liver, causing increased pressure in the portal venous system. This complication, called portal hypertension, leads to ascites fluid accumulation in the abdominal cavity, the bleeding of enlarged vessels in the digestive tract and further serious complications.

Cirrhosis doctor

Causes

Cirrhosis can have many causes. Some people suffer from cirrhosis without an obvious cause, a condition called cryptogenic cirrhosis (no known etiology). Most frequent causes of cirrhosis are excessive intake of alcohol for an extended period of time and infection with hepatitis B or C.

• Alcoholic cirrhosis. This can occur in men who consume large amounts of alcohol daily for 10-15 years. Women develop alcoholic cirrhosis by a lower consumption of alcohol daily for the same period of time. At least 10-15% of chronic users eventually develop alcoholic cirrhosis. Every year over 26,000 people die due to cirrhosis, at least 40% having a history of chronic alcohol consumption.
• Cirrhosis caused by the infection with hepatitis viruses. This occurs in approximately 40% of people suffering from chronic viral hepatitis. Cirrhosis occurs slowly, requiring 20 years or more until its appearance. However, in patients with chronic viral hepatitis who drink too much alcohol, cirrhosis is installed much faster than in patients with chronic viral hepatitis that don’t consume alcoholic drinks.
• Cirrhosis caused by NASH (Non-alcoholic Steatohepatitis). NASH is a disease caused by the accumulation of fat in the liver. The disease becomes increasingly common and can cause multiple types of cirrhosis, currently classified as cirrhosis of unknown etiology (idiopathic).
• Primary biliary cirrhosis is a type of cirrhosis that occurs when the bile ducts from the liver to the duodenum are inflamed and blocked. The exact cause is unknown, but it appears to be related to the immune system.
  Autoimmune hepatitis. In some people, the immune system attacks the liver causing cirrhosis.
• Hereditary diseases. Sometimes, cirrhosis may be caused by a congenital disease such as Wilson’s disease, cystic fibrosis or hereditary hemochromatosis. Other causes of cirrhosis that are less common include severe reactions to drugs, prolonged exposure to environmental pollutants, the disease called alpha-1-antitrypsin deficiency (AAT) (extremely rare cause) or a biliary tract disease with prolonged evolution, such as primary sclerosing cholangitis.

Cirrhosis

Symptoms

Some people suffering from cirrhosis have no symptoms until damage caused is already severe. Symptoms of cirrhosis and its complications include:

• Lower limb edema (swelling of legs) and ascites fluid (liquid accumulated in the abdomen);
• Fatigue;
• Jaundice (yellowing of the skin and whites);
• Generalized pruritus (itching);
• Nosebleeds (epistaxis);
• Mottled hands (red colored palms) – palmar erythrosis;
• Bruising from minor trauma;
• Weight loss and muscle weakness;
• Abdominal pain;
• Frequent infections.

Ascites

Diagnosis

Cirrhosis is a potentially life-threatening condition that occurs when the inflammation of the fibrotic tissue affects the liver. Physical examination and medical history to assess symptoms are first performed to investigate whether liver damage is severe enough to cause signs of cirrhosis and to determine the cause of liver disease.
A combination of tests can be used for diagnostic when physical examination and medical history suggests signs of cirrhosis. Blood tests can evaluate and determine the cause of the liver cirrhosis and reveal liver inflammation. Other tests that provide images of the liver are used to detect tumors and obstructed (blocked) bile ducts and to assess the size of the liver and intrahepatic blood flow.

Blood tests that can reveal the presence of an active liver inflammation include:

• Aspartate aminotransferase (AST) – A high AST level (also called SGOT) may indicate liver damage and the “death” of liver cells;
• Alanine aminotransferase (ALT) – High levels of ALT (also called SGPT) may also indicate liver damage and the “death” of liver cells;
• Lactate dehydrogenase (LDH) – High levels of LDH may indicate liver damage and the possible “death” of blood cells;
• Alkaline phosphatase (ALP) – High levels of ALP may indicate bile duct obstruction;
• Gamma-glutamyl transpeptidase (GGT) – An increased level of GGT reveals that the liver inflammation is caused by consumption of alcohol or bile duct obstruction; the level of GGT may also indicate the use of certain drugs, such as Phenobarbital and Dilantin. However, GGT can be increased without the presence of an inflammation.

Blood tests that evaluate liver function. Measuring levels of certain substances synthesized by the liver may be helpful in assessing the liver function. These tests include:

• Albumin and total serum proteins – Albumin is a type of protein. Cirrhosis can lead to decreased serum protein levels;
• Partial thromboplastin time (PTT), prothrombin time (PT) or international normalized ratio (INR). These tests measure the factors synthesized by the liver which have the role of coagulation;
• Bilirubin. It is produced by the liver by breaking down hemoglobin, which is a component of red blood cells with oxygen carrier role. Cirrhosis may increase blood levels of bilirubin, the clinical manifestation being jaundice (yellowing of the skin and the whites of the eyes).

Blood tests that can diagnose the cause of cirrhosis include:

• Anti-nuclear antibodies (ANA). ANA testing and Anti-smooth muscle antibodies (ASMA) can help detect chronic autoimmune hepatitis;
• Anti-mitochondrial antibodies (AMA) can help determine a primary biliary cirrhosis;
• Ferritin and serum iron can help diagnose hemochromatosis;
• Hepatitis B and hepatitis C antibodies or genetic material tests of liver viruses (RNA or DNA) can help diagnose a viral hepatitis infection;
• Blood alcohol level can help detect alcohol consumption, which can cause alcoholic cirrhosis;
• Analysis of serum ceruloplasmin help diagnose Wilson’s disease;
• The level of Alpha-1-antitrypsin can diagnose the alpha-1-antitrypsin deficiency (ATT), a rare cause of cirrhosis.

Blood Test

Imaging tests:
Imaging tests check for tumors and biliary obstruction and evaluate liver size and hepatic blood flow. These tests include:

• Abdominal ultrasound (ultrasonography);
• Abdominal Computed tomography (CT);
• Abdominal MRI;
• Liver and spleen scintigraphy (rarely used).

Other tests used to confirm the diagnosis of cirrhosis and assessment of possible complications include:

• Liver biopsy, the only test that can directly confirm the diagnosis of cirrhosis. Examination of liver tissue may also reveal signs of inflammation. Liver biopsy is done by inserting a long needle through the two lower ribs, extracting a tissue sample that will be microscopically analyzed;
• Paracentesis helps diagnose fluid accumulation in the abdominal cavity (ascites) or to detect the infection of the accumulated fluid (spontaneous bacterial peritonitis). Paracentesis is a procedure whereby a needle is inserted into the abdominal cavity to extract the liquid accumulated, which is to be analyzed;
• Upper gastrointestinal endoscopy is performed to detect varicose veins in the digestive tract that may cause variceal bleeding. Endoscopy allows your doctor to look inside the digestive organs, body cavities and channels, using a thin, flexible and light instrument called an endoscope;
• Blood levels of Alpha-fetoprotein (AFP) is a screening test for hepatocellular carcinoma;
• The ammonia test detects high levels of ammonium in the blood which can cause hepatic encephalopathy.

Treatment

There is currenly no treatment or cure for cirrhosis, nor is there a treatment that can heal the liver damage done.
However, treatment can sometimes prevent or delay further liver damage.
The main components of treatment include:

• Treating the cause of cirrhosis, if possible, to prevent further deterioration;
• Avoid substances that can aggravate liver damage, especially alcohol and NSAIDs (Non-steroidal anti-inflammatory drugs);
• Preventing and treating symptoms and complications or cirrhosis;
• Liver transplant, if severe liver damage and if the patient is included on the transplant waiting list and a compatible donor is found.

Cirrhosis

Currently there is no treatment or cure for cirrhosis, nor is there a treatment that can heal the liver damage already done. However, treatment can sometimes prevent or delay further liver damage.

The main components of cirrhosis treatment include:

• Treating the cause of cirrhosis, if possible, to prevent further deterioration;
• Avoid substances that can aggravate liver damage, especially alcohol and NSAIDs (Non-steroidal anti-inflammatory drugs);
• Preventing and treating symptoms and complications or cirrhosis;
• Liver transplant, if severe liver damage and if the cirrhosis patient is included on the transplant waiting list and a compatible donor is found.

Treatment

Initial cirrhosis treatment

When cirrhosis is diagnosed, it is recommended to:

• Stop any kind of alcohol intake! Alcohol consumption of any kind or quantity is not allowed;
• Avoid the use of NSAIDs such as Ibuprofen or Naproxen and other drugs that can affect the liver;
• Initiate a diet that is low in salt, if fluid retention occurs. Reducing salt consumption may prevent the accumulation of fluid in the abdomen (ascites) or chest;

Start immunization (if not already immune) against hepatitis A and B, influenza and Streptococcus pneumoniae(pneumococcus).

Following these steps prevents further complications and liver damage and also help alleviate symptoms. Initial treatment of cirrhosis also includes the treatment of already present complications. Depending on complications, cirrhosis patients may need drug therapy, surgery or other treatments.

Ongoing treatment of cirrhosis

Accumulation of fluid in the abdominal cavity, or ascites, is one of the most common complications of patients with cirrhosis and can become life threatening if not treated. A diet low in salt usually helps reduce fluid in the abdominal cavity. However, the following may also be required:

• Diuretics, such as Spironolactone and Furosemide, which help reduce fluid in the abdominal cavity and in other parts of the body. These drugs help prevent and treat ascites. They may be prescribed for long-term administration;
• Paracentesis with or without infusion of protein (albumin). Paracentesis is a procedure that involves inserting a needle through the abdominal wall in order to extract the liquid ascites. It can be used to treat severe cases of ascites that cause symptoms and do not respond to standard treatment with diuretics and low salt diet;
• Antibiotics, such as Cefotaxime, in case the patient develops a bacterial infection in the abdominal fluid (spontaneous bacterial peritonitis), as a complication of ascites;
• Transjugular intrahepatic portosystemic shunt (TIPS) or another type of surgery. These procedures can divert fluid from the abdominal cavity. It is used to treat ascites that are unresponsive to other forms of treatment.

Digestive tract bleeding varices (variceal bleeding) is another common complication and can be life-threatening for people with cirrhosis. Patients with variceal bleeding or at risk of bleeding should avoid taking Aspirin and other non-steroidal anti-inflammatory drugs. The following may be necessary:

Cirrhosis Medication

• Beta blockers, such as Propranolol or Nadolol. These drugs decrease the risk of variceal bleeding caused by portal hypertension. Beta blockers also help reduce blood pressure in the portal vein, thereby reducing the risk of a first variceal bleeding episode. These drugs are also used to reduce the risk of recurrent variceal bleeding;
• Vasoconstrictor agents. These drugs are used to treat acute variceal bleeding episodes. They also reduce blood flow through the portal vein by narrowing the blood vessels. Somatostatin and Vapreotide are the most frequently used;
• Endoscopic variceal heeling or sclerotherapy. These techniques can also be used in the treatment and prevention of bleeding esophageal varices;
• Balloon tamponade using a Sengstaken-Blakemore tube. The Sengstaken-Blakemore tube insertion is only a temporary variceal bleeding treatment. It helps stabilize the patient’s condition before the use of other forms of treatment or if the patient requires movement to a hospital unit where he will undergo a different treatment. It is used also when no other form of treatment is effective in stopping the variceal bleeding;

Cirrhosis Liver

Hepatic encephalopathy may also complicate cirrhosis when the liver is no longer effective in removing toxins from the bloodstream, especially substances produced by intestinal bacteria. These toxins accumulate in the bloodstream and affect the cerebral functions. For treatment and prevention of this complication the following might be necessary:

• Lactulose, a drug that reduces the accumulation of ammonia and other natural toxins in the intestine;
• Low protein diet. If liver damage is severe, the body becomes unable to properly use proteins, and that contributes to the accumulation of toxins;
• Avoidance of sedative drugs, sleeping pills and medications such as anxiolytics (anti-anxiety). These can aggravate the symptoms of encephalopathy;
• Regular medical appointments to monitor the disease are very important, especially because symptoms may be absent until the disease becomes severe. In addition to these, regular monitoring is needed for varicose veins and hepatocellular carcinoma.

American College of Gastroenterology (ACG) recommends the screening (monitoring) of varicose veins by endoscopy in individuals suffering from cirrhosis. If initial screening does not detect varicose veins, endoscopic re-evaluation is recommended every 1-2 years after the first endoscopy. If the initial assessment detects large varicose veins or if there was an episode of variceal bleeding, frequent endoscopic reassessment is recommended along with beta blockers therapy in order to prevent further bleeding episodes.
Screening for liver cancer (hepatocellular carcinoma) should be done every 6 months or 1 year, using a technique that uses both alpha-fetoprotein blood levels and liver ultrasound. Cirrhosis is a progressive disease. We recommend the consideration of possibilities for further treatment before the disease becomes severe. In particular, the following should be discussed:

• The possibility of being a good candidate for a liver transplant when cirrhosis becomes severe. The steps that must be followed in order to increase the chances of being a good candidate must be discussed;
• The level of medical interventions that the patient is willing to undergo when health conditions deteriorate. Some patients might want to undergo any medical treatment possible to keep them alive while others may prefer measures which creates more comfort, without prolonging their life;
• Severe liver cirrhosis can affect brain function, so all this talk makes sense, if done when the patient is able to make and communicate decisions.

Cirrhosis Liver

Treatment if medical condition worsens

Receiving a liver from an organ donor (liver transplant) is the only treatment that restores normal liver function and cures portal hypertension. Liver transplant is considered, usually only when liver damage is severe and life-threatening. Most patients who were transplanted were in final stages of liver cirrhosis and portal hypertension had severe complications. Liver transplant surgery is very expensive and waiting for a transplant is likely to be very long as very few organs are available.
Even if liver transplant is done, it may not be successful. Considering these factors, the physician must decide which patients may benefit from liver transplant. Liver transplant is an option for patients with end-stage cirrhosis who are good candidates for surgery. Good candidates for liver transplantation are:

• Those who did not abuse alcohol or illegal drugs in the past 6 months;
• Those who have good family support;
• Those who resist the complicated drug regime that needs to be followed in order to prevent post-transplant liver rejection;
• Liver transplant is not a good option for those who suffer serious concomitant other diseases (such as heart or lung diseases), which can reduce the chance of survival after surgery and can reduce life expectancy even if liver transplant is done.

End-stage liver cirrhosis

If the patient hasn’t yet made a decision regarding issues of this stage, it is recommended that he does so now. Many people find it helpful to put their choices regarding health care in writing, while they are still capable to decide and communicate the decisions of others. It also recommended to appoint a physician to carry out the decisions if the patient is unable to speak for himself.
If certain decisions were taken early in the course of the disease, there is the possibility that the patient will want to review them with the family and the doctor in order to make sure that is still what he wants. There comes a time in which the purpose of treatment is no longer to treat or cure the disease but to maintain the comfort and dignity of the patient. Your doctor may ask questions about maintaining comfort when cure is no longer an option. Doctors at hospices and palliative care centers can ensure a comfortable environment for people in final stages of cirrhosis.

Recommendations

No Alcohol

Abandonment of alcohol!
Consumption of excessive amounts of alcohol is the leading cause of cirrhosis. If diagnosed with cirrhosis, it is extremely important to completely renounce alcohol, even if alcohol consumption is not the cause of liver cirrhosis. If the patient doesn’t give up alcohol consumption, liver disease progresses more rapidly.

Diet modification
If the body retains fluid, the most important change in diet is to reduce the amount of sodium intake by reducing the amount of salt in your diet. People with liver damage tend to retain sodium. This may contribute to accumulation of fluid in the abdominal cavity (ascites), the most common complication of cirrhosis.
If the patient is at risk of developing hepatic encephalopathy (altered mental function) due to advanced liver disease, the doctor may recommend a temporary reduction of daily protein intake. However, protein is necessary in one’s diet in order to be well fed, but it is recommended that the majority of proteins should be of vegetable provenience. It also recommended to avoid eating large amounts of protein at one meal.

Avoidance of harmful drugs
Certain medications, including acetaminophen (Paracetamol) and NSAIDs (Ibuprofen, Naproxen) may accelerate liver damage in patients suffering from cirrhosis. They also increase the risk of variceal bleeding in patients who have varicose veins in the digestive tract. Consult your doctor for safe alternatives.
Certain prescription drugs that are meant to treat other conditions can be harmful to patients suffering from cirrhosis. The gastroenterologist who has cirrhotic patients under observation should be informed about all the medication that his patients use.