LIVER CIRRHOSIS COMPLICATIONS

Cirrhosis of the liver is a chronic disease that causes cell destruction and fibrosis (scarring) of hepatic tissue. Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow and resulting in hepatic insufficiency and hypertension in the portal vein. Complications include hyponatremia, water retention, bleeding esophageal varices. Coagulopathy, spontaneous bacterial peritonitis, and hepatic encephalopathy.

Cirrhosis is a potentially life-threatening condition that occurs when scarring damages the liver. This scarring replaces healthy tissue and prevents the liver from
working normally. Cirrhosis usually develops after years of liver inflammation. When chronic diseases cause the liver to become permanently injured and scarred, the condition is called Cirrhosis. Cirrhosis harms the structure of the liver and blocks the flow of blood. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also, the production of proteins and other substances made by the liver is suppressed. People with cirrhosis often have few symptoms at first. The person may experience fatigue, weakness, and exhaustion. Loss of appetite is usual, often with nausea and weight loss. As liver function declines, water may accumulate in the legs and the abdomen (ascites). A decrease in proteins needed for blood clotting makes it easy for the person to bruise, bleeding or infection. In the later stages of cirrhosis, jaundice (yellow skin) may occur, caused by the buildup of bile pigment that is passed by the liver into the intestines. The liver of a person with cirrhosis also has trouble removing toxins, which may build up in the blood. Drugs taken usually are filtered out by the liver, and this cleansing process also is slowed down by cirrhosis. 

People with cirrhosis often are very sensitive to medications and their side effects. The doctor often can diagnose cirrhosis from the patient’s symptoms and from laboratory tests. During a physical exam, the doctor could notice a change in how your liver feels or how large it is. If the doctor suspects Cirrhosis, you will be given blood tests. The purpose of these tests is to find out if liver disease is present. In some cases, other tests that take pictures of the liver are performed such as the computerized axial tomography (CAT) scan, and ultrasound. The doctor may decide to confirm the diagnosis by putting a needle through the skin (biopsy) to take a sample of tissue from the liver. In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver.

ANATOMY AND PHYSIOLOGY:

The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm and on top of the stomach, right kidney and intestines. The liver, a dark reddish-brown organ that weighs about 3 pounds, has multiple functions.

There are two distinct sources that supply blood to the liver:

• oxygenated blood flows in from the hepatic artery
• nutrient-rich blood flows in from the portal vein

The liver holds about one pint (13 percent) of the body’s blood supply at any given moment.

The liver consists of two main lobes, both of which are made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine).

The liver regulates most chemical levels in the blood and excretes a product called “bile,” which helps carry away waste products from the liver. All the blood leaving the stomach and intestines passes through the liver. The liver processes this blood and breaks down the nutrients and drugs into forms that are easier to use for the rest of the body. More than 500 vital functions have been identified with the liver. Some of the more well-known functions include the following:

Production of bile, which helps carry away waste and break down fats in the small intestine during digestion.

Production of certain proteins for blood plasma.

Production of cholesterol and special proteins to help carry fats through the body.

Conversion of excess glucose into glycogen for storage. (This glycogen can later be converted back to glucose for energy.)

Regulation of blood levels of amino acids, which form the building blocks of proteins.

Processing of hemoglobin for use of its iron content. (The liver stores iron.)

Conversion of poisonous ammonia to urea. (Urea is one of the end products of protein metabolism that is excreted in the urine.)

Clearing the blood of drugs and other poisonous substances.

Regulating blood clotting.

Resisting infections by producing immune factors and removing bacteria from the blood stream.

When the liver has broken down harmful substances, its by-products are excreted into the bile or blood. Bile by-products enter the intestine and ultimately leave the body in the feces. Blood by-products are filtered out by the kidneys, and leave the body in the form of urine.

PREDISPOSING FACTORS:

Chronic Alcoholism

Malnutrition – decrease Vitamin B, thiamin – main cause

Virus

Toxicity – e.g. carbon tetrachloride

Use of hepatotoxic agents

SIGNS AND SYMPTOMS:

Early Signs

Weakness, fatigue

Anorexia

Stomatitis

Urine – tea color

Stool – clay color

Amenorrhea

Decrease sexual urge

Loss of puic hair, axilla hair

Hepatomegaly

Jaundice

Pruritus or urticaria

Late Signs

Hematological changes – all blood cells decrease

Leukopenia – decrease

Thrombocytopenia – decrease

Anemia – decrease

Endocrine changes

Spider angiomas, Gynecomastia

Caput medusa, Palmar errythema

GIT changes

Ascitis, bleeding esophageal varices – due to portal Hypertension

Neurological Changes

PATHOPHYSIOLOGY:

Cirrhosis is characterized by diffuse fibrotic bands of connective tissue that distort the liver’s normal architecture. Inflammation caused by either toxins or disease results in extensive degeneration and destruction of hepatocytes ( liver cells ). As cirrhosis develops, the tissue becomes nodular. These nodules can block lile ducts and normal blood flow throughout the liver. Flow alterations in the vascular system and lymphatic bile duct channels result from compression caused by the proliferation of fibrous tissue. In early disease, the liver is usually enlarged, firm and hard. As the pathologic process continues, the liver shrinks in size.

COMPLICATIONS:

Cirrhosis is the eleventh leading cause of death by disease in the United States, killing more than 25,000 people each year. A damaged liver affects almost every bodily process, including the functions of the digestive, hormonal, and circulatory systems. The most serious complications are those associated with so-called decompensation, which occur when cirrhosis progresses. They include the following:

Bleeding and fluid buildup (ascites).

Infections.

Damage to the brain (encephalopathy). Impaired brain function occurs when the liver cannot detoxify harmful substances.

Liver cancer is also a long-term risk with cirrhosis.

Cirrhosis is irreversible, but the rate of progression can be very slow, depending on its cause and other factors. Five-year survival rates are about 85% and can be lower or higher depending on severity.

For example, alcoholics with cirrhosis who abstain can have a 5-year or more survival rate of as high as 85%. For those who continue drinking, the chance for living beyond 5 years is no higher than 60%.

In patients with hepatitis B or C, the 5-year survival rate after a diagnosis of cirrhosis ranges between 71 – 85%.

About two-thirds of patients with primary biliary cirrhosis never develop symptoms and can have a normal life span. Once symptoms of liver damage, such as jaundice, occur, however, the average survival time declines. In one study of women diagnosed with primary biliary cirrhosis, about 36% developed symptoms over an 11-year period, and 11% either died or required liver transplantation.

LEUKEMIA: CANCER OF THE WHITE BLOOD CELLS, SIGNS AND SYMPTOMS

Leukemia

The term leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). When a child has leukemia, large numbers of abnormal white blood cells are produced in the bone marrow. These abnormal white cells crowd the bone marrow and flood the bloodstream, but they cannot perform their proper role of protecting the body against disease because they are defective.

As leukemia progresses, the cancer interferes with the body's production of other types of blood cells, including red blood cells and platelets. This results in anemia (low numbers of red cells) and bleeding problems, in addition to the increased risk of infection caused by white cell abnormalities.

As a group, leukemias account for about 25% of all childhood cancers and affect about 2,200 American young people each year. Luckily, the chances for a cure are very good with leukemia. With treatment, most children with leukemia will be free of the disease without it coming back.

Types of Leukemia

In general, leukemias are classified into acute (rapidly developing) and chronic (slowly developing) forms. In children, about 98% of leukemias are acute.

Acute childhood leukemias are also divided into acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML), depending on whether specific white blood cells called lymphyocytes (or myelocytes), which are linked to immune defenses, are involved.

Approximately 60% of children with leukemia have ALL, and about 38% have AML. Although slow-growing chronic myelogenous leukemia (CML) may also be seen in children, it is very rare, accounting for fewer than 50 cases of childhood leukemia each year in the United States.

Causes

The ALL form of the disease most commonly occurs in younger children ages 2 to 8, with a peak incidence at age 4. But it can affect all age groups.

Kids have a 20% to 25% chance of developing ALL or AML if they have an identical twin who was diagnosed with the illness before age 6. In general, nonidentical twins and other siblings of children with leukemia have two to four times the average risk of developing this illness.

Children who have inherited certain genetic problems — such as Li-Fraumeni syndrome, Down syndrome, Kleinfelter syndrome,neurofibromatosis, ataxia telangectasia, or Fanconi's anemia — have a higher risk of developing leukemia, as do kids who are receiving medical drugs to suppress their immune systems after organ transplants.

Children who have received prior radiation or chemotherapy for other types of cancer also have a higher risk for leukemia, usually within the first 8 years after treatment.

In most cases, neither parents nor kids have control over the factors that trigger leukemia, although current studies are investigating the possibility that some environmental factors may increase the risk that a child will develop the disease. Most leukemias arise from noninherited mutations (changes) in the genes of growing blood cells. Because these errors occur randomly and unpredictably, there is currently no effective way to prevent most types of leukemia.

To limit the risk of prenatal radiation exposure as a trigger for leukemia (especially ALL), women who are pregnant or who suspect that they might be pregnant should always inform their doctors before undergoing tests or medical procedures that involve radiation (such as X-rays).

Regular checkups can spot early symptoms of leukemia in the relatively rare cases where this cancer is linked to an inherited genetic problem, to prior cancer treatment, or to use of immunosuppressive drugs for organ transplants.

Symptoms

Because their infection-fighting white blood cells are defective, kids with leukemia may experience increased episodes of fevers and infections. They also may become anemic, because leukemia affects the bone marrow's production of oxygen-carrying red blood cells. This makes them appear pale, and they may become abnormally tired and short of breath while playing.

Children with leukemia might bruise and bleed very easily, experience frequent nosebleeds, or bleed for an unusually long time after even a minor cut because leukemia destroys the bone marrow's ability to produce clot-forming platelets.

Other symptoms of leukemia can include:

• pain in the bones or joints, sometimes causing a limp
• swollen lymph nodes (sometimes called swollen glands) in the neck, groin, or elsewhere
• an abnormally tired feeling
• poor appetite

In about 12% of kids with AML and 6% of those with ALL, spread of leukemia to the brain causes headaches, seizures, balance problems, or abnormal vision. If ALL spreads to the lymph nodes inside the chest, the enlarged gland can crowd the trachea (windpipe) and important blood vessels, leading to breathing problems and interference with blood flow to and from the heart.

Diagnosis

Your child's doctor will perform a physical examination to check for signs of infection, anemia, abnormal bleeding, and swollen lymph nodes. The doctor will also feel your child's abdomen to see if there is an enlarged liver or spleen because they can become enlarged with some cancers in children.

In addition to doing a physical exam, the doctor will take a medical history by asking you about symptoms, past health, your family's health history, medications your child is taking, allergies, and other issues.

After this exam, the doctor will order a CBC (complete blood count) to measure the numbers of white cells, red cells, and platelets in your child's blood. A blood smear will be examined under a microscope to check for certain specific types of abnormal blood cells usually seen in patients with leukemia. Blood chemistries will also be checked.

Then, depending on the results of the physical exam and preliminary blood tests, your child may need:

• a bone marrow biopsy and aspiration, in which marrow samples are removed (usually from the back of the hip) for testing
• a lymph node biopsy, in which lymph nodes are removed and examined under a microscope to look for abnormal cells
• a lumbar puncture (spinal tap), where a sample of spinal fluid is removed from the lower back and examined for evidence of abnormal cells. This will show whether the leukemia has spread to the central nervous system (brain and spinal cord).

Bone marrow or lymph node samples will be examined and additional testing done to determine the specific type of leukemia. In addition to these basic lab tests, cell evaluations might be done, including genetic studies to distinguish between specific types of leukemia and certain features of the leukemia cells. Kids will receive anesthesia or sedative medications for any painful procedures.

Treatment

Certain features of a child's leukemia, such as age and initial white blood cell count, are used in determining the intensity of treatment needed to achieve the best chance for cure. Although all kids with ALL are treated with chemotherapy, the dosages and drug combinations may differ.

To decrease the chance that leukemia will invade the child's central nervous system, patients receive intrathecal chemotherapy, the administration of cancer-killing drugs into the cerebrospinal fluid around the brain and spinal cord.

Radiation treatments, which use high-energy rays to shrink tumors and keep cancer cells from growing, may be used in addition to intrathecal chemotherapy for certain high-risk patients. Children then require continued close monitoring by a pediatric oncologist, a specialist in childhood cancer.

After treatment begins, the goal is remission of the leukemia (when there is no longer evidence of cancer cells in the body). Once remission has occurred, maintenance chemotherapy is usually used to keep the child in remission. Maintenance chemotherapy is given in cycles over a period of 2 to 3 years to keep the cancer from returning. Leukemia will almost always relapse (reoccur) if this additional chemotherapy isn't given. Sometimes the cancer will return in spite of maintenance chemotherapy, and other forms of chemotherapy will then be necessary.

Sometimes a bone marrow transplant may be necessary in addition to — or instead of — chemotherapy, depending on the type of leukemia a child has. During a bone marrow transplant, healthy bone marrow is introduced into a child's body.

Intensive leukemia chemotherapy has certain side effects, including hair loss, nausea and vomiting, and increased risk for infection or bleeding in the short term, as well as other potential health problems down the line. As your child is treated for leukemia, the cancer treatment team will watch closely for those side effects.

But with the proper treatment, the outlook for kids who are diagnosed with leukemia is quite good. Some forms of childhood leukemia have a remission rate of up to 90%; all kids then require regular maintenance chemotherapy and other treatment to continue to be cancer-free. Overall cure rates differ depending on the specific features of a child's disease. Most childhood leukemias have very high remission rates. And the majority of kids can be cured (meaning that they are in permanent remission) of the disease.

FRUIT WONDERS: THE HEALTH BENEFITS OF APPLES

THE HEALTH BENEFITS OF APPLES

An Apple a day, keeps the doctors away. We've probably heard this phrase for a long time and a lot time by now. But what really are the health benefits of apples.
Health Benefits of Apples First up, what really is an apple.

Apple is the pomaceous fruit of the apple tree, species Malus domestica. It is one of the most popular, healthy and widely cultivated tree fruits. It is one of the most recognizable fruit and is well loved.


Apples or eating it can help in lowering cholesterol, aiding digestion and detoxifying the body. 
Apples are abundant in Quercetin, a flavonoid, which helps prevent the growth of prostate cancer cells.
Apples are said to help in slowing down ageing-related problems, avoiding wrinkles and promoting hair growth.
Apples have been found to have a positive result on those suffering from risk of stroke, Type II diabetes and asthma.


Apples, because of the presence of flavonoids, inhibit the growth of carcinogenic substances in the bladder and thus, diminish the risk of bladder cancer, especially in smokers.

Eating apples has been long associated with improvement of the lung function.
Researches have suggested that apples may protect post-menopausal women from osteoporosis and may also increase bone density.

The antioxidants and flavonoids present in apples help in the reducing the risk of respiratory diseases like chronic obstructive pulmonary disease (COPD).

The fiber and phytonutrients present in apples help in the reduction of blood cholesterol and also improve bowel function. In fact, apple juice has been found to restrain the oxidation of the harmful cholesterol (LDL or low-density lipoprotein).

The phytonutrients present in the skin of apples have been found to inhibit the growth of colon cancer cells.
The presence of dietary fiber in apples helps in better digestion and also promotes weight loss.
Researches have also suggested that foods like apples, which contain flavonoids, might reduce the risk of lung cancer.


Apples are low in calories; 100 g of fresh fruit slices provide only 50 calories. They are however contain no saturated fats or cholesterol; but rich in dietary fiber which helps prevent absorption of dietary LDL cholesterol in the gut. The dietary fibers also help protect the mucous membrane of the colon from exposure to toxic substances by binding to cancer causing chemicals in the colon.

Apple fruit contains good quantities of vitamin-C and beta carotene. Vitamin C is a powerful natural antioxidant. Consumption of foods rich in vitamin C helps body develop resistance against infectious agents and scavenge harmful, pro-inflammatory free radicals from the body.

Apples are rich in antioxidant phyto-nutrients flavonoids and polyphenols. The total measured anti-oxidant strength (ORAC value) of 100 g apple fruit is 5900 TE. The important flavonoids in apples are quercetin, epicatechin, and procyanidin B2. Apples are also good in tartaric acid that gives tart flavor to them. These compounds help body protect from deleterious effects of free radicals.

In addition, apple fruit is a good source of B-complex vitamins such as riboflavin, thiamin and pyridoxine (vitamin B-6). Together these vitamins help as co-factors for enzymes in metabolism as well as in various synthetic functions inside the body.

Apple also contains small amount of minerals like potassium, phosphorus and calcium. Potassium in an important component of cell and body fluids helps controlling heart rate and blood pressure; thus counters the bad influences of sodium.


If symptoms persists consult you doctors!