A subspecialty certification by the Board of Internal Medicine; practitioners focus on the stomach, intestines, colon, liver, and gallbladder (digestive organs). The gastroenterologist treats conditions such as abdominal pain, ulcers, diarrhea, cancer, and jaundice and they consult with surgeons when abdominal operations are indicated.
Nonalcoholic fatty liver disease (NAFLD)
refers to a wide spectrum of liver disease ranging from simple fatty liver
(steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible,
advanced scarring of the liver). All of the stages of NAFLD have in common the
accumulation of fat (fatty infiltration) in the liver cells (hepatocytes). In
NASH, the fat accumulation is associated with varying degrees of inflammation
(hepatitis) and scarring (fibrosis) of the liver.
The term nonalcoholic is used because NAFLD and NASH occur in individuals who
do not consume excessive amounts of alcohol. Yet, in many respects, the
histological picture of NAFLD (when we look at a biopsy piece of liver under the
microscope) is similar to what can be seen in liver disease that is due to
excessive intake of alcohol. As we shall see, however, the clinical
circumstances in NAFLD and NASH are very different from those in alcoholic liver
disease (ALD).
What is the NAFLD spectrum?
The NAFLD spectrum is thought to begin with and
progress from its simplest stage, called simple fatty liver (steatosis). That
is, fatty liver is the initial abnormality in the spectrum of NAFLD. Simple
fatty liver involves just the accumulation of fat in the liver cells with no
inflammation or scarring. The fat is actually composed of a particular type of
fat (triglyceride) that accumulates in tiny sacs within the liver cells. This
accumulation of fat in liver cells is not the same as the fat cells (adipocytes)
that constitute our body fat. Fatty liver is a harmless (benign) condition,
which means that it, by itself, does not cause any significant liver damage.
The next stage and degree of severity in the NAFLD spectrum is NASH.
Fortunately, only a fraction of patients with simple fatty liver will develop
NASH. As mentioned, NASH involves the accumulation of fat in the liver cells as...
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms. It should be noted that most women with the condition have a number of small cysts in the ovaries. However, women may have cysts in the ovaries for a number of reasons, and it is the characteristic constellation of symptoms, rather than the presence of the cysts themselves, that is important in establishing the diagnosis of PCOS.
PCOS occurs in 5% to 10% of women and is the most common cause of
infertility in women. The symptoms of PCOS may begin in adolescence with
menstrual irregularities, or a woman may not know she has PCOS until later in life when symptoms and/or infertility occur. Women of all ethnicities may be affected.
What are the symptoms of polycystic ovarian syndrome (PCOS)?
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Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Reye's syndrome (RS, or Reye syndrome) is a sudden, sometimes fatal, disease of the brain with degeneration of the liver. Reye syndrome occurs in children and comes after the chickenpox or an influenza-type illness, is also associated with taking medications containing aspirin. Symptoms include vomiting, listlessness, irritability or combativeness, confusion, delirium, delusions, convulsions, and loss of consciousness. Treatment depends on early diagnosis and focuses on protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest.
Fast food consumption and lack of exercise are just a couple of causes of childhood obesity. Health effects of childhood obesity include type 2 diabetes, heart attack, stroke, high cholesterol, asthma, sleep apnea, gallstones, fatty liver disease, GERD, depression, and eating disorders.
HCV is one of several viruses that cause hepatitis (inflammation of the
liver).
Up to 85% of individuals who are initially (acutely) infected with HCV will
fail to eliminate the virus and will become chronically infected.
HCV is spread most commonly through inadvertent
exposure to infected blood. Intravenous
drug abuse is the most common mode of transmission. The risk of
acquiring HCV through sexual contact is low.
Generally, patients do not develop symptoms of chronic infection with HCV
until they have extensive scarring of the liver (cirrhosis). Some individuals,
however, may have fatigue and other non-specific symptoms in the absence of
cirrhosis. A minority of patients with HCV have symptoms from organs outside of
the liver.
In the U.S., Infection with HCV is the most common cause of chronic
hepatitis and the most common reason for liver transplantation.
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