Input: What causes Urinary Retention ?

Output:
Urinary retention can result from

- obstruction of the urethra  - nerve problems  - medications  - weakened bladder muscles

Obstruction of the Urethra

Obstruction of the urethra causes urinary retention by blocking the normal urine flow out of the body. Conditions such as benign prostatic hyperplasiaalso called BPHurethral stricture, urinary tract stones, cystocele, rectocele, constipation, and certain tumors and cancers can cause an obstruction.

Benign prostatic hyperplasia. For men in their 50s and 60s, urinary retention is often caused by prostate enlargement due to benign prostatic hyperplasia. Benign prostatic hyperplasia is a medical condition in which the prostate gland is enlarged and not cancerous. The prostate is a walnut-shaped gland that is part of the male reproductive system. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a mans life. Benign prostatic hyperplasia often occurs with the second phase of growth.

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder.

More information is provided in the NIDDK health topic, Prostate Enlargement: Benign Prostatic Hyperplasia.

Urethral stricture. A urethral stricture is a narrowing or closure of the urethra. Causes of urethral stricture include inflammation and scar tissue from surgery, disease, recurring UTIs, or injury. In men, a urethral stricture may result from prostatitis, scarring after an injury to the penis or perineum, or surgery for benign prostatic hyperplasia and prostate cancer. Prostatitis is a frequently painful condition that involves inflammation of the prostate and sometimes the areas around the prostate. The perineum is the area between the anus and the sex organs. Since men have a longer urethra than women, urethral stricture is more common in men than women.1

More information is provided in the NIDDK health topic, Prostatitis: Inflammation of the Prostate.

Surgery to correct pelvic organ prolapse, such as cystocele and rectocele, and urinary incontinence can also cause urethral stricture. The urethral stricture often gets better a few weeks after surgery.

Urethral stricture and acute or chronic urinary retention may occur when the muscles surrounding the urethra do not relax. This condition happens mostly in women.

Urinary tract stones. Urinary tract stones develop from crystals that form in the urine and build up on the inner surfaces of the kidneys, ureters, or bladder. The stones formed or lodged in the bladder may block the opening to the urethra.

Cystocele. A cystocele is a bulging of the bladder into the vagina. A cystocele occurs when the muscles and supportive tissues between a womans bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina. The abnormal position of the bladder may cause it to press against and pinch the urethra.

More information is provided in the NIDDK health topic, Cystocele.

Rectocele. A rectocele is a bulging of the rectum into the vagina. A rectocele occurs when the muscles and supportive tissues between a womans rectum and vagina weaken and stretch, letting the rectum sag from its normal position and bulge into the vagina. The abnormal position of the rectum may cause it to press against and pinch the urethra.

Constipation. Constipation is a condition in which a person has fewer than three bowel movements a week or has bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass. A person with constipation may feel bloated or have pain in the abdomen the area between the chest and hips. Some people with constipation often have to strain to have a bowel movement. Hard stools in the rectum may push against the bladder and urethra, causing the urethra to be pinched, especially if a rectocele is present.

More information is provided in the NIDDK health topic, Constipation.

Tumors and cancers. Tumors and cancerous tissues in the bladder or urethra can gradually expand and obstruct urine flow by pressing against and pinching the urethra or by blocking the bladder outlet. Tumors may be cancerous or noncancerous.

Nerve Problems

Urinary retention can result from problems with the nerves that control the bladder and sphincters. Many events or conditions can interfere with nerve signals between the brain and the bladder and sphincters. If the nerves are damaged, the brain may not get the signal that the bladder is full. Even when a person has a full bladder, the bladder muscles that squeeze urine out may not get the signal to push, or the sphincters may not get the signal to relax. People of all ages can have nerve problems that interfere with bladder function. Some of the most common causes of nerve problems include

- vaginal childbirth  - brain or spinal cord infections or injuries  - diabetes  - stroke  - multiple sclerosis  - pelvic injury or trauma  - heavy metal poisoning

In addition, some children are born with defects that affect the coordination of nerve signals among the bladder, spinal cord, and brain. Spina bifida and other birth defects that affect the spinal cord can lead to urinary retention in newborns.

More information is provided in the NIDDK health topics, Nerve Disease and Bladder Control and Urine Blockage in Newborns.

Many patients have urinary retention right after surgery. During surgery, anesthesia is often used to block pain signals in the nerves, and fluid is given intravenously to compensate for possible blood loss. The combination of anesthesia and intravenous (IV) fluid may result in a full bladder with impaired nerve function, causing urinary retention. Normal bladder nerve function usually returns once anesthesia wears off. The patient will then be able to empty the bladder completely.

Medications

Various classes of medications can cause urinary retention by interfering with nerve signals to the bladder and prostate. These medications include

- antihistamines to treat allergies      - cetirizine (Zyrtec)    - chlorpheniramine (Chlor-Trimeton)    - diphenhydramine (Benadryl)    - fexofenadine (Allegra)    - anticholinergics/antispasmodics to treat stomach cramps, muscle spasms, and urinary incontinence      - hyoscyamine (Levbid)    - oxybutynin (Ditropan)    - propantheline (Pro-Banthine)    - tolterodine (Detrol)    - tricyclic antidepressants to treat anxiety and depression      - amitriptyline (Elavil)    - doxepin (Adapin)    - imipramine (Tofranil)    - nortriptyline (Pamelor)

Other medications associated with urinary retention include

- decongestants      - ephedrine    - phenylephrine    - pseudoephedrine    - nifedipine (Procardia), a medication to treat high blood pressure and chest pain  - carbamazepine (Tegretol), a medication to control seizures in people with epilepsy  - cyclobenzaprine (Flexeril), a muscle relaxant medication  - diazepam (Valium), a medication used to relieve anxiety, muscle spasms, and seizures  - nonsteroidal anti-inflammatory drugs  - amphetamines  - opioid analgesics

Over-the-counter cold and allergy medications that contain decongestants, such as pseudoephedrine, and antihistamines, such as diphenhydramine, can increase symptoms of urinary retention in men with prostate enlargement.

Weakened Bladder Muscles

Aging is a common cause of weakened bladder muscles. Weakened bladder muscles may not contract strongly enough or long enough to empty the bladder completely, resulting in urinary retention. </s>


Input: How many people are affected by Urinary Retention ?

Output:
Urinary retention in men becomes more common with age.

- In men 40 to 83 years old, the overall incidence of urinary retention is 4.5 to 6.8 per 1,000 men.2  - For men in their 70s, the overall incidence increases to 100 per 1,000 men.2  - For men in their 80s, the incidence of acute urinary retention is 300 per 1,000 men.2

Urinary retention in women is less common, though not rare.3 The incidence of urinary retention in women has not been well studied because researchers have primarily thought of urinary retention as a mans problem related to the prostate.4 </s>


Input: What are the symptoms of Urinary Retention ?

Output:
The symptoms of acute urinary retention may include the following and require immediate medical attention:

- inability to urinate  - painful, urgent need to urinate  - pain or discomfort in the lower abdomen  - bloating of the lower abdomen

The symptoms of chronic urinary retention may include

- urinary frequencyurination eight or more times a day  - trouble beginning a urine stream  - a weak or an interrupted urine stream  - an urgent need to urinate with little success when trying to urinate  - feeling the need to urinate after finishing urination  - mild and constant discomfort in the lower abdomen and urinary tract

Some people with chronic urinary retention may not have symptoms that lead them to seek medical care. People who are unaware they have chronic urinary retention may have a higher chance of developing complications.

When to Seek Medical Care   A person who has any of the following symptoms should see a health care provider right away:   - complete inability to urinate   - great discomfort or pain in the lower abdomen and urinary tract </s>


Input: How to diagnose Urinary Retention ?

Output:
A health care provider diagnoses acute or chronic urinary retention with

- a physical exam  - postvoid residual measurement

A health care provider may use the following medical tests to help determine the cause of urinary retention:

- cystoscopy  - computerized tomography (CT) scans  - urodynamic tests  - electromyography

Physical Exam

A health care provider may suspect urinary retention because of a patients symptoms and, therefore, perform a physical exam of the lower abdomen. The health care provider may be able to feel a distended bladder by lightly tapping on the lower belly.

Postvoid Residual Measurement

This test measures the amount of urine left in the bladder after urination. The remaining urine is called the postvoid residual. A specially trained technician performs an ultrasound, which uses harmless sound waves to create a picture of the bladder, to measure the postvoid residual. The technician performs the bladder ultrasound in a health care providers office, a radiology center, or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. The patient does not need anesthesia.

A health care provider may use a cathetera thin, flexible tubeto measure postvoid residual. The health care provider inserts the catheter through the urethra into the bladder, a procedure called catheterization, to drain and measure the amount of remaining urine. A postvoid residual of 100 mL or more indicates the bladder does not empty completely. A health care provider performs this test during an office visit. The patient often receives local anesthesia.

Medical Tests

Cystoscopy. Cystoscopy is a procedure that requires a tubelike instrument, called a cystoscope, to look inside the urethra and bladder. A health care provider performs cystoscopy during an office visit or in an outpatient center or a hospital. The patient will receive local anesthesia. However, in some cases, the patient may receive sedation and regional or general anesthesia. A health care provider may use cystoscopy to diagnose urethral stricture or look for a bladder stone blocking the opening of the urethra.

More information is provided in the NIDDK health topic, Cystoscopy and Ureteroscopy.

CT scans. CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where a technician takes the x rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. A health care provider may give infants and children a sedative to help them fall asleep for the test. CT scans can show

- urinary tract stones  - UTIs  - tumors  - traumatic injuries  - abnormal, fluid-containing sacs called cysts

Urodynamic tests. Urodynamic tests include a variety of procedures that look at how well the bladder and urethra store and release urine. A health care provider may use one or more urodynamic tests to diagnose urinary retention. The health care provider will perform these tests during an office visit. For tests that use a catheter, the patient often receives local anesthesia.

- Uroflowmetry. Uroflowmetry measures urine speed and volume. Special equipment automatically measures the amount of urine and the flow ratehow fast urine comes out. Uroflowmetry equipment includes a device for catching and measuring urine and a computer to record the data. The equipment creates a graph that shows changes in flow rate from second to second so the health care provider can see the highest flow rate and how many seconds it takes to get there. A weak bladder muscle or blocked urine flow will yield an abnormal test result.  - Pressure flow study. A pressure flow study measures the bladder pressure required to urinate and the flow rate a given pressure generates. A health care provider places a catheter with a manometer into the bladder. The manometer measures bladder pressure and flow rate as the bladder empties. A pressure flow study helps diagnose bladder outlet obstruction.  - Video urodynamics. This test uses x rays or ultrasound to create real-time images of the bladder and urethra during the filling or emptying of the bladder. For x rays, a health care provider passes a catheter through the urethra into the bladder. He or she fills the bladder with contrast medium, which is visible on the video images. Video urodynamic images can show the size and shape of the urinary tract, the flow of urine, and causes of urinary retention, such as bladder neck obstruction.

More information is provided in the NIDDK health topic, Urodynamic Testing.

Electromyography. Electromyography uses special sensors to measure the electrical activity of the muscles and nerves in and around the bladder and sphincters. A specially trained technician places sensors on the skin near the urethra and rectum or on a urethral or rectal catheter. The sensors record, on a machine, muscle and nerve activity. The patterns of the nerve impulses show whether the messages sent to the bladder and sphincters coordinate correctly. A technician performs electromyography in a health care providers office, an outpatient center, or a hospital. The patient does not need anesthesia if the technician uses sensors placed on the skin. The patient will receive local anesthesia if the technician uses sensors placed on a urethral or rectal catheter. </s>


Input: What are the treatments for Urinary Retention ?

Output:
A health care provider treats urinary retention with

- bladder drainage  - urethral dilation  - urethral stents  - prostate medications  - surgery

The type and length of treatment depend on the type and cause of urinary retention.

Bladder Drainage

Bladder drainage involves catheterization to drain urine. Treatment of acute urinary retention begins with catheterization to relieve the immediate distress of a full bladder and prevent bladder damage. A health care provider performs catheterization during an office visit or in an outpatient center or a hospital. The patient often receives local anesthesia. The health care provider can pass a catheter through the urethra into the bladder. In cases of a blocked urethra, he or she can pass a catheter directly through the lower abdomen, just above the pubic bone, directly into the bladder. In these cases, the health care provider will use anesthesia.

For chronic urinary retention, the patient may require intermittentoccasional, or not continuousor long-term catheterization if other treatments do not work. Patients who need to continue intermittent catheterization will receive instruction regarding how to selfcatheterize to drain urine as necessary.

Urethral Dilation

Urethral dilation treats urethral stricture by inserting increasingly wider tubes into the urethra to widen the stricture. An alternative dilation method involves inflating a small balloon at the end of a catheter inside the urethra. A health care provider performs a urethral dilation during an office visit or in an outpatient center or a hospital. The patient will receive local anesthesia. In some cases, the patient will receive sedation and regional anesthesia.

Urethral Stents

Another treatment for urethral stricture involves inserting an artificial tube, called a stent, into the urethra to the area of the stricture. Once in place, the stent expands like a spring and pushes back the surrounding tissue, widening the urethra. Stents may be temporary or permanent. A health care provider performs stent placement during an office visit or in an outpatient center or a hospital. The patient will receive local anesthesia. In some cases, the patient will receive sedation and regional anesthesia.

Prostate Medications

Medications that stop the growth of or shrink the prostate or relieve urinary retention symptoms associated with benign prostatic hyperplasia include

- dutasteride (Avodart)  - finasteride (Proscar)

The following medications relax the muscles of the bladder outlet and prostate to help relieve blockage:

- alfuzosin (Uroxatral)  - doxazosin (Cardura)  - silodosin (Rapaflo)  - tadalafil (Cialis)  - tamsulosin (Flomax)  - terazosin (Hytrin)

Surgery

Prostate surgery. To treat urinary retention caused by benign prostatic hyperplasia, a urologista doctor who specializes in the urinary tractmay surgically destroy or remove enlarged prostate tissue by using the transurethral method. For transurethral surgery, the urologist inserts a catheter or surgical instruments through the urethra to reach the prostate. Removal of the enlarged tissue usually relieves the blockage and urinary retention caused by benign prostatic hyperplasia. A urologist performs some procedures on an outpatient basis. Some men may require a hospital stay. In some cases, the urologist will remove the entire prostate using open surgery. Men will receive general anesthesia and have a longer hospital stay than for other surgical procedures. Men will also have a longer rehabilitation period for open surgery.

More information is provided in the NIDDK health topic, Prostate Enlargement: Benign Prostatic Hyperplasia.

Internal urethrotomy. A urologist can repair a urethral stricture by performing an internal urethrotomy. For this procedure, the urologist inserts a special catheter into the urethra until it reaches the stricture. The urologist then uses a knife or laser to make an incision that opens the stricture. The urologist performs an internal urethrotomy in an outpatient center or a hospital. The patient will receive general anesthesia.

Cystocele or rectocele repair. Women may need surgery to lift a fallen bladder or rectum into its normal position. The most common procedure for cystocele and rectocele repair involves a urologist, who also specializes in the female reproductive system, making an incision in the wall of the vagina. Through the incision, the urologist looks for a defect or hole in the tissue that normally separates the vagina from the other pelvic organs. The urologist places stitches in the tissue to close up the defect and then closes the incision in the vaginal wall with more stitches, removing any extra tissue. These stitches tighten the layers of tissue that separate the organs, creating more support for the pelvic organs. A urologist or gynecologista doctor who specializes in the female reproductive systemperforms the surgery to repair a cystocele or rectocele in a hospital. Women will receive anesthesia.

Tumor and cancer surgery. Removal of tumors and cancerous tissues in the bladder or urethra may reduce urethral obstruction and urinary retention. </s>


Input: What are the treatments for Urinary Retention ?

Output:
Complications of urinary retention and its treatments may include

- UTIs  - bladder damage  - kidney damage  - urinary incontinence after prostate, tumor, or cancer surgery

UTIs. Urine is normally sterile, and the normal flow of urine usually prevents bacteria from infecting the urinary tract. With urinary retention, the abnormal urine flow gives bacteria at the opening of the urethra a chance to infect the urinary tract.

Bladder damage. If the bladder becomes stretched too far or for long periods, the muscles may be permanently damaged and lose their ability to contract.

Kidney damage. In some people, urinary retention causes urine to flow backward into the kidneys. This backward flow, called reflux, may damage or scar the kidneys.

Urinary incontinence after prostate, tumor, or cancer surgery. Transurethral surgery to treat benign prostatic hyperplasia may result in urinary incontinence in some men. This problem is often temporary. Most men recover their bladder control in a few weeks or months after surgery. Surgery to remove tumors or cancerous tissue in the bladder, prostate, or urethra may also result in urinary incontinence. </s>


Input: How to prevent Urinary Retention ?

Output:
People can prevent urinary retention before it occurs by treating some of the potential causes. For example, men with benign prostatic hyperplasia should take prostate medications as prescribed by their health care provider. Men with benign prostatic hyperplasia should avoid medications associated with urinary retention, such as over-the-counter cold and allergy medications that contain decongestants. Women with mild cystocele or rectocele may prevent urinary retention by doing exercises to strengthen the pelvic muscles. In most cases, dietary and lifestyle changes will help prevent urinary retention caused by constipation. People whose constipation continues should see a health care provider.

More information about exercises to strengthen the pelvic muscles is provided in the NIDDK health topic, Kegel Exercise Tips. </s>


Input: What to do for Urinary Retention ?

Output: Researchers have not found that eating, diet, and nutrition play a role in causing or preventing urinary retention. </s>


Input: What to do for Urinary Retention ?

Output: - Urinary retention is the inability to empty the bladder completely.  - Urinary retention can be acute or chronic.  - Urinary retention can result from      - obstruction of the urethra    - nerve problems    - medications    - weakened bladder muscles    - The symptoms of acute urinary retention may include the following and require immediate medical attention:      - inability to urinate    - painful, urgent need to urinate    - pain or discomfort in the lower abdomen    - bloating of the lower abdomen    - The symptoms of chronic urinary retention may include      - urinary frequencyurination eight or more times a day    - trouble beginning a urine stream    - a weak or an interrupted urine stream    - an urgent need to urinate with little success when trying to urinate    - feeling the need to urinate after finishing urination    - mild and constant discomfort in the lower abdomen and urinary tract    - A health care provider diagnoses acute or chronic urinary retention with      - a physical exam    - postvoid residual measurement    - A health care provider may use the following medical tests to help determine the cause of urinary retention:      - cystoscopy    - computerized tomography (CT) scans    - urodynamic tests    - electromyography    - A health care provider treats urinary retention with      - bladder drainage    - urethral dilation    - urethral stents    - prostate medications    - surgery    - Complications of urinary retention and its treatments may include      - urinary tract infections (UTIs)    - bladder damage    - kidney damage    - urinary incontinence after prostate, tumor, or cancer surgery    - People can prevent urinary retention before it occurs by treating some of the potential causes. </s>


Input: What is (are) Proteinuria ?

Output:
Proteinuriaalso called albuminuria or urine albuminis a condition in which urine contains an abnormal amount of protein. Albumin is the main protein in the blood. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions. They protect the body from infection, help blood clot, and keep the right amount of fluid circulating throughout the body.

As blood passes through healthy kidneys, they filter out the waste products and leave in the things the body needs, like albumin and other proteins. Most proteins are too big to pass through the kidneys' filters into the urine. However, proteins from the blood can leak into the urine when the filters of the kidney, called glomeruli, are damaged.

Proteinuria is a sign of chronic kidney disease (CKD), which can result from diabetes, high blood pressure, and diseases that cause inflammation in the kidneys. For this reason, testing for albumin in the urine is part of a routine medical assessment for everyone. Kidney disease is sometimes called renal disease. If CKD progresses, it can lead to end-stage renal disease (ESRD), when the kidneys fail completely. A person with ESRD must receive a kidney transplant or regular blood-cleansing treatments called dialysis. </s>


Input: Who is at risk for Proteinuria? ?

Output:
People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. In the United States, diabetes is the leading cause of ESRD.1 In both type 1 and type 2 diabetes, albumin in the urine is one of the first signs of deteriorating kidney function. As kidney function declines, the amount of albumin in the urine increases.

Another risk factor for developing proteinuria is hypertension, or high blood pressure. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. If the hypertension is not controlled, the person can progress to full kidney failure.

African Americans are more likely than Caucasians to have high blood pressure and to develop kidney problems from it, even when their blood pressure is only mildly elevated. In fact, African Americans are six times more likely than Caucasians to develop hypertension-related kidney failure.2

Other groups at risk for proteinuria are American Indians, Hispanics/Latinos, Pacific Islander Americans, older adults, and overweight people. These at-risk groups and people who have a family history of kidney disease should have their urine tested regularly. </s>


Input: What are the symptoms of Proteinuria ?

Output:
Proteinuria has no signs or symptoms in the early stages. Large amounts of protein in the urine may cause it to look foamy in the toilet. Also, because protein has left the body, the blood can no longer soak up enough fluid, so swelling in the hands, feet, abdomen, or face may occur. This swelling is called edema. These are signs of large protein loss and indicate that kidney disease has progressed. Laboratory testing is the only way to find out whether protein is in a persons urine before extensive kidney damage occurs.

Several health organizations recommend regular urine checks for people at risk for CKD. A 1996 study sponsored by the National Institutes of Health determined that proteinuria is the best predictor of progressive kidney failure in people with type 2 diabetes. The American Diabetes Association recommends regular urine testing for proteinuria for people with type 1 or type 2 diabetes. The National Kidney Foundation recommends that routine checkups include testing for excess protein in the urine, especially for people in high-risk groups. </s>


Input: How to diagnose Proteinuria ?

Output:
Until recently, an accurate protein measurement required a 24-hour urine collection. In a 24-hour collection, the patient urinates into a container, which is kept refrigerated between trips to the bathroom. The patient is instructed to begin collecting urine after the first trip to the bathroom in the morning. Every drop of urine for the rest of the day is to be collected in the container. The next morning, the patient adds the first urination after waking and the collection is complete.

In recent years, researchers have found that a single urine sample can provide the needed information. In the newer technique, the amount of albumin in the urine sample is compared with the amount of creatinine, a waste product of normal muscle breakdown. The measurement is called a urine albumin-to-creatinine ratio (UACR). A urine sample containing more than 30 milligrams of albumin for each gram of creatinine (30 mg/g) is a warning that there may be a problem. If the laboratory test exceeds 30 mg/g, another UACR test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria, a sign of declining kidney function, and should have additional tests to evaluate kidney function. </s>


Input: How to diagnose Proteinuria ?

Output: Tests that measure the amount of creatinine in the blood will show whether a persons kidneys are removing wastes efficiently. Having too much creatinine in the blood is a sign that a person has kidney damage. The doctor can use the creatinine measurement to estimate how efficiently the kidneys are filtering the blood. This calculation is called the estimated glomerular filtration rate, or eGFR. CKD is present when the eGFR is less than 60 milliliters per minute (mL/min). </s>


Input: What to do for Proteinuria ?

Output: - Proteinuria is a condition in which urine contains a detectable amount of protein.  - Proteinuria is a sign of chronic kidney disease (CKD).  - Groups at risk for proteinuria include African Americans, American Indians, Hispanics/Latinos, Pacific Islander Americans, older people, overweight people, people with diabetes or hypertension, and people who have a family history of kidney disease.  - Proteinuria may have no signs or symptoms. Laboratory testing is the only way to find out whether protein is in a person's urine.  - Several health organizations recommend regular checks for proteinuria so kidney disease can be detected and treated before it progresses.  - A person with diabetes, hypertension, or both should work to control blood glucose and blood pressure. </s>


Input: What is (are) Nephrotic Syndrome in Adults ?

Output:
Nephrotic syndrome is a collection of symptoms that indicate kidney damage. Nephrotic syndrome includes the following:

- proteinurialarge amounts of protein in the urine  - hyperlipidemiahigher than normal fat and cholesterol levels in the blood  - edema, or swelling, usually in the legs, feet, or ankles and less often in the hands or face  - hypoalbuminialow levels of albumin in the blood

Albumin is a protein that acts like a sponge, drawing extra fluid from the body into the bloodstream where it remains until removed by the kidneys. When albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body, causing edema.

Nephrotic syndrome results from a problem with the kidneys filters, called glomeruli. Glomeruli are tiny blood vessels in the kidneys that remove wastes and excess fluids from the blood and send them to the bladder as urine.

As blood passes through healthy kidneys, the glomeruli filter out the waste products and allow the blood to retain cells and proteins the body needs. However, proteins from the blood, such as albumin, can leak into the urine when the glomeruli are damaged. In nephrotic syndrome, damaged glomeruli allow 3 grams or more of protein to leak into the urine when measured over a 24-hour period, which is more than 20 times the amount that healthy glomeruli allow. </s>


Input: What causes Nephrotic Syndrome in Adults ?

Output:
Nephrotic syndrome can be caused by diseases that affect only the kidneys, such as focal segmental glomerulosclerosis (FSGS) or membranous nephropathy. Diseases that affect only the kidneys are called primary causes of nephrotic syndrome. The glomeruli are usually the targets of these diseases for reasons that are not fully understood. In FSGSthe most common primary cause of nephrotic syndromescar tissue forms in parts of the glomeruli. In membranous nephropathy, immune molecules form harmful deposits on the glomeruli.

Nephrotic syndrome can also be caused by systemic diseases, which are diseases that affect many parts of the body, such as diabetes or lupus. Systemic diseases that affect the kidneys are called secondary causes of nephrotic syndrome. More than 50 percent of nephrotic syndrome cases in adults have secondary causes, with diabetes being the most common.1 </s>


Input: What are the symptoms of Nephrotic Syndrome in Adults ?

Output:
In addition to proteinuria, hyperlipidemia, edema, and hypoalbumina, people with nephrotic syndrome may experience

- weight gain  - fatigue  - foamy urine  - loss of appetite </s>


Input: What are the complications of Nephrotic Syndrome in Adults ?

Output:
The loss of different proteins from the body can lead to a variety of complications in people with nephrotic syndrome. Blood clots can form when proteins that normally prevent them are lost through the urine. Blood clots can block the flow of blood and oxygen through a blood vessel. Loss of immunoglobulinsimmune system proteins that help fight disease and infectionleads to an increased risk of infections. These infections include pneumonia, a lung infection; cellulitis, a skin infection; peritonitis, an abdominal infection; and meningitis, a brain and spine infection. Medications given to treat nephrotic syndrome can also increase the risk of these infections. Other complications of nephrotic syndrome include

- hypothyroidisma condition in which the thyroid gland does not produce enough thyroid hormone to meet the bodys needs  - anemiaa condition in which red blood cells are fewer or smaller than normal, which means less oxygen is carried to the bodys cells  - coronary artery disease, also called coronary heart diseaseheart disease caused by narrowing of the arteries that supply blood to the heart  - high blood pressure, also called hypertensiona condition in which blood flows through the blood vessels with a force greater than normal  - acute kidney injurysudden and temporary loss of kidney function </s>


Input: How to diagnose Nephrotic Syndrome in Adults ?

Output:
Urine samples are taken to diagnose people suspected of having nephrotic syndrome.

Nephrotic syndrome is diagnosed when large amounts of protein are found in the urine. The blood protein albumin makes up much of the protein that is lost, though many other important proteins are also lost in nephrotic syndrome.

The presence of albumin in the urine can be detected with a dipstick test performed on a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when protein is present in urine.

A more precise measurement is usually needed to confirm the diagnosis. Either a single urine sample or a 24-hour collection of urine can be sent to a lab for analysis. With the single urine sample, the lab measures both albumin and creatinine, a waste product of normal muscle breakdown. The comparison of the measurements is called a urine albumin-to-creatinine ratio. A urine sample containing more than 30 milligrams of albumin for each gram of creatinine may signal a problem. With a 24-hour collection of urine, the lab measures only the amount of albumin present. The single urine sample is easier to collect than the 24-hour sample and is usually sufficient to confirm diagnosis, though the 24-hour collection may be used in some cases.

Once nephrotic syndrome is diagnosed, blood tests are usually needed to check for systemic diseases that may be causing the nephrotic syndrome and to find out how well the kidneys are working overall. A blood test involves drawing blood at a health care providers office or commercial facility and sending the sample to a lab for analysis.

Though blood tests can point toward systemic diseases, a kidney biopsy is usually needed to diagnose the specific underlying disease causing the nephrotic syndrome and to determine the best treatment. A kidney biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. Kidney biopsies are performed by a health care provider in a hospital with light sedation and local anesthetic. A biopsy is often not needed for a person with diabetes because the persons medical history and lab tests may be enough to diagnose the problem as being a result of diabetes. </s>


Input: What are the treatments for Nephrotic Syndrome in Adults ?

Output:
Treating nephrotic syndrome includes addressing the underlying cause as well as taking steps to reduce high blood pressure, edema, high cholesterol, and the risks of infection. Treatment usually includes medications and changes in diet.

Medications that lower blood pressure can also significantly slow the progression of kidney disease causing nephrotic syndrome. Two types of blood pressure lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease by reducing the pressure inside the glomeruli and thereby reducing proteinuria. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretica medication that aids the kidneys in removing fluid from the bloodcan also be useful in helping to reduce blood pressure as well as edema. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed.

Statin medications may be given to lower cholesterol.

People with nephrotic syndrome should receive the pneumococcal vaccine, which helps protect against a bacterium that commonly causes infection, and yearly flu shots.

Blood thinning medications are usually only given to people with nephrotic syndrome who develop a blood clot; these medications are not used as a preventive measure.

Nephrotic syndrome may go away once the underlying cause has been treated. More information about treating the underlying causes of nephrotic syndrome is provided in the NIDDK health topic, Glomerular Diseases. </s>


Input: What to do for Nephrotic Syndrome in Adults ?

Output: Eating, diet, and nutrition have not been shown to play a role in causing or preventing nephrotic syndrome in adults. For people who have developed nephrotic syndrome, limiting intake of dietary sodium, often from salt, and fluid may be recommended to help reduce edema. A diet low in saturated fat and cholesterol may also be recommended to help control hyperlipidemia. </s>


Input: What to do for Nephrotic Syndrome in Adults ?

Output: - Nephrotic syndrome includes the following:      - proteinurialarge amounts of protein in the urine    - hyperlipidemiahigher than normal fat and cholesterol levels in the blood    - edema, or swelling, usually in the legs, feet, or ankles and less often in the hands or face    - hypoalbuminialow levels albumin in the blood    - Primary causes of nephrotic syndrome are diseases that affect only the kidneys, such as focal segmental glomerulosclerosis (FSGS). Secondary causes of nephrotic syndrome are diseases that affect many parts of the body, such as diabetes.  - In addition to proteinuria, hyperlipidemia, edema, and hypoalbumina, people with nephrotic syndrome may experience      - weight gain    - fatigue    - foamy urine    - loss of appetite    - The loss of different proteins from the body can lead to a variety of complications in people with nephrotic syndrome.  - Treating nephrotic syndrome includes addressing the underlying cause and taking steps to reduce high blood pressure, edema, high cholesterol, and the risks of infection. Treatment usually includes medications and changes in diet. </s>


Input: What is (are) What I need to know about Diarrhea ?

Output:
Diarrhea is frequent, loose, and watery bowel movements. Bowel movements, also called stools, are body wastes passed through the rectum and anus. Stools contain what is left after your digestive system absorbs nutrients and fluids from what you eat and drink. If your body does not absorb the fluids, or if your digestive system produces extra fluids, stools will be loose and watery. Loose stools contain more water, salts, and minerals and weigh more than solid stools.

Diarrhea that lasts a short time is called acute diarrhea. Acute diarrhea is a common problem and usually lasts only 1 or 2 days, but it may last longer. Diarrhea that lasts for at least 4 weeks is called chronic diarrhea. Chronic diarrhea symptoms may be continual or they may come and go.

*See the Pronunciation Guide for tips on how to say the words in bold type. </s>


Input: What causes What I need to know about Diarrhea ?

Output:
Causes of diarrhea include

- bacteria from contaminated food or water  - viruses that cause illnesses such as the flu  - parasites, which are tiny organisms found in contaminated food or water  - medicines such as antibiotics  - problems digesting certain foods  - diseases that affect the stomach, small intestine, or colon, such as Crohns disease  - problems with how the colon functions, caused by disorders such as irritable bowel syndrome

Sometimes no cause can be found. As long as diarrhea goes away within 1 to 2 days, finding the cause is not usually necessary. </s>


Input: What are the symptoms of What I need to know about Diarrhea ?

Output:
In addition to passing frequent, loose stools, other possible symptoms include

- cramps or pain in the abdomenthe area between the chest and hips  - an urgent need to use the bathroom  - loss of bowel control

You may feel sick to your stomach or become dehydrated. If a virus or bacteria is the cause of your diarrhea, you may have fever and chills and bloody stools.

Dehydration

Being dehydrated means your body does not have enough fluid to work properly. Every time you have a bowel movement, you lose fluids. Diarrhea causes you to lose even more fluids. You also lose salts and minerals such as sodium, chloride, and potassium. These salts and minerals affect the amount of water that stays in your body.

Dehydration can be serious, especially for children, older adults, and people with weakened immune systems.

Signs of dehydration in adults are

- being thirsty  - urinating less often than usual  - having dark-colored urine  - having dry skin  - feeling tired  - feeling dizzy or fainting

Signs of dehydration in babies and young children are

- having a dry mouth and tongue  - crying without tears  - having no wet diapers for 3 hours or more  - having sunken eyes, cheeks, or soft spot in the skull  - having a high fever  - being more cranky or drowsy than usual

Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released. </s>


Input: How to diagnose What I need to know about Diarrhea ?

Output:
To find the cause of diarrhea, the health care provider may

- perform a physical exam  - ask about any medicines you are taking  - test your stool or blood to look for bacteria, parasites, or other signs of disease or infection  - ask you to stop eating certain foods to see whether your diarrhea goes away

If you have chronic diarrhea, your health care provider may perform other tests to look for signs of disease. </s>


Input: What are the treatments for What I need to know about Diarrhea ?

Output:
Diarrhea is treated by replacing lost fluids, salts, and minerals to prevent dehydration.

Taking medicine to stop diarrhea can be helpful in some cases. Medicines you can buy over the counter without a prescription include loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate). Stop taking these medicines if symptoms get worse or if the diarrhea lasts more than 2 days. If you have bloody diarrhea, you should not use over-the-counter diarrhea medicines. These medicines may make diarrhea last longer. The health care provider will usually prescribe antibiotics instead.

Over-the-counter medicines for diarrhea may be dangerous for babies and children. Talk with the health care provider before giving your child these medicines. </s>


Input: What to do for What I need to know about Diarrhea ?

Output:
To prevent dehydration when you have diarrhea, it is important to drink plenty of water, but you also need to drink fluids that contain sodium, chloride, and potassium.

- Adults should drink water, fruit juices, sports drinks, sodas without caffeine, and salty broths.  - Children should drink oral rehydration solutionsspecial drinks that contain salts and minerals to prevent dehydration. These drinks include Pedialyte, Naturalyte, Infalyte, and CeraLyte. These drinks are sold in most grocery stores and drugstores.

- bananas  - plain rice  - boiled potatoes  - toast  - crackers  - cooked carrots  - baked chicken without the skin or fat

If a certain food is the cause of diarrhea, try to avoid it.

- drinks with caffeine, such as coffee and cola  - high-fat or greasy foods, such as fried foods  - foods with a lot of fiber, such as citrus fruits  - sweet foods, such as cakes and cookies

During or after an episode of diarrhea, some people have trouble digesting lactose, the sugar in milk and milk products. However, you may be able to digest yogurt. Eating yogurt with active, live bacterial cultures may even help you feel better faster.

When babies have diarrhea, continue breastfeeding or formula feeding as usual.

After you have had diarrhea caused by a virus, problems digesting lactose may last up to 4 to 6 weeks. You may have diarrhea for a short time after you eat or drink milk or milk products. </s>


Input: How to prevent What I need to know about Diarrhea ?

Output:
Two types of diarrhea can be preventedrotavirus diarrhea and travelers diarrhea.

Rotavirus Diarrhea

Two vaccines, RotaTeq and Rotarix, protect against rotavirusa common virus that causes diarrhea in babies and children. RotaTeq is given to babies in three doses at 2, 4, and 6 months of age. Rotarix is given in two doses. The first dose is given when the baby is 6 weeks old, and the second is given at least 4 weeks later but before the baby is 24 weeks old. To learn more about rotavirus vaccines, talk with your childs health care provider. You can also find more information at the Centers for Disease Control and Prevention rotavirus vaccination webpage at www.cdc.gov/vaccines/vpd-vac/rotavirus.

RotaTeq and Rotarix only prevent diarrhea caused by rotavirus. Children who have been vaccinated may still get diarrhea from another cause.

Travelers Diarrhea

People may develop travelers diarrhea while visiting developing areas of the world such as Latin America, Africa, and southern Asia. Travelers diarrhea is caused by eating food or drinking water that contains harmful bacteria, viruses, or parasites.

You can prevent travelers diarrhea by being careful:

- Do not drink tap water, use tap water to brush your teeth, or use ice cubes made from tap water.  - Do not eat or drink unpasteurized milk or milk products.  - Do not eat raw fruits and vegetables unless they can be peeled and you peel them yourself.  - Do not eat raw or rare meat and fish.  - Do not eat meat or shellfish that is not hot when served to you.  - Do not eat food sold by street vendors.

You can drink bottled water, carbonated soft drinks, and hot drinks such as coffee and tea.

Before traveling outside the United States, talk with your health care provider. Your health care provider may suggest taking medicine with you. In some cases, taking antibiotics before traveling can help prevent travelers diarrhea. And early treatment with antibiotics can shorten an episode of travelers diarrhea. </s>


Input: What to do for What I need to know about Diarrhea ?

Output: - Diarrhea is frequent, loose, and watery bowel movements.  - Acute diarrhea is a common problem. It usually lasts only 1 or 2 days, but it may last longer.  - Being dehydrated means your body does not have enough fluid to work properly. Dehydration can be serious, especially for children, older adults, and people with weakened immune systems.  - Diarrhea is treated by replacing lost fluids, salts, and minerals.  - See your health care provider if you have signs of dehydration, diarrhea for more than 2 days, severe pain in your abdomen or rectum, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry.  - Take your child to a health care provider right away if your child has signs of dehydration, diarrhea for more than 24 hours, a fever of 102 degrees or higher, stools containing blood or pus, or stools that are black and tarry.  - Two types of diarrhea can be prevented rotavirus diarrhea and travelers diarrhea. </s>


Input: What is (are) Alagille Syndrome ?

Output:
Alagille syndrome is a genetic condition that results in various symptoms in different parts of the body, including the liver. A person with Alagille syndrome has fewer than the normal number of small bile ducts inside the liver. The liver is the organ in the abdomenthe area between the chest and hipsthat makes blood proteins and bile, stores energy and nutrients, fights infection, and removes harmful chemicals from the blood.

Bile ducts are tubes that carry bile from the liver cells to the gallbladder for storage and to the small intestine for use in digestion. Bile is fluid made by the liver that carries toxins and waste products out of the body and helps the body digest fats and the fat-soluble vitamins A, D, E, and K. In people with Alagille syndrome, the decreased number of bile ducts causes bile to build up in the liver, a condition also called cholestasis, leading to liver damage and liver disease. </s>


Input: What is (are) Alagille Syndrome ?

Output: The digestive system is made up of the gastrointestinal (GI) tractalso called the digestive tractand the liver, pancreas, and gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestinewhich includes the colon and rectumand anus. Food enters the mouth and passes to the anus through the hollow organs of the digestive system. The liver, pancreas, and gallbladder are the solid organs of the digestive system. The digestive system helps the body digest food. </s>


Input: What causes Alagille Syndrome ?

Output:
Alagille syndrome is caused by a gene mutation, or defect. Genes provide instructions for making proteins in the body. A gene mutation is a permanent change in the DNA sequence that makes up a gene. DNA, or deoxyribonucleic acid, is the material inside cells that carries genetic information and passes genes from parent to child. Approximately 30 to 50 percent of people with Alagille syndrome have an inherited gene mutation, meaning it has been passed on by a parent. In the remaining cases, the gene mutation develops spontaneously.1 In spontaneous cases, neither parent carries a copy of the mutated gene.

Most cases of Alagille syndrome are caused by a mutation in the JAGGED1 (JAG1) gene. In less than 1 percent of cases, a mutation in the NOTCH2 gene is the cause.2

Genetic Disorders   Each cell contains thousands of genes that provide the instructions for making proteins for growth and repair of the body. If a gene has a mutation, the protein made by that gene may not function properly, which sometimes creates a genetic disorder. Not all gene mutations cause a disorder.   People have two copies of most genes; one copy is inherited from each parent. A genetic disorder occurs when one or both parents pass a mutated gene to a child at conception. A genetic disorder can also occur through a spontaneous gene mutation, meaning neither parent carries a copy of the mutated gene. Once a spontaneous gene mutation has occurred in a person, it can be passed to the person's children.   Read more about genes and genetic conditions at the U.S. National Library of Medicine's (NLM's) Genetics Home Reference at www.ghr.nlm.nih.gov. </s>


Input: How many people are affected by Alagille Syndrome ?

Output:
Alagille syndrome occurs in about one of every 30,000 live births.3 The disorder affects both sexes equally and shows no geographical, racial, or ethnic preferences.

JAG1 and NOTCH2 gene mutations are inherited in an autosomal dominant way, which means a child can get Alagille syndrome by inheriting either of the gene mutations from only one parent. Each child of a parent with an autosomal dominant mutation has a 50 percent chance of inheriting the mutated gene.

The following chart shows the chance of inheriting an autosomal dominant gene mutation:

The gene mutations that cause Alagille syndrome may cause mild or subtle symptoms. Some people may not know they are affected, while others with the gene mutation may develop more serious characteristics of Alagille syndrome. A person with a gene mutation, whether showing serious symptoms or not, has Alagille syndrome and can pass the gene mutation to a child.

Read more about how genetic conditions are inherited at the NLM's Genetics Home Reference website at www.ghr.nlm.nih.gov. </s>


Input: What are the symptoms of Alagille Syndrome ?

Output:
The signs and symptoms of Alagille syndrome and their severity vary, even among people in the same family sharing the same gene mutation.

Liver

In some people, problems in the liver may be the first signs and symptoms of the disorder. These signs and symptoms can occur in children and adults with Alagille syndrome, and in infants as early as the first 3 months of life.

Jaundice. Jaundicewhen the skin and whites of the eyes turn yellowis a result of the liver not removing bilirubin from the blood. Bilirubin is a reddish-yellow substance formed when hemoglobin breaks down. Hemoglobin is an iron-rich protein that gives blood its red color. Bilirubin is absorbed by the liver, processed, and released into bile. Blockage of the bile ducts forces bilirubin and other elements of bile to build up in the blood.

Jaundice may be difficult for parents and even health care providers to detect. Many healthy newborns have mild jaundice during the first 1 to 2 weeks of life due to an immature liver. This normal type of jaundice disappears by the second or third week of life, whereas the jaundice of Alagille syndrome deepens. Newborns with jaundice after 2 weeks of life should be seen by a health care provider to check for a possible liver problem.

Dark urine and gray or white stools. High levels of bilirubin in the blood that pass into the urine can make the urine darker, while stool lightens from a lack of bilirubin reaching the intestines. Gray or white bowel movements after 2 weeks of age are a reliable sign of a liver problem and should prompt a visit to a health care provider.

Pruritus. The buildup of bilirubin in the blood may cause itching, also called pruritus. Pruritus usually starts after 3 months of age and can be severe.

Xanthomas. Xanthomas are fatty deposits that appear as yellow bumps on the skin. They are caused by abnormally high cholesterol levels in the blood, common in people with liver disease. Xanthomas may appear anywhere on the body. However, xanthomas are usually found on the elbows, joints, tendons, knees, hands, feet, or buttocks.

Other Signs and Symptoms of Alagille Syndrome

Certain signs of Alagille syndrome are unique to the disorder, including those that affect the vertebrae and facial features.

Face. Many children with Alagille syndrome have deep-set eyes, a straight nose, a small and pointed chin, large ears, and a prominent, wide forehead. These features are not usually recognized until after infancy. By adulthood, the chin is more prominent.

Eyes. Posterior embryotoxon is a condition in which an opaque ring is present in the cornea, the transparent covering of the eyeball. The abnormality is common in people with Alagille syndrome, though it usually does not affect vision.

Skeleton. The most common skeletal defect in a person with Alagille syndrome is when the shape of the vertebraebones of the spinegives the appearance of flying butterflies. This defect, known as "butterfly" vertebrae, rarely causes medical problems or requires treatment.

Heart and blood vessels. People with Alagille syndrome may have the following signs and symptoms having to do with the heart and blood vessels:

- heart murmuran extra or unusual sound heard during a heartbeat. A heart murmur is the most common sign of Alagille syndrome other than the general symptoms of liver disease.1 Most people with Alagille syndrome have a narrowing of the blood vessels that carry blood from the heart to the lungs.1 This narrowing causes a murmur that can be heard with a stethoscope. Heart murmurs usually do not cause problems.  - heart walls and valve problems. A small number of people with Alagille syndrome have serious problems with the walls or valves of the heart. These conditions may need treatment with medications or corrective surgery.  - blood vessel problems. People with Alagille syndrome may have abnormalities of the blood vessels in the head and neck. This serious complication can lead to internal bleeding or stroke. Alagille syndrome can also cause narrowing or bulging of other blood vessels in the body.

Kidney disease. A wide range of kidney diseases can occur in Alagille syndrome. The kidneys are two bean-shaped organs, each about the size of a fist, that filter wastes and extra fluid from the blood. Some people have small kidneys or have cystsfluid-filled sacsin the kidneys. Kidney function can also decrease. </s>


Input: What are the complications of Alagille Syndrome ?

Output:
The complications of Alagille syndrome include liver failure, portal hypertension, and growth problems. People with Alagille syndrome usually have a combination of complications, and may not have every complication listed below.

Liver failure. Over time, the decreased number of bile ducts may lead to chronic liver failure, also called end-stage liver disease. This condition progresses over months, years, or even decades. The liver can no longer perform important functions or effectively replace damaged cells. A person may need a liver transplant. A liver transplant is surgery to remove a diseased or an injured liver and replace it with a healthy whole liver or a segment of a liver from another person, called a donor.

Portal hypertension. The spleen is the organ that cleans blood and makes white blood cells. White blood cells attack bacteria and other foreign cells. Blood flow from the spleen drains directly into the liver. When a person with Alagille syndrome has advanced liver disease, the blood flow backs up into the spleen and other blood vessels. This condition is called portal hypertension. The spleen may become larger in the later stages of liver disease. A person with an enlarged spleen should avoid contact sports to protect the organ from injury. Advanced portal hypertension can lead to serious bleeding problems.

Growth problems. Alagille syndrome can lead to poor growth in infants and children, as well as delayed puberty in older children. Liver disease can cause malabsorption, which can result in growth problems. Malabsorption is the inability of the small intestine to absorb nutrients from foods, which results in protein, calorie, and vitamin deficiencies. Serious heart problems, if present in Alagille syndrome, can also affect growth.

Malabsorption. People with Alagille syndrome may have diarrhealoose, watery stoolsdue to malabsorption. The condition occurs because bile is necessary for the digestion of food. Malabsorption can lead to bone fractures, eye problems, blood-clotting problems, and learning delays.

Long-term Outlook

The long-term outlook for people with Alagille syndrome depends on several factors, including the severity of liver damage and heart problems. Predicting who will experience improved bile flow and who will progress to chronic liver failure is difficult. Ten to 30 percent of people with Alagille syndrome will eventually need a liver transplant.3

Many adults with Alagille syndrome whose symptoms improve with treatment lead normal, productive lives. Deaths in people with Alagille syndrome are most often caused by chronic liver failure, heart problems, and blood vessel problems. </s>


Input: How to diagnose Alagille Syndrome ?

Output:
A health care provider diagnoses Alagille syndrome by performing a thorough physical exam and ordering one or more of the following tests and exams:

- blood test  - urinalysis  - x ray  - abdominal ultrasound  - cardiology exam  - slit-lamp exam  - liver biopsy  - genetic testing

Alagille syndrome can be difficult to diagnose because the signs and symptoms vary and the syndrome is so rare.

For a diagnosis of Alagille syndrome, three of the following symptoms typically should be present:

- liver symptoms, such as jaundice, pruritus, malabsorption, and xanthomas  - heart abnormalities or murmurs  - skeletal abnormalities  - posterior embryotoxon  - facial features typical of Alagille syndrome  - kidney disease  - blood vessel problems

A health care provider may perform a liver biopsy to diagnose Alagille syndrome; however, it is not necessary to make a diagnosis. A diagnosis can be made in a person who does not meet the clinical criteria of Alagille syndrome yet does have a gene mutation of JAG1. The health care provider may have a blood sample tested to look for the JAG1 gene mutation. The gene mutation can be identified in 94 percent of people with a diagnosis of Alagille syndrome.2

Blood test. A blood test involves drawing blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. The blood test can show nutritional status and the presence of liver disease and kidney function.

Urinalysis. Urinalysis is the testing of a urine sample. The urine sample is collected in a special container in a health care provider's office or a commercial facility and can be tested in the same location or sent to a lab for analysis. Urinalysis can show many problems of the urinary tract and other body systems. The sample may be observed for color, cloudiness, or concentration; signs of drug use; chemical composition, including glucose; the presence of protein, blood cells, or bacteria; or other signs of disease.

X ray. An x ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. An x-ray technician performs the x ray at a hospital or an outpatient center, and a radiologista doctor who specializes in medical imaginginterprets the images. Anesthesia is not needed. The patient will lie on a table or stand during the x ray. The technician positions the x-ray machine over the spine area to look for "butterfly" vertebrae. The patient will hold his or her breath as the picture is taken so that the picture will not be blurry. The patient may be asked to change position for additional pictures.

Abdominal ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The transducer can be moved to different angles to make it possible to examine different organs. In abdominal ultrasound, the health care provider applies a gel to the patient's abdomen and moves a handheld transducer over the skin. The gel allows the transducer to glide easily, and it improves the transmission of the signals. A specially trained technician performs the procedure in a health care provider's office, an outpatient center, or a hospital, and a radiologist interprets the images; anesthesia is not needed. The images can show an enlarged liver or rule out other conditions.

Cardiology exam. A cardiologista doctor who treats people who have heart problemsperforms a cardiology exam in a health care provider's office, an outpatient center, or a hospital. During a full exam, a cardiologist may inspect the patient's physical appearance, measure pulse rate and blood pressure, observe the jugular vein, check for rapid or skipped heartbeats, listen for variations in heart sounds, and listen to the lungs.

Slit-lamp exam. An ophthalmologista doctor who diagnoses and treats all eye diseases and eye disordersperforms a slit-lamp exam to diagnose posterior embryotoxon. The ophthalmologist examines the eye with a slit lamp, a microscope combined with a high-intensity light that shines a thin beam on the eye. While sitting in a chair, the patient will rest his or her head on the slit lamp. A yellow dye may be used to examine the cornea and tear layer. The dye is applied as a drop, or the specialist may touch a strip of paper stained with the dye to the white of the patient's eye. The specialist will also use drops in the patient's eye to dilate the pupil.

Liver biopsy. A liver biopsy is a procedure that involves taking a piece of liver tissue for examination with a microscope for signs of damage or disease. The health care provider may ask the patient to stop taking certain medications temporarily before the liver biopsy. The patient may be asked to fast for 8 hours before the procedure.

During the procedure, the patient lies on a table, right hand resting above the head. A local anesthetic is applied to the area where the biopsy needle will be inserted. If needed, sedatives and pain medication are also given. The health care provider uses a needle to take a small piece of liver tissue. The health care provider may use ultrasound, computerized tomography scans, or other imaging techniques to guide the needle. After the biopsy, the patient should lie on the right side for up to 2 hours and is monitored an additional 2 to 4 hours before being sent home.

Genetic testing. The health care provider may refer a person suspected of having Alagille syndrome to a geneticista doctor who specializes in genetic disorders. For a genetic test, the geneticist takes a blood or saliva sample and analyzes the DNA for the JAG1 gene mutation. The geneticist tests for the JAG1 gene mutation first, since it is more common in Alagille syndrome than NOTCH2. Genetic testing is often done only by specialized labs. The results may not be available for several months because of the complexity of the testing.

The usefulness of genetic testing for Alagille syndrome is limited by two factors:

- Detection of a mutated gene cannot predict the onset of symptoms or how serious the disorder will be.  - Even if a mutated gene is found, no specific cure for the disorder exists.

When to Consider Genetic Counseling   People who are considering genetic testing may want to consult a genetics counselor. Genetic counseling can help family members understand how test results may affect them individually and as a family. Genetic counseling is provided by genetics professionalshealth care professionals with specialized degrees and experience in medical genetics and counseling. Genetics professionals include geneticists, genetics counselors, and genetics nurses.   Genetics professionals work as members of health care teams, providing information and support to individuals or families who have genetic disorders or a higher chance of having an inherited condition. Genetics professionals   - assess the likelihood of a genetic disorder by researching a family's history, evaluating medical records, and conducting a physical exam of the patient and other family members   - weigh the medical, social, and ethical decisions surrounding genetic testing   - provide support and information to help a person make a decision about testing   - interpret the results of genetic tests and medical data   - provide counseling or refer individuals and families to support services   - serve as patient advocates   - explain possible treatments or preventive measures   - discuss reproductive options    Genetic counseling may be useful when a family member is deciding whether to have genetic testing and again later when test results are available. </s>


Input: What are the treatments for Alagille Syndrome ?

Output:
Treatment for Alagille syndrome includes medications and therapies that increase the flow of bile from the liver, promote growth and development in infants' and children's bodies, correct nutritional deficiencies, and reduce the person's discomfort. Ursodiol (Actigall, Urso) is a medication that increases bile flow. Other treatments address specific symptoms of the disorder.

Liver failure. People with Alagille syndrome who develop end-stage liver failure need a liver transplant with a whole liver from a deceased donor or a segment of a liver from a living donor. People with Alagille syndrome who also have heart problems may not be candidates for a transplant because they could be more likely to have complications during and after the procedure. A liver transplant surgical team performs the transplant in a hospital.

More information is provided in the NIDDK health topic, Liver Transplantation.

Pruritus. Itching may decrease when the flow of bile from the liver is increased. Medications such as cholestyramine (Prevalite), rifampin (Rifadin, Rimactane), naltrexone (Vivitrol), or antihistamines may be prescribed to relieve pruritus. People should hydrate their skin with moisturizers and keep their fingernails trimmed to prevent skin damage from scratching. People with Alagille syndrome should avoid baths and take short showers to prevent the skin from drying out.

If severe pruritus does not improve with medication, a procedure called partial external biliary diversion may provide relief from itching. The procedure involves surgery to connect one end of the small intestine to the gallbladder and the other end to an opening in the abdomencalled a stomathrough which bile leaves the body and is collected in a pouch. A surgeon performs partial external biliary diversion in a hospital. The patient will need general anesthesia.

Malabsorption and growth problems. Infants with Alagille syndrome are given a special formula that helps the small intestine absorb much-needed fat. Infants, children, and adults can benefit from a high-calorie diet, calcium, and vitamins A, D, E, and K. They may also need additional zinc. If someone with Alagille syndrome does not tolerate oral doses of vitamins, a health care provider may give the person injections for a period of time. A child may receive additional calories through a tiny tube that is passed through the nose into the stomach. If extra calories are needed for a long time, a health care provider may place a tube, called a gastrostomy tube, directly into the stomach through a small opening made in the abdomen. A child's growth may improve with increased nutrition and flow of bile from the liver.

Xanthomas. For someone who has Alagille syndrome, these fatty deposits typically worsen over the first few years of life and then improve over time. They may eventually disappear in response to partial external biliary diversion or the medications used to increase bile flow. </s>


Input: How to prevent Alagille Syndrome ?

Output: Scientists have not yet found a way to prevent Alagille syndrome. However, complications of the disorder can be managed with the help of health care providers. Routine visits with a health care team are needed to prevent complications from becoming worse. </s>


Input: What to do for Alagille Syndrome ?

Output:
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Alagille syndrome. However, these factors are important for people with Alagille syndrome, particularly children, who are malnourished, growing poorly, or have delayed puberty. Caregivers and parents of children with Alagille syndrome should try to maximize their children's potential for growth through good eating, diet, and nutrition.

A nutritionist or a dietitiana person with training in nutrition and dietcan work with someone with Alagille syndrome and his or her health care team to build an appropriate healthy eating plan. A person with Alagille syndrome may need to take dietary supplements or vitamins in addition to eating a set number of calories, based on the type of complications the person has. Researchers consider good nutrition to be one of the most important aspects of managing the disorder.

If potential liver problems are present, a person with Alagille syndrome should not drink alcoholic beverages without talking with his or her health care provider first.

Additionally, eating, diet, and nutrition play a part in overall health and preventing further health problems. </s>


Input: What to do for Alagille Syndrome ?

Output: - Alagille syndrome is a genetic condition that results in various symptoms in different parts of the body, including the liver.  - A person with Alagille syndrome has fewer than the normal number of small bile ducts inside the liver.  - In people with Alagille syndrome, the decreased number of bile ducts causes bile to build up in the liver, a condition also called cholestasis, leading to liver damage and liver disease.  - Alagille syndrome is caused by a gene mutation, or defect. Approximately 30 to 50 percent of people with Alagille syndrome have an inherited gene mutation, meaning it has been passed on by a parent.  - Alagille syndrome occurs in about one of every 30,000 live births. The disorder affects both sexes equally and shows no geographical, racial, or ethnic preferences.  - The gene mutations that cause Alagille syndrome may cause mild or subtle symptoms. Some people may not know they are affected.  - The signs and symptoms of Alagille syndrome and their severity vary, even among people in the same family sharing the same gene mutation.  - In some people, problems in the liver may be the first signs and symptoms of the disorder.  - The complications of Alagille syndrome include liver failure, portal hypertension, and growth problems.  - Ten to 30 percent of people with Alagille syndrome will eventually need a liver transplant.  - A health care provider diagnoses Alagille syndrome by performing a thorough physical exam and other tests.  - Genetic counseling can help family members understand how genetic test results may affect them individually and as a family.  - Treatment for Alagille syndrome includes medications and therapies that increase the flow of bile from the liver, promote growth and development in infants' and children's bodies, correct nutritional deficiencies, and reduce the person's discomfort.  - Scientists have not yet found a way to prevent Alagille syndrome.  - Caregivers and parents of children with Alagille syndrome should try to maximize their children's potential for growth through good eating, diet, and nutrition. </s>


Input: What is (are) Prevent diabetes problems: Keep your heart and blood vessels healthy ?

Output:
Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes, the leading causes of death for people with diabetes. You can do a lot to prevent or slow down diabetes problems.

This booklet is about heart and blood vessel problems caused by diabetes. You will learn the things you can do each day and during each year to stay healthy and prevent diabetes problems. </s>


Input: How to prevent Prevent diabetes problems: Keep your heart and blood vessels healthy ?

Output:
You can do a lot to prevent heart disease and stroke.

- Keep your blood glucose under control. You can see if your blood glucose is under control by having an A1C test at least twice a year. The A1C test tells you your average blood glucose for the past 2 to 3 months. The target for most people with diabetes is below 7. In some people with heart disease or other special circumstances, their doctor may recommend slightly higher levels of A1C.  - Keep your blood pressure under control. Have it checked at every doctor visit. The target for most people with diabetes is below 140/80, unless their doctor sets a different target.  - Keep your cholesterol under control. Have it checked at least once a year. The targets for most people with diabetes are      - LDLbadcholesterol: below 100    - HDLgoodcholesterol: above 40 in men and above 50 in women    - triglyceridesanother type of fat in the blood: below 150    - Make sure the foods you eat are "heart-healthy." Include foods high in fiber, such as oat bran, oatmeal, whole-grain breads and cereals, fruits, and vegetables. Cut back on foods high in saturated fat or cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil. Limit foods with trans fat, such as snack foods and commercial baked goods.  - If you smoke, quit. Your doctor can tell you about ways to help you quit smoking.  - Ask your doctor whether you should take an aspirin every day. Studies have shown that taking a low dose of aspirin every day can help reduce your risk of heart disease and stroke.  - Take your medicines as directed. </s>


Input: What are the symptoms of Prevent diabetes problems: Keep your heart and blood vessels healthy ?

Output:
You may have one or more of the following warning signs:

- chest pain or discomfort  - pain or discomfort in your arms, back, jaw, or neck  - indigestion or stomach pain  - shortness of breath  - sweating  - nausea  - light-headedness

Or, you may have no warning signs at all. Warning signs may come and go. If you have any of these warning signs, call 911 right away. Getting prompt treatment can reduce damage to the heart. </s>


Input: What causes Prevent diabetes problems: Keep your heart and blood vessels healthy ?

Output:
Narrowed blood vessels leave a smaller opening for blood to flow through. Having narrowed blood vessels is like turning on a garden hose and holding your thumb over the opening. The smaller opening makes the water shoot out with more pressure. In the same way, narrowed blood vessels lead to high blood pressure. Other factors, such as kidney problems and being overweight, also can lead to high blood pressure.

Many people with diabetes also have high blood pressure. If you have heart, eye, or kidney problems from diabetes, high blood pressure can make them worse.

You will see your blood pressure written with two numbers separated by a slash. For example, your reading might be 120/70, said as "120 over 70." For most people with diabetes, the target is to keep the first number below 140 and the second number below 80, unless their doctor sets a different target.

If you have high blood pressure, ask your doctor how to lower it. Your doctor may ask you to take blood pressure medicine every day. Some types of blood pressure medicine can also help keep your kidneys healthy.

You may also be able to control your blood pressure by

- eating more fruits and vegetables  - eating less salt and high-sodium foods  - losing weight if you need to  - being physically active  - not smoking  - limiting alcoholic drinks </s>


Input: What are the symptoms of Prevent diabetes problems: Keep your heart and blood vessels healthy ?

Output:
A stroke happens when part of your brain is not getting enough blood and stops working. Depending on the part of the brain that is damaged, a stroke can cause

- sudden weakness or numbness of your face, arm, or leg on one side of your body  - sudden confusion, trouble talking, or trouble understanding  - sudden dizziness, loss of balance, or trouble walking  - sudden trouble seeing in one or both eyes or sudden double vision  - sudden severe headache

Sometimes, one or more of these warning signs may happen and then disappear. You might be having a "mini-stroke," also called a TIA or a transient ischemic attack. If you have any of these warning signs, call 911 right away. Getting care for a TIA may reduce or prevent a stroke. Getting prompt treatment for a stroke can reduce the damage to the brain and improve chances for recovery. </s>


Input: How to prevent Prevent diabetes problems: Keep your heart and blood vessels healthy ?

Output:
- Don't smoke.  - Keep blood glucose and blood pressure under control.  - Keep blood fats close to normal.  - Be physically active.  - Ask your doctor if you should take aspirin every day.

You also may need surgery to treat PAD. </s>


Input: What is (are) Primary Hyperparathyroidism ?

Output:
Primary hyperparathyroidism is a disorder of the parathyroid glands, also called parathyroids. Primary means this disorder originates in the parathyroid glands. In primary hyperparathyroidism, one or more of the parathyroid glands are overactive. As a result, the gland releases too much parathyroid hormone (PTH). The disorder includes the problems that occur in the rest of the body as a result of too much PTHfor example, loss of calcium from bones.

In the United States, about 100,000 people develop primary hyperparathyroidism each year.1 The disorder is diagnosed most often in people between age 50 and 60, and women are affected about three times as often as men.2

Secondary, or reactive, hyperparathyroidism can occur if a problem such as kidney failure causes the parathyroid glands to be overactive. </s>


Input: What is (are) Primary Hyperparathyroidism ?

Output:
The parathyroid glands are four pea-sized glands located on or near the thyroid gland in the neck. Occasionally, a person is born with one or more of the parathyroid glands in another location. For example, a gland may be embedded in the thyroid, in the thymusan immune system organ located in the chestor elsewhere around this area. In most such cases, however, the parathyroid glands function normally.

The parathyroid glands are part of the bodys endocrine system. Endocrine glands produce, store, and release hormones, which travel in the bloodstream to target cells elsewhere in the body and direct the cells activity.

Though their names are similar, the thyroid and parathyroid glands are entirely different glands, each producing distinct hormones with specific functions. The parathyroid glands produce PTH, a hormone that helps maintain the correct balance of calcium in the body. PTH regulates the level of calcium in the blood, release of calcium from bone, absorption of calcium in the small intestine, and excretion of calcium in the urine.

When the level of calcium in the blood falls too low, normal parathyroid glands release just enough PTH to restore the blood calcium level. </s>


Input: What is (are) Primary Hyperparathyroidism ?

Output:
High PTH levels trigger the bones to release increased amounts of calcium into the blood, causing blood calcium levels to rise above normal. The loss of calcium from bones may weaken the bones. Also, the small intestine may absorb more calcium from food, adding to the excess calcium in the blood. In response to high blood calcium levels, the kidneys excrete more calcium in the urine, which can lead to kidney stones.

High blood calcium levels might contribute to other problems, such as heart disease, high blood pressure, and difficulty with concentration. However, more research is needed to better understand how primary hyperparathyroidism affects the cardiovascular systemthe heart and blood vesselsand the central nervous systemthe brain and spinal cord. </s>


Input: What causes Primary Hyperparathyroidism ?

Output:
In about 80 percent of people with primary hyperparathyroidism, a benign, or noncancerous, tumor called an adenoma has formed in one of the parathyroid glands.2 The tumor causes the gland to become overactive. In most other cases, the excess hormone comes from two or more overactive parathyroid glands, a condition called multiple tumors or hyperplasia. Rarely, primary hyperparathyroidism is caused by cancer of a parathyroid gland.

In most cases, health care providers dont know why adenoma or multiple tumors occur in the parathyroid glands. Most people with primary hyperparathyroidism have no family history of the disorder, but some cases can be linked to an inherited problem. For example, familial multiple endocrine neoplasia type 1 is a rare, inherited syndrome that causes multiple tumors in the parathyroid glands as well as in the pancreas and the pituitary gland. Another rare genetic disorder, familial hypocalciuric hypercalcemia, causes a kind of hyperparathyroidism that is atypical, in part because it does not respond to standard parathyroid surgery. </s>


Input: What are the symptoms of Primary Hyperparathyroidism ?

Output:
Most people with primary hyperparathyroidism have no symptoms. When symptoms appear, they are often mild and nonspecific, such as

- muscle weakness  - fatigue and an increased need for sleep  - feelings of depression  - aches and pains in bones and joints

People with more severe disease may have

- loss of appetite  - nausea  - vomiting  - constipation  - confusion or impaired thinking and memory  - increased thirst and urination

These symptoms are mainly due to the high blood calcium levels that result from excessive PTH. </s>


Input: How to diagnose Primary Hyperparathyroidism ?

Output:
Health care providers diagnose primary hyperparathyroidism when a person has high blood calcium and PTH levels. High blood calcium is usually the first sign that leads health care providers to suspect parathyroid gland overactivity. Other diseases can cause high blood calcium levels, but only in primary hyperparathyroidism is the elevated calcium the result of too much PTH.

Routine blood tests that screen for a wide range of conditions, including high blood calcium levels, are helping health care providers diagnose primary hyperparathyroidism in people who have mild forms of the disorder and are symptom-free. For a blood test, blood is drawn at a health care providers office or commercial facility and sent to a lab for analysis. </s>


Input: How to diagnose Primary Hyperparathyroidism ?

Output:
Once the diagnosis of primary hyperparathyroidism is established, other tests may be done to assess complications:

- Bone mineral density test. Dual energy x-ray absorptiometry, sometimes called a DXA or DEXA scan, uses low-dose x rays to measure bone density. During the test, a person lies on a padded table while a technician moves the scanner over the persons body. DXA scans are performed in a health care providers office, outpatient center, or hospital by a specially trained technician and may be interpreted by a metabolic bone disease expert or radiologista doctor who specializes in medical imagingor other specialists; anesthesia is not needed. The test can help assess bone loss and risk of fractures.  - Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show the presence of kidney stones.  - Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. A CT scan may include the injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist; anesthesia is not needed. CT scans can show the presence of kidney stones.  - Urine collection. A 24-hour urine collection may be done to measure selected chemicals, such as calcium and creatinine, which is a waste product healthy kidneys remove. The person collects urine over a 24-hour period, and the urine is sent to a laboratory for analysis. The urine collection may provide information on kidney damage, the risk of kidney stone formation, and the risk of familial hypocalciuric hypercalcemia.  - 25-hydroxy-vitamin D blood test. This test is recommended because vitamin D deficiency is common in people with primary hyperparathyroidism. </s>


Input: What are the treatments for Primary Hyperparathyroidism ?

Output:
Surgery

Surgery to remove the overactive parathyroid gland or glands is the only definitive treatment for the disorder, particularly if the patient has a very high blood calcium level or has had a fracture or a kidney stone. In patients without any symptoms, guidelines are used to identify who might benefit from parathyroid surgery.3

When performed by experienced endocrine surgeons, surgery cures primary hyperparathyroidism in more than 95 percent of operations.2

Surgeons often use imaging tests before surgery to locate the overactive gland to be removed. The most commonly used tests are sestamibi and ultrasound scans. In a sestamibi scan, the patient receives an injection of a small amount of radioactive dye that is absorbed by overactive parathyroid glands. The overactive glands can then be viewed using a special camera.

Surgeons use two main strategies to remove the overactive gland or glands:

- Minimally invasive parathyroidectomy. This type of surgery, which can be done on an outpatient basis, may be used when only one of the parathyroid glands is likely to be overactive. Guided by a tumor-imaging test, the surgeon makes a small incision in the neck to remove the gland. The small incision means that patients typically have less pain and a quicker recovery than with more invasive surgery. Local or general anesthesia may be used for this type of surgery.  - Standard neck exploration. This type of surgery involves a larger incision that allows the surgeon to access and examine all four parathyroid glands and remove the overactive ones. This type of surgery is more extensive and typically requires a hospital stay of 1 to 2 days. Surgeons use this approach if they plan to inspect more than one gland. General anesthesia is used for this type of surgery.

Almost all people with primary hyperparathyroidism who have symptoms can benefit from surgery. Experts believe that those without symptoms but who meet guidelines for surgery will also benefit from surgery. Surgery can lead to improved bone density and fewer fractures and can reduce the chance of forming kidney stones. Other potential benefits are being studied by researchers.

Surgery for primary hyperparathyroidism has a complication rate of 13 percent when performed by experienced endocrine surgeons.4 Rarely, patients undergoing surgery experience damage to the nerves controlling the vocal cords, which can affect speech. A small number of patients lose all their healthy parathyroid tissue and thus develop chronic low calcium levels, requiring lifelong treatment with calcium and some form of vitamin D. This complication is called hypoparathyroidism. The complication rate is slightly higher for operations on multiple tumors than for a single adenoma because more extensive surgery is needed.

People with primary hyperparathyroidism due to familial hypocalciuric hypercalcemia should not have surgery.

Monitoring

Some people who have mild primary hyperparathyroidism may not need immediate or even any surgery and can be safely monitored. People may wish to talk with their health care provider about long-term monitoring if they

- are symptom-free  - have only slightly elevated blood calcium levels  - have normal kidneys and bone density

Long-term monitoring should include periodic clinical evaluations, annual serum calcium measurements, annual serum creatinine measurements to check kidney function, and bone density measurements every 1 to 2 years.

Vitamin D deficiency should be corrected if present. Patients who are monitored need not restrict calcium in their diets.

If the patient and health care provider choose long-term monitoring, the patient should

- drink plenty of water  - exercise regularly  - avoid certain diuretics, such as thiazides

Either immobilizationthe inability to move due to illness or injuryor gastrointestinal illness with vomiting or diarrhea that leads to dehydration can cause blood calcium levels to rise further in someone with primary hyperparathyroidism. People with primary hyperparathyroidism should seek medical attention if they find themselves immobilized or dehydrated due to vomiting or diarrhea.

Medications

Calcimimetics are a new class of medications that decrease parathyroid gland secretion of PTH. The calcimimetic, cinacalcet (Sensipar), has been approved by the U.S. Food and Drug Administration for the treatment of secondary hyperparathyroidism caused by dialysisa blood-filtering treatment for kidney failureand primary hyperparathyroidism caused by parathyroid cancer. Cinacalcet has also been approved for the management of hypercalcemia associated with primary hyperparathyroidism.

A number of other medications are being studied to learn whether they may be helpful in treating primary hyperparathyroidism. These medications include bisphosphonates and selective estrogen receptor modulators. </s>


Input: What to do for Primary Hyperparathyroidism ?

Output:
Eating, diet, and nutrition have not been shown to play a role in causing or preventing primary hyperparathyroidism.

Vitamin D. Experts suggest correcting vitamin D deficiency in people with primary hyperparathyroidism to achieve a serum level of 25-hydroxy-vitamin D greater than 20 nanograms per deciliter (50 nanomoles per liter). Research is ongoing to determine optimal doses and regimens of vitamin D supplementation for people with primary hyperparathyroidism.

For the healthy public, the Institute of Medicine (IOM) guidelines for vitamin D intake are

- people ages 1 to 70 years may require 600 International Units (IUs)  - people age 71 and older may require as much as 800 IUs

The IOM also recommends that no more than 4,000 IUs of vitamin D be taken per day.

Calcium. People with primary hyperparathyroidism without symptoms who are being monitored do not need to restrict calcium in their diet. People with low calcium levels due to loss of all parathyroid tissue from surgery will need to take calcium supplements for the rest of their life.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medicine practices, including their use of dietary supplements, with their health care provider. Tips for talking with health care providers are available through the National Center for Complementary and Integrative Health. </s>


Input: What to do for Primary Hyperparathyroidism ?

Output: - Primary hyperparathyroidism is a disorder of the parathyroid glands, in which one or more of the parathyroid glands are overactive. As a result, the gland releases too much parathyroid hormone (PTH).  - High PTH levels trigger the bones to release increased calcium into the blood, causing blood calcium levels to rise above normal. T he loss of calcium from bones may weaken the bones. In response to high blood calcium levels, the kidneys excrete more calcium in the urine, which can lead to kidney stones.  - Most people with primary hyperparathyroidism have no symptoms. When symptoms appear, they are often mild and nonspecific, such as muscle weakness, fatigue, increased need for sleep, feelings of depression, or aches and pains in bones and joints.  - People with more severe primary hyperparathyroidism may have symptoms such as loss of appetite, nausea, vomiting, constipation, confusion or impaired thinking and memory, and increased thirst and urination.  - Health care providers diagnose primary hyperparathyroidism when a person has high blood calcium and PTH levels.  - Surgery to remove the overactive parathyroid gland or glands is the only definitive treatment for the disorder. When performed by experienced endocrine surgeons, surgery cures primary hyperparathyroidism in more than 95 percent of operations. Some people who have mild primary hyperparathyroidism may not need immediate or even any surgery and can be safely monitored. People with primary hyperparathyroidism due to familial hypocalciuric hypercalcemia should not have surgery. </s>


Input: What is (are) Urinary Incontinence in Men ?

Output:
Urinary incontinence is the loss of bladder control, resulting in the accidental leakage of urine from the body. For example, a man may feel a strong, sudden need, or urgency, to urinate just before losing a large amount of urine, called urgency incontinence.

UI can be slightly bothersome or totally debilitating. For some men, the chance of embarrassment keeps them from enjoying many activities, including exercising, and causes emotional distress. When people are inactive, they increase their chances of developing other health problems, such as obesity and diabetes. </s>