Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Potassium is a mineral found in many foods, especially milk, fruits, and vegetables. It affects how steadily your heart beats. Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. Potassium levels can rise between dialysis sessions and affect your heartbeat. Eating too much potassium can be very dangerous to your heart. It may even cause death.

To control potassium levels in your blood, avoid foods like avocados, bananas, kiwis, and dried fruit, which are very high in potassium. Also, eat smaller portions of other high-potassium foods. For example, eat half a pear instead of a whole pear. Eat only very small portions of oranges and melons.

Dicing and Boiling Potatoes to Reduce Potassium   You can remove some of the potassium from potatoes by dicing or shredding them and then boiling them in water. Your dietitian will give you more specific information about the potassium content of foods.

Talk With a Dietitian   Make a food plan that reduces the potassium in your diet. Start by noting the high-potassium foods (below) that you now eat. A dietitian can help you add other foods to the list.           High-Potassium Foods               apricots avocados bananas beets Brussels sprouts cantaloupe clams dates figs     kiwi fruit lima beans melons milk nectarines orange juice oranges peanuts pears (fresh)     potatoes prune juice prunes raisins sardines spinach tomatoes winter squash yogurt         Others:______________________________________   Changes:   Talk with a dietitian about foods you can eat instead of high-potassium foods.   Instead of _________, I will eat _________.   Instead of _________, I will eat _________.   Instead of _________, I will eat _________.   Instead of _________, I will eat _________. </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Potassium is a mineral found in many foods, especially milk, fruits, and vegetables. It affects how steadily your heart beats. Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. Potassium levels can rise between dialysis sessions and affect your heartbeat. Eating too much potassium can be very dangerous to your heart. It may even cause death.

To control potassium levels in your blood, avoid foods like avocados, bananas, kiwis, and dried fruit, which are very high in potassium. Also, eat smaller portions of other high-potassium foods. For example, eat half a pear instead of a whole pear. Eat only very small portions of oranges and melons.

Dicing and Boiling Potatoes to Reduce Potassium   You can remove some of the potassium from potatoes by dicing or shredding them and then boiling them in water. Your dietitian will give you more specific information about the potassium content of foods.

Talk With a Dietitian   Make a food plan that reduces the potassium in your diet. Start by noting the high-potassium foods (below) that you now eat. A dietitian can help you add other foods to the list.           High-Potassium Foods               apricots avocados bananas beets Brussels sprouts cantaloupe clams dates figs     kiwi fruit lima beans melons milk nectarines orange juice oranges peanuts pears (fresh)     potatoes prune juice prunes raisins sardines spinach tomatoes winter squash yogurt         Others:______________________________________   Changes:   Talk with a dietitian about foods you can eat instead of high-potassium foods.   Instead of _________, I will eat _________.   Instead of _________, I will eat _________.   Instead of _________, I will eat _________.   Instead of _________, I will eat _________. </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Phosphorus is a mineral found in many foods. If you have too much phosphorus in your blood, it pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Also, too much phosphorus may make your skin itch. Foods like milk and cheese, dried beans, peas, colas, nuts, and peanut butter are high in phosphorus. Usually, people on dialysis are limited to 1/2 cup of milk per day. The renal dietitian will give you more specific information regarding phosphorus.

You probably will need to take a phosphate binder like Renagel, PhosLo, Tums, or calcium carbonate to control the phosphorus in your blood between dialysis sessions. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is passed out of the body in the stool. </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Phosphorus is a mineral found in many foods. If you have too much phosphorus in your blood, it pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Also, too much phosphorus may make your skin itch. Foods like milk and cheese, dried beans, peas, colas, nuts, and peanut butter are high in phosphorus. Usually, people on dialysis are limited to 1/2 cup of milk per day. The renal dietitian will give you more specific information regarding phosphorus.

You probably will need to take a phosphate binder like Renagel, PhosLo, Tums, or calcium carbonate to control the phosphorus in your blood between dialysis sessions. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is passed out of the body in the stool. </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Before you were on dialysis, your doctor may have told you to follow a low-protein diet. Being on dialysis changes this. Most people on dialysis are encouraged to eat as much high-quality protein as they can. Protein helps you keep muscle and repair tissue. The better nourished you are, the healthier you will be. You will also have greater resistance to infection and recover from surgery more quickly.

Your body breaks protein down into a waste product called urea. If urea builds up in your blood, it's a sign you have become very sick. Eating mostly high-quality proteins is important because they produce less waste than others. High-quality proteins come from meat, fish, poultry, and eggs (especially egg whites).

Talk With a Dietitian   Meat, fish, and chicken are good sources of protein. Talk with a dietitian about the meats you eat.   I will eat ______ servings of meat each day. A regular serving size is 3 ounces. This is about the size of the palm of your hand or a deck of cards.   Try to choose lean (low-fat) meats that are also low in phosphorus. If you are a vegetarian, ask about other ways to get your protein.   Low-fat milk is a good source of protein. But milk is high in phosphorus and potassium. And milk adds to your fluid intake. Talk with a dietitian to see if milk fits into your food plan.   I (will) (will not) drink milk. I will drink ______ cup(s) of milk a day. </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Before you were on dialysis, your doctor may have told you to follow a low-protein diet. Being on dialysis changes this. Most people on dialysis are encouraged to eat as much high-quality protein as they can. Protein helps you keep muscle and repair tissue. The better nourished you are, the healthier you will be. You will also have greater resistance to infection and recover from surgery more quickly.

Your body breaks protein down into a waste product called urea. If urea builds up in your blood, it's a sign you have become very sick. Eating mostly high-quality proteins is important because they produce less waste than others. High-quality proteins come from meat, fish, poultry, and eggs (especially egg whites).

Talk With a Dietitian   Meat, fish, and chicken are good sources of protein. Talk with a dietitian about the meats you eat.   I will eat ______ servings of meat each day. A regular serving size is 3 ounces. This is about the size of the palm of your hand or a deck of cards.   Try to choose lean (low-fat) meats that are also low in phosphorus. If you are a vegetarian, ask about other ways to get your protein.   Low-fat milk is a good source of protein. But milk is high in phosphorus and potassium. And milk adds to your fluid intake. Talk with a dietitian to see if milk fits into your food plan.   I (will) (will not) drink milk. I will drink ______ cup(s) of milk a day. </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Sodium is found in salt and other foods. Most canned foods and frozen dinners contain large amounts of sodium. Too much sodium makes you thirsty. But if you drink more fluid, your heart has to work harder to pump the fluid through your body. Over time, this can cause high blood pressure and congestive heart failure.

Try to eat fresh foods that are naturally low in sodium Look for products labeled low sodium.

Do not use salt substitutes because they contain potassium. Talk with a dietitian about spices you can use to flavor your food. The dietitian can help you find spice blends without sodium or potassium.

Talk With a Dietitian   Talk with a dietitian about spices and other healthy foods you can use to flavor your diet. List them on the lines below.   Spice: _____________________________   Spice: _____________________________   Spice: _____________________________   Food: _____________________________   Food: _____________________________ </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Sodium is found in salt and other foods. Most canned foods and frozen dinners contain large amounts of sodium. Too much sodium makes you thirsty. But if you drink more fluid, your heart has to work harder to pump the fluid through your body. Over time, this can cause high blood pressure and congestive heart failure.

Try to eat fresh foods that are naturally low in sodium Look for products labeled low sodium.

Do not use salt substitutes because they contain potassium. Talk with a dietitian about spices you can use to flavor your food. The dietitian can help you find spice blends without sodium or potassium.

Talk With a Dietitian   Talk with a dietitian about spices and other healthy foods you can use to flavor your diet. List them on the lines below.   Spice: _____________________________   Spice: _____________________________   Spice: _____________________________   Food: _____________________________   Food: _____________________________ </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Calories provide energy for your body. If your doctor recommends it, you may need to cut down on the calories you eat. A dietitian can help you plan ways to cut calories in the best possible way.

Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils-like olive oil, canola oil, and safflower oil-are good sources of calories. Use them generously on breads, rice, and noodles.

Butter and margarines are rich in calories. But these fatty foods can also clog your arteries. Use them less often. Soft margarine that comes in a tub is better than stick margarine. Vegetable oils are the healthiest way to add fat to your diet if you need to gain weight.

Hard candy, sugar, honey, jam, and jelly provide calories and energy without clogging arteries or adding other things that your body does not need. If you have diabetes, be very careful about eating sweets. A dietitian's guidance is very important for people with diabetes. </s>


Input: What is (are) Kidney Failure: Eat Right to Feel Right on Hemodialysis ?

Output:
Calories provide energy for your body. If your doctor recommends it, you may need to cut down on the calories you eat. A dietitian can help you plan ways to cut calories in the best possible way.

Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils-like olive oil, canola oil, and safflower oil-are good sources of calories. Use them generously on breads, rice, and noodles.

Butter and margarines are rich in calories. But these fatty foods can also clog your arteries. Use them less often. Soft margarine that comes in a tub is better than stick margarine. Vegetable oils are the healthiest way to add fat to your diet if you need to gain weight.

Hard candy, sugar, honey, jam, and jelly provide calories and energy without clogging arteries or adding other things that your body does not need. If you have diabetes, be very careful about eating sweets. A dietitian's guidance is very important for people with diabetes. </s>


Input: What is (are) Ectopic Kidney ?

Output: An ectopic kidney is a birth defect in which a kidney is located below, above, or on the opposite side of its usual position. About one in 900 people has an ectopic kidney.1 </s>


Input: What is (are) Ectopic Kidney ?

Output: The kidneys are two bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. Every minute, a persons kidneys filter about 3 ounces of blood, removing wastes and extra water. The wastes and extra water make up the 1 to 2 quarts of urine a person produces each day. The urine flows to the bladder through tubes called ureters where it is stored until being released through urination. </s>


Input: What causes Ectopic Kidney ?

Output:
During fetal development, a babys kidneys first appear as buds inside the pelvisthe bowl-shaped bone that supports the spine and holds up the digestive, urinary, and reproductive organsnear the bladder. As the kidneys develop, they move gradually toward their usual position in the back near the rib cage. Sometimes, one of the kidneys remains in the pelvis or stops moving before it reaches its usual position. In other cases, the kidney moves higher than the usual position. Rarely does a child have two ectopic kidneys.

Most kidneys move toward the rib cage, but one may cross over so that both kidneys are on the same side of the body. When a crossover occurs, the two kidneys often grow together and become fused.

Factors that may lead to an ectopic kidney include

- poor development of a kidney bud  - a defect in the kidney tissue responsible for prompting the kidney to move to its usual position  - genetic abnormalities  - the mother being sick or being exposed to an agent, such as a drug or chemical, that causes birth defects </s>


Input: What are the symptoms of Ectopic Kidney ?

Output: An ectopic kidney may not cause any symptoms and may function normally, even though it is not in its usual position. Many people have an ectopic kidney and do not discover it until they have tests done for other reasons. Sometimes, a health care provider may discover an ectopic kidney after feeling a lump in the abdomen during an examination. In other cases, an ectopic kidney may cause abdominal pain or urinary problems. </s>


Input: What are the complications of Ectopic Kidney ?

Output:
Possible complications of an ectopic kidney include problems with urine drainage from that kidney. Sometimes, urine can even flow backwards from the bladder to the kidney, a problem called vesicoureteral reflux (VUR). More information about VUR is provided in the NIDDK health topic, Vesicoureteral Reflux.

Abnormal urine flow and the placement of the ectopic kidney can lead to various problems:

- Infection. Normally, urine flow washes out bacteria and keeps them from growing in the kidneys and urinary tract. When a kidney is out of the usual position, urine may get trapped in the ureter or in the kidney itself. Urine that remains in the urinary tract gives bacteria the chance to grow and spread. Symptoms of a urinary tract infection include frequent or painful urination, back or abdominal pain, fever, chills, and cloudy or foul-smelling urine.  - Stones. Urinary stones form from substances found in the urine, such as calcium and oxalate. When urine remains in the urinary tract for too long, the risk that these substances will have time to form stones is increased. Symptoms of urinary stones include extreme pain in the back, side, or pelvis; blood in the urine; fever or chills; vomiting; and a burning feeling during urination.  - Kidney damage. If urine backs up all the way to the kidney, damage to the kidney can occur. As a result, the kidney cant filter wastes and extra water from the blood. One ectopic kidney, even when it has no function, will not cause kidney failure. The other kidney can usually perform the functions of two healthy kidneys. Total kidney failure happens only in rare cases when both kidneys are damaged.  - Trauma. If the ectopic kidney is in the lower abdomen or pelvis, it may be susceptible to injury from blunt trauma. People with an ectopic kidney who want to participate in body contact sports may want to wear protective gear. </s>


Input: How to diagnose Ectopic Kidney ?

Output:
A health care provider may use one or more of the following imaging tests to diagnose an ectopic kidney:

- Ultrasound. An 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 radiologista doctor who specializes in medical imaging; anesthesia is not needed. The images can show the location of the kidneys.  - Intravenous pyelogram (IVP). An IVP is an x ray of the urinary tract. A special dye, called contrast medium, is injected into a vein in the persons arm, travels through the body to the kidneys, and makes urine visible on the x ray. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician, and the images are interpreted by a radiologist; anesthesia is not needed. An IVP can show a blockage in the urinary tract. In children, ultrasounds are usually done instead of IVPs.  - Voiding cystourethrogram (VCUG). A VCUG is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the x-ray images. The x-ray machine captures images of the contrast medium while the bladder is full and when the person urinates. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used for some people. The test can show abnormalities of the inside of the urethra and bladder and whether urine is backing up toward the kidneys during urination.  - Radionuclide scan. A radionuclide scan is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive chemicals. Because the dose of the radioactive chemicals is small, the risk of causing damage to cells is low. Special cameras and computers are used to create images of the radioactive chemicals as they pass through the kidneys. 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. This test can show the location of an ectopic kidney and whether the ureters are blocked.  - Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. An MRI may include the injection of contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines are designed to allow the person to lie in a more open space. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed though light sedation may be used for people with a fear of confined spaces. MRIs can show the location of the kidneys.

In addition to imaging tests, blood tests may be done to determine how well the kidneys are working. These tests are almost always normal in people with an ectopic kidney, even if it is badly damaged, because the other kidney usually has completely normal function. </s>


Input: What are the treatments for Ectopic Kidney ?

Output:
No treatment for an ectopic kidney is needed if urinary function is normal and no blockage of the urinary tract is present.

If tests show an obstruction, surgery may be needed to correct the position of the kidney to allow for better drainage of urine. Reflux can be corrected by surgery to alter the ureter or injection of a gellike liquid into the bladder wall near the opening of the ureter.

If extensive kidney damage has occurred, surgery may be needed to remove the kidney. As long as the other kidney is working properly, losing one kidney should have no adverse health effects. More information is provided in the NIDDK health topic, Solitary Kidney.

With the right testing and treatment, if needed, an ectopic kidney should cause no serious long-term health problems. </s>


Input: What to do for Ectopic Kidney ?

Output: Eating, diet, and nutrition have not been shown to play a role in causing or preventing an ectopic kidney. </s>


Input: What to do for Ectopic Kidney ?

Output: - An ectopic kidney is a birth defect in which a kidney is located below, above, or on the opposite side of its usual position.  - Factors that may lead to an ectopic kidney include      - poor development of a kidney bud    - a defect in the kidney tissue responsible for prompting the kidney to move to its usual position    - genetic abnormalities    - the mother being sick or being exposed to an agent, such as a drug or chemical, that causes birth defects    - An ectopic kidney may not cause any symptoms and may function normally, even though it is not in its usual position.  - Possible complications of an ectopic kidney include problems with urine drainage from that kidney. Abnormal urine flow and the placement of the ectopic kidney can lead to various problems such as infection, stones, kidney damage, and injury from trauma.  - No treatment for an ectopic kidney is needed if urinary function is normal and no blockage of the urinary tract is present. Surgery or other treatment may be needed if there is an obstruction, reflux, or extensive damage to the kidney. </s>


Input: What is (are) Viral Gastroenteritis ?

Output:
Viral gastroenteritis is inflammation of the lining of the stomach, small intestine, and large intestine. Several different viruses can cause viral gastroenteritis, which is highly contagious and extremely common. Viral gastroenteritis causes millions of cases of diarrhea each year.

Anyone can get viral gastroenteritis and most people recover without any complications, unless they become dehydrated. </s>


Input: What are the symptoms of Viral Gastroenteritis ?

Output:
The main symptoms of viral gastroenteritis are

- watery diarrhea  - vomiting

Other symptoms include

- headache  - fever  - chills  - abdominal pain

Symptoms usually appear within 12 to 48 hours after exposure to a gastroenteritis-causing virus and last for 1 to 3 days. Some viruses cause symptoms that last longer. </s>


Input: What are the complications of Viral Gastroenteritis ?

Output:
Dehydration is the most common complication of viral gastroenteritis. When someone does not drink enough fluids to replace those that are lost through vomiting and diarrhea, dehydration can result. When dehydrated, the body does not have enough fluids to keep the proper balance of important salts or minerals, known as electrolytes. Infants, young children, older adults, and people with weak immune systems have the greatest risk of becoming dehydrated.

The signs of dehydration in adults are

- excessive thirst  - infrequent urination  - dark-colored urine  - dry skin  - lethargy, dizziness, or faintness

Signs of dehydration in babies and young children are

- dry mouth and tongue  - lack of tears when crying  - no wet diapers for 3 hours or more  - high fever  - unusually cranky or drowsy behavior  - sunken eyes, cheeks, or soft spot in the skull

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

People should talk with a health care provider if they have

- blood in their stool, which may indicate a bacterial infection  - symptoms that are severe or last more than a few days  - symptoms of dehydration

Severe dehydration may require intravenous fluids and hospitalization. Untreated severe dehydration can cause serious health problems such as organ damage, shock, or comaa sleeplike state in which a person is not conscious. </s>


Input: What causes Viral Gastroenteritis ?

Output:
Four types of viruses cause most cases of viral gastroenteritis.

Rotavirus

Rotavirus is the leading cause of gastroenteritis among infants and young children. Rotavirus infections are most common in infants 3 to 15 months old. Symptoms usually appear 1 to 3 days after exposure. Rotavirus typically causes vomiting and watery diarrhea for 3 to 7 days, along with fever and abdominal pain. Rotavirus can also infect adults who are in close contact with infected children, but the symptoms in adults are milder.

Caliciviruses

Caliciviruses cause infection in people of all ages. Norovirus is the most common calicivirus and the most common cause of viral gastroenteritis in adults. Norovirus is usually responsible for epidemics of viral gastroenteritis. Norovirus outbreaks occur all year but are more frequent from October to April. People infected with norovirus typically experience nausea, vomiting, diarrhea, abdominal cramps, fatigue, headache, and muscle aches. The symptoms usually appear 1 to 2 days after exposure to the virus and last for 1 to 3 days.

Adenovirus

Adenovirus mainly infects children younger than 2 years old. Of the 49 types of adenoviruses, one strain affects the gastrointestinal tract, causing vomiting and diarrhea. Symptoms typically appear 8 to 10 days after exposure and last 5 to 12 days. Adenovirus infections occur year-round.

Astrovirus

Astrovirus primarily infects infants and young children, but adults may also be infected. This virus causes vomiting and watery diarrhea. Symptoms usually appear 3 to 4 days after exposure and last 2 to 7 days. The symptoms are milder than the symptoms of norovirus or rotavirus infections. Infections occur year-round, but the virus is most active during the winter months.

Viral gastroenteritis is often mistakenly called stomach flu, but it is not caused by the influenza virus. Some forms of gastroenteritis are caused by bacteria or parasites rather than viruses. More information about bacterial infections is provided in the NIDDK health topic, Foodborne Illnesses fact sheet from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). </s>


Input: How to diagnose Viral Gastroenteritis ?

Output:
Viral gastroenteritis is usually diagnosed based on symptoms alone. People who have symptoms that are severe or last for more than a few days may want to see a health care provider for additional tests. A health care provider may ask for a stool sample to test for rotavirus or norovirus or to rule out bacteria or parasites as the cause of the gastroenteritis.

During an epidemic of viral gastroenteritis, health care providers or public health officials may test stool samples to find out which virus is responsible for the outbreak. </s>


Input: What are the treatments for Viral Gastroenteritis ?

Output:
Most cases of viral gastroenteritis resolve over time without specific treatment. Antibiotics are not effective against viral infections. The primary goal of treatment is to reduce symptoms and prevent complications.

Over-the-counter medicines such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol) can help relieve symptoms in adults. These medicines are not recommended for children. </s>


Input: What to do for Viral Gastroenteritis ?

Output:
The following steps may help relieve the symptoms of viral gastroenteritis in adults:

- drinking plenty of liquids such as fruit juices, sports drinks, caffeine-free soft drinks, and broths to replace fluids and electrolytes  - sipping small amounts of clear liquids or sucking on ice chips if vomiting is still a problem  - gradually reintroducing food, starting with bland, easy-to-digest foods such as rice, potatoes, toast or bread, cereal, lean meat, applesauce, and bananas  - avoiding fatty foods, sugary foods, dairy products, caffeine, and alcohol until recovery is complete  - getting plenty of rest

Children present special concerns. Because of their smaller body size, infants and children are likely to become dehydrated more quickly from diarrhea and vomiting. The following steps may help relieve symptoms of viral gastroenteritis and prevent dehydration in children:

- giving oral rehydration solutions such as Pedialyte, Naturalyte, Infalyte, and CeraLyte  - giving food as soon as the child is hungry  - giving infants breast milk or full strength formula, as usual, along with oral rehydration solutions

Older adults and adults with weak immune systems should also drink oral rehydration solutions to prevent dehydration. </s>


Input: How to prevent Viral Gastroenteritis ?

Output:
People can reduce their chances of getting or spreading viral gastroenteritis if they

- wash their hands thoroughly with soap and warm water for 20 seconds after using the bathroom or changing diapers and before eating or handling food  - disinfect contaminated surfaces such as countertops and baby changing tables with a mixture of 2 cups of household bleach and 1 gallon of water  - avoid foods and drinks that might be contaminated

The U.S. Food and Drug Administration has approved two vaccines to protect children from rotavirus infections: rotavirus vaccine, live, oral, pentavalent (RotaTeq); and rotavirus vaccine, live, oral (Rotarix). RotaTeq is given to infants in three doses at 2, 4, and 6 months of age. Rotarix is given in two doses. The first dose is given when the infant is 6 weeks old, and the second is given at least 4 weeks later but before the infant is 24 weeks old.

Parents of infants should discuss rotavirus vaccination with a health care provider. For more information, parents can visit the Centers for Disease Control and Prevention rotavirus vaccination webpage at www.cdc.gov/vaccines/vpd-vac/rotavirus.

In the past, rotavirus infections were most common from November to April in the United States. However, recently widespread vaccination slowed the transmission of the virus, delaying rotavirus activity until late February. Overall rates of infection have also been lower than in previous years. </s>


Input: What to do for Viral Gastroenteritis ?

Output: - Viral gastroenteritis is inflammation of the lining of the stomach, small intestine, and large intestine. Several different viruses can cause viral gastroenteritis, which is highly contagious and extremely common.  - The main symptoms of viral gastroenteritis are watery diarrhea and vomiting.  - Dehydration is the most common complication of viral gastroenteritis.  - When someone does not drink enough fluids to replace those that are lost through vomiting and diarrhea, dehydration can result. Signs of dehydration in adults are excessive thirst, infrequent urination, dark-colored urine, dry skin, and lethargy, dizziness, or faintness.  - Infants, young children, older adults, and people with weak immune systems have the greatest risk of becoming dehydrated.  - Viral gastroenteritis is transmitted from person to person.  - Diagnosis of viral gastroenteritis is usually based on symptoms alone.  - Most cases of viral gastroenteritis resolve over time without specific treatment. Antibiotics are not effective against viral infections. The primary goal of treatment is to reduce symptoms.  - Adults with viral gastroenteritis should drink plenty of liquids such as fruit juices, sports drinks, caffeine-free soft drinks, and broths to replace fluids and electrolytes.  - Children with viral gastroenteritis should be given oral rehydration solutions to prevent dehydration.  - People can reduce their chances of getting or spreading viral gastroenteritis if they wash their hands thoroughly with soap and warm water for 20 seconds after using the bathroom or changing diapers and before eating or handling food, disinfect contaminated surfaces, and avoid foods or liquids that might be contaminated. </s>


Input: What is (are) Nutrition for Early Chronic Kidney Disease in Adults ?

Output: CKD usually takes a long time to develop and does not go away. In CKD, the kidneys continue to workjust not as well as they should. Wastes may build up so gradually that the body becomes used to having those wastes in the blood. Salts containing phosphorus and potassium may rise to unsafe levels, causing heart and bone problems. Anemialow red blood cell countcan result from CKD because the kidneys stop making enough erythropoietin, a hormone that causes bone marrow to make red blood cells. After months or years, CKD may progress to permanent kidney failure, which requires a person to have a kidney transplant or regular blood filtering treatments called dialysis. </s>


Input: Who is at risk for Nutrition for Early Chronic Kidney Disease in Adults? ?

Output: Millions of Americans are at risk for developing CKD because they have diabetes, high blood pressure, or both. High blood glucose levels put people with diabetes at risk for heart disease, stroke, amputation, and eye and kidney problems. People with high blood pressure are at risk for damaged blood vessels, including tiny vessels in the kidneys. </s>


Input: What is (are) Nutrition for Early Chronic Kidney Disease in Adults ?

Output:
People with either type 1 or type 2 diabetes must choose foods carefully to control their blood glucose, the bodys main source of energy. Following a meal plan to keep blood glucose at a healthy level may prevent CKD from developing.

People with diabetes should talk with their health care provider about setting goals for maintaining healthy blood glucose levels and about how often to check their blood glucose level. The results from these blood glucose checks indicate whether a persons meal plan is helping to keep diabetes under control. People with diabetes should also ask their doctor for an A1C test at least twice a year. The A1C number reflects a persons average blood glucose level over the past 2 to 3 months.

- Eating about the same amount of food each day.  - Eating meals and snacks at about the same times each day.  - Not skipping meals or snacks.  - Taking medicines at the same times each day.  - Participating in physical activity every day. </s>


Input: What is (are) Nutrition for Early Chronic Kidney Disease in Adults ?

Output:
As blood pressure rises, the risk of damage to the arteries, heart, brain, and kidneys increases. Controlling blood pressure through healthy food choices and regular physical activity can delay or prevent the development of CKD.

Blood pressure is expressed as two numbers. The top number represents the force of the blood pushing against the artery walls when the heart beats. The lower number represents the pressure between beats. Normal blood pressure is below 120/80 millimeters of mercury (mmHg). People with CKD should try to keep their blood pressure below 140/90 mmHg.

Following a meal plan can help control blood pressure and protect the kidneys. The National Heart, Lung, and Blood Institute supported research that compared a typical American diet with the Dietary Approaches to Stop Hypertension (DASH) eating plan, which is lower in saturated fat, cholesterol, and total fat and emphasizes eating fruits, vegetables, and low-fat dairy foods. People who followed the DASH eating plan were able to reduce their blood pressure much more than those who ate a typical diet. The DASH eating plan also includes whole grain products, fish, poultry, and nuts. Limiting sodium, or salt, is another important feature of the plan. A dietitian can help find low-salt or salt-free alternatives to foods that are high in salt. </s>


Input: What is (are) Nutrition for Early Chronic Kidney Disease in Adults ?

Output:
MNT is the use of nutrition counseling by a registered dietitian to help promote a medical or health goal. A doctor may refer a patient to a registered dietitian to help with the patients food plan. Many insurance policies cover MNT when recommended by a doctor. Anyone who qualifies for Medicare can receive a benefit for MNT from a registered dietitian or nutrition professional when a doctor provides a referral indicating the person has diabetes or kidney disease.

One way to locate a qualified dietitian is to contact the American Dietetic Association at www.eatright.organd click on Find a Registered Dietitian. Users can enter their address or ZIP code for a list of dietitians in their area. A person looking for dietary advice to prevent kidney damage should click on Renal (Kidney) Nutrition in the specialty field. Dietitians who specialize in helping people with CKD are called renal dietitians. </s>


Input: What to do for Nutrition for Early Chronic Kidney Disease in Adults ?

Output: - Controlling blood glucose and blood pressure through healthy food choices is an important step toward slowing or stopping the progression of chronic kidney disease (CKD).  - The kidneys remove wastes and extra water from the blood and make urine.  - Millions of Americans are at risk for developing CKD because they have diabetes, high blood pressure, or both.  - People with either type 1 or type 2 diabetes must choose foods carefully to control their blood glucose. Following a meal plan to keep blood glucose at a healthy level may prevent CKD from developing.  - Controlling blood pressure through healthy food choices and regular physical activity can delay or prevent the development of CKD. People with CKD should try to keep their blood pressure below 140/90 mmHg.  - Medical nutrition therapy (MNT) is the use of counseling by a registered dietitian to help promote a medical or health goal.   - Dietitians who specialize in helping people with CKD are called renal dietitians.   - Learning how to read and understand lab reports lets a person see how different foods can affect the kidneys. Patients can ask their doctor for copies of their lab reports and ask to have them explained, noting any results out of the normal range. </s>


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

Output:
Gas is air in the digestive tract. Gas leaves the body when people burp through the mouth or pass gas through the anus*the opening at the end of the digestive tract where stool leaves the body.

Everyone has gas. Burping and passing gas are normal. Many people believe that they burp or pass gas too often and that they have too much gas. Having too much gas is rare. </s>


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

Output:
Gas in the digestive tract is usually caused by swallowing air and the breakdown of certain foods in the large intestine.

*See the Pronunciation Guide for tips on how to say the underlined words.

You typically swallow a small amount of air when you eat and drink. You swallow more air when you

- eat or drink too fast  - smoke  - chew gum  - suck on hard candy  - drink carbonated or fizzy drinks  - wear loose-fitting dentures

Some of the air you swallow leaves the stomach through the mouth when you burp. Some swallowed air is absorbed in the small intestine. Some air moves through the small intestine to the large intestine and is passed through the anus.

The stomach and small intestine do not fully digest all of the food you eat. Undigested carbohydratessugars, starches, and fiber found in many foodspass through to the large intestine. Bacteria in the large intestine break down undigested carbohydrates and release gas. This gas is passed through the anus.

Normally, few bacteria live in the small intestine. Small intestinal bacterial overgrowth (SIBO) is an increase in the number of bacteria or a change in the type of bacteria in the small intestine. These bacteria can produce excess gas and may also cause diarrhea and weight loss. SIBO is usually related to diseases or disorders that damage the digestive system or affect how it works, such as Crohns disease or diabetes. </s>


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

Output:
Most foods that contain carbohydrates can cause gas. Foods that cause gas for one person may not cause gas for someone else. Some foods that contain carbohydrates and may cause gas are

- beans  - vegetables such as broccoli, cauliflower, cabbage, brussels sprouts, onions, mushrooms, artichokes, and asparagus  - fruits such as pears, apples, and peaches  - whole grains such as whole wheat and bran  - sodas; fruit drinks, especially apple juice and pear juice; and other drinks that contain high fructose corn syrup, a sweetener made from corn  - milk and milk products such as cheese, ice cream, and yogurt  - packaged foodssuch as bread, cereal, and salad dressingthat contain small amounts of lactose, the sugar found in milk and foods made with milk  - sugar-free candies and gums that contain sugar alcohols such as sorbitol, mannitol, and xylitol </s>


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

Output:
The most common symptoms of gas are:

- Burping. Burping once in awhile, especially during and after meals, is normal. If you burp very often, you may be swallowing too much air. Some people with digestive problems swallow air on purpose and burp because they believe it will help them feel better.  - Passing gas. Passing gas around 13 to 21 times a day is normal. If you think you pass gas more often than that, you may have trouble digesting certain carbohydrates.  - Bloating. Bloating is a feeling of fullness and swelling in the abdomen, the area between the chest and hips. Disorders such as irritable bowel syndrome (IBS) can affect how gas moves through the intestines. If gas moves through your intestines too slowly, you may feel bloated.  - Abdominal pain or discomfort. People may feel abdominal pain or discomfort when gas does not move through the intestines normally. People with IBS may be more sensitive to gas in the intestines. </s>


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

Output:
You can try to find the cause of gas by keeping a diary of what you eat and drink and how often you burp, pass gas, or have other symptoms. The diary may help you identify the foods that cause you to have gas.

Talk with your health care provider if

- gas symptoms often bother you  - your symptoms change suddenly  - you have new symptoms, especially if you are older than age 40  - you have other symptomssuch as constipation, diarrhea, or weight lossalong with gas

Your health care provider will ask about your diet and symptoms. Your health care provider may review your diary to see if specific foods are causing gas.

If milk or milk products are causing gas, your health care provider may perform blood or breath tests to check for lactose intolerance. Lactose intolerance means you have trouble digesting lactose. Your health care provider may ask you to avoid milk and milk products for a short time to see if your gas symptoms improve.

Your health care provider may test for other digestive problems, depending on your symptoms. </s>


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

Output:
You can try to treat gas on your own, before seeing your health care provider, if you think you have too much.

Swallowing less air and changing what you eat can help prevent or reduce gas. Try the following tips:

- Eat more slowly.  - If you smoke, quit or cut down.  - If you wear dentures, see your dentist and make sure your dentures fit correctly.  - Dont chew gum or suck on hard candies.  - Avoid carbonated drinks, such as soda and beer.  - Drink less fruit juice, especially apple juice and pear juice.  - Avoid or eat less of the foods that cause you to have gas.

Some over-the-counter medicines can help reduce gas:

- Taking alpha-galactosidase (Beano) when you eat beans, vegetables, and whole grains can reduce gas.  - Simethicone (Gas-X, Mylanta Gas) can relieve bloating and abdominal pain or discomfort caused by gas.  - If you are lactose intolerant, lactase tablets or liquid drops can help you digest milk and milk products. You can also find lactose-free and lactose-reduced milk and milk products at the grocery store.

Your health care provider may prescribe medicine to help relieve gas, especially if you have SIBO or IBS. </s>


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

Output:
Your eating habits and diet affect the amount of gas you have. For example, eating and drinking too fast can cause you to swallow more air. And you may have more gas after you eat certain carbohydrates.

Track what you eat and your gas symptoms to find out what foods cause you to have more gas. Avoid or eat less of the foods that cause your gas symptoms. </s>


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

Output: - Gas is air in the digestive tract.  - Everyone has gas. Burping and passing gas are normal.  - Gas in the digestive tract is usually caused by swallowing air and the breakdown of certain foods in the large intestine.  - Most foods that contain carbohydrates can cause gas.  - Foods that cause gas for one person may not cause gas for someone else.  - The most common symptoms of gas are burping, passing gas, bloating, and abdominal pain or discomfort.  - Swallowing less air and changing what you eat can help prevent or reduce gas.  - Some over-the-counter medicines can help reduce gas. </s>


Input: What is (are) Hemorrhoids ?

Output:
Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum. The rectum is the last part of the large intestine leading to the anus. The anus is the opening at the end of the digestive tract where bowel contents leave the body.

External hemorrhoids are located under the skin around the anus. Internal hemorrhoids develop in the lower rectum. Internal hemorrhoids may protrude, or prolapse, through the anus. Most prolapsed hemorrhoids shrink back inside the rectum on their own. Severely prolapsed hemorrhoids may protrude permanently and require treatment. </s>


Input: What are the symptoms of Hemorrhoids ?

Output:
The most common symptom of internal hemorrhoids is bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. Internal hemorrhoids that are not prolapsed are usually not painful. Prolapsed hemorrhoids often cause pain, discomfort, and anal itching.

Blood clots may form in external hemorrhoids. A blood clot in a vein is called a thrombosis. Thrombosed external hemorrhoids cause bleeding, painful swelling, or a hard lump around the anus. When the blood clot dissolves, extra skin is left behind. This skin can become irritated or itch.

Excessive straining, rubbing, or cleaning around the anus may make symptoms, such as itching and irritation, worse.

Hemorrhoids are not dangerous or life threatening. Symptoms usually go away within a few days, and some people with hemorrhoids never have symptoms. </s>


Input: How many people are affected by Hemorrhoids ?

Output: About 75 percent of people will have hemorrhoids at some point in their lives.1 Hemorrhoids are most common among adults ages 45 to 65.2 Hemorrhoids are also common in pregnant women. </s>


Input: What causes Hemorrhoids ?

Output:
Swelling in the anal or rectal veins causes hemorrhoids. Several factors may cause this swelling, including

- chronic constipation or diarrhea  - straining during bowel movements  - sitting on the toilet for long periods of time  - a lack of fiber in the diet

Another cause of hemorrhoids is the weakening of the connective tissue in the rectum and anus that occurs with age.

Pregnancy can cause hemorrhoids by increasing pressure in the abdomen, which may enlarge the veins in the lower rectum and anus. For most women, hemorrhoids caused by pregnancy disappear after childbirth. </s>


Input: How to diagnose Hemorrhoids ?

Output:
The doctor will examine the anus and rectum to determine whether a person has hemorrhoids. Hemorrhoid symptoms are similar to the symptoms of other anorectal problems, such as fissures, abscesses, warts, and polyps.

The doctor will perform a physical exam to look for visible hemorrhoids. A digital rectal exam with a gloved, lubricated finger and an anoscopea hollow, lighted tubemay be performed to view the rectum.

A thorough evaluation and proper diagnosis by a doctor is important any time a person notices bleeding from the rectum or blood in the stool. Bleeding may be a symptom of other digestive diseases, including colorectal cancer.

Additional exams may be done to rule out other causes of bleeding, especially in people age 40 or older:

- Colonoscopy. A flexible, lighted tube called a colonoscope is inserted through the anus, the rectum, and the upper part of the large intestine, called the colon. The colonoscope transmits images of the inside of the rectum and the entire colon.  - Sigmoidoscopy. This procedure is similar to colonoscopy, but it uses a shorter tube called a sigmoidoscope and transmits images of the rectum and the sigmoid colon, the lower portion of the colon that empties into the rectum.  - Barium enema x ray. A contrast material called barium is inserted into the colon to make the colon more visible in x ray pictures. </s>


Input: What are the treatments for Hemorrhoids ?

Output:
At-home Treatments

Simple diet and lifestyle changes often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms. Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.

Fiber is a substance found in plants. The human body cannot digest fiber, but fiber helps improve digestion and prevent constipation. Good sources of dietary fiber are fruits, vegetables, and whole grains. On average, Americans eat about 15 grams of fiber each day.3 The American Dietetic Association recommends 25 grams of fiber per day for women and 38 grams of fiber per day for men.3

Doctors may also suggest taking a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).

Other changes that may help relieve hemorrhoid symptoms include

- drinking six to eight 8-ounce glasses of water or other nonalcoholic fluids each day  - sitting in a tub of warm water for 10 minutes several times a day  - exercising to prevent constipation  - not straining during bowel movements

Over-the-counter creams and suppositories may temporarily relieve the pain and itching of hemorrhoids. These treatments should only be used for a short time because long-term use can damage the skin.

Medical Treatment

If at-home treatments do not relieve symptoms, medical treatments may be needed. Outpatient treatments can be performed in a doctor's office or a hospital. Outpatient treatments for internal hemorrhoids include the following:

- Rubber band ligation. The doctor places a special rubber band around the base of the hemorrhoid. The band cuts off circulation, causing the hemorrhoid to shrink. This procedure should be performed only by a doctor.  - Sclerotherapy. The doctor injects a chemical solution into the blood vessel to shrink the hemorrhoid.  - Infrared coagulation. The doctor uses heat to shrink the hemorrhoid tissue.

Large external hemorrhoids or internal hemorrhoids that do not respond to other treatments can be surgically removed. </s>


Input: What to do for Hemorrhoids ?

Output: - Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum.  - Hemorrhoids are not dangerous or life threatening, and symptoms usually go away within a few days.  - A thorough evaluation and proper diagnosis by a doctor is important any time a person notices bleeding from the rectum or blood in the stool.  - Simple diet and lifestyle changes often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms.  - If at-home treatments do not relieve symptoms, medical treatments may be needed. </s>


Input: What is (are) Growth Failure in Children with Chronic Kidney Disease ?

Output:
Growth failure is a complication of CKD in which children do not grow as expected. When a child is below the third percentilemeaning 97 percent of children the same age and gender are tallerhe or she has growth failure.1 CKD is kidney disease that does not go away with treatment and tends to get worse over time.

Health care providers use charts to monitor the growth of children with CKD and look for signs of growth failure. Growth charts for children use percentiles to compare a particular childs height with the height of children the same age and gender. For example, a child whose height is at the 50th percentile on a growth chart means half the children in the United States are taller than that child and half the children are shorter.

About one-third of children with CKD have growth failure.1 Children diagnosed with CKD at a younger age

- have a higher chance of developing growth failure  - have more health issues related to growth failure and CKD </s>


Input: What is (are) Growth Failure in Children with Chronic Kidney Disease ?

Output: The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. </s>


Input: What causes Growth Failure in Children with Chronic Kidney Disease ?

Output:
Researchers have found that many factors cause growth failure in children with CKD. In addition to removing wastes and extra fluid from the blood, the kidneys perform important functions for a childs growth. Understanding normal kidney function and growth helps families understand what causes growth failure in children with CKD.

Normal kidney function helps maintain the

- balance of nutrients and minerals, such as calcium and phosphorus, in the blood. These minerals are essential for normal bone growth. The kidneys use a hormone called calcitriol, a form of vitamin D, to help bones absorb the right amount of calcium from the blood. The kidneys also remove extra phosphorus, helping balance phosphorus and calcium levels in the blood.  - bodys ability to use growth hormone. Growth hormone is necessary during childhood to help bones grow and stay healthy. The pituitary gland naturally produces growth hormone, which acts as a messenger to help the body grow. Growth hormone tells the liver to produce another hormone, called insulin-like growth factor, that travels to muscles, organs, and bones and tells them to grow.  - correct levels of erythropoietin in the body. Erythropoietin is a hormone that helps bone marrow make red blood cells.  - proper balance of sodium, also called salt; potassium; and acid-base levels in the blood. Acid-base balance refers to the amount of acid in the blood.

Damaged kidneys can slow a childs growth by

- causing mineral and bone disorder, which occurs when      - vitamin D is not turned into calcitriol, which starves the bones of calcium.    - phosphorus levels rise in the blood and draw calcium out of the bones and into the blood, causing the bones to weaken.    - creating an imbalance of sodium, potassium, and acid-base levels in the blood, also called acidosis. When blood is not balanced, the body slows growth to focus energy on restoring the balance.  - decreasing appetite. A child with CKD may not be hungry, or he or she may not have the energy to eat, which may lead to poor nutrition and slower growth.  - decreasing the production of erythropoietin. When erythropoietin levels are low, a child may develop anemiaa condition that develops when the blood does not have enough healthy red blood cells to carry oxygen to cells throughout the body. Anemia can cause growth to slow or stop.  - making an abnormally large amount of urine, called polyuria, which disrupts the bodys fluid balance. A child with polyuria loses minerals as well. The body slows growth to make up for the lost fluid and minerals.  - preventing the body from correctly using growth hormone. When the kidneys are damaged, waste builds up in the blood and the body does not properly process growth hormone. </s>


Input: What are the treatments for Growth Failure in Children with Chronic Kidney Disease ?

Output:
Health care providers treat growth failure in children with CKD with

- changes in eating, diet, and nutrition  - medications  - growth hormone therapy

Most children with growth failure grow to about one-third of their adult height within the first two years of life; therefore, it is important to start treatment for growth failure early.1 </s>


Input: What to do for Growth Failure in Children with Chronic Kidney Disease ?

Output:
Children with CKD may lose their appetite or lack the energy to eat. To treat growth failure in children, a health care provider may recommend dietary changes, such as

- adding calcium. Children with CKD should get the recommended level of calcium for their age from their diet or from calcium supplements.  - monitoring liquids. Balancing the childs liquid intake based on his or her kidney disease is important. Some children will need to increase liquid intake, while other children will need to restrict liquid intake.  - limiting phosphorus. Children with CKD may need to limit phosphorus intake if they have mineral and bone disorder.  - monitoring protein. Children with CKD should eat enough protein for growth; however, they should avoid high protein intake, which can put an extra burden on the kidneys.  - monitoring sodium. The amount of sodium children with CKD need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care provider may recommend either limiting or adding sodium, often from salt, to the childs diet.  - adding vitamin D. Children who do not get enough vitamin D through diet may need to take vitamin D supplements.

To help ensure coordinated and safe care, parents and caregivers should discuss the use of complementary and alternative medical practices, including the use of dietary supplements, with the childs health care provider. Read more at www.nccam.nih.gov.

Some children will use a feeding tube to receive all their nutrition. A feeding tube is a small, soft plastic tube placed through the nose or mouth into the stomach. The child will receive supplements through the tube to provide a full supply of fluid and nutrients to help him or her grow and develop. Feeding tubes are most often used in infants; however, sometimes older children and adolescents benefit from them as well.

Encouraging children to develop healthy eating habits can help prevent poor nutrition and promote healthy growing. The health care team will work with parents or caretakers to develop a healthy diet tailored to meet the needs of their child.

More information about diet and kidney disease is provided in the NIDDK health topic, Nutrition for Chronic Kidney Disease in Children.

Medications

A health care provider may prescribe medications that can help correct the underlying problems causing growth failure.

- A health care provider may prescribe phosphate binders when phosphorus levels in the blood rise and interfere with bone formation and normal growth. In the intestine, the medications bind, or attach, to some of the phosphorus found in food, causing the phosphorus to move through the intestine without being absorbed and exit the body in the stool. This process can decrease blood phosphorus levels and increase blood calcium levels. Phosphate binders come as chewable tablets, liquids, capsules, and pills.  - A health care provider may prescribe alkaline agents such as sodium bicarbonate to restore the acid-base balance in a child with acidosis.  - Synthetic erythropoietin is a man-made form of erythropoietin given by injection to treat anemia.

Growth Hormone Therapy

When a health care provider diagnoses a child with CKD and the child begins to show signs of growth failure, the health care provider may prescribe daily human growth hormone injections. The injections are a man-made growth hormone that mimics the natural hormone found in the body. Researchers have shown that using growth hormone therapy is effective in helping children reach normal adult height.

More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children. </s>


Input: What to do for Growth Failure in Children with Chronic Kidney Disease ?

Output: - Growth failure is a complication of chronic kidney disease (CKD) in which children do not grow as expected.  - Health care providers use charts to monitor the growth of children with CKD and look for signs of growth failure.  - Researchers have found that many factors cause growth failure in children with CKD.  - Health care providers treat growth failure in children with CKD with      - changes in eating, diet, and nutrition    - medications    - growth hormone therapy    - Encouraging children to develop healthy eating habits can help prevent poor nutrition and promote healthy growing.  - The health care team will work with parents or caretakers to develop a healthy diet tailored to meet the needs of their child.  - When a health care provider diagnoses a child with CKD and the child begins to show signs of growth failure, the health care provider may prescribe daily human growth hormone injections. </s>


Input: What is (are) Mineral and Bone Disorder in Chronic Kidney Disease ?

Output:
Mineral and bone disorder in CKD occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a persons blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.

In the past, health care providers used the term renal osteodystrophy to describe mineral and hormone disturbances caused by kidney disease. Today, renal osteodystrophy only describes bone problems that result from mineral and bone disorder in CKD. Health care providers might use the phrase chronic kidney disease mineral and bone disorder, or CKD-MBD, to describe the condition that affects the bones, heart, and blood vessels. </s>


Input: What is (are) Mineral and Bone Disorder in Chronic Kidney Disease ?

Output: Chronic kidney disease is kidney damage that occurs slowly over many years, often due to diabetes or high blood pressure. Once damaged, the kidneys cant filter blood as they should. This damage can cause wastes to build up in the body and other problems that can harm a persons health, including mineral and bone disorder. </s>


Input: What causes Mineral and Bone Disorder in Chronic Kidney Disease ?

Output:
Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body. The kidneys

- stop activating calcitriol. The low levels of calcitriol in the body create an imbalance of calcium in the blood.  - do not remove the phosphorus in the blood properly, so phosphorus levels rise in the blood. The extra phosphorus pulls calcium out of the bones, causing them to weaken.

Another factor contributes to the cause of mineral and bone disorder. When the kidneys are damaged, the parathyroid gland releases parathyroid hormone into the blood to pull calcium from the bones and raise blood calcium levels. This response restores the balance of phosphorus and calcium; however, it also starves the bones of much-needed calcium. </s>


Input: What are the symptoms of Mineral and Bone Disorder in Chronic Kidney Disease ?

Output:
In adults, symptoms of mineral and bone disorder in CKD may not appear until bone changes have taken place for many years. For this reason, people often refer to the disease as a silent crippler. Eventually, a person with the condition may begin to feel bone and joint pain.

Mineral and Bone Disorder in Children with Chronic Kidney Disease   Mineral and bone disorder in CKD is most serious when it occurs in children because their bones are still developing and growing. Growing children can show symptoms of mineral and bone disorder even in the early stages of CKD. Slowed bone growth leads to short stature, which may remain with a child into adulthood. One deformity caused by mineral and bone disorder in CKD occurs when the legs bend inward or outward, a condition often referred to as "renal rickets." More information is provided in the NIDDK health topic, Growth Failure in Children with Kidney Disease. Find more about childrens bone health on the Eunice Kennedy Shriver National Institute of Child Health and Human Development website at www.nichd.nih.gov. </s>


Input: What are the complications of Mineral and Bone Disorder in Chronic Kidney Disease ?

Output:
The complications of mineral and bone disorder in CKD include slowed bone growth and deformities, and heart and blood vessel problems.

Slowed Bone Growth and Deformities

Damaged kidneys must work harder to clear phosphorus from the body. High levels of phosphorus cause lower levels of calcium in the blood, resulting in the following series of events:

- When a persons blood calcium level becomes too low, the parathyroid glands release parathyroid hormone.  - Parathyroid hormone removes calcium from bones and places it into the blood, raising a persons blood calcium level at the risk of harming bones.  - A low calcitriol level also leads to an increased level of parathyroid hormone.

If mineral and bone disorder in CKD remains untreated in adults, bones gradually become thin and weak, and a person with the condition may begin to feel bone and joint pain. Mineral and bone disorder in CKD also increases a persons risk of bone fractures.

Heart and Blood Vessel Problems

In addition to harming bones, mineral and bone disorder in CKD can cause problems in the heart and blood vessels:

- High levels of blood calcium can damage blood vessels and lead to heart problems.  - High phosphorus levels also can cause blood vessels to become like bone, leading to hardening of the arteries.  - High phosphorus levels also cause abnormal hormone regulation, even if the calcium level is acceptable.

Parathyroid hormone and another hormone made in the bones called FGF23 can also affect bone and heart health, leading to the following series of problems:

- When parathyroid hormone or FGF23 levels are high, a person can have heart problems.   - The complex hormone abnormalities that cause bone deformities can also harm a persons heart and blood vessels. </s>


Input: How to diagnose Mineral and Bone Disorder in Chronic Kidney Disease ?

Output:
A health care provider diagnoses mineral and bone disorder in CKD with

- a family and medical history  - a physical exam  - a blood test  - a bone biopsy  - an x-ray

Family and Medical History

Taking a medical and family history is one of the first things a health care provider may do to help diagnose mineral and bone disorder in CKD. He or she will ask the patient or caretaker questions about when the patient was first diagnosed with CKD and whether any family members have also had mineral and bone disorder with or without CKD.

Physical Exam

A physical exam may help diagnose mineral and bone disorder in CKD. During a physical exam, a health care provider usually examines a patients body for changes in bone structure.

Blood Test

A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. The blood test shows levels of calcium, phosphorus, parathyroid hormone, and sometimes vitamin D.

Bone Biopsy

A bone biopsy is a procedure that removes a piece of bone tissue for examination with a microscope. A health care provider performs the biopsy in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the hip bone. A pathologista doctor who specializes in diagnosing diseasesexamines the bone tissue in a lab. The test can show whether a persons bone cells are building normal bone.

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. A radiographer performs the x-ray at a hospital or an outpatient center, and a radiologista doctor who specializes in medical imaginginterprets the images. Patients do not need anesthesia. The patient will lie on a table or stand during the x-ray. The technician will position the x-ray machine over the bone area. The patient will hold his or her breath as the x-ray machine takes the picture so that the picture will not be blurry. The radiographer may ask the patient to change position for additional pictures. An x-ray can show extra calcium in blood vessels.

Each of these tests can help the health care provider determine whether CKD or some other condition is causing the mineral and bone disorder and decide on a course of treatment. </s>


Input: What are the treatments for Mineral and Bone Disorder in Chronic Kidney Disease ?

Output:
Treating mineral and bone disorder in CKD includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition; medications and supplements; and dialysis. If these treatments do not bring parathyroid hormone levels under control, a health care provider may remove a persons parathyroid glands surgically, a procedure called a parathyroidectomy.

Eating, Diet, and Nutrition

Changes in diet can treat mineral and bone disorder in CKD. Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease. Most foods contain phosphorus; however, processed and packaged foods contain especially high levels of phosphorus. Food producers use phosphorus as an additive to preserve the food on the shelf. People who have CKD or are on dialysis should avoid packaged foods containing ingredients that include the letters PHOS. A renal dietitian can help develop a dietary plan to control phosphorus levels in the blood. Some drinks and natural foods also contain high amounts of phosphorus, including

- beer  - cheese  - cocoa  - dark sodas  - dried beans  - milk  - nuts  - peanut butter  - peas

More information is provided in the NIDDK health topics, How To Read a Food Label: Tips for People with Chronic Kidney Disease and Phosphorus: Tips for People with Chronic Kidney Disease.

Medications and Supplements

Medications protect the bones by restoring the proper balance of minerals and hormones. If the kidneys do not make adequate amounts of calcitriol, a health care provider may prescribe synthetic calcitriol as a pill (Rocaltrol) or, for dialysis patients, in an injectable form (Calcijex). Calcitriol helps reduce parathyroid hormone levels. Medications called doxercalciferol (Hectorol) and paricalcitol (Zemplar) act like calcitriol because they are also activated forms of vitamin D. A health care provider may prescribe a calcium supplement in addition to calcitriol or another activated form of vitamin D.

Certain forms of vitamin Davailable by prescription or as over-the-counter vitamin supplementsrequire activation by a persons kidneys before they can act as calcitriol does. However, the benefits of some of these not-yet-activated forms of vitamin Dfor example, ergocalciferol (Calciferol, Drisdol) or cholecalciferol (Delta D3)are unclear. To help ensure coordinated and safe care, people should discuss their use of alternative medications, including use of vitamin and mineral supplements, with their health care provider.

Cinacalcet hydrochloride (Sensipar) belongs to another class of prescription medications called calcimimetics. Cinacalcet lowers parathyroid hormone levels by imitating calciums effects on the parathyroid gland. Generally, this medication is used only in people on dialysis.

Often, health care providers will prescribe medications called phosphate binderssuch as calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer carbonate (Renvela), or lanthanum carbonate (Fosrenol)to take with meals and snacks to bind phosphorus in the bowel. These medications decrease the absorption of phosphorus into the blood.

Dialysis

Dialysis is the process of filtering wastes and extra fluid from the body by means other than the kidneys. The two forms of dialysis are hemodialysis and peritoneal dialysis:

- Hemodialysis uses a machine to circulate a persons blood through a filter outside the body. The blood passes from a patients body through a needle, at nearly 1 pint per minute. The blood then travels through a tube that takes it to the filter, called a dialyzer. Inside the dialyzer, the blood flows through thin fibers that filter out wastes and extra fluid. After the machine filters the blood, it passes back to the body through another tube. More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Hemodialysis.  - Peritoneal dialysis uses the lining of the abdomen to filter a persons blood inside the body. A soft tube called a catheter is placed in the patients abdomen a few weeks before peritoneal dialysis begins. A person uses the catheter to fill the empty space inside the abdomen with dialysis solutiona kind of salty waterfrom a plastic bag. While inside the body, the dialysis solution absorbs wastes and extra fluid. After a few hours, the person drains the used dialysis solution into another bag for disposal. The person then restarts the process with a fresh bag of dialysis solution. More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Peritoneal Dialysis.

Increasing a persons dialysis dose can help control the blood phosphorus level. In hemodialysis, the health care provider can adjust the dose by increasing how quickly the blood flows to and from the dialyzer. Another way to adjust the dose involves increasing the time of a persons dialysis session or the number of sessions. In peritoneal dialysis, using more dialysis solution in each fill or increasing the number of fills each day increases the dose. More information is provided in the NIDDK health topics:

- Hemodialysis Dose and Adequacy  - Peritoneal Dialysis Dose and Adequacy

Parathyroidectomy

If diet, medications, and dialysis cant control parathyroid hormone levels, a surgeon can remove one or more of the parathyroid glands. He or she performs the procedure using general anesthesia.

A good treatment program, including a low-phosphorus diet, appropriate medications, adequate dialysis, and, if necessary, surgery, can improve the bodys ability to repair bones damaged by mineral and bone disorder in CKD. Overall, people can improve their bone health by exercising and not smoking. People should consult a health care provider before beginning any exercise program. </s>


Input: What to do for Mineral and Bone Disorder in Chronic Kidney Disease ?

Output: - Mineral and bone disorder in chronic kidney disease (CKD) occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a persons blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.  - Chronic kidney disease is kidney damage that occurs slowly over many years, often due to diabetes or high blood pressure. Once damaged, the kidneys cant filter blood as they should.  - Hormones and minerals are important because they help bones stay strong. If a persons hormones and minerals are out of balance, his or her bones can become weak and malformed.   - Parathyroid hormone plays an important role in controlling calcium levels in the blood. When kidneys do not function properly, extra parathyroid hormone is released in the blood to move calcium from inside the bones into the blood.  - Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body. The kidneys stop activating calcitriol and do not remove the phosphorus in the blood properly.  - The complications of mineral and bone disorder in CKD include slowed bone growth and deformities, and heart and blood vessel problems.   - Treating mineral and bone disorder in CKD includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition; medications and supplements; and dialysis.   - Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease.  - If diet, medications, and dialysis cant control parathyroid hormone levels, a surgeon can remove one or more of the parathyroid glands. </s>


Input: What is (are) Zollinger-Ellison Syndrome ?

Output:
Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum. The tumors, called gastrinomas, release large amounts of gastrin that cause the stomach to produce large amounts of acid. Normally, the body releases small amounts of gastrin after eating, which triggers the stomach to make gastric acid that helps break down food and liquid in the stomach. The extra acid causes peptic ulcers to form in the duodenum and elsewhere in the upper intestine.

The tumors seen with Zollinger-Ellison syndrome are sometimes cancerous and may spread to other areas of the body. </s>


Input: What is (are) Zollinger-Ellison Syndrome ?

Output:
The stomach, duodenum, and pancreas are digestive organs that break down food and liquid.

- The stomach stores swallowed food and liquid. The muscle action of the lower part of the stomach mixes the food and liquid with digestive juice. Partially digested food and liquid slowly move into the duodenum and are further broken down.  - The duodenum is the first part of the small intestinethe tube-shaped organ between the stomach and the large intestinewhere digestion of the food and liquid continues.  - The pancreas is an organ that makes the hormone insulin and enzymes for digestion. A hormone is a natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Insulin helps cells throughout the body remove glucose, also called sugar, from blood and use it for energy. The pancreas is located behind the stomach and close to the duodenum. </s>


Input: What causes Zollinger-Ellison Syndrome ?

Output:
Experts do not know the exact cause of Zollinger-Ellison syndrome. About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1).1 MEN1 causes hormone-releasing tumors in the endocrine glands and the duodenum. Symptoms of MEN1 include increased hormone levels in the blood, kidney stones, diabetes, muscle weakness, weakened bones, and fractures.

More information about MEN1 is provided in the NIDDK health topic, Multiple Endocrine Neoplasia Type 1. </s>


Input: How many people are affected by Zollinger-Ellison Syndrome ?

Output: Zollinger-Ellison syndrome is rare and only occurs in about one in every 1 million people.1 Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old. A child who has a parent with MEN1 is also at increased risk for Zollinger-Ellison syndrome.2 </s>


Input: What are the symptoms of Zollinger-Ellison Syndrome ?

Output:
Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers. A dull or burning pain felt anywhere between the navel and midchest is the most common symptom of a peptic ulcer. This discomfort usually

- occurs when the stomach is emptybetween meals or during the nightand may be briefly relieved by eating food  - lasts for minutes to hours  - comes and goes for several days, weeks, or months

Other symptoms include

- diarrhea  - bloating  - burping  - nausea  - vomiting  - weight loss  - poor appetite

Some people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER), which occurs when stomach contents flow back up into the esophagusa muscular tube that carries food and liquids to the stomach. In addition to nausea and vomiting, reflux symptoms include a painful, burning feeling in the midchest. More information about GER is provided in the NIDDK health topic, Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults. </s>


Input: What are the symptoms of Zollinger-Ellison Syndrome ?

Output:
A person who has any of the following emergency symptoms should call or see a health care provider right away:

- chest pain  - sharp, sudden, persistent, and severe stomach pain  - red blood in stool or black stools  - red blood in vomit or vomit that looks like coffee grounds

These symptoms could be signs of a serious problem, such as

- internal bleedingwhen gastric acid or a peptic ulcer breaks a blood vessel  - perforationwhen a peptic ulcer forms a hole in the duodenal wall  - obstructionwhen a peptic ulcer blocks the path of food trying to leave the stomach </s>


Input: How to diagnose Zollinger-Ellison Syndrome ?

Output:
A health care provider diagnoses Zollinger-Ellison syndrome based on the following:

- medical history   - physical exam  - signs and symptoms  - blood tests  - upper gastrointestinal (GI) endoscopy  - imaging tests to look for gastrinomas  - measurement of stomach acid

Medical History

Taking a medical and family history is one of the first things a health care provider may do to help diagnose Zollinger-Ellison syndrome. The health care provider may ask about family cases of MEN1 in particular.

Physical Exam

A physical exam may help diagnose Zollinger-Ellison syndrome. During a physical exam, a health care provider usually

- examines a persons body  - uses a stethoscope to listen to bodily sounds  - taps on specific areas of the persons body

Signs and Symptoms

A health care provider may suspect Zollinger-Ellison syndrome if

- diarrhea accompanies peptic ulcer symptoms or if peptic ulcer treatment fails.  - a person has peptic ulcers without the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen or a bacterial Helicobacter pylori (H. pylori) infection. NSAID use and H. pylori infection may cause peptic ulcers.  - a person has severe ulcers that bleed or cause holes in the duodenum or stomach.  - a health care provider diagnoses a person or the persons family member with MEN1 or a person has symptoms of MEN1.

Blood Tests

The health care provider may use blood tests to check for an elevated gastrin level. A technician or nurse draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. A health care provider will ask the person to fast for several hours prior to the test and may ask the person to stop acid-reducing medications for a period of time before the test. A gastrin level that is 10 times higher than normal suggests Zollinger-Ellison syndrome.2

A health care provider may also check for an elevated gastrin level after an infusion of secretin. Secretin is a hormone that causes gastrinomas to release more gastrin. A technician or nurse places an intravenous (IV) needle in a vein in the arm to give an infusion of secretin. A health care provider may suspect Zollinger-Ellison syndrome if blood drawn after the infusion shows an elevated gastrin level.

Upper Gastrointestinal Endoscopy

The health care provider uses an upper GI endoscopy to check the esophagus, stomach, and duodenum for ulcers and esophagitisa general term used to describe irritation and swelling of the esophagus. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenum. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A technician or nurse inserts an IV needle in a vein in the arm if anesthesia is given.

Imaging Tests

To help find gastrinomas, a health care provider may order one or more of the following imaging tests:

- Computerized tomography (CT) scan. A CT scan is an x ray that produces pictures of the body. A CT scan may include the injection of a special dye, called contrast medium. CT scans use a combination of x rays and computer technology to create images. CT scans require the person to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes x rays. A computer puts the different views together to create a model of the pancreas, stomach, and duodenum. The x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. The person does not need anesthesia. CT scans can show tumors and ulcers.  - Magnetic resonance imaging (MRI). MRI is a test that takes pictures of the bodys internal organs and soft tissues without using x rays. A specially trained technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The person does not need anesthesia, though people with a fear of confined spaces may receive light sedation, taken by mouth. An MRI may include the injection of contrast medium. With most MRI machines, the person will lie on a table that slides into a tunnel-shaped device that may be open ended or closed at one end. Some machines allow the person to lie in a more open space. During an MRI, the person, although usually awake, remains perfectly still while the technician takes the images, which usually takes only a few minutes. The technician will take a sequence of images from different angles to create a detailed picture of the upper GI tract. During sequencing, the person will hear loud mechanical knocking and humming noises.  - Endoscopic ultrasound. This procedure involves using a special endoscope called an endoechoscope to perform ultrasound of the pancreas. The endoechoscope has a built-in miniature ultrasound probe that bounces safe, painless sound waves off organs to create an image of their structure. A gastroenterologist performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The gastroenterologist carefully feeds the endoechoscope down the esophagus, through the stomach and duodenum, until it is near the pancreas. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A sedative helps the person stay relaxed and comfortable. The images can show gastrinomas in the pancreas.  - Angiogram. An angiogram is a special kind of x ray in which an interventional radiologista specially trained radiologistthreads a thin, flexible tube called a catheter through the large arteries, often from the groin, to the artery of interest. The radiologist injects contrast medium through the catheter so the images show up more clearly on the x ray. The interventional radiologist performs the procedure and interprets the images in a hospital or an outpatient center. A person does not need anesthesia, though a light sedative may help reduce a persons anxiety during the procedure. This test can show gastrinomas in the pancreas.  - Somatostatin receptor scintigraphy. An x-ray technician performs this test, also called OctreoScan, at a hospital or an outpatient center, and a radiologist interprets the images. A person does not need anesthesia. A radioactive compound called a radiotracer, when injected into the bloodstream, selectively labels tumor cells. The labeled cells light up when scanned with a device called a gamma camera. The test can show gastrinomas in the duodenum, pancreas, and other parts of the body.

Small gastrinomas may be hard to see; therefore, health care providers may order several types of imaging tests to find gastrinomas.

Stomach-acid Measurement

Using a sample of stomach juices for analysis, a health care provider may measure the amount of stomach acid a person produces. During the exam, a health care provider puts in a nasogastric tubea tiny tube inserted through the nose and throat that reaches into the stomach. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. Once the tube is placed, a health care provider takes samples of the stomach acid. High acid levels in the stomach indicate Zollinger-Ellison syndrome. </s>


Input: What are the treatments for Zollinger-Ellison Syndrome ?

Output:
A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery.

Medications

A class of medications called proton pump inhibitors (PPIs) includes

- esomeprazole (Nexium)  - lansoprazole (Prevacid)  - pantoprazole (Protonix)   - omeprazole (Prilosec or Zegerid)  - dexlansoprazole (Dexilant)

PPIs stop the mechanism that pumps acid into the stomach, helping to relieve peptic ulcer pain and promote healing. A health care provider may prescribe people who have Zollinger-Ellison syndrome higher-than-normal doses of PPIs to control the acid production. Studies show that PPIs may increase the risk of hip, wrist, and spine fractures when a person takes them long term or in high doses, so its important for people to discuss risks versus benefits with their health care provider.

Surgery

Surgical removal of gastrinomas is the only cure for Zollinger-Ellison syndrome. Some gastrinomas spread to other parts of the body, especially the liver and bones. Finding and removing all gastrinomas before they spread is often challenging because many of the tumors are small.

Chemotherapy

Health care providers sometimes use chemotherapy drugs to treat gastrinomas that cannot be surgically removed, including

- streptozotocin (Zanosar)  - 5-fluorouracil (Adrucil)  - doxorubicin (Doxil) </s>


Input: What to do for Zollinger-Ellison Syndrome ?

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


Input: What to do for Zollinger-Ellison Syndrome ?

Output: - Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum.  - Experts do not know the exact cause of Zollinger-Ellison syndrome.  - About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1).  - Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old.  - Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers.  - Some people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER).  - A health care provider diagnoses Zollinger-Ellison syndrome based on the following:      - medical history    - physical exam    - signs and symptoms    - blood tests    - upper gastrointestinal (GI) endoscopy    - imaging tests to look for gastrinomas    - measurement of stomach acid    - A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery. </s>


Input: What is (are) Hemolytic Uremic Syndrome in Children ?

Output:
Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system. Red blood cells contain hemoglobinan iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body.

When the kidneys and glomerulithe tiny units within the kidneys where blood is filteredbecome clogged with the damaged red blood cells, they are unable to do their jobs. If the kidneys stop functioning, a child can develop acute kidney injurythe sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children. </s>


Input: What is (are) Hemolytic Uremic Syndrome in Children ?

Output: The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. </s>


Input: What causes Hemolytic Uremic Syndrome in Children ?

Output:
The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system. The digestive system is made up of the gastrointestinal, or GI, tracta series of hollow organs joined in a long, twisting tube from the mouth to the anusand other organs that help the body break down and absorb food.

Normally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream. The toxins travel through the bloodstream and can destroy the red blood cells. E.coli O157:H7 can be found in

- undercooked meat, most often ground beef  - unpasteurized, or raw, milk  - unwashed, contaminated raw fruits and vegetables  - contaminated juice  - contaminated swimming pools or lakes

Less common causes, sometimes called atypical hemolytic uremic syndrome, can include

- taking certain medications, such as chemotherapy  - having other viral or bacterial infections  - inheriting a certain type of hemolytic uremicsyndrome that runs in families

More information about foodborne illnesses and the digestive system is provided in the NIDDK health topic, foodborne illnesses. </s>


Input: What are the symptoms of Hemolytic Uremic Syndrome in Children ?

Output:
A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritisan inflammation of the lining of the stomach, small intestine, and large intestine such as

- vomiting  - bloody diarrhea  - abdominal pain  - fever and chills  - headache

As the infection progresses, the toxins released in the intestine begin to destroy red blood cells. When the red blood cells are destroyed, the child may experience the signs and symptoms of anemiaa condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen.

Signs and symptoms of anemia may include

- fatigue, or feeling tired  - weakness  - fainting  - paleness

As the damaged red blood cells clog the glomeruli, the kidneys may become damaged and make less urine. When damaged, the kidneys work harder to remove wastes and extra fluid from the blood, sometimes leading to acute kidney injury.

Other signs and symptoms of hemolytic uremic syndrome may include bruising and seizures.

When hemolytic uremic syndrome causes acute kidney injury, a child may have the following signs and symptoms:

- edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face  - albuminuriawhen a child's urine has high levels of albumin, the main protein in the blood  - decreased urine output  - hypoalbuminemiawhen a child's blood has low levels of albumin  - blood in the urine

Seek Immediate Care   Parents or caretakers should seek immediate care for a child experiencing any urgent symptoms, such as   - unusual bleeding   - swelling   - extreme fatigue   - decreased urine output   - unexplained bruises </s>