Input: What is (are) Renal Tubular Acidosis ?

Output:
Type 1: Classical Distal RTA

Type 1 is also called classical distal RTA. "Distal," which means distant, refers to the point in the urine-forming tube of the kidney where the defect occursrelatively distant from the point where fluid from the blood enters the tiny tube, or tubule, that collects fluid and wastes to form urine.

This disorder may be inherited as a primary disorder or may be one symptom of a disease that affects many parts of the body. Researchers have discovered abnormal genes responsible for the inherited forms of the disease. More often, however, classical distal RTA occurs as a result of systemic diseasesdiseases that affect many organ systemslike the autoimmune disorders Sjgren's syndrome and lupus, which also attack the distal tubule.

Other diseases and conditions associated with classical distal RTA include sickle cell anemia, hyperparathyroidism, hyperthyroidism, chronic active hepatitis, primary biliary cirrhosis, a hereditary form of deafness, analgesic nephropathy, rejection of a transplanted kidney, renal medullary cystic disease, obstructive uropathy, and chronic urinary tract infections. Many of these conditions cause abnormal calcium deposits to build up in the kidney and impair distal tubule function.

A major consequence of classical distal RTA is a low blood potassium level. The level drops if the kidneys excrete too much potassium into urine instead of returning it to the blood supply. Because potassium helps regulate nerve and muscle health and heart rate, low levels can cause extreme weakness, irregular heartbeat, paralysis, and even death.

Untreated classical distal RTA causes growth retardation in children and progressive kidney and bone disease in adults. Restoring normal growth and preventing kidney stones are the major goals of therapy. If acidosis is corrected with sodium bicarbonate or sodium citrate, then low blood-potassium, salt depletion, and calcium leakage into urine will be corrected. This alkali therapy also helps decrease the development of kidney stones and stabilizes kidney function so kidney failure does not progress. Infants may need potassium supplements, but older children and adults rarely do because alkali therapy prevents the kidney from excreting potassium into the urine.

Type 2: Proximal RTA

Type 2 is also called proximal RTA. The word "proximal," which means near, indicates that the defect is closer to the point where fluid and wastes from the blood enter the tubule.

This form of RTA occurs most frequently in children as part of a disorder called Fanconi's syndrome. The features of Fanconi's syndrome include the abnormal excretion of glucose, amino acids, citrate, and phosphate into the urine, as well as vitamin D deficiency and low blood-potassium.

Proximal RTA can also result from inherited disorders that disrupt the body's normal breakdown and use of nutrients. Examples include the rare disease cystinosis, in which cystine crystals are deposited in bones and other tissues; hereditary fructose intolerance; and Wilson disease.

Proximal RTA also occurs in patients treated with ifosfamide, a drug used in chemotherapy. A few older drugssuch as acetazolamide or outdated tetracyclinecan also cause proximal RTA. In adults, proximal RTA may complicate diseases like multiple myeloma, or it may occur in people who experience chronic rejection of a transplanted kidney.

When possible, identifying and correcting the underlying causes are important steps in treating the acquired forms of proximal RTA. The diagnosis is based on the chemical analysis of blood and urine samples. Children with this disorder would likely receive large doses of an oral alkali, such as sodium bicarbonate or potassium citrate, to treat acidosis and prevent bone disorders, kidney stones, and growth failure. Correcting acidosis and low potassium levels restores normal growth patterns, allowing bone to mature while preventing further renal disease. Vitamin D supplements may also be needed to help prevent bone problems.

Type 3

Type 3 is rarely used as a classification because it is now thought to be a combination of type 1 and type 2.

Type 4: Hyperkalemic RTA

Type 4 is also called hyperkalemic RTA and is caused by a generalized transport abnormality of the distal tubule. The transport of electrolytes such as sodium, chloride, and potassium that normally occurs in the distal tubule is impaired. This form is distinguished from classical distal RTA and proximal RTA because it results in high levels of potassium in the blood instead of low levels. Either low potassiumhypokalemiaor high potassiumhyperkalemiacan be a problem because potassium is important in regulating heart rate.

Type 4 RTA occurs when blood levels of the hormone aldosterone are low or when the kidneys do not respond to it. Aldosterone directs the kidneys to regulate the levels of sodium, potassium, and chloride in the blood. Type 4 RTA also occurs when the tubule transport of electrolytes such as sodium, chloride, and potassium is impaired due to an inherited disorder or the use of certain drugs.

Drugs that may cause type 4 RTA include

- diuretics used to treat congestive heart failure such as spironolactone or eplerenone  - blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)  - the antibiotic trimethoprim  - the antibiotic pentamidine, which is used to treat pneumonia  - an agent called heparin that keeps blood from clotting  - a class of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs)  - some immunosuppressive drugs used to prevent rejection

Type 4 RTA may also result from diseases that alter kidney structure and function such as diabetic nephropathy, HIV/AIDS, Addison's disease, sickle cell disease, urinary tract obstruction, lupus, amyloidosis, removal or destruction of both adrenal glands, and kidney transplant rejection.

For people who produce aldosterone but cannot use it, researchers have identified the genetic basis for their body's resistance to the hormone. To treat type 4 RTA successfully, patients may require alkaline agents to correct acidosis and medication to lower the potassium in their blood.

If treated early, most people with any type of RTA will not develop permanent kidney failure. Therefore, the goal is early recognition and adequate therapy, which will need to be maintained and monitored throughout the person's lifetime. </s>


Input: What is (are) Renal Tubular Acidosis ?

Output:
Type 1: Classical Distal RTA

Type 1 is also called classical distal RTA. "Distal," which means distant, refers to the point in the urine-forming tube of the kidney where the defect occursrelatively distant from the point where fluid from the blood enters the tiny tube, or tubule, that collects fluid and wastes to form urine.

This disorder may be inherited as a primary disorder or may be one symptom of a disease that affects many parts of the body. Researchers have discovered abnormal genes responsible for the inherited forms of the disease. More often, however, classical distal RTA occurs as a result of systemic diseasesdiseases that affect many organ systemslike the autoimmune disorders Sjgren's syndrome and lupus, which also attack the distal tubule.

Other diseases and conditions associated with classical distal RTA include sickle cell anemia, hyperparathyroidism, hyperthyroidism, chronic active hepatitis, primary biliary cirrhosis, a hereditary form of deafness, analgesic nephropathy, rejection of a transplanted kidney, renal medullary cystic disease, obstructive uropathy, and chronic urinary tract infections. Many of these conditions cause abnormal calcium deposits to build up in the kidney and impair distal tubule function.

A major consequence of classical distal RTA is a low blood potassium level. The level drops if the kidneys excrete too much potassium into urine instead of returning it to the blood supply. Because potassium helps regulate nerve and muscle health and heart rate, low levels can cause extreme weakness, irregular heartbeat, paralysis, and even death.

Untreated classical distal RTA causes growth retardation in children and progressive kidney and bone disease in adults. Restoring normal growth and preventing kidney stones are the major goals of therapy. If acidosis is corrected with sodium bicarbonate or sodium citrate, then low blood-potassium, salt depletion, and calcium leakage into urine will be corrected. This alkali therapy also helps decrease the development of kidney stones and stabilizes kidney function so kidney failure does not progress. Infants may need potassium supplements, but older children and adults rarely do because alkali therapy prevents the kidney from excreting potassium into the urine.

Type 2: Proximal RTA

Type 2 is also called proximal RTA. The word "proximal," which means near, indicates that the defect is closer to the point where fluid and wastes from the blood enter the tubule.

This form of RTA occurs most frequently in children as part of a disorder called Fanconi's syndrome. The features of Fanconi's syndrome include the abnormal excretion of glucose, amino acids, citrate, and phosphate into the urine, as well as vitamin D deficiency and low blood-potassium.

Proximal RTA can also result from inherited disorders that disrupt the body's normal breakdown and use of nutrients. Examples include the rare disease cystinosis, in which cystine crystals are deposited in bones and other tissues; hereditary fructose intolerance; and Wilson disease.

Proximal RTA also occurs in patients treated with ifosfamide, a drug used in chemotherapy. A few older drugssuch as acetazolamide or outdated tetracyclinecan also cause proximal RTA. In adults, proximal RTA may complicate diseases like multiple myeloma, or it may occur in people who experience chronic rejection of a transplanted kidney.

When possible, identifying and correcting the underlying causes are important steps in treating the acquired forms of proximal RTA. The diagnosis is based on the chemical analysis of blood and urine samples. Children with this disorder would likely receive large doses of an oral alkali, such as sodium bicarbonate or potassium citrate, to treat acidosis and prevent bone disorders, kidney stones, and growth failure. Correcting acidosis and low potassium levels restores normal growth patterns, allowing bone to mature while preventing further renal disease. Vitamin D supplements may also be needed to help prevent bone problems.

Type 3

Type 3 is rarely used as a classification because it is now thought to be a combination of type 1 and type 2.

Type 4: Hyperkalemic RTA

Type 4 is also called hyperkalemic RTA and is caused by a generalized transport abnormality of the distal tubule. The transport of electrolytes such as sodium, chloride, and potassium that normally occurs in the distal tubule is impaired. This form is distinguished from classical distal RTA and proximal RTA because it results in high levels of potassium in the blood instead of low levels. Either low potassiumhypokalemiaor high potassiumhyperkalemiacan be a problem because potassium is important in regulating heart rate.

Type 4 RTA occurs when blood levels of the hormone aldosterone are low or when the kidneys do not respond to it. Aldosterone directs the kidneys to regulate the levels of sodium, potassium, and chloride in the blood. Type 4 RTA also occurs when the tubule transport of electrolytes such as sodium, chloride, and potassium is impaired due to an inherited disorder or the use of certain drugs.

Drugs that may cause type 4 RTA include

- diuretics used to treat congestive heart failure such as spironolactone or eplerenone  - blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)  - the antibiotic trimethoprim  - the antibiotic pentamidine, which is used to treat pneumonia  - an agent called heparin that keeps blood from clotting  - a class of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs)  - some immunosuppressive drugs used to prevent rejection

Type 4 RTA may also result from diseases that alter kidney structure and function such as diabetic nephropathy, HIV/AIDS, Addison's disease, sickle cell disease, urinary tract obstruction, lupus, amyloidosis, removal or destruction of both adrenal glands, and kidney transplant rejection.

For people who produce aldosterone but cannot use it, researchers have identified the genetic basis for their body's resistance to the hormone. To treat type 4 RTA successfully, patients may require alkaline agents to correct acidosis and medication to lower the potassium in their blood.

If treated early, most people with any type of RTA will not develop permanent kidney failure. Therefore, the goal is early recognition and adequate therapy, which will need to be maintained and monitored throughout the person's lifetime. </s>


Input: What to do for Renal Tubular Acidosis ?

Output: - Renal tubular acidosis (RTA) is a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a person's blood to remain too acidic.  - Without proper treatment, chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, chronic kidney disease, and possibly total kidney failure.  - If RTA is suspected, additional information about the sodium, potassium, and chloride levels in the urine and the potassium level in the blood will help identify which type of RTA a person has.  - In all cases, the first goal of therapy is to neutralize acid in the blood, but different treatments may be needed to address the different underlying causes of acidosis. </s>


Input: What to do for Renal Tubular Acidosis ?

Output: - Renal tubular acidosis (RTA) is a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a person's blood to remain too acidic.  - Without proper treatment, chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, chronic kidney disease, and possibly total kidney failure.  - If RTA is suspected, additional information about the sodium, potassium, and chloride levels in the urine and the potassium level in the blood will help identify which type of RTA a person has.  - In all cases, the first goal of therapy is to neutralize acid in the blood, but different treatments may be needed to address the different underlying causes of acidosis. </s>


Input: What is (are) Prevent diabetes problems: Keep your diabetes under control ?

Output:
Diabetes problems are health problems that can happen when you have diabetes. If your diabetes is not under control, you will have too much glucose*, also called sugar, in your blood. Having too much glucose in your blood for a long time can affect many important parts of your body, such as your

- blood vessels and heart  - nerves  - kidneys  - mouth  - eyes  - feet

You can do a lot to prevent or slow down these health problems if you keep your diabetes under control.

This chart shows the body parts that can be affected by diabetes and the resulting health problems you may have.

Affected Body Part    Resulting Health Problems You May Have          Blood vessels and heart             - Heart disease      - Heart attack      - Stroke      - High blood pressure      - Poor blood circulation, or flow, throughout your body            Nerves             - Pain, tingling, weakness, or numbness in your hands, arms, feet, or legs      - Problems with your bladder, digestion, having sex, and keeping your heartbeats and blood pressure steady            Kidneys             - Protein loss through your urine      - Buildup of wastes and fluid in your blood            Mouth             - Gum disease and loss of teeth      - Dry mouth      - Thrush, or the growth of too much fungus in the mouth            Eyes             - Loss of vision and blindness            Feet             - Sores      - Infections      - Amputation

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


Input: What is (are) Prevent diabetes problems: Keep your diabetes under control ?

Output:
The A1C test, also called the hemoglobin A1C test, HbA1C, or glycohemoglobin test, is a blood test that reflects the average level of glucose in your blood during the past 3 months. Your A1C test result is given in percents. Your doctor might use the A1C test to help diagnose your diabetes. Your doctor will draw a sample of your blood in the office or send you to a lab to have a sample of your blood drawn for the test. After being diagnosed with diabetes, you should have the A1C test at least twice a year.

Your A1C result plus your record of blood glucose numbers show whether your blood glucose is under control.

- If your A1C result is too high, you may need to change your diabetes care plan. Your health care team can help you decide what part of your plan to change. For instance, you might need to change your meal plan, your diabetes medicines, or your physical activity plan.  - If your A1C result is on target, then your diabetes treatment plan is working. The lower your A1C is, the lower your chance of having diabetes problems.

This chart shows the A1C goals for different types of people with diabetes.

Types of People    A1C Goals          Most people with diabetes    below 7%        Women with diabetes who want to get pregnant or who are pregnant    below 6%

A1C goals can also depend on

- how long you have had diabetes  - whether or not you have other health problems

Ask your doctor what goal is right for you.

This chart shows how your A1C result may match up to your average blood glucose number.

What Your A1C Result Means          My A1C Result    My Average Blood Glucose Number        6%    135        7%    170        8%    205        9%    240        10%    275        11%    310        12%    345 </s>


Input: What to do for Prevent diabetes problems: Keep your diabetes under control ?

Output:
Following a healthy eating plan is a key step in living with diabetes and preventing diabetes problems. Your health care team will help you make a healthy eating plan.

More information is provided in the NIDDK health topic, What I need to know about Eating and Diabetes or call 18008608747. </s>


Input: How to prevent Prevent diabetes problems: Keep your diabetes under control ?

Output:
You can take steps each day to prevent diabetes problems.

Steps          Healthy Eating                     - Follow the healthy eating plan that you and your doctor or dietitian have made.      - Learn what to eat to keep your blood glucose levels under control.      - Make wise food choices to help you feel good every day and to lose weight if needed.            Blood Glucose                     - Check your blood glucose every day.      - Each time you check your blood glucose, write the number in a record book to share with your health care team.      - Treat low blood glucose quickly.            Physical Activity                     - Even small amounts of physical activity help manage diabetes. Aim for 30 to 60 minutes of physical activity most days of the week. Children and adolescents with type 2 diabetes who are 10 to 17 years old should aim for 60 minutes of activity every day.      - Not all physical activity has to take place at the same time.      - Do aerobic activities, such as brisk walking, which use your large muscles to make your heart beat faster. The large muscles are those of the upper and lower arms and legs and those that control head, shoulder, and hip movements.      - Do activities to strengthen muscles and bone, such as lifting weights or sit-ups. Aim for two times a week.      - Stretch to increase your flexibility, lower stress, and help prevent muscle soreness after physical activity.      - Increase daily activity by decreasing time spent watching TV or at the computer. Children and adolescents should limit screen time not related to school to less than 2 hours per day. Limiting screen time can help you meet your physical activity goal.      - Always talk with your doctor before you start a new physical activity program.            Medicines                     - Take your medicines as directed, including insulin if ordered by your doctor.            Feet                     - Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.            Mouth                     - Brush and floss your teeth every day.            Blood Pressure                     - Control your blood pressure and cholesterol.            Smoking                     - Dont smoke. </s>


Input: How to diagnose Prevent diabetes problems: Keep your diabetes under control ?

Output:
This chart lists important tests, exams, and vaccines to get at least once or twice a year.

Tests, Exams, and Vaccines to Get at Least Once or Twice a Year    Make Sure to          A1C test             - Have this blood test at least twice a year. Your result will tell you what your average blood glucose level was for the past 3 months.            Cholesterol test             - Get a blood test to check your              - total cholesterol        - LDL        - HDL        - triglycerides                  Kidney tests             - Once a year, get a urine test to check for protein.      - At least once a year, get a blood test to check for creatinine, a waste product healthy kidneys remove from the body.            Eye exam             - See an eye doctor once a year for a complete eye exam that includes using drops in your eyes to dilate your pupils.      - If you are pregnant, have a complete eye exam in your first 3 months of pregnancy. Have another complete eye exam 1 year after your baby is born.            Dental exam             - See your dentist twice a year for a cleaning and checkup.            Flu vaccine             - Get a flu vaccine each year.            Pneumonia vaccine             - Get this vaccine if you are younger than 64.      - If youre older than 64 and your vaccine was more than 5 years ago, get another one.            Hepatitis B vaccine             - Get this vaccine if youre younger than 60 and you have not already had the vaccine.      - Prevent exposure to Hepatitis B by not sharing blood glucose monitors or other diabetes equipment. </s>


Input: What is (are) Hepatitis B: What Asian and Pacific Islander Americans Need to Know ?

Output:
Hepatitis B is a liver disease spread through contact with blood, semen, or other body fluids from a person infected with the hepatitis B virus. The disease is most commonly spread from an infected mother to her infant at birth. Hepatitis B is also spread through sex, wound-to-wound contact, and contact with items that may have blood on them, such as shaving razors, toothbrushes, syringes, and tattoo and body piercing needles.

Hepatitis B is not spread through casual contact such as shaking hands or hugging; nor is it spread by sharing food or beverages, by sneezing and coughing, or through breastfeeding. </s>


Input: What is (are) Hepatitis B: What Asian and Pacific Islander Americans Need to Know ?

Output:
Hepatitis B may start as a brief, flu-like illness. Most healthy adults and children older than 5 completely recover after the bodys immune system gets rid of the virus.

Hepatitis B becomes chronic when the bodys immune system cant get rid of the virus. Over time, having the virus can lead to inflammation of the liver; scar tissue in the liver, called cirrhosis; or liver cancer. Inflammation is the painful red swelling that results when tissues of the body become infected. Young children and people with weakened immune systems are especially at risk. People who were infected as infants have a 90 percent chance of developing chronic hepatitis B.1 </s>


Input: Who is at risk for Hepatitis B: What Asian and Pacific Islander Americans Need to Know? ?

Output: Since 1986, a hepatitis B vaccine has been available and should be given to newborns and children in the United States. The vaccine, however, is unavailableor has only recently become availablein many parts of the world. You are at higher risk for hepatitis B if you or your mother was born in a region of the world where hepatitis B is common, meaning 2 percent or more of the population is chronically infected with the hepatitis B virus.1 In most Asian and Pacific Island nations, 8 to 16 percent of the population is chronically infected.2 </s>


Input: What are the symptoms of Hepatitis B: What Asian and Pacific Islander Americans Need to Know ?

Output:
Hepatitis B is called a silent killer because many people have no symptoms, so the disease often progresses unnoticed for years. Unfortunately, many people first learn they have chronic hepatitis B when they develop symptoms of severe liver damage, which include

- yellowish eyes and skin, called jaundice  - a swollen stomach or ankles  - tiredness  - nausea  - weakness  - loss of appetite  - weight loss  - spiderlike blood vessels, called spider angiomas, that develop on the skin </s>


Input: Who is at risk for Hepatitis B: What Asian and Pacific Islander Americans Need to Know? ?

Output:
Anyone can get hepatitis B, but some people are at higher risk, including

- people who were born to a mother with hepatitis B  - people who have close household contact with someone infected with the hepatitis B virus  - people who have lived in parts of the world where hepatitis B is common, including most Asian and Pacific Island nations  - people who are exposed to blood or body fluids at work  - people on hemodialysis  - people whose sex partner(s) has hepatitis B  - people who have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease  - injection drug users  - men who have sex with men </s>


Input: What is (are) Acquired Cystic Kidney Disease ?

Output:
Acquired cystic kidney disease happens when a person's kidneys develop fluid-filled sacs, called cysts, over time. Acquired cystic kidney disease is not the same as polycystic kidney disease (PKD), another disease that causes the kidneys to develop multiple cysts.

Acquired cystic kidney disease occurs in children and adults who have

- chronic kidney disease (CKD)a condition that develops over many years and may lead to end-stage kidney disease, or ESRD. The kidneys of people with CKD gradually lose their ability to filter wastes, extra salt, and fluid from the blood properly.  - end-stage kidney diseasetotal and permanent kidney failure that requires a kidney transplant or blood-filtering treatments called dialysis.

The cysts are more likely to develop in people who are on kidney dialysis. The chance of developing acquired cystic kidney disease increases with the number of years a person is on dialysis. However, the cysts are caused by CKD or kidney failure, not dialysis treatments.

More information is provided in the NIDDK health topics, kidney failureand dialysis. </s>


Input: What is (are) Acquired Cystic Kidney Disease ?

Output:
Acquired cystic kidney disease differs from PKD in several ways. Unlike acquired cystic kidney disease, PKD is a genetic, or inherited, disorder that can cause complications such as high blood pressure and problems with blood vessels in the brain and heart.

The following chart lists the differences:

People with Polycystic Kidney Disease   - are born with a gene that causes the disease   - have enlarged kidneys   - develop cysts in the liver and other parts of the body   People with Acquired Cystic Kidney Disease   - do not have a disease-causing gene   - have kidneys that are normal-sized or smaller   - do not form cysts in other parts of the body

In addition, for people with PKD, the presence of cysts marks the onset of their disease, while people with acquired cystic kidney disease already have CKD when they develop cysts.

More information is provided in the NIDDK health topic, Polycystic Kidney Disease. </s>


Input: How many people are affected by Acquired Cystic Kidney Disease ?

Output:
Acquired cystic kidney disease becomes more common the longer a person has CKD.

- About 7 to 22 percent of people with CKD already have acquired cystic kidney disease before starting dialysis treatments.  - Almost 60 percent of people on dialysis for 2 to 4 years develop acquired cystic kidney disease.1  - About 90 percent of people on dialysis for 8 years develop acquired cystic kidney disease.1 </s>


Input: What causes Acquired Cystic Kidney Disease ?

Output: Researchers do not fully understand what causes cysts to grow in the kidneys of people with CKD. The fact that these cysts occur only in the kidneys and not in other parts of the body, as in PKD, indicates that the processes that lead to cyst formation take place primarily inside the kidneys.2 </s>


Input: What are the symptoms of Acquired Cystic Kidney Disease ?

Output: A person with acquired cystic kidney disease often has no symptoms. However, the complications of acquired cystic kidney disease can have signs and symptoms. </s>


Input: What are the complications of Acquired Cystic Kidney Disease ?

Output:
People with acquired cystic kidney disease may develop the following complications:

- an infected cyst, which can cause fever and back pain.  - blood in the urine, which can signal that a cyst in the kidney is bleeding.  - tumors in the kidneys. People with acquired cystic kidney disease are more likely than people in the general population to have cancerous kidney tumors. However, the chance of cancer spreading is lower in people with acquired cystic kidney disease than that of other kidney cancers not associated with acquired cystic kidney disease, and the long-term outlook is better.1 </s>


Input: How to diagnose Acquired Cystic Kidney Disease ?

Output:
A health care provider may diagnose a person with acquired cystic kidney disease based on

- medical history  - imaging tests

Medical History

Taking a medical history may help a health care provider diagnose acquired cystic kidney disease. A health care provider may suspect acquired cystic kidney disease if a person who has been on dialysis for several years develops symptoms such as fever, back pain, or blood in the urine.

Imaging Tests

To confirm the diagnosis, the health care provider may order one or more imaging tests. A radiologista doctor who specializes in medical imaginginterprets the images from these tests, and the patient does not need anesthesia.

- Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider's office, an outpatient center, or a hospital. The images can show cysts in the kidneys as well as the kidneys' size and shape.  - Computerized tomography (CT) scans use a combination of x rays and computer technology to create images. For a CT scan, a nurse or technician may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes the x-rays. An x-ray technician performs the procedure in an outpatient center or a hospital. CT scans can show cysts and tumors in the kidneys.  - Magnetic resonance imaging (MRI) is a test that takes pictures of the body's internal organs and soft tissues without using x-rays. A specially trained technician performs the procedure in an outpatient center or a hospital. Although the patient does not need anesthesia, a health care provider may give people with a fear of confined spaces light sedation, taken by mouth. An MRI may include the injection of contrast medium. With most MRI machines, the patient 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 patient to lie in a more open space. During an MRI, the patient, although usually awake, must remain 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 kidneys. During the test, the patient will hear loud mechanical knocking and humming noises from the machine.

Sometimes a health care provider may discover acquired cystic kidney disease during an imaging exam for another condition. Images of the kidneys may help the health care provider distinguish acquired cystic kidney disease from PKD. </s>


Input: What are the treatments for Acquired Cystic Kidney Disease ?

Output:
If acquired cystic kidney disease is not causing complications, a person does not need treatment. A health care provider will treat infections with antibioticsmedications that kill bacteria. If large cysts are causing pain, a health care provider may drain the cyst using a long needle inserted into the cyst through the skin.

When a surgeon transplants a new kidney into a patient's body to treat kidney failure, acquired cystic kidney disease in the damaged kidneys, which usually remain in place after a transplant, often disappears.

A surgeon may perform an operation to remove tumors or suspected tumors. In rare cases, a surgeon performs an operation to stop cysts from bleeding.

Have Regular Screenings to Look for Cyst or Tumor Growth   Some health care providers recommend all people with end-stage kidney disease get screened for kidney cancer using CT scans or MRIs after 3 years of dialysis. People with acquired cystic kidney disease should talk with their health care provider about when to begin screening. </s>


Input: What to do for Acquired Cystic Kidney Disease ?

Output:
No specific diet will prevent or delay acquired cystic kidney disease. In general, a diet designed for people on hemodialysis or peritoneal dialysis reduces the amount of wastes that accumulate in the body between dialysis sessions.

More information is provided in the NIDDK health topics, Eat Right to Feel Right on Hemodialysis and Nutrition for Advanced Chronic Kidney Disease in Adults. </s>


Input: What to do for Acquired Cystic Kidney Disease ?

Output: - Acquired cystic kidney disease happens when a person's kidneys develop fluid-filled sacs, called cysts, over time.  - Acquired cystic kidney disease occurs in children and adults who have      - chronic kidney disease (CKD)    - end-stage kidney disease (ESRD)    - People with acquired cystic kidney disease may develop the following complications:      - an infected cyst, which can cause fever and back pain    - blood in the urine, which can signal that a cyst in the kidney is bleeding    - tumors in the kidneys    - To confirm the diagnosis, the health care provider may order one or more imaging tests:      - Ultrasound    - Computerized tomography (CT) scan    - Magnetic resonance imaging (MRI)    - If acquired cystic kidney disease is not causing complications, a person does not need treatment.  - A health care provider will treat infections with antibioticsmedications that kill bacteria.  - If large cysts are causing pain, a health care provider may drain the cyst using a long needle inserted into the cyst through the skin.  - A surgeon may perform an operation to remove tumors or suspected tumors. In rare cases, a surgeon performs an operation to stop cysts from bleeding. </s>


Input: What is (are) Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output:
Benign prostatic hyperplasiaalso called BPHis a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.

The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a mans life. Benign prostatic hyperplasia often occurs with the second growth phase.

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retentionthe inability to empty the bladder completelycause many of the problems associated with benign prostatic hyperplasia. </s>


Input: What is (are) Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output: The prostate is a walnut-shaped gland that is part of the male reproductive system. The main function of the prostate is to make a fluid that goes into semen. Prostate fluid is essential for a mans fertility. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The bladder and urethra are parts of the lower urinary tract. The prostate has two or more lobes, or sections, enclosed by an outer layer of tissue, and it is in front of the rectum, just below the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis. </s>


Input: What causes Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output:
The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men. Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to aging and the testicles may cause benign prostatic hyperplasia.

Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.

Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia. </s>


Input: How many people are affected by Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output: Benign prostatic hyperplasia is the most common prostate problem for men older than age 50. In 2010, as many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign prostatic hyperplasia.1 Although benign prostatic hyperplasia rarely causes symptoms before age 40, the occurrence and symptoms increase with age. Benign prostatic hyperplasia affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80.2 </s>


Input: What are the symptoms of Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output:
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include

- urinary frequencyurination eight or more times a day  - urinary urgencythe inability to delay urination  - trouble starting a urine stream  - a weak or an interrupted urine stream  - dribbling at the end of urination  - nocturiafrequent urination during periods of sleep  - urinary retention  - urinary incontinencethe accidental loss of urine  - pain after ejaculation or during urination  - urine that has an unusual color or smell

Symptoms of benign prostatic hyperplasia most often come from

- a blocked urethra  - a bladder that is overworked from trying to pass urine through the blockage

The size of the prostate does not always determine the severity of the blockage or symptoms. Some men with greatly enlarged prostates have little blockage and few symptoms, while other men who have minimally enlarged prostates have greater blockage and more symptoms. Less than half of all men with benign prostatic hyperplasia have lower urinary tract symptoms.3

Sometimes men may not know they have a blockage until they cannot urinate. This condition, called acute urinary retention, can result from taking over-the-counter cold or allergy medications that contain decongestants, such as pseudoephedrine and oxymetazoline. A potential side effect of these medications may prevent the bladder neck from relaxing and releasing urine. Medications that contain antihistamines, such as diphenhydramine, can weaken the contraction of bladder muscles and cause urinary retention, difficulty urinating, and painful urination. When men have partial urethra blockage, urinary retention also can occur as a result of alcohol consumption, cold temperatures, or a long period of inactivity. </s>


Input: What are the complications of Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output:
The complications of benign prostatic hyperplasia may include

- acute urinary retention  - chronic, or long lasting, urinary retention  - blood in the urine  - urinary tract infections (UTIs)  - bladder damage  - kidney damage  - bladder stones

Most men with benign prostatic hyperplasia do not develop these complications. However, kidney damage in particular can be a serious health threat when it occurs.

When to Seek Medical Care   A person may have urinary symptoms unrelated to benign prostatic hyperplasia that are caused by bladder problems, UTIs, or prostatitisinflammation of the prostate. Symptoms of benign prostatic hyperplasia also can signal more serious conditions, including prostate cancer.   Men with symptoms of benign prostatic hyperplasia should see a health care provider.   Men with the following symptoms should seek immediate medical care:   - complete inability to urinate   - painful, frequent, and urgent need to urinate, with fever and chills   - blood in the urine   - great discomfort or pain in the lower abdomen and urinary tract </s>


Input: How to diagnose Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output:
A health care provider diagnoses benign prostatic hyperplasia based on

- a personal and family medical history  - a physical exam  - medical tests

Personal and Family Medical History

Taking a personal and family medical history is one of the first things a health care provider may do to help diagnose benign prostatic hyperplasia. A health care provider may ask a man

- what symptoms are present  - when the symptoms began and how often they occur  - whether he has a history of recurrent UTIs  - what medications he takes, both prescription and over the counter  - how much liquid he typically drinks each day  - whether he consumes caffeine and alcohol  - about his general medical history, including any significant illnesses or surgeries

Physical Exam

A physical exam may help diagnose benign prostatic hyperplasia. During a physical exam, a health care provider most often

- examines a patients body, which can include checking for      - discharge from the urethra    - enlarged or tender lymph nodes in the groin    - a swollen or tender scrotum    - taps on specific areas of the patients body  - performs a digital rectal exam

A digital rectal exam, or rectal exam, is a physical exam of the prostate. To perform the exam, the health care provider asks the man to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to the rectum. The man may feel slight, brief discomfort during the rectal exam. A health care provider most often performs a rectal exam during an office visit, and men do not require anesthesia. The exam helps the health care provider see if the prostate is enlarged or tender or has any abnormalities that require more testing.

Many health care providers perform a rectal exam as part of a routine physical exam for men age 40 or older, whether or not they have urinary problems.

Medical Tests

A health care provider may refer men to a urologista doctor who specializes in urinary problems and the male reproductive systemthough the health care provider most often diagnoses benign prostatic hyperplasia on the basis of symptoms and a digital rectal exam. A urologist uses medical tests to help diagnose lower urinary tract problems related to benign prostatic hyperplasia and recommend treatment. Medical tests may include

- urinalysis  - a prostate-specific antigen (PSA) blood test  - urodynamic tests  - cystoscopy  - transrectal ultrasound  - biopsy

Urinalysis. Urinalysis involves testing a urine sample. The patient collects a urine sample in a special container in a health care providers office or a commercial facility. A health care provider tests the sample during an office visit or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color to indicate signs of infection in urine.

PSA blood test. A health care provider may draw blood for a PSA test during an office visit or in a commercial facility and send the sample to a lab for analysis. Prostate cells create a protein called PSA. Men who have prostate cancer may have a higher amount of PSA in their blood. However, a high PSA level does not necessarily indicate prostate cancer. In fact, benign prostatic hyperplasia, prostate infections, inflammation, aging, and normal fluctuations often cause high PSA levels. Much remains unknown about how to interpret a PSA blood test, the tests ability to discriminate between cancer and prostate conditions such as benign prostatic hyperplasia, and the best course of action to take if the PSA level is high.

Urodynamic tests. Urodynamic tests include a variety of procedures that look at how well the bladder and urethra store and release urine. A health care provider performs urodynamic tests during an office visit or in an outpatient center or a hospital. Some urodynamic tests do not require anesthesia; others may require local anesthesia. Most urodynamic tests focus on the bladders ability to hold urine and empty steadily and completely and may include the following:

- uroflowmetry, which measures how rapidly the bladder releases urine  - postvoid residual measurement, which evaluates how much urine remains in the bladder after urination  - reduced urine flow or residual urine in the bladder, which often suggests urine blockage due to benign prostatic hyperplasia

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

Cystoscopy. Cystoscopy is a procedure that uses a tubelike instrument, called a cystoscope, to look inside the urethra and bladder. A urologist inserts the cystoscope through the opening at the tip of the penis and into the lower urinary tract. A urologist performs cystoscopy during an office visit or in an outpatient center or a hospital. The urologist will give the patient local anesthesia; however, in some cases, the patient may require sedation and regional or general anesthesia. A urologist may use cystoscopy to look for blockage or stones in the urinary tract.

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

Transrectal ultrasound. Transrectal ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The health care provider can move the transducer to different angles to make it possible to examine different organs. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images; the patient does not require anesthesia. Urologists most often use transrectal ultrasound to examine the prostate. In a transrectal ultrasound, the technician inserts a transducer slightly larger than a pen into the mans rectum, next to the prostate. The ultrasound image shows the size of the prostate and any abnormalities, such as tumors. Transrectal ultrasound cannot reliably diagnose prostate cancer.

Biopsy. Biopsy is a procedure that involves taking a small piece of prostate tissue for examination with a microscope. A urologist performs the biopsy in an outpatient center or a hospital. The urologist will give the patient light sedation and local anesthetic; however, in some cases, the patient will require general anesthesia. The urologist uses imaging techniques such as ultrasound, a computerized tomography scan, or magnetic resonance imaging to guide the biopsy needle into the prostate. A pathologista doctor who specializes in examining tissues to diagnose diseasesexamines the prostate tissue in a lab. The test can show whether prostate cancer is present.

More information is provided in the NIDDK health topic, Medical Tests for Prostate Problems. </s>


Input: What are the treatments for Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output:
Treatment options for benign prostatic hyperplasia may include

- lifestyle changes  - medications  - minimally invasive procedures  - surgery

A health care provider treats benign prostatic hyperplasia based on the severity of symptoms, how much the symptoms affect a mans daily life, and a mans preferences.

Men may not need treatment for a mildly enlarged prostate unless their symptoms are bothersome and affecting their quality of life. In these cases, instead of treatment, a urologist may recommend regular checkups. If benign prostatic hyperplasia symptoms become bothersome or present a health risk, a urologist most often recommends treatment.

Lifestyle Changes

A health care provider may recommend lifestyle changes for men whose symptoms are mild or slightly bothersome. Lifestyle changes can include

- reducing intake of liquids, particularly before going out in public or before periods of sleep  - avoiding or reducing intake of caffeinated beverages and alcohol  - avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics  - training the bladder to hold more urine for longer periods  - exercising pelvic floor muscles  - preventing or treating constipation

Medications

A health care provider or urologist may prescribe medications that stop the growth of or shrink the prostate or reduce symptoms associated with benign prostatic hyperplasia:

- alpha blockers  - phosphodiesterase-5 inhibitors  - 5-alpha reductase inhibitors  - combination medications

Alpha blockers. These medications relax the smooth muscles of the prostate and bladder neck to improve urine flow and reduce bladder blockage:

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

Phosphodiesterase-5 inhibitors. Urologists prescribe these medications mainly for erectile dysfunction. Tadalafil (Cialis) belongs to this class of medications and can reduce lower urinary tract symptoms by relaxing smooth muscles in the lower urinary tract. Researchers are working to determine the role of erectile dysfunction drugs in the long-term treatment of benign prostatic hyperplasia.

5-alpha reductase inhibitors. These medications block the production of DHT, which accumulates in the prostate and may cause prostate growth:

- finasteride (Proscar)  - dutasteride (Avodart)

These medications can prevent progression of prostate growth or actually shrink the prostate in some men. Finasteride and dutasteride act more slowly than alpha blockers and are useful for only moderately enlarged prostates.

Combination medications. Several studies, such as the Medical Therapy of Prostatic Symptoms (MTOPS) study, have shown that combining two classes of medications, instead of using just one, can more effectively improve symptoms, urinary flow, and quality of life. The combinations include

- finasteride and doxazosin  - dutasteride and tamsulosin (Jalyn), a combination of both medications that is available in a single tablet  - alpha blockers and antimuscarinics

A urologist may prescribe a combination of alpha blockers and antimuscarinics for patients with overactive bladder symptoms. Overactive bladder is a condition in which the bladder muscles contract uncontrollably and cause urinary frequency, urinary urgency, and urinary incontinence. Antimuscarinics are a class of medications that relax the bladder muscles.

Minimally Invasive Procedures

Researchers have developed a number of minimally invasive procedures that relieve benign prostatic hyperplasia symptoms when medications prove ineffective. These procedures include

- transurethral needle ablation  - transurethral microwave thermotherapy  - high-intensity focused ultrasound  - transurethral electrovaporization  - water-induced thermotherapy  - prostatic stent insertion

Minimally invasive procedures can destroy enlarged prostate tissue or widen the urethra, which can help relieve blockage and urinary retention caused by benign prostatic hyperplasia.

Urologists perform minimally invasive procedures using the transurethral method, which involves inserting a cathetera thin, flexible tubeor cystoscope through the urethra to reach the prostate. These procedures may require local, regional, or general anesthesia. Although destroying troublesome prostate tissue relieves many benign prostatic hyperplasia symptoms, tissue destruction does not cure benign prostatic hyperplasia. A urologist will decide which procedure to perform based on the mans symptoms and overall health.

Transurethral needle ablation. This procedure uses heat generated by radiofrequency energy to destroy prostate tissue. A urologist inserts a cystoscope through the urethra to the prostate. A urologist then inserts small needles through the end of the cystoscope into the prostate. The needles send radiofrequency energy that heats and destroys selected portions of prostate tissue. Shields protect the urethra from heat damage.

Transurethral microwave thermotherapy. This procedure uses microwaves to destroy prostate tissue. A urologist inserts a catheter through the urethra to the prostate, and a device called an antenna sends microwaves through the catheter to heat selected portions of the prostate. The temperature becomes high enough inside the prostate to destroy enlarged tissue. A cooling system protects the urinary tract from heat damage during the procedure.

High-intensity focused ultrasound. For this procedure, a urologist inserts a special ultrasound probe into the rectum, near the prostate. Ultrasound waves from the probe heat and destroy enlarged prostate tissue.

Transurethral electrovaporization. For this procedure, a urologist inserts a tubelike instrument called a resectoscope through the urethra to reach the prostate. An electrode attached to the resectoscope moves across the surface of the prostate and transmits an electric current that vaporizes prostate tissue. The vaporizing effect penetrates below the surface area being treated and seals blood vessels, which reduces the risk of bleeding.

Water-induced thermotherapy. This procedure uses heated water to destroy prostate tissue. A urologist inserts a catheter into the urethra so that a treatment balloon rests in the middle of the prostate. Heated water flows through the catheter into the treatment balloon, which heats and destroys the surrounding prostate tissue. The treatment balloon can target a specific region of the prostate, while surrounding tissues in the urethra and bladder remain protected.

Prostatic stent insertion. This procedure involves a urologist inserting a small device called a prostatic stent through the urethra to the area narrowed by the enlarged prostate. Once in place, the stent expands like a spring, and it pushes back the prostate tissue, widening the urethra. Prostatic stents may be temporary or permanent. Urologists generally use prostatic stents in men who may not tolerate or be suitable for other procedures.

Surgery

For long-term treatment of benign prostatic hyperplasia, a urologist may recommend removing enlarged prostate tissue or making cuts in the prostate to widen the urethra. Urologists recommend surgery when

- medications and minimally invasive procedures are ineffective  - symptoms are particularly bothersome or severe  - complications arise

Although removing troublesome prostate tissue relieves many benign prostatic hyperplasia symptoms, tissue removal does not cure benign prostatic hyperplasia.

Surgery to remove enlarged prostate tissue includes

- transurethral resection of the prostate (TURP)  - laser surgery  - open prostatectomy  - transurethral incision of the prostate (TUIP)

A urologist performs these surgeries, except for open prostatectomy, using the transurethral method. Men who have these surgical procedures require local, regional, or general anesthesia and may need to stay in the hospital.

The urologist may prescribe antibiotics before or soon after surgery to prevent infection. Some urologists prescribe antibiotics only when an infection occurs.

Immediately after benign prostatic hyperplasia surgery, a urologist may insert a special catheter, called a Foley catheter, through the opening of the penis to drain urine from the bladder into a drainage pouch.

TURP. With TURP, a urologist inserts a resectoscope through the urethra to reach the prostate and cuts pieces of enlarged prostate tissue with a wire loop. Special fluid carries the tissue pieces into the bladder, and the urologist flushes them out at the end of the procedure. TURP is the most common surgery for benign prostatic hyperplasia and considered the gold standard for treating blockage of the urethra due to benign prostatic hyperplasia.

Laser surgery. With this surgery, a urologist uses a high-energy laser to destroy prostate tissue. The urologist uses a cystoscope to pass a laser fiber through the urethra into the prostate. The laser destroys the enlarged tissue. The risk of bleeding is lower than in TURP and TUIP because the laser seals blood vessels as it cuts through the prostate tissue. However, laser surgery may not effectively treat greatly enlarged prostates.

Open prostatectomy. In an open prostatectomy, a urologist makes an incision, or cut, through the skin to reach the prostate. The urologist can remove all or part of the prostate through the incision. This surgery is used most often when the prostate is greatly enlarged, complications occur, or the bladder is damaged and needs repair. Open prostatectomy requires general anesthesia, a longer hospital stay than other surgical procedures for benign prostatic hyperplasia, and a longer rehabilitation period. The three open prostatectomy procedures are retropubic prostatectomy, suprapubic prostatectomy, and perineal prostatectomy. The recovery period for open prostatectomy is different for each man who undergoes the procedure. However, it typically takes anywhere from 3 to 6 weeks.4

TUIP. A TUIP is a surgical procedure to widen the urethra. During a TUIP, the urologist inserts a cystoscope and an instrument that uses an electric current or a laser beam through the urethra to reach the prostate. The urologist widens the urethra by making a few small cuts in the prostate and in the bladder neck. Some urologists believe that TUIP gives the same relief as TURP except with less risk of side effects.

After surgery, the prostate, urethra, and surrounding tissues may be irritated and swollen, causing urinary retention. To prevent urinary retention, a urologist inserts a Foley catheter so urine can drain freely out of the bladder. A Foley catheter has a balloon on the end that the urologist inserts into the bladder. Once the balloon is inside the bladder, the urologist fills it with sterile water to keep the catheter in place. Men who undergo minimally invasive procedures may not need a Foley catheter.

The Foley catheter most often remains in place for several days. Sometimes, the Foley catheter causes recurring, painful, difficult-to-control bladder spasms the day after surgery. However, these spasms will eventually stop. A urologist may prescribe medications to relax bladder muscles and prevent bladder spasms. These medications include

- oxybutynin chloride (Ditropan)  - solifenacin (VESIcare)  - darifenacin (Enablex)  - tolterodine (Detrol)  - hyoscyamine (Levsin)  - propantheline bromide (Pro-Banthine) </s>


Input: What are the treatments for Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output:
The complications of benign prostatic hyperplasia treatment depend on the type of treatment.

Medications

Medications used to treat benign prostatic hyperplasia may have side effects that sometimes can be serious. Men who are prescribed medications to treat benign prostatic hyperplasia should discuss possible side effects with a health care provider before taking the medications. Men who experience the following side effects should contact a health care provider right away or get emergency medical care:

- hives  - rash  - itching  - shortness of breath  - rapid, pounding, or irregular heartbeat  - painful erection of the penis that lasts for hours  - swelling of the eyes, face, tongue, lips, throat, arms, hands, feet, ankles, or lower legs  - difficulty breathing or swallowing  - chest pain  - dizziness or fainting when standing up suddenly  - sudden decrease or loss of vision  - blurred vision  - sudden decrease or loss of hearing  - chest pain, dizziness, or nausea during sexual activity

These side effects are mostly related to phosphodiesterase-5 inhibitors. Side effects related to alpha blockers include

- dizziness or fainting when standing up suddenly  - decreased sexual drive  - problems with ejaculation

Minimally Invasive Procedures

Complications after minimally invasive procedures may include

- UTIs  - painful urination  - difficulty urinating  - an urgent or a frequent need to urinate  - urinary incontinence  - blood in the urine for several days after the procedure  - sexual dysfunction  - chronic prostatitislong-lasting inflammation of the prostate  - recurring problems such as urinary retention and UTIs

Most of the complications of minimally invasive procedures go away within a few days or weeks. Minimally invasive procedures are less likely to have complications than surgery.

Surgery

Complications after surgery may include

- problems urinating  - urinary incontinence  - bleeding and blood clots  - infection  - scar tissue  - sexual dysfunction  - recurring problems such as urinary retention and UTIs

Problems urinating. Men may initially have painful urination or difficulty urinating. They may experience urinary frequency, urgency, or retention. These problems will gradually lessen and, after a couple of months, urination will be easier and less frequent.

Urinary incontinence. As the bladder returns to normal, men may have some temporary problems controlling urination. However, long-term urinary incontinence rarely occurs. The longer urinary problems existed before surgery, the longer it takes for the bladder to regain its full function after surgery.

Bleeding and blood clots. After benign prostatic hyperplasia surgery, the prostate or tissues around it may bleed. Blood or blood clots may appear in urine. Some bleeding is normal and should clear up within several days. However, men should contact a health care provider right away if

- they experience pain or discomfort  - their urine contains large clots  - their urine is so red it is difficult to see through

Blood clots from benign prostatic hyperplasia surgery can pass into the bloodstream and lodge in other parts of the bodymost often the legs. Men should contact a health care provider right away if they experience swelling or discomfort in their legs.

Infection. Use of a Foley catheter after benign prostatic hyperplasia surgery may increase the risk of a UTI. Anesthesia during surgery may cause urinary retention and also increase the risk of a UTI. In addition, the incision site of an open prostatectomy may become infected. A health care provider will prescribe antibiotics to treat infections.

Scar tissue. In the year after the original surgery, scar tissue sometimes forms and requires surgical treatment. Scar tissue may form in the urethra and cause it to narrow. A urologist can solve this problem during an office visit by stretching the urethra. Rarely, the opening of the bladder becomes scarred and shrinks, causing blockage. This problem may require a surgical procedure similar to TUIP.

Sexual dysfunction. Some men may experience temporary problems with sexual function after benign prostatic hyperplasia surgery. The length of time for restored sexual function depends on the type of benign prostatic hyperplasia surgery performed and how long symptoms were present before surgery. Many men have found that concerns about sexual function can interfere with sex as much as the benign prostatic hyperplasia surgery itself. Understanding the surgical procedure and talking about concerns with a health care provider before surgery often help men regain sexual function earlier. Many men find it helpful to talk with a counselor during the adjustment period after surgery. Even though it can take a while for sexual function to fully return, with time, most men can enjoy sex again.

Most health care providers agree that if men with benign prostatic hyperplasia were able to maintain an erection before surgery, they will probably be able to have erections afterward. Surgery rarely causes a loss of erectile function. However, benign prostatic hyperplasia surgery most often cannot restore function that was lost before the procedure. Some men find a slight difference in the quality of orgasm after surgery. However, most report no difference.

Prostate surgery may make men sterile, or unable to father children, by causing retrograde ejaculationthe backward flow of semen into the bladder. Men flush the semen out of the bladder when they urinate. In some cases, medications such as pseudoephedrine, found in many cold medications, or imipramine can treat retrograde ejaculation. These medications improve muscle tone at the bladder neck and keep semen from entering the bladder.

Recurring problems. Men may require further treatment if prostate problems, including benign prostatic hyperplasia, return. Problems may arise when treatments for benign prostatic hyperplasia leave a good part of the prostate intact. About 10 percent of men treated with TURP or TUIP require additional surgery within 5 years. About 2 percent of men who have an open prostatectomy require additional surgery within 5 years.2

In the years after benign prostatic hyperplasia surgery or treatment, men should continue having a digital rectal exam once a year and have any symptoms checked by a health care provider. In some cases, the health care provider may recommend a digital rectal exam and checkup more than once a year. </s>


Input: How to prevent Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output: Researchers have not found a way to prevent benign prostatic hyperplasia. Men with risk factors for benign prostatic hyperplasia should talk with a health care provider about any lower urinary tract symptoms and the need for regular prostate exams. Men can get early treatment and minimize benign prostatic hyperplasia effects by recognizing lower urinary tract symptoms and identifying an enlarged prostate. </s>


Input: What to do for Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output: Researchers have not found that eating, diet, and nutrition play a role in causing or preventing benign prostatic hyperplasia. However, a health care provider can give information about how changes in eating, diet, or nutrition could help with treatment. Men should talk with a health care provider or dietitian about what diet is right for them. </s>


Input: What to do for Prostate Enlargement: Benign Prostatic Hyperplasia ?

Output: - Benign prostatic hyperplasiaalso called BPHis a condition in men in which the prostate gland is enlarged and not cancerous.  - The prostate is a walnut-shaped gland that is part of the male reproductive system.  - The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men.  - Benign prostatic hyperplasia is the most common prostate problem for men older than age 50.  - Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include      - urinary frequencyurination eight or more times a day    - urinary urgencythe inability to delay urination    - trouble starting a urine stream    - a weak or an interrupted urine stream    - dribbling at the end of urination    - nocturiafrequent urination during periods of sleep    - urinary retentionthe inability to empty the bladder completely    - urinary incontinencethe accidental loss of urine    - pain after ejaculation or during urination    - urine that has an unusual color or smell    - The complications of benign prostatic hyperplasia may include      - acute urinary retention    - chronic, or long lasting, urinary retention    - blood in the urine    - urinary tract infections (UTIs)    - bladder damage    - kidney damage    - bladder stones    - A health care provider diagnoses benign prostatic hyperplasia based on      - a personal and family medical history    - a physical exam    - medical tests    - Treatment options for benign prostatic hyperplasia may include      - lifestyle changes    - medications    - minimally invasive procedures    - surgery    - The complications of benign prostatic hyperplasia treatment depend on the type of treatment.  - Researchers have not found a way to prevent benign prostatic hyperplasia.  - Researchers have not found that eating, diet, and nutrition play a role in causing or preventing benign prostatic hyperplasia. </s>


Input: What is (are) What I need to know about My Child's Urinary Tract Infection ?

Output:
A UTI is an infection in the urinary tract. Infections are caused by microbesorganisms too small to be seen without a microscope. Bacteria * are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are quickly removed by the body before they cause symptoms. But sometimes bacteria overcome the bodys natural defenses and cause infection.

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


Input: What causes What I need to know about My Child's Urinary Tract Infection ?

Output:
Most UTIs are caused by bacteria that live in the bowel, the part of the digestive tract where stool is changed from liquid to solid. The bacterium Escherichia coli (E. coli) causes most UTIs. The urinary tract has several systems to prevent infection. The points where the ureters attach to the bladder act like one-way valves to prevent urine from backing up, or refluxing, toward the kidneys, and urination washes microbes out of the body. The bodys natural defenses also prevent infection. But despite these safeguards, infections still occur.

Other factors that may cause a child to get a UTI include the following:

- Waiting to urinate. Regular urination helps flush away bacteria. Holding urine allows bacteria to grow.  - Making too little urine. A child that doesnt drink enough fluids may not make enough urine to flush away bacteria.  - Constipation. Constipation is a condition in which a child has fewer than two bowel movements a week. Stools can be hard, dry, small, and difficult to pass. The hard stool in the bowel may press against the urinary tract and block the flow of urine, allowing bacteria to grow.

Some children are just more prone to UTIs than others, just as some children are more prone to getting coughs, colds, or ear infections. </s>


Input: Who is at risk for What I need to know about My Child's Urinary Tract Infection? ?

Output:
Any child can get a UTI, though girls get UTIs more often than boys.

Children with a condition called vesicoureteral reflux (VUR) are at higher risk for UTIs. VUR causes urine to reflux at the point where one or both ureters attach to the bladder. When urine stays in the urinary tract, bacteria have a chance to grow and spread. Infants and young children who get a UTI often have VUR.

Boys younger than 6 months who are not circumcised are at greater risk for a UTI than circumcised boys the same age. Boys who are circumcised have had the foreskin, which is the skin that covers the tip of the penis, removed. </s>


Input: What are the symptoms of What I need to know about My Child's Urinary Tract Infection ?

Output:
A child with a UTI may not have any symptoms. When symptoms are present, they can range from mild to severe. UTI symptoms can include

- fever  - pain or burning during urination with only a few drops of urine at a time  - irritability  - not eating  - nausea  - diarrhea  - vomiting  - cloudy, dark, bloody, or foul-smelling urine  - urinating often  - pain in the back or side below the ribs  - leaking urine into clothes or bedding in older children </s>


Input: How to diagnose What I need to know about My Child's Urinary Tract Infection ?

Output:
A UTI is diagnosed by testing a sample of your childs urine. The way the urine is collected depends on your childs age:

The health care provider looks at the urine sample with a microscope to check for bacteria or pus. The sample is also sent to a lab. The lab performs a urine culture by placing the sample in a tube or dish with a substance that encourages any bacteria present to grow. The bacteria that grow can be identified and tested to see which medicines will work best to treat the infection. A urine culture usually takes 1 to 3 days to complete. </s>


Input: What are the treatments for What I need to know about My Child's Urinary Tract Infection ?

Output:
Bacteria-fighting medicines called antibiotics are used to treat a UTI. While the lab is doing the urine culture, the health care provider may begin treatment with an antibiotic that treats the bacteria most likely to be causing the infection. Once culture results are known, the health care provider may switch your child to a different antibiotic that targets the specific type of bacteria.

Your child will need to take antibiotics for at least 3 to 5 days and maybe as long as several weeks. Be sure your child takes every pill or every dose of liquid. Your child should feel better after a couple of days, but the infection might come back if your child stops taking the antibiotic too early.

You should let your child drink as much as your child wants. But dont force your child to drink large amounts of fluid. Call your childs health care provider if your child doesnt want to or isnt able to drink. Also, talk with your childs health care provider if your child needs medicine for the pain of a UTI. The health care provider can recommend an over-the-counter pain medicine. A heating pad on the back or abdomen may also help. </s>


Input: How to diagnose What I need to know about My Child's Urinary Tract Infection ?

Output: Talk with your childs health care provider after your childs UTI is gone. The health care provider may want to do more tests to check for VUR or a blockage in the urinary tract. Repeated infections in an abnormal urinary tract may cause kidney damage. The kinds of tests ordered will depend on the child and the type of infection. VUR and blockages in the urinary tract often go away as a child grows. In some cases, surgery may be needed to correct any defects in the urinary tract. More information about tests for VUR or a blockage in the urinary tract is provided in the NIDDK health topic, Urinary Tract Infections in Children. </s>


Input: How to prevent What I need to know about My Child's Urinary Tract Infection ?

Output:
You can take the following steps to help prevent your child from getting a UTI:

- Teach your child not to hold in urine and to go to the bathroom whenever your child feels the urge.  - Teach your child how to properly clean himself or herself after using the bathroom to keep bacteria from entering the urinary tract.  - Have your child wear loose-fitting clothes. Tight clothes can trap moisture, which allows bacteria to grow.  - Buy your child cotton underwear. Cotton lets in air to dry the area.  - If your child has constipation, talk with a health care provider about the best treatment options. </s>


Input: What to do for What I need to know about My Child's Urinary Tract Infection ?

Output: To help prevent a UTI, make sure your child drinks enough fluids each day. Talk with your childs health care provider to find out how much fluid your child should drink. </s>


Input: What to do for What I need to know about My Child's Urinary Tract Infection ?

Output: - A urinary tract infection (UTI) is an infection in the urinary tract. Infections are caused by microbesorganisms too small to be seen without a microscope.  - Most UTIs are caused by bacteria that live in the bowel, the part of the digestive tract where stool is changed from liquid to solid.  - Any child can get a UTI, though girls get UTIs more often than boys.  - Most UTIs are not serious, but some infections can lead to serious problems.  - A child with a UTI may not have any symptoms. When symptoms are present, they can range from mild to severe.  - A UTI is diagnosed by testing a sample of your childs urine.  - Bacteria-fighting medicines called antibiotics are used to treat a UTI.  - Talk with your childs health care provider after your childs UTI is gone. The health care provider may want to do more tests to check for vesicoureteral reflux (VUR) or a blockage in the urinary tract.  - You can take steps to help prevent your child from getting a UTI. </s>


Input: What is (are) Primary Biliary Cirrhosis ?

Output:
Primary biliary cirrhosis is a chronic, or long lasting, disease that causes the small bile ducts in the liver to become inflamed and damaged and ultimately disappear.

The bile ducts carry a fluid called bile from the liver to the gallbladder, where it is stored. When food enters the stomach after a meal, the gallbladder contracts, and the bile ducts carry bile to the duodenum, the first part of the small intestine, for use in digestion. The liver makes bile, which is made up of bile acids, cholesterol, fats, and fluids. Bile helps the body absorb fats, cholesterol, and fat-soluble vitamins. Bile also carries cholesterol, toxins, and waste products to the intestines, where the body removes them. When chronic inflammation, or swelling, damages the bile ducts, bile and toxic wastes build up in the liver, damaging liver tissue.

This damage to the liver tissue can lead to cirrhosis, a condition in which the liver slowly deteriorates and is unable to function normally. In cirrhosis, scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver.

The liver is the bodys largest internal organ. The liver is called the bodys metabolic factory because of the important role it plays in metabolismthe way cells change food into energy after food is digested and absorbed into the blood. The liver has many functions, including

- taking up, storing, and processing nutrients from foodincluding fat, sugar, and proteinand delivering them to the rest of the body when needed  - making new proteins, such as clotting factors and immune factors  - producing bile  - removing waste products the kidneys cannot remove, such as fats, cholesterol, toxins, and medications

A healthy liver is necessary for survival. The liver can regenerate most of its own cells when they become damaged. However, if injury to the liver is too severe or long lasting, regeneration is incomplete, and the liver creates scar tissue. Scarring of the liver may lead to cirrhosis.

The buildup of scar tissue that causes cirrhosis is usually a slow and gradual process. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse and scar tissue replaces more healthy tissue, the liver will begin to fail. Chronic liver failure, which is also called end-stage liver disease, progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or effectively replace damaged cells.

Primary biliary cirrhosis usually occurs between the ages of 30 and 65 and affects women more often than men.1 </s>


Input: What causes Primary Biliary Cirrhosis ?

Output:
The causes of primary biliary cirrhosis are unknown. Most research suggests it is an autoimmune disease. The immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. An autoimmune disease is a disorder in which the bodys immune system attacks the bodys own cells and organs. In primary biliary cirrhosis, the immune system attacks the small bile ducts in the liver.

Genetics, or inherited genes, can make a person more likely to develop primary biliary cirrhosis. Primary biliary cirrhosis is more common in people who have a parent or siblingparticularly an identical twinwith the disease. In people who are genetically more likely to develop primary biliary cirrhosis, environmental factors may trigger or worsen the disease, including

- exposure to toxic chemicals  - smoking  - infections

Genetics can also make some people more likely to develop other autoimmune diseases, such as

- autoimmune hepatitis, a disease in which the bodys immune system attacks liver cells  - Sjgrens syndrome, a condition in which the immune system attacks the glands that produce tears and saliva  - autoimmune thyroid dysfunctions, conditions in which the immune system attacks the thyroid gland </s>


Input: What are the symptoms of Primary Biliary Cirrhosis ?

Output:
The first and most common symptoms of primary biliary cirrhosis are

- fatigue, or feeling tired  - itching skin, and darkened skin in itching areas due to scratching  - dry eyes and mouth

Some people may have jaundice, a condition that causes the skin and whites of the eyes to turn yellow. Health care providers diagnose up to 60 percent of people with primary biliary cirrhosis before symptoms begin.2 Routine blood tests showing abnormal liver enzyme levels may lead a health care provider to suspect that a person without symptoms has primary biliary cirrhosis. </s>


Input: What are the complications of Primary Biliary Cirrhosis ?

Output:
Most complications of primary biliary cirrhosis are related to cirrhosis and start after primary biliary cirrhosis progresses to cirrhosis. In some cases, portal hypertension and esophageal varices may develop before cirrhosis.

Portal hypertension. The portal vein carries blood from the stomach, intestines, spleen, gallbladder, and pancreas to the liver. In cirrhosis, scar tissue partially blocks the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension. Portal hypertension is a common complication of cirrhosis. This condition may lead to other complications, such as

- edemaswelling due to a buildup of fluidin the feet, ankles, or legs, and ascitesa buildup of fluid in the abdomen  - enlarged blood vessels, called varices, in the esophagus, stomach, or both  - an enlarged spleen, called splenomegaly  - mental confusion due to a buildup of toxins that are ordinarily removed by the liver, a condition called hepatic encephalopathy

Edema and ascites. Liver failure causes fluid buildup that results in edema and ascites. Ascites can lead to spontaneous bacterial peritonitis, a serious infection that requires immediate medical attention.

Varices. Portal hypertension may cause enlarged blood vessels in the esophagus, stomach, or both. These enlarged blood vessels, called esophageal or gastric varices, cause the vessel walls to become thin and blood pressure to increase, making the blood vessels more likely to burst. If they burst, serious bleeding can occur in the esophagus or upper stomach, requiring immediate medical attention.

Splenomegaly. Portal hypertension may cause the spleen to enlarge and retain white blood cells and platelets, reducing the numbers of these cells and platelets in the blood. A low platelet count may be the first evidence that a person has developed cirrhosis.

Hepatic encephalopathy. A failing liver cannot remove toxins from the blood, so they eventually accumulate in the brain. The buildup of toxins in the brain is called hepatic encephalopathy. This condition can decrease mental function and cause stupor and even coma. Stupor is an unconscious, sleeplike state from which a person can only be aroused briefly by a strong stimulus, such as a sharp pain. Coma is an unconscious, sleeplike state from which a person cannot be aroused. Signs of decreased mental function include

- confusion  - personality changes  - memory loss  - trouble concentrating  - a change in sleep habits

Metabolic bone diseases. Some people with cirrhosis develop a metabolic bone disease, which is a disorder of bone strength usually caused by abnormalities of vitamin D, bone mass, bone structure, or minerals, such as calcium and phosphorous. Osteopenia is a condition in which the bones become less dense, making them weaker. When bone loss becomes more severe, the condition is referred to as osteoporosis. People with these conditions are more likely to develop bone fractures.

Gallstones and bile duct stones. If cirrhosis prevents bile from flowing freely to and from the gallbladder, the bile hardens into gallstones. Symptoms of gallstones include abdominal pain and recurrent bacterial cholangitisirritated or infected bile ducts. Stones may also form in and block the bile ducts, causing pain, jaundice, and bacterial cholangitis.

Steatorrhea. Steatorrhea is a condition in which the body cannot absorb fat, causing a buildup of fat in the stool and loose, greasy, and foul-smelling bowel movements. Steatorrhea may be caused by impairment of bile delivery to the small intestine or by the pancreas not producing enough digestive enzymes.

Liver cancer. Liver cancer is common in people with cirrhosis. Liver cancer has a high mortality rate. Current treatments are limited and only fully successful if a health care provider detects the cancer early, before the tumor is too large. For this reason, health care providers should check people with cirrhosis for signs of liver cancer every 6 to 12 months. Health care providers use blood tests, ultrasound, or both to check for signs of liver cancer. </s>


Input: How to diagnose Primary Biliary Cirrhosis ?

Output:
A health care provider may use the following tests to diagnose primary biliary cirrhosis:

- a medical and family history  - a physical exam  - blood tests  - imaging tests  - a liver biopsy

A health care provider usually bases a diagnosis of primary biliary cirrhosis on two out of three of the following criteria:

- a blood test showing elevated liver enzymes  - a blood test showing the presence of anti-mitochondrial antibodies (AMA)  - a liver biopsy showing signs of the disease

Health care providers may order additional tests to rule out other causes of symptoms. Health care providers diagnose the majority of people with primary biliary cirrhosis early in the course of the disease.

Medical and family history. Taking a medical and family history is one of the first things a health care provider may do to help diagnose primary biliary cirrhosis. He or she will ask a patient to provide a medical and family history.

Physical exam. A physical exam may help diagnose primary biliary cirrhosis. During a physical exam, a health care provider usually

- examines a patients body  - uses a stethoscope to listen to sounds in the abdomen  - taps on specific areas of the patients body

The health care provider will perform a physical exam to look for signs of the disease. For example, the liver may feel hard or ascites may cause the abdomen to enlarge.

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 can show elevated levels of liver enzymes, such as alkaline phosphatase. A routine blood test may show high levels of the liver enzyme alkaline phosphatase in people who have primary biliary cirrhosis and are not yet showing symptoms.

The health care provider will perform an AMA blood test to help confirm the diagnosis. A blood test will detect the presence of AMA in 90 to 95 percent of people with primary biliary cirrhosis.3

Imaging tests. A health care provider may use the following imaging tests to examine the bile ducts. These tests can distinguish between primary biliary cirrhosis and other conditions that affect the bile ducts.

- Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital, and a radiologista doctor who specializes in medical imaging interprets the images. A patient does not need anesthesia. In addition to showing problems with the bile ducts, the images can show signs of advanced cirrhosis or complications.  - Magnetic resonance cholangiopancreatography uses magnetic resonance imaging (MRI) to examine the bile ducts. MRI machines use radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. A specially trained technician performs magnetic resonance cholangiopancreatography in an outpatient center or a hospital, and a radiologist interprets the images. A patient does not need anesthesia, though a health care provider may use light sedation for patients with a fear of confined spaces. With most MRI machines, the patient lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some machines allow the patient to lie in a more open space.  - Endoscopic retrograde cholangiopancreatography uses an x ray to look at the bile ducts. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. After lightly sedating the patient, the gastroenterologist inserts an endoscopea small, flexible tube with a light and a camera on the endthrough the mouth into the duodenum and bile ducts. The endoscope is connected to a computer and video monitor. The gastroenterologist injects a special dye, called contrast medium, through the tube into the bile ducts, which makes the ducts show up on the monitor. This test is more invasive than other imaging tests, and health care providers do not routinely need the test to make the diagnosis of primary biliary cirrhosis. A health care provider uses the test selectively when he or she is concerned that the blockage of the bile ducts has another cause, such as a gallstone or a narrowing of the large bile ducts due to inflammation or cancer. Patients may have pain, nausea, or vomiting after the test or may develop bacterial cholangitis or pancreatitisinflammation of the pancreas.

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

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

A health care provider performs a liver biopsy at a hospital or an outpatient center. The health care provider sends the liver sample to a pathology lab, where the pathologista doctor who specializes in diagnosing diseaseslooks at the tissue with a microscope and sends a report to the patients health care provider.

A liver biopsy can confirm the diagnosis of primary biliary cirrhosis; however, a person does not always need this test. A health care provider will perform a biopsy if the AMA blood test is negative and the person shows other signs of primary biliary cirrhosis. Sometimes a health care provider finds a cause of liver damage other than primary biliary cirrhosis during biopsy. </s>


Input: What are the treatments for Primary Biliary Cirrhosis ?

Output:
Treatment for primary biliary cirrhosis depends on how early a health care provider diagnoses the disease and whether complications are present. In the early stages of primary biliary cirrhosis, treatment can slow the progression of liver damage to cirrhosis. In the early stages of cirrhosis, the goals of treatment are to slow the progression of tissue scarring in the liver and prevent complications. As cirrhosis progresses, a person may need additional treatments and hospitalization to manage complications.

Medications

Health care providers prescribe ursodiol (Actigall, Urso) to treat primary biliary cirrhosis. Ursodiol is a nontoxic bile acid that people can take orally. Ursodiol replaces the bile acids that are normally produced by the liver, which are more toxic and can harm the liver. Treatment with ursodiol can reduce levels of bilirubin and liver enzymes in the blood. Early treatment with this medication reduces the likelihood of needing a liver transplant and improves survival.3 Early treatment provides the most benefit; however, ursodiol treatment late in the course of the disease can still slow the progression of liver damage. While ursodiol treatment improves the outcome of primary biliary cirrhosis, it does not cure the disease.

Researchers are studying the effects of several other medications on the progression of primary biliary cirrhosis. To date, none has shown the positive effects of ursodiol.

Avoiding Alcohol and Other Substances

People with cirrhosis should not drink any alcohol or take any illegal substances, as both will cause more liver damage. People with cirrhosis should avoid complementary and alternative medications, such as herbs. People with cirrhosis should be careful about starting new medications and should consult a health care provider before taking prescription medications, over-the-counter medications, or vitamins. Many vitamins and prescription and over-the-counter medications can affect liver function.

Treatment of Symptoms and Complications

Health care providers treat symptoms and complications as follows:

Itching. Antihistamines may help with mild itching. However, antihistamines often cause drowsiness, and a person should take antihistamines just before bedtime to help with nighttime itching. A health care provider will treat more problematic itching with cholestyramine (Locholest, Questran), which reduces cholesterol in the blood. Experts believe high levels of cholesterol let substances that cause itching build up in tissues.

Dry eyes and mouth. Health care providers usually treat dry eyes and mouth with artificial tears and saliva substitutes, respectively. These products are available without a prescription. A health care provider may treat people whose symptoms do not improve with pilocarpine (Salagen) or cevimeline (Evoxac). People who have difficulty with dry eyes should see an ophthalmologista doctor who diagnoses and treats all eye diseases and eye disordersregularly. People with dry mouth should have regular dental exams.

Portal hypertension. A health care provider may prescribe a beta-blocker or nitrate to treat portal hypertension. Beta-blockers lower blood pressure by helping the heart beat slower and with less force, and nitrates relax and widen blood vessels to let more blood flow to the heart and reduce the hearts workload.

Varices. Beta-blockers can lower the pressure in varices and reduce the likelihood of bleeding. Bleeding in the stomach or esophagus requires an immediate upper endoscopy. This procedure involves using an endoscope to look for varices. The health care provider may use the endoscope to perform a band ligation, a procedure that involves placing a special rubber band around the varices that causes the tissue to die and fall off. A gastroenterologist performs the procedure at a hospital or an outpatient center. People who have had varices in the past may need to take medication to prevent future episodes.

Edema and ascites. Health care providers prescribe diureticsmedications that remove fluid from the bodyto treat edema and ascites. A health care provider may remove large amounts of ascitic fluid from the abdomen and check for spontaneous bacterial peritonitis. A health care provider may prescribe bacteria-fighting medications called antibiotics to prevent infection. He or she may prescribe oral antibiotics; however, severe infection with ascites requires intravenous (IV) antibiotics.

Hepatic encephalopathy. A health care provider will treat hepatic encephalopathy by cleansing the bowel with lactulose, a laxative given orally or as an enemaa liquid put into the rectum. A health care provider may also add antibiotics to the treatment. Hepatic encephalopathy may improve as other complications of cirrhosis are controlled.

Osteoporosis. A health care provider may prescribe bisphosphonate medications to improve bone density.

Gallstones and bile duct stones. A health care provider may use surgery to remove gallstones. He or she may use endoscopic retrograde cholangiopancreatography, which uses balloons and basketlike devices, to retrieve the bile duct stones.

Liver cancer. A health care provider may recommend screening tests every 6 to 12 months to check for signs of liver cancer. Screening tests can find cancer before the person has symptoms of the disease. Cancer treatment is usually more effective when the health care provider finds the disease early. Health care providers use blood tests, ultrasound, or both to screen for liver cancer in people with cirrhosis. He or she may treat cancer with a combination of surgery, radiation, and chemotherapy. </s>