Input: What is (are) What I need to know about Kidney Failure and How Its Treated ?

Output:
Peritoneal dialysis uses the lining of your belly to filter your blood inside your body. You can do peritoneal dialysis at home because it uses your body to filter. A doctor will place a soft tube called a catheter in your belly a few weeks before you start treatment. The catheter stays in your belly permanently.

The catheter lets you put a kind of salty water from a plastic bag into your belly. Then, you can move around and go about your day. While the salty water is inside your belly, it soaks up wastes and extra fluid from your body. After a few hours, you drain the salty water from your belly into a drain bag. The salty water removes wastes and extra fluid from your body. The salty water can be thrown away into a toilet or tub. Then you start over with a fresh bag of salty water. You will empty and fill your belly four to six times a day.

The salty water is always in your belly soaking up wastes and extra fluid. Peritoneal dialysis does not make the kidneys better. However, it may help you feel better by filtering your blood when your kidneys fail.

Is dialysis a cure for kidney failure?   No. Hemodialysis and peritoneal dialysis help you feel better and live longer; however, they do not cure kidney failure. Although people with kidney failure are now living longer than ever, over the years kidney disease can cause problems such as heart disease, bone disease, arthritis, nerve damage, infertility, and malnutrition. These problems wont go away with dialysis; however, doctors now have new and better ways to prevent or treat them. You should discuss these problems and their treatments with your doctor. </s>


Input: What is (are) What I need to know about Kidney Failure and How Its Treated ?

Output:
A kidney transplant places a healthy kidney from another person into your body. The kidney may come from someone who has just died. Your doctor will place your name on a waiting list for a kidney. A family member or friend might be able to give you a kidney. Then you dont have to wait.

Once it is placed inside your body, the new kidney takes over filtering your blood. The damaged kidneys usually stay where they are. The new kidney is placed in the front-lower abdomen, on one side of the bladder. Your body normally attacks anything that shouldnt be there, such as bacteria. The body will think the new kidney shouldnt be there. You will take medicines called immunosuppressants to keep your body from attacking the new kidney.

More information is provided in the NIDDK health topics:

- Treatment Methods for Kidney Failure: Hemodialysis  - Home Hemodialysis  - Treatment Methods for Kidney Failure: Peritoneal Dialysis  - Treatment Methods for Kidney Failure: Transplantation </s>


Input: What are the treatments for What I need to know about Kidney Failure and How Its Treated ?

Output: Conservative management means your doctors take care of you without dialysis or a transplant. The doctors may give you medicines that make you feel more comfortable. You can have conservative management in your home. You may want to go to a hospice, a special place where you receive nursing care. Some people choose conservative management when dialysis or a transplant would not help them live longer or would make them suffer longer. Without dialysis or a transplant, you may live for a few weeks or several months. </s>


Input: What are the treatments for What I need to know about Kidney Failure and How Its Treated ?

Output:
If you have kidney failure, learn about the treatments and think about which one best fits you. Talk with people who are on hemodialysis or peritoneal dialysis. Ask what is good and bad about each treatment. If you make a choice and find you dont like it, talk with your doctor about trying something else. Ask your doctor about the transplant waiting list and the medicines needed after a transplant. Talk with people who have had kidney transplants and ask how it has changed their lives.

If you plan to keep working, think about which treatment choice would make working easier. If spending time with family and friends means a lot to you, ask which treatment gives you the most free time. Find out which treatment will give you the best chance to be healthy and live longer.

If you are thinking about conservative management, you may wish to speak with your family, friends, doctor, or mental health counselor as you decide.

You can take control of your care by talking with your doctor. You may need time to get used to your new treatment. Kidney failure can make your life harder. Treatments can help improve your life. </s>


Input: What to do for What I need to know about Kidney Failure and How Its Treated ?

Output:
Eating healthy foods can help you keep up your energy and strength. All dialysis and transplant centers have a dietitian. The dietitian helps people with kidney failure learn about healthy food choices. You should talk with your centers dietitian to make a meal plan.

The best diet for you will depend on which kidney failure treatment you choose after talking with your doctor.

- Hemodialysis      - Limit how much liquid and water you drink. Fluid can build up in your body between hemodialysis sessions. Also, many foods contain water. The extra fluid in your body can cause swelling and high blood pressure. Extra fluid in your body makes your heart work harder.

-      - Limit sodium, or salt. Watch out for sodium in frozen foods and prepared meals. You can also find sodium in canned foods, hot dogs, and fast food. Sodium makes you thirsty, which makes you drink more water and other liquids than you should.    - Read more in the National Kidney Disease Education Program (NKDEP) fact sheet Sodium.    - Limit potassium. Potassium is found in many fruits and vegetables such as potatoes, tomatoes, oranges, and bananas. Too much potassium can make your heart beat unevenly. Hemodialysis does not remove potassium from your body well.    - Read more in the NKDEP fact sheet Potassium.    - Eat protein-rich foods such as meat, fish, and eggs. Hemodialysis removes protein from your body.    - Read more in the NKDEP fact sheet Protein.    - Limit phosphorus. Phosphorus helps your bones, blood vessels, and muscles work.    - However, too much phosphorus can make your bones weak. Limiting phosphorus can be hard. Foods that contain phosphorus, such as meat and milk, also contain protein that you need. You should be careful to eat enough protein, yet not so much that you get too much phosphorus. You can avoid other foods that contain phosphorus, such as cola, tea, beans, and nuts.    - Read more in the NKDEP fact sheet Phosphorus.    - Find healthy ways to add calories to your diet. Calories are found in all foods and give your body energy. Many people on hemodialysis do not have a good appetite and do not get enough calories. Vegetable oils are good sources of calories. Vegetable oils include olive oil, canola oil, and safflower oil. Use them on breads, rice, and noodles. Hard candy, sugar, honey, jam, and jelly provide calories and energy. However, if you have diabetes, speak with your doctor or dietitian before eating extra sweets.    - More information about nutrition for people who are on hemodialysis is provided in the NIDDK health topic, Eat Right to Feel Right on Hemodialysis.    - Peritoneal dialysis      - Drink as much water and other liquids as you need. If you are holding too much fluid or too little fluid, your doctor needs to know.    - Limit sodium to control your thirst and help prevent heart problems. You can use spices other than salt to flavor your food.

-      - You may need to eat more potassium-rich foods. Peritoneal dialysis removes potassium from your body. Talk with your doctor or dietitian about the right amount of potassium for you.    - Eat protein-rich foods. Peritoneal dialysis removes even more protein from your body than hemodialysis.    - Limit phosphorus to keep your bones strong.    - You may need to limit your calorie intake. The salty water also contains some sugar. Your body absorbs the sugar, which can cause you to gain weight.    - Kidney transplant      - Limit sodium to help prevent heart problems.    - You should be able to eat normal amounts of phosphorus and potassium. You may need to adjust the amounts if blood tests show a problem.

-      - Eat protein-rich foods to repair muscle breakdown and protect against infection.    - You may need to limit your calories. The medicines you take can make you gain weight.    - Conservative management      - Limit protein to prevent the buildup of wastes in your blood.

You may have other needs and limits, depending on how well your treatments work. </s>


Input: What to do for What I need to know about Kidney Failure and How Its Treated ?

Output: - Kidney failure means your kidneys no longer filter your blood well enough to keep you healthy.  - The treatments for kidney failure are      - hemodialysis    - peritoneal dialysis    - a kidney transplant    - conservative management    - Hemodialysis uses a machine to filter your blood when your kidneys are too sick to filter any more.  - Peritoneal dialysis uses the lining of your belly to filter your blood inside your body.  - A kidney transplant places a healthy kidney from another person into your body.  - Conservative management means your doctors take care of you without dialysis or a transplant. The doctors may give you medicines that make you feel more comfortable.  - All dialysis and transplant centers have a dietitian. The dietitian helps people with kidney failure learn about healthy food choices. </s>


Input: What is (are) What I need to know about Kidney Failure and How Its Treated ?

Output:
You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.

Booklets

- What I need to know about Kidney Failure and How its Treated  - Treatment Methods for Kidney Failure: Hemodialysis  - Treatment Methods for Kidney Failure: Peritoneal Dialysis  - Treatment Methods for Kidney Failure: Kidney Transplantation  - Kidney Failure: Eat Right to Feel Right on Hemodialysis

Fact Sheets

- Kidney Failure: What to Expect  - Vascular Access for Hemodialysis  - Hemodialysis Dose and Adequacy  - Peritoneal Dialysis Dose and Adequacy  - Amyloidosis and Kidney Disease  - Anemia in Chronic Kidney Disease  - Chronic Kidney Disease-Mineral and Bone Disorder  - Financial Help for Treatment of Kidney Failure

Learning as much as you can about your treatment will help make you an important member of your health care team.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank: Neil R. Powe, M.D., M.P.H., M.B.A., University of California, San Francisco; Delphine Tuot, M.D.C.M., M.A.S., University of California, San Francisco; Vicki McClelland and Brian Testerman, both of the Free Medical Clinic of Northern Shenandoah Valley in Winchester, VA

This information is not copyrighted. The NIDDK encourages people to share this content freely.

September 2014 </s>


Input: What is (are) Peyronie's Disease ?

Output:
Peyronies disease is a disorder in which scar tissue, called a plaque, forms in the penisthe male organ used for urination and sex. The plaque builds up inside the tissues of a thick, elastic membrane called the tunica albuginea. The most common area for the plaque is on the top or bottom of the penis. As the plaque builds up, the penis will curve or bend, which can cause painful erections. Curves in the penis can make sexual intercourse painful, difficult, or impossible. Peyronies disease begins with inflammation, or swelling, which can become a hard scar.

The plaque that develops in Peyronies disease is not the same plaque that can develop in a persons arteries. The plaque seen in Peyronies disease is benign, or noncancerous, and is not a tumor. Peyronies disease is not contagious or caused by any known transmittable disease.

Early researchers thought Peyronies disease was a form of impotence, now called erectile dysfunction (ED). ED happens when a man is unable to achieve or keep an erection firm enough for sexual intercourse. Some men with Peyronies disease may have ED. Usually men with Peyronies disease are referred to a urologista doctor who specializes in sexual and urinary problems. </s>


Input: What causes Peyronie's Disease ?

Output:
Medical experts do not know the exact cause of Peyronies disease. Many believe that Peyronies disease may be the result of

- acute injury to the penis  - chronic, or repeated, injury to the penis  - autoimmune diseasea disorder in which the bodys immune system attacks the bodys own cells and organs

Injury to the Penis

Medical experts believe that hitting or bending the penis may injure the tissues inside. A man may injure the penis during sex, athletic activity, or an accident. Injury ruptures blood vessels, which leads to bleeding and swelling inside the layers of the tunica albuginea. Swelling inside the penis will block blood flow through the layers of tissue inside the penis. When the blood cant flow normally, clots can form and trap immune system cells. As the injury heals, the immune system cells may release substances that lead to the formation of too much scar tissue. The scar tissue builds up and forms a plaque inside the penis. The plaque reduces the elasticity of tissues and flexibility of the penis during erection, leading to curvature. The plaque may further harden because of calcificationthe process in which calcium builds up in body tissue.

Autoimmune Disease

Some medical experts believe that Peyronies disease may be part of an autoimmune disease. Normally, the immune system is the bodys way of protecting itself from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Men who have autoimmune diseases may develop Peyronies disease when the immune system attacks cells in the penis. This can lead to inflammation in the penis and can cause scarring. Medical experts do not know what causes autoimmune diseases. Some of the autoimmune diseases associated with Peyronies disease affect connective tissues. Connective tissue is specialized tissue that supports, joins, or separates different types of tissues and organs of the body. </s>


Input: How many people are affected by Peyronie's Disease ?

Output: Researchers estimate that Peyronies disease may affect 1 to 23 percent of men between 40 and 70 years of age.1 However, the actual occurrence of Peyronies disease may be higher due to mens embarrassment and health care providers limited reporting.1 The disease is rare in young men, although it has been reported in men in their 30s.1 The chance of developing Peyronies disease increases with age. </s>


Input: What are the symptoms of Peyronie's Disease ?

Output:
The signs and symptoms of Peyronies disease may include

- hard lumps on one or more sides of the penis  - pain during sexual intercourse or during an erection  - a curve in the penis either with or without an erection  - narrowing or shortening of the penis  - ED

Symptoms of Peyronies disease range from mild to severe. Symptoms may develop slowly or appear quickly. In many cases, the pain decreases over time, although the curve in the penis may remain. In milder cases, symptoms may go away without causing a permanent curve. </s>


Input: What are the complications of Peyronie's Disease ?

Output:
Complications of Peyronies disease may include

- the inability to have sexual intercourse  - ED  - anxiety, or stress, about sexual abilities or the appearance of the penis  - stress on a relationship with a sexual partner  - problems fathering a child because intercourse is difficult </s>


Input: How to diagnose Peyronie's Disease ?

Output:
A urologist diagnoses Peyronies disease based on

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

Medical and Family History

Taking a medical and family history is one of the first things a urologist may do to help diagnose Peyronies disease. He or she will ask the man to provide a medical and family history, which may include the following questions:

- What is the mans ability to have an erection?  - What are the problems with sexual intercourse?  - When did the symptoms begin?  - What is the family medical history?  - What medications is the man taking?  - What other symptoms is the man experiencing?  - What other medical conditions does the man have?

Physical Exam

A physical exam may help diagnose Peyronies disease. During a physical exam, a urologist usually examines the mans body, including the penis.

A urologist can usually feel the plaque in the penis with or without an erection. Sometimes the urologist will need to examine the penis during an erection. The urologist will give the man an injectable medication to cause an erection.

Imaging Tests

To help pinpoint the location of the plaque buildup inside the penis, a urologist may perform

- ultrasound of the penis  - an x ray of the penis

For both tests, 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 need anesthesia.

Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.

X ray. An x ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. The man will lie on a table or stand during the x ray, and the technician may ask the man to change positions for additional pictures. </s>


Input: What are the treatments for Peyronie's Disease ?

Output:
A urologist may treat Peyronies disease with nonsurgical treatments or surgery.

The goal of treatment is to reduce pain and restore and maintain the ability to have intercourse. Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function may not need treatment until symptoms get worse. Peyronies disease often resolves on its own without treatment.

A urologist may recommend changes in a mans lifestyle to reduce the risk of ED associated with Peyronies disease.

Nonsurgical Treatments

Nonsurgical treatments include medications and medical therapies.

Medications. A urologist may prescribe medications aimed at decreasing a mans penile curvature, plaque size, and inflammation. A man may take prescribed medications to treat Peyronies disease orallyby mouthor a urologist may inject medications directly into the plaque. Verapamil is one type of topical medication that a man may apply to the skin over the plaque.

- Oral medications. Oral medications may include      - vitamin E    - potassium para-aminobenzoate (Potaba)    - tamoxifen    - colchicine    - acetyl-L-carnitine    - pentoxifylline    - Injections. Medications injected directly into plaques may include      - verapamil    - interferon alpha 2b    - steroids    - collagenase (Xiaflex)

To date, collagenase is the first and only medication specifically approved for Peyronies disease.

Medical therapies. A urologist may use medical therapies to break up scar tissue and decrease plaque size and curvature. Therapies to break up scar tissue may include

- high-intensity, focused ultrasound directed at the plaque  - radiation therapyhigh-energy rays, such as x rays, aimed at the plaque  - shockwave therapyfocused, low-intensity electroshock waves directed at the plaque

A urologist may use iontophoresispainless, low-level electric current that delivers medications through the skin over the plaqueto decrease plaque size and curvature.

A urologist may use mechanical traction and vacuum devices aimed at stretching or bending the penis to reduce curvature.

Surgery

A urologist may recommend surgery to remove plaque or help straighten the penis during an erection. Medical experts recommend surgery for long-term cases when

- symptoms have not improved  - erections, intercourse, or both are painful  - the curve or bend in the penis does not allow the man to have sexual intercourse

Some men may develop complications after surgery, and sometimes surgery does not correct the effects of Peyronies diseasesuch as shortening of the penis. Some surgical methods can cause shortening of the penis. Medical experts suggest waiting 1 year or more from the onset of symptoms before having surgery because the course of Peyronies disease is different in each man.

A urologist may recommend the following surgeries:

- grafting. A urologist will cut or remove the plaque and attach a patch of skin, a vein, or material made from animal organs in its place. This procedure may straighten the penis and restore some lost length from Peyronies disease. However, some men may experience numbness of the penis and ED after the procedure.  - plication. A urologist will remove or pinch a piece of the tunica albuginea from the side of the penis opposite the plaque, which helps to straighten the penis. This procedure is less likely to cause numbness or ED. Plication cannot restore length or girth of the penis and may cause shortening of the penis.  - device implantation. A urologist implants a device into the penis that can cause an erection and help straighten it during an erection. Penile implants may be considered if a man has both Peyronies disease and ED. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, a urologist may combine implantation with one of the other two surgeries. Once a man has an implant, he must use the device to have an erection.

A urologist performs these surgeries in a hospital.

Lifestyle Changes

A man can make healthy lifestyle changes to reduce the chance of ED associated with Peyronies disease by

- quitting smoking  - reducing alcohol consumption  - exercising regularly  - avoiding illegal drugs

More information is provided in the NIDDK health topic, Erectile Dysfunction. </s>


Input: How to prevent Peyronie's Disease ?

Output: Researchers do not know how to prevent Peyronies disease. </s>


Input: What to do for Peyronie's Disease ?

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


Input: What to do for Peyronie's Disease ?

Output: - Peyronies disease is a disorder in which scar tissue, called a plaque, forms in the penisthe male organ used for urination and sex.  - Medical experts do not know the exact cause of Peyronies disease. Many believe that Peyronies disease may be the result of      - acute injury to the penis    - chronic, or repeated, injury to the penis    - autoimmune diseasea disorder in which the bodys immune system attacks the bodys own cells and organs    - The following factors may increase a mans chance of developing Peyronies disease:      - vigorous sexual or nonsexual activities that cause microscopic injury to the penis    - certain connective tissue and autoimmune disorders    - a family history of Peyronies disease    - aging    - The signs and symptoms of Peyronies disease may include      - hard lumps on one or more sides of the penis    - pain during sexual intercourse or during an erection    - a curve in the penis either with or without an erection    - narrowing or shortening of the penis    - erectile dysfunction (ED)    - Complications of Peyronies disease may include      - the inability to have sexual intercourse    - ED    - anxiety, or stress, about sexual abilities or the appearance of the penis    - stress on a relationship with a sexual partner    - problems fathering a child because intercourse is difficult    - A urologist diagnoses Peyronies disease based on      - a medical and family history    - a physical exam    - imaging tests    - A urologist may treat Peyronies disease with nonsurgical treatments or surgery.  - Researchers do not know how to prevent Peyronies disease. </s>


Input: What is (are) Gastritis ?

Output:
Gastritis is a condition in which the stomachliningknown as the mucosais inflamed, or swollen. The stomach lining contains glands that produce stomach acid and an enzyme called pepsin. The stomach acid breaks down food and pepsin digests protein. A thick layer of mucus coats the stomach lining and helps prevent the acidic digestive juice from dissolving the stomach tissue. When the stomach lining is inflamed, it produces less acid and fewer enzymes. However, the stomach lining also produces less mucus and other substances that normally protect the stomach lining from acidic digestive juice.

Gastritis may be acute or chronic:

- Acute gastritis starts suddenly and lasts for a short time.  - Chronic gastritis is long lasting. If chronic gastritis is not treated, it may last for years or even a lifetime.

Gastritis can be erosive or nonerosive:

- Erosive gastritis can cause the stomach lining to wear away, causing erosionsshallow breaks in the stomach liningor ulcersdeep sores in the stomach lining.  - Nonerosive gastritis causes inflammation in the stomach lining; however, erosions or ulcers do not accompany nonerosive gastritis.

A health care provider may refer a person with gastritis to a gastroenterologista doctor who specializes in digestive diseases. </s>


Input: What causes Gastritis ?

Output:
Common causes of gastritis include

- Helicobacter pylori (H. pylori) infection  - damage to the stomach lining, which leads to reactive gastritis  - an autoimmune response

H. pylori infection. H. pylori is a type of bacteriaorganisms that may cause an infection. H. pylori infection

- causes most cases of gastritis  - typically causes nonerosive gastritis  - may cause acute or chronic gastritis

H. pylori infection is common, particularly in developing countries, and the infection often begins in childhood. Many people who are infected with H. pylori never have any symptoms. Adults are more likely to show symptoms when symptoms do occur.

Researchers are not sure how the H. pylori infection spreads, although they think contaminated food, water, or eating utensils may transmit the bacteria. Some infected people have H. pylori in their saliva, which suggests that infection can spread through direct contact with saliva or other body fluids.

More information about Peptic Ulcer Disease and H. pylori is provided in the NIDDK health topic, Peptic Ulcer Disease.

Damage to the stomach lining, which leads to reactive gastritis. Some people who have damage to the stomach lining can develop reactive gastritis.

Reactive gastritis

- may be acute or chronic  - may cause erosions  - may cause little or no inflammation

Reactive gastritis may also be called reactive gastropathy when it causes little or no inflammation.

The causes of reactive gastritis may include

- nonsteroidal anti-inflammatory drugs (NSAIDs), a type of over-the-counter medication. Aspirin and ibuprofen are common types of NSAIDs.  - drinking alcohol.  - using cocaine.  - exposure to radiation or having radiation treatments.  - reflux of bile from the small intestine into the stomach. Bile reflux may occur in people who have had part of their stomach removed.  - a reaction to stress caused by traumatic injuries, critical illness, severe burns, and major surgery. This type of reactive gastritis is called stress gastritis.

An autoimmune response. In autoimmune gastritis, the immune system attacks healthy cells in the stomach lining. The immune system normally protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Autoimmune gastritis is chronic and typically nonerosive.

Less common causes of gastritis may include

- Crohn's disease, which causes inflammation and irritation of any part of the gastrointestinal (GI) tract.  - sarcoidosis, a disease that causes inflammation that will not go away. The chronic inflammation causes tiny clumps of abnormal tissue to form in various organs in the body. The disease typically starts in the lungs, skin, and lymph nodes.  - allergies to food, such as cow's milk and soy, especially in children.  - infections with viruses, parasites, fungi, and bacteria other than H. pylori, typically in people with weakened immune systems. </s>


Input: What are the symptoms of Gastritis ?

Output:
Some people who have gastritis have pain or discomfort in the upper part of the abdomenthe area between the chest and hips. However, many people with gastritis do not have any signs and symptoms. The relationship between gastritis and a person's symptoms is not clear. The term gastritis is sometimes mistakenly used to describe any symptoms of pain or discomfort in the upper abdomen.

When symptoms are present, they may include

- upper abdominal discomfort or pain  - nausea  - vomiting

Seek Help for Symptoms of Bleeding in the Stomach   Erosive gastritis may cause ulcers or erosions in the stomach lining that can bleed. Signs and symptoms of bleeding in the stomach include   - shortness of breath   - dizziness or feeling faint   - red blood in vomit   - black, tarry stools   - red blood in the stool   - weakness   - paleness    A person with any signs or symptoms of bleeding in the stomach should call or see a health care provider right away.   More information is provided in the NIDDK health topic, Bleeding in the Digestive Tract. </s>


Input: What are the symptoms of Gastritis ?

Output:
Erosive gastritis may cause ulcers or erosions in the stomach lining that can bleed. Signs and symptoms of bleeding in the stomach include

- shortness of breath  - dizziness or feeling faint  - red blood in vomit  - black, tarry stools  - red blood in the stool  - weakness  - paleness

A person with any signs or symptoms of bleeding in the stomach should call or see a health care provider right away.

More information is provided in the NIDDK health topic, Bleeding in the Digestive Tract. </s>


Input: What are the complications of Gastritis ?

Output:
The complications of chronic gastritis may include

- peptic ulcers. Peptic ulcers are sores involving the lining of the stomach or duodenum, the first part of the small intestine. NSAID use and H. pylori gastritis increase the chance of developing peptic ulcers.  - atrophic gastritis. Atrophic gastritis happens when chronic inflammation of the stomach lining causes the loss of the stomach lining and glands. Chronic gastritis can progress to atrophic gastritis.  - anemia. Erosive gastritis can cause chronic bleeding in the stomach, and the blood loss can lead to anemia. Anemia is a condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen. Red blood cells contain hemoglobin, an iron-rich protein that gives blood its red color and enables the red blood cells to transport oxygen from the lungs to the tissues of the body. Research suggests that H. pylori gastritis and autoimmune atrophic gastritis can interfere with the body's ability to absorb iron from food, which may also cause anemia. Read more about anemia at www.nhlbi.nih.gov.  - vitamin B12 deficiency and pernicious anemia. People with autoimmune atrophic gastritis do not produce enough intrinsic factor. Intrinsic factor is a protein made in the stomach and helps the intestines absorb vitamin B12. The body needs vitamin B12 to make red blood cells and nerve cells. Poor absorption of vitamin B12 may lead to a type of anemia called pernicious anemia. Read more about pernicious anemia at www.nhlbi.nih.gov.  - growths in the stomach lining. Chronic gastritis increases the chance of developing benign, or noncancerous, and malignant, or cancerous, growths in the stomach lining. Chronic H. pylori gastritis increases the chance of developing a type of cancer called gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Read more about MALT lymphoma and gastric cancer at www.cancer.gov.

In most cases, acute gastritis does not lead to complications. In rare cases, acute stress gastritis can cause severe bleeding that can be life threatening. </s>


Input: How to diagnose Gastritis ?

Output:
A health care provider diagnoses gastritis based on the following:

- medical history  - physical exam  - upper GI endoscopy  - other tests

Medical History

Taking a medical history may help the health care provider diagnose gastritis. He or she will ask the patient to provide a medical history. The history may include questions about chronic symptoms and travel to developing countries.

Physical Exam

A physical exam may help diagnose gastritis. During a physical exam, a health care provider usually

- examines a patient's body  - uses a stethoscope to listen to sounds in the abdomen  - taps on the abdomen checking for tenderness or pain

Upper Gastrointestinal Endoscopy

Upper GI endoscopy is a procedure that uses an endoscopea small, flexible camera with a lightto see the upper GI tract. A health care provider performs the test at a hospital or an outpatient center. The health care provider carefully feeds the endoscope down the esophagus and into the stomach and duodenum. The small camera built into the endoscope transmits a video image to a monitor, allowing close examination of the GI lining. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patient's throat before inserting the endoscope. A health care provider will place an intravenous (IV) needle in a vein in the arm to administer sedation. Sedatives help patients stay relaxed and comfortable. The test may show signs of inflammation or erosions in the stomach lining.

The health care provider can use tiny tools passed through the endoscope to perform biopsies. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope by a pathologista doctor who specializes in examining tissues to diagnose diseases. A health care provider may use the biopsy to diagnose gastritis, find the cause of gastritis, and find out if chronic gastritis has progressed to atrophic gastritis. More information is provided in the NIDDK health topic, Upper GI Endoscopy.

Other Tests

A health care provider may have a patient complete other tests to identify the cause of gastritis or any complications. These tests may include the following:

- Upper GI series. Upper GI series is an x-ray exam that provides a look at the shape of the upper GI tract. An x-ray technician performs this test at a hospital or an outpatient center, and a radiologista doctor who specializes in medical imaginginterprets the images. This test does not require anesthesia. A patient should not eat or drink before the procedure, as directed by the health care provider. Patients should check with their health care provider about what to do to prepare for an upper GI series. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and health care provider can see these organs' shapes more clearly on x-rays. A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract may cause white or light-colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. More information is provided in the NIDDK health topic, Upper GI Series.  - Blood tests. A health care provider may use blood tests to check for anemia or H. pylori. A health care provider draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis.  - Stool test. A health care provider may use a stool test to check for blood in the stool, another sign of bleeding in the stomach, and for H. pylori infection. A stool test is an analysis of a sample of stool. The health care provider will give the patient a container for catching and storing the stool. The patient returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis.  - Urea breath test. A health care provider may use a urea breath test to check for H. pylori infection. The patient swallows a capsule, liquid, or pudding that contains ureaa waste product the body produces as it breaks down protein. The urea is labeled with a special carbon atom. If H. pylori are present, the bacteria will convert the urea into carbon dioxide. After a few minutes, the patient breathes into a container, exhaling carbon dioxide. A nurse or technician will perform this test at a health care provider's office or a commercial facility and send the samples to a lab. If the test detects the labeled carbon atoms in the exhaled breath, the health care provider will confirm an H. pylori infection in the GI tract. </s>


Input: What are the treatments for Gastritis ?

Output:
Health care providers treat gastritis with medications to

- reduce the amount of acid in the stomach  - treat the underlying cause

Reduce the Amount of Acid in the Stomach

The stomach lining of a person with gastritis may have less protection from acidic digestive juice. Reducing acid can promote healing of the stomach lining. Medications that reduce acid include

- antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan. Many brands use different combinations of three basic saltsmagnesium, aluminum, and calciumalong with hydroxide or bicarbonate ions to neutralize stomach acid. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt can cause constipation. Magnesium and aluminum salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can cause constipation.  - H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75). H2 blockers decrease acid production. They are available in both over-the-counter and prescription strengths.  - proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), dexlansoprazole (Dexilant), pantoprazole (Protonix), rabeprazole (AcipHex), and esomeprazole (Nexium). PPIs decrease acid production more effectively than H2 blockers. All of these medications are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.

Treat the Underlying Cause

Depending on the cause of gastritis, a health care provider may recommend additional treatments.

- Treating H. pylori infection with antibiotics is important, even if a person does not have symptoms from the infection. Curing the infection often cures the gastritis and decreases the chance of developing complications, such as peptic ulcer disease, MALT lymphoma, and gastric cancer.  - Avoiding the cause of reactive gastritis can provide some people with a cure. For example, if prolonged NSAID use is the cause of the gastritis, a health care provider may advise the patient to stop taking the NSAIDs, reduce the dose, or change pain medications.  - Health care providers may prescribe medications to prevent or treat stress gastritis in a patient who is critically ill or injured. Medications to protect the stomach lining include sucralfate (Carafate), H2 blockers, and PPIs. Treating the underlying illness or injury most often cures stress gastritis.  - Health care providers may treat people with pernicious anemia due to autoimmune atrophic gastritis with vitamin B12 injections. </s>


Input: How to prevent Gastritis ?

Output:
People may be able to reduce their chances of getting gastritis by preventing H. pylori infection. No one knows for sure how H. pylori infection spreads, so prevention is difficult. To help prevent infection, health care providers advise people to

- wash their hands with soap and water after using the bathroom and before eating  - eat food that has been washed well and cooked properly  - drink water from a clean, safe source </s>


Input: What to do for Gastritis ?

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


Input: What to do for Gastritis ?

Output: - Gastritis is a condition in which the stomach liningknown as the mucosais inflamed, or swollen.  - Common causes of gastritis include Helicobacter pylori (H. pylori) infection, damage to the stomach lining, and an autoimmune response.  - Some people who have gastritis have pain or discomfort in the upper part of the abdomen. However, many people with gastritis do not have any signs and symptoms.  - Erosive gastritis may cause ulcers or erosions in the stomach lining that can bleed. A person with any signs or symptoms of bleeding in the stomach should call or see a health care provider right away.  - A health care provider diagnoses gastritis based on a medical history, a physical exam, upper GI endoscopy, and other tests.  - Health care providers treat gastritis with medications to reduce the amount of acid in the stomach and treat the underlying cause. </s>


Input: What is (are) Multiple Endocrine Neoplasia Type 1 ?

Output:
MEN1 is an inherited disorder that causes tumors in the endocrine glands and the duodenum, the first part of the small intestine. MEN1 is sometimes called multiple endocrine adenomatosis or Wermer's syndrome, after one of the first doctors to recognize it. MEN1 is rare, occurring in about one in 30,000 people.1 The disorder affects both sexes equally and shows no geographical, racial, or ethnic preferences.

Endocrine glands release hormones into the bloodstream. Hormones are powerful chemicals that travel through the blood, controlling and instructing the functions of various organs. Normally, the hormones released by endocrine glands are carefully balanced to meet the body's needs.

In people with MEN1, multiple endocrine glands form tumors and become hormonally overactive, often at the same time. The overactive glands may include the parathyroids, pancreas, or pituitary. Most people who develop overactivity of only one endocrine gland do not have MEN1. </s>


Input: What to do for Multiple Endocrine Neoplasia Type 1 ?

Output: - Multiple endocrine neoplasia type 1 (MEN1) is an inherited disorder that causes hormone-secreting tumors in the duodenum and the endocrine glands-most often the parathyroid, pancreas, and pituitary.  - Overactive parathyroid glands can lead to tiredness, weakness, muscle or bone pain, constipation, indigestion, kidney stones, or thinning of bones.  - Pancreatic and duodenal endocrine tumors called gastrinomas can cause dangerous stomach or intestinal ulcers.  - Pituitary tumors called prolactinomas can cause excessive production of breast milk or interfere with fertility in women or with sex drive and fertility in men.  - Although many tumors associated with MEN1 are benign, about half of people with MEN1 will eventually develop a cancerous tumor.  - MEN1 carriers can be detected through gene testing or other laboratory tests.  - MEN1 cannot be cured, but regular testing can detect the problems caused by MEN1 tumors many years before serious complications develop. Careful monitoring enables doctors to adjust an individual's treatment as needed. </s>


Input: What is (are) Autoimmune Hepatitis ?

Output:
Autoimmune hepatitis is a chronicor long lastingdisease in which the body's immune system attacks the normal components, or cells, of the liver and causes inflammation and liver damage. The immune system normally protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances.

Autoimmune hepatitis is a serious condition that may worsen over time if not treated. Autoimmune hepatitis can lead to cirrhosis and liver failure. Cirrhosis occurs when scar tissue replaces healthy liver tissue and blocks the normal flow of blood through the liver. Liver failure occurs when the liver stops working properly. </s>


Input: What is (are) Autoimmune Hepatitis ?

Output:
Autoimmune diseases are disorders in which the body's immune system attacks the body's own cells and organs with proteins called autoantibodies; this process is called autoimmunity.

The body's immune system normally makes large numbers of proteins called antibodies to help the body fight off infections. In some cases, however, the body makes autoantibodies. Certain environmental triggers can lead to autoimmunity. Environmental triggers are things originating outside the body, such as bacteria, viruses, toxins, and medications. </s>


Input: What causes Autoimmune Hepatitis ?

Output: A combination of autoimmunity, environmental triggers, and a genetic predisposition can lead to autoimmune hepatitis. </s>


Input: What is (are) Autoimmune Hepatitis ?

Output:
Autoimmune hepatitis is classified into several types. Type 1 autoimmune hepatitis is the most common form in North America. Type 1 can occur at any age; however, it most often starts in adolescence or young adulthood. About 70 percent of people with type 1 autoimmune hepatitis are female.1

People with type 1 autoimmune hepatitis commonly have other autoimmune disorders, such as

- celiac disease, an autoimmune disease in which people cannot tolerate gluten because it damages the lining of their small intestine and prevents absorption of nutrients  - Crohn's disease, which causes inflammation and irritation of any part of the digestive tract  - Graves' disease, the most common cause of hyperthyroidism in the United States  - Hashimoto's disease, also called chronic lymphocytic thyroiditis or autoimmune thyroiditis, a form of chronic inflammation of the thyroid gland  - proliferative glomerulonephritis, or inflammation of the glomeruli, which are tiny clusters of looping blood vessels in the kidneys  - primary sclerosing cholangitis, which causes irritation, scarring, and narrowing of the bile ducts inside and outside the liver  - rheumatoid arthritis, which causes pain, swelling, stiffness, and loss of function in the joints  - Sjgren's syndrome, which causes dryness in the mouth and eyes  - systemic lupus erythematosus, which causes kidney inflammation called lupus nephritis  - type 1 diabetes, a condition characterized by high blood glucose, also called blood sugar, levels caused by a total lack of insulin  - ulcerative colitis, a chronic disease that causes inflammation and sores, called ulcers, in the inner lining of the large intestine

Type 2 autoimmune hepatitis is less common and occurs more often in children than adults.1 People with type 2 can also have any of the above autoimmune disorders. </s>


Input: What are the symptoms of Autoimmune Hepatitis ?

Output:
The most common symptoms of autoimmune hepatitis are

- fatigue  - joint pain  - nausea  - loss of appetite  - pain or discomfort over the liver  - skin rashes  - dark yellow urine  - light-colored stools  - jaundice, or yellowing of the skin and whites of the eyes

Symptoms of autoimmune hepatitis range from mild to severe. Some people may feel as if they have a mild case of the flu. Others may have no symptoms when a health care provider diagnoses the disease; however, they can develop symptoms later. </s>


Input: How to diagnose Autoimmune Hepatitis ?

Output:
A health care provider will make a diagnosis of autoimmune hepatitis based on symptoms, a physical exam, blood tests, and a liver biopsy.

A health care provider performs a physical exam and reviews the person's health history, including the use of alcohol and medications that can harm the liver. A person usually needs blood tests for an exact diagnosis because a person with autoimmune hepatitis can have the same symptoms as those of other liver diseases or metabolic disorders.

Blood tests. A blood test involves drawing blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. A person will need blood tests for autoantibodies to help distinguish autoimmune hepatitis from other liver diseases that have similar symptoms, such as viral hepatitis, primary biliary cirrhosis, steatohepatitis, or Wilson disease.

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 temporarily stop taking certain medications before the liver biopsy. He or she may also 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. A health care provider will apply a local anesthetic to the area where he or she will insert the biopsy needle. If needed, he or she will give sedatives and pain medication. Then, he or she will use a needle to take a small piece of liver tissue, and 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 liver sample is sent to a pathology lab where the pathologista doctor who specializes in diagnosing diseaselooks at the tissue with a microscope and sends a report to the patient's health care provider.

A health care provider can use liver biopsy to diagnose autoimmune hepatitis and determine if cirrhosis is present. People often have cirrhosis at the time they are diagnosed with autoimmune hepatitis. A health care provider can also use liver biopsy to look for changes in the severity of liver damage prior to ending treatment for autoimmune hepatitis. </s>


Input: What are the treatments for Autoimmune Hepatitis ?

Output:
Treatment for autoimmune hepatitis includes medication to suppress, or slow down, an overactive immune system. Treatment may also include a liver transplant.

Treatment works best when autoimmune hepatitis is diagnosed early. People with autoimmune hepatitis generally respond to standard treatment and the disease can be controlled in most cases. Long-term response to treatment can stop the disease from getting worse and may even reverse some damage to the liver.

Medications

People with autoimmune hepatitis who have no symptoms or a mild form of the disease may or may not need to take medication. A health care provider will determine if a person needs treatment. In some people with mild autoimmune hepatitis, the disease may go into remission. Remission is a period when a person is symptom-free and blood tests and liver biopsy show improvement in liver function.

Corticosteroids. Corticosteroids are medications that decrease swelling and reduce the activity of the immune system. Health care providers treat both types of autoimmune hepatitis with a daily dose of a corticosteroid called prednisone. Treatment may begin with a high dose that is gradually lowered as the disease is controlled. The treatment goal is to find the lowest possible dose that helps control the disease.

Side effects of prednisone may include

- weight gain  - weakness of the bones, called osteoporosis or osteomalacia  - thinning of the hair and skin  - acne  - diabetes  - high blood pressure  - cataracts, a clouding in the lens of the eyes  - glaucoma, elevated pressure in the eyes  - anxiety and confusion

A health care provider will closely monitor and manage any side effects that may occur, as high doses of prednisone are often prescribed to treat autoimmune hepatitis.

Immune system suppressors. Medications that suppress the immune system prevent the body from making autoantibodies and block the immune reaction that contributes to inflammation. In most cases, health care providers use azathioprine (Azasan, Imuran) in conjunction with prednisone to treat autoimmune hepatitis. When using azathioprine, a health care provider can use a lower dose of prednisone, which may reduce prednisone's side effects.

Side effects of azathioprine include

- low white blood cell count  - nausea  - vomiting  - skin rash  - liver damage  - pancreatitis, or inflammation of the pancreas

Azathioprine is an immune system suppressor, so people taking the medication should undergo routine blood tests to monitor their white blood cell counts. A low white blood cell count can lead to bone marrow failure. Bone marrow is the tissue found inside bones that produces new blood cells, including platelets. A health care provider will also check the platelet count when blood tests are done.

A person may need to discontinue prednisone or azathioprine if they cause severe side effects. The risk of side effects is higher in people who also have cirrhosis.

A health care provider may gradually reduce the dose of medication in people who show improvement, although the symptoms can return. When a person discontinues treatment, a health care provider will perform routine blood tests and carefully monitor the person's condition for a return of symptoms. Treatment with low doses of prednisone or azathioprine may be necessary on and off for many years.

People who do not respond to standard immune therapy or who have severe side effects from the medications may benefit from other immunosuppressive agents such as mycophenolate mofetil (CellCept), cyclosporine, or tacrolimus (Hecoria, Prograf).

Medications that suppress the immune system may lead to various forms of cancer. People on low doses of azathioprine for long periods of time are at slight risk of developing cancer.

Liver Transplant

In some people, autoimmune hepatitis progresses to cirrhosis and end-stage liver failure, and a liver transplant may be necessary. Symptoms of cirrhosis and liver failure include the symptoms of autoimmune hepatitis and

- generalized itching  - a longer-than-usual amount of time for bleeding to stop  - easy bruising  - a swollen stomach or swollen ankles  - spiderlike blood vessels, called spider angiomas, that develop on the skin  - abdominal bloating due to an enlarged liver  - fluid in the abdomenalso called ascites  - forgetfulness or confusion

Liver transplant is surgery to remove a diseased or an injured liver and replace it with a healthy one from another person, called a donor. A team of surgeons performs a liver transplant in a hospital. When possible, the patient fasts for 8 hours before the surgery. The patient stays in the hospital about 1 to 2 weeks to be sure the transplanted liver is functioning properly. The health care provider will monitor the patient for bleeding, infections, and signs of liver rejection. The patient will take prescription medications long term to prevent infections and rejection. Liver transplant surgery for autoimmune hepatitis is successful in most cases.

More information is provided in the NIDDK health topic, Liver Transplantation. </s>


Input: What is (are) Autoimmune Hepatitis ?

Output: People with autoimmune hepatitis and cirrhosis are at risk of developing liver cancer. A health care provider will monitor the person with a regular ultrasound examination of the liver. 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, and a radiologista doctor who specializes in medical imaginginterprets the images; anesthesia is not needed. The images can show the liver's size and the presence of cancerous tumors. </s>


Input: What to do for Autoimmune Hepatitis ?

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


Input: What to do for Autoimmune Hepatitis ?

Output: - Autoimmune hepatitis is a chronicor long lastingdisease in which the body's immune system attacks the liver and causes inflammation and damage.  - Autoimmune hepatitis is a serious condition that may worsen over time if not treated. Autoimmune hepatitis can lead to cirrhosis and liver failure.  - Autoimmune hepatitis is more common in females. The disease can occur at any age and affects all ethnic groups.  - Autoimmune hepatitis is classified as type 1 or type 2.  - A health care provider will make a diagnosis of autoimmune hepatitis based on symptoms, a physical exam, blood tests, and a liver biopsy.  - A person usually needs blood tests for an exact diagnosis because a person with autoimmune hepatitis can have the same symptoms as those of other liver diseases or metabolic disorders.  - Treatment for autoimmune hepatitis includes medication to suppress, or slow down, an overactive immune system.  - Treatment works best when autoimmune hepatitis is diagnosed early.  - People with autoimmune hepatitis generally respond to standard treatment and the disease can be controlled in most cases.  - In some people, autoimmune hepatitis progresses to cirrhosis and end-stage liver failure, and a liver transplant may be necessary. </s>


Input: What is (are) Dumping Syndrome ?

Output:
Dumping syndrome occurs when food, especially sugar, moves too fast from the stomach to the duodenumthe first part of the small intestinein the upper gastrointestinal (GI) tract. This condition is also called rapid gastric emptying. Dumping syndrome has two forms, based on when symptoms occur:

- early dumping syndromeoccurs 10 to 30 minutes after a meal  - late dumping syndromeoccurs 2 to 3 hours after a meal </s>


Input: What is (are) Dumping Syndrome ?

Output:
The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anusthe opening where stool leaves the body. The body digests food using the movement of muscles in the GI tract, along with the release of hormones and enzymes. The upper GI tract includes the mouth, esophagus, stomach, duodenum, and small intestine. The esophagus carries food and liquids from the mouth to the stomach. The stomach slowly pumps the food and liquids into the intestine, which then absorbs needed nutrients. Two digestive organs, the liver and the pancreas, produce digestive juices that reach the small intestine through small tubes called ducts.

The last part of the GI tractcalled the lower GI tractconsists of the large intestine and anus. The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is located between the last part of the coloncalled the sigmoid colonand the anus. The rectum stores stool prior to a bowel movement. During a bowel movement, stool moves from the rectum to the anus. </s>


Input: What causes Dumping Syndrome ?

Output: Dumping syndrome is caused by problems with the storage of food particles in the stomach and emptying of particles into the duodenum. Early dumping syndrome results from rapid movement of fluid into the intestine following a sudden addition of a large amount of food from the stomach. Late dumping syndrome results from rapid movement of sugar into the intestine, which raises the body's blood glucose level and causes the pancreas to increase its release of the hormone insulin. The increased release of insulin causes a rapid drop in blood glucose levels, a condition known as hypoglycemia, or low blood sugar. </s>


Input: What are the symptoms of Dumping Syndrome ?

Output:
The symptoms of early and late dumping syndrome are different and vary from person to person. Early dumping syndrome symptoms may include

- nausea  - vomiting  - abdominal pain and cramping  - diarrhea  - feeling uncomfortably full or bloated after a meal  - sweating  - weakness  - dizziness  - flushing, or blushing of the face or skin  - rapid or irregular heartbeat

- hypoglycemia  - sweating  - weakness  - rapid or irregular heartbeat  - flushing  - dizziness

About 75 percent of people with dumping syndrome report symptoms of early dumping syndrome and about 25 percent report symptoms of late dumping syndrome. Some people have symptoms of both types of dumping syndrome.1 </s>


Input: How to diagnose Dumping Syndrome ?

Output:
A health care provider will diagnose dumping syndrome primarily on the basis of symptoms. A scoring system helps differentiate dumping syndrome from other GI problems. The scoring system assigns points to each symptom and the total points result in a score. A person with a score above 7 likely has dumping syndrome.

The following tests may confirm dumping syndrome and exclude other conditions with similar symptoms:

- A modified oral glucose tolerance test checks how well insulin works with tissues to absorb glucose. A health care provider performs the test during an office visit or in a commercial facility and sends the blood samples to a lab for analysis. The person should fasteat or drink nothing except waterfor at least 8 hours before the test. The health care provider will measure blood glucose concentration, hematocritthe amount of red blood cells in the bloodpulse rate, and blood pressure before the test begins. After the initial measurements, the person drinks a glucose solution. The health care provider repeats the initial measurements immediately and at 30-minute intervals for up to 180 minutes. A health care provider often confirms dumping syndrome in people with      - low blood sugar between 120 and 180 minutes after drinking the solution    - an increase in hematocrit of more than 3 percent at 30 minutes    - a rise in pulse rate of more than 10 beats per minute after 30 minutes     - A gastric emptying scintigraphy test involves eating a bland mealsuch as eggs or an egg substitutethat contains a small amount of radioactive material. A specially trained technician performs this test in a radiology center or hospital, and a radiologista doctor who specializes in medical imaginginterprets the results. Anesthesia is not needed. An external camera scans the abdomen to locate the radioactive material. The radiologist measures the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. The test can help confirm a diagnosis of dumping syndrome.

- An upper GI endoscopy involves using an endoscopea small, flexible tube with a lightto see the upper GI tract. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive general anesthesia or a liquid anesthetic that is gargled or sprayed on the back of the throat. If the person receives general anesthesia, a health care provider will place an intravenous (IV) needle in a vein in the arm. The test may show ulcers, swelling of the stomach lining, or cancer.   - An upper GI series examines the small intestine. An x-ray technician performs the test at a hospital or an outpatient center and a radiologist interprets the images. Anesthesia is not needed. No eating or drinking is allowed before the procedure, as directed by the health care staff. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of a blockage or other complications of gastric surgery show up more clearly on x rays. </s>


Input: What are the treatments for Dumping Syndrome ?

Output: Treatment for dumping syndrome includes changes in eating, diet, and nutrition; medication; and, in some cases, surgery. Many people with dumping syndrome have mild symptoms that improve over time with simple dietary changes. </s>


Input: What to do for Dumping Syndrome ?

Output:
The first step to minimizing symptoms of dumping syndrome involves changes in eating, diet, and nutrition, and may include

- eating five or six small meals a day instead of three larger meals  - delaying liquid intake until at least 30 minutes after a meal  - increasing intake of protein, fiber, and complex carbohydratesfound in starchy foods such as oatmeal and rice  - avoiding simple sugars such as table sugar, which can be found in candy, syrup, sodas, and juice beverages  - increasing the thickness of food by adding pectin or guar gumplant extracts used as thickening agents

Some people find that lying down for 30 minutes after meals also helps reduce symptoms.

Medication

A health care provider may prescribe octreotide acetate (Sandostatin) to treat dumping syndrome symptoms. The medication works by slowing gastric emptying and inhibiting the release of insulin and other GI hormones. Octreotide comes in short- and long-acting formulas. The short-acting formula is injected subcutaneouslyunder the skinor intravenouslyinto a veintwo to four times a day. A health care provider may perform the injections or may train the patient or patient's friend or relative to perform the injections. A health care provider injects the long-acting formula into the buttocks muscles once every 4 weeks. Complications of octreotide treatment include increased or decreased blood glucose levels, pain at the injection site, gallstones, and fatty, foul-smelling stools.

Surgery

A person may need surgery if dumping syndrome is caused by previous gastric surgery or if the condition is not responsive to other treatments. For most people, the type of surgery depends on the type of gastric surgery performed previously. However, surgery to correct dumping syndrome often has unsuccessful results. </s>


Input: What to do for Dumping Syndrome ?

Output: - Dumping syndrome occurs when food, especially sugar, moves too fast from the stomach to the duodenumthe first part of the small intestinein the upper gastrointestinal (GI) tract.  - Dumping syndrome has two forms, based on when symptoms occur:      - early dumping syndromeoccurs 10 to 30 minutes after a meal    - late dumping syndromeoccurs 2 to 3 hours after a meal    - People who have had surgery to remove or bypass a significant part of the stomach are more likely to develop dumping syndrome. Other conditions that impair how the stomach stores and empties itself of food, such as nerve damage caused by esophageal surgery, can also cause dumping syndrome.  - Early dumping syndrome symptoms include      - nausea    - vomiting    - abdominal pain and cramping    - diarrhea    - feeling uncomfortably full or bloated after a meal    - sweating    - weakness    - dizziness    - flushing, or blushing of the face or skin    - rapid or irregular heartbeat    - The symptoms of late dumping syndrome include      - hypoglycemia    - sweating    - weakness    - rapid or irregular heartbeat    - flushing    - dizziness    - Treatment for dumping syndrome includes changes in eating, diet, and nutrition; medication; and, in some cases, surgery. Many people with dumping syndrome have mild symptoms that improve over time with simple dietary changes. </s>


Input: What is (are) Kidney Dysplasia ?

Output:
Kidney dysplasia is a condition in which the internal structures of one or both of a fetus kidneys do not develop normally while in the womb. During normal development, two thin tubes of muscle called ureters grow into the kidneys and branch out to form a network of tiny structures called tubules. The tubules collect urine as the fetus grows in the womb. In kidney dysplasia, the tubules fail to branch out completely. Urine that would normally flow through the tubules has nowhere to go. Urine collects inside the affected kidney and forms fluid-filled sacs called cysts. The cysts replace normal kidney tissue and prevent the kidney from functioning.

Kidney dysplasia can affect one kidney or both kidneys. Babies with severe kidney dysplasia affecting both kidneys generally do not survive birth. Those who do survive may need the following early in life:

- blood-filtering treatments called dialysis  - a kidney transplant

Children with dysplasia in only one kidney have normal kidney function if the other kidney is unaffected. Those with mild dysplasia of both kidneys may not need dialysis or a kidney transplant for several years.

Kidney dysplasia is also called renal dysplasia or multicystic dysplastic kidney. </s>


Input: What is (are) Kidney Dysplasia ?

Output:
The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, which is composed of wastes and extra fluid. Children produce less urine than adultsthe amount they produce depends on their age. The urine flows from the kidneys to the bladder through the two ureters, one on each side of the bladder. The bladder stores urine. The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to find a toilet soon. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder.

The kidneys, ureters, bladder, and urethra are parts of the urinary tract. More information is provided in the NIDDK health topics, the kidneys and the urinary tract. </s>


Input: What causes Kidney Dysplasia ?

Output:
Genetic factors can cause kidney dysplasia. Genes pass information from both parents to the child and determine the childs traits. Sometimes, parents may pass a gene that has changed, or mutated, causing kidney dysplasia.

Genetic syndromes that affect multiple body systems can also cause kidney dysplasia. A syndrome is a group of symptoms or conditions that may seem unrelated yet are thought to have the same genetic cause. A baby with kidney dysplasia due to a genetic syndrome might also have problems of the digestive tract, nervous system, heart and blood vessels, muscles and skeleton, or other parts of the urinary tract.

A baby may also develop kidney dysplasia if his or her mother takes certain prescription medications during pregnancy, such as some used to treat seizures and high blood pressure. A mothers use of illegal drugs, such as cocaine, during pregnancy may also cause kidney dysplasia in her unborn child. </s>


Input: How many people are affected by Kidney Dysplasia ?

Output: Kidney dysplasia is a common condition. Scientists estimate that kidney dysplasia affects about one in 4,000 babies.1 This estimate may be low because some people with kidney dysplasia are never diagnosed with the condition. About half of the babies diagnosed with this condition have other urinary tract defects.2 </s>


Input: What are the symptoms of Kidney Dysplasia ?

Output: Many babies with kidney dysplasia in only one kidney have no signs of the condition. In some cases, the affected kidney may be enlarged at birth and may cause pain. </s>


Input: What are the complications of Kidney Dysplasia ?

Output:
The complications of kidney dysplasia can include

- hydronephrosis of the working kidney. A baby with kidney dysplasia in only one kidney might have other urinary tract defects. When other defects in the urinary tract block the flow of urine, the urine backs up and causes the kidneys and ureters to swell, a condition called hydronephrosis. If left untreated, hydronephrosis can damage the working kidney and reduce its ability to filter blood. Kidney damage may lead to chronic kidney disease (CKD) and kidney failure.  - a urinary tract infection (UTI). A urine blockage may increase a babys chance of developing a UTI. Recurring UTIs can also lead to kidney damage.  - high blood pressure.  - a slightly increased chance of developing kidney cancer.

More information is provided in the NIDDK health topics, urine blockage in newbornsand UTIs in children. </s>


Input: How to diagnose Kidney Dysplasia ?

Output:
Health care providers may be able to diagnose kidney dysplasia during a womans pregnancy using a fetal ultrasound, also called a fetal sonogram. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. Fetal ultrasound is a test done during pregnancy to create images of the fetus in the womb. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital, and an obstetrician or a radiologist interprets the images. An obstetrician is a doctor who specializes in pregnancy and childbirth. A radiologist is a doctor who specializes in medical imaging. The patientin this case, the fetus motherdoes not need anesthesia for this procedure. The images can show defects in the fetus kidneys and other parts of the urinary tract.

Health care providers do not always diagnose kidney dysplasia before a baby is born. After birth, health care providers often diagnose kidney dysplasia during an evaluation of the child for a UTI or another medical condition. A health care provider uses ultrasound to diagnose kidney dysplasia after the baby is born. </s>


Input: What are the treatments for Kidney Dysplasia ?

Output:
If the condition is limited to one kidney and the baby has no signs of kidney dysplasia, no treatment may be necessary. However, the baby should have regular checkups that include

- checking blood pressure.  - testing blood to measure kidney function.  - testing urine for albumin, a protein most often found in blood. Albumin in the urine may be a sign of kidney damage.  - performing periodic ultrasounds to monitor the damaged kidney and to make sure the functioning kidney continues to grow and remains healthy. </s>


Input: How to prevent Kidney Dysplasia ?

Output: Researchers have not found a way to prevent kidney dysplasia caused by genetic factors or certain genetic syndromes. Pregnant women can prevent kidney dysplasia by avoiding the use of certain prescription medications or illegal drugs during pregnancy. Pregnant women should talk with their health care provider before taking any medications during pregnancy. </s>


Input: What is the outlook for Kidney Dysplasia ?

Output:
The long-term outlook for a child with kidney dysplasia in only one kidney is generally good. A person with one working kidney, a condition called solitary kidney, can grow normally and may have few, if any, health problems.

The affected kidney may shrink as the child grows. By age 10,3 the affected kidney may no longer be visible on x-ray or ultrasound. Children and adults with only one working kidney should have regular checkups to test for high blood pressure and kidney damage. A child with urinary tract problems that lead to failure of the working kidney may eventually need dialysis or a kidney transplant.

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


Input: What is the outlook for Kidney Dysplasia ?

Output:
The long-term outlook for a child with kidney dysplasia in both kidneys is different from the long-term outlook for a child with one dysplastic kidney. A child with kidney dysplasia in both kidneys

- is more likely to develop CKD.  - needs close follow-up with a pediatric nephrologista doctor who specializes in caring for children with kidney disease. Children who live in areas that dont have a pediatric nephrologist available can see a nephrologist who cares for both children and adults.  - may eventually need dialysis or a kidney transplant. </s>


Input: What to do for Kidney Dysplasia ?

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


Input: What to do for Kidney Dysplasia ?

Output: - Kidney dysplasia is a condition in which the internal structures of one or both of a fetus kidneys do not develop normally while in the womb.  - Genetic factors can cause kidney dysplasia.  - Genetic syndromes that affect multiple body systems can also cause kidney dysplasia.  - A baby may also develop kidney dysplasia if his or her mother takes certain prescription medications during pregnancy, such as some used to treat seizures and high blood pressure.  - Many babies with kidney dysplasia in only one kidney have no signs of the condition.  - Health care providers may be able to diagnose kidney dysplasia during a womans pregnancy using a fetal ultrasound, also called a fetal sonogram.  - Health care providers do not always diagnose kidney dysplasia before a baby is born.  - If the condition is limited to one kidney and the baby has no signs of kidney dysplasia, no treatment may be necessary.  - Researchers have not found a way to prevent kidney dysplasia caused by genetic factors or certain genetic syndromes.  - Pregnant women can prevent kidney dysplasia by avoiding the use of certain prescription medications or illegal drugs during pregnancy.  - The long-term outlook for a child with kidney dysplasia in only one kidney is generally good.  - The long-term outlook for a child with kidney dysplasia in both kidneys is different from the long-term outlook for a child with one dysplastic kidney. A child with kidney dysplasia in both kidneys      - is more likely to develop chronic kidney disease (CKD)    - needs close follow-up with a pediatric nephrologist    - may eventually need dialysis or a kidney transplant </s>


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

Output:
A kidney* stone is a solid piece of material that forms in a kidney when there are high levels of certain substances in the urine. These substances are normally found in the urine and do not cause problems at lower levels.

A stone may stay in the kidney or travel down the urinary tract. Kidney stones vary in size. A small stone may pass on its own, causing little or no pain. A larger stone may get stuck along the urinary tract. A stone that gets stuck can block the flow of urine, causing severe pain or bleeding.

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


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

Output:
The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are two bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. Every day, the two kidneys process about 200 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra water. The urine flows from the kidneys to the bladder through tubes called ureters.

The bladder stores urine until releasing it through urination. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder. </s>


Input: What causes What I need to know about Kidney Stones ?

Output:
Kidney stones are caused by high levels of calcium, oxalate, and phosphorus in the urine. Some foods may cause kidney stones in certain people. You may be more likely to get a kidney stone if you have

- a condition that affects levels of substances in your urine that can cause stones to form  - a family history of kidney stones  - repeating, or recurrent, urinary tract infections  - blockage of your urinary tract  - digestive problems

You may also be more likely to get a kidney stone if you dont drink enough fluids or if you take certain medicines. </s>


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

Output:
Doctors have found four main types of kidney stones:

- The most common types of stones contain calcium. Calcium is a normal part of a healthy diet. Calcium that is not used by the bones and muscles goes to the kidneys. In most people, the kidneys flush out the extra calcium with the rest of the urine. People who have calcium stones keep the calcium in their kidneys. The calcium that stays behind joins with other waste products to form a stone. People can have calcium oxalate and calcium phosphate stones. Calcium oxalate stones are more common.  - A uric acid stone may form when the urine contains too much acid. People who eat a lot of meat, fish, and shellfish may get uric acid stones.  - A struvite stone may form after you have a kidney infection.  - Cystine stones result from a genetic disorder, meaning a problem passed from parent to child. The disorder causes cystine to leak through the kidneys and into the urine. </s>


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

Output:
You may have a kidney stone if you

- have pain while urinating  - see blood in your urine  - feel a sharp pain in your back or lower abdomenthe area between your chest and hips

The pain may last for a short or long time. You may have nausea and vomiting with the pain.

If you have a small stone that passes on its own easily, you may not have symptoms at all. </s>


Input: How to diagnose What I need to know about Kidney Stones ?

Output:
To diagnose kidney stones, your doctor will do a physical exam and ask about your medical history. The doctor may ask if you have a family history of kidney stones and about your diet, digestive problems, and other health problems. The doctor may perform urine, blood, and imaging tests to complete the diagnosis.

- Urine tests can show whether you have an infection or your urine contains substances that form stones.  - Blood tests can show problems that lead to kidney stones.  - Imaging tests are used to find the location of kidney stones in your body. The tests may also be able to show problems that caused a kidney stone to form. </s>


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

Output:
The treatment for kidney stones usually depends on their size and what they are made of. Kidney stones may be treated by your regular doctor or by a urologista doctor who specializes in the urinary tract. You may need treatment if you have symptoms or if a kidney stone is blocking your urinary tract. Small stones dont usually need treatment. Still, you may need pain medicine. You should also drink lots of fluids to help move the stone along. If you are vomiting often or dont drink enough fluids, you may need to go to the hospital and get fluids through a needle in your arm.

If you have a large kidney stone or your urinary tract is blocked, the urologist can remove the stone or break it into small pieces with the following treatments: </s>


Input: How to prevent What I need to know about Kidney Stones ?

Output:
To prevent kidney stones, you need to know what caused your kidney stone. Your doctor may ask you to try to catch the kidney stone as it passes in your urine. The kidney stone can then be sent to a lab to find out what type of stone it is. If you have treatment in the hospital and the doctor removes the stone, it will also be sent to a lab for testing.

Your doctor may ask you to collect your urine for 24 hours after the stone has passed or been removed. Your doctor can then measure how much urine you produce in a day and mineral levels in the urine. You are more likely to form stones if you dont make enough urine each day or have a problem with mineral levels.

Once you know what type of kidney stone you had, you can make changes in your eating, diet, and nutrition and take medicines to prevent future kidney stones. </s>


Input: What to do for What I need to know about Kidney Stones ?

Output:
You can help prevent kidney stones by making changes in how much you consume of the following:

- fluids  - sodium  - animal protein  - calcium  - oxalate

Drinking enough fluids each day is the best way to help prevent most types of kidney stones. You should drink 2 to 3 liters of fluid a day. If you had cystine stones, you may need to drink even more.

Though water is best, other fluids may also help prevent kidney stones, such as orange juice or lemonade. Talk with your health care provider if you cant drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.

You can make the following changes to your diet based on the type of kidney stone you had:

Calcium Oxalate Stones

- reduce sodium  - reduce animal protein, such as meat, eggs, and fish  - get enough calcium from food or take calcium supplements with food  - avoid foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran

Calcium Phosphate Stones

- reduce sodium  - reduce animal protein  - get enough calcium from food or take calcium supplements with food

Uric Acid Stones

- limit animal protein

More information about how changes in diet affect kidney stone formation is provided in the NIDDK health topic, Diet for Kidney Stone Prevention.

Medicines

Your doctor may prescribe medicines based on the type of kidney stone you had and any health problems you have that make you more likely to form a stone. </s>


Input: What to do for What I need to know about Kidney Stones ?

Output: - A kidney stone is a solid piece of material that forms in a kidney when there are high levels of certain substances in the urine. These substances are normally found in the urine and do not cause problems at lower levels.  - Kidney stones are caused by high levels of calcium, oxalate, and phosphorus in the urine.  - You may have a kidney stone if you      - have pain while urinating    - see blood in your urine    - feel a sharp pain in your back or lower abdomen    - If you have a small stone that passes on its own easily, you may not have symptoms at all.  - To diagnose kidney stones, your doctor will do a physical exam and ask about your medical history. The doctor may perform urine, blood, and imaging tests to complete the diagnosis.  - The treatment for kidney stones usually depends on their size and what they are made of. You may need pain medicine. You should also drink lots of fluids. If you have a large kidney stone or your urinary tract is blocked, the urologist can remove the stone or break it into small pieces with shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy.  - To prevent kidney stones, you need to know what caused your kidney stone.  - Once you know what type of kidney stone you had, you can make changes in your eating, diet, and nutrition and take medicines to prevent future kidney stones. </s>


Input: What is (are) Porphyria ?

Output:
Porphyrias are rare disorders that affect mainly the skin or nervous system and may cause abdominal pain. These disorders are usually inherited, meaning they are caused by abnormalities in genes passed from parents to children. When a person has a porphyria, cells fail to change body chemicals called porphyrins and porphyrin precursors into heme, the substance that gives blood its red color. The body makes heme mainly in the bone marrow and liver. Bone marrow is the soft, spongelike tissue inside the bones; it makes stem cells that develop into one of the three types of blood cellsred blood cells, white blood cells, and platelets.

The process of making heme is called the heme biosynthetic pathway. One of eight enzymes controls each step of the process. The body has a problem making heme if any one of the enzymes is at a low level, also called a deficiency. Porphyrins and porphyrin precursors of heme then build up in the body and cause illness. </s>


Input: What is (are) Porphyria ?

Output: Heme is a red pigment composed of iron linked to a chemical called protoporphyrin. Heme has important functions in the body. The largest amounts of heme are in the form of hemoglobin, found in red blood cells and bone marrow. Hemoglobin carries oxygen from the lungs to all parts of the body. In the liver, heme is a component of proteins that break down hormones, medications, and other chemicals and keep liver cells functioning normally. Heme is an important part of nearly every cell in the body. </s>


Input: What is (are) Porphyria ?

Output:
Each of the eight types of porphyria corresponds to low levels of a specific enzyme in the heme biosynthetic pathway. Experts often classify porphyrias as acute or cutaneous based on the symptoms a person experiences:

- Acute porphyrias affect the nervous system. They occur rapidly and last only a short time.  - Cutaneous porphyrias affect the skin.

Two types of acute porphyrias, hereditary coproporphyria and variegate porphyria, can also have cutaneous symptoms.

Experts also classify porphyrias as erythropoietic or hepatic:

- In erythropoietic porphyrias, the body overproduces porphyrins, mainly in the bone marrow.  - In hepatic porphyrias, the body overproduces porphyrins and porphyrin precursors, mainly in the liver.

Table 1 lists each type of porphyria, the deficient enzyme responsible for the disorder, and the main location of porphyrin buildup.

Table 1. Types of porphyria

Type of Porphyria    Deficient Enzyme    Main Location of Porphyrin Buildup                  delta-aminolevulinate-dehydratase deficiency porphyria    delta-aminolevulinic acid dehydratase    liver        acute intermittent porphyria    porphobilinogen deaminase    liver        hereditary coproporphyria    coproporphyrinogen oxidase    liver        variegate porphyria    protoporphyrinogen oxidase    liver                congenital erythropoietic porphyria    uroporphyrinogen III cosynthase    bone marrow        porphyria cutanea tarda    uroporphyrinogen decarboxylase (~75% deficiency)    liver        hepatoerythropoietic porphyria    uroporphyrinogen decarboxylase (~90% deficiency)    bone marrow        erythropoietic protoporphyria*    ferrochelatase (~75% deficiency)    bone marrow

*Protoporphyria XLPP is a variant of erythropoietic protoporphyria. </s>


Input: How many people are affected by Porphyria ?

Output: The exact rates of porphyria are unknown and vary around the world. For example, porphyria cutanea tarda is most common in the United States, and variegate porphyria is most common in South America.1 </s>


Input: What causes Porphyria ?

Output:
Most porphyrias are inherited disorders. Scientists have identified genes for all eight enzymes in the heme biosynthetic pathway. Most porphyrias result from inheriting an abnormal gene, also called a gene mutation, from one parent. Some porphyrias, such as congenital erythropoietic porphyria, hepatoerythropoietic porphyria, and erythropoietic protoporphyria, occur when a person inherits two abnormal genes, one from each parent. The likeliness of a person passing the abnormal gene or genes to the next generation depends on the type of porphyria.

Porphyria cutanea tarda is usually an acquired disorder, meaning factors other than genes cause the enzyme deficiency. This type of porphyria can be triggered by

- too much iron  - use of alcohol or estrogen  - smoking  - chronic hepatitis Ca long-lasting liver disease that causes inflammation, or swelling, of the liver  - HIVthe virus that causes AIDS  - abnormal genes associated with hemochromatosisthe most common form of iron overload disease, which causes the body to absorb too much iron

For all types of porphyria, symptoms can be triggered by

- use of alcohol  - smoking  - use of certain medications or hormones  - exposure to sunlight  - stress  - dieting and fasting </s>


Input: What are the symptoms of Porphyria ?

Output:
Some people with porphyria-causing gene mutations have latent porphyria, meaning they have no symptoms of the disorder. Symptoms of cutaneous porphyrias include

- oversensitivity to sunlight  - blisters on exposed areas of the skin  - itching and swelling on exposed areas of the skin

Symptoms of acute porphyrias include

- pain in the abdomenthe area between the chest and hips  - pain in the chest, limbs, or back  - nausea and vomiting  - constipationa condition in which an adult has fewer than three bowel movements a week or a child has fewer than two bowel movements a week, depending on the person  - urinary retentionthe inability to empty the bladder completely  - confusion  - hallucinations  - seizures and muscle weakness

Symptoms of acute porphyrias can develop over hours or days and last for days or weeks. These symptoms can come and go over time, while symptoms of cutaneous porphyrias tend to be more continuous. Porphyria symptoms can vary widely in severity. </s>


Input: How to diagnose Porphyria ?

Output: A health care provider diagnoses porphyria with blood, urine, and stool tests. These tests take place at a health care providers office or a commercial facility. A blood test involves drawing blood and sending the sample to a lab for analysis. For urine and stool tests, the patient collects a sample of urine or stool in a special container. A health care provider tests the samples in the office or sends them to a lab for analysis. High levels of porphyrins or porphyrin precursors in blood, urine, or stool indicate porphyria. A health care provider may also recommend DNA testing of a blood sample to look for known gene mutations that cause porphyrias. </s>


Input: What are the treatments for Porphyria ?

Output:
Treatment for porphyria depends on the type of porphyria the person has and the severity of the symptoms.

Acute Porphyrias

A health care provider treats acute porphyrias with heme or glucose loading to decrease the livers production of porphyrins and porphyrin precursors. A patient receives heme intravenously once a day for 4 days. Glucose loading involves giving a patient a glucose solution by mouth or intravenously. Heme is usually more effective and is the treatment of choice unless symptoms are mild. In rare instances, if symptoms are severe, a health care provider will recommend liver transplantation to treat acute porphyria. In liver transplantation, a surgeon removes a diseased or an injured liver and replaces it with a healthy, whole liver or a segment of a liver from another person, called a donor. A patient has liver transplantation surgery in a hospital under general anesthesia. Liver transplantation can cure liver failure. More information is provided in the NIDDK health topic, Liver Transplantation.

Cutaneous Porphyrias

The most important step a person can take to treat a cutaneous porphyria is to avoid sunlight as much as possible. Other cutaneous porphyrias are treated as follows:

- Porphyria cutanea tarda. A health care provider treats porphyria cutanea tarda by removing factors that tend to activate the disease and by performing repeated therapeutic phlebotomies to reduce iron in the liver. Therapeutic phlebotomy is the removal of about a pint of blood from a vein in the arm. A technician performs the procedure at a blood donation center, such as a hospital, clinic, or bloodmobile. A patient does not require anesthesia. Another treatment approach is low-dose hydroxychloroquine tablets to reduce porphyrins in the liver.  - Erythropoietic protoporphyria. People with erythropoietic protoporphyria may be given beta-carotene or cysteine to improve sunlight tolerance, though these medications do not lower porphyrin levels. Experts recommend hepatitis A and B vaccines and avoiding alcohol to prevent protoporphyric liver failure. A health care provider may use liver transplantation or a combination of medications to treat people who develop liver failure. Unfortunately, liver transplantation does not correct the primary defect, which is the continuous overproduction of protoporphyria by bone marrow. Successful bone marrow transplantations may successfully cure erythropoietic protoporphyria. A health care provider only considers bone marrow transplantation if the disease is severe and leading to secondary liver disease.  - Congenital erythropoietic porphyria and hepatoerythropoietic porphyria. People with congenital erythropoietic porphyria or hepatoerythropoietic porphyria may need surgery to remove the spleen or blood transfusions to treat anemia. A surgeon removes the spleen in a hospital, and a patient receives general anesthesia. With a blood transfusion, a patient receives blood through an intravenous (IV) line inserted into a vein. A technician performs the procedure at a blood donation center, and a patient does not need anesthesia.

Secondary Porphyrinurias

Conditions called secondary porphyrinurias, such as disorders of the liver and bone marrow, as well as a number of drugs, chemicals, and toxins are often mistaken for porphyria because they lead to mild or moderate increases in porphyrin levels in the urine. Only highnot mild or moderatelevels of porphyrin or porphyrin precursors lead to a diagnosis of porphyria. </s>


Input: What to do for Porphyria ?

Output:
People with an acute porphyria should eat a diet with an average-to-high level of carbohydrates. The recommended dietary allowance for carbohydrates is 130 g per day for adults and children 1 year of age or older; pregnant and breastfeeding women need higher intakes.2 People should avoid limiting intake of carbohydrates and calories, even for short periods of time, as this type of dieting or fasting can trigger symptoms. People with an acute porphyria who want to lose weight should talk with their health care providers about diets they can follow to lose weight gradually.

People undergoing therapeutic phlebotomies should drink plenty of milk, water, or juice before and after each procedure.

A health care provider may recommend vitamin and mineral supplements for people with a cutaneous porphyria. </s>


Input: What to do for Porphyria ?

Output: - Porphyrias are rare disorders that affect mainly the skin or nervous system and may cause abdominal pain.  - Each of the eight types of porphyria corresponds to low levels of a specific enzyme in the heme biosynthetic pathway.  - The exact rates of porphyria are unknown and vary around the world. For example, porphyria cutanea tarda is most common in the United States, and variegate porphyria is most common in South America.  - Most porphyrias result from inheriting an abnormal gene, also called a gene mutation, from one parent.  - Porphyria cutanea tarda is usually an acquired disorder, meaning factors other than genes cause the enzyme deficiency.  - Symptoms of cutaneous porphyrias include      - oversensitivity to sunlight    - blisters on exposed areas of the skin    - itching and swelling on exposed areas of the skin    - Symptoms of acute porphyrias include      - pain in the abdomen    - pain in the chest, limbs, or back    - nausea and vomiting    - constipation    - urinary retention    - confusion    - hallucinations    - seizures and muscle weakness    - A health care provider diagnoses porphyria with blood, urine, and stool tests.  - Treatment for porphyria depends on the type of porphyria the person has and the severity of the symptoms. </s>