The efficacy of naltrexone for cholestatic pruritus suggests involvement of the endogenous opioid system. Many patients may experience jaundice as a result of cholestasis. This is usually evident after physical examination as yellow pigment deposits on the skin, in the oral mucosa, or conjunctiva. Jaundice is an uncommon occurrence in intrahepatic (metabolic) cholestasis, but is common in obstructive cholestasis. The majority of patients with chronic cholestasis also experience fatigue. This is likely a result of defects in the corticotrophin hormone axis or other abnormalities with neurotransmission. Some patients may also have xanthomas, which are fat deposits that accumulate below the skin. These usually appear waxy and yellow, predominantly around the eyes and joints. This condition results from an accumulation of lipids within the blood. If gallstones prevent bile flowing from the pancreas to the small intestine, it can lead to gallstone pancreatitis. Physical symptoms include nausea, vomiting, and abdominal pain. Bile is required for the absorption of fat-soluble vitamins. As such, patients with cholestasis may present with a deficiency in vitamins A, D, E, or K due to a decline in bile flow. Patients with cholestasis may also experience pale stool and dark urine. Causes
Possible causes:

pregnancy
androgens
birth control pills
antibiotics (such as TMP/SMX)
abdominal mass (e.g. cancer)
pediatric liver diseases
biliary trauma
congenital anomalies of the biliary tract
gallstones
biliary dyskinesia
acute hepatitis
cystic fibrosis
primary biliary cholangitis, an autoimmune disorder
primary sclerosing cholangitis, associated with inflammatory bowel disease
some drugs (e.g.
Tricuspid valve stenosis is a valvular heart disease that narrows the opening of the hearts tricuspid valve. It is a relatively rare condition that causes stenosis (increased restriction of blood flow through the valve). Cause
Causes of tricuspid valve stenosis are:
Rheumatic disease
Carcinoid syndrome
Pacemaker leads (complication)

Diagnosis
A mild diastolic murmur can be heard during auscultation caused by the blood flow through the stenotic valve. It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide-splitting S2. The diagnosis will typically be confirmed by an echocardiograph, which will also allow the physician to assess its severity. Treatment
Tricuspid valve stenosis itself usually does not require treatment. If stenosis is mild, monitoring the condition closely suffices. However, severe stenosis, or damage to other valves in the heart, may require surgical repair or replacement. The treatment is usually by surgery (tricuspid valve replacement) or percutaneous balloon valvuloplasty. The resultant tricuspid regurgitation from percutaneous treatment is better tolerated than the insufficiency occurring during mitral valvuloplasty. See also
Echocardiography
Tricuspid valve

References


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