Wednesday, July 30, 2014
Monday, May 27, 2013
Ehlers-Danlos syndrome
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Ehlers-Danlos syndrome is the name given to a group of conditions that are inherited through the genes. A faulty inherited gene means that there is a problem with the formation and structure of collagen and connective tissue in the body. This leads to stretchy skin, loose joints and fragile blood vessels and body tissues. Treatment is aimed at trying to protect the skin and joints from further damage.
What is Ehlers-Danlos syndrome and what causes it?
Ehlers-Danlos syndrome (EDS) is the name given to a group of conditions that are inherited through the genes. There is a problem with the formation and structure of collagen and connective tissue in the body.Connective tissue is a fibrous tissue that gives support and structure and binds, or connects, parts of the body together. Collagen is a type of protein and is one of the main components of connective tissue. There are over thirty different types of collagen, found in different parts of the body. More than 80% of the skin is made up from collagen. Collagen is also found in the tendons, ligaments and cartilage around joints, as well as the blood vessels.
In someone with EDS, faulty genes mean that the amount of collagen in their body can be reduced and/or the collagen and connective tissue can be weaker. It can affect the skin, joints and blood vessels throughout the body leading to:
- Fragile and hyperelastic (stretchy) skin.
- Unstable and hypermobile (loose) joints.
- Fragile blood vessels and body tissues.
It is called Ehlers-Danlos syndrome after Edvard Ehlers and Henri-Alexandre Danlos who recognised and described the features of the group of conditions in the early 1900s.
Wednesday, January 2, 2013
Why No Antibiotic?
Viral infections
Many common infections of the nose, throat, sinuses, ears, and chest are caused by viruses. Flu-like illnesses are also caused by viruses. Diarrhoea and/or vomiting are often due to a viral infection of the gut. If you are normally well, your immune (defence) system is good at fighting off many types of viral infection. An antibiotic is not needed if a virus is causing an infection. This is because:
Antibiotics do not kill viruses. Antibiotics only kill bacteria.
Antibiotics may cause side-effects such as diarrhoea, rashes, feeling sick, etc.
Overuse of antibiotics when they have not been necessary has led to some bacteria becoming resistant to them. This means that some antibiotics might not be as effective when they are really needed.
You may feel unwell for several days or more until a viral infection clears. Treatment aims to ease symptoms. Treatments that are commonly advised for viral infections include the following.
Paracetamol or ibuprofen to reduce a high temperature (fever), and to ease aches, pains, and headaches.
Make sure you drink enough to prevent mild dehydration. Dehydration may develop if you have a high temperature, and it can make a headache and tiredness much worse.
Do not wrap up, but try to cool down if you have a high temperature. This is particularly important in children. If a child has a high temperature, then take their clothes off (in a warm, but not hot, room) and consider giving some paracetamol or ibuprofen.
Other advice may be given for specific symptoms. For example, decongestants for a blocked nose, etc. Ask a pharmacist for advice.
What about bacterial infections?
The immune system can clear most bacterial infections. For example, antibiotics usually do little to speed up recovery of bronchitis, or most ear, nose, and throat infections that are caused by bacteria. However, you do need antibiotics if you have certain serious infections caused by bacteria, such as meningitis or pneumonia. When you are ill, doctors are skilled at checking you over to rule out serious illness, and to advise if an antibiotic is needed.
What if symptoms change?
Occasionally, a viral infection or minor bacterial infection develops into a more serious infection. See a doctor to review the situation if the illness appears to change, becomes worse, does not go after a few days, or if you are worried about any new symptom that develops.
Many common infections of the nose, throat, sinuses, ears, and chest are caused by viruses. Flu-like illnesses are also caused by viruses. Diarrhoea and/or vomiting are often due to a viral infection of the gut. If you are normally well, your immune (defence) system is good at fighting off many types of viral infection. An antibiotic is not needed if a virus is causing an infection. This is because:
Antibiotics do not kill viruses. Antibiotics only kill bacteria.
Antibiotics may cause side-effects such as diarrhoea, rashes, feeling sick, etc.
Overuse of antibiotics when they have not been necessary has led to some bacteria becoming resistant to them. This means that some antibiotics might not be as effective when they are really needed.
You may feel unwell for several days or more until a viral infection clears. Treatment aims to ease symptoms. Treatments that are commonly advised for viral infections include the following.
Paracetamol or ibuprofen to reduce a high temperature (fever), and to ease aches, pains, and headaches.
Make sure you drink enough to prevent mild dehydration. Dehydration may develop if you have a high temperature, and it can make a headache and tiredness much worse.
Do not wrap up, but try to cool down if you have a high temperature. This is particularly important in children. If a child has a high temperature, then take their clothes off (in a warm, but not hot, room) and consider giving some paracetamol or ibuprofen.
Other advice may be given for specific symptoms. For example, decongestants for a blocked nose, etc. Ask a pharmacist for advice.
What about bacterial infections?
The immune system can clear most bacterial infections. For example, antibiotics usually do little to speed up recovery of bronchitis, or most ear, nose, and throat infections that are caused by bacteria. However, you do need antibiotics if you have certain serious infections caused by bacteria, such as meningitis or pneumonia. When you are ill, doctors are skilled at checking you over to rule out serious illness, and to advise if an antibiotic is needed.
What if symptoms change?
Occasionally, a viral infection or minor bacterial infection develops into a more serious infection. See a doctor to review the situation if the illness appears to change, becomes worse, does not go after a few days, or if you are worried about any new symptom that develops.
Monday, December 10, 2012
Gastroscopy (Endoscopy)
What is a gastroscopy?
An endoscope is a thin, flexible telescope. It is about as thick as a little finger. The endoscope is passed through the mouth, into the oesophagus and down towards the stomach and duodenum.
The tip of the endoscope contains a light and a tiny video camera so the operator can see inside your gut.
The endoscope also has a 'side channel' down which various instruments can pass. These can be manipulated by the operator. For example, the operator may take a small sample (biopsy) from the inside lining of the stomach by using a thin 'grabbing' instrument which is passed down a side channel.
Who has a gastroscopy?
A gastroscopy may be advised if you have symptoms such as recurring indigestion, recurring heartburn, pains in the upper abdomen, repeated vomiting, difficulty swallowing, or other symptoms thought to be coming from the upper gut. The sort of conditions which can be confirmed (or ruled out) include:- Oesophagitis (inflammation of the oesophagus). The operator will see areas of redness on the lining of the oesophagus.
- Duodenal and stomach ulcers. An ulcer looks like a small, red crater on the inside lining of the duodenum or stomach.
- Duodenitis and gastritis (inflammation of the duodenum and stomach).
- Cancer of the stomach and oesophagus.
- Various other rare conditions.
What happens during a gastroscopy?
Gastroscopy is usually done as an outpatient 'day case'. It is a routine test which is commonly done. The operator may numb the back of your throat by spraying on some local anaesthetic, or give you an anaesthetic lozenge to suck. You may be given a sedative to help you to relax. This is usually given by an injection into a vein in the back of your hand. The sedative can make you drowsy but it does not 'put you to sleep'. It is not a general anaesthetic.You lie on your side on a couch. You are asked to put a plastic mouth guard between your teeth. This protects your teeth and stops you biting the endoscope. The operator will then ask you to swallow the first section of the endoscope. Modern endoscopes are quite thin and easy to swallow. The operator then gently pushes it further down your oesophagus, and into your stomach and duodenum. The video camera at the tip of the endoscope sends pictures to a screen. The operator watches the screen for abnormalities of the oesophagus, stomach and duodenum. Air is passed down a channel in the endoscope into the stomach to make the stomach lining easier to see. This may cause you to feel 'full' and want to belch.
The operator may take one or more biopsies (small samples) of parts of the inside lining of the gut - depending on why the test is done and what they see. This is painless. The biopsy samples are sent to the laboratory for testing, and to look at under the microscope. The endoscope is then gently pulled out.
A gastroscopy usually takes about 10 minutes. However, you should allow at least two hours for the whole appointment, to prepare, give time for the sedative to work (if you have one), for the gastroscopy itself, and to recover. A gastroscopy does not usually hurt, but it can be a little uncomfortable, particularly when you first swallow the endoscope.
What preparation do I need to do?
You should get instructions from the hospital department before your test. The sort of instructions given commonly include:- You should not eat for 4-6 hours before the test. The stomach needs to be empty. (Small sips of water may be allowed up to two hours before the test.)
- If you have a sedative you will need somebody to accompany you home.
- Advice about medication which may need to be stopped before the test.
What can I expect after a gastroscopy?
Most people are ready to go home after resting for half an hour or so.If you have had a sedative - you may take a bit longer to be ready to go home. The sedative will normally make you feel quite pleasant and relaxed. However, you should not drive, operate machinery or drink alcohol for 24 hours after having the sedative. You will need somebody to accompany you home and to stay with you for 24 hours until the effects have fully worn off. Most people are able to resume normal activities after 24 hours.
The operator writes a report and sends it to the doctor who requested the gastroscopy. The result from any biopsy may take a few days which can delay the report being sent. The operator may also tell you what they saw before you leave. However, if you have had a sedative you may not remember afterwards what they said. Therefore, you may wish to have a relative or close friend with you who may be able to remember what was said.
Is gastroscopy reliable?
Gastroscopy is a good test for seeing abnormalities in the upper gut. However, it is not foolproof. For example, gastroscopy may not detect a small number of cases of early ulcers or early cancer. Sometimes a repeat gastroscopy may be advised if symptoms persist or get worse, even if a previous gastroscopy was reported as normal.Are there any side-effects or complications from having a gastroscopy?
Most gastroscopies are done without any problem. Some people have a mildly sore throat for a day or so afterwards. You may feel tired or sleepy for several hours if you have a sedative. There is a slightly increased risk of developing a chest infection or pneumonia following a gastroscopy.Occasionally, the endoscope causes some damage to the gut. This may cause bleeding, infection, and rarely, perforation. If any of the following occur within 48 hours after a gastroscopy, consult a doctor immediately:
- Abdominal pain. (In particular, if it becomes gradually worse, and is different or more intense to any 'usual' indigestion pains or heartburn that you may have.)
- Fever (raised temperature).
- Difficulty breathing.
- Vomiting blood.
Rarely, some people have an allergic reaction to the sedative.
Wednesday, December 5, 2012
Hepatitis B
What are hepatitis and hepatitis B?
Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, drinking too much alcohol, various drugs and chemicals, and also several different viruses can cause hepatitis. One virus that causes hepatitis is called the hepatitis B virus. This leaflet is only about hepatitis B. See separate leaflets called Hepatitis A and Hepatitis C, which are caused by different viruses.
Hepatitis B is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver.
How common is hepatitis B?
The exact number of people infected is not known. In the UK around 1 person in 350 is thought to have chronic (persistent) hepatitis B infection. Worldwide, it is much more common and hepatitis B is the most common cause of hepatitis. For example, in parts of Asia and Africa more than 1 person in 10 has chronic hepatitis B infection.
How can you get hepatitis B?
Hepatitis B is a very infectious disease.
From mother to baby (sometimes called vertical transmission)
Worldwide, the most common way the virus is passed on is from an infected mother to her baby. This usually occurs during childbirth. This is very common in some parts of the world where many people are infected with this virus (but is rare in the UK). All women in the UK are now tested for hepatitis B when they are pregnant.
What are the symptoms and how does hepatitis B progress?
It is helpful to think of two phases of infection with hepatitis B virus.
An acute phase when you are first infected
A chronic (persistent) phase when the virus remains long-term in some cases.
How is hepatitis B diagnosed and assessed?
A simple blood test can detect if you are infected with the hepatitis B virus. This test detects a protein on the surface of the virus called hepatitis B surface antigen (HbsAg). If you are found to be infected (if you are HBsAg-positive), then other tests may be advised to check on the severity of infection, liver inflammation and damage to the liver.
For example:
A blood test can detect various parts of the virus. This can assess how active the virus is (if it is multiplying rapidly which indicates that it is more likely to cause liver damage).
Blood tests called liver function tests. These measure the activity of enzymes (chemicals) and other substances made in the liver. This gives a general guide as to whether the liver is inflamed, and how well it is working. See separate leaflet called Liver Function Tests.
An ultrasound scan of the liver.
A biopsy (small sample) of the liver may be taken to look at under the microscope. This can show the extent of any inflammation and cirrhosis. See separate leaflet called Liver Biopsy.
A blood test can also be performed to show if you have immunity to hepatitis B.
Other tests may be done if cirrhosis or other complications develop.
There are other specialised blood tests being developed which assess the development and severity of cirrhosis.
Can hepatitis B be prevented?
Immunisation
A vaccine is available to protect against hepatitis B. This should be offered to anyone who is at increased risk of being infected with the hepatitis B virus. For example, sexual and household contacts of someone infected with hepatitis B. (See separate leaflet called Hepatitis B Immunisation for a full list of people at increased risk who should be immunised.)
Post-exposure prevention
If you are not immunised and have been exposed to the virus, you should see a doctor immediately. (For example, if you are a healthcare worker and you have a needlestick injury.) You can be given an injection of antibodies called immunoglobulin as well as starting a course of immunisation. This may prevent infection from developing.
Preventing infection in newborn babies at risk
All pregnant women in the UK are offered a hepatitis B blood test. If the mother is infected, her baby is given injections of antibodies and also immunised straight after birth. (The transmission of the virus to the baby is thought to occur mainly during childbirth and not during the pregnancy.) With this treatment there is a good chance of preventing infection developing in the baby.
If I am infected, how can I prevent passing on the virus to others?
If you have a current hepatitis B infection you should:
Avoid having sex with anyone (especially any sex without using a condom) until they have been fully immunised and have been checked to see that the immunisation has worked by a blood test.
Not share any injecting equipment such as needles, syringes, etc.
Not donate blood or semen or carry a donor card.
Not share razors, toothbrushes, etc, that may be contaminated with blood.
Cover any cuts or wounds with a dressing.
Make sure that, if any of your blood spills on to the floor or other surfaces following an accident, it is cleaned away with bleach.
What is the treatment of hepatitis B?
Treatment for the acute phase
No treatment can clear the virus from the body. If you develop symptoms when first infected, treatment aims to help ease symptoms until they go - for example, drinking plenty of water to avoid dehydration. Rarely, a severe hepatitis develops which may need hospital care. No treatment can prevent acute hepatitis B from becoming chronic.
Treatment for chronic infection
Treatment for hepatitis B does not cure hepatitis B but works to delay or even to prevent complications from developing, like liver damage and cirrhosis. People with chronic hepatitis B usually need treatment to stop or to reduce the activity of the virus, so limiting liver damage. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given:
Interferon. This medicine is similar to a substance produced in your body, which is also called interferon. It works to fight infections by boosting your immune system. Interferon is usually given as an injection each week.
Antiviral medicines. These work by stopping the hepatitis B virus from multiplying in the body. They include lamivudine, adefovir, tenofovir, telbivudine, and entecavir. Your doctor will discuss these in more detail with you, as the medicine used can vary between people. A combination of antiviral medicines is sometimes used.
Treatment with medicines is usually continued for many years.
Side-effects with these medicines can occur. You will be monitored regularly while you are taking treatment, which includes blood tests. Some people need to change their medicines, or take a lower strength, if they have troublesome side-effects. Also, in some people, resistance can develop to their treatment medicine, which means that it does not work so well. If this happens then it is likely you will have to change the medicine you take.
The treatment of hepatitis B is a developing area of medicine. New medicines continue to be developed and the information above is very general. There are some newer medicines that have been introduced in the last few years that show promise to improve the outlook. The specialist who knows your case can give more accurate information about the outlook for your particular situation.
Liver transplant
For some people with advanced cirrhosis, liver transplantation may be an option. Although this is a major operation, the outlook following a liver transplant can be very good. However, the new liver may also eventually become damaged by the persisting hepatitis B infection.
Diet and alcohol
Most people with chronic hepatitis B will be advised to eat a normal healthy balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol. If you already have liver inflammation, alcohol increases the risk and speed of developing cirrhosis.
Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, drinking too much alcohol, various drugs and chemicals, and also several different viruses can cause hepatitis. One virus that causes hepatitis is called the hepatitis B virus. This leaflet is only about hepatitis B. See separate leaflets called Hepatitis A and Hepatitis C, which are caused by different viruses.
Hepatitis B is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver.
How common is hepatitis B?
The exact number of people infected is not known. In the UK around 1 person in 350 is thought to have chronic (persistent) hepatitis B infection. Worldwide, it is much more common and hepatitis B is the most common cause of hepatitis. For example, in parts of Asia and Africa more than 1 person in 10 has chronic hepatitis B infection.
How can you get hepatitis B?
Hepatitis B is a very infectious disease.
From mother to baby (sometimes called vertical transmission)
Worldwide, the most common way the virus is passed on is from an infected mother to her baby. This usually occurs during childbirth. This is very common in some parts of the world where many people are infected with this virus (but is rare in the UK). All women in the UK are now tested for hepatitis B when they are pregnant.
What are the symptoms and how does hepatitis B progress?
It is helpful to think of two phases of infection with hepatitis B virus.
An acute phase when you are first infected
A chronic (persistent) phase when the virus remains long-term in some cases.
How is hepatitis B diagnosed and assessed?
A simple blood test can detect if you are infected with the hepatitis B virus. This test detects a protein on the surface of the virus called hepatitis B surface antigen (HbsAg). If you are found to be infected (if you are HBsAg-positive), then other tests may be advised to check on the severity of infection, liver inflammation and damage to the liver.
For example:
A blood test can detect various parts of the virus. This can assess how active the virus is (if it is multiplying rapidly which indicates that it is more likely to cause liver damage).
Blood tests called liver function tests. These measure the activity of enzymes (chemicals) and other substances made in the liver. This gives a general guide as to whether the liver is inflamed, and how well it is working. See separate leaflet called Liver Function Tests.
An ultrasound scan of the liver.
A biopsy (small sample) of the liver may be taken to look at under the microscope. This can show the extent of any inflammation and cirrhosis. See separate leaflet called Liver Biopsy.
A blood test can also be performed to show if you have immunity to hepatitis B.
Other tests may be done if cirrhosis or other complications develop.
There are other specialised blood tests being developed which assess the development and severity of cirrhosis.
Can hepatitis B be prevented?
Immunisation
A vaccine is available to protect against hepatitis B. This should be offered to anyone who is at increased risk of being infected with the hepatitis B virus. For example, sexual and household contacts of someone infected with hepatitis B. (See separate leaflet called Hepatitis B Immunisation for a full list of people at increased risk who should be immunised.)
Post-exposure prevention
If you are not immunised and have been exposed to the virus, you should see a doctor immediately. (For example, if you are a healthcare worker and you have a needlestick injury.) You can be given an injection of antibodies called immunoglobulin as well as starting a course of immunisation. This may prevent infection from developing.
Preventing infection in newborn babies at risk
All pregnant women in the UK are offered a hepatitis B blood test. If the mother is infected, her baby is given injections of antibodies and also immunised straight after birth. (The transmission of the virus to the baby is thought to occur mainly during childbirth and not during the pregnancy.) With this treatment there is a good chance of preventing infection developing in the baby.
If I am infected, how can I prevent passing on the virus to others?
If you have a current hepatitis B infection you should:
Avoid having sex with anyone (especially any sex without using a condom) until they have been fully immunised and have been checked to see that the immunisation has worked by a blood test.
Not share any injecting equipment such as needles, syringes, etc.
Not donate blood or semen or carry a donor card.
Not share razors, toothbrushes, etc, that may be contaminated with blood.
Cover any cuts or wounds with a dressing.
Make sure that, if any of your blood spills on to the floor or other surfaces following an accident, it is cleaned away with bleach.
What is the treatment of hepatitis B?
Treatment for the acute phase
No treatment can clear the virus from the body. If you develop symptoms when first infected, treatment aims to help ease symptoms until they go - for example, drinking plenty of water to avoid dehydration. Rarely, a severe hepatitis develops which may need hospital care. No treatment can prevent acute hepatitis B from becoming chronic.
Treatment for chronic infection
Treatment for hepatitis B does not cure hepatitis B but works to delay or even to prevent complications from developing, like liver damage and cirrhosis. People with chronic hepatitis B usually need treatment to stop or to reduce the activity of the virus, so limiting liver damage. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given:
Interferon. This medicine is similar to a substance produced in your body, which is also called interferon. It works to fight infections by boosting your immune system. Interferon is usually given as an injection each week.
Antiviral medicines. These work by stopping the hepatitis B virus from multiplying in the body. They include lamivudine, adefovir, tenofovir, telbivudine, and entecavir. Your doctor will discuss these in more detail with you, as the medicine used can vary between people. A combination of antiviral medicines is sometimes used.
Treatment with medicines is usually continued for many years.
Side-effects with these medicines can occur. You will be monitored regularly while you are taking treatment, which includes blood tests. Some people need to change their medicines, or take a lower strength, if they have troublesome side-effects. Also, in some people, resistance can develop to their treatment medicine, which means that it does not work so well. If this happens then it is likely you will have to change the medicine you take.
The treatment of hepatitis B is a developing area of medicine. New medicines continue to be developed and the information above is very general. There are some newer medicines that have been introduced in the last few years that show promise to improve the outlook. The specialist who knows your case can give more accurate information about the outlook for your particular situation.
Liver transplant
For some people with advanced cirrhosis, liver transplantation may be an option. Although this is a major operation, the outlook following a liver transplant can be very good. However, the new liver may also eventually become damaged by the persisting hepatitis B infection.
Diet and alcohol
Most people with chronic hepatitis B will be advised to eat a normal healthy balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol. If you already have liver inflammation, alcohol increases the risk and speed of developing cirrhosis.
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