What is Diarrhea (Watery/Loose stools)

 

What is diarrhea?

Diarrhea describes bowel movements that are runny or watery, and happen 3 or more times in a day also called loose stools. Diarrhea is very common. Most adolescents and adults have diarrhea about 4 times a year. Just about everyone has it at some point.

What causes diarrhea?Diarrhea can be caused by: Food poisoning

●Viruses

●Bacteria that live in food or water

●Parasites, such as tiny worms that you can catch in some countries

●Side effects from some medicines

●Problems digesting certain types of food

●Diseases that harm the digestive system

Is there anything I can do on my own to get better?Yes. Here are some things you can try at home:

●Drink a lot of liquids that have water, salt, and sugar. Good choices are water mixed with juice, flavored soda, and soup broth. If you are drinking enough fluids, your urine will be light yellow or almost clear.

●Try to eat a little food. Good choices are potatoes, noodles, rice, oatmeal, crackers, bananas, soup, and boiled vegetables. Salty foods also help.

Should I see a doctor or nurse?See your doctor or nurse if:

●You have more than 6 runny bowel movements in 24 hours

●You have blood in your bowel movements

●You have a fever higher than 101.3ºF (38.5ºC) that does not go away after a day

●You have severe belly pain

●You are 70 or older

●Your body has lost too much water. This is called "dehydration." Signs include:

•Lots of diarrhea that is very watery

•Feeling very tired

•Thirst

•Dry mouth or tongue

•Muscle cramps

•Dizziness

•Confusion

•Urine that is very yellow, or not needing to urinate for more than 5 hours

Will I need tests?Many people do not need to have tests. But it's possible that your doctor will do tests to check if you are dehydrated or to figure out what is causing your diarrhea. Your doctor might do:

●Blood tests

●Tests on a sample of your bowel movements

How is diarrhea treated?That depends on what is causing your diarrhea. You might not need any treatment. If you do, your doctor might recommend:

●Fluids through an "IV" – An IV is a thin tube that goes into your vein. People with a lot of diarrhea might need IV fluids to treat or prevent dehydration.

●Stopping some of your medicines

●Changing the foods you eat

●Antibiotics – These medicines treat bacterial infections. Most people do not need antibiotics, even if they have a bacterial infection. If you are very sick with fever and blood in your bowel movements, your doctor might prescribe antibiotics to help you get better faster.

●Medicines that ease diarrhea –You should not take loperamide or diphenoxylate-atropine if you have a fever or blood in your bowel movements. Also, taking too much loperamide has led to serious heart problems in some people. If you have health problems or already take other medicines, talk to your doctor or nurse before trying loperamide. For all of these medicines, it's important to not take more than the label tells you to.

Can diarrhea be prevented?You can reduce your chances of getting and spreading diarrhea by:

●Washing your hands after changing diapers, cooking, eating, going to the bathroom, taking out the trash, touching animals, and blowing your nose.

●Staying home from work or school until you feel better.

●Paying attention to food safety. Tips include:

•Not drinking unpasteurized milk or foods made with it

•Washing fruits and vegetables well before eating them

•Keeping the refrigerator colder than 40ºF and the freezer below 0ºF

•Cooking meat and seafood until well done

•Cooking eggs until the yolk is firm

•Washing hands, knives, and cutting boards after they touch raw food.

Sree Gastro and Liver Clinic, Delhi

Dr Amit Bhasin, Senior Consultant Gastroenterologist

Sree Gastro and Liver Clinic

Cirrhosis of Liver

Cirrhosis of Liver( Cirrhosis liver)

What is cirrhosis?

Cirrhosis is a disease that scars the liver. The liver is a big organ in the upper right side of the belly. Damage to the liver can cause heavy bleeding, swelling, and breathing problems.

What are the symptoms of cirrhosis?

Some people with cirrhosis have no symptoms. When symptoms do occur, they can include:

●Swelling in the belly and legs, and fluid buildup in the lungs

●Heavy bleeding from blood vessels in the esophagus, the tube that connects the mouth to the stomach

●Bruising or bleeding easily

●Trouble breathing

●Feeling full

●Feeling tired

●Trouble getting enough sleep or sleeping too much

●Yellowing of the skin or whites of the eyes, called jaundice

●Confusion that can come on suddenly

●Coma

Cirrhosis also makes it more likely that you will get infections, and it can increase your risk of liver cancer.

What causes cirrhosis?

When something harms the liver, the organ tries to fix itself. In the process, scars form. Causes of liver damage include:

●Heavy alcohol use – People who abuse alcohol or who are addicted to it are most at risk for cirrhosis.

●Hepatitis B or hepatitis C – Viruses cause these liver diseases. People can catch the viruses by sharing needles or having sex with people who are infected.

●Nonalcoholic steatohepatitis (NASH) – People with this condition often don't drink alcohol. Doctors aren't sure what causes NASH, but many people who have it are overweight and have diabetes.

Is there a test for cirrhosis?

Yes. Tests include:

●Biopsy – In this test, a doctor puts a needle into your liver and takes out a small sample of tissue. The sample will show how severe the damage is.

●Blood tests – Results can show what is causing the disease.

●Imaging – Your doctor might take pictures of your liver with an ultrasound machine or with a MRI.

Is there anything I can do to prevent further liver damage?

Yes. To help protect your liver:

●Avoid alcohol

●Talk to your doctor before you start taking any new medicines, including pain killers. Also talk to your doctor before taking any herbs, vitamins, or supplements. Some medicines and supplements can damage the liver.

●Get vaccinated for B if you have not had the infections before

How is cirrhosis treated?

Treatments depend on the cause of cirrhosis, how severe it is, and what symptoms you have. Treatments fall into a few main categories, including those that:

●Treat the cause of the disease – 

Some causes of cirrhosis can be treated. For example, people with cirrhosis caused by alcohol abuse can try to stop drinking. People with chronic hepatitis C or B can take medicines.

●Lower the risk of bleeding – Cirrhosis can cause the blood vessels around the esophagus to swell or even burst and bleed. To prevent that from happening, doctors can:

•Prescribe medicines called "beta blockers." These medicines reduce blood pressure in the liver, and help reduce the chance of bleeding.

•Place tiny bands around the swollen blood vessels (this procedure is called "variceal band ligation")

●Decrease fluid buildup in the belly – 

In people with cirrhosis, the belly sometimes fills with fluid. To decrease fluid buildup, doctors can:

•Prescribe medicines called "diuretics." These medicines make you urinate a lot. People who take diuretic medicines often must also reduce the amount of salt they eat.

•Drain the fluid from your belly using a needle (this procedure is called a "paracentesis")

•Implant a device in the liver that reduces fluid buildup in the belly (this procedure is called "TIPS")

●Treat or prevent infection – 

People with cirrhosis have a higher than normal chance of getting infections. When they get an infection, they can also get much sicker than people without cirrhosis. As a result, people with cirrhosis sometimes need antibiotics to either treat or prevent infection. Most people with cirrhosis should also get the flu vaccine and other vaccines to prevent common infections.

●Treat confusion – Advanced cirrhosis can lead to confusion. Doctors usually use lactulose (a medicine that softens stool) or certain antibiotics to treat the confusion.

Will I need a new liver?

People with severe cirrhosis need a new liver. Talk to your doctor about the surgery before you get too sick, to find out if a liver transplant might be an option for you. People often have to wait for up to 2 years to get a new liver.

Can cirrhosis be prevented?

You can reduce your chances of getting cirrhosis by:

●Getting help if you have an alcohol problem

●Getting the vaccines for hepatitis B and hepatitis A, if you haven't already

●Using condoms when having sex

●Not sharing drug needles.

Dr. Amit Bhasin | Sree Gastro and Liver Clinic

Fatty Liver

 

What is non alcoholic fatty liver disease?

Nonalcoholic fatty liver disease, sometimes called NAFLD, is a condition in which fat builds up in the liver.( Fat in Liver). The liver is a big organ in the upper right side of the belly.

There are two types of NAFLD:

●Nonalcoholic fatty liver (also called NAFL) – In NAFL, the liver has fat buildup, but is not inflamed

●Nonalcoholic steatohepatitis (also called NASH) – In NASH, the liver has fat buildup and is inflamed

This article is mostly about NASH, because that is the condition that can lead to the most problems.

People who drink too much alcohol can get a condition similar to NASH. But NASH is not related to drinking too much alcohol.

What causes NASH?

Doctors do not know what causes NASH. They do know that NASH happens more often in some people, such as those who:

●Are overweight

●Have diabetes, which causes blood sugar levels to get too high

●Have high cholesterol

●Take certain medicines

What are the symptoms of NASH?

Most people with NASH have no symptoms.

Your doctor or nurse might suspect that you have NASH from the results of your routine blood tests.

Will I need more tests?

Yes. If your doctor or nurse suspects that you have NASH, you will likely have:

●More blood tests

●An imaging test of the liver, such as an ultrasound, CT, or MRI scan – Imaging tests create pictures of the inside of the body.

Some people need a liver biopsy. During this test, a doctor removes a small sample of tissue from the liver. Then another doctor looks at the sample under a microscope to see if NASH is present. A liver biopsy is the only test that can tell for sure if you have NASH. Your doctor might do this test if they are not sure if you have NASH or to see how much inflammation there is in the liver. If your blood tests and imaging tests are normal you will not need a liver biopsy.

How is NASH treated?

NASH is not typically treated directly. But the condition can get better when other medical conditions that often happen with NASH get treated. For example, losing weight, and controlling high blood sugar and cholesterol can help improve NASH.

With that in mind, your doctor can:

●Help you lose weight, if you are overweight – If your doctor recommends losing weight, they can help you make a plan to do this safely. It's important not to lose weight too quickly. Do not lose more than 3.5 pounds (1.6 kilograms) a week.

●Treat your high blood sugar, if you have high blood sugar

●Treat your high cholesterol, if you have high cholesterol

Making these changes has benefits besides helping with NASH. These changes can also reduce your chances of having a heart attack or stroke. That's important because people with NASH are often also at risk for heart disease and stroke.

If you take a medicine that could be causing NASH, your doctor will stop or change that medicine.

If you have a severe form of NASH but do not also have diabetes or heart disease, your doctor or nurse might suggest that you take vitamin E. A few studies suggest that vitamin E can reduce some of the liver damage that occurs as part of NASH. On the other hand, there are also studies that suggest that high doses of vitamin E increase the risk of death. So do not take vitamin E unless your doctor or nurse recommends it.

Does NASH get worse over time?

NASH might get worse over time. Sometimes it leads to serious scarring of the liver, called "cirrhosis." Cirrhosis can cause different symptoms, such as swelling in the legs, trouble breathing, or feeling tired. If you get cirrhosis, your doctor will talk with you about different possible treatments.

Do I need to follow up with my doctor?Yes. People who have NASH need to see their doctor for regular check-ups. Your doctor will do follow-up tests on a regular basis. These usually include blood tests.

Dr. Amit Bhasin | Sree Gastro and Lier Clinic

Hepatitis C

 

What is hepatitis C?

Hepatitis C is a disease that harms the liver. The liver is a big organ in the upper right side of the belly. A virus causes this disease. The virus is called the hepatitis C virus. It spreads from person to person through contact with blood. This can happen in a few ways, including sharing drug needles.

What are the symptoms of hepatitis C?

Most people with hepatitis C have no symptoms. When symptoms do occur, they can include:

●Feeling tired or weak

●Lack of hunger

●Nausea

●Muscle or joint aches

●Weight loss

In most cases, hepatitis C lasts for many years. That can lead to liver scarring, called "cirrhosis." Many people with cirrhosis have no symptoms. When symptoms do occur, they can include:

●Swelling in the belly and legs, and fluid build-up in the lungs

●Bruising or bleeding easily

●Trouble taking in a full breath

●Feeling full in the belly

●Yellowing of the skin or whites of the eyes, called jaundice

●Confusion that can come on suddenly

●Coma

How did I get the disease?

You can catch the hepatitis C virus if you have contact with the blood of someone who is infected. This can happen if you:

●Share drug needles or cocaine straws

●Use infected needles for tattooing, acupuncture, or piercings

●Share toothbrushes, razors, or other things that could have blood on them

●Got a blood transfusion in the United States before 1990 (after that time, blood banks started testing donated blood for hepatitis C)

You can catch the hepatitis C virus if you have sex with someone who is infected. But this does not happen very often.

A pregnant woman who is infected can also give hepatitis C to her baby.

Some people who have hepatitis C do not remember how they were infected. In the United States, many people with hepatitis C were born between 1945 and 1965. If you were born during these years, your doctor might want to test you for hepatitis C even if you did not do any of the things that put you at risk of infection.

Is there a test for hepatitis C?

Yes. Your doctor might order a few tests:

●Blood tests can show:

•If you have hepatitis C

•What type of the virus you have (there are at least 6 types)

•Which treatment will work best for you

If you have hepatitis C, your doctor will also want to know if you have any liver scarring. Ways to check for scarring include:

●Blood tests

●Liver scan – This is a type of imaging test that can show how much scarring you have. Not all doctors have access to the machine that does the scan.

●Biopsy – For this test, a doctor puts a needle into your liver and takes out a small sample of tissue. The sample will show how bad the damage is. Most people with hepatitis C do not need this test.

How is hepatitis C treated?

Treatment depends on what type of hepatitis C you have. There are different medicines to treat hepatitis C. Some of them only work on certain forms of the hepatitis C virus. You will have to take a combination of 2 or more medicines based on which virus you have. Treatment usually lasts 3 months. The medicines come in pill form.

Your doctor can help you decide which medicines are right for you.

Is there anything I can do to protect my liver?

Yes, you can:

●Avoid alcohol

●Maintain a healthy weight

●Get vaccinated for hepatitis A and B

●Get vaccinated for pneumonia, the flu, and other diseases

●Ask your doctor or nurse before taking any over-the-counter pain medicines (these medicines can sometimes damage the liver).

●Avoid marijuana

What if I want to get pregnant?

If you want to get pregnant, talk to your doctor or nurse first. About 1 in 20 women who have hepatitis C pass the virus on to the baby during pregnancy. That number goes up in women who are also infected with HIV.

What will my life be like?

Many people with hepatitis C are able to live normal lives. Treatment can cure the disease in almost all cases.

If you have hepatitis C, it is still safe to:

●Hug, kiss, and touch other people (but you can spread the infection through sex)

●Share forks, spoons, cups, and food

●Sneeze or cough

●Breastfeed.

Dr Amit Bhasin | Sree Gastro and Liver Clinic

Hepatitis B

 

What is hepatitis B?

Hepatitis B is a serious disease that can harm the liver and canbrarely lead to liver failure The liver is a big organ in the upper right side of the belly. A virus causes this disease. The virus spreads from person to person when their bodily fluids touch. This can happen in a few ways, like having sex or sharing needles.

What are the symptoms of hepatitis B?

When people first get hepatitis B (this is called "acute" hepatitis B), they can feel like they have the flu. People can also have:

●Nausea

●Pain in the upper right side of the belly

●Yellowing of the eyes or skin (called jaundice)

These symptoms usually get better, but it can take weeks to months.

Most people with hepatitis B get better within about 6 months. But 1 out of every 20 adults who gets hepatitis B ends up having the disease for a long time. This is called "chronic" hepatitis B.

Most people with chronic hepatitis B have no symptoms. But, over time, the infection can lead to a liver condition called cirrhosis. Symptoms of cirrhosis include:

●Swelling in the belly and legs, and fluid build-up in the lungs

●Bruising or bleeding easily

●Trouble breathing

●Feeling full

●Confusion that can come on suddenly

●Coma

Chronic hepatitis B also increases the risk of getting liver cancer.

How did I get the disease?

There are a few ways to catch the hepatitis B virus. All of them involve mixing bodily fluids with other people. You might have caught the disease by:

●Having sex with someone who was infected

●Sharing drug needles with someone who was infected

●Using infected needles for tattooing, acupuncture, or piercings

●Sharing toothbrushes, razors, or other personal items with someone who was infected

If your mother had hepatitis when she was pregnant with you, it's also possible you got the infection from her. This is especially likely if she is from a country where hepatitis B is common. In the same way, if you have hepatitis B and are pregnant, you can pass the infection on to your baby.

Is there a test for hepatitis B?

Yes. If your doctor or nurse suspects you have hepatitis B based on your symptoms, he or she will do blood tests to check for infection. Your doctor might also do these tests if you are at high risk of having hepatitis B, even if you don't have symptoms. For example, you might get tested if you live in an area where hepatitis B is common, or if you have had close contact with someone who might be infected.

Blood tests can also show if you have had hepatitis B in the past, even if the infection got better on its own.

Your doctor might also want to do tests to see if your liver is damaged. This can involve blood tests or tests to measure the liver's stiffness. Some people might get a liver biopsy. For this test, a doctor puts a needle into your liver and takes out a small sample of tissue. The sample will show how severe the damage is.

How is hepatitis B treated?

Most people with acute hepatitis B do not need treatment. The body usually gets rid of the infection on its own within about 6 months.

If you have chronic hepatitis, meaning the virus has not gone away after 6 months, your doctor might suggest taking medicine. However, not everyone with chronic hepatitis B needs treatment right away. If your doctor decides that you do not need to start treatment right away, he or she will monitor you over time. This involves doing regular blood tests. If the tests show that the virus is doing more damage to your liver, or if you start having new symptoms, you might start medicine at that time.

For people who do need treatment, it usually includes a medicine that fights the virus, called an "antiviral." People who take an antiviral usually need treatment for many years, and sometimes for life. In severe cases, a person might need a liver transplant, but this is rare. A liver transplant is surgery to replace a diseased liver with a healthy one.

In addition to getting treatment, your doctor or nurse might recommend getting an ultrasound test every 6 months. (An ultrasound creates pictures of the inside of the body.) This is to make sure you are not developing liver cancer.

Is there anything I can do to protect my liver?

Yes. You can:

●Avoid alcohol

●Get vaccinated for hepatitis A and other diseases, including the flu and pneumonia

●Ask your doctor or nurse before taking any over-the-counter pain medicines. (These medicines can sometimes damage the liver.)

How can I avoid giving the disease to other people?

If you have active hepatitis B infection, you can reduce your chances of spreading the virus by:

●Making sure your family and close friends get tested and get the vaccine for hepatitis B

●Using a latex condom every time you have sex

●Not sharing razors, toothbrushes, or anything that might have blood on it

●Not sharing needles or syringes

●Using bandages to cover cuts and open sores

●Cleaning drops of your blood off of things with a mixture of bleach and water. For the mixture, use 9 times more water than bleach.

What if I want to get pregnant?

If you have chronic hepatitis B and want to get pregnant, talk to your doctor or nurse first. If you are infected when you give birth, your baby should get special shots right away. These shots helps protect your baby from infection. You might also need treatment with a medicine for several weeks before giving birth. Plus, your baby will get a vaccine shot at 1 or 2 months old, and another one at 6 months. A test between 9 and 12 months will show if the baby has the disease. Your doctor will decide if he or she needs more vaccine shots at that time.

What will my life be like?

Many people with chronic hepatitis B are able to live normal lives. It is still safe to:

●Hug and kiss

●Share forks, spoons, and cups

●Sneeze and cough around other people.

Dr Amit Bhasin | Sree Gastro and Liver Clinic

Hepatitis A

 

What is hepatitis A ?

Hepatitis A is an infection that harms the liver. The liver is a big organ in the upper right side of the belly.

Hepatitis A is caused by a virus. When people have hepatitis A, the virus leaves their body in their bowel movements. If infected people do not wash their hands after they use the bathroom, they can have the virus on their hands. Then they can spread the virus to anything they touch, including food, water, and other people.

People all over the world can get hepatitis A.

Hepatitis A symptoms What are the symptoms of hepatitis A?

In children, hepatitis A does not usually cause any symptoms. In adults, hepatitis A causes a flu-like illness that starts suddenly about a month after a person is infected.

At first, symptoms usually include:

●Feeling tired

●Nausea or vomiting

●Having no appetite

●Fever higher than 100.4°F (38°C)

●Pain under the ribs on the right side of the belly

Later on, symptoms usually include:

●Dark-colored urine

●Light-colored bowel movements

●Jaundice, which is when the skin or white part of the eyes turn yellow

●Itchy skin

Rarely, hepatitis A can cause liver damage that can lead to death.

How do people get hepatitis A?

People can get hepatitis A after they eat food or drink water with the virus in it. People can also get it if they touch something that has the virus on it and then touch their food or put their hands in their mouth.

Is there a test for hepatitis A?

Yes. To check if you have hepatitis A, your doctor or nurse will do an exam and blood tests.

How is hepatitis A treated?Most of the time, the infection will get better on its own. But there are things you can do at home to help your liver heal. You can:

●Get plenty of rest – Do not return to work or school until your fever is gone, your appetite is back, and your skin and eyes are no longer yellow.

●Avoid drinking alcohol

●Avoid certain medicines – Your doctor or nurse will tell you which prescription and over-the-counter medicines to avoid.

In rare cases, people need to be treated in the hospital.

When will I feel better?It can take a few months to feel better. Most people are completely better within 6 months of getting infected. Hepatitis A does not lead to lifelong liver problems.

Can hepatitis A be prevented?Yes. To help prevent getting or spreading hepatitis A, you can:

●Wash your hands after going to the bathroom, changing diapers, and touching garbage or dirty clothes. Also, be sure to wash your hands before preparing food and eating.

●Get the hepatitis A vaccine – Vaccines can prevent certain serious or deadly infections. Doctors recommend that adults get the hepatitis A vaccine if they have a higher than normal chance of getting the infection. This includes adults who plan to travel to certain countries or have certain medical conditions.

●Make sure that your child gets the hepatitis A vaccine – Doctors recommend that all babies get the hepatitis A vaccine as one of their routine childhood vaccines.

●Pay attention to food safety

•Don't drink unpasteurized milk or foods made with it

•Wash fruits and vegetables well before eating them

•Keep the refrigerator colder than 40°F (4.4°C) and the freezer below 0°F (-17.8°C)

•Cook meat and seafood until well done

•Cook eggs until the yolk is firm

•Wash hands, knives, and cutting boards after they touch raw food

What if I live with or was with someone who has hepatitis A?

If you live with or were with someone who has hepatitis A, let your doctor or nurse know as soon as possible. If you never got the hepatitis A vaccine, you might need to get it.

You can catch hepatitis A from someone who is infected and is not yet having symptoms. You can also catch it from someone who has symptoms until the week after they develop jaundice (which is when the skin or white part of the eyes turn yellow).

Dr Amit Bhasin |Sree Gastro and Liver Clinic