Heavy Menstrual Bleeding: Sign, Symptom, Cause, Diagnosis And Treatment

Menorrhagia (Abnormal Uterine Bleeding) is an abnormal menstrual period in its quantity, timing or duration of bleeding.Bleeding excessively can cause anemia that presents fatigue, weakness, and shortness of breath.

Menstruation (Monthly) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina.The first period usually begins twelve years old and fifteen yearls old.It is also considered normal if the first period in eight years old.Bleeding usually lasts around two to seven days.The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women and  21 to 31 days in adults (about 28 days).The menstrual cycle occurs due to the rise and fall of hormones.The menstrual cycle is the monthly series of changes a woman's body goes through in preparation for the possibility of pregnancy.The menstrual cycle is different for every women.Blood flow averages about four or five days with a blood loss of about 40 cc or 3 tablespoon.The Common Symptoms of Menstruation, such as acne, mood changes, tender breasts, irritability, feeling tired, and bloating

The Signs or Symptoms of Menorrhagia

• Blood loss about 80 cc or 5 tablespoon.
• Bleeding for longer than a week.
• Soaking through one or more sanitary pads or tampons every hour for several consecutive hours.
• Needing to use double sanitary protection to control menstrual flow.
• Passing blood clots with menstrual flow for more than one day.
• Pale skin.
• Fatigue or tiredness.
• Shortness of breath.

The Causes of Menorrhagia

• Hormone imbalance occurs in which the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
• Uterine fibroids can cause heavier bleeding than normal or prolonged menstrual bleeding.
• Adenomyosis occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful menses.
• Dysfunction of the ovaries.The ovaries do not release an egg during a menstrual cycle.
• Polyps are small, benign growths on the lining of the uterus (uterine polyps) that may cause heavy and prolonged menstrual bleeding.
• Intrauterine device (IUD) is the cause of mentrual bleeding excessively.
• Inherited bleedibg disorder.
• Pregnancy complication.
• Cancer includes ovariam cancer, cervical cancer, and uterine cancer can cause excessive menstrual bleeding.
• Medications include anti-inflammatory drugs and anticoagulants can contribute heavy and prolonged menstrual bleeding.

Diagnosis

There are some tests and procedured to diagnose the cause of abnormal uterine bleeding.

• Complete Medical History.
• Physical Examination.
• Pelvic and Rectal Examination is to ensure that bleeding is not from lower productive tract or rectum.
• Pap Smear is to rule out cervical neoplasia.
• Pelvic Ultrasound Scan is the first line diagnostic tool for identifying structural abnormalities.
• Endometrial Biopsy is to exclude endometrial cancer or atypical hyperplasia.
• Sonohysterogram
• Laboratory test or Hysteroscopy.

Treatment of Menorrhagia

• Intrauterine System (IUS)
• Medications include Non-Steroidal anti-inflammatory drugs, Tranexamic Acid tablets, aminocaproic acid.
• Hysterectomy is removal of the uterus.
• Myomectomy is local removal.
• Endometrial Ablation (Destruction) is surgical tehnique by the use of applied heat (Thermoablation).

Surgery

• Dilation and Curettage is a procedure that reduces menstual bleeding.
• Endometrial Ablation
• Uterine Artery Embolisation (UAE)
• Hysteroscopic Myomectomy is to remove fibroids over 3 centimeters in diameter.

Medications For Menorrhagia

1. First Line

• Intrauterine device with progesterone.

2. Second Line

• Tranexamic Acid is an antifibrinolytic agent to reduce the amount of bleeding.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Combined Oral Contraceptive Pills are to prevent proliferation of the endometrium.

3. Third Line

• Oral Progestogen, such as Norethisterone is to prevent proliferation of the endometrium.
• Injected Progestogen, such as Depo Provera.

4. Other options

• Gonadotropin-Releasing Hormone Agonist.

Woman Sexual Arousal And Sexual Dysfunction Types

William Masters and Virginia Johnson were the first researchers to examine extensively the physical components of human sexual arousal.

They recorded four stages of sexual response as following :

• Excitement
• Plateau
• Climax (Orgasm)
• Resolution

Sexual arousal can be described as horny, turned on, randy, steamy and lustful.Sexual Arousal is the arousal of sexual desire during sexual activity.Sexual arousal in human reaches its climax during an orgasm.Mental stimuli, physical stimuli, and the internal fluctuation of hormones influence sexual arousal.Erotic stimuli is things that precipitate human sexual arousal.Every woman differs in sexual interest, response, and expression.The feeling of woman about sexuality can change according to circumtances and life stages.

One model suggests three stages of sexual response, such as :

• Desire
• Arousal
• Orgasm.

I. Woman Arousal

Woman arousal will respond body in sexual tissues, including nipples, vulva, clitoris, vaginal walls, and vaginal lubrication.Normally a woman is aroused and excited sexually to experience the expansion of the blood vessels in the pelvic region, allowing more blood to flow to the lower abdomen and genitals.Some women notice this as a feeling of fullness in the pelvis.Transudation is a phenomenon of increasing blood flow.It refers to seepage of fluid through the blood vessels walls.The fluid seeps into the vagina to provide lubrication before and during intercourse.Lubrication of the vagina can occur very rapidly in a minute.

* Woman Physiological Response

Woman sexual arousal causes various physical responses, most significantly in the genital organs :

• The vulva is wet
• The labia are slightly engorged
• Nipple erection
• Lubrication of vaginal
• Vasocongestion of the vaginal walls
• Elevation of the cervix and uterus
• Tumescence and erection of the clitoris and labia
• Expansion of the inner 2/3 of the vagina
• Change in shape, color, and size of the labia majora and labia minora
• Pupil dilation

* Woman Psychological Sexual Arousal

Cognitive factors, such as sexual motivation, perceived gender role expectations, and sexual attitudes play important roles in woman sexual arousal.woman sexual arousal is higher than man.

II. Sexual dysfunction (Sexual disorder)

Sexual Dysfunction is difficulty experienced by an individual or couple during any stage of a normal sexual activity, such as physical pleasure, desire preference, and orgasm.

Woman Sexual Dysfunction has four types :

• Low Sexual Desire is a lack of sexual interest or desire and willingness in having sex.
• Sexual Arousal Disorder is difficulty to maintain arousal during sexual activity.
• Orgasmic Disorder (Anorgasmia) is difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
• Sexual pain Disorder (Dyspareunia) is pain associated with sexual stimulation or vaginal contact.

Causes of Woman Sexual Dysfunction

• Physical : medical conditions, such as heart disease, cancer, kidney failure, bladder problem, multiple sclerosis and certain medications including antihistamines, chemotherapy drugs, blood pressure drugs, antidepressants.
• Hormonal : lower the levels of estrogen after menopause that can cause changes in genital tissue and sexual responsiveness.
• Psycological and social : untreated anxiety, depression, a history of sexual abuse, the worry of pregnancy, the conflict of partner, cultural and religious issues.

Diagnosis of Woman Sexual Dysfunction

To diagnose woman sexual dysfunction by doing some procedures or tests.

• Physical Exam is an exam of the body to check general signs of health.
• Pelvic Examination is to evaluate the health of the reproductive organs.
• Pap Test is to detect changes in the cells of the cervix that may be cancer
• Evaluation of person'attitude is about sex, past sexual trauma, anxiety, fear, alcohol, drug abuse, relationship problem.

Treatment of Woman Sexual Dysfunction

• Providing Education is to educate the anatomy of human, sexual function, sexual behaviors and responses and the normal changes due to aging.
• Enhancing Stimulation uses erotic materials, masturbation and changes to sexual routines.
• Distraction Techniques use erotic and non erotic fantasies, including video, music, exercises with intercourse.
• Minimizing Pain in which allows woman to control the depth of penetration.
• Hormone Replacement Therapy is to improve certain conditions, including the loss of vaginal lubrication, genital sensation, and loss of interest in sex.

Impotence : Symptoms, Causes, Diagnosis And Treatment

Impotence (Erectile Dysfunction) is repeated inability to insert the penis to the vagina or regular inability to maintain an erection of the penis during sexual activity.Physical and psychological issues can cause impotence.Psychological impotence is the failure of erection or penetration due to thoughts or feelings.Male sexual arousal involves the brain, hormones, emotions, nerves, muscles, and blood vessels.A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis.The process is initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis.

Penile erection is managed by two mechanisms

• The Reflex Erection is achieved by directly touching the penile shaft.
• The Psychogenic Erection is achieved by erotic or emotional stimuli.

Symptoms of Impotence or Erectile Dysfunction (ED)

• Problem in getting an erection.
• Reduced sexual desire.
• Trouble in keeping an erection.

Causes of Erectile Dysfunction (ED) or Impotence

I. Physical Causes

• Heart disease
• Diabetes Mellitus
• High blood pressure
• Atherosclerosis (clogged blood vessel)
• Obesity
• High cholesterol
• Parkinson's disease
• Multiple sclerosis
• Peyronie disease (development of scar tissue inside the penis)
• Hormonal disorders, including thyroid conditions and testosterone deficiency (Hypogonadism)
• Smoking, alcoholism, and cocaine use
• Injuries in the pelvic area or spinal cord
• Treatment for prostate disease
• Surgeries, including radical prostatectomy, cystectomy, transurethral resection of the prostate and rectal cancer surgery
• Radiation Therapy to the pelvic region
• Age
• Kidney failure

Medications can cause Impotence or Erectile Dysfunction (ED) :

• Drugs for controlling high blood pressure or antihypertensives, including Beta-Blockers and Clonidine.
• Heart drug, such as Digoxin.
• Antidepressants, including Monoamine Oxidase Inhibitors (MAOIs), Selective Serotonin Reuptake Inhibitors (SSRIs), and Tricyclic Antidepressants.
• Some Sleeping Pills and Amphetamines are drugs that act on the central nervous system or on the brain or spinal cord.
• Opioid painkillers.
• Some diuretics or Water Pills are drugs that increase urine output.
• Peptic ulcer drug, such as Cimetidine
• Some cancer drugs, including chemotherapeutic agents
• Drugs for acting on luteinizing hormone-releasing hormone and Hormone drugs, such as Estrogens.
• Anxiolytics
• Anti-Androgen drugs for treating prostate disease.
• 5a-Reductase Inhibitors are medications for treating cancer and for benign prostatic hypertrophy.
• Antocholinergics are drugs that block a neurotransmitter.

II. Psychological Causes 

• Depression or other mental disorders.
• Performance of  anxiety shows repeated feeling of doubt.
• Stress can include work, finance, and emotion problems.
• Guilt, anger
• Fear of intimacy
• Poor communication with a sex partner
• Pressure from a sex partner

Diagnosis for Impotence
Some tests and procedures are done to diagnose Impotence.

• Medical history is about patient's health habit and past illnesses.
• Physical exam is an exam of the body to check general signs of health.
• Blood Test is to measure hormone levels, cholesterol, blood sugar, liver, kidney function and thyroid function.
• Urinalysis is to analyze urine for protein (albumin), sugar (glucose), and hormone (testosterone) levels that may indicate diabetes, kidney dysfunction, or testosterone deficiency.
• Postage Stamp Test is used to determine if there is a medical cause of impotence or erectile dysfunction rather than a psychological one.It is to check for the presence of nighttime erections.
• Duplex Ultrasound is to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue.
• Penile Nerve Function-Tests such as the Bulbocavernosus Reflex Test are to determine if  there is sufficient nerve sensation in the penis.
• Penile Biothesiometry is a test that uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
• Dynamic Infusion Cavernosometry is a technique in which fluid is pumped into the penis at a known rate and pressure.
• Magnetic Resonance Angiography (MRA) uses magnetic fields and radio waves to provide detailed images of the blood vessels.
• The Nocturnal Penile Tumescence Test is to find out whether the problem of erectile is physical or psychological.Man is normal to have five to six erections during sleep, especially during rapid eye movement (REM).These erections occur about every 90 minutes and last for about 30 minutes.Two methods are used to measure changes in penile rigidity and circumference during nocturnal rection.Snap Gauge involves wrapping three plastic bands of varying strength around the penis.Erection function is assessed according to which bands break.Strain Gauge involves placing special elastic bands at the base and tip of the penis.These bands stretch during erection and register changes in  circumference.

Treatment Of Impotence or Erectile Dysfunction

1. Medications

• Oral Medication : Phosphodiesterase (PDE) 5 Inhibitors, including Sildenafil (Viagra), Vardenafil (Levitra), Tadalafil (Cialis), Avanafil (Stendra) are prescription drugs which are taken orally.PDE-5 Inhibitors increase the amount of cyclic guanosine monophosphate (cGMP) available in the blood supply to the penis and increase blood flow.
• Topical Medication : DDAIP is used in the topical drug Vitaros that is an Alprostadil Vasodilator cream to treat erectile dysfunction or impotence.
• Injected Medication : Papaverine, Phentolamine, Prostaglandin E1 are drugs that are injected to the penis.Choose one of these drugs is injected to the penis.

2. Extracorporeal Shockwave Therapy is a new treatment for impotence or erectile dysfunction that is non-drug, non-surgical, and without adverse side effects.

3. Vacuum Erection Devices are a mechanical way of producing an erection for men who do not want or cannot use drug treatments.The men use the devices if Drugs are not found working.They can cause bruising penis, cold penis'tip and damaged tissue.


4. Surgery  

• Penile Implants are a final option reserved of men who do not succeed with drug treatments and other non-invasive options.
• Vascular Surgery attempts to corect some blood vessels that cause erectile dysfunction.
• Arterial Reconstructive Surgery is an option limited to only very specific cases of impotence or erectile dysfunction.

5. Gene Therapy involves injection of a transfer gene, calcium-sensitive potassium channel (hMaxi-K) into the penis.It will allow for weeks or months long effect to support erections.

6. Acupuncture is an alternative treatment for impotence or erectile dysfunction.

7. Alternative Therapies are used to treat impotence.

• Korean Red Ginseng (Panax Ginseng)  is safe in short-term use.It can cause anemia.
• Dehydroepiandrosterone (DHEA) is safe at low doses.It may cause acne.
• L-Arginine is used in high doses that can dilate blood vessels, stimulate blood flow, and improve erectile function.It should not be taken with viagra.It may cause diarrhea, nausea, and cramp.

Mayo Clinic lists Three Risky Alternative Therapies

1. Yohimbe can be dangerous which has many side effects.It should not be used without physician supervision.
2. Ginkgo Biloba can increase the risk of bleeding.
3. Horny Goat Weed  may lower blood pressure.

Harmful Supplements Online for Erectile Dysfunction or Impotence

FDA (Food and Drug Administration) identified several products sold online as so called "Dietary Supplements" for treating erectile dysfunction or impotence and enhancing sexual performance.These products have contained harmful and undeclared ingredients as following :

• Actra-Rx
• Actra-Sx
• Adam Free
• Blue Steel
• Erextra
• 4EVERON
• Energy Max
• Hero
• HS Joy of Love
• Lady Shangai
• Libidus
• Liviro3
• Lycium Barbarum L
• Nasutra
• NaturalUp
• Naturale Super Plus
• Neophase
• Shangai Ultra
• Shangai Ultra X
• Shangai Regular or Shangai Chaojimengnan
• Super Shangai
• Strong Testis
• Vigor-25
• Yilishen
• Zimaxx
• True Man
• Rhino V Max
• V Max
• Xiadafil VIP Tablets (Lots 6K029 and 6K209-SEI only)

Premenstrual Syndrome (PMS) : Symptoms, Causes, Drugs, And Home Remedies

Premenstrual Syndrome (PMS) refers to emotional, behavioral and physical symptoms that happen in one to two weeks before a woman's period.Symptoms do not occur during pregnancy or following menopause.The exact symptoms and their intensity vary significantly from woman to woman.There are no laboratory tests or unique physical findings to verify the diagnosis of premenstrual syndrome.The standardized Instruments describe premenstrual syndrome, such as The Calendar of Premenstrual Syndrome Experiences (COPE), The Prospective Record Of The Impact And Severity Of Menstruation (PRISM), and The Visual Analogue Scales (VAS).

Premenstrual syndrome happens 

• More often in women who are between their late twenty years old and early forty years old.
• Having at least one child.
• Having a family history of depression
• Having a past medical history of either postpartum depression or a mood disorder.

Symptoms of Premenstrual Syndrome ( PMS )

Emotional Symptoms

• Tiredness
• Mood swings
• Irritability
• Feeling angry
• Depressed mood or stress
• Anxiety
• Restlessness
• Poor concentration
• Loss of confidence
• Feeling upset
• Tearfulness
• Insomnia (difficulty with sleep)

Behavioral Symptoms

• Overeating
• Food cravings
• Social withdrawal
• Loss of interest in sex

Physical Symptoms

• Headache
• Fatigue
• Breasts tenderness or swelling
• Joint or muscle pain
• Acne
• Bloating
• Abdominal cramps
• Lower back pain
• Constipation or diarrhea
• Weight gain
• Swolen ankles

Cause of Premenstrual Syndrome

The causes of premenstrual syndrome are not clear but several factors may be involved :

• Changes in hormones during the menstrual cycle.
• Chemical changes in the brain, stress and emotional problems ( depression).
• Low vitamins and minerals.
• High sodium, alcohol and/or caffein can exacerbate symptoms, such as bloating and water retention.
• Weight and Exercise

Treatment of Premenstrual Syndrome

Home Remedies and Lifestyle

• Diet is modified by choosing foods high in carbohydrate and rich in calcium, avoiding caffeine and alcohol, and limiting salt and salty food.
• Regular daily exercise can relieve fatigue and a depressed mood.
• Stress is reduced by doing yoga or massage, getting enough sleep and practising progressive muscle relaxation.
• Stop smoking

Alternative Medicine

• The consumption of Evening Primrose Oil (EPO) helps in relieving pre-menstrual breast pain in some women.It is a source of gamma linoic acid.
• Taking Calcium and Vitamin D are to alleviate premenstrual pain and migraine.
• Taking Vitamin B6 is to relieve irritability and mood swings
• Consuming folic acid is to relieve depression and fatigue.
• Taking 360 mg of supplemental magnesium daily is to reduce fluid retention, bloating and breast tenderness in women with premenstrual syndrome.
• Acupuncture can relieve symptoms of pms.

Drugs for Premenstrual Syndrome

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) eases cramps and breast discomfort, including Ibuproven (Advil, Motrin IB) or Naproxen (Aleve, Naprosyn).
• Antidepressants use Selective Serotonin Reuptake inhibitors (SSRIs), including Paroxetine (Paxil,Paxeva), Fluoxetine (Prozac, Xaravem), and Sertraline (Zoloft).They are to treat severe premenstrual syndrome (PMS).
• Diuretics include Spironolactone (Aldactone) that handle water retention.
• Hormonal Medications use Hormonal Contraception, including the combined oral contraceptive pill and the contraceptive patch that are to reduce physical symptoms, Gonadotropin-Releasing Hormone Agonist that are useful in treating severe forms of premenstrual syndrome, and Mirena Intra-Uterine System (IUS) that is a contraceptive coil to reduce the heaviness and duration of premenstrual syndrome period.
• Cognitive-Behavioral Therapy (CBT) is psychological treatment to find more adaptive ways of coping with premenstrual syndrome.

Facial Paralysis (Bell's Palsy) : Sign, Symptom, Cause, Risk Factor, Diagnosis, Treatment And Drug

Bell's Palsy is a form of facial paralysis resulting from a dysfunction of the seventh cranial nerve (the facial nerve) causing an inability to control facial muscles on the affected side.It causes one side of face to droop or become stiff.It often happens overnight. Bell's palsy is temporary.The time of Bell's Palsy recovery may vary depending on the severity of nerve damage. Symptoms usually begin to improve after about two until three weeks.They have gone within two months.Its symptoms improve without treatment in most cases. The facial muscles regain their normal strength for several weeks or months.  It most commonly occurs between the ages of 15 and 60.Bell's Palsy does not affect the brain or other parts of the body.It is a local problem confined to the facial nerve and facial muscles.In most cases, a Bell's Palsy is a one-off.It is an inflammatory condition that leads to swelling of the facial nerve.The exact cause of Bell's palsy is unknown.Studies suggest that this new activation could be preceeded by trauma, environmental factors, metabolic and emotional disorders.


Signs and Symptoms of Bell's Palsy

• An inability to make facial expressions, such as smiling, frowning, closing the eye
• Weakness of the face which  is usually one side
• Drooling
• Pain around the jaw or in/behind ear on the affected side
• Difficulty eating and drinking
• Dry or watery eye 
• Dry mouth
• Muscle twitches in the face
• Headache
• Increased sensitivity to sound on the affected side
• Loss of taste sensation

Causes of Bell's Palsy

Bell's Palsy is often linked to exposure to a viral infection.Viruses that have been linked to Bell's Palsy include :

• Herpes Simplex, which causes cold sores and genital herpes
• Herpes Zoster Virus which causes chickenpox and shingles
• Epstein-Barr Virus which causes mononucleosis
• HIV which damages the immune system
• Sarcoidosis which causes organ inflammation
• Adenovirus which causes respiratory illnesses
• Mumps Virus which causes mumps
• Cytomegalovirus infection
• Rubella which causes German measles
• Influenza B which causes flu
• Coxsackievirus which causes hand-foot-and-mouth disease

Risk Factors of Bell's Palsy

• Pregnancy, especially during the third semester or the first week after giving birth
• Diabetes
• An Upper Respiratory Infection, such as flu or cold
• Family history of Bell's Palsy

Diagnosis

A doctor will ask questions about symptoms and do many tests.

• Physical Examination is to determine the extent of the weakness in the facial muscles.
• Blood Test is to check for the presence of a bacterial or viral infection.
• Electromyography (EMG) is a test that confirms the presence of nerve damage and determines its severity.
• Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) is to rule out other possible sources of pressure on the facial nerve, such as tumor, skull fracture.

Treatment of Bell's Palsy

I. Home Remedy

1. Facial pain treatment by putting a washcloth soaked in warm water on the face several times a day to relieve pain.
2. Massaging and Exercising the face to relax facial muscles.
3. Eye will not close completely treatment by doing many ways :

• Using the finger to close the eye repeatedly throughout the day.
• Tapping the upper and lower lid together when sleeping.
• Using eye drops to lubricate the eye during the day.
• Using eye ointment to lubricate the eye overnight.
• Wearing eye glasses during the day to protect the eye.
• Wearing an eye patch at night.

II. Alternative Medicine

• Acupuncture can stimulate nerves and muscles by placing thin needles into a specific point in the skin.
• Meditation and Yoga may relieve muscle tension and chronic pain.
• Vitamin Therapy uses vitamin B6 and vitamin B12 and zinc to help the growth of nerve.
• Biofeedback Training uses thoughts to control the body.

III. Physical Therapy

A physical Therapist will teach how to massage and exercise the facial muscles to prevent this from occuring.

IV. Physiotherapy

Physiotherapy helps to maintain muscle tone of the affected facial muscles and stimulate the facial nerve.

V. Surgery

Surgery is rarely done for Bell's Palsy.It is done if Bell's Palsy does not recover fully.

• Plastic Surgery may be needed to correct lasting facial nerve problems but it is rare.
• Decompression Surgery is not recommended because it causes facial nerve injury and permanent hearing loss.
• Smile Surgery or Smile Reconstruction is a surgical procedure that may restore the smile for people with facial nerve paralysis.This surgery is unknown to be beneficial or harmful.

Drug for Bell's Palsy

• Corticosteroid drugs reduce inflammation.
• Antiviral medication may be prescribed if Bell's Palsy is caused by a virus
• Over-the-counter-pain medications, such as ibuproven (Advil, , Motrin IB) or acetaminophen (Tylenol), which help in relieving pain.
• Valacyclovir (Valtrex) is sometimes given in combination with prednisone in people with severe facial palsy.

Complication

Complication may happen in more severe cases of Bell's Palsy as the following :

• The damage of the seventh cranial nerve.
• The excessive dryness in the eye leads to eye infection, ulcers and even blindness.
• Synkinesis is a condition in which moving one body part causes another to move involuntarily.For instance, the eye may close when smiling.

The Lists Of Food, Fruit, Vegetable, Spice And Drink Should Not Be Combined Together Leading To Death

Foods, fruits, vegetables, spices and drinks contain vitamin, and mineral sources.They are good for human health.Several of them should not be consumed together.They will give some bad effects to the body and lead to the death.Beware of combining fruits, vegetables, spices, foods and drinks.Sweet fruits do not contain acid altogether, such as papaya, dried fruit, ripe mango and sweet grape.Sweet fruit should be eaten together with sweet fruit.The consumption of sweet fruit and sour fruit will slow down the formation  of glucose and allow the formation of toxin.Never combine sweet fruits with nut, cheese, fish, chicken, egg, red meat and coconut.The sour fruits are better to combine with the high protein foods, including chicken, red meat, egg, cheese and nut in order to be digested easily.The sour fruits like orange, lemon, strawberry and kiwi and Fruits with low acid, such as pear, mango, cherry and apple cannot be combined with foods that have the high carbohydrate because their combination make difficult to be digested.

The Lists of Food, Fruit, Vegetable and drink should not be combined together as follow :

• Watermelon with Meat

In the term of food, a watermelon is considered as cold while a mutton meat is hot.The nutritious effects from the meat will reduce drastically if they are consumed together.People with asthenia spleen disease will be hazardous.Gastric and spleen can be disturbed.

• Pear with Honey

Eating pear with honey can distub the five parts of vital organ.It is not recommeded to drink honey after eating pear.

• Mangosteen with soft drink

Mangosteen is highly acidic while soft drink contains a high amount of artificial sweetener.The combination of them together will disturb the system of digestion.Don't consume mangosteen and soft drink at the same time.

• Milk with Pomelo

Protein in milk is combined with acidic compound in a pomelo together can bring stomach flatulence and can overly trigger the disturbance of stomach that leads to diarrhea.

• Milk with Fruits

The combination of fruits, such as apple, strawberry, dragon fruit, melon and coconut and milk are not suitable.They will hardly digest inside the stomach.Fruits contain a lot of acidic compounds which can bind the high amount of protein in milk.

• Milk with Vegetables

The combination of milk and vegetables can harm the calcium metabolism of milk.Milk contains calcium while vegetables contains the chemical compounds.So they must be separated in a period of time.

• Soya Milk with Egg

Consuming soya milk with egg together can reduce the protease enzyme activity which is used by the body to help the process of metabolism.Egg is one of the protein sources.So the body will not get the best protein from egg.

• Soya Milk with Honey

The disturbance of hearing and the damage of eyesight will happen if soya milk is combined with honey together.

• Milk with Chocolate

Milk is rich with calcium while chocolate is high in oxalate acid.The combination of milk and chocolate together will form oxalate calcium that leads to diarrhea.Calcium in milk and oxalate in chocholate are insoluble.

• Beef with Chestnut

Chestnut contains a high amount of vitamin C which can react with the microorganism inside the beef.It will cause the reduction of the good benefits from chestnut.The digestion system will be bad if the both food and drink are combined.

• Meat with Vinegar

Consuming meat with vinegar together can cause the overactive circulation and energy released.Meat is considered as hot whereas vinegar is as warm.It will harm the heart.

• Yogurt with Ham

Combining yogurt with ham together can lead to cancer.Both of that food combinations will turn into nitrosamine and carcinogenic when organic nitrate acid meets artificial nitrate inside the body.Several amount of nitrate is usually added to prevent the decomposition of meat and be put botolinus to extend the lifespan of meat product.

• Seafood with Fruits

Eating seafood with fruits, such as grape and persimmon together will cause stomach flatulence, stomachache, nausea and diarrhea.The fruits contain tannin that will form insoluble compounds inside the body.Eating fruits may be done after consuming the seafood for four hours in order to avoid the bad effects.

• Shrimp with Vitamin C Supplement

The combination of shrimp and vitamin C supplement will bring a serious problem and lead to the death.Shrimp  basically contains arsenic pentoxide.Their combination will cause a chemical reaction process in the stomach and change arsenic pentoxide into arsenic trioxide, which is poisonous.The damage of liver, heart, kidney and blood vessels will happen.

• Crab with Tea

Consuming crab with tea together will lead to the problem of digestion.The gastric fluid will be dilluted by tea because of tannic acid in tea.The effects of their combination can not only disturb the process of assimilation but also reduce the gastric ability to sterilize the food in the stomach.

• Soya bean with Spinach

Soya bean should not be consumed with spinach.Spinach contains oxalate acid which reacts with calcium in soya bean to form insoluble sediment or oxalate calcium in intestine.

• Soya Bean with Green Onion

Soya bean contains calcium and protein while green onion contains oxalate acid.The oxalate acid will destroy the calcium if soya bean and green onion are consumed together.Their combination will affect the process of calcium absorption inside the body and form insoluble sediment inside the stomach for a period of time.Calcium deficiency will happen and lead to spasm, osteomalacia and broken bone.

• Persimmon with Yam

Consuming persimmon and yam together will disturb the process of food digestion in the body.

• Persimmon with Sweet Potato

Eating persimmon and sweet potato at the same time will cause peptic ulcer disease.

• Carrot with Turnip

Consuming carrot and turnip together will cause the digestion problem inside the stomach.

• Carrot with Orange

The consumption of carrot and orange excessively at the same time will cause malfunction of heart.Their combination can harm kidney and cause stomach upset.

• Papaya with Lemon

Eating papaya and lemon at the same time can affect haemoglobin problem.Anemia will happen if they are consumed for long term or continuously

• Pineapple with processed milk product

The combination of pineapple and processed milk products are dangerous for body.It will cause the fatal effect for the functions of body.

• Cucumber with Ice Lolly

The combination of both cucumber and lolly together will cause asthma.

• Neem leaf with Chicken Egg 

The consumption of neem leaf and chicken egg together will cause rheumatism.

• Chicken with Bitter Gourd 

The combination of chicken and bitter gourd will cause vomit

• Chicken with Indian Trumpet

Rheumatism can happen if chicken is consumed with indian trumpet together.

• Plum with Green Peas

The consumption of plum and green peas can cause diarrhea.

List of The consumption of foods , fruits, vegetables, spices and drinks together can cause death as below :

• Canned Fish with Indian Trumpet
• Shell with Beef
• Beef with Mollusc
• Land Crab with Mushroom
• Lamb Meat with Starfruit
• Buffalo Meat with Mutton Meat
• Gourd with Parrot Meat
• Pumpkin with Pigeon Meat
• Mushroom with Frog Meat
• Mushroom with Rabbit Meat
• Pigeon Meat with Ginger
• Castor bean with Bird Meat
• Parrot Meat with Gourd
• Lotus Root with Pork
• Pork with Toddy-Palm Sap / Milk
• Chocolate with Pea Root
• Starfruit with Chocolate
• Condensed Milk with Koeparsay
• Lemon with Milk
• Coconut with Honey
• Djenkol Bean with Asafetid
• Mushroom with Djengkol Bean
• Durian with Djengkol Bean (Vomit and Dead)
• Potato with Bitter Gourd (Vomit and Dead)
• Gway fruit with Ice Lolly
• Gway fruit with East Indian Arrowroot
• Elephant Grass Truffle with Pickled Shrimp
• Coconut Milk Noodle with Pepsi Cola
• Ice Cream with Ginger Salad
• Honey with Custard Apple
• Water Chestnut with Pickled Tea Leaf
• Watermelon with Duck Egg
• Mangosteen with Sugar
• Eugenia Fruit with Palm Sugar
• Banana with Toddy-Palm
• Pomelo with Lime
• Ginger with Papaya

Body Odor (Bromhidrosis) : Type, Factor, Symptom, Diagnosis,Treatment And Home Remedies

Body odor or Bromhidrosis is excessive body odor caused by bacteria and yeasts of sweat gland secretions and cellular debris.There are two types of sweat glands, such as Apocrine sweat glands and Ecrine sweat glands.Apocrine sweat glands, which secrete the majority of chemical compounds needed for the skin flora to metabolize it into odorant substances.It is located in the armpit (axillary) region, the areola, anogenital region and around the navel.Ecrine sweat glands produce a more dilute, watery sweat, when the body has an increase in temperature.It is located over the body, but most numerous on the hand palms and the feet soles.An individual's body odor is affected by genetics, sex, lifestyle and medication.Body odor is largely influenced by major histocompatibility complex (MHC) molecules.Body odor varies from person to person.

Two Types of Bromhidrosis or Body Odor (BO)

1. Apocrine Bromhidrosis happens in the axillary (armpit),  breasts and groin regions.The odor develops when bacteria break down the sweat.Bacterial decomposition of apocrine secretion yields ammonia and short-chain fatty acids with their characteristic strong odors.
2. Ecrine Bromhidrosis occurs when bacteria degrade keratin that has been softened by ecrine sweat.It is located in the soles of feet and the hand palms.Ecrine may be caused by ingestion of some foods, such as garlic, curry, onion, alcohol, toxins, and certain drugs (penicillin, bromides).

Factors of Body Odor

• Food
• Drink
• Disease

Symptoms of Body Odor :

• A change in the odor of the body
• Night sweat for no apparent reason
• A sudden sweat much more or less than usual
• Disruption of sweating in daily routine

Diagnosis

To diagnose body odor, a doctor uses some tests :

• Medical History is about patient's health habit and past illnesses.
• Physical Exam is an exam of the body to check general signs of health.
• Blood Test is a laboratory analysis performed on a blood sample.
• Urine Test is to check different components of urine.It is to find the cause of symptoms.

Treatment 

Body odor can be reduced or prevented by using :

• Deodorants are the substance applied to the body to prevent body odor caused by the bacterial breakdown of perspiration in the armpits, feets and other areas of the body.
• Antiperspirants prevent sweating by affecting sweat glands.They are typically applied to the underarms.
• Disinfectants are antimicrobial agent.
• Underarm liners eliminate armpit stains sometimes caused by antiperspirants.The liners are applied directly to clothing
• Triclosan is antibacterial and antifungal agent found in soap products.
• Special soaps or foams with antiseptic plant extracts, such as ribwort and liquorice, chlorophyllin ointments and sprays topically and chlorophyllin supplements internally.

Home Remedies

• Rosemary can inhibit the growth of bacteria.It has natural deodorant property.It contains menthol and chlorophyl to eliminate odor.

Its way : Put one half cup of dried rosemary leaves into four cups of hot water.Wait for ten minutes and mix into the bath water.Soak in the bath water for fifteen to twenty minutes and dry the body.Follow this way once daily.

• Lemon juice can lower pH level of the skin.It has acidic property.

Its way : Cut a fresh lemon into two halves and rub one half of the lemon on the armpits. Wait until drying on its own.Take a shower.The way can be done once daily.Stop using this remedy if the odor is gone completely.

• Baking Soda helps in absorbing moisture, sweat from the skin and killing bacteria.

Its way : Mix one tablespoon each of baking soda and lemon juice.Apply it to underarms and other areas of the body.Wait for a couple minutes and wash them off water.Do not scrub.This way can be done once daily for a week.

• Apple Cider Vinegar can eliminate body odor by balancing the pH level of the skin.It is a powerful bacteria-fighting ingredient.

Its way : Soak a cotton ball in apple cider vinegar and rub it on the armpits.Wait for two or three minutes then take a shower.This remedy can be done twice daily.

• Regular bathing with an antibacterial soap to reduce the growth of bacteria on the skin.

• Wearing synthetic fabric for exercise to avoid moisture from the skin.Wearing daily natural fabric, such as cotton, wool and silk to avoid trapping sweat and moisture.

• Doing yoga, meditation or biofeedback to control the stress that triggers perspiration.

• Drinking lots of water to flush toxins out of the body.

Fruit, Vegetable, Food, Spice And Drink Cannot Be consumed With Drugs Leading Dangerous Effects

Dr.Ross Walker told that certain foods had certain chemicals that affected the metabolic processes in the body.A food-drug interaction can prevent a medicine from working the way it should be, cause a side effect from a medicine to get worse or better and cause a new side effect.The age, weight, sex, herbals, vitamins, dairy supplements, and medicine dose can affect how the medicines work.

Durian, watermelon should be avoided if you want to consume medicines.Watermelon is rich in kalium.It can lower high blood pressure so people should not be comsumed it if they want to take high blood pressure drugs.Durian can increase the risk of heart disease, hypertension, cholesterol levels and diabetes.So people do not eat it if they consume those medicines.Grape can affect the absorption of diabetes drug.The consumption fruits, vegetables, foods, spices and drinks with drugs wrongly can lead dangerous effects for the health.

Several Drugs cannot be consumed with Fruits, Vegetables, Foods, Spices And Drinks as the following :

1. BANANA                
    ORANGE
    GREEN LEAFY VEGETABLES

    SALT SUBSTITUTES ( MORTON LITE SALT )
 WITH ACE INHIBITORS AND DIURETICS

ACE Inhibitors called as "Potassium Sparing" are used to lower blood pressure and treat heart failure.

ACE Inhibitors :

• Lisinopril (Prinivil Zestril)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Ramipril
• Quinapril
• Moexipril

Diuretics can increase the amount of potassium in the body.They are used to reduce fluid retention and treat high blood pressure.Diuretics are called water pills.

Diuretics :

• Triamterene (Dyrenium)
• Bumetanide
• Furosemide
• Metolazone
• Hydrochlorothiazide

Effects : 

• Irregular heart beat 
• Heart palpitations.

2. ALCOHOL
    APPLE
    ADVOCADO
    GREEN LEAFY VEGETABLES
WITH ANTIHISTAMINES

Antihistamines  are to treat or relieve colds and allergies symptoms, such as sneezing, runny nose, stuffy nose and itchy eyes.

Antihistamines :

• Cetirizine
• Levocetirizine
• Clemastine
• Fexofenadine
• Triprolidine
• Brompheniramine
• Chlorpheniramine
• Diphenhydramine

Effect :

• Drowsiness

3. APPLE
    MILK
    ALCOHOL

WITH NON-STEROIDAL ANTI-INFLAMMATORY DRUGS ( NSAIDs )

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are to relieve pain, fever and inflammation.NSAIDs can relieve minor aches, including headache, backache, toothache, menstrual cramps, muscleache and minor aches or pain of arthritis.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)  :

• Aspirin
• Ibuprofen
• Ketoprofen
• Celecoxib
• Naproxen
• Diclofenac

Effect :

• Drinking alcohol can cause stomach bleeding
• Milk or apple can be consumed if the medicines upset the stomach.

4. ALCOHOL
WITH ANALGESICS OR ANTIPYRETICS

Analgesics or antipyretics can relieve mild to moderate pain and lower fever.

Analgesics/Antipyretics

• Acetaminophen relieves mild to moderate pain from headache, toothache, backache, muscleache, common cold, menstrual cramps, arthritis pain and lower fever.

Effect :

• The chance of severe liver damage

5. CAFFEINE
    ALCOHOL
WITH BRONCHODILATORS

Bronchidilators are to treat and prevent breathing problems from bronchial asthma, chronic bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD).The medicines can relieve troubled breathing, shortness of breath, wheezing and chest tightness.

   
  Bronchodilators :

• Theophylline
• Albuterol

Effect :

• Caffeine with bronchodilators can cause nervousness, rapid heart beat and excitability.
• Coffee with theophylline can cause nausea, vomiting, headache and irritability.

6. BLACK LICORICE 
WITH GLYCOSIDES

Glycosides are used to treat heart failure and abnormal heart rhythms.

Glycosides :

• Digoxin

Effect :

• Black lycorice contains glycyrrhizin, which is in some candies, sweets and cakes).Digoxin with glycyrrhizin can cause irregular heart beat and heart attack.

7. GRAPEFRUIT
    ALCOHOL
WITH STATINS (LIPID-ALTERING AGENTS)

Statins are used to lower cholesterol by lowering the rate of production LDL (low - density lipoproteins) and lower triglycerides.LDL is also called bad cholesterol.

Statins : 

• Pravastatin
• Simvastatin
• Lovastatin
• Fluvastatin
• Atorvastatin
• Rosuvastatin

Effect :

• Taking grapefruit juice with Atorvastatin, simvastatin and lovastatin can raise the levels of those statins in the body.
• Alcohol with statins can increase the chance of liver damage.

8. ALCOHOL
WITH VASODILATORS - NITRATES

Nitrates can treat chest pain (angina).

Vasodilators - Nitrates :

• Isosorbide dinitrate or Mononitrate nitroglycerin

Effect :

• Alcohol may add to the blood vessel - relaxing effect of nitrates and lead to low blood pressure dangerously.

9. KALE

    BROCCOLI

    CABBAGE

    SPINACH

    TURNIP GREENS

    COLLARD GREENS

    BRUSSEL SPROUTS

    CRANBERRY JUICE/PRODUCTS

    GINGER

    GARLIC

    GINSENG

    GINKGO

    GLUCOSAMINE

    ALCOHOL

WITH ANTICOAGULANTS (BLOOD THINNERS)

Anticoagulants are used to lower the chance of blood clots forming or growing larger in the blood or blood vessel, treat heart attack,  irregular heart beat, and prosthetic heart valves.

Anticoagulants :

• Warfarin

Effect :

• Vitamin K in kale, broccoli, cabbage, spinach, turnip greens, collard greens and brussel sprouts can make the medicine less effective.
• Cranberry juice or cranberry products  with warfarin can change the effects of warfarin.
• Ginger, garlic, ginseng, ginkgo, and glucosamine with warfarin can increase the chance of bleeding.
• Alcohol with warfarin can affect the warfarin dose.

10. CAFFEINE
      MILK
      YOGURT
WITH ANTIBACTERIALS (ANTIBIOTICS)

Antibacterials or antibiotics are to treat infections caused by bacteria.

Quinolone Antibacterials  :

• Levofloxacin
• Moxifloxacin
• Ciprofloxacin

Effect :

• If caffeine with ciprofloxacin are taken caffeine may build up in the body.
• Don't take ciprofloxacin with milk, yogurt and calcium - fortified juice alone.

Tetracycline Antibacterials :

• Tetracycline
• Minocycline
• Doxycycline

Effect :

• Avoid milk, yogurt, cheese, and ice cream one hour before or two hours after taking these medicines.

Oxazolidinone Antibacterials :

• Linezolid

Avoid foods and drinks containing high tyramine while using linezolid.Foods with tyramine mean spoiled, not refrigerated, handled or stored properly and aged, permented, pickled and smoked foods.

Foods with tyramine :

• Stong, aged cheese
• Yogurt
• Sour cream
• Caviar
• Pickled or dried herring
• Beef or chicken liver
• Dry sausage ( hard salami, genoa salami, pepperoni)
• Meat extracts
• Canned fig
• Overripe fruit
• Dried fruits (raisins, prunes)
• Avocado
• Banana
• Rasphberry
• Soy beans
• Soy sauce
• Sauerkraut
• Yeast extract
• Excessive amount of chocolate
• Caffeine
• Alcohol

Effect : 

• Cause a sudden, dangerous increase in the blood pressure

Metronidazole Antibacterials :

• Metronidazole

Effect :

• Alcohol with metronidazole can cause nausea, headache, vomiting, stomach cramps, and flushing.

11. LIME
WITH COUGH MEDICINE

Cough medicine is to treat cough. 

Cough medicine :

• Dextromethorphan

Effect : 

• Drowsiness
• Halucination

11. ALCOHOL
      POMEGRANATE
WITH ANTIDEPRESSANTS

Antidepressants treat depression, general anxiety order, social phobia, obsessive-compulsive disorder, panic attacks and some eating disorders.

Antidepressants :

• Paroxetine
• Fluoxetine
• Citalopram
• Escitalopram
• Sertraline

Effect :

• Alcohol with antidepressant can cause drowsiness
• Pomegranate juice with antidepressants can reduce the effectiveness of these medicines.

12. CAFFEINE

      ALCOHOL

WITH ANTIPSYCHOTICS

Antipsychotics are used to treat the symptoms of schizophrenia and acute manic or mixed episodes from bipolar disorder.

Antipsychotics :

• Clozapine
• Quetiapine
• Olanzapine
• Ziprasidone
• Risperidone
• Aripiprazole

Effect :

• Caffeine with antipsychotics  can increase the amount of medicine in the blood and cause side effects.
• Alcohol with antipsychotics can add side effects and cause drowsiness.

13. ALCOHOL
WITH ANTIPROTOZOALS

Antiprotozoals are used to treat infections caused by certain protozoa, parasites living in the body, causing diarrhea.

Antiprotozoals :

• Tinidazole
• Metronidazole

Effect :

• Nausea
• Vomiting
• Headache
• Flushing
• Stomach cramps

14. WALNUT
      SOYBEAN FLOUR
      COTTON SEED MEAL
WITH THYROID MEDICINE

Thyroid medicines are used to reverse the symptoms of hypothyroidism, treat congenital hypothyroidism (cretinism), and goiter.

Thyroid medicines :

• Levothyroxine

Effect :

• Prevent the body from absorbing those medicines.

15. PINEAPPLE
      ORANGE
      APPLE
WITH HIGH BLOOD PRESSURE DRUG AND CANCER DRUG

High blood pressure drug is  used to treat hypertension.

High blood pressure drug :

• Cyclosporine

Cancer drug :

• Etoposide

Effect :

• Pineapple juice, orange juice and apple can reduce the absorption of etoposide.
• Pineapple juice can hamper the absorption of cyclosporine.

 

16. CHOCOLATE
WITH STIMULANT DRUG

Stimulant drug is used to tread ADHD ( Attention - Deficit Hyperactivity Disorder ).ADHD is a disorder that makes it difficult for a person to pay attention and control impulsive behaviors.

Stimulant Drug :

• Ritalin

Effect :

• Jitters
• Palpitations
• Sleeplessness

Lipoma : Characteristic, Appearance, Risk Factor, Diagnosis And Treatment

A lipoma is a growth of fatty tissue that develops under the skin slowly.The lipoma is not cancerous.It is harmless and painless.The lipoma is only painful if it grows into nerves underneath the skin.Its treatment is not necessary unless it bothers you.Many lipomas are relatively small with diameters of about one centimeter until three centimeters.They can enlarge to sizes greater than six centimeters.Some people have more than one lipoma.The lipoma cannot be reduced with self-care.Ice and heat packs are not helpful for lipomas because they are fat-based.

The lipoma can look similar to a liposarcoma, which is malignant or cancerous.The liposarcoma is painful and grows under the skin quickly.The lipoma can occur at any age.It can also be found in younger adults and children.The lipoma is commonly found in adults from forty years old to sixty years old.It can be felt to move slightly under the skin when you press on it.Lipomas are not serious and cause no symptoms.They are classified as a benign tumor of body fat.

The Characteristics of the Lipoma

• Soft to the touch
• Movable
• Painless
• Pale
• Colorless
• Growing slowly
• Appearance under the skin

Lipomas commonly appear on :

• The neck
• The face
• The back 
• The chest
• The shoulders
• The arms
• The tighs
• The stomach

Risk Factors of the Lipoma development

• Adiposis Dolorosa (Dercum Disease)
• Gardner's Syndrome
• Cowden Syndrome
• Madelung disease (Benign symmetric lipomatosis)
• Genetics

Diagnosis

Doctors diagnose a lipoma by doing some procedures.

• Physical Exam is an exam of the body to check general signs of health.
• Biopsy is a procedure that scrapes a small portion of the tissue and sends it to a lab for testing.It is done to rule out the possibility of cancer.
• Magnetic Resonance Imaging (MRI) is a procedure that uses a magnet, radio, wave, and computer to make a series of detailed pictures of areas inside the body.
• Computed Tomography (CT) scan is a procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis taken from different angles.

Treatment of The Lipoma

• Surgery is a procedure to remove by cutting out a fatty tissue from the body.If lipomas are removed surgically, they will rarely grow back once.
• Simple Excision is a removal that can be done under local anaesthetic.It takes less than thirty minutes.
• Liposuction is a cosmetic surgery type that removes fat from the human body in an attemp to change its shape.It involves a needle attached to a large syringe. Liposuction reduces its size.It results in less scarring.
• Steroid Injections can shrink the lipoma but it does not remove it completely.

Hepatitis : Type, Sign, Symptom, Cause,Transmission, Treatment Hepatitis A, B, C, D, And E

Hepatitis is the liver inflammation disease.It may occur without symptoms.

Hepatitis is divided into

I. Acute Hepatitis 

Acute Hepatitis is characterized by constitutional symptoms that are typically self-limiting.It is generally caused by viral infection.The signs of acute hepatitis also include easy bruising and bleeding, confusion, sleepiness and disorientation.

Acute Hepatitis involves three phases of an infection pattern :

1. The Initial Prodromal Phase (Preceeding Symptom) involves non-specific and flu-like.

Signs and symptoms :

• Fatigue
• Nausea
• Vomiting
• Poor appetite
• Joint pain
• Headache
• Fever
• Dark urine
• Clay-colored stools

2. Clinical Jaundice (Yellowing of the skin) and icterus (yellowing of the eyes) follow the prodrome after about one to two weeks and can last for up to four weeks.

Signs and symptoms :

• An enlarged liver
• Right upper abdominal pain
• An enlarged spleen
• A mild unintentional weight loss

3. The Recovery Phase is characterized by resolution of the clinical symptoms of hepatitis with persistent elevations in liver lab values and a persistently enlarged liver.

Cases of Hepatitis :

• Hepatitis A and hepatitis E will resolve fully after one to two months.
• Hepatitis B will resolve in three to four months.
• Hepatitis C will resolve completely.

Drug-induced hepatitis can have an allergic reaction signs such as :

• Rash
• Fever
• Inflammation of membranes lining certain organs
• Elevated a white blood cell type
• Suppression of bone marrow activity

II. Chronic Hepatitis

Chronic Hepatitis can manifest signs and symptoms specific to liver dysfunction with long-standing inflammation and damage to the organ.It presents constitutional symptoms like acute hepatitis.Chronic hepatitis interferes with hormonal function of the liver.

Signs and symptoms of Chronic hepatitis :

• Fatigue
• Nausea
• Vomiting
• Joint pain
• Poor appetite
• Jaundice
• Icterus
• Abnormal hair growth
• Acne
• Lack of menstrual period in women

III. Fulminant Hepatitis

Fulminant Hepatitis or Massive Hepatic cell death is a rare and life-threatening complication of acute hepatitis.It can occur in cases of hepatitis B, hepatitis D, and hepatitis E.

Causes of Hepatitis can be divided into some categories :

I. Infectious 

• Viral Hepatitis is caused by five viruses, such as hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E.

Hepatitis A and hepatitis E are both transmitted  by the fecal-oral-route.Hepatitis A and hepatitis E are self-limiting illnesses that do not lead to chronic hepatitis.Hepatitis B,  hepatitis C and hepatitis D are transmitted when blood or mucus membranes are exposed to infected blood and body fluids, such as semen and vaginal secretions.

Five Types of Viral Hepatitis :

1. Hepatitis A (HAV)

Hepatitis A is a liver disease caused by the Hepatitis A virus.It gets better in a few weeks without treatment.The incubation period of Hepatitis A is usually 14 until 28 days.Acetaminophen (Paracetamol) and medication against vomiting should not be given.

Signs and symptoms of Hepatitis A

• Nausea
• Vomiting
• Fatigue
• Loss of appetite
• Fever
• Abdominal pain or discomfort
• Dark urine
• Pale stool
• Jaundice (yelowing of the skin and eyes)
• Side or joint pain

Transmission of Hepatitis A

• Drinking contaminated water 
• Eating food handled by an infected person
• Being close contact with an infected person
• Having sex with person who has Hepatitis A virus
• Eating raw shellfish from water poluted with sewage

Risk factors

• HIV-positive
• Working or travelling in areas with high rates of Hepatitis A
• Hemophilia
• A man has sex with other men
• Living with person who has Hepatitis A
• Using injected or noninjected illicit drugs
• People with poor sanitary habits
• Do not have access to clean water

Diagnosis

Hepatitis A can be diagnosed by using tests.

• Blood test uses a blood sample that is sent to a laboratory to test for Hepatitis A.
• Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is to detect the Hepatitis A virus RNA

Treatment

• Vaccination is given as a shot into the muscle in two doses 6-8 months apart for children 12 months of age or older.It should be started before 24 months of age.All children should begin getting Hepatitis A vaccine at age one.The dose is different for adult depending on the vaccine type.
• Rest
• Eat more high-calorie foods, such as drinking fruit juice or milk rather than water
• Eat snack throughout the day rather than eat full meals
• Rest the liver

2. Hepatitis B (HBV)

Hepatitis B is a liver disease caused by Hepatitis B virus.Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).Acute Hepatitis B infection lasts less than six months.Chronic Hepatitis B infection lasts six months or longer.


Signs and symptoms of Hepatitis B

• Fever
• Nausea
• Vomiting
• Loss of appetite
• Weakness
• Fatigue
• Abdominal pain
• Dark urine
• Joint pain
• Yellowing of the skin and whites of the eyes (jaundice)

Transmission of Hepatitis B

• Pregnant women infected with HBV can pass the virus to their babies during childbirth.
• Needles or syringes have contaminated with infected blood.
• Needle stick injuries in health care setting.
• Sexual contact with infected partner through saliva, semen and vaginal secretion.

Risk Factors

• Multiple sex partners
• A man has sex with other men
• Sharing needles during intravenous (IV) drug use
• Infected mother to infant born
• Living with infected chronic HBV person
• Job that exposes to human blood
• Travelling to regions with high infection rates of HBV, such as Africa, Eastern Europe, and Central and Southeast Asia
• Having HIV
• Receiving kidney dialysis

Complication

• Cirrhosis (scarring of the liver)
• Liver failure
• Liver cancer
• Other conditions, including kidney disease and anemia

Diagnosis

Hepatitis B can be diagnosed by using tests as below :

• Blood Test is to determine virus in the body and whether it is acute or chronic.
• Liver Biopsy uses a small sample of the liver to determine the liver damage.

Treatment of Hepatitis B

• Vaccine

All children should get the first dose of hepatitis B vaccine at birth.Children at age of  six to eighteen months should get complete the vaccine series.Hepatitis B vaccine is recommended for all babies.Vaccine can prevent hepatitis B.Babies and young children are at much greater risk of a chronic infection if they are infected."Catch-up vaccination is recommended for children and adolescents who were never vaccinated or who did not get the entire vaccine series.

Treatment for Acute Hepatitis B infection

Acute hepatitis B infection may not need treatment because it will go away on its own.It is recommeded to take a rest, consume adequate nutritions and fluids which can fight this infection.

Treatment for Chronic Hepatitis B infection

• Antiviral medications, including Adefovir (Hepsera), Lamivudine (Epivir), Telbivudine (Tyzeka), Entecavir (Baraclude), Pegylated Interferon (Pegasys) and Tenofovir (Viread).
• Interferon Alfa-2b (Intron A) is an synthetic version of a substance produced by the body to fight infection.It is used by young people with hepatitis B who do not want to undergo long-term treatment.
• Liver transplant is surgery to remove injured liver and replace it in healthy one from another person.

3. Hepatitis C (HCV)

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness.It lasts a few weeks to a serious, lifelong illness.Hepatitis C is not spread through food or water and by hugging, breastfeeding, shaking hand, sneezing, coughing and sharing eating utensils.Hepatitis C Virus can survive outside the body for up to three weeks at room temperature or on environmental surfaces.Many people infected with the Hepatitis C virus do not know that they are infected because they do not feel sick.The average time of Hepatitis C symptoms occurs about six to seven  weeks after exposure.It can range from two weeks to six months.

Hepatitis C can be divided into :

• Acute Hepatitis C Virus Infection is a short-term illness that occurs within the first six months after exposing to the hepatitis C virus.
• Chronic Hepatitis C Virus is a long-term illness that occurs when hepatitis C virus remains in the body of a person.People with chronic Hepatitis C are common to have a liver enzyme (ALT) level up and down or normal to near normal period.

Signs and symptoms of Hepatitis C

• Fever
• Nausea
• Vomiting
• Loss of appetite
• Fatigue
• Abdominal pain
• Joint pain
• Dark urine
• Clay-colored bowel movement
• Jaundice (yellowing of the skin and eyes)

Transmission of Hepatitis C

• Pregnant women infected with HBV can pass the virus to their babies during childbirth.
• Sharing needles, syringes and other equipments to inject drugs.
• Accidental needle sticks.
• Having Sexual contact with infected partner of hepatitis C virus.
• Sharing care items that may have contact with blood, such as toothbrush, razor.

Risk factors

• Multiple sex partners
• Mother infected with hepatitis C virus to infant born
• Current injection drug users
• Past injection drug users
• Recipients of donated blood, blood products and organs
• Hemodialysis patients
• HIV-infected person
• Having tattoos or body piercings

Diagnosis

Hepatitis C can be diagnosed by using some tests or procedure as follow :

• Blood Test is to measure liver function and liver enzyme (protein produced by the liver) level.
• Screening Test is  to show whether someone has developed antibodies to the Hepatitis C virus.
• A Liver Biopsy is a test to take a small piece of liver to look for liver damage.
• Liver Transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor.

Treatment of Hepatitis C

Treatment for Acute Hepatitis C can be done without treatment because it will clear on its own.

Treatment for Chronic Hepatitis C

• Medications

The Food and Drug Administration (FDA) approved some drugs for chronic Hepatitis C :

• Ribavirin (CoPegus)
• Daclatasvir (Daklinza)
• Sofosbuvir, Velpatasvir (Epclusa)
• Ledipasvir (Harvoni)
• Telaprevir (Incivek)
• Interferon Alphacon-1 (Infergen)
• Interfeton Alpha-2b (Intron A)
• Simeprevir (Olysio)
• Boceprevir (Victrelis)
• Pegylated Interferon (Pegasys)
• Pegylated Interferon alpha-2b (Pegintron)
• Interferon Alpha-2a (Roferon)
• Boceprevir (Victrelis)
• Elbasvir (Zepatier)
• Ombitasvir, Paritaprevir and Ritonavir (Technivie)

4. Hepatitis D (HDV)

Hepatitis D or Delta Virus is an infection that causes the inflammation of liver.Hepatitis D is uncureable.It is common in the South America, Russia, West Africa, Pacific Islands, Central Asia and Mediterranean.The Hepatitis D virus requires that a person first be infected with Hepatitis B virus.Hepatitis D is divided into acute and chronic.Acute Hepatitis D may go away on its own.Chronic Hepatitis D infection lasts for six months or longer.The outcome of Hepatitis D depends on whether HDV is contracted as a co-infection or a superinfection.Co-infection happens when both HDV and HBV are contracted simultaneously.Co-infection of HDV and HBV is acute and self-limiting infections.

Signs and symptoms of Hepatitis D

• Vomiting
• Fatigue
• Loss of appetite
• Dark urine
• Abdominal pain
• Joint pain
• Jaundice (yellowing the skin and eyes)

Transmission of Hepatitis D

• Urine
• Blood
• Semen
• Vaginal fluids
• Pregnant women infected with hepatitis D to their babies during childbirth

Risk factors

• Having Hepatitis B
• Receiving blood transfusion frequently
• A man has sex with other men

Diagnosis

Hepatitis D can be diagnosed by using serologic test that is a blood test to look for antibodies in the blood.The diagnosis of delta hepatitis should be considered if positive Hepatitis B Virus is present.

• Blood Test is to evaluate liver by measuring protein levels, liver enzymes and bilirubin in the blood.
• Radioimmunoassay (RIA) is to detec total anti HDV antibodies.
• Enzyme Immunoassay (EIA) is to detect the presence of a substance, usually an antingen, in a liquid sample or wet sample.
• Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is to monitor ongoing HDV infection.

Treatment

There are unknown treatment for acute and chronic Hepatitis D.There is no vaccine for Hepatitis D.
Interferon Alpha is only temporary to inhibit viral activity.


5. Hepatitis E (HEV)

Hepatitis E or hep E is a liver disease that is caused by Hepatitis E Virus.Most people with hepatitis E recover completely.Hepatitis E virus infection results in a self-limited, acute illness.Developed Countries are common to get HEV because they have inadequate water supply and  environmental sanitation.The symptoms of Hepatitis E occur about fifteen to sixty days after exposure.

There are four genotypes of HEV :

• Genotype 1 locates in Africa and Asia

The transmision route is spread by water-borne fecal-oral person to person.

• Genotype 2 locates in Mexico and West Africa

The transmision route is spread by water-borne fecal-oral.

• Genotype 3 locates in Developed Countries

The transmision route is spread by food-borne.

• Genotype 4 locates in China, Taiwan and Japan

The transmision route is spread by food-borne.

Signs and symptoms of Hepatitis E

• Fever
• Loss of appetite
• Nausea
• Vomiting
• Fatigue
• Abdominal pain
• Joint pain
• Dark urine
• Clay-colored stool
• Jaundice (yellowing of the skin and eyes)
• Itching
• Tingling, numbness and weaknes in the arms and legs

Transmission

• Faecal-oral route due to faecal contamination of drinking water
• Ingestion of raw or uncooked shellfish
• Uncooked meat or organ from infected animals

Diagnosis

• Blood Test is to measure liver function and liver enzyme (protein produced by the liver) level.It looks for antibodies (protein substances) produced by immune system of the body to fight the virus.The blood test for antibodies should distinguish infection from Hepatitis A or B.
• Polymerase Chain Reaction (PCR) Test is used to reproduce selected section of DNA or RNA for analysis.

Risk Factors

• Poor sanitation
• Lack of safe water
• Travelling to regions of high endemicity without being immunized

Treatment of Hepatitis E

• Get adequate rest
• Get enough nutrients
• Drink plenty of fluids
• Hospitalization is for severe cases or pregnant woman.
• Ribavirin Therapy is used for severe acute Hepatitis E in 21 days.

There is no specific treatment for Hepatitis E infection.It runs a limited course.

• Parasitic Hepatitis is caused by parasites, such as Protozoans, Trypanosoma cruzi, Leishmania species and Malaria-causing Plasmodium.

• Bacterial Hepatitis is caused by bacteria.

Bacterial infection of the liver results in pyogenic abscesses, acute hepatitis, or chronic liver disease.

Pyogenic abscesses is caused by enteric bacteria, such as Escherichia coli and Klebsiella pneumoniae.

Acute hepatitis is caused by  Neisseria gonorrhoeae, Neisseria meningitidis, Borrelia burgdorferi, Bartonella henselae, Brucella species, Salmonella species and Campylobacter species.

Chronic hepatitis is infected by mycobacteria species, including Tropheryma whipplei, Treponema pallidum, Coxiella burnetii and rickettsia species.

II. Metabolic

• Alcoholic Hepatitis is caused by the exessive alcohol consumption.Development of alcoholic hepatitis is associated with long term of alcohol intake in excess of 80 grams of alcohol a day in men and 40 grams of alcohol a day in women.

Alcoholic hepatitis can vary from asymptomatic hepatomegaly (enlarged liver) to symptoms of acute hepatitis or chronic hepatitis to liver failure.

• Toxic and drug-induced Hepatitis is caused by chemical agents, including industrial toxins, medications and herbal and dietary supplements.

Toxins and drugs can cause liver injury through a variety of mechanisms, such as direct cell damage, disruption of cell metabolism and causing structural changes.

Drugs, such as :

Acetaminophen (aka Tylenol or paracetamol) exhibits predictable dose-dependent liver damage.

Isoniazid causes idiosyncratic and unpredictable reactions that vary among individuals.

III. Ischemic hepatitis (Shock liver) is resulted by injury to liver cells due to insufficient blood or oxygen.It rarely causes liver damage permanently.Blood testing of people with ischemic hepatitis will show very high transaminase Enzymes levels (AST and ALT).

IV. Genetic
Genetic causes of hepatitis include alpha-1-antitrypsin deficiency, hemochromatosis and Wilson disease.

Diagnosis of Hepatitis

• Physical Exam is to check the overall health.
• A Liver Biopsy is a test to take a small piece of liver to look for liver damage.
• Liver Function Test uses Alanine Transaminase (ALT) and Aspartate Amino transferase (AST), Albumin and Bilirubin tests.ALT and AST tests measure enzymes that the liver releases in response to damage or disease.
• Blood Test is to detect the presence of hepatitis virus antibodies and antingen in the blood.It will indicate the cause of hepatitis virus 
• Ultrasound is to reveal fluid in the abdomen, an enlarged liver or the damage of liver
• Viral Antibody Test is to determine the presence of a specific  type of hepatitis virus