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CEN Esophageal Varices Overview

Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). This condition occurs most often in people with serious liver diseases. Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren't designed to carry large volumes of blood. The vessels can leak blood or even rupture, causing life-threatening bleeding. A number of drugs and medical procedures can help prevent or stop bleeding from esophageal varices.

Signs and Symptoms

Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:

• Vomiting large amounts of blood
• Black, tarry or bloody stools
• Lightheadedness
• Loss of consciousness in severe cases

Causes

Esophageal varices sometimes form when blood flow to your liver is blocked, most often by scar tissue in the liver caused by liver disease. The blood flow begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. This increased pressure (portal hypertension) forces the blood to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins rupture and bleed. Causes of esophageal varices include:

• Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis.
• Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices.
• Parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and East Asia. The parasite can damage the liver, as well as the lungs, intestine, bladder and other organs.

Risk Factors

Although many people with advanced liver disease develop esophageal varices, most won't have bleeding. Esophageal varices are more likely to bleed if you have:

• High portal vein pressure. The risk of bleeding increases as the pressure in the portal vein increases (portal hypertension).
• Large varices. The larger the esophageal varices, the more likely they are to bleed.
• Red marks on the varices. When viewed through a thin, flexible tube (endoscope) passed down your throat, some esophageal varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
• Severe cirrhosis or liver failure. Most often, the more severe your liver disease, the more likely esophageal varices are to bleed.
• Continued alcohol use. Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.

Complications

The most serious complication of esophageal varices is bleeding. Once you've had a bleeding episode, your risk of another bleeding episode greatly increases. If you lose enough blood, you can go into shock, which can lead to death.

Treatment

The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding occurs, treatments are available to try to stop the bleeding.

 

CEN Inflammatory Bowel Disease Overview

Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract. Types of IBD include:

• Ulcerative colitis. This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.
• Crohn's disease. This type of IBD is characterized by inflammation of the lining of your digestive tract, which often spreads deep into affected tissues.

Both ulcerative colitis and Crohn's disease usually involve severe diarrhea, abdominal pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications.

Signs and Symptoms

Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs. Symptoms may range from mild to severe. You are likely to have periods of active illness followed by periods of remission. Signs and symptoms that are common to both Crohn's disease and ulcerative colitis include:

• Diarrhea
• Fever and fatigue
• Abdominal pain and cramping
• Blood in your stool
• Reduced appetite
• Unintended weight loss

Causes

The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause IBD. One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Heredity also seems to play a role in that IBD is more common in people who have family members with the disease. However, most people with IBD don't have this family history.

Risk Factors

• Age. Most people who develop IBD are diagnosed before they're 30 years old. But some people don't develop the disease until their 50s or 60s.
• Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you're of Ashkenazi Jewish descent, your risk is even higher.
• Family history. You're at higher risk if you have a close relative — such as a parent, sibling or child — with the disease.
• Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. Although smoking may provide some protection against ulcerative colitis, the overall health benefits of not smoking make it important to try to quit.
• Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium (Voltaren) and others. These medications may increase the risk of developing IBD or worsen disease in people who have IBD.
• Where you live. If you live in an industrialized country, you're more likely to develop IBD. Therefore, it may be that environmental factors, including a diet high in fat or refined foods, play a role. People living in northern climates also seem to be at greater risk.

Complications

Ulcerative colitis and Crohn's disease have some complications in common and others that are specific to each condition. Complications found in both conditions may include:

• Colon cancer. Having IBD increases your risk of colon cancer. General colon cancer screening guidelines for people without IBD call for a colonoscopy every 10 years beginning at age 50. Ask your doctor whether you need to have this test done sooner and more frequently.
• Skin, eye and joint inflammation. Certain disorders, including arthritis, skin lesions and eye inflammation (uveitis), may occur during IBD flare-ups.
• Medication side effects. Certain medications for IBD are associated with a small risk of developing certain cancers. Corticosteroids can be associated with a risk of osteoporosis, high blood pressure and other conditions.
• Primary sclerosing cholangitis. In this condition, inflammation causes scars within the bile ducts, eventually making them narrow and gradually causing liver damage.
• Blood clots. IBD increases the risk of blood clots in veins and arteries.

Treatment

The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduced risks of complications. IBD treatment usually involves either drug therapy or surgery.  

CEN Cholecystitis Overview

Cholecystitis is inflammation of the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, beneath your liver. The gallbladder holds a digestive fluid that's released into your small intestine (bile). In most cases, gallstones blocking the tube leading out of your gallbladder cause cholecystitis. This results in a bile buildup that can cause inflammation. Other causes of cholecystitis include bile duct problems, tumors, serious illness and certain infections. If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder rupture. Treatment for cholecystitis often involves gallbladder removal.

Signs and Symptoms

• Severe pain in your upper right or center abdomen
• Pain that spreads to your right shoulder or back
• Tenderness over your abdomen when it's touched
• Nausea
• Vomiting
• Fever

Causes

• Gallstones. Most often, cholecystitis is the result of hard particles that develop in your gallbladder (gallstones). Gallstones can block the tube (cystic duct) through which bile flows when it leaves the gallbladder. Bile builds up, causing inflammation.
• Tumor. A tumor may prevent bile from draining out of your gallbladder properly, causing bile buildup that can lead to cholecystitis.
• Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis.
• Infection. AIDS and certain viral infections can trigger gallbladder inflammation.
• Blood vessel problems. A very severe illness can damage blood vessels and decrease blood flow to the gallbladder, leading to cholecystitis.

Risk Factors

Having gallstones is the main risk factor for developing cholecystitis.

Complications

• Infection within the gallbladder. If bile builds up within your gallbladder, causing cholecystitis, the bile may become infected.
• Death of gallbladder tissue. Untreated cholecystitis can cause tissue in the gallbladder to die (gangrene). It's the most common complication, especially among older people, those who wait to get treatment, and those with diabetes. This can lead to a tear in the gallbladder, or it may cause your gallbladder to burst.
• Torn gallbladder. A tear (perforation) in your gallbladder may result from gallbladder swelling, infection or death of tissue.

Treatment

Treatment for cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Sometimes, surgery is needed. Treatments may include:

• Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder.
• Fluids through a vein in your arm. This treatment helps prevent dehydration.
• Antibiotics to fight infection. If your gallbladder is infected, your doctor likely will recommend antibiotics.
• Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.
• Procedure to remove stones. Your doctor may perform a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to remove any stones blocking the bile ducts or cystic duct.

 

CEN Temporal Arteritis Overview

Giant cell arteritis is an inflammation of the lining of your arteries. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis. Giant cell arteritis frequently causes headaches, scalp tenderness, jaw pain and vision problems. Untreated, it can lead to blindness. Prompt treatment with corticosteroid medications usually relieves symptoms of giant cell arteritis and might prevent loss of vision. You'll likely begin to feel better within days of starting treatment. But even with treatment, relapses are common.

Signs and Symptoms

The most common symptoms of giant cell arteritis are head pain and tenderness — often severe — that usually affects both temples. Head pain can progressively worsen, come and go, or subside temporarily.

• Persistent, severe head pain, usually in your temple area
• Scalp tenderness
• Jaw pain when you chew or open your mouth wide
• Fever
• Fatigue
• Unintended weight loss
• Vision loss or double vision, particularly in people who also have jaw pain
• Sudden, permanent loss of vision in one eye

Causes

With giant cell arteritis, the lining of arteries becomes inflamed, causing them to swell. This swelling narrows your blood vessels, reducing the amount of blood — and, therefore, oxygen and vital nutrients — that reaches your body's tissues. Almost any large or medium-sized artery can be affected, but swelling most often occurs in the arteries in the temples. These are just in front of your ears and continue up into your scalp. What causes these arteries to become inflamed isn't known, but it's thought to involve abnormal attacks on artery walls by the immune system. Certain genes and environmental factors might increase your susceptibility to the condition.

Risk Factors

Several factors can increase your risk of developing giant cell arteritis, including:

• Age. Giant cell arteritis affects adults only, and rarely those under 50. Most people with this condition develop signs and symptoms between the ages of 70 and 80.
• Sex. Women are about two times more likely to develop the condition than men are.
• Race and geographic region. Giant cell arteritis is most common among white people in Northern European populations or of Scandinavian descent.
• Polymyalgia rheumatica. Having polymyalgia rheumatica puts you at increased risk of developing giant cell arteritis.
• Family history. Sometimes the condition runs in families.

Complications

Giant cell arteritis can cause serious complications, including:

• Blindness. Diminished blood flow to your eyes can cause sudden, painless vision loss in one or, rarely, both eyes. Loss of vision is usually permanent.
• Aortic aneurysm. An aneurysm is a bulge that forms in a weakened blood vessel, usually in the large artery that runs down the center of your chest and abdomen (aorta). An aortic aneurysm might burst, causing life-threatening internal bleeding.Because this complication can occur even years after the diagnosis of giant cell arteritis, your doctor might monitor your aorta with annual chest X-rays or other imaging tests, such as ultrasound and CT.
• Stroke. This is an uncommon complication of giant cell arteritis.

Treatment

The main treatment for giant cell arteritis consists of high doses of a corticosteroid drug such as prednisone. Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy.  

CEN Neurogenic Shock Overview

Neurogenic shock is a life-threatening condition caused by irregular blood circulation in the body. Trauma or injury to the spine can cause this disruption. Neurogenic shock is extremely dangerous because it can cause your blood pressure to drop drastically and suddenly, and can leave irreversible damage to your body tissues. If left untreated, neurogenic shock can be fatal.

Signs and Symptoms

One of the main symptoms of neurogenic shock is low blood pressure from irregular blood circulation. However, this condition can cause a number of other symptoms:

• dizziness
• nausea
• vomiting
• blank stares
• fainting
• increased sweating
• anxiety
• pale skin

In more severe cases of neurogenic shock, you may experience:

• difficulty breathing
• chest pain
• weakness from irregular blood circulation
• bradycardia, or a slower heart rhythm
• faint pulse
• cyanosis, or discolored lips and fingers
• hypothermia, or decreased body temperature

Causes

Neurogenic shock is often a result of injury or trauma to the spinal cord. As a result, your body loses function and stimulation of the sympathetic nervous system. Your sympathetic nervous system maintains bodily functions during physical activity. That includes strengthening your heart beat, raising your blood pressure, and opening your airways to improve breathing. If your sympathetic nervous system doesn’t function well, your blood pressure could drop and can affect your brain, tissues, and spinal cord. Other causes of neurogenic shock include:

• car accidents that cause central nervous system damage or spinal cord injury
• sport injuries causing trauma to the spine
• gunshot wounds to the spine
• medications that affect the autonomic nervous system, which regulates breathing and other automatic bodily functions
• improper administration of anesthesia to the spinal cord

Treatment

Neurogenic shock can cause irreversible damage if not treated quickly. Treatment options are meant to stabilize you and prevent any additional injury or damage. First, your doctor will immobilize you to prevent further damage. Then they will give you fluids intravenously to regulate your blood pressure. If your blood pressure is too low, you may be given vasopressors, or medication that helps to tighten your blood vessels and raise pressure. Some of the most common vasopressors include:

• norepinephrine
• epinephrine
• dopamine
• vasopressin

 

CEN Diverticulitis Overview

Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems. The presence of diverticula is known as diverticulosis.  When one or more of the pouches become inflamed, and in some cases infected, that condition is known as diverticulitis. Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits. Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery.

Signs and Symptoms

• Pain, which may be constant and persist for several days. The lower left side of the abdomen is the usual site of the pain. Sometimes, however, the right side of the abdomen is more painful, especially in people of Asian descent.
• Nausea and vomiting.
• Fever.
• Abdominal tenderness.
• Constipation or, less commonly, diarrhea.

Causes

Diverticula usually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. Diverticulitis occurs when diverticula tear, resulting in inflammation, and in some cases, infection.

Risk Factors

• Aging. The incidence of diverticulitis increases with age.
• Obesity. Being seriously overweight increases your odds of developing diverticulitis.
• Smoking. People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis.
• Lack of exercise. Vigorous exercise appears to lower your risk of diverticulitis.
• Diet high in animal fat and low in fiber. A low-fiber diet in combination with a high intake of animal fat seems to increase risk, although the role of low fiber alone isn't clear.
• Certain medications. Several drugs are associated with an increased risk of diverticulitis, including steroids, opioids and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

Complications

About 25% of people with acute diverticulitis develop complications, which may include:

• An abscess, which occurs when pus collects in the pouch.
• A blockage in your bowel caused by scarring.
• An abnormal passageway (fistula) between sections of bowel or the bowel and other organs.
• Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care.

Treatment

Treatment depends on the severity of your signs and symptoms.  

CEN Hyperemesis Gravidarum Overview

Morning sickness is nausea and vomiting that occurs during pregnancy. And, despite its name, morning sickness can strike at any time of the day or night. Many pregnant women have morning sickness, especially during the first trimester. But some women have morning sickness throughout pregnancy. Management options include various home remedies, such as snacking throughout the day and sipping ginger ale or taking over-the-counter medications to help relieve nausea. Rarely, morning sickness is so severe that it progresses to a condition called hyperemesis gravidarum. This is when someone with nausea and vomiting of pregnancy has severe symptoms that may cause severe dehydration or result in the loss of more than 5 percent of pre-pregnancy body weight. Hyperemesis gravidarum may require hospitalization and treatment with intravenous (IV) fluids, medications and rarely a feeding tube.

Signs and Symptoms

Common signs and symptoms of morning sickness include nausea and vomiting, often triggered by certain odors, spicy foods, heat, excess salivation or - often times - no triggers at all. Morning sickness is most common during the first trimester and usually begins by nine weeks after conception. Symptoms improve for most expectant mothers by the mid to late second trimester.

Causes

What causes morning sickness isn't clear, but the hormonal changes of pregnancy are thought to play a role. Rarely, severe or persistent nausea or vomiting may be caused by a medical condition unrelated to pregnancy — such as thyroid or liver disease.

Risk Factors

Morning sickness can affect anyone who's pregnant, but it might be more likely if:

• You had nausea or vomiting from motion sickness, migraines, certain smells or tastes, or exposure to estrogen (in birth control pills, for example) before pregnancy
• You had morning sickness during a previous pregnancy
• You're pregnant with twins or other multiples

Complications

Mild nausea and vomiting of pregnancy typically won't cause any complications to you or your baby. If left untreated, severe nausea and vomiting can cause dehydration, an electrolyte imbalance, decreased urination and hospitalization. Research is mixed on whether hyperemesis gravidarum causes poor weight gain for your baby during your pregnancy.

Treatment

If your morning sickness symptoms persist, your health care provider may recommend vitamin B-6 supplements (pyridoxine), ginger and over- the-counter options such as doxylamine (Unisom) for management. If you still have symptoms, your health care provider may recommend prescription anti-nausea medications. Moderate to severe nausea and vomiting of pregnancy may cause dehydration and electrolyte, such as sodium or potassium, imbalance. Extra fluids and prescription medications are recommended for moderate to severe morning sickness.  

CEN Increased Intracranial Pressure Overview

A brain injury or another medical condition can cause growing pressure inside your skull. This dangerous condition is called increased intracranial pressure (ICP) and can lead to a headache. The pressure also further injure your brain or spinal cord. This kind of headache is an emergency and requires immediate medical attention. The sooner you get help, the more likely you are to recover.

Signs and Symptoms

• Headache
• Blurred vision
• Feeling less alert than usual
• Vomiting
• Changes in your behavior
• Weakness or problems with moving or talking
• Lack of energy or sleepiness

Causes

• Too much cerebrospinal fluid (the fluid around your brain and spinal cord)
• Bleeding into the brain
• Swelling in the brain
• Aneurysm
• Blood pooling in some part of the brain
• Brain or head injury
• Brain tumor
• Infections such as encephalitis or meningitis
• Hydrocephalus
• High blood pressure
• Stroke 

Complications

• Seizures
• Stroke
• Neurological damage
• Death

Treatment

Increased intracranial pressure is an emergency. Treatment might include:

• Medicine to reduce swelling
• Draining extra cerebrospinal fluid or bleeding around the brain
• Removing part of the skull (craniotomy) to ease swelling (though this is rare)

You may also be treated for the underlying cause of your intracranial pressure, which could be an infection, high blood pressure, tumor, or stroke.  

CEN Intussusception Overview

Intussusception is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This "telescoping" often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected, which can lead to a tear in the bowel (perforation), infection and death of bowel tissue. Intussusception is the most common cause of intestinal obstruction in children younger than 3. The cause of most cases of intussusception in children is unknown. Though rare in adults, most cases of adult intussusception are the result of an underlying medical condition, such as a tumor. In children, the intestines can usually be pushed back into position with an X-ray procedure. In adults, surgery is often required to correct the problem.

Signs and Symptoms

• Stool mixed with blood and mucus (sometimes referred to as "currant jelly" stool because of its appearance)
• Vomiting
• A lump in the abdomen
• Lethargy
• Diarrhea
• Fever

Causes

Your intestine is shaped like a long tube. In intussusception, one part of your intestine — usually the small intestine — slides inside an adjacent part. This is sometimes called telescoping because it's similar to the way a collapsible telescope folds together. In some cases, the telescoping is caused by an abnormal growth in the intestine, such as a polyp or a tumor (called a lead point). The normal wave-like contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be identified for intussusception.

Risk Factors

• Age. Children — especially young children — are much more likely to develop intussusception than adults are. It's the most common cause of bowel obstruction in children between the ages of 6 months and 3 years.
• Sex. Intussusception more often affects boys.
• Abnormal intestinal formation at birth. Intestinal malrotation is a condition in which the intestine doesn't develop or rotate correctly, and it increases the risk for intussusception.
• A prior history of intussusception. Once you've had intussusception, you're at increased risk of developing it again.
• A family history. Siblings of someone who's had an intussusception are at a much higher risk of the disorder.

Complications

Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. Tissue death can lead to a tear (perforation) in the intestinal wall, which can cause an infection of the lining of the abdominal cavity (peritonitis). Peritonitis is a life-threatening condition that requires immediate medical attention. Signs and symptoms of peritonitis include:

• Abdominal pain
• Abdominal swelling
• Fever

Treatment

Treatment of intussusception typically happens as a medical emergency. Emergency medical care is required to avoid severe dehydration and shock, as well as prevent infection that can occur when a portion of intestine dies due to lack of blood.  

CEN Subdural Hematoma Overview

A subdural hematoma occurs when blood collects on your brain’s surface beneath the skull. Subdural hematomas can be life-threatening. They usually result from a head injury. Subdural hematomas are either acute or chronic. Acute subdural hematomas commonly form because of a severe head injury. Approximately 20 to 30 percent of people regain full or partial brain function after having an acute subdural hematoma.

Signs and Symptoms

Acute subdural hematomas cause symptoms right away. However, people with chronic subdural hematomas may have no symptoms at all. Common symptoms of a subdural hematoma are:

• slurred speech
• loss of consciousness or coma
• seizures
• numbness
• severe headaches
• weakness
• visual problems

Causes

A head injury is the most common cause of bleeding within the skull. A head injury may result from motor vehicle or bicycle accidents, falls, assaults, and sports injuries.

Complications

Complications of subdural hematomas may occur soon after the injury or sometime after the injury has been treated. These complications may include:

• brain herniation, which puts pressure on your brain and can cause a coma or death
• seizures
• permanent muscle weakness or numbness

The extent of complications depends on the severity of your brain injury. Other health issues may affect either chronic or acute subdural. People who take anticoagulants (blood thinners) are at higher risk. People over the age of 65 also have a higher risk, especially for the chronic type.

Treatment

An acute subdural hematoma can only be treated in an operating room. A surgical procedure called a craniotomy may be used to remove a large subdural hematoma. It’s normally used to treat acute subdural hematomas. In this procedure, your surgeon removes a part of your skull in order to access the clot or hematoma. They then use suction and irrigation to remove it.