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Jaundice: Clinical essentials – Dr. Kiran Peddi MRCP(UK), FRCP(London), CCT(Gastro)

What is jaundice?
Jaundice is a condition in which the skin, sclera (whites of the eyes) and mucous membranes turn yellow. This yellow color is caused by a high level of bilirubin, a yellow-orange bile pigment. Bile is fluid secreted by the liver. Bilirubin is formed from the breakdown of red blood cells.

SYMPTOMS AND CAUSES
What causes jaundice?
Jaundice can be caused by a problem in any of the three phases in bilirubin production.

Before the production of bilirubin, you may have what’s called unconjugated jaundice due to increased levels of bilirubin caused by:

Reabsorption of a large hematoma (a collection of clotted or partially clotted blood under the skin).
Hemolytic anemias (blood cells are destroyed and removed from the bloodstream before their normal lifespan is over).
During production of bilirubin, jaundice can be caused by:

Viruses, including Hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis).
Alcohol.
Autoimmune disorders.
Rare genetic metabolic defects.
Medicines, including acetaminophen toxicity, penicillins, oral contraceptives, chlorpromazine (Thorazine®) and estrogenic or anabolic steroids.
After bilirubin is produced, jaundice may be caused by obstruction (blockage) of the bile ducts from:

Gallstones.
Inflammation (swelling) of the gallbladder.
Gallbladder cancer.
Pancreatic tumor.
What are the symptoms of jaundice?
Sometimes, the person may not have symptoms of jaundice, and the condition may be found accidentally. The severity of symptoms depends on the underlying causes and how quickly or slowly the disease develops.

If you have a short-term case of jaundice (usually caused by infection), you may have the following symptoms and signs:

Fever.
Chills.
Abdominal pain.
Flu-like symptoms.
Change in skin color.
Dark-colored urine and/or clay-colored stool.
If jaundice isn’t caused by an infection, you may have symptoms such as weight loss or itchy skin (pruritus). If the jaundice is caused by pancreatic or biliary tract cancers, the most common symptom is abdominal pain. Sometimes, you may have jaundice occurring with liver disease if you have:

Chronic hepatitis or inflammation of the liver.
Pyoderma gangrenosum (a type of skin disease).
Acute hepatitis A, B or C.
Polyarthralgias (inflammation of the joints).

DIAGNOSIS AND TESTS
—————————————-
How is jaundice diagnosed?
Doctors diagnose jaundice by checking for signs of liver disease such as:

Bruising of the skin.
Spider angiomas (abnormal collection of blood vessels near the surface of the skin).
Palmar erythema (red coloration of the palms and fingertips).
Urinalysis (urine testing) that’s positive for bilirubin shows that the patient has conjugated jaundice. The findings of urinalysis should be confirmed by serum testing. The serum testing will include a complete blood count (CBC) and bilirubin levels.

Your doctor will also do an exam to determine the size and tenderness of your liver. He or she may use imaging (ultrasonography and computer tomographic (CT) scanning) and liver biopsy (taking a sample of the liver) to further confirm diagnosis.

MANAGEMENT AND TREATMENT
——————————————————
How is jaundice treated?
Jaundice usually doesn’t require treatment in adults (it’s a more severe problem in infants). The causes and complications of jaundice can be treated. For instance, if itching is bothersome, it may be eased by cholestyramine (Questran®).

What are some of the complications/side effects of the treatments of jaundice?
Constipation.
Bloating.
Stomach pain.
Gas.
Upset stomach.
Vomiting.
Diarrhea.

#jaundice #clinicalessentials #next #nationalexittest #mbbs #usmle #jaundicecauses #jaundicetreatment #jaundicediagnosis #jaundicemanagement #jaundicepatienteducation

Jaundice Causes,Sign, Symptoms,Treatment and Risk Factor
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Knowing what will happen and what to expect at your first marriage counseling session is critical for getting the most out of it. Your marriage is having trouble. There shouldn’t be any wasted time working with a counselor who doesn’t know exactly how to help you fix your marriage. It’s critically important that you prepare yourself with the right knowledge before your first session so that when you and your spouse are meeting the counselor, you will be able to determine if they are going to be an adequate source of help or not.

Not knowing how to prepare for your first marriage counseling session can cause a lot of lost time and also create a situation where you are with the wrong therapist. In this video, Paul Friedman explains what you need to do and why. He also touches on important things about marriage you probably never knew or considered.

I’m going to try to help you today with something that is a little bit complicated but just a little bit. There’s going to be a general attitude that I’m going to try to convey to you sort of an overview on how to prepare for your first marriage counseling session and the reason why people will do that is going to marriage counseling is obviously, so that they can save their marriage or just improve it because it’s not going in the right direction.

There is a general consensus now that marriage counseling doesn’t really help but there are some marriage counselors who are top-notch. For The Marriage Foundation, we hired them or try to find them so they could be our counselors as people take the course or have questions so there are some really excellent marriage therapist counselors out there. I’m going to try and give you things that you need to look out for. The overview first is to remember why you’re going to marriage counseling. You’re not going to marriage counseling so that you can b*tch and moan about your husband or wife. You’re not going there so you could get everything out on the table and talk things out that’s a misconception. There is no good end to talking things out.

A good marriage counselor will not do that. They won’t ask you what’s going on in order to talk things out. They’ll ask you that only so that they could get a sense of your commitment to one another, your commitment to the marriage whether you’re willing as an individual to take responsibility for your end of the marriage and frankly, for the whole marriage. Try to understand that there are those marriage counselors out there far too many who want you to keep coming back. You become their bank account, you become a client of theirs. In contrast, there are others who just really want to help you get your marriage under control.

What are you looking for? What should the first session look like?

It should really not look like where you’re getting each other into trouble. You’re not trying to blame one another what you’re trying to do is find out here’s the critical piece. You’re trying to find out what you’re doing wrong, not what your spouse is doing wrong but what you’re doing wrong. You’re going into an arena where someone who’s a professional who knows what they’re doing can say “you need to look at this,” “you might want to read this” and there are many counselors who will recommend one of my books either Breaking the Cycle or Lessons for a Happy Marriage as a basis and then they’ll help you through the steps because you got to take the steps.

Marriage counseling doesn’t have to be tortured, it’s supposed to be where your marriage has gotten off the rails. Now you want to get back on the rails and you want to do it as quickly as possible so we’ve gotten a little bit off-track. Speaking off the rails we’ve gotten a little bit off-track about how to prepare. So, how you should prepare is you should literally grab a piece of paper and a pencil and write down your vision for a happy marriage. You shouldn’t write down your complaints, don’t write down what’s wrong with your spouse that will literally undermine any progress you possibly could make. You want to ask the question, “What can I as an individual do to improve our marriage?”

Don’t worry about what your spouse wants to do there. There’s this idea that marriage is these two people becoming one and that’s not exactly true, it’s two souls who merge, sure, that’s true, but two minds aren’t going to merge. You’re always going to maintain your individuality.

Watch the video for more.

#marriagecounseling #marriagetips #marriageadvice #counseling #marriageprogram #communication

http://www.MarriageGuy.com — Does Marriage Counseling Work?

So you’ve tried to make it work on your own, but no matter what do you it seems like you’re marriage just isn’t getting better. A friend recommended marriage counselling to you, but you brushed off the idea, thinking that your marriage wasn’t that doomed. But now, after months of trying different tips and ideas without results, you’re considering giving it a go. But does marriage counselling actually work, or is it just a waste of time and money?

My name is Brad Browning, I’m a marriage coach from Vancouver BC, and I’m also author of a best-selling program called “Mend the Marriage”.

Today I want to talk to you about the ins and outs of marriage counselling, so let’s begin with a few common situations.

Your partner is ready to end the marriage, but you’re not. You’ve watched self help videos, read the books and even turned to your friends and family for advice. You’re at the point where your spouse isn’t even speaking to you much anymore, and when you do talk, every conversation ends in a an argument. Or maybe you never argue at all because your spouse doesn’t want to talk anymore. You didn’t see this coming, and even if you did there was nothing you could do to change their mind. Your situation right now is painful, but you desperately don’t want to separate and you truly believe that your marriage can be saved.

Traditionally, couples in crisis are advised to attend “marriage counselling” or “couples therapy.” In these sessions the couple would work with a counsellor who creates a safe environment, open for honest discussions about their marriage. Together they look for the root causes of their problems, and may concentrate on improving certain areas of the relationship. These areas include: communication, conflict resolution, forgiveness, trust, commitment, intimacy and others depends on your personal situation. Essentially, the marriage counsellor provides the tools a couple needs to confront their marital issues, and a recovery plan. If these are done properly, it can be helpful.

For marriage counselling to work, both spouses must be willing to attend, participate, and work hard on facing your issues. More importantly, they must also both believe that their marriage is salvageable and worth saving. It is sometimes extremely difficult to convince your ex to go down this route.

So before you dump thousands of dollars into marriage counselling, you might want to consider investing in my Mend The Marriage program. This is a program that I’ve poured my heart and soul into… and it will give you and your spouse get a second chance at lifelong love. In fact, my program has been so wildly successful that it alone has helped save thousands of marriages — without marriage counselling. The great thing about it is…you don’t need don’t need your spouse’s effort right now and you don’t need to wait around for a marriage counsellor to help you. If you want to learn more details about my Mend The Marriage program, you can watch the free video presentation on my website, MarriageGuy.com. Again, the URL is MarriageGuy.com.

*** More from Brad Browning: ***
Ex Factor Guide: http://www.exfactorguide.com
Love Learnings: http://www.lovelearnings.com
Google+: http://www.google.com/+BradBrowning
Facebook: http://www.facebook.com/bbrowning
Twitter: http://www.twitter.com/brad_browning
Patreon: http://www.patreon.com/bradbrowning
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