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INTRODUCTION-

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels. This pressure depends on the resistance of the blood vessels and how hard the heart has to work.

Almost half of all adults in the United States have high blood pressure, but many are not aware of this fact.

Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart attack, heart failure, and aneurysm. Keeping blood pressure under control is vital for preserving health and reducing the risk of these dangerous conditions.

In this article, we explain why blood pressure can increase, how to monitor it, and ways to keep it within a normal range.

CAUSES-

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

• Obstructive sleep apnea
• Kidney problems
• Adrenal gland tumors
• Thyroid problems
• Certain defects you’re born with (congenital) in blood vessels
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

The cause of hypertension is often not known. In many cases, it is the result of an underlying condition.

Doctors call high blood pressure that is not due to another condition or disease primary or essential hypertension.

If an underlying condition is the cause of increasing blood pressure, doctors call this secondary hypertension.

Primary hypertension can result from multiple factors, including:

• blood plasma volume
• hormone activity in people who manage blood volume and pressure using medication
• environmental factors, such as stress and lack of exercise

Secondary hypertension has specific causes and is a complication of another health problem.

Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no longer filter out fluid. This excess fluid leads to hypertension.

Conditions that can lead to hypertension include:

• diabetes, due to kidney problems and nerve damage
• kidney disease
• pheochromocytoma, a rare cancer of an adrenal gland
• Cushing syndrome that corticosteroid drugs can cause
• congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
• hyperthyroidism, or an overactive thyroid gland
• hyperparathyroidism, which affects calcium and phosphorous levels
• pregnancy
• sleep apnea
• obesity

SYMPTOM

A person with hypertension may not notice any symptoms, and so people often call it the “silent killer.” Without detection, hypertension can damage the heart, blood vessels, and other organs, such as the kidneys.

It is vital to check blood pressure regularly.

In rare and severe cases, high blood pressure causes sweating, anxiety, sleeping problems, and blushing. However, most people with hypertension will experience no symptoms at all.

If high blood pressure becomes a hypertensive crisis, a person may experience headaches and nosebleeds.

When to see a doctor

You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.

Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.

Your doctor will likely recommend more frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.

If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.

Risk factors

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High blood pressure has many risk factors, including:

• Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
• Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
• Family history. High blood pressure tends to run in families.
• Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure. If you drink alcohol, do so in moderation .For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
• Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

• Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
• Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
• Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

TREATMENT-

Regular physical exercise-

Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes of moderate intensity, aerobic exercise every week, or 75 minutes a week of high intensity exercise.

People should exercise on at least 5 days of the week.

Examples of suitable activities are walking, jogging, cycling, or swimming.

Stress reduction

Avoiding or learning to manage stress can help a person control blood pressure.

Meditation, warm baths, yoga, and simply going on long walks are relaxation techniques that can help relieve stress.

People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.

Smoking can increase blood pressure. Avoiding or quitting smoke

educes the risk of hypertension, serious heart conditions, and other health issues.

Medication

People can use specific medications to treat hypertension. Doctors will often recommend a low dose at first. Antihypertensive medications will usually only have minor side effects.

Eventually, people with hypertension will need to combine two or more drugs to manage their blood pressure.

Medications for hypertension include:

• diuretics, including thiazides, chlorthalidone, and indapamide
• beta-blockers and alpha-blockers
• calcium-channel blockers
• central agonists
• peripheral adrenergic inhibitor
• vasodilators
• angiotensin-converting enzyme (ACE) inhibitors
• angiotensin receptor blockers

The choice of medication depends on the individual and any underlying medical conditions they may experience.

Anyone on antihypertensive medications should carefully read the labels of any over-the-counter (OTC) drugs they may also take, such as decongestants. These OTC drugs may interact with the medications they are taking to lower their blood pressure.

Diet

People can prevent high blood pressure by following a heart-healthy diet.

Reducing salt intake

People’s average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.

The World Health Organization (WHO) recommend reducing intake to under 5 g a day to help decrease the risk of hypertension and related health problems.

Lowering salt intake can benefit people both with and without hypertension.

Moderating alcohol consumption

Moderate to excessive alcohol consumption can increase blood pressure.

The American Heart Association (AHA) recommend a maximum of two alcoholic drinks a day for men, and one for women.

The following would count as one drink:

• a 12-ounce (oz) bottle of beer
• 4 oz of wine
• 1.5 oz of 80-proof spirits
• 1 oz of 100-proof spirits

A healthcare provider can help people reduce consumption if they find it difficult to moderate their alcohol intake.

Eating more fruit and vegetables and less fat

People who have high blood pressure or people at high risk of developing high blood pressure should eat as little saturated and total fat as possible.

Instead, experts recommend:

• whole grain, high fiber foods
• a variety of fruit and vegetables
• beans, pulses, and nuts
• fish rich in omega-3 twice a week
• nontropical vegetable oils, for example, olive oil
• skinless poultry and fish
• low fat dairy products

It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well as large portion sizes.

Some fats, such as those in oily fish and olive oil, have protective effects on the heart. However, these are still fats. While they are typically healthful, people with a risk of hypertension should still include them in their total fat intake.

Managing body weight

Excess body weight can contribute to hypertension. A fall in blood pressure usually follows weight loss, as the heart does not have to work so hard to pump blood around the body.

A balanced diet with a calorie intake that matches the individual’s size, sex, and activity level will help.

The DASH diet

The U.S. National Heart, Lung, and Blood Institute (NHLBI) recommend the DASH diet for people with high blood pressure. DASH stands for “Dietary Approaches to Stop Hypertension.”

DASH is a flexible and balanced eating plan with a firm grounding in research by the NHLBI who advise that the diet:

• lowers high blood pressure
• improves levels of fats in the bloodstream
• reduces the risk of cardiovascular disease

The NHLBI produce a cookbook called Keep the Beat Recipes that provides meal ideas to help reduce blood pressure.

Research from 2014 suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.

PHYSICAL THERAPY MANAGEMENT

According to the American Physical Therapy Association, “Physical therapist patient/client management integrates an understanding of a patient’s/client’s prescription and nonprescription medication regimen with consideration of its impact upon health, impairments, functional limitations, and disabilities. The administration and storage of medications used for PT interventions is also a component of patient/client management and thus within the scope of PT practice”. Considering the prevalence of hypertension, therapists will undoubtedly work with many patients taking antihypertensive medications and should factor the effects of antihypertensives in their plan of care. A few important considerations for the physical therapist when treating hypertensive patients include: ensuring efficient scheduling in correspondence with therapy schedule, monitoring side effects, ensuring patient adherence to medications, and also selecting appropriate therapeutic exercises for each individual patient.

In regards to monitoring side effects, orthostatic hypotension is of the utmost concern for patients currently taking antihypertensives. Clinicians should be cautious when their patient changes posture suddenly or engages in activities that may lower blood pressure. In addition, patients need to be educated on the significant impact that uncontrolled high blood pressure can have on their health. When hypertension is left uncontrolled it has the ability to become a “silent killer” which serves reason as to why adherence should be continuously reinforced. Exercise is an imperative component of evidence-based treatment for many conditions treated in PT settings, however, it is an essential aspect of improving health in those diagnosed with hypertension. Regular exercise has been shown to drastically decrease blood pressure and can potentially eliminate the need for antihypertensive medications when it is accepted as a lifestyle. Exercise may present health risks to patients with hypertension, making it crucial for physical therapists to identify which exercise interventions are appropriate and safe for individual patients.

A randomized controlled pilot study suggests positive outcomes with neuromuscular electrical stimulation (NMES) for patients with pulmonary arterial hypertension (PAH)

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INTRODUCTION-

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.

Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

The liver damage done by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.

The liver is the largest solid organ in the body. It performs many important functions, including:

• Making blood proteins that aid in clotting, transporting oxygen, and helping the immune system.
• Storing excess nutrients and returning some of the nutrients to the bloodstream.
• Manufacturing bile, a substance needed to help digest food.
• Helping the body store sugar (glucose) in the form of glycogen.
• Ridding the body of harmful substances in the bloodstream, including drugs and alcohol.
• Breaking down saturated fat and producing cholesterol.

Cirrhosis is a slowly developing disease in which healthy liver tissue is replaced with scar tissue. The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs and natural toxins (poisons). It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly.

CAUSES-

Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

• Fatigue
• Easily bleeding or bruising
• Loss of appetite
• Nausea
• Swelling in your legs, feet or ankles (edema)
• Weight loss
• Itchy skin
• Yellow discoloration in the skin and eyes (jaundice)
• Fluid accumulation in your abdomen (ascites)
• Spiderlike blood vessels on your skin
• Redness in the palms of the hands
• For women, absent or loss of periods not related to menopause
• For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)

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STAGES OF CIRRHOSIS-

Cirrhosis in itself is already a late stage of liver damage. In the early stages of liver disease there will be inflammation of the liver. If this inflammation is not treated it can lead to scarring (fibrosis). At this stage it is still possible for the liver to heal with treatment.

If fibrosis of the liver is not treated, it can result in cirrhosis. At this stage, the scar tissue cannot heal, but the progression of the scarring may be prevented or slowed. People with cirrhosis who have signs of complications may develop end-stage liver disease (ESLD) and the only treatment at this stage is liver transplantation.

• Stage 1 cirrhosis involves some scarring of the liver, but few symptoms. This stage is considered compensated cirrhosis, where there are no complications.
• Stage 2 cirrhosis includes worsening portal hypertension and the development of varices.
• Stage 3 cirrhosis involves the development of swelling in the abdomen and advanced liver scarring. This stage marks decompensated cirrhosis, with serious complications and possible liver failure.
• Stage 4 cirrhosis can be life threatening and people have develop end-stage liver disease (ESLD), which is fatal without a transplant.

SYMPTOM-

Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:

• Fatigue
• Easily bleeding or bruising
• Loss of appetite
• Nausea
• Swelling in your legs, feet or ankles (edema)
• Weight loss
• Itchy skin
• Yellow discoloration in the skin and eyes (jaundice)
• Fluid accumulation in your abdomen (ascites)
• Spiderlike blood vessels on your skin
• Redness in the palms of the hands
• For women, absent or loss of periods not related to menopause
• For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)

Risk factors

• Drinking too much alcohol. Excessive alcohol consumption is a risk factor for cirrhosis.
• Being overweight. Being obese increases your risk of conditions that may lead to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.
• Having viral hepatitis. Not everyone with chronic hepatitis will develop cirrhosis, but it’s one of the world’s leading causes of liver disease.

Complications

Complications of cirrhosis can include:

• High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen.
• Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
• Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen, and trapping of white blood cells and platelets. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.
• Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra pressure, these smaller veins can burst, causing serious bleeding. Portal hypertension may cause enlarged veins (varices) in the esophagus (esophageal varices) or the stomach (gastric varices) and lead to life-threatening bleeding. If the liver can’t make enough clotting factors, this also can contribute to continued bleeding.
• Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.
• Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
• Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn’t able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.
• Jaundice. Jaundice occurs when the diseased liver doesn’t remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
• Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
• Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.
• Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don’t fully understand its causes.

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Prevention

Reduce your risk of cirrhosis by taking these steps to care for your liver:

• Do not drink alcohol if you have cirrhosis. If you have liver disease, you should avoid alcohol.
• Eat a healthy diet. Choose a plant-based diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
• Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.
• Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about Hepatitis vaccinations.

DIAGNOSIS-

• Physical exam: During a physical exam, your doctor can observe how your liver feels or how large it is (a cirrhotic liver is bumpy and irregular instead of smooth).
• Blood tests: If your doctor suspects cirrhosis, you will be given blood tests to check for liver disease.
• Other tests: In some cases, other tests that take pictures of the liver are performed, such as a computerized tomography (CT) scan or an ultrasound.
• Biopsy: Your doctor may decide to confirm the diagnosis by taking a sample of tissue (biopsy) from the liver.
• Surgery: In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision (cut) in the abdomen.

TREATMENT-

Although there is no cure for cirrhosis, there are treatments that can delay its progress, and in so doing, decrease the damage to liver cells and reduce complications:

• For cirrhosis caused by alcohol abuse, the person must stop drinking alcohol.
• For other patients with cirrhosis caused by autoimmune diseases, Wilson’s disease, or hemochromatosis, the doctor will recommend the proper treatments for cirrhosis as well as for the underlying disease.
• Medications may be given to control the symptoms of cirrhosis.
• Edema (fluid retention) and ascites (fluid in the abdomen) are treated by reducing salt in the diet. Diuretics (water pills) are used to remove excess fluid and to prevent edema from coming back.
• Diet and drug therapies can help improve the confused mental state that cirrhosis can cause. For instance, decreasing the amount of salt in the diet results in less fluid retention in the abdomen and legs. Laxatives such as lactulose may be given to help absorb toxins.
• Some people with severe cirrhosis may need a liver transplant.

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INTRODUCTION-

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.

Your liver is located in the right upper area of your abdomen. It performs many critical functions that affect metabolism throughout your body, including:

• bile production, which is essential to digestion
• filtering of toxins from your body
• excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
• breakdown of carbohydrates, fats, and proteins
• activation of enzymes, which are specialized proteins essential to body functions
• storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
• synthesis of blood proteins, such as albumin
• synthesis of clotting factors

According to the Centers for Disease Control and Prevention (CDC), approximately 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people don’t even know that they have hepatitis.

Treatment options vary depending on which type of hepatitis you have. You can prevent some forms of hepatitis through immunizations and lifestyle precautions.

Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact. 

Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. 

The 5 types of viral hepatitis

Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis.

Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women.

Hepatitis A

Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.

Hepatitis B

Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.

It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease.

Hepatitis C

Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection.

Hepatitis D

Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States.

Hepatitis E

Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC.

NON INFECTION CAUSES-

Alcohol and other toxins

Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis. The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, a thickening and scarring of the liver.

Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons.

Autoimmune system response

In some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men.

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SYMPTOM-

Hepatitis A signs and symptoms typically don’t appear until you’ve had the virus for a few weeks. But not everyone with hepatitis A develops them. If you do, hepatitis signs and symptoms can include:

• Fatigue
• Sudden nausea and vomiting
• Abdominal pain or discomfort, especially on the upper right side beneath your lower ribs (by your liver)
• Clay-colored bowel movements
• Loss of appetite
• Low-grade fever
• Dark urine
• Joint pain
• Yellowing of the skin and the whites of your eyes (jaundice)
• Intense itching

These symptoms may be relatively mild and go away in a few weeks. Sometimes, however, hepatitis A infection results in a severe illness that lasts several months.

When to see a doctor

Make an appointment with your doctor if you have signs or symptoms of hepatitis A.

Getting a hepatitis A vaccine or an injection of immunoglobulin (an antibody) within two weeks of exposure to hepatitis A may protect you from infection. Ask your doctor or your local health department about receiving the hepatitis A vaccine if:

• You’ve traveled out of the country recently, particularly to Mexico or South or Central America, or to areas with poor sanitation
• A restaurant where you recently ate reports a hepatitis A outbreak
• Someone close to you, such as a roommate or caregiver, is diagnosed with hepatitis A
• You recently had sexual contact with someone who has hepatitis A

DIAGNOSIS-

History and physical exam

To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.

During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.

Liver function tests

Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.

Other blood tests

If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis.

Ultrasound

An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close at your liver and nearby organs. It can reveal:

• fluid in your abdomen
• liver damage or enlargement
• liver tumors
• abnormalities of your gallbladder

Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function.

Liver biopsy

A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample.

This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal

Risk factors

You’re at increased risk of hepatitis A if you:

• Travel or work in areas of the world where hepatitis A is common
• Attend child care or work in a child care center
• Live with another person who has hepatitis A
• Are a man who has sexual contact with other men
• Have any type of sexual contact with someone who has hepatitis A
• Are HIV positive
• Are experiencing homelessness
• Have a clotting-factor disorder, such as hemophilia
• Use any type of illegal drugs (not just those that are injected)

Complications

Unlike other types of viral hepatitis, hepatitis A does not cause long-term liver damage, and it doesn’t become chronic.

In rare cases, hepatitis A can cause a sudden loss of liver function, especially in older adults or people with chronic liver diseases. Acute liver failure requires a stay in the hospital for monitoring and treatment. Some people with acute liver failure may need a liver transplant

Prevention

The hepatitis A vaccine can prevent infection with the virus. The vaccine is typically given in two shots. The first one is followed by a booster shot six months later.

The Centers for Disease Control and Prevention recommends a hepatitis A vaccine for the following people:

• All children at age 1, or older children who didn’t receive the childhood vaccine
• Anyone age 1 year or older who is experiencing homelessness
• Infants ages 6 to 11 months traveling internationally
• Family and caregivers of adoptees from countries where hepatitis A is common
• People in direct contact with others who have hepatitis A
• Laboratory workers who may come in contact with hepatitis A
• Men who have sex with men
• People who work or travel in parts of the world where hepatitis A is common
• People who use any type of illicit drugs, not just injected ones
• People with clotting-factor disorders
• People with chronic liver disease, including hepatitis B or hepatitis C
• Anyone wishing to obtain protection (immunity)

If you’re concerned about your risk of hepatitis A, ask your doctor if you should be vaccinated.

TREATMENT-

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Hepatitis A

Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition.

The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine.

Hepatitis B

Acute hepatitis B doesn’t require specific treatment.

Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment.

Hepatitis B can be prevented with vaccination. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel.

Hepatitis C

Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment.

People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.

Currently, there is no vaccination for hepatitis C.

Hepatitis D

No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study, a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people.

Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop.

Hepatitis E

Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.

Autoimmune hepatitis

Corticosteroids, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition.

Azothioprine (Imuran), a drug that suppresses the immune system, is often included in treatment. It can be used with or without steroids.

Other immune suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (Neoral) can also be used as alternatives to azathioprine for treatment.

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The least invasive and most appropriate treatment for PAD conducted by Physiotherapists would be by prescribing an exercise program. The recommended parameters of physical exercise are a 6 month program of 30-35 minutes walking sessions at a frequency of 3-5 times a week at near-maximal pain tolerant.

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Supervised exercise programs have proved to be have better results that unsupervised exercise programs. An updated Cochrane review 2018 reports that the original version of this review was released in 2006, prescribed exercise therapy consisted mostly of “go home and walk” advice. However the compelling evidence now suggests that “Evidence of moderate and high quality shows that SET (supervised exercise programs) provides an important benefit for treadmill‐measured walking distance (MWD and PFWD) compared with HBET (home based exercise programs) and WA (walking advice) respectively.”

Even for clients having invasive therapies exercise is important A 2018 Cochrane review comparing mono invasive therapies (monotherapies) to supervised exercise programs (SET) with invasive therapies, concluded ” that exercise is a complication-free treatment, it appears to offer significant improvements in patients walk distances with a combination of both SET and intervention offering a superior walking outcome to monotherapy in those requiring invasive measures.”

A 2018 review of the best exercise prescription for PAD summarised their findings thus

• Supervised treadmill exercise improves treadmill walking performance in patients with PAD.
• Supervised treadmill exercise has greater benefit on treadmill walking performance than home-based walking exercise.
• Home-based walking exercise interventions that involve behavioral techniques are effective for functional impairment in people with PAD and improve the 6-min walk distance more than supervised treadmill exercise.
• Upper and lower extremity ergometry improve walking performance in patients with PAD and improve peak oxygen uptake.
• Lower extremity resistance training can improve treadmill walking performance in PAD, but is not as effective as supervised treadmill exercise.

The optimal exercise program for PAD recommended by the American Heart Association states the following

Exercise Prescription for Supervised Exercise Treadmill Training in Patients With Claudication

1. Modality Supervised Treadmill Walking
2. Intensity 40%–60% maximal workload based on baseline treadmill test or workload that brings on claudication within 3–5 min during a 6-MWT
3. Session duration 30–50 min of intermittent exercise; goal is to accumulate at least 30 min of walking exercise
4. Claudication intensity Moderate to moderate/severe claudication as tolerated
5. Work-to-rest ratio Walking duration should be within 5–10 min to reach moderate to moderately severe claudication followed by rest until pain has dissipated (2–5 min)
6. Frequency 3 times per week supervised
7. Program duration At least 12 wk
8. Progression Every 1–2 wk: increase duration of training session to achieve 50 min. As individuals can walk beyond 10 min without reaching prescribed claudication level, manipulate grade or speed of exercise prescription to keep the walking bouts within 5–10 min
9. Maintenance Lifelong maintenance at least 2 times per week

Based on currently available evidence. Exercise prescription should be individualized to each patient as tolerated. 6-MWT indicates 6-minute walk test.

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INTRODUCTION-

Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff — sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries.

Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaque), which can restrict blood flow.

The plaque can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis may be preventable and is treatable.

Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque. Arteries are the blood vessels that carry oxygen and nutrients from your heart to the rest of your body.

As you get older, fats, cholesterol, and calcium can collect in your arteries and form plaque. The buildup of plaque makes it difficult for blood to flow through your arteries. This buildup may occur in any artery in your body, including your heart, legs, and kidneys.

It can result in a shortage of blood and oxygen in various tissues of your body. Pieces of plaque can also break off, causing a blood clot. If left untreated, atherosclerosis can lead to heart attack, stroke, or heart failure.

Atherosclerosis is a fairly common problem associated with aging. This condition can be prevented and many successful treatment options exist.

CAUSES-

Plaque buildup and subsequent hardening of the arteries restricts blood flow in the arteries, preventing your organs and tissues from getting the oxygenated blood they need to function.

The following are common causes of hardening of the arteries:

High cholesterol

Cholesterol is a waxy, yellow substance that’s found naturally in the body as well as in certain foods you eat.

If the levels of cholesterol in your blood are too high, it can clog your arteries. It becomes a hard plaque that restricts or blocks blood circulation to your heart and other organs.

Diet

It’s important to eat a healthy diet. The American Heart Association (AHA) recommends that you follow an overall healthy dietary pattern that stresses:

• a wide range of fruits and vegetables
• whole grains
• low-fat dairy products
• poultry and fish, without skin
• nuts and legumes
• non-tropical vegetable oils, such as olive or sunflower oil

Some other diet tips:

• Avoid foods and drinks with added sugar, such as sugar-sweetened beverages, candy, and desserts. The AHA recommends no more than 6 teaspoons or 100 calories of sugar a day for most women, and no more than 9 teaspoons or 150 calories a day for most men.
• Avoid foods high in salt. Aim to have no more than 2,300 milligrams (mg) of sodium per day. Ideally, you’d consume no more than 1,500 mg a day.
• Avoid foods high in unhealthy fats, such as trans fats. Replace them with unsaturated fats, which are better for you. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat.

Aging-

As you age, your heart and blood vessels work harder to pump and receive blood. Your arteries may weaken and become less elastic, making them more susceptible to plaque buildup.

SYMPTOM-

Atherosclerosis develops gradually. Mild atherosclerosis usually doesn’t have any symptoms.

You usually won’t have atherosclerosis symptoms until an artery is so narrowed or clogged that it can’t supply adequate blood to your organs and tissues. Sometimes a blood clot completely blocks blood flow, or even breaks apart and can trigger a heart attack or stroke.

Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example:

• If you have atherosclerosis in your heart arteries, you may have symptoms, such as chest pain or pressure (angina).
• If you have atherosclerosis in the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, temporary loss of vision in one eye, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke.
• If you have atherosclerosis in the arteries in your arms and legs, you may have symptoms of peripheral artery disease, such as leg pain when walking (claudication).
• If you have atherosclerosis in the arteries leading to your kidneys, you develop high blood pressure or kidney failure.

When to see a doctor

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If you think you have atherosclerosis, talk to your doctor. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness.

Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke or another medical emergency.

Risk factors

Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of atherosclerosis include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Smoking and other tobacco use
• A family history of early heart disease
• Lack of exercise
• An unhealthy diet

DIAGNOSIS-

Your doctor will perform a physical exam if you have symptoms of atherosclerosis. They’ll check for:

• a weakened pulse
• an aneurysm, an abnormal bulging or widening of an artery due to weakness of the arterial wall
• slow wound healing, which indicates a restricted blood flow

A cardiologist may listen to your heart to see if you have any abnormal sounds. They’ll be listening for a whooshing noise, which indicates that an artery is blocked. Your doctor will order more tests if they think you may have atherosclerosis.

Tests can include:

• a blood test to check your cholesterol levels
• a Doppler ultrasound, which uses sound waves to create a picture of the artery that shows if there’s a blockage
• an ankle-brachial index (ABI), which looks for a blockage in your arms or legs by comparing the blood pressure in each limb
• a magnetic resonance angiography (MRA) or a computed tomography angiography (CTA) to create pictures of the large arteries in your body
• a cardiac angiogram, which is a type of chest X-ray that’s taken after your heart arteries are injected with radioactive dye
• an electrocardiogram (ECG or EKG), which measures the electrical activity in your heart to look for any areas of decreased blood flow
• a stress test, or exercise tolerance test, which monitors your heart rate and blood pressure while you exercise on a treadmill or stationary bicycle

Complications

The complications of atherosclerosis depend on which arteries are blocked. For example:

• Coronary artery disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure.
• Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke.
• Peripheral artery disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral artery disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene).
• Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency. If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at some distant point.
• Chronic kidney disease. Atherosclerosis can cause the arteries leading to your kidneys to narrow, preventing oxygenated blood from reaching them. Over time, this can affect your kidney function, keeping waste from exiting your body.

Prevention

The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These include:

• Quitting smoking
• Eating healthy foods
• Exercising regularly
• Maintaining a healthy weight

Just remember to make changes one step at a time, and keep in mind what lifestyle changes are manageable for you in the long run.

TREATMENT-

Treatment involves changing your current lifestyle to decrease the amount of fat and cholesterol you consume. You may need to exercise more to improve the health of your heart and blood vessels.

Unless your atherosclerosis is severe, your doctor may recommend lifestyle changes as the first line of treatment. You may also need additional medical treatments, such as medications or surgery.

Medications

Medications can help prevent atherosclerosis from worsening.

Medications for treating atherosclerosis include:

• cholesterol-lowering medications, including statins and fibrates
• angiotensin-converting enzyme (ACE) inhibitors, which may help prevent narrowing of your arteries
• beta-blockers or calcium channel blockers to lower your blood pressure
• diuretics, or water pills, to help lower your blood pressure
• anticoagulants and antiplatelet drugs such as aspirin to prevent blood from clotting and clogging your arteries

Aspirin is particularly effective for people with a history of atherosclerotic cardiovascular disease (e.g., heart attack and stroke). An aspirin regimen can reduce your risk of having another health event.

If there’s no prior history of atherosclerotic cardiovascular disease, you should only use aspirin as a preventive medication if your risk of bleeding is low and your risk of atherosclerotic cardiovascular disease is high.

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Surgery

If symptoms are especially severe or if muscle or skin tissue are endangered, surgery may be necessary.

Possible surgeries for treating atherosclerosis include:

• bypass surgery, which involves using a vessel from somewhere else in your body or a synthetic tube to divert blood around your blocked or narrowed artery
• thrombolytic therapy, which involves dissolving a blood clot by injecting a drug into your affected artery
• angioplasty, which involves using a catheter and a balloon to expand your artery, sometimes inserting a stent to leave the artery open
• endarterectomy, which involves surgically removing fatty deposits from your artery
• atherectomy, which involves removing plaque from your arteries by using a catheter with a sharp blade at one end

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INTRODUCTION

Nephritic syndrome is characterized by glomerular damage leading to hematuria, pyuria, water retention, and subsequent hypertension and edema. It can be caused by a variety of conditions including autoimmune, hereditary, and infectious diseases. This article provides an overview of nephritic syndrome; Nephritic diseases can present in varying degrees of severity, ranging from asymptomatic hematuria to systemic involvement as in rapidly progressive glomerulonephritis. The urine sediment is typically characterized by red blood cell (RBC) casts, mild to moderate proteinuria (< 3.5 g/day), and sterile pyuria. Diagnosis of the underlying disease is often based on presentation and laboratory values, although renal biopsy may be indicated for confirmation.

Nephritic syndrome is not a disease but a syndrome. A syndrome is a group of symptoms that often and predictably occur together, and which develop as a result of another condition. Syndromes are not necessarily specific to any disease or disorder. Nephritic syndrome has many potential triggers, therefore, successfully treating it involves identifying the underlying causes.

Nephritic syndrome has both acute and chronic forms. Acute, or rapidly-progressing, nephritic syndrome usually comes on suddenly and, because of acute and painful symptoms, seldom goes undetected. Chronic nephritic syndrome typically progresses slowly and often goes undetected for some time.

Chronic inflammation of the kidneys can cause scarring, which may negatively impact kidney function and lead to high blood pressure and, eventually, if left undiagnosed and untreated, to a need for dialysis (renal replacement therapy, when a dialysis machine replaces the kidneys’ function and filters waste products from the blood), and possibly kidney transplantation.

CAUSES-

Nephritic syndrome is the result of inflammation affecting small groups of blood vessels, known as glomeruli, in the kidneys. As the glomeruli are the kidneys’ main filter units, this inflammation disrupts the kidneys’ ability to adequately filter blood. The inflammation can originate in the kidneys themselves or be the result of infection or injury elsewhere in the body.

It can occur in people of any age, including children.

Nephritic syndrome can develop as a result of any of the following:

Primary glomerular diseases: Such as IgA nephropathy (Berger’s disease) or membranoproliferative glomerulonephritis. IgA nephropathy is a very common cause of nephritic syndrome.

Bacterial infections: Such as methicillin-resistant staphylococcus aureus (MRSA), pneumococcal pneumonia, typhoid, infective endocarditis, or secondary syphilis. Nephritic syndrome following a streptococcal throat infection is fairly common, especially in children.

Viral infections: Such as hepatitis B, mumps, measles, chickenpox or glandular fever (mononucleosis).

Multisystem systemic/inflammatory diseases: Such as vasculitis, Goodpasture’s Syndrome, granulomatosis with polyangiitis, Henoch-Schönlein purpura, or lupus (systemic lupus erythematosus).

	Associations	Findings	Treatment
Poststreptococcal glomerulonephritis	Occurs weeks after group A β-hemolytic streptococci infections Pharyngitis/tonsillitis (most common): 1–2 weeks Skin infections: 3–4 weeks Usually affects children between the ages of 3–12 years Can lead to RPGN in some cases	Positive antistreptococcal antibodies (ASO, ADB) ↓ Serum C3 complement levels Tea- or cola-colored urine LM: glomeruli appear enlarged and hypercellular IM: granular subepithelial immune complex depositions (IgG, IgM, C3) → “lumpy-bumpy” appearance EM: dome-shaped, subepithelial deposits (“humps”)	Usually self-limiting Supportive therapy (see “Treatment” below)
IgA nephropathy (Berger’s disease)	Most common idiopathic glomerulonephritis worldwide Episodic gross hematuria during or directly after upper respiratory tract (URT), gastrointestinal (GI) infections, or strenuous exercise Occurrence: ♂ > ♀ Peak incidence: 2nd to 3rd decade of life ∼ 25-30% of the patients progress to end-stage renal disease (ESRD) within 20–25 years	Asymptomatic microhematuria with intermittent gross hematuria ↑ Serum IgA Normal C3 complement levels LM: mesangial proliferation IM: mesangial IgA deposits EM: mesangial immune complex deposits	Supportive therapy (see “Treatment” below) Glucocorticoids in severe cases
Small vessel vasculitis	Granulomatosis with polyangiitis (Wegener’s)	Pulmonary and nasopharyngeal involvement is common → hemoptysis, nasal ulcers	c-ANCA Renal biopsy: segmental necrotizing glomerulonephritis EM: immune complex depositions	Supportive therapy (see “Treatment” below) Immunosuppressive therapy
Microscopic polyangiitis	Usually only mild respiratory symptoms	p-ANCA
Churg-Strauss syndrome	Patients present with: Asthma Allergic rhinitis Purpura Peripheral neuropathy	p-ANCA (∼ 50% of cases) Peripheral eosinophilia Focal segmental necrotizing glomerulonephritis
Goodpasture syndrome (Anti–GBM antibody disease)	Two peaks of occurrence: 3rd decade of life (♂ > ♀) and ≥ 60 years of age (♀ > ♂) Caused by antibodies against type IV collagen Antibodies can cross-react with basement membrane of pulmonary capillaries and lead to pulmonary hemorrhage and hemoptysis Can lead to RPGN	Pulmonary infiltrates on chest x–ray IM: linear deposition of immunoglobulin (IgG) along the glomerular basement membrane	Immunosuppressive therapy Plasmapheresis
Thin basement membrane disease	Hereditary disorder Abnormalities of type IV collagen Good prognosis	Persistent microhematuria Possible episodic gross hematuria, typically occurring during or directly after an upper respiratory tract infection or exercise EM: diffuse thinning of glomerular basement membrane	Renal function monitoring Supportive therapy (see “Treatment” below)
Alport syndrome	X-linked (usually affects males) Mutation in gene for type IV collagen Often leads to ESRD	Persistent microhematuria with intermittent gross hematuria Associated with sensorineural hearing loss and abnormalities of the eye EM: splitting and alternating thickening and thinning of the glomerular basement membrane	Supportive therapy (see “Treatment” below) Renal transplant can lead to development of Goodpasture syndrome
Lupus nephritis	Complication of systemic lupus erythematosus Can be nephritic or nephrotic Can lead to RPGN in some cases	ANA, anti-dsDNA antibodies Histologic changes are very variable	Supportive therapy (see “Treatment” below) Immunosuppressive therapy
Rapidly progressive glomerulonephritis (RPGN)	Glomerular diseases that progress to ESRD within weeks to months	Can be caused by a variety of diseases: Goodpasture syndrome (anti-GBM disease) Poststreptococcal glomerulonephritis Systemic lupus erythematosus (SLE) Microscopic polyangiitis Granulomatosis with polyangiitis (Wegener’s) LM, IM, EM: crescent formation, monocytes, macrophages	Immunosuppressive therapy Plasmapheresis

PATHOPHYSIOLOGY-

• Inflammation → cytokine release → glomerular capillary damage
  • Porous glomerular basement membrane → leakage of proteins and RBCs → nephritic sediment (all blood components are detectable on urinalysis)
    • Proteinuria (< 3.5 g/24h): leakage of proteins
    • Hematuria: leakage of RBCs, which stick together and form red blood cell casts in the renal tubules
  • Oliguria: inflammatory infiltrates reduce fluid movement across the membrane (↓ GFR)
  • Azotemia: inflammation prevents sufficient filtering and excretion of urea
  • Salt retention → intravascular volume expansion → hypertension and edema

SYMPTOM-

Typical symptoms include passing less urine than normal, having blood in the urine and swelling of the feet or face (edema). Other possible symptoms are flank pain, back pain, headache, shortness of breath and symptoms related to the underlying cause, for example a skin rash and joint pain.

The symptoms of nephritic syndrome differ, depending on whether the acute or chronic form of the syndrome is present.

Symptoms of acute nephritic syndrome include:

• Edema in the face and legs: Edema is the accumulation of fluids in the body, usually under the skin, leading to a puffy appearance.
• Low urine volume: Known as oliguria, this is defined as less than 500ml of urine being produced in a 24-hour period.
• Hematuria: Blood in the urine which often, but not necessarily, leads to red discoloration. There are two types of hematuria: microhematuria, which indicates unseen blood, and macrohematuria, in which the blood is visible to the eye.
• High blood pressure: Hypertension, which results from the disruption of kidney function, may also occur. High blood pressure is generally defined as a resting blood pressure of 140/90 mmHg or higher in adults,

. In children, what constitutes hypertension depends on the age and size of the child. Fever, weakness and fatigue

• Appetite loss, vomiting and abdominal pain
• Malaise (a feeling of general unwellness) and nausea may also be present.

Chronic nephritic syndrome usually presents with fairly mild or even undetectable symptoms, which can include:

• Edema
• Hypertension/high blood pressure
• Kidney failure in later stages

Symptoms of kidney failure can include:

• Edema
• Hypertension/high blood pressure
• Kidney failure in later stages

Symptoms of kidney failure can include:

• Itchy skin and/or rash
• Decreased appetite
• Nausea
• Vomiting
• Fatigue
• Difficulty breathing

In both chronic and acute nephritic syndrome, the urine will usually contain high concentrations of red blood cells, as the blood cells leak out of the damaged glomeruli.

DIAGNOSIS-

The diagnosis of nephritic syndrome is typically based on a physical examination of the person and analysis of their urine (urinalysis). People with nephritic syndrome tend to have high blood pressure, so a doctor will check this. A doctor will also look for signs of:

• Abnormalities, such as dark color or cloudiness in the urine
• Protein in the urine (proteinuria), which may indicate nephrotic syndrome
• Uremia, an excess of urea or creatinine in the blood, or azotemia, an excess of nitrogen-rich waste compounds in the blood
• Increased fluid volume in the body, which may lead to edema
• Reduced filtration in the kidneys, specifically the glomeruli

A kidney biopsy (tissue sample from the kidney) may be performed to investigate the cause of the nephritic syndrome.

Urinalysis, blood tests and diagnostic procedures

Because nephritic syndrome is a cluster of symptoms rather than a disease in itself, much of the testing that makes up the diagnosis is aimed at determining what the underlying cause is. Another important element in diagnosis is differential diagnosis, as the illness may be nephrosis rather than nephritis.

In examining a person with potential nephritic syndrome, a doctor might carry out the following tests:

Take patient history: A doctor will ask the affected person about the time at which their symptoms began and attempt to determine the point at which the kidneys began to excrete protein into the urine.

Check appearance and colour of urine: Urine that is dark in colour may be very concentrated and contain blood.

Blood pressure: Hypertension can be a sign of disrupted kidney function.

Edema assessment: Edema, or fluid gathering in the tissues, can be a sign that there is not enough protein in the blood and may suggest proteinuria.

Urine dipstick test: A simple form of urinalysis that is used as a quick test for blood and protein in the urine. They will use a dipstick test, in which a test-strip of paper is immersed in a urine sample, to check for blood and protein in the urine

Urinalysis: A urine sample will be sent to a laboratory to do a precise check for protein levels and red blood cells.

Blood tests: To check levels of electrolytes, creatinine, blood urea nitrogen, immunoglobulins, antibodies, and other substances.

Kidney biopsy: This relatively straightforward procedure may be performed as an outpatient procedure or after hospital admission, depending on the patient’s particular circumstances. It uses only local anesthetic and is done using ultrasound and specialized biopsy needles to remove a small sample of tissue. Kidney biopsies are a very reliable way of distinguishing chronic glomerulonephritis from other, similar, disorders.

TREATMENT–

Treatment depends on the underlying causes. Medications (such as ramipril, benazepril, candesartan, or valsartan) are typically used to treat the high blood pressure. Medications will also be administered to reduce inflammation in the kidneys.

Generally, doctors will recommend:

• Bed rest
• A diet that is restricted in salt, potassium and fluid
• Medication to control blood pressure, if necessary
• Medication to reduce inflammation
• Medication to remove fluids from the body
• Dialysis to replace kidney function in severe cases

The time it takes to recover from nephritic syndrome varies according to its severity and the underlying cause. Most patients begin to feel better fairly soon, especially if treatment is prompt.

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INTRODUCTION-

Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine.

Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. The condition causes swelling, particularly in your feet and ankles, and increases the risk of other health problems.

Treatment for nephrotic syndrome includes treating the condition that’s causing it and taking medications. Nephrotic syndrome can increase your risk of infections and blood clots. Your doctor might recommend medications and dietary changes to prevent complications.

Nephrotic syndrome isn’t a disease. It’s a group of symptoms that can appear if your kidneys aren’t working right.

Small blood vessels in your kidneys function as a filter, clearing out waste and extra water from your blood. That waste and water ends up in your bladder and leaves your body as urine. These vessels are part of what’s called “glomeruli,” the filtering part of your kidney.

When they’re damaged, too much protein slips through the filters into your urine. The result is nephrotic syndrome.

Nephrotic syndrome can affect both adults and children. It is treatable.

Practice Essentials

Nephrotic syndrome is the combination of nephrotic-range proteinuria with a low serum albumin level and edema. Nephrotic-range proteinuria is the loss of 3 grams or more per day of protein into the urine or, on a single spot urine collection, the presence of 2 g of protein per gram of urine creatinine.

Nephrotic syndrome has many causes, including primary kidney diseases such as minimal-change disease, focal segmental glomerulosclerosis, and membranous glomerulonephritis. Nephrotic syndrome can also result from systemic diseases that affect other organs in addition to the kidneys, such as diabetes, amyloidosis, and lupus erythematosus.

CSUSES-

You might have a condition that affects only your kidneys. Doctors call that a “primary” cause of nephrotic syndrome.

Or you might have an issue with another part of your body that also affects your kidneys. That’s called a “secondary” cause of nephrotic syndrome.

Some of the conditions that can damage your glomeruli include:

Minimal change disease, which is the main cause of nephrotic syndrome in children. Kidney tissue from people with this disease looks relatively normal under a microscope. Doctors don’t know why this disease stops the kidneys from working properly. Some potential causes of the disease include infections from viruses, allergic reactions, taking certain medications, and using non-steroidal anti-inflammatory drugs (NSAIDs)

Focal segmental glomerulosclerosis, or FSGS, is a disease that scars the glomeruli. It’s the most common primary cause of nephrotic syndrome in adults. FSGS can be caused by a virus, such as HIV, or medications.

Membranous nephropathy, in which the membranes of the glomeruli thicken. Causes may include cancer, malaria, hepatitis B, and lupus.

Diabetes, which is the most common secondary cause of nephrotic syndrome in adults. It can cause kidney damage, known as diabetic nephropathy.

Lupus (systemic lupus erythematosus), a chronic disease of the immune system, can seriously damage the kidneys.

Amyloidosis, which happens when you have a buildup of substances called amyloid proteins in your blood. This can damage your kidney.

RISK FACTOR-

Factors that can increase your risk of nephrotic syndrome include:

• Medical conditions that can damage your kidneys. Certain diseases and conditions increase your risk of developing nephrotic syndrome, such as diabetes, lupus, amyloidosis, reflux nephropathy and other kidney diseases.
• Certain medications. Medications that might cause nephrotic syndrome include nonsteroidal anti-inflammatory drugs and drugs used to fight infections.
• Certain infections. Infections that increase the risk of nephrotic syndrome include HIV, hepatitis B, hepatitis C and malaria.

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SYMPTOM-

Signs and symptoms of nephrotic syndrome include:

• Severe swelling (edema), particularly around your eyes and in your ankles and feet
• Foamy urine, a result of excess protein in your urine
• Weight gain due to fluid retention
• Fatigue
• Loss of appetite

COMPLICATION-

possible complications of nephrotic syndrome include:

• Blood clots. The inability of the glomeruli to filter blood properly can lead to loss of blood proteins that help prevent clotting. This increases your risk of developing a blood clot in your veins.
• High blood cholesterol and elevated blood triglycerides. When the level of the protein albumin in your blood falls, your liver makes more albumin. At the same time, your liver releases more cholesterol and triglycerides.
• Poor nutrition. Loss of too much blood protein can result in malnutrition. This can lead to weight loss, which can be masked by edema. You may also have too few red blood cells (anemia), low blood protein levels and low levels of vitamin D.
• High blood pressure. Damage to your glomeruli and the resulting buildup of excess body fluid can raise your blood pressure.
• Acute kidney injury. If your kidneys lose their ability to filter blood due to damage to the glomeruli, waste products can build up quickly in your blood. If this happens, you might need emergency dialysis — an artificial means of removing extra fluids and waste from your blood — typically with an artificial kidney machine (dialyzer).
• Chronic kidney disease. Nephrotic syndrome can cause your kidneys to lose their function over time. If kidney function falls low enough, you might need dialysis or a kidney transplant.
• Infections. People with nephrotic syndrome have an increased risk of infections.

DIAGNOSIS-

Tests and procedures used to diagnose nephrotic syndrome include:

• Urine tests. A urinalysis can reveal abnormalities in your urine, such as large amounts of protein. You might be asked to collect urine samples over 24 hours.
• Blood tests. A blood test can show low levels of the protein albumin and often decreased levels of blood protein overall. Loss of albumin is often associated with an increase in blood cholesterol and blood triglycerides. The creatinine and urea nitrogen levels in your blood also might be measured to assess your overall kidney function.
• Kidney biopsy. Your doctor might recommend removing a small sample of kidney tissue for testing. During a kidney biopsy, a needle is inserted through your skin and into your kidney. Kidney tissue is collected and sent to a lab for testing.

TREATMENT-

Treatment for nephrotic syndrome involves treating any medical condition that might be causing your nephrotic syndrome. Your doctor might also recommend medications and changes in your diet to help control your signs and symptoms or treat complications of nephrotic syndrome.

Medications might include:

• Blood pressure medications. Drugs called angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and the amount of protein released in urine. Medications in this category include lisinopril (Prinvil, Qbrelis, Zestril), benazepril (Lotensin), captopril and enalapril (Vasotec). Another group of drugs that works similarly is called angiotensin II receptor blockers (ARBs) and includes losartan (Cozaar) and valsartan (Diovan). Other medications, such as renin inhibitors, also might be used, though ACE inhibitors and ARBs are generally used first.
• Water pills (diuretics). These help control swelling by increasing your kidneys’ fluid output. Diuretic medications typically include furosemide (Lasix). Others include spironolactone (Aldactone, Carospir) and thiazides, such as hydrochlorothiazide or metolazone (Zaroxolyn).
• Cholesterol-reducing medications. Statins can help lower cholesterol levels. However, it’s not clear whether cholesterol-lowering medications can improve the outcomes for people with nephrotic syndrome, such as avoiding heart attacks or decreasing the risk of early death. Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor) and simvastatin (Zocor).
• Blood thinners (anticoagulants). These might be prescribed to decrease your blood’s ability to clot, especially if you’ve had a blood clot. Anticoagulants include heparin, warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), apixaban (Eliquis) and rivaroxaban (Xarelto).
• Immune system-suppressing medications. Medications to control the immune system, such as corticosteroids, can decrease the inflammation that accompanies some of the conditions that can cause nephrotic syndrome. Medications include rituximab (Rituxan), cyclosporine and cyclophosphamide.

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INTRODUCTION-

A urinary tract infection, or UTI, is an infection in any part of your urinary system, which includes your kidneys, bladder, ureters, and urethra.

If you’re a woman, your chance of getting a urinary tract infection is high. Some experts rank your lifetime risk of getting one as high as 1 in 2, with many women having repeat infections, sometimes for years. About 1 in 10 men will get a UTI in their lifetime.

Here’s how to handle UTIs and how to make it less likely you’ll get one in the first place.

Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys.

Doctors typically treat urinary tract infections with antibiotics. But you can take steps to reduce your chances of getting a UTI in the first place.

A urinary tract infection (UTI) is an infection from microbes. These are organisms that are too small to be seen without a microscope. Most UTIs are caused by bacteria, but some are caused by fungi and in rare cases by viruses. UTIs are among the most common infections in humans.

A UTI can happen anywhere in your urinary tract. Your urinary tract is made up of your kidneys, ureters, bladder, and urethra. Most UTIs only involve the urethra and bladder, in the lower tract. However, UTIs can involve the ureters and kidneys, in the upper tract. Although upper tract UTIs are more rare than lower tract UTIs, they’re also usually more severe.

Types of UTIs

An infection can happen in different parts of your urinary tract. Each type has a different name, based on where it is.

• Cystitis (bladder): You might feel like you need to pee a lot, or it might hurt when you pee. You might also have lower belly pain and cloudy or bloody urine.
• Pyelonephritis (kidneys): This can cause fever, chills, nausea, vomiting, and pain in your upper back or side.
• Urethritis (urethra): This can cause a discharge and burning when you pee.

Part of urinary tract affected	Signs and symptoms
Kidneys (acute pyelonephritis)	Upper back and side (flank) pain High fever Shaking and chills Nausea Vomiting
Bladder (cystitis)	Pelvic pressure Lower abdomen discomfort Frequent, painful urination Blood in urine
Urethra (urethritis)	Burning with urination Discharge

CAUSES-

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.

The most common UTIs occur mainly in women and affect the bladder and urethra.

• Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible. Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.
• Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

SYMPTOM-

Symptoms of a UTI depend on what part of the urinary tract is infected.

Lower tract UTIs affect the urethra and bladder. Symptoms of a lower tract UTI include:

• burning with urination
• increased frequency of urination without passing much urine
• increased urgency of urination
• bloody urine
• cloudy urine
• urine that looks like cola or tea
• urine that has a strong odor
• pelvic pain in women
• rectal pain in men

Upper tract UTIs affect the kidneys. These can be potentially life threatening if bacteria move from the infected kidney into the blood. This condition, called urosepsis, can cause dangerously low blood pressure, shock, and death.

Symptoms of an upper tract UTI include:

• pain and tenderness in the upper back and sides
• chills
• fever
• nausea
• vomiting

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UTI symptoms in men

Symptoms of an upper tract urinary infection in men are similar to those in women. Symptoms of a lower tract urinary infection in men sometimes includes rectal pain in addition to the common symptoms shared by both men and women.

UTI symptoms in women

Women with a lower tract urinary infection may experience pelvic pain. This is in addition to the other common symptoms. Symptoms of upper tract infections among both men and women are similar.

Risk factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

• Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
• Sexual activity. Sexually active women tend to have more UTIs than do women who aren’t sexually active. Having a new sexual partner also increases your risk.
• Certain types of birth control. Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
• Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

• Urinary tract abnormalities. Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
• Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
• A suppressed immune system. Diabetes and other diseases that impair the immune system — the body’s defense against germs — can increase the risk of UTIs.
• Catheter use. People who can’t urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
• A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

• Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
• Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
• Increased risk in pregnant women of delivering low birth weight or premature infants.
• Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
• Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

PREVENTION

You can take these steps to reduce your risk of urinary tract infections:

• Drink plenty of liquids, especially water. Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
• Drink cranberry juice. Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
• Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
• Empty your bladder soon after intercourse. Also, drink a full glass of water to help flush bacteria.
• Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
• Change your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

TREATMENT-

Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

Simple infection

Drugs commonly recommended for simple UTIs include:

• Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
• Fosfomycin (Monurol)
• Nitrofurantoin (Macrodantin, Macrobid)
• Cephalexin (Keflex)
• Ceftriaxone

The group of antibiotic medicines known as fluoroquinolones — such as ciprofloxacin (Cipro), levofloxacin (Levaquin) and others — isn’t commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, your doctor might prescribe a fluoroquinolone medicine if no other treatment options exist.

Often, symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. Take the entire course of antibiotics as prescribed.

For an uncomplicated UTI that occurs when you’re otherwise healthy, your doctor may recommend a shorter course of treatment, such as taking an antibiotic for one to three days. But whether this short course of treatment is enough to treat your infection depends on your particular symptoms and medical history.

Your doctor may also prescribe a pain medication (analgesic) that numbs your bladder and urethra to relieve burning while urinating, but pain usually is relieved soon after starting an antibiotic.

Frequent infections

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

• Low-dose antibiotics, initially for six months but sometimes longer
• Self-diagnosis and treatment, if you stay in touch with your doctor
• A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity
• Vaginal estrogen therapy if you’re postmenopausal

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INTRODUCTION-

Encephalitis is an inflammation of the brain tissue. The most common cause is viral infections. In rare cases it can be caused by bacteria or even fungi.

There are two main types of encephalitis: primary and secondary. Primary encephalitis occurs when a virus directly infects the brain and spinal cord. Secondary encephalitis occurs when an infection starts elsewhere in the body and then travels to your brain.

Encephalitis is a rare yet serious disease that can be life-threatening. You should call your doctor immediately if you have symptoms of encephalitis.

Encephalitis often causes only mild flu-like signs and symptoms — such as a fever or headache — or no symptoms at all. Sometimes the flu-like symptoms are more severe. Encephalitis can also cause confused thinking, seizures, or problems with movement or with senses such as sight or hearing.

In some cases, encephalitis can be life-threatening. Timely diagnosis and treatment are important because it’s difficult to predict how encephalitis will affect each individual.

Types-

Different types of encephalitis have different causes.

• Japanese encephalitis is spread by mosquitoes
• Tick-borne encephalitis is spread by ticks
• Rabies can be spread through a bite from a mammal

There is also primary or secondary encephalitis.

Primary or infectious encephalitis can result if a fungus, virus, or bacterium directly infects the brain.

Secondary, or post-infectious, encephalitis is when the immune system responds to a previous infection and mistakenly attacks the brain.

SYMPTOM-

The patient typically has a fever, headache, and photophobia (excessive sensitivity to light). There may also be general weakness and seizures.

Less common symptoms

The individual may also experience nuchal rigidity (neck stiffness), which can lead to a misdiagnosis of meningitis. There may be stiffness of the limbs, slow movements, and clumsiness. The patient may also be drowsy and have a cough.

More serious cases

In more serious cases, the person may experience very severe headaches, nausea, vomiting, confusion, disorientation, memory loss, speech problems, hearing problems, hallucinations, as well as seizures and possibly coma. In some cases, the patient can become aggressive.

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Signs and symptoms in infants

Initially, encephalitis is harder to detect in young children and babies. Parents or guardians should look out for vomiting, a bulging fontanel (the soft area on the top center of the head), incessant crying that does not get better when the baby is picked up and comforted, and body stiffness.

The symptoms of encephalitis can range from mild to severe.

Mild symptoms include:

• fever
• headache
• vomiting
• stiff neck
• lethargy (exhaustion)

Severe symptoms include:

• fever of 103°F (39.4°C) or higher
• confusion
• drowsiness
• hallucinations
• slower movements
• coma
• seizures
• irritability
• sensitivity to light
• unconsciousness

Infants and young children show different symptoms. Call a doctor immediately if your child is experiencing any of the following:

• vomiting
• bulging fontanel (soft spot in the scalp)
• constant crying
• body stiffness
• poor appetite

CAUSES-

Encephalitis can develop as a result of a direct infection to the brain by a virus, bacterium, or fungus, or when the immune system responds to a previous infection; the immune system mistakenly attacks brain tissue.

Primary (infectious) encephalitis can be split into three main categories of viruses:

1. Common viruses, including HSV (herpes simplex virus) and EBV (Epstein-Barr virus)
2. Childhood viruses, including measles and mumps
3. Arboviruses (spread by mosquitoes, ticks, and other insects), including Japanese encephalitis, West Nile encephalitis, and tick-borne encephalitis

Secondary encephalitis: could be caused by a complication of a viral infection. Symptoms start to appear days or even weeks after the initial infection. The patient’s immune system treats healthy brain cells as foreign organisms and attacks them. We still do not know why the immune system malfunctions in this way.

In more than 50 percent of encephalitis cases, the exact cause of the illness is not tracked down.

Encephalitis is more likely to affect children, older adults, individuals with weakened immune systems, and people who live in areas where mosquitoes and ticks that spread specific viruses are common.

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Common viral causes

The viruses that can cause encephalitis include:

• Herpes simplex virus (HSV). Both HSV type 1 — associated with cold sores and fever blisters around your mouth — and HSV type 2 — associated with genital herpes — can cause encephalitis. Encephalitis caused by HSV type 1 is rare but can result in significant brain damage or death.
• Other herpes viruses. These include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.
• Enteroviruses. These viruses include the poliovirus and the coxsackievirus, which usually cause an illness with flu-like symptoms, eye inflammation and abdominal pain.
• Mosquito-borne viruses. These viruses can cause infections such as West Nile, La Crosse, St. Louis, western equine and eastern equine encephalitis. Symptoms of an infection might appear within a few days to a couple of weeks after exposure to a mosquito-borne virus.
• Tick-borne viruses. The Powassan virus is carried by ticks and causes encephalitis in the Midwestern United States. Symptoms usually appear about a week after a bite from an infected tick.
• Rabies virus. Infection with the rabies virus, which is usually transmitted by a bite from an infected animal, causes a rapid progression to encephalitis once symptoms begin. Rabies is a rare cause of encephalitis in the United States.
• Childhood infections. Common childhood infections — such as measles (rubeola), mumps and German measles (rubella) — used to be fairly common causes of secondary encephalitis. These causes are now rare in the United States due to the availability of vaccinations for these diseases.

Risk factors

Anyone can develop encephalitis. Factors that may increase the risk include:

• Age. Some types of encephalitis are more common or more severe in certain age groups. In general, young children and older adults are at greater risk of most types of viral encephalitis.
• Weakened immune system. People who have HIV/AIDS, take immune-suppressing drugs or have another condition causing a weakened immune system are at increased risk of encephalitis.
• Geographical regions. Mosquito- or tick-borne viruses are common in particular geographical regions.
• Season of the year. Mosquito- and tick-borne diseases tend to be more common in summer in many areas of the United States.

DIAGNOSIS

Your doctor will first ask you about your symptoms. They may perform the following tests if encephalitis is suspected.

Spinal tap or lumbar puncture

In this procedure, your doctor will insert a needle into your lower back to collect a sample of spinal fluid. They will test the sample for signs of infection.

Brain imaging with CT scan or MRI

CT scans and MRI detect changes in brain structure. They can rule out other possible explanations for symptoms, such as a tumor or stroke. Certain viruses have a tendency to affect certain areas of the brain. Seeing what parts of your brain are affected can help determine what type of virus you have.

Electroencephalograph (EEG)

An EEG uses electrodes (small metal discs with wires) attached to the scalp to record brain activity. An EEG does not detect the virus that causes encephalitis, but certain patterns on the EEG may alert your neurologist to an infectious source of your symptoms. Encephalitis can lead to seizures and coma in later stages. That’s why the EEG is important in determining the areas of the brain that are affected and the types of brain waves that occur in each area.

Blood tests

A blood test can reveal signs of a viral infection. Blood tests are rarely performed alone. They usually help diagnose encephalitis along with other tests.

Brain biopsy

In a brain biopsy, your doctor will remove small samples of brain tissue to test for infection. This procedure is rarely performed because there’s a high risk of complications. It’s usually only done if doctors can’t determine the cause the brain swelling or if treatment isn’t working.

When to see a doctor

Get immediate care if you are experiencing any of the more-severe symptoms associated with encephalitis. A severe headache, fever and altered consciousness require urgent care.

Infants and young children with any signs or symptoms of encephalitis should receive urgent care.

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Complications

The complications of encephalitis vary, depending on factors such as:

• Your age
• The cause of your infection
• The severity of your initial illness
• The time from disease onset to treatment

People with relatively mild illness usually recover within a few weeks with no long-term complications.

Complications of severe illness

Inflammation can injure the brain, possibly resulting in a coma or death.

Other complications — varying greatly in severity — may persist for months or be permanent. These complications can include:

• Persistent fatigue
• Weakness or lack of muscle coordination
• Personality changes
• Memory problems
• Paralysis
• hearing defect
• vision defect

TREATMENT-

Treatment for encephalitis focuses on alleviating symptoms. There are only a limited number of reliably tested specific antiviral agents that can help, one of which is acyclovir; success is limited for most infections except when the condition is due to herpes simplex.

Corticosteroids may be administered to reduce the brain’s inflammation, especially in cases of post-infectious (secondary) encephalitis. If the patient has severe symptoms, they may need mechanical ventilation to help them breathe and other supportive treatment.

Anticonvulsants are sometimes given to patients who have seizures. Sedatives can be effective for seizures, restlessness, and irritability. For patients with mild symptoms, the best treatment is rest, plenty of fluids, and Tylenol (paracetamol) for fever and headaches. Tylenol is available to purchase online.

Prevention

Keeping up-to-date with vaccines is the most effective way of reducing the risk of developing encephalitis. These include vaccines for measles, mumps, rubella, and if the virus exists in those areas, Japanese encephalitis and tick-borne encephalitis.

In areas known to have mosquitoes that carry encephalitis-causing viruses, individuals should take measures to reduce the risk of being bitten. This may include wearing appropriate clothing, avoiding mosquito-infested areas, avoiding going outside at specific times during the day when there are large numbers of mosquitoes about, keeping the home mosquito-free, using mosquito repellent, and making sure there is no stagnant water around the home.

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INTRODUCTION-

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord.

The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck.

Most cases of meningitis in the United States are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Some cases of meningitis improve without treatment in a few weeks. Others can be life-threatening and require emergency antibiotic treatment.

Seek immediate medical care if you suspect that someone has meningitis. Early treatment of bacterial meningitis can prevent serious complications.

CAUSES-

Meningitis is almost always caused by a bacterial or viral infection that begins somewhere else in your body, like your ears, sinuses, or throat.

Less common causes of meningitis include:

• Autoimmune disorders
• Cancer medications
• Syphilis
• Tuberculosis

Bacterial Meningitis

It’s an extremely serious illness. You or your child will need to get medical help right away. It can be life-threatening or lead to brain damage unless you get quick treatment.

Several kinds of bacteria can cause bacterial meningitis. The most common ones in the U.S. are:

• Streptococcus pneumoniae (pneumococcus)
• Neisseria meningitidis (meningococcus)

• Listeria monocytogenes (in older people, pregnant women, or those with immune system problems)

A bacteria called Haemophilus influenzae type b (Hib) was a common cause of meningitis in babies and young children until the Hib vaccine became available for infants. There are also vaccines for Neisseria meningitidis and Streptococcus pneumoniae. Experts recommend that all children get them, as well as all adults who are at a higher risk for the disease.

In many cases, bacterial meningitis starts when bacteria get into your bloodstream from your sinuses, ears, or throat. The bacteria travel through your bloodstream to your brain.

The bacteria that cause meningitis can spread when people who are infected cough or sneeze. If you or your child has been around someone who has bacterial meningitis, ask your doctor what steps you should take to avoid catching it.

Viral Meningitis

Viral meningitis is more common than the bacterial form and generally — but not always — less serious. A number of viruses can trigger the disease, including several that can cause diarrhea.

Fungal Meningitis

Fungal meningitis is much less common than the bacterial or viral forms. Healthy people rarely get it. Someone with a problem with their immune system — because they have AIDS, for example — is more likely to become infected with this form of meningitis.

Meningitis Diagnosis

Your doctor will ask about your medical history and do a physical exam, including checking your neck for stiffness and looking for a skin rash that might suggest a bacterial infection. They will also need to do tests that can include:

• Blood tests to find bacteria
• CT or MRI scans of your head to find swelling or inflammation
• Spinal tap, in which a health care worker uses a needle to take fluid from around your spinal cord. It can tell what’s causing your meningitis.

SYMPTOM-

The symptoms of viral and bacterial meningitis can be similar in the beginning. However, bacterial meningitis symptoms are usually more severe. The symptoms also vary depending on your age.

Viral meningitis symptoms

Viral meningitis in infants may cause:

• decreased appetite
• irritability
• sleepiness
• lethargy
• fever

In adults, viral meningitis may cause:

• headaches
• fever
• stiff neck
• seizures
• sensitivity to bright light
• sleepiness
• lethargy
• nausea and vomiting
• decreased appetite

Bacterial meningitis symptoms

Bacterial meningitis symptoms develop suddenly. They may include:

• altered mental status
• nausea
• vomiting
• sensitivity to light
• irritability
• headache
• fever
• chills
• stiff neck
• purple areas of skin that resemble bruises
• sleepiness
• lethargy

Seek immediate medical attention if you experience these symptoms. Bacterial and viral meningitis can be deadly. There’s no way to know if you have bacterial or viral meningitis just by judging how you feel. Your doctor will need to perform tests to determine which type you have.

Fungal meningitis symptoms

Symptoms of fungal meningitis resemble the other types of this infection. These may include:

• nausea
• vomiting
• sensitivity to light
• fever
• headache
• confusion or disorientation

Each type of meningitis has some distinguishing symptoms.

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Risk factors

Risk factors for meningitis include:

• Skipping vaccinations. Risk rises for anyone who hasn’t completed the recommended childhood or adult vaccination schedule.
• Age. Most cases of viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20.
• Living in a community setting. College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at greater risk of meningococcal meningitis. This is probably because the bacterium is spread by the respiratory route, and spreads quickly through large groups.
• Pregnancy. Pregnancy increases the risk of listeriosis — an infection caused by listeria bacteria, which may also cause meningitis. Listeriosis increases the risk of miscarriage, stillbirth and premature delivery.
• Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant drugs and other factors that affect your immune system also make you more susceptible to meningitis. Having your spleen removed also increases your risk, and anyone without a spleen should get vaccinated to minimize that risk.

Complications

Meningitis complications can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including:

• Hearing loss
• Memory difficulty
• Learning disabilities
• Brain damage
• Gait problems
• Seizures
• Kidney failure
• Shock
• Death

With prompt treatment, even patients with severe meningitis can have good recovery.

Prevention

Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette.

These steps can help prevent meningitis:

• Wash your hands. Careful hand-washing helps prevent the spread of germs. Teach children to wash their hands often, especially before eating and after using the toilet, spending time in a crowded public place or petting animals. Show them how to vigorously and thoroughly wash and rinse their hands.
• Practice good hygiene. Don’t share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else. Teach children and teens to avoid sharing these items too.
• Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.
• Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose.
• If you’re pregnant, take care with food. Reduce your risk of listeriosis by cooking meat, including hot dogs and deli meat, to 165 F (74 C). Avoid cheeses made from unpasteurized milk. Choose cheeses that are clearly labeled as being made with pasteurized milk.

Characteristics/Clinical Presentation

Headache, fever, vomiting, and rigidity of the neck are the most common symptoms that present with the onset of meningitis. Early symptoms include nausea, drowsiness and confusion. Pain in the posterior thigh or lumbar region may also be noted. Later symptoms can include seizures, photophobia and rapid breathing rate. In addition, a rash on the skin, scanty petechial (red or purple non-blanching macules smaller than 2mm in diameter) ,or a purpuric (larger than 2mm) appears on approximately 80-90% of individuals with bacterial meningitis.

Meningitis causes inflammation of the meningeal membranes; as a result nerve roots may endure tension as they pass through these inflamed membranes. Passive ROM of the neck into flexion will gradually become painful and limited. Also, neck extension and rotation may be painful as well, however not to the extent of flexion. In severe cases, Brudzinki’s sign, or Kernig’s may be presented.

Brudzinki’s sign is caused by passive neck flexion producing flexion of the hips or knees. Kernig’s sign presents, as restrictive passive extension of the knee while the hip is flexed. In cases when meningitis is not treated immediately (especially bacterial meningitis), the parenchyma within the brain may be involved. As a result i,ndividuals may present with lethargy, vomiting, seizures, papilledema, confusion, coma, focal deficits, and cranial nerve palsies.

Immunizations

Some forms of bacterial meningitis are preventable with the following vaccinations:

• Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don’t have a spleen.
• Pneumococcal conjugate vaccine (PCV13). This vaccine also is part of the regular immunization schedule for children younger than 2 years in the United States. Additional doses are recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.
• Pneumococcal polysaccharide vaccine (PPSV23). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV23 vaccine for all adults older than 65; for younger adults and children age 2 and older who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia; and for anyone who doesn’t have a spleen.
• Meningococcal conjugate vaccine. The Centers for Disease Control and Prevention recommends that a single dose be given to children ages 11 to 12, with a booster shot given at age 16. If the vaccine is first given between ages 13 and 15, the booster is recommended between ages 16 and 18. If the first shot is given at age 16 or older, no booster is necessary. This vaccine can also be given to children between the ages of 2 months and 10 years who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It’s also used to vaccinate healthy but previously unvaccinated people who have been exposed in outbreaks.

physical therapy management-

According to the American Physical Therapy Association’s Guide to Physical Therapist Practice infectious disorders of the central nervous system fall under the following preferred practice patterns; 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System- Acquired in Adulthood or Adolescence and 5I: Impaired Arousal, Range of Motion, and Motor Control Associated with Coma, Near Coma, or Vegetative State.

Typically physical therapy treatment is initiated in the intensive care unit. While initiating a plan of care, it is crucial to keep in mind a patient’s chart information or contraindications to therapy such as intracranial pressure, cerebral perfusion pressure, and other lab values that determine rehabilitation guidelines. Meningitis may present with similar symptoms to brain injuries, neurological complications, immunological deficiency, vascular compromise, and additional secondary impairments.

Additionally understanding the various stages of consciousness or behavioural changes a patient with secondary complications may go through can guide the approach to treatment. The therapist should create an environment that would ease the patient’s hypersensitivity to sensory input such as light or sound thus creating a structured environment to eliminate behaviural outbursts. Close monitoring of the vital signs will allow the therapist to gauge the patient’s receptiveness to therapy. The therapist should be familiar with the Glasgow Coma Scale and monitor the patient’s progression through the levels of consciousness.

Proper positioning and range of motion exercise should be initiated as soon as safely possible in the acute phase. Proper positioning with pillows and towels will protect the skin integrity and prevention of contractures. Maintaining mobility of the trunk and neck are important to sustain functional mobility. The earlier therapy is initiated with a patient, the chances of secondary impairments are decreased allowing for a better prognosis.

A primary key component to treating a patient recovering from bacterial meningitis is proper education not only to the patient, but to the family and caregivers as well. Providing the patient and family with education on the disease, stages of the disease, secondary complications, warning sign,s and resources can encourage the patient and family to become more involved in the treatment. It is very important to educate on the effectsofm different systemic involvement and how the timeline of recovery may vary.

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