bowang0911/MedQuAD huggingface dataset:
The causes of primary biliary cirrhosis are unknown. Most research suggests it is an autoimmune disease. The immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. An autoimmune disease is a disorder in which the bodys immune system attacks the bodys own cells and organs. In primary biliary cirrhosis, the immune system attacks the small bile ducts in the liver.
                
Genetics, or inherited genes, can make a person more likely to develop primary biliary cirrhosis. Primary biliary cirrhosis is more common in people who have a parent or siblingparticularly an identical twinwith the disease. In people who are genetically more likely to develop primary biliary cirrhosis, environmental factors may trigger or worsen the disease, including
                
- exposure to toxic chemicals  - smoking  - infections
                
Genetics can also make some people more likely to develop other autoimmune diseases, such as
                
- autoimmune hepatitis, a disease in which the bodys immune system attacks liver cells  - Sjgrens syndrome, a condition in which the immune system attacks the glands that produce tears and saliva  - autoimmune thyroid dysfunctions, conditions in which the immune system attacks the thyroid gland
The first and most common symptoms of primary biliary cirrhosis are
                
- fatigue, or feeling tired  - itching skin, and darkened skin in itching areas due to scratching  - dry eyes and mouth
                
Some people may have jaundice, a condition that causes the skin and whites of the eyes to turn yellow. Health care providers diagnose up to 60 percent of people with primary biliary cirrhosis before symptoms begin.2 Routine blood tests showing abnormal liver enzyme levels may lead a health care provider to suspect that a person without symptoms has primary biliary cirrhosis.
A healthy diet is important in all stages of cirrhosis because malnutrition is common in people with this disease. Malnutrition is a condition that occurs when the body does not get enough nutrients. Cirrhosis may lead to malnutrition because it can cause
                
- people to eat less because of symptoms such as loss of appetite  - changes in metabolism  - reduced absorption of vitamins and minerals
                
Health care providers can recommend a meal plan that is well balanced and provides enough calories and protein. If ascites develops, a health care provider or dietitian may recommend a sodium-restricted diet. To improve nutrition, the health care provider may prescribe a liquid supplement. A person may take the liquid by mouth or through a nasogastric tubea tiny tube inserted through the nose and throat that reaches into the stomach.
                
A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. Cirrhosis affects the immune system, making people with cirrhosis more likely than healthy people to develop an infection after eating shellfish that contain this bacterium.
                
A health care provider may recommend calcium and vitamin D supplements to help prevent osteoporosis.
- Primary biliary cirrhosis is a chronic disease that causes the small bile ducts in the liver to become inflamed and damaged and ultimately disappear.  - When chronic inflammation damages the bile ducts, bile and toxic wastes build up in the liver, damaging liver tissue. This damage to the liver tissue can lead to cirrhosis.  - The causes of primary biliary cirrhosis are unknown. Most research suggests it is an autoimmune disease.  - Primary biliary cirrhosis is more common in people who have a parent or siblingparticularly an identical twinwith the disease.  - The first and most common symptoms of primary biliary cirrhosis are fatigue, itching, and dry eyes and mouth. Some people may have jaundice, a condition that causes the skin and whites of the eyes to turn yellow. Health care providers diagnose up to 60 percent of people with primary biliary cirrhosis before symptoms begin.  - Most complications of primary biliary cirrhosis are related to cirrhosis and start after primary biliary cirrhosis progresses to cirrhosis.  - A health care provider may use the following tests to diagnose primary biliary cirrhosis:      - a medical and family history    - a physical exam    - blood tests    - imaging tests    - a liver biopsy    - Health care providers prescribe ursodiol (Actigall, Urso) to treat primary biliary cirrhosis. Early treatment with this medication reduces the likelihood of needing a liver transplant and improves survival.  - A health care provider may consider a liver transplant when cirrhosis leads to liver failure or treatment for complications is ineffective.
People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.
                
-  eGFR. eGFR stands for estimated glomerular filtration rate. Each kidney contains about 1 million tiny filters made up of blood vessels. These filters are called glomeruli. Kidney function can be checked by estimating how much blood the glomeruli filter in a minute. The calculation of eGFR is based on the amount of creatinine, a waste product, found in a blood sample. As the level of creatinine goes up, the eGFR goes down.  Kidney disease is present when eGFR is less than 60 milliliters per minute.  The American Diabetes Association (ADA) and the National Institutes of Health (NIH) recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes.  -  Urine albumin. Urine albumin is measured by comparing the amount of albumin to the amount of creatinine in a single urine sample. When the kidneys are healthy, the urine will contain large amounts of creatinine but almost no albumin. Even a small increase in the ratio of albumin to creatinine is a sign of kidney damage.  Kidney disease is present when urine contains more than 30 milligrams of albumin per gram of creatinine, with or without decreased eGFR.  The ADA and the NIH recommend annual assessment of urine albumin excretion to assess kidney damage in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more.
                
If kidney disease is detected, it should be addressed as part of a comprehensive approach to the treatment of diabetes.
- Diabetes is the leading cause of chronic kidney disease (CKD) and kidney failure in the United States.  - People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are estimated glomerular filtration rate (eGFR) and urine albumin.  - Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease.  - In people with diabetes, excessive consumption of protein may be harmful.  - Intensive management of blood glucose has shown great promise for people with diabetes, especially for those in the early stages of CKD.
Lactose intolerance means you have symptoms such as bloating, diarrhea, and gas after you have milk or milk products.
                
If your small intestine does not produce much lactase, you cannot break down much lactose. Lactose that does not break down goes to your colon. The colon is an organ that absorbs water from stool and changes it from a liquid to a solid form. In your colon, bacteria that normally live in the colon break down the lactose and create fluid and gas, causing you to have symptoms.
                
The causes of low lactase in your small intestine can include the following:
                
- In some people, the small intestine makes less lactase starting at about age 2, which may lead to symptoms of lactose intolerance. Other people start to have symptoms later, when they are teenagers or adults.  - Infection, disease, or other problems that harm the small intestine can cause low lactase levels. Low lactase levels can cause you to become lactose intolerant until your small intestine heals.  - Being born early may cause babies to be lactose intolerant for a short time after they are born.  - In a rare form of lactose intolerance, the small intestine produces little or no lactase enzyme from birth.
                
Not all people with low lactase levels have symptoms. If you have symptoms, you are lactose intolerant.
                
Most people who are lactose intolerant can have some milk or milk products and not have symptoms. The amount of lactose that causes symptoms is different from person to person.
                

                
People sometimes confuse lactose intolerance with a milk allergy. While lactose intolerance is a digestive problem, a milk allergy is a reaction by the bodys immune system to one or more milk proteins. If you have a milk allergy, having even a small amount of milk or milk product can be life threatening. A milk allergy most commonly occurs in the first year of life. Lactose intolerance occurs more often during the teen years or adulthood.
Talk with your doctor about your dietary plan. A dietary plan can help you manage the symptoms of lactose intolerance and get enough nutrients. If you have a child with lactose intolerance, follow the diet plan that your childs doctor recommends.
                
Milk and milk products. You may be able to have milk and milk products without symptoms if you
                
- drink small amounts of milkhalf a cup or lessat a time  - drink small amounts of milk with meals, such as having milk with cereal or having cheese with crackers  - add small amounts of milk and milk products to your diet a little at a time and see how you feel  - eat milk products that are easier for people with lactose intolerance to break down:      - yogurt    - hard cheeses such as cheddar and Swiss
                

                
Lactose-free and lactose-reduced milk and milk products. You can find lactose-free and lactose-reduced milk and milk products at the grocery store. These products are just as healthy for you as regular milk and milk products.
                
Lactase products. You can use lactase tablets and drops when you have milk and milk products. The lactase enzyme breaks down the lactose in food. Using lactase tablets or drops can help you prevent symptoms of lactose intolerance. Check with your doctor before using these products. Some people, such as young children and pregnant and breastfeeding women, may not be able to use these products.
                

                

                
Calcium and Vitamin D   If you are lactose intolerant, make sure you get enough calcium each day. Milk and milk products are the most common sources of calcium. Other foods that contain calcium include   - fish with soft bones, such as canned salmon or sardines   - broccoli and other leafy green vegetables   - oranges   - almonds, Brazil nuts, and dried beans   - tofu   - products with the label showing added calcium, such as cereals, fruit juices, and soy milk    Vitamin D helps the body absorb and use calcium. Be sure to eat foods that contain vitamin D, such as eggs, liver, and certain kinds of fish, such as salmon. Also, being outside in the sunlight helps your body make vitamin D. Some companies add vitamin D to milk and milk products. If you are able to drink small amounts of milk or eat yogurt, choose those that have vitamin D added.   Talk with your doctor about how to get enough nutrientsincluding calcium and vitamin Din your diet or your childs diet. Ask if you should also take a supplement to get enough calcium and vitamin D.   For safety reasons, talk with your doctor before using dietary supplements or any other nonmainstream medicine together with or in place of the treatment your doctor prescribes. Read more at www.ods.od.nih.gov and www.nccam.nih.gov.
- Lactose is a sugar found in milk and milk products.  - Lactose intolerance means you have symptoms such as bloating, diarrhea, and gas after you have milk or milk products.  - Your doctor will try to find out if you have lactose intolerance with a medical, family, and diet history; a physical exam; and medical tests.  - Most people with lactose intolerance can eat or drink some lactose without symptoms.  - If you have lactose intolerance, you can make changes to what you eat and drink. Some people may only need to have less lactose. Others may need to avoid lactose altogether.  - Talk with your doctor about how to get enough nutrientsincluding calcium and vitamin Din your diet or your childs diet. Ask if you should also take a supplement to get enough calcium and vitamin D. For safety reasons, talk with your doctor before using dietary supplements or any other nonmainstream medicine together with or in place of the treatment your doctor prescribes.  - Lactose is in many food products and in some medicines.
A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder into the vagina. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. During urination, also called voiding, the bladder empties through the urethra, located at the bottom of the bladder. The urethra is the tube that carries urine outside of the body. The vagina is the tube in a womans body that runs beside the urethra and connects the womb, or uterus, to the outside of the body.
A cystocele occurs when the muscles and supportive tissues between a womans bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening. In a cystocele, the bladder tissue remains covered by the vaginal skin. A cystocele may result from damage to the muscles and tissues that hold the pelvic organs up inside the pelvis. A womans pelvic organs include the vagina, cervix, uterus, bladder, urethra, and small intestine. Damage to or weakening of the pelvic muscles and supportive tissues may occur after vaginal childbirth and with conditions that repeatedly strain or increase pressure in the pelvic area, such as
                
- repetitive straining for bowel movements  - constipation  - chronic or violent coughing  - heavy lifting  - being overweight or obese
                
A womans chances of developing a cystocele increase with age, possibly because of weakening muscles and supportive tissues from aging. Whether menopause increases a womans chances of developing a cystocele is unclear.
The symptoms of a cystocele may include
                
- a vaginal bulge  - the feeling that something is falling out of the vagina  - the sensation of pelvic heaviness or fullness  - difficulty starting a urine stream  - a feeling of incomplete urination  - frequent or urgent urination
                
Women who have a cystocele may also leak some urine as a result of movements that put pressure on the bladder, called stress urinary incontinence. These movements can include coughing, sneezing, laughing, or physical activity, such as walking. Urinary retentionthe inability to empty the bladder completelymay occur with more severe cystoceles if the cystocele creates a kink in the womans urethra and blocks urine flow.
                
Women with mild cystoceles often do not have any symptoms.
Diagnosing a cystocele requires medical tests and a physical exam of the vagina. Medical tests take place in a health care providers office, an outpatient center, or a hospital. The health care provider will ask about symptoms and medical history. A health care provider uses a grading system to determine the severity of a womans cystocele. A cystocele receives one of three grades depending on how far a womans bladder has dropped into her vagina:
                
- grade 1mild, when the bladder drops only a short way into the vagina  - grade 2moderate, when the bladder drops far enough to reach the opening of the vagina  - grade 3most advanced, when the bladder bulges out through the opening of the vagina
                
If a woman has difficulty emptying her bladder, a health care provider may measure the amount of urine left in the womans bladder after she urinates. The remaining urine is called the postvoid residual. A health care provider can measure postvoid residual with a bladder ultrasound. A bladder ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off the bladder to create an image and show the amount of remaining urine. A specially trained technician performs the procedure, and a radiologista doctor who specializes in medical imaginginterprets the images. A woman does not need anesthesia.
                
A health care provider can also use a cathetera thin, flexible tubeto measure a womans postvoid residual. The health care provider inserts the catheter through the womans urethra into her bladder to remove and measure the amount of remaining urine after the woman has urinated. A postvoid residual of 100 mL or more is a sign that the woman is not completely emptying her bladder. A woman receives local anesthesia.
                
A health care provider may use a voiding cystourethrograman x-ray exam of the bladderto diagnose a cystocele as well. A woman gets a voiding cystourethrogram while urinating. The x-ray images show the shape of the womans bladder and let the health care provider see any problems that might block normal urine flow. An x-ray technician performs a voiding cystourethrogram, and a radiologist interprets the images. A woman does not need anesthesia; however, some women may receive sedation. A health care provider may order additional tests to rule out problems in other parts of a womans urinary tract.
Cystocele treatment depends on the severity of the cystocele and whether a woman has symptoms. If a womans cystocele does not bother her, a health care provider may recommend only that she avoid heavy lifting or straining, which could worsen her cystocele. If a woman has symptoms that bother her and wants treatment, the health care provider may recommend pelvic muscle exercises, a vaginal pessary, or surgery.
                
Pelvic floor, or Kegel, exercises involve strengthening pelvic floor muscles. Strong pelvic floor muscles more effectively hold pelvic organs in place. A woman does not need special equipment for Kegel exercises.
                
The exercises involve tightening and relaxing the muscles that support pelvic organs. A health care provider can help a woman learn proper technique.
                
More information about pelvic muscle exercises is provided in the NIDDK health topic, Kegel Exercise Tips.
                
A vaginal pessary is a small, silicone medical device placed in the vagina that supports the vaginal wall and holds the bladder in place. Pessaries come in a number of shapes and sizes. A health care provider has many options to choose from to find the most comfortable pessary for a woman.
                
A heath care provider may recommend surgery to repair the vaginal wall support and reposition the womans bladder to its normal position. The most common cystocele repair is an anterior vaginal repairor anterior colporrhaphy. The surgeon makes an incision in the wall of the womans vagina and repairs the defect by folding over and sewing together extra supportive tissue between the vagina and bladder. The repair tightens the layers of tissue that separate the organs, creating more support for the bladder. A surgeon who specializes in the urinary tract or female reproductive system performs an anterior vaginal repair in a hospital. The woman receives either regional or general anesthesia. The woman may stay overnight in the hospital, and full recovery may take up to 4 to 6 weeks.
- A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder into the vagina.  - A cystocele occurs when the muscles and supportive tissues between a womans bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening.  - Diagnosing a cystocele requires medical tests and a physical exam of the vagina.  - Cystocele treatment depends on the severity of the cystocele and whether a woman has symptoms.
The small intestine is part of the upper gastrointestinal (GI) tract and is a tube-shaped organ between the stomach and large intestine. The upper GI tract also includes the mouth, esophagus, stomach, and duodenum, or the first part of the small intestine.
                
Most food digestion and nutrient absorption take place in the small intestine. The small intestine measures about 20 feet long and includes the duodenum, jejunum, and ileum. Villitiny, fingerlike protrusionsline the inside of the small intestine. Villi normally let nutrients from food be absorbed through the walls of the small intestine into the bloodstream.
Bacteria called Tropheryma whipplei (T. whipplei) cause Whipple disease. T. whipplei infection can cause internal sores, also called lesions, and thickening of tissues in the small intestine. The villi take on an abnormal, clublike appearance and the damaged intestinal lining does not properly absorb nutrients, causing diarrhea and malnutrition. Diarrhea is frequent, loose, and watery bowel movements. Malnutrition is a condition that develops when the body does not get the right amount of vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function. Over time, the infection spreads to other parts of the persons body and will damage other organs.
Signs and symptoms of Whipple disease can vary widely from person to person. The most common symptoms of Whipple disease are
                
- diarrhea  - weight loss caused by malabsorption
                
A person may not have diarrhea. Instead, other signs and symptoms of Whipple disease may appear, such as
                
- abnormal yellow and white patches on the lining of the small intestine  - joint pain, with or without inflammation, that may appear off and on for years before other symptoms  - fatty or bloody stools  - abdominal cramps or bloating felt between the chest and groin  - enlarged lymph nodesthe small glands that make infection-fighting white blood cells  - loss of appetite  - fever  - fatigue, or feeling tired  - weakness  - darkening of the skin
                
People with a more advanced stage of Whipple disease may have neurologic symptomsthose related to the central nervous systemsuch as
                
- vision problems.  - memory problems or personality changes.  - facial numbness.  - headaches.  - muscle weakness or twitching.  - difficulty walking.  - hearing loss or ringing in the ears.  - dementiathe name for a group of symptoms caused by disorders that affect the brain. People with dementia may not be able to think well enough to do normal activities such as getting dressed or eating.
                
Less common symptoms of Whipple disease may include
                
- chronic cough.  - chest pain.  - pericarditisinflammation of the membrane surrounding the heart.  - heart failurea long-lasting condition in which the heart cannot pump enough blood to meet the bodys needs. Heart failure does not mean the heart suddenly stops working.
People with Whipple disease may have complications caused by malnutrition, which is due to damaged villi in the small intestine. As a result of delayed diagnosis or treatment, people may experience the following complications in other areas of the body:
                
- long-lasting nutritional deficiencies  - heart and heart valve damage  - brain damage
                
A person with Whipple disease may experience a relapsea return of symptoms. Relapse can happen years after treatment and requires repeat treatments.