Archive for 12th March 2009


Hepatitis is inflammation of the liver. It can be caused by infection or by poisoning (for example, with alcohol, some industrial chemicals and some drugs).

When the liver becomes inflamed, its cells can’t work properly to turn food into chemicals that our bodies can use, or to turn waste products into chemicals’ that are easy to get rid of in urine or faeces. The inflamed liver tissue also swells, partly blocking the free flow of blood and other fluids, including bile, through the liver.

Hepatitis ranges from mild to very severe. Mild hepatitis may not cause any noticeable symptoms, just an off-colour feeling for a few days. Severe hepatitis causes a very serious disturbance of health, and can occasionally be fatal.

Jaundice (in which most of the tissues and fluids in the body turn yellow to dark orange) is the most obvious sign that the liver isn’t working properly. Jaundice is most noticeable in the skin, whites of the eyes and lining membranes. In acute hepatitis the urine is also dark orange or red while the stools (faeces) are pale.

Jaundice means that the liver can’t properly break down pigments from worn-out red blood cells, so that they build up in the blood and tissues. If the liver is inflamed enough to cause jaundice, many of its other important functions will also be disturbed.

You can become jaundiced from causes other than hepatitis. These include blocking of the duct that drains the gall bladder into the bowel (obstructive jaundice), and when anything causes red blood cells to wear out or break up too quickly (haemolytic jaundice) so that the liver can’t process the blood pigment fast enough to stop it from building up in the blood. You can also get orange staining of the skin from eating too many carrots, but this isn’t jaundice.

The rest of this section is about infectious hepatitis.

Viral hepatitis

The symptoms of acute viral hepatitis are jaundice, dark urine, pale stools, loss of appetite and energy, biliousness, fever, headache, aching muscles and generally feeling unwell. Sometimes there is also pain in the right upper abdomen and back. Symptoms range from none to very severe and may come on acutely or more slowly.

Most hepatitis is caused by viruses. The main ones are the hepatitis viruses of which we know six types: А, В, C, D (delta), E, and G.



In the past, serious kidney damage resulted from taking certain over-the-counter painkillers every day for some years. Powders or tablets containing mixtures of aspirin, phenacetin and caffeine were the most dangerous.

We didn’t know how dangerous these mixtures could be until about 40 years ago when it was noticed that many people with severe kidney damage had been using painkillers in excess. The majority were women. Many of the mixtures on sale at that time contained phenacetin (the old APCs, Bex and Vincent’s powders), the most dangerous culprit in analgesic kidney damage. Painkillers containing phenacetin are no longer sold, and other over-the-counter painkillers are now formulated to minimize the risk of kidney damage.

How did women become ‘hooked’ on painkillers? Maybe they started taking them for a headache or other pain and were vaguely aware that they felt brighter for a few hours afterwards (that was a ‘lift’ from the caffeine the treatments contained). As the effect wore off they noticed a ‘let down’ and ‘thick head’ feeling, so they took another one, and so on – a habit easily develops.

Prolonged use of the old painkiller mixtures caused destruction – a sort of gangrene – of tiny areas of kidney tissue.

As more and more tissue was destroyed, the kidneys became less able to function and could finally fail. Analgesic abuse could also lead to kidney stones, increased risk of kidney tumours, stomach ulcers, anaemia and high blood pressure.

If you’ve ever used analgesic mixtures regularly, ask your doctor for a checkup. If you need painkillers every day, you’re unlikely to have any problems if they’re prescribed by your doctor and your health is checked regularly. An occasional nonprescription painkiller for headache or other pain is safe, but a regular tablet or powder with your cup of tea and lie-down is not a good idea!



Other benign ovarian enlargements

Whether they are cystic or solid or a combination of both, other benign ovarian tumours generally continue to grow and will eventually cause problems. The most common are dermoid cysts and cystadenomas.

Dermoid cysts are extraordinary. They are thought to arise from an ovum that has, for some unknown reason, been stimulated to progress towards foetal development but in a totally disorganized way. Dermoids are most common in women under the age of 30, and are found on both ovaries in around a quarter of cases.

Dermoids are a mixture of solid tissue and cysts, and can contain any body tissue including lung, nervous tissue, skin, hair, teeth, bone and cartilage. The sebaceous and sweat glands in the skin produce an oily fluid that fills cysts and is severely irritating and damaging to the lining of the pelvic and abdominal cavities if a dermoid cyst ruptures.

Cystadenomas are benign overgrowths of cells that secrete watery or mucous fluids. Fluid often collects to form multiple cysts within an outer capsule. The mucous type contains a gelatinous fluid and can grow to enormous size: some have weighed over 20 kg. These cysts can usually be distinguished from follicular and corpus luteum cysts by ultrasound.

Dermoids and cystadenomas won’t disappear spontaneously and can be complicated: they may twist or rupture. Also, they can occasionally become malignant so removal is always advised.

Blood-filled cysts (chocolate cysts) can form on the ovaries affected by endometriosis.

Ovarian cancer

Though ovarian cancer is much less common than cervical or endometrial cancer, it causes more deaths than any other malignancy of the reproductive tract. It is the fourth most common cause of cancer death in Australian women, after that of breast, lung and large bowel.

Ovarian cancer is more common in women over the age of 40, and especially after the menopause. It is particularly malignant because it develops rapidly and spreads early and widely, often before it has caused any symptoms and when the ovaries aren’t noticeably enlarged. There is no screening test for ovarian cancer, and no particular group of women who should be watched carefully for it.

Early diagnosis before spread is uncommon; it is usually a chance discovery further investigation of a slightly enlarged ovary found at routine examination. Sadly, the symptoms of ovarian cancer are usually from the effects of its spread within the abdominal and pelvic cavities. These include indigestion, abdominal discomfort, swelling of the abdomen due to accumulation of fluid, weight loss and loss of energy.

Treatment is by surgery to remove ovaries, uterus and tubes, and all visible signs of spread. Unless it is certain that the tumour hasn’t spread beyond the ovaries, postoperative anticancer drugs (chemotherapy) and radiation therapy are used. Chemotherapy is often used when it appears that all tumour has been removed, in the hope of subduing growth of any microscopic spots.

The outlook depends on the type of cancer and the degree of spread. Your women generally survive longer.



Irregular periods

Variation in the length of the menstrual cycle and the occasional missed period are parts of every woman’s life, especially in puberty and as the menopause approaches. Irregular cycles at other times are only something to worry about if there are less than four periods per year, bleeding more often than every three weeks or if bleeding is very light. The cause is ally hormonal. Whether or not treatment is needed depends on whether you want to conceive or have symptoms of oestrogen deficiency.

Heavy periods

It can be hard to realize that your periods are heavier than normal, especially if the increased loss has come on very gradually. If you soak through or overflow a pad a tampon in less than an hour more than three times in a row on any one day of menstruation, or if bright red flow god on continuously for more than 48 hours – that’s too heavy.

Repeatedly losing more than 80 ml о blood at each menstruation can lead to anaemia, so heavy periods should always be investigated to find and correct the cause.

Hormonal causes
Failure to ovulate or faulty corpus-luteum formation result in progesterone deficiency in the second hi of the menstrual cycle. If the endometrium is stimulated by oestrogen without out sufficient progesterone, it will growl thicker, and its blood vessels won’t thicken and coil enough to close down efficiently when menstruation begins. An ovulation is the usual reason for heavier menstrual bleeding early in puberty and around the menopause. Lack of progesterone is also the reason for the heavier periods that are often an early sign of polycystic ovaries.

Heavy periods in women with endometriosis are also believed lobe the result of overgrowth of the endometrium due to faulty corpus-luteum formation and relative lack of progesterone.

Heavy periods resulting from lack of progesterone can usually be corrected by taking oral progesterone. The combined oral contraceptive Pill, if appropriate, usually works well to reduce menstrual blood loss.

Prostaglandins are also important in the control of bleeding when the endometrium is shed; they affect blood vessels aid contractions of the uterus. In some leases of heavy menstrual bleeding where no other cause can be found, treatment with antiprostaglandin medication is successful.

Uterine causes of heavy periods include:

• inflammation of the endometrium

• anything that increases the surface area of the endometrium, such as a fibroid protruding into the cavity of the uterus or septate uterus

anything that prevents the uterus from contracting properly, such as fibroids within its wall

•cancer of the endometrium; heavier periods can be an early symptom

Disorders of blood-clotting usually cause other symptoms – such as excessive bruising, prolonged bleeding from minor wounds and small haemorrhages under the skin – as well as increased menstrual blood loss. However, tests for blood-clotting are always done if no other cause can be found for heavy periods.



Around the time of the menopause the most common symptom is hot flushes. A typical flush starts suddenly and often for no apparent reason, though many women recognize that some flushes follow triggers such as hot drinks, alcohol, spicy or hot foods, getting flustered or anxious, rushing, or getting too hot in bed. A feeling of heat develops in the face, accompanied by flushing and often a tingling skin sensation. The hot feeling and flushing spread to the neck, trunk and upper arms -sometimes the whole body. The flush starts to subside within a few minutes; then you break out in a cold sweat, which is often profuse.

Flushes classically occur at night but can also be frequent during the day. They may be mild and infrequent or can happen several times each hour and be very distressing. They disturb sleep (many women need to change nightgowns – and sometimes sheets! – drenched with sweat) and daytime activities; I’ve known women who had to carry one or more spare shirts to work. Other physical symptoms dependent on loss of oestrogen include headaches, palpitations, skin eruptions, prickling skin sensations, genital and vaginal dryness, loss of libido, painful sex and worsening of bladder control.

Psychological symptoms include insomnia, lack of energy, irritability, tearfulness, anxiety, depression, lack of concentration, poor short-term memory, confusion and loss of confidence. Many of the psychological symptoms are linked with physical effects of a lack of oestrogen.

Without treatment, menopausal symptoms may last from a few months to many years after the last period. Most diminish with time but some, such as those due to the effect of lack of oestrogen on bones and in the genital and vaginal epithelium, progress as you get further beyond the menopause.

Do all women have menopausal symptoms?

No. About 15 per cent have no health disturbance around the time menstruation stops. These women are usually the more plump amongst us who have more body fat in which to convert adrenal hormones to oestrogen. The majority of women have some mild symptoms that are not too distressing. Twenty-five per cent of women have symptoms that really disturb their lives and health. In general, thin women suffer more. However, body
shape is not necessarily a good predictor of severity of symptoms.