Chlamydia
of sexual and reproductive

sharing sex toys that aren’t washed or covered with a new condom each time they’re used infected semen or vaginal fluid getting into your eye

Chlamydia can also be passed by a pregnant woman to her baby.

Symptoms

Most people with chlamydia don’t notice any symptoms and don’t know they have it.

If you do develop symptoms, you may experience:

pain when peeing unusual discharge from the vagina, penis or rectum (back passage) pain in the lower tummy, bleeding after sex, and bleeding between periods pain in the testicles red, sticky eyes

Diagnoses

If you think you have chlamydia you should make an appointment with your GP or local sexual health services.

The test for chlamydia is simple, painless and very reliable. It involves sending a sample to a lab for analysis from the area of the body thought to be infected.

In the majority of cases you don’t have to be examined by a doctor or nurse and can often collect the sample yourself.

The 2 main ways the sample can be collected are:

using a swab – a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina, throat, or inside the anus peeing into a container – this should ideally be done at least 1 or 2 hours after you last peed

Treatments

Antibiotics will get rid of the chlamydia infection.

You should also avoid having sex until one week after you and your partner(s) have been treated. This includes oral sex and sex using a condom.

If chlamydia is left untreated you may pass it onto other sexual partners.

Chlamydia can occasionally lead to more serious problems such as pelvic inflammatory disease (PID). This is when the infection gets into the womb and fallopian tubes. PID could lead to problems in the long term, such as infertility and ectopic pregnancy.

Infection can sometimes spread to the testicles causing pain, swelling and inflammation.

Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS)
of brain nerves and spinal cord

People with ME/CFS experience severe pain and fatigue associated with post-exertional malaise (PEM). This is when the body is not able to recover after using even small amounts of energy. This fatigue feels very different from ordinary tiredness. It might take a day or 2 to kick in after physical, mental, or emotional exertion.

ME/CFS affects more women than men, can affect children and adults of all ages and from all social and ethnic groups. It doesn’t go away with sleep or rest and affects everyday life. It can sometimes be diagnosed as post viral fatigue syndrome (PVFS).


ME/CFS affects more women than men, can affect children and adults of all ages and from all social and ethnic groups. It doesn’t go away with sleep or rest and affects everyday life. It can sometimes be diagnosed as post viral fatigue syndrome (PVFS).

Symptoms

The symptoms of the condition vary from person to person. There may be times when your symptoms improve and you’ll be able to do some normal everyday activities. At other times, symptoms may get worse, affecting your daily life.

If you experience new symptoms, talk to your GP or specialist as the new symptoms may be unrelated to ME/CFS. Women often find that symptoms worsen at different times in their menstrual cycle. Not everyone will experience all of the symptoms.

Post-exertional malaise

People with ME/CFS experience severe pain, fatigue and a range of other symptoms associated with PEM. This is the body and brain’s inability to recover after using even small amounts of energy.

Simple physical or mental activities, or combinations of activities, can leave people with ME/CFS feeling completely exhausted. It can also lead to an increase in other symptoms.

Other symptoms of ME/CFS include:

feeling generally unwell pain broken sleep problems with concentration, thinking and memory (‘brain fog’) speech and language problems, including word-finding difficulties poor temperature control dizziness being very sensitive to light and sound nausea loss of appetite muscle pain (myalgia)

For more information on the symptoms of ME/CFS visit the Action for M.E. website.

Frustration, anxiety, low mood and depression are sometimes experienced by people with ME/CFS because of the impact of the condition and its symptoms on their lives. This does not mean that ME/CFS is a mental health condition.

Causes

Further research is needed to confirm what causes ME/CFS. There might be various factors involved and there may be a number of different types of the illness. These different sub-groups still need more research to be identified, including how they lead to different experiences of the condition and how it develops.

ME/CFS may appear suddenly or more slowly over time. It may follow an infection, typically, but not always, viral.

Other possible triggers can be:

trauma surgery stressful major life events

In some cases, there may be no identifiable trigger.

Diagnoses

There’s no single test to detect ME/CFS. A diagnosis is made after other possible known causes for symptoms have been excluded.

The earlier the illness is recognised, the sooner you can get help to manage your symptoms. Many people with ME/CFS find it helps to keep a diary of their symptoms so that they can take this to their GP or specialist.

Your GP will usually:

do a physical and mental examination to rule out other conditions ask about recent travel, tick or insect bites, unusual infections, and drug and alcohol use review current medication arrange tests

They may be able to make a diagnosis after 3 or 4 months of seeing a pattern of symptoms. Anyone suspected of having ME/CFS should be considered for routine blood tests to identify other possible illnesses. More investigation may be needed if the diagnosis remains in doubt.

Some people with ME/CFS also have another long-term condition and it’s important that you talk to your GP about how to manage the symptoms of the 2 conditions.

Treatments

Although there’s no cure for ME/CFS, there are ways to help manage your symptoms.

Because of the complexity of the illness different things work for different people. Your GP may be able to support you through managing your individual symptoms.

To decide what treatment is right for you, you should look at the evidence, including published research and patient surveys. Make sure you fully understand what the treatment involves before you make a decision. You have the right to decline any treatment option you do not feel comfortable with.

Your GP may suggest some of the following treatment options.

Management of medicines Your GP may suggest reviewing and changing the medicines you take. They’ll consider other conditions you may already be receiving treatment for alongside the most important ME/CFS symptoms that need to be treated. Your GP may also need to consider the combined impact of medication for symptoms and possibly for managing other conditions, especially as sensitivity to medicine is a feature of ME/CFS. This could mean there may be issues around polypharmacy (use of many medications) for your healthcare professional to consider.

Dietary advice Your illness might make it more difficult for you to eat the right balance of nutrients in your diet due to loss of appetite and food intolerances. Your GP may be able to advise you on how you can alter and adjust your diet.

Disability support advice Your GP may work with you or refer you to another therapist to suggest aids, activities or support that can help you to recover or adjust.

Pacing advice Balancing periods of activity and rest and noticing what activities demand most from you, can allow you to reduce the number of episodes of PEM. Pacing yourself involves stopping activities before you feel the impact so that you have energy in reserve. It’s easy to do too much on a good day and then feel the impact later. It can take time to change your habits and stop doing something even while things are going well. However, doing this is key to managing your condition in the long term.

Counselling Counselling can support you to adjust to the impact ME/CFS can have on your life. This does not mean that the condition itself is psychological.

Cognitive behavioural therapy (CBT) CBT should only be delivered by a healthcare professional with the right training and experience in CBT for ME/CFS. The 2021 NICE guidelines suggest that CBT might help some people with ME/CFS manage their symptoms. CBT can sometimes be used to help changes in mood that can come with having a long-term condition.

Alternative and holistic therapies Alternative or holistic therapies may provide some comfort but be cautious of any method that claims to offer a cure for ME/CFS. You should discuss any alternative or holistic therapy with your GP before you try it. Until further research is done, no one can be certain whether someone with ME/CFS might benefit from alternative therapies.

Chronic kidney disease
of kidneys bladder and prostate

Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively.

CKD does not usually cause symptoms until it reaches an advanced stage. It’s usually detected at earlier stages by blood and urine tests.

Symptoms

The main symptoms of advanced kidney disease include:

tiredness swollen ankles, feet or hands (due to water retention) shortness of breath nausea blood in the urine

Read more about the symptoms of chronic kidney disease


Most people with CKD have no symptoms because the body can tolerate even a large reduction in kidney function.

In other words, we are born with a lot more kidney function than is necessary for survival. Kidney function is often sufficient if only 1 kidney is working. That is why people can give a kidney to someone needing a kidney transplant.

A change in kidney function is usually discovered through a routine blood or urine test. If you are diagnosed with kidney disease, your kidney function will be monitored with regular blood and urine tests, and treatment aims to keep any symptoms to a minimum.

If the kidneys continue to lose function and there is progression towards kidney failure (established renal failure or ERF), this will usually be tracked by blood tests and monitoring. If kidney failure does occur, the symptoms may include:

weight loss and poor appetite swollen ankles, feet or hands (due to water retention)  shortness of breath  blood or protein in your urine (protein in your urine is not something you will notice as it can only be detected during a urine test)  an increased need to urinate, particularly at night  insomnia itchy skin  muscle cramps high blood pressure (hypertension) nausea  erectile dysfunction in men (an inability to get or maintain an erection)

These are general symptoms and can be caused by many less serious conditions. Many of the symptoms above can be avoided if treatment begins at an early stage, before any symptoms appear.

If you are worried by any of these symptoms, arrange to see your GP.

Causes

The kidneys are 2 bean-shaped organs, the size of your fist. They’re located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also:

help maintain blood pressure  maintain the correct levels of chemicals in your body which, in turn, will help heart and muscles function properly produce the active form of vitamin D that keeps bones healthy  produce a substance called erythropoietin, which stimulates production of red blood cells

Chronic kidney disease is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure.

Read more about the causes of chronic kidney disease


Kidney disease is most often caused by other conditions that put a strain on the kidneys.

High blood pressure (hypertension) and diabetes are the most common causes of kidney disease.


There are many other conditions that less commonly cause CKD, including:

glomerulonephritis (inflammation of the kidney)  pyelonephritis (infection in the kidney)  polycystic kidney disease (an inherited condition where both kidneys are larger than normal due to the gradual growth of masses of cysts)  failure of normal kidney development in an unborn baby while developing in the womb systemic lupus erythematosus (a condition of the immune system where the body attacks the kidney as if it were foreign tissue) long-term, regular use of medicines, such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen    blockages, for example due to kidney stones or prostate disease

Diagnoses

Chronic kidney disease is most frequently diagnosed through blood and urine tests.

If you’re at a high risk of developing CKD, you may be screened annually. Screening may be recommended if you have:

high blood pressure (hypertension) diabetes a family history of CKD

Read more about diagnosing chronic kidney disease


Chronic kidney disease (CKD) is most frequently diagnosed through blood and urine tests.


Other tests are also used to assess the levels of damage to your kidneys:

kidney scans, such as an ultrasound scan, a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan, are used to find out whether there are any unusual blockages in your urine flow – in cases of advanced kidney disease, the kidneys are shrunken and have an uneven shape kidney biopsy – a small sample of kidney tissue is taken so that the cells can be examined under a microscope for damage

Treatments

There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing.

People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation.

In a minority of people, CKD may cause kidney failure, also known as established renal failure (ERF) or end-stage kidney disease. In this situation, the usual functions of the kidney stop working.

To survive, people with ERF may need to have artificial kidney treatment, called dialysis, or a kidney transplant.

Read more about treating chronic kidney disease

Living kidney donation

A kidney transplant from a living donor can be planned to avoid or reduce the time someone is on dialysis. This can offer a better long term outcome for the person receiving the organ.

There are 2 types of living kidney donation:

directed donation – a person can donate a kidney to someone they know, like a family member or a friend altruistic kidney donation – a person can donate a kidney anonymously to someone they do not know

Further information about living donation.



Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives.

In a few people, kidney disease will progress to the stage where the kidneys stop working and it becomes life threatening. This is called kidney failure or established renal failure (ERF).

This rarely happens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team.

Read more about dialysis and kidney transplants.


If you decide not to have dialysis or a transplant for kidney failure, or they are not suitable for you, you will be offered supportive treatment.

This is also called palliative care.

The aim is to treat and control the symptoms of kidney failure without using dialysis or transplantation. Supportive treatment includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.

Many people choose supportive treatment because they:

are unlikely to benefit or have quality of life with treatment do not want to go through the inconvenience of treatment with dialysis are advised against dialysis because they have other serious illnesses that will shorten their life, and the negative aspects of treatment outweigh any likely benefits  have been on dialysis but have decided to stop this treatment  are being treated with dialysis, but have another serious physical illness, especially severe heart disease or stroke, that will shorten their life

If you choose to have supportive treatment, your kidney unit will still look after you.

Doctors and nurses will make sure you receive:

medicines to protect your remaining kidney function for as long as possible  medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin  help to plan your home and money affairs  bereavement support for your family after your death

Read more information:

Kidney Research UK: Information on choosing not to start dialysis Bereavement support from CRUSE

Preventions

The main way to reduce the chances of CKD developing is to ensure any existing conditions, such as diabetes and high blood pressure, are carefully managed.

Some lifestyle changes can also reduce the risk of CKD developing, these include:

having a healthy diet avoiding drinking excessive amounts of alcohol exercising regularly avoiding medicines that can damage the kidney

Read more about preventing chronic kidney disease


In most cases, chronic kidney disease (CKD) cannot be completely prevented, although you can take steps to reduce the chances of the condition developing.

Chronic lymphocytic leukaemia
of cancer, cancer types in adults

Chronic lymphocytic leukaemia is a type of cancer that affects the white blood cells and tends to progress slowly over many years.

It mostly affects people over the age of 60 and is rare in people under 40. Children are almost never affected.

In chronic lymphocytic leukaemia (CLL), the spongy material found inside some bones (bone marrow) produces too many white blood cells called lymphocytes that aren’t fully developed and don’t work properly.

Over time this can cause a range of problems, such as an increased risk of picking up infections, persistent tiredness, swollen glands in the neck, armpits or groin, and unusual bleeding or bruising.

CLL is different from other types of leukaemia, including chronic myeloid leukaemia, acute lymphoblastic leukaemia and acute myeloid leukaemia.

Symptoms

CLL doesn’t usually cause any symptoms early on and may only be picked up during a blood test carried out for another reason.

When symptoms develop, they may include:

getting infections often anaemia – persistent tiredness, shortness of breath and pale skin bleeding and bruising more easily than normal a high temperature (fever) night sweats swollen glands in your neck, armpits or groin swelling and discomfort in your tummy unintentional weight loss

You should speak to your GP if you have any persistent or worrying symptoms. These symptoms can have other causes other than cancer, but it’s a good idea to get them checked out.

Read more about diagnosing CLL and complications of CLL.

Causes

It’s not clear what causes CLL. There’s no proven link with radiation or chemical exposure, diet or infections. You can’t catch it from anyone else or pass it on.

However, having certain genes can increase your chances of developing CLL. You may be at a slightly higher risk of it if you have a close family member with it, although this risk is still small.


It’s not known what causes most cases of leukaemia. However, there are many risk factors that are known to increase your chances of getting chronic lymphocytic leukaemia.

Risk factors for chronic lymphocytic leukaemia include:

having a family history of the condition being of European, American or Australian origin having certain medical conditions being male 

Diagnoses

Most cases of chronic lymphocytic leukaemia (CLL) are detected during blood tests carried out for another reason.

However, you should speak to your GP if you have worrying symptoms of CLL, such as persistent tiredness, unusual bleeding or bruising, unexplained weight loss or night sweats.

Your GP may:

ask about your symptoms and your medical and family history carry out a physical examination to check for problems such as swollen glands and a swollen spleen send off a blood sample for testing

If your GP thinks you could have CLL, you’ll be referred to a hospital doctor called a haematologist, a specialist in blood disorders, for further tests.


The main test used to help diagnose CLL is a type of blood test called a full blood count.

This is where the number and appearance of the different blood cells in a sample of your blood are checked in a laboratory.

An abnormally high number of unusual white blood cells (lymphocytes) can be a sign of CLL. A detailed examination of these cells can usually confirm the diagnosis.


Tests may also be carried out on your blood and bone marrow samples to check for any unusual genes in the cancerous cells.

Identifying unusual genes in these cells can help your doctors decide how soon you should start treatment and which treatment is best for you.

Some treatments for CLL don’t work as well in people with certain abnormal genes in the affected cells.

Treatments

As CLL progresses slowly and often has no symptoms at first, you may not need to be treated immediately.

If it’s caught early on, you’ll have regular check-ups over the following months or years to see if it’s getting any worse.

If CLL starts to cause symptoms, or isn’t diagnosed until later on, the main treatments are:

chemotherapy – where medication is taken as a tablet or given directly into a vein is used to destroy the cancerous cells a stem cell or bone marrow transplant – where donated cells called stem cells are transplanted into your body so you start to produce healthy white blood cells

Treatment can’t usually cure CLL completely, but can slow its progression and lead to periods where there are no symptoms. Treatment may be repeated if the condition comes back.

Read more about treating CLL.


Treatment for chronic lymphocytic leukaemia (CLL) largely depends on what stage the condition is at when it’s diagnosed.

You may just need to be monitored at first if it’s caught early on. Chemotherapy is the main treatment if it’s more advanced.

Treatment can often help keep CLL under control for many years.

It may go away after treatment initially (known as remission), but will usually come back (relapse) a few months or years later and may need to be treated again.


There are also a number of other treatments that are sometimes used to help treat some of the problems caused by CLL, particularly if you can’t have chemotherapy or it doesn’t work.

These include:

radiotherapy to shrink enlarged lymph glands or a swollen spleen surgery to remove a swollen spleen antibiotics, antifungals and antiviral medications to help reduce your risk of picking up an infection during treatment blood transfusions to provide more red blood cells and platelets (clotting cells) if you experience severe anaemia or problems with bleeding and bruising immunoglobulin replacement therapy – a transfusion of antibodies taken from donated blood that can help prevent infections injections of medication called granulocyte-colony stimulating factor (G-CSF) to help boost the number of white blood cells

You may also need additional treatment for any complications of CLL that develop.


As many of the treatments for CLL can have unpleasant side effects that may affect your quality of life, you may decide against having a particular type of treatment.

This is entirely your decision and your treatment team will respect any decision you make.

You won’t be rushed into deciding about your treatment, and before making a decision you can talk to your doctor, partner, family and friends.

Pain relief and nursing care will still be available as and when you need it.

Complications

Chronic lymphocytic leukaemia (CLL) can sometimes cause a number of further complications.

Chronic myeloid leukaemia
of cancer, cancer types in adults

Leukaemia is cancer of the white blood cells. Chronic leukaemia means the condition progresses slowly over many years. Chronic leukaemia is classified according to the type of white blood cells that are affected by cancer. There are 2 main types:

lymphocytes – mostly used to fight viral infections myeloid cells – which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage

These pages focus on chronic myeloid leukaemia, which is a cancer of the myeloid cells. The following other types of leukaemia are covered elsewhere:

chronic lymphocytic leukaemia acute myeloid leukaemia acute lymphoblastic leukaemia

Symptoms

In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms and it is often diagnosed during tests for a different condition.

When symptoms do develop, they are similar to those of many other illnesses and can include:

tiredness frequent infections unexplained weight loss a feeling of bloating less commonly, swollen lymph nodes – glands found in the neck and under your arms, which are usually painless

Chronic myeloid leukaemia can also cause swelling in your spleen (an organ that helps to filter impurities from your blood). This can cause a lump to appear on the left side of your abdomen, which may be painful when touched. A swollen spleen can also put pressure on your stomach, causing a lack of appetite and indigestion.

The symptoms of chronic myeloid leukaemia in its advanced stage will be much more noticeable and troublesome. They include:

severe fatigue bone pain night sweats fever easily bruised skin

Causes

Chronic myeloid leukaemia is caused by a DNA mutation in the stem cells which produce white blood cells.

The change in the DNA causes the stem cells to produce more white blood cells than are needed.

They are also released from the bone marrow before they are mature and able to fight infection like healthy ‘adult’ white blood cells.

As the number of immature cells increases, the number of healthy red blood cells and platelets fall, and it’s this fall which causes many of the symptoms of chronic leukaemia.

Diagnoses

Chronic myeloid leukaemia is often first detected when a routine blood test is carried out to diagnose another, unrelated, condition.

A blood test that reveals abnormally high levels of white blood cells could be a sign of chronic leukaemia. If you have a blood test with abnormal results, you will be referred to a haematologist (a specialist in treating blood conditions) for further testing.


There are a number of additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. These can also provide an insight into how the leukaemia should be treated. 

Cytogenetic testing

Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are a number of specific genetic variations that can occur during leukaemia and knowing what these variations are can have an important impact on treatment.

For example, 90% of people with chronic myeloid leukaemia have the Philadelphia chromosome. People who have this chromosome are known to respond well to a medicine called imatinib.

Polymerase chain reaction (PCR)

A polymerase chain reaction (PCR) test can be done on a blood sample. This is an important test to diagnose and monitor the response to treatment.

The blood test is repeated every 3 months for at least 2 years after starting treatment, then less often once remission is achieved.

Imaging tests

In some cases, the hospital may want to perform some imaging tests to help rule out other conditions or confirm a diagnosis. This may be either:

an X-ray – usually to examine your chest an ultrasound scan – usually to examine your spleen and liver

Treatments

Imatinib tablets are usually given as soon as you have been diagnosed with chronic myeloid leukaemia, to slow its progression. These tablets are taken every day for life, and most patients do really well on them.

The aim of treatment is to achieve the following:

by 3 months, correct the blood count by 12 months, clear the bone marrow of cells containing the Philadelphia chromosome (see Causes page for information on this) by 18 months, get to a stage where the leukaemia can only be detected by a very sensitive molecular test (molecular remission)

Chemotherapy is usually offered if the cancer reaches an advanced stage.


Imatinib

A medicine called imatinib is the main treatment recommended for chronic myeloid leukaemia. It is usually given as soon as a diagnosis is made because the medicine is designed to slow the progression of the cancer and to prevent the condition reaching the accelerated or advanced phase.

Imatinib is a type of tyrosine kinase inhibitor. This means it blocks a protein called tyrosine kinase (tyrosine kinase helps to stimulate the growth of cancer cells). This reduces the production of abnormal white blood cells.

Imatinib is taken as a tablet. The side effects of imatinib are usually mild and should improve with time. They include:

nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea

Nilotinib

It is estimated that 10 to 40% of people who take imatinib become resistant to its effects, so an alternative treatment is required.

The National Institute for Health and Care Excellence (NICE) has recommended nilotinib for the treatment of chronic myeloid leukaemia that is resistant or intolerant to imatinib. In some cases, nilotinib is recommended as the first treatment.

Nilotinib works in a similar way to imatinib in that it blocks the effects of proteins that help stimulate the growth of cancer cells.

Side effects of nilotinib can include:

vomiting abdominal pain bone and joint pain dry skin loss of appetite hair loss insomnia night sweats dizziness tingling or numbness

If the side effects become particularly troublesome, temporarily stopping the treatment usually helps to bring them under control. Treatment can then be resumed, possibly using a lower dose of medication.

Read about the complications of chronic myeloid leukaemia for more information and advice about being vulnerable to infection and bleeding.


Chemotherapy

Once chronic myeloid leukaemia has progressed to a more advanced stage, chemotherapy is the next treatment.

Chemotherapy tablets are usually used first because they have fewer and milder side effects than chemotherapy injections. Side effects include:

tiredness skin rash increased vulnerability to infection

Chemotherapy can weaken your immune system, which helps protect you against infection. This is known as being immunocompromised. Read chronic leukaemia complications for more information about this.

If your symptoms persist or get worse, chemotherapy injections (intravenous chemotherapy) will need to be used. Intravenous chemotherapy causes more side effects than chemotherapy tablets and they tend to be more severe.

Side effects include:

nausea vomiting tiredness hair loss infertility

These side effects should resolve after your treatment has finished, although there is a risk that infertility could be permanent.

Bone marrow and stem cell transplants

A bone marrow transplant can offer a cure for chronic leukaemia, although it is only suitable and necessary for some patients.

Before transplantation can take place, the person receiving the transplant has to have aggressive, high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body.

This can put enormous strain on the body and can cause significant side effects and potential complications. Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type.

Due to these issues, transplantations are usually only successful when they are carried out in children and young people, or older people in good health, and there is a suitable brother or sister who can provide a donation.

In most cases of chronic leukaemia, the potential risks of transplantation far outweigh any benefit. 

However, your specific circumstances may mean that the benefits of treatment outweigh the risks.

Read more about bone marrow transplants

Complications

Being immunocompromised (having a weakened immune system) is a possible complication for some patients with chronic leukaemia.

There are 2 reasons for this:

the lack of healthy white blood cells means your immune system is less able to fight infection many of the medicines used to treat chronic leukaemia can weaken the immune system

This means you are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications.

You may be advised to take regular doses of antibiotics to prevent infections from occurring. You should immediately report any possible symptoms of an infection to your GP or care team because prompt treatment may be required to prevent serious complications.

Symptoms of infection include:

high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness

Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be suppressed (lowered).

While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour.

Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine that contains activated particles of viruses or bacteria, such as:

the mumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine

Chronic obstructive pulmonary disease
of lungs and airways, copd

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.

People with COPD have difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction.

Typical symptoms of COPD include:

increasing breathlessness when active a persistent cough with phlegm frequent chest infections

Read more about the symptoms of chronic obstructive pulmonary disease

Symptoms

Symptoms of chronic obstructive pulmonary disease (COPD) usually develop over a number of years, so you may not be aware you have the condition.

COPD does not usually become noticeable until after the age of 35 and most people diagnosed with the condition are over 50 years old.

See your GP if you have the following symptoms:

increasing breathlessness when exercising or moving around a persistent cough with phlegm that never seems to go away frequent chest infections, particularly in winter wheezing

Middle-aged smokers and ex-smokers who have a persistent chesty cough (especially in the morning), breathlessness on slight exertion or persistent coughs and colds in the winter should see their GP or practice nurse for a simple breathing test.

If you have COPD, the airways of the lungs become inflamed and narrowed. As the air sacs get permanently damaged, it will become increasingly difficult to breathe out.

While there is currently no cure for COPD, the sooner the condition is diagnosed and appropriate treatment begins, the less chance there is of severe lung damage.

Read more about treating COPD.

Causes

The main cause of COPD is smoking. The likelihood of developing COPD increases the more you smoke and the longer you’ve been smoking. This is because smoking irritates and inflames the lungs, which results in scarring.

Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more mucus is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed. These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD.

Some cases of COPD are caused by fumes, dust, air pollution and genetic disorders, but these are rarer.

Read more about the causes of chronic obstructive pulmonary disease


There are several things that may increase your risk of developing chronic obstructive pulmonary disease (COPD), many of which can be avoided.

Diagnoses

It is important that COPD is diagnosed as early as possible so treatment can be used to try to slow down the deterioration of your lungs. You should see your GP if you have any of the symptoms of COPD.

COPD is usually diagnosed after a consultation with your doctor, which may be followed by breathing tests.

Read more about diagnosing chronic obstructive pulmonary disease


Chronic obstructive pulmonary disease (COPD) is usually diagnosed after a consultation with your GP, as well as breathing tests.

If you are concerned about the health of your lungs and have symptoms that could be COPD, see your GP as soon as you can.

Being diagnosed early means you will receive appropriate treatment, advice and help to stop or slow the progression of COPD.

At a consultation, your doctor will ask about your symptoms, how long you have had them, and whether you smoke, or used to smoke. They will examine you and listen to your chest using a stethoscope. You may also be weighed and measured to calculate your body mass index (BMI).

Your doctor will also check how well your lungs are working with a lung function test called spirometery.


You may have other tests as well as spirometry. Often, these other tests will help the doctor rule out other conditions that cause similar symptoms.

Chest X-ray

A chest X-ray will show whether you have another lung condition which may be causing symptoms, such as a chest infection or lung cancer.

Blood test

A blood test will show whether your symptoms could be due to anaemia, as this can also cause breathlessness.


Some people may need more tests. The tests may confirm the diagnosis or indicate the severity of your COPD. This will help you and your doctor plan your treatment.

Electrocardiogram (ECG) and echocardiogram

An electrocardiogram (ECG) or echocardiogram may be used to check the condition of your heart.

An ECG involves attaching electrodes (sticky metal patches) to your arms, legs and chest to pick up the electrical signals from your heart.

An echocardiogram uses sound waves to build a detailed picture of your heart. This is similar to an ultrasound scan.

Peak flow test

To confirm you have COPD and not asthma, you may be asked to take regular measurements of your breathing using a peak flow meter, at different times over several days. The peak flow meter measures how fast you can breathe out.

Blood oxygen level

The level of oxygen in your blood is measured using a pulse oximeter, which looks like a peg and is attached to the finger. If you have low levels of oxygen, you may need an assessment to see whether extra oxygen would help you.

Blood test for alpha-1-antitrypsin deficiency

If the condition runs in your family or you developed the symptoms of COPD under the age of 35 and have never smoked, you will probably have a blood test to see if you are alpha-1-antitrypsin deficient.

Computerised tomography (CT) scan

Some people may need a CT scan. This provides more information than an X-ray and can be useful in diagnosing other lung diseases or assessing changes to your lungs due to COPD.

Other breathing tests

If your symptoms seem worse than would be expected from your spirometry results, your doctor may decide you need more detailed lung function tests. You may be referred to a hospital specialist for these tests.

Phlegm sample

The doctor may take a sample of phlegm (sputum) to check whether it has been infected.

Treatments

Although the damage that has already occurred to your lungs cannot be reversed, you can slow down the progression of the disease. Stopping smoking is particularly effective at doing this.

Treatments for COPD usually involve relieving the symptoms with medication, for example by using an inhaler to make breathing easier. Pulmonary rehabilitation may also help increase the amount of exercise you are capable of doing.

Surgery is only an option for a small number of people with COPD.

Read more about treating chronic obstructive pulmonary disease



Nebulised medication

Nebulised medication can be used for severe cases of COPD if other inhaler devices have not worked effectively. A compressor is a machine that administers nebulised medicine through a mouthpiece or a face mask. The medicine is in a liquid form and is converted into a fine mist. This enables a large dose of medicine to be taken in one go.

You can usually choose whether to use nebulised medication with a mouthpiece or a facemask. Your GP will advise you on how to use the machine correctly.

Long-term oxygen therapy

If the oxygen level in your blood is low, you may be advised to have oxygen at home through nasal tubes, also called a nasal cannula, or through a mask. Oxygen is not a treatment for breathlessness, but it is helpful for some patients with persistently low oxygen levels in the blood.

You will probably be referred for more detailed assessment to see whether you might benefit from long-term oxygen therapy.

If you are prescribed long term oxygen therapy, it must be taken for at least 15 hours a day to be effective. However, the longer you use it, the more effective it is.

The tubes from the machine are long so you will be able to move around your home while you are connected. Portable oxygen tanks are available if you need to use oxygen away from home.

The aim of long-term oxygen therapy is to extend your life.

Do not smoke when you are using oxygen. The increased level of oxygen produced is highly flammable, and a lit cigarette could trigger a fire or explosion.

Ambulatory oxygen therapy

Part of the oxygen assessment is likely to consider if you may benefit from ambulatory oxygen – oxygen used when you walk or are active in other ways.

If your oxygen levels are normal while you are resting, but fall when you exercise, you may not need long-term oxygen therapy alongside ambulatory oxygen therapy.

Read more about home oxygen treatment.

Non-invasive ventilation (NIV)

Non-invasive ventilation (NIV) helps a person breathe using a portable machine connected to a mask covering the nose or face. You may receive it if you are taken to hospital because of a flare-up. You may be referred to a specialist centre to see if home NIV could help you. NIV is used to improve the functioning of your lungs.

Pulmonary rehabilitation programmes

Pulmonary rehabilitation is a programme of exercise and education designed to help people with chronic lung problems. It can increase your exercise capacity, mobility and self-confidence.

Pulmonary rehabilitation is based on a programme of physical exercise training tailored to your needs. It usually involves walking or cycling, and arm and strength-building exercises. It also includes education about your disease for you and your family, dietary assessment and advice, and psychological, social and behavioural changes designed to help you cope better.

A rehabilitation programme is provided by a multidisciplinary team, which includes physiotherapists, respiratory nurse specialists and dietitians.

Pulmonary rehabilitation takes place in a group and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms.

Pulmonary rehabilitation can greatly improve your quality of life.

Preventions

Although COPD causes about 25,000 deaths a year in the UK, severe COPD can usually be prevented by making changes to your lifestyle.

If you smoke, stopping is the single most effective way to reduce your risk of getting the condition.

Research has shown you are up to four times more likely to succeed in giving up smoking if you use NHS support along with stop-smoking medicines such as patches or gum. Ask your doctor about this, phone Quit Your Way Scotland on 0800 84 84 84 or read more about stopping smoking.

Also avoid exposure to tobacco smoke as much as possible.

Chronic pain
of brain nerves and spinal cord

Chronic pancreatitis
of stomach liver and gastrointestinal tract

Chronic pancreatitis is a condition where the pancreas (a small organ located behind the stomach and below the ribcage) becomes permanently damaged from inflammation.

It’s different to acute pancreatitis, where the inflammation is only short-term.

The most common symptom of chronic pancreatitis is repeated episodes of abdominal (tummy) pain, which can be severe.

Other symptoms tend to develop as the damage to the pancreas progresses, such as producing greasy, foul-smelling stools.

Read more about the symptoms of chronic pancreatitis and diagnosing chronic pancreatitis.

Symptoms

The most common symptom of chronic pancreatitis is repeated episodes of abdominal (tummy) pain. Eventually, there may also be digestion problems.

The pain usually develops in the middle or left side of the abdomen and can sometimes travel along your back. It’s been described as a burning or shooting pain which comes and goes, but can last for several hours or days, in some cases.

Some people also experience symptoms of nausea and vomiting during the pain. As chronic pancreatitis progresses, the painful episodes may become more frequent and severe.

Although the pain sometimes occurs after eating a meal, there’s often no trigger.

Eventually, a constant mild to moderate pain can develop in the abdomen in between episodes of severe pain. This is most common in people who continue to drink alcohol after being diagnosed with chronic pancreatitis.

Some people who stop drinking alcohol and stop smoking may experience a reduction in the severity of their pain.

Causes

Long-term alcohol misuse is responsible for around 7 out of every 10 cases of chronic pancreatitis. This is because heavy drinking over a number of years can repeatedly damage the pancreas.

Less common causes include:

smoking a problem with the immune system, causing it to attack the pancreas an inherited genetic mutation disrupting the functions of the pancreas

In as many as 3 out of 10 people with the condition, the cause cannot be identified – this is known as ‘idiopathic’ chronic pancreatitis.

Read more about the causes of chronic pancreatitis.


Most cases of chronic pancreatitis are associated with drinking excessive amounts of alcohol over a long period of time.

However, in up to 3 out of 10 people with the condition, the cause can’t be identified – known as ‘idiopathic’ chronic pancreatitis.


Several other rare causes of chronic pancreatitis have also been identified, including:

injury to the pancreas blocked or narrowed openings (ducts) of the pancreas smoking radiotherapy to the abdomen (tummy)

Diagnoses

Chronic pancreatitis can usually only be diagnosed by carrying out scans of the pancreas.

Your GP will ask about your symptoms and may carry out a simple physical examination, but they’ll refer you for further tests if they suspect chronic pancreatitis.

These tests are usually carried out in your local hospital and may include:

requesting a stool sample an ultrasound scan – where sound waves are used to build up a picture of the inside of your pancreas a computerised tomography (CT) scan – where a series of X-rays are taken to build up a more detailed, three-dimensional image of the pancreas an endoscopic ultrasonography a magnetic resonance cholangiopancreatography or MRCP

Endoscopic ultrasonography

During an endoscopic ultrasonography, a thin, flexible telescope (endoscope) is passed through your mouth and towards your stomach. An ultrasound probe attached to the tip of the endoscope is able to get close to the pancreas and take very accurate pictures of it.

You’ll usually be given a sedative to help you relax during the procedure.

MRCP

An MRCP involves injecting you with a substance known as a contrast agent that makes your pancreas and surrounding organs, such as the gallbladder and liver, show up very clearly on a magnetic resonance imaging (MRI) scanner.

An MRI scanner is a type of imaging system that uses magnetic fields and radio waves to build up a detailed image of the inside of your body.

An MRCP is a useful way of checking whether gallstones may be contributing to your symptoms.

Treatments

Always visit your GP if you’re experiencing severe pain – it’s a warning sign that something is wrong.


In most cases of chronic pancreatitis, there’s no specific treatment to reduce the inflammation and repair the damage to the pancreas.

Treatment mainly focuses on lifestyle changes and medication to relieve the pain. Surgery is sometimes needed to treat severe chronic pain that doesn’t respond to painkillers.

However, the pain can be difficult to treat and can seriously affect your quality of life.

People who don’t smoke cigarettes and avoid drinking alcohol tend to experience less pain and live longer than those who continue to drink and smoke after receiving a diagnosis.

Read more about treating chronic pancreatitis.


Always visit your GP if you’re experiencing severe pain, as this is a warning sign that something is wrong.

You should also visit your GP if you develop symptoms of jaundice. Jaundice can have a range of causes other than pancreatitis, but it’s usually a sign that there’s something wrong with your digestive system.

You should also visit your GP if you develop persistent vomiting.


Treatment for chronic pancreatitis aims to help control the condition and reduce any symptoms.

Complications

Living with chronic pain can cause mental as well as physical strain. It’s important to speak to your GP if you’re experiencing stress, anxiety or depression caused by chronic pancreatitis.

Diabetes is a common complication of chronic pancreatitis and affects about a third of people with the condition. It occurs when the pancreas is damaged and unable to produce insulin.

People with chronic pancreatitis also have an increased risk of developing pancreatic cancer.

Read more about the possible complications of chronic pancreatitis.


Complications of chronic pancreatitis are relatively common and usually caused by living with chronic pain or damage to the pancreas.

Cirrhosis
of stomach liver and gastrointestinal tract

Cirrhosis is scarring of the liver caused by continuous, long-term liver damage.

Scar tissue replaces healthy tissue in the liver and prevents the liver from working properly.

The damage caused by cirrhosis can’t be reversed and can eventually become so extensive that your liver stops functioning. This is called liver failure.

Cirrhosis can be fatal if the liver fails. However, it usually takes years for the condition to reach this stage and treatment can help slow its progression.

Each year in the UK, around 4,000 people die from cirrhosis and 700 people with the condition need a liver transplant to survive.

Symptoms

There are usually few symptoms in the early stages of cirrhosis. However, as your liver loses its ability to function properly, you’re likely to experience a loss of appetite, nausea and itchy skin.

In the later stages, symptoms can include jaundice, vomiting blood, dark, tarry-looking stools, and a build-up of fluid in the legs (oedema) and abdomen (ascites).

Read more about the symptoms of cirrhosis.


There are usually few symptoms during the early stages of cirrhosis. Noticeable problems tend to develop as the liver becomes more damaged.

In early stage cirrhosis, the liver is able to function properly despite being damaged. As the condition progresses, symptoms tend to develop when functions of the liver are affected.

Symptoms of cirrhosis can include:

tiredness and weakness loss of appetite weight loss and muscle wasting feeling sick (nausea) and vomiting tenderness or pain around the liver area tiny red lines (blood capillaries) on the skin above waist level very itchy skin yellowing of the skin and the whites of the eyes (jaundice) a tendency to bleed and bruise more easily, such as frequent nosebleeds or bleeding gums hair loss fever and shivering attacks swelling in the legs, ankles and feet due to a build-up of fluid (oedema) swelling in your abdomen (tummy), due to a build-up of fluid known as ascites (severe cases can make you look heavily pregnant)

You may also notice changes in your personality, problems sleeping (insomnia), memory loss, confusion and difficulty concentrating. This is known as encephalopathy and occurs when toxins affect your brain because your liver is unable to remove them from your body.


In the later stages of cirrhosis, you may vomit blood or have tarry, black stools. This is because blood can’t flow through the liver properly, which causes an increase in blood pressure in the vein that carries blood from the gut to the liver (portal vein).

The increase in blood pressure forces blood through smaller, fragile vessels that line your stomach and gullet (varices). These can burst under high blood pressure, leading to internal bleeding, which is visible in vomit and/or stools.

Over time, the toxins that would normally be removed from the body by a healthy liver can cause multiple organ failure, followed by death.


A number of treatments can ease the symptoms of cirrhosis, including:

a low-sodium (salt) diet or tablets called diuretics to reduce the amount of fluid in your body tablets to reduce high blood pressure in your portal vein (the main vein that transports blood from the gut to the liver) and prevent or treat any infection creams to reduce itching 

Causes

In the UK, the most common causes of cirrhosis are:

drinking too much alcohol (alcohol misuse) over many years being infected with the hepatitis C virus for a long time a condition called non-alcoholic steatohepatitis (NASH) that causes excess fat to build up in the liver

NASH is on the rise in the UK, due to increasing levels of obesity and reduced physical activity. It’s likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis.

Less common causes of cirrhosis include hepatitis B infection and inherited liver diseases, such as haemochromatosis.

Read more about the causes of cirrhosis.


There are many different causes of cirrhosis. In the UK, the most common causes are drinking excessive amounts of alcohol and long-term hepatitis C infections.

In some cases, no specific cause is identified.


There are a number of other conditions that can prevent the liver functioning healthily and can lead to cirrhosis. These include:

autoimmune liver disease – the immune system usually makes antibodies to attack bacteria and viruses; however, if you have an autoimmune disease, such as autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis (PSC), your immune system will make antibodies that attack healthy organs some rare, genetic conditions – such as haemochromatosis (a build-up of iron in the liver and other parts of the body) and Wilson’s disease (a build-up of copper in the liver and other parts of the body) any condition that causes the bile ducts to become blocked – such as cancer of the bile ducts or pancreatic cancer  Budd-Chiari syndrome – caused by blood clots blocking the veins that carry blood from the liver

Less commonly, the use of certain medications, such as amiodarone and methotrexate, can also cause cirrhosis.

Diagnoses

If your GP suspects cirrhosis, they’ll check your medical history and carry out a physical examination to look for signs of chronic liver disease.

If your GP suspects your liver is damaged, you’ll be referred for tests to confirm the diagnosis.


You may have a number of different tests.

Blood tests

Blood tests can measure your liver function and the amount of liver damage. A blood test may be used to measure the levels of the liver enzymes alanine transaminase (ALT) and aspartate transferase (AST) in your blood, as these will be raised if you have inflammation of the liver (hepatitis).

Scans

An ultrasound scan, transient elastography scan, computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be carried out on your liver. A transient elastography scan is similar to an ultrasound scan carried out during pregnancy (it’s sometimes known as a Fibroscan).

These scans can produce detailed images of your liver or check liver stiffness to identify any scarring.

The Lab Tests Online UK website has more information about ALT and AST measurements.

Liver biopsy

A liver biopsy is where a fine needle is inserted into your body (usually between your ribs) to remove a small sample of liver cells. The sample is sent to a laboratory so it can be examined under a microscope.

The biopsy is usually carried out under local anaesthetic, as a day case or with an overnight stay in hospital. The outcome of the biopsy will confirm a diagnosis of cirrhosis and may provide more information about the cause. However, transient elastography is increasingly being used as an alternative to a biopsy in the diagnosis of cirrhosis.

Endoscopy

An endoscopy is where an endoscope (a thin, long, flexible tube with a light and video camera at the end) is passed down your throat and into your stomach.

Images of your oesophagus (tube from your throat to your stomach) and stomach are transmitted to an external screen where any varices (swollen vessels), which are a sign of cirrhosis, can be seen.

Treatments

As cirrhosis doesn’t have many obvious symptoms during the early stages, it’s often picked up during tests for an unrelated illness.

See your GP if you have any of the following symptoms:

fever and shivering shortness of breath  vomiting blood very dark or black, tarry stools (faeces) periods of confusion or drowsiness

Read more about diagnosing cirrhosis.


There’s currently no cure for cirrhosis. However, it’s possible to manage the symptoms and any complications, and slow its progression.

Treating underlying conditions that may be the cause, such as using anti-viral medication to treat a hepatitis C infection, can also stop cirrhosis getting worse.

You may be advised to cut down or stop drinking alcohol, or to lose weight if you’re overweight. A wide range of alcohol support services are available.

In its more advanced stages, the scarring caused by cirrhosis can make your liver stop functioning. In this case, a liver transplant is the only treatment option.

Read more about treating cirrhosis.


You should see your GP if you have persistent signs and symptoms of cirrhosis.

Seek immediate medical help if you develop the following symptoms, particularly if you’ve been previously diagnosed with cirrhosis:

fever and shivering attacks shortness of breath  vomiting blood  very dark or black tarry stools periods of mental confusion or drowsiness


Cirrhosis can’t be cured, so treatment aims to manage the symptoms and any complications and stop the condition getting worse.

It’s usually not possible to reverse liver damage that’s already occurred, although recent research suggests this may eventually be possible in cases where the underlying cause of the liver damage can be successfully treated.

Treatment is likely to take place at a hospital with a specialist hepatology unit, which treats disorders of the liver, gall bladder and biliary ducts.

Preventions

Not exceeding the recommended limits for alcohol consumption is the best way of preventing alcohol-related cirrhosis.

Hepatitis B and C are infections you can get by having unprotected sex or sharing needles to inject drugs. Using a condom during sex and not injecting drugs will reduce your risk of developing hepatitis B and C.

A vaccine for hepatitis B is available, but there’s currently no vaccine for hepatitis C.

Read more about preventing cirrhosis.


You can reduce your chances of developing cirrhosis by limiting your alcohol consumption and protecting yourself from a hepatitis infection.

Complications

In cases of advanced cirrhosis, complications caused by the condition may need treatment.

Swollen varices

If you vomit blood or pass blood in your stools, you probably have swollen veins in your oesophagus (the long tube that carries food from the throat to the stomach). These are known as oesophageal varices.

In these cases, urgent medical attention is required. This means seeing your GP or going to the accident and emergency (A&E) department of your nearest hospital immediately.

Certain procedures can help stop the bleeding and reduce the risk of it happening again, such as:

banding – an endoscopy is carried out (a thin, flexible tube is passed down your throat) and a small band is placed around the base of the varices to help control the bleeding injection glue therapy – following an endoscopy, a type of medical ‘super glue’ is injected into the varices to make the blood clot, which helps to stop the bleeding a Sengstaken tube with a balloon on the end – a special tube is passed down your throat into your stomach and the balloon is inflated; this puts pressure on the varices and helps stop the bleeding and you’ll be heavily sedated during the procedure a transjugular intrahepatic portosystemic stent shunt (TIPSS) – a metal tube called a stent is passed across your liver to join 2 large veins (the portal vein and hepatic vein); this creates a new route for your blood to flow through, therefore relieving the pressure that causes the varices

You may also be given a type of medication called a beta-blocker, such as propanolol, to reduce the risk of bleeding or reduce the severity of any bleed that does occur.

Fluid in the tummy and legs

Ascites (a build-up of fluid around your stomach area) and peripheral oedema (fluid around your legs and ankles) are common complications of advanced cirrhosis. They’ll need to be addressed as soon as possible.

You may have 20 to 30 litres of free water in your stomach area (abdomen), which can make it difficult for you to eat and breathe properly. The main treatments for ascites and oedema are restricting sodium (salt) in your diet and taking diuretic tablets, such as spironolactone or furosemide.

If the fluid around your stomach becomes infected, you may need to be treated with antibiotics. Alternatively, antibiotics may be used on a regular basis to prevent infection in people at high risk.

In severe cases of ascites, tubes may be used to drain the fluid from your abdomen. This will usually be repeated every few weeks.

Encephalopathy

People with cirrhosis can sometimes develop problems with their brain function (encephalopathy). This occurs because the liver isn’t clearing toxins properly.

The main treatment for encephalopathy is lactulose syrup. This acts as a laxative (it helps clear the bowels) and helps the body remove the toxins that build up in the body when the liver is failing. In some cases, other laxatives or an enema may be used.

Bleeding

Cirrhosis can affect the liver’s ability to make the blood clot (thicken), leaving you at risk of severe bleeding if you cut yourself. Vitamin K and a blood product called plasma can be given in emergencies to treat episodes of bleeding. You’ll need to apply pressure to any cuts that bleed.

Therefore, you should seek specialist advice before having medical procedures, including any dental work.

Clostridium difficile
of infections and poisoning

The infection most commonly affects people who have recently been treated with antibiotics, but can spread easily to others.

C. difficile infections are unpleasant and can sometimes cause serious bowel problems, but they can usually be treated with another course of antibiotics.


C. difficile infections are unpleasant and can sometimes cause serious bowel problems, but they can usually be treated with another course of antibiotics.

Symptoms

Symptoms of a C. difficile infection usually develop when you’re taking antibiotics, or when you’ve finished taking them within the last few weeks.

The most common symptoms are:

watery diarrhoea, which can be bloody painful tummy cramps feeling sick signs of dehydration, such as a dry mouth, headaches and peeing less often than normal a high temperature (fever) of above 38C (100.4F) loss of appetite and weight loss

In some cases, serious complications can develop, such as damage to the bowel or severe dehydration, which may cause drowsiness, confusion, a rapid heart rate and fainting.

Treatments

Visiting your GP surgery with a possible C. difficile infection can put others at risk, so it’s best to phone your GP or NHS 111 if you’re concerned or feel you need advice.

Phone your GP if: you have persistent diarrhoea after finishing a course of antibiotics you have bloody diarrhoea you have diarrhoea and experience severe tummy pain, a high fever, a rapid heart rate or fainting you have symptoms of severe dehydration, such as confusion, drowsiness, only passing small amounts of urine or no urine at all If your GP is closed, phone 111.

Diarrhoea can be caused by a number of conditions and is a common side effect of antibiotics, so having diarrhoea while taking antibiotics doesn’t necessarily mean you have a C. difficile infection.

Your GP may suggest sending off a sample of your poo to confirm whether you have C. difficile. A blood test may also be carried out to help determine how severe the infection is, and sometimes you may need tests or scans in hospital to check if your bowel is damaged.


Your GP will decide whether you need hospital treatment (if you’re not already in hospital). If the infection is relatively mild, you may be treated at home.

If you’re in hospital, you might be moved to a room of your own during treatment to reduce the risk of the infection spreading to others.

Treatment for C. difficile can include:

stopping the antibiotics thought to be causing the infection, if possible – in mild cases, this may be the only treatment that’s needed taking a 10 to 14-day course of antibiotics that are known to kill C. difficile bacteria rarely, serious infections may require surgery to remove a damaged section of the bowel

C. difficile infections usually respond well to treatment, with most people making a full recovery in a week or two. However, the symptoms come back in around 1 in 5 cases and treatment may need to be repeated.