Genetic Counseling

Genetic counseling provides information and support to people who have, or may be at risk for, genetic disorders. A genetic counselor meets with you to discuss genetic risks. The counseling may be for yourself or a family member. Or you may get it when you are planning or expecting a baby. You may follow up with genetic testing.

There are many reasons to seek genetic counseling. You may consider it if you :

• Have a personal or family history of a genetic condition or birth defect
• Are pregnant or planning to be pregnant after age 35
• Already have a child with a genetic disorder or birth defect
• Have had two or more pregnancy losses or a baby who died
• Have had ultrasound or screening tests that suggest a possible problem

Helicobacter pylori Infections

Helicobacter pylori (H. pylori) is a type of bacteria that causes infection in the stomach. It is the main cause of peptic ulcers, and it can also cause gastritis and stomach cancer.

About 30 to 40% of people in the United States get an H. pylori infection. Most people get it as a child. H. pylori usually does not cause symptoms. But it can break down the inner protective coating in some people's stomachs and cause inflammation. This can lead to gastritis or a peptic ulcer.

Researchers aren't sure how H. pylori spreads. They think that it may spread by unclean food and water, or through contact with an infected person's saliva and other body fluids.

A peptic ulcer causes a dull or burning pain in your stomach, especially when you have an empty stomach. It lasts for minutes to hours, and it may come and go for several days or weeks. It may also cause other symptoms, such as bloating, nausea, and weight loss. If you have the symptoms of a peptic ulcer, your health care provider will check to see whether you have H. pylori. There are blood, breath, and stool tests to check for H. pylori. In some cases, you may need an upper endoscopy, often with a biopsy.

If you do have a peptic ulcer, the treatment is with a combination of antibiotics and acid-reducing medicines. You will need to be tested again after treatment to make sure the infection is gone.

There is no vaccine for H. pylori. Since H. pylori might spread through unclean food and water, you might be able to prevent it if you:

• Wash your hands after using the bathroom and before eating
• Eat properly prepared food
• Drink water from a clean, safe source

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:

• External hemorrhoids, which form under the skin around your anus
• Internal hemorrhoids, which form in the lining of your anus and lower rectum

Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.
• Frequently lifting heavy objects.

The symptoms of hemorrhoids depend on which type you have:

With external hemorrhoids, you may have:

• Anal itching
• One or more hard, tender lumps near your anus
• Anal pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

With internal hemorrhoids, you may have:

• Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement
• Prolapse, which is a hemorrhoid that has fallen through your anal opening

Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort.

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement.
• Drinking enough fluids every day.
• Not straining during bowel movements.
• Not sitting on the toilet for long periods of time.
• Taking over-the-counter pain relievers.
• Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.
• Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.

You should see your health care provider if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding.

To find out if you have hemorrhoids, your health care provider:

• Will ask about your medical history.
• Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.
• Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.
• May do procedures such as an anoscopy to check for internal hemorrhoids.

If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery.

You can help prevent hemorrhoids by:

• Eating foods that are high in fiber
• Taking a stool softener or a fiber supplement
• Drinking enough fluids every day
• Not straining during bowel movements
• Not sitting on the toilet for long periods of time

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hepatitis

What is hepatitis?

Hepatitis is inflammation of the liver. Inflammation is swelling that happens when tissues of the body are injured or infected. It can damage your liver. This swelling and damage can affect how well your liver functions.

Hepatitis can be an acute (short-term) infection or a chronic (long-term) infection. Some types of hepatitis cause only acute infections. Other types can cause both acute and chronic infections.

There are different types of hepatitis, with different causes:

• Viral hepatitis is the most common type. It is caused by one of several viruses -- hepatitis viruses A, B, C, D, and E. In the United States, A, B, and C are the most common.
• Alcoholic hepatitis is caused by heavy alcohol use
• Toxic hepatitis can be caused by certain poisons, chemicals, medicines, or supplements
• Autoimmune hepatitis is a chronic type in which your body's immune system attacks your liver. The cause is not known, but genetics and your environment may play a role.

Hepatitis A and hepatitis E usually spread through contact with food or water that was contaminated with an infected person's stool. You can also get hepatitis E by eating undercooked pork, deer, or shellfish.

Hepatitis B, hepatitis C, and hepatitis D spread through contact with the blood of someone who has the disease. Hepatitis B and D may also spread through contact with other body fluids. This can happen in many ways, such as sharing drug needles or having unprotected sex.

The risks are different for the different types of hepatitis. For example, with most of the viral types, your risk is higher if you have unprotected sex. People who drink a lot over long periods of time are at risk for alcoholic hepatitis.

Some people with hepatitis do not have symptoms and do not know they are infected. If you do have symptoms, they may include:

• Fever
• Fatigue
• Loss of appetite
• Nausea and/or vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice, yellowing of your skin and eyes

If you have an acute infection, your symptoms can start anywhere between 2 weeks to 6 months after you got infected. If you have a chronic infection, you may not have symptoms until many years later.

Chronic hepatitis can lead to complications such as cirrhosis (scarring of the liver), liver failure, and liver cancer. Early diagnosis and treatment of chronic hepatitis may prevent these complications.

To diagnose hepatitis, your health care provider:

• Will ask about your symptoms and medical history
• Will do a physical exam
• Will likely do blood tests, including tests for viral hepatitis
• Might do imaging tests, such as an ultrasound, CT scan, or MRI
• May need to do a liver biopsy to get a clear diagnosis and check for liver damage

Treatment for hepatitis depends on which type you have and whether it is acute or chronic. Acute viral hepatitis often goes away on its own. To feel better, you may just need to rest and get enough fluids. But in some cases, it may be more serious. You might even need treatment in a hospital.

There are different medicines to treat the different chronic types of hepatitis. Possible other treatments may include surgery and other medical procedures. People who have alcoholic hepatitis need to stop drinking. If your chronic hepatitis leads to liver failure or liver cancer, you may need a liver transplant.

There are different ways to prevent or lower your risk for hepatitis, depending on the type of hepatitis. For example, not drinking too much alcohol can prevent alcoholic hepatitis. There are vaccines to prevent hepatitis A and B. Autoimmune hepatitis cannot be prevented.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hepatitis B

What is hepatitis?

Hepatitis is inflammation of the liver. Inflammation is swelling that happens when tissues of the body are injured or infected. It can damage your liver. This swelling and damage can affect how well your liver functions.

Hepatitis B is a type of viral hepatitis. It can cause an acute (short-term) or chronic (long-term) infection. People with an acute infection usually get better on their own without treatment. Some people with chronic hepatitis B will need treatment.

Thanks to a vaccine, hepatitis B is not very common in the United States. It is more common in certain parts of the world, such as sub-Saharan Africa and parts of Asia.

Hepatitis B is caused by the hepatitis B virus. The virus spreads through contact with blood, semen, or other body fluids from a person who has the virus.

Anyone can get hepatitis B, but the risk is higher in:

• Infants born to mothers who have hepatitis B
• People who inject drugs or share needles, syringes, and other types of drug equipment
• Sex partners of people with hepatitis B, especially if they are not using latex or polyurethane condoms during sex
• Men who have sex with men
• People who live with someone who has hepatitis B, especially if they use the same razor, toothbrush, or nail clippers
• Health care and public-safety workers who are exposed to blood on the job
• Hemodialysis patients
• People who have lived in or traveled often to parts of the world where hepatitis B is common
• People who have diabetes, hepatitis C, or HIV

Often, people with hepatitis B don't have symptoms. Adults and children over 5 are more likely to have symptoms than younger children.

Some people with acute hepatitis B have symptoms 2 to 5 months after infection. These symptoms can include:

• Dark yellow urine
• Diarrhea
• Fatigue
• Fever
• Gray- or clay-colored stools
• Joint pain
• Loss of appetite
• Nausea and/or vomiting
• Abdominal pain
• Yellowish eyes and skin, called jaundice

If you have chronic hepatitis B, you may not have symptoms until complications develop. This could be decades after you were infected. For this reason, hepatitis B screening is important, even if you have no symptoms. Screening means that you are tested for a disease even though you don't have symptoms. If you are at high risk, your health care provider may suggest screening.

In rare cases, acute hepatitis B can cause liver failure.

Chronic hepatitis B can develop into a serious disease that causes long-term health problems such as cirrhosis (scarring of the liver), liver cancer, and liver failure.

If you have ever had hepatitis B, the virus may become active again, or reactivated, later in life. This could start to damage the liver and cause symptoms.

To diagnose hepatitis B, your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• Blood tests, including tests for viral hepatitis

If you have acute hepatitis B, you probably don't need treatment. Some people with chronic hepatitis B don't need treatment. But if you have a chronic infection and blood tests show that hepatitis B could be damaging your liver, you may need to take antiviral medicines.

The best way to prevent hepatitis B is to get the hepatitis B vaccine.

You can also reduce your chance of hepatitis B infection by:

• Not sharing drug needles or other drug materials
• Wearing gloves if you have to touch another person's blood or open sores
• Making sure your tattoo artist or body piercer uses sterile tools
• Not sharing personal items, such as toothbrushes, razors, or nail clippers
• Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

If you think you have been in contact with the hepatitis B virus, see your health care provider right away. Your provider may give you a dose of the hepatitis B vaccine to prevent infection. In some cases, your provider may also give you a medicine called hepatitis B immune globulin (HBIG). You need to get the vaccine and the HBIG (if needed) as soon as possible after coming into contact with the virus. It is best if you can get them within 24 hours.

National Institute of Diabetes and Digestive and Kidney Diseases