-Digestive Endoscopy of Celiac disease: Required biopsy confirmation of diagnosis of Celiac disease (whether positive immunological tests), is taken during a gastrointestinal endoscopy. Sometimes biopsy performed for diagnosis of other diseases, Celiac disease reveals the characteristic intestinal lesions.  An intestinal biopsy is recommended for those who have a gluten-free diet and symptoms characteristic of Celiac disease. If the biopsy shows Celiac disease lesions (vili and abnormal bowel inflammation of small intestine), gluten-free diet is recommended. If symptoms resolve and immunological tests are abnormal after a gluten-restricted diet, are confirming the diagnosis of Celiac disease. In suspicion case of Celiac disease in a person with a gluten-free diet is recommended ingestion of a prescribed amount of gluten, prior to biopsy.



-Treatment: General treatment forCeliac disease signs:  The most common cause of recurrence of Celiac disease signs is gluten food consumption. Some people may experience diarrhea and weight loss, even in small amounts ingestion of gluten. Chronic consumption of foods with gluten causes intestinal inflammatory lesions affecting vilia intestinal, even if symptoms are not present. The consequence is the appearance of intestinal lesions malabsorbtion, its consequences, anemia, osteoporosis and other diseases due to deficiency of vitamins and nutrients. A severe complication caused by intestinal lesions is T-cell lymphoma (malignant tumor of the gastrointestinal tract).



Patients with complications or symptoms of Celiac disease require:
- Assessment of diet, to ensure that it does not contain gluten. Doctor or nutritionist can provide more information about Celiac disease foods forbidden in. Children and adolescents with Celiac disease must acknowledge the importance of maintaining a strict diet without gluten, to prevent late complications of the disease;

- Clinical and biological review if symptoms persist for those who do not eat gluten because in such cases is possible another diagnosis (e.g. irritable bowel);
- Revaluation of digestive endoscopy and intestinal biopsy to confirm the accuracy of diagnosis;

- Oral steroid medication (rarely). Most doctors do not agree with corticosteroid use in treating celiac disease resistance gluten restricted diet. If complications of acute severe celiac disease, they recommend using corticosteroids injectable medication, oral steroids can be used for a while in refractory sprue (celiac disease unresponsive to gluten restriction).



Treatment of Celiac disease is made according to its complication, severity and type. For example, osteoporosis occurred in adults with Celiac disease, treatment requires a long time (months, years). As I said, some people with Celiac disease can eat foods with gluten without symptoms show, but nevertheless cause intestinal ingested gluten that time may be complicated by the emergence and growth deficiency rickets in children or anemia, osteoporosis and lymphoma in adults. 

Compliance with diet is very difficult, especially for those who have no symptoms after ingestion of gluten or when teens are tempted not to follow diet entourage. Awareness is very important for children and teenagers in connection with chronic consumption of gluten.

-Evolution of Celiac disease:  Celiac disease is a chronic illness caused by consumption of gluten. Vilia intestinal are some small, elongated formations in the intestinal lumen which creates a surface of absorption of vitamins, sugars and other food nutrients. Regarding the people with Celiac disease, vilia intestinal become flattened and inflamed, which decreases intestinal absorption surface, with the advent of malabsorbtion secondary. Malabsorption, secondary to celiac disease, can cause iron deficiency with iron deficiency anemia, vitamin D deficiency rickets appearance (the child), osteopenia and osteoporosis (adult).  A characteristic of celiac disease is deepening, that regression of symptoms.



Risk factors: Celiac disease is an immune disorder that occurs among genetically susceptible individuals, characterized by intestinal damage arising as a result of immune reactions to gluten ingestion.  Disease risk is increased in families with a family history of significant collateral. 10% of people who have a first degree relative (mother, father, brother, sister, son, daughter) with Celiac disease develop the disease at a time. In genetically susceptible persons, Celiac disease can be triggered by different environmental factors, including viral and bacterial infections.

People often associate with Celiac disease and other diseases, such as:
- Herpetiforma dermatitis (most common in adults but can occur in children);
- Osteoporosis ;
- Type I diabetes (insulin-dependent diabetes);
- Autoimmune thyroiditis;
- Down syndrome;
- Sjogren's syndrome;
- Selective antibody deficiency (immunoglobulin A deficiency);
- Iron deficiency anemia (iron deficiency) or macrocytic anemia (folate deficiency).
-Consult specialist:



The following evolution of celiac disease in children require a pediatric advice:
- Rapid weight loss;
- Diarrhea lasting more than 1-2 weeks;
- Stagnation stature weighted;
- Fatigue or indisposition unjustified, especially if they last more than a week and not related to another known cause (e.g. cold, flu).  People diagnosed with celiac disease (adults or children) need a medical occur whenever:
- Recurrence of symptoms (signs of the disease recur after an asymptomatic period) ;
- Marked fatigue or intense pain in stomach, appellant appeared with the symptoms;
- Diarrhea and weight loss, occurred in children with gluten-free diet;
- Persist evolution of celiac disease in some children who do not know exactly the diet (often parents do not know if children were out of food intake and other permits).



Investigations:  Diagnosis of Celiac disease is often confused with other conditions such as food intolerance or irritable bowel syndrome due to similar symptoms. Celiac disease diagnosis is often one of exclusion of other diseases with similar symptoms but does not respond to treatment.  Medical history, clinical examination and laboratory tests underlying diagnosis of Celiac disease. Diagnosis is confirmed by performing a biopsy of the small intestine, surgery performed during digestive endoscopy (video exploring the tube).

Blood immunological tests: Celiac disease triggers an immune system response to the emergence in excess of certain antibodies. In case of the suspicion of celiac disease are needed following the determination of antibodies:
- The TTG Ig: immunoglobulin (Ig A) and tissue antibodies of transglutamin (TAT);
- The EMA Ig: immunoglobulin A (Ig A) and EMA antibodies;
- The AGM Ig: immunoglobulin A (Ig A) and antigliadina antibodies (AGA). If immunological tests are positive, intestinal biopsy is performed to confirm the diagnosis.

Celiac disease is an immune system disorder triggered by gluten ingestion of food, in which injuries occur in the small intestine. Gluten is a protein of vegetable origin found in cereals such as wheat, barley or rye.  The injuries in the small intestine affect the normal absorption of nutrients, especially fat, calcium, iron and folate (malabsorption).  The Celiac disease is also called celiac sprue, gluten sensitive enteropathy, Enteropathy glutamate or nontropical sprue.



-Causes:  The exact cause of celiac disease is not known but medical research in recent years has identified certain genes that define an increased predisposition to disease.  People who have a first-degree relative with celiac sprue (mother, father, brother, sister, daughter or son) have an increased risk of developing the celiac disease. The environmental factors such as viral or bacterial infections can cause different changes in the small intestine in people genetically predisposed. Ingestion of food containing gluten then trigger different immune reactions that cause intestinal lesions characteristic of disease. These lesions of the small intestine, cause disorders of digestion and absorption (maldigestion, malabsorption).

Current genetic studies are focusing on the link between genes, immunity and environmental factors that characterize the disease pathophysiology. Studies made till now have not shown the real age of occurrence of disease, and long-term mechanism of complications.



-Symptoms of Celiac disease:  Symptoms of celiac disease occur secondary to lesions caused by ingestion of gluten. Symptoms vary from one case to another, from mild symptoms that often go unnoticed, to symptoms that cause severe complications and have a negative impact on daily life.  Symptoms of celiac disease, intermittent nature (symptoms that come and go at a certain time) are:

- Abdominal bloating, flatulence, abdominal discomfort - are caused by poor food digestion in the small intestine and colon (large intestine). Sometimes reported epigastria pain (stomach), but often not intense;
- Abnormal stool, usually diarrhea, watery, pale, creamy and smelly. The stool contains a high amount of lipid (fat), and has a glossy, shiny, and is also very sticky. Although celiac disease symptoms are the same regardless of age, they are more frequent and intense in children (early onset of disease);
- Weight loss despite a normal appetite, especially important among children, due to disorders of digestion and absorption is no longer developing normally (malnourished);
- Fatigue and weakness are the result of poor absorption of nutrients in the gut, and absorption of iron deficiency which causes anemia (especially among adults);
- Vomiting, occurring in a period of gluten ingestion is most common among children with celiac disease. Celiac disease may also lead to:



- Osteoporosis and other bone problems due to poor intestinal absorption of food calcium;
- Female infertility and amenorrhea (absence of menstruation) ;
- Delayed puberty
- Recurrent respiratory infections (common);
- Concentration and memory problems;
-Psychiatric disorders such as depression, irritability in children and adults.

All these symptoms are nonspecific, which may occur in other diseases, Celiac disease diagnosis is often delayed.

Thyroid is one of the largest and important glands of the body. It belongs to the endocrine system and its activity is regulated by the hypothalamus and pituitary influence. Thyroid controls metabolic processes, protein synthesis and overall sensitivity of the organism to the action of other hormones. It is located in the anterior cervical lodge, lower thyroid cartilage ("Adam's apple 'as he called on men) and secretes several hormones, mainly thyroxin, triiodothyronine and calcitonin (hormone important in calcium homeostasis).



Thyroid hormone secretion and influences exerted by the hypothalamus and pituitary are very complex processes, and any modification of the main factors involved in installing these leads to imbalance in the synthesis and secretion, which translates into clinical appearance of specific diseases such glands or Plummer disease.  By who produces hormones, thyroid affects many metabolic processes in the body. Thyroid disease is diverse and can range from anatomical changes of size, operating to major imbalances, which passed on the entire body, and even cancer. The most common thyroid problem is related to inadequate secretion of hormones, excess or less.

Synthesis and secretion of excessive amounts of hormones situation called hyperthyroidism and the reverse situation, characterized by deficient hormones hypothyroidism. Although Plummer disease evidence are very upset and alert the patient, thyroid pathology, the most they can be treated and controlled so that the patient's life to take place normally, and its quality is not affected.



-Hyperthyroidism is a condition caused by excessive secretion of thyroid hormones and may occur within several diseases, including:

- Graves Plummer disease evidence: the nature of autoimmune disease characterized by excess production of too much thyroid hormone. Is accompanied by macroscopic changes of the thyroid, thyroid goiter appearing. The most common symptoms are tachycardia, muscle weakness, sleep disturbance and irritability;

- Thyroid adenomas: is the nodules that occur in the parenchyma of thyroid gland and are able to secrete hormones which will influence internal homeostasis of the body, creating hormonal imbalances. Some goiter thyroid contain even more such nodules;

- Subacute thyroiditis: is due to inflammation that occurs in the parenchyma, which will favor appearance in excess of hormones, as that will cause temporary hyperthyroidism that usually lasts several weeks or even months;

- Toxic thyroid nodule: a benign thyroid tumor nature, which can be moved from clinically (non-functional) or can produce thyroid hormones, causing the appearance of clinical hyperthyroidism;



- Plummer's disease (toxic nodular goiter or) is a form of hyperthyroidism due to the existence of autonomous nodes that produce excessive amounts of hormones. It is considered the second case, in order of importance, of hyperthyroidism after Graves' disease;

- Pituitary pathology, pituitary tumors: in this category included: Strum Thyroid, thyroiditis De Quervain, toxic thyroiditis, thyroid cancer, lymphoma and metastases that may confine this level.

Hypothyroidism, in contrast to hyperthyroidism is a condition where the thyroid can not synthesize and / or secrete hormones circulating properly. Because the body is deprived of these hormones, which have many important functional roles, physiological processes can not arise in the normal parameters. The main symptoms associated with hypothyroidism include: fatigue muscle fatigue, cold intolerance, depression, muscle cramps, carpal tunnel syndrome, pallor, weight gain and fluid retention (edema), bradycardia, constipation.

Thyrotoxicosis or Plummer's dsease is the clinical syndrome caused by increased levels of circulating thyroid hormones. Thyrotoxicosis represents an exaggerated manifestations of the effects of thyroid hormones that are in excess:

-General Plummer's disease symptoms: weight loss (with normal or increased appetite), intolerance to heat, insomnia, psycho-emotional lability, anxiety, irritability, nervousness, and hyperkinesias with psychomotor agitation.

- Cardiovascular events: rhythm disturbances (sinus tachycardia, extra systoles, atrial fibrillation), marked peripheral vasodilatation (with greater differential BP) apexian intense shock, circulatory hyperkinetic syndrome.
- Neuromuscular manifestations: fatigue, muscle tremors of the extremities (due to exhaustion adrenergic receptors).

-Skin manifestations: warm skin, soft, thin, wet, thinning hair and nails, central temperature increased moderately (due to increase metabolism).

-Digestive manifestations: diarrhea, jaundice with hepatic steatosis.

- Genital Plummer's disease symptoms: decreased sexual activity in men, infertility, gynecomastia, dysmenorrhea in women.

-Ocular manifestations: upper eyelid retraction (the sclera visible above the corneal arc - Dalrymple sign), periorbital hyper pigmentation (sign Jelinek), spasmodic movements of the eye, bright eyes (the "live").



Thyrotoxicosis cases include: Graves disease (most common form of thyrotoxicosis), a toxic solitary or multinodular goiter (Plummer disease), and hyperthyroidism secondary to a TSH secreting pituitary adenoma or secondary hyperthyroidism excess hormones islands of ectopic thyroid tissue. Thyroids crisis is a medical emergency and is manifested by severe tachycardia, fever, confusion and disorientation.

-Epidemiology:  The disease affects primarily in females (ratio B: F = 1:7) at middle age (30-50 years), but can occur in adolescents, during pregnancy or menopause.

-Pathogenesis: Pathogenesis is represented by the presence of antibodies to TSH receptors on the surface of thyroid follicular cells, which stimulate the receptor and cause excessive secretion of thyroid hormones. Productions of anti-thyroid receptors can occur as a result of a lack of LTS that permit LTH Action stimulate production of clones of LB or triggering an immune response due to altered cell surface antigens post-iradiation thyroid.
Pathology: macroscopic - gland is diffusely and uniformly increased volume and microscopic - dusted small follicles may be observed by a cylindrical epithelium (hiperfunctional), with a small quantity of colloid and augmented blood supply, and there may be a limfoplasmocitar infiltrated.



Signs and symptoms of Plummer disease:

-Diffuse goiter;

- Thyrotoxicosis -Infiltrative orbitopathy: protrusion of the eyeballs due to enlarging bilateral retro bulbar tissue, over-and infra-orbital edema, congestion and swelling of the conjunctiva

-Infiltrative dermopathy with increased content of hyaluronic acid and condroitinsulfati: pretibial myxedema.

- Blast on gland listening. The data compression mechanics of formation Neighborhood: hoarseness, voice bitonic (due to compression nerve larynges appellant), dysphasia (due to compression of esophagus) syndrome Claude Bernard-Horner (miosis, exophthalmia, ptosis - due to compression inferior cervical sympathetic ganglion), dipnee (trachea due to compression), cyanosis and jugular turgor (due to jugular vein compression).

Called gallstones (from the Greek word lithos = stone)this disease is an evolutionary condition which consists of lodging, daily, about 500 ml of bile, rich in cholesterol, bilirubin (pigment crystalline) and bile salts (phosphates and calcium carbonates). The precipitation of cholesterol crystals and large stones are formed by precipitation bilirubinat calcium and calcium carbonate to form small stones, including sand.


Formation of stones in the bladder or bile ducts correlates with age, hereditary predisposition, endocrine disorders, pregnancy, menopausal status, diabetes, gout, rheumatism, kidney stones, obesity, sedentary, over nutrition and intestinal infections.  Gallstones represents 90% of all biliary diseases is one of the most common digestive diseases. Disease frequency increases with age parallel (after 70 years is 30-60%). It is more common in women 2-3 times more than men, due to disturbances arising in lipid metabolism.

Signs of gall bladder disease are manifested by violent pain, especially at night, giving biliary colic, accompanied by cramps, vomiting bilious green dark, cold sweats and fever. Urine becomes dark because of pigments and bile salts. In parallel, there remains a generalized pruritus, with itching all over.

Worsening occurs when passing from the bladder when calculating the channel or channel cystic common bile duct, causing obstruction of the biliary tract and mechanical jaundice. Worse is the passage of a calculation triggering intestinal obstruction in the intestine, acute hemorrhagic pancreatitis, portal vein thrombophlebitis or biliary tract cancer (about 10% of patients).

-Herbal Treatments for signs of gall bladder disease:
Plant species are used that property to reduce the rate of formation and deposition of stones and to help dissolve and eliminate them. In the acute phase will begin with plants antispasmodic, calming the pain and then, immediately after the pain stopped, it is recommended that treatment plants have choleretic properties, cholagogue and hepato-protective, if required use disinfectants.

-Biliary dyskinesia
The disease consists of functional disturbance of the mechanism of elimination of bile by reducing bladder capacity to ensure bile flow channel to the common bile duct duodenum. It should be stressed that the bile secreted by the liver is a very important role in food digestion by enzyme complex content and therefore need, necessarily, to be discharged in the duodenum, without downtime or functional anatomy.
Onset is due to complex digestive disorders, abdominal inflammatory processes of (appendix attached, pregnancy, menopause), or neurotic states triggered after some tense discussion, during or just after eating

Dyskinesia may be hypertonic or hypotonic.

-Hypertonic dyskinesia consists of enlargement, spontaneous slow contracting bladder capacity, with quick drain ball over capacity bile leakage through the shaft. The condition is common, frequently, women and youth, set on the central nervous system, following a mental stress or twitter. In addition, the disease can be caused by some disorder in the vicinity as appendicitis, peptic ulceration, gynecological diseases, pregnancy, menstrual cycle and hormonal diseases.

-Hypotonic dyskinesia consists of increase in volume due to the inability of the bladder to contract and release the ball to accumulate in excess inside the lazy bladder. The disease is manifested by hepatobiliary pains, nausea and bloating after meals, headaches, migraines, physical and intellectual fatigue, intolerance to certain foods that cause rejection even for them.

Symptoms of Gall bladder disease can be local by gallbladder perforation, followed by generalized peritonitis or secluded. Complications related to distance are cystic or common bile duct obstruction channel and other diseases (cirrhosis and ascites, infectious jaundice, angiocolita acute liver abscess, perforation into the peritoneum, hemorrhagic pancreatitis, sepsis, portal vein thrombosis and gallstones with cancer tendency. By blocking mechanical rhythmic bladder evacuation, microorganisms multiply and cause inflammation inside the ball and determine deposit bank areas, sand or gallstones. Crises intensifies after excessive consumption of animal fat like sauces, meat, eggs, tobacco, coffee, alcohol, or stress, tension and fatigue.


-Diet:
Painful phase of acute crisis recommended a strict diet with the consumption of fluid volumes of 1.5 liters of liquid with lemon juice, grapefruit, apples (one sip at 30 minutes). After these 2-3 days, mashed cooked vegetables are introduced, decoction of cereals (oats, bran and potatoes stewed fruit). Continue with a sparing regime consuming vegetable soups, meal, yogurt, skim milk, cheese, lean beef, vegetable juices (carrot, celery, beetroot, cucumber, parsley, spinach, radishes), potatoes in salad oil, biscuits, rusks and fruit juice (cherries, apples, pears, citrus) in the amount of over 2 liters per day, taken from rare bite. To housewives is recommended that instead of fried foods to prepare sauces and foods, tomato sauce broth, egg white sauce and cold milk, vegetable sauce suppressed, the flan caramel sauce used in dishes of dried fruit (prunes), sote with  carrot, semolina, rice milk and fruit sauce (apple, cherry, cherries, apricots).

The angiocolites are acute inflammation of the gall ducts inside and outside the liver, due to food poisoning with colibacili, enterococci, staphylococci, Salmonella and anaerobic germs. By non-toxic, inflammation is caused by gallstones, biliary dyskinesia, biliary tract cancer, pancreatic and intestinal diseases or local strikes.Symptoms of Gall bladder disease consist of: hepatomegaly (enlarged liver, soft and sensitive to touch), subicter moderate nausea, vomiting, diarrhea, anorexia, fever oscillations up to 40 ° C, chills, prolonged and intense, tachycardia, splenomegaly, malaise, with drowsiness and possible internal bleeding.

Most common complications are chronic hepatitis, biliary cirrhosis, hepatic and subhepatic abscess, generalized peritonitis or sepsis and even secluded. Analysis is found to increase the proportion of bilirubin in urine, while installing oliguria, as signs of worsening. Duration of illness with violent pain can reach 1-3 weeks.



- Phytotherapeutic treatment: Is made with ash leaf infusions, decoction from chicory roots and bark of Rhamnus frangula. In the acute phase is absolutely fluid diet with vegetable soup strained, stewed fruit, fruit juice, orange squash, and water. Gradually continue with tea mixed with milk, mashed vegetables, ripe fruits and races, boiled potatoes, and toast.

-Lifestyle: It is absolutely mandatory bed rest during the crisis and applying an ice pack on the liver and gallbladder.

-Hydrotherapy: On the upper abdomen is applied a hot water bottle or hot wax.

Gall bladder, called cholecystitis, is an annex of the liver, with a capacity of only 30-50 ml, which fulfills a major physiological role, bridging the bile juice that is secreted in continuous flow, for certain specialized cells from liver. Bile is collected in a network of channels intrahepatic ducts, liver channel routed to the central channel then cystic and gall bladder, as a body collection and concentration of bile juice. Bladder, common bile duct bile is transmitted through the channel in the duodenum (first portion of small intestine) which exerts a particularly important role in the digestion of fats and vitamins. In a healthy body, iron is yellow alkaline irritant, with a consistent or slightly viscous fluid. In the interval between meals, because bile accumulates in the bladder, sphincter Oddi is closed and bladder muscle is relaxed.


A sick body, with a high degree of intoxication, bile becomes dark green, almost black and is acidic and corrosive action on tissues. In this state no longer flow to duodenum, channel locks and cause inflammation of the liver, gall bladder and bowel burn. Symptoms of gall bladder disease as aggravating and painful as the liver, include a wide range of diseases such as cholecystitis, angiocolita, gallstones and biliary dyskinesia.

- Cholecystitis consisting of inflammation, acute or chronic gall bladder wall, to various degrees (congestion, suppurations, gangrene) due to blocked bile drainage channels narrowed cystitis. Frequency of disease is substantially higher in women aged 20-50 years.

The acute cholecystitis, very painful, is caused by infection with various microbial pathogens (colibacili, streptococcus, staphylococcus, pneumococcus, salmonella, bacillus typhous and paratific).

These germs get into the blood or gall bladder inland channels that connect to the liver and duodenum. Chronic cholecystitis is a persistent inflammation of walls, occurred after the formation of calculus within the bladder (gallstones) or biliary (liver channel and channel common bile duct). May occur and other symptoms of gall bladder disease: infectious, chemical, allergic, neurohormonal and dystrophic. The disease also occurs after activation of digestive diseases (colitis, appendicitis, ulcers, gallbladder repression in pancreatic juice) or intoxication with gold salts, barbiturates, and antibiotics. Ball passing through the bladder becomes cloudy due to bacteria polynuclear content, epithelial cells, pus, exudate and possibly calculus.



Pain from the increase in bladder volume with congested mucosa and wall necrosis, sometimes with superficial bleeding lesions. Besides pain, right hypochondria area immediately below the ribs, feel painful back and reflections to the right shoulder. Follow nausea, bilious vomiting, epigastria burning, bitter taste in mouth in the morning and subicter jaundice, bloating, constipation, loss of appetite, increased irritability, physical and intellectual asthenia, fatigue, headache, fever with chills, insomnia or restless sleep with nightmares, reduced work capacity and concentration. Patient is pale, haggard and shows frequent sweating.

A third of Wilson's disease diagnostic test involves measuring the level of copper in the liver. Consists of taking a sample of liver tissue (biopsy). It is one of the most effective ways to detect disease, but is more difficult. Other tests that may be used include: Measuring copper excreted in the urine daily (every 24 hours), measuring ceruloplastine’s ability to bind to some form of copper (Wilson's disease is low in) DNA tests.  Molecular genetic tests are not very effective in diagnosing Wilson's disease because of the large number of possible genetic mutations.

-Treatment for clinical symptoms of Wilson's disease:  Wilson's disease treatment goal is to remove excess copper and prevent its accumulation. Once you begin treatment, the disease stop evolution and many signs and symptoms are improving. But some problems require more time to improve. Other disorders - in particular, liver damage and certain neurological or psychological symptoms - are not fully reversible.

Chelated therapy
Chelated therapy is the use of chemicals that bind and remove metals and minerals from the body.

Penicillamine.
Penicillamine is the first drug approved for chelated copper for cure the clinical symptoms of Wilson's disease. Works by binding to copper and create a water-soluble complex that is excreted through urine.  Although an effective treatment, penicillamine can cause serious side effects, such as skin problems, bone marrow suppression, worsening of neurological symptoms and congenital defects. Penicillamine should not be managing people with kidney disease or those allergic to penicillin.People who follow treatment with penicillamine should consume vitamin B6 supplements, because the drug can cause a severe deficiency of this vitamin.



Trientina
A chelating agent is trientina that bind with copper and help remove it from the body. Since penicillamine is less toxic than many doctors recommend as a first line treatment, especially in people with neurological or hepatic symptoms.  Trientina also binds iron, and taking supplements rich in this mineral may reduce efficacy.

Zinc acetate
Acting differently than drugs chelate, zinc helps prevent copper absorption in stomach and small intestine. Zinc shows few side effects, but works slower than penicillamine and trientina. Is usually given as initial treatment only to pregnant women, people without symptoms of liver, or those who can not tolerate stronger medications. Doctors can alter the treatment of persons receiving penicillamine and zinc nitrate trientina once symptoms have improved. Zinc can also be used in combination with penicillamine in patients with neurological symptoms. People with Wilson's disease should follow medical treatment for life. Also, they should avoid foods rich in copper, such as liver, shellfish, mushrooms, nuts, chocolate, dried fruit, avocado.



Liver transplantation. In the case of patients with severe cirrhosis, fulminating hepatitis or other serious liver disease, liver transplantation may be the only treatment option.

-Prognosis:  If it’s not treated, Wilson's disease is always fatal.  With treatment, symptoms may continue to worsen for the first 6-8 weeks. After this period, clear improvements begin to be observed. However, it may take several years (2-5) for the treatment to achieve maximum efficiency in the brain and liver. Even if most patients do not regain the original level of functioning.  Patients with Wilson's disease must follow a certain form of treatment to prevent the rest of their life to increase the level of copper in the body. Discontinuation may lead to a relapse of the disease which is not reversible and can cause death.

Clinical symptoms of Wilson's disease: Regarding the people with Wilson disease, copper begins to accumulate in the liver soon after birth, but signs and symptoms rarely occur before the age of 5-6 years. Disease almost always becomes apparent before the age of 30 years, but symptoms can sometimes occur in old age. Accumulated copper may affect many organs and tissues, but most frequently are damaged liver and central nervous welfare payments. Symptoms of Wilson's disease include:

Liver problems: Because copper initially accumulates in the liver, most people shows signs of liver damage, including abdominal pain and yellow coloring of skin and cornea (jaundice).

Later, anemia and vomiting can occur with blood. Sometimes the disease progresses without obvious clinical symptoms of Wilson's disease until patients develop cirrhosis - irreversible liver damage that affects its function. At this stage, the signs and symptoms may include swelling of the abdomen (ascites) or legs (edema) and enlarged spleen (splenomegaly).

-Neurological problems: Approximately one third of patients with Wilson disease show neurological signs and symptoms such as tremors, muscle spasms, uncertain gait, and speech difficult and excessive salivation.

-Behavioral or psychological disorders: Wilson's disease can cause personality changes and inappropriate behavior. Children with this disorder are sometimes wrongly diagnosed with behavioral disorders because they misbehave or bad results at school.

-Eye disorders, kidney and bone: Many patients with Wilson's disease, even those who do not have other signs and symptoms, develop a yellowish-brown coloration characteristic around the cornea (Kayser-Fleischer ring). Caused by copper deposits, Kayser-Fleischer rings are frequently discovered during a routine ophthalmological. Wilson's disease can also affect kidney function and lead to brittle bones (osteoporosis). The disease can also lead to kidney stones.



-Diagnosis: Wilson's disease diagnosis can be made relatively easily by various tests. But as Wilson's disease is very rare and its main symptoms are very similar to those of hepatitis, alcoholic cirrhosis and other chronic liver diseases, diagnosis is often set later. Diagnosis is based on a combination of current symptoms and tests. Used tests can be performed in patients who have symptoms or not. It is important that the disease be found as quickly as to have liver damage may occur without any symptoms.



An easy way to diagnose Wilson's disease is to measure the level of glycoproteins found in blood, called ceruloplastina. Ceruloplastine can identify low levels of disease in approximately 80% of patients. This method is not effective in women who take birth control pills, are pregnant or children under 6 months.

Another test involves examining the eye to reveal a characteristic ring of copper stored in a membrane of the cornea (called the Kayser-Fleischer ring). This method is easily performed and is very effective in finding disease in patients who have symptoms. It is not as effective in people without symptoms (asymptomatic). This test is not sufficient to confirm this disease because some patients with liver disease may present the same results.