Liver Specialists of Texas

Colonoscopy Bowel Prep Instruction (with Podcast)

Tue, 16 Dec 2008 18:00:00 GMT

HALFLYTELY BOWEL PREP INSTRUCTIONS

NOTE: Before beginning the following steps, have your prescription for Halflytely® filled.

THE DAY BEFORE YOUR PROCEDURE:

*Make sure to take the Bisacodyl tablets at 10a.m. then wait 6 hours to start Halflytely®

*CLEAR LIQUIDS ONLY, ALL DAY BEFORE PROCEDURE.

Clear liquids include black coffee or tea, clear fruit juices (apple or white grape), broth or bouillon, non-red gelatin dessert, Sprite, Gatorade and Ginger ale.

1. In the morning, after a clear liquid breakfast, prepare your Halflytely® solution according to the instructions on the package and refrigerate.

2. Have a clear liquid lunch.

3. By 10 a.m. – Begin by taking the 2 time released Bisacodyl tablets provided in the prep kit box.

4. At 4 p.m. – begin drinking Halflytely® as instructed – 8 oz. every 10-15 minutes until the bottle is empty. (Rapidly drinking a glassful is better than sipping an ounce or two at a time).

•You will have consumed several glassfuls before having the first loose, watery bowel movement.

•Initially, you may feel slightly bloated, but will become more comfortable as you continue to have bowel movements.

5. You can drink clear liquids up until midnight.

6. Do not eat anything after midnight, until after your procedure.

THE DAY OF THE PROCEDURE:

1. Hold your morning medicines until after the procedure.

2. Please wear comfortable clothes, leave your valuables at home.

3. Remember to come to your appointment with a responsible adult who is able to drive you home after you are released from your procedure.

In order to have a good diagnostic result, it is very important to follow these instructions. If you fail to follow these instructions there may be a need to reschedule your colonoscopy.

LIVER SPECIALIST OF TEXAS

TEL (713) 794-0700 FAX (713) 794-0610

www.texasliver.com

16-Dec-08 12:00 PM

Podcast: Pregnancy and Cirrhosis

Thu, 25 Sep 2008 21:00:00 GMT

This podcast discusses the effect of cirrhosis on pregnancy. While women that have cirrhosis get pregnant less often, when women with cirrhosis do become pregnanct, there are added concerns and dangers. Complications include and increased risk of bleeding esophageal varicies, worsening hepatic function, internal bleeding, and hepatic encephalopathy.

Details from the article are posted below.

Esophageal Varicies

Esophageal variceal bleeding has been reported in 18% to 32% of pregnant women with cirrhosis and in up to 50% of those with known portal hypertension. Among those with preexisting varices, up to 78% will have gastrointestinal bleeding during pregnancy, with a mortality rate of 18% to 50%. In contrast, pregnant patients with noncirrhotic portal hypertension fare much better. Their mortality rate from variceal bleeding is between 2% to 6%] This disparity may be related to the severity of their underlying liver disease, with patients with cirrhosis more likely to be coagulopathic.

Variceal bleeding most commonly occurs during the second and third trimesters when maternal blood volume is maximally expanded and the larger fetus causes increased compression of the inferior vena cava and collateral vasculature.

As in nonpregnant patients with cirrhosis, endoscopic band ligation remains the mainstay of therapy for acute episodes of hemorrhage. The first case of successful band ligation in a pregnant patient with acute bleeding was reported in 1998 by Starkel et al., but no prospective randomized trials for this treatment currently exist. As in the nongravid population, sclerotherapy was previously looked to as a potential alternative, but it has largely been replaced by band ligation. Experts argue that band ligation should be preferred during pregnancy because it avoids any potential risk from chemical instillation.

Upper endoscopy in general appears to be safe during pregnancy, with the main risk being fetal hypoxia from sedative drugs or positioning. No cases of premature labor or fetal malformations have been reported in patients who have undergone endoscopy during pregnancy.

Octreotide, designated as pregnancy category B by the Food and Drug Administration, is often used to treat acute variceal bleeding, although its safety has not been well studied in pregnant patients. Given its similarity to vasopressin, however, possible concerns include arteriolar vasospasm, which can result in decreased placental perfusion and an increased risk of placental abruption, myocardial infarction, peripheral ischemia, and hypertension.

Hepatic Decompensation

Up to 24% of pregnant patients with cirrhosis will also experience hepatic decompensation, which can lead to rapid clinical deterioration. This has been described in all stages of pregnancy, but often occurs after episodes of variceal bleeding.

When fulminant hepatic failure occurs, the only treatment available may be emergent liver transplantation. This has been performed during pregnancy in a small number of cases, with successful outcomes for both mother and fetus. Reported complications remain high, however, and have included an increased risk of fetal ischemia, pregnancy-induced hypertension, anemia, caesarian section, and preterm delivery. Moreover, these case reports largely involved women without underlying cirrhosis, and it is unclear how underlying liver disease would change the outcome.

25-Sep-08 4:00 PM

Podcast: Normal Liver Enzymes in Fatty Liver Disease Still A Danger

Thu, 25 Sep 2008 04:00:00 GMT

Fatty liver disease remains a very big public health problem for all of us. This podcast reviewes a recent article in the journal Hepatology that discusses the impact of normal liver enzymes on the progression of fatty liver. Their findings suggest that patients with non-alcoholic fatty liver disease, who have normal liver enzymes, remain at risk for disease progression. It does not appear that having normal enzymes protects you from further damage. Additionally, having signs of insulin resistance and alterations in glucose metabolism (such as pre-diabetes) is equally alarming, and puts one at risk for further liver damage.

All of these patients should have a liver biopsy performed to evaluate the degree of damage.

Listen to the podcast for additional details.

24-Sep-08 11:00 PM

Healthy Breakfast for School Kids

Thu, 07 Aug 2008 12:00:00 GMT

Dr. Galati recently reported for News Radio 740 KTRH the importance of breakfast in children heading off to school. Here is the transcript of the podcast that can be listened to.

School will be starting in the next couple of weeks, and now is the time to begin thinking about your students health and what you need to do to have a healthy and productive school year.

A health breakfast is one of the most important things you can do for your child. Never allow your child to skip or skimp on breakfast-especially the girls. A nutritious breakfast including some of these foods items is the goal, and includes:

fresh fruits, fruit juice, eggs, oatmeal, whole grain toast, yogurt, a glass of milk, a small serving of chicken or turkey, reduced sugar cold cereals, and peanut butter will give your child a great start for the day.

Study after study show that children that start the school day with a poor quality, high sugar load breakfast perform worse, and feel bad through the day. A bowl of Coco Pebbles and a coke is not that way to start the day.

If you and your child are not used to this kind of breakfast, there is time now to start experimenting, seeing what your child will like. Preparing breakfast the night before may make the morning less hectic.

7-Aug-08 7:00 AM

Do You Know Your ALT? A Podcast Moment

Sat, 05 Jul 2008 20:00:00 GMT

Podcast Transcript below:

Over the years, we have all become programmed to know certain numbers related to your health, including you cholesterol levels, including the good and bad cholesterol numbers, your blood pressure, values of your body mass index, and for men, their PSA values. Now I have one more you need to know: your ALT or amino alanine transaminase.

Any elevated level of ALT often suggest the existence of other medical problems such as alcoholic or viral hepatitis, fatty liver disease , autoimmune problems involving the liver, reactions to medications you are taking, as well as a host of other problems, as well as non-liver issues including congestive heart failure, and infectious. For this reason, ALT is commonly used as a way of screening for liver problems.

All too often, individuals have no idea what their ALT is, yet problems with their liver may be brewing silently, usually without any reportable symptoms. Additionally, minor elevations of the ALT are commonly ignored by physicians.

This is your chance to take charge!

Look over your medical records and see what your ALT is. If it is elevated, contact your physician and ask for further testing and evaluation. If you don’t have any records at home, ask your physician when your ALT was last tested and find out if it has been elevated in the past. NO ALT elevation should be ignored and requires a through evaluation.

Knowing your ALT is a powerful tool in preventing serious problems in the years to come.

Where is the liver located in the body?

The liver is the largest organ in the body and is located in the right upper quadrant of the abdomen, immediately under the diaphragm and weighs approximately three pounds. The size of the liver is proportional to the size of the person. No two livers are the same size.

What does the liver do?

The liver is a complex chemical “factory” that works 24 hours a day. Virtually all the blood returning from the intestinal tract to the heart passes through the liver via the portal vein. Anything a person consumes is absorbed into the bloodstream and passes through the liver. The liver is a complex organ that is essential to life. It is impossible to live without it. Specifically, the liver helps by:

Cleansing blood by metabolizing alcohol and other drugs and chemicals, destroying and neutralizing poisonous substances.
Regulating the supply of body fuel by producing, storing and supplying quick energy (glucose) to keep the mind alert and the body active, and producing, storing and exporting fat. When the liver is failing due to severe damage, it is unable to produce the necessary glucose needed for survival.
Manufacturing many essential body proteins involved in transporting substances in the blood, clotting of blood, and providing resistance to infection.
Producing bile, which aids digestion.
Regulating the balance of sex hormones, thyroid hormones, cortisone and other adrenal hormones.
Regulating body cholesterol by producing, excreting and converting it into other essential substances.
Regulating the supply of essential vitamins and minerals, such as iron and copper.
Performing literally hundreds of other specific functions.

How can you take care of your liver?

Maintain a healthy, well-balanced diet.
Avoid taking medication unnecessarily.
Do not exceed the maximum daily dosages and do not mix alcohol and medication.
If you drink alcohol, have two or less drinks a day. Women should have even less.
Protect yourself from viral hepatitis A and B by getting vaccinated.
Avoid exposure to industrial chemicals.

How common is liver disease?

There are over 100 known liver diseases. The most common ones are:

Viral hepatitis A, B and C. Hepatitis C is the most common blood-borne infection in the U.S, four times more prevalent than HIV, which is the virus that causes AIDS.
Autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis)
Alcohol - related liver disorder
Gallstones / Gallbladder disease
Diseases of the bile ducts.
Liver disorders in children (biliary atresia, metabolic disorders, neonatal hepatitis)
Cancer of the liver
Acute Fulminant Liver Failure (adults and children)

Liver Disease is a serious national problem. Ten percent of all Americans - over 25 million people - suffer liver disease or a related illness. Liver disease kills more than 26,000 Americans a year, ranking eighth in
disease-related deaths. Untreated, liver disease degrades liver function and may lead to cirrhosis, cancer or liver failure. Transplantation is the only remedy for liver failure, which is otherwise fatal.
Every year, nearly 400,000 Americans contract viral hepatitis: 125,000-150,000 new cases of Hepatitis A, nearly 150,000 new cases of Hepatitis B, and 30,000-50,000 new Hepatitis C infections, according to the
Centers for Disease Control and Prevention. An estimated 4 million Americans, or 1 in 50, are chronically infected with hepatitis C virus (HCV).

What are the symptoms and signs of liver disease?

Consult your physician if you observe any of these signs or symptoms of liver disease:

Abnormally yellow discoloration of the skin and eyes. This is called jaundice, which is often the first and sometimes the only sign of liver disease.
Dark urine.
Grey, yellow or light colored stools.
Nausea, vomiting and/or loss of appetite.
Vomiting of blood, bloody or black stools. Intestinal bleeding can occur when liver diseases obstruct blood flow through the liver. The bleeding may result in vomiting of blood or bloody stools.
Abdominal swelling. Liver diseases may cause ascites, an accumulation of fluid in the abdominal cavity.
Prolonged generalized itching.
Unusual change of weight, an increase or decrease of more than 5% within two months.
Abdominal pain.
Sleep disturbances, mental confusion and coma are present in severe liver disease. These result from an accumulation of toxic substances in the body, which impair brain function.
Fatigue or loss of stamina.
Loss of sexual drive or performance.

Remember that many forms of liver disease can have no symptoms at all.

5-Jul-08 3:00 PM

Podcast: Sodium Content In Food - Patients Beware

noemail@texasliver.com — Sat, 23 Feb 2008 16:00:00 GMT

The sodium content in food is very important to those individuals with liver disease.

23-Feb-08 10:00 AM

Hepatitis C Risk Factors Discussed

noemail@texasliver.com — Wed, 06 Feb 2008 13:00:00 GMT

In this podcast, Dr. Galati outlines the various risk factors for hepatitis C.

Risk Factors for hepatitis C include:

PERSONS	RISK OF INFECTION	TESTING RECOMMENDED?
Injecting drug users	High	Yes
Recipients of clotting factors made before 1987	High	Yes
Hemodialysis patients	Intermediate	Yes
Recipients of blood and/or solid organs before 1992	Intermediate	Yes
People with undiagnosed liver problems	Intermediate	Yes
Infants born to infected mothers	Intermediate	After 12-18 mos. old
Healthcare/public safety workers	Low	Only after known exposure
People having sex with multiple partners	Low	No*
People having sex with an infected steady partner	Low	No*

6-Feb-08 7:00 AM

Dr. Galati Discussed New Patient Evaluations

Thu, 31 Jan 2008 16:00:00 GMT

Dr. Galati discusses in this podcast issues related to being a new patient in the practice, Liver Specialists of Texas. He talks about getting old records prior to the visit and other tips to have an meaningful visit with him and his staff.

31-Jan-08 10:00 AM

Improving Your Patient Experience with Jeff Toal

noemail@texasliver.com — Thu, 31 Jan 2008 14:00:00 GMT

Dr. Joe Galati and Jeff Toal, Practice Administrator for Liver Specialists of Texas, discuss patient responsibilities and what can be done to have the best experience while being a patient in our practice.

The key to any practice experience is to be prepared. Requesting old medical records before the visit will allow Dr. Galati and his staff to review records, and have a better idea of what testing has already been performed. This will lead to a more efficient evaluation, but also reduce the chance that testing and procedures will need to be repeated.

31-Jan-08 8:00 AM

Pod Cast: Liver Biopsy Information

Sat, 19 Jan 2008 17:00:00 GMT

Liver biopsy is a very useful tool in the diagnosis and management of patients with liver disease. Dr. Galati in the pod cast reviews various aspects of the procedure.

19-Jan-08 11:00 AM

Interferon Side Effect Management: Part 1

noemail@texasliver.com — Sat, 19 Jan 2008 17:00:00 GMT

Currently, Interferon and Ribavirin are the two medications, used in combination, to treat chronic hepatitis C. The course of therapy is usually 48 weeks. It is well known that interferon and ribavirin are associated with a number of side efffects. Despite this, therapy can be completed with minimal disruption. Over the years, Dr. Galati has learned that a well educated patient on the management of the side effects is the best option to complete therapy successfully.

In the pod cast, Dr. Galati and Erin Yates, PA-C, discuss some of the common concerns patients voice.

19-Jan-08 11:00 AM

Podcast Introduction

Thu, 17 Jan 2008 05:00:00 GMT

Podcasting has become an important part of the internet experience. From this website, our plan is to have topical and content relevant podcasts covering common topics in liver disease and digestive health, plus discussions including research, practice management and patient satisfaction, nutrition, exercise and aspects of wellness.

Visit often as new "episodes" will be added regularly.

Your feedback on the content we post, and topics you would like to hear about are very important to to Dr. Galati and his team at Liver Specialists of Texas.

16-Jan-08 11:00 PM