Category Archives: Diseases Of The Digestive System
Skin Rashes in Infants
Skin rashes of different types may occur in infants and children due to various reasons, but usually they are not very serious.
- Rashes in infants may be caused by viral, fungal and bacterial infections, or due to irritation of the skin and allergies.
- Different types of rashes include itchy red rashes; fluid filled cysts; yellow scaly rashes; milky pimples or bumps on the skin.
- Many rashes disappear without any treatment. Some may become better with the application of moisturizers and gentle cleansing lotions.
- Application of anti fungal and anti bacterial ointments and antibiotic therapy may be necessary in some cases. Anti-itch medication can relieve severe itching.
Diaper rash:
It is one of the most common rashes in infants. This bright red rash appearing in the diaper area is due to the irritation caused to the tender skin by the almost constant contact with excretory materials such as urine and stools. The areas of the skin which are in touch with the diaper are especially affected. It is also referred to as diaper dermatitis.
Bacterial and fungal infections can also cause diaper rash. A typical fungal infection caused by Candida gives rashes, bright red in color, along the skin creases. Tiny red spots also may be present. Diaper rash due to bacterial infections are rarer. Babies who are exclusively fed on breast milk are found to have lower incidence of diaper rash as their stools may not have as many irritating substances and enzymes as the stools of infants who take formula milk. Using highly absorbent diapers, with moisture-locking gel filling, may reduce rashes by keeping the infant dry. Frequent diaper changes, and avoiding plastic pants which keep moisture in and restrict air circulation, also may help. Most children who have diaper rash are not usually bothered by the condition.
The usual treatment for diaper dermatitis is frequent change of diapers, and allowing for air circulation in the diaper area. Mild soaps should be used to clean the affected area. Most cases of diaper rash clear up without any further treatment. Petroleum jelly, ointments containing zinc, vitamin A & D ointment, or moisturizers, can act as a barrier to moisture and may prevent rashes. If Candida infection is present, the doctor may prescribe an antifungal cream to clear up the rash. Antibiotic creams may be required to treat rashes caused due to bacterial infections.
Eczema:
It is a dry rash causing the skin in the affected area to appear red and scaly. It usually appears as patches at the joints of the hands and legs. Cold weather and dry climate worsens the condition. The rashes due to eczema, otherwise referred to as atopic dermatitis, may come and go without any apparent reason. Its cause is also not known. Allergy is thought to be the trigger for eczema and it is considered to be similar in origin to asthma. It usually runs in families too, much like asthma does.
Many children who have eczema in infancy and childhood may outgrow the condition eventually. However, in some cases, the episodes continue lifelong. There is no cure for eczema, but the condition can be treated with moisturizers, corticosteroid creams and the use of gentle cleansing agents. Anti-itch medication, and humidified air, may give some relief to the itching and scaling skin. Identifying triggers such as dust mites and other allergens, and avoiding them, may reduce the frequency and severity of attacks.
Cradle cap:
It is a crusty and scaling yellow and red rash often occurring on the infant’s scalp. Occasionally it may appear in some skin folds too. The cause of this condition, also referred to as seborrheic dermatitis, is not known. Infants with cradle cap do not seem to be bothered by the condition, and it usually disappears by the time the infant is six months old. Applying mineral oil to the scalp, and using shampoos regularly to wash the head, may help reduce the crusty scales. Those crusts tangled in the hair can be gently removed with a comb. A severe cradle cap which persists, and does not respond to the above measures, may require treatment with corticosteroid creams or the application of shampoos containing selenium.
Tinea:
It is a fungal infection affecting the skin in different parts of the body. While tinea capitis affects the skin of the scalp, tinea corporis, commonly called ringworm, appears on the body. When tinea is diagnosed in infants and children, it is treated in the same way this fungal infection is treated in adults. In some children, the condition may be worsened by an inflammatory response to the infection causing the formation of a scalp mass known as kerion. This complication requires further specialized treatment.
Molluscum contagiosum:
It is a rash caused by a virus. It appears as a cluster of pearly pimples or flesh-colored bumps, and disappears after a while without any specific treatment.
Milia:
They appear as small pearly white cysts on the infant’s face in the early days of life. It is caused by the first oil secretions from the newborn’s skin glands. They disappear within days, without any treatment.
Common Viral Infections:
They are common causes of rashes appearing suddenly in infants, as well as, children. Roseola, rubella, and the infection erythema infectiosum, which is known as the fifth disease, are viral infections causing characteristic rashes. They are not serious, and do not cause much discomfort to the children. Other common rash-forming viral diseases such as chicken pox and measles are increasingly becoming rare as vaccinations against them are being widely used.
Watch This Video About Viral Skin Rashes in Babies :
Share and Enjoy
Weaning A Baby and Starting Solid Foods
Depending on the baby’s requirement, starting solid foods is usually recommended 6 months after birth. After finishing a full feed, if the baby is hungry again within two to three hours, it is an indication of the increasing nutritional needs of the baby. Usually, by the time babies are 6 months old, this need for more nourishment become apparent. Since solid foods are more concentrated in calories, they will meet the additional need when given along with normal feedings.
Weaning a baby is a new experience for him. Swallowing solid foods is a new skill for the baby to develop, and by the age of six months, most babies may be ready for this task, even though a few may be already swallowing solid food that parents place on the back of their tongues. Some parents may start solid foods too early in the mistaken belief that it would help the baby to sleep soundly through the entire night. It is not wise to force infants to swallow solid food before they are ready, as it may lead to eating problems later. There is a high risk of developing pneumonia due to aspiration of food too. If solid food is offered after a bottle or breast feed, it may satisfy the both their sucking instinct and their hunger.
Parents should not introduce many different foods into the baby’s diet all at once. New foods should be introduced one at a time, as it would make it easy to identify allergies or intolerance towards any particular food. Since allergic reactions towards certain foods are more serious in babies than in adults or older children, the parents should try one new food for at least a week, to ensure that it is well tolerated, before introducing the next one.
It is recommended that cereals are introduced as the first solid food, that too, a single cereal at a time to begin with. Cooked vegetables and fruits can be introduced next. Meats, well-cooked and mashed up, may be given to babies older than 7 months, but many babies do not seem to like them initially, even though they provide good proteins.
When babies start on solid foods, they should be fed with a spoon. At around six to nine months, babies may try to grasp the spoon and try to feed themselves. Parents should encourage their attempts at self- feeding. However, hard bits of food which pose a risk of choking, such as uncooked carrots, peanuts, crackers etc, should not be offered to infants. Commercially available baby foods are better avoided during weaning a baby. Freshly cooked and pureed vegetables and fruits usually provide sufficient nutrition to the baby, while being less expensive than store-bought foods. Once babies start to sit up and feed themselves, soft finger foods such as cooked carrot sticks, bananas, and apple pieces without skin, can be given.
Most infants show a preference for sweet foods, but keeping in mind that sugar does not offer any nutritional benefit, it should be kept to a minimum. Babies do not need added sugar in their diet and sweetened deserts are not beneficial to them. Honey is not advisable for babies below one year of age due to the risk of them being affected by a type food poisoning called botulism, if the spores of Clostridium botulinum are contained in honey. It is generally harmless for adults as well as older children.
Share and Enjoy
Chronic Pancreatitis
Chronic pancreatitis is a progressive inflammatory condition of the pancreas continuing over a long period, and resulting in permanent structural and functional damage to the pancreas.
- Continuous or intermittent pain in the upper part of the abdomen is the usual symptom.
- In addition to the typical symptoms, imaging tests and blood tests may help in diagnosis.
- Treatment of chronic pancreatitis include diet modifications, giving complete rest to the pancreas, administration of pain relieving drugs and supplements of pancreatic enzymes.
Alcoholism is the major cause of chronic pancreatitis in the United States, accounting for almost half the cases. People who carry the gene for a condition called cystic fibrosis, and those who have this disease, account for most of the other cases. Pancreatitis may be caused by autoimmune disease or heredity too. In a few cases, when the reason for the chronic pancreatitis cannot be identified, it is known as idiopathic. If an episode of severe acute pancreatitis had narrowed the pancreatic duct, it can lead to the development of chronic pancreatitis. In certain tropical countries like Nigeria, Indonesia and India, chronic pancreatitis is found to occur without any apparent reason. This is known as tropical pancreatitis. It usually affects youngsters and children.
Symptoms
Chronic pancreatitis has the same symptoms which occur in acute pancreatitis. Two distinct patterns are usually observed. One of them is an almost constant pain of varying intensity felt in the upper part of the abdomen. When people have this type of pattern, there is a high possibility of complications due to chronic pancreatitis being present. Formation of a cyst, an inflammatory lump, or cancer of the pancreas, may be the usual complication. In the other pattern, intermittent attacks, usually referred to as flare ups, occur. Each episode exhibits symptoms of acute pancreatitis of mild or moderate intensity. The duration of the flare ups may vary, with severe pain lasting several hours, to even several days, at a time. Irrespective of the pattern of symptoms, the pain may finally stop when the chronic disease steadily progresses to cause severe damage to the enzyme-secreting tissues of the pancreas, eventually destroying them. It may take a period of 6 to 10 years for the disease to reach this stage.
When the gradual destruction of the pancreatic tissue results in the decreased production of the digestive enzymes, pancreatic insufficiency develops. Without sufficient amount of digestive enzymes, the breakdown of food cannot be complete. Inadequately digested food cannot be absorbed by the small intestine and this condition leads to malabsorption. Bulky and extremely foul-smelling light colored stools usually indicate malabsorption. Fatty stools termed steatorrhea may have visible droplets of oil. The stool may contain many undigested and partially digested food particles, especially muscle fibers. Malabsorption may result in deficiency diseases and weight loss. People develop diabetes when the insulin-producing endocrine glands of the pancreas get destroyed with the progress of the chronic pancreatitis.
Diagnosis
When a patient who has acute pancreatitis complains of frequent flare ups or worsening of symptoms, chronic pancreatitis is suspected. When a person with a history of alcoholism comes with the typical symptoms, then also the possibility of chronic pancreatitis needs to be investigated. High blood levels of pancreatic enzymes lipase and amylase may be indicative of chronic pancreatitis. High blood glucose levels are another indication. But blood tests cannot be treated as confirmation of diagnosis.
Further investigations include Computed tomography, or CT scan, to detect the changes or abnormalities typically caused by chronic pancreatitis. If the result of this test is inconclusive, other tests such as endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography may be done. In endoscopic ultrasonography, the probe is introduced into the duodenum with the help of an endoscope inserted through the mouth. Magnetic resonance cholangiopancreatography, or MRCP for short, is a specially designed MRI test which gives clearer pictures of the pancreatic and bile ducts than a CT scan. Because of this, MRCP is often preferred to CT scan.
The risk of developing pancreatic cancer is very high in people who have chronic pancreatitis. If the usual symptoms of pancreatitis are found to worsen, cancer is suspected and further investigations are done. The diagnostic tests for pancreatic cancer include CT scan and endoscopic evaluation in addition to blood tests. MRI scan also may be done.
Chronic Pancreatitis Treatment
The repeated episodes of chronic pancreatitis are treated by resting the digestive system completely. People with chronic pancreatitis should strictly avoid alcohol consumption even when their condition had not developed due to alcoholism. During flare ups, the patient is hospitalized and all nutritional support is given intravenously. Resting the pancreas may relieve the abdominal pain to some extent, but opioid analgesics may be necessary. People may need large amounts of opioid medication to get relief from pain, which can make them addicted to the drugs. In the case of chronic pancreatitis, drug therapy is not usually a satisfactory measure for pain relief.
After a period of fasting, oral feeding is restarted when the symptoms subside. Avoiding large meals, and taking several small meals low in fats, usually helps in avoiding frequent flare-ups. An effort is made to reduce malabsorption by taking supplements of pancreatic enzymes. It may reduce steatorrhea and improve digestion and absorption of nutrients. To reduce the acid production by the stomach, proton pump inhibitors or histamine-2 (H2) blockers may be given. The overall condition of the patient improves with this treatment and weight gain may be achieved. If the improvement is not satisfactory, further reducing the fat content in the food may help. To avoid the deficiency of fat-soluble vitamins such as vitamins A and D, they should be taken as supplements. Vitamin E and K are also fat-soluble.
If pain does not subside in spite of the drug therapy and diet modifications, further investigations are done check for complications. Possible complications include the formation of a pseudocyst, which is an accumulation of the debris of pancreatic cells, fluids and enzymes around the pancreas. If pain is caused by a rapidly enlarging pseudocyst, it is surgically drained. If an inflammatory mass in the pancreas is the reason of pain, it is removed surgically.
When such complications are not detected, pain management may involve the injection of alcohol and an anesthetic drug bupivacaine combined, directly into the nerves leaving the pancreas. It may bring relief from pain by blocking the impulses of pain so that they do not reach the brain. If anesthetic injection does not help, surgery may be considered. If there is enlargement of the pancreatic duct, a bypass surgery to connect the pancreas to the duodenum usually helps reduce the pain in 70 to 80% percent cases. If the duct is not enlarged, surgical removal of a portion of the pancreas is the option. When the surgery is performed, insulin-secreting cells of the pancreas are also lost, resulting in the development of diabetes. This option is considered in the case of patients who have quit alcohol consumption and are capable of managing the resultant diabetes.
Diabetes caused by chronic pancreatitis does not respond to taking oral antidiabetic drugs. Since the secretion of insulin as well as that of its counterpart glucagon is affected by chronic pancreatitis, taking insulin shots for blood sugar control poses some risks. The decreased levels of glucagon in the blood can cause excess insulin to remain in the blood, leading to coma due to hypoglycemia.
Share and Enjoy
What Is Acute Pancreatitis
Acute pancreatitis is an inflammatory condition of the pancreas which appears suddenly and subsides after a short period. It is often accompanied by severe pain.
- The first and foremost symptom of acutely inflamed pancreas is severe pain in the abdomen.
- Acute pancreatitis is usually caused by excess alcohol consumption or by the presence of gall stones.
- X-rays and CT scans are the usual imaging tests which help in diagnosing pancreatitis. Blood tests often indicate the condition.
- Hospitalization is necessary to treat acute pancreatitis, irrespective of the severity of the inflammation.
People who have biliary tract disease or gallstones are prone to acute pancreatitis. Excess alcohol consumption is another major cause of this condition. Around 80% cases of acute pancreatitis results from the above mentioned reasons. Acute pancreatitis resulting from gallstones is more common in women.w
The pancreatic fluid secreted by the pancreas contains enzymes in an inactive form which get activated on its way to the duodenum. The fluid also contains certain inhibitors which can stop the action of the enzymes, to protect the pancreatic tissue from damage due to exposure to digestive enzymes. But if the pancreatic duct, which carries the fluid secretion to the duodenum, is blocked at the sphincter of Oddi due to gallstones, the activated pancreatic fluid starts causing injury to the tissue. If the block clears up fast enough, the damage will be minimal and temporary. But if the blockage persists, the enzymes overcome the action of the inhibitors present in the pancreatic fluid, and start directing their digestive action on the pancreatic cells, causing severe widespread damage to the organ resulting in acute inflammation.
The tiny ductules which drain the pancreatic fluid into the pancreatic duct may get clogged if regular alcohol consumption exceeds three and a half ounces, for an extended period longer than 3 – 5 years.
One and a half ounce alcohol is approximately equivalent to:
- Wine – 1 bottle
- Beer – 8 bottles
- Hard liquor – 10 ounces
When the digestive fluid stagnates in the pancreas due to lack of proper drainage, it results in acute pancreatitis. Since the presence of food in the stomach activates the digestive glands into producing more enzymes, a large meal can trigger an episode of acute pancreatitis. Binging on alcohol is another trigger which brings about sudden inflammation.
Several other reasons also cause an acutely inflamed pancreas. Hereditary factors may contribute to the development of this condition. Some people are predisposed to developing this condition due to certain gene mutations. People who have the gene responsible for a condition called cystic fibrosis, as well as those who have that disease, are at a very high risk of developing both acute and chronic pancreatitis.
Pancreatitis resulting from viral infections is often self-limiting. Drugs which cause irritation to the pancreas may result in pancreatitis. but it is usually reversible with the discontinuation of the offending drug.
Symptoms
Severe pain located in the upper part of the abdomen just below the sternum is the typical symptom of acute pancreatitis. It is almost always felt by those who develop this condition. In about half the cases, the pain may be felt as penetrating towards the back. A few people feel it in the lower part of the abdomen initially. In acutely inflamed pancreas due to gallstones, severe pain appears suddenly, and increases rapidly. On the other hand, in acute pancreatitis due to excess alcohol consumption, the pain usually develops gradually over several days and then persists for several more days. It is usually a steady, penetrating kind of severe pain.
Taking deep breaths, coughing, and moving vigorously, can increase the pain. Sitting in an upright position and leaning slightly forward, usually brings certain amount of relief. Nausea and vomiting are some of the other symptoms of acute pancreatitis and people continue to retch without bringing up anything, which is known as dry heaves. The pain is not relieved by pain killers; even opioid analgesics injected in high doses may not completely block the pain. Ironically, some people developing acute pancreatitis due to alcoholism do not exhibit any of the severe symptoms except a moderate amount of pain.
Severe symptoms felt by some people include fast heart rate and shallow breathing. People may look very sick and sweat profusely. Those who have a condition called pleural effusion usually have rapid breathing. In this condition, the accumulation of fluid in the chest cavity makes the inflation of the lungs difficult, resulting in rapid but shallow breath. If the lungs have become inflamed, or if some areas of the lungs have collapsed, the breathing may become rapid and shallow. The blood oxygen levels drop as the absorption of oxygen by the lung tissue decreases.
There may not be any fever initially, but later on, low grade fever from 100° F to 101° F may develop. A person may faint when standing up, due to sudden dropping of blood pressure. As the condition worsens, people may become disoriented and confused; some may even become unconscious. Yellowish discoloration of the white part of the eye is another symptom that may be present in some cases.
Complications: Pancreatitis may cause certain toxins called cytokines and the digestive enzymes to enter the blood vessels, lowering the blood pressure as a result. It can damage organs such as kidneys and lungs, which are far away from the site of inflammation. However, the insulin producing parts, as well as the other endocrine tissues in the pancreas, are not usually affected by the inflammation.
In two out of every ten cases of acute pancreatitis, a swelling develops in the upper part of the abdomen. It may be due to the displacement of the stomach by the swelling of the pancreas or because of the distension of the stomach. Accumulation of the contents of the stomach or the intestine may result from the temporary paralysis of the intestine called ileus.
Necrotizing pancreatitis is a condition which usually develops in cases of severe acute pancreatitis. A portion of the pancreas dies, spilling its fluids as well as blood into the cavity of the abdomen. It is a potentially fatal condition as the loss of blood and fluids result in dangerously low blood pressure leading to shock. It also increases the risk of developing peritonitis, which is the inflammation and infection of the abdominal cavity.
The inflammation of the pancreas increases the risk of infections. When the condition of a person, who has been recovering from an episode of acute pancreatitis, suddenly deteriorates, it may indicate an infection developing. It usually happens in the second week of pancreatitis. Increase in the WBC count, and development of fever, are typical symptoms of infection.
Another complication is the development of a pseudocyst around the pancreas due to the accumulation of the pancreatic fluids and tissue fragments there. Pancreatic pseudocyst may disappear without any intervention in half the cases, but it can also develop infections. Surgical drainage of the pseudocyst may be necessary if it grows too big, or causes symptoms like pain.
Diagnosis
Acute pancreatitis is suspected from the typical abdominal pain associated with the condition. Since alcoholics and people having gallbladder disease are especially at risk of developing acute pancreatitis; those who are known to be having such conditions are always investigated for the development of acutely inflamed pancreas. Physical examination by the doctor may show rigidity of the muscles of the abdominal wall. Bowel sounds may be very few or completely absent when the doctor examines the abdomen using the stethoscope.
There are no specific blood tests to diagnose this condition, but the results of some tests may indicate the inflammation of the pancreas. The enzymes lipase and amylase secreted by the pancreas may increase on the first day and if higher levels detected by a blood test, pancreatitis may be suspected. But the blood levels of the enzymes may become normal within a few days to a week. However, it is not a dependable test as elevated blood enzyme levels may not be present if the person has had previous episodes of pancreatitis. This is because the damage already caused to the pancreas may have destroyed most of the enzyme producing cells. An elevated WBC count usually indicates inflammations.
When an x-ray of the abdomen is taken, the intestine may show enlarged loops. Gallstones may be seen occasionally. An x-ray of the chest may show pleural effusion, which is the accumulation of fluid in the pleural cavity. The collapse of some areas of the lung also may be seen. Gallstones present in the gallbladder, or in the bile duct, may show on the ultrasound scan, in addition to the enlargement of the inflamed pancreas.
When people have severe acute pancreatitis, or when complications like dangerously low blood pressure develop, a computed tomography scan is done to determine the exact condition of the pancreas. The CT scan is the ideal test for acutely inflamed pancreas as it gives very clear images which help the doctor in arriving at an accurate diagnosis.
When infection is suspected, a needle is inserted into the pancreas through the skin and a fluid and tissue sample is taken out for further testing. A modified MRI scan called Magnetic resonance cholangiopancreatography, or MRCP for short, is also done.
Prognosis
Prognosis depends on the extent of inflammation. In most cases, a CT scan may be able to assess the extent of the disease, and tissue damage caused. If there is large scale destruction of the pancreatic tissue, the prognosis is poor. But if the inflammation is mild, the chances of recovery are good. The fatality rate in people with mild acute pancreatitis is less than 5%, but it can increase with the severity of the inflammation. When the inflammation has spread to other organs such as kidneys and lungs, the death rate can climb up to 50%. Mortality in the first week of the disease is usually due to heart failure or because of lung or kidney failure. After the first week, death may be due to the infection of the pancreas or it may result from the rupture or bleeding of the pseudocyst.
Treatment
Acute pancreatitis is almost always treated with the patient hospitalized. In mild cases of acutely inflamed pancreas, only the symptoms are treated. Analgesic drugs are administered to get relief from pain. The digestive system is rested for a few days by complete fasting. Fluids and essential nutrients are administered intravenously. Normal diet is restored after the symptoms subside spontaneously. The treatment usually takes two to three days to a week in the hospital.
In acute pancreatitis which is moderate or severe, hospitalization is necessary, and it usually lasts for several days to several weeks, depending on the extent of the inflammation. Food and drinks stimulate the glandular tissues of the pancreas to produce more digestive enzymes. To give complete rest to the pancreas, all oral feeding is stopped, and intravenous administration of fluids is started. The fasting may extend to several days to several weeks. Drugs to decrease the pain as well as nausea are also given intravenously. The vital signs of people with severe acute pancreatitis, such as breathing rate, pulse rate and blood pressure, have to be constantly monitored. Hence they are kept in the intensive care units for close observation. Urine output is checked at regular intervals. Blood tests are done periodically to check blood glucose levels, hematocrit and WBC count, blood electrolyte levels, as well as the levels of pancreatic enzymes lipase and amylase, in the blood. A nasogastric tube is introduced into the stomach for the removal fluid and gas accumulated there, especially if ileus has developed or if vomiting is continuing.
Proton pump inhibitors or H2 blockers are given to stop or decrease the production of digestive acids by the stomach.
When the blood volume is lowered, blood pressure may drop to dangerously low levels, hence the volume of blood should be maintained with intravenous administration of fluids to prevent shock. Oxygen is also administered to some people, but a few critically ill people may need ventilator support. It is essential to monitor heart function parameters closely.
Antibiotic therapy is necessary to treat infections, and sometimes, the diseased tissue may have to be removed surgically to improve the chances of controlling the infection and the resultant inflammation of pancreas.
If a pseudocyst is causing the inflammation, it is surgically drained using a catheter. The location of the pseudocyst determines the type of procedure used to drain it. Sometimes the catheter is inserted through a cut in the skin, but in some cases, it can be introduced with the help of an endoscope which is threaded down into the intestine through the mouth. Pseudocysts may have to be drained for a long period of time extending into weeks.
When gallstones have caused acute pancreatitis, different treatment methods are employed according to the severity of the condition. In mild cases of acute pancreatitis, the gall bladder is removed only after the inflammation subsides. Majority of people who have developed pancreatitis due to gallstones spontaneously pass the gallstones without surgical intervention. But occasionally, to treat severe cases of pancreatitis due to gallstones, a minimally invasive procedure called endoscopic retrograde cholangiopancreatography may have to be done. In this procedure, the stones are located using a dye and then removed with the endoscope. Larger stones may have to be broken down by lithotripsy. After the removal of the stones, the gallbladder is surgically removed.
Share and Enjoy
What Is Pancreatitis
What Is Pancreatitis ? Pancreatitis is the inflammatory condition of the digestive gland pancreas.
The glandular organ called pancreas is a 5 inch-long, leaf-shaped, fleshy structure which lies between the stomach, and the first part of the intestine called duodenum. It has endocrine and exocrine functions, producing both hormones and digestive enzymes.
The three main functions of pancreas are:
- Secretion of digestive enzymes into the small intestine
- Secretion of sodium bicarbonate in large amounts for the neutralization of stomach acids entering into the small intestine
- Secretion of hormones glucagon and insulin necessary for the regulation of blood sugar.
There may be several reasons for developing pancreatitis including viral infections and gall stones. The action of alcohol, certain drugs, as well as digestive enzymes, may precipitate pancreatitis. Usually, acute pancreatitis develops suddenly and resolves after a few days of inflammation, but if the condition persists over a long period of time, causing steady damage to the pancreas, the condition is referred to as chronic pancreatitis.
Share and Enjoy
GIT Bezoars And Foreign Objects
A bezoar is a tight mass of undigested organic materials such as hair, or partially digested vegetable matter, retained in the stomach or elsewhere in the gastrointestinal tract (GIT). Foreign bodies include swallowed objects remaining in the digestive tract; they occasionally result in perforation of the intestines.
- Bezoars as well as foreign bodies may remain in the digestive tract without causing any symptoms.
- These undigested masses may get stuck in different parts of the gastrointestinal tract.
- An x-ray of the gastrointestinal tract may detect the presence of bezoars or foreign bodies. The gastrointestinal tract may be examined with a flexible viewing instrument called endoscope to confirm the diagnosis.
- Bezoars as well as foreign bodies are often eliminated via bowel movements but if any remaining large object causes discomfort, it may have to be broken down to smaller pieces for easy elimination, or surgically removed.
The bezoars and foreign objects are more often found in the stomach. Some of the undigested organic matter or partially digested food may form lumps which remain inside the stomach if they are too large to pass through the pyloric sphincter which regulates the passage of food from the stomach into the duodenum. Any object, whether it is a foreign body or a bezoar, having a diameter of three fourth of an inch or more may not be able to pass out into the intestine through the pyloric sphincter. The structure of the stomach with its curved shape is another reason for objects getting stuck there.
Indigestible material like hair or certain types of fiber contained in the fruits and vegetable, mixed with partially digested food particles and certain residue from drugs such as antacids clump together and become hardened lumps to form bezoars. They usually form in the stomach, but they can occur in other parts of the gastrointestinal tract too. They get stuck in parts of the digestive tract when they cannot pass through the smaller openings and valves at the junction of the different digestive organs.
Swallowing of small objects by children is very common. Adults too may swallow things intentionally or unintentionally, especially under the influence of intoxicants like alcohol. Smugglers swallow drug-containing balloons to pass through customs check at the airports.
Small objects usually pass down the digestive tract and out with the stool without causing any discomfort. Larger objects may get stuck in the esophagus or sometimes in the stomach, unable to move forward. Sharp objects like fish bones may pierce the wall of the digestive tract and remain stuck there.
Undigested food particles and other substances can accumulate in anyone’s digestive tract but certain conditions make some people more prone to it. Surgeries of the digestive tract, especially the surgical removal of a portion of the stomach or a part of the intestine, make people more prone to developing bezoars. People who have diabetes may have the problem of incomplete emptying of the stomach, which can lead to accumulation of food particles and lump formation.
Symptoms and Diagnosis
Foreign bodies and bezoars do not cause any symptoms in most cases. When the object swallowed is small and blunt, the person may feel that something has got stuck somewhere in the esophagus. Even when the object has moved on to the stomach, the feeling in the esophagus may remain. If the object swallowed is sharp, it may get stuck in the wall of the esophagus causing pain. If the object is small, it may not obstruct the passage of food. But if the object is large enough to completely block the esophagus, the person may not be able to swallow even the saliva and may start drooling and continuously spitting. Even if the person repeatedly tries to vomit, it may not be successful. If the esophagus gets pierced by a sharp object, serious consequences may result.
Occasionally, bleeding may occur due to foreign objects or bezoars and the stools may be stained with blood. When they cause partial or total obstruction in the stomach or in the small intestine, it may result in severe pain and cramping, loss of appetite, bloating and vomiting sometimes accompanied by fever. Obstruction in the large intestine is rare but perforations can occur there as well as in the small intestine and the stomach. Perforations are serious situations requiring immediate medical intervention as the content of the stomach and the intestines may spill into the abdominal cavity and cause a life threatening condition called peritonitis. Severe pain in the abdomen and fever are the usual symptoms which follows a leakage of the stool into the abdominal cavity. The person may faint, or go into shock, and it can even lead to a fatal outcome, if not treated promptly. When a drug-containing balloon is swallowed, there is the risk of the balloon bursting and releasing all its contents all at once leading to a dangerous overdosing of that drug.
When obstructions due to bezoars or other foreign bodies are seen on the x-ray, further investigations are done to rule out tumors. Endoscopic examination of the gastrointestinal tract is conducted using a flexible viewing tube to see the object directly. An ultrasound scan or a CT scan also may be useful in identifying the object but not necessary.
Treatment
As long as ingested foreign bodies or bezoars do not cause considerable discomfort, they are left alone. A small object like a coin usually passes out without any treatment. People may be advised to check the stools in the following days to ensure that the object has come out. A liquid diet is sometimes prescribed to aid in the elimination of the foreign body.
Larger bezoars may have to be broken down to facilitate their excretion or for easy removal. Instruments like forceps are used break the lump into smaller bits. Laser technology is also used for this purpose. Meat tenderizer or an enzyme called cellulase in a solution, when taken orally for many days, may help break down bezoars for easy elimination.
When a blunt object is detected in the esophagus, an attempt is made to help it pass down the digestive tract without surgical intervention. Intravenous administration of glucagon helps the esophagus to relax, which may help the onward movement of the object. Metoclopramide is a drug taken orally to make the muscles of the gastrointestinal tract to contract, propelling the foreign bodies and bezoars forward and out of the body. Sometimes, objects which are lodged in the esophagus can be removed by doctors with a forceps or with an endoscope which has a basket inserted through it.
To avoid the risk of sharp objects piercing the esophageal wall, they are always removed either surgically or by using an endoscope. Since batteries are corrosive in nature, they have to be removed to avoid causing chemical burns inside the esophagus. If drug-containing balloons are swallowed, they have to be removed as soon as possible to avoid drug overdose that can occur if they burst.
Share and Enjoy
What Is A Hiatal Hernia
What Is A Hiatal Hernia ? Hiatal hernia is the protrusion of the upper part of the stomach into the thoracic area through the hiatal opening in the diaphragm through which the esophagus passes into the abdominal area.
- The exact reason for this condition is unknown, but obesity, age, and smoking, are known to increase the risk of developing hiatal hernia.
- Hiatal hernia may be asymptomatic in most cases; but symptoms, when present, can vary from minor indigestion and esophageal reflux, to more troublesome cheat pain, difficulty in swallowing, belching and bloating.
- A barium swallow x-ray helps diagnose hiatal hernia.
- The symptoms due to hiatal hernia are treated by certain lifestyle changes and drug therapy. Occasionally surgery may be required to prevent dangerous complications.
Diaphragm is the thick muscular membrane between the thoracic (chest) cavity and the abdominal cavity. When any organ in the abdomen protrudes through the diaphragm, it is termed as diaphragmatic hernia. The esophagus passes from the thoracic cavity into the abdominal cavity through an opening in the diaphragm called esophageal hiatus. When a diaphragmatic hernia protrudes through the esophageal hiatus, it is known as hiatal hernia. The reason for the occurrence of this condition is not clear but it is prevalent in older people above the age of 50. It is more common in obese people, especially obese women, and in those who have the habit of smoking. Congenital defects and damage from injuries may be the cause of other forms of diaphragmatic hernia.
Hiatal hernias are of two types mainly:
- Sliding hiatal hernia - is a condition in which the upper part of the stomach, along with the junction of the esophagus and the stomach (gastroesophageal junction) slides up into the thoracic cavity through the esophageal hiatus.
- Paraesophageal hiatal hernia – occurs when the top most portion of the stomach protrudes into the thoracic cavity, to lie beside the esophagus, while the gastroesophageal junction remains in its normal position in the abdominal cavity.
Sliding hiatal hernia is a very common occurrence, with 40% people in the US having this condition. The frequency steadily increases with age so that among people above 60 years of age, the incidence is as high as 60%.
Symptoms
Sliding hiatal hernia does not usually cause any symptoms, especially if they are small. Minor symptoms which may occur are indigestion and gastroesophageal reflux. The symptoms are felt more often when people lie down after a meal or when the lean forward. Symptoms are worsened by activities such as lifting of heavy things and staining. During pregnancy also, people may have more severe symptoms.
Paraesophageal hiatal hernia has the potential of causing dangerous complications as it may get tightly pinched in the opening through which it protrudes, and the blood supply may get cut off. This dangerous condition is called strangulation, and it causes severe chest pain, difficulty in swallowing, bloating with gas, and belching. Strangulation is a medical emergency which requires immediate surgical intervention.
In both types of hiatal hernia there is a chance of the lining of the hernia bleeding, either slightly or massively, but it is not a very common occurrence.
Diagnosis and Treatment
An x-ray taken while slightly pressing down the abdomen can show the presence of hiatal hernia, but usually a barium swallow x-ray is done to get a better picture. The patient is given a radio opaque solution of barium to swallow prior to the x-ray so that the abnormalities in the digestive tract will be clearly shown in the image.
Sliding hiatal hernia may not need any medical treatment unless the symptoms such as gastroesophageal reflux are causing too much discomfort. Certain simple lifestyle changes may reduce the acid reflux considerably. Instead of a few large meals, several small meals should be consumed. Quitting the habit of smoking usually helps, so does reducing weight. People should avoid performing exercises or strenuous activities, as well as lying down, immediately after meals. Sleeping with the head in a higher position by raising the head of the bed, and wearing loose-fitting clothes also relieve reflux.
Dietary modifications which may help ease the discomfort due to this condition mainly involve avoiding foods which increase acidity. Acidic drinks such as colas and orange juice as well as other drinks like coffee and alcohol should be avoided. Food items to avoid include chocolate and onions in addition to all fatty foods. Avoiding acidic and spicy foods also helps. Drugs which inhibit the production of acids, and antacids which neutralize the acids produced by the stomach, help in reducing esophageal reflux.
Paraesophageal hiatal hernia poses a high risk of strangulation and may have to be surgically corrected by laparoscopic procedure. It is a minimally invasive surgery involving a small cut in the abdomen or chest to insert the laparoscope through which doctors can see the affected area while doing the surgical correction. In some instances, open surgery may be necessary.
Share and Enjoy
Travellers Diarrhea (Turista)
Travellers diarrhea is a type of gastroenteritis which usually develops during travels to places with inadequately treated water supply. The illness, characterized by diarrhea, nausea, and vomiting, is also known as turista.
- Nausea and vomiting, as well as diarrhea accompanied by abdominal pain and cramping, are the usual symptoms, but the severity of the symptoms may vary.
- Traveler’s diarrhea may be caused by viral or bacterial infection. Parasites also may be responsible.
- The infection originates from food or drink consumed on a visit to developing countries with inadequate water purification measures.
- The illness can be prevented by certain precautions such as using only carbonated drinks and bottled water for drinking purposes as well as for brushing teeth.
- The gastroenteritis is treated with rehydration therapy and drugs to control diarrhea. Sometimes antibiotics are also used for the treatment of travellers diarrhea.
The occurrence of Traveler’s diarrhea is common in people who visit developing countries which do not have a water supply system of purified water. Lack of immunity to local microorganisms, due to lack of previous exposure, is the main reason for this type of gastroenteritis affecting visitors. Bacterial infection by Escherichia coli, or viral infection by norovirus, is the usual cause of the disease. Avoiding drinking water from local sources is not sufficient to prevent this disease. If ice cubes made from ordinary water is added to bottled water, it may get contaminated. Brushing the teeth with tap water or eating from dishes rinsed in ordinary water may lead to infection. Eating fresh fruits with skin, even after washing them, can result in infection. Occasionally, certain parasitic infestations also cause travellers diarrhea.
Symptoms and Diagnosis
Nausea and vomiting as well as diarrhea are the usual symptoms. Abdominal pain and cramping are usually present. Rumbling of the intestines may be audible. Severity of the symptoms may vary and they usually start within 12 hours to three days after the consumption of contaminated water or food. Travellers diarrhea due to noro virus infection typically has symptoms such as headache and muscular pain in addition to vomiting. Diagnostic tests are not usually done, and the illness is often mild, with the patient recovering in about 3-5 days without any treatment.
Prevention
Travellers diarrhea may be prevented by taking a number of precautionary measures on traveling to susceptible areas:
- Eating in reputed restaurants following proper food hygiene practices
- Drinking only bottled water and carbonated drinks
- Eating only freshly cooked hot food
- Eating fruits only after peeling the skin
- Using bottled water to wash food items, cutlery, and toothbrush, and for rinsing the mouth
- Avoiding food and drinks at roadside eateries
- Avoiding fresh vegetables and fruits in salads
- Not participating in buffets, open air food fests and feasts
As a preventive measure, an antibiotic drug may be taken by people with lower immunity when they visit areas known to cause travellers diarrhea. Ciprofloxacin is the antibiotic of choice in such situations.
Treatment
When gastroenteritis develops, plenty of water and other liquids should be taken to compensate for the fluid loss due to diarrhea. An antidiarrheal drug like loperamide may be taken to control diarrhea. However, loperamide should not be taken if fever is present or if stools are bloody. Children below 2 years are also not treated with antidiarrheal drugs. Travelers developing fever or passing bloody stools should get medical care as soon as possible.
Antibiotic therapy is started if diarrhea persists with more than 3 bowel movements in an 8 hour period. Azithromycin, ciprofloxacin, rifaximin, or levofloxacin are given to adult patients, while children above 2 years of age are usually treated with azithromycin
Share and Enjoy
Clostridium perfringens Food Poisoning
Clostridium perfringens food poisoning is caused by the consumption of food containing a high concentration of Clostridium perfringens bacteria. The bacterial toxin responsible for the symptoms is produced inside the small intestine.
In most cases, the food poisoning due to Clostridium perfringens causes mild or moderate illness which resolve without any treatment. However, certain strains cause severe illness, causing damage to the small intestine called necrotic enteritis, which may become fatal due to septicemia. Meat and meat products are the usual foods contaminated by Clostridium perfringens bacteria. Thorough cooking of the food items may destroy some strains of the bacteria but not all.
Symptoms
Severe watery diarrhea accompanied by abdominal pain and cramping is the usual symptom which appear within 6 hours to a day of eating food containing a large number of Clostridium perfringens bacteria. Distention of the abdomen due to gas accumulation may be present. Though the illness is often mild, severe dehydration resulting from frequent watery stools can lead to complications such as very low blood pressure, leading to shock. Usually the symptoms subside after 24 hours, without any treatment.
Diagnosis and Treatment
The diagnosis of Clostridium perfringens food poisoning follows the news of an outbreak in the local area. Testing of the stool samples and the suspected food samples may help in confirming the diagnosis.
Treatment involves rehydration therapy and rest. Antibiotics are not usually used to treat the illness. Clostridium perfringens food poisoning can be prevented by proper handling of cooked meat which is not consumed immediately. It should be refrigerated without delay and should be thoroughly reheated before consumption.
Share and Enjoy
Staphylococcal Food Poisoning
Staphylococcal food poisoning is caused by the toxins produced in the food contaminated by staphylococcal bacteria. It results in nausea, vomiting, and diarrhea, accompanied by abdominal cramps.
The staphylococci bacteria are commonly found in the nose, mouth as well as the throat of people. They are present in the skin too, occasionally causing boils and other infections. They may grow in food, especially in milk, custard, fish and meat. Rather than the bacteria; it is the toxins made by the organism which are responsible for food poisoning. The contamination usually starts with unhygienic handling of food, especially by those with skin infections harboring staphylococcal bacteria. The bacteria multiply rapidly in undercooked food, and in cooked food remaining long at room temperature, producing the toxins which cause food poisoning.
Symptoms and Diagnosis
Nausea and severe vomiting are the usual symptoms of staphylococcal food poisoning and they usually appear within 2-8 hours of consuming food contaminated by staphylococcal bacteria. Abdominal pain and cramping as well as diarrhea are often present. Some people may develop symptoms such as fever and headache too. Dehydration due to severe vomiting may lead to low blood pressure, and eventually shock, if the water and electrolytes lost are not replenished effectively. In some cases, especially in very young children and among those who are already weak from illnesses and old age, staphylococcal food poisoning may have fatal consequences. But otherwise, people completely recover from the illness within 12 hours of the onset of symptoms.
The typical symptoms of gastroenteritis alert the doctor to the possibility of Staphylococcal food poisoning. A lab test can detect staphylococci in the food suspected to have caused the food poisoning, but it is not often necessary. If other people who have consumed the same food have developed similar symptoms, it may be considered as confirmation of staphylococcal food poisoning. Large scale infections originating from public sources such as restaurants are investigated further for public safety.
Prevention and Treatment
Staphylococcal food poisoning can be avoided by practicing good hygiene measures while preparing and preserving food. People who have skin lesions or infected sores should refrain from handling food till the infection clears off completely. Prepared food should not be left at room temperature for long. If prepared food is not consumed immediately, it should be cooled down fast, and refrigerated, to avoid the growth of staphylococcus.
Treatment involves rehydrating the body by plenty of fluid consumption. Since bacterial infection is not the cause of illness, but the ingestion of toxins produced by the bacteria, antibiotics are not needed. If nausea and vomiting are severe, the doctor may prescribe a suppository or give an injection to reduce them. Intravenous administration of fluids may be necessary to combat severe fluid loss.