Tag: Digestive Disorders

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Ailmemts & Remedies

Peritonitis

Alternative Name: Abdominal wall inflammation

Definition:
Peritonitis is defined as inflammation of the peritoneum (the serous membrane which lines part of the abdominal cavity and some of the viscera it contains). It may be localised or generalised, generally has an acute course, and may depend on either infection (often due to rupture of a hollow organ as may occur in abdominal trauma) or on a non-infectious process.

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There are three types of Peritonitis:

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1.primary (spontaneous)
2.secondary (anatomic)………click to see
3.tertiary (peritoneal dialysis related)

Primary peritonitis is caused by the spread of an infection from the blood and lymph nodes to the peritoneum. This type of peritonitis is rare — less than 1% of all cases of peritonitis are primary. The more common type of peritonitis, called secondary peritonitis, is caused when the infection comes into the peritoneum from the gastrointestinal or biliary tract. Both cases of peritonitis are very serious and can be life threatening if not treated quickly

Signs and Symptoms:
The signs and symptoms of peritonitis include:

•Swelling and tenderness in the abdomen with pain ranging from dull aches to severe, sharp pain
•Fever and chills
•Loss of appetite
•Thirst
•Nausea and vomiting
•Limited urine output
•Inability to pass gas or stool

Risk Factors:
The following factors may increase the risk for primary peritonitis:

•Liver disease (cirrhosis)
•Fluid in the abdomen
•Weakened immune system
•Pelvic inflammatory disease
Risk factors for secondary peritonitis include:

•Appendicitis (inflammation of the appendix)
•Stomach ulcers
•Torn or twisted intestine
•Pancreatitis
•Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
•Injury caused by an operation
•Peritoneal dialysis
•Trauma

Diagnosis and investigations
Diagnosing peritonitis is accomplished through a medical procedure often colloquially referred to as a “cough test“.

Patient is asked to lie flat (in position for undertaking abdominal examination) and to give a deep cough.
Sometimes the patient is asked to stand, and then asked to turn their head and cough.
If this produces pain/tenderness/obvious discomfort, peritonitis can be considered as a differential diagnosis.
Obviously this is not a particularly specific or sensitive test, but may be highly suggestive when combined with other physical signs of peritonitis such as absent bowel sounds.
It is important to look at the patient’s face when carrying out this test, as they may later deny that they experienced pain.

A diagnosis of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, surgery is performed without further delay from other investigations. Leukocytosis, hypokalemia, hypernatremia and acidosis may be present, but they are not specific findings. Plain abdominal X-rays may reveal dilated, edematous intestines, although it is mainly useful to look for pneumoperitoneum (free air in the peritoneal cavity), which may also be visible on chest X-rays.

Definitive diagnosis of peritonitis is achieved via paracentesis (abdominal tap). More than 250 polymorphonuclear cells per ?L is considered diagnostic. In addition, gram stain, and culture with sensitivity of the peritoneal fluid can determine the underlying etiologic organism.

Causes

Infected peritonitis:-
*Perforation of a hollow viscus is the most common cause of peritonitis. Examples include perforation of the distal oesophagus (Boerhaave syndrome), of the stomach (peptic ulcer, gastric carcinoma), of the duodenum (peptic ulcer), of the remaining intestine (e.g. appendicitis, diverticulitis, Meckel diverticulum, inflammatory bowel disease (IBD), intestinal infarction, intestinal strangulation, colorectal carcinoma, meconium peritonitis), or of the gallbladder (cholecystitis). Other possible reasons for perforation include abdominal trauma, ingestion of a sharp foreign body (such as a fish bone, toothpick or glass shard), perforation by an endoscope or catheter, and anastomotic leakage. The latter occurrence is particularly difficult to diagnose early, as abdominal pain and ileus paralyticus are considered normal in patients who just underwent abdominal surgery. In most cases of perforation of a hollow viscus, mixed bacteria are isolated; the most common agents include Gram-negative bacilli (e.g. Escherichia coli) and anaerobic bacteria (e.g. Bacteroides fragilis). Fecal peritonitis results from the presence of faeces in the peritoneal cavity. It can result from abdominal trauma and occurs if the large bowel is perforated during surgery.

*Disruption of the peritoneum, even in the absence of perforation of a hollow viscus, may also cause infection simply by letting micro-organisms into the peritoneal cavity. Examples include trauma, surgical wound, continuous ambulatory peritoneal dialysis, intra-peritoneal chemotherapy. Again, in most cases mixed bacteria are isolated; the most common agents include cutaneous species such as Staphylococcus aureus, and coagulase-negative staphylococci, but many others are possible, including fungi such as Candida.

*Spontaneous bacterial peritonitis (SBP) is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination. It occurs either in children, or in patients with ascites. See the article on spontaneous bacterial peritonitis for more information.

*Systemic infections (such as tuberculosis) may rarely have a peritoneal localisation.

Non-infected peritonitis:-
*Leakage of sterile body fluids into the peritoneum, such as blood (e.g. endometriosis, blunt abdominal trauma), gastric juice (e.g. peptic ulcer, gastric carcinoma), bile (e.g. liver biopsy), urine (pelvic trauma), menstruum (e.g. salpingitis), pancreatic juice (pancreatitis), or even the contents of a ruptured dermoid cyst. It is important to note that, while these body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.

*Sterile abdominal surgery normally causes localised or minimal generalised peritonitis, which may leave behind a foreign body reaction and/or fibrotic adhesions. Obviously, peritonitis may also be caused by the rare, unfortunate case of a sterile foreign body inadvertently left in the abdomen after surgery (e.g. gauze, sponge).

*Much rarer non-infectious causes may include familial Mediterranean fever, porphyria, and systemic lupus erythematosus.

Pathology:-
The peritoneum normally appears greyish and glistening; it becomes dull 2–4 hours after the onset of peritonitis, initially with scarce serous or slightly turbid fluid. Later on, the exudate becomes creamy and evidently suppurative; in dehydrated patients, it also becomes very inspissated. The quantity of accumulated exudate varies widely. It may be spread to the whole peritoneum, or be walled off by the omentum and viscera. Inflammation features infiltration by neutrophils with fibrino-purulent exudation.

Treatment:-
Depending on the severity of the patient’s state, the management of peritonitis should be done.

Peritonitis is a potentially life-threatening condition, and you should see immediate emergency medical attention when symptoms occur. You will likely need to be hospitalized for treatment. You may need surgery to remove the source of infection, such as an inflamed appendix, or to repair a tear in the walls of the gastrointestinal or biliary tract. Antibiotics are used to control infection. Integrative therapies may also be used for supportive care when recovering from peritonitis.

Medications
Your doctor will prescribe antibiotics to kill bacteria and prevent the infection from spreading. The antibiotics prescribed vary, depending on the type of peritonitis and the organism causing the condition.

Surgery and Other Procedures
People with peritonitis often need surgery to remove infected tissue and repair damaged organs.

Nutrition and Dietary Supplements
Peritonitis is a medical emergency and should be treated by a medical doctor. Do not try to treat peritonitis with herbs or supplements. However, a comprehensive treatment plan for recovering from peritonitis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

When recovering from any serious illness, it is important to follow good nutrition habits:

•Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
•Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
•Avoid refined foods, such as white breads, pastas, and especially sugar.
•Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
•Use healthy oils in foods, such as olive oil or vegetable oil.
•Avoid caffeine and other stimulants, alcohol, and tobacco.
•Drink 6 – 8 glasses of filtered water daily.
•Ask your doctor about taking a multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
•Probiotic supplement (containing Lactobacillus acidophilus among other species), 5 – 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Probiotics can be especially helpful when taking antibiotics, because probiotics can help restore the balance of “good” bacteria in the intestines.

Herbs
Herbs are generally a safe way to strengthen and tone the body’s systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 – 10 minutes for leaf or flowers, and 10 – 20 minutes for roots. Drink 2 – 4 cups per day. You may use tinctures alone or in combination as noted.

Herbs can be used as a supportive therapy when you are recovering from peritonitis, but do not use herbs alone to treat peritonitis. Ask your doctor before taking any of the herbs listed below.

•Green tea (Camellia sinensis) standardized extract, 250 – 500 mg daily, for antioxidant, anti-inflammatory, and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
•Cat’s claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, to reduce inflammation. Cat’s claw also has antibacterial and antifungal effects.
•Olive leaf (Olea europaea) standardized extract, 250 – 500 mg one to three times daily, for antibacterial and antifungal effects. You may also prepare teas from the leaf of this herb.
•Milk thistle (Silybum marianum) seed standardized extract, 80 – 160 mg two to three times daily, for liver health.

Homeopathy
Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for peritonitis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type — your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

•Belladonna — for people who are hypersensitive to touch, have sudden attacks of pain that come and go, and have a high fever
•Arsenicum album — for people with a swollen abdomen, unquenchable thirst, extreme chills, and symptoms that worsen at night

Other Considerations:
Prognosis and Complications:-

Complications from peritonitis can include:

•Sepsis — an infection throughout the blood and body that can cause shock and multiple organ failure
•Abnormal clotting of the blood (generally due to significant spread of infection)
•Formation of fibrous tissue in the peritoneum
•Adult respiratory distress syndrome — a severe infection of the lungs
The prognosis for peritonitis depends on the type of the condition. For example, the outlook for people with secondary peritonitis tends to be poor, especially among the elderly, people with compromised immune systems, and those who have had symptoms for longer than 48 hours before treatment. The long-term outlook for people with primary peritonitis due to liver disease also tends to be poor. However, the prognosis for primary peritonitis among children is generally very good after treatment with antibiotics.
Supporting Research
Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006;100(4):1164-70.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea — a review. J Am Coll Nutr. 2006;25(2):79-99.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Schwartz SI, et al. Principles of Surgery. 8th ed. Vol. 2. New York, NY: McGraw-Hill; 2005.

Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J. Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Intensive Care Med. 2008 Sep;34(9):1580-92.

Tok D, Ilkgul O, Bengmark S, Aydede H, Erhan Y, Taneli F, et al. Pretreatment with pro- and synbiotics reduces peritonitis-induced acute lung injury in rats. J Trauma. 2007 Apr;62(4):880-5.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.

Yeh SL, Lai YN, Shang HF, Lin MT, Chiu WC, Chen WJ. Effects of glutamine supplementation on splenocyte cytokine mRNA expression in rats with septic peritonitis. World J Gastroenterol. 2005 Mar 28;11(12):1742-6.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Yue GG, Fung KP, Tse GM, Leung PC, Lau CB. Comparative studies of various ganoderma species and their different parts with regard to their antitumor and immunomodulating activities in vitro. J Altern Complement Med. 2006 Oct;12(8):777-89.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Peritonitis
http://www.umm.edu/altmed/articles/peritonitis-000127.htm

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Herbs & Plants

Uncaria Gambir

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Botanical Name: Uncaria Gambir
Family: Rubiaceae
Genus: Uncaria
Species: U. gambir
Kingdom: Plantae
Order: Gentianales
Common Name: :Catechu Pallidum, Terra Japonica, Gambier, Cutch; Gambir Cubique, Fr.; Catechu, P. G.; Katechu, Gambir-Catechu, G.; Catecu, It., Sp.

Habitat: It is a native of Malacca, Sumatra, Cochin-China, and other parts of Eastern Asia, and is largely cultivated in the islands of Bintang, Singapore, and Prince of Wales.

Description;This is a climbing shrub with slender stems somewhat thickened at the nodes; leaves ovate or oblong, entire, rounded at the base but abruptly attenuated at the summit, opposite and stipulated, smooth on both sides.
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The stem is woody, often angular; leaves oblong-ovate, 7.5-10 Cm. (3-4′) long, petiolate, acuminate, entire, smooth; flowers small, pinkish, in clusters, calyx and corolla 5-divided, stamens 5, ovary 2-celled; fruit 2.5 Cm. (1′) long, narrow, ovoid tapering at each end, dehiscent, pericarp dry; seeds numerous, minute, pale brown, rough, tailed at each end.
The flowers are small, crowded into a dense globular head on a hairy receptacle; the flower heads are borne on long axillary peduncles which bear in the middle a whorl of bracts. At the point where these bracts occur the peduncle breaks after the falling of the inflorescence and the remainder of the peduncle becomes elongated and curved into hooks by means of which the plant climbs. Corolla gamopetalous, trumpet-shaped, tube slender; fruit one inch long, pericarp dry, dehiscing vertically into two valves; seeds very numerous.

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The gambir is prepared by lopping off the leaves, shoots, and twigs of the plant, chopping them into pieces, and throwing them into an iron pot filled with boiling water. When the leaves are exhausted and the liquid sufficiently thick, it is poured into small wooden tubs, and so soon as sufficiently cool, a half-closed hand is plunged into the semi-fluid mass and a piece of light wood shaped like an elongated dice box rapidly worked up and down in the hollow formed by the hand. The extract begins to thicken by a process which is compared to crystallization. The mass is finally turned out, and cut into cubes, which are put upon trays and smoke-dried. This extract, which is known by the native Malays as pinang or siren was first brought to the attention of the profession by Campbell.

Enormous quantities of gambir are used both in Europe and America in tanning, calico printing, dyeing, as an ingredient in boiler compounds for preventing the hard scaly incrustation caused by certain kinds of water, and other art processes requiring tannic acid.

Vanderkleed and E’we call attention to the fact that the apparent alcohol soluble content of gambir may be unduly raised by the high moisture content of some of the commercial varieties, which they report as containing over 21 per cent. of moisture, all of which would be calculated in the alcohol soluble extractive by the ordinary methods in which no allowance is made for water. (J. A. Ph. A., 1914, 1685.)

Parts used for medicinal purposes:Leaves,Twigs
Constituents. Catechin,Catechutannic acid
Tannic acid 25-38 p. c, Catechin (catechuic acid) 20 29 p. c, ash 9 p. c.

Medical Action & Uses:
Gambir is a serviceable remedy in those cases where astringents are indicated.

The complaints to which it is best adapted are diarrhea dependent on debility or relaxation of the intestinal mucous membrane, and passive hemorrhages, particularly from the uterus. A small piece held in the mouth and allowed slowly to dissolve is an excellent remedy in relaxation of the uvula and the irritation of the fauces and troublesome cough which depend upon it. Applied to spongy gums, in the state of powder, it sometimes proves useful; and it has been recommended as a dentifrice in combination with powdered charcoal, Peruvian bark, myrrh, etc.

Uses. – Diarrhoea, leuchorrhoea, gonorrhoea, cough, chronic sore throat, phthisis, bronchitis, hemorrhages, relaxed uvula, ulcerated nipples, chronic ulcers, relaxed oral mucous membrane and spongy gums (mouth-wash). In the arts for tanning, dyeing.

Dose, from ten grains to half a drachm (0.65—2.0 Gm.), which should be frequently repeated, and is best given with sugar, gum arable, and water.

Extract (gambir)„ usually in cubical or rectangular pieces 20-30 Mm. (4/5 – 1 1/5′) broad, grayish-, reddish-brown, dull, porous, friable; internally light brown, dull earthy color; inodorous; taste bitterish, very astringent; microscopically – numerous acicular crystals, non-glandular hairs, tracheae, few starch grains, .005-015 Mm. (1/5000-1/1650) broad, bacteria (?). Tests: 1. Macerate 1 Gm. with water (50), brownish filtrate, + dilute ferric chloride T. S. – intense green; with copper sulphate T. S. – no precipitate. Solvents: water dissolves 65 p. c; alcohol GO p. c. Dose, gr. 5-30 (.3-2 Gm.).

KNOWN EFFECTS
Shrinks tissues. Interferes with absorption of iron and other minerals when taken internally.

UNPROVED SPECULATED BENEFITS
Decreases unusual bleeding. Treats chronic diarrhea. Is used as gargle for sore throats.

WARNINGS AND PRECAUTIONS
Don’t take if you:
Have any chronic disease of the gastrointestinal tract, such as stomach or duodenal ulcers, esophageal reflux (reflux esophagitis), ulcerative colitis, spastic colitis, diverticulosis, diverticulitis.

Consult your doctor if you:
Take this herb for any medical problem that doesn’t improve in 2 weeks. There may be safer, more-effective treatments. Take any medicinal drugs or herbs including aspirin, laxatives, cold and cough remedies, antacids, vitamins, minerals, amino acids, supplements, other prescription or non-prescription drugs.

Pregnancy:
Dangers outweigh any possible benefits. Don’t use.

Breast-feeding:
Dangers outweigh any possible benefits. Don’t use.

Infants and children:
Treating infants and children under 2 with any herbal preparation is hazardous.

Storage:
Keep cool and dry, but don’t freeze. Store safely away from children.

Safe dosage:
At present no “safe” dosage has been established.

TOXICITY
Rated relatively safe when taken in appropriate quantities for
short periods of time.
For symptoms of toxicity: See Adverse Reactions, Side Effects or Overdose Symptoms section below.

ADVERSE REACTIONS, SIDE EFFECTS OR OVERDOSE SYMPTOMS
Signs and symptoms:  What to do:
Diarrhea  Discontinue. Call doctor immediately.
Kidney damage characterized by  Seek emergency treatment.
blood in urine, decreased urine
flow, swelling of hands and feet.
Vomiting

Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:
http://www.henriettesherbal.com/eclectic/usdisp/ourouparia.html
http://www.healthse.com/vitamins/vitamin148.php
http://chestofbooks.com/health/materia-medica-drugs/Manual-Pharmacology/Gambir-Gambir.html

http://en.wikipedia.org/wiki/Uncaria_gambir

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Diagnonistic Test

Endoscopic Retrograde Cholangiopancreatography (ERCP)

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Definition:
Endoscopic retrograde cholangiopancreatography  (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.
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This procedure uses x-rays and an endoscope to see inside your digestive system and diagnose problems such as tumors, gallstones, and inflammation in your liver, gallbladder, bile ducts, or pancreas. Your doctor might use the test to investigate the cause of jaundice, upper abdominal pain, or unexplained weight loss.

Why an ERCP is Performed
ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice, or an ultrasound or CT scan that shows stones or a mass in these organs.

ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. Tumors, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic tubes that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Preparation
For a week before the test, don’t take aspirin or other NSAIDs because they can irritate the stomach lining and increase your chance of bleeding during the procedure. Also tell the doctor if you are taking blood-thinning medicines or any diabetes medications. People with heart valve problems may also have to take antibiotics before the procedure. Avoid eating or drinking anything for eight hours before the test because it needs to be done on an empty stomach.

Tell your doctor if you are allergic to iodine, which is used for the procedure. Arrange for someone to drive you home because the medication given during the test will make you drowsy.

Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home—you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.

What can be expected during ERCP
Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour. The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure or find it only slightly uncomfortable. You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum. As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor discomfort.

What happens when the test is performed
The test is performed by a specially trained gastroenterologist either in the doctor’s office or in a hospital. You are usually given a sedative through an IV line. You wear a hospital gown for the procedure and lie on your side against a backrest on an x-ray table. If you wear dentures, remove them. A local anesthetic is sprayed into your throat to prevent you from having a gag reflex (choking feeling) when the endoscope is placed inside. The endoscope is about a third of an inch in diameter and 21/2 feet long with a light on the end. It also has holes at the end that allow your doctor to pump air into your intestine, squirt fluid, and suck out liquid or air.

You are asked to swallow at the moment the tube is placed into your throat. This helps guide the endoscope into your esophagus.You are likely to feel pressure against your throat while the tube is in place and you might experience a “full” feeling in your stomach. The doctor or doctor’s assistant gently advances the tube until it reaches your duodenum, the first part of the small intestine.

Next, the doctor inserts a slender tube, called a cannula, through the endoscope, and places the tip of the cannula into the bile duct or the pancreatic duct. These ducts are natural tubes of tissue that drain liquids out of the liver and pancreas. Once the tip of the cannula is lodged inside one of these ducts, the doctor injects contrast dye (usually iodine) through the cannula. The dye can be seen by x-rays, so it lights up the ducts clearly on an x-ray image, showing any obstruction (such as from gallstones or cancer) or unusual widening of the ducts (indicating an obstruction in the past). It also can light up the gallbladder, which connects to the bile duct, and helps the doctor to visualize the liver and pancreatic tissue around the ducts.

Depending on what the x-rays show, the doctor may undertake different interventions using tools operated through the endoscope. The doctor can remove gallstones or take biopsies of suspicious tissue. He or she can prop open narrowed bile ducts with a stent, a tube-shaped object that can be inserted through the scope. Depending on what is done, the test can take from 30 minutes to two hours.

Risk Factors:Complications are rare. One possibility is aspiration-accidentally inhaling saliva into the lungs – which can cause pneumonia. Other risks include inflammation of the pancreas, infection, and bleeding. Injury to the lining of the stomach, esophagus, or intestine, as well as abdominal pain and fever, can also occur.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

Time required to do the test:
ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

What happens after the Test is over
You will be monitored in the endoscopy area for 1-2 hours until the effects of the sedatives have worn off. Your throat may be a little sore for a day or two. You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed.

Your surgeon will usually inform you of your test results on the day of the procedure. Biopsy results take several days to return, and you should make arrangements with your surgeon to get these results. The effects of sedation may make you forget what you were instructed after the procedure. Call your surgeon’s office for the results.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endoscopic-retrograde-cholangiopancreatography.shtml
http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/
http://www.alabangmedicalcenter.ph/patientscorner/ERCP.htm

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Diagnonistic Test

Barium Enema

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Alternative Names : Lower gastrointestinal series
Definition:
Barium enema is a special x-ray of the large intestine, which includes the colon and rectum. Before x-rays are taken, a liquid called barium sulfate is placed in the rectum. The liquid is a type of contrast. Contrast highlights specific areas in the body, creating a clearer image. The barium eventually passes out of the body with the stools.

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Because the colon and rectum are normally not visible on x-rays, you need to temporarily coat their inner surfaces with barium, a liquid that does show up on x-rays. This makes the outline of these organs visible on the x-ray pictures. This test is useful for diagnosing cancers and diverticuli (small pouches that may form in the intestinal wall).

How do you prepare for the test?
Tell your doctor if there is any chance you might be pregnant. If you have diabetes and take insulin, discuss this with your doctor before the test.

You will be given very specific instructions to ensure that your colon is completely empty before the test. You may be told to eat only a light breakfast and a liquid lunch and dinner (such as broth, fruit juice, or plain gelatin) on the day before the test. You may also be instructed to drink a large amount of clear liquid between meals and to avoid dairy products. You will need to take a laxative, a medicine that stimulates your intestine to move things through more quickly, so that you have a bowel movement to empty the colon. It is a good idea to stay at home or at least near a bathroom for a few hours after taking the laxative. On the day of the test, do not eat any breakfast.

How the Test is Performed
This test may be done in an office or a hospital radiology department. You lie on the x-ray table and a preliminary x-ray is taken. You will then be told to lie on your side. The health care provider will gently insert a well-lubricated tube (enema) into your rectum. The tube is connected to a bag that contains the barium. The barium flows into your colon.

A small balloon at the tip of the enema tube may be inflated to help keep the barium inside your colon. The health care provider monitors the flow of the barium on an x-ray fluoroscope screen, which is like a TV monitor.

You must completely empty your bowels before the exam. This may be done using an enema or laxatives combined with a clear liquid diet. Your health care provider will give you specific instructions. Thorough cleaning of the large intestine is necessary for accurate pictures.

There are two types of barium enemas:
1.Single contrast barium enema uses barium to highlight your large intestine.
2.Double contrast barium enema uses barium, but also delivers air into the colon to expand it. This allows for even better images.

You are asked to move into different positions and the table is slightly tipped to get different views. At certain times when the x-ray pictures are taken, you hold your breath and are still for a few seconds so the images won’t be blurry.

The enema tube is removed after the pictures are taken. You will be given a bedpan or helped to the toilet, so you can empty your bowels and remove as much of the barium as possible. One or two x-rays may be taken after you use the bathroom.

What happens when the test is performed?
You wear a hospital gown and lie on a table in the radiology department. To administer the enema, a nurse pushes a small tube an inch or two into your rectum, and then uses this tube to fill your colon and rectum with barium liquid. You may find the sensation of the filling of your colon somewhat strange (you might feel like you need to have a bowel movement), but it is not painful.

The x-ray for this test is taken as a video that begins immediately after your enema is started. The x-ray video is taken by a large camera positioned over your abdomen. Usually the room is darkened while the video is taken so that the doctor can watch the pictures on a TV screen. If the doctor wants to save a view in “freeze frame” (developed later for a closer look), you may be asked to hold your breath for a few seconds so that your breathing movement does not blur the image. A few more pictures may be taken after the lights are turned back on. After this, you are asked to empty your bowel in a nearby bathroom.

Usually one picture is taken of your abdomen after you have had your bowel movement, to make sure that the bowel has emptied well.

How the Test Will Feel
When barium enters your colon, you may feel like you need to have a bowel movement. You may also have a feeling of fullness, moderate to severe cramping, and general discomfort. Try to take long, deep breaths during the procedure. This may help you relax.

Risks Factors:
There are no significant risks. You will be exposed to a small amount of radiation during the test. The amount of radiation from a barium enema is larger than from a simple chest x-ray, but still very small — too small to be likely to cause any harm.

Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of the x-ray.

A more serious risk is a perforated colon, which is very rare.

Must you do anything special after the test is over?
In some cases, if some stool was still present in your colon despite your preparation the day before, the test must be repeated.

How long is it before the result of the test is known?
It takes the x-ray department 30 minutes to an hour to develop the pictures from your barium enema, and it will take additional time for a doctor to examine the x-rays and to decide how they look. Typically you can get the results within a day or two.

RESULTS:-

Normal Results: Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.

What Abnormal Results Mean

Abnormal test results may be a sign of:
*Acute appendicitis
*Cancer
*Colorectal polyps
*Diverticulitis
*Irritable colon
*Twisted loop of the bowel
*Ulcerative colitis

Additional conditions under which the test may be performed:
*Crohn’s disease
*Hirschsprung’s disease
*Intestinal obstruction
*Intussusception
*Ulcerative colitis

Resources:
https://www.health.harvard.edu/fhg/diagnostics/barium-enema.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003817.htm

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The Poop!

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Stool – Healthy and Unhealthy Stool:-

Click to see the  pictures of ->
Bristol  Stool  Chart

This writing might “stink” a little, but this information might serve as an important revelation to many particularly for elderly and persons with contineus stomac problem!

Human poops or  stools, is the waste product of the human digestive system and varies significantly in appearance, depending on the state of the whole digestive system, influenced and found by diet and health.

Normally stools are semisolid, with a mucus coating. Small pieces of harder, less moist feces can sometimes be seen impacted on the distal (leading) end. This is a normal occurrence when a prior bowel movement is incomplete; and feces are returned from the rectum to the intestine, where water is absorbed.

Meconium (sometimes erroneously spelled merconium) is a newborn baby’s first feces. Human feces are a defining subject of humor.

Some persons have bloody stools on and off, usually accompanied by a sight tinch of discomfort. Many times, this doesn’t appear as a threat or danger to them as they often regard it as constipation though they may be passionate lover of fruits and vegetables. This might go  on for some time until one day, bloody stools became really “bloody” and the pain became increasingly painful. Alarmed and paranoid, they call their dear ones who will  recommend  to see the doctor over at his or her clinic.

Now let us see What Does an Ideal Bowel Movement Look Like?

Click to see the pictures

Click for different pictures

Alternative practitioners often ask clients about their stool as part of their assessment. Find out what normal stool should look like, and learn about the causes of green stool, pale stool, yellow stool, blood in stool, mucus in stool, pencil thin stool, infrequent stool, and more.

What Does an Ideal [amazon_textlink asin=’B001U1UKOO’ text=’Bowel Movement’ template=’ProductLink’ store=’finmeacur-20′ marketplace=’US’ link_id=’5c1f8c56-ee7e-11e6-87a4-8d88514c5f8b’]

Look Like?
An ideal bowel movement is medium brown, the color of plain cardboard. It leaves the body easily with no straining or discomfort. It should have the consistency of toothpaste, and be approximately 4 to 8 inches long. Stool should enter the water smoothly and slowly fall once it reaches the water. There should be little gas or odor.

Stool That Sinks Quickly
Rapidly sinking stool can indicate that a person isn’t eating enough fiber-rich foods, such as vegetables, fruits, and whole grains, or drinking enough water. This stool is often dark because they have been sitting in the intestines for a prolonged time. Click to learn 5 tips to boost your water intake.

Pale Stool
Stool that is pale or grey may be caused by insufficient bile output due to conditions such as cholecystitis, gallstones, giardia parasitic infection, hepatitis, chronic pancreatitis, or cirrhosis. Bile salts from the liver give stool its brownish color. If there is decreased bile output, stool is much lighter in color.

Other causes of pale stool is the use of antacids that contain aluminum hydroxide. Stool may also temporarily become pale after a barium enema test.

Pale stool may also be shiny or greasy, float, and be foul smelling, due to undigested fat in the stool (see soft and smelly stool).

Soft, Smelly Stool
Soft, foul-smelling stool that floats, sticks to the side of the bowl, or is difficult to flush away may mean there is increased fat in the stools, called steatorrhea. Stool is sometimes also pale. Click to Learn more about the causes of soft, foul-smelling stool.

Mucus in Stool
Whitish mucus in stool may indicate there is inflammation in the intestines. Mucus in stool can occur with either constipation or diarrhea. Click to Read more about the causes of mucus in stool.

Green Stool
The liver constantly makes bile, a bright green fluid, that is secreted directly into the small intestine or stored in the gallbladder. Continue reading about the causes of green stool.

Loose Stool
In traditional Chinese medicine, loose stools, abdominal bloating, lack of energy, and poor appetite can be signs of a condition known as spleen qi deficiency. It doesn’t necessarily involve your actual spleen, but it is linked to tiredness and weak digestion brought on by stress and poor diet. Learn more about the causes of loose stool.

Pencil Thin Stool
Like loose stools, stool that is pencil thin can be caused by a condition known in traditional Chinese medicine as spleen qi deficiency.

Other symptoms of spleen qi deficiency are: easy bruising, mental fogginess, bloating, gas, loose stools, fatigue, poor appetite, loose stools with little odor, symptoms that worsen with stress, undigested food in the stools, and difficulty ending the bowel movement. Spleen qi deficiency can be brought on by stress and overwork.

Eating certain foods in excess is thought to worsen spleen qi deficiency. Offending foods include fried or greasy foods, dairy, raw fruits and vegetables, and cold drinks, all believed to cause “cold” and “dampness” in the body. Dietary treatment of spleen qi deficiency involves eating warm, cooked foods. Ginger tea and cinnamon tea are also warming.

Pencil thin stool can also be caused by a bowel obstruction. Benign rectal polyps, prostate enlargement, colon or prostate cancer are some of the conditions that can cause obstruction.

Infrequent Stool
With constipation, infrequent or hard stool is passed with straining. Learn about the causes of infrequent stool.

Pellet Stool
Pellet stool is stool that comes out in small, round balls. In traditional Chinese medicine, pellet stool is caused by a condition known as liver qi stagnation. Liver qi stagnation can be brought on by stress. Lack of exercise can worsen the problem. Find out more about the causes of pellet stool.

Yellow Stool
Yellow stool can indicate that food is passing through the digestive tract relatively quickly. Yellow stool can be found in people with GERD (gastroesophageal reflux disease). Symptoms of GERD include heartburn, chest pain, sore throat, chronic cough, and wheezing. Symptoms are usually worse when lying down or bending. Foods that can worsen GERD symptoms include peppermint, fatty foods, alcohol, coffee, and chocolate.

Yellow stool can also result from insuffient bile output. Bile salts from the liver gives stool its brownish color. When bile output is diminished, it often first appears as yellow stool. If there is a greater reduction in bile output, stool lose almost all of its color, becoming pale or grey.

If the onset is sudden, yellow stool can also be a sign of a bacterial infection in the intestines.

Yellowing of stool can be caused by an infection known as Giardiasis, which derives its name from Giardia, an anaerobic flagellated protozoan parasite that can cause severe and communicable yellow diarrhea. Another cause of yellowing is a condition known as Gilbert’s Syndrome. This condition is characterized by jaundice and hyperbilirubinemia when too much bilirubin is present in the circulating blood.

Dark Stool
Stool that is almost black with a thick consistency may be caused by bleeding in the upper digestive tract. The most common medical conditions that cause dark, tar-like stool includes duodenal or gastric ulcer, esophageal varices, Mallory Weiss tear (which can be linked with alcoholism), and gastritis.

Certain foods, supplements, and medications can temporarily turn stool black. These include:

*Bismuth (e.g. Pepto bismol)

*Iron

*Activated charcoal

*Aspirin and NSAIDS (which can cause bleeding in the stomach)

*Dark foods such as black licorice and blueberries

Stool can be black due to the presence of red blood cells that have been in the intestines long enough to be broken down by digestive enzymes. This is known as melena (or melaena), and is typically due to bleeding in the upper digestive tract, such as from a bleeding peptic ulcer. The same color change (albeit harmless) can be observed after consuming foods that contain substantial proportion of animal bloods, such as Black pudding or Ti?t canh. The black color is caused by oxidation of the iron in the blood’s hemoglobin (haemoglobin). Black feces can also be caused by a number of medications, such as bismuth subsalicylate, and dietary iron supplements, or foods such as black liquorice, or blueberries. Hematochezia (also haemochezia or haematochezia) is similarly the passage of feces that are bright red due to the presence of undigested blood, either from lower in the digestive tract, or from a more active source in the upper digestive tract. Alcoholism can also provoke abnormalities in the path of blood throughout the body, including the passing of red-black stool.

Dark stool can also occur with constipation.

If you experience this type of stool, you should see your doctor as soon as possible.

Blue Stool
Prussian blue, used in the treatment of radiation cesium and thallium poisoning, can turn the feces blue. Also, substantial consumption of products containing blue food dye (things such as blue koolaid or grape soda)

Bright Red Stool
When there is blood in stool, the color depends on where it is in the digestive tract. Blood from the upper part of the digestive tract, such as the stomach, will look dark by the time it reaches exits the body as a bowel movement. Blood that is bright or dark red, on the other hand, is more likely to come from the large intestine or rectum.

Conditions that can cause blood in the stool include hemorrhoids, anal fissures, diverticulitis, colon cancer, and ulcerative colitis, among others.

Eating beets can also temporarily turn stools and urine red.

Blood in stool doesn’t always appear bright red. Blood may be also present in stool but not visible, called “occult” blood. A test called the Fecal Occult Blood Test is used to detect hidden blood in stool.

Silver Stool
A tarnished-silver or aluminum paint-like stool color characteristically results when biliary obstruction of any type (white stool) combines with gastrointestinal bleeding from any source (black stool). It can also suggest a carcinoma of the ampulla of Vater, which will result in gastrointestinal bleeding and biliary obstruction, resulting in silver stool.

 

You may click to see white stool:–>   : Should I be concerned

Note: Speak with your doctor about any change or abnormality concerning bowel movements.

YOU MAY CLICK TO SEE :Doctors explain exactly how often you should be pooping and give tips for regularity

Resources
http://gracemagg.blogspot.com/2008/07/poop.html
http://altmedicine.about.com/od/gettingdiagnosed/a/stools.htm
http://www.healingwatersaz.com/colon.html

http://en.wikipedia.org/wiki/Human_feces

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