Categories
Ailmemts & Remedies

Diverticular disease

Alternative Name:   Diverticulosis…………..click for picture

Definition:
Over a lifetime, it’s estimated the human gut digests more than 65 tonnes of food and drink. Much of this food will be low in fibre, putting the gut under strain.

One common outcome of this is diverticular disease, a condition affecting the large bowel, or colon, believed to be the result of too little fibre in the diet.

A diet low in fibre creates the ideal conditions for constipation to develop. When this happens, the pressure in the large part of the gut increases, which forces small parts of the gut lining outwards through the muscles surrounding the gut. This causes the lining to form small balloon-like pouches called diverticula..

CLICK & SEE THE PICTURES

Author: U.S. National Institute of Diabetes an...
Author: U.S. National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health (NIH) Source URL: http://win.niddk.nih.gov/publications/gastric.htm Copyright tag: Why? Because it’s from an NIH department. Category:Obesity images (Photo credit: Wikipedia)

Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.

click to see the picture

About one in two adults over 50 is affected, and most adults are affected by the time they reach 80 to 90. Men and women are affected equally.

Diverticular disease is very uncommon in countries such as Africa, where diets are high in fibre. In Western countries, where many people still don’t eat enough fibre, it becomes more common as people get older.

Symptoms:
Signs and symptomsMost people with colonic diverticulosis are unaware of this structural change. When symptoms do appear in a person over 40 years of age it is important to obtain medical advice and exclude more dangerous conditions such as cancer of the colon or rectum.

The clinical forms of colonic diverticulosis are

*Symptomatic colonic diverticulosis………..click to see the picture
This is the most common complication of colonic diverticulosis. This is when the motility (that is, the onward propulsive nature of contractions) of the bowel becomes disorganized. Sometimes, spasm can develop. This results in pain in the left lower abdomen and often is accompanied by the passage of small pelletty stools and slime which relieves the pain. Symptoms can consist of (1) bloating, (2) changes in bowel movements (diarrhea or constipation), (3) Non-specific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain, (4) abdominal pain, often aftick to see the pictureer meals often in the left lower abdomen. If these persist clinical investigation is advised.

*Complicated colonic diverticulosis
This is very uncommon but highly dangerous. The diverticulae may bleed, either rapidly (causing bleeding through the rectum) or slowly (causing anaemia). The diverticulae can become infected and develop abscesses, or even perforate. These are serious complications and medical care is needed. Infected diverticulae and development of abscesses merits the term diverticulitis. First time bleeding from the rectum, especially in individuals aged over age 40, could be due to colon cancer, colonic polyps and inflammatory bowel disease rather than diverticulosis and requires clinical investigation.

Infection in the diverticula, possibly caused by an impacted piece of faeces, is responsible for the inflammation that develops. When this happens – called diverticulitis – the pain is very severe and usually felt in the lower left side of the abdomen.

A person will often feel feverish and have nausea and vomiting. They may pass blood rectally.

Risk factors:
1.increasing age
2.constipation
3.a diet that is low in dietary fiber content or high in fat
4.high intake of meat and red meat
5.connective tissue disorders (such as Marfan syndrome) that may cause weakness in the colon wall.

The exact aetiology of colonic diverticulosis has yet to be fully clarified and many of the claims are only anecdotal.  The modern emphasis on the value of fiber in the diet began with Cleave. A strong case was made by Neil Painter  and Adam Smith  that a deficiency of dietary fiber is the cause of diverticular disease. They argued that the colonic muscles needed to contract strongly in order to transmit and expel the small stool associated with a fiber deficient diet. The increased pressure within the segmented section of bowel over years gave rise to herniation at the vulnerable point where blood vessels enter the colonic wall. Denis Burkitt had suggested that the mechanical properties of the colon may be different in the African and the European subjects. Because Africans eat a diet containing much more fiber than Europeans and use the natural squatting position for defecation, they pass bulky stools, and hence rarely if ever develop colonic diverticulosis. The US National Institutes of Health (NIH) considers the fiber theory “unproven.”

However, change in the strength of the colonic wall with age may be an aetiological factor. Connective tissue is a significant contributor to the strength of the colonic wall. The mechanical properties of connective tissue depend on a wide variety of factors, the type of tissue and its age, the nature of the intramolecular and intermolecular covalent cross links and the quantity of the glycosaminoglycans associated with the collagen fibrils. The submucosa of the colon is composed almost entirely of collagen, both type I and type III. Several layers of collagen fibres make up the submucosa of the human colon. The collagen fibril diameters and fibril counts are different between the left and right colon and change with age and in colonic diverticulosis,. The implication being that changes which are normally associated with ageing are more pronounced in colonic diverticulosis. Iwasaki found that the tensil strength of the Japanese colon obtained at postmortem declined with age. Similarly the mechanical properties of the colon are stronger in African than European subjects. However, this race-based claim is contradicted by the virtually identical incidence of diverticular disease in black and white Americans.

The strength of the colon decreases with age in all parts of the colon, except the ascending colon. The fall in tensile strength with age is due to a decrease in the integrity of connective tissue. Cross linkage of collagen is increased in colonic diverticulosis. The mucosal layer is possibly more elastic and it is likely that the stiffer external layers break and allow the elastic mucosa to herniate through forming a diverticulum. Collagen has intermolecular and intramolecular cross links which stabilise and give strength to the tissue in which it is located. Accumulation of covalently linked sugar molecules and related increasing cross linking products are found in a variety of tissues with ageing, skin, vascular tissue, the cordae tendinae of heart valves and the colon.  This reduces the strength and pliability of the collagen. Colonic diverticulosis increases in frequency with age.  There is a reduction in the strength of the colonic mucosa with age, and that increased contractions in the descending and sigmoid colon secondary to an insufficient fibre content of the diet cause protrusion through this weakened wall. Colonic diverticulosis is in general a benign condition of the bowel which uncommonly becomes symptomatic and even less commonly becomes a truly clinical complicated problem.

Diagnosis:
In cases of asymptomatic Diverticulosis, the diagnosis is usually made as an incidental finding on other investigations.

While a good history is often sufficient to form a diagnosis of Diverticulosis or Diverticulitis, it is important to confirm the diagnosis and rule out other pathology (notably colorectal cancer) and complications.

Investigations:-

*Plain Abdominal X-ray may show signs of a thickened wall, ileus, constipation, small bowel obstruction or free air in the case of perforation. Plain X-rays are insufficient to diagnose Diverticular Disease.

*Contrast CT is the investigation of choice in acute episodes of Diverticulitis and where complications exist.

*Colonoscopy will show the diverticulum and rule out malignancy. A Colonoscopy should be performed 4–6 weeks after an acute episode.

*Barium enema is inferior to colonoscopy in terms of image quality and is usually only performed if the patient has strictures or an excessively tortuous sigmoid colon where colonoscopy is difficult or dangerous.

*MRI provides a clear picture of the soft tissue of the abdomen, however its expense often outweighs the benefits when compared to contrast CT or colonoscopy.

*There is no blood test for Diverticulosis.

It is important to note that both Barium enema and Colonoscopy are contraindicated during acute episodes of diverticulitis.

Management  & Treatment:
Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high-fiber diet and fiber supplements are advisable to prevent constipation  . The American Dietetic Association recommends 20-35 grams each day. Wheat bran has much to commend it as this has been shown to reduce intra colonic pressure  Ispaghula is also effective at 1-2 grams a day. Colonic stimulants should be avoided. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says foods such as nuts, popcorn hulls, sunflower seeds, pumpkin seeds, caraway seeds, and sesame seeds have traditionally been labelled as problem foods for people with this condition; however, no scientific data exists to prove this hypothesis. The seeds in tomatoes, zucchini, cucumbers, strawberries, raspberries, and poppy seeds, are not considered harmful by the NIDDK. Treatments, like some colon cleansers, that cause hard stools, constipation, and straining, are not recommended. Some doctors also recommend avoidance of fried foods, nuts, corn, and seeds to prevent complications of diverticulosis. Whether these diet restrictions are beneficial is uncertain; recent studies have stated that nuts and popcorn do not contribute positively or negatively to patients with diverticulosis or diverticular complications. When the spasm pain is troublesome the use of peppermint oil (1 drop in 50 ml water), or peppermint tablets (e.g., colpermin), can be helpful. Complicated diverticulosis requires treatment of the complication. These complications are often grouped under a single diagnosis of diverticulitis and require skilled medical care of the infection, bleeding and perforation which may include intensive antibiotic treatment, intravenous fluids and surgery. Complications are more common in patients who are taking NSAIDS or aspirin. As diverticulosis occurs in an older population such complications are serious events.

Someone with diverticulitis may be treated at home with painkillers, antibiotics, laxatives and dietary advice. But diverticulitis is often severe, and can need hospital treatment with antibiotics and fluids given through a drip.

In some cases, the bowel may perforate, become obstructed or bleed heavily. When this happens, the situation becomes an emergency and an operation may be needed.

Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there’s little or no response to medication. Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.

Surgical treatment for diverticulitis removes the diseased part of the colon, most commonly, the left or sigmoid colon. Often the colon is hooked up or “anastomosed” again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks. In emergency surgeries, patients may require a temporary colostomy bag. Patients are encouraged to seek medical attention for abdominal symptoms early to help avoid complications.

Complications:
Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis (NIDDK website). Tears in the colon leading to bleeding or perforations may occur; intestinal obstruction may occur (constipation or diarrhea does not rule this possibility out); and peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation are also possible occurrences. Rarely, an enterolith may form.

Low fiber, high fat diet, constipation and use of stimulant laxatives increase the risk of bleeding, also history of diverticulitis increases the chance to bleed.

Infection of a diverticulum often occurs as a result of stool collecting in a diverticulum.

More than 10% of the US population over the age of 40 and half over the age of 60 has diverticulosis. This disease is common in the US, Britain, Australia, Canada, and is uncommon in Asia and Africa . Large-mouth diverticula are associated with scleroderma.

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://www.bbc.co.uk/health/physical_health/conditions/diverticulardisease1.shtml
http://en.wikipedia.org/wiki/Diverticulosis
http://www.fascrs.org/patients/conditions/diverticular_disease/

http://www.procto-med.com/images/2009/05/diverticular-disease.gif

Understanding Diverticular Disease

http://www.advgastro.com/diverticulitis.htm

Categories
Diagnonistic Test

Upper Endoscopy

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Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).

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For the procedure you will swallow a thin, flexible, lighted tube called an endoscope (EN-doh-skope). Right before the procedure the physician will spray your throat with a numbing agent that may help prevent gagging. You may also receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach.

The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don’t show up well on x rays. The physician can also insert instruments into the scope to treat bleeding abnormalities or remove samples of tissue (biopsy) for further tests.

Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.

The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 1 to 2 hours until the medication wears off.

Preparation
Your stomach and duodenum must be empty for the procedure to be thorough and safe, so you will not be able to eat or drink anything for at least 6 hours beforehand. Also, you must arrange for someone to take you home—you will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.

For More Information
American Gastroenterological Association (AGA)
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–654–5920
Email: info@gastro.org
Internet: www.gastro.org

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Sources: http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy/index.htm

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Categories
Diagnonistic Test

Upper GI Series

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The upper gastrointestinal (GI) series uses x rays to diagnose problems in the esophagus, stomach, and duodenum (first part of the small intestine). It may also be used to examine the small intestine. The upper GI series can show a blockage, abnormal growth, ulcer, or a problem with the way an organ is working.
Click to see the pictures>....(1)…..(2)..…..(3)....(4).……….(5)……....(6)
During the procedure, you will drink barium, a thick, white, milkshake-like liquid. Barium coats the inside lining of the esophagus, stomach, and duodenum, and makes them show up more clearly on x rays. The radiologist can also see ulcers, scar tissue, abnormal growths, hernias, or areas where something is blocking the normal path of food through the digestive system. Using a machine called a fluoroscope, the radiologist is also able to watch your digestive system work as the barium moves through it. This part of the procedure shows any problems in how the digestive system functions, for example, whether the muscles that control swallowing are working properly. As the barium moves into the small intestine, the radiologist can take x rays of it as well.

An upper GI series takes 1 to 2 hours. X rays of the small intestine may take 3 to 5 hours. It is not uncomfortable. The barium may cause constipation and white-colored stool for a few days after the procedure.

Preparation
Your stomach and small intestine must be empty for the procedure to be accurate, so the night before you will not be able to eat or drink anything after midnight. Your physician may give you other specific instructions.

For More Information:
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Sources:http://digestive.niddk.nih.gov/ddiseases/pubs/uppergi/index.htm

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Categories
Diagnonistic Test

Lower GI Series

Endoscopic image of colon cancer identified in...
Image via Wikipedia

A lower gastrointestinal (GI) series uses x rays to diagnose problems in the large intestine, which includes the colon and rectum. The lower GI series may show problems like abnormal growths, ulcers, polyps, diverticuli, and colon cancer.

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Before taking x rays of your colon and rectum, the radiologist will put a thick liquid called barium into your colon. This is why a lower GI series is sometimes called a barium enema. The barium coats the lining of the colon and rectum and makes these organs, and any signs of disease in them, show up more clearly on x rays. It also helps the radiologist see the size and shape of the colon and rectum.

You may be uncomfortable during the lower GI series. The barium will cause fullness and pressure in your abdomen and will make you feel the urge to have a bowel movement. However, that rarely happens because the tube used to inject the barium has a balloon on the end of it that prevents the liquid from coming back out.

You may be asked to change positions while x rays are taken. Different positions give different views of the colon. After the radiologist is finished taking x rays, you will be able to go to the bathroom. The radiologist may also take an x ray of the empty colon afterwards.

A lower GI series takes about 1 to 2 hours. The barium may cause constipation and make your stool turn gray or white for a few days after the procedure.

Preparation
Your colon must be empty for the procedure to be accurate. To prepare for the procedure you will have to restrict your diet for a few days beforehand. For example, you might be able to drink only liquids and eat only nonsugar, nondairy foods for 2 days before the procedure; only clear liquids the day before; and nothing after midnight the night before. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. To make sure your colon is empty, you will be given a laxative or an enema before the procedure. Your physician may give you other special instructions.

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Sources
: http://digestive.niddk.nih.gov/ddiseases/pubs/lowergi/index.htm

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Categories
Ailmemts & Remedies

Indigestion

Indigestion, also known as upset stomach or dyspepsia, is discomfort or a burning feeling in the upper abdomen, often accompanied by nausea, abdominal bloating, belching, and sometimes vomiting. Some people also use the term indigestion to describe the symptom of heartburn.

Indigestion might be caused by a disease in the digestive tract such as ulcer or gastroesophageal reflux disease (GERD), but for many people, it results from eating too much, eating too quickly, eating high-fat foods, or eating during stressful situations. Smoking, drinking too much alcohol, using medications that irritate the stomach lining, being tired, and having ongoing stress can also cause indigestion or make it worse.

Some people have persistent indigestion that is not related to any of these factors. This type of indigestion—called functional or nonulcer dyspepsia—may be caused by a problem in the muscular squeezing action of the stomach (motility).

To diagnose indigestion, the doctor might perform tests for problems, like ulcers. In the process of diagnosis, a person may have x rays of the stomach and small intestine or undergo endoscopy, in which the doctor uses an instrument to look at the inside of the stomach.

Avoiding the foods and situations that seem to cause indigestion in some cases is the most successful way to treat it. Heartburn caused by acid reflux is usually improved by treatment with antacids, H2-blockers, or proton pump inhibitors. Smokers can help relieve their indigestion by quitting smoking, or at least not smoking right before eating. Exercising with a full stomach may cause indigestion, so scheduling exercise before a meal or at least an hour afterward might help.

To treat indigestion caused by a functional problem in the digestive tract, the doctor may prescribe medicine that affects stomach motility.

Because indigestion can be a sign of, or mimic, a more serious disease, people should see a doctor if they have :

1.Vomiting, weight loss, or appetite loss

2.Black tarry stools or blood in vomit

3.Severe pain in the upper right abdomen

4.Discomfort unrelated to eating

5.Indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or arm

6.Symptoms that persist for more than 2 weeks

For More Information

International Foundation for Functional Gastrointestinal Disorders (IFFGD) Inc.
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org

Additional Information on Indigestion

The National Digestive Diseases Information Clearinghouse collects resource information on digestive diseases for National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Reference Collection. This database provides titles, abstracts, and availability information for health information and health education resources. The NIDDK Reference Collection is a service of the National Institutes of Health.

To provide you with the most up-to-date resources, information specialists at the clearinghouse created an automatic search of the NIDDK Reference Collection. To obtain this information, you may view the results of the automatic search on Indigestion.

If you wish to perform your own search of the database, you may access and search the NIDDK Reference Collection database online

Ayurvedic & Natural Treatment For Indigestion……………...(1).…….(2)…...(3).……(4)

Homeopathic Treatment for Indigestion……………...(1).………...(2)……..(3)

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

Source:http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/index.htm

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