Tag Archives: Stomach

Gastroparesis

Definition:
Gastroparesis (gastro-, “stomach” + -paresis, “partial paralysis”), also called delayed gastric emptying, is a medical condition consisting of a paresis (partial paralysis) of the stomach, resulting in food remaining in the stomach for an abnormally long time. Normally, the stomach contracts to move food down into the small intestine for additional digestion. The vagus nerve controls these contractions. Gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not properly function. Food then moves slowly or stops moving through the digestive tract….CLICK & SEE

YOU MAY CLICK & SEEOur Digestive System and How It Works 
Symptoms:
The most common symptoms of gastroparesis are the following:
*Chronic nausea (93%)
*Vomiting (especially of undigested food) (68-84%)
*Abdominal pain (46-90%)
*A feeling of fullness after eating just a few bites (60-86%)

Other symptoms include the following:
*Palpitations
*Heartburn
*Abdominal bloating
*Erratic blood glucose levels
*Lack of appetite
*Gastroesophageal reflux
*Spasms of the stomach wall
*Weight loss and malnutrition

Morning nausea may also indicate gastroparesis. Vomiting may not occur in all cases, as sufferers may adjust their diets to include only small amounts of food.

Symptoms may be aggravated by eating greasy or rich foods, large quantities of foods with fiber—such as raw fruits and vegetables—or drinking beverages high in fat or carbonation. Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases.

Causes:
Transient gastroparesis may arise in acute illness of any kind, as a consequence of certain cancer treatments or other drugs which affect digestive action, or due to abnormal eating patterns.

It is frequently caused by autonomic neuropathy. This may occur in people with type 1 or type 2 diabetes. In fact, diabetes mellitus has been named as the most common cause of gastroparesis, as high levels of blood glucose may affect chemical changes in the nerves.The vagus nerve becomes damaged by years of high blood glucose or insufficient transport of glucose into cells resulting in gastroparesis. Other possible causes include anorexia nervosa and bulimia nervosa, which may also damage the vagus nerve. Gastroparesis has also been associated with connective tissue diseases such as scleroderma and Ehlers-Danlos syndrome, and neurological conditions such as Parkinson’s disease. It may also occur as part of a mitochondrial disease.

Chronic gastroparesis can be caused by other types of damage to the vagus nerve, such as abdominal surgery.  Heavy cigarette smoking is also a plausible cause since smoking causes damage to the stomach lining.

Idiopathic gastroparesis (gastroparesis with no known cause) accounts for a third of all chronic cases; it is thought that many of these cases are due to an autoimmune response triggered by an acute viral infection. “Stomach flu”, mononucleosis, and other ailments have been anecdotally linked to the onset of the condition, but no systematic study has proven a link.

Gastroparesis sufferers are disproportionately female. One possible explanation for this finding is that women have an inherently slower stomach emptying time than men.A hormonal link has been suggested, as gastroparesis symptoms tend to worsen the week before menstruation when progesterone levels are highest. Neither theory has been proven definitively.

Gastroparesis can also be connected to hypochlorhydria and be caused by chloride, sodium and/or zinc deficiency, as these minerals are needed for the stomach to produce adequate levels of gastric acid (HCL) in order to properly empty itself of a meal.

Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. For reasons that are not very clear, gastroparesis is more commonly found in women than in men.

Complications:
The complications of gastroparesis can include

*severe dehydration due to persistent vomiting

*gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagus

*bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form

*difficulty managing blood glucose levels in people with diabetes

*malnutrition due to poor absorption of nutrients or a low calorie intake

*decreased quality of life, including work absences due to severe symptoms

Diagnosis:
Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the doctor may perform one or more of the following tests:

*Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy.

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Exercise on an Empty Stomach is good or bad

There is a misconception that if exercising without “fuel” you’ll burn more fat and calories. Turns out that this is actually probably not the best decision. According to the fitness experts at sparkpeople.com, if you do this, then “your body does not have enough adequate fuel to workout at it’s optimum level.” Here’s some more information about exercising on an empty stomach from Spark People‘s Exercise Tip of the Day.

Question: I heard that when you exercise on an empty stomach (such as first thing in the morning) you’ll burn more fat. Is this true?

Expert Answer:
In the morning, your body has gone 8+ hours since eating or drinking anything. Your blood sugar levels are lower at this point, and your body doesn’t have adequate fuel to workout optimally. Usually, experts recommend eating something–even if it’s just a small snack–within 2 hours before working out. When your body doesn’t have proper fuel in it, many problems can result, the lesser being that your workout performance suffers, and the greater being something like passing out during exercise.

However, every body is different. Some people can workout on an empty stomach with no problems, while others would end up very sick and feel the negative effects of it. When I workout in the morning, I always eat (and drink) something first thing after I wake up. Usually by the time I start my workout it doesn’t hurt my stomach to exercise with a bit of food on it.

Also, I think there might have been a bit of confusion here about metabolic rates in the morning. Eating breakfast in the morning has a positive effect on your metabolism, but exercising on an empty stomach does not. Some people say that it will burn fat stores, but overall, the number of calories your burn during a workout (regardless of where they come from) is much more important. Plus, fat burns in the carbohydrate flame. This means that exercising without eating (such as after “fasting” during sleep) your body does not burn fat efficiently, or sometimes at all.

Of course you should always check with your physician before starting any kind of exercise/workout routine, and try to eat something, like a banana, before hitting the gym or going for a cold, morning jog.

Disadvantages of exercising on empty stomach  exercise…

If you exercise on an empty stomach you’re more likely to get a shorter and less effective workout, due to:
*Unnecessary fatigue
*Lethargy
*Dizziness
*Dehydration

As a result, you burn less calories because you can’t keep going as long as you should have been able to.

It’s also thought that exercising on an empty stomach leads to eating more following the workout, which is counter productive in the end.

Advantages of eating before you workout:
*Helps energise your workout
*Prevents low blood sugars, which can make you feel dizzy, nauseous, and lethargic
*You can exercise more intensely
*Your workout will be more enjoyable overall
*Can boost your recovery time

So, what should you eat before exercise?

In his report, Eating for Peak Performance, Dr Derek Schramm states,

“Low-glycaemic index foods, such as rice, pasta, and bananas, should be consumed before exercise because they are absorbed into the blood stream at a lower rate, which will help sustain energy.

In studying the relationship between carbohydrate and fat metabolism during exercise, exercise physiologists have found that during the first 15 minutes of exercise, carbohydrates help to prime skeletal muscle for efficient fat burning. Thus, eating small amounts of low-glycaemic foods before exercise can help a dieting exerciser to lose fat.”

The bottom line is, we each have to find a system that works for us. You may be fine doing cardio without a meal in the morning, but strength training may require more fuel to really challenge your muscles. The best answer to this is to do what works for you. Don’t go hungry just because you think you’re burning more fat…after all, if you cut it short or lower the intensity because of low energy, how much fat are you burning anyway?

If you do eat before a workout, make sure you give your body time to digest. The larger the meal, the more time you’ll need. But, if you choose a light snack (100-200 calories) and stick with higher carb fare, you can probably exercise after about 30-60 minutes. Pre-workout snack ideas:
•Banana (or other type of fruit)
•Yogurt
•Oatmeal
•Energy bar or gel
•Fruit smoothie
•Sports drink

It is best to have a banana before working out. Some people like to have a cup of tea or coffee before exercising. The caffeine probably helps them to kick-start the regimen. You could carry water and a banana with you while exercising. If you prefer exercising during the day, make sure to schedule it at least two hours after a meal.

Ultimately, it is entirely up to you whether you do your morning workout on an empty stomach, or not.

But, if you have to cut your exercise routine short because your energy levels are so low, it is suggested a small snack beforehand, so you can get the most out of your exercise time.

Resources:
http://exercise.about.com/od/weightloss/f/emptystomach.htm
http://sports4allfoundation.blogspot.com/2011/12/exercising-on-empty-stomach-good-or-bad.html
http://www.telegraphindia.com/1130218/jsp/knowhow/story_16573126.jsp

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Pyloric stenosis

Alternative Name : Infantile hypertrophic pyloric stenosis

Definition:
Pyloric stenosis is a condition that causes severe vomiting in the first few months of life. There is narrowing (stenosis) of the opening from the stomach to the intestines, due to enlargement (hypertrophy) of the muscle surrounding this opening (the pylorus, meaning “gate”), which spasms when the stomach empties. It is uncertain whether there is a real congenital narrowing or whether there is a functional hypertrophy of the muscle which develops in the first few weeks of life. Babies with this condition may seem to always be hungry
click to see the pictures……..(01)...…(1)..….…(2).……..(3)....……
Pyloric stenosis also occurs in adults where the cause is usually a narrowed pylorus due to scarring from chronic peptic ulceration. This is a different condition from the infantile form.

Prompt treatment of pyloric stenosis is important for preventing complications. Pyloric stenosis can be corrected with surgery.

Males are more commonly affected than females, with firstborn males affected about four times as often, and there is a genetic predisposition for the disease. It is commonly associated with people of Jewish ancestry, and has multifactorial inheritance patterns. Pyloric stenosis is more common in Caucasians than Hispanics, Blacks, or Asians. The incidence is 2.4 per 1000 live births in Caucasians , 1.8 in Hispanics, 0.7 in Blacks, and 0.6 in Asians. It is also less common amongst children of mixed race parents.  Caucasian babies with blood type B or O are more likely than other types to be affected

Symptoms:
Signs of pyloric stenosis usually appear within three to five weeks after birth. Pyloric stenosis is rare in babies older than age 3 months.

Signs and symptoms are:
*Frequent projectile vomiting. Pyloric stenosis often causes projectile vomiting — the forceful ejection of milk or formula up to several feet away — within 30 minutes after your baby eats. Vomiting may be mild at first and gradually become more severe. The vomit may sometimes contain blood.

*Persistent hunger. Babies who have pyloric stenosis often want to eat soon after vomiting.

*Stomach contractions. You may notice wave-like contractions that move across your baby’s upper abdomen (peristalsis) soon after feeding but before vomiting. This is caused by stomach muscles trying to force food past the outlet of the pylorus.

*Dehydration. Your baby may cry without tears or become lethargic. You may find yourself changing fewer wet diapers or diapers that aren’t as wet as you expect.

*Changes in bowel movements. Since pyloric stenosis prevents food from reaching the intestines, babies with this condition may be constipated.

*Weight problems. Pyloric stenosis can prevent a baby from gaining weight, and can sometimes even cause weight loss.

*Less active or seems unusually irritable

*Urinating much less frequently or is having noticeably fewer bowel movements

 

Causes:
The cause of the thickening is unknown, although genetic factors may play a role. Children of parents who had pyloric stenosis are more likely to have this problem.

Normally, food passes easily from the stomach into the duodenum (the first part of the small intestine) through a valve called the pylorus. In pyloric stenosis, the muscles of the pylorus are thickened. This thickening prevents the stomach from emptying into the small intestine.

Risk Factors:
Risk factors for pyloric stenosis include:

*Sex. Pyloric stenosis occurs more often in males than in females.

*Birth order. About one-third of babies affected by pyloric stenosis are firstborns.

*Family history. More than 1 in 10 babies with pyloric stenosis has a family member who had the disorder.

*Early antibiotic use. Babies given certain antibiotics, such as erythromycin, in the first weeks of life for whooping cough (pertussis) have an increased risk of pyloric stenosis. In addition, babies born to mothers who were given certain antibiotics in late pregnancy also may have an increased risk of pyloric stenosis.

Complications:
Pyloric stenosis can lead to:

*An electrolyte imbalance. Electrolytes are minerals, such as chloride and potassium, that circulate in the body’s fluids to help regulate many vital functions, such as heartbeat. When a baby vomits every time he or she eats, dehydration and an imbalance of electrolytes eventually occurs

*Stomach irritation. Repeated vomiting can irritate your baby’s stomach. This irritation may even cause mild bleeding.

*Jaundice. Rarely, infants who have pyloric stenosis develop jaundice — a yellowish discoloration of the skin and eyes caused by a buildup of a substance secreted by the liver called bilirubin.

 

Diagnosis:
Diagnosis is via a careful history and physical examination, often supplemented by radiographic studies. There should be suspicion for pyloric stenosis in any young infant with severe vomiting. On exam, palpation of the abdomen may reveal a mass in the epigastrium. This mass, which consists of the enlarged pylorus, is referred to as the ‘olive,’ and is sometimes evident after the infant is given formula to drink. It is an elusive diagnostic skill requiring much patience and experience. There are often palpable (or even visible) peristaltic waves due to the stomach trying to force its contents past the narrowed pyloric outlet.

At this point, most cases of pyloric stenosis are diagnosed/confirmed with ultrasound, if available, showing the thickened pylorus. Although somewhat less useful, an upper GI series (x-rays taken after the baby drinks a special contrast agent) can be diagnostic by showing the narrowed pyloric outlet filled with a thin stream of contrast material; a “string sign” or the “railroad track sign”. For either type of study, there are specific measurement criteria used to identify the abnormal results. Plain x-rays of the abdomen are not useful, except when needed to rule out other problems.

Blood tests will reveal hypokalemic, hypochloremic metabolic alkalosis due to loss of gastric acid (which contain hydrochloric acid and potassium) via persistent vomiting; these findings can be seen with severe vomiting from any cause. The potassium is decreased further by the body’s release of aldosterone, in an attempt to compensate for the hypovolaemia due to the severe vomiting.

Pathophysiology
The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. The vomited material does not contain bile because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach.

This results in loss of gastric acid (hydrochloric acid). The chloride loss results in hypochloremia which impairs the kidney’s ability to excrete bicarbonate. This is the significant factor that prevents correction of the alkalosis.

A secondary hyperaldosteronism develops due to the hypovolemia. The high aldosterone levels causes the kidneys to:

*avidly retain Na+ (to correct the intravascular volume depletion)

*excrete increased amounts of K+ into the urine (resulting in hypokalaemia).

The body’s compensatory response to the metabolic alkalosis is hypoventilation resulting in an elevated arterial pCO2.=[pp\][[\=0808i[po9il;

 

Treatment:
Infantile pyloric stenosis is typically managed with surgery; very few cases are mild enough to be treated medically.

Prior to surgery and surgery alternatives:
The danger of pyloric stenosis comes from the dehydration and electrolyte disturbance rather than the underlying problem itself. Therefore, the baby must be initially stabilized by correcting the dehydration and hypochloremic alkalosis with IV fluids. This can usually be accomplished in about 24–48 hours.

Intravenous and oral atropine may be used to treat pyloric stenosis. It has a success rate of 85-89% compared to nearly 100% for pyloromyotomy, however it requires prolonged hospitalization, skilled nursing and careful follow up during treatment. It might be an alternative to surgery in children who have contraindications for anesthesia or surgery.

Surgery
The definitive treatment of pyloric stenosis is with surgical pyloromyotomy known as Ramstedt’s procedure (dividing the muscle of the pylorus to open up the gastric outlet). This is a relatively straightforward surgery that can possibly be done through a single incision (usually 3–4 cm long) or laparoscopically (through several tiny incisions), depending on the surgeon’s experience and preference.
CLICK & SEE THE PICTURES
Today, the laparoscopic technique has largely supplanted the traditional open repairs which involved either a tiny circular incision around the navel or the Ramstedt procedure. Compared to the older open techniques, the complication rate is equivalent, except for a markedly lower risk of wound infection.[9] This is now considered the standard of care at the majority of Children Hospitals across the US, although some surgeons still perform the open technique. Following repair, the small 3mm incisions are hard to see.

The vertical incision, pictured and listed above, is no longer usually required. Though many incisions have been horizontal in the past years.

Once the stomach can empty into the duodenum, feeding can commence. Some vomiting may be expected during the first days after surgery as the gastro-intestinal tract settles. Very occasionally the myotomy was incomplete and projectile vomiting continues, requiring repeat surgery. But the condition generally has no long term side-effects or impact on the child’s future.

Prognosis:
Surgery usually provides complete relief of symptoms. The infant can usually tolerate small, frequent feedings several hours after surgery.

Prevention
There are no known ways of preventing pyloric stenosis, although it is possible that breastfeeding might reduce the risk.

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/Pyloric_stenosis
http://www.mayoclinic.com/health/pyloric-stenosis/DS00815
http://www.nlm.nih.gov/medlineplus/ency/article/000970.htm
http://www.bbc.co.uk/health/physical_health/conditions/pyloricstenosis.shtml
http://www.empowher.com/media/reference/pyloric-stenosis

Study Finds Troubles With Gastric Band Surgery

A study has found that nearly half of a group of patients who received gastric band surgery for weight loss over ten years ago had the bands removed because of medical complications.

click & see

The study is the first to track laparoscopic gastric band surgery outcomes over a long period. The bands eroded in almost a third of the patients, and sixty percent went on to undergo additional weight loss surgery in spite of the bands.

According to the New York Times:
“Researchers concluded that the adjustable gastric band surgery, which is growing in popularity in the United States, ‘appears to result in relatively poor long-term outcomes.’ The results ‘are worse than we expected,’ said Dr. Jacques Himpens … lead author of the new study.”

Furthermore, significant bone loss has been shown to occur in teens receiving gastric bypass surgery, the same result that occurs in adults receiving this more invasive type of stomach surgery. Researchers took bone density measurements every three months for two years after the teen’s surgeries and according to USA Today found that:

“Two years after the surgery, the bone mineral content of the 61 obese teens studied had declined, on average, by 7.4 percent.”

Resources:
New York Times March 24, 2011
Archives of Surgery
USA Today April, 2011
Pediatrics March 28, 2011

Posted By Dr. Mercola | April 15 2011

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Some Health Quaries & Answers

Stop the bottle, spare the teeth  :

———————————————–

Q: My three and a half-year-old daughter has a poor appetite. She is only 10 kg while the expected weight is 15 kg (as per the pediatrician’s calculation). The doctor prescribed de-worming medication several times as well as tonics. I give her milk with Pediasure in a bottle at night. She has several decayed teeth and frequently complains of toothache.


A: Your daughter probably has caries. The bottle will worsen her cavities because the milk will stick to the teeth which will allow bacteria to thrive in her mouth. These milk teeth will eventually fall off and you may feel they do not require any treatment. But food will get stuck there and cause discomfort. This will make her reluctant to eat, resulting in inadequate weight gain. Also, she is old enough to discard the bottle. You are probably giving it to her in the hope that she receives some calories. Stop the bottle and take her to a dentist. He might be able to fill the cavities.

Hiatus hernia
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Q: I have heart burn all the time. After some tests the doctor found that I have hiatus hernia. What should I do?

A: The esophagus runs through the diaphragm to the stomach. It functions to carry food from the mouth to the stomach.The esophagus passes through the diaphragm just before it meets the stomach, through an opening called the esophageal hiatus.

 

A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity and/or smoking.


Hiatus hernia is a condition where part of the stomach slides into the chest cavity. Many hiatus hernias are asymptomatic. Pain occurs because of acid reflux from the stomach into the esophagus.

You can get relief by losing weight, not lying down for an hour after food, and using medications like omeprazole and pantoprazole. If the hiatus hernia is long-standing with severe symptoms, surgery may be required.

Sugar free
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Q: I am diabetic and have been taking Sugar Free in my coffee, tea and curd. Is it safe?


A:
There are many natural and synthetic sugar substitutes available. In India, the ones commonly used are saccharin and aspartame. Both have been certified as safe although initially saccharin was found to cause bladder cancer in mice. Aspartame consumption should not be more than 40 mg a day. In these circumstances, perhaps it is better for you to get used to tea and coffee without sugar.

Vital fluid
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Q: I am a 37-year-old woman. I am pale and the doctor said I am anaemic. My haemoglobin is 7gm. He gave me a capsule containing iron and zinc to be taken twice a day. After three months there has been no improvement. What should I do?

A: Your anaemia needs to be investigated. You may be losing blood because of heavy periods, piles or a stomach ulcer. Or you may have intestinal parasites that are depleting you of blood. Rarely, cancer may present itself as anaemia. If there is no cause for the anaemia other than iron and zinc deficiency, it should respond to supplements. The binding sites on the intestines for iron and zinc absorption are identical. If you consume a tablet containing both these elements they compete for the binding site and block it. To be effective, iron and zinc have to be taken as separate tablets or capsules 12 hours apart (one in the morning and the other in the evening). Or, you take iron one day and zinc the next.

Health hour
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Q: My son is unable to run or jog owing to a tight work schedule. Can he follow some other form of exercise?


A:
The requirements of exercise for the maintenance of health have increased from 30 minutes three times a week to an hour a day. If you son is unable to spare that kind of time, he can get more or less the same benefits by skipping or continuous stair climbing (up and down) for 20 minutes. Cross training and doing different activities probably deliver the best benefits as compared to repeating the same one. Different sets of muscles are used, producing all-round toning.

Source: The Telegraph ( Kolkata, India)

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