Module 4: Digestive system Pathology Notes
Diagnosis of Hirschsprung's disease
A barium enema is used to identify the narrow collapsed segment of bowel. The x-ray may show a constricted area, with a dilated area above. The dilated area may have pneumatosis, a "soap bubble" appearance. A biopsy, or tissue sample, from the part of the bowel an inch above the anus is necessary to confirm the absence of ganglia when the x-rays appear normal. Also, manometry may compliment the rectal biopsy. A small balloon is inflated inside the rectum. Normally, the anal muscle will relax. If it doesn't, HD may be the problem. This test is most often done in older children and adults who can cooperate.
Describe bowel obstruction
A bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. They may occur at any level in both the small bowel and large bowel.
Diagnosis of Hiatal Hernia
A chest x-ray may show an air shadow behind the heart. Barium studies will show reflux, and protrusion of abdominal structures into the thorax. Endoscopy and biopsy procedures may differentiate between hiatal hernias, small lesions and malignancies.
Diagnosis of Ulcerative Colitis
A doctor will likely diagnose ulcerative colitis only after ruling out other possible causes, including Crohn's disease, ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colorectal cancer. To help confirm a diagnosis of ulcerative colitis, one or more of the following tests and procedures may be done: Blood tests. Will check for anemia or signs of infection. Colonoscopy. This test allows the doctor to view the entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, small samples of tissue (biopsy) for laboratory analysis may be taken. Sometimes a tissue sample can help confirm a diagnosis. If there are clusters of inflammatory cells called granulomas, for instance, it's likely a patient has Crohn's disease, because granulomas don't occur with ulcerative colitis. Risks of this procedure include perforation of the colon wall and bleeding, especially when a biopsy is taken. Flexible sigmoidoscopy. In this procedure, a doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last 2 feet of the colon. Barium enema. A typical finding of a barium enema is a fine granularity of the mucosa. Eventually, the colon loses it's haustral pattern and the bowel appears smooth or "hose-like". Small bowel X-ray. This test can help distinguish between ulcerative colitis and Crohn's disease. CT and MRI can also be done. These tests are more sensitive for finding inflammation of the bowel.
Describe Hiatal Hernia
A hiatal hernia is a condition in which the upper part of the stomach pushes up through the diaphragm into the chest cavity. The loss of function in the lower esophageal sphincter allows movement of the stomach into the chest. There are two types of hiatal hernias: 1. A sliding hiatal hernia, which is more common, happens when a part of the stomach and gastroesophageal junction slip up and down through the diaphragm. 2. A paraesophageal hernia is much less common but can be more serious. This type occurs when part of the stomach slips through the opening of the diaphragm and becomes trapped and cannot return to the abdomen. Hiatal hernias often cause, or contribute to, gastroesophageal reflux disease (GERD). GERD occurs when a hernia displaces the lower esophageal sphincter upward a few inches above the diaphragm, causing reduced pressure on the valve, which opens at the wrong time, allowing stomach acid to reflux up into the esophagus.
Symptoms of Diverticulosis
A patient with diverticulosis may have few or no symptoms. When a diverticulum ruptures and becomes infected, the condition is called diverticulitis. A patient suffering from diverticulitis will have abdominal pain, abdominal tenderness, and fever. the most common sympton is bleeding (variable amounts) bloating abdominal pain/cramping after meals or otherwise often in the left lower abdomen changes in bowel movements (diarrhea or constipation) Sometimes, symptoms include nonspecific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain. The discomfort is sometimes described as a general feeling of pressure in the region, or pulling sensation. A tickling sensation may be felt as the small pockets fill and unfill; a feeling like gas may be moving in areas outside the colon. First-time bleeding from the rectum should be followed up with a physician, especially if over age 40 because of the possibility of colon cancer. Symptoms of anemia may present: fatigue, light-headedness, or shortness of breath.
Description of Diverticulosis
A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to as diverticula. Diverticula can occur throughout the colon but are most common near the sigmoid colon. The condition of having these diverticula in the colon is called diverticulosis. When diverticula rupture and become infected, it is called diverticulitis.
Diagnosis of Volvulus
A stool guaiac is positive for blood in the stool. An upper GI x-ray with small bowel follow-through shows a malrotated bowel or midgut volvulus. A CT scan may show evidence of intestinal obstruction. A barium enema often shows an abnormal position of the bowel, suggesting malrotation. The lumen of the bowel tapers toward the site of the stenosis and a bird's-beak appearance is produced. Blood tests to check the electrolytes may show abnormalities.
Describe Volvulus
A volvulus is a life-threatening bowel obstruction in which a loop of bowel has abnormally twisted on itself.
Describe Achalasia
Achaenlasia iengs a rare disease of the muscle of the esophagus. The term achalasia means "failure to relax" and refers to the inability of the lower esophageal sphincter to open and let food pass into the stomach. As a result, patients with achalasia have difficulty swallowing food.
What is Celiac disease
Also known as Sprue, gluten-induced enteropathy, or malabsorption syndrome, this is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, which is found in wheat, rye, barley, and oats. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the villi in the small intestine. Villi absorb nutrients into the bloodstream, and without villi, a person becomes malnourished.
Description of Hirschsprung's disease
Also known as congenital megacolon, aganglionosis, Hirschsprung's disease (HD) is an abnormality in which certain nerve fibers are absent in segments of the bowel, resulting in severe bowel obstruction. HD develops before a child is born. Normally, nerve cells (parasympathetic ganglion cells) grow in the wall of the baby's colon soon after the baby begins to grow in the womb. These nerve cells grow down from the top of the intestine all the way to the anus. With HD, the nerve cells stop growing before they reach the end. The affected segment of the intestine lacks the ability to relax and move bowel contents along. As a result of this area of constriction, the bowel proximal to the stricture dilates, producing megacolon. The disease affects varying lengths of bowel segment, most often involving the region around the recturm.
Etiology of Ulcerative Colitis
Although considerable progress has been made in IBD research, investigators do not yet know what causes this disease. Studies indicate that the inflammation in IBD involves a complex interaction of factors: the genes the person has inherited, the immune system, and something in the environment. Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body's defenses to produce an inflammation that continues without control. Researchers believe that once the IBD patient's immune system is "turned on," it does not know how to properly "turn off" at the right time. As a result, inflammation damages the intestine and causes the symptoms of IBD. That is why the main goal of medical therapy is to help patients regulate their immune system better. Like Crohn's disease, ulcerative colitis causes inflammation and ulcers in the intestine. But unlike Crohn's, which can affect the colon in various sections, ulcerative colitis usually affects one continuous section of the inner lining of the colon beginning with the rectum.
etiology of Esophageal varices
Blood flow through the spleen and liver slows down and results in increased pressure and accumulation of blood in the esophagus as it is unable to move effectively through the liver and spleen. The most common cause is cirrhosis in the liver, due to either alcoholism or hepatitis C. The liver becomes hardened and scarred, which results in increased resistance to the flow of blood through the portal (liver) circulation. As blood has more trouble getting through the liver, it "backs up" into several veins. Included are the splenic and mesenteric veins and eventually the esophageal veins, causing esophageal varies. It can also be caused by hepatitis B, extrahepatic portal vein occlusion from umbilical vein infection, trauma, or chronic pancreatitis. It can also be caused by malignant invasion of the liver sinusoids or the portal vein, which is seen in lymphoma, leukemia and other carcinomas.
what is the Etiology of Bowel Obstruction
Bowel obstruction may have two basic causes; one is an ileus, in which the bowel doesn't function correctly but there is no "mechanical" or anatomic problem. Second is a mechanical cause. The causes of ileus may include the following: Medications, especially narcotics Intraperitoneal infection Mesenteric ischemia (decreased blood supply to the support structures in the abdomen) Injury to the abdominal blood supply Complications of intra-abdominal surgery Kidney or thoracic disease Metabolic disturbances (such as decreased potassium levels) Mechanical obstruction occurs when movement of material through the intestines is physically blocked. The mechanical causes of obstruction are numerous and may include the following: Hernias Postoperative adhesions or scar tissue Impacted feces (stool) Gallstones Tumors blocking the intestines Granulomatous processes (abnormal tissue growth) Intussusception Volvulus (twisted intestine) Foreign bodies (ingested materials that obstruct the intestines) Causes of small bowel obstruction include: Adhesions from previous abdominal surgery Hernias containing bowel Crohn's disease causing adhesions or inflammatory strictures Neoplasms, benign or malignant Intussusception in children Volvulus Superior mesenteric artery syndrome, a compression of the duodenum by the superior (Links to an external site.)Links to an external site.mesenteric artery and the abdominal aorta Ischemic strictures Foreign bodies (e.g. gallstones in gallstone ileus, swallowed objects) Intestinal atresia Carcinoid rare, preferred location: ileum Causes of large bowel obstruction include: The leading cause of large bowel obstructions is from malignancies Neoplasms Hernias Inflammatory bowel disease Colonic volvulus (sigmoid, caecal, transverse colon) Fecal impaction Colon atresia Benign strictures (Diverticular Disease) Endometriosis
What are the symptoms of celiac disease
Celiac disease affects people differently. Some develop symptoms as children, others as adults. One factor thought to play a role in when and how celiac disease appears is whether, and how long, a person was breastfed. The longer one was breastfed, the later symptoms will appear. Other factors include the age at which one began eating foods containing gluten and how much gluten is eaten. Symptoms may or may not occur in the digestive system. One person may have diarrhea and abdominal pain, while another has irritability or depression. Irritability is one of the most common symptoms in children. Symptoms may include one or more of the following: recurring abdominal bloating and pain chronic diarrhea weight loss pale, foul-smelling stool unexplained anemia gas bone pain behavior changes muscle cramps fatigue delayed growth failure to thrive in infants pain in joints seizures sores inside the mouth tooth discoloration missed menstrual periods
what is the etiology of Celiac disease
Celiac disease is a serious autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications Sometimes the disease becomes active for the first time after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
Symptoms of Crohn's Disease include
Common symptoms of Crohn's disease include: abdominal pain diarrhea weight loss Less common symptoms include poor appetite fever night sweats rectal pain rectal bleeding The symptoms of Crohn's disease are dependent on the location, the extent, and the severity of the inflammation.
Describe Crohn's Disease
Crohn's disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It is named after the physician who described the disease in 1932. It also is called granulomatous enteritis or colitis, regional enteritis, ileitis, or terminal ileitis. Crohn's disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis. Together, Crohn's disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Both Crohn's disease and ulcerative colitis are inflammatory bowel diseases, but there are some key differences. Crohn's disease Inflammation may develop anywhere in the GI tract from the mouth to the anus Most commonly occurs at the end of the small intestine May appear in patches May extend through entire thickness of bowel wall About 67% of people in remission will have at least 1 relapse over the next 5 years Ulcerative colitis Limited to the large intestine (colon and rectum) Occurs in the rectum and colon, involving a part or the entire colon Appears in a continuous pattern Inflammation occurs in innermost lining of the intestine About 30% of people in remission will experience a relapse in the next year
What is the diagnosis of celiac disease
DNA testing is available (either via blood test or a cheek swab) to determine whether or not an at-risk individual carries the genes responsible for the development of celiac disease. These genes are located on the HLA-class II complex and are called DQ2 and DQ8. Each case of celiac disease has been found to show these so-called "haplotypes"; therefore, a negative gene test indicates that celiac disease cannot develop in that individual Diagnosis of celiac disease can be difficult because some of its symptoms are similar to those of other diseases, such as, Crohn's disease, ulcerative colitis, diverticulosis and depression. People with celiac disease have higher than normal levels of certain antibodies in their blood. Blood tests are done to measure various levels of antibodies to gluten. The antibodies are antigliadin, antiendomysium and antireticulin. If those tests and symptoms suggest celiac disease, a biopsy is done to check for damage to the villi. Biopsy of the small intestine is the best way to diagnose celiac disease. A small bowel study may be done that will reveal slowed barium passage. The bowel is dilated and the mucosal folds are thickened. In place of the normal continuous flow of barium, there may be clumping, so that the barium is broken up into multiple segments. The barium-filled loops of bowel may appear less opaque than normal because of dilution by excessive fluid. DNA testing is available (either via blood test or a cheek swab) to determine whether or not an at-risk individual carries the genes responsible for the development of celiac disease. These genes are located on the HLA-class II complex and are called DQ2 and DQ8. Each case of celiac disease has been found to show these so-called "haplotypes"; therefore, a negative gene test indicates that celiac disease cannot develop in that individual Diagnosis of celiac disease can be difficult because some of its symptoms are similar to those of other diseases, such as, Crohn's disease, ulcerative colitis, diverticulosis and depression. People with celiac disease have higher than normal levels of certain antibodies in their blood. Blood tests are done to measure various levels of antibodies to gluten. The antibodies are antigliadin, antiendomysium and antireticulin. If those tests and symptoms suggest celiac disease, a biopsy is done to check for damage to the villi. Biopsy of the small intestine is the best way to diagnose celiac disease. A small bowel study may be done that will reveal slowed barium passage. The bowel is dilated and the mucosal folds are thickened. In place of the normal continuous flow of barium, there may be clumping, so that the barium is broken up into multiple segments. The barium-filled loops of bowel may appear less opaque than normal because of dilution by excessive fluid.
Diagnosis of Pyloric Stenosis
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. 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 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". 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.
symptoms Intussusception
Early symptoms can include: nausea vomiting (sometimes bile-stained green in color) pulling legs to the chest moderate to severe cramping abdominal pain. Later signs include: rectal bleeding, often with red jelly-like stool (blood mixed with mucus) the physical examination may reveal a sausage-shaped mass felt upon palpation of the abdomen. Children that are too young to communicate may cry, draw their knees up to their chest, or experience dyspnea. Fever is not a symptom of intussusception. However, intussusception can cause a loop of bowel to become necrotic, which will lead to perforation and sepsis, which causes fever.
Treatment of Volvulus
Emergency surgery to repair the volvulus is necessary. An incision is made in the abdomen, the bowels are inspected, and the volvulus is reduced. This means that the bowels are untwisted and the blood supply restored. If a small segment of bowel is necrotic (dead from lack of blood flow), it is removed and the ends of the bowels sewn back together, or used to form a colostomy or ileostomy through which bowel contents can be removed. If the entire bowel is necrotic, the outlook is poor, and the situation may be fatal.
Description of Esophageal varices
Esophageal varices are a form of varicose veins, which means that they are distended, swollen, or knotted. Veins in the esophagus become varicose because the blood pressure in them has increased. This most often occurs in large collateral veins located in the submucosa of the esophagus, most prominently in the distal esophagus. When these veins become distended they tend to bleed. The bleeding may be heavy and can become a medical emergency because it is very difficult to stop the bleeding once it has started.
Symptoms of Hiatal Hernia
Heartburn A full feeling in the chest Belching Pain and breathing difficulties that mimics a heart attack. Most experience acid reflux. Paraesophageal hernias can cause pressure on the heart and reduce lung capacity.
Diagnosis of Esophageal varices
Hemorrhage is the usual first sign of esophageal varices, with the patient requiring emergency treatment. Upper GI - esophageal varices will appear as lucent, tortuous wave-like filling defects that deform the mucosal pattern so that the folds are no longer parallel. The filling defects are the result of enlarged collateral veins. The varices are best demonstrated after the passage of the main bolus. The Valsalva maneuver will further dilate the collateral veins and enlarge the filling defects. EGD - esophagogastroduodenoscopy - this will identify the exact site of the hemorrhage. Esophageal venogram Capsule endoscopy. In this test, the patient swallows a vitamin-sized capsule containing a tiny camera which takes pictures of the esophagus as it goes through the digestive tract.
etiology of Intussusception
In infants, the causes of intussusception are unknown, although there are some theories about why it occurs. Because intussusception is seen most often in spring and fall, this seems to suggest a possible connection to the kinds of viruses that children catch during these seasons, including upper respiratory infections. In some cases, intussusception may follow a recent bout of gastroenteritis. Gastrointestinal infections may cause swelling of the infection-fighting lymph tissue that lines the intestine, which may pull one part of the intestine into the other. Intussusception is most common around the age that infants are being introduced to solid foods. It has been suggested that the introduction of new foods may also cause some swelling of the lymph tissue in the intestines, increasing the chance of developing an instussusception. Usually when an adult or a child older than 3 develops an intussusception, it's often the result of enlarged lymph nodes, a tumor, or a polyp in the intestine.
treatment of Intussusception
In the developed world the condition is not immediately life-threatening. The intussusception is usually treated with either a barium or water-soluble contrast enema or an air-contrast enema, which both confirms the diagnosis of intussusception, and in most cases successfully reduces it. If the barium or air enema procedures aren't successful or the child is too ill to attempt the enema, the child will undergo surgery. Enemas are less successful in older children, and they're more likely to require surgery to treat intussusception. Surgeons will try to fix the obstruction but if too much damage has been done, that part of the bowel will be removed.
What are the symptoms of Obstructed Bowel
Intestinal obstruction causes a wide range of uncomfortable symptoms including: severe bloating abdominal pain decreased appetite nausea vomiting inability to pass gas or stool constipation diarrhea severe abdominal cramps abdominal swelling Some of the symptoms may depend on the location and length of time of the obstruction. For example, vomiting is an early sign of small intestine obstruction. This may also occur with an obstruction of the large intestine, if it's ongoing. A partial obstruction can result in diarrhea, while a complete obstruction can result in an inability to pass gas or stool. Intestinal obstruction may also cause serious infection and inflammation of the abdominal cavity, known as peritonitis. This occurs when a portion of the intestine has ruptured. It leads to fever and increasing abdominal pain.
Description of Intussusception
Intussusception occurs when one portion of the bowel slides into the next, much like the pieces of a telescope. When this occurs, it creates an obstruction in the bowel, with the walls of the intestines pressing against one another. This, in turn, leads to swelling, inflammation, and decreased blood flow to the intestines.
Treatment of Hiatal Hernia
Lifestyle and dietary changes are recommended for most people. These changes include weight loss, avoiding foods and beverages that aggravate the condition, decreasing meal portions and smoking cessation. Medications; *Antacids can temporarily neutralize the acidity in the esophagus. *H-2 blockers reduce the amount of acid produced by blocking histamine receptors. *Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. *Motility drugs act on the upper GI tract and can increase the strength of the lesser esophageal sphincter. Surgery is a last resort but may be necessary in extreme cases of esophagitis or if a paraesophageal hernia is in danger of becoming strangulated. Laparoscopic surgery is done to tighten the hole in the diaphragm and wrap the fundus of the stomach around the gastroesophageal junction.
Treatment of Diverticulosis
Medical 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 and the formation of more diverticula. Patients with mild symptoms of bloating or abdominal pain may benefit from anti-spasmodic drugs. 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; however, recent studies have mentioned nuts and popcorn do not contribute positively or negatively to one with diverticulosis or diverticular complications. When diverticulitis occurs, antibiotics are usually needed. Oral antibiotics are sufficient when symptoms are mild. Liquid or low fiber foods are advised during acute diverticulitis attacks. In severe diverticulitis with high fever and pain, patients are hospitalized and given intravenous antibiotics. Surgery is needed for those with persistent bowel obstruction or abscess not responding to antibiotics. Surgery Diverticulitis that does not respond to medical treatment requires surgical intervention. Surgery usually involves drainage of any collections of pus and resection of that segment of the colon containing the diverticuli, usually the sigmoid colon. Therefore, surgical removal of the bleeding diverticula is necessary for those with persistent bleeding. Sometimes, diverticula can erode into the adjacent bladder, causing severe recurrent urine infection and passage of gas during urination. This situation also requires surgery. Sometimes, surgery may be suggested for patients with frequent, recurrent attacks of diverticulitis leading to multiple courses of antibiotics, hospitalizations, and days lost from work.
What is the treatment for Crohn's disease
Medicines that may be prescribed include: Aminosalicylates (5-ASAs) are medicines that help control mild to moderate inflammation. Some forms of the drug are taken by mouth; others must be given rectally. Corticosteroids (prednisone and methylprednisolone) are used to treat moderate to severe Crohn's disease. They may be taken by mouth or inserted into the rectum. Immunomodulators such as azathioprine or 6-mercaptopurine help reduce the need for corticosteroids and can help heal some fistulas. Antibiotics may be prescribed for abscesses or fistulas. Biologic therapy is used to treat patients with severe Crohn's disease that does not respond to any other types of medication. Infliximab (Remicade) and adalimumab (Humira) are approved for Crohn's disease. They belong to a class of drugs called monoclonal antibodies, which help block an immune system chemical that promotes inflammation. Infliximab is also approved for patients with fistulous disease. Other related drugs are being studied. If medicines do not work, a type of surgery called bowel resection (Links to an external site.)Links to an external site. may be needed to remove a damaged or diseased part of the intestine or to drain an abscess. A procedure called anastomosis (Links to an external site.)Links to an external site. is done to connect the remaining two ends of the bowel. According to the Crohn's and Colitis Foundation of America, two-thirds to three-quarters of patients with Crohn's disease will need bowel surgery at some time. However, unlike ulcerative colitis (Links to an external site.)Links to an external site., surgically removing the diseased portion of the intestine does not cure the condition. Patients who have Crohn's disease that does not respond to medications may need surgery, especially when there are complications such as: Bleeding (hemorrhage) Fistulas Infections (abscesses) Narrowing (strictures) Some patients may need surgery to remove the entire large intestine (colon), with or without the rectum. No specific diet has been shown to improve or worsen the bowel inflammation in Crohn's disease. However, eating a healthy amount of calories, vitamins, and protein is important to avoid malnutrition and weight loss. Avoid foods that worsen diarrhea. Specific food problems may vary from person to person. People who have a blockage of the intestines may need to avoid raw fruits and vegetables. Those who have difficulty digesting milk sugar (lactose) may need to avoid milk products.
Diagnosis of Diverticulosis
Once suspected, the diagnosis of diverticular disease can be confirmed by a variety of tests. Barium enemas can be performed to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall. Direct visualization of the intestine can be done with flexible tubes inserted through the rectum and advanced into the colon. Either short tubes (sigmoidoscopes) or longer tubes (colonoscopes) may be used to assist in the diagnosis and to exclude other diseases that can mimic diverticular disease. In patients suspected of having diverticular abscess causing persistent pain and fever, ultrasound and CT scan examinations of the abdomen and pelvis can be done to detect collections of pus fluid.
Description forPyloric Stenosis
Pyloric stenosis is a narrowing of the pylorus, the lower part of the stomach through which food and other stomach contents pass to enter the small intestine. When an infant has pyloric stenosis, the muscles in the pylorus have become enlarged to the point where food is prevented from emptying out of the stomach.
Etiology of Hiatal Hernia
Several things can cause this: Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen, resulting in a hiatal hernia. Obesity can contribute to hiatal hernias due to the increased pressure in the abdomen. Medications, especially smooth muscle relaxants, oral bronchodilators, calcium channel blockers, and diazepam can cause a lack of muscle tone in the sphincter. Trauma can cause tearing of the diaphragm. Loosening of the muscle tone of the sphincter may be caused by normal aging and pregnancy, as well as by fatty foods, alcohol, coffee, and nicotine. Some cases are present at birth.
What is the treatment of obstructed bowel
Some causes of bowel obstruction may resolve spontaneously; many require operative treatment. Other treatement options are nasogastric suction, IV fluids, and IV antibiotics if bowel ischemia is suspected. In adults, frequently the surgical intervention and the treatment of the causative lesion are required. In malignant large bowel obstruction, endoscopically placed self-expanding metal stents may be used to temporarily relieve the obstruction as a bridge to surgery, or as palliation.
symptoms of Hirschsprung's disease
Symptoms of HD usually show up in very young children. However, sometimes they don't appear until the person is a teenager or an adult. The symptoms are different for different ages. Newborns with HD don't have their first bowel movement when they should. They are unable to pass meconium, the sticky substance that is a newborn's first bowel movement in the first 24 hours after birth. They may also throw up green bile after eating. Their abdomens may be distended and the children are uncomfortable and fussy. They can develop infections. The most life-threatening emergency is enterocolitis, a severe inflammatory condition of the bowel wall. Enterocolitis can lead to severe diarrhea and massive fluid loss, which can cause death from dehydration unless surgery is done immediately to relieve the obstruction. Most children have always had severe problems with constipation. Some also have more diarrhea than usual. They may also be anemic because blood is lost in the stool. Babies grow and develop more slowly than they should. Teenagers and adults usually have had severe constipation all their lives. They may also be anemic.
symptoms of Pyloric Stenosis
Symptoms of pyloric stenosis generally begin around 3 weeks of age. They include: Vomiting - The first symptom of pyloric stenosis is usually vomiting. At first it may seem that the baby is simply spitting up frequently, but then it tends to progress to projectile vomiting, in which the breast milk or formula is ejected forcefully from the mouth, in an arc, sometimes over a distance of several feet. Projectile vomiting usually takes place soon after the end of a feeding, although in some cases it may be delayed for hours. Rarely, the vomit may contain blood. In some cases, the vomited milk may smell curdled because it has mixed with stomach acid. The vomit will not contain bile, a greenish fluid from the liver that mixes with digested food after it leaves the stomach. Despite vomiting, a baby with pyloric stenosis is usually hungry again soon after vomiting and will want to eat. The symptoms of pyloric stenosis can be deceptive because even though a baby may seem uncomfortable, he may not appear to be in great pain or at first look very ill. Changes in stools - Babies with pyloric stenosis usually have fewer, smaller stools because little or no food is reaching the intestines. Constipation or stools that have mucus in them may also be symptoms. Failure to gain weight and lethargy - Most babies with pyloric stenosis will fail to gain weight or will lose weight. As the condition worsens, they are at risk for developing fluid and salt abnormalities and becoming dehydrated. Dehydrated infants are lethargic and less active than usual, and they will develop a sunken "soft spot" on their heads, sunken eyes, and a doughy, softened, or wrinkled appearance of the skin on the belly and upper parts of the arms and legs. Because urine output is decreased, it may be more than 4 to 6 hours between wet diapers. After feedings, increased stomach contractions may make noticeable ripples, or waves of peristalsis, which move from left to right over the infant's belly as the stomach tries to empty itself against the thickened pylorus.
Etiology of Hirschsprung's disease
The cause is unknown. Some children who have HD also have other health problems, such as Down's syndrome. There may be a genetic basis since up to 50% of siblings are also affected by HD
What is the etiology of Crohn's disease
The cause of Crohn's disease is unknown. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohn's disease. To date, however, there has been no convincing evidence that the disease is caused by infection. Activation of the immune system in the intestines appears to be important in IBD. The immune system is composed of immune cells and the proteins that these immune cells produce. Normally, these cells and proteins defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. (Inflammation is an important mechanism of defense used by the immune system.) Normally, the immune system is activated only when the body is exposed to harmful invaders. In patients with IBD, however, the immune system is abnormally and chronically activated in the absence of any known invader. The continued abnormal activation of the immune system results in chronic inflammation and ulceration. The susceptibility to abnormal activation of the immune system is genetically inherited. Thus, first degree relatives (brothers, sisters, children, and parents) of patients with IBD are more likely to develop these diseases. Recently a gene called NOD2 has been identified as being associated with Crohn's disease. This gene is important in determining how the body responds to some bacterial products. Individuals with mutations in this gene are more susceptible to developing Crohn's disease.
What is the etiology of Achalasia
The cause of achalasia is unknown. Theories include infection, heredity or an abnormality of the immune system that causes the body itself to damage the esophagus (autoimmune disease). The esophagus contains both muscle and nerves. The nerves coordinate the relaxation and opening of the sphincters as well as the peristaltic waves in the body of the esophagus. Achalasia has effects on both the muscles and nerves of the esophagus; however, the effects on the nerves are believed to be the most important. Early in achalasia, inflammation can be seen under the microscope in the muscle of the lower esophagus, especially around the nerves. As the disease progresses, the nerves begin to degenerate and ultimately disappear, particularly the nerves that cause the lower esophageal sphincter to relax. Still later in the progression of the disease, muscle cells begin to degenerate, possibly because of the damage to the nerves. The result of these changes is a lower sphincter that cannot relax and muscle in the lower esophageal body that cannot support peristaltic waves. With time, the body of the esophagus stretches and becomes dilated.
What is the diagnosis of Crohn's
The diagnosis of Crohn's disease is suspected in patients with fever, abdominal pain and tenderness, diarrhea with or without bleeding, and anal diseases. Laboratory blood tests may show elevated white cell counts and sedimentation rates, both of which suggest infection or inflammation. Other blood tests may show low red blood cell counts (anemia), low blood proteins, and low body minerals, reflecting loss of these elements due to chronic diarrhea. Barium x-ray studies can be used to define the distribution, nature, and severity of the disease. Barium x-rays can show ulcerations, narrowing, and, sometimes, fistulae of the bowel. The earliest finding are tiny erosion that appear as collections of barium with a thin halo of edema around them. As Crohn's progresses, the ulcers become deeper and more irregular. Deep linear ulcers separate loops of bowel. Direct visualization of the rectum and the large intestine can be accomplished with flexible viewing tubes (colonoscopes). Colonoscopy is more accurate than barium x-rays in detecting small ulcers or small areas of inflammation of the colon and terminal ileum. Colonoscopy also allows for small tissue samples (biopsies) to be taken and sent for examination under the microscope to confirm the diagnosis of Crohn's disease. Colonoscopy also is more accurate than barium x-rays in assessing the degree (activity) of inflammation. CT allows imaging of the entire abdomen and pelvis. It can be especially helpful in detecting abscesses. Most recently, video capsule endoscopy has been added to the list of diagnostic tests for diagnosing Crohn's disease. For video capsule endoscopy, a capsule containing a miniature video camera is swallowed. As the capsule travels through the small intestine, it sends video images of the lining of the small intestine to a receiver carried on a belt at the waist. The images are downloaded and then reviewed on a computer. The value of video capsule endoscopy is that it can identify the early, mild abnormalities of Crohn's disease. Video capsule endoscopy may be particularly useful when there is a strong suspicion of Crohn's disease but the barium x-rays are normal. (Barium x-rays are not as good at identifying early, mild Crohn's disease.) Video capsule endoscopy should not be performed in patients who have obstruction of the small intestine. The capsule may get stuck behind the obstruction and make the obstruction worse. Doctors usually also are reluctant to perform video-capsule endoscopy for the same reason in patients who they suspect of having small intestinal strictures (narrowed segments of small intestine that can result from prior surgery, prior radiation, or chronic ulceration, for example, from Crohn's disease). There is also a theoretical concern for electrical interference between the capsule and implanted cardiac pacemakers and defibrillators; however, so far in a small number of patients with pacemakers or defibrillators who have undergone video capsule endoscopy there have been no problems.
what is the diagnosis of Achalasia
The diagnosis of achalasia often is suspected on the basis of the history. Patients usually describe a progressive worsening of dysphagia for solid and liquid food over a period of many months to years. They may note regurgitation of food, chest pain, or loss of weight. Rarely, the first symptom is aspiration pneumonia. X-ray studies The diagnosis of achalasia usually is made by an esophagram. The barium fills the esophagus, and the emptying of the barium into the stomach can be observed. The esophagus is dilated, with a characteristic tapered narrowing of the lower end, sometimes likened to a "bird's beak." In addition, the barium stays in the esophagus longer than normal before passing into the stomach. Esophageal manometry Another test, esophageal manometry, can demonstrate specifically the abnormalities of muscle function that are characteristic of achalasia, that is, the failure of the muscle of the esophageal body to contract with swallowing and the failure of the lower esophageal sphincter to relax. For manometry, a thin tube that measures the pressure generated by the contracting esophageal muscle is passed through the nose, down the back of the throat and into the esophagus. In a patient with achalasia, no peristaltic waves are seen in the lower half of the esophagus after swallows, and the pressure within the contracted lower esophageal sphincter does not fall with the swallow. An advantage of manometry is that it can diagnose achalasia early in its course at a time at which the esophagram may be normal. Endoscopy Endoscopy also is helpful in the diagnosis of achalasia although it can be normal early in achalasia. Endoscopy is a procedure in which a flexible fiberoptic tube with a light and camera on the end is swallowed. The camera provides direct visualization of the inside of the esophagus. One of the earliest endoscopic findings in achalasia is resistance as the endoscope is passed from the esophagus and into the stomach due to the high pressure in the lower esophageal sphincter. Later, endoscopy may reveal a dilated esophagus and a lack of peristaltic waves. Endoscopy also is important because it excludes the presence of esophageal cancer.
diagnosis of Intussusception
The doctor will perform a physical exam on the child, paying special attention to the abdomen. Often, the doctor can feel the part of the intestine that's involved. If the doctor thinks an intussusception may be the cause of the child's pain, a pediatric surgeon will be consulted to examine the child and decide about treatment. The doctor may order an abdominal X-ray, which may or may not show an obstruction. An ultrasound examination may also help make the diagnosis. A barium or air enema is often used to both diagnose and treat a suspected intussusception. Barium outlines the bowels on the X-rays and, if an intussusception is present, shows the doctors the telescoping piece of intestine. Radiographically, an intussusception produces a classic coiled-spring appearance of barium trapped between the intussusceptum and the surrounding portions of bowel.
Etiology of Pyloric Stenosis
The exact cause for pyloric stenosis is unknown. Researchers believe that genetics are involved, as the condition often runs in families. Possible causes that are under investigation include the following: Allergic reactions Problems with maternal hormones Nerves, chemicals, and enzymes produced by the body that do not interact with the pylorus correctly (Nitric oxide, which is a chemical that helps to regulate the pyloric muscles, may play a role.)
what is the diagnosis of obstructed bowel
The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning and/or ultrasound. If a mass is identified, biopsy may determine the nature of the mass. Radiological signs of bowel obstruction include bowel distension and the presence of multiple (more than six) gas-fluid levels on supine and erect abdominal radiographs. Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction. Colonoscopy, small bowel investigation with ingested camera or push endoscopy, and laparoscopy are other diagnostic options On plain x rays, a ladder-like series of distended small-bowel loops is typical of small-bowel obstruction but may also occur with obstruction of the right colon. Fluid levels in the bowel can be seen in upright views In large-bowel obstruction, abdominal x ray shows distention of the colon proximal to the obstruction. In cecal volvulus, there may be a large gas bubble in the mid-abdomen or left upper quadrant. With both cecal and sigmoidal volvulus, a contrast enema shows the site of obstruction by a typical "bird-beak" deformity at the site of the twist; the procedure may actually reduce a sigmoid volvulus. If contrast enema is not done, colonoscopy can be used to decompress a sigmoid volvulus but rarely works with a cecal volvulus.
what are the symptoms of Achalasia
The most common symptom of achalasia is difficulty swallowing (dysphagia). Patients typically describe food sticking in the chest after it is swallowed. Dysphagia occurs with both solid and liquid food. Moreover, the dysphagia is consistent, meaning that it occurs during virtually every meal. Sometimes, patients will describe only a heavy sensation in their chest after eating that may force them to stop eating. Occasionally, pain may be severe and mimic heart pain. Regurgitation of food that is trapped in the esophagus can occur, especially when the esophagus is dilated. If the regurgitation happens at night while the patient is sleeping, food can enter the throat and cause coughing and choking. If the food enters the trachea and lung, it can lead to pneumonia (aspiration pneumonia). Because of the problem swallowing food, a large proportion of patients with achalasia lose weight.
treatment of Esophageal varices
The objective of treatment is to stop acute bleeding as soon as possible. Propranolol or isosorbide therapy is effective in the prophylaxis of variceal bleeding. In patients with acute variceal hemorrhage, endoscopic sclerotherapy which involves injecting a clotting agent at the site if the varices can be performed. Transjugular Intrahepatic Portosystemic Shunt TIPS - a catheter is extended through a vein into the liver where it connects the portal system to the systemic venous system and decreases portal venous pressure. Vasopressin is a medication that may be used to decrease portal blood flow and slow bleeding. Emergency surgery may be necessary. Portacaval shunts that pass blood to the vena cava from the portal vein by a graft or resection of part of the esophagus are 2 treatment options, but these procedures have a high death rate. Liver transplantation.
What is the treatment for celiac disease
The only treatment for celiac disease is to follow a gluten-free diet, a lifetime requirement. People need to avoid eating all foods that contain wheat, rye, barley, and oats. This includes most grain, pasta, cereal and many processed foods.
Etiology of Diverticulosis
The reason diverticula form in the colon wall is not completely understood. Doctors think diverticula form when high pressure inside the colon pushes against weak spots in the colon wall. Normally, a diet with adequate fiber produces stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool. A low-fiber diet also can increase the time stool remains in the bowel, adding to the high pressure. Pouches may form when the high pressure pushes against weak spots in the colon where blood vessels pass through the muscle layer of the bowel wall to supply blood to the inner wall. Risk factors: • a diet which is low in fiber content or high in fat • high intake of meat and red meat • increasing age • constipating conditions • connective tissue disorders which may cause weakness in the colon wall (such as Marfan syndrome).
Treatment of Ulcerative Colitis
There are several types of medical treatments available: Cortisone, Steroids, Prednisone -- powerful drugs usually provide highly effective results. A high dose is often used initially to bring the disorder under control. Then the drug is tapered to low, maintenance doses, even to a dose every other day. These medications are given by pill, enema or intravenously during an acute attack. In time, the physician will usually try to discontinue these drugs because of potential long-term, adverse side effects Other Anti-inflammatory Drugs -- There are increasing numbers of these drugs available Immune System Suppressors -- An overactive immune system is probably important in causing ulcerative colitis. Certain drugs suppress the immune system and at times are effective. There are no foods known to injure the bowel. However, during an acute phase of the disease, bulky foods, milk, and milk products can increase diarrhea and cramping. Generally, the patient is advised to eat a healthy, well-balanced diet with adequate protein and calories. A multiple vitamin is often recommended. Iron may be prescribed if anemia is present Stress and anxiety may aggravate symptoms of the disorder, but are not believed to cause it or make it worse. Any chronic disease can produce a serious emotional reaction in the patient. This can usually be handled through discussion with the physician. There are excellent support groups available in most communities For patients with longstanding disease that is difficult or impossible to control with medicine, surgery is a welcomed option. In these rare cases, the patient's lifestyle and general health have been significantly affected. Surgical removal of the colon cures the disease and returns good health and a normal lifestyle to the patient. In the past a permanent bag, or ileostomy, was required for this surgery. Advances in surgery now can avoid this problem. The colon is removed and a pouch or reservoir is created from the small intestine. Three to six liquid bowel movements occur daily. Most patients are extremely pleased with this new surgery.
treatment of Hirschsprung's disease
Treatment requires surgery to remove the affected bowel and includes: 1. A pull-through surgery that involves taking out part of the intestine that is affected and connecting the healthy part that's left to the anus. 2. A colostomy or ileostomy may be done on a child that is too small or ill to have a pull-through. The diseased part of the intestine is removed, and an opening is created through the abdomen to which the top part of the intestine is attached. Stool is then emptied into a bag. Later, the doctor will do a pull-through, connecting the intestine back to the anus.
what is the treatment of Achalasia
Treatments for achalasia include oral medications, dilation or stretching of the lower esophageal sphincter (dilation), surgery to cut the sphincter (esophagomyotomy), and the injection of botulinum toxin (Botox) into the sphincter. All four treatments reduce the pressure within the lower esophageal sphincter to allow easier passage of food from the esophagus into the stomach. Oral medications Oral medications that help to relax the lower esophageal sphincter include groups of drugs called nitrates, e.g., isosorbide dinitrate (Isordil) and calcium-channel blockers, e.g., nifedipine (Procardia) and verapamil (Calan). Although some patients with achalasia, particularly early in the disease, have improvement of symptoms with medications, most do not. By themselves, oral medications are likely to provide only short-term and not long-term relief of the symptoms of achalasia, and many patients experience side-effects from the medications. Dilation The lower esophageal sphincter also may be treated directly by forceful dilation. Dilation of the lower esophageal sphincter is done by having the patient swallow a tube with a balloon on the end. The balloon is placed across the lower sphincter with the help of x-ray, and the balloon is blown up suddenly. The goal is to stretch--actually to tear--the sphincter. The success of forceful dilation has been reported to be between 60 and 95%. Patients in whom dilation is not successful can undergo further dilations, but the rate of success decreases with each additional dilation. If dilation is not successful, the sphincter may still be treated surgically. The main complication of forceful dilation is rupture of the esophagus, which occurs 5% of the time. Half of the ruptures heal without surgery, though patients with rupture who do not require surgery still must be followed closely and treated with antibiotics. The other half of ruptures require surgery. (Although surgery carries additional risk for the patient, surgery can repair the rupture as well as permanently treat the achalasia with esophagomyotomy.) Death following forceful dilation is rare. Dilation is fast, inexpensive compared with surgery, and requires only a short hospital stay. Esophagomyotomy The sphincter also can be cut surgically, a procedure called esophagomyotomy. The surgery can be done using a large abdominal incision or laparoscopically through small punctures in the abdomen. In general, the laparoscopic approach is used with uncomplicated achalasia. Alternatively, the surgery can be done with a large incision or laparoscopically through the chest. Esophagomyotomy is more successful than forceful dilation, probably because the pressure in the lower sphincter is reduced to a greater extent and more reliably; 80-90% of patients have good results. With prolonged follow-up, however, some patients develop recurrent dysphagia. Thus, esophagomyotomy does not guarantee a permanent cure. The most important side effect from the more reliable and greater reduction in pressure with esophagomyotomy, is reflux of acid (gastroesophageal reflux disease or GERD). In order to prevent this, the esophagomyotomy may be modified so that it doesn't completely cut the sphincter or the esophagomyotomy may be combined with anti-reflux surgery (fundoplication). Whichever surgical procedure is done, some physicians recommend life-long treatment with oral medications for acid reflux. Others recommend 24 hour esophageal acid testing with lifelong medication only if acid reflux is found. Botulinum toxin The newest treatment for achalasia is the endoscopic injection of botulinum toxin into the lower sphincter to weaken it. Injection is fast, nonsurgical, and requires no hospitalization. Treatment with botulinum toxin is safe, but the effects on the sphincter often last only for months, and additional injections with botulinum toxin may be necessary. Injection is a good option for patients who are very elderly or are at high risk for surgery, e.g., patients with severe heart or lung disease. It also allows patients who have lost substantial weight to eat and improve their nutritional status prior to "permanent" treatment with surgery. This may reduce post-surgical complications.
Etiology of Volvulus
Twisting in volvulus may result from an anomaly of rotation, an ingested foreign body, or an adhesion; in some cases, however, the cause is unknown. Volvulus usually occurs in a bowel segment with a mesentery long enough to twist. The most common area, particularly in adults, is the sigmoid; the small bowel is a common site in children. Other common sites include the stomach and cecum. Volvulus secondary to meconium ileus may occur in patients with cystic fibrosis. Malrotation of the bowel during fetal development may predispose infants to a volvulus, although a volvulus can occur in the absence of malrotation. Volvulus associated with malrotation often occurs early in life, frequently in the first year.
symptoms of Ulcerative Colitis
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. For these reasons, doctors often classify ulcerative colitis according to its location. Here are the signs and symptoms that may accompany ulcerative colitis, depending on its classification: Ulcerative proctitis. In this form of ulcerative colitis, inflammation is confined to the rectum and for some people, rectal bleeding may be the only sign of the disease. Others may have rectal pain, a feeling of urgency or an inability to move the bowels in spite of the urge to do so (tenesmus). Left-sided colitis. As the name suggests, inflammation extends from the rectum up the left side through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and pain, and weight loss. Pancolitis. Affecting the entire colon, pancolitis causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, weight loss and night sweats. Fulminant colitis. This rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications including colon rupture and toxic megacolon, which occurs when the colon becomes severely distended. The course of ulcerative colitis varies, with periods of acute illness often alternating with periods of remission. But over time, the severity of the disease usually remains the same. Only a small percentage of people with a milder condition, such as ulcerative proctitis, go on to develop more severe signs and symptoms.
Description of Ulcerative Colitis
Ulcerative colitis, an inflammatory bowel disease (IBD) that causes chronic inflammation of the digestive tract, is characterized by abdominal pain and diarrhea. Like Crohn's disease, another common IBD, ulcerative colitis can be debilitating and sometimes can lead to life-threatening complications. Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon, unlike Crohn's disease, which occurs in patches anywhere in the digestive tract and often spreads deep into the layers of affected tissues.
Treatment of Pyloric Stenosis
When an infant is diagnosed with pyloric stenosis, either through physical examination, ultrasound, or barium swallow, the baby will be admitted to the hospital and prepared for surgery. Any dehydration or electrolyte problems in the blood will be corrected with intravenous (IV) fluids, usually within 24 hours. A surgical procedure called pyloromyotomy, which involves cutting through the thickened muscles of the pylorus, is performed to relieve the obstruction from pyloric stenosis. The pylorus is examined through a very small incision, and the muscles that are overgrown and thickened are spread. Nothing is cut out - the stitches are under the skin and there are no stitches or clips to remove.
Symptoms of Volvulus
• Abdominal tenderness • Nausea or vomiting • Vomiting green bile-looking material • Bloody or dark red stool • Constipation or difficulty expelling stools • Distended abdomen • Shock
Symptoms of Esophageal varices
• vomiting • vomiting blood • black, tarry stools • decreased urine output • excessive thirst • paleness • low BP • rapid heart rate
