Patient Corner

Alcohol-Induced Liver Disease

What is alcohol-induced liver disease?
Alcohol-induced liver disease is caused by drinking too much alcohol. It is a common, but preventable, disease.

There are three primary types of alcohol-induced liver disease, including the following:
Fatty liver.
Alcoholic hepatitis.
Alcoholic cirrhosis.

What are the symptoms of alcohol-induced liver disease?

The effects of alcohol on the liver depend on how much and how long a person has been drinking alcohol. The following are the most common symptoms and signs of alcohol-induced liver disease:

  • Enlarged liver
  • Nausea
  • Vomiting
  • Jaundice (yellowing of the skin and eyes)
  • Enlarged spleen
  • Ascites (fluid buildup in the abdominal cavity)
  • Kidney failure
  • Confusion

How is alcohol-induced liver disease diagnosed?

  • Lab tests.
  • Liver function tests
  • Liver biopsy.
  • Computed tomography (CT) scan.

What is the treatment for alcohol-induced liver disease?

    Specific treatment for alcohol-induced liver disease will be determined by your doctor based on:
  • Your age, overall health,
  • Extent of the disease

Appendicitis

Appendicitis means inflammation of the appendix. The appendix is a small pouch that comes off the gut wall at the start of the large intestine. Appendicitis is common. Typical symptoms include abdominal pain and vomiting. These symptoms gradually get worse over 6-24 hours. The usual treatment is an operation to remove the inflamed appendix, and the aim is to do this before it bursts. A perforated appendix is a very serious condition.

What are the symptoms of appendicitis?

Pain in abdomen is usually the main symptom. Commonly, the pain starts in the middle of the abdomen. The pain usually develops quickly, over an hour or so. Over the next few hours the pain typically travels to the lower right-hand side of the abdomen. This is over where the appendix normally lies.

Other symptoms that may occur include the following.

  • Feeling sick (nausea) You may vomit.
  • High temperature (fever) and generally feeling unwell.
  • Constipation may occur, and sometimes diarrhoea.
  • Frequent passing of urine may develop.
  • If the appendix bursts (perforates) then severe pain can spread to all the abdomen.

There is no easy and foolproof test to confirm appendicitis. A surgeon often has to make a judgement whether to operate or not. Blood tests are also done when you are admitted to hospital, and this may also help diagnosis. An ultrasound scan or a CT scan may help to clarify the cause of the symptoms.

What is the treatment for appendicitis?
An operation to remove the inflamed appendix is usually done quite quickly once the diagnosis is made. Removal of the appendix is one of the most commonly performed operations. In most cases, the operation is done before the appendix perforates. This is usually a straightforward and successful operation needing just a short recovery. However, surgery can be more difficult and you will take longer to recover if the appendix has perforated.

Surgery is commonly done by a keyhole operation, as the recovery is quicker compared to having an open operation. The keyhole operation is performed through three tiny cuts, the largest of which is only around 1.0 cm in size.

Sometimes keyhole surgery isn't recommended and open surgery is performed instead. This is likely to be needed if the appendix has already burst and formed a lump called an appendix mass.

Cholecystitis

What is cholecystitis?
Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepatic duct. Other causes of cholecystitis may include the following:

  • Stone in Gall Bladder
  • Bacterial infection in the bile duct system.
  • Tumor of the pancreas or liver.
  • Decreased blood supply to the gallbladder.
  • Gallbladder "sludge."

What are the symptoms of cholecystitis?

    A typical attack of cholecystitis usually lasts two to three days. However, each individual may experience symptoms differently. Symptoms may include:
  • Sudden pain in the upper right part of the abdomen
  • Recurrent painful attacks for several hours after meals
  • Nausea
  • Vomiting
  • Rigid abdominal muscles on right side
  • Slight fever
  • Chills
  • Jaundice. A yellowing of the skin and eyes.
  • Itching (rare)
  • Loose, light-colored bowel movements

How is cholecystitis diagnosed?
In addition to a complete medical history and medical examination, diagnostic procedures for cholecystitis may include the following:

Ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen, such as the liver, spleen, and kidneys, and to assess blood flow through various vessels.

Computed tomography scan A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

What is the treatment for cholecystitis?
Treatment for acute cholecystitis usually involves a hospital stay to reduce stimulation to the gallbladder. Antibiotics are usually administered to fight the infection. Fluids are given intravenously and the stomach is kept empty until symptoms resolve. Sometimes, the gallbladder is surgically removed, either immediately or later after the episode of acute cholecystitis has resolved.

Chronic Liver Disease / Cirrhosis

What is chronic liver disease?

    Chronic liver disease is marked by the gradual destruction of liver tissue over time. Several liver diseases fall under this category:
  • Cirrhosis of the liver
  • Fibrosis of the liver

Because of chronic damage to the liver, scar tissue slowly replaces normal functioning liver tissue, progressively diminishing blood flow through the liver. As the normal liver tissue is lost, nutrients, hormones, drugs, and poisons are not processed effectively by the liver. In addition, protein production and other substances produced by the liver are inhibited.

What are the symptoms of cirrhosis?

    Symptoms of cirrhosis vary, depending on severity of the condition. Mild cirrhosis may not cause any symptoms at all. The following are the most common symptoms of cirrhosis. However, each individual may experience symptoms differently. Symptoms may include:
  • Ascites (fluid buildup in the abdominal cavity)
  • Breast enlargement in men
  • Vomiting blood
  • Curling of fingers (Dupuytren's contracture of the palms)
  • Itching
  • Jaundice (yellowing of the skin and eyes)
  • Kidney failure
  • Liver encephalopathy
  • Muscle loss
  • Poor appetite
  • Portal hypertension
  • Salivary gland enlargement in cheeks
  • Shrinking of testes
  • Spider-like veins in the skin

The symptoms of cirrhosis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What causes cirrhosis?

    The most common cause of cirrhosis is alcohol abuse. Other causes include:
  • Hepatitis and other viruses
  • Use of certain drugs
  • Chemical exposure
  • Bile duct obstruction
  • Autoimmune diseases
  • Obstruction of outflow of blood from the liver
  • Diabetes
  • Malnutrition

How is cirrhosis diagnosed?

    In addition to a complete medical history and physical examination, diagnostic procedures for cirrhosis may include:
  • Laboratory tests.
  • Liver function tests.
  • Liver biopsy.
  • Computed tomography scan (CT scan).
  • Ultrasound.

What is the treatment for cirrhosis?
Cirrhosis is a progressive liver disease, and damage sustained to the liver is irreversible. However, with proper nutrition, avoidance of certain toxins (such as alcohol), vitamin supplementation, and management of cirrhosis complications, further liver damage can often be delayed or stopped. In severe cases of cirrhosis, liver transplantation may be considered.

Chronic Venous Insufficiency

What is chronic venous insufficiency?
Chronic venous insufficiency occurs when the leg veins do not allow blood to travel back to the heart because of damaged valves. If chronic venous insufficiency is left untreated, pain, swelling, and leg ulcers may result.Chronic venous insufficiency does not pose a serious health threat, but the condition can be disabling and cause pain.

What causes chronic venous insufficiency?

    Chronic venous insufficiency is more common among those who are obese, pregnant, or who have a family history of the problem.
  • High blood pressure in the leg veins over a long time, due to sitting or standing for prolonged periods
  • Lack of exercise
  • Smoking
  • Deep vein thrombosis (a blood clot in a deep vein, usually in the calf or thigh)

What are the symptoms of chronic venous insufficiency?

    Symptoms of chronic venous insufficiency may include:
  • Swelling in legs and/or ankles
  • Tight feeling calves or itchy painful legs
  • Pain during walking that stops with rest
  • Brown-colored skin, particularly near the ankles
  • Varicose veins
  • Leg ulcers that are sometimes very resistant to treatment

How is chronic venous insufficiency diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for chronic venous insufficiency may include:

Duplex ultrasound. A type of vascular ultrasound procedure done to assess blood flow and the structure of the leg veins. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.

Chronic venous insufficiency treatment may include:

  • Measures to improve blood flow in the leg veins.
  • Medications.
  • Sclerotherapy.
  • Surgical repair.
  • Subfascial endoscopic perforator surgery.

Constipation

What is constipation?
Constipation is a condition in which a person has uncomfortable or infrequent bowel movements. Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week. However, normal stool elimination may consist of having a bowel movement three times a day or three times a week; it depends on the person.

What causes constipation?
Normally, as food moves through the colon (also known as the large intestine) the colon absorbs water while forming stool (waste products). Muscle contractions then push the stool toward the rectum, and, by the time the stool reaches the rectum, most of the water has been absorbed, making the stool solid.

When the colon's muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in too much water being absorbed. Some of the most common causes of constipation include the following:

  • Medications
  • Lack of exercise
  • Not enough liquids
  • Not enough fiber in the diet
  • Irritable bowel syndrome
  • Ignoring the urge to have a bowel movement
  • Changes in habits or lifestyle, such as travel, pregnancy, and old age
  • Abuse of laxatives

What are the symptoms of constipation?
The following are the most common symptoms of constipation. However, each individual may experience symptoms differently. Symptoms may include:

  • Difficult and painful bowel movements
  • Bowel movements fewer than three times a week
  • Feeling bloated or uncomfortable
  • Abdominal pain
  • The symptoms of constipation may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is constipation diagnosed?
The tests performed by a doctor will depend on the duration and severity of the constipation, since most persons experience constipation at one time or another. The doctor will also take into account the patient's age, and whether there is blood in the stool, recent changes in bowel habits, or weight loss.

    Diagnosing constipation may include:
  • Medical history.
  • Physical examination.
  • Abdominal X-ray
  • Colonoscopy.
  • Sigmoidoscopy.
  • Colorectal transit study.
  • Anorectal function tests.
    Treatment for constipation
    Treatment may include:
  • Diet modifications.
  • Laxatives.
  • Eliminating or changing medication
  • Biofeedback.

What are good fiber sources?

Bread -Whole wheat bread, bread,

Cereal -Bran Flakes, Raisin Bran, Shredded Wheat, Frosted Mini Wheats, oatmeal, oat bran

Vegetables -Beets, broccoli, brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado

Fruits -Apples with peel, dates, papayas, mangos,oranges, pears, kiwis, strawberries, raisins

What are complications of constipation?
Constipation can cause complications, such as hemorrhoids, which occur by straining to have a bowel movement, or anal fissures (tears in the skin around the anus) which occur when hard stool stretches the sphincter muscle. This can result in rectal bleeding. Sometimes, straining also causes rectal prolapse, where a small amount of intestinal lining pushes out from the anal opening.

Diverticular Disease

What is diverticular disease?
In the colon, some people have small pouches that bulge outward through weak spots. Diverticular disease is an inflammation or infection in the pouches, known as diverticula, which are located in the colon:.
The conditions of diverticulosis or diverticulitis are referred to as diverticular disease.
The disease is common in developed or industrialized countries, particularly the United States, England, and Australia where low-fiber diets are common. It is rare in countries such as Asia and Africa, where people eat high-fiber, vegetable diets.

What causes diverticular disease?
Although not proven, the main cause of diverticular disease is believed to be a low-fiber diet. Fiber is the part of fruits, vegetables, and grains that the body cannot digest.

Soluble fiber dissolves easily in water and takes on a soft, jelly-like texture in the intestines.

Insoluble fiber passes almost unchanged through the intestines.

Both kinds of fiber help make stools soft and easy to pass, which helps to prevent constipation.

Constipation is the main cause of increased pressure in the colon, making the muscles strain to move stool that is too hard. The excess pressure caused by the straining makes the weak spots in the colon bulge out, forming diverticula.

Doctors do not know what causes the infection that causes diverticulitis, but believe it may begin when stool or bacteria are caught in the diverticula.

What are the symptoms of diverticular disease?
The following are the most common symptoms of diverticular disease. However, each individual may experience symptoms differently. Symptoms may include:

Diverticulosis. Diverticulosis may not cause any discomfort or symptoms, but could include mild cramps, bloating, and constipation.

Diverticulitis. The most common symptom is abdominal pain and the most common sign is tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may also occur.

How is diverticular disease diagnosed?
Abdominal ultrasound, computerized tomography scan, barium enema, flexible sigmoidoscopy, colonoscopy, and X-rays may also be part of the diagnostic process.

Treatment for diverticular disease

    Treatment may include increasing dietary fiber intake by eating foods, such as the following:
  • Whole grain breads, cereals, and other products
  • Fruit, such as berries, apples, and peaches
  • Vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, and squash
  • Beans

Treatment for diverticulitis may also include:

  • Medications - to control pain, control infection,control muscle spasms)
  • Resting the colon, with liquid diet and bed rest
  • Preventing or minimizing complications, such as the following:
  • Infection
  • Perforations or tears
  • Blockages
  • Bleeding
  • Hospitalization may be required for acute attacks with severe pain or infection. Surgery may be necessary in some cases.

Gallstones

What are gallstones?
Gallstones form when bile stored in the gallbladder hardens into stone-like material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can cause gallstones.

What causes gallstones?
Cholesterol stones are believed to form when bile contains too much cholesterol, too much bilirubin, not enough bile salts, or when the gallbladder does not empty as it should for some other reason.
Pigment stones tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia. The causes of these stones are uncertain.

What are the symptoms of gallstones?
At first, most gallstones do not cause symptoms. However, when gallstones become larger, or when they begin obstructing bile ducts, symptoms or "attacks" begin to occur. Attacks of gallstones usually occur after a fatty meal and at night. The following are the most common symptoms of gallstones. However, each individual may experience symptoms differently. Symptoms may include:

  • Severe pain in the upper abdomen
  • Pain in the back between the shoulder blades
  • Pain in the right shoulder
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Jaundice. A yellowing of the skin or eyes.
  • Intolerance of fatty foods
  • Belching or gas

Some people with gallstones do not have any symptoms. These stones are called "silent stones," because they do not interfere with the function of the gallbladder, liver, or pancreas, and do not require treatment in most cases.
The symptoms of gallstones may resemble other conditions or medical problems, such as heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, or hepatitis.

Who is affected by gallstones?

    The following are suggested risk factors for gallstones:
  • Obesity
  • Estrogen
  • Gender. Women are twice as likely to develop gallstones than men.
  • Age. People over 60 are more likely to develop gallstones than younger people.
  • Cholesterol-lowering drugs.
  • Diabetes.
  • Rapid weight loss. F
  • Fasting.

  • How are gallstones diagnosed?
  • Ultrasound.
  • Blood tests. These look for signs of infection, obstruction, jaundice, and/or pancreatitis.
  • Computed tomography scan

Treatment for gallstones
Gallbladder removal (Cholecystectomy). Once removed, the bile flows directly from the liver to the small intestine

Gastritis

What is gastritis?

    Gastritis is an inflammation of the stomach lining.
    Gastritis may be caused by the following:
  • Drinking too much alcohol
  • Spicy foods
  • Smoking
  • Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Infection with bacteria, Helicobacter pylori (H. pylori)
  • Major surgery
  • Traumatic injury or burns
  • Severe infection
  • Extreme physiological stress

What are the symptoms of gastritis?

    The following are the most common symptoms of gastritis. However, each individual may experience symptoms differently. Symptoms may include:
  • Stomach upset or pain
  • Belching or hiccups
  • Abdominal bleeding
  • Nausea
  • Vomiting
  • Feeling of fullness or burning in the stomach
  • Loss of appetite
  • Blood in vomit or stool (a sign that the stomach lining may be bleeding)

How is gastritis diagnosed?
Upper GI Endoscopy. A procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum.

Blood tests.

Stool culture.

Treatment for gastritis
Generally, treatment for gastritis involves antacids and other medications aimed at reducing stomach acid, relieving symptoms, and promoting the healing of the stomach lining. If gastritis is related to an illness or infection, that problem should be treated as well. If gastritis is caused by H. pylori, the most common treatment is a triple therapy that combines two antibiotics with a proton pump inhibitor (PPI) to kill the bacteria.
Patients are also advised to avoid foods, beverages, or medications that cause symptoms or irritate the lining of the stomach. If the gastritis is related to smoking, quitting is recommended.

Gastroesophageal Reflux Disease (GERD) / Heartburn

Gastroesophageal Reflux Disease (GERD):
Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.
The following is the most common symptom of GERD. However, each individual may experience symptoms differently.

Heartburn, also called acid indigestion, is the most common symptom of GERD. Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn.

Most children younger than 12 years of age, and some adults, diagnosed with GERD will experience a dry cough, asthma symptoms, or trouble swallowing, instead of heartburn.

What causes GERD?

    The lower esophageal sphincter (LES), a muscle located at the bottom of the esophagus, opens to let food in and closes to keep it in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing heartburn. Other lifestyle contributors to GERD may include the following:
  • Being overweight
  • Overeating
  • Consuming certain foods, such as citrus,chocolate, fatty, and spicy foods
  • Excess coffee
  • Alcohol
  • Smoking
  • Use of drugs, such as aspirin and ibuprofen

How is GERD diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for GERD may include the following:

Upper GI Scopy : Upper endoscopy is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

Esophageal manometry. This test helps determine the strength of the muscles in the esophagus.

pH monitoring. This measures the acidity inside of the esophagus. It is helpful in evaluating gastroesophageal reflux disease (GERD).

Treatment for GERD

    In many cases, GERD can be relieved through diet and lifestyle changes, as directed by your doctor. Some ways to manage heartburn include the following:
  • Monitor the medications you are taking--some may irritate the lining of the stomach or esophagus.
  • Quit smoking.
  • Watch food intake and limit fried and fatty foods
  • Avoid overeating.
  • Do not lie down or go to bed right after a meal. Instead, wait a couple of hours.
  • Take an antacid, as directed by your doctor.
  • "H2-blockers" and "protein pump inhibitors".
  • Occasionally, a surgical procedure called fundoplication may be performed to help keep the esophagus in proper position and prevent reflux.

Halitosis (Bad Breath)

What is halitosis?
Halitosis is an oral health problem where the main symptom is bad smelling breath. In most cases, finding the cause of the bad breath is the first step toward treating this preventable condition.

What causes bad breath?
There are many causes of bad breath, just as there are many sources of bacteria in the mouth. Halitosis may be caused by the following:

  • Certain foods.
  • Poor oral health care.
  • Improper cleaning of dentures.
  • Periodontal disease.
  • Xerostomia (dry mouth).
  • Tobacco products.
  • A respiratory infection
  • A gastrointestinal disorder
  • A liver or kidney disorder

Treatment for halitosis
Specific treatment for halitosis will be determined by your physician or dentist based on: Treatment depends primarily on the cause of the condition.

Hemorrhoids

What are hemorrhoids?
Hemorrhoids are veins, normally present in and around the anus and lower rectum, that have become swollen due to stretching under pressure. These are very common in both men and women, and about half the population have hemorrhoids by age 50. Hemorrhoids are also common in pregnant women due to the pressure of the fetus in the abdomen, as well as hormonal changes, which cause hemorrhoidal vessels to enlarge.

Hemorrhoids are either internal (inside the anus) or external (under the skin around the anus).

What causes hemorrhoids?
Hemorrhoids may develop as a result of repeated straining during bowel movements, pregnancy, heredity, aging, and chronic constipation or diarrhea.

What are the symptoms of hemorrhoids?

    The following are the most common symptoms of hemorrhoids. However, each individual may experience symptoms differently. Symptoms may include:
  • Bright red blood present on the Motion, toilet paper, or in the toilet bowl
  • Irritation and pain around the anus
  • Swelling or a hard lump around the anus
  • Itching
  • The symptoms of hemorrhoids may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How are hemorrhoids diagnosed?
Diagnosing hemorrhoids may include:

Physical examination. This is done to check the anus and rectum and look for swollen blood vessels that indicate hemorrhoids.

Digital rectum examination (DRE). The doctor inserts a gloved, lubricated finger into the rectum to check for abnormalities..

Proctoscopy. A lighted tube, which allows the doctor to completely examine the entire rectum, is inserted into the anus.

Sigmoidoscopy. A diagnostic procedure that allows the doctor to examine the inside of the last portion of the large intestine.

Treatment for hemorrhoids

Medical treatment of hemorrhoids :

  • Sitting in plain, warm water in the tub several times a day
  • Ice packs to reduce swelling
  • Application of hemorrhoidal creams or suppositories

Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.

Electrical or laser coagulation or infrared photo coagulation. Techniques that use special devices to burn hemorrhoidal tissue.

Hemorrhoidectomy. A surgical procedure that permanently removes the hemorrhoids.

Stappler Haemorrhoidectomy.

Hiatal Hernia

What is a hiatal hernia?
A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest.. These acids and other substances can easily back up (reflux or regurgitate) into the esophagus.

Most of the time, a hiatal hernia does not cause symptoms. Heartburn, belching, nausea, vomiting, and regurgitation - or backflow of stomach content into the esophagus or throat - are the most common symptoms.

    Symptoms include:
  • Intermittent difficulty swallowing, especially solid foods
  • Feeling full after eating only a small amount of food
  • Abdominal or chest pain

What causes hiatal hernia

    The cause of a hiatal hernia is unknown, but possible triggers include the following:
  • Coughing
  • Vomiting
  • Straining while defecating (having a bowel movement)
  • Obesity can also contribute to this disorder.

Treatment for hiatal hernia
Medication may be prescribed by a doctor to neutralize stomach acid, decrease acid production, or strengthen the lower esophageal sphincter. The esophageal sphincter is the muscle that prevents stomach acid from coming up into the esophagus. Surgery may also be needed in these cases to reduce the size of the hernia.

Hydrocele

What is a hydrocele?
A hydrocele occurs from a build up of fluid in the thin pouch that holds the testes within the scrotum.

What are the symptoms of a hydrocele?

    The following are the most common symptoms of hydrocele:
  • The swelling is generally painless
  • If the hydrocele is large and tense, it may require more immediate attention.

How is a hydrocele diagnosed?
Diagnosis of a hydrocele is usually made by a physical exam and a complete medical history.

Transillumination

Ultrasound

What is the treatment for a hydrocele?
The surgery involves making a small incision on the scrotum and draining the fluid an suturing the tunica vaginalis.

Indigestion

What is indigestion?
Indigestion, also known as dyspepsia, is a painful or burning feeling in the upper abdomen and is usually accompanied by nausea, bloating or gas, a feeling of fullness, and, sometimes, vomiting. While indigestion may be the result of a disease or an ulcer in the digestive tract, most often it is the result of eating too much, eating too quickly, eating high-fat foods, or eating during stressful situations.

What causes indigestion?

    Some causes of indigestion may include the following:
  • Stomach or duodenal ulcers
  • Stomach irritation (gastritis)
  • Regurgitation or reflux of acid from the stomach into the esophagus
  • Helicobacter pylori (H. pylori) infection
  • Inflammation of the gallbladder (cholecystitis)
  • Irritable bowel syndrome and other disorders affecting intestinal motility
  • Smoking
  • Drinking too much alcohol

What are symptoms of indigestion?

    Symptoms may include:
  • • Pain and discomfort in the upper abdomen
  • • Belching and loud intestinal sounds (borborygmi)
  • • Nausea
  • • Poor appetite
  • • Diarrhea
  • • Flatulence

If the indigestion is accompanied by vomiting, weight loss or appetite loss, black tarry stools, blood in the vomit, severe pain in the upper right abdomen, shortness of breath, sweating, radiating pain to the jaw, neck, or arm, or difficult, painful swallowing, it may be an indication of a more serious problem.

How is indigestion diagnosed?
Often the diagnosis is made based on physical examination. However, because indigestion can be a sign of more serious medical problems, often laboratory examinations and X-rays of the stomach and small intestine are performed to rule out other problems. Sometimes, endoscopy is also performed.

Treatment for indigestion
Medications such as antacids, H2 receptor antagonists, proton pump inhibitors, antibiotics, and prokinetics

Avoiding foods, medications, and situations that can cause indigestion is one of the most successful ways to treat the problem. Smokers are advised to quit smoking or at least to avoid smoking before meals. If indigestion is caused by movement problems in the digestive system that prevent the stomach from emptying properly, medications to treat this may be prescribed.

Inguinal Hernia

What Is It?
When part of an organ protrudes through an abnormal opening or in an abnormal way, this is called a hernia. A groin (inguinal) hernia occurs when part of the intestine bulges through a weak spot in the abdominal wall at the inguinal canal. The inguinal canal is a passageway through the abdominal wall near the groin. Inguinal hernias are up to 10 times more common in men than in women. About one in four men develop a hernia at some point in life.

Inguinal hernia.

Symptoms
At first, an inguinal hernia either may not cause any symptoms or may cause only a feeling of heaviness or pressure in the groin. As the hernia grows, it eventually causes an abnormal bulge under the skin near the groin. This bulge may become increasingly more uncomfortable or tender to the touch. As the hernia increases in size, a portion of herniated intestine may become trapped and unable to slide back into the abdomen. If this happens, there is a danger that the trapped intestine may twist and die because its blood supply is cut off. This causes severe pain and requires immediate treatment.

Diagnosis
Doctors can diagnose most inguinal hernias by examining the area. Your doctor will look for an abnormal protrusion near your groin and will feel the area to check for a mass. Often, the protruding hernia can be pushed back temporarily into the abdomen with careful pressure.

Expected Duration
An inguinal hernia will not heal on its own. It is likely to become larger and cause increased discomfort until it is repaired. Hernias that are not repaired can cause bowel obstruction or strangulation, which is when part of the intestine dies because its blood supply is cut off.

Prevention
Indirect hernias in children cannot be prevented. To reduce the risk of inguinal hernia as an adult, you can:

    Maintain a normal body weight.
  • Exercise regularly to strengthen abdominal muscles.
  • Avoid straining while defecating or urinating.
  • Avoid lifting heavy objects.

Treatment
There are two basic types of hernia repair: open surgery or laparoscopic surgery.

Open surgery — Most inguinal hernias are repaired by open surgery with the patient under general or local anesthesia. After the surgeon makes an incision in the groin, he or she pushes the herniated tissue back into place and repairs the hernia opening with stitches. In many cases, a small piece of synthetic mesh material is used to reinforce the area to prevent another hernia.

Stomach and Duodenal Ulcers (Peptic Ulcers)

What is a stomach or duodenal ulcer?

Somach showing an ulcer

    About one in 10 Indians develops at least one ulcer during his or her lifetime.
  • An ulcer in the lining of the stomach or duodenum is referred to as a peptic ulcer.
  • When the ulcer is in the stomach, it is called a gastric ulcer.
  • When the ulcer is in the duodenum, it is called a duodenal ulcer.

What causes gastric and duodenal ulcers?
In the past, it was believed lifestyle factors, such as stress and diet caused ulcers. Today, research shows that most ulcers (80 percent of gastric ulcers and 90 percent of duodenal ulcers) develop as a result of infection with a bacterium called Helicobacter pylori (H. pylori).

It is believed that, although all three of these factors--lifestyle, acid and pepsin, and H. pylori--play a role in ulcer development,H. pylori is considered to be the primary cause, in most cases.

Factors in the development of peptic ulcers

    Factors suspected of playing a role in the development of stomach or duodenal ulcers include:
  • Helicobacter pylori.
  • Smoking.
  • Caffeine.
  • Alcohol.
  • Stress.
  • Physical stress.
  • Acid and pepsin.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • What are the symptoms of ulcers?

The pain often occurs between meals and in the early hours of the morning. It may last from a few minutes to a few hours. Less common ulcer symptoms may include:

  • Belching
  • Nausea
  • Vomiting
  • Poor appetite
  • Loss of weight
  • Feeling tired and weak

What are some complications from ulcers?
People with ulcers may experience serious complications if they do not seek appropriate treatment. The most common problems include the following:
Bleeding.

Perforation. Ulcer makes a hole in the stomach or duodenum, and cause peritonitis, severe inflammation of the abdominal cavity and wall.

Narrowing and obstruction. Ulcers located at the end of the stomach, where the duodenum is attached, can cause swelling and scarring, which can narrow or close the intestinal opening. This obstruction can prevent food from leaving the stomach and entering the small intestine, resulting in vomiting the contents of the stomach.

How are ulcers diagnosed?

  • Upper GI endoscopy.
  • Blood, breath, and stomach tissue tests.

Treatment for stomach and duodenal ulcers
Lifestyle changes.

Medications. Doctors treat stomach and duodenal ulcers with several types of medications, including the following:

  • Antibiotics. Medications used to kill H. pylori if it has been detected.
  • H2-blockers.
  • Acid pump inhibitors.
  • Mucosal protective agents.

Surgery. In most cases, anti-ulcer medications heal ulcers quickly and effectively, and eradication of H. pylori prevents most ulcers from recurring. However, people who do not respond to medication, or who develop complications, may require surgery.

At present, standard open surgery is performed to treat ulcers. Types include the following:

Vagotomy

Antrectomy.

Laparoscopic surgery may also be used to treat ulcer disease.

Ulcerative Colitis

What is ulcerative colitis?
Ulcerative colitis is an inflammatory bowel disease (IBD) in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually begins in the rectum and lower (sigmoid) intestine and spreads upward to the entire colon. Ulcerative colitis rarely affects the small intestine, except for the lower section, the ileum.

The inflammation causes diarrhea, or frequent emptying of the colon. As cells on the surface of the lining of the colon die and slough off, ulcers (open sores) form and may cause the discharge of pus and mucus, in addition to bleeding.

What are the symptoms of ulcerative colitis?

    The following are the most common symptoms of ulcerative colitis. However, each individual may experience symptoms differently. Symptoms may include:
  • Abdominal pain
  • Bloody diarrhoea
  • Weight loss
  • Loss of appetite
  • Rectal bleeding
  • Loss of body fluids and nutrients
  • Anemia caused by severe bleeding
    Sometimes, symptoms may also include:
  • Skin lesions
  • Joint pain
  • Inflammation of the eyes
  • Liver disorders
  • Osteoporosis
  • Rashes
  • Kidney stones

What causes ulcerative colitis?
Although many theories exist regarding the cause of ulcerative colitis, none has been proven. The cause of ulcerative colitis is unknown, and currently there is no cure, except through surgical removal of the colon. One theory suggests that some agent, possibly a virus or an atypical bacterium, interacts with the body's immune system to trigger an inflammatory reaction in the intestinal wall.

How is ulcerative colitis diagnosed?

    A thorough physical examination, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation), is part of the diagnostic process. In addition, diagnostic procedures for ulcerative colitis may include the following:
  • Stool culture
  • Colonoscopy.
  • Biopsy. A procedure performed to remove tissue or cells from the lining of the colon for examination under a microscope.

What is the treatment for ulcerative colitis?
Treatment may include:

Drug therapy . Abdominal cramps and diarrhea may be helped by medications to reduce inflammation in the colon. More serious cases may require steroid medications, antibiotics, or medications that affect the body's immune system.

Hospitalization. Patients with ulcerative colitis occasionally have symptoms severe enough to require hospitalization to correct malnutrition and to stop diarrhea and loss of blood, fluids, and mineral salts. The patient may need a special diet, intravenous (IV) feedings, medications, or, sometimes, surgery.

Surgery. Most people with ulcerative colitis do not need surgery. However, about 25 to 40 percent of ulcerative colitis patients eventually require surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or risk of cancer.

There are several surgical options, including the following:

Proctocolectomy with ileostomy.

Ileoanal anastomosis.