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Piles, medically called as hemorrhoid is a very common disease. It occurs more in female than male. It is probably the award to human race for adaption of erect posture, as quadrupeds do not suffer from this disease. Piles, as such occurs due to various local factors, mainly a cushion defect in the vascular bed of rectum and anal canal. But, there are some diseases which present as piles. Common amongst those are:

• Cancer Rectum and Colon
• Portal Hypertension

Cancer of rectum and colon: Many times the clinicians avoid digital rectal examination and presume that the bleeding from anus is from the simple piles. That is why, it is said that” If the clinician has not put his finger inside, he may put his foot in it”. This shows how much vexing it is, if not carried out. Many great surgeons have missed the diagnosis and operated as simple piles leaving the underlying disease intact. Rectal cancer may present as painless bleeding from anus. As the tumor grows there occurs some obstruction to the venous flow resulting in engorged anal veins, apart from it there may be direct bleeding from the tumor itself. Multiple polyposis is a predisposing cause among many others. Non-vegetarian diet, especially meat consumption is associated with colon cancer. Vegetarian diet, fiber in diet, aspirin, metformin and regular exercise may have some protective effect.
Portal Hypertension: This disease is rather a complication of cirrhosis of liver. Here, there is obstruction to free flow of blood from lower extremities through the liver; and alternative channels open up for the flow of blood to the heart. In that way an alternative channel opens up in the rectum and anal canal, in addition to other sites; the veins become engorged resulting in bleeding from the anus. Cirrhosis of liver may result from chronic hepatitis, commonly hepatitis B and C; amongst other causes alcoholic cirrhosis, biliary cirrhosis and aflatoxin poisoning are some of the common causes.

So, for any bleeding from anus a simple examination like digital examination should not be skipped.

The pain; will actually be understood by one who has suffered from it,the burning sensation one gets in the middle of chest. It usually occurs about half an hour to one hour after taking food. Certain foods particular to the individual trigger it. More commonly pickle, dry foods, fad foods, spicy and chilly food are responsible for it. There is regurgitation of fluid and food with burning sensation. It may be mild to severe. By experience person will rush to drink water or antacids to get relief from it.

This is termed as gastroesophageal reflux disease (GERD). It may be a part of acid peptic disease, more commonly. GERD may occur due to a lax lower esophageal sphincter mechanism, in isolation. It may be due to hiatus hernia, herniation of stomach in various proportions into chest through a defect in the diaphragm that separates chest from abdomen. Esophageal dismotility may also cause it. A bad dietary habit is responsible for its exaggeration.

Diagnosis of it starts from the history of typical symptoms. An endoscopy will show the evidence of the disease. There may be erosions in the mucosa of esophagus. A Barrett’s esophagus, where the normal inner layer is replaced by intestinal pattern. A hiatus hernia also can be distinguished. Esophageal manometric study finds dismotility if any.

The proton pump inhibitors are the main stay of treatment where, no organic problem is noticed.Specific diseases like hiatus hernia and a lax lower esophageal sphincter will require surgical intervention. The surgeries are usually successful. But, before that one may change some of his habits and try to get relief. Refraining from taking water immediately after food, walking in slow pace in the room, not going to bed immediately after taking food and keeping head end up supported by pillow may help. Some Yogic practices like taking deep respiration and exhaling it with full force,repeating it for several times in a session may strengthen the diaphragm to block acid eructation from stomach to esophagus. Barrett’s esophagus requires special mention because it may lead to cancer of esophagus in the long run. If found has to be followed with regular endoscopic reviews.

Though a benign disease; it is associated with considerable morbidity, if left untreated. But, the proton pump inhibitors have changed the total outlook of treatment. Many times patients become dependent on it.

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Alcoholics have the exclusive right to suffer from a disease called pancreatitis.Gall stone disease also take a sizable share from this. All others have some share.

Pancreas is responsible for digestion of protein and fat.If some injury to it’s integrity done by way of being toxic to it ,there occurs inflammation of it’s tissue.There is pain in the upper abdomen. Patient prefers a prop up position or feels better if leans forward.Symptoms may range from mild attack to severe.There may be features of severe shock in form of sweating ,pulselessness and vomiting.Abdomen may be distended and there may be a firm feeling of abdominal wall.

There are several scoring systems to asses the severity of the disease.Diagnosis is based on several blood tests and ultrasonogram.A CT scanning may be needed sometimes.The disease is usually serious and mortality is high.Treatment is usually medicinal and sometimes surgery may be required.

Steps to prevent it is by far the best solution.And the key to it is to leave drinking alcohol.

Pain in middle of upper abdomen in a commonly encountered complain from patients in any hospital.There are vast nuber of causes for it.Many of them are for academic interest.Among the most commonly encountered conditions Acid Peptic disease is one.

Here there is pain in the middle of upper abdomen .This pain may come in empty stomach or after taking food.It is typically colicky in nature,sometimes subsides after taking food or aggravated after taking food.It my appear  seasonally in the winter.Gradually this timing of pain changes  and pain is always felt. There may appear vomiting which may contain freshly eaten food to stale food, blood and bile.Some times there occurs  blood vomiting and passing of black stool.Some times patient may present in the emergency with a complication called perforation of stomach or duodenum.

This disease may be seen in the stomach,duodenum,Lower esophagus or in  a mackel’s  diverticulum.The symptoms and signs may differ according to the site of disease. To-day we will see the disease of stomach and duodenum.

Hydrochloric acid secretion is an integral part of stomach inner layer called gastric mucosa.There in also secretion of protein digesting enzyme called pepsinogen.The digestion of own gastric mucosa hangs on a fine balance between the secretions and mucosal defense. Mucosal defense  rests on the amount of bicarbonate  and  mucus present in the stomach.There are various means to dis-balance it.It my be stress and strain,Ingestion of analgesics and steroid,Severe trauma lading to blood loss and infection by a microbe called H.Pylori. There may occur inflammation to ulcerations in mucosa and may progress to other layers of stomach and duodenum.

The disease can very nicely be diagnosed by  an endoscopy.This can be treated by newer proton pump inhibitor drugs.This drug has left the surgical option for this disease limited  to the complications only.If drug treatment fails nice surgical options are available.

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One patient came to me in great distress with hiccup,pain in the abdomen and inability to stand. Apart from this ,patients present to a doctor with complains of vomiting of stale food some hours or  days of  taking food.There is loss of appetite ,weakness,malnutrition,hiccup and desire to induce vomiting to get relief from pain.

These are the cardinal symptoms of obstruction to passage of food from stomach called Pyloric obstruction/Duodenal stenosis.Causes are varied.Important common cause are development of stenosis after a benign duodenal or pyloric ulcer,a cancer obstructing the passage from stomach and a foreign body such as leaves or hair ball(eaten) seen in psychotics.After invent of stomach acid suppressing drugs these cases are seldom seen.But the patient in question was a road side vendor with irregular and bad eating habit.The patient said that he is in empty stomach .So to find out the cause in hope of some interesting findings the endoscope was put. Read the rest of this entry »

                           This is a very nasty disease to me.Somehow I am not comfortable to treat this one.Patient comes with a painful swelling near to anus,fever and prostration .On examination a painful swelling will be found near the anal opening.Once drained a large amount of foul swelling pus will  come out and relief the patient to a considerable extent. And this cycle goes on unless the patient is not  throughly investigated for possibility of Fistula-In-Ano.
It is a condition where there is build up of a   tunnelled connection ,of course small in caliber between interior of lower gut and the exterior i.e. skin.This occurs from an infection of anal glands located inside the anus and rectum and gradually enlarge to burst to the out side.With  passing of time the inside of the fistula or tunnel matures and continuously discharges pus.That is why I call a nasty disease.
Fistula may also manifestation of some diseases like TB,Ulcerative Colitis,Chron’s Disease ,A rectal cancer and some other diseases.These are of various types and classified in various manner.
                                                                         Most accepted being superficiel,deep,intershincteric,transphencteric and high etc.which is required for the treating doctors.Treatment of more complex fistulas are not very much satisfactioy.A fistulogram gives good idea of it’s extension to help in operation.Besides trans rectal ultrasonogram is helpful.Tuberculosis if suspected should be searched for the primary site of infection .A simple per rectal examination is helpful to supect a cancer inside.
Surgery is the option for most of fistulas except TB and some other diseases.Here the whole tract is excised leaving a raw area to heal from the depth. And if dressing done properly and wound heals fromthe depth probably the surgeon should be able to sleep cmfortably.The excised specimen is to be subjected to histopathological study to exclude associated cancer and TB in the  tract.And in that case furhter treatment for the specific disease to be taken up.

Most common complication of surgery is inardverent injury to the anal sphincture making the patient incompetent to hold faecal matter.And the next is recurrance.
So this surgey many times brings down the ranking of the surgeon’s popualrity.People taking non-veg diet and suffering fron constipation are prone for this disease.

Hepatocellular carcinoma

Fever,loss of appetite ,pain in upper abdomen and yellow colourization of eye balls,palms and body point to a disease loosely called jaundice.Actually jaundice is a symptom of an underlying disease.There are a number causes for it and some are age specific.Commonly it occurs due to viral hepatitis.Also there are a number of viruses affecting liver such as hepatitis virus A,B,C and many more.Amongst them most common is hepatitis A followed by hepatitis B.While the former is transmitted through contaminated food and drink the later is through contaminated blood and blood products to the blood of victim.By far the hepatitis A has the easiest mode of transmission especially in the under developed and developing countries.Supply of safe drinking water and safe raw eaten vegetables and fruits are the ways to prevent it which is very difficult to achieve in these countries. A good vaccine is available and can be taken at prescribed intervals to prevent the disease.However hepatitis A usually subsides without much of sequel.
On the other hand hepatitis B usually goes for a protracted course and may go chronic leading to cirrhosis of lever and much dreaded hepatocellular carcinoma.Potent vaccines are available to prevent it .Avoiding contaminated syringes,blood for transfusion and other blood products are also important.However in the face of complicated situation it is better to be vaccine protected .So to say the vaccine can prevent a fraction of hepatocellular carcinoma.

hepatitis A prevalence

ESOPHAGEAL VARICES.

Bleeding from upper intestine ,most commonly from an ulcer in stomach and duodenum causes black stool .Black stool is due to action of acid (hydrochloric)on the hemoglobin (present in the red blood cells).That is substantiated by occult blood test of a stool sample.
The exact disease of stomach and duodenum can be determined by endoscopy.Amongst various other causes of bleeding cancer of stomach, esophageal varices and tear of upper end of stomach are important.
Bleeding blood vessels in an ulcer can be sealed endoscopically and further blood loss be prevented. Along with that acid suppression also important.Some times it may be required to transfuse blood to the patient.
Analgesics are most common triggering factor for ulceration and subsequent bleeding.To prevent this dreaded complication analgesics to be taken when it is essential and informing doctor for previous acid peptic disease while getting treatment is absolutely necessary.

Stomach Ulcer

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A patient feeling weak,sweating,pain in the upper abdomen and complaining of passage of black tarry stool, the common diagnosis comes to mind is bleeding from a pre-existing or a fresh stomach or duodenal ulcer.

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Now-a-days the terminology used for the peptic ulcer is “Acid peptic disease”. Due to various reasons one may get the inner line of stomach and/or duodenum breached/damaged leading to ulceration.
Most common causes being stress of life, spicy chilly foods, perfectionist personality, intake of analgesics, smoking, H.Pylori infection and severe trauma etc..
There occurs ulceration which may bleed at times to a larger extent. This blood goes down to the lower intestine and the haemoglobin, an iron containing protein gets converted to acid haematin making stool appear black, tarry and sticky. If excessive bleeding is there the patient may feel weak or may get fainting attacks.
Treatment commences with conservative measures after a stool sample test for occult blood and usually successful. Sometimes blood transfusion and surgery may save the life of the patient.
Taking green leafy vegetables and iron containing capsules may impart a black colour to stool.
AVOIDING THE FOODS MENTIONED AND AVOIDING STRESS WILL PREVENT IT TO A LARGER EXTENT.