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Acid peptic disease commonly affects stomach,duodenum and/or lower esophagus .An uncommon site is Mackel’s Diverticulum. There may be the presence of ectopic stomach mucosa to cause the symptoms.Here there is  the same pathology to cause ulcer or inflammation.

Mackel’s diverticulum is an out pouching of intestine in it’s lower end.It is of short length and is blind.The pain here may not have a time relation to food or periodicity.Sometimes it causes perforation.Pain is felt little to the right side of umbilicus .May confuse with an appendicitis or a stone in the  right ureter.

It is difficult to diagnose.An ultrasonogram ,CT or barium meal follow through may help in diagnosis.Now-a-days a capsule endoscopy will accuratey diagnoses it.Nuclear imaging may help in diagnosing Mackel’s diverticulitis. Many a times when a normal looking appendix is found in a surgery for appendicitis a Mackel’s diverticulum is searched for.

Treatment is only surgery and is very effective.

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 »

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.