Digestive Disorders & Treatment

Digestive Disorders

Digestive disorders include the treatment of diseases of the liver and digestive tract, including the stomach, duodenum, gallbladder, biliary tract, pancreas, small intestine and colon.

PANCREAS

The pancreas is a large gland located behind the stomach and close to the upper part of the small intestine.

Secretes digestive enzymes into the small intestine through a tube is called the pancreatic duct. These enzymes help digest the fats, proteins and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it derives from food for energy.

1- Acute Pancreatitis

Acute pancreatitis is an inflammation of the pancreas.

Signs and Symptoms:

Acute pancreatitis usually begins with a sharp, severe pain in the upper abdomen that may last for a few hours or a few days.

Symptoms include:

1- Constant pain in the upper abdomen, in the back and other areas

2- Pain may be sudden and intense or may begin as a mild pain that is aggravated by eating and drinking

3- Elevated pulse

4- Fever

5- Nausea and vomiting

6- Swollen and tender abdomen

Diagnosis:

Your doctor will ask about your medical history, perform a physical exam and order blood tests to check for certain enzymes.

During acute attacks, the blood contains at least three times more than the normal amount of digestive enzymes formed in the pancreas. Changes may occur in blood levels of glucose, calcium, magnesium, sodium, potassium and bicarbonate. After the pancreas recovers, these levels usually return to normal.

An abdominal ultrasound to look for gallstones and a computerized tomography (CT) scan to check for injury to the pancreas may be performed.

A procedure, called an endoscopic retrograde Cholangiopancreatography (ERCP), may determine if there is a bile duct obstruction. During this procedure, a flexible tube is inserted down the throat into the stomach and small intestines. Dye is injected into the drainage tube of the pancreas to locate a possible obstruction.

Treatment:

Treatment for acute pancreatitis depends on the severity of the attack. Many cases get better with time, unless complications develop. Usually, patients are hospitalized to receive intravenous fluids to restore blood volume and hydration as well as medications to control pain. Antibiotics may be given if an infection occurs.

Dietary guidelines are usually prescribed to reduce the fat you eat, since your body has trouble digesting these substances.
Surgery

Surgery may be needed if complications such as infection, cysts or bleeding occur. If gallstrones are the cause of your attack, the gallbladder may be removed. If a bile duct obstruction is suspected of causing the pancreatitis, a procedure called an endoscopic retrograde cholangiopancreatography (ERCP) may be performed. A flexible tube is inserted down the throat into the stomach and small intestines. Dye is injected into the drainage tube of the pancreas to locate the possible obstruction. Special instruments are inserted through the endoscope or tube to remove the obstruction or stretch a narrowing segment of the bile duct. Patients with severe acute pancreatitis may develop pancreatic necrosis, a serious infection in which tissue within the pancreas dies and later becomes infected. This result in a condition called acute necrotizing pancreatitis. An abscess may form on the dead tissue several weeks after an attack of acute necrotizing pancreatitis.

2- Barrett's Esophagus

Barrett's esophagus is a chronic condition in which the lining of the esophagus the "food tube" that connects the throat to the stomach is damaged by bile or acid from the stomach. The damage is characterized by changes in the cells at the base of the esophagus. The esophageal cells gradually elongate and thicken, and eventually come to resemble intestinal cells.

Normally, the body has a mechanism to prevent stomach acid from reaching the esophagus. A circular band of muscle at the lower end of the esophagus, called the lower esophageal sphincter, seals shut and prevents stomach contents from rising up. But certain conditions, such as chronic gastroesophageal reflux disease (GERD) or obesity, weaken the sphincter. When that happens, stomach acid can gurgle up and burn the lower end of the esophagus.

Occasional heartburn is harmless, but chronic GERD can set the stage for Barrett's esophagus. Experts estimate that between 10 and 15 percent of people with GERD will develop Barrett's esophagus.

Barrett's esophagus is serious because it increases a person's risk for a type of cancer called esophageal adenocarcinoma. In most cases, precancerous cells, called dysplasia, appear first and offer a chance for early intervention.

Signs & Symptoms:

Barrett's esophagus itself has no symptoms but its precursor, gastroesophageal reflux disease (GERD), does. Signs of GERD include regular heartburn, which is often described as a painful burning sensation either in the chest, behind the breastbone, or in the middle of the abdomen.

However, not all people with Barrett's esophagus have chronic heartburn. As many as half of all Barrett's esophagus patients don't have any symptoms at all. Because the condition can go undetected, it's good to know about other risk factors for Barrett's esophagus, which include:

Obesity

1- Smoking

2- Gender (men are twice as likely as women to get Barrett's esophagus)

3- Age (Barrett's esophagus is more common in people age 50 or older)

4- A close family member with the condition

Diagnosis:

Barrett's esophagus is diagnosed with an upper gastrointestinal (GI) endoscopy and biopsies.

To perform an upper GI endoscopy, a doctor threads a thin, flexible tube through the mouth, down the esophagus and into the stomach while the patient is lightly sedated. The endoscope has a flashlight and camera on one end that allows the doctor to inspect the esophageal lining for cellular changes that might indicate dysplasia. The doctor can also use the endoscope to take small tissue samples called biopsies. These samples help doctors diagnose the presence and grade of Barrett's esophagus.

New technologies also allow doctors to do optical biopsies, which don't involve removing any tissue at all.

The results may be labeled one of the following:

1- No dysplasia, meaning the patient has Barrett's esophagus but no precancerous cellular changes

2- Low-grade dysplasia, meaning cells show early signs of precancerous changes

3- High-grade dysplasia, meaning cells are moving toward esophageal cancer.

Treatment:

Treatment of Barrett's esophagus depends on the condition's severity, the grade of dysplasia and the patient's overall health.

The first line of treatment is often surveillance and medication. If the biopsy shows no or even low-grade dysplasia, we may simply monitor the patient for changes. That may mean a follow-up endoscopy in six months to a year and, for some patients, daily medication.

For Bartlett's esophagus, the most common type of drug therapy is proton pump inhibitors, or PPIs. These medications are designed to treat GERD and work by suppressing the stomach's acid production. Less stomach acid means less damage to the esophagus. PPIs are best taken short term. Examples of common PPIs include:

1- Omeprazole (Prilosec, Zegerid)

2- Lansoprazole (Prevacid)

3- Pantoprazole (Protonix)

4- Rabeprazole (AcipHex)

5- Esomeprazole (Nexium)

6- Dexlansoprazole (Dexilant)

3- Cholangiocarcinoma

Cholangiocarcinoma is a rare cancer found in the tissue of the bile ducts, occurring in approximately two out of 100,000 people. Men and women are equally affected and most cases occur in people over age 65. The bile duct is a small tube that connects the liver and gallbladder to the small intestine. The ducts carry bile -- the liquid that helps break down fat in food during digestion out of the liver.

Tumors can develop anywhere on the bile ducts and are typically slow growing. However, by the time a diagnosis usually is made, many of the tumors are too advanced to be surgically removed. Other conditions such as primary sclerosing cholangitis, bile duct cysts and chronic biliary irritation, are associated with an increased risk of cholangiocarcinoma.

Signs & Symptoms:

Cholangiocarcinoma is a rare cancer found in the tissue of the bile ducts. Tumors produce symptoms by blocking the bile ducts. Common symptoms may include:

- Clay colored stools

- Jaundice, which is a yellowing of the skin and eyes

- Itching

- Abdominal pain that may extend to the back

- Loss of appetite

- Unexplained weight loss

- Fever

- Chills

Diagnosis:

Your doctor will first ask about your medical history and perform a physical examination. In addition, he or she may order the following tests:

Computed Tomography (CT) Scan: An X-ray that uses a computer to provide an image of the inside of the abdomen.

Magnetic Resonance Imaging (MRI) Scan: This test uses magnetic waves to create an image.

Ultrasound: This test uses high-frequency sound waves that echo off the body to create a picture. Endoscopic Retrograde Cholangiopancreatography (ERCP): During an ERCP, a flexible tube is inserted down the throat and into the stomach and small intestine. By injecting dye into the drainage tube of the pancreas, your doctor can see the area more clearly.

Endoscopic Ultrasound (EUS): EUS involves passing a thin, flexible tube called an endoscope through the mouth or the anus to exam the lining and walls of the upper and lower gastrointestinal tract and nearby organs such as the pancreas and gall bladder. The endoscope is equipped with a small ultrasound transducer that produces sounds waves that create a viewable image of the digestive track. When combined with fine needle aspiration, EUS becomes a state-of-the-art, minimally invasive alternative to exploratory surgery to remove tissue samples from abdominal and other organs. It also may be used to determine the cause of symptoms such as abdominal pain, to evaluate a growth, to diagnose diseases of the pancreas, bile duct and gall bladder when other tests are inconclusive and to determine the extent of certain cancers of the lungs or digestive tract.

Percutaneous Transhepatic Cholangiography (PTC): By injecting dye into the bile duct through a thin needle inserted into the liver, blockages can be seen on X-ray.

Bile Duct Biopsy and Fine Needle Aspiration: A tiny sample of the bile duct fluid or tissue is removed and examined under a microscope.

Treatment:

Surgery and radiation therapy are the two most common treatments for cholangiocarcinoma.

Surgery

If the cancer is small and has not spread beyond the bile duct, your doctor may remove the whole bile duct and make a new duct by connecting the duct openings in the liver to the intestine. Lymph nodes also will be removed and examined under the microscope to see if they contain cancer. If the cancer has spread and cannot be removed, your doctor may perform surgery to relieve symptoms.

If the cancer is blocking the small intestine and bile builds up in the gallbladder, surgery may be required. During this operation, called a biliary bypass, your doctor will cut the gallbladder or bile duct and sew it to the small intestine.

After complete removal of the tumor, 30 percent to 40 percent of patients survive for at least five years, with the possibility of being completely cured. If the tumor cannot be completely removed, it generally is not possible to cure the patient. In these cases, if you are not a candidate for surgery and have an obstruction, percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) can be used to place plastic or metal stents, which help to relieve obstructions.

Radiation Therapy

Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumors. There are two main types of radiation therapy:

External-Beam Radiation Therapy: Radiation comes from a machine outside the body.

Internal Radiation Therapy: Materials that produce radiation, called radioisotopes, are put into the area where the cancer cells are found through thin plastic tubes.

Experimental Therapy

There are a couple types of therapy that are currently being studied in clinical trials for the treatment of cholangiocarcinoma, including:

Chemotherapy: Uses drugs to kill cancer cells

Biological Therapy: Uses the body's immune system to fight cancer.

Photodynamic Therapy: Uses a specific type of light and photosensitizing agent to kill cancer cells.

4- Chronic Pancreatitis

Chronic pancreatitis begins as acute pancreatitis and becomes chronic when irreversible scarring of the pancreas occurs. There are a number of things that increase a person's risk of developing this condition, such as alcohol consumption, smoking, genetic factors and other conditions or traumatic events that injure the pancreas. The pancreas may eventually stop producing the enzymes necessary for your body to digest and absorb nutrients. In its advanced stages, the disease can cause the pancreas to lose its ability to produce insulin.

Signs & Symptoms:

Most people with chronic pancreatitis experience pain in the back and abdomen. In some cases, abdominal pain goes away as the condition advances, probably because the pancreas is no longer making digestive enzymes. Weight loss is often a symptom of chronic pancreatitis because the body does not secrete enough pancreatic enzymes to break down food and nutrients are not absorbed normally. Poor digestion leads to excretion of fat, protein and sugar in the stool. If the insulin-producing cells of the pancreas have been damaged, diabetes may develop.

Diagnosis:

The diagnosis of chronic pancreatitis frequently can be made based entirely on your symptoms and medical history. Endoscopic retrograde cholangiopancreatography (ERCP), computerized tomography (CT) scans, and endoscopic ultrasound also can help your doctor make a definite diagnosis. Pancreatic function tests help determine if your pancreas is still making enough digestive enzymes. In more advanced stages of the disease when diabetes and malabsorption occur, your doctor may recommend blood, urine and stool tests.

Treatment:

Treatment of chronic pancreatitis depends on the cause of the disease, severity of the associated pain and effectiveness of former treatment approaches. The first step of treatment focuses on relieving pain and eating a diet that is high in carbohydrates and low in fat. It is essential to stop drinking alcohol entirely.

Your doctor may prescribe pancreatic enzymes to take with meals if your pancreas does not secrete enough of its own enzymes. The supplemental enzymes should be taken with every meal to help your body digest food and regain some weight. If you have diabetes, insulin and other drugs may be needed to control blood sugar levels.

Surgery

There are a number of surgical procedures available for patients whose pain is not relieved by medications or other approaches. Surgery may involve removing stones from the pancreas, draining blocked ducts, or partial or entire removal of the pancreas.

Pancreatectomy

A partial pancreatectomy involves removing part of the pancreas, such as the body or tail, during a Puestow or Whipple procedure. A total pancreatectomy involves removing the entire pancreas. While a total pancreatectomy is usually effective in relieving pain in patients when all other treatments fail, it induces permanent diabetes, requiring patients to take insulin shots or use an insulin pump for the rest of their lives. This is because the pancreas contains Islets of Langerhans also known as islets or islet cells that regulate the body's blood sugar levels.

UCSF's Islet and Cellular Transplantation Center is one the few medical centers in the country to offer a total pancreatectomy performed with an islet autotransplant. This innovative dual procedure helps alleviate pain caused by pancreatitis, while preserving the ability to secrete insulin and reducing the risk of developing surgically induced diabetes.

Pancreatectomy and Islet Autotransplant

Patients with chronic pancreatitis have the option of having an islet auto (meaning "self") transplant after their total pancreatectomy. During an islet autotransplant, the patient's own islet cells are isolated from their removed pancreas and then put back into the patient, where they start producing insulin.

This procedure may prevent diabetes from developing or make the diabetes milder than if a patient had had a pancreatectomy alone.

While the goal is to eliminate each patient's pain, preserve their pancreatic function and prevent diabetes, there is no guarantee that diabetes will not develop because there is no way of determining the quality of a patient's islets before transplantation.

Patients who have a pancreatectomy with an islet autotransplant have a 50 percent chance of becoming insulin dependent for life, while patients who have only a pancreatectomy have a 100 percent chance of becoming permanently insulin dependent. Patients who are at the highest risk of developing diabetes are those who have not had prior surgery to remove a portion of their pancreas.

Typically, patients spend two to three weeks in the hospital following a pancreatectomy with an islet autotransplant. During this time, patients receive an insulin drip and learn how to manage diabetes in case they develop the condition.

As islets start working, patients are able to reduce the amount of insulin they take. Within a month, it usually becomes clear whether islets are working well enough for patients to completely stop taking insulin. If diabetes develops, it is important that a patient works closely with their doctor to develop an insulin treatment plan.

5- Constipation

Constipation is the infrequent and difficult passage of stools. It is the most common digestive complaint in the United States, resulting in approximately two million doctor visits annually. Women, especially those who are pregnant, and adults aged 65 and older are most commonly affected. Virtually everyone experiences an occasional bout of constipation that resolves itself with dietary changes and time. Although uncomfortable, it is usually not dangerous. However, it can lead to other problems such as hemorrhoids or signal an underlying health condition.

Although bowel movement frequency varies greatly for each person, if more than three days pass without a bowel movement, the contents in the intestines may harden, making it difficult or even painful to pass. Straining during bowel movements or the feeling of incomplete emptying also may be considered constipation.

Constipation is a symptom, not a disease, and can be caused by many factors. The most common are poor diet and lack of exercise. Other causes include irritable bowel syndrome, pregnancy, laxative abuse, travel, specific diseases, hormonal disturbances, loss of body salts and nerve damage. A variety of medications also can cause constipation, such as pain medications, especially narcotics, antacids that contain aluminum, antispasmodic drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants for epilepsy, antiparkinsonism drugs and antihypertensive calcium channel blockers. Each individual may experience symptoms of constipation differently. However, some of the most common symptoms include:

- The inability to have a bowel movement for several days or passing hard, dry stools

- Abdominal bloating, cramps or pain

- Decreased appetite

- Lethargy

Your doctor will ask about your medical history, perform a physical examination and order routine blood, urine and stool tests. Other diagnostic tests used to make a diagnosis of constipation include sigmoidoscopy and colonoscopy.

Sigmoidoscopy

For a sigmoidoscopy, the doctor uses a special instrument called a colonoscope, which is a long, flexible tube that is about as thick as your index finger and has a tiny video camera and light on the end, to exam your rectum and lower part of your colon. During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse and the oxygen level in your blood will be carefully monitored.

Your doctor will do a rectal exam with a gloved, lubricated finger; then the lubricated colonoscope will be gently inserted. As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or no discomfort. Occasionally, some abdominal pressure, which may be provided by your nurse, or a change in position may be needed to avoid looping of the colonoscope within the abdomen. Your doctor will advance the scope until he or she has examined the left side of the colon. Afterwards, the scope is then carefully withdrawn while a thorough exam of the colon is performed. At this point in the exam, your doctor will use the colonoscope to look closely for any polyps or other problems that may require evaluation, diagnosis or treatment. The procedure typically takes between 10 and 15 minutes.

Colonoscopy

Colonoscopy is used to evaluate symptoms such as abdominal pain, bloody bowel movements, altered bowel habits such as constipation or diarrhea, and weight loss. This test is similar to sigmoidoscopy, but the doctor looks at the entire colon, rather than just the left side. The term "colonoscopy" means looking inside the colon. Colonoscopy is a procedure performed by a gastroenterologist, a well-trained specialized doctor.

Colonoscopy also is performed using a colonoscope, which is a long, flexible tube that is about as thick as your index finger and has a tiny video camera and light on the end, to exam your rectum and lower part of your colon. During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse and the oxygen level in your blood will be carefully monitored.

By adjusting the various controls on the colonoscope, the gastroenterologist can safely maneuver the instrument to carefully examine the inside lining of the colon from the anus to the cecum. The colonoscope contains a channel that allows instruments to be passed in order to take tissue or stool samples, remove polyps and provide other therapy. The high quality picture from the colonoscope, shown on a TV monitor, provides a clear, detailed view of the colon. It provides a more precise examination than X-ray studies.

Your doctor will do a rectal exam with a gloved, lubricated finger; then the lubricated colonoscope will be gently inserted. As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or no discomfort. Occasionally, some abdominal pressure, which may be provided by your nurse, or a change in position may be needed to avoid looping of the colonoscope within the abdomen. Your doctor will advance the scope until he or she reaches the beginning of the colon, called the cecum. After reaching this point, the scope is then carefully withdrawn while a thorough exam of the colon is performed. At this point in the exam, your doctor will use the colonoscope to look closely for any polyps or other problems that may require evaluation, diagnosis or treatment. The procedure typically takes between 10 and 15 minutes.

Treatment for constipation depends on the cause, severity and duration. However, in most cases, dietary and lifestyle changes will help relieve symptoms and prevent the condition altogether. A well-balanced diet that includes fiber-rich foods, such as unprocessed bran, whole-grain bread and fresh fruits and vegetables, is recommended. Ideally, you should consume 20 to 35 grams of fiber each day. In addition, drinking plenty of fluids and exercising regularly helps stimulate intestinal activity.

Although most people who are mildly constipated do not need laxatives and an overuse of laxatives can actually cause constipation, they may be recommended for those who are still suffering from the condition even after making diet and lifestyle changes. Your doctor is best qualified to determine when a laxative is needed and which type.

6- Crohn's Disease

Crohn's disease causes inflammation of the small intestine. Although it may involve any part of the digestive tract from the mouth to the anus, it most commonly affects the last part of the small intestine, called the ileum, and the large intestine, including the colon and rectum. This is considered a chronic condition because it may recur at various times throughout your lifetime, with periods of remission in which you are free of symptoms. There is no consistently accurate way to predict when a remission may occur or when symptoms will return.

The disease may occur in people of all ages, although most are diagnosed before the age of 30. However, it also can affect young children and older people in their seventies or beyond. Crohn's disease occurs most commonly in people living in northern climates and affects men and women equally. The condition can be inherited and is common in some families. About 20 percent to 25 percent of those with Crohn's disease have a close relative who also has the disease or the related condition, ulcerative colitis. The cause of Crohn's disease has not been proven definitely. However, the immune system's response to certain viruses and bacteria that cause inflammation of the intestines is believed to be the primary cause of the disease.

Signs & Symptoms:

Common symptoms of Crohn's disease include the following:

- Loose, watery or frequent bowel movements

- Abdominal cramps and pain

- Fever

- Rectal bleeding

- Loss of appetite and subsequent weight loss

During periods of active symptoms, you also may experience:

- Fatigue

- Joint pain

- Skin problems

- Fissures, or tears in the lining of the anus

- Fistulas, a tunnel that connects the intestine to the bladder, vagina or skin

- Oral or skin lesions

Diagnosis:

First your doctor will ask about your medical history and perform a physical evaluation. There is no single test that can provide a diagnosis of Crohn's disease, but rather a series of X-rays, laboratory tests, endoscopy and pathology tests that are used. These may include the following:

Blood Tests: Blood tests may be done to check for anemia, which may indicate bleeding in the intestines. Blood tests also may uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. C reactive protein, a marker of inflammation, also may be elevated.

· Stool Sample: By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines.

· Small Bowel Radiograph: Your doctor may perform a small bowel follow through to look at the small intestine. For this test, you will drink barium, a chalky solution that coats the lining of the small intestine, before X-rays are taken. The barium and irregularity of the border between the barium and intestine shows up white on X-ray film, revealing inflammation or other abnormalities in the intestine.

Treatment:

Although there is no cure for Crohn's disease, there are a number of treatment options available.

Drug Therapy

Drugs are used to suppress the inflammatory response associated with Crohn's disease, which in turn helps the intestines to heal and relieves symptoms. Once symptoms are under control, medications are used to decrease the frequency of flare-ups and prevent symptoms from recurring. There are several types of drugs available to treat Crohn's disease including aminosalicylates, corticosteroids, immune modifiers and biologic therapy.

7- Diarrhea

Diarrhea can be described as an abnormal increase in the frequency, volume or liquidity of your stools. The condition usually lasts a few hours to a couple of days. Diarrhea is typically associated with abdominal cramps. The most common causes of the condition are viruses, bacteria and parasites.

Signs & Symptoms:

The most common causes of diarrhea include:

Viruses

Bacteria

Parasites

Other causes include medications, such as antibiotics that disturb the natural balance of the bacteria in your intestines, artificial sweeteners and lactose, which is a sugar found in milk.

Diarrhea that persists for more than a couple of days is considered chronic and may be a sign of an underlying condition, such as inflammatory bowel disease or an infection. In these cases, diarrhea may lead to dehydration and requires the care of your doctor. Dehydration occurs when the body has lost too much fluid and electrolytes -- the salts potassium and sodium. The fluid and electrolytes lost during diarrhea need to be replaced promptly because the body cannot function properly without them.

Signs and symptoms associated with diarrhea may include:

- Frequent loose, watery stools

- Abdominal cramps

- Abdominal pain

- Fever

- Bleeding

- Lightheadedness or dizziness from dehydration

Diarrhea caused by a viral infection, such as a stomach virus, or bacterial infection also may cause vomiting. In addition, blood and mucus in the stools may appear with diarrhea caused by bacterial infections.

Diagnosis:

Sigmoidoscopy

Colonoscopy

Your doctor will do a rectal exam with a gloved, lubricated finger; then the lubricated colonoscope will be gently inserted. As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or no discomfort. Occasionally, some abdominal pressure, which may be provided by your nurse, or a change in position may be needed to avoid looping of the colonoscope within the abdomen. Your doctor will advance the scope until he or she reaches the beginning of the colon, called the cecum. After reaching this point, the scope is then carefully withdrawn while a thorough exam of the colon is performed. At this point in the exam, your doctor will use the colonoscope to look closely for any polyps or other problems that may require evaluation, diagnosis or treatment. The procedure typically takes between 10 and 15 minutes.

Treatment:

In most cases, diarrhea resolves itself after two or three days, and almost always within one to two weeks. Usually, the only treatment necessary is preventing dehydration, which can be done by drinking replacement fluids and an electrolyte mixture. Adequate levels of minerals such as sodium, magnesium, calcium and especially potassium are essential in maintaining the electrical pacing of your heartbeat. Disruption of your body's levels of fluids and minerals creates a serious electrolyte imbalance.

Medicines that stop diarrhea should not be used for people whose diarrhea is caused by bacterial infection or a parasite because they may prolong the infection. In these cases, antibiotics are typically recommended. Depending on the severity and type of virus, viral caused diarrhea is either treated with medication or left to run its course.

8- Enterocutaneous Fistula

An enterocutaneous fistula (ECF) is an abnormal connection that develops between the intestinal tract or stomach and the skin. As a result, contents of the stomach or intestines leak through to the skin. Most ECFs occur after bowel surgery. Other causes include infection, perforated peptic ulcer, inflammatory bowel disease, Crohn's disease or ulcerative colitis. An ECF may also develop from an abdominal injury or trauma, such as a stabbing or gunshot.

Patients with ECFs often experience complex problems requiring a team approach that includes surgeons, nurses, enterostomal therapists, social workers and nutritionists to customize a treatment plan.

Signs & Symptoms:

Enterocutaneous fistulas (ECFs) can cause contents of the intestines or stomach to leak through a wound or opening in the skin. It also can cause:

- Dehydration

- Diarrhea

- Malnutrition

Diagnosis:

Your doctor will conduct a thorough physical exam and may prescribe the following tests to confirm a diagnosis of enterocutaneous fistula (ECF) :

- Abdominal CT scan

- Barium enema, if the fistula involves the colon

- Barium swallow, also called an esophagram. This test is a series of X-rays of the esophagus.

You drink a liquid containing barium, which coats the inside of your esophagus. The barium causes changes in the shape of the esophagus to show up on the X-rays.

- Fistulogram, which involves injecting contrast dye into the opening of the skin of an ECF and taking X-rays.

Treatment:

If the enterocutaneous fistula (ECF) doesn't heal on its own after a few weeks or months, a complex surgery is required to close the fistula and reconnect the gastrointestinal tract.

Patients with ECFs often need specialized wound care, nutritional rehabilitation and physical rehabilitation

9- Gallstones

Gallstones are solid pieces of material that form in the gallbladder, which is the sac located on the undersurface of the liver in the upper right-hand portion of the stomach cavity. The gallbladder aids in digestion by storing bile, which is produced and secreted continuously by the liver. After a meal, the gallbladder contracts and sends the stored bile into the intestine. When digestion of the meal is over, the gallbladder relaxes and continues to store bile.

About one million new cases of gallstones are diagnosed every year in the United States, and an estimated one in 10 people suffer from the condition, which is particularly common during the mid-life years. Women tend to develop gallstones more commonly than men and at a younger age.

Gallstones vary in size and volume, ranging from the size of a grain of sand to the size of a plum. The gallbladder may develop a single, often large stone or many smaller ones, even several thousand. Gallstones occur when the gallbladder crystallizes the components of bile it concentrates. Bile is a brown liquid containing bile salts, cholesterol, bilirubin and lecithin. Risk factors for developing gallstones include obesity, inherited body chemistry, body weight, sluggish gallbladder movement, hormones and possibly diet. For instance, very low calorie, rapid weight-loss diets and prolonged fasting, have been shown to cause gallstones. Some proteins in bile also can promote or inhibit gallstone development.

Signs & Symptoms:

Many people do not experience any symptoms and are said to have "silent gallstones." Often the gallstones are found when a test is performed to evaluate some other problem. Treatment is only recommended if a person actually experiences symptoms of the condition.

A severe and steady pain in the upper abdomen or right side is the most common symptom of gallstones. The pain, which also may affect the shoulder blades or right shoulder, lasts anywhere from several minutes to hours. In addition, you may experience sweating or vomiting.

In its more advanced and severe stages, gallstones can cause prolonged pain and infection of the gallbladder. Stones that have passed into the bile duct usually result in pain, fever and jaundice, which is yellow discoloration of the eyes and skin.

Diagnosis:

Your doctor will first ask about your medical history and perform a physical examination. In addition, he or she may order the following tests: Computed Tomography (CT) Scan: An X-ray that uses a computer to provide an image of the inside of the abdomen. Magnetic Resonance Imaging (MRI) Scan: This test uses magnetic waves to create an image.

Treatment:

Gallstones may be treated with surgery and medications.

Surgery

If surgery is required, the following procedures may be used:

Cholecystectomy: Surgical removal of the gallbladder, a procedure called cholecystectomy, is the most widely used therapy for gallstones, although this procedure is now mostly done laparoscopically. Though in some cases, due to infections or other surgeries, this traditional form of cholecystectomy will be performed. Four or five days of hospitalization are generally required for this procedure. Patients often do well after surgery and have no difficulty with digesting food.

10- Gastroparesis

Gastroparesis is a disorder affecting the nerves and muscles of the stomach, resulting in a paralyzed stomach that cannot perform its normal function. Normally, your stomach contracts slowly to squeeze solid food into small particles, which are then pushed into the small bowel. With gastroparesis, food is not moved into the small bowel and remains in the stomach for much longer than usual. When food lingers too long in the stomach, problems such as bacterial overgrowth can develop in the small bowel. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting and an obstruction in the stomach.

Although the cause of gastroparesis is unknown in more than half of patients, type 1 diabetes is the most common cause. It also can develop in people with type 2 diabetes, although this is less common. Other causes of gastroparesis include:

- Postviral syndromes

- Anorexia nervosa

- Surgery on the stomach or vagus nerve, a nerve that runs from the brain to the abdomen

- Medications, particularly anticholinergics and narcotics, which slow contractions in the intestine

- Gastroesophageal reflux disease, although this is rare

- Smooth muscle disorders such as amyloidosis and scleroderma

- Nervous system diseases, including abdominal migraine and Parkinson's disease

Signs & Symptoms:

Symptoms of gastroparesis range from mild to severe and commonly include:

- Nausea

- Vomiting

- An early feeling of fullness when eating

- Weight loss

- Abdominal bloating

- Abdominal discomfort

Diagnosis:

A diagnosis of gastroparesis begins with X-rays and an endoscopy. If your doctor does not detect another problem, the following tests may be recommended to make a definite diagnosis.

Endoscopy: During this procedure, the upper portion of the gastrointestinal tract is visualized with a flexible endoscope. The areas examined include the esophagus, or the swallowing tube leading to the stomach, the stomach and the beginning of the small intestine, called the duodenum.

The procedure is performed using an endoscope, which is a long, thin and flexible tube with a tiny video camera and light on the end. By adjusting the various controls on the endoscope, the gastroenterologist can safely maneuver the instrument to carefully examine the inside lining of the upper digestive system. The endoscope contains a channel that allows instruments to be passed in order to take tissue samples, remove polyps and provide other therapy. The high-quality picture from the endoscope is shown on a TV monitor. In many cases, upper GI endoscopy is a more precise examination than X-ray studies.

Gastric Emptying Scan: For this test, you will eat foods, typically eggs, that contain a very safe radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radioisotope is small and not dangerous. After eating, you will lie under a machine that shows an image of the food in the stomach and how quickly it leaves the stomach. A diagnosis of gastroparesis is made if more than half of the food remains in the stomach after 60 to 90 minutes. However, sometimes it requires more than one gastric emptying scan to detect gastroparesis.

Manometry: A test that measures the strength of your stomach contractions.

Electrogastrogram: This test is for patients who are experiencing unexplained nausea and vomiting. During the one-hour procedure, electrodes are placed on your stomach, which record the electrical activity of your stomach. This must be performed on an empty stomach, followed by a liquid meal.

Treatment:

Dietary Requirements

Therapy for gastroparesis requires that you follow certain dietary requirements, such as eating small meals throughout the day and avoiding foods that are difficult to digest. These include fatty foods, legumes, lentils and citrus fruits. If you have gastroparesis as a complication of diabetes, you may need to increase your insulin therapy.

Medications

Medications also are used to treat gastroparesis. One of the most effective is metoclopramide, which helps the stomach to empty by stimulating stomach activity. It also may relieve nausea and vomiting. Common side effects include drowsiness and fatigue. In addition, some people may experience depression, movement disorders, anxiety and breast tenderness or discharge. Metoclopramide is not recommended for patients with Parkinson's disease.

The antibiotic erythromycin also improves stomach emptying, but its side effects of nausea, vomiting and abdominal cramps limit its usefulness. One additional drug called domperidone is not approved for use in the United States. Domperidone improves stomach emptying by stimulating stomach motor activity, relieves nausea and has few side effects. Additional new methods are being evaluated in studies, and it is recommended that you speak to your doctor about these.

If drugs do not work for you, your doctor may recommend a jejunostomy tube, which allows food to bypass your stomach. Liquid nutrition, fluids and medication are delivered directly to the small bowel through the tube during severe attacks of gastroparesis. In extreme cases of gastroparesis, patients may need a semi-permanent intravenous (IV) line that delivers nutrients and fluids directly into the bloodstream.

Other Treatments

Gastric electrical stimulation uses a device, surgically implanted in the abdomen, to deliver mild electrical pulses to the nerves and smooth muscle of the lower part of the stomach. This stimulation may reduce chronic nausea and vomiting in patients with gastroparesis resulting from diabetes or unknown causes.

If gastroparesis is related to an injury of the vagus nerve, patients may benefit from a procedure called pyloroplasty. This procedure widens and relaxes the valve separating the stomach from the upper part of the small intestine, called the pyloric valve. This allows the stomach to empty more quickly. In some cases, before deciding to perform the procedure, botulinum toxin (Botox) will be injected at the pyloric valve to temporarily paralyze and relax it. This helps us determine if the patient would benefit from a pyloroplasty.

11- Heartburn

Heartburn, also known as acid indigestion, is a common symptom of gastroesophageal reflux (GERD) or acid reflux. You may experience GERD when acid contents in your stomach back up into your esophagus. This occurs when a muscle at the end of the esophagus, called the lower esophageal sphincter (LES), fails to operate properly. The LES opens when swallowing to allow the passage of food to the stomach and then closes to prevent food juices from returning, or refluxing, back into the esophagus.

The cause of heartburn is unknown, but certain factors may contribute to the condition. They include:

- Specific foods such as garlic, spicy foods and fried foods

- Smoking

- Caffeine

- Pregnancy

- Being overweight

- Alcohol

- Certain medications, such as nitrates and some muscle relaxants

A condition known as hiatal hernia also may contribute to heartburn. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up.

Occasional heartburn doesn't mean you have GERD. Ten percent of the population experiences heartburn and other symptoms of GERD at least once a week. But heartburn that occurs more than twice a week may be considered GERD, which can lead to more serious health problems such as inflammation of the esophagus or Barrett's esophagus and lung problems.

Signs & Symptoms:

Heartburn is a burning pain in the lower breastbone that may travel toward your neck. It also is associated with regurgitation of food and liquid into your mouth and a bitter or acidic taste.

Heartburn, also known as acid indigestion, is actually a common symptom of an underlying condition called gastroesophageal reflux (GERD) or acid reflux. In addition to heartburn, symptoms of GERD may include:

- Persistent sore throat

- Hoarseness

- Chronic cough

- Asthma

- Chest pain

- Feeling like there is a lump in your throat

Diagnosis:

Talking with your doctor about your symptoms may be enough for him or her to make a diagnosis of gastroesophageal reflux (GERD). However, additional tests may be recommended to determine its severity, including:

Upper GI Endoscopy: An endoscope is a device consisting of a flexible tube and a mini camera. In endoscopy, this device is introduced through the mouth to view the esophagus, stomach and upper small intestines.

Upper GI Series: These are a series of X-rays that examine the esophagus, stomach and small intestine. The X-rays are taken after you have swallowed a barium suspension, which coats the lining of the upper gastrointestinal tract. A radiologist then looks for irregularities in the linings, which can help diagnose a variety of digestive problems.

Esophageal Manometry: This test measures the motor action of the lower esophageal sphincter and esophageal body. A catheter measures esophageal pressure and records the duration and sequence of contractions.

Esophageal pH Monitoring: This is a test to measure the frequency and duration of stomach acid that enters the esophagus.

Treatment:

If you have ever experienced occasional heartburn associated with gastroesophageal reflux (GERD), you are probably familiar with the popular over-the counter antacids that neutralize stomach acid and relieve heartburn symptoms. However, these medications will typically not work if your heartburn is more frequent and severe. Other medications, which work to prevent reflux and block acid production, are available for more severe cases of heartburn.

In addition, lifestyle and dietary modifications are recommended and may relieve symptoms in some patients. A surgical procedure called fundoplication to tighten the lower esophageal sphincter muscles, or LES muscles, may be an alternative to drug therapy.

Recently, less invasive endoscopy techniques have been developed to tighten the barrier between the esophagus and the stomach. However, the safety and effectiveness of these new alternatives to surgery are still being determined.

12- Intestinal Failure

Intestinal failure occurs when your intestines can't digest food and absorb the fluids, electrolytes and nutrients essential to live. Intestinal failure is most often caused by short bowel syndrome, a problem that affects people who have had half or more of their small intestine removed due to injury or surgery to treat conditions such as trauma or mesenteric artery thrombosis. Intestinal failure also may be caused by digestive disorders, such as Crohn's disease or chronic idiopathic intestinal pseudoobstruction syndrome, which causes the bowel to malfunction.

Signs & Symptoms:

If you have intestinal failure, you may receive all or most of your nutrients and calories intravenously through total parenteral nutrition (TPN). TPN is given through a catheter placed in the arm, groin, neck or chest. Patients on TPN may live for many years, but long-term use of TPN can result in serious complications, such as bone disorders, central venous catheter infections and liver disease. Our goal is to restore intestinal function to minimize and ultimately eliminate the need for TPN. Unfortunately, not every patient can be weaned from TPN. In these cases, we work to optimize the use of TPN and decrease the risk of complications.

Conditions

Patients who may benefit from being treated at the Intestinal Rehabilitation and Transplantation Program include:

Adults with intestinal failure caused by:

- Desmoid tumor, a benign growth of tissue that can develop in the abdomen

- Fistulae or an abnormal duct that connects an abscess, cavity or hollow organ to the body surface or to another hollow organ

- Inflammatory bowel disease, such as Crohn's disease where chronic inflammation occurs in the intestines

- Multiple intestinal surgeries resulting in adhesions, motility problems that may lead to abnormal intestinal contractions and spasms

- Pseudoobstruction that impairs gastrointestinal motility despite the absence of an actual obstruction

- Radiation enteritis, a disorder of the large and small bowel that occurs during or after a course of radiation therapy to the abdomen, pelvis or rectum

- Refractory celiac disease, also known as sprue, a digestive disease that damages the small intestine and interferes with absorption of nutrients from food

- Superior mesenteric artery/vein thrombosis

- Trauma

- Tumor resection

- Volvulus or an abnormal rotation of the intestine

Signs & Symptoms:

Patients interested in the Intestinal Rehabilitation and Transplantation Program must complete an evaluation before qualifying for the program. Our team reviews each patient's medical history, including the primary diagnosis, previous surgeries, previous treatments and current nutritional status to determine whether he or she will benefit from intestinal rehabilitation.

The patient evaluation process includes:

- Consultations with a gastroenterologist and nurse practitioner, surgeon, nutritionist and social worker

- Laboratory tests

- Radiological tests

Additional tests when necessary, such as endoscopy with biopsy, gastrointestinal motility testing, breath hydrogen testing for bacterial overgrowth or malabsorption and imaging tests, such as abdominal CT scan

After the evaluation process is completed, our team determines if the patient should be admitted into the Intestinal Rehabilitation Program. If the patient is admitted, a comprehensive, individual treatment plan is designed to best meet their needs.

Diagnsosis:

The patient evaluation process includes:

Consultations with a gastroenterologist and nurse practitioner, surgeon, nutritionist and social worker

Laboratory tests

Radiological tests.

Treatment:

The Intestinal Rehabilitation and Transplantation Program offers a wide range services for adults and children. The type and length of treatment differs for each patient, depending on the needs and goals.

Services include:

Counseling and education about intestinal rehabilitation

Drug and diet modification to train the small intestine to absorb more nutrients. Consultations to help assess and correct nutrient deficiencies and prevent damage to kidneys, bones and liver

Management of TPN to avoid complications.

13- Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects the normal functions of the intestines, causing recurrent abdominal pain and discomfort, changes in bowel function, diarrhea and constipation. People with IBS have colons that are more sensitive and react to things that might not bother other people, such as stress, large meals, gas, medicines, certain foods, caffeine and alcohol.

IBS occurs in an estimated one in five Americans, and is more prevalent among women. It usually develops in late adolescence or early adulthood around age 20 and rarely appears for the first time after the age of 50.

Signs & Symptoms:

Common symptoms of irritable bowel syndrome (IBS) include:

- Abdominal pain

- Bloating

- Constipation

- Diarrhea

- Abnormal stool frequency, form and passage

- Some patients with IBS experience alternating diarrhea and constipation. Mucus also may be present around or within the stool.

Diagnosis:

Irritable bowel syndrome (IBS) shares many of the same symptoms with other gastrointestinal disorders. If you think you have IBS, you should visit your doctor.

There is no particular diagnostic test for IBS. The condition is diagnosed based on its symptoms and by ruling out other diseases. Typically your doctor will begin by asking about your medical history and your current symptoms. In addition, he or she will perform a physical evaluation. Diagnostic tests may be used to rule out other disorders. These can include stool or blood tests, X-rays, endoscopy and colonoscopy.

Treatment:

Although there is no cure for irritable bowel syndrome (IBS), there are many options available for treating and eliminating its symptoms.

Because stress and feeling mentally or emotionally tense, troubled, angry or overwhelmed can stimulate intestinal spasms in people with IBS, your doctor may suggest relaxation techniques, such as yoga, exercise and meditation. Tranquilizers and anti-depressants also may relieve symptoms. In addition, a healthy diet that includes lots of water, fiber and small meals may reduce flare-ups.

Fiber supplements or occasional laxatives may help with constipation, while medicines to decrease diarrhea and control intestinal muscle spasms may help reduce abdominal pain.

14- Obesity

An estimated 60 percent of Americans aged 20 years and older are considered overweight and one-quarter are considered obese. Being overweight means that you have an excess amount of body weight, including muscle, bone, fat and water. Being obese means that you have an excess amount of body fat.

Obesity significantly increases your risk of developing life-threatening conditions, such as heart disease, stroke, high blood pressure, type 2 diabetes and some forms of cancer. Each year, approximately 280,000 adults die from an obesity-related condition in the United States. Additionally, studies have shown that people who are overweight often suffer from societal discrimination, which may lead to depression, self-esteem and body issue problems.

Causes of Obisety

Obesity is a complex and chronic disease with many causes. It is not simply a result of overeating. Research has shown that genetics can play a significant role in determining a person's body weight, particularly for morbidly obese people. Diet and exercise may have a limited ability to provide effective, long-term relief for obese people.

Factors such as the environment, metabolism, eating disorders and certain medical conditions also may contribute to obesity.

Genetics

Research has shown that a person's genes play an important role in their tendency to gain weight. Just as some genes determine eye color or height, others affect appetite, ability to feel full or satisfied, metabolism, fat-storing ability and even natural activity levels.

Environment

Environmental and genetic factors are closely intertwined.

Fast food, long days sitting at a desk and suburban neighborhoods that require cars exacerbate hereditary factors such as metabolism and efficient fat storage. For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.

Metabolism

We used to think that a person could lose weight if they burned more calories than they consumed. Now we know that for some people, it's not that simple.

Obesity researchers now refer to a theory called the "set point," a sort of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.

Eating Disorders

Many obese and morbidly obese people suffer from eating disorders. In these cases, behavior and diet modification therapy are recommended to help treat the eating disorder before weight loss surgery is considered.

There also are certain medical conditions, such as hypothyroidism, that can cause weight gain and may be treated with medication.

Evaluation:

If you are obese or morbidly obese, you are at risk for developing a number of serious health problems. The most common conditions include:

Depression — Depression is very common after repeated failure with dieting and disapproval from family, friends and the public.

Diabetes — Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, high blood sugar can cause type 2 diabetes that can lead to serious damage to the body.

Gastroesophageal Reflux or Heartburn — When acid escapes from the stomach into the esophagus through a weak or overloaded valve, can occur, causing "heartburn" and acid indigestion. Gastroesophageal reflux disease can lead to Barrett's esophagus, a pre-cancerous change in the lining of the esophagus and a cause of esophageal cancer.

High Blood Pressure and Heart Disease — Excess body weight strains the heart. This may lead to high blood pressure, which can cause strokes as well as heart and kidney damage.

Incontinence — In obese people, a large, heavy abdomen may cause the valve on the urinary bladder to weaken, leading to urinary stress incontinence or the leakage of urine with coughing, sneezing or laughing.

Infertility: Obese women may experience infertility — an inability or diminished ability to become pregnant.

Menstrual Irregularities — Morbidly obese women may experience disruptions of menstrual cycles as well as abnormal flow and increased pain.

Osteoarthritis: The weight placed on joints, particularly knees and hips, results in rapid wear and tear of joints as well as pain caused by inflammation, called osteoarthritis. Excess weight puts a strain on bones and muscles of the back, which can cause disk problems, pain and decreased mobility.

Sleep Apnea and Respiratory Problems — Fat deposits in the tongue and neck can cause intermittent obstruction of your air passage, called sleep apnea. Because the obstruction is more severe when sleeping on your back, you may wake frequently to reposition yourself. Loss of sleep often causes drowsiness and headaches.

Depending on your health, your doctor may recommend one or several treatment options, ranging from diet to medication to surgery.

Treatment:

There are countless weight-loss strategies available but many are ineffective and short-term, particularly for those who are morbidly obese. Among the morbidly obese, less than 5 percent succeed in losing a significant amount of weight and maintaining the weight loss with non-surgical programs — usually a combination of dieting, behavior modification therapy and exercise.

People do lose weight without surgery, however, particularly when they work with a certified health care professional to develop an effective and safe weight-loss program. Most health insurance companies don't cover weight-loss surgery unless you first make a serious effort to lose weight using non-surgical approaches.

Many people participate in a combination of the following therapies.

Dietary Modification

Many of us have tried a variety of diets and have been caught in a cycle of weight gain and loss — "yo-yo" dieting — that can cause serious health risks by stressing the heart, kidneys and other organs.

Ninety percent of people participating in all diet programs regain the weight they've lost within two years. For people who have weight-loss surgery, dieting is an instrumental part of maintaining weight loss after surgery.

If you decide to go on a diet, we recommend that you work with a health professional who can customize a diet to meet your needs. A diet should greatly restrict your calorie intake, but maintain your nutrition. Calorie-restrictive diets fall into two basic categories.

Low calorie diets (LCDs) are individually planned to include 500 to 1,000 calories a day less than you burn.

Very low calorie diets (VLCDs) typically limit intake to only 400 to 800 calories a day and feature high-protein, low-fat liquids.

Behavior Modification

The goal of behavior modification therapy is to change your eating and exercise habits to promote weight loss. Examples include:

Setting realistic weight loss goals short term and long term.

Recording your diet and exercise patterns in a diary.

Identifying high-risk situations and avoiding them.

Rewarding specific actions, such as exercising for a longer time or eating less of a certain type of food.

Adopting realistic beliefs about weight loss and body image.

Developing a support network, including family, friends and co-workers, or joining a support group that can help you focus on your goal.

Although some people experience success with behavior modification, most patients achieve only short-term weight loss for the first year. If you plan on having weight-loss surgery, behavior therapy and dieting will be instrumental in helping you maintain your weight loss after surgery.

Surgery is a tool to get your body to start losing weight. Diet and behavior modification will determine your ultimate success.

Exercise

Exercise greatly increases your chance of long-term weight loss. It is a key component for any long-term weight management program, particularly weight-loss surgery.

Research shows that when you reduce the number of calories you consume, your body reacts by slowing your metabolism to burn fewer calories, rather than promote weight loss. Daily physical activity can help speed up your metabolism, effectively reducing the "set point" — a sort of thermostat in the brain that makes you resistant to either weight gain or loss — to a lower natural weight.

Starting an exercise program can be intimidating if you're morbidly obese. Your health condition may make any level of physical exertion extremely difficult. But you can learn strategies to help you start a realistic exercise routine. The following strategies can help you start exercising and can be incorporated into your daily routine.

Medications

A variety of over-the-counter and prescription weight loss drugs are available. Some people find these drugs help curb their appetites. Studies show that patients on drug therapy lose around 10 percent of their excess weight, and that the weight loss plateaus after six to eight months. As patients stop taking the medication, weight gain usually occurs.

Weight loss drugs, approved by the U.S. Food and Drug Administration (FDA) for treating obesity, include:

Beta-methyl-phenylethylamine (Fastin) — This is a stimulant that increases fat metabolism.

Orlistat (Xenical) — This drug works by blocking about 30 percent of dietary fat from being absorbed. Alli is a lower-dose, over-the-counter formula of the same medication.

Phentermine — Phentermine, an appetite suppressant, has been available for many years. It is half of the "fen-phen" combination that remains available for use. The use of phentermine alone has not been associated with the adverse health effects of the fenfluramine-phentermine combination.

Sibutramine (Meridia) — This is an appetite suppressant approved for long-term use.

Medications are an important part of the morbid obesity treatment process but weight-loss drugs can have serious side effects. We recommend that you visit a certified health care professional who can prescribe appropriate medications. Before insurance companies will reimburse you for weight-loss surgery, you must follow a well-documented treatment plan that typically includes medications.

Surgery

Many people ,who are morbidly obese and who have been unsuccessful in losing and keeping off the weight, opt for bariatric or weight-loss surgery.

Bariatric surgery, which involves sealing off most of the stomach to reduce the quantity of food you can consume, can be an effective means for morbidly obese people to lose weight and maintain that weight loss.

To be considered for weight-loss surgery, you must meet at least one of the following qualifications:

Be more than 100 pounds over your ideal, recommended body weight.

Have a body mass index (BMI) of 40 or higher (20 to 25 is considered a normal). BMI is a number based on both your height and weight. Surgery may be considered with a BMI as low as 35 if your doctor determines that there's a medical need for weight reduction and surgery appears to be the only way to accomplish the targeted weight loss. (Calculate your BMI.)

To qualify for surgery, you must complete a medical and psychological pre-evaluation process, and show how that you are committed to long-term, follow-up care after surgery. Most surgeons require that you demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of your life.

15- Primary Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) causes inflammation and scarring of the bile ducts located inside and outside the liver. The ducts carry bile — the liquid that helps break down fat in food out of the liver. As scarring accumulates, the ducts become blocked causing bile to build up in the liver, which damages liver cells. Eventually, if left untreated, PSC can cause liver failure or hardening of the liver, called cirrhosis.

PSC typically begins between the ages of 30 and 50, occurring most often in men. Although the cause of the condition is unknown, research has shown that it may be an autoimmune disorder, meaning that the immune system mistakes certain body parts and organs as foreign invaders and thus wrongly attacks them. PSC also may be genetically linked to another condition, called ulcerative colitis, which causes inflammation of the colon. It is estimated that 70 percent of PSC patients also suffer from ulcerative colitis. In addition, people with PSC have an increased risk of developing cholangiocarcinoma and cancer of the bile ducts.

Signs & Symptoms:

In the early stages of primary sclerosing cholangitis (PSC), you may not experience any symptoms at all. As the disease progresses, symptoms may come and go and are caused by the bile not being drained properly. This can affect liver function and cause the bile to seep into your bloodstream. Symptoms may include:

- Chronic fatigue

- Jaundice, yellowing of the skin and eyes

- Loss of appetite

- Weight loss

- Chronic fatigue

- Chills

- Fever

- Upper abdominal tenderness

Diagnosis:

Your doctor will first ask you about your medical history, which can suggest a likelihood of primary sclerosing cholangitis (PSC), especially if there is a history of inflammatory bowel disease and abnormal blood test results.

PSC is diagnosed through a procedure called cholangiography, which involves injecting dye into the bile ducts and taking an X-ray. Cholangiography can be performed as an endoscopic procedure, called endoscopic retrograde cholangiopancreatography (ERCP), through radiology or surgery, or with magnetic resonance imaging (MRI) scans. Cholangiography is performed under sedation. A lighted, flexible endoscope is inserted through the mouth, stomach and then into the small intestine. A thin tube is place through the scope into the bile ducts and dye is injected to highlight the bile ducts on the X-ray. If there is a narrowing of the bile ducts, the diagnosis of PSC is confirmed.

As the disease progresses, a liver biopsy is usually needed to confirm PSC, and determine how much damage has occurred. Under local anesthesia, a slender needle is inserted through the right lower chest to extract a small piece of liver for microscopic analysis.

Treatment:

Treatment for primary sclerosing cholangitis (PSC) includes medication to reduce itching and jaundice, antibiotics to treat infections and vitamin supplements since people with PSC are often deficient in vitamins A, D and K. In some cases, surgery to open major blockages in the common bile duct also is necessary. In addition, liver transplantation may be required and in some cases, can cure PSC.

16- Ulcerative Colitis

Ulcerative colitis, also called colitis or proctitis, is an inflammatory bowel disease of the large intestines. Although inflammation usually occurs in the rectum and lower part of the colon, it may affect the entire colon. Unlike Crohn's disease, ulcerative colitis is limited to the colon.

It is estimated that as many as one million Americans are affected with colitis or Crohn's disease. Most cases of colitis are diagnosed before the age of 30, although it can affect anyone, including children and older people between the ages of 50 and 70. There is a greater incidence of the disease among Caucasians and Jews than in other populations.

The condition can be inherited and is common in some families. About 20 percent to 25 percent of those with ulcerative colitis have a close relative with the condition or Crohn's disease. The immune system's response to certain environmental antigens and the patient's own genetic makeup, are believed to be the primary factors causing disease.

Signs & Symptoms:

Commonly, the first symptom of colitis is a progressive loosening of stool, or diarrhea. The stool may be bloody and may occur with abdominal pain, cramps and a severe urgency to have a bowel movement. Skin lesions and pain in the joints also may occur. Colitis can be associated with problems such as:

Arthritis

Inflammation of the eye

Liver disease such as hepatitis, cirrhosis and primary sclerosing cholangitis

Osteoporosis

Skin rashes

Anemia

Diagnosis:

Your doctor will ask about your medical history and perform a physical examination. Stool tests will then be performed to determine what is causing your diarrhea — colitis or something else. You will then undergo either a sigmoidoscopy or colonoscopy to exam your colon.

Sigmoidoscopy

Colonoscopy

The term "colonoscopy" means looking inside the colon. The colon, or large bowel, is the last portion of your digestive tract. Its main function is to store unabsorbed food products prior to their elimination. Colonoscopies are performed by a gastroenterologist, a doctor specially trained in digestive disorders. Your doctor will be assisted by specially trained nurses and technicians.

The procedure is performed using a colonscope. This device is a long, flexible tube that is about as thick as your index finger and has a tiny video camera and light on the end. By adjusting the various controls on the colonscope, the gastroenterologist can carefully examine the inside lining of the colon from the anus to the cecum. The colonoscope contains a channel that allows instruments to be passed in order to take tissue or stool samples, remove polyps and provide other therapy.

The high quality picture from the colonoscope is shown on a television monitor. Colonoscopy provides the best imaging of the colon at present. It is a more precise examination than X-ray studies. This procedure also allows other instruments to be passed through the colonoscope. These may be used, for example, to painlessly remove a suspicious-looking growth or to take a biopsy, during which a small piece of tissue is obtained, for further analysis. In this way, colonoscopy help doctors assess whether surgery is necessary as well as what type of surgery may be needed.

Treatment:

Currently, the only cure for colitis is surgery. However, treatments are available that can relieve symptoms and suppress the inflammatory process. Therapy varies depending on the seriousness of the disease. Most people will require long-term medication. In severe cases or if cancer is found, surgery may be required to remove the diseased colon.

Drug Therapy

Drug therapy aims to improve the quality of life for people with colitis by inducing and maintaining remission, or symptom-free periods. There are three types of drugs most commonly prescribed to treat colitis. These include aminosalicylates, corticosteroids and immunomodulatory medicines.

Surgery

An estimated 25 percent to 40 percent of patients will require surgery. This may be because medications are ineffective, they become dependent on corticosteroids, they have dysplasia (early cancer) or cancer, or they develop complications of the disease, such as bleeding, rupture of the colon, or dilation of the colon. In these cases, surgery to remove the colon and rectum, called proctocolectomy, may be recommended. Unlike Crohn's disease, which can recur after surgery, colitis is cured once the colon has been removed. However, associated diseases associated with colitis may still develop or progress after surgery. For example, primary sclerosing cholangitis, a liver condition, and Ankylosing spondylitis, an inflammation of the lower back, will still progress after surgery. Surgery is followed by one of the following:

Ileal Pouch Anal Anastomosis Also called a restorative proctocolectomy, this procedure preserves part of the anus, which allows the patient to have normal bowel movements. The surgeon removes the diseased part of the colon and the inside of the rectum, leaving the outer muscles of the anus. The surgeon then creates a pouch from the end of the ileum and attaches it to the inside of the anus. Waste is stored in the pouch and passed through the anus in the usual manner. Bowel movements may be more frequent and watery than before the procedure and inflammation of the internal pouch is a possible complication. This is known as pouchitis. However, patients who have an ileoanal anastomosis do not have to wear a permanent external ileostomy pouch.

Ileostomy

During this surgical procedure, the surgeon creates a small opening in the abdomen, called a stoma, to which he or she attaches the end of the small intestine, called the ileum. Waste will travel through the small intestine and exit the body through the stoma, which is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed.

17- Ulcers

Contrary to popular belief, ulcers are not due to stress and diet. A bacterial infection brought on by the bacteria Helicobacter pylori (H. pylori) is the cause of the majority of all stomach ulcers. Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relievers such as aspirin, ibuprofen and naproxen sodium, which affect the stomach's ability to protect itself from acidic stomach juices, also may lead to ulcers.

Signs & Symptoms:

If you have a peptic ulcer, you may only experience very mild symptoms or none at all. However, abdominal discomfort is the most common symptom associated with ulcers. Other symptoms include:

- Weight loss

- Poor appetite

- Bloating

- Burping

- Nausea

- Vomiting

Diagnosis:

Your doctor may first perform an upper gastrointestinal (GI) series and endoscopy to check for ulcers.

An upper GI series involves X-rays of the esophagus, stomach and the beginning of the small intestine, called the duodenum. You will be asked to drink a chalky liquid, called barium, to make these organs appear more clearly on the X-ray.

During an endoscopy, the upper portion of the gastrointestinal tract is visualized by using a long, thin and flexible tube with a tiny video camera and light on the end, called an endoscope. The areas examined during this procedure include the esophagus, or the swallowing tube leading to the stomach, the stomach and the duodenum. The high-quality picture from the endoscope is shown on a television monitor and provides a clear, detailed view. In many cases, upper GI endoscopy is a more precise examination than X-ray studies.

This procedure is performed by a gastroenterologist, a well-trained specialist who uses the endoscope to diagnose, and in some cases treat, problems of the upper digestive system. Your doctor will be assisted by specially trained nurses and technicians who are essential in performing the procedure safely and effectively.

If an ulcer is found, your doctor will then test you for the bacteria Helicobacter pylori (H. pylori). This test is important because treatment for an ulcer caused by H. pylori is different from that of an ulcer caused by nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori is most commonly diagnosed through blood test, although breath, stool and tissue tests also may be used.

Treatment:

Peptic ulcers caused by the bacteria Helicobacter pylori (H. pylori) are usually treated with a combination of antibiotics that kill the bacteria as well as other drugs to reduce stomach acid and protect the stomach lining. The use of only one medication to treat H. pylori is not recommended.

At this time, the most proven effective treatment is a two-week course of treatment called triple therapy. It involves taking two antibiotics to kill the bacteria and an acid suppressor known as a proton-pump inhibitor (PPI). By decreasing the amount of acid in the stomach, PPIs are used to heal stomach ulcers, including those caused by nonsteroidal anti-inflammatory drugs (NSAIDS), and duodenal ulcers. Two-week triple therapy reduces ulcer symptoms, kills the bacteria and prevents the ulcer from recurring in more than 90 percent of patients.

Ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) usually heal once the person stops taking the medication. To help the healing process and relieve symptoms, your doctor may recommend taking PPIs to neutralize the acid and drugs called H2-blockers to decrease the amount of acid the stomach produces.

18- Ventral Hernia

Hernias most commonly develop in the abdominal wall, where an area weakens and develops a tear or hole. Abdominal tissue or part of the intestines may push through this weakened area, causing pain and potentially serious complications.

Ventral hernias are a type of abdominal hernia. They may develop as a defect at birth, resulting from incomplete closure of part of the abdominal wall, or develop where an incision was made during an abdominal surgery, occurring when the incision doesn't heal properly.

Incisional hernias can develop soon after surgery or many years later. They affect as many as 30 percent of the patients who have abdominal surgery, such as an appendectomy.

Signs & Symptoms:

Ventral hernias cause a bulge or lump in the abdomen, which increases in size over time. In some cases, the lump may disappear when you lie down, and then reappear or enlarge when you put pressure on your abdomen, such as when you stand, or lift or push something heavy.

When tissue inside the hernia becomes stuck or trapped in abdominal muscle, it can cause pain, nausea, vomiting and constipation. In rare cases, this may lead to a potentially life-threatening condition known as "strangulation," which requires emergency surgery. This occurs when the blood supply to the herniated bowel is cut off or greatly reduced, causing the bowel tissue to die or rupture. Other symptoms of a strangulated hernia include severe abdominal pain, profuse sweating, rapid heartbeat, severe nausea, vomiting and high fever.

Diagnosis:

In many cases, a hernia can be diagnosed through a physical examination of the abdomen.

Your doctor will examine the area where a ventral hernia may exist and may ask you to cough while examining your abdomen.

A CT scan may be performed as part of the diagnosis.

Treatment:

Ventral hernias are repaired by surgery. Without treatment, most hernias will increase in size.

An untreated hernia may also result in intestinal blockage and "strangulation," which requires immediate medical attention. Strangulation occurs when the blood supply to the herniated bowel is cut off or greatly reduced, causing the bowel tissue to die or rupture.Surgical repair of ventral hernias is a complicated, major procedure. Extremely large ventral hernias require a procedure called progressive pneumoperitoneum.

Laparoscopic Repair

In this approach, surgeons use a laparoscope, a tiny telescope with a television camera attached, to view the hernia from the inside. The laparoscope is placed inside a cannula, or small, hollow tube, which is inserted into the abdomen through a small incision.In most cases, three or four incisions of about 1/4 to 1/2 inch in size are made to insert the cannula, instruments used to remove any scar tissue and a special mesh. The mesh is placed behind the abdominal muscles instead of between the muscles. It is held in place by surgical tacks or sutures. This procedure is usually performed under general anesthesia. Bladder catheterization is required.

Compared to traditional hernia surgery, laparoscopic repair includes less post-surgery pain, less wound numbness and an earlier return to work and normal activities.

Search This Blog

Human Diseases; amp Treatment

Digestive Disorders & Treatment

Comments

Post a Comment

Popular posts from this blog

Cell Reproduction

The Anterior Pituitary and Hypothalamus

Hypothalamic Tumor