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Symptoms of Anal Fistula

Anal Fistula causes unpleasant symptoms such as:
•    Fever, around 380 C (100.4F) or above
•    Constipation or pain during bowel movements
•    Irritation, redness or swelling of the skin surrounding the anus
•    Discharge of pus or blood during defecation
•    A constant and severe pain which worsens during bowel movements or while sitting
bad odour near the anus
•    Trouble in controlling bowel movements or bowel incontinence in some cases
•    Fatigue
•    Abdominal pain, loss of appetite, nausea, vomiting (if the Anal Fistula is caused by the inflammation of the intestines)
If your symptoms are persistent, then you must consult a doctor.

Causes

The leading cause of Anal Fistulas is a poor healing of the anal abscess. Nearly 25-50% of the patients with anal abscess develop an Anal Fistula. It can also occur as a complication with the surgical repair of anal problems.
Risk factors
The risk factors include:
•    Crohn's disease, which is the inflammation of the digestive tract
•    Diverticulitis, which is the infection of the small sacks on the sides of the large intestine
•    Tuberculosis and HIV Infections

Complications

The risk factors include:

Infections: Like any other surgical procedure, surgery for Anal Fistula increases the risk of infections. If the Fistula is not completely removed (i.e. if the surgery is carried out in several stages), then the infection can spread to the other organs.
Antibiotics are given either orally or intravenously based on the severity of the infection.

Incontinence: During the surgical repair, there can be damage to the sphincter muscles which can lead to Bowel Incontinence (Uncontrolled Bowel Movement).

Recurrence: In some patients, the Fistula can reoccur even after surgery.

Diagnosis

Diagnosis involves the examination of the complete Fistula for proper treatment. The opening of the channel is easy to detect and appears red, and swollen and discharges pus and blood. However, the examination of the internal opening is difficult and requires any of the below tests for visualization.

The other methods include the use of a Fistula probe, anoscope, flexible sigmoidoscopy, etc.

Anal Fistula Treatment

Treatment for Fistula depends on certain factors such as the location of the Fistula, the presence of sepsis or large abscess and the findings of the physical examination. The goal is to completely repair the Fistula prevent its recurrence and safeguard the sphincter muscles. Damage to the sphincter muscles can lead to Uncontrolled Bowel Movements.

Usually, surgery is the best treatment for Anal Fistulas. The main surgical procedures include:

Fistulotomy: This procedure involves cutting open the Fistula which heals into a flat scar. During the 17th century, when the state of medicine was very bad, Louis XIV, the Sun King of France had an Anal Fistula and was treated by Fistulotomy.

Seton Procedure: This procedure involves the insertion of a small surgical thread called Seton, in the Fistula to drain the infection. This helps in healing before carrying another treatment.

Ligation of Intersphincteric Fistula Tract: This procedure is done in two stages and is to treat complex Fistulas. Initially, a seton is placed in the Fistula to widen it. After several weeks, the infected tissue is removed, and the Fistula opening is closed.

Other techniques such as filling the Fistula with special medical glue covering it with a tissue or blocking it with a special plug may be performed. For more complex Fistulas, techniques such as ostomy and stoma, or muscle flap are performed.

Discuss the benefits and the risks of every procedure with your surgeon about the procedures before undergoing one

Self-management

Certain home remedies can help with your condition during the treatment. They are:

Fibrous Diet: Foods rich in fibre content increase stool volume and play an important role in the treatment of Anal Fistula. Examples include brown rice, brown bread, banana, barley, etc. Avoid spicy foods.

Drinking Water: Drink plenty of water to soften the stools.

Symptoms

These are a few symptoms which will let you know if you need to undergo further evaluation to diagnose if you have Barrett’s Oesophagus.

• Heartburn
• Pain while swallowing
• Unexpected weight loss
• Blood in vomit
• Black-coloured stools

Diagnosis

The condition can be diagnosed only by doing an upper Gastrointestinal Endoscopy. During the procedure, you will be sedated. Your doctor would insert a flexible tube called an endoscope that has a light and a miniature camera, into the Oesophagus. If your doctor suspects changes in the lining tissue he would do a biopsy (remove very small pieces using a pincher-like device) through the endoscope. These tissue pieces are then sent further to a Pathologist who examines them under a microscope.

Preventive measures

Your physician would advise you to take a few preventive measures. They are:

• Adapt a healthy lifestyle
• Quit smoking
• Avoid drinking alcohol
• Exercise
• Avoid foods like caffeine, chocolate, and peppermint that can worsen heartburn.
• Avoiding lying down after meals
• Drink plenty of water
• Follow a healthy diet

Risk factors

If you have been diagnosed with Barrett’s Oesophagus your risk of developing Oesophageal Cancer is 40 times higher than in the normal person. However, it is also true that less than 1% of patients with Barrett’s Oesophagus are seen to develop Cancer. If unfortunately, you develop Cancerous changes in the Barrett's tissue, then your doctor will brief you on the endoscopic and surgical options available and help you in deciding the best option for you.

Treating the condition

Certain medicines called proton pump inhibitors, antacids, H2 receptor blockers, and promotility agents can help in reducing the amount of acid in the stomach.

Your physician may recommend the option of surgery if a biopsy shows cell changes that are likely to lead to Cancer. These treatments use heat (as in radiofrequency ablation, thermal ablation with argon plasma coagulation and multipolar coagulation), cold energy (as in cryotherapy) or light and special chemicals (as in photodynamic therapy) to remove the harmful tissue in your Oesophagus.

Points to remember!!!

• Barrett’s Oesophagus is developed in people suffering from gastroesophageal reflux disease for several years.
• Use acid-reducing drugs.
• Barrett’s Oesophagus can be only diagnosed by upper gastrointestinal endoscopy and biopsy.
• Endoscopy and biopsy are of paramount importance in an attempt towards early detection and management of the condition.

Oesophagus - The basic anatomy

Oesophagus is the medical term for the hollow muscular tube/ food pipe that goes from your throat to your stomach. When you swallow food or drink any liquids; it passes into your stomach through the Oesophagus. The upper and lower ends of the tube are pinched together by muscles called Sphincters. When you swallow food these sphincter muscles relax and allow for food and water to pass to the stomach, and then they close back rapidly to prevent the leaking of food, drink or acid from the stomach back into the Oesophagus.

However, if the sphincter at the lower end of the Oesophagus does not close properly or opens spontaneously for varying periods stomach contents and digestive juices (acid) rise into the Oesophagus. The refluxed acid touches the lining of the Oesophagus and causes a burning sensation that you experience as Heartburn.

Understanding Barrett’s Oesophagus

When you suffer from Persistent Acid Reflux/ Gastroesophageal Reflux Disease (GERD) for several years, the acid can cause damage to the tissue lining the inside of the Oesophagus. During the healing process, normal tissue of the Oesophagus (where it joins the stomach) gets replaced by tissue that looks similar to that lining your intestines. This medical condition is termed Barrett's Oesophagus.

However, it is also true that not all patients with GERD develop Barrett’s Oesophagus nor do all patients with Barrett’s Oesophagus have GERD. Less than 1% of patients with GERD may develop this condition. It is not associated with any particular signs or symptoms other than Heartburn, Regurgitation of Food, excessive belching, Hoarseness of Voice, Sore Throat, or Chronic Cough as seen in GERD. The condition gains importance as in a small number of people it is known to lead to a rare but often deadly type of Oesophageal Cancer.

If you are a man over 50 years of age with a history of acid reflux disease for more than 10 years you are at an increased risk of developing Barrett’s Oesophagus. Smoking and obesity are also risk factors for the condition.

Need for surveillance

Abnormal tissue in Barrett’s Oesophagus can degenerate into a premalignant phase called Dysplasia that can further degenerate into Cancer. If you have Barrett's esophagus it is therefore important that you consult your physician about undergoing Endoscopy to evaluate for the risk or existence of Cancer. You should have an Endoscopy performed every 1 to 3 years. A biopsy (section of tissue) may be taken for examination if there is suspicion of any abnormal changes in the cells. This surveillance is necessary because it is seen that before Cancer develops pre-cancerous cells appear in the Barrett's tissue and your physician can warn you of any early signs of Cancer. In the presence of abnormal cells suggestive of a pre-cancerous condition close surveillance with Endoscopy every 3 to 6 months is recommended.

Symptoms

Intestinal obstruction manifests clinically through the following signs and symptoms:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Severe bloating
• Loss of appetite
• Abdominal cramps

Some symptoms depend on the location of the obstruction. Small Bowel Obstruction symptoms would include vomiting. If there is any rupture in the intestinal wall, you may experience high-grade fever. Large Bowel Obstruction is a medical emergency that requires early medical interventions.

Tips that help reduce Bowel Obstruction

• Drinking more water
• Increasing fibre in the diet
• Drinking fresh orange juice every day
• Consuming fresh vegetables and fruits
• Drinking water and honey early morning on an empty stomach

When to call a doctor?

Bowel Obstruction is considered a medical emergency. You must for sure call your doctor if you have abdominal bloating, severe constipation, loss of appetite, or if you have recently undergone any Abdominal Surgery.

Causes

There may be numerous reasons for blockage in your intestines, some of which are;

• Herniation (caused by weakness) of the small intestine
• Adhesions caused due to surgery
• Inflammatory disease of the intestines such as Crohn’s disease
• Severe constipation that causes impacted bowel
• In colon Cancer, the tumour blocks the intestine
• Gall stones, volvulus, intussusception, or paralytic ileus may cause blockage in your intestines

Complications

If Bowel Obstruction is left untreated, it can lead to more severe complications such as:

Tissue death: Intestinal obstruction can stop the blood supply, which causes intestinal wall death and infections.

Infection: Peritonitis is an infection of the abdominal cavity. It is a life-threatening condition that requires medical attention or surgical intervention

Diagnosis

Physical Examination: Your doctor would take a medical history understand your symptoms and also perform a physical exam to assess the situation. Your abdomen will be swollen or tender if there is any obstruction. Your doctor would listen for the bowel movements using a Stethoscope.

X-ray: Only small intestinal obstructions can be seen using X-rays, but this helps in confirming the diagnosis

Ultrasound: This is the most preferred type of imaging for children. It helps show the coils in the intestine in young patients.

Computer Tomography (CT) Scan: It gives a series of X-rays in a cross-sectional fashion. This shows intestinal obstruction in a perfect view.

Barium Enema: It is an enhanced type of imaging for any suspected causes of obstruction.

Treatment

The commonly used strategies for intestinal obstruction treatment or Bowel Obstruction treatment are: medications do not reduce Bowel Obstruction; they just give symptomatic relief, by reducing nausea, and vomiting until other medical interventions are performed.

The drugs include:

• Pain relievers to alleviate the pain
• Antibiotics for treating the infection
• Anti-emetics to reduce vomiting

Surgery: Intestinal Obstruction Surgery relieves Bowel Obstruction. At first, you will be given fluids intravenously for at least six to eight hours. This helps reduce the dehydration and prevents shock during the surgical procedures.

In the case of death in the intestinal tissue, your surgeon will remove the dead tissue and join the two healthy intestinal ends.

Procedures for blocked bile ducts

If your Gallbladder Cancer is in the advanced stage associated with bile duct blockage, it may cause further complications eventually. Your doctor would, therefore, perform procedures to relieve blockages. Your surgeon would instil a stent to make the place hollow or may surgically reroute the biliary passage. A new stent should be inserted every 3-4 months to prevent blockage. If it does block, jaundice and fever are seen. You need to consult your doctor immediately if these symptoms appear.

Risk factors

Gender: Being a female can increase the risk of developing Gallbladder Cancer. Age: As your age increases, the risk of developing Gallbladder Cancer increases. Weight: Obese people are at higher risk for developing Gallbladder Cancer.

Causes

The major causes of Gallbladder Cancer are unknown; Gallbladder Cancer develops when there are sudden mutations in the DNA. These cause cells to grow abnormally, these cells accumulate and form a tumour that can grow larger and spread to different areas of the body.

Symptoms

The major signs and symptoms of Gallbladder Cancer include:

• Nausea
• Jaundice
• Itchiness
• Loss of appetite
• Abdominal pain
• Unusual weight loss
• Abdominal bloating

Diagnosis

Your doctor would order the following diagnostic tests to confirm Gallbladder Cancer, the tests include:

Physical Exam:

During a physical examination, your doctor would palpate your Gallbladder, and ask you to breathe, if you feel any sort of pain. Then he/she suspects the presence of Gallbladder disease.

Blood Tests:

Your doctor would order liver function tests to determine the cause of the presenting signs and symptoms.

Chest and Abdominal X-ray:

To rule out the presence of gallstones, your doctor would order a chest or abdominal X-ray.

Imaging Tests:

Your doctor would order for Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI). The following tests and procedures are recommended to determine the stage of Gallbladder Cancer.

Exploratory Surgery:

Your doctor orders exploratory surgery to look at the inside of your abdomen to check if Cancer has invaded any other parts.

Examination of Bile Ducts:

This test allows evaluation of the presence of any blockages in the bile ducts. A dye is injected into bile ducts and is followed by image testing.

Stages of Gallbladder Cancer

Treatment

The treatment plan is to cure the Gallbladder Cancer. But when you are in an advanced stage that does not cure with treatment, then the goal of the treatment is to control the spread of the disease and improve the quality of life.

Surgery: Surgery is reserved for an early stage of Gallbladder Cancer.

Removing the Gallbladder: A procedure called cholecystectomy is performed for the removal of the Gallbladder if the Cancer is in its early stage.

Removing Gallbladder and a portion of liver: If Gallbladder Cancer is extended to the surrounding organs such as the liver, then along with the Gallbladder a small portion of the liver and the surrounding bile ducts are also removed.

Managing final or late-stage Gallbladder Cancer: The final-stage Cancers after their spread cannot be cured. So, your doctor provides appropriate treatment to reduce the signs and symptoms to make you feel comfortable.

Treatment options include:

• Chemotherapy is a drug treatment that helps kill the Cancerous cells.
• Radiation Therapy is useful in killing Cancer cells with the help of high-powered beams such as X-rays

Symptoms

Most often, people with GIST do not exhibit any symptoms or signs. If symptoms occur, they may include:

• Nausea and vomiting
• Bowel Obstruction
• Early satiety and bloating
• Pain or discomfort in the abdomen
• A mass in the abdomen can be felt with the hands
• Fatigue due to anaemia (associated with bleeding in the intestine)
• Vomiting blood or blood in the stools

Treatment

Localized Tumours: Treatment involves complete surgical resection. It needs to be done very carefully to prevent the rupture of the tumour and dissemination into the abdomen. Some of the tumours may be treated with Laparoscopic Surgery.

Adjuvant Therapy with imatinib may be given to delay the recurrence after the resection.

Radiation Therapy is often not used in the treatment of GISTs. It can be used to relieve only the associated symptoms.

Advanced Tumors: Some metastatic GISTs are resectable. But if they are not resectable, then imatinib (tyrosine kinase inhibitor) is recommended. It can control up to 70-85% of the advanced GISTs. The other kinase inhibitor which is approved for advanced GISTs is Sunitinib.

Chemotherapy is not effective for GISTs and hence it is not recommended.

Causes

Most of the GISTs develop Sporadically, i.e. without a known reason. Usually, a tumour is produced when healthy cells grow and divide uncontrollably, forming a mass. GISTs occur due to mutations in the two most common genes called Platelet-derived Growth Factor Receptor Alpha (PDGFRA) and KIT Receptor Tyrosine Kinase. The resultant tumour can be Benign (localized) or Cancerous (spreads to other parts).

Complications

The most important complication of untreated Throat Cancer is its spread to the other organs of the body. They can spread to the Liver, Entire Abdomen, Lymph Nodes (rare), Lungs and also Bones.

Diagnosis

No laboratory test can specifically confirm if you have GIST. Your doctor will ask you to go for the following tests if you present the above symptoms:

• Complete blood cell count
• Coagulation profile (clotting of blood)
• Serum chemistry studies
• Serum albumin
• BUN and creatinine
• Liver function tests (amylase and lipase)

The other tests which may be required to confirm the diagnosis of GIST based on the above tests are:

Risk factors

Doctors could not find specific risk factors other than hereditary syndromes which include:

• Age: GIST is more common in people older than 50. The occurrence of GIST in children is very rare.
• Gender: Men are at slightly higher risk for GIST than women
• Heredity: GIST rarely runs in families
• Medical conditions: Neurofibromatosis type I and Carney's triad Tumour Syndrome which are genetic disorders.

Causes

The main cause of a Hiatal Hernia is not clear. But in most of the patients, the cause would be any injury or damage to the diaphragm muscle.

When there is extra pressure on the muscles of the stomach, then there would be chances for a Hiatal Hernia, This happens when you:

• Cough
• Vomit
• Lift heavy objects
• Strain during bowel movements

You may have a large hiatus from birth, which makes it easier for the stomach to move through the diaphragm.

When to call a doctor?

You must call your doctor if you experience nausea, vomiting, and difficulty in passing gas or stools.

You cannot always assume that the chest pain or discomfort is due to a Hiatal Hernia, but a Heart disease or Peptic Ulcer disease can also pop up this sign. Therefore, it is important to see your doctor immediately.

Symptoms

Common symptoms associated with Hiatal Hernia include:

• Belching
• Chest pain
• Difficulty in swallowing
• Herat burns when you lie over

Types of Hiatal Hernia

Sliding Hiatal Hernia: Sliding Hiatal Hernia tends to be small and occurs when your stomach and Oesophagus slide into and out of your chest. These types of hernias do not require treatment.

Fixed Hiatal Hernia: This type of hernia is also called a Para-esophageal Hernia. It is a rare type of Hiatal Hernia. In such cases, there are chances that your blood flow to the stomach could become blocked. This can cause serious damage and is considered a medical emergency.

Risk factors

Increasing age, obesity, stress, heavy lifting, and smoking are the factors that may increase your risk of developing a Hiatal Hernia.

Lifestyle modifications

Following the below-listed lifestyle changes helps in controlling the signs and symptoms that are caused by a Hiatal Hernia.

• Maintaining weight
• Elevating the head of the bed
• Avoiding smoking and alcohol consumption
• Eating smaller meals more times a day
• Avoiding foods that provoke heartburn or acidity
• Eating the food at least two or three hours before going to bed

Diagnosis

Your doctor would order for following tests to diagnose a Hiatal Hernia.

Barium X-ray

Before taking an X-ray, your doctor would ask you to drink Barium Liquid. This helps in providing a clear structure of the digestive tract, which helps your doctor to see the location of your stomach. If it is found protruding from the diaphragm, then it is considered a Hiatal Hernia.

Endoscopy

The endoscope is a thin tube that slides into your Oesophagus and stomach. Your doctor then will be able to see if the stomach is pushing your diaphragm or the presence of any strangulation or obstruction.

Treatment

The most bothersome symptom of Hiatal Hernia is Heartburn and Acid Reflux. Your doctor would prescribe the following drugs:

Antacids help to neutralize the stomach acids which may give instant relief. Medications to reduce acid production, block acid secretion and heal your Oesophagus are prescribed.

Surgical intervention for repairing a Hiatal Hernia, rarely a Hiatal Hernia may require surgery, but it is recommended for emergency situations. People who do not get relieved from medications are also recommended for surgery.

The surgery is performed by pulling the stomach down into the abdomen and by making the opening in the diaphragm smaller. Your surgeon would remove the Hernia sac completely.

In some cases, a Thoracotomy or Laparotomy is performed by using a single incision in the chest wall. In some cases, your surgeon may insert a tiny camera to view the images on a video monitor and perform Laparoscopic Surgery.

An Inguinal Hernia is the most common type of all hernias with a 73% prevalence.

Types

Symptoms

Symptoms of Inguinal Hernia include:

Dragging or aching type of pain is present. It is the earliest and common symptom which appears much before the lump of a Hernia appears. Pain may be localised to one region or can be present all over the abdomen due to the dragging of the contents. You may also observe a lump or bulge in the groin region.

In advanced cases, oms like vomiting abdominal distension, and intestinal obstruction may occur due to complications.

Diagnosis

Diagnostic tests are performed to confirm the diagnosis and to rule out other abdominal conditions such as Hydrocele, Femoral Hernia, Epididymitis, and Varicocele.

Your doctor performs a physical examination examines the groin area for a bulge and makes a provisional diagnosis. To confirm the diagnosis, your doctor may recommend imaging tests such as Ultrasonography, Magnetic Resonance Imaging, or Computed Tomography (CT) Scans.

Causes

An Inguinal Hernia can be congenital (by birth) or acquired (excessive fat, weakness of muscle after multiple pregnancies, after surgical procedures).

Complications

If the contents of the Hernia become trapped in the weak point of the abdominal wall, it can obstruct the bowel causing intestinal obstruction. Strangulation may cause gangrene. In a few cases, there may be a chance of recurrence of Hernia even after a surgical procedure.

Risk Factors

About 25% of males and 5% of females develop an Inguinal Hernia. The male-to-female ratio of occurrence is 9:1. Prevalence of a hernia increases with age. The risk factors for inguinal hernia include chronic cough, obesity, pregnancy, and powerful muscular effort like straining or heavy lifting. All these factors are responsible for increasing intra-abdominal pressure hence pushing the abdominal content through the Inguinal Canal.

Past medical history of Appendectomy, Chronic Cough, Multiple Pregnancies, Constipation, Family History, and Recurrent Pregnancies are more likely to be associated with a higher number of Inguinal Hernia cases.

Treatment

Conservative treatment: Inguinal Truss is used in cases of reducible hernia where a patient refuses operative procedures. A truss acts by pressing the interior wall against the posterior wall and preventing a hernia from coming out.

Operative Treatment: Herniorrhaphy, an open repair or Laparoscopy procedures are performed to treat Inguinal Hernias Surgically.

Prevention

The lifetime risk of inguinal herniation is approximately 27% for men and 3% for women. So, following a few measures may help prevent a Hernia or keep an existing Hernia from getting worse. This includes:

• Quit smoking.
• Maintain a healthy body weight.
• Avoid straining during bowel movements or urination.
• Lift objects by bending your knees and not your back.
• Avoid lifting weights that are too heavy for you.

Types of Intestinal Ischemia

Depending upon the duration and location of the disease, it can be divided into:

• Acute or chronic

1. Acute intestinal ischemia
2. Chronic intestinal ischemia

• Small intestine or large intestine
• Occlusive or non-occlusive
• Arterial or venous occlusion

Chronic Intestinal Ischemia

Medical care:

• Nitrate therapy for short-term relief
• Antispasmodic drugs like Papaverine
• Anticoagulants like heparin
• The high frequency of developing malnutrition, infarction and sepsis warrants surgical care

Surgical care:

• Transaortic endarterectomy: To remove plaque deposits from the celiac or mesenteric artery to remove the obstruction to blood flow.
• Bypass Surgery: Using a graft from another area of the body to repair the blocked Blood Vessel.

Diagnosis

• Blood Tests: White blood cell count and Lactic acid level are determined. An increase in these identities may indicate Intestinal Ischemia.
• Plain Abdominal X-ray: Often shows normal or non-specific findings. They can be used to rule out other possible causes.
• Computed Tomography (CT) Scan: May show gas in the intestinal walls, portal vein or mesenteric vein. Bowel wall thickening or dilatation can be seen. Perforation in the bowel can also be seen. Mesenteric oedema or swelling may be present depending on the duration of the disease.
• Angiography: It is the gold standard to diagnose the cause of the disease. It helps in determining whether the disease is of an occlusive or non-occlusive nature. A thin, flexible tube called a catheter is inserted into an artery in the groin area. Contrast dye is injected through this tube to visualize the abnormalities in the blood vessels and X-ray images are taken. This technique is also used to treat blockages in an artery by injecting medication through the tube.
• Duplex Ultrasound: This test is done to assess the blood flow in the arteries and veins. It can also reveal any blockage in the blood vessels. A wand called a transducer is moved over the area to be examined. Sound waves sent by it are measured by the computer, which changes them into images.

Causes

• Hernia: when a part of the intestine protrudes through the lower abdominal wall, most commonly into the inguinal canal (in the groin). This condition is more common in males.
• Adhesions: These refer to the formation of scar tissue between the small or large intestine and the inner lining of the abdominal wall and organs in the Abdominal Cavity. Blood flow is obstructed due to the formation of these adhesions causing Intestinal Ischemia.
• Embolus: It is composed of clotted blood cells that dislodge themselves and move in the bloodstream and can cause obstruction of the arteries, usually the superior mesenteric artery. This is the most common cause of acute intestinal ischemia and can occur due to congestive Heart Failure or Cardiac Arrhythmia (irregular Heartbeat).
• Atherosclerosis: It involves the formation of an Atheroma which forms due to fatty deposits in the blood vessels. It can slow down or block the blood flow depending on its size. This is seen in patients with chronic Intestinal Ischemia.
• Venous Thrombosis: It occurs due to the formation of a thrombus or blood clot in the veins. This is less common as compared to arterial obstruction and is known to occur in patients with liver disease, Cancer or Clotting Disorders.
• Hypotension: Low blood pressure due to shock, heart failure or chronic renal disease may cause a slow down of blood flow. This condition in the presence of arterial insufficiency exaggerates the impaired blood flow and can cause an acute attack of Intestinal Ischemia.
• Malignancy: Tumours which cause venous or arterial compression

Risk Factors

• Age: Adults over the age of 60 years are most commonly affected.
• High cholesterol diet: Predispose to fatty deposits in the vessels causing atherosclerosis
• Low blood pressure
• Heart conditions: Like congestive heart failure increases the risk of the disease.
• Medications

1. Migraine medications
2. Birth control pills
3. Vasopressive drugs such as dobutamine

• Blood clotting disorders such as deficiency of Protein C and Protein S, prevent clotting.
• Previous abdominal surgery: Scar formation can occur around the small or large intestine obstructing blood flow.
• Smoking

Signs & Symptoms

Symptoms of the disease can be divided by its occurrence: acute or chronic

Acute Intestinal Ischemia

• Sudden severe abdominal pain
• Frequent and forceful bowel movements
• Passage of bloody stools
• Abdominal tenderness
• Nausea
• Vomiting
• Fever
• Fatigue
• Mental confusion

Chronic Intestinal Ischemia

• Abdominal pain usually after eating ranges from mild to severe, lasting from one to three hours
• Fear of eating or change in eating habits due to abdominal pain
• Diarrhea
• Nausea
• Vomiting
• Bloating
• Blood tinged stools

Treatment

It depends upon the underlying cause and severity of the disease.

Acute Intestinal Ischemia Medical care

• Supportive therapy including intravenous fluid and oxygen therapy.
• Medications:

1. Anti-spasmodic drugs like Papaverine
2. Thrombolytics injected through an angiogram catheter
3. Anti-coagulants like heparin

Surgical care

• Angioplasty: It involves the use of an inflated balloon at the end of a catheter to compress the fatty deposits and to widen the blocked artery or vein. This improves blood flow in the blood vessels. A metallic stent may also be placed in the blood vessel to keep it stretched.
• Embolectomy: Surgical removal of the embolus is done to improve the blood flow.
• Aortomesenteric Bypass and Resection of Bowel: This surgery is done in case, gangrene develops.

Symptoms

The most common signs and symptoms of a Ruptured Spleen include:

• Pain in the upper left quadrant of the abdomen
• Tenderness near the abdomen
• Lightheadedness or dizziness
• Disorientation or confusion

As a Ruptured Spleen is a medical emergency, you must seek medical attention immediately if you have any of the above-listed signs or symptoms.

Causes

When the abdomen suffers a direct blow or blunt trauma, your Spleen may be ruptured. Motor vehicle accidents, sports injuries, bicycle accidents and domestic violence may cause a rupture in the Spleen.

Certain illnesses such as Malaria, Hemolytic anaemia, Lymphoma and Infectious Mononucleosis cause your Spleen to swell and make the capsule-like covering weak and thin; this leads to splenic rupture.

It is also known that colonoscopy, a procedure used for looking at the large intestine, may also increase the risk of splenic rupture.

Diagnosis

The tests and procedures that are used for diagnosing Ruptured Spleen include:

Physical Examination: Your doctor performs a physical examination to determine the size of your Spleen and checks if you feel abdominal tenderness.

Blood Tests: Your doctor would order routine blood tests to evaluate the platelet count and the overall blood cells, and to check the presence of any infection, which is determined by the increase in WBC or ESR rate.

Ultrasound Testing: Your doctor may use ultrasound testing to check for the blood in your abdominal cavity due to a splenic rupture that may require emergency treatment.

Imaging Tests of your Abdomen: Your doctor may recommend for Computerized Tomography (CT) scan or other imaging tests to rule out other possible causes of the presented symptoms.

Treatment

The treatment options for a Ruptured Spleen are based on the severity of your condition and include the following:

Hospitalization: Small to moderate forms of Spleen ruptures can heal without surgery. Your doctor would provide nonsurgical care, such as blood transfusions, etc. if necessary. Your doctor may follow-up CT scans to check the condition of the Spleen and if it has healed or does it requires surgery.

Surgery: Surgical procedures for Ruptured Spleen include:

• Repair: The surgeon would stitch up the Ruptured Spleen
• Splenectomy: The injured Spleen is removed in this procedure. However, the drawback of this procedure is the chances of infection or sepsis.
• Partial Splenectomy: Your doctor removes only the portion of the Spleen that is damaged. This procedure has fewer chances of acquiring infection post-surgical.

These procedures are performed laparoscopically (through small incisions), and a special camera and surgical tools are used. Spleen surgery is considered the safest surgery, although all the surgical techniques would have the risk of bleeding, blood clots, infection, and pneumonia.

These are common in infants. Most commonly seen in premature babies, babies who are born underweight (1.5 kg) often develop an Umbilical Hernia.

Symptoms

You may find a soft bulge near the Umbilical region, ranging from 1-5 centimetres. It may be more noticeable if the baby laughs, cries, or strains. It is not usually painful in children. However, in adults, it may be painful and may cause discomfort if the Hernia size is large.

You must call the doctor immediately when you have severe vomiting if the bulge causes pain and if the bulge gets discoloured and swells up.

Diagnosis

Your doctor would perform a physical examination to determine the presence of an Umbilical Hernia. The doctor would try to see if a hernia can be pushed back into its place. It is also checked if the umbilical cord is trapped because the trapped part of the intestine may be disconnected from the blood supply.

An X-ray or Ultrasound of the abdomen is performed to check if there are any complications. A blood test is performed to check if there is any evidence of infection.

Treatment

Most Umbilical Hernias in infants close on their own by the age of 1 or 2 years. During the physical examination, your doctor may push back the hernia into its place. You should not push it back on your own.

For children, Hernia Surgery is typically needed if an Umbilical Hernia is painful, bigger than 1.5 centimetres, trap or block the intestines, is large and do not reduce in size. In adults, the surgery is recommended to avoid possible complications and if a Hernia is larger and more painful.

During the hernia repair surgery, a small incision is made at the base of the belly button and herniated tissue is returned to the abdominal wall. After that, the wall is stitched closed.

Causes

Umbilical Hernia in Infants: In the womb, the fetus is connected to the mother with the help of the Umbilical Cord. This opening should close eventually on its own after the birth. When the opening does not close, it may accumulate in fatty tissue and form an Umbilical Hernia

Umbilical Hernia in Adults: In adults, if there is much pressure on the abdominal area, the fatty tissue or a part of the intestine may poke through a weak part and appear as a protrusion.

Risk factors

The major risk factors for developing Umbilical Hernia are:

Age: premature infants are at a higher risk for developing an Umbilical Hernia.

Obesity: Obese children and adults have increased pressure on the abdominal area and may develop an Umbilical Hernia.

Coughing: Too much pressure applied on the abdominal area while coughing may lead to the occurrence of an Umbilical Hernia.

Multiple Pregnancies: The risk of developing Umbilical hernias is increased when the pregnant mother carries more than one baby inside the womb.