December « 2009 « ThePclinic

Diseases Presenting as Piles

: Digital Rectal Examination

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

Cancer Rectum and Colon
Portal Hypertension

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

: Hemorrhoid

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

Filed under: Digestive Disorders — Tags: Cancer, Cirrhosis, Digestive Disorders, hemohhhoid, piles, Rectum — Dr.Prahallad @ December 9, 2009 6:27 am

Unusual Presentations of Intestinal Worms

: Ascaria

Round worm, hook worm, tape worm, thread worm and whipworms are some of the common helminthes affecting human. These are transmitted through feco-oral route in the areas of poor sanitation. Common manifestations of the diseases caused by these groups of parasites include: pain abdomen, anemia, vomiting and poor health. Apart from these, some unusual complications from infestation of these worms are also seen.

Round worm (Ascariasis): These may lodge in the common bile duct, pancreatic duct and liver apart from their natural habitat; small intestine. That may cause obstruction to the free flow of bile resulting in obstructive jaundice, pancreatitis and liver abscess respectively. That may affect the liver function and cause inflammation of bile channel called cholangitis. Ascaria larva during the course of its development passes through the respiratory tract to come over to the alimentary tract once again, which causes night hawking cough and sometimes lungs infection by secondary bacterial invasion. A lot of adult round worms living or dead after administration of drugs or as such may cause obstruction of the alimentary tract which may arouse an emergency situation. These may become irritated during surgery by anesthetics and come up, to be aspirated to the respiratory tract causing the dangerous collapse of lungs.

Hook worm larva enters the body through the bare skin of foot, to find its way to the blood or lymphatic to reach the alimentary tract via respiratory tract. At the site of entry may evoke inflammation and intense pruritus called “Ground itch”. The route of its migration can be seen as an inflamed streak over the skin called the “Larva migrans”, which evokes pruritus. Finally they lodge themselves in the upper part of small intestine to cause the classical symptoms of the ankylostomiasis.

Thread worm egg are laid near the anal canal, hatch there and larva may migrate to the vagina in female to cause pruritus there. It may ascend upwards to the fallopian tubes, and even to the peritoneum to cause an infection there. Sometimes these may enter the appendix to cause appendicitis. These find their way again to the alimentary tract being carried by the nail to the mouth during intake of food.