Constant acis reflux from the stomach may change the inner lining of esophagus from squamous cell to columnar cell. It is called Barret’s esophagus and cancerous changes may occur in ti in future; patient should remain under observation endoscopically.

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

• Cancer Rectum and Colon
• Portal Hypertension

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

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

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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.

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A lady reports to the surgery out patients department three days after a struck fish bone while taking food, with pain inside the neck. She narrates that a fish bone was struck in the throat while taking food; she tried to remove by putting her finger inside the throat, but failed. She again tried to dislodge that by taking bland and dry diet, very much in practice in local folks in India; but failed. She vomited blood while trying to remove it. This type of foreign bodies are usually removed by ENT specialist, and in his absence it came to the surgery OPD. She was examined and nothing could be found, as far as visibility goes in the mouth and throat. She was put to an upper gastrointestinal endoscopy; a nice ulcer covered with scab was visible in the esophagus just below the level of vocal cords. The suspected fish bone was searched up to the exit from the stomach, but in vain. The patient was put on a local anesthetic mixed soothing agent, a proton pump inhibitor and a mild antibiotic. She was advised to take normal diet, not hot; barring chillies and excessive spices. She has not reported back for five days since the advice. It presumed that she is alright.

Many times dentures, fish bones get into throat; but in children different small toys, pins, small batteries, dress hooks and many unusual objects have been recovered. It may sometimes prove fatal, if accidentally finds its way into the respiratory tract. Infants and small children are to be watched while they play, so that nothing is put into mouth; as, at this age they try to gather information about an objects by the lips. So, They put anything and everything to try that and accidentally land in trouble; and the whole family suffers.

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In this age of speed the distance is gradually losing its identity. But this has given rise to a problem to which frequent and distant flyers suffer. That is jet lag. It is due to the maladjustment of the biological clock. Like our wrist watch body maintains a clock for its activity, the circadian rhythm, called biological clock. It is a function of the brain.

Most of the researchers agree that the effect of light on eyes sets it into motion, maintains it and adjusts it whenever required. Light stimulus is felt in part of brain called suprachiasmatic area which maintains the biological clock. Circadian rhythm refers to the daily activity of body in relation to the day and night. Some hormones are secreted according to a set time.

Melatonin is a hormone responsible for inducing sleep is secreted around 10 PM and ends towards 5 AM. Of course, it may shift a little this way or that way according habit of sleep of a person. Corticosteroid hormones are secreted towards 5 AM to make the person active and face the challenge of the day to day activity. So, if it is 12 midnight in the biological clock and a local time is morning 6AM, body cannot respond to it and the disparity ensues. Of course, biological clock adjusts but not very swiftly. And, that is the Jet lag; to cope with it players are flown to  distant places sufficiently ahead of scheduled time.

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