- 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.
- Chemical structure of vitamin D 3
In Indian mythology, there was a story related to the worship of Sun God. Samba, son of Lord Krishna was cursed to suffer from leprosy due to some evil act of his. He realized the mistake and sought the remedy. It was suggested to him that, only Sun God had the power to heal that disease, and he should make the god happy by prayers to get his blessings. He followed that and got cured. Whatever might be the behind story, it goes without saying that sun rays have much more implications in our lives, than originally thought of.
It is the sun rays, which helps in the synthesis of vitamin D from cholesterol in our body. This vitamin is not available in plenty in our day to day food. Vitamin D is converted to the active form in the kidney and help in calcium metabolism. In its deficiency, one may suffer from rickets to osteomalacia etc.. This was the traditional teaching about the utility of this vitamin.
- Milk and cereal grains are often fortified with vitamin D.
Now more informations are pouring in regarding its role in human life. Researchers have found that this vitamin along with calcium maintain the integrity of cells of human body. The regulation of multiplication of cells, autonomy of cells and inhibition of unwanted growth like cancer are managed by vitamin D. Low level of it may be associated with cancer of breast, ovary, prostate and colon etc.. A higher level at about 40-60ngms/ml may actually prevent these cancers. This is very interesting development and further study will enlighten more about its role in cancer prevention.
That is why, now-a-days outdoor activity is encouraged in the school curriculum. Let us go outdoors to prevent these aggressive cancers for free.
- 3)Prostate.
One of the most slow growing cancer is prostate cancer.The symptoms are indistinguishable from the benign prostate enlargement.The patient may have symptoms due to obstruction of the lower urinary tract and/or irritation of the same. The symptoms all together called prostatism.
One may have
- Frequency of urination especially at night called nocturia making him almost awake throughout the night.
- Slow start of urination i.e.patient has to patiently wait for the urine stream to start, called hesitancy.
- Patient may not be able to postpone an urge for urination called urgency.
- Precipitancy is fall of a few drops of urine before the person finds a suitable place to pass urine.
- A narrow stream of urine.
- Longer time taken to pass urine.
- A sense of incomplete evacuation of bladder.
- At a later stage may come with acute retention of urine.
- Burning urination may occur.
If these symptoms are seen one has to undergo examination for prostate disease. A simple per rectal digital examination will reveal many information. An enlarged, hard,painless and irregular prostate indicates towards cancer. There are a battery of investigations to confirm cancer.They are
- An ultrasonogram.
- CT scanning.
- Plain x-rays of hip and vertebra.
- Plain x-rays of chest.
Blood tests particularly for prostate cancer are
- Prostate specific antigen
- Acid phosphatase
- Alkaline phosphatase
important apart from routine blood tests.
Tissue diagnosis is an important aspect of confirming cancer of prostate.It is done by
A tissue sampling for heat shock protein-27 is under research to predict the aggressive nature of the disease.It is because some prostate cancer are so slow growing that the patient may pass away from an unrelated condition rather than from prostate cancer.
Many treatment options are available.They are
- Surgery.
- Hormonal manipulation.
- Chemotherapy.
- Radiotherapy in case of bone metastasis.
- Opened Gall Bladder with Gal Stones
The tags attached to the disease are fat,fertile,fifty and female are not absolute.It is said for gall stone disease.This disease gives rise to pain in the upper mid-abdomen.Other tags attached to it are flatulent dyspepsia .Some other diseases may be associated with it namely a hiatus hernia , diverticulosis of colon or pancreatitis.
Typically pain comes after a fatty meal.Other symptoms are vomiting ,loss of appetite,jaundice and fever .If associated with other diseases their symptoms also manifest.Gall stones form in a diseased gall bladder,supersaturated bile and infected biliary system .It is prevalent in a areas prone for malaria and haemolytic diseases such as sickle cell disease.It is said that “Every gall tone is a tomb stone erected to the memory of bacteria living or dead within it”.
The stones are of a few types namely a cholesterol stone,a pigment stone or a mixed stone.The inflammation of gall bladder is called cholecystitis.It may occur with a gall stone when it is called a cholelithiasis with cholecystitis . when cholecystitis occurs without a gall stone is called an acalculus chilecystitis.Complications do follow a long standing cholecystitis.They are gangrene of gall bladder,pancreatitis,perforation of gall bladder,stone migration to common bile duct and it’s obstruction, stone obstruction of intestine and pus in gall bladder to name few.It may become associated with a cancer of gall bladder also.
- Laparoscopic Cholecystectomy
Medical treatment for small cholesterol stone may become effective.Nevertheless surgery is indicated for it’s cure.A laparoscopic approach is the gold standard treatment now-a-days.
- A Lipoma On Abdominal Wall.
Patient comes with a swelling on his body to a doctor which has been there for along period.Many swellings are seen on the body surface which have to be differentiated from each other .A lipoma is a swelling on the body surface.This is painless,no pain on pressure,can be pushed in different directions to a little extent and soft to firm. And some amount of fluctuation as observed in fluid containing cavities can be elicited. This is not an actual fluctuation, called a pseudo-fluctuation .It grows in size over the years without much problem except a disfigurement. It can grow in any site but commonly in the neck region ,forehead and abdomen are affected.It also can be seen in the body cavities and near vital areas can to cause problem due to pressure.
It is a benign tumor of fat cells .Can be diagnosed basing the on the above findings.A fine needle aspiration cytology will clinch the diagnosis. An ultrasonogram is also helpful.Lipoma very rarely may turn to malignancy called a Liposarcoma.One important feature of this tumor is that it burrows into the surrounding tissue if not capsulated.But many times it is capsulated.
- Removed Lipoma
Surgical removal is the answer under local,regional or general anaesthesia.Recovery is uneventful and recurrence is usually not seen.If tumor tissue incompletely removed from holed up locations fear of recurrence remain.
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