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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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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This is termed as gastroesophageal reflux disease (GERD). It may be a part of acid peptic disease, more commonly. GERD may occur due to a lax lower esophageal sphincter mechanism, in isolation. It may be due to hiatus hernia, herniation of stomach in various proportions into chest through a defect in the diaphragm that separates chest from abdomen. Esophageal dismotility may also cause it. A bad dietary habit is responsible for its exaggeration.
Diagnosis of it starts from the history of typical symptoms. An endoscopy will show the evidence of the disease. There may be erosions in the mucosa of esophagus. A Barrett’s esophagus, where the normal inner layer is replaced by intestinal pattern. A hiatus hernia also can be distinguished. Esophageal manometric study finds dismotility if any.
The proton pump inhibitors are the main stay of treatment where, no organic problem is noticed.Specific diseases like hiatus hernia and a lax lower esophageal sphincter will require surgical intervention. The surgeries are usually successful. But, before that one may change some of his habits and try to get relief. Refraining from taking water immediately after food, walking in slow pace in the room, not going to bed immediately after taking food and keeping head end up supported by pillow may help. Some Yogic practices like taking deep respiration and exhaling it with full force,repeating it for several times in a session may strengthen the diaphragm to block acid eructation from stomach to esophagus. Barrett’s esophagus requires special mention because it may lead to cancer of esophagus in the long run. If found has to be followed with regular endoscopic reviews.
Though a benign disease; it is associated with considerable morbidity, if left untreated. But, the proton pump inhibitors have changed the total outlook of treatment. Many times patients become dependent on it.
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Pain in middle of upper abdomen in a commonly encountered complain from patients in any hospital.There are vast nuber of causes for it.Many of them are for academic interest.Among the most commonly encountered conditions Acid Peptic disease is one.
Here there is pain in the middle of upper abdomen .This pain may come in empty stomach or after taking food.It is typically colicky in nature,sometimes subsides after taking food or aggravated after taking food.It my appear seasonally in the winter.Gradually this timing of pain changes and pain is always felt. There may appear vomiting which may contain freshly eaten food to stale food, blood and bile.Some times there occurs blood vomiting and passing of black stool.Some times patient may present in the emergency with a complication called perforation of stomach or duodenum.
This disease may be seen in the stomach,duodenum,Lower esophagus or in a mackel’s diverticulum.The symptoms and signs may differ according to the site of disease. To-day we will see the disease of stomach and duodenum.
Hydrochloric acid secretion is an integral part of stomach inner layer called gastric mucosa.There in also secretion of protein digesting enzyme called pepsinogen.The digestion of own gastric mucosa hangs on a fine balance between the secretions and mucosal defense. Mucosal defense rests on the amount of bicarbonate and mucus present in the stomach.There are various means to dis-balance it.It my be stress and strain,Ingestion of analgesics and steroid,Severe trauma lading to blood loss and infection by a microbe called H.Pylori. There may occur inflammation to ulcerations in mucosa and may progress to other layers of stomach and duodenum.
The disease can very nicely be diagnosed by an endoscopy.This can be treated by newer proton pump inhibitor drugs.This drug has left the surgical option for this disease limited to the complications only.If drug treatment fails nice surgical options are available.
ESOPHAGEAL VARICES.Bleeding from upper intestine ,most commonly from an ulcer in stomach and duodenum causes black stool .Black stool is due to action of acid (hydrochloric)on the hemoglobin (present in the red blood cells).That is substantiated by occult blood test of a stool sample.
The exact disease of stomach and duodenum can be determined by endoscopy.Amongst various other causes of bleeding cancer of stomach, esophageal varices and tear of upper end of stomach are important.
Bleeding blood vessels in an ulcer can be sealed endoscopically and further blood loss be prevented. Along with that acid suppression also important.Some times it may be required to transfuse blood to the patient.
Analgesics are most common triggering factor for ulceration and subsequent bleeding.To prevent this dreaded complication analgesics to be taken when it is essential and informing doctor for previous acid peptic disease while getting treatment is absolutely necessary.
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