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GI tract infections PDF Print E-mail
Written by Vice-Gov. Greg Sanchez Jr.   
Monday, 13 April 2009 13:39

           Cholera is a severe infectious disease which caused by a bacterium Vibrio cholerae. A person can be infected by such infectious disease after ingesting food or water contaminated with the cholera bacteria. The symptoms of cholera are diarrhea and the loss of water and salts in the stool. In severe cholera, the patient develops violent diarrhea with characteristic “rice-water stools,” vomiting, thirst, muscle cramps, and sometimes circulatory collapse. Death can occur as quickly as a few hours after the onset of symptoms. The mortality rate is more than 50 percent in untreated cases, but falls to less than 1 percent with proper treatment. Worldwide in 1999, more than 254,000 people were diagnosed with cholera and there were over 9,100 cholera-related deaths reported.

          Prevention of the disease is a matter of sanitation. Cholera epidemics swept through Europe and the United States in the 19th century but did not recur in those areas after improvement of the water supply.

          Control of the disease is still a major medical problem worldwide. The World Health Organization (WHO) estimates that 78 percent of the population in less developed countries is without clean water and 85 percent without adequate fecal waste disposal. Epidemics of cholera occurred in 1953 in Calcutta (now Kolkata), India; between 1964 and 1967 in South Vietnam; among Bangladeshi refugees fleeing to India during the civil war of 1971; in Latin America in 1991, and in Democratic Republic of the Congo in 1994 where the epidemic deaths were estimated at 23,800 within one month.
          Colic, severe abdominal pain, a symptom of several disorders. When arising in the intestine, it is characterized by spasmodic and irregular contractions of the muscular coat of the intestines. Intestinal colic is often caused by infection, obstruction, irritating food, or purgative medicine. The etiology of infant intestinal colic is poorly understood, although gas and disturbed digestion are suspected causes. Renal colic is caused by a passage of a calculus, or stone, from the kidney through the ureter into the urinary bladder. Biliary colic is caused by the passage of a gallstone from the gallbladder into the bile ducts. The symptoms of colic are often confused with those of appendicitis and peritonitis.
          Constipation, a condition which one experiences difficulty in eliminating bowel movements from the body, because of a hard, dry stools that could result in a tear in the lining of the lower rectum or anus or, more often, in painfully swollen and itchy veins in the lower rectum or anus, known as hemorrhoids. Tenseness and straining to achieve evacuation tend to worsen such conditions. Constipation is sometimes associated with feelings of sluggishness, headache, and distension of the abdomen.

          Chronic constipation may be caused by a diet insufficient in roughage or fiber, irregular eating hours, improper use of laxatives, or the voluntary avoidance of bowel movements. Many cases are believed to be caused by emotional disturbances. Constipation can usually be relieved by drinking adequate fluids; eating healthy foods such as fruits, vegetables, and cereals; and establishing routine evacuation habits. A high-fiber diet is particularly important for people who are taking medications that tend to harden stools and produce irregular bowel habits.

          Some people become stressed or depressed when their bowel habits are irregular. Neglecting dietary measures, they may become addicted to the use of laxatives, suppositories, and enemas. These individuals may eventually lose muscle strength in the bowel wall, making it difficult for them to return to normalbowel habits. They also face the possibility that the digestive system will be unable to absorb all the nutrients in their food supply.

          Constipation that develops suddenly in people who have previously had normal bowel function may be a symptom of a serious disorder, such as excessive production of thyroid hormones or kidney failure. Disturbing changes in bowel habits should be reported to a physician.

          Crohn’s Disease, sometimes called regional enteritis, a chronic inflammation of the intestines resulting from an extreme reaction of the immune system. The cause is unknown, although there is a genetic tendency to develop this disease and environmental factors are also thought to play a part. It may occur at any age but is most common in young adults, with most people first affected during their teens or twenties. A small proportion (15 percent) of patients contract the disease after they are 50. Crohn's disease is found mainly in Europe, North America, and Australia. Crohn's disease, together with a related condition called ulcerative colitis, are generally referred to as inflammatory bowel diseases (IBDs), and affect as many as 2 million people each year in the United States.

          The symptoms of Crohn's disease include diarrhea, abdominal pain, weight loss, and fever. Anemia is also common due to bleeding from the intestine but such hemorrhaging is rare, occurring in only 1 to 2 percent of patients. The lining of the intestine becomes inflamed and ulcers form. Parts of the lining also become swollen, forming a characteristic “cobble-stoned” appearance. The muscle wall of the intestine becomes toughened and fibrous and some areas may become obstructed. Abnormal passages, called fistulae, may form when the inflammation spreads from the intestine through its wall and makes a hole, allowing partly digested or fecal material to pass from the inside of the intestine to another part of the body.

          Crohn's disease is often difficult to diagnose and may be mistaken for other diseases such as ulcerative colitis. Various techniques may be used to facilitate diagnosis, including a sigmoidoscopy (examination of the inside of the intestine with a lighted device). In addition, a biopsy taken from the mucous membrane of the affected intestine and a barium meal (swallowing of barium sulfate to facilitate x-ray examination) may be helpful.

          Treatment typically consists of controlling any dietary deficiencies caused by the disease and administering anti-inflammatory drugs called corticosteroids. Drugs to suppress the immune system may also be used to counteract abnormal allergic reactions or exaggerated response to an infectious agent. Some 70 to 80 percent of patients require surgery at some stage of their disease in order to remove the most severely affected areas or to repair fistulae. However, there is no cure for Crohn's disease, and although symptoms may be brought under control for a while, there are often relapses.

          Diarrhea, frequent passage of abnormally loose, watery stool. Diarrhea usually develops suddenly and may last from several hours to a few days. It is often accompanied by abdominal pains, low fever, nausea, and vomiting. If the attacks are severe or increasingly frequent, exhaustion and dehydration can result. In normal digestion the large intestine absorbs excess water from liquid food residues produced by earlier phases of the digestive process before excreting semisolid stools. When the mucous membrane lining the large intestine is irritated or inflamed, food residues move through the large intestine too quickly and the resulting stool is watery because the large intestine cannot absorb the excess water.

          Diarrhea is not a disease.  It is a symptom of numerous disorders, such as food poisoning from contaminated foods or beverages,  infections  by  viruses  and bacteria, or anxiety. Chronic diarrhea, which lasts weeks or months, may be caused by amoebic dysentery (intestinal infection), tumors, and other serious intestinal disorders such as Crohn’s disease, ulcerative colitis, or irritable bowel syndrome. Except in the case of irritable bowel syndrome, the stool may contain blood or pus.

          The usual treatment for diarrhea consists of bed rest, drinking liquids to replace fluids and salts lost from the body, and eating soft foods. Dehydration is a serious concern in infants and the elderly. If the condition lasts more than a few days, a physician should be consulted

          Dysentery, acute or chronic disease of the large intestine of humans, characterized by frequent passage of small, watery stools, often containing blood and mucus, accompanied by severe abdominal cramps. Ulceration of the walls of the intestine may occur. Although many severe cases of diarrhea have been called dysentery, the word properly refers to a disease caused by either a specific amoeba, Entamoeba histolytica, or a bacillus that infects the colon.

          Amoebic dysentery, caused by the parasite Entamoeba histolytica, is endemic in many tropical countries, but is attributable more to unsanitary conditions than to heat. It is the most common type of dysentery in the Philippine Islands, the Malay Archipelago, and the West Indies, but it also occurs in almost all temperate countries.

          Amoebic dysentery is most commonly spread by water or contaminated, uncooked food or from carriers. Flies may carry the cysts to spread the amoeba from the feces of infected persons to food.

          Various drugs, including metronidazole, ementine, and iodine-containing preparations, have been useful in treating severe cases of the disease.

          Bacillary dysentery is caused by certain nonmotile bacteria of the genus Shigella. This form of dysentery is also most prevalent in unhygienic areas of the Tropics, but, because it is easily spread, sporadic outbreaks are common in all parts of the world. This dysentery is usually self-limiting and rarely manifests the more severe organ involvements characteristic of amoebic dysentery.

Bacillary dysentery is spread by contaminated water, milk, and food. Feces from active cases and those from healthy carriers as well contain immense numbers of the disease-producing bacteria.

          Flies carry the bacteria on their feet or in their saliva and feces and deposit them on food; ants are also believed to spread the disease.

          In the treatment of bacillary dysentery, proper replacement of fluid is important. Sulfonamides, tetracycline, and streptomycin were effective in curing acute cases until drug-resistant strains emerged. Chloramphenicol is sometimes used to treat these strains. Quinolones such as norfloxacin and ciprofloxacin are also effective against Shigella infection.

          Dyspepsia, condition of impaired or painful digestion resulting from failure of some phase of the normal digestive process. The cause may be physical or emotional upset. Among the physical causes are gastritis, ulcers, or gallbladder inflammation. Symptoms may include a heavy feeling in the pit of the stomach, gas, constipation, diarrhea, nausea, or heartburn. Headache or dizziness may accompany the discomfort. Treatment is prescribed according to the specific cause; such treatment may include administering drugs and placing the patient on a special diet. See also Indigestion.

          Indigestion, also called dyspepsia, a condition that occurs when the normal process of digestion is disturbed. The symptoms of indigestion include stomach cramps, belching, and a feeling of fullness. Nausea, vomiting, bloating heartburn, which is a burning sensation in the esophagus, sometimes accompany these symptoms.

          In most cases, indigestion is caused by poor eating habits such as eating too much or too quickly, swallowing air while eating, or not chewing food properly. It may result from eating excessive amounts of fatty foods, improperly cooked foods, or vegetables such as cabbage, onions, and radishes. It may also be caused by emotional upsets. Indigestion caused by any of these factors can usually be treated by taking over-the-counter antacids.

          Indigestion can also be caused by diseases of the stomach and gallbladder. When caused by disease, indigestion can be relieved only by treatment of the disease. Persistent or severe indigestion or the sudden onset of indigestion in a person who has no history of digestive problems should be checked by a physician. Prolonged use of antacids can mask a more serious problem and should be avoided.

          Enteritis, inflammatory disease of the intestine, accompanied usually by abdominal pain or cramps, fever, loss of appetite, nausea, and diarrhea. Chronic or regional enteritis, also known as terminal ileitis, may persist for years; it requires medical treatment and sometimes surgery. Acute enteritis, although short-lived and less serious, can be severely debilitating to infants and elderly people. Causes of enteritis include food or chemical poisoning, allergies, and emotional upset; it may also result from infectious diseases such as typhoid fever and dysentery.

          Flatulence, presence of excessive amounts of gas in the stomach or intestines. Most of the gas in the stomach consists of atmospheric nitrogen and oxygen that have been swallowed. The nitrogen is largely unabsorbable and travels on through the intestines. Additional gases, principally carbon dioxide, methane, and hydrogen, are formed within the intestines. The carbon dioxide, produced by fermentation, is largely absorbed. The other gases, produced by incomplete digestion of foods rich in starch or cellulose, such as beans or cabbage, are eventually expelled from the rectum as flatus. The disagreeable odor of flatus is caused by several sulfur compounds, particularly by mercaptans. Large amounts of gas in the stomach or intestines may cause distention and pain.

          Gastritis, acute or chronic inflammation of the mucosal lining of the stomach. The ailment was first described in 1833 by the American military surgeon William Beaumont, who was able to study the mucosa of a man who had suffered a gunshot wound in the abdomen. The wound healed with an opening in the stomach wall, through which Beaumont was able to observe the patient's digestive process. In gastritis the inflammation may be marked by the erosion of surface cells of the mucosa, formation of granular nodules, and hemorrhage.

           n chronic gastritis, there is a growth of fibrous tissue on the lining. Weight loss and delayed emptying of the contents of the stomach may accompany the disease. Gastritis may be caused by excessive consumption of alcohol, abnormal secretion of hydrochloric acid in the gastric juices, and various infections ranging from syphilis and tuberculosis to fungus. Psychological stress may also be involved in the development of gastritis.

          Ileitis, acute or chronic inflammation of the ileum, the terminal portion of the small intestine. It is characterized by vomiting, anemia, abdominal cramps, loss of weight, fever, and occasionally bloody diarrhea.

         Because it often occurs in the lower right abdomen, the pain is sometimes mistakenly diagnosed as a symptom of acute appendicitis. The cause of ileitis is unknown. Therapy includes replacement of fluid to counter dehydration and loss of minerals, bed rest, a bland diet free of roughage, antibiotics to control secondary infection, and corticosteroids to reduce inflammation.

          In severe cases of ileitis, perforation of the intestine, resulting in peritonitis, may occur. Present-day treatment usually involves surgery, as there is no known medical therapy that can eliminate the inflammatory lesion. The two main types of surgery are excision of the affected segments and the so-called bypass operation, in which the diseased part is isolated and the bowel contents diverted from the lesion. The rate of recurrence after surgery is about 50 percent.

          Irritable Bowel Syndrome (IBS), also known as spastic colon, recurring symptoms of constipation, diarrhea, and abdominal cramping that appear without a clear cause. IBS accounts for 30 to 50 percent of patient visits to gastroenterologists (physicians who specialize in disorders of the intestinal tract).

          The diarrhea associated with IBS is not true diarrhea in that there is no increase in stool volume. Patients sometimes pass mucus with the stools and have a sensation of incomplete evacuation of the bowels following defecation.

          Recurring IBS has been associated with stress, although abdominal distress is a common reaction to anxiety in many people who do not suffer from IBS.

         Physicians diagnose IBS only after conducting a series of tests that rule out other gastrointestinal disorders, such as inflammatory bowel disease, intestinal parasites, and polyps. These tests include a barium enema, stool parasite culture, and sigmoidoscopy, examination of the lower intestines with a hollow, tubelike instrument passed through the anus.

          There is no cure for IBS and treatment focuses on alleviating symptoms. High fiber diets or antispasmodic drugs may relieve constipation, and antidiarrheal drugs may alleviate prolonged diarrhea. Although there is no scientific evidence linking irritable bowel syndrome and the amount of fiber in the diet, some people benefit from eating a high-fiber diet, while others find reducing their carbohydrate intake helps.

           Ulcer, shallow sore produced by the destruction of skin or mucous membrane. Skin ulcers may occur in association with a number of chronic illnesses, such as diabetes, kidney and heart ailments, varicose veins, syphilis, leprosy, tuberculosis, and cancer.  Gastrointestinal ulcers occur with chronic gastritis, ulcerative colitis, and typhoid fever.

          Peptic ulcers are ulcers of the stomach (gastric) or small intestine (duodenal). In addition to the pain caused by the ulcer itself, peptic ulcers give rise to such complications as hemorrhage from the erosion of a major blood vessel; perforation of the wall of the stomach or intestine, with resultant peritonitis; or obstruction of the gastrointestinal tract because of spasm or swelling in the area of the ulcer.

          The direct cause of peptic ulcers is the destruction of the gastric or intestinal mucosal lining by hydrochloric acid, an acid normally present in the digestive juices of the stomach. Infection with the bacterium Helicobacter pylori is thought to play an important role in causing both gastric and duodenal ulcers. Injury of the gastric mucosal lining, and weakening of the mucous defenses such as by nonsteroidal anti-inflammatory drugs, are also responsible for gastric ulcer formation. Excess secretion of hydrochloric acid, genetic predisposition, cigarette smoking, and psychological stress are important contributing factors in duodenal ulcer formation and exacerbation.

          Several different types of prescription drugs are used in the treatment of ulcers. Antacids may be ingested to neutralize the hydrochloric acid secretions. Drugs such as cimetidine and ranitidine block the action of histamine, the body chemical that triggers acid secretion, and have been shown to induce healing of ulcers in many patients. Omeprazole inhibits acid secretion by disabling the cellular pumps that pump acid into the stomach. Bismuth-containing compounds and antibiotics may be used to eradicate Helicobacter pylori infection, accelerating healing and reducing the rate of ulcer recurrence. Sucralfate forms a protective layer that enhances the mucosal lining of the stomach and intestines. Misoprostol is effective against gastric ulcers caused by nonsteroidal anti-inflammatory drugs. Quitting smoking can also accelerate the healing process. Alcohol and caffeine should be avoided, although in general a bland diet is of no benefit. In extreme cases surgery may be required.

          Ulcerative Colitis, a chronic disease of unknown cause in which the lining of the colon and rectum becomes severely inflamed and eventually wears away, forming shallow sores known as ulcers. Frequently the colon is permanently damaged.

          Ulcerative colitis, together with a related condition called Crohn’s disease, are generally referred to as inflammatory bowel diseases (IBDs), and affect as many as 2 million people each year in the United States.

          Although it can occur for the first time at any age, onset of ulcerative colitis tends to occur in young adulthood, with a subsequent rise in the number of cases for individuals over 65 years. Most people with ulcerative colitis have inflammation in their descending colon, the section of the large intestine stretching from the left side of the abdomen to the pelvis, and in the sigmoid colon, the section of the intestine that is joined to the rectum. Some people have inflammation and ulceration in all of the large intestine. The disease does not affect the small intestine.

          Most people have only mild or moderate forms of the disease, with symptoms that include rectal bleeding, diarrhea, and feces that contains mucus, all of which are easily controlled with medication. People with a more severe form of the disease have extensive diarrhea, stomach pain, and fever, and they also tend to suffer from such problems as arthritis, liver problems, and leg ulcers. Patients with ulcerative colitis involving the whole colon that has lasted for more than ten years are at major risk for cancer.


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