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Gastroenterology

Esophagus

Geriatric orthopaedics is a specialised science concerned with the special musculoskeletal health of older people. With age, bones weaken (osteoporosis), joints tend to wear out (osteoarthritis), and the amount of muscle tissue decreases (sarcopenia). Such alterations increase the vulnerability of older adults to falls and fractures, as well as persistent pain. Geriatric orthopaedics does its best to be very comprehensive and take care of not only the injury or condition but also the health of the patient, their mental capabilities, and their support system so that an adequate result is achieved.

Indications

  • Dysphagia: This is the term for the inability to swallow. It may indicate many disorders, including minor muscle spasms and significant blockage, such as a tumour or stricture (narrowing).
  • Odynophagia: Uncomfortable swallowing is present in oesophagus inflammation, infection, esophagitis, or a foreign body.
  • Heartburn and Regurgitation: These are typical symptoms of Gastroesophageal Reflux Disease (GERD), wherein there is lowered straightness at the lower oesophageal sphincter, which in turn causes heartburn and regurgitation, which is the upward course of food or liquid back into the mouth.
  • Unexpected Weight loss: It is a troubling symptom of a severe condition, like an oesophageal cancer, which might block the path of the food and diminish the possibility of a person eating.

Effects

  • Chronic Inflammation and Damage: Long-term acid reflux (GERD) may cause chronic inflammation to the oesophageal lining, referred to as esophagitis. This may result in cellular transformation known as Barrett's oesophagus, a pre-cancerous symptom that can develop over time.
  • Stricture Formation: Repeated challenges with tissues or chronic inflammation may lead to scarring and squeezing in the oesophagus, leading to a stricture. This may cause swallowing to be more and more challenging, and it might need to be opened using dilation.
  • Oesophageal Cancer: The most serious and deadly occurrence is that of oesophageal cancer, especially in patients having longstanding GERD and Barrett's oesophagus.
  • Aspiration: Severe dysphasia or regurgitation may result in food or liquids slipping into the airway (trachea) at the expense of the oesophagus. This may result in severe lung diseases such as aspiration pneumonia.

Stomach issues

The stomach is an upper abdominal J-shaped muscular organ, which is critical in digestion. It gets food through the oesophagus, dissolves it with some gastric juices, with acid and enzymes and stirs it to a semi-liquid paste known as chyme. This action is to get the food to be digested further and absorbed in the small intestine. A healthy stomach environment is decisive in the digestion of food and safeguarding the body against pathogenic bacteria. The cause of problems may be an infection, inflammation, structural issues, or chronic diseases.

Indications

  • Chronic abdominal pain: Recurring or persistent pain in the upper abdomen that may be burning, gnawing, or cramping pain is a recurrent characteristic of disorders such as gastritis or peptic ulcers. It could also progress when the stomach is empty and improve with food.
  • Nausea and Vomiting: Although many factors may cause them, constant and frequent nausea and vomiting tend to mark an essential stomach condition, such as a stomach flu, gastritis, or, in more severe cases, obstruction.
  • Indigestion and Bloating: After any meal, a feeling of fullness, uncomfortable pressure and bloating may appear, even after a small amount of food. The state of poor digestion is one of the causes of such symptoms and is often referred to as dyspepsia.
  • Appetite or Weight Decrease: Loss of appetite or unintentional weight loss may be a severe sign of complications to the stomach, such as ulcers, tumours or other chronic conditions disturbing the digestion and absorption of nutrients.

Effects

  • Peptic Ulcers: Gastritis, tissue inflammation, ulcers, or bacteria like H. pylori may form open wounds or ulcers on the stomach lining. These may produce intolerable pain, and in others, haemorrhage or perforation (a puncture in the stomach wall).
  • Gastrointestinal Bleeding occurs when ulcers or other extreme inflammation cause blood vessels in the stomach to be eroded, causing bleeding. It may present in the form of black, tarry stool (melena) or bleeding from the mouth (hematemesis), both of which are life-threatening conditions.
  • Chronic Dietary Insufficiencies: The digestion and absorption of specific essential nutrients may be hindered due to the inability of the stomach to produce adequate acid and enzymes that aid in their conveyance, thus resulting in conditions like anaemia due to a lack of Vitamin B12 and iron and so on.
  • Higher Chances of Cancer: Chronic inflammation and the damage caused by chronic diseases, such as gastritis, increase the chances of developing stomach cancer, especially when untreated.

Small and Large Intestine

The small and large intestines are the main parts of the digestive system, and they are joined together to accomplish digestion and absorption of food. A large number of chemical breakdowns and nutrient uptake happen in the small intestine, which is a long, narrow, coiled tube. It processes half-digested food acquired in the stomach, by the use of enzymes breaking up carbs, proteins and fats. The smaller, wider tube known as the large intestine then takes up the water and electrolytes in the remainder of the indigestible food material to produce solid waste (faeces), which is stored and shed. A healthy digestive system is a vital aspect of health, as it helps people get proper nutrients, hydrate, and maintain their overall health.

Indications

  • Chronic Abdominal Pain: Cramping, bloating and abdominal discomfort that is severe or repetitive in the abdomen can be an indication of a disease such as Irritable Bowel Syndrome (IBS), Crohn's Disease, and colitis.
  • Bowel Habits: Alterations in frequency or consistency of bowel movements are common symptoms of intestinal obstructions and include chronic diarrhoea or constipation.
  • Blood in Stool: The Presence of blood, which can be very bright red, dark red, black and beautifully coagulated, is a serious indicator that needs urgent medical care. It may signify a source of bleeding in a peptic ulcer, diverticulitis, or something worse, cancer.
  • Accidental Weight Loss: Losing weight without making any effort could be an indication of a severe bowel disease that impairs the body's ability to absorb nutrients.

Effects

  • Malabsorption: Alterations in the lining of the small intestine, such as Celiac disease or even Crohn's disease, can result in the inability to absorb important nutrients, resulting in malnutrition and weight loss.
  • Dehydration and Electrolyte Imbalance: Severe or chronic diarrhoea, which is typically associated with problems of the large intestine, may result in the loss of large amounts of water and electrolytes, causing dehydration, fatigue, as well as other health problems of serious consequences.
  • Bowel Obstruction: When the intestine is actually blocked physically, either by a tumour, scar tissue or a bowel loop that has twisted (volvulus), this can be a life-threatening emergency.
  • Higher Risk of Cancer: Due to unusual changes that appear over time in chronic inflammatory diseases such as ulcerative colitis and Crohn's disease, there is a risk of developing colorectal cancer.

Colon and rectum

The last two parts are the colon (large intestine) and the rectum of the digestive system. The colon takes in water and salts of indigestible food substances and reserves waste materials until they are collected. The last part of the large intestine is made up of the rectum, the component where faeces are retained until the body gets rid of them. The organs play an important role in regulating the fluid balance of the body and in the end processes of waste.

Signs of Colon and Rectum problems

  • Bowel Habits: A lasting alteration in the characteristics of the stool, how often it happens, and/or when bowel movements are needed is indicative of underlying problems. This can include the development of constipation or diarrhoea for a couple of weeks.
  • Rectal Bleeding: Bright red on the stool or dark tar-like blood is a serious red flag symptom to pay attention to. It may be triggered by such harmless phenomena as haemorrhoids or fissures, but it may also signify the existence of polyps or cancer.
  • Abdominal Pain or Cramping; Chronic or recurrent abdominal pain, gas or discomfort and abdominal pain that is new or getting worse should be considered a symptom of inflammatory bowel diseases (IBD) or a blockage.
  • Unexplained Weight Loss: Unintentional weight loss is a grave indicator that may occur alongside high-stage colorectal cancer or acute inflammatory disorders, which make the body incapable of nutrient digestion.

Impacts of Uncontrolled Conditions

  • Development of cancer: Precancerous polyps or an early stage of colorectal cancer will develop and eventually spread to other body organs if they are not identified and managed before progressing to become fatal.
  • Inflammation and Damage: Chronic inflammatory diseases, such as ulcerative colitis and Crohn's disease, may produce persistent inflammation and ulceration of the colon and rectum, resulting in severe discomfort, bleeding, and in the long run, the development of cancer.
  • Bowel Obstruction: A blockage of the bowel may result from constriction by a tumour or severe inflammation, or because of inflammation swelling. That is a life-threatening situation which may result in excruciating pain and nausea, and a possible bowel rupture.
  • Chronic Pain and Dehydration: IBD or infections can lead to chronic diarrhoea, which can lead to severe dehydration and an imbalance of electrolytes. Aches, discomfort, and the necessity to use the bathroom all the time may considerably worsen the quality of life of an individual.

Pancreas

The pancreas is a gland at the back of the stomach which performs two functional roles: exocrine enzymes to facilitate the digestion of food material by the body, and endocrine hormones, mainly insulin and glucagon, that control the level of sugar in the blood. Proper nutrition and nutrient assimilation require a healthy pancreas. The disorders include inflammation and infection, and even more severe ones, such as tumours and cysts.

Signs of Pancreas Trouble

  • Pain Abdominal: In severe cases, pain is the most frequent complaint, ranging from great pain in the upper abdomen extending to the back. This pain could either be sudden and severe, such as in acute pancreatitis or chronic and recurring.
  • Jaundice: The skin and eyes may appear yellow-colored as a result of the obstructed bile duct by the pancreatic tumour or inflammation that does not allow bile to pass into the small intestine.
  • Weight Loss: Unknown and particularly painful weight loss is a serious one. It may arise out of the failure of the pancreas to manufacture the digestive enzyme, thus causing malabsorption or a tumour in the pancreas.
  • Symptoms of diabetes: Since the pancreas is responsible for the production of insulin, its dysfunction may and will result in high blood sugar. These symptoms can be in the form of higher thirst, excessive urination, and feeling weary as a result of pancreatic damage that causes diabetes.

Consequences of Untreated Pancreas Problems

  • Diabetes: A chronic pancreatitis may obliterate cells in the pancreas which produce insulin, causing the development of Type 3c diabetes, a type of diabetes caused by pancreatic illness.
  • Malabsorption: The body is not able to break down and absorb nutrients without a substantive digestive enzyme, especially fat. This may cause gross weight loss and low levels of vitamins, as well as greasy and odorous bowel movements.
  • Pancreatic Necrosis: Severe forms of acute pancreatitis may result in digestive enzymes attacking the pancreatic tissue, causing tissue death (necrosis) and a strong likelihood of infection and multi-organ failure.
  • Pancreatic Cancer: Pancreatic cancer is amongst the most rampant and lethal types of cancer. Sadly, it is usually diagnosed later since its early symptoms are indeterminate and readily confused with other diseases.

Gallbladder

The gallbladder is a small organ which takes the shape of a pear and is situated below the liver. It mainly has the role of storing and concentrating bile, which is a digested secretion released by the liver. The gallbladder contracts and empties bile into the small intestine once we have consumed fatty foods to assist in the digestion of fats. The gallbladder is a beneficial organ of the digestive system, but not one necessary to live. The issue occurs when the cholesterol, bile salts, and bilirubin constituting the bile cause hard deposits referred to as gallstones.

Signs of a Gallbladder Problem

  • Acute, severe pain: The inability to exaggerate is acute, cramp-like or dull upper right quadrant abdominal discomfort that generally transfers to the shoulder or back. This type of pain normally follows eating a fatty meal and may last between minutes and hours.
  • Nausea and Vomiting: A gallbladder attack is likely to cause pain that is followed by feelings of nausea that result in vomiting.
  • Jaundice: There may be a yellowing of the skin and eyes (jaundice) in the event that a gallstone obstructs the common bile duct, resulting in an extreme failure to discharge bile into the intestine.
  • Chronic Indigestion: Constant bloating, gas, and fullness after a meal, especially fatty foods, can also be an indication of a slow-moving and inflamed gallbladder.

Consequences of an Untreated Gallbladder Problem

  • Cholecystitis: This is inflammation of the gall bladder, normally provoked by a gallstone obstructing the cystic duct. It may cause intense pain and fever, and in cases where it is not treated, the bursting of the gallbladder.
  • Pancreatitis: A gallstone can travel and enter the pancreatic duct and lead to a painful and severe condition that could turn out to be fatal: inflammation of the pancreas.
  • Bile Duct Obstruction: The impact of a gallstone in the common bile duct may result in its blockage, resulting in the accumulation of bile. It may lead to serious infection (cholangitis), liver destruction and jaundice.
  • Peritonitis: When the gallbladder is highly infected and bursts, then the bile and bacteria enter the cavity of the abdomen and cause a diffuse and life-threatening infection of the abdominal lining, which is called peritonitis.

Bile duct

Bile ducts consist of a collection of fine tubes that move bile, a digestive fluid that is generated by the liver, into the gallbladder to store and the small intestine to digest. The common bile duct (the main one) is constituted of smaller ducts connecting the gallbladder and liver together. A bile duct system can help one digest healthily and get rid of waste products in the body. Problems usually occur in cases where the ducts may be blocked either due to gallstones, tumours or inflammation.

Signs of Problems with Bile Ducts

  • Jaundice: Hypoxia is often manifested by yellowing of the skin and eyes. When there is some trouble with the outflow of bile, it creates a substance known as bilirubin in the tissues and the blood.
  • Severe Abdominal Pain: Sudden pain in the upper right area of the belly is a usual symptom, which causes severe, steady pain in the belly, and it may spread to the back or the shoulder. It is mostly caused by a blockage, which results in this pain.
  • Dark urine and Pale stools: Excess of bilirubin in the blood leads to the darkening of urine to a dark brown or tea colour. On the other hand, the inadequacy of bilirubin in reaching the intestines leads to pale, clay-colored stools.
  • Chills and Fever: A combined attack of elevated temperature and chills with obstruction of the bile duct is an extreme indicator of bacterial infection in the bile duct and referred to as cholangitis.

Consequences of Uncontrolled Bile Duct Problems

  • Cholangitis: This refers to a serious and fast infection of the ducts. A blocked biliary duct creates the ideal background for the growth of the bacteria, resulting in fever, pain, and septic shock that may be life-threatening.
  • Liver Damage: Excessive pressure on the bile duct over a long period may cause stagnation of the bile in the liver, provoking inflammation, cirrhosis of the liver, and finally, permanent liver failure.
  • Pancreatitis: A gallstone that obstructs the common bile duct where it enters the pancreatic duct may cause biliary stasis and result in pancreatic inflammation that induces painful and deadly pancreatitis.
  • Biliary Cirrhosis: Chronic, untreated blockage may result in biliary cirrhosis, which is a liver disease that slowly kills the bile ducts of the liver.

Liver

The liver is the largest internal organ and is situated in the upper right quadrant of the abdomen. It has more than 500 essential functions, such as detoxification of blood, the synthesis of proteins needed to clot the blood, and the processing of fats and carbohydrates. Bile is another fluid produced by the liver, and this fluid is required in digestion. It is very resilient due to its regenerative capabilities, with chronic damage being permanently irrecoverable as scarring occurs and functional loss ensues.

Signs of Liver Problems

  • Jaundice: The yellowing of the skin and the eyes is a characteristic of liver disease. It comes into action when the liver is unable to process the bilirubin, a waste product, leading to deposits that increase in the blood.
  • Abdominal Bloating: Bloating in the abdomen is called ascites, which is further caused by fluid accumulation. It is a typical indicator of severe liver ailment since the liver is no longer able to generate sufficient amounts of a substance, known as albumin, in order to maintain liquid within the blood streams.
  • Fatigue and Weakness: Chronic and unexplained fatigue is a very common symptom. A liver that is not functioning properly cannot properly turn nutrients into energy, and one ends up having a deep feeling of fatigue.
  • Simple Bruising or Bleeding: Clotting factors are the proteins which are produced by the liver and are necessary for blood clotting. The liver is unable to make these proteins in adequate amounts when it is impaired, resulting in easy bruising and extended bleeding.

Outcomes of Liver Problems

  • Cirrhosis: This is irreversible damage to the liver. The healthy tissue is replaced by scar tissue, which clogs the blood flow and makes the liver poorly functional. Liver failure is often caused by cirrhosis.
  • Liver Failure: A liver with extreme damage is no longer able to perform its important functions. This causes the accumulation of toxins in the blood, a lack of ability to form vital proteins, and it is lethal unless a liver transplant is carried out.
  • Portal Hypertension and Varices: Cirrhosis may obstruct the blood circulation through the liver and, as a result, the blood inches back into the portal vein (portal hypertension). This causes blood to push through smaller vessels that may enlarge and rupture (varices), causing dreadful, life-threatening bleeding.
  • Hepatic Encephalopathy: When the liver stops filtering blood toxins, they end up in the brain, resulting in symptoms such as confusion, disorientation, slurred speech and coma in worst cases.