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Gastroenterology

Gastroenterology (or Gastrology) is the medical specialty involved with diseases of the digestive system which includes the stomach, esophagus, liver, small intestine and large intestine (colon), gallbladder, and pancreas.


A Gastroenterologist is a specialist whose first training is in Internal Medicine and later in diagnosing and treating illnesses of the digestive system. Normally, a Gastroenterologist is summoned in cases of rectal bleeding, abdominal pain, or change in bowel habits when the diagnosis is vague or where specific diagnostic procedures are required.



A Gastroenterologist deals with an extensive range of conditions, including, but not limited to:

• Abdominal Pain
• Colon Cancer
• Constipation
• Crohn's Disease
• Diarrhea
• Esophageal Reflux
• Gastritis
• Heartburn
• Hemorrhoids
• Hepatitis
• Hiatal Hernia
• Indigestion
• Irritable Bowel Syndrome
• Jaundice
• Liver Disease
• Nausea Diarrhea
• Post-Operative Colon Tests
• Rectal Bleeding
• Spastic Colon
• Ulcers
• Ulcerative Colitis
• Unexplained Weight Loss
• Vomiting
  

The oncologist regularly directs the multidisciplinary treatment of cancer patients, which may entail counseling, physiotherapy, and clinical genetics. On the other hand, the oncologist often has to communicate with pathologists on the precise biological nature of the tumor that is being treated.

COLON CANCER

Colon cancer (also known as Colorectal cancer or bowel cancer) pertains to cancerous tumors in the colon, rectum and appendix. Colon cancer is the third most common kind of cancer and the second primary cause of death among cancers in the Western world. Numerous colorectal cancers are believed to start from adenomatous polyps in the colon. These mushroom-like growths are usually benign, but some may grow into cancer over time. Most of the time, the identification of localized colon cancer is through colonoscopy. Therapy is regularly through surgery, which in many cases is followed by chemotherapy.

CAUSES
Healthy cells develop and divide in a systematic way to keep the body running normally. But now and again this growth gets out of control—cells go on dividing even when new cells aren't required. In the colon and rectum, this inflated growth may produce precancerous polyps (adenomas, or adenomatous polyps) to materialize in the lining of the intestine. Over a long period of time, some of these polyps may turn cancerous. In later periods of the disease, cancerous polyps may pierce the colon walls and metastasize to neighboring lymph nodes and other organs. There are also several different kinds of colon polyps: adenomas, hyperplastic polyps, and inflammatory polyps.

DIAGNOSIS & SYMPTOMS
Diagnosis entails screening to identify colorectal cancer in patients without symptoms and with no family history of colon cancer. Screening is proposed starting at age 50 and includes digital rectal examination (DRE) and fecal occult blood test annually, double-contrast barium enema every 5–10 years, flexible sigmoidoscopy every 5 years and total colonoscopy every 10 years. 

Diagnosis in symptomatic patients and high-risk patients consists of laboratory and imaging tests. Biopsy is essential to validate the diagnosis.

A doctor must be consulted by if one develops any of the following signs and symptoms:

• A change in the bowel habits--diarrhea or constipation or a change in the texture of your stool for more than a couple of weeks
• Rectal bleeding or blood in the stool
• Narrow stools
• Abdominal pain with a bowel movement
• Constant abdominal discomfort, such as cramps, gas or pain
• Unexplained weight loss
• A feeling that the bowel doesn't empty completely

TESTS & TREATMENT

Test
Screening is really vital for detecting polyps before they become cancerous. It can also help to spot colorectal cancer in its beginning stages when you have a good likelihood for recovery. Common screening and diagnostic measures include the following:

• Digital rectal exam—The doctor uses a gloved finger to check the first few inches of the rectum for large polyps and cancers.
• Fecal occult (hidden) blood test—A sample of then stool is checked for blood.
• Flexible sigmoidoscopy—A flexible, slim, and lighted tube is used to observe the rectum and sigmoid — about the last 2 feet of the colon.
• Barium enema—Allows the doctor to assess the entire large intestine with an X-ray.

Colonoscopy—The most sensitive test for colon cancer, rectal cancer and polyps. It is similar to flexible sigmoidoscopy, but the device used—a colonoscope, which is a long, flexible and slim tube affixed to a video camera and monitor—lets the doctor view the full colon and rectum.

Treatment
Surgery--Surgeries can be classified into palliative, curative, bypass, fecal diversion or open-and-close.

Chemotherapy--Chemotherapy is used to ease the likelihood of metastasis developing, shrink tumor size, or slow tumor growth.

Monoclonal antibody therapy--The Food and Drug Administration approved two drugs from a new set of medications that deal with colon cancer and rectal cancer by holding back the action of the cancer cells' growth factor. The drugs bevacizumab (Avastin) and cetuximab (Erbitux) are allowed for use in people with colon cancer that has spread (metastatic cancer).

COMPLICATIONS
Some possible complications of both colonoscopy and virtual colonoscopy procedures:

• Perforation
• Bleeding
• Postpolypectomy coagulation syndrome
• Splenic Rupture
• Infection
• Abdominal swelling
• Recurrence of carcinoma within the colon
• Development of a second primary colorectal cancer
• Small bowel obstruction   
• Cancer spreading to other organs or tissues (metastasis)

PREVENTIONS
Protection from colon cancer can start with a few simple changes in the diet and lifestyle:

• Eat lots of vegetables, fruits, and whole grains.
• Get plenty of vitamins and minerals. Calcium, pyridoxine (vitamin B-6), magnesium, and vitamin B-9 may help lessen the risk of colorectal cancer.
• Regulate alcohol consumption.
• Limit fat, especially saturated fat from red meat.
• Stop smoking.
• Stay physically active and maintain a healthy body weight.

INCIDENCE & STATISTICS
Apart from skin cancers, colorectal cancer is the third most widespread cancer diagnosed in men and in women in the U.S. The American Cancer Society approximates that about 106,680 new cases of colon cancer (49,220 men and 57,460 women) and 41,930 new cases of rectal cancer (23,580 men and 18,350 women) will be diagnosed in 2006.  Colorectal cancer is the second leading cause of cancer-related deaths in the United States and is projected to cause about 55,170 deaths (27,870 men and 27,300 women) during 2006.

APPENDICITIS

Appendicitis (also called epityphlitis) is a condition typified by inflammation of the appendix. Though mild cases may work out without treatment, most call for removal of the swollen appendix, either by laparotomy or laparoscopy. If not treated, mortality is high, largely due to shock and peritonitis.

CAUSES
It is not clear in all cases why appendicitis happens. Every so often it is the result of an obstacle when food waste or a hard bit of stool (fecal stone) becomes trapped in an opening of the cavity that runs the span of the appendix.

Appendicitis may also crop up after an infection, such as a gastrointestinal viral infection, or it may stem from other forms of inflammation. In both cases, bacteria may consequently attack rapidly, triggering the appendix to become inflamed and filled with pus. If not treated quickly, your appendix ultimately may rupture.

DIAGNOSIS & SYMPTOMS

Diagnosis
The diagnosis starts with a methodical history and physical examination. Patients frequently have an elevated temperature, and there typically will be average to severe tenderness in the right lower abdomen when the doctor presses on there. If inflammation has reached the peritoneum, the tenderness usually returns. This means that when the doctor presses on the abdomen and then swiftly releases his hand, the pain becomes rapidly worse.

Other ways to diagnose appendicitis: 

• White blood cell count test in the blood which usually becomes elevated with infection in someone with appendicitis.
• Urinalysis
• Abdominal x-ray
• Ultrasound
• Barium Enema
• CT Scan
• Laparoscopy

Symptoms
The most frequent early symptom is a throbbing pain around the navel that often moves later to the lower right abdomen. As the inflammation in the appendix extends to nearby tissues, particularly in the inner lining (peritoneum) of the abdomen, the pain may become sharper.

Aside from pain, a person with appendicitis may have one or more of the following symptoms:

• Abdominal swelling
• Constipation
• Diarrhea
• Failure to pass gas
• Loss of appetite
• Low-grade fever that begins after other signs and symptoms emerge
• Nausea and every so often, vomiting

TESTS & TREATMENT

Test

• Urinalysis—A microscopic examination of the urine that identifies red blood cells, white blood cells and bacteria in the urine.
  
• Abdominal X-Ray—This may detect the fecalith (the hardened and calcified, pea-sized piece of stool that blocks the appendiceal opening) that may be the cause of appendicitis. This is markedly true in children.
• ltrasound--A painless process that uses sound waves to spot organs within the body. It can also identify an inflamed appendix.
• Barium Enema—An x-ray test where liquid barium is introduced into the colon from the anus to fill up the colon. This test can, at times, show a mark on the colon in the section of the appendix where the swelling from the nearby inflammation intrudes on the colon.
• CT Scan--In patients who are not pregnant, a CT scan of the section of the appendix is helpful in diagnosing appendicitis
• Laparoscopy--A surgical procedure wherein a small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall. Laparoscopy permits a direct view of the appendix as well as other abdominal and pelvic organs.
  
  

Treatment
Appendectomy is a surgical procedure where the appendix is removed. The operation can be done via a laparoscopic method, or through small incisions with a camera to picture the area of concern in the abdomen. If the results show suppurative appendicitis with complications such as abscess, rupture, adhesions, etc., a switch to open laparotomy may be needed.

Antibiotics are administered intravenously to help destroy left over bacteria and thus decrease the occurrence of infectious complication in the abdomen or wound.

COMPLICATIONS

• Perforation of the appendix—This can lead to a periappendiceal abscess (a set of infected pus) or diffuse peritonitis (infection of the whole lining of the abdomen and the pelvis). The major cause for appendiceal perforation is postponement in diagnosis and treatment.
• Blockage of the intestine--This occurs when the inflammation enclosing the appendix sets off the intestinal muscle to stop functioning, and this stops the intestinal contents from passing. If the intestine above the blockage starts to fill with liquid and gas, the abdomen bloats and nausea and vomiting may occur. It may be essential to drain the contents of the intestine through a tube passed through the nose and esophagus and into the stomach and intestine.
• Sepsis--A state in which the contaminating bacteria go into the blood and pass through other parts of the body. This rarely occurs.

PREVENTIONS
Appendicitis is probably not preventable, though there is some sign that a diet high in fiber (green vegetables and tomatoes) may assist in preventing appendicitis. Breast-feeding also seems to cut the risk of a child later getting appendicitis.

INCIDENCE & STATISTICS

• Appendicitis occurs in 7% of the U.S. population, with a rate of 1.1 cases per 1000 people per year.

• Globally, incidence of appendicitis is lower in cultures with a higher intake of fiber in their diet. Fiber is thought to reduce the thickness of feces, lessen bowel transit time, and deter formation of fecaliths, which inclines individuals to obstructions of the appendiceal lumen.
• The incidence of appendicitis is approximately 1.4 times bigger in men than in women. The occurrence of primary appendectomy is just about equal in both sexes. Appendicitis slowly rises from birth and peaks in the late teen years.