Intestinal Diseases

Overview

Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.

Ulcerative colitis can be debilitating and can sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and bring about long-term remission.

Symptoms

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:

• Diarrhea, often with blood or pus
• Abdominal pain and cramping
• Rectal pain
• Rectal bleeding — passing small amount of blood with stool
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever
• In children, failure to grow

Most people with ulcerative colitis have mild to moderate symptoms. The course of ulcerative colitis may vary, with some people having long periods of remission.

Types

Doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis include:

• Ulcerative proctitis.
  Inflammation is confined to the area closest to the anus (rectum), and rectal bleeding may be the only sign of the disease.
• Proctosigmoiditis.
  Inflammation involves the rectum and sigmoid colon — the lower end of the colon. Signs and symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus).
• Left-sided colitis.
  Inflammation extends from the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and urgency to defecate.
• Pancolitis.
  This type often affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.

When to see a doctor

See your doctor if you experience a persistent change in your bowel habits or if you have signs and symptoms such as:

• Abdominal pain
• Blood in your stool
• Ongoing diarrhea that doesn’t respond to over-the-counter medications
• Diarrhea that awakens you from sleep
• An unexplained fever lasting more than a day or two

Although ulcerative colitis usually isn’t fatal, it’s a serious disease that, in some cases, may cause life-threatening complications.

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Crohn’s disorder is a form of the inflammatory intestinal disease (IBD). It induces inflammation of the digestive tract, which can result in abdominal pain, severe diarrhea, fatigue, losing weight, and malnourishment. Inflammation triggered by Crohn’s disease may involve various locations of the digestive tract in different individuals. This inflammation frequently spreads to the different levels of the intestines. Crohn’s disease can be either painful and harmful and sometimes it can lead to serious health problems.

There is effectively no cure for Crohn’s disease, and there is no singular cure that works for everybody. One objective of medical therapy is to remove the inflammation that causes clinical symptoms. Another objective is to improve long-term diagnosis by limiting health problems. In the best-case scenarios, this may contribute not only to symptom relaxation but also to long-term cure. Anti-inflammatory drugs are often the first step in the treatment of inflammatory diseases.

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Criteria that affect the digestive process or cause severe pain in the abdomen are often interpreted and described as digestive issues, although the stomach may not always be affected. Most abdomen problems are related to the digestive system, although disorders may also be due to body wall situations, blood vessels, urinary tract, reproductive cells, or chest organs. When discomfort is visible, stomach difficulties may be caused by organs near the discomfort site, such as the belly or gall bladder in the abdominal area, or by an appendix in the lower abdomen. General difficulties with the stomach may be correlated with diet, infection, or swelling.

Troubles particular to the stomach and upper digestive system include belching, heartburn, gastroesophageal reflux illness (GERD), hiatal hernia

(weakened area of the abdomen that enables the stomach to protrude into the chest), gastritis, or ulcerative ulcers. Our professional will guide you to the best possible treatment as per your condition.

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Overview

Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.

Constipation is generally described as having fewer than three bowel movements a week.

Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause people to strain excessively in order to have a bowel movement.

Treatment for chronic constipation depends in part on the underlying cause. However, in some cases, a cause is never found.

When to see a doctor

Make an appointment with your doctor if you experience unexplained and persistent changes in your bowel habits.

Symptoms

Signs and symptoms of chronic constipation include:

• Passing fewer than three stools a week
• Having lumpy or hard stools
• Straining to have bowel movements
• Feeling as though there’s a blockage in your rectum that prevents bowel movements
• Feeling as though you can’t completely empty the stool from your rectum
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Chronic constipation has many possible causes.

Blockages in the colon or rectum

Blockages in the colon or rectum may slow or stop stool movement. Causes include:

• Tiny tears in the skin around the anus (anal fissure)
• A blockage in the intestines (bowel obstruction)
• Colon cancer
• Narrowing of the colon (bowel stricture)
• Other abdominal cancer that presses on the colon
• Rectal cancer
• Rectum bulge through the back wall of the vagina (rectocele)

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:

• Damage to the nerves that control bodily functions (autonomic neuropathy)
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injury
• Stroke

Difficulty with the muscles involved in elimination

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

• The inability to relax the pelvic muscles to allow for a bowel movement (anismus)
• Pelvic muscles that don’t coordinate relaxation and contraction correctly (dyssynergia)
• Weakened pelvic muscles

Conditions that affect hormones in the body

Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:

• Diabetes
• Overactive parathyroid gland (hyperparathyroidism)
• Pregnancy
• Underactive thyroid (hypothyroidism)

Risk factors

Factors that may increase your risk of chronic constipation include:

• Being an older adult
• Being a woman
• Being dehydrated
• Eating a diet that’s low in fiber
• Getting little or no physical activity
• Taking certain medications, including sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure
• Having a mental health condition such as depression or an eating disorder

Complications

• Swollen veins in your anus (hemorrhoids).
  Straining to have a bowel movement may cause swelling in the veins in and around your anus.
• Torn skin in your anus (anal fissure).
  A large or hard stool can cause tiny tears in the anus.
• Stool that can’t be expelled (fecal impaction).
  Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
• Intestine that protrudes from the anus (rectal prolapse).
  Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.

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Overview

Diarrhea — loose, watery and possibly more-frequent bowel movements — is a common problem.

Luckily, diarrhea is usually short-lived, lasting no more than a few days. But, when diarrhea lasts for weeks, it usually indicates that’s there’s another problem. If you have diarrhea for weeks or longer, you may have a condition such as irritable bowel disorder, or a more serious disorder, such as a persistent infection or inflammatory bowel disease.

Symptoms

Signs and symptoms associated with diarrhea may include:

• Loose, watery stools
• Abdominal cramps
• Abdominal pain
• Fever
• Blood in the stool
• Mucus in the stool
• Bloating
• Nausea
• Urgent need to have a bowel movement

When to see a doctor

If you’re an adult, see your doctor if:

• Your diarrhea persists beyond a few days
• You become dehydrated
• You have severe abdominal or rectal pain
• You have bloody or black stools
• You have a fever above 102 F (39 C)

In children, particularly young children, diarrhea can quickly lead to dehydration. Call your doctor if your child’s diarrhea doesn’t improve within 24 hours or if your baby:

• Becomes dehydrated
• Has a fever above 102 F (39 C)
• Has bloody or black stools

Causes

A number of diseases and conditions can cause diarrhea, including

• Viruses.
  Viruses that can cause diarrhea include Norwalk virus, cytomegalovirus and viral hepatitis. Rotavirus is a common cause of acute childhood diarrhea. The virus that causes coronavirus disease 2019 (COVID-19) has also been associated with gastrointestinal symptoms, including nausea, vomiting and diarrhea.
• Bacteria and parasites.
  Contaminated food or water can transmit bacteria and parasites to your body. When traveling in developing countries, diarrhea caused by bacteria and parasites is often called traveler’s diarrhea. Clostridium difficile is another type of bacteria that can cause serious infections that cause diarrhea, and it can occur after a course of antibiotics or during a hospitalization.
• Medications.
  Many medications, such as antibiotics, can cause diarrhea. Antibiotics destroy both good and bad bacteria, which can disturb the natural balance of bacteria in your intestines. Other drugs that cause diarrhea are cancer drugs and antacids with magnesium.
• Lactose intolerance.
  Lactose is a sugar found in milk and other dairy products. People who have difficulty digesting lactose have diarrhea after eating dairy products. Lactose intolerance can increase with age because levels of the enzyme that helps digest lactose drop after childhood.
• Fructose.
  Fructose is a sugar found naturally in fruits and honey. It’s sometimes added as a sweetener to certain beverages. In people who have trouble digesting fructose, it can lead to diarrhea.
• Artificial sweeteners.
  Sorbitol and mannitol — artificial sweeteners found in chewing gum and other sugar-free products — can cause diarrhea in some otherwise healthy people.
• Surgery.
  Abdominal or gallbladder removal surgeries can sometimes cause diarrhea.
• Other digestive disorders.
  Chronic diarrhea has a number of other causes, such as Crohn’s disease, ulcerative colitis, celiac disease, microscopic colitis and irritable bowel syndrome.

Complications

Diarrhea can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems.

If you have signs of serious dehydration, seek medical help.

Indications of dehydration in adults

These include:

• Excessive thirst
• Dry mouth or skin
• Little or no urination
• Weakness, dizziness or lightheadedness
• Fatigue
• Dark-colored urine

Indications of dehydration in infants and young children

These include:

• Not having a wet diaper in three or more hours
• Dry mouth and tongue
• Fever above 102 F (39 C)
• Crying without tears
• Drowsiness, unresponsiveness or irritability
• Sunken appearance to the abdomen, eyes or cheeks

Prevention

Preventing viral diarrhea

Wash your hands to prevent the spread of viral diarrhea. To ensure adequate hand-washing:

• Wash frequently.
  Wash your hands before and after preparing food. Wash your hands after handling uncooked meat, using the toilet, changing diapers, sneezing, coughing and blowing your nose.
• Lather with soap for at least 20 seconds.
  After putting soap on your hands, rub your hands together for at least 20 seconds. This is about as long as it takes to sing “Happy Birthday” twice through.
• Use hand sanitizer when washing isn’t possible.
  Use an alcohol-based hand sanitizer when you can’t get to a sink. Apply the hand sanitizer as you would hand lotion, making sure to cover the fronts and backs of both hands. Use a product that contains at least 60 percent alcohol.

Vaccination

You can help protect your infant from rotavirus, the most common cause of viral diarrhea in children, with one of two approved vaccines. Ask your baby’s doctor about having your baby vaccinated.

Preventing traveler’s diarrhea

Diarrhea commonly affects people who travel to countries where there’s inadequate sanitation and contaminated food. To reduce your risk:

• Watch what you eat.
  Eat hot, well-cooked foods. Avoid raw fruits and vegetables unless you can peel them yourself. Also avoid raw or undercooked meats and dairy foods.
• Watch what you drink.
  Drink bottled water, soda, beer or wine served in its original container. Avoid tap water and ice cubes. Use bottled water even for brushing your teeth. Keep your mouth closed while you shower.Beverages made with boiled water, such as coffee and tea, are probably safe. Remember that alcohol and caffeine can aggravate diarrhea and worsen dehydration.
• Ask your doctor about antibiotics.
  If you’re traveling to a developing country for an extended time, ask your doctor about antibiotics before you go, especially if you have a weakened immune system.
• Check for travel warnings.
  The Centers for Disease Control and Prevention maintains a travelers’ health website where disease warnings are posted for various countries. If you’re planning to travel outside of the United States, check there for warnings and tips for reducing your risk.

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Overview

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Abdominal involvement may occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera. Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases. Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important. We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.

How does abdominal TB occur?

Ingestion of the tuberculous germ by drinking unpasteurized milk of a cow infected with TB is one of the mechanisms of abdominal TB.

Abdominal TB can also occur by the spread of the TB bacillus from the lungs to the intestines by the bloodstream.

In 2/3 rd of children, there is predominant involvement of the digestive system. The involvement of the abdominal cavity (peritoneum) occurs in the remaining of the patients. The involvement of only the lymph glands in the abdomen is rare.

What are the signs and symptoms of abdominal TB?

The clinical feature of abdominal tuberculosis is varied. The most common symptoms are pain in the abdomen, loss of weight, anorexia, recurrent diarrhea, low-grade fever, cough, and distension of the abdomen.

The doctor on examination may feel a lump, fluid in the abdomen or a doughy feel of the abdomen. Also, there may be enlarged lymph glands elsewhere in the body.

How is the diagnosis of abdominal TB made?

Diagnosis can be confirmed by isolating the TB germ from the digestive system by either a biopsy or endoscopy. However, other supportive tests that may be done are the Mantoux test, Chest X-Ray, Abdominal X-Rays (with or without barium), and scans such as ultrasound and CT scan.

What are the complications of abdominal TB?

Untreated TB of the intestine may lead to intestinal obstruction, fistula or even abscess and perforation with resultant peritonitis.

What is the treatment of abdominal TB?

Abdominal TB needs to be treated with at least 3-4 anti TB drugs for the initial 2 months and subsequently 2 anti TB drugs for at least 7-10 months.

The commonly used drugs during the initial 2 months therapy (intensification phase) are Isoniazid (INH), Rifampicin, Ethambutol and Pyrazinamide. During the next 7-10 months (continuation phase) 2 the drugs commonly used are INH and Rifampicin.

When is surgery required for Abdominal TB?

Surgery is required whenever there is perforation, abscess or fistula formation.

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