Acute vs. chronic diarrhea.
Diarrhea can be acute, which is defined as the abrupt onset of three or more loose stools per day; it may also be chronic, lasting longer than 14 days. Chronic diarrhea often has different causes than acute diarrhea, and may be managed differently.
Diagnosing the cause of diarrhea.
When evaluating diarrhea, your physician will want to know the characteristics of your stool, which include the consistency, color, and frequency. It is important to note the presence or absence of other symptoms that include nausea, vomiting, fever or abdominal pain.
Ingestion of raw or contaminated foods may be the cause of your diarrhea, and in children, certain pathogens are routinely transmitted in daycare centers. Other important clues to the etiology of your diarrhea may be exposure to contaminated water or food encountered while traveling or camping. Recent hospitalization, the use of antibiotics, or the presence of conditions that have compromised your immune system are all important parts of your history that will guide you doctor as he determines the cause of your diarrhea.
Dehydration caused by diarrhea.
If you have diarrhea, you may be dehydrated. If it has gone on for a while, your dehydration can be severe enough to cause lethargy, depressed consciousness, dry mucous membranes, and poor perfusion of your tissues with oxygen carrying blood.
Symptoms associated with diarrhea.
Your doctor will look for abdominal tenderness or unusual bowel sounds. In young children or infants, failure to thrive may occur as a result of diarrhea, and the infant may have a sunken fontanel, reduced muscle and fat mass, and poor skin turgor, or elasticity.
Tests for diarrhea.
Some studies your doctor may order include stool samples which will look for parasites or their eggs, a white blood cell count which is important to consider in the diagnosis of an infectious diarrhea, and cultures for Salmonella, Shigella and Campylobacter, which are common pathogens that cause diarrhea. If you are recently hospitalized or have had a recent antibiotic course, your doctor will look for Clostridium difficile, which is a common cause of diarrhea under those conditions. Studies may include special tests for rotavirus or adenovirus antigens.
Treatment of diarrhea.
Acute onset diarrhea usually resolves by itself, but if it is due to an infectious process, it may have a long course. Often, the best therapy is oral rehydration.
Depending upon the cause, your physician may prescribe agents that work against parasites, or antibiotics that work against specific pathogens. Children may be candidates for vaccines that will immunize them against certain common pathogens. Infants require close follow up to ensure that they remain adequately hydrated.
Treatment for Constipation
The most common digestive complaint in the United States, constipation is a symptom and not a disease. Constipation is diagnosed when a patient has had at least 2 of the following symptoms over 3 months:
-Lumpy or hard stools
-Fewer than 3 bowel movements per week
– A feeling of obstruction in the anal or rectal area
– A feeling of incomplete emptying after having a bowel movement
-The use of fingers to extract stool
Constipation may not cause any symptoms, but patients with constipation often feel a sensation of abdominal bloating or low back pain. There may be pain when having a bowel movement, or bleeding from the rectum. Signs for concern include rectal bleeding, the inability to pass gas, or vomiting, which suggest an obstruction of the colon. Abdominal pain suggests the possibility of irritable bowel syndrome with constipation. Physical signs of constipation may include hemorrhoids.
Your doctor will take a detailed history that will include your normal pattern of bowel movement, and how frequently the constipation differs from your normal pattern. He will be interested in how hard the stools are, and whether or not you have to strain to have a bowel movement. Your doctor will want to known exactly what happens when you try to have a bowel movement, and if you use any laxatives.
A list of all of your current medications and dietary changes will help your doctor determine if medication or a change in diet is responsible for your symptoms. Patients on opioid medications often have constipation as a result. A diet low in fiber, or decreased fluid intake, can also cause constipation. There is a link between coffee consumption and constipation, and milk products may also cause constipation.
Expert Doctors for Constipation.
The duration of the constipation is important, as new onset in patients who are over 50 years old may suggest a tumor or other obstruction. Patients in the hospital may have decreased motility of the bowel due to an ileus.
There are some neurologic and endocrine problems, including diabetes or hypothyroidism, which may cause constipation. Central nervous system diseases, including Parkinson disease or stroke, may cause constipation. Constipation may have a psychological component, and is frequently observed in patients with a history of sexual abuse.
Initial treatment for constipation may include an enema or disimpaction may be require in patients with impaction of stool in the anorectal canal. Dietary changes and exercise should be the focus of medical treatment, rather than laxatives, enemas, or suppositories. Chronic laxative use can lead to poor motility in the colon over time, with a dependence upon laxatives. Increasing fiber and fluid in the diet, while decreasing the intake of those things that may increase constipation, such as milk products, coffee, tea and alcohol, is the key component of treatment.
Medications for treatment of constipation include fiber supplements, stool softeners, lubricants like mineral oil, stimulant laxatives that include senna, and a class of medications known as prokinetics, which include tegaserod. There are some newer therapies for constipation, which may be recommended by your doctor, including prucalopride, which stimulates bowel motility, and lubiprostone, which is an osmotic agent and pulls water into the colon.
There are two major types of inflammatory bowel disease, ulcerative colitis and Crohn’s disease. Ulcerative colitis involves the large intestine. The rectum is usually involved. The exact causes are not well understood, but patients with ulcerative colitis have several immunologic changes, including production of antibodies that attack the colon. Some potential causes of ulcerative colitis include genetic factors, immune system reactions, and use of nonsteroidal anti-inflammatory drugs, environmental factors, psychological stressors, a history of smoking, and the consumption of milk products.
The top ulcerative colitis doctors in Connecticut.
If you have ulcerative colitis, you may be experiencing rectal bleeding, frequent bowel movements, difficulty holding bowel movements, mucous from the rectum, and lower abdominal pain, sometimes with dehydration. Ulcerative colitis has a gradual onset.
When you are experiencing a particularly bad episode, you may have severe cramping and diarrhea, fever and a high white blood cell count, with a distended abdomen.
Conditions associated with ulcerative colitis include ankylosing spondylitis, pyoderma gangrenosum, pleuritis, and uveitis, primary sclerosing cholangitis, multiple sclerosis, and immune diseases of the skin that produce bullae.
Diagnosis of Ulcerative colitis.
Diagnostic tests include laboratory studies to exclude other diagnoses, and to assess the patient’s nutritional status. Patients with ulcerative colitis may have severe anemia or elevated platelet counts. They may have low albumin, a sign of poor nutritional status; low potassium and low magnesium levels are not uncommon. Signs of inflammation are commonly seen. Examination of the stool is used to exclude other causes for the symptoms.
Endoscopy and biopsy of the colon is the primary diagnostic modality. Endoscopy will show uniform inflammation throughout the colon, and abnormally red mucosa, which may or may not have ulceration. The abnormal mucosa is seen extending from the rectum to all or part of the colon. There may be bleeding with contact, and mucus is seen in the lumen, or interior, of the bowel. Biopsy is done to determine the extent of the disease into the bowel wall. Plain x-rays of the abdomen may show dilatation of the colon, evidence of perforation, obstruction, or ileus. Double contrast barium enemas may be used to diagnose ulcerative colitis initially. It will reveal the fine details of the mucosa of the intestine.
Treatment of Ulcerative colitis.
Treatment of ulcerative colitis initially includes steroids and anti-inflammatory agents like sulfasalazine. Patients are often treated with anti-diarrheal medications and rehydration.
Surgery may be considered if medical treatment fails, and the options include a total colectomy and ileostomy, total colectomy, and ileoanal pouch reconstruction, or an ileorectal anastomosis, which involves removing a large part of the colon, and joining the ileum of the small intestine to the rectum.
Ulcerative colitis is a lifelong illness that has a significant impact on the emotions and the social interactions of patients. Developing a close relationship with your physician will often provide the medical and psychological support you require if you are diagnosed with ulcerative colitis.
If you suffer from ulcerative colitis call the expert physicians at Norwich GI today.
Screening for colon cancer.
Colorectal cancer is not only the second leading cause of cancer deaths in the United States, but it is also the third most commonly diagnosed cancer in the US. Colon cancer screening is done because evidence has shown that it prevents significant morbidity and mortality.
The American Gastroenterological Association developed new guidelines in 2008 and 2012 using a grading system for recommendations for assessment, development, and evaluation. Guidelines are based upon risk factors, including family history, and are based upon evidence that lives are saved because of screening.
The recommended screening strategies for colorectal cancer include tests based on the study of stool, which include the guaiac based fecal occult blood test and the immunochemical based fecal occult blood test. The other important strategy is based upon structural examination of the rectum and the colon, using flexible sigmoidoscopy and colonoscopy, which are both able to detect cancer and lesions that may be pre-malignant.
The methods of screening vary by age group. For patients between the ages of thirty and forty-nine, a review of family history is suggested to identify individuals who are at a higher risk of inherited syndromes.
In patients aged fifty through seventy-five years of age, routine screening that is recommended for those individuals who have no history of adenomas, colorectal cancer, or inflammatory bowel disease, and those with a negative family history. If a patient has one first-degree relative with colorectal cancer or adenoma diagnosed after the age of 60, they are considered to be at average risk and will fall under these guidelines, which include a high sensitivity stool test.
The other option in this group is to have flexible sigmoidoscopy every 5 years with a high sensitivity stool test every 3 years. Colonoscopy is another screening method which may be provided as an alternative by providers who prefer this approach to screening, but patients should be informed of the risk of the procedure as compared to annual tests of the stool.
Patients aged seventy-six through eighty-four may have continued screening, but for those ages 85 and older, screening is not recommended.
Polyps are growths that arise from the lining of the large intestine, or colon, and protrude into the lumen, or interior portion, of the colon. They are common and occur in almost 50% of people who are over the age of 60. Only six percent of these patients with polyps develop colon cancer. Polyps are removed during colonoscopy, and they are examined under a microscope which will determine if the polyp is hyperplastic or adenomatous. Adenomatous polyps, or adenomas, are usually benign but may be a precursor to colorectal cancer.
Patients with rectal or sigmoid polyps appear to be a low risk group, so if the most advanced lesions at the baseline colonoscopy are distal hyperplastic polyps less than ten millimeters, colonoscopy follow-up should be at five to ten year intervals.
Patients who are found to have tubular adenomas at baseline colonoscopy are considered low risk if they have one to two adenomas that are less than 10 mm in diameter.
High-risk adenomas are defined as tubular adenomas greater than or equal to ten mm in diameter, with patients considered high risk if they have 3 or more adenomas, adenomas with microscopic findings that have pre-cancerous signs or are dysplastic in nature. Patients with high-risk adenomas or polyps, especially those that are in the proximal portion of the colon, are at greater risk for development of colorectal cancer in the intervals between colonoscopy, and the screening recommendations for these patients reflect that risk.
Experts in colon cancer screening, Norwich CT.
A discussion with your physician after a baseline screening will help you understand your choices and the frequency at which screening by stool test, flexible sigmoidoscopy, or colonoscopy are recommended.
A common digestive disorder, gastroesophageal reflux disease affects the lower esophageal sphincter, which is the muscle between the esophagus and the stomach. Gastroesophageal reflux disease may be related to hiatal hernia, which refers to the stomach herniating through the diaphragm. While some people with hiatal hernia may have GERD, it occurs in many people who do not have hiatal hernia.
Experts in GERD, Norwich GI.
Reflux refers to the return of contents from the stomach into the esophagus. The esophagus is muscular and the muscles of the esophagus pump food towards the stomach through a movement called peristalsis. Normally, the lower esophageal sphincter opens to allow food to pass into the esophagus, and it closes to prevent the acidic stomach juices from flowing back into the esophagus. When the lower esophageal sphincter relaxes inappropriately, gastric juice and stomach contents reflux into the esophagus, damaging the esophageal mucosa. Other causes of GERD may be poor movement of food through the esophagus, which delays clearance of acidic material. Delay of gastric emptying can increase the volume and pressure in the stomach, which will put increased pressure on the lower esophageal sphincter, also resulting in reflux. It is important for your doctor to identify which of these problems may be causing the patient’s GERD.
Symptoms of gastroesophageal reflux disease include regurgitation of stomach contents with a “water brash” taste, heartburn, and dysphagia. Reflux may also cause atypical symptoms, which are extraesophageal, which include coughing and wheezing, hoarseness, sore throat, noncardiac chest pain, and enamel erosion on the teeth.
Diagnosis is made by an initial contrast-enhanced radiographic study of the upper GI tract. This establishes whether or not the patient has a hiatal hernia. The condition is then confirmed by upper gastrointestinal endoscopy/esophagogastroduedenoscopy and manometry. During manometry, a tube is passed down the back of the throat, through the nose. It is passed down the esophagus and into the stomach. This tube measures the movement of the esophagus, and also allows the physician to examine the lower esophageal sphincter.
If you have gastroesophageal reflux disease, your treatment will be directed at controlling the symptoms, healing esophagitis, and preventing recurrent esophagitis or other complications.
Lifestyle modifications recommended by your doctor include avoiding foods that relax the lower esophageal sphincter, which may be alcohol, chocolate, citrus juices, tomato-based product, peppermint, coffee, and, sometimes, onions. Your doctor will recommend that you eat frequent small meals instead of large meals, and weight loss if you are overweight.
Since a weak lower esophageal sphincter allows food and gastric acid to reflux back into the esophagus, it is recommended that patients with GERD elevate the head of the bed 8 inches, and avoidance of positions which include bending or stooping. You will be advised to wait 3 hours after a meal to lie down, and to refrain from eating within 3 hours of bedtime.
In addition to lifestyle modifications, your doctor will prescribe one of several types of medications that are used to manage gastroesophageal reflux disease. These include medications known as H2 receptor antagonists, which are a special type of anti-histamines. These include cimetidine and ranitidine. Proton pump inhibitors, like omeprazole and lansoprazole, are typically used to inhibit the production of acid in the stomach, and have been shown to work well with gastroesophageal reflux disease. Antacids are among the medications that may be suggested by your doctor.
Treatment for GERD at Norwich GI, Connecticut.
Finally, if these methods are unsuccessful, fundoplication is a surgery that is recommended, or surgeons can place a device to augment the action of the lower esophageal sphincter. Indications for surgery include continued symptoms that are not controlled by proton pump inhibitors, or patients who want a definitive, one-time treatment. The presence of changes in the esophageal mucosa, known as Barrett esophagus, or the presence of extraesophageal manifestations are other indications for surgery. Young patients or patients with poor medication compliance, post-menopausal women with osteoporosis and patients with cardiac conduction defects may benefit from surgery.
Whether your doctor recommends a colonoscopy because you are having signs of bleeding from the large intestine, or colon, or because it is time for colon cancer screening, the procedure is the same. A colonoscope is a thin and flexible tube between 48 inches to 72 inches long, with a small video camera attached, allowing the doctor to take pictures or video of the entire colon and the lower part of the small intestine. This test is used to help find ulcers, tumors, areas of inflammation or bleeding, or colon polyps.
Experts in colonoscopy, Norwich CT GI
While performing colonoscopy, your doctor will be able to take tissue samples, or biopsies, which will be examined under a microscope by a pathologist for signs of abnormal tissue architecture or cell architecture. If you have growths in the colon, called polyps, they can be removed and microscopically examined.
Before you have a colonoscopy, you will be given a “colon prep” to clean out the colon. The liquid you drink for the colon prep will cause loose stools and diarrhea, as it is used to empty your colon so the doctor can see the interior, or lumen, of the intestine. You will also be on a liquid diet for about a day before your colonoscopy.
When you have your colonoscopy, you will be sedated and will not have any discomfort. You will not remember the colonoscopy after the test. Your doctor, however, will come in to inform you of the results of the test, and will probably show you some pictures that were taken during the test. If there were biopsy samples taken, your doctor will follow up with you and let you know the results within a few days.
The doctors at Norwich GI have extensive experience with colonoscopies.
Depending upon your age and your risk factors, you may have screening colonoscopies recommended every three, five or ten years. Your doctor will follow guidelines that are based upon evidence that has shown that there is a benefit in terms of mortality and morbidity, or prevention of death and disease, by having a colonoscopy performed.