A stressful event like speaking in public, going to a job interview can give you butterflies in your stomach that may literally make you want to run to the bathroom. Stress affects every aspect of our lives including digestion. This includes indigestion, heartburn and irritable bowel syndrome. When put in a stressful situation, the body releases hormones known as corticotropin-releasing hormone or CRH. This, in turn, signals the adrenal gland to pump out adrenaline and steroids that help with the body's flight or fight response. Here are a few ways stress affects the gastrointestinal system.Here are a few ways stress affects the gastrointestinal system.

Stress kills appetite: Stress eating is a real problem that results from the contradictory reactions of hormones. The hormones released by stress kill a person's appetite, but at the same time, the steroids released by these hormones make the person crave unhealthy foods like ice-cream, chocolate or potato chips. These foods aren't easy to digest and can cause indigestion, gas buildup and heart burn.
Stress leads to ulcers: Ulcers are caused by bacteria, but stress strengthens the infection and disturbs the balance of hydrochloric acid and protective secretions in the stomach. This increases the risk of ulcer formation in the stomach. Once the ulcers are present in the stomach, stress can worsen the symptoms.
Stress alters the gastrointestinal pathophysiology: Stress can cause changes in gastrointestinal secretions and reduce the amount of oxygen available to the digestive system. It also impairs gastroduodenal motility and amount of enzymes being secreted by the pancreas. Additionally, it interferes with the passage of food through the intestinal tract and alters colonic motility. Stress also affects the absorption of nutrients from the stomach and increases the blood flow to the digestive system by four times the normal amount thus decreasing metabolism rates.
Stress affects irritable bowel syndrome: Stress in itself does not cause irritable bowel syndrome but can worsen the situation. This is because stress can make the colon contract and cause abdominal pain. These contractions are usually uncoordinated and can lead to constipation. It also makes the body more sensitive to pain thus increasing discomfort.
Stress lowers immunity: A large part of the immune system is housed in the gut. Stress reduces the secretion of enzymes in the gut and leaves the digestive system vulnerable to bacterial infections. By weakening the immune system in the gut, stress also increases the risk of suffering from infections in other parts of the body.

Stress & Its Effects on Gastroenterology

During breathing activity, chest wall moves out & in, lungs expand & relax. For the smooth movement of the lungs inside the chest cavity, they are lined by pleura.

Pleura includes two thin linings, the layer lining lungs is called visceral pleura and the one lining chest wall is called parietal pleura. The cavity formed between these two layers is called Pleural cavity. It contains a small amount of lubricant called Pleural fluid which helps smooth sliding of two pleural surfaces. Any condition which results in inflammation of the pleural surfaces or accumulation of excessive fluid in the pleural cavity gives rise to symptoms attributable to pleural involvement or disease.

Pleural effusion is nothing but the collection of excess fluid in the pleural cavity. Excess fluid in the pleural space is not normal and can occur due to a variety of reasons. Depending on the chemical composition it is broadly divided into two categories, transudate and exudate. 


What Causes Pleural Effusion?

1. Transudate pleural effusions 

Transudate pleural effusion is formed when fluid leaks from blood vessels into the pleural space. Chemically, transudates contain less protein and LDH than exudates. It is generally seen in the following conditions.

Congestive heart failure

Liver failure or cirrhosis

Kidney failure or nephrotic syndrome

Peritoneal dialysis

2. Exudate pleural effusions 

Exudate pleural effusion is caused by inflammation of the pleura itself and are often due to diseases involving the lung. Following are some common illnesses giving rise to exudate pleural effusion.

Tuberculosis
Pneumonia
Lung or breast cancer
Lymphoma
Pulmonary embolism
Post chest wall trauma or surgery
Asbestosis and mesothelioma
Secondary to intra-abdominal pathology 
Pancreatic pseudocyst, etc
Symptoms of Pleural Effusion -

Chest Pain: Chest pain is mainly due to irritation of the pleural lining. The pain is sharp, localized and worsens with a deep breath, yawning, coughing which is usually described as pleuritic. If the effusion causes inflammation of the diaphragm the pain may be referred to the shoulder or the upper abdomen. As the pleural effusion increases in size, the pain may increase or disappear altogether due to the separation of inflamed pleural surfaces.

Shortness of breath: As the effusion grows larger with more fluid, the harder it is for the lung to expand and the more difficult it is for the patient to breathe resulting in shortness of breath.

Other Symptoms: Other symptoms are generally attributable to the underlying disease process.

Diagnosis of Pleural Effusion -

Patient s Detailed History and Clinical Examination are the mainstays of diagnosing pleural effusion and it s the underlying cause. Following investigative modalities are generally opted for working out the final diagnosis before instituting appropriate therapy.

Chest X-ray: X-ray will help indicate the presence of fluid. 
Chest Ultrasound(USG): will help in confirming the presence of the fluid and it s localization which in turn can guide the physician about its quantity and its capability.
CT Scan: CT scan of the chest may at times be required to ascertain the underlying cause or to know about any other co-morbid conditions.
Thoracentesis: Thoracentesis is a procedure used to sample the fluid from the pleural effusion. Using a long thin needle, fluid can be removed and sent for testing to confirm the diagnosis.
This can be just for diagnostic purposes or can even be used as a therapeutic procedure.
Chemical analysis of the fluid will help determine the type of pleural effusion.
Treatment of Pleural Effusion -

Treatment of underlying Disease: The treatment of a pleural effusion usually requires that the underlying illness or disease is treated and controlled to prevent the accumulation of the pleural fluid. Like anti-TB therapy for Tubercular etiology or treatment of Cancer in malignant pleural effusion, etc.

Thoracentesis: As discussed earlier Thoracentesis can be used as a therapeutic procedure to remove excess fluid and help lung expand and function properly.

Tube thoracostomy: Thoracostomy or chest tube insertion may be done to drain and treat fluids which cannot be removed by needle aspirations, e.g. empyemas (pus collections).

Pleurodesis: Some pleural effusions reoccur multiple times; sclerosing agents that induce scarring such as talc or tetracycline was used to prevent a recurrence.

Decortication: If sclerosing agents fail, surgery may be required, called Decortication.

Pleural Effusion - What Is It?

Hepatitis A is an infectious disease caused by the Hepatitis A Virus (HAV), which affects the liver. It leads to inflammation of the liver. Even though it does not cause any severe harm in the initial stages, it can become acute or chronic later if not treated or managed on time. If it becomes chronic, it can lead to cirrhosis of the liver and permanent liver failure too. 

Hepatitis A is caused by ingestion of contaminated food or water and it can also result due to anal or oral contact during sex. This infectious disease results in specific signs and symptoms, including fatigue, nausea, vomiting, fever, jaundice, anorexia, and rashes on the body. There are many allopathic medicines to cure Hepatitis A but they can be harsh on the body. If one wants to avoid the possible side effects of these medications, then Ayurvedic remedies offer to be a better choice as they do not have any side effects and also cure the infection completely, giving permanent and full relief. 

So, here are some Ayurvedic remedies for Hepatitis A.

Virechana: A part of the Panchakarma process, it is a detoxification therapy that flushes out the toxins from the body. In Ayurveda, it is believed that any disorder of the liver is caused by pitta imbalance and this imbalance is rectified by a purgation technique. In the first step, the patient is made to vomit and then is kept on a light diet for a few days and watched over. In the last step, the patient is administered virechana drugs such as sweet herbs to cleanse the toxins and purify the blood. After cleansing, the patient is given a warm bath to calm the senses.
Echinacea: This herb is a natural immunizing agent that helps fight the infection caused by HAV. It is an antibiotic and anti-inflammatory in nature and thus, provides relief to the liver. It also stimulates the secretion of enzymes in the body and improves blood circulation as well. Lastly, it prevents auto-immune diseases.
Phyllanthus niruri: Also known as Bhumi Amla, it is very effective in fighting infections of the liver and can cure all forms of liver diseases. It possesses analgesic, antibacterial, and anti-spasmodic properties. It cures the liver inflammation and corrects the pitta imbalance.
Triphala: A mixture of bibhataki, haritaki and amlaki, triphala is a very effective cleansing herb. It carries laxative properties and thus, helps remove toxins from the intestines.
Katuki: This Ayurvedic herb is very effective in the treatment of different liver diseases and is known as a strong laxative. It helps in the detoxification of the intestines and also kills the intestinal worms.
These Ayurvedic remedies are known to provide lasting relief in Hepatitis A, no matter what the stage of the infection is. The herbal medicines can be consumed in the form of tablets, capsules, mixture (churna), or even taken as a tea. Nevertheless, it is advised to consult an Ayurvedic doctor before resorting to any of these remedies. Proper diagnosis and accurate dosage is a must in the treatment of Hepatitis A.

Ayurvedic Remedies For Hepatitis A!

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Symptoms

Pain- Constant pain which gets worse when sitting down
Irritation around the anus, like swelling, redness and tenderness
Discharge of blood or pus
Constipation or pain while evacuation
Fever
Diagnosis
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

Treatment
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.
Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes in continence. Patients usually don t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.

Fistula-in-Ano or Anal Fistula - How It Can Be Treated?

It is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the oesophagus, stomach, or duodenum. Blood is often observed in vomit (hematemesis) or in the stool (melena). Upper gastrointestinal bleeding denotes a medical emergency and typically requires hospital care for primary diagnosis and treatment. The incidence of upper gastrointestinal bleeding is 50-150 individuals per 100,000 annually. Depending on its severity, it carries an estimated mortality risk of 11%.

The causes of upper gastrointestinal bleeding are as follows:

Oesophagal causes (gastrorrhagia):

Oesophagal varices
Esophagitis
Oesophagal cancer
Oesophagal ulcers
Mallory-Weiss tear
Gastric causes: 

Gastric ulcer
Gastric cancer
Gastritis
Gastric varices
Gastric antral vascular ectasia
Dieulafoy's lesions

Duodenal causes
Duodenal ulcer
Vascular malformation, including aorto-enteric fistulae
Hematobilia or bleeding from the biliary tree
Hemosuccus pancreaticus or bleeding from the pancreatic duct
Severe superior mesenteric artery syndrome
The signs and symptoms of upper gastrointestinal bleeding are as follows:

Hematemesis - Vomiting of blood
Melena - Blood in the stool
Hematochezia - Passage of fresh blood through the anus, usually in or with stools
Syncope - Loss of consciousness (fainting)
Presyncope - State of lightheadedness, muscular weakness, blurred vision, and feeling faint
Dyspepsia   IndigestionEpigastric painHeartburnDiffuse abdominal pain
Dysphagia - Difficulty in swallowing. Weight lossJaundice - Yellow discolouration of the skin, mucous membranes, and sclera
The diagnosis of upper gastrointestinal bleeding is made when hematemesis is present. In the absence of hematemesis, an upper source of GI bleeding is likely in the presence of at least two factors among - Black stool, age < 50 years or blood urea nitrogen/creatinine ratio 30 or more

If these findings are absent, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test. Also, the following diagnostic tests are done:

Orthostatic blood pressure
Complete blood count with differential counts
Hemoglobin level
Type and crossmatch blood
Basic metabolic profile, BUN,
Coagulation profile
Serum calcium
Serum gastrin
Endoscopy
Chest radiography
Nasogastric lavageAngiography (if bleeding persists and endoscopy fails to identify a bleeding site)
Upper gastrointestinal bleeding can be managed in the following ways:

Airway management and fluid resuscitation using either intravenous fluids and or blood
Medications to stop the bleeding (Proton-pump inhibitors are often given in the emergency)
Surgical intervention
Treating the consequences (like anaemia) that the bleeding may have caused
Precautions are taken to prevent re-bleeding

What Are The Reasons Behind Ulcer?

The liver is a key organ in metabolism and will have some amount of fat. However, excessive fat accumulation in the liver can be abnormal and is referred to as fatty liver. If the fat content exceeds anything more than 5% to 10% of the liver s weight, it would be referred to as fatty liver.

Types - There are mainly two types based on causes:

Alcoholic fatty liver: This is very common in people who consume excessive amounts of alcohol. Even a one-off instance of binge drinking can cause increased fat accumulation in the liver, but it would not produce any symptoms though. Preexisting hepatitis, pregnancy, obesity, and genetic predisposition may also lead to alcoholic liver disease.
Non-alcoholic liver disease: This is the less common type of fatty liver, and there would be no alcoholic abuse history here. However, there could be genetic predisposition, obesity, autoimmune liver disease, malnutrition, which can lead to this condition.
Symptoms

Fatty liver disease is a chronic condition with insidious onset (meaning to say, the exact time of onset cannot be pinpointed). However, as the disease condition progresses, symptoms will become evident, which can trigger a medical evaluation to identify the fatty liver. Some of the symptoms include:

Excessive fatigue and weakness
Unexplained weight loss
Loss of appetite
Nausea
Trouble focusing and concentrating
Impaired judgment
Constant, slow enlargement of the liver can cause pain in the right upper quadrant of the abdomen (where the liver is)
There could be jaundice, where the skin and the white of the eyes turn pale yellow
Symptoms of liver failure, including increased levels of proteins in the chemical tests.
Diagnosis

As noted earlier, it is not easy to identify liver disease, as there are no specific symptoms. However, the above symptoms could point to a potential fatty liver.

Blood tests, especially for liver enzymes
Ultrasound, where the liver is imaged to look for any structural changes
Biopsy, where liver tissue is extracted to confirm the diagnosis of fatty liver
Treatment

There is no specific treatment for fatty liver. It can be managed through the following, where symptoms reduce in severity, and overall prognosis improves.

Diabetes control: There is a relation between how well diabetes is controlled and severity of fatty liver. Improving diabetes control ensures fatty liver does not progress.
Alcohol: Cutting down or even better quitting alcohol, definitely helps improve symptoms. If it is alcohol induced fatty liver, alcohol should be stopped.
Weight management: Obesity and fatty liver are related, so weight management is essential.
Healthy diet: Eating a healthy diet and regular exercise regimen also helps improve symptoms of fatty liver.

Fatty Liver - Signs You Are Suffering From It!

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