Nausea and vomiting are two symptoms that are usually considered to be an indication of a disruption in the alimentary tract (gut). In most cases it is associated with alimentary pathology and accompanied by other symptoms like changes in bowel movements, heartburn, loud stomach noises (borborygmi), abdominal pains or cramps, excessive belching or flatulence. It is also often related to eating and aggravated after meals. Most alimentary causes of vomiting are due to infections, food poisoning, overdistension or irritation of the upper gastrointestinal tract. However, there are times when vomiting may not be related to any pathology within the alimentary tract and usually these conditions present without any of the associated gastrointestinal signs and symptoms.
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The alimentary tract extends from the mouth to the anus. Food or drink, once swallowed, should only travel in one direction – down the alimentary tract. From the mouth it passes into the throat with voluntary swallowing and then reflexes coordinate involuntary processes that transports the food or drinks down the esophagus. From here it passes to the stomach, then the small intestine and after passing through the large intestine, any remnants are eventually expelled as feces. The contractions of the muscles in the wall of the gut that facilitates the movement of substances within is known as peristalsis. Sometimes the contents of the small intestine, stomach, esophagus or throat can travel in the opposite direction which is known as antiperistalsis. If it is forcefully expelled then it is known as vomiting. However, in some cases the violent eruption as seen with vomiting is not present. Instead the contents pass out quite passively in comparison to vomiting and this is known as regurgitation.
Vomiting, also known as emesis, is the process where the upper gastrointestinal contents are expelled through the mouth often with force. It is a coordinated process that starts from the small intestine or stomach. Since peristaltic waves pushes food from the mouth downwards into the esophagus and through the rest of the gut, the waves during vomiting “work” in the opposite direction. This is known as antiperistalsis. It is coordinated by the vomiting center in the brain, often with input from another area known as the chemoreceptor trigger zone (CTZ).
Vomiting is not always a sign of an illness. It is actually a protective mechanism whereby the gut quickly expels noxious substances before it travels further down the gastrointestinal tract. Vomiting may be caused by overdistention of the gut or irritation of the gut lining which is not related to any disease. Upon expelling the causative agent, vomiting may cease. It is often preceded by nausea which may persist for a short while after vomiting but no other symptoms are usually present. However, when vomiting is persistent or recurrent, for just a few days or even weeks and months, it needs to be investigated further. It may be accompanied by other symptoms which would indicate a possible cause – for example, fever may be an indication of an infection.
continue reading Persistent and Recurrent Vomiting (Emesis) in Adults and Children
The normal pattern for bowel movements varies among individuals. For some it is a daily occurrence, and often even several times in the day. For others it is less frequent and possibly not even daily. Normally bowel movements occur at least 3 or more times a week. Ideally it should occur at least once daily but if more than 200g or 200ml of stool is passed in 3 or more movements in a day then it is labeled as diarrhea. Conversely, passing stool less than 3 times a week is labeled as constipation. However, it is not just a matter of the number of bowel movements in a week with constipation – the stool is usually hard and dry and there is significant discomfort and straining during the bowel movement.
Constipation is not a disease, it is a symptom. Most cases of constipation occur for no known reason, is not associated with any underlying disease and responds well to dietary changes. These cases are known as simple constipation. When constipation arises due to some underlying disease or contributing factor, it can resolve once the disease is treated and properly managed. A minority of cases are termed as severe idiopathic constipation where bowel movements are very infrequent yet there is no clearly evident underlying cause. It is most likely functional in nature, possibly associated with reduces motor activity of the bowels and excessive contraction of the anal sphincter muscles. When stool or gas is not passed out, however, this is referred to as obstipation.
The esophagus is the part of the alimentary tract that connects the throat to the stomach. A bolus of food is propelled down the esophagus and enters the stomach when it pushes past the lower esophageal sphincter (LES). The one-way flow mechanism largely controlled by the LES and mouth-to-anus direction of peristaltic waves ensures that the stomach contents do not spill over into the esophagus. However, this mechanism may sometimes fail to act effectively. Despite the esophagus being developed to withstand mechanical injury, it is not as well suited to chemical insults. Esophageal injury may occur very rapidly if the stomach contents, including its highly corrosive hydrochloric acid, flow backwards up into the esophagus. The subsequent inflammation of the esophageal wall is known as esophagitis or more specifically as reflux esophagitis.
From the time food passes into the throat, the alimentary tract takes over the process of moving the bolus (ball of food) or its digested remnants through the gut. The walls of the alimentary tract has muscular layers which contract and relax in a synchronized manner to achieve this transit. This process is known as peristalsis. As food moves through the gut and is broken down in various stages, a host of other substances is added to the mix including digestive enzymes, bile, mucus and water.
Food enters through the mouth, is digested, the nutrients absorbed and waste discarded through the anus. The time for this to occur is known as the bowel transit time. It varies even in the same person but is on average about 24 to 36 hours. At certain times it can as early as 12 hours or as late as 72 hours. The bowel transit time depends on multiple factors including the foods eaten, water and fiber intake and any periodic disruptions in bowel motility.
Stomach pain is a common term to describe upper abdominal pain, particularly pain or discomfort on the left side and center (epigastrium). The abdominal cavity contains many structures and organs, most of which are part of the digestive tract. It is lies next to the thoracic cavity which houses the heart and great blood vessels as well as the lungs and terminal airways. The abdominal cavity and thoracic cavity are separated by the muscular diaphragm.
Stomach pain may be associated with any of the structures contained within these two cavities and needs to be carefully assessed in conjunction with other symptoms to reach a possible diagnosis. This is further evaluated with diagnostic investigations. On its own stomach pain is not an extremely accurate indicator of a specific pathology. It is largely non-specific and a common occurrence without any clear cause. Stomach pain may come and go sometimes with no correlation to specific events and therefore concurrent symptoms need to be identified as far as possible.
The small intestine, also referred to as the small bowel, extends from the stomach to the large intestine. It is the longest portion of the human alimentary tract and measures approximately 6 meters (20 feet). The small intestine is an important site of both digestion and absorption of nutrients. It has three parts – the duodenum leading from the stomach, jejunum and ileum which continues to the large intestine. As with any part of the alimentary tract, the small intestine may become inflamed through a number of mechanisms. When the small intestine alone is inflamed, it is then referred to as enteritis or it can be more specific like ileitis which is inflammation of the ileum of the small intestine.
Gastritis is the term for inflammation of the stomach. As a hollow sac, it is the walls of the stomach that are inflamed to varying degrees. This may sometimes be isolated to the superficial inner lining of the stomach (mucosa) or it can extend through the entire wall of the stomach. Persistent inflammation leads to ulcers, which can be deep or shallow. Most cases of chronic gastritis are due to H.pylori (Helicobacter pylori) infection or the excessive and/or long term use of NSAIDs (non-steroidal anti-inflammatory drugs). However, a minority of chronic gastritis cases are not due external factors but arises with an immune-mediated reaction and is known as autoimmune gastritis. It needs to be considered as a possible cause of chronic gastritis that is not associated with H.pylori infection or NSAID use.
Inflammatory bowel disease (IBD) is the a chronic inflammatory disorder of the bowels characterized by periods of acute flareups (active) and mildly symptomatic or asymptomatatic periods (remission). The two main types of inflammatory bowel disease, Crohn’s disease and ulcerative colitis, are largely the same but there is distinct differences in the distribution, histopathology and clinical features. Ulcerative colitis, the more common form of IBD, is isolated to the rectum and colon whereas Crohn’s disease which mainly involves the colon and ileum of the small intestine may affect any part of the alimentary tract. Inflammatory bowel disease is a difficult condition to treat and manage and both surgical and medical treatment (the use of medication) is primarily directed at reducing the severity of symptoms during active phases and decreasing the frequency of these flareups.
Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the bowels, mainly affecting the colon and often involving the neighboring parts of the gut. Although the exact cause of inflammatory bowel disease is unknown, it appears to be associated with a genetic defect on the mucosal lining of the bowels and/or its response to the normal intestinal flora (bowel bacteria). There are two major types of IBD – Crohn’s disease and ulcerative colitis – with the latter being more common. The colon and rectum, like the entire gastrointestinal tract, is lined with a mucosal epithelium simply referred to as the mucosa. In inflammatory bowel disease, this mucosal lining and often the deeper layers are severely inflamed, ulcerated and structurally damaged to varying degrees.
The alimentary tract extends from the mouth to the anus. Most of the length of this tract is made up on the bowels, namely the small intestine and large intestine. The small intestine is divided into three parts – duodenum (leading from the stomach), jejunum and ileum (leading to the large intestine). The large intestine is composed of the cecum, colon and rectum. Most of the digestion, absorption and stool formation occurs within the bowels. Various chronic diseases can afflict the bowels. One of the more common of these conditions is inflammatory bowel disease or IBD. This condition should not be confused with inflammatory bowel syndrome (IBS) which is a functional disorder of the bowels, meaning that it is in a state of dysfunction although there is not evident pathology of the bowels.
continue reading Inflammatory Bowel Disease (IBD) Differences, Causes, Symptoms
Normal bowel movements occur once or twice in day, the stool is passed out with ease and is well formed, firm and brown in color. It is still normal to pass out bowel movements less frequently or more often provided that there is no straining, pain, very hard and dry or very loose and watery stool. Diarrhea is defined as the passage of more than 200g or 200ml of stool usually in three or more movements in a day.
It is not uncommon to experience diarrhea for various reasons several times in life and it remains one of the most common intestinal disorders. However, diarrhea is more often acute, lasting for just a few days, and resolves quickly on its own or with medical treatment and further complications rarely arise. Diarrhea is a sign of an underlying gastrointestinal or systemic disturbance and always needs to be investigated thoroughly if it is persistent or recurrent.
The human gut, also referred to as the alimentary tract, is a long hollow organ that extends from the mouth to the anus. The longest part of the alimentary tract lies between the stomach and anus – it is known as the intestines or bowel. Broadly, the intestines are made up of the small intestine and large intestine which are responsible for digestion, absorption and waste expulsion from the body. The small intestine is about 6 meters long while the large intestine is about 1.5 meters in length. Of the two intestines, the small intestine is the narrower segment.
The sense of itch is elicited when there is irritation on the surface of the skin like that of an insect crawling on it. It is closely associated with a tickle and its purpose is to make a person act against the offending agent by scratching or rubbing it off. In this manner, itching is a protective mechanism that is intended to warn a person of a potential danger on the skin surface and therefore to act against it as soon as possible. This sensation is elicited when highly-sensitive mechanoreceptors (itch receptors) on the skin surface are stimulated and nerve impulses travel along small unmyelinated nerve fibers to the central nervous system. It is also closely associated with and may precede the sensation of pain.
Escherichia coli (E.coli) is a group of bacteria that have a close relationship with humans. Some strains exist in the human gut and do not cause any disease if the population is kept within certain limits. In fact it helps to fight off any pathogenic bacteria that may enter the gut and can also help with nutrition. Other strains of E.coli can cause severe infections in humans, particularly of the bowel and abdominal cavity, urinary tract, lungs and brain lining (meninges). E.coli infection can cause inflammation of the small intestine (enteritis) or large intestine (colitis) which is associated with severe diarrhea.
continue reading Escherichia coli (E.coli) Diarrhea, Spread, Types and Symptoms
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