Acid reflux or gastroesophageal reflux (not disease) occurs sporadically in a healthy person and has no long term consequences. As discussed under What is Acid Reflux, the alimentary tract has means of dealing with small amounts of stomach acid that occasionally enters the esophagus. However, in cases of persistent or recurrent acid reflux, the extent of the mucosal damage can lead to a complex of signs and symptoms, as well as other long term complications. This is a more severe and chronic form of acid reflux known as gastroesophageal reflux disease (GERD or GORD) and should be investigated and treated appropriately. Acute acid reflux however, is temporary and may pass with no treatment.
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Acid reflux is the backward flow of the acidic stomach contents (food + acid + other secretions) up into the esophagus. It is not uncommon for every healthy person to experience acid reflux occasionally but in certain cases, this retrograde flow may become persistent or recurrent. Prolonged exposure to the stomach acid irritates or damages the lining of the esophagus (esophagitis) and causes a range of signs and symptoms that are collectively referred to as gastroesophageal reflux disease (GERD, GORD ~ UK).
The presence of blood in the saliva may not necessarily be an indication of bleeding from the mouth cavity (stomatorrhagia). The mouth communicates with the nose, esophagus and larynx via the throat. This could mean that any bloody saliva may be due to bleeding in the nasal cavity, respiratory or gastrointestinal tracts.
Tracing the cause may be easier if the blood in the saliva is only evident or more pronounced in one of these situations :
- After or during vomiting, regurgitating or when belching indicates bleeding from the esophagus. Read more under Blood In Vomit.
- After or during coughing (hemoptysis) or sneezing indicates bleeding from the airways or lungs. Read more under Coughing Up Blood.
- After sneezing, blowing the nose, in post nasal drip, with nasal congestion or accompanying a bleed from the nose indicates bleeding from the nasal cavity. Read more under Epistaxis.
Stimulants are substances that are used to enhance brain activity and has a host of mental and physical effects. Due to the psychoactive nature of these substances, stimulants may also have a number of effects on the emotional state.
A stimulant has pronounced effect on the central nervous system, which is the reason it is often used, and it may also influence the activity of the peripheral nervous system. In most cases, stimulants are used to increase alertness, reduce the need for sleep and give a temporary boost in energy. However, certain illicit drugs that are known stimulants are also used for the euphoria it induces due to the disruption of the brain hormones – dopamine, endorphins, norepinephrine and serotonin.
A stimulant is colloquially known as an ‘upper’. It is believed to enhance mental and physical activity, however, these effects are temporary and the following withdrawal period actually hampers functioning. In addition, large quantities and long term use of stimulants may permanently impair mental and physical activity. Stimulants are no longer used frequently in medical treatments except for conditions like depression and ADHD (attention deficit hyperactivity disorder).
A stomach polyp or gastric polyp is a mass or growth in the layers of the stomach that protrudes above the surface of the surrounding mucosa (stomach lining). A stomach polyp has the potential to become cancerous – most will remain benign but in a minority of cases it will progress into cancer.
Overall, a stomach polyp is a rare condition when compared to other gastric conditions. Most stomach polyps are less than 1 centimeter in diameter and due to inflammation or hyperplasia (explained below). Larger stomach polyps, greater than 1.5 centimeters in diameter, are associated with a greater risk of malignancy (cancer) and if the polyp is larger than 2 centimeters in diameter, it is usually removed immediately.
A gallstone is a small pebble that develops in the gallbladder often as a result of sediment from the bile. The medical term for a gallstone is a cholelith and the process of gallstone formation and the presence of gallstones in the gallbladder is known as cholelithiasis.
There are some less common types of gallstones that do not develop within the gallbladder but rather in the bile ducts (medical term : choledocholithiasis). Many gallstones exit the gallbladder and pass out with the bile. It often goes unnoticed. At times however, the gallstone may get stuck in the narrow neck of the gallbladder or within the bile duct itself.
The color of sputum or phlegm, which is the mucus and sometimes pus discharge expectorated from the respiratory tract, is often an indication of the type of respiratory disease that gives rise to sputum production. By examining the type of sputum and noting the color as well as the presenting signs and symptoms, a differential diagnosis may be reached prior to laboratory tests and examination – sputum cytology and culture. A thorough case history and complete physical examination is also necessary.
Ideally, the morning sputum specimen should be examined as this provides a more vivid indication of the cause. Sputum samples that are coughed or spat up during the course of the day may lack the features that would provide a clue to the disease process and be tainted by foods and drinks, especially those rich in artificial colorants.
Stomach bloating may refer to a sensation of fullness or pressure, typically after eating, and/or excessive gas accumulation within the gastrointestinal tract. Typically these symptoms are associated with indigestion, however, there are various other causes that may or may not be related to the gastrointestinal tract (gut).
With stomach bloating, there may be little or no enlargement of the abdomen (distension). Common causes of a visible bulging or protrusion of the stomach may be due to fluid (ascites), feces (constipation), fat (abdominal fat/central obesity), fetus (pregnancy), flatus (gas accumulation). This is is discussed further under :
Stomach cramps is a general term used to describe mild discomfort (stomach ache) to pain (gastric pain) in the stomach. It is usually difficult to isolate the pain as originating from the stomach itself. Often any focal or diffuse abdominal pain is attributed to the stomach (refer to stomach location) but may arise from other parts of the gastrointestinal tract, surrounding abdominal structures or referred from elsewhere in the body.
Although the stomach is a muscular sac, there is no conclusive indication that the pain described as stomach cramps is due to actual spasms of the stomach muscles. Stomach cramp is a subjective term that could be attributed to pain elsewhere in the region.
What is Diabetic Neuropathy?
Diabetic neuropathy is the nerve dysfunction and damage that is a result of long-standing and often poorly controlled diabetes mellitus (sugar diabetes). It is the most common complication of diabetes mellitus and these neurological disturbances may affect more than half of all cases of long term diabetes.
Diabetic neuropathy is a broad therm that encompasses a variety of clinical neurological syndromes. It can be in the form of focal neuropathy, polyneuropathy, or autonomic neuropathy. Although neuropathy is a common complication of long standing and uncontrolled diabetes mellitus, it is often ignored until the late stages of the disease. At this point, symptoms like paresthesia, numbness or tingling, especially of the legs, affects daily functioning and leads to repeated injuries that predisposes to the formation of diabetic ulcers.
What is sputum?
Sputum or phlegm is the discharge that is expectorated from the respiratory system. It is a combination of mucus produced by the airways combined with saliva from the mouth. It also contains other components including microorganisms, whole cells (like the immune cells), debris and dust even if there is no respiratory disease present. In the event of a respiratory disease, it may contain the components above in higher quantities and sometimes blood as well.
The legs, particularly the lower leg and foot, are the most prone to circulatory problems due to its distance from the heart and the range of disorders that may arise within the long and extensive network of leg arteries and leg veins. This can therefore affect the flow of blood from the heart to the legs via the arteries or from the legs to the heart via the veins.
When the blood flow is hampered, it is essentially slowed down and may not reach the leg at a rate that is sufficient to maintain the oxygen and nutrient supply to the tissues of the lower leg or feet. This is seen in poor leg circulation problems affecting the arteries – arterial insufficiency. If the flow back to heart is disrupted, due to problems in the vein(s), the blood will pool in the legs and the circulation becomes sluggish. This is seen in venous insufficiency as a result of varicose veins, superficial thrombophlebitis or deep vein thrombosis.
A moderate amount of vaginal discharge is common in most women and is considered to be normal. Under certain circumstances, vaginal discharge may become excessive – this may be physiological or pathological.
Excessive vaginal discharge which is not related to any disease process (physiological discharge) may be seen during ovulation and pregnancy. It is usually temporary.
At other times, the excessive vaginal discharge may be related to an underlying disease and this is known as a pathological discharge. While some level of local irritation may be seen with physiological discharge, any excessive and persistent discharge accompanied by vaginal itching (itchy vagina), localized redness, swelling or skin lesions should be considered as pathological. This can be further confirmed by the appearance of the discharge – refer to Abnormal Vaginal Discharge and Vaginal Discharge Color.
Polycythemia is due to an excess of red blood cells. This is known as true polycythemia and occurs when some pathology triggers the excessive production of red blood cells. True polycythemia leads to an elevated red blood cell count.
Relative polycythemia or apparent polycythemia is where the total red blood cell count is normal but due to the lower plasma volume the hematocrit is higher – this is the ratio of red blood cells to the volume of whole blood. This type of polycythemia is often caused by dehydration, either due to the excessive use of diuretics or alcohol.
Causes of Polycythemia (True)
Red blood cells are produced in the bone marrow and are manufactured from hematopoietic stem cells. The main stimulus for red blood cell production is hypoxia – a low oxygen state. Erythropoietin (Epo), a hormone primarily secreted by the kidney, has to also be present for red blood cell production.
Stomach acid is the collection of gastric secretions secreted by the lining of the stomach and contained with the stomach cavity. It is a combination of hydrochloric acid (HCl), pepsin and intrinsic factor and due to the presence of HCl, the overall pH of the solution is low meaning that it is acidic.
The stomach secretes about 1.5 liters of juices per day which includes digestive enzymes, mucus and water. Every liter of stomach secretions (juices) contain about 160 millimoles of HCl resulting in a pH of 1 to 2, although it can be as low as 1.8 or as high as 3.
Stomach acid is necessary for digestion because it chemically breaks down foods. The acidity also activates other digestive enzymes which contribute to chemical digestion as well. Apart from its role in digestion, the stomach acid is the first major line of defense against invading microorganisms that enter the gut with food or drink.
The production of stomach acid and the stimulation and inhibition of its secretion is discussed further under Gastric Acid.
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