Gastroenteritis

Definition

Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu, although the virus is not associated with this illness. Major symptoms include , and abdominal cramps. These symptoms are sometimes also accompanied by and overall weakness. Gastroenteritis typically lasts about three days. Adults usually recover without problem, but children, the elderly, and anyone with an underlying disease are more vulnerable to complications.

Description

Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threatening in the United States and other developed nations. However, an estimated 220,000 children younger than age five are hospitalized with gastroenteritis symptoms in the United States annually. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrheal illnesses are a major source of mortality. In 1990, approximately three million deaths occurred worldwide as a result of diarrheal illness.

The most common cause of gastroenteritis is viral infection. Viruses such as rotavirus, adenovirus, astrovirus, and calicivirus and small round-structured viruses (SRSVs) are found all over the world. Exposure typically occurs through the fecal-oral route, such as by consuming foods contaminated by fecal material related to poor sanitation. However, the infective dose can be very low (approximately 100 virus particles), so other routes of transmission are quite probable.

Typically, children are more vulnerable to rotaviruses, the most significant cause of acute watery diarrhea. Annually, worldwide, rotaviruses are estimated to cause 800,000 deaths in children below age five. For this reason, much research has gone into developing a vaccine to protect children from this virus. Adults can be infected with rotaviruses, but these infections typically have minimal or no symptoms.

Children are also susceptible to adenoviruses and astroviruses, which are minor causes of childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton, and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major symptom.

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water, or contaminated food-conditions common in developing nations. Natural or man-made disasters can make underlying problems in sanitation and food safety worse. In developed nations, the modern food production system potentially exposes millions of people to disease-causing bacteria through its intensive production and distribution methods. Common types of bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed nations. and Shigella remain two diseases of great concern in developing countries, and research to develop long-term vaccines against them is underway.

Stomach (Gastric) Ulcer

A stomach ulcer is usually caused by an infection with a bacterium (germ) called H. pylori. A 4-8 week course of acid-suppressing medication will allow the ulcer to heal. In addition, a one week course of two antibiotics plus an acid-suppressing drug will usually clear the H. pyloriinfection. This usually prevents the ulcer recurring again. Anti-inflammatory drugs used to treat conditions such as arthritis sometimes cause stomach ulcers. If you need to continue with the anti-inflammatory drug, then you may need to take long term acid-suppressing medication.
Understanding your gut and digestion
Food passes down the oesophagus (gullet) into the stomach. The stomach makes acid which is not essential, but helps to digest food. After being mixed in the stomach, food passes into the duodenum (the first part of the small intestine). In the duodenum and the rest of the small intestine, food mixes with enzymes (chemicals). The enzymes come from the pancreas and from cells lining the intestine. The enzymes break down (digest) the food which is absorbed into the body.
Some terms explained
Peptic inflammation is inflammation caused by stomach acid. Inflammation may be in the stomach, the duodenum (as acid flows in with food), or the lower oesophagus (if acid splashes up to cause 'reflux oesophagitis').
A peptic ulcer is an ulcer caused by stomach acid. An ulcer is where the lining of the gut is damaged and the underlying tissue is exposed. If you could see inside your gut, an ulcer looks like a small, red crater on the inside lining of the gut.
A stomach ulcer is one type of peptic ulcer. A stomach ulcer is sometimes called a gastric ulcer. (The most common type of peptic ulcer is a duodenal ulcer.)
The rest of this leaflet deals only with stomach ulcers. See separate leaflets on 'Duodenal Ulcer', and 'Acid Reflux and Oesophagitis'.

What causes stomach ulcers?
Your stomach normally produces acid to help with the digestion of food and to kill bacteria. This acid is corrosive so some cells on the inside lining of the stomach and duodenum produce a natural mucus barrier which protects the lining of the stomach and duodenum. There is normally a balance between the amount of acid that you make and the mucus defense barrier. An ulcer may develop if there is an alteration in this balance allowing the acid to damage the lining of the stomach or duodenum. Causes of this include the following:
Infection with Helicobacter pylori
Infection by Helicobacter pylori (commonly just called H. pylori) is the cause in about 8 in 10 cases of stomach ulcer. More than a quarter of people in the UK become infected with H. pylori at some stage in their life. Once you are infected, unless treated, the infection usually stays for the rest of your life. In many people it causes no problems and a number of these bacteria just live harmlessly in the lining of the stomach and duodenum. However, in some people this bacterium causes an inflammation in the lining of the stomach or duodenum. This causes the defence mucus barrier to be disrupted (and in some cases the amount of acid to be increased) which allows the acid to cause inflammation and ulcers.
Anti-inflammatory drugs - including aspirin
Anti-inflammatory drugs are sometimes called non-steroidal anti inflammatory drugs (NSAIDs). There are various types and brands. For example: aspirin, ibuprofen, diclofenac, etc. Many people take an anti-inflammatory drug for arthritis, muscular pains, etc. Aspirin is also used by many people to protect against blood clots forming. However, these drugs sometimes affect the mucus barrier of the stomach and allow acid to cause an ulcer. About 2 in 10 stomach ulcers are caused by anti-inflammatory drugs.
Other causes and factors
Other causes are rare. For example, some virus infections can cause a stomach ulcer. Crohn's disease may cause a stomach ulcer in addition to other problems of the gut. Stomach cancer may at first look similar to an ulcer. Stomach cancer is uncommon, but may need to be 'ruled out' if you are found to have a stomach ulcer.

What are the symptoms of a stomach ulcer?
Pain in the upper abdomen just below the sternum (breastbone) is the common symptom. It usually comes and goes. It may be eased if you take antacid tablets. Sometimes food makes the pain worse. The pain may wake you from sleep.
Other symptoms which may occur include: bloating, retching, and feeling sick. You may feel particularly 'full' after a meal.
Complications develop in some cases, and can be serious. These include:
Bleeding ulcer. This can range from a 'trickle' to a life-threatening bleed.
Perforation. This is where the ulcer goes right through ('perforates') the wall of the stomach. Food and acid in the stomach then leak into the abdominal cavity. This usually causes severe pain and is a medical emergency.
What tests may be done?
Endoscopy is the test that can confirm a stomach ulcer. In this test a doctor looks inside your stomach by passing a thin, flexible telescope down your oesophagus. They can see any inflammation or ulcers. (See leaflet called 'Endoscopy' for details.)
A test to detect the H. pylori bacterium is usually done if you have a stomach ulcer. If H. pylori is found then it is likely to be the cause of the ulcer. See separate leaflet on Helicobacter Pylori & Stomach Pain and how it can be diagnosed. Briefly, it can be detected in a sample of faeces, or in a 'breath test', or from a blood test, or from a biopsy sample taken during an endoscopy.
Biopsies (small samples) are usually taken of the tissue in and around the ulcer during endoscopy. These are sent to the 'lab' to be looked at under the microscope. This checks for cancer (which is ruled out as the cause of the ulcer in most cases).

What are the treatments for a stomach ulcer?
Acid suppressing medication
A 4-8 week course of a drug that greatly reduces the amount of acid that your stomach makes is usually advised. The most commonly used drug is a proton pump inhibitor. Proton pump inhibitors (PPIs) are a class (group) of drugs that work on the cells that line the stomach, reducing the production of acid. They include: esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole, and come in various brand names. Sometimes a drug from another class of drugs called H2 blockers is used. H2 blockers work in a different way on the cells that line the stomach, reducing the production of acid. They include: cimetidine, famotidine, nizatidine and ranitidine, and come in various brand names. As the amount of acid is greatly reduced, the ulcer usually heals. However, this is not the end of the story ...
If your ulcer was caused by H. pylori
Most stomach ulcers are caused by infection with H. pylori. Therefore, a main part of the treatment is to clear this infection. If this infection is not cleared, the ulcer is likely to return once you stop taking acid-suppressing medication. Two antibiotics are needed to clear H. pylori. In addition, you need to take an acid-suppressing drug to reduce the acid in the stomach. This is needed to allow the antibiotics to work well. You need to take this 'combination therapy' (sometimes called 'triple therapy') for a week. One course of combination therapy clears H. pylori infection in up to 9 in 10 cases. If H. pylori is cleared, then the chance of a recurrence of a stomach ulcer is greatly reduced. However, in a small number of people H. pylori infection returns at some stage in the future.
If your ulcer was caused by an anti-inflammatory drug
If possible, you should stop the anti-inflammatory drug. This allows the ulcer to heal. You will also normally be prescribed an acid-suppressing drug for several weeks. This stops the stomach from making acid and allows the ulcer to heal. However, in many cases the anti-inflammatory drug is needed to ease symptoms of arthritis or other painful conditions, or aspirin is needed to protect against blood clots. In these situations, one option is to take an acid-suppressing drug each day indefinitely. This reduces the amount of acid made by the stomach, and greatly reduces the chance of an ulcer forming again.
Treatment for other uncommon causes
Treatment depends on the underlying cause.
Surgery
In the past, surgery was commonly needed to treat a stomach ulcer. This was before it was discovered that H. pylori was the cause of most stomach ulcers, and before modern acid-suppressing drugs became available. Surgery is now usually only needed if a complication of a stomach ulcer develops such as severe bleeding or a perforation.
After treatment
A repeat endoscopy is usually advised a few weeks after treatment has finished. This is mainly to check that the ulcer has healed, and also to be doubly certain that the 'ulcer' was not due to stomach cancer. If your ulcer was caused by H. pylori then a test to check that H. pylori has gone is usually advised. This is done at least four weeks after the course of combination therapy has finished. In most cases, the test is 'negative' meaning that the infection has gone. If it has not gone, then a repeat course of combination therapy with a different set of antibiotics may be advised

Causes of anemia

Anemia Caused by Destruction of RBCs

Hemolytic ("hemo" means blood, "lytic" means destroying) anemia occurs when red blood cells are being destroyed prematurely. (Normally, the lifespan of RBCs is 120 days. In hemolytic anemia, they have a much shorter lifespan.) And the bone marrow (the soft, spongy tissue inside bones that makes new blood cells) simply can't keep up with the body's demand for new cells. This can happen for a variety of reasons. Sometimes, infections or certain medications - such as antibiotics or antiseizure medicines - are to blame.

In a condition known as autoimmune hemolytic anemia, the immune system mistakes RBCs for foreign invaders and begins destroying them. Other children inherit defects in the red blood cells that lead to anemia. Common forms of inherited hemolytic anemia include sickle cell anemia, thalassemia, and glucose-6-phosphate dehydrogenase deficiency.

• Sickle cell anemia is a severe form of anemia found most commonly in people of African heritage, although it can affect those of Caucasian, Saudi Arabian, Indian, and Mediterranean descent. In this condition, the hemoglobin forms long rods when it gives up its oxygen, stretching red blood cells into abnormal sickle shapes. This leads to premature destruction of RBCs, chronically low levels of hemoglobin, and recurring episodes of pain, as well as problems that can affect virtually every other organ system in the body. About 1 out of every 625 African-American children is born with this form of anemia.
• Thalassemia, which usually affects people of Mediterranean, African, and Southeast Asian descent, is marked by abnormal and short-lived RBCs. Thalassemia major, also called Cooley's anemia, is a severe form of anemia in which RBCs are rapidly destroyed and iron is deposited in the skin and vital organs. Thalassemia minor involves only mild anemia and minimal red blood cell changes.
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency most commonly affects men of African heritage, although it has been found in many other groups of people. With this condition the RBCs either do not make enough of the enzyme G6PD or the enzyme that is produced is abnormal and doesn't work well. When someone born with this deficiency has an infection, takes certain medicines, or is exposed to specific substances, the body's RBCs suffer extra stress. Without adequate G6PD to protect them, many red blood cells are destroyed prematurely.
  

Anemia Caused by Blood Loss

Blood loss can also cause anemia - whether it's because of excessive bleeding due to injury, surgery, or a problem with the blood's clotting ability. Slower, long-term blood loss, such as intestinal bleeding from inflammatory bowel disease (IBD), can also cause anemia. Anemia sometimes results from heavy menstrual periods in teen girls and women. Any of these factors will also increase the body's need for iron because iron is needed to make new RBCs.

Anemia Caused by Inadequate Production of RBCs

Aplastic anemia occurs when the bone marrow can't make enough RBCs. This can be due to a viral infection, or exposure to certain toxic chemicals, radiation, or medications (such as antibiotics, antiseizure drugs, or cancer treatments). Some childhood cancers can also cause aplastic anemia, as can certain chronic diseases that affect the ability of the bone marrow to make blood cells.

High levels of hemoglobin and RBCs help fetal blood carry enough oxygen to developing babies in the relatively oxygen-poor environment in utero. Thus, infants are born with some protection from iron deficiency. After the child is born, more oxygen is available and the baby's hemoglobin level normally drops to a low point at about 2 months of age, a condition known as physiologic anemia of infancy. This temporary and expected drop in the blood count is considered normal and no treatment is required because the infant's body soon starts making red blood cells on its own.

Anemia also occurs when the body isn't able to produce enough healthy RBCs because of an iron deficiency. Iron is essential to hemoglobin production. Poor dietary iron intake (or excessive loss of iron from the body) can lead to iron deficiency anemia, the most common cause of anemia in children. Iron deficiency anemia can affect children at any age, but is most commonly seen in those younger than 2 years old.

Girls going through puberty also have a particularly high risk for iron deficiency anemia because of the onset of menstruation; the monthly blood loss increases the amount of iron they need to consume in their diets.

What is Anemia?

Anemia, one of the more common blood disorders, occurs when the level of healthy red blood cells (RBCs) in the body becomes too low. This can lead to health problems because RBCs contain hemoglobin, which carries oxygen to the body's tissues. anemia can cause a variety of complications, including fatigue and stress on bodily organs.

Anemia can be caused by many things, but the three main bodily mechanisms that produce it are:

• excessive destruction of RBCs
• blood loss
• inadequate production of RBCs

Among many other causes, anemia can result from inherited disorders, nutritional problems (such as an iron or vitamin deficiency), infections, some kinds of cancer, or exposure to a drug or toxin.

What is Cancer?

"Cancer" is an abnormal growth of cells anywhere in the body. It occurs when the genes in a cell allow it to split (make new cells) without control.
There are many kinds of cancer, because there are many kinds of cells in the body, and because there are many genes that control cell growth.
Some cancers form solid growths called tumors. Others, like cancers of the blood (leukemias) travel all over the body.
Cancers may harm the body in two ways. They may replace normal cells with cells that don't work properly, and they may kill normal cells.
Sometimes cancers stay put. Sometimes they spread to nearby organs. Sometimes they shed cells into the bloodstream or lymphatic system and travel to distant parts of the body.
The farther a cancer spreads, the harder it is to control. The distant spread of cancer, called "metastasis," is dangerous, because a number of vital organs may be harmed at once.
Many things may cause cancer by affecting the genes that control cell growth. The most common causes of cancer in Rhode Island are tobacco, unbalanced diets (diets with too much fat and red meat, and not enough fruits and vegetables), and too much sunlight. We can control many causes of cancer by making good choices in our everyday lives.
The National Cancer Institute has a book, Cancer Rates and Risks, which describes the major causes of cancer in the United States. The book refers to causes of cancer as "risk factors for cancer," because "risk" reminds us that getting cancer is "ify," not "certain," when we are exposed to things that may cause cancer.


Highlights
Rhode Island’s Cancer Burdenis a comprehensive report that includes cancer rates (incidence and mortality), trends, and disparities.
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Waht is Aids

A serious (often fatal) disease of the immune system transmitted through blood products especially by sexual contact or contaminated needles.

Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that can lead to acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. Previous names for the virus include human T-lymphotropic virus-III (HTLV-III), lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus (ARV).[1][2]
Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breas milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The four major routes of transmission are unprotected sexual intercourse, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (Vertical transmission). Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world.

Artificial Liver Support System

Is the only treatment for end-stage liver disease, but many patients die before receiving a transplant due to the severe shortage of donor organs. Researchers, therefore, have explored various liver assist technologies, or "artificial livers," to keep patients alive while waiting for a transplant.

San Diego, CA -- January 7, 2009 -- Vital Therapies, Inc. (VTI), a development stage company targeting liver disease, today announced patient enrollment has begun for a randomized, controlled, multi-center, Phase 2 clinical trial that will study the Extracorporeal Liver Assist Device (ELAD) as a treatment for patients with Acute Liver Failure (ALF) under three protocols. The study is open for enrollment at seven U.S. sites, which will be expanded to 15 sites in the U.S. and Europe during the first half of 2009. Six patients have already been enrolled in the first protocol and four patients have been treated under the emergency use Expanded Access regulations.