Patient Info

Cirrhosis is the term used to describe a liver that has been severely scarred, and is no longer able to perform its normal functions.

CAUSES
Longstanding alcohol abuse
Chronic hepatitis (B or C )
Non-alcoholic steatohepatitis (a condition in which fat and scar tissue accumulate in the liver)
Hemochromatosis ( iron overload  in the body)
Autoimmune hepatitis (a condition in which the body’s immune system recognizes the liver as foreign)
Primary sclerosing cholangitis (a disease of the large bile ducts)
Primary biliary cirrhosis (a disease of the small bile ducts)
Wilson’s disease (a rare disease of copper metabolism)
SYMPTOMS
Fatigue
Malnutrition
Jaundice (yellowing of the skin and eyes)
Variceal bleeding ( Varices are abnormal dilated veins in any part of gastrointestinal tract)
Fluid  accumulation in the legs (edema) and abdomen (ascites)
Spontaneous bacterial peritonitis-infection in ascitic fluid
Easy bruising and bleeding ( secondary to decreased platelets and clotting factors)
Hepatic encephalopathy -confusion, delirium, and even coma
People with cirrhosis are at increased risk for developing liver cancer (hepatocellular carcinoma).
DIAGNOSIS
Laboratory tests often reveal abnormal blood chemistries, low albumin level and  platelet counts, and increased bilirubin.
Special blood tests help determine the exact cause of cirrhosis.
Imaging studies such as CT scan, ultrasound, or MRI show small shrunken liver and associated findings such as varices , ascites.
Liver biopsy is the definitive test to diagnose cirrhosis.
TREATMENT
Abstinence from alcohol and avoidance of medications that can hurt the liver are of primary importance in preventing further damage to the liver
Early diagnosis and treatment of the underlying cause of liver damage  can reverse cirrhosis.
Liver transplantation, a procedure in which the diseased liver is replaced with a new healthy liver is a major advance in treatment of Cirrhosis / End stage Liver disease

Measures to decrease complications include
beta blockers to reduce the pressure inside varices to decrease the risk of variceal bleeding
Early diagnosis and treatment of  spontaneous bacterial peritonitis
vaccinations against hepatitis A and B
pneumococcal vaccine and yearly influenza vaccine
For more information please see
www.liverfoundation.org
www.nlm.nih.gov/medlineplus/healthtopics.html
www.gastro.org/wmspage.cfm?parm1=681
www.hepnet.com
www.hepb.org

Celiac disease ( also known as gluten sensitive enteropathy, celiac sprue, nontropical sprue) is a condition in which the immune system reacts abnormally to a protein called gluten which  is found in wheat, rye and barley. In celiacs exposure to gluten damages the inner lining of the small intestine causing malabsorption.
Genetic factors are  important since celiac disease occurs primarily in certain groups of people, specifically whites of northern European ancestry. People who inherit specific genes that regulate the immune response (HLA DQ2 and HLA DQ8) have a higher risk of celiac disease than people without these genes

Overall prevalence is approximately 1 in 125 to 250 people in the United States.

SYMPTOMS

Anemia
Abdominal discomfort
Excessive gas
Diarrhea
Weight loss
Osteoporosis
Short stature
Mood problems
Symptoms due to nutrient malabsorption of iron, folic acid, vitamin B12, calcium, vitamin D, or vitamin K.

Associated conditions include

Dermatitis herpetiformis
Neuropsychiatric problems
Down syndrome
Selective IgA deficiency
Type I diabetes mellitus
Thyroid disease
Infertility
Cardiomyopathy
Myocarditis
Arthritis
Kidney disease
Glossitis
Pancreatitis
Liver disease.

Complications of Celiac disease include

Refractory sprue
Lymphoma

DIAGNOSIS
Celiac disease can be difficult to diagnose because the signs and symptoms are similar to other gut ailments.
Blood tests -IgA tissue transglutaminase antibody levels are high in > 98 % of patients with this disease.
Before having this test, it is important to eat a normal diet, including foods that contain gluten.
Endoscopy reveals loss of proximal small bowel  folds, visible fissures, nodular or mosaic appearance or the folds may be scalloped.
Small intestine biopsy shows loss of villi.

TREATMENT

Complete elimination of gluten (wheat, rye, and barley) is the mainstay of treatment.
Oats should be avoided unless the package specifically indicates that the product is gluten free and was processed in a gluten free facility. Soybean or tapioca flours, rice, corn, buckwheat, and potatoes are safe.
For more information please see
www.nlm.nih.gov/medlineplus/healthtopics.html
www.celiac.org
www.csaceliacs.org
www.celiac.com
www.glutenfree.com/
www.gfutah.org

The most common cause of Barrett’s esophagus is longstanding acid reflux disease.
Barrett’s esophagus occurs when the normal  squamous cells that line the lower part of the esophagus are replaced by an abnormal, intestinal-type epithelium

In those with chronic GERD symptoms- long segment Barrett’s esophagus ( > 3cms in length)  is  seen in 3 to 5 percent and  short-segment Barrett’s esophagus ( < 3 cm) in 10 to 15 percent .
Barrett’s esophagus is a predisposing factor for esophageal adenocarcinoma.

Endoscopy with biopsy of the abnormal looking area is required to make a definitive diagnosis.

Also see ACID REFLUX

For more information please see
www.barrettsinfo.com
http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm

The pancreas is an elongated organ that lies in the back of the mid-abdomen that is responsible for producing digestive juices and certain hormones, including insulin.
Acute pancreatitis refers to inflammation of the pancreas, causing a sudden onset of severe abdominal pain.
Most attacks of acute pancreatitis do not lead to complications.
In a small proportion of people, acute pancreatitis  can be serious needing hospitalization.

CAUSES

Gallstones and  heavy alcohol consumption are the common causes in US.
Other causes include medications, genetic diseases, infectious agents, endoscopic procedures involving the pancreatic and bile ducts etc.

SYMPTOMS

Sudden, constant pain associated with nausea and vomiting  in the upper part of the abdomen is the  hallmark of acute pancreatitis.

DIAGNOSIS

Based on medical history, physical examination, and the results of specific diagnostic tests such as serum amylase and lipase.
Computed tomography scan is a good test for diagnosing acute pancreatitis
TREATMENT
Treatment usually requires hospitalization for at least a few days. The specific treatment measures used depend upon whether a person has mild or moderate to severe pancreatitis.

Antibiotics, drugs to control the pain and intravenous fluids are commonly used.

Laparoscopic cholecystectomy is recommended to prevent   recurrence of gallstone pancreatitis.

For more information please see
www.gastro.org
www.acg.gi.org
www.pancreasfoundation.org

The esophagus is a tube like structure approximately 10 inches long. It is  made of tissue and muscle layers that expand and contract to propel food  into the stomach . At the lower end of the esophagus, there is a circular ring of muscle that acts like a valve called the lower esophageal sphincter (LES). After swallowing, this valve relaxes to allow food to enter the stomach and then contracts to prevent the back-up of food and acid into the esophagus. Acid reflux occurs when the LES is weak, allowing  stomach acid to wash back into the esophagus.

Acid reflux  ( defined  as at least once a week  heartburn and/or acid regurgitation) is seen in  10 to 20 percent  of people in the western world.

Symptoms
Heartburn / Regurgitation
Non-burning chest pain
Difficulty or painful swallowing
Hoarseness of voice
Persistent sore throat
Chronic cough
New onset asthma, or asthma only at night
Sense of a lump in the throat
Worsening dental disease
Recurrent pneumonia
Chronic sinusitis

Diagnosis
GERD is usually diagnosed based upon symptoms and the response to treatment with acid blockers.

Endoscopy is indicated in those with:
Longstanding acid reflux ( especially whites >50 yrs of age)
Difficulty or pain with swallowing (feeling that food gets “stuck”)
Unexplained weight loss
Bleeding (vomiting blood or dark-colored stools)

Other tests include ambulatory esophageal pH study ( directly measures esophageal acid exposure) and  esophageal manometry ( measures the muscle contractility in esophagus)
Treatment
In people who have symptoms of reflux but no evidence of complications, a trial of treatment with lifestyle changes and medications, are often recommended. Available medications include antacids, histamine antagonists, proton pump inhibitors. Surgery – usually a Nissen fundoplication- is indicated in some patients.

COMMONLY USED DRUGS
H2 RECEPTOR ANTAGONISTS
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

PROTON PUMP INHIBITORS

Omeprazole ( Prilosec )
Esomeprazole (Nexium)
Pantoprazole (Protonix)
Rabeprazole  (Aciphex)
Lansoprazole ( Prevacid)

For more information please see
www.gastro.org/public/digestinfo.html
www.niddk.nih.gov/health/digest/pubs/heartbrn/heartbrn.htm

www.gerd.com

http://www.acg.gi.org/acg-dev/patientinfo/frame_giproblems.html