Gastroenterology

Differential Diagnosis Of Acute Abdominal Pain

Here’s a sordid acronym: BITCH.

Acute abdominal pain

  • Bleeding (haemorrhage)
  • Inflammation
  • Twisting (torsion, leading to ischaemia)
  • Congestion (obstruction)
  • Hole (perforation)

Bleeding

  • Ruptured AAA, ovarian cyst, ectopic pregnancy or abdominal organ
  • Leads to haemoperitoneum, meaning blood in the abdominal cavity

Inflammation

  • -itis of any organ in the abdominal area
  • Just think of the anatomy in the region to come up with possibilities
  • Appendicitis is the most likely surgical cause, while gastroenteritis is a common ailment of the masses

Twisting

  • Sigmoid volvulus
  • Torsion of gonadal structures (ovaries or testes)

Congestion

  • Things that involve blockage
  • Constipation
  • Intestinal obstruction, ureteric obstruction from renal calculus or urinary retention
  • Mesenteric ischaemia

Hole

  • Perforated gastrointestinal structure
  • Gastric or duodenal ulcers

Important Facts For People Who Wear Lingerie And Have Kidneys

Issues With Breast Tissues

Bras haven’t been proven to be useful. One argument is that it’s more of a personal preference or even a fashion statement.

There isn’t much research on this front. But based on the limited evidence out there, bras  are more likely to be harmful if they’re the wrong fit. The nudists win again.

Renal Complications

DKA can lead to AKI.

DKA can lead to lactic acidosis, which can be associated with thiamine deficiency.

Thiamine deficiency less commonly involves vomiting, which can stain clothing. The nudists win again.

References

  1. Mills, D. (2016). Health Effects of Not Wearing a Bra. Retrieved from https://www.healthline.com/health-news/going-braless-wont-hurt-breast-health
  2. Why is BRA important?. (2016). Retrieved from https://smah.uow.edu.au/brl/bra/whyisbraimportant/index.html
  3. Prywes, M. Science Proves That Wearing Bras Is Bad For Your Health. Retrieved from https://www.lifehack.org/336735/science-proves-that-wearing-bras-bad-for-your-health
  4. Hunimed Web Team. (2017). The advantages and disadvantages of wearing a bra. Retrieved from https://www.hunimed.eu/news/advantages-disadvantages-wearing-bra/
  5. Orban, J. C., Maizière, E. M., Ghaddab, A., Van Obberghen, E., & Ichai, C. (2014). Incidence and characteristics of acute kidney injury in severe diabetic ketoacidosis. PloS one, 9(10), e110925. doi:10.1371/journal.pone.0110925
  6. Feenstra, R. A., Kiewiet, M. K., Boerma, E. C., & ter Avest, E. (2014). Lactic acidosis in diabetic ketoacidosis. BMJ case reports, 2014, bcr2014203594. doi:10.1136/bcr-2014-203594
  7. Moskowitz, A., Graver, A., Giberson, T., Berg, K., Liu, X., Uber, A., Gautam, S., … Donnino, M. W. (2013). The relationship between lactate and thiamine levels in patients with diabetic ketoacidosis. Journal of critical care, 29(1), 182.e5-8.
  8. Berkheiser, K. (2018). 11 Signs and Symptoms of Thiamine (Vitamin B1) Deficiency. Retrieved from https://www.healthline.com/nutrition/thiamine-deficiency-symptoms

The Persimmon Principle

As delicious as they might be, persimmons can cause a phytobezoar. This refers to an indigestible clump of fibres that can lead to intestinal obstruction. (Everyone’s least favourite thing, unless you’re super weird!)

That’s an uncommon complication from eating too many of this fruit, not that eating fruit is inherently a bad thing.

Luckily, persimmon phytobezoars can be conquered with Coca-Cola.

It’s drinks such as that which, under normal circumstances, contain an excess of sugar. That’s in contrast to fruit. Ironically, in this case, the roles of causative agent and cure have been reversed.

References

  1. Picco, M. (2017). Bezoars: What foods can cause this digestive problem?. Retrieved from https://www.mayoclinic.org/diseases-conditions/gastroparesis/expert-answers/bezoars/faq-20058050
  2. Naotake Funamizu, Tomotaka Kumamoto, Atsushi Watanabe, Tomoyoshi Okamoto, and Katsuhiko Yanaga (2015) Intestinal Obstruction Caused by Persimmon Bezoar: A Case Report. Int Surg: July-August 2015, Vol. 100, No. 7-8, pp. 1194-1198.
  3. DAVIS C, TARUN D. The Persimmon Bezoar. AMA Arch Surg. 1957;75(2):188–192. doi:10.1001/archsurg.1957.01280140026005
  4. Fengbo Tan, Hongbin Mo, Xiao He, Haiping Pei; An unusual case of gastric outlet obstruction caused by multiple giant persimmon phytobezoars, Gastroenterology Report, , gow042, https://doi.org/10.1093/gastro/gow042
  5. Hayashi, K., Ohara, H., Naitoh, I., Okumura, F., Andoh, T., Itoh, T., Nakazawa, T., … Joh, T. (2008). Persimmon bezoar successfully treated by oral intake of Coca-Cola: a case report. Cases journal, 1(1), 385. doi:10.1186/1757-1626-1-385
  6. Ertuğrul, G., Coşkun, M., Sevinç, M., Ertuğrul, F., & Toydemir, T. (2012). Treatment of gastric phytobezoars with Coca-Cola given via oral route: a case report. International journal of general medicine, 5, 157-61.
  7. Dickinson, K., & Bernstein, J. (2018). If sugar is so bad for us, why is the sugar in fruit OK?. Retrieved from https://theconversation.com/if-sugar-is-so-bad-for-us-why-is-the-sugar-in-fruit-ok-89958

Colon Cancer Polyp Conditions

Familial Adenomatous Polyposis

  • Many benign polyps form in the colon, but they can become malignant if the colon is not removed
  • Average age of affected individual developing colon cancer is 39
  • Mostly commonly, is due to autosomal dominant mutation in APC gene
  • Memory aid: FAP and APC both have 3 letters

Hereditary Non-Polyposis Colorectal Cancer

  • Also called Lynch syndrome
  • Increased risk of colorectal cancer and other cancers
  • Associated with increased risk of endometrial cancer in females
  • Colon polyps can occur earlier than in the general population but not in greater numbers
  • Autosomal dominant inheritance but can be due to mutations in a variety of genes, some of which have 3 or 5 letters
  • Memory aid: the one that’s not FAP

References

  1. Genetics Home Reference. (2018). Familial adenomatous polyposis. [online] Available at: https://ghr.nlm.nih.gov/condition/familial-adenomatous-polyposis#genes [Accessed 22 Jul. 2018].
  2. Genetics Home Reference. (2018). Lynch syndrome. [online] Available at: https://ghr.nlm.nih.gov/condition/lynch-syndrome#genes [Accessed 22 Jul. 2018].

On The Origin Of Faeces

Digestion begins with saliva.

Before food goes through your body and is turned into excrement, the process is begun by amylase.

α-amylase can digest up to 75% of the starch in potatoes and bread before this salivary enzyme is inactivated by stomach acid. That’s more than you would have anticipated, isn’t it?

Yes, α-amylase is that super awkward person at a party who just keeps hanging around and doesn’t know when to leave. Even though you’d expect it to lose its effect once food is past the mouth, it remains there for ages.

In case you’re someone who drools while asleep, the salivary secretion rate is actually 10 times higher when awake and resting than while sleeping. So basically you’re disgusting.

References

  1. Smith, M. E., & Morton, D. G. (2010). The digestive system: Basic science and clinical conditions (2nd ed.). New York; Edinburgh: Churchill Livingstone.