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Bleeding per rectum, unexplained anemia, weight loss Nevertheless, colonoscopy remains a procedure requiring Postpolypectomy surveillance manual dexterity and concentration. The experienced examiner Prevention/aftercare colorectal carcinoma can now successfully reach the cecum in 98% of patients and in Pathological thickening of the colon wall detected by other most cases can also reach the terminal ileum. Difficulties can be imaging procedures posed by a mobile and elongated sigmoid colon or transverse Primary tumor search with metastasizing malignancy, colon as well as by postoperative intestinal fixations and other if resulting therapeutic measures adhesions. Rapid advancement and inspection up to the cecum is desirable, considering the discomfort to the patient, though a Figure 1. The diagnostic spectrum of colonoscopy encompasses examination of the not only macroscopic assessment of the condition of the mu left lower abdomen. The instrument channel of the flexible endoscope allows for therapeutic treatment during the examination to an extent not possible with any other imag I ing technique. Polyps, for example, can be removed at first diag nosis and bleeding can be stopped immediately. Thus, colonoscopy is a technically demanding examination procedure with a high clinical yield combined with the capabil ity of therapeutic intervention. An assessment of the condition of the colonic mu those aged 55 and over in the general population (14). Changes in bowel habits and an well, total colonoscopy has proved itself over sigmoidoscopy increasing tendency toward constipation are cause for perform and Hemoccult testing (11) (Tab. Only in a limited number of situations do the ing techniques such as sonography (Fig. Contraindications include suspected intestinal perfora cal finding is an indication for colonoscopy that often can pro tion, imminent risk of perforation accompanying acute diver vide greater accuracy and allows taking a biopsy. The overall condition of the patient should always be Early detection and cancer prevention. Colonoscopy is becoming assessed to determine whether he could tolerate the physical increasingly important for early detection and the prevention of strain of preparing for colonoscopy and endoscopy, including colorectal carcinoma in the asymptomatic general population. Colonoscopy in patients with a recent According to the guidelines established by the German Federal myocardial infarction is associated with a higher rate of minor Committee of Doctors and Health Insurers (Bundesausschuss der cardiovascular complications compared with control patients. Acute diverticulitis Deep ulcerations 1 Severe ischemic necroses Complications and Risks Fulminant colitis Cardiopulmonary decompensation Perforation, bleeding, and infection. Endoscopy of the colon en tails risk of perforation, injury to blood vessels causing bleeding, I and infection (Figs. The rate of complications can be minimized if the examiner takes precautions such as advancing the instrument only under conditions of high visibility. Comparing diagnostic and therapeutic colonoscopy (1, 4), statistics indicate that, with a total morbidity of 0.
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Corynebacterium diphtheriae, Clostridium tetani, Actinomyces spp, and Nocardia brasiliensis c. Treponema pallidum (syphilis), Borrelia burgdorferi (Lyme disease), and Leptospira f. Trypanosoma cruzi (Chagas disease), Toxoplasmosis gondii, Plasmodium spp (malaria), and Leishmania spp b. Echinococcus granulosus, Trichinella spiralis, Schistosoma spp, and Strongyloides stercoralis 4. Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, and Sporothrix schenckii B. Some agents that have a direct toxic effect on the myocardium include: alcohol, arsenic, anthracyclines (cancer chemotherapy), carbon monox ide, copper, iron, lead, and cocaine. Some agents include antibiotics (most commonly penicillins, cephalosporins, tetracy clines, and sulfonamides), diuretics, lithium, tetanus toxoid, benzodiazepines, tricyclic antidepressants, and insect or snake bites. Rheumatoid arthritis, systemic lupus, Kawasaki dis ease, Crohn disease, ulcerative colitis, scleroderma, dermatomyositis, myas thenia gravis, and sarcoidosis. While a number of infectious and non infectious causes are associated with myocarditis, viral myocarditis predominates as 8. This phase is initiated in the rst 2 weeks after infection by introduction, or reactivation, of a viral pathogen in a host followed by hema togenous or lymphangitic spread to reach the myocardium (this phase is also initiated by direct or indirect cardiac toxins). Viral or other microbial patho gens gain entry followed by proliferation within the myocytes resulting in cyto pathic effects, myocyte death, release of cytokines/chemokines, and activation of the innate immune response. Most patients eliminate the viral or microbial pathogen, have a decline in immune response, and recover cardiac contractile function. This phase is characterized as a persistent immune response in some patients associated with myocardial brosis and remodeling leading to dilated cardiomyopathy. The clinical presentation var ies among adults and children but can range from an asymptomatic course to a fulminant illness associated with cardiogenic shock or sudden death. While the clinical manifestations are variable, frequently adults experi ence a viral prodrome characterized by fever, maculopapular rash, myalgias, arthralgias, fatigue, dyspnea, palpitations, decreased exercise tolerance, or gas trointestinal symptoms. May occur as the result of new-onset atrial or ven tricular arrhythmias or atrioventricular conduction blocks. In general, newborns and infants more often present with a fulminant illness than older children (age greater than 2 years) and adults. While the most common symptoms are respiratory distress and lethargy, additional symptoms may include cough, chest pain, abdominal pain, fever, myalgia, fatigue, anorexia, malaise, and anxiousness. Myocarditis is a diagnosis often missed; therefore, this illness should always be included in the differential diagnosis when evaluating a patient with chest pain, heart failure, or cardiac arrhythmia. The history should focus on the timing of events, recent infections, vaccination history, comorbid illnesses, occu pational or environmental exposures, medications, and recent travels. A complete examination should be performed in the evaluation of myocarditis; however, the examination should also emphasize: 1. Cardiovascular examination (to detect murmurs, S3 or S4 gallop, pericardial friction rub, tachycardia, or laterally displaced point of maximal impulse).
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Although diverticula of colon are commonly left sided in Asian people 75 % of cases are right-sided. Diverticulitis, an inflammation of the diverticula, is considered to be disease of elderly no meter of the gender. Diverticulitis is characterized by recurrence (20 25% recurrence rate) and evolution of fistulas and adhesions. Studies has shown that patients with more diverticula have more often the inflammation; in 15-20 % of those. Since lifestyle and dietary modifications are one of the reasons for occurrence of diverticula and subsequent inflammation logically is more prevalent in Western countries. Appendicitis is an inflammation of the inner lining of the appendix and is one of the most common causes of acute abdomen usually ending by urgent surgical procedure. In pediatric population occurs more likely in 6-10 years because of lymphoid hyperplasia and later in the 10 to 19 year-old age group. In cholestatic diseases (such as primary biliary cirrhosis, drug induced diseases, and malignant obstructions) predominate the features of inhibition of bile flow, and in hepatocellular (such as viral hepatits and alcoholic liver disease) predominate the features of liver injury, inflammation and necrosis. Hepatitis, an inflammation of the liver parenchyma may result from various causes, both infectious (viral, bacterial, fungal, and parasitic organisms) and noninfectious (alcohol, drugs, autoimmune diseases, and metabolic diseases). Acute viral hepatitis is a systemic infection that predominately affects the liver and is caused by many different viruses but in the majority of cases is caused by hepatitis virus A, B and C virus. Although all viruses have an acute form, in the clinical setting more important is the incidence and prevalence of the chronic hepatitis. Classification and epidemiology of gastrointestinal diseases intravenous drug users. More than 900 drugs and medications in general have been reported to cause liver injury, and drugs account for 20-40% of all instances of fulminate hepatic failure. Approximately 75% of the idiosyncratic drug reactions result in liver transplantation or death. Autoimmune hepatitis is a chronic disease of unknown cause, characterized by continuing hepatocellular inflammation and necrosis and tends to progress to cirrhosis. The diagnosis is based on present immune serum markers, liver specific and non liver specific autoantibodies and is often associated with other autoimmune diseases. Women are often more affected that men (in 80% of cases), and the disease has a bimodal age distribution with the first peak at 10-20 years of age and a second at 45-70. The prevalence of alcoholic hepatitis was found to be approximately 25-30%, although the true prevalence is unknown because patients with milder forms can be asymptomatic or never seek medical attention. The long-term prognosis of individuals with alcoholic hepatitis depends heavily on whether patients have established cirrhosis and whether they continue to drink, patients who have had a major complication of cirrhosis have a 5-year survival of less than 50%. Alcoholic hepatitis now represents a leading indication for liver transplantation (16). Epidemiology has not been studied systematically, it is reported to be more prevalent in the Northern countries with a prevalence ranging from 2. About 70-90% of patients are women in their middle age with a mean of 39 years, but men are more likely to develop hepatocellular carcinoma.
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The adult worms reside in the colon and caecum, the anterior portions threaded into the superficial mucosa. After ingestion, infective eggs hatch in the duodenum, releasing larvae that mature before migrating to the large bowel. Large worm burden may be associated, especially in children, with diarrhea of long duration, dysentery, mucoid stools, abdominal pain 38 Internal Medicine and tenderness, dehydration, anemia, weight loss and weakness. Diagnosis: Diagnosis is reached by demonstration of characteristic lemon-shaped whip worm eggs. Treatment: Trichuriasis can be effectively treated with mebendazole or albendazol. Mebendazole 100mg twice daily for 3 days or Albendazole 4mg/kg as a single dose 3. Tiology and development:-Enterobius vermicularis is a spindle-shaped parasite of humans. The gravid female worm migrates nocturnally out into the perianal region and releases upto 10, 000 immature eggs. Self-infection results from perianal scratching and transport of eggs to the hands or nails and then to mouth. Clinical fearures: While pinworm infection may be asymptomatic, the most common symptom is the intense nocturnal pruritus ani. This is because of the cutaneous irritation in the perianal region produced by the migrating gravid females and the presence of eggs. Intense pruritus may lead to dermatitis, eczema and severe secondary bacterial infections of the skin. Rarely, pinworms may invade the female genital tract, causing vulvovaginits and pelvic granulomas. Diagnosis: Eggs are not found in the stool because they are released in the perineum. Therefore, eggs deposited in the perianal region are detected by the application of clear 39 Internal Medicine cellulose tape to the perianal region in the morning. Treatment: Keeping personal hygiene is part of the treatment; patients should keep their nails short and wash hands with soap and water after defecation. A single dose of mebendazole 100mg, or pyrantel pamoate10mg/kg, both repeated after 2 weeks is effective. Design appropriate methods of prevention and control of tissue nematodes Tissue nematodes include Trichinosis, Visceral and Ocular larva migrans, Cutaneous larva migrans, Cerbral angiostrogliasis and Gnathostomiasis. Epidemiology:-It is widely spread throughout the temperate regions of the world wherever pork or pork products are eaten. It is enzootic in wildlife in Africa and man is involved sporadically by eating fresh or inadequately cooked pork. Development:-The worm gains entrance to the digestive tract as larvae encysted in muscle tissue.