Zollinger-Ellison syndrome

Zollinger-Ellison syndrome defines severe peptic ulcer disease secondary to unregulated gastrin release from a non-beta cell endocrine tumour. It is one type of disease of the gastrointestinal system. The aetiology is 1. Most common site of gastrinoma is in pancreas, 2.Gastrinoma can occur in non-pancreatic sites, 3.More than 60% of these tumours are malignant, 4. Gastrinoma may be a part of multiple endocrine neoplasia. Some clinical features are manifestations of peptic ulcerations but of shorter duration, ulcers are severe can occur at unusual sites like jejunum or oesophagus, bleeding and perforation are common, may present as intractable recurrent ulceration, following surgery for peptic ulcer, diarrhea occurs in nearly 50% cases and about one-third of patients have multiple endocrine neoplasia. Following investigation should be followed for this disease 1. Barium meal shows abnormally coarse gastric folds and ulcers; 2.Endoscopy reveals multiple ulcers at atypical sites; 3.Gastrin level in the blood is raised; 4.Tumour localization by ultrasound, endoscopic ultrasound and CT abdomen; 5.Another method of tumour localization is a radionuclide scan using oestroscan. Some treatments are surgical removal of the tumour whenever possible, Omeprazole can heal the ulcers but in the higher dose and unresponsive patients are treated by total gatrectomy.

Ulcerative colitis

Ulcerative colitis is an inflammatory disease affecting mainly the large intestine, characterized by recurrent mainly of blood diarrhea, and pathologically by diffuse inflammation of colonic mucosa. It is one type of diseases of the gastrointestinal system. Some clinical features are severity of symptoms reflects the extent of colonic involvement and the intensity of inflammation , exacerbations and remissions are characteristic, bloody diarrhea with mucus and pus,abdominal pain especially lower abdominal, symptoms and signs of dehydration and anaemia. Apart from this it also have some others features namely fever ,weight loss ,loss of appetite and incidence of carcinoma colon is high, especially in cases of total colitis ,duration more than 10 years and early age of onset. Some of the Main investigations are anaemia, electrolyte abnormalities, hypoproteinaemia, abnormal liver function tests, barium enema, stool examination etc. To prevent this disease we should follow the following treatments such as parental nutrition through a central venous line in seriously ill-patients, high protein, blood infusions and plasma infusions, correction of dehydration. Following surgical procedure should be taken 1.Emergency surgical procedure is colostomy with ileostomy; the rectum and distal colon being removed at a later stage, 2.Elective surgical procedure is total proctocolectomy with ileostomy.

Syncope

Syncope comprises generalized weakness of muscles, loss of postural tone, ability to stand upright and a loss of consciousness. It is one type of disease of cardio vascular system. Various types of syncope are vasovagal syncope, Cardiac syncope, and orthostatic syncope. In vasovagal syncope mechanisms includes reflex slowing of heart mediated through vagus, and marked fall in arterial pressure and peripheral vascular resistance and it causes emotional stress, warm overcrowded room, sudden pain, mild blood loss, anemia fever and fasting. Clinical features include a prodromal phase characterized by nausea, sweating, yawning, tachypnoea, weakness and confusion. Cardiac syncope is due to a sudden reduction in cardiac output. This can occur when the heart is beating too fast or too slow when it is not beating at all. Common causes of cardiac syncope are complete heart block, primary pulmonary hypertension, tetralogy of fallot, aortic stenosis, sick sinus syndrome, paroxysmal tachycardias. Orthostatic syncope occurs when the person suddenly gets up from a lying down position or stands still for a long time. Basic mechanism is postural hypotension resulting from loss of vasoconstrictor reflexes in the lower limb vessels. Common causes are hemorrhage, drugs , physiological, idiopathic orthostatic hypotension and diabetic neurotheraphy and tabes dorsalis.

Threadworm infections

Enterbiasis is an intestinal infection of humans caused by Enterbius vermicularis. The adult female averages 10mm in length and the male 3mm. It is one type of diseases due to infections. They are seen in the caecum, appendix, and the adjacent parts of the colon. The gravid female migrates through the anal canal at night, deposit her eggs on the perianal skin and dies. These eggs are ingested and the larvae released in the small intestine. The larvae migrate down the bowel lumen to reach the caecum and develop into adult worms. Clinical features are follows 1.Humans are usually infected by the direct transfer of eggs from the anus to the mouth by way of contaminated fingers;2.Retroinfection occurs when the eggs latch in the perianal area and the larva migrate back into the bowel lumen; 3. Common symptom is perianal itching especially at night being related to the migration of the gravid female; 4.Other symptom may include irritability, insomnia and enuresis. Effective treatment such as two highly satisfactory drugs is available. Pyrantel pamoate given in a single oral dose of 11mg/kg is the treatment of choice. During this period all night clothes and red linen are laundered and finger nails must be scrubbed before meals.