Amoebiasis

Amoebiasis is an infective disease caused by the Entamoeba group, mainly Entamoeba histolytica. All age groups are affected, with no gender differences. prevalence of infection varies with level of sanitation, and generally higher in tropical and sub-tropical regions than in temperate climates. Cysts of the organism survive for upto 1month in soil and for upto 45 minutes under fingertips.

The disease present with no, mild or severe symptoms. It includes two types of manifestations:- intestinal and extra-intestinal. The incubation period may last from days to weeks.

Ayurvedic View

Due to the improper and untimely intake of food, ingestion of contaminated food and water, abnormal quantity and quality of intake;

Ap dhatu (ie body fluids or liquid tissues) in the Gastro-intestinal tract profusely increases causing the diminution of strength of Agni (digestive power). This undigested form of feces is strainfully expelled out by the Vata dosha.

It can be associated with pain, burning sensation, mucus-mixed feces or mixed with blood, according to the aggravated Dosha involved.

Pathophysiology

The disease manifests when the causative organism comes in contact with the cells lining the intestine. Caecum is the first part to be affected. The organism secretes the enzymes that destroy cell membranes and proteins. This process leads to digestion of human tissues, resulting in flask-shaped ulcers in the intestine.

If the parasite reaches the bloodstream it can spread throughout the body, most frequently ending in the liver where it causes Amoebic Liver Abscess.

Clinical Features

1. Intestinal features:-

  • Stomach cramps
  • Nausea and anorexia
  • Blood in stool
  • Diarrhoea
  • Abdominal tenderness
  • Fever
  • Weight loss

Signs & Symptoms

2. Extra-intestinal features:-

  • Liver
  • Lungs
  • Brain

Clinical Manifestations

The disease clinically manifest in two ways. They are:-

  • Acute Amoebic Dysentery
  • Chronic Amoebic Dysentery
    • Acute Amoebic Dysentery
      • Onset is abrupt
      • High fever
      • Nausea
      • Profuse bloody diarrhoea
      • Tenesmus (painfull straining at stool and urination)
      • Abdominal cramps
      • Perforation may result
    • Chronic Amoebic Dysentery
      • Onset is gradual
      • Vague abdominal pain
      • Anorexia
      • Weight loss
      • Intermittent diarrhoea with foul smelling stool
      • Constant fatigue and lassitude
      • Periods of relapse and remission occur and lasts for weeks to months
      • Liver may be enlarged

Transmission

  • Feaco-oral route:-
    • Contaminated water and food
    • Direct hand to mouth contact
  • Contamination of food by flies, cockroach, rats etc
  • Sexual contact:-
    • Via oro-rectal contact
    • Veneral transmission among homo-sexual

Factors Contributing To Infection

  • Stress
  • Immuno-deficiency
  • Alcoholism
  • Malnutrition

Diagnosis

  • Sigmoidoscopy
  • If asypmtomatic:-
    • By finding cyst sheds in stool

Crohn’s disease

Crohn’s disease is a chronic inflammatory disease of the Gastro-intestinal tract. Inflammation extends all the way through the intestinal wall from mucosa to serosa. Generally it affects the terminal ileum, but can affect any part of the intestine. Infact, it may involve any portion of the GIT from mouth to anus. ‘Skip lesions’ are one of the important features of the disease.

Crohn’s disease is caused by a combination of environmental, bacterial and immune factors in genetically susceptible persons. It tends to start at young age, although it can occur at any age. Both genders are equally affected. Any patient who present with triad of colicky pain, weight loss and diarrhoea may be suspected to be suffering from Crohn’s disease.

Ayurvedic View

Due to the aggravated and vitiated Doshas, and also due to emotional stress; the Agni gets affected causing the impaired functioning of digestive power. This causes expulsion of foul smelling, semi-digested and abdominal pain. This results in decreased level of metabolism and absorption causing gastric disorders and ill-health.

Causes

The actual cause is unknown. But evidences have shown that the disease is associated with immunological disturbances. Some other causes may be enlisted as:-

  • Inherited metabolic defects
  • Lymphatic obstruction
  • Trauma
  • Genetic factors such as Turner’s Syndrome
  • Absorption of toxic substances
  • Smoking
  • Emotional stress – in initiation and perpetuation of the disease

Signs & Symptoms

  • Vague right upper abdominal pain
  • Spider-web like blood vessels over abdomen
  • Nausea and vomiting
  • Diarrhoea
  • Yellowish discolouration of skin
  • Accumulation of fluid in peritoneal cavity
  • Edema over lower limbs

Clinical Features

The disease manifests in two ways:-

  • Intestinal
  • Extra-intestinal

Intestinal Manifestations

  • In about 10% patients – onset is acute
  • Mid-abdominal pain
  • Low-grade fever
  • Nausea and vomitting
  • Frothy and foul smelling stools
  • Pain often mimics acute Appendicitis
  • Presence of Aphthous stomatitis in mouth
  • Weight loss
  • Anemia
  • Anal lesions includes anal fissure, fistula-in-ano, ischio-rectal abscess
  • Bloody stools are rare

Extra-intestinal Manifestations

  • Skin :- erythema nodosum, pyoderma
  • Joints :- arthritis, Ankylosing spondylitis
  • Kidney :- nephrolithiasis, hydronephrosis

Duodenal ulcers

Duodenal ulcers are the ulcers formed in the initial parts of intestine, especially within the first 2cm of duodenum. The average sizes of ulcers are about 1cm in diameter. The features of duodenal ulcers are almost similar to acute gastric ulcers. The ulcer is of punched-out appearance.

The young or mid-adult (25-40 years of age) groups are most prone to this disease. It is more commonly seen among male population. The pain is severe and spasmodic in nature.

Ayurvedic View

Indulgence in food and activities which causes the increase of all the three doshas produce a severe colicky pain, which occurs soon after the digestion of food.

Causes

  • Common causes :-
    • Helicobacter pylori
    • NSAIDs
  • Less common causes :-
    • Liver Cirrhosis
    • Tobacco smoking
    • Crohn’s disease
    • Psychological stress

Clinical Features

  • The symptoms of duodenal ulcers would initially be relieved by a meal. The pain manifest mostly 2-3 hours after the meal.
  • Bloating and abdominal fullness.
  • Some amount of weight gain maybe expected as the person is tend to take food more frequently.

Diagnosis

Diagnosis is mainly established on the basis of the characteristic symptoms.

  • Examination of blood :- hemoglobin level is tested
  • Examination of stool :- for occult blood
  • Endoscopy
  • Radiological :- barium meal X-ray

Gastritis

Gastritis is defined as the inflammation of the stomach lining. It is one of the most common disease affecting the stomach. It is believed to affect more than half the people around the world. As the age increases, the chance of getting affected by the disease is more likely.

Ayurvedic View

Intake of food which causes the increase and vitiation of all the three doshas which in turn causes a type of colicky pain in the abdominal region, along with nausea and vomiting.

Causes

  • Common causes :-
    • Helicobacter pylori
    • Constant use of NSAIDs
  • Less common causes :-
    • Crohn’s disease
    • Auto-immune factors
    • Excess consumption of alcohol
    • Intake of cocaine
    • Radiation therapy
    • Smoking
    • Psychological stress

Risk Factors

  • Hepatic failure
  • Renal failure
  • Sepsis
  • History of peptic ulcer
  • Multiple trauma
  • Organ transplant recipients

Clinical Features

  • Most common symptom is abdominal pain.
  • Other symptoms include :-
    • Nausea
    • Vomitting
    • Bloating
    • Heartburn
    • Pallor
    • Epigastric tenderness

Diagnosis

  • Blood tests for detecting :-
    • Blood Cell Count
    • Blood Cell Count
  • Stool test :-
    • To detect blood in stools
  • Endoscopy
  • Stomach tissue biopsy

Pancreatitis

Pancreatitis can be defined as the inflammation or infection of pancreas. When pancreas is inflamed, the hypersecreted enzymes damages the tissues that produce them. The disease manifests in two ways :- acute and chronic pancreatitis. It is more common among males than in females, and the peak age of manifestation is between 30-40. About 90% of acute pancreatitis is secondary to acute cholelithiasis.

Ayurvedic View

Indulgence in foods which are hard to digest, fatty foods taken frequently; make for increase of kapha, which inactivates the digestive fire. This causes difficulty in digestion, nausea, vomiting, loss of appetite and heaviness. The feces becomes inadequately processed, mucus-mixed and heavy.

Causes

  • Mainly due to history of gallstones
  • Excess consumption of alcohol
  • Congenital malformation of pancreas
  • Viral or bacterial infection
  • Conditions like hyperlipidemia, peptic ulcer

Signs & Symptoms

  • Severe and sudden upper or left-upper abdominal pain which radiates to the back
  • Nausea and vomiting
  • Symptoms relieves on vomiting
  • Low grade fever
  • Discolouration of abdominal wall
  • Respiratory and heart rates are usually elevated

Diagnosis

  • Physical examination
  • Laboratory investigations
    • serum amylase
    • serum lipase
    • blood glucose
    • triglycerides
  • Radiological examination :-
    • CT csan
    • MRI
    • Abdominal/endoscopic ultrasound

Ulcerative colitis

Ulcerative colitis is an idiopathic disease of the colon, confined to the mucosal and sub-mucosal layers of the colonic wall. The incidence is more in women than in men, and it occurs most likely between the age of 20–30. It is found to be more fatal if affects the elderly than the young. The disease occurs in a relapse and remission manner.

Ayurvedic View

The dosha, Vata, among the Tridosha (Vata, Pitta, Kapha) gets aggravated which affects the Agni (digestive power) and the Koshta, mainly affecting the Pakvashaya region. Thus the functioning of Purishavaha Srotas is impaired causing symptoms like diarrhoea. This condition if left untreated may lead to conditions like Ulcerative colitis.

Causes

The actual cause of the disease is unknown. But several theories have been put forward. The cause maybe :-

  • Infective
  • Nutritional
  • Immunological
  • Psychosomatic

The possibility that Ulcerative colitis is an Auto – immune disease is also one of the important theories.

Signs & symptoms

  • Incessant diarrhoea containing blood, mucus , pus
  • Weight loss
  • Fatigue
  • Rectal pain
  • Fever
  • Decreased level of Serum albumin

The condition also includes additional symptoms like :-

  • Nausea
  • Vomiting
  • Joint pain and swelling

Diagnosis

  • Straight X-ray
  • Barium meal enema
  • Endoscopy (sigmoidoscopy, colonoscopy)
  • Rectal biopsy

Gastro-esophageal reflux disease

Gastro-esophageal reflux disease is a digestive disorder, also known as Acid Reflux, that affects the lower esophageal sphincter. It occurs when the sphincter is weak or relaxes inappropriately, and thus the stomach contents return back to esophagus. The disease is often chronic and relapsing. Both the genders are equally affected.

Risk factors include obesity, smoking, Hiatus hernia, pregnancy, alcohol consumption etc. Severity of the disease depends on the lower esophageal sphincter dysfunction, the type and amount of fluid brought up, and the neutralizing effects of saliva.

Ayurvedic View

Intake of food which are very sour, stale, and which those which causes burning sensation in the chest region. This causes the increase in pitta among the tridoshas, leading to this disease.

Causes

The main cause for the reflux is the failure of lower esophageal sphincter.

The factors contributing to GERD includes :-

  • Obesity
  • Hiatus hernia
  • Drinks with caffeine
  • Increased blood calcium levels
  • Medications with calcium-channel blockers
  • Certain foods :-
    • Citrus foods
    • Fried and fatty foods
    • Spicy foods

Clinical Features

Most common feature of the disease is heartburn.

Other features include:-

  • Belching
  • Waterbrush (sudden excess of saliva)
  • Regurgitation and sour taste in mouth
  • Dry cough
  • Chest pain
  • Bad breath
  • Chronic sore throat
  • Inflammation of gums

Diagnosis

  • Clinically the disease is diagnosed with classic symptoms of heartburn and regurgitation.
  • Upper gastro-esophageal endoscopy