Intestinal Obstruction

A complete or partial blockage of the bowel thereby preventing intestinal content to move through is termed as intestinal obstruction. The bowel comprises the large intestine and the small intestine. When there is a block in either of them, the condition shows up. Intestinal content like fluids, food and gas do not pass through completely or partially due to this condition.

Intestinal obstruction is also known as paralytic ileus, bowel obstruction or colonic ileus. The blockage or obstruction may cause pain that is intermittent. If left untreated, intestinal obstruction may lead to death of those parts of the intestine that are blocked leading to further complications. However if treated on time, intestinal obstruction can be treated effectively.

What causes intestinal obstruction?

Common causes for intestinal obstruction:

• Inflammatory bowel diseases such as Crohn's disease
  
  
• Tumors in the small intestine
  
  
• Intestinal adhesions, bands of fibrous tissue in the abdominal cavity that are formed after the pelvic or abdomen surgery.
  
  
• Intussusception
  
  
• Volvulus i.e. twisted intestine.

Mechanical causes for intestinal obstruction arise from

• Hernia
  
• Tumor, Colon cancer
  
• Stricture, narrowing of the colon caused by inflammation or scarring.
  
• Diverticulitis
  
• Impacted stool, noticed in people who get constipated for long periods.
  
• Post surgery scar tissues or adhesions.
  
• Gallstones in a few cases
  
• Inflammatory bowel diseases such as Crohn's disease.

Paralytic ileus or pseudo-obstruction is a major cause of intestinal obstruction in children and infants. Conditions that cause paralytic ileus include:

• Complications from an abdominal surgery or pelvic surgery.
  
• Kidney or lung disease
  
• Bacteria or virus that cause intestinal infections
  
• Decreased blood supply to the intestine
  
• Abdominal infections like appendicitis
  
• Chemical, mineral or electrolyte imbalance
  
• Substance abuse like use of narcotics
  
• Muscle and nerve disorders like Parkinson's.

Symptoms include abdominal pain and cramping, distention and bloating. There is reduced appetite and vomiting. An obstruction in the intestines can lead to either constipation, diarrhea or flatulence. After physical examination, Xray or CT scan of the abdomen might be suggested as also . In some cases, an enema or stent is required to open up a partial blockage. Nasogastric tube (tube from nose to stomach) is passed so as to relieve abdominal swelling and vomiting. Volvulus of the large bowel may be treated by passing a tube into the rectum.

Erythema Nodosum

Inflammation of the skin that shows up as painful reddish tender lumps is called Erythema nodosum. This inflammation is usually located in a part of the fatty layer of skin (subcutaneous fat). The size of the lump could vary in size from 1 to 5 cm. The inflammation causes nodular swelling. The inflammation remains for about a week and then becomes flat leaving behind a bruised appearance. They usually show up on the shins (front portion of the legs, just below the knee). Erythema nodosum is a type of panniculitis, i.e. inflammation that can cause nodules below the surface of the skin. The condition is more common among youngsters aged between 12-20 years.

Erythema nodosum settles down on its own after a period of three to six weeks. It may leave behind a temporary bruised appearance or a chronic indentation in the part where the fatty layer has been injured. Though the condition is annoying and painful, the condition does not cause any damage to the internal organs of our body. In adults, the condition is more often seen in women than in men. In kids, it affects boys and girls equally. In a few people the trigger can be identified and in yet a few it cannot be identified. However identifying the trigger becomes very important as it needs to be treated.

Erythema nodosum causes

Erythema nodosum may show up on its own or may occur in association with other conditions. In about 30-50% of cases, the cause is unknown. However the common triggers that may cause Erythema nodosum include:

• Step throat (streptococcal infection) in adults and kids
  
• Fungal diseases
  
• Tuberculosis
  
• Cat scratch disease
  
• Few medications like penicillin, oral contraceptive, Hepatitis B vaccination, etc
  
• Sarcoidosis
  
• Inflammatory bowel diseases
  
• Behcet's disease
  
• Pregnancy
  
• Certain types of cancers like lymphoma, leukemia, etc

Erythema nodosum symptoms

• Painful nodules are commonly seen on the shin and sometimes on the arms, thighs and trunk of the body. The nodule when it first appears is red, hot and firm to touch and becomes flat over a few days. It appears as bruise that is blue in color and later turns yellowish as it fades. A person may develop just a couple of nodules or much more.
  
• Flu-like feeling before the appearance of lumps.
  
• Aching joints and legs before the appearance of lumps. Ankle, knee and wrist joints are the most affected.
  
• Loss of weight.
  
• Symptoms may vary depending on the underlying trigger that caused the condition.

Erythema nodosum diagnosis

• By means of physical examination
  
• Biopsy of the affected area
  
• Blood test to identify the trigger
  
• Chest X-ray in case of TB or sarcoidosis induced condition
  
• Throat swab

Erythema nodosum treatment

• Cortisone injection
  
• Oral cortisone
  
• Anti-inflammatory drugs
  
• Bed rest
  
• Compression bandages
  
• Cool wet compresses
  

Ulcerative Colitis

Ulcerative colitis is an condition of inflammation or ulcers in the lining of the large intestine, rectum and colon. Rarely is the small intestine affected by ulcerative colitis. Ulcerative colitis is also referred to as proctitis. While this condition can affect anyone, it is noticed more often in the US, England, Eastern Europe and persons of Jewish ancestry. Ulcerative colitis is a chronic condition that is often noticed to run in families. The symptoms of Ulcerative colitis are similar to Crohn's disease. But this disease tends to affect the small intestine or the mouth, esophagus, appendix or duodenum. Ulcerative colitis and Crohn's disease are both inflammatory bowel diseases. Typical symptoms of Ulcerative colitis include fatigue, nausea and severe abdominal cramps. Rectal bleeding and diarrhea are noticed with persons suffering from Ulcerative colitis, though the intensity depends on the inflammation. There is loss of appetite and weight loss. The symptoms may tend to recur at regular intervals or when eating highly seasoned food or raw fruits and vegetables. Other conditions such as hepatitis, osteoporosis, anemia and arthritis are sometimes triggered by Ulcerative colitis.

Ulcerative colitis has been traced to abnormal disorder of the immune system of the intestine. Consequently the immune system triggers off an inflammation of the intestinal tissues. Often a diet high in fat and refined foods may be responsible for ulcerative colitis. Symptoms of ulcerative colitis tend to come in spurts, with periods of acute illness followed by periods of remission. If left untreated, persons suffering from ulcerative colitis carry significant risk of carcinoma. Treatment for ulcerative colitis is based on the seriousness of the condition. While medication can help in most cases, surgery is resorted to for severe inflammation and life-threatening condition. Medications cannot cure ulcerative colitis but they can help in maintaining periods of remission. The patient can enjoy a better quality of life. Anti-inflammatory and immunomodulators are prescribed for patients of ulcerative colitis to reduce inflammation.