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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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The main symptom is vomiting, which typically occurs after meals of undigested food, devoid of any bile. A history of previous peptic ulcers and loss of weight is not uncommon. In advanced cases, signs to look for on physical examination are wasting and dehydration. Visible peristalsis from left to right may be present. Succussion splash is a splash-like sound heard over the stomach in the left upper quadrant of the abdomen on shaking the patient, with or without the stethoscope. Bowel sound may be increased due to excessive peristaltic action of stomach. Fullness in left hypochondrium may also be present.
Inflammation of the diverticulum can mimic symptoms of appendicitis, i.e., periumbilical tenderness and intermittent crampy abdominal pain. Perforation of the inflamed diverticulum can result in peritonitis. Diverticulitis can also cause adhesions, leading to intestinal obstruction.
Diverticulitis may result from:
- Association with the mesodiverticular band attaching to the diverticulum tip where torsion has occurred, causing inflammation and ischaemia.
- Peptic ulceration resulting from ectopic gastric mucosa of the diverticulum
- Following perforation by trauma or ingested foreign material e.g. stalk of vegetable, seeds or fish/chicken bone that become lodged in Meckel's diverticulum.
- Luminal obstruction due to tumors, enterolith, foreign body, causing stasis or bacterial infection.
- Association with acute appendicitis
Bleeding of the diverticulum is most common in young children, especially in males who are less than 2 years of age. Symptoms may include bright red blood in stools (hematochezia), weakness, abdominal tenderness or pain, and even anaemia in some cases.
Hemorrhage may be caused by:
- Ectopic gastric or pancreatic mucosa:
1. Where diverticulum contains embryonic remnants of mucosa of other tissue types.
2. Secretion of gastric acid or alkaline pancreatic juice from the ectopic mucosa leads to ulceration in the adjacent ileal mucosa i.e. peptic or pancreatic ulcer.
3. Pain, bleeding or perforation of the bowel at the diverticulum may result.
4. Mechanical stimulation may also cause erosion and ulceration.
- Gastrointestinal bleeding may be self-limiting but chronic bleeding may lead to iron deficiency anaemia.
The appearance of stools may indicate the nature of the haemorrhage:
- "Tarry stools": Alteration of blood produced by slow bowel transit due to minor bleeding in upper gastrointestinal tract
- "Bright red blood stools": Brisk haemorrhage
- "Stools with blood streak": Anal fissure
- ""Currant jelly" stools": Ischaemia of the intestine leads to copious mucus production and may indicate that one part of the bowel invaginates into another intussusception.
A gastrojejunocolic fistula is a disorder of the human gastrointestinal tract. It may form between the transverse colon and the upper jejunum after a Billroth II surgical procedure. (The Billroth procedure attaches the jejunum to the remainder of the stomach). Fecal matter thereby passes improperly from the colon to the stomach, and causes halitosis.
Patients may present with diarrhea, weight loss and halitosis as a result of fecal matter passing through the fistula from the colon into the stomach.
Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into the small intestine due to the obstruction. The stomach often dilates to accommodate food intake and secretions. Causes of gastric outlet obstruction include both benign causes (such as peptic ulcer disease affecting the area around the pylorus), as well as malignant causes, such as gastric cancer.
Causation related to ulcers may involve severe pain which the patient may interpret as a heart condition/attack.
Treatment of the condition depends upon the underlying cause; it can involve antibiotic treatment when Helicobacter pylori is related to an ulcer, endoscopic therapies (such as dilation of the obstruction with balloons or the placement of self expandable metallic stents), other medical therapies, or surgery to resolve the obstruction.
In an organoaxial gastric volvulus, the stomach rotates around an axis that connects the gastroesophageal junction and the pylorus. The antrum rotates in opposite direction to the fundus of the stomach.This is the most common type of gastric volvulus, occurring in approximately 59% of cases, and it is usually associated with diaphragmatic defects. Strangulation and necrosis commonly occur with organoaxial gastric volvulus and have been reported in 5–28% of cases.
Symptoms are not necessarily distinguishable from other kinds of distress. A dog might stand uncomfortably and seem to be in extreme discomfort for no apparent reason. Other possible symptoms include firm distension of the abdomen, weakness, depression, difficulty breathing, hypersalivation, and retching without producing any vomitus ("non-productive vomiting"). A high rate of dogs with GDV have cardiac arrhythmias (40 percent in one study). Chronic GDV may occur in dogs, symptoms of which include loss of appetite, vomiting and weight loss.
Gastric volvulus or volvulus of stomach is a twisting of all or part of the stomach by more than 180 degrees with obstruction of the flow of material through the stomach, variable loss of blood supply and possible tissue death. The twisting can occur around the long axis of the stomach: this is called organoaxial or around the axis perpendicular to this, called mesenteroaxial. Obstruction is more likely in organoaxial twisting than with mesenteroaxial while the latter is more associated with ischemia. About one third of the cases are associated with a hiatus hernia. Treatment is surgical.
The classic triad (Borchardt's Triad) of gastric volvulus, described by Borchardt in 1904, consists of severe epigastric pain, retching (due to sour taste in mouth) without vomiting, inability to pass a nasogastric tube and reportedly occurs in 70% of cases. Sometimes severe pain at the top of left shoulder, this may be due to internal bleeding irritating the diaphragm upon respiration.
Diagnosis is typically via a CT angiography, esophagogastroduodenoscopy, or arteriography. It is part of the differential diagnosis of gastrointestinal bleeding.
Surgical repair can sometimes result in complications, including:
- Stricture, due to gastric acid erosion of the shortened esophagus
- Leak of contents at the point of anastomosis
- Recurrence of fistula
- Gastro-esophageal reflux disease
- Dysphagia
- Asthma-like symptoms, such as persistent coughing/wheezing
- Recurrent chest infections
- Tracheomalacia
A fistula involving the bladder can have one of many specific names, describing the specific location of its outlet:
- Bladder and intestine: "vesicoenteric", "enterovesical", or "vesicointestinal"
- Bladder and colon: "vesicocolic" or "colovesical"
- Bladder and rectum: "vesicorectal" or "rectovesical"
Most damage to the pyloric valve occurs as a complication of gastric surgery. Other causes of biliary reflux may be:
- Peptic ulcer
- Gallbladder surgery (cholecystectomy)
A significant fraction of cases are idiopathic, with no identified specific etiology.
Tracheoesophageal fistula is suggested in a newborn by copious salivation associated with choking, coughing, vomiting, and cyanosis coincident with the onset of feeding. Esophageal atresia and the subsequent inability to swallow typically cause polyhydramnios in utero. Rarely it may present in an adult.
If fecal matter passes through the fistula into the bladder, the existence of the fistula may be revealed by pneumaturia or fecaluria.
Gastric dilatation volvulus (GDV), also known as twisted stomach or gastric torsion, is a medical condition in which the stomach becomes overstretched and rotated by excessive gas content. The word "bloat" is often used as a general term to mean gas distension without stomach torsion (a normal change after eating), or to refer to GDV.
GDV is a life-threatening condition in dogs that requires prompt treatment. It is common in certain dog breeds; deep-chested breeds are especially at risk. Mortality rates in dogs range from 10 to 60 percent, even with treatment. With surgery, the mortality rate is 15 to 33 percent.
Biliary reflux, bile reflux or duodenogastric reflux is a condition that occurs when bile flows upward (refluxes) from the duodenum into the stomach and esophagus.
Biliary reflux can be confused with acid reflux, also known as gastroesophageal reflux disease (GERD). While bile reflux involves fluid from the small intestine flowing into the stomach and esophagus, acid reflux is backflow of stomach acid into the esophagus. These conditions are often related, and differentiating between the two can be difficult.
Bile is a digestive fluid made by the liver, stored in the gallbladder, and discharged into duodenum after food is ingested to aid in the digestion of fat. Normally, the pyloric sphincter prevents bile from entering the stomach. When the pyloric sphincter is damaged or fails to work correctly, bile can enter the stomach and then be transported into the esophagus as in gastric reflux. The presence of small amounts of bile in the stomach is relatively common and usually asymptomatic, but excessive refluxed bile causes irritation and inflammation.
An aortoenteric fistula is a connection between the aorta and the intestines, stomach, or esophageus. There can be significant blood loss into the intestines resulting in bloody stool and death. It is usually secondary to an abdominal aortic aneurysm repair.
Anal fistulae can present with the following symptoms:
- skin maceration
- pus, serous fluid and/or (rarely) feces discharge — can be bloody or purulent
- pruritus ani — itching
- depending on presence and severity of infection:
A biliary fistula is a type of fistula in which bile flows along an abnormal connection from the bile ducts into nearby hollow structure. Types of biliary fistula include:
- bilioenteric fistula: abnormal connection to small bowel, usually duodenum.
- thoracobiliary fistula: abnormal connection to pleural space or bronchus (rare).
These may be contrasted to a bile leak, in which bile escapes the bile ducts through a perforation or faulty surgical anastomosis into the abdominal cavity. Damage to a bile duct may result in a leak, which may eventually become a biliary fistula.
If a colostomy is not performed immediately after birth, patients with rectovestibular fistulae may present later in life with complications including severe constipation and megacolon (abnormal dilation of the colon), requiring colostomy or further surgery.
Bleeding of the lower GI tract will typically appear as hematochezia and can vary in degree of seriousness. Slow bleeding from the ascending portion of the colon can result in partial digestion of the blood and the appearance of melena in the stool.
The upper GI tract is defined as the organs involved in digestion above the ligament of Treitz and comprises the esophagus, stomach, and duodenum. Upper gastrointestinal bleeding is typically characterized by melena (black stool). Bright red blood may be seen with active, rapid bleeding.
A pancreatic fistula is an abnormal communication between the pancreas and other organs due to leakage of pancreatic secretions from damaged pancreatic ducts. An "external" pancreatic fistula is one that communicates with the skin, and is also known as a pancreaticocutaneous fistula, whereas an internal pancreatic fistula communicates with other internal organs or spaces. Pancreatic fistulas can be caused by pancreatic disease, trauma, or surgery.
Anorectal anomalies are medical problems affecting the structure of the anus and rectum. A person with an anorectal problem would have some sort of deformative feature of the anus or rectum, collectively known as an anorectal malformation.
Examples of anorectal anomalies include:
- Anal stenosis
- Imperforate anus
- Proctitis
- Anal bleeding
- Anal fistula
- Anal cancer
- Anal itching
- Hemorrhoid (piles)
Depending on their relationship with the internal and external sphincter muscles, fistulae are classified into five types:
- Extrasphincteric fistulae begin at the rectum or sigmoid colon and proceed downward, through the levator ani muscle and open into the skin surrounding the anus. Note that this type does not arise from the dentate line (where the anal glands are located). Causes of this type could be from a rectal, pelvic or supralevator origin, usually secondary to Crohn's disease or an inflammatory process such as appendiceal or diverticular abscesses.
- Suprasphincteric fistulae begin between the internal and external sphincter muscles, extend above and cross the puborectalis muscle, proceed downward between the puborectalis and levator ani muscles, and open an inch or more away from the anus.
- Transphincteric fistulae begin between the internal and external sphincter muscles or behind the anus, cross the external sphincter muscle and open an inch or more away from the anus. These may take a 'U' shape and form multiple external openings. This is sometimes termed a 'horseshoe fistula.'
- Intersphincteric fistulae begin between the internal and external sphincter muscles, pass through the internal sphincter muscle, and open very close to the anus.
- Submucosal fistulae pass superficially beneath the submucosa and do not cross either sphincter muscle.