CAUSES SYMPTOMS AND SIGNS OF PILES

THE CAUSES OF PILES OR HEMORRHOIDS?

What are the causes of piles?
The causes include reduced vascular drainage of the pelvic organs such as pregnancy, constipation; repeated trauma to rectum and anus due to sodomy , sexual perversion, large and hard stool which can followed by mucous fissures, sitting on the toiled for a long time. Infection and ruptured blood vessels and increased venous pressure in portal hypertension. Bacterial infection may develop in the venous circulation, producing peri-phlebitis and endo-phlebitis.
Bacterial infection may cause proctitis or rectitis [inflammation of the rectum caused mucosa dilatation] may be due to staphylococcus, streptococcus, pseudomonas aeroginosa, gonorrhea, lymphopathya venereum, amebiasis dysentery, anaerobic bacteria
Thrombosis or rupture of vessels often results in slough and ulceration.

Symptoms and signs

There are 4 principle symptoms:
Pruritus ani: the itching is usually localized anal circle; distressing symptoms of a underlying local or general disorder , it occurs because the sensitive, often moist perinea [pudenda] skin is exposed to irritating fecal material retained in anal recesses. The perinea skin may be erythematous [reddish], moist or bleeding.
Pain: mild or severe pain is the result of constriction, edema, or strangulation of piles; severe pain usually in external piles due to the sensitive of the skin; the internal piles mucosa is less sensitive than the skin.
Bleeding: which may be mild or severe occur with mucous laceration, venous distention, obstruction, or ulceration of prolapsed internal piles as a result of straining or difficult defecation.
Prolapse: protrusion of piles may occur suddenly after sub-mucous rupture of veins, thrombosis or strangulation of internal piles.

The stage of pile consists of: [continued]

HEMORRHOIDS OR PILES AND TREATMENT OPTION

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HEMORRHOIDS AND TREATMENT OPTION

What is the hemorrhoid?

Hemorrhoids or piles are ano-rectal varicose dilatation involving the hemorrhoids plexus of veins, there are lax pelvic veins and venous stasis Inadequate peri-vascular support and may be the absence of valves permit reversed venous flow in the hemorrhoids plexus.

Figure 1: Anatomy of venous drainage of the rectum and anus showing the superior or internal and the inferior or external hemorrhoid plexuses; these called as "anal cushions."


Figure 2: Prolapsed or protruded piles stage 3 or stage 4.

Source: http://www.colon.com.sg/

In the West, it has been estimated that at least 50 percent of individuals over the age of 50 years have at some time experienced piles complaints. A part of women have hemorrhoids, which often develop during pregnancy or delivery, sedentary habits, erect posture, and venous congestion and dilatation accentuate this varicose. Hemorrhoids can occur at any age and affect both sexes female and male.Hereditary factors may predispose to piles.

What types or varieties of piles?

There are external, internal and mixed piles.

External piles are those of the inferior hemorrhoids plexus, are covered by anal skin and arise below the ano-rectal line.

Internal piles implicate the superior hemorrhoids plexus of veins, are covered by mucous membrane and have their origin above the ano-rectal line.

Mixed piles are partly within and partly outside the ano-rectal canal and both are covered by mucosa and skin.

Fig. 3: Cross section of prolapsed internal and external hemorrhoids or mixed hemorrhoids or piles.

Source: Ibid.

There are a few questions about piles or hemorrhoids:

What are the causes, symptoms and signs of hemorrhoids?

How about the examination and diagnose of hemorrhoids or piles?
What are the option of treatments?
What are about the prognosis of the treatments?
What are the potential complication of treatments?

The answers for these questions are as the follows : [continued]

STARVATION

STARVATION

Picture 1: A girl, shown suffering the effects of severe hunger and malnutrition.

Starvation is the result of a serious lack or deficiency of nutrients need for maintenance of life, it is the most extreme form of malnutrition.

SITUATION.

According to FAO [Food and Agriculture Organization] the starvation currently affects more than one billion people or one in six people of the world population 6.7 billion. Prolonged starvation can cause permanent organ change, and eventually death, that is about 20 000 die each day. The WHO [World Health Organization] also states that malnutrition is by far the biggest contributor to child mortality, present in half of all cases.

Picture 2: Starved Vietnamese man,who was deprived of food in Viet Cong prison camp.

PROBLEM

What is the cause of starvation ?
What are the symptoms and signs of starvation?
How to treat starvation ?
How to prevent starvation ?
What is the prognosis of starvation ?

THE CAUSES OF STARVATION.

The basic cause of starvation is the imbalance between energy of intake and energy expenditure. In other words: the body expends more energy that it takes is as food.
The starvation is caused by a number of factors. They include: Anorexia nervosa, fasting, coma, stroke, severe gastrointestinal disease, famine and extreme poverty. The poverty where half of the world’s population lives on less than $ 2 a day.

Picture 3: Adult,shown suffering of starvation is dying

THE SYMPTOMS AND SIGNS .

1. Chronic diarrhea, decreased ability to digest of food because of lack of digestive acid production in the stomach.
2. Shrinkage of vital organs such as heart, lungs, ovaries or testes and their functions.
3. Reduction in muscle mass and weakness because of it.
4. Low body temperature.
5. Irritability.
6. Immune deficiency, less of resistance to infections.
7. Decrease sex drive.
8. The signs of specific nutrient deficiency may occur such as deficiency of vitamins.

TREATMENT.

It is necessary to treat the cause of starvation. Nutrients feeding rich in protein, energy and adequate vitamins and minerals. If the degree of malnutrition is severe, the intravenous feeding must begin the treatment and then the treatment with liquid nutrients. Gradually, solid foods are introduced with high protein and energy.

PREVENTION.

For the individual, prevention obviously consists of ensuring they eat plenty of food, varied enough to provide a nutritionally complete diet. Supporting farmer in areas of food insecurity through such measures as free or subsidized fertilizers and seeds increases food harvest and reduces food prices.

PROGNOSIS

People can recover from severe diagnosis of starvation to a normal stature and function. Children may suffer from permanent mental retardation or growth defects of their deprivation was long and extreme.

Reference:

http://en.wikipedia.org/wiki/starvation.

http://healthandenergy.com/food_short...

http://www.answers.com/topic/marasmus.

http://www.answers.com/topic/starvation.

http://www.medstudents.com.br/pedia/

Cecil & Loeb A Textbook of Medicine.W.B.Saunders Company,Philadelphia,USA,1959,p 537-540.

Waldo E.Nelson,M.D., D.Sc. Texbook of Pediatrics.W.B.Saunders Company,Philadelphia,USA,1959,p 358-369.

MARASMUS [SEVERE ENERGY DEFICIENCY]

MARASMUS.

Marasmus is a form of severe malnutrition, dominated by energy deficiency of nutrients or foods intake. Probably combine with protein, vitamins and minerals deficiency. Marasmus occurrence increases prior to age one to under five year age.

The syndrome of marasmus:
1. Clinically, there is failure to gain weight, later followed by weight less and finally emaciation [to cause to lose flesh so as to become very thin] and dry skin.
2. There is loss of adipose tissue from normal areas for deposits like buttocks and tights.
3. There is extensive tissue and muscle wasting and weakness.
4. Other common symptoms include loose skin folds hanging over the axillary skin and gluteal skin.
5. The abdomen may be concave or flat; if there is distention of the abdomen, usually it is due to parasitic diseases such as ascariasis [roundworm], schistosoma, oxyuriasis [enterobius vermicularis or seatworm] combines with mild edema.
6. Vitamins deficiency vitamin B-complex and C are common often leading to anemia, pellagra, dry beriberi and scurvy.
7. The afflicted patients are often fretful and irritable.

Picture: Child suffering with marasmus in India.

Source: http://en.wikipedia.org/wiki/Marasmus

It seems, the child is about under five years old.

Causes:
Marasmus is caused by a severe deficiency of nearly all nutrients or foods intake particularly energy or calories and protein.

Treatment:
It is necessary to treat the cause of marasmus with adequate nutrients feeding rich in energy or calories, protein, vitamins and minerals. Treatment in the uncomplicated case requires temporarily a high energy, high protein diet, with much of the nutrients derived from milk, eggs and meat.
The maintenance diet should be an average one according to age and weight of the patient.

Others treatment for anemia, pellagra, dry beriberi and scurvy can be administered with vitamin B-complex and vitamin C; and the treatment of any coexisting infections with antibiotics.

Parasitic diseases treatment with combantrin [pyrantel pamoate] syrup for children.
Treatment of dry skin and dehydration, administer the Ringer's lactate solution or Dextran 6 % in saline intravenous infusion.

Prevention:
Nutrients should be planned to avoid dietary deficiency by feeding rich in protein, adequate in energy, vitamins and minerals. Nutrients derived from milk, eggs, meat, whole grain, fruit, and vegetables.
Good hygienic habit and immunization to prevent infectious diseases.

KWASHIORKOR,MARASMUS AND STARVATION

PLURI-DEFICIENCY SYNDROME

[KWASHIORKOR,MARASMUS AND STARVATION].

Pluri-deficiency means more than one deficiency or multiple deficiency of nutrient. Syndrome is from the Greek word meaning “run together” diseases and symptoms. Clinical pluri-deficiency syndrome [PDS] which results from more than one deficiency such as deficiency of calories [energy], protein and probably other nutrients such as vitamins and minerals.
PDS is the most extreme form of malnutrition [under nourished].
The basic cause of PDS is an imbalance between energy, protein, and vitamins intake and expenditure. In other words: the body expends more energy, protein and vitamins than it takes in as food. The imbalance can come from one or more medical condition causes and socio-economic condition causes.
Medical causes: Anorexia nervosa, digestive diseases, depression and coma.
Socio-economic causes: famine, poverty, uneducated, deprivation and observed in various countries, especially in war-torn areas where starvation is common.
We can identify 3 types of extreme PDS:
1.Kwashiorkor
2. Marasmus
3. Starvation.

KWASHIORKOR

Kwashiorkor is the term applied to a clinical syndrome which results from an extreme deficiency of protein, and probably deficiency of other nutrients, especially those of vitamins B-complex and vitamin A, , C and K.
The term “kwashiorkor” is said to mean “red boy” in the language of Gold Coast Africa. Another interpretation is the “syndrome of the changeling”
The syndrome of kwashiorkor as it has been described signs among the children consist of :

Picture 1: A. Kwashiorkor in a two year-old boy. Note the generalized edema and the skin lesions.B. Close-up of the same child the showing hair changes ; the edema of the face and the skin lesions can be seen more clearly.

Source: Waldon E.Nelson,M.D.,D.Sc.
Textbook of PEDIATRICS. Seven Edition,W.B.SaundersCompany,Philadelphia,USA,1959, p 358.
1. Retarded growth in the weaning and post-weaning under 3 years old children.
2. Edema usually associated with hypo-proteinemia [low protein in the plasma of the blood].

Picture 2: Left, infant with "sugar-baby" kwashiorkor,showing stunting, edema of feet and hands,moon face and depigmentation of the hair.
Right, normal infant of same age and racial group.Source: Ibid, p 360
3. Alteration in skin and hair pigmentation.
4. The frequent association of a variety of dermatoses [skin disorders] such as pellagra.
5. Gastrointestinal disorders, including anorexia, vomiting, and diarrhea.
6. Irritability and apathy.
7. Fatty infiltration, cellular necrosis or fibrosis of the liver.
8. A high mortality rate.

Diagnosis:
Some combinations of these signs is essential for diagnosis.
Edema usually starts in the feet, but soon involves the face, hands, arms and genitals; ascites [accumulation of fluid in the abdominal cavity] is rare.
The hair loses its luster and in Negro tends to lose its curl and become straight and fine; it becomes pale or almost reddish.
If there is vitamin A deficiency with symptoms of night blindness, xerophthalmia [ocular disease] appear late in the disease.

Picture 3: Recovery from xerophthalmia, showing permanent eye lesion.
Source : Opcit, p 361



Vitamin B-complex deficiency is a common , often leading to anemia, beri-beri and pellagra.

Vitamin C deficiency there may be a "rosary" at the costochondral junctions and a depression of the sternum.Rickets due to vitamin D deficiency. Hemorrhagic jaundice of vitamin K deficiency.
Picture 4: Vitamin C deficiency scorbutic rosary,depression of sternum and the so-called frog position. Source: Opcit, p 369

Treatment:
Kwashiorkor is usually treated with the diet rich in proteins of high biological value, vitamins and minerals, adequate energy ; and the treatment of the coexisting infections.

Prevention:
It can be accomplished by feeding an adequate diet during the post-weaning phase. Nutrient diet rich in source of protein such as dried milk, skim milk, fish meal and legume [soy beans]; adequate energy, vitamins and minerals

Picture 5: Hemorrhagic jaundice due to vitamin K deficiency.Source: Cecil & Loeb. A Textbook of MEDICINES. W.B.Saunders Company, Philadelphia,USA,1959, p 540

LIST OF WATER SOLUBLE VITAMIN [CONT.]

VITAMIN B5 [PANTOTHENIC ACID]


Functions: As a constituent of coenzyme A, pantothenic acid is essential to several reactions in metabolism. An example is the combination of coenzyme A with acetate to form acetyl-coenzyme A [active acetate] participate in a number of metabolic processes. Coenzyme A has also an essential function in lipid metabolism. Activation of some amino acids may also involve coenzyme A. The important function for this vitamin in metabolism, involving as it does the utilization of carbohydrate, fat and protein with various acetylation reactions.
Effects of deficiency: Dermatitis, vomiting, enteritis, alopecia [bald of hair], and muscle cramps, postural hypotension, tachycardia and “burning feed syndrome”. Treatment: Pantothenic acid 20-100 mg/day.
Effects of excess: No toxic effects reported.
Requirements: Recommended Daily Amount [RDA] 6 mg.
Sources: Eggs, liver, yeast, lean meats, whole grain, vegetables and fruits.

VITAMIN B6 [PYRIDOXINE].

Functions: Form prosthetic group of certain decarboxylaces and transaminaces .Converted in the body into pyridoxal phosphate and pyridoxamine phosphate. Helps build body tissue and aids in metabolism of protein.
Effects of deficiency: Convulsions, hyperirritability, muscular weakness, nausea and vomiting of pregnancy, acne and other dermatologic disorder. Treatment: pyridoxine 100 mg/day or in combination with vitamin B1 and B12 such as neurobion tablet which contains: vitamin B1 100 mg, B6 200 mg and B12 200 micro-grams/tablet. Treatment: Neurobion twice one tablet daily, or administration of pyridoxine twice 200 mg daily..
Effects of excess: Long term mega-doses may cause nerve damage in hands and feet.
Requirements: RDA 2.0 mg
Sources: Fish, poultry, lean meats, banana, dried beans, whole grains, avocados.

VITAMIN B7 [BIOTIN]

Functions: Involved in metabolism of protein, fats and carbohydrates.
Effects of deficiency: Nausea, vomiting, depression, alopecia [hair loss or bald of hair], and dermatitis. Treatment: 1-2 mg vitamin B7 daily.
Effects of excess: No toxic effects reported.
Requirements: RDA 150 micro-grams.
Sources: Liver, legume, yeast and whole grain products.

VITAMIN B9 [FOLIC ACID, FOLATE].

Functions: Involved in red blood cells formation, aids in genetic material development or reproduction, important metabolic process in the body, growth.
Effects of deficiency: Sprue [absorption from and motility of the small intestine are impaired], gastrointestinal disorders, anemia particularly in premature infants and pregnant women, cracks on lips. Treatment: The average dose is 5-10 mg per day, produces a prompt hemopoietic [producing red blood and white blood cells] response which is parallel by striking clinical response.
Effects on excess: mild symptoms in large doses.
Requirements: RDA For Nutritional Labeling of Food Products 200 micro-grams.
Sources: Green leafy vegetables, beans, dried peas, and lentils.

VITAMIN B12 [COBALAMIN]

Functions: Nervous system function, normal development of red blood cells, aids in cell development, and the metabolism of protein and fat.
Effects of deficiency: Pernicious anemia, nervousness, fatigue, neuritis and in some cases brain degeneration. Treatment: Intramuscular injection 1000 micro-grams daily continuing until deficiency relief. Neurobion tablet twice daily.
Effects of excess: No toxic effect reported.
Requirements: RDA 3 micro-grams.
Sources: liver, meats, sea-foods and milk products

VITAMIN C [ASCORBIC ACID].

Functions: Essential for matrix structure of bones, cartilage, muscle and blood vessels , dentin, collagen of fibrous tissue structure, helps maintain capillaries and gums structure. Act as antioxidant in cell metabolism. Play a role in endowing the organism with increased powers of resistance. Aids in absorption of iron.

Effects of deficiency: Mild symptoms include apathy, anorexia, fatigability and loss of strength; in more severe cases there is tenderness of extremities and gums with hemorrhage tendency. Scurvy: Bleeding and swollen of gums, the teeth become loose and fragile. Slow wound healing, subcutaneous hemorrhage occur upon slight injury. Hemorrhage is predominating feature of the disease, and when it occurs internally it is frequently the cause of death. Treatment: Per oral 1000 mg/tablet twice daily after meal. In severe cases intramuscular injection solution of 1-2 % vitamin C, 5 ml twice daily for weeks.
Effects of excess: Vitamin C has a brief, pronounced laxative effect when taken in large amounts, typically n the range of 5-20 grams per day in divided doses for a person in normal “good health”, although seriously ill people, may take 100-200 grams without inducing vitamin poisoning.
Requirements: RDA for Nutritional Labeling of Food Products 60 mg.
Sources: Citrus fruits, berries, and vegetables-especially potatoes and peppers.

LIST OF WATER SOLUBLE VITAMINS

THE LIST OF WATER SOLUBLE VITAMINS:

by function, effects of deficiency, effects of excess, requirements and sources.

Water soluble vitamins usually be used by the body right away. If the concentration in the blood are higher, those vitamins will be excreted through the urine. Vitamin B12 is the water soluble vitamin that can be stored in the liver. Water soluble vitamins consist of vitamins B-Complex and vitamin C:

VITAMIN B1 [Thiamine]

Functions: Use for carbohydrate metabolisms, digestion, normal function of striated muscles, cardiac muscle and nervous systems.
Effects of deficiency: Lost of strength of the quadriceps muscle; loss of vibration sense: first of the toes and later of the malleoli [ankle] and tibias. Tenderness of the calves and hyperesthesia of the feet. Diminution and loss of the Achilles tendon and patellar reflexes first, in the stage of polyneuritis of “dry beriberi". Edema of the shins, ankles and knee joints, found in “wet beriberi”. Enlarged heart with dependent edema and elevated venous pressures: poor response to rest and administration of digitalis unless thiamine is given. This is the late manifestation of severe deficiency [beriberi heart]. Treatment: 50 mg twice daily until relief of symptoms.
Effects of excess: No case reported, high doses are excreted by the kidney.
Requirements: 1.5 mg per day.
Sources: Liver, whole grains, unrefined cereal grains, yeast.

VITAMIN B2 [RIBOFLAVIN]

Functions: Constituent of flavor-proteins, helps body release energy from protein, carbohydrates and fat metabolism.

Figure 1: Photophobia,epiphora and scleral injection in riboflavin deficiency.

Source: Cecil & Loeb. A TEXTBOOK OF MEDICINE. W.B.Saunders

Company,Philadelphia,USA,1959,p 548.

Effects of deficiency: Photophobia, epiphora and scleral injection. Cheilitis: Excessive and irregular wrinkling of the lips. Angular stomatitis, various combinations of erythema [redness] and open fissuring in the angles of the mouth .Magenta tongue: A purplish red coloring with moderate edema and flattening of fili-form papillae. Treatment: 5 mg three times daily for weeks.
Effects of excess: No toxic effects reported.
Requirements: 1.6 mg daily.
Sources: Liver, milk, whole grains, eggs, yeast and green leafy vegetables.

Fig. 2: Cheilitis and photophobia in riboflafin deficiency.

Source: Ibid.

VITAMIN B3 [NIACIN,NICOTINIC ACID] .

Functions: As a constituent of coenzyme for carbohydrate, protein and fat metabolism. It is also has cholesterol lowering effects.

Fig. 3: Glossitis of nicotinic acid deficiency

Source: Opcit

Effects of deficiency: Glossitis: edema of the tongue, shown by dental indentation. Increase redness of the tongue: Scarlet red in severe acute deficiency, beefy red in chronic states. Congestion and hypertrophy of papillae of the tongue, followed by fusion and atrophy.

Pellagrous dermatitis: Erythema [redness], rough scaling with ulceration and formation of bullae [ bag of plasma], affecting primarily areas of the skin exposed to light; namely wrists, calf, ankles, neck and face; observed in severe deficiency [pellagra[, and frequently associated with diarrhea and dementia. Treatment: Acute deficiency state: 100 mg niacin-amide twice daily for weeks, chronic state: 100 mg of niacin-amide twice daily over a prolonged period.
Effects of excess: No case reported
Requirements: 20 mg daily
Sources: Meat, dairy products, poultry eggs, peanuts, fish.

Fig. 4: Pellagrous dermatitis of hands in nicotinic acid

deficiency.
Source: Opcit.

[CONTINUED]