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The gastrointestinal tract this over here, It is the gastrointestinal tract a system of organs where the food is supposed to enter over here through here and then ultimately end up leaving the body down there.

This should happen regularly but what if it doesn’t what if it doesn’t happen regularly. Join us now in this video to learn about five things that should and could be done in patients with constipation. It’s annoying almost all of us have been there at one point in our lives. This can cause bloating and even loss of appetite, going to the toilet can even cause abdominal pain but also anal pain. Because of all the straining. Furthermore, patients can experience a perforation of the gastrointestinal wall. So, The first thing you can do about constipation is figure out if you have it at all just because you didn’t have a bowel movement today. It doesn’t mean that there is something wrong. Constipation is medically defined as having less than three bowel movements a week and bowel movements that are hard to pass so properly. Defining constipation and analyzing it that way through evidence-based medicine is the first thing that we can do. The second thing is something that patient himself can do and that is a lifestyle modification and i know that sounds like a washed up phrase but here it really helps. It includes drinking more water, eating more fiber, but also working out and exercise but yes sadly, It is often the case that these lifestyle modification options are not enough and constipation still persists that’s why we should explain the remaining three things about constipation and what can be done about it. The third thing that can be done is to like this video and subscribe to this channel because a lot of people suffer from constipation and youtube and other platforms will simply not suggest our videos to them unless we get enough likes and subscriptions that’s just how their algorithms work. So, finally we get to the point where a skilled gastroenterologist should show his skills and knowledge. The fourth thing that can be attempted is a treatment with laxatives. Our gastrointestinal organs secrete a lot of water almost all the time. It starts with saliva in the mouth and almost 10 liters of water enters our stomach daily. Additionally, we drink water with our food but around 80 to 90 percent of this water is absorbed by the small intestine and the remaining 10 is passed on to the large intestine.

Large intest intestine attempts to absorb as much as water as possible and because of our small intestine. Our enlarged intestine absorbing all this water back into the bloodstream we don’t have to drink five or ten liters of water every day. So, This is exactly where we can try to use some hyper osmotic agent and those are substances attempting to hold back some of this water from being absorbed back into the bloodstream. This can create a soft stool that is easier to pass and this osmotic effect stimulates bowel movement but if you look closely upon an anatomical or histological examination of the gastrointestinal walls. You will see that they are made up of muscle tissue. This is important because the stool doesn’t simply fall out down. There, It has to be moved towards the anus by the contractions of the gastrointestinal walls. This is the second point where we can attempt to stimulate the nerves innervating the gastrointestinal walls to start and activate these contractions in a synchronized way. The inner lining of the gastrointestinal wall is made up of mucosa and subsubstances can irritate this mucosa and ultimately cause these contractions as well stimulating contractions of the gastrointestinal tract walls is actually done by a group of medication called stimulating laxatives but it should only be used if the first mechanism failed. That is the osmotic laxatives which attempt to hold the water over here and prevent it from being absorbed back into the bloodstream besides. These first two options to treat the patient with osmotic laxatives as a first line treatment as well as stimulating laxatives. There are also other options such as injection of enemas but also physical and surgical intervention but before we get to any of these scary treatments such as surgical intervention and before we even get to these conservative methods of treating constipation. I want to highlight one last thing, That is maybe the most important thing in this entire topic about constipation diagnostics and proper differential diagnosis. It is a must whenever we deal with a patient with constipation constipation can be caused by a whole variety of dangerous underlying conditions such as cancers or benign tumors. They might obstruct the gastrointestinal tract anatomically and therefore also obstruct the bowel movement. A damage of the nerves innervating the gastrointestinal wall or injuries of the spinal cord can paralyze the muscle tissue of the gastrointestinal tract. Ultimately, Hormonal problems that we cannot see easily such as diabetes mellitus and hypothyroidism can lead to constipation as well because of that it sometimes makes sense to even measure the patient’s thyroid hormones such as fd3 and fd4. If we suspect the possible presence of cancer or a tumor then a colonoscopy can be performed in order to examine and record the colon from the inside. But, When do we expect a presence of cancer there are specific red flags that should never be ignored but besides these specific red flags such as blood in the stool there are somewhat less alarming symptoms in signs that might indicate other causes as well. A skilled and a well-educated doctor should be able to recognize these signs and therefore organize these diagnostics in a proper way and the right direction we all can benefit from these videos. If you’re a medical doctor and you want to make videos like these then go to anatomsky.com but if you have more questions about constipation then go to symtomsky.com/help/constipation

This over here would be the chest bone. The sternum feeling a burning sensation or pain behind this bone is referred to as heartburn, while, It might be just a mild annoyance that we all experience once in a while the gastroesophageal reflux disease is actually a major cause of this condition but there are other dangerous causes for heartburn as well and before we get to that let us explain where it all starts. The stomach, It is an organ capable of producing acid that is capable of digesting all sorts of foods meat and plants. Its walls are mainly made out of muscle tissue and that muscle tissue can contract and relax in a synchronized way besides only mixing up the content being digested. It can also help push it further down the digestive tract or it can return it back up through the esophagus in a process we usually refer to as vomiting. The acid with which this content is mixed up in the stomach is very aggressive to organic tissues the major reason why stomach can survive and contain this acid inside of itself is because it protects its walls with a pre-epithelial protection. This pre-epithelial protection is made up by the mucous bicarbonate barrier mucous and bicarbonate secreted by mucous cells create a ph gradient maintaining the epithelial cell surface at the neutral ph value. In more simple terms, They are capable of reducing the acidity on the surface inside of the stomach, but, What about this organ over here, The Esophagus. This organ is normally not supposed to be exposed to all the acid that is in the stomach at the junction of the esophagus and stomach. There is a circular muscle called the lower esophageal sphincter and it helps close this opening and therefore it prevents the acid from the stomach going upwards into the esophagus because of that sphincter you can lay down in your bed at night and you can be sure that the acid will not leave your stomach and end up in your throat or your mouth, but, If somehow that actually does happen and the acid does leave the stomach and ends up in your esophagus you might experience heartburn. You might even feel sour acidic taste in your mouth or pieces of food you ate. Ultimately, You might even feel pain in the stomach area the epigastric pain, but, What causes this and what can be done about it. Before i explain this i have to ask you something you see youtube and other websites will only promote our video or suggest our video to other people suffering from gastroeso esophageal reflux disease. If we get enough of likes and subscriptions that’s just how their algorithms work and we notice that the videos that don’t get enough of likes usually are not suggested to the audience. So, You can help us, Help other people by liking this video or subscribing. But, now back to the heartburn. I pretty much explained that the gastroesophageal reflux diseases. When the content of the stomach can get into the esophagus primarily the acidic content of the stomach. But, What about the pathophysiology and how does that happen. If there is a narrowing here at the exit of the stomach and the food cannot leave the stomach easily then that might cause this reflux into the esophagus. But, That is not the only cause of the gastroesophageal reflux disease pregnancy and obesity can also cause it. But, Primarily it is the insufficiency of the lower esophageal sphincter that causes the gastroesophageal reflux disease as you can see there are different and many causes for gastroesophageal reflux disease. There are also different types and consequences of this condition diagnosing it properly can be tricky and conducting. Just one clinical test is not enough. There is a set of clinical examinations and tests which have to be performed in order to properly diagnose gastroesophageal reflux disease. Luckily, However if the patient experiences these specific symptoms, I have described and there are no red flags or something like that which might indicate that there is some malignant or cancerous condition then, Even before these diagnostics are performed a therapy with medication can be started normally. We are working with proton pump inhibitors or h2 receptor blockers also with antacids the proton pump inhibitors and h2 receptor blockers are basically limiting the acid production capabilities of the stomach. That means, that less acid is released into the stomach then antacids. However, Work on neutralizing the acid that was already produced one other type of medication called sucral fate is binding to the proteins in the pre-epithelial protection of the stomach and that way it reinforces this protective layer. So, You can see that the mechanism through which these drugs help are somewhat different actually quite different, So, The patient was taking one type of medication and it didn’t help well. Maybe, additional medication might help because they work differently but also the first medication that was taken in the first place was maybe simply taken at a wrong time in a wrong situation. The antacids neutralize the acid of the stomach right away but their effects fade quite quickly proton pump inhibitors require some time till they kick in but their effects are stronger and they last longer. That is however if the medication is taken properly we have to consider when and how in what situation and in what combination It is taken. So, Just taking one pill might not help. The therapy for a gastroesophageal reflux disease has to be planned in order to avoid further frustration and suffering for the patient. So, I explained two major problems especially for patients but also untrained clinicians and those were the diagnostics and therapeutic issues with the gastroesophageal reflux disease. At the end, I want to explain the third problem and that is the red flags. Red flags that might indicate a presence of a cancerous malignant disease. These red flags include loss of body weight, anemia and difficulty swallowing. They should never be ignored. If a patient reports such symptoms, Additional diagnostics are a must. Doctors and patients, We have something for you. If you’re a doctor and you want to make videos like these then go to anatomsky.com but if you have more questions about heartburn or gastroesophageal reflux disease then go to symtomsky.com/help/gerd.

Although Crohn’s disease and ulcerative colitis are very different diseases. They still have things in common. We call these diseases inflammatory bowel diseases and they affect the gastrointestinal track. What makes them similar are some of the symptoms like diarrhoea, abdominal pain, cramping, cramping but sometimes rectal bleeding.

They have some very different characteristics that help us distinguish them from each other. Basically, when it comes to location. It is important to understand that ulcerative colitis affects the colon, which is the large intestine, and Crohn’s disease affects the entire gastrointestinal tract. Basically, when it comes to location.

Crohn’s disease also affects the entire thickness of the stomach wall. Ulcerative colitis, however, affects only the inner two layers of the stomach wall in the colon. These pathological differences result in differences in symptoms and results of diagnostic tests.

On endoscopic examination, we can see how these two conditions harm the patient’s health in different ways. Ulcerative colitis is definitely more likely to have bloody diarrhea. Includes erosions and ulcers. Crohn’s disease causes thickening of the lining of the gastrointestinal tract and is characterized by strictures. A stricture, it is basically a narrowing of the stomach at a certain point.

Another endoscopic feature of Crohn’s disease is the presence of fistulas such as enterovesical fistulas. This is an unusual opening that connects the bowel and bladder. This opening between the bowel and the bladder that shouldn’t normally be there can cause recurrent urinary tract infections.

All of the things you just read are complications of these two conditions. But, there are serious life-threatening complications like cancer.

Crohn’s Disease because it affects the entire gastrointestinal tract that can cause cancer of the small intestine whereas ulcerative colitis causes colon cancer. Only crohn’s disease affects this part over here that is the small intestine and it can indeed cause cancer in that part of the gastrointestinal tract.

But, This part of the gastrointestinal tract is responsible for the absorption of nutrients from the food and therefore crohn’s disease can result in malnutrition and while we might assume that crohn’s disease is way more dangerous because of these additional risks and complications. We have to remember that ulcerative colitis is also a lethal condition. Ulcerative colitis with all the erosions ulcers and inflammation in the colon can cause a weakened gastrointestinal wall and that can result in perforation of it. This can allow bacteria to enter abdomen causing peritonitis and a wide spread sepsis. Around one third of patients, Experiencing sepsis eventually dies from that condition.

That is why, Recognizing changes in symptoms that might indicate these life-threatening complications or a possible poor management of these conditions can not only improve patients life quality but also save the patient’s life. Ulcerative colitis can be cured by completely removing the colon and the surgery can be performed if required criteria has been met and indications are present. On the other hand, Crohn’s disease cannot be cured surgically but it can be quite successfully managed. It is often a struggle with recognizing and treating complications and also choosing the appropriate therapy as well as being ready for recurrent episodes of this condition.

almost all of us have been there it’s itching it hurts it can even bleed and it’s in the anus this which you can see here is a cross section of the anus this would be an internal hemorrhoid and this over here an external hemorrhoid actually everybody has hemorrhoids and why am i saying this well because hemorrhoids are normal anatomical vascular structures that everyone has they can be found over here and they are small cushions that help control the stool these hemorrhoids can become swollen and then we refer to them as internal hemorrhoids a disease internal hemorrhoids here we see the perineal and they can become thrombosed and we refer to that as external hemorrhoids so this is what patients usually get wrong internal hemorrhoids are actually normal anatomical structures that became swollen the external hemorrhoids are not hemorrhoids at all those are perianal vessels that became thrombosed luckily not all of us experience hemorrhoids that are swollen or thrombosed perianal vessels but two out of three individuals of general population actually do have this disease it’s rather common how and why exactly they happen we don’t know what we do know however is that constipation diarrhea pregnancy and sitting on the toilet for too long does increase the risk of having hemorrhoids or simply it makes them worse so what can be done about this condition and what are our options well there are many options and many suggested treatments which actually do not work flavonoids are often suggested as this successful miracle treatment but the benefits are questionable and there are potential side effects chinese herbal treatments were not proven successful in clinical studies either and the steroids which actually do help can only be used for 14 days this is the case because steroids are associated with thinning of the skin so what can be done about these hemorrhoids well there are four things i’d like to highlight and because it can be extremely frustrating if you tried some of these previously mentioned treatments and they didn’t work i guess the first thing i should suggest is to listen to doctors who follow evidence-based medicine and adhere to the guidelines usually created by the relevant american societies for medicine for example the american society of colon and rectal surgeons does not recommend the use of topical agents and suppositories and i don’t know why across america but also around the world doctors keep suggesting treatments like that that simply don’t work the second thing that can be done is to subscribe to our channel and like this video because youtube and other platformers will not suggest this video to other people suffering from hemorrhoids unless we get enough likes and subscriptions that’s simply how their algorithms work these days so that’s something you can do to help us help other people and now let’s explain the third thing that can be done and that is to understand that treatment of hemorrhoids consists of a teamwork between a patient and a physician and what patients can do about hemorrhoids is simply to eliminate the causes of hemorrhoids that we identified not the causes but the risk factors first and foremost diet is important with a lot of water and fiber after that it is important to treat diarrhea and obstacles if it’s present and not to spend a lot of time on the toilet or straining concerning the pain patients can take non-steroidal anti-inflammatory drugs without a prescription that is if they don’t have any other contraindications doctors however concerning the pain can prescribe local anesthetics such as lidocaine but to cure hemorrhoids doctors can perform a procedure called rubber band legation this procedure has some potential side effects such as pain bleeding and inflammation rubber band ligation is actually a first-line treatment for grade one to three and this is actually a good way to treat this condition because it has a cure rate of up to 87 and a complication rate of up to just 3 percent this is where skills and knowledge of a doctor can help solve the problems for the patient this is not just some pill you prescribe it is a procedure in which an operating surgeon and his skills have a direct impact on the success rate and the outcome of the procedure another successful treatment for hemorrhoids is a treatment with a success rate of up to 70 percent and it is called sclerotherapy it involves an injection of a sclerosing agent there are also cauterization methods and this is what evidence-based medicine suggests and recommends this doesn’t mean that we immediately treat every patient surgically there are specific indications when to attempt a surgical treatment of hemorrhoids so for example this which you can see here is a prolapsed internal hemorrhoid it is prone to ulcers bleeding and progression and that might be an indication to treat it surgically non-prolapsing internal hemorrhoids might cause bleeding and also anemia through this bleeding and therefore that