Sign & Symptoms of Ulcer

Signs and Symptom of Ulcer

Stomach pain is the most common symptom of an ulcer. This feels like sharp aches between the breastbone and the belly button.  This kind of pain usually comes a few hours after eating. This can also happen during the night or early in the morning.

The symptom of ulcer can be different by various types, though there are similarities with general symptom. The standard signs of a stomach ulcer or other type of ulcer are as follows:

• Abdominal pain – caused by the inflammation of the stomach lining and by  buildup of gases
• Heartburn – also known as acid reflux that is caused by slowing down of the digestive system
• Discomfort after meals – also related to above, usually a couple of hours after eating
• Anaemia – iron deficiency can come about as a result of the bacteria involved in causing ulcers
• Bad breath – again a cause of the bacteria
• Constipation – the bacteria causes the loss of food processing
• Nausea and vomiting – apparently caused by the bacteria

These are some of the main symptoms associated with stomach and other digestive system ulcers, so, it is vital to understand they can also occur with other condition. There are a number of lesser or secondary symptoms that can also manifest. Ex:

• Anxiety and depression
• nausea
• Fatigue and general tiredness
• Unusual headaches
• loss of appetite
• sudden, sharp stomach pains
• Sinus and sleep problems
• weight loss
• Abnormal weight gain or loss
• frequent burping or hiccupping
• bloody or blackish bowel movements

Untreated ulcers grow larger and deeper over time and can lead to other problem, such as bleeding in the digestive system or a hole in the wall of the stomach or duodenum, that can make someone very sick.

Pain is the most common symptom

Burning pain is the most common peptic ulcer symptom. Pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. Pain typically may:

• Be felt anywhere from navel up to breastbone.
• Flare at night.
• Be worse when stomach is empty.
• Relieved temporarily by eating certain foods that buffer stomach acid or by taking an acid reducing medication like antacids.
• Sometimes disappear and then return for a few days or weeks.

Symptoms of a stomach ulcer

• The most common symptom of a stomach ulcer is a burning or gnawing pain in the upper abdomen just below the sternum (breastbone). It usually comes and goes.  The pain can also travel up to neck, down to your navel (belly-button) or through to back. Sometimes food makes the pain worse. Pain may wake from sleep.
•  Other symptom that may occur includes: bloating, retching and feeling sick.
•  Complications develop in some cases that can be serious. These includes:

• Bleeding ulcer. This can range from a 'trickle' to a life-threatening bleed.
• Perforation. This is where the ulcer goes right through ('perforates') the wall of the stomach. Then food and acid in the stomach then leak into the abdominal cavity. It usually causes severe pain and is a medical emergency.

Symptom of a peptic ulcer

Symptom of ulcer disease are variable. A group of ulcer patients experience minimal indigestion, abdominal discomfort that occurs after meal. Some complain of upper abdominal burning or hunger pain one to three hours after meals or in the middle of the night. This symptom often are promptly relieved by food or antacids that neutralize stomach acid. Pain of ulcer disease correlates poorly with the presence or severity of active ulceration. Patient have  persistent pain even after an ulcer is almost completely healed by medications. Some experience no pain. Ulcer often come and go spontaneously without the individual ever knowing that they are present unless a serious complication (like bleeding or perforation) occurs.
The pain associated with a stomach ulcer is caused by the ulcer itself and stomach acid that comes into contact with the ulcer and irritates it.  Pain can last from a few minutes to a few hours.
Eating more food and taking antacids (indigestion medication) can often help relieve the pain of a duodenal ulcer, though not usually the pain of a stomach ulcer.

Symptoms based on Classification of Ulcer

Gastric Ulcer

The symptoms of gastric ulcer include feelings of indigestion, heartburn and repetition of gastrointestinal bleeding.  Pain of  ulcer is described as gnawing, dull, aching, or resembling hunger pang. Patient may be nauseated and suffer loss of appetite.  About 30% of patient with gastric ulcer are awakened by pain at night. A lot of patient have periods of chronic ulcer pain alternating with symptom free periods that last for several weeks or months. This kind of  characteristic is called periodicity.

Duodenal Ulcer

The symptoms of duodenal ulcer include heartburn, stomach pain relieved by eating or antacid, weight gain, and a burning sensation at the back of the throat. Patient is most likely to feel discomfort two to four hours after meal or sometimes after having citrus juice, coffee or NSAID like aspirin. About 50% of patients with duodenal ulcer awake during the night with pain. That occurs usually between midnight and three a.m. There is a regular pattern of ulcer pain associated with certain periods of day or night or a time interval after meals is called rhythmicity.

Hypertension & its Cause

Hypertension

Hypertension is also called as high blood pressure. It is a condition in where the arteries have persistently elevated blood pressure. When the human heart beats then it pumps blood to the whole body through the arteries. The term blood pressure is the force of blood, pushing up against the blood vessel wall. The higher the pressure the harder the heart pump. The heart pumps blood into the arteries that carry the blood throughout the body. Hypertension is dangerous because it makes the heart work harder to pump blood to the body and contributes to hardening of the arteries, called atherosclerosis and to development of heart failure.

A blood pressure reading has a bottom number (diastolic) and top number (systolic). Hypertension can damage organs and cause several illnesses like heart failure, kidney failure, stroke and heart attack.

In American Academy of Neurology Journal, researchers reported that hypertension during middle age may raise the risk of cognitive decline later in life.

The normal level for blood pressure is below 120/80, here 120 represent the systolic measurement (peak pressure in arteries) and 80 represent the diastolic measurement (minimum pressure in arteries). Blood pressure between 120/80 and 139/89 is called prehypertension (to denote increased risk of hypertension). A blood pressure of 140/90 or above is called hypertension.

Hypertension can be classified as primary or secondary. Primary hypertension is the term for high blood pressure with unknown cause. It accounts for about 95% of cases. Secondary hypertension is the term for high blood pressure with a known direct cause, like-kidney disease, tumor, or birth control pill.

Person can have hypertension for many years without any symptom. Uncontrolled high blood pressure increases the risk of serious health problems.

Hypertension typically develops over many years. It affects nearly everyone eventually. Hypertension can be easily detected. Once people know that they have hypertension, they should consult to doctor immediately to control it.

Causes of Hypertension

The exact causes of hypertension are usually unknown; but there are several general factors that have been highly associated with the condition.

They are:

• Smoking
• Obesity or overweight
• Diabetes
• Sedentary lifestyle
• Lack of physical activity
• High levels of salt (sodium) intake.
• Insufficient potassium, calcium and magnesium consumption
• Vitamin D deficiency
• Aging
• Stress
• Tumors
• Medicines- birth control pills
• High levels of alcohol consumption
• Genetics and a family history of hypertension.  
• Chronic kidney disease
• Adrenal and thyroid problems

Based on the cause, Hypertension can be classified into two main types: 

Primary or Essential Hypertension

When a direct cause for high blood pressure can not be identified, the condition is described as primary hypertension. This hypertension makes up 90 to 95% of cases in adults, though scientists still aren’t sure exactly what causes this common form of hypertension.

Though essential hypertension remains mysterious, it has been associated to certain risk factors. Hypertension tends to run in families and affect men more than women. Age and race also play a role. In US, blacks are twice as like as whites to have hypertension.

Essential hypertension is also greatly influenced by diet and lifestyle. The relation between salt and hypertension is especially undeniable. By compare, people who do not add salt to their food show virtually no traces of essential hypertension.

The majority of all people with hypertension is "salt sensitive," that means, anything more than the minimal bodily need for salt is too much for them and increases their blood pressure. Some other factors that can raise the risk of having essential hypertension include overweight, stress, diabetes, insufficient intake of minerals like potassium, calcium or magnesium, lack of physical activity and excess alcohol consumption.

Primary hypertension is not directly attributable to one condition; it is caused by a combination of factors. Changes in the arteries over the years are often associated with hypertension. Such changes include:

• Buildup of fatty deposits inside arteries (atherosclerosis)
• Thickening of artery walls
• Excessive contraction of small arteries (arterioles)

Secondary Hypertension

When a direct cause for high blood pressure can be identified, the condition is called as secondary hypertension.  Kidney disease ranks first, among the known causes of secondary hypertension, Hypertension can also be triggered by tumors or other abnormalities that cause the adrenal glands (small glands, sit atop the kidneys) to secrete excess amounts of hormones that elevate blood pressure.

This form of hypertension makes up 5-10% of cases in adults as well as most cases in children age under 10. Secondary hypertension is the direct result of an underlying health condition that causes blood pressure to shoot up. This can have a number of causes including-

Kidney diseases

Kidney disease is the most common cause of secondary hypertension. Kidney regulates the amount of fluid in the body. If there is a kidney problem, the volume of blood can be increased. The more blood that must be pumped through artery, the higher the force that is needed.

Hypertension can be caused by several forms of kidney diseases. Diabetic nephropathy occurs when diabetes damages the kidneys’ filtering system. Polycystic kidney diseases is an inherited condition characterized by cysts in the kidney. Glomerular disease is characterized by swelling of microscopic kidney filters called glomeruli. Hypertension can also result from a blockage inside the kidney, called hydronephrosis or narrowing of arteries and leading to them renovascular hypertension.

Hormonal disorder

The adrenal glands produce hormones that affect blood pressure.  In case of Cushing’s disease, adrenal glands release too much cortisol that causes blood pressure to rise. In case of aldosteronism, they release too much aldosterone that can affect kidney function. Other glands and their hormones can play a role also. In hypothyroidism, the thyroid gland produces too little thyroid hormone that can raise blood pressure. In case of hyperthyroidism, the same gland releases too much thyroid hormone. That can also raise blood pressure by increasing the activity of two other hormones- epinephrine and nor-epinephrine. In hyperparathyroidism, the parathyroid glands secret parathyroid hormone that increase calcium in blood. So, in turn this can cause a blood pressure increase.

Birth control pills

Some birth control pills particularly those containing estrogen can raise blood pressure and also pregnancy can boost up blood pressure, because this medications can constrict blood vessels.

Chemotherapy

Chemotherapy

Chemotherapy is the use of anticancer drugs to treat cancerous cell. Chemotherapy has been used for many years and is one of the most common treatment for cancer. Chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different group of drugs work in different ways to fight cancer cell. Chemotherapy is used alone for some types of cancer or in combination with other treatments such as surgery or radiation. A combination of chemotherapy drugs is used to fight a specific cancer. 

Chemotherapy can be administered:

•             As a pill to swallow
•       As an injection into the muscles or tissues.
•       Intravenously (directly to the bloodstream; also called IV).
•      Topically (applied to the skin)
•           Directly into a body cavity

·        There are over 50 chemotherapy drugs that are commonly used. Chemotherapy is the way to cure cancer by killing cell. It kills cancer cell and also can kill normal cell. But killing normal cells can cause some unpleasant side effects. The side effects vary from one drug to another drug and from patient to patient. 

The good news about these side effects is that there are some ways to ease most of the symptoms of this effect. Sometimes, certain side effects can have long lasting or permanent effects. Certain chemotherapy drugs can result in infertility or the inability to father a child which may be permanent. So, it is necessary to talk to doctor about any concerns before starting chemotherapy.

Types of Insulin

Types of Insulin

There are three main groups of insulin: Fast-acting, Intermediate-acting and Long-acting insulin.

Fast-acting insulin

• Is absorbed quickly from fat tissue (subcutaneous) into the bloodstream.
• Is used to control the blood sugar during meal and snack and to correct high blood sugars

Includes:
Rapid Acting Insulin Analogs (Insulin Aspart, Insulin Glulisine, insulin Lyspro): This has an onset of action of 5 to 15 minute, peak effect in 1 to 2 hours and duration of action that lasts 4-6 hours. In all doses whether it is small or large, onset of action and time to peak effect is similar. The duration of insulin action is affected by the dose. For this, a few units may last 4 hours or less, where 25 or 30 units may last 5 to 6 hours. It assume that these insulins have duration of action of 4 hours.
Regular Human Insulin: This has an onset of action of 1/2 hour to 1 hour, peak effect in 2 to 4 hour, the duration of action of 6 to 8 hours. Larger the dose of regular the faster the onset of action, the longer the time to peak effect and the longer the duration of the effect.

Intermediate-acting insulin

• Is absorbed more slowly, lasts longer
• Is used to control the blood sugar overnight, both in fasting and between meals

Includes:
NPH Human Insulin which has an onset of insulin effect of 1 to 2 hour, peak effect of 4 to 6 hours, duration of action of more than 12 hours. A very small dose will have an earlier peak effect and shorter duration of action and higher doses will have a longer time to peak effect and prolonged duration.
Pre-Mixed Insulin which is NPH pre-mixed with either regular human insulin or a rapid- acting insulin analog. This insulin action profile is a combination of the short and intermediate acting insulins.

Long-acting insulin

• Is absorbed slowly and has a minimal peak effect. It has a stable plateau effect that lasts most of the day.
• Is used to control the blood sugar overnight, in fasting and between meals

Includes:
Long acting insulin analogs (Detemir, Glargine) have an onset of insulin effect in 1 1/2-2 hours. This insulin effect plateaus over the next few hours and is followed by a relatively flat duration of action that lasts 12-24 hours for insulin detemir and 24 hours for insulin glargine.

Table: Comparison of insulin action

Insulin Types	Onset	Peak Hour	Duration	Appearance
Fast-acting
Regular	½-1 hr.	2-4	6-8 hr.	clear
Lyspro/ Aspart/ Glulisine	<15 min.	1-2	4-6 hr.	clear
Intermediate-acting
NPH	1-2 hr.	6-10	12+ hr.	cloudy
Long-acting
Detemir	1 hr.	Flat, Max effect in 5	12-24 hr.	clear
Glargine	1.5 hr.	Flat, Max effect in 5	24 hr.	clear

Graph: Time action curve of different insulin