9
July
2008
Food Poisoning occurs about 76 million times a year in Americans, leading to over 300,000 hospitalizations and 5,000 deaths. Ones most hurt by food poisoning are the elderly, immunocompromised, and young kids. Food poisoning is usually from bacteria, but also viruses and chemical ingestion. Incubation time most c/w: <1 hr chemical ingestion, 1-7 hrs toxins from staph aureus or bacillus cereus, 8-14 hours bacteria, and 15 or more hrs viruses.
For outbreaks, Salmonella is #1. Though Listeria account for like 0.2% cases, it is the #1 cause of death from food poison outbreaks. #2 is viruses, in particular norovirus. Chemical ingestion and then parasites follow.
drjohnhong 
infection, GI 
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18
May
2008
Hemorrhoids
drjohnhong Uncategorized, GI Comments (0) » |
20
February
2008
Nausea and Vomiting (N/V): who likes to feel nauseous and then throw up? Nausea is the feeling you are going to vomit. Vomit is actually bring up the stomach contents up and out through the mouth. If you don’t bring anything up, then it is called retching.
Many things cause nausea and vomiting. If you get motion sick like me, you will know that is one cause. Vertigo A viral GI bug usually goes around a community once or twice a year it seems. Bacterial GI bug comes from food normally, especially in undercooked or ill-prepared chicken. Pregnant all too well know N/V, like 70-85% of them. Diabetic ketoacidosis, hyperthyroidism, parathyroid disease are metabolic reasons. GI illness: peptic ulcers, pancreas disease, gallbladder disease, hepatitis, gastroparesis (slow GI system), small bowel obstruction. Migraines, meningitis, anxiety. Medicines, alcohol, narcotics, vitamins. Forcing vomiting is bulimia.
Vomiting can be protective against poisons and toxins. It is not GERD in which stomach acid and contents creep up the esophagus. Vomiting is forceful expulsion. If you are like me, I hate to vomit. Retching is when the throat and respiratory muscles prevent the vomit from coming up. Projectile vomiting can be a sign of an underlying neurological problem
Problems that can result from N/V: dehydration from not keeping fluids down. Puking up the acids can drop the body’s potassium and raise the pH of the blood. The esophagus can tear and bleed.
Treatment: well relief of the N/V depends on the underlying problem. Ginger and vitamin B6 can work for some people, in particular in pregnancy. Phenergan, compazine, reglan are common meds. Dexamethasone is a steroid that sometimes is used after surgery if vomiting is bad, or droperidol. Chemotherapy can cause terrible N/V and Zofran (ondansetron), granisetron, and dexamethasone can be used. Marijuana in cancer patients, but marijuana abusers can have the opposite and vomit. For people like me with vertigo, treating the vertigo is the main goal.
drjohnhong Uncategorized, GI Comments (0) » |
28
November
2007
Fecal Incontinence: #2 cause of nursing home placement. Adult diapers in 1988 $400 million in USA. This means an adult accidentally poops at least once a month. Minor fecal incontinence is while passing gas (flatulence/farting) some stool comes our, or a person has loose stools (like in diarrhea) and it comes out accidentally. Major fecal incontinence means feces comes out unwillingly.
Who knows how many people have fecal incontinence because most people are too embarrassed to admit to it. It is estimated to affect 11-15% of community-dwelling adults (like nursing homes, assisted living)
Risk factors: age, obesity, COPD, IBS, urinary incontinence, colectomy, mentation. Men and women have the same prevalence, but women are 2x more likely to admit to it.
People with brain injury often have fecal incontinence. After childbirth, trauma to the anal sphincter or pudendal nerve can cause fecal incontinence for years. Surgeries such as for hemorrhoids & anal fistulas can lead to fecal incontinence. Rectal prolapse is risk.
Diabetics with autonomic neuropathy, bacterial overgrowth syndrome, and reduced sphincter pressure can have fecal incontinence. History of radiation therapy can lead to proctitis. Ulcerative proctitis as well.
Some cannot sense stool in the rectum: diabetics, MS, dementia, spinal cord injuries.
With fecal impactions, liquid stool can seep around the hard stool and out the anus in elderly.
Continence relies on many factors. The bottom line is when stool stretches the rectum, the person should sense this. To poop or not poop is based on relaxing or not relaxing the external anal sphincter muscles.
Work up: history and physical examination by doctor. Endoscopy is often needed. Anorectal manometry measures the function of the anus and rectum which can give valuable information. Pudendal nerve terminal latency test, endorectal ultrasound, defecography, and EMG can be done.
Treatment: Medical therapy, biofeedback, and surgery. Depends on the underlying causes.
drjohnhong senior citizen, GI Comments (0) » |
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