Emma

What is insulin?

Insulin is a hormone made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.
Insulin plays a major role in metabolism—the way the body uses digested food for energy. The digestive tract breaks down carbohydrates—sugars and starches found in many foods—into glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, cells throughout the body absorb glucose and use it for energy.

Insulin’s Role in Blood Glucose Control

When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to cells throughout the body.
Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels.
Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen.
Insulin also lowers blood glucose levels by reducing glucose production in the liver.
In a healthy person, these functions allow blood glucose and insulin levels to remain in the normal range.

What is insulin resistance?

Insulin resistance is a condition in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells, leading to type 2 diabetes or prediabetes.
Most people with insulin resistance don’t know they have it for many years—until they develop type 2 diabetes, a serious, lifelong disease. The good news is that if people learn they have insulin resistance early on, they can often prevent or delay diabetes by making changes to their lifestyle.
Insulin resistance can lead to a variety of serious health disorders.

What happens with insulin resistance?

In insulin resistance, muscle, fat, and liver cells do not respond properly to insulin and thus cannot easily absorb glucose from the bloodstream. As a result, the body needs higher levels of insulin to help glucose enter cells.
The beta cells in the pancreas try to keep up with this increased demand for insulin by producing more. As long as the beta cells are able to produce enough insulin to overcome the insulin resistance, blood glucose levels stay in the healthy range.
Over time, insulin resistance can lead to type 2 diabetes and prediabetes because the beta cells fail to keep up with the body’s increased need for insulin. Without enough insulin, excess glucose builds up in the bloodstream, leading to diabetes, prediabetes, and other serious health disorders.

What causes insulin resistance?

Although the exact causes of insulin resistance are not completely understood, scientists think the major contributors to insulin resistance are excess weight and physical inactivity.
Excess Weight
Some experts believe obesity, especially excess fat around the waist, is a primary cause of insulin resistance. Scientists used to think that fat tissue functioned solely as energy storage. However, studies have shown that belly fat produces hormones and other substances that can cause serious health problems such as insulin resistance, high blood pressure, imbalanced cholesterol, and cardiovascular disease (CVD).
Belly fat plays a part in developing chronic, or long-lasting, inflammation in the body. Chronic inflammation can damage the body over time, without any signs or symptoms. Scientists have found that complex interactions in fat tissue draw immune cells to the area and trigger low-level chronic inflammation. This inflammation can contribute to the development of insulin resistance, type 2 diabetes, and CVD. Studies show that losing the weight can reduce insulin resistance and prevent or delay type 2 diabetes.

Physical Inactivity

Many studies have shown that physical inactivity is associated with insulin resistance, often leading to type 2 diabetes. In the body, more glucose is used by muscle than other tissues. Normally, active muscles burn their stored glucose for energy and refill their reserves with glucose taken from the bloodstream, keeping blood glucose levels in balance.
Studies show that after exercising, muscles become more sensitive to insulin, reversing insulin resistance and lowering blood glucose levels. Exercise also helps muscles absorb more glucose without the need for insulin. The more muscle a body has, the more glucose it can burn to control blood glucose levels.

Other Causes

Other causes of insulin resistance may include ethnicity; certain diseases; hormones; steroid use; some medications; older age; sleep problems, especially sleep apnea; and cigarette smoking.

Cirrhosis Complications

Monday, February 4, 2013 3:40:04 PM

Complications of cirrhosis can include:

High blood pressure in the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, increasing pressure in the vein that brings blood from the intestines and spleen to the liver.

Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make certain blood proteins.

Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.

Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra load, these smaller veins can burst, causing serious bleeding. High blood pressure also may enlarge veins and lead to life-threatening bleeding in the esophagus (esophageal varices) or the stomach (gastric varices).

Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
High levels of toxins in the blood (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. Toxins in the blood can cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.

Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes, and darkening of urine.

Increased risk of liver cancer.

By Mayo Clinic staff

What is cirrhosis?

Wednesday, January 23, 2013 2:51:22 AM

Cirrhosis is a complication of many liver diseases that is characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis do so because they injure and kill liver cells, and the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue. There are many causes of cirrhosis; they include chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic diseases), and autoimmune liver disease in which the body's immune system attacks the liver.

What are the symptoms and signs of cirrhosis?

Patients with cirrhosis may have few or no symptoms and signs of liver disease. Some of the symptoms may be nonspecific, that is, they don't suggest that the liver is their cause. Some of the more common symptoms and signs of cirrhosis include:

*Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood

*Fatigue

*Weakness

*Loss of appetite

*Itching

*Easy bruising from decreased production of blood clotting factors by the diseased liver.

Hiatal Hernia

Thursday, December 13, 2012 1:46:34 AM

A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted.

Normally, the esophagus or food tube passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years.

What causes a hiatal hernia?

It is thought that hiatal hernias are caused by a larger-than-normal esophageal hiatus, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen; as a result of the large opening, part of the stomach "slips" into the chest. Other potentially contributing factors include:

1-A permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid) which pulls the stomach up.

2-An abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.

What are the symptoms of hiatal hernia?

The vast majority of hiatal hernias are of the sliding type, and most of them are not associated with symptoms. The larger the hernia, the more likely it is to cause symptoms. When sliding hiatal hernias produce symptoms, they almost always are those of gastroesophageal reflux disease (GERD) or its complications. This occurs because the formation of the hernia often interferes with the barrier (lower esophageal sphincter) which prevents acid from refluxing from the stomach into the esophagus. Additionally, it is known that patients with GERD are much more likely to have a hiatal hernia than individuals not afflicted by GERD. Thus, it is clear that hiatal hernias contribute to GERD. However, it is not clear if hiatal hernias alone can result in GERD. Since GERD may occur in the absence of a hiatal hernia, factors other than the presence of a hernia can cause GERD.

Symptoms of uncomplicated GERD include:

.heartburn
.regurgitation
.nausea

How is a hiatal hernia diagnosed?

Hiatal hernias are diagnosed incidentally when an upper gastrointestinal x-ray or endoscopy is done during testing to determine the cause of upper gastrointestinal symptoms such as upper abdominal pain. On both the x-ray and endoscopy, the hiatal hernia appears as a separate "sac" lying between what is clearly the esophagus and what is clearly the stomach. This sac is delineated by the lower esophageal sphincter above and the diaphragm below. The hernia may only be visible during swallows, however.

Hiatal Hernia At A Glance

.A hiatal hernia is an anatomical abnormality of the esophagus.
.Hiatal hernias contribute to gastro-esophageal reflux disease (GERD).
.The symptoms in individuals with hiatal hernias parallel the symptoms of the associated GERD.
.The treatment of most hiatal hernias is the same as for the associated GERD.

Día del Médico en Argentina / 3 de Diciembre

Monday, December 3, 2012 7:34:06 PM

En la Argentina, se festeja el Día del Médico por una iniciativa del Colegio Médico de Córdoba, avalada por la Confederación Médica Argentina, y oficializada por decreto del gobierno nacional, en 1956.

¿Por qué se eligió el 3 de diciembre? Porque ese día nació Carlos Finlay, el médico cubano que demostró el modo de transmisión de la fiebre amarilla -a través de un mosquito-, un hallazgo de trascendencia mundial que evitó miles de muertes en América latina. La fiebre amarilla fue estudiada clínicamente durante centurias. Pero los estudios de Finlay, que comenzó a ocuparse de la enfermedad en 1865, resultaron determinantes.

En 1881, ante la Academia de Ciencias de La Habana, presentó su trabajo fundamental: "El mosquito hipotéticamente considerado como agente transmisor de la fiebre amarilla", en el que describía los detalles, las características y los hábitos del mosquito y anunciaba la trascendente experiencia del contagio en personas: "Cinco casos en los cuales, por una sola picadura de mosquito, se reprodujo la enfermedad", decía.

Tras la lectura de Finlay hubo silencio total en el auditorio, y los académicos se retiraron uno a uno. Y hubo que esperar 19 años para que la IV Comisión Americana para el Estudio de la Fiebre Amarilla (integrada por Reed, Carroll, Agramonte y Lazear) se dispusiera a comprobar si la teoría de Finlay era cierta..

En 1901, la comisión confirmó y amplió las ideas de Finaly, que dieron las bases para la prevención por medio de la lucha contra los mosquitos, dejando atrás la idea de que el mal se transmitía por la ropa o por los objetos que hubieran estado en contacto con los enfermos.

Que Dios los ilumine siempre, que la sabiduría este siempre presente en ustedes, que la paciencia habite en su corazón, que su oído y su mente siempre estén escuchando y que su vista nunca se aparte del camino de la vocación.

TESTS THAT EXAMINE THE STOMACH ARE USED TO DETECT AND DIAGNOSE GASTRIC CANCER.

Tuesday, August 7, 2012 4:30:31 PM

The following tests and procedures may be used:

.Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

.Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

.Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:

.The number of red blood cells, white blood cells, and platelets.
.The amount of hemoglobin (the protein that carries oxygen) in the
red blood cells.
.The portion of the sample made up of red blood cells.

.Upper endoscopy: A procedure to look inside the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus.

Upper endoscopy. A thin, lighted tube is inserted through
the mouth to look for abnormal areas in the esophagus,
stomach, and first part of the small intestine.

.Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

.Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

Barium swallow for stomach cancer.
The patient swallows barium liquid and
it flows through the esophagus and into the stomach.
X-rays are taken to look for abnormal areas.

.Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy of the stomach is usually done during the endoscopy.

.CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

.The stage of the cancer (whether it is in the stomach only or has spread to lymph nodes or other places in the body).

.The patient’s general health.

When gastric cancer is found very early, there is a better chance of recovery. Gastric cancer is often in an advanced stage when it is diagnosed. At later stages, gastric cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered.

WHAT IS STOMACH CANCER?

Tuesday, August 7, 2012 4:11:04 PM

Stomach cancer, also called gastric cancer, is a cancer that starts in the stomach.

After food is chewed and swallowed, it enters the esophagus, a tube that carries food through the neck and chest to the stomach. The esophagus joins the stomach at the gastroesophageal junction, which is located just beneath the diaphragm (the breathing muscle under the lungs). The stomach is a sac-like organ that holds food and starts to digest it by secreting gastric juice. The food and gastric juice are mixed and then emptied into the first part of the small intestine called the duodenum.

Some people use the word stomach to refer to the area of the body between the chest and the pelvic area. The medical term for this area is the abdomen. For instance, some people with pain in this area would say they have a "stomach ache," when in fact the pain could be coming from the appendix, small intestine, colon (large intestine), or other organs in the area. Doctors would refer to this symptom as abdominal pain, because the stomach is only one of many organs in the abdomen in which cancers may start.

Stomach cancer should not be confused with other cancers that can occur in the abdomen, like cancer of the colon (large intestine), liver, pancreas, or small intestine because these cancers may have different symptoms, a different outlook, and different treatments.

Parts of the stomach

The stomach has 5 parts:

.Cardia: The upper portion (closest to the esophagus)

.Fundus: Located next to the cardia. Some cells in these areas of the stomach make acid and pepsin (a digestive enzyme), the parts of the gastric juice that help digest food.

.Body (corpus): The area between the upper and lower parts of stomach

.Antrum: The lower portion (closest to the intestine), where the food is mixed with gastric juice

.Pylorus: Acts as a valve to control emptying of the stomach contents into the small intestine.
The first 3 parts of the stomach (cardia, fundus, and body) are sometimes called the proximal stomach, and the lower 2 parts (antrum and pylorus) are called the distal stomach.

Cancers starting in different sections of the stomach may cause different symptoms and tend to have different outcomes. The cancer’s location can also affect the treatment options. Cancers that start at the gastroesophageal junction are staged and treated the same as cancers of the esophagus. A cancer that started in the cardia of the stomach but then grew into the gastroesophageal junction is also staged and treated like a cancer of the esophagus.

The stomach has 2 curves, which form its upper and lower borders. They are called the lesser curve and greater curve, respectively. Other organs next to the stomach include the colon, liver, spleen, small intestine, and pancreas.

The stomach wall has 5 layers. As a cancer grows deeper into them, the prognosis (outlook) is not as good. The innermost layer is the mucosa. This is where stomach acid and digestive enzymes are made, and where most stomach cancers start. Under this is a supporting layer called the submucosa. This is surrounded by the muscularis propria, a layer of muscle that moves and mixes the stomach contents. The outer 2 layers, the subserosa and the outermost serosa, act as wrapping layers for the stomach.

Development of stomach cancer

Stomach cancers tend to develop slowly over many years. Before a true cancer develops, pre-cancerous changes often occur in the lining of the stomach. These early changes rarely cause symptoms and therefore often go undetected.

Stomach cancers can spread (metastasize) in different ways. They can grow through the wall of the stomach and invade nearby organs. They can also spread to the lymph vessels and nearby lymph nodes. Lymph nodes are bean-sized structures that help fight infections. The stomach has a very rich network of lymph vessels and nodes. If cancer spreads to the lymph nodes, the patient's outlook is not as good. As the stomach cancer becomes more advanced, it can travel through the bloodstream and spread to organs such as the liver, lungs, and bones.

Types of stomach cancers

Adenocarcinoma

About 90% to 95% of cancerous (malignant) tumors of the stomach are adenocarcinomas. The term stomach cancer, or gastric cancer, almost always refers to adenocarcinoma. This cancer develops from the cells that form the innermost lining of the stomach (known as the mucosa).

Lymphoma

These are cancers of the immune system tissue that are sometimes found in the wall of the stomach. They account for about 4% of stomach cancers. Prognosis and treatment depend on the type of lymphoma present. For more detailed information, see our document, Non-Hodgkin Lymphoma.

Gastrointestinal stromal tumor

These are rare tumors that seem to start in cells in the wall of the stomach called interstitial cells of Cajal. Some are non-cancerous (benign); others are cancerous. Although these tumors can be found anywhere in the digestive tract, most (about 60% to 70%) occur in the stomach. For more information, see our document, Gastrointestinal Stromal Tumor (GIST).

Carcinoid tumor

These are tumors that start in hormone-making cells of the stomach. Most of these tumors do not spread to other organs. About 3% of stomach cancers are carcinoid tumors. These tumors are discussed in more detail in our separate document, Gastrointestinal Carcinoid Tumors.

LEARN ABOUT COLON POLYPS

Saturday, June 2, 2012 8:29:40 PM

Colon polyps can be various shapes and sizes, and it helps to learn about the different types of colon polyps so you know whether they increase your risk of colon cancer. You can work with your doctor to develop an appropriate treatment plan if you are diagnosed with colon polyps.

What Are Colon Polyps?

"Polyp" is a general term used to describe a benign (non-cancerous) growth on the lining, or inside, of a mucous membrane. This includes mucous membranes that are found in the digestive tract, including the colon, and the nasal passages. Other areas with mucous membranes, such as the mouth, uterus, bladder, and the genital areas can develop polyps as well.

The likelihood of having polyps increases with age. In other words, older people are more likely to develop polyps. Approximately half of people over the age of 60 have at least one polyp and often more.

Polyps are considered pre-cancerous, which means that they are not cancer, but if left untreated, they may develop into cancer. Fortunately, colon polyps typically are found during routine colon cancer screening tests, such as a colonoscopy or flexible sigmoidoscopy. When found, these growths can be removed, which reduces the likelihood of later developing colon cancer.

What Are the Different Types of Colon Polyps?

Shape

In terms of shape, colon polyps come in two basic varieties: pedunculated and sessile. Pedunculated polyps are mushroom-like tissue growths that are attached to the surface of the mucous membrane by a long, thin stalk, or peduncle. Sessile polyps sit right on the surface of the mucous membrane. They do not have a stalk. Sessile polyps are flat.

Polyp Types

The four most common types of colon polyps are inflammatory, adenomatous (adenoma), hyperplastic, and villous (tubulovillous) adenoma. In addition to these, two less common polyp types include lymphoid, which are considered rare and benign (non-cancerous), and juvenile. Juvenile refers to the type of polyp, not the age at which polyps first develop.

Inflammatory

Inflammatory colon polyps are found most often in people with a inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis. Inflammatory polyps may be referred to as "pseudopolyps," which means false polyps. This is because these are not true polyps, but rather are a reaction to chronic inflammation in the colon. Inflammatory polyps are benign and generally are not at risk of developing into colon cancer.

Adenomatous

Adenomatous polyps, or adenomas, are the most common type of polyp and make up about 70% of the polyps found in the colon. Adenomas can develop into colon cancer, but fortunately, this process typically takes many years. This means that with regular colon cancer screening, these polyps can be found and removed, before they develop into colon cancer.

More recent research has found that the sessile, or flat, type of polyps may be more common than originally believed and may be harder to detect on screening. Despite this, colon cancer screening can drastically reduce your colon cancer risk. Don’t make the mistake of assuming that if you are diagnosed with sessile polyps, you shouldn’t bother with follow-up or additional colon cancer screening. Colon cancer screening saves lives, plain and simple.

Hyperplastic

The word "hyperplastic" refers the activity of the cells making up the polyp. The cells in this type of polyp are increasing in number. Hyperplasia means an abnormal increase in the number of cells in a tissue, with enlargement of the area.

Despite the fact that the cells in hyperplastic polyps are growing and reproducing, these are considered lower risk for developing into cancer. Even so, hyperplastic polyps are removed during colon cancer screening when they are found. This allows your doctor to check the polyp thoroughly and make sure it is not showing signs of cancer.

Villous or Tubulovillous Adenoma

Approximately 15% of polyps that are found and removed with colon cancer screening are villous or tubulovillous adenomas. These polyps are more dangerous because they have the highest likelihood of developing into colon cancer. Villous adenomas may be sessile, or flat, making them more difficult to remove. Smaller villous adenoma polyps may be removed during colonoscopy, while larger polyps of this type may require surgery for complete removal.

Cell Types In Colon Polyps

Finally, polyp also are defined by the type of cells found in them. In general, cells in polyps are considered non-neoplastic or neoplastic. Non-neoplastic polyps are unlikely to develop into colon cancer. Polyps comprised of neoplastic cells, such as adenomas, have a higher likelihood of developing into colon cancer.

Fortunately, colon cancer screening allows your health care provider to detect and remove polyps made up of both non-neoplastic and neoplastic cells. If you’re squeamish about the idea of being screened for colon cancer, take a few moments to learn how to prepare for these tests and how not to dread a colonoscopy.