02 Maret, 2011

Eye

The eye is a slightly asymmetrical globe, about an inch in diameter. The front part of the eye (the part you see in the mirror) includes:

• The iris (the pigmented part)
• The cornea (a clear dome over the iris)
• The pupil (the black circular opening in the iris, which lets light in)
• The sclera (the white part)
• The conjunctiva (an invisible, clear layer of tissue covering the front of the eye, except the cornea)

Just behind the iris and pupil lies the lens, which helps to focus light on the back of the eye. Most of the eye is filled with a clear gel, called the vitreous. Light projects through the pupil and the lens to the back of the eye. The inside lining of the eye is covered by special light-sensing cells, together called the retina. The retina converts light into electrical impulses. Behind the eye, the optic nerve carries these impulses to the brain. The macula is a small sensitive area within the retina that gives central vision. It is located in the center of the retina and contains the fovea.

Eye color is created by the amount and type of pigment in the iris. Multiple genes inherited from each parent determine a person’s eye color.

Eye Conditions

  • Age-related macular degeneration: A loss of central vision in both eyes.
  • Myopia (nearsightedness): Inability to see clearly at a distance. The eye is “too long” for the lens, so light isn’t focused properly on the retina.
  • Hyperopia (farsightedness): Inability to see near objects clearly. The eye is “too short” for the lens, or certain eye muscles have weakened with age.
  • Strabismus: The eyes do not point in the same direction. The brain may then favor one eye, causing decreased vision (amblyopia) in the other eye.
  • Pterygium: A thickened conjunctival mass usually on the inner part of the eyeball. It may cover a part of the cornea, causing vision problems.
  • Scotoma: A blind or dark spot in the visual field.
  • Amblyopia (lazy eye): One eye sees better than the other, a problem of childhood development. The weaker eye may or may not “wander.” The weaker eye is called the "lazy eye."
  • Astigmatism: A defect that causes an inability to properly focus light onto the retina. Astigmatism causes blurry vision that can be corrected with glasses or contact lenses.
  • Cataract: A clouding of the lens, which hinders the passage of light through the lens.
  • Conjunctivitis: Also known as "pinkeye,” conjunctivitis is an infection or inflammation of the conjunctiva. It is usually caused by allergies, a virus, or a bacterial infection.
  • Glaucoma: Increased pressure inside the eye slowly reduces vision. Peripheral vision is lost first, often going undetected for years.
  • Diplopia (double vision): Seeing double can be caused by many serious conditions. Diplopia requires immediate medical attention.
  • Retinal detachment: The retina comes loose from the back of the eye. Trauma and diabetes are common causes of this medical emergency.
  • Diabetic retinopathy: High blood sugar damages blood vessels in the eye. Eventually, weakened blood vessels may overgrow the retina or bleed, threatening vision.
  • Stye: Bacteria infect the skin on the edge of the eyelid, creating a tender red bump.
  • Chalazion: An oil-making gland gets blocked and swells into a bump. Often confused with styes, chalazions are not caused by infections.
  • Hyphema: Bleeding into the front of the eye, behind the cornea. Hyphema is usually caused by trauma.
  • Blepharitis: Inflammation of the eyelids near the eyelashes. Blepharitis is a common cause of itching or a feeling of grit in the eyes.
  • Corneal abrasion: A scratch on the clear part of the front of the eye. Pain, light sensitivity, or a feeling of grit in the eye are the usual symptoms.
  • Keratitis: Inflammation or infection of the cornea. Keratitis typically occurs after germs enter a corneal abrasion.
  • Retinitis: Inflammation or infection of the retina. Retinitis may be a long-term genetic condition or result from a viral infection.
  • Uveitis (iritis): The colored part of the eye becomes inflamed or infected. An overactive immune system, bacteria, or viruses can be responsible.
  • Dry eye: Either the eyes don’t produce enough tears, or the tears are of poor quality. Dry eye can be caused by medical problems such as lupus, scleroderma, and Sjogren's syndrome.
  • Optic neuritis: The optic nerve becomes inflamed, usually from an overactive immune system. Painful vision loss in one eye typically results.
  • Black eye: Swelling and discoloration around the eye as a result of injury to the face.

Eye Tests

  • Tonometry: A test that measures pressure in the eye, called intraocular pressure. Tonometry is used to check for glaucoma.
  • Slit lamp examination: A physician or optometrist shines a vertical slit of light across your eye while examining through a magnifying glass. This general exam can detect many eye problems.
  • Fundoscopic exam: Dilating drops first widen the pupil. By shining bright light in the back of the eye, the examiner can view the retina.
  • Refraction: If vision is impaired, a series of lenses are placed before the eyes to determine the right corrective lens prescription.
  • Visual acuity test: Reading ever-smaller-sized letters across the room identifies distance vision problems. Reading up-close can identify problems with near vision.
  • Fluorescein angiography: A fluorescent dye is used to take a sequence of retinal images.
  • Regular adult eye exam: This collection of tests may include the ones mentioned above plus others, such as eye movement.

Eye Treatments

  • Contact lenses and glasses: Glasses or contact lenses correct refractive errors such as nearsightedness, farsightedness, and astigmatism.
  • LASIK (laser assisted in situ keratomileusis): A doctor cuts a flap in the cornea with a tiny saw. A laser reshapes the cornea’s surface, improving nearsightedness. Used for correcting myopia, hyperopia, and astigmatism.
  • Radial keratotomy (RK): A series of small incisions are made in the cornea to correct nearsightedness. Radial keratotomy is rarely used today.
  • Photorefractive keratectomy (PRK): A doctor rubs off the surface of the cornea, then uses a laser to improve nearsightedness. The cornea then heals and grows back.
  • Laser epithelial keratomileusis (LASEK): Similar to LASIK, but no flap is cut in the cornea. Instead, the topmost layer of cornea cells is pulled off, allowing the laser to reshape the cornea.
  • Artificial tears: Eyedrops with similar composition to natural tears, used to treat dry or irritated eyes.
  • Cyclosporine eye drops (Restasis): When dry eye is from a condition called keratoconjunctivitis sicca, immune-suppressing eye drops could help.
  • Laser photocoagulation: A doctor uses a laser to burn blood vessels in the retina that are leaking or growing abnormally. Laser photocoagulation is most often done for diabetic retinopathy.
  • Cataract surgery: The cloudy cataract is removed from the lens and replaced by a manmade lens.

Ear

The ear has external, middle, and inner portions. The outer ear is called the pinna and is made of ridged cartilage covered by skin. Sound funnels through the pinna into the external auditory canal, a short tube that ends at the eardrum (tympanic membrane).

Sound causes the eardrum and its tiny attached bones in the middle portion of the ear to vibrate, and the vibrations are conducted to the nearby cochlea. The spiral-shaped cochlea is part of the inner ear; it transforms sound into nerve impulses that travel to the brain.

The fluid-filled semicircular canals (labyrinth) attach to the cochlea and nerves in the inner ear. They send information on balance and head position to the brain. The eustachian (auditory) tube drains fluid from the middle ear into the throat (pharynx) behind the nose.

Ear Conditions

  • Earache: Pain in the ear can have many causes. Some of these are serious, some are not serious.
  • Otitis media (middle ear inflammation): Inflammation or infection of the middle ear (behind the eardrum). Usually, this is caused by an infection.
  • Swimmer’s ear (Otitis externa): Inflammation or infection of the outer ear (pinna and ear canal). Sudden cases are usually infections; chronic otitis is often a skin condition (dermatitis).
  • Meniere’s disease: A condition in which the inner ear on one side malfunctions. Vertigo, tinnitus, hearing loss, and pain are common symptoms.
  • Tinnitus: Ringing in one or both ears. Usually this is due to damage from noise exposure, or from aging.
  • Cerumen (ear wax) impaction: Ear wax may block the ear canal and adhere to the eardrum. The eardrum’s reduced vibrations impair hearing.
  • Ruptured eardrum: Very loud noises, sudden changes in air pressure, or foreign objects can tear the eardrum. The small hole usually heals within a few weeks.
  • Acoustic neuroma: A noncancerous tumor that grows on the nerve traveling from the ear to the brain. Hearing loss, vertigo, and tinnitus can be symptoms.
  • Mastoiditis: Infection of the mastoid bone, just behind the ear. Mastoiditis was once a common complication of untreated ear infections.
  • Benign paroxysmal positional vertigo (BPPV): A disruption of function in the inner ear, causing episodes of vertigo. Although not medically serious, its symptoms can be distressing.
  • Cholesteatoma: This is a benign condition. It is the buildup of fibrous tissue within the middle ear and surrounding bones. Often there is a foul smelling discharge associated with hearing loss.

Ear Tests

  • Ear exam: The first test for an ear problem is often just looking at the ear. An otoscope is a device to look into the ear canal to see the drum.
  • Auditory testing: An audiologist formally examines a person’s hearing in each ear, using sounds of varying volume and frequency.
  • Computed tomography ( CT scan): A CT scanner uses X-rays and a computer to create images of the ears and surrounding structures.
  • Magnetic resonance imaging: Using radio waves in a magnetic field, a scanner creates high-resolution images of the ears and surrounding structures.

Ear Treatments

  • Antibiotics: If an ear infection is caused by bacteria, antibiotics (in the form of pills or eardrops) may be needed.
  • Cerumenolytics (ear-wax drops): Drops of a solution of mineral oil, or hydrogen peroxide and water, and other preparations can loosen impacted wax.
  • Irrigation (lavage): Gentle irrigation of the ear canal with salt water and diluted hydrogen peroxide can treat some cerumen impactions.
  • Antihistamines: A side effect of histamine blockers is a calming effect on the inner ear, reducing symptoms of vertigo.
  • Surgery: An operation may be necessary to remove an acoustic neuroma. Children with frequent ear infections may undergo surgery to place drainage tubes.
  • Positional exercises: Certain exercise regimens may improve BPPV symptoms by helping the particles in the inner ear move around.

Sinus

The sinuses are a connected system of hollow cavities in the skull. The largest sinus cavities are around an inch across; others are much smaller. The sinus cavities include:

• The maxillary sinuses (the largest), in the cheekbones.
• The frontal sinuses, in the low-center of the forehead.
• The ethmoid sinuses, between the eyes, at the nasal bridge.
• The sphenoid sinuses, in bones behind the nasal cavity.

The sinuses are lined with soft, pink tissue called mucosa. Normally, the sinuses are empty except for a thin layer of mucus.

The inside of the nose has ridges called turbinates. Normally these structures help humidify and filter air. The nose is divided in the center by a thin wall, called the septum. Most of the sinuses drain into the nose through a small channel or drainage pathway called the middle meatus.

The purpose of the sinuses is unclear. One theory is that sinuses help humidify the air we breathe in; another is that they enhance our voices.

Sinus Conditions

  • Acute sinusitis (sinus infection): Viruses or bacteria infect the sinus cavity, causing inflammation. Increased mucus production, nasal congestion, discomfort in the cheeks, forehead or around the eyes and headaches are common symptoms.
  • Chronic sinusitis (or chronic rhinosinusitis): More than just a series of infections, chronic sinusitis is a persistent process of inflammation of the sinuses.
  • Allergic rhinitis: Allergens like pollen, dust mites, or pet dander cause the defenses in the nose and sinuses to overreact. Mucus, nasal stuffiness, sneezing, and itching result.
  • Deviated septum: If the septum that divides the nose deviates too far too one side, airflow can be obstructed.
  • Turbinate hypertophy: The ridges on the nasal septum are enlarged, potentially obstructing airflow.
  • Nasal polyps: Small growths called polyps sometimes grow in the nasal cavity, in response to inflammation. Asthma, chronic sinus infections, and allergic rhinitis can lead to nasal polyps.

Sinus Tests

  • Physical examination: A doctor can look into the nose with a lighted viewer to see the turbinates, which may be swollen. She may press or tap on the face over the sinuses to check for pain.
  • Computed tomography (CT scan): A CT scanner uses X-rays and a computer to create detailed images of the sinuses. CT scanning can help diagnose chronic sinusitis.
  • Magnetic resonance imaging (MRI): Magnetic waves create highly detailed images of the sinuses. CT and MRI scans may be used together.
  • Endoscopy (rhinoscopy): Using a flexible tube with a camera on its end, a doctor can examine the inside of the nose and sinuses.
  • Sinus cultures: A mucus sample can be taken from inside the sinuses. This is done with a needle or during endoscopy.
  • Skin Test for Allergies: Skin testing for various allergens can help determine if allergies are contributing to sinusitis.
  • Sinus X-ray: A plain X-ray may show problems with the bones around the sinuses. A CT scan is superior to plain X-ray films.

Sinus Treatments

  • Decongestants: Medications that cause blood vessels in the inner nasal tissue to constrict. As a result, there is less sinus congestion, mucus production and postnasal drip.
  • Nasal steroid spray: Regular use of nasal steroids can reduce the symptoms of allergic rhinitis. These medications help relieve tissue swelling and help prevent the regrowth of nasal polyps after sinus surgery.
  • Nasal saline spray: Salt water nasal spray breaks up dried mucus and helps to keep the nose moist.
  • Nasal washes: rinse mucous from the nasal cavities and sinuses.
  • Antihistamines: Oral histamine blockers (Benadryl, Claritin, Zyrtec, Allegra) can reduce the nasal and sinus symptoms from allergic rhinitis.
  • Antibiotics: Anti-bacterial oral medicines may be needed to treat bacterial sinusitis.
  • Sinus surgery: Surgery can improve or correct some sinus conditions. Usually surgery is used to remove growths or to open an obstruction.

Teeth

The teeth are the hardest substances in the human body. Besides being essential for chewing, the teeth play an important role in speech. Parts of the teeth include:

• Enamel: The hardest, white outer part of the tooth. Enamel is mostly made of calcium phosphate, a rock-hard mineral.
• Dentin: A layer underlying the enamel. Dentin is made of living cells, which secrete a hard mineral substance.
• Pulp: The softer, living inner structure of teeth. Blood vessels and nerves run through the pulp of the teeth.
• Cementum: A layer of connective tissue that binds the roots of the teeth firmly to the gums and jawbone.
• Periodontal ligament: Tissue that helps hold the teeth tightly against the jaw.

A normal adult mouth has 32 teeth, which (except for wisdom teeth) have erupted by about age 13:

• Incisors (8 total): The middlemost four teeth on the upper and lower jaws.
• Canines (4 total): The pointed teeth just outside the incisors.
• Premolars (8 total): Teeth between the canines and molars.
• Molars (8 total): Flat teeth in the rear of the mouth, best at grinding food.
• Wisdom teeth or third molars (4 total): These teeth erupt at around age 18, but are often surgically removed to prevent displacement of other teeth.

The crown of each tooth projects into the mouth. The root of each tooth descends below the gum line, into the jaw.

Teeth Conditions

  • Cavities (caries): Bacteria evade removal by brushing and saliva and damage the enamel and deeper structures of teeth. Most cavities occur on molars and premolars.
  • Tooth decay: A general name for disease of the teeth, including cavities and periodontitis.
  • Periodontitis: Inflammation of the deeper structures of the teeth (periodontal ligament, jawbone, and cementum). Poor oral hygiene is usually to blame.
  • Gingivitis: Inflammation of the surface portion of the gums, around and between the crowns of the teeth. Plaque and tartar buildup can lead to gingivitis.
  • Plaque: A sticky, colorless film made of bacteria and the substances they secrete. Plaque develops quickly on teeth after eating sugary food, but can be easily brushed off.
  • Tartar: If plaque is not removed, it mixes with minerals to become tartar, a harder substance. Tartar requires professional cleaning for removal.
  • Overbite: The upper teeth protrude significantly over the lower teeth.
  • Underbite: The lower teeth protrude significantly past the upper teeth.
  • Teeth grinding (bruxism): Stress, anxiety, or sleep disorders can cause teeth grinding, usually during sleep. A dull headache or sore jaw are symptoms.
  • Tooth sensitivity: When one or more teeth become sensitive to hot or cold, it may mean the dentin is exposed.

Teeth Tests

  • Teeth X-ray films: X-ray pictures of the teeth may detect cavities below the gum line, or that are too small to identify otherwise.
  • Teeth examination: By viewing and gently manipulating the teeth, a dentist can detect potential teeth problems.

Teeth Treatments

  • Brushing teeth: Daily brushing of the teeth removes plaque and prevents cavities.
  • Flossing teeth: Using floss or an approved dental gum cleaner cleans teeth below the gum line, where brushing cannot reach.
  • Teeth cleaning: Professional teeth cleaning every six months may help prevent teeth and gum disease.
  • Tooth filling: Drilling out the diseased part of a tooth and packing the space with a mineral filling can prevent a cavity from destroying the tooth.
  • Root canal: The deep pulp of a tooth is drilled out, cleaned, and filled. A root canal is done when damage to the teeth has affected the deep pulp.
  • Tooth extraction: If a tooth is too damaged to repair with a filling or root canal, it may be removed. Wisdom teeth are often extracted to prevent displacement of the other teeth.
  • Braces: An artificial device or system that places teeth under tension for a long period of time. Eventually, braces can help crooked teeth become realigned.
  • Mouth guard: A plastic mouthpiece can provide protection from teeth grinding and injury during sports.
  • Dental sealants: A plastic sealant applied to the teeth can help block bacteria from hiding in crevices on teeth surfaces. Sealants can help prevent cavities.
  • Teeth whitening: Over-the-counter and professional chemical treatments can bleach teeth to a brighter white. Tooth sensitivity is the most common side effect.

Tonsil

The tonsils (palatine tonsils) are a pair of soft tissue masses located at the rear of the throat (pharynx). Each tonsil is composed of tissue similar to lymph nodes, covered by pink mucosa (like on the adjacent mouth lining). Running through the mucosa of each tonsil are pits, called crypts.

The tonsils are part of the lymphatic system, which helps to fight infections. However, removal of the tonsils does not seem to increase susceptibility to infection. Tonsils vary widely in size and swell in response to infection.

Tonsil Conditions

  • Acute tonsillitis: A bacteria or virus infects the tonsils, causing swelling and a sore throat. The tonsil may develop a gray or white coating (exudate).
  • Chronic tonsillitis: Persistent infection of the tonsils, sometimes as a result of repeated episodes of acute tonsillitis.
  • Peritonsillar abscess: An infection creates a pocket of pus next to the tonsil, pushing it toward the opposite side. Peritonsillar abscesses must be drained urgently.
  • Acute mononucleosis: Usually caused by the Epstein-Barr virus, “mono” causes severe swelling in the tonsils, fever, sore throat, rash, and fatigue.
  • Strep throat: Streptococcus, a bacterium, infects the tonsils and throat. Fever and neck pain often accompany the sore throat.
  • Enlarged (hypertrophic) tonsils: Large tonsils reduce the size of the airway, making snoring or sleep apnea more likely.
  • Tonsilloliths (tonsil stones): Tonsil stones, or tonsilloliths, are formed when this trapped debris hardens, or calcifies.

Tonsil Tests

  • Throat (pharynx) swab: A doctor rubs a cotton swab on the tonsils and throat and sends the swab for tests. Usually this is done to check for bacteria such as Streptococcus.
  • Monospot test: A blood test can detect certain antibodies, which can help confirm that a person’s symptoms are due to mononucleosis.
  • Epstein-Barr virus antibodies: If a monospot test is negative, antibodies in the blood against EBV might help diagnose mononucleosis.

Tonsil Treatments

  • Antibiotics: Tonsillitis due to bacterial infection can be cured with antibiotics.
  • Abscess drainage: A peritonsillar abscess generally must be punctured with a needle, to allow the infection to drain and heal.
  • Tonsillectomy: In cases of tonsils that are too large or repeatedly infected, surgery to remove them may be necessary.

Tongue

The tongue is a muscular organ in the mouth. The tongue is covered with moist, pink tissue called mucosa. Tiny bumps called papillae give the tongue its rough texture. Thousands of taste buds cover the surfaces of the papillae. Taste buds are collections of nerve-like cells that connect to nerves running into the brain.

The tongue is anchored to the mouth by webs of tough tissue and mucosa. The tether holding down the front of the tongue is called the frenum. In the back of the mouth, the tongue is anchored into the hyoid bone. The tongue is vital for chewing and swallowing food, as well as for speech.

The four common tastes are sweet, sour, bitter, and salty. A fifth taste, called umami, results from tasting glutamate (present in MSG). The tongue has many nerves that help detect and transmit taste signals to the brain. Because of this, all parts of the tongue can detect these four common tastes; the commonly described “taste map” of the tongue doesn’t really exist.

Tongue Conditions

  • Thrush (candidiasis): Candida albicans (a yeast) grows over the surface of the mouth and tongue. Thrush can occur in almost anyone, but it occurs more often in people taking steroids or with suppressed immune systems, the very young, and the elderly.
  • Oral cancer: A growth or ulcer appears on the tongue and grows steadily. Oral cancer is more common in people who smoke and/or drink alcohol heavily.
  • Macroglossia (big tongue): This can be broken down into various categories based on the cause. These include congenital, inflammatory, traumatic, cancerous, and metabolic causes. Thyroid disease, lymphangiomas, and congenital abnormalities are among some of the causes of an enlarged tongue.
  • Geographic tongue: Ridges and colored spots migrate over the surface of the tongue, periodically changing its appearance. Geographic tongue is a harmless condition.
  • Burning mouth/burning tongue syndrome: a relatively common problem. The tongue feels burned or scalded, or strange tastes or sensations develop. Apparently harmless, burning mouth syndrome may be caused by a mild nerve problem.
  • Atrophic glossitis (bald tongue): The tongue loses its bumpy texture, becoming smooth. Sometimes this is due to anemia or a B vitamin deficiency.
  • Canker sores (aphthous ulcers): Small, painful ulcers appear periodically on the tongue or mouth. A relatively common condition, the cause of canker sores is unknown; they are unrelated to the cold sores caused by herpes viruses. Canker sores are not contagious.
  • Oral leukoplakia: White patches appear on the tongue that can’t be scraped off. Leukoplakia may be benign, or it can progress to oral cancer.
  • Hairy tongue: Papillae can overgrow the surface of the tongue, giving it a white or black appearance. Scraping off the papillae corrects this harmless condition.
  • Herpes stomatitis: The herpes virus can uncommonly cause cold sores on the tongue. Herpes virus cold sores are usually on the lip.
  • Lichen planus: A harmless condition that can affect the skin or the mouth. The cause is unknown; however, it is believed to be caused by the immune system attacking the skin and lining of the mouth.

Tongue Tests

  • Biopsy: A small sample of tissue is taken from a suspicious-looking area on the tongue. This is most often done to check for oral cancer.
  • Flavor discrimination test: Four solutions of different amounts of sweetener are used to evaluate taste and smell.

Tongue Treatments

  • Steroid gel: Applying a prescription steroid gel like Lidex hastens the resolution of canker sores.
  • Silver nitrate: Doctors can apply this chemical to a canker sore, speeding healing and relieving pain.
  • Viscous lidocaine: Applied to the tongue, lidocaine gel provides immediate, though temporary, pain relief.
  • Antifungal medicines: Antifungal drugs can eliminate Candida albicans, the thrush-causing fungus. Swish-and-spit mouthwash and pills are both effective.
  • Tongue scraping: Simply scraping the tongue can usually remove the overgrown papillae causing black or white hairy tongue.
  • B vitamins: A B vitamin supplement can correct a vitamin deficiency, if present.
  • Tongue surgery: Surgery may be required to remove oral cancer or leukoplakia.

Esophagus

The esophagus is a muscular tube connecting the throat (pharynx) with the stomach. The esophagus is about 8 inches long, and is lined by moist pink tissue called mucosa. The esophagus runs behind the windpipe (trachea) and heart, and in front of the spine. Just before entering the stomach, the esophagus passes through the diaphragm.

The upper esophageal sphincter (UES) is a bundle of muscles at the top of the esophagus. The muscles of the UES are under conscious control, used when breathing, eating, belching, and vomiting. They keep food and secretions from going down the windpipe.

The lower esophageal sphincter (LES) is a bundle of muscles at the low end of the esophagus, where it meets the stomach. When the LES is closed, it prevents acid and stomach contents from traveling backwards from the stomach. The LES muscles are not under voluntary control.

Esophagus Conditions

  • Heartburn: An incompletely closed LES allows acidic stomach contents to back up (reflux) into the esophagus. Reflux can cause heartburn, cough or hoarseness, or no symptoms at all.
  • Gastro Esophageal reflux disease (GERD): When reflux occurs frequently or is bothersome, it's called gastroesophageal reflux disease (GERD).
  • Esophagitis: Inflammation of the esophagus. Esophagitis can be due to irritation (as from reflux) or infection.
  • Barrett's esophagus: Regular reflux of stomach acid irritates the esophagus, which may cause the lower part to change its structure. Very infrequently, Barrett's esophagus progresses to esophageal cancer.
  • Esophageal ulcer: An erosion in an area of the lining of the esophagus. This is often caused by chronic reflux.
  • Esophageal stricture: A narrowing of the esophagus. Chronic irritation from reflux is the usual cause of esophageal strictures.
  • Achalasia: A rare disease in which the lower esophageal sphincter does not relax properly. Difficulty swallowing and regurgitation of food are symptoms.
  • Esophageal cancer: Although serious, cancer of the esophagus is uncommon. Risk factors for esophageal cancer include smoking, heavy drinking, and chronic reflux.
  • Mallory-Weiss tear: Vomiting or retching creates a tear in the lining of the esophagus. The esophagus bleeds into the stomach, often followed by vomiting blood.
  • Esophageal varices: In people with cirrhosis, veins in the esophagus may become engorged and bulge. Called varices, these veins are vulnerable to life-threatening bleeding.
  • Esophageal ring (Schatzki's ring): A common, benign accumulation of tissue in a ring around the low end of the esophagus. Schatzki's rings usually cause no symptoms, but may cause difficulty swallowing.
  • Esophageal web: An accumulation of tissue (similar to an esophageal ring) that usually occurs in the upper esophagus. Like rings, esophageal webs usually cause no symptoms.
  • Plummer-Vinson syndrome: A condition including chronic iron-deficient anemia, esophageal webs, and difficulty swallowing. Iron replacement and dilation of esophageal webs are treatments.

Esophagus Tests

  • Upper endoscopy, EGD (esophagogastroduodenoscopy): A flexible tube with a camera on its end (endoscope) is inserted through the mouth. The endoscope allows examination of the stomach and duodenum (small intestine).
  • Esophageal pH monitoring: A probe that monitors acidity (pH) is introduced into the esophagus. Monitoring pH can help identify GERD and follow the response to treatment.
  • Barium swallow: A person swallows a barium solution, then X-ray films are taken of the esophagus and stomach. Most often, a barium swallow is used to seek the cause of difficulty swallowing.

Esophagus Treatments

  • H2 blockers: Histamine stimulates acid release in the stomach. Certain antihistamines called H2 blockers can reduce acid, improving GERD and esophagitis.
  • Proton pump inhibitors: These medicines turn off many of the acid-producing pumps in the stomach wall. Reduced stomach acid can reduce GERD symptoms, and help ulcers or esophagitis to heal.
  • Esophagectomy: Surgical removal of the esophagus, usually for esophageal cancer.
  • Esophageal dilation: A balloon is passed down the esophagus and inflated to dilate a stricture, web, or ring that interferes with swallowing.
  • Esophageal variceal banding: During endoscopy, rubber band-like devices can be wrapped around esophageal varices. Banding causes varices to clot, reducing their chance of bleeding.
  • Biopsy: Often done through an endoscope, a small piece of the esophagus is taken to be evaluated under a microscope.
  • Confocal laser endomicroscopy: A new procedure that takes the microscope inside a patient, which may replace the need for many biopsies.

Stomach

The stomach is a muscular sac located on the left side of the upper abdomen. The stomach receives food from the esophagus. As food reaches the end of the esophagus, it enters the stomach through a muscular valve called the lower esophageal sphincter.

The stomach secretes acid and enzymes that digest food. Ridges of muscle tissue called rugae line the stomach. The stomach muscles contract periodically, churning food to enhance digestion. The pyloric sphincter is a muscular valve that opens to allow food to pass from the stomach to the small intestine.

Stomach Conditions

  • Gastroesophageal reflux: Stomach contents, including acid, can travel backward up the esophagus. There may be no symptoms, or reflux may cause heartburn or coughing.
  • Gastroesophageal reflux disease (GERD): When symptoms of reflux become bothersome or occur frequently, they’re called GERD. Infrequently, GERD can cause serious problems of the esophagus.
  • Dyspepsia: Another name for stomach upset or indigestion. Dyspepsia may be caused by almost any benign or serious condition that affects the stomach.
  • Gastric ulcer (stomach ulcer): An erosion in the lining of the stomach, often causing pain and/or bleeding. Gastric ulcers are most often caused by NSAIDs or H. pylori infection.
  • Peptic ulcer disease: Doctors consider ulcers in either the stomach or the duodenum (the first part of the small intestine) peptic ulcer disease.
  • Gastritis: Inflammation of the stomach, often causing nausea and/or pain. Gastritis can be caused by alcohol, certain medications, H. pylori infection, or other factors.
  • Stomach cancer: Gastric cancer is an uncommon form of cancer in the U.S. Adenocarcinoma and lymphoma make up most of the cases of stomach cancer.
  • Zollinger-Ellison syndrome (ZES): One or more tumors that secrete hormones that lead to increased acid production. Severe GERD and peptic ulcer disease result from this rare disorder.
  • Gastric varices: In people with severe liver disease, veins in the stomach may swell and bulge under increased pressure. Called varices, these veins are at high risk for bleeding.
  • Stomach bleeding: Gastritis, ulcers, or gastric cancers may bleed. Seeing blood or black material in vomit or stool is usually a medical emergency.
  • Gastroparesis (delayed gastric emptying): Nerve damage from diabetes or other conditions may impair the stomach’s muscle contractions. Nausea and vomiting are the usual symptoms.

Stomach Tests

  • Upper endoscopy (esophagogastroduodenoscopy or EGD): A flexible tube with a camera on its end (endoscope) is inserted through the mouth. The endoscope allows examination of the esophagus, stomach, and duodenum (the first part of the small intestine).
  • Computed tomography (CT scan): A CT scanner uses X-rays and a computer to create images of the stomach and abdomen.
  • Magnetic resonance imaging: Using a magnetic field, a scanner creates high-resolution images of the stomach and abdomen.
  • pH testing: Using a tube through the nose into the esophagus, acid levels in the esophagus can be monitored. This can help diagnose or change treatment for GERD.
  • Barium swallow: After swallowing barium, X-ray films of the esophagus and stomach are taken. This can sometimes diagnose ulcers or other problems.
  • Upper GI series: X-rays are taken of the esophagus, stomach, and upper part of the small intestine.
  • Gastric emptying study: A test of how rapidly food passes through the stomach. The food is labeled with a chemical and viewed on a scanner.
  • Stomach biopsy: During an endoscopy, a doctor can take a small piece of stomach tissue for tests. This can diagnose H. pylori infection, cancer, or other problems.
  • H. pylori test : While most people with H. pylori infection don't develop ulcers, tests can be done to check for infection in people with ulcers.

Stomach Treatments

  • Histamine (H2) blockers: Histamine increases stomach acid secretion; blocking histamine can reduce acid production and GERD symptoms.
  • Proton pump inhibitors: These medicines directly inhibit the acid pumps in the stomach. They must be taken daily to be effective.
  • Antacids: These medicines can help against the effects of acid but don't kill bacteria or stop acid production.
  • Endoscopy: During an upper endoscopy, tools on the endoscope can sometimes stop stomach bleeding, if present.
  • Motility agents: Medicines can increase contraction of the stomach, improving symptoms of gastroparesis.
  • Stomach surgery: Cases of severe stomach bleeding, ruptured ulcers, or cancer require surgery to be cured.
  • Antibiotics: H. pylori infection can be cured with antibiotics, which are taken with other medicines to heal the stomach.

Liver

Front View of the Liver

The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can't feel the liver, because it's protected by the rib cage.

The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food.

The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

Liver Conditions

  • Hepatitis: Inflammation of the liver, usually caused by viruses like hepatitis A, B, and C. Hepatitis can have non-infectious causes too, including heavy drinking, drugs, allergic reactions, or obesity.
  • Cirrhosis: Long-term damage to the liver from any cause can lead to permanent scarring, called cirrhosis. The liver then becomes unable to function well.
  • Liver cancer: The most common type of liver cancer, hepatocellular carcinoma, almost always occurs after cirrhosis is present.
  • Liver failure: Liver failure has many causes including infection, genetic diseases, and excessive alcohol.
  • Ascites: As cirrhosis results, the liver leaks fluid (ascites) into the belly, which becomes distended and heavy.
  • Gallstones: If a gallstone becomes stuck in the bile duct draining the liver, hepatitis and bile duct infection (cholangitis) can result.
  • Hemochromatosis: Hemochromatosis allows iron to deposit in the liver, damaging it. The iron also deposits throughout the body, causing multiple other health problems.
  • Primary sclerosing cholangitis: A rare disease with unknown causes, primary sclerosing cholangitis causes inflammation and scarring in the bile ducts in the liver.
  • Primary biliary cirrhosis: In this rare disorder, an unclear process slowly destroys the bile ducts in the liver. Permanent liver scarring (cirrhosis) eventually develops.

Liver Tests

Blood Tests:

  • Liver function panel: A liver function panel checks how well the liver is working and consists of many different blood tests.
  • ALT (Alanine Aminotransferase): An elevated ALT helps identify liver disease or damage from any number of causes, including hepatitis.
  • AST (Aspartate Aminotransferase): Along with an elevated ALT, the AST checks for liver damage.
  • Alkaline phosphatase: Alkaline phosphatase is present in bile-secreting cells in the liver; it's also in bones. High levels often mean bile flow out of the liver is blocked.
  • Bilirubin: High bilirubin levels suggest a problem with the liver.
  • Albumin: As part of total protein levels, albumin helps determine how well the liver is working.
  • Ammonia: Ammonia levels in the blood rise when the liver is not functioning properly.
  • Hepatitis A tests: If hepatitis A is suspected, the doctor will test liver function as well as antibodies to detect the hepatitis A virus.
  • Hepatitis B tests: Your doctor can test antibody levels to determine if you have been infected with the hepatitis B virus.
  • Hepatitis C tests: In addition to checking liver function, blood tests can determine if you have been infected with the hepatitis C virus.
  • Prothrombin Time (PT): A prothrombin time, or PT, is commonly done to see if someone is taking the correct dose of the blood thinner warfarin (Coumadin). It also checks for blood clotting problems.
  • Partial Thromboplastin Time (PTT): A PTT is done to check for blood clotting problems.

Imaging Tests:

  • Ultrasound: An abdominal ultrasound can test for many liver conditions, including cancer, cirrhosis, or problems from gallstones.
  • CT scan (computed tomography): A CT scan of the abdomen gives detailed pictures of the liver and other abdominal organs.
  • Liver biopsy: A liver biopsy is most commonly done after another test, such as a blood test or ultrasound, indicates a possible liver problem.
  • Liver and spleen scan: This nuclear scan uses radioactive material to help diagnose a number of conditions, including abscesses, tumors, and other liver function problems.

Liver Treatments

  • Hepatitis A treatment: Hepatitis A usually goes away with time.
  • Hepatitis B treatment: Chronic hepatitis B often requires treatment with antiviral medication.
  • Hepatitis C treatment: Treatment for hepatitis C depends on several factors.
  • Liver transplant: A liver transplant is needed when the liver no longer functions adequately, whatever the cause.
  • Liver cancer treatment: While liver cancer is usually difficult to cure, treatment consists of chemotherapy and radiation. In some cases, surgical resection or liver transplantation is performed.
  • Paracentesis: When severe ascites -- swelling in the belly from liver failure -- causes discomfort, a needle can be inserted through the skin to drain fluid from the abdomen.
  • ERCP (Endocscopic retrograde cholangiopancreatography): Using a long, flexible tube with a camera and tools on the end, doctors can diagnose and even treat some liver problems.

Gallbladder

Front View of the Gallbladder

The gallbladder is a small pouch that sits just under the liver. The gallbladder stores bile produced by the liver. After meals, the gallbladder is empty and flat, like a deflated balloon. Before a meal, the gallbladder may be full of bile and about the size of a small pear.

In response to signals, the gallbladder squeezes stored bile into the small intestine through a series of tubes called ducts. Bile helps digest fats, but the gallbladder itself is not essential. Removing the gallbladder in an otherwise healthy individual typically causes no observable problems with health or digestion yet there may be a small risk of diarrhea and fat malabsorption.

Gallbladder Conditions

  • Gallstones (cholelithiasis): For unclear reasons, substances in bile can crystallize in the gallbladder, forming gallstones. Common and usually harmless, gallstones can sometimes cause pain, nausea, or inflammation.
  • Cholecystitis: Inflammation of the gallbladder, often due to a gallstone in the gallbladder. Cholecystitis causes severe pain and fever, and can require surgery when inflammation continues or recurs.
  • Gallbladder cancer: Although rare, cancer can affect the gallbladder. It is difficult to diagnose and usually found at late stages when symptoms appear. Symptoms may resemble those of gallstones.
  • Gallstone pancreatitis: An impacted gallstone blocks the ducts that drain the pancreas. Inflammation of the pancreas results, a serious condition.

Gallbladder Tests

  • Abdominal ultrasound: a noninvasive test in which a probe on the skin bounces high-frequency sound waves off structures in the belly. Ultrasound is an excellent test for gallstones and to check the gallbladder wall.
  • HIDA scan (cholescintigraphy): In this nuclear medicine test, radioactive dye is injected intravenously and is secreted into the bile. Cholecystitis is likely if the scan shows bile doesn’t make it from the liver into the gallbladder.
  • Endoscopic retrograde cholangiopancreatography (ERCP): Using a flexible tube inserted through the mouth, through the stomach, and into the small intestine, a doctor can see through the tube and inject dye into the bile system ducts. Tiny surgical tools can be used to treat some gallstone conditions during ERCP.
  • Magnetic resonance cholangiopancreatography (MRCP): An MRI scanner provides high-resolution images of the bile ducts, pancreas, and gallbladder. MRCP images help guide further tests and treatments.
  • Endoscopic ultrasound: A tiny ultrasound probe on the end of a flexible tube is inserted through the mouth to the intestines. Endoscopic ultrasound can help detect choledocholithiasis and gallstone pancreatitis.
  • Abdominal X-ray: Although they may be used to look for other problems in the abdomen, X-rays generally cannot diagnose gallbladder disease. However, X-rays may be able to detect gallstones.

Gallbladder Treatments

  • Gallbladder surgery (cholecystectomy): A surgeon removes the gallbladder, using either laparoscopy (several small cuts) or laparotomy (traditional “open” surgery with a larger incision).
  • Antibiotics: Infection may be present during cholecystitis. Though antibiotics don’t typically cure cholecystitis, they can prevent an infection from spreading.
  • Chemotherapy and radiation therapy: After surgery for gallbladder cancer, chemotherapy and radiation may be used to help prevent cancer from returning.
  • Ursodeoxycholic acid: In people with problems from gallstones who are not good candidates for surgery, this oral medicine is an option. Ursodeoxycholic acid may help dissolve small cholesterol gallstones and reduce symptoms. Another oral solution is called Chenix.
  • Extracorporeal shock-wave lithotripsy: High-energy shockwaves are projected from a machine through the abdominal wall, breaking up gallstones. Lithotripsy works best if only a few small gallstones are present.
  • Contact solvent dissolution: A needle is inserted through the skin into the gallbladder, and chemicals are injected that dissolve gallstones. This technique is rarely used.