What is gastritis? 

Gastritis is inflammation or irritation of the lining of your stomach.

What increases my risk for gastritis? 

•     Infection with bacteria, a virus, or a parasite

•     NSAIDs, aspirin, or steroid medicine

•     Use of tobacco products or alcohol

•     Trauma such as an injury to your stomach or intestine

•     Autoimmune disorders such as diabetes, thyroid disease, or Crohn disease

•     Stress

•     Age older than 60 years

•     Illegal drugs, such as cocaine

What are the signs and symptoms of gastritis? 

•     Stomach pain, burning, or tenderness when you press on it

•     Stomach fullness or tightness

•     Nausea or vomiting

•     Loss of appetite, or feeling full quickly when you eat

•     Bad breath

•     Fatigue or feeling more tired than usual

•     Heartburn

How is gastritis diagnosed?

Your doctor will ask about your signs and symptoms and examine you. You may need any of the following: 

•     Blood tests may be used to show an infection, dehydration, or anemia (low red blood cell levels)

•     A bowel movement sample may be tested for blood or the germ that may be causing your gastritis

•     A breath test may show if H pyloriis causing your gastritis. You will be given a liquid to drink. Then you will breathe into a bag. Your doctor will measure the amount of carbon dioxide in your breath. Extra amounts of carbon dioxide may mean you have an H pylori infection

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid's job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

Hyperthyroidism

The term hyperthyroidism refers to any condition in which there is too much thyroid hormone produced in the body. In other words, the thyroid gland is overactive.

What are the symptoms of hyperthyroidism?

Since hyperthyroidism increases your metabolism, every function of the body tends to speed up:

•     Nervousness, irritability, increased sweating, heart racing, hand tremors, anxiety, difficulty sleeping, tired is very common

•     Thinning of the skin, fine brittle hair and weakness in muscles, especially in the upper arms and thighs

•     More frequent bowel movements, but diarrhea is uncommon

•     Lose weight despite a good appetite

•     For women, menstrual flow may lighten and menstrual periods may occur less often

•     Enlarged eyes and swelling of the front of the neck

What causes hyperthyroidism?

The most common causes include Graves disease (GD), toxic multinodular goiter, toxic adenoma and painless thyroiditis.

How is hyperthyroidism diagnosed?

•     Indicated symptoms and physical examinations

•     Confirm by laboratory tests that measure the amount of thyroid hormones

•     Measure levels of thyroid autoantibodies

•     Imaging of thyroid glands

How is hyperthyroidism treated?

Hyperthyroidism can be effectively cured by anti-thyroid drugs, oral radioactive iodine capsule or surgical removal of all or most of thyroid gland. However, no single treatment is be st for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by the patient's age, the type of hyperthyroidism, the severity of hyperthyroidism, other medical conditions that may affect the problems, and the patient's own preference. It may be a good idea to consult with an endocrinologist who is experienced in the treatment of hyperthyroid patients. 

Are other family members at risk?

Because hyperthyroidism, especially Graves' disease, may run in families, examinations of the members of your family may reveal other individuals with thyroid problems.

Hypothyroidism

Hypothyroidism (underactive) is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can't make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood. Common causes are autoimmune disease (Hashimoto's thyroiditis), surgical removal of the thyroid, and radiation treatment.

What are the symptoms of hypothyroidism?

When thyroid hormone levels are too low, the body's cells can't get enough thyroid hormone and the body's processes start slowing down. As the body slows, you may notice that you feel colder, you tire more easily, your skin is getting drier, you're becoming forgetful and depressed, and you've started getting constipated. Because the symptoms are so variable and nonspecific, the only way to know for sure whether you have hypothyroidism is with a simple blood test for TSH.

Keeping other people informed:

•     Tell your hypothyroidism to your relatives and encourage them to get periodic TSH tests

•     Tell your other doctors and your pharmacist about your hypothyroidism and the drug and dose with which it is being treated

•     If you start seeing a new doctor, tell the doctor that you have hypothyroidism and you need your TSH tested every year

•     If you are seeing an endocrinologist, ask that copies of your reports be sent to your primary care doctor

What can you expect over the long term?

•     There is no cure for hypothyroidism, and most patients have it for life. There are exceptions: many patients with viral thyroiditis have their thyroid function return to normal, as do some patients with thyroiditis after pregnancy

•     Hypothyroidism may become more or less severe, and your dose of thyroxine may need to change over time. You have to make a lifetime commitment to treatment. But if you take your pills every day and work with your doctor to get and keep your thyroxine dose right, you should be able to keep your hypothyroidism well controlled throughout your life

•     Your symptoms should disappear and the serious effects of low thyroid hormone should improve. If you keep your hypothyroidism well-controlled, it will not shorten your life span

What causes hypothyroidism?

There can be many reasons why the cells in the thyroid gland can't make enough thyroid hormone. Here are the major causes, from the most to the least common:

•     Autoimmune disease

•     Surgical removal of part or all of the thyroid gland

•     Radiation treatment

•     Congenital hypothyroidism (hypothyroidism that a baby is born with)

•     Thyroiditis

•     Medicines which prevent the thyroid gland from being able to make hormones

•     Too much or too little iodine

•     Damage to the pituitary gland

•     Rare disorders that infiltrate the thyroid

Thyroid Nodules

Thyroid nodules refer to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign (noncancerous), a small proportion of thyroid nodules do contain thyroid cancer. In order to diagnose and treat thyroid cancer at the earliest stage, most thyroid nodules need some type of evaluation.

What are the symptoms of thyroid nodules?

The important points to remember are the following:

•     Thyroid nodules generally do not cause symptoms and mostly discovered incidentally

•     Thyroid function tests are very important, especially when you have symptoms

•     Thyroid function tests are most typically normal - even when cancer is present in a nodule

•     To determine a thyroid nodule is to make sure your doctor checks your neck

What causes thyroid nodules and how common are they?

The causes of most thyroid nodules is unknown even though they are extremely common. Fortunately, over 90% of such nodules are benign. Hashimoto's thyroiditis, which is the most common cause of hypothyroidism, is associated with an increased risk of thyroid nodules. Iodine deficiency or overload is also known to cause thyroid nodules.

How is a thyroid nodule evaluated and diagnosed?

•     Once the nodule is discovered, your doctor will try to determine whether the rest of your thyroid is healthy or whether the entire thyroid gland has been affected by a more general condition such as hyperthyroidism or hypothyroidism. Your physician will feel the thyroid to see whether the entire gland is enlarged and whether a single or multiple nodules are present

•     Since it's usually not possible to determine whether a thyroid nodule is cancerous by physical examination and blood tests alone, the evaluation of the thyroid nodules often includes specialized tests such as thyroid ultrasonography and fine needle biopsy. Thyroid ultrasound is a key tool and a painless test to obtain a picture of the thyroid and evaluate thyroid nodules

•     A fine needle biopsy of a thyroid nodule may sound frightening, but the needle used is very small and a local anesthetic may not even be necessary. For a fine needle biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. The biopsy does not usually require any other special preparation (no fasting) and the patients typically return home or to work after the biopsy without even needing a bandaid

How are thyroid nodules treated?

•     All thyroid nodules that are found to contain a thyroid cancer or highly suspected should be removed by an experienced thyroid surgeon

•     Most thyroid cancers are curable and rarely cause life-threatening problems

•     Thyroid nodules that are benign by FNA or too small to biopsy should still be watched closely with ultrasound examination every 6 to 12 months and annual physical examination by your doctor

Fine Needle Aspiration (FNA) Biopsy of Thyroid Nodules

A fine needle aspiration (FNA) biopsy of a thyroid nodule is a simple and safe procedure. Typically, the biopsy is performed under ultrasound guidance to ensure accurate placement of the needle within the thyroid nodule. You will be asked to lie down on your back with your head tipped backwards, so that your neck is extended. Sometimes, a pillow is placed under your shoulders to help you get in right position for the biopsy.

During the procedure you may feel some neck pressure from the ultrasound probe and from the needle. You will be asked to remain as still as possible and avoid coughing, talking and swallowing during the biopsy.

How can you prepare for your thyroid FNA?

•     Most medications can be continued. However, anticoagulant often need to be stopped temporarily in anticipation of your thyroid biopsy for the increasing risk of bleeding caused by these drugs. It is common to receive specific instructions regarding when to stop taking medications from your doctor's office prior to the procedure

•     Generally, you will not be required to be fasting on the day of your appointment

•     During the thyroid biopsy, ultrasound gel will be applied to the neck to obtain ultrasound images. This gel is water soluble and non-toxic, but may get on clothing or jewelry. You may wish to wear comfortable clothing and take off any jewelry from around the neck for the procedure

How is a thyroid FNA performed?

•     The neck will first be cleaned with an antiseptic. A local or topical anesthetic may be applied. For the biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. The needle used is smaller in diameter than those used in most blood draws. Your doctor will insert the needle through the skin and into the thyroid nodule. After the sampling, which only takes several seconds, the needle will be removed. New needles are used for additional samples. Several samples of cells will be obtained, by sticking a fine needle in various parts of the nodule usually between two and six times. This assures a better chance to find cancerous cells if they are present

•     If there is fluid in the nodule, a syringe may be used to drain it

•     Once the biopsy is completed, pressure will be applied to the neck. The procedure usually lasts less than 30 minutes

What should you expect after the procedure?

•     The procedure is usually performed using a local anesthetic and no medications are used that affect consciousness or thinking. After the procedure, you may be asked to sit up slowly to prevent you from getting lightheaded. Most patients typically leave feeling well. Because of this, it is not generally necessary to bring a companion to help or drive you home

•     Some neck discomfort at the site of the biopsy is expected following the procedure. Pain killer and ice compresses can be used to relieve discomfort

What happens to the biopsy material after the procedure?

The biopsy samples may be used to make slides immediately and/or collected in a solution to wash excess blood. Specially trained doctors, cytopathologists, then make slides from the material and examine them under a microscope to make a diagnosis.

How long does it take for the results to return?

Generally, it can take anywhere from 3-4 working days for the result to return.

With reference to the website of the American Thyroid Association: 

What is a bronchoscopy?

A bronchoscopy is a procedure where a tube is inserted into the lower respiratory tract via the nose or mouth. This allows your physician to clearly visualize lesions in the trachea and bronchi. The bronchoscope is equipped to take samples of tissue directly observed by your physician for biopsy, to take smears by brushing, and to perform bronchial lavage. The equipment involved allows your physician to make an accurate diagnosis and to perform treatment more easily.

The bronchoscope is a soft and flexible tube with a small diameter, enabling a clear field of vision with a high degree of safety. The patient experiences minimal discomfort and only requires a local anesthetic. Most importantly, a bronchoscopy is the best method for diagnosing bronchial lesions. It can be used to discover lesions deep within the trachea, bronchi, and lungs that are difficult to detect that would not be found using chest CT. Diagnosis and treatment can be performed without the need to perform surgery.

When does a bronchoscopy need to be performed?

A bronchoscopy is needed to diagnose disease in the following circumstances:

• Causes of chronic cough，hemoptysis or blood-stained sputum，localized wheezing or hoarseness are unknown

• Chest X-ray and/or CT suggests abnormal changes

• Evaluation before thoracic operation

• Diagnosis for laceration or rupture of the trachea or bronchi in chest trauma

• Etiological diagnosis of infectious disease of the lung or bronchi

• Management of the airways during mechanical ventilation

• Diagnosis and treatment for fistulas of the trachea or bronchi

A bronchoscopy is needed for disease treatment in the following circumstance:

• Remove foreign objects from the bronchi, clearing abnormal secretions from the trachea, such as sputum, pus, and blood clots

• Remove emboli from the bronchi and pulmonary reexpansion in the event of pulmonary atelectasis caused by embolism involving pus, sputum, or blood

• Confirm the location of bleeding for patients with hemoptysis, then attempting to stop bleeding locally.

• Perform local radiation or local injection with chemotherapy drugs for patients with lung cancer

• Guided intubation of the airways and guided bronchial intubation where there are difficulties with intubation

• Laser, microwave, frozen, or high-frequency electrosurgical treatment for patients with benign or malignant tumors of the airways

When should a bronchoscopy not be performed?

• Active massive hemoptysis

• Severe arrhythmia

• Recent myocardial infarction or history of unstable angina pectoris

• Severe heart or pulmonary dysfunction

• Thrombocytopenia, coagulation dysfunction or the other bleeding disorder.

• Newly onset cerebral infarction or hemorrhage

• Aortic aneurysm

• Incompatibility or intolerable to bronchoscopy exam

What should I pay special attention to before my bronchoscopy?

• Before the bronchoscopy do not eat or drink for 4–6 hours，sign the consent form and a family member should accompany you on the day of the procedure

• Before the bronchoscopy give an accurate account of your health condition and past medical history to your physician. Remember to also let your physician know about any drug allergies, anticoagulants orantiplatelet drugs still used, hypertrophic rhinosinusitis, snoring, throat surgery you have had done, or serious cervical vertebrae diseases you may have

• Before the bronchoscopy take medications for illnesses strictly following the schedule provided by your physician. For example, medications for hypertension or heart disease can be taken orally two hours before the bronchoscopy and will not affect the procedure

• Before the bronchoscopy complete your preoperative examination: This includes chest CT, ECG, FBC, check for infections pre-surgery, and blood coagulation studies. Before leaving home, be sure to bring any chest X-ray or CT images, ECG, FBC, and blood coagulation reports for your physician to look at

• After the bronchoscopy wait outside the examination room after your procedure for at least 30 minutes to ensure that you are not experiencing any dizziness or other symptoms before you leave the hospital

• After the bronchoscopy appearance of blood-stained sputum following bronchoscopy is normal. See your doctor immediately if there is a significant amount of hemoptysis, bloody sputum, intense chest pain, difficulty breathing, recurring fevers, or arrhythmia

• After the bronchoscopy rest well and avoid talking to reduce hoarseness and a painful throat or chest

• After the bronchoscopy do not eat or drink for 2–3 hours following the procedure. Try drinking some warm water 3 or more hours after the procedure. If you are not choking or coughing, you can eat some cool, mild food

Is a bronchoscopy dangerous?

A bronchoscopy is a relatively safe procedure. Complications may occur (such as allergies to anesthetics, laryngeal edema, cramps in the airways, hypoxia, infections, bleeding, pneumothorax, and cardiocerebral events), however the chance of them occurring is low, and your physician will actively respond if such events occur. Your physician will perform strict checks, especially before the procedure, for indications and contraindications, to ensure that you are prepared. During the procedure, your physician will perform close monitoring, and respond immediately to any symptoms, reducing the risk of complications, and ensuring that the procedure is safe and effective.  

Why is fluorescence bronchoscopy necessary?

Autofluorescence bronchoscopy (AFB) is a new type of bronchoscopy procedure combining regular white light bronchoscopy (WLB) with cell autofluorescence and information technology. This equipment stimulates cell fluorescence, to determine differences in cell fluorescence. The principle behind it is that dysplasia and microinvasive carcinoma of the bronchial epithelium occurs during blue laser exposure creates a weaker red fluorescence and weaker green fluorescence compared with normal tissue. This makes lesions appear in a reddish brown color whereas normal tissue appears green. Computer-aided imaging techniques enable such lesions and their extent to be identified. AFB is unique compared with other microscopic techniques, as it allows discovery of extremely minute lesions, therefore increasing the sensitivity and accuracy of biopsies carried out via bronchoscopy.

As with regular bronchoscopies, AFB is suitable for screening and diagnosis for patients at high risk of developing lung cancer and central type lung cancer in its early stages: AFB is also suitable as a preoperative examination or follow-up examination for lung cancer, useful in determining the scope of surgery prior to a procedure, avoiding resection line involvement, and in the early discovery of relapse and local metastasis following surgery.

Reference

中华医学会呼吸病学分会：诊断性可弯曲支气管镜应用指南（2008年版）