Alcohol intake damage many organs of our body and pancreas is one of them, Pancreas is one of the vital organ of our body which has got two main functions, one is secretion of digestive enzymes and other is regulation of blood sugar level
Short term alcohol intake can cause acute pancreatitis which is acute inflammatory condition of the pancreas, Most of the cases are mild pancreatitis and resolve; But severe pancreatitis can be life threatening; Stopping alcohol intake prevent further episodes of pancreatitis
Long term alcohol intake and repeated episodes of acute pancreatitis can cause chronic pancreatitis which is an irreversible condition and patient suffer from frequent and severe pain abdomen, Loss of functional pancreatic tissue can give rise to diabetes and digestive enzymes deficiency; Chronic pancreatitis is a risk factor for pancreatic cancer
Gall-bladder stone disease is common; Ultrasound abdomen is the commonest investigation for any abdomen complaint and the result being the incidence of asymptomatic gallstones are also increasing
It is said that in 90% of patients the first complaint of gallbladder stone is right upper abdomen pain and after first episode the frequency of pain abdomen increases and so the complication rate
In 10% of patients the first presentation can be one of the complication of gallbladder stone; The complications of gallbladder stones include jaundice/cholangitis/pancreatitis/cancer gallbladder/fistulous communication to nearby organs
When the stone in the gallbladder pass to common bile duct through cystic duct patient can have just jaundice if it simply obstruct the CBD lumen and prevent passage of bile from CBD to duodenum; This obstruction when leads to infection patient will have fever and it is called as cholangitis which is a serious condition and patient may develop septic shock and require urgent biliary drainage; Biliary pancreatitis is another life threatening complication, it is said that passage of stone lower down causes temporary blockage of pancreatic secretions and can cause pancreatitis
Long standing inflammation anywhere in the body predispose to cancer so in case of gallbladder stone; Gallbladder stone is known risk factor for cancer gallbladder
The incidence of stomach cancer is increasing, Dietary factors predispose to gastric cancer, Patient can present in different ways, There can be just mild epigastric pain or feeling of lump left upper abdomen, if the tumor obstruct the passage of food patient can have vomitting and if the tumor bleed patient can have black colored stools and symptoms of anemia such as weakness; Anorexia and weight loss are common
Ultrasound is the first investigation in any abdominal complaints, which may show a mass in the stomach; Upper GI endoscopy show the mass in the stomach and biopsy can be taken, once the diagnosis is confirmed CECT abdomen is done for staging and if the tumor is resectable surgery is the treatment of choice
Intra-op staging laparoscopy is the first step and if there is no metastases definitive surgical procedure is performed, depending on the location of tumor either radical distal/sub-total/complete gastrectomy is performed
Obesity is a silent killer, root cause of a number of diseases such as diabetes, hypertension, sleep apnoea, fatty liver, cancer, osteoarthritis, infertility and so; As the incidence of obesity is increasing so the incidence of all these diseases; Most of these diseases do not cause immediate harm but silently take our body to end stage of life; thats why it is a silent killer
Prevention is always better than cure, Obesity is preventable if we take care of our diet and do regular exercise but may be the side effect of today life-style its incidence is increasing; Again it can be treated if we follow the same but again we got failed
Today we have the option of Bariatric Surgery to control weight and prevent ourself from all these silent killer diseases
GERD is reflux of gastric contents into the esophagus, It occur when the lower esophageal sphincter which normally prevents reflux of gastric contents into the esophagus is weak
Patient complain of heartburn, reflux of food content into the esophagus; patient can have extra-esophageal symptoms such as cough; Upper GI Endoscopy is the first step which will show features of esophagitis
Proton pump inhibitors such as pantaprazole which inhibit acid formation will give relieve to the symptom of heartburn but it does not prevent reflux and patient is predisposed to cancer due to reflux so endoscopy is advised to these patients who are on long term on proton pump inhibitors
Surgery is advised to those patients who on investigation are confirmed to have reflux disease and have extra-esophageal symptoms, young age, defective lower esophageal sphincter; Surgery performed is Laparoscopic Fundoplication
The incidence of obesity is increasing, Lifestyle and dietary changes has made young population vulnerable to this disease and result being more and more young population with high BMI are being referred for Bariatric Surgery
Young females with high BMI being referred for Bariatric Surgery have a doubt whether this surgery have an effect on there married life and what about course of Pregnancy after Bariatric Surgery Marriage after Bariatric Surgery has never been an issue; Infact Infertility associated with obesity improve after weight loss from Bariatric Surgery; There is high incidence of abortions, diabetes, hypertension, fetal growth malformation and cesareans in high BMI pregnant female patinets; Now we have ample data which suggest that incidence of diabetes and hypertension during pregnancy and low birth weight are reduced after this surgery
Most of the weight loss after Bariatric Surgery occur in the first 12 months thats why it is recommended to weight atleast 12 months after this surgery for conception; This is based on the fact that pregnancy during a period of malnutrition can lead to low birth weight or malformations
Prevention is always better than cure; Known major risk factors for liver cancer are Alcohol, Smoking, Hepatitis B and C Infection, Fatty liver disease; If we quit alcohol and smoking not only liver cancer risk but we can reduce the risk for so many other cancer also; Hepatitis B & C infection spread from one infected person to other through sexual contact, using infected needles and syringes and through blood and blood products, so by taking precautions these infections can also be prevented, Hepatitis B Vaccine is also available; Fatty liver disease in now emerging as the major cause of liver damage and as liver cancer risk factor, Major cause of fatty liver disease is obesity and diabetes, Weight control by means of healthy life style and good diabetic control can reverse it
The symptoms of Liver cancer are right upper abdomen pain, anorexia and weight loss; Sometime patient present with symptoms of chronic liver disease such as hematemesis (blood in vomitus), black colored stools, Abdomen distension due to ascites, jaundice and during investigation they are found to have chronic liver disease along with Liver cancer
Cancer patients survival rate is is good if detected and treated at early stage, In patients of chronic liver disease routine USG and a blood test for alpha feto protein level is done every 6 month; These tests can detect cancer at early stage when the tumor size is small
Once Ultrasound suggest a mass lesion in the liver, triple phase CT abdomen is done to further delineate the lesion and for any other lesion not picked by USG, CECT chest is also done for staging purpose
Treatment options for liver cancer patients are Surgery, Local ablative procedures and chemotherapy; Surgery is the preferred one, There are two options in surgery one is liver transplantation and other is liver resection, Liver transplantation is preferred in those patients who have liver cancer on background of chronic liver disease, as the chances of recurrence after liver resection is high in these patients, In 20% patients liver cancer develop on background of normal liver, liver resection is the treatment of choice in these patients; Local ablative procedures are done when patient is not fit for surgery and as a bridge to liver transplant but the results are inferior to surgery; Chemotherapy is used in advanced cancer
As the no of bariatric surgery is increasing and the majority of patients being female and of reproductive age, it is important to know its effect on future pregnancy
As the majority of weight loss after bariatric surgery occur in first 12 months it is advised to wait at least for 12 months prior to conception because pregnancy occurring during this period of malnutrition can lead to low birth weight and malformations.
Jaundice occurs when there are excess biliary pigments in our blood; Bile is produced in the liver and through the bile duct it reaches to duodenum where its main function is fat digestion, The cause of jaundice is Surgical or Obstructive when there is obstruction in the bile duct and bile does not reach up to duodenum and get accumulated in our blood; It can be due to external compression of bile ducts or internal obstruction due to stone, cancer or stricture
Clinically patient has itching and pale colored stools in obstructive jaundice; Blood tests show high direct bilirubin level and increased alkaline phosphatase levels; Dilated biliary channels on ultrasound confirm obstruction as cause of jaundice and also show site and cause of obstruction; MRI and Endoscopic Ultrasound are done when in doubt.
Treatment depends on the cause of obstruction, Most common cause is CBD stone and the treatment of choice is ERCP and stone removal
Gallbladder stone formation is common and the standard treatment for symptomatic gallbladder stone is Laparoscopic Cholecystectomy (gallbladder removal). Gall bladder is an important organ of our body but a body can still function well in its absence.
Myth: Lifelong we have to avoid fatty food
Fact: Liver produces bile and stored in the gallbladder and the function of bile is the digestion of fat, so when we eat a meal that is high in fat content, bile is released from gallbladder to duodenum for fat digestion, but after surgery when gallbladder is removed bile produced in the liver is released in a continuous slow trickle into the intestine. Thus the adequate amount of bile may not be there in the intestine initially for the normal absorption process and a patient may develop diarrhea and bloat but with time body get streamline; so we need to consume after surgery low-fat diet for few weeks till our body gets used to the new situation of gall bladder absence.
Myth: Gall bladder removal only removes gallstones
Fact: Stones formation in the gallbladder reflect a poor and abnormal function of the gall . So, there is no way of keeping the gall bladder because it is inflamed and function improperly and its removal will avoid subsequent stones formation and complications.
Myth: Scarring at the surgical site
Fact: Nowadays surgery is done laparoscopically which requires only 3-4 small cuts in the abdomen and the gall bladder is removed through this small hole so scarring will be almost nil. Patients typically have less post-operative pain and experience a faster recovery period than open surgery.
Obesity Causes Liver Damage Equivalent to Alcohol Abuse
These are two very different health issues, but both cause liver damage in a similar fashion. Fatty Liver disease is a condition which develops when fat is deposit in the liver. Both Obesity and Alcohol abuse can lead to fatty liver. When fatty liver occurs in those who do not take alcohol like obesity, it is called nonalcoholic fatty liver disease, or NAFLD.
When there is too much fat deposition in the liver, it leads to an inflammatory process in the liver and the liver cells get damaged, this severe form is called nonalcoholic steatohepatitis or NASH, and this continuous liver cell damage can lead to cirrhosis and ultimately liver failure