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
Pancreas is vital organ of our body which has got two major functions, Firstly it releases certain enzymes which help in digestion and Second it releases hormones which maintain blood glucose level
Pancreatic cancer is known for its poor prognosis; Nearly more than 25,000 new pancreatic cancer patients are diagnosed every year in India, It is 13th most common cancer but 5th most common cause of death due to cancer in India; Without treatment not more than 15% patient survive more than a year and with best treatment possible still less than 15% patient survive more than 5 years
Smoking is most common risk factor, Nearly 75% patients are chronic smokers and risk equalize to non-smoker after 10 year of quitting it; Alcohol causes chronic inflammatory condition of the pancreas called chronic pancreatitis which is a risk factor for pancreatic cancer; Recent studies show long term diabetes is also a risk factor, Pancreatic cancer in itself can cause diabetes; Obesity leading to diabetes is also one of the risk factor; It runs in about 5% of families
During the early stage patient is asymptomatic, Pain is constant feature which is mild to moderate in intensity and localized to upper abdomen which may radiate to back; Anorexia and weight loss are common, Cancer located in the head of pancreas can cause distal CBD obstruction leading to jaundice and Duodenal obstruction leading to vomitting, Tumor located at body and tail region of pancreas can grow to large size without any symptom and may present as lump andomen
Ultrasound is the first investigation in patients presenting with any abdominal complaint, When it suggest a mass lesion in the pancreas, CECT abdomen is done to further delineate the mass, its relation with surrounding structures and any distant lesions; Once it suggests tumor is resectable surgery is the treatment of choice, in case of locally advanced tumor pre-operative chemoradiothearpy is given; The standard surgical procedure done in case of tumor located in head of pancreas is whipple procedure (pancreatico-duodenectomy), if it is located in the distal part distal pancreatcetomy with splenectomy is done
Patient with head tumor can have jaundice, Pre-operative biliary stenting is done if the bilirubin level is very high, patient have fever and poor general condition with poor nutrition
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
Dr Amit Jain is currently working as a Senior Consultant at the Department of GI Surgery, GI Oncology, Minimally Invasive and Bariatric Surgery at Yatharth Hospital Noida Sector 110 and Greater Noida sector omega 1