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What is Biliary Pancreatitis Management

The most common cause of acute pancreatits are alcohol intake and gallbladder stone; When acute pancreatitis is caused by biliary stones it is called as biliary pancreatitis; Biliary pancreatitis management involve team work of critical care doctor, Gastrophysician, Gastrointestinal surgeon & Radiologist, Patients present with features of acute pancreatitis like severe acute abdomen pain radiating to back; Investigations show increased serum amylase and Lipase level with deranged Liver function tests (LFT)
The main stay of biliary pancreatitis management is supportive; MRI/MRCP abdomen is done to know the status of Common bile duct; Mostly stone has passed through the Common bile duct into the duodenum; If the MRI/MRCP show stone in the common bile duct then patient require ERCP and CBD stone clearance; The need for ERCP is urgent if the patient condition is not stable and is in cholangitis/septic shock otherwise ERCP is done on elective basis once pancreatitis settle
In mild biliary pancreatitis managementwith no associated fluid collection gallbladder is removed during same hospitalization because gallstone is the cause and the gallbladder is the source; if not removed patient may again develop pancreatitis; In moderate biliary pancreatitis management and severe pancreatitis cholecystectomy is advised after 4 weeks as if some comlications of pancreatitis require intervention that can also be done at same time
Consult GI Surgeon/ Gastrointestinal Surgeon/Gastroenterologist/Hepatologist/ Surgical Gastroenterologist/Laparoscopic Surgeon/Pancreas Specialist to know more about Biliary pancreatitis/ Management of biliary pancreatitis/ Clinical features of biliary pancreatitis/ Treatment of biliary pancreatitis/ Diagnosis of biliary pancreatitis

Biliary pancreatitis management

Pancreatic Pseudocyst Treatment

The most common complication of pancreatitis is pseudocyst pancreas; Less likely pancreatic pseudocyst treatment require surgery, Pseudocyst pancreas can occur following acute pancreatitis or chronic pancreatitis, it is more common following acute pancreatitis, After an attack of acute pancreatitis there is fluid collection around the pancreas, mostly this fluid collection gets resolved but if not then it develops a wall of granulation tissue, as this wall is not a true lining it is called as pseudocyst, The size of this pseudocyst may remain stable, decrease or increase; Mostly these pseudocysts also resolve; As the cyst enlarge it may compress surrounding structures and produces symptoms accordingly like jaundice/vomitting
Only symptomatic pseudocyts require intervention; As these pseudocyts communicate with the pancreatic duct external drainage is not recommended as if drained externally it may develop into pancreatic fistula; Most recommended treatment is internal drainage which can be done either surgically or endoscopically; MRI can help in this decision making; Generally if the contents of the cyst if fluid then endoscopic drainage is preferred and if solid component is more surgical drainage is preferred; Depending upon the location of cyst either cysto-gastrostomy, cyst-duodenostomy or cysto-jejunostomy is done
Consult GI Surgeon/ Gastrointestinal Surgeon/Gastroenterologist/Hepatologist/ Surgical Gastroenterologist/Laparoscopic Surgeon/Pancreas Specialist to know more about Pseudocyst Pancreas/Management of Pseudocyst pancreas/ Clinical Features of pseudocyst pancreas/Treatment of pseudocyst pancreas/ Endoscopic Managament of pseudocyst pancreas

Know About Bile Duct Stricture

Bile is produced in the liver and through the common bile duct bile reaches into the duodenum where it helps in fat digestion; The narrowing of common bile duct is bile duct stricture; Bile duct stricture causes obstruction to the biliary flow and causes jaundice, this jaundice is called as obstructive surgical jaundice as there is obstruction to bile flow due to which there is jaundice and which require surgical intervention
The cause of bile duct stricture may be benign called as benign biliary stricture or malignant called as malignant biliary stricture; The cause of benign stricture is inflammatory which may be after bile duct injury; External compression over the common bile duct (CBD) like compression from pancreatic head mass or from surrounding lymph nodes can also cause biliary stricture; Primary malignancy or cancer of the common bile duct causing narrowing is malignant biliary stricture
To know more about Biliary stricture Consult GI Surgeon/ Gastrointestinal Surgeon/Gastroenterologist/Hepatologist/GI Oncosurgeon Bile duct stricture

What Is Surgical Obstructive Jaundice

Bilirubin pigment is produced in our body after the destruction of Red Blood Cells; This pigment is secreted by the liver in the bile; Bile produced in the liver containing bilirubin pigment goes to the duodenum where it helps in fat digestion (duodenum is part of small intestine )through common bile duct; When there is obstruction to the passage of bile to the duodenum bilirubin pigment gets accumulated in the body giving rise to yellowish discoloration of the sclera and body which is termed as jaundice; Because there is obstruction to the bile flow which require some intervention either endoscopic or surgical to relieve the obstruction to the bile flow thats why it is called as Surgical Obstructive Jaundice
Clinical features which distinguish surgical obstructive jaundice from medical jaundice are that in obstructive jaundice patient will have pale colored stool, itching because of deposition of bile salts and Liver function tests (LFT) will reveal increased direct bilirubin level and increase alkaline phosphate level; Ultrasound abdomen can show the site of obstruction and reason of obstruction with dilated biliary tracts; MRI/MRCP abdomen is done which give more information
Consult GI Surgeon/ Gastrointestinal Surgeon/Gastroenterologist/Hepatologist/GI Oncosurgeon to know more about Surgical Obstructive Jaundice

Laparoscopic GI Cancer Surgery

There are so many advantages of Laparoscopy in Abdominal surgery; Minimal incision, Less Pain, early mobility, reduced chest infections, early enteral feeding; All these help in early recovery in the post-operative period and after the introduction of Laparoscopic Surgery it has been proved that there has been marked reduction in the post-operative morbidity and mortality
Cancer Surgery is different from surgery done for benign disease, Like for Gallbladder, simple cholecystectomy is done for Gallbladder stone disease but for Gallbladder Cancer, Radical cholecystectomy is done in which gallbladder is removed along with part of the liver and surrounding lymph nodes that is cancer surgery is done on oncological principle
Initially when laparoscopy surgery was started for cancer disease also there were issues like the expertize require for complete lymphadenectomy and port site metastases; But with experience and data it has been proved that Laparoscopy surgery in Abdominal Cancer patients if done on oncological principle is safe and give same result on long term

Laparoscopic Surgery Advantages

Laparoscopic Surgery is also known as Minimally Invasive Surgery or Key hole surgery; These surgery are done with minimal incision; The idea behind small incision is less pain in the post-operative period, minimal damage to the tissue with less inflammation
Less pain mean low requirement of analgesia in the post-operative period, early mobility, patient can do deep breath exercise and expand lung fully; Early mobility and lung exercise prevent a lot of post-operative complications which were major cause of morbidity and mortality in post-operative period; These complications include deep vein thrombosis, chest infections and so on
After Laparoscopic surgery it has been observed that bowel motility return early which allow early enteral feeding; Early enteral feeding helps in buliding nutrition and immunity the two most important factors for success of any abdominal surgery

Incidental Gallbladder Cancer

The term incidental gallbladder cancer means when gallbladder cancer is detected on histopathology following either Laparoscopic cholecystectomy or open cholecystectomy; Incidental Gallbladder cancer carries a good prognosis as generally these are detected at early stage; Radical cholecystectomy is performed in these patients as early as possible;
When there is doubt of Gallbladder cancer pre-operatively and these patients are not further investigated for same and on histopathology gallbladder cancer is detected then this is not true incidental gallbladder cancer, it is termed as missed gallbladder cancer
The term missed gallbladder cancer also applies when gallbladder specimen after removal is not cut intra-op and its mucosa is not examined and histopathology comes out to be Gallbladder Cancer
Missed Gallbladder Cancer is different from True Incidental Gallbladder Cancer because it is true incidental gallbladder cancer which carries a good prognosis and radical cholecystectomy is done for these patients

How to prevent acid reflux naturally

How to prevent acid reflux naturally is most common question by patients who suffer from acid reflux, and the best doctor to answer the question how to prevent acid reflux naturally is gastroenterlogist;

Lose weight: Obesity causes GERD in many ways; pressure on the stomach by excess belly fat; increase in estrogen and development of hiatus hernia
Dietary Modifications: Avoid fatty food, spicy foods, chocolate,coffee, acidic foods like citrus
Eat frequent small meal as large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
Don’t lie down immediately after eating: Gravity normally helps keep acid reflux from developing. With full stomach on lying down acid more easily presses against the LES and flows into the esophagus.
Elevate your bed at Head End Side: This works on the principle of gravity, raising the head end of the bed allow gastric acid down in the stomach because of gravity; just extra pillows does not help much
Medications: A number of medications increase risk of GERD, either by relaxing the LES or further irritating an already inflamed esophagus like, Non-steroidal anti-inflammatory drugs, or NSAIDs, Calcium channel blockers (often used to treat high blood pressure), Certain asthma medications, including beta-agonists like albuterol, Potassium, Iron tablets
Quit smoking and Alcohol: Nicotine and Alcohol relax the muscles of lower esophageal sphincterHow to prevent acid reflux naturally

Hemorrhoids Cause & Clinical Features

Hemorrhoids also known as piles is swelling at lower rectum and anus and this swelling consist of engorged veins; Incidence is common and increases with age but not all patients have symptoms
Most common cause is straining during bowel movement, obesity, pregnancy and low fibre diet
The typical symptom is bleeding which is bright red in color and it is few drops which drips after passage of stool and is painless; Prolapsed piles present as swelling around the anus
Piles are of two types internal and external; Internal piles are inside the rectum and they cause bleeding and may also prolapse; External piles are under the skin around anus and can itch or bleed when irritated
The only painful condition of piles is when there is clot in the external piles which causes swelling and painful mass around anus

Fatty Liver

Know About Fatty Liver Disease

Fatty liver is accumulation of fat in the liver; Fatty liver is most common USG finding done for abdomen complain,In long term fatty liver can cause liver damage, The main causes of fatty liver are obesity, diabetes, alcohol intake and hyperlipidemia, It will be the main cause of liver failure in next decade

Liver is vital organ of our body with so many functions, Small amount of fat is normal in the liver leading , But excessive amount can damage the liver and hamper its function, Simple Fatty liver does not cause any symptom but if it progress to second stage liver damage that is liver inflammation medically called as steatohepatitis patients may develop symptoms such as loss of appetite, weight loss, pain abdomen and fatigue; if not taken care at this stage it may progress to chronic liver damage and have symptoms of liver failure such as jaudice, bleeding from GI tract, ascites, confusion and so on, Liver function tests  may be deranged but these does not confirm, Ultrasound abdomen and CT scan can detect fat but the severity of injury is determined by Liver biopsy,There is no specific medication to treat fatty liver, The first line recommended treatment is reduce risk factors such as avoiding alchol intake, reduce weight, control diabetes