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Ulcerative Colitis

What is Ulcerative Colitis

Ulcerative colitis is inflammatory condition of large bowel which starts from the rectum amd involves in a retrograde fashion the proximal large bowel. Rarely it involves the small bowel. The most common symptom is diarrhoea. The cause of ulcerative colitis is unknown. It has been postulated that it may be caused by interaction between patient genetic susceptibility and the environment. The course of the disease is characterized by period of exacerbation of symptoms and remission. The remission of symptoms may be spontaneous or may be due to medicine. Because of trasmural nature of disease it may lead to complications like abscess formation, fistula to orther organs and bowel stenosis. Long term ulcerative colitis is risk factor for bowel cancer. It is managed initally by Gastroenterologist
Ulcerative ColitisIndications for Surgery in Ulcerative Colitis

  • Emergency Indications

Hemorrhage
Perforation
Toxic Megacolon
Fulminant disease activity not responsive to maximal medical therapy

  • Elective Indications

Complications of Medical therapy for ulcerative colitis
Frequent remission despite maximal medical therapy
Cancer/Intestinal Dysplasia
Growth retardation in children

Surgery for Ulcerative Colitis

  • Emergency surgery

Total abdominal colectomy with Hartman procedure or mucus fistula and end ileostomy is done

  • Elective Surgery

It can be done in one stage or two stage. Surgery done is total procto-colectomy in which whole of large bowel and rectum are removed. After that a pouch is created from distal part of ileum and this pouch is anastomosed to anal canal. The whole procedure is called as total procto-colectomy with ileo-anal pouch anastomeses.This can be done as a single time surgery. In high risk patients who are on steroids a diverting loop ileostomy is also created. In these patients ileostomy is closed after 4 weeks

Consult Dr Amit Jain Best Laparoscopic Surgeon in Noida Delhi Ghaziabad NCR for ColoRectal Surgery. Call us at 7351088686 for any query related to management of inflammatory bowel disease

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Colostomy: Indications, Types & Complications

  • What is a Colostomy

A colostomy is a surgically created opening in the abdomen through which a part of large intestine is brought outside the abdominal cavity through which fecal matter or undigested food material passes into a bag attached to the bowel opening. The opening in the skin where bag is attached for fecal waste collection is called as stoma

  • Why a Colostomy

ColostomyIt is indicated either to protect a distal bowel anastomosis or as a permanent procedure in very low  bowel cancer with anal sphincter muscle involvement

  • Types of colostomy

Temporary : It is a diversion stoma in which fecal matter is diverted outside proximal, to protect an anastomosis distally. Whenever there is doubt of healing of any bowel anastomosis then proximal to this anastomosis a diverting or temporary stoma is created so that fecal matter does not pass through the anastomotic site.

Permanent : It is done in case of very low rectal or anal cancer in which anal sphincter mechanism cannot be preserved. Also done in severe perineal injury which destroys sphincter muscles completely

  • Risks 

It is a major surgery with risk of anesthesia and procedure itself. There may be blockage of the colostomy, prolapse of the stoma, para-stomal hernias, internal bleeding

  • Life with a Colostomy

Except very heavy lifting jobs, stoma should not interfere with any other job. Patient can have normal sexual activity and  it does not effect pregnancy. In diet a very important practice is to chew thoroughly and proper hydration. Can wear clothes as before stoma. No restriction in any sports activity

Dr Amit Jain is Best ColoRectal Surgeon in Delhi Noida Ghaziabad NCR

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Colorectal Polyp: Risk factors, Symptoms & Treatment

  • What are Colorectal Polyp

Colorectal polyp or colonic polyp are growth or mass that appear on the inner surface of the colon. Most of them are benign or harmless. Usually these does not cause any symptom. Colorectal polypTwo main types of polyps, One is non-neoplastic which is most common in which chances of conversion to cancer is negligible and other is neoplastic polyp which have a chance to convert to cancer
Non-neoplastic polyps are of three types: Hyperplastic polyps most common, inflammatory polyps and hamartomatous polyps
Neoplastic are of two types: Adenomas and serrated polyps.

  • Symptoms:

Most colorectal polyp do not cause any symptom, but some people with large polyps may have such as change in bowel habits, Rectal bleeding, Pain, Iron deficiency anemia due to blood loss, mucus discharge

  • Risk Factors

Age: It is the most commmon risk factor. Chances of developing colonic polyp are more in older age
Inflammatory bowel disease such as ulcerative colitis and crohns disease
Family history and Genetic disorders such as Familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome
Other rare cause: tobacco and alcohol use, obesity, type 2 diabetes

  • Diagnosis

Colonoscopy is the most common test for detection of colorectal polyp. It is an OPD base procedure in which gastroenterologist examine mucosa or the inner lining of the colon and rectum using a long, thin flexible tube with a camera and a light on the end. If polyp size is large they take a biopsy, otherwise small polyps can be removed at the same time
CT colonography also called as virtual colonoscopy can also be used to examine the colon indirectly but no biopsy or polypectomy can be done

  • Treatment

Polypectomy is advised for colorectal polyps as no test can predict which polyp will turn into cancer. most polyps can be removed during colonoscopy, rarely patients may require surgery for removal of large polyps

  • Prognosis

After polypectomy prognosis depends on the histopathology report. Polpectomy is sufficient for non-neoplastic and non-invasive cancer. Bowel resection may be required in invasive cancer. Follow up colonoscopy is required as patient may again develop polyps. Daily Aspirin or NSAIDs may reduce the risk of new polyps forming

Consult Dr Amit Jain Best Gastroenterologist in Noida for Colon Cancer

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Colonoscopy: Indication, Preparation, Complications & Cost

  • What is Colonoscopy

A colonoscopy is lower gastrointestinal tract endoscopy in which inside that is mucosa of the large intestine (Colon & Rectum) is examined. It is used to evaluate GI symptoms such as rectal bleeding, chronic diarrhoea and altered bowel habits. During the procedure a flexible tube called as colonoscope which has a tiny video camera at the tip is inserted into the rectum and the doctor view the inside of the entire colon

  • Indications for Colonoscopy

colonoscopy

Colon Cancer Screening: For average risk patients for colon cancer, colonoscopy is done starting from age of 50 year and after 10 year thereafter for early detection of colon cancer
For Evaluation of intestinal symptoms and signs such as rectal bleeding, chronic diarrhoea, chronic constipation

  • Preparation for Colonoscopy

It is important to clean out or empty the colon as any residue may obscure the view of rectum and colon. Patient is asked to have clear liquid diet one day prior to procedure. Laxative in the form of solution in the evening a day before procedure to empty the large bowel

  • Complications

Perforation: Most serious complication which may be life threatening and in 80% of cases require immediate surgery for perforation repair.
Bleeding: Generally occur during therapeutic procedures such as polypectomy. It may be treated during the procedure itself by cauterization. Patient may require surgery if not controlled endoscopically

  • Day After Colonoscopy

Patient may feel bloating and abdomen fullness during first few hours after the procedure. Better not to drive himself after the procedure.It is expected a full recovery by the next day, if not so doctor should be consulted

  • Cost

Cost varies from one institute to other and also vary whether diagnostic or therapeutic procedure is done. It vary from RS 5000 to Rs 15,000

Consult Dr Amit jain best Gastroenterologist in Delhi for your queries on GI problems

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Gastrointestinal Cancer: An Overview

Gastrointestinal CancerThe incidence of gastrointestinal cancer is increasing. Reason being change in lifestyle, dietary habits, increased alcohol intake and smoking.The prognosis of gastrointestinal cancer patients is good if it is detected early and treated at early stage.Anorexia and weight loss are common symptom in cancer patients, along these symptoms with some GI symptoms if present should not be ignored and doctor should be consulted. There are various screening programmes for early detection of colo-rectal and liver cancer. These programmes are done for high risk patients. Screening Colonoscopy is done for patients with inflammatory bowel disease, family history of colo-rectal cancer diagnosed at early age. Regular ultrasound is done in chronic liver disease patients. Neo-adjuvant therapy for locally advance cancer of esophagus, rectum and pancreas has shown good result. Pre-operative biliary drainage is done in patients with high bilirubin who require liver resection

  • Upper Gastrointestinal Cancer

It include cancer of the esophagus, stomach, duodenum and small intestine.Dysphagia, Vomitting,melena are common symptom. Upper GI Endoscopy is helpful for diagnosis. CECT chest and abdomen for staging.

  • Lower Gastrointestinal Cancer

Cancer of the colon and rectum are lower gastrointestinal cancer. Most common symaptoms are altered bowel habits, blood in stool. Diagnosis is made by Colonoscopy. CECT abdomen for staging.MRI is done for cancer rectum There is role of Neoadjuvant therapy in locally advance rectal cancer.Surgery is the treatment of choice if cancer is resectable

  • Hepato-Biliary GI Cancer

It include cancer of the liver, gallbladder, bile duct and pancreas. Patient have symptom of right sided pain abdomen with jaundice. CECT abdomen along with MRCP is helpful to delineate biliary anatomy

  • Symptoms of GI Cancer

Vomitting

It occur when there is obstruction in the gastrointestinal tract. Obstruction distal to the bile duct opening causes billious vomitting. Obstruction proximal to it causes non-billious vomitting.Primary stomach cancer or small bowel cancer casues vomitting due to intrinsic mass which compromise the lumen. Gallbladder mass can cause external compression over the duodenum and antro-pyloric region resulting in gastric outlet obstruction

Dysphagia

Early and Common symptom of esophagus cancer. In patients with esophagus cancer patients have initial dysphagia to solid foods and gradually progress to liquid. This progressive dysphagia is indicative of any progressive mass lesion in the esophagus which is compomising the esophagus lumen and causing dysphagia

Jaundice

It occur when there is obstruction in the Common bile duct. Most common symptom of hepato-biliary gastrointestinal cancer symptom.This obstruction can be intrinsic due to bile duct cancer. It may be extrinsic due to external compression such as Gallbladder mass or pancreatic head mass causing external compression over the CBD. patient present with features of obstructive jaundice such as pale colored stool, dark urine and pruritus

It is passage of black tarrish colored stool. Melena indicate slow bleed in the GI tract. This bleed can originate at any site along the GI tract. Cancer stomach and peri-ampullary cancer and right sided colon cancer have a tendency to bleed. Sometimes patient have occult bleed and present with feature of anemia such as weakness/tiredness

Hematochezia

It is the passage of fresh blood per rectum. symptom of lower gastrointestinal tract cancer that is colo-rectal cancer

Anorexia and Weight Loss

These are common symptoms of any malignancy in our body

Dr Amit Jain MS MCh (GI Surgery) is Best Gastro Doctor in Delhi Noida Ghaziabad Indrapuram. Call us at 7351088686 for your queries. 

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Colon Cancer Treatment: Whats New

The recommended colon cancer treatment or intestinal cancer is surgery. Colon cancer is one of the gastrointestinal cancer in which surgery carries a very good prognosis. Patient should be fit for surgery and cancer should be resectable. Recent studies suggest that no bowel preparation is required before surgery.Patient should be on clear liquid diet one day prior to surgery

  • Colon Cancer Treatment: Curative

The standard surgical treatment of colon cancer is radical colectomy. Colon is divided into four parts, ascending or right colon, transverse colon, descending or left colon and sigmoid colon. Depending on location of cancer respective colectomy is done. After colonic resection depending on patient nutrition status and tumor burden either anastomosis is done or stoma is created. Minimal 12 lymph nodes is the criteria for adequate lymadenectomy for colon cancer has been recommended. If the number of lymph nodes resected is less than 12 then the patient need adjuvant chemotherapy irrespective of staging on histopathology report

Colon cancers are being operated more frequently laparoscopically by Laparoscopic surgeon. The length of incision in laparoscopic surgery is very minimum as compared to open surgery. Minimal incision cause less pain in the post-op period, allow early mobilization of patient and early recovery

Colon Cancer Treatment
Treatment of Colon Cancer
  • Colon Cancer Treatment: Palliative

Palliative surgery is done for multiple site metastatic disease.The two most common symptoms for which palliation is required is large bowel obstruction and bleeding. Right or ascending colon have a tendency to bleed. Left or descending colon because diameter is less compared to right colon causes obstruction. For patients who present with large bowel obstruction depending on tumor burden and patient nutrition status either bypass is done or stoma is created. For bleeding tumors resection is done and attendants are counselled for high risk surgery

  •  Colon Cancer Treatment: Role of Chemo-Radiotherapy

Colon cancer are less sensitive to chemo-radiotherapy thats why its role is minimal in the management of colon cancer

Consult Dr Amit Jain MS MCh (GI Surgery) Best ColoRectal Surgeon in India Delhi for Treatment of Colon Cancer.Fellow in Advance Laparoscopic ColoRectal Surgery

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Laparoscopic Colorectal Surgery: Indications

Today is era of Laparoscopic Surgery.Laparoscopic Colorectal Surgery has evolved gradually and nowadays even Colorectal Cancer surgery are also being done Laparoscopically.

  • Laparoscopic ColoRectal Surgery for Benign ColoRectal Disease

There are various benign colorectal diseases which are being done Laparoscopically. Common disease include Appendectomy, Right Hemicolectomy for ileo-cecal tuberculosis, Sigmoidectomy for sigmoid diverticular disease, Total abdominal colectomy for Ulcerative Colitis. In Ulcerative colitis patients even pouch procedure is done laparoscopically

Laparoscopic ColoRectal Surgery
Laparoscopic ColoRectal Surgery

  • Laparoscopic ColoRectal Surgery for ColoRectal Cancer

Malignancy can involve any part of colon and rectum. Depending on the site of cancer various colectomy are done. These are called as radical colectomy as lymphadenectomy is also done. For rectal cancer anterior resection is done. Depending on the location of tumor in the rectum either low anterior resection or ultra-low resection is done. Initially there was concern of long term survival rate in colorectal cancer patients being operated Laparoscopically. But now we have enough data which says that there is no difference in recurrence rate and survival rate patients being operated open or laparoscopic approach.It is the reason that colorectal malignancy patients are being operated more commonly laparoscopically by colorectal surgeon who are trained in laparoscopic surgery

  • Emergency Laparoscopic ColoRectal Surgery

It Include surgery for large bowel perforation, traumatic large bowel injury and large bowel obstruction.

  • Advantages

Advantages of Laparoscopy ColoRectal surgery is early recovery.Patient can be discharged early from the hospital.No prolonged rest is required.

  • Intestine Surgery/Intestine operation/Bowel Resection Cost

The cost for bowel surgery depends whether it is done for ulcerative colitis, diverticulitis, colon cancer. Also varies between open or laparoscopic. The cost varies from Rs 1 lakh to 3 lakhs

To Know more about Role of Laparoscopic Surgery in ColoRectal Disease plz visit our facebook page Dr Amit Laparoscopic GI Cancer and Bariatric Surgeon.
Dr Amit Jain is Best ColoRectal Surgeon in Noida. Trained in GI Surgery at GB Pant Hospital Delhi. Special training in advance laparoscopic GI Cancer Surgery. Got Fellowship in Advance Laparoscopic ColoRectal Surgery. He is working at Max Hospital Patparganj Delhi and Vaishali Ghaziabad as Senior Consultant Dept of GI Surgery

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