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Constipation: Causes, Investigations & Treatment

  • What is Constipation

Most common complaint seen in day to day clinical practice is Constipation. Most frequently patient complain of difficult, infrequent or incomplete defecation. It is difficult to define it as there is wide range of normal bowel habit. More than 90% of population have at least three bowel movements per week.But frequency is not the only criteria as most patients who complain it have a normal frequency of defecation. Most commonly these patients complain of hard stools, excessive staining, a sense of incomplete evacuation and lower abdomen fullness

Constipation
Constipation
  • Causes

Usually due to less fluid intake, low fibre diet and decreased colonic transit time.
Recent onset may be due to colonic obstruction. Reason for same may be colorectal cancer, ischemic stricture, diverticular disease. Painful anal spasm which may be due to anal fissure or painful hemorrhoids
Most common cause of chronic constipation is irritable bowel syndrome with constipation predominant. Medical causes include hypothyroidism, hypercalcemia. There are some medications which on long term can cause constipation. Slow colonic transit time is common

  • Investigation

Colonoscopy is advised to rule out mechanical cause such as colonic stricture or malignancy especially in old age patients and with recent history associated with anorexia and weight

  • Constipation Treatments

Lifestyle: Regular time for defecation is important. Always respond to defecatory urge. Physical activity should be encouraged for those who have inactive lifestyle.The drugs which cause it should be avoided
Psychological Support: It can be result of emotional disturbance and can be aggravated by stress. Counselling is required for these patients
Fluid Intake: Less fluid intake causes salt and water absorption by the large intestine,it causes passage of small, hard stools. Thats why patient is encouraged to take plenty of fluids
Laxatives: Two types, Bulk laxatives and osmotic laxatives

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Symptoms of Gastrointestinal 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

Gastrointestinal
GI Cancer Symptoms
  • 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.

  • Melena

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

Consult Dr Amit Jain Best Gastrointestinal Doctor for stomach, Liver, Pancreas, Gallbladder, Colo-Rectal Diseases. Call us at 7351088686 for your queries. Visit our facebook page Dr Amit Jain Laparoscopic Gastrointestinal Cancer & Bariatric Surgeon to know more stomach problems

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Multispeciality Gallbladder Cancer Management (Oncologist)

Team work of Cancer Doctor or Oncologist for Gallbladder Cancer

Gallbladder Cancer Management is team work of GI Oncosurgeon, GI Oncologist, Gastroenterologist and Intervention radiologist.Once patient is diagnosed to have gallbladder cancer further management depend on pre-operative staging of the cancer

  • Role of GI Oncosurgeon in Gallbladder Cancer Management
oncologist
Gallbladder Cancer

If the tumor is resectable, first line of management is surgery. The standard surgical procedure performed for gallbladder cancer is radical cholecystectomy. In this surgery gallbladder is removed along with liver bed and lympadenectomy is done. Staging laparoscopy is first step. There is high incidence of metastases which are missed on pre-operative imaging, which can be detected on staging laparoscopy and morbidity of long incision can be avoided

  • Role of GI Medical Oncologist in Gallbladder Cancer Management

If the cancer is metastatic on imaging then palliative chemotherapy is given. For locally advance cancer but not metastatic pre-operative chemotherapy is given to downstage the tumor and make it resectable.Once cancer seems resectable surgery is done
Chemotherapy is given in the post-op period if the tumor is beyoned certain stage

  • Role of Gastroenterologist in Gallbladder Cancer Management

Patients who are not surgical candidates either because tumor is locally advanced or metastatic or poor peformance status, these patients if have jaundice or vomitting require endoscopic palliation. Jaundice occur when the tumor compress the biliary system and vomitting occur either due to antro-pyloric or duodenal obstruction. Endoscopic Biliary and duodenal stenting is done in these patients. Jaundice and vomitting are relieved after stenting in these patients

  • Role of Intervention Radiologist in Gallbladder Cancer Management

There role comes when palliative endoscopic biliary stenting is not possible because there is complete blockage of biliary system. In these patients percutaneous transhepatic biliary drainage is done to relief jaundice

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Gastroenterologist: Role in Gastro Intestinal Cancer Sypmtoms Management

  • Best Palliative Care by Gastroenterologist for Advance GI Cancer

Surgery is the treatment of choice in gastrointestinal cancers if the tumor is resectable and patient is fit for surgery. Gastroenterologist play important role if the tumor is advanced and metastatic. These patients require treatment for there symptoms. Best way of palliation of symptoms is minimally invasive approach

Gastroenterologist
Role of Gastroenterologist in GI Cancer
  • Palliation of Upper GI Cancers Symptoms by Gastroenterologist

Dysphagia is the most common symptom of esophageal cancer and the best way of palliation is endoscopic placement of esophagus stent across the site of obstruction.In similar way in patients of stomach cancer and duodenal cancer who have gastric outlet obstruction and have vomitting, stent can be placed across the obstruction site and vomitting can be relieved
Patients of esophagus and stomach cancer can present with hematemesis or melena. It indicate tumor site bleed. Many a times these bleeds can be controlled endoscopically

  • Palliation of Lower GI Cancer Symptoms by Gastroenterologist

Growth in the colon or rectum can cause bowel obstruction.Many a times these patients present in emergency with features of large bowel obstruction such as abdomen distension, vomitting, not passage of flatus and motion. When investigated further are found to have advanced colo-rectal cancer. In these patients endoscopically stent can be placed and obstruction can be relieved. A major surgery can be avoided in these patients

  • Palliation of Hepato-biliary Cancer symptoms by Gastroenterologist

Most common hepato-biliary cancer symptom which require palliation is jaundice. Jaundice is either due to primary cancer such as cholangiocarcinoma or it may be caused by external compression by nearby organ malignancy. Gallbladder neck mass, periampullary cancer, pancreatic cancer are common GI malignancy which can cause jaundice.Endoscopic internal biliary stenting is best palliation for these patients

Best Gastroenterologist in Noida Delhi Ghaziabad NCR India Dr Amit Jain

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An Approach to Jaundice Patient

jaundice
Jaundice

Yellowish discoloration of body mainly sclera of eye is jaundice. It occur due to accumulation of bilirubin pigment in the body. Bilirubin pigment is formed after destruction of old red blood cells in the body and after that it is secreted through bile in to stool. Hyperbiliruninemia occur either due to excessive production because of excessive hemolysis. It also occur if there is obstruction in the passage of bilirubin pigment through liver in to small intestine

  • Blood Investigations

The most common blood investigation done is Liver Function Test. Bilirubin is raised in these patient. In case of obstructive jaundice conjugated part of bilirubin is raised while in hemolysis or other medical cause unconjugated bilirubin is raised. If the cause is hepatitis then enzymes SGOT/SGPT are also raised. Serum alkaline phosphate is marker for obstructive jaundice
Uncojugated bilirubin is raised in Hepatitis patients. Most common cause of hepatitis are alcoholic hepatitis, Viral hepatitis and steaohepatitis. Most common viral infections which cause hepatitis are Hepatitis A, E, B and C infection. Blood test for the presence of these infections should be done in case of acute hepatitis
Total Leucocyte counts is raised in patient with cholangitis. Renal function tests should be done

  • Radiological Investigations in Jaundice Patient

The most common first investigation done is Ultrasound abdomen. The dilatation of biliary channels on ultrasound suggest biliary tract obstruction. The level of bile duct dilatations indicate the site of obstruction. CBD stones or mass can be visualized on ultrasound as cause of obstruction
MRI/MRCP is more helpful to delineate biliary anatomy before any intervention. There are guidelines which recommend EUS in these patients before ERCP

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