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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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GERD (Gastroesophageal Reflux Disease)

  • What is GERD (Gastroesophageal reflux disease)

GERD

(GERD) Gastroesophageal reflux disease as the name indicates is the reflux of stomach contents back into the esophagus. Generally what happens, when we ingest food it passes through the esophagus, there is a valve at the lower end of esophagus which relax or opens and food enter into the stomach and after that valve gets closed. When this valve is not competent enough stomach contents reflux back

  • GERD Causes

  • Improper function of lower esophageal sphincter muscle as described above is the reason for gastroesophageal reflux
  • Symptoms of GERD

  • Heartburn (Burning sensation in chest, usually after eating, worsened at night)
    Regurgitation of food contents
    Difficulty swallowing
    Chronic cough/ New or worsening asthma
  • Risk Factors

  • Obesity
    Hiatus Hernia
    Delayed stomach emptying
    Pregnancy
    Smoking
    Alcohol/ Coffee
    Eating large meal
  • Complications
  • Esophagus ulcer is the first finding on endoscopy in simple reflux disease. Long standing reflux can cause Barretts esophagus which is a premaligant condition which predispose to esophagus cancer. Continuous reflux can cause benign esophageal stricture
  • Diagnosis
    Esophageal pH monitoring is the gold standard test to confirm the prsence of reflux
    Upper GI Endoscopy
    Esophageal Manometry
  • Treatment
    First step in acid reflux treatment is life-style modification
    Medical treatment include proton pump inhibitors which decrease the amount of acid produced by the stomach. these includes pantocid, rabeprazole. Another group of medicines which are beneficial include H2 blockers, Antacids, Prokinetics
    Surgical management: Surgery is indicated if above methods fail, and lower esophageal sphincter muscle is weak, associated hiatus hernia. In these cases Niissen fundoplication is done
  • GERD Diet
  • There is no special diet for GERD. Small frequent meal. Certain foods which trigger GERD symptoms should be avoided. These foods include coffee, alcohol, spicy foods, chocolate, peppermint
  • Prevention
  • Stop alcohol & Smoking
    Take small amount of meal at one time
    Donot lie immediately after eating
    Loose weight
    Stop eating 2 to 3 hours before sleeping
  • Consult Dr Amit Jain Best Gastroenterologist in Noida for reflux disease
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Liver Disease: Causes, Risk Factors, Symptoms, Prevention & Treatment

  • Liver Disease Causes

Infection: Various infections can cause liver disease, the most common types of liver infection are hepatitis viruses such as Hepatitis A, B, C & E

Liver Disease

Chronic Alcohol Abuse: Most common cause of liver cancer and indication for liver transplant
Fatty Liver: Common causes of fatty liver are obesity, hypertriglyceridemia, diabetes
Immune system abnormality: Examples include Autoimmune hepatitis, Primary sclerosing cholangitis, Primary biliary cirrhosis
Other Causes: Drugs and Toxins, Genetics

  • Risk Factors: Following factors may increase your risk for Liver problem

  • Alcohol Abuse
    Diabetes
    Obesity
    Exposure to certain toxins or chemicals
    Unprotected sex
    Injecting drugs using shared needles
    Blood transfusion
  • Liver Disease Symptoms

  • Yellowish discoloration of skin and eyes (Jaundice)
    Nausea & Vomitting
    Chronic Fatigue
    Pruritus / Itching
    Abdomen pain and distension (Ascites)
    Swelling or edema in the ankle and leg
    Dark colored urine
    Pale stools
    Loss of appetite
    Blood in the vomitus (Hematemesis)
    Fresh blood in the stool (Hematochezia) or Black tarry stools (melena)
  • Liver Disease Treatment

Treatment varies from life-style modifications to drugs to surgery depending on the specific cause. Changes in life-style include stopping alcohol use, regular exercise, diabetes and weight control for fatty liver, Chronic liver damage is managed conservatively with drugs initially and Liver transplant for end stage liver problem

  • Liver Disease Prevention

Healthy life style with regular exercise and weight management is must for healthy liver. Diabetes control. It is predicted that Fatty liver will be the leading cause of liver failure  and liver cancer in future. Avoid alcohol intake and smoking. Hepatitis B vaccine is available. Unprotected sex, infected blood transfusion, sharing infected needles are risk for hepatitis infection and should be avoided

Dr Amit Jain MS MCh (GI Surgery) is Best GI Surgeon in Delhi for Liver Disease. Call us at 7351088686 for your queries. Visit our facebook page Dr Amit Jain Laparoscopic Gastrointestinal Cancer & Bariatric Surgeon to know more about Liver problems

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HeartBurn: Causes, Symptoms, Complications & Treatment

  • What is HeartBurn

Heartburn is a burning type chest pain usually lower chest caused by gastric reflux. It causes bitter or acidic taste in the mouth, depending on gastric reflux contents. It usually occurs after eating and wosens when lying down or bending over

Heartburn
Heartburn

Heartburns which are occasional are common and no cause for alarm. However frequent or interfering with routine activity require medical attention

  • Cause

It occur when lower esophageal sphincter is not tight enough to prevent reflux of gastric contents. Associated sliding hiatus hernia aggravates the problem

  • Risk Factors

Ceratin foods and drinks can aggravate heart burn. Obesity and pregnancy can also increase risk. Drinks and food which increase risk include: Alcohol, Coffee, Fried or fatty foods, chocolate, onions, spicy foods

  • Complications

Acid Reflux can cause esophagus sricture and esophageal cancer. It can be the cause of prolonged cough

  • Medical Management
  • First is life style modifications

Avoid smoking and alcohol
Reduce weight and regular exercise
Avoid lying down immediately after food intake
Small frequent meal

  • Medicines available for treatment of heartburn are proton pump inhibitors which include pantocid/rabeprazole. Should be taken on empty stomach

Heart Burn Surgery

Nissen fundoplication is the surgery for heartburn

Consult Dr Amit jain best Gastroenterologist in Noida Delhi NCR for acidity treatment

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Upper GI Endoscopy

Upper GI Endoscopy is a procedure which may be diagnostic or therapeutic done by gastroenterologist to see lining of upper GI tract. It is done with an endoscope- a flexible tube with a camera, under light sedation to relax the patient

Upper GI Endoscopy
Upper GI Endoscopy
  • Symptoms for which Upper GI endoscopy is done

  • Nausea & Vomitting
    Swallowing problem or dysphagia
    Heart burn/ acid reflux
    Hematemesis/ melena
    Unexplained weight loss

Hematemesis is blood in vomitus. Melena is passage of black tarry stool, generally indicate slow bleed in GI tract, most commonly Upper GI from stomach and duodenum

  • Diagnosis

  • Esophagus Cancer/ Stomach Cancer
    Corrosive Injury
    Esophagus/Stomach Ulcer
    Esophageal and Gastric varices
    Biopsy taken during procedure make the diagnosis of cancer

  • Therapeutic procedures

  • Dilatation of the esophagus and antral stricture
    Banding and glue injection for varices
    Foreign body removal
  • Preparation 

  • Fasting for 4 hrs
    Blood thinner drugs should be stopped
  • Complications
  • Bleeding
  • Perforation

It is not a painful procedure as nowadays it is done under mild sedation. Cost of procedure varies from one institute to other and also the indication for procedure. Simple diagnostic procedure cost varies from 1500 INR to 4000 INR 

Dr Amit Jain is best Gastroenterologist in Noida Delhi. Call us at 7351088686 for your queries. Visit our facebook page Dr Amit Jain Laparoscopic Gastrointestinal Cancer & Bariatric Surgeon to have regular updates on Gastrointestinal diseases

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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

Dr Amit jain is best Gastroenterologist in Delhi Noida Ghaziabad

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Gallbladder Polyps: Are These Indications for Gallbladder Removal

What are Gallbladder polyps

Gallbladder polyps are gallbladder wall elevations that project into the lumen. Commonly detected on ultrasound done for other symptoms. Incidence vary from 0.3 to 9%
As the incidence of polyp is more and chances of malignancy is rare, selective surgery is done for these patients and should be counselled accordingly

Symptoms of Gallbladder polyps

As the gallbladder polyp are attached to gallbladder wall and are non-mobile these do not cause any symptoms. Large polyps because of there size and twisting effect or when change into cancer may cause pain

Gallbladder Polyps
Gallbladder polyps

Diagnosis of Gallbladder polyps

Ultrasound abdomen is the most common investigation for diagnosis.It will detect the number and size of polyp. CECT abdomen is done when USG show suspicious of gallbladder cancer

Indication of Surgery

The only indication for surgery in gallbladder polyps is risk of cancer. It is said that risk of cancer is high in polyp size more than 10mm, single polyp and sessile polyp
For Polyp less than 6mm follow up ultrasound is done at 1, 3 and 5 year. For polyp 6-9 mm ultrasound is done at 6 months, 1,2,3,4 and 5 year; If during follow up increases by 2mm or more cholecystectomy is advised
For polyps 6-9mm if there are risk factors for gallbladder malignancy like age > 50 years, sessile polyp, indian ethinicity, PSC then also cholecystectomy is advised

Surgery for gallbladder polyp

Laparoscopic cholecystectomy is the standard surgical procedure for gallbladder polyp. Advantage of laparoscopy surgery being early recovery and discharge from the hospital. If investigations suggest cancer doubt in polyp then it should be treated like gallbladder cancer. Intra-op frozen section should be sent from suspicious area and should proceed accordingly

Consult Dr Amit Jain MS MCh (GI Surgery) Best Laparoscopic Surgeon in Ghaziabad for Gallbladder ployp management. Call us at 7351088686 for your queries.

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Hiatus Hernia: Undervalued Cause of Acid Reflux

Diaphragam is a muscular wall which separates chest cavity from abdomen cavity. Hiatus is an opening in the diaphragam through which esophagus enters from thorax into the abdomen. A hiatus hernia occur when stomach most commonly or other abdomen organs enters into thorax through this opening.

  • Types of Hiatus Hernia

There are two types of hiatus hernia one is sliding and other is paraesophageal. In sliding hernia GE junction migrates into the thorax.In Paraesophageal hernia GE junction remains stable, stomach most commonly or other abdomen organs rolls into the thorax through side of esophagus

Hiatus Hernia
Hiatus Hernia

Symptoms

Most commonly patient present with features of acid reflux such as heartburn. Heartburn is defined as pressure sensation localized to epigastric and retrosternal area which does not radiate to back.As the disease become more severe patient complain of regurgitation of digested food. Dysphagia occur due to mechanical obstruction to food.Patient may complain of chest pain

Diagnosis

Upper GI Endoscopy is first step to rule out other disorders whose symptoms mimics with hiatus hernia. It also grades the esophagus injury severity due to acid reflux. Esophagus manometery and Esophagogram are other investigations which are also done. CECT chest and upper abdomen is helpful in large paraesophagus hernia for management

Medical Treatment

Proton pump inhibitors and life style modification are first step. Pantoprazole will reduce the heartburn. Weight reduction is important. Eat small but frequent meal. Do not lie immediately after food intake

Surgical Management

Failed medical therapy, Large hiatus defect, Herniation of other abdomen organs are indications for surgery. The standard surgical procedure is reduction of hernia contents with repair of hiatus and fundoplication. It is done Laparoscopically

Dr Amit Jain MS MCh (GI Surgery) Senior Consultant Max Hospital Patparganj Delhi & Vaishali Ghaziabad is best Laparosopic Surgeon for Laparoscopic Fundoplication Surgery. Call us at 7351088686 for your queries

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Stomach Pain: Symptoms & Investigations

Abdomen pain or stomach pain is pain or discomfort that occur between the rib cage and pelvis. It occur due to pathology in the organs situated in the abdomen cavity. It may also occur due to disease located in organs outside the abdomen cavity or some systemic cause. Abdomen pain occur due to inflammation of these organs or distension of these organs or when there is reduction in the blood supply of organs

Associated symptoms

Associated symptoms along with pain abdomen give clue that pain may occur due to disease involvement of that system. Abdomen pain along with dysuria, frequecy of urine may be due to involvement of urinary system. Vomitting alone may be non-specific. Specific cause of vomitting include gastritis most common cause, intestinal obstruction. Jaundice suggestive of liver disease, most commonly hepatitis. The cause of hepatitis may be viral hepatitis or alcohol hepatitis. Diarrhoea suggestive of colitis

Stomach Pain
Stomach Pain

Location of stomach pain

Abdomen is divided into nine quadrants. Pain located to specific quadrant may be due to inflammation or infection in the organ located in that quadrant

Blood Investigations in stomach pain

Complete blood count (CBC), Kidney function test (KFT), Liver Function test (LFT) are blood test which are helpful in stomach pain. In CBC Hemoglobin and total leucocyte count are most helpful. LFT may be deranged suggestive of hepatitis/ obstructive jaundice.KFT are deranged in chronic renal failure patients.

Radiological Investigations in stomach pain

The most common radiological investigation done for any abdomen complaint is ultrasound abdomen. It is easily available, no radiation exposure, not much expensive and non-invasive. Most common cause of abdomen pain are easily diagnosed on ultrasound. CECT abdomen is done if the findings on ultrasound are inconclusive and patient has significant pain abdomen

Dr Amit Jain is Best gastroenterologist in delhi noida ghaziabad for stomach problems. Dr Amit Jain is Senior Consultant at Max Hospital Patparganj Delhi & Vaishali Ghaziabad

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Surgical Obstructive Jaundice: Causes & Treatment

What is Surgical Obstructive Jaundice

Obstruction of the bile flow into the duodenum lead to accumultion of bile pigments.As the cause of jaundice is obstruction it is called as obstructive jaundice and as it require surgical intervention it is called as surgical obstructive jaundice

Clinical Features of Surgical Obstructive Jaundice

The most prominent clinical feature which distinguish medical jaundice from surgical jaundice is pale stool in surgical jaundice. Because of obstruction bile pigments does not reach up to intestine and stools become pale. Patient complain of itching due to accumulation of bile salts in the blood

Surgical Obstructive Jaundice
Surgical Obstructive Jaundice
Liver Function Tests in Surgical Obstructive Jaundice

Total bilirubin level is raised. It is conjugated type of bilirubin which is raised in obstructive jaudice. Serum alkaline phosphatase level is raised, it indicates there is obstruction in bile passage

Radiology

Ultrasound is the first investigation to be done as it is non-invasive, no radiation exposure and readily available. Dilatation of Biliary radicles is indicative of obstructive biliopathy. Level of biliary tract dilatation is suggestive of site of obstruction. The most common cause of surgical obstructive jaundice is Common Bile duct stones. In old age patients malignancy can be the cause of  jaundice. Small CBD stones may be missed on Ultrasound.
MRI/MRCP to detect small CBD stones missed on ultrasound. Biliary anatomy is more defined on MRI.

Treatment

Vitamin K is administered to correct coagulation profile before any intervention. If patient is in cholangitis proper antibiotic and I.V fluids are administered. Specific treatment depends on the cause of CBD obstruction. The first line of treatment for CBD stones is ERCP stone clearance. Surgery is done for malignant cause of jaundice.

Consult Dr Amit Jain Best Gastroenterologist in Delhi Noida Ghaziabad for Management of Surgical obstructive jaundice. Dr Amit Jain is renowned Laparoscopic Surgeon in Delhi specialized in Laparoscopic GI Surgery.Call us at 7351088686

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