Blog - BIG Super Speciality Hospital, Bengaluru

16/Nov/2019

Understanding Liver Cirrhosis: Causes, Symptoms, and Treatment Options

Liver is an organ that has a remarkable ability to regenerate when the liver cells get damaged as a part of the regular repair process. However, if there is repeated injury due to intake of substances ( Ex: alcohol), the regenerative ability of the liver fails to keep pace with damage elements leading to progressive destruction and build-up of irreversible scar tissue formation. Thereby converting the functional organ to a mass of scar tissue called cirrhosis and is the end stage of the chronic liver diseases. In cirrhosis, there is a partial blockage of blood flow through the liver, obstructing normal metabolic and regulatory process due to the replacement of healthy liver tissue with the scar tissues.

Number of liver diseases and other conditions can damage the liver and lead to irreversible cirrhosis. The major causes of the cirrhosis include

• Alcohol abuse
• Chronic viral hepatitis
• Genetic and bile duct disease

Causes for the development of cirrhosis in those with chronic NASH (Non-alcoholic Steatohepatitis) include

• Fat accumulation in the liver
• Hypertension
• Diabetes 2
• Obesity
• Hyperlipidaemia

Recognizing the Signs: Common Symptoms of Liver Cirrhosis

Initial symptoms of liver cirrhosis include abdomen pain, fatigue, nausea and weight loss. As the cirrhosis progresses, at an advanced stage the severely affected liver show the symptoms that may include
• Fluid collection in abdomen (Ascites)
• Yellowish discoloration of eyes and skin (Jaundice)
• Swelling in legs
• Dilated and curly blood vessels over abdomen (Spider like) blood vessels
• Itchy skin
• Men may experience fat deposit in the breast area
• Hair loss
• Bruising and easy bleeding
• Swelling of the feet ( Oedema)

Treatment

Scar tissues are an irreversible result of liver injury, hence no treatment can cure liver cirrhosis. The management or treatment options of the disease completely depends on the cause and the extent of liver damage. The treatment can only delay the further damage but cannot cure cirrhosis. Depending on the disease causing cirrhosis, medications or lifestyle changes are advised by the doctor. Liver transplantation is recommended as the best option at an advanced stage or when liver completely stops working.

Reference

http://www.nhs.uk/conditions/Cirrhosis/Pages/Introduction.aspx
http://www.liver.ca/liver-disease/types/cirrhosis/
http://www.liverfoundation.org/abouttheliver/info/cirrhosis/
https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis

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16/Nov/2019

One condition that people are embarrassed about discussing is haemorrhoids, or piles as it is commonly called. The stigma is so high that medical attention is sought at an advanced level when the issues have started affecting the quality of life. Very few people even know that this is a GI condition and a GI surgeon is to be consulted for Haemorrhoids. Knowing about haemorrhoids helps us seek the right solution for both prevention and treatment. This condition affects men and women equally and a study indicates that nearly 50% the population of men and women above the age of 50 are affected by haemorrhoids and only 4% seek medical attention and treatment.

Haemorrhoids presents with a typical symptom of rectal pain, itching and bleeding. This is due to distended and swollen blood vessels that lie beneath the mucous membranes lining the lowest part of the rectum and the anus. These are caused when the veins become swollen to a cluster size that just looks similar to varicose veins.

Haemorrhoids are classified into two types based on their location; Internal Haemorrhoids – if the distended swollen veins occur in the lower rectum and External Haemorrhoids –if the swollen veins develop in the lining of the anus. Internal Haemorrhoids are typically painless when compared to the external ones which are the most uncomfortable and very painful during blood clotting.

Treatments

Treatment of Haemorrhoids (or piles) range from home measures, traditional haemorrhoid removal to minimally invasive treatments that are less painful and allow a quicker recovery. In many instances, when conservative treatment fails to produce effective management, it is advisable to go to the doctor who carefully assesses, diagnose, and treats the haemorrhoid patient. Surgical treatment is the final stage of treating haemorrhoids which is required at a very advanced stage.

Home Treatment

Treatment at home is the best option to manage pain and itching at a very initial stage. Good bathroom habits, rub on relief, icing, drinking lot of fluids, exercise, making a habit to sit on a soft cushioned surface, taking warm bath, and increasing intake of fibre can improve haemorrhoid symptoms dramatically.

Topical treatment

Topical treatment are used for mild itching and controlling the symptoms in combination with other treatments for moderate to severe haemorrhoids. Creams and suppositories including ointment, gel and medicated wipes deliver temporary relief of acute symptoms of haemorrhoids, such as bleeding and pain on defecation.

Non- surgical treatment

Rubber Band Ligation (RBL)

It is a simple, quick, cost-effective and widely used treatment for internal haemorrhoids, but is limited to 1 to 2 haemorrhoids at a time. The procedure involves tying the swollen cluster at its base with rubber bands restricting the blood flow. RBL require fewer sessions for treatment, although poses higher rate of post-treatment pain.

Sclerotherapy

It is a fixative non-surgical procedure typically prescribed for first and second-degree haemorrhoids and for those who do not respond well for the home treatment. The procedure employs injecting a chemical into the base of the haemorrhoid that hardens the inflamed tissue, thus reducing haemorrhoids blood flow.

Surgical treatment

Haemorrhoidectomy

Haemorrhoidectomy is a surgical procedure that is recommended by doctors when there is a failure in non-operative management and is opted only for the most severe cases. It is one of the effective treatment when compared to other treatments. There are several techniques of Haemorrhoidectomy which are briefed below

Conventional Surgical Haemorrhoidectomy (CH)

Certainly conventional surgical techniques are more invasive and painful in post-operative period and yield better long-term results. It basically involves the excision of the piles by clamping, tying off and then cutting the haemorrhoidal tissue. The risk of recurrence is lower. CH is suggested in IV grade cases.

Stapled Haemorrhoidectomy (SH) Non-excisional

It is a new technique using a stapler to excise a ring of mucosa. For patient with second-degree haemorrhoids and recurrent bleeding, who have failed to respond to non-surgical methods and in the management of third- or fourth-degree haemorrhoids, SH is the gold standard method. The advantages of this surgery includes shorter operative time, less urinary retention, less post-operative pain and quick recovery when compared to conventional one.

Harmonic scalpel removal:

It uses ultrasonic technology to cut and coagulate the haemorrhoidal tissue at the fixed point of application. This treatment modality is most widely used for large haemorrhoids. The pain and recovery time is lesser when compared to conventional surgical haemorrhoidectomy.

Laser removal

It uses laser to remove haemorrhoids by vaporizing and excising, offering less discomfort, less medication, and faster healing. The heat of the laser cauterizes the blood vessels so the haemorrhoid removal procedure is nearly bloodless. Laser can be used alone or in combination with other modalities.

Atomizing (Ferguson Haemorrhoidectomy)

It involves reducing a haemorrhoid into very minute particles. Atomizing is cost-effective and results in less bleeding and yielding excellent results with very rare complications

Summary

Treatment of haemorrhoids ranges from dietary and lifestyle modification to radical surgery, depending on degree and severity of symptoms. Surgery becomes an effective treatment of haemorrhoids, only for advanced disease and when non-operative treatment fail to resolve appreciable complications. Hence, a better understanding of the physiological process of haemorrhoids are needed to aid the development of novel and innovative methods for the treatment of haemorrhoids.

For further information, contact BIG hospital at 080-67779777/11

Reference

http://www.ijppsjournal.com/Vol3Suppl5/2136.pdf
http://www.health.harvard.edu/diseases-and conditions/hemorrhoids_and_what_to_do_about_them
https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342598/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037334/
https://www.ncbi.nlm.nih.gov/pubmed/22462333
http://www.hemorrhoid.net/harmonic.php

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16/Nov/2019

What is colonoscopy?

Colonoscopy is a diagnostic test to examine the lining of the colon (large intestine)and rectum for any abnormalities. The instrument used to perform this procedure in known as Colonoscope, which is made of thin long flexible tube with a light and tiny camera on its tip. This diagnostic modality allows doctors to view images thatcan show visible cancer characteristics such as polyps (mushroom like growth), ulcers, tumours and swollen tissues and is regarded as the best diagnostic treatment to diagnosebowel cancer. Colonoscopy is extensively used toscreen for colon cancer.

When it is advised to go for colonoscopy?

A colonoscopy will beperformed for diseases that are localized to lower GI track – the colon and rectal diseases.

Colonoscopy is advised by a doctor when a person experiences

• Frank Blood in the stool
• Abnormalities in bowel activity (constipation or diarrhoea)
• Sudden or Long-standingdiarrhoea
• Isolated unexplainedabdominal pain
• Unintentional weight loss with or without abdominal symptoms

Also, Doctors recommend Colonoscopy as a screening test for colorectal cancer and for individuals with a previous history of polyps or colon cancer. The procedure is also used to excisepolypswhich inturn prevents polyps fromturning cancerous, to stop bleeding, dilatation of colon (in stenosis) and any foreign body removal from lower GI.

How do doctors perform colonoscopy?

Colonoscopy is performed by a GI specialist in a hospital and the entire procedure may take around 45 minutes.

• The person will be sedated to numb the pain and relax during the procedure.
• Continuous monitoring of blood pressure and heart rhythm will be done prior to the procedure and during colonoscopy.
• During the procedure, the doctor passes a colonoscope into the patient anus and slowly makes it through rectum and colon.
• The scope pumps air into the large intestine. And the tiny camera sends an image of the intestinal lining to a monitor, allowing the doctor to examine.
• Once the tip of the colon is touched, the doctor will slowly withdraw the colonoscope after examining.

During the treatment if the doctor identifies any abnormalities over the image sent to monitor, a biopsy forceps can be passed to collect the sample of the tissue to be sent to lab for further examination.
What preparation is required for colonoscopy procedure?

Patients are advised to complete the bowel prep as an important part of preparation which facilitates the doc to view colon clearly.For a better view of the image and better analysis, preparation from patient’s side is required.

1. Special diet a day prior to the planned colonoscopy: Avoid solid food, consume clear fluids ( water, tender-coconut water, black tea etc), avoid red liquid that may be confused with blood, you may be asked not to eat or drink anything after midnight.

2. Laxatives: The doctor will ask a patient to drink a special preparation which may cause diarrhoea.

3. Enema: In some cases, enema is used a few hours prior to the procedure.

Please keep the doctor informed of this elective procedures so that appropriate adjustments can be made on your current medications, such as blood thinning agents like warfarin, rivroxaban, dabigatran to reduce the risk of blood clots.

What happens post colonoscopy?

Cramping and bloating will be common and will fade quickly when gas is passed out. On a safer point of view, the patient will be advised against driving and will be strongly recommended to get a ride after the procedure. It is advised to take special diet for a short period of time.

Reference

https://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/colonoscopy/Pages/diagnostic-test.aspx

http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/about-colonoscopy

http://www.asge.org/patients/patients.aspx?id=7838

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16/Nov/2019

“Ever since I am 24, I have been trying to lose weight” says 38 year old Srinivasan(name changed). He seems very determined when he narrates his story of weight loss regimens and thousands of rupees spent on gyms, health-spas, personal trainers and ayurvedic massages. “I have even tried gomuthra (cow urine) therapy, as one of my relative suggested. I have to lose weight because I don’t want to suffer the risk of diabetes and other diseases, so I would like to know about this surgery”. Several patients like Mr. Srinivasan are in a confused and exhausted state to decide on whether to decide on weight loss surgery or not. Weight loss surgery is a life changing event and certainly helps you lose weight. If your doctor has recommendedweight loss surgery as a best option to lose morbid obesity, then you should know where you are heading and what is weight loss surgery journey is all about to make an informed choice. Here is apiece of informationabout weight loss surgery that may help you understand and giveclarity to aid your decision making.

What is Obesity?

Obesity is a leading cause and a state of being overweight that has proven negative effect on health.

What is Bariatric surgery?

Bariatric surgical procedures is an effective treatment lose weight that restricts the amount of food the stomach can hold and reducing its absorption. People are realizing that obesity can be managed beyond exercise, diet (both require motivation) or medication (mostly avoided due to a taboo on harmful effects), and are switching to bariatric surgery. Performing bariatric surgery at the right time helps you to reduce weight significantly.

Is bariatric necessary for weight loss for all?

Weight loss surgery is not advisable to everyone. If you have medical associated illness related to overweight and you are obese, weight loss surgery is typically recommended. Consult your doctor for more info.

Why weight loss surgery?

Weight loss surgery acts as an effective tool on a longer term to sustained relief in losing weight in a more rapid way and toimprove quality of life. Obesity related medical conditions like diabetes, high blood pressure, joint disease and sleep apnoea can be managed effectively with the significant improvement in resolution of related diseases by weight loss surgery.

What are different types of bariatric surgery?

• Gastric Sleeve (vertical sleeve gastrectomy) – Most popular choice for patients who require minimal maintenance. It involves reducing the stomach size significantly by creating a small stomach sleeve using a stapling devicethrough laparoscopic approach.
• Gastric Bypass (Roux-en-Y gastric bypass) –An excellent weight loss solution which is still widely accepted as the gold standard method. It is done by reducing the size of stomach to a small pouch by stapling off a section of it.
• Duodenal Switch (Biliopancreatic diversion) – The surgery is performed in two steps. Makes the stomach smaller by rearranging the intestines and removing the gall bladder that results in decreased caloric intake and reduced absorption.
• Lap-Band (Gastric Banding) – Has the slowest rate of weight loss than any other bariatric surgeries. It involves the placement of an adjustable belt around the upper portion of the stomach using a laparoscope.

How does Bariatric Surgery Work?

Bariatric surgery work by

• Changing the shape of your gastrointestinal tract that produces hormones to reduce your hunger and increasing your feeling of fullness.
• Altering physiologic changes in your body.

How do I opt for right bariatricsurgery?

Each weight loss procedure comes with its pros and cons and offer different weight loss metabolic effect. It is strongly advisable to discuss the best option with your GI doctor.

How much weight will I lose after bariatric surgery?

The amount of weight you lose depends on types of surgery undergone along with other factors like such as nutrition, exercise, life style modification and more.

What are the dietary changes need to do after weight loss surgery?

It is required for you to strictly follow post op diet recommended by your doctor for the first 3 weeks after weight loss surgery for your safety and for the long term weight loss management.
Post-surgery for the first 3 weeks, you will be advised to be on liquid diet and mashed food for another week, followed by soft diet and the normal nutritious food there on.

Are there any risk associated with bariatric surgery?

Bariatric surgery is not free from potential risks. However, the benefits far outweigh the risk associated with weight loss surgery.

Discussion

Body is our temple is what claims the ancient aphorism. It is good for you, if you understand that the healthy body is healthy you. It’s time for you to change in life, to focus on meal planning, exercise and most importantly to stay on track to stay fit. Change your life forever, with bariatric surgery and prevent potential pitfalls early on.

Reference

http://www.surgery.usc.edu/uppergi-general/bariatric-understandingobesity.html

http://www.pamf.org/bariatric-surgery/resources

http://www.obesitycoverage.com/are+you+ready+for+weight+loss+surgery

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16/Nov/2019

In a recent study published by British Medical Council, 22% of people from south India suffer from GE reflux disorder. Commonly seen as a lifestyle disorder in urban dwellers and in the elderly population,in male individualsand with those with obesity and habit of pan masala chewing.
GERD is one of the most troublesome problems that can be identified early to provide symptomatic relief, treat the problem and prevent progression. So, if you are experiencing these symptoms, visit a Gastroenterologist at BIG.

Heart Burn

Heartburnis a typical symptom of GERD and acid reflux and is self-diagnosable. It is perceived as a burning sensation in the middle of your chest, when it is perceived as a pain than a burning sensation, it can be confused with a heart attack. If you get a severe heart burn, seek immediate medical attention. Heart burn occurs when you lie down a part of stomach juice escape through the LES valve (lower oesophageal sphincter a circular muscle which closes and opens your oesophagus after food passes to the stomach) and flow back all through the food pipe leaving a bitter taste in your mouth and burning sensation in your chest. Heart burn can happen if the stomach is stretched a lot due to a large meal and relatively high when you lie down. This can also happen even if your stomach half empty, when you lean forward or certain food that triggers.

Chest Pain

People often gets confused with the heart attack pain with sharp tender pain caused by acid reflux. Chest pain can also be one of the most possible causes for acid reflux. One cannot ignore the chest pain as it can be a sign of heart attack as well. One can distinguish chest pain caused due to heart attack and GERD related pain through the spread. Unlike cardiacchest pain that radiatesthroughout your body including arms, back, shoulders and neck, chest paincaused due to GERDaffect the upper area of chest and just underneath the breastbone without much affecting the left arm. You should seek a doctor immediately if the chest pain gets worse.

Chronic cough

Sick in bed with a cough may be very distressing. It remains untroublesome if bad cough lasts only for a week. But ifthe symptoms persists, there may be sign of chronic cough which is one of the common symptom of GERD. Cough do occur as defensivereaction of the body when the stomach acidrises above the oesophagus entering as micro droplets into your lungs and land in larynx. They occasionally make their way to bronchial tree resulting in laryngopharyngeal reflux (LPR).

Pay attention to your symptoms. Visit the GI specialist if cough persists.

Sore throat

Sore throatis often a symptom of many conditionsand can be a very silent symptom of GERD.When the stomach acid makes its entry in to your food pipe, it can cause discomfort in the throat causing irritation in the vocal chord with frequent hiccups. If your throat gets inflamedjust right after the meal,it may be a marked sign to GERD.
It’s good to see a GI doctor, if you experience severe sore throats frequently.

Difficulty Swallowing

Although difficulty swallowing can be a side effect of some types of cancer that blocks the throat or the oesophagus, it is common among all age groups, especially the elderly. Trouble in swallowing is nothing but having a difficulty in passing food down the throat or a feel that food is getting choked while swallowing. Difficulty swallowingcan also be a serious complication due to oesophagealdamage caused by acid reflux.
It is important that you get evaluated by a GI specialist, if you have any difficulty in swallowing without any hesitation./P>

Nausea/ Vomiting

Nausea and Vomiting can happen anytime anywhere due to varied reasons. Indigestion and sour throat in the mouth created when stomach juices stay in the lining of food pipe trigger nausea and sometimes even vomiting. There is high possibility that you are prone to GERD, if you feel nauseated right after meals.

Discussion

“An ounce of prevention is worth a pound of cure” because it takes minimal effort to prevent than to cure.
Making lifestyle changes, following a healthy diet, avoiding smoke and following some home remedies as a natural way to prevent acid reflux and heart burning at a very early stage. Things get complicated if left untreated. Proper diagnosis and a prompt visit to a GI doctor help you to manage and prevent acid reflux. Do not hesitate to visit GI doctor if you have heartburn, nauseated, chest pain, persistent cough, and bitter taste in your mouth or have a difficulty in swallowing in order to get a right treatment at the right time as underreporting a problem may turn costly.

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791779/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740808/

https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072438/

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16/Nov/2019

Introduction

You will be surprised to know on how many microbes has just been a part of your body that are acting as superheroes to maintain the overall health. It’s around trillions of microbes diversely distributed and are known asgut microflorathat are filled with both bad and good microbes present in the key part of the digestive system – Gut. Normally people most often think that bacteria can only be harmful and cause variety of diseases. But that’s not true. For example: bacteria that are present in our gut aid in digestion, reduce pathogenic microorganisms etc.

It is vital to maintain balance between both good and bad microbes to promote healthy digestive system. The gut with more bad microbes’ causes tiredness, diarrhoea, compromised immune system and on a longer term with the unbalanced diet, may contribute to the development of Inflammatory and bowel syndrome, colon and liver cancer, arthritis, celiac disease etc.

What are Probiotics?

Good microbesare working hard to reduce the growth of harmful bacteria, maintaining the balance in gut flora and keeping us healthy and strong.These are popularly known as Probiotics which are nothing but the live bacteria and yeast thatare intended to have several health benefitsand a key role in overall health.

How many types of probiotics are naturally found?

Human digestive tract contains about 400 types ofprobiotic bacteria and the most common probiotic found belong to two groups called Lactobacillus and Bifidobacterium. Apart from these yeasts such as Saccharomyces boulardii are also a part of probiotic that arewidely found.

How do you acquire probiotics?

Probiotics are acquired when you just ingestmashed foodthat experiences to have roller coaster ride via foodpipe and travel all along the gut. These probiotics can be naturally found in the body or can be found in foods and supplements. We acquire probiotics in variety of food like legumes, fruits , fermented foods (yogurt) , milk products (aged cheeses) , supplement form as capsules, liquid and chewable and fortified food products like juices, chocolates, flour and cereal.

What are benefits of Probiotics?

Several benefits of probiotics have been studied and research has suggested that probiotic bacteria can
• Decompose the food and aid in digestive function
• Reduce cholesterol
• Treat conditions like Irritable bowel syndrome, inflammatory bowel disease (IBD), Urinary and vaginal health, Liver disease, Tooth decay, periodontal disease.
• Reduce diarrhoea
• Improve tolerance to lactose
• Improvebrain function
• Stimulate cell growth
• Prevent allergies and cold
• Strengthen immune system
• Colic in infants

When to take probiotics?

Doctors recommend to ingest probiotics rite after the meal for maximum benefit.

How long one should take probiotics?

There is no fixed amount of time to start and stop probiotics. Daily intake it the optimal way to effectively use probiotics. However, it is always advisable to consult your gastroenterologist for the duration of use.

Discussion

Benefits of probiotics are several and it is important to know that research have suggested that probiotics play a crucial role in overall maintenance of the health.Visit a Gastroenterologist once in life timeto know more about the probiotics and on the health conditions of the digestive system.