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What is the pancreas?

It is a "silent," solid organ positioned behind the stomach in the upper part of the abdomen. Different cells produce digestive "juices" or enzymes, while the others produce hormones. The pancreatic enzymes break proteins, fat, carbohydrates. Pancreatic juice through small channel draining into the first part of the small intestine, called the duodenum. Food that passes through the duodenum stimulates the pancreas to produce digestive enzymes. The most important hormone the pancreas produces is insulin, which controls the amount of glucose in our bloodstream. In addition to insulin, the pancreas makes other hormones, all of which pass into the blood that flows through the organ.

What are the most common problems that affect the pancreas?

Normally the pancreas does not cause us much trouble, but when it does, the symptoms can be quite bothersome and, in some cases, fatal. Pancreatitis is the most common pancreatic condition, categorized as either acute and chronic. In acute pancreatitis the organ suddenly becomes swollen and releases digestive juices into the bloodstream. After an acute attack a patient may either completely recover or have several more episodes, which can lead to chronic pancreatitis. This is characterized by persistent abdominal pain, intolerance of food and sometimes disabling nausea diarrhoea, weight loss. Perhaps the most feared condition is pancreatic cancer, since it is almost always fatal.

What causes these pancreastic conditions

Acute pancreatitis is usually caused by a gallstone getting stuck in the bile duct which share common channel with pancreatic duct. Furthermore, alcoholism, abdominal injuries, parathyroid adenoma, autoimmune, high triglyceride levels are other causes Chronic pancreatitis can be caused by any one of the triggers associated with acute episodes, but the most common one is excessive use of alcohol apart from pancreatic divisum and other reare causes.
Pancreatic cancer occurs without any apparent reason, although smoking seems to be the only known preventable risk factor.

What are the warning signs of pancreatic problems?

Pancreatic conditions can produce severe upper abdominal pain usually refer to ack or no symptoms. In addition, if the patient experiences loss of weight, either chronic pancreatitis or cancer should be considered. Most pancreatic cancer patients have minimal or no symptoms until later, less curable stages, and the symptoms that do arise are usually the same as those for chronic pancreatitis. Jaundice may be the typical presentation for pancreatic cancer.

If I suspect a pancreatic problem, what should I do?

If the symptoms are severe, seek immediate medical help. Severe acute pancreatitis may require hospitalization. At the very least, a series of tests should be performed to establish a diagnosis as per advised given by dpecialist (Surgical or Medical Gastroenterologist). Prescribed blood test, Ultrasonography, CT scan, Endoscopic interventions can be utilized after consultation with specialist to diagnose as well as to guide the treatment.

What are some of the other tests and treatments available today to treat pancreatitis and other common problems?

Using ERCP technology, doctors can place stents where there is a stricture or narrowing of the ducts. Modern equipments like Endosonography and laparoscopic surgery have changed the outcome and quality of life even after major pancreatic surgey. With utmost expertise and advanced instruments team of Superspecialist doctors/surgeons for pancreatic problems are available at SIDS Hospital.
The liver produces bile, a greenish yellow, sticky fluid. Bile aids digestion by making cholesterol, fats, and fat-soluble vitamins easier to absorb from the intestine.The biliary tract consists of small tubes (ducts) that carry bile from the liver to the gallbladder and then to the small intestine. The gallbladder is a small, pear-shaped sac located beneath the liver. It stores bile.

Gall Stones

Gallstones are usually composed of cholesterol that has crystallized from bile. They form in the gallbladder. They may leave the gallbladder and lodge in the cystic duct, the common bile duct, or the ampulla of Vater. About 80% of people with gallstones do not have any symptoms for many years, Gallstones may cause pain. In the upper abdomen, usually on the right side under the ribs. Location is hard to pinpoint, particularly for people with diabetes and older people. People often feel nauseated and vomit. If the blockage persists, the gallbladder becomes inflamed (a condition called acute cholecystitis). causes fever. Blockage of the common bile duct or the ampulla of Vater can cause the ducts to widen (dilate). It can also cause fever, chills, and jaundice (a yellowish discoloration of the skin and the whites of the eyes). Stones that block the ampulla of Vater also can block the pancreatic duct, causing inflammation of the pancreas (pancreatitis), as well as pain. Gallstones can erode the gallbladder wall, sometimes resulting in a hole (perforation).

Ultrasonography is essential. It is 95% accurate in detecting gallstones in the gallbladderOther diagnostic tests include Magnetic resonance imaging (MRI) and computed tomography (CT). If results of these imaging tests are unclear, endoscopic ultrasonography may be done better than standard ultrasonography. Blood tests used to evaluate liver functioning.
If gallstones cause disruptive, recurring episodes of pain, a doctor may recommend surgical removal of the gallbladder (cholecystectomy). No special dietary restrictions are required after surgery. About 90% of cholecystectomies are done using a laparoscope. Laparoscopic cholecystectomy has lessened the discomfort after surgery, shortened the length of hospital stays, provided better cosmetic results, and reduced the time needed to recover.

Treatment for stones in the bile ducts

Most stones in the bile ducts can be removed during ERCP. During this procedure, doctors pass an instrument through the endoscope to trap and then pull the stone out of the duct. Gallstones cannot be removed using this technique. Most people who have had ERCP and endoscopic sphincterotomy later have their gallbladder removed, typically using a laparoscope. If the gallbladder remains, stones in the gallbladder may pass into the ducts, causing repeated blockages.

Cancer

Cancer of the gallbladder is also rare. Nearly everyone with gallbladder cancer has gallstones. This cancer is more common among North Indians, people with large gallstones, and people with a extensive scarring of the gallbladder, which can occur in severe chronic cholecystitis. Polyps, which are noncancerous (benign) outgrowths of tissue, may develop in the gallbladder. They rarely cause symptoms or require treatment. They are found in about 5% of people during ultrasonography. Sometimes cancers can block the flow of bile, but most blockages are caused by gallstones. Noncancerous tumors in bile ducts also cause blockages.

Symptoms

• Worsening jaundice (yellowish discoloration of the skin and whites of eyes)
• Abdominal discomfort
• Loss of appetite
• Weight loss
• Itchiness
The diagnosis is confirmed by imaging. Usually, ultrasonography is done followed by computed tomography (CT).

Treatment

Most bile duct and gallbladder cancers are fatal, but treatment can help control symptoms. Tubes (stents) inserted into a duct allow bile to flow past the blockage. This procedure helps control pain and relieves itchiness. Surgery to remove a cancerous tumor is the best choice if in earlier stage. If tumors have spread from other parts of the body (metastasized), chemotherapy may provide some symptom relief but does not dramatically improve survival.

At SIDS Hospiatal

Our expert team of surgeons are performing maximum number of procedure s in south gujarat for gall bladder diseases, Biliary diseases and cancer with most advanced laparoscopic instruments. SIDS Hospital is equipped with most advanced set up of endoscopic instruments to diagnose and treat the biliary problems where we are performing more than 7000 procedures in a year by our panel of most experienced endoscopist.

RISKS

Colorectal cancer is the second leading cause of death from cancer, and the third most common cancer overall. Men and women aging 50 or older are at almost equal risk of developing colorectal cancer. Those who have a personal or family history of colorectal cancer or polyps are at higher risk of developing the disease. Anyone who has a long-term personal history of inflammatory bowel disease (Ulcerative Colitis or Crohn's Disease) also is at higher risk. The other disorder is Hereditary Non-Polyposis Colorectal Cancer (HNPCC). In this syndrome, cancers also occur early and develop from polyps. The disease also can present at a later age.

WHAT CAUSES COLORECTAL • NCER ?

The exact causes of colorectal cancer are unknown, but the disease appears to be caused by both inherited (genetic) and lifestyle factors. Lifestyle factors - such as cigarette smoking, lack of physical exercise, and obesity - may increase the risk of developing the disease.

SYMPTOMS

Colorectal cancer can be associated with blood in your stools, narrower than normal stools, unexplained abdominal pain, unexplained change in bowel habits, unexplained anemia or unexplained weight loss. It is also important to remember that colon cancer may not be associated with any symptoms, which is why early detection through screening is so important. The most common causes of bleeding from the rectum and anus are hemorrhoids and anal fissures or tears, which are usually easily treated. Some less common causes are infections of the colon (infectious diarrhoea), inflammatory bowel disease (ulcerative colitis or Crohn's colitis), colonic diverticula, or abnormal blood vessels (arteriovenous malformations or angiodysplasia). Colonic obstruction, or blockage of the passing of stool and gas through the colon, is a late symptom of colon cancer.

SCREENING

Colorectal cancer screening should be a part of routine healthcare for people starting at the age of 50. People at higher risk for colon cancer should be screened earlier. Several screening options exist. These include the fecal occult blood test (FOBT), flexible sigmoidoscopy, double contrast barium enema, and colonoscopy. Colonoscopy is considered the gold standard for colorectal cancer screening should be done by endoscopist only.

POLYPS

Polyps are mushroom-like growths that form when cells lining the colon grow, divide and reproduce in an unhealthy, disorderly way. Polyps can become cancerous over time. Colorectal cancer can occur without polyps

At SIDS Hospital

With most advanced endoscopic / colonoscopic / laparoscopic system we are doing more than 30 diagnostic, screening and surgical procedures per day. Our experienced surgical team have successfully treated more than 200 patients suffering from colorectal cancer. Our experience surgical team is performing highest number of procedures for colorectal cancer in south gujarat.

Gas ic can is ad' eastin w ich malignant (cancer) colts o *n Ifni of the stomach.

The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods. Food moves from the throat to the stomach through a hollow, muscular tube called the esophagus..

Risk of developing gastric cancer.

Helicobacter pylori (H. pylori) infection of the stomach.
Chronic gastritis (inflammation of the stomach).
Pernicious anemia.
Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines).
Familial adenomatous polyposis (FAP) or gastric polyps.
Eating a diet high in salted, smoked foods and low in fruits and vegetables.
Eating foods that have not been prepared or stored properly.
Being older or male.
Smoking cigarettes.
Having a mother, father, sister, or brother who has had stomach cancer.
This factors do not ensures the cancer but just increases the risk)

Symptoms of gastric cancer

In the early stages of gastric cancer, the following symptoms may occur:
Indigestion and stomach discomfort.
A bloated feeling after eating.
Heartburn.
Mild nausea, Loss of appetite.
In more advanced stages of gastric cancer, the following signs and symptoms may occur: Blood in the stool, Vomiting.
Weight loss for no known reason, Stomach pain.
Jaundice (yellowing of eyes and skin).
Ascites (build-up of fluid in the abdomen).
Trouble swallowing.

Tests that examine the stomach and esophagus are used to detect and diagnose gastric cancer.

Physical exam and history : An examination of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
Upper endoscopy : A procedure to look inside the esophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the esophagus and stomach and directly visualize cancer along with biopsy.
CT scan : The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly .

Certain factors affect prognosis (chance of recovery) and treatment options.

• The stage of the cancer (whether it is in the stomach only or has spread to lymph nodes or other places in the body).
• The patient's general health.
When gastric cancer is found very early, there is a better chance of recovery.

There are different types of treatment for patients with gastric cancer.
Surgery

• Surgery is a common treatment of all stages of gastric cancer. The following types of surgery Removal of the part of the stomach or stomach that contains cancer, nearby lymph nodes, and parts of other tissues and organs near the tumor.
• Inoperable cases may require bypass surgery in form of gastrojejunostomy where stomach anstomosed with small intestine.
• If the tumor is blocking the stomach but the cancer cannot be completely removed by standard surgery, Endoluminal stent placement can be done.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

What is the esophagus ?

The esophagus muscular tube travels down through the chest, between the lungs. It then passes through a hole in the diaphragm to connect with the stomach.

Risk for esophageal cancer

Risk factors for this type of cancer include smoking and alcohol use. Other potential carcinogens include nitrosamines, asbestos fibers, and petroleum products.
Lower esophageal cancer in most cases arise in the setting of Barrett's esophagus (chronic irritation due to stomach acid called as Gastro esophageal reflux disease), which is a condition in which the normal lining of the esophagus is replaced by lining normally found in the stomach. Barrett's esophagus is diagnosed by endoscopy. Other pre-existing esophageal conditions may also increase the risk like achalasia, which is a condition where there is ineffective peristalsis (movement) in the esophagus, as well as caustic esophageal injury, from acid ingestion, can increase the risk of esophageal cancer

How to revent eso ha eal cancer ?

Smoking cessation and decreasing alcohol intake are by far the best methods of decreasing the risk of developing squamous cell carcinoma of the esophagus. The best prevention of adenocarcinoma would be decreasing the risk of chronic GERD, the cause of Barrett's esophagus.

What screening tests are available ?

The "gold standard" for diagnosis is endoscopy and biopsy.
The primary goal of endoscopy is to detect dysplasia early perticularly in Barrett's esophagus.

What are signs of esophageal cancer ?

Over 90% of people with esophageal cancer present with problems swallowing, often leading to a significant amount of weight loss prior to the actual diagnosis. Patients also report a sensation that food "gets stuck" somewhere in the chest, where the growing of the cancer precludes the passage of food. Problems usually start with food, though eventually even liquids could "get stuck" if the cancer progresses and continues to grow into the hollow tube that the esophagus is. A larger tumor can erode the wall to the point where it causes bleeding. This can cause patients to cough up blood, or vomit blood. Additionally, if the blood is swallowed, one may notice blood in the stool or black tarry stools also known as melena. The trachea (windpipe) is located directly in front of the esophagus, and it is possible for an esophageal cancer to erode the entire way through the esophageal wall and into the trachea, creating what is called a tracheoesophageal (respiratory) fistula. This causes cough, an irritating sensation with breathing (especially with deep breaths), and hoarseness.

How is esophageal cancer diagnosed ?

An endoscopy is commonly done when people first present with symptoms. Using endoscopy, the area of concern in the esophagus can be viewed directly with the fiber-optic camera, and the location of the abnormality, the presence or absence of bleeding, and the amount of obstruction can all be seen. Endoscopy also allows a biopsy to be performed. The standard of care today would also include performing an ultrasound during the endoscopy, called an endoscopic ultrasound examination (EUS). This allows for the prediction of how much of the esophageal wall is involved by tumor.
The CT scan should include imaging of chest and upper abdomen to assess the stage.

What are the treatments for esophageal cancer?

Certain very early tumors, limited to the submucosa (the superficial layer of the esophagus), may be treated with endoscopic resection. More commonly, people present with advanced stage disease because symptoms often develop only after the tumor has grown to a large size or has spread. There are a number of different modalities that can be used to treat esophageal cancer including surgery, radiation, and chemotherapy. However, in people who can tolerate it, combined modality is preferred. When the esophagus is removed, the stomach is pulled up into the chest to keep the passageway for food intact. Not only is there a risk of infection and bleeding from the surgery itself, but the recovery period after surgery can be difficult. Additionally, there is the risk of a leak forming at the new connection that is formed between the stomach and the remaining portion of the esophagus (known as an anastamosis), which can then require further surgery and potentially lead to very serious complications. Though the results of these studies are somewhat mixed, it is thought that both radiation and chemotherapy add a benefit. Therefore, radiation therapy (for local tumor control) and chemotherapy (for distant control as well as to improve the effectiveness of radiation therapy) is almost always recommended either before or after the surgery.
A peptic ulcer is a condition when there is an open sore in the lining of the stomach or intestine. In many ways it is similar to a sore in the mouth. When the ulcer occurs in the stomach it is called a "gastric ulcer". When it occurs in the duodenum it is called a "Duodenal ulcer." An ulcer occurs when the lining of these organs is corroded by the acidic digestive juices which are secreted by the stomach cells. Normally, glands in the stomach secrete acid and the enzyme pepsin (hence the name peptic ulcer) that help to break down of food in the digestive process. The stomach and duodenum meanwhile secrete mucus to protect them against harm from pepsin and gastric acid. In peptic ulcer disease the digestive tract's defensive mechanisms break down, often as a result of infection with the bacterium Helicobacter pylori.

Causes:

Excess acid was considered the major cause of ulcer disease. Acid is still considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by a bacteria called "Helicobacter pyloridus" (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs), such as Ibuprofen also including aspirin. Cigarette smoking is also an important cause of ulcer formation and ulcer treatment failure.

Symptoms:

Upper abdominal burning or burning stomach pain or hunger pain one to three hours after meals and in the middle of the night. These pain symptoms are often promptly relieved by food or antacids.

Care and Guidance:

The goal of ulcer treatment is to relieve pain and to prevent ulcer complications, such as bleeding, obstruction, and perforation. The first step in treatment involves the reduction of risk factors (NSAIDs and cigarettes). The next step is medications. Antacids neutralize existing acid in the stomach but these can give just temprory relief. H2 blockers are effective in ulcer healing, they have limited role in eradicating H. pylori without antibiotics. Therefore, ulcers frequently return when H2 blockers are stopped. Generally, these drugs are well tolerated and have few side effects even with long term use. So a proper diagnosis and treatment can successfully handle the situation.
The liver is one of the important and largest organs in the human anatomy (Body) and is essential to the proper functioning of our complete body. The liver synthesizes proteins, bile, acids, and cholesterol. it is the Primary organ which maintain balance of many nutrients and chemicals like glucose, fat, cholesterol, vitamins, and hormones and aids in the excretion of many waste products such as bilirubin, cholesterol, poison, and drugs. Liver disease is thus a serious condition that can be cured if it is cared for in the early stages.

Causes:

Excessive alcohol consumption over many years is a leading cause of liver disease. Too much alcohol can make a normal liver swell with fat, causing a condition called fatty liver. If the fat becomes inflamed, it can lead to either alcoholic hepatitis, a liver problem that causes serious but often reversible liver damage. Exposure to Industrial Chemicals, Toxin Substance, Aerosols and Excess Intake of NSAIDs (Pain Killer) can also Harm your liver proper Functioning. Viral hepatitis can lead to serious liver problems and is the most common type of liver disease. Hepatitis causes inflammation of the liver. The three types of hepatitis viruses - hepatitis A, hepatitis B and hepatitis C - can all be prevented.

Symptoms & Diagnosis

There are four stages for any malfunction of liver such as inflammation, fibrosis, cirrhosis, and cancer.

1. Inflammation

The liver can get inflamed due to certain conditions, use of alcohol and certain chemicals. The conditions that can cause liver inflammation are Hepatitis B, Hepatitis C, Autoimmune Hepatitis, and Wilson's disease. Extensive alcohol use also causes inflammation of the liver. Some drugs and industrial pollutants may affect the liver. Inflammation is characterized by redness, swelling, heat and possible pain in the liver.

2. Fibrosis

The second stage of liver disease is fibrosis or scar tissues. After the liver has been inflamed for a long period, connective tissues of the liver accumulate. At this stage the liver functions slowly degrade.

3. Cirrhosis

The third stage of liver disease is called cirrhosis. When liver has been damaged due to inflammation and fibrosis, it does not function properly. Accumulation of scar tissues blocks blood flow through the liver, preventing it from functioning normally. Some of the symptoms of end stage cirrhosis are edema, bruising and bleeding, jaundice, gallstones, and an increase of toxins in the blood, enlarged blood vessels, and diabetes.

4. Cancer

If liver disease is not treated in the earlier three stages, cancer may develop. Liver cancer, or hepatocellular carcinoma, affects approximately 4% of patients with cirrhosis. A liver transplant is one of the options for treating liver cancer.

Care and Guidance:

Early Stage Liver Diseases can be treated by taking preventive actions and Medications, Vaccine for Hepatitis A and Hepatitis B viruses are available. moreover patients should be property investigated to diagnose the disease at an early stage. Most of the times the disease is detected at an advanced stage and cure them, is not possible.

What is Jaundice?

Jaundice is described as yellow discolouration of the eyes, which may be accompanied by deep yellow coloured urine. Usually patients have decreased appetite. Jaundice per se is a symptom but not a disease. There are many causes of jaundice.
  • Hepatic causes (Inflammation in liver)
  • Post Hepatic causes (Obstructive causes)

Hepatic Causes / Hepatitis:

Inflammation in the liver is hepatitis and is the most common cause of jaundice. The common causes of hepatitis are:

(a) Viral Hepatitis ( Hepatitis A, B, C, & E ):

This is the most common cause of jaundice in the community. In majority of patients the disease has got a self- limiting course. Very few patients have a fatal course and need for hospitalization. Hepatitis B & C are transmitted via infected blood and the liver completely recovers, However, some patients of HEPATITIS B & C GO INTO CHRONIC HEPATITIS AND CIRRHOSIS. How can Hepatitis B and C be prevented
HEPATITIS A & B can be prevented by VACCINATING the person against it. There is no vaccine to prevent hepatitis C. Hepatitis B and C can be prevented by using SAFE AND SCREENED BLOOD, which is negative for these viruses.

(b) Alcoholic Hepatitis:

Alcoholic hepatitis is caused by EXCESS DRINKING of alcohol for a prolonged period of more than 10 years. This is a serious condition and can lead to complications which can be:
  • Jaundice.
  • Blood in vomitus.
  • Black colured stools.
  • Swelling of feet and abdomen.
  • Coma.
This condition can be prevented by limiting the quantity of alcohol intake to 2-3 pegs/ day. Those who drink daily should refrain from drinking at least 2 days in a week. This gives time for the liver to recover from the toxic effects of alcohol.

Obstructive causes:

The Common causes of obstructive jaundice are:
  • Stone in the bile duct.
  • Cancer of the pancreas.
  • Cancer of the bile duct and the gall bladder.
These patients should be property investigated to diagnose the disease at an early stage. Most of the times the disease is detected at an advanced stage and cure them, is not possible.
Ulcerative Colitis is a condition characterized by DIARRHEA, BLOOD AND MUCOUS in stools and PAIN while passing stools. This gradually leads to weakness and anemia. The ulcerative colitis is characterized by ulceration of the inner lining of the large bowel. There are numerous ulcers and the extent of ulceration varies from patient of patient.

Symptoms of Ulcerative Colitis:

  •   Blood in Stools
  •   Mucous in stools.
  •  Loose stools.
  •  Joint pains and swelling.
  •  Weakness, lethargy, shortness of breath after a walk because of anemia.

Diagnosis:

The correct diagnosis is the 1st step to right treatment. All patients with blood in stools and diarrhea are not necessarily suffering from ulcerative colitis, which has to be differentiated from other diseases. COLONOSCOPY is performed to arrive at the correct diagnosis.

Care and Guidance:

Ulcerative Colitis follows a prolonged course with periods of activity ( relapse) and inactivity ( remission). A majority of the cases respond to medical treatment and do not require surgery. Patients diagnosed with ulcerative colitis should be on a regular follow up. If the disease is MORE THAN 10 YEARS old and has involved the whole of the colon then chances of COLONIC CANCER INCREASE. These patients should be REGULARLY SCREENED for the same.

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