Dr. Abhishek Jain

MBBS, MS (General Surgery)
FAMAS(Italy), FAAOS(Italy)
FICS (GI Surgery), FISCP (Colo Proctology)

Colorectal Surgery,Advance Laparoscopic Surgery,
Abdominal Oncology Surgery, Bariatric & Metabolic Surgery


Gall Bladder

the gallbladder is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver.It receives and stores bile, produced by the liver, via the common hepatic duct, and releases it via the common bile duct into the duodenum, where the bile helps in the digestion of fats.The gallbladder is part of the biliary system, which includes the liver and the pancreas.

The gallbladder can be affected by gallstones, formed by material that cannot be dissolved.The presence of stones in the gallbladder is referred to as cholelithiasis.

What Are Gallstones?

  • Gallstones are “stones” that form in the gallbladder . The common types of gallstones are cholesterol, black pigment, and brown pigment.

The two main kinds are:

  • Cholesterol stones. These are usually yellow-green in color. They’re the most common kind, accounting for 80% of gallstones.
  • Pigment stones. These stones are smaller and darker. They’re made up of bilirubin, which comes from bile, a fluid your liver makes and your gallbladder stores.

What Causes Gallstones?

Gallstones may form when the chemicals in the gallbladder are out of balance, such as cholesterol, calcium bilirubinate, and calcium carbonate.

Am I at Risk?
You’re more likely to get gallstones if:

You’re obese. This is one of the biggest risk factors. Obesity can raise your cholesterol level and also make it harder for the gallbladder to empty completely.

You take birth control pills, hormone replacement therapy for menopause symptoms, or are pregnant.

The extra estrogen is the problem. It can increase cholesterol and make it harder for the gallbladder to empty.

You have diabetes. People with this condition tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.

You take medicine to lower your cholesterol. Some of these drugs boost the amount of cholesterol in bile, which may increase your chances of getting cholesterol stones.

You lost weight too quickly. Your liver makes extra cholesterol, which may lead to gallstones.

You’re fasting. Your gallbladder may not squeeze as much.
Gallstones are also more likely if they run in your family, and they’re likelier among women, older people, and some ethnic groups, including Native Americans and Mexican-Americans.

What Are the Symptoms?
You might not notice anything, or even know you have gallstones, unless your doctor tells you. But if you do get symptoms, they usually include:

• Pain in your upper belly and upper back that can last for several hours

• Nausea

• Vomiting

• Other digestive problems, including bloating, indigestion and heartburn, and gas.

Asymptomatic gallstones

Gallstones themselves don’t cause pain. Rather, pain occurs when the gallstones block the movement of bile from the gallbladder.

How Do Doctors Diagnose Them?
If your doctor thinks you may have gallstones, he’ll give you a physical exam. You may also get:

Blood tests to check for signs of infection or obstruction, and to rule out other conditions.

Ultrasound. : An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis

Abdominal CT scan. Specialized X-rays allow your doctor to see inside your body, including your gallbladder.

Magnetic resonance cholangiopancreatography (MRCP)  is a medical imaging technique that uses magnetic resonance imaging to visualize the biliary and pancreatic ducts in a non-invasive manner.This procedure can be used to determine if gallstones are lodged in any of the ducts surrounding the gallbladder.

Cholescintigraphy (HIDA scan). This test can check on whether the gallbladder squeezes correctly. Doctors inject a harmless radioactive material, which makes its way to the organ. The technician can then watch its movement.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones.

Endoscopic retrograde cholangiopancreatography (ERCP). The doctor inserts an endoscope through your mouth down to the small intestine and injects a dye to allow the bile ducts to be seen. He can often then remove any gallstones that have moved into the bile duct.

What’s the Treatment?
Many people with gallstones get surgery to take out the gallbladder. There are two different kinds of operations.

Laparoscopic cholecystectomy. This is the more common procedure. The surgeon passes instruments, a light, and a camera through several small cuts in the abdominal cavity. He views the inside of the body on a video monitor. Afterward, you spend the night in the hospital.

Open cholecystectomy. The surgeon makes bigger cuts in the belly to remove the gallbladder. You stay in the hospital for a few days after the operation.
If gallstones are in your bile ducts, the doctor may use ERCP to find and remove them before or during gallbladder surgery.

Can You Treat Gallstones Without Surgery?
If you have a medical condition and your doctor feels you shouldn’t have an operation, he may prescribe the medications chenodiol (Chenix), ursodiol (Actigall), or both. These drugs work by dissolving cholesterol stones. Mild diarrhea can be a side effect.

Complication of Gall Bladder Stone :

  • Inflammation of gall bladder ( Acute Cholecystitis)
  • Jaundice
  • Infection of the bile ducts (Acute cholangitis)
  • Acute pancreatitis
  • Cancer of the gallbladder
  • Gallstone ileus

What is the appendix?

The appendix is a small, pouch-like sac of tissue that is located in the first part of the colon (cecum) in the lower- right abdomen. Lymphatic tissue in the appendix aids in immune function. The official name of the appendix is veriform appendix, which means “worm-like appendage.” The appendix harbors bacteria.

What is appendicitis?

The suffix “-itis” means inflammation, so appendicitis is inflammation of the appendix. Appendicitis occurs when mucus, stool, or a combination of the two blocks the opening of the appendix that leads to the cecum. Bacteria proliferate in the trapped space and infect the lining of the appendix. If the inflammation and blockage are severe enough, the tissue of the appendix can die and even rupture or burst, leading to a medical emergency.

Who is affected by appendicitis?

Anyone can get appendicitis, but it occurs most often in people between the ages of 10 and 30.  Very young children and elderly people are at higher risk of complications due to appendicitis. Early recognition and prompt treatment of the condition are necessary, especially in vulnerable populations.

What are the most frequent complications of appendicitis?

Delaying the diagnosis and treatment of appendicitis increases the risk of complications. One potential complication — perforation — can lead to an accumulation of pus (abscess) around the appendix or an infection that spreads throughout the abdominal cavity (peritonitis). Surgery should occur as soon as possible after the diagnosis of appendicitis. Longer delays between diagnosis and treatment (surgery) increase the risk of perforation. For example, the risk of perforation 36 hours after appendicitis symptoms first appear is 15% or more.

What is another complication of appendicitis?

Sometimes the inflammation associated with appendicitis interferes with the action of the intestinal muscle and prevents bowel contents from moving. Nausea, vomiting, and abdominal distention can occur when liquid and gas build up in the part of the intestine above the blockage. In these cases, the insertion of a nasogastric tube — a tube that is inserted into the nose and advanced down the esophagus into the stomach and intestines — may be necessary to drain the contents that cannot pass.

What are the symptoms of appendicitis?

The presentation of acute appendicitis includes abdominal pain, nausea, vomiting, and fever. As the appendix becomes more swollen and inflamed, it begins to irritate the adjoining abdominal wall. This leads to the localization of the pain to the right lower quadrant. This classic migration of pain may not be seen in children under three years. This pain can be elicited through signs and can be severe. Signs include localized findings in the right iliac fossa. The abdominal wall becomes very sensitive to gentle pressure (palpation). There is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). If the appendix is retrocecal (localized behind the cecum), even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix). This is because the cecum, distended with gas, protects the inflamed appendix from pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney’s point), historically called Dunphy’s sig

How is appendicitis diagnosed?

Doctors diagnose appendicitis based on the patient’s symptoms and findings during physical examination.
  • Clinical
  • Blood and urine test
  • Ultrasound
  • Computed tomography

 

How is appendicitis treated?

Surgical removal of the appendix is called an appendectomy. Antibiotics are given to a patient with suspected or confirmed appendicitis both before and after surgery. Appendectomy can be performed laparoscopically.

About Laparoscopic Hernia Surgery

Laparoscopic hernia surgery is an important part of comprehensive hernia repair. By providing hernia patients the option of laparoscopic hernia surgery, some patients may have a better outcome.Patients who have large ventral hernias, recurrent hernias, bilateral inguinal hernias, and others may be a good candidate for laparoscopic hernia repair. Some patients desire laparoscopic hernia surgery to help minimize their recovery during sports seasons or when there are upcoming athletic competitions.

Laparoscopic Hernia Surgery Repair – Inguinal

A laparoscopic inguinal hernia requires a 1-2cm incision at the belly button, and two smaller punctures below the umbilicus. The belly button incision allows the camera to view the inside of the abdomen and the two smaller punctures are for the operating instruments.

To begin, a balloon is placed from the umbilicus to separate the peritoneum, or the lining of the abdomen, from the overlying muscle. Once this space is created, a camera is placed under the muscle to view the hernia.

The hernia is then pulled back into the abdomen from it’s hole in the muscle. This hole can either be lateral to the blood vessels (indirect inguinal hernia, left below) or towards the middle from the blood vessels (direct inguinal hernia, right below). Regardless, the surgery is the same; once the hole is found, a small mesh is placed under the muscle to reinforce the hernia defect.

Laparoscopic Hernia Surgery Repair Cases – Inguinal

This patient had a noticeable bulge in the left groin. He opted for laparoscopic surgery for treatment. The balloon spacemaker (see above) is placed under the muscle but over the intestines. When the balloon is removed, the hole in the muscle is found. A lightweight mesh is placed over the defect to repair the hernia.

Laparoscopic Hernia Surgery Repair – Ventral/Incisional

Ventral hernias, epigastric hernias, recurrent umbilical hernias, as well as several other, are excellent candidates for laparoscopic hernia repair. Similar to the inguinal hernia, a camera is placed through the muscle into the abdomen along with two smaller punctures for the operating instruments. From there, any scar tissue between the intestine and the hernia is cut allowing complete exposure of the hole.

A hernia mesh is rolled and placed through one of the laparoscopic ports into the abdomen. From there, it is pulled up against the muscle surrounding the hernia with stitches (sutures). Once the mesh is secured in place with about 4 sutures, a special stapling device is used to further fix the mesh to the healthy muscle.

Patients should read our ‘Comparison of Open & Laparoscopic Surgery‘ page to read the pro’s and con’s of open versus laparoscopic surgery.

Laparoscopic Ventral/Incisional Hernia Repair Cases

The following two patients had incisional hernias which came back after a prior surgical repair (recurrent incisional hernias). Both were done at large university hospitals and both recurred within months after having their surgery. We treated both patients with laparoscopic surgery after discussions with the patients about their desires and expectations for after the surgery. Some patients will benefit from laparoscopic repair, while some might benefit from an open approach.

1. Laparoscopic repair of recurrent incisional hernia in a 74 year old doctor.

A 74 year old physician had a large pelvic tumor removed which was non cancerous. She developed a hernia 2 years after her surgery and underwent a laparoscopic incisional hernia repair at a large University Hospital in Southern California. Weeks after her surgery, she noticed a recurrent bulge in the lower part of her abdomen.

She presented to California Hernia Specialists for evaluation and treatment. On examination she had a 1-2 inch bulge in the lower abdomen, just above her pubic bone. This recurrent incisional hernia was painful when she exercised and while she was at work. We offered her laparoscopic recurrent incisional hernia repair.

2. Hernia in a 30 year old woman after endometriosis surgery and c-section.

This patient had several surgeries for endometriosis and c-sections. After one of her surgeries she developed pain in the lower abdomen and a bulge. The bulge would get bigger and smaller, and sometimes extend down to the right labia. She had pain with most activities including simple tasks like standing and sitting.

She had a laparoscopic hernia repair previously, but the mesh wasn’t placed low enough to cover the entire hernia defect, or the hole in the muscle. She presented to us for a second opinion and further treatment. Her small intestine was stuck in the hole at the beginning of the surgery and had to be pulled out prior to repairing the defect. A ‘tension free’ repair (see below) was performed.

Tension Free Repair

The term ‘tension free’ hernia repair is commonly used to describe hernia surgery. Hernias are caused by a weakening of the abdominal muscles. Some surgeons choose to sew the muscles back together, thus causing ‘tension’ on the muscles around the hernia. However, the muscles around a hernia are already weak, and over time those muscles tend to pull apart and the hernia can recur, or come back.
Therefore, most hernia specialists today utilize a mesh to help strengthen the muscles. When using a mesh, the muscles themselves are not sewn together (see below). Instead, a mesh is placed over or under the hole in the muscle to prevent anything from pushing through the abdominal wall.

Some patients have heard or read negative information about mesh surgery. However, the unbiased government agency The National Institutes of Health performed a study of whether mesh should or should not be used for hernia surgery. Read the article by clicking on the logo to the right:

Duodenal obstruction

Definition
Duodenal obstruction is a partial or complete obstruction of the duodenum, the first part of the small intestine. Obstruction prevents food from passing through the digestive tract, interfering with digestion and nutrition.

Description

The duodenum is the first part of the small intestine, extending from the valve at the bottom of the stomach that regulates stomach emptying (pylorus valve) to the second part of the small intestine (jejunum). It is a short but often troublesome section of the digestive tract. The stomach, gallbladder, and pancreas each empty their contents into the duodenum in anticipation of digestion. Obstruction prevents the normal passage of stomach contents into the duodenum and keeps the gallbladder and pancreas from draining their secretions. This problem can lead to a number of conditions and complications involving digestion, nutrition, and fluid balance. In infants and children, congenital defects (anomalies) usually cause duodenal obstruction, and symptoms are present at birth or shortly after when the infant attempts to feed.

When obstruction occurs, regardless of cause, food, gas, and secretions from within the intestine will accumulate above the point of obstruction, bloating (distending) the affected portion of intestine. Infection of peritoneal tissue lining the intestines and the abdomen (peritonitis) may result from bacteria growing in the accumulation of undigested material. As the distention increases, fluids continue to increase, and the intestine absorbs less. The fluid accumulation and reduced absorption lead to bilious vomiting , which is the vomitus will appear greenish, the classic sign of upper intestinal obstruction. Persistent vomiting or diarrhea (which can occur in a partial blockage) can result in dehydration . Fluid imbalances upset the balance of specific essential chemicals (electrolytes) in the blood, which can cause complications such as irregular heartbeat and, without correction of the electrolyte imbalance, shock.

In newborns, congenital duodenal obstruction can occur when the duodenal channel (duodenal lumen) is not correctly formed (recanalized) during fetal development. The duodenum may have a membrane reducing the channel size (lumen), or two blind pouches instead of one duodenal channel, or a gap or flap of tissue may be present. In each case, the channel is not be sufficiently developed at birth or sufficiently open to allow the passage of food and liquid, resulting in poor digestion and poor nutrition. This condition is known as duodenal atresia, and it results in duodenal obstruction. About 30 to 50 percent of infants born with duodenal atresia also have Down syndrome , and some have cardiac abnormalities as well. Duodenal atresia can occur with other conditions such as a narrowing of the duodenal lumen (duodenal stenosis) or twisting of the duodenum around itself (duodenal volvulus). It may also occur in combination with volvulus in another part of the bowel below the duodenum. Inflammation of the pancreas (pancreatitis) may also accompany duodenal atresia.

Malrotation of the duodenum is a more common cause of duodenal obstruction, typically appearing in the first few weeks of life. In malrotation, the duodenum is usually coiled to the right, causing obstruction of the duodenum and failure of the stomach contents to pass through to the next portion of small intestine. Malrotation may also involve the presence of Ladd’s bands, abnormal folds or bands of tissue under tension across the lumen of the duodenum. Malrotation can also occur with duodenal volvulus or volvulus lower in the bowel. With volvulus, it can result in serious consequences by cutting off the supply of blood to a portion of bowel (strangulation), reducing the flow of oxygen to bowel tissue (ischemia), and leading to tissue death (gangrene) and shock or to rupture (perforation) of the intestine. Surgery is required immediately to correct this type of duodenal obstruction.

Demographics

Duodenal atresia, one of the causes of duodenal obstruction, affects one in 10,000 live births in the United States and is found equally among boys and girls and more often among premature births. Intestinal malrotation is a more common cause, occurring in one in 500 live births, although only a small percentage of these have duodenal malrotation. The male to female ratio is two to one in the first year of life and then becomes equal.

Causes and symptoms

Obstruction of the duodenum occurs in infants as a result of congenital causes. The duodenal channel may be underdeveloped (duodenal hypoplasia), narrowed (duodenal stenosis), or the duodenum channel may not be properly formed (duodenal atresia). Malrotation or coiling of the duodenum can also obstruct the duodenum, sometimes accompanied by volvulus, a twisting of the duodenum around itself. As of 2004 the specific cause of these congenital defects was not known.

Vomiting is the prevailing symptom of duodenal obstruction and may occur in the first day of life. The vomitus will be greenish (bilious) because it contains bile from the gallbladder. An infant will vomit feedings, lose weight, and be restless and irritable. Other symptoms may include difficulty breathing, excessive salivation and drooling, the presence of a palpable mass in the abdomen, yellow-tinted skin (jaundice ), and failure to respond (lethargy). If the duodenum is twisted as in volvulus, the newborn may have a distended abdomen and bloody diarrhea.

When to call the doctor

Frequent or constant vomiting, unsuccessful feeding, and poor weight gain should be reported to the pediatrician as soon as noted. If an infant in the first few weeks of life pulls the knees up and intermittently cries in pain along with frequent vomiting, the pediatrician should be consulted immediately, and examination in the emergency department of the hospital may be necessary.

Diagnosis

Abdominal x-rays will be performed and will typically show what is called the characteristic “double bubble,” a combination of air bubbles in the stomach and a dilated duodenum. An echocardiogram and chest x rays may be done to evaluate the infant for any other possible abnormalities, including cardiac defects and abnormal development of the pancreas, which is often associated with duodenal obstruction. If malrotation is suspected, contrast-enhanced x rays of the upper intestinal region are usually able to visualize the twisted duodenum. Ultrasound imaging may also be used to evaluate these conditions.

Diagnostic tests performed in the clinical laboratory will include a complete blood count (CBC), electrolytes (sodium, potassium, chloride), blood urea nitrogen (BUN), and other blood chemistries, especially to evaluate kidney and pancreas function. A urinalysis will be performed. Coagulation tests may be performed if the child is going to have surgery.

Treatment

Duodenal obstruction requires surgery, but it is not always urgent. Treatment may be delayed to evaluate or treat other life-threatening congenital anomalies. A nasogastric tube will first be placed through the infant’s nose down into the stomach to decompress both the stomach and duodenum. Intravenous fluids may be given to maintain fluid levels and urine output or to correct dehydration that already has occurred. Electrolyte solutions may be given intravenously to restore electrolyte balance. Surgery to correct duodenal atresia is usually duodenoduodenostomy. It involves opening the duodenum channel along its length from the stomach to the next portion of intestine, correcting the duodenal lumen end to end (gastrojejunal anastomosis) so that it is a fully open channel.

What is liver disease?

Liver disease is any disturbance of liver function that causes illness. The liver is responsible for many critical functions within the body and should it become diseased or injured, the loss of those functions can cause significant damage to the body. Liver disease is also referred to as hepatic disease.

Liver disease is a broad term that covers all the potential problems that cause the liver to fail to perform its designated functions. Usually, more than 75% or three quarters of liver tissue needs to be affected before a decrease in function occurs.

The liver is the largest solid organ in the body; and is also considered a gland because among its many functions, it makes and secretes bile. The liver is located in the upper right portion of the abdomen protected by the rib cage. It has two main lobes that are made up of tiny lobules. The liver cells have two different sources of blood supply. The hepatic artery supplies oxygen rich blood that is pumped from the heart, while the portal vein supplies nutrients from the intestine and the spleen.

Normally, veins return blood from the body to the heart, but the portal vein allows nutrients and chemicals from the digestive tract to enter the liver for processing and filtering prior to entering the general circulation. The portal vein also efficiently delivers the chemicals and proteins that liver cells need to produce the proteins, cholesterol, and glycogen required for normal body activities.

What is liver disease? (Continued)

As part of its function, the liver makes bile, a fluid that contains among other substances, water, chemicals, and bile acids (made from stored cholesterol in the liver). Bile is stored in the gallbladder and when food enters the duodenum (the first part of the small intestine), bile is secreted into the duodenum, to aid in the digestion of food.

The liver is the only organ in the body that can easily replace damaged cells, but if enough cells are lost, the liver may not be able to meet the needs of the body.

The liver can be considered a factory; and among its many functions include:

• Production of bile that is required in the digestion of food, in particular fats.

• Storing of the extra glucose or sugar as glycogen, and then converting it back into glucose when the body needs it for energy.

• Production of blood clotting factors.

• Production of amino acids (the building blocks for making proteins), including those used to help fight infection.

• The processing and storage of iron necessary for red blood cell production.

• The manufacture of cholesterol and other chemicals required for fat transport.

• The conversion of waste products of body metabolism into urea that is excreted in the urine.

• Metabolizing medications into their active ingredient in the body.

Cirrhosis is a term that describes permanent scarring of the liver. In cirrhosis, the normal liver cells are replaced by scar tissue that cannot perform any liver function.

Acute liver failure may or may not be reversible, meaning that on occasion, there is a treatable cause and the liver may be able to recover and resume its normal functions.

What are the causes of liver disease (alcohol and cirrhosis)?

The liver can be damaged in a variety of ways.

• Cells can become inflamed, for example, hepatitis.

• Bile flow can be obstructed, for example, cholestasis).

• Cholesterol ortriglycerides can accumulate, for example, steatosis).

• Blood flow to the liver may be compromised.

• Liver tissue can be damaged by chemicals and minerals, or infiltrated by abnormal cells, like cancer cells.

Alcohol abuse

Alcohol abuse is the most common cause of liver disease in North America. Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic hepatitis. In chronic alcohol abuse, fat accumulation occurs in liver cells affecting their ability to function.

Cirrhosis

Cirrhosis is a late-stage of liver disease. Scarring of the liver and loss of functioning liver cells cause the liver to fail. Significant amounts of liver cells need to be damaged before the hole organ fails to function.

What are the causes of liver disease (drug-induced liver disease)?

Drug-induced liver disease

Liver cells may become temporarily inflamed or permanently damaged by exposure to medications or drugs. Some medications or drugs require an overdose to cause liver injury while others may cause the damage even when taken in the appropriately prescribed dosage.

Taking excess amounts of acetaminophen (Tylenol, Panadol) can cause liver failure. This is the reason that warning labels exist on many over-the-counter medications that contain acetaminophen and why prescription narcotic-acetaminophen combination medications (for example, Vicodin, Lortab, Norco, Tylenol #3) limit the numbers of tablets to be taken in a day. For patients with underlying liver disease or those who abuse alcohol, that daily limit is lower and acetaminophen may be contra-indicated in those individuals.

Statins are drugs commonly prescribed to control elevated blood levels of cholesterol. Even when taken in the appropriately prescribed dose, liver inflammation may occur. This inflammation can be detected by blood tests that measure liver enzymes. Stopping the medication usually results in return of the liver function to normal.

Niacin is another medication used to control elevated blood levels of cholesterol, but liver inflammation with this medication is related to the dose taken. Similarly, patients with underlying liver disease may be at higher risk of developing liver disease due to medications such as niacin. Recent studies have found that niacin may not be as effective as previously thought in controlling high cholesterol. Patients who take niacin may want to see their health care professional to determine if other treatment options may be appropriate.

There are numerous other medications that may cause liver inflammation, most of which will resolve when the medication is stopped. These include antibiotics such as nitrofurantoin (Macrodantin, Furadantin, Macrobid), amoxicillin and clavulanic acid (Augmentin, Augmentin XR), tetracycline (Sumycin), and isoniazid (INH, Nydrazid, Laniazid). Methotrexate (Rheumatrex, Trexall), a drug used to treat autoimmune disorders and cancers, has a variety of side effects including liver inflammation that can lead to cirrhosis. Disulfiram (Antabuse) is used to treat alcoholics and can cause liver inflammation.

Some herbal remedies and excessive amounts of vitamins can cause hepatitis, cirrhosis and liver failure. Examples include vitamin A, kava kava, ma-huang, and comfrey.

Many mushrooms are poisonous to the liver and eating unidentified mushrooms gathered in the wild can be lethal.

What is pancreatitis?

The pancreas is a gland located in the upper part of the abdomen. It produces two main types of substances: digestive juices and digestive hormones. Inflammation of the pancreas is termed pancreatitis and its inflammation has various causes. Once the gland becomes inflamed, the condition can progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the gland. There, digestive juices become trapped and start “digesting” the pancreas itself. If this damage persists, the gland may not be able to carry out normal functions. Pancreatitis may be acute (new, short-term) or chronic (ongoing, long-term). Either type can be very severe, even life-threatening. Either type can have serious complications.

• Acute pancreatitis usually begins soon after the damage to the pancreas begins. Attacks are typically very mild, but about 20% of them are very severe. An attack lasts for a short time and usually resolves completely as the pancreas returns to its normal state. Some people have only one attack, whereas other people have more than one attack, but the pancreas always returns to its normal state unless necrotizing pancreatitis develops and becomes life-threatening.

• Chronic pancreatitis begins as acute pancreatitis. If the pancreas becomes scarred during the attack of acute pancreatitis, it cannot return to its normal state. The damage to the gland continues, worsening over time.

The reported annual incidence of acute pancreatitis has ranged from 4.9 to 80 cases per 100,000 people. About 80,000 cases of acute pancreatitis occur in the United States each year. Pancreatitis can occur in people of all ages, although it is very rare in children. Pancreatitis occurs in men and women, although chronic pancreatitis is more common in men than in women.

The spleen is the largest organ in the lymphatic system. It is an important organ for keeping bodily fluids balanced, but it is possible to live without it.

The spleen is located under the ribcage and above the stomach in the left upper quadrant of the abdomen. Adult spleens are usually about 5 inches wide and weigh about 6 ounces. Spleens are soft and purple, possessing many blood vessels.

Function

“The spleen acts as a blood filter; it controls the amount of red blood cells and blood storage in the body, and helps to fight infection,” said Jordan Knowlton, an advanced registered nurse practitioner at the University of Florida Health Shands Hospital. If the spleen detects potentially dangerous bacteria, viruses, or other microorganisms in the blood, it — along with the lymph nodes — creates white blood cells called lymphocytes, which act as defenders against invaders, according to the U.S. National Library of Medicine. The lymphocytes produce antibodies to kill the foreign microorganisms and stop infections from spreading.

According to the Children’s Hospital of Pittsburgh of UPMC, when blood flows into the spleen, red blood cells must pass through narrow passages within the organ. Healthy blood cells can easily pass, but old or damaged red blood cells are broken down by large white blood cells. The spleen will save any useful components from the old blood cells, including iron, so they can be reused in new cells. The spleen can increase in size in order to store blood. The organ can widen or narrow, depending on the body’s needs. At its largest, the spleen can hold up to a cup of reserve blood.

Spleen problems

Some problems associated with the spleen are:

Lacerated spleen or ruptured spleen

According to Knowlton, spleen lacerations or ruptures “usually occur from trauma (like a car accident or contact sports).” These emergency situations cause a break in the spleen’s surface and can lead to “severe internal bleeding and signs of shock (fast heart rate, dizziness, pale skin, fatigue),” said Knowlton. The Mayo Clinic reported that without emergency care, the internal bleeding could become life-threatening.

On the continuum of spleen breakage, a laceration refers to a lower-grade extent of injury, in which just a part of the spleen is damaged. A ruptured spleen is the highest grade of broken spleen injury, according to HealthTap, an online network of doctors who answer health questions.

According to Medical News Today, symptoms of a lacerated or ruptured spleen include pain or tenderness to the touch in the upper left part of the abdomen, left shoulder, and left chest wall, as well as confusion and lightheadedness. If you experience any of the symptoms after a trauma, seek emergency medical attention immediately.

Treatment options depend on the condition of the injury, according to Medscape. Lower-grade lacerations may be able to heal without surgery, though the Mayo Clinic noted that they will probably require hospital stays. Higher-grade lacerations or ruptures may require surgery to repair the spleen, surgery to remove part of the spleen, or surgery to remove the spleen completely.

Enlarged spleen

An enlarged spleen, also called a splenomegaly, is a serious but typically treatable condition. “An enlarged spleen puts one at risk for rupture,” said Knowlton. According to the Mayo Clinic, anyone can get an enlarged spleen, but children suffering from mononucleosis, adults with certain inherited metabolic disorders including Gaucher’s and Neimann-Pick disease, and people who live or travel to malaria-endemic areas are more at risk.

Knowlton listed infection, liver diseases, cancer, and blood diseases as typical causes for enlarged spleens. According to the Mayo Clinic, specific infections and diseases include:

• viral infections, such as mononucleosis.

• bacterial infections.

• parasitic infections, such as malaria.

• metabolic disorders.

• hemolytic anemia.

• liver diseases, such as cirrhosis.

• blood cancers and lymphomas, such as Hodgkin’s disease.

• pressure on or blood clots in the veins of the liver or spleen.

In many cases, there are no symptoms associated with an enlarged spleen, according to the University of Maryland Medical Center. Doctors typically discover the condition during routine physicals because they can feel enlarged spleens. When there are symptoms, they might include:

• pain in the upper left abdomen that may spread to the shoulder.

• fatigue

• anemia

• bleeding easily

• feeling full without eating

Typically, enlarged spleens are treated by addressing the underlying problem, according to the Mayo Clinic. If the cause of the enlarged spleen can’t be determined or if the condition is causing serious complications such as a ruptured spleen, doctors may suggest removing the spleen.

Spleen cancer

Cancers that originate in the spleen are relatively rare, according to HealthGrades’ Better Medicine. When they do occur, they are almost always lymphomas, blood cancers that occur in the lymphatic system. Usually lymphomas start in other areas and invade the spleen. According to the National Cancer Institute, adult non-Hodgkin lymphoma can have a spleen stage. This type of spleen invasion can also happen with leukemia, blood cancer that originates in bone marrow. Rarely, other types of cancers — like lung or stomach cancers — will invade the spleen.

Spleen cancer symptoms may resemble a cold or there may be pain or fullness in the upper abdomen. An enlarged spleen can also be the result of spleen cancer.

Treatment for spleen cancer will depend on the type of cancer and how much it has spread. The National Institues of Health’s MedlinePlus lists spleen removal as a possible treatment.

Spleen removal

Spleen removal surgery is called a splenectomy. Knowlton said that the procedure is done in cases such as: “trauma, blood disorders (idiopathic thrombocytopenia purpura (ITP), thalassemia, hemolytic anemia, sickle cell anemia), cancer (lymphoma, Hodgkin disease, leukemia), and hypersplenism to name a few.” [Related: What Organs Can You Live Without?]

Spleen removal is typically a minimally invasive laparoscopic surgery, according to the Cleveland Clinic, meaning that surgeons make several small incisions and use special surgical tools and a small camera to conduct the surgery. In certain cases, a surgeon may opt for one large incision, instead.

“You can live without a spleen because other organs, such as the liver and lymph nodes, can take over the duties of the spleen,” said Knowlton. Nevertheless, removing the spleen can have serious consequences. “You will be more at risk to develop infections,” said Knowlton. Often, doctors recommend getting vaccines, including a pneumococcus vaccine, Haemophilus B vaccine, Meningococcal vaccine, and yearly flu vaccine after a splenectomy, according to University of Michican Hospitals and Health Centers. It is important to see a doctor at the first sign of infection if you do not have a spleen.

2. Department of Gynecology & Obstetrics

• Cesarean Section

What is C section?

A Caesarean section, more commonly known as C section, is the surgical delivery of a child. The baby is brought out from the mother’s abdomen. A C section involves an incision or cuts in the mother’s abdomen and uterus.

A pregnancy lasts for about 40 weeks and C section is usually avoided before 39 weeks of pregnancy so that the child has proper time to develop in the womb. Sometimes when complications arise, C section may be performed prior to 39 weeks.

During the operation, the infant is delivered through cuts in the mother’s abdomen and uterus. The muscles of the abdomen are spread apart and the bladder is moved down and a route is made to get to the uterus. An incision is made into the uterus and the baby is guided out. The placenta is taken out shortly after.
The uterus is stitched shortly after which the tissues and abdominals are stitched up to varying degrees.

C Section Causes

A C section may be scheduled for the following reasons:

• Certain chronic medical conditions like heart disease, diabetes, high blood pressure, etc.

• In cases of infections like HIV-positive, a C section is necessary as the virus can be passed on to the baby after delivery.

• An illness or congenital condition of the baby.

• Women also think about scheduling a C section in advance for other reasons (wanting to plan the time the baby is born, etc.).

• The age of the mother

• A large baby (sometimes the baby is too large).

• Being obese increases the chances of a requirement for C section.

• If carrying multiple babies like twins or triplets in the womb, there may be chances of C section.

• A C section is recommended if there is a large fibroid that obstructs the birth canal.

• If there has been a delivery through a C section previously.

• Problems with the placenta, umbilical cord.

• Pre-eclampsia is a condition of high blood pressure during pregnancy. During the condition, the proper amount of blood requirement is not met by the placenta and there is a decrease in the blood flow to the baby.

• Active genital herpes infection in the mother may be the reason of a C section delivery. A Caesarean may be recommended to avoid the contact of infection with the baby as it passes through the birth canal.

• The condition in which the baby is coming out, known as breech position- feet first or butt first and can’t be turned, a caesarean may be recommended.

• Cesarean on choice (elective) c section- Caesarean being safe, and also preventing the pain when the woman goes through labour, this may be a reason to opt for a C section.

Reasons for a sudden (unscheduled) C section may be:

• Fetal distress- Signs of the baby in distress in the mother’s womb, or the mother herself in distress, may be the reason for a C section.

• Uterine tear– if the uterus tears, it may signal a C section.

• Labour doesn’t start, and the foetus doesn’t seem to be moving in the first place- here the surgeon may opt immediately for a C section

The procedure of C section

Before the procedure, your healthcare provider may recommend certain blood tests and enquire about the current medical history of the patient. A C section procedure, whether planned, unplanned, or elective, begins with an anesthesia to make the mother numb or fully asleep, after which the surgeon usually makes two incisions or cuts:

• A low transverse incision made at the lower abdomen

• A vertical cut made in the middle of the uterus.

Next, the amniotic fluid (the fluid that surrounds the foetus during pregnancy) will be suctioned out and right after that, the baby is brought out after which the umbilical cord is cut. The surgeon will remove the placenta which is a connection of the fetus to the uterine wall. Certain antibiotics may be advised by the surgeon to control bleeding.

After the C section is done, the hospital stay lasts for about three days. Often you may be encouraged to walk, to prevent the formation of a blood clot.

During the procedure, the surgery may last for 30 to 45 minutes and is straightforward, though there may be few complications if there was a Cesarean operation in the past.

Some women may think about scheduling a C section in advance for other reasons like wanting to have an exact plan for when their baby will be born, or because they’re worried about the pain of having a vaginal birth, but experts’ advice against having the procedure strictly for convenience’s sake, especially before 39 weeks.

Risks of C Section

A C section was considered rarely safe but has nowadays become a common delivery type. Few risks may include:

• Bleeding

• Blood clots

• Breathing problems for the child, especially if done before 39 weeks of pregnancy

• Increased risks for future pregnancies

• Infection

• Injury to the child during surgery

• Longer recovery time compared to vaginal birth

• Surgical injury to other organs
Recovery after C Section

The following measures may be taken for fast recovery after the C section:

• Get plenty of rest.

• A C section is a major surgery; hence the body needs time to heal. Expect to stay in the hospital for three to four days after the delivery and the body may be given six weeks to fully heal.

• Take care of a healing body; avoid going up and down and keep everything near you when taking care of your body.

• Avoid strenuous exercise- take gentle walks and look for emotional support as a mentor during the period of pregnancy.

• Relieve pain with the help of pain medicines which you may take on the advice of your surgeon after surgery. A heating pad is usually advised to relieve discomfort at the surgical site.

• Focus on good nutrition; drink plenty of fluids, especially water. Extra fluids should be taken during the recovery phase of the delivery.

• Avoid sex.

• Support your abdomen by using extra pillows while breastfeeding.
Seek the advice of your healthcare provider if you experience any signs such as

• High fever, severe pain in your abdomen, redness, swelling and discharge at the incision site.

• Breast pain accompanied by redness or fever

• Foul-smelling vaginal discharge

• Painful urination

• Heavy bleeding that soaks a sanitary napkin within one hour or bleeding that continues longer than eight weeks after delivery.

• Post-partum depression, which is severe mood swings, loss of appetite, overwhelming fatigue, and lack of joy in life.

• Redness or swelling in the leg.

Risks to the baby include:

• During incision, there may be an injury to the baby (rarely).

• Breathing problems in the baby which are temporary.

• Chest pain.

Tips for quick recovery

• Make sleep a top priority.

• Look at your scar. As every C section scar is different, the cosmetic benefits of vitamin E and scar improvement creams are in the talk by researchers for scar improvement.

• The incision done might be affected if it is bright red, tender, swollen, or if there is yellowish pus in the incision.

• Emotional care after a caesarean.

• Take time out to sit and bond with the baby.

• You may have problems in breastfeeding your child after the delivery; contact a lactation consultant for direction and support.

• To avoid negative feelings affecting your mental well-being, discuss the birth experience with a supportive person.

• Discuss your pregnancy experience.

• See a woman help physiotherapist/physical therapist.

Planning for a C section

Here is what you may need to know:

• In some situations, a C section is safer than vaginal birth.

• C sections are major surgeries that come with risks.

• You are given a local anesthesia which means you will be awake during the whole surgery.

• The recovery period after a C section is more than a vaginal birth.

• The pain is more intense.

• You will end up with a scar which will heal with time.

• One C section does not mean subsequent C sections in the future; vaginal birth in future is possible.