General Surgery

Gastrointestinal Problems

Gastroenterology :- It includes study of the function and diseases of the gastro intestinal organs which includes oesophagus, stomach, small intestine, large intestine, rectum, pancreas, gall bladder, liver and biliary ducts.

The study of normal functioning of all gastro intestinal organs that includes:

• Digestion and absorption of nutrients  in the body
• Movement of the food and other material via stomach and intestine
• Functioning of the digestive organs
• Functioning of liver, gall bladder and bile duct and
• Excretion of the waste products from digestive system.

Disease of the GI tract

Gastroenterology surgery or treatment is commonly indicated if you are suffering from any of the following problems:

• Acute and chronic pancreatitis
• Hepatitis
• Fissures, Fistula
• Irritable bowel syndrome
• Ulcerative colitis or crohn's disease
• Gall bladder diseases like gallstones
• Appendicitis
• Colon or rectal cancers
• Haemorrhoids
• Hernia

Hernia

Overview

Hernia - is a protrusion of an organ from the wall of the cavity of the organ.

Hiatus is the opening in the diaphragm - the muscular wall that splits the chest cavity from the abdomen. Hiatal hernia occurs when the stomach protrude in to the chest via the hiatal opening.

Hiatal Hernias can be classified into two types;

Sliding hiatus hernia: It is the sliding of stomach along with the small part of oesophagus into the chest through hiatus.

Paraesophageal Hernia: in which the section of the stomach press through the hiatus protruding it adjacent to the oesophagus. It is dangerous as it can make the stomach strangled, viz. shutting off the blood supply to the stomach.

Causes

Exact cause is unknow but possible causes are these;

• Congenital
• Increased and intense pressure on the abdomen and adjacent muscles while coughing, straining while bowels, pregnancy, obesity, or while lifting heavy objects.
• Injury to the area

Treatment options

The following are the option to treat hiatal hernia;

Drug therapy:

• To reduce the acid production cimetidine
• To neutralize acid

To stop acid production and healing of oesophagus

Surgical interventions:

Normally surgery not required but in emergency situation like paraesophageal hernias. In the surgical procedure the surgeon either pulls your stomach down to the original place that makes the hiatus smaller, reconstruct the weak sphincter of oesophagus or remove the hernia sac completely.

This can be done using one of the following procedure;

• Thoracotomy: In this surgery is done through a single incision on your chest wall.
• Laprotomy: surgery is done through an incision in the abdomen.
• Laparoscopic: Surgery is performed using the small camera and surgical tools which are inserted in the abdomen through multiple small incisions. This is the minimally invasive technique.

Piles Treatment in India

Overview

Piles are haemorrhoids that have become inflamed. Haemorrhoids are masses, clumps, cushions of tissue in the rectum, the last part of the intestine, commonly known as anus. Haemorrhoids are full of blood vessels, support tissue, muscle and elastic fibres.

Some of the common symptoms of piles are:

• Loss of blood while passing stools
• Itchiness, redness or soreness around the anus
• Pain and mucus discharge while emptying the bowels
• Feeling of bowel fullness even after defecation
• Feeling of hard lump around the anus, which is often very painful

Piles can either be in the inside or outside the anus. Internal piles typically are 2 to 4cm above the opening of the anus and are much more common. External piles occur on the outside edge of the anus.

Cause for piles

Following factor that can cause piles;

• Chronic constipation and excessive straining during passing stools
• Sitting hard surfaces for long duration
• lifting heavy objects
• Pregnancy is one of the factors,because of added weight and pressure on bowels.
• Hereditary

Treatment options

Following are the other treatment options for treating haemorrhoids.

• Improving dietary habits. Intake of high fibre diet including vegetables, fruits, cereals and plenty amount of water helps in soft bowel movements with easy and regular motions.
• Drug therapy and
• Banding and ligation of haemorrhoids.
• Surgery

The commonly performed surgical procedures are;

• Stapler Haemorrhoidectomy- haemorrhoidectomy is the procedure during which the excess tissue that is causing the bleeding is surgically removed. The surgery can be done under local/ spinal or general anaesthesia. Haemorrhoidectomy results in complete removal of piles.
• Other GI Surgeries

Liver Transplant Surgery

Overview

Liver is an accessory digestive gland or organ located in upper right abdomen in humans. It helps in detoxification of various metabolites, protein synthesis and produce biochemicals which helps in digestion on foods. It also helps in regulation of glycogen storage, decomposition of red blood clells and the production of hormones.

Types of liver transplants:

Deceased donor transplants: Clinical died patient’s liver is used for transplantation. Donated liver can be used for two persons on same time, large part for adults and smaller part for childs.

Living donor transplants: When healthy person give his/her half part of liver to his/her own family member.

Signs and symptoms of liver failure

• Jaundice
• fatigue without physical exercise
• weakness
• loss of appetite
• nausea
• Abdominal sweeling
• weight & muscle loss
• itching
• bruising or bleeding easily because blood does not clot
• bleeding in the stomach
• blood while vomiting
• white or chalky stool

Diagnosis for Liver Transplant

Acute liver failure – sudden onset of liver failure due to following reasons;

• viral hepatitis,
• drug-induced
• injury / clots in vessel supplying blood to liver
• infection.

Chronic Liver failure; due to following factors

• Alcoholic liver disease
• Cancer
• Cirrhosis , fatty liver disease
• Biliary atresia common reason in children
• Auto immune , genetic disorders

Tests Required for Liver Transplant

• Doppler ultrasound to examine the flow of blood is open to liver
• PFT (pulmonary functioning test)- lungs ability to exchange oxygen and carbon dioxide.
• ECG- to evaluate the patient’s heart.
• CT Scan- to generate pictures of the liver and showing its shape and size.
• Blood tests examine blood type, biochemical status of blood, PT INR  and to gauge liver function. Viral marker and Hepatitis tests are also included.

Living donor liver transplants: is an option for those patients with end-stage liver disease. In this procedure, segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.

The donor, who may be a blood relative, spouse. Blood type and body size are critical factors in determining an appropriate donor.

Guidelines for Liver Transplant:

Donor should be close relative and donating liver by it’s own wish.

Prefered age fpr donor is 18-45 years. He/she should be fit, strong and have a matching or compatible blood group:

Generally the donor’s right half of the liver is donated during an adult – to – adult liver transplant.