Pancreatitis Pancreatitis Home Overview Pancreatitis refers to inflammation of the pancreas, which is a vital organ that aids digestion and regulates blood sugar. Pancreatitis might be acute (sudden) or chronic (long-term), and it varies in severity. Types Acute pancreatitis: This refers to a sudden inflammation of the pancreas that can range from mild discomfort to a life-threatening condition. Acute pancreatitis usually resolves with treatment, but complications can arise if left untreated. It can also be divided into subtypes, a representative subtype includes:Necrotizing pancreatitis: It is a severe form of acute pancreatitis where the pancreatic tissue becomes damaged to the point of necrosis (tissue death). Necrotising pancreatitis is a potentially life-threatening complication that occurs in approximately 20% of the severe cases of acute pancreatitis.Chronic pancreatitis: This refers to long-term inflammation that leads to permanent damage to the pancreas. Over time, chronic pancreatitis can impair pancreatic function, affecting digestion and insulin production.Other types (less common): These include:Autoimmune pancreatitis: This is a rare form of pancreatitis that is caused when the immune system starts attacking the pancreas. Autoimmune pancreatitis is often associated with other autoimmune conditions and can be treated with steroids to reduce inflammation.Hereditary pancreatitis: This is a rare genetic condition in which repeated episodes of pancreatitis occur, often starting in childhood or adolescence. Individuals with hereditary pancreatitis may develop chronic pancreatitis at an earlier age. Causes and risk factors The causes and risk factors of pancreatitis have been enumerated below.Acute pancreatitis causes:Gallstone pancreatitis: It occurs when a gallstone blocks the bile duct or the pancreatic duct—causing digestive enzymes to build up in the pancreas—leading to inflammation of the pancreas. Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Alcohol consumption: Heavy drinking is a leading cause of acute pancreatitis.High blood triglyceride levels: Elevated fat levels in the blood can contribute to acute pancreatitis.Medications: Certain drugs, like steroids, diuretics, and some antibiotics, can trigger inflammation, which induces acute pancreatitis.Infections: Viral infections like mumps or hepatitis can affect the pancreas.Trauma: Injury to the abdomen, e.g., such as that from surgery or accidents, may lead to acute pancreatitis.Genetic disorders: Rare genetic mutations can cause pancreatitis, especially in younger individuals.Chronic pancreatitis causes:Prolonged alcohol abuse: The most common cause of chronic pancreatitis is prolonged alcohol abuse, where repeated bouts of acute pancreatitis (due to alcohol-induced inflammation) cause lasting damage.Cystic fibrosis: This inherited disease can lead to thickened pancreatic secretions, resulting in chronic pancreatitis.Autoimmune pancreatitis: The immune system attacks the pancreas, leading to chronic inflammation.Hereditary conditions: Inherited mutations or conditions like hyperparathyroidism can lead to chronic pancreatitis.Obstructions in the pancreatic duct: Blockages or narrowing can lead to chronic inflammation.Risk factorsAcute pancreatitis risk factors:Gallstones: Women, especially those who are overweight, have a higher risk of developing gallstones, and by extension acute pancreatitis.Heavy alcohol use: Chronic, excessive alcohol consumption is a significant risk factor.High triglyceride levels: Can lead to pancreatitis, especially when levels are extremely elevated.Certain medications: Some drugs, including steroids, diuretics, and specific antibiotics.Trauma or surgery: Injuries or complications from surgeries affecting the abdomen can cause acute pancreatitis.Chronic pancreatitis risk factors:Long-term alcohol use: A history of heavy drinking significantly increases the risk of chronic pancreatitis.Family history: Genetic predisposition can contribute to the development of chronic pancreatitis.Age: Chronic pancreatitis is more common in adults aged 30-40, especially in individuals with a history of acute episodes.Smoking: Cigarette smoking can increase the risk of chronic pancreatitis. Symptoms The symptoms of pancreatitis have been enumerated below.Acute pancreatitis symptoms:Severe upper abdominal pain (often radiating to the back and worsened by eating).Nausea (urge to vomit) and vomitingFeverRapid pulseSwollen abdomen that is tender to touchJaundice (in cases of gallstone-related pancreatitis)Chronic pancreatitis symptoms:Persistent upper abdominal pain that may become less severe over timeWeight loss (due to malabsorption of nutrients)Steatorrhea (fatty, foul-smelling stools due to poor fat digestion)Diabetes (as pancreatic function declines, insulin production may be affected)Nausea and vomiting Diagnosis The various strategies used to diagnose pancreatitis have been discussed below.Physical examination: This involves checking for abdominal tenderness or swelling.Blood tests: Elevated levels of pancreatic enzymes (amylase and lipase) indicate pancreatitis.Imaging tests:Ultrasound: Can detect gallstones or other obstructions in the pancreas.CT: Provides detailed images to assess inflammation or complications.MRI: Provides detailed images to assess any blockages or changes in the pancreas.Endoscopic ultrasound: A more detailed imaging tool that is often used to assess chronic pancreatitis or complications.Biopsy: In rare cases, a biopsy of the pancreas may be needed to confirm chronic pancreatitis. Treatment The various treatment modalities available for pancreatitis have been enumerated below.Acute pancreatitis treatment/management:Hospitalisation: Most people with acute pancreatitis require a stay in the hospital for observation and supportive care.Fasting: Patients are usually not allowed to eat or drink for several days to allow the pancreas to heal.Intravenous (IV) fluids: To maintain hydration and support overall health.Pain management: Pain killers are provided to control pain.Antibiotics: These are provided if an infection is suspected.Surgery: In cases where gallstones or blockages are present, removal or drainage may be necessary.Chronic pancreatitis treatment/management:Pain management: Chronic pancreatitis often requires long-term pain management strategies.Enzyme replacement therapy: If digestion is impaired, patients may be recommended pancreatic enzyme supplements.Insulin therapy: This is recommended for patients who develop diabetes.Dietary changes: Low-fat, high-protein diets can reduce symptoms and improve digestion.Endoscopic or surgical interventions: These are used to remove obstructions or drain pseudocysts (fluid-filled sac-like structures in the abdomen). Prevention Various strategies to prevent the occurrence of pancreatitis have been enumerated below.Avoiding heavy alcohol consumption: Limiting alcohol intake reduces the risk of both acute and chronic pancreatitis.Maintaining a healthy diet: Avoiding high-fat diets can help prevent obesity and elevated triglyceride levels.Managing triglyceride levels: Regular check-ups and managing conditions like high cholesterol or diabetes can lower the risk.Quitting smoking: As smoking significantly increases the risk of both acute and chronic pancreatitis, quitting it may be a good preventive strategy.Treating underlying conditions: Managing gallstones, high triglyceride levels, or hereditary conditions can reduce the chances of developing pancreatitis.Regular check-ups: For individuals with a history of pancreatitis, regular monitoring can help catch issues early and prevent further complications. Read more about Pancreatitis Filter Alphabet P
Dizziness Dizziness Home Overview Dizziness is a common symptom which can mean spinning of head, imbalance while walking, light headedness due to postural hypotension, faintness, blurring of vision etc. Causes Inner ear problems like BPPV, Labyrinthitis, vestibular migrainePosterior circulation strokesAnxiety/ panic attacksAdverse drug reactionMeniere’s diseaseCardiac arrhythmiasAutonomic disturbancesSyncopal attacksSeizures Risk factors Female sexMuscular pain in the neck and shoulder regionStressSleep durationMigraine Specialist to approach Neurologist Diagnosis Directed towards finding underlying aetiologyPure tone audiometryMRI brain and angiographyECGHolter monitoringAutonomic nervous testingEEG Treatment Symptomatic/ treatment of underlying cause Read more about Dizziness Filter Alphabet D
Gallbladder Cancer Gallbladder Cancer Home Overview Gallbladder cancer is a rare but aggressive cancer that develops in the gallbladder. Early detection and treatment are crucial for improving the outcomes, especially as this cancer is often diagnosed at later stages when it is more difficult to treat. Types Adenocarcinoma: The most common type, accounting for ~90% of all gallbladder cancers. This type of cancer originates in the glandular cells of the gallbladder, which are responsible for secreting mucus and bile.Adenosquamous carcinoma: A rare form of gallbladder cancer that has both glandular (adenocarcinoma) and squamous cell (flat) characteristics.Squamous cell carcinoma: This type of gall bladder cancer involves the squamous cells lining the gallbladder.Small cell carcinoma: A rare, aggressive form of gallbladder cancer that often spreads quickly and is typically diagnosed at an advanced stage.Other rare types:Sarcomas: These originate in connective tissues of the gallbladder and are extremely rare.Neuroendocrine tumours: These are very rare and arise from hormone-producing cells in the gallbladder. Causes and risk factors The exact cause of gallbladder cancer is unknown; however, several factors may contribute to its development.Chronic inflammation: Persistent inflammation of the gallbladder, often due to conditions like chronic cholecystitis (inflammation of the gallbladder), increases the risk of cancer.Gallstones: These may lead to irritation and inflammation, which increases the risk of cancer. Further, inflammation and infection from gallstones can promote the accumulation of genetic mutations in the gallbladder cells.Bile duct abnormalities: Biliary dysplasia or abnormal changes in the bile ducts, are a risk factor for gallbladder cancer.Age and gender: Gallbladder cancer is more common in people over the age of 65 and is also more common in women than men.Obesity and overweight: These increase the risk of gallbladder cancer, likely due to changes in bile composition and increased inflammation in the gallbladder.Family history and genetics: A family history of gallbladder cancer or other types of gastrointestinal cancer may increase the risk of developing gallbladder cancer. Genetic conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome, may also predispose individuals to gallbladder cancer.Tobacco and alcohol use: Smoking and heavy alcohol consumption have been linked to an increased risk of gallbladder cancer.Other medical conditions: Conditions like primary sclerosing cholangitis (a disease of the bile ducts) or porcelain gallbladder (a condition where the gallbladder wall becomes calcified) are associated with a higher risk of gallbladder cancer. Symptoms Gallbladder cancer often does not present any symptoms until it reaches an advanced stage, which makes early detection difficult. When symptoms do occur, they may include:Upper right abdominal pain: The most common symptom (pain may be dull or sharp).Nausea and vomiting: Often due to the obstruction of the bile ducts or inflammation.Jaundice: Caused by bile buildup in the bloodstream.Unexplained weight loss: Sudden and unexplained weight loss can be a sign of gallbladder cancer.Loss of appetite: A common symptom in individuals with cancer.Feeling of fullness or bloating: Often accompanied by a change in bowel movements.Fever: Can occur as a result of an infection or inflammation in the gallbladder.Dark urine: Due to the presence of excess bilirubin in the bloodstream.Clay-coloured stools: Due to the inability of bile to reach the intestines. Diagnosis Gallbladder cancer can be difficult to diagnose because the associated symptoms often resemble those of other conditions, such as gallstones or cholecystitis (inflamed gallbladder). The diagnostic strategy generally includes:Imaging tests:Ultrasound: The first imaging test often used to detect gallbladder abnormalities and tumours.CT: Can detect tumours and provide information regarding the spread of cancer (if the cancer has spread to other parts of the body).MRI: Useful for assessing the liver and bile ducts.Endoscopic ultrasound (EUS): May be used for better visualisation, especially for small tumours.Cholangiography: An X-ray or MRI-based test that helps visualise bile duct obstructions.Biopsy:Needle biopsy: A sample of tissue from the gallbladder is taken for examination under a microscope to confirm cancer.Endoscopic biopsy: If the cancer is accessible via the digestive tract, an endoscopic procedure may be used to obtain tissue samples.Blood tests:Tumour marker analysis: Elevated levels of CA 19-9 and CEA (carcinoembryonic antigen) may indicate the presence of gallbladder cancer, though the levels of these markers can also be elevated in other conditions. Treatment Treatment for gallbladder cancer depends on the stage at the time of diagnosis, whether the cancer has spread, and the patient's overall health.Surgery:Cholecystectomy (gallbladder removal): Primary treatment if the cancer is detected early on and is localised. If cancer has spread to nearby structures, a partial liver resection or removal of nearby lymph nodes may be required.Chemotherapy (gemcitabine and cisplatin): This may be used as an adjuvant treatment after surgery or in advanced cases where the tumour cannot be surgically removed.Radiation therapy: This therapy may be used to shrink tumours or relieve symptoms in cases where surgery is not an option. It is often used in combination with chemotherapy for treating advanced gallbladder cancer.Targeted therapy: Targeted drugs like HER2 inhibitors may be used in cases where genetic mutations have been identified.Palliative care: In advanced stages of gallbladder cancer, palliative care is provided to manage symptoms and improve quality of life, including drainage of bile ducts to alleviate jaundice. Prevention While there is no guaranteed way to prevent gallbladder cancer, certain lifestyle changes and medical interventions can reduce the risk:Removing the gallbladder: Removal of the gallbladder (cholecystectomy) in patients with gallstones can reduce the risk of gallbladder cancer.Healthy diet: Eating a balanced diet with a focus on fruits, vegetables, and low-fat foods may help lower the risk of gallbladder cancer.Maintaining a healthy weight: Avoiding obesity can reduce the risk of gallbladder cancer.Avoid smoking and excessive alcohol consumption: These risk factors should be minimised to reduce the likelihood of developing gallbladder cancer.Regular medical check-ups: For individuals at higher risk of gallbladder cancer (family history, chronic inflammation, or genetic conditions), regular screenings and medical check-ups are important for early detection. Read more about Gallbladder Cancer Filter Alphabet G
Gallbladder Polyps Gallbladder Polyps Home Overview Gallbladder polyps are growths or lesions that protrude from the lining of the gallbladder. Most are benign (non-cancerous), but some maybe malignant (cancerous), particularly larger ones. Types Cholesterol polyps: These are the most common gallbladder polyps and are often associated with cholesterolosis. Cholesterol polyps are generally benign.Adenomatous polyps: These are rue neoplasms with potential to become malignant (adenocarcinoma), and the cancer risk increases with size (>1 cm)Inflammatory polyps: These occur in response to chronic inflammation, often in chronic cholecystitis.Hyperplastic polyps: These are benign growths due to mucosal overgrowth, and generally, there is no cancer risk.Adenomyomatosis: This entity refers to hyperplasia (overgrowth) of the gallbladder wall, not is considered a true polyp; however, it may mimic one.Malignant polyps: These are rare and can progress to primary gallbladder carcinoma. Causes and risk factors The causes and risk factors of gallbladder polyps have been enumerated below.Accumulation of cholesterol and triglycerides in the gallbladder wall.Chronic inflammation (chronic cholecystitis).Abnormal cell growth due to genetic mutations (adenomatous polyps).Association with gallstones and biliary sludge.Risk factorsIndividuals aged over 50 years of age are more prone to polyp development and men are at a higher malignancy risk.Metabolic conditions:ObesityDyslipidaemiaMetabolic syndromeGallbladder-related conditions:GallstonesChronic gallbladder inflammation.A family history of gallbladder cancer or polyps is a risk factor. Symptoms Many gallbladder polyps are asymptomatic and discovered incidentally. When symptoms occur, they may include:Right upper quadrant painNausea and vomitingBloating or indigestionJaundice (rare, may indicate obstruction or malignancy) Diagnosis Various diagnostic modalities for gallbladder polyps have been enumerated below.Imaging tests:Ultrasound (first-line imaging): Ultrasound can detect polyps, measure polyp size, and assess gallbladder wall thickness.Endoscopic ultrasound (EUS): Provides more detailed imaging, especially for small or suspicious polyps.CT or MRI: Can evaluate larger polyps or suspected malignancy.MRCP (magnetic resonance cholangiopancreatography): Can visualise the biliary tree and gallbladder.Histological examination (if gallbladder is removed): Confirms the type of polyp and presence of cancer. Treatment Various treatment modalities based on gallbladder polyp size have been enumerated below.Small polyps (<1 cm, benign-looking): Regular follow-up with ultrasound every 6‒12 months. No treatment unless growth is detected or symptoms develop.Larger polyps (>1 cm or suspicious features): Cholecystectomy (gallbladder removal): recommended due to increased malignancy risk.Symptomatic polyps: Cholecystectomy is advised if symptoms like pain or inflammation occur.Malignant polyps: Radical cholecystectomy may be needed, sometimes with additional liver resection or lymph node dissection if cancer is present.Monitoring and Follow-UpPolyps <6 mm with no risk factors may not need frequent follow-up.Polyps 6-9 mm may require annual ultrasound monitoring.Immediate surgical evaluation for polyps >1 cm. Read more about Gallbladder Polyps Filter Alphabet G
Diffuse Lewy Body Disease (DLBD) Diffuse Lewy Body Disease (DLBD) Home Overview DLBD is progressive neurodegenerative brain disease refers to condition caused by alpha synuclein deposits in brain. These deposits are called Lewy bodies. It is accounted as the second most prevalent cause of dementia after Alzheimer’s disease. Causes The exact cause is unknownSome genes may elevate the risk of developing DLDB Risk factors Age >60 yearsFemale sexFamily history Symptoms Visual hallucinations are the hallmark of DLDBMovement disorders like bradykinesia, rigidity, tremorsCognitive problems- dementia, confusion, agitationFluctuation in sensoriumSleep disordersBehaviour and mood symptoms- depression, apathy, anxiety Specialist to approach Neurologist Diagnosis Clinical examinationMRI brain showing atrophy predominantly in occipital areasPET scan to show hypometabolism in these areasBrain biopsy (not done routinely) Treatment Medications (cholinesterase inhibitors, antipsychotics, antidepressants)Speech, cognitive therapyMovement disorders treatmentNo specific cure Read more about Diffuse Lewy Body Disease (DLBD) Filter Alphabet D
Cholangitis Cholangitis Home Overview Cholangitis is an inflammation of the bile ducts, which can disrupt the flow of bile from the liver to the intestines. It is often a serious condition requiring prompt medical attention. Types Acute cholangitis (ascending cholangitis): Caused by bacterial infection, often due to bile duct obstruction.Primary sclerosing cholangitis (PSC): Chronic, progressive disease leading to scarring and narrowing of bile ducts. Often associated with inflammatory bowel disease (IBD).Secondary sclerosing cholangitis: Resulting from a secondary cause like infection, trauma, or ischemia. IgG4-related cholangitis: Autoimmune condition, often linked with IgG4-related disease.Recurrent pyogenic cholangitis: Common in East Asia, characterized by recurrent infections with stone formation. Causes and risk factors There are many causes and risk factors for this condition, these include:Infections:Bacterial infections (e.g., E. coli, Klebsiella, Enterococcus)Parasites (e.g., liver flukes)Obstructions:GallstonesBile duct stricturesTumours (e.g., cholangiocarcinoma)Autoimmune:IgG4-related cholangitis, PSCIatrogenic:Post-surgical or post-endoscopic procedures (e.g., ERCP)History of IBD (e.g., ulcerative colitis in PSC) Symptoms Multiple symptoms exist depending on the type of disease. These have been enumerated below.Acute cholangitis (Charcot's Triad):Fever and chillsRight upper quadrant abdominal painJaundiceObstructive ascending cholangitis (Reynolds' Pentad):Fever and chillsRight upper quadrant abdominal painJaundiceHypotension (low blood pressure)Altered mental status.Chronic cholangitis (e.g., PSC):FatiguePruritus (itching)Progressive jaundiceWeight loss Diagnosis Multiple types of diagnostic modalities are available cholangitis; these include:Blood tests:Liver function tests: Elevated ALP, GGT, AST, ALT, and bilirubin levelsComplete blood count (CBC) test: Leukocytosis (high white blood cell (WBC) countsAutoimmune marker analysis: Elevated IgG4 and ANCA (in PSC)Imaging:Ultrasound: Detects bile duct dilationMRCP (Magnetic resonance cholangiopancreatography): Non-invasive visualisation of bile ductsERCP (Endoscopic retrograde cholangiopancreatography): For diagnosing and treating cholangitisMicrobiological studies: Blood cultures in suspected infection Treatment Treatments vary depending on the type of cholangitis; the same have been enumerated below.Acute cholangitis:Antibiotics: Broad-spectrum targeting gram-negative and anaerobic bacteria.Biliary decompression: Via ERCP or percutaneous drainage if obstructedSupportive care (intravenous (IV) fluids, pain medication)Primary sclerosing cholangitis (PSC):No curative treatment; focus on symptom control.Ursodeoxycholic acid (UDCA) may help bile flow.Liver transplant in advanced cases.IgG4-related cholangitis: Steroids or other immunosuppressantsRecurrent pyogenic cholangitis: Antibiotics and removal of stone Read more about Cholangitis Filter Alphabet C
Gallbladder Stone Disease Gallbladder Stone Disease Home Overview Gallbladder stone disease, also known as cholelithiasis, refers to the presence of gallstones (solid crystals) in the gallbladder. These stones can vary in size from tiny grains to large stones and can obstruct the normal flow of bile. This blockage can lead to various symptoms, including pain and inflammation, and may result in complications if not properly managed. Types Gallstones can be of various types, including:Cholesterol gallstones: These are the most common type of gallstones and are usually yellow or green in colour.Pigment gallstones: These are made of excess bilirubin (a substance that is released the when red blood cells break down) and are dark brown or black in colour. Pigment gallstones are more common in individuals with medical conditions, like cirrhosis, biliary tract infection, and sickle cell anaemia.Mixed gallstones: These gallstones are made up of cholesterol, bilirubin, and calcium salts. Causes and risk factors There are multiple causes and risk factors for gallbladder stone disease; these include:Excess cholesterol: When the liver produces too much cholesterol, the gallbladder is not able to properly break it down; this leads to the formation of cholesterol stones.Excess bilirubin: Certain conditions like liver disease or haemolytic anaemia result in increased production of bilirubin, which may then be used to form pigment gallstones.Incomplete emptying of the gallbladder: If the gallbladder does not empty completely—or often enough—bile can become concentrated and form stones.Obesity: Being overweight or obese results in increased cholesterol levels, thereby contributing to the formation of gallstones.Pregnancy: Hormonal changes during pregnancy, particularly increased oestrogen levels, may lead to gallstone formation.Diabetes: Increased blood sugar levels and high insulin levels can promote the formation of gallstones.Age: The risk for gallstone disease increases after 40 years of age.Gender: Women are more likely than men to develop gallstones owing to the effects of oestrogen and progesterone, which increase the cholesterol levels.Family history: A family history of gallstones increases the risk of developing gallstones.Cholesterol-lowering medications: Certain medications, like cholesterol-lowering drugs (e.g., statins), may increase the risk of gallstone formation.Rapid weight loss: Speedy weight loss (e.g., through very low-calorie diets or weight-loss surgery) can cause the liver to release more cholesterol into the bile, increasing the likelihood of stone formation.Other medical conditions: Conditions like diabetes, cirrhosis, Crohn's disease, and certain blood disorders (such as sickle cell disease) increase the risk of developing gallstones. Symptoms Many individuals with gallstones do not experience any symptoms ("silent gallstones"); however, when symptoms do occur, they can include:Abdominal pain: Often in the upper right abdomen or the centre of the abdomen. Can be severe and last from a few minutes to several hours (gallbladder attack).Nausea and vomiting: Especially after eating fatty foods.Indigestion: Bloating, heartburn, and gas.Jaundice: Occurs when a stone blocks a bile duct and prevents bile from draining properly.Dark urine or pale stool: Caused by the blockage of bile flow.Fever: If the gallstones cause an infection or inflammation (cholecystitis), fever and chills may occur. Diagnosis The diagnostic modalities for gallbladder stone disease have been enumerated below.Imaging tests:Ultrasound: The most common and reliable test for detecting gallstones.CT: Can be used to identify gallstones, but it is not as sensitive as ultrasound.MRI: A magnetic resonance imaging (MRI) scan with a special focus on the biliary system can help detect stones in the bile ducts.Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used both for diagnosing and treating gallstones that may be blocking the bile ducts. It involves using a flexible tube with a camera to view the bile ducts.Blood tests: Bile duct blockage can result in elevated levels of bilirubin or liver enzymes. Treatment Treatment depends on the symptoms manifested and the size and type of gallstones.Non-surgical treatments:Medications: Medications like ursodeoxycholic acid can dissolve cholesterol stones, but they are usually only effective for small stones and may take months or years to work.Shock wave lithotripsy: A technique where shock waves are used to break up large stones, making them easier to pass.Surgical treatments:Cholecystectomy: The most common treatment for symptomatic gallstones. It involves the surgical removal of the gallbladder, usually through minimally invasive laparoscopic surgery. After this procedure, bile flows directly from the liver into the small intestine.Endoscopic surgery: If the stones are stuck in the bile ducts, a procedure like ERCP may be used to remove them without requiring full gallbladder removal.Dietary changes: Though dietary changes cannot result in the dissolution of existing gallstones, a low-fat, high-fibre diet can help manage symptoms and prevent new stones from forming.Lifestyle modifications: Maintaining a healthy weight, avoiding rapid weight loss, and exercising regularly can help reduce the risk of developing gallstones in the future. Prevention Healthy Eating: A balanced, low-fat diet with plenty of fibre can help reduce the risk of gallstones.Regular exercise: Staying active can help maintain a healthy weight and reduce the risk of developing gallstones.Gradual weight loss: Losing weight at a slow and steady rate can help prevent gallstone formation. Read more about Gallbladder Stone Disease Filter Alphabet G
Liver cancer Liver cancer Home Overview Liver cancer, also known as hepatic cancer, occurs when malignant cells form in the tissues of the liver. The liver is a vital organ responsible for functions such as detoxifying the body, producing bile, and synthesising proteins, making liver cancer particularly concerning. Hepatocellular carcinoma (HCC) is the most common type of liver cancer, but there are also other forms like cholangiocarcinoma (bile duct cancer) and rare types like hepatoblastoma (found mainly in children). Types Hepatocellular carcinoma (HCC):The most common type of liver cancer, making up around 75-85% of cases. It originates in the liver cells (hepatocytes).Cholangiocarcinoma (bile duct cancer):Cancer that starts in the bile ducts inside or outside the liver. It’s less common than HCC.Hepatoblastoma:A rare and aggressive form of liver cancer, primarily affecting children.Angiosarcoma and hemangiosarcoma:Rare cancers that originate in the blood vessels of the liver. Causes Chronic liver disease:Long-term conditions like cirrhosis (scarring of the liver) or chronic hepatitis B or C infections are primary causes. The damage to liver cells can lead to cancer over time.Cirrhosis:This is often caused by alcohol abuse, hepatitis, fatty liver disease, or other liver conditions.Hepatitis B and C:Both viral infections can increase the risk of liver cancer by causing chronic liver inflammation and damage.Fatty liver disease:Non-alcoholic fatty liver disease (NAFLD) is associated with obesity, diabetes, and high cholesterol, which increase cancer risk.Aflatoxin exposure:A toxin produced by mold in certain grains and nuts, which can increase liver cancer risk.Inherited liver diseases:Conditions like hemochromatosis (excess iron accumulation) or Wilson’s disease (copper buildup) can increase risk.Tobacco and alcohol use:Smoking and heavy drinking damage the liver and increase the likelihood of developing liver cancer. Risk Factors Chronic viral infections:Hepatitis B or C.Alcohol consumption:Long-term alcohol abuse is a major risk factor for cirrhosis, leading to liver cancer.Obesity and diabetes:Both conditions contribute to the development of non-alcoholic fatty liver disease (NAFLD), which raises cancer risk.Gender and age:Men are more likely to develop liver cancer, and the risk increases with age, typically occurring in people over 50.Family history:A family history of liver cancer or chronic liver disease can increase risk.Exposure to chemicals:Chemicals such as vinyl chloride and arsenic have been linked to a higher risk of liver cancer. Symptoms Unexplained weight loss:One of the most common symptoms of liver cancer.Loss of appetite:Feeling full after eating only a small amount or a loss of interest in food.Abdominal pain:Pain or a feeling of fullness in the upper right side of the abdomen, where the liver is located.Jaundice:Caused by a buildup of bilirubin.Fatigue and weakness:Chronic tiredness or a feeling of weakness.Abdominal swelling (ascites):Legs and feet may swell due to fluid retention.Nausea and vomiting:Digestive issues often accompany liver cancer.Itchy skin:An uncommon but possible symptom. Diagnosis Physical examination:A doctor will check for signs of liver enlargement or tenderness.Blood tests:Alpha-fetoprotein (AFP): Elevated levels of AFP may indicate liver cancer, although it can also be high in other liver conditions.Imaging tests:Ultrasound: Often the first imaging test to identify liver tumours.CT: Helps provide detailed images of the liver.MRI (Magnetic Resonance Imaging): Used for a more detailed assessment of liver cancer and surrounding structures.Biopsy:A biopsy may be done to confirm the diagnosis. A small sample of liver tissue is removed for examination.Liver function tests:To assess how well the liver is working. Treatment The treatment depends on the stage, type, and overall health of the patient.Surgical options:Liver resection: Removal of part of the liver if the cancer is localized.Liver transplant: In cases where the liver is severely damaged or cancer has spread to the entire liver.Ablation therapy:Radiofrequency ablation (RFA): Uses heat to destroy cancer cells.Microwave ablation: Similar to RFA but uses microwave energy.Ethanol injection: Injecting alcohol directly into the tumour to destroy it.Chemotherapy:Traditional chemotherapy: Drugs used to target and kill cancer cells, although liver cancer is often resistant to chemotherapy.Transarterial chemoembolization (TACE): Delivers chemotherapy directly to the tumour and cuts off its blood supply.Immunotherapy:Checkpoint Inhibitors: Drugs like pembrolizumab (Keytruda) or nivolumab (Opdivo) stimulate the immune system to recognize and attack cancer cells.Cytokine Therapy: Uses substances like interleukin-2 (IL-2) to help the immune system fight cancer.Targeted therapy:Sorafenib (Nexavar) or Lenvatinib (Lenvima) target specific pathways that allow liver cancer cells to grow.Radiation therapy:Used in certain situations to target specific tumours, though it’s not commonly used for liver cancer.Palliative care:For patients with advanced liver cancer, palliative care focuses on relieving Read more about Liver cancer Filter Alphabet L
Diabetic Neuropathy Diabetic Neuropathy Home Overview Diabetic neuropathy is the commonest cause of neuropathies worldwide. It is often observed in patients with poor sugar control or long-standing diabetes mellitus. Causes The exact cause remains unknown Risk factors Poor blood sugar controlDuration of diabetesKidney diseaseBeing overweightSmoking Types, their symptoms, and treatment methods Diabetic polyneuropathyThis condition presents as a distal, symmetrical sensory neuropathy, predominantly affecting the toes and progressing up to knees in a glove-and-stocking distribution. It may be associated with autonomic dysfunction.SymptomsNumbness, tingling, and burning sensations in the feetWeakness in small muscles of the feetAbsence of ankle and/or knee reflexesSpecialist to approach NeurologistDiagnosisNerve conduction studies- reveal mixed axonal and demyelinating changesNerve biopsy is rarely neededTreatmentFoot care to prevent diabetic ulcersRegular ophthalmologic and renal evaluationsTight glycaemic controlMedications for neuropathic pain (e.g., gabapentin, pregabalin, carbamazepine, amitriptyline, lamotrigine)Diabetic cachectic neuropathy (Acute painful neuropathy of DM)This condition is commonly seen in older men with poorly controlled diabetes and significant loss of weight.SymptomsBurning, allodynia, and hypersensitivitySpontaneous recovery with improved control over diabetesInsulin neuritis- Painful neuropathy onset during insulin therapy that improves with better management of diabetesDiabetic lumbosacral radiculo-plexus-neuropathy (Bruns–Garland syndrome)Typically affects men over age 50 with type 2 diabetes.SymptomsSudden, unbearable pain in the hips, back, hips, thighs, followed by progressive proximal muscle weakness and atrophyDiagnosisNerve conduction tests to assess distal sensory diabetic neuropathyElectromyography to detect changes in denervation related to paraspinal, proximal, and distal musclesMRI (with contrast) of the lumbosacral spine and plexus for signs of infiltrationCSF testing for malignancy changesNerve tests can sometimes show microvasculitisTreatmentStrict diabetic controlSteroids and intravenous immunoglobulin treatment is uncertainPain managementMost patients recover without interventionDiabetic truncal radiculoneuropathyThis rare complication causes pain and discomfort in the trunk.SymptomsSudden onset of radicular pain with burning sensation over the thoracic spine, chest, ribs, or abdomen.Weakness in respiratory or abdominal musclesTreatmentRecovery within 2-6 months without interventionCranial neuropathiesThese involve damage to the third and sixth cranial nerves, which control sensation and facial and eye movements.SymptomsPain, tingling, numbnessAltered smell or tasteSensitive skinTinnitus or ringing in the earsWeakness or paralysis of muscles, leading to issues like drooling, choking, or slurred speechVision changes, including double visionDiagnosisMagnetic resonance angiography (MRA) to rule out posterior communicating artery aneurysmTreatmentMedicationRadiosurgeryMicrovascular decompression (MVD)Peripheral nerve stimulation (supraorbital and infraorbital)Percutaneous Glycerol RhizotomyRecovery typically within 3 monthsMononeuropathiesThis type of neuropathy results from damage to a peripheral nerve, often caused by injury.SymptomsLoss of sensation or weakness in the affected areaPain or burning sensationTingling or “pins and needles” feelingIncreased risk of compression injuries like carpal tunnel syndrome, ulnar nerve entrapment, and peroneal nerve damageTreatmentRemoving pressure from the affected nerveSplints to immobilize the areaCorticosteroid injectionsTreatment of any underlying medical conditionsSurgery to relieve pressure if other treatments fail Read more about Diabetic Neuropathy Filter Alphabet D
Dementia Dementia Home Overview Dementia is characterized as a syndrome involving the gradual decline of cognitive function in two or more domains, leading to difficulties in daily activities. These cognitive domains include memory, abstract reasoning, language, praxis, perception, visuospatial skills, personality, and social behaviour. By the age of 60, approximately 1% of the population is prone to dementia. Causes Alzheimer’s diseaseBenign tumours (e.g. subdural haematoma or subfrontal meningioma)Cortical Lewy body diseaseCerebrovascular diseaseCorticobasal degenerationCJDCADASILDepressive pseudodementiaFrontotemporal dementia (10%)HIVHypothyroidismNormal pressure hydrocephalusSyphilisVitamin B12 deficiency Risk factors AgingLack of physical activitySmokingExcessive alcohol intakeObesityUnhealthy eating habitsUncontrolled blood pressure and cholesterol and blood sugar levelsDepressionSocial isolationLow educational levelCognitive inactivityAir pollution Specialist to approach Neurologist Diagnosis Primary investigationsComplete blood count (CBC) and erythrocyte sedimentation rate (ESR)Standard biochemical testsThyroxine (T4) level assessmentVitamin B12 concentration levelsSerological testing for syphilis (e.g., VDRL and TPHA)Chest X-ray (CXR)Brain imaging via CT or MRIComprehensive neuropsychological evaluationSecondary investigationsCerebrospinal fluid (CSF) analysisTesting for HIV infectionGenetic analysisElectroencephalography (EEG)Volumetric MRISingle-photon emission computed tomography (SPECT)Brain tissue biopsy Treatment Dementia cannot be cured. However, the following are used to bring about temporary relief from symptoms:Cholinesterase inhibitorsMemantineLecanemab (Leqembi) and donanemab (Kisunla) approved by the USFDAMedicines for depression, sleep problems, hallucinations, parkinsonism, or agitation Read more about Dementia Filter Alphabet D