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Gastritis

Management Team

Gastritis

Overview

Gastritis is a condition wherein the inner layer of the stomach wall (gastric lining) that secretes key molecules required for digestion gets inflamed. This inflammation can cause symptoms, such as pain, nausea (sensation of vomiting), and indigestion, and in severe cases, it may also damage the stomach lining, potentially leading to ulcers, bleeding, or even an increased risk of stomach cancer.

Broadly speaking, gastritis is of the following three types:

  • Acute gastritis: It refers to the sudden inflammation of the gastric lining that is usually caused by irritants, such as alcohol or infection.
  • Chronic gastritis: It refers to the persistent (long-term) inflammation that is caused by persistent bacterial infection (particularly Helicobacter pylori), prolonged use of certain medications, or autoimmune conditions.
  • Erosive gastritis: This is a more severe form of gastritis wherein the stomach lining develops erosions or ulcers.

Gastritis has various causes; these have been enumerated below.

  • Infection:
    • Bacterial infections: Helicobacter pylori (H. pylori) is the leading cause of gastritis. It can damage the protective lining of the stomach, leading to inflammation. It is known to cause both acute and chronic gastritis and is associated with the occurrence of peptic ulcers as well as gastric cancer.
    • Oher infections: Infections caused by other entities, such as viruses, fungi, or parasites can also cause inflammation, though they are less common.
  • Medications:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Chronic (prolonged and persistent) use of NSAIDs like ibuprofen and aspirin is particularly problematic as they can irritate the stomach lining, leading to gastritis. These are linked to all three types of gastritis.
    • Corticosteroids: Medications like corticosteroids that reduce stomach acid can also contribute to the development of gastritis.
  • Alcohol abuse: Alcohol acts as an irritant and can wear away the stomach lining, leading to all three types of gastritis. Alcohol also increases the risk of stomach bleeding.
  • Bile reflux: When bile produced by the liver backflows into the stomach (bile reflux), the stomach lining gets inflamed, leading to gastritis. This condition is associated with both chronic and acute gastritis.
  • Autoimmune reactions: Long-term (chronic) is caused when the body’s immune surveillance mechanism erroneously targets cells lining the stomach.
  • Stress: Physical stress (due to surgery, injury, or illness) or emotional stress may exacerbate gastritis symptoms or contribute to its development, though it is not usually the primary cause.
  • Other causes:
    • Smoking: Nicotine, the key component of tobacco, can increase stomach acid production even in the absence of food, resulting in higher acidity. Excess acid can irritate the stomach lining, thereby causing gastritis.
    • Dietary factors: Very spicy foods or large meals can irritate the stomach lining, especially when it is already inflamed, thereby causing gastritis.

Common symptoms of gastritis have been described below.

  • Upper abdominal pain: The key features of gastritis, i.e., increased gastric acid production, irritation, inflammation, and damaged gastric lining result in a burning or gnawing pain in upper abdomen, a place where the stomach is situated.
  • Nausea (feeling to vomit) and vomiting: Excess acid in the stomach causes the stomach to send signals to the brain to induce nausea and vomiting (possibly with blood in severe cases).
  • Indigestion (dyspepsia): Irritation and inflammation of the stomach lining lead to an imbalance in stomach acid production and delayed gastric emptying, which contributes to symptoms of indigestion, like pain, bloating, feeling full, and nausea.
  • Loss of appetite: The combination of irritation, inflammation, pain, acidity, nausea, and bloating might result in loss of appetite in some individuals.
  • Black, tarry stools: Gastrointestinal bleeding due to excess gastric acid production might result in black tarry stools, which require immediate medical attention.
  • Vomiting blood: In severe cases of gastritis due to excess gastric production and eroded gastric lining the stomach lining may bleed, leading to blood in the vomit.

Gastritis involves several tests and examinations; these include:

  • Physical examination: Palpation (physical examination) might reveal bloating and tenderness in the abdomen, which along with medical history might indicate gastritis.
  • Endoscopy (EGD): EGD can help identify inflammation, ulcers, or other abnormalities in the stomach.
  • Biopsy: Tissue sample collected during endoscopy can help detect infections (e.g., H. pylori), autoimmune gastritis, or gastric cancer.
  • Blood tests: Blood tests may help detect signs of anaemia (a sign of bleeding gastritis) or infections (e.g., H. pylori).
  • Stool test: This test can provide information as to whether there is gastrointestinal bleeding (blood in the stool) or infection (pathogen in stool).
  • Urea breath test: This test can detect H. pylori infection by measuring certain the carbon dioxide produced by the bacteria upon breaking down urea.

Common approaches to treat gastritis include:

  • Medications:
    • Antibiotics: If H. pylori is the causative agent, antibiotics (such as clarithromycin, amoxicillin, or metronidazole) are prescribed to eradicate the bacteria.
    • Proton pump inhibitors (PPIs): Drugs, like omeprazole, lansoprazole, and esomeprazole decrease the amount of gastric acid produced, thereby providing relief in gastritis.
    • H2-receptor antagonists: Similar to PPIs, drugs like famotidine and ranitidine also decrease the amount of stomach acid produced and can provide relief in gastritis.
    • Antacids: Prescription-free medications, like calcium carbonate and magnesium hydroxide can help neutralise stomach acid, thereby providing relief from discomfort.
    • Cytoprotective agents: Medications like sucralfate may be used to help protect the stomach lining from further irritation.
    • Antiemetics: If nausea is a significant symptom, anti-nausea medications (like ondansetron) may be prescribed.
  • Lifestyle modifications:
    • Avoiding alcohol and NSAIDs: Limiting alcohol consumption and avoiding drugs like ibuprofen or aspirin (unless otherwise directed by your doctor) can prevent further irritation of the stomach lining.
    • Eating smaller meals: Consuming smaller meals though, more frequently can help reduce stomach irritation.
    • Avoiding spicy, acidic, and fatty foods: Spicy, acidic, or fat-rich foods can exacerbate gastritis, therefore a bland diet, with foods like rice, oatmeal, and bananas, may be recommended during flare-ups.
    • Managing stress: Techniques for managing stress, such as deep breathing, meditation, yoga, and exercise can help reduce gastritis symptoms, especially in individuals with stress-related gastritis.
  • Endoscopic treatment: If there is significant bleeding or ulcers, endoscopic procedures may be needed to stop the bleeding or remove damaged tissue.
  • Surgery: In rare cases, if gastritis causes severe complications like perforation (a hole in the stomach lining), surgical intervention may be necessary.

Please consult a healthcare professional if you observe any symptoms of gastritis. Seek immediate medical attention if you experience any of the following:

  • Persistent or severe abdominal pain
  • Vomiting blood
  • Black, tarry stools, which can indicate gastrointestinal bleeding

Gastritis can be prevented by taking the following steps:

  • Limiting alcohol consumption: Avoid excessive drinking, which can irritate the stomach lining.
  • Using NSAIDs cautiously: Take NSAIDs only as prescribed, and try to avoid long-term use. If you need pain relief, consider alternatives like acetaminophen.
  • Washing hands regularly: This can help prevent H. pylori infection, especially in areas with poor sanitation.
  • Avoiding spicy and irritating foods: Avoid foods that can aggravate an already inflamed stomach lining.
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Mammography

Management Team

Mammography

Overview

A mammogram is a specialized X-ray of the breast showing small details of breast tissue performed. It is performed both as a screening test and as a diagnostic exam.

The early detection of breast cancer can lead to early treatment. Mammograms can detect breast changes that may or may not be felt during a physical examination, including small changes requiring further investigation. The images are then interpreted by a radiologist.

  • A screening mammogram is used to detect early breast cancer in women with no symptoms. Screening mammography can begin at 40 years of age (according to latest American College of Radiology and Society of Breast Imaging guidelines), but some women at high risk of breast cancer may need to start earlier. Discussion with your doctor about your risk for breast cancer and when you should get screened would be worthwhile.
  • Diagnostic mammogram is done to evaluate abnormal clinical findings, such as a breast lump or nipple discharge identified by the woman or her doctor. Diagnostic mammography may also be performed after an abnormal screening mammogram to further evaluate the area of concern.

Breast tomosynthesis or 3D mammography is a new technique wherein images in multiple slices of entire breast are taken to better aid in determining size, shape, and location of an abnormality. Global research has shown better cancer detection rates and a decrease in call backs when compared to using conventional 2D mammography.

Mammograms typically involve a small radiation dose, and thus, the health risk is very low. The radiation does not remain in the patient’s body after the test. The benefits of detecting small tumours far outweigh the risk associated with radiation exposure.

In case you are pregnant or breast-feeding, it is vital to inform prior to undergoing the mammogram. Another appropriate alternative like an ultrasound scan may be performed, if deemed pertinent. 

  • No fasting is required
  • Please bring all your previous investigations (films and reports) when you come for the test
  • You will be asked to undress waist upwards
  • If you have undergone breast implant surgery, any previous breast surgery, chemoport insertion or pacemaker, please inform the technician when you come to the mammography room
  • Avoid wearing perfume, lotion, powder or deodorant on your breasts and underarms as it may affect image quality.
  • Fall risk assessment: If you have any prior history of vertigo, giddiness, vasovagal attacks, difficulty in standing, please inform the technician in the mammogram room.
  • You will be asked to sign a consent form, which states that you agree to undergo the test and understand what it involves.

Pressure may be felt as each breast is squeezed by the compression paddle. If you experience any discomfort, please inform the technologist. During tomosynthesis, the tube rotates in an arc-like fashion; therefore, your face and other body parts must remain away from the tube to avoid artefacts.

The images will be interpreted by a radiologist and sometimes a follow-up is necessary to further evaluate an area of concern. Though it may seem alarming, many women are called back to help in preparing the most accurate report. If the radiologist spots a potential area of concern, you may be asked to return for additional diagnostic mammogram images or ultrasound.

No special instructions need to be followed, and one can pursue normal activities.

Dense breast tissue makes it difficult to see a cancer on mammogram. In such scenarios, a sonomammogram (breast ultrasound) may be suggested for additional evaluation. Breast implants may block a clear view of tissues underneath and it is advisable to inform the technologist prior to the test.

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Bile Duct Stones

Management Team

Bile Duct Stones

Overview

Bile duct stones (also called choledocholithiasis) are solid particles that form in the biliary ducts. These stones can interfere with bile flow, which results in various complications and symptoms. If left untreated, they may cause pain, jaundice, or inflammation of the entire biliary system (cholangitis).

Based on the origin of bile stones, they can be classified into two categories.

  • Primary bile duct stones: These originate in the bile ducts. They are less common and usually occur in people with conditions that affect bile flow or the chemical composition of bile (e.g., chronic biliary infections or strictures).
  • Secondary bile duct stones: These typically originate in the gallbladder and then relocate to the bile ducts. The stones are usually cholesterol-based. Generally, secondary bile duct stones are more common than primary bile duct stones and are cholesterol-based.

Bile ducts can be attributed to multiple factors, including:

  • Abnormal bile composition: If bile has too much cholesterol or too little bile salts, it can lead to stone formation. Conditions like gallbladder disease, biliary cirrhosis, or chronic liver disease can affect bile composition.
  • Bile duct stricture or narrowing: A bile duct stricture or narrowing, often caused by inflammation, infection, or scarring (from previous surgeries, injury, or certain diseases), can make it easier for stones to form and become trapped in the bile duct.
  • Chronic biliary infections: Long-term infections of the bile ducts (e.g., ascending cholangitis) can increase the risk of stone formation due to changes in bile composition.
  • Other medical conditions: Diseases like cirrhosis and pancreatitis, and haematological disorders like sickle cell disease or thalassemia can also predispose individuals to the formation of bile duct stones.
  • Age and gender: Individuals over 40, especially women are at high risk of developing gallstones, and by extension, bile duct stones.

When a bile duct stone blocks the bile duct, it can cause a range of symptoms, particularly if the stone causes a biliary obstruction or leads to complications like cholangitis or pancreatitis. Common symptoms include:

  • Jaundice: This occurs due to obstruction of bile flow, resulting in bilirubin accumulation in blood, which in normal cases is excreted in bile.
  • Dark urine: This occurs due to excess bilirubin in the bloodstream.
  • Pain: When a stone obstructs bile flow, an intense pain in the right upper abdominal region referred to as biliary colic can occur.
  • Fever and chills: These are signs of cholangitis (bile duct infection), which is a potentially serious complication of bile duct stones.
  • Nausea and vomiting: These symptoms may accompany biliary colic or other complications, particularly in case of bile duct infection or inflammation.
  • Clay-coloured stools: This happens when bile (which gives stool its characteristic brown colour) cannot reach the intestine due to the blockage.

To diagnose bile duct stones, doctors may use a combination of the following methods:

  • Ultrasound: Often it is the first imaging test performed. An abdominal ultrasound can detect gallstones, and in many cases, bile duct stones.
  • Endoscopic retrograde cholangiopancreatography (ERCP): The ERCP procedure involves using endoscopy in conjunction with X-ray scanning to examine the bile ducts and pancreas. ERCP is both diagnostic and therapeutic, as it can be used to remove or retrieve stones from the bile ducts.
  • Magnetic resonance cholangiopancreatography (MRCP): This non-invasive MRI-based technique can identify stones or blockages in the bile ducts.
  • CT scan: This can also help identify bile duct stones, especially if there is suspicion of complications such as pancreatitis.
  • Blood tests: These can help identify liver dysfunction, infection, or bile stone-induced obstruction based on elevated levels of liver enzymes (e.g., ALT, AST) and bilirubin, and increased white blood cell counts.

Common treatment options for bile duct stones include:

  • Endoscopic removal (ERCP): This is the most common treatment for bile duct stones, especially if there is a blockage or infection. ERCP can be used to extract stones from the bile duct using specialised tools passed through a flexible tube inserted into the duodenum.
  • Surgery: This modality might be used to extract bile duct stones or treat complications like bile duct strictures. Cholecystectomy (removal of the gallbladder) may also be performed to prevent further stone formation in the future, as it is often the source of the stones.
  • Medications: Although not as common, medications like ursodeoxycholic acid may be used in some cases to dissolve cholesterol stones. This is typically more effective for gallstones than for bile duct stones.
  • Percutaneous transhepatic cholangiography (PTC): If ERCP is not successful or available, this procedure can be used to access the bile ducts through the skin and remove stones.

While it is not always possible to prevent bile duct stones, certain lifestyle modifications can reduce bile duct stone risk:

  • Maintaining a healthy weight: This is important as obesity is associated with enhanced formation of gallstones, which relocate to the biliary system as bile duct stones.
  • Eating a balanced diet: A low-fat and high-fibre diet can help reduce gallstone risk.
  • Managing underlying conditions: Managing pre-existing health issues, like diabetes, high cholesterol, or liver disease, can help lower the risk of bile duct stones.
  • Avoiding rapid weight loss: This is associated with increased risk of gallstone formation, hence when going for weight loss, one should aim for gradual, steady weight loss.
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Bone Density Testing

Management Team

Bone Density Testing

Overview

The weight of our entire body is borne by the bones that make up our skeletal system. Every movement needs muscles that move the bones to allow varied range of movements. The strength of the bones, particularly in the important weight bearing areas, is important in preserving health and quality of life.  

The measurement of bone density allows us to learn about the risks of bone fracture. For several reasons, some people have reduced bone density, which increases the risk of fractures and can take away the ability to lead a healthy and fulfilling life.

The bone density is measured using a technique called Dual Energy X Ray Absorptiometry (DEXA). This technique can measure several components comprising the body and bones, which allows one to decide risk of having fractures and whether specific treatment is required to improve the strength of the bones.

  • Tell you if you have reduced bone density
  • Predict you risk of having a fracture in the future
  • Measure if the bone density is improving or getting worse
  • Monitor treatment outcomes

  • Anyone with a fracture and who the doctor may suspect to have reduced bone density
  • Women after menopause, particularly if they have risk factors
  • Men over 70 years of age or earlier if they have certain risk factors
  • Patients with an X-ray of the spine showing a bone with fracture or density loss
  • Patients with back pain
  • Patients with height loss

If you are on medicines for correcting bone density, the test should be repeated once a year or once every two years at the very least. Your doctor will decide how often you need testing depending on your condition.

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B

Liver Cirrhosis

Management Team

Liver Cirrhosis

Overview

Cirrhosis is characterised by the progressive replacement of healthy liver tissue with the scar tissue (fibrosis), which disrupts key liver functions, such as detoxification, bile secretion, clotting factor production, and nutrient storage in addition to impairing normal blood flow to the liver, ultimately resulting in life-threatening complications. Importantly, the regeneration capacity of the liver is also compromised by the scar tissue formed in cirrhosis; therefore, in advanced stages of the disease, the liver is unable to regenerate and start functioning properly, i.e., permanent loss of function. Thus, cirrhosis is the final stage of chronic liver disease. Cirrhosis can be attributed to various factors, including persistent inflammation of the liver, fatty liver disease (N/AFLD), viral hepatitis, and certain inherited conditions.

Cirrhosis can be attributed to the following factors:

  • Excessive and prolonged (chronic) alcohol consumption
  • Hepatitis:
    • Chronic viral hepatitis: Viral infections result in significant liver damage as viral clearance involves killing of the cells harbouring the virus. Especially, Hepatitis B and C viruses can cause more liver damage (compared to other Hepatitis viruses) as they are more persistent (chronic), causing chronic liver inflammation that progressively leads to scarring, eventually culminating in cirrhosis.
    • Autoimmune hepatitis: Killing of self-liver cells by the immune surveillance machinery causes chronic inflammation (a hepatitis hallmark), which then progresses to scarring (fibrosis), and eventually cirrhosis.
  • Fatty liver: Accumulation of fat in the liver results in inflammation, which over time induces scarring, and ultimately leads to cirrhosis.
  • Genetic disorders: Certain inherited conditions can lead to cirrhosis; these include:
    • Wilson’s disease (copper overload)
    • Haemochromatosis (iron overload)
    • Alpha-1 antitrypsin deficiency (a disorder that can cause liver damage).
  • Biliary diseases: Diseases of the biliary system, such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) cause bile duct damage, resulting in bile buildup in the liver, which causes inflammation that ultimately culminates in scarring and cirrhosis.
  • Medications and toxins: Long-term use of certain medications (e.g., methotrexate, isoniazid) and exposure to industrial toxins or chemicals can cause liver damage and cirrhosis.
  • Chronic heart failure: Severe, long-standing heart failure can cause liver congestion, a condition where blood pools in the liver and associated blood vessels, this causes liver tissues to become stressed due to lack of oxygen and bile acid accumulation, ultimately leading to liver damage and cirrhosis (cardiac cirrhosis).
  • Other causes: Conditions like gallstones and hepatocellular carcinoma (liver cancer) can also contribute to cirrhosis.

Cirrhosis, in its early stages may be asymptomatic (no obvious symptoms); however, as it progresses, the symptoms become more pronounced and may include:

  • Fatigue
  • Jaundice
  • Abdominal pain
  • Swelling (oedema
  • Nausea and loss of appetite
  • Easy bruising or bleeding
  • Spider angiomas: These are small, red, spider-like blood vessels visible under the skin, often on the chest and upper body.
  • Hepatic encephalopathy: The buildup of toxins like ammonia in the blood owing to the impaired detoxification function of the liver might result in hepatic encephalopathy, which manifests as confusion, altered mental status, forgetfulness, and even coma.
  • Pruritus (itching)
  • Dark urine and pale stools
  • Impaired clotting

  • Physical examination: Cirrhosis can be diagnosed by looking for signs, such as jaundice, ascites, an enlarged liver (hepatomegaly), or an enlarged spleen (splenomegaly) in clinical examination.
  • Blood tests:
    • Liver function tests: To evaluate the levels of liver enzymes (ALT, AST), bilirubin, and albumin, and determine the prothrombin time (clotting function)
    • Complete blood count (CBC): To check for anaemia, low platelet counts, or signs of bleeding
    • Ammonia level assessment: To detect hepatic encephalopathy
  • Imaging:
    • Ultrasound: To detect liver size and shape, and signs of cirrhosis, such as nodularity and ascites
    • CT: To detect complications like liver cancer
    • MRI: To assess liver fibrosis and portal hypertension
  • Elastography (FibroScan): To assess the degree of fibrosis based on measurement of liver stiffness
  • Liver biopsy: This may be performed to assess the degree of fibrosis and confirm cirrhosis. However, liver biopsy is usually reserved for cases where other diagnostic methods are inconclusive.

The treatment of cirrhosis is aimed at managing symptoms, preventing complications, and addressing the underlying cause. While cirrhosis is not reversible, interventions can slow the progression and improve quality of life.

  • Treating the underlying cause:
    • Alcohol abstinence: In case of alcohol abuse-induced cirrhosis, stopping alcohol consumption is crucial in preventing further liver damage.
    • Antiviral therapy: In case of viral hepatitis-induced cirrhosis, antiviral medications can reduce viral load and prevent further liver damage.
    • Weight management: For patients with NAFLD or NASH, weight loss through diet and exercise is important for managing liver fat and improving liver function.
    • Medications:
      1. Antiviral medications: These are used to manage viral hepatitis.
      2. Immunosuppressive drugs: These are used to manage autoimmune hepatitis.
  • Managing complicated cirrhosis:
    • Beta-blockers: These medications (e.g., propranolol, nadolol) reduce portal pressure, thereby helping manage portal hypertension-associated complicated cirrhosis.
    • Transjugular intrahepatic portosystemic shunt (TIPS): It is generally used for complicated cases of cirrhosis where portal hypertension and associated complications are difficult to manage. TIPS involves creating a shunt between the portal and hepatic veins, which diverts blood flow from the portal circulation to systemic (whole body) circulation, thereby reducing the pressure in the portal system. Thus, TIPS can provide relief for portal hypertension-associated complications of cirrhosis.
  • Managing symptoms:
    • Medications:
      1. Diuretics: These are used to decrease fluid accumulation in tissues (ascites).
      2. Lactulose: It is used to manage hepatic encephalopathy by reducing the ammonia levels.
  • Liver transplant: This might be necessary in cases of advanced cirrhosis with liver failure.

  • Avoiding excessive alcohol consumption.
  • Vaccination against hepatitis B and C
  • Employing safe practices to prevent hepatitis transmission (e.g., avoid sharing needles)
  • Weight management and exercise to prevent fatty liver disease
  • Regular screenings for individuals with chronic liver disease or a family history of liver conditions
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L

Oesophageal Varices

Management Team

Oesophageal Varices

Overview

Oesophageal varices, i.e., expanded oesophageal veins, primarily occur in response to elevated blood pressure in the portal vein that transports blood from the intestines and spleen to the liver. This elevated portal vein pressure (a condition known as portal hypertension) causes blood to be rerouted through smaller veins, including those in the oesophagus, which can become engorged and prone to rupture. Oesophageal varices are a serious medical condition because if they rupture, they can lead to severe bleeding, which can be life-threatening.

As specified above, the predominant cause of oesophageal varices is portal hypertension, and therefore, all factors that cause portal hypertension are also the factors responsible for oesophageal varices; these include:

  • Cirrhosis of the liver: In cirrhosis, the blood-filtering ability of the liver is impaired, leading to an increase in portal vein pressure.
  • Chronic liver diseases: Chronic conditions like viral hepatitis, fatty liver disease, or alcoholic liver disease can cause progressive liver damage that culminates in cirrhosis, which leads to portal hypertension.
  • Portal vein thrombosis: Blood clots formed in the portal vein obstruct normal blood flow, causing increased blood pressure in the portal venous system, ultimately leading to varices.
  • Schistosomiasis: In certain geographies, particularly parts of Africa and Asia, liver flukes are common. Upon infection (schistosomiasis), the eggs of these parasites get lodged in various tissues, especially liver, and trigger an inflammatory reaction that leads to hypertension, thereby contributing to varices.
  • Congenital abnormalities: Rarely, portal hypertension can be caused by congenital conditions such as portal vein malformations.

Initially, oesophageal varices are asymptomatic (no noticeable symptoms); however, later on, the varices begin to bleed. The observed symptoms are mostly of the complications. The symptom trends for these conditions have been described below. 

  • Uncomplicated oesophageal varices (no bleeding):
    • None or mild symptoms: In many cases, oesophageal varices are asymptomatic and are only discovered during an endoscopy or imaging study for another condition (e.g., liver disease).
    • Signs of liver disease: Patients with oesophageal varices often have signs of liver failure, like yellow skin (jaundice), excess fluid in the abdomen (ascites), and enlarged spleen (splenomegaly).
  • Bleeding oesophageal varices (most serious complication):
    • Hematemesis (vomiting blood): The most dramatic and dangerous symptom of bleeding oesophageal varices is vomiting bright red blood or coffee-ground-like material (which indicates partially digested blood).
    • Melena: Black, tarry stools, indicating the presence of digested blood from varices that have bled into the stomach.
    • Hypovolemic shock: When varices rupture and bleed heavily, the person can go into shock. Symptoms of shock include:
      1. Dizziness or fainting
      2. Pale or cold extremities
      3. Rapid heartbeat (tachycardia)
      4. Low blood pressure (hypotension)
      5. Confusion or altered mental status due to loss of blood.

Oesophageal varices are often suspected in cases of chronic liver disease or portal hypertension and confirmed through a variety of tests; these include:

  • Endoscopy (gastroscopy):
    • Esophagogastroduodenoscopy or EGD: This is the best diagnostic modality for oesophageal varices. During the procedure, a camera bound to a fine tube is endoscopically guided via the mouth to visualise the interior of the oesophagus and assess the size and severity of any varices. This modality can also detect signs of bleeding or red spots on varices, which indicate a higher risk of rupture.
  • Imaging:
    • Doppler ultrasound: This technique can assess the flow of blood through the liver and portal vein, which helps in diagnosing portal hypertension.
    • CT and MRI: These techniques can determine the severity of portal hypertension or any complications, such as a portal vein thrombosis.
    • Endoscopic ultrasound: This technique can be used to assess the varices in more detail, especially if there is bleeding risk.
    • Liver function tests: These tests help diagnose the underlying liver disease that might be causing portal hypertension and include:
      1. Liver enzyme tests (ALT, AST, ALP)
      2. Bilirubin tests
      3. Prothrombin time assessment (to assess clotting function)
      4. Albumin tests

  • Prevention of bleeding (primary prophylaxis):
    • Non-specific beta-blockers (e.g., propranolol or nadolol): These medications reduce portal hypertension and lower the risk of variceal bleeding. Further, they reduce blood flow to the oesophagus, helping prevent varices from expanding or rupturing.
    • Endoscopic variceal ligation (EVL): This technique involves stopping blood flow and preventing rupture by ligating the varices using a small rubber band. It is often employed for larger varices or high-risk patients.
    • Endoscopic sclerotherapy: In this technique, variceal shrinkage and sealing is induced by introducing a sclerosing agent into the varices. This modality is not employed very often but may be an option for some patients.
  • Acute bleeding (emergency treatment):
    • Stabilisation: The first step after bleeding is patient stabilisation via fluid resuscitation (IV fluids or blood transfusions) to manage blood loss and restore blood pressure.
    • Endoscopic treatment: Once the patient is stabilised, EVL treatment of choice for acute bleeding varices is used to stop bleeding. If EVL is not successful, endoscopic sclerotherapy or balloon tamponade (a technique in which an endoscopically guided inflatable balloon is used to tamponade (compress) the bleeding varices) may be employed.
    • Pharmacologic therapy: Vasopressin or octreotide (somatostatin analogue) may be used to reduce portal pressure and control bleeding. These medications constrict blood vessels and help stop the bleeding.
    • Transjugular intrahepatic portosystemic shunt (TIPS): It may be used for refractory cases where bleeding cannot be controlled. TIPS involves implanting a stent between the portal and hepatic veins; this creates a shunt that allows blood to flow directly from the portal vein to the hepatic vein, thereby reducing portal pressure, and by extension, varices.
    • Surgery: In severe cases where other treatments fail, surgery (such as oesophageal devascularisation or a liver transplant) may be needed.

  • Regular monitoring for varices in individuals with liver disease, especially cirrhosis can help prevent varices.
  • Lifestyle changes (e.g., refraining from smoking and drinking) and managing hepatitis can diminish the risk of liver disease progression.
  • Prompt treatment of liver disease (including medications, lifestyle changes, and, in some cases, liver transplantation) can help prevent varices.
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O

Trans-urethral resection of the prostate (TURP)

Management Team

Trans-urethral resection of the prostate (TURP)

Overview

Trans-urethral resection of the prostate (TURP) is widely used surgical procedure to effectively treat symptoms of urinary system associated with prostate enlargement.

TURP is typically used for patients with moderate-to-serious urinary problems that have not responded to pharmaceutical treatment. It is worthwhile to remember the following things about TURP: 

  • The effects of TURP may last for 15 years or longer
  • Follow-up treatment may be needed several years after treatment to reduce recurring symptoms

Since the prostate surrounds the urethra (the tube that carries urine out of the body), enlargement tends to restrict urine flow. Removing excess prostate tissue helps unblock urine flow.

  • During the procedure, an instrument called a resectoscope is inserted through the urethral opening at the tip of the penis
  • The surgeon views and trims away excess prostate tissue through the resectoscope
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T

Robotic Radical Prostatectomy

Management Team

Robotic Radical Prostatectomy

Overview

During a robotic radical prostatectomy, the prostate gland is completely removed by an experienced surgeon with the assistance of a robotic surgical platform. Our hospital, we utilise the da Vinci® Surgical System, an advanced robotic technology designed for radical laparoscopic prostatectomy, providing enhanced vision, control, and precision.

The surgery offers a number of benefits as compared to traditional open surgery:

  • Minimal invasiveness
  • Lower blood loss
  • Minimal pain
  • Shorter hospital stays
  • Quicker recovery times

Robotic-assisted radical prostatectomy can be used to treat conditions and diseases in which the prostate gland needs to be removed, such as prostate cancer.

  • The procedure utilises a three-dimensional endoscope and advanced imaging equipment to provide surgeons with a magnified view of the delicate structures surrounding the prostate gland, including nerves, blood vessels, and muscles. This helps to optimally preserve these vital structures
  • Keyhole incisions are used to access and remove the prostate gland
  • During most of the surgery, the surgeon sits at a computer console using precision wristed instruments to perform the procedure. These permit a far greater range of motion than the human wrist.
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R

Prostatic Urethral Lift

Management Team

Prostatic Urethral Lift

Overview

The prostate surrounds the urethra (the tube that carries urine out of the body), so when it is enlarged, it restricts the flow of urine out of the body. A prostatic urethral lift can relieve these symptoms. In this procedure, small implants are used to pull the prostate away from the urethra. It is also called a UroLift.

A prostatic urethral lift is used to relieve the symptoms of benign prostate enlargement or hyperplasia (BPE or BPH). It offers the following advantages:

  • It offers quick relief
  • You may no longer need a catheter
  • It reduces the risk of retrograde ejaculation, a condition in which semen travels into the bladder instead of through the penis during ejaculation
  • Recovery is faster and more comfortable than other surgical procedures

It is a minimally invasive procedure. The technique is relatively new, but it has shown good short- and medium-term results.

  • The procedure is an outpatient procedure that usually takes less than an hour
  • After the procedure, most patients will be able to go home on the same day and without a catheter
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Nephrectomy

Management Team

Nephrectomy

Overview

This is a surgical procedure in which a part of a kidney or the complete kidney is removed. Nephrectomy is normally used to remove cancerous or non-cancerous tumours from the kidney.

The length of your hospital stay and recovery time will vary based on your overall health and the type of nephrectomy. After the procedure, it is worthwhile to keep the following in mind:

  • A catheter may be placed for a short time in the bladder to drain urine from the body
  • Light, everyday activities can be resumed a short time after the surgery. However, it is recommended to avoid strenuous activity or heavy lifting for at least 6 weeks after surgery
  • After recovery, you can expect to return to your usual routine and activities; nephrectomy typically does not affect your quality of life

Nephrectomy is categorised into two main types —radical and partial. The complete kidney is removed during a radical nephrectomy. In a partial nephrectomy, only a part of the kidney is removed, and the healthy tissue is left in place.

There are three approaches to a nephrectomy:

  • Open: This is a major surgical procedure in which a surgeon opens up the abdomen and obtains a full view of the internal organs
  • Laparoscopic: This is a technique that uses a thin tube called a laparoscope to perform a minimally invasive surgery in the abdomen
  • Robotic: This is a robot-assisted surgical procedure to remove a part of or the complete kidney
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