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Enteroscopy

Management Team

Enteroscopy

Overview

Enteroscopy is a technique used for the examination of the small bowel or small intestine. The small intestine is a crucial part of the digestive system, where most of the nutrients from food are absorbed. Enteroscopy allows doctors to inspect the lining of the small intestine for abnormalities such as inflammation, ulcers, tumours, and bleeding. Enteroscopy can also be used to remove polyps or for taking tissue samples for biopsies.

Your doctor may recommend enteroscopy for a number of reasons including:

  • Chronic Abdominal Pain or Bleeding: If you are experiencing unexplained gastrointestinal symptoms such as abdominal pain, bleeding, or iron-deficiency anaemia, enteroscopy may be recommended to pinpoint the cause.
  • Investigation of Malabsorption Syndromes: For conditions like celiac disease or Crohn’s disease, enteroscopy can be used to investigate whether there is any damage to the small intestine that affects nutrient absorption.
  • Detection of Tumours and Growths: Enteroscopy can detect tumours, polyps, and other growths within the small intestine, which might otherwise go undetected in other types of imaging.
  • Evaluation of Inflammatory Bowel Diseases (IBD): Conditions such as Crohn’s disease and ulcerative colitis may affect the small intestine. Enteroscopy can help assess the extent of the disease and monitor for complications.

Before undergoing enteroscopy, patients typically need to avoid eating or drinking for at least 6–8 hours before the procedure to ensure the small intestine is clear for examination. Another step involves taking special preparations like laxatives or enemas which may be required to clean out the intestines, as a clean bowel improves the quality of the examination.

Some medications, especially blood thinners, may need to be paused before the procedure. It is important to discuss ongoing treatments with your doctor.

Enteroscopy can be performed in several ways, depending on the area of the small intestine that needs to be examined. The most common approaches include:

  • Standard Enteroscopy: In standard enteroscopy, a long, flexible tube with a camera at the tip (endoscope) is inserted into the mouth or the rectum, depending on whether the doctor is accessing the upper or lower parts of the small intestine.
  • Double-Balloon Enteroscopy (DBE): The DBE is a more advanced form of enteroscopy. It uses two balloons attached to the endoscope to help navigate through the loops of the small intestine. This method is particularly useful for examining parts of the small intestine that are hard to reach with standard enteroscopy.
  • Single-Balloon Enteroscopy (SBE): This technique is similar to DBE, but instead of using double balloon, this technique uses just a single balloon.
  • Capsule Endoscopy: In some cases, patients may swallow a small, pill-sized camera that captures images of the small intestine as it moves through the digestive tract. This is typically used when other methods are unsuccessful or unsuitable.

The common procedure remains the same for all including the following steps:

  • First, the patients are sedated to make the procedure more comfortable.
  • Next, the endoscope or balloon device is gently inserted through the mouth or rectum, depending on the part of the small intestine being examined.
  • The doctor then inspects the walls of the small intestine, looking for abnormalities. At this step, if needed, tissue samples (biopsies) can be taken for further analysis, and small growths like polyps can be removed.
  • The procedure might take up to 30 minutes to 1 hour. This depends on the complexity of the condition.

Enteroscopy offers several benefits for both diagnostic and therapeutic purposes:

  • Comprehensive Visualization: Enteroscopy allows for detailed images of the small intestine, which cannot be fully assessed through other imaging techniques such as X-rays or CT scans.
  • Early Detection: The ability to directly visualize and biopsy suspicious areas leads to earlier detection of tumours, polyps, and other pathologies.
  • Minimally Invasive: As a less invasive alternative to surgery, enteroscopy reduces recovery times and complications.
  • Treatment and Diagnosis Combined: Enteroscopy can be used to both diagnose and treat certain conditions, such as bleeding, removing polyps, or even treating strictures in the intestine.

Depending on the symptoms and medical condition, some alternative procedures may include:

  • CT or MRI Enterography: These imaging techniques use contrast to capture detailed images of the small intestine and surrounding organs, though they lack the direct visualization and therapeutic capabilities of enteroscopy.
  • Capsule Endoscopy: For patients who may not tolerate traditional enteroscopy, capsule endoscopy offers a less invasive alternative, though it does not allow for biopsies or therapeutic interventions.
  • Colonoscopy: While primarily used to examine the large intestine, a colonoscopy can sometimes provide useful information about the lower portion of the small intestine.

Though enteroscopy is generally safe, it carries some side effects and risks including:

  • Discomfort: Patients may experience bloating, cramping, or mild discomfort after the procedure.
  • Bleeding: A small risk of bleeding can occur, particularly if a biopsy is taken or polyps are removed.
  • Perforation: Though rare, there is a very small risk of a tear or puncture in the wall of the small intestine.
  • Infection: Any invasive procedure carries a slight risk of infection, though this is uncommon.
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Endoscopic Ultrasound (EUS)

Management Team

Endoscopic Ultrasound (EUS)

Overview

Endoscopic Ultrasound (EUS) is an imaging technique that combines endoscopy and ultrasound technology. It is performed to get detailed images of the digestive organs including the pancreas, liver and also the surrounding parts like lymph nodes. The procedure involves inserting a flexible tube called endoscope equipped with an ultrasound probe at its tip. The ultrasound waves create high-resolution images, allowing for a thorough examination of soft tissues and structures that may not be visible on other imaging tests.

EUS is widely used for diagnosing and managing a variety of medical conditions. Your doctor may recommend an EUS for the following cases:

  • Cancer Detection: It is crucial for detecting and staging cancers of the pancreas, bile ducts, and other nearby organs.
  • Pancreatic Disorders: In case you are suffering from a pancreatic disorder, EUS may help in diagnosing the underlying causes such as pancreatitis, cysts or pancreatic tumours.
  • Bile Duct and Gallbladder Issues: It helps detect blockages, stones, and growths in the bile ducts and gallbladder.
  • Liver and Lymph Node Evaluation: EUS can assess abnormalities in the liver and help evaluate enlarged or suspicious lymph nodes.
  • Biopsy: Biopsies involve collection of tissue samples from suspicious areas for further analysis. If required, EUS can be used for fine-needle aspiration (FNA) biopsies.

Before undergoing EUS, patients typically need to avoid eating or drinking for at least 6 hours before the procedure. Some medications, particularly blood thinners, may need to be paused, so it is important to discuss any ongoing treatments with your doctor.

The procedure is generally performed in an outpatient setting, and it follows these steps:

  • The patient receives a sedative to ensure comfort during the procedure.
  • Once the patient is sedated, the doctor gently inserts the endoscope either through the mouth (for upper GI tract) or rectum (for lower GI tract), depending on the area being examined.
  • The ultrasound probe on the endoscope emits sound waves that generate detailed images of the organs.
  • If a suspicious area is found, a fine needle is used to obtain tissue samples for analysis.
  • The procedure usually lasts between 30 to 60 minutes. However, in case there are any complexities, it may take longer.

EUS provides several significant advantages for both diagnosis and treatment:

  • High-Resolution Imaging: It delivers clear images of soft tissues, making it a valuable tool for assessing conditions that might not be visible with CT or MRI.
  • Early Detection: EUS can detect cancers in the pancreas, liver, and bile ducts at early stages, which is essential for successful treatment outcomes.
  • Minimally Invasive: Since biopsies can be performed during the procedure, EUS avoids the need for more invasive surgeries.
  • Accurate Staging: The procedure helps determine the stage of cancer or other diseases, which is critical for planning treatment.
  • Real-Time Monitoring: The ability to monitor areas in real-time aids in the timely identification of any changes that could indicate progression or improvement.

While EUS is a powerful diagnostic tool, there are alternative procedures that might be used depending on the patient's condition:

  • CT Scan: A computed tomography (CT) scan offers detailed images of the abdomen and can help detect tumours, but it is less effective than EUS for assessing soft tissue.
  • MRI: Magnetic resonance imaging (MRI) provides clear images of soft tissues and can be an alternative for evaluating certain conditions, particularly liver abnormalities.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure uses an endoscope to inject dye into the bile ducts, allowing for X-ray imaging of the biliary system. It is especially useful for detecting bile duct blockages and for performing procedures like stone removal.
  • Ultrasound: Traditional ultrasound, often used for liver or gallbladder evaluations, can detect structural changes but lacks the detail provided by EUS.

Although EUS is generally considered safe, there are some risks to be aware of:

  • Discomfort: Some patients may experience mild discomfort during the insertion of the endoscope.
  • Bleeding: Minor bleeding can occur, especially if a biopsy is taken, but this usually resolves without issue.
  • Infection: There is a slight risk of infection at the biopsy site, although this is rare.
  • Perforation: Though uncommon, there is a very small chance of puncturing the digestive tract, requiring additional treatment
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Endoscopic Retrograde Cholangiopancreatography (ERCP)

Management Team

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Overview

ERCP is a medical examination of the digestive system which combines endoscopy with X-ray imaging. In this examination, a flexible tube called endoscope is inserted through the mouth and into the upper digestive tract. This allows the physician to inject dye into the bile and pancreatic ducts for clear X-ray imaging. It is used for diagnosing and treating conditions related to the gallbladder, bile ducts and pancreas.

An ERCP may be suggested by your doctor in the following cases:

  • Gallstones and Bile Duct Blockage: In case there is a suspicion of gallstones being trapped in the bile duct, an ERCP may be recommended. ERCP can also identify and relieve other blockages in the bile duct that may cause jaundice or pain.
  • Yellow Jaundice: ERCP may help to determine the cause of yellowing of the skin and dark urine, often related to bile duct issues.
  • Pancreatitis: in case of pancreatitis, ERCP is helpful for diagnosing the level of inflammation of the pancreas. It can also help to identify the cause of pancreatitis.
  • Pancreatic or Bile Duct Cancer: ERCP can help detect cancer in the bile ducts or pancreas.
  • Infections: ERCP is also used to identify and treat infections within the bile ducts.
  • Leaks in the Bile or Pancreatic Ducts: In cases where leaks in the bile or pancreatic ducts are suspected, ERCP is recommended for identifying and addressing these issues.

The preparation for ERCP typically involves fasting where the patient is asked not to eat or drink for up to 8 hours prior to the procedure In some cases, the patient may also be asked to stop certain medications, especially blood thinners.

ERCP is usually performed in a room equipped for X Rays. The procedure follows these steps:

  • The patient is first positioned on his/her left side, with his/her head turned to the right.
  • A mild sedative is administered to help the patient relax and remain comfortable.
  • A flexible tube (endoscope) is gently inserted through the patient's mouth and into the upper digestive tract.
  • A thin tube is then inserted through the endoscope to inject dye into the bile ducts. After this, X-rays are taken to visualize the ducts.
  • If necessary, gallstones are removed, blockages cleared, or stents placed to keep the ducts open. Electrocautery is used to make an incision in the bile duct. It is a technique that uses heat generated by an electric current to cut tissues.
  • The procedure typically lasts between 20 to 40 minutes, but it may take longer depending on its complexity.

The positive outcomes of ERCP include:

  • ERCP can identify the cause of symptoms related to the bile ducts and pancreas, such as gallstones or blockages.
  • It allows some immediate treatments, such as removing gallstones or placing stents, reducing the need for major surgery.
  • It can help relieve symptoms like jaundice and pain caused by bile duct blockages with some immediate interventions.

  • Endoscopic Ultrasound (EUS): Uses sound waves to image the bile ducts and pancreas.
  • Percutaneous Transhepatic Cholangiography (PTC): A needle is used to inject the dye into the bile ducts through the skin.
  • Magnetic Resonance Cholangiopancreatography (MRCP): an MRI to visualize bile and pancreatic ducts.
  • Ultrasound

Common side effects of ERCP may include:

  • Sore Throat: A mild, temporary sore throat may occur due to the insertion of the endoscope.
  • Pancreatitis: in rare cases, there is a risk of inflammation of the pancreas due to the close proximity of pancreas with the bile duct.
  • Bleeding: Minor bleeding can occur if an incision is made during the procedure.
  • Infection: There is a risk of infection in very rare cases.
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Endobronchial Ultrasound (EBUS)

Management Team

Endobronchial Ultrasound (EBUS)

Overview

EBUS is a technique that uses ultrasound along with a bronchoscope to visualise the airway wall and structures adjacent to it.

  • Radial Probe EBUS
    This system has an ultrasound processor and balloon catheter attached to the probe. The balloon is fixed at the tip of the probe. It helps take biopsies from the peripheral parts of the lung, which are otherwise not accessible by routine flexible bronchoscopy.
  • Convex Probe EBUS
    In contrast to the radial probe, convex probe has the advantage of accessing central lesions that are in or adjacent to the lung (mediastinum). High-resolution, real-time ultrasound imaging enables direct visualisation of the needle as it penetrates the lymph node, which optimises the biopsy sample and makes the procedure relatively safe.

  • Assess the extent of airway invasion: EBUS has extended vision beyond the tracheobronchial wall. With EBUS, the delicate multilayer structure of the tracheobronchial wall can be analysed. This knowledge becomes decisive for the management of early cancer in the central airways.
  • Peripheral intrapulmonary lesions: Radial probe EBUS can be used to localise peripheral pulmonary nodules and sampling of the lesion can be done without fluoroscopy.
  • Analysis of mediastinal lesions: Assessment of mediastinal lymph nodes is important for lung cancer staging and planning appropriate treatment strategy. Once target lymph node is identified, linear probe EBUS allows real-time ultrasound guidance during needle insertion. EndoBronchial UltraSound-Guided TransBronchial Needle Aspiration (EBUS-TBNA) can be used in the evaluation of mediastinal adenopathy due to other aetiologies like sarcoidosis and tuberculosis.
  • Guidance of endobronchial therapy: EBUS provides useful additional information during various interventions, including resection of endobronchial lesions, stricture dilatation, airway stenting, laser therapy and argon plasma coagulation.

  • Life-threatening cardiac arrhythmias
  • Current or recent myocardial ischaemia
  • Poorly controlled heart failure
  • Severe hypoxemia
  • Uncooperative patient

Additional contraindications to EBUS-TBNA are related to bleeding risk and include following:

  • Current anti-platelet agents, such as Ecosprin and Clopidogrel
  • Current anticoagulant therapy, such as warfarin
  • Coagulopathy
  • Thrombocytopenia
  • Elevated blood urea nitrogen or serum creatinine levels

EBUS and EBUS-TBNA are usually safe. Some complications are agitation, cough, hypoxia, laryngeal injury, fever, bacteraemia and infection, bleeding, pneumothorax and broken equipment being stuck in the airway.

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Evoked Potentials (EPs)

Management Team

Evoked Potentials (EPs)

Overview

Evoked potentials are electrical responses in the brain or nervous system that are elicited by specific stimuli such as sound or touch. EP tests the intactness and conductivity of sensory conduction pathway from peripheral receptor organ to the brain.

  • Electrodes are placed over cortical areas
  • Stimulus is given as described above
  • The electrical response is recorded from the scalp electrodes
  • Latency and amplitude of stimulation is analysed.

  1. Visual evoked potential (VEP)

    Visual stimulation is given in the form of inverse checker board pattern or flash stimulation and the response is recorded from the occipital areas.

    Indications

    • Optic neuritis
    • Demyelinating disorders like multiple sclerosis
    • In head injury/ encephalopathy to check the visual pathway functioning

  2. Auditory evoked potentials (BAER)

    BAER, also known as brainstem auditory evoked response, measures the electrical activity generated in response to an auditory stimulus.

  3. Somatosensory evoked potentials (SSEP)

    SSEP measures the responses to touch or pressure stimulation. They enable to check the integrity of large sensory pathways through peripheral nerves, spinal cord, and brain.

    Indications

    • Differentiate between central and peripheral causes of large fibre sensory dysfunction
    • Study proximal peripheral nerves, when standard sensory NCV are normal
    • Confirmation of non-organic peripheral sensory loss
    • SSEPs in specific conditions
    • Multiple sclerosis (increased sensory latencies).
    • Need for localizing the level of lesion in spinal cord
    • Coma (bilateral absence of the thalamo-cortical (N19–P22) waveforms indicate poor prognosis)
    • Brain death (Absence of N19–P22 waveforms)
    • Cortical myoclonus (progressive myoclonic epilepsy, CJD, post-hypoxic myoclonus)

  4. Motor evoked potentials

    Measures the electrical response of muscles to electrical stimulation of brain or spinal cord.

    Indications

    • Assess motor pathway function
    • Spinal cord injury or multiple sclerosis
    • Intra-operative monitoring in spinal cord surgeries
    • Nerve injury evaluation
    • Assess muscle function in muscle weakness/ paralysis
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Electromyography (EMG)

Management Team

Electromyography (EMG)

Overview

EMG is the other component of NCV, which is used to record the baseline muscle activity, motor units, and recruitment of multiple motor units on complete stimulation.

It is helpful in differentiating between disorders of lower motor neuron disorders such as anterior horn cell, nerve, neuromuscular junction, and muscles.

  • A thin needle electrode is inserted in the muscles
  • Muscle activity is studied

  • Diagnosis of muscle dystrophy and other muscle diseases
  • Evaluation of muscle weakness or paralysis
  • Single fibre EMG for neuromuscular diseases
  • Evaluation of peripheral neuropathy/ radiculopathy/ nerve compression/ entrapment
  • Establishing diagnosis of anterior horn cell disorders
  • Evaluation of cramps/ spasms/ tremors
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Electroencephalography (EEG)

Management Team

Electroencephalography (EEG)

Overview

Electroencephalography is a non-invasive (painless) neuroimaging technique that measures the electrical activity of brain through electrodes placed on scalp. The activity in the brain evolves as the brain develops. In a sleep deprived state, the chances of abnormal activities in the brain being recorded are higher. EEG is performed under video recording to correlate the electrical activity with simultaneous abnormal body movements. Sometimes, prolonged EEG recording is also done for 48–72 hours to isolate the exact focus of abnormal activity.

  • Various electrodes are placed in frontal, parietal, temporal and occipital areas
  • Activities in these areas are recorded
  • Various manoeuvres such as photic stimulation, hyperventilation, eye opening and closure are performed during the recording
  • The responses are recorded to find any abnormality in the brain activity

  • Delta waves (0.5–4 Hz): during deep sleep and unconsciousness
  • Theta waves (4–8 Hz): during drowsiness and early sleep
  • Alpha waves (8–12 Hz): during relaxed state with eyes closed
  • Beta waves (13–30 Hz): during alert, thinking state

  • Epilepsy and seizures, status epilepticus
  • Sleep disorders
  • Coma, encephalopathy
  • Encephalitis and other brain infections
  • Metabolic disorders causing altered sensorium
  • Head injury
  • Additional testing for brain death
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Eosinophilic Lung Diseases

Management Team

Eosinophilic Lung Diseases

Overview

Eosinophilic lung diseases comprise a diverse group of conditions, including acute and chronic eosinophilic pneumonia, Löffler Syndrome, allergic bronchopulmonary aspergillosis, Hypereosinophilic Syndrome and eosinophilic granulomatosis with polyangiitis. These conditions are characterised by an abnormal accumulation of eosinophils in the lung tissues.

Eosinophils, white blood cells involved in immune responses, particularly in allergies and parasite defence, can cause inflammation, tissue damage, and respiratory symptoms when present in large amounts in the lungs. Some causes include:

  1. Infectious

    Parasitic infections, such as Ascariasis and Strongyloidiasis, are the most common cause of eosinophilic pneumonia (EP) worldwide.

  2. Non-infectious
    • Allergic bronchopulmonary aspergillosis (ABPA)
    • Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and selective serotonin reuptake inhibitors (SSRIs)
    • Inhaled toxins, such as chemical fumes, particulate metals, or dust
    • Smoking, especially if you've recently changed your smoking habits
    • Underlying conditions, such as cancer, autoimmune disease, or inflammatory disease

Common symptoms of eosinophilic lung diseases include persistent cough, dyspnoea (difficulty in breathing), chest pain, and wheezing. Patients may also experience non-specific symptoms, such as high fever, night sweats, weight loss, and fatigue. Extrapulmonary complications (i.e., complications involving organs other than the lung) can include gastrointestinal issues and peripheral neuropathy (a disease that damages the peripheral nervous system), necessitating a multi-systemic diagnostic approach with a high degree of clinical suspicion.

Diagnosis of eosinophilic lung diseases typically involves imaging-based techniques like chest X-rays or CT scans to identify infiltration of substances, such as pus, blood or protein, into the lung alongside blood tests revealing elevated eosinophil counts. Clinical history review, skin testing for Aspergillus sensitivity, and measuring serum IgE levels are also important. Complex cases may require bone marrow biopsy or lung tissue biopsy for confirmation, guiding tailored treatment and management strategies.

Eosinophilic lung disease treatment involves a comprehensive approach based on the specific condition and its severity.

  • Initially, high-dose corticosteroids are administered intravenously to rapidly reduce inflammation and improve respiratory function, transitioning to oral steroids as symptoms improve for ongoing control.
  • Long-term management often includes maintenance corticosteroid therapy to prevent relapses.

Antifungal medications like itraconazole manage fungal growth, while immunosuppressive drugs such as hydroxyurea or interferon-alpha, and targeted biologic therapies like monoclonal antibodies (e.g., mepolizumab) effectively reduce eosinophil levels and manage symptoms. Severe cases may require stronger immunosuppressive agents like cyclophosphamide or azathioprine.

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Endometriosis

Management Team

Endometriosis

Overview

Endometriosis is a condition in which the endometrial tissue, i.e., the tissue that normally lines the inside of your uterus (the endometrium), starts growing outside the uterus. These misplaced bits of tissue behave just like they would inside the uterus: they thicken, break down, and bleed with your menstrual cycle. However, this blood cannot exit the body and thus, becomes trapped, leading to pain, inflammation, and scar tissue formation. Sometimes, endometriosis is associated with the formation of adhesive bands of fibrous tissues, due to which pelvic tissues and organs may stick to each other. While endometriosis affects the ovaries, fallopian tubes, and the tissues lining your pelvis, in more severe cases, it may even spread to other organs beyond the pelvic region. Endometriosis is associated with a great deal of discomfort and pain, especially during the menstrual cycle; in many cases, it has also been reported to cause fertility problems.

The exact cause of endometriosis is still somewhat of a mystery, but several theories exist:

  • Retrograde menstruation: This theory postulates the backward flow of endometrial cell-rich menstrual blood into the fallopian tubes and eventually, into the pelvic cavity. These cells then adhere to the pelvic organs, where they start to grow.
  • Embryonic cell transformation: Hormones such as oestrogen may cause embryonic cells (which can develop into any type of body tissue) to transform into endometrial-like cell implants during puberty.
  • Immune system disorders: Sometimes, the immune system may fail to recognise endometrial tissue growing outside the uterus, allowing it to continue developing.
  • Surgical scars: After surgeries like caesarean section delivery, endometrial cells might attach to surgical incisions; this can cause endometriosis.
  • Genetics: If a patient’s mother or sister has endometriosis, the patient has a higher risk of developing this condition.

  • Pelvic pain: This is the hallmark of endometriosis. Pain may start before your period and continue through it. It is often much more intense than typical menstrual cramps.
  • Dyspareunia (painful sexual intercourse): Many women with this condition report pain during or after sex.
  • Pain during bowel movements or urination: These symptoms are most common during the menstrual cycle.
  • Excessive bleeding: Some women experience heavy periods or bleeding between periods.
  • Infertility: Endometriosis can make it harder to conceive. In fact, this condition is often diagnosed in women undergoing fertility treatments.
  • Other symptoms: Patients may experience fatigue, nausea, bloating, constipation, or diarrhoea, particularly during your menstrual cycle.

  • Pelvic exam: During a pelvic exam, cysts or scar tissue near your reproductive organs may be felt
  • Ultrasound: A transvaginal or abdominal ultrasound can help identify cysts caused by endometriosis, called endometriomas.
  • Magnetic resonance imaging (MRI): An MRI can provide a detailed image of the internal organs and help plan surgeries or other procedures.
  • Laparoscopy: This is the gold standard for diagnosing endometriosis.

One or more of the following methods may be recommended for endometriosis treatment:

  • Pain medication: Over-the-counter pain relievers (such as ibuprofen) can help alleviate mild symptoms.
  • Hormonal therapy: Hormones play a key role in endometriosis. Options include:
    • Birth control pills: These can regulate your menstrual cycle and reduce pain.
    • GnRH agonists: These drugs temporarily stop your body from producing certain hormones, putting you into a temporary menopause.
    • Progestin therapy: This can reduce or stop menstrual flow and the growth of endometrial implants.
  • Surgery: If conservative treatments are not effective or if the patient is trying to conceive, surgery to remove as much endometrial tissue as possible may be recommended. Laparoscopic surgery is often used to remove or destroy growths, scar tissue, and adhesions.
  • Fertility treatment: If endometriosis is causing infertility, assisted reproductive techniques like in-vitro fertilisation (IVF) may be necessary.
  • Hysterectomy: In severe cases, removing the uterus—hysterectomy—may be considered, which includes laparoscopic hysterectomy. This is generally recommended only if you are not planning to have children in the future and is usually the last resort.

  • You have severe pelvic pain that does not go away even after the consumption of over-the-counter pain medications.
  • You are unable to conceive for over a year despite repeated attempts.
  • Your periods have become unusually heavy or irregular.
  • You experience pain during or after intercourse.
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Epilepsy

Management Team

Epilepsy

Overview

Epilepsy is chronic neurological disorder with recurrent seizures (altered electrical activity in the brain resulting in physical changes in behaviour and movement) or tendency to have recurrent seizures. This activity of the brain may be due to structural or genetic abnormality.

  • Genetic mutations
  • Head injuries
  • Infections (meningitis, encephalitis)
  • Stroke or haemorrhage
  • Mass lesions in the brain

  • Age: Epilepsy is the most common in children and older adults. However, it can present at any age 
  • Family history
  • Brain injuries
  • Vascular diseases
  • Infections and brain infections
  • Other conditions like dementia, Alzheimer's disease, and certain genetic syndromes can increase the risk of epilepsy
  • Other factors including sleep deprivation, hormonal changes, certain medications, and low blood sugar

  • Depends on the seizure type related with epilepsy
  • Aura, which is an abnormal sensation or feeling before the convulsions start
  • Bloating, nausea, visual phenomenon, olfactory hallucinations, or déjà vu, which means feeling that you have already experienced something which is happening for the first time
  • Convulsions, which are motor reflexes following aura with tonic posturing or jerky movements of the limbs
  • Confusion or a feeling of disorientation
  • Repetitive seizures may lead to cognitive impairment

  • Generalized epilepsy (jerking of all the four limbs accompanied with unconsciousness)
  • Focal seizures (affecting a single part of the brain)
  • Temporal lobe epilepsy
  • Absence epilepsy

Neurologist

  • History
  • EEG demonstrates specific epileptiform discharges, localized to a particular area in focal epilepsy
  • Ictal PET scan shows hypermetabolism of area from where seizure starts
  • Interictal SPECT shows hypometabolism of the area

  • Antiseizure medication
  • Epilepsy surgery can be contemplated, when the seizures tend to arise from a single focus in the brain repetitively and when they are poorly controlled even after using adequate doses of appropriately chosen medication for an adequate duration
  • Vagal nerve stimulation can be implemented based on the principle of stimulation of the vagus nerve in response to detection of generation of abnormal motor excitability of cortex. Stimulating the vagus nerve aborts the abnormal excitability of cortex before it spreads to the neighbouring areas; thereby terminating the seizure
  • Ketogenic diet
  • Lifestyle modification such as regular and adequate sleep, avoiding the use of stimulating medications, and using antiseizure medications helps to decrease the frequency of attacks
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