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Pancreatic Cyst

Management Team

Pancreatic Cyst

Overview

Pancreatic cyts are fluid-filled pouch-like structures that develop on/in the pancreas and may or may not be cancerous.

  • Serous cystadenomas:
    • Often benign (non-cancerous) fluid-filled cysts.
    • Common in older adults (especially women).
    • Typically asymptomatic.
  • Mucinous cystadenomas:
    • Can be benign but have potential to become cancerous (malignant).
    • More common in women.
    • Found in the body or tail of the pancreas.
  • Intraductal papillary mucinous neoplasms (IPMNs):
    • These are precancerous cysts that form in the pancreatic ducts.
    • Can progress to pancreatic cancer if untreated.
    • Often found in the head of the pancreas.
  • Pseudocysts:
    • Typically caused by pancreatitis (inflammation of the pancreas).
    • Contain fluid and debris from the inflammation.
    • Can be asymptomatic but may cause pain or infection.
  • Cystic neuroendocrine tumours:
    • Rare, typically slow-growing tumours that may have cystic areas.
    • May be benign or malignant.
  • Solid-pseudopapillary tumours:
    • Rare and usually benign but can turn malignant.
    • More common in young women.

  • Pancreatitis (inflammation of the pancreas): A key cause of pseudocysts.
  • Genetic mutations: Inherited conditions like Von Hippel-Lindau disease or Gardner's syndrome may increase cyst formation.
  • Chronic alcohol use: This can increase the risk of pancreatic inflammation and cyst formation.
  • Cystic fibrosis: A genetic disorder that may contribute to pancreatic cyst development.
  • Pancreatic cancer: In some cases, cysts can be an early sign of pancreatic cancer.
  • Other underlying diseases: Certain conditions, like familial pancreatitis or conditions affecting pancreatic ducts, can predispose individuals to cyst formation.

  • Age: Risk increases with age, especially over 50.
  • Gender: Some cysts, like mucinous cystadenomas, are more common in women.
  • Chronic pancreatitis: Inflammation due to alcohol use or other factors can lead to pseudocysts.
  • Genetic factors: Inherited conditions, including Von Hippel-Lindau disease or cystic fibrosis, can increase cyst risk.
  • Family history: A family history of pancreatic cysts or pancreatic cancer increases the likelihood of developing cysts.
  • Smoking: Smoking can increase the risk of pancreatic cysts, particularly those that are pre-cancerous.

  • Asymptomatic: Many pancreatic cysts do not cause symptoms, especially serous cysts or small cysts.
  • Abdominal pain: Cysts, especially large ones, can cause discomfort or pain in the upper abdomen or back.
  • Digestive issues: Nausea, vomiting, and bloating may occur if a cyst obstructs the pancreatic duct.
  • Jaundice: If a cyst compresses the bile duct, it can cause jaundice.
  • Weight loss: Unexplained weight loss can occur, especially with larger or malignant cysts.
  • Pancreatitis symptoms: Fever, chills, and abdominal pain if cysts lead to infection or pancreatitis.

  • Imaging tests:
    • CT scan (computed tomography): Helps identify the presence, size, and location of cysts.
    • MRI (magnetic resonance imaging): More detailed and can differentiate cyst types.
    • Endoscopic ultrasound: Provides clear images and allows for biopsy in some cases.
    • Endoscopic retrograde cholangiopancreatography (ERCP): Helps visualize the bile and pancreatic ducts; it may also help in draining cysts or taking biopsies.
  • Biopsy: A tissue sample may be taken through a needle biopsy or during an endoscopic procedure to analyze the cyst's cells for cancerous changes.
  • Cyst fluid analysis: Fluid obtained from the cyst may be analyzed for certain markers (like CEA or amylase) to assess the likelihood of malignancy.

  • Observation: Small, asymptomatic cysts that do not show signs of malignancy may simply be monitored over time with regular imaging tests.
  • Surgical removal: If the cyst is large, causing symptoms, or suspected to be cancerous, surgery may be recommended. Surgical options include:
    • Cyst drainage: For pseudocysts, fluid may be drained.
    • Pancreatic resection: Part of the pancreas may be removed to prevent cyst growth or cancer spread.
    • Distal pancreatectomy: Removal of the tail or body of the pancreas, often used for mucinous cysts or IPMNs.
  • Endoscopic drainage: For pseudocysts, endoscopic drainage may be used to remove fluid from the cyst using a flexible tube.
  • Medication:
    • Pain management and treatment of any underlying conditions like pancreatitis.
    • Antibiotics if the cyst becomes infected.
  • Chemotherapy or radiation: For malignant cysts or pancreatic cancer, chemotherapy, and radiation therapy may be necessary after surgical resection.
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Pancreatitis

Management Team

Pancreatitis

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.

  • 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.

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 factors

  • Acute 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.

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 vomiting
    • Fever
    • Rapid pulse
    • Swollen abdomen that is tender to touch
    • Jaundice (in cases of gallstone-related pancreatitis)
  • Chronic pancreatitis symptoms:
    • Persistent upper abdominal pain that may become less severe over time
    • Weight 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

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.

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).

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.
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Portal Hypertension

Management Team

Portal Hypertension

Overview

Portal hypertension refers to increased blood pressure within the hepatic portal system, which includes the portal vein—which carries blood from the digestive organs to the liver—and its branches. Portal hypertension generally arises as a result of liver disease, particularly cirrhosis, but it can also be caused by various other conditions that affect the liver and blood vessels.

The most common cause of portal hypertension is liver cirrhosis as scarring of the liver tissue blocks blood flow, resulting in increased blood pressure. Other causes and risk factors include:

  • Liver fibrosis: Progressive liver damage can lead to increased resistance to blood flow, and by extension, portal hypertension.
  • Schistosomiasis: This parasitic infection that can cause liver fibrosis, and by extension, portal hypertension.
  • Liver tumours: Tumours in the liver (both malignant (cancerous) and benign (non-cancerous) can obstruct blood flow, resulting in portal hypertension.
  • Budd‒Chiari syndrome: This condition—characterised by blockage of the veins that drain blood from the liver—can result in portal hypertension.
  • Non-cirrhotic portal fibrosis: Scarring of the portal vein without cirrhosis can also lead to portal hypertension.
  • Congenital abnormalities: Malformations of the blood vessels, particularly in children can also lead to portal hypertension.

The symptoms of portal hypertension include:

  • Ascites: Accumulation of fluid in the abdomen.
  • Variceal bleeding: Large veins in the oesophagus or stomach can rupture, leading to excessive bleeding.
  • Splenomegaly: Enlarged spleen due to blood pooling.
  • Hepatic encephalopathy: Confusion or altered level of consciousness due to toxins in the brain (often a result of liver failure); sometimes, the patient might also slip into a coma.
  • Caput medusae: Visible distended veins on the abdomen.
  • Portal system collaterals: Development of new blood vessels to bypass blocked areas, which can lead to abnormal blood flow.
  • Fatigue and weakness: Liver dysfunction and decreased blood flow to vital organs can result in fatigue and weakness.

Portal hypertension can be diagnosed using the following modalities:

  • Physical examination: Enlarged spleen (splenomegaly), ascites, or abdominal veins visible.
  • Blood tests:
    • Liver function tests to assess liver damage.
    • Complete blood count (CBC) to look for anaemia or signs of bleeding.
  • Imaging:
    • Ultrasound to detect ascites, enlarged spleen (splenomegaly), and assess liver structure.
    • CT or MRI to visualise liver damage and hepatic blood flow.
    • Endoscopy to detect oesophageal or gastric varices (dilated blood vessels at risk of bleeding).
    • Endoscopic ultrasound to assess the portal vein and surrounding structures.
  • Portal pressure measurement: Hepatic venous pressure gradient (HVPG) is the most accurate test for confirming portal hypertension (measuring the pressure in the portal vein).
  • Liver biopsy: This can confirm liver cirrhosis or other liver conditions.

  • Medical management:
    • Beta blockers: Medications like propranolol or nadolol are used to lower portal pressure and prevent variceal bleeding.
    • Diuretics: They are used to manage ascites by removing excess fluid from the body.
    • Antibiotics: They are used to prevent infections in patients with cirrhosis, especially if ascites is present.
    • Lactulose or rifaximin: They are used to manage hepatic encephalopathy as they reduce toxins in the blood that affect brain function.
  • Endoscopic treatment:
    • Endoscopic band ligation (EBL): This modality is used to prevent or treat oesophageal variceal bleeding; it involves placing rubber bands around the varices to stop bleeding.
    • Sclerotherapy: This involves injecting a sclerosing agent (irritant that has the ability to damage the endothelial layer of blood vessels) into varices to reduce bleeding risk.
  • Surgical treatment:
    • Transjugular intrahepatic portosystemic shunt (TIPS): In this procedure, a stent is placed in the liver to divert blood flow, thereby reducing portal pressure.
    • Liver transplantation: This intervention is used in cases of severe cirrhosis or liver failure where other treatments are not effective.
  • Lifestyle and diet:
    • Low-salt diet: To reduce fluid retention and manage ascites.
    • Avoidance of alcohol: Crucial to prevent worsening liver damage.
  • Managing the underlying liver disease: Addressing (managing) conditions like hepatitis or N/AFLD.
  • Managing complications of portal hypertension: Complications of portal hypertension, such as variceal bleeding (a potentially life-threatening complication where the dilated veins in the oesophagus or stomach rupture), ascites (fluid build-up in the abdomen, which can lead to infection (spontaneous bacterial peritonitis) or kidney failure), hepatic encephalopathy (altered brain function due to accumulation of liver toxins in the bloodstream), and portal vein thrombosis (a blood clot in the portal vein), should be managed to ensure a good quality-of-life for the patient.
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Peritoneal Dialysis

Management Team

Peritoneal Dialysis

Overview

Peritoneal dialysis is a home-based dialysis method that uses the peritoneal cavity to filter waste, excess fluids, and toxins from the blood stream. A catheter (a flexible tube), surgically placed near the umbilicus (belly button), facilitates the exchange of dialysis fluid (dialysate).

The process involves filling the peritoneal cavity with dialysate through the catheter (called a dwell), usually for several hours. The lining of the abdominal cavity (the peritoneal membrane) acts as a natural filter, enabling the removal of fluids and waste products. Once the exchange is complete, the used dialysate is drained and replaced with fresh dialysate solution.

Peritoneal dialysis treatments may be done by hand four to five times a day (Known as CAPD) or by using a machine (called a cycler- CCPD/APD) while you sleep. Some people use a cycler at night and also do one or two exchanges during the day.

  • Compared to haemodialysis the Peritoneal dialysis allows more uninterrupted time for work, family, and social activities.
  • Home-based treatment eliminates the need for frequent hospital visits.

  • Requires the patient or a caregiver to be trained in setting up equipment and managing connections
  • May not be suitable for individuals with limited dexterity or support at home.
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Polycystic Kidney Disease

Management Team

Polycystic Kidney Disease

Overview

Polycystic kidney disease (PKD) is a condition in which the normal kidney tissue gets replaced with multiple fluid-filled sacs called cysts. It is a genetic condition inherited in an autosomal dominant manner, meaning that multiple members of the same family may be affected. This disease progresses slowly over several years unless complicated by conditions such as infection of the cysts, bleeding into the cyst, cyst rupture, or stone formation in the cysts. This may also be associated with other organ system involvement, such as cysts in other organs like the liver, brain aneurysms, and more.

The condition is genetically inherited, with family history being a major risk factor. If a close relative has the disease, there is an increased chance of developing it.

The condition may be asymptomatic and is often detected during routine imaging or scans for other complaint.

Systemic symptoms include fever, abdominal pain, and haematuria (blood in urine), which are caused by bleeding, rupture, infection, or stone formation within the cysts.

It is advisable to consult a kidney specialist (nephrologist) for appropriate evaluation and management of PKD.

The following investigations are typically used to diagnose PKD:

  • Imaging studies: Ultrasound examination, CT scan, or MRI of the abdomen to identify cysts.
  • Genetic testing: Conducted in select cases to confirm the diagnosis and identify family risk.

Monitoring: Regular follow-ups and monitoring are sufficient for uncomplicated cases with preserved kidney function.

Advanced treatments: In end-stage renal disease, renal replacement therapies such as dialysis or kidney transplantation may be required.

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Piles (Haemorrhoids)

Management Team

Piles (Haemorrhoids)

Overview

Piles (haemorrhoids) refers to painful, swollen/inflamed veins in or around the rectum and anus. However, they are not serious. This condition affects many people at some point in their lives. In severe cases, haemorrhoids can cause substantial discomfort and complications.

  • Internal haemorrhoids: These are usually painless as they are located inside the rectum and there are no pain-sensitive nerves in the rectum. However, these haemorrhoids can cause rectal bleeding during emptying of the bowels and in severe cases, may protrude (prolapse) through the anus.
  • External haemorrhoids: These haemorrhoids are located under the skin around the anus and can cause pain, itching, and swelling.
  • Prolapsed haemorrhoids: Internal haemorrhoids that have become so enlarged that they bulge outside the anus are known as prolapsed haemorrhoids. They may be painful and can often be pushed back inside manually; however, surgery may be required for clearing others.

Factors that can cause haemorrhoids have been enumerated below.

  • Increased pressure on anal and rectal veins: This is the most significant factor in haemorrhoid development. It can occur due to:
    • Straining during emptying of the bowels (often due to constipation or diarrhoea);
    • Obesity: It leads to increased intra-abdominal pressure, thereby affecting veins in the anus and rectum.
    • Pregnancy: The enlarged uterus can exert pressure on the pelvic veins, thereby increasing haemorrhoid risk.
    • Heavy lifting: Repeated heavy lifting or strenuous physical activities can increase abdominal pressure, contributing to haemorrhoid formation.
    • Old age: Ageing can weaken the tissues supporting the veins in the anus and rectum, thereby increasing haemorrhoid risk.
  • Dietary Factors:
    • Low-fibre diet: Such a diet can lead to constipation, thereby increasing the risk of straining during bowel emptying, and consequently, haemorrhoids.
    • Inadequate fluid intake: Not drinking enough fluids can also contribute to constipation.
  • Pregnancy-related hormonal changes: These weaken the connective tissue around the rectum, thereby increasing haemorrhoid risk.
  • Genetics: Some individuals may have a genetic predisposition to develop haemorrhoids.
  • Sedentary lifestyle: Sitting for prolonged periods can increase pressure on the veins around the anus.

Common symptoms of haemorrhoids include:

  • Discomfort: Pain, especially when sitting or during bowel movements, is more common with external haemorrhoids. Internal haemorrhoids typically do not cause pain unless they prolapse.
  • Bleeding: Blood that appears during or after a bowel movement and is not mixed with the stool is a common feature associated with internal haemorrhoids.
  • Itching or Irritation: Itching or irritation around the anus that can be exacerbated by moisture, wiping, or bowel movement-related irritation is common in case of external haemorrhoids.
  • Feeling of fullness: Prolapsed internal haemorrhoids may cause a feeling of fullness or discomfort.
  • Lumps: Swollen, tender lumps around the anus may be felt in case of external haemorrhoids.
  • Mucus discharge: Some individuals may experience a mucus discharge from the rectum, particularly those affected by internal haemorrhoids.

Haemorrhoids can be diagnosed using the following strategies:

  • Physical examination: For external or prolapsed haemorrhoids the area around the anus is inspected to look for visible haemorrhoids.
  • Digital rectal scan: For internal haemorrhoids, the doctor feels for internal swelling or abnormalities by inserting a gloved finger into the rectum.
  • Anoscopy: In this technique, a small, lighted tube (anoscope) is inserted into the rectum to visualise internal haemorrhoids and assess their size and location.
  • Sigmoidoscopy or Colonoscopy: This may be performed to exclude conditions, such as colorectal cancer, especially in individuals over 50 of age or with a history of bowel issues.
  • Proctoscopy: In this technique, a proctoscope is used to examine the rectum and lower colon for any indication of internal haemorrhoids or other diseases.

Haemorrhoids can be managed using various strategies, including:

  • Over-the-counter medications:
    • Hydrocortisone or witch hazel creams: These can help reduce pain, inflammation, and itching.
    • Suppositories: For internal haemorrhoids, suppositories may help relieve symptoms.
  • Medical treatments:
    • Rubber band ligation: This is a common outpatient procedure for more individuals with severe internal haemorrhoids. In this procedure, the base of the haemorrhoid is bound using a rubber band to cut off the blood supply, which causes the haemorrhoid to shrink, and eventually, fall off.
    • Sclerotherapy: In this procedure, the haemorrhoid is induced to shrink by injecting a chemical solution.
    • Infrared coagulation (IRC): IRC employs heat to shrink internal haemorrhoids.
    • Electrocoagulation: In this technique, electrical current is used to shrink the haemorrhoidal tissue.
  • Surgical treatment: If conservative treatments and minimally invasive procedures are not effective, or if the haemorrhoids are very large, surgical intervention may be required.
    • Haemorrhoidectomy: This surgical procedure is used to remove large or prolapsed haemorrhoids under local or general anaesthesia. It is considered the most effective treatment for severe haemorrhoids.
    • Stapled haemorrhoidopexy: This technique involves removing part of the haemorrhoidal tissue using a stapling device and repositioning the remaining tissue. Though this method is less painful than haemorrhoidectomy but is used less frequently.

The occurrence of haemorrhoids can be prevented by incorporating dietary changes; the same have been enumerated below.

  • Dietary changes:
    • Increasing the fibre intake: Eating a high-fibre diet helps soften the stool and decreases straining during bowel voiding.
    • Staying hydrated: This helps prevent constipation and reduces haemorrhoid risk.
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Platelet-rich Plasma (PRP) Injections

Management Team

Platelet-rich Plasma (PRP) Injections

Overview

Commonly referred to as the “Vampire Facial”, this treatment is highly popular in Hollywood. It is a regenerative therapy that is performed using just the patient's own blood. Platelets, which are tiny fragments of blood cells, play an essential role in wound healing and tissue regeneration. Dentists and orthopaedics commonly use this therapy to aid in early healing. Recently, this method has been applied to skincare, and it is used to improve the appearance of wrinkles, scars, and stretch marks as well as rejuvenate the under-eye skin. It also helps plump facial contours. Presently, it is the most popular natural anti-ageing treatment. 

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Phobias

Management Team

Phobias

Overview

Phobias are a subtype of anxiety disorders marked by intense, irrational, and persistent fear or disabling anxiety or fear triggered by specific objects or situations. These phobias are often unwanted and include fear of heights or flying, fear of closed spaces, fear of insects, fear of crowded places, to name a few. Phobias can be further classified into various subgroups. Social phobia or agoraphobia are the further subgroups of phobias.

Causes of phobias include the following:

  • Genetic
  • Environmental factors

The different types of phobias are:

  • Specific phobia
  • Social phobia
  • Agoraphobia

Symptoms of phobia include:

  • Anxiety
  • Daily activities are affected
  • Physical symptoms
    • Sweating
    • Shortness of breath
    • Tremor
    • Shaking
    • Increased heartrate

Diagnosis includes:

  • Persistent fear
  • Avoidance
  • Diagnosing underlying mental disorder

Phobia can be treated using:

  • Exposure therapy
  • Mindful therapy
  • Medications
  • Cognitive behavioural therapy
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Pancreatic Stones

Management Team

Pancreatic Stones

Overview

Pancreatic stones are hard, calcified deposits that form in the pancreas, typically within the pancreatic ducts. These stones can vary in size and composition and are sometimes referred to as pancreatic calculi. They are most often associated with chronic pancreatitis, though they can also occur in other pancreatic disorders. Here's a more detailed look at pancreatic stones:

  • Chronic pancreatitis: The most common underlying condition for pancreatic stone formation. Inflammation of the pancreas leads to damage to the ductal structures, promoting stone formation.
  • Alcohol abuse: Long-term alcohol consumption is a major risk factor for chronic pancreatitis, which in turn increases the likelihood of stone formation.
  • Genetic factors: Hereditary forms of pancreatitis (such as those linked to mutations in the PRSS1 gene) can predispose individuals to developing pancreatic stones.
  • Obstruction of the pancreatic duct: Blockage or narrowing of the duct can lead to stagnation of pancreatic juices, creating an environment conducive to stone formation.
  • Hypercalcaemia: Elevated levels of calcium in the blood may lead to the formation of calcified pancreatic stones.
  • Other factors: Disorders like cystic fibrosis, autoimmune pancreatitis, or ductal obstruction due to a tumour can contribute to stone formation.

Pancreatic stones may be asymptomatic, especially in the early stages. However, they can lead to several symptoms if they obstruct the pancreatic ducts or cause inflammation. These symptoms include:

  • Chronic abdominal pain: Often in the upper abdomen, typically aggravated by eating.
  • Jaundice: Due to obstruction of the bile duct if the stones are located near the common bile duct.
  • Nausea and vomiting: In some cases.
  • Steatorrhea (fatty stools): Caused by malabsorption due to pancreatic insufficiency.
  • Weight loss: Resulting from malnutrition or insufficient digestion of food.
  • Diabetes: The inflammation and damage to the pancreas can affect insulin production.

Pancreatic stones are typically diagnosed through imaging studies:

  • CT Scan: Can reveal calcifications in the pancreas, which are indicative of stones.
  • MRI or MRCP (magnetic resonance cholangiopancreatography): These techniques provide detailed images of the pancreatic duct and can identify stones as well as any ductal dilation or narrowing.
  • Endoscopic ultrasound (EUS): This is highly sensitive for detecting small stones that may not be visible on CT scans or MRCP.
  • ERCP (endoscopic retrograde cholangiopancreatography): A diagnostic and therapeutic procedure that can visualise and sometimes treat the stones, especially when they are causing obstruction.

  • Conservative management: For small, asymptomatic stones, treatment may not be necessary, but managing the underlying cause (e.g., treating pancreatitis or correcting hypercalcaemia) is important.
  • Pain management: For patients with chronic pain, pain relief strategies, such as analgesics, may be employed.
  • Endoscopic stone removal: In cases where the stones are causing obstruction, endoscopic procedures like ERCP can be used to remove or fragment the stones.
  • Surgical intervention: If stones are large or causing significant complications, surgery may be required to remove the stones or even part of the pancreas (pancreatectomy).
  • Pancreatic enzyme replacement: In cases where pancreatic insufficiency develops, enzyme replacement therapy can help with digestion and absorption.
  • Lifestyle modifications: Avoiding alcohol, following a low-fat diet, and maintaining good hydration can help reduce the risk of future stones.
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Pancreatitis

Management Team

Pancreatitis

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.

Below, various types of pancreatitis have been described.

  • 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:
    • Necrotising 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.

Chronic pancreatitis is a long-lasting inflammation of the pancreas that leads to irreversible damage, fibrosis, and dysfunction of the organ. The pancreas is responsible for producing digestive enzymes and hormones, including insulin, which regulate blood sugar levels. Chronic pancreatitis can result in loss of pancreatic function, including the ability to secrete digestive enzymes and regulate blood sugar, and can lead to pancreatic insufficiency, diabetes, and other complications.

The primary causes of chronic pancreatitis include:

  • Alcohol consumption: Chronic heavy alcohol use is the most common cause of chronic pancreatitis, accounting for about 70-80% of cases. The exact mechanism is not fully understood, but alcohol damages pancreatic cells, leading to inflammation and scarring over time.
  • Genetic factors:
    • Mutations: Certain mutations can increase susceptibility to chronic pancreatitis. Mutations in the CFTR gene (cystic fibrosis transmembrane conductance regulator), which causes cystic fibrosis, and in genes such as PRSS1, SPINK1, and CFTR are known to predispose individuals to chronic pancreatitis.
    • Hereditary pancreatitis: This is a rare condition that can occur in families and is often caused by mutations in the PRSS1 gene, leading to increased activation of pancreatic enzymes within the pancreas.
  • Autoimmune pancreatitis: This form of pancreatitis is caused by an abnormal immune response where the body’s immune system attacks the pancreas. It is associated with other autoimmune diseases like IgG4-related disease.
  • Obstruction of the pancreatic duct: Blockage or narrowing of the pancreatic duct can cause chronic inflammation. This may occur due to pancreatic duct stones, strictures (narrowing of the duct), or tumours that obstruct the normal flow of pancreatic enzymes.
  • Idiopathic: In many cases, the exact cause of chronic pancreatitis remains unknown, even after thorough investigation. This is referred to as idiopathic pancreatitis.
  • Other causes: Hypercalcaemia (elevated blood calcium levels), high cholesterol (hyperlipidemia), and certain infections (e.g., mumps or hepatitis) can also contribute to the development of chronic pancreatitis.

Common symptoms include:

  • Abdominal pain: The most common symptom is recurrent or persistent upper abdominal pain, which may radiate to the back.
  • Digestive problems: As the pancreas becomes less able to produce digestive enzymes, patients may experience symptoms of pancreatic insufficiency:
    • Steatorrhea (fatty stools): This occurs due to malabsorption of fat.
    • Bloating, nausea, and diarrhoea: These are also common as food is not properly digested.
  • Weight loss: Unexplained weight loss occurs because the body cannot properly digest food, leading to malnutrition. This can be exacerbated by poor appetite and diarrhoea.
  • Diabetes: As the pancreas becomes damaged, the insulin-producing cells may also be affected, leading to diabetes mellitus. This can occur over time in people with chronic pancreatitis, especially if the condition is severe.
  • Jaundice: If chronic pancreatitis causes obstruction of the bile duct (by a pancreatic pseudocyst or fibrosis), jaundice (yellowing of the skin and eyes) may develop.
  • Nausea and vomiting: Persistent nausea and vomiting may occur, particularly during episodes of pain or in cases where there is a significant impairment of digestion.
  • Fatigue: Chronic inflammation and the body’s inability to properly absorb nutrients can result in chronic fatigue and weakness.

Diagnosing chronic pancreatitis involves the following tests:

  • Blood tests:
    • Amylase and lipase: The levels of these enzymes are typically elevated in acute pancreatitis, but in chronic pancreatitis, they may be normal or only mildly elevated.
    • Pancreatic function tests: These may assess how well the pancreas is producing digestive enzymes.
    • Glucose levels: Elevated blood sugar may indicate diabetes due to pancreatic damage.
    • Liver function tests: Elevated liver enzymes can suggest complications like bile duct obstruction.
  • Imaging studies:
    • Abdominal ultrasound: This is the first-line imaging modality and may reveal pancreatic calcifications, bile duct dilation, or pancreatic masses.
    • CT scan: CT is a more detailed imaging technique that can identify structural changes in the pancreas, such as pancreatic calcifications, pseudocysts, or ductal strictures.
    • MRI/MRCP (magnetic resonance cholangiopancreatography): MRCP provides high-resolution images of the pancreatic duct and bile ducts, helping to identify ductal dilation, strictures, or stones.
  • Endoscopy:
    • Endoscopic ultrasound (EUS): EUS is highly sensitive for detecting pancreatic calcifications and can also be used to obtain tissue samples (biopsy) for evaluation of the pancreas.
    • Endoscopic retrograde cholangiopancreatography (ERCP): This procedure is not commonly used for diagnosis but can be useful to visualise the pancreatic duct and remove stones or relieve ductal obstructions.
  • Pancreatic function tests: These tests assess how well the pancreas is functioning in terms of enzyme production. The secretin stimulation test and faecal elastase levels are commonly used to evaluate pancreatic exocrine function.

The treatment of chronic pancreatitis is primarily aimed at managing pain, improving pancreatic function, and addressing complications. There is no cure for chronic pancreatitis, but treatment can help improve quality of life and reduce symptoms.

  • Pain management: Pain is one of the most common and debilitating symptoms of chronic pancreatitis. Treatment options include:
    • Medications:
      1. Nonsteroidal anti-inflammatory drugs (NSAIDs): Used for mild-to-moderate pain relief.
      2. Opioids: In cases of severe pain, opioids may be used, but their long-term use should be closely monitored due to the risk of dependence.
      3. Gabapentin or pregabalin: These medications, which are used for nerve pain, can sometimes be helpful for chronic pancreatitis pain.
  • Endoscopic therapy: If there is ductal obstruction, endoscopic drainage or stenting can help relieve pain.
  • Surgical intervention:
    • Pancreatic surgery: In some cases, surgical intervention may be required to relieve pain, remove stones, or treat complications such as pseudocysts or strictures.
    • Pancreatic resection: For patients with localised disease, removing part of the pancreas may help alleviate symptoms.
    • Pancreatic duct drainage: This might be required for severe cases.
  • Nutritional support:
    • Enzyme replacement therapy: Pancreatic enzyme supplements can help improve digestion and nutrient absorption in patients with pancreatic insufficiency. These are typically taken with meals.
    • Dietary changes: A low-fat, high-protein diet may be recommended to improve digestion and reduce discomfort. Patients should avoid alcohol and smoking to prevent further damage to the pancreas.
    • Vitamin supplementation: Deficiencies in fat-soluble vitamins (A, D, E, K) can occur due to poor absorption of fat. These may need to be replaced through supplements.
  • Lifestyle changes:
    • Avoid alcohol: Alcohol consumption should be completely avoided in patients with chronic pancreatitis, as it can worsen the condition and cause flare-ups.
    • Smoking cessation: Smoking is a significant risk factor for the development and progression of chronic pancreatitis and should be avoided.
    • Weight management: Maintaining a healthy weight is important to reduce the strain on the pancreas and improve overall health.
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