Sigmoidoscopy

Management Team

Sigmoidoscopy

Overview

Sigmoidoscopy also known as flexible sigmoidoscopy is a medical procedure that involves the visual inspection of the sigmoid colon and rectum. The last part of the human colon which is located above the rectum is called sigmoid colon. While the human colon is 5-6 feet long, sigmoidoscopy only analyses 1-2 feet of the colon from the rectum. For the observation, a flexible tube with a light and camera called a sigmoidoscope, is inserted through the rectum and the internal structure is observed on the video screen.

Your doctor may recommend sigmoidoscopy as a diagnosis in the following cases:

  • Bleeding: If you experience rectal bleeding, sigmoidoscopy may be recommended since it can identify the cause of bleeding. Rectal bleedings are mostly caused due to haemorrhoids (piles) or anal fissures which involves tearing of the wall of anus. There could also be a serious underlying condition like benign polyps which can lead to rectal and colon cancer. For such cases, sigmoidoscopy plays an important role in its diagnosis.
  • Persistent diarrhoea: Persistent diarrhoea can be an indication of an underlying condition which can be identified through sigmoidoscopy.
  • Pain: if you are experiencing pain in the rectum or colon, your doctor may advise for a sigmoidoscopy to identify the cause of the pain. Common causes include haemorrhoids, anal fissures, and diverticulosis. Diverticulosis is a condition affecting the lower bowel in which small pockets are seen projecting from the bowel walls. Pain or discomfort could also be a sign of colon or rectal cancer.
  • X-Ray findings: Sigmoidoscopy is often performed to confirm the findings from a barium enema X-ray examination.
  • Detection of cancer: Colon cancer is the most common form of cancer in the country. It usually starts as benign polyps within the colon which further develop to be cancerous. If these are identified early, these polyps can easily be removed and can avoid the development of cancer. Hence it is advisable to get a sigmoidoscopy done to ensure protection from colon cancer. In cases of a family history of colon cancer, sigmoidoscopy is highly recommended.

The preparation for examination usually involves the intake of clear liquids and use of enema and laxatives by the patient. This is to ensure that the sigmoid colon and rectum are clean for observation.

Sigmoidoscopy is usually performed on outpatient basis. The examination involves the following steps:

  • The patient is asked to lay flat on his/her left side with the legs drawn up.
  • A sheet is placed between over the lower part to cover the lower body of the patient
  • A prior finger or digital examination of the anus is performed
  • The sigmoidoscope is then slowly inserted via the rectum. The colon is expanded by inflating air to ensure the smooth insertion of the tube. At this point, the patient may experience some discomfort which is similar to gas cramps.
  • The sigmoidoscope is then moved slowly around the curves to advance into the colon. It is inserted only till the patient doesn’t feel discomfort. In cases where the patient feels any discomfort due to an underlying cause, the procedure is immediately stopped.
  • The procedure requires usually requires only up to 15-20 minutes and doesn’t require any sedation due to very low chances of discomfort.

The positive outcomes of sigmoidoscopy can include:

  • Identifying the specific cause of symptoms.
  • Monitoring conditions like colitis and diverticulosis to assess the effectiveness of treatment.
  • Detecting polyps and tumours at an early stage.

  • Colonoscopy: A more comprehensive procedure that examines the entire colon.
  • CT Colonography: An external imaging that provides detailed views of the colon.
  • Stool Tests: It is used for initial screening but may not provide detailed results.

Common side effects of sigmoidoscopy include

  • Bloating: Bloating and a feeling of fullness in the abdomen is caused by air being introduced into the bowel. These symptoms typically subside within 30 to 60 minutes.
  • Minor bleeding: If a biopsy is performed or a polyp is removed, there may be minor bleeding, though it is generally not concerning.

Sigmoidoscopy is a simple procedure that can help detect serious health issues. It allows for the accurate diagnosis of conditions, assessment of treatment plans, and also provides reassurance if the results are normal. It is one of the most valuable and simple tools for the diagnosis of the digestive tract.

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Spinal +/- Epidural Anaesthesia

Management Team

Spinal +/- Epidural Anaesthesia

Overview

Spinal and epidural anaesthesia are types of local anaesthesia that are used to numb (block sensation) specific regions of the body. Both these anaesthesia techniques act by targeting the nerves near the spinal cord and are generally used for surgical procedures in the lower body, including childbirth, urological procedures, and orthopaedic (bone) surgeries. Though these two types of anaesthesia have certain similarities, they differ in terms of technique, onset, and applications.

As spinal anaesthesia causes profound loss of sensation (no pain felt) and muscle movement (inability to move the affected area) and reduction in the activity of the sympathetic nervous system (part of the nervous system that controls blood pressure, heart rate, and blood vessel constriction), it is effective for lower body procedures like orthopaedic surgeries (e.g., hip and knee replacement), abdominal surgeries (e.g., caesarean section and hernia repair surgery), and urological procedures (bladder surgery). In contrast, epidural anaesthesia provides pain relief without substantial loss of muscle movement (epidural analgesia, i.e., no muscle paralysis), and is therefore the anaesthesia of choice during labour where pain relief (labour pain management) is required without affecting consciousness. Epidural anaesthesia can be used in combination with general anaesthesia to improve pain control and reduce the dependence on systemic opioids (a class of pain-relieving medications that is often used during surgery—as part of the anaesthesia management plan—whose use in addition to causing addiction, is associated with side effects (like respiratory depression and gastrointestinal issues) and long-term complications.

Both spinal and epidural anaesthesia improve patient outcomes by providing effective pain relief and reducing the recovery time. This makes them safer and more targeted alternatives to general anaesthesia. I have enumerated a few benefits of these anaesthesia techniques blow.

  • Avoidance of risks associated with general anaesthesia: Both spinal and epidural anaesthesia are associated with low risk of nausea, vomiting, sore throat, and cognitive dysfunction (all of which are risks associated with general anaesthesia).
  • Enhanced safety due to the provision of patients remaining conscious during surgery: Conscious patients do not require airway management. This reduces the risk of complications like aspiration, respiratory depression, or adverse reactions to general anaesthetics.
  • Effective pain control: These techniques provide excellent pain relief, especially in the lower half of the body and are therefore considered the optimal methods of anaesthesia in that region, hence their use to ensure numbness and pain relief during labour and childbirth (labour pain management) and surgeries in the region below the chest.
  • Minimal systemic effects: As these techniques avoid the use of systemic (affecting the entire body) sedatives or narcotics, they do not cause drowsiness or respiratory depression.
  • Improved postoperative recovery: Owing to improved blood flow in patients undergoing these types of anaesthesia, patients are at a lower risk of developing complications like deep vein thrombosis (DVT) or pulmonary embolism. Additionally, these techniques are associated with faster return of gastrointestinal function compared to general anaesthesia. All of these aspects result in early post-operative mobilization and recovery.
  • Haemodynamic stability: These techniques reduce the surgical stress response, which leads to better blood pressure control during surgery (and hence smoother surgery).
  • Cancer pain relief: Local anaesthetics or opioid medications can be delivered into the epidural space (epidural) or directly into the cerebrospinal fluid (CSF; spinal block) to provide pain relief for advanced cancers that cause widespread pain in the lower body or abdomen. These strategies are often used in palliative care (aimed at improving the quality-of-life of individuals with life-threatening diseases) settings for continuous pain relief.
  • Chronic pain treatment: Epidural anaesthesia is an effective treatment option for chronic pain management, especially for conditions related to the spine, such as herniated discs, sciatica, and spinal stenosis.

As mentioned above, the techniques for spinal and epidural anaesthesia differ. However—just like in case of general anaesthesia—there is a preoperative stage where medical history, medications, and allergies are taken into account. The techniques for spinal and epidural anaesthesia (following the preoperative stage) have been provided below.

  • Spinal anaesthesia technique:
    • Checking of spinal anatomy: This is done to allow for safe needle placement and drug delivery to ensure reduced risk of complications, such as spinal cord injury, nerve damage, or failed anaesthesia.
    • Drug administration: A small amount of local anaesthetic is directly injected via a needle into the cerebrospinal fluid (CSF) in the subarachnoid space (the space surrounding the spinal cord) in the lower back (lumbar region). This results in the rapid numbing of the target region (1 to 5 minutes for numbing).
    • Monitoring: Vital signs like blood pressure, heart rate, and oxygen saturation are continuously monitored and complications like low blood pressure (hypotension) and slow heartbeat (bradycardia)—which may require treatment with intravenous fluids, ephedrine, or atropine—are looked out for.
    • Onset of anaesthesia: Numbing is checked using a pinprick test or cold swab.
    • Post-procedure care: After the completion of the procedure, patients are positioned flat on their back to allow even distribution of the anaesthetic and continuously monitored for complications like low blood pressure (hypotension), spinal headache (headache caused due to cerebrospinal fluid (CSF) leakage through the dura matter), nerve damage, and in rare cases, respiratory and cardiovascular compromise (a situation where the normal functioning of the lungs and heart is impaired or weakened, potentially leading to life-threatening conditions).
  • Epidural anaesthesia technique:
    • Identification of epidural space: The epidural space, i.e., the site of injection is identified to ensure safe needle placement.
    • Needle insertion and catheter placement: A Tuhoy needle is inserted to access the epidural space, which lies just outside the dura mater surrounding the spinal cord. Once the epidural space is located, a catheter is inserted to deliver local anaesthetics and/or pain relief medications.
    • Test dose administration: Before administering the final dose, a small amount of anaesthetic mixed with epinephrine is administered to the patient and the patient is subsequently checked for tachycardia (rapid heartbeat) or metallic taste (indicating accidental vein injection) and rapid numbness or motor block (indicating accidental dural puncture). If both are negative, the anaesthetic is administered.
    • Drug administration: A local anaesthetic (e.g., bupivacaine) is injected into the epidural space (the space outside the dura matter)— either as a single dose (bolus) or continuously—through the catheter to block nerve signals and provide pain relief. This technique results in slow numbing of the target region (10 to 25 minutes for numbing).
    • Monitoring: Vital signs like blood pressure, heart rate, and oxygen saturation are continuously monitored, and signs of low blood pressure (hypotension) looked out for.
    • Onset of anaesthesia: Numbing is checked using a pinprick test or cold swab.
    • Post-procedure care: After the completion of the procedure, the catheter is removed and patients are observed for complications like low blood pressure (hypotension), infection, or bleeding (and in rare cases, dural puncture‒associated headache).

As with general anaesthesia, the risks associated with spinal anaesthesia may be common or rare depending on the root cause or the patient’s medical history or genetics.

  • Common risks
    • Hypotension (low blood pressure): This is caused when the anaesthetic blocks the sympathetic nerves (nerves that control the body's "fight-or-flight" response, which prepares the body for situations requiring heightened alertness or quick action), resulting in reduced cardiac output. Symptoms include dizziness, nausea, fainting, or, in severe cases, cardiovascular collapse.
    • Post-dural puncture headache (PDPH): This is caused by the leakage of cerebrospinal fluid (CSF) through the puncture site in the dura mater. Symptoms include severe headache, stiffness in the neck, nausea, and sensitivity to light.
    • Nausea and vomiting: These are the result of low blood pressure (hypotension) or visceral nerve irritation (a condition in which, nerves that carry signals between the internal organs (viscera) and the central nervous system (CNS) get inflamed, injured, or compressed).
      Back pain: This is caused due to local tissue trauma or muscle spasm at the injection site.
    • Difficulty urinating (Urinary retention): This is caused due to the inability of sacral nerves—which control bladder function—to transmit signals.
  • Rare but serious risks:
    • High or total spinal block: This is caused by the excessive spread of the anaesthetic into higher spinal levels, potentially affecting respiratory muscles or the brainstem. Symptoms include difficulty in breathing, low blood pressure (hypotension), slow heartbeat (bradycardia), or loss of consciousness.
    • Neurological complications: These are caused as a result of direct nerve injury, spinal cord trauma, or hematoma (leakage of blood from the blood vessels into the surrounding tissue). Symptoms include persistent numbness, weakness, tingling, or in extremely rare cases, paralysis.
    • Infection: Meningitis (infection of the membranes enveloping the brain and spinal cord, i.e., meninges) and brain abscess (infection of the brain) can be caused as a result of contamination during the procedure. Symptoms include severe back pain, fever, and neurological issues, such as memory problems, difficulty in thinking, confusion, changes in sensation, and even seizures.
    • Bleeding (Spinal hematoma): This is caused due to the accidental puncture of the blood vessels during anaesthesia. This is especially common in patients with blood clotting disorders or who are on anticoagulants (agents that do not allow the blood to clot). Symptoms include severe back pain and neurological deficits ranging from ranging from pain and numbness to paralysis and autonomic dysfunction (a condition where the part of nervous system that controls core functions, like heart rate, blood pressure, digestion, and temperature regulation, does not function properly).
    • Allergic reactions: These are caused when the patient is sensitive to the anaesthetic drug or preservatives used. Symptoms include rash, itching, or anaphylaxis (a severe, potentially life-threatening allergic reaction that occurs immediately after exposure to an allergen).

If spinal or epidural anaesthesia fails, i.e., the anaesthetic does not work as expected and does not provide the desired level of pain relief, or if the patient is incompatible with the anaesthetics used in these techniques, the doctors can choose to go with general anaesthesia for the procedure.

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Sleep Study

Management Team

Sleep Study

Overview

A sleep study, also known as polysomnography, is a comprehensive test used to diagnose sleep disorders. It records the brain waves, oxygen levels in the blood, heart rate, breathing, as well as eye and leg movements during sleep. It also measures eye and leg movements.

The test is usually performed at night. However, it may be done during the day for shift workers who usually sleep in the daytime. In addition to diagnosis, a sleep study might help determine a treatment plan in case of a sleep disorder diagnosis. It also might be used to adjust treatment.

  • Sleep apnoea or another sleep-related breathing disorder: In this condition, breathing stops and starts repeatedly during sleep.
  • Periodic limb movement disorder: People with this sleep disorder flex and extend their legs while sleeping. This condition is sometimes linked to restless legs syndrome. Restless legs syndrome causes an uncontrollable urge to move the legs while awake, usually in the evenings or at bedtime.
  • Narcolepsy: People with narcolepsy experience overwhelming daytime drowsiness. They can fall asleep suddenly.
  • Rapid eye movement (REM) sleep behaviour disorder: This sleep disorder involves acting out dreams during sleep.
  • Unusual behaviours during sleep: This includes walking, moving around, or rhythmic movements during sleep.
  • Unexplained long-lasting insomnia: People with insomnia have trouble falling asleep or staying asleep

  • Diagnose Sleep Disorders like sleep apnoea, narcolepsy, restless legs syndrome, insomnia.
  • Investigate Sleep-Related Behavioural disorders like sleepwalking, night terrors and other unusual activities during sleep.
  • Evaluate Treatment Efficacy, i.e., how well the treatment for a sleep disorder is working, which includes titration sleep study.

  • Polysomnography (PSG): It is the most common sleep study. PSG requires the patient to sleep overnight in a sleep disorder clinic (i.e., Level 1 sleep study). Levels 2, 3 and 4 include home-based sleep studies. The number of monitoring parameters reduces as the level of sleep study increases.
  • Multiple Sleep Latency Test (MSLT): This test measures how quickly you fall asleep in a quiet environment during the day.
  • Maintenance of Wakefulness Test (MWT): This test evaluates your ability to stay awake during the day.

  • Avoid caffeine
  • Follow specific instructions regarding medication use

  • Setup: Sensors are placed on the scalp, face, chest, limbs, and a finger.
  • Monitoring: The equipment monitors sleep stages and cycles, heart rate, breathing, oxygen levels and movements.
  • Environment: Measurements are taken in a comfortable, quiet room for overnight studies.

A specialist will analyse the data. A follow-up appointment will be scheduled to discuss the results and potential treatments.

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Short Stature

Management Team

Short Stature

Overview

Short stature refers to a height significantly below the average for a person’s age and sex. It can be caused by genetic factors, hormone deficiencies, chronic illnesses, or malnutrition. Children with short stature may face emotional and social challenges.

Assessing growth patterns, evaluating family history, and conducting tests to identify any underlying conditions.

Treatment depends on the cause. If a hormone deficiency is identified, growth hormone therapy might be prescribed to help stimulate growth. In cases wherein short stature is due to nutritional deficiencies or chronic illnesses, addressing these underlying issues is crucial.

Supportive care and counselling can also help children cope with the social and emotional aspects of short stature. If you have any worries about your child's growth or development, please consult our paediatric endocrinology department.

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Sheehan’s Syndrome

Management Team

Sheehan’s Syndrome

Overview

Sheehan’s syndrome, known as postpartum pituitary necrosis, arises when severe blood loss during childbirth damages the pituitary gland (pea-sized organ that is situated at the base of the brain), leading to hormone deficiencies.

Fatigue, low blood pressure, weight loss, and inability to produce breast milk.

Assessing hormone levels through blood tests and evaluating symptoms. Imaging studies may be conducted to check the pituitary gland.

Hormone replacement therapy to address deficiencies, including cortisol, thyroid hormones, and sex hormones. Regular monitoring and adjusting hormone doses are necessary to manage the condition effectively. Early diagnosis and treatment are crucial for enhancing quality of life and preventing complications.

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Smoking and Pulmonary Health: The Critical Role of Smoking Cessation

Management Team

Smoking and Pulmonary Health: The Critical Role of Smoking Cessation

Overview

Medical management plays a crucial role in aiding individuals in their journey to quit smoking, a habit notorious for its detrimental health effects. This comprehensive approach combines various strategies from multiple specialties to address both the physical and psychological aspects of addiction.

  • Firstly, nicotine replacement therapies (NRTs), such as patches, gums and lozenges deliver controlled amounts of nicotine to alleviate withdrawal symptoms. These aids help gradually wean smokers off nicotine, reducing cravings and making the quitting process more manageable.
  • Additionally, prescription medications like bupropion and varenicline target nicotine receptors in the brain, effectively reducing the pleasure derived from smoking and minimising withdrawal symptoms. These medications can be prescribed based on individual health profiles and smoking habits, enhancing their efficacy.
  • Furthermore, behavioural counselling and support groups are integral components of medical management. Counselling sessions provide smokers with coping mechanisms, stress management techniques, and strategies to modify behavioural triggers associated with smoking. Group support fosters a sense of community and encouragement, reinforcing motivation and accountability.
  • Medical professionals play a pivotal role in guiding and monitoring progress, adjusting treatment plans as needed to optimise success. Regular follow-ups ensure adherence and provide opportunities for addressing challenges or relapses.
  • Ultimately, the synergy between medical interventions and behavioural support maximises the likelihood of long-term smoking cessation, promoting better health outcomes and a higher quality of life for individuals overcoming tobacco addiction.
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Sleep-related Breathing Disorders

Management Team

Sleep-related Breathing Disorders

Overview

Sleep-related breathing disorders are a group of conditions characterised by abnormal respiration during sleep.

These disorders can range from simple snoring to more serious conditions like obstructive sleep apnoea (OSA), central sleep apnoea (CSA) and complex sleep apnoea syndrome.

  • OSA: This is the most common sleep-related breathing disorder. It occurs when the muscles in the throat relax excessively, causing a temporary blockage of the airways during sleep. Symptoms include loud snoring, choking or gasping sensation during sleep, excessive daytime sleepiness, morning headache, fatigue, irritability, memory lapses, resistant hypertension (requirement of three or more antihypertensive drugs). Untreated OSA can lead to uncontrolled high blood pressure, uncontrolled diabetes and increases the risk of stroke, cardiac arrythmias and cardiac arrest.
  • CSA: Unlike OSA, CSA is due to the brain failing to send proper signals to the muscles that control breathing. This results in periodic pauses in breathing during sleep. CSA is less common than OSA and is often associated with certain medical conditions, such as heart failure or stroke.
  • Complex Sleep Apnoea Syndrome: This condition is a combination of OSA and CSA. It can occur when someone being treated for OSA with continuous positive airway pressure (CPAP) therapy develops CSA.

  • Sleep history
  • overnight monitoring of your breathing and other body functions during sleep testing at a sleep center (Home sleep testing also might be an option)
  • Tests to detect sleep apnea include:
    • Nocturnal polysomnography. During this test, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
    • Home sleep tests. These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns. Your provider is more likely to recommend polysomnography in a sleep testing facility, rather than a home sleep test, if central sleep apnoea is suspected.

For OSA:

  • CPAP therapy
  • Other airway pressure devices (auto-CPAP/BPAP) 
  • Oral appliances
  • Surgery

For CSA:

  • Treatment for associated medical problems
  • Medicine changes for managing breathing
  • Supplemental oxygen
  • Adaptive servo-ventilation (ASV)
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Sarcoidosis

Management Team

Sarcoidosis

Overview

Sarcoidosis is an inflammatory disease characterised by the formation of granulomas—tiny clumps of inflammatory cells—in various organs, most commonly in the lungs, lymph nodes, eyes and skin.

The exact cause of sarcoidosis is unknown, but it is believed to result from an abnormal immune response, possibly triggered by infections or environmental factors; it might also occur as a result of genetic predisposition.

  • General: Fatigue, fever, weight loss and night sweats
  • Lungs: Persistent cough, shortness of breath and chest pain
  • Skin: Rashes, lesions and nodules
  • Eyes: Blurred vision, eye pain, redness and sensitivity to light
  • Lymph nodes: Swelling, especially in the neck or armpits

  • Medical history and physical examination.
  • Imaging tests: Chest X-rays, CT scans to check for lung involvement.
  • Biopsy: Collection of tissue samples from affected organs to identify granulomas. Endobronchial ultrasound (EBUS)-guided biopsy of mediastinal lymph nodes or transbronchial lung biopsy using a bronchoscope are commonly done.
  • Blood tests: To check for signs of inflammation and organ function. Serum angiotensin-converting enzyme (ACE) levels may help in supporting the diagnosis.

  • Observation: Mild cases may resolve on their own without treatment.
  • Medications
    • Corticosteroids: They are the first line of treatment to reduce inflammation.
    • Immunosuppressants: For severe or persistent cases

Prognosis: The course of sarcoidosis varies widely. Some people experience only mild symptoms that improve on their own, while others may have chronic, severe symptoms that require ongoing treatment. In some cases, sarcoidosis can lead to complications such as lung fibrosis or organ damage.

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Stomach Cancer

Management Team

Stomach Cancer

Overview

Stomach or gastric cancer occurs when the stomach cells grow abnormally. The most common site of cancer in the stomach is the main body of the stomach. Initially, the cancer cells are seen near the lining of the stomach, after which they eventually invade deeper into the walls.

The exact cause is not yet known. However, some common causes of stomach cancer include:

  • Genetics: Cancer occurs due to mutation in the DNA in the cells of the stomach
  • Infections: Helicobacter pylori and Epstein-Barr virus
  • Obesity and diet: High-fat diet, high salt diet - including pickles, and less consumption of fruits and vegetables
  • Alcohol and tobacco
  • Gastritis and gastrointestinal reflux disease

  • Bloated feeling
  • Loss of appetite
  • Unexplained weight loss
  • Blood in stools or vomit
  • Nausea
  • Feeling full after a snack

  • Endoscopy
  • CT scan
  • Biopsy
  • Barium swallow test
  • Biomarker tests

Treatment for stomach cancer depends on the stage of cancer.

Surgery is performed to remove the cancer, which includes removing stomach parts affected by cancer, along with the lymph nodes. Diet changes such as eating smaller and frequent meals will be necessary. Doctors may prescribe vitamin supplements to compensate the actions of stomach, some of which can only be injected. Stomach cancer surgery involves different types:

  • Total gastrectomy: This operation involves the complete removal of stomach along with the lymph nodes and omentum, sometimes including parts of intestines, pancreas, spleen, and oesophagus. The remaining parts are attached (usually the end of oesophagus to the remaining small intestine). This is performed when the cancer is in the upper part of stomach.
  • Subtotal (partial) gastrectomy: This operation involves removal of only a part of the stomach. It is often recommended when the cancer is in the lower part only or upper part of the stomach.
  • Palliative surgery: Surgery is preferred even in cases of advanced cancer and unresectable stomach cancer to prevent the blockage of stomach by the tumour and to prevent bleeding or relieve symptoms or complications. This includes subtotal gastrectomy as well. The goal is not to cure cancer but to relieve symptoms.
  • Endoscopic resection: Endoscopic mucosal and submucosal resections are used in early stage cancers, when the chances of cancer spreading to the lymph nodes is minimal. This procedure involves an endoscope to remove the tumour and surrounding parts of the stomach.
  • Endoscopic tumour ablation: An endoscope is used to guide laser beam to eliminate the parts of tumour in people in whom surgery cannot be done. This is performed to relieve blockage and stop bleeding without any surgery.
  • Gastric bypass (gastrojejunostomy): Sometimes, the tumours are large enough to block the food from leaving the lower part of the stomach. An option to help prevent or treat this blockage of food passage is to bypass the lower part of stomach. A part of the jejunum is attached to the upper part of the stomach, so that food passes without any obstruction.
  • Stent placement: A stent is placed using an endoscope to prevent the blockage at the opening or end of stomach. So that the food passes freely through it.
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Sagging Skin

Management Team

Sagging Skin

Overview

Sagging skin occurs when the skin loses its firmness and elasticity, leading to a drooping appearance.

  • Mild skin sagging: It is marked by slight loss of firmness.
  • Severe skin sagging: It is marked by significant sagging and drooping.

Loose, droopy skin, particularly on the face, neck, and arms.

Aging, weight loss, sun damage, loss of collagen and elastin, among others.

Physical examination by a dermatologist.

  • Threads (PDO threads)
  • Morpheus8
  • Fillers
  • Radiofrequency therapy, depending on the severity of condition
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