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Ultrasonography Guided Liver Biopsy

Management Team

Ultrasonography Guided Liver Biopsy

Overview

A liver biopsy is regarded as a minimally invasive medical procedure in which a small sample of tissue from a patient’s liver is removed for further analysis. This makes it possible for physicians to determine what may be occurring in a person’s liver, particularly if other techniques such as blood tests or imaging do not provide appropriate clues. The liver is an organ in the body whose location is upper right side of the abdomen and serves the essential functions of cleansing poison, forming proteins, and assisting in food metabolism. Depending on the enzymes and biochemicals analysis, a biopsy can reveal a wide range of conditions including infection and inflammation to malignancy or other structural lesions.

Liver biopsy may be done at the request of the doctor for the following reasons:

  • Assessment of undiagnosed symptoms: Chronic lack of energy, jaundice, or inactive thyroid alongside abnormal test results focusing on the functioning of the liver may warrant a biopsy to be done for further diagnosis.
  • Chronic liver conditions: Other liver diseases such as hepatitis, liver fat, liver cirrhosis and other chronic liver conditions can be treated based on the patient's liver biopsy.
  • Cancer screening: If the imaging studies indicate possibility of presence of liver malignancy, then use of a liver cancer biopsy can confirm the diagnosis.
  • Evaluate progression of the disease: A liver biopsy may help give some evaluative insight on how much body damage has been inflicted over issues like auto immune hepatitis, genetic liver diseases amongst many others.
  • Assess treatment responses: It is often used for monitoring the outcome of conditions that affect the liver.

As for the procedure, your doctor will educate you on how to prepare for the biopsy You would be advised to not take any food or drink for a few hours prior to the procedure. Some medications that may cause bleeding need to be temporarily suspended. Additionally you will be advised to have a blood check performed to ensure safe clotting during the biopsy.

  • A liver biopsy is a quick procedure, taking around 15 to 20 minutes, and is performed under daycare admission process. Here is what you need to be ready for:
  • The patient will be asked to lie down flat on the back or perhaps on the left side at a slight angle.
  • Thereafter, the skin that is above the liver area will be disinfected and local anaesthesia will be injected into the region.
  • Using ultrasound or physical guidance, a thin needle is inserted to collect a small tissue sample. This part lasts only a few seconds.
  • The sample collected is sent to a pathology lab for analysis while the patient will be monitored for a few hours afterward to ensure there are no immediate complications.

A liver biopsy presents the following advantages:

  • Accurate Diagnosis: It directly reflects the health of the liver and can show a number of conditions.
  • Disease Assessment: Assists in determining the treatment depending on how far advanced the condition is.
  • Chronic Diseases Surveillance: Assesses variations over time in order to modify treatment approaches.

If a biopsy is deemed not suitable, one’s healthcare practitioner may recommend:

  • Imaging tests: Ultrasound, CT scans, or MRI for structural analysis.
  • Non-invasive techniques: FibroScan or specialized blood tests to assess liver stiffness and function.
  • Liver function tests (LFTs): These can monitor enzyme levels but don’t provide as much detail as a biopsy.

Liver biopsies are generally safe, but like any procedure, they carry some risks:

  • Mild discomfort: You might feel soreness where the needle was inserted or in your shoulder.
  • Bleeding: While rare, internal bleeding can occur but is usually manageable without surgery.
  • Bile leakage: A very rare complication if bile ducts are punctured.
  • Infection: As with any invasive procedure, there is a small chance of infection.
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Upper Gastrointestinal Endoscopy

Management Team

Upper Gastrointestinal Endoscopy

Overview

Upper gastrointestinal (GI) endoscopy is called esophagogastroduodenoscopy (EGD). It is a tool used for diagnosis and therapeutic procedures in digestive systems. It is used to examine the upper digestive tract. This includes the oesophagus (food pipe), stomach, and the duodenum (first part of the small intestine). During the procedure, a flexible tube with a camera (endoscope) is used to visualize the inner lining, identify abnormalities, and, if needed, perform therapeutic interventions like biopsies or polyp removal.

Upper GI endoscopy, usually performed as an outpatient procedure, may be recommended by your doctor for various reasons, including:

  • Unexplained symptoms: Such as persistent heartburn, nausea, vomiting, or abdominal pain.
  • Gastrointestinal bleeding: To identify the source of bleeding, whether hidden or visible.
  • Difficulty swallowing: To investigate conditions causing dysphagia (trouble swallowing).
  • Diagnosis of conditions: Such as peptic ulcers, gastritis, esophagitis, GERD, and celiac disease.
  • Surveillance: For patients with a history of polyps, upper GI cancer, or Barrett's oesophagus.

Proper preparation is essential for an accurate result. For preparation, the patients are advised to avoid solid foods for at least 8 hours and liquids for 4 hours before the procedure. Medication adjustments might be required and you are advised to follow specific instructions from your doctor regarding which medications need to be continued or stopped.

The procedure involves minimal steps including the following:

  • A mild sedative and throat-numbing spray are often used for comfort.
  • A thin, flexible tube is inserted through the mouth and guided through the oesophagus, stomach, and duodenum.
  • The physician examines the tract and may take biopsies, remove polyps, or treat bleeding areas.

The procedure typically lasts 15 to 30 minutes. Results are often available immediately after the procedure. If biopsies are taken, it may take several days for pathology reports. Findings may include inflammation, ulcers, polyps, or signs of infection or cancer.

  • Diagnostic accuracy: Identifies issues that imaging tests may miss.
  • Therapeutic potential: Allows for immediate treatment, such as stopping bleeding or removing polyps.
  • Minimally invasive: Avoids the need for exploratory surgery in most cases.

  • Mild throat irritation or bloating due to endoscope insertion.
  • Rare complications such as bleeding, infection, or perforation of the GI tract.
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Uveitis

Management Team

Uveitis

Overview

Uveitis refers to inflammation of the uvea (the middle layer of the eye). The uvea comprises the iris (the coloured part of the eye), ciliary body (a thin, ring-shaped membrane behind the iris), and choroid (a vascular tissue layer supporting the retina).

While uveitis may be idiopathic (autoimmune or unknown causes) or arise as a consequence of an underlying systemic disease or infection, it can also result from an injury or in rare cases, from ocular surgery. If left untreated, uveitis can cause serious damage to the eye and severely affect eyesight.

Uveitis has also been associated with further ocular complications, including glaucoma and cataract development. However, in most cases, patients recover well after treatment. Diagnosing uveitis early is critical as the timely diagnosis and treatment of this condition markedly improves the patient outcomes.

Uveitis can affect anyone. However, uveitis most commonly affects people of working age, especially in the aged group of 20–59 years, and can occur in children.

Based on the affected part of the eye, uveitis may be categorised as follows:

  • Anterior uveitis: Inflammation of the iris (iritis) or the collective inflammation of the iris and the ciliary body (iridocyclitis). It affects the front of the eye (usually the iris). Depending on the cause, one or both eyes are affected. It is most common type, accounting for 75% of all uveitis cases in adults.
  • Intermediate uveitis: The vitreous humour is affected. This occurs in children, teenagers, and young adults and is the second most common type of ocular inflammation.
  • Posterior uveitis: A severe form of uveitis that affects the choroid and the retina (back layers of the eye). It can seriously damage visual acuity.
  • Panuveitis: Affects the entire uveal tract (the simultaneous inflammation of the front and the back of the eye). This condition seriously threatens vision and requires immediate medical attention.

Based on the duration for which it lasts, uveitis may also be categorised as follows:

  • Acute uveitis: Lasts for 2–3 weeks and can recur.
  • Chronic uveitis: Lasts for three or more months, with symptoms varying over the course of the disease.

Repeated episodes of inflammation in the eye may also occur at intervals of a few months between each episode. This is termed as recurrent uveitis.

Uveitis is broadly categorised into the infectious and non-infectious types. Often, the exact cause of uveitis is unclear. After clinical investigation, no specific cause can be pinpointed for roughly 40% of patients. In many cases, uveitis is linked to an increased degree of immune responses in the eye (occurring due to unknown reasons). In rare cases, uveitis has been reported to be caused by injuries or infections or as a complication of surgical procedures.

The following health conditions have been reported as risk factors for uveitis:

  • Inflammatory or autoimmune conditions (when the body attacks its own organs), such as rheumatoid arthritis (autoimmune joint inflammation), ankylosing spondylitis (also known as lumbar (lower back) arthritis), inflammatory bowel disease, or psoriasis, or other systemic conditions, including sarcoidosis (formation of lumps (granulomas) in various body parts), Behçet’s disease (inflammation and damage of blood vessels), and Reiter’s disease (inflammatory arthritis triggered by bacterial infections).
  • Bacterial (tuberculosis, Lyme disease, etc.), viral (herpes simplex virus infection, herpes zoster infection (shingles), etc.), fungal infections (candidiasis, aspergillosis, etc.), and parasitic infections (toxoplasmosis, filariasis, etc.). The development of immunodeficiency or an immunocompromised state, which are commonly observed in patients with known underlying conditions, such as lymphoma, leukaemia, and/or HIV/AIDS may increase the susceptibility of these patients to opportunistic eye infections, such as cytomegalovirus retinitis.
  • Juvenile idiopathic arthritis (JIA). In children, JIA has been identified as the most common cause of uveitis.

The symptoms of uveitis may vary in intensity from mild to severe depending on the type of the disease.

  • Anterior uveitis symptoms may progress over several hours or days. Their severity may gradually increase. They include:
    • An aching, painful, red eye, ranging from mild eye pain to intense discomfort
    • Cloudy or blurry vision
    • Decreased pupil size or distortion of pupil shape
    • Slight alterations in iris colour
    • Sensitivity to light (photophobia)
    • Headaches
  • Intermediate uveitis is usually painless and affect both eyes. The symptoms of this condition include:
    • Floaters (dots that move across the field of vision)
    • Blurry vision due to the leakage of proteins and cells from the blood vessels into the vitreous humour because of retinal vasculitis (inflammation of retinal blood vessel walls) or pars planitis (the formation of deposits behind the ciliary body)
    • Mild redness (despite the symptoms, the inflamed eye may appear completely normal)
  • Posterior uveitis is usually painless and affects one or both eyes. Its symptoms develop slower, and often last longer, than those of anterior uveitis. This condition can cause a greater degree of ocular damage than other types of uveitis. Its symptoms include:
    • Decreased vision and floaters
    • Retinal detachment
    • In some cases, loss of vision

As uveitis is predominantly diagnosed based on clinical examinations, meticulous collection of patient history (ocular and systemic history) is vital. Further tests to confirm or exclude certain eye and/or systemic conditions may be recommended based on the symptoms, presentation, and severity of the condition. These include:

  • Comprehensive eye examinations that include the collection and assessment of a complete, detailed medical history (overall ocular health and general health).
  • Assessment of eye scans and/or photographs, especially using the slit-lamp examination.
  • Blood tests to detect the causative pathogen (for cases of infectious uveitis).
  • Chest radiography (X-ray) to identify any underlying condition that may be the cause of uveitis.
  • Tests for rheumatoid arthritis (RA) factor, serum uric acid tests, the purified protein derivative (PPD) skin test or Mantoux test (skin tests for detecting tuberculosis in which a PPD is injected into the forearm, and the diameter of the resulting swelling is measured after 48–72 hours), tests for the levels of HLA B-27, acetylcholine esterase (ACE) inhibitors, and C-reactive protein, fluorescent treponemal antibody absorption (FTA-ABS) test, perinuclear anti-neutrophil cytoplasmic antibody (P-ANCA) and cytoplasmic ANCA (C-ANCA) level measurements, and serum IgG and serum IgM antibody tests are usually recommended in cases of suspected uveitis.

Based on the results of the aforementioned analyses, ophthalmologists recommend further tests to be conducted.

The type and underlying cause of uveitis usually determine the recommended course of action and treatment. However, an exact cause cannot always be identified. The methods used for treating uveitis include:

  • Steroid medications, which are the most common uveitis treatment modality, help reduce inflammation. While steroid-based eyedrops are usually administered for treating anterior uveitis, steroid-based tablets or injections (administered as systemic medications) may be required for treating severe cases of anterior uveitis and several types of non-infectious posterior uveitis.
  • Additional treatment, usually in the form of eye drops, may be prescribed for pain relief or dilation of the pupils.
  • In rare instances, such as uveitis cases in which cataract or glaucoma development is observed (eye drops are unable to mitigate the increase in intraocular pressure), surgery may be needed.

In most cases, patients with uveitis, especially, those with anterior uveitis, respond quickly to treatment without any long-lasting eye damage or further complications. However, the risk of complications is markedly high among patients with intermediate or posterior uveitis or those with recurrent uveitis. These complications include retinal damage, glaucoma, cataract development, macular oedema, and the permanent deterioration of vision.

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Utero Vaginal Prolapse

Management Team

Utero Vaginal Prolapse

Overview

Utero vaginal prolapse is a common age-related condition, wherein the uterus drops down into the vaginal canal due to weakened ligaments and pelvic floor muscles (muscles and tissues in the pelvis that support pelvic organs, such as the uterus, bladder, rectum, and vagina). Generally, it can happen to any woman; however, it commonly occurs in menopausal women and in women who have had more than one vaginal delivery. Generally, utero vaginal prolapse has many stages. In an incomplete uterine prolapse, the uterus may slip partly into the vagina, creating a bulge. In severe cases, i.e., complete prolapse, the uterus may slip so far enough that it comes out of the vagina.

The main cause of utero vaginal prolapse is weakened pelvic floor muscles, which can be attributed to

  • Childbirth: Multiple pregnancies and vaginal deliveries can weaken the muscles and tissues of the pelvic floor.
  • Aging: With age, the pelvic muscles may lose strength and elasticity, increasing the risk of prolapse, particularly after menopause.
  • Hormonal changes: A decrease in oestrogen levels during menopause can weaken the pelvic support tissues.
  • Obesity: Excessive weight puts additional pressure on the pelvic floor, thereby contributing to its weakening over time.
  • Chronic coughing or straining: Conditions such as chronic bronchitis or constipation can lead to repeated straining, further weakening the pelvic floor.
  • Genetic predisposition: Some women may be more prone to developing pelvic floor disorders based on their genetic background.

Mild cases of uterine prolapse may be associated with the absence of any obvious symptoms. However, as the uterus slips farther out, other pelvic organs (bowels or the bladder) might be affected, resulting in one or more of the following symptoms: 

  • Feeling of pressure or heaviness: Many women report a sensation of heaviness in the pelvic region, especially towards the end of the day or after prolonged standing.
  • Bulging or protrusion: You may notice or feel a bulge or lump in the vaginal area, which can be more pronounced when straining or during physical activity.
  • Urinary issues: Increased frequency of urination, urgency, or even incontinence can occur as the prolapse affects bladder function.
  • Bowel problems: Difficulty emptying the bowels or a feeling of incomplete bowel evacuation may arise.
  • Discomfort during intercourse: Prolapse can lead to discomfort or pain during sexual activity.
  • Lower back pain: Chronic discomfort or pain in the lower back can sometimes be associated with prolapse.

Discussing any symptoms you have been experiencing can help in the detection and subsequent diagnosis of the condition. A few diagnostic strategies include:

  • Pelvic examination: A thorough pelvic exam will help the doctor assess the position of your uterus and other pelvic organs.
  • Imaging tests: Imaging tests such as ultrasound or MRI may be used detect any changes in the position of the uterus.
  • Urodynamic testing: This test assesses how well the bladder and urethra are functioning and may be recommended if urinary symptoms are present.

  • Lifestyle modifications: Simple changes like weight loss, pelvic floor exercises (e.g., Kegel exercises), and avoiding heavy lifting can help alleviate symptoms.
  • Pessaries: A pessary is a device inserted into the vagina to support the uterus. It is a non-surgical option that many women find helpful.
  • Physical therapy: Pelvic floor physical therapy can strengthen the pelvic muscles and provide relief from symptoms.
  • Medications: If urinary symptoms are present, medications may help manage those symptoms.
  • Surgery: If symptoms are severe or persistent and non-surgical methods are not effective, surgical options may be considered. These can include procedures to support the uterus or remove it altogether (hysterectomy), depending on individual circumstances.

  • You observe a noticeable bulge or protrusion in the vaginal area.
  • You exhibit symptoms of urinary or bowel dysfunction.
  • You experience discomfort or pain in the pelvic region.
  • You observe any changes in the menstrual pattern or unusual bleeding.
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Urinary Incontinence

Management Team

Urinary Incontinence

Overview

Urinary incontinence is a commonly encountered condition that refers to loss of bladder control, resulting in the unintentional passing of urine. Incontinence can occur at any age and is more prevalent in women, particularly after childbirth or during menopause. Urinary incontinence can sometimes be linked to other underlying health issues, so understanding its nature is crucial for effective management.

Urinary incontinence can be of many types; these include:

  • Stress incontinence: This is characterised by occasional urine leakage when bladder is under pressure, e.g., when sneezing, coughing, laughing, exercising, or lifting heavy weights.
  • Urge incontinence: This is characterised by a sudden, strong, uncontrollable urge to urinate.
  • Overflow incontinence: This is characterised by inability to completely empty the bladder, which results in frequent leakage of small amounts of urine over time (instead of one big gush). Overflow incontinence is more common in individuals with chronic conditions like diabetes, stroke, or multiple sclerosis (MS).
  • Neurogenic incontinence: This is characterised by bladder dysfunction or the lack of bladder control due to brain, spinal cord, or nerve problems. Neurogenic incontinence is extremely common in people with spinal cord injuries, cerebral palsy, and stroke; sometimes, it may also be congenital (caused by birth defects).
  • Total incontinence: This is characterised by the inability of the bladder to store urine, which results in frequent urine leakage.
  • Mixed incontinence: A combination of factors is responsible for urine leakage.

Several factors can contribute to urinary incontinence, and they often differ between individuals. Some common causative factors are enumerated below:

  • Weak pelvic floor muscles: Childbirth, pregnancy, and menopause can weaken the muscles that support the bladder, leading to stress incontinence.
  • Overactive bladder: This condition is characterised by an urgent need to urinate, often resulting in urge incontinence. It can happen without warning and may lead to frequent trips to the bathroom.
  • Neurological conditions: Multiple sclerosis, Parkinson’s disease, and stroke can affect the nerves that are responsible for normal bladder control and function.
  • Urinary tract infections (UTIs): Infections can irritate the bladder, causing temporary incontinence. Once the infection is treated, incontinence usually resolves.
  • Medications: Some medications, such as diuretics, can increase urine production and lead to incontinence.
  • Obesity: Excess body weight can put pressure on the bladder, contributing to stress incontinence.
  • Chronic coughing: Conditions like chronic bronchitis can weaken pelvic floor muscles, leading to leakage when coughing.
  • Hormonal changes: Fluctuations in hormone levels, particularly during menopause, can impact bladder function and support.

The symptoms of urinary incontinence can vary based on the type of incontinence experienced. Lower urinary tract symptoms (LUTS) are common features associated with urinary incontinence; these include:

  • Problems with storing urine, e.g., a sudden or frequent urge to pass urine or feeling that you need empty your bladder again just after you have done so.
  • Problems with passing urine, e.g., straining to pass urine, slow stream of urine, or stopping and starting when you pass urine.
  • Problems after passing urine, e.g., feeling of not completely emptying the bladder or leakage of few urine drops after urination.

Discussing the patients’ symptoms, medical history, and any medications they are taking can help understand the situation better. Additionally, keeping a bladder diary, i.e., a record of the urination frequency, fluid intake, and leakage episodes (if any) can provide valuable information about your condition. The following tests can be conducted to diagnose urinary incontinence:

  • Physical examination: A physical examination of the pelvis can be conducted to assess the strength of the pelvic floor and check for any abnormalities.
  • Urinalysis: A simple urine test can help detect infections or blood in the urine, and urinary incontinence attributed to infections can be treated following a positive diagnosis.
  • Urodynamic testing: This involves measuring how well your bladder and urethra are storing and releasing urine. It can help determine the cause of incontinence more precisely.
  • Imaging tests: In some cases, an ultrasound or MRI may be necessary to check for anatomical abnormalities responsible of urinary incontinence.

The treatment of urinary incontinence depends on the underlying cause and type of incontinence. Here are some common approaches:

  • Pelvic floor exercises (Kegel exercises): These helps strengthen the pelvic floor muscles, helping the patient control the sphincter muscles better and prevent leakage.
  • Bladder training: This involves scheduling bathroom visits and gradually increasing the time between urinations to help retrain the bladder.
  • Medications: For urge incontinence, medications that relax the bladder may be prescribed. Hormonal therapies can help some women post-menopause.
  • Lifestyle modifications: Simple changes, such as weight loss, reducing caffeine and alcohol intake, and quitting smoking, can significantly correct the symptoms.
  • Absorbent products: If leakage occurs, using absorbent pads or adult diapers can provide a sense of security while managing the condition.
  • Physical therapy: Working with a physical therapist trained in pelvic floor rehabilitation can provide personalised strategies for managing incontinence.
  • Surgical options: In severe cases, surgical procedures may be recommended to support the bladder or to enhance control.

While not all types of urinary incontinence can be prevented, one or more of the following steps can be taken to reduce the risk of developing this condition: 

  • Maintain a healthy weight: Obesity management can help decrease pressure on the bladder.
  • Stay active: Regular exercise strengthens pelvic floor muscles and improves bladder function.
  • Pelvic floor exercises: Incorporate Kegel exercises into your routine to keep your pelvic floor strong.
  • Limit irritants: Reducing caffeine, alcohol, and spicy foods can lessen bladder irritation.
  • Stay hydrated: Drinking enough water can help maintain bladder health; however, excessive water intake should be avoided right before activities.
  • Seek help for constipation: Chronic straining can weaken the pelvic muscles, so addressing constipation is crucial.
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Under-eye Hollowness or Sunken Eyes

Management Team

Under-eye Hollowness or Sunken Eyes

Overview

Under-eye hollowness, also known as tear trough deformity or sunken eyes, is the sunken appearance under the eyes, often accompanied by dark circles. This often occurs due to a loss of fat in the tear trough area.

  • Mild: It is marked by slight indentation.
  • Severe: It is marked by deep hollows with prominent dark circles.

Sunken appearance under the eyes, dark circles, and a tired look.

Aging, genetics, dehydration, lack of sleep, and weight loss.

 Physical examination and patient history.

  • Fillers (hyaluronic acid)
  • Platelet-rich plasma (PRP) therapy
  • Morpheus8, depending on the underlying cause
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Under-Eye Pigmentation

Management Team

Under-Eye Pigmentation

Overview

Eye pigmentation, such as dark circles or pigmentation around the eyes, occurs when the skin under the eyes appears darker than the surrounding skin. It can result from various factors, including genetics and lifestyle.

  • Hyperpigmentation: This occurs due to excess melanin production.
  • Vascular pigmentation: This occurs due to blood vessels showing through the thinning skin.

Darkened skin around the eyes and uneven skin tone.

  • Genetics
  • Sun exposure
  • Aging
  • Allergies
  • Lack of sleep

Visual examination and patient history.

  • Topical lightening agents
  • Laser treatments (Clear + Brilliant)
  • PRP therapy, depending on the underlying cause
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Ulcerative colitis

Management Team

Ulcerative colitis

Overview

Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) that primarily affects the colon (large intestine) and rectum. It is characterised by inflammation and ulceration of the mucosal lining of the colon, leading to symptoms such as diarrhoea, abdominal pain, and rectal bleeding. UC is considered an autoimmune condition, though its exact cause is not fully understood.

  • Diarrhoea (often with blood or mucus)
  • Abdominal pain or cramping
  • Rectal bleeding
  • Urgency to have bowel movements
  • Fatigue
  • Weight loss
  • Fever (in severe cases)
  • Anaemia (due to blood loss)

  • Genetics: A family history of IBD increases the risk.
  • Age: UC often develops in early adulthood (ages 15–30) but can occur at any age.
  • Ethnicity: UC is more common in individuals of Jewish descent, particularly Ashkenazi Jews.
  • Environment: Living in urban areas and industrialised countries is associated with a higher risk of UC, suggesting environmental factors, including diet and hygiene, may play a role.

Diagnosis of UC is based on a combination of clinical presentation, laboratory tests, imaging, and endoscopic evaluation.

  • Colonoscopy: The gold standard for diagnosis. It allows direct visualisation of the colon and rectum, showing characteristic ulcers, inflammation, and mucosal changes.
  • Biopsy: Small tissue samples are taken during colonoscopy to confirm the diagnosis.
  • Stool tests: To rule out infections that could mimic UC symptoms.
  • Blood tests: To check for anaemia, elevated white blood cell count (inflammation), or other signs of disease activity.

While there is no cure for UC, treatment focuses on managing symptoms, inducing remission, and preventing flare-ups.

  • Medications:
    • Aminosalicylates (5-ASA): Such as sulfasalazine, mesalamine. These help reduce inflammation in the colon.
    • Corticosteroids: For short-term control during flare-ups, but not for long-term use due to side effects.
    • Immunomodulators: Such as azathioprine or methotrexate to suppress the immune system and prevent inflammation.
    • Biologics: TNF inhibitors (e.g., infliximab, adalimumab) and other biologic agents (e.g., vedolizumab, ustekinumab) target specific parts of the immune response.
    • Janus kinase inhibitors (e.g., tofacitinib): A newer class of drugs for moderate-to-severe UC.
  • Dietary modifications:
    • No specific diet can cure UC, but during flare-ups, a low-residue or low-fibre diet may be recommended to reduce irritation.
    • Maintaining good hydration and addressing nutrient deficiencies (e.g., iron, vitamin D) is important.
  • Surgery:
    • If UC is severe, unresponsive to medication, or causing complications, surgery may be required. The most common procedure is a colectomy, which involves removing the colon. In some cases, an ileoanal pouch is created, allowing the patient to have normal bowel movements.
  • Psychosocial support: Chronic illnesses like UC can have a psychological impact, and managing stress is often part of the treatment plan. Support from mental health professionals or joining support groups can be helpful.
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Urinary tract infections

Management Team

Urinary tract infections

Overview

Urinary tract infection (UTI) is an infection of the tissues in the urinary system that is especially common in women.

UTIs are typically accompanied by the following symptoms:

  • Abnormal urination, such as increased frequency, bladder urgency, excessive night-time urination, poor urine flow, or intermittent urine flow
  • Fever with chills
  • Burning sensation during urination
  • Blood in urine
  • Pain in the flank (side of the abdomen)
  • Suprapubic pain, or pain in the area below the belly button and above the pubic bone

UTIs can be diagnosed using the following techniques:

  • Urinalysis: A routine urine test
  • Kidney function test, complete blood count, and c-reactive protein: A blood test that detects common indicators of UTIs
  • Ultrasound abdomen/KUB/pelvis: An ultrasound examination of the abdomen, kidneys, ureters and bladder, or pelvis
  • Urine culture and sensitivity: The cells present in the urine are cultured and studied
  • CT KUB: A CT scan of the kidneys, ureters, and bladder

UTIs can be treated in the following ways:

  • Conservative management using medication
  • Surgical management depending upon the underlying cause for the UTI
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Urinary incontinence

Management Team

Urinary incontinence

Overview

Unintentional urination or leaking or urine is referred to as urinary incontinence. Underlying medical conditions, physical problems, childbirth, or everyday habits can contribute to urinary incontinence.

Urinary incontinence has the following symptoms:

  • Inadvertent leaking of urine
  • Accidental leaking or urine
  • Bladder urgency, or the sudden, intense urge to urinate
  • Nocturnal/Night-time leaking of urine
  • Suprapubic discomfort, or discomfort in the area below the belly button and above the pubic area
  • Recurrent urinary infections

Urinary incontinence can be investigated using the following techniques:

  • Ultrasound KUB or PVR: An ultrasound examination of the kidneys, ureters, and bladder or post-void residual (PVR) test that analyses the volume of urine left in the bladder after urination
  • Uroflowmetry: An analysis of the flow, amount, and duration of urination
  • Urodynamic study: This is a procedure that examines how the muscles and other parts of the urinary tract participate in the storage and release of urine
  • Bladder diary maintenance: The patient keeps a diary of urination and incontinence events and discusses it with their physician

Urinary incontinence can be treated in the following ways:

  • Conservative management using medication, pelvic floor muscle exercises, and bladder training
  • Surgical management based on the underlying cause for urinary incontinence
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