Dr. Raj Vigna Venugopal is a Gastroenterologist and Hepatologist from Bangalore and is available at the Manipal Hospital, Bangalore of which he is also the Head of the Department of Gastroenterology. He completed his MBBS from T.D. Medical College in 1995. He also completed his Doctor of Medicine (MD) in internal Medicine in 1998. He pursued his DM in Gastroenterology from the Sanjay Gandhi Institute of Post Graduate Sciences and completed it in 2002. He has a sound knowledge in Gastroenterology, Hepatology and Liver Diseases. He is also widely experienced in handling Endoscopy, Ultrasonography, Therapeutic Endoscopy and Medical Gastroenterology.
Dr. Raj Vigna Venugopal has been in this field for many years and his contributions to the field of medicine are commendable. He is considered one of the best Gastroenterologists in Bangalore and was the first doctor from Bangalore to have set up an Endosonography Unit. His wide experience is noteworthy and he has been involved in more than 700 cases in Diagnostic and Therapeutic Endosonography. Apart from Manipal Hospital, he also visits Swastik Clinic in HAL, Bangalore as a consultant.
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Fatty liver is a condition where excess fat is deposited on this organ. Also called as steatosis, this condition happens when more than 5- 10 percent of the weight of the liver is made up of fat.
Fatty liver is a common condition among people. A study from coastal regions of India found ~ 25% of healthy persons had patients had fatty liver on ultrasound.
It can occur at all ages including childhood, highest prevalence is in 40–50 year age group. Prevalence more in patient who are obese and in diabetic patients.
Types of Fatty Liver
1 Alcoholic fatty liver: This condition occurs when there is a heavy consumption of alcohol. Gastroenterologists recommend abstention from alcohol for this condition to subside. If the patient continues to consume alcohol, then liver cirrhosis may develop.
2 Non alcoholic fatty liver (NAFL): One may develop a fatty liver even if one is not an alcoholic. The liver in some cases is unable to process the fat in cells causing them to build-up on the organ.
When more than 10% of the liver is made of fat then this condition is called Non Alcoholic Fatty Liver (NAFL).
Non alcoholic steatohepatitis (NASH): When fatty liver is associated with inflammation in liver patient is said to be having Non alcoholic steatohepatitis. NASH is a more advanced stage of NAFLD, and has a higher risk of progressing to liver cirrhosis or hepatocellular carcinoma (HCC). These condition display symptoms like jaundice, vomiting, nausea, loss of appetite and abdominal pain. Blood test (LFT) shows raised enzymes level. Approx 5-8% of the Indian population has NASH. Consult a doctor if you are experiencing any of these symptoms.
During the early stages (fatty liver) of the disease, patients usually have no symptoms directly related to liver disease. However, people may experience a vague abdominal discomfort. If their liver is inflamed (NASH) then they may display symptoms of poor appetite, weight loss, pain in the abdomen and disorientation.
What causes fatty liver?
The most common cause of fatty liver is alcoholism. When the human liver is unable to metabolize fat fast enough or when there is an excess accumulation of fat on the liver cells then the liver becomes fatty. However, intake of high-fat foods may not result in a fatty liver.
2. Obesity or being overweight
3. Hyperlipidemia or the condition where there are high levels of fat in the blood
4. Genetic reasons
5. Rapid loss of weight
6. Drugs: Aspirin, steroids, tamoxifen, tetracycline etc. cause side effects which also leads to fatty liver
7. Nutritional status (eg, overnutrition, severe malnutrition, total parenteral nutrition [TPN], or starvation diet)
In case you have a concern or query you can always consult an expert & get answers to your questions!
A cut on your skin can be seen by the naked eye, but injuries and infections to internal organs are not so easily visible to the eye. The procedure to view and operate on the body’s internal organs is known as an endoscopy. An endoscopy is performed using a flexible tube with a camera attached at one end known as an endoscope. This is inserted into the body though a natural opening in the body such as the mouth or through a small incision on the body.
While the camera gives the doctor a view of the internal organs, forceps or a pair of scissors can be used to operate or remove tissue that needs to be biopsied. Since an endoscopy is performed without making large incisions, it negates the development of scarring.
Types of Endoscopies
Endoscopies can be used for both diagnostic and therapeutic purposes. It is also one of the means for early detection of cancer. There are 11 main types of endoscopies which include:
- Arthroscopy: This is used to get a closer look at joints. In such cases, the endoscope is inserted into a small incision near the joint being examined.
- Upper gastrointestinal endoscopy: Examining the esophagus and upper intestinal tract by inserting a scope through the mouth is known as an upper gastrointestinal endoscopy.
- Colonoscopy: In this procedure, a scope is inserted through the anus to get a view of the colon.
- Bronchoscopy: This procedure is used to examine a patient’s lungs. It involves the insertion of a scope into the nose or mouth to give a view of the lungs.
- Cystoscopy: When the bladder needs to be examined closely, an endoscope is inserted through the urethra. This is known as a cystoscopy.
- Enteroscopy: This is a procedure where the scope is inserted through the mouth or anus to get a look at the small intestines.
- Hysteroscopy: Here a scope is inserted through the vagina to get a look at the inside of the uterus.
- Laparoscopy: It is an endoscopy to examine the abdominal area is known as a laparoscopy. This scope is inserted through an incision in the abdomen.
- Laryngoscopy: This type of endoscopy involves inserting a scope through the mouth or nose to examine the voice box.
- Mediastinoscopy: By inserting a scope into an incision above the breastbone, doctors can get a look at the area between the lungs. This is known as a mediastinoscopy.
- Ureteroscopy: This procedure is used to examine the patient’s ureter by inserting a scope through the urethra.
In case you have a concern or query you can always consult an expert & get answers to your questions!
In healthy individuals, the liver contains little or no fat. In overweight or obese people, gradual fat accumulation leads to significant liver disease. Interestingly, these individuals may be consuming minimal to no alcohol. So, alcohol, which is the main cause for liver damage, does not have a significant role to play.
The non-alcoholic fatty liver disease (NAFLD) has 4 significant stages as outlined below. It is a chronically progressive disease and may take years to reach the final stages of cirrhosis and fibrosis.
1. Simple fatty liver (steatosis): This is usually identified when diagnostic tests are done for some other suspected conditions. There are usually no symptoms obvious in this stage, other than the buildup of fat in the liver.
2. Non-alcoholic steatohepatitis (NASH): The second stage where the liver is inflamed to a greater extent due to fat accumulation.
3. Fibrosis: The next degree of inflammation where blood vessels may be narrowed leading to scarring in the liver with impaired liver functions.
4. Cirrhosis: This is the most severe stage that occurs due to years of cumulative inflammation. The liver shrinks in size, is scarred, and liver functions are markedly impaired and can also result in liver cancer.
Risk factors for NAFLD: The exact reason why a person develops NAFLD is not established, but some of the risk factors include
1. Obesity, with more weight concentrated around the abdomen
2. Type 2 diabetes
4. High cholesterol levels
5. Age greater than 50
Symptoms: This will depend on the stage in which it is identified. While there are no symptoms in the early stages, in some people there could be a dull, aching below the ribs, unexplained weight loss, weakness, and extreme tiredness. As it progresses to cirrhosis, there could be jaundice, fluid accumulation in the abdomen and feet, and itching of the skin.
Management: While there is no treatment aimed at curing the disease per se, there are ways to manage the symptoms, as noted below.
1. Weight loss: Reducing excess accumulated fat will help reverse symptoms and prevent further progression of the disease. A BMI of 18 to 26 is considered optimal.
2. Dietary changes: Modify your diet to a carbohydrates and protein rich and reduced fats and sugars. Increasing fiber through fruits and vegetables is highly recommended.
3. Exercise: Whatever your choice of workout, it will do wonders for NAFLD. Keep a target of an hour or two of moderate to intense exercise per day to reduce weight.
4. Smoking: This is another risk factor and can also help prevent other effects of NAFLD such as diabetes and heart disease.
NAFLD is highly controllable with these changes and other damages can be reversed too. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.
A Gastroenterologist is a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver. If you are planning to visit one, you most likely have a problem in one or many organs like esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver.
Visit your doctor to understand the severity of your condition and the course of treatment, as it is obvious that during this time you must be suffering from anxiety and you may not ask the questions arising in your mind. That is why you need to prepare in advance for your first visit with a gastroenterologist.
Being an active partner in the doctor patient relationship is bound to have its benefits. Here are some handy tips:
- Come mentally prepared: Don't let the anxiety get to you. If you need some extra help calming down, try yoga or meditation. You can simply go out on a walk alone to help you focus your thoughts. This is just like any other doctor visit. The good part is that you are taking the first step in easing your discomfort and starting treatment, so go with a positive mind.
- Maintain a diary of symptoms: It is likely that you are experiencing discomfort from past few days or weeks before you finally realize the need to seek out a specialist. Try to remember as much as possible about the symptoms you experienced in a chronological order. Write down any over the counter medicines you've tried or anything unusual that you may have consumed in the past week.
- Take stock of your medical history: It is likely that your doctor may want to know about any historic conditions you've suffered that may or may not relate to your present condition. Many ask you to fill out forms during your first time patient registration which includes many minor details about your medical past. List down any allergies, especially food allergies you have.
- Take stock of your recent medical tests: Bring your latest blood tests and imaging tests (X-rays, ultrasounds, MRIs, and CT scans) with you for the doctor's visit. If you have a pre-existing condition like diabetes, thyroid or you suffer from other chronic conditions like increased uric acid, carry your most recent medical reports with you.
- Make a list of questions for the doctor: In most cases, the first visit is a crucial factor in determining whether you want to continue the course of treatment with a particular doctor. This comes out of your ability to trust the doctor, his knowledge and diagnosis and an overall comfort level that comes with how well he handles your questions. Start by making a list of questions you want to ask about your specific condition and course of treatment and see if you get satisfactory answers.
- Brace yourself: If you want to suggest a treatment option, make sure you read up all about it before you tell the doctor. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.
Colorectal surgery is performed to repair damages that occur in the organs of the anus, rectum, and colon. The damage that takes place in these organs can be the result of problems with lower GI like diverticulitis (a condition wherein pouches known as diverticula in the colon wall become inflamed), cancer and inflammatory bowel disease (a group of intestinal disorders that bring about inflammation of the GI).
Who needs this surgery?
In general, colorectal surgery is an essential treatment option for ulcerative colitis, colorectal cancer, Crohn's disease (an inflammatory bowel disease that gives rise to inflammation of the gastrointestinal tract) as well as certain diverticulitis cases. In such cases, the intestinal tract undergoes major reconstruction.
There are also other bowel problems that may require surgery but not of a serious nature and these are anal fissures, hemorrhoids, bowel incontinence and rectal prolapse. Most of the surgical procedures will aid in repairing tears, get rid of blockages, or make tighter sphincter muscles (muscles that surround openings in the body).
Colorectal surgery is also performed in cases of pelvic floor disorders like rectocele (a condition in which the rectum bulges towards the vagina) and perineal hernia (a hernia that involves the pelvic floor).
At the same time, injury, ischemia or compromised blood supply and obstruction may require the performance of bowel surgery as well. Scar tissue and masses can form within the rectum, clogging the organ and preventing the normal discharge of feces from the body.
Problems like ulcerative colitis (an inflammatory bowel disease that leads to the development of ulcers in the colon as well as inflammation of the area) and diverticulitis can give rise to perforations in the rectum. Surgery is suggested in instances when drugs fail to treat the problem of ulcerative colitis.
Likewise, in the case of recurrent instances of perforations or complications in diverticulitis, surgery may be required to remove the portion of the colon affected. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.
The production of gas in the body is a natural process as long as it is within normal limits. Whether it makes you burp or causes flatulence, excessive gas can be embarrassing. Gas can also make you uncomfortable and cause bloating. This is simply the buildup of excessive gas in the stomach before it is ready to be released. Here are a few simple tips that can help you prevent the buildup of excessive gas.
- Avoid eating gaseous foods: Beans, broccoli, milk, cheese and fruits like pears and apples; these are some of the foods to avoid if you suffer from frequent bouts of gaseousness. This is because they contain fiber and sugar that is difficult to digest and creates gas. If you cannot avoid them completely, try steaming them instead of frying or baking them. Some people may also react to certain food combinations such as fruits and proteins by producing gas. Keeping a food diary may help identify such combinations.
- Drink a glass of water before meals: Drinking water while you are eating can hinder digestion. When water mixes with solid food, it interferes with the way stomach acid breaks down food. Instead, drink a glass of water half an hour before your meals. In this way, the water flushes your system and prepares it for the digestion process.
- Eat slowly: Grabbing a bite on the go is one of the leading causes of indigestion. When you eat anything, ensure that you chew it properly and do not swallow large bites of food. This prevents air from collecting in your stomach and thus prevents gaseousness.
- Probiotics: Probiotics boost the production of ‘good gut bacteria’ that is essential for digestion. Probiotics can also help ease bloating. If you suffer from gas, try including probiotics like yogurt, pickles, kimchi and buttermilk in your diet or get yourself a probiotic supplement.
- A cup of chamomile tea: Chamomile not only calms the body but can also fight indigestion and gas. A cup of chamomile tea after a heavy meal helps speed up the digestion process. This helps relieve bloating, as the faster the stomach is emptied, the faster gas can move out of the stomach and into the intestines. Fennel, dill, peppermint and ginger can also be used as alternatives to chamomile.
- Digestive aids: Gas is a fairly common problem faced by a number of people and hence digestive aids are easily available over the counter. Look for medication that contains activated charcoal or digestive enzymes.
If you wish to discuss about any specific problem, you can consult a Gastroenterologist.
Also called gluten-sensitive enteropathy and celiac sprue, celiac disease is an autoimmune digestive disorder, wherein the consumption of gluten-based foods leads to damage of the tissues that line the small intestine. This hinders the ability of your body to absorb the essential nutrients from the foods you eat.
Under normal conditions, the immune system of the body offers protection against external intruders. When individuals diagnosed with celiac disease consume gluten-based foods, gluten resistant antibodies are formed by the immune system. This causes them to attack the linings around the intestines, thus causing irritation in the digestive tract and harming the villi (hair-like structures on the covering of the small intestine which absorb nutrients from the food). This impairs the nutrient absorbing capacity of the individual, thus increasing chances of malnourishment.
Celiac disease has symptoms that vary from patient to patient. Some of the common symptoms include:
- A severe skin rash called dermatitis herpetiformis.
- Digestive problems such as:
- Musculoskeletal problems such as bone and joint pain as well as muscle cramps
- Aphthous ulcers which are basically sores occurring in the mouth
- Tingling sensation in the legs which are caused by low calcium and nerve damage
- Growth issues in children since they cannot absorb the required amount of nutrients
- Irregular menstrual cycles
Other complications associated with celiac disease
- Miscarriage or Infertility
- Osteoporosis: This is a disease which weakens the bones and causes fractures. It is caused because of a deficiency of Vitamin D and calcium.
- Intestinal Cancer
- Other birth defects: Such as irregular spinal shape because of the deficiency of certain nutrients, especially folic acid. If you wish to discuss about any specific problem, you can consult a gastroenterologist.