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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The new epidemic that has taken the world by storm is obesity. The proportion of obese people is increasing and the age of onset of obesity is decreasing gradually.
There is an optimal weight for a given height of a person. Obesity is when a person's weight is 20% more than the optimal weight. It brings with it a host of other health conditions, as it impairs the body’s overall functioning.
Diabetes 2: In a normal person, food gets broken down into glucose to provide the required energy for the body using insulin. The body’s inability to produce sufficient insulin to convert the excessive amount of sugar in the body leads to diabetes. Growing to be a leading cause of early death, diabetes brings with it a host of complications affecting almost all systems and parts of the body including stroke, kidney disease, blindness, and death. Diabetes and obesity have a direct correlation and can be prevented and managed by eating a balanced diet, losing weight, exercising, and having a healthy lifestyle.
Heart problems: An increased BMI also ups the risk for coronary heart disease (CHD), where the blood vessels are narrowed due to constant accumulation of fat in their inner walls. This gradually reduces the blood flow through these and may when complete cut-off happens, it could result in heart attack or stroke, affecting the heart or the brain. There could also be cases where the heart fails to pump sufficient blood to the rest of the body, affecting their effective functioning. Obese people also have a higher blood pressure than people who maintain a good BMI.
Breathing problems: One of the main causes of labored breathing is excessive weight. The condition called sleep apnea which is sudden bouts of absence of breathing during sleep is very high in obesity. It can cause snoring, daytime sleepiness, increase the risk of heart disease and stroke. In people with sleep apnea, weight loss is one of the first and most recommended therapies. Asthma and general breathing disorders are also higher in obese people.
Abnormal body cholesterol: Obese people also tend to have abnormally higher levels of body fat, especially the bad cholesterol, which again leads to coronary disease. It is a vicious cycle with one leading to the other and aggravating the other.
Cancer: Some cancers, of the colon, endometrium, kidney, pancreas, gallbladder, breast and esophagus are more prevalent in obese people.
These are just some, there are more. The best way to avoid all these is to watch your weight.
Any kind of injury on the surface of the skin is immediately noticed by us, but when something happens to one of our internal organs, it can take a little longer to get to your notice for example, an obstruction in the bile duct. The bile duct is a tubular structure responsible for carrying bile from the liver and gall bladder through the pancreas to the small intestine. This bile helps the digestion process and the absorption of fat.
An obstruction in the bile duct can be triggered by a number of factors. Some of these are:
- Inflammation of the bile ducts
- Traumatic accidents
- Bile duct or pancreatic tumors
- Hepatitis infections
- Cirrhosis or severe liver damage
- Abnormal narrowing of the bile duct
This can affect anyone, but the people who have a history of gall stones or tumors in the abdomen are at a higher risk of suffering from bile duct obstruction. Chronic pancreatitis, sudden weight loss or obesity can also increase this risk.The symptoms of biliary obstruction include light coloured stool, dark urine, pain in the upper right abdomen, nausea, vomiting and fever. Your doctor will also probably need an X-ray of the bile ducts, blood tests, a hepatobiliary iminodiacetic acid scan and ultrasonograph to confirm a diagnosis before they can start treating you for the same.
If not treated in time, bile duct blockages can lead to a dangerous buildup of bilirubin in the body and trigger a number of life threatening diseases. Treatment for biliary obstruction can be through medication or surgery with surgery being the more preferred mode of treatment. It is aimed at resolving the underlying cause of the obstruction and alleviating the blockage. Treatment for biliary obstruction can be two common forms of treatment include a cholecystectomy and ERCP. The former involves the removal of the gall bladder and is suited to obstructions caused by gallstones. The latter is a procedure to remove small stones from the bile duct or place a stent inside the duct.
There are many ways bile duct obstruction can be prevented which first and foremost includes following a healthy lifestyle. If you are overweight, exercise for at least half an hour a day to regulate your weight and reach a healthy BMI. Decrease your intake of sugar and saturated fats as both these can cause gall stones. Also, increase the amount of fibre in your diet. All the above mentioned tips will certainly help you in preventing bile duct obstruction. If you wish to discuss about any specific problem, you can consult a gastroenterologist.
The only thing that can ruin a great meal is the feel of a bloated tummy afterwards! Usually any abnormal swelling, or increase in diameter of the abdominal area is termed as bloating. The condition has become very common and is experienced by people around the world. Poor diets, sedentary lifestyle, high levels of stress and need for daily medications seem to be making people more prone to this epidemic. It can sometimes also be a result of an underlying health issue that you might be unaware of. The good thing is that there are signs of it which can be watched out for.
What to Keep an Eye Out For: To start off, there is the sign which is considered to be rather obvious by many- flatulence. If a person wants to get rid of flatulence for an extended period, he or she should consider this to be a warning.
Bloating itself can be a sign for other problems which are deeper. The prime example of this happens to be coeliac disease. A bloating of the stomach which is accompanied by pain and a puzzling loss of weight could be signs of this disease.
If a fever seems to keep recurring without a cause which is explainable, it could be a sign of bloating. As a matter of fact, this sign along with bloating also does signal some infection, which should be looked at immediately by a medical professional. Also, too much stress on a person could be a sign of impending bloating issues.
Getting Rid of Bloating: In order to cure bloating which is caused by flatulence, an easy and elementary solution is to eat your food slowly and to chew properly. In serious case, seeking adequate medical help is important.
When a person finds that he or she seems to be suffering from bloating very often, it is a good idea to maintain a food diary. This will help find whether there are certain trigger foods which cause bloating. The pattern can be discussed with your doctor and concrete steps can be taken towards a complete solution.
Simple lifestyle changes beyond the diet can also make a difference. These include correction of sleeping and eating habits of a person. You are also required to be very regular with this.
Bloating always has some signs which are associated with its causes so it makes good sense to be aware of the same as the saying goes - A stitch in time saves nine!
In case you have a concern or query you can always consult an expert & get answers to your questions!
Irritable bowel syndrome or IBS includes a group of medical symptoms. These include abdominal pain and changes in the pattern of bowel movements. The symptoms mostly continue for a long period of time and are divided into four types depending on diarrhoea or constipation symptoms.
Irritable bowel syndrome causes several negative effects on our health and should be treated as soon as possible. IBS is caused because of various reasons and factors. They are as follows:
- Digestive problems: Food is moved through the digestive system with the help of squeezing and relaxation movement of the intestinal muscles in a certain rhythm. In case of IBS, this process is altered and food moves through the digestive system very fast or very slow. When the food moves too fast, diarrhoea is caused as there is not enough time for absorption of water from food. In case of slow food movement, constipation occurs as a result of too much absorption of water. Disorders such as malabsorption of bile acid may also cause IBS in some cases.
- Psychological factors: Psychological factors also play a vital role in IBS. When a person is overtly emotional or is suffering from intense stress or anxiety, then these emotions trigger chemical changes in the body which affect the proper functioning of the digestive system. This is not likely in all people who get IBS. People who did not have IBS before, may undergo changes in bowel movements because of immense stress and tension. Many people who have undergone a traumatic experience such as abuse, neglect or a childhood disease can get IBS. These traumatic events or experiences in the past made these people more sensitive to stress, which may result in IBS.
- Several triggers of IBS: There are several food items and drinks, which may trigger the symptoms of IBS in a person. These triggers vary from person to person. The most common ones include alcohol, aerated drinks, chocolates, drinks which contain caffeine like coffee or cola, processed snacks such as crackers and biscuits and fried foods, which contain a lot of fat. You should maintain a food diary for identification of triggers that may lead to IBS in your everyday diet. Stress is also an important trigger which may lead to IBS. You should try to find ways to get rid of stress and must avoid over stressing.
Irritable bowel syndrome or IBS results due to several reasons which may be physical or psychological. If you experience symptoms of IBS, you must try to detect or diagnose the reason and then look for proper treatment while consulting with your physician.
A chronic condition, Irritable Bowel Syndrome (IBS) is a disorder of the large intestine that exhibits symptoms such as bloating, abdominal cramps, gas and diarrhea. The symptoms of IBS can be controlled by making lifestyle changes such as incorporating certain modifications to your diet and reducing or managing stress levels. For severe symptoms, you may require medications.
The symptoms of IBS can vary; some of them are:
- Bloated stomach
- Abdominal cramps
- Constipation or diarrhea
- Presence of mucus in the stool
- Some other severe symptoms of IBS include sudden loss of weight and rectal bleeding.
The exact cause of IBS is not known, but there are certain factors that may act as triggers. There are muscles lining the walls of the intestine that relax and contract in a proper rhythm, thus allowing the passage of food through the intestine. In case of IBS, these contractions tend to be irregular, resulting in gas, bloating and diarrhea.
Some of the factors that can trigger this condition are:
- Hormones: Hormonal changes can play a role in triggering IBS. For a woman, the symptoms can worsen during her menstrual cycles.
- Stress: Studies show that symptoms of IBS considerably increase if you are subject to increased stress levels over a prolonged period of time.
- Foods: Certain foods such as spices, chocolate, milk and broccoli can act as triggers.
- Other Disorders: In some cases, other underlying conditions such as bacterial overgrowth or infectious diarrhea can cause IBS.
The initial step to manage the symptoms of this condition is to make prompt changes in your diet, such as eliminating spicy foods and dairy products, at least till the symptoms subside. It is advised to resort to medications only if the dietary changes fail to yield results.
The various treatments are:
- Anti-diarrheal Medications: Anti-diarrheal medication such as ‘loperamide’ is used to control and manage diarrhea.
- Fiber Supplements: Certain fiber supplements such as ‘methylcellulose’ and ‘psyllium’ can help in managing constipation.
- Antibiotics: Antibiotics are prescribed only if the symptoms result from bacterial overgrowth in the intestine.
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.