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Dear: Sir/Madam I am asking you how to solve in my face in pimples I have been troubled for a long time So please tell me.
Hello, I am Dr. Somasekhar Rao, gastroenterologist and hepatologist at the Apollo Hospitals, Jubilee Hill, Hyderabad. I would like to talk about cirrhosis of liver and its complications and how to manage those things. Basically cirrhosis of liver is nothing but the liver get shrunken and it becomes nodular and hard so the functions of the liver comes down. The functions which are there are 600 vital functions that a liver does normally in a human being and all these functions are compromised in a patient with cirrhosis.
Most important cause for cirrhosis is always alcohol and next comes viruses called hepatitis B and hepatitis C. The evolving most increasing cause no is nonalcoholic fatty liver disease. Fatty liver disease which we see on ultrasound can cause cirrhosis. Any patient in early cirrhosis may not present with any symptoms. The initial symptoms of decompensations would be:-
- There will be swelling in the fluid
- Swollen feet
- There will be distinction of abdomen because of accumulation of fluid in the abdominal cavity
- Patients may have jaundice.
- Sometimes they may present with a history of passing black color motion that means this patient is having bleeding in the gastrointestinal tract. It can be most common because of the swollen blood vessels called viruses in the esophagus.
So other presentations would be disorientation. Patient can have hepatic encephalopathy, the functions of the liver because the liver acts as a filter to many toxins. All these toxins enter into your brain and cause disorientation this is called hepatic encephalopathy.
So now we will talk about the treatment of cirrhosis. Whenever we see a patient with cirrhosis, most important thing is we will try and evaluate the cause of cirrhosis. See if the patient is a chronic alcoholic. We are taking a history of all college. The first thing is to cut down and stop intake of alcohol when the patient is in early cirrhosis. It can reverse the cirrhosis to normal liver. Most important and nutritional aspects along with some supportive medication but when a patient presents with complications already, then we will be treating only the complications. Once the cirrhosis sets in and he is in CTP. By the time. you see that the patient eventually progresses most of the time. We are trying to treat the complications of cirrhosis. Then a patient presents to us with bleeding then we will find out whether it is very variceal bleeding and there is a procedure called endoscopic variceal ligation to decrease the pressure of the varices blood pressure in the esophageal varices.
We have some medications which decrease the pressure. We treat these patients and we control the bleeding and a patient presents with fluid in the stomach abdominal cavity or fluid in the legs. These patients are treated with so called restricted diet. Also we give some tablets called diuretics which increase the urine output and decrease the fluid in the legs and in the abdominal cavity and a patient presents with hepatic encephalopathy. We treat hepatic encephalopathy by medications and we try to decrease the ammonia level which is released by cleansing the gut and all those things. So all these things are managing complications of cirrhosis. Very rarely we see a patient in early cirrhosis then we treat the host.
The cirrhosis can be reversible. It is very rare but eventually when we see a patient in complications, he would always be in a stage called CTPB where he will progress to CTBC. CTBC is the end stage of cirrhosis and at that point of time the patient is left only with option of liver transplant.
Liver transplantation is again transplantation. It can be a live donor transplantation or deceased donor transplantation. So Eventually when you see a patient in CTBC we have to plan for liver transplantation. In these patient he can wait maybe for 2 or 3 months meanwhile we will be managing for complications.
Sir/Maam, This is Sambhav Jain here, male 25. I have been suffering from stomach problem since ages. I consulted a doctor in Surat who checked me and revealed that there is a tightness in my anus which does not let my poop to move out properly. For the past one and half year, I have been using water through a pipe to wash off and while doing so I let water enter my anus and then I forcefully make it go out. This makes more poop to come out and cleans my anus but still I am facing the problems. Sometimes, the water even reaches my stomach.
I am 22 year old I am feeling uneasy with gastric problem I went to nearby 5 doctors but my problem not solved. I am having this problem from 5 years now my stomach is bloating. Please tell me best medicine or syrup to cure this problem and running may help to cure this problem ha I want to know Waiting for answer sir.
Hi Im 26yr old working in night shift and my food time is not correct, I will have 2 times food only. Some time night dinner and some snacks in midnight only. I have gastritis from past 3 years and I have piles (no bleeding)(type of muscular growth) from past 6 years, Problem:- I feel I release excess gas than normal from anal way. Is this normal or need to get treat, as I have piles it makes more sound when I relaxed and excess gas will move, its embarising in office and very difficult to controls as abdomen pain. I have not taken any treatment for my piles problem, and I have lost my weight from 75 to 65kg from past 8 months (i started night shift job from 8 months).
I am 26 year old suffering from IBS from 6 years. I almost lost hopes of recovering from IBS. Due to that I almost lost my career now coming suicidal thought. Help me.
Hi. I am a professional and having 26 years of age. Since last 3 years I am suffering with the problem of acidity. Everytime I visit doctor, they ask me to take tablet daily empty stomach (medicine like Pantop, Pan-D, Cyra D etc ). If I leave taking these medicines, acidity starts. Also, I can't fresh properly. Can anyone please suggest me about a permanent solution of this problem.
I have acidity from above 6 month, tastes bitter, not completely cured by any medicine. Now I am continuing with cyra-d medicine. But it also shows after eating chicken egg or after hunger. Please give me a solution for this bitter test.
I am having digestion problem and I am using pantocid-l one tab daily. Some times even one tab is not sufficient. I feel as if I have over eaten or if I take some other food than regular food I feel very different in my stomach. Pl advice me.
I am having heavy gas trouble issues even having or without having food. May I know a reason to avoid it.
Hello Dr, In anal fissure, DId anus became red and swollen which make sphincter tight? And Did inflammation spread to whole anal sphincter?(Painless Inflammation) or This Is Infection which is spreading? Thanks.
I am 19 year old male. I have these headaches, these are due to gastric problem or tension. My eyes start paining very easily after using laptop for few minutes and sometime I also have this anxiety problem. Like sometime when I am with my friends or family. It feels like am I really belong here, and then it become hard to breath. And I also have this suicidal mind more than 10 times a day I feel like ending my life. I already lost interest in my classes/studies. I do not like to do anything new. And sometime I become depressed but sometime not very frequently. So I am asking that it is possible that these all problems are made up by my brain. Because when I become angry I harm myself like I punch on the wall, or scratch myself till bleeding or beat myself up with stick. That make my headache low. But sometime I do it these thing without any situation. Sometime my hand shake, I think that is due to my smoking habit but I am not chain smoker. So please tell me is there any problem or just my mind playing with me.
Hi sir. My question is in concern with my brothers disease named acute pancreatitis. He has suffered 2 episodes of acute pancreatitis covering of 15 days each. Although my brother is not an alcoholic. Then what was the cause regarding this disease. Please advice.
Sir there is a problem in my abdomen. I always suffered from digestive problem. I tried many local treatment but my digestion not become as usual. There is also a problem in my ear it always appear popping sound in my ear. Please recommend me better suggestion.
I have been suffering from bowel movement trouble, heartburn, urination difficulties and has gas problems. I also have diarrhea for which I took meds but above problems have started. Loose motions have stopped but above symptoms have also started. Trouble in bowel movements are very painful and my stomach fills bloated. So, please someone help me. I also have difficulties in urination.
Hello sir. I have some problem. My body was very heat I'm going to bathroom bleeding with motion What can I do sir please Any medicine I will eat daily one tablet. B complex. Any advice which tablet I'll take to keep my body cool.
My mother have problem in stomach. In blood test result she have a fat in liver. She feel very hard in stomach. She say when she eat some thing her stomach is increased n feel heavy around neck.
I am 2 weeks pregnant and it is going good. But last two days started feeling acute acidity followed by contraction with pain. Kindly suggest.
It is an extremely embarrassing situation to have a bladder leakage. Social life could be altered, with reduced socialising for fear of losing control in the presence of others. Though not discussed frankly, it is an extremely common issue and about 25 million people in the United States suffer from this, with 75% of these being women.
Treatment depends on the type of incontinence, such as stress, urge, overflow, functional, or mixed. It starts with least invasive methods like lifestyle changes moving over to surgical approaches.
Ways to manage it
With trips to the toilet increasing considerably when you have urinary incontinence, simple measures can help manage leakage.
- Bladder training: Train your bladder to control the urge for another 10 minutes. This happens by voluntarily contracting the muscles and holding up the urge to go to the toilet. Gradually, it will help increase the frequency of the visit to 4 to 6 hours.
- Scheduled toilet trips: Whether or not there is an urge, visit the toilet every 4 to 6 hours.
- Double emptying: Even after you have voided, force yourself to void one more time. The residual urine, which is almost always present in the bladder, also gets emptied.
- Food/diet modifications: Stress incontinence is worsened by alcohol, spicy foods, acidic foods, and caffeine. Avoiding these can help reduce bladder leakage.
- Kegel exercises: The simple repetition of contracting the pelvic floor muscles, holding it in place, and releasing it can do wonders for strengthening the pelvic floor. This can be done anywhere and any time of the day and is very effective for improving bladder control.
- Catheters: These can be used if the incontinence is short-lived; the person would need to learn how to safely insert and remove it.
- Absorbent pads and medical devices: The absorbent pads are helpful in preventing embarrassment during social situations. On the other hand, medical devices like pessary are inserted into the vagina to support the bladder neck and thereby prevent leakage from the bladder.
- Drugs: Anticholinergics/antimuscarinics are useful to control a leaking bladder. Botox injections can help paralyse the overactive bladder muscles and provide a solution. Topical oestrogen may be used in small amounts to improve tone and reduce incontinence. Alpha blockers are also used in some people with good results. There are muscles that relax the bladder and increase the amount of urine it can contain.
- Surgery: In the event that all these measures are not useful, surgical correction is possible. Sling procedure where an artificial mesh is used to support the urethra. Bladder neck suspension is where the bladder neck is given support to prevent leakage. If there is a pelvic organ prolapse, that is corrected to rectify the bladder leakage. If you wish to discuss about any specific problem, you can consult a Urologist.