A pancreatic transplantation or pancreas transplantation refers to the surgical procedure, which involves replacing a dysfunctional pancreas with a healthy one.  The donor of the pancreas is usually a deceased person. Pancreas is an important organ of the body as it produces several important hormones, which play a significant role of regulating our body cycles. Pancreas transplantation is usually performed for the treatment of type 1 diabetes which is linked to the inability of the pancreas to produce the insulin hormone.

A pancreatic transplant is considered as one of the potential cures for type 1 diabetes. However it is not considered to be a standard treatment due to complications, such as:

Rejection of graft by the recipient body or similar complications
The medications which are given to prevent the rejection can have serious side effects too
Certain complications like blood clots or infections can occur following the procedure
Failure to control the blood sugar levels and rejection of the graft or complete pancreatic failure are Common complications that occur after a pancreas transplant.
These are the primary reasons why pancreas transplant is often considered to be one of the last measures of treating diabetes. Nevertheless, there are certain conditions where a pancreas transplant is worth considering. Some of the conditions include diabetes which cannot be controlled with the usual treatment procedure, chronic poor blood sugar control, insulin reactions which turns chronic or a serious kidney disease.

Certain medications are also prescribed for anti rejection purposes. These medications need to be taken after the operation for the rest of your life to prevent rejection of the donor graft. These medications can have a few adverse side effects. Some of the side effects include hypertension, thinning of your bones, unwanted weight gain and a rise in your cholesterol levels. Swollen gums or acne are also observed in several cases.  

Often a pancreas transplant is carried out along with a kidney transplant, especially if you have a serious kidney condition. It helps to provide a healthy kidney and a pancreas and also reduces a risk of kidney damage caused due to diabetes later in the future.

Know More About Pancreatic Transplantation!

Peptic ulcer often referred to as stomach ulcer, is usually a misunderstood disease. Most people are unaware of the reasons why the ulcer is caused and are also unaware of the early symptoms of the disorder. Here is a look at some of the strange facts about peptic ulcers that you may not know.

Stress does not cause ulcers: The myth that stress causes ulcers is just that- a myth. Ulcers are not caused by stress and tension. However, if you are already affected by an ulcer, stress can alleviate the symptoms and make matter worse. Non-steroidal anti-inflammatory drugs can result in ulcers. So, if you have already been diagnosed with peptide ulcer, try not to stress too much.
Ulcer pain is not caused due to food: Contrary to popular belief, ulcer pain is not alleviated when you eat something. In fact, the pain increases if your stomach remains empty for a long period of time. So, if you are an ulcer patient, make a point of eating at regular intervals. In fact, the American College of Gastroenterology claims that people with ulcers do not need to follow a bland diet in order to recover from the condition.
Heartburn medication is effective against ulcer: Stomach acid is the common link between heartburn and ulcer, as both of these disorders are caused as a result of excess acid formation in the stomach. This is why physicians often prescribe antacids to ulcer patients.
Untreated ulcers can be problematic: Ulcers are easy to cure and can be completely treated with proper medication and adherence to restrictions. However, you should seek treatment for ulcers as soon as it is diagnosed. If left untreated, this ulcer may go on to cause severe issues for the patient. For instance, untreated ulcers may lead to internal bleeding and scar tissue. The same also impede the digestive process. So, do not leave ulcers untreated and think that they will be repaired automatically over time.
Endoscopy is the best way to diagnose ulcers: Even though X-rays may often reveal ulcers, a normal X-ray cannot detect certain smaller ulcers. Endoscopy is the best way to detect the disorder. In this process, a small tube, containing a light and a camera, is inserted inside the patient s oesophagus. The camera reveals any abnormal growth or infection inside the stomach. If you suspect an ulcer, book an appointment with the doctor as soon as possible.

Strange Things About Peptic Ulcer!

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

The quote 'Good day starts with coffee' suits a lot of people who love nothing more than a cup of coffee every morning. However, your morning tryst with a cup of coffee might not be a very healthy habit. Believe it or not, addiction to caffeine (in the form of coffee) is as harmful as addiction to any other drug. In fact, caffeine is a legal drug that slowly and gradually damages your gastrointestinal tract. Here are the negative effects of coffee on your digestive system:

Increases Acidity: Coffee is known to contain different kinds of oils, acids and caffeine. These compounds have an adverse impact on the digestive system. The stomach and intestinal linings get damaged due to the over-consumption of these compounds in the form of coffee. Moreover, as you take coffee, your stomach produces more hydrochloric acid for digestion. This causes acidity and hampers the HCL levels altogether. When we take coffee regularly for years in empty stomach, our body's capacity of producing proper amounts of HCL gets hampered. Often, HCL production gets reduced as well. This leads to indigestion of other food items and effects flatulence and produces unwanted gases due to the improper breaking of proteins and fats by the body.
Ulcers and Irritable Bowel Syndrome: Doctors believe that coffee acts as an irritant for patients of Irritable Bowel Syndrome (IBS), gastritis, Crohn's disease, colitis and ulcers. Coffee is responsible for the irritation of the lining of stomach and intestine. It is also noticed that certain enzymes present in the coffee beans are also harmful to the gastrointestinal tract.
Heartburn: Coffee is responsible for relaxing the esophageal sphincter muscle. The relaxation of this muscle hinders the process of digestion and causes acid-reflux, resulting in heartburn. It is known to have compounds that have diuretic, laxative and mineral blocking effects on the body.
Laxative Effects: Coffee stimulates the process of peristalsis or movement of food through the gastrointestinal tract. The peristalsis starts immediately after food is swallowed by the individual. The intake of coffee catalyzes peristalsis and consequently leads to emptying of the stomach even before the food is digested properly. The semi-digested food is sent to the intestine too early, causing injury to the intestine and hampering the absorption of nutrients.
Affects absorption of minerals: Caffeine reduces the ability of the stomach to absorb iron and also hinders the absorption of minerals like calcium, zinc and magnesium by the kidney. All these minerals help in digestion at different points and regulate the bowel movement.
Coffee is known to have benefits like reduction of constipation and sugar absorption. But, it also interferes with the smooth functioning of the digestive system. It has a tendency to increase stomach aches, disturb the fluid balance and the overall process of digestion.

Coffee and Your Digestion

In modern day societies of intense stress and work pressure, the average diet mostly comprises of street foods, packaged fast foods and processed foods. Such stress and overexposure to a lot of toxins (present in the processed food, fast foods, and street foods) disable the liver from performing its primary function of cleansing the toxic materials through the skin, the respiratory and the digestive system. Besides, this overexposure to toxins also disrupts bile formation, which hinders the absorption of necessary nutrients, resulting in a severe disruption in health. Also, liver is responsible for the proper functioning of the eyes, the brain, the kidneys and the joints in the body. Thereby, it is necessary to include these 7 foods in your diet which help to detoxify your liver from the excessive toxins and allow it to function properly.

    Avocado: Avocados contain a rich amount of the antioxidant glutathione, which helps the liver to fight against the toxins.
    Garlic: Garlic contains a rich amount of selenium and allicin, which helps to cleanse the liver. A little amount of garlic helps in the activating liver enzymes which in turn helps to eliminate the toxins from the body.
    Green tea: Green tea contains a rich amount of the plant antioxidant known as Catechin, which help the liver to function properly. It also helps to protect the liver from the toxins.
    Beets and Carrots: Beets and carrots contain a rich amount of beta - carotenes and plant flavonoids which help to regulate the overall function of the liver.
    Turmeric: A little amount of turmeric in your daily meal helps in the cleansing the liver by helping the enzymes to get rid of the toxic carcinogens.
    Green Vegetables: Green Vegetables like spinach, bitter gourd and chicory contains a rich amount of detoxifying components, which helps in the neutralization of heavy metals which in turn regulates the cleansing ability of the liver. Green vegetables also help in the simulation of the flow of bile.
    Grape Fruit: Grape fruit contains a rich amount of vitamin C and antioxidants which initiates the cleansing process of the liver. Grape fruit also help in the formation of enzymes that destroys toxins like carcinogens.

Cleanse Your Liver - 7 Natural Foods that Will Help You 

An infant is usually called a bundle of joy and with good reason. There are simple and carefree, and bring a smile to your face with their antics. However, the mood and health of an infant can be tarnished due to an issue which is known as galactosemia.

What is Galactosemia?
When a baby has galactosemia, he or she will have a problem when it comes to digesting galactose, which is something that is present not only in milk but in all milk products. Galactose is a sort of sugar, just like fructose and glucose is. As a matter of fact, lactose, which is what milk has, is, in fact, a combination of glucose and galactose. Also, when lactose is processed, it is broken down by the human body into its constituents.

The condition is something that is passed down through the genes of the parents of the baby. The condition would occur if the gene which causes a tendency for a baby to have galactosemia is present not only in one parent but both of them. A baby who has the condition will be lacking an enzyme which is known as the GALT enzyme. The enzyme could also not be functioning as it should be under normal circumstances.

When it comes to the problem, it is very important, to say the least, to detect it sooner rather than later as if there is a build-up of unprocessed galactose which is allowed to occur, it can affect the baby adversely and in some cases, it can also be threatening to the life of the baby!

How does it affect a baby?
The problems which can erupt due to galactosemia include issues which affect organs such as the brain, eyes, liver and kidneys. It is interesting to take note of the fact that these are all organs which either have something to do either processing the blood or are heavily dependent on it. While a baby is not in the position in which he or she can communicate the issues that are being faced, when keeping an eye out for galactosemia, the signs which are displayed include an irritability of the baby as well as lacking consumption of the milk of the mother.

Even though galactosemia may not be the case, a doctor should be consulted as the exacerbated issue can include seizures and jaundice. It is to be kept in mind that galactose is something that can be found not only in the milk of the cow but also human milk as well as the milk of other animals such as goats.

Galactosemia In Infants - Know the Reasons Behind It!

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