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!

Irritable bowel syndrome (IBS) is one of the most common disorders of digestive system producing a spectrum of symptoms such as persistent and recurring abdominal pain associated with passing of motion, change of bowel habit (diarrhea, constipation, or alternating diarrhea and constipation), etc. without any apparent cause.

Irritable bowel syndrome (IBS) is the disorder of function, which means that the bowel doesn't work, as it should. If one visualizes the bowel, it appears perfectly normal without any inflammation or other structural changes. In people with IBS, the intestines squeeze too hard or not hard enough and cause food to move too quickly or too slowly through the intestines.

What Are the Symptoms of IBS?

People with IBS have symptoms that can include:

Diarrhea (often described as violent episodes of diarrhea)

Constipation

Constipation alternating with diarrhea

Belly pains or cramps, usually in the lower half of the belly, that get worse after meals and feel better after a bowel movement

A lot of gas or bloating

Harder or looser stools than normal (pellets or flat ribbon stools)

A belly that sticks out

Stress can make symptoms worse.

How does Homeopathy treat IBS?

IBS can have significant impact on individual's social, personal, and professional life. Homeopathy offers proven treatment for the IBS which treats the Mind and Body connections. IBS calls for the treatment which should address the emotional stress, the stress coping system and the intestinal hypersensitivity. This is what homeopathy attempts doping exactly. The scientific and documented study shows that the homeopathic treatment helps achieve:

Soothing of mind

Slowing down of negative emotions such as anxiety, sadness, frustration, hyperactivity, anger, restlessness, etc.

Helping body's stress coping system

Alleviating the abnormal hypersensitivity of the bowels

Relieving the symptoms of bowel hyper-motility

Enhancing level of joyous state of mind

Individualistic approach whereby every patient is treated based on one's case

Homeopathic Treatment-

The Homeopathy medicine works at the deeper level, bringing the deviations of harmony among various systems of body back to normalcy. The homeopathic medicine establishes a good communication between the brain and the gut, thus ensuring proper relay of signals. The positive outcome of this is that the motility of intestines becomes regular and rhythmic, thus relieving complaints of either diarrhea or constipation or both.

Moreover, Homeopathy improves the pain threshold of individual, thus alleviating symptoms of pain and cramps associated with IBS. Homeopathy medicines work at deeper level of an individual to root out root causes. The two factors that are triggering causes of IBS are emotional stress and exaggerated sensitivity to food items.

Homeopathy has very well perceived the influences of psyche on the physique of an individual. Homeopathy medicines positively influences the emotions and thinking of an individual so that the person can cope with stress optimistically. Homeopathy medicines have proven efficacy to manage mental stress and its offshoots like IBS. Homeopathy medicines aid in minimizing food sensitivities and allergies.

Homeopathy and Irritable Bowel Syndrome

Abdominal Laparoscopy is a surgical diagnostic procedure, which is used to examine the organs inside the abdomen. It is an invasive procedure, but only small incisions are made.
The procedure is usually done in the hospital and the patient is given general anaesthesia to make the procedure pain free. The laparoscope is inserted through an incision in the abdominal wall. As it moves along, the image of the inside of your abdomen is then seen on the monitor. After the exam, laparoscope and instruments are removed and the cuts are closed. Laparoscopy is usually done as an outpatient procedure. This means that you will be able to go home the same day.

Why Is laparoscopy performed?
Laparoscopy is often used to identify the source of abdominal pain. It is usually performed when x-rays or ultrasound are unable to determine the root cause of the problem. Laparoscopy allows your doctor to see inside your body in real time and helps to diagnose or help discover what the abdominal problem is.

Tips to deal with laparoscopic surgery

Before Surgery

    The first and the foremost thing is to prepare yourself for the surgery by watching some videos and going through some blogs on it as doing so will help you clear your doubts
    Do not eat or drink anything 8 hours before the procedure
    Make sure someone accompanies you on the day of the surgery
    Fix your Pre Op appointment to ask any questions or address any concerns regarding the surgery, anaesthesia, etc
    Shave the area where the surgery will be performed. This will substantially reduce itchiness
    Lastly, prepare your hospital bag and discuss it with the person who is going to accompany you so that he/she knows what all you packed

After Surgery

    Don t lie down in bed all the time. Keep yourself active by moving every two hours as it promotes healing and helps eliminate gas pain
    Wear comfortable clothing
    Do not take bath for a week. However, you can take a shower 24 hours post surgery
    Drink at least 1.5 to 2 litres of water per day to prevent constipation. If constipated, take a stool softener.
    While sneezing or coughing, hold a pillow against your stomach to lessen the pain
    Roll onto your side and sit up using your arms for support and then stand up
    Don t drive for two weeks
    Refrain yourself from intercourse, douching, and swimming
    Make sure to visit your doctor 2 to 3 weeks post surgery to make sure your wounds are healing

It might take some time for the wounds to heal, but in case of any prolonged pain do remember to consult your doctor immediately.

Easy Tips to Deal with Abdominal Laparoscopy

The diagnosis as well as management of pancreatic cystic lesions is a general problem. Nearly 1% of the patients in the chief medical centers have been observed to have pancreatic cystic lesions on cross sectional imaging. It has also been observed that a quarter of all pancreas scanned in an autopsy series contain pancreatic cysts. Earlier, these cystic lesions were regarded benign but with increasing evidence made available from the cystic lesions, they are regarded as origin of pancreatic malignancies.


Information on asymptomatic neoplastic pancreatic cysts
The most vital medical tools that are used in the diagnosis and management of pancreatic cystic lesions include the endoscopic ultrasound and cross sectional imaging. These are used to distinguish non-mucinous cysts from mucinous cysts. The identification of pancreatic cysts creates a lot of anxiety for the clinicians as well as the patients related to the probable presence of a fatal tumor. The findings of a macro cystic lesion that enclose viscous fluid loaded in cea are helpful in the analysis of a mucinous lesion. 


The most common pancreatic cysts are the non-neoplastic inflammatory pseudo cysts, and they can be detected easily by imaging. The identification of pancreatic irregularity with probable association with malignant cells is a vital source of referral for the specialist. The set of guidelines that have been proposed for the management and diagnosis of patients with asymptomatic neoplastic pancreatic cysts are based specifically on the analysis of the quality of the data. It is also designed to address the most important and frequent clinical scenarios. The diagnostic suggestions are provided based on the clinical problem as well as the risk of malignancy.


Imperative guidelines to follow
To achieve accurate diagnosis of asymptomatic neoplastic pancreatic cysts is indeed a great challenge. It is all the more important to find the reproducible methods that can be used to stratify threat of cancer for the patients. The main guidelines include a two year screening interval of cysts that can be of any size as well as stopping observation after 5 years, in case there is no change. The new guidelines, for the most part, recommend surgery if more than one concerning feature is confirmed on the mri by use of endoscopic ultrasound. The new guidelines even suggest discontinuation of inspection after the surgery if no dysplasia or invasive cancer is identified. The guidelines have mainly been developed by use of grading of recomendations assessment, development and evaluation.

Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

An anorectal abscess is a painful swelling near the anus or in the buttock. The swelling contains pus. 60% anorectal abscesses are superficial and resulting from infection in small anal glands present in between internal and external anal sphincters (intersphincteric space). They are known as a perianal abscess. 30% of anorectal abscesses are deep-seated and results in systemic infection. They are call Ischiorectal abscess. Submucous abscess, pelvirectal abscess and pilonidal abscess developed from versatile cause are comparatively less common. Inadequate and improper management of anorectal abscess may potentially cause complication like fistula formation.


Fast facts on Anorectal abscess-

* Anorectal abscess should be drained at the earliest.
* Conservative medical management almost invariably invites complication like fistula formation.
* Surgical drainage of pus reduces the chance of fistula formation by 50%.


What causes Anorectal abscess?

* Blocked and infected anal glands (cryptoglandular infection).
* Untreated anal fissure that becomes infected.
* Sexually transmitted infections.
* Penetrating injury of the perianal or buttock region.
* Crohn s disease.
* Colon cancer.
* Tuberculosis.



What are the symptoms of Anorectal abscess?

Superficial abscess-

* Constant and throbbing pain that worsens on sitting down.
* Swelling, redness and tenderness of the skin around the anus.
* Discharge of pus.
* Pain is often associated with bowel movement.

Deep abscess-

* All or some of the symptoms of a superficial abscess.
* Fever with chill and rigor.
* General weakness.
* Sometimes fever is the only symptom of the deep abscess.

The anorectal abscess should preferably be explored under general or spinal anesthesia. Medical management often fails and subsequently fistula is formed.

Anorectal Abscess - Know In Detail About It!

Gallstones are bits of solid material that may be formed in the gallbladder. The gallbladder is a little organ located under the liver. You won't know you have them until they've blocked your bile duct, causing pain that will need immediate medical intervention and even hospitalization in some cases.

They may comprise of cholesterol, salt, or bilirubin, which consists of red platelets. Gallstones vary in size. They can be as little as a grain of sand or as even the size of an apricot in many cases. Women are more likely to develop gallstones than men. Here we discuss ayurvedic medicine & treatment to remove gallbladder stones.

Most Common Causes of Gallstones
Here we found out the reason behind the gallstone problem. There is a number of reason which creates gallstone conditions, especially in women.

Intake of anti-conception medication pills, hormone trade treatment for menopause side effects, or pregnancy.
Fasting.
Malfunctioning of the gall bladder.
High cholesterol levels.
Gallstones may be created when there is an excessive amount of cholesterol in the bile discharged by the liver. This bile normally separates the cholesterol and helps in the normal functioning of the liver and other digestive organs of the body.
Bilirubin: Bilirubin is a substance created when your liver wrecks old red platelets. A few conditions, like cirrhosis of the liver and certain blood issues, causes the liver to create more bilirubin than it ought to. This can lead to complicated conditions like gallstones.
Bile: Your gallbladder needs to exhaust bile to be sound. In the event that it discharges its bile content, the bile turns out to be excessively thick which causes stones to shape.
Weight: Being overweight or underweight can also cause a malfunction which can lead to the appearance of such gallstones. The gallstones diet also has a bearing in such cases.
Symptoms of Gallstones Problem
Fever
A yellowish tint in your skin or eyes, which can demonstrate jaundice
Sickness or retching
Clay coloured stools
Pain in the right upper quadrant of your stomach area
Nausea
Vomiting
Other digestive issues
How do you Dissolve Gallstones in Ayurveda?
Ayurveda is a holistic system of medicine that gets to the root cause of the gallstone disorder instead of just treating the symptoms. Ayurvedic remedies improve your overall wellbeing, in addition to treating the symptoms. The various Ayurvedic remedies for gallstone removal are:



Diet: Following a healthy diet is one of the key measures to prevent gallstones problem. Eat a well-balanced diet that has plenty of fruits and vegetables; avoid eating foods that contain saturated fats. Fat rich foods such as nuts and seeds should be consumed in moderation.
Exercise: Exercising regularly helps in keeping your weight in check. Cardio exercises such as swimming and running are good for your heart and overall health. Remember that obesity is a risk factor for gallbladder stones.
Keep Diabetes in check: If you are diabetic, make sure your blood sugar levels are in check. High blood sugar may cause high-fat levels in the blood which may result in gallstones.
Limit Stress: Stress may be a direct or an indirect cause for the formation of gallstones. Hence practice relaxation techniques such as meditation to deal with stress in an effective manner.
Ayurvedic Herbs: Numerous ayurvedic medicine for dissolving gallstones known as cholagogues and choleretics have been found useful in preventing gallstones in traditional ayurvedic medicine. Cholagogues are herbs that stimulate the gallbladder to contract, while choleretics stimulate the liver to secrete more bile. Both these actions could help reduce the risk of developing gallstones. Turmeric, citrus fruits, dried ginger, black pepper, long pepper, hing, etc., fall under these categories.
Table Salt Remedy: Before breakfast, on an empty stomach, take a tsp of Saindhava lavanam or ordinary table salt in a glass of hot water. After drinking this, lie down for about 45 minutes on your right side. Do this once or twice a week.
Castor Oil: Apply castor oil pack over the gallbladder area.
Therapeutic Procedures: Apatarpana (fasting), langhana (light diet), and virechana (mild purgation) are some of the ayurvedic therapeutic procedures that are usually advised as a part of the gallbladder stone removal treatment.
Ayurvedic Remedies: Various ayurvedic treatment use to remove gallbladder stones and some specific Ayurvedic remedies such as Shankavati, Sootasekar ras, Pravaalpanchaamrit, Hingwaashtak choorna, Avipattikar choorna, etc., are generally prescribed to dissolve gallbladder stone. The duration of the ayurvedic treatment and dosage of these ayurvedic medicines depends on the severity of the gallstone condition. If you wish to discuss any specific problem, you can consult an Ayurveda.
Update From Lybrate: Stay fit and strong by consuming Health Drinks for Gallstone, available at Lybrate. Being a blend of natural ingredients, these products give a vitalizing boost of freshness.

Ayurvedic Treatment of Gallstones Removal - Cause & Symptoms

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