Types of abdominal and pelvic surgical incision

At the time of a surgical procedure, while making an incision a doctor has to take care of a number of factors before making an incision. Considering a number of factors, different types of incisions have come into fore, such as 

Midline Incision: It s the commonest incision and is done along the linea alba (fibrous structure running through the mid of the abdomen). These are preferred, especially in diagnostic laparotomy as it permits a wide access to the abdomen.
Pfannenstiel Incision: It is transverse in nature, extending from the umbilicus to the pubic-symphysis. It is generally employed for abdominal hysterectomy of benign nature and caesarean section.
Chevron Incision: It is an incision under the rib-cage and is done on the abdomen. It starts from beneath the ribs on the right abdomen and extends till the other mid axillary line. Thus, the entire abdominal width is incised for proper reach into the liver. The incision can be up to 2 feet.
Kustner Incision: It is transverse in nature and extends from the symphysis pubis till the iliac spine (anterior). This type of incision takes time to perform. A Pfannenstiel incision offers more exposure than a Kustner incision.
Lanz Incision: It is a variation of the more common mcburney-incision (also known as Gridiron s incision). It is generally used for open appendectomies. There are quite a few variations for this type of an incision.
Gridiron s incision: It is done for appendectomies. It is an oblique short incision which is done in the lower right quadrant in the abdomen.
Kocher s Incision: It is oblique in nature, extending from the abdominal upper right quadrant and is generally used for performing an open cholecystectomy. Gallbladder, biliary tract and certain liver operations can be suited for a Kocher s incision. This however is different from the same named incision used for the thyroid gland surgery.
Cherney Incision: It is transverse in nature. It allows a great range of exposure for the pelvic sidewall. It is less painful than a midline incision. It allows for the greatest pelvic exposure and hence is a widely preferred and practiced incision.

8 Types Abdominal and Pelvic Surgical Incisions

Living with ulcerative colitis can be very challenging. Patients of this disease will have to deal with pain in the abdomen and several digestion related issues in their daily lives. It is known to adversely impact the digestive tract. There can be extreme discomfort at the time of flare-ups. A patient can find life extremely difficult while dealing with symptoms like abdominal pain, fever, weight loss, and chronic diarrhea.

What is Ulcerative colitis (UC)?
It is a serious inflammatory disease. It is caused due to inflammatory bowel movements in the digestive tract. It can affect your daily life adversely. The worst part about this disease is that it relapses in the individual. It is characterized by flare-ups. You need to know fist what is an UC flare-up. Well, it is a term to refer to an exaggerated condition in the disease. It refers to a state when things turn worse. These flare-ups can be caused due to a number of factors. Some of these include:

Side-effect of certain medicines
Hormonal imbalance, especially during pregnancy
Sudden withdrawal from medication
Any infection or other medical condition
How to deal with the UC flare-ups?

Doctors often prescribe corticosteroids to deal with the flare-ups. Some of the most common drugs are Prednisone and budesonide.
Doctors prescribe the intake of steroids, 5-Aminosalicylates, antibiotics, and biologics.
Lifestyle changes are helpful in treating this disease. You can work towards detoxification and de-stressing yourself to get rid of the flare-ups. Take up some exercises, meditation and Yoga for best results.
You can also control chronic diarrhea by keeping a check on what you eat. You should avoid eating fibrous diet. Fibres are tough to digest for patients with UC. You must maintain proper hygiene as well to stay away from diarrhea.
Surgical Management of Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory disease of the colon and rectum limited to the mucosa, and may vary in severity from a mild intermittent disease to an acute fulminant and potentially fatal disease requiring urgent surgery. Management of ulcerative colitis depends on severity, extent, and duration of the disease, response and tolerance to medication, patient age and comorbidity as well as patient preference.

Surgery plays an important role in the management of UC both because of the premalignant nature of the disease, and because of the periodic failure of medical management. The underlying rationale for surgical treatment of the disease is that the disease is confined to the colon and rectum, and therefore proctocolectomy is curative. The goal of surgical therapy for ulcerative colitis is to remove the disease with as little alteration of normal physiological functions and lifestyle as possible.

Four surgical options exist for patients with ulcerative colitis and each has its own advantages and disadvantages.

The surgical choices are:

Proctocolectomy and Brooke ileostomy.
Abdominal colectomy and ilcorectal anastomosis.
Proctocolectomy and Kock pouch.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA).
The choice of operation requires consideration of the advantages and disadvantages of each option and must be tailored to an individual patient's needs and circumstances. Important factors to be considered in the choice of operation include the indication for surgery, age, associated medical conditions, body habitues, and quality of the anal sphincter. Extensive preoperative education is required which should include discussion with a specialized Gastroenterologist.

Ways To Deal With Ulcerative Colitis!

Irritable bowel syndrome or IBS as it is more commonly known is a problem with the gastrointestinal tract, where, as the name suggests, the bowel is irritated. It is a syndrome, which is a group of symptoms, and not a single issue. The exact cause is still not known, but most people with IBS have higher levels of stress, anxiety, and depression. It is therefore considered a psychosomatic condition, where an unhealthy state of mind is reflected in body symptoms.

Unani also refers to IBS as nervous indigestion, intestinal neurosis, and irritable colon.
Symptoms: 

These are worsened when there is an actual episode, which is usually during increased stress levels.
Altered bowel movement (violent episodes of diarrhoea) alternating with constipation
Severe stomach cramps, which is worsened with eating and better after passing stools
Bloated feeling (stomach full of gas)
Change in stool (flat ribbon stools or pencil stools)
Feeling of incomplete stool emptying
General fatigue and malaise
Diagnosis is confirmed with a combination of symptoms, clinical exam, and investigations including stool tests. The two common findings are altered intestinal motility and increased visceral perception to stimulus.
If a patient presents with constipation, the bowel motility is reduced, and in those presenting with diarrhoea, the movement of food through the colon is very rapid.

While there are no sure remedies for IBS in allopathy, natural medicine systems like Unani have effective remedies. Both single and compound drugs are tried, and in most studies, the results have been very encouraging. The commonly used products are listed below.

Bel (Aegle marmelos): The fruit and leaves of bel are known for their stomach-friendly properties. It is useful in chronic diarrhoea conditions and also during typhoid. Bel juice is available for ready use. Also, the leaves can be boiled in water, and this extract can be stored and consumed over a period of time.
Cumin seeds (Cuminum cyminum): This common ingredient in most curries does wonders for the stomach. It is very friendly on the stomach and soothes the stomach lining. It reduces irritation and eases bowel movement. In addition to regular usage, when IBS flares up, cumin seeds can be boiled in water, and this can be cooled and stored for use over a period of time.
Amla (gooseberry) (Embilica Oficinalis): This again is useful in treating diarrhoea and has a cooling and soothing effect on the stomach. This is used in multiple forms   raw gooseberry, boiled, and even juice forms.
These are used either as a single agent or as compound agents for treating IBS. Unani also believes that controlling anxiety and emotional symptoms can help in avoiding flare-ups of IBS.

Irritable Bowel - How Unani Medicine Can Help to Treat It?

Urinary tract infection (UTI) is usually caused by inflammation or bacteria in the urinary tract. Pregnant mothers are most susceptible to this infection, especially after the sixth week and before the twenty fourth week of pregnancy. This usually happens due to the alterations that take place in the urinary tract during pregnancy.

Also, a growing uterus can block the urine drainage from this part of the body, leading to the accumulation of bacteria which causes infection. The symptoms are uncomfortable and even painful. These include pain and burning sensation, frequent urination, fever and chills. So how can you prevent UTI during pregnancy? we have a few tips for you!

- Hydration: The best thing you can do to both prevent and treat a urinary tract infection is to start drinking at least six to eight glasses of water in a day. Another good way to prevent and treat UTIs is with the help of cranberry juice which has powerful antioxidants that flush toxins out of your system effectively. You will, however, need to ensure that the cranberry juice is fresh and natural, without any sweeteners.

- Hygiene: Keeping yourself clean is one of the most important ways in which you can avoid UTI. It is best to clean from front to back, rather than the other way, so that you drive away bacteria and dirt. Also, make sure that you wash your private parts with warm water infused with a few drops of normal liquid antibacterial, so that you can be sure that the bacteria do not get a chance to thrive and affect your system. Also, remember to use soaps, washes and creams that have a mild formula, rather than a harsh chemical concoction. Hygiene for this area of the body includes keeping it dry.

- Diet: Your diet should have plenty of fluids and lemons or other citrus food that are rich in vitamin c, as this is a good vitamin to keep bacteria at bay. Also, you should eliminate sweet and refined products to ensure that you do not contract UTI. Other foods to avoid include caffeine and alcohol.

- Clothing: Wear airy and cotton based undergarments that are breathable and have a soft texture. This non abrasive type clothing can also help in keeping the area dry, so that bacteria does not get a chance to develop, as they typically need a damp environment for growth. Change your undergarments twice a day, if need be, and avoid wearing trousers and shorts that are too tight.

These tips and many others including urinating as soon as the urge sets in, can help in fighting the risk of contracting UTI during pregnancy.

Tips To Prevent UTI During Pregnancy

Chronic pancreatitis refers to an inflammation of the pancreas   the organ that creates enzymes and hormones to manage blood sugar levels and aids in digestion. The condition either does not heal completely and keeps coming back, or persists for months or years at a stretch.

Chronic pancreatitis is a serious, debilitating condition, which can potentially lead to permanent damage and scarring of the organ. The following are the consequences-

  Formation of cysts and calcium stones in the pancreas
  Blockage of the gastrointestinal tract
  Malnutrition
  Diabetes

The condition is most likely to develop between the ages of 30 and 40 and is commonly observed in men than in women.

Causes of Chronic Pancreatitis:

A number of factors are responsible for long-term pancreatitis. The most common ones include-

  Alcohol abuse   Reportedly, 70% of all cases regarding the condition is related to alcohol consumption
  Autoimmune diseases   When your body attacks the healthy tissues and cells mistakenly
  Genetics
  A constrict pancreatic duct   The tube that carries enzymes to the small intestine from the pancreas
  A blockage of the pancreatic duct by stones
  Cystic fibrosis   A hereditary disorder that causes mucus to build up in the lungs
  Hypercalcemia   When the level of calcium in the bloodstream increases abnormally
  Hypertriglyceridemia   When the level of triglycerides in the blood rises up

Warning Signs of Chronic Pancreatitis:

Symptoms of chronic pancreatitis do not show up at the early stages. They become more evident when inflammation aggravates. However, you should look out for the following signs-

  Severe abdominal pain   Usually in the upper portion
  Loose stool that appears pale and does not flush away easily
  Vomiting and nausea
  Unintentional weight loss
  Fatigue
  Excessive thirst
  Shortness of breath
  Diarrhoea
  Jaundice
  Pancreatic fluids inside the stomach
  Intestinal blockage
  Internal bleeding

The above symptoms vary based on the severity of the condition. Painful episodes may last for days. For some people, drinking and eating seem difficult because that makes the pain worse. With the progression of persistent pancreatitis, the pain becomes constant. Seeking treatment at the earliest is necessary for the condition to heal.

Diagnosis and Treatment:

A blood test alone is not sufficient to detect the changes in your pancreas in the initial stages. An imaging test is the most reliable method to confirm the diagnosis. Your doctor may recommend the following tools-

  CT Scan
  X-ray
  Ultrasound
  MRI Scan

The objective of the treatment is to reduce pain and improve the functioning of your digestive system. The damage to the pancreas cannot be cured, but your doctor will prescribe necessary measures to manage the symptoms of the condition.

The primary treatment methods include endoscopic therapy, medications, and surgery.

  Medication - Pain killers, insulin steroids, and artificial digestive enzymes may be taken as per the doctor s recommendation
  Endoscopy - The procedure involves inserting a flexible, long tube (known as an endoscope) through the mouth. It allows the doctor to look at the pancreatic stones formed inside. He/she then removes the stones, places stents to improve the flow, and seals the leakage.
  Surgery - The last resort is surgery. The doctor will recommend it only if medications and endoscopy therapy have failed to rectify the painful symptoms. Removing a portion of the diseased pancreas can offer relief. Surgery may also be performed to drain cysts and to unblock or widen the pancreatic duct.

The outlook depends on the underlying causes and the seriousness of the disease. However, immediate treatment and diagnosis can improve the outlook. Consult a doctor as soon as you encounter the above symptoms of pancreatitis.

Chronic Pancreatitis - Everything You Should Be Knowing!

Gallstones are small stones that form in the gallbladder as a result of the deposits caused by the bile, a type of digestive fluid. Actually, the gallbladder stores bile and releases it into the duodenum (part of the small intestine) for the digestion of fats. However, when the gallbladder is unable to release the bile properly, the bile deposits start building up and manifest in the form of stones. These stones vary in size, ranging from tiny sand-like grains to big golf ball-like stones.

Symptoms of gallstones: Many times, individuals have stones in their gallbladder and yet they do not experience any discomfort. These stones are very small in size and therefore, do not cause trouble. This is why they are called silent stones and for such individuals, treatment is not needed. But if an individual experiences discomfort, it is a signal for treatment. The signals come in the form of specific symptoms such as pain in the upper right side of the abdomen, pain between the shoulder blades, nausea, vomiting, fever, and even jaundice.

Causes of gallstones: Gallstones may result due to common. Excess bilirubin produced by the liver causes hard, dark brown stones called pigment gallstones. Even when the gallbladder cannot empty the bile, stones are formed due to the concentration of bile.

Treatment: Once gallstones are detected through a CT scan or ultrasound, the doctor begins the course of treatment. Gallstones can be removed only through surgery. In surgery, the gallbladder is removed to help the bile flow directly into the duodenum from the liver. This surgery is called cholecystectomy and it is a safe procedure. The removal of gallbladder does not affect the digestive system in any way. 

Prevention: Gallstones can form in any individual s gallbladder but some people are more susceptible to the condition. Such individuals include women over 40, those who lead a sedentary lifestyle, obese/overweight individuals, and those with a family history of gallstones. Therefore, such people should be aware of the risk they face. If such individuals report any symptoms related to gallbladder stones, they should get it diagnosed immediately. Apart from this, one should also keep a check on the diet. A high-fat or high-cholesterol diet should be replaced with a high-fiber diet and one should also take meals on time. Not eating anything for long hours and fasting increases the risk of gallstones. Regular exercise also helps in this matter. Last but not the least, one should drink plenty of water as it regulates the functioning of the liver and prevents the formation of stones. Gallstones are a common disorder but they cause difficulties for the patient and hence, one should get it treated on time. If surgery is recommended, one should not delay it and get it done as soon as possible. Delay only aggravates the problem.

Gallstones - What All Should You Know About It?

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