There may be times when we get completely drained and fatigued and may feel like our insides could jump out because of the pain that we have in our stomachs. We may dismiss the issue as unimportant or due to a stressful day at work, and may think the stomach pain could be because of the extra spicy food we love to have every once in a while. However, a lot of people may tend to ignore this symptom and that is when stomach ache may turn out to be actually because of a peptic ulcer.

Peptic ulcer or stomach ulcer is a common occurrence and happens to a lot of people; however, it must be understood that not treating the problem in time may be troublesome in the long run and increase the recovery time. In order to be able to identify the peptic ulcers and to take the right treatment measures, it may be important for you to understand the problem and know how it is caused, and how it may be treated.

What causes peptic ulcers?
A peptic ulcer is diagnosed as inflammatory sores on the lining of the stomach or the food pipe, which transfers food to the stomach or even in the intestine. There are a number of factors that can cause inflammatory sores in the stomach region. The factors are as follows:

    The use of medicines that are meant to be painkillers or anti-inflammatory drugs. The acid levels of the stomach and the food pipe may get disturbed because of these medicines and may give rise to ulcers.
    In a lot of cases, the ulcers may also take place because of the presence of a tumour or a gastrinoma in the stomach that imbalance the levels of acid in the stomach.
    High alcohol consumption may also lead to the formation of sores on the stomach lining.
    Using tobacco or smoking are some other factors that contribute to the acid imbalance in the stomach.
    In the case of some serious illnesses, a lot of people may fall prey to peptic ulcers.
    Those who may have undergone radiation treatment around the stomach may also experience ulcers.

Though it may be known that excessive pain in the abdominal region may be due to stomach ulcers, it is important to understand that it happens due to bacterial infections, and when there is a bacterial infection in the body, you may have to undergo proper treatment. The treatment for this problem includes the use of medications as suggested by a qualified doctor, surgery in some severe cases, and most importantly lifestyle changes.

Peptic Ulcer - 6 Reasons Behind it

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!

These Gallstones don t cause any problems in most cases. But prompt treatment is required if stones block ducts and cause infections and inflammation in the pancreas. This may lead to the removal of the gallbladder through a surgery, known as cholecystectomy, which further includes techniques such as laparoscopic (keyhole) cholecystectomy or open surgery.

Although it is a less vital organ, the body can cope up even after removal.

Procedure of surgery:

The surgery involves removal of gallbladder and gallstones through several incisions in the abdomen. In order to see clearly, the surgeon inflates the abdomen with air or carbon dioxide.
A lighted scope attached to a video camera is inserted into one incision near the belly button. The video monitor is used as a guide for inserting other surgical instruments into the other incisions to remove the gallbladder.
Intraoperative cholangiography is the X-ray procedure which shows the anatomy of bile ducts. This is done before the surgeon removes the gallbladder.
Bile flows from the liver through the common bile duct after the surgery into the small intestine. As the gallbladder has been removed, the gallbladder can no longer store bile between meals but has no effect or little effect on digestion.
In case of open surgery, the surgeon reaches the gallbladder through a large, single incision in the abdominal wall.
Complications after gallbladder surgery:

This surgery carries some degree of risk like any other surgery. Complications such as internal bleeding, infection, injury to nearby digestive organs, injury to the bile duct and injury to blood vessels.

Types of gallstones:

There are three main types of gallstones. They are

Mixed stones: They are made up of cholesterol and salts. They tend to develop in batches.
Cholesterol stones: Mainly made of cholesterol, which is crucial to many metabolic processes. They can grow large enough to block the bile ducts.
Pigment stones: The colour of bile is greenish-brown, due to some particular pigments.
Medical factors to consider before cholecystectomy:

The most important factor is a consideration of your medical history. This is because the pre-existing conditions influence decisions on surgery and anaesthetic and information about any bad reactions or side effects from any medications would be helpful for surgery.

Self-care after the surgery:

Taking rest is the most important thing after surgery. Avoid things such as heavy lifting and physical exertion. The usual recovery period after the surgery is one week.

Know Everything About Gallstone Surgery!

The term cirrhosis refers to liver scarring due to various diseases and conditions such as chronic alcoholism and hepatitis. Each time the liver gets injured, it tries to repair itself, resulting in the formation of the scar tissue. With the progression of cirrhosis, a number of tissues generate making the task of liver difficult. Since the liver is an important organ of the body due to its functionalities such as detoxification and nutrient generation, reduced function of liver poses a serious threat to the body.

Symptoms of liver cirrhosis:
Unfortunately, cirrhosis doesn t portray any conspicuous symptoms that can be easily identified until the scarring has reached a level of threat. Some of the common signs and symptoms of this disease include fatigue, nausea, itchy skin, drowsiness, enlarged breasts, testicular atrophy, fluid in the abdomen, bleeding from the mouth, leg swelling, redness in palms etc.

Causes of liver cirrhosis:
There could be an array of reasons for the occurrence of liver cirrhosis. The major causes include an accumulation of fat in the liver, chronic alcoholism and chronic hepatitis. Some of the other reasons include cystic fibrosis, bile duct deformation, Wilson s disease, hemochromatosis, schistosomiasis, continuous consumption of medicines such as methotrexate, a disease involving glycogen storage and Aalagille syndrome.

Complications involved in liver Cirrhosis:

High blood pressure: Cirrhosis results in slow blood movement through the passage of the liver resulting in an increased pressure on the vein that is responsible for carrying blood from the intestine to the liver. This increases the blood pressure in the body.
Swelling of abdomen and legs: Portal hypertension can result in accumulation of fluid in the leg and the abdomen due to the liver s inability to producing an important protein known as the albumin.
Spleen enlargement: Portal hypertension is responsible for changing the shape of the spleen. Decreased count of WBC and the platelets indicate towards portal hypertension and cirrhosis.
Bleeding: Portal hypertension doesn t let the blood flow in its normal path. It directs the blood to flow through smaller veins. The veins, in turn, swell and burst to cause a massive amount of bleeding.
Apart from these some of the other complications involve jaundice, liver cancer, infections, bone diseases and liver failure.

Diagnosis:
Liver cirrhosis doesn t get detected easily. It is often diagnosed with a routine blood test. Some of the lab tests that can help to identify cirrhosis include blood work to check organ function of liver and kidney. Your doctor might suggest other tests such as MRI scan, CT scan or liver biopsy.

Treatment:
Treatment for the underlying cause of liver cirrhosis is done to keep the disease under control. A doctor might treat you for weight loss, alcohol dependency, complications related to hepatitis, portal hypertension and hepatic encephalopathy. For advanced cases where the liver stops functioning, a doctor might suggest a patient go for a liver transplant.

Liver Cirrhosis - What You Must Know About It?

Common Signs of Diarrhea

Diarrhea is a very common condition, which is associated with the passage of the ingested fluids and foods through your colon more frequently than usual or in huge amounts. This condition is mostly caused by the action of viruses, parasites, bacteria, medications like antibiotics, certain digestive disorders, abdominal surgery, lactose intolerance, and consumption of an excessive amount of alcohol etc. Here are some of the common symptoms, which indicate that you are suffering from diarrhea:

Passing watery and loose stools
Frequent bowel movements
Pain or cramps in the abdomen
Feeling of nausea
Vomiting
Bloating in the stomach

If you are suffering from a more serious form of diarrhea, you might also experience symptoms like:

Presence of mucus, blood and traces of undigested food in your stool
Fever

Diarrhea mostly gets cured even without consuming any medicines within a couple of days. However, you need to consult a doctor and get proper treatment for diarrhea in the following cases:

If you are continuously experiencing the condition for more than two days
Your stools contain blood or are black
Severe pain in the rectum or abdomen is bothering you
You experience signs of dehydration like excessive thirst, weakness, dizziness, dry mouth, urine of dark color or reduced frequency and amount of urination
Your body temperature exceeds 102 F (39 C)



Common Signs of Diarrhea

Gastroparesis is a condition when your stomach feels full and heavy even after it has been more than a couple of hours after meal. Generally, it takes maximum 1 &   hours for the stomach to feel empty, but if the time taken for it is more, then this is a condition of gastroparesis. It means there is some change in your normal digestion process.

In this circumstance, the food in your stomach doesn t digest easily and creates a lump. As a result, you have hard time digesting your food. It also means the nerves connected to the stomach are not functioning well. There are a number of reasons for which you can get gastroparesis.

Diabetes is one of the most common causes of making you feel fuller.
Disorders in the nervous system, mainly Parkinson s disease or cerebral attack can create this problem.
Some medicines, especially antidepressants or anti-inflammatory in nature and certain painkillers can cause this problem.
Gastroparesis shows a number of symptoms:

Occasional vomiting as you feel unnecessarily fuller. When you vomit, it gives out chunks of undigested food
A feeling of nausea
You feel full after you have eaten very little
Bloating and pain in your abdomen
There is alteration in the blood sugar level
You don t feel like eating due to loss of appetite
You lose considerable weight as you don t eat much
A possibility of suffering from malnutrition, again due to lack of appetite
How it can be treated?
When you identify the reason for gastroparesis, then treating it becomes easier. If diabetes or nerve disorder is creating the problem, leave it to your doctor to treat. For other causes like lack of appetite, there are some natural ways of treating it.

Have frequent smaller meals. This way you don t push yourself to eat much and at the same time, the body doesn t lack nutrition and energy
Avoid fibrous fruits
Avoid high carbohydrate and high fat foods, which takes time to digest
Intake foods which you can swallow, like soups or stew. They are healthy and are also easy to digest
If the problem still persists, consult your doctor who may prescribe some medicines to stimulate the stomach muscles. They generally have no side-effects. There are some medicines which can control your vomiting and nausea. There are some surgical treatments for gastroparesis, where the doctors place a feeding tube in your small intestine. A gastric venting channel is another option, which helps you to get relief from excessive gas formation in your stomach, thus accelerating the process of digestion.

Gastroparesis - Nausea on Regular Basis Can be a Sign of it

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