GERD is a digestive disorder that affects the lower esophageal sphincter, which is the ring of muscle between the esophagus and stomach. Gastroesophageal reflux is the backward flow of acids from the stomach into the esophagus. Doctors believe that some people usually suffer due to a condition called hiatal hernia. Pregnant women usually suffer from heartburn or acid indigestion caused by Gastroesophageal Reflux Disease.

The primary goals in the treatment of this disease are relief from symptoms, healing of erosive esophagitis and prevention of complications of esophagitis. The symptoms include heartburn and regurgitation. The setting includes a proton pump inhibitor (PPI). Patients suspected due to GERD with non-cardiac chest pain are recommended to have diagnostic evaluation before institution of therapy. For diagnosing GERD, barium radiographs should not be used.

The other points that must be remembered to diagnose GERD are
1. Endoscopy is recommended only in case of alarming symptoms. Even in typical symptoms, the upper endoscopy is not recommended.
2. For preoperative evaluation, esophageal manometry is recommended, but it has no role in diagnosing GERD.
3. Ambulatory reflux monitoring is a test that can assess association of reflux symptoms.

Management:
The suggested lifestyle modifications for the patients with GERD are

    Weight loss is recommended for patients who are overweight. So, avoid large meals and decrease dietary fat intake.
    Avoid alcohol, chocolate, onions, garlic, acidic foods and peppermint.
    Do not lie down within 3 to 4 hours after meal (recommended for nocturnal GERD patients).
    For symptom relief and to heal erosive esophagitis, a 8-week course of PPIs is the therapy of choice.
    Medications that help in potentiating GERD symptoms, including alpha-adrenergic agonists, nitrates, calcium channel blockers and theophylline should be avoided.
    For patients without diagnostic evaluation, therapy for GERD other than acid suppression, including prokinetic therapy should not be used.
    For patients with partial response to PPI therapy, additional symptom relief can be achieved by increasing the dose twice daily or switching to a different PPI.
    It is recommended to elevate the head of the bed 10 to 20 cm.
    Avoid wearing clothes which are tight around the waist.
    If patients experience heartburn relief, Histamine-receptor antagonists (H2RA) therapy can be used as a maintenance option in patients without erosive disease.

Some surgical options
1. For long-term therapy for patients suffering with GERD, surgical therapy is the best treatment option.
2. In patients who have no evidence of erosive esophagitis, preoperative ambulatory pH monitoring in mandatory.
3. Gastric bypass is the preferred operation for patients who are suffering with obesity and are contemplating surgical therapy for GERD.

Apart from these, there are potential risks that are associated with PPIs such as switching them can be considered in setting of side effects and the therapy can be a risk factor for Clostridium difficile infection.

Management of Gastroesphageal Reflux Disease (GERD)

Menorrhagia refers to very heavy and prolonged menstrual bleeding or periods in women. The bleeding is abnormal in nature, and if this continues for a long time, a hysterectomy surgery needs to be carried out to solve the problem.

Bleeding during the night time and passage of large blood clots during menstruation are other symptoms of Menorrhagia.

Causes:

The various possible causes of this kind of heavy menstrual bleeding are:

Hormonal imbalance, specifically of estrogen and progesterone is a common cause, which is more likely in adolescents and in women nearing menopause. Dysfunction in the ovaries also causes hormonal imbalance.

Non-cancerous tumors or fibroids may also be responsible for menorrhagia.

Women suffering from a miscarriage or ectopic pregnancy are likely to experience heavy menstrual bleeding.

Using blood thinners may lead to menorrhagia.

An intrauterine device used for birth control measures can cause disturbance and may lead to heavy menstruation.

A condition known as adenomyosis, where the glands in the uterus lining get embedded in the walls of the uterus, also causes menorrhagia.

Pelvic inflammatory diseases, infection in the uterus or fallopian tubes are other common causes.

Heavy bleeding may occur in patients with ovarian or cervical cancer.

Diseases of the kidney, liver or thyroid diseases may also cause menorrhagia.

Diagnostic Tests:

Several tests and methods are carried out for the diagnosis of menorrhagia. They are:

A general physical examination.

Bleeding diary of the woman.

Blood tests to detect anemia or thyroid.

Pap Smear for the evaluation of cervical inflammation, infections or cancer

Ultrasound for evaluation of pelvic organs like uterus, ovaries and pelvis.

Hysteroscopy, where a camera is inserted into the uterus to observe the linings.

Sonohysterography, where a fluid gets instilled into the uterus along with an ultrasound test.

Treatment:

Certain drugs are used to treat menorrhagia. They include:

Iron supplements for treating anemia.

NSAIDS or non-steroidal anti-inflammatories for treating and reducing blood loss.

Tranexamic acid is used for reducing menstrual bleeding.

Several oral contraceptives are used for regulation of the menstrual cycle. Oral progesterone corrects hormonal imbalance and reduces bleeding.

Surgical procedures for treatment of menorrhagia include:

Hysteroscopy, dilation and curettage, where uterus lining is scraped and evaluated.

Uterine artery embolization treats menorrhagia with fibroids.

Focused ultrasound ablation enables the killing of the fibroid tissue.

Myomectomy, endometrial ablation and endometrial resection are other surgical techniques.

Hysterectomy surgery is the penultimate solution, where the uterus, cervix or ovaries are completely removed.

Menorrhagia is characterized by abnormally heavy menstrual bleeding in women. This is quite unhealthy and proper measures must be taken for curing the heavy bleeding.

Menorrhagia (Heavy Menstrual Periods) - A Common Indication For Hysterectomy

Splenectomy is an operation conducted to remove the spleen. The spleen plays a vital role in building immunity against bacterial infections, located in the uppermost area of the left hand side of the abdomen, just below the diaphragm. There are some specific requirements with regard to the immunizations as well as blood work that might need to be completed before this surgery takes place.

Why is Splenectomy need to be performed?
There are a number of chronic illnesses like Hereditary Spherocytosis or Idiopathic Thrombocytopenic Purpura, which make it a necessity to get a child s spleen removed. Though it is a rare case but still any kind of trauma to the spleen along with uncontrolled bleeding can create a very serious situation, wherein an emergency might arise to get the spleen removed immediately.

Immunization of child before the operation
Before the surgery of Splenectomy is conducted, immunizations are given to children as a preventive against some specific kinds of infections that are most common for patients to arise after having undergone the surgery of Splenectomy.

How is the surgery performed?
The paediatric surgeon, who performs the surgery, need not require making a large incision for going about the process of operation. In most of the instances, a splenectomy is performed in the following manner, which includes:

A laparoscopic way through which a Paediatric Surgeon makes use of a small telescope along with some instruments of miniaturized nature, while placing them through small band-aid sized cuts on the abdomen.
The operation gets completed within three hours
At the time of hospitalization, a child would receive intravenous fluids, antibiotics as well medicines to get relieve from any kind of pain.
As and when the child feels as if he or she is fit enough, he or she would be allowed to eat, drink and also take medicines by mouth.
Essentials after the Surgery
After the surgery has taken place and the child returns home after a couple of days, there are certain essentials that require to be kept in mind:

Pain Management: Management of pain is the very first thing which should be kept in mind. The medicines prescribed by doctor for dealing with pain are not required after getting discharged from the hospital.
Most of the children would only need Acetaminophen or Ibuprophen once they get back home.
Care for Dressings: One may remove the gauze and clear plastic, which are placed over the small cuts, a couple of days after the surgery. The skin that surrounds the incision might have a reddish tinge and look bruised, which can last for few weeks.
Restrictions related to Activities: There are no real restrictions with regard to the resumption o regular activities. A child can go back to school as and when he or she feels totally comfortable.

Spleen Removal - Why Is It Performed In Kids?

Obesity is a condition characterized by the accumulation of large quantities of fat in the body. This condition drastically increases the risks of health problems. The most important cause for obesity is the intake of larger number of calories than what are usually burned through exercises or other routine activities. One with a BMI (Body Mass Index) more than 25 is considered obese. The primary ways of treating obesity are through exercising regularly and following a healthy diet.

How can Ayurveda help?
Ayurveda is a holistic system of medicine which is free from side effects, unlike conventional methods of treatment. Ayurvedic treatments focus on getting to the root cause of the disorder instead of just focusing on the symptoms. There are multiple remedies in Ayurveda that are effective in controlling obesity. They are:

Restrict your calorie intake: While this may sound easy, it is actually difficult to implement. One of the major reasons for obesity is eating too much. The idea is to avoid overeating, so you need to be aware of your portion size. Eat frequent meals but in smaller quantities; this helps in keeping your metabolic rate elevated, that in turn is a prerequisite for greater fat burning.
Start exercising: Exercise is a great way to burn those extra calories around your middle. The best and simple way to go about it is to start jogging. Low intensity jogging done over a period of time is a great way to burn fat. If you want to gain muscle, then do weight based exercises instead of just doing cardio.
Meditate: The beneficial effects of meditation are well known. Apart from reducing your stress level, it also helps in boosting your focus and concentration. Being stressed can make you eat more and thus gain weight, so meditating on a regular basis can help manage stress effectively.
Get sufficient rest: Sleeping less than 6 hours a day? You are only setting your body for obesity. Not sleeping enough brings about hormonal changes in the body which increase your appetite.
Avoid junk food: Junk food should strictly be avoided as it can make you put on some serious pounds. Instead, opt for healthier food options, but keep in mind the portion sizes.

Obesity - How Ayurvedic Remedies Are Best For It?

On each side of the uterus, two ovaries are present. It is the size of an almond and produces ova or eggs in simple terms, along with the release of hormones like oestrogen and progesterone. When a cancerous growth or a tumour grows in the outer lining (epithelium) of the ovary, it is known as ovarian cancer. Ovarian cancer occurs in women who are aged above 65 years.

There are three types of tumour
Ovaries are made up of three kinds of cells and each kind is capable of developing different types of tumour.

Epithelial tumour- It develops from the cells that cover the ovary s outer surface.
Germ cell tumour- It develops from the cells that produce ova.
Stromal tumour- It develops from the tissue cell which is the structure holding the ovary together and produces oestrogen and progesterone.
Some tumours are non-cancerous and never spread beyond the ovary. Cancerous or ovarian tumours that are less malignant can metastasize to other body parts. The signs initially would be mistaken with premenstrual syndrome or poor bowel movement or a bladder problem, but if the problems are persistent then one must get an expert opinion. Ovarian cancer often goes undetected till it spreads within the abdomen or the pelvis. 

Causes of ovarian cancer
Cancer develops when the cells of the body divide and multiplies in an unregulated manner. Mutations that are genetic like BRCA1 and BRCA2 can be the cause often or if an individual is diagnosed with any other type of cancer before like breast, colon or uterine. There is a higher risk of being affected by this type of cancer if the person had undergone fertility treatment or is suffering from infertility. Hormone Replacement Therapy (HRT) is another cause of this type of cancer. Experts say that longer the HRT, higher the risk. Women who are obese or are overweight has more chances of being affected. Endometriosis or the disorder in which the growth of the tissue occurs outside the uterus, in such a case the risk is 30% higher.

The signs or symptoms of ovarian cancer differ from one woman to another. Some of the symptoms given below might as well be non-cancerous because since the ovaries are situated near the intestines and bladder, it might be often mistaken to be symptoms of gastrointestinal issues. It is advisable to consult a doctor if the symptoms are persistent.

Symptoms that occur at an early stage
Pelvic pain, Abdomen pain, Indigestion issues, Loss of appetite, Painful sexual intercourse, and Changed bowel movement are a few of the symptoms that occur during the early stages of the development of an Ovarian cancer.

Signs at a progressive stage
Loss of weight, Fatigue, Short of breath, and Nausea are the predominant symptoms when the Ovarian cancer has progressed more. Early diagnosis may lead to complete cure

Symptoms of ovarian cancer are similar to that of ovarian cysts. These ovarian cysts are often non-malignant but women with such cysts have a higher risk of being affected by cancer. Ovarian cancer can begin silently and are often detected at a later stage. Thus any individual undergoing these symptoms can avail medical assistance for further diagnosis.

Ovarian Cancer - Things You Need To Know!

If the blood flow between left ventricle and aorta is obstructed, it is known as Aortic Stenosis.
Aortic stenosis can occur in newborn, infants, children and adolescents. It is more common among boys than in girls.
Mild cases of this disorder do not need treatment. However, if a child has a severe case of aortic stenosis, then it requires treatment.

Aortic stenosis: Causes-

Blockage in the valve, mainly in the form of bicuspid valve stenosis (Aortic valve stenosis)
Muscular/fibrinous obstruction beneath the aortic valve (Subaortic stenosis)
Narrowing above the aortic valve in aorta itself (Supravalvular aortic stenosis)
Aortic valves regulate blood flow to the body parts. When aortic valve opens, it allows blood to go forward then it closed down so that blood will not come back to left ventricle.
However, if there is a problem with the aortic valve, it cannot open entirely and that restricts the passage of blood. The heart has to work extra hard to ensure that the entire volume of blood flow through the faulty valve.

Sometimes babies are born with deformed aortic valve in the form of bicuspid aortic valve that is prone for obstruction as compared to normal trileaflet aortic valve.

Aortic Stenosis: Symptoms-

Symptoms due to aortic stenos is depends on age of the child and its severity.
If occurs in newborn babies, it is generally severe in intensity and babies are generally in shock like state due to low cardiac output.
Infants are generally tired easily during feeding.
Children show signs of easy fatigue, chest pain, loss of consciousness and in late stages with shortness of breath.
Diagnosis of Aortic Stenosis-

Pre-natal testing like a fetal echocardiogram can reveal aortic stenosis if moderate to severe in intensity. That is why as soon as the baby is born, treatment is initiated.
Even if the child was not born with a problematic valve, this condition can arise a few years later.
For diagnosing this disease pediatric echocardiogram by pediatric cardiologist needs to be done from the chest of the child
Treatment of Aortic Stenosis-

If aortic stenosis is mild to moderate in intensity then we need to do follow-up of the child at regular intervals.
However, in severe aortic stenosis, treatment needs to be done
In valvular aortic stenosis, treatment of choice is by doing ballooning of aortic valve (Balloon aortic valvuloplasty, BAV) in any age group.

Balloon Aortic Valvuloplasty - This is not open-heart surgery. It is done in cardiac cath lab under fluoroscopic guidance by using vessels in thigh. We cross the valve with wire and catheters and we inflate a balloon across the stenosed aortic valve.

Open heart surgery: In subvalvular and supravalvular aortic stenosis, treatment is by open heart surgery.

Valve Replacement - An artificial valve or a donor valve is surgically attached at aortic valve location when valve is not amenable for ballooning. It is generally done in adolescent or adult patients.
Parents need to be alert and attentive to any physical discomfort that their child is suffering because that could be a symptom of aortic stenosis. The right treatment at the right time is necessary whenever required.

Aortic Stenosis - All You Must Know About It!

Don't wait any longer, manage your General Surgeon online with a Lybrate doctor today

Consult for General Surgeon - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES