The kidneys are responsible for the elimination of waste from the body. The blood is filtered in the kidneys and all toxic wastes are filtered out and excreted through urine. When this filtration does not happen effectively, a lot of waste can be found in the blood, which affects normal body function.

Kidneys may lose their functioning either due to age, injury, or disease conditions. Whatever the reason, when kidney function is hampered, the body suffers. If there was an injury or congenital problem, it could be unilateral and the non-affected kidney could still do the function. However, if it is infection or old age, normally both kidneys are affected and then replacement should be looked for externally. This is where a kidney transplant comes into the picture.

What is it?

It is a surgery where a healthy, functioning kidney is placed into the body. The donor could be

Living: These donors have to be related or unrelated. Related is often termed someone, who is a family member and is willing to donate one kidney (one kidney is sufficient for normal, healthy individuals) to the diseased person.
Cadaver: If a person is willing to donate kidneys post death, these are used for transplant, within a specified time.
Identifying the right donor and recipient:

Blood type and tissue type should be matched; a good tissue type match improves the chances of success
Overall health of the donor to ensure there is no heart disease, lung disease, or diabetes
The recipient also should be healthy
What to expect during surgery?

Once a donor is identified, in living donors, the surgery to remove the kidney and to transplant it are done simultaneously
The surgery usually takes about 3 to 4 hours
Antibiotics are given prior to the surgery to prevent infection
The blood vessels and ureter are connected back to the kidney after the transplant
Hospital stay can range from 5 days to 2 weeks, depending on the overall health of the patient and the anticipated risk of rejection.
Most transplanted kidneys work effectively almost immediately. A kidney stored from a cadaver may take a little longer compared to a fresh kidney from a living donor
People who have had transplants are put on immunosuppressants on a chronic basis to reduce chances of rejection. The new kidney will always be recognised by the body as a foreign body, and so this is essential.
Kidney transplant success rates are quite high, and more and more people are opting for transplants as opposed to dialysis.

Kidney Transplant - What To Expect From It?

Formation of blood clots in the arteries of the lungs, heart or legs can actually kill a person. In such a case, the immediate medical action is necessary and the only way to deal with blood clots is thrombolysis.
Thrombolysis or thrombolytic therapy is a medical process that dissolves blood clots and facilitates blood flow to all parts of the body. Thus, it protects tissues and muscles from damage.

What are the causes of blood clots in the body?

  Poor blood circulation
  Conditions such as Deep Venous Thrombosis and atrial fibrillation
  Blood clots can also be formed because of dialysis catheters and by-pass grafts

How can you tell if you have blood clots?

  Swelling in one or more legs
  Cramp and tenderness in the legs
  Breathing trouble might indicate that blood clots have travelled to the lungs
  Sweating and frequent chest pain may suggest that blood clots have travelled to the heart

How is Thrombolysis performed?

Thrombolytic drugs are injected into the body intravenously. They make their way to where the blood clots exist and dissolve them. If there is a medical emergency, the drugs are delivered to the exact location of the blood clots and immediately start dissolving them. Another method is inserting a device into the blood clot infested region to break the clots up. The drugs which on entering the body dissolve blood clots are called thrombolytics. There are many varieties of thrombolytics such as the following-

  Streptokinase - It is a kind of enzyme. It is used when a person has just suffered a heart attack or pulmonary embolism. Doctors do not usually prescribe the second usage of this drug. It is injected into a vein and can be administered to pregnant women.

  Tenecteplase - Also an enzyme, it is a plasminogen activator. When it binds to the surface of the blood clot, it makes the clot degenerate.

  Reteplase - It is actually extracted from E-Coli. It is a sterile intravenous bolus injection

The leading cause of heart attacks and ischemic heart disorder is the formation of blood clots in the arteries that connect the heart and the brain. Thrombolysis is often employed as an emergency treatment for this purpose. Thrombolysis is also effective against blood clots formed in the lungs (which lead to acute pulmonary embolism). Sometimes blood clots are formed in the legs, upper extremities of the body, the pelvic region (deep vein thrombosis). These clots may travel to the lungs and heart.

Consult your doctor before undergoing the treatment.

Thrombolysis - Causes, Symptoms & Treatment Of It!

The incidence of pain and lumps in the breast is on the rise. Breast cancer has grown in incidence over the years. More women are getting diagnosed with it, and the age at which they are being diagnosed has reduced too. Therefore, preventative checks and screenings have gone up significantly. The number of women diagnosed with small lumps has gone up drastically. The good thing is that since these are diagnosed in the early stages, the treatment is simpler and the prognosis far better than women who get diagnosed much later in life.

In a majority of cases, once a lump is identified the most preferred treatment is removal. This is known as lumpectomy. However, before a final decision is made to remove the lump, there are certain tests that are run by the doctor to confirm the diagnosis and extent of spread.

A thorough breast exam to identify if this is an isolated lump or if there are more lumps in either breast. The exact shape and size of the lump also need to be identified so that treatment can be planned accordingly.
Imaging to see if the lymph nodes have been involved. In most cases, there could be spread to the lymph nodes in the armpits which also need to be removed if required. If the lump is too big or too many in number, then a mastectomy may be required instead of a lumpectomy. This requires removal of the entire breast tissue on one or both sides (rarely) along with involved lymph nodes.
Pre-surgery: Once the diagnosis is confirmed, then the doctor will plan treatment. Prior to the surgery,

Talk to your doctor about your other medical conditions and medications and allergies, if any
Gynecologic history is very important to be discussed in detail
Blood thinners have to be stopped prior to the surgery
Post-surgery care needs to be planned, including a caretaker for a few days and postop care
During surgery:

Lumpectomy or mastectomy is often done under general anaesthesia
This requires hospitalization and carries the risks associated with anaesthesia
The outlined breast tissue or complete breast and surrounding lymph nodes will be removed. The area will be closed using sutures and bandaged
Post-surgery:

The wound needs to heal, and so postop care is very important
For the first few days, painkillers and antibiotics are used to control pain and infection
As a follow-up, some women may require radiation therapy to contain the suspicious tissue that may be left behind after lumpectomy
If extensive breast tissue was removed, some women may prefer to have reconstructive surgery done
Remember that lumpectomy is not a definitive procedure, and there could be cases that require a repeat operation
Advantages:

Less invasive compared to a mastectomy
The appearance of the breast is minimally affected, and symmetry is maintained
Disadvantages:

May not ensure complete removal
May require additional radiation therapy
May require repeat surgery

Surgical Treatment For Pain And Lumps In Breasts Of Women!

Gastroesophageal reflux disease (GERD) is also called as acid reflux. It is a long-term digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach which causes the stomach contents to come back up into the esophagus resulting in either symptoms or complications. Gastroesophageal reflux disease is mild acid reflux that occurs at least twice a week or moderate-to-severe acid reflux which occurs at least once a week.

Epidemiology

In western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. In developed nations, the prevalence rate of GERD is associated with age; with adults aged 60 to 70 being the most commonly affected.

Signs and Symptoms

Esophageal symptoms include:

Heartburn
Regurgitation of food or sour liquid
Dysphagia
Sensation of a lump in the throat
Extraesophageal symptoms include:

Coughing and/or wheezing
Hoarseness, sore throat, or laryngitis
Otitis media
Noncardiac chest pain
Enamel erosion or other dental manifestations
New or worsening asthma
Disrupted sleep
Risk Factors

Obesity
Pregnancy
Hiatus hernia 
Scleroderma and systemic sclerosis
The use of medicines such as prednisolone
Delayed stomach emptying Zollinger-Ellison syndrome which can show an increase in gastric acidity because of gastrin production
A high blood calcium level which can increase gastrin production, leading to increased acidity
Visceroptosis or Gl nard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.
Factors that can increase acid reflux involve:

Smoking habit
Eating heavy meals or eating late at night
Eating fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Medications, such as aspirin
Tight clothes
Increased intra-abdominal pressure
Differential Diagnosis

Heart disease causing chest pain
Laryngopharyngeal reflux OR extraesophageal reflux disease
Infection
Peptic ulcer
Esophageal spasm
Complications

Narrowing of the esophagus (esophageal stricture): Stomach acid causes the formation of a scar tissue which narrows the food pathway.
An open sore in the esophagus (esophageal ulcer): Acid causes an open sore which bleeds, causes pain, and makes swallowing difficult.
Precancerous changes in the esophagus (Barrett's esophagus): Damage from acid can cause changes in the tissue lining the lower esophagus
Anemia
How to arrive at the diagnosis?

Upper gastrointestinal endoscopy/esophagogastroduodenoscopy
Esophageal manometry
Ambulatory 24-hour pH monitoring
Treatment

The goals of treatment are controlling symptoms, healing esophagitis, and prevention of recurrent esophagitis or other complications.

Lifestyle modifications include the following:

Losing weight (if overweight)
Eating small and frequent meals instead of large meals
Waiting 3 hours after a meal to lie down
Elevating the head end of the bed by 8 inches
Avoiding bending or stooping positions
Medications

H2 receptor antagonists (ranitidine, cimetidine)
Proton pump inhibitors (omeprazole, pantoprazole)
Prokinetic agents (aluminum hydroxide)
Antacids (magnesium hydroxide)
Surgery

Transthoracic and transabdominal fundoplication
Placement of a device to augment the lower esophageal sphincter

Gastroesophageal Reflux Disease - What Should You Know

Problems of the large intestine are very common and patients should usually consult gastroenterologists for the proper diagnosis and treatment

1. Bleeding per rectum: Bleeding through the anal canal or rectum is usually the most common problem of the patients. It can be due to following reasons: 

A. Piles also known as Hemorrhoids: Hemorrhoids are dilated venous channels of the anal canal. They occur due to long term constipation or chronic cough or due to less fibre intake in the diet. Sigmoidoscopy or proctoscopy is required for diagnosis. Treatment options include medicines and high fibre intake, Injection therapy(Sclerotherapy) for stopping bleeding from piles and Stapler hemorrhoidectomy if the piles are large.

B.  Polyps: Polyps are soft tissue growths seen in the large intestine. They are usually silent but can present with bleeding or anaemia. Polyps usually grow slowly in size and large polyps can turn into cancer of large intestine also known as colorectal carcinoma. Colonoscopy is required for the diagnosis. The gastroenterologists can diagnose the presence of polyps by colonoscopy. Smaller polyps can be removed by polypectomy by gastroenterologists without the need for open surgery. However large polyps or those polyps with suspicion of cancer require surgery.

C. Large intestine Ulcer: They can occur due to early cancer, SRUS, Infections or drugs. They require colonoscopy for the diagnosis. The gastroenterologists usually take Biopsy from the ulcer to know the cause of the ulcer. The mere taking of biopsy does not mean cancer and biopsy samples are seen in the microscope for better diagnosis.

D. Ulcerative Colitis and Crohn s disease: Ulcerative colitis is one form of Inflammatory bowel disease (IBD). The other IBD is known as Crohn s disease. Whereas ulcerative colitis involves only large intestine, Crohn s disease can involve any part of the gastrointestinal tract including small intestine. Ulcerative colitis and Crohn s disease present with Loose stools(diarrhea), bleeding , abdominal pain, weight loss, Anemia and Perianal fissures and  fistula. The diagnosis of IBD is challenging and involves blood tests, CT Scan abdomen, Colonoscopy with biopsy and clinical history. Management includes Medicines which control the inflammation such as Pentasa, Rowasa, Mesacol etc. Severe disease requires additional drugs such as Azathioprine and Anti TNF sich as Infliximab and Adalimumab. Occasional cases require surgery such as those with tight stricture of the intestine, severe dilatation of Large intestine (also known as Toxic megacolon), excessive bleeding, the disease not responding to medical management, or presence of cancer with IBD.

E. Anal fissures: Cut in the anal skin (fissure) causes severe pain in the anal area during passing motions. It is usually due to constipation or straining. It is usually treated by Gastroenterologists initially by medicines and ointments. If the pain continues Surgery is required named as Lateral internal sphincterotomy (LIS).

2. Loose motions or Diarrhea: Excessive passing of liquid motions is known as diarrhea or commonly lose motions. It is usually due to Infections caused by contaminated food and water. It is usually self-limiting. Severe cases with dehydration require admission for IV fluids and antibiotics for the infection. Loose motions for more than 6 to 8 weeks is known as chronic diarrhea. It is evaluated by blood tests and colonoscopy. Usual causes include tuberculosis, celiac disease, ulcerative colitis, microscopic colitis, Malabsorption such as chronic pancreatitis and small bowel bacterial overgrowth.

3. Irritable bowel syndrome (IBS): IBS is very common and at least 20 to 30 percent of Indian patients suffer from it. Symptoms include altered bowel habits such as diarrhoea or constipation, abdominal pain which is usually relieved or increased by defecation. Weight loss or bleeding is not the feature of IBS. Few simple blood tests are required and good medicines are now available for IBS. Few cases may require colonoscopy to rule out alternative causes of the symptoms.

Understanding colonoscopy: Colonoscope is a flexible tube with a camera at its tip to see the inside of the large and small intestine. Bowel preparation is required at least 8 hours before the procedure so that the inside of the large intestine can be seen clearly without the interference of stools.colonoscopy is an OPD based procedure where the patients are discharged the same day. A colonoscopy helps in evaluation symptoms of the large intestine such as loose stools, bleeding and abdominal pain.

In Detail About Colorectal Disorders!

Adrenal Glands are endocrine glands located right above the kidneys. They produce important hormones such as adrenaline, aldosterone and cortisol which are involved in a number of biological functions. The dysfunction of the adrenal glands can cause serious endocrine diseases.

Need for Surgery?
The adrenal glands may not function properly due to a number of reasons, including any kind of infection in the glands, kidney disorders, genetic ailments, lesions, tumours on or around the adrenal glands. Due to the irregularity in the release of hormones and enzymes that are essential to the normal functioning of a human body, a number of serious illnesses arise. There is an excess or absolute insufficiency in the release of hormones. This can even turn into a medical emergency. It can lead to uncontrollable obesity, very high or low blood pressure, dermatological problems, menstrual irregularities, blood sugar level irregularities, severe headaches, cramps, fluctuations in potassium levels and so on. That is when surgery is required.

How surgery is performed?
Laparoscopy is the type of surgery which requires minimum invasion. This is fairly a new and successful method of surgery. The patient recovers speedily and is able to go back home within a short span of time after the surgery. Removal of adrenal glands can be performed by making a maximum of three or four-and-a-half inches incision. This results in quicker cosmetic recovery compared to other patients of open surgery.
The surgery is performed under general anaesthesia. A narrow tube-like instrument, known as the cannula is placed into the upper abdominal cavity, below the ribs. Through the cannula, a tiny telescope, known as the laparoscope is inserted. It is connected to a special camera that provides a magnified view of the patient s internal organs on a large monitor. Using such technology, the adrenal glands are dissected free from other organs and removed.

Post Operative Care
In case of a simple laparoscopic surgery, there are hardly any post operative complications. In case of mild pain or discomfort, the doctors may however prescribe some medications. It is important to go for a medical check up after a couple of weeks of the surgery, to make sure you are completely fine.

Laparoscopic Adrenal Gland Removal Surgery - What Is It?

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