The liver has a significant role to play in metabolism and digestion. The failure of a liver can lead to significant health issues. There are some causes for liver failure, which cannot be treated with medications. In these people, a transplant, which is replacing the diseased or injured liver with another liver, is the only definitive treatment option.

Some conditions which can require a liver transplant are:

Severe cirrhosis with a life expectancy of less than a year
Severe liver failure
Non-alcoholic steatohepatitis (NASH)
Liver cancer
Chronic hepatitis C
Biliary atresia in children
Types of transplant:

Living donor transplant: In some patients, partial liver can be removed from a close family member and transplanted into the affected individual. The liver is known for its regeneration ability, and over time, will grow in the recipient.
Cadaveric transplant: Immediately after death, a liver can be removed and transplanted.
While the concept of a transplant sounds quite convincing and appealing for those with a severe liver disease, it is also important to note that not all would qualify for a liver transplant. The conditions which would disqualify a recipient are discussed below:

Significant heart disease: Those with severe coronary artery disease, valvular disease, cardiomyopathy, aortic stenosis, and cardiomyopathy are not candidates for a liver transplant.
Severe lung disease: Those with poor lung perfusion do not qualify for a liver transplant.
Advanced age: Greater the age, lesser the survival rates. So, people aged more than 70 are usually not considered for a transplant.
Obesity: A person with a BMI of more than 35 is often not a good candidate for a transplant. The overall health should be managed in these people.
Malnutrition: On the other extreme, severely malnourished individuals are also not considered for a transplant.
HIV infection: A person who is HIV-infected does not qualify for a liver transplant.
Substance abuse: Anyone who is actively abusing alcohol and/or substances is definitely removed from the list for a transplant.
Metastasis: If a patient is looking for a liver transplant due to hepatic cancer, it is essential that the cancer is contained. If it has spread to various parts, then containing it would be difficult, and a transplant may not succeed.
Multisystem organ failure: Other than heart and lungs, even people with poor renal function are not ideal candidates for a liver transplant.
A detailed liver recipient evaluation assessing the severity of liver disease, chances of survival, and overall health are done before a person is listed for liver transplant. This evaluation ensures a better success rate with the transplant.

Common Surgical Complications That One Should Be Prepared For?

Hernia surgery is performed for the correction of a hernia which refers to the bulging of internal organs or tissues through an abnormal opening. It is easy to detect hernia through any pain or discomfort while lifting heavy objects, cough and strain during urination or bowel movements or during prolonged standing or sitting. It can be found in both men and women. The Hernia can be congenital or can be developed over a period of time. If it doesn t get better over time and also does not go away by itself, then surgery becomes the only option.

Types of Surgery
There are two types of surgery for hernia treatment. One is the conventional open method, which requires an incision in the skin directly over the hernia. The other one is the Laparoscopic hernia repair in which surgery is performed using a small telescope known as a laparoscope. In this type of surgery minimal invasions are made and the hernia is repaired with only small incisions adjacent to the hernia. Most hernia operations are performed on an outpatient basis, which means that you can go home the very same day.

Tips for early recovery

    Wear comfortable clothing with expandable waistbands.
    Keep yourself active by moving around as much as you can as it increases circulation, which further speeds up healing.
    Eat a diet rich in fibre, fresh fruits and vegetables.
    Drink lots of water and other fluids to avoid constipation.
    Do not lift any objects even if it is very light as it can bring back pain.
    Do not to pick up things from the floor as it will be difficult to bend.
    Hold a pillow against your stomach while sneezing or coughing to lessen the pain.
    Use stool softener for a few days before and after surgery to help you with your bowel movements.
    Avoid driving till the time you feel any pain and as long as you are taking narcotic pain medicines.
    Band-Aids which cover the incisions should be changed as and when needed.
    Refrain yourself from intercourse as it can be painful.
    Check with your doctor when to take a shower so as not to hurt your incisions, and make sure to gently dry your incisions and replace the Band-Aids after taking a shower.
    Do not consume any alcoholic drinks for at least 24 hours.

The tips mentioned above will definitely provide help to cope up with post surgery blues. However, in case of fever, excessive sweating, difficulty in urinating, bleeding or any prolonged pain consult your doctor immediately.

Hernia Surgery - 13 Tips to Help You Recover from it

The ovaries are mainly made up of 3 kinds of cells.... Most ovarian tumors are epithelial cell tumors. Germ cell tumors start from the cells that produce the eggs (ova). Stromal tumors start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone.

Types:

The ovaries are made up of three types of cells. Each cell can develop into a different type of tumor:

-Epithelial tumors form in the layer of tissue on the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors
-Stromal tumors grow in the hormone-producing cells. Seven percent of ovarian cancers are stromal tumors.
-Germ cell tumors develop in the egg-producing cells. Germ cell tumors are rare.

Causes:

Ovarian cancer happens when cells divide and multiply in an unregulated way. However, exactly why this happens is not clear.

The following risk factors are linked to a higher chance of developing the disease:

*Family history:
Women with close relatives who have had ovarian or breast cancer have a higher risk of developing ovarian cancer, compared with other women. Genetic screening can determine whether somebody carries certain genes that are associated with an increased risk.

*Age:
Most cases of ovarian cancer occur after menopause, and especially in women aged over 63 years. It is rare before the age of 40 years.

*Reproductive history:
Women who have had one or more full-term pregnancies, especially before the age of 26 years, have a lower risk. The more pregnancies they have, the lower the risk.

*Breastfeeding may also decrease the risk.

-Birth control:
Using the contraceptive pill for at least 3 to 6 months appears to reduce the risk. The longer the pill is used, the lower the risk appears to be. Using an injectible contraceptive hormone, depot medroxyprogesterone acetate (DMPA or Depo-Provera CI), especially for 3 years or more, reduces the risk further.

-Infertility or fertility treatment:
Fertility drugs have been linked to a higher risk of ovarian cancer, especially in women who used them for more than one year without becoming pregnant. Those who are infertile may also have a higher risk than those who are not, possible due to not carrying a pregnancy.

-Breast cancer:
Women who have received a diagnosis of breast cancer have a higher chance of being diagnosed with ovarian cancer.

For this reason, women who are diagnosed with breast cancer and who test positive for the BRCA1 or BRCA2 gene may opt to have an oophorectomy as preventive therapy.

Symptoms:

It s easy to overlook the early symptoms of ovarian cancer because they re similar to other common illnesses or they tend to come and go. The early symptoms include:

-abdominal bloating, pressure, and pain
-abnormal fullness after eating
-difficulty eating
-an increase in urination
-an increased urge to urinate

*Ovarian cancer can also cause other symptoms, such as:

-fatigue
-indigestion
-heartburn
-constipation
-back pain
-menstrual irregularities
-painful intercourse
-dermatomyositis (a rare inflammatory disease that can cause skin rash, muscle weakness, and inflamed muscles)

These symptoms may occur for any number of reasons. They aren t necessarily due to ovarian cancer. Many women have some of these problems at one time or another. These types of symptoms are often temporary and respond to simple treatments in most cases.

Again, cancers are best treated when detected early. Please consult with your doctor if you experience new and unusual symptoms.

The symptoms will persist if they re due to ovarian cancer. Symptoms usually become more severe as the tumor grows. By this time, the cancer has usually spread outside of the ovaries, making it much harder to treat effectively.

Diagnosis:

A doctor will carry out a pelvic examination and check for any palpable abnormalities in the uterus or ovaries. They will also check the patient's medical history and family history.

The following tests are used to help diagnose ovarian cancer:

-Blood tests: Checking for elevated levels of a marker called CA-125.

-Imaging tests: Transvaginal ultrasound, MRI, or a CT scan might be used.

-Laparoscopy: A laparoscope, a thin viewing tube with a camera at the end, is inserted through a small incision in the lower abdomen. This will allow the doctor to see the ovaries and, if necessary, to take a tissue sample

-Colonoscopy: If there is constipation or bleeding from the rectum, a colonoscopy may be needed, to examine the large intestine, or colon.

-Abdominal fluid aspiration: If the patient's abdomen is swollen, there may be a buildup of fluid, which can be examined by using a fine needle to remove some fluid through the abdomen.

-Biopsy: The usual way to diagnose ovarian cancer is to remove the tumor or part of the tumor to examine for the presence of cancer cells.

Role of Homeopathy In Ovarian:

Treatment of ovarian cancer has to be multi-way therapy. Its not either Homeopathy or conventional treatment. The best long-term results are achieved by combination therapy depending on age, stage of ovarian cancer and general health condition of patient. While conventional treatments like chemotherapy or radiation therapy helps in faster removal of cancer, Homeopathy Treatment for ovarian cancer can help in:

-Regression of ovarian cancer
-Prevention of recurrence of ovarian cancer,
-Removing side-effects of chemo and radiation therapy,
-Relieving cancer pains
-Improving general quality of life and hence, a better reaction to other treatments.

The speciality Homeopathic treatment for ovarian cancer, developed at Welling Clinics can be very helpful for those suffering from ovarian cancer.

Diet and non-diet:

There is no proven evidence regarding the cause of PCOD though gynaecologists are of the opinion that some females possess a predisposition to this disease, and it may run hereditarily in the family. You can alleviate your PCOD symptoms to a considerable extent by regulating your diet properly.

Have loads of fruits and green leafy vegetables and try to abstain from dairy products as many experts believe that dairy products are a direct cause of an increase in insulin levels, which can aggravate skin troubles along with other PCOD symptoms. Avoiding red meat and eating lean meat instead will help the condition and reduce the chances of infertility. It is always recommended to avoid hydrogenated and saturated fats, which are normally found in animal and dairy-based food. Try to put a stop to cheese, cottage cheese, clarified butter, pork, lamb, beef, etc. and certain baked products like cookies, cakes and fudges as they will trigger a rise in your blood sugar and cholesterol levels.

What Is Ovarian Cancer?

Benign prostatic hyperplasia or BPH is a condition where the prostate gland gets enlarged. This is mostly common in men who are ageing. When the prostate gland gets enlarged, the flow of urine through the urethra gets blocked, and hence, several problems related to urination may occur. BPH occurs as a result of hormonal imbalance. If untreated, BPH can lead to severe bladder and urinary health conditions.
There are several symptoms and signs of benign prostatic hyperplasia. Here are 7 common symptoms:

1. A frequent need for urination: Men affected by BPH feel an increased need to urinate frequently. This gets enhanced during the night and is called nocturia. The patient may even need to urinate more than eight times a day. Due to the enlarged prostate gland, more pressure is put on the urethra, which leads to uncontrollable urination.
2. Urinating difficulties: The act of urination becomes difficult. Because of enhanced pressure on the urethra, the flow of urine to the penis from the bladder gets blocked. This makes a urine stream hard to start. The urine stream gets weak and interrupted, and more difficulty may be experienced during the end of urination.
3. Pain during urination and ejaculation: Due to pressure on the urinary tract and reproductive system, pain can accompany urination and ejaculation. Some patients tend to push urine out, which results in pain. The pain may also occur because of infection during BPH.
4. Blood in urine and an unusual color/smell: Urine may take a dark color and have an unusual smell due to urinary retention. Unpleasant urine smell signifies urinary tract infection. Blood in the urine may also result because of dilated veins present on the surface of the enlarged prostate.
5. Urinary retention: When a patient is unable to pass any urine, it is called urinary retention. Such a condition requires immediate treatment, and you need to consult a doctor immediately.
6. Urinary tract infections: Bacteria may start growing in the bladder when the bladder is not fully emptied of urine. This bacterial infection causes darkening of the urine, and emission of a foul odor.
7. Bladder stones: Bladder stones may develop because of the inability of the bladder to empty itself completely. This is a major symptom of BPH. Hard lumps of minerals or bladder stones are formed when the urine present in the bladder gets highly concentrated, which causes the crystallization of minerals. Bladder stones may cause infections, result in blood in urine, cause bladder irritation and may also block urine flow.

So you see that benign prostatic hyperplasia involves the enlargement of the prostate gland, and results in several problems related to urination and different symptoms. Hence, immediate treatment is advisable.

7 Symptoms of Benign Prostatic Hyperplasia

Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.  

Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.

Bariatric Surgery - Know Problems Of It!

Following are some common Gall Bladder and Biliary Disorders. Read on to know in brief about them. 

1. Gall stones: Gall stones also known as cholelitiasis is a condition in which gall bladder contains stones or calculi. Usually, these stones are asymptomatic and do not cause any trouble to the patients. Few patients experience recurrent right upper abdominal pain. This condition is known as biliary colic and if it persists, the patiet is adviced gall bladder removal surgery. Sometimes the patient presents with severe right upper abdominal pain with fever and deranged Liver function tests. This condition is known as acute cholecystitis. The surgery is minimally invasive and is called Laproscopic cholecystectomy. If there are dense adhesions, the surgeon may plan to convert the surgery to open cholecystectomy. The patient is usually discharged by day 3 of surgery.

2. Common bile duct stone or choledocholithiasis: Occasionally stone from the gall bladder slips into the common bile duct (CBD stone).This causes obstruction of the bile duct causing Fever, abdominal pain and Jaundice. This is called Cholangitis and is a medical emergency. The patient requires urgent hospitalisation and decompression of the bile duct by inserting a plastic stent in the CBD with the help of ERCP. Severe untreated cholangitis can be life threatenig.CBD Stones which are detected because of dull aching abdominal pain, deranged liver function tests or by ultrasonography also need removal. The CBD stone is removed by an endoscopic modality called ERCP, which is minimally invasive and needs no surgery.

3. Bile duct cancer or cholangiocarcinoma: Cancer of bile duct usually occurs in the elderly patients who present with gradually progressive jaundice. Because of the obstruction to the flow of bile, produced in the liver, the patient develops jaundice. Gastroenterologists examine the patient and CT scan abdomen with MRCP is required to fully evaluate the stage and extent of the tumour. The treatment is multimodality and requires the expertise of Radiologists, Surgeons, Oncologists and gastroenterologists. The Gastroenterologists can help in decreasing Jaundice by inserting plastic or a metal stent (SEMS self-expanding metal stent ) in the common bile duct. These are very aggressive tumours and very few patients are fit for surgery. Survival is very low for these tumours.

4. Gall bladder cancer: Gall bladder cancers are very aggressive and lethal cancers. The patients present with obstructive Jaundice and Itching all over the body. Definitive treatment is surgery but very patients present in the early stage. Advanced stage cancers are treated with palliative intent by metal stenting (SEMS for cancer of gall bladder) to reduce jaundice.

Learn More About Gall Bladder And Biliary Disorders!

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