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

Measures to be taken before surgery for fast recovery from Abdominal Surgery.

Ancillary measures

Take regular walks several times daily to prevent blood clots and help the bowels moving.
Avoid climbing the stairs every day, at least for the first ten days. 
Avoid strenuous exercise such as lifting, carrying, pulling, or moving heavy objects (more than 5 pounds) until your surgeon advises as it may open the sutures due to pressure. Avoid lifting anything over a certain weight for at least six weeks after your operation.
Maintaining a good posture will help your wound heal correctly. Use a comfortable pillow while sitting to give rest to the operated site.
Take good sleep and proper rest for a quick recovery as most of the repair and healing occurs during sleep.
Avoid straining with bowel movements by eating a high-fiber diet or taking stool softeners to avoid constipation.
An abdominal binder can also help with the recovery process. These help keep everything in place and can decrease the possibility of a hernia.
A gradual return to work may be advised because sudden resume to work may cause opening of sutures and delay the process of healing.
Use table that easily wheels away from the bed but can also straddle the bed. This will allow you to read, use the computer, and eat without putting any pressure on your stomach or twisting around.
Cough and sneeze carefully by applying pressure to the incision with your hands or a pillow to avoid reopening of the surgical incision.
Improper dressing or not maintaining hygiene during dressing and keeping dressing unchanged for a longer period of time may lead to infection which may cause delayed healing. Thus, in order to prevent this a gentle wash with soap and water is required to avoid infection.
Dietary measures

A protein-rich diet should be consumed in order to hasten wound healing.
Have a liquid diet with lots of vitamins as vitamin C and zinc help with healing. Also, include B12 and Iron   as both aid bone marrow in forming new blood cells.
Intake of Fiber and probiotics help boost the immune system and also keeps your digestive tract moving along.
Have plenty of water-this will help the recovery process and removal of toxins from the body.
Try sitting in the sunlight as it will help with getting some extra Vitamin D.
Keep control over sugar levels if you are diabetic as increased levels of sugar in the blood helps bacteria to grow rapidly. This will further lead to infection and delay the process of healing.

Abdominal Surgery - Recovery Tips!

What are Different Types of Bariatric Surgeries? 

Bariatric Surgery is one of the most popular options for obese people looking for a way to control their weight. To get bariatric surgery, one has to qualify for certain criteria like BMI (Body Mass Index), associated comorbidities like Diabetes, Hypertension, sleep apnea, infertility, hypercholesterolemia etc. There are many kinds of bariatric surgeries or weight loss surgeries, different surgeries work differently in order to give the desired effect, which is why it is important to understand these surgeries thoroughly. 

Weight loss surgeries are divided into different categories like - 

  Restrictive surgeries: Some bariatric surgeries are focused on limiting the amount of food that can be stored in the stomach. This allows a person to eat less than they used to, because of the limited capacity of the stomach. Sleeve gastrectomy, Adjustable gastric banding, Gastric imbrication, Gastric balloon surgery are examples of restrictive procedures. In sleeve gastrectomy, the stomach is divided into two halves first, then one half of the stomach is completely removed. The remaining part of the stomach is formed into a tube-like structure. This tube-like structure cannot hold enough food and restricts excessive food intake. It also limits the secretion of an appetite hormone called Ghrelin which limits the desire of a person to eat. 

  Malabsorptive procedures: In this procedure, a large segment of the small intestine is bypassed i.e the food is not allowed to enter a large segment of the small intestine and hence malabsorption will be there. Duodenal switch is a malabsorbtive surgery. 

To Summarize: The weight loss procedures that suit our Indian population are the Roux en Y gastric bypass and the sleeve gastrectomy. We do not come across any sign of malnutrition in patients who have undergone these procedures. For successful outcomes, vitamin, calcium and protein supplements are required. 

There are certain myths about bariatric surgery --- life will never be normal after the surgery, pregnancy is a problem after this surgery, one will never be able to eat after this surgery, marriage is a problem after this surgery etc. All these are incorrect as one live a better life after the surgery as one has shed the extra kilos, one is cured of existing problems like diabetes, high cholesterol, hypertension, obesity induced infertility and sleep apnea extra. IN FACT, the quality of life is phenomenal after this surgery. CHOICE of surgery depends on the existing BMI, existing associated problems and results of the investigations that are done prior to the surgery. Your surgeon is the best to decide the right procedure for you. As the procedure which your friend has undergone might not be good for you. Choice of procedure and proper follow up are the key points for a successful surgical outcome. 

  Combination of restrictive and Malabsorptive surgeries: In these procedures, the surgery is done on the stomach as well as the small intestine. It involves creating a small stomach pouch which is attached to the small intestine, thus bypassing a small segment of the small intestine to get the desired effect if the person has diabetes associated. The rest of the stomach produces important digestive juices and is also connected to the intestine so that it can transfer these digestive juices in it. As a part of the stomach and few centimetres of the small intestine are bypassed i.e food does not enter this part, the surgery is called the gastric bypass. The Roux en Y gastric bypass and the Mini Gastric bypass surgeries are examples of these combination procedures.

Bariatric Surgeries - Know Forms Of Them!

This surgery involves the removal of Gallbladder, which is a pear-shaped organ that lies right beneath the right side of the liver. The main function of the gallbladder is to collect and concentrate bile, which is a digestive juice produced by liver after eating, aiding digestion. The most common disorder of the digestive system is presence of Gallstones, which are the stones made up of a mixture consisting of cholesterol, bile pigment and calcium salts.

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 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
1. Mixed stones: They are made up of cholesterol and salts. They tend to develop in batches.
2. Cholesterol stones: Mainly made of cholesterol, which is crucial to many metabolic processes. They can grow large enough to block the bile ducts.
3. 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. 

Gallstone Surgery - Things You Should Know About It 

Ovarian cysts are fluid-filled sacs in the ovaries, often in multiples, which are very common in women. This is absolutely different condition from polycystic ovaries. Most of them are benign and not indicative of an underlying problem. They produce no specific symptoms and even if detected, can be watched over a period of time. Treatment may be required only if there are serious symptoms or there is higher possibility of cancerous nature of the cyst. Read on to know more. 

Types 

Functional: There are two types in this. The follicular variety is when the egg that is ready for fertilization does not completely shrink and stays for a few more days before it disappears. Another variety, the luteal ovarian cysts are formed when after the release of the egg, there is blood filling up in the corpus luteum. 
Pathological: There are many types here   dermoid, cystadenomas, endometriomas, cancerous cystadenocarcinomas etc. These are worrisome and need to be treated. Both varieties, once identified, should be monitored. The functional variety, though may not cause a problem, can cause infertility and so necessitate treatment. 
Symptoms 

Any ovarian follicle larger than 2 cm can be called as an ovarian cyst. They are usually benign and do not produce any symptoms. However, if they turn pathologic or grow in size, they can cause various symptoms such as: 

Irregular menstruation 
Heavy bleeding 
Intermittent spotting 
Painful and/or frequent urination 
Severe, recurrent abdominal pain 
Infertility 
Abdominal bloating 
Constipation or loose motions 
Nausea, sudden vomiting 
Fever, dizziness, and weakness 
While cysts are often quiet and do not produce any symptoms, they can cause intermittent, nonspecific symptoms like above. If there is a family history of ovarian cancers in mothers, maternal aunt, Sisters, Grandmothers etc then women should have regular Gynaecological checkups to have a check done for ovarian cysts. 

Why go for laparoscopic surgery? 

Laparoscopic surgery is considered to be one of the most effective ways of treating the condition of ovarian cysts. During the surgery, problem causing non-cancerous cyst can be removed without harming the ovaries. In the case of cancer, both ovaries along with uterus etc may have to be removed. This decision is taken by the operating surgeon depending upon age of the patient, characteristics and nature of the cyst and future fertility desires of the patient. 
The patient is given general anesthesia during the surgery. After the surgery, one is suggested to rest for a day and may be permitted to return to normal activities within a day s time. However, one needs to avoid any strenuous activity for almost a week. 
While some cysts can be watched for years, others need treatment. This would be specifically true in cases where the couple is facing infertility issues or if there is a higher possibility of cancerous cysts. Such cysts need urgent intervention and should be monitored by a gynecologist with an experience in oncology. There are few blood tests that are needed to be done to know the nature of the cyst if it is benign or cancerous.

Ovarian Cysts - Ways Laparoscopic Surgery Can Help! 

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

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