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?

One of the most significant glands in the male reproductive system is the prostate gland, which is responsible for carrying urine from the bladder. It is located right under the bladder and helps in production of semen which contains sperm.
Prostate cancer is a slow growing form of cancer that is rarely seen in men below the age of 50. It may occur due to both, genetic and environmental factors. Here is a list of measures that can help in preventing this ailment.
Food Intake and Weight: Apart from age, the major factor that contributes to the risk of prostate cancer includes food and weight. Doctors suggest that bringing down your intake of calcium and fat that comes from red meat and excess dairy can help in preventing the onset of this ailment. The calcium intake should not go beyond 1,500 mg per day, which is why doctors will usually ask you not to have supplements. Cooked tomatoes with olive oil as well as cruciferous vegetables including broccoli and cauliflower should be included as a vital part of one's diet, while fish should be taken regularly as it is a source of healthy or good fat like Omega-3 fatty acids. In general, you should have fewer calories which should be matched up with ample exercise so that a healthy weight and balance is maintained.
Stress and Blood Pressure: Stress and anxiety are also major reasons that contribute to the onset of this disease. One will need to see a doctor about high blood pressure, especially the kind that is triggered by stress and causes hypertension. Also, you must control your cholesterol and stay out of depression to ensure that your risk of developing prostate cancer reduces. Also, having these conditions along with prostate cancer makes the survival chances that much lower. So, you must get the right medication and treatment for these conditions as well.
Lifestyle: One will need to quit smoking, that can cause a number of ailments including prostate cancer. Also, drinking alcohol in moderation is required in order to have a healthier lifestyle and cut the chances of developing such ailments.
Screening: While your diet and other aspects may be right, there is still a great chance of developing prostate cancer, especially if anyone in your family has been afflicted with this condition in the past. Therefore, it is recommended to get an annual screening done so that you eliminate the chances of finding it out late, and can check the growth of any anomalies as soon as they take place. Getting regular checks ups done and getting diagnosed for the problem when the earliest symptoms begin to show are both crucial for prostate cancer.


Prevention Of Prostate Cancer

Medical science constantly challenges the boundaries by finding not only the cures to the most dangerous diseases, but finds a way to prevent them even before they occur. With years of research, practice and data available for analysis, scientists are using advanced technology in combination with years of research to create a predicting mechanism for often fatal diseases like cancer.

Breast cancer screening has always been done with mammography. The fact is that this method is only 75% accurate, laden with false positives and misses a whole set of women totally- and that too when cancer has already developed. Part of the problem comes from the dense breast tissue which one in three women have. This tissue masks the lumps, which makes it difficult for mammograms to accurately screen cancer.

Some breakthrough scientific methods are changing this by drawing on years of research to predict this deadly disease, years before it can manifest itself.

A genetic test to predict cancer 10-11 years ahead of time
This test was performed to see how environmental factors could influence cancer, along with habits like smoking, abusing alcohol or hormones, genetic changes that occur and are put a large percentage of the women at a high risk of developing this disease.

A simple blood test is used for the genetic analysis of hereditary cancer. Researchers found a biological marker, methylation of the ATM gene, which has a very high ability to predict the risk of developing cancer, several years before diagnosis. 'Methylation' concluded that when one biological indicator is exposed to carcinogenic substances, or other abusive substances like tobacco and alcohol, it may trigger the development of cancer. On the flip side, this test will take time to reach the commercial market and even then cannot give an exact timeline as to when someone may develop the disease.

A simple blood test to predict breast cancer 5 years before it develops
This is the kind of medical miracle the world is looking for. Last year in April, researches in Denmark identified a simple blood test that can predict breast cancer five years before it actually develops with an accuracy of a whopping 80%.

It works by "measuring all of the compounds in the blood to build a 'metabolic profile' of an individual, in order to detect changes in the way chemicals are processed, during a pre-cancerous stage," says Laura Donnelly, health editor at The Telegraph, which covered this development. Danish researchers observed 57,000 participants over 20 years, gathering blood samples along the way, specifically comparing a set of 800 women who remained healthy or developed breast cancer within 7 years of their first blood sample. The researchers found they were able to predict, with 80 percent accuracy, which patients would be affected by the disease, just by looking at the metabolic profiles they built from the participants' blood samples. The results have been published in Metabolomics.


Are you living with the uncertainty of a lump in your breast? It's time you take the first step and consult a specialist here.

Can Breast Cancer Be Predicted Before It Develops?

Adrenal cancer is a rare and aggressive disease that causes abnormal cell growth inside the adrenal cortex. This cancer usually appears as tumors at the outermost layer of the adrenal glands and gradually develops cancerous cells. In the majority of the cases, adrenal cancer is diagnosed only after it has been growing for several years.

Symptoms
While most of the adrenal cancer patients have the common symptoms, often some people feel just fine, unless until their doctors find the presence of cancerous cells in the adrenal cortex through CT scan. Generally, the symptoms of this life-threatening disease depend on three factors, which are:

The particular type of overproduced hormone
The tumor producing hormones excessively
And, type of the tumor
However, it is the overproduction of particular hormones, that makes the majority of the symptoms visible. Below are the common symptoms of adrenal cancer, depending on hormone types that are overproduced during the presence of this disease.

Symptoms of cortisol overproduction
When the presence of adrenal cancer leads to excess production of the cortisol hormone, people start experiencing different types of symptoms. The accumulation of fat behind the shoulders and neck, gradual weight gain in the stomach and chest portions irregular periods, and hair growth on the chest, face and back (in women) are the most prominent ones. One can also suffer from depression, weakness in legs, and easy bruising as other signs of cortisol overproduction.

Symptoms of aldosterone overproduction
As a result of the overproduction of the aldosterone hormone, people generally have feelings of excessive thirst, feelings of tiredness and weakness and sometimes high blood pressure. The desire of urinating frequently and painful muscle cramps too become evident due to the excessive production of aldosterone.

Symptoms of testosterone overproduction
When as a result of malignant tumors in the adrenal cortex the production of the testosterone hormone goes to higher than normal levels, it is considered to be overproduction. The voice becoming deeper, excessive invasion of acnes, irregular periods become prominently visible symptoms of this kind of adrenal cancer. Even, excessive growth of body hair or the facial hair and heightened muscle mass are some of its common symptoms.

Symptoms of estrogen overproduction
The growth of the breast in males and the early puberty in females are the most common symptoms of adrenal cancer where the malignant tumors overly produce estrogen hormone. Even decreased sex drive or impotence in males can be considered as its other serious symptoms.

Apart from the above mentioned adrenal cancer symptoms, in some cases, the adrenal tumors become so big that they start pressing the nearby organs which leads to signs of abdominal pain or feelings of fullness in the belly. The moment one identifies having any one of the signs discussed here, he or she should look for medical attention immediately.

Adrenal Cancer - What Are The Symptoms?

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!

GERD or acid reflux is caused by the regurgitation of acidic liquid stomach contents back up into the esophagus. It is a long-term condition where stomach contents come back upwards from the gastro-intestinal tract resulting in either symptoms or complications. It is a commonly occurring digestion condition. A burning sensation in the chest is usually caused by acid reflux which radiates up from the stomach to the mid-chest or throat. This condition is also known as the heartburn. A sour taste in the back of the mouth is a common experience amongst the patients. Long term reflux of gastric contents causes the condition to become chronic which can lead to difficulty in swallowing. In some cases the erosion of the tract lining can also cause breathing problems.

Symptoms:

Heartburn is a burning sensation felt in the retrosternal area. Most commonly it occurs post-prandial or nocturnally. Consumption of fatty foods, spicy foods, acidic foods aggravates the condition. Burning sensation is relieved with antacids, water or milk.
Perception of gastric content reflux in the mouth or hypopharynx is termed as acid regurgitation. It is also known as water brash. A bitter or acidic taste is felt in the mouth.
Other symptoms include dysphagia, odynophagia, nausea, chest pain, dyspepsia, epigastric fullness, bloating, frequent belching
Extra-esophageal symptoms like chronic cough, hoarseness, laryngitis, dysfunction of the vocal cords, bronchospasm can also be observed.
Complications:

Peptic stricture
Ulcers of the esophagus
Metaplastic disease (Barrett s esophagus)
Dysplastic disease (Adenocarcinoma)
Laryngitis or bronchitis
Pulmonary disease
Fluid in the sinuses and the middle ear
Diagnosis:
The diagnosis of GERD is made by its most commonly presenting symptom- heartburn. To confirm the diagnosis of GERD, the physicians treat patients with medications for suppression of the production of acid by stomach. If heartburn diminishes to a large extent by the medications, diagnosis of GERD is considered confirmed.

Conditions like an ulcer caused by bacterial infection, mimic the symptoms of GERD. To get a clearer diagnosis, an endoscopy is then performed. The common diagnostic modality for GERD is Upper intestinal gastro-endoscopy. A tube containing an optical system for visualization is swallowed, the tube progresses down the gastrointestinal tract, and then the lining of the esophagus, stomach, and duodenum can be examined. A normal esophagus is observed in most patients with symptoms of reflux. 

However, sometimes the lining of the esophagus appears inflamed. If erosions (superficial breaks in the esophageal lining) or ulcers (deeper breaks in the lining) are seen, a diagnosis of GERD can be made definitely. Other complications of GERD like ulcers, strictures, and Barrett's esophagus are also identified. Biopsies also may be obtained. Other common problems that may be causing GERD like symptoms can be diagnosed (for example ulcers, inflammation, or cancers of the stomach or duodenum) with EGD. Previously, barium meal x-ray was undertaken to diagnose GERD. It is now discontinued.

Other tests that are carried out are esophageal acid testing, esophageal motility testing, gastric emptying studies and acid perfusion test.

Treatment:

Lifestyle modifications   Avoiding acidic foods, quitting smoking, weight loss, abstaining from alcohol consumption improves symptoms in people with GERD.
Medications   Proton pump inhibitors (Pantoprazole, Omeprazole, Rabeprazole), H2 receptor blockers (Ranitidine, Cimetidine) and antacids.
Surgery   In cases where the proton pump inhibitors are unsuccessful in relieving symptoms of GERD, a surgical procedure called Nissen fundo-plication is done.

GERD - Complications Associated With It!

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