Treatment Of Alcoholic Liver Disease
Treatment of Liver Disease
Treatment of Chronic Pancreatitis
Treatment of Nonalcoholic Fatty Liver Disease
Treatment of Amebic Liver Abscess (Liver Abscess)
Treatment of Colon Cancer
Treatment of Liver Cancer
Treatment of Eosinophilic Esophagitis
Treatment of Acute Pancreatitis
Treatment of Pancreatic Cancer
Treatment of Gastroesophageal Reflux
Treatment of Gastrointestinal Bleeding
Gastrointestinal Endoscopic Mucosal Resection
Treatment of Gastroparesis
Treatment of Esophageal Cancer
Treatment of Gallbladder Disease
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What is Pancreas?
The pancreas is an organ placed behind the stomach in abdomen. It produces: digestive juices (produce by exocrine pancreas, it help in digestion of food) as well as digestive hormones i.e. insulin and glucagon (produce by endocrine pancreas) which help in regulation of the level of glucose (sugar) in the blood.
What is pancreatitis?
Pancreatitis is abnormal swelling and inflammation of the pancreas. Once the gland becomes inflamed, the condition can progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the gland. Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. But when the pancreas is inflamed, digestive juices become trapped and start "digesting" the pancreas itself. If this damage persists, the gland may not be able to carry out normal functions.
What Are the Types of Pancreatitis?
Pancreatitis may be acute (new, short-term) or chronic (ongoing, long-term). Either type can be very severe, even life-threatening. Either type can have serious complications.
- Acute pancreatitis usually begins soon after the damage to the pancreas begins. Attacks are mostly very mild, but about 20% of them are very severe. The onset of acute pancreatitis is often very sudden. The inflammation usually clears up within several days after treatment begins. An attack lasts for a short time and usually resolves completely as the pancreas returns to its normal state. Some people have only one attack, whereas other people have more than one attack, but the pancreas always returns to its normal state unless necrotizing pancreatitis develops and becomes life-threatening.
- Chronic pancreatitis begins as acute pancreatitis. If the pancreas becomes scarred during the attack of acute pancreatitis, it cannot return to its normal state. The damage to the gland continues, worsening over time. Pancreatitis can come and go quickly, or it can be a chronic problem. Treatment will depend on whether your pancreatitis is acute or chronic.
What are the causes of pancreatitis?
Alcohol abuse and gallstones are the two main causes of pancreatitis, accounting for 80% to 90% of all individuals diagnosed with pancreatitis.
- Gallstones form from a buildup of material within the gallbladder, another organ in the abdomen (please see previous illustration). A gallstone can block the pancreatic duct, trapping digestive juices inside the pancreas. Pancreatitis due to gallstones tends to occur most often in women older than 50 years of age.
- Pancreatitis from alcohol use usually occurs in individuals who have been long-term alcohol drinkers for at least five to seven years. Most cases of chronic pancreatitis are due to alcohol abuse. Pancreatitis is often already chronic by the first time the person seeks medical attention (usually for severe pain).
- The remaining 10% to 20% of cases of pancreatitis have various causes, including the following:
- exposure to certain chemicals,
- injury (trauma), as might happen in a car accident or bad fall leading to abdominal trauma,
- hereditary disease,
- surgery and certain medical procedures,
- infections such as mumps (not common),
- abnormalities of the pancreas or intestine, or
- high fat levels in the blood.
- In about 15% of cases of acute pancreatitis and 40% of cases of chronic pancreatitis, the cause is never known.
What are the risk factors for pancreatitis?
The major risk factors for pancreatitis are excessive alcohol intake and gallstones. Although the definition for excessive alcohol intake can vary from person-to-person, most health-care professionals suggest that moderate consumption is no more than two alcoholic drinks a day for men and one a day for women and the elderly. However, people with pancreatitis secondary to alcohol intake are usually advised to avoid all alcohol intake. Other risk factors include:
- a family history of pancreatitis,
- high levels of fat (triglycerides) in the blood,
- cigarette smoking,
- certain inherited disorders such as cystic fibrosis, and
- taking certain medicines (for example estrogen therapy, diuretics, and tetracycline).
What Are the Symptoms of Pancreatitis?
Most people who have acute or chronic pancreatitis experience upper abdominal pain as their primary symptom. Some of those who have chronic pancreatitis may show inflammation on imaging scans, but otherwise may show no symptoms. Symptoms of pancreatitis may include:
- upper abdominal pain: pain that wraps around the upper body and involves the back in a band-like pattern
- Pain associated with pancreatitis may last from a few minutes to several hours at a time.
In severe cases, discomfort from chronic pancreatitis could become constant. Your pain is likely to increase after you eat or when you’re lying down. Try sitting up or leaning forward to make yourself more comfortable.
- nausea or vomiting
- abdominal tenderness
- unintentional weight loss
- bloating with a distended (swollen) stomach
Severe acute pancreatitis is a medical emergency. Severe acute pancreatitis may cause dehydration and low blood pressure. The heart, lungs, or kidneys can fail. If bleeding occurs in the pancreas, shock and even death may follow. People who have chronic pancreatitis may also experience steatorrhea, or fatty stools that give off a foul odor. Steatorrhea can be a sign of malabsorption. This means you’re not getting all of your essential nutrients because your pancreas doesn’t secrete enough digestive enzymes to break down your food.
How pancreatitis is diagnosed?
Your doctor will likely use a combination of blood tests and imaging scans to make a diagnosis. If you have acute pancreatitis, blood tests may show a rise in your level of pancreatic enzymes. During acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas. Changes may also occur in other body chemicals such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the person's condition improves, the levels usually return to normal. Ultrasound, MRI/MRCP, and CT scans can reveal the size of your pancreas and whether you have a blockage of the bile ducts.
How to treat pancreatitis?
Treatment for acute or chronic pancreatitis often involves hospitalization. In acute pancreatitis, the choice of treatment is based on the severity of the attack. If no complications are present, care usually focuses on relieving symptoms and supporting body functions so that the pancreas can recover. Treatment for acute pancreatitis includes intravenous (IV) fluids, and medications for pain, nausea and vomiting.
- The pancreas is key to your digestive process and needs to rest to heal. No food or liquid should be taken by mouth for a few days. This is called bowel rest. By refraining from food or liquid intake, the intestinal tract and pancreas are given a chance to start healing.
- For this reason, you may receive fluids and nutrition intravenously or through a tube that goes from your nose directly into your jejunum (part of small intestine), which is called a nasojejunal feeding tube. Restarting an oral diet depends on your condition. Some people feel better after a couple of days. Others need a week or two to heal sufficiently.
- If needed, medications for pain and nausea are prescribed.
- Those people who are having trouble breathing are given oxygen.
- Antibiotics are given if the health-care professional suspects an infection may be present.
- Some people may need a nasogastric (NG) tube. The thin, flexible plastic tube is inserted through the nose and down into the stomach to suck out the stomach juices. This suction of the stomach juices rests the intestine further, helping the pancreas recover.
- If the attack lasts longer than a few days, nutritional supplements are administered through an IV line.
- Surgery is sometimes needed to treat complications
- If your doctor diagnoses gallstones or other blockages of the bile ducts, you may need surgery to correct these problems later on.
What are the complications of pancreatitis?
Some patients may develop complications. These complications are rare, but they’re more common in people with chronic pancreatitis:
- kidney damage
- pancreatic cancer
- pancreatic infection
- Patients who have acute pancreatitis may also be at risk for developing breathing difficulties.
Can pancreatitis be prevented?
The following recommendations may help to prevent further attacks or to keep them mild:
- Completely eliminate alcohol because it is the only way to reduce the chance of further attacks in cases of pancreatitis caused by alcohol use, to prevent the pancreatitis from worsening, and to prevent the development of complications that can be very serious or even fatal.
- Eat small frequent meals. If in the process of having an attack, avoid solid foods for several days to give the pancreas a chance to recover.
- Eat a balanced diet high in carbohydrates and low in fats because may help individuals decrease the risk for pancreatitis since it is likely these actions will decrease the risk of gallstones, a major risk factor for pancreatitis.
- If pancreatitis is due to chemical exposure or medications, the source of the exposure will need to be found and stopped, and the medication will need to be discontinued.
- Don't smoke
- Maintain a healthy weight
- Exercise regularly. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.
Cirrhosis of liver is slow and gradual replacement of normal healthy liver tissue with scar tissue which results in poor liver function and blockage of flow of blood through liver which comes from intestines. As more scar tissue replaces normal healthy liver, liver begins to fail.
What causes cirrhosis?
- Alcohol: Amount of alcohol which can cause liver damage varies from person to person, however those who consume alcohol for long in significant amount are more prone to develop liver damage.
- Hepatitis B or hepatitis C: Caused by hepatitis B and C viruses, respectively, which are acquired by contact with contaminated blood (like needlestick injury, blood transfusion, injection drug abuser), sexual contact with infected person and from mother to child during childbirth.
- Non-alcoholic fatty liver disease (NAFLD): Caused by presence of extra fat in liver (after excluding significant alcohol intake) which causes inflammation and scarring leading to cirrhosis. Usually seen in patients who are overweight or obese, having diabetes, high fat in blood, high blood pressure or metabolic syndrome.
- Drugs causing liver injury.
- Others: Autoimmune hepatitis (body`s own immunity acting against liver), Wilson disease (build up of copper in body), hemochromatosis (excess of iron in body), certain bile duct disorders, etc.
What are the symptoms of cirrhosis?
- Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
- Advanced disease can present with fluid accumulation in legs (edema) or abdomen (ascites), facial puffiness, yellowish discoloration of eyes or urine (jaundice), redness of palm (palmer erythema), decrease urine output, small red lesions on skin, easy bleeding following trauma, blood coming out of mouth/anus/other body site, black colored feaces, mental confusion, flapping tremors of hand, etc. In men it can cause impotence, breast enlargement and shrinking of testis.
What are the complication of cirrhosis?
Portal hypertension: It is a common complication of cirrhosis which is due to increased pressure in portal vein. Portal vein is main blood vessel which carries blood to liver from stomach, intestines, spleen, gallbladder and pancreas. Because of scar formation in liver the normal flow of blood from these organs to liver is hampered. As a result of blockage of blood flow to liver there are few complications which can arise like accumulation of fluid in abdomen (ascites) and legs (edema), formation of enlarged veins (varices) in food pipe (esophagus), stomach, etc., enlargement of spleen (splenomegaly), mental confusion/altered behavior/altered sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
- Increase risk of infection because of immune system dysfunction.
- Development of liver cancer (Hepatocellular carcinoma)
- Easy brusibility or bleeding following light trauma.
- Gall bladder stone formation
- Metabolic bone disease
What are the stages of cirrhosis?
- Compensated cirrhosis: Liver damage is damaged but no abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
- Decompensated cirrhosis: Presence of abdominal swelling (ascites), blood in vomiting or black/red color feaces (variceal bleed), altered behavior/sensorium (hepatic encephalopathy), respiratory discomfort (hepatic hydrothorax or hepato-pulmonary syndrome) or decrease urine output/rise in creatinine (hepato-renal syndrome).
How cirrhosis is diagnosed?
Your doctor will take good history and do proper physical examination. If there is suspicion of cirrhosis then he will subject you to some blood test, ultrasound abdomen, fibroscan/elastography, upper GI endoscopy and if needed CT scan or MRI of abdomen or liver biopsy.
Ultrasound of abdomen in cirrhosis may shows coarse liver echotexture, nodular liver surface, dilated portal vein or collateral, enlarged spleen or abdominal fluid (ascites).
How to prevent cirrhosis?
Best way to avoid development of cirrhosis from predisposing stage of liver illness is to recognize and treat early. Few advices to keep liver healthy are:
- Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
- Lifestyle modification: Maintain healthy body weight. Avoid being overweight or obese. Aerobic exercise (like brisk walk 30-45min/day atleast 5days/week) regularly helps to lower liver fat.
- Avoid: Avoid use of contaminated needles, sharing of items of personal hygiene (like shaving razors, toothbrush, nail clippers, etc), use of illicit drugs, self medication with over the counter drugs or using drugs beyond doctor`s advice.
- Practice safe protected sex
- Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
- Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
- Vaccination: For hepatitis A or hepatitis B, if you are not vaccinated or not already infected or unsafe antibody titre. Transmission rate of hepatitis B from mother to child at birth can be reduced with vaccination and immunization of newborn starting within 12 hours of birth as well as by using antiviral drugs (if indicated).
Prevent others from getting infected from you if you harbor virus causing liver damage.
How to treat cirrhosis?
Treatment of cirrhosis is based on cause of cirrhosis and complication of cirrhosis. Main aim of treatment in early stage of cirrhosis is to slow the progression of cirrhosis and prevent complications development
- Stop alcohol, antiviral drugs for hepatitis b or hepatitis C, proper sugar level if diabetes, steroid or other medications for autoimmune hepatitis, medications to reduce copper from body in patients with Wilson's disease, etc.
- Drugs to lower portal pressure (beta-blocker or nitrates), drugs to remove fluid from body (diuretics), drugs to lower ammonia level for encephalopathy (lactulose and others), drugs to improve kidney function (albumin, terlipressin and others).
- Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
- Low salt high protein diet
- Stop alcohol intake even if you have other cause of cirrhosis.
- Stop smoking
- Avoid over the counter drugs (especially pain killers)
- Vaccinate if not done already or infected
If you wish to discuss about any specific problem, you can consult a gastroenterologist.
Fatty liver is a condition where excess fat is deposited on this organ. Also called as steatosis, this condition happens when more than 5- 10 percent of the weight of the liver is made up of fat.
Fatty liver is a common condition among people. A study from coastal regions of India found ~ 25% of healthy persons had patients had fatty liver on ultrasound.
It can occur at all ages including childhood, highest prevalence is in 40–50 year age group. Prevalence more in patient who are obese and in diabetic patients.
Types of Fatty Liver
1 Alcoholic fatty liver: This condition occurs when there is a heavy consumption of alcohol. Gastroenterologists recommend abstention from alcohol for this condition to subside. If the patient continues to consume alcohol, then liver cirrhosis may develop.
2 Non alcoholic fatty liver (NAFL): One may develop a fatty liver even if one is not an alcoholic. The liver in some cases is unable to process the fat in cells causing them to build-up on the organ.
When more than 10% of the liver is made of fat then this condition is called Non Alcoholic Fatty Liver (NAFL).
Non alcoholic steatohepatitis (NASH): When fatty liver is associated with inflammation in liver patient is said to be having Non alcoholic steatohepatitis. NASH is a more advanced stage of NAFLD, and has a higher risk of progressing to liver cirrhosis or hepatocellular carcinoma (HCC). These condition display symptoms like jaundice, vomiting, nausea, loss of appetite and abdominal pain. Blood test (LFT) shows raised enzymes level. Approx 5-8% of the Indian population has NASH. Consult a doctor if you are experiencing any of these symptoms.
3 Fatty liver during pregnancy: Occurring mainly in the third trimester, the symptoms of this condition are vomiting, nausea, pain the right part of the abdomen and jaundice.
During the early stages (fatty liver) of the disease, patients usually have no symptoms directly related to liver disease. However, people may experience a vague abdominal discomfort. If their liver is inflamed (NASH) then they may display symptoms of poor appetite, weight loss, pain in the abdomen and disorientation.
What causes fatty liver?
The most common cause of fatty liver is alcoholism. When the human liver is unable to metabolize fat fast enough or when there is an excess accumulation of fat on the liver cells then the liver becomes fatty. However, intake of high-fat foods may not result in a fatty liver.
1 Diabetes mellitus
2 Obesity or being overweight
3 Hyperlipidemia or the condition where there are high levels of fat in the blood
4 Genetic reasons
6 Drugs: Aspirin, steroids, tamoxifen, tetracycline etc. cause side effects which also leads to fatty liver
7 Nutritional status (eg, overnutrition, severe malnutrition, total parenteral nutrition [TPN], or starvation diet)
8 Other health problems (eg, Hepatitis C infection, celiac sprue and Wilson disease)
If you wish to discuss about any specific problem, you can consult a gastroenterologist.
A chronic condition, Irritable Bowel Syndrome (IBS) is a disorder of the large intestine that exhibits symptoms such as bloating, abdominal cramps, gas and diarrhea. The symptoms of IBS can be controlled by making lifestyle changes such as incorporating certain modifications to your diet and reducing or managing stress levels. For severe symptoms, you may require medications.
The symptoms of IBS can vary; some of them are:
- Bloated stomach
- Abdominal cramps
- Constipation or diarrhea
- Presence of mucus in the stool
- Some other severe symptoms of IBS include sudden loss of weight and rectal bleeding.
The exact cause of IBS is not known, but there are certain factors that may act as triggers. There are muscles lining the walls of the intestine that relax and contract in a proper rhythm, thus allowing the passage of food through the intestine. In case of IBS, these contractions tend to be irregular, resulting in gas, bloating and diarrhea.
Some of the factors that can trigger this condition are:
- Hormones: Hormonal changes can play a role in triggering IBS. For a woman, the symptoms can worsen during her menstrual cycles.
- Stress: Studies show that symptoms of IBS considerably increase if you are subject to increased stress levels over a prolonged period of time.
- Foods: Certain foods such as spices, chocolate, milk and broccoli can act as triggers.
- Other Disorders: In some cases, other underlying conditions such as bacterial overgrowth or infectious diarrhea can cause IBS.
The initial step to manage the symptoms of this condition is to make prompt changes in your diet, such as eliminating spicy foods and dairy products, at least till the symptoms subside. It is advised to resort to medications only if the dietary changes fail to yield results.
The various treatments are:
- Anti-diarrheal Medications: Anti-diarrheal medication such as ‘loperamide’ is used to control and manage diarrhea.
- Fiber Supplements: Certain fiber supplements such as ‘methylcellulose’ and ‘psyllium’ can help in managing constipation.
- Antibiotics: Antibiotics are prescribed only if the symptoms result from bacterial overgrowth in the intestine.
If you wish to discuss about any specific problem, you can consult a gastroenterologist.