Ck Birla Hospital For Women

APPENDICITIS LAPAROSCOPIC APPENDECECTOMY

APPENDICITIS is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.

Symptoms Signs and symptoms of appendicitis may include:

• Sudden pain that begins on the right side of the lower abdomen Sudden pain that begins around your navel and often shifts to your lower right abdomen

Pain that worsens if you cough, walk or make other jarring movements

• Nausea and vomiting

• Loss of appetite

• Low-grade fever that may worsen as the illness progresses

• Constipation or diarrhea

• Abdominal bloating

Causes

A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.

Complications Appendicitis can cause serious complications, such as:

A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.

• A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for two weeks, and you're given antibiotics to clear the infection. Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

Diagnosis

To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests and procedures used to diagnose appendicitis include:

A physical exam to assess your pain. Your doctor may apply gentle pressure to the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding).

• Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.

• Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain.

• Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain.

Treatment Appendicitis

Treatment usually involves surgery to remove the inflamed appendix. Before surgery, you may be given a dose of antibiotics to prevent infection. Surgery to remove the appendix (appendectomy) Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy).

LAPAROSCOPIC APPENDECTOMY , surgery can be done through a few small abdominal incisions During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix. In general, laparoscopic surgery allows you to RECOVER FASTER and heal with LESS PAIN and scarring. It may be better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.

Gestational diabetes, as the name suggests, occurs during gestation or pregnancy when the blood sugar levels exceed the normal level. Gestational diabetes, like other form of diabetes, affects how your body cells use glucose or sugar during pregnancy, and usually disappears after you’ve given birth.

Causes and symptoms to look out for!
During gestation, the placenta produces hormones that lead to the accumulation of blood glucose. Under normal condition, the pancreas forms enough insulin to counter the buildup of blood glucose. The level of blood sugar rises when the pancreas fails to produce adequate insulin to manage your blood sugar.

Usually, women with gestational diabetes do not show symptoms. So, the presence of the condition can go unnoticed if they are not diagnosed during routine checkups and screening tests. Nevertheless, if the condition goes out of control, you may feel tired, feel thirsty or hungry, or feel the urge to urinate more often.

What are the risk factors?
About 2-10% of pregnant women are affected by gestational diabetes every year. The following factors are likely to put you at risk of developing gestational diabetes-

1. Excess body weight- You may develop gestational diabetes if you were overweight or had gained excess weight (BMI equal to or greater than 30) before getting pregnant
2. Family history- Women who have a family history of diabetes are likely to have gestational diabetes.
3. Age- Women aged more than 25 years are at a greater risk of developing this condition.
4. Diabetic history- A slightly raised blood sugar level may act as the precursor to Type-2 diabetes, which in turn increases your chance of getting affected by gestational diabetes.
5. Previous pregnancy- Women who’ve previously given birth to a child weighing more than 4.1 Kg (9 pounds), or have delivered a stillborn child are likely to have gestational diabetes.

What is the treatment for gestational diabetes?
Urine tests are performed to check for ketones. In a non-diabetic person, glucagon, insulin and other hormones avert ketone levels in your blood from soaring up too high. Once you’re diagnosed with gestational diabetes, it’s important that you consult your doctor for treatment. Uncontrolled blood sugar level can affect you and your baby’s health after birth. This condition can be treated in the following ways-

1. Keep a check on your blood sugar- During pregnancy, your doctor will have you tested for gestational diabetes 4-5times a day to keep a tab on your blood glucose level. For this, a small drop of blood is first drawn from the finger using a needle. The sample of blood is then placed on the test strip inserted into a device called the blood glucose meter to measure and monitor the level of blood sugar in your body.
2. Medication- Anti-diabetic medications and insulin are prescribed to control the amount of glucose or sugar in the bloodstream. Your doctor may also suggest oral medications like Diabeta and Glynase to manage your blood glucose level.
3. Healthy diet- Diabetic diet- one that helps control blood sugar levels- is highly prescribed by doctors during pregnancy. Cut down on carbohydrates and sugar, and switch to food items that provide your body sufficient nutrients and calories.

Post treatment the blood sugar levels usually come down to normal within 4-6 weeks of giving birth.

Breast cancer is a very common form of cancer that develops in the cells of your breast. The cancer typically forms in either the ducts of your breast (the pathway through which milk reaches the nipples from the glands) or the lobules (the glands which produce milk).

Breast cancer can affect both males and females. However, it is more commonly observed in women aged between 45-55 years.

Look out for these symptoms!
Signs and symptoms of breast cancer include the following-

1. Discharge of blood from the nipples
2. A lump near the breast or the armpit
3. Scaling or peeling of skin around the breasts
4. Sore nipple
5. Breast pain
6. Swelling of lymph nodes in the armpit or on the neck
7. Change in the shape and size of the nipple or the breast
8. An inverted nipple

What are the risk factors?

1. Age- Breast cancer usually strikes at an older age. Women aged over 55 years are most often diagnosed with invasive breast cancer.
2. Family history- If you have someone in your family who’ve had a history of breast cancer, then you too may develop this disease later in life.
3. Inherited genes- Mutation of certain genes- BRCA1 and BRCA2- can put you at a higher risk of developing breast cancer.
4. Obesity- People with Body Mass Index (BMI) higher than or equal to 30 are at risk of developing breast cancer.
5. Alcohol consumption- Aggressive or frequent alcohol consumption can make you prone to breast cancer.
6. Early menstruation- Those who’ve had their first menstrual cycle before the age of 12, are more likely to get affected by breast cancer in the later stage.
7. Postmenopausal therapy- Women undergoing hormonal therapy or medications combining progesterone and estrogen to treat menopause have greater risk of having breast cancer.

What is the treatment for breast cancer?
After a thorough evaluation of your overall health condition, your doctor will determine the options to treat your breast cancer depending on the type, size and stage of the cancer. The usual methods of curing breast cancer are-

1. Lumpectomy- This is a minimally invasive surgical procedure whereby smaller tumors are removed from the lumps of your breast. Your doctor will only remove a portion of the cancerous lump, leaving the remaining portion of the breast intact. This allows for better symmetry of your breast. However, you may need to undergo chemotherapy or radiation therapy following a lumpectomy to make sure that all the cancer cells are destroyed.
2. Mastectomy- This surgical procedure is performed to remove all of the breast tissues including the ducts, lobules, nipples and areola.
3. Sentinel Node Biopsy- In order to determine whether or not the cancer has metastasized to other body parts including the lymph nodes, your doctor will first discuss with you the importance of removing the lymph nodes which are likely to be in the receipt of the lymph drainage from the tumor.
4. Breast removal- In certain cases where people have a greater risk of developing breast cancer due to family history or a genetic susceptibility, removal of both the breasts are prescribed by doctors.

The rate of survival for breast cancer has increased in recent times owing to modern treatment techniques. Nearly 90% of breast cancer patients survive for at least 5 years after the treatment is done.

Overview - INGUINAL HERNIA

An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.An inguinal hernia isn't necessarily dangerous, however, it can lead to life-threatening complications. Inguinal hernia repair is a common surgical procedure.    

Symptoms

• A bulge in the area on either side of your pubic bone, which becomes more obvious when you're upright, especially if you cough or strain .
• A burning or aching sensation at the bulge   
• Pain or discomfort in your groin, especially when bending over, coughing or lifting    
• A heavy or dragging sensation in your groin    
• Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum
• You should be able to gently push the hernia back into your abdomen when you're lying down.

Incarcerated hernia

If you aren't able to push the hernia in, the contents of the hernia can be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that's trapped. A strangulated hernia can be life-threatening if it isn't treated.

Signs and symptoms of a strangulated hernia 

• Nausea, vomiting 
• Fever    
• Sudden pain that quickly intensifies    
• A hernia bulge that turns red, purple or dark
• Inability to move your bowels or pass gas

Signs and symptoms in children

• Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. Sometimes the hernia will be visible only when an infant is crying, coughing or straining. 
• In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period.
• Seek immediate medical care if a hernia bulge turns red, purple or dark.

Causes

• Some inguinal hernias have no apparent cause. 
• Increased pressure within the abdomen    
• A pre-existing weak spot in the abdominal wall
• Straining during bowel movements or urination    
• Strenuous activity    
• Pregnancy    
• Smoking
• Inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous physical activity or coughing that accompanies smoking.

Risk factors

• Male. Men are eight times more likely to develop an inguinal hernia than are women.   
• Old age
• Family history.
• Chronic cough, such as from smoking.    
• Chronic constipation.
• Pregnancy.

Complications

1. Pressure on surrounding tissues

Most inguinal hernias enlarge over time if not repaired surgically. In men, large hernias can extend into the scrotum, causing pain and swelling.    

2. Incarcerated hernia

If the contents of the hernia become trapped in the weak point in the abdominal wall, it can obstruct the bowel, leading to severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas.    

3. Strangulation

An incarcerated hernia can cut off blood flow to part of your intestine. Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is life-threatening and requires immediate surgery.           

Diagnosis

A physical exam is usually all that's needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. 

.If the diagnosis isn't readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.                                

Treatment

If your hernia is small and isn't bothering you, your doctor might recommend watchful waiting. 

Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.                Open hernia repair - In this procedure, which might be done with spinal anesthesia or general anesthesia, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The opening is then closed with stitches, staples or surgical glue.After the surgery, you'll be encouraged to move about as soon as possible, but it might be several weeks before you're able to resume normal activities.  

COMPARISON OF OPEN AND LAPAROSCOPIC SURGERY

Laparoscopy

In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.A tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities.

It also might be a good choice for people with hernias on both sides of the body (bilateral).

LIFT (LIGATION OF INTERNAL FISTULA TRACT ) MININAL INVASIVE PROCEDURE FOR FISTULA IN ANO

What is Fistula in Ano?

A fistula-in-ano is an abnormal tract with an external opening in the perianal area that is communicating with the rectum or anal canal by an identifiable internal opening. Most fistulas are thought to arise as a result of cryptoglandular infection with resultantperirectal abscess.

Treatment of anal fistulas depends on their location and complexity. When considering surgery, the ultimate goal is to protect the sphincter muscle and prevent recurrence of an anal fistula. 

LIFT (ligation of internal fistula tract) technique is yet another approach in treating a fistula-in-ano.

The Technique

LIFT procedure is based on secure closure of the internal opening and removal of infected cryptoglandular tissue through the intersphincteric approach. The LIFT technique is often performed for complex or deep fistulas. The procedure allows surgeon to access the fistula between the sphincter muscles and avoid cutting them.

1. Minimally invasive procedure for fistula in ano
2. Very liitle risk of incontinence
3. Very little risk of recurrence
4. Safe and effective method of treatment
5. No need of repeated dressing
6. No scarring of tissue
7. Early return to work
8. Minimal pain

Sebaceous cyst - superficail skin lumps

Sebaceous cysts are noncancerous small bumps beneath the skin. They can appear anywhere on the skin, but are most common on the face, neck and trunk.

Epidermoid cysts are slow growing and often painless, so they rarely cause problems or need treatment. 

True sebaceous cysts are less common. They arise from the glands that secrete oily matter that lubricates hair and skin (sebaceous glands).

Symptoms

Epidermoid cyst signs and symptoms include:

• A small, round bump under the skin, usually on the face, neck or trunk
• A tiny blackhead plugging the central opening of the cyst
• A thick, yellow, smelly material that sometimes drains from the cyst
• Redness, swelling and tenderness in the area, if inflamed or infected

Complications

Potential complications of epidermoid cysts include:

• Inflammation. An epidermoid cyst can become tender and swollen, even if it's not infected. An inflamed cyst is difficult to remove. Your doctor is likely to postpone removing it until the inflammation subsides.
• Rupture. A ruptured cyst often leads to a boil-like infection that requires prompt treatment.
• Infection. Cysts can become infected and painful (abscessed).
• Skin cancer. In very rare cases, epidermoid cysts can lead to skin cancer.

When to see a doctor

Most epidermoid cysts don't cause problems or need treatment. See your doctor if you have one or more that:

• Grows rapidly
• Ruptures or becomes painful or infected
• Occurs in a spot that's constantly irritated
• Bothers you for cosmetic reasons
• Is in an unusual location, such as a finger and toe

A corn (or clavus, plural clavi or clavuses) is a distinctively shaped callus of dead skin that usually occurs on thin or glabrous (hairless and smooth) skin surfaces, especially on the dorsal surface of toes or fingers. They can sometimes occur on the thicker skin of the palms or bottom of the feet.

Corns form when the pressure point against the skin traces an elliptical or semi-elliptical path during the rubbing motion, the center of which is at the point of pressure, gradually widening. If there is constant stimulation of the tissue producing the corns, even after the corn is surgically removed, the skin may continue to grow as a corn.

 Signs and symptoms

The hard part at the center of the corn resembles a barley seed, that is like a funnel with a broad raised top and a pointed bottom. Because of their shape, corns intensify the pressure at the tip and can cause deep tissue damage and ulceration. Hard corns are especially problematic for people with insensitive skin due to damaged nerves (e.g., in people with diabetes mellitus). The scientific name for a corn is heloma(plural helomata). A hard corn is called a heloma durum, while a soft corn is called a heloma molle.

The location of soft corns tends to differ from that of hard corns. Hard corns occur on dry, flat surfaces of skin. Soft corns (frequently found between adjacent toes) stay moist, keeping the surrounding skin soft. The corn's center is not soft, however, but indurated.

Diagnosis

To exclude other differential diagnoses, a skin biopsy may be taken.

Treatment

 A popular method is to use a corn plaster, a felt ring with a core of salicylic acid that relieves pressure and erodes the hard skin. However, if an abnormal pressure source remains, the corn generally returns. If the source of any abnormal pressure is detected, this may be avoided, usually through a change to more comfortable footwear or with various types of shoe inserts or footwear with extra toe space. In extreme cases correcting gait abnormalities may be required. If no other treatment is effective, surgery may be performed.