Submit a review for Gastro And Liver CareYour feedback matters!
Patient Review Highlights
Consultation with Dr. Neeraj had been a superb experience for me. It's amazing to have a Fortis Gastroenterologist responding in such a detail oriented, cooperative & timely manner.
In healthy individuals, the liver contains little or no fat. In overweight or obese people, gradual fat accumulation leads to significant liver disease. Interestingly, these individuals may be consuming minimal to no alcohol. So, alcohol, which is the main cause for liver damage, does not have a significant role to play.
The non-alcoholic fatty liver disease (NAFLD) has 4 significant stages as outlined below. It is a chronically progressive disease and may take years to reach the final stages of cirrhosis and fibrosis.
1. Simple fatty liver (steatosis): This is usually identified when diagnostic tests are done for some other suspected conditions. There are usually no symptoms obvious in this stage, other than the buildup of fat in the liver.
2. Non-alcoholic steatohepatitis (NASH): The second stage where the liver is inflamed to a greater extent due to fat accumulation.
3. Fibrosis: The next degree of inflammation where blood vessels may be narrowed leading to scarring in the liver with impaired liver functions.
4. Cirrhosis: This is the most severe stage that occurs due to years of cumulative inflammation. The liver shrinks in size, is scarred, and liver functions are markedly impaired and can also result in liver cancer.
Risk factors for NAFLD: The exact reason why a person develops NAFLD is not established, but some of the risk factors include
1. Obesity, with more weight concentrated around the abdomen
4. High cholesterol levels
5. Age greater than 50
Symptoms: This will depend on the stage in which it is identified. While there are no symptoms in the early stages, in some people there could be a dull, aching below the ribs, unexplained weight loss, weakness, and extreme tiredness. As it progresses to cirrhosis, there could be jaundice, fluid accumulation in the abdomen and feet, and itching of the skin.
Management: While there is no treatment aimed at curing the disease per se, there are ways to manage the symptoms, as noted below.
1. Weight loss: Reducing excess accumulated fat will help reverse symptoms and prevent further progression of the disease. A BMI of 18 to 26 is considered optimal.
2. Dietary changes: Modify your diet to a carbohydrates and protein rich and reduced fats and sugars. Increasing fiber through fruits and vegetables is highly recommended.
3. Exercise: Whatever your choice of workout, it will do wonders for NAFLD. Keep a target of an hour or two of moderate to intense exercise per day to reduce weight.
4. Smoking: This is another risk factor and can also help prevent other effects of NAFLD such as diabetes and heart disease.
NAFLD is highly controllable with these changes and other damages can be reversed too. If you wish to discuss about any specific problem, you can consult a gastroenterologist.
The new epidemic that has taken the world by storm is obesity. The proportion of obese people is increasing and the age of onset of obesity is decreasing gradually. There is an optimal weight for a given height of a person. Obesity is when a person's weight is 20% more than the optimal weight. It brings with it a host of other health conditions, as it impairs the body’s overall functioning.
- Diabetes 2: In a normal person, food gets broken down into glucose to provide the required energy for the body using insulin. The body’s inability to produce sufficient insulin to convert the excessive amount of sugar in the body leads to diabetes. Growing to be a leading cause of early death, diabetes brings with it a host of complications affecting almost all systems and parts of the body including stroke, kidney disease, blindness, and death. Diabetes and obesity have a direct correlation and can be prevented and managed by eating a balanced diet, losing weight, exercising, and having a healthy lifestyle.
- Heart problems: An increased BMI also ups the risk for coronary heart disease (CHD), where the blood vessels are narrowed due to constant accumulation of fat in their inner walls. This gradually reduces the blood flow through these and may when complete cut-off happens, it could result in heart attack or stroke, affecting the heart or the brain. There could also be cases where the heart fails to pump sufficient blood to the rest of the body, affecting their effective functioning. Obese people also have a higher blood pressure than people who maintain a good BMI.
- Breathing problems: One of the main causes of labored breathing is excessive weight. The condition called sleep apnea which is sudden bouts of absence of breathing during sleep is very high in obesity. It can cause snoring, daytime sleepiness, increase the risk of heart disease and stroke. In people with sleep apnea, weight loss is one of the first and most recommended therapies. Asthma and general breathing disorders are also higher in obese people.
- Abnormal body cholesterol: Obese people also tend to have abnormally higher levels of body fat, especially the bad cholesterol, which again leads to coronary disease. It is a vicious cycle with one leading to the other and aggravating the other.
- Osteoarthritis: Added weight leads to pressure on the hips, knees and lower back. There is added wear and tear and pain, which further limits movement.
- Cancer: Some cancers, of the colon, endometrium, kidney, pancreas, gallbladder, breast and esophagus are more prevalent in obese people.
These are just some, there are more. The best way to avoid all these is to watch your weight. If you wish to discuss about any specific problem, you can consult a doctor.
A cut on your skin can be seen by the naked eye, but injuries and infections to internal organs are not so easily visible to the eye. The procedure to view and operate on the body’s internal organs is known as an endoscopy. An endoscopy is performed using a flexible tube with a camera attached at one end known as an endoscope. This is inserted into the body though a natural opening in the body such as the mouth or through a small incision on the body.
While the camera gives the doctor a view of the internal organs, forceps or a pair of scissors can be used to operate or remove tissue that needs to be biopsied. Since an endoscopy is performed without making large incisions, it negates the development of scarring.
Types of Endoscopies
Endoscopies can be used for both diagnostic and therapeutic purposes. It is also one of the means for early detection of cancer. There are 11 main types of endoscopies which include:
1. Arthroscopy: This is used to get a closer look at joints. In such cases, the endoscope is inserted into a small incision near the joint being examined.
2. Bronchoscopy: This procedure is used to examine a patient’s lungs. It involves the insertion of a scope into the nose or mouth to give a view of the lungs.
3. Colonoscopy: In this procedure, a scope is inserted through the anus to get a view of the colon.
4. Cystoscopy: When the bladder needs to be examined closely, an endoscope is inserted through the urethra. This is known as a cystoscopy.
5. Enteroscopy: This is a procedure where the scope is inserted through the mouth or anus to get a look at the small intestines.
6. Hysteroscopy: Here a scope is inserted through the vagina to get a look at the inside of the uterus.
7. Laparoscopy: It is an endoscopy to examine the abdominal area is known as a laparoscopy. This scope is inserted through an incision in the abdomen.
8. Laryngoscopy: This type of endoscopy involves inserting a scope through the mouth or nose to examine the voice box.
9. Mediastinoscopy: By inserting a scope into an incision above the breastbone, doctors can get a look at the area between the lungs. This is known as a mediastinoscopy.
10. Upper gastrointestinal endoscopy: Examining the esophagus and upper intestinal tract by inserting a scope through the mouth is known as an upper gastrointestinal endoscopy.
11. Ureteroscopy: This procedure is used to examine the patient’s ureter by inserting a scope through the urethra.
In most cases, pain anywhere in the body can be explained as a symptom of some other problem, but sometimes, there is no reason for abdominal pain. This type of pain is known as chronic functional abdominal pain. This is a gastrointestinal disorder that cannot be explained through X-ray or laboratory findings. It can be triggered by altered sensitivity to nerve impulses in the brain and gut. People suffering from this condition are often so debilitated by the pain that it becomes the central focus of their life.
This condition cannot be cured, but with proper treatment, it can be managed so that it does not affect the quality of your life. The aim of treatment for this condition is to control the symptoms and improve functioning. When it comes to treating this condition, the patient’s relationship with his or her doctor plays an important role as the condition cannot be proven through any form of testing and it has a great psychological effect on the person. Regular checkups are also a key to managing this condition effectively.
The first step towards achieving this is to identify possible emotional and situational triggers. Maintaining a journal that records these experiences can help with this. Further treatment is usually either through psychological treatment or antidepressants.
Psychological treatment is based on the understanding that the brain can block pain by diverting attention elsewhere. Nerve impulses that travel from the abdomen to the brain must pass through a type of ‘gate’ that is controlled by nerve impulses generated by the brain. When these impulses close the gates, pain is blocked while when these gates are open, the pain can be magnified. Psychological treatment for chronic functional abdominal pain can be in the form of relaxation techniques, imagery, hypnosis and cognitive behavioral therapy. While relaxation techniques such as meditation and hypnosis help a person shift focus from the pain, cognitive behavioral therapy teaches a person how to change thoughts and perceptions in order to control the pain.
Antidepressants can also act as pain relievers. This form of medication stimulates the production of brain signals that close the ‘gates’ of nerve transmissions. This blocks the pain but can take several weeks to be effective. Some people may experience side effects such as drowsiness and nausea and hence should never be taken without a doctor’s supervision. In some cases, antidepressants may also be combined with cognitive behavioral therapy or medication to regulate bowels. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.
For a healthy body, proper digestion and absorption of food is very important. The digestion is an extremely intricate process and involves many organs. Impairment in any of the organs can hamper the digestive process, leading to a very common condition called dyspepsia. It is caused by malfunction of one of the muscular organs along the digestive tract including esophagus, stomach, small and large intestines and colon.
Causes: While dyspepsia is more a symptom, there are various reasons that lead to it including gastritis, peptic ulcer disease, infections, motility disorders, gastroesophageal reflux disease (GERD), cancers of the digestive tract or any other abnormality in the digestive tract.
Evaluation: When a patient has chronic dyspepsia or indigestion, the first thing to do is a thorough evaluation to find out the underlying cause. As noted above, there are functional and nonfunctional causes leading to dyspepsia. While gastric ulcers or polyps are visible during an endoscopy, conditions like gastritis and malignancy can only be diagnosed under microscopic examinations.
Some of the tests that are used for evaluation of the cause of dyspepsia include:
1. X-ray: Any growth would be visible on an x-ray and further testing can then be done to confirm the exact nature of it.
2. Endoscopy: This will allow the doctor to see the actual digestive tract and identify any structural abnormalities or growth.
3. Colonoscopy: If the problem is suspected to be in the lower gastrointestinal tract, then a colonoscopy may be in indicated.
4. Gastric emptying study: This study can also reveal the abnormalities in the digestive tract
5. Culture: Dyspepsia caused by Helicobacter pylori can be diagnosed through cultures of the stomach contents.
Treatment: The treatment of dyspepsia is quite complicated and cannot be clearly outlined given the various conditions that it is associated with. Even specific foods can induce indigestion in some people. Therefore, a multipronged approach is required to treat dyspepsia.
Education: The affected person should be educated about the non-life-threatening nature of the problem and its chronicity. Some of the drugs used in treatment include:
1. Proton pump inhibitors: These reduce the amount of acid produced in the stomach and thereby help in relieving symptoms.
2. Promotility drugs: They improve the movement of the muscles in the intestinal tract and are so used in managing dyspepsia.
3. Antibiotics: If an infection is suspected, antibiotics are effective.
4. Smooth muscle relaxants: Drugs like hyoscyamine and methscopolamine have been shown to provide relief in some patients.
5. Psychotropic drugs: Anxiety and depression are frequently seen in people with dyspepsia, and managing these can help reduce the dyspepsia.
As noted, the causes, symptoms, and management are very specific to individuals and needs to be managed by the doctor.
Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.
This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.
This is inserted through the patient’s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient’s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor’s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.
ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:
• Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.
• Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.
• Persistent upper abdominal pain
• Unexplained weight loss and loss of appetite
• Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater
ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient’s needs.