Swastik Hospital & Clinic

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?

1. 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.
2. 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.
3. 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.
4. Drugs causing liver injury.
5. 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?

1. Early disease can present with nonspecific symptoms like weakness, fatigue (loss of energy), decrease wish to take food, vomiting or nausea, weight loss, etc.
2. 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).

1. Increase risk of infection because of immune system dysfunction.
2. Development of liver cancer (Hepatocellular carcinoma)
3. Easy brusibility or bleeding following light trauma.
4. Gall bladder stone formation
5. Metabolic bone disease

What are the stages of cirrhosis?

1. 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).
2. 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?

1. 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.

2. 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:

1. Dietary modification: Eat healthy balanced diet. Avoid high calorie food or drinks, saturated fat, sugar and refined carbohydrates. Keep yourself hydrated.
2. 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.
3. 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.
   1. Practice safe protected sex
   2. Alcohol
4. Motivate others: to stop drinking and follow hand hygiene and doctor`s advice.
5. Hand hygiene: Wash hand with soap and water regularly before eating, after going to toilet and after touching dirty objects.
6. 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

1. 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.
2. 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).
3. Opt for liver ransplant, If cirrhosis is life threatening or treatment of cirrhosis complication is ineffective.
4. Low salt high protein diet
5. Stop alcohol intake even if you have other cause of cirrhosis.
6. Stop smoking
7. Avoid over the counter drugs (especially pain killers)
8. Vaccinate if not done already or infected

In case you have a concern or query you can always consult an expert & get answers to your questions!

Many times we forget about the importance of our health in the race to pursue our careers and goals. We take our bodies for granted and keep working them without stopping for a breath. While some may have mastered this art, there are many who may not be able to cope with such a lifestyle and may end up falling ill. The most common problem that most people suffer from is stomach upset, gas, or stomach pain, and all of this may be because of not eating right or having irregular eating habits.

It is due to such problems that people fall ill and then go to the doctor with a problem that may take much longer to treat. However, if the patient starts to check in with the doctor before the stomach pain worsens, it may be easier to treat because very often the pain arises from stomach ulcers. Ulcers are sores that are caused on the lining of the stomach or the oesophagus or even on the intestines. In serious cases, the sores may cause great damage to the stomach and may lead to much worse issues. However, with the right intake of food, the damage may be controlled in combination with medicines and treatment from experts.

Foods to avoid
In controlling the spread of stomach ulcers or peptic ulcers, it may be important to know the food that should be avoided so that the medicines and treatments taken for controlling the problem may work better. Here is a list of foods that you should avoid:

1. Hot beverages such as tea, coffee, cocoa and milk should be avoided because they cause acid imbalance in the stomach.
2. Anything that may contain caffeine should also be avoided.
3. Alcohol should be completely avoided by those suffering from peptic ulcers.
4. Citric or sour drinks such as grape or orange drinks should also be avoided for remaining at ease.
5. Any spicy powders or seasonings, such as pepper, chilli powder and garlic should be excluded from the diet.
6. Anything that is made from milk or cream and is extremely fatty in nature should not be consumed.
7. Flavoured cheese that is strong and spicy should not be eaten.
8. Meats that include high levels of fat or those that are highly seasoned should be completely avoided.
9. Chillies or peppers in any form should be kept away from your diet.
10. Anything that is made from tomato should also be avoided, such gravy, sauces or raw tomatoes.

When you start to keep your diet clean and healthy, it may be much easier for your doctor to cure you of stomach ulcers.

In case you have a concern or query you can always consult an expert & get answers to your questions!

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.

Symptoms

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.

Predisposing factor:

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
5. Rapid loss of weight
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)

In case you have a concern or query you can always consult an expert & get answers to your questions!

Also called gluten-sensitive enteropathy and celiac sprue, celiac disease is an autoimmune digestive disorder, wherein the consumption of gluten-based foods leads to damage of the tissues that line the small intestine. This hinders the ability of your body to absorb the essential nutrients from the foods you eat.

Causes
Under normal conditions, the immune system of the body offers protection against external intruders. When individuals diagnosed with celiac disease consume gluten-based foods, gluten resistant antibodies are formed by the immune system. This causes them to attack the linings around the intestines, thus causing irritation in the digestive tract and harming the villi (hair-like structures on the covering of the small intestine which absorb nutrients from the food). This impairs the nutrient absorbing capacity of the individual, thus increasing chances of malnourishment.

Symptoms
Celiac disease has symptoms that vary from patient to patient. Some of the common symptoms include:

1. A severe skin rash called dermatitis herpetiformis.
2. Digestive problems such as:
   • Pain
   • Gas
   • Abdominal Bloating
   • Diarrhoea
   • Weight loss
   • Pale stools
3. Musculoskeletal problems such as bone and joint pain as well as muscle cramps
4. Seizures
5. Aphthous ulcers which are basically sores occurring in the mouth
6. Tingling sensation in the legs which are caused by low calcium and nerve damage
7. Growth issues in children since they cannot absorb the required amount of nutrients
8. Irregular menstrual cycles

Other complications associated with celiac disease

1. Miscarriage or Infertility
2. Osteoporosis. This is a disease which weakens the bones and causes fractures. It is caused because of a deficiency of Vitamin D and calcium.
3. Intestinal Cancer
4. Other birth defects: Such as irregular spinal shape because of the deficiency of certain nutrients, especially folic acid. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.

The human body with its multiple organs is a highly complicated structure and one or more organs often malfunction for various reasons. However, for some, no reasons are identified for this problem. One such is irritable bowel syndrome or IBS as it is commonly referred to.

It is a common disorder affecting the large intestine leading to alternate bouts of diarrhea and constipation, abdominal cramps and a feeling of fullness. It is common in people younger than 45 years of age, affects women more than men, and though the exact reason is not known, the following are attributed.

Physical/Physiologic reasons:

1. Signal issues between the brain and intestines: For various or even unknown reasons, the brain may not be able to send the right signal to the stomach to process food, making the stomach to be hyperactive and have an increased sense of pain or sensitivity or discomfort. Neurotransmitters, which are chemicals responsible for sending signals to various organs also could be involved.
2. Hormonal connection: Menstrual periods tend to aggravate symptoms of IBS, while postmenopausal women are largely free of IBS symptoms.
3. Genetics: People with a family history of IBS are more likely to develop IBS too.
4. Aggravating foods: Foods rich in carbohydrates, spicy foods, fatty foods, caffeine and alcohol aggravate IBS symptoms. Ability to absorb sugar could be a cause too.
5. Infections: Some people with IBS have certain bacteria identified in their gut which produces excessive gas and this could lead to altered bowel movements.
6. GI Motility Issues: Alterations in the way the food passes through the stomach can lead to either constipation (slow movement) or diarrhea (quicker movement). There could also be spasms and contractions after eating, especially if the stress levels are high.
7. Psychological issues: Panic disorder, anxiety, depression, and posttraumatic stress disorder are common in IBS patients. It is possible that they are not able to express their psychological stress, it manifests as physical symptoms. Stress increases symptoms of IBS and vice versa.

Management:

1. Manage stress: Meditation, yoga, support groups, medication and even hypnosis in severely stressed people helps control stress, providing great relief in IBS symptoms.
2. Lifestyle changes: Reduce alcohol and smoking
3. Dietary changes: Avoid aggravating foods, increase the amount of fiber if you have diarrhea and space out meals to avoid intestinal overload
4. Herbal remedies: Probiotics, peppermint oil and a variety of herbal medicines are available.
5. Symptomatic medications: Based on presenting symptoms, different medications including antibiotics for infections and motility drugs can be used. Anti anxiety and antidepressants are also prescribed to manage the psychological issues.

In terms of causes, symptoms, or treatment, IBS requires a very individualized approach and your doctor is the right person to discuss this with and decide. Consult an Expert & get answers to your questions!

The gallbladder can be found under the liver and is a pear shaped organ. This four inch organ is responsible for storing bile, which is a combination of the various fluids as well as fat and cholesterol. These are essential for the body and its metabolism, as the bile helps in breaking down the food that enters the digestive system. With the help of the gallbladder, this bile divides the food into smaller parts within the intestine. This ensures that the energy released by the food is more easily absorbed into the bloodstream. There are a host of problems that can attack the gall bladder including stones, infection and more.

Let us find out the symptoms of a gallbladder attack and the various ways in which it may be successfully treated.

1. Pain: One of the most common symptoms of a gallbladder attack includes pain. This can be felt in the section that lies in the middle and the upper right portion of the abdomen. The patient may initially experience mild pain that comes and goes intermittently. Eventually, if the pain is not treated, it can start to radiate on a constant basis and hold the patient in its grip.
2. Nausea: Nausea and vomiting are also common symptoms of any gallbladder related problem. Chronic cases usually end up experiencing these symptoms. Nausea and vomiting in such conditions are a result of digestive problems like acid reflux which can be caused due to the gall bladder condition.
3. Fever: If there is an infection in the gall bladder, then the patient may also experience fever and chills. This will require immediate treatment and the prescription of antibiotics. If it is not treated on time, the problem can become serious and dangerous.
4. Loose Motions: Diarrhoea is a problem faced by many patients suffering from this condition along with jaundice and lighter coloured stools.

Treatments: Mostly, doctors will recommend surgical methods to deal with gall bladder attacks and conditions. A laparoscopic surgery may be conducted to remove the gallbladder. Also, medication will be prescribed to dissolve the gallstones that may have been caused by cholesterol. The patient will also have to undertake many lifestyle changes in order to successfully treat this condition over a period of time.

One will have to avoid greasy and oily food. Also, the fat intake of the patient will have to be reduced so that the cholesterol build up does not affect the gallbladder again. The patient will also have to add fibre to his or her daily diet, in the form of fruit and oats. This will help in improving the bowel movements as well. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.

Cancer, the name itself sends chills down the spine! But every time we hear someone has cancer, though we feel sorry for them, we never think it could happen to us. But even though the probability of it may not be high at all, a disease that is rare can still hit you like a bolt from the blue! This is exactly the case with anal cancer, which is a very rare form of cancer. But, since the rates of its incidence are rising, it is well worth learning a few things about it.

Who is at Risk?
While it is unlikely that a person will contract anal cancer over the course of his life, asking himself a few questions about it so as to assess the risk he or she is at makes sense. To start off, age is an important factor. If a person is somewhere between middle age and old age, there is a far greater risk of anal cancer than a person who is not.

A person can easily reduce the risk of contracting anal cancer quite dramatically by doing something which is quite simple: refraining from anal sexual activity. This goes a rather long way as it means that a person is at a much lower risk of contracting HIV or HPV. HPV is far more common and affects most adults in sexual contact with each other. That being said, it is usually the type 16 variant of HPV which is linked to anal cancer. In order to reduce the chance of this, making good use of condoms is a very good idea but this does not eliminate the risk of transmission of HPV.

Smoking a cigarette may be great for a person to obtain a little bit of mental peace, but it has a really disastrous effect on the prospects of developing anal cancer at the same time. The chemicals that the body takes in are as harmful as they affect so many body tissues. There are many reasons to quit smoking but the fact that smokers have an eight time higher risk of developing anal cancer is probably among the good ones!

If a person is suffering from low immunity, it is quite possible that he or she is at a higher risk of developing the cancer, at least on a relative basis. This is because the ability of the body to fight back is lower. A person is especially weak after an organ transplant has taken place and if a person has HIV it further increases his or her risk of developing anal cancer.

Now, cutting the risk of anal cancer also involves possibly getting an HPV vaccination. The doctor is the person to talk to regarding this! When the risk of anal cancer is anyway minimal, it makes sense to cut it even further, by following a fit and healthy lifestyle. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.