Download - Grande Hospital

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4
DR PRAKASH KARKI FROM
INDIANA, USA ON US HEALTHCARE SYSTEM
DIGESTIVE DISEASES
EXPERT SURGEON FROM CHICAGO, USA
a monthly newsletter for staff and friends of
Dr. Prakash Karki (MD, FHM) Regional
Medical Director, EmCare North Division,
USA – Visited Grande International
Hospital.
GRANDE INTERNATIONAL HOSPITAL
The Pulse
FEB 2017
VOL 14.
CUPID PACKAGE
PEPTIC ULCERS
CIRRHOSIS
DIARRHOEAL DISEASES
DOCTOR’S VISIT
DID YOU KNOW
w w w. g ra n d e h o s p i ta l . c o m
He presented 'An overview of US
healthcare delivery, how it affects hospitals
and how they function, and discussion of
publicly reported measures.' In the
specially organized continuing medical
education.
Doctors, medical staff and administrators
from Grande International Hospital
participated in that interactive CME held
in the conference hall at second floor.
Dr. Sushil Pandey, Colorectal Surgeon visited Grande International Hospital on 26th
of December 2016.
WORLD RENOWNED
LIVER TRANSPLANT
SURGEON FROM
KOREA
VISITS GIH
Professor Kwang-Woong Lee, Executive
Director of International Healthcare
Centre, Seol National University college of
Medicine, Department of Surgery and
Professor Young Rok Choi from Hepato
Billiary Pancreas Division, Department of
Surgery, Seol National University Bundang
hospital visited Grande International
Hospital in January 2017.
Professor Kwang-Woong Lee graduated
from Seoul National University. He has
been with Samsung Medical Center and
National Cancer Center, Korea as a hepatic
and transplant surgeon. He has also been
in Johns Hopkins University Hospital as a
LDLT consultant. He is an executive of
international health care center and a
professor of department of surgery, Seoul
National University, Korea.
He performed the first successful hepato
cyte transplantation in Korea when he was
in Samsung Medical Center. His research
topics are hepatocyte transplantation, gene
delivery, cancer stem cell, best
immunosuppressant for HCC, bile duct
ischemia induced by warm ischemia,
polymorphism and so on. He developed
several innovative techniques to reduce
biliary
complications
after
liver
transplantation such as high hilar
dissection (HHD) and Tailored Telesco pic
Reconstruction (TTR) of bile duct.
He also played an important role to change
deceased donor allocation system in Korea
(split liver transplantation regulation and
Deceased donor allocation system based
on MELD) by publishing several
important papers analyzing Korean
database. He performed first living donor
liver transplantation for pure foreign
patients in Korea when he was in National
Cancer Center, Korea. He has performed
more than 40 cases of LDLT in Kazakhstan
and Georgia since 2013.
Professor Young Rok Choi graduated from
Seoul National University. He has been
with Samsung Medical Center and
National Cancer Center, Korea as a hepatic
and transplant surgeon. He was one of the
member of the first successful hepato cyte
transplantation in Korea when he was in
Samsung Medical Center.
Dhapasi, Kathmandu, Nepal
P.O. Box: 11796
T : 01-5159266, 5159267, 1618015159266 (Audio Notice)
F : 977-1-5159276
E : [email protected]
www.grandehospital.com
An initiative by the Marketing & Business Development
Department, Grande International Hospital.
Dr. Pandey has graduated from Montefiore Medical Center, New York and he is
currently associated with institute of Colon & Rectal Surgery, Chicago, USA.
Prime Minister
visits GIH
GIH felicitated the esteemed surgeon Dr. Sushil Pandey for his valuable speech on
the CME to help us taking the Department of GI Surgery at GIH to the next level.
WORKSHOP ON INFECTION CONTROL HELD AT GIH
Recently concluded a one day workshop on infection control that was jointly
organized by GIH, Critical Care Nurses Association; ASK foundation and Critical
Care Development Foundation.
100 nurses and clinical staff members from different hospitals were present in the
workshop.
The Rt. Hon. Prime Minister Pushpa Kamal Dahal with the Medical Director of GIH, Dr Chakra Raj Pandey,
Gastroenterologist Dr Vivek Sharma and Nursing Director LD Maharjan
editorial
This issue of The Pulse focuses on Gastroenterology. Diseases like diaorrhea,
peptic ulcers & cirrhosis are common in Nepal. With a team of well-trained
doctors and state-of-the-art equipment, Grande International Hospital has
been able to achieve excellent clinical outcomes. A dedicated department for
endoscopy allows for procedures to be done without delay so patients can feel
relaxed and comfortable.
Did you know?
1
Liver is the second largest organ
(approximately 1.5 kg) in the human body.
2
HOW WELL DO YOU
KNOW YOUR
Grande International Hospital received the
‘Hospital of the Year’
?
2016 award from Frost & Sullivan.
Liver performs over 500 functions including fighting off infection,
neutralizing toxins and helping to clot the blood, and produces proteins.
3
Liver is the only organ that grows back (this makes it
possible for people with normal liver to donate a part of
it to another person with a diseased liver).
5
This Valentine’s Day buy The Cupid Package
for Rs.13,000 and get one free
for your partner.
At any time, liver contains about 10% of the blood in our
body and pumps 1.4 litres per minute.
4
Liver is our battery. It stocks up sugar and when required,
uses it avoiding any drastic fall in blood sugar level.
Package includes
Doctors Consultation
Chest X-Ray
CBC
Blood Sugar (F)
USG Abdomen & Pelvis
ECG
Lipid Profile
ECHO
TSH
TMT or BMD
Creatinine
SGPT
Uric Acid
Urine (R)
Breakfast & Hospital Registration Card
For further information and appointments
F ro st & S u lli va n 2 0 1 6 Nep a l
01-5159266, 5159267
Offer valid from 14 - 21 Feb
www.grandehospital.com
page
4
DR PRAKASH KARKI FROM
INDIANA, USA ON US HEALTHCARE SYSTEM
DIGESTIVE DISEASES
EXPERT SURGEON FROM CHICAGO, USA
a monthly newsletter for staff and friends of
Dr. Prakash Karki (MD, FHM) Regional
Medical Director, EmCare North Division,
USA – Visited Grande International
Hospital.
GRANDE INTERNATIONAL HOSPITAL
The Pulse
FEB 2017
VOL 14.
CUPID PACKAGE
PEPTIC ULCERS
CIRRHOSIS
DIARRHOEAL DISEASES
DOCTOR’S VISIT
DID YOU KNOW
w w w. g ra n d e h o s p i ta l . c o m
He presented 'An overview of US
healthcare delivery, how it affects hospitals
and how they function, and discussion of
publicly reported measures.' In the
specially organized continuing medical
education.
Doctors, medical staff and administrators
from Grande International Hospital
participated in that interactive CME held
in the conference hall at second floor.
Dr. Sushil Pandey, Colorectal Surgeon visited Grande International Hospital on 26th
of December 2016.
WORLD RENOWNED
LIVER TRANSPLANT
SURGEON FROM
KOREA
VISITS GIH
Professor Kwang-Woong Lee, Executive
Director of International Healthcare
Centre, Seol National University college of
Medicine, Department of Surgery and
Professor Young Rok Choi from Hepato
Billiary Pancreas Division, Department of
Surgery, Seol National University Bundang
hospital visited Grande International
Hospital in January 2017.
Professor Kwang-Woong Lee graduated
from Seoul National University. He has
been with Samsung Medical Center and
National Cancer Center, Korea as a hepatic
and transplant surgeon. He has also been
in Johns Hopkins University Hospital as a
LDLT consultant. He is an executive of
international health care center and a
professor of department of surgery, Seoul
National University, Korea.
He performed the first successful hepato
cyte transplantation in Korea when he was
in Samsung Medical Center. His research
topics are hepatocyte transplantation, gene
delivery, cancer stem cell, best
immunosuppressant for HCC, bile duct
ischemia induced by warm ischemia,
polymorphism and so on. He developed
several innovative techniques to reduce
biliary
complications
after
liver
transplantation such as high hilar
dissection (HHD) and Tailored Telesco pic
Reconstruction (TTR) of bile duct.
He also played an important role to change
deceased donor allocation system in Korea
(split liver transplantation regulation and
Deceased donor allocation system based
on MELD) by publishing several
important papers analyzing Korean
database. He performed first living donor
liver transplantation for pure foreign
patients in Korea when he was in National
Cancer Center, Korea. He has performed
more than 40 cases of LDLT in Kazakhstan
and Georgia since 2013.
Professor Young Rok Choi graduated from
Seoul National University. He has been
with Samsung Medical Center and
National Cancer Center, Korea as a hepatic
and transplant surgeon. He was one of the
member of the first successful hepato cyte
transplantation in Korea when he was in
Samsung Medical Center.
Dhapasi, Kathmandu, Nepal
P.O. Box: 11796
T : 01-5159266, 5159267, 1618015159266 (Audio Notice)
F : 977-1-5159276
E : [email protected]
www.grandehospital.com
An initiative by the Marketing & Business Development
Department, Grande International Hospital.
Dr. Pandey has graduated from Montefiore Medical Center, New York and he is
currently associated with institute of Colon & Rectal Surgery, Chicago, USA.
Prime Minister
visits GIH
GIH felicitated the esteemed surgeon Dr. Sushil Pandey for his valuable speech on
the CME to help us taking the Department of GI Surgery at GIH to the next level.
WORKSHOP ON INFECTION CONTROL HELD AT GIH
Recently concluded a one day workshop on infection control that was jointly
organized by GIH, Critical Care Nurses Association; ASK foundation and Critical
Care Development Foundation.
100 nurses and clinical staff members from different hospitals were present in the
workshop.
The Rt. Hon. Prime Minister Pushpa Kamal Dahal with the Medical Director of GIH, Dr Chakra Raj Pandey,
Gastroenterologist Dr Vivek Sharma and Nursing Director LD Maharjan
editorial
This issue of The Pulse focuses on Gastroenterology. Diseases like diaorrhea,
peptic ulcers & cirrhosis are common in Nepal. With a team of well-trained
doctors and state-of-the-art equipment, Grande International Hospital has
been able to achieve excellent clinical outcomes. A dedicated department for
endoscopy allows for procedures to be done without delay so patients can feel
relaxed and comfortable.
Did you know?
1
Liver is the second largest organ
(approximately 1.5 kg) in the human body.
2
HOW WELL DO YOU
KNOW YOUR
Grande International Hospital received the
‘Hospital of the Year’
?
2016 award from Frost & Sullivan.
Liver performs over 500 functions including fighting off infection,
neutralizing toxins and helping to clot the blood, and produces proteins.
3
Liver is the only organ that grows back (this makes it
possible for people with normal liver to donate a part of
it to another person with a diseased liver).
5
This Valentine’s Day buy The Cupid Package
for Rs.13,000 and get one free
for your partner.
At any time, liver contains about 10% of the blood in our
body and pumps 1.4 litres per minute.
4
Liver is our battery. It stocks up sugar and when required,
uses it avoiding any drastic fall in blood sugar level.
Package includes
Doctors Consultation
Chest X-Ray
CBC
Blood Sugar (F)
USG Abdomen & Pelvis
ECG
Lipid Profile
ECHO
TSH
TMT or BMD
Creatinine
SGPT
Uric Acid
Urine (R)
Breakfast & Hospital Registration Card
For further information and appointments
F ro st & S u lli va n 2 0 1 6 Nep a l
01-5159266, 5159267
Offer valid from 14 - 21 Feb
www.grandehospital.com
page
2
page
CIRRHOSIS
Dr. Vivek Sharma
Consultant, Gastroenterologist, Therapeutic
Endoscopist & Hepatologist
Cirrhosis of the Liver: Causes, Symptoms
and Treatments
Cirrhosis is an abnormal liver condition in
which there is irreversible scarring of the
liver. Cirrhosis is a progressive disease,
developing slowly over many years, until
eventually it can stop liver function (liver
failure).
likely to develop symptoms compared to
men who consume the same amount.
Heavy drinkers will eventually develop fatty
liver. 20% to 30% of those who continue
drinking heavily will develop alcoholic
hepatitis, the next stage. Approximately 10%
of heavy drinkers will subsequently develop
cirrhosis - the third stage of alcoholic liver
disease.
Galactosemia - inability to process sugars
in milk
Schistosomiasis - a parasite commonly
found in some developing countries
Biliary atresia - badly formed bile ducts
in babies
Glycogen storage disease - problems in
the storage and energy release vital for cell
function.
Hepatitis
Symptoms of cirrhosis
Hepatitis C, hepatitis B and D may cause
cirrhosis
of
liver.
Non-alcoholic
steatohepatitis (NASH). NASH is more
likely to occur with people who are obese,
diabetes patients, those with high blood
lipid (fat) levels, as well as individuals with
hypertension (high blood pressure). NASH,
in its early stages, begins with the
accumulation of too much fat in the liver.
The fat causes inflammation and scarring,
resulting in possible cirrhosis later on.
Autoimmune hepatitis
The person's own immune system attacks
healthy organs in the body as though they
were foreign substances. Sometimes the
liver is attacked. Eventually the patient can
develop cirrhosis.
The following signs and symptoms may
occur:
Blood capillaries become visible on the
skin on the upper abdomen
Fatigue
Insomnia
Itchy skin
Loss of appetite
Loss of bodyweight
Nausea
Pain or tenderness in the area where the
liver is located
Red or blotchy palms
Weakness.
The following signs and symptoms may
appear as liver cirrhosis progresses:
Abdomen fills up with fluid, giving the
patient a large tummy (ascites)
Causes of cirrhosis
Common causes of cirrhosis are long-term
alcohol abuse, hepatitis B and C infection,
and fatty liver disease. Of those, hepatitis B
and C together are said to be the leading
cause of cirrhosis (WHO).
Overconsumption of alcohol
According to the NHS (National Health
Service),
UK,
excessive
alcohol
consumption is when a man drinks more
than 21 units and a woman drinks more
than 14 units per week. Alcohol is one of the
leading causes of liver cirrhosis. Heavy,
regular, long-term drinkers are much more
likely to develop cirrhosis, compared to
other healthy people. Typically, heavy
drinking needs to be sustained for at least
ten years for cirrhosis to develop. The period
varies according to each individual.
Regular heavy female drinkers are more
Some genetic conditions
Hemochromatosis - iron accumulates in
the liver and other parts of the body.
Wilson's disease - copper accumulates in
the liver and other parts of the body.
Other diseases and conditions
Some of the other diseases and conditions
that can contribute to cirrhosis are:
Cystic fibrosis
Primary sclerosing cholangitis hardening and scarring of the bile ducts
fo o d t hat cle ans e t he liver
Accelerated heartbeat
Altered personality (as blood toxins
build up and affect the brain)
Bleeding gums
Body and upper arms lose mass
Body finds it harder to process alcohol
Body finds it harder to process drugs
Confusion
Dizziness
Fluid buildup on ankles, feet and legs
(edema)
Hair loss
Higher susceptibility to bruising
Jaundice (yellowing of the skin, whites
of the eyes, and tongue)
Loss of libido (sex drive)
Memory problems
More frequent fevers (susceptibility to
infections)
Muscle cramps
Nosebleeds
Pain on the right shoulder
Panting (breathlessness)
Stools become black and tarry, or very
pale
Urine becomes darker
Vomiting blood
Walking problems (staggering).
Diagnosis of cirrhosis
The following tests may also be ordered:
A blood test - to measure how well the liver
is functioning and determine whether there
PEPTIC ULCERS
is any damage. If levels of ALT (alanine
transaminase) are high the patient may have
hepatitis. Imaging tests - CT (computerized
tomography), or MRI (magnetic resonance
imaging) scan of the liver, Fibro scan.
A biopsy – may help in diagnosis of
cirrhosis.
Endoscopy - The doctor sees the inside of
the stomach on a screen, and looks out for
swollen blood vessels (varices); a hallmark
sign of cirrhosis.
Breathe test for early-stage liver disease
steps closer
Treatments for cirrhosis
If the cirrhosis is diagnosed early enough,
damage may be minimized by treating its
underlying cause.
Alcohol
dependency
(alcoholism)
treatment - it is important for the patient to
stop drinking if their cirrhosis was caused
by long-term, regular heavy alcohol
consumption. In many cases the doctor will
recommend a treatment program for
alcoholism.
Medications - the patient may be prescribed
drugs to control liver cell damage caused by
hepatitis B or C.
Treatment of swollen varices - if the patient
vomits blood or passes bloody stools they
probably have esophageal varices (in the
food pipe). Urgent medical attention is
required. The following procedures may
help:
Banding
Injection sclerotherapy - A Sengstaken
tube with a balloon
TIPSS (transjugular intrahepatic
portosystemic stent shunt) –
Infections
Screening for liver cancer - patients with
cirrhosis have a much higher risk of
developing liver cancer. The doctor may
recommend regular blood tests and imaging
scans.
Hepatic encephalopathy (high blood toxin
levels) - drugs can help treat excessive blood
toxin levels. The signs and symptoms need
to be explained to the patient so that they
know what to look out for.
SBP – treated with antibiotics.
Liver transplant - if the cirrhosis is
advanced and there is liver failure (liver
does not function) the patient may need a
liver transplant.
Prevention of cirrhosis
Alcohol - do not exceed the recommended
daily/weekly alcohol limit.
Men: maximum of 21 units per week, or
three/four units per day
Women: maximum of 14 units per week,
or two/three units per day
Individuals who have cirrhosis should
abstain from alcohol completely. Alcohol
accelerates the progression of the disease.
Dr. Akhilesh Kumar Kasyap
Consultant Gastroenterologist
What is a Peptic ulcer?
Peptic ulcers are painful sores that can be
found in the stomach lining or small
intestine. Stomach ulcers are the most
visible sign of peptic ulcer disease. They
occur when the thick layer of mucus that
protects your stomach from digestive juices
is reduced, thus enabling the digestive acids
to eat away at the lining tissues of the
stomach.
Stomach ulcers are easily cured, but they can
become severe without proper treatment.
What causes stomach ulcers?
Stomach ulcers aren’t necessarily caused by
one single factor. The decrease in the
stomach’s mucus lining that leads to an ulcer
is usually caused by one of the following:
• An infection with the bacterium
Helicobacter pylori (H. pylori)
• Long-term use of nonsteroidal
anti-inflammatory drugs (NSAIDs), such as
aspirin and ibuprofen
• Excess acid (hyperacidity) in the
stomach, which may be related to genetics,
lifestyle (stress, smoking), and certain foods
• Zollinger-Ellison syndrome, a rare
disease that makes the body produce excess
stomach acid
Certain factors and behaviors can put you at
higher risk for developing stomach ulcers:
• Smoking
• Frequent use of steroids (such as those
for treating asthma)
• Hypercalcemia (overproduction of
calcium)
• Family history of stomach ulcers
• Being over 50 years old
• Excessive consumption of alcohol
Symptoms of stomach ulcers
A number of symptoms are associated with
stomach ulcers. The severity of the
symptoms depends on the severity of the
ulcer.
The most common symptom is a burning
sensation or pain in the area between your
chest and belly button. Normally, the pain
will be more intense when your stomach is
empty and it can last for a few minutes or
several hours.
Other common symptoms include:
• Dull pain in the stomach
• Weight loss
• Not wanting to eat because of pain
• Nausea or vomiting
• Bloating
• Burping or acid reflux
• Heartburn (burning sensation in the
chest)
• Pain improves when you eat, drink, or
take antacids
Talk to your doctor if you experience
symptoms of a stomach ulcer. Even though
discomfort may be mild, ulcers can worsen
if they aren’t treated.
How are stomach ulcers diagnosed?
Diagnosis and treatment will depend on
your symptoms and the severity of your
ulcer. To diagnose a stomach ulcer, your
doctor will review your medical history
DIARRHOEAL DISEASES
Dr. Vivek Sharma
Diarrhoeal diseases are the leading cause of
death in developing countries. Death of
diarrhoeal diseases is usually from severe
dehydration and fluid loss. Children under
five, malnourished or have impaired
immunity (HIV, Tuberculosis, Cancer) are
more affected.
There are three types of Diarrhoea
• Acute diarrhoea - lasts several hours or
days.
• Chronic diarrhoea - lasts two weeks or
longer.
• Factitious diarrhoea – commonly seen
in females due to high dose of purgatives.
Cause of diarrhoeal disease
• Most common cause of diarrhoea is due
to infections like rotavirus, e-coli, shigella,
salmonella, entamoeba histolytica and
giardia.
• Travelers diarrhoea which affects people
travelling to developing countries.
• Cause of chronic diarrhoea like,
inflammatory bowel disease, carcinoma,
thyroid problem, allergy to milk products,
wheat, oats and gastroenterology infection.
Signs and symptoms
• Fever
• Blood in stool
• Abdominal pain
• Vomiting
• If severe – diarrhoea can be a problem.
The most severe threat by diarrhoea is as
follows
along with your symptoms and any
prescription
or
over-the-counter
medications you’re taking.
• Endoscopy: a thin, lighted tube is
inserted through the mouth and into the
stomach to look for the presence of an ulcer
• Endoscopic biopsy: a piece of stomach
tissue is removed so it can be analyzed
Treating stomach ulcers
Treatment will vary depending on the cause
of your ulcer. Most ulcers can be treated
with a prescription from your doctor, but in
rare cases, surgery may be required.
It’s important to promptly treat an ulcer.
Talk to your doctor to discuss a treatment
plan. If you have an actively bleeding ulcer,
you’ll likely be hospitalized for intensive
treatment with IV ulcer medications, and
you may also require blood transfusion.
• Over-the-counter antacids: to help
neutralize stomach acid
• Cytoprotective agents: to protect the l
ining of the stomach and small intestine,
such as Pepto-Bismol
Doctors will also suggest that you avoid
smoking, alcohol, and any medications or
foods that can trigger symptoms.
Surgical treatment
In very rare cases, a complicated stomach
ulcer will require surgery.
Complications associated with stomach
ulcers
Seek treatment as soon as you believe that
you might have a stomach ulcer. The longer
an ulcer remains untreated, the more likely
you are to develop complications. You
should seek medical treatment if you
experience any of the following symptoms:
• Sudden, sharp pain that doesn’t stop
• Black or bloody stools
• Bloody vomitus
• Vomit that looks like coffee grounds
Prevention of stomach ulcers
To prevent the spread of bacteria and
reduce risk of bacterial infection, wash
Nonsurgical treatment
If your stomach ulcer is the result of H.
pylori, you’ll need antibiotics. For mild to
moderate stomach ulcers, your doctor will
usually prescribe the following medications:
• H2 blockers: to prevent your stomach
from making too much acid
• Proton pump inhibitors: blocks the cells
that produce acid
Prevention and management
Key Measures
•
Access to safe drinking water
•
Use of improved sanitations
•
Hand washing
•
Good personal and food hygiene
•
Health education
•
Vaccination
1. Mild dehydration - no signs or
symptoms can be thirsty.
•
Irritable
2. Moderate dehydration
•
Thirsty
•
Irritable
•
Weak pulse
•
Sunken eyes
•
Decreased skin elasticity
3. Severe dehydration
•
Symptoms become more severe
•
Shock with diminished consciousness,
decreased urine output, feeble pulse,
decreased blood pressure.
3
Investigations
•
Stool examination
•
Blood count
•
Kidney functions test
• Colonoscopy or sigmoidoscopy and
biopsy.
your hands with soap and water on a
regular basis. Make sure all food is
properly
cleaned
and
cooked
thoroughly.
To prevent ulcers caused by NSAIDs, stop
using these medications (if possible) or limit
their use. If you need to take NSAIDs, be
sure to follow the recommended dosage and
avoid alcohol while taking these
medications.
Certain lifestyle changes can also help
prevent ulcers from forming. Limiting
alcohol consumption, avoiding tobacco
products, and properly managing stress can
all contribute to a healthy stomach lining.
•
Other investigations according to
cause.
Key measures to treat diarrhoea include
the following:
• Rehydration with oral rehydration salt
solution in mild / moderate dehydration.
• Rehydration with intravenous fluids in
case of severe dehydration or shock.
• Nutrient rich foods.
• Zink supplements.
• Antibiotics and other treatment
according to cause of diarrhoea.
• Treatment according to colonoscopy,
sigmoidoscopy with biopsy repeat in
chronic diarrhoea.
Key Facts
• Diarrhoeal disease is leading cause of
death in developing country, it is
preventable and treatable.
• A significant proportion of diarrhoeal
disease can be prevented through safe
drinking water and adequate sanitation
and hygiene.
• Young children and very old are more
susceptible to dehydration.
• Diarrhoea is a leading cause of
malnutrition in children under five years
old.
page
2
page
CIRRHOSIS
Dr. Vivek Sharma
Consultant, Gastroenterologist, Therapeutic
Endoscopist & Hepatologist
Cirrhosis of the Liver: Causes, Symptoms
and Treatments
Cirrhosis is an abnormal liver condition in
which there is irreversible scarring of the
liver. Cirrhosis is a progressive disease,
developing slowly over many years, until
eventually it can stop liver function (liver
failure).
likely to develop symptoms compared to
men who consume the same amount.
Heavy drinkers will eventually develop fatty
liver. 20% to 30% of those who continue
drinking heavily will develop alcoholic
hepatitis, the next stage. Approximately 10%
of heavy drinkers will subsequently develop
cirrhosis - the third stage of alcoholic liver
disease.
Galactosemia - inability to process sugars
in milk
Schistosomiasis - a parasite commonly
found in some developing countries
Biliary atresia - badly formed bile ducts
in babies
Glycogen storage disease - problems in
the storage and energy release vital for cell
function.
Hepatitis
Symptoms of cirrhosis
Hepatitis C, hepatitis B and D may cause
cirrhosis
of
liver.
Non-alcoholic
steatohepatitis (NASH). NASH is more
likely to occur with people who are obese,
diabetes patients, those with high blood
lipid (fat) levels, as well as individuals with
hypertension (high blood pressure). NASH,
in its early stages, begins with the
accumulation of too much fat in the liver.
The fat causes inflammation and scarring,
resulting in possible cirrhosis later on.
Autoimmune hepatitis
The person's own immune system attacks
healthy organs in the body as though they
were foreign substances. Sometimes the
liver is attacked. Eventually the patient can
develop cirrhosis.
The following signs and symptoms may
occur:
Blood capillaries become visible on the
skin on the upper abdomen
Fatigue
Insomnia
Itchy skin
Loss of appetite
Loss of bodyweight
Nausea
Pain or tenderness in the area where the
liver is located
Red or blotchy palms
Weakness.
The following signs and symptoms may
appear as liver cirrhosis progresses:
Abdomen fills up with fluid, giving the
patient a large tummy (ascites)
Causes of cirrhosis
Common causes of cirrhosis are long-term
alcohol abuse, hepatitis B and C infection,
and fatty liver disease. Of those, hepatitis B
and C together are said to be the leading
cause of cirrhosis (WHO).
Overconsumption of alcohol
According to the NHS (National Health
Service),
UK,
excessive
alcohol
consumption is when a man drinks more
than 21 units and a woman drinks more
than 14 units per week. Alcohol is one of the
leading causes of liver cirrhosis. Heavy,
regular, long-term drinkers are much more
likely to develop cirrhosis, compared to
other healthy people. Typically, heavy
drinking needs to be sustained for at least
ten years for cirrhosis to develop. The period
varies according to each individual.
Regular heavy female drinkers are more
Some genetic conditions
Hemochromatosis - iron accumulates in
the liver and other parts of the body.
Wilson's disease - copper accumulates in
the liver and other parts of the body.
Other diseases and conditions
Some of the other diseases and conditions
that can contribute to cirrhosis are:
Cystic fibrosis
Primary sclerosing cholangitis hardening and scarring of the bile ducts
fo o d t hat cle ans e t he liver
Accelerated heartbeat
Altered personality (as blood toxins
build up and affect the brain)
Bleeding gums
Body and upper arms lose mass
Body finds it harder to process alcohol
Body finds it harder to process drugs
Confusion
Dizziness
Fluid buildup on ankles, feet and legs
(edema)
Hair loss
Higher susceptibility to bruising
Jaundice (yellowing of the skin, whites
of the eyes, and tongue)
Loss of libido (sex drive)
Memory problems
More frequent fevers (susceptibility to
infections)
Muscle cramps
Nosebleeds
Pain on the right shoulder
Panting (breathlessness)
Stools become black and tarry, or very
pale
Urine becomes darker
Vomiting blood
Walking problems (staggering).
Diagnosis of cirrhosis
The following tests may also be ordered:
A blood test - to measure how well the liver
is functioning and determine whether there
PEPTIC ULCERS
is any damage. If levels of ALT (alanine
transaminase) are high the patient may have
hepatitis. Imaging tests - CT (computerized
tomography), or MRI (magnetic resonance
imaging) scan of the liver, Fibro scan.
A biopsy – may help in diagnosis of
cirrhosis.
Endoscopy - The doctor sees the inside of
the stomach on a screen, and looks out for
swollen blood vessels (varices); a hallmark
sign of cirrhosis.
Breathe test for early-stage liver disease
steps closer
Treatments for cirrhosis
If the cirrhosis is diagnosed early enough,
damage may be minimized by treating its
underlying cause.
Alcohol
dependency
(alcoholism)
treatment - it is important for the patient to
stop drinking if their cirrhosis was caused
by long-term, regular heavy alcohol
consumption. In many cases the doctor will
recommend a treatment program for
alcoholism.
Medications - the patient may be prescribed
drugs to control liver cell damage caused by
hepatitis B or C.
Treatment of swollen varices - if the patient
vomits blood or passes bloody stools they
probably have esophageal varices (in the
food pipe). Urgent medical attention is
required. The following procedures may
help:
Banding
Injection sclerotherapy - A Sengstaken
tube with a balloon
TIPSS (transjugular intrahepatic
portosystemic stent shunt) –
Infections
Screening for liver cancer - patients with
cirrhosis have a much higher risk of
developing liver cancer. The doctor may
recommend regular blood tests and imaging
scans.
Hepatic encephalopathy (high blood toxin
levels) - drugs can help treat excessive blood
toxin levels. The signs and symptoms need
to be explained to the patient so that they
know what to look out for.
SBP – treated with antibiotics.
Liver transplant - if the cirrhosis is
advanced and there is liver failure (liver
does not function) the patient may need a
liver transplant.
Prevention of cirrhosis
Alcohol - do not exceed the recommended
daily/weekly alcohol limit.
Men: maximum of 21 units per week, or
three/four units per day
Women: maximum of 14 units per week,
or two/three units per day
Individuals who have cirrhosis should
abstain from alcohol completely. Alcohol
accelerates the progression of the disease.
Dr. Akhilesh Kumar Kasyap
Consultant Gastroenterologist
What is a Peptic ulcer?
Peptic ulcers are painful sores that can be
found in the stomach lining or small
intestine. Stomach ulcers are the most
visible sign of peptic ulcer disease. They
occur when the thick layer of mucus that
protects your stomach from digestive juices
is reduced, thus enabling the digestive acids
to eat away at the lining tissues of the
stomach.
Stomach ulcers are easily cured, but they can
become severe without proper treatment.
What causes stomach ulcers?
Stomach ulcers aren’t necessarily caused by
one single factor. The decrease in the
stomach’s mucus lining that leads to an ulcer
is usually caused by one of the following:
• An infection with the bacterium
Helicobacter pylori (H. pylori)
• Long-term use of nonsteroidal
anti-inflammatory drugs (NSAIDs), such as
aspirin and ibuprofen
• Excess acid (hyperacidity) in the
stomach, which may be related to genetics,
lifestyle (stress, smoking), and certain foods
• Zollinger-Ellison syndrome, a rare
disease that makes the body produce excess
stomach acid
Certain factors and behaviors can put you at
higher risk for developing stomach ulcers:
• Smoking
• Frequent use of steroids (such as those
for treating asthma)
• Hypercalcemia (overproduction of
calcium)
• Family history of stomach ulcers
• Being over 50 years old
• Excessive consumption of alcohol
Symptoms of stomach ulcers
A number of symptoms are associated with
stomach ulcers. The severity of the
symptoms depends on the severity of the
ulcer.
The most common symptom is a burning
sensation or pain in the area between your
chest and belly button. Normally, the pain
will be more intense when your stomach is
empty and it can last for a few minutes or
several hours.
Other common symptoms include:
• Dull pain in the stomach
• Weight loss
• Not wanting to eat because of pain
• Nausea or vomiting
• Bloating
• Burping or acid reflux
• Heartburn (burning sensation in the
chest)
• Pain improves when you eat, drink, or
take antacids
Talk to your doctor if you experience
symptoms of a stomach ulcer. Even though
discomfort may be mild, ulcers can worsen
if they aren’t treated.
How are stomach ulcers diagnosed?
Diagnosis and treatment will depend on
your symptoms and the severity of your
ulcer. To diagnose a stomach ulcer, your
doctor will review your medical history
DIARRHOEAL DISEASES
Dr. Vivek Sharma
Diarrhoeal diseases are the leading cause of
death in developing countries. Death of
diarrhoeal diseases is usually from severe
dehydration and fluid loss. Children under
five, malnourished or have impaired
immunity (HIV, Tuberculosis, Cancer) are
more affected.
There are three types of Diarrhoea
• Acute diarrhoea - lasts several hours or
days.
• Chronic diarrhoea - lasts two weeks or
longer.
• Factitious diarrhoea – commonly seen
in females due to high dose of purgatives.
Cause of diarrhoeal disease
• Most common cause of diarrhoea is due
to infections like rotavirus, e-coli, shigella,
salmonella, entamoeba histolytica and
giardia.
• Travelers diarrhoea which affects people
travelling to developing countries.
• Cause of chronic diarrhoea like,
inflammatory bowel disease, carcinoma,
thyroid problem, allergy to milk products,
wheat, oats and gastroenterology infection.
Signs and symptoms
• Fever
• Blood in stool
• Abdominal pain
• Vomiting
• If severe – diarrhoea can be a problem.
The most severe threat by diarrhoea is as
follows
along with your symptoms and any
prescription
or
over-the-counter
medications you’re taking.
• Endoscopy: a thin, lighted tube is
inserted through the mouth and into the
stomach to look for the presence of an ulcer
• Endoscopic biopsy: a piece of stomach
tissue is removed so it can be analyzed
Treating stomach ulcers
Treatment will vary depending on the cause
of your ulcer. Most ulcers can be treated
with a prescription from your doctor, but in
rare cases, surgery may be required.
It’s important to promptly treat an ulcer.
Talk to your doctor to discuss a treatment
plan. If you have an actively bleeding ulcer,
you’ll likely be hospitalized for intensive
treatment with IV ulcer medications, and
you may also require blood transfusion.
• Over-the-counter antacids: to help
neutralize stomach acid
• Cytoprotective agents: to protect the l
ining of the stomach and small intestine,
such as Pepto-Bismol
Doctors will also suggest that you avoid
smoking, alcohol, and any medications or
foods that can trigger symptoms.
Surgical treatment
In very rare cases, a complicated stomach
ulcer will require surgery.
Complications associated with stomach
ulcers
Seek treatment as soon as you believe that
you might have a stomach ulcer. The longer
an ulcer remains untreated, the more likely
you are to develop complications. You
should seek medical treatment if you
experience any of the following symptoms:
• Sudden, sharp pain that doesn’t stop
• Black or bloody stools
• Bloody vomitus
• Vomit that looks like coffee grounds
Prevention of stomach ulcers
To prevent the spread of bacteria and
reduce risk of bacterial infection, wash
Nonsurgical treatment
If your stomach ulcer is the result of H.
pylori, you’ll need antibiotics. For mild to
moderate stomach ulcers, your doctor will
usually prescribe the following medications:
• H2 blockers: to prevent your stomach
from making too much acid
• Proton pump inhibitors: blocks the cells
that produce acid
Prevention and management
Key Measures
•
Access to safe drinking water
•
Use of improved sanitations
•
Hand washing
•
Good personal and food hygiene
•
Health education
•
Vaccination
1. Mild dehydration - no signs or
symptoms can be thirsty.
•
Irritable
2. Moderate dehydration
•
Thirsty
•
Irritable
•
Weak pulse
•
Sunken eyes
•
Decreased skin elasticity
3. Severe dehydration
•
Symptoms become more severe
•
Shock with diminished consciousness,
decreased urine output, feeble pulse,
decreased blood pressure.
3
Investigations
•
Stool examination
•
Blood count
•
Kidney functions test
• Colonoscopy or sigmoidoscopy and
biopsy.
your hands with soap and water on a
regular basis. Make sure all food is
properly
cleaned
and
cooked
thoroughly.
To prevent ulcers caused by NSAIDs, stop
using these medications (if possible) or limit
their use. If you need to take NSAIDs, be
sure to follow the recommended dosage and
avoid alcohol while taking these
medications.
Certain lifestyle changes can also help
prevent ulcers from forming. Limiting
alcohol consumption, avoiding tobacco
products, and properly managing stress can
all contribute to a healthy stomach lining.
•
Other investigations according to
cause.
Key measures to treat diarrhoea include
the following:
• Rehydration with oral rehydration salt
solution in mild / moderate dehydration.
• Rehydration with intravenous fluids in
case of severe dehydration or shock.
• Nutrient rich foods.
• Zink supplements.
• Antibiotics and other treatment
according to cause of diarrhoea.
• Treatment according to colonoscopy,
sigmoidoscopy with biopsy repeat in
chronic diarrhoea.
Key Facts
• Diarrhoeal disease is leading cause of
death in developing country, it is
preventable and treatable.
• A significant proportion of diarrhoeal
disease can be prevented through safe
drinking water and adequate sanitation
and hygiene.
• Young children and very old are more
susceptible to dehydration.
• Diarrhoea is a leading cause of
malnutrition in children under five years
old.