Month: March 2016

Why Am I A Robot Doc

ROBOT

Why Robotics

Because the Benefits include:

  • Decreased blood loss, less pain, and quicker healing time
  • Decreased risk of infection
  • Smaller scars
  • Shorter hospital stays
  • ​Better control over surgical instruments and better view of the surgical site
  • Reduces or eliminates the tissue trauma associated with open surgery

 

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Hemorrhoids: Internal or External?

hemorrhoid bleedingAre Yours Internal or External?

Internal hemorrhoids lie far enough inside the rectum that you can’t see or feel them. They don’t usually hurt because there are few pain-sensing nerves in the rectum. Bleeding may be the only sign they’re there.

Sometimes internal hemorrhoids “prolapse,” or enlarge and protrude outside the anal sphincter. When this happens, you may be able to see or feel them as moist, pink pads of skin that are pinker than the surrounding area. Prolapsed hemorrhoids may hurt because the anus is dense with pain-sensing nerves.

External hemorrhoids lie within the anus. They’re usually painful. If they move, or prolapse, to the outside (usually when you have a bowel movement), you can see and feel it.

Blood clots sometimes form within prolapsed external hemorrhoids, causing a very painful condition called a thrombosis. If that happens, the hemorrhoid can turn purple or blue, and could possibly bleed. Despite its appearance, it’s usually not serious, apart from the pain. It will go away in a couple of weeks. Your doctor can remove it if the pain is unbearable.

You should get any anal bleeding and pain checked by a doctor to make sure it’s not a more serious condition. Hemorrhoids are the No. 1 cause of this type of bleeding and are rarely dangerous, but you should find out for sure.

What Are Hemorrhoids?

understandinghemorrhoidsbasics-hemorrhoids

They’re swollen blood vessels of the rectum. The hemorrhoidal veins are located in the lowest area of the rectum and the anus. Sometimes they swell so that the vein walls become stretched, thin, and irritated when you have bowel movements.

Do You Need Surgery?

Surgical hemorrhoidectomy is performed when more conservative treatments fail. Most patients can go home the same day, but the need for catheterization may require an overnight stay.

Patients may expect pain that makes it difficult to sit after surgery. But they can resume normal activities in a few days, and some do so immediately

While surgery is generally reserved for internal hemorrhoids,  thrombosed external hemorrhoids may require prompt attention.

We Fix Hernias-Robotically!

epigastric_fig2_flat

WE FIX HERNIAS!
Call Matt Johnson, MD (Vegas Robot Doc)
Desert Surgical Associates
702-369-7152

A hernia is the exit of an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of different types. Most commonly they involve the abdomen, specifically the groin.Groin hernias are most common of the inguinal type but may also be femoral. Other hernias include hiatus, incisional, and umbilical hernias. For groin hernias symptoms are present in about 66% of people. This may include pain or discomfort especially with coughing, exercise, or going to the toilet. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down. Groin hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the bowel is blocked. This usually produces severe pain and tenderness of the area. Hiatus or hiatal hernias often result in heartburn but may also cause chest pain or pain with eating.

Risk factors for the development of a hernia include: smoking, chronic obstructive pulmonary disease, obesity, pregnancy, peritoneal dialysis, collagen vascular disease, and previous open appendectomy, among others. Hernias are partly genetic and occur more often in certain families. It is unclear if groin hernias are associated with heavy lifting. Hernias can often be diagnosed based on signs and symptoms. Occasionally medical imaging is used to confirm the diagnosis or rule out other possible causes. The diagnosis of hiatus hernias is often by endoscopy.

Groin hernias that do not cause symptoms in males do not need to be repaired. Repair, however, is generally recommended in women due to the higher rate of femoral hernias which have more complications. If strangulation occurs immediate surgery is required. Repair may be done by open surgery or by laparoscopic surgery. Open surgery has the benefit of possibly being done under local anesthesia rather than general anesthesia. Laparoscopic surgery generally has less pain following the procedure. A hiatus hernia may be treated with lifestyle changes such as raising the head of the bed, weight loss, and adjusting eating habits. The medications, H2 blockers or proton pump inhibitors may help. If the symptoms do not improve with medications the surgery known as laparoscopic fundoplication may be an option.

About 27% of males and 3% of females develop a groin hernia at some time in their life. Groin hernias occur most often before the age of one and after the age of fifty. Inguinal, femoral and abdominal hernias resulted in 32,500 deaths in 2013 and 50,500 in 1990. It is not known how commonly hiatus hernias occur with estimates in North America varying from 10 to 80%. The first known description of a hernia dates back to at least 1550 BC in the Ebers Papyrus from Egypt.

 

Umbilical hernia with surrounding inflammation
By far the most common hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or “defect”, through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. Another common hernia involves the spinal discs and causes sciatica. A hiatus hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm.

Hernias may or may not present with either pain at the site, a visible or palpable lump, or in some cases more vague symptoms resulting from pressure on an organ which has become “stuck” in the hernia, sometimes leading to organ dysfunction. Fatty tissue usually enters a hernia first, but it may be followed or accompanied by an organ.

Hernias are caused by a disruption or opening in the fascia, or fibrous tissue, which forms the abdominal wall. It is possible for the bulge associated with a hernia to come and go, but the defect in the tissue will persist.

Symptoms and signs vary depending on the type of hernia. Symptoms may or may not be present in some inguinal hernias. In the case of reducible hernias, a bulge in the groin or in another abdominal area can often be seen and felt. When standing, such a bulge becomes more obvious. Besides the bulge, other symptoms include pain in the groin that may also include a heavy or dragging sensation, and in men, there is sometimes pain and swelling in the scrotum around the testicular area.

Irreducible abdominal hernias or incarcerated hernias may be painful, but their most relevant symptom is that they cannot return to the abdominal cavity when pushed in. They may be chronic, although painless, and can lead to strangulation (loss of blood supply) and/or obstruction (kinking of intestine). Strangulated hernias are always painful and pain is followed by tenderness. Nausea, vomiting, or fever may occur in these cases due to bowel obstruction. Also, the hernia bulge in this case may turn red, purple or dark and pink.

In the diagnosis of abdominal hernias, imaging is the principal means of detecting internal diaphragmatic and other nonpalpable or unsuspected hernias. Multidetector CT (MDCT) can show with precision the anatomic site of the hernia sac, the contents of the sac, and any complications. MDCT also offers clear detail of the abdominal wall allowing wall hernias to be identified accurately.

Causes

Causes of hiatus hernia vary depending on each individual. Among the multiple causes, however, are the mechanical causes which include: improper heavy weight lifting, hard coughing bouts, sharp blows to the abdomen, and incorrect posture.

Furthermore, conditions that increase the pressure of the abdominal cavity may also cause hernias or worsen the existing ones. Some examples would be: obesity, straining during a bowel movement or urination (constipation, enlarged prostate), chronic lung disease, and also, fluid in the abdominal cavity (ascites).

Also, if muscles are weakened due to poor nutrition, smoking, and overexertion, hernias are more likely to occur.epigastric_fig2_flatepigastric_fig2_flat