Upper gastrointestinal

Upper gastrointestinal surgery, often referred to as upper GI surgery, refers to a practice of surgery that focuses on the upper parts of the gastrointestinal tract. There are many operations relevant to the upper gastrointestinal tract that are best done only by those who keep constant practice, owing to their complexity. Consequently, a general surgeon may specialize in ‘upper GI’ by attempting to maintain currency in those skills.

Upper GI surgeons would have an interest in, and may exclusively perform, the following operations:

Pancreaticoduodenectomy
Esophagectomy
Liver resection
Lower gastrointestinal[edit]
Further information: Colorectal surgery
Lower gastrointestinal surgery includes colorectal surgery as well as surgery of the small intestine.

Academically, it refers to a sub-specialisation of medical practise whereby a general surgeon focuses on the lower gastrointestinal tract.

A lower GI surgeon might specialise in the following operations:

Colectomy
Low or ultralow resections for rectal cancer, etc.

The appendix is a small, worm-like appendage attached to the colon.
Appendicitis occurs when the appendix becomes blocked, and bacteria invade and infect the wall and lumen of the appendix.
The most common complications of appendicitis are rupture, abscess, and peritonitis.
The most common signs and symptoms of appendicitis in adults and children are
*abdominal pain,
*loss of appetite,
*nausea and vomiting,
*fever, and
*abdominal tenderness.
Appendicitis usually is suspected on the basis of a patient’s history and physical examination; however, a white blood cell count, urinalysis, abdominal X-ray, barium enema, ultrasonography, CT scan, and laparoscopy also may be helpful in diagnosis.
Due to the varying size and location of the appendix and the proximity of other organs to the appendix, it may be difficult to differentiate appendicitis from other abdominal and pelvic diseases or even during the onset of labor during pregnancy.
The treatment for appendicitis usually is antibiotics and appendectomy (surgery to remove the appendix).

Hemorrhoids are fairly common, especially among people ages 45 to 75. And most hemorrhoid symptoms, such as mild itching or mild pain, can usually be treated at home with over-the-counter remedies.

But there are times when a trip to the doctor is warranted — and many people do seek medical help, such as more specific medication or, in some cases, simple hemorrhoid surgery. Approximately 3.2 million hospital visits and 2 million prescriptions are for hemorrhoid treatment each year.

Severe complications of hemorrhoids are quite rare, but it’s important to know when to see your doctor.

“Anytime you have bleeding, you feel a lump in the anus, or have rectal pain you should see a doctor to make sure you don’t have a more serious cause of the symptoms,” says Aline Charabaty, MD, director of the Center of Inflammatory Bowel Disease at Georgetown University Hospital in Washington, D.C.

However, even a less serious situation can prompt a call to your doctor. If you’ve been trying to treat hemorrhoids on your own, for instance, yet the hemorrhoid symptoms linger, a doctor visit makes sense.

“If you have already been diagnosed with hemorrhoids and your symptoms are not improving with fiber supplements, an increase in water intake, over-the-counter pain relievers, or a warm bath, schedule an appointment,” Dr. Charabaty says.

In most cases, you can see a general practitioner or your family physician about your hemorrhoid symptoms. If complications arise, you may be referred to a specialist, such as a gastroenterologist or a proctologist.

Different Types of Hemorrhoids

There are two types of hemorrhoids, external and internal. “External hemorrhoids come from the most external part of the anal canal,” Charabaty says. Internal hemorrhoids come from the inner part of the anal canal, near the rectum.

According to Cuckoo Choudhary, MD, a gastroenterologist at Thomas Jefferson University Hospital in Philadelphia, one type is not worse than the other, but both can cause problems. “It all depends on the size and degree of the hemorrhoid,” Dr. Choudhary says. “Untreated internal hemorrhoids can cause bleeding. External hemorrhoids can cause thrombosis [blood clotting], which gives way to severe pain from hemorrhoidal strangulation.”

If you know you have hemorrhoids and you have acute and severe anal pain, it could be a sign of thrombosed hemorrhoids.

Know When to See Your Doctor

Though the annoyance of hemorrhoids can be reason enough to call your doctor, use this checklist to know when a visit is a must:

If you are experiencing any type of rectal bleeding.
If the hemorrhoids are causing you pain or discomfort.
If the problems persist despite trying over-the-counter hemorrhoid creams or other remedies.
If you are passing stools that look maroon in color or tarry in color, a sign of bleeding.
If you experience a large amount of rectal bleeding that is accompanied by dizziness or faintness, be sure to seek emergency medical care immediately.

From Everyday Health

A version of the artificial pancreas could be available within the next 2 years, according to a review.
The device — which uses a closed-loop algorithm to monitor blood glucose in type 1 diabetes patients and automatically adjusts insulin levels — has already undergone several smaller trials in different populations and in different settings, wrote Hood Thabit, MD, and Roman Hovorka, PhD, at the University of Cambridge in England.

But those trials have been relatively small and short-term, and several issues must be addressed before the device is up for approval, including speed of action, accuracy of glucose monitors, reliability, and cybersecurity, since the device would need to be protected from hacking. Thabit and Hovorka published their review on Thursday in Diabetologia.
“Significant milestones, with research moving from laboratory to free-living unsupervised home settings, have been achieved in the past decade,” wrote the authors. They noted that the challenges to other potential treatments like beta cell transplantation — transplanting functional islet cells into the pancreas — and immunological therapies make closed-loop systems a “viable alternative” in the meantime.
The artificial pancreas has attracted a lot of attention in the form of money. Worldwide, funders have provided grants for more than $200 million to study the artificial pancreas on top of the significant resources from pharmaceutical companies And Edward Damiano, PhD, at Boston University — one of the earliest and most well-known of the researchers working on closed-loop systems — founded Beta Bionics earlier this year. The company has designed a bi-hormonal bionic pancreas called the iLet that integrates insulin and glucagon delivery systems into a single device.
Damiano has also said that 2018 is a realistic date for a device to reach the market, adding that a large trial is planned for 2017. So far, the device has been studied in the laboratory and in real-world settings like summer camps, hotels, and at home. It has generally outperformed or matched pump therapies in the setting that it has been studied in — the authors called the totality of the results “encouraging” — and dual hormone systems minimize the risk of hypoglycemia that can come with tighter glucose control.
But Thabit and Hovorka added that long-term data are still needed on the safety and tolerability of subcutaneously delivering glucagon. And the 2018 date is dependent not only on approval from the FDA but also on whether infrastructure and support is in place for clinicians who are providing care, they said.

Another challenge: “Performance of closed-loop systems is damped by variable and relatively slow absorption of currently available rapid-acting insulin analogues, delaying onset of and prolonging insulin action,” wrote the authors, adding that this is a serious concern during exercise and postprandial conditions, because that is when glucose fluctuations can happen.
A few further technological advances could make the device more appealing to users, including better glucose sensing, a smaller glucose sensor, avoidance of the need for calibration, and a longer sensor wear time.
“Further technological advancements should also focus on improvements in insulin delivery to prolong infusion catheter use, reduce silent infusion catheter occlusions and accelerate insulin absorption and action to improve efficacy of closed-loop therapies, possibly allowing for the development of a fully closed-loop system without the need for user-initiated prandial insulin dosing,” Thabit and Hovorka wrote.

 

Happy 4th of July