Author: vegasrobotdoc

GERD? It Could Be A Hiatal Hernia

Hiatal-Hernia-It-can-be-diagnosed-if-the-following-symptoms-are-found-heartburn-chestA hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm). Your diaphragm has a small opening (hiatus) through which your food tube (esophagus) passes before connecting to your stomach.

Risk Factors
Several risk factors make a weakening of the hiatus, an opening in the diaphragm through which the food pipe passes, more likely. For example, hiatal hernias are more common among people over 50 years of age and those who have obesity.

Other risk factors include an upward force that occurs due to weightlifting, straining to empty the bowel, or persistent coughing or vomiting. These actions temporarily increase the pressure inside the abdominal cavity. Injury to the diaphragm, such as trauma from a fall or traffic accident, can also lead to a hiatal hernia.

Symptoms
Symptoms are usually the result of acid moving up from the stomach. This acid can cause heartburn, which is a burning sensation around the lower chest area.

Heartburn tends to get worse in response to certain foods and beverages, and it often occurs when a person is lying down or bending over, especially soon after eating. It can lead to bloating, belching, and a bad taste in the back of the throat.

If heartburn becomes a regular problem, this might signify that a person has acid reflux. Acid reflux is a condition in which heartburn occurs at least twice a week. If acid reflux happens too regularly for a prolonged period, it might progress to gastroesophageal reflux disease.

Treatments
Lifesytle changes including weight loss, timing and size of meals, avoidance of acid producing foods can help minimize acid refluz
Over the counter antacida and prescription medication can also help.

Surgery
People who develop severe and long-term reflux problems may need to consider having an operation if lifestyle changes and drug treatments are not effective. Surgery also becomes necessary if a hernia is large enough to disrupt the blood supply.

The operations for hiatal hernias are laparoscopic. Surgeons perform these procedures through small “keyhole” cuts, so they are minimally invasive.

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Surgery for Colon Cancer

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Surgery is often the main treatment for earlier-stage colon cancers. The type of surgery used depends on the stage (extent) of the cancer, where it is, and the goal of the surgery.

Any type of colon surgery needs to be done on a clean and empty colon. You will be put on a special diet before surgery and may need to use laxative drinks and enemas to get all of the stool out of your colon. This bowel prep is a lot like the one used before a colonoscopy.

Polypectomy and local excision

Some early colon cancers (stage 0 and some early stage I tumors) and most polyps can be removed during a colonoscopy. This is a procedure that uses a long flexible tube with a small video camera on the end that’s put into the person’s rectum and threaded into the colon. These surgeries can be done during a colonoscopy:

  • For a polypectomy, the cancer is removed as part of the polyp, which is cut at its stalk (the part that looks like the stem of a mushroom). This is usually done by passing a wire loop through the colonoscope to cut the polyp off the wall of the colon with an electric current.
  • local excision is a slightly more involved procedure. Tools are used through the colonoscope to remove small cancers on the inside lining of the colon along with a small amount of surrounding healthy tissue on the wall of colon.

When cancer or polyps are taken out this way, the doctor doesn’t have to cut into the abdomen (belly).

Colectomy

A colectomy is surgery to remove all or part of the colon. Nearby lymph nodes are also removed.

  • If only part of the colon is removed, it’s called a hemicolectomy, partial colectomy, or segmental resection. The surgeon takes out the part of the colon with the cancer and a small segment of normal colon on either side. Usually, about one-fourth to one-third of the colon is removed, depending on the size and location of the cancer. The remaining sections of colon are then reattached. At least 12 nearby lymph nodes are also removed so they can be checked for cancer.
  • If all of the colon is removed, it’s called a total colectomy. Total colectomy isn’t often needed to treat colon cancer. It’s mostly used only if there’s another problem in the part of the colon without cancer, such as hundreds of polyps (in someone with familial adenomatous polyposis) or, sometimes, inflammatory bowel disease.

How it’s done

A colectomy can be done in 2 ways:

  • Open colectomy: The surgery is done through a single long incision (cut) in the abdomen (belly).
  • Laparoscopic-assisted colectomy: The surgery is done through many smaller incisions and special tools. A laparoscope is a long, thin lighted tube with a small camera and light on the end that lets the surgeon see inside the abdomen. It’s put into one of the small cuts, and long, thin instruments are put in through the others to remove part of the colon and lymph nodes.

Because the incisions are smaller in a laparoscopic-assisted colectomy than in an open colectomy, patients often recover faster and may be able to leave the hospital sooner than they would after an open colectomy. But this type of surgery requires special expertise, and it might not be the best approach for everyone. If you’re considering this type of surgery, be sure to look for a skilled surgeon who has done many of these operations.

Overall survival rates and the chance of the cancer returning are much the same between an open colectomy and a laparoscopic-assisted colectomy.

If the colon is blocked

When cancer blocks the colon, it usually happens slowly and the person can become very sick over time. In cases like this, a stent may be placed before surgery is done. A stent is a hollow metal or plastic tube that the doctor can put inside the colon and through the blockage using a colonoscope. This tube to keeps the colon open and relieves the blockage to help you prepare for surgery.

If a stent can’t be placed in a blocked colon or if the tumor has caused a hole in the colon, surgery may be needed right away. This usually is the same type of colectomy that’s done to remove the cancer, but instead of reconnecting the ends of the colon, the top end of the colon is attached to an opening (called a stoma) made in the skin of the abdomen. Stool then comes out this opening. This is called a colostomy and is usually only needed for a short time. Sometimes the end of the small intestine (the ileum) instead of the colon is connected to a stoma in the skin. This is called an ileostomyEither way, a bag sticks to the skin around the stoma to hold the waste.

Once the patient is healthier, another operation (known as a colostomy reversal or ileostomy reversal) can be done to put the ends of the colon back together or to attach the ileum to the colon. Rarely, if a tumor can’t be removed or a stent placed, the colostomy or ileostomy may need to be permanent.

Common Surgical Procedures

inside-edition-surgical-servicesCommon Surgical Procedures

According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include

  • Appendectomy is the surgical removal of the appendix, a small tube that branches off the large intestine, to treat acute appendicitis. Appendicitis is the acute inflammation of this tube due to infection.
  • Cholecystectomy is surgery to remove the gallbladder (a pear-shaped sac near the right lobe of the liver that holds bile). A gallbladder may need to be removed if the organ is prone to troublesome gallstones, if it is infected, or becomes cancerous.
  • Hemorrhoidectomy is the surgical removal of hemorrhoids, distended veins in the lower rectum or anus.
  • Partial colectomy is the removal of part of the large intestine (colon) which may be performed to treat cancer of the colon or long-term ulcerative colitis.

Yes, Dr Matt Johnson does them all!

Trauma Surgery

downloadTrauma surgery is the branch of surgical medicine that deals with treating injuries caused by an impact. for example, a trauma surgeon may be called to the emergency room to evaluate a patient who is a victim of a car crash.

Trauma Explained

Trauma is the injuries suffered when a person experiences a blunt force. You may also hear trauma referred to as a “major trauma.” Many trauma patients are the victims of car crashes, stabbings, and gunshot wounds. Trauma can also be caused by falls, crush type injuries, and pedestrians being struck by a car.

Traumatic injuries can affect internal organs, bones, the brain, and the other soft tissues of the body. No area of the body is immune to trauma, but trauma can range from minor (hitting your finger with a hammer) to major (being hit by a car traveling at a high rate of speed or falling off of a building).

Who Performs Trauma Surgery

In the case of severe trauma, such as a catastrophic car crash, the trauma surgeon may be one part of a surgical team that includes general surgeons (to repair internal abdominal injuries), vascular surgeons (to repair damage to blood vessels), orthopedic surgeons (to repair broken bones), and other surgeons as needed.

The trauma team will include not only one or more surgeons, but also the paramedics who stabilize and transport the patient, nurses, anesthetist, respiratory therapist, radiographer, and the support of the medical laboratory scientists, including the blood bank.

For surgeons, extensive education is required in order to practice in their chosen field. As with all physicians, they first graduate from college with a bachelor’s degree and enter medical school for four years. For general surgeons, five years of surgical training as a residency is required. For surgeons who want to specialize, the same five-year residency is completed, followed by additional years of training in the area of specialization. Trauma surgery fellowships are usually one to two years long. Trauma surgeons often also serve a critical care fellowship. They take their boards for a certification in Surgical Critical Care.

From the Emergency Room to Surgery

A trauma surgeon has a different set of skills and functions from an emergency room doctor. When you arrive in the emergency room for any complaint, the ER doctor will see you, stabilize your condition, examine you, and order tests and imaging studies. She will alert the specialists needed, which may include the trauma surgeon. The ER doctor’s function includes referring you for admission or discharging you with appropriate treatment and follow-up referrals.

If your condition requires trauma surgery, you will be handed off to the trauma surgeon, who will become your provider. She will not only perform the surgery but you will also be followed by her and her team through recovery, rehabilitation, and discharge. When you need emergency surgery, you may be treated at the facility where you arrived, or you may be transported to a facility that has the specialists needed for your condition. The trauma surgeon may not be available to examine you until you arrive at her facility.

The trauma surgeon is often the person responsible for prioritizing which of your injuries will be treated first and determining the order of the diagnostic and operative procedures needed.

What is ERCP

What is ERCP?

Endoscopic Retrograde Cholangio Pancreatography (ERCP) is a method for getting into the bile duct and pancreas though the mouth. When invented over 40 years ago, ERCP was a breakthrough that allowed doctors to find local diseases. Today, most local diseases can be detected safely by non-invasive imaging tests such as Computed Tomography (CT), Magnetic Retrograde CholangioPancreatography (MRCP) scans and an endoscopic method of imaging called Endoscopic Ultrasound (EUS). ERCP is used mainly to treat diseases that have been detected by these means.ercp_medium

ERCP uses an endoscope, which is a long flexible narrow tube with a camera at the end. After the patient is sedated, the specialist passes the endoscope through the mouth and esophagus, to view the lining of the stomach and first part of the small intestine (the duodenum). The goal is to access the papilla of Vater, a small nipple in the duodenum. This papilla is the drainage hole for the bile and pancreatic duct, which bring digestive juices from the livergallbladder and pancreas. The doctor injects contrast dyes through the papilla into the ducts and takes X-rays to show lesions such as stones, strictures or blockages. Some of these can be treated right away with other instruments passed through the endoscope.

Hernia Basics

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Hernia Basic
A bulging of an organ or tissue through an abnormal opening.
Common
More than 200,000 US cases per year
Treatable by a medical professional
Usually self-diagnosable
Lab tests or imaging rarely required
Medium-term: resolves within months
Typically, a hernia involves the stomach or intestine.
Symptoms include a bulge, swelling, or pain. In some cases, there are no symptoms.
Treatment includes monitoring the condition. If needed, surgery can return tissue to its normal location and close the opening.
Ages affected
0-2 Common
3-5 Rare
6-13 Rare
14-18 Common
19-40 Common
41-60 Very common
60+ Very common
Genders affected
Males Very common
Females Common

Your Gallbladder

493ss_getty_rf_gallbladder_anatomy_illustrationYour gallbladder sits on the right side of your belly, below your liver. It’s a small organ, shaped like a pear, that holds a fluid called bile. This liquid, made in your liver, helps you digest fats and certain vitamins. When you eat, your body gets the signal to release it — through channels called ducts — into your small intestine.
The most common reason people have trouble with their gallbladder is gallstones. You get them when bile clumps together and forms solid masses. They can be as big as a golf ball, and you can have just one or several.

If a gallstone gets into a duct and keeps bile from flowing out, your gallbladder can get inflamed. That’s called cholecystitis, and it can lead to nausea, vomiting, and belly pain. Bacteria also can cause it. You can tell you’re having gallbladder trouble by where it hurts: the upper right part of your belly. It might get worse when you take deep breath, .and you may also feel an ache in your back or right shoulder blade.

If You Think You Have a Problem

Your doctor will examine you and might want to take a sample of your blood to look for signs your body is fighting an infection. You probably will have an imaging test, like an ultrasound. It uses sound waves to make detailed images of your gallbladder. Your doctor also might want an X-ray of your belly or other blood tests to see how well your liver is working. Your doctor may recommend surgery, called cholecystectomy, to take out your gallbladder. You’ll be fine without it — the bile your liver makes will flow straight into your intestine.

 

From Web MD

 

Hernia Basics

download
A bulging of an organ or tissue through an abnormal opening.
Common
More than 200,000 US cases per year
Treatable by a medical professional
Usually self-diagnosable
Lab tests or imaging rarely required
Medium-term: resolves within months
Typically, a hernia involves the stomach or intestine.
Symptoms include a bulge, swelling, or pain. In some cases, there are no symptoms.
Treatment includes monitoring the condition. If needed, surgery can return tissue to its normal location and close the opening.
Ages affected
0-2
Common
3-5
Rare
6-13
Rare
14-18
Common
19-40
Common
41-60
Very common
60+
Very common
Genders affected
Males
Very common
Females
Common

 

Gastrointenstinal Surgery

gastrointestinal-surgery-500x500

Upper gastrointestinal surgery, often referred to as upper GI surgery, refers to a practise 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 practise, owing to their complexity. Consequently, a general surgeon may specialise 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:

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.

In the U.S., a student wanting to specialize and practice in adult lower GI surgery would generally have to go through four years of undergraduate college pre-medical education and get a bachelor’s degree, then finish the four years of medical school, then finish a typically five-year-long residency in general surgery, and then perform a subsequent one-year-long (minimum) residency in surgery of the small intestine or large intestine (the colon– specifically, the cecum, the vermiform appendix, the ascending colon, the transverse colon, the hepatic flexure and the splenic flexure, the descending colon, and the sigmoid colon; and also the rectum and the anus). A fellowship (in surgery of the small intestine or of the large bowel, or in pediatric/neonatal lower GI surgery, or in surgery of congenital abnormalities or rare disorders of the lower GI tract, or in emergency/trauma surgery or in cancer surgery of the area), would add on approximately one to three more years.[1]

lower GI surgeon might specialise in the following operations:

  • Colectomy
  • Low or ultralow resections for rectal cancer, etc.

Worst Foods for Digestion

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FRIED FOODS:  They’re high in fat and can bring on diarrhea. Rich sauces, fatty cuts of meat, and buttery or creamy desserts can cause problems, too.

Choose roasted or baked foods and light sauces that feature vegetables instead of butter or cream.

CITRUS FRUITS: Because they’re high in fiber, they can give some folks an upset stomach. Go easy on oranges, grapefruit, and other citrus fruits if your belly doesn’t feel right.

ARTIFICIAL SWEETENER:  Chew too much sugar-free gum made with sorbitol and you might get cramps and diarrhea. Food made with this artificial sweetener can cause the same problems.

The FDA warns that you might get diarrhea if you eat 50 or more grams a day of sorbitol, though even much lower amounts reportedly cause trouble for some people.

TOO MUCH FIBER:  Foods high in this healthy carb, like whole grains and vegetables, are good for digestion. But if you start eating lots of them, your digestive system may have trouble adjusting. The result: gas and bloating. So step up the amount of fiber you eat gradually.

BEANS  They’re loaded with healthy protein and fiber, but they also have hard-to-digest sugars that cause gas and cramping. Your body doesn’t have enzymes that can break them down. Bacteria in your gut do the work instead, giving off gas in the process.

Try this tip to get rid of some of the troublesome sugars: Soak dried beans for at least 4 hours and pour off the water before cooking.

CABBAGE AND ITS COUSINS:  Cruciferous vegetables, like broccoli and cabbage, have the same sugars that make beans gassy. Their high fiber can also make them hard to digest. It will be easier on your stomach if you cook them instead of eating raw.

FRUCTOSE:  Foods sweetened with this — including sodas, candy, fruit juice, and pastries — are hard for some people to digest. That can lead to diarrhea, bloating, and cramps.

SPICY FOODS:  Some people get indigestion or heartburn after eating them, especially when it’s a large meal.

Studies suggest the hot ingredient in chili peppers, called capsaicin, may be a culprit.

DAIRY FOODS:  If they trigger diarrhea, bloating, and gas, you may be “lactose intolerant.” It means you don’t have an enzyme that digests a sugar in milk and other forms of dairy.

Avoid those foods or try an over-the-counter drop or pill that has the missing enzyme.

PEPPERMINT : It can relax the muscle at the top of the stomach, which lets food move back into your esophagus. That can cause heartburn. Other culprits include chocolate or coffee.

Experts say you can lower the pressure that pushes the food back up if you lose extra weight, eat smaller portions, and don’t lie down after eating.

Also, learn what foods give you problems, so you can avoid them.

 

From Medicine.Net