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Appendicitis

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Appendicitis begins with pain near the belly button and then moves to the right side. This is often accompanied by nausea, vomiting, poor appetite, fever, and chills.
People may experience:
Pain areas: in the mid-abdomen or right lower abdomen
Pain types: can be dull, sharp, mild, or severe
Whole body: chills, fever, loss of appetite, or malaise
Gastrointestinal: diarrhea, nausea, or vomiting
Also common: abdominal pain migration or abdominal tenderness
Critical: consult a doctor for medical advice

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What are the signs and symptoms of a hemorrhoid?

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Hemorrhoids are the most common cause of rectal and anal complaints. The most common complaint symptoms are:

painless bleeding,
anal itching,
pain,
swelling and feeling a lump at the anus are all associated with an inflamed hemorrhoid.
It is important to remember that rectal bleeding or blood in the stool is never normal and while it may come from a relatively benign cause like hemorrhoids, more serious causes can be life threatening. These include bleeding from ulcers, diverticulitis, inflammatory bowel disease, and tumors. If rectal bleeding occurs, it is important to contact your health care professional or seek emergency medical care. This is especially important if the person is taking blood thinning medications.

When an internal hemorrhoid becomes inflamed, it can cause swelling. This in itself does not cause pain because there are no pain fibers attached to the veins above the pectinate line. Passing a hard stool can scrape off the thinned lining of the hemorrhoid causing painless bleeding. However, the swollen hemorrhoid can also cause spasm of the muscles that surround the rectum and anus causing pain, especially if they protrude or prolapse through the anus. A lump can be felt at the anal verge. Internal hemorrhoids can also thrombose (clot) leading to severe pain.

The Small Intestines

Blausen_0817_SmallIntestine_AnatomyThe small intestine or small bowel is the part of the gastrointestinal tract between the stomachand the large intestine, and is where most of the end absorption of food takes place. The small intestine has three distinct regions – the duodenumjejunum, and ileum. The duodenum is the shortest part of the small intestine and is where preparation for absorption begins. It also receives bile and pancreatic juice through the pancreatic duct, controlled by the sphincter of Oddi. The primary function of the small intestine is the absorption of nutrients and minerals from food, using small finger-like protrusions called villi

Size

The length of the small intestine can vary greatly, from as short as 2.75 m (9.0 ft) to as long as 10.49 m (34.4 ft).[3] The average length in a living person is 3m-5m.[4][5] The length depends both on how tall the person is and how the length is measured.[3] Taller people generally have a longer small intestine and measurements are generally longer after death and when the bowel is empty.[3]

It is approximately 1.5 cm in diameter in newborns after 35 weeks of gestational age,[6] and 2.5–3 cm (1 inch) in diameter in adults. On abdominal X-rays, the small intestine is considered to be abnormally dilated when the diameter exceeds 3 cm.[7][8] On CT scans, a diameter of over 2.5 cm is considered abnormally dilated.[7][9] The surface area of the human small intestinal mucosa, due to enlargement caused by folds, villi and microvilli, averages 30 square meters.[10]

Parts

The small intestine is divided into three structural parts.

  • The duodenum is a short structure ranging from 20 cm (7.9 inches) to 25 cm (9.8 inches) in length, and shaped like a “C”.[11] It surrounds the head of the pancreas. It receives gastric chyme from the stomach, together with digestive juices from the pancreas (digestive enzymes) and the liver (bile). The digestive enzymes break down proteins and bile and emulsify fats into micelles. The duodenum contains Brunner’s glands, which produce a mucus-rich alkaline secretion containing bicarbonate. These secretions, in combination with bicarbonate from the pancreas, neutralize the stomach acids contained in gastric chyme.
  • The jejunum is the midsection of the small intestine, connecting the duodenum to the ileum. It is about 2.5 m long, and contains the plicae circulares, and villi that increase its surface area. Products of digestion (sugars, amino acids, and fatty acids) are absorbed into the bloodstream here. The suspensory muscle of duodenum marks the division between the duodenum and the jejunum.
  • The ileum: The final section of the small intestine. It is about 3 m long, and contains villi similar to the jejunum. It absorbs mainly vitamin B12 and bile acids, as well as any other remaining nutrients. The ileum joins to the cecum of the large intestine at the ileocecal junction.

The jejunum and ileum are suspended in the abdominal cavity by mesentery. The mesentery is part of the peritoneum. Arteries, veins, lymph vessels and nerves travel within the mesentery.[12]

Blood supply

The small intestine receives a blood supply from the coeliac trunk and the superior mesenteric artery. These are both branches of the aorta. The duodenum receives blood from the coeliac trunk via the superior pancreaticoduodenal artery and from the superior mesenteric artery via the inferior pancreaticoduodenal artery. These two arteries both have anterior and posterior branches that meet in the midline and anastomose. The jejunum and ileum receive blood from the superior mesenteric artery.[13] Branches of the superior mesenteric artery form a series of arches within the mesentery known as arterial arcades, which may be several layers deep. Straight blood vessels known as vasa recta travel from the arcades closest to the ileum and jejunum to the organs themselves.[13]

Gallstones, Hepatitis, or Cirrhosis

HEPATOBILIARY DISEASE: DEFINED AND EXPLAINED

UntitledWhen you are diagnosed with gallstones, hepatitis, or cirrhosis of the liver, it’s doubtful that you are thinking of the whole system of which the liver and gallbladder are only single parts. While these are hardly insignificant parts, it may be helpful to understand that they are important cogs in a machine known as the hepatobiliary system. This system is essential for digestion and includes the liver, pancreas, bile ducts and the gallbladder.

Several ailments (hepatobiliary disease) can affect this system. Hepatobiliary disease includes a varied group of diseases of the liver and biliary system caused by viral, bacterial, and parasitic infections, cysts and tumors, toxic chemicals, alcohol consumption, poor nutrition, metabolic disorders, and cardiac failure. The two predominant diseases of the liver in the United States are viral hepatitis and cirrhosis; the predominant chronic disease of the biliary system is gallstones (cholelithiasis).

The liver is one of the largest organs in the human body and has many functions including:

  • Processing food and changing it into energy
  • Breaking down toxic substances in the body
  • Storing iron reserves, as well as vitamins and minerals
  • Creating bile, which aids in digestion

The pancreas is an organ behind the stomach and in front of the spine. The two primary functions of the pancreas are to produce fluids to help break down food and to produce hormones that help control blood sugar levels.

The biliary tract consists of the gallbladder and duct system. After being produced by the liver, bile is secreted into the bile ducts and stored in the gallbladder. Bile aids in the digestion of fats.

Often hepatobiliary diseases require surgery as part of treatment. Dr. Matthew Johnson is a Las Vegas Board Certified Robotic Surgeon, specializing in hernia surgery, foregut surgery, and hepatobiliary surgery. He also cares for patients in the fields of general surgery, trauma & acute care surgery, and critical care. To schedule an appointment with Dr. Johnson to discuss your robotic surgery options, call his clinic at (702) 369-7152.

Matthew Johnson MD Robotic Surgeon, GI General Surgeon, Trauma & Critical Care Surgeon Offers Three Locations in the Las Vegas Area.

MATTHEW JOHNSON, MD Trauma Surgeon, General Surgeon &
Critical Care Surgeon
Dr. Matthew Johnson is a very compassionate surgeon that always takes extra time when communicating with his patients as well as their families regarding their care. He is driven, kind, and extremely innovative in the field of surgery. He is also one of the few surgical endoscopists in the country. In 2011, as a chief resident, he received the Professionalism Award at the University of Nevada School of Medicine and continues to emphasize this professionalism throughout his surgical practice. He is very well respected by his colleagues in the field and always strives for perfection.

Dr. Johnson did his undergraduate training at the University of Texas at Austin and is a faithful Texas Longhorn to this day. He subsequently attained his Medical Doctorate at the American University of the Caribbean, in St. Maarten, N.A. where he also attained a Masters in Medical Science (M.M.S.). Dr. Johnson’s residency training was completed at the University of Nevada School of Medicine, Las Vegas, NV in General Surgery (2005-11).

He then went on to become one of the early fellows in the country to complete an Acute Care Surgery fellowship at the University of Nevada School of Medicine, Las Vegas, NV (2011-13). During his residency and fellowship, Dr. Johnson also trained in Surgical Endoscopy with a specific emphasis on both diagnostic & therapeutic ERCP. In fact, along with other colleagues, he developed a new method for treating obstructing complicated biliary disease using combined cholecystectomy and ERCP in a one stage procedure, so-called the “One-Step/ELBS”. Throughout residency and fellowship, Dr. Johnson presented at many national conferences regarding ERCP use by surgeons for trauma and general surgery in addition to authoring several publications.
Following post-graduate training, Dr. Johnson joined Desert Surgical Associates and hit the ground running. He cares for patients in the field of general surgery, minimally invasive surgery, trauma, and critical care. Dr. Johnson’s specific interests involve minimally invasive robotic surgery, advancement of minimally invasive surgery in trauma patients, foregut surgery, hepatobiliary surgery and the use of ERCP for both diagnostic and therapeutic measures.

Patients can schedule and appointments with Dr Johnson at three locations in Las Vegas by calling 702-369-7052

Central: Maryland Parkway at Sunrise Hospital, North Tenaya, across from Mountain View Hospital and in Henderson.

 

 

Matthew Johnon, MD Vegas Robot Doc GI Surgeon, Trauma Surgeon, Critical Care Surgeon

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Matthew Johnson, MD is a team member at Desert Surgical Associates (DSA).

Dr Johnson performs GI, trauma and critical care surgeries.

Gastrointestinal (GI) diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.

Gallstones

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The best test for gallstones is an ultrasound. It’s quick and safe and gives us a lot of information about how the gallbladder looks, and it has pretty high accuracy. The ultrasound tech will be able to see gallstones or gallbladder irritation, such as a thickened wall or fluid around the gallbladder.

Some patients may be referred for a second kind of test called an HIDA (hepatobiliary) scan, in which a radioactive chemical is injected into your arm and the tech watches what happens when it reaches your gallbladder. Generally, HIDA scans are only performed on patients who have other underlying conditions or who have gallbladder pain symptoms, but no stones on an ultrasound.

Escaped stones could lead to jaundice or pancreatitis and require surgery.

If it’s not causing symptoms, or if you pass it as a few lucky people do, nothing. But if they are causing trouble,the gallbladder may need to be removed. If the person is experiencing pain, called biliary colic, or develops a gallbladder infection, called cholecystitis, gallbladder surgery is probably needed.

If the stones get outside your gallbladder and travel down the duct, they can cause some pretty serious complications, so it’s important to have them taken care of if you’re having a problem.

Escaped stones can cause obstructions in the ducts that lead to jaundice or pancreatitis, Any of these symptoms would require gallbladder surgery, called cholecystectomy.

Gallbladder removal surgery is usually an outpatient procedure, with a short recovery time and for most people,no long-lasting effects.

Benefits of Robotic Surgery

Dr Johnson new portrait

Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions. It is also sometimes used in certain traditional open surgical procedures.

About robotic surgery

Robotic surgery with the da Vinci Surgical System was approved by the Food and Drug Administration in 2000.  The technique has been rapidly adopted by hospitals in the United States and Europe for use in the treatment of a wide range of conditions.

The most widely used clinical robotic surgical system includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3-D view of the surgical site. The surgeon leads other team members who assist during the operation.

Advantages

Surgeons who use the robotic system find that for many procedures it enhances precision, flexibility and control during the operation and allows them to better see the site, compared with traditional techniques. Using robotic surgery, surgeons can perform delicate and complex procedures that may have been difficult or impossible with other methods.

Often, robotic surgery makes minimally invasive surgery possible. The benefits of minimally invasive surgery include:

  • Fewer complications, such as surgical site infection
  • Less pain and blood loss
  • Quicker recovery
  • Smaller, less noticeable scars