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Esophagus is the food pipe through which food passes, from the pharynx to the stomach. It is about 25 cm long in adults. The esophagus may be affected by gastric reflux, cancer, prominent dilated blood vessels called varices that can bleed profusely, and disorders of motility. Diseases may cause difficulty in swallowing (dysphagia), painful swallowing (odynophagia), chest pain, or cause no symptoms at all. Clinical investigations include X-rays when swallowing barium, endoscopy, and CT scans.
- Oesophageal malignancy or corrosive stricture = Oesophagectomy with Oesophageal Replacement (stomach or colonic conduit) – Transthoracic or transhiatal.
- Zenker’s diverticula = Esophageal Diverticulectomy.
- Gastroesophageal reflux disease (GERD) = Laparoscopic Fundoplication.
The stomach is located between the esophagus and the small intestine. Its main function is digestion and storage of food. The stomach may be affected by gastritis, peptic ulcer disease, stomach cancer and pyloric stenosis. Diseases may cause pain in epigastric region, non bilious vomiting, early satiety and abdominal fullness.
- Stomach cancer = Distal gastrectomy, subtotal or total gastrectomy.
- Pyloric stenosis = Pyloromyotomy.
- Palliative Procedures = Laparoscopic / Open Gastro-jejunostomy, Celiac Plexus Block
Small Intestine is a part of the gastrointestinal tract between the stomach and the large bowel. The small intestine has three parts- Duodenum, Jejunum and Ileum. The primary function of small bowel is the absorption of nutrients and minerals from food. Small bowel may be affected by appendicitis, meckel’s diverticula, strictures and malignancy.
- Acute appendicitis = Laparoscopic Appendectomy
- Meckel’s diverticula = diverticulectomy.
- Benign strictures or malignancy = Resection & Anastomosis.
Large intestine is the last part of the gastrointestinal tract. Water is absorbed here and remaining waste material is stored as feces before being removed by defecation. It has two parts- colon and rectum. Large bowel may be affected by Inflammatory Bowel Disease, Acute Inflammatory Diseases, Rectal Prolapse, Haemrroids and Malignancy. Disease may cause constipation, blood in stool, and abdominal distension.
- Segmental Colonic Resections- Right/left hemicolectomy, Transverse colectomy, sigmoidectomy.
- Total abdominal colectomy with Ileorectal anastomosis.
- Total proctocolectomy with ileal pouch anal anastomosis.
- Lap anterior resection.
- Lap Abdomino-perineal Resections.
Gallbladder is a hollow organ where bile is stored and concentrated before it is released in small intestine. Humans can live without a gallbladder. Common gallbladder problems are gallstone disease and cancer, they usually manifest with pain in right upper abdomen or found incidentally.
- Gallstone Disease: Laparoscopic cholecystectomy.
- Gall Bladder Cancer: Radical Cholecystectomy including Multiorgan Resections +/- Wedge/ anatomical liver resection + Extended portal lymphadenectomy.
Bile duct is a long tube like structure that carry bile from liver to gastrointestinal tract. Bile, required for the digestion of food. Blockage of the bile duct by stones, scarring from bile duct injury, or cancer prevents the bile from being transported to the intestine and the active ingredient in the bile (bilirubin) instead accumulates in the blood. This condition results in jaundice, where the skin and eyes become yellow from the bilirubin in the blood. This condition also causes severe itching/pruritis from the bilirubin deposited in the tissues. In certain types of jaundice (surgical obstructive jaundice), the urine will be noticeably darker, and the stools will be much paler than usual.
- Choledochal Cysts: Excision of Choledochal Cyst with Hepaticojejunostomy.
- Biliary Atresia: Kasais procedure, Liver Transplant.
- CBD Stone: Laparoscopic / Open CBD Exploration, Choledocodudenostomy or hepaticojejunostomy.
- Bile Duct Strictures: Roux en Y Hepaticojejunostomy.
- Bile Duct cancer (hilar cholangicarcinoma) : Right/Left extended hepatectomy with Caudate Lobe Resection +/- portal venous resection.
Pancreas is a digestive organ, secreting pancreatic juice containing digestive enzymes that assist digestion and absorption of nutrients in the small intestine. It is also an endocrine organ producing several important hormones, including insulin, glucagon, somatostatin, and pancreatic polypeptide which circulate in the blood and have important role of blood sugar control within the body. Anatomically, the pancreas is divided into head, neck, body and the tail of pancreas. The head is surrounded by the duodenum in its concavity. Common conditions that may affect pancreas are inflammation of pancreas (pancreatitis) or pancreatic cancer, which usually manifests as pain in upper abdomen radiating to the back, and sometimes with jaundice.
- Acute severe necrotizing pancreatitis = lap/open necrosectomy.
- Pancreatic pseudocyst= lap/open cystogastrostomy/cystojejunostomy.
- Chronic pancreatitis= Drainage procedure (Lateral pancreaticojejunostomy), Drainage + Resection procedure [head coring with Lateral pancreaticojejunostomy (Frey’s procedure), Whipple’s pancreatico-duodenectomy].
- Periampullary carcinoma= Whipple’s pancreatico-duodenectomy +/- Portal venous resection.
- Carcinoma body & tail of the pancreas= Distal pancreatectomy with or without splenectomy (spleen preserving).
The liver is a vital organ and it has a wide range of functions, including detoxification of various metabolites, protein synthesis, and the production of biochemicals necessary for digestion. Liver is the only organ that has a remarkable capacity to regenerate and grow back again. The classic symptoms of liver damage are Pain in the upper right quadrant, Jaundice (yellow skin and/or whites of the eyes), Swelling of the abdomen, ankles and feet, Pale stools, Dark urine, Excessive fatigue and Bruising and easy bleeding.
Portal hypertension is an increase in pressure within the portal venous system and its branches, which draining most of the intestine to the liver. It is defined as a hepatic venous pressure gradient equal to or more than 5 mm of hg. The most common cause of portal hypertension is liver cirrhosis followed by non cirrhotic portal hypertension (NCPH).
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Frequently Asked Questions
Any amount of alcohol can produce damage to the liver. In an otherwise healthy person with no underlying liver problems, the general rule of thumb is different for men and women:
Men metabolize and are able to clear alcohol more efficiently than women due to body size, body fat, and certain enzymes, so they should limit to three to four drinks in a day.
Women, because of the same reasons, should limit themselves to one to two drinks a day.
Beer and wine are not “safer” than whiskey or spirits. One drink is defined as one shot (1 and 1/4 ounces) of whiskey or spirits, one four-ounce glass of wine, or one 12-ounce beer. If an individual has an underlying liver condition such as hepatitis B or C, or prior damage from alcohol or other diseases, the liver is very sensitive to any amount of alcohol. In those conditions, the only safe dose of alcohol is zero.
The liver is a unique organ. It is the only organ in the body that is able to regenerate. With most organs, such as the heart, the damaged tissue is replaced with a scar, like on the skin. The liver, however, is able to replace damaged tissue with new cells. If up to 50 to 60 percent of the liver cells may be killed within three to four days in an extreme case like a Tylenol overdose, the liver will repair completely after 30 days if no complications arise. Complications of liver disease occur when regeneration is either incomplete or prevented by progressive development of scar tissue within the liver. This occurs when the damaging agent such as a virus, a drug, alcohol, etc., continues to attack the liver and prevents complete regeneration. Once scar tissue has developed it is very difficult to reverse that process. Severe scarring of the liver is a condition known as cirrhosis. The development of cirrhosis indicates late-stage liver disease and is usually followed by the onset of complications.
There are vaccines to prevent hepatitis A and B. Hepatitis B is a disease that could be completely eradicated with universal vaccination. It is now one part of the newborn vaccination series. Attempts are ongoing to vaccinate all children by the time they reach junior high age. Adults who are in high-risk occupations such as the healthcare field or carry out high-risk activities, such as IV drug use and multiple sexual partners, should also be vaccinated. Hepatitis A vaccine is recommended in a number of child-care settings and should be discussed with your pediatrician. Adults or children travelling to areas of the world where hepatitis A is very common, including all underdeveloped or poorly developed countries, should be vaccinated before they go. Any individual with underlying chronic liver disease that is not due to hepatitis B, particularly those with hepatitis C or cirrhosis, should be vaccinated against both hepatitis A and hepatitis B unless they are already immune.