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COLON / RECTAL CANCER OVERVIEW Colon cancer is cancer of the large intestine while rectal cancers occur in the last part of the colon. The two are combined and known as colorectal cancers and often begin as non-cancerous tissues known as polyps. The polyps over a period of time grow into cancerous cells. Polyps themselves do not have any symptoms but with their metamorphosis into cancerous cells they begin to exhibit certain evident symptoms. Regular check-up to identify the presence of polyps and their removal is suggested to ensure that the risk of colon cancer is lowered. Colorectal Cancer is caused by the genetic mutation of cells turning them from normal to abnormal cells in the colon. The exact cause of the mutation is yet unascertained. Adhering to a healthy lifestyle and staying away from smoking, drinking & drug abuse helps decrease the risk of cancer. Including fibers in diet and following a healthy fitness regime is also helpful. SYMPTOMS The common symptoms of Colorectal Cancer can be enumerated as the following • Rectal bleeding or blood in stools • Frequent diarrhea or constipation • Abdominal discomfort - gas, cramps etc., • Unexplained weight loss • Excessive & frequent fatigue CAUSES & RISK FACTORS Colorectal Cancer is caused by the genetic mutation of cells turning them from normal to abnormal cells in the colon. The exact cause of the mutation is yet unascertained. A low-fiber, high-fat diet also increases the risk of colorectal cancer as does type-2 diabetes, sedentary lifestyle and excessive smoking and drinking. Diagnosis Stool test Colonoscopy (painless) Sigmoidoscopy
GERD OVERVIEW The Gastroesophageal reflux is commonly known as Acid reflux. It is a chronic digestive disorder wherein the stomach acids or contents flow back into the esophagus. The disease is characterized by a burning sensation in the chest region, chest pain, difficulty in swallowing, dry cough and lumpy sensation in the throat. The disease is easily mistaken with heartburn due to the similarity of symptoms. In most cases, people can overcome the effects of acid reflux in the natural course. However, in certain cases medical attention and treatment is necessary. People who are more likely to develop the disease include those with obesity issues, smoking habit, diabetes and constipation. Chronic occurrence of the disease in due course could lead to a narrowing of the esophagus or result in sores of the esophagus. In some extreme cases acid reflux could culminate in esophageal cancer, the occurrence of which is considerably low. SYMPTOMS The common symptoms of Acid Reflux can be enumerated as the following • Burning sensation in the chest area • Problems in swallowing • Dry cough • Lumpiness in the throat • Regurgitation of food CAUSES & RISK FACTORS Lifestyle factors play a critical role in the incidence of acid reflux. Factors such as obesity, excessive weight gain and smoking greatly increase the risk while pre-existing health conditions frequent constipation, diabetes, asthma and others also add to the risk. Complication Bleeding Stricture Respiratory symptoms not responding to treatment Barrets esophagus Cancer Diagnosis UGI Endoscopy (Painless) PH monitoring Manometry
Endoscopic Retrograde Cholangiopancreatography - Procedure and Results..Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater. This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen. This is inserted through the patient’s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient’s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor’s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts. ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include: • Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs. • Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine. • Persistent upper abdominal pain • Unexplained weight loss and loss of appetite • Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient’s needs.
What is Nonalcoholic Fatty Liver Disease (NAFLD)? In healthy individuals, the liver contains little or no fat. In overweight or obese people, gradual fat accumulation leads to significant liver disease. Interestingly, these individuals may be consuming minimal to no alcohol. So, alcohol, which is the main cause for liver damage, does not have a significant role to play. The non-alcoholic fatty liver disease (NAFLD) has 4 significant stages as outlined below. It is a chronically progressive disease and may take years to reach the final stages of cirrhosis and fibrosis. 1. Simple fatty liver (steatosis): This is usually identified when diagnostic tests are done for some other suspected conditions. There are usually no symptoms obvious in this stage, other than the buildup of fat in the liver. 2. Non-alcoholic steatohepatitis (NASH): The second stage where the liver is inflamed to a greater extent due to fat accumulation. 3. Fibrosis: The next degree of inflammation where blood vessels may be narrowed leading to scarring in the liver with impaired liver functions. 4. Cirrhosis: This is the most severe stage that occurs due to years of cumulative inflammation. The liver shrinks in size, is scarred, and liver functions are markedly impaired and can also result in liver cancer. Risk factors for NAFLD: The exact reason why a person develops NAFLD is not established, but some of the risk factors include 1. Obesity, with more weight concentrated around the abdomen 2. Type 2 diabetes 3. High blood pressure 4. High cholesterol levels 5. Age greater than 50 6. Smoking Symptoms: This will depend on the stage in which it is identified. While there are no symptoms in the early stages, in some people there could be a dull, aching below the ribs, unexplained weight loss, weakness, and extreme tiredness. As it progresses to cirrhosis, there could be jaundice, fluid accumulation in the abdomen and feet, and itching of the skin. Management: While there is no treatment aimed at curing the disease per se, there are ways to manage the symptoms, as noted below. 1. Weight loss: Reducing excess accumulated fat will help reverse symptoms and prevent further progression of the disease. A BMI of 18 to 26 is considered optimal. 2. Dietary changes: Modify your diet to a carbohydrates and protein rich and reduced fats and sugars. Increasing fiber through fruits and vegetables is highly recommended. 3. Exercise: Whatever your choice of workout, it will do wonders for NAFLD. Keep a target of an hour or two of moderate to intense exercise per day to reduce weight. 4. Smoking: This is another risk factor and can also help prevent other effects of NAFLD such as diabetes and heart disease. NAFLD is highly controllable with these changes and other damages can be reversed too. If you wish to discuss about any specific problem, you can consult a gastroenterologist.