Liver Cancer Treatment Surgery Chandigarh

What are the symptoms of liver cancer?

Symptoms of liver cancer vary widely and may include

  • Fatigue
  • Jaundice (yellowness of the skin)
  • Pain
  • Easy bruising or bleeding
  • Swelling of abdomen
  • Weight loss.
  • What are the risk factors for liver cancer?

    • Viral hepatitis such as hepatitis B and C
    • Regular alcohol consumption
    • Cirrhosis – cirrhosis due to any cause increases the risk of liver cancer
    • Diabetes – It can result in fatty liver disease and thus leading to hepatitis and predisposes to cancer.
    • Non alcoholic fatty liver disease – it can lead to inflammation of liver cell thus predisposing to formation of cancer.
    • Hereditary conditions like hemochromatosis( iron deposition in liver), Wilson disease ( copper deposition in liver)
    • Aflatoxins – consumption of food product infected with fungus producing aflatoxins can also produce liver cancer

    How can liver cancer be prevented?

    Prevention is very important when it comes to a disease like liver cancer. The underlying cause of liver cancer is often liver inflammation and the development of a condition called Cirrhosis.  In addition to avoidance of drugs and alcohol, infection (such as Hepatitis B or C) and obesity can contribute to the development of liver cancer.

    Steps to minimize these risks include

    • Vaccination against hepatitis B for those at risk,
    • Prompt treatment for patients infected with hepatitis C,
    • Maintaining a healthy weight through diet and exercise.
    • Avoidance of alcohol
    • Good control of diabetes.

    How is liver cancer detected?

    Patients diagnosed at an earlier stage have better outcomes. There are many strategies that are used to detect liver cancer, including.

  • Frequent imaging studies (ultrasoundcomputed tomography scanmagnetic resonance imagining) in high risk patients.
  •  Routine physical exams with blood testing in high risk patients.
  • Several researchers are looking to find the one blood test that will help identify liver cancer much sooner. Until that time, we continue to remain vigilant and screen with a variety of methods to try to catch this disease as early as possible.

    Are fatty liver disease and liver cancer related?

    Fatty liver disease progressing onto non-alcoholic fatty liver disease(NAFLD) and non-alcoholic steatohepatitis(NASH) can result in cirrhosis of the liver. Cirrhosis of the liver predisposes the patient to liver cancer. The fatty liver itself does not predispose a patient to cancer however if it is controlled at an early stage before it progresses onto cirrhosis then the risk of liver cancer is negligible.

    What is the optimal treatment of liver cancers?

    In general, the basic approach of any cancer therapy can also apply to liver cancer. The treatment of the local disease. In liver cancer, we often address the local disease with:

  • Surgery (removal of the tumor) – treatment of choice for patients
    without cirrhosis of the liver.
  • Liver transplantation – it is the treatment of choice in patients with
    cirrhosis provided tumor size and number criteria are met. It takes
    care of cirrhosis of the liver also.
  • Radiation therapy
  • Local ablation of the tumor by radiofrequency
  • Catheter-directed chemotherapy or embolization.
  • Are herbal medicines recommended to treat liver cancer?

    The term ‘herbal medicine’ can represent thousands of compounds. Unfortunately, most are not rigorously tested or regulated by the companies that produce them, so real evidence of any benefit is not known. In fact, they may have harmful side effects that one comes to know only after using them.

    Should I be worried if I have a cyst on my liver?

    There is often nothing to worry about with simple cysts in the liver. They can be quite common. When we find cysts that are growing, we will often take extra care to ensure that

    • There is not an associated tumor causing the growth
    • That cyst is not causing problems.

    This is often discussed over time with your hepatologist and/or liver surgeon who can help in differentiating malignant ( cancerous) cysts from nonmalignant ones.

    What should I do if some lesion is found in the liver on a regular check-up?

    Lesions in the liver on ultrasound can be of many types

    Non-cancerous

    • Hemangioma ( abnormal formation of blood vessels)
    • Abscess ( pus collection in liver)
    • Granulomas in liver- because of TB , Sarcoidosis etc.
    • Cysts of liver – that can be simple cyst or hydatid cysts ( worm infestation)

    Cancerous

    • Primary liver cancer
    • Metastatic tumor from some other organ- liver is most common site of spread of tumors from other abdominal organs.
    • Neuroendocrine tumor of liver
    • Malignant cysts of liver

    A hepatologist or liver surgeon can help you in guiding you towards diagnosis and treatment by carrying out relevant investigations.

    If a parent had/has liver cancer, are their children at greater risk of getting it?

    In some cases, yes, a parent with liver cancer can raise your personal risk e.g in hereditary disease as Hemochromatosis, or Wilson’s disease. However, this is not true for the majority of patients. It’s always good to talk to your primary care doctor about your concerns or questions.

    Colon and Rectal Cancer Treatment

    What is colon?

    A colon, also called the large intestine or large bowel, is part of the bodys digestive system. The colon is a muscular tube about five feet long and three inches wide. During digestion, food moves from the stomach to the small intestine and then to the colon. The colon absorbs water and nutrients from the bodys waste, creates stool and then pushes that stool into the rectum

    What is the differences between colorectal, colon and rectal cancer?

    Colorectal cancer is the term used to describe cancer of the colon and/or rectum. The two cancers are grouped together because they share many common characteristics. Together, the colon and rectum make up the large intestine, a question mark-shaped bowel four feet in length. Colon cancer develops in all but the last few inches of the large intestine, between the appendix and rectum. Rectal cancer develops in the rectum, the last few inches of the large intestine that attaches to the anus. Colon cancer is more common.

    Colon and Rectal cancer

    What are polyps?

    A polyp is a clump of cells that forms on the lining of the colon giving rise to swelling that project from wall of colon into lumen of colon. Most polyps are not harmful, but some may develop into colon cancer. Colonoscopies can help detect pre-cancerous polyps

    What are sign and symptoms of colon cancer?

    Colorectal cancer may develop when benign polyps in the large intestine grow and become cancerous. If early-stage colorectal cancer does cause symptoms, early warning signs may include sudden weight loss and/or narrow, ribbon-like stools. Other common early warning signs of colorectal cancer include:

    • Rectal bleeding, either bright or dark red in color
    • Tenesmus, which is the feeling that you have to empty your bowel but nothing passes
    • Anemia caused by iron deficiency
    • Persistent abdominal pain
    • As the cancer grows, symptoms may include:
    • Abdominal pain or cramps
    • Constipation
    • Diarrhea
    • Blood in your stool
    • Bloating or a sense of not feeling empty after a bowel movement
    • Flat or ribbon-shaped stool
    • Unexplained weight loss
    • Fatigue
    • Loss of appetite

    What are risk factors for colon cancer?

    A risk factor is something that increases your chances of getting a disease. Having a risk factor does not mean that you will definitely get a disease, only that you and your doctor should watch more carefully for warning signs. Some risk factors can be avoided through lifestyle changes and some cannot. Some of the risk factors for colon cancer include:

    • Age 50 or older
    • Type-II diabetes
    • Personal or family history of colon cancer or polyps
    • Personal history of inflammatory bowel disease
    • Some inherited genetic syndromes
    • Diet high in fat and/or low in fiber or calcium
    • Obesity
    • Smoking
    • Heavy drinking
    • Physical inactivity

    How is colon cancer diagnosed?

  • Doctors use many tools and techniques to diagnose colon cancer including:
  • History and physical examination by physician
  • Testing blood and stool
  • Performing colonoscopies
  • Performing CT scans, PET scans, MRIs, endoscopies and ultrasounds
  • How can we prevent / decrease risk of colon cancer?

    The risk factors for colorectal cancer may be reduced with regular checkups and lifestyle changes. In western countries it is recommended that men and women have acolonoscopybeginning at age 50 as the rates of cancer are higher in west. If you have a family history of colorectal cancer, you should get screened 10 years earlier than when your family member was diagnosed. For example, if your father was diagnosed with colon cancer at 48, you should talk to your doctor about getting a colonoscopy at 38. Talk to your doctor about how often you should get a colonoscopy. The procedure may be able to help your doctor spot cancer in its early stages. Pre-cancerous polyps are removed andbiopsies areperformed during the procedure, if necessary.

    Changes in your lifestyle may also help you lower your risk and prevent colorectal cancer from developing. Obesity, smoking, alcohol, diet and a sedentary lifestyle have been linked to an increased risk for colorectal cancer

    Is colon cancer hereditary?

    Colorectal cancer isnt always passed down in families, but it can be. If someone in your family has had colorectal cancer, you may be more likely to develop it.

    Colorectal cancer can sometimes be caused by Lynch syndrome, a genetic condition also called hereditary nonpolyposis colorectal cancer (HNPCC). About one in 30 colorectal cancer cases are a result of Lynch syndrome. Patients with Lynch syndrome tend to get colorectal cancer at a younger age than others, with a higher likelihood of developing other types of cancer as well, such as:

    • Stomach cancer
    • Liver Cancer
    • Ovarian Cancer
    • Uterine Cancer

    How is colon cancer treated?

    Surgeryis the most commonform of treatment for colorectal cancer. Surgery is used to remove the tumor and surrounding tissue. A portion of the colon or rectum may need to be removed, and acolostomy( part of colon is brought out through abdominal wall and bag if fixed over it in which stool gets collected)may be required permanently or temporarily, depending on the extent of the cancer and how much of the colon or rectum is removed. Other treatment options include chemotherapy and/or targeted therapy drugs, which may also be used in addition to surgery.Radiation therapy is usually an option only for rectal cancer, not colon cancer.

    What types of doctors will I see during my treatment?

    Your colorectal cancer care team may include one or more of these doctors:

    • A gastroenterologist, who specializes in the digestive system and performs colonoscopies
    • Surgical gastroenterologist/ GastroIntestinal Surgeon – who performs surgery to remove tumors and provide best functional outcome e.g pouch formation in case of hereditary cancers. If disease is early only surgery can be curative.
    • A radiation oncologist, who uses radiation therapy to treat cancer
    • A medical oncologist, who treats cancer with drug therapies.

    Surgery is the mainstay of treatment in colon cancer. Preoperative chemoradiation is used in rectal cancer in locally advanced cases. Surgeon can assess the local stage of disease on scans and thus can plan upfront surgery or chemoradiation. Postoperative chemotherapy/radiation therapy is decided after final stage of disease is determined after examining removed specimen.

     Hepato Biliary Surgery

    What is hepato biliary system?

    Hepatobiliary system involves combination of liver and its ductal system(hepatic ducts, bile duct and gall bladder) draining bile (juice secreted by liver) from liver to intestine.

    What are diseases that can affect hepatobiliary system that require surgery?

    Hepato biliary disease treatment is best achieved by multimodality approach with involvement of Medical gastroenterologist, Interventional radiologist and Hepatobiliary surgeon. Diseases that require surgery are

    1. Liver cancer
    2. Cysts of liver
    3. Cancer from other organs that have spread to liver
    4. Stones in liver and bile duct ( can be treated with endoscopy also)
    5. Neuroendocrine tumor in liver.
    6. Liver abscess
    7. Tumors of bile duct ( cholangiocarcinoma)
    8. Gall bladder cancer
    9. Shunt surgery for bleeding varices;
    10. Bile duct stricture and fistula

    How hepatobiliary surgeon can score over general and oncosurgeons in treating these diseases?

    Hepato biliary system is very complex system that involves not only dealing with liver but also its complex blood supply and bile ductal system. As surgery is main modality of treatment so every effort is made to convert the unresectable tumors to resectable stage with help of radiology and other interventions. This is possible only if case is initially assessed by hepatobiliary surgeon who can plan resection in such a way that tumor is also removed completely and adequate amount of liver is also left that is compatible with survival.

    How much liver can be removed safely?

    In patients with normal liver around 75% of liver can be removed safely and person can lead normal life. However in case of diseased liver e.g cirrhosis , jaundice etc ,more amount of liver needs to be left behind for person to lead normal life.

    Is it safe to operate on patients with jaundice or with liver disease?

    Before operating upon patient with jaundice every effort is made to lower jaundice by various means e.g stenting, putting catheter in liver to drain bile duct. After bilirubin decreases to near normal levels then surgery is planned.

    Why liver or biliary surgery complex?

    Liver is a solid organ in which complex network of small bile ducts and blood vessels are hidden. Also bile duct and blood vessels are very closely associated outside liver. So tumors of liver and bile duct very commonly involve these blood vessels thus making surgery complex. Moreover as they are hidden inside liver, surgery is planned by preoperative imaging and intraoperative marking that is possible for surgeon regularly involved in doing hepatobiliary surgery. These planes have to be followed otherwise lot of bleeding can happen that is dangerous for patient.

    Who should consult hepatobiliary surgeon?

    Any patient suffering from any of diseases mentioned above should always consult hepatobiliary surgeon before starting upon any form of treatment. As assessment by hepatobiliary surgeon increases chance of cure by resecting even advanced tumors.

    Do hepatobiliary surgeon treat gall baldder diseases also?

    Yes. Gall bladder is an important component of hepatobiliary system is most commonly diseased organ due increased prevalence of stone disease. Hepatobiliary surgeon treats gall bladder diseases more effectively as he is ready for all surprises that can be encountered with gall bladder diseases that are not detected before surgery e.g complicated gall bladder disease, ruptured gall bladder detected during surgery, gall bladder cancer detected during surgery etc. Hepatobiliary surgeon would be able to deal with all this during surgery.

    Does hepatobiliary surgeon treat CBD Stones also?

    Majority of stones in bile duct are managed by endoscopy done by medical gastroenterologist but in some cases stones are very large in size and are very high in numbers then surgery can be better choice of treatment in form of removal of stones or providing bypass to prevent recurrent stone formation.

    Acute and Chronic Pancreatitis Difference and Treatment

    What is the difference between acute pancreatitis and chronic pancreatitis?

    Acute pancreatitis is an isolated episode of abdominal pain accompanied by elevations
    in blood enzyme levels. Essentially, it describes active inflammation of the pancreas.
    More than 80 percent of the cases of acute pancreatitis are related to biliary stones or
    alcohol use. Acute pancreatitis may lead to chronic pancreatitis.

    Chronic pancreatitis is a painful disease of the pancreas in which inflammation has resolved, but with resultant damage to the gland characterized by fibrosis, calcification and ductal inflammation. It is possible for patients with chronic pancreatitis to have episodes of acute pancreatitis.

    What causes chronic pancreatitis?

    The most common cause of chronic pancreatitis are

    1. Alcohol consumption.
    2. Hyperparathyroidism (increased secretion from the parathyroid glands)
    3. Trauma to the pancreas.
    4. Tropical pancreatitis, a variant of chronic pancreatitis, is seen in tropical parts of
      Asia and Africa, and can affect children between 12 and 15 years of age.
    5. Recurrent acute pancreatitis..

    What are the symptoms of chronic pancreatitis?

    Symptoms of chronic pancreatitis range widely

    • Acute abdominal pain ranging from severe to mild radiating to back. The pain of chronic pancreatitis often radiates to the back, although it may radiate to both upper and lower quadrants. Sitting up and leaning forward may relieve or reduce discomfort
    • Vomiting
    • Epigastric tenderness
    • Weight loss
    • Steatorrhea( passing of undigested fat in stools)
    • Glucose intolerance/ Diabetes
    • Diarrhea which may be chronic (six or more bowel movements per day). The diarrhea is a result of fat malabsorption, which results in bulky, foul-smelling stools that may appear oily and float (steatorrhea).

    How is chronic pancreatitis diagnosed?

    Chronic pancreatitis is best diagnosed using historical information, serum enzymes,
    exocrine function and radiographic studies (X-rays), ultrasound abdomen, CT/MRI scan.
    Tests of exocrine function (fat absorption) are helpful.

    Are there any particular complications that result from chronic pancreatitis?

    Yes. Nutrient malabsorption, diabetes mellitus are main complications of chronic pancreatitis. Patients with chronic pancreatitis are also at increased risk of chronic pancreatitis.

    Malabsorption is faulty absorption of nutrients from the digestive tract. In chronic pancreatitis, malabsorption occurs after the capacity for enzyme secretion is reduced by more than 90 percent. Fat absorption suffers to maximum extent in case of chronic pancreatitis.

    Chronic pancreatitis affects the endocrine function of the pancreas, responsible for insulin and glucagon production.

    Diabetes is common in patients with chronic pancreatitis, and the incidence increases over time with the progression of the disease. Approximately 45 percent of patients with chronic pancreatitis will develop diabetes. Fortunately, the pancreatic form of diabetes is usually mild and the usual complications (retinopathy, nephropathy and vasculopathy) are uncommon. Neuropathic complications may occur with continued alcohol abuse or malnutrition.

    How is chronic pancreatitis treated?

    Treatment for chronic pancreatitis includes medical, endoscopic and surgical therapy.

    Can patients expect long-term relief of pain after surgery?

    Surgical intervention provides long-term relief of pain in 90 percent of patients. When
    patients have exhausted other avenues of treatment for pain relief, surgery should be
    considered.

    If I have chronic pancreatitis and am being treated, can I expect a full recovery from this disease?

    The changes of chronic pancreatitis are not reversible. However, it is possible to have
    control of pain and steatorrhea with medical, endoscopic, percutaneous or surgical
    treatment. Surgery provides the best relief of pain in short as well as long term. In
    addition to pain relief , surgery can slow down destruction of pancreas thus delaying
    onset of diabetes mellitus and malabsoption.

    Colorectal Surgery

    What are types of colorectal surgery?

    Colorectal surgeries are of various types depending on part of colon or rectum removed.

    Types of colorectal surgeries are –

    1. Hemicolectomy – removal of half of colon – right or left
    2. Segemental resection of colon – removal of part of colon
    3. Subtotal colectomy – removal of whole colon leaving small part behind
    4. Total colectomy – removal of whole colon
    5. Proctocolectomy- removal of whole colon and rectum
    6. Anterior resection – removal of part of rectum
    7. APR – Removal of rectum and anus.
    8. Rectopexy for rectal prolapse

     All these are types of surgeries done for various indications –

    1. Cancer of colon
    2. Cancer of rectum
    3. Colitis
    4. Benign tumor of colon or rectum.
    5. Colonic perforation
    6. Diverticulitis
    7. Rectal prolapse

    What is Colorectal surgery recovery time?

    Laparoscopic colorectal surgery  is gold standard in today’s time. Open colorectal surgery is thing of past these days. Just like laparoscopy is gold standard for gall bladder removal, laparoscopy is gold standard for colorectal surgery. since introduction of laparoscopy in colorectal surgery recovery time has decreased considerably and patients are usually discharged from hospital within 3-5 days as compared to 7-10 days after open surgery. Patient is able to eat and move around early as compared to open surgery.  Shorter hospital stay also decreases cost of colorectal surgery. 

    Risks involved in colorectal surgery?

    Various risks involved with colorectal surgery are

    1. Bleeding after surgery – very rare
    2. Leak from anastomosis ( joints of intestine)
    3. Infection
    4. Injury to ureter ( urine pipe)
    5. Urinary bladder disturbance due to nerve injury ( especially after rectal surgery)

    Facts and Myths About Gall Bladder Surgery

    facts-about-gall-bladder-surgery

    Gall bladder diseases are very common these days. These diseases range from innocuous gall stones to cancer of the gall bladder which has a very dismal prognosis. As a GASTROINTESTINAL SURGEON with HEPATOBILIARY experience we daily see cases from one extreme to another. The majority are simple gall stones and are managed at the periphery, however, what we receive are ones that are either left to be referred to as higher-level or are complicated ones. Many a times we also deal with cases that are operated elsewhere and become complicated and are then referred to us.

    So today in this blog I would like to discuss gall bladder diseases with a special focus on stone diseases. The most commonly asked questions in the patient’s mind are

    How are stones formed?

    Bile is juice produced by the liver and stored in the gall bladder and released when food reaches the small intestine. It is composed of bile salts, and pigments, and they are kept in solution form by mixing with cholesterol. So any change that disturbs this proportion of each component required to keep these in solution form can result in the formation of stones. For example diet rich in fats can result in high cholesterol components and can result in stone formation.

    How can we prevent formation of gall stones?

    Gall stones are usually formed by a mismatch in the concentration of cholesterol and bile salts in bile. So a balanced diet that is low in fats can help in decreasing the chances of gall stone formation.

    What are risks associated with gall stones?

    Gall stones can cause pain by themselves. They can result in jaundice if a stone slips into bile duct. It can cause pancreatitis which can be mild or life-threatening. The gall bladder neck can be blocked by stone resulting in huge distension of the gall bladder thus causing pain and can result in pus formation in the gall bladder. Large stones in gall bladder are risk factors for cancer of gall bladder.

    If they are not causing any trouble, should I undergo surgery?

    These are called asymptomatic stones. Asymptomatic stones usually do not require surgery unless
    a. Patient is having low immunity
    b. The patient is living in a place where medical facilities are meager.
    c. Patient is undergoing surgery of abdomen for some other reason
    Relative indications are
    i. Multiple small stones
    ii. Diabetic patient
    iii. Large stone

    Can we just remove stones and leave gall bladder behind?

    We have to remove the gall bladder as its functionally abnormal and stones would reform. Moreover cut on gall bladder heal very poorly.

    Will removal of the gall bladder affect my digestion?

    There is no effect on digestion if the gall bladder is removed. Body adapts to removal of gall bladder very well and digestion is not affected at all.

    What are dietary restrictions after gall bladder surgery?

    There is no dietary restriction and the patient can have a normal diet as before. Digestive system adapts well to removal of gall bladder and there is no effect on the digestion of food.

    Is it major surgery?

    Gall bladder removal surgery is performed by laparoscopy. It is successful in more than 99% of cases. Occasionally it is done by open surgery if anatomy is difficult or there is a risk of injury to important structures. But as the experience of the surgeon increases chances of conversion to open procedure decrease.

    Is it very painful?

    Laparoscopy surgery is done through small cuts made on your tummy ranging from 0.5-1 cm. these are small cuts and pain is minimum.

    Should we undergo open or laparoscopic surgery?

    That is to be decided by the surgeon operating upon you. As mentioned above large majority of procedures can be done by laparoscopy and needs open surgery only if surgery is difficult or in the presence of gall bladder cancer.

    How long does it take to remove gall bladder?

    Surgery is never about time. It is better to finish the procedure safely than quickly. It may take from 10 mintues to an hour depending upon anatomy.

    What are the risks of surgery?

    Apart from anaesthesia risk that depends upon general condition of patient gall bladder surgery carries minimum risk. Still there is a small but real risk of bleeding, injury to bile duct or injury to bowel.

    How long does it take to recover and get back to normal life?

    Gall bladder surgery is usually done as daycare surgery and the patient is send home same evening of surgery. The patient is up about a Few hours after surgery and starts his normal routine within a few days of surgery.

    How does the experience of the surgeon matter in gall bladder surgery?

    The experienced surgeon has fewer conversion rate and the chances of complication are less. Surgeon experienced in hepatobiliary or gastrointestinal surgery can handle the majority of complications on table and can provide better outcome in difficult cases.

    Why some people are unsatisfied after gall bladder surgery?

    Gallstones can cause abdominal pain, bloating, or discomfort after food intake and the complications listed above. Symptoms such as indigestion, heartburn, constipation and increased frequency of stools are very common in the general population and are not related to gallstones. Mostly when the patients / treating doctors try to correlate these symptoms with gallstones it leads to unhappiness as these symptoms may not get relieved by the removal of the gall bladder. So proper patient selection and counseling can help avoid the unsatisfied patient.

    Myths and Facts About Constipation

    Constipation is a common problem affecting people of all age groups. It has many definitions according to people understanding and myths. It is correlated with many symptoms and afflictions. Many problems are attributed to constipation and many homemade remedies are used to get over these problems. Basically we lack understanding of process of passing motion and thus have many wrong notions and myths about passing motion.

    “There is no standard when it comes to passing motion. Everyone’s system is different, so if you’re concerned about how many times a day you should pass motion, it really depends on your body. Some people pass motion three to four times per day, others pass it once a week – and they’re fine, not sick. Everything from motion’s consistency (soft or hard) and fecal size, to how long it takes the body to pass feces( stools) is based on the individual. At what time one should pass motion is different for different individual and depends upon his food consumption previous day. What’s important is to your track any changes in bowel habits.”

    When is time to consult your healthcare provider is when you notice the following changes in bowel habits:

    1. Uncomfortable bloating
    2. Pain while passing stools
    3. Extremely hard stools, difficult to push out, or thin stools
    4. Uncontrolled passage of stools, accidents in pants or bed
    5. Feeling the colon never completely empties
    6. Pooping, or lack thereof, disrupts day-to-day work and functionality

    Passing Gas

    It’d be hard to talk about passing of motion without mentioning passage of gas, or as some people call it, farting. Like passing stools, gas is related to bacteria in our digestive system, as well as the foods we eat.
    “Gas is a by-product of bacteria in our large intestine digesting leftovers of the foods we ate. Bacteria produce hydrogen, nitrogen, oxygen, carbon dioxide and methane. Yes, it’s the methane that explodes, if you fart near a flame. There is no healthy or unhealthy amount of gas. How much gas you pass and the odor largely depends upon what you have eaten.

    Foods that Make You pass stools easily

    It’s no surprise that what we eat determines how we pass motion, more or less. Eating foods high in fiber is well known for helping ease time spent on the toilet and producing voluminous, bulky stools, sometimes gas, too.

    “Fiber, both soluble and insoluble, holds moisture, keeping stools soft and bulky, which allows the colon to gently squeeze your stools through, as opposed to squeezing and straining to pass small hard bowel movements, possibly with cramping and discomfort.

    In addition to what you eat, how much you drink can also play a role.“Staying well-hydrated is important. You know you are well-hydrated if you’re urinating every three to five hours, and the urine is barely yellow. Generally, stools stays softer then, too.

    You can try these natural laxatives to ease passage of stools for occasional use:

    1. Apple juice
    2. Coconut milk/juice
    3. Aloe vera juice
    4. Coffee
    5. Tea
    6. Fiber supplements

    When is constipation a problem ?

    1. A sudden and recent change in the routine of passing stools
    2. Change in color of stool – black color
    3. Change in consistency and shape of feces
    4. Blood in stool
    5. Loss of weight and appetite along with any of the above symptoms

    Don’t be scared or shy in discussing these problems with your physicians as they may indicate development of tumor. These symptoms are more important in patients with family history of cancer. They should not cause worry as they are signs for early check up to catch disease at early stage.

    Diet in Patients With Gall Stones

    Gall stones occur when bile, which is normally fluid, forms stones in your gallbladder. This is the organ that sits beneath the liver. Most commonly, gallstones contain lumps of fatty (cholesterol-like) material that has solidified and hardened. Sometimes bile pigments or calcium deposits form gallstones. Sometimes just a few small stones are formed; sometimes a great many. Occasionally, just one large stone is formed.

    About one in three women and one in six men form gallstones at some stage in their lives. Gallstones become more common with increasing age. The risk of gallstones forming increases with:

    1. Pregnancy
    2. Obesity
    3. Diabetes
    4. Smoking
    5. Rapid weight loss
    6. Having a close relative with gallstones
    7. Taking certain medicines such as the contraceptive pill
    8. Eating a generally unhealthy diet, particularly a diet which is high in fat

    You can reduce your risk of developing gallstones by:

    Eating vegetable protein – for example, beans and pulses.

    1. Increasing fibre intake
    2. Eating nuts
    3. Increasing dietary calcium
    4. Increasing vitamin C intake
    5. Drinking coffee
    6. Drinking a moderate amount of alcohol.

    The role of the gallbladder in digestion

    The gallbladder plays a part in the digestion of food. It collects and stores bile, then releases the bile into the small intestine when food enters the small intestine from the stomach. This helps with the digestion of food because the gallbladder contains bile salts (and other substances) which break down fat. The bile duct which connects the gallbladder to the small intestine can become blocked by gallstones. This may cause symptoms such as pain, bloating, a feeling of sickness (nausea), and being sick (vomiting). The stone may cause a blockage and make it difficult for the bile to be released from the bile duct.

    Dietary changes to help with symptoms of gallstones

    There is no specific diet for treating symptoms of, or to prevent, gallstones. Most people with gallstones will have surgery to remove the gallbladder in an operation called a cholecystectomy. However, eating a low-fat diet is likely to reduce symptoms while you are waiting for the operation, as the gallbladder will not be stimulated to release bile into the small intestine. If you find that any particular foods trigger the onset of the pain then try to avoid eating those foods until you have had your gallbladder removed. Once you have had the operation there is no need to follow any particular diet, although of course it is always a good idea to eat as healthily as possible. If you are overweight, attaining a healthy weight will be beneficial. However, it is important to do this gradually, as rapid weight loss has been associated with the development of gallstones. A safe weight loss of 1-2 lbs (0.5 to 1 kg) per week is recommended

    A healthy balanced diet consists of:

    Plenty of fruit and vegetables. Aim to have at least five portions each day

    1. Plenty of starchy carbohydrates. Examples include bread, rice, cereals, pasta, potatoes, chapattis, and plantain. Choose wholegrain varieties where possible
    2. Some milk and dairy products (2-3 portions per day). Choose low-fat dairy products
    3. Some meat, fish, eggs, and alternatives such as beans and pulses
    4. Limited amounts of foods high in fats and sugars
    5. Limit saturated fat that is found in animal products, such as butter, ghee, cheese, meat, cakes, biscuits, and pastries. Replace these with unsaturated fats found in non-animal products, such as sunflower, rapeseed and olive oil, avocados, nuts, and seeds. But remember that unsaturated fats can also trigger gallstone pain
    6. Make sure your diet is high in fiber. This can be found in beans, pulses, fruit and vegetables, oats, and wholegrain products, such as bread, pasta, and rice
    7. Drink plenty of fluid – at least two liters daily, such as water or herbal teas

    Try not to eat too much fat at one mealtime. It might be helpful to have smaller, more frequent meals. Some people find that specific foods are the triggers for symptoms. Keep a food and symptom diary to identify trigger foods. Avoid these foods for a two-week trial period and note any improvements in symptoms.

    Jaundice ( Peelia) – Symptoms Causes Treatment

    Jaundice-Myths-And-Facts

    Jaundice (peelia)- It’s yellowness of eyes and skin due to disturbance in metabolism of bilirubin.

    Liver produces bile and then put it into intestine through a tract called biliary tract.

    Any disturbance from making of bile and obstruction to its outflow will cause jaundice.

    If one has this idea then one can really negate the myths prevalent in society about jaundice.

    Myths and facts

    1. Jaundice will subside on its own.  Majority of jaundice do subside on its own as majority are due to infection but it’s for doctor to decide by testing as which type will subside on its own and which type require further treatment.
    2. We should not eat turmeric in jaundice.  It’s untrue. Turmeric does not do any harm to liver and does not increase jaundice.
    3. We should not eat certain foodstuffs in jaundice. – Untrue . One can eat all types of foodstuffs during jaundice. One should have good healthy diet during an episode of jaundice.
    4. Jaundice can be cured some spiritual leader by some herbal medicine. Majority of jaundice are self limiting so will cure even if you don’t take any medicine. So these types of jaundice get cured by any means and credit goes to spiritual leader.
    5. Jaundice can be transmitted from one person to another. Some type viral infection can be transmitted by sexual contact or sharing needle with infected person as seen with AIDS while another can spread by consuming food contaminated by infected person so infected person should maintain good hygiene to prevent further spread to its family members and friends.
    6. How can one prevent jaundice ?
      • Maintain good hygiene and have well cooked food.
      • Drink clean water.
      • Do not have unsafe sex.
      • Do not share syringes or needle.

    What is treatment for jaundice?

    Treatment of jaundice depends upon type of jaundice. For treatment purposes jaundice is divided into

    1. Medical jaundice- this type is primarily treated with medicines
    2. Surgical jaundice- It requires surgical intervention for its cure.

    Medical jaundice arises usually due damage to cells of liver while surgical jaundice is caused by obstruction to flow of bile from liver to intestine. Liver function tests, Ultrasound abdomen, MRCP helps in classifying the jaundice. Your general physician/gastroenterologist/gastrosurgeon can help in diagnosing the type of jaundice based on these tests.

    Causes of medical jaundice –

    1. Hepatitis – infectious or toxic
    2. Drug toxicity
    3. Damage to liver by abnormal deposition
    4. Defect in bilirubin metabolism
    5. Alcohol hepatitis
    6. Autoimmune hepatitis

    Causes of surgical jaundice

    1. Stone in bile duct
    2. Gall bladder stone
    3. Tumor of gall bladder or bile duct
    4. Tumor of liver
    5. Liver cysts
    6. Liver abscesses

    Except for stone in bile duct that is treated with ERCP, all other causes of surgical jaundice require surgical treatment. These cases are best treated by surgeon with knowledge and expertise in liver and biliary tract surgery.