Author Archives: Dr Datta

Gallbladder cancer

The gallbladder is a pear-shaped organ. It stores bile. The gallbladder is located under the liver and above the pancreas and duodenum. The liver makes bile and transports it to the gallbladder through a tube called the common hepatic duct and cystic duct. The gallbladder releases bile through a tube called the common bile duct. This tube connects the liver, gallbladder, and the first part of the small intestine. Bile is released from the gallbladder when the food is broken down in the stomach and small intestine.

There are four main layers in the anatomical structure of the gallbladder. They include the inner mucosal layer, middle muscle layer, connective tissue layer, and the outer serosal layer. In the beginning, gallbladder cancer develops in the inner layer and then it grows and spreads to the outer layers. Learn more about Gallbladder Stones.

The Risk of Developing Gallbladder Cancer

Compared to men women are at increased risk of developing gallbladder cancer. The risk increases with age, ethnicity, and geographical region where the person is living.

Gallbladder cancer symptoms

• Fever
• Lumps in the abdomen
• Bloating
• Nausea and vomiting
• Pain in the upper abdomen
• Yellow in the whites of the eyes and skin (jaundice)

The above signs and symptoms may also be due to other gastrointestinal conditions. Therefore, it is better to consult a gastroenterologist if you have any of the above signs and symptoms.

Gallbladder Cancer Diagnosis

Gallbladder cancer is difficult to detect (find) and diagnose early.

In the early stages, gallbladder cancer is difficult to detect and diagnose as there are no prominent signs and symptoms. Symptoms if present may mimic the signs and symptoms of other common health conditions. Therefore, in most cases, symptoms often go unnoticed. Another reason for cancer going undetected is the position of the gallbladder behind the liver. Cancer is most often detected after surgical removal of the gallbladder for other reasons.

Gallbladder Cancer Staging

Surgical gastroenterologists try to find out the area in which cancer has spread including the surrounding areas as well. The process involved here is known as staging. Doctors, therefore, order tests and procedures to detect, diagnose and stage gallbladder cancer. The tests involve physical examination, blood tests, abdominal ultrasound, CT scan, MRI, liver function tests, endoscopic ultrasound, ERCP, laparoscopy, and biopsy.

The chances of recovery (prognosis) of the disease depend on whether the cancer has been removed completely by surgery; the stage of cancer and the type of gallbladder cancer.

Treatment depends on the stage, type and age, and general health of the patient.

What are the treatment options for gallbladder cancer?

Gallbladder Cancer Treatment: The standard treatment for gallbladder cancer include surgery, radiation therapy, and chemotherapy. Robust treatment approaches include targeted therapy and immunotherapies.

Gallbladder removal surgery or cholecystectomy is the surgical removal of the gallbladder and also some of the surrounding cancerous cells and tissues around cancer. Expert surgical gastroenterologists who specialize in cancer surgeries remove nearby lymph nodes as well. Laparoscopic surgeons use a laparoscope attached to a camera to guide the surgery. They use other sophisticated surgical instruments inserting and guiding them through small incisions to the surgical site and extensively removing cancerous tissues (cytoreductive) surgery.

Early detection of gallbladder cancer ensures prompt treatment.

The diaphragm separates the chest from the abdomen. It is a thin sheet of muscles or a muscular barrier between the chest and abdominal cavities. During the development of the fetus inside the womb, a hole is present in the diaphragm due to a gap formation during the development of the fetus. The stomach, bowel, and even liver move up into the chest cavity through this hole. This condition is known as a congenital diaphragmatic hernia (CDH). The space for the lungs reduces due to the presence of abdominal organs in the chest. This may lead to breathing problems and respiratory complications. The lungs of the growing baby grow in a restricted and compressed environment due to CDH. Therefore, a baby’s lungs do not develop normally until the birth of the baby.

What are the complications of pulmonary hypoplasia?

A congenital diaphragmatic hernia may lead to pulmonary hypoplasia – a type of underdeveloped lungs condition. In this condition, the baby may have abnormalities that impact the number of alveoli (air sacs) available; and pulmonary hypertension. The fetus may not suffer from low oxygen levels (hypoxemia) while growing in the womb as the placenta takes over all the functions of the lungs. However, immediately after birth, the baby depends on the lungs for oxygen. If the lungs are underdeveloped, then the baby requires artificial ventilation techniques. CDH can develop on right, left, or both sides of the diaphragm (chest). It occurs in around 1 in every 2500 live births.

How is CDH Detected?

A routine ultrasound during pregnancy may reveal excess abdominal contents in the fetal chest cavity. Experienced gynecologists recommend a detailed ultrasound and fetal chromosome testing and also measure the lung size of the fetus. The other tests include CT scan, MRI, and arterial blood gas test. Based on the findings of these tests, CDH is detected.

Gynecologists measure and compare the lung size of the fetus to the expected size at this stage of pregnancy. They also measure lung area to head circumference ratio (LHR) and then compare the observed and expected LHR. They also determine whether the liver has also moved into the chest. Based on these findings, they grade congenital diaphragmatic hernia as mild, moderate, or severe.

After Birth

A physical examination after birth may reveal the following abnormalities:

• One side of the chest lacks breath sounds
• Cyanosis – The skin of the baby turns blue
• Breathing difficulty
• Abnormal chest movements
• Bowels sound in the chest
• A half-empty feeling in the abdomen.

CDH Treatment

After delivery, gastroenterologists perform surgery on a baby with CDH to close the defect. Congenital diaphragmatic hernia treatment is an emergency situation. It typically requires surgery. Surgical gastroenterologists perform surgery within 48 to 72 hours after delivery.  The main objective of the surgery is to remove abdominal organs from the chest and place them back into the abdomen. The surgical gastroenterologist who specializes in performing hernia repair surgery repairs the diaphragm as well.

In emergency situations, surgery is performed earlier. Surgery may be delayed in some cases though. Prior to performing surgery doctors stabilize the baby and increase her oxygen levels.

GERD Specialist in Hyderabad | Best Doctor for Acid Reflux in Hyderabad

When stomach content moves into the esophagus (flow backward), the condition is known as Gastroesophageal efflux disease (GERD). It is a common condition that most often becomes frequent and causes severe symptoms, inflammation, irritation, and injury to the esophagus. Chronic and untreated acid reflux may damage the esophagus, pharynx, or respiratory tract. There are several other names for this condition – such as Heartburn, acid regurgitation, acid reflux, and acid indigestion. If you have this condition, you must see a GERD specialist in Hyderabad – A gastroenterologist or a surgical gastroenterologist for GERD Surgery or Laparoscopic Nissen’s Fundoplication for GERD.

Signs and Symptoms of GERD

• Heartburn is the most common symptom
• Mild heartburn may occur twice a week (mild GERD)
• Moderate to Severe GERD – symptoms may manifest more than twice a week
• Severe GERD is associated with inflammation in the esophagus
• A burning and painful sensation in the middle of the chest
• Bad breath
• Swallowing difficulty
• Regurgitation of the stomach content
• Chest pain
• Irritated feeling in the esophagus and sore throat

GERD Diagnosis

A gastroenterologist begins the diagnosis of GERD with a comprehensive physical examination by taking into consideration the medical history and symptoms of the patient. If a person is presented with the typical symptoms of GERD – such as regurgitation and heartburn then the doctor diagnoses the cause as GERD without further referring any additional tests.

The gastroenterologist may recommend tests if the GERD specialist suspects esophageal damage due to atypical symptoms and severity of the reflux. If the symptoms do not respond to initial treatment, the surgical gastroenterologist may consider anti-reflux surgery.

The diagnostic tests for GERD include the following:

• Reflux testing (wireless pH/pH impedance)
• Upper endoscopy
• Barium esophagram
• Esophageal manometry [esophageal motility (movement) studies]

Complications Associated with GERD

• Esophagitis
• Esophageal ulcer
• Esophageal Strictures
• Barrett’s Esophagus
• Esophageal cancer

Causes and Risk Factors of GERD

The lower esophageal sphincter ensures that the acid remains intact in the stomach. It is a ring of muscles that helps keep the top portion of the stomach closed, but the following factors cause the sphincter to relax:

• Eating a heavy, greasy (oily), and large meal
• Eating soon before going to bed
• Lying flat soon after eating
• Eating spicy or fried foods – onions, cabbage, citrus fruits
• Consuming carbonated beverages and alcohol
• Belching
• Eating certain foods such as peppermint, chocolate, and high-fat foods.
• Increased abdominal pressure due to obesity or overweight or during pregnancy in women
• Inhaling second-hand smoke or smoking
• Usage of certain medications such as painkillers, calcium channel blockers, antihistamines, asthma, and antidepressants.

Hiatal hernia can cause the opening of the diaphragm through which the upper part of the stomach moves up. When this happens the pressure in the esophageal sphincter lowers and acid reflux occurs.

GERD Treatment in Hyderabad

To manage and relieve symptoms of GERD, your doctor might encourage you to make certain lifestyle changes, like:

One should make changes in their lifestyle to manage and get rid of GERD symptoms. A GERD Specialist in Hyderabad may recommend and encourage us to make the following lifestyle changes:

• Weight management (reducing weight if applicable)
• Quitting smoking
• Avoiding carbonated and acidic beverages
• Avoiding heavy and big meals in the evening
• Raising the head of the bed by around 8 to 10 inches
• Elevating the head during sleep
• maintaining a moderate weight, if applicable
• waiting a few hours after eating to lie down

Treatment also includes prescription and other medicines such as antacids, H2 receptors blockers, and proton pump inhibitors.

Bottom Line

Acid reflux can become problematic as it interferes with daily living. A majority of people can get relief from acid reflux through home remedies, lifestyle changes, and medical treatment. In some cases, surgery is recommended when lifestyle changes, medicines, and home-based treatment have not stopped the symptoms. A surgical gastroenterologist or a GERD specialist in Hyderabad will recommend surgery if a person develops complications associated with GERD. Fundoplication is the recommended option.

Read more about “Laparoscopic Nissens fundoplication for GERD”