Sudden onset of severe abdominal pain is considered medical emergency and must be evaluated by qualified gastroenterologist.
Sudden onset of severe abdominal pain is considered medical emergency and must be evaluated by qualified gastroenterologist. Severe abdominal pain can be due to multiple causes such as acute cholecystitis, acute appendicitis, intestinal onstruction, acute pancreatitis, acute diverticulitis, acute colitis or hollow viscous perforation. Based on the specific diagnosis, specific management is started which can include urgent surgery or medical management.
Our Hepatologist is one of the best in Rajkot who has extensive experience in managing patients suffering from Hepatitis B and Hepatitis C. Liver diseases are increasing due to Hepatitis B and Hepatitis C, Alcohol and Fatty liver. If ignored and not detected in time they can progress to chronic liver disease. Liver disease and Liver cancer are managed by the liver disease specialist doctor. He was trained in diagnosis and management of chronic liver disease.
Obstruction of biliary system by stone or malignancy leads to acute ascending cholangitis and is one of the most common and life threatening medical emergency. Patient is admitted and initial clinical assessment and stabilization is done. ERCP with placement of biliary plastic stent is usually performed to urgently decompress the biliary system and prevent of spread of sepsis.
Inflammation of pancreas with severe epigastric abdominal pain radiating to back is consistent with acute pancreatitis. The usual causes are alcohol abuse and gall stones. The patient would require admission and started on IV Fluids, analgesics and kept nil per mouth for variable period of time. Later diet is gradually started once inflammation and pain subsides. Twenty percent patients suffer from severe pancreatitis and develop end organ failure such as respiratory failure requiring mechanical ventilation, Kidney failure requiring Hemodialysis or GI bleeding requiring endoscopy or CT angioembolisation to stop the bleed. Later few patients develop peripancreatic fluid collection (pancreatic pseudocyst) which may require drainage if symptomatic. Gastroenterologist will discuss the relevant medical issues with you during Indoor admission and OPD
In a known case of ulcerative colitis patient, sudden onset of bloody loose stools, fever and abdominal pain is consistent with flare of the disease. The patient is admitted in the hospital and is evaluated for the causes of flare and is started on medial management. Most respond to conservative treatment but few may require more aggressive treatment such as use of Biologics (Infliximab or adalimumab) or surgery.
Hemetemesis (vomiting of coffee coloured or fresh red blood through mouth) is considered a medical emergency and is one of the most common presentations seen in patient suffering from liver disease or gastric or duodenal ulcer. Patient can also have Melena (black tarry fowl smelling stools). Patient must seek medical attention urgently and must be admitted for further management. After initial evaluation and stabilization gastroscopy is performed to diagnose the cause of hemetemesis and Endotherapy is performed for stopping the bleed.
Passing of fresh blood per rectum, maroon coloured or black stools is considered medical emergency. Patient must seek medical attention urgently and must be admitted for further management. After initial evaluation and stabilization colonoscopy is performed to diagnose the cause of bleeding and Endotherapy is performed for stopping the bleed.
Colonoscopy is the examination of Ileum (Last part of the small intestine) and colon. Colonoscope may be a versatile tube that features a little camera and a lightweight supply at its tip and might give the high-resolution pictures of the Lower GI tract. The patient lies within the left lateral position and therefore the endoscope is advanced below direct vision through the porta of the patient for examination. Local anaesthesia is comfortable for many patients however sometimes general anaesthesia is needed looking on the patient preferences and procedure quality.
Gastroscopy additionally called Esophago-gastro-duodenoscopy is that the examination of muscular structure (Food pipe), stomach and duodenum (First part of the intestine). Endoscope could be a versatile tube that encompasses a little camera and a light source at its tip and may give the high-resolution pictures of the higher alimentary canal. The patient lies in the left lateral position and the gastroscope is advanced under direct vision through the mouth of the patient for examination. Pharyngeal anaesthesia is sufficient for most patients but occasionally general anaesthesia is required depending on the patient preferences and procedure complexity. Gastroscopy is a very quick and safe examination and is usually performed on a day care basis.
To establish the etiology of chronic liver disease (once routine panel of etiological workup is negative) liver biopsy is required. Normally it can be done through transabdominal percutaneous route. But in case of ascites or coagulopathy, transabdominal liver biopsy is not safe and hence TJLB is done via internal jugular vein. It is safe procedure but has small risks of complications. Prior to procedure the gastroenterologist will discuss with the patient and their relatives the benefits, risks, alternatives and technical details of TJLB.
HVPG is measured to document portal hypertension and measures the pressure gradient between portal vein and hepatic vein. Value more than 5 mm Hg is considered to establish portal hypertension. HVPG has prognostic significance in a liver disease patient since it can predict the risk of bleed from esophageal varices. HVPG can also assess the response of medications to reduce the portal pressure (Propranolol/Carvedilol). It is safe procedure but has small risks of complications. Prior to procedure the gastroenterologist will discuss with the patient and their relatives the benefits, risks, alternatives and technical details of HVPG.
Ingestion of sharp objects or button battery ingestion must be urgently removed by endoscopy. Delay may result in esophageal necrosis or GI tract perforation. Once the foreign passes the stomach, conservative management is usually required. If peritoneal signs such as abdominal pain or bleeding occurs patient would require surgery and removal of foreign body.
Cancer management is not a one person’s responsibility. The society and the physician must join hands together for early diagnosis and treatment of cancers. Late referrals and patient ignorance of their symptoms are the main reasons for cancers presenting at an advanced stage where limited therapeutic options are available. We regularly hold camps and CMEs for educating primary care physicians and common man about the symptoms of various GI cancers and emphasizing the need for screening of GI cancers. Elderly patients, those persons with risk factors for a particular cancer and persons with family history of cancer must volunteer for screening, for possibility of early-stage cancer diagnosis.
Risk factors for esophageal cancer (Persons with below mentioned risk factors are advised to undergo screening for early diagnosis of esophageal cancer).
Patients are usually advised esophageal ESD for SESCC and esophagectomy (Removal of oesophagus) for locally advanced cancers.
Risk factors for Gastric cancer
Patients are usually advised gastric ESD for early gastric cancer and gastrectomy (Removal of stomach) for locally advanced cancers.
Risk factors for colorectal cancer
All adenomas are removed endoscopically; few advanced polyps or frank cancer will require surgery with removal of colon.