Gastric Health

Gallstone disease Gallstones are commonly found in the middle to the elderly aged population.  They are found in the gallbladder as a result of a variety of risk factors. Gallstones are of primary of 3 types Yellow cholesterol stones (70%-80%)- Due to supersaturation of bile with cholesterol Black pigment stones (20%-25%)- Due to the precipitation of calcium with unconjugated bilirubin.   Brown pigment stones- are commonly associated with bacterial infection due to the release of beta-glucuronidase to hydrolyze glucuronic acid from bilirubin.  Modifiable risk factors Obesity Low fiber high calorie foods Low physical activity Hypertriglyceridemia Low HDL and high LDL Metabolic syndrome Non-modifiable risk factors Age More common in females  Inherited lipid metabolism disorders Signs and Symptoms Right upper quadrant pain predominantly post-meals, especially if the high-fat meal Nausea and vomiting Fever (Acute cholecystitis, cholangitis) Leukocytosis Altered me...

 DASH diet The dietary approach to stop hypertension (DASH) is a customised diet that has been proven to be extremely useful in controlling hypertension along with many other conditions. It is so great significance for the Indian population as regular compliance can both prevent and manage the following: -  Hypertension Diabetes mellitus Fatty liver disease Non-alcoholic steatohepatitis (NASH) Hyperlipidemia Hypercholesterolemia Polycystic ovarian disease (PCOD) Hypothyroidism Advantages in the Indian setting All varieties of fruits and vegetables (listed in the diet) are easily available  Grains and nuts (listed in the diet) are easily available Dash Diet & How It works -  The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is a dietary pattern that is designed to lower blood pressure and improve overall cardiovascular health. The diet works by emphasizing the consumption of certain foods that have been shown to be beneficial for blood press...

 Esophageal webs and rings Esophageal webs and rings are outpouchings or growths which may partially occlude the lumen. The clinical presentation varies from being asymptomatic to having intermittent dysphagia to solids. Webs are predominantly seen in the proximal esophagus (near the throat) and ring in the distal esophagus (near the stomach). Risk factors The etiology of esophageal webs and rings is poorly understood. However, it is commonly seen with the following disorders: - Plummer-Vinson syndrome Zenker’s diverticulum Epidermolysis bullosa Hiatus hernia Eosinophilic esophagitis (rings) Clinical features Most esophageal webs and rings are seen incidentally on upper gastrointestinal endoscopy. However, a small percentage may present with Intermittent dysphagia to solids Impaction of food Evaluation Upper gastrointestinal endoscopy is the best diagnostic test. It helps identify the cause of the dysphagia Complete blood count and iron studies to rule out Plummer Vinson Treatment ...

 Gastroparesis Gastroparesis is ('gastro' means 'stomach' and 'paresis' means 'weakness or partial paralysis') a condition in which muscles of the stomach become weak and impair the passage of food and the process of digestion.  Clinical features Burning over the abdomen or chest  Food literally getting 'stuck' in the stomach Regurgitation of undigested or partially digested food  Abdominal fullness and bloating Decrease in appetite Eventual loss of weight Causes Diabetes mellitus Injury to vagus nerve during surgeries Deposition disorders like amyloidosis etc Drug-induced- opioids, anti-depressants, etc Nervous system disorders like Parkinson's and multiple sclerosis etc Management Gastroparesis is a clinical diagnosis that can be confirmed by Gastric emptying study Upper GI endoscopy Treatment Small and frequent meals are advised in patients having paresis. Some medications can be tried to manage the symptoms like: - Erythromycin  Anti-emet...

 Per-oral endoscopic myotomy POEM (Per oral Endoscopic Myotomy) is an advanced endoscopic procedure used to treat Achalasia and other swallowing disorders. It can take about 2-3 hours and requires inpatient admission.  It is done using a high-definition endoscope and a dye which aids in identification of the layers of the esophagus. Longitudinal hydro-dissection is done (creation of third space) until the LES is reached.  Selective myotomy of the inner circular muscles or sometimes full-thickness myotomy is done. Any active minor bleeding is cauterized and clips are used for suturing. Indications: -  1. Achalasia  2.Diffuse esophageal spasm   3. Nutcracker esophagus  Special note: -  1) POEM reported more clinical response compared to laparoscopic myotomy.  2) Rate of adverse events lower in POEM compared to laparoscopic myotomy therefore is a safer clinical alternative  3) Improvement in dysphagia is more pronounced in POEM

 Achalasia Achalasia is an esophageal disorder caused due to tightening or contraction of the lower portion of the esophagus (as it loses the ability to relax). The esophageal musculature around the lower esophageal sphincter is affected leading to unopposed contraction.  The exact cause is not yet known, but its pathogenesis has been linked to loss of neurons (nerve cells) which help dilate the esophagus Signs and Symptoms  1. Feeling of food getting ‘stuck’ in the chest. 2. Abrupt onset of difficulty in swallowing both solids and liquids. 3. Heartburn  4. Vomiting of food undigested food particles  5. Pain in the chest that is waxing and waning i.e (comes and goes) Evaluation  1. Upper Endoscopy to rule out other structural causes of esophageal dysphagia.  2. Esophageal manometry  Management  The type of therapy is decided by considering the severity of signs and symptoms and investigative evaluation. Medical therapy is instituted if the di...

 Liver cirrhosis Liver cirrhosis  Cirrhosis is a late and permanent stage of liver disease. It is characterized by fibrosis due to repeated cycles of damage and repair. As a result of excess of scarring, there is profound damage to the liver and its functioning.  Common causes  1. Non- alcoholic steatohepatitis 2. Chronic viral hepatitis 3. Alcoholic hepatitis  4. Autoimmune hepatitis Clinical features 1. Chronic fatigue  2. Loss of appetite  3. Weight loss 4. Jaundice  5. Abdominal distension 6. Pedal edema 7. Redness of palms  Complications  1. Increased risk of bleeding 2. Hepatic encephalopathy  3. Increased risk of infections  4. Malnutrition 5. Elevated risk of liver cancer Management  The goal is to identify the cause of the disease and the stage of the disease. 1. Liver function tests  2. Blood counts 3. Liver biopsy  4. Fibro scan  5. Magnetic resonance elastography Treatment  1. Supportiv...

Non-alcoholic steatohepatitis (NASH)   Non-alcoholic steatohepatitis (NASH) is a stage of liver disease after NAFLD. It is due excess fat deposits in the liver and the inflammation that ensues due to it. Unlike NAFLD, there is extensive damage to the liver parenchyma. All the conditions which cause NAFLD, also lead to NASH which include: - 1)     Uncontrolled/ poorly controlled Diabetes Mellitus 2)     Unbalanced diet high in fat content 3)     High serum cholesterol due to any cause 4)     High serum triglycerides due to any cause 5)     Metabolic syndrome 6)     Polycystic ovarian syndrome 7)     Hypothyroidism Signs and symptoms 1)     Right upper quadrant pain 2)     Nausea 3)     Yellowness of the eyes and mucosal membranes (jaundice) 4)     Fatigue and generalized  weakness 5)  ...

Acute liver failure   Acute liver failure is characterized  by serious rapid onset deterioration of the liver.   It is diagnosed via a combination of clinical features and laboratory investigations. Common causes 1. Viral hepatitis 2. Drug toxicity 3. Ischemic hepatitis 4. Acute fatty liver of pregnancy   Risk factors Pre-existing liver disorders like Alcoholic hepatitis Nonalcoholic steatohepatitis (NASH) Chronic viral hepatitis    Clinical features of ALF Rapid onset jaundice (yellowness of eyes and skin) Right upper quadrant abdominal pain Anorexia Fatigue Distension of abdomen Malaise Sleepiness   Complications Hepatic encephalopathy Cerebral edema Renal failure Bleeding disorders  

Non-alcoholic fatty liver disease (NAFLD)  Non-alcoholic fatty liver disease (NAFLD) is an accumulation of fat in the liver. The deposition of fat in the liver is due to either excess production or decreased breakdown of fats. The causes of this form of ‘fatty liver’ are: - 1)     Uncontrolled/ poorly controlled Diabetes Mellitus (both type I and II) 2)     Unbalanced diet high in fat content 3)     High serum cholesterol due to any cause 4)     High serum triglycerides due to any cause 5)     Metabolic syndrome 6)     Polycystic ovarian syndrome 7)     Hypothyroidism Signs and symptoms NAFLD is mostly ‘clinically silent’ i.e having no signs or symptoms unless it progresses to its next stage NASH (Non-alcoholic steatohepatitis). A minority of patients may present with fatigue and right upper-quadrant abdominal discomfort . Why is it important to screen? 1. ...