GI Surgery

Gastroesophageal Reflux Disease (GERD)

The esophagus carries food from the mouth to the stomach. The lower oesophageal sphincter is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and the stomach.

Gastroesophageal reflux disease, or GERD, is a chronic disease that occurs when the lower oesophageal sphincter does not close properly and stomach contents leak back, or reflux, into the esophagus.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

Symptoms

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

The most frequent symptoms of GERD are so common that they may not be associated with a disease. Self-diagnosis can lead to mistreatment. Consultation with a physician is essential to the proper diagnosis and treatment of GERD.

Causes

• Hiatal hernia- hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest.
• Alcohol use
• Overweight
• Pregnancy
• Smoking

Also, certain food and drinks are associated with reflux

Infections and Inflammations

An infection is the condition of the multiplication of parasitic organisms or microorganisms within the body. Inflammation is the reactions that occur in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biological agent. Many people use the terms interchangeably since they have several symptoms in common and usually are treated similarly.

• Appendicitis
• Pancreatitis
• Hepatitis
• Cholecystitis
• Oesophagitis
• Peritonitis

Cancer

What is Cancer?

Cancer is a disease that results from abnormal growth and division of cells that make up the body’s tissues and organs. Under normal circumstances, cells reproduce in an orderly fashion to replace old cells, maintain tissue health, and repair injuries.

However, when growth control is lost and cells divide too much and too fast, a cellular mass -or “tumor” -is formed.

If the tumor is confined to a few cell layers and does not invade surrounding tissues or organs, it is considered benign. By contrast, if the tumor spreads to surrounding tissues or organs, it is considered malignant, or cancerous. In order to grow further, cancer develops its own blood vessels and this process is called angiogenesis. When it first develops, a malignant tumor may be confined to its original site.

If cancerous cells are not treated they may break away from the original tumor, travel, and grow within other body parts, the process is known as metastasis.

Cancer Screening is the performance of tests on apparently well people in order to detect a medical condition at an earlier stage.

Click on the below links to find out more about individual cancers.

• Oesophageal cancer
• Liver cancer
• Pancreatic cancer

Oesophageal cancer

Oesophageal cancer (also called cancer of the esophagus) is a malignant tumor that grows in the lining of the esophagus. The esophagus (the gullet) is the tube that carries food from the mouth down into the stomach using a series of muscular movements.

Types of oesophageal cancer

Two types of cancer, squamous cell carcinoma, and adenocarcinoma, make up 90% of all oesophageal cancers. Oesophageal cancer can occur in any section of the esophagus. Most cancers in the top part of the esophagus are squamous cell cancers. They are called this because the cells lining the top part of the esophagus are squamous cells. Squamous means scaly.

Most cancers at the end of the esophagus that joins the stomach are adenocarcinomas. Adenocarcinomas are often found in people who have a condition called Barrett’s.

Liver Cancer

Alt. names: Hepatocellular carcinoma. The liver will function normally with only a small portion of it in working order.

Liver cancer can be a primary cancer (which starts in the liver) or a secondary cancer (which starts in another part of the body and spreads to the liver).

Primary liver cancers

Primary liver cancer is one of the less common cancers. It is more common in men and people aged over 60 years. Most primary liver cancers are called hepatocellular carcinoma, as they start in liver cells called hepatocytes. Others start in a bile duct and are called cholangiocarcinoma.

In the western world, most people who develop primary liver cancer also have cirrhosis of the liver. This is scarring of the liver which is due to a variety of causes including heavy alcohol drinking over a long period of time. However, only a small proportion of people who have cirrhosis of the liver develop primary liver cancer. Infection with hepatitis B, C, or D can also increase the risk of developing cirrhosis and, later, primary liver cancer.

Secondary liver cancers

Secondary liver cancer is the most common liver cancer in the western world. Secondary liver cancer is cancer that starts somewhere else in the body and spreads (metastasizes) to the liver. Most cancers can spread to the liver but the common ones are breast, stomach, and bowel cancers. These liver cancers are named after the primary cancer, for example, breast cancer that has spread to the liver is called metastatic breast cancer. Sometimes, liver cancer is discovered first, which leads to the diagnosis of the primary cancer.

Symptoms

Liver cancer usually has no symptoms in the early stages. Symptoms can include:

• Pain in the upper right side of the abdomen
• Fever
• Yellowing of the skin and eyes (jaundice)
• Nausea
• Weakness
• Weight loss
• Loss of appetite
• Swelling of the abdomen.

Diagnosis methods

Liver cancer is usually diagnosed with a number of different tests, which may include:

• Blood tests – to check your general health and to check for a chemical (AFP), which is usually found in increased levels in people with a certain type of primary liver cancer.
• Ultrasound– a picture of the liver is taken using sound waves.
• CT scan – a specialized X-ray taken from many different angles to build a three-dimensional picture of the body.
• Magnetic resonance imaging (MRI) – is similar to a CT scan but uses magnetism instead of X-rays to build a picture of the body.
• Liver biopsy – a small piece of liver tissue is removed with a needle and examined for cancer cells.
• Laparoscopy – a small cut in the lower abdomen allows a thin mini-telescope (laparoscope) to be inserted to look at the liver and take a sample of the liver tissue. If the tests show you have secondary liver cancer (and you did not know that you had primary cancer), you may need further tests to find out where the primary cancer is.

Treatment options

Treatment for liver cancer will depend on whether it is a primary or secondary cancer. Treatment options may include:

• Surgery – to remove the cancer and as much damaged tissue as possible. This is the main treatment for primary liver cancer. It is only useful for secondary liver cancer if the cancer cells only affect one part of the liver.
• Chemotherapy – either tablets or injections of anti-cancer drugs. Sometimes they are injected directly into the artery that feeds the tumor in the liver (hepatic arterial infusion). It is the main treatment for secondary liver cancer and is sometimes used for primary liver cancer.
• Radiotherapy – x-rays are used to target and kill cancer cells. It may help in treating some types of primary liver cancers and may be used to relieve symptoms of pain and discomfort from secondary liver cancer.

Pancreatic Cancer

Pancreatic cancer starts in the cells of the duct and spreads into the body of the pancreas. Nearby blood vessels and nerves may be invaded. Without treatment, this type of cancer will spread to every abdominal organ and to other parts of the body, via the lymphatic system. The causes are unknown, but risk factors may include:

• Cigarette smoking
• Chronic pancreatitis
• Advancing age (over 65 years).

Symptoms

The symptoms of pancreatic cancer are often vague and can appear similar to those caused by other conditions. This means that pancreatic cancer is often not diagnosed until it is quite advanced. Some of the common symptoms may include:

• Persistent pain in the abdomen
• Loss of appetite
• Weight loss
• Jaundice, if the bile duct is blocked
• Back pain (in some cases).

Diagnosis

If pancreatic cancer is suspected, your doctor will refer you for tests. Diagnosis may require the following:

• CT scan – a special x-ray taken from many different angles, to build a three-dimensional picture of your body. A dye may be injected to further highlight internal organs.
• Magnetic resonance imaging (MRI) – is similar to a CT scan but uses magnetism instead of X-rays to build three-dimensional pictures of your body.
• Ultrasound – sound waves create a picture of your pancreas.
• Endoscopy – a thin telescope is inserted down your throat to allow the doctor to see inside your digestive system.
• Laparoscopy – the internal organs are examined with an instrument inserted into the abdomen through a small cut.
• Tissue biopsy – a small sample of the pancreas is removed with a needle and examined in a laboratory.

Treatment

Treatment for pancreatic cancer depends on your age and general health, the size and location of the cancer, and whether it has spread to other parts of the body. You may receive one type of treatment or a combination. Generally, options include:

• Surgery – is used when the cancer has not spread beyond the pancreas. Cancer and part of the pancreas and part of the small bowel are removed in an operation called ‘Whipple’s resection’. Some of the bile ducts, gall bladder, and stomach may also be removed.
• Radiotherapy – radiation is used after surgery to destroy any cancer cells that may remain in the body.
• Chemotherapy – either tablets or injections of anti-cancer drugs may be used after surgery.