Colonoscopy
Posted by on Wednesday, 22nd January 2014
A colonoscopy is an internal examination of the colon (large intestine) and rectum, using an instrument called a colonoscope.
The colonoscope has a small camera attached to a flexible tube that can reach and examine the entire length of the colon.
How the Test is Performed
You will usually be given medicine into a vein to help you relax and not feel any discomfort. You will be awake during the test and may even be able to speak, but you will likely not remember anything.
You will lie on your left side with your knees drawn up toward your chest. The colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and slowly moved as far as the lowest part of the small intestine.
Air will be inserted through the scope to provide a better view. Suction may be used to remove fluid or stool.
Because Dr. B C Shah gets a better view as the colonoscope is pulled back out, a more careful examination is done while the scope is being pulled out. Tissue samples may be taken with tiny biopsy forceps inserted through the scope. Polyps may be removed with snares, and photographs may be taken.
Specialized procedures, such as laser therapy, may also be done.
See more at: http://drbcshah.com/colonoscopy/
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512 stones found in Gall bladder
Posted by on Saturday, 18th January 2014
(Dr. B C Shah recently performed Laparoscopic Cholecystectomy on Mr. N_____ G______ who had 512 stones!)
Mr. N_____ G______ came to me with history of chronic pain in upper abdomen. The pain would get aggravated after meals. His sonography revealed that his gall bladder was distended & full of stones. I performed Laparoscopic Cholecystectomy on him. It was a difficult case as there were lot of adhesions. The gall bladder was delivered successfully It was a pleasant surprise to find 512 stones in the Gall Bladder.
One often wonders as to why patients wait so long. Many times patients come to me with Gall Stones. Often they have only one small stone. The common question asked is "Do I still need surgery for just a small stone?"
As per my observation of last 23 years, one stone or many stones – all have a potential to create complications including even death. Its not just the numbers or size. One small stone can just simply slip into the bile duct and is sufficient to trigger Pancreatitis. I personally know of a patient who developed severe pancreatitis due to a 3 mm small stone. She battled for two months in one of the best hospitals in Mumbai and ultimately died.
In kidney stones, one of the criteria on which the therapy is based is the number of stones and its size. Smaller stones can pass out spontaneously and the patient's problem gets solved naturally. However, this is not the situation with gall stones. A gall stone or its fragment passing out can be dangerous as it can cause blockage of bile in liver or swelling in pancreas. Such complications can occur any time and no doctor on earth can predict when this will occur.
Many patients wait for the stones to grow and multiply. Surely this has a potential of inviting big untimely trouble. Don't wait. There are no warning signs.As far as records go, the largest number of gallstones removed was 3,110 in an open surgery in Britain in 1983, reported in the Guinness Book of World Records.
- See more at: http://drbcshah.com/512-stones-found-in-gall-bladder/
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Intestinal Obstruction due to Stones
Posted by on Wednesday, 15th January 2014
MRS R____ K____ , a 55 year old female was transferred from a local nursing home
She was admitted in a local Nursing home with abdominal pain & vomiting. She was treated as a case of acidity. In spite of the treatment for a week, she did not improve.
When she came to me, her symptoms were suggestive of intestinal obstruction (blockage). A CT scan of abdomen was undertaken. CT scan revealed that she had intestinal obstruction due to a large 5 centimeter stone. This is called Gall stone ileus.
How did the stone land up in her intestine?
No it was not a swallowed stone. This stone had formed in her Gall Bladder over many years. Due to its weight & chronic inflammation, the stone gradually perforated into her small intestine (duodenum). Since the stone was very large it could not pass thro the small intestine and got stuck in the last part of small intestine. Patient was having pain & constantly vomiting due to this blockage.
The treatment was done using minimal access surgery instead of making a big cut on her abdomen – laparotomy. Using laparoscopy, the site of blockage was identified. A small incision was made on her abdomen. The stone was cut open from the intestine (enterolithotomy) and the intestine was placed back into the abdomen.
The blockage was cleared and the patient recovered smoothly and was discharged in few days.
See more at: http://drbcshah.com/intestinal-obstruction-due-to-stones/
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Hernia Becomes Gangrenous
Posted by on Monday, 13th January 2014
Often Indian ladies have large bellies. Common causes are multiple pregnancies, sedentary lifestyle, poor physical exercises and health neglect. At times scars on abdomen of surgeries compound the weakness of the tummy.
It is not uncommon to notice a protrusion (hernia) thro natural scar (umbilicus) or surgical scars. "My mom also had it" is a common answer which denotes that they have a metabolic error whereby the scars are inherently formed weak. They move around with such bulges on their huge tummies. At times there is no umbilicus visible because of huge hernias. At times they are huge protrusions of the intestines and other contents.
So when the patients are advised to get operated their argument is that so many have it and for so many years they are carrying on without any complaints, so why operate? Well the reason to get it operated is that slowly all of them grow. More and more contents of the tummy start protruding out and one day it becomes so tight or overcrowded that they get strangulated and there is no space for blood to nourish the intestines and other contents. Thus a simple problem gets complicated. The patient all of a sudden suffers from great pain as a result has to be rushed to the hospital. The surgery becomes lengthy and riskier. The recovery period increases and so does the cost. Why wait so long?
- See more at: http://drbcshah.com/hernia-becomes-gangrenous/
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A case of Anemia with Cancer Colon
Posted by on Tuesday, 7th January 2014
A 75 year old female came to me in emergency with complaints of constipation, inability to pass faltus (obstipation), severe pain abdomen, persistent vomiting, extreme weakness & stomach fullness since 5 days.
Prior to this, she had chronic constipation often alternating with loose stools since six months. She was taking laxatives from various doctors but it was helping her some times.
She had low haemoglobin (anemia) & was taking treatment from General practitioner.
On examination she was looking toxic and her abdomen was distended. She per rectal examination showed that there was no stools.
X-ray of abdomen showed that the large intestine was totally blocked. CT Scan revealed a possiblity of a tumour in har large intestine.
Her haemoglobin was 6 grams ( half of normal).
She required urgent surgery to relieve blockage in her intestine.
She was a high risk for surgery in view of old age , low haemoglobin, weak heart & major surgery.
She was taken for surgery & part of her large intestine was removed. After surgery, she was in ICU. In few days she was discharged. - http://drbcshah.com/a-case-of-anemia-with-cancer-colon/
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