Mr. Jim S Khan, Consultant Laparoscopic, Colorectal & General Surgeon, Havant Hampshire
Mr Jim S Khan - Consultant Laparoscopic, Colorectal & General Surgeon : 023 9245 6034
 
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Gall Bladder Conditions

Gallbladder is a pear shaped organ situated below liver which stores bile produced by the liver. Bile is a watery, yellow-green fluid made by liver to digest fat.

Functions of gallbladder include:

  • Concentration and storage of bile
  • Release of bile into the small intestine
  • Enzyme secretion to aid in fat digestion

Gall bladder diseases

  • Cholecystitis: It is the inflammation of the gall bladder that causes severe abdominal pain. It results from a gallstone blocking the flow of bile.
  • Cholelithiasis: presence of one or more stones in the gallbladder.
  • Acalculous gallbladder disease: It is a inflammatory disease of the gallbladder which is not associated with gallstones.
  • Gangrenous gallbladder: Gangrene is death of tissue caused by poor blood supply. Inflammation of the gallbladder caused by the blockage of bile by gall stones, can lead to gangrenous gallbladder.
  • Gallbladder polyps: Gall bladder polyps are the growth of the tissue that protrude from the lining of the gallbladder.
  • Sclerosing cholangitis: It is a chronic liver disease caused by progressive inflammation, scarring and destruction of the bile ducts inside and outside of the liver.
  • Congenital defects of the gall bladder
  • Tumors of gallbladder


Rectal Bleeding

Rectal bleeding refers to passage of blood through the anus along with the stools. The rectum is the last part of the large intestine and lies right above the anus. The blood may be bright red to dark maroon. Usually, it may occur as a result of constipation and hemorrhoids. The amount of blood that is passed may vary from few drops to large quantities often mixed with stools or blood clots.

The common causes of rectal bleeding are disease conditions which include colon cancer, anal cancer, anal fissure, colon polyp, hemorrhoids, constipation, and Crohn’s disease. Rarely, rapid and severe bleeding from stomach ulcers can cause rectal bleeding.

Common symptoms of rectal bleeding are loss of large amounts of blood associated with other symptoms such as weakness, dizziness, and fainting. Severe bleeding may also cause a state of shock.

Diagnosis & Treatment

Your physician will identify the location and the cause of rectal bleeding as it is important for an appropriate treatment plan. Proper diagnosis begins with a brief medical history and physical examination which is followed by few clinical tests such as anoscopy, flexible sigmoidoscopy, colonoscopy, radionuclide scans, angiograms, and blood tests.

The treatment plan for rectal bleeding comprises of the following:

  • Identification of the cause and location of bleeding: Colonoscopy procedure helps to determine the cause and location of bleeding.
  • Treatment of anemia and low blood volume: Administration of intravenous fluids and blood transfusion is done to replenish the lost blood. Iron supplements should be taken for a long term as a treatment of anemia.
  • Stopping active rectal bleeding and preventing further bleeding: Mild rectal bleeding such as that in anal fissures and haemorrhoids can be stopped with the use of haemorrhoidal creams and stool softeners. Colonoscopy, apart from being a diagnostic procedure also helps to stop bleeding by cauterization. Cauterization is done with a long cauterizing probe. Visceral angiograms can also be used to infuse medications to constrict the blood vessel and stop bleeding.

Surgery becomes necessary when there is a bleeding polyp or colon cancer to be excised.


Gallstones

Gallstones are small, hard substances formed in the gallbladder. They are formed when bile stored in gall bladder hardens. Bile is a fluid secreted by liver that helps in digestion of fats. Bile contains cholesterol, fats, water, bile salts, and bile pigments. Gallstones block the flow of bile to small intestine. Due to this blockage digestive enzymes and bile remains in the bile ducts causing inflammation of gall bladder and liver.

Ultrasound or computed tomography (CT) scan is used to diagnose gallstones. Medicines are given to dissolve the stones and analgesics to relive pain. If the pain succumbs your doctor would suggest for surgery.

Cholecystectomy is the surgical removal of the gallbladder. Laparoscopic cholecystectomy is most commonly used. In this technique, the surgeon makes several tiny incisions in the abdomen and inserts a laparoscope and a miniature video camera. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon uses surgical instruments to carefully separate the gallbladder from the liver, bile ducts, and other structures. Then the surgeon removes the gallbladder through one of the small incisions.
If gallstones are formed in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate the gallstone and remove them before or during the gallbladder surgery.


Diverticular Disease

Diverticular disease is a common disorder of the large intestine (colon) which involves two conditions namely diverticulosis and diverticulitis. Diverticulosis is a condition which occurs commonly in individuals aged 40 and above where small pouches form in the lining of the large intestine. These are often the weak spots. When these pouches are inflamed, the condition is known as diverticulitis. Diverticulosis and diverticulitis combined together is the diverticular disease.

A low-fiber diet is often the cause for diverticular disease. Lack of fiber content in the food we eat makes the stools very hard, resulting in constipation. You may need to strain a lot during bowel movement, which may cause the colon to bulge out through the weak spots in its lining. Inactive lifestyle or lack of exercise serves as a risk factor for diverticulosis. If the stools get collected in the pouches, inflammation may set in, causing diverticulitis. Most people may not have any discomfort, but some people complain of severe cramps in the lower part of abdomen, bloating, constipation and blood in the stools.

A computed tomography (CT scan) is the most common diagnostic test used. Other tests include

  • Blood testIt is done to detect infections.
  • Stool sample It is done to detect bleeding in the intestinal tract.
  • Digital rectal exam: Your doctor will examine the rectum by passing a gloved finger to check for any bleeding or a blockage.
  • X- ray and barium enema
  • Colonoscopy

Treatment

Diverticulosis: A diet containing lots of fiber and fluids can help reduce symptoms of diverticulosis. The American Dietetic Association recommends an intake of 20-35 grams of fiber per day. Fiber containing products such as methylcellulose (Citrucel) or psyllium (Metamucil) can be taken up to three times a day.

Diverticulitis: Your doctor will prescribe an oral antibiotic, pain reliever and advise bed rest. A liquid diet is recommended in order to rest the colon. If the symptoms of diverticulitis recur and you do not respond well to the antibiotics, your doctor may recommend surgery which involves removal of the affected part of the colon (colon resection).

 

Mr Jim S Khan - Consultant Laparoscopic, Colorectal & General Surgeon
Mr Jim S Khan - Consultant Laparoscopic, Colorectal & General Surgeon
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