surgery

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Acute cholecystitis – find out more about the signs and symptoms of swelling of the gallbladder.

Acute cholecystitis

Acute cholecystitis

Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital.

The main symptom of acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder.

The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse.

Unlike some others types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn’t go away within a few hours.


Some people may additional symptoms, such as:

  • a high temperature (fever)
  • nausea and vomiting
  • sweating
  • loss of appetite
  • yellowing of the skin and the whites of the eyes (jaundice)
  • a bulge in the abdomen

When to seek medical advice

You should see your GP as soon as possible if you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a fever.

If it’s not possible to contact your GP immediately, phone your local out-of-hours service or call NHS 111 for advice.

It’s important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly (see below).

What causes acute cholecystitis?

The causes of acute cholecystitis can be grouped into two main categories: calculous cholecystitis and acalculous cholecystitis.

Calculous cholecystitis

Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases.

Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge.

Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt.

The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around one in every five cases, the inflamed gallbladder also becomes infected by bacteria.

Acalculous cholecystitis

Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.

Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.

Who is affected

Acute cholecystitis is a relatively common complication of gallstones.

It is estimated that around 10-15% of adults in the UK have gallstones. These don’t usually cause any symptoms, but in a small proportion of people they can cause infrequent episodes of pain (known as biliary colic) or acute cholecystitis.

In England, around 28,000 cases of cholecystitis were reported during 2012-13.

Diagnosing cholecystitis

To diagnose acute cholecystitis, your GP will examine your abdomen.

They will probably carry out a simple test called Murphy’s sign. You will be asked to breathe in deeply with your GP’s hand pressed on your tummy, just below your rib cage.

Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctor’s hand.

If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment.

Tests you may have in hospital include:

  • blood tests to check for signs of inflammation in your body
  • an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder

Other scans – such as an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan – may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis.

Treating acute cholecystitis

If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment.

Initial treatment

Initial treatment will usually involve:

  • fasting (not eating or drinking) to take the strain off your gallbladder
  • receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration
  • taking medication to relieve your pain

If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home.

With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder and the inflammation often settles down.

Surgery

In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy.

Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder.

If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or two, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks.

Surgery can be carried out in two main ways:

  • laparoscopic cholecystectomy – a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen
  • open cholecystectomy – where the gallbladder is removed through a single, larger incision in your abdomen

Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder.

The organ can be useful but it’s not essential, as your liver will still produce bile to digest food.

Read more about recovering from gallbladder removal.

Possible complications

Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications.

The main complications of acute cholecystitis are:

  • the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body
  • the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess)

In about one in every five cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.

Preventing acute cholecystitis

It’s not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones.

One of the main steps you can take to help lower your chances of developing gallstones is adopting a healthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones.

Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly.

However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best.

Read more about preventing gallstones.

[Original article on NHS Choices website]

Leave a comment Posted on Hormones

Acromegaly – what are the signs, symptoms , causes and treatments of Acromegaly?

Growth hormone complications

Growth hormone complications

Acromegaly is a condition in which the body produces too much growth hormone, leading to the excess growth of body tissues over time.

Typical features include:

  • abnormally large hands and feet
  • large, prominent facial features
  • an enlarged tongue
  • abnormally tall height (if it occurs before puberty)

Growth hormone is produced and released by the pituitary gland, a pea-sized gland just below the brain.

When growth hormone is released into the blood, it stimulates the liver to produce another hormone – insulin-like growth factor 1 (IGF-1) – which causes growth of muscle, bones and cartilage throughout the body.

This process is essential for growth and repair of body tissues.

What happens in people with acromegaly?

Acromegaly is caused by excessive production of growth hormone.


This usually occurs as the result of a benign (non-cancerous) brain tumour in the pituitary gland called an adenoma, but rare cases have been linked to tumours elsewhere in the body, such as in the lungs and pancreas.

Although acromegaly does very occasionally run in families, most adenomas are not inherited – they usually develop spontaneously as a result of a genetic change within a cell of the pituitary gland. This genetic change switches on a signal that tells cells in the pituitary gland to divide and secrete growth hormone.

The tumour almost never spreads to other parts of the body, but it may grow to more than 1cm in size and compress the surrounding nerves and normal pituitary tissue, which can affect the production of other hormones, such as thyroid hormones released from the thyroid gland.

Who is affected

It’s not clear exactly how many people are affected by acromegaly, although it’s been estimated that around 4 to 13 in every 100,000 people may have the condition.

This means there is likely to be between 2,500 and 8,300 people in the UK with the condition.

Acromegaly can affect people of any age, but it is rare in children. The average age at which people are diagnosed is around 40-45.

Problems caused by acromegaly

Acromegaly can cause a wide range of symptoms that tend to develop slowly over time.

Typical symptoms include:

Some of the above symptoms are the result of the tumour compressing nearby tissues – for example, headaches and vision problems may occur if the tumour squashes nearby nerves.

If you think you have acromegaly, see your GP straight away. Acromegaly can usually be successfully treated with brain surgery and medication, but early diagnosis and treatment is important to prevent the symptoms getting worse and to reduce your chance of getting complications.

Possible complications

If acromegaly is left untreated, you may be at risk of the following health problems:

Left untreated, these complications can become serious and fatal.

Diagnosing acromegaly

Blood tests

If your doctor suspects acromegaly from your symptoms, they will order blood tests to measure your levels of human growth hormone.

Levels of growth hormone naturally vary from minute to minute as it is released from the pituitary gland in spurts. Therefore to accurately diagnose acromegaly, growth hormone needs to be measured under conditions that normally suppress growth hormone secretion.

To ensure an accurate result, you may be referred to a hospital doctor for a glucose tolerance test. This involves testing your blood after drinking a solution or drink containing the sugar glucose.

In most people, drinking the glucose solution will suppress the release of growth hormone, but in people with acromegaly, the level of growth hormone in the blood will remain elevated.

Your doctor will also measure your level of IGF-1, which should increase with the level of growth hormone. An elevated IGF-1 level almost always indicates acromegaly.

Brain scans

You may then have a magnetic resonance imaging (MRI) scan of your brain to locate and define the size of the pituitary gland tumour causing your acromegaly.  A computerised tomography (CT) scan can be carried out if you are unable to have an MRI scan.

Treating acromegaly

Treatment aims to:

  • reduce excess growth hormone to normal levels
  • relieve the pressure the tumour is exerting on the surrounding structures
  • treat any hormone deficiencies
  • improve the symptoms of acromegaly

This is usually achieved through surgical removal of the tumour and medication.

Brain surgery

In most cases, surgery is recommended to remove the adenoma from your pituitary gland. This is effective in most people, although sometimes the tumour is too large to be removed completely.

Under a general anaesthetic, the surgeon will make an incision inside your nose or behind your upper lip to access the gland. An endoscope (a long, thin, flexible tube that has a light source and a video camera at one end) and surgical instruments are then passed through the incisions to remove the tumour.

Removing the tumour promptly relieves the pressure on the surrounding structures and leads to a rapid lowering of growth hormone levels. Facial appearance and swelling often improve within a few days.

Possible complications of surgery include damage to the healthy parts of the pituitary gland, leakage of cerebrospinal fluid (which surrounds and protects the brain), and  meningitis, though this is rare. Your surgeon will discuss these risks with you and answer any questions you have.

Radiotherapy

If surgery is not possible, or surgery and medication do not cure the condition, radiotherapy aimed at the adenoma may be an option.

This can eventually lead to a reduction in growth hormone levels, although it may not have a noticeable effect for several years and you may need to take medication in the meantime.

There are two main types of radiotherapy for acromegaly:

  • Stereotactic radiosurgery – where a high-dose beam of radiation is precisely aimed at the tumour, requiring you to wear a rigid head frame to keep your head still. This can sometimes be done in a single session.
  • Conventional radiotherapy – where the tumour is targeted with external beams. This can potentially damage the surrounding pituitary gland and brain tissue, so small doses of radiation are given over four to six weeks, giving normal tissue time to heal in between treatments.

Stereotactic radiosurgery is generally preferred to conventional radiotherapy because it minimises the risk of damage to nearby healthy tissue, although it is not always widely available.

Radiotherapy can have a number of side effects. For example, the treatment will often cause a gradual decline in the production of other hormones from your pituitary gland, so you’ll usually need to take hormone replacement therapy for the rest of your life. There’s also a risk it will impair fertility. Speak to your doctor about the risks involved.

Bowel cancer screening

There is some evidence acromegaly may increase your risk of bowel cancer, so guidelines recommend having a colonoscopy when you are diagnosed with the condition, and regular colonoscopy screening from the age of 40.

A colonoscopy is an examination of your entire large bowel using a type of endoscope called a colonoscope that is inserted into your bottom. See bowel cancer tests for more information about what a colonoscopy involves.

Outlook

Treatment is often effective at stopping the excessive production of growth hormone and improving problems caused by the condition. Treatment can also increase life expectancy to around that of someone without acromegaly.

Some treatments can take a long time to have a noticeable effect and you may need to take medication for a long period of time.

After treatment, you’ll need regular follow-up appointments with your specialist for the rest of your life. These will be used to monitor your pituitary function, check you are on the correct hormone replacement treatment, and to ensure the condition does not return.

Without treatment, acromegaly can cause long-term problems and may reduce life expectancy by a number of years.

[Original article on NHS Choices website]

Leave a comment Posted on Cancer, Patient Talk, Surgery

The future is here today. How a surgical robot can help cure cancer!

Leicester’s Hospitals hopes its new £2 million surgical robot will make a major difference to the lives of men and women in Leicester and beyond. In doing so it hopes to attract world-class surgeons.

Healthcare and social media

Healthcare and social media

Leicester’s Hospitals hopes its new £2 million surgical robot will make a major difference to the lives of men and women in Leicester and beyond. In doing so it hopes to attract world-class surgeons.

The Robotic Surgical Programme at Leicester’s Hospitals will help patients requiring surgery for multiple forms of cancer, these include prostate, rectal, cervical, liver, pancreatic, bladder and ovarian cancers.

In comparison to keyhole and open surgery, the robot offers a host of benefits such as better cosmetic results, shorter hospital stays for patients, a lower chance of developing complications, less pain after surgery and reduced blood loss during the operation.


Esther Moss, consultant gynaecological oncologist for Leicester’s Hospitals, said: “We are very excited to launch our new robotic programme. Robotic surgery provides a level of surgical dexterity, which cannot be achieved by standard keyhole surgery. It will enable many patients to have keyhole surgery who are not suitable for standard surgery, thereby enabling them to have the associated benefits, especially shorter recovery time.”

Sanjay Chaudhri, consultant colorectal surgeon at Leicester’s Hospitals, said: “We are the one of the largest colorectal units in England and treat over 500 patients with colorectal cancer every year. The robot will allow us to offer keyhole surgery to patients with rectal cancer with improved surgical outcomes.” In addition to major benefits to its patients, Leicester’s Hospitals hopes to attract and retain world class surgeons, while strengthening its position as a teaching hospital.

Paul Butterworth, consultant urologist at Leicester’s Hospitals, said: “The addition of the robot should ensure we become a regional centre of excellence for cancer networks. It will also enable us to continue to be a leading centre for clinical trials.”

He added: “This is really great news for Leicester’s Hospitals and for the people of Leicester.”

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Would you ever consider cosmetic surgery? Take our poll of the week!


Cosmetic Surgery

Cosmetic Surgery

Cosmetic surgery has been defined by the UK’s NHS web site as “Cosmetic or aesthetic surgery is a type of surgery used to change a person’s appearance to achieve what they perceive to be a more desirable look. In certain situations cosmetic surgery may be needed for functional reasons. For example, breast reduction is sometimes used to alleviate back or neck pain. Cosmetic surgery is different to reconstructive plastic surgery, which is a type of surgery used to repair damaged tissue following injury or illness.”

You can get more information here http://www.nhs.uk/Conditions/Cosmetic-surgery/Pages/Introduction.aspx

Obviously cosmetic or aesthetic surgery is a big decision for any person.  So we have decided to see what your readers think.  It would be really great if you could take our poll below.



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Back, knee and hip pain– Pain management with surgery. Why surgery can sometimes be your best bet!

Neck pain

Neck pain

A new study of people who have undergone surgery finds many spent years trying other treatments without success.   But experts say operative treatment would have saved them years of pain and stress

Health experts are concerned that people with serious back, knee and hip conditions are using surgery as a last resort after years of pain, stress and even depression, despite the fact that simple surgical procedures performed early, could save them from many complications.

That’s following a study which questioned people who have undergone knee, hip and back operations and found that one average patients wait four years before opting to have surgery, trying more than seven alternative routes and treatments before seeing a surgical specialist.

This surgical procrastination means patients are enduring years of pain and risking the problem worsening, with patients who wait years before being operated on, more likely to face complicated procedures.

Before having surgery, close to three quarters tried to treat or cure the problem with pain killers, more than half physiotherapy, almost one in five self-help strategies, one in seven acupuncture and one in 10 chiropractors.

But during this time more than three quarters could only perform limited daily activities, almost 60% had disrupted and poor quality of sleep, close to 40% had restricted ability to fulfil family duties, more than a third were reliant on other people, more than a quarter were unable to work at all, one in five were unable to work to full capacity, and one in eight had to reduce hours. The study showed that women are far more likely to be able to continue with their daily routines compared to men.

Furthermore, more than three quarters said they felt frustrated, just under 60% depressed, a similar number stressed and 40% resigned to living with pain.

Almost a third says they felt like a burden a similar number negative and pessimistic, and a quarter confused about their long term health.

The impact of this also has a significant impact on the economy too; the exchequer suggests that back pain alone account for £5 billion per year in lost earnings and the TUC estimates that 4.9 million days are lost.

Following surgery more than 40% say they have regained their freedom, a third feel more independent, a fifth now feel they can make long term plans again and more than one in ten are more focussed at work.

When asked how they would approach their condition if given the chance again, more than a quarter surveyed by BMI Healthcare say they wouldn’t have waited so long for surgery, a similar number would have been proactive to seek out consultative advice earlier and one in five would have sought more information about the surgery options available.

 

So how many people could be suffering unnecessarily and what are the risks of putting off surgery?

To find out PatientTalk.Org’s Teekshana Smith interviewed Marnin Romm of BMI.

ROOM: My name is Marnin Room and I’m a senior specialist pain management physiotherapist.

SMITH: So a study of people who have undergone surgery has found that most spend years trying out alternative treatments without success and then they end up with years of pain and stress when they could have actually stopped it and nipped it in the bud. So what are main concerns patients have about surgery, particularly this kind of surgery?

ROOM: I think with general surgery it’s a fear factor, going under the knife, getting an anaesthetic, worrying that they’re not going to wake up, perhaps having more pain after the surgery or the pain is still not going to go away so there’s a big fear factor around surgery, I guess that’s the main thing.

SMITH: To what extent are they justified?

ROOM: There is a proportion of people who will have surgery and the pain has not gone away, their pain might even be worse. In addition their original pain might have gone away but there’s a different type of pain because the surgery causes soft tissue damage. You’re cutting through muscle and you are bound to have a different type of pain. The recovery is often long and tedious and hard, the rehabilitation is hard afterwards, so there is some justification underlying it I guess.

SMITH: Basically you found that patients were failing to seek advice from healthcare professionals. Why do you think they are often failing to do so?

ROOM: I do think that if you’re living with long term pain, after a while you’re scared of being judged and people think you’re making it up and you have probably gone from one clinician to a clinician and been referred to someone else, someone else and nothing comes of it. So you almost become quite despondent and getting further advice almost pushes the patient more into that vicious cycle and that pain centred life.

SMITH: Alternative therapy routes, if it’s not that effective, should there be a point where the professionals that you’re seeing, professional therapists, suggest a more traditional approach to surgery? Should it be on them or should you be the one researching it yourself?

ROOM: I definitely think that if you are seeing a professional, and I just want to correct the term “alternative treatment”, I’d rather say conservative management. So for example if you’re seeing a physiotherapist or you’re going to someone for acupuncture or you’re seeing an osteopath, if your physio or osteopath or whoever feels that things aren’t progressing or there’s been no change whatsoever or things are getting worse, it’s definitely their job to refer elsewhere and suggest well perhaps you should consider this type of surgery. I don’t think it’s an individual’s job to have to research these things, I think people need to be educated.

SMITH: What sort of conditions lead to these kind of surgeries?

ROOM: OK so patients for example who have lower back pain can often have a herniated or slipped disc as it’s known and what can happen with that is patients can have a neurological fall out. So for example, if it’s the lower back, people can have lower limb symptoms like weakness, unable to stand, unable to walk, balance problems, numbness, pins and needles, extreme pain down the legs and in those cases often patients’ functional abilities, so walking, so to stand, daily life is completely affected. In those situations perhaps surgery is a route to follow.

SMITH: What is the typical experience of a patient who is undergoing these procedures?

ROOM: Well it’s as we said, it’s quite scary undergoing back surgery for example or undergoing any joint type of surgery, there is a big fear factor around it but generally for example knee replacement surgeries are very effective and patients rehabilitate quite well afterwards. There is a big amount of rehabilitation following surgery, they have to go back to physios, back to strengthening the joints, the areas, getting the mobility back. So it doesn’t end with surgery, so there’s a lot of rehabilitation following that and it’s important that patients understand that.

SMITH: However, if you ignored the surgery and left the condition to get further damaged as such, what could be the issue with the deterioration that happens?

ROOM: Again that depends on the condition as well. Each person needs to be looked at individually. So I think it is very important that if someone is suffering from chronic or long lasting pain, that they go to pain management clinics to manage their pain so that they get back on top of their life. Often patients’ quality of life is significantly affected and we know that through good pain management programmes, patients can start self-managing their pain. That’s not saying that their pain is going to go away, but they can gain a quality of life back. If that doesn’t happen, if it still spirals out of control and you get this vicious cycle between increases of pain, reduced activity, emotional instability and so the cycle repeats itself.

SMITH: As I mentioned you’ve done a study of people, so why have BMI commissioned this research?

ROOM: Well a large proportion of the population or a large sample of people who come to BMI suffer from some sort of orthopaedic pain or neurological pain and it was important to investigate people’s quality of life before surgical intervention, how they reported that in comparison to post intervention. So for example before intervention, people did report a poor quality of life, however post intervention in the majority of cases patients’ quality of life improved significantly.

SMITH: If you had one piece of advice for somebody suffering from back pain, what would it be?

ROOM: One piece of advice? I definitely feel patients or people should not be despondent and  let the back pain get on top of you, seek professional help, go for different types of information. Try to manage one’s pain instead of the pain managing you. So not to lie in bed all day, we know that is not useful with chronic lower back pain, it makes things worse. Try to move around in its limits.

SMITH: Fantastic and where can people go for more information?

ROOM: GPs are a very good first port of call and gain further insight through the GPs with relation to physios, consultants, go online, check out the different sites. So the information is out there, but seek the right information.

To find out more about pain management please check out our previous blogs.at https://patienttalk.org/?tag=pain-management