There are some surgical conditions that may result in a tummy ache, but we will be focusing on these 4 conditions: Gallstones, Gastritis and Gastric ulcer, Swollen Piles and Painful Hernia.
- Gallstones
Definition & Causes:
They are a small, hard crystalline mass formed abnormally in the gall bladder
Usually caused by
A lack of physical activity
Increased intake of oily food
Some facts on Gallstones:
- Majority of gallstones are cholesterol stones, formed by cholesterol aggregates
- Majority of individuals with gallstones do not have symptoms, which is why it is often discovered but surgery may not be offered from the get-go
- 15-20% of them will develop symptoms within 5 years of diagnosis, that’s where they start to experience some pain
Symptoms include:
- ‘Indigestion’; Feeling bloated and discomfort
- In severe cases, if the gallbladder is infected- pain in the right upper abdomen
- Acute setting - high fever followed by yellowing of skin and eyes
- ‘Tea’-coloured urine (bile duct blockage as a result of gallstones)
- Pain and fever- usually denotes a gallbladder or bile duct infection, at this point urgent medical attention is needed
Treatment and Diagnosis:
- Gallstones are usually detected on ultrasound or CT scan
- Keyhole surgery is the recommended treatment
- The gallbladder will have to be removed together with the gallstones as there is no way of removing the stones without damaging gallbladder
- Despite the presence of new technology that could remove gallstones without damaging the gallbladder, it will just continue to form gallstones
- No deleterious effects on health by removing the entire gallbladder
- Gastritis and Gastric ulcer
Definition & Causes:
Gastritis refers to the inflammation of stomach lining
Increased secretion of gastric acid acting on a weakened protective layer -> Increased attack, decreased defence
Can progress to ulcers and subsequent bleeding or perforation (hole in the stomach)
Usually caused by
Stress
Smoking
Drinking
Stressful Lifestyle
Symptoms include:
- Pain over the upper central abdomen
- Nausea and vomiting with loss of appetite
- No definite relation to food - can occur before or after meals
- Black stools
Treatment and Diagnosis:
- Gastroscopy- To investigate, look at the lining of the stomach and also test for helicobacter pylori (bacteria that causes recurrent ulcers, the persistence of bacteria increases the risk of gastric cancer)
- Treatment includes anti-acid medications and eradication of H.pylori with antibiotics (triple therapy regime: takes about 6 weeks)
- Swollen Piles
Definition & Causes:
Piles are ‘anal cushions’ filled with blood vessels that are present in everyone, prevents faeces from leaking out
Can be caused by an idle lifestyle, physical inactivity
Becomes problematic when they get larger and become swollen
Usually caused by
long term constipation
long term laxative use
Symptoms include:
- Lump at the edge of the anus
- Fresh blood on passing motion
- Itchiness around anus
- Prolapsed and thrombosed piles - piles are purplish and tender, the patient can’t sit down properly
Treatment and Diagnosis:
- Simple bedside examination can easily visualise and diagnose piles
- If there is bleeding, it is essential to get a colonoscopy especially individuals nearing 40 years old, to eliminate other colonic causes such as cancer
- Conventional hemorrhoidectomy
- Stapled hemorrhoidectomy (less painful option, when the piles are diagnosed early and small enough)
- Rubber band ligation (for even smaller piles)
- Total Hemorrhoidal Devascularisation (for piles with predominant bleeding)
- Avoid seeking treatment only when the piles become too large to tolerate
- Early treatment gives you more surgical options and reduces the complication rate
- Colonoscopy must not be delayed as bleeding may not always be from piles
- Painful Hernia
Definition & Causes:
Protrusion of abdominal contents (fat or intestine) through the abdominal wall
Groin or inguinal hernia is the most common type of hernia and can occur in all age groups
For older patients, it is a direct hernia where the muscle weakens when you get older and provides an area of weakness for the hernia to protrude
In younger patients, it is an indirect hernia and the cause is not a weakness of muscle but a patent processus vaginalis (PPV), a congenital connection that is not closed up
Usually caused by
Jobs or daily lifestyle with prolonged heavy lifting and/or standing
Chronic smokers with cough
Chronic constipation or straining at urination
Ageing
Symptoms include:
- Lump at the groin (can disappear when lying down or when pushed back in)
- Groin discomfort
- Large hernias (that have been left alone for years) can extend all the way to the scrotum (for males) -> at this stage recurrence is much higher
Treatment and Diagnosis:
- Avoid delaying to get your hernia confirmed or checked - contents can become strangulated or obstructed
- Open surgery (usually for single side) and laparoscopic surgery (for both sides)
- Surgery involves putting in an artificial plastic mesh (non-absorbable, stays in your body for life) to avoid recurrences
- Need to avoid heavy lifting and straining for 4-6 weeks after surgery