PANCREATITIS

PANCREATITIS

1. What is pancreas and pancreatitis?

• Pancreas is a gland situated behind the stomach that produces hormones namely insulin, glucagons that help in metabolism. 

• Pancreas also produces other hormones and essential enzymes to aid digestion of fats, proteins and carbohydrates. 

• These enzymes reach the upper part of small intestine (duodenum) through the pancreatic duct. 

• Pancreatitis means the inflammation of pancreas. 

• Inflammation occurs when these digestive enzymes leak out of the pancreatic duct and damage the pancreas. 

• This can develop suddenly or over a period of time like years.
  

2. Cause of pancreatitis

• The main cause is the leakage of enzymes within the pancreas, leaking from it and causing internal or external damage. 

• Normally, pancreas and the duct prevent the enzymes from leaking but in certain conditions, it leaks and oozes out which may cause damage to the pancreas and the pancreatic duct.
  

3. What is acute pancreatitis?

• Most of the acute pancreatitis cases are due to the stones present in the gall bladder which prevent the proper flow of pancreatic enzymes through the duct in to the intestines. 

• The other reason for this is the excessive consumption of alcohol. 

• This usually occurs after continuous abuse of alcohol on the body or many episodes of heavy drinking of alcohol. 

• Even though it is not established how stones in gall bladder cause pancreatitis but they may block the common bile duct joining pancreatic duct at an opening to the small intestine. 

• Like blocked drain can throw the fluid back, the enzymes can back flow into the pancreas and cause damage. 

• These enzymes digest the food but also damage the tissues to great extent, causing additional inflammation.

• The other causes include the hereditary aspect, mumps, high level of triglycerides (fat) or calcium in blood, surgery or other procedures done on the pancreas like ERCP (Endoscopic Retrograde Cholangiopancreatography), tumors of pancreas, trauma, toxins like scorpion venom, some times medications too. 

4. What are the indications of pancreatitis?

• Pancreatitis usually appears as a sudden onset (acute) attack of gripping pain, in the upper epigastric region, of the abdomen.

• At this point of time, the disease can be mild to severe. 

• The severity is gauged with "Scoring System" considering the age, result of tests, symptoms, causes and other complications. 

• Most of the cases have milder version of acute pancreatitis. 

• This does not affect the other parts of the body usually. 

• Patients can recover without problems what so ever with pain relieving medication and some intravenous fluids. 

• Once the pain subsides, pancreas starts functioning normally.

• In some cases, when pancreatic enzymes start circulating in other parts of the body, this may cause complications like infection, shock or pseudo cyst (collection of fluid and pancreatic enzymes enclosed in a wall of tissue).

• In many cases, the pancreatic tissue is inflamed but not destroyed, and this is known as Interstitial Pancreatitis. 

• In serious complications like pancreatic necrosis (death), the pancreatic tissue dies. 

• The risk to the life of the patient suffering is greater with this kind of pancreatitis than the interstitial pancreatitis.
  

5. Risk factors of pancreatitis

• Presence of even one stone in the gall bladder smaller than 5 mm may block the flow of the enzymes in to the small intestine.

• Excessive consumption of alcohol.

• Blood containing high levels of triglycerides (fat), which can be due to family history too.

• Having hyperactive parathyroid glands may cause excessive calcium in blood.

• Structural problem of the pancreas, pancreatic duct or the bile, especially in a condition where the pancreas is divided and has two main ducts (pancreas divisum). 

• Pancreatitis can be life threatening if one has severe abdominal pain with vomiting which does not subside in few hours, or mild abdominal pain which does not respond to home remedies within a couple of days or so.

• These symptoms may be that of a pancreatitis condition and should be treated by a specialist immediately.

6. Diagnosis

• It varies from patient to patient based on the symptoms narrated by him and taking in account the family history and other factors. 

• Blood tests to analyse the enzymes are: 

• Serum Amylase: increase in the level of this enzyme by three fold indicates pancreatitis.

• Serum Lipase: Acute condition always raises the levels of this enzyme in blood.

• Other blood tests are also done like:

• Complete Blood Count: Some times the number of white blood cells increase dramatically.

• Liver Function Test: Increase in liver enzymes is noticed due to pancreatitis.

• Serum Bilirubin: When there is a blockage in common bile duct, bilirubin may increase in blood.

• Imaging and Scan tests:

• Ultra sound scan or Computer aided Tomography Imaging (C.T.) scan or Magnetic Resonance Imaging (M.R.I) scan: to get a correct picture and situation of the damage done.
  

7. Treatment

• Treatment for pancreatitis depends on the condition of the pancreas. 

• In initial stages of pancreatitis, the treatment may be supportive and allowing the pancreas to heal on its own. 

• Pain killers may be given to take care of pain aspect, some Intra venous fluids to compensate the loss of body fluids and other medication to tackle medical imbalance like blood pressure etc.

• For allowing the pancreas to rest, one may not be allowed to eat food and be kept on fluids to supplement the energy of the body for about a week's time. 

• If it is found that pancreatitis is due to the presence of gall stones in the gall bladder, then E.R.C.P (Endoscopic Retrograde Cholangiopancreatography) may be advised to remove the stones from the common bile duct. 

• Once this is done, one may be advised a surgery removal of gall bladder, "Cholecystectomy", either open or laparoscopic. 

• This may prevent further occurrence of pancreatitis.

8. Prevention

• Pancreatitis due to gall stones cannot be absolutely prevented. 

• One can reduce the risk of forming gallstones bye timely surgery and proper diet control and regular exercise.

• Avoiding alcohol can prevent further complications.

• In chronic pancreatitis one should totally abstain from alcohol.

• Consult the doctor for avoiding those medications that can inflame the pancreas.

9. Medications

• Medication differs in different conditions of pancreatitis like Acute pancreatitis and Chronic pancreatitis. 

• But in general the medications are for:
  a)    Pain management with pain killers.
  b)    Infections with antibiotics.
  c)    Suppressing pancreatic enzymes.
  d)    Suppressing stomach acid like H2 receptor blockers.
  e)    Supplementing enzymes.
  f)    Avoiding chance of being affected with diabetes when the pancreas stops producing insulin.

TUBERCULOSIS OF THE SPINE

TUBERCULOSIS OF THE SPINE

CAUSE

• Spinal Tuberculosis (Pott’s Disease) is caused by the bacteria Mycobacterium Tuberculosis, in which the spinal column is affected.
• It is called tuberculosis spondylitis and the original name was formed after Percivall Pott, a London surgeon.
• It is most common during the first three decades of life, though the disease may occur at any age between 1-80 years.
• It is a presentation of extra-pulmonary tuberculosis that affects the spine.
• Bone and joint TB accounts for up to 35% of cases of extra-pulmonary TB.
• Most commonly, it affects the thoracic and thoraco-lumber spine.
• Skeletal TB most often involves the spine, followed by tuberculosis arthritis in weight-bearing joints and extra-spinal tuberculous osteomyelitis.
• In the spine, the bacterium usually gets lodged within the vertebral body, and causes an inflammatory reaction initially.
• Progressive infection causes destruction of bone and the supporting structures with collapse and fracture of the vertebrae and formation of pus within and adjacent to the spinal column.
• There is loss of disc height and soft tissue swelling of the vertebrae.
• Abscesses and tissue formation can narrow the spinal canal, leading to neurological damage. 
• This, in turn, results in the compression of the spinal nerves and may cause complete paralysis of both legs, and rarely, upper limbs.
• This health condition is irreversible, even with good surgical treatment.

SYMPTOMS

• Localised back pain 
• Painful movements in the early stages
• Fever, weight loss and loss of appetite
• Later, the patient may develop a hunch back or weakness in the hands or legs.
• The deformity varies in each patient, delaying the diagnosis in early stages.

PREVENTION AND CURE

• The challenge is on early detection of spinal TB through its symptoms.
• X-rays in the early stages may be normal.
• MRI scans pick up the infection long before we see it on X-rays.
• The definitive diagnostic test is pathological / microbiological examination of disease tissue obtained from the site of lesion (wound).
• Blood test, X-rays, MRI scan and biopsy aid diagnosis.
• Early diagnosis, followed by prompt and adequate treatment, can completely cure spinal TB.
• In neglected cases, the patient may develop angular deformity due to destruction of vertebral bodies called kyphosis.
• Treatment options include antibiotics and corrective spin surgeries.
• Taking anti-TB medication religiously is effective in control of the disease.
• A brace is used to protect the spine during the treatment period.
• Improper or inadequate treatment with medicines can aggravate the problem by creating drug-resistant bacteria which may be very difficult to treat.
• Nowadays, there is an increasing trend of spine TB in view of irregular medical management, emergence of resistant strains and low immunity in patients to chemotherapy, steroids or surge in patients of HIV.
• Patients who do not respond to medical treatment, and those who develop neurological deficit in spite of treatment, need surgery.
• Surgery involves drainage of inflammation area and stabilization using bone graft or implants.

DYSILIPIDEMIA OF THE HEART

DYSILIPIDEMIA OF THE HEART

• Dyslipidemia is a condition wherein lipid levels in the blood stream go too high or too low.
• Lipids comprise of HDL-‘good’ cholesterol, LDL-‘bad’ cholesterol, and triglycerides.
• A Lipid Profile Check determines their levels in the blood.
• Ideally, HDL should be at high levels, and LDL and triglycerides should be at low levels.

RISK FACTORS

• High blood pressure
• Excess body weight
• Uncontrolled diabetes
• Male above 40 years of age
• A family history of cholesterol problem
• Unhealthy lifestyle – 
• Irregular food habits
• Smoking
• Excessive alcohol
• Little or no physical activity
• Mental stress and strain
• Chances are that you may have high levels of LDL and triglycerides, and low level of HDL, which increases your risk of heart attacks, reduced blood flow in the limbs, and stroke.

HEALTHY TIPS FOR HEART

Do’s

• Eat more of fruit, vegetables, high-fibre, and low-cholesterol food.
• Try to eat a new healthy recipe each week.
• When traveling, carry heart-healthy snacks to avoid fast foods.
• Drink plenty of water daily.
• Exercise regularly and go for a brisk walk for 45 minutes to an hour, 3-4 times a week, to help increase your good cholesterol.
• Take the stairs routinely.
• Take the first available parking space and walk the extra distance to office or work.
• Stop drinking alcohol, or limit it to a peg a day, twice a week.
• Maintain a healthy body weight.
• Control your blood glucose level.
• If you are diabetic, get your lipid profile checked every 3 months.
• Get a yearly checkup.
• Sleep for 6-8 hours at a stretch.
• Practice yoga to keep your lungs and heart healthy along with strengthening your back muscles.
• Know the symptoms of a heart attack and get help right away.

Don’t’s

• Don’t eat fried, junk, salty and oily food, and avoid red meat.
• Don’t give diabetes a chance to increase your heart risk.
• Don’t take stress for too long, by taking a ‘stress break’ of 15 minutes for relaxation, meditation or a walk.
• Don’t feel depressed, with the help of a friend or relative. 

• Don’t start exercising without your doctor’s permission.
• Don’t start late on good lifestyle practices such as walking, jogging, cycling or playing regularly with your children.
• Quit smoking.
• Don’t miss your regular appointments with the doctor.

TESTS FOR YOUR HEART

• Checking your family history for causes of heart diseases.
• Blood pressure levels (normal is 120 mmHg systolic / 80 mmHg diastolic)
• Blood sugar level tests (fasting and post-meal).
• Glucose tolerance test (GTT) and/ or a Glycosylated haemoglobin level test.
• Lipid profile test (total cholesterol, HDL-good cholesterol, LDL-bad cholesterol, HDL: cholesterol ratio, and triglycerides)
• ECG, 2D echo and a stress test.
• Angiography.

CAROTID ARTERY DISEASE

CAROTID ARTERY DISEASE

1. ATHEROSCLEROSIS

• Carotid arteries in the neck supply most of the blood to the brain.
• These arteries can be affected by atherosclerosis that leads to progressive narrowing (stenosis), and in some cases, complete blockage (occlusion).
• In occlusion, attempting to reopen the blocked artery isn’t beneficial, so treatment focuses on the arteries that are only partially blocked.
• Atherosclerosis of the carotid arteries develops when fatty deposits or plaque clogs them.
• The buildup blocks the blood supply to the brain and increases risk of stroke.
• In its early stages, carotid artery disease has no symptoms.
• As it progresses, it deprives the brain of blood and leads to a transient ischemic attack (TIA).
• The symptoms of TIA include 
• sudden numbness or weakness on the face, arm or leg, typically on one side of the body
• slurred, garbled speech or difficulty understanding others
• sudden blindness in one eye.
• Although a TIA produces symptoms similar to a stroke, it usually lasts a few minutes and causes no permanent damage, but is a warning of an impending stroke.

2. CAROTID ARTERY STENTING

• In moderate cases, carotid artery disease improves with quitting smoking, losing weight, eating healthy food, and exercising regularly with medication.
• But, in severe cases, where the carotid artery is blocked 70 percent, the blockage must be removed and the artery opened.
• Carotid artery stenting is a safe, effective option.
• A tiny balloon is threaded by catheter to the area where the artery is clogged.
• The balloon is inflated to widen the artery and a small wire-mesh stent inserted to keep the artery from narrowing again.
• This is low risk in most healthy people, prevents strokes and has lasting benefit.

3. ROTABLATION

• Rotablation is a technological advancement which has immensely helped in improving the results of angioplasty.
• Over time, plaque – a fatty substance made up of cholesterol, calcium and other materials, builds up in our arteries.
• When a heart artery is completely blocked by a plaque, it can cause heart attack.
• If a plaque is soft enough, angioplasty can be easily performed by opening the block with a balloon first and then placing a stent (kind of spring) across the block and opening the stent completely so as to keep the vessel fully open.
• But, what if the plaque is too hard for angioplasty?
• As calcium builds up in artery walls, plaque can become extremely rigid and hard or even too hard for an angioplasty balloon to stretch the artery open.
• That is where rotablation, or rotational atherectomy, comes in.
• A device called rotablator was invented, which is a tiny drill with a burr on the end that is coated in diamond dust.
• The rotablator drills through calcific plaque breaking it up into tiny pieces and forming a smooth tunnel through the plaque.
• These tiny pieces are small and safe enough to be picked up by the blood stream.
• Because of the smooth tunnel formed by the rotablator through the block, it is easily possible to take the balloon and then the stent to the block, place the stent across the block after stretching open the block with the balloon and then easily open the balloon to its fullest – thus optimizing and perfecting the result of angioplasty.
• It is because of the rotablator that it is possible to avoid bypass surgery in patients who have complicated open blockages.

4. CIRCLE OF WILLIS

• But if a carotid artery is completely blocked, risk of stenting usually outweighs the benefit.
• Fortunately, the brain can use alternative routes to provide blood to the area of the brain supplied by the blocked artery.
• A network of blood vessels at the base of the brain, called the circle of Willis, can supply the necessary blood flow.
• Many people function normally with one completely blocked carotid artery, provided they haven’t had a disabling stroke.
• Medical treatment and carotid angioplasty is effective for preventing TIA and strokes in such cases.