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Medical Gastroenterology

What is Gastroenterology?


It is a branch of medical sciences which deals with digestive system and associated disorders. The digestive system includes the mouth, esophagus, stomach, small intestine, large intestine—which includes the rectum—and anus. Food enters the mouth and passes to the anus through the hollow organs of the GI (Gastrointestinal) tract. The liver, pancreas, and gallbladder are the solid organs of the digestive system.

What is Hepatology?


It is a branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders

 

Types of Gastrointestinal Disorders:

Gastrointestinal disorders may include:

Functional disorders – They occur due to impairment in normal functions of digestive system’s organs – Esophagus(Food Tube),Stomach, which include but not limited to :

  • Throat congestion – lump-like feeling
  • Chest pain similar to cardiac pain
  • Persistent burning sensation
  • Bloating- swelling in abdominal region due to filling of fluid or gas
  • Frequent vomits
  • Difficulty in Swallowing (Dysphagia)
  • Backward flow of swallowed food ( Regurgitation)
  • Bad odor burps (Eructation)
  • Problems in Emptying bowels in absence of neurological cause– blood in stools(Hematochezia), pain during defecation, incomplete emptying, loose motions(Diarrhoea), hardening of stools and difficulty in removal ( Constipation),loss of control over going to latrine (defecation problems)
  • Indigestion of food ( Dyspepsia)

Types of Hepatological Disorders

Liver Cirrhosis :

Serious liver disorder in which connective tissue replaces normal liver tissue and liver failure often occurs. Hepatitis C infection, fatty liver and alcohol abuse are the most common causes .

Fatty Liver :

It is a disorder in which fat level in the liver exceeds more than 5-10 % of weight of liver. It is associated with obesity and diabetes

Hepatitis “B” and “C” :

They are types of infectious diseases which may cause permanent scarring of the liver with risk of liver cirrhosis, liver failure, etc.

Jaundice :

It is a disorder caused by abnormal increase in level of bilirubin (a protein), which reflects in form of yellow discoloration of skin and eyes. In normal body, bilirubin is processed by liver for removal from body, but when it is not under control of liver, this condition occurs.

Diagnosis of G.I. Disorders


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  • Diagnosis is made on basis of medical history, clinical signs and symptoms, psychological evaluation (if applicable),laboratory investigations(Hb,AST,ALT). An Endoscopy confirms GI disorders.
  • Endoscope is a device used for visualization of internal organs of human body. It comprises of thin (to be inserted in mouth or anus), flexible tube with light source and a video camera. Through a relay system, captured images are transferred to television.
  • Initially lesion of internal organ could be diagnosed by endoscopy. Biopsy is performed for further histo-pathological investigations and if required, surgical therapy should be performed under sedation or local anesthesia without long hospitalization time.
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  • Endoscopy is sometimes combined with other procedures, such as ultrasound. An ultrasound probe may be attached to the endoscope to create specialized images of the wall of your esophagus or stomach. An endoscopic ultrasound may also help create images of hard-to-reach organs, such as your pancreas.

Diagnosis of Hepatic Disorders


There are various investigations for determining hepatic disorders, which include:

  • Blood tests for measurement of extent of liver enzymes elevation,
  • Ultrasound, CT scan, MRI for evaluation of presence of any scarring

For histo-pathological examination of cirrhosis, liver biopsy is performed under local anesthesia

Colorectal Cancer Screening

Colorectal cancer screening is done by observational investigation for blood in stool (high-sensitivity fecal occult blood tests) or by using an instrument to observe the lining of the colon and rectum.

Various Endoscopy Procedures at CIMS:

Upper GI Gastroscopy: for visualization of esophagus, stomach and duodenum (upper part of small intestine).
Colonoscopy: for visualization of colon.
Endoscopic Retrograde Cholangio Pancreatography (ERCP): for visualization of bile duct, pancreas and gall bladder. Under this procedure, dye is injected into bile and pancreatic duct; series of X-rays are taken.
It could identify lesions such as

  • stricture of bile duct
  • stone in bile duct
  • stones in gallbladder
  • stones in pancreatic duct

CIMS Gastroenterology and Hepatology Unit


CIMS Gastroenterology and Hepatology Unit has been well-equipped with latest Olympus endoscope technology with qualified personnel including infection control nurses, Gastroenterologists, Surgeons, Pulmonologist, and Endoscopy trained nurses and technicians.
CIMS has achieved continuously increasing volumes of GI diagnostic and surgical procedures with better temporal trends in terms of average length of stay.

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Apart from diagnostic procedures, CIMS has also been successful in delivering patient-friendly surgical outcomes.

To name a few:

  • Surgical removals of tumors like polyps from stomach, duodenum, large intestine, bile duct stones and gallbladder stones
  • Capsule endoscopy
  • Stent placement in food pipe, bile duct and pancreatic duct
  • Management of acute bleeding in upper and lower GI tracts
  • Removal of foreign objects lodged in upper GI tract

For detailed information, please visit CIMS G.I Surgery webpage.

CIMS Cases


A Case of Obstructive Jaundice (Dr. Bhavesh Thakkar)
A 60-years male with yellowish discoloration of urine and eyes since 1 month, itching and pale stool for last 45 days, was diagnosed with jaundice, enlarged liver and liver ducts. MRI of bile vessel showed two tumors widely spread in the right lobe of liver. Endoscopic Retrograde Cholangiopancreatography (ERCP) and biliary Self Expanding Metal Stent (SEMS) placement with cytological investigation of Biliary brush. Conservative treatment of Adenocarcinoma was done. The patient was discharged 24 hours after ERCP. On 6 week follow-up, the patient showed good symptomatic improvement.Whipple’s Surgical Procedure
A 70 year male patient presented with history of yellowish discoloration of urine and eyes since 20 days duration, weight loss of 5 kg in last 2 months, reduced appetite, weakness, tiredness easy fatigability since last 3 months, was diagnosed of jaundice. Ultrasound sonography revealed enlargement of liver with dilated liver ducts and substructures. ERCP was indicative of narrowing and ulceration at first and second parts of duodenum. Histopathologic and CT examination showed adenocarcinoma and malignancy in the inner part of abdomen (ampula of Vater). Whipple’s surgical procedure was performed and patient was stable post-operatively. Studies have shown that for good outcomes from the Whipple surgery, experience of the center and the surgeon contributes significantly.