PORTAL HYPERTENSION

Portal hypertension is increased pressure within the portal venous system. It

is determined by increased portal pressure gradient (the difference in
pressures between the portal venous pressure and the pressure within the
inferior vena cava or the hepatic vein.
Portal hypertension is an elevated pressure in the portal vein (veins that carry
blood from stomach, intestine, spleen and pancreas to the liver). Elevated
pressure is caused by blockage in blood flow through the liver. Increased
pressure on portal veins causes large blood vessels (varies) to grow across the
throat and the stomach to go around the blockage. The main cause of portal
hypertension is cirrhosis (scarring of the liver).
The Symptoms and Complications of Portal Hypertension?
a) Gastrointestinal hemorrhage or bleeding is often the the initial
presenting symptom of patients with portal hypertension. Blood
vomiting, blood in the stool or Black, tarry stool due to bleeding and
rupture from varices. These patients with advanced liver disease
generally present with jaundice, ascites, coagulopathy, hepatic
encephalopathy or spider nevus (spider angiomas), additional
indication like enlargement of the spleen (splenomegaly) and dilated
abdominal wall veins.
b) Varices describes enlarged blood vessels. Blood, diverted to and
gathered in another vein when heading to the heart. These varices can
occur in the esophagus, stomach, around the umbilicus and in the anus
and anal.
c) Ascites is the end result of a series of events. Cirrhosis of the liver is
the most common cause of ascites. When cirrhosis occurs, blood flow
through the liver is blocked.
d) Hepatic Encephalopathy is a decline in brain function (forgetfulness
and confusion) that occurs as a result of severe liver disease. In this
condition, your liver can’t adequately remove toxins from your blood.
This causes a buildup of toxins in your bloodstream, which can lead to
brain damage.
e) Enlargement of the spleen (splenomegaly) often caused by infections,
cirrhosis and other liver diseases, blood diseases characterized by
abnormal blood cells, problems with the lymph system, or other

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 conditions. Other causes of an enlarged spleen include: Inflammatory
diseases such as sarcoidosis, lupus, and rheumatoid arthritis.
f) Decreased platelets levels and white blood cell counts increase the risk
of general infection.

Treatment options for portal hypertension?

Treatment start with preventing complications of Portal hypertension. Once
the complications identified, treating the underlying cause and alcohol abuse
(due to the risk of further liver damage). It can be managed through diet,
medications, endoscopic treatment, radiology or finally surgery.
Liver Transplantation: Liver transplantation is the only effective treatment for
end-stage liver disease.

Dr. Khaled Khairi

LIVER CIRRHOSIS
Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver damage.
The scar tissue prevents the liver working properly. Cirrhosis is sometimes
called end-stage liver disease because it happens after other stages of damage
from conditions that affect the liver, such as hepatitis.
Common Causes cirrhosis of the liver?
1) Excessive drinking of alcohol.
2) Hepatitis B and C virus infections.
3) Fatty liver that's caused by obesity and diabetes.
Symptoms of cirrhosis of the liver?
a) During early stages
1) fatigue; weakness and weight loss; nausea;
1) bruising or bleeding easily;
2) swelling in your legs, feet or ankles;
3) itchy skin; redness on the palms of your hands; and spider-like blood
vessels on your skin.
b) During later stages, patients may develop
1) jaundice (yellowing of the skin),
2) gastrointestinal bleeding,
3) abdominal swelling,
4) confusion.

Best treatment for liver cirrhosis?

If cirrhosis progresses and your liver is severely damaged, a liver transplant
may be the only treatment option. This is a major operation that involves
removing your diseased liver and replacing it with a healthy liver from a
donor.

Dr. Khaled Khairi

PANCREATITIS
Pancreatitis is the redness and swelling (inflammation) of the pancreas. This
happens when digestive juices or enzymes attack the pancreas. The pancreas
lies behind your stomach on the left side of your belly.
The two main types are:
A. Acute Pancreatitis which comes on suddenly.
B. Chronic Pancreatitis which is long-lasting.
Pancreatitis can cause severe complications that require immediate
attention:
a) Malnutrition, due to lack of digestive enzymes.
b) Diabetes, due to insulin mismanagement.
c) Pancreas infection.
d) Kidney problem / failure.
e) Pancreatic cancer.
f) Fatigue and dehydration due to diarrhea.
g) Necrotizing pancreatitis (tissues death inside the pancreas due to
limited blood supply).
h) Pancreatic pseudocyst (fluid collection in pancreas).
i) Lungs problem such as difficult in breathing.

These conditions can cause acute or chronic pancreatitis:

a) Moderate or heavy alcohol consumption and smoking (25% cases of
pancreatitis)
b) Gallbladder stone (40% cases of acute pancreatitis)
c) Hormonal abnormalities
d) Abdominal injury / Abdominal surgery
e) Hereditary conditions
f) Obesity
g) Recurrent acute pancreatitis can cause chronic pancreatitis
h) Cystic fibrosis (inherited life-threatening disorder that damages the
digestive system and lungs)
i) Certain Medications
j) Increased level of triglycerides (fat in a blood that gives energy).

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Pancreatitis diagnosis
Blood and Stool tests: Amylase or lipase blood test and Stool routine test for
digestive enzymes of the pancreas. It will be elevated 3 times in pancreatitis
from its normal range.
Imaging tests: X-rays with a barium meal and Ultrasound imaging:
specifically evaluate the gallbladder for stones
Endoscopic ultrasound (EUS): Endoscopic examination to evaluate
pancreatic masses and tumors, pancreatic cysts, small stone in bile duct and
gall bladder not identified during ultrasound.
CT Scan, Magnetic resonance imaging (MRI), Magnetic resonance
cholangiopancreatography (MRCP), or PET scans: Non-invasive tests for
detailed imaging of the pancreas and the surrounding.
Biopsy or Tissue analysis: a tissue sample (biopsy) from pancreas may help
diagnose pancreatitis and further look for signs of pancreatitis.
Endoscopic retrograde cholangiopancreatography (ERCP): to view the bile
duct and pancreatic duct. It helps to remove gallstones from the bile duct
gallstones that are causing a blockage.
Pancreatitis treatment?
Pancreatitis treatment depends upon its type, cause, and stags. It’s very
important to find the cause and extent of pancreas damage in guiding
treatment. Pancreatitis treatment usually require short-term or long-term
hospitalization to initiate the aggressive treatment.
In general, the following treatment will be initiated for the treatment of
pancreatitis -
a) Pain medicine and antibiotics to lower down the infection.
b) Intravenous (IV) fluids, it helps to prevent dehydration so that the rest
of the organs of the body get adequate blood flow to support the healing
process.
c) Low-fat diet or fasting, to stop eating so your pancreas can recover. In
this case, nutrition will be given through a feeding tube.
d) Gallbladder surgery (cholecystectomy) if gallstones caused your
pancreatitis.

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 e) Endoscopic Retrograde Cholangiopancreatography (ERCP): to take
out gallstones if they’re blocking your bile or pancreatic ducts. There
different procedures that can be performed using ERCP like:
1. Gallstone removal
2. Sphincterotomy for pseudocyst drainage
3. Balloon dilatation: to dilate, or stretch, a narrowed
pancreatic or bile duct to keep the duct open
4. Stent placement: placing a tiny piece of plastic or metal
that looks like a straw into a narrowed pancreatic or bile
duct to keep it open.
f) Pancreas surgery such as
1. Distal pancreatectomy
2. Pancreaticoduodenectomy (Whipple procedure)
3. Total pancreatectomy to clean out fluid or dead or
diseased tissue a liver transplant.
AMEBIASIS
is an intestinal (bowel) illness caused by a microscopic (tiny) parasite called
Entamoeba histolytica, which is spread through human feces (poop). Often
there are no symptoms, but, sometimes it causes diarrhea (loose stool/poop),
nausea (a feeling of sickness in the stomach), and weight loss.
Entamoeba histolytica.
Amoebiasis infection is most common in tropical areas with untreated water.
It spreads through drinking or eating uncooked food, such as fruit, that may
have been washed in contaminated local water.
Signs & Symptoms of Amebiasis?
a) diarrhea (which may be bloody)
b) stomach pains.
c) cramping.
d) nausea.
e) loss of appetite.
f) fever.

Dr. Khaled Khairi

Amoebiasis diagnosed?
Examination of stools (poop) under a microscope is the most common way
for a doctor to diagnose amebiasis. Sometimes, several stool samples must be
collected because the number of amoeba being passed in the stool, which
varies from day to day, may be too low to detect from any single sample.
Treatment for amebiasis?
Treat with metronidazole or tinidazole to eliminate amebic trophozoites,
followed by iodoquinol or paromomycin to kill cysts in the intestine.
Because parasites persist in the intestines of 40-60% of patients treated with
metronidazole, this drug should be followed with paromomycin to cure
luminal infection.

Amebic liver abscess

Amebic liver abscess is the most frequent extraintestinal manifestation of
Entamoeba histolytica infection. Entamoeba histolytica exists in two forms:
a) Cyst stage is the infective form non invasive diseases.
b) Trophozoite stage causes invasive disease.
People who chronically carry E histolytica shed cysts in their feces; these cysts
are transmitted primarily by food and water contamination.
Cysts are resistant to gastric acid, but the wall is broken down by trypsin in
the small intestine. Trophozoites are released and colonize the cecum. To
initiate symptomatic infection, E histolytica trophozoites present in the lumen
must adhere to the underlying mucosa and penetrate the mucosal layer.

Liver involvement occurs following invasion by E histolytica into mesenteric

venules. Amebae then enter the portal circulation and travel to the liver where
they typically form one or more abscesses.

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Prognosis( complication)
In most cases, rapid clinical improvement is observed in less than 1 week with
antiamebic drug therapy alone. Radiological resolution lags behind the
resolution of clinical symptoms. The average time to radiological resolution
is approximately 12 months, with a range of 3 months to more than 10 years.
Death occurs in approximately 5% of persons having extraintestinal infection,
including liver abscess. Rupture into the peritoneal cavity and the pericardium
are responsible for most deaths.
Pleuropulmonary infection is the most common complication. Mechanisms of
infection include development of a sympathetic serous effusion; rupture of a
liver abscess into the chest cavity, leading to empyema; or a hematogenous
spread, resulting in parenchymal infection.
Cardiac involvement results following the rupture of an abscess involving the
left lobe of the liver. It usually is associated with very high mortality.

HYDATID DISEASE
Hydatid disease is a parasitic infestation by a tapeworm of the genus
Echinococcus.
Human infection with E. granulosus leads to the development of one or more
hydatid cysts located most often in the liver and lungs, and less frequently in
the bones, kidneys, spleen, muscles and central nervous system.

People become infected by ingesting

(eating) eggs of the parasite, usually
when there is hand-to-mouth transfer
of eggs in dog faeces. This can occur
when handling dogs or objects
(including food and water) soiled
with dog faeces.

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Clinical presentation
Patients may be either completely asymptomatic or present with non-specific
signs and symptoms in early disease.
Liver involvement usually presents with symptoms when the cyst size is large
(> 10 cm) in diameter or when 70% of the organ volume has been taken up by
the cyst(s).
Common presenting complaints may include right hypochondrial pain, a
hepatic mass, and nausea and vomiting.
Obstructive jaundice may occur if an adjacent liver cyst compresses the biliary
system.
Physical examination findings may exhibit hepatomegaly or abdominal
distension.

ULCERATIVE COLITIS
Definition
Ulcerative colitis is a condition in which the lining of the large intestine
(colon) and rectum become inflamed. It is a form of inflammatory bowel
disease (IBD). Crohn disease is a related condition.
Causes
The cause of ulcerative colitis is unknown. People with this condition have
problems with their immune system.
Ulcerative colitis may affect any age group. There are peaks at ages 15 to 30
and then again at ages 50 to 70.
The disease begins in the rectal area. It may stay in the rectum or spread to
higher areas of the large intestine. However, the disease does not skip areas.
It may involve the entire large intestine over time.
Symptoms
The symptoms can be more or less severe. They may start slowly or suddenly.

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Symptoms may include:
✓ Pain in the abdomen (belly area) and cramping.
✓ A gurgling or splashing sound heard over the intestine.
✓ Blood and possibly pus in the stools.
✓ Diarrhea, from only a few episodes to very often.
✓ Fever.
✓ Feeling that you need to pass stools, even though your bowels are
already empty. It may involve straining, pain, and cramping
(tenesmus).
✓ Weight loss.
Other symptoms that may occur with ulcerative colitis include the following:
Joint pain and swelling
Mouth sores (ulcers)
Nausea and vomiting
Skin lumps or ulcers
Exams and Tests
Colonoscopy with biopsy is most often used to diagnose ulcerative colitis.
Treatment for ulcerative colitis
Aminosalicylates, also known as 5-ASAs, are medicines that help to reduce
inflammation. This in turn allows damaged tissue to heal. They're usually the
first treatment option for mild or moderate ulcerative colitis.
Surgical treatment
Surgery is indicated for ulcerative colitis that fails to respond to treatment.
Crohn's DISESASE
Crohn's disease is a type of inflammatory bowel disease (IBD). It causes
swelling of the tissues (inflammation) in your digestive tract.
Causes for Crohn's disease
The cause of Crohn's disease is unknown.

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Symptoms for Crohn's disease
a) Diarrhea.
b) Fever.
c) Fatigue.
d) Abdominal pain and cramping.
e) Blood in your stool.
f) Mouth sores.
g) Reduced appetite and weight loss.
Treatments for Crohn's disease
There's no cure for Crohn's disease, but treatment can help reduce or control
your symptoms.

COLORECTAL CANCER
Colorectal cancer starts in the colon or the rectum. These cancers can also be
called colon cancer or rectal cancer, depending on where they start. Colon
cancer and rectal cancer are often grouped together because they have many
features in common. Cancer starts when cells in the body start to grow out of
control.
Most of these cancers start as noncancerous growths called polyps. Removing
polyps can prevent cancer, so health care providers recommend screenings for
those at high risk or over the age of 45.
Symptoms may vary depending on the cancer's size and location.
Symptoms might include
a) blood in the stool.
b) abdominal discomfort.
c) a change in bowel habits, such as diarrhea or constipation.

Dr. Khaled Khairi