Journal of Clinical Gastroenterology and Hepatology is an open accessed, peer reviewed journal, publishes papers reporting clinical and scientific research which are of a high standard and which contribute to the advancement of knowledge in the fields of Gastro-intestinal system and hepatology and its associated disorders. The editorial office promises a peer reviewing of the submitted manuscripts to maintain quality.
This Open access journal publishes quarterly issues containing original articles, review articles, case reports, short communications, etc. in all areas of the hepatology, gastro-intestinal disorders like constipation, Irritable Bowel Syndrome (IBS) etc and making them freely available worldwide.
The pancreas is a long flattened gland located deep in the belly (abdomen). Because the pancreas isn’t seen or felt in our day to day lives, most people don't know as much about the pancreas as they do about other parts of their bodies. The pancreas is, however, a vital part of the digestive system and a critical controller of blood sugar levels.
The pancreas is located deep in the abdomen. Part of the pancreas is sandwiched between the stomach and the spine. The other part is nestled in the curve of the duodenum (first part of the small intestine).
Chronic pancreatitis is inflammation of the pancreas that does not heal or improve—it gets worse over time and leads to permanent damage. Chronic pancreatitis eventually impairs a patient’s ability to digest food and make pancreatic hormones. Industrialized countries have estimated an annual incidence rate of 5-12/100,000 people who will develop chronic pancreatitis. The prevalence of chronic pancreatitis is 50/100,000 people. Chronic pancreatitis often develops in patients between the ages of 30 and 40, and is more common in men than women.
Cystic fibrosis(CF) is a genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. Other signs and symptoms may include sinus infections, poor growth, fatty stool, clubbing of the fingers and toes, and infertility in some males. Different people may have different degrees of symptoms.
Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as fasting and aggressive intravenous fluid rehydration, severe cases may require admission to the intensive care unit or even surgery to deal with complications of the disease process.
A pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomy exist, including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy. These procedures are used in the management of several conditions involving the pancreas, such as benign pancreatic tumors, pancreatic cancer, and pancreatitis.
The gallbladder is basically a pear-shaped pouch for storing bile - a liquid made by the liver to help digest fatty foods. Although a person with a gallbladder problem may not have any symptoms, sometimes a problem can cause severe abdominal pain.
Medical conditions that can cause gallbladder pain are:
Biliary colic: An intermittent blockage of a duct from gallstones or bile sludge (sometimes referred to as uncomplicated gallstone disease).
Acute cholecystitis: Inflammation of gallbladder tissue.
Acute pancreatitis: Sometimes linked to gallstones formed in the gallbladder blocking the pancreatic duct (which merges with one of the bile ducts), causing inflammation of the pancreas.
Cholangitis: An infection of the bile ducts.
Some fat in your liver is normal. But if it makes up more than 5%-10% of the organ's weight, you may have fatty liver disease. If you're a drinker, stop. That's one of the key causes of the condition.
There are two main types of fatty liver disease.
Alcoholic liver disease (ALD):You can get alcoholic liver disease from drinking lots of alcohol. It can even show up after a short period of heavy drinking. Genes that are passed down from your parents may also play a role in ALD. They can affect the chances that you become an alcoholic. And they can also have an impact on the way your body breaks down the alcohol you drink.
Nonalcoholic fatty liver disease (NAFLD):It's not clear what causes this type of fatty liver disease. It tends to run in families. It's also more likely to happen to those who are middle-aged and overweight or obese. People like that often have high cholesterol and diabetes as well.
You can also get fatty liver disease during pregnancy.It's rare, but fat can build up in your liver when you're pregnant. This could be risky for both you and your baby. It could lead to liver or kidney failure in either of you. It might also cause a serious infection or bleeding. No one fully understands why fatty liver happens during pregnancy, but hormones may play a role. Once you get a diagnosis, it's important that your baby gets delivered as soon as possible. Although you may need intensive care for several days, your liver often returns to normal in a few weeks.
Gallbladder is a small organ below the liver in the upper right abdomen. It’s a pouch that stores bile, a green-yellow liquid that helps with digestion. Most gallstones form when there’s too much cholesterol in the bile.
Gallstones can lead to pain in the upper right abdomen. You may start to have gallbladder pain from time to time when you eat foods that are high in fat, such as fried foods.The pain doesn’t usually last more than a few hours.
You may also experience: Nausea; Vomiting; Dark urine; Clay-colored stools; Stomach pain; Burping; Diarrhea; Indigestion These symptoms are also known as biliary colic.
"It's an organ you could easily trash if you don't take good care of it,"
Here are some ways to keep your liver healthy:
Don't drink a lot of alcohol. It can damage liver cells and lead to the swelling or scarring that becomes cirrhosis, which can be deadly. How much alcohol is too much? U.S. government guidelines say men should drink no more than two drinks a day and women only one.
Eat a healthy diet and get regular exercise. Your liver will thank you. You'll keep your weight under control, which helps prevent nonalcoholic fatty liver disease (NAFLD), a condition that leads to cirrhosis.
Watch out for certain medicines. Some cholesterol drugs can occasionally have a side effect that causes liver problems. The painkiller acetaminophen (Tylenol) can hurt your liver if you take too much.
You may be taking more acetaminophen than you realize. It's found in hundreds of drugs like cold medicines and prescription pain medicines.
Common digestive problems include heartburn/GERD, IBD, and IBS. Symptoms may include bloating, diarrhea, gas, stomach pain, and stomach cramps.Treatment includes a combination of medication and lifestyle changes.
A selection of the more common digestive problems are below
Acute Diarrhoea, Coeliac Disease, Constipation, Crohn's Disease, Diarrhoea, Gallstones, Haemorrhoids (Piles) Heartburn and acid reflux, Indigestion, Irritable Bowel Syndrome (IBS) and Ulcerative Colitis
Hepatology is a branch of medicine concerned with the study, prevention, diagnosis and management of diseases that affect the liver, gallbladder, biliary tree and pancreas. The term hepatology is derived from the Greek words “hepatikos” and “logia,” which mean liver and study, respectively.
Hepatitis affects millions of individuals globally and is associated with several poor outcomes including liver transplant and liver cancer. In particular, hepatitis B and hepatitis C are major causes of liver cancer, while alcohol abuse has been linked to conditions such as cirrhosis and other serious complications. The conditions hepatologists deal with most frequently are viral hepatitis and alcohol-related liver disease.
The liver is the largest gland in the human body. It weighs approximately 3 lb (1.36 kg). It is reddish brown in color and is divided into four lobes of different sizes and lengths. It is also the largest internal organ (the largest organ is the skin). It is below the diaphragm on the right in the thoracic region of the abdomen. Blood reaches the liver through the hepatic artery and the portal vein. The portal vein carries blood containing digested food from the small intestine, while the hepatic artery carries oxygen-rich blood from the aorta. The liver is made up of thousands of lobules, each lobule consists of many hepatic cells - hepatic cells are the basic metabolic cells of the liver.
Biliary atresia, also known as extrahepatic ductopenia and progressive obliterative cholangiopathy, is a childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked, or absent. It can be congenital or acquired. As a birth defect in newborn infants, it has an incidence of one in 10,000–15,000 live births in the United States, and a prevalence of one in 16,700 in the British Isles.Biliary atresia is most common in East Asia, with a frequency of one in 5,000.
The causes of biliary atresia are not well understood. Congenital biliary atresia has been associated with certain genes, while acquired biliary atresia is thought to be a result of an autoimmune inflammatory response, possibly due to a viral infection of the liver soon after birth. The only effective treatments are surgeries such as the Kasai procedure and liver transplantation.
Viral hepatitis is liver inflammation due to a viral infection. It may present in acute (recent infection, relatively rapid onset) or chronic forms.
The most common causes of viral hepatitis are the five unrelated hepatotropic viruses hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. In addition to the nominal hepatitis viruses, other viruses that can also cause liver inflammation include cytomegalovirus, Epstein–Barr virus, and yellow fever. Up to 1997 there has been also 52 cases of viral hepatitis caused by herpes simplex virus.
There is the opportunity to prevent or treat the most common types. Hepatitis A and hepatitis B can be prevented by vaccination. Effective treatments for hepatitis C are available but expensive.
Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells.
Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure.
Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people.
Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat.
Colorectal cancer (CRC), also known as bowel cancer and colon cancer, is the development of cancer from the colon or rectum (parts of the large intestine). A cancer is the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Signs and symptoms may include blood in the stool, a change in bowel movements, weight loss, and feeling tired all the time.
Most colorectal cancers are due to old age and lifestyle factors with only a small number of cases due to underlying genetic disorders. Some risk factors include diet, obesity, smoking, and lack of physical activity. Dietary factors that increase the risk include red and processed meat as well as alcohol. Another risk factor is inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis.Some of the inherited genetic disorders that can cause colorectal cancer include familial adenomatous polyposis and hereditary non-polyposis colon cancer; however, these represent less than 5% of cases. It typically starts as a benign tumor, often in the form of a polyp, which over time becomes cancerous
Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. It is commonly associated with itchiness. The feces may be pale and the urine dark.Jaundice in babies occurs in over half in the first week following birth and in most is not a problem. If bilirubin levels in babies are very high for too long a type of brain damage, known as kernicterus, may occur.
Causes of jaundice vary from non-serious to potentially fatal. Levels of bilirubin in blood are normally below 1.0 mg/dL (17 µmol/L) and levels over 2–3 mg/dL (34-51 µmol/L) typically results in jaundice. High bilirubin is divided into two types: unconjugated (indirect) and conjugated (direct). Conjugated bilirubin can be confirmed by finding bilirubin in the urine. Other conditions that can cause yellowish skin but are not jaundice include carotenemia from eating large amounts of certain foods and medications like rifampin
Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voice, enlarged lymph nodes ("glands") around the collarbone, a dry cough, and possibly coughing up or vomiting blood.
The two main sub-types of the disease are esophageal squamous-cell carcinoma (often abbreviated to ESCC), which is more common in the developing world, and esophageal adenocarcinoma (EAC), which is more common in the developed world.
Gastroenterology (MeSH heading) is the branch of medicine focused on the digestive system and its disorders. Diseases affecting the gastrointestinal tract, which include the organs from mouth to anus, along the alimentary canal, are the focus of this speciality.
Physicians practicing in this field are called gastroenterologists. They have usually completed about eight years of pre-medical and medical education, a year-long internship (if this is not a part of the residency), three years of an internal medicine residency, and two to three years in the gastroenterology fellowship. Gastroenterologists perform a number of diagnostic and therapeutic procedures including colonoscopy, endoscopy, endoscopic retrograde cholangiancreatography (ERCP), endoscopic ultrasound and liver biopsy. Some gastroenterology trainees will complete a "fourth-year" (although this is often their seventh year of graduate medical education) in transplant hepatology, advanced endoscopy, inflammatory bowel disease, motility or other topics.
Hepatology, or hepatobiliary medicine, encompasses the study of the liver, pancreas, and biliary tree, while proctology encompasses the fields of anus and rectum diseases. They are traditionally considered sub-specialties of gastroenterology.
A distal pancreatectomy is where the bottom half of the pancreas is removed by a surgical procedure. The most frequent reason for performing a distal pancreatectomy is the presence of a tumor in the body or tail of the pancreas. After removal of the pancreas, the cut edge of the pancreas is often sutured to prevent leakage of pancreatic juice from this area. Most common complication of a distal pancreatectomy is leakage of pancreatic juice from the cut edge of the pancreas. Dilip Parekh M.D. has developed a specialized technique for suturing this part of the pancreas that has led to a very low incidence (less than 3%) of leakage of pancreatic juice after the surgery.
A pancreatic fistula is an abnormal communication between the pancreas and other organs due to leakage of pancreatic secretions from damaged pancreatic ducts. An external pancreatic fistula is one that communicates with the skin, and is also known as a pancreaticocutaneous fistula, whereas an internal pancreatic fistula communicates with other internal organs or spaces. Pancreatic fistulas can be caused by pancreatic disease, trauma, or surgery.
Constipation refers to bowel movements that are infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids, anal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day.
A colorectal polyp is a polyp (fleshy growth) occurring on the lining of the colon or rectum. Untreated colorectal polyps can develop into colorectal cancer.
Colorectal polyps are often classified by their behaviour (i.e. benign vs. malignant) or cause (e.g. as a consequence of inflammatory bowel disease). They may be benign (e.g. hyperplastic polyp), pre-malignant (e.g. tubular adenoma) or malignant (e.g. colorectal adenocarcinoma).
Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localized or generalized, and may result from infection (often due to perforation of the intestinal tract as may occur in abdominal trauma or inflamed appendix) or from a non-infectious process.
Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis.
Appendicitis is caused by a blockage of the hollow portion of the appendix. This is most commonly due to a calcified "stone" made of feces. Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage. This blockage leads to increased pressures in the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation. The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue death. If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to increased complications
Schistosomiasis, also known as snail fever and bilharzia, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Signs and symptoms may include abdominal pain, diarrhea, bloody stool, or blood in the urine. Those who have been infected for a long time may experience liver damage, kidney failure, infertility, or bladder cancer. In children, it may cause poor growth and learning difficulty.
A partial hepatectomy can be done as either a traditional, open surgical procedure or as a less invasive, laparoscopic procedure.
Patients who undergo laparoscopic liver resection tend to:
Experience less pain.
Have a shorter stay in the hospital.
Recover more quickly.
Resume other treatments (e.g., chemotherapy) more quickly because they recover from surgery in less time than with open surgery.
Have less scarring/better cosmetic appearance where incisions are mad.
Author(s): Antonio Ponzetto, Giovanni Cavallo, Brunilda Alushi, Natale Figura and Elena Moretti
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