Conditions Treated

Hernia
– Inguinal Hernia
– Ventral hernia
– How Do I Know If I Have a Ventral Hernia?
– What Causes a Ventral Hernia?
– Umbilical hernia
– Spigelian hernia
– Epigastric hernia
– Femoral hernia
– Incarcerated hernia
– Incisional hernia
Gall Stones
Adrenal mass
Colorectal cancer
Diverticulosis
Gastrointestinal bleeding
Stomach cancer
Stomach ulcer
Dysphagia
Esophageal cancer
Liver cancer
Pancreatic cancer
Chronic pancreatitis
Small intestine cancer
Small intestine ulcer
Spleen problems
– Splenomegaly
– Auto-immune thrombocytopenia purpura (ITP)
– Hemolytic anemia
– Hereditary (genetic) conditions
– Malignancy
Appendicitis
Gastroesophageal Reflux Disease (GERD)

---

Hernia

Hernia is a general term that describes an opening in the body between 2 spaces that are not normally connected. Hernia can occur in multiple areas of the body and the most common area is the abdominal region. In the abdomen, hernias occur when the inside layers of the abdominal muscle have weakened resulting in a bulge or tear. This can allow a loop of intestine or abdominal tissue to push into the sac. Symptoms of hernia can include pain, discomfort and they can be unsightly. Usually they are not life-threatening, however they can be dangerous if the organ becomes entrapped and the blood supply is disrupted. Both men and women get hernias. One may be born with a hernia. A hernia does not get better over time, nor will it go away by itself. There are no exercises or physical therapy regimen that can make a hernia go away.

How do I know if I have a hernia? The most common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional). It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain or discomfort when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting. Other times, a hernia may be detected by your doctor on a routine physical examination. The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day. Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. Another sign of this is, if the bulge used to come and go, but now is stuck out continuously. These symptoms are cause for concern and you should immediately contact your physician or surgeon.

There are many different types of hernias:

Inguinal Hernia

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. The inguinal canal is found in the groin and both and women. The hernia occurs when the intestine pushes through this week spot in the abdominal wall. Symptoms of inguinal hernia include pain when you cough, bend or lift heavy objects in the groin area, pressure or weakness in the groin, swelling of the groin or testicles, physical protrusion or bulge of the intestine in the groin.

Ventral hernia

Ventral hernia is a general term to describe a bulge of tissue through an opening or weakness within the abdominal wall muscles and can occur at any location in the abdominal wall. When a ventral hernia occurs, it usually arises in the abdominal wall where a previous surgical incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a balloon-like sac. This can allow a loop of intestines or other abdominal contents to push into the sac. If the abdominal contents get stuck within the sac, they can become trapped or “incarcerated.” This could lead to potentially serious problems that might require emergency surgery. Other sites that ventral hernias can develop are the belly button (umbilicus) or any other area of the abdominal wall. A hernia does not get better over time, nor will it go away by itself.

How Do I Know If I Have a Ventral Hernia?

A ventral hernia is usually recognized as a bulge under your skin. Occasionally, it causes no discomfort at all, but you may feel pain when you lift heavy objects, cough, strain during urination or bowel movements or with prolonged standing or sitting. The discomfort may be sharp or a dull ache that gets worse towards the end of the day. Any continuous or severe discomfort, redness, nausea or vomiting associated with the bulge are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon is recommended.

What Causes a Ventral Hernia?

An incision in your abdominal wall will always be an area of potential weakness. Hernias can develop at these sites due to heavy straining, aging, obesity, injury or following an infection at that site following surgery. They can occur immediately following surgery or may not become apparent for years later following the procedure. Anyone can get a hernia at any age. They are more common as we get older. Certain activities may increase the likelihood of a hernia including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining.

Umbilical hernia

In child development, the umbilical cord connects the fetus with the mother’s womb. It passes through a small opening in the stomach muscles. Normally, this hole closes shortly after birth. An umbilical hernia occurs when the canal through the stomach muscle does not close completely. This allows the intestine or other tissues to bulge through this week spot around the umbilicus (navel). Umbilical hernias are usually painless and don’t cause discomfort. Symptoms include swelling or bulging near the navel and sometimes can be painful.

Spigelian hernia

The Spigelian fascia is a layer of tissues between the abdominal muscles. A spigelian hernia occurs when the intestine protrudes through this layer of tissues between the abdominal muscles. Symptoms include abdominal pain and discomfort, and often do not cause swelling or bulging.

Epigastric hernia

The epigastric region of the abdomen defined by the area between the sternum and navel. Epigastric hernia forms when there is a hole or weak spot in the abdominal wall in this region. Symptoms of epigastric hernia include a bulge or bump in the area below the sternum and above the belly button. This raised area may be visible all the time, or only when a person coughs, sneezes or laughs. It can cause tenderness in the region, however, most often it is not painful and does not cause discomfort.

Femoral hernia

The femoral canal is the channel in the groin where the femoral artery and other nerves and vessels pass into the leg. A femoral hernia occurs when the abdominal tissues are pushed through this canal. It is most commonly caused by straining in a person with an already weakened area around the femoral canal. Often there are no symptoms associated with femoral hernias. One may see a bulge that is visible in the groin area or upper thigh. It may cause pain with lifting heavy objects or straining in any way.

Incarcerated hernia

Incarcerated hernia can be a life-threatening condition. It occurs when the intestine pushes through a weakened area of the abdominal muscle. The surrounding muscle cuts off the blood supply to the intestine resulting in intestinal perforation, bowel obstruction, shock and sepsis. Symptoms of incarcerated hernia include pain that may be severe, bloody stools, constipation, fever, inflammation and tenderness of the abdominal wall, nausea, vomiting and bowel obstruction.

Incisional hernia

Incisional hernia is caused by an incompletely healed surgical wound of the abdomen. After abdominal surgery there can be weakness or a hole in the abdominal wall that allows the intestine to perforate out through it. Often, they are caused by postoperative hematoma, seroma, infection and improper wound healing. Symptoms of incisional hernia include a bulge or protrusion in the area of the surgical incision, pain and discomfort in the area of the incision, and inflammation.

Gall Stones

The gallbladder is a digestive organ in the right upper abdomen. It stores and releases bile which aids in the digestion of fat. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine. A gallstone is a hard collection of cholesterol, calcium salt or bilirubin. The stones harden when there is an increased concentration of these elements within the bile. This can occur from the liver producing too much or from the gallbladder failing to empty, causing an increased concentration. It is uncertain why some people form gallstones, but risk factors include being female, prior pregnancy, age over 40 years and being overweight. Gallstones are also more common as you get older and some people may have a family history of gallstones. There is no known means to prevent gallstones. These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever. If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur. Ultrasound is most commonly used to find gallstones. In more complex cases, other X-ray test such as a CAT scan or a gallbladder nuclear medicine scan may be used to evaluate gallbladder disease. Gallstones do not go away on their own. Some can be temporarily managed by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed. Symptoms of gallstones include nausea, vomiting, dark colored urine, clay colored stools, abdominal pain, diarrhea and indigestion.

Adrenal mass

There are 2 adrenal glands in the body that are just above each kidney. They are triangular in shape and about the size of a thumb. The adrenal glands are known as endocrine glands because they produce hormones. These hormones are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the “fight or flight” reaction during times of stress. These adrenal-produced hormones include cortisol, aldosterone, the adrenaline hormones – epinephrine and norepinephrine – and a small fraction of the body’s sex hormones (estrogen and androgens).

Diseases of the adrenal gland are relatively rare. The most common reason that a patient may need to have the adrenal gland removed is excess hormone production by a tumor located within the adrenal. Masses of the adrenal gland can be benign or cancerous. Most of these tumors are small and not cancers. They are known as benign growths that can usually be removed with laparoscopic techniques. Removal of the adrenal gland may also be required for certain tumors even if they aren’t producing excess hormones, such as very large tumors or if there is a suspicion that the tumor could be a cancer, referred to as malignant tumors. Fortunately, malignant adrenal tumors are rare. An adrenal mass or tumor is sometimes found by chance when a patient gets an X-ray study to evaluate another problem.

A cancerous tumor of the adrenal gland is called an adrenal cortical carcinoma. Benign tumor of the adrenal gland is called a benign adenoma. Benign adenomas are usually small and do not present with any symptoms. Adrenal cortical carcinoma are usually much larger and cause symptoms when they put pressure on other organs around them. Most symptoms of adrenal cortical carcinoma are multiple changes in the body due to the excessive production of hormones. They can produce androgen, estrogen, cortisol and aldosterone. Many times, the symptoms do not occur until the mass is large enough to press on other organs. Symptoms of these increased hormones in children can include excessive hair growth, enlarged venous, intermuscular risks, enlarged breasts in males, early puberty in girls. Symptoms of these increased hormones in adults include high blood pressure, high blood sugar, weight gain, easily bruising, irregular periods, and muscle cramps. If an adrenal tumor is suspected based on symptoms or has been identified by X-ray, the patient should undergo blood and urine tests to determine if the tumor is over-producing hormones. Special X-ray tests, such as a CAT scan, nuclear medicine scan, an MRI or selective venous sampling are commonly used to locate the suspected adrenal tumor.

Patients with adrenal gland problems may have a variety of symptoms related to excess hormone production by the abnormal gland. Adrenal tumors associated with excess hormone production include pheochromocytomas, aldosterone-producing tumors, and cortisol-producing tumors. Some of these tumors and their typical features are given below.

Pheochromocytomas produce excess hormones that can cause very high blood pressure and periodic spells characterized by severe headaches, excessive sweating, anxiety, palpitations, and rapid heart rate that may last from a few seconds to several minutes. Aldosterone producing tumors cause high blood pressure and low serum (blood) potassium levels. In some patients this may result in symptoms of weakness, fatigue, and frequent urination. Cortisol producing tumors cause a syndrome termed Cushing’s syndrome that can be characterized by obesity (especially of the face and trunk), high blood sugar, high blood pressure, menstrual irregularities, fragile skin, and prominent stretch marks. Most cases of Cushing’s syndrome, however, are caused by small pituitary tumors and are not treated by adrenal gland removal. Overall, adrenal tumors account for about 20% of cases of Cushing’s syndrome. An incidentally found mass in the adrenal may be any of the above types of tumors, or may produce no hormones at all. Most incidentally found adrenal masses do not make excess hormones, cause no symptoms, are benign, and do not need to be removed.

Colorectal cancer

The colon is the large intestine. It is the lower part of your digestive tract. The intestine is a long, tubular organ consisting of the small intestine, the colon (large intestine) and the rectum, which is the last part of the colon. After food is swallowed, it begins to be digested in the stomach and then empties into the small intestine, where the nutritional part of the food is absorbed. The remaining waste moves through the colon to the rectum and is expelled from the body. The colon and rectum absorb water and hold the waste until you are ready to expel it. Colorectal cancer is a cancer that starts in the rectum or the large intestine. There are many different types of colon cancer. It is important to stage the cancer. There are progressive stages from 1-4, with 4 being the most advanced. Treatment depends on the type of cancer in the stage of the cancer. Symptoms of colon cancer include constipation, diarrhea, changes in the stool, blood in the stool, rectal bleeding, weakness, fatigue, weight loss, abdominal pain and abdominal cramps. It is not completely understood what causes colorectal cancer, however, in general it occurs when healthy cells become abnormal and multiply faster than they should or do not turn over as they should.

Diverticulosis

Diverticulosis occurs when there is a bulging sac within the large intestine or other parts of the digestive system. It often becomes inflamed or infected and is then called diverticulitis. Symptoms include pain and discomfort of the abdomen, abdominal bleeding, nausea, vomiting, constipation, fever, bloating, diarrhea, and loss of appetite. The cause of diverticulosis is not completely understood however it is thought to occur when there is increased pressure within the colon leading to the bulging out. Diverticulitis occurs when fecal matter gets lodged within the diverticula and cause inflammation and infection.

Gastrointestinal bleeding

There are many causes of gastrointestinal bleeding. GI bleeding can occur in the esophagus, stomach, small intestine, large intestine, rectum, or anus. Causes may include: Stomach ulcers, peptic ulcers, esophageal varices, cirrhosis, acid reflux, Crohn’s disease, gastritis, intussusception, colorectal cancer, liver disease, esophageal cancer, rectal polyps, hemorrhoids, stomach cancer, liver cancer, diverticulitis, hemophilia, colitis, thrombocytopenia, and many types infections. The amount of bleeding can be very small to life-threatening hemorrhage. Symptoms include stool that can become dark or sticky black tar for the bleeding occurs in the upper GI tract. When there is bleeding of the lower GI tract, there is often red blood in the stool. Another symptom is vomiting blood that looks like coffee grounds. Other general symptoms include weakness, dizziness, shortness of breath and paleness.

Stomach cancer

Stomach cancer, also called gastric cancer, occurs when cancerous cells occur in the lining of the stomach organ. It occurs when the normal cells become cancerous, growing out of control and form a tumor in the stomach lining. Often stomach cancer is difficult to diagnose due to lack of symptoms. It is slow growing most of the time. When symptoms occur, they include nausea and vomiting, heartburn, loss of appetite, weight loss, bloating, GI bleeding, fatigue and stomach pain which occurs mostly after meals.

Stomach ulcer

Stomach ulcer also called gastric ulcers. They occur when there is a sore in the stomach lining. Symptoms of stomach ulcers include pain that may be mild or severe, burning sensation, chest pain, weight loss, lack of appetite, nausea, vomiting, bloating, heartburn, blood in stool, anemia, and burping. Ulcers of the stomach may be caused by infection, long-term use of anti-inflammatory medications, and any other condition where the acid erodes through the stomach lining.

Dysphagia

Dysphagia is a condition that describes difficulty swallowing. It is often caused by reflux of acid into the esophagus which causes scarring and narrowing of the esophagus, called esophageal stricture. It can also be caused by direct damage to the esophagus. Symptoms of dysphagia include difficulty swallowing, pain with swallowing, sore throat, choking, coughing, regurgitation or mood and stomach acid, the feeling of food stuck within the chest, burning of the chest, and pain with speaking.

Esophageal cancer

Esophageal cancer occurs when normal cells of the esophagus lining become cancerous and grow out of control forming a tumor. There are two common types of esophageal cancer, squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma occurs when the cancer originates in the thin, flat cells that make of the lining of the esophagus. Adenocarcinoma occurs when the cancer starts in the glandular cells of the esophagus. These cells are responsible for production of fluid and mucus within the esophagus. Symptoms of esophageal cancer include weight loss, indigestion, heartburn, painful swallowing, difficulty swallowing, choking while eating, vomiting, chest pain and fatigue.

Liver cancer

There are many types of liver cancer. Some primary liver cancers include: Hepatocellular carcinoma, cholangiocarcinoma, liver angiosarcoma, and hepatoblastoma. Liver cancer occurs when the normal cells grow out of control and become tumors. Hepatocellular carcinoma originates in the hepatocyte cells. Cholangiocarcinoma originates in the bile ducts of the liver. Angiosarcoma originates in the blood vessels within the liver. Hepatoblastoma is nearly almost always found in children and is very rare. Symptoms are liver cancer include abdominal discomfort, abdominal pain, tenderness of the abdomen, yellowing of the skin and lengths of the eyes cold jaundice, white, chalky stools, nausea, vomiting, easily bruising, fatigue and weakness.

Pancreatic cancer

Cancer of the pancreas occurs when the normal pancreas cells grow out of control and become a tumor. Pancreatic cancers are staged on a scale of 0-4 based on the tumor size, approximately to the lymph nodes, and whether it is present other organs. There are multiple types of pancreatic cancer. Common types including pancreatic adenocarcinoma and non—adenocarcinoma, and neuroendocrine tumors. Adenocarcinoma start within the part of the pancreas that make digestive enzymes. Neuroendocrine tumors arise from the pancreas cells are responsible for integrating the nervous and endocrine system. Symptoms of pancreatic cancer include pain in the upper abdomen or back, yellowing of the skin or whites of the eyes called jaundice, weight loss, loss of appetite, improper digestion, pressure on other organs, diabetes, and many others.

Chronic pancreatitis

Chronic pancreatitis is inflammation of the pancreas that does not improve over time by itself. Acute pancreatitis occurs when there is inflammation that occurs periodically, and lasts for a short period of time. It is considered chronic pancreatitis when the inflammation keeps coming back, and does not subside for many months or years. Chronic pancreatitis can lead to permanent scarring and damage of the pancreas. Calcium stones may develop within the pancreas. Cysts may develop within the pancreas. There can be blockage of bile ducts. Causes of chronic pancreatitis including autoimmune disease, narrowing of the pancreatic duct, blockage of the pancreatic duct, cystic fibrosis, hypercalcemia, hypertriglyceridemia and family history. Symptoms of chronic pancreatitis include pain in the upper abdomen, diarrhea, pale and loose fatty stools, nausea, vomiting, shortness of breath, weight loss, excessive thirst, fatigue, yellowing of the skin otherwise the eyes cold jaundice, bleeding, and intestinal blockage.

Small intestine cancer

Cancer of the small intestine is also called small bowel cancer. It can occur in different parts of the small bowel including duodenal cancer, jejunum cancer or ilium cancer. Several different types of small intestine cancer include: adenocarcinoma, sarcoma, gastrointestinal stromal tumor, lymphoma, and carcinoid tumor. Cancer of the small bowel occurs when the normal cells grow out of control forming a tumor. Symptoms of small intestine cancer include constipation, diarrhea, changes in the stool, blood in the stool, rectal bleeding, weakness, fatigue, weight loss, abdominal pain and abdominal cramps.

Small intestine ulcer

Small intestine ulcers are also called duodenal ulcers. They occur when there is a sore in the intestine lining. Symptoms of small intestine ulcers include pain that may be mild or severe, burning sensation, chest pain, weight loss, lack of appetite, nausea, vomiting, bloating, heartburn, blood in stool, anemia, and burping. Ulcers of the stomach may be caused by infection, long-term use of anti-inflammatory medications, and any other condition where the acid erodes through the intestine lining.

Spleen problems

The spleen is an organ that is found on the left side of the body below the rib cage. It is responsible for filtering antibiotic coated bacteria, reprocessing old red blood cells and recycling iron in hemoglobin. It is a storage organ for red blood cells and contains many specialized white blood cells called “macrophages” (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria. The spleen can affect the platelet count, the red blood cell count and even the white blood count.

How are problems of the spleen found? An evaluation typically includes a complete blood count (CBC), to look at the amount, sizes and shapes of the cells in your blood. Sometimes it is important to get a specimen of bone marrow. The bone marrow is where red cells and other components of the blood are made and can be very helpful to understand the source of the problems. The spleen is also evanluated using imaging such as an ultrasound, a computerized tomography (CAT scan), or magnetic resonance imaging (MRI). Evaluating the size and shape of the spleen is very helpful to understanding the cause of the problem as well as for surgical planning. In addition, sometimes a nuclear scan of the spleen can be helpful especially if satellites of the spleen known as accessory spleens or “splenules” are suspected.

Splenomegaly

An enlargement of the spleen is also called splenomegaly. Often, there are no symptoms associated with splenomegaly. When they are present, symptoms of splenomegaly include pain and discomfort on the upper left side of the abdomen, feeling of fullness after eating a small amount, pressure on the stomach, pressure on other organs, anemia, and infections due to lack of white blood cells. There are number of diseases that can cause splenomegaly including: Viral, bacterial or parasitic infections, cirrhosis, cystic fibrosis, rheumatoid arthritis, malaria, Hodgkin’s disease, leukemia, heart failure, cirrhosis, tumors of the spleen, lupus, sickle cell disease.

Auto-immune thrombocytopenia purpura (ITP)

This is the most common reason. In this disease, a patient’s platelet count is low because the body makes antibodies to the platelets which cause them to be destroyed in the spleen. Since platelets are blood cells which aid in blood clotting, patients are at risk for bleeding. The first line of treatment is medical therapy but when this is not successful, removal of the spleen (splenectomy) can be curative or at least significantly improve the platelet count in the vast majority of cases.

Hemolytic anemia

In this disease the body makes antibodies to red blood cells which are subsequently destroyed in the spleen. When medical therapy fails, some patients require spleen removal to prevent or decrease the need for transfusion.

Hereditary (genetic) conditions

There are several diseases that affect the shape of red blood cells, such as, spherocystosis, sickle cell disease or thalassemia. In these patients, the spleen recognizes the red cells as abnormal and may reduce them, possibly requiring splenectomy to improve the symptoms.

Malignancy

Rarely, patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, require spleen removal. When the spleen gets enlarged, it sometimes removes too many platelets from your blood and has to be removed. Sometimes the spleen is removed to diagnose or treat a tumor.

Appendicitis

The appendix is a narrow tube (a few inches in length) that attaches to the first part of the colon. It is usually located in the lower right quadrant of the abdominal cavity. The appendix produces bacterium destroying proteins called immunoglobulins, which help fight infection in the body. Its function, however, is not essential. Appendicitis occurs when there is inflammation of the appendix. It can be acute or chronic. Symptoms of appendicitis include pain in the abdomen, often on the right side, loss of appetite, nausea, vomiting, diarrhea, constipation, fever, and abdominal swelling. Symptoms often include mild cramping that becomes more severe over time. Often the cause appendicitis is unknown. It may be due to obstruction of the appendix.

Gastroesophageal Reflux Disease (GERD)

Although “heartburn” is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or “back up”, from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below the neck. The feeling may radiate through the chest and into the throat and neck. Many adults experience this uncomfortable, burning sensation at least once a month. Other symptoms may also include vomiting or regurgitation, difficulty swallowing and chronic coughing or wheezing. When eating, food travels from the mouth into the stomach through the tube called the esophagus. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter. The lower esophageal sphincter acts like a one-way valve, allowing food to pass through into the stomach. Normally, the lower esophageal sphincter closes immediately after swallowing to prevent back-up of stomach content, which is highly acidic, into the esophagus. GERD occurs when the lower esophageal sphincter does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus. Patients may develop a condition in which there is a change in the type of cells in the lining of the lower esophagus, called Barrett’s esophagus. This is important because having this condition increases the risk of developing cancer of the esophagus.

Some people are born with a naturally weak lower esophageal sphincter. For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the lower esophageal sphincter to relax, causing reflux. A hiatal hernia is found in many patients who suffer from GERD. This refers to the condition in which the top part of the stomach bulges above the diaphragm and into the chest cavity. This phenomenon is thought to contribute to the development of acid reflux.