Open Hernia Pathway Reduces Post Op Pain and Visits to the ER

A new study shows that adults in San Diego who went through open inguinal hernia repair experienced reduced post-op pain. Besides, they made fewer visits to the emergency room when the hospital staff adhered to a standard clinical protocol prior, during and post surgery.


The protocols for Enhanced Recovery After Surgery (ERAS) are usually discussed and mostly applied in hernia repair, even though few published studies show what works effectively and how. Most of the information on ERAS emanates from colorectal surgery with the focus being on the length of stay at the hospital and re-admission.


However, the most unusual aspect of this study is that it centers around hernia repair, and instead of looking at re-admission, it looks at the unplanned visits. In the study’s analysis, the most influential ERAS elements are patient education before the surgery and monitored anesthesia care (MAC).


• First efficiency protocol in 2011 – Surgeons, nurses and anesthesiologists developed an efficiency protocol specifically for ambulatory surgery in Kaiser Permanente Southern California region. Their objective was to reduce time spent by patients at the facility. Although this led to over 50 percent drop in time that patients spent at the hospital, the staff was worried that patients could be re-admitteddue to nausea and post-op pain, or they would make more visits to the ER.

• Refined program – So the health professionals refined the program and devised an eight-element bundle based on the best practices and well-known ERAS protocols. Preoperatively, it included patient education, prescriptions, and the need for patients to carb-load prior to surgery. Preoperatively, patients were given analgesia with meloxicam or ketorolac IV, gabapentin and acetaminophen, and MAC, or local anesthesia along with regional and field blocks. The amount of intravenous fluids was below 500 ml. After operation, analgesia was continued and patients received a follow-up call within 72 hours.


During the study period, 2,390 patients went through open inguinal hernia repair and:


• Only 6 percent of patients received all of the protocol’s elements
• 5.6 of the 8 elements were conducted for each patient
• The most completed steps include preoperative prescriptions and education, at 95 percent
• 89 percent of patients received multimodal analgesia
• 38 percent had MAC anesthesia
• Only 24 percent received limited IV fluids
• The 150 people who received the eight elements experienced less post-op pain and their likelihood of returning to the hospital for urgent care was 80 percent.


Two important aspects: Researchers discovered two essential elements of the protocol – patient education and use of MAC rather than general anesthesia. Patients who got preoperative education had a higher chance (60%) of not returning to the emergency department.


On the other hand, MAC lowered the scores of post-anesthesia care unit (PACU) by 1.43. It resulted in a 66 percent lower risk that patients would go back to the emergency department to seek pain control.




Acid Reflux Might Increase Risks of Head and Neck Cancer in Seniors

New studies and research have been performed to examine if there actually is a relationship between acid reflux, and head and neck cancer in seniors.

Every year in the United States, it is projected that around 62,000 Americans are most likely to be diagnosed with head and neck cancer. Doctors provide several reasons and factors for this estimated statistics, such as viral infections, inflammation of theupper respiratory tractand most prevailing of all, usage of tobacco and alcohol.

But now,new studies have found that there is one more factor that can increase the risks of developing head and neck cancer in the elderly. Scientists and analysts investigated the relationship between heartburn or acid reflux and UADT cancers. The research showed mixed results.

Risks of laryngeal cancermay becaused by Acid reflux
In order to learn more about acid reflux and head and neck cancer, a group of 13,805 diagnosed with UADT cancer, individuals of ages 66 and above were selected. To conduct a fair study, another group of healthy 13,805 individuals of the same sex and age bracket were included.

From the group of cancer patients, more than 60 percent were found to have laryngeal cancer. The focus group of cancer patients included 3,418 females who had been spotted with malignant oropharynx, larynx, tonsil, hypopharynx,paranasal sinusesand nasopharynx.

The findings of the research showed that a strong link was seen between acid reflux and cancer of paranasal sinuses, throat and tonsils. The scientists especially found the link to be the strongest by the malignancyshown in the larynx.

The conclusion that was derived from the results of the studyis that senior American patients suffering from acid reflux have 3.47 times higher rate of developing laryngeal, 3.23 of developing hypopharyngeal, 2.88 of developing oropharyngeal and 2.37 of developing tonsillar cancers than those who did not suffer from acid reflux.

Limitations Found In This Study
There were certain limitations that showed up in this study. This study was first conducted in the United States. This research was an observational study and more research needs to be done. Researchers have said that this study needs to be tested on a younger group, to further authenticate if the chances of developing UADT cancers due to acid reflux is high just for seniors.

Gallbladder Pain: The Common Causes and Symptoms

Gallbladder pain refers to the pain that originates from the areas in or close to the gallbladder that interfere with its functioning. Such conditions include gallstones, ascending cholangitis, biliary colic, and pancreatitis.

The gallbladder is attached to the liver, and it supplies bile, a fluid that’s yellowish brown in color that helps in fat digestion in the small intestine.

Causes of Gallbladder Pain

• Gallstones -The stones form because of an imbalanced cholesterol level in the body. They can also form if the gallbladder doesn’t empty efficiently. Their size varies from one to several millimeters. They don’t usually cause problems until they grow big and block the bile ducts, which cause pain. Their symptoms include jaundice (yellowing of the eyes and skin), severe abdominal pain, and fever.
• Cholecystitis –Often, the gallbladder can get inflamed because gallstones block the ducts that exit the gallbladder. The other causes of cholecystitis are tumors and bile duct problems that obstruct bile flaw.

Symptoms of Gallbladder Pain

• Biliary colic – This is where one experiences sudden pain in the upper-right abdomen, although it may move to other abdominal area parts. Consuming fatty food can trigger biliary colic; it’s typically accompanied by vomiting and nausea. The pain can last anywhere from a couple of minutes to five hours.
• Acute pancreatitis – The condition results from the inflammation of one’s pancreas – an organ responsible for secreting digestive enzymes. The common bile duct connects the pancreas to the gallbladder. Acute pancreatitis can cause severe abdominal pain usually felt in the back and below the ribs. It’s associated with vomiting and nausea.
• Cholangitis –It’s caused by a bacterial infection in the bile duct. The infection originates from the small intestine. Jaundice, pain in the right upper quadrant, and fever are the main symptoms of this condition.
• Other symptoms – They include weakness, heartburn, chest pain, sweating, increased pain when breathing deeply, acute abdominal pain, and pain between the shoulder blades.

If you experience intense abdominal pain, it’s recommended that you seek medical attention right away to rule out any life-threatening condition.



Do Gallstones Always Demand Surgery?

The chronic pain and discomfort associated with gallstones and gallstone pancreatitis often drives people into emergency rooms or their doctors’ offices seeking help. For many of these people, a simple surgical procedure will be recommended to address concerns related to gallstones once and for all.

While addressing the sometimes-severe pain of gallstones is often a priority, some people may find their symptoms aren’t quite so serious. When that is the case, they may wonder if surgery is absolutely necessary. Researchers have found that it may not always be 100-percent necessary to undergo surgery if symptoms of gallstone pancreatitis don’t warrant intervention.

Gallstone pancreatitis arises when a gallstone or gallstones manage to become lodged in a duct that leads to the pancreas. This may block pancreatic enzymes from leaving the pancreas and assisting with digestion. As the enzymes back up into the pancreas, they may create inflammation and pain. The standard intervention in this case is to remove the gallbladder entirely.

Researchers interested in seeing if the surgery was always necessary with gallstone pancreatitis looked into the cases of more than 17,000 people with gallstone pancreatitis. Nearly 80 percent of the patients had their gallbladders removed. Roughly 2,500 patients did not have their gallbladders removed over the course of a four-year period. These patients were reportedly doing okay that far down the road without major recurrence concerns.

The bottom line, researchers say, is that some people may fare well without surgery. Further study is needed to understand why that is the case and when avoidance of surgery might be advisable. In the meantime, people who are diagnosed with gallstone pancreatitis are urged to work closely with their doctors to find the right treatment for their case. Most commonly, surgery to remove the gallbladder will be recommended to prevent recurrences and further complications.




Hernia Pain? Here’s Why Seeing a Doctor is Important

When a funny bulge appears in the abdomen or other part of the body that serves as a source of pain when lifting, exerting or even coughing, it’s time to make an appointment with a healthcare provider. Most often, these symptoms signal the formation of a hernia. Although highly common and quite feasible for people to “live with” for a time, hernias are structural problems in the body. That means they won’t go away on their own. It also means they are likely to get worse as time passes.


A hernia forms when an organ or other tissue pokes through a weakened spot in the muscles that are meant to keep organs in place. The poking through of the organ may create that visible bulge in the abdomen. It may also promote pain during certain activities.


Getting a hernia properly diagnosed by a doctor is important for a few reasons. Firstly, it is important to make 100 percent sure a hernia is the cause of the bulge and pain. Secondly, doctors are often able to help patients control the pain and discomfort that may arise from hernias through medications, dietary changes and other options. When hernias are severe or continually getting worse, surgery is indicated to repair the concern once and for all. In most cases, a minimally invasive laparoscopic procedure will be used to reinforce the muscular wall to prevent tissue from poking through.


Although surgery to repair a hernia may not be necessary at the onset, people who suffer this type of pain will find this condition does not repair itself over time. If a hernia becomes severe, the organ that pokes through the weakened spot may become “strangled.” That means its blood supply has been cut off, which is considered cause for emergency surgery to save the organ and prevent further damage.


While hernia surgery may not be indicated at the onset, people who suspect they have this condition should get checked out by a healthcare provider. The only surefire things with a hernia is that this structural complaint will only get worse as time passes. Earlier intervention can prevent the need for emergency surgery down the road.


Gallstones: Can They Be Ignored?

The gallbladder is a tiny part of the body most people never think twice about. After all, when it does its job, there’s really no reason to consider it. This little sac is designed to store and release bile into the body during the digestive process. It is essentially tasked with making the digestion of fats flow a little more smoothly. When it performs as expected, the gallbladder is easy to ignore. If something goes wrong, however, discomfort and pain are likely.

Gallstones are the most common gallbladder-related concern that can arise. These form when there is too much cholesterol in the bile. Essentially, excess cholesterol promotes the formation of crystals that clump together to create the stones. If left unchecked, the stones can impede the flow of bile and cause a fair amount of pain in the process. Bouts of pain are known as gallbladder attacks. Other complications may arise, as well. As bile becomes trapped in the gallbladder thanks to those gallstones, it can lead to inflammation, which can cause a host of other problems.

Gallstones that don’t cause symptoms or interfere with digestion are generally not a cause for action. If symptoms, such as pain, vomiting and nausea occur, doctors will generally recommend the removal of the gallbladder itself. This involves a surgical procedure that is generally performed laparoscopically. Once the gallbladder is out of the body, the pain associated with attacks should go away. The good news is that people can lead long, healthy lives without a gallbladder.

Gallstones are not a reason for alarm. If they form without symptoms, it is generally okay to leave them in place. Should pain, discomfort or inflammation go along with their arrival, medical intervention is a wise choice to prevent complications.

People who suspect they have gallbladder-related pain should speak with a healthcare provider. The best recommendation will come from a physician with information about the particular case.


Tips For Avoiding Gallstones and Gallbladder Issues

Anyone who has suffered from gallstones knows this is a condition that’s best avoided, if possible. Quite painful and often only resolved through surgical intervention, this potential development can sometimes be prevented or treated through calculated lifestyle changes.

The gallbladder itself is a small storage sac in the body that stores bile made by the liver. When food is consumed, bile is injected into the small intestine to help break up fat. When the components of bile manage to solidify, they form stones that can vary in size and severity. In some cases, gallstones may be treated without surgical intervention. Oftentimes, however, a removal of the gallbladder is required to alleviate pain and recurrence issues.

There are lifestyle changes that may help prevent gallstones and assist in the treatment process should they develop. Some of the suggestions include:

• Eating a healthy diet – A healthy, well-balanced diet that is high in fiber and vitamin C can be especially helpful. Be mindful of vitamin C overuse, however, as it can increase the risk of kidney stones – an equally painful development.
• Drinking coffee – A number of studies have found that drinking coffee on a regular basis, at least for women, can reduce the risk of gallbladder disease.
• Drinking moderate amounts of alcohol – Some studies have suggested that drinking no more than two standard drinks a day can help lower the risk of gallbladder disease.
• Avoiding rapid weight loss – While obesity is also a risk factor, fast weight loss can increase the risk of gallstone formation. If weight loss is necessary, be sure to take a steady, healthy approach and don’t eliminate fat from the diet entirely.

Gallstones may not always be avoidable. If this condition is a concern, be sure to speak with a qualified healthcare provider. Courtesy of advanced surgical techniques, having the gallbladder removed when it is necessary, generally only involves a fairly simple procedure.