Medically Speaking Archives - Dr Christian Jeske

History of Surgery

surgeon — Mon, 21 Sep 2026 08:23:33 +0000

MAJOR DEVELOPMENTS IN THE HISTORY OF SURGERY

People | discoveries | innovations | better lives

As a surgeon in daily practice, I am often reminded of the responsibility we carry. Patients, their families and friends place their hopes, expectations and, at times, their lives in our hands.

Yet much of what we rely on every day is easily taken for granted. Modern surgery rests on the work of generations of scientists, physicians, surgeons, nurses, engineers, researchers and countless support personnel. Every safe anaesthetic, sterile instrument, blood transfusion, scan, antibiotic and surgical technique has a history behind it.

It is worthwhile, occasionally, to look back at that history — not only to appreciate how far surgery has come, but also to recognise the extraordinary collective effort that has made what we do today possible.

PEOPLE | IDEAS | INNOVATIONS | BETTER LIVES

Full timeline overview. On smaller screens, swipe horizontally to view the detail; click the image to enlarge it in a lightbox.

Global Milestones

South African Contributions

Global Milestones (15 selected developments)

From ancient practices to robotic surgery — the innovations that shaped modern medicine.

Ancient world–Middle Ages

Early surgical practice

Imhotep; Sushruta; Hippocratic/Greco-Roman practitioners; Al-Zahrawi

Wound care, fracture treatment, suturing, cautery and purpose-made instruments were described and refined across several medical traditions.

Created systematic approaches to wounds, fractures and reconstruction; many instrument concepts remain recognisable.

Ancient surgical instruments and medical practice (representative)

1543 / Renaissance

Scientific human anatomy

Andreas Vesalius and Renaissance anatomists

Direct study of human bodies corrected many inherited anatomical errors and produced more reliable descriptions of organs and structures.

Gave surgeons a much more accurate map of the human body and improved operative planning.

Vesalian anatomical study, 16th century (representative)

16th century

Better control of bleeding

Ambroise Paré

Paré promoted tying bleeding vessels after amputation instead of routinely burning them, and advocated gentler wound care.

Reduced suffering and helped move surgery toward observation and practical evidence.

Ambroise Paré and early vessel ligation (representative)

1840s

Surgical anaesthesia

Crawford Long; Horace Wells; William T. G. Morton; James Young Simpson

Ether, nitrous oxide and chloroform made it possible to prevent severe pain during operations. Morton's 1846 public ether demonstration accelerated adoption.

Allowed surgeons to work more slowly and deliberately and made major internal operations feasible.

Public ether anaesthesia demonstration, 1846 (representative)

1847–1900

Hand hygiene, antisepsis and sterile surgery

Ignaz Semmelweis; Louis Pasteur; Joseph Lister; Ernst von Bergmann; operating-room teams

Hand cleaning, germ theory, antiseptic wound treatment, heat sterilisation and increasingly sterile operating practice developed in stages.

Postoperative infection fell dramatically, allowing safer surgery inside the chest, abdomen and other body cavities.

Antiseptic and sterile operating practice (representative)

1860s onward

Modern nursing and organised perioperative care

Florence Nightingale; professional nurses; hospital reformers

Trained nursing, sanitation, observation and record-keeping became integral to hospital care.

Reduced preventable complications and created the coordinated care needed before and after major surgery.

Florence Nightingale and modern nursing reform (representative)

1895 onward

Medical imaging

Wilhelm Conrad Röntgen; radiologists; physicists; engineers

X-rays allowed doctors to see bones and foreign bodies without an operation. Ultrasound, CT, MRI and intraoperative imaging followed.

Improved diagnosis, planning and navigation while reducing unnecessary exploratory surgery.

Early X-ray imaging of the hand (representative)

1901–1940s

Blood typing, transfusion and blood banking

Karl Landsteiner; Richard Lewisohn; Oswald Robertson; Charles Drew; transfusion teams

Blood groups were identified and methods for anticoagulation, storage and organised blood banking were developed.

Made replacement of major blood loss reliable enough for trauma and increasingly complex operations.

Blood typing, storage and transfusion practice (representative)

1930s–1940s

Antibiotics

Gerhard Domagk; Alexander Fleming; Howard Florey; Ernst Chain; clinical teams

Sulfonamides and then penicillin transformed treatment of bacterial wound and postoperative infections.

Reduced infection-related deaths and widened the range of operations that patients could survive.

Alexander Fleming and the development of penicillin (representative)

Early–mid 20th century

Vascular surgery

Alexis Carrel; René Leriche; Michael DeBakey and others

Surgeons developed dependable methods to join, replace and bypass blood vessels.

Enabled limb salvage, aneurysm repair, organ transplantation and much of modern heart surgery.

Vascular surgery (representative)

1950s

Open-heart surgery

John Gibbon; C. Walton Lillehei; cardiac teams; perfusionists; engineers

The heart–lung machine could temporarily take over circulation and oxygenation while surgeons worked inside the heart.

Made repair of complex heart defects and later valve and coronary operations possible.

Heart–lung machine and open-heart surgery (representative)

1954 onward

Organ transplantation

Joseph Murray; Peter Medawar; Thomas Starzl; Roy Calne; transplant teams

Kidney transplantation was followed by liver, heart and other organ transplantation as immune-suppressing treatment and organ preservation improved.

Changed some forms of end-stage organ failure from inevitably fatal disease into treatable conditions.

Kidney transplantation at Boston in 1954.

1960s–1980s

Microsurgery and reconstruction

Julius Jacobson; Harry Buncke; Chen Zhongwei; reconstructive teams

Operating microscopes and very fine sutures allowed surgeons to reconnect tiny blood vessels and nerves.

Enabled replantation of severed parts, free-tissue transfer and more sophisticated reconstruction after trauma and cancer.

Microsurgery using an operating microscope (representative)

1980s–2000s

Minimally invasive and endoscopic surgery

Kurt Semm; Erich Mühe; Philippe Mouret; multidisciplinary teams

Cameras and long instruments allowed many operations to be performed through small openings rather than large incisions.

Often reduced pain and hospital stay and sped recovery, while creating new training and safety requirements.

Laparoscopic instruments used through small incisions (representative)

2000s–present

Robotic, image-guided and data-assisted surgery

Surgical teams; radiologists; engineers; computer scientists

Robotic systems, 3-D imaging, navigation, simulation and AI-based tools are increasingly integrated into selected procedures.

Can improve visualisation, access and precision in selected settings; evidence, cost, access and accountability remain important.

Robotic and image-guided operating theatre (representative)

Contact

(012) 644 1327, or use any of the provided links on our website or facebook page to book or send us an e-mail at unitas@generalsurgery.co.za.

We are dedicated to helping you. Please note that this information is not exclusive

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Diverticular Disease of the Colon

surgeon — Mon, 17 Aug 2026 08:35:32 +0000

What is diverticular disease?

Diverticular disease is a common condition that affects the large intestine (colon). Small pouches, called diverticula, form in the wall of the colon. This is known as diverticulosis. Many people have diverticulosis without any symptoms.

When these pouches cause symptoms such as abdominal pain or changes in bowel habits, it is called symptomatic diverticular disease.

If one or more pouches become inflamed or infected, the condition is called diverticulitis.

What causes diverticular disease?

The exact cause is not always known, but factors that increase the risk include:

Increasing age
A diet low in fibre
Constipation
Being overweight
Lack of regular physical activity
Smoking
Family history

What are the symptoms?

Many people have no symptoms at all.

Symptoms of diverticular disease may include:

Pain or discomfort, usually in the lower left side of the abdomen
Bloating
Constipation or diarrhoea
Passing mucus
Feeling that the bowel does not empty completely

Symptoms of diverticulitis may include:

Severe abdominal pain
Fever or chills
Nausea or vomiting
Loss of appetite
Tenderness over the abdomen

How is it diagnosed?

Your healthcare provider may recommend:

A medical history and physical examination
Blood tests
A CT scan if diverticulitis is suspected
A colonoscopy after recovery from diverticulitis to examine the colon (not usually during an acute attack)

How is it treated?

Diverticulosis or mild diverticular disease

Treatment may include:

Eating more fibre
Drinking plenty of water
Regular exercise
Fibre supplements if recommended
Pain relief as advised by your healthcare provider

Diverticulitis

Treatment depends on how severe the infection is.
It may include:

Rest
A temporary low-fibre or liquid diet
Antibiotics in selected cases
Pain medication
Hospital treatment for severe illness

Some people with repeated severe attacks or complications may require surgery.

What should I eat?

A healthy, high-fibre diet is recommended once you have recovered from an attack.

Choose foods such as:

Wholegrain bread and cereals
Brown rice
Oats
Beans and lentils
Fresh fruits
Vegetables

Increase fibre gradually to reduce bloating and gas.

Drink 6–8 glasses of water each day, unless your healthcare provider advises otherwise.

Good to know: Current evidence shows that most people with diverticular disease do not need to avoid nuts, seeds, popcorn, or corn. These foods do not increase the risk of diverticulitis.

When should I seek urgent medical attention?

Seek immediate medical care if you develop:

Severe or worsening abdominal pain
Fever above 38°C
Persistent vomiting
Heavy bleeding from the rectum
Black, tarry stools
A swollen, hard abdomen
Dizziness, fainting, or signs of dehydration

Can diverticular disease be prevented?

You can reduce your risk by:

Eating a high-fibre diet
Drinking enough fluids
Exercising regularly
Maintaining a healthy weight
Avoiding smoking
Managing constipation without frequent use of laxatives unless advised by your healthcare provider

Living with diverticular disease

Most people with diverticular disease live normal, healthy lives. Following a healthy lifestyle and attending regular medical follow-up can help prevent complications and improve symptoms.

Remember

Contact your healthcare provider if:

Your symptoms become worse.
You develop a fever.
You notice blood in your stool.
Your bowel habits change for more than a few weeks.
You have repeated attacks of abdominal pain.

This information is intended to support, not replace, advice from your healthcare provider.

Contact

Please contact our rooms for an appointment if you need any more information about Diverticular Disease of the Colon at (012) 644 1327, or use any of the provided links on our website or facebook page to book or send us an e-mail at unitas@generalsurgery.co.za.

We are dedicated to helping you. Please note that this information is not exclusive

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GLP-1 Medications: Benefits, Risks and Safe Use

Christian Jeske — Mon, 27 Jul 2026 06:05:42 +0000

What are GLP-1 medications?

GLP-1 medications are prescription medicines that help regulate appetite, blood sugar and digestion. They are used to treat conditions such as:

Type 2 diabetes
Overweight and obesity (in appropriate patients)
To reduce the risk of heart disease in selected high-risk patients

Examples include semaglutide, liraglutide and tirzepatide.

What are the benefits?

When prescribed by a healthcare professional and combined with healthy eating and regular physical activity, GLP-1 medications may:

Help you lose weight by reducing hunger and helping you feel full sooner.
Improve blood sugar control in people with diabetes.
Lower the risk of developing type 2 diabetes in some people with prediabetes.
Reduce blood pressure.
Improve cholesterol levels.
Reduce fat in the liver.
Lower the risk of heart attack and stroke in some patients with diabetes or cardiovascular disease.
Improve overall health and quality of life.

What are the possible side effects?

The most common side effects are usually mild and improve over time, especially when the dose is increased gradually.

These may include:

Nausea
Vomiting
Diarrhoea
Constipation
Stomach pain or discomfort
Heartburn or indigestion
Feeling full quickly
Reduced appetite

Are there any serious risks?

Serious side effects are uncommon but can occur.

Seek medical attention immediately if you develop:

Severe or persistent abdominal pain, especially if it spreads to your back.
Persistent vomiting leading to dehydration.
Yellowing of the skin or eyes (jaundice).
Severe allergic reactions such as swelling of the face or difficulty breathing.

Your doctor may recommend stopping the medication temporarily before surgery because it slows stomach emptying.

Who should not use GLP-1 medications?

These medicines may not be suitable if you:

Have a personal or family history of medullary thyroid cancer.
Have Multiple Endocrine Neoplasia type 2 (MEN2).
Have had a serious allergic reaction to one of these medicines.

Always tell your healthcare provider about your medical history and any other medicines you are taking.

Can these medicines be addictive?

No.

GLP-1 medications are not addictive. They do not produce a “high,” do not cause dependence, and are not drugs of abuse.

However, some people misuse them by:

Using them without a medical need.
Taking someone else’s prescription.
Buying them online or through social media.
Using higher doses than prescribed.

Using these medicines without medical supervision can be dangerous.

Buying GLP-1 medications safely

Only obtain GLP-1 medications:

From a registered doctor or healthcare provider.
From a licensed pharmacy.
With a valid prescription.

Do not buy injectable medicines from:

Social media advertisements.
WhatsApp groups.
Online marketplaces.
Friends or family members.
Unlicensed weight-loss clinics.

Why is this important in South Africa?

South African health authorities have warned about fake and illegally imported GLP-1 medications being sold outside licensed pharmacies.

These products may:

Contain the wrong amount of medicine.
Contain harmful or unapproved ingredients.
Be contaminated during manufacture.
Not work as expected.
Cause serious health problems.

Because these medicines are injected, products made or stored incorrectly can pose additional risks.

Getting the best results

GLP-1 medications work best when combined with:

Healthy eating.
Regular physical activity.
Good sleep.
Ongoing medical follow-up.
Regular monitoring by your healthcare team.

These medicines are designed to support long-term health and should only be used under medical supervision.

Contact

Please contact our rooms for an appointment if you need any more information about GLP-1 medication at (012) 644 1327, or use any of the provided links on our website or facebook page to book or send us an e-mail at unitas@generalsurgery.co.za.

We are dedicated to helping you. Please note that this information is not exclusive

To keep up to date or rate us, please like our social media pages:
https://www.facebook.com/drcjeske
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Patient Orientation for surgery

Christian Jeske — Tue, 25 Nov 2025 21:31:55 +0000

Dr Jeske guides you through the process when going for surgery at Netcare Unitas hospital.

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Understanding Fatty Liver Disease: A Patient Guide

Christian Jeske — Wed, 25 Jun 2025 12:52:54 +0000

Fatty liver disease, or hepatic steatosis, occurs when an abnormal amount of fat accumulates in the liver. While the liver normally contains some fat, more than 5–10% of the liver’s weight in fat is considered unhealthy. This condition can lead to liver inflammation (steatohepatitis), scarring (fibrosis), and in severe cases, cirrhosis or liver failure. Fatty liver disease is broadly divided into two types: alcoholic fatty liver disease, caused by excessive alcohol intake, and non-alcoholic fatty liver disease (NAFLD), which is more common and not related to alcohol.

NAFLD is closely linked with metabolic risk factors such as obesity, type 2 diabetes, insulin resistance, high blood pressure, and elevated cholesterol or triglycerides. Genetics, poor diet, rapid weight loss, or certain medications may also contribute. Most people with fatty liver do not experience symptoms in the early stages, making regular health screening important.

Diagnosis

Fatty liver is often discovered incidentally during routine blood tests or imaging done for other reasons. Elevated liver enzymes (ALT and AST) may suggest liver inflammation, although many people with fatty liver can have normal levels.

A liver ultrasound is usually the first imaging test used and may show a “bright” liver indicating fat accumulation. More advanced imaging like FibroScan (transient elastography) or MRI can measure the degree of liver stiffness or fat. In some cases, a liver biopsy is needed to confirm the extent of inflammation or fibrosis, especially if non-invasive tests are inconclusive or if liver disease is advanced.

When to Consult a Doctor

You should consult a healthcare provider if you have:

Unexplained fatigue, weakness, or weight loss
Discomfort in the upper right side of your abdomen
Yellowing of the skin or eyes (jaundice)
Persistently abnormal liver function tests
Risk factors such as obesity, diabetes, or high cholesterol

Early detection is crucial. If left untreated, fatty liver can progress silently over years.

Treatment and Lifestyle Changes

There is no specific medication to cure fatty liver, but it is often reversible with lifestyle changes. The main treatment goals are reducing liver fat, improving metabolic health, and preventing disease progression.

Dietary Changes

Adopting a healthy, balanced diet is essential. The Mediterranean diet—rich in vegetables, fruits, legumes, whole grains, lean protein (especially fish), olive oil, and nuts—has been shown to reduce liver fat. Avoid:

Processed foods and refined carbohydrates
Sugar-sweetened beverages and snacks
Saturated and trans fats
Alcohol, which can worsen liver damage

Smaller, more frequent meals and mindful eating can also support liver health and weight control.

Physical Activity

Regular exercise significantly reduces liver fat—even without major weight loss. Aim for:

150–300 minutes of moderate aerobic activity per week (e.g., brisk walking, cycling, swimming)
Or 75–150 minutes of vigorous activity (e.g., running, aerobics)
Plus 2 or more days of strength training

Exercise improves insulin sensitivity, reduces inflammation, and supports weight loss. Find an activity you enjoy and maintain consistency.

Weight Loss

A weight loss of 5–10% of body weight can reduce liver fat and improve liver enzyme levels. A slow, steady weight loss of 0.5–1 kg per week is safe and effective. Those who struggle with weight loss may benefit from:

Referral to a dietitian
Structured programs involving behavioral therapy
Medications for weight or diabetes control, if appropriate
Bariatric surgery in severe cases of obesity with related conditions

Ongoing Monitoring

Follow-up is essential. Your doctor will monitor liver enzymes, metabolic health, and possibly repeat imaging or blood tests to assess your progress. Early intervention can prevent irreversible liver damage.

Conclusion

Fatty liver disease is common, often silent, but potentially serious. The good news is that with timely diagnosis and lifestyle changes—focusing on diet, exercise, and weight loss—it can often be reversed or halted. If you have risk factors or symptoms, do not delay in seeking medical advice. Protecting your liver today safeguards your health for the future.

Contact

Please contact our rooms for an appointment if you have experienced or are experiencing any of the above mentioned symptoms at (012) 644 1327, or use any of the provided links on our website or facebook page to book or send us an e-mail at unitas@generalsurgery.co.za.

We are dedicated to helping you. Please note that this information is not exclusive

To keep up to date or rate us, please like our social media pages:
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Gastroesophageal Reflux Disease (GERD) – Making lifestyle changes to manage GERD

Christian Jeske — Mon, 02 Sep 2024 20:25:50 +0000

GERD

Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up the esophagus. This backwash is known as acid reflux, and it can irritate the lining of the esophagus. GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach.

When you swallow, a circular band of muscle around the bottom of the esophagus, called the lower esophageal sphincter, relaxes to allow food and liquid to flow into the stomach. Then the sphincter closes again.

If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed.

Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it’s uncommon, some may need surgery to help with symptoms.

Symptoms:

A burning sensation in the chest, often called heartburn that usually happens after eating and might be worse at night or while lying down.
Backwash of food or sour liquid in the throat.
Upper belly or chest pain.
Trouble swallowing, called dysphagia.
Sensation of a lump in the throat.
If you have nighttime acid reflux, you also might experience:
- An ongoing cough
- Inflammation of the vocal cords known as laryngitis
- New or worsening asthma

Lifestyle factors that reduce risk of Gerd:

Drink more water – 2Lt per day
no more than two cups of coffee/tea/soda daily
a healthy diet (comparatively higher intake of fruits, vegetables, whole grains, legumes, poultry, and fish)
Moderate or vigorous exercise for at least 30 minutes daily – if your heartburn gets worse after exercise, time your meals and wait 2h after eating
Avoid alcohol
Avoiding eating meals at least 3 hours before going to bed
Eating smaller portions and avoiding overeating, eat slowly and chew food properly
Quitting smoking
Obtaining/maintaining a healthy body weight (body mass index between 18.5 and 25)
Not lying down for at least two hours after a meal
Avoiding heartburn triggers such as certain foods and drinks for example:
- Onions, peppermint, chocolate, caffeinated beverages, citrus fruit or juice, tomatoes or high fat and spicy foods.
Sleeping in an inclined position
Keep a heart burn diary is a good way for you to figure out which foods cause your symptoms. Jot down when your heartburn hits and the specific things you’re doing when it comes.

Conditions that can increase the risk of GERD include:

Obesity
Bulging of the top of the stomach up above the diaphragm, known as a hiatal hernia.
Pregnancy
Connective tissue disorders, such as scleroderma
Delayed stomach emptying

Factors that can aggravate acid reflux include:

Smoking
Eating large meals or eating late at night
Eating certain foods, such as fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Taking certain medicines, such as aspirin.

Possible complications:

Over time, long-lasting inflammation in the esophagus can cause:

Inflammation of the tissue in the esophagus, known as esophagitis. Stomach acid can break down tissue in the esophagus. This can cause inflammation, bleeding and sometimes an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult.
Narrowing of the esophagus, called an esophageal stricture. Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
Precancerous changes to the esophagus, known as Barrett esophagus. Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.

When to see a doctor:

If you have have severe or frequent GERD symptoms.
Take non-prescription medicines for heartburn more than twice a week.
Have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be symptoms of a heart attack.

Contact

We are dedicated to helping you. Please note that this information is not exclusive

To keep up to date or rate us, please like our social media pages:
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Jaundice

Christian Jeske — Fri, 31 Mar 2023 10:49:31 +0000

Jaundice

Jaundice is a sign of an underlying disease; it occurs when there’s too much bilirubin in your blood. Bilirubin comes from the break down of old red blood cells, which the liver filters from the bloodstream.

Jaundice may develop if there is either an increased breakdown of red blood cells, the liver’s functional capacity decreases or there is a blockage in the excretion of bile. Bilirubin builds up and can cause your skin to look yellow.

What is Bilirubin?

Bilirubin is a yellowish pigment that is made during the normal breakdown of red blood cells. Higher than normal levels of bilirubin may indicate an underlying liver or bile duct problem. Eventually, most of it leaves the body in the faeces.

Causes

Jaundice is divided into 3 groups: according to the different causes.

Pre-hepatic (before bile is made in the liver).

- Haemolysis (rupture or destruction of red blood cells), the most common cause of prehepatic jaundice, this involves increased production of bilirubin.
- Less common cause of pre-hepatic jaundice includes Gilbert’s disease and Grigler-Najjar syndrome

Hepatic (problems arising within the liver).

Jaundice in these cases is caused by the liver’s inability to properly metabolize and excrete bilirubin. Examples include:

- Certain medicines: Drugs like acetaminophen, penicillin, birth control pills, and steroids have been linked to liver disease.
- Alcohol-related liver disease: If you drink too much over a long period of time — typically 8 to 10 years — you could seriously damage your liver. Two diseases in particular, alcoholic hepatitis and alcoholic cirrhosis, harm the liver.
- Hepatitis: Most of the time, this infection is caused by a virus. It may be short-lived (acute) or chronic, which means it lasts for at least 6 months. Drugs or autoimmune disorders can cause hepatitis. Over time, it can damage the liver and lead to jaundice.

Post-hepatic (after bile has been made in the liver)

- Blocked bile ducts: These are thin tubes that carry a fluid called bile from the liver and gallbladder to the small intestine. Sometimes, they get blocked by gallstones, cancer, or rare liver diseases. If they do, you could get jaundice.
- Pancreatic cancer: This is the 10th most common cancer in men and the ninth in women. It can block the bile duct, causing jaundice.
- Cancer is also an overlapping cause of post-hepatic jaundice.

Symptoms

Yellow discolouration of the skin and mucous membranes
Light-coloured stools
Dark-coloured urine
Itching of the skin
Nausea and vomiting
Abdominal pain or discomfort
Fever
Loss of appetite
Headache

Tests

Liver function tests.

Blood tests that measure certain enzymes or proteins in your blood as well as your bilirubin levels

Albumin and total protein.

Levels of albumin — a protein made by the liver — and total protein show how well your liver is making proteins that your body needs to fight infections and perform other functions.

Complete blood count.

This test measures several components and features of your blood

Prothrombin time.

This test measures the clotting time of your blood

Treatment

The treatment of jaundice depends on what is causing it. All cases of jaundice require a detailed physical examination and work-up to ensure optimal treatment.

Contact

We are dedicated to helping you. Please note that this information is not exclusive

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Pancreatitis

Christian Jeske — Tue, 14 Mar 2023 08:50:06 +0000

Pancreatitis

Pancreatitis is a common nonbacterial inflammatory disease caused by activation and autodigestion; a process whereby pancreatic enzymes destroy its own tissue leading to inflammation. This may or may not be accompanied by permanent anatomical and functional changes in the pancreas.

Pancreatitis is mostly caused by gallstone disease or alcoholism, a few cases result from trauma, hypercalcemia, hyperlipidemia with the remainder cases being of no identifiable cause.

There are two different types of pancreatitis namely, acute, and chronic pancreatitis.

Acute Pancreatitis

Acute pancreatitis is a syndrome resulting from acute inflammation, it is the 3^rd most common indication for hospital admissions among gastrointestinal diseases. It is associated with significant morbidity and mortality.

Acute pancreatitis has many causes but biliary tract disease and alcohol consumption accounts for most cases, with drug reactions, metabolic causes, and traumatic injuries accounting for almost all the remaining cases. In patients who do not drink alcohol, the most common cause of acute pancreatitis is biliary tract disease. Acute pancreatitis associated with biliary tract disease is more common in women, because gallstones are more common in women.

Symptoms of acute pancreatitis

Abdominal pain

The pain of acute pancreatitis is characteristic, often described as an intense, deep, searing pain that radiates to the back. The acute attack frequently begins following a large meal and consists of severe epigastric pain, this is usually accompanied by vomiting and retching.

Fever

Almost two-thirds of patients develop fever, this is due to tissue injury, inflammation, and necrosis.

Dehydration and increased heart rate (tachycardia)

Depending on the severity of the disease, dehydration and tachycardia may be profound.

Treating acute pancreatitis

Fluid replacement in patients with acute pancreatitis are necessary to maintain circulation of blood and renal function.
Antibiotics, prophylactic broad-spectrum antibiotics are often used in patients with severe pancreatitis since the likelihood of infections are high.
Oxygen therapy is used in more than 30% of all patients who develop hypoxemia.
Calcium and magnesium replacements are used in severe attacks of acute pancreatitis.
Surgical treatment is generally contraindicated in uncomplicated acute pancreatitis.

Chronic Pancreatitis

Chronic alcoholism causes the most cases and accounts for 70-80% of the cases. Patients with chronic pancreatitis resulting from alcohol abuse usually have a long history (6-12 years) of heavy alcohol consumption (150-175 ml of pure alcohol a day). Other causes include bile duct obstruction due to gallstones, hypercalcemia (calcium level in your blood is above normal), hyperlipidemia (your blood has too many lipids (or fats), such as cholesterol).

Chronic pancreatitis causes irreversible damage towards the pancreas, whereas the damage in acute pancreatitis is reversable. In patients with chronic pancreatitis diabetes mellitus is commonly present.

Symptoms of chronic pancreatitis

Abdominal pain

Chronic pancreatitis may be asymptomatic, or it may produce abdominal pain. The pain is usually felt deep in the upper abdomen and radiates through the back. Early in the disease, the pain may be episodic lasting for days to weeks and then vanishing for several months before returning.

Continued alcohol intake may increase the frequency of painful episodes

Nausea and vomiting
Weight loss and malabsorption
Jaundice and diabetes mellitus

Treating chronic pancreatitis

The treatment for chronic pancreatitis is mainly symptomatic and directed toward relieving pain.
Discontinue the use of alcohol. Abstention from alcohol will reduce chronic pain in more than half of cases even though damage to the pancreas is irreversible.
Diabetes in these patients usually require insulin therapy.
Fluid replacement with calcium and magnesium replacements is also advisable in patients with chronic pancreatitis.

Medical tests

Endoscopic pancreatography (ERCP) – is helpful in establishing the diagnosis of chronic pancreatitis, and in the ruling out of pancreatic cancer.

Imaging studies – CT scans with contrast. MRI if suspected cause is bile duct obstruction.

Blood tests – Pancreatic function tests, Liver function tests (LFT’s), CRP (C-reactive protein), Kidney function tests

We are dedicated to helping you. Please note that this information is not exclusive

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Disease of endocrine pancreas

Christian Jeske — Mon, 27 Feb 2023 09:48:16 +0000

Disease of endocrine pancreas

About the pancreas

The pancreas lies behind your stomach, extending laterally from the duodenum toward the spleen. The pancreas is an elongated, pinkish grey organ with a length of about 15cm and weight of about 80g. The broad head of the pancreas lies within the loop formed by the duodenum. The slender body of the pancreas extends toward the spleen, and the tail is short and bluntly rounded. The surface of the pancreas has a lobular texture.

Arterial blood supply includes the branches of the splenic, superior mesenteric and common hepatic arteries. The pancreatic arteries and pancreaticoduodenal arteries are the major branches from these vessels. The splenic vein and its branches drain the pancreas.

The pancreas is primarily an exocrine organ, producing digestive enzymes and buffers. The large pancreatic ducti (Duct of Wirsung) deliver theses secretions to the duodenum. A small accessory pancreatic duct or duct of Santorini may branch from the pancreatic duct. This pancreatic duct extends within the attached mesentery to reach the duodenum, where it meets the common bile duct from the liver and gallbladder. These two ducts empty into the duodenal ampulla, a chamber located roughly halfway along the length of the duodenum.

Functions of the pancreas

The pancreas has digestive and hormonal functions and is known as the only organ in the body to have both endocrine and exocrine secretions. Each day your pancreas secretes abut 1000ml of pancreatic juice. The secretory activities are controlled primarily by hormones from the duodenum. Furthermore, some enzymes are secreted as inactive proenzymes that are activated only after they reach the small intestine. The release of proenzymes rather than active enzymes in the pancreas protects the secretory cells from the destructive effects of their own products.

Carcinoma of the pancreas (Cancer)

Pancreatic carcinoma has become the third leading cause of death in the United States and is known to be the eight most common cancer in women and tenth in men respectively. Pancreatic cancer usually occurs after the age of 50 years and increases in incidence with age, with most patients diagnosed between the ages of 60 and 80 years of age.

Carcinomas occur more often in the head of the pancreas (70%) and body (20%) than in the tail which accounts for 10% of the cases. Carcinoma of the head of the pancreas tend to obstruct the common bile duct early in their course, with resulting jaundice, and can extend into the uncinate processes to involve the superior mesenteric artery and vein, thus compromising surgical respectability. Tumours of the body and tail tend to present later in their course, as they cause few symptoms until they become quite large. Patients with carcinoma of the body or tail of the pancreas typically present with epigastric abdominal pain, profound weight loss, abdominal mass, and early satiety. Due to the vague nature of the symptoms, patients tend to present at later stages, often with distant metastases, particularly in the liver. Microscopically, 90% of pancreatic cancers are adenocarcinomas; the remainder are adenosquamous, anaplastic, or acinar cell carcinomas.

Risk factors of pancreatic cancer includes

Cigarette smoking has the strongest overall association and is thought to account for one-quarter of cases diagnosed.
High dietary intake of saturated fat (cream, butter, cheese, pastries, cured meats, chocolate etc.)
The role of other dietary factors such as coffee, high fat intake and the use of alcohol are still much debated.
Diabetes mellitus has also recently been identified as a risk factor for the disease.
Chronic pancreatitis increases the risk of developing pancreatic adenocarcinoma by 10 – 20-fold.

Whipple Procedure (Pancreaticoduodenectomy)

A Whipple procedure is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the lower half of the common bile duct, with reestablishment of continuity of the biliary, pancreatic, and GI tract systems. Gastrointestinal continuity is re-established by connecting a portion of the intestine to the bile duct, remaining pancreatic body/tail, and the stomach or duodenum. The procedure may take anything from 6-12 hours, with post operative High care for 7-10 days if no complications arise.

References

Martini, F. and Ober, W.C. (2001). Fundamentals of anatomy & physiology: [main volume]. Upper Saddle River, N.J.: Prentice Hall.
Mcphee, S.J. and Hammer, G.D. (2019). Pathophysiology of disease: an introduction to clinical medicine. 8th ed. New York: Mcgraw-Hill Education Medical.
Lowe, J.S., Anderson, P.G., Anderson, S.I. and Stevens, A. (2020). Stevens & Lowe’s human histology. Amsterdam: Elsevier.
www.bartleby.com. (n.d.). Illustrations. Fig. 1062. Gray, Henry. 1918. Anatomy of the Human Body. [Online – Accessed 11 Aug. 2022].
Edythe Louise Alexander, Rothrock, J.C. and Mcewen, D.R. (2015). Alexander’s care of the patient in surgery. St. Louis, Missouri: Elsevier/Mosby.

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Liver health

Christian Jeske — Mon, 13 Feb 2023 10:59:14 +0000

Liver Health

The liver

The liver is located in the right upper quadrant of the abdomen, just below the diaphragm and the rib cage. It is anatomically divided into a left and right lobe. The liver weighs approximately 1400g and is the second largest organ in the human body. It receives nearly 25% of the cardiac output (The amount of blood your heart pumps in one minute) approximately 1500ml of blood flow per minute. This is achieved by the portal vein and hepatic artery.

Since the liver has such a rich and systemic blood supply, the liver is a prime site for the metastatic spread of cancer, especially from the GI tract, breast, and lung. It performs over 500 functions, this includes protein, lipid, carbohydrate metabolism as well as drug metabolism and excretion. Iron is also stored in the liver/bone marrow to make red blood cells which carries oxygen in our bodies. The liver adjusts cholesterol levels, builds proteins, and makes bile, which helps you absorb fats, stores sugar for when you really need it and regulates hormone levels

Liver health and diseases

Many health problems can keep your liver from functioning properly and cause disease.

Alcoholic Liver Disease. Alcoholic liver disease is a result of alcohol abuse. Repeated episodes of acute injury ultimately cause necrosis, fibrosis, and regeneration, leading to cirrhosis.

Cholestasis. This happens when the flow of bile from your liver is limited or blocked. Cholestasis can be caused by certain drugs, genetic factors or even pregnancy. It can also occur from a blockage caused by a tumour, or a gallstone stuck in the body’s digestive system.

Cirrhosis. An irreversible alteration of normal liver architecture, characterized by hepatic injury, fibrosis, and nodular regeneration. Heavy alcohol use and viruses like hepatitis are common causes of cirrhosis. Not all patients will Cirrhosis develop life-threatening complications.

Hepatitis. This is the name for any condition involving inflammation of your liver. There are many different types, acute, viral, toxic, chronic, and alcoholic hepatitis. Hepatitis can lead to liver failure, liver cancer and other life- threatening conditions.

Non-alcoholic Fatty Liver Disease (NAFLD). A form of chronic liver disease associated with the metabolic syndrome. This is an umbrella term for a wide range of liver diseases. NAFLD is diagnosed when there are no other causes of secondary hepatic fat accumulation (e.g., heavy alcohol consumption)

Lifestyle

Get vaccinated for hepatitis. Hepatitis A and B are viral diseases of the liver. While many children have now been immunized, many adults have not. Ask your doctor if you are at risk.
Avoid contaminated needles while tattoos and piercing.
Avoid toxins like drugs and some medicines that can harm your liver.
Practice safe sex because there is no vaccine for hepatitis C. Hepatitis B and C can develop into chronic conditions that may eventually destroy your liver. They are transmitted by blood and other bodily fluids.
Wash your hands: Hepatitis A is spread through contact with contaminated food or water.
Avoid smoking and the use of tabaco products.
Pesticides and other toxins can damage your liver. Read warning labels on the chemicals you use.

Diet

Don’t eat foods high in fat, sugar, and salt.
Stay away from a lot of fried foods including fast food restaurant meals.
Raw or undercooked shellfish such as oysters and clams are a definite no-no.
Try to limit alcohol consumption to no more than one drink a day if you’re a woman and two drinks a day if you’re a man.
Eat a balanced diet: Select foods from all food groups: Grains, fruits, vegetables, meat and beans, milk, and oil.
Eat food with fibre: Fibre helps your liver work at an optimal level. Fruits, vegetables, whole grain breads, rice and cereals can take care of your body’s fibre needs.
Drink lots of water: It prevents dehydration, and it helps your liver to function better.

Exercise

Maintain your body mass index in the normal range (18 to 25) by eating healthy and exercising on a regular basis to decrease your risk of developing non-alcoholic fatty liver disease (NAFLD).

Screening

Blood Test – several blood tests are commonly used to assess liver function, these range from measuring the enzymes (AST and ALT) of the liver as well as levels of albumin, clotting factors and bilirubin.
Imaging Tests – Ultrasound, CT scan, MRI gives a detailed picture of the liver and abdominal part.
Biopsy – A small part of the tissue is removed to diagnose the type of liver disease by means of inserting a needle through the skin and aspirating liver cells. Most biopsies are performed as day-case procedures.

References

Mohan, Y., 2022. Liver – Anatomy, Functions, Diseases, Diagnosis, Tips – LeoGenic Healthcare Pvt Ltd. [online] LeoGenic Healthcare Pvt Ltd. [Accessed 19 August 2022].
Mcphee, S.J. and Hammer, G.D. (2019). Pathophysiology of disease: an introduction to clinical medicine. 8th ed. New York: Mcgraw-Hill Education Medical.
American Liver Foundation. 2022. Liver Disease Diets – American Liver Foundation. [online] [Accessed 19 August 2022].
Hopkinsmedicine.org. 2022. 5 Ways to Be Kind to Your Liver. [online] [Accessed 19 August 2022].

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Medically Speaking Archives - Dr Christian Jeske

History of Surgery

MAJOR DEVELOPMENTS IN THE HISTORY OF SURGERY

Global Milestones (15 selected developments)

Early surgical practice

Scientific human anatomy

Better control of bleeding

Surgical anaesthesia

Hand hygiene, antisepsis and sterile surgery

Modern nursing and organised perioperative care

Medical imaging

Blood typing, transfusion and blood banking

Antibiotics

Vascular surgery

Open-heart surgery

Organ transplantation

Microsurgery and reconstruction

Minimally invasive and endoscopic surgery

Robotic, image-guided and data-assisted surgery

South African Contributions (Selected milestones with global significance)

Early ether anaesthesia in South Africa

Cape Town cardiac and transplant research

First human-to-human heart transplant

South African roots of CT imaging

First successful penis transplant

Pioneering HIV-positive living-donor liver transplant

3-D printed middle-ear reconstruction

Diverticular Disease of the Colon

What is diverticular disease?

What causes diverticular disease?

What are the symptoms?

How is it diagnosed?

How is it treated?

What should I eat?

When should I seek urgent medical attention?

Can diverticular disease be prevented?

GLP-1 Medications: Benefits, Risks and Safe Use

What are GLP-1 medications?

What are the benefits?

What are the possible side effects?

Are there any serious risks?

Who should not use GLP-1 medications?

Can these medicines be addictive?

Buying GLP-1 medications safely

Why is this important in South Africa?

Getting the best results

Patient Orientation for surgery

Understanding Fatty Liver Disease: A Patient Guide

Diagnosis

When to Consult a Doctor

Treatment and Lifestyle Changes

Dietary Changes

Physical Activity

Weight Loss

Ongoing Monitoring

Conclusion

Gastroesophageal Reflux Disease (GERD) – Making lifestyle changes to manage GERD

Symptoms:

Lifestyle factors that reduce risk of Gerd:

Conditions that can increase the risk of GERD include:

Factors that can aggravate acid reflux include:

Possible complications:

When to see a doctor:

Jaundice

What is Bilirubin?

Causes

Symptoms

Tests

Treatment

Pancreatitis

Acute Pancreatitis

Symptoms of acute pancreatitis

Treating acute pancreatitis

Chronic Pancreatitis

Symptoms of chronic pancreatitis

Treating chronic pancreatitis

Medical tests

Disease of endocrine pancreas

About the pancreas

Functions of the pancreas