Dr Christian Jeske https://generalsurgery.co.za/ Your liver, pancreas & gastrointestinal specialist surgeon Tue, 13 Jan 2026 08:37:14 +0000 en-ZA hourly 1 https://wordpress.org/?v=7.0.1 https://generalsurgery.co.za/wp-content/uploads/2021/07/DrJeske-Favicon.png Dr Christian Jeske https://generalsurgery.co.za/ 32 32 Patient Orientation for surgery https://generalsurgery.co.za/patient-orientation-for-surgery/ Tue, 25 Nov 2025 21:31:55 +0000 https://generalsurgery.co.za/?p=1886 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 https://generalsurgery.co.za/understanding-fatty-liver-disease-a-patient-guide/ Wed, 25 Jun 2025 12:52:54 +0000 https://generalsurgery.co.za/?p=1867 Fatty liver disease is common, often silent, but potentially serious. The good news is that with timely diagnosis and lifestyle changes it can often be reversed or halted.

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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

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]]> Gastroesophageal Reflux Disease (GERD) – Making lifestyle changes to manage GERD https://generalsurgery.co.za/gastroesophageal-reflux-disease-gerd-making-lifestyle-changes-to-manage-gerd/ Mon, 02 Sep 2024 20:25:50 +0000 https://generalsurgery.co.za/?p=1789 GERD is a common condition that can be managed through lifestyle changes, learn to recognise the symptoms and when you should seek medical advice.

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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

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

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]]> Jaundice https://generalsurgery.co.za/jaundice/ Fri, 31 Mar 2023 10:49:31 +0000 https://generalsurgery.co.za/?p=1735 Jaundice is a sign of an underlying disease that occurs when there’s too much bilirubin in your blood. Dr Jeske discusses the causes and diagnosis options in dealing with Jaundice.

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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.

  1. 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
  1. 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.
  1. 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

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

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]]> Pancreatitis https://generalsurgery.co.za/pancreatitis/ Tue, 14 Mar 2023 08:50:06 +0000 https://generalsurgery.co.za/?p=1719 Pancreatitis is a common nonbacterial inflammatory disease, identifying the causes and treating Pancreatitis effectively is key to resolving the disease, Dr Christian explains more.

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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 3rd 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

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]]> Disease of endocrine pancreas https://generalsurgery.co.za/disease-of-endocrine-pancreas/ Mon, 27 Feb 2023 09:48:16 +0000 https://generalsurgery.co.za/?p=1712 Pancreatic cancer is known as the eighth most common cancer in the world, Dr Christian examines the pancreas and options for patients.

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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 https://generalsurgery.co.za/liver-health/ Mon, 13 Feb 2023 10:59:14 +0000 https://generalsurgery.co.za/?p=1705 Dr Christian explains the functioning of the liver and how best you can take care of this vital organ.

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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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]]> In Room Procedures https://generalsurgery.co.za/in-room-procedures/ Mon, 30 Jan 2023 11:58:24 +0000 https://generalsurgery.co.za/?p=1697 In room procedures are recommended for small and minimal invasive procedures. Dr Jeske discusses which procedures are suitable.

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In Room Procedures

The following procedures are done in the rooms by Dr C Jeske with the help of an Anaesthesiologist and clinical assistant. Anaesthesia is given in the form of sedation; sedation is used in small and minimal invasive procedures whereby the patient is still able to breath on their own with no loss if cardiac function. The patient is unconscious.

Gastroscopy

Procedure

A gastroscopy is best described as a minimal invasive procedure where Dr Jeske inserts a long, thin tube with a small camera through the mouth to reach the stomach via the path of the esophagus. During the procedure Dr Jeske may perform other small procedures such as taking specimens of the esophagus and stomach with a small biopsy forceps which he inserts through the scope.

Indications

Indications for a gastroscopy range from different digestive problems and complaints such as.

  • Difficulty or pain when swallowing (dysphagia)
  • Heartburn and Chest pain
  • Stomach or abdominal pain
  • Continues vomiting and nausea
  • Family history of esophageal/stomach cancer

Side effects of a gastroscopy

  • Slight pain in the throat
  • Feeling bloated
  • Belching

Preparing for a gastroscopy

  • Do not eat/drink after 22h00, the night before the procedure.
  • You should be fasting for at least 6 hours before the procedure for solids, but you are allowed to take clear liquids up to two hours before your procedure.

Colonoscopy

Procedure

The procedure colonoscopy provides visualization of the colon from the rectum to the ileocecal valve. During the procedure Dr Jeske will insert a long, flexible tube inside the rectum through the anus to reach the end of the large bowel (colon). During the procedure Dr Jeske may perform other small procedures such as taking specimens of the colon with a small biopsy forceps which he inserts through the scope.

Indications

Indications for which a colonoscopy will be performed are as follow.

  • Difficulty or pain when passing stool
  • Bleeding when passing stool or blood in stool
  • Abdominal pain
  • Acute and chronic diarrhoea
  • Family history of colon/rectal cancer

Side effects of a colonoscopy

  • Slight blood in stool
  • Passing a lot of gas
  • Minor discomfort in abdomen
  • Diarrhoea from residual effects of bowel preparation

Bowel preparation before the procedure

  • You will be provided with all the necessary information in the rooms as well as a script for Picoprep.
  • Picoprep is a laxative used in preparation for the colonoscopy to ensure the bowel is empty for optimal vision.

Patients using medication

Diabetes patients – please check your sugar levels the evening and morning; omit medication the morning of the procedure.

Warfarin – Stop 4 days prior to the procedure. If unsure whether you are allowed to stop medication, please check with your physician or cardiologist, and have an INR check the morning of your procedure.

Iron tablets – must be stopped one week prior to the procedure

Specimens

Specimens are taken with both the above-mentioned procedures. They are then sent to pathology labs (Lancet) to be tested; this is advantageous in making or confirming a diagnosis. The sizes of these specimens vary between 2 and 3mm, with no obvious side effects afterwards, Dr can take up to 6 specimens in the colon and up to 4 in the gastroscopy.

Duration of gastroscopy and colonoscopy

  • Gastroscopy – You will be in the procedure room for about 25-30 minutes. The scope itself will take 10-15 minutes (this is dependent on whether a procedure is done with/-out biopsies). You will need a few minutes to recover from the sedation afterwards in the recovery area.
  • Colonoscopy – You will be in the procedure room for about 30-40 minutes. The scope itself will take 15-20 minutes (this is dependent on whether a polypectomy or biopsy is being done). You will need a few minutes to recover from the sedation in the recovery area.

Important information

  • Please contact the rooms to schedule an appointment to follow-up scope and biopsy results, at least 7 days after your procedure.
  • You can return to work the day after your procedure. A sick note will be provided for the day of the procedure. Please discuss with our rooms if you need a longer sick leave note.
  • It is advised to bring a family member or friend who will be able to take you home, as you will not be able to drive due to the anaesthetic drugs administered during the procedure.

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

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]]> Laparoscopic Surgery https://generalsurgery.co.za/laparoscopic-surgery/ Mon, 16 Jan 2023 06:12:33 +0000 https://generalsurgery.co.za/?p=1692 Laparoscopic surgery is a minimally invasive surgical technique. Dr Jeske discusses the advantages and myths surrounding laparoscopic surgery.

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Laparoscopic surgery

Laparoscopic surgery is a minimally invasive surgical technique used in the abdominal and pelvic areas. It uses the aid of a laparoscope — a thin, telescopic rod with a camera at the end — to see inside your body without opening it all the way up. Instead of the 15-30cm cut necessary for open abdominal surgery, laparoscopic surgery uses two to four small incisions of half a centimetre or less. One is for the camera, and the others are for the surgical instruments. Minimally invasive surgery may also be called “keyhole surgery,” referring to these small incisions.

History and Pioneers of Laparoscopic procedures

  • Endoscopy is derived from Greek and means “viewing the inner spaces of the human body” (“endo” and “skopein”)
  • Georg Kelling was the first to describe the basic principles of endoscopy of the abdomen. Kelling performed the procedure in a dog. Almost exactly a hundred years ago, Jacobaeus performed the first endoscopy in humans. Major advancements in endoscopy were accomplished from the 1960s to the 1980s, accompanied by a transition from diagnostic to surgical laparoscopy. These developments are inseparably linked with the names of Raoul Palmer in Paris and Kurt Semm in Kiel.
  • The first laparoscopic appendectomy was performed by Semm on 13 September 1980 at the department of obstetrics and gynaecology, University of Kiel. 

Advantages of laparoscopic surgery

  • Smaller incisions and smaller scars
  • Less pain than open procedures
  • The chances of infection after the procedure are lower than with open procedures
  • Faster recovery for the patient
  • Shorter hospital stays
  • Due to the increase in intra-abdominal pressure, patients bleed less than with open procedures.

Disadvantages of laparoscopic surgery

  • Sometimes the procedure must be converted to an open procedure due to bleeding or other complications
  • Limited degree of motion
  • Increased operation time
  • Increased technical difficulty

Procedures done laparoscopically by Dr Jeske

  • Laparoscopic incisional hernia repair – This is a bulge or area of weakness in the muscles which form the lower front of the stomach in the groin region.
  • Laparoscopic drainage of abscess in the liver, pancreas, and abdomen
  • Laparoscopic liver resections and liver biopsies – The reason for removing part of the liver is likely due to one or more growths, cancerous or non-cancerous. Trauma to the liver is also a possible indication for this operation. A liver biopsy may be done to look for the cause of liver abnormalities, to assess if, and how much, the liver is damaged and/or to help in planning treatment.
  • Laparoscopic cholecystectomy – Removal of the gallbladder due to gallstones, both the gallbladder and stones are removed.
  • Laparoscopic appendicectomy – Removal of the appendix due to infection which causes pain and can ultimately rupture.
  • Laparoscopy for diagnostic purposes
  • Laparoscopic hemicolectomies – Removal of part of the large intestine due to cancer or other obstructions.
  • Laparoscopic splenectomy – Removal of the spleen may be due to Splenic cysts, abscesses, or tumours. Spleen damaged because of certain auto-immune diseases or traumatic trauma may also be an indication to remove the spleen.

Myths and facts about laparoscopic surgeries

  1.  Myth – Laparoscopic surgery is more costly than open surgery
    Fact – Since patients have a shorter hospital stay and can return to work quicker the costs of laparoscopic procedures are less than that of open surgeries.
  2. Myth – Visualization of the abdomen is limited using lapscopes
    Fact – Laparoscopy provides better visualization of the abdomen when compared to the open approach.
  3. Myth – Patients with multiple previous abdominal surgeries cannot have a laparoscopic procedure.
    Fact – Laparoscopy can be safely performed in patients with multiple prior surgeries regardless of the size or location of the prior skin incisions.

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

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]]> Palliative care (for the patient) https://generalsurgery.co.za/palliative-care-for-the-patient/ Thu, 20 Oct 2022 08:40:50 +0000 https://generalsurgery.co.za/?p=1674 Palliative care is also known as end-of-life care is aimed at aiding the individual in passing on with dignity and as comfortably as possible.

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Palliative Care (for the patient)

This information is for you if you have advanced disease that is no longer responding to treatment. You and your loved ones may have been focused on treatment in hopes of remission or recovery, this focus may now have to shift to making choices about care and future steps. Receiving a terminal diagnosis is a traumatic experience for the patient as well as the patient’s loved ones. This document contains information which aims to assist you in navigating this last stage of life.

Conversations surrounding End-of-life wishes

Conversations with your partner about end of life

Although this might likely be one of the most emotional and painful conversations which you will have with your spouse or partner, it will also provide comfort in knowing that there is a plan going forward and your wishes are known and will be honoured. The following topics are a good place to get the conversation started:

  • When to stop cancer treatment
  • Preparing for the future – Final Will and Testament
  • Hospice and palliative care assistance
  • Fears about death
  • Wishes at end of life – Medical Proxy
  • Funeral wishes

This conversation doesn’t need to be completed in one sitting and may most likely not be.

This conversation will be revisited regularly as your condition progresses and your needs change.

Sharing your diagnosis with your loved ones

Family and friends will react in a vast range of ways, be prepared for any of the following:

  • Shock
  • Confusion
  • Helplessness
  • Anger
  • Sadness

Knowing what to expect may help you understand their feelings or reactions. Some relationships may change due to individuals having trouble coping with the thought of losing you.

Sharing your diagnosis can be done in a group setting or individually and largely depends on the type of relationships you have with your loved ones and what you are able to manage physically and psychologically.

In a group setting all questions can be answered in one sitting and electing a family member to speak onyour behalf may be helpful if you are not yet comfortable talking about your diagnosis.

In an individual setting you are able to have a more intimate conversation and may be reserved for your children and partner/spouse.

Palliative Care options available to the patient

Most often a combination of all/some of the options are used during the palliative phase as your needs and condition changes.

  • Hospice – “the goal of hospice is to help patients live each day to the fullest by making then as comfortable and symptom-free as possible…They are dedicated to supporting the emotional, social, and spiritual needs of both patients and their families, as well as dealing with patients’ medical symptoms.” As stated by U.S. Department of Health and Human Sciences’ National Cancer Institute. Services offered by hospices are as follows:
    • Doctor services
    • Nursing care
    • Medical supplies and equipment
    • Drugs for managing cancer-related symptoms and pain
    • Short-term in-patient care
    • Homemaker and home health aide services
    • Respite services to give caretaker a break
    • Counseling
    • Social work service
    • Spiritual care
    • Bereavement(grief) counseling and support
  • Homecare – the patient receives medication and specialised nursing/medical care at home. 24hour care is available and covered by most medical aids when motivated by the Oncologist/treating Doctor.
  • Palliative treatment – Medicines and treatments used to treat cancer can also be used to reduce pain and other symptoms and help you feel more comfortable. Chemotherapy or surgery may be suggested to slow growth of the tumor causing pain or remove some of the tumor that may be pressing on nerves and causing pain.

Psychological wellbeing

Your emotional wellbeing may seem unimportant in-light of your physical health failing, but the opposite is true. It is possible to find joy in your life, even during this difficult season you are weathering. You will have many feelings after receiving a terminal diagnosis it is important to note that all your feelings are valid and that there are ways to work through them so that you are not held captive by them, these will be discussed below:

  • Denial – having possibly put your all into treatment in hope for remission or recovery, acceptance that curative treatment is no longer an option can take time. Support groups or psychological therapy are two options which can assist in coming to terms with your mortality.
  • Anger – after accepting your diagnosis it is normal to feel angry, to wonder “why me?” and be angry at:
    • The cancer
    • Your healthcare providers
    • Your healthy friends and family
    • And even God if you are religious

Talk with your friends and family about your feelings of anger, most often verbalising your feelings provides relief from them as you no longer need to carry them alone.

  • Fear and worry – to mitigate paralysing fear it is advisable to empower yourself with knowledge from reliable sources, to help you prepare for any eventuality. Reliable sources are for example, CANSA website, your treating Oncologist and Hospice Organisation websites.
  • Stress – you can learn coping strategies to help you handle your stress like:
    • Exercising – as is appropriate to your physical state (Yoga)
    • Listening to music
    • Reading books, poems, or magazines
    • Getting involved in hobbies such as music or crafts
    • Relaxing or meditating, such as lying down and slowly breathing in and out
    • Talking about your feelings with family and friends
    • See a social worker or psychologist
  • Pain – there are many ways to control pain. As soon as you have pain you should let your doctor know, be honest about the amount of pain you are in, adequate pain control is an integral part of the palliative care process and will aid in bringing you comfort and enabling you to enjoy your daily life. Keep these guidelines in mind when describing your pain to your healthcare provider:
    • Where you feel pain
    • What it feels like (sharp, dull, throbbing, steady)
    • How strong the pain is
    • How long it lasts
    • What eases the pain and what makes it worse
    • What medicines you are taking for pain and how well it works
  • Depression & sadness – many individuals feel sad or depressed when faced with their mortality. Treatment for depression can alleviate feelings of despair whilst still being able to feel and process the necessary emotions you are going through whilst still being able to find joy in your daily life with your loved ones.
  • Guilt – many people feel guilty for various reasons, such as being a burden to others, lifestyle choices which could have led to your cancer. Discuss your feelings with your loved ones or ask to speak to a social worker or psychologist to work through these feelings.
  • Loneliness – this could be due to friends and loved ones distancing themselves from you because of their own difficulty dealing with loosing you, or because you feel like your loved ones simply do not fully understand what you are going through. Support groups are a wonderful tool in discussing, working through feelings that you may experience which your loved ones may not be able to fully understand, or may not want to discuss with your loved ones.
  • Gratitude – it may be hard at first, but you can find joy in your life. Do things that are meaningful to you and makes you smile. Pay attention to small day-to-day activities which bring you comfort and pleasure. Share these activities with your loved ones to enjoy joyous moments which will bring feelings of gratitude and happiness during this difficult chapter of your lives.

Talking to your healthcare team

These tips will assist you in getting the most out of your medical appointments,

  • Make a list of questions before every appointment
  • Bring a family member or trusted friend with to appointments. They will provide emotional support and may remember some information you may not remember
  • Ask all your questions. If you do not understand keep asking until you do. Being well informed is empowering and can put many misconceptions to rest.
  • Take notes. Ask a family member to assist you with this so that you can concentrate on asking your questions.
  • Get contact details for follow up questions.
  • Keep file or notebook of all the papers and test results. Take with to all your appointments and keep a diary of all your appointments and medications taken
  • Keep record of any upsetting symptoms or side effects. Note when and where they occur.
  • Find out what to do in an emergency, such as whom to call and where to go.

A check list for organising your affairs

  • Make a list of where to find important documents in the event that you are unable to gather them yourself
  • Keep documents in a fireproof box or with your lawyer
  • If papers are kept in a safety deposit box, make sure that a trusted family member or friend has access to it
  • Although original documents are needed for legal purposes, family members should have photocopies
  • Advance directives to be finalised early on, this includes Living will and durable power of attorney and health care proxy

Nutrition

It is important to continue eating a well-balanced diet with keen focus on high energy, antioxidant, high fibre, and protein intake. Keep hydrated by drinking 1.5L to 2L of water daily. Closely follow instructions of your healthcare team and consult a dietician for clarity should you feel this would be of benefit to you.

Also, important to note is to eat and enjoy the foods that bring positive memories and make you happy. Enjoy your morning coffee as part of your routine, this brings a sense of normalcy to this unfamiliar chapter you are navigating.

As your disease progresses your nutritional and fluid intake needs will change. Due to a decrease in activity and slowing down of the body’s processes you will require less and less calories. It is not unusual to have little to no desire for food and drink, do not try to force yourself to eat this is expected and normal.

Celebrating your life together:

Examples:

  • Make videos of special memories
  • Review and arrange family photos
  • Chart/write down your family history or family tree
  • Keep a daily journal of feelings and experiences
  • Make a scrapbook
  • Write notes or letters to loved ones and children
  • Read or write poetry
  • Create artwork or jewellery
  • Give meaningful items to objects to loved ones
  • Write down or record funny or meaningful stories from the past
  • Plant a garden
  • Create a playlist of your favourite songs
  • Gather favourite recipes and create a cookbook

For a comprehensive leaflet covering all of the above topics and more, kindly visit National Cancer Institute (U.S.) and read their information for patients, this is a brilliant source of reliable and easy to understand information covering an extensive number of topics pertaining to cancer.

Support groups are helpful to aid in connecting with individuals who are in the same position as you, some examples are:

  • CANSA
  • Cancer Dojo
  • Cancer Buddies
  • Cancer Alliance
  • https://cansa.org.za/cansas-care-support/cansas-online-support-resources/

Important contacts:

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
https://www.instagram.com/drchristianjeske/

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