Anatomy Archives - Dr Christian Jeske

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.

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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

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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

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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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