Abdominal Pain Treatment in Delhi - Removemypain

1. Abdominal Pain Treatment in Delhi - Removemypain Chronic abdominal pain is a common reason for seeking medical attention. Pain generators in abdominal pain are not always easy to identify and may be located inside the abdomen, in the abdominal wall or in the nearby organs with pain being referred to the abdomen. ACNES is a common cause of abdominal wall pain and it involves entrapment of small nerves which supply the skin of abdominal wall as they pass through the abdominal muscle (lateral part of rectus muscle). A study from a Dutch teaching hospital found approximately 2% of patients presenting to emergency department with acute abdominal pain suffered from ACNES. ACNES presents as localized unilateral abdominal pain and patients can usually pinpoint painful areas close to the middle of abdomen. Pain may be provoked by position change or tensing of abdominal muscles and is generally independent of food intake, bowel habits. Trauma or previous surgery can also contribute to the entrapment of these small nerves. Abdominal wall pain is frequently unrecognized and this often leads to a magnitude of investigations, specialist consultations, prolonged suffering, overtreatment and inefficient utilization of resources. Ultrasound guided injections are used to confirm the diagnosis of ACNES and provide pain relief. Ultrasound guidance can not only help in identifying local but also helps in improving the accuracy and safety of injections. Sometimes repeat injections are required to provide sustained pain relief. I have successfully identified and treated ACNES on numerous occasions- most often after local trauma or surgeries such as caesarean section, open/ laparoscopic abdominal surgeries etc.

2. INTRODUCTION The pancreas is a 6 to 10-inch organ located in upper part of abdomen behind the stomach. It produces enzymes needed to digest food and hormones such as insulin and glucagon. Pancreatitis is swelling (inflammation) of the pancreas can occur due to a wide variety of reasons. When this occurs quickly it is addresses as acute pancreatitis. If acute pancreatitis fails to resolve or gets worse or if there are repeated attacks, it can lead to permanent damage or continuing inflammation. This is addressed as chronic pancreatitis and is seen more commonly in men, especially those between the ages of 30 to 40 years. Chronic pancreatitis is a multifaceted long-term illness with impact of all aspects of one’s life including social, financial, employment and relationships. Pain in pancreatitis can be continuous, severe with associated mood and sleep disturbances. It is often the main reason behind seeking hospital admission and is known to be responsible for reduced quality of life, disability. For those with uncontrolled pain hospital environment becomes a safe haven and hence long-term control of this pain is important not only for preventing repeated hospital admissions but also for improving the quality of life. SYMPTOMS Common presenting features of chronic pancreatitis include: Upper abdominal pain – this may be present constantly or may come and go Described as dull aching, penetrating or boring pain. Some of the other words used by patents to describe the pancreatitis pain include burning, ripping, bursting, stabbing, crushing, and electric shock like Pain is generally diffuse and poorly localised Can radiate to back, chest and occasionally the left shoulder It can increase in severity after eating, drinking alcoho

3. Often relieved by leaning forwards Loss of appetite with weight Diarrhoea, nausea and vomiting Foul-smelling fatty, oily or pale coloured stools which are difficult to flush CAUSES There are many factors behind the development of pancreatitis and of these, alcohol is an important preventable trigger. The common causes of chronic pancreatitis include: Alcohol Blockade of ducts draining the pancreatic enzymes such as with gallstones and pancreatic duct strictures High levels of a fat called triglycerides in the body (hyperlipidaemia) Smoking Abdominal/ pancreatic trauma Infections Autoimmune conditions where one’s immune system attacks the body Hereditay/ genetic conditions where it is passes down the families idiopathic Chronic renal failure Increased calcium levels (Hypercalcaemia) Medicines such as sulfonamides, thiazides, and azathioprine. Research evidence suggests that smokers have a 2.8 times higher risk of development of chronic pancreatitis compared with non-smokers. Smoking accelerates alcohol related chronic pancreatitis and pancreatic calcification (calcium deposition in pancreas) Many theories have been proposed to explain the pain in chronic pancreatitis and these include: In about 30% of patients there is persisting pain despite removal of the pancreas and this implies that not all pain originates from the pancreas and new bouts of pain do not always imply new injury as there are other pain contributing mechanisms independent of the pancreas. DIAGNOSIS

4. It can be challenging to diagnose chronic pancreatitis in early stages. Generally imaging modalities are used more commonly as the routine laboratory tests such as amylase, lipase, and inflammatory parameters can be completely normal or only slightly elevated in chronic pancreatitis. Histological evidence of loss of issue and fibrosis is perhaps the most definitive diagnostic method but is not always available. Imaging tests include CT scan of the abdomen MRI with MRCP (Magnetic resonance cholangiopancreatography) Endoscopic ultrasound (EUS) Endoscopic retrograde cholangiopancreatography (ERCP)- this involves visualising the bile and pancreatic ducts using an endoscope. It provides good images of the pancreatic ducts but is not used so often for the diagnosis. Ultrasound of the abdomen