Diverticular Disease

Diverticulitis is a common condition of the large intestine.  It is responsible for hospital admissions as well as numerous emergency operations a year for any general surgeon.  But how does diverticulitis start, what is it, and how is it treated?  Diverticulitis is an inflammatory condition of the colon. It starts out with the presence of diverticuli or diverticulosis.

 

Diverticuli of the colon form because of increased pressure inside the colon.  This causes small outpouchings of the colon to form, diverticulum, pl. diverticuli.  The increased pressure can almost always be traced back to chronic constipation.  Constipation and irregular bowel habits can be caused by a long list of conditions.  Once the pouches have formed the patient is said to have Diverticulosis.  This condition can be silent,  it can cause rectal bleeding, or it can lead to the complication Diverticulitis.

 

Once inflammation of the diverticuli occurs treatment with antibiotics is necessary.  Liquid diet and rest are also part of the treatment.  Sometimes antibiotic treatment can be given orally and sometimes it must be given through IV infusion.  This can require hospital admission.  If diverticulitis is serious enough to merit hospital admission, a patient may develop recurrent or complicated diverticulitis.

 

Recurrent or complicated diverticulitis requires surgery to remove the diseased portion of the colon.  Sometimes the colon ruptures and requires emergency surgery.  Diverticulitis is a serious medical condition and can be life-threatening.  Prompt attention and treatment can help avoid serious complication.

 

This blog should not be taken as medical advice.  Only after establishing a provider-patient relationship and undergoing a complete examination can medical advice be given.  Please contact your primary care provider if you have questions about your medical condition.

 

Scott R. McDearmont, M.D., F.A.C.S., is a board certified general surgeon practicing in Southern Denton County, Texas  www.scottmcdearmont.com

Gallbladder Surgery, Other Options?

I am frequently asked about alternative treatments for gallbladder disease.  There are several possibilities to treat gallbladder disease without surgery. These treatments can be symptomatic or curative.  All non-surgical options have the theoretical advantage of avoiding surgery.  There are also disadvantages of non-surgical options.

Symptomatic treatment of gallstones with antispasmotic medication will sometimes control the pain caused by gallstones.  Pain from gallstones is only one reason to have surgery to remove the gallbladder.  The more important reason to have the gallbladder removed is to avoid the complications of gallstones which include cholecystitis, pancreatitis, and cholagitis.  These can all be life threatening complications.

Herbal treatment or commonly referred to “gallbladder cleansing” is another option I am asked about frequently.  This involves taking usually some combination of oils and/or herbal ingredients to flush gallstones out of the gallbladder.  This can be successful, but each time a stone or stone fragment passes out of the gallbladder the patient is at risk of developing bile duct blockage which can result in infection in the entire biliary system. This can be a life threatening infection.

Similar to the flush there has been past enthusiasm to use ultrasound to break up gallstones.  Any passing stone or stone fragment has the same possibilities of causing complications of pancreatitis and cholangitis.  It is a risky proposition to try and flush or break up gallstones.  I encourage my patients to ask a lot of questions and make sure they understand all surgical and non-surgical options before proceeding with gallbladder removal.

This blog should not be taken as medical advice.  Only after establishing a provider-patient relationship and undergoing a complete examination can medical advice be given.  Please contact your primary care provider if you have questions about your medical condition.

Gallbladder Disease and Diet

Gallbladder disease is a very common cause of abdominal pain. This pain is usually worse after eating high fat or spicy foods.  When you eat certain types of foods, your body releases a hormone called CCK.  This hormone causes contraction of the gallbladder.  This contraction can be painful if the gallbladder is distended, inflamed or full of stones. 

 

Does a certain type of diet make it more likely for you to have gallbladder disease?  This is a geat question and no one can find a definitive answer.  Some gallstones are made of cholesterol, but high cholesterol is not necessarily a risk factor to form gallstones.  High fat foods can certainly create worse symptoms once gallstones are present.

 

Can changing my diet cure my gallbladder problems?  Some patients can control the symptoms of gallbladder disease by modifying their diet.  This is symptomatic treatment and does not eliminate the risks of complications associated with gallstones which include cholecystitis, and pancreatitis.

 

The treatment of choice for gallstones is surgery to remove the gallbladder, laparoscopic cholecystectomy.  After removal of the gallbladder, a low fat diet is recommended for several weeks to allow the body to adjust to the absence of the gallbladder.  Once this adjustment is made there are usually no dietary restrictions long term.

 

This blog should not be taken as medical advice.  Only after establishing a provider-patient relationship and undergoing a complete examination can medical advice be given.  Please contact your primary care provider if you have questions about your medical condition.

 

Scott R. McDearmont, M.D., F.A.C.S., is a board certified general surgeon practicing in Southern Denton County Texas, www.scottmcdearmont.com

 

Intestinal Obstruction

 

One of the most common causes of recurrent abdominal pain requiring hospital admission is intestinal obstruction.  Obstruction can occur in the small or large intestine.  The causes of obstruction can vary from a tumor to scar tissue from previous surgery.  The treatment plan depends on the cause of the obstruction.

 

Symptoms from intestinal obstruction are usually abdominal pain with nausea and vomiting.  The pain is usually cramping in nature.  The vomiting will usually not improve until treatment is initiated.  Fever is rare and when present is usually a late sign.  Bowel function will slow down or stop completely.  The abdomen usually becomes distended or swollen in cases of obstruction. X-rays  of  the abdomen will show distended intestine as well.

 

Once the diagnosis of obstruction is made the patient is admitted to the hospital, hydrated and placed on bowel rest.  Sometimes a tube is placed through the nose into the stomach for decompression.  The most common cause of intestinal obstruction is scar tissue from previous abdominal surgery.

 

This type of obstruction will usually improve without surgery.  Sometimes for complete obstruction an operative intervention is necessary to relieve the obstruction.  As with any type of abdominal pain, evaluation by a surgeon is always necessary to rule out the need for surgical exploration.

 This blog should not be taken as medical advice. Establishing a provider-patient relationship and a complete examination are necessary for providing medical advice.  If you have questions about your medical condition please contact your primary healthcare provider.

Sports Hernia

Sports injuries are common with as much youth sports activity as we have in our community.  The injuries range from muscle strains to more serious fractures or intraabdominal injuries.  Orthopedic surgeons have always been the mainstay of team physicians and most injuries continue to be under their care.  In the recent medical literature, an injury known as a sports hernia has been described in more detail. Surgical treatment of hernia goes back a long time.  Every guy who ever played sports knows about the turn and cough drill.  This embarrassing exam has always looked for inguinal or groin hernias.  These hernias are defects in the abdominal wall often present since birth.  The defects allow intrabdominal contents to press outside the abdomen or herniate.  The symptoms of this are groin pain and swelling.  These hernias should be repaired to prevent trapping or incarceration of intestine. Young athletes with a hernia should always fail a sports physical because of the risks of incarcerated intestine.

 

Now a sports hernia is a bit of a different story.  There is usually no major abnormality on physical exam, and these can be easily missed on a regular hernia exam.  The most common causes are overuse or trauma in sports like soccer, hockey, track, and football.  The overuse will cause a weakness in the insertion of the rectus muscle onto the pubis bone in the lower abdomen.  The injury manifests itself as pain which limits the athlete’s maximum exertion or performance.  Because the physical exam is normal, these injuries are often treated for weeks as groin pulls or strains.  A high index of suspicion is the key to recognizing and treating a sports hernia.  Different physicians and surgeons will have different philosophies about treatment of sports hernia.  If a player has groin pain and no defect can be felt in the abdominal wall, conservative treatment should come first.  If seven to ten days of rest and antiinflammatory measures resolves the symptoms, a sports hernia is less likely.  If the player still has significant pain after this period of rest, then sports hernia must be ruled out.

 

Laparoscopic or open exploration are both options for sports hernia diagnosis and repair.  The open approach is to expose the inguinal canal from a groin incision.  From this perspective, the weakness will be found at the insertion of the rectus muscle onto the pubic bone. The laparoscopic approach will see the defect from inside the abdomen. Repair of this weakness requires placement of a mesh prosthesis to strengthen the abdominal wall.  This area of weakness is usually near the midline above the pubic bone in  an area which can  not be felt on physical exam.  The mesh will prevent trapping of the intestine outside the abdominal cavity.

 I encourage parents to utilize the team of physicians who volunteer at the various schools around the area. These physicians volunteer their services because of their interest in sports and the well being of the youth of our community.  Sports hernia is only one of many injuries which our kids can need medical attention for. Always ask plenty of questions and be a partner in the health care of your young athlete.  The athletic training staffs in our area do a excellent job caring for their athletes.  In some cases though, a tear of the what? from the where? can hide from even the most experienced eyes.

 

 This blog should not be taken as medical advice.  Only after establishing a provider-patient relationship and undergoing a complete examination can medical advice be given.  Please contact your primary care provider if you have questions about your medical condition.

The Silent Killer

The phone rings. It’s four o’clock in the morning and I am not on call.  This can not be good.  I get the news that my Dad is loading on an ambulance with symptoms of a stroke.  As a physician, there are  times when you know too much.  Knowing all the possibilities and complications of a disease is very difficult. As I drive to the hospital, the car seems to be in slow motion. But how could he have a stroke, he’s too young for that.  The silent killer, that’s how.

 

High blood pressure or hypertension is very common and most cases have no readily identifiable cause.  My Dad has had high blood pressure since age twenty-three.  Long term increases in blood pressure cause heart disease, stroke, blindness, and kidney failure. In his case a small blood vessel in the base of his brain was weakened by years of increased pressure.  This blood vessel ruptured causing what is known as a hemorrhagic stroke. Stroke can also be caused by a blocked artery in the brain.  This is similar to how a heart attack occurs.  Family history can also be a factor as his grandmother and mother had both had strokes.  But the silent killer often strikes people who have no idea they are at risk.

 

Headaches, blurred vision, heart palpitations, or just feeling lightheaded can all be symptoms of high blood pressure.  So many folks walk around with these symptoms and write them off to other conditions.  High blood pressure is defined as blood pressure greater than 140/90.  The top number is called systolic blood pressure and is the maximum pressure generated when the heart contracts.  The bottom number is diastolic blood pressure and corresponds to the pressure during relaxation of the heart.  Borderline numbers are 130/80.   Stroke can occur anytime the systolic pressure is above 170.  It is important to get regular blood pressure checks with your primary care provider. This is sometimes the only time people will know the have high blood pressure.  Most cases of high blood pressure are easily controlled with daily medication.

 

Other things that may aggravate high blood pressure or make it difficult to control include high salt diet and heavy caffeine intake.  Smoking will also cause increase in blood pressure from the effects of nicotine.  A healthy lifestyle with a balanced diet, limited caffeine, and no tobacco use is the best way to control your risks for high blood pressure.  Weight loss can also help control high blood pressure.  External stressors will tend to cause a stress related spike in blood pressure.

 

My Dad is now home from inpatient rehabilitation and improving day to day.  He has survived this attempt by the silent killer.  We must all be vigilant and know the warning signs.  High blood pressure can strike quickly and leave otherwise healthy individuals disabled or worse.

 This blog should not be taken as medical advice.  Only after establishing a provider-patient relationship and undergoing a complete examination can medical advice be given.  Please contact your primary care provider if you have questions about your medical condition.

Appendicitis, know the signs

The appendix is a vestigial organ in humans. This means basically that it serves no purpose or function. This small hollow organ sits in the right lower abdomen and can certainly cause serious problems for patients of all ages. So what is appendicitis and how can you tell if you have it? The first thing I tell anyone when they ask me about abdominal pain is if it does not go away within twelve hours you should seek medical attention. Acute abdominal pain is very common and most cases are due to self limiting conditions that do not require surgery. The following description can help determine if abdominal pain is serious or could be from appendicitis. Most cases of appendicitis start with a generalized abdominal cramping. This pain occurs with blockage of the inside of the appendix. Over a period of hours, the pain will move to the right lower abdomen. The character of the pain will go from an ache to a sharp pain. In appendicitis, pain almost always comes before nausea or vomiting. Whereas in a viral illness, the nausea and vomiting often come before the abdominal pain.
There are many symptoms other than pain seen in acute appendicitis. The most common are nausea with or without vomiting, fever and/or chills, and loss of appetite. Again nausea and vomiting from appendicitis runs in waves and is different from the unrelenting nausea from a viral syndrome. Fever is less common, but when present is usually low grade. Fever>102 F is less likely related to appendicitis. Loss of appetite is one of the best indicators in children with abdominal pain. It is extremely rare for a child to refuse their favorite food. I always ask children about this and it is a fairly good indicator in kids who have other symptoms of appendicitis.
Other ways to determine if abdominal pain is related to appendicitis are physical findings. The pain in the abdomen with appendicitis is worse with movement. A common question to help with this has to do with the effect riding in a car has on the pain. Starting and stopping will make pain from appendicitis worse. Having a child jump up and down will be very painful if they have appendicitis. Walking into an exam room where the patient holds their right side and tries not to move makes the surgeon highly suspicious for appendicitis.
Why is this information important? Because appendicitis, if not treated, is one of the acute inflammatory conditions of the abdomen which needs prompt diagnosis and surgical treatment. If the appendix becomes inflamed this can progress rapidly, within twelve to eighteen hours to gangrene and perforation. Perforated appendicitis is very serious and can be fatal. Prompt medical attention by a trained health care provider and rapid surgical intervention are the keys to preventing complications from appendicitis and other causes of acute abdominal pain.

Highland Village Surgeon–new blog

Dr. Scott McDearmont welcomes you to this blog.  I have been serving Southern Denton County since 2001.  I am a board certified general surgeon and a Fellow of the American College of Surgeons. Scott McDearmont MD, PA is my general surgery practice with specialization in laparoscopic surgery and minimally invasive surgery. I trained at UT Southwestern Center for minimally invasive surgery.  My clinical interests also include colon and rectal surgery and breast cancer surgery. I have privleges at Baylor Surgicare in Lewisville and Medical Center of Lewisville.  Please call for an appointment today for your general surgery needs at 972-219-6800. Visit my website at www.scottmcdearmont.com.