Gastro Oesophageal Reflux Disease (GORD)

The oesophagus carries food from the mouth to the stomach. The lower oesophageal sphincter is a ring of muscle at the bottom of the oesophagus that acts like a valve between the oesophagus and stomach. Gastro Oesophageal reflux disease, or GORD, is a chronic disease that occurs when the lower oesophageal sphincter does not close properly and stomach contents leak back, or reflux, into the oesophagus.

When refluxed stomach acid touches the lining of the oesophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GORD. Heartburn that occurs more than twice a week may be considered GORD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GORD.

The main symptoms are persistent heartburn and acid regurgitation. Some people have GORD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GORD can also cause a dry cough and bad breath.

The most frequent symptoms of GORD are so common that they may not be associated with a disease. Self-diagnosis can lead to mistreatment. Consultation with a physician is essential to proper diagnosis and treatment of GORD.


  • Hiatal hernia- hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest.
  • Alcohol use
  • Overweight
  • Pregnancy
  • Smoking

Also, certain food and drinks are associated with reflux



  • Medical history
  • Response to Omeprazole – A recent study 12 demonstrated a potential role for a proton pump inhibitor, omeprazole, in the diagnosis of GORD
  • Barium swallow radiograph – Uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus
  • Endoscopy


Conservative treatment

  • Lifestyle modification
  • Medications including antacids, Foaming agents, H2 receptor blockers, Proton Pump inhibitors

Surgical treatment

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Laparoscopic Nissen Fundoplication

This surgery is performed under general anaesthesia.

If a combination of lifestyle changes and drug therapy does not remedy reflux symptoms, a Nissen Fundoplication can be a very effective surgical procedure to correct reflux. This procedure involves wrapping the upper portion of the stomach around the base of the oesophagus to reinforce the strength of the lower oesophageal sphincter. Until recently, the procedure required a large abdominal incision. A hospital stay of 3-5 days was usually required, and the time to full recovery and return to work was measured in weeks.

A laparoscopic Nissen Fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the procedure through four tiny incisions, most of which are less than a half-centimetre in size. One advantage of this method is a brief hospitalization. Most of the time it will require an overnight stay. Other advantages include less pain (less of a need for pain medication), fewer and smaller scars, and a shorter recovery time.

Laparoscopic Nissen Fundoplication is a safe and effective treatment of GORD. However, in rare cases the laparoscopic approach is not possible because it becomes difficult to visualize or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation.


A gall stone, is a lump of hard material usually range in size from a grain of sand to 3-4cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.

Types of gallstones and causes

  • Cholesterol stones
  • Pigment stones
  • Mixed stones – the most common type. They are comprised of cholesterol and salts

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe
cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed. Other causes are related to excess excretion of cholesterol by liver through bile.

They include the following:

  • Gender – Women between 20 and 60 years of age are twice as likely to develop gallstones as men
  • Obesity – Obesity is a major risk factor for gallstones, especially in women
  • Oestrogen – Excess oestrogen from pregnancy, hormone replacement therapy,or birth control pills
  • Cholesterol-lowering drugs
  • Diabetes – People with diabetes generally have high levels of fatty acids called triglycerides
  • Rapid weight loss – As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones


Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called “silent stones.” Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.

Symptoms may vary and often follow fatty meals, and they may occur during the night.

  • Abdominal bloating
  • Recurring intolerance of fatty foods
  • Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
  • Pain in the back between the shoulder blades
  • Pain under the right shoulder
  • Nausea or vomiting
  • Indigestion & belching


Ultrasound is the most sensitive and specific test for gallstones. Other diagnostic tests may include:


  • Computed tomography (CT) scan may show the gallstones or complications
  • Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope–a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts
  • Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice

Cause of illness
Bile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.


The obstruction caused by gall stone may lead to Biliary colic, Inflammation of gall bladder (Cholecystitis) . Other complications may include:

  • Cirrhosis- Cirrhosis is the result of chronic liver disease that causes scarring of the liver (fibrosis – nodular regeneration) and liver dysfunction
  • Cholangitis- Cholangitis is an infection of the common bile duct, which carries bile (which helps in digestion) from the liver to the gallbladder and then to the intestines



Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.
If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.


A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient.

Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions.

Signs and Symptoms


  • Lump in groin area when standing/straining & disappears when reclining
  • Pain at the site of the lump, especially when lifting a heavy object
  • Swelling of the scrotum
  • Excruciating abdominal pain (if you have strangulation)
  • Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs)

Cause of hernia

Once a hernia has developed, it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk, most surgeons therefore recommend that hernias be repaired when diagnosed, unless there is serious medical problem which makes it too risky.


Hernia repair (Surgery)

The standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures. Often a prosthetic material, or another plastic material, is sutured in place to strengthen the area of weakness. Finally, the skin and other healthy tissues that were cut at the beginning are sutured back together to complete the repair.

Newer hernia repair involves minimally invasive laparoscopic techniques. However, hernia operation with open techniques is still a valid option reaching the highest standards of care. Laparoscopic techniques of hernia repair are especially attractive when patients are dealing with recurrent hernias or bilateral inguinal hernias.


Cancer is a disease that results from abnormal growth and division of cells that make up the body’s tissues and organs. Under normal circumstances, cells reproduce in an orderly fashion to replace old cells, maintain tissue health and repair injuries. However, when growth control is lost and cells divide too much and too fast, a cellular mass -or “tumour” -is formed.

If the tumour is confined to a few cell layers and it does not invade surrounding tissues or organs, it is considered benign. By contrast, if the tumour spreads to surrounding tissues or organs, it is considered malignant, or cancerous. In order to grow further, a cancer develops its own blood vessels and this process is called angiogenesis. When it first develops, a malignant tumour may be confined to its original site.

If cancerous cells are not treated they may break away from the original tumour, travel, and grow within other body parts, the process is known as metastasis. Cancer Screening is the performance of tests on apparently well people in order to detect a medical condition at an earlier stage.

Oesophageal Cancer

Oesophageal cancer (also called cancer of the oesophagus) is a malignant tumour that grows in the lining of the oesophagus. The oesophagus (the gullet) is the tube that carries food from the mouth down into the stomach using a series of muscular movements.

Types of oesophageal cancer

Two types of cancer, squamous cell carcinoma and adenocarcinoma, make up 90 per cent of all oesophageal cancers. Oesophageal cancer can occur in any section of the oesophagus. Most cancers in the top part of the oesophagus are squamous cell cancers. They are called this because the cells lining the top part of the oesophagus are squamous cells. Squamous means scaly.
Most cancers at the end of the oesophagus that joins the stomach are adenocarcinomas. Adenocarcinomas are often found in people who have a condition called Barrett’s.


Infections and Inflammations

An infection is the condition of multiplication of parasitic organisms or microorganisms within the body. An inflammation is the reactions that occur in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent. Many people use the terms interchangeably since they have several symptoms in common and usually are treated similarly.


Appendicitis is an inflammation of the appendix, a small worm-like pouch attached to the large bowel. It can happen at any age but most cases are between 8 and 25 years of age. For young people, appendicitis is probably the most common cause of stomach pain requiring emergency surgery.


In most cases, the specific reason for the inflammation is not known but it is due to blocking of the opening connecting the large intestine and appendix. In many cases it is caused by small pieces of hardened stool (faecaliths) that get stuck in the appendix.


The first sign is usually a pain or discomfort in the centre of the abdomen. The pain usually begins near the umbilicus and moves down and to the right. This pain comes and goes in waves and increases on movement. Pain is often thought at first to be a simple stomach upset.

  • Nausea
  • Vomiting
  • Constipation
  • Diarrhoea
  • Inability to pass gas
  • Low fever that begins after other symptoms
  • Abdominal swelling
  • Anorexia


  • The doctor takes a medical history from the patient and checks their temperature
  • Blood and urine tests are performed to look for infection
  • The doctor examines the patient by pressing on the lower right part of the abdomen and sometimes by inserting a finger in the anus (back passage) in order to exclude other causes of pain
  • Women are often given a vaginal examination

There is no one test that will diagnose appendicitis with certainty, usually doctors use CT scan or ultrasound to see whether the appendix looks inflamed. Surgery is performed on the basis of the doctor’s examination and results of the tests. Many diseases can cause the same symptoms as appendicitis.

Cause of illness

The inflammation can cause infection, a blood clot, or rupture of the appendix. Because of the risk of rupture, appendicitis is considered an emergency. Anyone with symptoms needs to see a doctor immediately.


  • Surgical removal of the appendix (appendicectomy) is the most common procedure. A 3-6cm horizontal incision is made in the lower part of the abdomen on the right side, through which the appendix is removed
  • In some hospitals, the appendix is routinely removed by a keyhole operation or the insertion of a three-fibre optic camera through the stomach (laparoscopy)

In uncomplicated cases, a two to three day hospital stay is typical. The person can go home when their temperature is normal and their bowel starts to function again. The stitches are removed 10 days after the operation. A return to ordinary daily life within four to six weeks is usual.


Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start digesting” the pancreas itself. This process is called autodigestion and causes swelling, haemorrhage, and damage to the blood vessels. An attack may last for 2 days

    • Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Acute pancreatitis is usually caused by drinking too much alcohol or by gallstones. A gallstone can block the pancreatic duct, trapping digestive enzymes in the pancreas and causing pancreatitis.
    • Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas and nearby tissues. Chronic pancreatitis is usually caused by many years of alcohol abuse, excess iron in the blood, and other unknown factors. However, it may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged.

Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Pseudocysts, accumulations of fluid and tissue debris, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Acute pancreatitis generally causes severe pain and the sufferer will need emergency treatment in a hospital. Pancreatitis is generally diagnosed quickly, by examination of the abdomen, and confirmed using a series of medical tests, including:

  • General tests – such as blood tests, physical examination and x-rays
  • Ultrasound – sound waves form a picture that detects the presence of gallstones
  • CT scan – a specialised x-ray takes three-dimensional pictures of the pancreas


Some of the complications from pancreatitis are: low blood pressure, heart failure, kidney failure, ARDS (adult respiratory distress syndrome), diabetes, ascites (accumulation of fluid in the abdomen) and cysts or abscesses in the pancreas.

Treatment options

Treatment depends on the causes and severity of the condition, but may include:

Acute pancreatitis

  • Hospital care – in all cases of acute pancreatitis
  • Intensive care in hospital – in cases of severe acute pancreatitis
  • Fasting and intravenous fluids – until the inflammation settles down
  • Endoscopy – a thin tube is inserted through your oesophagus to allow the doctor to see your pancreas
  • Surgery – if gallstones are present, removing the gallbladder will help prevent further attacks. In rare cases, surgery is needed to remove damaged or dead areas of the pancreas
  • Lifestyle change – eliminating alcohol

Chronic pancreatitis

  • Lowering fat intake
  • Supplementing digestion by taking pancreatic enzyme tablets with food
  • Eliminating alcohol
  • Insulin injections, if the endocrine function of the pancreas is compromised
  • Analgesics for pain


The word “hepatitis” means inflammation of the liver. This can be caused by a number of things, such as chemicals, alcohol, drugs and infection by viruses.
The symptoms of acute viral hepatitis include fever, headache, lethargy, nausea, dark urine, pale stools and jaundice. The most commonly encountered viral hepatitis are type A, type B and type C.

Hepatitis A

Hepatitis A is a viral disease that affects the liver. It is spread by direct contact or by touching items that have been handled by, and contaminated with faeces from, an infected person. These can include food, drinks and other objects.

Hepatitis B

Hepatitis B is a viral infection that causes liver inflammation and can lead to serious illness or death. It is transmitted in several ways, including through unsafe sex and using other people’s needles. It can be passed from an infected mother to her baby. You can be immunised against hepatitis B.

Most people recover completely, but it can lead to cirrhosis (scarring) of the liver, increased risk of liver cancer and, in extreme cases, death. It is passed on by carriers who may not even know they have the virus.

Hepatitis C

Hepatitis C is a blood-borne virus which causes inflammation of the liver. It is most often transmitted through sharing needles, syringes and other equipment during drug use. There is currently no cure for hepatitis C and no vaccine to prevent it.


An acute condition in which the gall bladder becomes inflamed and swollen because flow of bile into duodenum is blocked by Gallstones; result is biliary colic – intense pain in upper right abdomen or between shoulders, Indigestion, especially after fatty food, and Nausea with or without vomiting; untreated, condition can lead to Jaundice and occasionally, if gall bladder bursts, to Peritonitis. If site of pain is as described above, and pain persists for more than 3 hours, consult your doctor if there is no improvement in 2 hours.


    • Gallstones
    • Ischemia (decrease blood supply to gallbladder)
    • Secondary Infections


    • Often starts after a large fatty meal
    • Sudden, steady pain in the middle or right upper abdomen
    • Vomiting
    • Fever


    • Medical History
    • Clinical examination
    • Abdominal X-ray
    • Ultrasound

Cause of illness

If untreated cholecystitis may lead to

    • Gangrene in the gallbladder may occur. This is a severe infection with destruction of tissue. Diabetics and the elderly are at highest risk.
    • Cholangitis – infection that occurs in common bile duct outside the gallbladder


    • Bowel rest (no food or drink)
    • Intravenous fluid/feeding
    • Antibiotics to combat Infections. I.V. antibiotics may be used
    • Pain medications
    • Laparoscopic Cholecystectomy, Surgical removal of the gallbladder 2-3 days after cholecystitis for most patients

What you should do?

Go to the Hospital emergency or call the local emergency number if you have symptoms that may indicate peritonitis, as it is a medical emergency.


Alternative names: Indigestion and Heartburn

The term ‘indigestion’ is a layman’s term and is used to cover the symptoms of a few different medical conditions.Medical conditions that are often described as ‘indigestion’ and which have ‘indigestion’ as a symptom are:

  • Heartburn (gastro-oesophageal reflux)
  • Ulcers
  • Non-ulcer dyspepsia (when you have symptoms of an ulcer but no sign of ulcer on investigation)
  • Food intolerance, e.g. lactose intolerance
  • Bloating and flatulence
  • Aerophagia (swallowing excessive amounts of air)

Many people with indigestion suffer in silence, sometimes for years, receiving little or no medical treatment apart from over-the-counter antacids. While these are very effective in medicating heartburn, there are now many more medications available, which can provide perfect symptomatic relief.

There is also a greater awareness that acid reflux which causes the heartburn may damage the lining of the oesophagus and increase the potential for serious health problems due to the process of chronic inflammation. It is becoming increasingly important to treat your symptom of heartburn less casually and discuss the prospects for treatment with your doctor.


Peritonitis is an inflammation of the peritoneum, which is the membrane that lines the wall of the abdomen and covers the abdominal organs.

Causes, incidence, and risk factors

Types of peritonitis include:

  • Spontaneous Peritonitis – an infection that occurs as a complication of ascites (a collection of fluid in the peritoneal cavity), which is usually related to liver or kidney failure
  • Secondary Peritonitis – caused by another condition, most commonly the spread of an infection from the digestive organs or bowels
  • Dialysis associated Peritonitis – this is an acute or chronic inflammation (irritation and swelling) of the peritoneum (lining of the abdominal cavity) that occurs in people receiving peritoneal dialysis

Intra-abdominal abscess (abdominal abscess). This condition involves a collection of pus in the abdomen and may cause peritonitis. Before peritonitis develops, it can still cause symptoms that are similar or identical to peritonitis.

An intra-abdominal abscess may arise following:

  • Localisation of peritonitis
  • Gastrointestinal perforation
  • Anastomotic leak
  • Haematogenous (bloodstream) spread
  • They develop in sites of gravitational drainage
  • Pelvis
  • Subhepatic spaces
  • Subphrenic spaces
  • Paracolic gutters


  • Nausea
  • Vomiting
  • Abdominal pain, which increases on movement
  • Abdominal tenderness
  • Abdominal distension
  • Fever
  • Low urine output
  • Point tenderness
  • Thirst
  • Fluid in the abdomen
  • Constipation
  • Inability to pass faeces gas
  • Signs of shock in extreme cases


  • Physical examination and medical history
  • Blood tests including blood culture and X-rays or CT scans may be ordered
  • Peritoneal fluid analysis( paracentesis) & culture


The cause must be identified and treated promptly.

Treatment typically involves fluid infusion to control shock, surgery to drain the peritoneal cavity and repair the cause, and antibiotics to deal with the infection. In cases associated with peritoneal dialysis, antibiotics may be infused through the dialysis catheter, but if the infection is severe, the catheter itself must often be removed.

Treatment typically involves surgery and antibiotics. In cases associated with peritoneal dialysis, antibiotics may be infused through the dialysis catheter, but if the infection is severe, the catheter itself must often be removed.

Course of illness

The outcome is often good with treatment, but can be poor without treatment. Sometimes the outcome is poor even with prompt and adequate treatment.


Peritonitis can be life-threatening and cause a number of different complications, depending on the type.
Complications may include:

  • Peritonitis stops the movement of bowel contents (peristalsis), which can block the bowel (paralytic ileus).
  • Septic shock – Fluid from the blood accumulates in the abdominal cavity and the loss of fluid from the circulation may also cause shock.
  • Abscess
  • Intraperitoneal adhesions

What you should do?

Go to the Hospital emergency or call the local emergency number (such as 000, for Australia) if you have symptoms that may indicate peritonitis, as it is a medical emergency.