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Conditions And Treatments

Coronary Heart Disease

What is Coronary Heart Disease?

Coronary heart disease is a condition that occurs when the heart’s arteries cannot deliver enough oxygen-rich blood to the heart muscle due to narrowing caused by fat deposits (plaque). This condition is also known as coronary artery disease or ischemic heart disease.

The coronary arteries are responsible for delivering blood to the heart muscle. If these arteries are damaged or diseased and unable to deliver oxygen and nutrients to the heart, it can lead to heart attacks and even death.

Symptoms of Coronary Heart Disease

The main symptoms of coronary heart disease include:

  • Chest pain (angina)
  • Shortness of breath
  • Pain in the neck, shoulders, jaw, or arms
  • Feeling faint
  • Nausea

Not everyone with coronary heart disease experiences the same symptoms. In fact, some people may not experience any symptoms at all before being diagnosed by a doctor.

Causes of Coronary Heart Disease

Coronary heart disease is caused by the buildup of fat, cholesterol, and other substances in and on the walls of the heart’s arteries. This condition is called atherosclerosis, and the deposits are known as plaque.

Plaque can cause arteries to narrow, blocking blood flow. Plaque can also rupture, leading to blood clots.

Some common causes of atherosclerosis and coronary heart disease include:

  • Diabetes or insulin resistance
  • High blood pressure (hypertension)
  • Lack of physical activity
  • Smoking or tobacco use

Diagnosis of Coronary Heart Disease

If a doctor suspects you are at risk for coronary heart disease, they may perform a risk assessment. The doctor will also ask about your personal and family medical history and lifestyle, and may order blood tests.

Further tests may be required to confirm a diagnosis of coronary heart disease, such as:

  • Electrocardiogram (ECG)
  • Echocardiogram
  • Chest X-ray
  • Coronary angiogram

Treatment for Coronary Heart Disease

1. Managing Risk Factors

There are several risk factors for coronary heart disease that you can control to prevent its onset, such as quitting smoking, managing cholesterol and blood sugar levels, improving your diet, maintaining an ideal weight, and managing blood pressure.

2. Medications

Doctors may prescribe medications for coronary heart disease, including:

  • Antiplatelets: Medications that reduce blood clotting, such as aspirin, clopidogrel, ticlopidine, and prasugrel.
  • Antihyperlipidemics: Medications to reduce blood lipids (fats), especially low-density lipoprotein (LDL) cholesterol.
  • Antihypertensives: Medications to lower blood pressure.

3. Coronary Angioplasty

Coronary angioplasty uses a balloon to widen the blood vessels, improving blood flow. Though angioplasty may be done on blood vessels in other parts of the body, it can help increase blood flow to the heart.

4. Heart Bypass Surgery

Heart bypass surgery is often performed on people who experience chest pain and have coronary heart disease. During the surgery, a bypass is created by grafting a vein above and below the blocked coronary artery area, allowing blood to flow around the blockage.

The vein is usually taken from the leg, but arteries from the chest and arms can also be used for the bypass graft. Sometimes, multiple bypasses are needed to restore full blood flow to all parts of the heart.

5. Rotablator

A rotablator is a device used to shave off hardened plaque in the coronary blood vessels, especially in cases where plaque is difficult to treat with balloons or stents.

Using a rotablator, doctors can remove blockages and improve or restore blood flow to the heart.

Want to consult further about coronary heart disease or overall heart health? Visit Mandaya Royal Hospital Puri. Our hospital is equipped with modern medical technology to handle various heart conditions. You can also consult with experienced heart specialists.

Schedule your appointment through our WhatsApp Chat feature, Book Appointment, or the Care Dokter app—available on Google Play and the App Store—to ease your visit, check your queue number, and access complete information.

Vertigo

What is vertigo?

Vertigo is a type of dizziness that creates a false sensation that you or your surroundings are spinning or moving. This condition may feel similar to motion sickness but is different from regular dizziness.
Vertigo is not a disease, but rather a symptom of an underlying condition. There are many medical issues that can trigger it.

Vertigo is classified into several types:

  • Peripheral Vertigo

Peripheral vertigo is the most common type. It occurs due to problems in the inner ear or the vestibular nerve, which controls balance.

  • Central Vertigo

Central vertigo results from problems in the brain. This condition may be caused by a variety of medical issues, such as stroke, brain tumors, migraines, traumatic brain injuries, infections, or multiple sclerosis.

Symptoms of Vertigo

The main symptom of vertigo is the feeling that your head or surroundings are moving or spinning.
While vertigo itself is a symptom, it can cause or occur alongside other symptoms such as:

  • Balance issues
  • Dizziness
  • Motion sickness
  • Nausea and vomiting
  • Ringing in the ears (tinnitus)
  • A feeling of fullness in the ears
  • Headache
  • Nystagmus (involuntary eye movements, usually from side to side)

Causes of Vertigo

Common causes of vertigo include:

  • Benign Paroxysmal Positional Vertigo (BPPV)

This is the most common cause of vertigo, producing a strong and brief spinning sensation. It’s triggered by rapid head movements, such as being hit.

  • Infections

Viral infections affecting the vestibular nerve, known as vestibular neuritis or labyrinthitis, can cause intense and persistent vertigo.

  • Meniere’s Disease

When excess fluid builds up in the inner ear, it can result in sudden vertigo episodes that last for several hours.

  • Migraines

Migraine-induced vertigo can last from a few minutes to several hours.

  • Head or Neck Injury

Vertigo is a common symptom that can follow traumatic injury to the head or neck, particularly if the vestibular system is affected.

  • Medications

Certain medications can cause vertigo, along with other symptoms like dizziness, hearing loss, and tinnitus.

Diagnosing Vertigo

To determine the cause of vertigo, a doctor will need to conduct a physical examination, ask about potential triggers, and review the patient’s medical history.
Here are some tests that may be used to diagnose vertigo:

  • Romberg Test: The doctor asks the patient to stand with arms at the sides and feet together, then close their eyes. If the patient becomes unstable, it may indicate a problem in the central nervous system.
  • Fukuda-Unterberger Test: The patient is asked to march in place for 30 seconds with their eyes closed. If they rotate to one side, it may indicate a lesion in the inner ear labyrinth, which can cause peripheral vertigo.

Depending on the results of these and other tests, the doctor may recommend a CT scan or MRI of the head for more detailed information.

Treatment for Vertigo

Here are some treatments for vertigo that a doctor may recommend:

  • Vestibular Rehabilitation Therapy

Vestibular rehab typically includes a series of exercises to alleviate common vertigo symptoms like dizziness, unstable vision, and balance issues. The treatment is tailored to the patient’s needs.

  • Medications

Vertigo medications may help in some acute cases (sudden and short episodes). Doctors usually recommend motion sickness drugs (such as meclizine or dimenhydrinate) or antihistamines (like cyclizine) to relieve vertigo symptoms.

  • Surgery

If vertigo is caused by a brain tumor or neck injury, surgery may be necessary. However, surgery is generally only considered if other treatments have failed.

Visit Mandaya Royal Hospital Puri. Our Ear, Nose, and Throat (ENT) Clinic has a team of specialists ready to help you manage your vertigo.

Use the Chat via WhatsApp, Book Appointment, or the Care Dokter app (available on Google Play and the App Store) to make your visit easier, check your queue number, and get complete information.

Brain Abscess

What is a brain abscess?

A brain abscess is a swelling filled with pus inside the brain. This condition typically happens when bacteria or fungi enter the brain tissue after an infection or severe head injury.

When an infection reaches part of the brain, inflammation occurs as the body tries to fight it. Waste from the immune system fighting the infection (including dead cells, bacteria, or fungi) accumulates in an area of the brain. As a result, tissue can form around this collection of waste (pus) and create an abscess.
The abscess can swell and put pressure on the brain. This is a medical emergency and can be life-threatening if not treated.

Symptoms of a brain abscess

Symptoms of a brain abscess may include:

  • Headache
  • Cognitive changes (confusion, difficulty thinking, or processing information)
  • Numbness, weakness, or paralysis in parts of the body
  • Sensory changes
  • Difficulty speaking and using language
  • Vision changes
  • Fever
  • Seizures
  • Nausea and vomiting
  • Stiff neck

Symptoms may appear suddenly or develop over several days to weeks. If you experience any of the above symptoms, visit a hospital immediately.

Causes of a brain abscess

There are three main ways a brain abscess can develop:

  1. Infection in another part of the skull, such as an ear infection, sinusitis, or a dental abscess, which can spread directly to the brain.

  2. Infection in another part of the body, such as pneumonia, that spreads to the brain through the bloodstream.

  3. Trauma, such as a head injury that causes a skull fracture, allowing bacteria or fungi to enter the brain.

Additionally, the following are some risk factors for developing a brain abscess:

  • Having a condition that weakens the immune system
  • Having cancer
  • Having congenital heart disease
  • Taking immunosuppressant drugs (such as corticosteroids or chemotherapy)

Diagnosing a brain abscess

Doctors will diagnose a brain abscess after a physical and neurological examination. These exams may indicate increased pressure inside the skull, causing the brain to malfunction.

To confirm the diagnosis, doctors may conduct several tests, such as:

  • Blood tests
  • Imaging tests (MRI and/or CT scan)
  • Electroencephalogram (EEG)
  • Needle biopsy to identify the cause and type of infection to help guide treatment

Treatment for brain abscess

A brain abscess is a medical emergency that requires immediate attention. Treatment includes:

  • Medications

Doctors may prescribe antibiotics or antifungal medications to treat the abscess. Patients typically need to take antibiotics for at least 4–8 weeks. They may also need diuretics (water pills) to reduce fluid in the body, anti-seizure medications to manage seizures, or steroids to reduce swelling.

  • Surgery

Doctors may perform surgery to open the skull and remove the abscess. A sample of the abscess fluid is sent to the lab to identify the cause. After surgery, patients will need to take antibiotics or antifungals as the lab identifies the infection source.

Doctors may also perform awake brain surgery, especially if the abscess is located in areas that control speech, movement, or vision. Additionally, Endoscopic Endonasal Transsphenoidal Surgery (EETS) may be recommended, which treats the brain abscess through the nose, without opening the skull.

  • Needle aspiration

Imaging tests like MRI or CT scans help doctors locate the abscess. Using a needle, the doctor will drain the abscess and may inject medication directly to shrink it.

A brain abscess is not a condition to be taken lightly. If you experience any of the symptoms mentioned above, visit the hospital immediately for prompt treatment.

Have more questions about this condition or brain health in general? Feel free to visit Mandaya Royal Hospital Puri. Our hospital is equipped with modern medical technology and experienced specialist doctors.

Use our WhatsApp Chat, Book Appointment feature, or the Care Dokter app, available on Google Play and the App Store, to simplify your visit, check queue numbers, and get complete information.

Aneurysm

What is an aneurysm?

An aneurysm is a medical condition in which the wall of an artery weakens, leading to a bulge in the blood vessel. Most aneurysms are asymptomatic and not immediately dangerous. However, in more severe cases, the bulge can rupture, causing life-threatening internal bleeding.

Aneurysms are classified based on their location in the body. The brain and heart arteries are the two most common sites for serious aneurysms.

There are two main forms of aneurysmal bulges:

  • Fusiform aneurysms, which bulge on all sides of the artery, and
  • Saccular aneurysms, which bulge on only one side.

The risk of rupture depends on the size of the bulge.

Here are the types of aneurysms to watch out for:

1. Brain Aneurysm

An aneurysm in a brain blood vessel that ruptures can be fatal within 24 hours. About 40% of brain aneurysms are fatal, and around 66% of survivors often suffer from neurological impairment or disability.

A ruptured cerebral aneurysm is the most common cause of a type of stroke called subarachnoid hemorrhage.

2. Aortic Aneurysm

The aorta is a large artery that begins in the left ventricle of the heart and runs through the chest and abdomen. A normal aorta is 2–3 cm in diameter, but it can swell to over 5 cm due to an aneurysm.

The most common aortic aneurysm is the abdominal aortic aneurysm (AAA), occurring in the part of the aorta passing through the abdomen.

AAA can quickly become fatal. Patients who survive this type of aneurysm have a 50% chance of overall survival once hospitalized.

Another type is the thoracic aortic aneurysm (TAA), affecting the part of the aorta running through the chest.

3. Peripheral Aneurysm

Peripheral aneurysms occur in peripheral arteries. Types include:

  • Popliteal aneurysm – behind the knee; the most common peripheral aneurysm.
  • Splenic artery aneurysm – near the spleen.
  • Mesenteric artery aneurysm – affects arteries supplying the intestines.
  • Femoral artery aneurysm – near the groin.
  • Carotid artery aneurysm – in the neck.
  • Visceral artery aneurysm – affects arteries supplying blood to the intestines or kidneys.

Peripheral aneurysms are less likely to rupture compared to aortic aneurysms.

Aneurysm Symptoms

Aneurysms near the body’s surface may show signs of swelling and pain. A large mass may also appear. Symptoms vary based on the aneurysm’s location.

Brain Aneurysm Symptoms

Symptoms of a ruptured cerebral aneurysm include:

  • Sudden, severe headache
  • Vision problems (e.g., double vision)
  • Light sensitivity
  • Nausea and vomiting
  • Loss of consciousness

Aortic Aneurysm Symptoms

Symptoms depend on location.

Thoracic Aortic Aneurysm (TAA):

  • Sudden, severe chest pain
  • Sudden back pain
  • Significant drop in blood pressure
  • Limb numbness

Abdominal Aortic Aneurysm (AAA):

  • Sudden, severe abdominal or lower back pain
  • Rapid heartbeat
  • Dizziness or fainting
  • Shortness of breath
  • Cold sweats

Peripheral Aneurysm Symptoms

Symptoms vary by type. For example:

  • Mesenteric aneurysm: abdominal pain, fainting, early satiety after eating
  • Leg aneurysms: sudden leg pain, weakness or numbness in the leg, painful or discolored toes

Causes of Aneurysm

The exact cause of aneurysms is unknown. However, several factors contribute, such as:

1. Atherosclerosis

This condition can cause aortic aneurysms. Atherosclerosis involves plaque buildup in arteries. Plaque—made up of cholesterol, fat, and other substances—can damage arteries and hinder blood flow.

2. High Blood Pressure

Hypertension can trigger aneurysms. Increased blood pressure puts extra stress on artery walls, potentially weakening or enlarging them. Normal adult blood pressure ranges from 90/60 mmHg to 120/80 mmHg.

3. Other Risk Factors

Risk of aneurysm depends on specific factors.

  • Men are more likely to develop aneurysms than women.
  • People over 65 are at greater risk.

Other risk factors:

  • High-fat, high-cholesterol diet
  • Family history of heart conditions
  • Smoking
  • Obesity
  • Pregnancy (increased risk of splenic aneurysm)

Aneurysm Diagnosis

Diagnostic tools depend on the location of the problem.
Most cerebral aneurysms are diagnosed incidentally during brain imaging procedures. In such cases, the patient is referred to a specialist like a cardiothoracic or vascular surgeon.

Common diagnostic tests include CT scans and ultrasound. CT scans use X-rays to examine the body and identify blockages, bulges, or weak spots in blood vessels.

Aneurysm Treatment

If a doctor detects an unruptured aneurysm, they will monitor the patient closely. The goal is to prevent rupture.

Treatment depends on the type, location, and size of the aneurysm, and may include medication or surgery.
Doctors may prescribe medications to:

  • Improve blood flow

  • Lower blood pressure

  • Control cholesterol

These treatments help slow aneurysm growth and reduce stress on artery walls.

Larger aneurysms at risk of rupturing—or already ruptured—may require surgery. Surgical options include:

1. Endovascular Aneurysm Repair (EVAR)

A catheter (thin tube) is inserted into the blood vessel. Through it, the surgeon places a graft (special tube section) to reinforce or repair the artery.

For thoracic aneurysms, the procedure is called thoracic endovascular aneurysm repair (TEVAR).
If the surgeon needs a graft with custom openings, they may perform fenestrated endovascular aneurysm repair (FEVAR).

2. Open Surgery

In some cases, the aneurysm is removed or repaired through open surgery with an incision.

3. Digital Subtraction Angiography (DSA)

Through DSA, surgeons can perform:

  • Endovascular coiling – for cerebral aneurysms, inserting platinum wire coils into the aneurysm via catheter to reduce blood flow and rupture risk.
  • Microvascular clipping – placing a metal clip at the base of a cerebral aneurysm to stop blood flow.
  • Catheter embolization – cutting off blood supply to the aneurysm using embolic agents via catheter.

If you have questions or want to consult a doctor about aneurysms, don’t hesitate to visit the Mandaya Brain Tumor and Aneurysm Center for medical advice, screening, and treatment options.

Make an appointment using the Chat on WhatsApp, Book Appointment, or Care Dokter app available on Google Play and App Store to simplify your visit, check queue numbers, and get more complete information.

Ovarian Cancer

What is Ovarian Cancer?

Ovarian cancer is a type of cancer that occurs when abnormal cells in the ovaries or fallopian tubes grow and reproduce uncontrollably.
The ovaries are part of the female reproductive system. These walnut-sized, round organs produce eggs during a woman’s reproductive years.

Ovarian cancer is divided into several types, including:

  • Epithelial ovarian cancer: This is the most common type and includes several subtypes, such as serous carcinoma and mucinous carcinoma.
  • Stromal tumors: These rare tumors are usually diagnosed at an earlier stage compared to other types of ovarian cancer.
  • Germ cell tumors: This rare type of ovarian cancer tends to occur in younger women.

Symptoms of Ovarian Cancer

Ovarian cancer can develop and spread throughout the abdomen before causing any noticeable symptoms, making early detection difficult.

Some potential symptoms include:

  • Abdominal bloating or swelling
  • Feeling full quickly when eating
  • Weight loss
  • Discomfort in the pelvic area
  • Fatigue
  • Back pain
  • Changes in bowel habits, such as constipation
  • Frequent urination

Causes of Ovarian Cancer

The exact cause of ovarian cancer is not known. However, some people are at a slightly higher risk of developing it.

Risk factors for ovarian cancer include:

  • Being over the age of 60
  • Obesity
  • A family history of ovarian cancer or inherited genetic mutations (BRCA1 or BRCA2) or Lynch syndrome
  • Never having been pregnant or having children later in life
  • Endometriosis

The risk also increases with age.

Diagnosis of Ovarian Cancer

If a doctor suspects ovarian cancer, they will ask about your symptoms and perform a pelvic examination. During this exam, the doctor checks for abnormal growths or enlarged organs.

Doctors may also recommend several tests to diagnose ovarian cancer:

1. Imaging tests

  • Pelvic ultrasound
  • MRI (magnetic resonance imaging)
  • CT scan (computed tomography)
  • PET scan (positron emission tomography)

2. Blood tests

Blood tests are used to detect the presence of a substance called CA-125. High levels of CA-125 in the blood can be a sign of cancer. However, CA-125 levels can be normal even in people with cancer, and elevated levels may also occur in other medical conditions.

Therefore, doctors often use a combination of blood tests and other diagnostic methods.

3. Surgical evaluation

In some cases, doctors may diagnose ovarian cancer during surgery. If abnormal growths are found, they are typically removed during the same procedure.

4. Laparoscopy

During a laparoscopy, a thin camera (laparoscope) is inserted through a small incision in the abdomen.

Using the camera and additional instruments, the surgeon can assess the cancer, perform a biopsy, and remove ovarian tumors.

Treatment for Ovarian Cancer

  • Surgery

Ovarian cancer treatment through surgery typically involves removing the reproductive organs and any other affected areas. Doctors may use laparoscopy (minimally invasive surgery) or laparotomy (open surgery through a larger abdominal incision).

  • Chemotherapy

Chemotherapy may be recommended before or after surgery. It involves drugs designed to target and kill cancer cells. It can be administered intravenously or orally.

  • Targeted therapy

This cancer treatment uses drugs that identify and attack cancer cells. It works by changing how the cancer cells grow and divide.

  • Hormone therapy

Some ovarian cancers grow in response to hormones. Hormone therapy can block these hormones, slowing or stopping the cancer’s growth.

  • Brachytherapy

Brachytherapy is a form of internal radiation therapy, meaning the radiation source is placed directly near the tumor inside the body. The radiation source is in the form of a very small capsule inserted into the body through a thin tube.

Do you have further questions or want to consult about cancer? Feel free to visit the Mandaya Comprehensive Cancer Center. Our hospital is equipped with modern technology to treat various types of cancer, supported by an experienced team of specialist doctors.

Schedule an appointment easily through the Chat feature on WhatsApp, Book Appointment, or the Care Dokter app, available on Google Play and the App Store to simplify your visit, view queue numbers, and access more detailed information.

Cholecystitis

What is Cholecystitis?

Cholecystitis is an inflammation of the gallbladder, a small, pear-shaped organ located beneath the liver that stores bile produced by the liver. Infection or blockage in the gallbladder or bile ducts can cause inflammation, pain, and swelling.

If left untreated, cholecystitis can lead to serious complications, such as gallbladder rupture, which can be life-threatening. Treatment often involves surgery to remove the gallbladder.

Symptoms of Cholecystitis

Common symptoms of cholecystitis include:

  • Severe pain in the upper right or middle abdomen
  • Pain radiating to the right shoulder or back
  • Tenderness in the abdomen when touched
  • Nausea
  • Vomiting
  • Fever

These symptoms often occur after eating, particularly fatty or large meals.

Causes of Cholecystitis

Several factors can cause gallbladder inflammation, including:

  • Gallstones Gallstones are the most common cause of cholecystitis. These hard particles form in the gallbladder and can block the duct that carries bile out of the gallbladder, leading to bile accumulation, swelling, and irritation.
  • Tumors A tumor can block the normal flow of bile from the gallbladder, leading to fluid buildup and inflammation.
  • Bile Duct Blockage A blocked bile duct can cause gallbladder inflammation. Scarring or bending of the bile ducts can also contribute to obstruction.
  • Infections Conditions like AIDS or other viral infections can cause gallbladder swelling and irritation.
  • Severe Illness Serious illnesses can damage blood vessels and reduce blood flow to the gallbladder, leading to inflammation.

Risk Factors for Cholecystitis

Certain individuals are at a higher risk of developing cholecystitis, including those who:

  • Are female
  • Are pregnant
  • Are obese
  • Have diabetes
  • Have high cholesterol levels
  • Experience rapid weight loss
  • Are over the age of 40

Diagnosis of Cholecystitis

To diagnose cholecystitis, doctors perform a physical examination and assess the patient’s symptoms and medical history. Diagnostic tests and procedures may include:

  • Blood Tests These tests check for signs of infection or other gallbladder problems.
  • Imaging Tests Imaging tests such as endoscopic ultrasound, abdominal ultrasound, CT scan, and magnetic resonance cholangiopancreatography (MRCP) provide images of the gallbladder and bile ducts, helping doctors identify signs of cholecystitis or gallstones.
  • Hepatobiliary Iminodiacetic Acid (HIDA) Scan This scan tracks the production and flow of bile from the liver to the small intestine. A radioactive dye is injected, which attaches to bile-producing cells, allowing doctors to detect any blockages.

Treatment for Cholecystitis 

Treatment options for cholecystitis include:

  • Fasting Patients may need to refrain from eating or drinking initially to relieve stress on the inflamed gallbladder.
  • Intravenous Fluids IV fluids help prevent dehydration.
  • Antibiotics Antibiotic medications may be necessary if the gallbladder is infected.
  • Pain Relievers Pain management medications help reduce discomfort and inflammation.
  • Gallbladder Drainage In some cases, a gallbladder drainage procedure (cholecystostomy) may be required to remove infection, especially for patients who cannot undergo gallbladder removal surgery.

Gallstones

What Are Gallstones?

Gallstones are small, hardened deposits of digestive fluid that form in the gallbladder. The gallbladder is a small, pear-shaped organ located on the right side of the abdomen, just beneath the liver. Its main function is to store bile, a digestive fluid released into the small intestine.

Gallstones vary in size, ranging from as small as a grain of sand to as large as a golf ball. Some people may develop just one gallstone, while others may have multiple stones at the same time.

If gallstones cause symptoms, doctors may recommend gallbladder removal surgery. However, gallstones that do not cause any symptoms typically do not require treatment.

Symptoms of Gallstones

Gallstones usually do not cause symptoms unless they become lodged and create a blockage. When this happens, symptoms may include upper abdominal pain and nausea.

In severe cases where a blockage persists for an extended period, additional symptoms may include:

  • Sweating
  • Fever
  • Rapid heartbeat
  • Abdominal swelling and pain
  • Yellowing of the skin and eyes (jaundice)
  • Dark urine and pale stools

Causes of Gallstones

Gallstones are believed to form due to an imbalance in the chemical composition of bile in the gallbladder.

In most cases, high cholesterol levels in bile contribute to gallstone formation.

You may be at a higher risk of developing gallstones if you:

  • Are overweight or obese
  • Are a woman (especially if you have given birth)
  • Are 40 years of age or older (risk increases with age)

Diagnosis of Gallstones

Several tests and procedures can help diagnose gallstones and related complications:

  • Abdominal Ultrasound

This is the most commonly used test to detect gallstones. It involves placing a transducer on the abdomen to send sound waves to a computer, which then creates an image of the gallbladder and surrounding structures.

  • Endoscopic Ultrasound (EUS)

This procedure helps identify smaller gallstones that may not be visible on an abdominal ultrasound. A thin, flexible tube (endoscope) is inserted through the mouth and into the digestive tract. The transducer within the endoscope generates sound waves to produce highly detailed images of surrounding tissues.

  • Additional Imaging Tests

Other diagnostic imaging tests that may be recommended include oral cholecystography, hepatobiliary iminodiacetic acid (HIDA) scan, CT scan, magnetic resonance cholangiopancreatography (MRCP), or endoscopic retrograde cholangiopancreatography (ERCP). If gallstones are detected during ERCP, they can be removed during the procedure.

  • Blood Tests

Blood tests can help detect infections, jaundice, pancreatitis, or other complications caused by gallstones.

Treatment for Gallstones

Most cases of asymptomatic gallstones do not require treatment. However, if symptoms occur, the following treatment options may be recommended:

  • Cholecystectomy (Gallbladder Removal Surgery)

Doctors may suggest gallbladder removal surgery (cholecystectomy), especially if gallstones frequently recur. After gallbladder removal, bile flows directly from the liver to the small intestine instead of being stored in the gallbladder.

The gallbladder is not essential for survival, and its removal does not affect digestion. However, some people may experience temporary diarrhea after surgery.

  • Medications

Doctors may prescribe medications to dissolve gallstones. However, this treatment can take months or even years to be effective, and gallstones may reappear if the medication is discontinued.

Need More Information on Gallstones? If you have questions about gallstones or other digestive health issues, visit the Digestive & Liver Clinic at Mandaya for expert medical advice, examinations, and the best treatment options from our experienced doctors.

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Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is a condition characterized by a loss of bladder control, causing frequent urination accidents. The severity of this condition varies, ranging from minor leaks when coughing or sneezing to sudden, intense urges to urinate that make it difficult to reach the toilet in time.

Symptoms of Urinary Incontinence

The main symptom of urinary incontinence is involuntary urine leakage. When and how this occurs depends on the type of incontinence:

  • Stress Incontinence: Urine leaks when pressure is applied to the bladder due to coughing, sneezing, laughing, exercising, or lifting heavy objects.
  • Urge Incontinence: A sudden, intense need to urinate is followed by involuntary urine leakage. This may lead to frequent urination, including at night.
  • Overflow Incontinence: Frequent dribbling of urine occurs because the bladder does not empty completely after urination.
  • Functional Incontinence: Physical or mental impairments prevent a person from reaching the toilet in time. For instance, severe arthritis may make it difficult to unbutton pants quickly enough.
  • Mixed Incontinence: This occurs when a person experiences more than one type of incontinence, commonly a combination of stress and urge incontinence.

Causes of Urinary Incontinence

The causes of urinary incontinence vary depending on the type. Here are some explanations:

  • Stress Incontinence: Usually caused by weakened or damaged muscles that prevent urination, such as the pelvic floor muscles and urethral sphincter.
  • Urge Incontinence: Often due to overactivity of the detrusor muscle, which controls the bladder.
  • Overflow Incontinence: Frequently triggered by a bladder blockage that prevents complete emptying.
  • Total Incontinence: Can be caused by congenital bladder issues, spinal cord injuries, or the formation of a small tunnel-like opening between the bladder and a nearby area (fistula).

Several factors may increase the risk of developing urinary incontinence, including:

  • Pregnancy and vaginal childbirth
  • Obesity (excess weight)
  • Family history of incontinence
  • Aging

Diagnosis of Urinary Incontinence

Several methods are used to diagnose urinary incontinence:

  • Bladder diary: Patients record their fluid intake, urination frequency, urine volume, and incidents of incontinence.
  • Physical examination: Doctors may check the vagina and assess pelvic floor muscle strength. For men, a rectal exam can help determine if the prostate gland is enlarged.
  • Urinalysis: This test detects signs of infection or abnormalities.
  • Blood test: Can be conducted to evaluate kidney function.
  • Postvoid residual (PVR) test: Measures the amount of urine left in the bladder after urination.
  • Pelvic ultrasound: Provides images to help detect any issues.
  • Stress test: The patient applies sudden pressure to the bladder while the doctor checks for urine leakage.
  • Urodynamic testing: Determines how much pressure the bladder and urethral sphincter can withstand.
  • Cystogram: An X-ray procedure that provides images of the bladder.
  • Cystoscopy: A thin tube with a lens is inserted into the urethra, allowing the doctor to identify any urinary tract abnormalities.

Treatment for Urinary Incontinence

Initially, doctors may recommend simple interventions to help relieve symptoms, such as:

  • Lifestyle Changes

Lifestyle modifications, such as weight loss and reducing caffeine and alcohol intake, can be advised for incontinence related to unhealthy habits.

  • Regular Exercise

Routine exercises, including pelvic floor and bladder training, can help reduce the risk of urinary leakage. Pelvic floor exercises strengthen the muscles, while bladder training teaches individuals to wait longer between the urge to urinate and actual urination.

  • Artificial Urinary Sphincter Implantation

If other methods fail to provide positive results, doctors may recommend an artificial urinary sphincter (AUS). This adjustable device helps restore natural urinary control by simulating the function of a normal sphincter, opening and closing the urethra at the patient’s discretion.

This device is primarily indicated for treating stress incontinence in men due to intrinsic sphincter deficiency, such as post-prostatectomy incontinence. The AUS is placed around the penis to close the urethra when not urinating, preventing leaks and accidental urination.

If you suffer from urinary incontinence and are interested in trying an artificial urinary sphincter, visit Mandaya Royal Hospital Puri for a consultation and installation. Our hospital also has a Urology Center equipped with modern and advanced technology to treat conditions like urinary incontinence.

Use our WhatsApp Chat feature, Book Appointment, or the Care Dokter app (available on Google Play and App Store) to facilitate visits, check queue numbers, and access complete information.

Uterine Cancer

Uterine cancer is a type of cancer that affects the uterus, the organ where a baby grows and develops during pregnancy. Any woman of any age can develop uterine cancer. However, this condition most commonly occurs in women who have entered menopause or are over the age of 50.

What is Uterine Cancer?

Uterine cancer is the abnormal growth of cells in the uterine tissue. In most cases, cancer cells originate in the inner lining of the uterus, known as the endometrium. This lining is where a fertilized egg (ovum) attaches, which is why this condition is also known as endometrial cancer.

Apart from the endometrial lining, cancer cells can also grow in the connective tissue or muscle surrounding the uterus.

Types of Uterine Cancer

There are two main types of uterine cancer, classified based on the location where cancer cells develop:

  1. Endometrial Cancer
    • This type of cancer begins in the endometrium and is one of the most common reproductive system cancers in women.
  2. Uterine Sarcoma
    • This type of cancer originates in the middle muscle layer (myometrium) and connective tissue of the uterus. Uterine sarcoma is considered very rare.

Symptoms of Uterine Cancer

Common symptoms of uterine cancer may include:

  • Vaginal bleeding outside of the menstrual cycle or after menopause
  • Heavier or longer menstrual periods than usual
  • Unusual vaginal discharge with a foul odor
  • Pain in the lower back or pelvis
  • Pain during sexual intercourse
  • Blood in the urine
  • Lump or swelling in the abdominal or pelvic area

However, these symptoms may also resemble signs of other conditions. To determine the cause of your symptoms, consult a doctor for further evaluation.

Causes of Uterine Cancer

Uterine cancer is caused by genetic mutations in the cells of the uterine tissue. These mutations cause cells in the uterus to divide uncontrollably, crowding out healthy cells.

Although the exact cause of these mutations is unknown, several factors may increase the risk of developing uterine cancer, including:

  • Age over 50
  • Menopause
  • Overweight or obesity
  • High-fat animal diet
  • Family history of uterine cancer
  • Inherited Lynch syndrome
  • High estrogen levels
  • Diabetes
  • Endometriosis
  • Polycystic ovary syndrome (PCOS)
  • Hormone replacement therapy with estrogen or tamoxifen
  • Early menstruation (before age 12)
  • Late menopause

Diagnosis

A doctor will begin diagnosing uterine cancer by evaluating your medical history, symptoms, risk factors, and family history. A physical and pelvic examination will also be performed.

Several tests may be conducted to confirm a diagnosis of uterine cancer, including:

  • Blood tests
  • Imaging tests such as CT scans, MRI, or transvaginal ultrasound
  • Endometrial biopsy
  • Hysteroscopy
  • Dilation and curettage (D&C)

These tests not only help determine whether you have uterine cancer but also assist in developing an appropriate treatment plan.

Treatment for Uterine Cancer

Treatment for uterine cancer depends on the type and stage of the cancer, as well as your overall health condition. Common treatment options include surgery, chemotherapy, radiotherapy, and hormone therapy.

Often, a combination of two or more treatment methods is used. The following are some treatment options for uterine cancer:

  1. Surgery
     Surgery is generally the primary treatment for endometrial cancer. Some surgical options include:

    • Hysterectomy
      • A procedure to remove the uterus and cervix, performed through an abdominal incision or vaginally.
      • Depending on the cancer stage, the doctor may remove only the uterus if the cancer has not spread. If it has spread, the uterus, cervix, and surrounding tissues may be removed.
    • Bilateral Salpingo-Oophorectomy (BSO)
      • A procedure to remove the uterus along with the ovaries and fallopian tubes, often necessary to ensure all cancer cells are eliminated.
    • Lymphadenectomy
      • A procedure to remove the uterus along with lymph nodes around the uterus to check for cancer spread.
  2. Chemotherapy
    • A treatment using chemical compounds to destroy cancer cells. Chemotherapy can be administered orally, by injection, or via implantable devices.
  3. Radiotherapy
    • Uses high-energy radiation to destroy cancer cells. This treatment can kill cancer cells or stop them from growing.
    • One commonly recommended radiotherapy method for uterine cancer is brachytherapy.
  4. Hormone Therapy
    • A treatment that involves administering or blocking certain hormones to combat cancer cells.
  5. Immunotherapy
    • A treatment that strengthens the immune system to help fight cancer.

Prevention of Uterine Cancer

While there is no vaccine or medication to prevent uterine cancer, certain steps can help reduce the risk:

  • Consult a doctor if you have multiple risk factors for uterine cancer.
  • Maintain a healthy weight by eating a nutritious diet and exercising regularly.
  • Manage diabetes effectively.
  • Have regular reproductive health check-ups.
  • Use hormonal birth control as directed by a doctor.

Uterine cancer is often detected in its early stages because many women seek medical attention upon experiencing abnormal vaginal bleeding.

Consult an Expert

To determine how often you need check-ups or which tests are appropriate, consult an obstetrician-gynecologist (OBGYN) or an oncology surgeon.

You can visit the Advanced Cancer and Radiotherapy Centre at Mandaya Royal Hospital Group to consult with our experts. Schedule an appointment via WhatsApp chat, Book Appointment, or the Care Dokter app, available for download on Google Play and the App Store. This will facilitate your visit, allow you to check queue numbers, and access other complete information.

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