Paying Attention to your Body

1. Paying Attention to your Body Dr Sanjay De Bakshi; MS(Cal) FRCS(Eng;Edin) Consultant Surgeon; Dept. of General Surgery and Surgical Gastroenterology; Calcutta Medical Research Institute; Surgical Tutor & Examiner ; Royal College of Surgeons of Edinburgh. Tutor for DNB; General Surgery & Surgical Gastro.

2. The Miracle of Conception & Birth !!

3. A Highly evolved machine • Far far more evolved than even the most sophisticated machine that man could ever build!!!

4. A Highly evolved machine • Far far more evolved than even the most sophisticated machine that man could ever build!!!

5. A Highly evolved machine • Far far more evolved than even the most sophisticated machine that man could ever build!!!

6. A Highly evolved machine • COMPLETE RESPIRATORY TRACT • Mouth and upper respiratory tract. • Persistent bleeding from the mouth or nose; • Inability to open mouth; • Persistent change in voice; • Ulcer that will not heal;

7. A Highly evolved machine • COMPLETE RESPIRATORY TRACT • Lower respiratory tract (including the lung) • Unusual intolerance to usual exertion. • Persistent cough; • Blood in the sputum; • Persistent pain chest which increases on movement.

8. A Highly evolved machine • HEART (Beats 80 times a minute; Beats 4,800 times an hour; Beats 1,15,200 times a day; Beats 420,48,000 times a year –from the time one is born to the very last day!!!) • Pain chest – constricting • Pain also at neck, left arm and abdomen – sometimes on exercising. • Often associated with sweating, vomiting.

9. A Highly evolved machine • HEART (Beats 80 times a minute; Beats 4,800 times an hour; Beats 1,15,200 times a day; Beats 420,48,000 times a year –from the time one is born to the very last day!!!) • Pain chest – constricting • Pain also at neck, left arm and abdomen – sometimes on exercising. • Often associated with sweating, vomiting. • MAY NOT BE GASEOUS PAIN!!!!

10. A Highly evolved machine • BREASTS A very very embarrassing topic NEVER TO BE DISCUSSED, NOT EVEN WITH YOUR DOCTOR!!! • VARIATIONS OF NORMAL Accessory nipple and Axillary Breasts • PAINFUL BREASTS During periods, pregnancy and lactation • PAINLESS BREAST LUMP Innocent breast lumps & Not so innocent breast lump

11. A Highly evolved machine BREASTS • Regular and methodical breast self examination -- follow–up with medical examination if anything abnormal found. • Investigations if necessary— • Mammogram - preferably after the age of 45 years, RARELY OF USE at a young age where repeated mammograms may actually be risky!! CHOOSE A CENTRE WHICH HAS A MAMMOGRAPHIC MACHINE AND NOT ON A REGULAR X-RAY MACHINE

12. A Highly evolved machine INTESTINAL TRACT LIVER AND GALL BLADDER • LIVER; --- One common expression of disease is • JAUNDICE. • CIRRHOSIS • Following severe hepatitis • Following alcohol ingestion • Other conditions.

15. CIRRHOTIC LIVER NORMAL LIVER

16. BLOCK OF THE CBD • STONE OR WORMS INSIDE CBD. • TUMOURS OF THE BILE DUCT OR PANCREAS • PRESSURE FROM OUTSIDE BY ENLARGED GLANDS

17. CARCINOMA Pancreas

18. CARCINOMA UNCOMPLICATED GALL BLADDER COMPLICATED GALL BLADDER

19. CARCINOMA ERCP SHOWING STONES AND EXTRACTION AT LAPAROSCOPY

20. A Highly evolved machine INTESTINAL TRACT UPPER TRACT (Oesophagus, Stomach and Duodenum) We love GOOD FOOD but WE DO NOT LIKE TO WORK IT OUT ---- This leads to mismatch of INPUT VERSUS OUTPUT

21. A Highly evolved machine INTESTINAL TRACT UPPER TRACT (Oesophagus, Stomach and Duodenum) • Heartburn and discomfort behind the breastbone. • Pain in the abdomen Relieved by food --suggests duodenal ulcers; Aggravated by food – suggests ulceration of the stomach. • HOWEVER, if the pain is not relieved by or recurs after medication, or there is black stool or vomiting with or without blood – Medical consultation is needed.

22. 1 cm. A Highly evolved machine INTESTINAL TRACT UPPER TRACT (Oesophagus, Stomach and Duodenum) The doctor may suggest some tests including a UGI Endoscopy

23. A Highly evolved machine INTESTINAL TRACT MIDDLE PART (Small Intestine) • Infestation with worms (Round worms affects upto a quarter of the world population); • Tuberculosis is also very common in our part of the world and is often related to having un-pasteurised milk; • Typhoid ulcers often affect the last part of the small intestine.

24. A Highly evolved machine INTESTINAL TRACT MIDDLE PART (Small Intestine) • Infestation with worms (Round worms affects upto a quarter of the world’s population); • The symptoms are often vague but • Many may have abdominal pain with vomiting, • Or present with anaemia and failure to thrive

25. WASH VEGETABLES VERY WELL

26. A Highly evolved machine INTESTINAL TRACT MIDDLE PART (Small Intestine) • Tuberculosis affects the lower part of the small intestine and may present with • Pain abdomen; • Bleeding from the intestine or • Features of Intestinal Obstruction. • Raw milk often harbours the Germs for Bovine tuberculosis.

27. Pasteurization OF Milk and TB • 1894-1907 Russell realized the prevalence of tuberculosis in Wisconsin dairy cows and organized a statewide program of education, with changes in state law, that dramatically reduced the level of the disease, with significant enhancement of Wisconsin's prestige as a dairy state. • 1899-1901 Russell and E.G. Hastings demonstrated at industrial scale that lower temperature pasteurization kills tuberculosis bacilli without damaging the appearance of milk, helping increase the use of pasteurization of the Wisconsin milk supply.

28. A Highly evolved machine INTESTINAL TRACT LAST PART (Large Intestine) • The first part has the appendix attached to the caecum. Infection can present in many ways:- • Mild recurrent pain on the right lower abdomen. • Acute pain which often starts around the navel or even just below the breast bone ---- and then the pain “shifts” to the right lower abdomen. Acute appendicitis can:- • Perforate – leading to severe all-abdominal pain and collapse or • The body in trying to protect itself, makes a cocoon around the inflammed appendix in 3 -4 days. THIS PAIN – NEVER TO BE PRESUMED TO BE CONSTIPATION – LAXATIVES --- VIOLENT PERFORATION!!!!!

29. Laparoscopic Appendicectomy APPENDIX

30. A Highly evolved machine INTESTINAL TRACT LAST PART (Large Intestine) • Often prone to infections with one of the commonest parasite -Entamoeba histolytica. • However, ALL diarrhoea is often always labelled as “AMOEBIASIS” and treated empirically - without testing. • And treatment often stopped after the first few doses!!!!

31. A Highly evolved machine INTESTINAL TRACT LAST PART (Large Intestine) • Severe constipation – lack of dietary fibre and good habit. • Bleeding from the large bowel.

32. A Highly evolved machine INTESTINAL TRACT LAST PART (Large Intestine) • Severe constipation – lack of dietary fibre and good habit. • Bleeding from the large bowel. MUST BE EXAMINED EVERY BLEEDING MAY NOT BE “PILES”

33. A Highly evolved machine UROLOGICAL SYSTEM • Kidneys, Ureters and Urinary Bladder • Bleeding – may be painless or painful • Painful bleeding usually associated with infection and stones. • Painless bleeding has many causes like infections, prostatism and tumours.

34. A Highly evolved machine UROLOGICAL SYSTEM • Kidneys, Ureters and Urinary Bladder • Pain may be due to:- • Infection of the kidney. • Stones of the urinary passage (Typically colicky pain radiating from loin to groin with periods of complete relief ) • Infection of the urinary tract

35. A Highly evolved machine UROLOGICAL SYSTEM • Kidneys, Ureters and Urinary Bladder • Stones URETERIC STONE BEING TREATED WITH LASER

36. A Highly evolved machine UROLOGICAL SYSTEM • Kidneys, Ureters and Urinary Bladder and Prostate • Retention of urine in various degrees due to:- • Hypertrophy of prostate. • Tumours of the prostate(After the age of 70 years it is suggested that Blood should be tested for Serum PSA yearly)

37. A Highly evolved machine GENITAL SYSTEM • Ovarian problem can also present with acute abdominal pain due to twisting of the ovary, or due to ectopic pregnancy. • PAP smear yearly after the age of 40yrs. GANGRENOUS OVARIAN CYST

38. THE HUMAN BODY-COMES IN VARIOUS SHAPES AND SIZESSERVE VARIOUS FUNCTIONS

39. THE HUMAN BODY-HATE IT-LOVE IT

40. DO LOOK AFTER YOUR BODY--- IT IS THE ONLY ONE WE HAVE!!!