疝氣

疝氣
疝氣是指整個或部分器官由原本正常的位置，透過疝孔移至不正常的位置並凸出，令該處出現隆起物，形成俗稱「小腸氣」的疝氣。



疝氣的成因
先天因素：腹壁結構出現先天性缺陷。
後天因素：腹壁肌肉長期受壓而變弱或膠原流失。腹壁長期受壓下，腹腔內臟會從變弱的位置凸出。


疝氣種類
疝氣可分多種，以其臨床特徵或出現位置而區分。臨床特徵包括可縮小、不可縮小、血流受阻或阻塞的疝氣，而疝氣出現的位置則分別有腹股溝、股骨、肚臍、臍側、切口、上腹部及橫隔膜等。一般來說，大部分患者以患上腹股溝疝氣為主，即腹腔內的器官如小腸，因腹肌力度不足，經腹股溝移至陰囊。


疝氣徵狀
若閣下出現以下徵狀，可能是患上疝氣的先兆：
腹壁出現隆起物。
腹壁的隆起物不斷變大。
隆起位置偶然出現痛楚。
當平臥時，腹壁的隆起物會縮回腹腔內。
患者站立或咳嗽時，腹部隆起物會變大。


疝氣併發症
疝氣會令血流受阻，供血量減少，有關部位會出現局部缺血，組織逐漸壞死，嚴重的會引致腹膜炎。由於腹膜炎會影響性命，務必盡快進行手術治理。
除此之外，因疝氣而出現的隆起物，可能會令患者感到劇烈疼痛，該部位的皮膚更會變紅，痛楚不停加劇，並會逐步蔓延至整個腹部。


疝氣治療
要治療疝氣，手術是有效的治理方法，手術方式包括傳統修補手術配合人工網膜，以及腹腔鏡疝氣修補手術。
目前腹腔鏡疝氣修補手術是最常用的手術療程，由於此手術的入侵性較少，患者在術後會感到較少痛楚，住院及康復時間亦較短，而復發率更相對較低。








參考資料: psclinic.com.hk/
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。

靜脈曲張 (Varicose Vein)

靜脈曲張是指淺層的靜脈擴張、突起，充盈著血液的靜脈。下肢靜脈曲張通常牽涉兩條血管，一條為小隱靜脈，而另一條為大隱靜脈。

靜脈曲張病徵

˙    雙腳腫脹

˙    出現蜘蛛網狀的靜脈

˙    靜脈如蚯蚓纏繞在腳上，俗稱『青筋』

˙    青筋附近皮膚痕癢

˙    當情況嚴重時，足踝會出現鬱血性皮膚炎；皮膚變成紫黑色。原因是靜脈的壓力增加，令紅血球從微絲血管溢出。當這些紅血球被分解後，色素就會沉積。

˙    靜脈性潰瘍: 嚴重的靜脈曲張令皮膚的氧份供應不足，容易引致潰瘍，而且極難痊癒。

靜脈曲張診斷

醫生會根據患者的病歷及臨床檢查的結果，配合多普勒超音波 (Doppler ultrasound)進行。儀器主要用來診斷功能不全的靜脈瓣膜在那裏及牽涉的範圍。(續)

參考資料: psclinic.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向外科醫生查詢，而不應單倚賴以上提供的資料。

激光包皮環切術 (下)

包皮手術前準備:

手術前應盡量嘗試翻開包皮清理包皮垢如只是包皮過長，可以正常翻起包皮的男士，可於手術前一星期，多點翻開包皮，讓龜頭有較多時間外露及有機會有較多時間直接與衣物接觸，減少龜頭於手術後的敏感不適。

手術前應在家中自行剃掉陰莖旁的毛髮，目的是減少手術後傷口感染發炎的機會及方便傷口護理。手術前４－６小時需要空腹，不可進食及飲水，避免麻醉藥物引起的不適。患者最好帶備緊身內褲或泳褲於手術後穿著。另外，手術後一個月都不適宜進行性行為。

包皮環切術後的護理

手術後患者或會感到傷口輕微痛楚，可遵醫生處方服食止痛藥。手術後24小時後方可沐浴，避免浸浴，傷口位置只需用清水沖洗並且每天用消毒藥水或生理鹽水清理，然後用紗布包紮。傷口周圍或會滲出透明黃色分泌物，輕微滲血或紅腫，一星期內便會逐漸消失。手術後穿著緊身內褲或泳褲，可以保護傷口免受碰撞，而保持陰莖向上，可以減少龜頭水腫。

此外，手術後患者最好坐下來小便，以免弄濕紗布。一旦弄濕了紗布，可以自行更換。如發現傷口滲血，可自行按住傷口數分鐘，便會自然止血。

如果發再現傷口大量出血、四周紅腫發炎、或發燒等，便應盡快通知醫生。

參考資料: psclinic.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向外科醫生查詢，而不應單倚賴以上提供的資料。

激光包皮環切術 (上)

包皮是男性陽莖頭外可伸縮的皮膚組織，蓋著男性陰莖前端的龜頭部份，頂端是尿道口，用來排尿和射精。男性包皮的長度各有不同，通常都可以輕易拉後，露出龜頭，以便清潔。

包皮過長

包皮過長，即指陰莖勃起時龜頭不能外露。即使用手都不能拉下包皮，或拉下時會產生痛楚，是因為包皮口狹窄，使包皮無法拉下，這稱為"包莖"，有些更嚴重至包皮上翻後未能回復原處，卡在冠狀溝位置，以致龜頭水腫。

包皮過長會令男士無法完全清潔包皮上的污垢，以致細菌容易滋生，並有機會經由性行為傳播至女士生殖器官上，最常見的有盆腔炎、念珠菌、甚至是誘發子宮頸癌的HPV病毒。 所以，現時包皮過長這問題已不只是男性的問題，跟女性健康都有著重大的關係了。

如有以下情況，都必須考慮接受包皮環切術 :

ü   因反覆感染導致包皮口形成纖維性疤痕狹窄，令包皮無法自然翻起清潔

ü   陰莖頭包皮反覆發炎

ü   反覆尿道感染

ü   成年人包莖經反覆嘗試都未能將包皮翻開

包皮環切術

包皮環切術以往都是用傳統手術刀，將龜頭四周過緊或過長的包皮組織進行切割，令龜頭得以外露;而近年則引進了新的手術方式，便是用激光進行切割。使用激光的好處是使手術進行時出血較少及相對復原得較快;一般成年人可使用局部麻醉在診所進行手術，過程只需大約20至30分鐘，術後1至2天便可如常上班或上學。(續)

參考資料: psclinic.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向外科醫生查詢，而不應單倚賴以上提供的資料。

OGD---The lumen of the upper digestive tract-

Oesophagogastroduodenoscopy (OGD)

OGD is the method for examination of the lumen of the upper digestive tract. OGD means the use of a flexible endoscope to examine the oesophagus (Oesopha-), stomach (Gastro-) and duodenum (Duodeno-). 

OGD is indicated for diagnosis, biopsy and delivery of targeted therapies. It may be used for patients suffering from peptic ulcer disease or bleeding, suspected oesophageal and gastric cancer, symptoms of indigestion, acid reflux and difficulty in swallowing.



Procedures
1. Prior to the examination, local anesthetics will be sprayed to the throat of patients. During the procedure, patients are fully conscious.
2. A flexible endoscope with a diameter of 0.9-1.2cm will then be introduced by the endoscopist through patients’ mouth into the esophagus, stomach and the duodenum.
3. Blood pressure and heart rate will be closely monitored during the procedure.
4. The entire procedure will last for about 10 to 20 minutes.





Reference: psclinic.com.hk/
The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.

Hernia

Hernia is the protrusion of the whole or part of a viscous from its normal position through an opening in the walls of its containing cavity.

Causes of hernia

Hernia can be either congenital or acquired. Increased intra-abdominal pressure or collagen derangement may also increase the risk of developing hernia.

Types of hernia

Hernia can be classified either by their clinical features or their sites. Clinical features include reducible, irreducible, strangulated and incarcerated / obstructed hernia. Sites include inguinal, femoral, umbilical and paraumbilical, incisional, epigastric, obturator, etc.

Symptoms

If you have any of the following symptoms, you may be experiencing hernia:

˙    A lump over the abdominal wall (eg. Groin)

˙    The lump may increase in size progressively

˙    Occasional pain

˙    Disappear when lying flat

˙    Lump size increases if patient is in standing position or coughing

Complications of hernia

When the hernia becomes strangulated, the blood supply to the content of hernia is impaired. The content becomes ischemia and then gangrenous, resulting in peritonitis.

Emergent operation is then required for this life threatening condition. You may experience severe pain over the lump, which could not be reduced. The overlying skin becomes redden and the pain will become severer and then spread out to the entire abdomen

Hernia treatment

Surgical repair is the only effective treatment for hernia. Conservative treatment is the exception rather the rule. Open hernia repair with mesh and laparoscopic hernia repair are two commonly used surgical treatment.

Open and laparoscopic surgeries are both common for hernia repair, decisions are made according to patients’ condition. Open surgery is more preferred for patients with recurrent hernia.

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult

Surgery Specialist before considering treatment and should not rely on the information

above.

Gallstones

A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components

Classification

There are three major types of gallstones, namely cholesterol, pigmented and mixed stones.

Risk factors for gallstones:

•        Fat
•        Female
•        Fifty
•        Fertile
•        Others:
•        Hemolytic disease
•        Biliary tract infection
• 
  

Symptoms

Some patients may be asymptomatic. About 10% may become symptomatic within 5 years. Those symptoms include vague upper abdominal pain, dyspepsia and flatulence. If patients experience intense pain over right upper quadrant of abdomen, that may be the symptom of biliary colic.

Diagnosis

Diagnosis is made by clinical assessment and ultrasound examination.

Gallbladder cancer

Gallbladder cancer is a relatively uncommon cancer, most commonly seen in elderly ladies. For cases that are diagnosed early, patients can be cured by removing the gallbladder, part of the liver and associated lymph nodes. Endoscopic retrograde cholangiopancreatography (ERCP) is a common endoscopic surgery performed for such cases.

Complications of gallstones

Listed below are common complications of gallstones

•        Acute cholecystitis: this may cause empyema,
  gangrenous, perforation, peritonitis
•        Chronic cholecystitis – recurrent biliary colic
•        Cholecystointestinal fistula
•        Carcinoma – porcelain gallbladder

If gallstones migrate into the ducts of the biliary tract, the condition is referred to as choledocholithiasis, which is frequently associated with obstruction of the biliary tree. This may lead to acute ascending cholangitis, a serious infection of the bile ducts.

Gallstones within the ampulla of Vater may obstruct the exocrine system of the pancreas, which in turn can result in pancreatitis.

Either of these two conditions can be life-threatening and are therefore considered to be medical emergencies.

Gallstones Treatment

•         Surgery. Laparoscopic cholecystectomy is the standard
   treatment of gallstone disease.
•         Medical dissolution therapy
•          Extracorporeal shock wave lithrotripsy

Gallbladder polyps

Gallbladder polyps are growths or lesions resembling growths (polypoid lesions) in the wall of the gallbladder. Most polyps are benign and do not need to be removed.

However, for patients over 50 years old with polyps larger than 1 cm, they may have the gallbladder removed (cholecystectomy), especially if there are several polyps or the polyps appear to be malignant. 

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult

Surgery Specialist before considering treatment and should not rely on the information

above.