Gall Bladder Stone

The gallbladder is a small, pouch-like organ situated underneath the liver. The main purpose of the gallbladder is to store and concentrate bile. The bile is stored in the gallbladder and over time it becomes more concentrated, which makes it better at digesting fats.


Gallstones are very common. You are more at risk of developing gallstones if you are:

  • Female – women are two to three times more likely to be affected by gallstone disease than men
  • 40 or ove
  • • A mother – women who have had children have an increased risk of gallstone disease, which may be because the hormonal changes that occur during pregnancy increase cholesterol levels


Gall stone symptoms may vary based on what type of gallbladder condition you have, although many symptoms are common among the different types of gallbladder problems. Below are common symptoms of gallbladder stones:

  • Severe abdominal pain
  • Pain that may extend beneath the right shoulder blade or to the back
  • Pain that worsens after eating a meal, particularly fatty or greasy foods
  • Pain that feels dull, sharp, or crampy
  • Pain that increases when you breathe in deeply
  • Chest pain
  • Heartburn, indigestion, and excessive gas
  • A feeling of fullness in the abdomen or bloating or trapped gas
  • Vomiting, nausea, fever
  • Shaking with chills
  • Tenderness in the abdomen, particularly the right upper quadrant
  • Jaundice (yellowing of the skin and eyes)
  • Stools of an unusual color (often lighter, like clay

Some gallbladder problems, like simple gallstones that are not blocking the cystic duct, often cause no symptoms at all. They’re most often discovered during an X-ray or ultrasonography or CT scan that’s performed to diagnose a different condition, or even during an abdominal surgery. If you spot any symptoms of gallbladder stones, consult a gastroenterologist or gastrointestinal surgeon for a diagnosis and prompt treatment to get your digestive tract running smoothly again.

The colon and rectum

The intestine is part of the digestive system. It is made up of the small intestine and the large intestine. The colon and rectum are parts of the large intestine. The colon is a U-shaped tube made of muscle and found below the stomach. The rectum is a shorter tube connected to the colon. Together, the colon and rectum are about 2 metres (6 feet) long. They are surrounded by other organs including the spleen, liver, pancreas, bladder and reproductive organs.

Parts of the large intestine

The large intestine is made up of the cecum, colon, rectum and anus. The colon and rectum are held in the abdomen by folds of tissue called mesenteries.


The cecum is a pouch-like passage that connects the colon to the ileum (the last part of the small intestine). If cancer develops in the cecum, it is treated like colon cancer.


The colon is the longest part of the large intestine. It receives almost completely digested food from the cecum, absorbs water and nutrients, and passes waste (stool or feces) to the rectum. The colon is divided into 4 parts.

The ascending colon is the start of the colon. It is on the right side of the abdomen. It continues upward to a bend in the colon called the hepatic flexure.

The transverse colon follows the ascending colon and hepatic flexure. It lies across the upper part of the abdomen. It ends with a bend in the colon called the splenic flexure.

The descending colon follows the transverse colon and splenic flexure. It is on the left side of the abdomen.

The sigmoid colon is the last part of the colon that connects to the rectum. Rectum

The rectum is the lower part of the large intestine that connects to the sigmoid colon. It is about 15 cm (6 in) long. It receives waste (stool or feces) from the colon and stores it until it passes out of the body through the anus. Anus

The anus is the opening at the lower end of the rectum through which waste (stool or feces) is passed from the body. Cancer in the anal canal or anus is treated differently from colorectal cancer. Find out more about anal cancer.


A hernia is a weakness or opening in the abdominal wall, that often results in bulging out of fat or an organ such as intestine, which then occupies space under the skin. The opening in the abdominal wall through which the fat or organs protrude is called the Hernia defect. Hernia can affect anybody – going by statistics one-in-ten of us will have hernia at some point in our lives. It is found in both sexes, can occur at any age and sometimes infants may be born with it. Surgery for hernia is one of the most commonly performed operations worldwide with millions of cases being treated every year.

Hernias Occur

  • Any condition that increases the pressure of the abdominal cavity over a prolonged period of time may become a cause for hernia eg. Obesity, chronic cough, heavy lifting, chronic constipation leading to straining during bowel movement.
  • Family history of hernia makes one more likely to get it.
  • Some hernias may be present at birth
  • Idiopathic, which means the cause is not known.


  • A hernia may first appear as a new lump or bulge in the groin or in the abdominal area. There may be an associated dull ache but usually it is not painful on touch. The lump increases in size on standing, coughing and may be pushed back/disappear on lying down.
  • A small painless hernia if left untreated, usually increases in size.
  • Occasionally, the hernia may become irreducible i.e. it cannot return to the abdominal cavity on lying down or with manual pushing. At this stage it also becomes painful.
  • Sometimes the loop of bowel that has herniated becomes obstructed. This can cause extreme pain, nausea, vomiting, constipation and needs immediate treatment.
  • At times the hernia becomes 'strangulated' ( explained further below ) in which the person appears ill with/without fever, nausea, vomiting and extreme pain even to touch. This condition is life threatening and thus a surgical emergency.

Diagnosis of hernia

The diagnosis of hernia is usually a clinical one, which means that your doctor will go through a history of your symptoms followed by a brief physical examination. During this check up she/he may feel the area of bulge by raising your abdominal pressure ( this is done by making you stand/cough ), as this manoeuvre makes the hernia more obvious. In case you have an inguinal hernia, the doctor will feel for the potential pathway by examining along your scrotum.To summarise, in vast majority of cases where there is an obvious swelling in the groin/abdominal area, which increases in size on standing, straining or coughing, a clinical diagnosis of hernia is made and NO TESTS are needed. More challenging diagnoses are best performed by hernia specialists.

Breast Disease

While it may be common to think of breast disease as exclusive to women, men also develop breast diseases of both benign and malignant varieties. All breast masses in males must be investigated and any solitary mass must be studied because it is considered malignant until proven otherwise.
Breast masses in females are quite common, and notably, benign over 80% of the time. Contrary to those in men, most female breast masses do not require biopsies. Modern day ultrasound studies, mammograms, MRIs, and molecular breast imaging are used to accurately diagnose female breast problems. In the event a biopsy is required, Dr. Raikwar performs “core biopsies” whereby no incision is made and no scar results. In the course of investigation of breast problems.
Advanced breast surgical approaches including sentinel node surgery, breast preserving procedures, radioactive seed localization, and oncoplastic techniques are routinely used by Dr. Raikwar.

Piles, Fissure, Fistula, Cancer

Piles clinically known as Haemorrhoids, is the swelling of the blood vessels near the anal opening. An increased pressure on these blood vessels due to any reason, causes them to enlarge and swell, thus forming lumps which are occasionally felt at the anal opening .

Causes Of Piles

  • Constipation - Most common cause
  • Hard stools/ Straining during bowel movement
  • Faulty toilet habits ( sitting on the toilet for a long time ex. reading )
  • Family history
  • Pregnancy and childbirth
  • Lifting heavy weights
  • Obesity

Symptoms Of Piles

  • Painless bleeding while passing stools
  • Feeling a lump outside the anus
  • Pruritus ani or itching around the anus
  • Faecal soiling of undergarments
  • Obesity

Diagnosis Of Piles

A medical history followed by visual examination of the anus is usually enough. However, a digital examination and Proctoscopy ( a scope is inserted to examine the anal canal ) is done to confirm the diagnosis. At times a Barium study or Colonoscopy may be advised if your doctor suspects any other cause of bleeding that needs to be ruled out.


An anal fissure or Fissure-in-ano is a tear or cut in the skin of the anal canal. The condition affects men and women equally and can occur at any age ( infants too ). Anal fissures are commonly found in the back part of your anus, in line with the cleft of your buttock.

A fissure which is present for less than 6 weeks is called an Acute fissure. That which is more than 6 weeks old is called a Chronic fissure. The Chronic fissure is usually hard to feel and may have a skin tag like growth called Sentinel Pile.

Causes of Fissure

Usually trauma to the anal canal causes a fissure.

  • Hard stools especially associated with constipation - The increased pressure exerted in an effort to pass the hard stools causes tearing of the delicate perianal skin.
  • Diarrhoea - The frequent forceful bowel movement causes tearing of the anal skin.
  • Iatrogenic - A tear may occur during insertion of a rectal thermometer, USG probe, endoscope, enema tube.
  • Childbirth
  • Anal sex - Commonly encountered in homosexuals.
  • Rare causes - Crohns disease, leukaemia, tuberculosis, sexually transmitted diseases, viral infections etc

Diagnosis Of Fissure

A history of your symptoms followed by external inspection of the anus is enough to confirm the diagnosis. On rare occasions your doctor may advice you other tests to rule out any suspected underlying cause for the fissure.


An anal fistula ( Bhagandar / Fistula in ano ) is a small channel that develops between the end of the bowel and the skin around the anus. It frequently is the result of a previous or current anal abscess. Fistula has a tract with two openings - Internal opening into the rectum or anal canal and External opening through the skin of the buttocks.

Causes Of Fistula

  • Anorectal abcess - Almost all anal fistulas are a result of a preceding anorectal abcess. An anorectal abcess begins as an infection of one of the anal glands. The infection soon forms a pool of pus - abcess. An anal fistula results when the abcess fails to heal completely with/without treatment.
  • Conditions that cause inflammation of the intestines like Crohn's disease, Diverticulitis.
  • Malignancy in the anorectal region.
  • Infections - Tuberculosis, HIV, sexually transmitted diseases
  • Iatrogenic - As a complication of a previous surgery in the region.

Symptoms Of Fistula

  • Throbbing pain that worsens on sitting
  • Swelling, tenderness, itching or redness around the anus
  • Discharge of pus, blood and debris which is usually foul smelling
  • Pain associated with bowel movements
  • Fever

Diagnosis Of Fistula

Usually a brief history followed by clinical evaluation - including a digital rectal examination is enough to diagnose an anal fistula. At the same time Proctoscopy (a minor inspection of the rectum using a small tube like scope) is also done to check for any concomitant condition in the rectum.
An MRI Fistulogram may be needed for complicated fistulas in which the tract is difficult to delineate. Fistulography, an X-Ray of the fistula after injecting a contrast solution is not done any longer as it may lead to the formation of a false tract due to forceful injection of the dye.

Thyroid Surgery

Thyroid is a butterfly shaped gland which is located in the neck is a master gland for metabolism.

If there are problems with functioning of thyroid, it can affect the weight, energy levels, and other aspects of the health.

It is estimated that almost half of the population in the world is suffering from some sort of thyroid problem, but the majority are not aware about it.

Thyroid problems which are not diagnosed can

Thyroid dramatically increase the risk of obesity, hair loss, infertility, anxiety, depression and other health problems. Thus, it is important for people to go for a proper diagnosis.

What is Thyroid Surgery?

Thyroid surgeryis a surgery performed to treat thyroid cancer, thyroid nodules and other thyroid problems.

During thyroid surgery, a part of or all of the thyroid gland is removed. An incision is made in the skin and the muscles and other tissues are pulled aside to expose the thyroid gland.

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

The enlargement of the thyroid gland due to any reason is called goiter.

What is a hiatus hernia?

The diaphragm is a sheet of muscle that separates the lungs from the abdomen. The left half of the diaphragm contains a small hole (hiatus) through which passes the food pipe or esophagus. Normally this hole fits snugly around the esophagus. The J-shaped stomach sits below the diaphragm. Hiatus hernia is a condition in which the upper portion of the stomach protrudes into the chest cavity through the esophageal hiatus.

What causes a hiatus hernia?

In some people, the hiatus in the diaphragm weakens and enlarges; it is not known why this occurs. In some patients it may be due to heredity while in others it may be caused by obesity, exercises such as weightlifting, or straining at stool. Whatever the cause, a portion of the stomach herniates, or moves up, into the chest cavity through this enlarged hole producing a hiatus hernia. Hiatus hernias are very common and occur in up to 60% of people by the age of 60.

What causes a hiatus hernia?

Patients who have a sliding hiatus hernia and associated gastroesophageal reflux disease are often advised some lifestyle modifications and medication as the first line of treatment.

Lifestyle modifications

  • Avoid foods or substances that increase reflux of acid into the esophagus, such as:
  • Nicotine (cigarettes)
  • Caffeine or coffee
  • Chocolate
  • Fatty or oily foods
  • Alcohol
  • Eat smaller, more frequent meals
  • Not to eat within 2-3 hours of bedtime
  • Avoid bending, stooping, abdominal exercises or tight belts all of which increase abdominal pressure and cause reflux
  • If overweight, lose weight as obesity is likely to increases abdominal pressure
  • At nighttime elevate the head end of the bed 8 to 10 inches by putting pillows or a wedge under the upper part of the mattress. Gravity helps keep stomach acid out of the esophagus while sleeping


Some patients with severe symptoms may be prescribed drugs to reduce the secretion of stomach acid or to increase the muscle strength of the lower esophagus, thereby reducing acid reflux.

Ventral Hernia ?

A ventral hernia is a hernia that occurs along the vertical center of the abdominal wall. This article discusses the “open” surgical approach to repair this type of hernia, how to prepare for surgery, and what to except during your hospital stay and post-op care.

What is a ventral hernia?

A hernia occurs when there is a hole in the muscles of the abdominal wall, allowing a loop of intestine or abdominal tissue to push through the muscle layer. A ventral hernia is a hernia that occurs at any location along the midline (vertical center) of the abdomen wall. There are three types of ventral hernia:
Epigastric (stomach area) hernia. This hernia occurs anywhere from just below the breastbone to the navel (belly button). This type of hernia is seen in both men and women. Umbilical (belly button) hernia. This hernia occurs in the area of the belly button.
Incisional hernia. This hernia develops at the site of a previous surgery. Up to one-third of patients who have had an abdominal surgery will develop an incisional hernia at the site of their scar. This type of hernia can occur anytime from months to years after an abdominal surgery.

What is the Gallbladder?

The gallbladder is a pear-shaped organ that rests beneath the right side of the liver.

Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine.

Removal of the gallbladder is not associated with any impairment of digestion in most people.

What Causes Gallbladder Problems?

Gallbladder problems are usually caused by the presence of gallstones which are usually small and hard, consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct.

It is uncertain why some people form gallstones but risk factors include being female, prior pregnancy, age over 40 years and being overweight. Gallstones are also more common as you get older and some people may have a family history of gallstones.

There is no known means to prevent gallstones.

These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever.

If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.

How are Gallbladder Problems Found and Treated?

Ultrasound is most commonly used to find gallstones.

In a few more complex cases, other X-ray test such as a CT scan or a gallbladder nuclear medicine scan may be used to evaluate gallbladder disease.

Gallstones do not go away on their own. Some can be temporarily managed by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed. Treatments to break up or dissolve gallstones are largely unsuccessful.

Surgical removal of the gallbladder is the time-honored and safest treatment of gallbladder disease.

What is Laparoscopic Surgery?

laparoscopic surgery is a widely accepted surgical technique that uses small incisions and long pencil-like instruments to perform operations with a camera. As the incisions are much smaller than their open counterparts, recovery is faster and post-operative pain is typically less. Procedures such as hernia repairs, gastric bypass, bowel resection, and organ removal are now routinely carried out laparoscopically.

Laparoscopic approaches avoid large incisions on the skin and abdominal wall. These techniques avoid having the intestines exposed to the room air during surgery. While not fully understood, laparoscopic approaches cause less systemic inflammation and post-operative intestinal scar tissue.

Laparoscopic surgery has successfully replaced open surgery as the preferred treatment option for issues such as bariatric surgery and gallbladder removal. In fact this surgery can now be performed as an outpatient operation. The treatment of gastroesophageal reflux disease is now carried out using minimally invasive techniques. Laparoscopic fundoplication offers the advantage of faster recovery and quicker return to oral ingestion of food. Laparoscopic surgery for weight loss has caught on in a big way. Laparoscopy has advanced sufficiently to the extent that it can be repeated for a patient who has undergone a previous laparoscopic operation. However, care needs to be taken than organs do not get injured and to this end the entry site may have to be different and an alternate entry technique may have to be used. The risk to benefit ratio of laparoscopic surgery is improving continuously in favor of benefits.

What is Abdominal Pain?

The most common kind of abdominal pain is a stomach- or bellyache, which happens from time to time throughout our lives.

Most people experience abdominal discomfort or pain at some point in their lives. Abdominal pain is usually felt in the part of the trunk below the ribs and above the pelvis and the groin, and can range in intensity from a mild ache or nausea to severe, acute, disabling pain. People with abdominal pain often double over, clutch their gut, feel nauseated or dizzy, and avoid food and water.

While we don’t usually feel the inner workings of our abdomen, pain occurs when there is a disruption of the normal functioning of the organs and tissues inside, including the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas. The most common kind of abdominal pain is a stomach- or bellyache, which happens from time to time throughout our lives. While abdominal pain isn’t normal, it isn’t necessarily serious, and it often resolves itself.
The first step to addressing mild stomach pain not associated with a medical condition or trauma is to try to identify and avoid the trigger. For example, overeating or eating rich or gas-inducing food can cause heartburn, distended stomach, and abdominal pain, which can be avoided by practicing dietary changes and moderation. Some people find relief from stomachaches by lying on their left side, which may ease pressure on the digestive tract.

Bariatric surgery

Medicare covers some bariatric surgical procedures, like gastric bypass surgery and laparoscopic banding surgery, when you meet certain conditions related to morbid obesity.

For surgeries or procedures, it's difficult to know the exact costs in advance because no one knows exactly what services you'll need. If you're having surgery or a procedure, you can do some things in advance to figure out approximately how much you'll have to pay.

Ask the doctor, hospital, or facility how much you'll have to pay for the surgery and any care afterward.
Make sure you know if you're an inpatient or outpatient because what you pay may be different.
Check with any other insurance you may have (like a Medicare Supplement Insurance (Medigap) policy, Medicaid, or coverage from your or your spouse's employer) to see what it will pay. If you belong to a Medicare health plan, contact your plan for more information.