But some clinicians are also hesitant to discuss weight with their patients. Because obesity is so stigmatized and such a sensitive topic, many providers don’t want to offend anyone, so they don’t bring up weight at all, even when the patient’s long-term health is at risk. This is not uncommon as most providers receive inadequate training on what obesity is (a complex, chronic disease), how to treat it (medical intervention is generally indicated per guidelines) and how to discuss it appropriately with patients. Now that we have more effective treatments for obesity and access to care is slowly improving, however, patients in my obesity medicine practice have actually begun to lament that their primary care and women’s health providers are staying quiet.

Many women first experience difficulty losing weight in connection with pregnancy or menopause. But because obesity is associated with more than 200 health conditions (including type 2 diabetes, coronary disease, sleep apnea, urinary incontinence, breast cancer, osteoarthritis and depression, to name just a few), providers in virtually any context can find themselves wondering whether and how to talk to patients about their weight.

If the patient presents with an acute condition or a situation that’s not weight-related, it may not be an opportune time to bring up the subject; however, if weight is pertinent to the patient’s medical concern, gently raising the issue in the context of that condition could be appropriate and even welcome. The following are tips to help make that discussion more fruitful.

1. Ask permission

Address the patient’s concerns first, and then ask permission to talk about her weight, explaining why it’s relevant.

If the patient doesn’t want to address the issue, respect her wishes and simply let her know that you’ll be there to provide support when she’s ready.

• Think about language and tone

With regard to terminology, weight experts recommend putting people first, to avoid defining them by their disease. In the same way that we would refer to “people with schizophrenia” rather than “schizophrenics,” we say “people with obesity” rather than “obese people.” We also try to avoid euphemisms (like “people of size” or “curvy women”) as well as terms that suggest victimhood (“she suffers from obesity”).

Although obesity is widely recognized as a complex chronic disease, and many people find it extremely liberating to realize that their inability to lose weight is due to biology rather than a lack of willpower, the terms “obesity” and “disease” themselves can be off-putting. I find that most patients tend to respond better to “excess weight” and “medical condition.”

The essential thing, in every interaction, is to be empathetic and respectful. Individuals with obesity are more than pounds on a scale, and they are not lazy or lacking in willpower. They are fighting a multifactorial disease. Whatever their weight, they deserve the best in compassionate, evidence-based care — just like patients with any other condition.

• Assess without making assumptions

Always assess the situation before telling patients what to do. While it’s true that obesity can cause or compound a wide variety of health issues, excess weight isn’t always the source of these problems. Providers who immediately tell their patients to lose weight, without considering all the potential causes and conducting a thorough assessment, risk overlooking other serious conditions.

It’s also possible that the patient has already lost considerable weight; insisting she do more without acknowledging this achievement may be demoralizing. Relatively small amounts of weight loss (5%-10% of body weight) can bring significant health benefits over time, even if the individual’s BMI isn’t within the normal range, so knowing the patient’s weight history is key.

Or maybe the patient has already made all the recommended lifestyle changes but her efforts are being thwarted by medications that promote weight gain. Drug-induced weight gain is common with some forms of birth control and antidepressants, for example, and this issue should be taken into account when evaluating the risks and benefits of any medication. If a woman needs hormonal treatments for breast cancer, for instance, it’s obviously most important to treat the cancer first, but when equivalent weight-neutral medications are available in any given situation, they should be considered first.

In short, it’s critical to get the full picture and listen carefully to the patient’s story to understand what factors have contributed to her weight gain and what barriers might be preventing weight loss. Specific factors and barriers are associated with each weight-related health condition, and these factors depend on the woman’s stage of life, comorbidities and other variables. An effective individualized treatment plan requires a thorough assessment.

• Provide support

If the patient agrees that she’s ready to make changes, simply telling her to eat less and exercise more is unlikely to be helpful. Obesity is a medical condition that needs to be addressed with a comprehensive medical approach, with ongoing support and regular follow-up.

Lifestyle changes are the cornerstone of any weight-management program, so focus first on collaboratively setting realistic goals for healthy eating and physical activity. If you don’t have the time or expertise to provide the necessary guidance, you can connect your patients with outside resources such as dietitians, behavioral therapists, health coaches, and community or telehealth programs.

When lifestyle interventions have been optimized or aren’t working, consider referring patients to an obesity medicine specialist to discuss adding anti-obesity medications to the mix. These agents can help overcome metabolic adaptation (our bodies’ anti-starvation responses to weight loss that push weight back up) and allow patients to lose significant weight.

• Offer hope

Most women with obesity have tried to lose weight many times, only to gain it back. This pattern often leads not only to feelings of shame and personal failure, but also to a sense of futility. To give these women hope, it’s important to emphasize, first, that their inability to lose weight is not their fault — the body has evolved many complex hormonal, metabolic, and neurobehavioral mechanisms to actively fight weight loss — and second, that excess weight is a treatable condition.

Every day we’re learning more about this complex disease, and although only 2% of eligible patients are currently receiving medical weight management according to guidelines, telemedicine and data-driven tools are expanding access to evidence-based obesity treatment, new anti-obesity medications offer increasingly effective pharmacotherapy options, and insurance coverage of obesity treatment is improving. Now is not the time to give up!

If we as women’s healthcare providers can help our patients overcome the discomfort of bringing up a difficult topic, we can help more women with obesity achieve better health and well-being.

The post Hesitant to Discuss Weight with Your Patients? appeared first on Medika Life.

But what bout when your immune system mistakes your tissues for a threat? You may develop an autoimmune disorder.

Autoimmune conditions include type 1 diabetes, rheumatoid arthritis, multiple sclerosis, Crohn’s disease, lupus, psoriasis, certain thyroid problems, and more. Women are more likely to develop such problems.

Autoimmunity: Definition

An aberrant immune response directed at a normal body entity characterizes autoimmune diseases. The immune system’s B or T cells (or both) get revved up without an ongoing infection or other detectable cause. This unwanted response leads to cell injury and inflammation.

Autoimmune diseases can be generalized or tissue- or organ-specific. They can be acute or chronic.

With the exceptions of autoimmune thyroiditis and rheumatoid arthritis, autoimmune diseases are fortunately relatively rare. Still, autoimmune diseases, in aggregate, strike five percent of the population in Western countries.

Autoimmune mechanisms

Autoimmunity affects targets such as proteins, carbohydrates, and nucleic acids. We call such targets self-antigens or autoantigens. On the other hand, a molecule from an infecting organism that stimulates an immune response is a foreign antigen or non-self.

While autoimmune diseases are the product of a pathologic state, autoimmunity is based on mechanisms that underlie normal immune responses to foreign substances.

We may divide immune responses into two categories, including innate and adaptive. The former is a rapid, non-specific response to stress, trauma, or an infection. On the other hand, an adaptive immune response is slow (days to weeks). We make B- or T-cell antigens targeting a foreign invader for an adaptive response.

So here’s the thing: An adaptive immune response can be persistent and retain memory. In this context, autoimmune disease is the product of a specific autoimmune response to an autoantigen. There is a system failure, as normally, the immune system should prevent this kind of hyper-reactivity to self-antigens.

Autoimmune disease treatment

Autoimmune disease treatment requires substances that lower immune system activity or block the inflammation that causes tissue injury. Sometimes, treatment targets a specific infection. Other approaches aim at a functional disturbance (for example, replacing insulin for those with type 1 diabetes).

Let’s turn to some ways to protect your body from itself.

1. Autoimmune: Get a team

Gather a team that takes a whole-person approach. Members may include:

• Rheumatologists treat joint diseases such as rheumatoid arthritis and other autoimmune diseases like lupus or Sjögren’s syndrome.
• Gastroenterologists treat diseases of the GI tract, such as celiac and Crohn’s disease.
• Endocrinologists treat conditions of the glands, including Graves’ disease, Hashimoto’s thyroiditis, and Addison’s disease.
• Dermatologists treat skin conditions, such as psoriasis.
• Others. Nutritionists, physical therapists, and others can provide significant value.

2. Autoimmune: Complementary approaches

Writing in the August 2022 issue of Prevention, Dr. Andrew Weil explains that while there is generally no cure for autoimmune conditions, many are manageable with prescription medications. In addition, lifestyle and natural remedies may help, too.

• Lower your stress
• Consider an anti-inflammatory diet. This approach includes more fruits and vegetables (preferably organic) and the replacement of meat with plant-based protein. Dr. Weil also recommends increasing omega-3 fatty acids (such as salmon or sardines). These maneuvers may tamp down inflammation.
• Consider supplements. Tumeric and omega-3 fatty acids may be helpful, but check in with your doctor before considering them.

More than 80 autoimmune diseases exist. I hope we can find better solutions soon. Thank you for joining me.

The post When Immunity Goes Rogue appeared first on Medika Life.

There are a few major reasons for this:

• Patients are bearing the responsibility of a larger portion of their healthcare bills.
• Patients can’t afford to pay large hospital bills, at least not all at once.
• Healthcare billing is often confusing.

Here are a few quotes from Becker Hospital Review’s whitepaper:

• “As more patients enroll in health plans with high out-of-pocket costs, provider organizations must shift their focus to ensure patients are at the center of their revenue cycle strategy. Hospitals and health systems that fail to make this transition may see their patient experience scores and finances suffer.”
• “Patients are now responsible for more than a quarter of healthcare revenue and are the fastest growing payer.”
• “An analysis of 400,000 claims by The Advisory Board confirmed that the greater a patient’s deductible, the less likely he or she is to pay the owed amount, irrespective of his or her income level.”
• “Healthcare payments are a uniquely complex multi-party ecosystem, and the numerous bills and benefits statements patients receive after hospital visits confuse them. Patients often choose not to pay the bills because they are unsure of the amount they owe, even after comparing invoices from providers and statements from insurers over an extended period of time.”

And, here are a few more important statistics that shed some light on healthcare billing and its relation to patient experience:

• “Research from the Deloitte Center for Health Solutions shows that hospitals with better patient experiences perform better financially and there is a positive correlation between patient experience and clinical quality measures.”
• Research from InstaMed reveals that 72% of consumers preferred electronic payment for their healthcare bills. Yet in 2015, 87% of consumers received paper medical bills from their providers.” (Trends in Healthcare Payments Sixth Annual Report: 2015)
• Patient satisfaction ratings can fall by an average of more than 30% after discharge because of the billing process, according to a 2015 survey by the Hospital Consumer Assessment of Healthcare Providers and Systems

Healthcare billing can often create problems and this can have a negative impact on a patient’s overall experience.

Every hospital’s overall goal should be to make patient payment easier.
Here are some ideas to help facilitate this:

• Give patients multiple methods of payment (“71% of consumers saying that being offered multiple ways to pay increases their satisfaction” (Fiserv, “Eighth Annual Billing Household Survey, Fiserv Inc., 2016))
• Set up automatic payments and save credit card information for recurring bills.
• Consolidate multiple charges for the same visit into one bill.
• Use electronic/digital communication/billing whenever possible to speed up the process.
• Create online, user-friendly, customizable platforms to view and pay EOBs/bills.
• Offer multiple options to pay bills over extended periods of time.
• Offer discounts for paying early (even at time of service) or paying with cash.
• Educate staff on how to discuss payments with patients.
• Allow/offer the option of patients paying prior to service or while they are still on site.
• Know how much you are spending on debt collection and cut your losses when needed. Only $15.77 of every $100 is recovered once debt goes to collections. (https://nationallist.blog/2016/10/13/medical-debt-collection-difficulties/)

These solutions can help make bills less confusing, relieve patients’ financial burdens, and help hospitals reduce bad debt by seeing more bills paid and by seeing bills get paid sooner.

The post Hospital Billing and Patient Experience appeared first on Medika Life.

Fatigue and overwork have entered the equation, as it always has, and we should have remediation currently, but do we? Hurriedly rushing to complete chart notes is no excuse for including inaccuracy, not including information, or entering unintended bias in an attempt to meet the timely completion of a healthcare professional’s daily workload.

It would seem that electronic records would eliminate powerful and potentially damaging information, or lack thereof, from the chart record.

Patients too often never had access to their records, but that is changing in our new electronic health records decade where patients can access “patient portals” and review what has been immortalized. Formerly, patients had to request hard copies of patient summary visit notes, which weren’t always forthcoming.

One neurologist who didn’t know his summary would be read by a patient who came for a consult presented a dim view of the woman. He referred to her as a “mirthless woman” and proceeded to go downhill from there.

A recent study of 600 encounters with 138 physicians appeared in a prestigious medical journal. The study found six ways that physicians “express part of positive findings toward patients in medical records, including comments, approval, and personalization.”

However, in addition to these laudatory comments, the researchers also found five ways medical professionals “express negative feelings toward patients, including disapproval, discrediting, and stereotyping.”

How may the latter affect those healthcare professionals who read these chart notes in the future? The question almost doesn’t need to be asked because we already know the answer; negatively.

The Power Differential in Healthcare

The current study was revealing in its negative comments, which will affect future readers of these charts.

Negative themes noted in the 600 encounters notes included:

questioning patient credibility

expressing disapproval of patient reasoning or self-care

stereotyping by race or social class

portraying the patient as difficult

emphasizing patient authority over the physician authority over the patient

Physician authority over the patient? Isn’t this supposed to be a working relationship with the patient and the physician, who both come to an understanding? One is not in a position of one up, while the other is always in a one-down position, or are they? Is this an artifact of the study or reality-based in all areas?

It reminded me of a time when I was standing with a family next to the bed of a hearing-impaired woman who was gravely ill. Her hands had been tied to the bed rails, prohibiting her use of ASL. This was done despite a clear sign over her bed which indicated she was hearing-impaired.

A young physician came in and didn’t like that the family told him the patient had not signed consent for treatment and needed to use her hands to communicate. “I don’t care what you say,” he said. “You can talk to me until you’re blue in the face, and I’ll do as I want,” and with that, he stormed off.

After the woman died at another hospital to which she had been transferred once she developed sepsis, the hospital, which a surgeon owned, was charged with insurance fraud (they had an unnecessary surgical procedure gambit running with shelters for men), closed, and opened with a new name afterward. So much for change.

Which groups receive poorer quality of care than others according to certain factors in the medical record? They have included racial/ethnic identity, social class, older adults, individuals with low health literacy, obesity, and substance use disorders. There are also problems in a person’s language ability that can affect medical outcomes.

In one study, 655 emergency medical physicians used the term “sickler” which indicated the patient had sickle cell disease. Language, hearing, or reading ability also contributed to problems in the medical record.

The most recent study also stated that “Readers of stigmatizing (vs. normal) language had more negative attitudes toward the patient and opted to administer less analgesia, even though all clinically relevant information was the same.”

Bias, therefore, was shown even in the administration of pain-relieving medications (the ‘sicklers’) as a result of a note in the chart. Should patients have suffered this way? Undoubtedly, the answer is in the negative. But this was particularly noted in sickle cell disease, which would indicate a racial bias of the writer. Do medical professionals believe that Black patients need less pain medication than white patients? I would advise you review this in the medical literature or is it a question of medical training?

The documentation of any medical information must be devoid of anything but relevant medical information that contributes to the treatment and diagnoses of patients. The problem appears to stem from an inability of supervision in this area because of the crush of business that hospitals have brought on themselves.

How will electronic health records serve as a means to curb this type of behavior? Unless artificial intelligence reaches a level that can clearly distinguish between utilitarian information and unnecessary personal bias, it will continue. The continuance of this heinous behavior is one of which everyone in healthcare must become fully aware.

We must do our best to ensure that records are clearly scientific-based and avoidant of personal biases. There is no excuse for writing records that may damage the patient in the future. In fact, this diminishes the profession as a whole and must be countered; however, we must do it.

The post Healthcare Chart Notes Set the Stage for Dangerously Skewed Negative Patient Profiles appeared first on Medika Life.

Now, it is common for full-term pregnant people to have contractions, even if they do not hurt. After abdominal trauma, contractions can indicate an obstetrical emergency, and it is somewhat routine to have a cervical exam to rule out labor or other complications. It is also okay for a patient to decline a cervical exam given all that information. 

But my sister was kept in the hospital for several hours because she declined a cervical exam. She did not “refuse” or act belligerent, she enacted her right to decline a procedure based on knowledge of her body and the risks/benefits of the cervical exam. 

The nurse, however, told her, “Well, then we’re not letting you go since you won’t let us examine you.” Honestly. Repeat that sentence out loud. 

Once you’re as mad as I am about that sentence, think about this: Millions of people refuse medical treatment/procedures every day and are often given consequences or ridicule by healthcare providers. 

There can be a significant perception of inequality by patients, most notably if they feel the provider is condescending or “knows best.”

As a healthcare provider, I want the very best for my patients. But I also know that what I want for my patients may not be what the patient wants. And that’s okay. 

As long as I have educated my patient on the risks, benefits, and alternatives of a medication, procedure, or screening option, then the patient has every right to decline or accept treatment without punishment or derisive comments by the healthcare team. 

On the flip side, the provider has the right to refuse further treatment for a patient that declines care because the liability may be too risky. And that’s also okay! 

The most important aspect of any treatment plan is ensuring the patient is informed of every aspect of the plan, and not just what I want to tell the patient to get them to concede to my plan.

Shared decision-making between a patient and provider is supposed to be shared, not dominated by the provider because patriarchal healthcare is no care at all. 

Compliance is not the same as informed consent; healthcare compliance may be an acquiescence to the standard line, “Well, my provider knows what’s best for me.” No, my friends, the provider knows the best recommendation or treatment options based on conditions, risk factors, socioeconomic status, and historical medical issues. 

What is best for you is to understand why the provider is recommending/prescribing a treatment for you, and to understand that you can say no.

You don’t want a cervical exam? You don’t want to undergo a biopsy? You don’t want a specific medication? Then just say no. But in all fairness, if your provider provided you with all the education on risks, benefits, and alternatives, then have the decency to tell your provider why you are declining. If there is a lack of understanding or knowledge, then your provider can clarify those issues for you. 

Before you consent or refuse a treatment, always make sure you understand what that will mean for you and your body.

For the healthcare providers, ask yourselves why it is so important for a patient to consent to your treatment plan. Is it due to compassion for the patient’s well-being, or because you believe you know more than the patient?

Incomplete and inadequate education puts patients at risk. 

Uninformed or partially informed consent is not consent. 

Don’t put all of your success as a provider on your ability to get patients to do what you want. I am always curious about patient motives when they actively seek treatment but don’t want to follow through with my recommendations, but it is not my job to understand. It is my job to inform.

One last point to consider. The internet is full of information and not all that information is accurate or applicable to all people. If you have a medical question, ask a medical provider. 

Do not limit your decisions based on the experience or limited knowledge of some Keyboard Karen on social media.

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold.

The post Putting the Information Back into Informed Consent and Refusal appeared first on Medika Life.

The average American is blissfully unaware of this world, even though it directly affects them, often in hugely personal ways. Your most intimate details, like medical records, may be available for sale online and there’s nothing you can do to prevent it.

When the hack, referred to as a Ransomware Attack, hits closer to home, it becomes public knowledge. Take for instance the attack in early May on American gasoline supplier Colonial Pipeline, which crippled many cities. Americans were soon queuing for gas, hoarding supplies, as gas stations across the US closed or ran out of gas. 

The hackers had taken control of the systems operating the supply of gasoline via pipelines that criss-cross America. This was personal and the American public felt the effects first hand. Ransomeware was all over the news.

What most Americans don’t realize, however, is just how common these attacks are. It’s the perfect digital crime. Take over some company’s system, shut it down remotely from a place of safety, and then demand payment from the company. Once the company pays — the ransom — their systems are unlocked and they can resume business.

Bizarrely, the hacker’s “code of ethics” for want of a better term, seems to hold true. Once payment is made, the systems are released. Payment is a simple matter, digital currencies like Bitcoin make tracking the money all but impossible. 

It could be argued that without access to digital currencies, these hackers would be unable to extort money from their victims without leaving a clear trail for authorities to pursue.

Aside from the obvious inconvenience and potential dangers to essential energy supplies and other critical systems, there is another hugely unreported consequence of these hacks. The bleeding of personally identifying data. That’s your info and mine, all of it fair game. Don’t forget, these hackers are inside the systems they compromise, they have sufficient access to lock down the system.

It would be hugely naive to imagine they simply leave it there. While companies run around trying to secure loans to pay off ransom demands, the hackers are merrily downloading every shred of data they can strip from the systems.

That’s where the real value lies. Your information or data, which is spread throughout numerous systems across the US. This data is worth real hard cash on the dark web, especially certain types of personal data, like your healthcare information. From recent reports, it would appear no systems within the US are immune.

Your Data, Healthcare, and the silent war

Most ransomware attacks never see the public light of day. They’re kept quiet and settled away from the prying eyes of the media and the public. For very good reasons. Investors don’t like companies that appear vulnerable and companies would rather not spend the next six months explaining to their customers that their data was compromised.

Healthcare is particularly vulnerable. It’s a sector favored by hackers. Easy access to poorly protected systems, rich data pickings, and a culture of “keeping it on the QT’ among medical institutions, hospitals, and healthcare systems make this sector almost irresistible. 1 in 3 companies or institutions within healthcare get hit, according to a recent whitepaper from IT Security firm Sophos. Here are the key takeaways from the paper. 

• 34% of healthcare organizations were hit by ransomware in the last year.
• 65% that were hit by ransomware in the last year said the cybercriminals succeeded in encrypting their data in the most significant attack. 
• 44% of those whose data was encrypted used backups to restore data. 
• 34% of those whose data was encrypted paid the ransom to get their data back in the most significant ransomware attack. 
• However, on average, only 69% of the encrypted data was restored after the ransom was paid. 
• 89% of healthcare organizations have a malware incident recovery plan. 
• The average bill for rectifying a ransomware attack, considering downtime, people time, device cost, network cost, lost opportunity, ransom paid etc. was US$1.27 million. While this is a huge sum, it’s also the lowest among all sectors surveyed.

Scripps is an excellent example in case. Scripps began notifying more than 147,000 individuals in early June this year that their protected health information was exposed during a malware attack. They now face 4 class-action lawsuits.

For certain patients, exposed information included names, addresses, birthdates, health insurance data, medical record numbers, patient account numbers, and treatment details. Less than 2.5 percent of individuals’ Social Security numbers and/or driver’s license numbers were involved, according to the health system.

The list of attacks is growing exponentially.

• 500,000 patient files were potentially stolen in a ransomware attack on Iowa clinics.
• 334,000 Ohio Medicaid providers’ data were breached in a vendor hack

Keep in mind that only a small percentage of these attacks are ever made public and the data above should serve as a fair warning to all healthcare organizations. No one is immune and even smaller organizations are targeted.

Protecting yourself

Clearly, we cannot exist in a modern society without sharing our most private details with companies on a daily basis. There is a huge amount of trust involved, and where many Americans now simply take this relationship for granted, assuming companies will protect their information, ransomware exploits have exposed clear flaws in companies’ approaches to protecting our privacy.

We cannot affect or restrict the data we share without compromising, for instance in a healthcare setting, our quality of care and service. In these instances, the onus falls squarely on the shoulders of the service providers to protect our data and they are failing. 

Our only recourse in this instance is to lobby our congressmen and women. Changes need to be urgently brought to bear on the holders of personal data, fines imposed for lack of proper security, and audited processes put in place to ensure our data is safe.

This is going to prove challenging, particularly when not even the federal government’s systems appear immune to attack. Perhaps it is time to apply Bitcoin-style encryption to our data and fight fire with fire.

The post Held for Ransom. A New Pandemic is Sweeping American Healthcare appeared first on Medika Life.

When the baby is delivered through an incision in the abdomen and uterus, it is called a cesarean delivery or C-section. Most women will have a horizontal lower abdominal incision. Sometimes surgeons make a vertical incision if a woman has an extensive past surgical history or large uterine fibroid or if there is an emergency. 

Some women will choose to have a permanent contraception surgery, or tubal ligation, with their c-section.

Why do some women need a cesarean delivery?

Some women with a history of a prior c-section will have a scheduled cesarean delivery. Some women require cesarean delivery during labor. The most common reasons for a cesarean birth during labor are unsuccessful labor and fetal distress. Sometimes during labor, the contractions fail to open the cervix enough for the baby to pass through the birth canal.

Fetal distress means that the baby’s heart rhythm is abnormal and indicates that the baby’s health is in danger. Delivery via cesarean section may be the fastest way to remove the baby from the stress of labor and also the fastest way for the medical team to evaluate the baby. 

Other common reasons for a scheduled cesarean delivery include:

1. Breech or fetal malpresentation (not head down) 
2. Twin pregnancy
3. Prior uterine surgery (myomectomy)
4. Placenta disorders like placenta previa  

What are the possible complications of cesarean delivery?

Most women will have an uncomplicated C-section. A small percentage of women may develop complications and these are usually easily treated. Potential complications include bleeding, infection, injury to the bowel or bladder, blood clots in legs or lungs, and reactions to anesthesia.

For most women, vaginal delivery carries less risk of heavy bleeding, infection, and injury to abdominal organs compared to c-section. Vaginal delivery is also associated with less risk of postoperative complications and shorter recovery times compared to cesarean delivery. However, some women may not be candidates for vaginal delivery and some women may develop unavoidable indications for cesarean delivery during labor. You and your doctor will determine which approach is most suitable for you.

How long will I be in the hospital?

Most women will need to stay 48-72 hours after cesarean delivery. Various factors, such as the reason for C-section, surgical complexity and postoperative recovery course help determine the surgical plan.

Can my family visit me?

A trusted family member should drive you to and from the hospital. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary with the ongoing COVID-19 pandemic.

Does my procedure require an anesthetic?

Most women receive regional anesthesia for cesarean delivery. This can be an epidural and/or a spinal block. During regional anesthesia, only the lower half of the body is numbed and the patient is awake during the procedure. This technique allows the mom to be awake during delivery and enjoy the experience of seeing their newborn baby.  To place a regional block, a tiny incision is made in the lower back. For an epidural, a small tube is placed to deliver medication through the tube when needed. For a spinal block, the drug is injected directly into the spinal fluid. 

Rarely, general anesthesia is needed for cesarean delivery. This means that the patient will not be awake during the delivery. General anesthesia is used only if the regional block does not work or if there is an emergency without enough time to administer a regional block.  

How should I prepare?

For scheduled cesarean sections, at your final OB appointment, the doctor will review your specific instructions. You should also confirm the date, time, and location of the surgery. We will need to carefully review your medications and plan when the last dose should be taken prior to the surgery and when to resume medications. This is particularly important for patients taking aspirin, blood pressure medicines, and diabetes medicines. 

Your doctor should review all medication and food allergies. We remind patients to avoid alcohol 24 hours before the surgery. We also instruct patients to refrain from eating or drinking at least 8 hours prior to the surgery time. 

Please keep in mind that the hospital will perform a car seat check prior to discharge (it needs to be purchased prior to discharge). Also if you are planning on cord blood banking, please bring your kit with you to the hospital. 

The hospital will supply almost everything you and your baby will need for your stay, including gowns, pads, underwear, baby clothing, diapers, breast pumps, formula, and bottles. However, you will need to bring clothes and supplies for your trip home. Some women also prefer to bring some of their own things to be more comfortable, such as their toothbrush, comfortable clothing, and lotion.   

What happens after I check-in at the hospital?

After checking in on Labor & Delivery, you will change into a surgical gown and store your belongings. You will meet the nursing team who will provide care during your surgery. They will review your medical history. The surgical consent form is reviewed, signed, or updated with any changes. An IV will be placed at this time. 

The anesthesia team will also interview you and answer questions. Typically your surgeon will review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure. Then the anesthesiologist will place the regional block. 

After the anesthesiologist has confirmed the regional block is functioning appropriately, the OR team will lay you down and adjust your position. The anesthesiologist will administer IV antibiotics through your IV. The OR nursing team will then apply an antibacterial fluid to your abdomen, trim the pubic hair if needed, and cover your body with drapes. In addition, a tube called a foley catheter will be placed in your bladder to drain urine. 

The team then performs a “surgical time-out.” A surgical safety check-list is read aloud, requiring all surgical team members to be present and attentive. One family member is allowed to be with you during the procedure and is called to your side at this time. 

The OB/Gyn begins by making a skin incision in the lower abdomen. It is typically horizontal, but sometimes a vertical incision is needed if there is an extensive surgical history, a known pelvic mass such as a large fibroid, or if there is an emergency. 

The abdominal muscles are separated and the uterus is visualized. An incision is then made in the uterine wall. This incision is also typically horizontal. The baby is delivered through these incisions and the umbilical cord is clamped and cut. The baby is given to a special team of nurses for immediate evaluation. After the baby is evaluated, the baby will be brought to the mother. 

The placenta is then removed and the uterus is sewed closed with stitches that will dissolve as the uterus heals over the next few weeks. The surgeons then confirm there is no active bleeding. If permanent birth control is planned, it is performed at this time. Finally, the abdomen and pelvis are washed in a warm saltwater solution and all the abdominal wall layers are closed. The skin is closed with dissolvable sutures or staples.

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the team will transfer the patient to the recovery room.

What happens in the recovery room and postpartum ward?

The recovery room is equipped to monitor patients’ blood pressure, heart rate, and bleeding after surgery. In the recovery room, we encourage mothers to begin breastfeeding. 

You will remain in the recovery room for observation for 1-2 hours. Afterward, you will be moved to a hospital room in the postpartum ward.

Immediately after the C-section, you will need to stay in bed until the regional block wears off and you are able to use your legs.  You will need someone to assist the first few times you move out of bed.  Because the lower half of the body is still numb, the bladder catheter is usually removed the next morning. 

As soon as possible, your nurses will encourage you to move around as much as you can. You may be encouraged to get out of bed and walk after your operation. Walking helps reduce the risk of blood clots. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal. 

Your incision may be sore for the first few weeks. The nursing team will give pain medicine as needed to help keep you comfortable. 

If you want to breast-feed, the lactation consultant will typically visit to provide guidance and support. The neonatal team will be monitoring the baby’s health for the first few days of life.

AFTERCARE AND RECOVERY QUESTIONS 

What preparations should I make for aftercare at home?

You should speak with your physician regarding the resumption of exercise and sexual activity. Your doctor will also review wound care instructions. We generally recommend avoiding strenuous activity, heavy lifting, and sexual intercourse for 6 weeks after cesarean delivery. Also please avoid inserting anything into the vagina (no sex, tampons, or douching) until cleared by your doctor. 

Some mild cramping and light bleeding are expected after c-sections. You may have more cramping if you are breast-feeding.

Most women can return to basic activities in one to two weeks. Generally, we recommend patients stick to light activity only for the first 4–6 weeks. Light exercise helps your body heal and prevents some postoperative complications. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. 

You may resume a regular diet on the day of surgery. It may be helpful to prepare some meals and do your grocery store shopping and laundry before surgery. If you are breast-feeding, it is recommended to continue the prenatal vitamins to ensure good nutrition for you and your baby.

You will be given instructions to help control postoperative pain during healing. Some pain is expected for the first few weeks after the surgery. You may also have light bleeding and vaginal discharge for a few weeks. Sanitary pads can be used after the surgery. Constipation is common after cesarean deliveries. Try a stool softener and fiber supplement. Some women have temporary problems with emptying the bladder. 

Your doctor will schedule a postpartum visit 4–6 weeks after the procedure. We also schedule a wound check 1-2 weeks after delivery. At this time, the incision is inspected for appropriate healing. We also review your contraception options and evaluate for postpartum depression. 

After your postpartum visit, we recommend continuing your annual routine gynecologic exams.

Danger Signals to look out for after the procedure

Call your doctor or report to the ER if you experience:

• Pain not controlled with prescribed medication
• Fever > 101
• Severe nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas or have a bowel movement

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

This article was contributed by MacArthur Medical Center’s Dr. Reshma Patel

The post Preparing for Cesarean Delivery (C-Section) appeared first on Medika Life.

A hysterectomy is a surgery to remove the uterus. Gynecologists perform hysterectomies for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse, and gynecologic cancer.

During a hysterectomy, a surgeon removes the uterus. Gynecologists often recommend removing the fallopian tubes (bilateral salpingectomy) to reduce the risk of ovarian cancer. Some women will also need the removal of the ovaries (oophorectomy). Removal of the ovaries triggers hormonal changes. After a hysterectomy, a woman can longer get pregnant.

Gynecologists perform hysterectomies through a variety of techniques. The patient’s uterus size, body type, and prior surgical history help determine the surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy
3. Laparoscopic hysterectomy
4. Laparoscopic-assisted vaginal hysterectomy
5. Robotic hysterectomy

What are the advantages of abdominal hysterectomy?

In an abdominal hysterectomy, the uterus is removed through an incision in the lower abdomen. The abdominal incision gives a large clear view of the pelvis and allows us to work through adhesions from prior surgeries or endometriosis most carefully. It can be performed even if the uterus is huge.

However, abdominal hysterectomy is associated with a greater risk of complications than a vaginal hysterectomy or laparoscopic hysterectomy.

Wound infections, bleeding, blood clots, and nerve and tissue damage are more common. Abdominal hysterectomy also requires a more extended hospital stay and a longer recovery time.

Some patients may not be candidates for minimally invasive approaches because of uterine size or prior surgical history. Your doctor will determine which surgical approach is most suitable for you.

Is a hysterectomy safe?

Hysterectomy is a very safe surgical procedure, and complications are rare. However, as with any surgery, problems can occur, such as:

• Fever and infection
• Heavy bleeding during or after surgery
• Injury to the urinary tract or nearby organs
• Blood clots in the leg that can travel to the lungs
• Breathing or heart problems related to anesthesia
• Death

Some problems are discovered immediately, and some may not show until days, weeks, or even years after surgery. These problems include the formation of a blood clot, infection, or bowel blockage. Complications are generally more common after an abdominal hysterectomy and in women with certain underlying medical conditions.

How long will I be in the hospital?

Most women will need to stay 1–2 nights after an abdominal hysterectomy. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Can my family visit me?

A trusted family member should drive you to and from the hospital. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary with the ongoing COVID-19 pandemic.

Does my procedure require an anesthetic?

An abdominal hysterectomy requires general anesthesia, meaning patients will temporarily be put to sleep. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

Why do I need a preoperative clinic visit?

Most surgeries will involve a preoperative visit with your surgeon to review the procedure’s risks and benefits and answer your questions regarding the upcoming surgery. Because hysterectomies will eliminate the possibility of child-bearing, your doctor will confirm that you do not want children in the future.

It is essential to provide your doctor with an updated list of all medications, vitamins, and dietary supplements before surgery. The surgical team will review your medications. Together we can plan when to take the last dose when to resume medications. Medication management is particularly important for patients taking aspirin, blood pressure medicines, and diabetes medicines. Your doctor should review all medication and food allergies. We remind patients to avoid alcohol 24 hours before the surgery.

If any blood work or preoperative testing is required, it will be scheduled and confirmed. If appropriate, share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon before your surgery. Some patients may need to supply a surgical clearance letter from their primary care physician.

Finally, the doctor will give instructions regarding your diet before the surgery.

Try to avoid wearing jewelry, make-up, nail polish/acrylic nails on the day of surgery. If you wear contacts, glasses or dentures, please bring a case.

You should also confirm the date, time, and location of the surgery.

What happens after I check-in at the hospital?

After arrival at the hospital, the staff will guide you to the pre-operative holding area to change into a surgical gown and store your belongings. You will meet the nursing team who will provide care during your surgery. They will review your medical history. The surgical consent form is reviewed, signed, or updated with any changes. An IV will be placed at this time. You may be given special stockings to help prevent a blood clot.

The anesthesia team will also interview you and answer questions. Typically your surgeon will review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure. Then the anesthesiologist will give medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and apply an antibacterial fluid to your abdomen and vagina. After you are asleep, a tube called a catheter will be placed in your bladder to drain urine. The team then performs a “surgical time-out.” A surgical safety check-list is read aloud, requiring all surgical team members to be present and attentive.
The gynecologist begins by making an incision in the lower abdomen. It is typically horizontal, but sometimes a vertical incision is needed if there is a large uterus or large mass.

Once the uterus and ovaries are visualized, we place a metal retractor to maintain a clear view of the pelvis. This step helps us safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon works carefully from the outer edges inward. First, we dissect the broad ligament, the thin layer of connective tissue covering the female organs. If the plan is to remove the ovaries, we start with this step. Otherwise, we begin by separating the tubes from the surrounding tissues until the uterus is reached. 

The surgeon then separates the uterus from the surrounding connective tissue by moving downward toward the cervix. At this point, the surgeons detach the bladder from the uterus. After the bladder is safely out of the way, the surgeon will focus on the uterine arteries.

These two blood vessels are the main blood supply to the uterus and travel over the ureters, the tubes which connect the kidney to the bladder. Once the uterine arteries are controlled, the surgeon then safely gradually separates the uterus from the body. Depending on the anatomy, bleeding, or scar tissue, the surgeon may decide not to removal the cervix. 

The uterus and tubes (and sometimes ovaries) are sent to the pathology lab for microscopic analysis. The surgeon examines all of the surgical sites for bleeding.

The surgeon then sews the edges of the vagina closed to form the vaginal cuff. If the cervix has not been removed, it is carefully inspected for bleeding.
Afterward, the abdomen and pelvis are washed in a warm saltwater (saline) solution. Then, the layers of the abdominal wall and skin are carefully closed.
Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake up the patient and then transfer her to the recovery room.

AFTERCARE AND RECOVERY QUESTIONS

What happens in the recovery room?

Once the operation is over, you will be moved into the recovery area. This area is equipped to monitor patients after surgery.

Many patients feel groggy, confused, and chilly when they wake up after an operation. You may have muscle aches or a sore throat shortly after surgery. These problems should not last long. You can ask for medicine to relieve them. You will remain in the recovery room until you are stable. Afterward, you will be moved to a hospital room for the rest of your stay.

As soon as possible, your nurses will have you move around as much as you can. You may be encouraged to get out of bed and walk around more quickly after your operation. Walking helps reduce the risk of blood clots. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal.

What preparations should I make for aftercare at home?

You should speak with your physician regarding the resumption of exercise and sexual activity. Your doctor will also review wound care instructions. Sexual activity is typically restricted for 6–8 weeks to allow the vagina to heal. Do not insert anything into your vagina — no sex, tampons, or douching — until cleared by your doctor.

Most women can return to basic activities in one to two weeks. Generally, we recommend patients stick to light activity only for the first 4–6 weeks. Light exercise helps your body heal and prevents some postoperative complications. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. Avoid strenuous exercise and heavy lifting.

You may resume a regular diet on the day of surgery. It may help prepare some meals and do your grocery store shopping and laundry before surgery.

You will be given instructions to help control postoperative pain during healing. Some pain is expected for the first few weeks after the surgery. You may also have light bleeding and vaginal discharge for a few weeks. Sanitary pads can be used after the surgery. Constipation is common after hysterectomies. Try a stool softener and fiber supplement. Some women have temporary problems with emptying the bladder after a hysterectomy. Some women have an emotional response to hysterectomy. You may feel depressed that you are no longer able to carry a pregnancy, or you may be relieved that your former symptoms are gone.

Your doctor will schedule a postoperative examination 4–6 weeks after the procedure.

After recovery, we recommend continuing your annual routine gynecologic exams. Depending on your age and reason for the hysterectomy, you may still need pelvic exams and pap tests.

Danger Signals to look out for after the procedure

Call your doctor or report to the ER if you experience:

• Pain not controlled with prescribed medication
• Fever > 101
• Severe nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas or have a bowel movement

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

This article was contributed by MacArthur Medical Center’s Dr. Reshma Patel

The post Preparing for: Abdominal Hysterectomy appeared first on Medika Life.

An endometrial biopsy is a simple office-based procedure where a doctor removes a small amount of tissue from inside the uterine cavity. This tissue is called the endometrium. To find out if any abnormal cells are present, the doctor must sample the endometrial tissue to be tested and evaluated under a microscope.

An endometrial biopsy is used to diagnose or rule out endometrial cancer or precancerous changes in the tissue called endometrial hyperplasia.

Women with postmenopausal bleeding, heavy periods, irregular periods, or abnormal findings on a sonogram may be candidates for this procedure. Most often, an endometrial biopsy is performed as part of the evaluation of abnormal uterine bleeding, but it also is used in cases of infertility.

What does this procedure involve?

The gynecologist inserts a thin, flexible tube called a pipelle into the uterine cavity through the cervix’s opening called the cervical os. Using negative pressure, the doctor pulls a small amount of endometrial tissue into the pipelle for sampling. The procedure takes only a few minutes and causes mild cramps.

Where is an endometrial biopsy procedure performed?

Gynecologists perform endometrial biopsy procedures in an office setting.

Can my family visit me?

Endometrial biopsies are performed in a medical office setting. The vast majority of patients will be able to drive themselves to and from the procedure. Some may prefer a trusted family member to bring them. 

Does my procedure require an anesthetic?

Anesthesia is not typically required for an endometrial biopsy procedure. Some physicians spray a topical anesthetic directly onto the cervix. Occasionally, gynecologists provide local anesthesia via a paracervical anesthetic.

A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery.

Some gynecologists recommend oral medication to reduce anxiety

What’s the procedure when I check in?

Most procedures will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed.

The consent form is reviewed, signed, or updated with any changes.

Because an endometrial biopsy is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

What happens in the procedure room?

Your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in position to allow visualization of the cervix, the procedure will attempt to pass a small pipelle through the cervix into the endometrial cavity. If the cervical os (opening) is too narrow, then the doctor will attach an instrument called a Tenaculum to the top of the cervix to stabilize the uterus. Then, they will use a small tool to dilate the cervix wide enough for the pipelle to enter. 

Once the pipelle is safely inside the uterus a small amount of endometrial tissue is pulled into the tube for sampling. 

These cells are sent to a pathologist for evaluation. 

After the biopsy, the speculum is removed and the procedure is complete. Some patients will experience mild bleeding, spotting or a brown, coffee-ground vaginal discharge over the next few days.

How long will I be in the procedure?

Once the patient enters the procedure room a series of safety steps must occur.

An endometrial biopsy procedure takes approximately 2–5 minutes. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments

When can I go home?

After an office-based endometrial biopsy procedure, patients may go home after getting dressed as long as you are feeling normal.

Post-procedure recovery time will vary from person to person.

Endometrial biopsy procedures require a minimal amount of recovery. Patients may leave as soon as the procedure is complete.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time

You should be able to resume all work and household activities on the same day as your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

• Some patients will require mild pain medication like NSAIDs.
• It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.
• You will be instructed to abide by pelvic rest for approximately 1–2 days. This includes no douching, no sex, and no tampons.
• You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the same day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is to avoid vaginal intercourse for 1–2 days.

You should not use tampons for 1–2 days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination to review the pathology report findings. If any abnormalities are found on the biopsy, your doctor will discuss the next steps

Danger Signals to look out for after the procedure

After an endometrial biopsy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge

What should I pack at home?

Nothing special is required after an endometrial biopsy procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for an Endometrial Biopsy appeared first on Medika Life.

It descends downward into the superior mediastinum of the thorax, positioned between the trachea and the vertebral bodies of T1 to T4. It then enters the abdomen via the oesophageal hiatus (an opening in the right crus of the diaphragm) at T10.

The abdominal portion of the oesophagus is approximately 1.25cm long – it terminates by joining the cardiac orifice of the stomach at level of T11.

Anatomical Structure

The oesophagus shares a similar structure with many of the organs in the alimentary tract:

• Adventitia – outer layer of connective tissue.
  • Note: The very distal and intraperitoneal portion of the oesophagus has an outer covering of serosa, instead of adventitia.
• Muscle layer – external layer of longitudinal muscle and inner layer of circular muscle. The external layer is composed of different muscle types in each third:
  • Superior third – voluntary striated muscle
  • Middle third – voluntary striated and smooth muscle
  • Inferior third – smooth muscle
• Submucosa
• Mucosa – non-keratinised stratified squamous epithelium (contiguous with columnar epithelium of the stomach).

Food is transported through the oesophagus by peristalsis – rhythmic contractions of the muscles which propagate down the oesophagus. Hardening of these muscular layers can interfere with peristalsis and cause difficulty in swallowing (dysphagia).

Oesophageal Sphincters

There are two sphincters present in the oesophagus, known as the upper and lower oesophageal sphincters. They act to prevent the entry of air and the reflux of gastric contents respectively.

Upper Oesophageal Sphincter

The upper sphincter is an anatomical, striated muscle sphincter at the junction between the pharynx and oesophagus. It is produced by the cricopharyngeus muscle. Normally, it is constricted to prevent the entrance of air into the oesophagus.

Lower Oesophageal Sphincter

The lower oesophageal sphincter is a physiological sphincter located in the gastro-oesophageal junction (junction between the stomach and oesophagus). The gastro-oesophageal junction is situated to the left of the T11 vertebra, and is marked by the change from oesophageal to gastric mucosa.

The sphincter is classified as a physiological (or functional) sphincter, as it does not have any specific sphincteric muscle. Instead, the sphincter is formed from four phenomena:

• The oesophagus enters the stomach at an acute angle.
• The walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
• The folds of mucosa present aid in occluding the lumen at the gastro-oesophageal junction.
• The right crus of the diaphragm has a “pinch-cock” effect.

During oesophageal peristalsis, the sphincter is relaxed to allow food to enter the stomach. Otherwise at rest, the function of this sphincter is to prevent the reflux of acidic gastric contents into the oesophagus.

The post The Esophagus appeared first on Medika Life.