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STAR Hospital - Region's First Internationally Certified Super-Specialist Centre for Bariatric Surgery and Advanced Laparoscopic Surgery. Dr. Jasmeet Singh Ahluwalia (MS, FNB-MAS, FBMS) Super-Specialist Bariatric, Metabolic & Advanced Laparoscopic Surgeon Helpline: +91-9888958889 Website: http://drjasmeetahluwalia.com YouTube channel : https://youtube.com/c/drjasmeetsinghahluwalia Facebook page: https://m.facebook.com/drjasmeetahluwalia/ Google Map Link - Dr Jasmeet Singh : http://location.drjasmeetahluwalia.com Star Hospital : http://location.thestarhospital.com Appointment: 0181-4674888 For International Patients- - Tour planning & help in medical visa - Airport pickup and drop - Deluxe Suit - Local accomodation - Long term followup from India Why is ERCP performed? Jaundice (yellowing of eyes or skin). Abnormal liver blood tests. Blockage of bile or pancreatic ducts caused by stone, cancer or narrowing (stricture). To alleviate bile leak after surgery How is it done? A special endoscope is inserted through mouth and opening of CBD (pipe connecting liver with bowel) is entered. Then stone is removed and a stent may be left in place to keep it open for some time. In case of cancers, stent helps to keep CBD open and relieve jaundice. In cases of stricture, a balloon can be used to dilate it. By injection of a dye which can be immediately viewed on Xray, we can get more information about bile ducts and pancreatic ducts. An ERCP can give more information about the pancreas and bile ducts, and brushings and biopsies (specimens of cells for analysis) can be taken from the bile ducts or the pancreas. Risks? ERCP is generally safe but complications can sometimes occur. Mild- Mild abdominal discomfort Sore throat Mild pancreatitis Inability to gain access to the bile or pancreatic ducts Major- Severe pancreatitis can occur following an ERCP but is rare Infection in the bile duct can occur (cholangitis). Usually settles with antibiotics Bleeding - usually stops quickly by itself Very frail and/or elderly patients can get pneumonia A hole may be made in the wall of the duodenum (perforation), either as a result of sphincterotomy or due to a tear made by the endoscope. This happens in less than one in 750 cases and might require surgery Although ERCP carries risks, it is only carried out when the doctors have carefully balanced the risks of doing this test compared with doing any other test or operations, and the risks of doing nothing. Laparoscopic Cholecystectomy- This surgery is performed to remove gall bladder. Gall Bladder is a small pear shaped organ which lies under liver in right upper part of your abdomen as shown in pictures above. Its function is to store bile (digestive juice) secreted by liver in-between meals. Since its size is small as compared to amount of bile produced by liver, it concentrates bile inside it. When bile becomes too concentrated, stones are formed. Common symptoms of Gall Bladder stones – They may not cause any symptoms at all for many years. Pain in the right upper abdomen (Can be in upper centre abdomen as well) when stone blocks gall bladder. Pain may be short lasting if stone dislodges quickly (called biliary colic) or may be long lasting when gall bladder becomes inflamed and may start to have infection inside it. Nausea or vomiting may occur as well. Loss of appetite or dyspepsia. Jaundice can occur if stone slips into bile duct thereby blocking the flow of bile (liver juice). Fever may occur if infection becomes severe. But all these symptoms may not be present and others may be present. Hence examination by your doctor is very crucial to diagnose or rule-out gall stone pain. It usually occurs in females of 20 to 40 but no age is immune and many males also have gall stones. Causes- There are many reasons for it and it is usually impossible to find out exact cause in most patients. 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State officials now say only dispensaries can sell CBD products, but some store owners say CBD and marijuana are not the same. Two stores at Cincinnati’s Findlay Market were forced to remove CBD products from their shelves after they received visits from the Cincinnati Health Department. “This entire shelf was full of CBD seltzers and all the wonderful flavors,” said Debbie Gannaway who owns Gramma Debbie’s Kitchen. Gannaway says the CBD seltzers helped her arthritis. “People asking me, 'Well, is it really any good? Does it really do anything?' So, I decided I was going to do it every day so I could see, and the arthritis in my knee stopped bothering me,” said Gannaway. It’s the same story at Dean’s Mediterranean Imports. Owner Kate Zaidan says her customers enjoyed the products. “It was a great product for us. People loved it. We had repeat business," said Zaidan. “People would come back and tell us they had great effects from it.” CBD oil is a cannabis compound, but it does not contain THC. That’s the psychoactive compound found in marijuana that gives you a euphoric feeling. The Ohio Board of Pharmacy says the state’s new medical marijuana program only allows dispensaries to sell CBD products. “Well, I think it’s ridiculous. They need to figure out how to reword the law that hemp and hemp products are perfectly legal and should be used in any way possible,” said Gannaway. The Cincinnati Health Department says it's just following directions from the state. In a statement, Antonio Young, director of environment health at Cincinnati’s health department, said the department is just acting as an extension of the Ohio Department of Agriculture. Young said the issue will ultimately need to be handled by regulators like the Ohio Board of Pharmacy. “I just think it's a shame that access has been limited. To me, it's important that people have access to things that make their lives better,” said Zaidan. The CBD products pulled from the shelves have been embargoed. The store owners say the health department will pay them another visit in the coming days to determine if the products need to be destroyed. The Cincinnati Health Department released the following statement of Local 12: The Ohio Department of Agriculture (ODA) has identified retail food facilities throughout the state that may potentially be selling food containing Cannabidiol (CBD) products. CBD oil is derived from the cannabis plant, has become the new product in states that have legalized medical marijuana. Food and beverage products containing CBD were introduced in the United States in 2017. Similar to energy drinks and protein bars which may contain vitamin or herbal additives, food and beverage items can be infused with CBD as an alternative means of ingesting the substance. These products may only be legally sold by a licensed dispenser. On 1/31/2019, the Cincinnati Health Department’s Food Inspection office received a phone call from ODA stating that establishments within our health Jurisdiction may be affected. Local health departments were instructed by ODA to visit the City of Cincinnati locations and embargo the products. Embargoing involves identifying potentially harmful food products, having the products removed from retail sale; itemized/ inventoried and photographed on-site. The Cincinnati Health Department inspected all of the identified establishments. Only one establishment required an embargo. The remaining locations had either already removed the product from the shelves or altogether discontinued products for retail sale prior to the inspector’s visit. It is important to note that due to our jurisdictional authority and familiarly of these facilities, local health departments are acting as an extension of the ODA only. The issue will ultimately need to be handled at the distribution points by medical marijuana regulating entities such as the Ohio Board of Pharmacy."