Dr. Noushif M
MBBS., MS (GENERAL SURGERY)., MCH (SURGICAL GASTROENTEROLOGY)., FELLOWSHIP IN LIVER TRANSPLANT AND HEPATO-
General Surgery, Medical Gastroenterology, Surgical Gastroenterology
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I could find three issues with your brother. They are obesity, cirrhosis, and fissure. All these are related. He needs to lose weight. He has to be motivated with regular physical activity, modified diet and restrict fluid to 2 liters a day. Regarding cirrhosis, he needs to be on regular follow up. We need to check how bad his liver is. We need to check his :
- Blood count.
- Liver function test.
- INR (international normalized ratio).
- USG (ultrasonography) abdomen.
Being cirrhotic he needs to have two to three times of bowel movements daily that too soft stools. When stools become hard, his fissures (cracks) in the anal region become worse and painful. So, the first step is to avoid constipation and constipating foods. Take syrup Looz (Lactulose) 30 ml at night or twice or thrice daily to achieve adequate soft stools. You can use these two creams alternately every four hours for acute pain, Cremagel (Diltiazem) and Smuth (Lidocaine, Dobisilate, and Hydrocortisone) cream. Better to try without surgery as he is cirrhotic. If pain does not settle with these measures you can go ahead with surgery. Definitely, he has to be abstinent from all liver-damaging substances.
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