Abdominal diseases, a category of diseases that affect the abdominal area, encompass some of the leading causes of morbidity and mortality worldwide. These conditions encompass a broad range of pathologies and occur with varying frequencies in different populations. Some diseases, such as irritable bowel syndrome, are very common in most populations, while others, such as hepatocellular carcinoma, are relatively uncommon in the Western world yet lead to causes of death for certain ethnic demographics in Asia. Moreover, the chronicity and recurrence of some abdominal diseases can significantly impair lifestyle and productivity. For some, including pancreatic cancer and male polyposis colorectal cancer, the mortality can be above 50%. The diseases often present late—beyond the early phase of the cancer, the average 5-year survival is often below 30% in the West—and the reasons for these observations are still not entirely clear. They are multifactorial. They can be traced back to the late diagnosis, the complexity and variability of the diseases, and the lack of an integrated modern medical system between different specialties. Health awareness and education on the diseases are also insufficient.
Factors that contribute to the development and progression of abdominal diseases are numerous and often vary by disease. Genetic predisposition can play a role in developing many abdominal diseases, such as colorectal cancer and irritable bowel syndrome; in the case of the latter, females are more commonly affected, suggesting a hormonal role as well. Lifestyle factors can predispose to disease development, such as alcohol for liver disease or smoking for pancreatitis, and modulation of these risks can decrease the incidence of a number of abdominal diseases. Treatment, at least for some, is more likely to succeed when the cancer or other etiologies of the abdominal diseases are found and diagnosed at an earlier stage when therapeutic intervention is likely to be more effective. This great success is particularly relevant for common abdominal conditions such as colorectal cancer, which is becoming increasingly treatable due in part to early colorectal cancer screening programs.
Common Types and Causes
Abdominal diseases, in simplest terms, are diseases related to the abdominal cavity or abdomen. They are commonly classified according to the part of the abdomen they occur in: the upper (gastrointestinal) and the lower abdomen. People experiencing a constellation of symptoms such as bloating, pain, altered bowel habits, and distension are often diagnosed with ‘non-specific abdominal pain.’ Common diseases of the gastrointestinal system that can lead to these symptoms include gastritis, peptic ulcers, and other organic diseases like colon cancer, among others. Diseases causing inflammation of the abdominal organs may present with generalized lower abdominal pain, while diseases that have bacterial infection as a possible etiology will typically cause an increase in body temperature. The most common intra-abdominal disease remains localized infections—both of the urinary and genital tracts. Knowledge of a patient’s immunity, antibiotic use, and local spreading of the disease is ideal for identifying possible diseases.
Appendicitis, occurring from a spectrum of clinical pathology progressing from appendiceal inflammation to gangrene and perforation, remains one of the most common intra-abdominal diseases worldwide—with a prevalence of up to 8.6%. Diverticulitis, or localized inflammation of the intestinal pouches projecting from the sigmoid colon, has an average prevalence of 3.2% in populations without affliction with this condition. However, in Western populations, the prevalence of this disease increases to 4.6%. Pensioners have been reported to have an increased risk of developing asymptomatic diverticula—approaching 60%. Irritable bowel syndrome (IBS), currently classified as a functional gut disorder associated with dysfunction of the enteric nervous system, presents with abdominal pain and altered bowel habits. With a prevalence of 12.70 ± 1.30% in Northern Europe, the female population has a higher risk of developing IBS compared to men. Causes of abdominal diseases leading to these symptoms can generally be attributed to 1) infection—causative agents include among others Mycobacterium, diffuse Burkholderia, and Rothera bacteria if the abdominal cavity is involved; 2) dietary habits; 3) genetics, with defined risk polymorphisms present in people with affected first or second-degree relatives; 4) unidentified causes where lifestyle choices can exacerbate these diseases later in life. The incidence and prevalence of these diseases, absent unknown reasons, typically increase with age. Moreover, proper diagnosis at earlier stages of disease can help to better manage the condition.
Diagnostic Techniques in Abdominal Diseases
In recent years, impressive advancements have taken place in diagnostic techniques that aid the detection of different abdominal diseases, such as inflammatory bowel diseases, colorectal cancer, cholelithiasis, and hepatic cysts. In particular, technological advancements in endoscopy allow for precise visualization of the abdominal organs at a higher resolution. Additionally, other common techniques to detect the various abdominal diseases include positron emission tomography scans, CT, or ultrasonography in the case of hepatic cysts, among others. However, they may still be inaccurate, often resulting in delayed or mistaken diagnoses and ineffective treatments. Proper, early, and accurate detection of abdominal diseases is crucial to prevent complications and to better predict the treatment outcomes. Endoscopy, using either a colonoscope or endoscope, is commonly used to detect inflammatory bowel diseases and colorectal cancer. These are important tools for the detection of malignancies in different organs within the abdominal region, such as the liver, gastrointestinal organs, and pancreas. Ultrasound is also used to identify cholelithiasis and hepatic cysts effectively, especially since its availability to general hospitals is easy and affordable worldwide. CT imaging has also been effective against hepatic cysts since it provides sufficient information that helps significantly with not only the diagnosis but the treatment as well. Apart from ultrasound and CT imaging, magnetic resonance imaging is also another important technique for the diagnosis of hepatic cysts that may occur in the abdominal cavity. The reliability of all of these techniques ensures that diagnosis and timely care are initiated by healthcare professionals based on safety, effectiveness, and patient preference. It is also important to note that misdiagnosing abdominal diseases can lead to negative effects, affecting the progress of accurate diagnostics and therapeutics for such conditions.
Imaging Technologies
Advanced imaging technologies play a crucial role in the diagnosis of abdominal diseases. X-rays have traditionally been used to assess the bony components of the abdomen, while oral contrast studies have been employed to visualize the viscera. MRI of the abdomen, utilizing high-field strengths and the appropriate imaging sequences, will allow very accurate assessment of the liver, pancreas, biliary tree, and the entire gut without any ionizing radiation. High-resolution ultrasound allows precise anatomical and dynamic evaluation of the hepatobiliary system, pancreas, hollow viscera, and to some extent, the small bowel. Comparatively, all these modalities are operator-dependent; the performance of none of them can be standardized across all vendors and models available in the market.
While the strengths of these imaging modalities are without question, their limitations must also be noted. The improvements in imaging technology have, in turn, paved the way for newer imaging modalities. A major technological advancement that can help in imaging the abdominal cavity is in speed. The advent of 128-, 256-, and 512-slice CT has seen an improvement in the speed of data acquisition and allowed scanning during contrast enhancement. These have allowed for high-quality CT angiography of the entire abdomen. Conventional axial images acquired by CT and MRI have been replaced by 3D images that are reformatted into the standard planes, including multiplanar imaging. Reformatted images can be seen synthesized by computer programs as virtual endoscopy. Another feature in medical imaging over the last decade has been the increased use of contrast material for enhancement of images. The surgical lessons learned from newer advances over decades and centuries in technology, in contrast to the traditional methods employed in the past, are well documented.
An accurate diagnosis is the first step in any rational decision-making process, whether it is for medical or surgical reasons. The application of these diagnostic techniques has improved treatment algorithms and reduced morbidity and mortality for many pathological processes. With better imaging techniques, we can now plan better treatment strategies. Thus, a rapid and accurate imaging diagnosis is of critical importance, not only for the well-being of patients but also to improve the efficiency and cost of the health care system. Done correctly, abdominal imaging may avoid unnecessary surgery, reduce hospital length of stay, and improve patient care by early intervention. In terms of imaging the small intestine in vivo, the small bowel enema has essentially run its course in favor of CT and MR enterography, which provide quite exquisite images of the small bowel and the mesenteric vessels.
Treatment Modalities
Management of abdominal diseases takes various approaches. It depends on the disease itself; in general, it consists of pharmacological and non-pharmacological treatment modalities. An abdominal disease can be a result of physical changes, from trauma or congenital origin, or a part of a systemic process, such as autoimmune diseases. Therefore, treatment modalities in individuals might differ from one another. In some diseases, lifestyle modification is still the most effective treatment to decrease or alleviate the symptoms. Surgery is the primary management for several diseases and is considered to save patients’ lives. Laparoscopic techniques have become increasingly popular over the last few years. For malignant diseases, the treatment can be neoadjuvant and can be performed if it might render the disease resectable; adjuvant, to increase survival via chemotherapy in colorectal cancer; or palliative with stoma indication.
Diverse practices are performed in IBS and IBD cases. In IBS, studies reveal that a strong relationship is shown in the necessity of care among gastroenterologists. This is particularly important in personalized medicine and has also been shown with the use of the Rome IV tool to classify IBS through the use of biomarkers. Disease activity should be considered when using mesalazine or systemic corticosteroids for induction and maintenance of remission. Non-systemic therapy, such as exclusive enteral nutrition, if effective, will only be administered to a patient with mild disease. Otherwise, infliximab is used for inducing control of IBD and should be stopped when a patient goes into remission. Other daily activity details are included. Therapy seems to comply, even though patients’ perceptions of the condition certainly affect the implementation of evidence in daily practice. In diseases for which there is strong guideline evidence, physicians find it easy to follow evidence-based practice. Since a rather generic significant QoL change is only achieved with treatment and a chronic condition, efficacy can be seen primarily through biomarkers, endoscopic scores, and histology assessments, while in real life the patient will judge the follow-up mostly in terms of symptom occurrence. In addition to being an important counselor for their patients, the preferences of the individual play a crucial role when it comes to deciding what therapy should be used.
Surgical Interventions
Surgery is a critical part of treating abdominal diseases. This can involve minimally invasive laparoscopic techniques, which use video cameras and smaller incisions to perform operations with minimal trauma, or include more traditional open surgeries that involve larger incisions that allow the surgeon to physically feel the area and perform a more complex procedure. Advantages of minimally invasive surgery include a shorter length of stay in the hospital and quicker recovery; however, this option is not suitable for everyone. There have been technological barriers in the development of surgery; current limitations include the need for the performing surgeon to physically hold and undertake parts of procedures, and many of these barriers are currently being or have been broken down to optimize patient outcomes. The role of the colorectal surgeon involves not just operating but also a range of preoperative assessments and the holistic care of the patient, in particular selected emergency conditions. The management of abdominal diseases is often multidisciplinary, and the nursing perspective of both preoperative education and support as well as comprehensive postoperative care and pain relief has been outlined.
Role of Specialists from Singapore
Specialists from Singapore play an important role in the modern system of treatment and rehabilitation of patients with abdominal diseases. Doctors from various departments who specialize in the health problems of the abdominal cavity and organs and have vast experience in treating diseases of the gastrointestinal tract and liver—endoscopists, therapists, pathologists, pediatricians, general surgeons, emergency physicians—cooperate with these doctors in multidisciplinary teams. Singapore specialists participate in the development of national and international clinical guidelines for the treatment and prevention of abdominal diseases. The training programs for Singaporean specialists are comprehensive and holistic: the doctors acquire not only great clinical experience, but they also develop skills in communication with patients and colleagues from various medical fields. Singapore has an exceptional number of gastroenterologists and general surgeons who have been trained in Asia as well as in European and American universities of high repute.
Specialists in Singapore often employ diagnostic tools and treatment methods that are traditionally used by their colleagues around the world; therefore, such specialists could benefit from the knowledge about the modern approaches to the management of diseases of the abdominal cavity and organs. One of the successful treatments by a Singapore specialist is presented as a case study showing how a high level of expertise, vast experience, and successful collaboration between doctors from different departments may improve the health of patients with diseases of the abdominal cavity and organs. As the growing number of researchers have shown, the best way to make a state-of-the-art diagnosis, prevention, and treatment decisions in the majority of cases is to develop a network of expertise led by professionals within and outside major medical institutions to include the whole care pathway of the 21st century. This multidisciplinary approach adopted by a growing number of Singapore’s specialists in the field of abdominal disease treatment draws direct benefits from global mega-trends shaping the future of the healthcare industry.
Expertise in Minimally Invasive Procedures
As such, it is essential to have the expertise and resources to provide options to the patient to select the best approach for her in the management of abdominal diseases, whether acute or chronic, as well as in the diagnosis of abdominal conditions. Specialists have developed significant know-how in utilizing minimally invasive tools for the treatment of abdominal diseases. The experienced panelists unanimously agreed that minimally invasive procedures are less painful, require limited anesthesia, and involve smaller incisions, which result in shorter hospital stays. In their experience, patients with certain intra-abdominal conditions can even go home on the same day after surgery. Interestingly, the experts mentioned that many patients and laypersons still believe that larger incisions are associated with a higher probability of cure of the disease. They mentioned the need for patient education to the contrary.
Minimally invasive procedures, such as laparoscopic surgery, also result in a lower chance of wound infections and hernia formation. Minimally invasive surgical procedures can be adopted for a wide range of conditions related to the abdominal wall, occurring within the abdominal cavity. This includes conditions that require a fixed small bowel while subsequently conducting laparoscopic surgery for abdominal wall hernia. This is different from abdominal wall hernia repair surgery alone. Surgeons are well versed in advanced endoscopic procedures, including high-definition per-oral endoscopic myotomy for achalasia, diagnostic and drainage endoscopy for deep-seated fluid collections, endovascular approaches to bleeding from the gastrointestinal tract, endoscopic submucosal dissection for early cancers in the stomach and colon, and colostomy, among other procedures. The latest with robot assistance for abdominal issues is the robot-assisted procedure, which involves making small puncture wounds to place the robot arms and the camera rather than opening the abdomen. The clinician control panel is utilized to manipulate the robot arms and camera, and the procedure is viewed on high-definition monitors. The arms provide simplicity in performing complex tasks and precision in small spaces, including those inside the body. More patients are opting for robotic surgery, despite the procedures costing more than traditional surgeries, according to the experts. Technologies like virtual reality can certainly help in quick learning of the procedures, but developing expertise in managing unexpected incidents with complex patient physiology is something that virtual reality can’t mimic. Robotic systems can supplement the endoscopist’s skill set and help deliver the best outcome for the patients. However, in the right hands and appropriate patient population, the benefits can be immense. The adoption of single-incision laparoscopy in children has been reported to be safe and feasible. Most of the children and/or their guardians were satisfied with the cosmetic appearance of their umbilicus early postoperatively. The main reported barrier is the learning curves and better cosmetic results with the multichannel ports.
