Perforated peptic ulcer
|
|
- Myron Jeremy Parks
- 6 years ago
- Views:
Transcription
1 Perforated peptic ulcer - Despite the widespread use of gastric anti-secretory agents and eradication therapy, the incidence of perforated peptic ulcer has changed little, age limits increase NSAIDs elderly Anterior d.u& incisura g.u most common perforate Clinical features History of peptic ulceration sudden-onset, severe generalized abdominal pain as a result of the irritant effect of gastric acid on the peritoneum bacterial peritonitis supervenes over a few hours patient may be shocked with a tachycardia abdomen exhibits a board-like rigidity The abdomen does not move with respiration Very frequently, the elderly patient who is taking NSAIDs will have a less dramatic presentation, board-like rigidity not observed Difficult diagnosis: potent analgesic effect of NSAID Small perforation Posterior g,u perforation to lesser sac Sealed perforation Diabetic patient(silent) Investigations An erect plain chest radiograph will reveal free gas under the diaphragm in more than 50% of cases CT scan imaging is more accurate S.amylase to distinguish from pancreatitis Treatment resuscitation and analgesia Laparotomy P a g e 1
2 thorough peritoneal toilet to remove all of the fluid and food debris Duodenal perf. it can usually be closed by several well-placed sutures, closing the ulcer in a transverse direction omental patch =leak sealing Massive duodenal or gastric perforation=billroth II gastrectomy Gastric ulcers should, if possible, be excised and closed, so that malignancy can be excluded definitive procedures TV+PP or HSV: in well-selected patients and in expert hands this is a very safe strategy Minimally invasive techniques if the expertise is available Anti h. pylori + ppi post op. Conservative management of perforated ulcer - Patients with a delayed presentation (i.e. greater than 24 hours) and extensive co-morbid factors. - In patients who are hemodynamically stable with minimal abdominal symptoms Causes of upper gastrointestinal bleeding Condition Incidence (%) Ulcers 60 - Esophageal 6 - Gastric 21 - Duodenal 33 Erosions 26 - Esophageal 13 - Gastric 9 - Duodenal 4 Mallory Weiss tear 4 Esophageal varices 4 Tumor 0.5 Vascular lesions, e.g. Dieulafoy s disease 0.5 Others 5 P a g e 2
3 Bleeding peptic ulcers - In recent years, the population affected has become much older and the bleeding is commonly associated with the ingestion of NSAIDs - The three cardinal principles in the management are: 1- Vigorous resuscitation of the initial bleed to restore hemodynamic stability, followed by monitoring for re-bleeding and appropriate resuscitation if this should occur. 2- Prompt investigation to establish the cause. 3- Institution of appropriate measures to arrest bleeding and prevent further hemorrhage. - Upper gastrointestinal endoscopy should be carried out by an experienced operator - In patients in whom the bleeding is relatively mild, endoscopy may be carried out on the morning after admission. - In all cases of severe bleeding it should be carried out immediately Medical and minimally interventional treatments - proton pump antagonist - tranexamic acid, an inhibitor of fibrinolysis, reduces the re-bleeding rate - injection of the bleeding ulcer with adrenaline or sclerosant, - laser photocoagulation - coagulation with bipolar diathermy Surgical treatment - if bleeding persists, or recurs despite endoscopic intervention surgery, should attempted - factors which should encourage surgical intervention A large vessel, visible in the ulcer base a major initial bleed, a re-bleed in hospital advanced age Patient who has required more than 6 units - The aim of the operation is to stop the bleeding - The most common site of bleeding from a peptic ulcer is the duodenum P a g e 3
4 - the duodenum, and usually the pylorus, are opened longitudinally - bleeding controlled by using well-placed sutures that under-run the vessel - Pyloroplasty is then closed with interrupted sutures in a transverse direction - Bleeding G.U same line +biopsy or excision - Definitive acid lowering surgery is not now required - very large ulcer eroding into a major branch of the left gastric artery may necessitate a subtotal gastrectomy incorporating the ulcer GASTRIC OUTLET OBSTRUCTION - gastric outlet obstruction should be considered malignant until proven otherwise - Clinical features In benign gastric outlet obstruction there is usually a long history of peptic ulcer disease pain may become unremitting and in other cases it may largely disappear vomitus is characteristically unpleasant in nature and is totally lacking in bile, recognize foodstuff taken several days previously Examination wt loss, unwell look, dehydrated Succession splash +ve - Metabolic effects - Acid loss - hypochloraemic alkalosis - initially, sodium and potassium levels may be relatively normal - Initially, the urine has a low chloride and high bicarbonate content - Progressive hyponatremia - Dehydration - Na retention - Potassium and hydrogen are excreted - Urine becoming paradoxically acidic - hypokalemia P a g e 4
5 Management - aim correcting the metabolic abnormality dealing with the mechanical problem intravenous isotonic saline with potassium Supplementation stomach should be emptied using a wide-bore gastric tube.+ lavage the stomach - Investigation FBC,s. electrolyte, Endoscopy biopsy to exclude malignancy. Contrast radiology - Treatment an anti-secretory agent, initially given intravenously severe cases are treated surgically, usually with a gastroenterostomy rather than a pyloroplasty Endoscopic treatment with balloon dilatation has been practised and may be most useful in early case Causes of gastric outlet obstruction - Ca stomach - Peptic ulcer - Adult pyloric stenosis - Pyloric mucosal diaphragm Intractability/Non-healing - rare indication for operation nowadays Surgical treatment should be considered in patients with - non-healing or intractable peptic ulcer who have multiple recurrences, - Large ulcers (>2 cm), - complications (obstruction, perforation or hemorrhage), or - suspected gastric cancer Done by: #MOHDZ Dr.Loay Surgery P a g e 5
OPEN ACCESS TEXTBOOK OF GENERAL SURGERY
OPEN ACCESS TEXTBOOK OF GENERAL SURGERY PEPTIC ULCER DISEASE PC Bornman RS Du Toit EPIDEMIOLOGY AND PATHOGENESIS The prevalence of duodenal ulcer disease has a variable geographical distribution and differs
More informationSurgery for Complications of Peptic Ulcer Disease (Definitive Treatment)
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation
More informationStomach. R.B. Kolachalam, MD
Stomach R.B. Kolachalam, MD Relevent Anatomy 1.four regions: Cardia, Fundus, Body, and the Pylorus 2. fixed in two locations- at the GEJ and the duodenum Gastric Anatomy body of the stomach: site of mechanical
More informationAcute Upper Gastrointestinal Hemorrhage Surgical Perspective. Dr.J.H.Barnard Dept. of Surgery PAH
Acute Upper Gastrointestinal Hemorrhage Surgical Perspective Dr.J.H.Barnard Dept. of Surgery PAH Introduction: AGH is a leading cause of admissions into ICU. Overall mortality 5-12%, but increases to 40%
More informationEmergency Operations for Bleeding Duodenal Ulcer:A simple option to consider Case Report Abstract Key words Case Report
Vtáx exñéüà :A simple option to consider: Case Report Gamal E H A El Shallaly, Eltayeb A Ali, Suzan Salih Abstract We report a 46 years-old man who had severe bleeding from a posterior duodenal ulcer (DU)
More informationPeptic ulcer disease. Nomin-Erdene. D SOM-531
Peptic ulcer disease Nomin-Erdene. D SOM-531 Learning objectives Stomach gross anatomy PUD Epidemiology Pathogenesis Clinical manifestation Diagnosing Treatment Complicated ulcer disease Surgical procedures
More informationPerforated peptic ulcers. Dr V. Roudnitsky KCH
Perforated peptic ulcers Dr V. Roudnitsky KCH Peptic ulcer disease Peptic ulcers are focal defects in the gastric or duodenal mucosa that extend into the submucosa or deeper Caused by an imbalance between
More informationDefinitive Surgical Treatment When Endoscopy Fails. Erik Peltz D.O. Resident Debate February 26 th 2007 University of Colorado Dept.
Nonvariceal Gastrointestinal Hemorrhage: Definitive Surgical Treatment When Endoscopy Fails Erik Peltz D.O. Resident Debate February 26 th 2007 University of Colorado Dept. Surgery Non-Variceal Upper GI
More informationChapter 14: Training in Radiology. DDSEP Chapter 1: Question 12
DDSEP Chapter 1: Question 12 A 52-year-old white male presents for evaluation of sudden onset of abdominal pain and shoulder pain. His past medical history is notable for a history of coronary artery disease,
More informationSTOMACH and DUODENUM DISEASE
STOMACH and DUODENUM DISEASE STOMACH ANATOMY In the living and upright posture, the stomach is a j-shaped. It has two surfaces, two curvatures and two openings. Esophagus Fundus cardia Pylorus B o d y
More informationEmergency Surgery Course Graz, March UPPER GI BLEEDING. Carlos Mesquita Coimbra
UPPER GI BLEEDING Carlos Mesquita Coimbra Aim Causes Management Problem Above angle of Treitz Common emergency 1-2/1000 pts 10% rebleeed 1% angioembolization 20% over 60
More informationPeptic ulcer disease Disorders of the esophagus
Peptic ulcer disease Disorders of the esophagus Peptic ulcer disease Burning epigastric pain Exacerbated by fasting Improved with meals Ulcer: disruption of mucosal integrity >5 mm in size, with depth
More informationINVESTIGATIONS OF GASTROINTESTINAL DISEAS
INVESTIGATIONS OF GASTROINTESTINAL DISEAS Lecture 1 and 2 دز اسماعيل داود فرع الطب كلية طب الموصل Radiological tests of structure (imaging) Plain X-ray: May shows soft tissue outlines like liver, spleen,
More informationKK College of Nursing Peptic Ulcer Badil D ass Dass, Lecturer 25th July, 2011
KK College of Nursing Peptic Ulcer Badil Dass, Lecturer 25 th July, 2011 Objectives: By the end of this lecture, the students t will be able to: Define peptic pp ulcer Describe the etiology and pathology
More informationOPERATIVE TREATMENT OF ULCER DISEASE
Página 1 de 8 Copyright 2001 Lippincott Williams & Wilkins Greenfield, Lazar J., Mulholland, Michael W., Oldham, Keith T., Zelenock, Gerald B., Lillemoe, Keith D. Surgery: Scientific Principles & Practice,
More informationHistorical perspective
Raj Santharam, MD GI Associates, LLC Clinical Assistant Professor of Medicine Medical College of Wisconsin Historical perspective FFS first widespread use in the early 1970 s Expansion of therapeutic techniques
More informationACG Clinical Guideline: Management of Patients with Ulcer Bleeding
ACG Clinical Guideline: Management of Patients with Ulcer Bleeding Loren Laine, MD 1,2 and Dennis M. Jensen, MD 3 5 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut,
More informationBleeding in the Digestive Tract
Bleeding in the Digestive Tract National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health
More informationGastroenterology Tutorial
Gastroenterology Tutorial Gastritis Poorly defined term that refers to inflammation of the stomach. Infection with H. pylori is the most common cause of gastritis. Most patients remain asymptomatic Some
More informationChapter 9. An Unusual Case of Gastric Outlet Obstruction in a Ghanaian Woman. 2 Top 25 Clinical Case Reports
Chapter 9 An Unusual Case of Gastric Outlet Obstruction in a Ghanaian Woman Joachim Amoako, Henry Obaka, Nelson Affram, Wordui Theodore and Faizal Z Asumda* Department of Surgery, Korle Bu Teaching Hospital,
More informationHelicobacter Pylori Testing HELICOBACTER PYLORI TESTING HS-131. Policy Number: HS-131. Original Effective Date: 9/17/2009
Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,
More informationCOPYRIGHTED MATERIAL. 1 Approach to the patient with gross gastrointestinal bleeding. Grace H. Elta, Mimi Takami
1 Approach to the patient with gross gastrointestinal bleeding Grace H. Elta, Mimi Takami Gastrointestinal (GI) bleeding is a common clinical problem that requires more than 300 000 hospitalizations annually
More informationGastric Outlet Obstruction Following Postoperative Adhesions From Open Cholecystectomy In A Nigerian Female: A Case Report And Review Of Literature
ISPUB.COM The Internet Journal of Surgery Volume 31 Number 2 Gastric Outlet Obstruction Following Postoperative Adhesions From Open Cholecystectomy In A Nigerian Female: A Case Report And Review Of Literature
More informationA bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?
Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians
More informationGIT RADIOLOGY. Water-soluble contrast media (e.g. gastrograffin) are the other available agents.which doesn t cause inflammatory peritonitis..
GIT RADIOLOGY Imaging techniques-general principles: Contrast examinations: Barium sulphate is the best contrast for GIT (with good mucosal coating & excellent opacification & being inert); but is contraindicated
More informationUpper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology
Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal
More informationChapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased
1 2 3 4 5 6 7 Chapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased Ingestion of Caustic Substances Poor Bowel Habits
More informationVOMITING. Tan Lay Zye
VOMITING Tan Lay Zye Vomiting is a common symptom. It is a complex reflex behavioural response involving forceful expulsion of the stomach contents through oral cavity. Contents Emetic reflex Causes of
More informationEndoscopic Treatment of Luminal Perforations and Leaks
Endoscopic Treatment of Luminal Perforations and Leaks Ali A. Siddiqui, MD Professor of Medicine Director of Interventional Endoscopy Jefferson Medical College Philadelphia, PA When Do You Suspect a Luminal
More informationGI Pharmacology. Dr. Alia Shatanawi 5/4/2018
GI Pharmacology Dr. Alia Shatanawi 5/4/2018 Drugs Used in Gastrointestinal Diseases Drugs used in Peptic Ulcer Diseases. Drugs Stimulating Gastrointestinal Motility &Laxatives. Antidiarrheal Agents. Drugs
More informationPerforated Peptic Ulcer Disease at Kenyatta National Hospital, Nairobi.
Perforated Peptic Ulcer Disease at Kenyatta National Hospital, Nairobi. N.A. Nasio 1, H. Saidi 1,2 1 Department of Surgery, 2 Department of Human Anatomy, University of Nairobi Correspondence to: Nasio
More informationUGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital ABSTRACT
Original Article Jewsuebpong T THAI J GASTROENTEROL 2008 Vol. 9 No. 2 May - Aug. 2008 67 UGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital Jewsuebpong T ABSTRACT Background:
More informationSURGICAL MANAGEMENT OF PEPTIC ULCER DISEASE IN PROTON PUMP INHIBITOR ERA
ORIGINAL ARTICLE ABSTRACT SURGICAL MANAGEMENT OF PEPTIC ULCER DISEASE IN PROTON PUMP INHIBITOR ERA M.A.NASIR MALIK, OMER SALAHUDDIN, MOBASHER AHMAD, MUHAMMAD AZHAR, OMER DILAWAR, AYESHA SALAHUDDIN Objective
More informationLOOKING FOR AIR IN ALL THE WRONG PLACES Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, IL
SIGNIFICANCE OF EXTRALUMINAL ABDOMINAL GAS: LOOKING FOR AIR IN ALL THE WRONG PLACES Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, IL SCBT/MR 2012 October 26,
More informationGastrointestinal Emergencies CEN REVIEW 2017 MARY RALEY, BSN, RN, CEN, TCRN, TNSCC
Gastrointestinal Emergencies CEN REVIEW 2017 MARY RALEY, BSN, RN, CEN, TCRN, TNSCC Gastrointestinal Emergencies is 7% of the CEN A. Acute abdomen B. Bleeding C. Cholecystitis D. Cirrhosis E. Diverticulitis
More informationP R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal
More informationEpidemiology of Peptic Ulcer Disease
Epidemiology of Peptic Ulcer Disease Introduction Peptic Ulcer Disease (PUD) is disruption of the mucosal integrity of the stomach and/or duodenum leading to a local defect or excavation due to active
More informationEvidence-based medicine: data mining and pharmacoepidemiology research
Data Mining VII: Data, Text and Web Mining and their Business Applications 307 Evidence-based medicine: data mining and pharmacoepidemiology research B. B. Little 1,2,3, R. A. Weideman 3, K. C. Kelly 3
More informationMcHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2018 #10 Acute GI Bleeds
McHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2018 #10 Acute GI Bleeds Gastrointestinal bleeding is a very common problem in emergency medicine. Between
More informationPeptic Ulcer Disease Update
Peptic Ulcer Disease Update Col Pat Storms RAM 2005 Disclosure Information 84th Annual AsMA Scientific Meeting Col Patrick Storms I have no financial relationships to disclose. I will discuss the following
More informationAnticoagulants are a contributing factor. Other causes are Mallory-Weiss tears, AV malformations, and malignancy and aorto-enteric fistula.
Upper GI Bleeding EMU2018 Dr. Walter Himmel MD Incidence: In non-cirrhotics, the commonest causes are peptic ulcer disease (50%) followed by erosive gastritis. In cirrhotic patients, variceal bleeding
More informationClinical Management of Obscure- Overt Gastrointestinal Bleeding. Presented by Dr. 張瀚文
Clinical Management of Obscure- Overt Gastrointestinal Bleeding Presented by Dr. 張瀚文 Definition Obscure: : hard to understand; not clear. Overt: : public; not secret. Occult: : hidden from the knowledge
More informationINTRODUCTION TO UPPER ENDOSCOPY
INTRODUCTION TO UPPER ENDOSCOPY Satish Nagula, MD Associate Professor of Medicine Icahn School of Medicine at Mount Sinai NYSGE First Year Fellows Course July 14, 2018 Early endoscopes 1805: Bozzini Lichtleiter
More informationColonoscopy. In the work-up of intestinal disorders For prevention and early recognition of colon cancer
The informed patient Colonoscopy In the work-up of intestinal disorders For prevention and early recognition of colon cancer How do I prepare for the examination? How is the examination performed? Colonoscopy
More informationA STUDY OF DUODENAL ULCER PERFORATION: RISK FACTORS AND PROGNOSTIC DETERMINANTS IN BTGH, GULBARGA
A STUDY OF DUODENAL ULCER PERFORATION: RISK FACTORS AND PROGNOSTIC DETERMINANTS IN BTGH, GULBARGA Rajshekhar Patil 1, Sangamesh Kamthane 2, Palla Abhishek Reddy 3 1Associate Professor, Department of General
More informationAn unusual case of gastritis in an infant. Disna Abeysuriya PathWest Princess Margaret Hospital
An unusual case of gastritis in an infant Disna Abeysuriya PathWest Princess Margaret Hospital Acknowledgements Dr Kunal Thacker Paediatric gastroenterologist Dr Gareth Jevon Paediatric pathologist Hx
More informationGASTROINTESTINAL AND ANTIEMETIC DRUGS. Submitted by: Shaema M. Ali
GASTROINTESTINAL AND ANTIEMETIC DRUGS Submitted by: Shaema M. Ali GASTROINTESTINAL AND ANTIEMETIC DRUGS by: Shaema M. Ali There are four common medical conditions involving the GI system 1) peptic ulcers
More informationThe usual dose is 40 mg daily with amoxycillin 1.5 g (750 mg b.d.) for 2 weeks. Up to 2 g/day of amoxycillin has been used in clinical trials.
Name Gasec - 2 Gastrocaps Composition Gasec-20 Gastrocaps Each Gastrocaps contains: Omeprazole 20 mg (in the form of enteric-coated pellets) Properties, effects Proton Pump Inhibitor Omeprazole belongs
More informationSimon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor
Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment
More informationOutline. GI-Bleeding. Initial intervention
Internal Medicine Board Review 2016: GI-Bleeding Stephan Goebel, M.D. Assistant Professor Division of Digestive Diseases Management UGI-Bleeding (80%) Ulcers Varices others LGI-Bleeding (20%) Outline Initial
More informationOn-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding
On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year
More informationSARCINA VENTICULARI IS A POSSIBLE CAUSATIVE MICROORGANISM OTHER THAN H.PYLORI IN GASTRIC OUTLET OBSTRUCTION PATHOGENESIS
SARCINA VENTICULARI IS A POSSIBLE CAUSATIVE MICROORGANISM OTHER THAN H.PYLORI IN GASTRIC OUTLET OBSTRUCTION PATHOGENESIS 55 years old male, Farm worker, married, from Ibb Heavy Smoker, Khat chewer non-alcohol
More informationUpper GI Bleeding. HH Tsai MD FRCP FECG Consultant Gastroenterologist
Upper GI Bleeding HH Tsai MD FRCP FECG Consultant Gastroenterologist Financial Disclosures I have no financial relationship with any manufacturer or supplier of any product mentioned in this talk. GI Audits:
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 1 2013 Article 9 ISSUE 1 Perforation Of The Caecum Owing To Benign Rectal Obstruction: A Paradigm Of Damage Control In Emergency Colorectal Surgery DIMITRIOS
More informationWhat is Crohn's disease?
What is Crohn's disease? Crohn's disease is a chronic inflammatory disorder that causes inflammation of the digestive tract. It can affect any area of the GI tract, from the mouth to the anus, but it most
More informationGastrectomy procedure and its complications: Findings at TC multi-detector 64 row.
Gastrectomy procedure and its complications: Findings at TC multi-detector 64 row. Poster No.: C-2184 Congress: ECR 2012 Type: Educational Exhibit Authors: M. M. Mendigana Ramos, A. Burguete, A. Sáez de
More informationد. عصام طارق. Objectives:
GI anatomy Lecture: 5 د. عصام طارق Objectives: To describe anatomy of stomach, duodenum & pancreas. To list their main relations. To define their blood & nerve supply. To list their lymph drainage. To
More informationNon Operative Management of Perforated Duodenal Ulcers. Rabih Nemr M.D. Kings County Hospital Sept 2006
Non Operative Management of Perforated Duodenal Ulcers Rabih Nemr M.D. Kings County Hospital Sept 2006 Case presentation 40 year old male presenting with abdominal pain: Epigastric Worsening over the last
More informationDelayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer
CASE REPORT Clin Endosc 2015;48:251-255 Print ISSN 2234-2400 / On-line ISSN 2234-2443 http://dx.doi.org/10.5946/ce.2015.48.3.251 Open Access Delayed Perforation Occurring after Endoscopic Submucosal Dissection
More informationOmar Bellorin, 1 Anna Kundel, 2 Alexander Ramirez-Valderrama, 1 and Armando Castro Introduction. 2. Case Description
Case Reports in Surgery Volume 2015, Article ID 170901, 4 pages http://dx.doi.org/10.1155/2015/170901 Case Report Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying
More informationThe Role of Endoscopy in the Diagnosis and Management of Upper Gastrointestinal Bleeding.
Original Article ISSN (O):2395-2822; ISSN (P):2395-2814 The Role of Endoscopy in the Diagnosis and Management of Upper Gastrointestinal Bleeding. Faroze A. Khan 1, M. H. Raza 2, Vikrant 1 1 Senior Resident,
More informationBritish Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion
British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit
More informationTools of the Gastroenterologist: Introduction to GI Endoscopy
Tools of the Gastroenterologist: Introduction to GI Endoscopy Objectives Endoscopy Upper endoscopy Colonoscopy Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic ultrasound (EUS) Endoscopic
More informationDuodenal Ulcer / Duodenitis
Duodenal Ulcer / Duodenitis Endoscopy Department Patient information leaflet You will only be given this leaflet if you have been diagnosed with duodenitis and/or a duodenal ulcer. The information below
More informationTurning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient
Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient John Greenaway 1 Turning off the tap: Endoscopy Answer the questions Benefits and risks of endoscopy Urgency
More informationNCD for Fecal Occult Blood Test
NCD for Fecal Occult Blood Test Applicable CPT Code(s): 82272 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal
More informationEGD Data Collection Form
Sociodemographic Information Type Zip Code Gender Height (in inches) Race Ethnicity Inpatient Outpatient Male Female Birth Date Weight (in pounds) American Indian (Native American) or Alaska Native Asian
More informationPlain abdomen The standard films are supine & erect AP views (alternative to erect, lateral decubitus film is used in ill patients).
Plain abdomen The standard films are supine & erect AP views (alternative to erect, lateral decubitus film is used in ill patients). The stomach can be readily identified by its location, gastric rugae
More informationESOPHAGEAL CANCER AND GERD. Prof Salman Guraya FRCS, Masters MedEd
ESOPHAGEAL CANCER AND GERD Prof Salman Guraya FRCS, Masters MedEd Learning objectives Esophagus anatomy and physiology Esophageal cancer Causes, presentations of esophageal cancer Diagnosis and management
More informationParietal cells These are in the bodacid-secreting portion) of the stomach and line the gastric crypts,they are responsible for the production of
Parietal cells These are in the bodacid-secreting portion) of the stomach and line the gastric crypts,they are responsible for the production of hydrogen ions to form hydrochloric acid. Chief cells proximally
More informationAND TECHNIC. GEORGE CRILE, Jr., M.D. Division of Surgery
SUBDIAPHRAGMATIC VAGOTOMY; AND TECHNIC INDICATIONS GEORGE CRILE, Jr., M.D. Division of Surgery The principle of vagotomy as described by Dragstedt 1 has been widely accepted in the treatment of peptic
More informationJOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES
JOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES THE PROBLEM DUODENAL / PANCREATIC INJURIES Difficult to diagnose Not very common Anatomic and physiologic challenges 90% rate of associated
More informationSummary of the Home Health Prospective Payment System Final Rule FY 2014
Summary of the Home Health Prospective Payment System Final Rule FY 2014 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014, Home Health Quality Reporting Requirements,
More informationUNC HOSPITALS CHAPEL HILL, NORTH CAROLINA REQUEST AND AUTHORIZATION FOR UPPER GASTROINTESTINAL ENDOSCOPY AND BIOPSY MIM#180
UNC HOSPITALS CHAPEL HILL, NORTH CAROLINA 27514 REQUEST AND AUTHORIZATION FOR UPPER GASTROINTESTINAL ENDOSCOPY AND BIOPSY MIM#180 I request and authorize and/or associates or assistants of his/her choice
More informationA cute upper gastrointestinal haemorrhage is
399 BEST PRACTICE Management of haematemesis and melaena K Palmer... Acute upper gastrointestinal bleeding is a common medical emergency which carries hospital mortality in excess of 10%. The most important
More informationGastrointestinal Obstruction
Customer Name, Street Address, City, State, Zip code Phone number, Alt. phone number, Fax number, e-mail address, web site Gastrointestinal Obstruction (Blockage of the Gastrointestinal Tract) Basics OVERVIEW
More informationModule 2 Heartburn Glossary
Absorption Antacids Antibiotic Module 2 Heartburn Glossary Barrett s oesophagus Bloating Body mass index Burping Chief cells Colon Digestion Endoscopy Enteroendocrine cells Epiglottis Epithelium Absorption
More informationStudy of the effect of post-operative medical management on peptic ulcer in patients of perforated peptic ulcer disease
International Surgery Journal Deshmukh SB et al. Int Surg J. 2016 Aug;3(3):1267-1272 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20161459
More informationEmergency - Upper gastrointestinal haemorrhage
Emergency - Upper gastrointestinal haemorrhage Definitions in upper gastrointestinal (UGI) haemorrhage UGI haemorrhage: bleeding that arises proximal to the ligament of Treitz i.e. from the oesophagus,
More informationHCPCS Codes (Alphanumeric, CPT AMA) ICD-9-CM Codes Covered by Medicare Program
HCPCS s (Alphanumeric, CPT AMA) 82272 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening ICD-9-CM
More informationCT EVALUATION OF GASTRIC LESIONS:
CT EVALUATION OF GASTRIC LESIONS: Pictural essay Hasni Bouraoui I, Kahloun A, Jemni H, Elouni F, Moulahi H, Daadoucha A, Ben Ali A, Sriha B, Tlili Graies K Departments of Radiology, Gastro enterology,
More informationWhich Blunt Trauma Patients Should Be Studied by Abdominal CT?
MDCT of Bowel and Mesenteric Injury: How Findings Influence Management 4 th Nordic Trauma Radiology Course 2006 4 th Nordic Trauma Radiology Course 2006 Stuart E. Mirvis, M.D., FACR Department of Radiology
More informationSafe Answers For The American Board of Surgery Certifying Exam & Recertifying Exam
Safe Answers For The American Board of Surgery Certifying Exam & Recertifying Exam By Sarmad Aji, MD., FACS. A comprehensive review of the most commonly asked questions on the American Board of Surgery
More informationCase Series. Cost effective management of duodenal ulcers in Uganda: interventions based on a series of seven cases
Case Series Cost effective management of duodenal ulcers in Uganda: interventions based on a series of seven cases Gabriel R. Nzarubara Makerere University, Faculty of Medicine, Department of Anatomy,
More informationWASSIM ABI JAOUDE, MD SUNY DOWNSTATE MEDICAL CENTER MAY 20 TH, 2010 MANAGEMENT OF ACUTE UPPER GI BLEEDING
WASSIM ABI JAOUDE, MD SUNY DOWNSTATE MEDICAL CENTER MAY 20 TH, 2010 MANAGEMENT OF ACUTE UPPER GI BLEEDING CASE PRESENTATION 74 YO female JEHOVAH S WITNESS admitted for CHEST PAIN to telemetry on 4/26/2010
More informationSangrado Gastrointestinal Alto Upper GI Bleeding
Sangrado Gastrointestinal Alto Upper GI Bleeding Curso Internacional Retos Clinicos en la Gastroenterologia de Urgencias Asociacion Colombiana de Gastroenterologia 31 de Agosto, 2012 Pereira, Risaralda
More informationDON T LET OBESITY SPOIL YOUR HEALTH AND YOUR LIFE
July 2015 Issue No.17 DON T LET OBESITY SPOIL YOUR HEALTH AND YOUR LIFE www.sghgroup.com JEDDAH RIYADH MEDINA ASEER HAIL SANAA DUBAI CAIRO Definitions Over View and General Facts General Key facts! Worldwide
More informationPerforated duodenal ulcer: which operation?
The Ulster Medical Journal, Volume 56, No. 2, pp. 130-134, October 1987. Perforated duodenal ulcer: which operation? P J Gill, C F J Russell Accepted 7 September 1987. SUMMARY Between January 1968 and
More informationEmergency Surgery Board Department of General Surgery Rambam Health Care Campus
Emergency Surgery Board Department of General Surgery Rambam Health Care Campus Surgical Complications of Peptic Ulcer Disease Case Presentation and Review of the Literature Case Presentation 40y male
More informationClinical Questions. Clinical Questions. Clinical Questions. Health-Process-Evidencebased Clinical Practice Guidelines Acute Abdomen
Health-Process-Evidencebased Clinical Practice Guidelines Acute Abdomen 1. What is an operational concept of acute abdomen? any abdominal condition of acute onset from various causes involving the intraabdominal
More informationSupplementary Online Content
Supplementary Online Content Guimarães PO, Krishnamoorthy A, Kaltenbach LA, et al. Accuracy of medical claims for identifying cardiovascular and bleeding events after myocardial infarction: a secondary
More informationGI update. Common conditions and concerns my patients frequently asked about
GI update Common conditions and concerns my patients frequently asked about Specific conditions I ll try to cover today 1. Colon polyps, colorectal cancer and colonoscopy 2. Crohn s disease 3. Peptic ulcer
More information(1964) found that 11.1 % of 6,085 patients admitted. with duodenal ulceration to the Cook County. It is difficult to estimate the incidence of pyloric
POSTGRAD. MED. J. (1966), 42, 778. Current Survey STENOSIS THE lumen of the first part of the duodenum is a comparatively narrow segment of the alimentary canal so that when the surgeon passes his finger
More information58 year old male complaining of 3-week history of increasing epigastric pain
Peptic Ulcer Disease 58 year old male complaining of 3-week history of increasing epigastric pain Has had dyspepsia in the past for which he took Tums, but this is much worse and only partially relieved
More informationStudy of Peptic Ulcer Perforation in 80 Cases
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Abstract Study of Peptic Ulcer Perforation in 80 Cases Authors Dr. Jitendra.T.Sankpal 1, Dr. Vivek.P.Tilwani 2, Dr. Tushar Walvi 3 Dr.Vijay
More informationMazen E. Iskandar, Fiona M. Chory, Elliot R. Goodman, and Burton G. Surick
Case Reports in Surgery Volume 2015, Article ID 353468, 4 pages http://dx.doi.org/10.1155/2015/353468 Case Report Diagnosis and Management of Perforated Duodenal Ulcers following Roux-En-Y Gastric Bypass:
More information