Esophageal Varices Pathophysiology Explained in 40 Characters

Esophageal Varices Pathophysiology
Introduction Esophageal varices are abnormally enlarged veins usually located in the submucosa of
the lower esophagus and are caused when there is an obstruction of the portal venous circulation.
Esophageal varices are most common in individuals with liver diseases and in most circumstances
can be life threatening. It is imperative that we diagnose esophageal varices in a timely manner to
decrease complications.
Pathophysiology and Concept
Pathophysiology
Esophageal varices is usually always caused by portal hypertension, but can also be caused by
abnormalities of the circulation in the splenic vein or superior vena cava and also by hepatic
venothrombosis. Esophageal varices occur when the portal venous circulation becomes obstructed,
causing ... Show more content on Helpwriting.net ...
An endoscopy is used to detect varices and also to identify the bleeding site if there is one. An
ultrasonography, CT scanning, and angiography can all be used as well. A spelenoportography is
used to detect if there is collateral circulation in the esophageal vessels and if there is that indicates
varices are present. Since portal hypertension is the main cause of esophageal varices it is important
that we assess for it. It is detected when there is dilated abdominal veins and/or hemorrhoids, ascites
and also if the spleen is enlarged .The portal venous pressure can be measured in two different ways
indirectly or directly. It is measured indirectly by using the hepatic vein pressure gradient and it is
measured directly by introducing a needle into the spleen during a laparotomy or by inserting a
catheter into the portal vein. Lab tests that can be considered include: liver function tests like serum
aminotransferases, bilirubin, alkaline phosphatase, and serum proteins, as well as other tests such as
CBC, electrolytes, creatinine, BUN, pt, and ptt.
Review of Related Literature
Conduction
After researching and reviewing several articles online about esophageal varices two articles were
obtained. The literature within each article stated that the key to success in dealing with esophageal
varices is prompt diagnosis and treatment. Each article stated essential risk factors, assessments,
treatments, and teachings that are essential to the condition.
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Portal Hypertension Paper
Hello, my name is Amy Gordon and I will be discussing the disease process of Portal Hypertension,
and discussing how the disease process can affect the neurological, gastrointestinal, reproductive,
skin, hematological, metabolic and circulatory Systems. I will also be discussing the types of
treatments, the average annual cost of medication therapy, side effects of the medications, and how
to prevent exacerbation of the disease from occurring.
Portal Hypertension is known as an increase in the pressure of the portal venous system (Lewis,
Heitkemper, Dirksen, & Bucher, 2014). Portal Hypertension puts an individual at risk of damage to
the vessels that lead to the liver, resulting in poor blood circulation (Lewis et al., 2014). As portal
hypertension ... Show more content on Helpwriting.net ...
The reason I have chosen the medication therapy is for five reasons: the individual will have less
drop in potassium levels with a potassium sparing diuretic (Lehne, 2013). The individual will be on
Klor–con to assist with keeping the potassium levels within the normal range only if not on a
potassium sparing diuretic. Lasix will help with prevention of ascites, by removing the excess fluid
around the major organs and abdominal area (Lehne, 2013). Inderal is the drug of choice in the
prevention of bleeding, due to increased pressure in the portal vein (Lehne, 2013). Finally, I would
have the individual in some form of antibiotic therapy three times a week, to help prevent bacterial
peritonitis (Lehne, 2013). This will decrease the mortality rate, due to multiple system organ failure
caused by infection (Lehne,

GI Endoscopy Biopsy (EGD)
43239 Upper GI endoscopy biopsy (Esophagogastroduodenoscopy, flexible, transoral; with biopsy,
single or multiple). The beneficiary underwent an esophagogastroduodenoscopy (EGD) and was
diagnosed with "unspecified disorder of the stomach and duodenum" (537.9), which is not covered
by the Local Coverage Determination Policy L29167. The documentation did not include prior
physician progress notes to support the medical necessity for the EGD procedure. There was no
indication of symptoms of physical findings that would support the medical necessity of the
procedure in accordance with Medicare guidelines. The beneficiary was a 65 year old woman who
had been diagnosed with mild gastritis. She complained of abdominal pain for approximately 5 ...
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The provider submitted a copy of the claim and medical records. The provider also indicated that a
corrected claim had been submitted with the diagnosis code 537.89. On March 09, 2014, the QIC
sent a letter to the provider stating that the payment was "denied due to the lack of medical
necessity/invalid diagnosis." The claim was billed with the diagnosis 537.9 (the incorrect code) not
covered within the LCD. However, the provider had already submitted the appeal with the correct
diagnosis twice. Was that information taken into account at the time of the QIC's determination? The
QIC also indicated that the documentation submitted did "not include any prior physician progress
notes from the billing physician/PCP to substantiate medical necessity for the procedure billed."
How would the progress notes have changed the determination? The claimant was evaluated in the
ER; the ER doctor discussed the case with the billing provider while the claimant was still in the
ER. Per the ER documentation "6:46 PM Discussed case with Dr. Selub (GI) states for the PT to call
his office at 9 AM and he will be able to F/U with the Pt in 1

Is The Alimentary Canal A Long And Complex Structure?
Over the past few weeks we have been studying the gastrointestinal system, as we progress thru our
clinical and didactic instruction, I have learned that the alimentary canal is a long and complex
structure. Although the basic positioning concepts are similar to those of the chest and abdomen, the
organs of digestive system are difficult to visualize without the use of contrast media. While at
Christus Spohn South, I have had the opportunity to view several esophagograms, however there has
only been one upper GI series (UGI). Below I will explain the many aspects of this exam and how it
is performed. A fluoroscopic upper GI series is generally used to study ". . . the form and function of
the distal esophagus, stomach, and duodenum and to detect abnormal anatomic and functional
conditions" (Bontrager and Lampignano). This particular upper GI series was performed on a forty–
eight–year–old female, outpatient. In addition, the patient had previously undergone this exam and
understood the basics of the procedure. Even though there are a multitude of clinical indications to
perform an upper GI, such as bezoars, diverticula and gastritis. The reason for the patient's exam
was due to possible esophageal gastric reflux and a hiatal hernia. Former surgeries recorded in the
patient's history, were both an appendectomy and a cholecystectomy. Besides this, the patient also
indicated a history of gastric ulcers that were previously treated. Before an UGI several preparations
need to

Esophagus
Objective/Question Tested The main objective for this study was to determine the effect of chronic
gastric reflux on the microscopic status and histology of esophageal mucosa and the expression of
mRNA for Cyclooxygenase–2 (COX–2) and plasma proinflammatory cytokine levels. The
researchers were interested in role of COX–2 and chronic inflammation that leads to the progression
of Barrett's Esophagus (BE) to adenocarcinoma in the esophagus. This connection has not been
studied in experimental models as extensively as it has in human models, so this study conducts the
in vitro examination of the esophagus in rats. They chose to study cyclooxygenase–2 and
proinflammatory cytokine levels based on the fact that these two molecules are the central
contributors to the inflammatory response. They hypothesized that the overproduction and excessive
release of COX–2 and ... Show more content on Helpwriting.net ...
There were also whitish nodular patches (1–2mm) that covered the surface, giving the appearance a
cobblestone figure. In all EDGA rats, chronic esophagitis occurred, and the highest lesion index and
histological score was reported. The chronic exposure to the mixed reflux of acid and bile salts
resulted in this along with the cells being replaced by intestinalized columnar epithelium with
neutrophils, eosinophils, plasma cells, and lymphocytes. Intestinal metaplasia and mucinous
adenocarcinoma was also present in the esophageal wall. The levels of plasma IL–1 beta and TNF–
alpha were increased in the EGDA rats, and the expression of COX–2 mRNA and protein had a
dramatic upregulation of mRNA for COX–2 and protein. The IL–1 beta cytokines increased from
4pg/mL to 17pg/mL, and the TNF–alpha cytokines increased from 3pg/mL to 17pg/mL. The COX–2
mRNA/beta–actin mRNA ratio increased from 0.03 to 0.15, and the COX–2 protein/beta–actin
protein ratio increased from 250 to

Synthesis Of Most Coagulation Factors And Inhibitors
Discussion:
Liver has many haemostatic functions including the synthesis of most coagulation factors and
inhibitors as well as fibrinolytic factors. The balance between procoagulant and anticoagulant
factors is essential to prevent excessive blood loss from injured vessels and to prevent spontaneous
thrombosis (11).The global effect of liver disease with regard to hemostasis is therefore complex, so
that patients with advanced liver disease can experience severe bleeding or even thrombotic
complications (12).
Non– PVT group
At presentation (N=26)
After 6 months (N=26) p No
%
No
%
Gastropathy
Gastropathy grade I
3
11.53
4
15.3
0.6
Gastropathy grade II
4
15.38
3
11.5
Gastropathy grade III
3
11.53
0
0
Esophageal varices
OV I
2
7.69
3

11.5
OV II
3
11.53
3
11.5
0.09
OV III
5
19.23
2
7.6
OV IV
4
15.38
1
3.8
ISSN 2320–5407 International Journal of Advanced Research (2015), Volume 3, Issue 12, 1539 –
1548
1545
In our study as regards presence of co– morbid factors namely DM and hypertension, the prevalence
of DM and hypertension was higher in PVT group than non–PVT group, these results match the
findings reported by Martinelli et al. (13) who clarified that hypertension and DM were associated
with increased risk of PVT. That finding may be attributed to the association of dyslipidemia with
diabetes and increased risk of atherosclerosis, so patients with liver cirrhosis and associated diabetes
or hypertension carry the risk for PVT more than cirrhotic patients without them.
The

Virrhotic Patients: Evaluation Of Thyroid Dysfunction In...
Volume 5 Issue 8, August 2016 www.ijsr.net Evaluation of Thyroid Dysfunction in Egyptian
Chronic Hepatitis C Virus Cirrhotic Patients
Complicated with Portal Hypertension
Waseem M. Seleem MD, Fady M. Wadea MD
Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Abstract: Introduction: Alterations in thyroid hormones regulation and metabolism are observed in
cirrhotic patients with decreased serum (T3).Objectives: to investigate the relation of these
hormonal alterations to esophageal varices, portal hypertensive gastropathy
(PHG) and degree of liver dysfunction in Egyptian cirrhotic patients with portal hypertension.
Material and methods: study included
124 cirrhotic patients and 62 controls, patients were stratified into: group I (62 patients) with
esophageal varices and group II (62 patients) with portal hypertensive gastropathy without varices,
each group was classified according to presence or absence of bleeding into subgroup A and B
respectively. Grading of esophageal varices and PHG was done. Serum free T3 (FT3), free T4 and
TSH levels were measured using Electrochemiluminescence immunoassay. Results: Cirrhotic
patients had significantly lower levels of FT3 than controls (ps classes and in patients with higher
variceal and PHG grades. FT3 was significantly negatively correlated to oesophageal varices,
PHG grades and INR. Conclusion: FT3 level was significantly negatively correlated to the degree of
hepatic dysfunction, grades of

Barret's Esophagus: Gastro Esophageal Reflux Disease
Barret's Esophagus is a serious complication of GERD, in which stands for Gastro Esophageal
Reflux Disease. With Barret's esophagus normal tissue lining the esophagus; the tube that carries
food from the mouth to the stomach changes to tissue that resembles the lining of the intestine, this
process is called intestinal metaplasia ("Barret's esophagus: Symptoms," 2005). Patients who are
diagnosed with Barret's esophagus are at an increase risk of developing esophageal adenocarcinoma,
which is cancer of the esophagus and can be fatal. The cause of Barret's esophagus is unknown.
Barret's esophagus is very rare and affects only about 1%–6.8% of people. The average age of
diagnose is around the age of 55, and more men develop Barret's esophagus twice as often as
women would ("Barret's esophagus– national," 2013). Also more Caucasian men get diagnosed
more than men of other races, and Barret's esophagus is not commonly seen in children. People who
are diagnosed with GERD have a 5–10% chance to develop Barret's esophagus. Researches did find
that patients who are diagnosed with heartburn are 5–15% more likely to end up getting diagnosed
with Barret's esophagus, it is sometimes hard to diagnose for Barret's esophagus because it is rare.
Most people with acid reflux don't develop Barret's esophagus. Patients with frequent acid reflux;
cells that are similar to cells in the intestine to become Barret's esophagus may eventually replace
the normal cells in the esophagus. The

Essay On Esophageal Varices
Currently endoscopy has been the gold standard modality in identifying esophageal varices 108[13].
However, many studies have identified many noninvasive markers predicting the presence and
grading of esophageal varices 109,110[14,15]. Many studies have revealed that multiple factors can
be used in prediction of the presence of esophageal varices like splenomegaly, 111–113[16–18]
spider nevi, ascites114[19]Child Turcotte Pugh grading system113,114[18,19] platelet count 114–
118[19–23] portal vein diameter, prothrombin time119[24], platelet count: spleen diameter ratio
119,120[24,25], serum bilirubin 114[19], and serum albumin. Esophageal varix (EV) is the result of
spontaneous formation of collateral vessels between esophageal veins and ... Show more content on
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The serum markers (platelet count, APRI score, Forn's score, Lok score, FIB–4, Transient
Elastography [TE]) were compared with percutaneous liver biopsy (LB) to predict the extent of
disease. All the evaluated tests had outstanding predictive value (AUROCs 0.839–0.979). 124[29] In
our study, liver biopsy and elastography were not taken as variables, but portal vein size; an indirect
evidence of portal hypertension (due to liver fibrosis) was compared with serum markers. In a study
reported by Sudha Rani et al (2015) measurement of PVD (> 13 mm) and ultrasound findings were
independent non–invasive predictors for presence of esophageal varices in patients with chronic
liver disease with portal hypertension 125[29] Either large varices or small varices or both with the
Red signs are globally known as Varices Needing Treatment (VNT). In another study conducted in
2016, Xiao G et al [30] studied two markers i.e. APRI and FIB–4 on 2176 patients to correlate with
liver fibrosis. However these two models had very low accuracy in predicting HBV–related liver
fibrosis in HCC patients suggesting that liver fibrosis alone may not be the sole factor to influence
these markers. In our study, we did not study this variate of HCC presence of which could

There Was Highly Statistical Significant Difference Between
There was highly statistical significant difference between cirrhotic variceal group and cirrhotic non
variceal group regarding serum albumin, Prothrombin time(PT), and platelet count.(table2)
variceal group regarding child score, platelet count spleen diameter, Portal vein diameter (PVD) and
spleen diameter (table 2)
variceal group regarding to presence of ( spider naevi, ascites, encephalopathy, jaundice and ...
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,platelet count at cutoff less than 74000 mm3 is significant in prediction of variceal bleeding risk
with sensitivity 82.5% and specificity 55%. and platelet count/spleen diameter ratio (PC/SD) at
cutoff 851.6 is significant in prediction of variceal bleeding risk with sensitivity 45% and specificity
90%.(table 5)
Table (1) : Comparison between variceal Patients (group[A] cirrhotic patient with history of variceal
bleeding , group[B] cirrhotic patient with esophageal varices but no history of

Splenectomy: A Case Study
The article I chose to review regarding my patient's diagnosis discussed several studies looking at
the effects of splenectomy on liver volume and function, and prognosis of cirrhosis in patients with
esophageal varices. These studies were quite interesting considering my patient's history of
splenectomy, liver cirrhosis, and esophageal varices. Changes in hepatic function, splenic function,
and liver volume were evaluated, as well as each patient's probability of increased survival rate.
Results showed that restoration of liver function accelerated over time once a splenectomy had been
performed. No patient in the studies had any serious complications, such as severe infection as a
result of splenectomy. The two groups showed no significant

Clinical Overview : Esophageal Varices
CLINICAL OVERVIEW – Esophageal Varices
TERMINOLOGY
CLINICAL CLARIFICATION o Esophageal varices are abnormal, enlarged veins in the lower part
of the esophagus. Esophageal varices develop when normal blood flow to the liver is obstructed by
scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood
vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even
rupture, causing life–threatening bleeding. CLASSIFICATION
Small varices and no hemorrhage
Hepatic venous pressure gradient ≥ 10mmHg
Varices development rate 8% per year
Large varices and no hemorrhage
Hyper dynamic circulation
Progression from small to large 8% per year
Variceal hemorrhage
Pressure > Variceal wall tension
Esophageal hemorrhage 5–15% per year
Bleeding in patients with gastric varices is reports in 25% of patients in 2 years
Recurrent hemorrhage
Persistence of portal pressure and variceal status
DIAGNOSIS
CLINICAL PRESENTATION History
Patients are usually asymptomatic unless they bleed
Symptoms of bleeding esophageal varices include:
Vomiting blood
Black, tarry or bloody stools Physical Examination
If varices are related to liver disease, may see any of the following: Shock (in severe cases)
Yellow coloration of your skin and eyes (jaundice)
A cluster of tiny blood vessels on the skin, shaped like a spider (spider nevi)
Reddening of the skin on the palm of hands (palmar

Endophagogastrograde Cholango-Pancreatography
What is the difference between an EGD and an ERCP? What are their functions?
The acronym for ERCP stands for Endoscopic Retrograde Cholango– Pancreatography. ERCP has a
fiberlike inserter called the endoscope. An endoscope is a camera that is attached at the end
following along with flouroscope that placed in the throat slowly to the pancrea to to how the
pancrea and gallbladder. At this point the MRI machine takes images of the diagnostic. The ERCP is
for patients in the hospital that has disorders with bile and pancreatic ducts.
The Endophagogastroduodenoscopy is an endoscopic test that dilates the esophagus, stomach and
small intestine. This procedure is to diagnose and treat the gastrointestinal (GI) tract. When getting
this procedure the physician would place a endoscope from your mouth to your throat with a long
blendable tube that appears to be a video camera. A light is attached to visualize the upper part of the
GI tract down to the video images.
www.differencebetween.net/science/health/difference–between–ercp–and–mrcp/ ... Show more
content on Helpwriting.net ...
My husband took off for 2 days meanwhile my mother came to visit us for a week. Even I got a little
help from my 14 year old son. It is a huge gap of 14 years in between my children. I would never
forget how much pain I endured, crying spells and depression. I stayed tired with little rest because I
would be up all night with the baby. I was dealing with these emotionals for atleast a month.
Eventually, I felt better but had to get use to having a baby around and including him with every step
I made. Therefore I do understand the importance of postpartum care provides support for new
mothers during the care of having a newborn. The purpose of postpartum care is make sure the new
mother transition pleasant and smooth. Some women breastfeed, need help with bathing, diapering,
light cooking,

Endoscopy Essay
ENDOSCOPY EGD stands for an esophagogastroduodenoscopy. This procedure is used to visualize
the esophagus, stomach, and the duodenum. This is done via a lighted tube or endoscope to detect
abnormalities. Possible abnormalities are tumors, ulcerations, or an obstruction. The patient should
be NPO for 8 hours before the test. When the patient arrives medical history, consent forms,
explanation of test, and insertion of an IV are all completed. The patient is given preoperative
sedation and an IV sedation may also be given for the test. The throat is anesthetize with a local
spray or gargle. Each facility has different ways the patient is positioned for the test. The book states
that the patient lies on a table with head extended. GVMH has the patient sit and the endoscope is
introduced ... Show more content on Helpwriting.net ...
Polyps can be removed or biopsies taken during the procedure. Clear liquid diet should be 1–3 days
before the test. The patient should be NPO for 8 hours before the test. Laxatives are given for 1–3
days before the test and enemas the night before. GVMH has a different prep than the book. Their
prep consists of clear liquid diet, five Dulcolax in the am, and then at 3pm a 64oz of Gatorade with
Miralax the day before the test. When the patient arrives medical history, consent forms, explanation
of test, and insertion of an IV are all completed. The patient is given preoperative sedation and is
moderately sedated via IV for the test. The patient is positioned on their left side in bed. The length
of the procedure depends on the reason for the test. Most colonoscopies take 30 minutes to an hour
but some can take 1.5–2 hours if abnormalities are found. After the procedure is complete vital signs
should be monitored every 15–30 minutes or as ordered. Watch for increased temperature,
abdominal distention, or pain. This could be a possible complication known as perforation or rectal
bleeding

Gastroesophageal Reflux Disease : A Literature Review
Gastroesophageal Reflux Disease: A Literature Review Abstract: Gastroesophageal reflux disease
(GERD) is a common illness affecting approximately 20–40% of adults.1 The symptoms of GERD
vary considerably in severity and are primarily caused by highly acidic gastric juice from the
stomach ascending into the esophagus.1 Frequent episodes of GERD are strongly associated with
Barrett's esophagus (BE), a condition caused by the metaplastic transformation of normal squamous
epithelial cells to columnar epithelial cells in the lower esophagus.2 Although BE is considered
premalignant, the risk of developing the deadly esophageal adenocarcinoma (EAC) increases nearly
40 times in patients with BE lesions.2 PubMed database searches were screened to ... Show more
This study was selected because it included two phases, used calculated regression models for data
interpretation, and had a large number of participants (n=4,880). The 2012 article by Ashktorab et
al.4 was selected because it was the largest study (n=2,020) analyzing the prevalence of H. pylori in
African Americans. In the United States, H. pylori colonization of the stomach is 2–3 times higher
among non–Hispanic blacks and Mexican Americans.3 NHANES data from 1999–2000 showed that
the age–adjusted rates of positive serological tests among non–Hispanic whites, non–Hispanic
blacks, and Mexican Americans were 21.2%, 52.0%, and 64.0%, respectively.3 Furthermore, these
data show significant declines in the prevalence of H. pylori only among non–Hispanic whites from
1988–1991 to 1999–2000 (Odds ratio=1.38).3 Ashktorab et al.4 documented a 38 % prevalence of
H. pylori among African Americans receiving care at Howard University hospital between January
2004 and December 2007.4 Grad et al.3 drew rational conclusions using multivariate logistic
models to adjust for age, socioeconomic status, and country of birth. On the other hand, Ashktorab
et al.4 drew conclusions on a smaller homogenous population receiving care at one hospital. For
instance, they conclude that H. pylori colonization is inversely associated with esophagitis, based on
the colonization rate in the esophagitis group versus

Eosinophilic Gastroenteritis
Diagnosis and management of Eosinophilic Gastroenteritis (EGE) requires a background knowledge
of hallmark characteristics, the use of medical procedures for differential diagnosis and a
multidimensional approach to treatment (Ingle & Hinge, 2013). Diagnosis begins with identifying
gastrointestinal symptoms of EGE, eosinophilic infiltration of the gastrointestinal tract, exclusion of
parasitic disease and the lack of other systemic involvement (Ingle & Hinge, 2013). Treatment
options for EGE include dietary restrictions and steroid use or a combination of both depending on
the determined reason for onset. Overall, the lack of information on EGE is telling of the rarity of
the disease, with only 280 cases being described in the literature before 2013 (Mori, ... Show more
In 1961, Ureles, Alschibaja, Lodico, & Stabins (1961) classified EGE's depending on presentation
for the first time, class I a diffuse EGE and class II a EGE with well–defined edges. In 1970, Klein,
Hargrove, Sleisenger, & Jeffries (1970) classified EGE by the anatomical location of the
eosinophilic infiltration within the three layers of the intestinal tract: the mucosal, muscularis and
subserosal layers. In 1990, Talley, Shorter, Phillips, & Zinsmeister (1990) proposed three diagnostic
criteria: presence of gastrointestinal symptoms, biopsies showing eosinophilic infiltration of the
gastrointestinal tract in one or more areas, and characteristic radiological findings of eosinophilia
with no evidence of parasites or intestinal disease. In 1993, a longitudinal study on eight adult
patients was published which provided information on the relapsing nature of EGE as 50% of the
individuals in the study needed continuous low does steroid therapy to stay in remission (Lee,
Changchien, Chen, Lin, Sheen, Wang, . . . Wu,

Esophagogastroduodenoscopy Research Paper
Esophagogastroduodenoscopy Esophagogastroduodenoscopy (EGD) is a procedure to examine the
lining of the esophagus, stomach, and first part of the small intestine (duodenum). A long, flexible,
lighted tube with a camera attached (endoscope) is inserted down the throat to view these organs.
This procedure is done to detect problems or abnormalities, such as inflammation, bleeding, ulcers,
or growths, in order to treat them. The procedure lasts about 5–20 minutes. It is usually an outpatient
procedure, but it may need to be performed in emergency cases in the hospital. LET YOUR
CAREGIVER KNOW ABOUT: Allergies to food or medicine. All medicines you are taking,
including vitamins, herbs, eyedrops, and over–the–counter medicines and creams. Use ... Show
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However, as with any procedure, complications can occur. Possible complications include:
Infection. Bleeding. Tearing (perforation) of the esophagus, stomach, or duodenum. Difficulty
breathing or not being able to breath. Excessive sweating. Spasms of the larynx. Slowed heartbeat.
Low blood pressure. BEFORE THE PROCEDURE Do not eat or drink anything for 6–8 hours
before the procedure or as directed by your caregiver. Ask your caregiver about changing or
stopping your regular medicines. If you wear dentures, be prepared to remove them before the
procedure. Arrange for someone to drive you home after the procedure. PROCEDURE A vein will
be accessed to give medicines and fluids. A medicine to relax you (sedative) and a pain reliever will
be given through that access into the vein. A numbing medicine (local anesthetic) may be sprayed on
your throat for comfort and to stop you from gagging or coughing. A mouth guard may be placed in
your mouth to protect your teeth and to keep you from biting on the endoscope. You will be asked to
lie on your left side. The endoscope is inserted down your throat and into the esophagus, stomach,
and duodenum. Air is put through the endoscope to allow your caregiver to view the lining of your
esophagus

Informative Essay On Cancer
Cancer. You never thought you would be one of the unlucky human beings to get cancer, but then all
of a sudden, you're sick. Throwing up, not being able to swallow anything, and chest pains. You go
to the doctor and he says something you are not expecting. Something you never thought you would
ever hear. You have cancer. Did you know that men are more likely to get Esophageal cancer than
women? Tobacco and Alcohol use is the leading cause of this type of cancer. In this essay, I will be
talking about Esophageal cancer. I will cover the topics of what it is, causes of the disease, how to
treat it, how to prevent it, and the many effects it has on your body. Cancer is a disease that no one
wants, but it is a disease everyone is willing to fight if it means getting your life back. What is
esophageal cancer? Well, esophageal or esophagus is the tube that connects the throat to the
stomach. The cancer starts in the inner layer and continues to grow outward. There are two types of
esophageal cancer. The first one is Squamous Cell Carcinoma. The second type is Adenocarcinoma.
Squamous is a cell in the body that are thin and flat and they look like fish scales. They are found in
the tissue of the body and they form the surface of the skin and is a lining on the hollow organs of
the body and of the respiratory digestive tracts. Squamous cell carcinoma can be located on
anywhere on the esophagus, but it is mostly found in the neck area and upper chest cavity.
Adenocarcinoma is a

How Technology Has Impacted Our Society
Early diagnosis is not a concept considered by everyone; however, it should be. In short, it is the
detection of a disease or disorder before it has completely developed. Now one might think, "Why
should I care about such a thing?" Well, these folks should think about a person they cherish the
most. How would it affect them if they discovered that their loved one had cancer, but it was too late
to treat it? This does not always have to be the case with early detection and diagnosis. People
around the world ought to embrace the beauty of technology, and take every measure possible to
continue living a healthy, happy life. Technological advancements have greatly impacted our
society, in a positive way, by allowing early diagnosis, which can lead to early action. I maintain that
the benefits of early detection heavily outweigh the potential associated risks.
Due to the overwhelming abundance of the technological advancements in medicine, society is now
able to help citizens prevent, detect, and treat many disorders of the human body. Developments in
medical technology came as a complete and total surprise to some, including Olga Golubnitschaja,
author of Predictive Diagnostics and Personalized Treatment: Dream or Reality. Written in 2009, she
describes her astonishment of the endless possibilities medical technology has begun to offer people
across the globe. As our brain is one of the most thought of organs in the body, psychiatry was an
experimental field early on in the

Diet For Infant 's Gasteroesophasial Reflux
Hypoalergenic diet for infant's gasteroesophasial reflux: A Randomized,case–controlled Trial
.Introduction Gastroesophageal reflux (GER) is defined as the passive movement of gastric contents
into the esophagus with or without regurgitation or vomiting. It is a physiologic state occurring
several times per day, with no symptoms.(1) . Episodes of regurgitation peaks at about 4 months of
age (2). and it resolves without treatment in 95 % of infants by 1 year of age. .(1) GER disease
(GERD) occurs when reflux of the gastric contents causes some complications, including failure to
thrive, feeding or sleeping problems, chronic respiratory disorders, irrtability , hematemesis, apnea,
and life–threatening events.(1) . Infant with GERD needs intervention to resolve complications. The
best method for diagnosis is PH metry + multiple intraluminal impedance but is very difficult doing
the procedure in infants, so diagnosis of it is on base of sign and symptoms and excluding other
pathologic causes of vomiting and severe regurgitation(3) Some authors advised medical treatment
for this purpose. They believe that when infants suffer from any sign and symptoms of GERD more
intensive management like antisecretory agents,antiacids,surface barrier agents and prokinetics is
needed.( 1, 3) Drug treatment of gastroesophageal reflux includes antiacids, H2 blockers or
PPIs(Proton pomp inhibitors). H2 blockers such as Ranitidine,cimetidine are useful in mild to

Esophagogastroduodenoscopy (EGD) is the most widely used...
Esophagogastroduodenoscopy (EGD) is the most widely used method to investigate esophageal
diseases with excellent accuracy. Till date it has been considered the gold standard for the diagnosis
and surveillance of esophageal diseases including interventional procedures. It has mainly been used
for diagnosing barret's esophagus, reflux esophagitis, esophageal varices and esophageal cancers.
However the EGD is expansive and uncomfortable to the patient along with a small potential risk
for complications. It involves the risk of conscious sedation along with loss of productivity. It has
more complication rate in cases of cirrhosis. Next step was the development of a safer and more
comfortable method to view the mucosa of esophagus thus came ... Show more content on
Helpwriting.net ...
First the study was done on healthy volunteers which are themselves capsule endoscopists.
Subsequently study was done of patients with suspected esophageal disease to compare the
feasibility, efficacy, quality and patient discomfort between the two methods. Feasibility and the
quality of the test has been compares in al the four main diagnostic indications of EGD and this has
been shown the table format as well as compared with the pictures.
This article is on a very commonly performed procedure EGD, all over the world which has
changed its role from mainly diagnostic procedure in the early years to a therapeutic procedure.
Authors have presented the feasibility data compares to EGD. More than feasibility they have
emphasized that SSCE is more comfortable to the patient. It has less complication rate as compared
to EGD. It has equal quality of the images of the esophagus and rather better image quality than
EGD in certain diseases. Capsule endoscopy has shown moderate efficacy in lower end esophageal
images because of no control over the movement of the capsule. SSCE has overcome the difficulty
by attaching a string to the capsule with which up and down movement of the capsule can be
controlled ad lib to improve the focus on the area of interest. It has many other advantages:
It is a controlled method for esophagoscopy
No sleeve or string Was broken in the study
More comfortable to the patient

Abnormal Factors And The Prevalence Of Dm And Hypertension
In our study as regards presence of co– morbid factors namely DM and hypertension, the prevalence
of DM and hypertension was higher in PVT group than non–PVT group, these results match the
findings reported by Martinelli et al. (13) who clarified that hypertension and DM were associated
with increased risk of PVT. That finding may be attributed to the association of dyslipidemia with
diabetes and increased risk of atherosclerosis, so patients with liver cirrhosis and associated diabetes
or hypertension carry the risk for PVT more than cirrhotic patients without them.
The number of patients who were smokers and users of contraceptive pills were also statistically
higher in PVT group than non–PVT group indicating that these factors may increase the risk for
PVT development in cirrhotic patients which goes in agreement with Shetty and Ghosh study (14).
These results may be attributed to the hypercoagulability caused by hormonal pills and increased
risk of atherosclerosis with smoking.
Risk factors:
PVT in patients with liver disease is the result of concomitant local and systemic thrombophilic
factors (15). In current study as shown in table (II) malignancy specially (HCC) was the most
common local risk factor for PVT followed by abdominal infection specially SBP then abdominal
intervention especially splenectomy. Similar results were also reported by other studies as Sogaard
et al.(6) in which abdominal inflammation especially pancreatitis was the most common risk factor
(19%)

Barium Swallow Case Study
Barium Swallow A barium swallow is an X–ray exam that is used to evaluate the area at the back of
your throat (pharynx) and the tube that carries food and liquid from your mouth to your stomach
(esophagus). For this exam, you will swallow a white chalky liquid called barium. X–rays are done
while the barium passes through your pharynx and esophagus. The barium makes it easier for your
health care provider to see possible problems in this area. A barium swallow may be done to check
for various problems, such as: Ulcers. Tumors. Inflammation of the esophagus. Hiatal hernia. This is
a condition in which the upper portion of the stomach protrudes into the chest cavity. Scarring.
Blockages. Problems with the muscular ... Show more content on Helpwriting.net ...
You will likely drink the barium through a straw. During the procedure, the X–ray table may be
moved to a more upright angle. You may also be asked to shift your position on the table. This will
allow your entire esophagus to be viewed. The health care provider will watch the barium flow
through your esophagus using a type of X–ray that allows images to be viewed on a monitor in a
movie–like sequence (fluoroscopy). X–ray images will also be stored for later viewing. AFTER
THE PROCEDURE You can return to your regular activities and diet unless instructed otherwise by
your health care provider. Your stool (feces) may be white or gray for 2–3 days until all the barium
has passed out of your body in your stool. You may be given a laxative to take in order to help
remove the barium from your body. Your health care provider may recommend other things to help
prevent constipation after this procedure, including: ○ Drinking enough fluid to keep your urine
clear or pale yellow. ○ Eating foods that have a lot of fiber, such as fruits, vegetables, whole grains,
and beans. Call your health care provider

Essay On Cirrhosis
P.P.I therapy is often used in patients with cirrhosis, sometimes, in the absence of a specific
indication (e.g.: acid related diseases), there are conflicting reports for their use in cirrhotic patients.
The dosage of most PPIs should be reduced in cirrhotic as they are metabolized by the liver and
associated with adverse effects of prolonged use.
Keywords
Proton pump inhibitors, liver cirrhosis, peptic ulcer, H. pylori, esophageal band ligation.
Abbreviations
P.P.I: proton pump inhibitors.
EVS: esophageal variceal Sclerotherapy.
EVL: esophageal variceal ligation.
HE: hepatic encephalopathy.
SBP: spontaneous bacterial peritonitis.
CDI: Clostridium difficile infection.
PHG: portal hypertensive gastropathy.
GERD: gastroesophageal ... Show more content on Helpwriting.net ...
However, high–dose infusion (e.g., pantoprazole 8 mg/h) and prolonged use in the absence of
endoscopic procedures is not supported by the literature and should be discouraged until evidence of
benefit becomes available. (8)
GERD
Functional studies showed decreased LES function with low amplitude of acid clearance and
primary esophageal peristalsis in cirrhotic patients with large varices [9]. These phenomena could be
due to a mechanical effect of the varices. Cirrhotic patients without EV have also esophageal motor
disorders and mixed acid and bile reflux as the main pattern, whereas the cirrhosis itself is an
important causative factor. It is unclear whether this might contribute to bleeding from varices [8].
Data on management of GERD in cirrhosis are few, however, the indications of use for PPIs may
remain exactly the same in patient with cirrhosis of the liver as general population for the treatment
of erosive esophagitis, or in general the pathology secondary to gastroesophageal reflux of acid (10)
Peptic ulcer and H. pylori infection
Prevalence of duodenal and gastric ulcers in patients with liver cirrhosis increases as the disease
progress[11] and this prevalence becomes higher in decompensated cirrhosis than in compensated
cirrhosis [12]. Currently, PPIs are the mainstay treatment option of peptic ulcers in the general
population [13]. Helicobacter pylori infection contributes to the development of hyperammonemia
[14] and subsequent episodes of

International Journal Of Advanced Research
Page 8
Page 9
15481546INR levels were less in PVT group than control group but in patients with early stages of
liver cirrhosis, no differences in their levels was found between the 2 groups. Therefore, patients
with advanced liver cirrhosis and less prolonged coagulation parameters appear to carry a higher
risk of PVT compared with patients with advanced liver cirrhosis and markedly prolonged
coagulation parameters. These findings were also reported by Weber et al. (19)in their study on
cirrhotic patients with PVT. The platelet levels were also lower with advanced stages of liver disease
possibly from hypersplenism, immune mechanisms and/or decreased production of thrombopoietin
synthesis in the liver (23).Our study demonstrated that platelet count inversely proportionate with
degree of liver decompensation. In patients with Child 's class C, the decrease in platelet count in
PVT group was less than that of control group. These results werein agreement with Francoz et al.
(24)and Donglei et al. (21)who reported that cirrhotic patients with PVT had higher platelet level in
comparison with cirrhotic patients without PVT and advanced stages of liver disease. From the
previous results we can conclude that, in cirrhotic patients the impact of portal hypertension and
deficiency of natural

Cirrhosis Research Papers
Cirrhosis is a chronic and irreversible disease that causes cell destruction and fibrosis of the hepatic
tissues. This scared tissue formation alters normal liver structure and vasculature that impairs blood
and lymph flow. Ultimately resulting in hepatic insufficiency and hypertension in the portal vein.
Three major forms of cirrhosis of the liver are Laennec's cirrhosis, post necrotic cirrhosis, and
biliary cirrhosis. Laennec's cirrhosis results from malnutrition and chronic alcohol consumption. It is
also the most common form of cirrhosis. Post necrotic cirrhosis results from drug induced massive
hepatic necrosis and biliary cirrhosis consists of chronic bile obstruction. Cirrhosis is more prevalent
among malnourished older adult men over ... Show more content on Helpwriting.net ...
Men will have decreased testosterone levels and breast enlargement.
Treatment plans for cirrhosis of the liver consist of antacids, vitamins, nutritional supplements,
avoidance of alcohol, pharmacological, and surgical interventions. To combat the issue of ascites,
the client should visit the health care provider to receive a prescription to take spironolactone, which
is a potassium sparring diuretic, pain medications, and antiemetic's for nausea. Clients should also
go to their health care providers to receive scheduled paracentesis. If the client has high ammonia
levels they should take lactulose, which is an ammonia reducer and laxative.
The clients diet in the early stages of cirrhosis should consist of high protein and high
carbohydrates. In the advanced stages the diet should consist of fiber, protein, fat, and sodium
restrictions. Clients should receive small frequent meals, be on fluid restrictions, rest frequently,
avoid infections, and avoid excess use of soap to prevent skin irritation. Surgical interventions for
cirrhosis can consist of a transjugular intrahepatic portosystemic shunt and liver transplant. Clients
will ultimately receive a shunt if ascites is resistant to other forms of treatment. The shunt is to
reduce portal pressure and relieve ascites. Clients can also visit support

Patient Clinical Details And Treatments
Patient clinical details The patient was referred to the Radiologist from his GP, because of ongoing
pain and difficulty when swallowing. The patient was 45years old male, consumed alcohol regularly
and a heavy smoker.
Due to the clinical details the radiologist decided to perform a barium swallow this allows for the
best visualisation of the internal structures, mainly the upper gastrointestinal tract and the stomach.
Barium swallows show any strictures or narrowing 's in this region which would account for the
patients clinical details.
Diagnosis of esophageal carcinomas require imaging to visualise the involvement: Barium swallow
are the most common form of imaging and diagnosis of esophageal carcinoma but other procedures
such as Chest MRI or thoracic CT, Endoscopic ultrasound and some nuclear medicine scans will
demonstrate esophageal carcinomas Because barium swallows are non–invasive and clearly outline
the shape of the esophagus, the radiologist decided this form of imaging was best suited to the
patient and his clinical details which strongly suggested cancer to be the cause of the clinical details.
Esophageal cancers usually present with the following symptoms: Difficulty swallowing
(dysphagia), Backwards movement of food through the esophagus and possibly mouth
(regurgitation), Chest pain not related to eating, Weight loss without trying ,Worsening indigestion
or heartburn, Coughing or hoarseness But an early esophageal cancer typically causes no symptoms

Patient Care for Esophagogastric Balloon Tamponade Tubes
Writing Assignment #7
Tiara Diaz
ITT Technical Institute/Breckinridge School of Nursing
NUR 270
Jennifer Kyte APRN, MSN
May 7th, 2012
The plan of care for a patient with esophagogastric balloon tamponade tubes is formulated around
the primary nursing diagnosis of ineffective airway clearance related to aspiration of blood (Ackley,
B., Ladwig, G., 2011) Bleeding often stop spontaneously, but if it does not, a Sengstaken–
Blakemore or Minnesota tube is inserted to provide constant pressure at the source of bleeding of
the varices by using a balloon tamponade. For continued bleeding, a nasogastric tube may be
inserted and connected to continuous low suction with periodic lavages. Intra–arterial infusion of
vasopressin or ... Show more content on Helpwriting.net ...
Major complications occurred in 14 patients (35%), and death was attributed to these complications
in nine patients (22%). Regurgitation of gastric contents caused death in six patients. Two died of
rupture of the esophagus and one of airway obstruction. Balloon tamponade is a difficult and
dangerous technique. It should be reserved for those patients proven unequivocally to be bleeding
from esophageal varices in whom massive bleeding continues despite conservative therapy and in
whom surgical intervention is impossible. Prophylactic tracheostomy or endotracheal intubation
prior to the use of the balloon tubes may prevent complications (Conn, H., 1997). Before SBT
insertion, the nurse should inspect and inflate all balloons to check for leaks, then deflate them and
label each port. Because insertion can induce projectile vomiting and further deterioration of the
patient's condition, clinicians should be prepared to clear the patient's airway and to resuscitate if
necessary. Following insertion, the esophageal balloon is inflated to the specified pressure and tube
placement is radiographically confirmed. To maintain correct position, the tube is then securely
taped to the side of the face. If the applied force, known as skin traction, isn't adequate to stop the
bleeding, a weighted traction apparatus can be applied; however, this may increase the risk of tube
migration (Christensen, T., Chrsitensen, M., 2007). Because

Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma which is also known as nasopharyngeal cancer or cancer of the
nasopharynx. It is a cancer that begins in the upper part of the throat behind the nose and near the
base of the skull. The nasopharynx is the upper part of the throat, the pharynx, which lies behind the
nose. The nasopharynx is a chamber about 1 ½ inches. It lies above the soft part of the roof of the
mouth, the soft palate, and in back of the nasal passages. The nasopharynx serves as a passageway
for air from the nose to the throat, and then to the lungs. It is included in the respiratory system,
which is responsible for the exchange of oxygen and carbon dioxide. The nasopharynx is part of the
upper respiratory tract, where one of the function consists ... Show more content on Helpwriting.net
...
The American Cancer Society states that the exact cause of most cases of nasopharyngeal cancer is
not known but studies have shown that the disease is linked with certain diets, infections, and
inherited characteristics. The organization has found that nasopharyngeal cancer is fairly rare where
there is less than one case for every 100,000 people each year in most parts of the world. They
predicted that in 2015 there would be about 3,200 cases in the United States. From research and data
they conducted and gathered, they found that the cancer is more common in certain parts of Asia and
North Africa, particularly in Southern China. It is also more common among Inuit's of Alaska and
Canada, and among some immigrant groups in the United States, such as recent Chinese and Hmong
immigrants (American Cancer Society). According to the National Cancer Institute, there are several
risk factors for nasopharyngeal cancer, which include having Chinese or Asian ancestry, being
expose to the Epstein–Barr virus, and drinking large amounts of alcohol. The organization states

The following questions relates to the patient within the...
The following questions relates to the patient within the first 24 hours
1. Outline the causes, incidence and risk factors of the identified disease and how it can impact on
the patient and family (450 words)
This case study is about Abdul Chidiac, a 51 year old male, married with 4 children. He had a
medical history of hypertension, hypercholesterolaemia and cirrhosis with two admissions in the last
six months. He is a smoker and drinks beer, 5–6 bottles per day. As Carithers & McClain (2010)
explained the patient's medical history is another indicator of the risk for cirrhosis; the progression
to cirrhosis is adaptable and may take time over weeks or many years. Cirrhosis is a liver disease
characterized by permanent scarring of the ... Show more content on Helpwriting.net ...
The reason of weight loss like nine kilos is attributed to his lack of appetite (Du, Pan, & Li, 2010).
Liver damage has intense and disturbing effects on metabolism of all nutrients like malnutrition
which is common among with patients with cirrhosis that also affects major impairment in their
social, occupational functioning and behavioral and psychological changes (National Institute on
Alcohol Abuse and Alcoholism [NIAAA], 2005).
Limited physical activity
Loss of mobility will affect his job and families' financial needs. A client with cirrhosis usually
experiences severe fatigue, lack of energy and respiratory problems (Dirksen, Lewis, Heitkemper, &
Bucher, 2011). As agreed by Wood and Garner (2012) drowsiness, confusion, and tiredness are
associated features of respiratory problems, while the numbness of his legs and feet, lightheadedness
and mood fainting is controlled by the nervous system. Patients with chronic liver disease frequently
experience neurological problems due to the connection between the brain and the liver function
(Dirksen et al., 2011); these problems will have a major impact in his daily activity and the
possibility of losing his job.
Psychosocial problem related to loss of body image
Psychosocial problem is an example of liver cirrhosis that Mr. Abdul is presently experiencing
which is linked to malnutrition (Dudek, 2010). Currently he is having jaundiced sclera, bruises on
both arms and legs, oedema on his ankle and

Barium Swallow : Patient Clinical Details
Barium swallow Patient clinical details The patient was referred to the Radiologist from his GP,
because of ongoing pain and difficulty when swallowing. The patient was 45years old male,
consumed alcohol regularly and a heavy smoker. Due to the clinical details the radiologist decided
to perform a barium swallow this allows for the best visualisation of the internal structures, mainly
the upper gastrointestinal tract and the stomach. Barium swallows show any strictures or narrowing
's in this region which would account for the patients clinical details. Esophageal carcinomas are
able to be diagnosed from: Barium swallow Chest MRI or thoracic CT Endoscopic ultrasound
Esophagogastroduodenoscopy (EGD) and biopsy PET scan Because barium swallows are non–
invasive and clearly outline the shape of the esophagus, the radiologist decided this form of imaging
was best suited to the patient and his clinical details which strongly suggested cancer to be the cause
of the clinical details. Esophageal cancers usually present with the following symptoms: Difficulty
swallowing (dysphagia) Backwards movement of food through the esophagus and possibly mouth
(regurgitation) Chest pain not related to eating Weight loss without trying Worsening indigestion or
heartburn Coughing or hoarseness But early esophageal cancers typically causes no symptoms and
have no apparent signs. Barium Swallow A barium swallow is a procedure of the upper
gastrointestinal tract,

Cirrhotic Essay
Abstract P.P.I therapy is often used in patients with cirrhosis, sometimes, in the absence of a specific
indication (e.g.: acid related diseases), there are conflicting reports for their use in cirrhotic patients.
The dosage of most PPIs should be reduced in cirrhotic as they are metabolized by the liver and
associated with adverse effects of prolonged use. We aimed to review strict indications and adverse
effects for their use in this group of patients. Keywords Proton pump inhibitors, liver cirrhosis,
peptic ulcer, H. pylori, esophageal band ligation. Abbreviations P.P.I: proton pump inhibitors. EVS:
esophageal variceal Sclerotherapy. EVL: esophageal variceal ligation. HE: hepatic encephalopathy.
SBP: spontaneous bacterial ... Show more content on Helpwriting.net ...
A short course for 10 days post–EVL may be reasonable if we concern for ulcer healing. However,
high–dose infusion (e.g., pantoprazole 8 mg/h) and prolonged use in the absence of endoscopic
procedures is not supported by the literature and should be discouraged until evidence of benefit
becomes available. (8) GERD Functional studies showed decreased LES function with a low
amplitude of acid clearance and primary esophageal peristalsis in cirrhotics with large varices [9].
These phenomena could also be due to a mechanical effect of the varices. Cirrhotic patients without
EV have also esophageal motor disorders and mixed acid and bile reflux as the main pattern
whereas the cirrhosis itself was an important causative factor. It is unclear whether this might
contribute to bleeding from varices [8]. Data on management of GERD in cirrhosis are few,
however, the indications of use for PPIs may remain exactly the same also in patient with cirrhosis
of the liver as general population for the treatment of erosive esophagitis or in general the pathology
secondary to gastroesophageal reflux acid (10) Peptic ulcer and H. pylori infection Prevalence of
duodenal and gastric ulcers in patients with liver cirrhosis increases as the disease progress[11] and
this prevalence becomes higher in decompensated cirrhosis than in compensated cirrhosis [12].
Currently, PPIs are the mainstay treatment option of peptic ulcers in the

Esophageal Cancer : A Lethal Variation Of Cancer
Esophageal cancer, or oesophageal cancer, is a lethal variation of cancer globally ranking sixth as
the leading cause of cancer–associated deaths and eighth as the most common type of cancer
(Pennathur et al. 2013). In contrast to other parts of the world, the United States has experienced a
decrease in esophageal squamous cell carcinoma incidence rates and a distinct increase in
esophageal adenocarcinoma, which corresponds to increased obesity and gastroesophageal reflux
rates over the years (Simard et al. 2012). Along with increasing incidence rates, esophageal cancer is
associated with a 15–25% survival rate of five years regardless of treatment, poor prognosis due to
diagnosis during the cancer's later stages, and predisposition to metastases regardless of tumor type
(Pennathur et al. 2013, Chen et al. 2013). In addition, patients who have been treated are at risk for
high incidences of recurrence and approximately 90% of patients are faced with mortality from
esophageal cancer (Lou et al. 2013), all of which contributes to the poor prognosis associated with
the disease. With increasing incidence rates and poor prognosis, esophageal cancer poses challenges
to healthcare providers in finding effective and standardized guidelines with respect to screening,
treatment, and surveillance.
Lifestyle, medical history, socioeconomic factors, and premalignant conditions influence the
development of esophageal cancer. Three primary risk factors include consumption of tobacco,

Oral Squamous Cell Carcinoma (OCC)
2. Literatures Review 2.1. Oral squamous cell carcinoma (OSCC) Oral cancer (OC) includes a
group of neoplasms affecting any region of the oral cavity, pharyngeal regions and salivary glands.
However, this term tends to be used interchangeably with oral squamous cell carcinoma (OSCC)
(Choi and Myers, 2008). Oral SCC is the most common malignant neoplasm of the oral cavity
derived from stratified squamous epithelium including lips, buccal mucosa, lower and upper
alveolar ridges, retromolar gingiva, floor of the mouth, hard palate, and the anterior two–thirds of
the tongue (Lozano et al., 2013). By gross morphologic examination, the exophytic, ulcerative, or
verrucous types are seen (Mehrotra and Yadav 2006). Regardless of the easy access of oral cavity
for clinical examination, OSCC is usually diagnosed in advanced stages. ... Show more content on
Helpwriting.net ...
2.1.1. Epidemiology Head and neck squamous cell carcinomas (HNSCCs) is the sixth most common
cancer with an annual incidence of ~400.000 cases (Duray et al., 2012)6 and represents about 3.5%
of all malignant tumors Siegel et al., 2012). Head and neck SCC is quite heterogeneous and most of
the tumors arise in the oral cavity, oropharynx, hypopharynx and larynx. Nearly 90% of these
cancers are OSCC, which is associated with a poor prognosis, with a 5–year survival rate less than
50% (Osei–Sarfo et al.,

Cancer Is The Second Leading Cause Death Globally
Introduction
Cancer is the second leading cause of death globally. Esophageal cancers (EC) are a significant
worldwide health problem because of its poor prognosis and specifically, esophageal
adenocarcinoma (EAC) incidence has been rising at an alarming rate for the past few decades
(Howlader N et al., 2011). It is estimated that in 2013, 17,990 people in the United States will be
diagnosed with esophageal cancer and greater than 85% of those diagnosed will succumb to the
disease (Cancer Statistics, 2013). Even do there have been advances in surgical techniques,
chemotherapy and radiotherapy; still these methods have not significantly modified its prognosis
over the past decades. Diagnosis of EAC tends to drastically occur at an advanced ... Show more
Three years later GERD was associated with Barrett's development (Allison PR, 1953) and
subsequently in 1975 a study of 140 cases showed that 8.5% of those patients developed EAC (Naef
AP et al, 1975). Only about 10–15% of patients with chronic GERD develop BE, this suggest that
further genetic and environmental factors are possibly involved in the development of BE and/or
EAC (Contedica V et al., 2012).
The process of neoplastic transformation from Barrett's esophagus to EAC is a stepwise process,
which involves serial grades of dysplasia. Even do BE is considered an acquire pre–malignant lesion
of the esophagus, the exact mechanism for this development and progression are still not
understood. Some studies have shown that bile acids can cause injury in the esophageal squamous
lining and lead to the development of metaplasia by inducing oxidative stress and DNA damage
(Dvorak K, 2007). Also, patients with central obesity are more predispose to suffer from increase
intra–gastric pressure which increases the GERD. Studies trying to understand the progression from
BE to EAC looking at expression profiles compared to normal tissue, have suggested different
pathways activated in the BE, but still, the cell of origin of BE is not known (Shaheen NJ and
Richter JE, 2009). Patients who suffer from BE are enrolled in surveillance programs were they take
biopsies by endoscopy

Portal Vein Thrombosis On Patients With Liver
1548
1539
Journal homepage: http://www.journalijar.com INTERNATIONAL JOURNAL OF ADVANCED
RESEARCH RESEARCH ARTICLE
Portal vein thrombosis in patients with liver cirrhosis Insights to risk factors, clinical presentation
and outcome
Afifi F. Afifi 1
, Usama M. Basha 1
, Fady M. Wadea 1
, Abdelaziz E. Samack 2
, Raghda A. Elsherbini 3
1– GIT and hepatology unit, internal medicine department, faculty of medicine, zagazig university.
2– radiology department, faculty of medicine, zagazig university.
3– clinical pathology department, faculty of medicine, zagazig university. EGYPT
Manuscript Info Abstract
Manuscript History:
Received: xxxxxxx
Final Accepted: xxxxxxxxxxxxxx
Published Online: xxxxxxxxxxxx
Key words:
Portal vein, Thrombosis, risk factors, cirrhosis.
*Corresponding Author
Pawan Kumar Thakur
Background and objectives: Portal vein thrombosis (PVT) is an increasingly recognized
complication of liver cirrhosis. It is associated with worsening liver function, ascites and the
occurrence of gastroesophageal variceal bleeding. The aim of this work was to clarify the risk
factors, clinical presentation and complications of portal vein thrombosis in patients with liver
cirrhosis and to study the outcome with or without treatment after
6 months follow up.
Methods: Hospitalized cirrhotic patients (N = 80) were segregated into the
PVT and non–PVT groups. PVT was detected by

Portal Vein Thrombosis, Risk Factors, Cirrhosis
Abstract
Manuscript History: Received: 14 October 2015 Final Accepted: 22 November 2015 Published
Online: December 2015 Key words: Portal vein, Thrombosis, risk factors, cirrhosis. *Corresponding
Author
Pawan Kumar Thakur Background and objectives: Portal vein thrombosis (PVT) is an increasingly
recognized complication of liver cirrhosis. It is associated with worsening liver function, ascites and
the occurrence of gastroesophageal variceal bleeding. The aim of this work was to clarify the risk
factors, clinical presentation and complications of portal vein thrombosis in Egyptian patients with
liver cirrhosis and to study the outcome with and without treatment after 6 months follow up period.
Methods: Hospitalized cirrhotic patients (N = 80) were segregated into the PVT and non–PVT
groups. PVT was detected by Doppler ultrasonography; each group was divided in two sub groups
(A and B) according to presence or absence of HCC respectively. The 2 groups were compared as
regards risk factors, clinical presentation and complications. The outcome of treatment with
anticoagulation in 6 patients was evaluated. Result: PVT developed as result of combination of both
local and systemic risk factors. HCC, abdominal infection especially spontaneous bacterial
peritonitis and abdominal intervention were the most important local risk factors. Abnormalities of
coagulation system were among systemic risk factors. Most of cases were asymptomatic and
accidentally discovered, others presented

Risk Factors, Clinical Presentation And Outcome
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Portal vein thrombosis in patients with liver cirrhosis: insights to risk factors, clinical presentation
and outcome
Article in International Journal of Advanced Research 3(12):1539–1548 · December 2015
1st Afifi F Afifi
2nd Osama Basha
6.99 · Zagazig University
+ 1
3rd Fady Maher
Zagazig University
Last Raghda Abd Ellatif Hafez
16.2 · Faculty of medicine/Zagazig University.www.zu.edu.eg
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Page 1
15481539Journal homepage:http://www.journalijar.comINTERNATIONAL JOURNALOF
ADVANCED RESEARCHRESEARCH ARTICLEPortal vein thrombosis in patients with liver
cirrhosis:insights to risk factors, clinical presentation and outcomeAfifi F. Afifi 1, Osama M. Basha
1, Fady M. Wadea 1, Abdelaziz E. Samack 2, Raghda Abd–elatif Hafez31–GIT and hepatology unit,

Internal Medicine department, Faculty of Medicine, Zagazig University.2–Radiology department,
Faculty of Medicine, Zagazig University.3–Microbiology&Immunologydepartment, Faculty of
Medicine, Zagazig University. EGYPTManuscriptInfoAbstract Manuscript History:Received:14
October 2015Final Accepted: 22 November 2015Published Online: December 2015Key words:
Portal vein,

Portal Vein Thrombosis On Patients With Liver Cirrhosis
Portal vein thrombosis in patients with liver cirrhosis: insights to risk factors, clinical presentation
and outcome
Afifi F. Afifi 1, Osama M. Basha 1 , Fady M. Wadea 1, Abdelaziz E. Samack 2, Raghda Abd–elatif
Hafez 3
1– GIT and hepatology unit, Internal Medicine department, Faculty of Medicine, Zagazig
University.
2– Radiology department, Faculty of Medicine, Zagazig University.
3– Microbiology&Immunology department, Faculty of Medicine, Zagazig University. EGYPT
Manuscript Info Abstract
Manuscript History: Received: 14 October 2015 Final Accepted: 22 November 2015 Published
Online: December 2015 Key words: Portal vein, Thrombosis, risk factors, cirrhosis. *Corresponding
Author
Pawan Kumar Thakur
Background and objectives: Portal vein thrombosis (PVT) is an increasingly recognized
complication of liver cirrhosis. It is associated with worsening liver function, ascites and the
occurrence of gastroesophageal variceal bleeding. The aim of this work was to clarify the risk
factors, clinical presentation and complications of portal vein thrombosis in Egyptian patients with
liver cirrhosis and to study the outcome with and without treatment after 6 months follow up period.
Methods: Hospitalized cirrhotic patients (N = 80) were segregated into the PVT and non–PVT
groups. PVT was detected by Doppler ultrasonography; each group was divided in two sub groups
(A and B) according to presence or absence of HCC respectively. The 2 groups were compared as
regards risk factors,

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Esophageal Varices Pathophysiology Explained in 40 Characters