Here are a few myths about diverticulosis and diverticulitis:
- Eating seeds, nuts, or popcorn will not cause a diverticulum to perforate. While a high-fiber diet may help prevent diverticula, there is no evidence that certain foods directly cause a diverticulum to rupture.
- Most people with diverticulosis will never develop diverticulitis. Only a minority (15-25%) of those with diverticulosis will have an episode of diverticulitis.
- Mild or moderate diverticulitis can often be treated without antibiotics. For uncomplicated cases, a liquid diet and pain medications may be sufficient. Antibiotics are usually reserved for more severe
This document provides an overview of gastroenterology topics for EMS personnel. It discusses general pathophysiology, risk factors, and assessment for abdominal pain. It also reviews specific conditions like peptic ulcers, gastroenteritis, esophageal varices, Crohn's disease, and irritable bowel syndrome. For each condition, it describes causes, signs and symptoms, and general treatment guidelines for EMS. The document is intended as an educational reference for responding to and managing gastrointestinal emergencies and complaints.
Constipation is defined as difficulty evacuating the bowels or passing hard stools. It is caused by irregular eating patterns, lack of fluids and fiber, sedentary lifestyle, and psychological stress. Symptoms include incomplete bowel movements and pain. Ayurvedic remedies and yoga asanas like Dhanurasana can help treat constipation by strengthening the digestive system. Increasing fiber intake through fruits and vegetables, staying hydrated, exercising, and reducing stress can also help manage constipation.
This document defines constipation and outlines its causes, symptoms, diagnosis, and treatment options. Constipation is a common condition affecting approximately 2% of the US population. It is defined as having less than 3 bowel movements per week or experiencing straining with defecation. Causes can include low fiber diet, lack of exercise, certain medications, and underlying medical conditions. Treatment focuses on increasing fiber and fluid intake, exercise, stool softeners, laxatives, and if needed, surgery to address complications. Long term monitoring may involve screening for underlying causes and ensuring dietary and medication management is effective.
This document summarizes several diseases of the female reproductive system including endometriosis, ovarian cysts, dysmenorrhea, premenstrual dysphoric disorder, vaginal fistulas, and uterine prolapse. It describes the causes, symptoms, examinations, tests, medical and surgical treatments, nursing diagnoses, and nursing interventions for managing each condition.
GEMC - Abdominal Emergencies- For NursesOpen.Michigan
The document provides an overview of abdominal emergencies including objectives, assessment techniques, common conditions, and management strategies. Specifically, it reviews abdominal trauma, diagnosis, abdominal focused exam, common abdominal structures, diagnostic procedures, nursing considerations, documentation, and key factors for geriatric and pediatric patients. Common conditions discussed in detail include gastritis, ulcers, bowel obstructions, and gastroenteritis.
1. Enteric fever is a systemic infection caused by Salmonella typhi or paratyphi that results in a severe multisystem illness characterized by prolonged fever and bacterial invasion of organs.
2. S. typhi typically infects humans through contaminated food or water and spreads from the intestines to the bloodstream and organs like the liver, spleen and lymph nodes.
3. Treatment depends on antibiotic susceptibility but usually involves fluoroquinolones, third generation cephalosporins, or azithromycin. Relapse can occur in 10-20% of cases.
Typhoid fever is caused by the bacterium Salmonella enterica serotype Typhi and is transmitted through contaminated food or water. It has a variable incubation period of 1-2 weeks. Clinical presentation includes a stepwise fever pattern, gastrointestinal symptoms like abdominal pain, and occasionally a rose-colored rash. Without treatment, typhoid fever can last 3-4 weeks and be life threatening, but with antibiotics mortality is low. It remains common in areas with poor sanitation.
This document discusses constipation, including its causes, symptoms, types, and treatment options. Some key points include:
- Constipation is difficulty passing stool and results from factors like low fiber intake, dehydration, medication side effects, medical conditions, smoking cessation, and surgery.
- Symptoms include pain, bloating, infrequent bowel movements, and hard stool that is difficult to pass.
- Treatment focuses on increasing fiber and fluid intake, exercise, homeopathy, and addressing any underlying medical issues. Lifestyle changes like diet and staying hydrated are emphasized.
This document provides an overview of gastroenterology topics for EMS personnel. It discusses general pathophysiology, risk factors, and assessment for abdominal pain. It also reviews specific conditions like peptic ulcers, gastroenteritis, esophageal varices, Crohn's disease, and irritable bowel syndrome. For each condition, it describes causes, signs and symptoms, and general treatment guidelines for EMS. The document is intended as an educational reference for responding to and managing gastrointestinal emergencies and complaints.
Constipation is defined as difficulty evacuating the bowels or passing hard stools. It is caused by irregular eating patterns, lack of fluids and fiber, sedentary lifestyle, and psychological stress. Symptoms include incomplete bowel movements and pain. Ayurvedic remedies and yoga asanas like Dhanurasana can help treat constipation by strengthening the digestive system. Increasing fiber intake through fruits and vegetables, staying hydrated, exercising, and reducing stress can also help manage constipation.
This document defines constipation and outlines its causes, symptoms, diagnosis, and treatment options. Constipation is a common condition affecting approximately 2% of the US population. It is defined as having less than 3 bowel movements per week or experiencing straining with defecation. Causes can include low fiber diet, lack of exercise, certain medications, and underlying medical conditions. Treatment focuses on increasing fiber and fluid intake, exercise, stool softeners, laxatives, and if needed, surgery to address complications. Long term monitoring may involve screening for underlying causes and ensuring dietary and medication management is effective.
This document summarizes several diseases of the female reproductive system including endometriosis, ovarian cysts, dysmenorrhea, premenstrual dysphoric disorder, vaginal fistulas, and uterine prolapse. It describes the causes, symptoms, examinations, tests, medical and surgical treatments, nursing diagnoses, and nursing interventions for managing each condition.
GEMC - Abdominal Emergencies- For NursesOpen.Michigan
The document provides an overview of abdominal emergencies including objectives, assessment techniques, common conditions, and management strategies. Specifically, it reviews abdominal trauma, diagnosis, abdominal focused exam, common abdominal structures, diagnostic procedures, nursing considerations, documentation, and key factors for geriatric and pediatric patients. Common conditions discussed in detail include gastritis, ulcers, bowel obstructions, and gastroenteritis.
1. Enteric fever is a systemic infection caused by Salmonella typhi or paratyphi that results in a severe multisystem illness characterized by prolonged fever and bacterial invasion of organs.
2. S. typhi typically infects humans through contaminated food or water and spreads from the intestines to the bloodstream and organs like the liver, spleen and lymph nodes.
3. Treatment depends on antibiotic susceptibility but usually involves fluoroquinolones, third generation cephalosporins, or azithromycin. Relapse can occur in 10-20% of cases.
Typhoid fever is caused by the bacterium Salmonella enterica serotype Typhi and is transmitted through contaminated food or water. It has a variable incubation period of 1-2 weeks. Clinical presentation includes a stepwise fever pattern, gastrointestinal symptoms like abdominal pain, and occasionally a rose-colored rash. Without treatment, typhoid fever can last 3-4 weeks and be life threatening, but with antibiotics mortality is low. It remains common in areas with poor sanitation.
This document discusses constipation, including its causes, symptoms, types, and treatment options. Some key points include:
- Constipation is difficulty passing stool and results from factors like low fiber intake, dehydration, medication side effects, medical conditions, smoking cessation, and surgery.
- Symptoms include pain, bloating, infrequent bowel movements, and hard stool that is difficult to pass.
- Treatment focuses on increasing fiber and fluid intake, exercise, homeopathy, and addressing any underlying medical issues. Lifestyle changes like diet and staying hydrated are emphasized.
The document discusses a care conference for a patient diagnosed with thrombosed piles who underwent a haemorrhoidectomy. It provides details of the patient's medical history, surgery findings, nursing diagnoses, medications, and objectives of the care conference which are to discuss haemorrhoids including causes, symptoms, grades, complications, and post-operative nursing care.
Diverticulitis is an inflammation of pouches that form in the colon. It is most common in older adults over age 60. Symptoms include abdominal pain, fever, nausea, and bloody stool. Tests like colonoscopy are used to diagnose diverticulitis. Treatment involves antibiotics and sometimes surgery to remove the infected part of the colon. Research is ongoing to find new drug treatments.
Ms. C.J. is a 71-year-old woman who presents with hard, dry stools for weeks despite trying fiber and increased fluids. Her medical history includes hypertension, chronic renal insufficiency, and a stroke one year ago. Differential diagnoses include medication-induced constipation, colon cancer, or inadequate food intake. Treatment goals are to investigate the cause, educate the patient, and restore normal bowel movements. The treatment plan includes lifestyle modifications, probiotics, bulk laxatives, and osmotic laxatives if needed. She is prescribed PEG 17g daily for one week and asked to follow up if constipation is not resolved.
1) The document discusses constipation as a common side effect in cancer patients, especially those treated with opioids, with a prevalence of up to 90%.
2) It provides an assessment approach for constipation involving a thorough history, physical exam, and identification of risk factors to develop an effective bowel care plan.
3) Treatment recommendations include general measures like activity and diet, as well as specific measures like stool softeners, stimulant laxatives, osmotic laxatives, lubricants, and enemas tailored to the individual case.
Mr. Marlou W. Miao, a 3-year old male from Leyte, was admitted to the hospital for typhoid fever. He had a 7-day history of intermittent fever, cough, and abdominal pain. Diagnostic tests confirmed Salmonella typhi in his blood. As a toddler experiencing illness and hospitalization, he exhibited signs of separation anxiety from his aunt, fear of medical professionals due to previous painful procedures, and loss of control from changes to his routine. The student nurse assessed his developmental stage and needs to develop an appropriate nursing care plan.
Presentation1.pptx, radiological imaging of divertiular disease and diverticu...Abdellah Nazeer
This document summarizes the key radiological imaging techniques used to diagnose and monitor diverticular disease and diverticulitis of the colon. It describes the epidemiology and pathophysiology of diverticular disease. Computed tomography is outlined as the gold standard imaging method, able to detect wall thickening, inflammation, abscesses, fistulas, and complications. Ultrasound, barium enema, and magnetic resonance imaging are also discussed. The document presents various images demonstrating diverticulitis findings on the different modalities.
This document discusses appendicitis, a condition where the appendix becomes inflamed or infected. The appendix is a small, tube-like structure attached to the large intestine. While its function is unknown, appendicitis occurs when the appendix becomes blocked and bacteria grow, causing swelling. Common symptoms include abdominal pain, nausea, and fever. Untreated appendicitis can lead to the appendix rupturing, resulting in a serious infection of the abdominal cavity. Standard treatment is surgical removal of the appendix to prevent rupture and further complications.
The document discusses typhoid fever, caused by the Salmonella Typhi bacteria. It is contracted by consuming food or water contaminated with infected feces. Symptoms include prolonged fever for up to 4 weeks, abdominal pain, constipation, and rose-colored spots on the skin. Definitive diagnosis is made by isolating S. Typhi from blood, bone marrow or stool samples. Treatment involves antibiotics like fluoroquinolones or third-generation cephalosporins. Travelers can be vaccinated with either an oral or injectable vaccine to help prevent typhoid.
The document provides a history of typhoid fever, including key figures who contributed to understanding the disease. It describes Salmonella enterica serotype Typhi, the bacteria that causes typhoid fever. It discusses the epidemiology, transmission, signs and symptoms, pathological changes, and classical presentation of the disease.
Constipation is a common condition in children that can have significant impacts on quality of life. It is usually functional and caused by behavioral, psychological, or dietary factors. The main symptoms are infrequent bowel movements occurring less than every 2-3 days and hard stools that are difficult or painful to pass. Treatment involves disimpaction followed by maintenance therapy using laxatives like polyethylene glycol or lactulose, along with behavioral modifications and dietary changes like increased fiber intake. Treatment may need to be continued for 6 months to a year to prevent recurrence of symptoms.
The document provides information about appendicitis, including its definition, pathophysiology, clinical features, diagnosis, differential diagnosis, and treatment. It states that appendicitis is caused by obstruction of the appendix lumen, most commonly by a faecalith. It describes the progression from obstruction to infection and perforation. It outlines the typical symptoms of abdominal pain that migrates to the right lower quadrant, anorexia, vomiting, and low-grade fever. It provides details on various clinical examination signs used in diagnosis like rebound tenderness and McBurney's point tenderness.
Typhoid fever is caused by the bacterium Salmonella typhi. It remains a major public health problem, infecting over 21 million people annually and causing over 200,000 deaths per year globally. The disease is transmitted through contaminated food or water. Clinical features include a sustained high fever over several weeks and complications can include intestinal bleeding or perforation. Diagnosis is made through blood or stool cultures. Treatment involves antibiotics. Prevention relies on vaccination, improved sanitation and hygiene practices like handwashing to control the spread from infected cases and carriers.
This document discusses intestinal gas, its sources and composition. Gas is introduced through swallowing air, carbonated drinks, and metabolic processes of bacterial flora. In the stomach, oxygen levels decrease and carbon dioxide increases as gases diffuse across the mucosa. In the duodenum, bicarbonate alters gas composition. Most intestinal gases are not from air swallowing but from bacterial fermentation, including methane, hydrogen and carbon dioxide. Treatment includes diet modification, laxatives, prokinetics, antibiotics and behavioral therapies. Abdominal x-rays can detect abnormal gas patterns including pneumoperitoneum, Rigler's sign and small bowel obstruction.
A 50-year-old man presented with abdominal pain, distension, vomiting, and constipation. Imaging showed findings suggestive of bowel obstruction. The document discusses the evaluation, causes, and management of bowel obstructions, focusing on distinguishing between small vs. large bowel obstruction and determining the etiology and complications like strangulation. Initial management involves resuscitation, decompression, correction of electrolyte abnormalities, and antibiotics while determining need for surgery.
This document provides an overview of emergency radiology procedures in surgery. It discusses various radiological imaging techniques like chest x-rays, abdominal x-rays, and sonograms. For each imaging type, it describes what normal images should appear as and highlights some key abnormalities like pleural effusions, pneumothorax, free air, bowel obstructions, calcifications, and foreign bodies. The document provides examples of imaging findings and discusses how to differentiate between possible diagnoses. The overall document serves as a guide for surgeons to interpret common radiology tests and identify important findings.
This document discusses the radiological anatomy and pathologies of the stomach. It begins with an overview of examination techniques including endoscopy, barium meal, CT, and endoscopic ultrasound. It then describes the anatomy of the stomach and surrounding structures. The main pathologies discussed are gastritis, peptic ulcer disease, neoplasms, and congenital anomalies. For inflammatory conditions like gastritis and peptic ulcers, the document outlines imaging findings and distinguishing features of different types. It similarly discusses imaging features that help differentiate benign from malignant ulcers.
This document discusses gastroesophageal reflux disease (GERD). It describes GERD as occurring when reflux of stomach contents causes troublesome symptoms or complications. The pathogenesis of GERD involves an imbalance between defensive factors that protect the esophagus and aggressive factors like gastric acid that reflux from the stomach. Defensive factors include the lower esophageal sphincter, esophageal motility, the diaphragm, and stomach function. Transient lower esophageal sphincter relaxations are a major mechanism for acid reflux. Symptoms of GERD include heartburn, regurgitation, dysphagia, chest pain, laryngeal and pulmonary issues. Tests to diagnose GERD include questionnaires
The document provides information on various causes of dysphagia (difficulty swallowing). It discusses reflux esophagitis, the most common cause, describing symptoms like heartburn relieved by antacids. It also covers benign esophageal stricture, usually due to reflux, presenting with slowly progressive dysphagia. Achalasia is described as lack of LES relaxation, causing longstanding dysphagia and vomiting of stale food. Treatment options like pneumatic dilation are mentioned. Finally, it provides a clinical scenario of a patient with symptoms suggestive of reflux esophagitis.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD and discusses the pathogenesis, including factors like lower esophageal sphincter dysfunction, gastric contents, and impaired esophageal clearance mechanisms. It also covers the clinical presentation of GERD and diagnostic tests used to evaluate GERD, such as endoscopy, pH monitoring, and histology. Treatment options for GERD are also briefly mentioned.
The document provides an overview of the digestive system, including its main organs and their functions. It describes the mouth, esophagus, stomach, small intestine, large intestine, liver, gallbladder and pancreas. It explains that food is broken down mechanically and chemically by these organs, through processes like digestion and absorption, into nutrients that can be used by the body's cells. Key enzymes produced by organs like the stomach, pancreas and intestines help break down carbohydrates, proteins and fats during digestion.
The document discusses a care conference for a patient diagnosed with thrombosed piles who underwent a haemorrhoidectomy. It provides details of the patient's medical history, surgery findings, nursing diagnoses, medications, and objectives of the care conference which are to discuss haemorrhoids including causes, symptoms, grades, complications, and post-operative nursing care.
Diverticulitis is an inflammation of pouches that form in the colon. It is most common in older adults over age 60. Symptoms include abdominal pain, fever, nausea, and bloody stool. Tests like colonoscopy are used to diagnose diverticulitis. Treatment involves antibiotics and sometimes surgery to remove the infected part of the colon. Research is ongoing to find new drug treatments.
Ms. C.J. is a 71-year-old woman who presents with hard, dry stools for weeks despite trying fiber and increased fluids. Her medical history includes hypertension, chronic renal insufficiency, and a stroke one year ago. Differential diagnoses include medication-induced constipation, colon cancer, or inadequate food intake. Treatment goals are to investigate the cause, educate the patient, and restore normal bowel movements. The treatment plan includes lifestyle modifications, probiotics, bulk laxatives, and osmotic laxatives if needed. She is prescribed PEG 17g daily for one week and asked to follow up if constipation is not resolved.
1) The document discusses constipation as a common side effect in cancer patients, especially those treated with opioids, with a prevalence of up to 90%.
2) It provides an assessment approach for constipation involving a thorough history, physical exam, and identification of risk factors to develop an effective bowel care plan.
3) Treatment recommendations include general measures like activity and diet, as well as specific measures like stool softeners, stimulant laxatives, osmotic laxatives, lubricants, and enemas tailored to the individual case.
Mr. Marlou W. Miao, a 3-year old male from Leyte, was admitted to the hospital for typhoid fever. He had a 7-day history of intermittent fever, cough, and abdominal pain. Diagnostic tests confirmed Salmonella typhi in his blood. As a toddler experiencing illness and hospitalization, he exhibited signs of separation anxiety from his aunt, fear of medical professionals due to previous painful procedures, and loss of control from changes to his routine. The student nurse assessed his developmental stage and needs to develop an appropriate nursing care plan.
Presentation1.pptx, radiological imaging of divertiular disease and diverticu...Abdellah Nazeer
This document summarizes the key radiological imaging techniques used to diagnose and monitor diverticular disease and diverticulitis of the colon. It describes the epidemiology and pathophysiology of diverticular disease. Computed tomography is outlined as the gold standard imaging method, able to detect wall thickening, inflammation, abscesses, fistulas, and complications. Ultrasound, barium enema, and magnetic resonance imaging are also discussed. The document presents various images demonstrating diverticulitis findings on the different modalities.
This document discusses appendicitis, a condition where the appendix becomes inflamed or infected. The appendix is a small, tube-like structure attached to the large intestine. While its function is unknown, appendicitis occurs when the appendix becomes blocked and bacteria grow, causing swelling. Common symptoms include abdominal pain, nausea, and fever. Untreated appendicitis can lead to the appendix rupturing, resulting in a serious infection of the abdominal cavity. Standard treatment is surgical removal of the appendix to prevent rupture and further complications.
The document discusses typhoid fever, caused by the Salmonella Typhi bacteria. It is contracted by consuming food or water contaminated with infected feces. Symptoms include prolonged fever for up to 4 weeks, abdominal pain, constipation, and rose-colored spots on the skin. Definitive diagnosis is made by isolating S. Typhi from blood, bone marrow or stool samples. Treatment involves antibiotics like fluoroquinolones or third-generation cephalosporins. Travelers can be vaccinated with either an oral or injectable vaccine to help prevent typhoid.
The document provides a history of typhoid fever, including key figures who contributed to understanding the disease. It describes Salmonella enterica serotype Typhi, the bacteria that causes typhoid fever. It discusses the epidemiology, transmission, signs and symptoms, pathological changes, and classical presentation of the disease.
Constipation is a common condition in children that can have significant impacts on quality of life. It is usually functional and caused by behavioral, psychological, or dietary factors. The main symptoms are infrequent bowel movements occurring less than every 2-3 days and hard stools that are difficult or painful to pass. Treatment involves disimpaction followed by maintenance therapy using laxatives like polyethylene glycol or lactulose, along with behavioral modifications and dietary changes like increased fiber intake. Treatment may need to be continued for 6 months to a year to prevent recurrence of symptoms.
The document provides information about appendicitis, including its definition, pathophysiology, clinical features, diagnosis, differential diagnosis, and treatment. It states that appendicitis is caused by obstruction of the appendix lumen, most commonly by a faecalith. It describes the progression from obstruction to infection and perforation. It outlines the typical symptoms of abdominal pain that migrates to the right lower quadrant, anorexia, vomiting, and low-grade fever. It provides details on various clinical examination signs used in diagnosis like rebound tenderness and McBurney's point tenderness.
Typhoid fever is caused by the bacterium Salmonella typhi. It remains a major public health problem, infecting over 21 million people annually and causing over 200,000 deaths per year globally. The disease is transmitted through contaminated food or water. Clinical features include a sustained high fever over several weeks and complications can include intestinal bleeding or perforation. Diagnosis is made through blood or stool cultures. Treatment involves antibiotics. Prevention relies on vaccination, improved sanitation and hygiene practices like handwashing to control the spread from infected cases and carriers.
This document discusses intestinal gas, its sources and composition. Gas is introduced through swallowing air, carbonated drinks, and metabolic processes of bacterial flora. In the stomach, oxygen levels decrease and carbon dioxide increases as gases diffuse across the mucosa. In the duodenum, bicarbonate alters gas composition. Most intestinal gases are not from air swallowing but from bacterial fermentation, including methane, hydrogen and carbon dioxide. Treatment includes diet modification, laxatives, prokinetics, antibiotics and behavioral therapies. Abdominal x-rays can detect abnormal gas patterns including pneumoperitoneum, Rigler's sign and small bowel obstruction.
A 50-year-old man presented with abdominal pain, distension, vomiting, and constipation. Imaging showed findings suggestive of bowel obstruction. The document discusses the evaluation, causes, and management of bowel obstructions, focusing on distinguishing between small vs. large bowel obstruction and determining the etiology and complications like strangulation. Initial management involves resuscitation, decompression, correction of electrolyte abnormalities, and antibiotics while determining need for surgery.
This document provides an overview of emergency radiology procedures in surgery. It discusses various radiological imaging techniques like chest x-rays, abdominal x-rays, and sonograms. For each imaging type, it describes what normal images should appear as and highlights some key abnormalities like pleural effusions, pneumothorax, free air, bowel obstructions, calcifications, and foreign bodies. The document provides examples of imaging findings and discusses how to differentiate between possible diagnoses. The overall document serves as a guide for surgeons to interpret common radiology tests and identify important findings.
This document discusses the radiological anatomy and pathologies of the stomach. It begins with an overview of examination techniques including endoscopy, barium meal, CT, and endoscopic ultrasound. It then describes the anatomy of the stomach and surrounding structures. The main pathologies discussed are gastritis, peptic ulcer disease, neoplasms, and congenital anomalies. For inflammatory conditions like gastritis and peptic ulcers, the document outlines imaging findings and distinguishing features of different types. It similarly discusses imaging features that help differentiate benign from malignant ulcers.
This document discusses gastroesophageal reflux disease (GERD). It describes GERD as occurring when reflux of stomach contents causes troublesome symptoms or complications. The pathogenesis of GERD involves an imbalance between defensive factors that protect the esophagus and aggressive factors like gastric acid that reflux from the stomach. Defensive factors include the lower esophageal sphincter, esophageal motility, the diaphragm, and stomach function. Transient lower esophageal sphincter relaxations are a major mechanism for acid reflux. Symptoms of GERD include heartburn, regurgitation, dysphagia, chest pain, laryngeal and pulmonary issues. Tests to diagnose GERD include questionnaires
The document provides information on various causes of dysphagia (difficulty swallowing). It discusses reflux esophagitis, the most common cause, describing symptoms like heartburn relieved by antacids. It also covers benign esophageal stricture, usually due to reflux, presenting with slowly progressive dysphagia. Achalasia is described as lack of LES relaxation, causing longstanding dysphagia and vomiting of stale food. Treatment options like pneumatic dilation are mentioned. Finally, it provides a clinical scenario of a patient with symptoms suggestive of reflux esophagitis.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD and discusses the pathogenesis, including factors like lower esophageal sphincter dysfunction, gastric contents, and impaired esophageal clearance mechanisms. It also covers the clinical presentation of GERD and diagnostic tests used to evaluate GERD, such as endoscopy, pH monitoring, and histology. Treatment options for GERD are also briefly mentioned.
The document provides an overview of the digestive system, including its main organs and their functions. It describes the mouth, esophagus, stomach, small intestine, large intestine, liver, gallbladder and pancreas. It explains that food is broken down mechanically and chemically by these organs, through processes like digestion and absorption, into nutrients that can be used by the body's cells. Key enzymes produced by organs like the stomach, pancreas and intestines help break down carbohydrates, proteins and fats during digestion.
Group 4 dysphagia 2016 version 3.1 validatedDennis Lee
This document discusses dysphagia (difficulty swallowing) including its anatomy, physiology, causes, investigation, and management. It covers the anatomy of the oropharynx and hypopharynx. The physiology section describes the three phases of swallowing - oral, pharyngeal, and esophageal. Common causes of dysphagia include presbyphagia, laryngopharyngeal reflux, xerostomia, tonsillitis, epiglottitis, oropharyngeal/hypopharyngeal malignancies, and pharyngeal pouches. Investigations include endoscopy, barium swallow, and manometry. Management is tailored based on the cause and resource availability,
Drugs used in git system (GIT - Laxatives /purgatives , drugs used to treat p...Vinitkumar MJ
CLASS FOR OPHTHALMIC ASSISTANT STUDENTS ( O.A. STUDENTS 2nd year .
educational purpose
short description regarding GIT SYSTEM & drugs used to treat diarrhoea , peptic ulcer diseases , irritable bowel syndrome , IBS, antimotility drugs & laxatives /purgatives etc..
This document provides an overview of how to systematically review an x-ray of the abdomen. It discusses normal bowel gas patterns and positions. It then describes signs of perforation including free air under the diaphragm, the Rigler's sign, and football sign. Other topics covered include small bowel obstruction features, large bowel obstruction including volvulus, toxic megacolon, and other sources of aberrant air such as pneumobilia. Images are included illustrating many of these findings.
This document discusses intestinal obstruction and provides an overview of its classification, causes, pathophysiology, clinical presentation, management, and complications. It begins with definitions and outlines the various types of obstruction. Common causes are extramural factors like hernias or adhesions, intraluminal objects, and intramural issues like tumors or inflammatory lesions. The presentation depends on the site and severity of obstruction. Management involves supportive care as well as surgical intervention if needed to relieve the obstruction.
The document provides information on various pulmonary conditions including normal adult ABG values, COPD, asthma, bronchiectasis, primary ciliary dyskinesia, pulmonary tuberculosis, and their signs and symptoms, pathophysiology, predisposing factors, radiology findings, auscultation findings, potential complications, and management including medications, physiotherapy, exercise programs, and lifestyle changes. Conditions discussed include the structures affected, causes of inflammation and airway obstruction, and methods to reduce symptoms and exacerbations through airway clearance techniques and antibiotic treatment of infections.
1) Chilaiditi syndrome, first reported in 1865, is a rare condition where the colon is interposed between the diaphragm and liver.
2) It occurs more commonly in men and in certain Asian populations, possibly due to differences in diet and fiber consumption.
3) Chilaiditi syndrome is usually asymptomatic but can cause abdominal pain and distention. Diagnosis is made through imaging like x-rays and CT scans. Conservative treatment with decompression and bed rest is typically effective.
Abdominal xray - imaging and interpretation ArushiGupta119
everythng about abdominal radiograph is discussed from views to obstruction to foreign body.
definetly u r not going to get bored
read and share with your peers.
Peptic ulcers develop in the stomach, esophagus, or duodenum (upper small intestine) and are usually caused by H. pylori bacteria or nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin. Symptoms include abdominal pain, nausea, vomiting, weight loss, and bloody stools. Diagnosis involves blood tests, breath tests, stool tests, endoscopy, or imaging. Treatment involves antibiotics to kill H. pylori, proton pump inhibitors to reduce acid, and medications to protect the stomach lining. Complications can include bleeding, perforation, and scarring.
This document provides an overview of normal and abnormal findings on abdominal x-rays. It describes the normal bowel gas pattern and anatomy seen on x-rays. Key signs of abdominal pathology are outlined, including localized ileus, mechanical small bowel obstruction, mechanical large bowel obstruction, and extraluminal air. Specific radiographic findings that help identify conditions like volvulus, hernia and malignancy are also reviewed. The document emphasizes the diagnostic value of obtaining multi-view x-rays to accurately evaluate abdominal abnormalities.
This document provides an overview of how to approach and interpret abdominal x-rays. It describes normal bowel gas patterns and anatomy. Key signs of bowel obstruction, ileus, and free air are outlined. Specific radiographic findings that help localize or characterize abdominal pathologies are also reviewed, including thumbprinting, coffee bean sign, and pneumoperitoneum. Common causes and appearances of abdominal calcifications are summarized based on their location and morphology.
Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux Disease (LPRD) are conditions caused by stomach acid and digestive enzymes backing up into the esophagus and throat. GERD affects the lower esophagus while LPRD affects the throat and larynx. Symptoms include heartburn, hoarseness, and cough. Treatment involves lifestyle changes, medications to reduce acidity, and sometimes surgery. Left untreated, long-term reflux can damage the esophagus and increase cancer risk. Voice problems are a common symptom of LPRD that may require voice therapy.
Gastric outlet obstruction has various causes, both benign and malignant. Benign causes include peptic ulcer disease and gastric polyps, while pancreatic cancer is the most common malignant cause. Patients present with non-bilious vomiting, weight loss, and dehydration. Diagnosis involves imaging studies and endoscopy. Treatment involves rehydration, nutritional support, and surgery if medical management fails or for malignant obstructions. Surgical options include vagotomy with gastrojejunostomy. Complications can include perforation from endoscopic procedures or anastomotic leak from surgery due to patient malnutrition.
Similar to 02.06.12(b): A GI Smorgasbord - Common GI Problems part I (20)
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document provides an overview of ocular emergencies. It begins with an introduction to the Project: Ghana Emergency Medicine Collaborative and author information. The bulk of the document consists of slides reviewing various eye conditions and emergencies, including styes, chalazions, conjunctivitis, iritis, orbital cellulitis, subconjunctival hemorrhages, and scleritis. Treatment approaches are provided for many of the conditions. The document concludes with a discussion of the eye examination approach and areas to be reviewed.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This document provides an overview of disorders of the pleura, mediastinum, and chest wall. It discusses several topics in 1-3 sentences each, including costochondritis (inflammation of the costal cartilages), mediastinitis (infection of the mediastinum), mediastinal masses, pneumothorax (air in the pleural space), and catamenial pneumothorax (recurrent pneumothorax associated with menstruation). The document aims to enhance understanding of the major clinical disorders commonly encountered in emergency medicine involving the pleura, mediastinum, and chest wall.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document summarizes cardiovascular topics including pericardial tamponade, pericarditis, infective endocarditis, hypertension, tumors, and valvular disorders. It provides details on the causes, signs and symptoms, diagnostic studies, and management of these conditions. The document also includes bonus sections on cardiac transplant patients, pacemakers and ICDs, and EKG morphology.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses the evaluation and management of patients with kidney failure presenting to the emergency department. It covers causes of acute kidney injury including pre-renal, intra-renal and post-renal failure. It also discusses evaluation of kidney function, risks of intravenous contrast, dialysis indications and complications in chronic kidney disease patients including infection, cardiovascular issues and electrolyte abnormalities. Special considerations are outlined for resuscitating, evaluating and treating kidney failure patients in the emergency setting.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
02.06.12(b): A GI Smorgasbord - Common GI Problems part I
1. Author(s): Rebecca W. Van Dyke, M.D., 2012
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3. M2 GI Sequence
A GI Smorgasbord:
Common GI Problems – Part I
Rebecca W. Van Dyke, MD
Winter 2012
4. Industry Relationship
Disclosures
Industry Supported Research and
Outside Relationships
• None
6. Hiatal Hernia
James Heilman, M.D., Wikimedia Commons
A large hiatus hernia on X-ray marked by open arrows in
contrast to the heart borders marked by closed arrows
7. Hiatal hernia: extremely common
Schematic diagram of different types of
hiatus hernia. Green is the esophagus, red is
the stomach, purple is the diaphragm, blue is
the HIS-angle. A is the normal anatomy, B is
a pre-stage, C is a sliding hiatal hernia, and D
is a paraesophageal type. Wikipedia
8. Views of a Hiatal Hernia
Esophagus
Gastric
mucosa in
hernia
Diaphragm
indentation
View from esophagus View from stomach
into hernia back up into hiatal
hernia
10. Consequences of Hiatal Hernia
• Benign
• Usually asymptomatic
• May predispose to
development of acid
reflux (and
complications)
• Rarely, gastric ulcers
develop within hiatal
hernia
12. Gas Facts
• Gas is a normal constituant of the GI tract
• Bowel sounds are due to turbulent flow/
mixing of liquid and gas in the tubular
intestines
• What goes in must come out
• Everyone passes flatus many times per
day but most people are not aware of
most of these passages
• Most people pass gas (infused into the GI
tract) very rapidly
13. Origin of Intestinal Gas
Input: H2S
NO2
Air swallowing trace gases
O2
Acid neutralization +
H2 CO2
Bacterial CO2 H+ +
HCO
fermentation, CH4 -
= CO
3
CO2
2
H2
metabolism
O2
CHO CH4
Output:
Eructation
Diffusion (lungs)
Flatus
N2, O2, H2, CO2, CH4, trace gases
14. Normally, gas does not accumulate in the
bowel as it is rapidly passed through the GI
tract.
30 ml/min
12 ml/min
4 ml/min
15. Thus, usually
there is only a
modest amount
of gas in the
GI tract (~200 ml)
at any one time.
This is a normal
gas pattern
16. Some patients
do have too
much gas, due
to: Colon
obstruction
dysmotility
(ileus)
This patient Small
has excess gas bowel
in both
colon and
small bowel, due
to profound ileus
and continued
input from
air swallowing.
18. Gas Symptoms
• However, most people with “gas”
symptoms have normal amounts of gas in
the GI tract
• Instead they have sensations of increased
gut distension and/or increased flatus
• True increases in gas (and symptoms)
ususally arises from:
– Excess air swallowing
– Excess bacterial fermentation of carbohydrate
22. Most Common Cause of
Bloating
• Sense of overdistension of stomach or
bowels
– Abnormal sensation with normal volume of
gas
– ?Due to poor “compliance” of stomach/gut
– Triggers eructation/belching
– Abdominal muscles relax leading to increased
abdominal girth
23. Bloating Perception and Response
of Abdominal Wall
Figure. Abdominal
imaging in a patient with
functional gut disorder.
Note anterior abdominal
wall protrusion and
diaphragmatic
descent during bloating
compared with basal with
only a small increase (by
22 mL) in gas content.
Accarino et al. Gastroenterology 136:1544, 2009
24. By contrast: a patient with bowel
obstruction or dysmotility
25. Patient-initiated Treatment:
Eructation/Belching
Patients feel “full” or “bloated”
Common response = belch
Eructation may release
some gastric gas
26. Belching/Eructation Facts
In the supine position, patients cannot belch
as liquid forms a water seal between gastric gas
and esophagus.
27. Belching Can Worsen Symptoms
3
1. Patients feel “full” or 2
“bloated”
2. However, prior to belch,
patient swallows
additional air
3. The LES relaxes, releasing
air
4. Net volume of air in GI
tract may increase.
5. Bloating sensation may
continue or even worsen.
28. Better Rx: Decrease Input
• Air swallowing accounts for virtually all air
in the upper GI tract
• Occurs during eating, drinking, talking and
dry swallows
• Can be reduced by
– Reduce belching/eructation
– Using straw
– Tilt glass/cup so fluid is above upper lip
– Not chewing gum, sucking on candies
• “Gas” from carbonated drinks plays a
minor role in most people
29. Other Gas Symptoms
• Enlarged abdomen: “my belly sticks out”
– Due to reflex relaxation of anterior abdominal
muscles
• Rx:
– reassure patient
– loosen clothes
30. Lower Gas Symptoms: Flatus
• Normal process – 5-20 times per day
• Increased by
– Changes in air/gas intake (air swallowing)
– Intake of foods containing undigestible
carbohydrates (remember lactose)
– Carbohydrate malabsorption (disease)
– Altered bacterial flora
• Some individuals do pass excess and/or especially
malodorous flatus, likely due to variations in colon
bacterial flora
• Noxious flatus involves sulfer-containing
compounds (onions, meat, cabbage etc.)
31. Foods Can Cause Flatus:
Plants make many interesting compounds
• Fruit juices, sodas
– fructose, sorbitol
• Cruciferous vegatables (cabbage family)
– sulfur-containing compounds (odoriferous gas)
• Beer (sulfer compounds)
• Legumes (dried beans)
– melitose, stachyose, raffinose
• Sugar-free gums/candies
– sorbitol, mannitol
• Milk
– lactose
32. Treatment of “Gas”: Poor Evidence
• Reassurance
• Reduce air swallowing and suppress belching
• Promotility agents (metoclopramide)
• Agents that alter gas bubble surface tension
(simethicone)
• Identify and eliminate intake of poorly absorbed
carbohydrates/other foods associated with
gas
• Alter bacterial flora (lactobacillus or yeast
“probiotics”)
• Bismuth subsalicylate (Pepto-Bismol) or zinc for
H2S
• Consider evaluation for malabsorptive disorders
33. Constipation
• Definition
– <3 stools per week
– Hard stool, difficult to pass
– Straining, sensation of incomplete evacuation
• Prevalence (self-perceived): 10-20%
• Occasional constipation is a part of normal
life for most humans
34. Constipation: Pathophysiology - I
• Liquid material enters cecum from ileum
• Colon’s job:
– Reabsorb electrolytes (Na, Cl, K) and water
– Salvage nutrients, utilizing bacterial
fermentation
– Move material, in a timely manner, to rectum
for appropriate defecation
• Constipation or diarrhea usually reflect
imbalances in these functions
35. Constipation: Pathophysiology - II
• Slow colon transit
– Motility decrease (diabetes, hypothyroidism)
– Drugs (narcotics, Ca channel blockers,
anticholinergics, Ca/Al antacids, cholestyramine)
– Idiopathic
• Increased bowel Na/H2O absorption (?)
• Insufficient fiber - ?”natural laxative”
– Unabsorbed complex carbohydrate
– Increases stool bulk
– Fermented to osmotically active compounds
• adds water to stool
– May stimulate colon motility
36. Constipation: Pathophysiology - III
• Insufficient bile acids or endogenous pro-
secretory or osmotically active compounds
• Defecatory problems
– Anal sphincter
– Pelvic floor dysfunctions
• Psychological factors/eating disorders
37. Enterohepatic Circulation of Bile Acids:
recycling is efficient
Bile acid
synthesis
Bile acids cycle between
the liver and the small
intestine.
Liver Total bile acid pool is
about 3 grams.
About 90% of bile acids
are reabsorbed in the
terminal ileum.
However about 5-10% of
bile acids are lost daily
into the colon. Effect?
Liver synthesizes about
Small bowel 5-10% of the total bile acid
Colon pool each day.
38. Enterohepatic Circulation of Bile Acid
Cholestyramine:
Bile acid bile acid binding resin
synthesis that removes bile acids
from the enterohepatic
circulation
Liver Liver upregulates bile acid
synthesis (using up
what compound in the
process?)
If liver cannot keep up,
what happens?
Less free bile acid in
the colon causes what?
Small bowel
Colon
40. Constipation: Myth Busting
• Having 1 stool a day is not required for
health
– Normal range is 1 every 3 days up to 3/day
– Thus, reassurance often works
• More exercise rarely works (controlled trial was
done)
• Drinking more water/fluids rarely works
– Water is absorbed and excreted by kidneys
• Colace (dioctyl sodium sulfosuccinate), a
detergent, has no effect on stool weight or
frequency in controlled studies.
41. Diverticuli of the Colon: A phenomenon
of aging and ? too little dietary fiber?
43. Saccular Colonic Diverticuli
Very large diverticuli in a woman with scleroderma. She had undergone a barium
swallow study one day before, leading to oral contrast accumulating in the
colonic diverticuli.
45. Complications of Diverticuli
• Stool/particulate matter accumulates in the
diverticulum
• Mucosa inside diverticulum ulcerates and
erodes into the underlying artery
– Diverticular bleed
• Obstruction of diverticulum leads to
infection, perforation and contained
abscess outside the wall of the colon
– Diverticulitis
46. Diverticulitis: if a perforation
occurs, the contents can travel.
The usual
route is
into
omentum
47. Diverticular perforation - outcomes
Abscesses can
Local, confined erode into nearby
perforation and structures
local infection
(diverticulitis)
Free rupture of
diverticulum
Rupture of
with release of
diverticular
free air and infection
abscess
into peritoneum
48. Diverticulitis
A 70-year-old, previously healthy man had had sudden, colicky lower abdominal pain and
increased urinary frequency for four days
Nanda, R. et al. N Engl J Med 1995;333:498
51. Diverticular bleeds are arterial – thus bleeding is often
massive. Since most diverticuli are in the distal colon,
the blood passed is often bright red.
52. Myth Busting: Diverticulitis
• Clinical teaching states that patients with diverticuli should avoid nuts,
seeds, popcorn intake to reduce the chance that these might obstruct the
mouth of diverticuli and cause diverticulits.
• There is no evidence for this but it has become imbedded in medical/nursing
lore.
• This article (JAMA 300:907-914, 2008) is an 18 year study of 47,000 men
and there actually was an inverse relationship between intake of these food
items and development of diverticulitis or other complications.
• Please do not tell your patients to avoid these foods for this reason.
54. Anal Anatomy
No
pain
Pain
Vascular cushions (“plexus”) provide for fine control of
continence, but can be injured, enlarge, stretch and “sag”.
55. Pathophysiology: Hemorrhoidal
Disease
• Vascular basis
– cushions of soft tissue with large vascular channels
• Injury/age/passage of hard stool damages or
fragments these cushions or their supporting
structures
• Straining increases venous pressure and
engorgement of these tissues
• Once tissues prolapse, damage progressively
worsens
• Trauma causes epithelial damage leading to
ulceration, bleeding, pain
• Thrombosis of external hemorrhoids causes pain
56. Appearance
WikipedianProlific, Wikimedia Commons
Internal: above the dentate line – not painful unless prolapsed
External: below the dentate line – may be painful
57. Visual inspection makes the
diagnosis
Large external hemorrhoids
or
severely prolapsed internal hemorrhoids
60. Complications of Hemorrhoids
• Pain/irritation/discomfort
– prolapsed internal hemorrhoids
– ulcerated or thrombosed external hemorrhoids
• Bleeding
– small amounts of bright red blood
– rarely a major bleed
• Leakage of liquid/stool
– Prolapsing internal hemorrhoids impair tight closure of
the anal sphincters
61. Medical Management:
Little Evidence-Based Therapy
• To prevent or reduce hemorrhoids:
– Soften stool, reduce straining
– fiber, osmotic agents
• To treat pain/irritation:
– Topical creams (OTC)
– Anusol suppositories with hydrocortisone
– 5-ASA suppositories
– Sitz baths (soak in warm water)
– Donut ring to sit on
62. Treatment of Hemorrhoids
1 – Sclerosis-internal
2 – Banding - internal
3 – Infrared photocoagulation - internal
4 – Surgery – internal and external
64. Part II will be on Thursday,
February 9 at 11:10 a.m.
65. Additional Source Information
for more information see: http://open.umich.edu/wiki/CitationPolicy
Slide 6: James Heilman, M.D., Wikimedia Commons, http://upload.wikimedia.org/wikipedia/commons/3/3a/HiatusHernia10.JPG, CC:BY-SA,
http://creativecommons.org/licenses/by-sa/3.0/deed.en
Slide 56: WikipedianProlific, Wikimedia Commons, http://upload.wikimedia.org/wikipedia/commons/7/7b/Hemorrhoid.png, CC:BY-SA,
http://creativecommons.org/licenses/by-sa/3.0/deed.en
Editor's Notes
Figure 1. A 70-year-old, previously healthy man had had sudden, colicky lower abdominal pain and increased urinary frequency for four days. He had marked suprapubic tenderness but no other abnormal physical findings. There was mild leukocytosis and a slight leftward shift; the results of urinalysis were unremarkable. A computed tomographic (CT) scan of the pelvis obtained on the first hospital day (Panel A and adjacent sketch) shows thickening of the sigmoid colon (thick arrows). The dark areas represent gas in the lumen, and the white areas represent contrast material. The small dark areas (thin arrows) represent gas in diverticula. A low-pressure barium enema (Panel B) performed on the same day revealed moderate narrowing of the distal sigmoid colon due to mucosal thickening and spasm (curved arrows), corresponding to the CT findings, and multiple diverticula in the proximal sigmoid colon (arrows). Within 48 hours of the initiation of therapy with metronidazole and clindamycin, the patient's pain, tenderness, and urinary frequency decreased. Three weeks later, when he was symptom-free, flexible sigmoidoscopy, carried out because of his concern about cancer, revealed wide-mouth diverticula with normal mucosa (Panel C). The patient remained well during 15 months of follow-up.