This document provides guidelines for the treatment of gastric cancer from the National Comprehensive Cancer Network (NCCN). It was updated in January 2022 and includes:
1) Revisions to the recommended workup, including universal testing for microsatellite instability by PCR, next-generation sequencing, or mismatch repair immunohistochemistry for all newly diagnosed patients.
2) A recommendation for perioperative chemotherapy as the preferred primary treatment for medically fit patients with locoregional cT2 or higher gastric cancer.
3) Revisions to the principles of pathologic biomarker testing, including consideration of next-generation sequencing if sufficient tissue is available after initial testing.
description of the most common and rare vascular malformation of the GIT and main presentation and approach to treatment and the most common complications
This document defines cirrhosis as a condition where the liver slowly deteriorates and malfunctions due to chronic injury, with scar tissue replacing healthy liver tissue and partially blocking blood flow. It discusses the anatomy, physiology, causes including hepatitis and alcohol abuse, pathophysiology, clinical manifestations such as jaundice and ascites, diagnostic studies, collaborative care including management of ascites and esophageal varices, drug therapy, surgical management, nutritional management focusing on low protein and sodium diets, nursing management, and patient education on continuing healthcare and avoiding alcohol and aspirin.
The document discusses various tumors and conditions of the small intestine. The common benign and malignant tumors of the small intestine are listed. Details are provided about carcinoid tumors, including their classification and characteristics. Megaolon is described as a dilatation of the colon that can be congenital or acquired. Hirschsprung's disease is mentioned as a congenital form. Other topics covered include the carcinoid syndrome, Meckel's diverticulum, volvulus, and intussusception - the telescoping of one segment of intestine into another.
Acute Diverticulitis is an inflammation of diverticula in the large intestine that commonly occurs in the sigmoid colon. It presents with lower abdominal pain, fever, and changes in bowel habits. Diagnosis is made through CT scan findings and blood tests. Treatment depends on severity and complications, ranging from oral antibiotics for uncomplicated cases to emergency surgery for perforated diverticulitis with peritonitis. Long term risks include recurrence requiring further treatment or surgery.
The document discusses mesenteric vascular disease, specifically focusing on acute mesenteric ischemia. It describes the different types of acute mesenteric ischemia including mesenteric artery embolism and thrombosis, mesenteric vein thrombosis, and nonocclusive mesenteric ischemia. It details the anatomy of the mesenteric circulation and signs, symptoms, diagnostic imaging findings, and treatments for the different types of acute mesenteric ischemia.
Gallstones are concretions that form in the biliary tract, usually in the gallbladder. Cholelithiasis refers to gallstones in the gallbladder, while choledocholithiasis refers to gallstones in the common bile duct. Treatment depends on whether gallstones are asymptomatic or symptomatic. Asymptomatic gallstones may be managed expectantly, while symptomatic gallstones usually require surgical removal of the gallbladder (cholecystectomy) or other interventions if complications occur.
Diverticulitis: Popular Misconceptions and New ManagementPatricia Raymond
Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
This document provides guidelines for the treatment of gastric cancer from the National Comprehensive Cancer Network (NCCN). It was updated in January 2022 and includes:
1) Revisions to the recommended workup, including universal testing for microsatellite instability by PCR, next-generation sequencing, or mismatch repair immunohistochemistry for all newly diagnosed patients.
2) A recommendation for perioperative chemotherapy as the preferred primary treatment for medically fit patients with locoregional cT2 or higher gastric cancer.
3) Revisions to the principles of pathologic biomarker testing, including consideration of next-generation sequencing if sufficient tissue is available after initial testing.
description of the most common and rare vascular malformation of the GIT and main presentation and approach to treatment and the most common complications
This document defines cirrhosis as a condition where the liver slowly deteriorates and malfunctions due to chronic injury, with scar tissue replacing healthy liver tissue and partially blocking blood flow. It discusses the anatomy, physiology, causes including hepatitis and alcohol abuse, pathophysiology, clinical manifestations such as jaundice and ascites, diagnostic studies, collaborative care including management of ascites and esophageal varices, drug therapy, surgical management, nutritional management focusing on low protein and sodium diets, nursing management, and patient education on continuing healthcare and avoiding alcohol and aspirin.
The document discusses various tumors and conditions of the small intestine. The common benign and malignant tumors of the small intestine are listed. Details are provided about carcinoid tumors, including their classification and characteristics. Megaolon is described as a dilatation of the colon that can be congenital or acquired. Hirschsprung's disease is mentioned as a congenital form. Other topics covered include the carcinoid syndrome, Meckel's diverticulum, volvulus, and intussusception - the telescoping of one segment of intestine into another.
Acute Diverticulitis is an inflammation of diverticula in the large intestine that commonly occurs in the sigmoid colon. It presents with lower abdominal pain, fever, and changes in bowel habits. Diagnosis is made through CT scan findings and blood tests. Treatment depends on severity and complications, ranging from oral antibiotics for uncomplicated cases to emergency surgery for perforated diverticulitis with peritonitis. Long term risks include recurrence requiring further treatment or surgery.
The document discusses mesenteric vascular disease, specifically focusing on acute mesenteric ischemia. It describes the different types of acute mesenteric ischemia including mesenteric artery embolism and thrombosis, mesenteric vein thrombosis, and nonocclusive mesenteric ischemia. It details the anatomy of the mesenteric circulation and signs, symptoms, diagnostic imaging findings, and treatments for the different types of acute mesenteric ischemia.
Gallstones are concretions that form in the biliary tract, usually in the gallbladder. Cholelithiasis refers to gallstones in the gallbladder, while choledocholithiasis refers to gallstones in the common bile duct. Treatment depends on whether gallstones are asymptomatic or symptomatic. Asymptomatic gallstones may be managed expectantly, while symptomatic gallstones usually require surgical removal of the gallbladder (cholecystectomy) or other interventions if complications occur.
Diverticulitis: Popular Misconceptions and New ManagementPatricia Raymond
Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
Benign Billiary Stricture By Dr Dhaval Mangukiya
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document discusses surgical jaundice, defined as jaundice that can be treated surgically, usually due to extrahepatic biliary obstruction. It covers the definition, causes, pathophysiology, clinical evaluation and treatment of surgical jaundice. The most common cause is gallstones, which can become lodged in the common bile duct. Physical examination may reveal jaundice and abdominal tenderness. Imaging studies can locate the obstruction and determine if it is intrahepatic or extrahepatic. Treatment involves addressing the underlying cause, often through surgery such as cholecystectomy for gallstones or bypass procedures for cancer.
1. The document discusses peripheral arterial occlusive disease (PAOD), also known as peripheral artery disease (PAD), which refers to obstruction of arteries outside the heart and brain.
2. Risk factors for PAOD include smoking, diabetes, hypertension, hyperlipidemia, older age, male sex, family history of vascular disease, and certain ethnicities.
3. Symptoms range from intermittent claudication to critical limb ischemia with rest pain and tissue loss. Physical exam findings and tests like the ankle-brachial pressure index can help in diagnosis.
4. Management options discussed include conservative treatment for mild cases as well as endovascular and surgical revascularization procedures for more severe cases.
The document summarizes key features of intestinal obstruction. It describes cardinal symptoms including pain, vomiting, distension and constipation. Pain patterns differ by location and duration of obstruction. Proximal obstructions cause more vomiting, while distal causes less. Strangulation requires urgent surgery due to constant severe pain and peritonism. Intussusception presents as episodes of pain in infants. Caecal and sigmoid volvulus present as acute large bowel obstruction and distension.
A 43-year-old male presented with dyspepsia, chronic diarrhea, weight loss, and faeculant vomiting. Imaging revealed a gastrojejunocolic fistula. He underwent a surgery involving truncal vagotomy, distal gastrectomy, segmental jejunal resection, involved transverse colon resection, and Roux-en-Y gastrojejunostomy and jejunojejunostomy with double barrel diversion colostomy. Histology found no malignancy. Postoperatively, he recovered well and was discharged on postoperative day 11. Gastrojejunocolic fistula is a rare complication that can develop years after gastrojejunostomy, often due to stomal ulcer from inadequate vag
Bezoars are partially or undigested masses that can form in the stomach. There are several types, including phytobezoars made of plant matter, trichobezoars made of hair, and pharmacobezoars made of medications. Trichobezoars commonly form in patients with psychiatric issues who chew and swallow their hair. Phytobezoars often occur after gastric surgery that reduces stomach acid. Bezoars may cause symptoms like nausea, but many are asymptomatic. Endoscopy can detect and sometimes remove bezoars. Treatment depends on symptoms and can include observation, enzymes to dissolve them, or endoscopic or surgical removal.
This document provides information about ulcerative colitis (UC), including:
- UC is a type of inflammatory bowel disease that affects only the large intestine. It causes inflammation and ulcers in the lining of the intestine.
- Symptoms include bloody diarrhea, abdominal pain, and frequent bowel movements. The disease involves periods of remission and flares of symptoms.
- UC is diagnosed through patient history, physical exam, lab tests, endoscopy, and biopsy of the intestine. Treatment aims to induce and maintain remission of symptoms and includes mesalamine, corticosteroids, immunomodulators, and surgery in severe cases.
Deep vein thrombosis is a type of venous thromboembolism that can lead to pulmonary embolism. Risk factors include age, immobilization, cancer, and genetic factors. Clinical features include leg swelling, pain, and tenderness. Diagnosis involves a modified Wells score, D-dimer test, and Doppler ultrasound. Treatment is anticoagulation with drugs like heparin, low molecular weight heparin, fondaparinux, or novel oral anticoagulants. Post-thrombotic syndrome is a complication of DVT involving long-term leg pain and swelling.
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
Liver lesions benign and malignant and treatment options.pptxAbd266
This document discusses benign and malignant liver lesions and their treatment options. For benign lesions, it covers hemangioma, focal nodular hyperplasia, liver cysts, and hepatic adenoma. It describes their symptoms, diagnostic imaging findings, and treatments. For malignant lesions, it focuses on hepatocellular carcinoma (HCC). It discusses the risk factors, pathogenesis, presentations, diagnostic workup including CT and AFP levels, staging systems like BCLC, and treatment options for HCC such as resection, transplantation, ablation, and chemoembolization. It also briefly mentions colon cancer often metastasizing to the liver.
1. Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic liver disease characterized by inflammation and fibrosis of both intrahepatic and extrahepatic bile ducts, leading to multifocal bile duct strictures.
2. PSC is diagnosed based on cholangiography showing characteristic bile duct changes along with elevated cholestatic liver enzymes and exclusion of secondary causes.
3. There is no established medical treatment for PSC, but ursodeoxycholic acid and immunosuppressants have been used to limited benefit. Endoscopic retrograde cholangiography can help relieve symptoms from dominant strictures.
Upper gastrointestinal bleeding is a common medical condition that requires prompt assessment and treatment. Key steps in evaluation include determining hemodynamic stability, performing nasogastric aspiration to identify the source and activity of bleeding, and endoscopy within 24 hours of presentation to identify the cause and risk stratify patients. Resuscitation focuses on restoring circulating volume through blood transfusions and intravenous fluids while controlling active bleeding endoscopically. Risk stratification scores like Rockall and Blatchford are used to determine patient disposition and guide management.
The document discusses acute cholangitis, including its pathogenesis, clinical manifestations, diagnostic criteria, severity assessment, imaging, and management. Regarding diagnostic criteria, it summarizes that Charcot's triad has low sensitivity for diagnosing acute cholangitis compared to the Tokyo Guidelines 2007 and 2013 criteria. It also notes that the Tokyo Guidelines 2007 criteria for severity assessment were insufficient and have been revised in subsequent guidelines to better distinguish mild from moderate cases in the initial diagnosis.
Information about Sigmoid Diverticular Disease by Dr Dhaval Mangukiya.
Details of sigmoid diverticular disease, classification of diverticular disease, pathophysiology, diverticular disease, presenting sumptoms, physical findings, diagnostic tests etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document summarizes recent advances in the diagnosis and treatment of gastroesophageal reflux disease (GERD).
(I) New diagnostic tests include the PPI test, Bravo capsule, new acid exposure sensors, and multichannel intraluminal impedance to identify acid and non-acid reflux. (II) Therapeutic advances include new drugs targeting transient lower esophageal sphincter relaxations, combination therapy, long-term management strategies, prokinetics, and endoscopic procedures such as Endocinch, Stretta, Enteryx and Gatekeeper. (III) Barrett's esophagus screening and surveillance remains an area requiring further prospective studies to determine who and when to screen.
Casi Clinici 1 - del Prof. Sasso. 27 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
Benign Billiary Stricture By Dr Dhaval Mangukiya
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document discusses surgical jaundice, defined as jaundice that can be treated surgically, usually due to extrahepatic biliary obstruction. It covers the definition, causes, pathophysiology, clinical evaluation and treatment of surgical jaundice. The most common cause is gallstones, which can become lodged in the common bile duct. Physical examination may reveal jaundice and abdominal tenderness. Imaging studies can locate the obstruction and determine if it is intrahepatic or extrahepatic. Treatment involves addressing the underlying cause, often through surgery such as cholecystectomy for gallstones or bypass procedures for cancer.
1. The document discusses peripheral arterial occlusive disease (PAOD), also known as peripheral artery disease (PAD), which refers to obstruction of arteries outside the heart and brain.
2. Risk factors for PAOD include smoking, diabetes, hypertension, hyperlipidemia, older age, male sex, family history of vascular disease, and certain ethnicities.
3. Symptoms range from intermittent claudication to critical limb ischemia with rest pain and tissue loss. Physical exam findings and tests like the ankle-brachial pressure index can help in diagnosis.
4. Management options discussed include conservative treatment for mild cases as well as endovascular and surgical revascularization procedures for more severe cases.
The document summarizes key features of intestinal obstruction. It describes cardinal symptoms including pain, vomiting, distension and constipation. Pain patterns differ by location and duration of obstruction. Proximal obstructions cause more vomiting, while distal causes less. Strangulation requires urgent surgery due to constant severe pain and peritonism. Intussusception presents as episodes of pain in infants. Caecal and sigmoid volvulus present as acute large bowel obstruction and distension.
A 43-year-old male presented with dyspepsia, chronic diarrhea, weight loss, and faeculant vomiting. Imaging revealed a gastrojejunocolic fistula. He underwent a surgery involving truncal vagotomy, distal gastrectomy, segmental jejunal resection, involved transverse colon resection, and Roux-en-Y gastrojejunostomy and jejunojejunostomy with double barrel diversion colostomy. Histology found no malignancy. Postoperatively, he recovered well and was discharged on postoperative day 11. Gastrojejunocolic fistula is a rare complication that can develop years after gastrojejunostomy, often due to stomal ulcer from inadequate vag
Bezoars are partially or undigested masses that can form in the stomach. There are several types, including phytobezoars made of plant matter, trichobezoars made of hair, and pharmacobezoars made of medications. Trichobezoars commonly form in patients with psychiatric issues who chew and swallow their hair. Phytobezoars often occur after gastric surgery that reduces stomach acid. Bezoars may cause symptoms like nausea, but many are asymptomatic. Endoscopy can detect and sometimes remove bezoars. Treatment depends on symptoms and can include observation, enzymes to dissolve them, or endoscopic or surgical removal.
This document provides information about ulcerative colitis (UC), including:
- UC is a type of inflammatory bowel disease that affects only the large intestine. It causes inflammation and ulcers in the lining of the intestine.
- Symptoms include bloody diarrhea, abdominal pain, and frequent bowel movements. The disease involves periods of remission and flares of symptoms.
- UC is diagnosed through patient history, physical exam, lab tests, endoscopy, and biopsy of the intestine. Treatment aims to induce and maintain remission of symptoms and includes mesalamine, corticosteroids, immunomodulators, and surgery in severe cases.
Deep vein thrombosis is a type of venous thromboembolism that can lead to pulmonary embolism. Risk factors include age, immobilization, cancer, and genetic factors. Clinical features include leg swelling, pain, and tenderness. Diagnosis involves a modified Wells score, D-dimer test, and Doppler ultrasound. Treatment is anticoagulation with drugs like heparin, low molecular weight heparin, fondaparinux, or novel oral anticoagulants. Post-thrombotic syndrome is a complication of DVT involving long-term leg pain and swelling.
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
Liver lesions benign and malignant and treatment options.pptxAbd266
This document discusses benign and malignant liver lesions and their treatment options. For benign lesions, it covers hemangioma, focal nodular hyperplasia, liver cysts, and hepatic adenoma. It describes their symptoms, diagnostic imaging findings, and treatments. For malignant lesions, it focuses on hepatocellular carcinoma (HCC). It discusses the risk factors, pathogenesis, presentations, diagnostic workup including CT and AFP levels, staging systems like BCLC, and treatment options for HCC such as resection, transplantation, ablation, and chemoembolization. It also briefly mentions colon cancer often metastasizing to the liver.
1. Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic liver disease characterized by inflammation and fibrosis of both intrahepatic and extrahepatic bile ducts, leading to multifocal bile duct strictures.
2. PSC is diagnosed based on cholangiography showing characteristic bile duct changes along with elevated cholestatic liver enzymes and exclusion of secondary causes.
3. There is no established medical treatment for PSC, but ursodeoxycholic acid and immunosuppressants have been used to limited benefit. Endoscopic retrograde cholangiography can help relieve symptoms from dominant strictures.
Upper gastrointestinal bleeding is a common medical condition that requires prompt assessment and treatment. Key steps in evaluation include determining hemodynamic stability, performing nasogastric aspiration to identify the source and activity of bleeding, and endoscopy within 24 hours of presentation to identify the cause and risk stratify patients. Resuscitation focuses on restoring circulating volume through blood transfusions and intravenous fluids while controlling active bleeding endoscopically. Risk stratification scores like Rockall and Blatchford are used to determine patient disposition and guide management.
The document discusses acute cholangitis, including its pathogenesis, clinical manifestations, diagnostic criteria, severity assessment, imaging, and management. Regarding diagnostic criteria, it summarizes that Charcot's triad has low sensitivity for diagnosing acute cholangitis compared to the Tokyo Guidelines 2007 and 2013 criteria. It also notes that the Tokyo Guidelines 2007 criteria for severity assessment were insufficient and have been revised in subsequent guidelines to better distinguish mild from moderate cases in the initial diagnosis.
Information about Sigmoid Diverticular Disease by Dr Dhaval Mangukiya.
Details of sigmoid diverticular disease, classification of diverticular disease, pathophysiology, diverticular disease, presenting sumptoms, physical findings, diagnostic tests etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document summarizes recent advances in the diagnosis and treatment of gastroesophageal reflux disease (GERD).
(I) New diagnostic tests include the PPI test, Bravo capsule, new acid exposure sensors, and multichannel intraluminal impedance to identify acid and non-acid reflux. (II) Therapeutic advances include new drugs targeting transient lower esophageal sphincter relaxations, combination therapy, long-term management strategies, prokinetics, and endoscopic procedures such as Endocinch, Stretta, Enteryx and Gatekeeper. (III) Barrett's esophagus screening and surveillance remains an area requiring further prospective studies to determine who and when to screen.
Casi Clinici 1 - del Prof. Sasso. 27 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
Problems in diagnosing celiac disease,in communicating to patients in the last years.
Descibing how the disease is changed and which are the challenges for the future
I meccanismi del danno gastrico e la patologia H. Pylori correlataASMaD
Presentazione a cura del Dottor Vincenzo De Francesco - "Malattia da reflussogastroesofageo e infezione da Helicobacter Pylori: old topics?" - Roma 11/05/2019
L'osteoporosi é un importante problema di salute pubblica che coinvolge piú di quattro milioni di italiani. Conoscere i fattori di rischio della malattia oltre che delle cadute e delle fratture é importante, cosí come conoscere le giuste strategie a tavola.
Intolleranza al glutine e contraccettivi orali: quale relazione?Gynevra.it
Sono diversi i fattori che caratterizzano l'intolleranza al glutine che potrebbero compromettere l'efficacia e la consistenza d'uso dei contraccettivi ormonali orali .
Una rassegna a cura di Alessandra Graziottin Direttore del Centro di Ginecologia e Sessuologia Medica dellOspedale San Raffaele Resnati di Milano
I Mille volti della Nutrizione - Nutrizione e intolleranzaDigital for Academy
I Mille Volti della Nutrizione - Università degli Studi di Milano - Bicocca, 18 Settembre 2015.
Intervento della dott.ssa Luisa Marini, Senior Brand Manager - Eurospital.
1. CALCOLOSI DELLA COLECISTI:
UPDATE E NOVITA'
TERAPEUTICHE
Dott. Andrea Favara
Dirigente Medico I liv Chirurgia Generale
Laparoscopica e Mininvasiva
Ospedale di Cantù | ASST Lariana Como
3. Colelitiasi
• Condizione relativamente frequente
• Patologia nota da tempo
• Terapia abbastanza codificata
• La colecistectomia è uno degli interventi più comunemente
eseguiti
MA…
4. Siamo proprio certi che tutti ciò che riteniamo
essere giusto è vero ed attuale?
5. Colelitiasi epidemiologia
Tra il 10 ed il 20% della popolazione adulta nei paesi occidentali
20 milioni di persone negli Usa, 2,5 Milioni in Italia
Colecistectomie: 500.000 all’ anno USA, 50.000 ogni anno in
Italia
7.000 morti ogni anno in USA
Costi economici sociali: 8 milioni euro per anno in Italia
7. Colelitiasi epidemiologia nel mondo
Elevata in Europa USA e Sud America, meno in Africa e Asia
Donne soprattutto in età fertile 3:1
Aumenta con età
Calo ponderale, chirurgia bariatrica
Resezioni gastriche
GENETICA
8. Fattori protettivi (LC)
• Moderato consumo di alcol
• Dieta ricca in fibre vegetali
• Attività fisica
•Caffè
10. Fattori di rischio della calcolosi della colecisti
Età
Sesso
Gravidanza
Famigliarità
Obesità
Rapido calo ponderale
Nutrizione parenterale
Diabete
Cirrosi
Morbo di Crohn
Estrogeni
Ceftriazone
Clofibrate
Somatostatine
11. LITIASI BILIARE
PREVALENZA
15-20% in età adulta nei paesi occidentali
sesso femminile: 2-3 volte più frequente
4.000.000 di individui sono affetti da litiasi
15. Evoluzione della malattia
L’ 80% dei pazienti con colelitiasi non ha alcun sintomo o
complicanza
Nei pazienti sintomatici (colica) il 50% avrà almeno una complicanza
nei 20 anni successivi se non trattato
16. Storia naturale della colelitiasi asintomatica
Colelitiasi asintomatica vs. sintomatica
17. Quali sintomi?
• Colica biliare dolore improvviso postprandiale intenso che
aumenta e diminuisce nel giro di alcune ore in ipocondrio destro a
volte irradiato alla spalla, a volte associato a nausea e vomito
• Sintomi aspecifici :dispepsia, eruttazioni, meteorismo
19. Resta valido il testo di Morgagni del 1761
La prevalenza della malattia litiasica
aumenta con l’età….
L’Obesità può essere un fattore di
rischio…
La calcolosi biliare può rimanere
asintomatica per tutta la vita….
IN GB MORGAGNI:
’’De sedibus et cousis morborum per anatomen
indagatis’’
20. Mortalità per colelitiasi in USA
Mortality rates for GD decreased between 1979 and 2004 in the United States by 56% for gallstones as the
underlying cause and by 71% for GD as the underlying or other cause. This was the greatest rate of decline for
any common digestive disease in this time period. The trend is not the same with respect to morbidity rates.
Although symptomatic and complicated stones represent only 20% of all gallstones, they lead to clinically
relevant morbidity and complications as well as high costs of medical care. Complication rates are higher in
older people and in some ethnic groups, and are also influenced by socio-economic factors
21. Terapia: cosa vogliamo trattare?
• Prevenire ed evitare che si formino?
• La colelitiasi asintomatica?
• La colica biliare?
• La colelitasi sintomatica?
• Le complicanze e la coledocolitiasi?
28. Preventive measures are especially effective in the case of cholesterol gallstones.
Primary prevention of gallstones (which contributes to maintaining isotropic bile,
meaning free of cholesterol crystals and stones), is already indicated in the general
population (at low risk) by generally maintaining healthy lifestyles. (B) Tailored
forms of prevention are indicated particularly in high-risk groups. Patients with
known biliary sludge, pregnant women, patients undergoing rapid weight loss,
patients on long-term octreotide, and those receiving long-term total parenteral
nutrition are at the highest risk of developing gallstones and subsequent biliary
symptoms and/or gallstone-related complications. Once gallstones/sludge are
formed, oral litholysis (by ursodeoxycholic acid) has a very limited role in a small
subgroup of symptomatic patients with small, pure cholesterol stones in a
functioning gallbladder. If dissolution of concrements is achieved, secondary
prevention is indicated in the subgroup of patients at risk of recurrent
gallstones/sludge.
29.
30. Prevenzione colelitiasi?
• Di bilirubina
Da eccessiva emolisi:
malattia ematologiche
epatopatia alcolica
età
infezioni parassitarie vie biliari
31. Terapia: la
colelitiasi
asintomatica
L’ 80% dei pazienti portatori di
calcoli alla colecisti è e restera’
asintomatica
Probabilita’ di sviluppare
sintomi: 1-2% per anno
La colelitiasi asintomatica non
richiede alcun trattamento con
alcune eccezioni
32. Terapia: la colelitiasi asintomatica
INDICAZIONI ALLA COLECISTECTOMIA
• Età pediatrica
• Calcoli di dimensioni superiori a 2.5cm
(rischio di tumore)
• Colecisti a porcellana (rischio tumore)
• Lesioni midollari o neuropatie sensitive addominali
• Anemia a cellule falciformi
• Cirrosi (A e B di Child, C?)
• Ipertensione portale
• Candidati a trapianto
• Diabetici
• Difficile accesso alle cure
36. Quale terapia? Rischi colecistectomia
• Dimissione verso lunga degenza 5.4% 0.6%
• Lesione delle vie biliari 0.5% 0.5%
• Ritenzione di calcoli in coledoco da 4 a 40%
• Complicanze per intervento eseguito in gravidanza morte 4%
42. E nelle
complicanze?
Coledocolitiasi
Bonifica della via biliare
Preoperatoria (ERCP) e successiva
colecistectomia
Contestuale (Rendez vous)
Postoperatoria (ERCP) dopo
sfinterotomia
Se gia’ colecistectomizzato o paziente
fragile solo ercp
43. E nelle complicanze? Pancreatite acuta
• ERCP precoce e colecistectomia durante il ricovero o a distanza
44.
45. Colelitiasi terapia
• Evitare colecistectomie inutili e con rischi non trascurabili
L'intervento di colecistectomia per
via laparoscopica se da un lato ha
ridotto i tempi di
ospedalizzazione, dall'altro ha
portato ad un vertiginoso
aumento della percentuale di
interventi
46. Colelitiasi terapia
• Evitare terapia ‘medica’ inefficace , potenzialmente dannosa e che
ritarda la terapia efficace nelle forme sintomatiche o complicate
57. Ma chi è Barry Marshall?
• Mediocre studente di medicina australiano
• ‘trova un progetto di ricerca…’
• Ulcere gastroduodenali
• Helicobacter pylori