GIT Kurdistan Board GEH Journal club: Post ERCP Pancreatitis prophylaxis.
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This document provides guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) for prophylaxis of post-ERCP pancreatitis. It defines post-ERCP pancreatitis and notes an incidence of 4.4% with mild, moderate, and severe types occurring in 69%, 23%, and 8% of cases, respectively. The main recommendations are to administer rectal NSAIDs before or after ERCP, consider prophylactic pancreatic stenting for high-risk patients, minimize cannulation attempts, and use needle-knife fistulotomy as the preferred precut technique.
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Case Report: ERCP
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Basic- anatomy, endoscopy
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ERCP
An ERCP involves inserting an endoscope through the mouth and stomach into the duodenum, then inserting a thin tube through the endoscope into the biliary tract to inject radiopaque dye and take x-rays of the biliary tract and pancreatic duct. ERCPs are used diagnostically to detect gallstones, cancer, and other pathologies and to remove stones or lesions or repair narrow ducts. Patients must not eat or drink for 8-10 hours before the exam, which typically lasts 30 minutes to 2 hours. Required supplies include an endoscope, oral anesthetic, contrast media, films, and a C-arm may be used to take images.
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An ERCP involves inserting an endoscope through the mouth and stomach into the duodenum, then inserting a thin tube through the endoscope into the biliary tract to inject radiopaque dye and take x-rays of the biliary tract and pancreatic duct. ERCPs are used diagnostically to detect conditions like gallstones and cancer, and therapeutically to remove stones or lesions or repair narrowings of the biliary ducts. Patients must not eat or drink for 8-10 hours before the procedure, which uses an endoscope, oral anesthetic, contrast media, films, and may use a C-arm to take preliminary, procedure, and post-procedure images centered at the iliac crest on
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Laparoscopic cholecystectomy is the current gold standard for surgical removal of the Gall bladder, particularly in benign pathologies. Hence, it is necessary to highlight some steps to accomplish this procedure successfully while avoiding pitfalls.
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Open cholecystectomy vs laparoscopic cholecystectomy
1. Open Cholecystectomy v/s Laparoscopic cholecystectomy - Gallbladder Stone Surgery
2. Introduction - Gallstones are a common occurrence in northern India. However, this trend is now showing pa
3. n India presence probably because of migration and blending of cultures and lifestyle. As many as 16% and 29% of women above the age of 40-49 years and 50-59 years, respectively, had gall stones. For every patient with symptomatic gallstone disease there are many more with asymptomatic gallstones. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first-choice of treatment for gallbladder stone and inflammation of the gallbladder.
4. Open Cholecystectomy - Cholecystectomy is one of the most commonly performed abdominal surgical procedures. The laparoscopic approach is preferred due to documented physiologic, economic, and cosmetic benefits compared with the open approach. However, when laparoscopic cholecystectomy is not possible or cannot be completed safely, open cholecystectomy is indicated. Open cholecystectomy may also be performed as an integral part of another operation (eg, pancreaticoduodenectomy) or incidentally, if indicated, during another gastrointestinal operation (eg, colon resection).
5. Laparoscopic cholecystectomy - Cholecystectomy is one of the most commonly performed abdominal surgical procedures, and in developed countries many are performed laparoscopically. As an example, 90 percent of cholecystectomies in the United States are performed laparoscopically. Laparoscopic cholecystectomy is considered the "gold standard" for the surgical treatment of gallstone disease. This procedure results in less postoperative pain, better cosmetics, and shorter hospital stays and disability from work than open cholecystectomy [2-8]. However, the overall serious complication rate in laparoscopic cholecystectomy remains higher than that seen in open cholecystectomy.
6. Risks & Complications - The risk of complications is very low, however, potential risks might include: - Bleeding, Infection, Common bile duct injury, Minor shoulder pain (from the carbon dioxide gas), Bile leakage.
7. Benefits: - Less discomfort than regular surgery, Shorter hospital stay, with a quicker recovery time compared to regular (open) surgery, Smaller scars than regular surgery.
8. Consult us for Gallbladder Stone Treatment - For Appointment Call 079-29703438 Or Visit :- www.drchiragthakkar.com
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This document compares open and laparoscopic cholecystectomy procedures. Open cholecystectomy is easier to perform and more cost effective, but results in a longer hospital stay and poorer cosmetic outcomes. Laparoscopic cholecystectomy is now the gold standard, providing shorter recovery time and fewer complications, but requires specialized equipment and training and carries a higher risk of duct injuries. Both approaches are appropriate depending on the patient's condition and surgeon's expertise.
P T C
A PTC involves inserting a needle through the liver and into the bile ducts under fluoroscopy to inject contrast media and examine the biliary ducts for abnormalities or blockages. It is used for patients with obstructive jaundice suspected to be caused by gallstones or strictures to potentially remove stones or drain the bile ducts. Patients must not eat or drink before the exam and the radiologist must have equipment like fluoroscopy, needles, and contrast media.
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Laparoscopic Cholecystectomy
Laparoscopic surgery has undergone rapid development in recent years. Laparoscopic cholecystectomy was first performed in 1985. Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery.
Laparoscopic Cholecystectomy
A laparoscopic cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder through several small incisions in the abdomen. During the procedure, carbon dioxide is used to inflate the abdomen so instruments can be inserted to tie off the cystic duct and artery before removing the gallbladder. It is usually performed to treat gallstones, gallbladder polyps, or cholecystitis. Compared to open surgery, laparoscopic cholecystectomy results in less pain, shorter hospital stays, and better cosmetic outcomes, though there are risks such as injury to other organs or postoperative bleeding.
Ptc )percutaneous transhepatic cholangiography
PTC is a radiological procedure that involves inserting a fine needle into the liver under imaging guidance to inject contrast directly into the biliary ducts, allowing visualization of the biliary tree. It is used to investigate biliary obstruction and anatomy when other imaging modalities are insufficient. The document outlines the anatomy, indications, technique, findings, and complications of PTC in detail.
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Post cholecystectomy syndrome
This document discusses post-cholecystectomy syndrome, beginning with case studies of patients who developed symptoms after gallbladder removal surgery. It then defines post-cholecystectomy syndrome as the persistence or development of new symptoms after cholecystectomy. The document outlines that 15% of patients develop symptoms, which can be due to functional disorders, prior surgery complications, or other underlying causes affecting the biliary tract, pancreas, or other organs. Investigation and management depends on identifying the specific cause, which can be found in 95% of cases, through imaging, endoscopy, or surgery to address conditions like sphincter of Oddi dysfunction.
Complications
This document discusses complications that can occur during and after laparoscopic cholecystectomy (gallbladder removal surgery). It first describes common complications of gallstones, both within and outside the gallbladder, such as pancreatitis, jaundice, and cholangitis. It then discusses benefits and steps of the laparoscopic procedure. Potential complications of laparoscopic cholecystectomy are outlined, including CO2 embolism, bile duct injury, bleeding, gallbladder perforation, and port site issues. Bile duct injuries are described in further detail using classification systems to characterize the extent of injury. Factors involved in bile duct injuries during the procedure are also mentioned.
Cholecystectomy
A cholecystectomy involves the surgical removal of the gallbladder. The gallbladder stores and concentrates bile produced by the liver to aid in fat digestion. Cholecystectomy is commonly performed to treat gallstones and related complications like gallbladder inflammation. The surgery can be performed through traditional open surgery or through laparoscopic methods involving small incisions. Conditions that may require open rather than laparoscopic cholecystectomy include severe inflammation, abdominal lining inflammation, liver cirrhosis, late-stage pregnancy, or bleeding disorders.
Copy of Evaluation & Management of Postcholecystectomy syndrome in patients u...
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This thesis examines the evaluation and management of postcholecystectomy syndrome in patients who have undergone cholecystectomy surgery. The study aims to evaluate risk factors for developing postcholecystectomy syndrome in patients at Peoples Medical College Hospital. It will be a prospective observational study of 100 patients over one year. Data on patient demographics, symptoms, investigations and treatments will be collected and analyzed to identify risk factors and evaluate management strategies. The results will be compared to literature to improve understanding and management of postcholecystectomy syndrome.Spc ppt final
This document provides guidelines from the British Association of Urological Surgeons on suprapubic catheter placement and care. It discusses indications for suprapubic catheters including acute urinary retention and long-term bladder drainage needs. Risks like bowel injury are addressed, and techniques like ultrasound-guidance are recommended to mitigate these risks. Precatheter assessment, consent discussions, and various insertion methods are outlined. Complications, long-term care including catheter changes, and blockage management are also covered. The guidelines aim to standardize safe suprapubic catheter practice based on evidence and expert consensus.
The Management of Pancreatic Trauma in the Modern Era
The Management of Pancreatic Trauma in the Modern Era
Surgical Clinics of North America
Volume 87, Issue 6 (December 2007)
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Ercp
ERCP (Endoscopic Retrograde Cholangio Pancreatography) is an endoscopic procedure used to diagnose and treat issues in the bile and pancreatic ducts. It involves positioning an endoscope and using x-rays to view the ducts while performing procedures like draining bile ducts, removing gallstones, and placing stents. Potential complications include pancreatitis, bleeding, infection, or perforation. Careful pre- and post-procedure steps like monitoring and antibiotics are important to minimize risks.
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2. Introduction - Gallstones are a common occurrence in northern India. However, this trend is now showing pa
3. n India presence probably because of migration and blending of cultures and lifestyle. As many as 16% and 29% of women above the age of 40-49 years and 50-59 years, respectively, had gall stones. For every patient with symptomatic gallstone disease there are many more with asymptomatic gallstones. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first-choice of treatment for gallbladder stone and inflammation of the gallbladder.
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5. Laparoscopic cholecystectomy - Cholecystectomy is one of the most commonly performed abdominal surgical procedures, and in developed countries many are performed laparoscopically. As an example, 90 percent of cholecystectomies in the United States are performed laparoscopically. Laparoscopic cholecystectomy is considered the "gold standard" for the surgical treatment of gallstone disease. This procedure results in less postoperative pain, better cosmetics, and shorter hospital stays and disability from work than open cholecystectomy [2-8]. However, the overall serious complication rate in laparoscopic cholecystectomy remains higher than that seen in open cholecystectomy.
6. Risks & Complications - The risk of complications is very low, however, potential risks might include: - Bleeding, Infection, Common bile duct injury, Minor shoulder pain (from the carbon dioxide gas), Bile leakage.
7. Benefits: - Less discomfort than regular surgery, Shorter hospital stay, with a quicker recovery time compared to regular (open) surgery, Smaller scars than regular surgery.
8. Consult us for Gallbladder Stone Treatment - For Appointment Call 079-29703438 Or Visit :- www.drchiragthakkar.com
Cholecystectomy open versus laparoscopic surgery
This document compares open and laparoscopic cholecystectomy procedures. Open cholecystectomy is easier to perform and more cost effective, but results in a longer hospital stay and poorer cosmetic outcomes. Laparoscopic cholecystectomy is now the gold standard, providing shorter recovery time and fewer complications, but requires specialized equipment and training and carries a higher risk of duct injuries. Both approaches are appropriate depending on the patient's condition and surgeon's expertise.
P T C
A PTC involves inserting a needle through the liver and into the bile ducts under fluoroscopy to inject contrast media and examine the biliary ducts for abnormalities or blockages. It is used for patients with obstructive jaundice suspected to be caused by gallstones or strictures to potentially remove stones or drain the bile ducts. Patients must not eat or drink before the exam and the radiologist must have equipment like fluoroscopy, needles, and contrast media.
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This document discusses urinary tract obstruction, specifically ureteropelvic junction obstruction (UPJO). It covers the causes, evaluation, and surgical treatment options for UPJO, with a focus on laparoscopic pyeloplasty. Key points include that UPJO can be congenital or acquired, and indications for intervention include symptoms, impaired renal function, stones or infection. Laparoscopic pyeloplasty is a less invasive alternative to open surgery that provides comparable success rates while reducing morbidity. The procedure involves mobilizing the colon, dissecting the ureter, and performing a dismembered pyeloplasty reconstruction.
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Laparoscopic surgery has undergone rapid development in recent years. Laparoscopic cholecystectomy was first performed in 1985. Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery.
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A laparoscopic cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder through several small incisions in the abdomen. During the procedure, carbon dioxide is used to inflate the abdomen so instruments can be inserted to tie off the cystic duct and artery before removing the gallbladder. It is usually performed to treat gallstones, gallbladder polyps, or cholecystitis. Compared to open surgery, laparoscopic cholecystectomy results in less pain, shorter hospital stays, and better cosmetic outcomes, though there are risks such as injury to other organs or postoperative bleeding.
Ptc )percutaneous transhepatic cholangiography
PTC is a radiological procedure that involves inserting a fine needle into the liver under imaging guidance to inject contrast directly into the biliary ducts, allowing visualization of the biliary tree. It is used to investigate biliary obstruction and anatomy when other imaging modalities are insufficient. The document outlines the anatomy, indications, technique, findings, and complications of PTC in detail.
LAP PYELOPLASTY
Laparoscopic pyeloplasty can be performed via either a transperitoneal or retroperitoneal approach. The transperitoneal approach involves mobilizing the colon to access the retroperitoneum. Trocar placement is typically in a triangular configuration. The procedure involves dissecting the ureter and renal pelvis, transecting the UPJ, spatulating the ureter, placing a stent, and performing an anastomosis with absorbable sutures to create a tension-free repair. Variations include a transmesenteric approach and retroperitoneal approach via a flank position. Success rates of laparoscopic pyeloplasty match those of open surgery.
Post cholecystectomy syndrome
This document discusses post-cholecystectomy syndrome, beginning with case studies of patients who developed symptoms after gallbladder removal surgery. It then defines post-cholecystectomy syndrome as the persistence or development of new symptoms after cholecystectomy. The document outlines that 15% of patients develop symptoms, which can be due to functional disorders, prior surgery complications, or other underlying causes affecting the biliary tract, pancreas, or other organs. Investigation and management depends on identifying the specific cause, which can be found in 95% of cases, through imaging, endoscopy, or surgery to address conditions like sphincter of Oddi dysfunction.
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Spc ppt final
This document provides guidelines from the British Association of Urological Surgeons on suprapubic catheter placement and care. It discusses indications for suprapubic catheters including acute urinary retention and long-term bladder drainage needs. Risks like bowel injury are addressed, and techniques like ultrasound-guidance are recommended to mitigate these risks. Precatheter assessment, consent discussions, and various insertion methods are outlined. Complications, long-term care including catheter changes, and blockage management are also covered. The guidelines aim to standardize safe suprapubic catheter practice based on evidence and expert consensus.
The Management of Pancreatic Trauma in the Modern Era
The Management of Pancreatic Trauma in the Modern Era
Surgical Clinics of North America
Volume 87, Issue 6 (December 2007)
Colonic Stenting: Still a Challenge?!
This document provides guidelines on colonic stent placement for malignant large bowel obstruction. It recommends that colonic stenting be reserved for left-sided colon cancers with clinical and imaging evidence of obstruction without perforation. A CT scan is the primary diagnostic tool, and examination of the remaining colon should occur within 3 months after alleviating the obstruction. Colonic stenting by an experienced endoscopist using endoscopy and fluoroscopy combined is suggested. Covered and uncovered stents are equally effective but uncovered stents have higher tumor ingrowth rates. Stent placement may be an alternative to emergency surgery in a palliative setting.
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Juza Chen and Avi Bery
Director of Sexual Dysfunction Clinic
Department of Urology
Tel-Aviv Sourasky Medical Center
Sackler Faculty of Medicine Tel-Aviv University
Moscow 2010
Ercp complications copy
Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure used to diagnose and treat pancreatic and biliary diseases. While it provides both diagnostic and therapeutic benefits, complications can occur in approximately 5-10% of cases. The most common complication is pancreatitis, occurring in 3-5% of cases, which usually causes abdominal pain and nausea but resolves within a few days. Other potential complications include perforation, bleeding, cholangitis, and cholecystitis. Careful patient selection and preventative measures like pancreatic duct stenting and antibiotic prophylaxis in high risk cases can help reduce the risk of complications.
Bibliografía pa grave y stent biliar
1. The document discusses three studies that evaluated the use of pancreatic duct stenting during endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute biliary pancreatitis. All three studies found lower complication rates for patients who received pancreatic duct stents compared to those who did not. The pancreatic duct stents helped reduce pressure in the pancreatic duct and reversed the progress of acute biliary pancreatitis. However, further research is still needed.
Top 10 Mistakes in ERCP.pptx
This document outlines 10 common mistakes in endoscopic retrograde cholangiopancreatography (ERCP) procedures based on case examples. The mistakes include performing ERCP without a clear therapeutic aim, not informing patients of risks, preferring balloon dilation over sphincterotomy, repeated cannulation without changing technique, incomplete mapping of bile ducts, drainage without imaging, placing metal stents without diagnosis, interventions before visualizing leaks, mistaking ducts during stenosis, and ignoring Mirizzi syndrome associations. The document provides recommendations to avoid each mistake and improve safety and outcomes of ERCP.
pancreatic cas managementby bedrumoh.pptx
1. Pancreatic cancer is the 4th leading cause of cancer death and often presents with jaundice, abdominal pain, weight loss, or new-onset diabetes. Diagnosis involves blood tests, CT, MRI, EUS, and biopsy.
2. Surgical management includes Whipple procedure for head tumors or distal pancreatectomy for body/tail tumors. Palliative options relieve biliary/duodenal obstruction and pain via stenting, bypass, or celiac plexus block.
3. Adjuvant chemo-radiotherapy after surgery can increase survival compared to surgery alone. Neoadjuvant FOLFIRINOX increases resectability of borderline resect
Eswl
Extra-corporeal shock wave lithotripsy (ESWL) is a treatment for pancreatic stones in chronic pancreatitis. ESWL uses focused shock waves to fragment pancreatic duct stones from outside the body. It has been shown to successfully fragment stones in 92% of cases and provide complete stone clearance and symptom relief in around 70% when combined with ERCP. However, stone recurrence rates are around 22% on average due to factors like pancreatic duct strictures. ESWL is generally safe but rare complications include bleeding and perforations. It is considered a first-line treatment option for painful chronic pancreatitis associated with obstructive ductal calculi but endotherapy may also be needed after ESWL if strictures
Pediatric laparoscopy
Laparoscopy is becoming more widely used in pediatric surgery due to its advantages over open surgery. It can be used diagnostically and for various procedures such as appendectomy, cholecystectomy, splenectomy, hernia repair, and treatment of undescended testes. Some challenges in pediatric laparoscopy include the thin abdominal wall and limited space. Care must be taken with trocar placement and insufflation pressures. Laparoscopy provides benefits like less pain, shorter hospital stays, and quicker recovery times for children. It is an important technique for pediatric surgeons to learn and incorporate into clinical practice.
Radiology 5th year, 5th lecture (Dr. Salah Mohammad Fatih)
Interventional radiology has evolved from providing purely diagnostic information to offering minimally invasive therapeutic alternatives to treat abdominal, thoracic, and vascular disorders. Procedures such as biopsies, drainages, angioplasty and stenting can now replace conventional surgery in many cases. Common interventional radiology procedures include liver biopsies, ERCP, PTC, percutaneous nephrostomies, gastrostomies, angioplasty and stenting of vessels. These procedures help diagnose and treat conditions affecting many organ systems such as the liver, bile ducts, kidneys, blood vessels and gastrointestinal tract.
Chronic pancreatitis
This document summarizes chronic pancreatitis, including its definition, pathogenesis, clinical manifestations, diagnosis, and treatment options. It provides details on the histopathological changes in chronic pancreatitis, including fibrosis, reduced acinar cells and islets of Langerhans, duct dilation, and pancreatic stones. Medical management focuses on pain control and enzyme supplementation, while surgical options are considered for complications or intractable pain, and include pancreaticoduodenectomy, duodenum-preserving pancreatic head resection, and decompressive procedures.
inflammatory bowel diseases, what`s new ?
This document summarizes recent advances in the diagnosis and treatment of inflammatory bowel disease (IBD). Key points include:
1) New imaging techniques like CT enterography and MRI enterography allow better visualization of the bowel. Narrow band imaging and confocal laser endoscopy provide enhanced detection of dysplasia.
2) Treatment advances include biologics targeting TNF and IL-12/23, as well as endoscopic balloon dilation and stenting.
3) Surgery options depend on disease severity but include laparoscopic approaches, which provide better outcomes than open surgery. Surgical treatments include resection, stricturoplomy, and restorative proctocolectomy with ileal pouch-anal
Management of pancreatic necrosis.pdf
This document provides 15 pieces of best practice advice for the management of pancreatic necrosis based on a review of the available evidence and expert recommendations. Some key points include:
1) Management of pancreatic necrosis requires a multidisciplinary approach including gastroenterologists, surgeons, radiologists and other specialists.
2) Antibiotics are recommended for confirmed infected necrosis but prophylactic antibiotics are not recommended.
3) Early enteral nutrition via oral, nasogastric or nasojejunal tubes is preferred to total parenteral nutrition to reduce risks of infection and other complications.
4) Drainage and/or debridement of infected or symptomatic necrosis is indicated but should be performed minimally invasively where possible
Presentazione pancreatite e vlc sic versione 1
This document describes a study examining the use of laparoscopic cholecystectomy for patients with mild biliary pancreatitis. The study reviewed 220 patients over an 11-year period who underwent laparoscopic cholecystectomy after symptoms improved. Common bile duct stones were identified in 23.1% of patients. The procedure had acceptable morbidity and mortality rates. It allowed for high rates of common bile duct clearance in a single surgery. Outcomes were better than alternative approaches like preoperative ERCP. The results support laparoscopic cholecystectomy as a viable option for treating mild biliary pancreatitis.
Chronic pancreatitis
Chronic pancreatitis is a progressive disease characterized by permanent destruction and fibrosis of the pancreatic tissue. It can be categorized into different types including relapsing, chronic cholecysto-pancreatitis, and obstructive. The main symptoms are pain and weight loss due to malabsorption. Diagnosis involves lab tests, imaging like CT, and ERCP. Treatment includes conservative measures like pain medications and enzymes, or surgical options like drainage procedures or pancreatic resection to relieve symptoms.
esophageal cancer surgery types and complications
Background-Anatomy & Staging
Surgical Candicate
Contraindication of sx
Assessment of patients for surgery
Approaches of esophagectomies
Esophageal reconstruction
Complications of esophagectomy
Gastrointestinal endoscopic Case Periamp Cancer.
This document discusses a case of a 65-year-old woman who presented with recurrent abdominal pain and jaundice and was found to have an ampullary adenoma. She underwent an endoscopic snare ampullectomy to remove the adenoma. The document then provides further information on ampullary adenomas, including their risk of progression to cancer, appropriate management based on size and invasion, and techniques for performing endoscopic ampullectomy.
Enteral nutrition method
1. The document discusses various enteral feeding methods including nasogastric tubes, nasojejunal tubes, percutaneous endoscopic gastrostomy (PEG) tubes, radiologically placed gastrostomy tubes, and jejunostomy tubes.
2. It describes the indications, contraindications, techniques, advantages, and complications of each method. PEG tubes are the most common method for long-term enteral access beyond 4-6 weeks while NG and NJ tubes are used for short-term feedings.
3. Access methods are chosen based on factors like the patient's condition, prognosis, ability to tolerate different sites of feeding, and risk of complications. Overall the document provides an overview
Esophageal diagnostics
This document discusses oesophageal endoscopy procedures and their uses. It covers the anatomy and technology behind endoscopes, as well as various diagnostic and therapeutic applications. Key points include:
- Endoscopy has advanced from a purely diagnostic tool to one capable of various therapies for conditions like GERD, achalasia, and obesity.
- Imaging technologies like chromoendoscopy and narrow band imaging help detect early neoplastic lesions and distinguish between dysplastic and non-dysplastic tissue.
- Endoscopy is used to diagnose and treat conditions that cause dysphagia like peptic strictures, Schatzki rings, eosinophilic esophagitis, and post-surgical an
Similar to GIT Kurdistan Board GEH Journal club: Post ERCP Pancreatitis prophylaxis. (20)
The Management of Pancreatic Trauma in the Modern Era
The Management of Pancreatic Trauma in the Modern Era
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Radiology 5th year, 5th lecture (Dr. Salah Mohammad Fatih)
Radiology 5th year, 5th lecture (Dr. Salah Mohammad Fatih)
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Git j club fiber in git20
Dietary fiber from whole foods like grains, legumes, vegetables, and fruits has demonstrated benefits for gastrointestinal (GIT) health. Isolated and extracted fibers also show promising regulatory effects on the gut and microbiome. However, fibers have varying physicochemical properties depending on their origin and processing that influence their functional characteristics and clinical applications. More research is needed, including well-designed randomized controlled trials, to determine which fiber sources, characteristics, doses and durations optimize GIT health benefits and manage gastrointestinal disorders. Combining fibers with different physiological effects may be a promising therapeutic strategy.
Med j club mm covid20
- Coronaviruses typically cause common colds but SARS-CoV and MERS-CoV can cause pneumonia, respiratory failure, and death. A novel coronavirus, SARS-CoV-2, emerged in Wuhan, China in late 2019 and caused a global pandemic.
- SARS-CoV-2 spreads mainly through respiratory droplets when people cough, sneeze or talk within 6 feet of each other. Asymptomatic and pre-symptomatic people are highly infectious.
- COVID-19 symptoms range from mild to critical illness. The elderly and those with pre-existing conditions are at higher risk for severe disease. Diagnosis involves PCR testing of respiratory samples.
GIT J Club IBD- sexual dysfunction20.
- Sexual dysfunction and infertility are more prevalent in men with IBD compared to the general population.
- Depression is the most consistent negative predictive factor of sexual function among men with IBD.
- Sulfasalazine can reversibly reduce male fertility, so it is recommended to discontinue 3-4 months prior to conception. Most other IBD medications do not significantly impact fertility.
- Men with IBD have an increased risk of prostate cancer and prostate cancer screening guidelines for higher risk patients should be followed.
GIT J Club IBD- pregnancy2020
The document summarizes a consensus clinical care pathway for women with inflammatory bowel disease (IBD) who are considering pregnancy or are pregnant. The pathway was created by an expert multidisciplinary team representing multiple societies to provide standardized, evidence-based recommendations for gastroenterology and obstetric providers to ensure healthy pregnancies for women with IBD. It addresses the lack of consistent advice available previously by compiling available data on therapeutic options for IBD that have increased over the last 15 years and putting them into an easily accessible format for clinical practice.
Med 5th geriatrics20
This document provides an overview of geriatrics and common issues in caring for elderly patients. It discusses how biological age is more important than chronological age in clinical decision making. Frailty and disability are also addressed. Common geriatric problems like falls, delirium, incontinence and adverse drug reactions are examined in terms of presentation, evaluation, and management strategies. The importance of a comprehensive assessment, considering multiple comorbidities and functional status, is emphasized in developing treatment plans for elderly patients.
GIT 4th abd wall pain
Here are the answers to the CME questions:
1. b
2. e
3. a
4. b
5. d
6. b
7. Inguinal hernias
8. E
GIT 4th endoscopy indications20
Upper and lower GI endoscopies have diagnostic, therapeutic, and screening indications. For upper endoscopy, common diagnostic indications include dyspepsia in patients over age 60 or with red flags, upper GI bleeding, and dysphagia. Therapeutic uses include treatment of bleeding, removal of foreign bodies, dilation of strictures, and stenting. Screening is done for portal hypertension, Barrett's esophagus, eosinophilic esophagitis, and cancers. Lower endoscopy indications involve diagnostic evaluation of bleeding, abdominal pain, diarrhea, and screening of average-risk adults over 50 and high-risk groups. Therapeutic colonoscopy is used for polypectomy, bleeding treatment, and stricture dilation
GIT J Club from UEG Week 2018.
Dr. Hiwa Abubakir and Dr. Mohamed Alshekhani discuss the management of nonvariceal gastrointestinal bleeding. They recommend endoscopy within 24 hours, or earlier for high-risk patients, to identify and treat the bleeding source. A variety of endoscopic tools can be used for hemostasis, including injection of adrenaline combined with clips, bands, electrocautery, or laser coagulation. Newer tools like over-the-scope clips are best for high-risk or recurrent bleeders. Doppler probes help ensure complete vessel occlusion. Additional prothrombotic agents or interventions may be needed in some cases.
Med j club dm antithrombosis19
The document discusses antithrombotic strategies for patients with diabetes who are at risk of cardiovascular events. It proposes strategies for primary prevention, stable coronary artery disease, acute coronary syndromes, ischemic stroke, peripheral artery disease, atrial fibrillation, and venous thromboembolism. More aggressive antithrombotic therapies are associated with greater reduction in recurrent cardiovascular events for patients with diabetes. However, these strategies must be weighed against the risk of bleeding. Further clinical trials are still needed to better understand optimal antithrombotic treatment for cardiovascular patients with diabetes.
Git 4th GC18.
1) Gastric carcinoma is the third leading cause of cancer death worldwide, with highest incidence in East Asia and parts of South America.
2) Risk factors include H. pylori infection, smoking, diet high in salted/preserved foods, and family history of gastric cancer.
3) Early detection through endoscopy in dyspeptic patients over 50 years old or with red flags can improve outcomes, as resection allows for potential cure in early gastric cancer confined to mucosa or submucosa.
GIT J Club IBS NEJM17.
This document summarizes guidelines for the diagnosis and management of irritable bowel syndrome (IBS). It defines IBS and its subtypes based on the Rome IV criteria. It recommends diagnosing IBS based on symptoms in the absence of alarm features or abnormal test results. Limited testing like fecal calprotectin can help distinguish IBS from inflammatory bowel disease. Treatment involves dietary changes, probiotics, antispasmodics, antidepressants, and targeted therapies depending on IBS subtype and predominant symptoms. For refractory cases, a multidisciplinary approach including psychological support may help manage persistent symptoms.
GIT 4th indication for upper GI endoscopy.
Upper gastrointestinal endoscopy has diagnostic, therapeutic, and screening indications. Diagnostically, it is used to detect diseases causing dyspepsia like gastric cancer, investigate upper GI bleeding, diagnose dysphagia, remove foreign bodies, assess GERD, detect esophageal varices, and diagnose celiac disease. Therapeutically, it treats upper GI bleeding, removes foreign bodies, dilates strictures, treats achalasia, places stents, treats GERD, eradicates Barrett's esophagus, inserts feeding tubes, and performs bariatric procedures. Screening indications include detecting Barrett's esophagus, portal hypertension, and cancers of the esophagus and stomach in high-risk patients
GIT Cholestatic AI HBD 17
The document discusses various autoimmune and cholestatic liver diseases including primary biliary cholangitis, primary sclerosing cholangitis, and intrahepatic cholestasis of pregnancy. It provides details on the epidemiology, clinical features, diagnosis, and management of these conditions. It also includes several multiple choice questions to test understanding of topics covered in the document.
GiIT 4th CRC 2017.
- Screening and surveillance are recommended for CRC starting at age 50 to detect and remove precancerous polyps through colonoscopy.
Git j club colonoscopy mistakes.
1. The document outlines 19 potential mistakes that can occur during colonoscopy procedures. These include doing colonoscopies without proper indications or patient evaluation, failing to adequately prepare the colon, misdiagnosing conditions like ulcerative colitis or hemorrhoids, not performing important parts of the exam like ileal intubation or biopsies, and not adhering to quality standards. Addressing these issues can help improve safety, accuracy of diagnoses, and overall quality of colonoscopy.
GIT 4th ibd 2017
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It discusses risk factors, clinical manifestations, diagnostic testing, and treatment approaches. The main points are:
- IBD is characterized by idiopathic inflammation of the gastrointestinal tract. The two main types are ulcerative colitis and Crohn's disease.
- Genetic and environmental factors contribute to risk. Smoking increases risk for Crohn's but decreases risk for ulcerative colitis.
- Symptoms vary based on disease location but may include abdominal pain, diarrhea, bleeding, weight loss, and nutritional deficiencies. Extraintestinal manifestations are more common with Crohn's.
GIT 4th IBS 2017
This document provides information on irritable bowel syndrome (IBS), including its definition, diagnostic criteria, subtypes, differential diagnosis, evaluation, and management approaches. Some key points:
- IBS is a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It affects 10-15% of the population.
- Diagnosis is based on fulfilling the Rome symptom criteria, with subtyping based on predominant stool pattern. Additional testing is usually not needed in absence of alarm features.
- Treatment involves reassurance, dietary modifications, antispasmodics, laxatives/antidiarrheals based on subtype, and tricyclic antidepressants/SSRIs for refractory cases.
Ppi seminar hiwa.
This document discusses the classical and long-term indications for PPI use, including GERD, Barrett's esophagus, use with NSAIDs, use with anti-platelets, and non-ulcer dyspepsia. For GERD, guidelines recommend daily PPI for erosive esophagitis but intermittent PPI courses may be sufficient for many patients. For Barrett's esophagus, the absolute cancer risk reduction with daily PPI is low. For NSAID and anti-platelet users at high risk of bleeding, the benefits of daily PPI are well documented. Intermittent PPI courses are often sufficient for non-ulcer dyspepsia, though some patients may require long-
Ppi symposium araz.
This document discusses potential long-term side effects of PPI use including increased risk of dementia, chronic kidney disease, and fractures. It notes that the evidence for associations between PPI use and these conditions is not conclusive. The document advises using the lowest effective dose of PPIs for indicated conditions and avoiding long-term daily use when possible. It also stresses the importance of only prescribing PPIs for appropriate indications and discontinuing them when no clear benefit exists.
Ppi symposium muhsin
The document summarizes short-term side effects of PPIs (proton pump inhibitors), which are generally well tolerated. The most common side effects are headache, diarrhea, abdominal pain and nausea. Diarrhea appears to be related to acid suppression and the overall incidence is less than 5%, though it may be dosage and age related. PPIs are considered safe for short-term use and have similar safety profiles to H2 blockers. PPIs should be used cautiously in patients with liver disease.
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GIT Kurdistan Board GEH Journal club: Post ERCP Pancreatitis prophylaxis.
- 1. LOGO Prophylaxis of post-ERCP pancreatitis: ESGE Guideline 2014 Prepared by: Dr.Mohamed Shekhani Endoscopy 2014
- 2. PEP diagnosis definition: Requires two of the three following criteria: (i) abdominal pain consistent with acute pancreatitis (acute onset of a persistent, severe, epigastric pain often radiating to the back) (ii) serum lipase or amylase activity at least three times >ULN; and (iii) characteristic findings of acute pancreatitis on contrast-enhanced CT &less commonly, MRI or TAUS. 4 degrees of severity based on the presence or absence of complications, both local (necrosis of the pancreas&/or peripancreatic tissue) &systemic (cardiovascular, renal, or respiratory organ failure).
- 3. Incidence: 4.4 %. Mild, moderate, severe type in 69%, 23%& 8%, respectively.
- 6. Main recommendations: 1. ESGE recommends routine rectal administration of 100mg of diclofenac or indomethacin immediately before or after ERCP in all patients without contraindication. In addition to this, in the case of high risk for (PEP), the placement of a 5-Fr prophylactic pancreatic stent should be strongly considered. Sublingually administered glyceryl trinitrate or 250 μg somatostatin given in bolus injection might be considered as an option in high risk cases if (NSAIDs) are contraindicated&if prophylactic pancreatic stenting is not possible or successful.
- 7. Main recommendations: 2. ESGE recommends keeping the number of cannulation attempts as low as possible. 3. ESGE suggests restricting the use of a pancreatic guidewire as a backup technique for biliary cannulation to cases with repeated inadvertent cannulation of the pancreatic duct; if this method is used, deep biliary cannulation should be attempted using a guidewire rather than the contrast-assisted method&a prophylactic pancreatic stent should be placed.
- 8. Main recommendations: 4. ESGE suggests that needle-knife fistulotomy should be the preferred precut technique in patients with a bile duct dilated down to the papilla. Conventional precut & transpancreatic sphincterotomy present similar success &complication rates; if conventional precut is selected& pancreatic cannulation is easily obtained, ESGE suggests attempting to place a small-diameter (3-Fr or 5-Fr) pancreatic stent to guide the cut& leaving the pancreatic stent in place at the end of ERCP for a minimum of 12–24 hours.
- 9. Main recommendations: 5. ESGE does not recommend endoscopic papillary balloon dilation as an alternative to sphincterotomy in routine ERCP, but it may be advantageous in selected patients; if this technique is used, the duration of dilation should be longer than 1 minute.
- 11. LOGO Click to edit subtitle style