1) A 66-year-old male presented to the emergency department with worsening abdominal pain and was found to have diffuse abdominal tenderness and guarding. Abdominal imaging would most likely reveal colonic dilation with loss of haustral markings, indicative of diverticulitis.
2) A 65-year-old female presented with abdominal pain and CT showed sigmoid diverticula and perisigmoid stranding. She returned days later with worsening symptoms and a new CT showed a 5 cm rim-enhancing perisigmoid fluid collection, requiring laparotomy for drainage and debridement.
3) Surgical management of diverticulitis may include laparoscopic or open sigmoid
1. The key presentations discussed are dysphagia, pancreatitis, and gallstone disease. For a case of dysphagia, oesophagogastroscopy is the most appropriate initial investigation to obtain a biopsy.
2. Pancreatitis is diagnosed with elevated amylase and can be graded using the Glasgow score from blood tests. Initial treatment is supportive with IV fluids and analgesia.
3. Gallstone disease includes biliary colic, cholecystitis, and ascending cholangitis which are differentiated based on symptoms, exam findings, and bloodwork. Ascending cholangitis requires ERCP for definitive treatment to remove obstructing stones.
Laparostomy management - ABThera™ Open Abdomen Negative Pressure Therapy Syst...Dr Edward Fitzgerald
Laparostomy Management with ABThera™
Case Experience: ABThera™ Open Abdomen Negative Pressure Therapy System in a Grade IV Open Abdomen Secondary to Acute Pancreatitis
- A 59-year-old female with a history of liver cirrhosis and previous surgeries presented with abdominal distension and was diagnosed with Ogilvie syndrome after imaging found colon dilation.
- Ogilvie syndrome, also called acute colonic pseudo-obstruction, occurs when the colon becomes dilated without a mechanical blockage due to autonomic nervous system dysfunction.
- It is usually caused by recent surgery, illness, or medications and carries risks of perforation if not decompressed. Treatment options include conservative measures, neostigmine to stimulate motility, or surgical decompression through cecostomy or colectomy.
The document discusses the assessment, investigations, and treatment of intestinal obstruction. It provides details on the history, physical examination, and various tests used to diagnose the cause of obstruction including blood tests, imaging like x-rays and CT scans. It then outlines supportive care measures and describes specific surgical treatments for different types of intestinal obstructions like resection of gangrenous bowel or hernia repair with bowel resection if needed.
MDCT in upper gastrointestinal obstruction: A pictorial review summarizes the causes, epidemiology, pathophysiology, and key MDCT findings of gastro-duodenal obstruction. Intrinsic causes include gallstones, tumors, ulcers, and hematomas. Extrinsic causes include pancreatitis, gastric volvulus, surgical complications, hiatal hernias, mesenteric artery syndrome, and external masses. MDCT is useful for differentiating mechanical from functional obstruction and identifying lesions, complications, and the level of obstruction to guide management. The document reviews anatomy and illustrates various pathologies through case examples.
A 77-year-old female presented with progressive dysphagia and chest pain and was found to have a large paraesophageal hernia; she underwent a laparoscopic paraesophageal hernial repair with gastropexy and had an uneventful postoperative course with resolution of her symptoms. Paraesophageal hernias are rare types of hiatal hernias that can cause symptoms from GERD to obstruction and require surgical repair to prevent complications like strangulation.
The document discusses a pub quiz on oesophageal rupture held by Dr. Deanne Chiu. It provides 10 trivia questions covering topics like the historical description of Boerhaave's syndrome, types and causes of oesophageal rupture, clinical presentation, imaging features, and management priorities. The questions test knowledge of key facts around this medical condition and its diagnosis and treatment.
1. The key presentations discussed are dysphagia, pancreatitis, and gallstone disease. For a case of dysphagia, oesophagogastroscopy is the most appropriate initial investigation to obtain a biopsy.
2. Pancreatitis is diagnosed with elevated amylase and can be graded using the Glasgow score from blood tests. Initial treatment is supportive with IV fluids and analgesia.
3. Gallstone disease includes biliary colic, cholecystitis, and ascending cholangitis which are differentiated based on symptoms, exam findings, and bloodwork. Ascending cholangitis requires ERCP for definitive treatment to remove obstructing stones.
Laparostomy management - ABThera™ Open Abdomen Negative Pressure Therapy Syst...Dr Edward Fitzgerald
Laparostomy Management with ABThera™
Case Experience: ABThera™ Open Abdomen Negative Pressure Therapy System in a Grade IV Open Abdomen Secondary to Acute Pancreatitis
- A 59-year-old female with a history of liver cirrhosis and previous surgeries presented with abdominal distension and was diagnosed with Ogilvie syndrome after imaging found colon dilation.
- Ogilvie syndrome, also called acute colonic pseudo-obstruction, occurs when the colon becomes dilated without a mechanical blockage due to autonomic nervous system dysfunction.
- It is usually caused by recent surgery, illness, or medications and carries risks of perforation if not decompressed. Treatment options include conservative measures, neostigmine to stimulate motility, or surgical decompression through cecostomy or colectomy.
The document discusses the assessment, investigations, and treatment of intestinal obstruction. It provides details on the history, physical examination, and various tests used to diagnose the cause of obstruction including blood tests, imaging like x-rays and CT scans. It then outlines supportive care measures and describes specific surgical treatments for different types of intestinal obstructions like resection of gangrenous bowel or hernia repair with bowel resection if needed.
MDCT in upper gastrointestinal obstruction: A pictorial review summarizes the causes, epidemiology, pathophysiology, and key MDCT findings of gastro-duodenal obstruction. Intrinsic causes include gallstones, tumors, ulcers, and hematomas. Extrinsic causes include pancreatitis, gastric volvulus, surgical complications, hiatal hernias, mesenteric artery syndrome, and external masses. MDCT is useful for differentiating mechanical from functional obstruction and identifying lesions, complications, and the level of obstruction to guide management. The document reviews anatomy and illustrates various pathologies through case examples.
A 77-year-old female presented with progressive dysphagia and chest pain and was found to have a large paraesophageal hernia; she underwent a laparoscopic paraesophageal hernial repair with gastropexy and had an uneventful postoperative course with resolution of her symptoms. Paraesophageal hernias are rare types of hiatal hernias that can cause symptoms from GERD to obstruction and require surgical repair to prevent complications like strangulation.
The document discusses a pub quiz on oesophageal rupture held by Dr. Deanne Chiu. It provides 10 trivia questions covering topics like the historical description of Boerhaave's syndrome, types and causes of oesophageal rupture, clinical presentation, imaging features, and management priorities. The questions test knowledge of key facts around this medical condition and its diagnosis and treatment.
Inthis playlist, i discussed various causes for Lower GI Hemorrahage like Hemorrhoids, Fissure in ano, diverticulosis, inflammatory bowel disease and colorectal cancer
Acute appendicitis is caused by obstruction of the appendix lumen, which increases intraluminal pressure and leads to vascular compromise and tissue necrosis. Initial symptoms are vague abdominal pain that localizes to the right lower quadrant as inflammation spreads. A physical exam may reveal tenderness at McBurney's point. Imaging studies like CT scans can help diagnose appendicitis, especially in atypical cases. Treatment is an appendectomy along with preoperative antibiotics to prevent infection.
- Perforation of the gastrointestinal tract can occur due to various causes like perforated ulcers, penetrating injuries, or ischemic bowel. Signs include severe abdominal pain, fever, and tenderness.
- Diagnosis is suggested by imaging showing free air or fluid in the abdomen. Treatment requires emergency surgery to repair any perforations followed by intensive care and broad-spectrum antibiotics to treat peritonitis.
- Surgical management involves thorough irrigation and drainage of the abdominal cavity followed by resection of non-viable bowel and primary anastomosis or stoma formation as needed. Close postoperative monitoring in the ICU is important to support organ function and detect any complications.
This document discusses a case of a 20-year-old man presenting with abdominal pain and diarrhea who was found to have elevated inflammatory markers and free fluid on ultrasound. It then provides a general overview of acute abdomen including common causes, diagnostic approach, important physical exam findings and signs, and appropriate imaging studies.
This document summarizes the anatomy, pathophysiology, diagnosis, and treatment of spontaneous esophageal rupture (SER), also known as Boerhaave's syndrome. It describes the anatomy of the esophagus and explains that SER usually occurs due to vomiting against a closed upper esophageal sphincter, which increases intraesophageal pressure and can cause a tear. Diagnosis involves considering the patient's history, symptoms of chest and abdominal pain, and findings on imaging tests. Treatment involves antibiotics, nothing by mouth, gastric decompression, and possibly surgery if symptoms do not improve with initial non-operative management. Early diagnosis and treatment are important for prognosis.
This document discusses the diagnosis and management of acute abdominal pain. It defines acute abdomen as sudden abdominal pain lasting less than 24 hours. Common causes are appendicitis, cholecystitis, intestinal obstruction, and perforated viscus. A thorough history, physical exam, and lab/imaging workup is needed to diagnose the specific cause as treatment depends on the etiology. Laparoscopy can help diagnose unclear cases or distinguish surgical from non-surgical conditions. The goal is to determine if the patient requires immediate surgery, surgical observation, medical management, or further diagnostics.
This document presents a case report of a 2.5 year old male patient who was admitted with persistent fluid leaking from his right chest tube for 1 month following swallowing of a button battery. The patient underwent various procedures including esophagoscopy, esophageal stent placement, and feeding jejunostomy. He was later readmitted with fever, cough, and abdominal distension. Imaging showed fluid in the chest and esophagus had not healed. The case report reviews the patient's hospital course and provides background information on esophageal perforation including causes, presentation, imaging, and management considerations.
This document describes various diagnostic modalities used to evaluate esophageal diseases. It discusses barium swallow, esophagoscopy, esophageal manometry, pH monitoring, impedance pH monitoring, endoscopic ultrasound, and Bilitec 2000. Details provided include indications, contraindications, techniques, measurements obtained, and example images for each test. The modalities allow examination of esophageal anatomy and function, identification and staging of conditions like gastroesophageal reflux disease and cancer.
"Abdominal Exploration-When to cut, anatomic review and surgical techniques"
Presented by Dr. Earl (Trey) F. Calfee, III
Form more information about nashville Veterinary Specialists and Animal Emergency services, please visit our website at http://www.nashvillevetspecialists.com
The document discusses various diagnostic procedures used in gastrointestinal (GIT) diseases. It describes structural tests like imaging techniques (X-rays, ultrasound, CT, MRI, endoscopy), functional tests (motility tests, pH monitoring, malabsorption tests), tests for infections like Helicobacter pylori, blood tests, and stool tests. Key diagnostic procedures mentioned include upper and lower endoscopy, capsule endoscopy, ERCP, EUS, biopsy, and hydrogen breath testing.
This document presents a case of a 40-year-old female who experienced chest pain and dysphagia after a rigid esophagoscopy for a food bolus impaction. She was found to have a right pleural effusion due to an iatrogenic esophageal perforation during the procedure. She underwent tube thoracostomy followed by right thoracotomy and esophageal repair. Key factors in esophageal perforation include prompt diagnosis, primary repair when possible, and management of sepsis and nutrition. Outcomes depend on location, etiology, and time to treatment, with cervical perforations having the lowest mortality.
Lecture on abdominal trauma during Basic Life Support 2018 course in Sibu Hospital. Encompasses blunt and penetrating trauma, principles and tips of management
The document discusses surgical treatments for gastroesophageal reflux disease (GERD) and achalasia performed by surgeons at Beth Israel Medical Center, including minimally invasive procedures like laparoscopic fundoplication and myotomy which provide relief for patients with these conditions. It also provides an overview of the general surgery division and some of the conditions they treat ranging from hernias and gallbladder disease to obesity and trauma.
This document provides an overview of gastroenterology and hepatology. It discusses common GI diseases and symptoms, as well as various tests used to evaluate GI structure, infections, and function. These include imaging studies, endoscopy, biopsies, bacterial cultures, serology tests, breath tests, and radioisotope tests to assess conditions like gastric emptying, HP infection, Meckel's diverticulum, bleeding, and malabsorption. Therapeutic endoscopy is highlighted as a less invasive alternative to surgery for many GI conditions.
The document discusses various pediatric surgical conditions and their anesthetic management, including pyloric stenosis, tracheoesophageal fistula, congenital diaphragmatic hernia, intestinal obstruction, omphalocele, gastroschisis, and necrotizing enterocolitis. For each condition, it covers topics like incidence, etiology, clinical presentation, pre-operative preparation and management, induction and maintenance of anesthesia, as well as post-operative care and complications.
1. The document discusses various diseases of the esophagus, including hiatal hernia, achalasia, esophageal motility disorders, and esophageal cancer.
2. It describes the symptoms, diagnosis, and treatment of these conditions. For example, it notes that hiatal hernia can cause acid reflux and be treated with antacids or surgery, while achalasia involves failure of the esophagus to relax and may require dilation or surgery.
3. The document also covers traumatic injuries to the esophagus from ingestion of caustic substances, perforation, and diaphragmatic hernia. Early treatment is important for conditions like perforation to prevent infection.
This document discusses various topics related to diseases of the esophagus including:
1. Causes, symptoms, diagnosis and treatment of esophageal rupture and perforation.
2. Etiology, clinical features, diagnosis and management of corrosive esophageal burns.
3. Etiology, clinical features, diagnosis and endoscopic treatment of esophageal strictures.
4. Causes, symptoms, diagnosis and treatment options for gastroesophageal reflux disease and Barrett's esophagus.
This document provides an overview of the anatomy, physiology, pathologies, clinical presentation, diagnosis, and treatment of the esophagus. Key points include:
- The esophagus functions to pass food to the stomach and allows for endoscopic evaluation. It has two sphincters and two muscle layers.
- Gastroesophageal reflux disease (GERD) and hiatal hernias are common causes of reflux. Other pathologies include achalasia, diverticula, and esophageal cancer.
- Symptoms vary depending on the pathology but can include dysphagia, heartburn, chest pain, and respiratory issues. Diagnosis involves imaging, endoscopy, and biops
This document provides an overview of emergency ultrasound for acute appendicitis. It discusses the post-appendectomy status, including the appearance of the appendiceal stump at various time points after surgery. It also reviews complications of appendicitis and appendectomy such as abscesses. The document presents several case studies demonstrating ultrasound findings for acute appendicitis and unusual cases, including appendicitis in hernias. It concludes with a discussion of conditions that can mimic the symptoms of appendicitis.
This document discusses the role of imaging in evaluating patients presenting with an acute abdomen. It begins by defining an acute abdomen and describing the nonspecific clinical presentation. Potential causes are categorized as self-limiting, life-threatening, or surgical vs. nonsurgical. The role of imaging is to help determine if surgery is needed and to narrow the differential diagnosis. Imaging modalities discussed include plain radiography, ultrasound, CT scan, and others. The document then reviews how different modalities can help evaluate for specific common acute abdominal conditions like appendicitis, cholecystitis, and diverticulitis. It also describes signs to screen for on imaging like free air, free fluid, bowel wall thickening, and ileus.
Inthis playlist, i discussed various causes for Lower GI Hemorrahage like Hemorrhoids, Fissure in ano, diverticulosis, inflammatory bowel disease and colorectal cancer
Acute appendicitis is caused by obstruction of the appendix lumen, which increases intraluminal pressure and leads to vascular compromise and tissue necrosis. Initial symptoms are vague abdominal pain that localizes to the right lower quadrant as inflammation spreads. A physical exam may reveal tenderness at McBurney's point. Imaging studies like CT scans can help diagnose appendicitis, especially in atypical cases. Treatment is an appendectomy along with preoperative antibiotics to prevent infection.
- Perforation of the gastrointestinal tract can occur due to various causes like perforated ulcers, penetrating injuries, or ischemic bowel. Signs include severe abdominal pain, fever, and tenderness.
- Diagnosis is suggested by imaging showing free air or fluid in the abdomen. Treatment requires emergency surgery to repair any perforations followed by intensive care and broad-spectrum antibiotics to treat peritonitis.
- Surgical management involves thorough irrigation and drainage of the abdominal cavity followed by resection of non-viable bowel and primary anastomosis or stoma formation as needed. Close postoperative monitoring in the ICU is important to support organ function and detect any complications.
This document discusses a case of a 20-year-old man presenting with abdominal pain and diarrhea who was found to have elevated inflammatory markers and free fluid on ultrasound. It then provides a general overview of acute abdomen including common causes, diagnostic approach, important physical exam findings and signs, and appropriate imaging studies.
This document summarizes the anatomy, pathophysiology, diagnosis, and treatment of spontaneous esophageal rupture (SER), also known as Boerhaave's syndrome. It describes the anatomy of the esophagus and explains that SER usually occurs due to vomiting against a closed upper esophageal sphincter, which increases intraesophageal pressure and can cause a tear. Diagnosis involves considering the patient's history, symptoms of chest and abdominal pain, and findings on imaging tests. Treatment involves antibiotics, nothing by mouth, gastric decompression, and possibly surgery if symptoms do not improve with initial non-operative management. Early diagnosis and treatment are important for prognosis.
This document discusses the diagnosis and management of acute abdominal pain. It defines acute abdomen as sudden abdominal pain lasting less than 24 hours. Common causes are appendicitis, cholecystitis, intestinal obstruction, and perforated viscus. A thorough history, physical exam, and lab/imaging workup is needed to diagnose the specific cause as treatment depends on the etiology. Laparoscopy can help diagnose unclear cases or distinguish surgical from non-surgical conditions. The goal is to determine if the patient requires immediate surgery, surgical observation, medical management, or further diagnostics.
This document presents a case report of a 2.5 year old male patient who was admitted with persistent fluid leaking from his right chest tube for 1 month following swallowing of a button battery. The patient underwent various procedures including esophagoscopy, esophageal stent placement, and feeding jejunostomy. He was later readmitted with fever, cough, and abdominal distension. Imaging showed fluid in the chest and esophagus had not healed. The case report reviews the patient's hospital course and provides background information on esophageal perforation including causes, presentation, imaging, and management considerations.
This document describes various diagnostic modalities used to evaluate esophageal diseases. It discusses barium swallow, esophagoscopy, esophageal manometry, pH monitoring, impedance pH monitoring, endoscopic ultrasound, and Bilitec 2000. Details provided include indications, contraindications, techniques, measurements obtained, and example images for each test. The modalities allow examination of esophageal anatomy and function, identification and staging of conditions like gastroesophageal reflux disease and cancer.
"Abdominal Exploration-When to cut, anatomic review and surgical techniques"
Presented by Dr. Earl (Trey) F. Calfee, III
Form more information about nashville Veterinary Specialists and Animal Emergency services, please visit our website at http://www.nashvillevetspecialists.com
The document discusses various diagnostic procedures used in gastrointestinal (GIT) diseases. It describes structural tests like imaging techniques (X-rays, ultrasound, CT, MRI, endoscopy), functional tests (motility tests, pH monitoring, malabsorption tests), tests for infections like Helicobacter pylori, blood tests, and stool tests. Key diagnostic procedures mentioned include upper and lower endoscopy, capsule endoscopy, ERCP, EUS, biopsy, and hydrogen breath testing.
This document presents a case of a 40-year-old female who experienced chest pain and dysphagia after a rigid esophagoscopy for a food bolus impaction. She was found to have a right pleural effusion due to an iatrogenic esophageal perforation during the procedure. She underwent tube thoracostomy followed by right thoracotomy and esophageal repair. Key factors in esophageal perforation include prompt diagnosis, primary repair when possible, and management of sepsis and nutrition. Outcomes depend on location, etiology, and time to treatment, with cervical perforations having the lowest mortality.
Lecture on abdominal trauma during Basic Life Support 2018 course in Sibu Hospital. Encompasses blunt and penetrating trauma, principles and tips of management
The document discusses surgical treatments for gastroesophageal reflux disease (GERD) and achalasia performed by surgeons at Beth Israel Medical Center, including minimally invasive procedures like laparoscopic fundoplication and myotomy which provide relief for patients with these conditions. It also provides an overview of the general surgery division and some of the conditions they treat ranging from hernias and gallbladder disease to obesity and trauma.
This document provides an overview of gastroenterology and hepatology. It discusses common GI diseases and symptoms, as well as various tests used to evaluate GI structure, infections, and function. These include imaging studies, endoscopy, biopsies, bacterial cultures, serology tests, breath tests, and radioisotope tests to assess conditions like gastric emptying, HP infection, Meckel's diverticulum, bleeding, and malabsorption. Therapeutic endoscopy is highlighted as a less invasive alternative to surgery for many GI conditions.
The document discusses various pediatric surgical conditions and their anesthetic management, including pyloric stenosis, tracheoesophageal fistula, congenital diaphragmatic hernia, intestinal obstruction, omphalocele, gastroschisis, and necrotizing enterocolitis. For each condition, it covers topics like incidence, etiology, clinical presentation, pre-operative preparation and management, induction and maintenance of anesthesia, as well as post-operative care and complications.
1. The document discusses various diseases of the esophagus, including hiatal hernia, achalasia, esophageal motility disorders, and esophageal cancer.
2. It describes the symptoms, diagnosis, and treatment of these conditions. For example, it notes that hiatal hernia can cause acid reflux and be treated with antacids or surgery, while achalasia involves failure of the esophagus to relax and may require dilation or surgery.
3. The document also covers traumatic injuries to the esophagus from ingestion of caustic substances, perforation, and diaphragmatic hernia. Early treatment is important for conditions like perforation to prevent infection.
This document discusses various topics related to diseases of the esophagus including:
1. Causes, symptoms, diagnosis and treatment of esophageal rupture and perforation.
2. Etiology, clinical features, diagnosis and management of corrosive esophageal burns.
3. Etiology, clinical features, diagnosis and endoscopic treatment of esophageal strictures.
4. Causes, symptoms, diagnosis and treatment options for gastroesophageal reflux disease and Barrett's esophagus.
This document provides an overview of the anatomy, physiology, pathologies, clinical presentation, diagnosis, and treatment of the esophagus. Key points include:
- The esophagus functions to pass food to the stomach and allows for endoscopic evaluation. It has two sphincters and two muscle layers.
- Gastroesophageal reflux disease (GERD) and hiatal hernias are common causes of reflux. Other pathologies include achalasia, diverticula, and esophageal cancer.
- Symptoms vary depending on the pathology but can include dysphagia, heartburn, chest pain, and respiratory issues. Diagnosis involves imaging, endoscopy, and biops
This document provides an overview of emergency ultrasound for acute appendicitis. It discusses the post-appendectomy status, including the appearance of the appendiceal stump at various time points after surgery. It also reviews complications of appendicitis and appendectomy such as abscesses. The document presents several case studies demonstrating ultrasound findings for acute appendicitis and unusual cases, including appendicitis in hernias. It concludes with a discussion of conditions that can mimic the symptoms of appendicitis.
This document discusses the role of imaging in evaluating patients presenting with an acute abdomen. It begins by defining an acute abdomen and describing the nonspecific clinical presentation. Potential causes are categorized as self-limiting, life-threatening, or surgical vs. nonsurgical. The role of imaging is to help determine if surgery is needed and to narrow the differential diagnosis. Imaging modalities discussed include plain radiography, ultrasound, CT scan, and others. The document then reviews how different modalities can help evaluate for specific common acute abdominal conditions like appendicitis, cholecystitis, and diverticulitis. It also describes signs to screen for on imaging like free air, free fluid, bowel wall thickening, and ileus.
Tasleem Akhtar, a 50-year old female, presented with post-prandial vomiting, abdominal pain, and constipation. Imaging showed signs of intestinal obstruction. She underwent exploratory laparotomy, which found a stricture in the sigmoid colon due to a hard mass. A segment of the sigmoid colon was resected along with the mass. Histopathology revealed colorectal cancer. She was diagnosed with colorectal cancer affecting the sigmoid colon.
The patient presented with symptoms of intestinal obstruction including abdominal pain, nausea, vomiting and abdominal distension. Physical exam revealed abdominal tenderness and laboratory tests showed signs of dehydration and inflammation. Radiographic imaging confirmed multiple dilated loops of small bowel consistent with mechanical intestinal obstruction. The obstruction was determined to be complete based on symptoms. The patient's history of previous appendectomy suggested the underlying cause was likely adhesive obstruction. Treatment involved fluid resuscitation, gastrointestinal decompression and antibiotics, with potential for surgical lysis of adhesions if symptoms did not improve.
Managament of anastomotic leak - case capsule- Dr Keyur BhattDrKeyurBhattMSMRCSEd
Management of anastomotic leak after gastrointestinal surgery. This is very important step for any general or GI surgeons to know how to deal with the anastomotic leak following surgery.
This document discusses the anesthetic management of several pediatric surgical conditions:
1. Pyloric stenosis - presents with projectile vomiting. Preparation focuses on correcting dehydration and electrolyte abnormalities. Induction is done with pentathol and suxamethonium followed by caudal epidural for pain relief.
2. Tracheoesophageal fistula - presents with excessive salivation and cyanotic spells. Pre-op management aims to avoid feeding and suction secretions. Induction risks entering the fistula; careful intubation and ventilation are needed.
3. Congenital diaphragmatic hernia - presents with cyanosis, dyspnea and apparent dextrocardia
This document describes a case of a patient with refractory left-sided ulcerative colitis. The patient presented with a history of loose stools mixed with blood and was diagnosed with ulcerative colitis 1.5 years ago. Colonoscopy and biopsy reports confirmed left-sided ulcerative colitis. The patient was treated with corticosteroids, mesalamine, and antibiotics, which resulted in decreased bleeding and normalization of stool consistency by day 6. The treatment plan aims to induce remission and maintain quality of life through medication, monitoring, and lifestyle modifications.
The patient is a 45-year-old female presenting with sudden abdominal pain for 3 hours in her epigastric and right upper quadrant areas. She reports one episode of vomiting and a subjective fever. Her vital signs show elevated blood pressure, heart rate, and temperature. Physical exam reveals tenderness in the epigastric and right upper quadrants. Based on her history and exam findings, she is suspected to have acute cholecystitis.
The document discusses bowel obstruction, defining it as an interruption in intestinal contents passage. It describes clinical presentations and differentiation between dynamic and mechanical obstruction. Common causes are discussed including those external to the bowel wall like adhesions, hernias and tumors, and those inside the wall or lumen like tumors, infections, and gallstones. Management principles are outlined including fluid resuscitation, electrolyte replacement, and indications for operative vs non-operative treatment depending on signs of strangulation or complete obstruction. Several case examples are presented and their outcomes summarized.
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
Gastric volvulus and other types of volvulusPrabha Om
Bhori Singh, a 45-year-old male, presented with abdominal pain, distension and inability to pass flatus or stool for the past few days. Examination and investigations revealed acute intestinal obstruction likely due to gastric volvulus or perforation peritonitis. He underwent an exploratory laparotomy with gastropexy where gastric volvulus was found and repaired by suturing the stomach to the abdominal wall. Post-operatively, he recovered well and was discharged on the 8th day. Gastric volvulus is the twisting of the stomach and can be acute or chronic. Treatment involves endoscopic or surgical reduction and fixation of the stomach to prevent recurrence.
Acute appendicitis is caused by obstruction of the appendix lumen, which increases intraluminal pressure and leads to tissue ischemia, necrosis, and potential perforation. It presents with initially vague periumbilical pain that migrates to the right lower quadrant. Diagnosis is suggested by tenderness over McBurney's point on exam. Imaging such as CT can help diagnosis but is not always needed. Treatment is appendectomy with preoperative antibiotics. Patients may be observed briefly if diagnosis is uncertain.
This document provides an overview of small bowel obstruction, including classification, common causes, clinical features, investigation, and treatment. It discusses how to determine if a patient has bowel obstruction or ileus, and how to investigate and manage the patient. The main causes of small bowel obstruction are discussed, including adhesions, hernias, volvulus, and intussusception. Indications for surgery include generalized peritonitis, failure to improve with conservative treatment, and unclear diagnosis. Initial management focuses on resuscitation, decompression, and monitoring for signs of strangulation or perforation that would require surgery.
- A 49-year-old man presented with abdominal pain and vomiting. Imaging showed a partial small bowel obstruction.
- During surgery, a Meckel's diverticulum was found torsed around the small bowel, causing the obstruction. The Meckel's diverticulum was resected.
- Meckel's diverticulum is the most common congenital gastrointestinal abnormality, occurring in about 2% of the population. It can cause bleeding, intestinal obstruction, or inflammation/perforation from diverticulitis.
This document provides an overview of a seminar on evidence-based practices in cholelithiasis and choledocholithiasis. It discusses the anatomy and physiology of the gallbladder, defines the conditions, and covers etiology, pathophysiology, types of gallstones, signs and symptoms, diagnostic findings, medical and surgical treatment options, complications, and patient education. Key objectives of the seminar are to discuss anatomy/physiology of the gallbladder, define the conditions and explain cholelithiasis including epidemiology, etiology, pathophysiology, and management approaches.
An acute abdomen refers to severe abdominal pain lasting less than 5 days that may require urgent surgical intervention. The document discusses several potential life-threatening causes of acute abdomen including ruptured abdominal aortic aneurysm, perforated viscus, bowel ischemia, ruptured ectopic pregnancy, and testicular torsion. It provides details on the clinical presentation, diagnostic findings, and management of each condition. Common non-life threatening causes like acute appendicitis and acute cholecystitis are also reviewed.
113/01/26-高雄地區第495次小兒科聯合病例討論會(社團法人高雄市醫師公會)Ks doctor
1. The patient presented with persistent fever and abdominal pain and was diagnosed with infectious enterocolitis, likely caused by rotavirus. Imaging showed colitis of the ascending colon with suspected perforation and abscess formation.
2. Gastrointestinal perforation requires full-thickness injury to the bowel wall and can result from various medical and surgical causes. Clinical features depend on the location and contents released.
3. Management involves IV fluids, antibiotics, and surgery to repair the perforation site for patients with signs of peritonitis or worsening symptoms. Some perforations can be managed non-operatively with antibiotics if the perforation is contained.
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: October ...Sean M. Fox
This document summarizes an adult abdominal imaging case study series from Carolinas Medical Center. It discusses three cases presented in the series: 1) A 36-year-old female with a perforated gastric ulcer. 2) A 63-year-old man with left lower extremity pain and ulcers diagnosed with May-Thurner syndrome. 3) An 11-year-old female with abdominal pain and difficulty urinating diagnosed with hematocolpos secondary to an imperforate hymen. The document provides brief discussions of the diagnoses, relevant anatomy, risk factors, and management considerations. It encourages systematic review of abdominal CT scans and sharing of case studies between departments and internationally.
This document discusses the management of abdominal trauma. It begins with classifications for abdominal injuries and describes the pathophysiology of blunt and penetrating trauma. The primary and secondary surveys are outlined, including important physical exam findings. Diagnostic imaging options are presented, such as FAST ultrasound, CT scans, and DPL. Specific injuries to organs like the spleen are discussed. Management approaches for both blunt and penetrating trauma are covered, including options for non-operative management versus laparotomy. Damage control resuscitation principles and abdominal compartment syndrome are also mentioned.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Learning Objectives
• To understand clinical presentation of diverticular disease and
complications.
• To describe imaging findings suspicious for diverticular disease.
• To determine management options for diverticular disease.
• To determine indications for operation in diverticular disease
• To understand operative approaches and benefits, drawbacks
• To identify the steps needed to assess a patient after surgery and
what symptoms to look for to ensure a safe recovery.
3. A 66 yo male comes into the ED d/t worsening abd pain. Over the past
week, he has had vague lower abdominal discomfort, nausea, anorexia,
and constipation. This morning, the patient had sudden, severe lower
abdominal pain accompanied by an episode of vomiting. The pain
initially improved but then gradually intensified to involve the entire
abdomen. On physical exam the patient is alert, uncomfortable,
heart/lung normal. Diminished BS. Abd diffusely tender w guarding and
rebound tenderness. T 38.3 C (100.9 F), BP 110/54, HR 108 RR 20
Abdominal imaging is most likely to reveal which of the findings?
• a) colonic dilation w loss of haustral markings
• b) dilated small bowel w a transition point
• c) embolic occlusion of a mesenteric artery
• d) free air in the peritoneal cavity
4. 65 yo f to the ED w 2 day hx of lower abd pain, nausea w/o vomiting. Pmh
osteoarthritis and constipation (docusate).
T 37.9 C (100.2 F), BP 144/92, HR 90. LLQ tender to deep palp.
CT shows sigmoid diverticula and perisigmoid stranding suggestive of
inflammation. The patient is started on oral cipro and metronidazole and
sent home.
Three days later she returns to the ED with persistent abd pain, nausea,
fever. Last BM 12 hr ago. PE shows LLQ wo guarding/rebound. CT shows 5 cm
rim enhancing perisigmoid fluid collection.
Next step?
a) IV ab and observation
b) Laparotomy for colonic resection
c) Laparotomy for drainage and debridement
d) Oral ab, bowel rest, observation
e) Percutaneous abscess drainage under CT guidance
11. Steps
• Mobilization of the descending colon along
the white line of Toldt
• Mobilization of the splenic flexure
• Allows for tension-free anastomosis in the
pelvis
• Anastomoses under tension have increased
leak rates
• Division of the distal descending colon and
rectosigmoid junction
• Ligation of the sigmoid mesentery
• Unlike in a cancer operation, the
mesentery may be taken close to the bowel
wall, as opposed to at the root. This is
because lymph node resection is not
required.
• Once the specimen is removed, a hand-
sewn or stapled anastomosis is performed.
• A leak test is performed by insufflating air
per rectum while submerging the
anastomosis under water and looking for
bubbles.
• No bubbles = no leak
• If bubbles are noted, the surgeon may re-
do the anastomosis and try again.
Alternatively, depending on the condition
of the colon and other factors, the surgeon
may elect to perform a proximal diversion
with a loop ileostomy to allow the
anastomosis to heal.
• Finally, the abdomen is closed in the usual
fashion
12. Post op
• Check bowel function
• Advancement of diet
• infections
• After 8 weeks?
13. Our Patient – not so easy
• TV is a 83 yo m w recent hx of surgery early Dec for pyloric ulcer perf
• 1/13 presents to ED w abd pain, diarrhea for 2 weeks, 20lb weight loss, and
fevers at night.
• Abd tender to palp, lactate/procalcitonin elevated, white count elevated, anion gap
• CT showed “persistent pneumoperitoneum near stomach from 12/6”
• 1/14 ICU on vasopressin + norepi. Ex lap -> sigmoid colectomy w creation
of descending colostomy (Hartmann's procedure). Peritonitis 2/2 perf
sigmoid diverticulitis
• 1/16 extubated, off pressors. Bradycardia 40’s, +dopamine
• 1/17 wbc trending down, lactate normal, anion gap resolved
• 1/19 V fib + LOC
Today he is doing pretty well! Eating and learning how to use ostomy.
small mucosal herniations protruding through the smooth muscle in the layers of the bowel wall
There are false, or pseudo diverticulae in the sense that they don't contain all layers of the bowel wall, but only the mucosa and submucosal layers. Typically, these false diverticulae are due to a pushing force.
true diverticulae, such as the appendix, contain all layers of the bowel wall.
, in the US they are more common in the sigmoid.
Diverticulosis refers to the simple condition of having diverticula, which may be asymptomatic in the majority of cases.
Epidemiology – age
<40 yo less than 5%
85+ 65%
Risk factors: low fiber diet, constipation, obesity
Occasionally, fecal material or undigested food becomes lodged in the diverticula obstructing it. this leads to inflammation
Diverticulitis, however, means that one or more of the diverticula become inflamed, as indicated in this CT scan by fat stranding and haziness of the bowel wall.
CT findings:
acute uncomplicated diverticulitis are fat stranding…Bowel thickening or possibly a small pocket of extra luminal air.
complicated diverticulitis have more serious issues.
Is the patient septic?
PE: distention? Tympanic? Peritonitic?
Img:
Xray – pneumoperitoneum – perforated something - free air?
dilated loops of bowel -> ileus/obstruction
CT findings:
acute uncomplicated diverticulitis are fat stranding…Bowel thickening or possibly a small pocket of extra luminal air.
complicated diverticulitis have more serious issues.
A perforation may be associated with a phlegmon, which is an ill-defined area of inflammation involving the colon or a discrete abscess. So you might see a mass of inflamed tissue near where the diverticulitis is located.
You could see a fistula from the colon, most commonly to the bladder, or you might see obstruction that would be demonstrated by dilated loops of small or large intestine proximal to the affected area.
Labs?
In ordering and evaluating laboratory studies in a patient with diverticulitis, you may want to include a CBC with differential looking at the white count for inflammation or signs of infection.
The hemoglobin and hematocrit for dehydration and anemia.
The BMP includes electrolytes and renal function studies which also give you an indicator of dehydration.
Surgery: PT, PTT, and coagulation studies, beta HCG
LFT's, amylase and lipase are generally not indicated unless you're ruling out another disease, and you may order a urinalysis for symptoms of a UTI in consideration of a colovesical fistula.
The management of acute diverticulitis is largely dictated by the stage of the disease at presentation. The modified Hinchey Classification scheme separates acute diverticulitis into a spectrum of severities.
Mild clinical diverticulitis (stage 0) and inflammation confined to the pericolic region (stage 1a), meaning otherwise uncomplicated diverticulitis, are typically treated conservatively with bowel rest and IV antibiotics.
this is “uncomplicated diverticulitis”
The presence of a pericolic abscess or phlegmon (stage 1b) and that of a pelvic, retroperitoneal, or distant intraperitoneal abscess/phlegmon (stage 2) indicate the need for possible drainage in addition to antibiotics.
The more severe complicated diverticulitis classifications include the presence of purulent peritonitis in which there is no communication between the bowel lumen and the peritoneal cavity (stage 3) and feculent peritonitis with open communication (stage 4). These patients will need emergent surgery.
Resected amount:
The distal margin must be the proximal rectum
identified by the splaying of the teniae
The proximal margin does not have to include all of the diverticuli but must include the entire muscular portion of the sigmoid colon.
This is where diverticulitis is most likely to occur, and
‘we determine this point by palpating the muscular portion of the sigmoid wall.
The diseased sigmoid itself will feel woody and thickened; whereas, the distal descending colon will feel healthy and soft.
Hartmanns procedure: resection of the rectosigmioid colon w closure of the anosrectal stump and formation of end colostomy
>>: Post operative care in patients who have had surgery for diverticulitis include routine issues such as monitoring of bowel function. This is done by assessing for nausea and vomiting as well as the passage of gas and bowel movements. Nasogastric tubes, if they’re used, can be removed early unless the patient has high outputs recorded. Advancement of the patient's diet can be done as tolerated if the patient isn't nauseous or distended, or if they have signs of return of bowel function. Pulmonary toilet and ambulation should be encouraged, and the use of narcotics minimized.
Additionally one must monitor for signs of infection as some of the most common complications after bowel surgery are wound infection or intra-abdominal abscesses. Both of these should be suspected if the patient has persistent low-grade fever, nausea and vomiting, or abdominal distention particularly around postoperative day 5 .
Long-term complications include recurrent diverticulitis.
In patients who have not had a preoperative colonoscopy, such as patients who underwent urgent or emergent surgery, a colonoscopy should be done to assess the remaining colon at four to six weeks postoperatively . Issues such as constipation and potential dietary recommendations should be discussed with the patients as well.