Benign Billiary Stricture By Dr Dhaval Mangukiya
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
Benign Billiary Stricture By Dr Dhaval Mangukiya
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
Recent Update on Management of Ulcerative ColitisDr Amit Dangi
Recent update on the surgical and medical management of ulcerative colitis, including various controversies regarding IPAA and recent medical management incorporating the role of biologicals
Bile duct injury:How safe is emergency laparoscopic cholecystectomy?KETAN VAGHOLKAR
laparoscopic cholecystectomy has become the gold standard . But its safety in acute cholecystitis is debatable. The traditional dictum to wait for 6 weeks before contemplating removal of the gall bladder still remains the safest option rather than removing the gall bladder on an emergency basis and heightening the chances of bile duuct injury leading to a surgical disaster.The presentation outlines the evaluation and management of bile duct injuries.
Recent Update on Management of Ulcerative ColitisDr Amit Dangi
Recent update on the surgical and medical management of ulcerative colitis, including various controversies regarding IPAA and recent medical management incorporating the role of biologicals
Bile duct injury:How safe is emergency laparoscopic cholecystectomy?KETAN VAGHOLKAR
laparoscopic cholecystectomy has become the gold standard . But its safety in acute cholecystitis is debatable. The traditional dictum to wait for 6 weeks before contemplating removal of the gall bladder still remains the safest option rather than removing the gall bladder on an emergency basis and heightening the chances of bile duuct injury leading to a surgical disaster.The presentation outlines the evaluation and management of bile duct injuries.
Surgical management of pancreatic pseudocyst..by dr chris alumonaCHRIS ALUMONA
Pancreatic pseudocyst is the commonest cystic lesion of the pancreas but generally rare. It commonly complicates pancreatitis and resolves spontaneously with conservative management. Indications for intervention include complications and to rule out malignancy
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Anatomy
• Cantlie’s line: separates the lobes. Line
between GB fossa and IVC
• Ligamentum Teres: carries obliterated
umbilical vein
• Foramen of Winslow:
– Anterior: portal triad
– Posterior: IVC
– Inferior: duodenum
– Superior: Liver
3.
4.
5.
6. Anatomy
• Replaced right hepatic artery arises from the
SMA, travels posterolateral to CBD in Porta
Hepatis. Important in Whipples
• Replaced left hepatic artery arises from the
left gastric artery, travels through the
gastrohepatic ligament into the falciform
ligament. Important in Nissens
7. Blood Supply
• Portal vein 75% blood flow, 50% of O2
• Portal vein formed by confluence of SMV and
splenic
• Hepatic artery 25% blood flow, 50% O2
• Left HV segments II, III, IVa; right HV segments
VI, VII, VIII; middle HV segments IV and V;
caudate drains into IVC
8. Pyogenic liver abscess
• MCC biliary instrumentation, can also be from
strictures, stones or Portal venous spread via GI
infections (diverticulitis, appendicitis, perf ulcer)
• MC in right lobe, can be multiple
• MC organism: E. Coli
• Present: fever, chills, RUQ pain
• Elevated wbc, elevated t bili, elevated alk phos
• Dx via CTCT-contrast enhancing, well defined
masses with low density, US-hypoechoic lesions
• Tx: perc drainage and broad spectrum abx
9.
10.
11.
12. Amebic Abscess
• Amebic: tropical travel, complication of
intestinal amebiasis (E. Histolytica), spread to
liver via portal vein, usually solitary
• Fever, RUQ pain, hepatomegaly
• Imaging: often solitary right lobe, CT: low
density with peripheral rim of edema,
• Serology: indirect hemagglutination
• Treatment: Metronidazole aka Flagyl
13.
14. Echinococcal Cyst
• Caused by tapeworm
• Mediterranean/Middle East
• sheep→dogs→humans
• Fever, abdominal pain, jaundice, weight loss
• Serology: indirect hemagglutination, also if
they mention positive Casoni test
(intradermal injection of sterilized fluid from
hydatid cyst that results in a wheal response)
• Imaging: unilocular or complex lesion with
daughter cysts
15. • Rupture or leak from PC aspiration
anaphylactic shock
• Tx: Albendazole
• PAIR (Puncture, Aspiration, Injection, Re-
Aspiration) for unilocular
• Surgical excision or deroofing and evacuation
for complicated cysts (ruptured cyst, biliary
fistula, multiseptated)
16.
17.
18. Simple Liver Cyst
• Thin walled cyst with water dense content
• True cyst, no malignant potential
• If symptomatic can do laparoscopic
marsupialization
• Ovarian stroma – cystadenoma and needs
resection
21. Hemangioma
• Most common benign solid tumor
• Congenital
• Asymptomatic
• Women of childbearing age
• Kasabach-Merritt syndrome (consumptive
coagulopathy, CHF, DIC) in infants
22. Hemangioma
• Imaging:
– US: Hyperechoic, well-demarcated, increased
vascular flow
– CT: rim enhancing with central filling on delayed
imaging on arterial phase
– MRI: isodense on T1, Hyperdense on T2,
peripheral enhancement to central enhancement
– TC99 RBC study: highly specific/sensitive
– hypervascular
25. Focal nodular hyperplasia (FNH)
• Second MC liver tumor
• Due to polyclonal proliferation within liver
• No risk of malignant transformation and low
rupture risk
• Imaging:
– US: non-specific
– CT: central stellate scar on portal venous phase
– MRI: T1 and T2, early hyperdensity with gadolinium
– Tc 99 sulfur colloid scan: Enhancement due to bile
proliferation (FNH has Kupffer cells)
• Conservative treatment
26.
27.
28. Adenoma
• Oral Contraceptives, Anabolic Steroids
• Rupture risk: >5cm
• Risk of malignant transformation 5%
• Imaging:
– MRI/CT scan: hypodense
– Sulfur Colloid scan: cold, no uptake, because no
Kupffer cells in adenomas
29.
30.
31. Adenoma
• Treatment:
• Asymptomatic + <4cm
– Stop OCPs, repeat imaging, if regression then you are done
– Resection if no regression
• Symptomatic or >4cm
– Resect for malignancy and rupture risk
• Ruptured angioembolization
32. Budd-Chiari Syndrome
• Occlusion of hepatic veins
• Women with hypercoagulable disorders
• Acute onset of ascites
• abdominal pain, ascites, hepatosplenomegaly
• Caudate lobe hypertrophy
• Best diagnostic test: Ultrasound
• Treatment: anticoagulation; surgical
portosystemic shunt
– Remember any shunt that uses the IVC or portal
vein makes transplant much more difficult
33.
34. HCC
• Most common primary hepatic tumor
• Chronic Liver disease - hep B and Hep C; Can also
be alpha-1 antitrypsin, NAFLD, glycogen storage,
aflatoxin rash
• Clinical deterioration, painful hepatomegaly,
weight loss, anorexia
• AFP >400 diagnostic
• Cirrhotics need periodic imaging (US) and AFP
• No biopsy
• Fibromellar variant younger patients w/o
cirrhosis – best prognosis
35. HCC
• Surgical resection – 1 cm margins, need at least
25% healthy liver remnant
• Transplant (best results) – Milan criteria – one
tumor <5cm, 3 or fewer each less than 3cm, no
PV or IVC involvement; best option for Childs B+C
• Tumor ablation– ethanol, RFA, small tumors or as
bridge to transplant
• Embolization: transarterial chemoembolization
(TACE) – palliative or bridge to transplant, also for
large unresectable tumors
36.
37. Intrahepatic Cholangiocarcinoma
• Related to PSC, clonorchis (flukes), cirrhosis
• Elevated alk phos, bili, GGT; normal ast/alt
• Many present painless jaundice
• Surgical resection only potential for cure
• Start with diagnostic laparoscopy since large
percentage have peritoneal mets
• Palliative if mets
39. Liver mets
• Mets to Primary ratio 20:1
• Intraop US = most sensitive for identifying mets in liver
• MCC colorectal mets
• Need to achieve r0 resection
• When combined chemotherapy 5yr survival 30-50%
• RFA in unresectable
• Contraindications for hepatic resection: celiac or
periarotic LN, carcinomatosis, unresectable
extrahepatic disease
• Monitor CEA levels
40. Acute Liver Failure
• Most common with hepatitis, liver toxins, drug toxicity
• Rapid hepatocellular decline, jaundice, coagulopathy,
encephalopathy
• High likelihood of infections
• Cerebral edema uncal herniation
• Kings College Criteria for transplant: PT >100 seconds
or 3 of following: <10 or >40, non-A/non-B hepatitis,
jaundice >7days prior to encephalopathy, PT >50, bili
>17
• Supportive tx: prophy GI bleed, correct hypoglycemia,
ICP monitoring with interventions, urgent transplant
42. Hepatic Encephalopathy
• Development of asterixis = sign of progression
• Tx: Lactulose acidifies colon, preventing
uptake of ammonia – titrate 2-3 stools/day
–Neomycin: gets rid of ammonia producing
bacteria
–Limit protein intake (<70g/day)
–Feed with branch chain Amino Acids (VIL-
valine, isoleucine, leucine)
• Metabolized by skeletal muscle
43. Hep B
• Serology Test for: HBsAg, HBeAg, Anti-HBs,
Anti-HBc
• 1st Ab to appear is IgM (anti-HBc)
• HBcAg is never found in serum
• HBeAG is a marker for active viral replication
• HBsAB is a marker for immunity or recovered
past infections
44. Portal HTN
• Hepatic venous pressure gradient >12
• Varices – esophagus, hemorrhoids,
periumbilical, veins of Retzius
• If esophageal bleed- abx, vasopressin,
octreotide, egd with banding; propranolol,
TIPS
Editor's Notes
5.
Puncture under US guidance with or without catheter
6.
Aspiration of cyst fluid (10-15 cc)
a.
If protoscolices are absent and/or antigen detection negative:
i.
if clinical and epidemiological data, and biochemical fluid data are negative
stop procedure
(probably non-parasitic cyst) (non-parasitic cysts are treated with alcohol injection only when
symptomatic)
ii.
if clinical and epidemiological data, and biochemical fluid data are positive
proceed to next steps
b.
If protoscolices are present:
continue PAIR procedure
7.
Intracystic injection of contrast medium and cystography
8.
a.
if communication with bile ducts:
stop the procedure; contrast medium may be left in the cyst as
a
substitute of protoscolicide
b.
If no communication with bile ducts:
inject 95% ethanol solution or hypertonic saline (1/3 of the
amount of aspirated fluid)
9.
Reaspiration of alcohol solution after 5 minutes
10.
New parasitological control (to check protoscolex viability; eosin or methyl blue staining
Kasabach-Merritt: giant hemangioma, thrombocytopenia, and consumptive coagulopathy
Very esoteric
If IVC patent/no gradient: mesocaval or side to side portocaval shunt
If IVC occluded or gradient >20 mmHG, then mesoatrial shunt using graft
If Chronic, only real treatment is transplant
primary sclerosing cholangitis (PSC)
Not Aromatic Amino Acids (PTT- phenylalanine, tyrosine, tryptophan)
Rifaximin can be used in chronic liver failure to decrease risk of acute hepatic encephalopathy episodes and severity of encheph
