This document discusses the management of acute and chronic pelvic radiation toxicity. It begins with an introduction and overview of risk factors and organs at risk from pelvic radiation. It then provides detailed information on the symptoms, investigations, dose constraints, timelines, and management approaches for toxicities affecting specific organs, including the rectum, bowel, bladder, and vagina. Conservative approaches are generally recommended for acute toxicities while both medical and surgical interventions may be needed for chronic complications such as strictures or fistulas.
Chronic pancreatitis is a relapsing inflammatory process that results in irreversible fibrotic changes to the pancreas, causing abdominal pain, exocrine and endocrine insufficiency. It is most commonly caused by prolonged alcohol abuse. Other causes include genetic mutations, autoimmune disorders, and obstructive factors. Diagnosis involves imaging tests like CT, MRI, and ERCP to identify morphological changes and complications. Treatment focuses on pain management, enzyme supplementation, endoscopic procedures to address duct abnormalities, and surgery for refractory cases or complications. Surgical options aim to relieve pain by draining the pancreatic duct or resecting inflamed areas, while preserving function.
Inflammatory bowel diseases (IBD) include ulcerative colitis and Crohn's disease, which cause chronic inflammation in the intestines. Ulcerative colitis affects only the colon, causing ulcers, while Crohn's disease can impact any part of the digestive tract and deeper layers. Both have no known cause but involve genetic, immune, microbial, and psychosocial factors. Common symptoms are diarrhea, abdominal pain, and rectal bleeding. Diagnosis involves blood tests, endoscopy, imaging, and biopsy. Treatment focuses on medications to reduce inflammation like 5-aminosalicylates, corticosteroids, antibiotics, immunosuppressants, and biological therapies. Surgery may be needed for complications or drug
Dysphagia is difficulty swallowing that can affect any part of the swallowing pathway from the mouth to the stomach. It is commonly seen in ENT clinics and may have oropharyngeal or esophageal causes. Common oropharyngeal causes include neurological disorders, while common esophageal causes include GERD, motility disorders like achalasia, and malignancies. Evaluation involves history, examination, barium swallow, endoscopy, and manometry. Treatment depends on the underlying cause but may include dilation, myotomy, stenting, chemotherapy, or radiation. Palliative measures are often needed for advanced or incurable esophageal cancer.
Dysphagia is difficulty swallowing that can affect any part of the swallowing pathway from the mouth to the stomach. It is commonly seen in ENT clinics. There are two main types - oropharyngeal dysphagia involving preparation and transport of food in the mouth and throat, and esophageal dysphagia with food sticking in the lower throat or chest. Causes vary by age from foreign bodies in children to malignancy in the elderly. Evaluation involves history, examination, barium swallow, endoscopy and manometry. Treatment depends on the underlying cause but may include dilation, stenting or surgery.
This document summarizes the management of autosomal dominant polycystic kidney disease (ADPKD). Current therapy focuses on treating renal and extrarenal complications through pain management, infection control, and hypertension management. New therapies targeting vasopressin receptors like tolvaptan have shown benefits in slowing kidney growth and decline. Kidney transplantation remains the treatment of choice for end-stage renal disease from ADPKD.
The document provides information on disorders of the gallbladder and pancreas. It begins with learning objectives related to cholelithiasis, cholecystitis, pancreatitis, and surgical treatment of pancreatic tumors. Key topics covered include risk factors for cholelithiasis, clinical manifestations, diagnostic findings, medical and surgical management of gallbladder disorders, and types of acute and chronic pancreatitis. Nursing implications are also discussed for various diagnostic and treatment procedures.
1) Gastroesophageal reflux disease (GERD) occurs when stomach contents back up into the esophagus or beyond, causing troublesome symptoms or complications.
2) Diagnosis is confirmed by endoscopic findings of erosive esophagitis or positive pH monitoring, showing abnormal acid exposure in the esophagus.
3) Treatment involves lifestyle changes and medication. Surgery is considered for patients with severe, refractory GERD or complications like strictures. The most common anti-reflux surgery is laparoscopic Nissen fundoplication, which has high success rates but risks dysphagia.
Chronic pancreatitis is a relapsing inflammatory process that results in irreversible fibrotic changes to the pancreas, causing abdominal pain, exocrine and endocrine insufficiency. It is most commonly caused by prolonged alcohol abuse. Other causes include genetic mutations, autoimmune disorders, and obstructive factors. Diagnosis involves imaging tests like CT, MRI, and ERCP to identify morphological changes and complications. Treatment focuses on pain management, enzyme supplementation, endoscopic procedures to address duct abnormalities, and surgery for refractory cases or complications. Surgical options aim to relieve pain by draining the pancreatic duct or resecting inflamed areas, while preserving function.
Inflammatory bowel diseases (IBD) include ulcerative colitis and Crohn's disease, which cause chronic inflammation in the intestines. Ulcerative colitis affects only the colon, causing ulcers, while Crohn's disease can impact any part of the digestive tract and deeper layers. Both have no known cause but involve genetic, immune, microbial, and psychosocial factors. Common symptoms are diarrhea, abdominal pain, and rectal bleeding. Diagnosis involves blood tests, endoscopy, imaging, and biopsy. Treatment focuses on medications to reduce inflammation like 5-aminosalicylates, corticosteroids, antibiotics, immunosuppressants, and biological therapies. Surgery may be needed for complications or drug
Dysphagia is difficulty swallowing that can affect any part of the swallowing pathway from the mouth to the stomach. It is commonly seen in ENT clinics and may have oropharyngeal or esophageal causes. Common oropharyngeal causes include neurological disorders, while common esophageal causes include GERD, motility disorders like achalasia, and malignancies. Evaluation involves history, examination, barium swallow, endoscopy, and manometry. Treatment depends on the underlying cause but may include dilation, myotomy, stenting, chemotherapy, or radiation. Palliative measures are often needed for advanced or incurable esophageal cancer.
Dysphagia is difficulty swallowing that can affect any part of the swallowing pathway from the mouth to the stomach. It is commonly seen in ENT clinics. There are two main types - oropharyngeal dysphagia involving preparation and transport of food in the mouth and throat, and esophageal dysphagia with food sticking in the lower throat or chest. Causes vary by age from foreign bodies in children to malignancy in the elderly. Evaluation involves history, examination, barium swallow, endoscopy and manometry. Treatment depends on the underlying cause but may include dilation, stenting or surgery.
This document summarizes the management of autosomal dominant polycystic kidney disease (ADPKD). Current therapy focuses on treating renal and extrarenal complications through pain management, infection control, and hypertension management. New therapies targeting vasopressin receptors like tolvaptan have shown benefits in slowing kidney growth and decline. Kidney transplantation remains the treatment of choice for end-stage renal disease from ADPKD.
The document provides information on disorders of the gallbladder and pancreas. It begins with learning objectives related to cholelithiasis, cholecystitis, pancreatitis, and surgical treatment of pancreatic tumors. Key topics covered include risk factors for cholelithiasis, clinical manifestations, diagnostic findings, medical and surgical management of gallbladder disorders, and types of acute and chronic pancreatitis. Nursing implications are also discussed for various diagnostic and treatment procedures.
1) Gastroesophageal reflux disease (GERD) occurs when stomach contents back up into the esophagus or beyond, causing troublesome symptoms or complications.
2) Diagnosis is confirmed by endoscopic findings of erosive esophagitis or positive pH monitoring, showing abnormal acid exposure in the esophagus.
3) Treatment involves lifestyle changes and medication. Surgery is considered for patients with severe, refractory GERD or complications like strictures. The most common anti-reflux surgery is laparoscopic Nissen fundoplication, which has high success rates but risks dysphagia.
Approach, indications and surgical management of gerd 2Shambhavi Sharma
GERD is diagnosed clinically or with endoscopy and pH monitoring. Surgical options include laparoscopic Nissen fundoplication, which is the gold standard for treating failed medical management, complications, or large hiatal hernias. Complications include dysphagia, which can be reduced using a partial fundoplication or short wrap. Newer minimally invasive options include the LINX device and endoscopic fundoplication but long-term data is still emerging. Revisional surgery is an option for failed initial antireflux procedures.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It involves diffuse inflammation and ulceration of the colonic mucosa. The cause is unknown but likely related to genetic and immune factors. Symptoms include bloody diarrhea. Diagnosis involves colonoscopy and biopsy. Treatment involves medications to induce and maintain remission such as mesalamine, corticosteroids, immunomodulators, and biologics. Surgery may be required for severe cases or cancer prevention. Long-term monitoring is needed due to cancer risk.
Gastric outlet obstruction is caused by benign or malignant diseases that obstruct gastric emptying. Common benign causes include peptic ulcer disease while pancreatic cancer is a frequent malignant cause. Patients experience nausea, vomiting and weight loss. Diagnosis involves distinguishing functional from mechanical causes and identifying the underlying etiology. Treatment focuses on rehydration and correcting metabolic abnormalities as well as addressing the mechanical obstruction through endoscopic or surgical interventions.
Pancreatitis is an inflammation of the pancreas that can be acute or chronic. Acute pancreatitis involves reversible injury to the pancreas and can range from mild to severe, with severe cases involving organ failure. Chronic pancreatitis is characterized by irreversible damage to the pancreas that typically causes pain and loss of pancreatic function over time. Treatment for acute pancreatitis depends on severity and may involve hospitalization, IV fluids, monitoring for organ failure, and antibiotics for severe cases. Treatment for chronic pancreatitis focuses on pain management, treating complications, and sometimes surgical interventions.
Gastrointestinal surgery procedures involve cutting and suturing of the abdominal cavity tissues including the digestive tract, attached glands, fascia, peritoneum, muscle and skin. Common issues addressed include gastrointestinal bleeding, peptic ulcer disease, delayed gastric emptying, gastric cancer and acute appendicitis. Surgical techniques such as vagotomy, antrectomy, gastrectomy and appendectomy are used to treat these conditions. Post-operative care and dietary changes are important for recovery.
This document discusses the pathology and management of malignant bowel obstruction. It defines malignant bowel obstruction as luminal narrowing of the small or large bowel due to metastatic cancer. The most common primary cancers causing MBO are colorectal, ovarian, stomach, and pancreatic cancers. The document outlines the classification, signs and symptoms, diagnostic tests including CT scan, and various treatment options for MBO, including surgical resection, endoscopic stenting, non-operative management with medications like octreotide to relieve symptoms, and palliative care since MBO represents terminal cancer. The primary goals of treatment are palliation to improve quality of life by relieving nausea, vomiting and pain.
Malignant bowel obstruction is caused by luminal narrowing of the small or large bowel due to metastatic intra-abdominal cancer. The most common primary cancers are colorectal, ovarian, breast, and melanoma. Treatment aims to palliatively relieve symptoms like pain, nausea, and vomiting to improve quality of life, as cure is not possible. Both non-operative treatments like octreotide, opioids, antiemetics, and stenting as well as surgical options may be considered depending on the extent of malignancy and patient's condition. The goal is symptom control and allowing oral intake and return home if possible.
Ulcerative colitis is a long-term condition characterized by inflammation and ulcers of the colon and rectum. The causes are not fully known but may include genetic and environmental factors. Symptoms include bloody diarrhea, abdominal pain, and weight loss. Diagnosis involves medical imaging, endoscopy, and biopsy of the colon. Treatment focuses on reducing inflammation, managing symptoms, and correcting nutritional deficiencies through medications, dietary changes, and sometimes surgery to remove all or part of the colon. Nursing care involves managing symptoms, preventing complications, providing education on lifestyle changes and treatment plans, and supporting patients through the challenges of living with a chronic condition.
Gastroesophageal reflux disease (GERD) is a common disorder where gastric or duodenal contents backflow into the esophagus, causing symptoms or mucosal injury. It results from lower esophageal sphincter incompetence allowing reflux of acidic stomach contents. GERD affects approximately 20% of adults in western cultures. Symptoms include heartburn, acid regurgitation, and dysphagia. Diagnosis involves endoscopy, pH monitoring, or barium swallow. Treatment includes lifestyle changes, antacids, H2 blockers, PPIs, and sometimes surgery. Complications can include esophagitis, strictures, ulcers, Barrett's esophagus, and pulmonary
GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Gastroesophageal reflux and Hiatal HerniaViswa Kumar
The document discusses GERD/hiatus hernia. It provides information on:
1) The factors involved in GERD pathogenesis including the antireflux barrier, aggressive factors like gastric acid, and mechanisms of reflux.
2) Diagnostic tests for GERD like endoscopy, pH monitoring, and barium swallow which assess esophageal damage, acid exposure, and function.
3) Treatment approaches including lifestyle changes, medications like PPIs, H2 blockers, and prokinetics, and surgical options like Nissen fundoplication.
4) Complications of long-term GERD including Barrett's esophagus, strictures, and adenoc
Ulcerative colitis is a chronic inflammatory bowel disease that involves the colonic mucosa. It typically affects the rectum first and may extend proximally in a continuous manner. The disease runs a relapsing and remitting course. Treatment involves 5-aminosalicylates and corticosteroids to induce and maintain remission. For moderate to severe disease, immunosuppressants like azathioprine, anti-TNF agents, and vedolizumab may be used. Surgery with proctocolectomy and ileal pouch-anal anastomosis is the treatment of choice for those who require colectomy.
This document provides an overview of acute pancreatitis, including:
- The epidemiology, with highest rates in the US and among males related to alcohol use.
- The pathophysiology, involving premature activation of digestive enzymes within the pancreas.
- Diagnosis is based on abdominal pain plus elevated pancreatic enzymes or imaging findings. Severity is assessed using scores like Ranson's criteria or CT severity index.
- Treatment involves fluid resuscitation, nutritional support, pain management, and antibiotics only for proven or suspected infected pancreatic necrosis. The goals are to prevent complications and infections.
1. Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis, chronic disorders causing inflammation in the intestines. Crohn's disease causes transmural inflammation that can affect any part of the GI tract. Ulcerative colitis causes ulcers and inflammation limited to the inner lining of the colon and rectum.
2. The exact causes of IBD are unknown but may involve genetic, immunological, microbial, and psychosocial factors. Treatment includes lifestyle changes, medications like 5-ASAs, glucocorticoids, antibiotics, immunosuppressants, and biological therapy. Surgery is considered for severe cases or complications that do not respond to drug therapy.
The document provides an overview of the gastrointestinal (GIT) system including its anatomy, function and common disorders. It discusses the anatomy of the GIT and identifies its main parts. It outlines the three main functions of the digestive system which are to break down food, absorb nutrients, and eliminate waste. The document then examines some common GIT disorders in more detail including stomatitis, appendicitis, intestinal obstruction, liver cirrhosis and hepatic encephalopathy. It provides definitions, causes, signs and symptoms, treatments and nursing considerations for each condition.
This document provides an overview of diverticular disease of the colon, including its anatomy, epidemiology, pathogenesis, diagnosis, and treatment. It describes the typical presentation of uncomplicated and complicated diverticulitis and reviews treatment approaches including antibiotics, abscess drainage, fistula repair, and surgery. Recurrent diverticulitis is noted to increase the risk of complications, with younger patients and more severe initial attacks posing higher risks.
This document discusses peptic ulcer disease. It defines ulcers and erosions, and describes the most common sites of ulcers. The main causes of peptic ulcers are Helicobacter pylori infection, NSAID use, smoking, alcohol, and certain medical conditions. H. pylori plays a key role in pathogenesis. Diagnosis involves endoscopy, imaging, and tests for H. pylori. Treatment involves eradicating H. pylori, reducing acid with medications, and surgery for complications or refractory cases. Complications can include bleeding, perforation, penetration, and narrowing.
This document discusses obstructive jaundice and intestinal obstruction. It provides details on a case of a 78-year-old man admitted with abdominal pain and jaundice. Investigation showed gallstones and elevated bilirubin. Management of obstructive jaundice may include cholecystectomy, ERCP, or stenting. Complications include sepsis and liver/renal failure. Intestinal obstruction can be dynamic or adynamic, and may be caused by adhesions, hernias, tumors or impacted feces. Treatment involves decompression, IV fluids, and surgery to remove obstructions or bypass affected areas.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Approach, indications and surgical management of gerd 2Shambhavi Sharma
GERD is diagnosed clinically or with endoscopy and pH monitoring. Surgical options include laparoscopic Nissen fundoplication, which is the gold standard for treating failed medical management, complications, or large hiatal hernias. Complications include dysphagia, which can be reduced using a partial fundoplication or short wrap. Newer minimally invasive options include the LINX device and endoscopic fundoplication but long-term data is still emerging. Revisional surgery is an option for failed initial antireflux procedures.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It involves diffuse inflammation and ulceration of the colonic mucosa. The cause is unknown but likely related to genetic and immune factors. Symptoms include bloody diarrhea. Diagnosis involves colonoscopy and biopsy. Treatment involves medications to induce and maintain remission such as mesalamine, corticosteroids, immunomodulators, and biologics. Surgery may be required for severe cases or cancer prevention. Long-term monitoring is needed due to cancer risk.
Gastric outlet obstruction is caused by benign or malignant diseases that obstruct gastric emptying. Common benign causes include peptic ulcer disease while pancreatic cancer is a frequent malignant cause. Patients experience nausea, vomiting and weight loss. Diagnosis involves distinguishing functional from mechanical causes and identifying the underlying etiology. Treatment focuses on rehydration and correcting metabolic abnormalities as well as addressing the mechanical obstruction through endoscopic or surgical interventions.
Pancreatitis is an inflammation of the pancreas that can be acute or chronic. Acute pancreatitis involves reversible injury to the pancreas and can range from mild to severe, with severe cases involving organ failure. Chronic pancreatitis is characterized by irreversible damage to the pancreas that typically causes pain and loss of pancreatic function over time. Treatment for acute pancreatitis depends on severity and may involve hospitalization, IV fluids, monitoring for organ failure, and antibiotics for severe cases. Treatment for chronic pancreatitis focuses on pain management, treating complications, and sometimes surgical interventions.
Gastrointestinal surgery procedures involve cutting and suturing of the abdominal cavity tissues including the digestive tract, attached glands, fascia, peritoneum, muscle and skin. Common issues addressed include gastrointestinal bleeding, peptic ulcer disease, delayed gastric emptying, gastric cancer and acute appendicitis. Surgical techniques such as vagotomy, antrectomy, gastrectomy and appendectomy are used to treat these conditions. Post-operative care and dietary changes are important for recovery.
This document discusses the pathology and management of malignant bowel obstruction. It defines malignant bowel obstruction as luminal narrowing of the small or large bowel due to metastatic cancer. The most common primary cancers causing MBO are colorectal, ovarian, stomach, and pancreatic cancers. The document outlines the classification, signs and symptoms, diagnostic tests including CT scan, and various treatment options for MBO, including surgical resection, endoscopic stenting, non-operative management with medications like octreotide to relieve symptoms, and palliative care since MBO represents terminal cancer. The primary goals of treatment are palliation to improve quality of life by relieving nausea, vomiting and pain.
Malignant bowel obstruction is caused by luminal narrowing of the small or large bowel due to metastatic intra-abdominal cancer. The most common primary cancers are colorectal, ovarian, breast, and melanoma. Treatment aims to palliatively relieve symptoms like pain, nausea, and vomiting to improve quality of life, as cure is not possible. Both non-operative treatments like octreotide, opioids, antiemetics, and stenting as well as surgical options may be considered depending on the extent of malignancy and patient's condition. The goal is symptom control and allowing oral intake and return home if possible.
Ulcerative colitis is a long-term condition characterized by inflammation and ulcers of the colon and rectum. The causes are not fully known but may include genetic and environmental factors. Symptoms include bloody diarrhea, abdominal pain, and weight loss. Diagnosis involves medical imaging, endoscopy, and biopsy of the colon. Treatment focuses on reducing inflammation, managing symptoms, and correcting nutritional deficiencies through medications, dietary changes, and sometimes surgery to remove all or part of the colon. Nursing care involves managing symptoms, preventing complications, providing education on lifestyle changes and treatment plans, and supporting patients through the challenges of living with a chronic condition.
Gastroesophageal reflux disease (GERD) is a common disorder where gastric or duodenal contents backflow into the esophagus, causing symptoms or mucosal injury. It results from lower esophageal sphincter incompetence allowing reflux of acidic stomach contents. GERD affects approximately 20% of adults in western cultures. Symptoms include heartburn, acid regurgitation, and dysphagia. Diagnosis involves endoscopy, pH monitoring, or barium swallow. Treatment includes lifestyle changes, antacids, H2 blockers, PPIs, and sometimes surgery. Complications can include esophagitis, strictures, ulcers, Barrett's esophagus, and pulmonary
GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Gastroesophageal reflux and Hiatal HerniaViswa Kumar
The document discusses GERD/hiatus hernia. It provides information on:
1) The factors involved in GERD pathogenesis including the antireflux barrier, aggressive factors like gastric acid, and mechanisms of reflux.
2) Diagnostic tests for GERD like endoscopy, pH monitoring, and barium swallow which assess esophageal damage, acid exposure, and function.
3) Treatment approaches including lifestyle changes, medications like PPIs, H2 blockers, and prokinetics, and surgical options like Nissen fundoplication.
4) Complications of long-term GERD including Barrett's esophagus, strictures, and adenoc
Ulcerative colitis is a chronic inflammatory bowel disease that involves the colonic mucosa. It typically affects the rectum first and may extend proximally in a continuous manner. The disease runs a relapsing and remitting course. Treatment involves 5-aminosalicylates and corticosteroids to induce and maintain remission. For moderate to severe disease, immunosuppressants like azathioprine, anti-TNF agents, and vedolizumab may be used. Surgery with proctocolectomy and ileal pouch-anal anastomosis is the treatment of choice for those who require colectomy.
This document provides an overview of acute pancreatitis, including:
- The epidemiology, with highest rates in the US and among males related to alcohol use.
- The pathophysiology, involving premature activation of digestive enzymes within the pancreas.
- Diagnosis is based on abdominal pain plus elevated pancreatic enzymes or imaging findings. Severity is assessed using scores like Ranson's criteria or CT severity index.
- Treatment involves fluid resuscitation, nutritional support, pain management, and antibiotics only for proven or suspected infected pancreatic necrosis. The goals are to prevent complications and infections.
1. Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis, chronic disorders causing inflammation in the intestines. Crohn's disease causes transmural inflammation that can affect any part of the GI tract. Ulcerative colitis causes ulcers and inflammation limited to the inner lining of the colon and rectum.
2. The exact causes of IBD are unknown but may involve genetic, immunological, microbial, and psychosocial factors. Treatment includes lifestyle changes, medications like 5-ASAs, glucocorticoids, antibiotics, immunosuppressants, and biological therapy. Surgery is considered for severe cases or complications that do not respond to drug therapy.
The document provides an overview of the gastrointestinal (GIT) system including its anatomy, function and common disorders. It discusses the anatomy of the GIT and identifies its main parts. It outlines the three main functions of the digestive system which are to break down food, absorb nutrients, and eliminate waste. The document then examines some common GIT disorders in more detail including stomatitis, appendicitis, intestinal obstruction, liver cirrhosis and hepatic encephalopathy. It provides definitions, causes, signs and symptoms, treatments and nursing considerations for each condition.
This document provides an overview of diverticular disease of the colon, including its anatomy, epidemiology, pathogenesis, diagnosis, and treatment. It describes the typical presentation of uncomplicated and complicated diverticulitis and reviews treatment approaches including antibiotics, abscess drainage, fistula repair, and surgery. Recurrent diverticulitis is noted to increase the risk of complications, with younger patients and more severe initial attacks posing higher risks.
This document discusses peptic ulcer disease. It defines ulcers and erosions, and describes the most common sites of ulcers. The main causes of peptic ulcers are Helicobacter pylori infection, NSAID use, smoking, alcohol, and certain medical conditions. H. pylori plays a key role in pathogenesis. Diagnosis involves endoscopy, imaging, and tests for H. pylori. Treatment involves eradicating H. pylori, reducing acid with medications, and surgery for complications or refractory cases. Complications can include bleeding, perforation, penetration, and narrowing.
This document discusses obstructive jaundice and intestinal obstruction. It provides details on a case of a 78-year-old man admitted with abdominal pain and jaundice. Investigation showed gallstones and elevated bilirubin. Management of obstructive jaundice may include cholecystectomy, ERCP, or stenting. Complications include sepsis and liver/renal failure. Intestinal obstruction can be dynamic or adynamic, and may be caused by adhesions, hernias, tumors or impacted feces. Treatment involves decompression, IV fluids, and surgery to remove obstructions or bypass affected areas.
Similar to pelvic toxicities management (2).pptx (20)
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
বাংলাদেশ অর্থনৈতিক সমীক্ষা (Economic Review) ২০২৪ UJS App.pdf
pelvic toxicities management (2).pptx
1. Management of acute and
chronic pelvic radiation toxicity
Presentor – Dr.G.Sai Sunayana
DNB 1 st year resident
Radiation oncology
Moderator- Dr . Premitha . R
2. Flow of presentation
• Introduction
• Risk factors
• Organs at risk
• Management of toxicities of each organ
• Summary
• References
3. PELVIC RADIATION TOXICITY
• Acute – less than 3 months
• Subacute- 3-6 months
• Chronic – greater than 6 months
• Gastrointestinal manifestations are the most common
• Genitourinary symptoms are 2nd most common
4. Pelvic radiation toxicity
• Although symptoms can be similar in acute and late stages, the treatment approach
differs because the underlying insult differs.
Acute injury Late injury
Epithelial damage
Inflammatory response
Small vessel endothelial damage
Ischemia
Fibrosis
Necrosis
Self limiting
Conservative management
Cessation of radiation
Symptomatic after latent period
Need intervention
Mostly surgical management
5. RISK FACTORS FOR PELVIC RADIATION
TOXICITY
• diabetes mellitus
• inflammatory bowel disease
• concurrent chemotherapy
• prior abdominal surgery
• collagen vascular disease
• HIV
• lower body mass index (18.5 kg/m2)
• chronic tobacco use
• have an increased risk for developing pelvic radiation toxicities
6. Organ at risk in Pelvic Irradiation
• Rectum
• Small and large bowel
• Bladder
• Bone
• Vagina
• Gonads
• Skin
7. Rectum – radiation proctitis
• Diarrhea
• Tenesmus
• Abdominal discomfort (including rectal/perineal areas)
• Fecal urgency
• Fecal incontinence
• Mucus in the stool
• Rectal bleeding (secondary to radiation-induced formation of telangiectasias and
neovascularization)
8. Radiation proctitis
Acute proctitis Chronic proctitis
Time within 3 months of
treatment
Either continue acute phase
or begins after atleast 90
days of treatment
Pathophysiology Tissue hypoplasia
Loss of epithelial barrier
integrity
Exposure of lamina propria
to luminal microbes
Acute inflammatory
response triggered
Progressive vasculitis –
thrombosis of small vessels
Ischemia , necrosis,
ulceration and fistula
Arteritis and submucosal
fibrosis lead to stricture and
obstruction
Symptoms Diarrhoea
Urgency
Tenesmus
Rectal bleeding
Stricture
Sepsis
Intestinal obstruction
10. RTOG ACUTE Radiation Morbidity
Grade I Grade II Grade III Grade IV
Lower GI / Pelvis Increased frequency
or change in quality
of bowel habits not
requiring
medication
rectal discomfort
not requiring
analgesics
Diarrhea requiring
parasympatholytic
drugs (e.g. Lomotil)
mucous discharge
not necessitating
sanitary pads
rectal or abdominal
pain requiring
analgesics
Diarrhea requiring
parenteral support
Severe mucous or
blood discharge
necessitating
sanitary pads
abdominal
distention (flat plate
radiograph
demonstrates
distended bowel
loops)
Acute or subacute
obstruction, fistula
or perforation; GI
bleeding requiring
transfusion
abdominal pain or
tenesmus requiring
tube decompression
or bowel diversion
11. RTOG/EORTC LATE Radiation Morbidity
Grade I Grade II Grade III Grade IV
Lower GI / Pelvis Mild diarrhea; mild
cramping
bowel movement 5
times daily
slight rectal
discharge or
bleeding
Moderate diarrhea
and colic
bowel movement
> 5 times daily
excessive rectal
mucus or
intermittent
bleeding
Obstruction or
bleeding, requiring
surgery
Necrosis /
perforation fistula
17. Investigations
• sigmoidoscopy or colonoscopy
• Direct visualization of mucosa often
shows pale friable tissue. In patients
with severe rectal bleeding, endoscopy
typically reveals multiple
telangiectasias
• biopsies(suspectedmalignancy) tissue
is obtained from the posterior and
lateral rectal walls.
18. Management of acute radiation proctitis
• Self limiting
• Hydration
• Supportive management (sitz bath , stool softners)
• Anti inflammatory agents (sulfasalazine , rectal sucralfate , steroid enema)
• Anti diarrhoeals (loperamide)
• Probiotics
• Cessation of therapy is definitive treatment
• Surgical intervention rarely required
19. • Dietary interventions should be considered
• If the symptoms persist, medication should be considered, such as anti-inflammatory
agents.
• Medical treatment is the first-line approach
Management of Chronic Radiation Proctitis
20. Treatment Administration Mechanism of action
Sucralfate Topical administration stimulate mucosal healing by its
angiogenic action
Corticosteroids As enema is effective for rectal
bleeding
inhibiting the inflammation by
blocking cytokine release and
production, inhibiting histamine
release and activation of
macrophages
Sulfasalazine/mesalazine 5ASA - inhibits pro
inflammatory mediators
inhibit the acute inflammatory
and immune response
21. Treatment Administration Mechanism of action
metronidazole bactericidal agent and
immunomodulator effect
effective in treating chronic
rectal bleeding and diarrhea
formalin highly irritant and direct
application to radiation-
damaged tissues leads to local
chemical cauterization
Hyperbaric oxygen treatment hypoxia decreasing properties inducing angiogenesis in
patients whose bowel was
affected by radiotherapy and
promotes healing
22. Management of Chronic
Radiation Proctitis
• Endoscopic coagulation has become the
preferred approach in the management of
rectal bleeding from chronic radiation
proctitis.
• most common method utilizes argon plasma
coagulation, which delivers high-frequency,
non- contact thermal therapy to control
bleeding in the gastro-intestinal tract
23. Surgical intervention
• more severe complications which are associated with radiation proctitis, including
strictures that may lead to large bowel obstruction, fistulas, or even perforation.
• Fecal diversion either colostomy or ileostomy is commonly done
26. INVESTIGATIONS
• In chronic radiation enteritis, direct visualization through standard endoscopy,
enteroscopy, or capsule endoscopy may show telangiectasias, strictures, adhesions,
mucosal ulceration, or, rarely, necrotic changes
Symptoms Investigations
nausea/vomiting, abdominal
pain, dyspepsia, bloating
upper endoscopy or small
bowel fluoroscopic studies.
Nonspecific symptoms CT or MR enterography
Bleeding Enteroscopy or capsule
endoscopy
27.
28. Management of acute radiation enteritis
• Self resolving within weeks
• Supportive treatment with antimotility agents and good water intake
• Oral antibiotics - suspected of bacterial overgrowth
• Vitamins and electrolytes replacement if needed
• Surgery is rarely needed
29. Management of Chronic Radiation Enteritis
• Dietary modifications - first-line treatment
• Antidiarrheal agents can be effective in symptomatic management.
• loperamide slow intestinal transit and even increase the absorption of bile acids.
• Bile acid sequestrants - diarrhea secondary to bile salt malabsorption
• Argon plasma coagulation has been successful in radiation- induced enteritis caused
by telangiectasias in the large and small bowel
• Hyperbaric oxygen remains an option for the treatment of chronic radiation enteritis,
especially as a result of its ability to target multiple portions of noncontiguous small
bowel
30.
31. RADIATION STRICTURES
• submucosa of the affected bowel becomes injured as endarteritis obliterans
• ischemia — fibrosis —— strictures and obstruction
• Symptoms
• postprandial nausea
• Vomiting
• abdominal pain and distension
32. Small Bowel Radiation Strictures
• Endoscopic therapy for small bowel strictures is often limited, because the location can be
difficult to access with standard endoscopes
• Endoscopic dilation of benign small bowel strictures using double-balloon enteroscopy
• Surgery is often avoided unless absolutely necessary
• Complete small bowel obstructions from radiation strictures may require surgical
intervention
• The affected segment can be resected with a primary anastomosis or bypassed. Intestinal
bypass has a lower operative mortality and a decreased incidence of anastomotic dehiscence.
• Patients who are not surgical candidates can obtain a decompressive gastrostomy and
parental nutrition
34. Large Bowel Radiation Strictures
• Pelvic radiation strictures can also occur in the sigmoid colon and rectum.
• Constipation, abdominal pain, distension, nausea, and vomiting.
• Important to maintain a broad differential for colonic strictures, because malignant,
nonsteroidal anti-inflammatory drug–induced, and inflammatory bowel disease
strictures can have similar presentations
• Dilations can be performed with a push-type bougie dilator, which has a fixed
diameter, or radial expanding balloon dilators.
• Balloon dilators are typically used for shorter, more focal strictures.
• Major adverse events (perforation, bleeding, abscess, fistula, sepsis) for dilation
35. • Partial colonic obstruction - endoscopic therapy can be performed to decrease
the need for surgical intervention.
• Complete colonic obstruction, surgical management is indicated with a
diverting colostomy or a resection with anastomosis.
• Self-expanding metal stents have been used for malignant colonic strictures for
palliative intent or as a bridge to surgery.
36. Bladder – radiation cystitis
Acute cystitis Chronic cystitis
Time Within 3 months of
treatment
Months to years later
treatment
Symptoms Frequency
Urgency
Dysuria
hematuria
Fibrosis
Urinary incontinence
Hydronephrosis
Mucosal ulceration
Fistula formation
39. RTOG – acute toxicity
Grade I Grade II Grade III Grade IV
Genitourinary Frequency of
urination or
nocturia twice
pretreatment habit
/ dysuria, urgency
not requiring
medication
Frequency of
urination or
nocturia that is
less frequent than
every hour.
Dysuria, urgency,
bladder spasm
requiring local
anesthetic (e.g.
Pyridium)
Frequency with
urgency and
nocturia hourly or
more frequenty /
dysuria, pelvis
pain or bladder
spasm requiring
regular, frequent
narcotic / gross
hematuriawith/with
out clot passage
Hematuria
requiring
transfusion / acute
bladder
obstruction not
secondary to clot
passage,
ulceration, or
necrosis
40. RTOG – late toxicity
Grade I Grade II Grade III Grade IV
bladder Slight epithelial
atrophy; minor
telangiectasia
(microscopic
hematuria)
Moderate
frequency;
generalized
telangiectasia;
intermittent
macroscopic
hematuria
Severe frequency
& dysuria; severe
telangiectasia
(often with
petechiae);
frequent
hematuria;
reduction in
bladder capacity
(<150 cc)
Necrosis/contracte
d bladder
(capacity < 100
cc); severe
hemorrhagic
cystitis
51. • Patients who have bladder involvement at diagnosis are at risk of
developing a vesicovaginal fistula after definitive RT.
• Small vesicovaginal fistulae may be managed with simple fulguration and
catheter drainage, but they may require open surgical repair and,
occasionally, urinary diversion.
52.
53. Ureteral strictures
• Ureteral strictures have been noted
• Strictures of the ureter may be managed by endoscopic procedures, such as dilation
or stent placement, but they often require ureteral reimplantation or ileal ureteral
substitution.
• The classical teaching is that a ureteral stricture represents recurrent cancer until
proven otherwise; imaging with CT or MRI is recommended.
• Ureteroarterial fistulae are rarely encountered and have a 10% acute mortality rate
• They should be treated with endovascular stent placement or, if this fails, open
surgical repair
54. Vagina
• Changes in the microvasculature, with loss of capillaries and impaired
microcirculation, result in secondary mucosal atrophy.
• Pathological dilation of capillaries results in telangiectasias, which are prone to
bleeding.
• In addition, increased collagen production within the fibroconnective tissue can
lead to shortening and tightening of the vagina.
• Eventually, ulceration, necrosis, and fistulae can develop
60. Dose constraints
• Upper vagina – 120 Gy
• Middle vagina – 80-90 Gy
• Lower vagina – 60-70 Gy
• Radiation dose >70 Gy was significantly related to development of
vaginal toxicity
• Tolerance doses are high – 90Gy for ulceration and 100Gy for fistula
61. Management
• Vaginal dilator therapy
• VDT four weeks after completing RT treatment, perform VDT 2–3 times
per week for 1–3 min and to continue VDT for 9 to 12 months.
• Hyaluronic acid therapy
• Vaginal estrogen therapy
• Intravaginal laser treatment
62. Bone effects
• After pelvic radiotherapy, bones of the pelvic region can undergo changes
secondary to decreased osteoblast proliferation and decreased bone blood flow as
a result of blood vessel fibrosis combined with bone resorption from osteoclast
activity that can result in fracture or necrosis
• The sites of fracture were sacroiliac joints, pubic rami, iliac bones, and femoral neck.
• The significant risk factors of PIF were old age, body mass index <23, bone mineral
density <−3.5 SD
63. Pelvic
insufficiency
fractures
• Insufficiency fracture (IF)
is a type of stress fracture,
which occurs when normal
or physiological stress
applied to weakened bone
with demineralization and
decreased elastic
resistance.
64. Dose constraints
• Femoral head – Dmean<30Gy
• Median time to development of PIF was 12.5 months (range 5–30
months).
65.
66. Management
• Most symptomatic patients were fully resolved after conservative treatment
using analgesics and rest
• some patients needs narcotics or hospitalization because of severe pain and
disability those who generally have multiple sites of fracture or larger lesions
• Pentoxifylline may be effective in recovering symptoms
• CT-guided sacroplasty for sacral IF was reported to be helpful in patients with
pain resistant to conservative treatment
69. Bone marrow suppression
• Bone marrow is one of the most radiosensitive organs in the pelvis.
• Approximately 40% of the total body bone marrow reserve lies within the pelvic
bones
• Neutropenia occurs in 2–3 weeks
• Followed by thrombocytopenia
• Anemia in 2–3 months.
• Growth factor administration is now a common supportive measure in patients
with white cell deficiencies.
• Erythropoietin is now approved for use in patients with depressed hemoglobin
levels. Transfusion is typically reserved for patients with hemoglobin levels below
8 g/dL
73. Gonads – Ovarian dysfunction
• Oocytes are extremely radiosensitive, with 50% destruction at doses less than
2 Gy.
• Premature menopause and the ensuing hormonal changes can lead to hot
flashes, mood changes, and vaginal dryness.
• ASCO guidelines for patients receiving pelvic radiotherapy include embryo or
unfertilized oocyte cryopreservation, ovarian transposition, and ovarian tissue
cryopreservation and transplantation.
• In addition, the uterus in an irradiated pelvis will not function to carry a fetus
to term, resulting in miscarriage, preterm labor, low birth weight, and placental
abnormalities
74. Radiation dermatitis
• At a dose of 40 Gy, grade 2 reactions are typically observed, defined as tender and
edematous erythema with patchy, moist desquamation in skin folds and associated
pain.
• Grade 1 and 2 skin reactions are common in gynecologic RT, with an incidence
of 10% to 50% in cervical and endometrial cancerand 85% to 100% in the
treatment of vulvar cancer.
• Grade 3 skin reactions are associated with confluent moist desquamation when
doses exceed 50 to 60 Gy with bolus placement.
• Grade 4 skin reactions include skin ulceration, hemorrhage, and necrosis.
75. Acute Radiation dermatitis
• Mild erythema is most commonly observed in the vulva, perineum, and the inguinal
and gluteal folds.
• Mild skin reactions, such as erythema topical moisturizers without added perfumes
or metals like zinc or silver, which can irritate the skin or enhance the reaction.
• Daily use of a sitz bath with the addition of sodium bicarbonate, Epsom salts, or
Domeboro soaks may provide symptomatic relief.
• Gentle cleaning with a mild, unperfumed soap is advised for folliculitis.
• Wearing loose fitting clothes, avoiding sun exposure and metallic topical products,
and using water-based lipid-free moisturizers.
• Topical corticosteroids have been used to prevent radiodermatitis as well as itching
due to inflammation
77. Late radiation dermatitis
• In the months after RT, folliculitis is common because of regrowth of
occluded hair follicles, sweat glands, and sebaceous glands and may be relieved
with warm compresses or occasionally may require antibiotics.
• Subcutaneous fibrosis with associated woody thickening of the skin may also
be observed, although tissue retraction and pain are less common.
• Twice daily use of a 1:10 diluted hydrogen peroxide douche can prevent the
formation of necrotic tissue, particularly in previously irradiated patients.
78. Second malignancy
• Risk of smoking related lung cancer squamous cell carcinoma
• Second malignancy of colon, soft tissue , melanoma and non hodgkins
lymphoma adenocarcinoma
• HPV related cancers pharynx,genital and anal cancers
• Secondary leukaemia 5-10 yrs after treatment
• Uterine sarcomas
79. References
• Perez and bradys principles and practice of radiation oncology
• Radiation ProctitisDavid G. McKeown; Scott Goldstein.Last
Update: January 27, 2023.
• Radiation EnteritisBeenish S. Bhutta; Rawish Fatima; Muhammad Aziz.
Last Update: February 22, 2023.
• Strategies to Minimize Late Effects From Pelvic Radiotherapy
• Insufficiency fracture after radiation therapy
• Radiation-induced femoral head necrosisAbdulkareem, IH