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Gastrointestinal Bleeding case 5
Medusa was a goddess with snakes instead of hair on her head. The caput medusa (Medusa's head) is an old term still in fairly common use for numerous varicose veins radiating over the abdomen from the area of the umbilicus. ...
Lecture 25: Blood and Nerve Supply of GIT / Flashcards - Create ...
What is hematemesis, - Fresh bleeding from esophageal varices... 17. what is caput medusa: - enlarged parambilica v which drain directly... 8. What is Hematochezia, fresh bleeding from hemorrhoids (enlarged... 18. what is splenomegaly ...
Journal of Medical Case Reports | Full text | VACTERL (vertebral ...
Understandably, clinicians should give low priority to looking for portal hypertension in VACTERL spectrum patients presenting with gastrointestinal bleeding. However before routinely looking for a thready portal vein and/or ... The late consequences of portal hypertension may be esophageal varices, gastric varices, splenomegaly, ascites, and caput medusae [2]. The association of VACTERL spectrum and portal hypertension in a child has not been reported so far. ...
UPPER GASTROINTESTINAL BLEEDING
51 UPPER GASTROINTESTINAL BLEEDING
G. Edward Kimm Jr. M.D., Allen T. Belshaw M.D.
1. What is upper gastrointestinal (GI) bleeding?
Show answer
Bleeding from proximal to the ligament of Treitz (the transition point between duodenum and jejunum).
2. What are the most common causes of upper GI bleeding?
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In descending order of frequency, they are gastritis, duodenal ulcer, esophageal varices, benign gastric ulcer, esophagitis, and Mallory-Weiss tear. All other causes account for < 5% of cases.
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can a upper gi miss a duodenal ulcer, esophageal gastroduodenotomy with esophageal banding,Lower Gastrointestinal Bleeding
52 LOWER GASTROINTESTINAL BLEEDING
Kathleen Liscum M.D.
1. Describe the treatment of a patient who presents with lower gastrointestinal (GI) bleeding.
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Treatment begins with the ABCs (airway, breathing, circulation). Place two large-bore intravenous (IV) catheters in the upper extremities. Obtain hemoglobin and hematocrit levels, blood type, and cross-match. A Foley catheter should be placed to help monitor volume status.
2. What is the next step in evaluating the patient?
Show answer
A nasogastric tube should be placed to rule out an upper GI source. If the aspirate is bilious, the examiner can be fairly certain that the source is distal to the ligament of Treitz. However, if the aspirate reveals no bile, the patient may still be bleeding in the duodenum with a competent pylorus.
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Queries 5
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euro-ion in dextrose 5% water, mss,Queries 4
InitialAssessment. Controversies
CONTROVERSIES
28. What is the role of the pneumatic antishock garment?
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The military antishock trouser (MAST) has fallen out of favor in most instances. The MAST suit is valuable for patients requiring long-distance transfer who have major bleeding from pelvic fractures. The MAST suit should be avoided in the presence of major thoracoabdominal trauma, especially if a diaphragmatic injury is suspected. The traction splints still are preferred for femur fracture transfer; they decrease bleeding and assist with pain control.
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Anorectal Disease. Hemorrhoids
HEMORRHOIDS
21. What are hemorrhoidal tissues, and what are their normal functions?
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Hemorrhoids are cushions of vascular tissue that contribute to anal continence and protect the sphincter mechanism during defecation. Hemorrhoids are not veins, but sinusoids. Bleeding originates from presinusoidal arterioles, thus explaining the bright red arterial color.
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Anorectal Disease. Anal Fissure
ANAL FISSURE
14. What is the most common location for idiopathic anal fissure?
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90% are posterior, and 10% are anterior.
15. What are the most common symptoms of anal fissure?
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Tearing anal pain and bleeding with bowel movements.
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42 PORTAL HYPERTENSION AND ESOPHAGEAL VARICES
Ramin Jamshidi B.S., B.S., Gregory V. Stiegmann M.D.
1. Describe the blood supply to the liver.
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Total hepatic blood flow is roughly 1500 mL/min, or 25% of cardiac output. The hepatic artery normally supplies about 30% of blood flow, and the portal vein contributes 70%. The hepatic artery and portal vein each supply 50% of the liver’s oxygen, however. With portal hypertension, portal flow decreases and the relative contribution of the hepatic artery necessarily increases.
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Hepatic & Biliary Trauma. Operative Management Of Liver Injury
OPERATIVE MANAGEMENT OF LIVER INJURY
11. How are acute liver injuries classified?
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Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
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pringle maneuver technique liver injury, biliary trauma, finger fracture hepatotomy, liver laceration surgical management, liver laceration/pringle maneuver, liver packing, billiary trauma and its management, finger fracture in liver injuries, grading liver lacerations surgical management, hepatic arterial bleeding management, hepatic fracture, hepatic fracture treatment, hepatic trauma and its management, indication hepatic artery ligation, is penrose drain required to provide pringle maneuver, laceration inferior vena cava, liver fracture surgical management, liver hemorrhage maneuver, liver injury-operative steps, liver laceration management, liver packing for trauma, liver packing in trauma, liver trauma-operative steps, management of hepatic trauma, management of liver injuries, management of liver trauma, operative indications liver laceration, operative management of liver injury, operative management of liver trauma bile, option to control liver hemorrhage,Diverticular Disease Of The Colon
48 DIVERTICULAR DISEASE OF THE COLON
Gregory P. Victorino M.D., Jyoti Arya M.D., Lawrence W. Norton M.D.
1. What is a colonic diverticulum?
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A protrusion of mucosa and submucosa through the muscular layers of the bowel wall. It has no muscular covering. Because diverticula do not involve all layers of the bowel wall, they are really “false” diverticula. Diverticulum formation may be related either to weakness of the bowel wall at the sites of vessel perforation or to increased intraluminal pressure caused by low dietary fiber and constipation.
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Hepatic & Biliary Trauma
25 HEPATIC AND BILIARY TRAUMA
Reginald J. Franciose M.D., Ernest E. Moore M.D.
1. How often is the liver injured in trauma?
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The liver is both big and central, so it is an easy target.
2. Do the liver and spleen respond similarly to injury?
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No. The liver has a unique ability to establish spontaneous hemostasis even with extensive injuries. For this reason, the majority of liver injuries in hemodynamically stable patients can be managed nonoperatively. In contrast, many splenic fractures continue to bleed; therefore, a greater percentage require operative intervention.
Acid Peptic Ulcer Disease. Gastric Ulcer Disease
GASTRIC ULCER DISEASE
41. What is the most important factor in managing gastric ulcers?
Show answer
All gastric ulcers must be evaluated for malignancy. The incidence of malignancy is about 10%.
42. How is gastric ulcer evaluated?
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Biopsy is mandatory. Esophagogastroduodenoscopy (EGD) with multiple biopsies (typically, six) of the ulcer crater is the best method. Upper GI series may be helpful, but biopsy is not possible. The CLO test can be performed at the time of the EGD to detect H. pylori. Benign ulcers usually heal by 12 weeks. Intractability should arouse suspicion for malignancy.
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Splenic Trauma
26 SPLENIC TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What is the physiologic role of the spleen?
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In fetal development, the spleen serves as a major site for hematopoiesis. In early childhood the spleen produces immunoglobulin M (IgM) and tuftsin. The spleen also functions as a filter, allowing resident macrophages to remove abnormal red blood cells (RBCs), cellular debris, and encapsulated and poorly opsonized bacteria.
Pelvic Fractures
29 PELVIC FRACTURES
Steven J. Morgan M.D., Wade R. Smith M.D.
1. What are the first steps in the evaluation and treatment of a patient with pelvic trauma?
Show answer
The ABCs (airway, breathing, and circulatory assessment). The answer to this first trauma question is always the same. Trauma patients with displaced pelvic fractures have a high incidence of associated injuries to the head, chest, and abdomen.
Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
