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Palmar Erythema With Intense Itching | Eczema Relief
Caput Medusa (winding around the navel). Rectal Hemorrhoids. Ascites – Change fluid and vague boredom (In case of large amount of ascites),. paraumbilical hernia. Jaundice. spider naevi. Gynecomastia. Dupuytren's disease ... Portal hypertension syndrome in first year. intense, unbearable, "itching, pain in both hypochondria dull pain in the angle of the right scapula, eyes constantly yellow, the bitterness in the mouth, constipation. cirrhosis, liver failure and ...
Bariatric Surgery in Patients with Liver Cirrhosis and Portal ...
After an initial history and physical exam, searching for evident clinical data (history of gastrointestinal bleeding, ascites, caput medusae), and assessing liver function, patients with cirrhosis should undergo an upper endoscopy, ...
caput medusae
· caput medusae (varicose abdominal veins) is the symptom of visible veins in the abdominal wall. · caput medusae (varicose abdominal veins) appear as swollen and engorged veins within the abdominal wall, extending out from the belly ...
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Liver Transplantation
89 LIVER TRANSPLANTATION
Thomas E. Bak M.D., Michael E. Wachs M.D., Igal Kam M.D.
1. When and where was the first liver transplant performed?
Show answer
Dr. Thomas Starzl performed the first operation on March 1, 1963, at the University of Colorado in Denver.
2. Is liver transplantation considered a safe and effective operation?
Show answer
Yes. Although still a major operation with significant risks, patient and graft survival have continuously improved. One-year survival should be well over 90% in major centers.
3. What are the most common indications for liver transplantation in the United States?
Portal Hypertension & Esophageal Varices
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.
Show answer
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. Surgical Anatomy Of The Liver
SURGICAL ANATOMY OF THE LIVER
7. How many anatomic lobes are present in the liver? What is their topographic boundary?
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The liver is divided into two anatomic lobes, the right and the left. Their boundary lies in an oblique plane extending from the gallbladder fossa anteriorly to the inferior vena cava posteriorly. The three hepatic veins define the division between the lobar segments and the planes of surgical resection. Lobar segments are numbered I-VIII, according to Couinaud’s nomenclature. (See Figure 25-1.)
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Portal Hypertension & Esophageal Varices. Controversy
CONTROVERSY
32. How should a patient with known esophageal varices be treated to prevent an initial variceal bleed?
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The combination of beta blocker and nitrate is used for primary prophylaxis, but endoscopic band ligation is at least equivalent to pharmacotherapy without the side effects (one third of patients cannot tolerate beta-blockers because of fatigue or bronchospasm, and 20% cannot tolerate nitrates secondary to pounding headaches). These treatments reduce the incidence of an initial bleed from 30% to < 10% and the mortality from 30% to 20%. Endoscopic band ligation was previously suggested for prophylaxis only in class C disease, but mounting evidence suggests that EBL is more effective than pharmacotherapy in all patients. The effect of combined EBL and beta blockade in primary prophylaxis remains to be established but makes great intuitive sense.
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Abdominal Tumors
87 ABDOMINAL TUMORS
Frederick M. Karrer M.D., Denis D. Bensard M.D.
1. What are the most common malignant solid abdominal tumors in children?
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Neuroblastomas, Wilms’ tumors, and hepatoblastomas, in that order. Neuroblastomas are derived from neural crest tissue; in the abdomen, they originate from the adrenal glands and paraspinal sympathetic ganglia. Wilms’ tumor (nephroblastoma) derives from the kidney, and hepatoblastomas originate in the liver.
2. Is it tough to differentiate Wilms’ tumor from neuroblastomas clinically?
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Yes. Both tumors present as an asymptomatic abdominal mass. The differences are summarized in Table 87-1. In addition, because neuroblastomas produce hormones, affected children may exhibit flushing, hypertension (catecholamine release), watery diarrhea, periorbital ecchymosis, and abnormal ocular movements.
Table 87-1. DIFFERENTATION BETWEEN WILMS’ TUMOR AND NEUROLASTOMA
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Wilms’ Tumor
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Neuroblastoma
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|
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Age at presentation
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3-4 yr
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1-2 yr
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Extend across midline
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Rare
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Common
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Surface on palpation
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Smooth
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Knobby
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X-ray calcifications
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No
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Yes
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3. How are Wilms’ tumors and neuroblastomas treated?
Table 87-2. TREATMENT OF WILMS’ TUMOR AND NEUROBLASTOMA
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Wilms’ Tumor
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Neuroblastoma
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|
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Primary surgical excision
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Important (likely)
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Important (less likely)
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Chemotherapy
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Enormous impact
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Less responsive
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4. What are the major prognostic factors in neuroblastomas and Wilms’ tumor?
In neuroblastomas, age at presentation is the major prognostic factor. Children younger than 1 year have an overall survival rate > 70%, whereas the survival rate for children older than 1 year is < 35%. Shimada proposed a prognostic classification based on evaluation of histologic parameters (tumor differentiation, mitosis-karyorrhexis index [MKI]) as well as age. Aneuploid tumors, tumors with low MKI, and tumors with < 10 copies of the n-myc gene also have better outcomes.
Age is also important in children with Wilms’ tumors, but the prognosis is better because the tumors are more readily excised and much more sensitive to chemotherapy.
5. What are the differences between hepatoblastomas and hepatocellular carcinomas? How are the tumors treated?
Hepatoblastomas usually occur in infants and young children, whereas hepatocellular carcinoma usually occurs in children older than 10 years. Hepatocellular carcinoma usually is associated with cirrhosis and hepatitis B and is histologically identical to the adult form. Surgical resection is the primary therapy for both tumors. Hepatoblastomas often have a good response to adjunctive chemotherapy, whereas hepatocellular carcinoma rarely responds to chemotherapy.
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major abdominal tumors in pediatrics, tumor neurolastoma,Nutritional Assessment & Enteral Nutrition. Nutritional Assessment
8 NUTRITIONAL ASSESSMENT AND ENTERAL NUTRITION
Margaret M. McQuiggan M.S., R.D., CNSD, Frederick A. Moore M.D.
NUTRITIONAL ASSESSMENT
1. What does a nutritional assessment include? Show answer
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chilocalorie diprivan,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?
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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,Risks Of Bloodborne Disease
101 RISKS OF BLOODBORNE DISEASE
Caesar M. Ursic M.D., Doru I. E. Georgescu M.D.
1. What infectious diseases are transmissible via blood transfusion?
Acid Peptic Ulcer Disease. Duodenal Ulcer Disease
45 ACID-PEPTIC ULCER DISEASE
Frank H. Chae M.D.
DUODENAL ULCER DISEASE
1. What is the risk of duodenal ulcer disease?
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The lifetime risk for duodenal ulcer is about 1 in 14. It usually occurs between ages 20 and 60 years, with peak incidence in the fourth decade of life. It is more common in males. Hemorrhage is the most common cause of hospital admission. The annual number of deaths in the United States is about 10,000 deaths caused by duodenal ulcers.
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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
