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Is cirrhosis reversible 2015.2
Cirrhosis can be reversible to some degree depending on the severity and persistence of the underlying disease. While uncommon, regression of fibrosis and scarring can occur, especially in early-stage cirrhosis diagnosed on histology. Complete reversal is not seen in clinical or decompensated cirrhosis, as the vascular changes do not regress. Histological cirrhosis may reverse without full reversal of clinical cirrhosis, suggesting there is a "point of no return" where cirrhosis becomes irreversible.
Liver stiffness measurement (fibroscan®)
This document discusses liver stiffness measurement (FibroScan) for assessing liver fibrosis. It begins by describing FibroScan as a non-invasive test that measures liver stiffness using ultrasound to evaluate the velocity of shock wave propagation through liver tissue. FibroScan has several advantages over liver biopsy as it is simple, reproducible, readily available, less expensive, and can predict the full spectrum of fibrosis. The document then reviews factors that can affect liver stiffness measurements such as obesity, operator experience, acute liver injury, extrahepatic cholestasis, increased central venous pressure, and ascites. It concludes that while FibroScan is a useful test, its results must be interpreted in the overall clinical context while considering potential limitations and pitfalls
Is cirrhosis reversible 2015.2
Cirrhosis can be reversible to some degree depending on the severity and persistence of the underlying disease. While uncommon, regression of fibrosis and scarring can occur, especially in early-stage cirrhosis diagnosed on histology. Complete reversal is not seen in clinical or decompensated cirrhosis where vascular changes are established. Historically cirrhosis was considered a single stage disease, but it is now recognized as a series of progressive steps, with the potential for some regression if the cause is treated early enough before irreversible changes develop.
Ppt
The document discusses the use of biologicals such as infliximab and adalimumab in treating Crohn's disease. It provides details on their indications, administration protocols, effectiveness, safety considerations like risks of tuberculosis and autoimmune reactions, and constraints to their use like cost and lack of insurance coverage. Special precautions are needed with biologicals regarding vaccinations, screening for latent infections, and monitoring for adverse effects. Overall, biologicals are effective for inducing and maintaining remission in severe Crohn's disease and fistulizing disease when conventional treatments have failed or are not tolerated.
Role of surgeon dr.p.radhakrishan
Surgery is often required in the treatment of Crohn's disease to address complications such as strictures, fistulae, inflammatory masses, and perforations. Approximately 50% of Crohn's patients develop strictures or fistulae within 20 years of diagnosis. Immunomodulators and anti-TNF therapies have reduced the need for surgery. When surgery is needed, non-resectional techniques like strictureplasty may be used to avoid excessive intestine removal, while resectional techniques remove only the severely affected portions. The document discusses various surgical procedures for different areas affected by Crohn's disease including the small bowel, colon, and perianal region. A multidisciplinary approach is emphasized for optimal Crohn's disease
Crohn vs tb 2015 03 22 tnisgcon
Crohn's disease and tuberculosis can be difficult to differentiate based on clinical features alone. Key factors that may help include disease duration, family history, presence of extraintestinal manifestations, and endoscopic and histological findings on biopsies. Radiological imaging findings can also provide clues but often overlap between the two conditions. A high index of suspicion is needed and further investigations including microbiological tests may be required in uncertain cases to arrive at the correct diagnosis and avoid unnecessary double treatment.
Poem 03 15
This document summarizes the technique and outcomes of peroral endoscopic myotomy (POEM) based on the author's experience and literature. In 3 sentences:
POEM is a minimally invasive treatment for achalasia that involves cutting the esophageal muscle through an incision in the mouth using an endoscope, with benefits over laparoscopic surgery of being less invasive, allowing full control of the myotomy, and preserving the phrenoesophageal membrane. Studies show POEM provides over 90% treatment success based on the author's experience of 282 cases. While long-term data is still needed, POEM appears as effective as surgery with fewer side effects and shorter recovery time based on comparative studies.
Cbd stones
This document discusses biliary stone diseases and treatments. It defines difficult bile duct stones as those over 15mm or impacted. Standard treatment involves endoscopic retrograde cholangiopancreatography (ERC) but factors like stone size, number, and location; bile duct anatomy; and prior surgeries can make removal difficult. Methods for difficult stones include lithotripsy, balloon dilation, cholangioscopy, and dissolution, with the goal of decreasing stone size and increasing bile duct access. Complete stone removal can be achieved in most cases using various endoscopic techniques, but sometimes requires a multidisciplinary approach.
Empfohlen
Is cirrhosis reversible 2015.2
Cirrhosis can be reversible to some degree depending on the severity and persistence of the underlying disease. While uncommon, regression of fibrosis and scarring can occur, especially in early-stage cirrhosis diagnosed on histology. Complete reversal is not seen in clinical or decompensated cirrhosis, as the vascular changes do not regress. Histological cirrhosis may reverse without full reversal of clinical cirrhosis, suggesting there is a "point of no return" where cirrhosis becomes irreversible.
Liver stiffness measurement (fibroscan®)
This document discusses liver stiffness measurement (FibroScan) for assessing liver fibrosis. It begins by describing FibroScan as a non-invasive test that measures liver stiffness using ultrasound to evaluate the velocity of shock wave propagation through liver tissue. FibroScan has several advantages over liver biopsy as it is simple, reproducible, readily available, less expensive, and can predict the full spectrum of fibrosis. The document then reviews factors that can affect liver stiffness measurements such as obesity, operator experience, acute liver injury, extrahepatic cholestasis, increased central venous pressure, and ascites. It concludes that while FibroScan is a useful test, its results must be interpreted in the overall clinical context while considering potential limitations and pitfalls
Is cirrhosis reversible 2015.2
Cirrhosis can be reversible to some degree depending on the severity and persistence of the underlying disease. While uncommon, regression of fibrosis and scarring can occur, especially in early-stage cirrhosis diagnosed on histology. Complete reversal is not seen in clinical or decompensated cirrhosis where vascular changes are established. Historically cirrhosis was considered a single stage disease, but it is now recognized as a series of progressive steps, with the potential for some regression if the cause is treated early enough before irreversible changes develop.
Ppt
The document discusses the use of biologicals such as infliximab and adalimumab in treating Crohn's disease. It provides details on their indications, administration protocols, effectiveness, safety considerations like risks of tuberculosis and autoimmune reactions, and constraints to their use like cost and lack of insurance coverage. Special precautions are needed with biologicals regarding vaccinations, screening for latent infections, and monitoring for adverse effects. Overall, biologicals are effective for inducing and maintaining remission in severe Crohn's disease and fistulizing disease when conventional treatments have failed or are not tolerated.
Role of surgeon dr.p.radhakrishan
Surgery is often required in the treatment of Crohn's disease to address complications such as strictures, fistulae, inflammatory masses, and perforations. Approximately 50% of Crohn's patients develop strictures or fistulae within 20 years of diagnosis. Immunomodulators and anti-TNF therapies have reduced the need for surgery. When surgery is needed, non-resectional techniques like strictureplasty may be used to avoid excessive intestine removal, while resectional techniques remove only the severely affected portions. The document discusses various surgical procedures for different areas affected by Crohn's disease including the small bowel, colon, and perianal region. A multidisciplinary approach is emphasized for optimal Crohn's disease
Crohn vs tb 2015 03 22 tnisgcon
Crohn's disease and tuberculosis can be difficult to differentiate based on clinical features alone. Key factors that may help include disease duration, family history, presence of extraintestinal manifestations, and endoscopic and histological findings on biopsies. Radiological imaging findings can also provide clues but often overlap between the two conditions. A high index of suspicion is needed and further investigations including microbiological tests may be required in uncertain cases to arrive at the correct diagnosis and avoid unnecessary double treatment.
Poem 03 15
This document summarizes the technique and outcomes of peroral endoscopic myotomy (POEM) based on the author's experience and literature. In 3 sentences:
POEM is a minimally invasive treatment for achalasia that involves cutting the esophageal muscle through an incision in the mouth using an endoscope, with benefits over laparoscopic surgery of being less invasive, allowing full control of the myotomy, and preserving the phrenoesophageal membrane. Studies show POEM provides over 90% treatment success based on the author's experience of 282 cases. While long-term data is still needed, POEM appears as effective as surgery with fewer side effects and shorter recovery time based on comparative studies.
Cbd stones
This document discusses biliary stone diseases and treatments. It defines difficult bile duct stones as those over 15mm or impacted. Standard treatment involves endoscopic retrograde cholangiopancreatography (ERC) but factors like stone size, number, and location; bile duct anatomy; and prior surgeries can make removal difficult. Methods for difficult stones include lithotripsy, balloon dilation, cholangioscopy, and dissolution, with the goal of decreasing stone size and increasing bile duct access. Complete stone removal can be achieved in most cases using various endoscopic techniques, but sometimes requires a multidisciplinary approach.
Esophstrictures chennai
1) The document provides information on the efficacy of different treatment modalities for esophageal strictures including dilation, stenting and intralesional steroid injections.
2) Data from studies show that fully covered self-expanding metal stents (SEMS) achieve clinical success in 30-66% of patients with refractory strictures, but have migration rates of 14-37%.
3) Biodegradable stents have a lower clinical success rate of 30-33% and require frequent reinterventions, but avoid issues of migration associated with metal stents.
Vgn cfhennai isg-2015_latest new final _
This document discusses the use of transient elastography (TE) or Fibroscan to assess liver fibrosis as an alternative to liver biopsy. TE uses ultrasound pulses to measure liver stiffness, with higher stiffness indicating more severe fibrosis. The document provides cutoff values for various fibrosis stages and notes TE has excellent accuracy and reproducibility. TE can detect significant fibrosis in many non-alcoholic fatty liver disease patients where ultrasound only detects fatty liver. Case studies demonstrate how TE scores decreased with treatment and abstinence from alcohol. While liver biopsy is still the reference standard, TE suffices in most cases to avoid invasive tests and is useful for screening and monitoring liver disease patients.
Isgtncon 2015 sessions (1) 1
The document lists the sponsors for various academic sessions and panels about gastrointestinal topics such as constipation, obscure GI bleeding, liver fibrosis assessment, Crohn's disease, cirrhosis, and acute pancreatitis. Each session listing includes the name of the session and the company supporting it as a pharmaceutical maker of various drugs.
Crohns symposium mathew philps beyond biologicals
This document discusses potential new drugs for inflammatory bowel disease (IBD) beyond current biological therapies. It outlines several therapeutic pipelines targeting cytokines like TNF, IL-12/IL-23, IL-13 and IL-6. Anti-adhesion molecules targeting integrins and MadCAM-1 are also discussed. The document explores manipulating the microbiome through probiotics, antibiotics or fecal transplantation, as well as using prognostic genomics to predict treatment responses. Overall it concludes that future IBD treatment will be personalized based on biomarkers and tissue signatures to select therapies beyond TNF blockers.
5 Liver Fibrosis Assessment Dr. V.G. Mohanprasad
This document discusses the use of transient elastography (TE) or Fibroscan to assess liver fibrosis as an alternative to liver biopsy. TE uses ultrasound pulses to measure liver stiffness, which correlates with the stage of fibrosis. The document provides cutoff values for various stages of fibrosis. It also describes a study comparing TE to Philips shear wave elastography, finding a high correlation. TE detected significant fibrosis in 17.85% of patients where ultrasound only found fatty liver. The document concludes that while biopsy is still the gold standard, TE is a useful noninvasive tool for initial screening and monitoring of patients with liver diseases.
Prof.N. Madanagopalan Oration
This document summarizes the work of Dr. N Madanagopalan regarding Budd-Chiari syndrome (BCS) from 1978-1996. It highlights that Dr. Madanagopalan made major contributions to understanding the epidemiology, clinical presentation, investigations and management of BCS. Through angiographic and surgical studies conducted with collaborators, he helped establish the patterns and treatment of hepatic vein outflow tract obstruction in India. His work demonstrated differences from Western countries and identified congenital abnormalities as a major cause. This laid the foundation for endovascular treatments now used.
Bariatric Surgery
Senior Consultant in Surgical Gastroenterology and Minimal Access Surgery. Started GI endoscopy services in 1984 and established GI surgery and minimal access surgery departments. Affiliated with several societies including Indian Society of Gastroenterology. Four main bariatric surgical procedures are gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. These procedures restrict food intake and absorption leading to significant and sustained weight loss as well as resolution of obesity-related comorbidities like diabetes and hypertension. Long-term studies show bariatric surgery improves survival rates compared to non-surgical weight loss methods.
Prevention Of Gi Malignancy
This document discusses strategies for preventing gastrointestinal (GI) cancers. It outlines several key risk factors for GI cancers, including H. pylori infection for gastric cancer, obesity for pancreatic cancer, and family history for colon and gastric cancers. Prevention strategies discussed include H. pylori eradication, vaccination for hepatitis B, lifestyle modifications like diet and exercise, and cancer screening programs. The document emphasizes that while knowledge of risk factors is sound, interventions need improved implementation and awareness and education are critical to reducing the burden of GI cancers.
Post liver tx complication surgeon role
This document discusses surgical complications that can occur after liver transplantation. Immediate postoperative complications include bleeding, arterial complications like hepatic artery thrombosis, portal venous complications, and biliary complications like bile leaks. Long term complications include biliary strictures, which can develop due to technical issues or ischemia. Proper prevention through surgical technique and a multidisciplinary approach are important to address these complications after liver transplantation.
Isg chennai march 2015 rajasekar
This document summarizes key developments and the current state of cadaveric liver transplantation. It discusses:
1) Important milestones in transplantation history including the introduction of cyclosporine and advances in India.
2) Current transplant statistics in India showing high 1-year survival rates of 88-90% for liver transplants but an ongoing organ shortage.
3) Techniques for deceased and living donor liver transplants including recipient hepatectomy, implantation, and management of complications.
4) Efforts to expand the donor pool through use of marginal donors and grafts with steatosis, though these can increase risk of poor outcomes. Ongoing research aims to further improve long-term results
Dr lvk liver transplpantation l.venkatakrishan
The document discusses the evaluation process for patients being considered for liver transplantation. It covers the common indications for transplant including complications of cirrhosis and liver failure. The evaluation involves assessing cardiac, pulmonary, surgical, infectious disease, renal, neurological, laboratory and radiology factors. Scores like MELD are used to determine priority on transplant waiting lists. Certain conditions may qualify for MELD exceptions. The evaluation aims to ensure candidates are medically suitable and have necessary social support for transplant.
PHYSICIANS ROLE C.E.Eapen
1. Lifelong immunosuppression is needed after liver transplant to prevent graft rejection. Calcineurin inhibitors like cyclosporine and tacrolimus are the mainstay but require monitoring to avoid toxicity due to drug interactions.
2. Drug interactions are a major concern, as many drugs are metabolized by the CYP3A4 pathway which is inhibited or induced by calcineurin inhibitors. This can increase or decrease drug levels and impact outcomes.
3. Long term complications include chronic rejection, recurrence of original liver disease, infections, renal failure, and malignancy. Careful management is needed long term to monitor for issues and minimize immunosuppression when possible.
Acute Pancreatitis
The panel discussion summarized:
1) Serum amylase and lipase levels are reliable markers for acute pancreatitis during pregnancy.
2) MRCP is the best imaging modality for evaluating the bile duct for choledocholithiasis in pregnancy due to lack of radiation exposure, though EUS provides the highest accuracy.
3) Therapeutic ERCP can be performed safely in pregnancy with precautions to minimize radiation exposure to the fetus, and is safest during the second trimester.
Case Capsule
1. A 47-year-old male presented with abdominal pain, back pain, weight loss, and worsening diabetes. Imaging showed ill-defined masses in the pancreas. Differential considerations included pancreatic malignancy or autoimmune pancreatitis.
2. Endoscopic ultrasound-guided fine needle aspiration of the masses was nondiagnostic but showed no malignancy. Surgery found an infiltrative pancreatic mass but biopsy again showed no malignancy.
3. Follow up showed jaundice and imaging characteristics suggestive of autoimmune pancreatitis. Histopathology and elevated IgG4 supported a diagnosis of type 1 autoimmune pancreatitis. The patient was started
Chronic Abdominal Pain in Children
This panel session discusses various causes and management of recurrent abdominal pain (RAP) in children. Common causes include functional causes (70-75%), psychogenic causes (12-15%), and organic causes (10-15%). The document provides guidance on evaluating a child with constipation, discussing the importance of obtaining a thorough history. It also reviews common and rare organic causes of abdominal pain in children and discusses approaches to investigating and managing a child with suspected functional abdominal pain.
Role of Surgery in CA Oesophagus
This document discusses surgical options for treating carcinoma of the esophagus, focusing on esophagectomy. It describes the main debate around open esophagectomy approaches like transhiatal versus en-bloc resection. While en-bloc may provide better survival, it also increases morbidity. Transhiatal esophagectomy provides relief of dysphagia with less morbidity but similar survival and is still a valid option. Minimally invasive esophagectomy is presented as a promising newer approach with benefits like less pulmonary complications and shorter hospital stay based on early studies, but more research is still needed.
Obscure G I BLEED
A 48-year-old man presented with rectal bleeding and was found to have diffuse submucosal edema in the distal jejunum and ileum, along with beading in the superior mesenteric artery branches and narrowing of the ileal vas recta. He was diagnosed with polyarteritis nodosa (PAN) based on these imaging findings and clinical course. PAN is a necrotizing vasculitis typically involving medium-sized arteries. The patient was treated with steroids and anticoagulation for PAN and associated pulmonary thromboembolism. He was later discharged after improvement of symptoms.
Approach to Constipation
The document discusses the evaluation and management of constipation. It outlines the clinical approach which includes determining if it is constipation, identifying potential causes like drugs or disease, and checking for alarm symptoms. Evaluation involves examination, labs like TSH and calcium, and tests like anorectal manometry and balloon expulsion tests to classify constipation and identify defecatory disorders. Biofeedback therapy is described as the treatment of choice for defecatory disorders by training muscles through visual cues. Surgery may be considered for issues like rectocele or Hirschsprung's disease.
NUCs in Chronic Hepatitis B
HBV has been associated with humans for over 1,000 years. Recent evidence from a mummified Korean child who tested positive for HBV DNA establishes that HBV has been present in humans for at least 500 years. Treatment guidelines recommend antiviral therapy for patients with chronic HBV based on HBV DNA levels and ALT levels. Tenofovir and entecavir are preferred first-line treatments due to their superior efficacy, tolerability and low resistance profiles. Long-term antiviral therapy can reduce the risk of liver decompensation, hepatocellular carcinoma, and death in patients with chronic HBV.
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Esophstrictures chennai
1) The document provides information on the efficacy of different treatment modalities for esophageal strictures including dilation, stenting and intralesional steroid injections.
2) Data from studies show that fully covered self-expanding metal stents (SEMS) achieve clinical success in 30-66% of patients with refractory strictures, but have migration rates of 14-37%.
3) Biodegradable stents have a lower clinical success rate of 30-33% and require frequent reinterventions, but avoid issues of migration associated with metal stents.
Vgn cfhennai isg-2015_latest new final _
This document discusses the use of transient elastography (TE) or Fibroscan to assess liver fibrosis as an alternative to liver biopsy. TE uses ultrasound pulses to measure liver stiffness, with higher stiffness indicating more severe fibrosis. The document provides cutoff values for various fibrosis stages and notes TE has excellent accuracy and reproducibility. TE can detect significant fibrosis in many non-alcoholic fatty liver disease patients where ultrasound only detects fatty liver. Case studies demonstrate how TE scores decreased with treatment and abstinence from alcohol. While liver biopsy is still the reference standard, TE suffices in most cases to avoid invasive tests and is useful for screening and monitoring liver disease patients.
Isgtncon 2015 sessions (1) 1
The document lists the sponsors for various academic sessions and panels about gastrointestinal topics such as constipation, obscure GI bleeding, liver fibrosis assessment, Crohn's disease, cirrhosis, and acute pancreatitis. Each session listing includes the name of the session and the company supporting it as a pharmaceutical maker of various drugs.
Crohns symposium mathew philps beyond biologicals
This document discusses potential new drugs for inflammatory bowel disease (IBD) beyond current biological therapies. It outlines several therapeutic pipelines targeting cytokines like TNF, IL-12/IL-23, IL-13 and IL-6. Anti-adhesion molecules targeting integrins and MadCAM-1 are also discussed. The document explores manipulating the microbiome through probiotics, antibiotics or fecal transplantation, as well as using prognostic genomics to predict treatment responses. Overall it concludes that future IBD treatment will be personalized based on biomarkers and tissue signatures to select therapies beyond TNF blockers.
5 Liver Fibrosis Assessment Dr. V.G. Mohanprasad
This document discusses the use of transient elastography (TE) or Fibroscan to assess liver fibrosis as an alternative to liver biopsy. TE uses ultrasound pulses to measure liver stiffness, which correlates with the stage of fibrosis. The document provides cutoff values for various stages of fibrosis. It also describes a study comparing TE to Philips shear wave elastography, finding a high correlation. TE detected significant fibrosis in 17.85% of patients where ultrasound only found fatty liver. The document concludes that while biopsy is still the gold standard, TE is a useful noninvasive tool for initial screening and monitoring of patients with liver diseases.
Prof.N. Madanagopalan Oration
This document summarizes the work of Dr. N Madanagopalan regarding Budd-Chiari syndrome (BCS) from 1978-1996. It highlights that Dr. Madanagopalan made major contributions to understanding the epidemiology, clinical presentation, investigations and management of BCS. Through angiographic and surgical studies conducted with collaborators, he helped establish the patterns and treatment of hepatic vein outflow tract obstruction in India. His work demonstrated differences from Western countries and identified congenital abnormalities as a major cause. This laid the foundation for endovascular treatments now used.
Bariatric Surgery
Senior Consultant in Surgical Gastroenterology and Minimal Access Surgery. Started GI endoscopy services in 1984 and established GI surgery and minimal access surgery departments. Affiliated with several societies including Indian Society of Gastroenterology. Four main bariatric surgical procedures are gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. These procedures restrict food intake and absorption leading to significant and sustained weight loss as well as resolution of obesity-related comorbidities like diabetes and hypertension. Long-term studies show bariatric surgery improves survival rates compared to non-surgical weight loss methods.
Prevention Of Gi Malignancy
This document discusses strategies for preventing gastrointestinal (GI) cancers. It outlines several key risk factors for GI cancers, including H. pylori infection for gastric cancer, obesity for pancreatic cancer, and family history for colon and gastric cancers. Prevention strategies discussed include H. pylori eradication, vaccination for hepatitis B, lifestyle modifications like diet and exercise, and cancer screening programs. The document emphasizes that while knowledge of risk factors is sound, interventions need improved implementation and awareness and education are critical to reducing the burden of GI cancers.
Post liver tx complication surgeon role
This document discusses surgical complications that can occur after liver transplantation. Immediate postoperative complications include bleeding, arterial complications like hepatic artery thrombosis, portal venous complications, and biliary complications like bile leaks. Long term complications include biliary strictures, which can develop due to technical issues or ischemia. Proper prevention through surgical technique and a multidisciplinary approach are important to address these complications after liver transplantation.
Isg chennai march 2015 rajasekar
This document summarizes key developments and the current state of cadaveric liver transplantation. It discusses:
1) Important milestones in transplantation history including the introduction of cyclosporine and advances in India.
2) Current transplant statistics in India showing high 1-year survival rates of 88-90% for liver transplants but an ongoing organ shortage.
3) Techniques for deceased and living donor liver transplants including recipient hepatectomy, implantation, and management of complications.
4) Efforts to expand the donor pool through use of marginal donors and grafts with steatosis, though these can increase risk of poor outcomes. Ongoing research aims to further improve long-term results
Dr lvk liver transplpantation l.venkatakrishan
The document discusses the evaluation process for patients being considered for liver transplantation. It covers the common indications for transplant including complications of cirrhosis and liver failure. The evaluation involves assessing cardiac, pulmonary, surgical, infectious disease, renal, neurological, laboratory and radiology factors. Scores like MELD are used to determine priority on transplant waiting lists. Certain conditions may qualify for MELD exceptions. The evaluation aims to ensure candidates are medically suitable and have necessary social support for transplant.
PHYSICIANS ROLE C.E.Eapen
1. Lifelong immunosuppression is needed after liver transplant to prevent graft rejection. Calcineurin inhibitors like cyclosporine and tacrolimus are the mainstay but require monitoring to avoid toxicity due to drug interactions.
2. Drug interactions are a major concern, as many drugs are metabolized by the CYP3A4 pathway which is inhibited or induced by calcineurin inhibitors. This can increase or decrease drug levels and impact outcomes.
3. Long term complications include chronic rejection, recurrence of original liver disease, infections, renal failure, and malignancy. Careful management is needed long term to monitor for issues and minimize immunosuppression when possible.
Acute Pancreatitis
The panel discussion summarized:
1) Serum amylase and lipase levels are reliable markers for acute pancreatitis during pregnancy.
2) MRCP is the best imaging modality for evaluating the bile duct for choledocholithiasis in pregnancy due to lack of radiation exposure, though EUS provides the highest accuracy.
3) Therapeutic ERCP can be performed safely in pregnancy with precautions to minimize radiation exposure to the fetus, and is safest during the second trimester.
Case Capsule
1. A 47-year-old male presented with abdominal pain, back pain, weight loss, and worsening diabetes. Imaging showed ill-defined masses in the pancreas. Differential considerations included pancreatic malignancy or autoimmune pancreatitis.
2. Endoscopic ultrasound-guided fine needle aspiration of the masses was nondiagnostic but showed no malignancy. Surgery found an infiltrative pancreatic mass but biopsy again showed no malignancy.
3. Follow up showed jaundice and imaging characteristics suggestive of autoimmune pancreatitis. Histopathology and elevated IgG4 supported a diagnosis of type 1 autoimmune pancreatitis. The patient was started
Chronic Abdominal Pain in Children
This panel session discusses various causes and management of recurrent abdominal pain (RAP) in children. Common causes include functional causes (70-75%), psychogenic causes (12-15%), and organic causes (10-15%). The document provides guidance on evaluating a child with constipation, discussing the importance of obtaining a thorough history. It also reviews common and rare organic causes of abdominal pain in children and discusses approaches to investigating and managing a child with suspected functional abdominal pain.
Role of Surgery in CA Oesophagus
This document discusses surgical options for treating carcinoma of the esophagus, focusing on esophagectomy. It describes the main debate around open esophagectomy approaches like transhiatal versus en-bloc resection. While en-bloc may provide better survival, it also increases morbidity. Transhiatal esophagectomy provides relief of dysphagia with less morbidity but similar survival and is still a valid option. Minimally invasive esophagectomy is presented as a promising newer approach with benefits like less pulmonary complications and shorter hospital stay based on early studies, but more research is still needed.
Obscure G I BLEED
A 48-year-old man presented with rectal bleeding and was found to have diffuse submucosal edema in the distal jejunum and ileum, along with beading in the superior mesenteric artery branches and narrowing of the ileal vas recta. He was diagnosed with polyarteritis nodosa (PAN) based on these imaging findings and clinical course. PAN is a necrotizing vasculitis typically involving medium-sized arteries. The patient was treated with steroids and anticoagulation for PAN and associated pulmonary thromboembolism. He was later discharged after improvement of symptoms.
Approach to Constipation
The document discusses the evaluation and management of constipation. It outlines the clinical approach which includes determining if it is constipation, identifying potential causes like drugs or disease, and checking for alarm symptoms. Evaluation involves examination, labs like TSH and calcium, and tests like anorectal manometry and balloon expulsion tests to classify constipation and identify defecatory disorders. Biofeedback therapy is described as the treatment of choice for defecatory disorders by training muscles through visual cues. Surgery may be considered for issues like rectocele or Hirschsprung's disease.
NUCs in Chronic Hepatitis B
HBV has been associated with humans for over 1,000 years. Recent evidence from a mummified Korean child who tested positive for HBV DNA establishes that HBV has been present in humans for at least 500 years. Treatment guidelines recommend antiviral therapy for patients with chronic HBV based on HBV DNA levels and ALT levels. Tenofovir and entecavir are preferred first-line treatments due to their superior efficacy, tolerability and low resistance profiles. Long-term antiviral therapy can reduce the risk of liver decompensation, hepatocellular carcinoma, and death in patients with chronic HBV.
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. Cbd stones
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