The document provides information on the management of massive gastrointestinal hemorrhage. It discusses that the majority of massive GI bleeds originate from the upper GI tract. The initial management of a patient with massive GI hemorrhage involves airway protection, intravenous fluid resuscitation, monitoring of vital signs, and blood transfusions if indicated. Early endoscopy within 4 hours is advocated for diagnostic and therapeutic purposes such as locating the bleeding site and achieving hemostasis. Additional procedures like angiography may be used if endoscopy is unsuccessful or for lower GI bleeds. Antibiotic prophylaxis is recommended for patients with cirrhosis to reduce infectious complications. Restrictive blood transfusion strategies with a hemoglobin threshold of 7-8 g
This document discusses the management of variceal bleeding, specifically focusing on esophageal and gastric varices. It provides an overview of endoscopic and medical therapies for controlling acute esophageal variceal bleeding such as endoscopic band ligation, sclerotherapy, and pharmacologic therapies like octreotide. For gastric varices, it describes different classification systems and challenges in managing bleeding, noting endoscopic therapies like sclerotherapy, ligation, and glue injection can control acute bleeding but have high rebleeding risks. It emphasizes a multidisciplinary approach is often needed for gastric variceal management.
This document discusses the causes and management of upper gastrointestinal bleeding. It begins by listing common causes such as portal hypertension, peptic ulcer disease, angiomatous malformations, and neoplasms. For portal hypertension, it focuses on variceal bleeding and techniques for controlling acute variceal hemorrhage such as band ligation, sclerotherapy, and cyanoacrylate injection. For peptic ulcer disease, it covers risk assessment using the Forrest classification and Rockall score, medical and endoscopic treatment options, and the role of H. pylori eradication. It also briefly discusses less common causes of upper GI bleeding like Dieulafoy lesions and telangectasia.
This document discusses the approach to patients with upper gastrointestinal bleeding and its management. It covers the following key points in 3 sentences:
The document outlines sources of GI bleeding, signs of blood loss severity, immediate assessment steps, diagnostic testing, endoscopic treatment options for variceal and non-variceal bleeding, risk stratification tools like the Rockall score, and angioembolization as a treatment option. Management involves fluid resuscitation, identifying the bleeding source, stopping active bleeding endoscopically, treating underlying causes, preventing rebleeding, and considering a second look endoscopy or other interventions based on risk stratification. Outpatient management may be appropriate for low risk patients while higher risk patients require intensive
This document provides an overview of gastrointestinal bleeding, including:
- Clinical presentation and definitions of upper and lower GI bleeding
- Core principles of assessment, stabilization, determining bleeding source, stopping active bleeding, and treatment/prevention
- Risk stratification based on vital signs and estimated blood loss
- Differential diagnosis and management of acute upper GI bleeding including endoscopic findings, therapies, and outcomes
- Risk factors, scoring systems, and definitions used in gastrointestinal bleeding management
Anselmo A. Cirrosi Epatica e Tumori del Fegato: dalla Resezione al Trapianto....Gianfranco Tammaro
The document discusses cirrhosis and liver tumors, from resection to transplantation. It covers:
- The epidemiology of liver cancer, including risk factors, global incidence, and age-specific incidence.
- The pathogenesis and risk factors involved in the development of hepatocellular carcinoma (HCC).
- The clinical features, diagnosis, and management of HCC according to guidelines from EASL and other sources.
- Treatment options for HCC including resection, transplantation, and prevention.
All you need to know about peri-ampullary cancer
Periampullary cancer is a common diagnosis with patient with progressive jaundice in northern part of India
Timely diagnosis and proper treatment in a way towards cure
ACUTE GASTROINTESTINAL HAEMORRHAGE - NON VARICEAL BLEEDINGArkaprovo Roy
Peptic ulcer disease is the most common cause of non-variceal upper GI bleeding, accounting for 30-50% of cases. Initial management involves resuscitation followed by endoscopy within 24 hours to locate the source of bleeding and apply appropriate treatment such as thermal therapy or hemoclip application. Surgery is reserved for cases with continued or recurrent bleeding despite endoscopic treatment. Proper risk stratification and management can reduce mortality rates from GI bleeding.
This document discusses the management of variceal bleeding, specifically focusing on esophageal and gastric varices. It provides an overview of endoscopic and medical therapies for controlling acute esophageal variceal bleeding such as endoscopic band ligation, sclerotherapy, and pharmacologic therapies like octreotide. For gastric varices, it describes different classification systems and challenges in managing bleeding, noting endoscopic therapies like sclerotherapy, ligation, and glue injection can control acute bleeding but have high rebleeding risks. It emphasizes a multidisciplinary approach is often needed for gastric variceal management.
This document discusses the causes and management of upper gastrointestinal bleeding. It begins by listing common causes such as portal hypertension, peptic ulcer disease, angiomatous malformations, and neoplasms. For portal hypertension, it focuses on variceal bleeding and techniques for controlling acute variceal hemorrhage such as band ligation, sclerotherapy, and cyanoacrylate injection. For peptic ulcer disease, it covers risk assessment using the Forrest classification and Rockall score, medical and endoscopic treatment options, and the role of H. pylori eradication. It also briefly discusses less common causes of upper GI bleeding like Dieulafoy lesions and telangectasia.
This document discusses the approach to patients with upper gastrointestinal bleeding and its management. It covers the following key points in 3 sentences:
The document outlines sources of GI bleeding, signs of blood loss severity, immediate assessment steps, diagnostic testing, endoscopic treatment options for variceal and non-variceal bleeding, risk stratification tools like the Rockall score, and angioembolization as a treatment option. Management involves fluid resuscitation, identifying the bleeding source, stopping active bleeding endoscopically, treating underlying causes, preventing rebleeding, and considering a second look endoscopy or other interventions based on risk stratification. Outpatient management may be appropriate for low risk patients while higher risk patients require intensive
This document provides an overview of gastrointestinal bleeding, including:
- Clinical presentation and definitions of upper and lower GI bleeding
- Core principles of assessment, stabilization, determining bleeding source, stopping active bleeding, and treatment/prevention
- Risk stratification based on vital signs and estimated blood loss
- Differential diagnosis and management of acute upper GI bleeding including endoscopic findings, therapies, and outcomes
- Risk factors, scoring systems, and definitions used in gastrointestinal bleeding management
Anselmo A. Cirrosi Epatica e Tumori del Fegato: dalla Resezione al Trapianto....Gianfranco Tammaro
The document discusses cirrhosis and liver tumors, from resection to transplantation. It covers:
- The epidemiology of liver cancer, including risk factors, global incidence, and age-specific incidence.
- The pathogenesis and risk factors involved in the development of hepatocellular carcinoma (HCC).
- The clinical features, diagnosis, and management of HCC according to guidelines from EASL and other sources.
- Treatment options for HCC including resection, transplantation, and prevention.
All you need to know about peri-ampullary cancer
Periampullary cancer is a common diagnosis with patient with progressive jaundice in northern part of India
Timely diagnosis and proper treatment in a way towards cure
ACUTE GASTROINTESTINAL HAEMORRHAGE - NON VARICEAL BLEEDINGArkaprovo Roy
Peptic ulcer disease is the most common cause of non-variceal upper GI bleeding, accounting for 30-50% of cases. Initial management involves resuscitation followed by endoscopy within 24 hours to locate the source of bleeding and apply appropriate treatment such as thermal therapy or hemoclip application. Surgery is reserved for cases with continued or recurrent bleeding despite endoscopic treatment. Proper risk stratification and management can reduce mortality rates from GI bleeding.
Management of acute lymphoblatic leukemia with light on etiology, clinical features, diagnosis and different aspects of management including chemotherapy and radiation therapy
This document discusses gastrointestinal bleeding, focusing on upper GI bleeding (UGIB) and lower GI bleeding (LGIB). It covers the typical presentation, evaluation, and management of acute UGIB and LGIB. For UGIB, initial management involves hemodynamic stabilization, upper endoscopy to identify the source within 12 hours, and endoscopic therapy if possible. For high risk lesions, angiography or surgery may be needed. For LGIB, initial steps are the same while colonoscopy is preferred for evaluation once stable, though angiography can be used if bleeding is ongoing. Most episodes of UGIB and LGIB stop spontaneously without intervention.
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
This document summarizes the presentation, evaluation, and management of a 70-year-old man with upper gastrointestinal bleeding due to esophageal varices from liver cirrhosis. Key points include: the patient presented with blood vomiting and black stools; examination found dehydration and signs of liver disease; endoscopy revealed esophageal varices that were banded to stop the bleeding. Variceal bleeding is a complication of portal hypertension in cirrhosis and has high rebleeding risks. Initial stabilization is followed by endoscopic treatment, vasoactive drugs, and antibiotics to prevent rebleeding.
UGIB can be defined as bleeding from the gastrointestinal tract above the ligament of Treitz. The most common causes are peptic ulcers, varices, and Mallory-Weiss tears. Presentation includes hematemesis, melena, hematochezia, or signs of blood loss. Management involves resuscitation, endoscopic diagnosis and treatment such as band ligation or coagulation, and drug therapy like PPIs or vasoconstrictors. Prognosis depends on age, comorbidities, signs of shock, and rebleeding risk.
HEPATOCELLULAR AND GALL BLADDER CARCINOMA.pptxMkindi Mkindi
Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the third leading cause of cancer deaths worldwide. Risk factors include hepatitis B and C infections, aflatoxin exposure, and alcohol use. Screening with ultrasound and alpha-fetoprotein (AFP) levels can detect HCC early in high-risk patients with cirrhosis. Treatment depends on tumor stage but may include surgical resection, liver transplantation, radiofrequency ablation, chemoembolization, or the drug sorafenib for advanced disease. Prognosis is generally poor due to late stage at presentation, with a 5-year survival rate of less than 10% for untreated HCC.
This document summarizes guidelines for the management of upper gastrointestinal bleeding (UGIB). It discusses initial patient assessment and risk stratification, the role of endoscopy within 24 hours, endoscopic findings that predict risk of rebleeding, endoscopic therapies, post-endoscopy management including PPI infusion, and strategies to prevent recurrent bleeding related to causes like H. pylori and NSAID use. Endoscopy is important to determine the source of bleeding and apply therapies when needed to reduce risks of additional bleeding, surgery, and mortality. Post-endoscopy care involves PPI therapy and follow up based on risk level.
1. The document summarizes guidelines for the management of bleeding duodenal ulcers, including the etiology, risk factors, clinical assessment, endoscopic diagnosis and treatment options.
2. Key recommendations include performing early endoscopy within 24 hours, using the Forrest classification system to assess bleeding risk, and employing combination endoscopic therapy with epinephrine injection and thermal coagulation or clipping for high risk stigmata.
3. Doppler ultrasound may help guide endoscopic therapy by identifying persistent blood flow signals requiring further treatment to reduce rebleeding risk.
The document discusses the principles of trauma management for abdominal and pelvic injuries, including classifications of injuries, mechanisms of injury, assessment techniques, management approaches like damage control resuscitation and surgery, and guidelines for treatment of specific injuries to the liver, spleen, and other abdominal organs. Case scenarios are presented and management strategies are outlined for various injury patterns and severity.
This document provides an overview of the practical approach to managing non-variceal upper gastrointestinal bleeding. It discusses initial considerations including risk stratification, definitions, differential diagnosis, history and physical exam findings. It then covers resuscitation including fluid management and transfusion thresholds. The role of endoscopy is explained, including optimal timing and findings requiring endoscopic therapy. Risk scores for predicting outcomes and need for intervention are presented. Management strategies before and after endoscopy are outlined.
1. Pancreatic endocrine tumors (PETs) are rare neuroendocrine tumors that arise from pancreatic islet cells. They include functional tumors like insulinomas and gastrinomas, as well as non-functional PETs.
2. Insulinomas are the most common functional PET and cause hypoglycemia. Diagnosis involves demonstrating inappropriate insulin levels during hypoglycemia. Surgical resection is usually curative.
3. Gastrinomas cause Zollinger-Ellison syndrome with severe peptic ulcer disease. They are often malignant and surgical resection offers the best chance of cure if localized.
This document provides an overview of gastrointestinal bleeding, including:
- Clinical presentation and definitions of upper and lower GI bleeding
- Core principles of assessment, stabilization, determining bleeding source, stopping active bleeding, and treatment/prevention
- Risk stratification scoring systems like Blatchford and Rockall scores
- Differential diagnosis and management of acute upper GI bleeding from sources like peptic ulcers, varices, and Mallory-Weiss tears
- Endoscopic findings, therapies, and outcomes for peptic ulcer bleeding
- Management of variceal bleeding with band ligation or TIPS procedures
- Guidelines for antibiotic prophylaxis and management of ulcer bleeding from professional organizations
This document summarizes primary and secondary liver malignancies, their management, and principles of liver resection. It covers hepatocellular carcinoma (HCC), the most common primary liver cancer, risk factors, presentation, diagnosis, staging, and treatment options. Intrahepatic cholangiocarcinoma and metastatic tumors to the liver are also discussed. Surgical resection is the main curative treatment for early-stage HCC and intrahepatic cholangiocarcinoma when possible.
Upper Gastrointestinal Bleeding (UGIB) - General ApproachMohamed Badheeb
What does the science & evidence say about UGIB ?
Introduction & Background on Upper GI Bleeding.
- Incidence and Epidemiology
- Etiologies
2. Guidelines on UGIB
- Resuscitation, Risk assessment
- Diagnostic Modalities
- Treatment Options
- The document provides an overview of gastrointestinal bleeding (GIB), including causes, evaluation, and management.
- Common causes of upper GI bleeding (UGIB) include peptic ulcer disease, esophageal varices, esophagitis, and malignancy. Evaluation involves history, physical exam, and laboratory tests to assess severity and risk of rebleeding.
- Initial management of UGIB includes IV fluids, blood transfusions if needed, and upper endoscopy within 24 hours to identify the source of bleeding and guide treatment. Management depends on the cause and risk of rebleeding.
Budd-Chiari syndrome is a condition where there is an interruption or diminution of normal blood flow out of the liver. It commonly involves thrombosis of the hepatic veins and/or inferior vena cava. Underlying causes can be identified in over 80% of patients and often involve multiple thrombotic risk factors. Common clinical manifestations include ascites, hepatomegaly, abdominal pain, and hepatic outflow obstruction of the hepatic veins or inferior vena cava. Diagnosis involves imaging modalities like Doppler ultrasonography, CT scan, MRI, or venography. Treatment options depend on whether the condition is acute, subacute, or chronic and may include supportive care, anticoagulation, thrombolytic therapy
This document provides an overview of upper gastrointestinal bleeding (UGIB), including its definition, classification, epidemiology, clinical features, diagnostic evaluation, and management. Some key points:
1. UGIB is more common than lower GI bleeding, with a reported incidence of 170 patients per 100,000 population per year. The most common cause is peptic ulcer disease (40% of cases).
2. Risk of rebleeding is higher in patients on antiplatelet therapy and those with recurrent bleeding within 48-72 hours. Mortality is 5-10% for severe UGIB.
3. Diagnostic evaluation includes endoscopy within 24 hours to identify the source of bleeding, as well as
Malignant ascites, an abnormal accumulation of fluid in the abdominal cavity, is commonly associated with cancers like ovarian cancer, gastrointestinal cancers, and breast cancer. It develops due to mechanical obstruction of lymphatic drainage by tumors and increased vascular permeability caused by cytokines. Diagnosis involves abdominal ultrasound or CT scan followed by diagnostic paracentesis of the fluid to examine for malignant cells. Treatment options include dietary salt restriction, diuretics, repeated paracentesis, indwelling catheters, peritoneovenous shunting, and intraperitoneal chemotherapy.
Management of acute lymphoblatic leukemia with light on etiology, clinical features, diagnosis and different aspects of management including chemotherapy and radiation therapy
This document discusses gastrointestinal bleeding, focusing on upper GI bleeding (UGIB) and lower GI bleeding (LGIB). It covers the typical presentation, evaluation, and management of acute UGIB and LGIB. For UGIB, initial management involves hemodynamic stabilization, upper endoscopy to identify the source within 12 hours, and endoscopic therapy if possible. For high risk lesions, angiography or surgery may be needed. For LGIB, initial steps are the same while colonoscopy is preferred for evaluation once stable, though angiography can be used if bleeding is ongoing. Most episodes of UGIB and LGIB stop spontaneously without intervention.
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
This document summarizes the presentation, evaluation, and management of a 70-year-old man with upper gastrointestinal bleeding due to esophageal varices from liver cirrhosis. Key points include: the patient presented with blood vomiting and black stools; examination found dehydration and signs of liver disease; endoscopy revealed esophageal varices that were banded to stop the bleeding. Variceal bleeding is a complication of portal hypertension in cirrhosis and has high rebleeding risks. Initial stabilization is followed by endoscopic treatment, vasoactive drugs, and antibiotics to prevent rebleeding.
UGIB can be defined as bleeding from the gastrointestinal tract above the ligament of Treitz. The most common causes are peptic ulcers, varices, and Mallory-Weiss tears. Presentation includes hematemesis, melena, hematochezia, or signs of blood loss. Management involves resuscitation, endoscopic diagnosis and treatment such as band ligation or coagulation, and drug therapy like PPIs or vasoconstrictors. Prognosis depends on age, comorbidities, signs of shock, and rebleeding risk.
HEPATOCELLULAR AND GALL BLADDER CARCINOMA.pptxMkindi Mkindi
Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the third leading cause of cancer deaths worldwide. Risk factors include hepatitis B and C infections, aflatoxin exposure, and alcohol use. Screening with ultrasound and alpha-fetoprotein (AFP) levels can detect HCC early in high-risk patients with cirrhosis. Treatment depends on tumor stage but may include surgical resection, liver transplantation, radiofrequency ablation, chemoembolization, or the drug sorafenib for advanced disease. Prognosis is generally poor due to late stage at presentation, with a 5-year survival rate of less than 10% for untreated HCC.
This document summarizes guidelines for the management of upper gastrointestinal bleeding (UGIB). It discusses initial patient assessment and risk stratification, the role of endoscopy within 24 hours, endoscopic findings that predict risk of rebleeding, endoscopic therapies, post-endoscopy management including PPI infusion, and strategies to prevent recurrent bleeding related to causes like H. pylori and NSAID use. Endoscopy is important to determine the source of bleeding and apply therapies when needed to reduce risks of additional bleeding, surgery, and mortality. Post-endoscopy care involves PPI therapy and follow up based on risk level.
1. The document summarizes guidelines for the management of bleeding duodenal ulcers, including the etiology, risk factors, clinical assessment, endoscopic diagnosis and treatment options.
2. Key recommendations include performing early endoscopy within 24 hours, using the Forrest classification system to assess bleeding risk, and employing combination endoscopic therapy with epinephrine injection and thermal coagulation or clipping for high risk stigmata.
3. Doppler ultrasound may help guide endoscopic therapy by identifying persistent blood flow signals requiring further treatment to reduce rebleeding risk.
The document discusses the principles of trauma management for abdominal and pelvic injuries, including classifications of injuries, mechanisms of injury, assessment techniques, management approaches like damage control resuscitation and surgery, and guidelines for treatment of specific injuries to the liver, spleen, and other abdominal organs. Case scenarios are presented and management strategies are outlined for various injury patterns and severity.
This document provides an overview of the practical approach to managing non-variceal upper gastrointestinal bleeding. It discusses initial considerations including risk stratification, definitions, differential diagnosis, history and physical exam findings. It then covers resuscitation including fluid management and transfusion thresholds. The role of endoscopy is explained, including optimal timing and findings requiring endoscopic therapy. Risk scores for predicting outcomes and need for intervention are presented. Management strategies before and after endoscopy are outlined.
1. Pancreatic endocrine tumors (PETs) are rare neuroendocrine tumors that arise from pancreatic islet cells. They include functional tumors like insulinomas and gastrinomas, as well as non-functional PETs.
2. Insulinomas are the most common functional PET and cause hypoglycemia. Diagnosis involves demonstrating inappropriate insulin levels during hypoglycemia. Surgical resection is usually curative.
3. Gastrinomas cause Zollinger-Ellison syndrome with severe peptic ulcer disease. They are often malignant and surgical resection offers the best chance of cure if localized.
This document provides an overview of gastrointestinal bleeding, including:
- Clinical presentation and definitions of upper and lower GI bleeding
- Core principles of assessment, stabilization, determining bleeding source, stopping active bleeding, and treatment/prevention
- Risk stratification scoring systems like Blatchford and Rockall scores
- Differential diagnosis and management of acute upper GI bleeding from sources like peptic ulcers, varices, and Mallory-Weiss tears
- Endoscopic findings, therapies, and outcomes for peptic ulcer bleeding
- Management of variceal bleeding with band ligation or TIPS procedures
- Guidelines for antibiotic prophylaxis and management of ulcer bleeding from professional organizations
This document summarizes primary and secondary liver malignancies, their management, and principles of liver resection. It covers hepatocellular carcinoma (HCC), the most common primary liver cancer, risk factors, presentation, diagnosis, staging, and treatment options. Intrahepatic cholangiocarcinoma and metastatic tumors to the liver are also discussed. Surgical resection is the main curative treatment for early-stage HCC and intrahepatic cholangiocarcinoma when possible.
Upper Gastrointestinal Bleeding (UGIB) - General ApproachMohamed Badheeb
What does the science & evidence say about UGIB ?
Introduction & Background on Upper GI Bleeding.
- Incidence and Epidemiology
- Etiologies
2. Guidelines on UGIB
- Resuscitation, Risk assessment
- Diagnostic Modalities
- Treatment Options
- The document provides an overview of gastrointestinal bleeding (GIB), including causes, evaluation, and management.
- Common causes of upper GI bleeding (UGIB) include peptic ulcer disease, esophageal varices, esophagitis, and malignancy. Evaluation involves history, physical exam, and laboratory tests to assess severity and risk of rebleeding.
- Initial management of UGIB includes IV fluids, blood transfusions if needed, and upper endoscopy within 24 hours to identify the source of bleeding and guide treatment. Management depends on the cause and risk of rebleeding.
Budd-Chiari syndrome is a condition where there is an interruption or diminution of normal blood flow out of the liver. It commonly involves thrombosis of the hepatic veins and/or inferior vena cava. Underlying causes can be identified in over 80% of patients and often involve multiple thrombotic risk factors. Common clinical manifestations include ascites, hepatomegaly, abdominal pain, and hepatic outflow obstruction of the hepatic veins or inferior vena cava. Diagnosis involves imaging modalities like Doppler ultrasonography, CT scan, MRI, or venography. Treatment options depend on whether the condition is acute, subacute, or chronic and may include supportive care, anticoagulation, thrombolytic therapy
This document provides an overview of upper gastrointestinal bleeding (UGIB), including its definition, classification, epidemiology, clinical features, diagnostic evaluation, and management. Some key points:
1. UGIB is more common than lower GI bleeding, with a reported incidence of 170 patients per 100,000 population per year. The most common cause is peptic ulcer disease (40% of cases).
2. Risk of rebleeding is higher in patients on antiplatelet therapy and those with recurrent bleeding within 48-72 hours. Mortality is 5-10% for severe UGIB.
3. Diagnostic evaluation includes endoscopy within 24 hours to identify the source of bleeding, as well as
Malignant ascites, an abnormal accumulation of fluid in the abdominal cavity, is commonly associated with cancers like ovarian cancer, gastrointestinal cancers, and breast cancer. It develops due to mechanical obstruction of lymphatic drainage by tumors and increased vascular permeability caused by cytokines. Diagnosis involves abdominal ultrasound or CT scan followed by diagnostic paracentesis of the fluid to examine for malignant cells. Treatment options include dietary salt restriction, diuretics, repeated paracentesis, indwelling catheters, peritoneovenous shunting, and intraperitoneal chemotherapy.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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2. CASE
• 50 yo female with massivehematemesis
• Hypotensive and tachycardic, drowsy
• Initial actions?
3. Facts
•Majority (>75%) of massiveGIbleed is from the
upper GI tract (Proximal to ligament of Treitz– D4)
•Majority of the LGIBleeding is self limiting
•More common in males and in the elderly (>60),
antiplatelet use/anticoagulants/co-morbidities.
•Mortality 5-10%
5. Clinical features
• Upper abdominal pain
• Odynophagia, gastro-esophageal reflux, dysphagia
• Emesis, retching, or coughing prior to hematemesis
• Jaundice, abdominal distention (ascites)
• Dysphagia, early satiety, involuntary weight loss, cachexia
• Hematochezia, Melena, Occult GI bleed(anemic symptoms)
6. Physical Examination
• Resting tachycardia, orthostatic blood pressure changes
suggest moderate to severe blood loss;
• Hypotension suggests life-threatening blood loss(>40% of
body volume)
• Rectal examination is performed to assess stool color
(melena versus hematochezia)
• Significant abdominal tenderness accompanied by signs of
peritoneal irritation (eg, involuntary guarding) suggests
perforation
7. Rockall Score
Variable Score 0 Score 1 Score 2 Score 3
Age <60 60-79 >80
Blood pressure fall
(Shock)
No shock Pulse >100
BP >100 systolic
SBP <100
Co morbidity Nil Major CHF, IHD ESRD, Liver failure,
metastatic disease
Diagnosis Mallory Weiss All other Diagnosis GI malignancy
Evidence of bleeding None Blood, Adherent
clot, Spurting vessel
A score of less than 3 carries good prognosis, but a total score of more
than 8 carries high risk of mortality.
9. Fluid resuscitation
• Administer IVFs (Crystalloids) in well-defined boluses (eg,
500 to 1000 mL) that can be repeated until blood pressure
and tissue perfusion are acceptable. (Aiming for a perfusing
MAP>65)
• NGT and gastric lavage not useful in risk stratification, may
play role in improving visualization for endoscopy.
10. Investigations
• Bedside: ECG, VBG
• Initial investigations
-CBC with differential, platelet count,Hct
-Group and cross match
-Coags– INR:<2 (for endoscopy),D-dimer
-U&E; urea andcreatinine ratio - 30:1
-LFT- Toassessforcirrhosis
-Cardiac enzymes –Trop T/I – elderly pt toexclude
AMI in large bleed
-Imaging– CXR
-Consult- Gastroenterology / IR, Surgery if indicated
11. Blood Transfusions
• Hemodynamic instability despite crystalloid resuscitation
• Hemoglobin <9 g/dL (90 g/L) in high-risk patients (eg, elderly,
coronary artery disease0
• Hemoglobin <7 g/dL (70 g/L) in low-risk patients
• Give fresh frozen plasma for coagulopathy; give platelets for
thrombocytopenia (platelets <50,000) or platelet dysfunction (eg,
chronic aspirin therapy)
• 1 FFP should generally be transfused every 4 pRBC transfusions.
• Transfusing pt with Hb levels <7-8 (Restrictive BT) –
-Decreases rebleeding
-Reduces complications
-Increases survival
• Hbideally >9-10g/dL for unstable CAD/Elderly
12. Pharmacologic therapy
1.ProtonPumpInhibitors–Inhibitiongastric
H+/K+ATPase/neutralizationofgastricacid/Pepsin
• Current empiricin acute UGIB
Hasbeenthe mainstay early treatment/Adjunct toendoscopy
• Proposedreduction in haemorrhageduring endoscopy,noimmediate
impact.
• Given mainly to prevent rebleeding.
• Esomeprazole 40mg IV BD after initial 80 mg bolus.
2. Prokinetics- The goal of using a prokinetic agent is to improve
gastric visualization at the time of endoscopy by
clearing the stomach of blood, clots, and foodresidue.
eg- erythromycin or metoclopramide (A dose of
3 mg/kg intravenously over 20 to 30 minutes)
13. Cont.
3. Vasoactive medications-
-Reduction of portal HTN via splanchnic and systemic
vasoconstriction
-In patients with suspected variceal bleeding, octreotide is given as an
intravenous bolus of 20 to 50 mcg, followed by a continuous infusion
at a rate of 25 to 50 mcg per hour
4. Antibiotics for patients with cirrhosis- May reduce
risk of recurrence bleeding in variceal bleeding/Prior or after
endoscopy – 23% infection prevention.
16. Colonoscopy
• Full length colonoscopy is the most important
investigation in a patient with suspected Lower GI
bleed. It helps in visualizing from rectum to the last 10-
15 cms of terminal ileum
•Therapeutic uses are
1-Electro-cauterization of bleeding points
2-Polypectomy
• Diagnostic uses are
1- Imaging
2- Biopsy of thelesion
18. Disposition
• ICU – Hct<30%, syst BP<100, Hx cirrhosis/ascites, vomiting
frank red blood, Hematochezia.
• Manage complications.
• Early involvement of sub specialities
• Risk Stratification – Rockall / Modified Blatchford/ AIMS65
19. Some Interesting studies
• In a meta-analysis of five randomized trials with a total of 1965 patients with acute upper
gastrointestinal bleeding, patients assigned to a restrictive transfusion strategy were at lower
risk than those assigned to a liberal transfusion strategy for mortality (absolute risk reduction
[ARR] 2.2 percent, relative risk [RR] 0.65, 95% CI 0.44-0.97) and rebleeding (ARR 4.4 percent,
RR 0.58, 0.40-0.84).
• A meta-analysis examined five trials with 316 patients who were assigned to erythromycin,
metoclopramide and placebo. The analysis found that the use of a prokinetic agent decreased
the need for second-look endoscopy, but did not affect the number of units of blood transfused,
length of hospital stay, or need for surgery. In subgroup analyses, erythromycin continued to
show a benefit with regard to the need for second-look endoscopy, but metoclopramide did not.
• Multiple trials evaluating the effectiveness of prophylactic antibiotics in cirrhotic patients
hospitalized for GI bleeding suggest an overall reduction in infectious complications and
possibly decreased mortality. Antibiotics may also reduce the risk of recurrent bleeding in
hospitalized patients who bled from esophageal varices. A reasonable conclusion from these
data is that patients with cirrhosis who present with acute upper GI bleeding (from varices or
other causes) should be given prophylactic antibiotics, preferably before endoscopy
• A total of 225 patients assigned to the restrictive strategy (51%), as compared with 61 assigned
to the liberal strategy (14%), did not receive transfusions (P<0.001) [corrected].The probability
of survival at 6 weeks was higher in the restrictive-strategy group than in the liberal-strategy
group (95% vs. 91%; hazard ratio for death with restrictive strategy, 0.55; 95% confidence
interval [CI], 0.33 to 0.92; P=0.02).
20. Questions?
• References-
- Barkun A, Bardou M, Marshall JK, Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus
recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003;
139:843.
• Hwang JH, Fisher DA, Ben-Menachem T, et al. The role of endoscopy in the management of acute non-variceal upper GI
bleeding. Gastrointest Endosc 2012; 75:1132.
- Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal
hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47:a1.
- LongstrethGF.Epidemiologyof hospitalization for acuteuppergastrointestinal hemorrhage:apopulation-basedstudy.AmJ
Gastroenterol 1995; 90:206.
Hinweis der Redaktion
Blood volume loss of at least 15 percent- orthostatic hypotension.
The studies suggested that a single dose of intravenous erythromycin given 20 to 120 minutes before endoscopy can significantly improve visibility, shorten endoscopy time, and reduce the need for second-look endoscopy
Bacterial infections are present in up to 20 percent of patients with cirrhosis who are hospitalized with gastrointestinal bleeding; up to an additional 50 percent develop an infection while hospitalized. We typically use a broad spectrum antibiotic such as ceftriaxone (1 g intravenously daily for seven days).