Gallbladder-Appendicular Fistula
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Mouth Esophagus Stomach Rectum and Anus Large Intestine Small
1 Liver The liver produces bile, which aids in digestion of fats through a dissolving process known as emulsification. In this process, bile secreted into the small intestine 4 combines with large drops of liquid fat to form Healthy tiny molecular-sized spheres. Within these spheres (micelles), pancreatic enzymes can break down fat (triglycerides) into free fatty acids. Pancreas Digestion The pancreas not only regulates blood glucose 2 levels through production of insulin, but it also manufactures enzymes necessary to break complex The digestive system consists of a long tube (alimen- 5 carbohydrates down into simple sugars (sucrases), tary canal) that varies in shape and purpose as it winds proteins into individual amino acids (proteases), and its way through the body from the mouth to the anus fats into free fatty acids (lipase). These enzymes are (see diagram). The size and shape of the digestive tract secreted into the small intestine. varies in each individual (e.g., age, size, gender, and disease state). The upper part of the GI tract includes the mouth, throat (pharynx), esophagus, and stomach. The lower Gallbladder part includes the small intestine, large intestine, The gallbladder stores bile produced in the liver appendix, and rectum. While not part of the alimentary 6 and releases it into the duodenum in varying canal, the liver, pancreas, and gallbladder are all organs concentrations. that are vital to healthy digestion. 3 Small Intestine Mouth Within the small intestine, millions of tiny finger-like When food enters the mouth, chewing breaks it 4 protrusions called villi, which are covered in hair-like down and mixes it with saliva, thus beginning the first 5 protrusions called microvilli, aid in absorption of of many steps in the digestive process. -
Risk Factors of Biliary Peritonitis Following T-Tube Removal- the Unsolved Problem
Jemds.com Original Research Article Risk Factors of Biliary Peritonitis following T-Tube Removal- The Unsolved Problem Partha Pratim Barua1, Devid Hazarika2, Khorshid Alom Hussain3 1Associate Professor, Department of Surgery, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India. 2Assistant Professor, Department of Surgery, Assam Medical College, Dibrugarh, Assam, India. 3Registrar, Department of Surgery, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India. ABSTRACT BACKGROUND Gall stone disease remains one of the most common problems leading to surgical Corresponding Author: intervention. About 15% of all gall stone disease patients have stones in the common Devid Hazarika, Gunjan’s Aparna Enclave, bile duct (choledocholithiasis). Open choledocholithotomy is still widely performed, Hatigarh Chariali, Geetanagar, particularly in centres without ERCP facilities. Though primary repair of the common Guwahati-781021, Assam, India. bile duct is possible, most surgeons prefer to drain the common bile duct with T-tube. E-mail: [email protected] This avoids pressure build up in the CBD in case of oedema around the ampulla of Vater in the immediate post-operative period. Normally, the T-tube is left for 14–20 DOI: 10.14260/jemds/2019/546 days in order to allow a fibrous tract to form around it. In absences of any distal obstruction, the T-tube is removed by gentle traction in the horizontal limb. In Financial or Other Competing Interests: None. majority of the cases no complications occur after tube removal. However, in some patients, biliary peritonitis occurs with varying severity. The aim of this study is to How to Cite This Article: find out if there are yet unrecognized factors that increases the risk of biliary Barua PP, Hazarika D, Hussain KA. -
Multiple Epithelia Are Required to Develop Teeth Deep Inside the Pharynx
Multiple epithelia are required to develop teeth deep inside the pharynx Veronika Oralováa,1, Joana Teixeira Rosaa,2, Daria Larionovaa, P. Eckhard Wittena, and Ann Huysseunea,3 aResearch Group Evolutionary Developmental Biology, Biology Department, Ghent University, B-9000 Ghent, Belgium Edited by Irma Thesleff, Institute of Biotechnology, University of Helsinki, Helsinki, Finland, and approved April 1, 2020 (received for review January 7, 2020) To explain the evolutionary origin of vertebrate teeth from closure of the gill slits (15). Consequently, previous studies have odontodes, it has been proposed that competent epithelium spread stressed the importance of gill slits for pharyngeal tooth formation into the oropharyngeal cavity via the mouth and other possible (12, 13). channels such as the gill slits [Huysseune et al., 2009, J. Anat. 214, Gill slits arise in areas where ectoderm meets endoderm. In 465–476]. Whether tooth formation deep inside the pharynx in ex- vertebrates, the endodermal epithelium of the developing pharynx tant vertebrates continues to require external epithelia has not produces a series of bilateral outpocketings, called pharyngeal been addressed so far. Using zebrafish we have previously demon- pouches, that eventually contact the skin ectoderm at corre- strated that cells derived from the periderm penetrate the oropha- sponding clefts (16). In primary aquatic osteichthyans, most ryngeal cavity via the mouth and via the endodermal pouches and pouch–cleft contacts eventually break through to create openings, connect to periderm-like cells that subsequently cover the entire or gill slits (17–19). In teleost fishes, such as the zebrafish, six endoderm-derived pharyngeal epithelium [Rosa et al., 2019, Sci. -
Immune Functions of the Vermiform Appendix
The Proceedings of the International Conference on Creationism Volume 3 Print Reference: Pages 335-342 Article 30 1994 Immune Functions of the Vermiform Appendix Frank Maas Follow this and additional works at: https://digitalcommons.cedarville.edu/icc_proceedings DigitalCommons@Cedarville provides a publication platform for fully open access journals, which means that all articles are available on the Internet to all users immediately upon publication. However, the opinions and sentiments expressed by the authors of articles published in our journals do not necessarily indicate the endorsement or reflect the views of DigitalCommons@Cedarville, the Centennial Library, or Cedarville University and its employees. The authors are solely responsible for the content of their work. Please address questions to [email protected]. Browse the contents of this volume of The Proceedings of the International Conference on Creationism. Recommended Citation Maas, Frank (1994) "Immune Functions of the Vermiform Appendix," The Proceedings of the International Conference on Creationism: Vol. 3 , Article 30. Available at: https://digitalcommons.cedarville.edu/icc_proceedings/vol3/iss1/30 IMMUNE FUNCTIONS OF THE VERMIFORM APPENDIX FRANK MAAS, M.S. 320 7TH STREET GERVAIS, OR 97026 KEYWORDS Mucosal immunology, gut-associated lymphoid tissues. immunocompetence, appendix (human and rabbit), appendectomy, neoplasm, vestigial organs. ABSTRACT The vermiform appendix Is purported to be the classic example of a vestigial organ, yet for nearly a century it has been known to be a specialized organ highly infiltrated with lymphoid tissue. This lymphoid tissue may help protect against local gut infections. As the vertebrate taxonomic scale increases, the lymphoid tissue of the large bowel tends to be concentrated In a specific region of the gut: the cecal apex or vermiform appendix. -
Appendicitis
Appendicitis National Digestive Diseases Information Clearinghouse The appendix is a small, tube-like structure abdomen. Anyone can get appendicitis, attached to the first part of the large intes- but it occurs most often between the ages tine, also called the colon. The appendix of 10 and 30. is located in the lower right portion of National Institute of the abdomen. It has no known function. Diabetes and Removal of the appendix appears to cause Causes Digestive The cause of appendicitis relates to block- and Kidney no change in digestive function. Diseases age of the inside of the appendix, known Appendicitis is an inflammation of the as the lumen. The blockage leads to NATIONAL INSTITUTES appendix. Once it starts, there is no effec- increased pressure, impaired blood flow, OF HEALTH tive medical therapy, so appendicitis is and inflammation. If the blockage is not considered a medical emergency. When treated, gangrene and rupture (breaking treated promptly, most patients recover or tearing) of the appendix can result. without difficulty. If treatment is delayed, the appendix can burst, causing infection Most commonly, feces blocks the inside and even death. Appendicitis is the most of the appendix. Also, bacterial or viral common acute surgical emergency of the infections in the digestive tract can lead to Inflamed appendix Small intestine Appendix Large intestine U.S. Department The appendix is a small, tube-like structure attached to the first part of the large intestine, also called the colon. The of Health and appendix is located in the lower right portion of the abdomen, near where the small intestine attaches to the large Human Services intestine. -
Incidental Cholecystojejunal Fistula: a Rare Complication of Gall Stone Disease
MedCrave Online Journal of Surgery Case Report Open Access Incidental cholecystojejunal fistula: a rare complication of gall stone disease Abstract Volume 8 Issue 4 - 2020 Cholecystoenteric fistula is a rare complication of gallstone disease and difficult to diagnose Vipul K Srivastava,1 Shilpi Roy,1 Ramniwas preoperatively. Among Cholecystoenteric fistula, cholecystojejunal fistulae are even rarer Meena,2 Rahul Khanna2 and only a few case reports have been published on it. Here we report a case of a 60-year 1Resident, Department of General Surgery, Institute of Medical male patient with cholecystojejunal fistula diagnosed intraoperatively while performing Sciences, India laparoscopic cholecystectomy. Fundus of the gall bladder was found to be communicating 2Professor, Department of General Surgery, Institute of Medical with proximal jejunum. We conclude that in elderly patients if the ultrasonography shows Sciences, India features of contracted gall bladder in presence of large gall stones one should consider an option of getting a computed tomography scan done preoperatively. Correspondence: Dr. Ramniwas Meena, Professor Department of General Surgery, Institute of Medical Sciences Banaras Hindu University, Varanasi–221005, UP, India, Keywords: cholecystoenteric, cholecystojejunal, fistula, gall-stones, cholecystitis Tel +919935141697, Email Received: October 25, 2020 | Published: December 17, 2020 Introduction Cholecystoenteric fistula (CEF) was first described by Courvoisier in 1890. They are a rare complication of gallstone disease and are formed due to ongoing inflammation.1 They are bilioenteric type of Internal Biliary fistula which is rare to find. Preoperative diagnosis of CEF is difficult to make with pneumobilia being the most common radiological finding.2 So here we report a rare case of cholecystojejunal fistula. -
Reflux Esophagitis
Reflux Esophagitis KEY FACTS TERMINOLOGY • Caustic esophagitis • Inflammation of esophageal mucosa due to PATHOLOGY gastroesophageal (GE) reflux • Lower esophageal sphincter: Decreased tone leads to IMAGING increased reflux • Irregular ulcerated mucosa of distal esophagus • Hydrochloric acid and pepsin: Synergistic effect • Foreshortening of esophagus: Due to muscle spasm CLINICAL ISSUES • Inflammatory esophagogastric polyps: Smooth, ovoid • 15-20% of Americans commonly have heartburn due to elevations reflux; ~ 30% fail to respond to standard-dose medical • Hiatal hernia in > 95% of patients with stricture therapy ○ Probably is result, not cause, of reflux ○ Prevalence of GE reflux disease has increased sharply • Peptic stricture (1- to 4-cm length): Concentric, smooth, with obesity epidemic tapered narrowing of distal esophagus • Symptoms: Heartburn, regurgitation, angina-like pain TOP DIFFERENTIAL DIAGNOSES ○ Dysphagia, odynophagia • Scleroderma • Confirmatory testing: Manometric/ambulatory pH- monitoring techniques • Drug-induced esophagitis ○ Endoscopy, biopsy • Infectious esophagitis Imaging in Gastrointestinal Disorders: Diagnoses • Eosinophilic esophagitis (Left) Graphic shows a small type 1 (sliding) hiatal hernia ſt linked with foreshortening of the esophagus, ulceration of the mucosa, and a tapered stricture of distal esophagus. (Right) Spot film from an esophagram shows a small hiatal hernia with gastric folds ſt extending above the diaphragm. The esophagus appears shortened, presumably due to spasm of its longitudinal muscles. A stricture is present at the gastroesophageal (GE) junction, and persistent collections of barium indicate mucosal ulceration. (Left) Prone film from an esophagram shows a tight stricture ſt just above the GE junction with upstream dilation of the esophagus. The herniated stomach is pulled taut as a result of the foreshortening of the esophagus, a common and important sign of reflux esophagitis. -
Appendix B: Muscles of the Speech Production Mechanism
Appendix B: Muscles of the Speech Production Mechanism I. MUSCLES OF RESPIRATION A. MUSCLES OF INHALATION (muscles that enlarge the thoracic cavity) 1. Diaphragm Attachments: The diaphragm originates in a number of places: the lower tip of the sternum; the first 3 or 4 lumbar vertebrae and the lower borders and inner surfaces of the cartilages of ribs 7 - 12. All fibers insert into a central tendon (aponeurosis of the diaphragm). Function: Contraction of the diaphragm draws the central tendon down and forward, which enlarges the thoracic cavity vertically. It can also elevate to some extent the lower ribs. The diaphragm separates the thoracic and the abdominal cavities. 2. External Intercostals Attachments: The external intercostals run from the lip on the lower border of each rib inferiorly and medially to the upper border of the rib immediately below. Function: These muscles may have several functions. They serve to strengthen the thoracic wall so that it doesn't bulge between the ribs. They provide a checking action to counteract relaxation pressure. Because of the direction of attachment of their fibers, the external intercostals can raise the thoracic cage for inhalation. 3. Pectoralis Major Attachments: This muscle attaches on the anterior surface of the medial half of the clavicle, the sternum and costal cartilages 1-6 or 7. All fibers come together and insert at the greater tubercle of the humerus. Function: Pectoralis major is primarily an abductor of the arm. It can, however, serve as a supplemental (or compensatory) muscle of inhalation, raising the rib cage and sternum. (In other words, breathing by raising and lowering the arms!) It is mentioned here chiefly because it is encountered in the dissection. -
Appendicitis US Protocol
Appendicitis US Protocol Reviewed By: Sarah Farley, MD; Shireen Khan, MD; Spencer Lake, MD Last Reviewed: June 2019 Contact: (866) 761-4200 **NOTE for all examinations: 1. CINE clips to be labeled: -MIDLINE structures: “right to left” when longitudinal and “superior to inferior” when transverse -RIGHT/LEFT structures: “lateral to medial” when longitudinal and “superior to inferior” when transverse **each should be 1 sweep, NOT back and forth** General The appendix can be located anywhere in the right abdomen from the liver to the deep pelvis, from lateral of the ascending colon to the midline near the umbilicus. In pregnant patients, the appendix is often displaced into the right upper quadrant. The key to successful scanning is to identify the cecum and focus attention on the likely location of the appendix. When the appendix is inflamed, secondary findings of echogenic fat (inflammation) and fluid may be present to assist in locating the appendix. However, a normal appendix can be more challenging. 1 Strategies for finding the appendix include: 1. Review prior CT abdomen/pelvis or appendix US to see where appendix has been previously. 2. Scan in area of greatest pain (indicated by focal tenderness by 1 finger, not general pain). Label as such. 3. Localize cecum. 4. Localize ileocecal valve, if possible. Equipment: 1. Linear high frequency transducer is required, as this will best demonstrate anatomy of appendix. 2. In larger or obese patients, a curved lower frequency transducer may be used to obtain an overview and localize the cecum first. THEN, switch to the linear probe. a. When you locate the appendix, turn ON harmonics to better visualize the walls and appendiceal lumen together. -
Spontaneous External Biliary Fistula Uncomplicated by Gallstones B.R.P
Postgrad Med J: first published as 10.1136/pgmj.67.786.391 on 1 April 1991. Downloaded from Postgrad Med J (1991) 67, 391 - 392 i) The Fellowship of Postgraduate Medicine, 1991 Spontaneous external biliary fistula uncomplicated by gallstones B.R.P. Birch and S.J. Cox Department ofSurgery, Watford General Hospital, Vicarage Road, Watford, Hertfordshire, UK Summary: External biliary fistulae are rare. Only 65 cases have been reported in the literature and in each instance gallstones were a complicating factor. We report in this paper the first case of spontaneous external (cholecystocutaneous) biliary fistula uncomplicated by gallstones. Introduction External biliary fistulae, first described by Thilesus The necrotic area of the abdominal wall was in 1670 and common in the last century, have initially debrided under local anaesthesia with become rare since the advent of modern biliary antibiotic cover. The patient subsequently became surgery. There have been just 65 cases recorded apyrexial and was transfused to correct her since 19001,'2 and all of these were complicated by anaemia. gallstones. We report here the first case of spon- Four days after debridement the patient was taneous external biliary fistula in which gallstones returned to theatre for examination under anaes- were not a complicating factor. thetic. This showed there was a very narrow fistula communicating intra-abdominally. A decision was copyright. made to proceed to laparotomy. An incision was Case report made encompassing all necrotic tissues on the abdominal wall and the fistula was seen to be A 79 year old woman was admitted with a painful communicating with the fundus of the gallbladder, mass in the right upper quadrant ofher abdominal which was adherent to the anterior abdominal wall. -
The British Society of Gastroenterology
Gut: first published as 10.1136/gut.19.5.A432 on 1 May 1978. Downloaded from Gut, 1978, 19, A432-A458 The British Society of Gastroenterology The Spring Meeting of the BSG, together with the BSDE, took place at Warwick University, Coventry, from 31 March to 1 April. The meeting was largely given up to parallel sessions of scientific communications, abstracts of which appear below. During the proceedings, the President of the BSG, Dr. W. Sircus, presented Dr. D. B. Silk with the Research Medal for 1977-8: Dr. Silk later addressed the Society on 'Peptide transport in the human small intestine'. A varied social programme included a medieval banquet in Warwick Castle. R. FERGUSON AND MICHAEL ATKINSON recently managed three patients who bled ENDOSCOPY (General Hospital, Nottingham) In 43 from an angiomatous lesion of the patients (mean age 67 years) with benign gastric antrum. Each patient presented Disinfection of upper gastrointestinal fibre- oesophageal stricture caused by gastro- with a profound iron deficiency anaemia optic equipment oesophageal reflux, after initial dilatation due to persistent gastrointestinal blood by the Eder Puestow method, active loss. Barium studies of the upper and D. L. CARR-LOCKE AND P. CLAYTON medical measures were instituted. lower gastrointestinal tract failed to (Area Endoscopy Unit and Department of Ten subjects have not required further demonstrate the cause for the bleeding. Microbiology, Leicester General Hospital, dilatation after periods ranging from Gastroscopy in each patient demonstrated Leicester) As there is little information three months to three years, and 27 a striking antral abnormality consisting of available on the bacteriological con- have needed further dilatation. -
Management of Postoperative Biliary Fistula After Hydatid Liver Surgery
arch and se D e e v R f e l o o l p a m n r e Gokhan et al., J Res Development 2016, 4:1 n u t o Journal of Research and Development J DOI: 10.4172/2311-3278.1000140 ISSN: 2311-3278 Research Article Open Access Management of Postoperative Biliary Fistula After Hydatid Liver Surgery: Are There Any Differences between Localizations? Gokhan A1, Ali K1, Bora K2, Soykan A3, Mustafa K1, Emin G2, Halil A1, Servet K2, Sebahattin C4* and Özgür K4 1Department of Surgery, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul 2Department of Surgery, Okmeydani Training and Research Hospital, Istanbul 3Department of Surgery, Istanbul Training and Research Hospital, Istanbul 4Department of Surgery, Yüzüncü Yıl University Medical Faculty, Turkey *Corresponding author: Sebahattin Celik, Department of General Surgery, Yüzüncü Yıl University Faculty of Medicine Van, Turkey; Tel: +90 505 705 79 57; E-mail: [email protected] Rec date: Jan 24, 2016; Acc date: Mar 04, 2016; Pub date: Mar 15, 2016 Copyright: © 2016 Gokhan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Objectives The most common complication of hepatic hydatid cysts is the intra-biliary rupture seen approximately in 10-30% of patients. This complication mainly seen in the centrally localized, large hydatid cyst operations. The aim of this study is to compare managements of postoperative biliary fistula after hydatid liver surgery, according to localization of hepatic cyst.