Gastroparesis: Introduction
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Routine Use of Feeding Jejunostomy in Pancreaticoduodenectomuy: A
Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 95 JuneSeptember 2020 2020 doi:10.20944/preprints202006.0114.v1 doi:10.20944/preprints202006.0114.v2 Routine use of Feeding Jejunostomy in Pancreaticoduodenectomuy: A Metaanalysis. DR.Bhavin Vasavada Consultant HepatoPancreaticobiliary and Liver Transplant Surgeon, Shalby Hospitals, Ahmedabad. Email: [email protected] Dr.Hardik Patel Consultant HepatoPancreaticobiliary and Liver Transplant Surgeon, Shalby Hospitals, Ahmedabad. Conflict of Interests: none. Funding disclosure: none. Abbreviations: Post operative pancreatic fistula (POPF), total parentral nutrition (TPN), Surgical site infections. (SSI) Keywords: Pancreaticoduodenectomy; feeding jejunostomy; morbidity; mortality Abstract: Aims and objectives: The primary aim of our study was to evaluate morbidity and mortality following feeding jejunostomy in pancreaticoduodenectomy compared to the control group. We © 2020 by the author(s). Distributed under a Creative Commons CC BY license. Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 95 JuneSeptember 2020 2020 doi:10.20944/preprints202006.0114.v1 doi:10.20944/preprints202006.0114.v2 also evaluated individual complications like delayed gastric emptying, post operative pancreatic fistula, superficial and deep surgical site infection. We also looked for time to start oral nutrition and requirement of total parentral nutrition. Material and Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. [9,10]. We searched pubmed, cochrane library, embase, google scholar with keywords like “feeding jejunostomy in pancreaticodudenectomy”, “entral nutrition in pancreaticoduodenectomy, “total parentral nutrition in pancreaticoduodenectomy’, “morbidity and mortality following pancreaticoduodenectomy”. Two independent authors extracted the data (B.V and H.P). The meta-analysis was conducted using Open meta-analysis software. -
Granisetron "Vianex"
EU‐RISK MANAGEMENT PLAN GRANISETRON VIANEX® 1 MG/ML, SOLUTION FOR INJECTION/ INFUSION precautionary measure, breast‐feeding should not be advised during treatment with Granisetron “Vianex”. Legal Status: Prescription only product. VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Nausea and vomiting associated with chemotherapy and radiotheraphy: One of the most distressing symptoms for patients undergoing both surgery and chemotherapy is nausea and vomiting. These symptoms have a significant impact on quality of life and can lead to malnutrition, inability to respond to treatment and an increased length of hospitalization. Emesis is more commonly associated with chemotherapeutic agents; however, radiation‐induced nausea and vomiting (RINV) can affect a significant proportion of patients, depending on the treated area, dose fractionation, and volume of radiotherapy. The relative risk for developing nausea and vomiting with chemotherapy ranges from 30 to 90% and is dependent upon the chemotherapeutic agent used. Relative risk for nausea and vomiting with radiation therapy is approximately 40%.2,3,4,5 Post‐operative nausea and vomiting Postoperative nausea and vomiting (PONV) is a major source of patient dissatisfaction and is the leading cause of discharge delays and unanticipated postsurgical hospital admissions. In the absence of pharmacological treatment, the rate of PONV is approximately 30% in general population, and can be as high as 70% in patients at highest risk. Several risk factors as surgery type, female gender, non‐smoker status, history of postoperative nausea and vomiting or motion sickness and post‐operative opioid use have been acknowledged. Additionally, post‐ operative vomiting (POV) occurs twice as frequently in children as in adults, increasing until puberty and then decreasing to adult incidence rates. -
No.9 September 2003
Vol.46, No.9 September 2003 CONTENTS Defecatory Dysfunction Pathogenesis and Pathology of Defecatory Disturbances Masahiro TAKANO . 367 Diagnosis of Impaired Defecatory Function with Special Reference to Physiological Tests Masatoshi OYA et al. 373 Surgical Management for Defecation Dysfunction Tatsuo TERAMOTO . 378 Dysfunction in Defecation and Its Treatment after Rectal Excision Katsuyoshi HATAKEYAMA . 384 Infectious Diseases Changes in Measures against Infectious Diseases in Japan and Proposals for the Future Takashi NOMURA et al. 390 Extragenital Infection with Sexually Transmitted Pathogens Hiroyuki KOJIMA . 401 Nutritional Counseling Behavior Therapy for Nutritional Counseling —In cooperation with registered dietitians— Yoshiko ADACHI . 410 Ⅵ Defecatory Dysfunction Pathogenesis and Pathology of Defecatory Disturbances JMAJ 46(9): 367–372, 2003 Masahiro TAKANO Director, Coloproctology Center, Hidaka Hospital Abstract: In recent years the number of patients with defecatory disturbances has increased due to an aging population, stress, and other related factors. The medical community has failed to focus enough attention on this condition, which remains a sort of psychosocial taboo, enhancing patient anxiety. Defecatory distur- bance classified according to cause and location can fall into one of four groups: 1) Endocrine abnormalities; 2) Disturbances of colonic origin that result from the long-term use of antihypertensive drugs or antidepressants or from circadian rhythm disturbances that occur with skipping breakfast or lower dietary -
Impact of HIV on Gastroenterology/Hepatology
Core Curriculum: Impact of HIV on Gastroenterology/Hepatology AshutoshAshutosh Barve,Barve, M.D.,M.D., Ph.D.Ph.D. Gastroenterology/HepatologyGastroenterology/Hepatology FellowFellow UniversityUniversityUniversity ofofof LouisvilleLouisville Louisville Case 4848 yearyear oldold manman presentspresents withwith aa historyhistory ofof :: dysphagiadysphagia odynophagiaodynophagia weightweight lossloss EGDEGD waswas donedone toto evaluateevaluate thethe problemproblem University of Louisville Case – EGD Report ExtensivelyExtensively scarredscarred esophagealesophageal mucosamucosa withwith mucosalmucosal bridging.bridging. DistalDistal esophagealesophageal nodulesnodules withwithUniversity superficialsuperficial ulcerationulceration of Louisville Case – Esophageal Nodule Biopsy InflammatoryInflammatory lesionlesion withwith ulceratedulcerated mucosamucosa SpecialSpecial stainsstains forfor fungifungi revealreveal nonnon-- septateseptate branchingbranching hyphaehyphae consistentconsistent withwith MUCORMUCOR University of Louisville Case TheThe patientpatient waswas HIVHIV positivepositive !!!! University of Louisville HAART (Highly Active Anti Retroviral Therapy) HIV/AIDS Before HAART After HAART University of Louisville HIV/AIDS BeforeBefore HAARTHAART AfterAfter HAARTHAART ImmuneImmune dysfunctiondysfunction ImmuneImmune reconstitutionreconstitution OpportunisticOpportunistic InfectionsInfections ManagementManagement ofof chronicchronic ¾ Prevention diseasesdiseases e.g.e.g. HepatitisHepatitis CC ¾ Management CirrhosisCirrhosis NeoplasmsNeoplasms -
Gastrostomy Feeding Tubes
Gastrostomy feeding tubes With Dr Anastasia Volovets, Gastroenterologist and Hepatologist, Royal Prince Alfred Hospital, Sydney, Australia Introduction In patients with prolonged inadequate or absent oral intake gastrostomy tubes can be used to provide a route for enteral feeding, hydration, and medication administration. Case 1 - You are a junior doctor on the wards and you’re called to see a 65 year old male, who is day 5 post- stroke with an impaired swallow he is unable to tolerate oral feed and his family is worried he will starve to death. 1. Management of this patient IV fluids do not provide the caloric support or nutrients needed by patients, after 48 hours of impaired oral feeding, enteral feeding should be considered. • Short term this would be a nasogastric tube • Longer term (greater than 6 weeks) a gastrostomy or jejunostomy should be considered 2. Indications for enteral feeding • Neurological disorders causing impaired swallowing and aspiration of food o Stroke (most common) o Traumatic brain injury o Parkinson’s disease • Structural problems o Malignancy obstructing the gastrointestinal tract, this can include upper GI, head, nose or throat. Gastrostomy insertion can be done prophylactically prior to treatment that will impair the functioning or path of the tract such as surgery or radiotherapy 3. Contraindications to gastric feeding tubes • Absolute o High bleeding risk - uncorrected coagulopathy, thrombocytopenia o Chronic liver disease - varies and ascites o Peritonitis or abdominal perforation o Cellulitis at selected -
About Your Gastrectomy Surgery
Patient & Caregiver Education About Your Gastrectomy Surgery About Your Surgery .................................................................................................................3 Before Your Surgery .................................................................................................................5 Preparing for Your Surgery ............................................................................................................6 Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) ............................................................... 14 Herbal Remedies and Cancer Treatment ................................................................................ 19 Information for Family and Friends for the Day of Surgery ............................................22 After Your Surgery .................................................................................................................27 What to Expect ............................................................................................................................... 28 How to Use Your Incentive Spirometer .................................................................................. 32 Patient-Controlled Analgesia (PCA) ....................................................................................... 35 Eating After Your Gastrectomy ..................................................................................................37 Resources ................................................................................................................................53 -
Laparoscopic Truncal Vagotomy and Gatrojejunostomy for Pyloric Stenosis
ORIGINAL ARTICLE pISSN 2234-778X •eISSN 2234-5248 J Minim Invasive Surg 2015;18(2):48-52 Journal of Minimally Invasive Surgery Laparoscopic Truncal Vagotomy and Gatrojejunostomy for Pyloric Stenosis Jung-Wook Suh, M.D.1, Ye Seob Jee, M.D., Ph.D.1,2 Department of Surgery, 1Dankook University Hospital, 2Dankook University School of Medicine, Cheonan, Korea Purpose: Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and Received January 27, 2015 an important target for surgical treatment. Laparoscopy applies to most surgical procedures; however Revised 1st March 9, 2015 its use in elective peptic ulcer surgery, particularly in cases of pyloric stenosis, has not been popular. 2nd March 28, 2015 The aim of this study was to describe the role of laparoscopic surgery and an easily performed Accepted April 20, 2015 procedure for pyloric stenosis. We accordingly performed laparoscopic truncal vagotomy with gastrojejunostomy in 10 consecutive patients with pyloric stenosis. Corresponding author Ye Seob Jee Methods: Data were collected prospectively from all patients who underwent laparoscopic truncal Department of Surgery, Dankook vagotomy with gastrojejunostomy from August 2009 to May 2014 and reviewed retrospectively. University Hospital, Dankook Results: A total of 10 patients underwent laparoscopic trucal vagotomy with gastrojejunostomy for University School of Medicine, 119, peptic ulcer obstruction from August 2009 to May 2014 in ○○ university hospital. The mean age was Dandae-ro, Dongnam-gu, Cheonan 62.6 (±16.4) years old and mean BMI was 19.3 (±2.5) kg/m2. There were no conversions to open 330-714, Korea surgery and no occurrence of intra-operative complications. -
General Signs and Symptoms of Abdominal Diseases
General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid. -
The American Society of Colon and Rectal Surgeons' Clinical Practice
CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Evaluation and Management of Constipation Ian M. Paquette, M.D. • Madhulika Varma, M.D. • Charles Ternent, M.D. Genevieve Melton-Meaux, M.D. • Janice F. Rafferty, M.D. • Daniel Feingold, M.D. Scott R. Steele, M.D. he American Society of Colon and Rectal Surgeons for functional constipation include at least 2 of the fol- is dedicated to assuring high-quality patient care lowing symptoms during ≥25% of defecations: straining, Tby advancing the science, prevention, and manage- lumpy or hard stools, sensation of incomplete evacuation, ment of disorders and diseases of the colon, rectum, and sensation of anorectal obstruction or blockage, relying on anus. The Clinical Practice Guidelines Committee is com- manual maneuvers to promote defecation, and having less posed of Society members who are chosen because they than 3 unassisted bowel movements per week.7,8 These cri- XXX have demonstrated expertise in the specialty of colon and teria include constipation related to the 3 common sub- rectal surgery. This committee was created to lead inter- types: colonic inertia or slow transit constipation, normal national efforts in defining quality care for conditions re- transit constipation, and pelvic floor or defecation dys- lated to the colon, rectum, and anus. This is accompanied function. However, in reality, many patients demonstrate by developing Clinical Practice Guidelines based on the symptoms attributable to more than 1 constipation sub- best available evidence. These guidelines are inclusive and type and to constipation-predominant IBS, as well. The not prescriptive. -
Management of Chronic Problems
MANAGEMENT OF CHRONIC PROBLEMS INTERACTIONS BETWEEN ALCOHOL AND DRUGS A. Leary,* T. MacDonald† SUMMARY concerned. Alcohol may alter the effects of the drug; drug In western society alcohol consumption is common as is may change the effects of alcohol; or both may occur. the use of therapeutic drugs. It is not surprising therefore The interaction between alcohol and drug may be that concomitant use of these should occur frequently. The pharmacokinetic, with altered absorption, metabolism or consequences of this combination vary with the dose of elimination of the drug, alcohol or both.2 Alcohol may drug, the amount of alcohol taken, the mode of affect drug pharmacokinetics by altering gastric emptying administration and the pharmacological effects of the drug or liver metabolism. Drugs may affect alcohol kinetics by concerned. Interactions may be pharmacokinetic or altering gastric emptying or inhibiting gastric alcohol pharmacodynamic, and while coincidental use of alcohol dehydrogenase (ADH).3 This may lead to altered tissue may affect the metabolism or action of a drug, a drug may concentrations of one or both agents, with resultant toxicity. equally affect the metabolism or action of alcohol. Alcohol- The results of concomitant use may also be principally drug interactions may differ with acute and chronic alcohol pharmacodynamic, with combined alcohol and drug effects ingestion, particularly where toxicity is due to a metabolite occurring at the receptor level without important changes rather than the parent drug. There is both inter- and intra- in plasma concentration of either. Some interactions have individual variation in the response to concomitant drug both kinetic and dynamic components and, where this is and alcohol use. -
Diet Guidelines for Kidney Disease and Gastroparesis
Diet Guidelines for Kidney Disease and Gastroparesis Introduction Gastroparesis means “stomach (gastro) paralysis (paresis).” In gastroparesis, your stomach empties too slowly. Gastroparesis can have many causes, so symptoms range from mild (but annoying) to severe, and week-to-week or even day-to-day. This handout is designed to give some suggestions for diet changes in the hope that symptoms will improve or even stop. Very few research studies have been done to guide us as to which foods are better tolerated by patients with gastroparesis. The suggestions are mostly based on experience and our understanding of how the stomach and different foods normally empty. Anyone with gastroparesis should see a doctor and a Registered Dietitian for advice on how to maximize their nutritional status. Essential Nutrients - Keeping Healthy Calories - A calorie is energy provided by food. You need calories (energy) every day for your body to work, just like putting gas in a car. If you need to gain weight, you need more calories. If you need to lose weight, you need fewer calories. Protein, carbohydrate, and fat are all different kinds of calories. Protein – Most people need about 60 grams of protein per day to meet their protein needs. For patients on dialysis, a higher protein intake is encouraged to replace dialysis protein loss. Eat at least 8 ounces of lean meat per day. Examples: meats, fish, poultry, milk, eggs, cheeses (see table 2). Carbohydrate (starches and natural sugars) – Our main energy source and one of the easiest nutrients for our bodies to use. Get some at every meal or snack. -
Pancreaticoduodenectomy with Preservation of Gastric Tube Blood
CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 5 (2014) 746–749 Contents lists available at ScienceDirect International Journal of Surgery Case Reports j ournal homepage: www.casereports.com Pancreaticoduodenectomy with preservation of gastric tube blood flow after esophagectomy: Report of a case ∗ Sho Okimoto, Tsuyoshi Kobayashi , Shintaro Kuroda, Hiroyuki Tahara, Masahiro Ohira, Kentaro Ide, Kohei Ishiyama, Hirotaka Tashiro, Hideki Ohdan Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan a r a t b i c l e i n f o s t r a c t Article history: INTRODUCTION: During pancreaticoduodenectomy (PD), the gastroduodenal artery (GDA) is commonly Received 10 July 2014 divided. In this study, we described the clinical features of PD in which the GDA was preserved in order Received in revised form 5 August 2014 to avoid gastric tube ischemia in a patient who had previously undergone esophagectomy. Accepted 7 August 2014 PRESENTATION OF CASE: A 70-year-old man had previously undergone esophagectomy. Esophagectomy Available online 28 August 2014 and gastric tube reconstruction were performed 10 years earlier due to superior thoracic esophageal can- cer. The patient was referred to our hospital for the treatment of obstructive jaundice and was diagnosed Keywords: with middle bile duct cancer. We performed PD and preserved the GDA. The postoperative course was Bile duct cancer Pancreaticoduodenectomy uneventful, and the gastric tube continued functioning well. DISCUSSION: In a patient with a prior esophagectomy and gastric tube reconstruction, the blood flow to Gastroduodenal artery Esophagectomy the gastric tube is supplied only by the GDA via the right gastroepiploic artery (RGEA).