Common gastrointestinal emergencies:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2008
|
| Series: | Medical clinics of North America
92,3 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Item Description: | Includes bibliographical references and index |
| Physical Description: | XIV S., S. 491 - 715 Ill., graph. Darst. 24 cm |
| ISBN: | 9781416058625 1416058621 |
Staff View
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| 245 | 1 | 0 | |a Common gastrointestinal emergencies |c guest ed. Mitchell S. Cappell |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2008 | |
| 300 | |a XIV S., S. 491 - 715 |b Ill., graph. Darst. |c 24 cm | ||
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| 490 | 1 | |a Medical clinics of North America |v 92,3 | |
| 500 | |a Includes bibliographical references and index | ||
| 650 | 4 | |a Gastrointestinal emergencies | |
| 650 | 4 | |a Emergencies | |
| 650 | 4 | |a Endoscopy, Gastrointestinal | |
| 650 | 4 | |a Gastrointestinal Diseases |x surgery | |
| 650 | 4 | |a Gastrointestinal emergencies | |
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Record in the Search Index
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| adam_text | CONTENTS
Preface xi
Mitchell S. Cappell
Initial Management of Acute Upper Gastrointestinal Bleeding:
From Initial Evaluation up to Gastrointestinal Endoscopy 491
Mitchell S. Cappell and David Friedel
Acute upper gastrointestinal bleeding is a relatively common,
potentially life-threatening medical emergency responsible for
more than 300,000 hospital admissions and about 30,000 deaths
per annum in America. The initial assessment focuses on bleeding
activity, bleeding severity, hemodynamic compromise from the
bleeding, and differentiating upper from lower gastrointestinal
bleeding. The initial supportive therapy includes fluid resuscitation
to reverse the hypovolemia, blood transfusions to replete the lost
blood, respiratory support as necessary, and proton pump inhibitor
therapy to stabilize mucosal blood clots and promote hemostasis.
Esophagogastroduodenoscopy is the best test to determine the
bleeding site and cause.
Acute Nonvariceal Upper Gastrointestinal Bleeding:
Endoscopic Diagnosis and Therapy 511
Mitchell S. Cappell and David Friedel
Acute upper gastrointestinal bleeding is a relatively common,
potentially life-threatening condition that causes more than 300,000
hospital admissions and about 30,000 deaths per annum in
America. Esophagogastroduodenoscopy is the procedure of choice
for the diagnosis and therapy of upper gastrointestinal bleeding
lesions. Endoscopic therapy is indicated for lesions with high risk
stigmata of recent hemorrhage, including active bleeding, oozing, a
visible vessel, and possibly an adherent clot. Endoscopic therapies
VOLUME 92 • NUMBER 3 • MAY 2008 vii
include injection therapy, such as epinephrine or sclerosant
injection; ablative therapy, such as heater probe or argon plasma
coagulation; and mechanical therapy, such as endoclips or endo-
scopic banding. Endoscopic therapy reduces the risk of rebleeding,
the need for blood transfusions, the requirement for surgery, and
patient morbidity.
Portal Hypertension and Variceal Hemorrhage 551
Nagib Toubia and Arun }. Sanyal
Portal hypertension, a major hallmark of cirrhosis, is defined as a
portal pressure gradient exceeding 5 mm Hg. In portal hyper¬
tension, porto-systemic collaterals decompress the portal circula¬
tion and give rise to varices. Successful management of portal
hypertension and its complications requires knowledge of the
underlying pathophysiology, the pertinent anatomy, and the
natural history of the collateral circulation, particularly the gastro-
esophageal varices.
Mechanical Obstruction of the Small Bowel and Colon 575
Mitchell S. Cappell and Mihaela Batke
Mechanical obstruction of the small bowel and colon is moderately
common, accounting for several hundred thousand admissions per
year in the United States. Patients generally present with
abdominal pain, nausea and emesis, abdominal distention, and
progressive obstipation. Clinical findings of high fever, localized
severe abdominal tenderness, rebound tenderness, severe leuko-
cytosis, or metabolic acidosis suggest possible complications of
bowel necrosis, bowel perforation, or generalized peritonitis.
Differentiation of total mechanical obstruction from partial
mechanical obstruction and pseudo-obstruction is important
because total mechanical obstruction is generally treated surgically,
whereas the other two entities are usually treated medically.
Mechanical obstruction is usually suggested by plain abdominal
radiographs, and confirmed by small bowel follow through,
abdominal CT, or CT enteroclysis.
Gastrointestinal Perforation and the Acute Abdomen 599
John T. Langell and Sean J. Mulvihill
The acute abdomen accounts for up to 40% of all emergency-
surgical hospital admissions and is considered in the differential in
the more than 7 million visits to the emergency department
annually for abdominal pain in the United States. A large
percentage of these cases are secondary to perforation or impending
gastrointestinal perforation. Gastrointestinal perforation causes
considerable mortality and usually requires emergency surgery.
Rapid diagnosis and treatment of these conditions is essential to
reduce the high morbidity and mortality of late-stage presentation.
Successful treatment requires a thorough understanding of the
viii CONTENTS
anatomy, microbiology, and pathophysiology of this disease process
and in-depth knowledge of the therapy, including resuscitation,
antibiotics, source control, and physiologic support.
Acute Abdominal Vascular Emergencies 627
Charles J. Shanley and Jeffrey B. Weinberger
Abdominal vascular emergencies are relatively uncommon, fre¬
quently catastrophic, and highly lethal. Despite improved under¬
standing of the pathophysiology and natural history of these
disorders, delays in diagnosis and treatment remain the most
important factors contributing to the observed high mortality. A
high index of clinical suspicion together with a sound under¬
standing of the clinical presentation, natural history, and manage¬
ment of these disorders are critical to improving outcomes. This
article focuses on abdominal vascular emergencies presenting with
acute visceral ischemia or catastrophic intra-abdominal hemor¬
rhage.
Adynamic Ileus and Acute Colonic Pseudo-Obstruction 649
Mihaela Batke and Mitchell S. Cappell
Ileus and colonic pseudo-obstruction cause functional obstruction
of intestinal transit, without mechanical obstruction, because of
uncoordinated or attenuated intestinal muscle contractions. Ileus
usually arises from an exaggerated intestinal reaction to abdominal
surgery that is often exacerbated by numerous other conditions.
Colonic pseudo-obstruction is induced by numerous metabolic
disorders, drugs that inhibit intestinal motility, severe illnesses, and
extensive surgery. It presents with massive colonic dilatation with
variable, moderate small bowel dilatation. Both conditions are
initially treated with supportive measures that include intravenous
rehydration, correction of electrolyte abnormalities, discontinua¬
tion of antikinetic drugs, and treatment of other contributing
disorders. Specific therapies for colonic pseudo-obstruction include
neostigmine (an anticholinesterase) for pharmacologic colonic
decompression and colonoscopic decompression.
Severe Complications of Inflammatory Bowel Disease 671
Francisco Marrero, Mohammed A. Qadeer, and Bret A. Lashner
Patients who have inflammatory bowel disease occasionally
develop severe complications or emergency situations that require
expert and expedited medical care, including toxic colitis, fistulas,
abdominal abscesses, malignancy, primary sclerosing cholangitis,
and pouchitis. Morbidity and mortality rates of Crohn s disease
and ulcerative colitis are increased over the expected rates in the
unaffected population. Knowledge of the presenting features,
natural history, and treatment of these complications should to
lead to early and effective therapy and better outcomes.
CONTENTS *
Endoscopic Mucosal Resection of Colonic Lesions: Current
Applications and Future Prospects 687
David M. Poppers and Gregory B. Haber
The introduction of submucosal fluid injection has remarkably
extended the range of endoscopically resectable polyps. The
limiting factor for endoscopic resection is not polyp size, but
polyp depth. Endoscopic ultrasound is a useful adjunctive
diagnostic tool to assess the depth of invasion. The success of a
resection ultimately depends on pathologic confirmation of a
benign nature of this lesion or of a cancer limited to the mucosa.
Selected well-differentiated cancers without lymphovascular in¬
vasion of the superficial submucosa can be successfully resected
endoscopically.
Index 707
x CONTENTS
|
| adam_txt |
CONTENTS
Preface xi
Mitchell S. Cappell
Initial Management of Acute Upper Gastrointestinal Bleeding:
From Initial Evaluation up to Gastrointestinal Endoscopy 491
Mitchell S. Cappell and David Friedel
Acute upper gastrointestinal bleeding is a relatively common,
potentially life-threatening medical emergency responsible for
more than 300,000 hospital admissions and about 30,000 deaths
per annum in America. The initial assessment focuses on bleeding
activity, bleeding severity, hemodynamic compromise from the
bleeding, and differentiating upper from lower gastrointestinal
bleeding. The initial supportive therapy includes fluid resuscitation
to reverse the hypovolemia, blood transfusions to replete the lost
blood, respiratory support as necessary, and proton pump inhibitor
therapy to stabilize mucosal blood clots and promote hemostasis.
Esophagogastroduodenoscopy is the best test to determine the
bleeding site and cause.
Acute Nonvariceal Upper Gastrointestinal Bleeding:
Endoscopic Diagnosis and Therapy 511
Mitchell S. Cappell and David Friedel
Acute upper gastrointestinal bleeding is a relatively common,
potentially life-threatening condition that causes more than 300,000
hospital admissions and about 30,000 deaths per annum in
America. Esophagogastroduodenoscopy is the procedure of choice
for the diagnosis and therapy of upper gastrointestinal bleeding
lesions. Endoscopic therapy is indicated for lesions with high risk
stigmata of recent hemorrhage, including active bleeding, oozing, a
visible vessel, and possibly an adherent clot. Endoscopic therapies
VOLUME 92 • NUMBER 3 • MAY 2008 vii
include injection therapy, such as epinephrine or sclerosant
injection; ablative therapy, such as heater probe or argon plasma
coagulation; and mechanical therapy, such as endoclips or endo-
scopic banding. Endoscopic therapy reduces the risk of rebleeding,
the need for blood transfusions, the requirement for surgery, and
patient morbidity.
Portal Hypertension and Variceal Hemorrhage 551
Nagib Toubia and Arun }. Sanyal
Portal hypertension, a major hallmark of cirrhosis, is defined as a
portal pressure gradient exceeding 5 mm Hg. In portal hyper¬
tension, porto-systemic collaterals decompress the portal circula¬
tion and give rise to varices. Successful management of portal
hypertension and its complications requires knowledge of the
underlying pathophysiology, the pertinent anatomy, and the
natural history of the collateral circulation, particularly the gastro-
esophageal varices.
Mechanical Obstruction of the Small Bowel and Colon 575
Mitchell S. Cappell and Mihaela Batke
Mechanical obstruction of the small bowel and colon is moderately
common, accounting for several hundred thousand admissions per
year in the United States. Patients generally present with
abdominal pain, nausea and emesis, abdominal distention, and
progressive obstipation. Clinical findings of high fever, localized
severe abdominal tenderness, rebound tenderness, severe leuko-
cytosis, or metabolic acidosis suggest possible complications of
bowel necrosis, bowel perforation, or generalized peritonitis.
Differentiation of total mechanical obstruction from partial
mechanical obstruction and pseudo-obstruction is important
because total mechanical obstruction is generally treated surgically,
whereas the other two entities are usually treated medically.
Mechanical obstruction is usually suggested by plain abdominal
radiographs, and confirmed by small bowel follow through,
abdominal CT, or CT enteroclysis.
Gastrointestinal Perforation and the Acute Abdomen 599
John T. Langell and Sean J. Mulvihill
The acute abdomen accounts for up to 40% of all emergency-
surgical hospital admissions and is considered in the differential in
the more than 7 million visits to the emergency department
annually for abdominal pain in the United States. A large
percentage of these cases are secondary to perforation or impending
gastrointestinal perforation. Gastrointestinal perforation causes
considerable mortality and usually requires emergency surgery.
Rapid diagnosis and treatment of these conditions is essential to
reduce the high morbidity and mortality of late-stage presentation.
Successful treatment requires a thorough understanding of the
viii CONTENTS
anatomy, microbiology, and pathophysiology of this disease process
and in-depth knowledge of the therapy, including resuscitation,
antibiotics, source control, and physiologic support.
Acute Abdominal Vascular Emergencies 627
Charles J. Shanley and Jeffrey B. Weinberger
Abdominal vascular emergencies are relatively uncommon, fre¬
quently catastrophic, and highly lethal. Despite improved under¬
standing of the pathophysiology and natural history of these
disorders, delays in diagnosis and treatment remain the most
important factors contributing to the observed high mortality. A
high index of clinical suspicion together with a sound under¬
standing of the clinical presentation, natural history, and manage¬
ment of these disorders are critical to improving outcomes. This
article focuses on abdominal vascular emergencies presenting with
acute visceral ischemia or catastrophic intra-abdominal hemor¬
rhage.
Adynamic Ileus and Acute Colonic Pseudo-Obstruction 649
Mihaela Batke and Mitchell S. Cappell
Ileus and colonic pseudo-obstruction cause functional obstruction
of intestinal transit, without mechanical obstruction, because of
uncoordinated or attenuated intestinal muscle contractions. Ileus
usually arises from an exaggerated intestinal reaction to abdominal
surgery that is often exacerbated by numerous other conditions.
Colonic pseudo-obstruction is induced by numerous metabolic
disorders, drugs that inhibit intestinal motility, severe illnesses, and
extensive surgery. It presents with massive colonic dilatation with
variable, moderate small bowel dilatation. Both conditions are
initially treated with supportive measures that include intravenous
rehydration, correction of electrolyte abnormalities, discontinua¬
tion of antikinetic drugs, and treatment of other contributing
disorders. Specific therapies for colonic pseudo-obstruction include
neostigmine (an anticholinesterase) for pharmacologic colonic
decompression and colonoscopic decompression.
Severe Complications of Inflammatory Bowel Disease 671
Francisco Marrero, Mohammed A. Qadeer, and Bret A. Lashner
Patients who have inflammatory bowel disease occasionally
develop severe complications or emergency situations that require
expert and expedited medical care, including toxic colitis, fistulas,
abdominal abscesses, malignancy, primary sclerosing cholangitis,
and pouchitis. Morbidity and mortality rates of Crohn's disease
and ulcerative colitis are increased over the expected rates in the
unaffected population. Knowledge of the presenting features,
natural history, and treatment of these complications should to
lead to early and effective therapy and better outcomes.
CONTENTS '*
Endoscopic Mucosal Resection of Colonic Lesions: Current
Applications and Future Prospects 687
David M. Poppers and Gregory B. Haber
The introduction of submucosal fluid injection has remarkably
extended the range of endoscopically resectable polyps. The
limiting factor for endoscopic resection is not polyp size, but
polyp depth. Endoscopic ultrasound is a useful adjunctive
diagnostic tool to assess the depth of invasion. The success of a
resection ultimately depends on pathologic confirmation of a
benign nature of this lesion or of a cancer limited to the mucosa.
Selected well-differentiated cancers without lymphovascular in¬
vasion of the superficial submucosa can be successfully resected
endoscopically.
Index 707
x CONTENTS |
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| isbn | 9781416058625 1416058621 |
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| physical | XIV S., S. 491 - 715 Ill., graph. Darst. 24 cm |
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| spelling | Common gastrointestinal emergencies guest ed. Mitchell S. Cappell Philadelphia [u.a.] Saunders 2008 XIV S., S. 491 - 715 Ill., graph. Darst. 24 cm txt rdacontent n rdamedia nc rdacarrier Medical clinics of North America 92,3 Includes bibliographical references and index Gastrointestinal emergencies Emergencies Endoscopy, Gastrointestinal Gastrointestinal Diseases surgery Cappell, Mitchell S. Sonstige oth Medical clinics of North America 92,3 (DE-604)BV000003310 92,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016490428&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Common gastrointestinal emergencies Medical clinics of North America Gastrointestinal emergencies Emergencies Endoscopy, Gastrointestinal Gastrointestinal Diseases surgery |
| title | Common gastrointestinal emergencies |
| title_auth | Common gastrointestinal emergencies |
| title_exact_search | Common gastrointestinal emergencies |
| title_exact_search_txtP | Common gastrointestinal emergencies |
| title_full | Common gastrointestinal emergencies guest ed. Mitchell S. Cappell |
| title_fullStr | Common gastrointestinal emergencies guest ed. Mitchell S. Cappell |
| title_full_unstemmed | Common gastrointestinal emergencies guest ed. Mitchell S. Cappell |
| title_short | Common gastrointestinal emergencies |
| title_sort | common gastrointestinal emergencies |
| topic | Gastrointestinal emergencies Emergencies Endoscopy, Gastrointestinal Gastrointestinal Diseases surgery |
| topic_facet | Gastrointestinal emergencies Emergencies Endoscopy, Gastrointestinal Gastrointestinal Diseases surgery |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016490428&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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