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Management of Malignant Biliary Strictures
The management of malignant biliary strictures involves a multidisciplinary approach aimed at relieving obstruction, improving quality of life, and potentially extending survival. Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is a common intervention to alleviate biliary obstruction. Metal stents are preferred over plastic stents for their durability and longer patency. In cases where ERCP is not feasible, percutaneous transhepatic biliary drainage may be employed. Systemic chemotherapy or radiation therapy may be considered as part of a comprehensive treatment plan, particularly in cases where the malignancy is unresectable. Surgical resection remains the curative option when feasible. Palliative care plays a crucial role in managing symptoms and enhancing the overall quality of life for patients with advanced disease. Close collaboration among gastroenterologists, oncologists, interventional radiologists, and surgeons is essential for the optimal management of malignant biliary strictures.
About the Speaker
Dr. Khalid Bamakhrama
Consultant Physician & Gastroenterologist, Rashid Hospital, DXB
Upcoming Case Discussions
H. pylori Treatment with PYELRA®: Best Practices
PYLERA® is a medication used for the treatment of Helicobacter pylori (H. pylori) infection, a common cause of stomach ulcers and gastritis. It contains a combination of three active ingredients: bismuth subcitrate potassium, metronidazole, and tetracycline. This combination works synergistically to eradicate H. pylori bacteria and reduce associated symptoms. Treatment with PYLERA® typically involves taking multiple capsules four times a day for a specified duration, as prescribed by a healthcare provider. It is important to follow the treatment regimen as directed and to discuss potential side effects
Alcoholic Hepatitis: Management Strategies
Management of alcoholic hepatitis involves a comprehensive approach aimed at halting disease progression, managing symptoms, and promoting liver recovery. The cornerstone of treatment involves complete alcohol cessation to prevent further liver damage and promote healing. Patients often have malnutrition, so nutritional therapy with a focus on adequate protein intake and vitamin supplementation is crucial. Corticosteroids like prednisolone may be prescribed in severe cases to reduce liver inflammation and improve survival rates. In severe cases unresponsive to medical therapy, liver transplantation may be considered, although strict criteria must be met. Diuretics may be used cautiously to manage ascites while monitoring for renal function. Prophylactic measures such as beta-blockers may be used to reduce the risk of variceal bleeding.
Pneumonia in Children
Pneumonia in children is often caused by viral or bacterial infections, leading to inflammation of the lungs. Symptoms may include cough, fever, rapid breathing, and chest pain. Diagnosis typically involves physical examination, chest X-ray, and sometimes blood tests or other imaging studies. Treatment may include antibiotics for bacterial pneumonia, supportive care such as rest, fluids, and fever management, and in severe cases, hospitalization for oxygen therapy and close monitoring. Vaccination against common pathogens like Streptococcus pneumoniae and Haemophilus influenzae type b can help prevent pneumonia in children.
New Developments in Interventional Cardiology
Recent advancements in interventional cardiology have witnessed the evolution of cutting-edge techniques and technologies aimed at improving patient outcomes. From innovative stent designs to refined imaging modalities and minimally invasive procedures, interventional cardiologists now have a broader arsenal to address complex coronary artery disease. Drug-eluting stents with novel coatings aim to reduce restenosis rates, while bioresorbable scaffolds offer the promise of temporary vessel support without long-term metal implantation. Moreover, advances in imaging, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), enable more precise lesion assessment and optimized stent placement. Additionally, the advent of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, offering a less invasive option for high-risk patients. These developments underscore the continuous pursuit of innovation in interventional cardiology, striving for enhanced patient care, and improved long-term outcomes.
Patient Centric Care in Critical Care
Patient-centric care in critical care is a holistic approach that places the patient at the center of medical decision-making and treatment processes. It prioritizes the individual's preferences, values, and needs, considering not only their medical condition but also their emotional and psychological well-being. This approach involves clear communication, shared decision-making, and active involvement of patients and their families in care planning. Healthcare providers strive to deliver personalized care that respects the patient's dignity, autonomy, and cultural beliefs, aiming to optimize outcomes and enhance overall quality of life.
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The management of malignant biliary strictures involves a multidisciplinary approach aimed at relieving obstruction, improving quality of life, and potentially extending survival. Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is a common intervention to alleviate biliary obstruction. Metal stents are preferred over plastic stents for their durability and longer patency. In cases where ERCP is not feasible, percutaneous transhepatic biliary drainage may be employed. Systemic chemotherapy or radiation therapy may be considered as part of a comprehensive treatment plan, particularly in cases where the malignancy is unresectable. Surgical resection remains the curative option when feasible. Palliative care plays a crucial role in managing symptoms and enhancing the overall quality of life for patients with advanced disease. Close collaboration among gastroenterologists, oncologists, interventional radiologists, and surgeons is essential for the optimal management of malignant biliary strictures.