विवरण
The abdomen is often referred to as "Pandora's Box" due to the complexity and range of potential issues it can present. It houses numerous vital organs, including the stomach, liver, intestines, pancreas, and kidneys, making diagnosis and treatment challenging. Symptoms originating in the abdomen can be vague and nonspecific, often requiring comprehensive evaluation to identify the underlying cause. Conditions ranging from benign gastrointestinal disorders to life-threatening emergencies like perforations or obstructions can manifest similarly. Advanced diagnostic tools such as imaging and endoscopy are essential for accurate assessment. Understanding the intricate anatomy and interconnections within the abdomen is crucial for effective medical intervention.
सारांश
- Upper GI bleeds are a common emergency, with increasing incidence due to antiplatelet agents, alcohol consumption, and processed foods. Acid peptic disease (gastritis, gastric ulcer, duodenal ulcer, esophagitis) is the most frequent cause. While most patients survive, mortality exists, particularly in the elderly, and recurrence is possible.
- Variceal bleeds, mainly occurring in cirrhotic patients due to altered liver vasculature, account for a significant portion of upper GI bleeds in this specific population. Peptic ulcers are the leading cause of GI bleeding, often associated with NSAID use and H. pylori infection.
- Patients may present with hematemesis, melena, or hematochezia. Anemia can also be a symptom in chronic cases, while acute bleeds may lead to hypovolemic shock. Initial treatment involves airway management, breathing support (ventilation), and circulation restoration with IV fluids and blood transfusions.
- Blood tests, including hemogram, electrolytes, liver function tests, and coagulation assessment, are essential for diagnosis. Intravenous pantoprazole and octreotide are administered, and a urinary catheter is used to monitor kidney perfusion. A nasogastric tube helps remove blood clots.
- Resuscitation involves maintaining a systolic blood pressure between 90-100 mmHg and a urine output of at least 0.5 ml/kg/hour. Metoclopramide and erythromycin can aid gastric emptying. Vitamin K and fresh frozen plasma are administered to improve coagulation.
- Endoscopy, performed after stabilization and blood aspiration, is crucial for diagnosis and treatment. Ulcers can be injected, and varices can be banded to stop bleeding. In severe cases, a TIPS procedure may be necessary to reduce portal pressure. Malary-Weiss tears and Dieulafoy lesions are less common causes.
- For chronic abdominal pain diagnosis, radiological imaging helps identify any potential underlying structural abnormalities. Screening tests, CT scans, MRI, and radiological images have revolutionized the way abdominal pain is now managed.
- If endoscopy and colonoscopy don't identify the bleeding point, it's beneficial to proceed with nuclear imaging with nuclear tagged RBCs or an arteriogram. During embolization procedures, caution must be taken to prevent bowel ischemia.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
डॉ. विक्रम अनंतकृष्णन
सीनियर कंसल्टेंट सर्जिकल गैस्ट्रोएंटेरोलॉजिस्ट, अगाडा हॉस्पिटल, चेन्नई
टिप्पणियाँ
टिप्पणियाँ
टिप्पणी करने के लिए आपको लॉगिन होना होगा।