Recommended after approximately 6 weeks to rule out the presence of other

Recommended after approximately 6 weeks to rule out

This preview shows page 67 - 76 out of 76 pages.

Recommended after approximately 6 weeks , to rule out the presence of other diseases, such as cancer and inflammatory bowel disease
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Recurrent Diverticulitis 25 % will have more than one attack of acute diverticulitis Recurrence was more virulent and lead to recommendation for elective resection: after the second episode in >50year old after first episode in younger patients. However, more recent data fails to show worse prognosis in recurrent attacks. American Society of Colon and Rectal Surgeons: Decision for elective resection is on a case by case basis
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Diverticular Hemorrhage Rupture of the vasa recta at the dome of a diverticulum Source proximal to the splenic flexure in 60% Mean age 66 year old Most common cause of life threatening lower GI bleed (3-5% of those with diverticulosis)
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Hemorrhoids arises from a plexus of dilated veins arising from the: Superior and inferior hemorrhoidal veins. Submucosal layer in the lower rectum External or internal: below or above the dentate line. Classifications Grade I: May bulge into the lumen but do not extend below the dentate line. Grade II : Prolapse out of the anal canal with defecation or with straining but reduce spontaneously. Grade III: Prolapse out of the anal canal with defecation or straining, and require the patient to reduce them into their normal position. Grade IV: Irreducible and may strangulate
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Hemorrhoids are common and can cause bleeding, itching, of perianal skin pain thrombosis, occur in both internal and external hemorrhoids Mild cases can be treated with fiber supplements and topical medications. Minimally invasive (endoscopic) techniques are available. Surgery is reserved for severe cases or thrombosis
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Pathogenesis of Diseases of the Oesophagus
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Gastro-Oesophageal Reflux Disease (GORD) Abnormal retrograde movement of stomach contents to oesophagus Hydrochloric acid, pepsin Very common ~ 1 in 12 people heartburn daily ~ 1 in 6 heartburn weekly Oesophagitis in ~5% Reflux more likely to occur when: Decreased tone of sphincter Sliding hiatal hernia Decreased oesophageal clearance Decreased saliva production When lying down
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Hydrochloric acid and pepsin -> H+ ions diffuse into cells -> acidification of mucosa -> inflammation, necrosis Clinical : symptoms of heartburn Endoscopic : red/congested mucosa Manometric : decreased sphincter pressure pH: number, duration of dips: pH<4 Pathological: microscopic evidence of oesophagitis
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Normal Inflamed
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