Ecab Gastrointestinal Hemorrhage

ECAB Gastrointestinal Hemorrhage - E-Book

Defined as a portal pressure of 12 mmHg or more, portal hypertension results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. Esophagogastric varices is the most important complication of severe portal hypertension because of the high risk of bleeding and mortality associated with them. Ascites is another important complication which may at times be refractory to treatment and may also get complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. Portal hypertension is a predictable and preventable condition but has no definite cure. An aggressive approach to prevention and treatment of portal hypertension is therefore warranted. Treatment of portal hypertension is evolving rapidly and many changes in the therapeutic protocols have been incorporated in recent times. Endoscopic treatment of the bleeding varices and prophylactic role of beta-blockers to prevent rebleeding are well-established therapeutic options. The measurement of the hepatic venous pressure gradient may identify a suboptimal response to beta-blockers in patients at risk of bleeding from varices. However, the costeffectiveness of routine hepatic venous pressure gradient measurements to guide primary prophylaxis has not been examined. Besides these, there is a definite role of somatostatin analogs and shunt surgeries in the treatment of portal hypertension and its complications. This book is designed to update the reader on all such issues related to diagnosis, treatment and complications of portal hypertension along with supportive typical case scenarios. Thus it provides an excellent opportunity to widen one’s perspective in this area.

Acute pancreatitis is defined as an acute inflammatory process of the pancreas that may also involve peripancreatic tissues and/or remote organ systems. It typically presents with sudden deep, boring pain that starts in the epigastrium and radiates to the back, which usually worsens on intake of food. It may be of varying severity ranging from mild to severe. Mild disease, if managed promptly and adequately resolves with minimal or no sequelae and seldom leads to extended morbidity or mortality. However Severe Acute Pancreatitis has a longer course of resolution, usually requires hospitalization and has a greater propensity to lead to adverse outcomes. As a thumb rule, it has greater morbidity and mortality rates as compared to Mild Acute Pancreatitis. Understandably, the management protocol for the severe acute pancreatitis is more invasive and emergent, and may require intensive care management. Hence understanding and assessment of the condition in the first 48 hours is a critical step in deciding the outcome. The various assessment criteria that are used to prognosticate and plan the management for this disease have been discussed in this clinical update. Previously, the condition was thought to be caused by infection, but now it is an established fact that it is an acute inflammation of the pancreatic gland with activation of the pancreatic enzymes within the gland leading to its autodigestion. Previously, acute pancreatitis was considered to be mostly associated with chronic alcohol abuse or acute bouts of binge drinking. With the availability of data from recent studies in India and the Asian subcontinent, Biliary disease is emerging as the commonest etiological agent. Extensive genetic analysis and mapping have helped put a cause to the erstwhile "idiopathic" cases. Newer diagnostic modalities and minimal invasive procedures have made the conventional surgeries nearly obsolete now. The rationale and use of antimicrobial treatment in the medical management of the condition has also undergone a change. This clinical update has been designed to update the readers on the important aspects of Acute Pancreatitis. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient including the supportive and nutritional management. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.

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