Meconium stained amniotic fluid with meconium aspiration syndrome by uma
Prezentácia programu PowerPoint · •Stones, foreign bodies, meconium •Functional ilues...
Transcript of Prezentácia programu PowerPoint · •Stones, foreign bodies, meconium •Functional ilues...
Ileus
• Definition• Intestinal obstruction
• Disruption of the propulsion and passage of intestinal contents
• Classification• ileum/jujunum/colon
• Partial/localized vs Complete/generalized
• Acute/chronic
• Mechanical vs Functional
Etiology
• Mechanical ileus• Intramural
• Tumor, inflammation, hematoma
• Extramural• Volvulus, hernia, adhesion
• Intraluminal• Stones, foreign bodies, meconium
• Functional ilues• Secondary – postoperative ileus, trauma• Metabolic causes – uremia, ketoacidosis, hypokalemia• Drugs – morphine, antacids, anticonvulsants
Epidemiology
• 1% of all hospitalizations
• Adhesion is the most common cause of small bowelileus (60%)
• Colorectal carcinoma is causing colon ileus (60%)
• Mortality 3-30%
Pathophysiology
• Unclear mechanisms
• Hypersecretion into the lumen
• Intramural inflammation
Symptoms
• Pain
• Vomiting (proximal)
• Distension (distal)
• Obstipation
Clinics
• Dg• Symptoms• Imaging (X-ray, CT)
• Air-fluid levels, dilated loops
• Biochemistry?
• Th• Conservative
• Previous surgery, malignancy, incomplete obstruction
• Surgery• Perforation, peritonitis, failure to improve
• Coffee, chewing gum
Complications
• Perforation
• Peritonitis
• Sepsis
Peptic ulcer disease
• Breaks in the gastric and duodenal mucosa
• Gastric ulcers
• Duodenal ulcers
• Zollinger-Ellison syndrome• Gastrinoma
Gastric vs duodenal ulcers
Etiopathogenesis
Etiopathogenesis
Risk factors
• Smoking
• Stress
• Alcohol
• Epidemiology• Decreased mortality in the past 20 years
Symptoms
• Pain• Gastric ulcer pain is aggravated by meals – weight loss• Pain of duodenal ulcers is relieved by meals
• Nausea
• Complications• Bleeding• Perforation• Penetration• Pyloric stenosis
Clinics
• Dg• X-ray
• Urea breath test
• Endoscopy
• Histology
• Th• Proton pump inhibitors
• H2 receptor antagonists
• Surgery – vagotomy, gastrectomy
Th
Pancreatitis
• Inflammation of the pancreas
• Autodigestion• Digestive enzymes active in the pancreas
• Acute vs chronic
• Mild vs severe
Etiology
• Alcohol
• Biliary pancreatitis
• Hyperlipidemia
• Hypercalciemia
• Trauma
• Cystic fibrosis
• Infections• Coxsackie• CMV• Legionella
Symptoms
• Epigastric pain
• Nausea
• Vomiting
• Hypotension, tachycardia
• Turner’s sign
• Cullen’s sign
Complications
• Ileus
• Renal failure
• Hemorhagic pancreatitis
• Abscess
• ARDS
• Diabetes mellitus
Clinics
• Dg• Amylase, lipase• Hyperglycemia• CT• Calcifications, steatorrhea, diabetes mellitus (chronic)
• Th• Restriction of oral intake• Analgetics• Fluids• Antibiotics (fever is not an infection)