Journal of clinical gastroenterology
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Aspiration of oropharyngeal and gastric contents during surgery, although infrequent, is a recognized complication of general anesthesia that carries significant risk for serious complications. Complications of aspiration have been reported to cause 10% to 30% of anesthesia-related deaths. Unconsciousness interferes with multiple biologic mechanisms that guard the airway against aspiration, and this is compounded in surgery by anesthesia-induced neurologic impairment and the risks related to placement of nasogastric and endotracheal tubes. ⋯ Although antacids and histamine 2-receptor antagonists have been used perioperatively with some success, they are limited by short duration of action and systemic side effects, among other factors. Proton pump inhibitors are currently being investigated in surgical patients at risk for aspiration or stress ulcers and seem to be potent, extremely effective, and well tolerated. This article reviews the risks for, and potential outcomes of, anesthesia-related aspiration, identifies high-risk populations, and outlines the experience to date with available preventive treatments.
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J. Clin. Gastroenterol. · Jan 2004
ReviewHepatic hydrothorax: pathophysiology, diagnosis, and management.
Hepatic hydrothorax occurs in approximately 5 to 12% of patients with cirrhosis and portal hypertension. Various therapeutic modalities ranging from dietary and pharmacologic interventions to surgical approaches are available for the management of this condition. ⋯ Hepatic hydrothorax may be complicated by spontaneous bacterial empyema, which portends a poor prognosis with a mortality rate of up to 20%. All patients with hepatic hydrothorax should be evaluated for possible liver transplantation.
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After routine investigations, including a thorough history, routine laboratory study, and noninvasive imaging with transcutaneous ultrasonogram, 10% to 25% of cases of acute pancreatitis have no readily identifiable cause and are termed idiopathic. But modern medicine has made notable advances in uncovering various causes of acute pancreatitis, and several new diagnostic tools that allow clinicians to less invasively approach the patient without sacrificing the diagnostic yield have been introduced. By being knowledgeable of these new changes and by their proper use in a proper circumstances, clinicians will be able to find the cause more accurately and earlier. This better management will not only improve the well-being of the patients but also reduce the number of "true" idiopathic acute pancreatitis to a minimum.
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Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an hereditary disorder that results in fibrovascular dysplasia with the development of telangiectasias and arteriovenous malformations. It predominantly involves the skin, mucous membranes, viscera, lungs, and brain. Hereditary hemorrhagic telangiectasia shows great genetic heterogeneity, and its phenotypes have been classified based on the recently identified mutated genes: endoglin (HHT-1) and activin-like kinase receptor-1 (HHT-2). ⋯ Liver involvement is reported in up to 30% of persons affected by HHT. Large arteriovenous malformations in the liver can lead to significant complications, including high-output congestive heart failure, portal hypertension, hepatic encephalopathy, biliary ischemia, and liver failure. Embolization of large arteriovenous malformations in the liver remains controversial; however, liver transplantation can successfully eradicate these complications.
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J. Clin. Gastroenterol. · Jul 2001
ReviewShould indirect calorimetry be used as part of nutritional assessment?
The use of indirect calorimetry in the design of nutritional support regimens is poorly appreciated by clinicians, who fail to recognize the importance of providing a sufficient volume of enteral feeding to critically ill patients. In contrast to the overfeeding that routinely occurred in the past with the provision of total parenteral nutrition, patients placed on the enteral route of support tend to be underfed because of problems with intolerance and frequent cessation. Clearly identifying and coming as close as possible to the caloric goal may be required to achieve the therapeutic endpoints of enteral tube feeding (which include maintenance of gut integrity, attenuation of the stress response, prophylaxis against stress-induced gastropathy, and stimulation of immune function). Indirect calorimetry is a convenient, accessible, and highly accurate instrument for the measurement of caloric requirements and is a valuable tool for the optimization of nutritional support in the intensive care unit.