Introduction Acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) appears to be the most frequent major complication, occurring in 1-10% of patients overall, with a mortality rate ranging from 0.2-0.6% and an annual healthcare expenditure cost reaching $150 million in USA alone (1) (2). Several risk factors have been reported to play a role in ERCP-induced pancreatitis; some are patient-related (i.e. sphincter of Oddi dysfunction (SOD), female gender, history of pancreatitis, pancreatic acinar opacification), while others are procedure-related (i.e. precut or needle-knife endoscopic sphincterotomy, repeated pancreatic duct injection, difficult cannulation), and this may be useful in stratifying patients into low-risk or and high-risk categories (3). The exact mechanism that leads to post-ERCP pancreatitis (PEP) is not fully established;however, , but it is suggested that, once the inflammatory cascade is initiated, it promotes intraluminal activation of proteolytic enzymes, autodigestion of the pancreas, impaired acinar secretion and synthesis of chemokines and proinflammatory cytokines, augmenting the inflammatory process. Given the severity of pancreatitis, attempts to interrupt one or more of these critical steps were made in order to prevent this complication (4). Therefore, more than 35 pharmacological agents have been studied, but to date no medication is being constantly used in wide clinical practice. Multiple studies have demonstrated the prophylactic effect of rectal declophenate (5-9) and rectal indomethacin (10, 11) or combined diclophenate and indomethacin (12), but no studies have evaluated the prophylactic effect of oral NSAIDs. On the other hand, Almeida et al demonstrated data on the ... ... middle of paper ... ...ia from one side and incidence of PEP (curve 1). In a separate analysis we divided the patients to 2 groups, a group that used Proton pump inhibitor (omeprazole) and the control group; we found that out of 98 patients, 7 patients had PEP (5 sever, 1mild, 1 moderate) compared to 91patients that did not use PPI had 5 PEP. P value =0.7703 We found that out of 22 patients had stone removed during the ERCP, 11 used balloon to remove the stone, and While 10 patients used basket and mechanical tools to remove the stones. Out of 22 patients 15 had multiple stone removal less than 1 cm, On the other hand out of the 7 patients with stone more than 1cm. Balloon dilation of biliary sphincter (n=28) in most of the patient Dilatation caliber (9*12)-(10*12) mm, Biliary stent placement isn made of plastic caliber ranging from 10-French 5-cm to 9-French 7-cm in 45 ERCP.
Improved Compliance. The Rectal Rocket offers extended relief in 1 dosage form for both types of hemorrhoids. The most common formulation provides 3% lidocaine (an anesthetic for pain and itching) and 2.5% hydrocortisone (an anti-inflammatory), and 1% Pramoxine HCl (an anesthetic for pain and itching) in a special suppository blend. **Int J Pharm Compd.
The pros of the CPOE system included that the prescribing of wrong medications was reduced, there were fewer errors with the patient’s basic information, orders for lab work, blood work, and medications were standardized; and mistakes in the ordering...
complications include hemorrhage, perforation, obstruction (from intessusception or volvulus) and neoplasia. In our case the patient had a proximal small bowel obstruction secondary to gallstone ileus with impaction of two smaller stones at a MD. This is exceptionally rare with only 3 cases having been reported in the literature. The techniques for surgical resection of MD are simple diverticulectomy or a segmental small bowel resection. As far as we know, there are no studies directly comparing these two resection techniques. However, as in our case, if the small bowel lumen is in danger of being narrowed or the neck of the diverticulum is wide, a segmental resection is favored over a simple diverticulectomy. [3]
It has been argued that medication can contribute to pressure ulcers. Certain analgesics may reduce stimulus to relieve pressure ulcers. Non -steroidal anti-inflammatory drugs have been found to prevent inflammatory responses to pressure injuries thus worsening the condition. It has been found that nurses lack communication with a pharmacist regarding pressure ulcers in order to seek specialist advice (Royal college of nursing, 2001).
...d ciprofloxin. In cases with severe stone formation, surgery is necessary to remove the blockage.
“Crohn’s disease appears to be caused by a dysfunctional inflammatory response in the gastrointestinal tract” (U. S. News, 2009). Inflammation is the body’s natural way to heal by sending immune cells to the site of the injury or invader. Researchers think that this immune system response may be triggered by bacteria or viruses, material in the intestinal contents, or a defective signal from the body’s own cells, called an autoimmune response. Inflammation results in pain, heat, redness, and swelling of the tissue. Chronic inflammation can harm the function of tissues and organs (U.S. News, 2009).
Marinella, L.B. et al: (2010). Acute Diverticulitis. The New England Journal of Medicine. 327: 1521-1526
By the end, all the aspects above will be explored. Yet, like most medical topics and conditions, PP is still being researched and scientists are discovering new components the more they explore.
In most of the patient’s pressure ulcer resulted in to patient’s health deterioration and increases chances of infection. Therefore it is very critical to formulate PICOT statement as it provides comprehensive analysis of the issue (Boswell & Cannon, 2012). PICOT can be described as below. P represents the patient’s population (P), I represent intervention or issue (I), and C refers to comparison of different intervention related to issue. O refers to the expected outcome of interest and, T refers to the time that is going to be use for targeted result of
Davies NM, Reynolds JK, Undeberg MR, Gates BJ, Ohgami Y, Vega-Villa KR. Minimizing risks of NSAIDs: cardiovascular, gastrointestinal and renal. Expert Rev Neurother. 2006 Nov;6(11):1643-55.
The pancreas is a large gland that is located in the upper abdomen that secretes digestive juices, and releases insulin and glucagon into the bloodstream. Pancreatitis is a medical term for inflammation of the pancreas. When the pancreas is inflamed, it can progress to swelling of the gland, and surrounding blood vessels, bleeding, infection, and damage to the gland. It occurs when digestives enzymes start digesting the pancreas itself. Pancreatitis has two types; acute or chronic and either type can be life-threatening and have some serious complications.
Mr. P is a 70-year-old male with originally seen at gastrointestinal surgical Oncology clinic after esophagogastroduodenoscopy (EGD) at his local hospital showed a 5cm laterally spreading polypoid mass with submucosal invasion in the second part of the duodenum. The pathology study of the mass showed tubular adenoma. Once surgical resection of the mass was considered, initial preoperative cardiac evaluation revealed high risk of perioperative complications. Cardiologist was consulted and Mr. P underwent left heart catheterization (LHC) after abnormal pharmacologic stress testing result. LHC revealed normal coronary arteries and normal left ventricle ejection fraction of 55%. Cardiologist cleared Mr. P for surgery based above result.
A randomized trial of ondansetron for the treatment of irritable bowel syndrome with diarrhea, was a two-centre, double-blind, placebo controlled crossover study of ondansetron 4 mg/tablet versus placebo. The inclusion criteria of the study were age 18–75 years, IBS-D patients meeting the Rome III criteria, women of childbearing age should agree to have contraception during the study, no evidence of inflammatory bowel disease/microscopic colitis and able to give informed consent. The exclusion criteria were pregnancy or br...
Turner, B. J., Newschaffer, C. J., Zhang, D., Fanning, T., & Hauck, W. W. (1999). Translating clinical trial results into practice. Annals of Internal Medicine, 130(12), 979-986.
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