Report on 8G

Prelly Garcia07-05-09

HEMATOCHEZIA

→Passage of maroon colored stool.It is distinguished from melena, which is stool with blood that has been altered by the gut flora and appears black/"tarry". It is also different from bright-red blood per rectum (BRBPR). It is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper GI bleed.

Hematochezia as a Symptom of Colon Cancer

It can also be a symptom of colon cancer and a variety of other conditions. Examples include:

• Infection of the intestines (such as bacterial enterocolitis)

• Inflammatory bowel disease

• recent trauma

• Large polyps

• the presence of a foreign object

• a lack of proper blood flow to the intestines (bowel ischemia)

Hematochezia as a Symptom of Cancer

• Tumors tend to bleed -- not a lot and not constantly, but they do bleed. As a result, some of that blood may show up in your stool. If the tumor is in the beginning of the colon, the blood will most likely be dry and virtually invisible by the time the waste leaves your body. However, if the tumor is in the rectum or toward the end of the colon, it may still be fresh, and therefore, bright red.

HERNIOPLASTY

→ A surgical procedure for correcting hernia. A hernia is a bulging of internal organs or tissues, which protrude through an abnormal opening in the muscle wall. Hernias can occur in the abdomen, groin, and at the site of a previous surgery.

An operation in which the hernia sac is removed without any repair of the inguinal canal is described as a 'herniotomy'.

Also called herniorrhaphy, meaning hernia repair.

Common types of hernias

• inguinal or femoral hernias, located in the groin

• umbilical hernias, located at the belly button

• incisional hernias, which form at the site of an earlier surgery

Two methods are used to perform a hernia repair

• Traditional repair. In this technique, surgery is done from the outside of the body. A cut is made through the skin over the hernia. The intestine or other tissue is pushed back into the abdominal cavity. The weakened or torn muscle is repaired with stitches. Sometimes, the surgeon will strengthen the area with a patch made of a synthetic material. Local anesthesia is usually used for this type of surgery. General anesthesia or regional anesthesia can also be used.

• Laparoscopic repair. This type of operation is done using a tiny telescope called a laparoscope. It is linked to a special camera. The device allows the doctor to see the hernia on a video screen. A cut is made in the skin to insert the device. Other small cuts are made, as well. These let the doctor insert long-handled tools into the body. He or she can then repair the hernia from behind the wall of the abdomen. Three or four quarter-inch cuts are usually needed. A small piece of mesh is placed over the hernia. This is held in place with small staples. Most of the time, general anesthesia is used. This surgery leaves smaller scars than traditional repair.

Complications of Hernioplasty

• A small number of people suffer side effects after hernia repair surgery. These can include: infection around the incision breathing problems trouble urinating bleeding

• Intra-operative *Injury to vas deferens

*Injury to viscus (colon, bladder)*Bleeding

• Post-operative *Testicular atrophy

*Recurrence     - Bassini (3-33%)     - Shouldice (0.8%)     - Laparoscopic repair (2-6%)

COLONOSCOPY

→ Endoscopic and internal examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus, using an intrument called a colonoscope. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions.

When Is a Colonoscopy Ordered?

• Unexplained iron deficiency anemia to find eventual bleeding from the large intestine

• Blood in the stool - to find the source of bleeding and treat it • Unexplained chronic diarrhea – to find eventual inflammation in the

colon (colitis) • Unexplained abdominal pain • Unexplained sudden weight loss- to find a  cause like inflammatory

bowel disease or colorectal cancer • Inflammatory bowel disease to monitor its progress and treat

eventual complications • Abnormal result of a X-ray with barium enema to confirm

suspected disorder of the colon • Twisting (volvulus) of sigmoid colon – to resolve it • Individuals after 50 with no risk factors for colorectal carcinoma; after

40 if they have family history of colorectal carcinoma; in adolescence if they there is a hereditary type of carcinoma in the family.

Why the Test is Performed?

• To evaluate unexplained anemia• To evaluate unexplained blood in the stool,

abdominal pain, persistent diarrhea, or abnormalities (such as polyps) found on contrast x-rays (barium enema)

• To determine the type and extent of inflammatory bowel disease (ulcerative colitis and Crohn's disease)

• To follow a previous finding of polyps

1. Relative Contraindications for a Colonoscopyres

2. Drugs and ProceduNot Allowed Before Colonoscopy

3. Foods to Eat and to Avoid Before Colonoscopy (Bowel Cleanse)

4. Have Someone with You5. Agreement6. Sedation

Colonoscopy Preparation

Complications• Colonoscopy is generally a safe procedure and

complications are rare:• Bleeding may appear (and in most cases can be

stopped) during the procedure or as late as a week later; it usually stops spontaneously but sometimes another colonoscopy is needed.

• Arrhythmia, mostly due to side effect of sedatives • Small bowel obstruction • Diverticulitis • Colon perforation • Possibility of transmission of a disease from one patient to

another is practically excluded. Sedatives may cause anxiety, nausea, allergy or respiratory depression.

• Rupture of the spleen is extremely rare

Cachexia• is the loss of body mass that cannot be reversed nutritionally; even if

you supplement the patient calorically, lean body mass will be lost, indicating there is a fundamental pathology in place.

• Cachexia is seen in patients with cancer, AIDS, COPD (chronic obstructive pulmonary disease), and CHF (congestive heart failure). It is a positive risk factor for death - meaning if the patient has cachexia, the chance of death from the underlying condition is increased dramatically.

• It can be a sign of various underlying disorders; when a patient presents with cachexia, a doctor will generally consider the possibility of cancer, metabolic acidosis (from decreased protein synthesis and increased protein catabolism), certain infectious disease (e.g. tuberculosis, AIDS), and some autoimmune disorders, or addiction to drugs such as amphetamines or cocaine.

• Cachexia physically weakens patients to a state of immobility stemming from loss of appetite, asthenia, and anemia, and response to standard treatment is usually poor

Symptoms

• loss of weight• muscle atrophy• Fatigue• weakness• significant loss of appetite

All Causes of Cachexia

• The full list of all possible causes for Cachexia described in various sources is as follows:

• Acute myelosclerosis• Addison’s disease• Andrade’s syndrome• Atypical pneumonia• Bone marrow transplants

Causes of Cachexia that are very common

• The following causes of Cachexia are diseases or medical conditions that affect more than 10 million people in the USA:

• COPD• Mutiple Trauma

Causes of Cachexia that are common

• The following causes of Cachexia are diseases or conditions that affect more than 1 million people in the USA:

• Carcinoma• Celiac Disease• Congestive Heart Failure• Hepatitis B

Causes of Cachexia that are uncommon

• The following causes of Cachexia are diseases or conditions that affect more than 200,000 people, but less than 1 million people in the USA:

• Breast Cancer• Burns • Crohn’s disease

Causes of Cachexia that are rare and very rare

• Mastocytosis• Brucellosis• Colorectal cancer• Leukemia• Liver cancer• Lymphoma• Mycobacterium tuberculosis• Pancreatic cancer• Sarcoidosis

Thanks for viewing…..