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	Cirrhosis Microchapters
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Latest revision as of 00:04, 30 July 2020

Physical examination

References

Template:WH Template:WS

References

Pathophysiology prev

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Pathophysiology prev


Cirrhosis Microchapters
Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cirrhosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Sandbox:Cherry On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox:Cherry All Images X-rays Echo & Ultrasound CT Images MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox:Cherry

CDC on Sandbox:Cherry

Sandbox:Cherry in the news

Blogs on Sandbox:Cherry

Directions to Hospitals Treating Cirrhosis

Risk calculators and risk factors for Sandbox:Cherry

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief:

History and Symptoms

History should include:
- Appearance of bowel movements
- Travel history
- Associated symptoms
- Immune status
- Woodland exposure

References

Template:WH Template:WS

Other Imaging Findings

Other diagnostic studies

Other Diagnostic Studies

Breath hydrogen test

HIV testing for those patients suspected of having HIV

==

Overview

References

Template:WH Template:WS

Pathophysiology prev

https://https://www.youtube.com/watch?v=5szNmKtyBW4%7C350}}


Cirrhosis Microchapters
Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cirrhosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Sandbox:Cherry On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox:Cherry All Images X-rays Echo & Ultrasound CT Images MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox:Cherry

CDC on Sandbox:Cherry

Sandbox:Cherry in the news

Blogs on Sandbox:Cherry

Directions to Hospitals Treating Cirrhosis

Risk calculators and risk factors for Sandbox:Cherry

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief:

Video codes

Normal video

Video in table

Floating video

Title
https://https://www.youtube.com/watch?v=ypYI_lmLD7g%7C350}}

Redirect

REDIRECTEsophageal web

synonym website

https://mq.b2i.sg/snow-owl/#!terminology/snomed/10743008

Image

Normal versus Abnormal Barium study of esophagus with varices

Image to the right

Image and text to the right

<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.

Gallery

Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas^[1]
Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas^[1]
Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas^[1]

References

↑ ^1.0 ^1.1 ^1.2 Neuroendocrine tumor of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas

Template:WS Template:WH

REFERENCES

[aaa-1] 1.0 ^1.1 ^1.2 Neuroendocrine tumor of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas

[1]

@@ Line 1: / Line 1: @@
-In patients with pancreatic cancer, surgery is the primary modality of treatment.
+==Physical examination==
-Extrapancreatic disease requires palliative therapy and curative resection is not performed in such patients.Patients with unresectable disease are treated with chemotherapy and/or radiation therapy as a part of adjuvant or neoadjuvant therapy.
+==References==
-Curative resection is not contraindicated in all patients with vascular invasion. Involvement of the portal or superior mesenteric vein can be resected and reconstructed with the help of splenic, saphenous or internal jugular veins. However, the involvement of arteries such as the hepatic, celiac or superior mesenteric are contraindications to resection.
+{{reflist|2}}
-Various methods of surgical resection may be employed and each of these has its own sets of risks and perioperative complications. The facts are discussed by the patient and surgical team before arriving at a well-informed decision.
-The method of surgical resection depends on the following features:
-*Locally invasive characteristics of the neoplasm
-*Size
-*Location
-Methods of curative resection options include:
-**Distal Pancreatectomy
-*Total pancreatectomy
-*Pancreaticoduodenectomy, where pylorus may or may not be spared on an individual basis
-The National Comprehensive Cancer Network (NCCN) has recommended certain guidelines on resectability of pancreatic neoplasms:
+{{WH}}
-*Patient selection is based on:
+{{WS}}
-**Resection margins
-**High probability of cure
-**Patient's age
-**Comorbidities
-European Society for Medical Oncology (ESMO) has certain guidelines on the treatment of metastatic pancreatic cancer:
-*Chemotherapy not preferred
-*Gemcitabine is preferred over 5 FU
-*Treatment is symptomatic with bypass surgery or stent placement for gastric outlet obstruction or obstructive jaundice
-In case of locally advanced disease which is unresectable, the following methods of treatment are preferred:
-Microwave ablation
-Photodynamic therapy
-Irreversible electroporation
-Photodynamic therapy
-High-intensity focused ultrasound (HIFU)
-Iodine-125–cryosurgery
-Iodine-125
-Stereotactic body radiation therapy (SBRT)
-Radiofrequency ablation (RFA)
-CHEMOTHERAPY
+==References==
+{{Reflist|2}}
-Metastatic disease/ Advanced pancreatic cancer which is unresectable:
-The National Comprehensive Cancer Network (NCCN) has recommended guidelines for treatment in patients based on their performance status.
-In order to predict survival of patients in various stages of pancreatic cancer, the performance status of a patient is a major prognostic factor. Patients with poor prognostic factors have poor performance status. This includes-<ref name="pmid22996141">{{cite journal |vauthors=Tas F, Sen F, Odabas H, Kılıc L, Keskın S, Yıldız I |title=Performance status of patients is the major prognostic factor at all stages of pancreatic cancer |journal=Int. J. Clin. Oncol. |volume=18 |issue=5 |pages=839–46 |year=2013 |pmid=22996141 |doi=10.1007/s10147-012-0474-9 |url=}}</ref>
-Metastatic disease
-Large tumor
-Severe weight loss
-In patients with locally advanced unresectable or metastatic disease with good performance status
-Preferred treatment: FOLFIRINOX
-In patients with locally advanced unresectable or metastatic disease with good performance status with intolerance to FOLFIRINOX
-Preferred treatment:Paclitaxel protein bound+ Gemcitabine
-In patients with locally advanced unresectable or metastatic disease with poor performance status
-Preferred treatment: Gemcitabine monotherapy
-In patients with locally advanced unresectable or metastatic disease with poor performance status refractory to Gemcitabine:
-Preferred treatment: Capecitabine or capecitabine+erlotinib
-One year survival of FOLFIRINOX (leucovorin+5-lfuorouracil [LV5-FU]+oxaliplatin+irinotecan)>Gemcitabine
-One year survival of Gemcitabine+ Erlotinib> Gemcitabine
-One year survival of Gemcitabine+ Capecitabine≥Gemcitabine
-One year survival of Gemcitabine+ nanoparticle albumin-bound (nab)-paclitaxel> Gemcitabine
+===Pathophysiology prev===
+<div style="-webkit-user-select: none;">
+{| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;"
+|-
+| {{#ev:youtube|https://https://www.youtube.com/watch?v=5szNmKtyBW4|350}}
+|-
+|}
+__NOTOC__
+{{Cirrhosis}}
+{{CMG}} {{AE}}
-NEW TREATMENTS
- Irinotecan in an encapsulated form inside a nanoliposome is being used in advanced pancreatic cancer patients who have been earlier been treated using gemcitabine-based chemotherapy.
-Liposomal Irinotecan is used along with leucovorin and fluorouracil.
+===Pathophysiology prev===
+<div style="-webkit-user-select: none;">
+{| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;"
+|-
+| {{#ev:youtube|https://https://www.youtube.com/watch?v=5szNmKtyBW4|350}}
+|-
+|}
+__NOTOC__
+{{Cirrhosis}}
+{{CMG}} {{AE}}
-ADJUVANT THERAPY
+== History and Symptoms ==
-The use of gemcitabine as adjuvant therapy is considered a standard form of therapy following surgical resection in pancreatic cancer patients.
-NEOADJUVANT THERAPY
-Neoadjuvant therapy may be used as a form of therapy due to the following reasons:
-Toxic effects of chemotherapy can be tolerated more easily before surgery as compared to after resection
-Shrinkage of tumor with neoadjuvant therapy makes resection easier and improves patient prognosis
-Systemic treatment for cancer involving various systems improves prognosis
-No therapy is considered as first line therapy under this category.Decisions for treatment are made on an individual basis.
-SURGERY
+* History should include:
+** Appearance of bowel movements
+** Travel history
+** Associated symptoms
+** Immune status
+** Woodland exposure
+==References==
+{{reflist|2}}
-Pancreaticoduodenectomy (Whipple Procedure)
+{{WH}}
-It is mainly performed for tumors located in:
+{{WS}}
-Periampullary region
-Duodenum
-Bile duct (Cholangiocarcinoma)
-Pancreatic duct
-Head of pancreas
-Whipple procedure involves removal of the following components due to common blood supply:
-Stomach antrum
-Gallbladder
-Duodenum
-Head of pancreas
-After removal of the above structures, the biliary and distal pancreatic ducts are anastomosed to the jejunum to facilitate surgical drainage.
- This procedure is associated with several morbidities:
+==Other Imaging Findings==
-Postoperative abcess
+* [[Endoscopy]]
-Wound infection
+* [[Barium enema]]
-Anastomotic leak
+* [[Colonoscopy]]
-Delay in gastric emptying
+* [[Sigmoidoscopy]]
-Pylorus sparing Whipple procedure:
-The pylorus may be spared as a modification of Whipple procedure to decrease gastric emptying due to antrectomy. This significantly reduces the incidence of nutritional deficiencies arising from this surgery.
+==Other diagnostic studies==
+== Other Diagnostic Studies ==
-The European Society for Medical Oncology states that the only curative therapy is surgical resection.
+* Breath hydrogen test
-Ten percent is the five year survival of patients with pancreatic cancer.
-Patients with node-positive tumors have very poor long term survival.
-Distal Pancreatectomy
+* [[HIV test]]ing for those patients suspected of having HIV
-This procedure has a limited use in curative resection of pancreatic cancer.
-It is mainly performed for tumors located in:
-Body of pancreas
-Tail of pancreas
-This form of surgery has fewer morbidities than the Whipple procedure.
+==
-Distal Pancreatectomy involves the following components:
- Separation of the distal pancreas bearing the tumor from the normal tissue
- Resection of the affected portion
-Oversewing of the distal pancreatic duct
- This procedure is associated with several morbidities:
+==Overview==
-Pancreatic endocrine insufficiency
-Bleeding
-Leakage of pancreatic stump
-Total Pancreatectomy
+==References==
+{{reflist|2}}
+{{WH}}
+{{WS}}
-It is the least preferred due to high mortality rate.
+===Pathophysiology prev===
-It is mainly performed for tumors located in:
+<div style="-webkit-user-select: none;">
-Neck of the pancreas.
+{| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;"
-Due to involvement of neck, patients develop insulin dependent DM.
+|-
+| {{#ev:youtube|https://https://www.youtube.com/watch?v=5szNmKtyBW4|350}}
+|-
+|}
+__NOTOC__
+{{Cirrhosis}}
+{{CMG}} {{AE}}
-PALLIATIVE THERAPY
+==Video codes==
-Pain
+===Normal video===
-There are various techniques for pain management as palliative therapy in patients:
+{{#ev:youtube|x6e9Pk6inYI}}
+{{#ev:youtube|4uSSvD1BAHg}}
+{{#ev:youtube|PQXb5D-5UZw}}
+{{#ev:youtube|UVJYQlUm2A8}}
-Narcotic analgesics
+===Video in table===
-Narcotic analgesics+ tricyclic antidepressants/ antiemetics
+<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
-Endoscopic decompression with stent placement in patients with biliary or pancreatic duct obstruction
-Radiation therapy
-Neurolysis of the celiac ganglia by many approaches
-Intraoperative
- transgastric
- transthoracic
- transabdominal
-Jaundice
+===Floating video===
-Obstructive jaundice can present with features of cholangitis:
-Fever and chills
-Nausea, vomitting
-Clay coloured stools
-Dark urine
-yellowish discolration of skin
-pruritus
- right upper quadrant pain
-Anorexia
-Preferred treatment in patients: Endoscopic decompression with stent placement in patients with biliary obstruction
-Techniques of biliary decompression:
-Cholecystojejunostomy
-Choledochojejunostomy
-Types of stents:
+{| class="infobox mw-collapsible" id="floatvideo" style="position: fixed; top: 65%; width:361px; right: 10px; margin: 0 0 0 0; border: 0; float: right;"
-Metal- costly, longer lifespan
+| Title
-Plastic- cheaper, need replacement every three months
+|-
+|-
-Duodenal obstruction
+| {{#ev:youtube|https://https://www.youtube.com/watch?v=ypYI_lmLD7g|350}}
-Preferred treatment:
+|-
-Endoscopic stenting of duodenal obstruction
+|}
-Gastrojejunostomy
+===Redirect===
+#REDIRECT[[Esophageal web]]
+===synonym website===
+https://mq.b2i.sg/snow-owl/#!terminology/snomed/10743008
+===Image===
+[[Image: Normal versus Abnormal Barium study of esophagus.jpg|thumb|left|200px|Normal versus Abnormal Barium study of esophagus with varices]]
+===Image to the right===
+{| style="float: right; width: 350px;"
+| [[Image:Coxiella burnetii.JPG|right|400px|C. burnetii, the Q fever causing agent]]
+|}
+===Image and text to the right===
+<figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Global distribution of leptospirosis.jpg|577x577px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.
+===Gallery===
+<gallery widths="250px">
+Pancreatic insulinoma histology 2.JPG|Histopathology of a pancreatic endocrine tumor (insulinoma). ''Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas''<ref name=aaa> Neuroendocrine tumor of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas</ref>
+Pancreatic insulinoma histopathology 3.JPG|Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. ''Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas''<ref name=aaa> Neuroendocrine tumour of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas</ref>
+Pancreatic insulinoma histology 4.JPG|Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. ''Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas''<ref name=aaa> Neuroendocrine tumour of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas</ref>
+</gallery>
+==References==
+{{Reflist|2}}
+{{WS}}
+{{WH}}
+REFERENCES
+<references />
+[[Category:Gastroenterology]]
+[[Category:Needs overview]]
+[[Category:Hepatology]]
+[[Category:Disease]]

Sandbox:Cherry: Difference between revisions

Latest revision as of 00:04, 30 July 2020

Physical examination

References

References

Pathophysiology prev

Pathophysiology prev

History and Symptoms

References

Other Imaging Findings

Other diagnostic studies

Other Diagnostic Studies

Overview

References

Pathophysiology prev

Video codes

Normal video

Video in table

Floating video

Redirect

synonym website

Image

Image to the right

Image and text to the right

Gallery

References

Navigation menu

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