e****0
发帖数: 678 | 1 • Exaggerated deep tendon reflexes can be seen in lock in syndrome.
• Non bleeding varices are managed with nonselective beta-
adrenergic antagonists, such as propranolol.
• Sclerotherapy, endoscopic band ligation, and surgery are
indicated after a patient has a first episode of variceal bleeding.
• TIPS is a last resort in variceal bleeding unresponsive to
medical and endoscopic intervention.
• Ischemic colitis
CT—thickening of eth bowel ... 阅读全帖 |
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c****i
发帖数: 40 | 2 不忍心看着你焦急的心情，其实这里很多人都愿意帮忙，但是由于种种原因，无法给你
回复。
就以一般性的回复几句，首先你给的非常有限的病史体检化验结果等等，所以基本上没
人能在这里给你一个诊断。我search了一下，下面是链接以及原文，希望对你能有帮助
。另外，也不要小看国内的医生，有很多是不错的。
点击链接可以发现更多的内容。
http://emedicine.medscape.com/article/958739-overview
History
Despite the extensive differential diagnoses of splenomegaly, careful
history taking and physical examination, along with a CBC count and liver
function tests, often help in narrowing the list of possible causes. The
history should include attention to the following importan... 阅读全帖 |
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l********y
发帖数: 2295 | 3 6am-7am: Arrive to the residents’ workroom to receive checkout from the
night float intern covering your service. Earlier in the year, you will
probably arrive on the earlier side of this time, but you MUST arrive prior
to 7am because this is when night float gets to leave.
Early morning before work rounds with the resident and med students: Look
through eResults and RadWeb to gather information about your patients for
the day. This includes looking at all bloodwork, radiology, and other
studies... 阅读全帖 |
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s********4
发帖数: 64 | 4 Chief Complaint: “I have blood in my stool, and nausea with coffee-ground
emesis.”
History of Present Illness: TH is a 55-year-old man with a past medical
history significant for liver cirrhosis secondary to alcoholic liver disease
and portal hypertension with multiple episodes of esophageal varices who
presented to the emergency room with a two week history of black tarry
stools 2-4 times per day sometimes mixed with bright blood. He also had some
nausea with intermittent vomiting for the same ... 阅读全帖 |
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f******I
发帖数: 769 | 5
some
on
big
spleen
can't tell much with very limited information you provided, the type of
liver cancer and whether is hepatic primary or metastatic would be helpful,
assume he had hepatocellular carcinoma from hep C, and maybe he had upper gi
bleed from either esophageal or gastric varices from portal hypertension
from cirrhosis from hep C, the outlook is not very good,
if it's metastatic disease with solitary hepatic mets sometimes they could
consider chemo embolization, |
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f******I
发帖数: 769 | 6
i don't think because of overwork you'd get liver cirrhosis, but anyway,
for varices resulted from cirrhosis, need to take non-selective beta blocker
, to treat for bleeding, endoscopic banding or sclerotherapy,
sometimes TIPS is used for decompression of hepatic sinoids, it has pretty
good effect in preventing rebleed, but it does not decrease mortality, and
sometimes it increases it, so depends on the liver doctor he is seeing, may
or may not recommend TIPS, |
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f******I
发帖数: 769 | 7
esophageal varices from liver cirrhosis is not the same as in varicose veins
in legs |
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y*****g
发帖数: 193 | 8 I am not a doctor and I try to answer some questions you have. Hopefully, it
will clear some things up for you.
胃镜 will not cause 阴影. The reason the doctor asking whether your dad has
胃镜. He wants to know whether he has esophageal varices which could be
caused by liver cirrhosis or portal hypertension, or stomach ulcers, etc..
Usually, CT-scan with IV contrast will give some details about the liver
nodule, whether it has vascular invasion or not. AFP is serum tumor marker
for hepatocellur carcin... 阅读全帖 |
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d******0
发帖数: 22800 | 9 跑步让腿部肌肉的血管粗大，供血供氧供养料效率更高，平时跑步运动加速血液循环，
腿部需要很大才能支持一直跑步。这个和大家说的病态的靜脈曲張是完全不同的。靜脈
曲張(varices)是不正常擴張的靜脈。下肢靜脈曲張是由於工作上需要長時間站立，令
靜脈的血液流速減緩，漸漸出現腿部腫脹及發麻，加上靜脈血管管壁變弱而誘發病變。
跑者这个是功能加强，不是靜脈曲張病里的功能减弱。楼主不用担心。。运动不会让你
得靜脈曲張的，因为你是在运动，不是像收银员那样站着不动。 |
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l********y
发帖数: 2295 | 10 LIVER:
- Volume: be careful not to fluid overload these pts; hypoalbuminemic
already, 3rd spacing. If unstable, hypotensive, consider IV albumin rather
than NS. Can do salt-poor 12.5gm BID for a few days (not much data supports
use past albumin levels of 3.0); useful in renal failure to reperfuse
kidneys. Esp if concern for hepatorenal syndrome, can start albumin. If
bolus fluids, do so gently.
- Variceal bleeding: immediately place 2 LBIVs; reverse coagulopathy with
FFP (contains ALL coagulatio... 阅读全帖 |
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l******k
发帖数: 27533 | 11 不是高手，抛砖引玉
1. May consider propranolol if still has recurrent variceal bleeding after
TIPS and portacaval shunt
2. If intra-abdominal infection is suspected and ABX is needed, vancomycin
should be started due to the Hx of MRSA wound infection, and metronidazole
should be added for anaerobic coverage. Cultures are needed.
3. change Protonix drip to BID IV push after 72 hours infusion if active
bleeding stopped
5. do iron panel. If need iron supplement, us IV iron, and D/C oral iron for
GI adverse ... 阅读全帖 |
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l******k
发帖数: 27533 | 12 建议把nonvariceal and variceal GI bleeding 学习下再来讨论
这是个典型的acute care patient case |
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n*******c
发帖数: 501 | 13 早起，又是繁忙一天的开始。
这个轮转是消化科，不能不说是胆战心惊的，虽说在国内轮转过这科，可是此一时也，
彼一时也，知识更新千变万化，国内的临床经验也非常短暂粗浅。
查房开始，病人A是从国内来探亲的，妻子是留学生，刚来没多久，英语还不利索，于
是就用中文交谈，一旁的印度Intern自然是云里雾里，呵呵，你们也有今天（以前也常
有印度病人，只会说印度不知道哪里的方言，俺也有云里雾里的时候）不过查房记录就
得自己写了，A说着自己的病情，原来他排黑便已经三天了，没有腹痛，一直以为是吃
太多巧克力，结果昨晚排便后一下晕倒，送到急诊查HB才60，紧急输血加PPI infusion
，嘿嘿，也亏他一个大男生，能捱这么久…有心的妻子把便盆拍了照片，唉呀，大滩的
malena，没说的，紧急胃镜，果然十二指肠球部溃疡出血，所幸血已止住，于是anti-
HP三联治疗，如果稳定，很快可以出院了。
病人B是一个酒精肝硬化的病人，还是执迷不悟，这不，再次酗酒入院，看看他的病史
，三次Variceal bleed做了Banding，一次SBP现在已经在吃norfloxacin，腹水每半年
抽一次，还有过encep... 阅读全帖 |
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