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Gastroenterology

FitSugar — Wed, 08 Oct 2008 17:35:35 -0700

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HEALTH GUIDE REFERENCE FROM A.D.A.M

Review Date:
11/21/2006
Reviewed By:
Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Intussusception - x-ray

FitSugar — Wed, 08 Oct 2008 17:35:31 -0700

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HEALTH GUIDE REFERENCE FROM A.D.A.M

This abdominal x-ray shows an intestinal condition in which a loop of bowel has slipped into another section of bowel (intussusception), causing swelling, reduced blood flow, obstruction, and tissue damage. Intussusception requires emergency treatment (barium enema or surgery) to prevent intestinal tissue death (necrosis), intestinal perforation, peritonitis, and death.

Review Date:
8/7/2007
Reviewed By:
Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Heartburn

FitSugar — Wed, 08 Oct 2008 17:35:28 -0700

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HEALTH GUIDE REFERENCE FROM A.D.A.M

A.D.A.M. Copyright

adam.com

Glitterati: JBalducci Jewelry

FabSugar — Wed, 07 Nov 2007 04:00:22 -0800

When one of your necklaces is featured on Tim Gunn's Guide to Style as one of Tim's Essentials, you're done - in a good way. That's just what happened to Jenifer Balducci, the San Francisco-based designer who created the necklace at left as part of her JBalducci Jewelry collection.

She started out designing high-end jewelry and custom pieces in LA, but eventually moved into her Bay Area studio, where JBalducci was born in 2003. Jenifer loves incorporating vintage and antique pieces with fine materials for her namesake line, producing a contemporary look.

All of her pieces are handmade, and they run from $25-$130 at JBalducci.com.

To see more from JBalducci, read more

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Biliary obstruction - series

admin — Thu, 04 Sep 2008 19:44:48 -0700

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HEALTH GUIDE REFERENCE FROM A.D.A.M

Normal anatomy

Bile is a digestive fluid secreted by the liver and stored in the gallbladder which normally is released into the duodenum portion of the small intestine through the sphincter of Oddi. Bile, released after a meal containing fats, aids in absorption and digestion of the fat.

Indication

Biliary obstruction occurs when the duct which transports bile from the liver to the small intestine (duodenum) is blocked by a stone, a tumor, an injury or inflammation of any of the ducts. A tumor in the pancreas may press in on the ducts, causing a backup of bile in the gallbladder. Blood tests may indicate a high level of bilirubin, a waste product of the liver, or diagnosis may come from an endoscopic examination. Untreated biliary obstruction may cause life-threatening infection or chronic liver disease.

Procedure

One method of relieving a blockage of the bile duct due to pancreatic tumors is the placement of a stent, a device designed to hold tube-shaped structures open. An endoscope (an instrument placed down the throat into the esophagus, through the stomach to the duodenum of the small intestine) helps the surgeon to see the blockage and to place the stent in the correct position. Dye may be injected and X-ray images taken to insure the stent is correctly placed and the flow of bile is restored.

Aftercare

Once the flow of bile is restored, the threat of infection and inflammation is decreased. However, the prognosis may not be significantly altered if the pancreatic carcinoma is otherwise untreatable. Reoccurrence of the blockage (restenosis) may also occur, requiring further surgery or replacement of the stent.

Review Date: 7/25/2006

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-TorresdaleHospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 3_100199

Gastroesophageal reflux - series

admin — Thu, 04 Sep 2008 19:44:34 -0700

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Overview

Normal anatomy
Indication
Incision
Procedure, part 1
Procedure, part 2

HEALTH GUIDE REFERENCE FROM A.D.A.M

Normal anatomy

The esophagus is a narrow, muscular tube that leads from the mouth to the stomach. The esophagus carries food from the mouth to the stomach. A sphincter at the junction of the esophagus and the stomach prevents reflux of food and acid from the stomach into the esophagus.

Indication

When the lower esophageal sphincter doesn't function properly, acid and food can reflux up from the stomach into the esophagus. This can lead to pain (heartburn) and damage to the lower esophagus. This damage can cause strictures (narrowing) of the esophagus, and eventually, cancer of the esophagus. Frequently, dysfunction of the lower esophageal sphincter is associated with a hiatal hernia, in which the lower esophagus and upper part of the stomach slips up into the chest.

Incision

The first step in managing esophageal reflux disease involves medical treament. Anti-acid medications can neutralize acid that refluxes into the esophagus and prevent damage to the eophagus. If these medications do not eliminate symptoms, surgery may be necessary. The primary surgical treatment of esophageal reflux is called esophageal fundoplication. Fundoplication can be performed through an upper midline incision, or using a laparoscopic procedure.

Procedure, part 1

Currently, the laparoscopic procedure is being performed more frequently. Long narrow instruments are passed through small incisions in the abdomen, and the surgery is viewed using a long narrow camera passed through one of these incisions.

Procedure, part 2

There are a number of different types of fundoplication procedures, which all involve wrapping a part of the upper stomach around the esophagus and re-creating the lower esophageal sphincter. The most commonly performed fundoplication procedure is called Nissen's fundoplication. Fundoplication generally has excellent results, and cures reflux disease without the need for life-long anti-acid medications.

Review Date: 7/28/2006

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-TorresdaleHospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 3_100181

GI bleeding - series

admin — Thu, 04 Sep 2008 19:44:26 -0700

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Overview

Normal anatomy
Indication
Procedure, part 1
Procedure, part 2
Procedure, part 3

HEALTH GUIDE REFERENCE FROM A.D.A.M

Normal anatomy

The gastrointestinal tract starts at the mouth, which leads to the esophagus, stomach, small intestine, colon, and finally, the rectum and anus. The GI tract is a long, hollow, muscular tube through which food passes and nutrients are absorbed.

Indication

Bleeding from the GI tract is a common medical problem. Patients usually notice either dark red blood or bright red blood in their stool.

Ulcers of the stomach and duodenum are common causes of bleeding from the upper GI tract. Bleeding can also occur in the lower GI tract (colon). Diverticular bleeding is a common cause of lower GI bleeding.

Procedure, part 1

The first step in the treatment of GI bleeding is to locate the source of the bleeding. Patients who have lost significant amounts of blood are transfused with blood.

Next, an endoscopy is used to locate the source of the bleeding. Upper endoscopy is generally performed first, and if no bleeding source is located, then lower endoscopy is performed. During an endoscopy, the patient is usually sedated but awake.

Procedure, part 2

In many cases, GI bleeding will stop on its own, with no treatment. In other cases, treatment can be provided with the endoscope, most often in the form of cautery (electrocoagulation) of the site of bleeding.

Procedure, part 3

If the bleeding cannot be stopped using the endoscope, surgery may be required. The bleeding segment of intestine or stomach is removed. However, most cases of GI bleeding are managed succesfully with endsocopy.

Review Date: 8/7/2007

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 3_100162

Gastrostomy tube placement - series

admin — Thu, 04 Sep 2008 19:43:50 -0700

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Overview

Normal anatomy
Indications
Incision
Procedure, part 1
Procedure, part 2
Aftercare

HEALTH GUIDE REFERENCE FROM A.D.A.M

Normal anatomy

The stomach connects the esophagus to the small intestine, and acts as an important reservoir for food, prior to delivery to the small intestine .

Indications

Gastrostomy tubes are inserted for various reasons. They may be needed temporarily or permanently.

Gastrostomy tube insertion may be recommended for:

birth defects of the mouth, esophagus, or stomach (esophageal atresia or tracheal esophageal fistula)
problems with sucking and/or swallowing, for example in patients debilitated by stroke or dementia

Incision

While the patient is deep asleep and pain-free (general anesthesia), a small incision is made on the left side of the abdomen.

Procedure, part 1

A small, flexible, hollow tube (catheter) with a balloon or flared tip is inserted into the stomach. The stomach is stitched closed around the tube and the incision is closed.

Procedure, part 2

Alternatively, gastrostomy tubes can be placed under endoscopic guidance, using a much smaller incision (percutaneous endoscopic gastrostomy tube placement, or PEG). PEG tube placement can generally be performed under local anesthesia rather than general anesthesia. An endoscope is passed into the mouth, down the esophagus, and into the stomach. The surgeon can then see the stomach wall through which the PEG tube will pass. Under direct visualization with the endoscope, a PEG tube passes through the skin of the abdomen, through a very small incision, and into the stomach. A balloon is then blown up on the end of the tube, holding in place. PEG gastrostomy tubes avoid the need for general anesthesia and a large incision.

Aftercare

The stomach and abdomen generally heals in 5 to 7 days. Moderate pain can be managed with medications. The patient will be fed intravenously (IV) for at least 24 hours. Feedings will begin when bowel sounds are heard. Feedings will start slowly with clear liquids and gradually be increased.

The patient/family will be taught:

how to care for the skin around the tube
signs and symptoms of infection
what to do if the tube is pulled out
signs and symptoms of tube blockage
how to empty (decompress) the stomach through the tube
how and what to feed through the gastrostomy tube
how to conceal the tube under clothing
what normal activities can be continued

Review Date: 10/13/2006

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 3_100125

Liver transplant - series

admin — Thu, 04 Sep 2008 19:43:20 -0700

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Overview

Normal anatomy
Indications
Incision
Procedure
Aftercare

HEALTH GUIDE REFERENCE FROM A.D.A.M

Normal anatomy

The liver is in the right upper abdomen. The liver serves many functions, including the detoxification of substances delivered to it from the intestines, and the synthesis of many proteins.

Indications

A liver transplant may be recommended for:

liver damage due to alcoholism (Alcoholic cirrhosis)
primary biliary cirrhosis
long-term (chronic) active infection (hepatitis)
liver (hepatic) vein clot (thrombosis)
birth defects of the liver or bile ducts (biliary atresia)
metabolic disorders associated with liver failure (e.g., Wilson's disease)

Incision

Liver failure causes many problems, including malnutrition, problems with blood clotting, bleeding form the gastrointestinal tract, and jaundice. Frequently, patients who undergo liver transplantation are quite ill, and require hospitalization in the Intensive Care Unit prior to surgery. A large, upper abdominal transverse incision is used for liver transplant.

Procedure

Liver transplants are performed in many centers across the country. The healthy liver is obtained from a donor who has recently died but has not suffered liver injury. The healthy liver is transported in a cooled saline solution that preserves the organ for up to 8 hours, thus permitting the necessary analysis to determine blood and tissue donor-recipient matching. The diseased liver is removed through an incision made in the upper abdomen. The new liver is put in place and attached to the patient's blood vessels and bile ducts. The operation can take up to 12 hours to complete and requires large volumes of blood transfusions.

Aftercare

Patients require hospital care for one to four weeks after liver transplant, depending on the degree of illness. After liver transplantation, patients must take immunosuppressive medications for the rest of their lives to prevent immune rejection of the transplanted organ.

Review Date: 5/8/2006

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 3_100090

Imperforate anus repair - series

admin — Thu, 04 Sep 2008 19:42:50 -0700

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Overview

Normal anatomy
Indications
Procedure
Aftercare

HEALTH GUIDE REFERENCE FROM A.D.A.M

Normal anatomy

In individuals with a normal anatomy, the large intestine (colon) empties into a pouch-like portion of bowel (rectum). Through complex nerve and muscle structures, the rectum releases stool through the anus out of the body.

Indications

This surgery is recommended to repair cases of imperforate anus and other anorectal malformations. There are two types of imperforate anus; a low type and a high type. The low type imperforate anus repair is illustrated.

Procedure

Surgical repair involves creating an opening for passage of stool. Complete absence of an anal opening requires emergency surgery for the newborn.

Surgical repairs are done while the baby is deep asleep and pain-free (using general anesthesia).

Surgery for a high type imperforate anus defect usually involves creation of a temporary opening of the large intestine (colon) onto the abdomen to allow passage of stool (this is called a colostomy). The baby is allowed to grow for several months before attempting the more complex anal repair.

The anal repair involves an abdominal incision, loosening the colon from its attachments in the abdomen to allow it to be repositioned. Through an anal incision, the rectal pouch is pulled down into place, and the anal opening is completed. The colostomy may be closed during this stage or may be left in place for a few more months and closed at a later stage.

Surgery for the low type imperforate anus (which frequently includes a fistula) involves closure of the fistula, creation of an anal opening, and repositioning the rectal pouch into the anal opening.

A major challenge for either type of defect and repair is finding, using, or creating adequate nerve and muscle structures around the rectum and anus to provide the child with the capacity for bowel control.

Aftercare

The child may require several days in the hospital. Dilatation of the new anus (to improve muscle tone and prevent narrowing) will begin in the hospital and continue for some months. Stool softeners and a high-residue diet will need to continue throughout childhood.

Review Date: 6/25/2007

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 3_100030