causative organism for pyogenic liver abscesspyogenic
→ 80% of liver abscesses
Polymicrobial infection (most common)
E. coli is the most common causative organism.
K. pneumoniae is the second most common.
Other causative bacteria: Enterococci, Streptococci (eg, ☆viridans), Staphylococcus aureus, Proteus vulgaris, anaerobes infectious diseasegastrointestinal国試 HirotoShishido
follow up for Helicobacter pylori eradication therapyUrea breath test, stool antigen test, or biopsy 4–6 weeks after completion of therapy.
Serology is not preferred to confirm eradication, as it remains positive for weeks/months after eradication.
incubation period for each organisms which cause acute diarrheaemetic B cereus 1-6h
S aureus 2-4h
C perfringens 8-12h
diarrheal B cereus 8-16h
Norovirus 1d
Salmonellosis 大腸, V cholerae, EIEC, ETEC 1-3d
Rotavirus 2-4d
☆Campylobacter jejuni 大腸2-10d
EHEC 大腸3-8d
Yersinia 大腸5d
Cryptosporidium 7d
S typhi 大腸10-14d
Giardia lamblia 7-28d
E histolytica 大腸14-28d gastrointestinal卒試 HirotoShishido
pancreatic cancer borderline respectable and non resectablelocally advanced, borderline resectable
■ tumours that ☆abut the SMA, SMV, portal vein, hepatic artery, or celiac artery
locally advanced, non-resectable (palliative→ relieve pain, obstruction)
■ encasement of major vascular structures including arteries
■ most ☆body/tail tumours are not resectable (due to late presentation) gastrointestinal国試過去3回 HirotoShishido
perianal abscess肛門周囲膿瘍
① 肛門陰窩に細菌が侵入し,そこに開口する肛門腺に感染することで炎症が括約筋などの肛門・直腸周囲組織に波及し,膿瘍が形成される病態である.
② 小児では,生後3ヵ月以内の男児に好発する.乳児期は肛門陰窩が深く,便が泥状・液状であり,腸管局所免疫が未熟であることが原因となる.
③ 肛門周囲の激しい疼痛がみられ,発熱を伴うことが多い.視診では,発赤,腫脹,硬結もみられる.
④ 慢性肉芽腫症,Crohn病に伴うものは難治性である.
⑤ 膿瘍の発赤・腫脹を認める場合は切開排膿を行うが,乳幼児では保存的療法で治癒することが多い. pediatricsgastrointestinal国試過去3回 HirotoShishido
treatment for large bowel obstruction (LBO)•supportive management: IV fluids, gastrointestinal decompression; 75% require surgical intervention
•surgical correction of obstruction
•volvulus: ☆initial decompression with flexible sigmoidoscopy, operative reduction or sigmoid resection dependent on severity
•mechanical obstruction: ostomy alone(fecal diversion), colectomy with primary anastomosis or Hartmann procedure. May pursue stenting as bridging (follow with another intervention) or palliation gastrointestinalsurgery国試過去3回 HirotoShishido
the hallmark of ischemic hepatitisThe hallmark of ischemic hepatopathy is a rapid and significant increase in the transaminases ★with modest accompanying elevations in total bilirubin and alkaline phosphatase. AST and ALT levels peak at 25 to 250 times the upper limit of normal and can reach >10,000 U/L. gastrointestinalUWorld step2CK HirotoShishido
laparotomy is mandatory in the patient with penetrating abdominal trauma if★Hemodynamic instability
Peritonitis
Evisceration
Impalement
Peritoneal penetration & significant organ injury
Free air in abdomen
Blood in NG tube, Foley catheter, or on
DRE(digital rectal exam) gastrointestinalsurgeryUWorld step2CK HirotoShishido
follow up of the patients with liver cirrhosisin any patient with cirrhosis, screening ★abdominal ultrasound is recommended every 6 months to evaluate for new-onset HCC
signs of complicated SBO(small bowel obstruction)changes in the character of the pain, fever, hemodynamic instability (hypotension, tachycardia), guarding, leukocytosis, and significant metabolic acidosis (low bicarbonate in this patient)
Delay in surgery (★urgent surgical exploration)may lead to perforation and significant risk of mortality.