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
what produce aflatoxin B1
and what is caused by aflatoxin B1aspergillus flavus(not fumigatus)
High levels of dietary aflatoxin exposure is associated with a G:C → T:A transversion in codon 249 of the ☆p53 gene, a mutation thought to greatly increase the risk of developing hepatocellular carcinoma. microbiologygastrointestinalUWorld 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
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
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
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.
caused by any abdominal process irritating the phrenic nerve
☆splenic laceration, peritonitis, ☆pneumoperitoneum(commonly caused by
anterior duodenal ulcer), hemoperitoneum, etc. gastrointestinalUWorld HirotoShishido
small intestinal bacterial overgrowth
cause, resultcause→ Roux-en-Y gastric bypass
result→ overproduction of vitamin K and ☆folate, associated with nausea, bloating, abdominal discomfort, and malabsorption gastrointestinalUWorld HirotoShishido
risk fators for diverticular disease☆diet in red meat & fat & low in fiber
obesity, physical inactivity, smoking gastrointestinalUWorld HirotoShishido
action of vasoactive intestinal polypeptide(VIP)increase secretion of water and electrolytes into the intestinal lumen
Picture
symptoms, etiologytoxic megacolon
severe abdominal pain with visibly distended colon→ ☆increased risk of colonic perforation(☆colonoscopy and barium contrast are contraindicated)
Predisposing factors include infection with Clostridium difficile, ☆loperamide use (especially in young children<2yo), and ulcerative colitis. gastrointestinalUWorld HirotoShishido
