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Esophageal Rupture

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242. New Swallowing Method to Improve Pharyngeal Passage of a Bolus by Creating Negative Pressure in the Esophagus—Vacuum Swallowing Full Text available with Trip Pro

New Swallowing Method to Improve Pharyngeal Passage of a Bolus by Creating Negative Pressure in the Esophagus—Vacuum Swallowing Herein, we present a case of a patient with Wallenberg syndrome with severe bulbar dysphagia who discovered a unique swallowing method: creating strong negative pressure in the esophagus to improve pharyngeal passage of a bolus. A 47-yr-old man presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm in the right vertebral artery. After coil (...) embolization, he experienced severe dysphagia due to Wallenberg syndrome and required tube feeding. Eighty-one days after the onset of the stroke, a videofluoroscopic swallowing evaluation revealed that the bolus was rapidly sucked into the esophagus. High-resolution manometry showed weak constriction of the pharynx simultaneous with forced, voluntary constriction of the diaphragm before swallowing; this created negative pressure in the esophagus. The authors named this unique swallowing method "vacuum

2018 American journal of physical medicine & rehabilitation

248. Avibactam sodium / ceftazidime (Avycaz)

Claforan Ceftazidime Fortaz, Tazicef Ceftriaxone Rocephin Cefepime Maxipime ß- l ac t am / ß-lactamase Inhibitor Combinations Ticarcillin clavulanate Timentin Ampicillin-sulbactam Unasyn Piperacillin-tazobactam Zosyn Ceftolozane-tazobactam Zerbaxa Fluoroquinolones Risk of tendonitis, tendon rupture, QTc prolongation, exacerbation of myasthenia gravis, CNS effects, peripheral neuropathy Ciprofloxacin Cipro Moxifloxacin Avelox Carbapenems Imipenem-cilastatin Primaxin Meropenem Merrem Ertapenem Envanz (...) Piperacillin-tazobactam Zosyn Ceftolozane-tazobactam Zerbaxa Fluoroquinolones Risk of tendonitis, tendon rupture, QTc prolongation, exacerbation of myasthenia gravis, CNS effects, peripheral neuropathy Levofloxacin Levaquin Ciprofloxacin Cipro Carbapenems Imipenem-cilastatin Primaxin Ertapenem Envanz Doripenem Doribax Monobactams Although used in pts with allergy to penicillins/cephalosporins, there are concerns about cross-reactivity with ceftazidime Aztreonam Azactam Aminoglycosides Risk

2015 FDA - Drug Approval Package

250. Eating disorders

and lead to social isolation. Physical abnormalities — can affect many systems including: Cardiovascular — arrhythmias (due to hypokalaemia), diet pill toxicity (for example palpitations, hypertension), valve prolapse, peripheral oedema. Dermatological —knuckle calluses from inducing vomiting (Russell's sign). Dental — erosion of tooth enamel from vomiting. Endocrine — amenorrhoea, irregular menses, hypoglycaemia, osteopenia. Gastrointestinal — acute gastric dilation, oesophageal rupture, Mallory–Weiss (...) -worth in terms of body weight and shape. Fear of gaining weight, with a sharply defined weight threshold set by the person. Mood disturbance and symptoms of anxiety and tension. Persistent preoccupation and craving for food and feelings of guilt and shame about binge eating. Self-harm, often by scratching or cutting. Physical symptoms , such as bloating, fullness, lethargy, gastro-oesophageal reflux, abdominal pain, and sore throat (from vomiting). In severe cases, physical signs may include

2019 NICE Clinical Knowledge Summaries

251. Pelvic inflammatory disease

cyst rupture, torsion, or haemorrhage; and urinary tract infection) should also be considered. Women with suspected PID should ideally be managed in a genito-urinary medicine (GUM) clinic or other local specialist sexual health service. Empirical antibiotics should be started as soon as possible. Diagnostic investigations should be performed to confirm the diagnosis and to test for other STIs and other genital infections (ideally before starting antibiotics). Sexual contacts should be traced (...) . Threatened abortion. Ruptured corpus luteal cyst. Acute appendicitis — nausea and vomiting occur in most women with appendicitis, but in only 50% of women with PID. Cervical motion pain occurs in about 25% of women with acute appendicitis. See the CKS topic on for more information. Endometriosis — the relationship between symptoms and the menstrual cycle may be helpful in establishing a diagnosis. See the CKS topic on for more information. Gastrointestinal disorders, including irritable bowel syndrome

2019 NICE Clinical Knowledge Summaries

252. Pulmonary embolism

coronary syndrome. Acute congestive heart failure. Dissecting or rupturing aortic aneurysm. Unstable angina. For more information, see the CKS topic on . Myocardial infarction. For more information, see the CKS topic on . Pericarditis. Musculoskeletal chest pain. Note that chest pain with chest wall palpation occurs in up to 20% of people with confirmed PE. Gastro-oesophageal reflux disease. For more information, see the CKS topic on . Any cause for collapse, such as: Vasovagal syncope. Orthostatic (...) congestive heart failure, dissecting or rupturing aortic aneurysm, and pericarditis. Musculoskeletal chest pain. Note that chest pain with chest wall palpation occurs in up to 20% of people with confirmed PE. Gastro-oesophageal reflux disease. Any cause for collapse, such as vasovagal syncope, orthostatic (postural) hypotension, cardiac arrhythmias, seizures, and cerebrovascular disorders. For people with a Wells score of more than 4 points (PE likely), arrange hospital admission for an immediate

2019 NICE Clinical Knowledge Summaries

253. Vascular diseases of the liver

be treated endoscopically. Risk of endobiliary maneuvers is haemobilia from ruptured intrabiliary varices, which can be massive. Biliary stricture associated with jaundice or bile stones can also be treated endoscopically with repeated stenting. When superior mesenteric vein or splenic veins are evi- dent a surgical shunt can be considered. Because of anecdotal reports of successful TIPS placement, such a procedure can also be considered although results beyond a few months of follow- up have not been (...) studies from India the majority of patients present with gastrointestinal haemorrhage related to portal hypertension. This is most commonly due to esophageal varices, although gastric varices and portal hypertensive gas- tropathycanoccurinaminority.Commonly,andmoreoftenthan in other causes of portal hypertension (e.g. liver cirrhosis and PVT), a large spleen is observed in patients with INCPH [120,122]. At initial diagnosis, patients present mainly with nor- mal liver function [120–122]. Only

2015 European Association for the Study of the Liver

255. Sore throat - acute

gastro-oesophageal reflux disease or chronic cigarette smoke, and hayfever. Common causes of sore throat in primary care are usually not life-threatening and include common cold, influenza, streptococcal infection, and infectious mononucleosis. Less common causes include HIV, gonococcal pharyngitis, and diphtheria. Acute throat infections most commonly occur in people aged 5–24 years. Complications include otitis media (most common), peri-tonsillar abscess (quinsy), and parapharyngeal abscess. Sore (...) diphtheria. Arcanobacterium haemolyticum — causes arcanobacterial pharyngitis. Yersinia enterocolitica — causes yersinial pharyngitis. Francisella tularensis — causes oropharyngeal tularaemia. Chlamydophila pneumoniae , Mycoplasma pneumonia — can cause chlamydial pharyngitis and mycoplasmal pharyngitis. HIV-1. Non-infectious causes are uncommon, and include [ ] : Physical irritation (e.g. from a nasogastric tube or from smoke). Hayfever. Gastro-oesophageal reflux disease. Kawasaki disease — usually

2018 NICE Clinical Knowledge Summaries

256. Cirrhosis

with cirrhosis each year), and is more common in people with other evidence of decompensated liver disease [ ; ; ]. It is usually associated with a predisposing event, for example, constipation, dehydration, infection, gastrointestinal bleeding, or drugs (for example opiates, benzodiazepines, diuretics) [ ; ; ; ]. Haemorrhage from oesophageal varices The increase in portal pressure causes varices as a result of dilation of veins in the oesophagus and stomach [ ]. Rupture of varices and associated bleeding (...) , which can present as haematemesis or melaena, has a high mortality rate [ ; ]. Risk factors for rupture include size of varices, severity of liver disease, sepsis, and hepatocellular carcinoma [ ]. Gastro-oesophageal varices occur in around half of people with cirrhosis, but this is dependent on the clinical stage. Fewer people with compensated cirrhosis have varices (30–40%) compared with decompensated cirrhosis (up to 85%) [ ]. Infection People with cirrhosis are at increased risk of bacterial

2018 NICE Clinical Knowledge Summaries

257. Malaria prophylaxis

occur. Transmission of malaria to humans occurs through the bite of infected female Anopheles mosquitoes. The infecting agent (sporozoite) is inoculated into humans in the saliva of infected mosquitoes during a blood meal. The sporozoites travel in the bloodstream to the liver where they enter liver cells and mature into schizonts which eventually rupture and release tens of thousands of merozoites. Each merozoite can infect a red blood cell where they mature and divide to form more parasites (...) . These are released into the bloodstream when the red blood cell ruptures and go on to infect other red blood cells. The number of parasites in the blood increases rapidly and produces clinical illness. Some parasites in the red blood cells form male and female gametocytes. These mate if taken up by a mosquito and mature to release sporozoites ready to be inoculated into a new human host. Anopheles mosquitoes are found mainly in tropical and subtropical areas of the world — malaria does not occur naturally

2018 NICE Clinical Knowledge Summaries

258. Nausea/vomiting in pregnancy

% of pre-pregnancy weight. Findings which may suggest an alternative diagnosis include: Onset of symptoms after 11 weeks of gestation. Abdominal pain or tenderness (more than mild epigastric tenderness after retching). Fever. Headache or abnormal neurological examination. Goitre. Complications are more likely in women with severe vomiting and include: Maternal — weight loss, dehydration, hyponatraemia, vitamin deficiencies, Mallory-Weiss tear or oesophageal rupture, increased risk of venous (...) , metabolic acidaemia can occur). Abnormal liver function test results. Vitamin deficiencies (for example thiamine [vitamin B 1 ] which may cause Wernicke's encephalopathy). Mechanical complications: Retinal haemorrhage. Splenic avulsion. Mallory–Weiss tears or oesophageal rupture. Pneumothorax or pneumomediastinum. The combination of immobility and dehydration associated with hyperemesis gravidarum may increase a woman's risk of venous thromboembolism [ ]. Today, maternal death from nausea and vomiting

2018 NICE Clinical Knowledge Summaries

259. Bites - human and animal

, haematoma, avulsion, amputation). The degree of crush injury, devitalized tissue, nerve or tendon damage, and involvement of muscle, bones, joints, or blood vessels. Examine wounds overlying a joint through the full range of motion to detect retracted injuries and tendon rupture. Neurovascular function in the area distal to the bite — check pulses and sensation. The range of movement of any adjacent joints. Any lymphadenopathy. The presence of any foreign bodies (for example teeth) in the wound. Any (...) , and involvement of muscle, bones, joints, or blood vessels. Examine wounds overlying a joint through the full range of motion to detect retracted injuries and tendon rupture. Neurovascular function in the area distal to the bite — check pulses and sensation. The range and movement of any adjacent joints. Any lymphadenopathy. The presence of any foreign bodies (for example teeth) in the wound. Any signs of infection (for example redness, swelling, induration, necrotic tissue, purulent discharge, pain

2018 NICE Clinical Knowledge Summaries

260. Dyspepsia - proven functional

Dyspepsia - proven functional Dyspepsia - proven functional - NICE CKS Share Dyspepsia - proven functional: Summary The term 'dyspepsia' is used to describe a complex of upper gastrointestinal tract symptoms which are typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and/or vomiting. If symptoms of heartburn and acid regurgitation predominate, then gastro-oesophageal reflux disease (GORD) is the more likely diagnosis (...) . Functional dyspepsia (also known as non-ulcer dyspepsia) refers to people with dyspepsia symptoms and normal findings on endoscopy (gastric or duodenal ulcer, gastric malignancy, or oesophagitis have been excluded). Functional dyspepsia is the most common diagnosis when endoscopy is performed to investigate dyspepsia symptoms. Two sub-types of functional dyspepsia have been defined, which can overlap: Epigastric pain syndrome, where intermittent or burning pain is localized to the epigastrium. Post

2018 NICE Clinical Knowledge Summaries

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