[GI] Sigmoid volvulus

By HCH_IM_CR |

2010年3月29日 星期一

0 意見

Sigmoid volvulus乙狀結腸扭結為一"腹部急症"﹐一旦診斷確定﹐須立即治療﹐
否則一旦腸壞死﹐則死亡率會大幅升高。

UpToDate:

The goals of treatment of sigmoid volvulus are to prevent the development of gangrene and to address the anatomic abnormality that led to the volvulus. In patients who do not have clinical features suggestive of gangrene or perforation, we suggest "flexible sigmoidoscopy" in an attempt to detorse the twisted segment (Grade 2B). Following successful detorsion, we suggest leaving a rectal tube in place (Grade 2C).

"Recurrent" volvulus develops in about "50 to 60 percent" of patients. As a result, we suggest surgery to prevent recurrence (Grade 2C). We generally perform a mechanical bowel prep and then a standard open laparotomy with sigmoid resection and primary anastomosis. Exceptions are patients in whom definitive surgical therapy is considered to be associated with prohibitive risks. (See 'Treatment' above.)

By HCH_IM_CR |

2009年11月12日 星期四

0 意見

The early prediction of mortality in acute pancreatitis: a large population-based study.

Gut. 2008; 57(12):1698-703 (ISSN: 1468-3288)

Wu BU; Johannes RS; Sun X; Tabak Y; Conwell DL; Banks PABrigham & Women's Hospital, Division of Gastroenterology, Center for Pancreatic Disease, Harvard Medical School, Boston, Massachusetts 02115, USA. buwu@partners.org

BACKGROUND:

Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome.

METHODS:

Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17,992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18,256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II.

RESULTS:

CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1%>

CONCLUSIONS:

A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

Acronym: BISAP (BUN, impaired mental status, SIRS, age, pleural effusion)

Parameters during the first 24 hours after hospital admission:
(1) serum BUN
(2) mental status
(3) systemic inflammatory response syndrome (SIRS)
(4) age of the patient
(5) pleural effusion

BISAP score =
= SUM(points for all 5 parameters)

By HCH_IM_CR |

2009年11月10日 星期二

0 意見

胖出來的病 脂肪肝炎

更新日期:2009/11/11 04:09

文／李祥和

疲勞嗎？如果你經過休養，疲勞依舊，肝功能指數也沒有回復正常，要留意，這是肥胖導致的脂肪肝炎在作怪！

再怎麼休養 肝功能指數還是高

臨床上，經常有病人反應，自己沒有罹患Ｂ型肝炎、Ｃ型肝炎，沒有糖尿病病史，也不喝酒，卻出現疲倦、食慾不振、黃疸等狀況，加上有體重過重、脂肪肝與高三酸甘油脂等問題，經抽血驗肝功能指數（GOT與GPT）結果果真高出正常值許多。

肝臟是沉默的器官，雖然沒有不舒服的感覺，其實已有了狀況，因此要靠抽血檢驗、腹部超音波等方法來檢驗。譬如：我們會例行抽血檢驗肝功能指數（GOT與GPT），以了解肝臟細胞有沒有壞死、發炎的情形。

如果GOT與GPT指數偏高，表示肝臟正被破壞而發炎，釋出酵素GOT與GPT至血液中，而被偵測出來。日常生活中，僅能靠自我感覺身體不適症狀。雖然，肝功能指數不好的症狀往往是疲倦、食慾不振、黃疸等症狀，但7成往往無症狀。等到出現症狀時，病情已進展到不可收拾的程度。

常見肝功能不好的原因有：肥胖導致脂肪肝炎、高血脂、Ｂ型肝炎、Ｃ型肝炎、糖尿病、酗酒、藥物等。如果充分仔細檢查其中病因，將會發現脂肪肝炎已經悄悄站上肝功能不好的冠軍寶座，而肥胖往往就是背後主要原因。

◎如何減肥，防治脂肪肝炎呢？在日常生活就應該要努力控制：

●每天固定精確地量體重，以自我提醒。

●最好每天吃5到7小碟蔬菜。

●水果限兩顆，約兩個拳頭大。

●任何含糖飲料切記不可以喝。

●以恆心運動，使身體代謝。

●隔餐勿超過6小時，故三餐都要吃，以免引發飢餓或代謝停阻。

●不可過速脫水減重，卻不去減脂肪。

●細嚼慢嚥，每口食物嚼20下，要享受食物滋味，避免吃太快而多吃！

●學習辨識食物熱量，知道自己在吃什麼？

●要永遠控制體重在合宜範圍！

（作者為台北縣祥和診所主任醫師）