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Esophageal stents are devices used to maintain or restore the lumen of the esophagus. There are several types of esophageal stents including self-expanding plastic stents (SEPS), self-expanding metal stents (SEMS), and biodegradable stents. SEMS are the most commonly used and come in uncovered, partially covered, and fully covered varieties. Stents are used to treat conditions causing dysphagia such as esophageal cancer, benign strictures, leaks, and fistulas. Complications include pain, bleeding, reflux, perforation, migration, and tissue growth through the stent mesh. Placement of stents near the upper esophagus or gastroesophageal junction
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EUS has revolutionized both the diagnostic and therapeutic aspects of gastroenterology. It combines an endoscope with an ultrasound probe to examine the GI tract walls and nearby structures. EUS is very useful for staging cancers of the esophagus, pancreas, and biliary tract, and is the most sensitive method for distinguishing between benign and malignant pancreatic tumors. EUS also has several important therapeutic roles, including draining pancreatic fluid collections, accessing the biliary tree non-surgically, celiac plexus neurolysis for pancreatic cancer pain relief, and delivering targeted cancer treatments. Recent advances have further increased the diagnostic and therapeutic capabilities of EUS.
This document discusses the management of common bile duct (CBD) stones. It begins by describing the causes, symptoms, signs, and diagnosis of CBD stones. CBD stones can be primary (formed in the duct) or secondary (passed from the gallbladder). Diagnosis involves blood tests, ultrasound, MRCP, and ERCP. Treatment depends on whether stones are detected before, during, or after cholecystectomy. Options include ERCP sphincterotomy and stone extraction, laparoscopic CBD exploration, open CBD exploration, and surgery like choledochoduodenostomy. For retained stones, additional options are extracting through a T-tube or dissolving chemically. The goal is to remove stones using the least
Bile duct injuries are a complex complication seen more frequently with laparoscopic cholecystectomies due to aberrant anatomy and increased procedures. They can involve the cystic duct, gallbladder bed, or major bile ducts. Various classification systems exist to describe the level and extent of injury. Injuries may be detected intraoperatively by cholangiogram abnormalities, bile drainage from unusual locations, or anomalous anatomy. Prevention strategies include proper case selection, opening retroperitoneal folds, dissecting close to the gallbladder, achieving the critical view of safety, and using intraoperative cholangiography.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
37 slides•5.2K views
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Stents are hollow tubes used to hold open strictured areas in various parts of the body, usually due to malignancy. There are two main types - simple plastic stents and self-expanding metal stents (SEMS). Plastic stents are used in the biliary tree and pancreas while SEMS can be placed in various areas using a guidewire. Stents are used to relieve obstructive symptoms from cancer and as a bridge to surgery. Complications include perforation, tumour overgrowth, and migration.
This document provides information on gastrointestinal stents. It discusses the history of stents, the types of stents including metal, plastic and biodegradable stents. It outlines the indications for stenting in the esophagus, stomach and colon. It details the procedure for stent placement and possible complications. It provides specifics on esophageal, gastric and colonic stents.
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
Dumping syndrome occurs after gastric surgery when food empties too quickly from the stomach into the small intestine. It has early and late forms. Early dumping causes GI symptoms like nausea within 30 minutes and cardiovascular symptoms like palpitations. Late dumping 2-3 hours later can cause hypoglycemia. Treatment involves dietary changes and medications like octreotide. Other post-gastrectomy syndromes include afferent loop obstruction and vitamin deficiencies. Surgery may be needed to correct mechanical issues or revise reconstructions.
This document discusses surgical approaches for esophageal cancer. It covers:
- Esophageal anatomy, blood supply, lymph drainage
- Staging of esophageal cancer and criteria for resection
- Preoperative evaluation including imaging, biopsy, and laparoscopy
- Surgical procedures for cervical, thoracic, and esophagogastric junction cancers including transhiatal esophagectomy, Ivor-Lewis procedure, and tri-incisional esophagectomy
- Oncologic principles for lymphadenectomy and margins during resection
In Depth review of the Surgical management of esophageal carcinoma including management overview, endoscopic management, Type of surgeries, Open, and minimally invasive, Extent of lymphadenectomy. Literature review of evidence for type of surgery and complications
Pseudomyxoma peritonei, also known as "jelly belly", is a condition characterized by mucus accumulation and disseminated tumor cells in the peritoneal cavity. It typically arises from a primary appendiceal or colon tumor that ruptures, releasing mucus and cells. Treatment involves surgical debulking to remove all visible tumor, followed by hyperthermic intraperitoneal chemotherapy to address remaining microscopic disease. Complete cytoreduction and low disease burden based on the peritoneal cancer index are associated with improved outcomes.
Retroperitoneal lymph node dissection (RPLND) is a surgical procedure used to treat testicular cancer. It involves removing lymph nodes in the retroperitoneum which are the first draining sites of metastasis from testicular cancer. Over time, the procedure has evolved from open approaches to minimally invasive techniques. Key developments included mapping of lymphatic drainage patterns, adoption of nerve-sparing approaches to preserve ejaculation, and use of modified or extended templates based on tumor staging. While RPLND remains an important treatment option, ongoing debates include its role compared to surveillance for very small residual masses after chemotherapy and optimal surgical extent. Complication rates also vary based on whether performed for primary staging or post-
1. Neuroendocrine tumors (NETs) arise from neuroendocrine cells throughout the body and share features like secretory granules and hormone production. Pancreatic NETs (PNETs) comprise 1-2% of pancreatic tumors.
2. PNETs can be functional, producing symptoms from hormone hypersecretion, or nonfunctional. Major functional types are insulinomas, gastrinomas, VIPomas, and glucagonomas. Nonfunctional PNETs are usually larger and have worse prognosis than functional tumors.
3. Treatment involves surgical resection for localized disease. For advanced or metastatic disease, options include somatostatin analogs, hepatic artery embolization, targeted drugs, and
1. Endoscopic mucosal resection (EMR) during colonoscopy allows for the complete and safe removal of colorectal lesions, helping to prevent colorectal cancer. EMR has been shown to reduce CRC mortality by up to 50% when removing adenomas.
2. EMR is a multi-step process involving injection of a solution beneath the lesion, followed by snare excision of the lesion in a single piece (en bloc) for smaller lesions, or in multiple pieces (piecemeal) for larger lesions.
3. Complications of EMR include bleeding, perforation, and recurrence of adenomas, but these are generally minor and managed endoscopically or conservatively. Metic
Whipple's procedure - Indications, Steps, ComplicationsVikas V
47 slides•23K views
The document describes the Whipple procedure, which was first performed by Dr. Allen Whipple in 1935. It involves removing the head of the pancreas, part of the small intestine, the gallbladder, and bile duct. The original procedure was done in two stages but is now typically done in one stage. The document outlines the key steps of the modern Whipple procedure, including mobilizing tissues, dividing vessels, transecting organs, and reconstructing the digestive and biliary systems with anastomoses. Vascular resection of veins like the splenic vein may sometimes be required as well.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
Chromoendoscopy refers to the application of dyes or stains during endoscopy to enhance tissue characterization. Various dyes can be used to identify epithelial cell types, highlight mucosal topography, or react with cellular constituents. Stains like Lugol's iodine, methylene blue, and toluidine blue have been used to detect abnormalities in the esophagus, stomach, and colon. Studies show these dyes can increase the detection of conditions like Barrett's esophagus, gastric intestinal metaplasia, and dysplasia compared to white light endoscopy alone. The dyes are sprayed onto the mucosa using catheter systems and findings are interpreted after a brief staining period.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
57 slides•15.1K views
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Complications of laparoscopic cholecystectomy, by Dr. Bashab Bijoy Roy, PGT,SMC,Dr.Bashab Roy
93 slides•802 views
Laparoscopic cholecystectomy is the standard procedure for gallbladder removal. However, it can come with complications such as bile duct injury, hemorrhage, and retained stones if not performed carefully. Achieving the "critical view of safety" prior to cystic duct division and obtaining help from an experienced surgeon if needed can help prevent complications. It is also important to convert to an open procedure if the anatomy cannot be clearly visualized or if there is significant bleeding or inflammation. While techniques have improved, the surgeon must take care to correctly identify the biliary anatomy and dissect carefully to safely perform this laparoscopic procedure.
Endoscopy involves examining the interior of hollow organs using an endoscope. It has become an important tool for both diagnostic and therapeutic purposes in GI surgery. Key developments include the first endoscopes in the early 1800s, and the modern fiberoptic endoscope in the 1950s. Common endoscopic procedures today include upper and lower GI endoscopy, ERCP, EUS, and PEG/PEG-J placement. Endoscopy is used to diagnose and treat conditions like GI bleeding, varices, strictures, cancers, and stones. Procedures include biopsy, polypectomy, dilation, ablation, ligation, and stent/drain placement.
This document discusses ampullary carcinomas, including their epidemiology, clinical manifestations, diagnosis, staging, treatment, and prognosis. It provides details on: the average age of diagnosis being 60-70 years old; the most common histologic subtype being intestinal (47%); obstructive jaundice being the most common presenting symptom (80%); diagnostic tests including ERCP, CT, and tumor markers; the TNM staging system; pancreaticoduodenectomy being the standard treatment for localized disease; and adjuvant therapy options including chemotherapy and chemoradiotherapy for stage IB or higher cancers.
Biliary stricture is an abnormal narrowing of the bile duct. The most common cause is injury during cholecystectomy, accounting for 80% of non-malignant strictures. Bile duct injury can cause inflammation, fibrosis, scarring, and cirrhosis. Surgical treatment depends on when the injury is recognized, with immediate repair during surgery or delayed repair weeks later being options. Roux-en-Y hepaticojejunostomy is a common repair method that involves a mucosa-to-mucosa anastomosis of the bile duct to the jejunum. Factors like multiple prior repairs, proximal strictures, and surgeon inexperience can lead to poor outcomes.
This document provides an overview of cholangiocarcinoma including its epidemiology, risk factors, molecular pathology, tumor classification, clinical presentation, diagnosis, and treatment. Some key points:
- Cholangiocarcinoma arises from the epithelial cells of the bile ducts and can be intrahepatic, perihilar, or distal.
- Risk factors include primary sclerosing cholangitis, parasitic infections, cholelithiasis, hepatitis, and toxins.
- Clinical presentation is usually jaundice. Diagnosis involves blood tests of tumor markers like CEA and CA19-9 and imaging studies.
- Tumor classification is based on extent of involvement
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
This document discusses the role of stents in surgery. It provides a history of stents, describes the different types of stents including self-expanding metal stents (SEMS), self-expanding plastic stents (SEPS), and biodegradable stents. It outlines the indications for stents and the procedures for placement. Complications of stenting are also mentioned.
Types of intestinal stomas and management Ankita Singh
64 slides•6.5K views
The document discusses types of intestinal stomas including classifications based on duration, anatomical location, and reconstruction. It covers indications for stoma creation, principles of stoma formation including challenges, common complications, and dietary advice for ostomates. Stoma appliances and management of various stoma-related complications are also described.
This document discusses surgical approaches for esophageal cancer. It covers:
- Esophageal anatomy, blood supply, lymph drainage
- Staging of esophageal cancer and criteria for resection
- Preoperative evaluation including imaging, biopsy, and laparoscopy
- Surgical procedures for cervical, thoracic, and esophagogastric junction cancers including transhiatal esophagectomy, Ivor-Lewis procedure, and tri-incisional esophagectomy
- Oncologic principles for lymphadenectomy and margins during resection
In Depth review of the Surgical management of esophageal carcinoma including management overview, endoscopic management, Type of surgeries, Open, and minimally invasive, Extent of lymphadenectomy. Literature review of evidence for type of surgery and complications
Pseudomyxoma peritonei, also known as "jelly belly", is a condition characterized by mucus accumulation and disseminated tumor cells in the peritoneal cavity. It typically arises from a primary appendiceal or colon tumor that ruptures, releasing mucus and cells. Treatment involves surgical debulking to remove all visible tumor, followed by hyperthermic intraperitoneal chemotherapy to address remaining microscopic disease. Complete cytoreduction and low disease burden based on the peritoneal cancer index are associated with improved outcomes.
Retroperitoneal lymph node dissection (RPLND) is a surgical procedure used to treat testicular cancer. It involves removing lymph nodes in the retroperitoneum which are the first draining sites of metastasis from testicular cancer. Over time, the procedure has evolved from open approaches to minimally invasive techniques. Key developments included mapping of lymphatic drainage patterns, adoption of nerve-sparing approaches to preserve ejaculation, and use of modified or extended templates based on tumor staging. While RPLND remains an important treatment option, ongoing debates include its role compared to surveillance for very small residual masses after chemotherapy and optimal surgical extent. Complication rates also vary based on whether performed for primary staging or post-
1. Neuroendocrine tumors (NETs) arise from neuroendocrine cells throughout the body and share features like secretory granules and hormone production. Pancreatic NETs (PNETs) comprise 1-2% of pancreatic tumors.
2. PNETs can be functional, producing symptoms from hormone hypersecretion, or nonfunctional. Major functional types are insulinomas, gastrinomas, VIPomas, and glucagonomas. Nonfunctional PNETs are usually larger and have worse prognosis than functional tumors.
3. Treatment involves surgical resection for localized disease. For advanced or metastatic disease, options include somatostatin analogs, hepatic artery embolization, targeted drugs, and
1. Endoscopic mucosal resection (EMR) during colonoscopy allows for the complete and safe removal of colorectal lesions, helping to prevent colorectal cancer. EMR has been shown to reduce CRC mortality by up to 50% when removing adenomas.
2. EMR is a multi-step process involving injection of a solution beneath the lesion, followed by snare excision of the lesion in a single piece (en bloc) for smaller lesions, or in multiple pieces (piecemeal) for larger lesions.
3. Complications of EMR include bleeding, perforation, and recurrence of adenomas, but these are generally minor and managed endoscopically or conservatively. Metic
Whipple's procedure - Indications, Steps, ComplicationsVikas V
47 slides•23K views
The document describes the Whipple procedure, which was first performed by Dr. Allen Whipple in 1935. It involves removing the head of the pancreas, part of the small intestine, the gallbladder, and bile duct. The original procedure was done in two stages but is now typically done in one stage. The document outlines the key steps of the modern Whipple procedure, including mobilizing tissues, dividing vessels, transecting organs, and reconstructing the digestive and biliary systems with anastomoses. Vascular resection of veins like the splenic vein may sometimes be required as well.
This document discusses the role of stents in surgery. It provides a history of stents, describes the different types of stents including self-expanding metal stents (SEMS), self-expanding plastic stents (SEPS), and biodegradable stents. It outlines the indications for stents and the procedures for placement. Complications of stenting are also mentioned.
Types of intestinal stomas and management Ankita Singh
64 slides•6.5K views
The document discusses types of intestinal stomas including classifications based on duration, anatomical location, and reconstruction. It covers indications for stoma creation, principles of stoma formation including challenges, common complications, and dietary advice for ostomates. Stoma appliances and management of various stoma-related complications are also described.
This document discusses ureteral stents and percutaneous nephrostomy (PCN) tubes. It covers the history of stents, ideal stent properties, common biomaterials used, coatings to reduce complications, and newer stent designs. Common indications for stents include intrinsic and extrinsic urinary obstruction. Complications include urinary symptoms, infection, encrustation, and migration. The ideal length depends on patient height or anatomy. Stent removal is important to prevent long-term issues like encrustation.
Vaginal approach for Stress Urinary Incontinence surgeryRohan Sharma
94 slides•339 views
This document discusses various surgical approaches for stress urinary incontinence (SUI), including pubovaginal slings and midurethral slings. It provides details on the operative technique for pubovaginal sling surgery, including patient positioning, incisions, dissection, sling placement, and postoperative care. Complications like erosion, extrusion, and voiding dysfunction are also reviewed. The document also discusses the anatomical basis for midurethral slings and how they work to treat SUI.
This document provides guidelines on the role of endoscopy in the evaluation and management of dysphagia. It discusses the various causes of dysphagia including structural and motility disorders. Endoscopy is an effective tool for diagnosing and treating dysphagia through procedures like dilation. Different types of dilators and techniques are described for dilating various types of esophageal strictures. The risks, outcomes, and alternatives for refractory cases are also covered.
Resection & anastomosis of boweL its complications PRANAYA PPTPRANAYA PANIGRAHI
104 slides•12.1K views
This document discusses intestinal resection and anastomosis. It defines anastomosis as establishing communication between two portions of intestine after removal of diseased bowel. Factors that influence healing, techniques for performing anastomoses (hand sewn vs. stapling), and common complications are described. Maintaining adequate blood supply, tension-free closure, and paying attention to technical details are emphasized for achieving successful anastomotic healing.
This document outlines Seth Familian's presentation on working with big data. It discusses key concepts like what constitutes big data, popular tools for working with big data like Splunk and Segment, and techniques for building dashboards and inferring customer segments from large datasets. Specific examples are provided of automated data flows that extract, load, transform and analyze big data from various sources to generate insights and populate customized dashboards.
This document outlines Netflix's culture of freedom and responsibility. Some key points:
- Netflix focuses on attracting and retaining "stunning colleagues" through a high-performance culture rather than perks. Managers use a "Keeper Test" to determine which employees they would fight to keep.
- The culture emphasizes values over rules. Netflix aims to minimize complexity as it grows by increasing talent density rather than imposing processes. This allows the company to maintain flexibility.
- Employees are given significant responsibility and freedom in their roles, such as having no vacation tracking or expense policies beyond acting in the company's best interests. The goal is to avoid chaos through self-discipline rather than controls.
- Providing
Three business basics to always remember! People don't care about your brand. They care about what you can do for them. Back to basics... Give people what they want, do it consistently and do it better than your competition.
We'd like to take a break on presentation techniques and share with our viewers a slideshow featuring leadership lessons from former South African President Nelson Mandela.
Transcript Below:
1.) “A good leader can engage in a debate frankly and thoroughly, knowing that at the end he and the other side must be closer, and thus emerge stronger. You don't have that idea when you are arrogant, superficial, and uninformed.”
“I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.”
2.) “It is better to lead from behind and to put others in front, especially when you celebrate victory when nice things occur. You take the front line when there is danger. Then people will appreciate your leadership.”
“Resentment is like drinking poison and then hoping it will kill your enemies.”
3.) “Long speeches, the shaking of fists, the banging of tables and strongly worded resolutions out of touch with the objective conditions do not bring about mass action and can do a great deal of harm to the organization and the struggle we serve.”
“Do not judge me by my successes, judge me by how many times I fell down and got back up again.”
4.) “Real leaders must be ready to sacrifice all for the freedom of their people.”
"Action without vision is only passing time, vision without action is merely day dreaming, but vision with action can change the world."
5.) “What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others that will determine the significance of the life we lead.”
“Courageous people do not fear forgiving, for the sake of peace.”
We hope you enjoyed our latest SlideShare presentation!
How to Craft Your Company's Storytelling Voice by Ann Handley of MarketingProfsMarketingProfs
24 slides•2.6M views
You know your company's story, but what's the right voice to use in telling it? Find out how to craft your company's storytelling voice. Ann Handley, chief content officer of MarketingProfs and author of "Content Rules" shares tips and ideas for crafting your brand's storytelling voice.
The document discusses how product design can form habits and behaviors through a "Hook" model. The Hook has 4 parts: a trigger that initiates behavior, an action performed by the user, a variable reward received, and an investment of some kind by the user. Frequent repetition of the trigger-action-reward loop can form habits over time. Products aim to address internal triggers like boredom, fear, or social needs. Variable rewards like social approval, achievement, or novelty keep users engaged. Investments like data, time or content shared increase the likelihood of returning. The goal is to shape user preferences and attitudes through repeated experiences with the Hook.
Design thinking is an iterative process that involves empathizing with users, defining problems from their perspective, ideating solutions, prototyping ideas, and testing prototypes with users. It focuses on understanding user needs through observation and interviews to identify root problems. Potential solutions are then explored through brainstorming techniques and low-fidelity prototyping before gathering user feedback through testing techniques like card sorting and the "Wizard of Oz" method to further refine solutions. The goal is to generate a wide range of ideas and learn through iterative prototyping and user testing.
This document provides an overview of Scrum and the role of the Product Owner in Agile product management. It discusses key Scrum terms like sprint and Scrum Master. It describes the responsibilities of the Product Owner in maintaining the product backlog, prioritizing items, and collaborating with the team. It provides tips for the Product Owner on creating a product vision, grooming the backlog, planning releases, and transitioning into the role.
The abdominal aorta continues from the descending thoracic aorta and supplies blood to the abdominal organs and lower limbs. It lies slightly left of the spine and divides into the common iliac arteries. Abdominal aortic aneurysms are focal dilations that are 1.5 times larger than normal diameter and can be saccular or fusiform in shape. Ultrasound is used to diagnose and measure aneurysms longitudinally, transversely, and with color Doppler to identify flow patterns. Measurements of greater than 5.5 cm indicate risk of rupture.
Transarterial chemoembolization (TACE) involves delivering chemotherapy drugs and embolic agents directly into liver cancers via catheters in the hepatic artery. TACE is generally used to treat hepatocellular carcinoma that cannot be surgically removed. During the procedure, a catheter is placed into the hepatic artery supplying the tumor and chemotherapy mixed with iodinated oil is injected, followed by embolization of the artery with gelatin sponges. TACE can reduce tumor size and symptoms but common side effects include abdominal pain and nausea. Response to treatment is evaluated after 3-4 weeks using imaging to assess the extent of tumor coverage by the oil and residual enhancement.
Retrograde pyelography is an x-ray imaging technique used to visualize the kidneys and ureters. A catheter is inserted into the ureter and contrast dye is injected under fluoroscopy. Images are taken of the renal pelvis, ureters and bladder. It is used to evaluate abnormalities seen on intravenous urograms or investigate causes of hematuria when the ureters were not fully visualized. The procedure has some risks but is less risky than intravenous urography. It can demonstrate various conditions like ureteral strictures, filling defects, diverticula or stenosis. Care is taken during injection to avoid overdistension and complications.
This document discusses various imaging modalities used to evaluate renal masses, including plain radiography, intravenous urography, ultrasound, computed tomography, magnetic resonance imaging, and renal arteriography. For each modality, it describes their utility in detecting and characterizing renal masses and differentiating renal cell carcinoma from other lesions. It also provides examples of imaging findings for various renal pathologies such as abscesses, cysts, angiomyolipomas, and others.
This document provides an overview of renal isotope studies used to assess renal function and anatomy. It describes the radiopharmaceuticals, patient preparation, indications, and findings for renal scans, renograms, and nuclear cystograms. Key points include that renal scans evaluate renal blood flow, structure, and drainage using agents retained in tubules, filtered by glomeruli, or secreted by tubules. Renograms generate time-activity curves to assess obstruction, transplantation, renovascular hypertension, and hydronephrosis. Nuclear cystograms evaluate vesicoureteral reflux.
Multiplanar reformatted images in CT scans of the chest allow radiologists to view the scans in different planes and orientations beyond just axial sections. This helps identify patterns of diffuse lung disease, distributions of lesions, and other findings more quickly. Techniques like longitudinal reformation, minimum intensity projection (mIP), maximum intensity projection (MIP), multiplanar virtual reality (VR) averaging, and three-dimensional VR and volume intensity projection (VIP) generate reformatted images that provide additional clinical information about characteristics and locations of abnormalities in a more efficient manner compared to just reviewing numerous axial images.
This document discusses obstructive jaundice and the role of various imaging modalities in evaluating it. It begins by defining jaundice and describing its types and causes. Imaging methods for investigating obstructive jaundice are then outlined, including ultrasound, CT cholangiography, MRCP, ERCP, PTC and intraoperative cholangiography. The anatomy of the biliary tree is reviewed along with normal findings and examples of obstructions on different exams. The principal role of imaging is identified as identifying and assessing major bile duct obstruction to determine if it is present, its level, cause, and whether any obstruction appears malignant.
HIDA scan evaluates hepatobiliary function and anatomy. It involves injecting a radiotracer that is taken up by the liver and excreted in bile. Images track the radiotracer's flow from liver to gallbladder and small intestine. Findings are used to diagnose conditions like acute cholecystitis, bile duct obstruction, and leaks. A normal scan shows sequential activity in the liver, bile ducts, gallbladder, and small bowel within an hour, confirming a patent system.
Course: ITEP 1st semester
Subject: Understanding India ( Indian Ethos and Knowledge System ) - 1
Unit- 2
Topic: Fine Arts (Traditional Art forms, contemporary arts, arts and spirituality, arts and identity, and art and globalization)
Explore the complete implementation of CareCompass through these detailed slides. From intuitive designs to powerful features, see how every aspect of the product comes together to enhance productivity and emotional well-being.
This is a submission for the GitHub Copilot Challenge : New Beginnings in dev.to platform
01.21.2025 AI-Powered Nonprofits_ 2025 Report on AI Adoption Rates, Use Cases...TechSoup
43 slides•350 views
In this webinar, members gained insights from our recent survey of over 1,000 nonprofits exploring how AI is reshaping the sector. This webinar shared the latest findings on how organizations like yours leverage AI to drive efficiency, enhance engagement, and achieve measurable outcomes.
Errors and exceptions in Odoo 18 - Odoo SlidesCeline George
18 slides•247 views
In Odoo 18, there are many kinds of errors and exceptions possible while running the module or code under development.
Error management in Odoo 18 involves understanding how the system handles exceptions and bugs, as well as employing good practices to manage and resolve them effectively.
3. History
• Invented in 1856 by the English dentist
Charles Stent .
• The first (self expanding) "stents" used in
medical practice in 1986 by Ulrich Sigwart in
Lausanne were initially called "Wallstents".
• Julio Palmaz et al. created a balloon
expandable stent that is currently used.
4. • Sir Charters Symonds was the first to successfully
place an oesophageal prosthesis across a
malignant stricture.
• There were many modifications of rigid
oesophageal stents in which various materials
(wood, metal, plastic, latex) and designs were
used.
• The rigid prosthesis (plastic and latex) was
extensively used from the 1970s to the 1990s,
but the complication rates and mortality
associated with insertion-related perforations
remained significant.
5. • In the early 1990s, self-expandable metal
stents (SEMS) were developed for
oesophageal use.
6. Types of Esophageal Stents
1. SEPS (self-expanding plastic stents)
2. SEMS (self-expanding metal stents)
3. Biodegradable stents
7. SEPS
• SEPS (Polyflex; Boston Scientific, Natick, Mass)
has been developed for esophageal strictures.
• This stent has a woven polyester skeleton and
is completely covered with a silicone
membrane.
8. • The silicone prevents tissue in growth through
the mesh.
• Polyester braids on the external surface
anchor the stent to the mucosa to limit
migration.
9. SEMS
• There are three varieties of metal stents:
uncovered, partially covered, and fully
covered.
• The advantage of covered stents is that they
resist tumour ingrowth, but they have a higher
migration rate, especially when fully covered
but have advantage of potentially being
removable.
10. • Partially covered stents are uncovered at their
ends, which allows the stent to embed in the
tissue and helps to prevent migration.
• Uncovered stents are less likely to migrate, but
are subject to tumour ingrowth and resultant
obstruction.
• SEMS consist of woven, knitted, or laser-cut
metal mesh cylinders that exert self-expansive
forces until they reach their maximum fixed
diameter.
11. • SEMS are composed of stainless steel, alloys
such as elgiloy and nitinol, or a combination of
nitinol and silicone.
• Elgiloy, an alloy composed primarily of cobalt,
nickel, and chromium, is corrosion resistant
and capable of generating high radial forces.
• Nitinol, an alloy of nickel and titanium, yields
increased flexibility that is helpful for stenting
sharply angulated regions at the cost of lesser
radial force.
12. • To prevent tumour ingrowth, the interstices
between the metal mesh of oesophageal
SEMSs may be wholly or partially covered by a
plastic membrane or silicone.
• For tumours located near the GE junction
(Oesophageal Z-stent with Dual Anti-reflux
valve; Wilson-Cook Medical, Winston-Salem,
NC) uses an extended polyurethane
membrane 8 cm beyond the metal portion of
the stent to prevent gastroesophageal reflux.
13. Biodegradable stents
• Oesophageal Degradable BD (Ella-CS, Czech
Republic) is made from woven surgical suture
material, polydioxanone.
• It is uncovered and does not have an anti-
reflux valve.
• The stent fully degrades in approximately
three months
14. Photograph shows
Atkinson (A) and
Celestin (B) plastic
stents and
Wilson-Cook (C)
Ultraflex nitinol (D),
Wallstent (E),
Gianturco Z (F), and
Esophacoil (G) metal
stents.
16. From left to right,
Boston Scientific’s
Polyflex
Esophageal Stent,
Ultraflex
Esophageal NG
Stent System,
WallFlex Fully
Covered
Esophageal Stent,
and WallFlex
Partially Covered
Esophageal Stent.
21. Technique
• Assessment of the length of the stricture and
degree of obstruction is the first step.
• If the stricture is too tight to advance a
standard gastroscope, an ultrathin endoscope
may be used.
• To guide accurate stent deployment, the
proximal and distal ends of the stricture need
to be marked appropriately.
22. • During stent selection, it is important to
choose a stent length that is 4 cm longer than
the stricture being stented.
• This allows for 2 cm of stent on either end of
the stricture to decrease the risk of migration.
• Foreshortening is the property of the stent by
which, on fluoroscopy, the stent constrained
in its catheter will appear longer than the
unconstrained deployed stent length.
23. • Stenting a stricture in the cervical oesophagus
ensure at least a 2-cm distance between the
proximal end of the stent and the upper
oesophageal sphincter.
24. Barium swallow shows a short
stricture in the mid oesophagus.
Biopsy showed squamous cell
carcinoma.
25. A guide wire and catheter
combination has been passed
down through the stricture and a
small amount of contrast injected
at the proximal and distal margins
of the tumour.
Paper clips have been taped to the
patient’s skin to indicate the
stricture length.
26. The stent deployment system has
been passed across the stricture.
Note in this example the markers
on the proximal and distal ends of
the stent and also in the centre of
the stent. The stent should be
placed so that the proximal and
distal ends are 2 cm beyond the
stricture.
27. The stent has been
released.
Note the immediate
expansion of the proximal
and distal ends, while the
central area is still
constrained by the tumor.
28. The delivery system has been
removed. The stent expanded
fully over the next 48 hours
without further dilatation.
33. Complications
Complications associated with oesophageal
stents are generally classified as either early or
delayed.
Early complications- 2-4 weeks
• Chest pain, fever, bleeding, gastroesophageal
reflux disease, globus sensation, perforation,
and stent migration
34. Delayed complications- after 4 weeks
• Tumour ingrowth, stent migration, stent
occlusion, development of oesophageal
fistulae, and recurrence of strictures.
35. Perforation. Barium
esophagogram shows a
Celestin tube placed across
the oesophagogastric
junction. There is
extravasation of barium into
the left pleural space and
mediastinum due to
perforation.
38. Challenges in Oesophageal Stent
Placement
High-Grade Strictures
• If a stricture is very tight or difficult to traverse
with a standard endoscope.
• One option is to use a dilator(Mercury or
tungsten-weighted bougies, Polyvinyl dilators
& Through-the-scope (TTS) balloon dilators).
• Another method involves using a stent with a
smaller diameter.
39. Upper Oesophageal and Cervical Oesophageal
Strictures
• Traditionally, strictures close to the upper
oesophageal sphincter (UES) have been
considered more difficult to manage.
• However, studies have recently demonstrated the
effectiveness and safety of newer stents for the
palliation of dysphagia and sealing of fistulae in
patients with strictures close to the UES.
40. Distal Oesophageal Strictures,
Gastroesophageal Cancers, and Cardia Cancers
• Distal oesophageal strictures still present a
significant challenge because stent placement
across the gastroesophageal junction can lead
to gastroesophageal reflux disease and
aspiration.
• In an attempt to remedy these problems,
stents with antireflux mechanisms have been
developed (Esophageal Z-Stent with Dua Anti-
Reflux Valve)
41. Management of Benign Oesophageal
Conditions
• The use of self-expandable oesophageal stents
for the management of benign conditions has
grown immensely over the past decade.
• Temporary placement of self-expandable stents is
now used in a variety of benign conditions,
including postoperative anastomotic leaks,
refractory strictures due to peptic ulcers or
radiation, and tracheoesophageal fistulae.
42. • SEPS are increasingly being used for the
treatment of benign oesophageal conditions.
• These stents are thought to have several
advantages over standard SEMS—including
low cost, ease of placement and retrieval, and
limited local tissue reaction—and still provide
symptomatic relief of dysphagia
43. Management of Malignant
Oesophageal Diseases
• Despite advances in the diagnosis, staging,
neoadjuvant care, and perioperative care of
patients with oesophageal cancer, the 5-year
survival rate of these patients remains less than
15%, and chemotherapy has shown limited
survival benefit.
• Therefore, patients with incurable oesophageal
and other nonluminal malignancies of the head
and neck often require palliation for dysphagia
and/or tracheoesophageal fistulae.
44. • Currently, SEMS, along with SEPS, have
become the mainstay of treatment for
malignant oesophageal strictures and fistulae.
• Covered stents are commonly used as they
resist tumour ingrowth because they do not
have an uncovered region that embeds into
tissue they also offer the advantage of being
completely removable.
45. • Use of SEMS for treating cancer closer to the
UES is controversial because of the perceived
increased risk of complications such as
perforation, migration, pain, and patient
intolerance.