By Robert Logan, Adam Harris, J. J. Misiewicz, J. H. Baron
(BMJ Books) Univ. sanatorium, Nottingham, united kingdom. presents a concise advisor to issues of the higher gastrointestinal tract. hugely illustrated with charts, diagrams, and colour photos. displays most up-to-date advances in realizing the pathophysiology and pathogenesis of this affliction. For scientific scholars, nurses, and clinicians. Softcover.
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(BMJ Books) Univ. sanatorium, Nottingham, united kingdom. presents a concise consultant to problems of the higher gastrointestinal tract. hugely illustrated with charts, diagrams, and colour pictures. displays most recent advances in knowing the pathophysiology and pathogenesis of this sickness. For clinical scholars, nurses, and clinicians.
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Extra resources for ABC of the Upper Gastrointestinal
Gastric cancer is found in less than 2% of all cases referred for endoscopy. Early gastric cancer comprises only 10% of cancer cases, but it is important to diagnose because it is curable and 60-90% of patients initially present with dyspepsia. However, the risk of gastric cancer is extremely low in patients under the age of 55 years presenting with the new onset of dyspepsia in most Western countries including Britain. Furthermore, “alarm” symptoms such as weight loss, dysphagia, or anaemia help to identify those who need to be investigated in order to exclude malignancy, although between 15% and 50% of dyspeptic patients with gastric cancer do not have these symptoms.
Oxygen should be given. Management in primary care is limited, and the priority is to arrange early admission to hospital and to support associated comorbidity, such as that of angina or chest disease. Hospital management Resuscitation The first priority is to support the circulation rather than to identify the source of bleeding. Endoscopy is undertaken once resuscitation has been achieved. At least one large bore cannula is inserted into a substantial vein. When the pulse rate is more than 100 beats/min or the systolic blood pressure falls below 100 mm Hg, infusion with a crystalloid such as normal saline is started.
It must be remembered that both vasoactive drugs and the Minnesota tube are temporising measures used to control active bleeding until definitive endoscopic, surgical, or radiological measures are taken. When varices have been obliterated portal pressure is reduced with propanolol at a dose to decrease the pulse rate by 20%. This diminishes the risk of subsequent rebleeding. Endoscopic treatment Non-variceal bleeding—A range of endoscopic haemostatic approaches are available. Each has a similar efficacy, but there is evidence that an injection combined with a thermal method is best.