R0 resection Cancer in polyp

 




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Anticoagulation and Endoscopy procedures

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 Source- UTD https://www.jtcvs.org/action/showPdf?pii=S0022-5223%2818%2931859-2 Endoscopic Sphincterotomy  - Risk of bleeding persist for upto 3 to 5 days after sphincterotomy           Low to Mod risk of Thrombosis: Delay attaining therapeutic anticoagulation for 3 to 5 days after                                                                 For eg: Re-start Warfarin at day 3 / Restart DOAC at day 5                      High risk of Thrombosis:  Re-start Warfarin on the evening of procedure / LMWH 48H after / DOAC day 5  - UFH 24-48H post.                     Mechanical Heart valves: Mechanical Mitral / Pulmonary vaalve - HIGHEST risk Mechanical Aortic valve - low to moderate ri...
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Hep B / HCC screening - ReachB

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 https://www.youtube.com/watch?v=3cP2kvPq7iQ m.c form of acquiring Hep B in Asia - Vertically m.c form of acquiring Hep B in western coutnries: Parenterally (sexual / needles etc) Neonates have immature immune system, so they cant 'fight-off' vertically acquired virus. Over 90% of babies infected with Hep B, go on to have chronic Hep B infection 95% of adults if they acquire Hep B - fight it off! HBV is a DNA virus - replicates efficiently. But is error-prone. Plagued with mutants.  e-antigen negative mutant - tend to be in older patients, tend to be more aggressive. 30-50% of HCC in HBV occurs in absence of cirrhosis. Reveal study - 15 year follow-up study of untreated patients with HEp B. The only factor that was relevant in predicting risk of HCC was viral load at base-line! Viral load more than 10*4 (2000 IU/ml) was predictive of risk of HCC or Cirrhosis (similar graph for Cirrhosis as for HCC) Immune Tolerant Phase: typically after vertical infection. DNA remains very hig...
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Anatomy of Gastric Varix - basics

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  Gastrorenal shunts:  Vast majority of IGVs are Gastro-renal shunts (and rarely Gastro-caval shunts). Gastro-renal shunts, at haemodynamic level, are truly spleno-(gastro)-renal shunts. The Afferent to the GRS shunt is usually - either a LGV (left gastric vein) which is either the first branch of portal vein, or can arise from splenic vein just after the portal confluence, a posterior gastric vein (arising from Splenic vein) or Short gastric veins (arising from splenic vein).  The GRS empties in to Left renal vein. A true splenic-renal shunt, while will give rise to plenty of encephalopathy, but will not cause Gastric varix in its own right, as an SRS does not go through the GIT wall.  One of the important concepts to understand, as highlighted in the figure below, is each Gastric varix, has 'True gastric varix' component, which is the intraluminal component (and the one, that is prone to bleeding), and often a larger, 'False gastric varix' or an Extra-luminal compo...
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