R0 resection Cancer in polyp

 




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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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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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