Emergencies and Complications in Gastroenterology by Petr Dite

By Petr Dite

Acute stipulations in gastroenterology are usually attached with excessive morbidity and mortality; an optimum remedy of those stipulations calls for an in depth cooperation among a number of disciplines, really gastroenterology and surgical procedure. although, systematic facts for a generalized method of be certain the optimum diagnostic approaches and treatment have to date now not been on hand. The book available attempts to fill this hole through supplying gastroenterologists and surgeons with suggestions for a rational multidisciplinary method. Acute states are characterised via multifactorial etiological alterations in addition to polymorbidity, that have an adversarial effect on diagnostic accuracy and influence of treatment. during this scenario, endoscopic exam which allows a simultaneous therapeutical answer is of primary value. despite the fact that, endoscopy is an invasive approach, and because of sufferers' polymorbidity, endoscopic ways are constrained by means of their normal scientific .

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Extra info for Emergencies and Complications in Gastroenterology

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All patients with signs of moderate to severe acute pancreatitis should be admitted to an intensive care unit (ICU) and referred to specialized centers for maximum supportive care [10, 12, 13]. Since complications may develop at any time, frequent reassessment and continuous monitoring are necessary. The most important supportive therapy is an adequate and prompt fluid resuscitation with intravenous fluids and supplemental oxygen with a liberal indication for assisted or controlled ventilation to guarantee optimal oxygen transport [34–36].

CRP predicts severe pancreatitis and pancreatic necrosis accurately from the third day after onset of symptoms onwards [31– 33]. Moreover, measurement of CRP is readily available almost everywhere. In contrast, no single parameter has been developed which is suitable for early prediction of infected pancreatic necrosis. Consequently, it is wise to treat every patient aggressively until disease severity has been established [9–13]. There are two primary objectives in the treatment of patients with acute pancreatitis.

In a direct comparison of pefloxacin (400 mg, twice daily, 14 days) vs. imipenem (500 mg, 3 times daily, 14 days), imipenem proved significantly more effective in prevention of the infection as well as of extrapancreatic infections than pefloxacin [47]. However, the latest and largest randomized controlled multicenter study finished in 2002 including 114 patients with necrotizing acute pancreatitis compared ciprofloxacin and metronidazole vs. placebo and could not show any beneficial effect of antibiotics on mortality [50].

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