Microsoft PowerPoint Gastrointestinal bleeding in children

Microsoft PowerPoint Gastrointestinal bleeding in children tài liệu, giáo án, bài giảng , luận văn, luận án, đồ án, bài...

Int. J. Med. Sci. 2011, 8 http://www.medsci.org 30 IInntteerrnnaattiioonnaall JJoouurrnnaall ooff MMeeddiiccaall SScciieenncceess 2011; 8(1):30-38 © Ivyspring International Publisher. All rights reserved. Research Paper Identification of clinical and simple laboratory variables predicting re-sponsible gastrointestinal lesions in patients with iron deficiency anemia Songul Serefhanoglu , Yahya Buyukasik, Hakan Emmungil, Nilgun Sayinalp, Ibrahim Celalettin Hazne-daroglu, Hakan Goker, Salih Aksu, Osman Ilhami Ozcebe Hacettepe University Hospital, Department of Internal Medicine, Division of Hematology, Ankara, Turkey  Corresponding author: Songul Serefhanoglu, Hacettepe University Hospital, Department of Internal Medicine, Division of Hematology, Ankara, Turkey. E-mail: dr.songul1978@yahoo.com; Tlf: +903123051543. Received: 2010.08.29; Accepted: 2010.12.20; Published: 2010.12.28 Abstract I r o n d e f i c i e n c y a n e m i a ( I D A ) i s a f r e q u e n t d i s o r d e r . A l s o , i t m a y b e a s i g n o f u n d e r l y i n g s e rious d i s e a s e s . I r o n d e f i c i e n c y p o i n t s t o a n o c c u l t o r f r a n k b l e e d i n g l e s i o n w h e n o c c u r r e d i n m e n o r p o s t m e n o p a u s a l w o m e n . I n t h i s s t u d y , w e a i m e d t o e v a l u a t e t h e d i a g n o s t i c y i e l d o f e n d o s c o p y in patients with IDA and to define predictive factors of gastrointestinal (GI) lesions causing IDA. Ninety-one patients (77 women, 14 men; mean age: 43 years) who were decided to have esophago-duodenoscopy and/or colonoscopy for iron deficiency anemia were interviewed and responded to a questionnaire that included clinical and biochemical variables. The en-doscopic findings were recorded as GI lesions causing IDA or not causing IDA. Endoscopy r e v e a l e d a s o u r c e o f I D A i n 1 8 . 6 % o f c a s e s . T h e r i s k f a c t o r s f o r f i n d i n g G I l e s i o n s c a u s i n g I D A were as follows: male gender (p= 0.004), advanced age (> 50 years) (p= 0.010), weight loss (over 20% of total body weight lost in last 6 month) (p= 0.020), chronic diarrhea (p= 0.006), change of bowel habits (p= 0.043), epigastric tenderness (p= 0.037), raised carcinoembryonic antigen (CEA) level (normal range: 0-7 ng/mL) (p= 0.039), < 10 gr/dl hemoglobin (Hb) level (p=0.054). None of these risk factors had been present in 21 (23%) women younger than 51 years. In this group, no patient had any GI lesion likely to cause IDA (negative predictive value= 100%). In multivariate analysis, advanced age (p=0.017), male gender (p< 0.01) and weight lost (p=0.012) found that associated with GI lesions in all patients. It may be an ap-propriate clinical approach to consider these risk factors when deciding for gastrointestinal endoscopic evaluation in iron deficiency anemia. Key words: Iron deficiency anemia, gastrointestinal lesions, predictive risk factors, endoscopic in-vestigation. Introduction Iron deficiency anemia (IDA) remains the most common cause of anemia and affects about 5–12% of non-pregnant women and 1–5% of men have IDA [1-2]. It is a result of blood loss from the gastrointes-tinal tract or the uterus and is a requiring further in-vestigation due to sign of serious underlying disease. While menstrual blood loss is the commonest cause of IDA Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION • Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal duodenum, commonly presents with hematemesis and/or melena • The incidence : not well established in children, # 20 % of all episodes of gastrointestinal bleeding in children • The most common causes of UGI in children vary depending upon age • The most common cause of severe UGI bleeding in children : Variceal rupture & ulcer bleeding Approach to upper gastrointestinal bleeding in children • The initial evaluation : assessment of hemodynamic stability & the necessity for fluid resuscitation • Nasogastric or orogastric lavage : performed in pts with clinically significant UGI bleeding Lavage using ice water is not recommended Resuscitation Ulcer bleeding Blood transfusions should be administered to a patient with a hemoglobin level of 7g/dL or less (IC) Active variceal hemorrhage • Acute GI hemorrhage in a patient with cirrhosis, blood transfusions to maintain a hemoglobin of 8g/dL (IB) Pharmacologic Management Ulcer bleeding • Preendoscopic PPI therapy may be considered to downstage the endoscopic lesion & decrease the need for endoscopic intervention but should not delay endoscopy (1B) • An intravenous bolus followed by continuous-infusion PPI therapy should be used to decrease rebleeding and mortality in patients with high-risk stigmata who have undergone successful endoscopic therapy (IA) Active variceal hemorrhage • Somatostatin or its analogues should be initiated as soon as variceal hemorrhage is suspected and continued for 3-5 days after diagnosis is confirmed (IA) Endoscopic Management Upper endoscopy should be performed : acute severe hemorrhage, low-grade persistent, recurrent hemorrhage Ulcer bleeding • Clips, thermocoagulation, or sclerosant injection should be used in patients with high-risk lesions, alone or in combination w epinephrine injection (1A) • Routine second-look endoscopy is not recommended (IIB) Variceal hemorrhage • EGD, performed within 12 hours, should be used to make the diagnosis and to treat variceal hemorrhage, either with EVL or sclerotherapy ( IA) Ulcer bleeding • Patients with bleeding peptic ulcers should be tested for H pylori & receive eradication therapy if it is present, with confirmation of eradication (IA) • Negative H pylori diagnostic tests obtained in the acute setting should be repeated (IB) Ulcer bleeding Postdischarge, ASA & NSAIDs • In patients with previous ulcer bleeding who require an NSAID, treatment with a traditional NSAID plus PPI or a COX-2 inhibitor alone is still associated with a clinically important risk for recurrent ulcer bleeding (IB) • In patients with previous ulcer bleeding who require an NSAID, the combination of a PPI and a COX-2 inhibitor is recommended to reduce the risk for recurrent bleeding from that of COX-2 inhibitors alone (IB) Variceal bleeding : Primary prophylaxis • All patients with cirrhosis undergo diagnostic endoscopy to document the presence of varices & to determine their risk for variceal hemorrhage (IIB) • In patients at high risk of variceal hemorrhage Non selective beta-blockers (propranolol or nadolol) or EVL may be recommended for the prevention of first variceal hemorrhage ( I A) • In patients who have high risk varices & have potential contraindications to beta blockers or have been intolerant to beta blockers, we suggest EVL (I A) Secondary prophylaxis • Patients with cirrhosis who survive an episode of active variceal hemorrhage should receive therapy to prevent recurrence of variceal hemorrhage (secondary prophylaxis) (IA) • Combination of non selective –beta blockers plus EVL is the best option for secondary prophylaxis of variceal hemorrhage (IA) • TIPS should be considered in patients who are Child A or B who experience recurrent variceal hemorrhage despite combination pharmacological & endoscopic therapy (IA) • Patients who are otherwise transplant candidates should be referred to a transplant center for evaluation(IC) References UPTODATE VERSION 19.1 (2011) Approach to upper gastrointestinal bleeding in children CLINICAL GUIDELINES (2011) International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding AASLD PRACTICE GUIDELINES (2007) Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis by Peter Weverka PowerPoint ® 2007 ALL-IN-ONE DESK REFERENCE FOR DUMmIES ‰ 01_040629 ffirs.qxp 11/29/06 12:08 AM Page iii PowerPoint ® 2007 All-in-One Desk Reference For Dummies ® Published by Wiley Publishing, Inc. 111 River Street Hoboken, NJ 07030-5774 www.wiley.com Copyright © 2007 by Wiley Publishing, Inc., Indianapolis, Indiana Published by Wiley Publishing, Inc., Indianapolis, Indiana Published simultaneously in Canada No part of this publication may be 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Library of Congress Control Number: 2006925912 ISBN-13: 978-0-470-04062-1 ISBN-10: 0-470-04062-9 Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 1 1O/RU/RS/QW/IN 01_040629 ffirs.qxp 11/29/06 12:08 AM Page iv About the Author Peter Weverka is the bestselling author of several For Dummies books, including Office All-in-One Desk Reference For Page 1 of 4 (page number not for citation purposes) Available online http://ccforum.com/content/10/4/218 Abstract Whether it is the primary reason for admission or a complication of critical illness, upper gastrointestinal bleeding is commonly encountered in the intensive care unit. In this setting, in the absence of endoscopy, intensivists generally provide supportive care (transfusion of blood products) and acid suppression (such as proton pump inhibitors). More recently, octreotide (a somatostatin analogue) has been used in such patients. However, its precise role in patients with upper gastrointestinal bleeding is not necessarily clear and the drug is associated with significant costs. In this issue of Critical Care, two expert teams debate the merits of using octreotide in non-variceal upper gastrointestinal bleeding. Clinical scenario A 59 year old male has been admitted to the intensive care unit with febrile neutropenia and septic shock. The patient has been diagnosed with acute myelogenous leukemia and following induction is pancytopenic. He is mechanically ventilated and receiving H 2 antagonists. You are called because the patient is having large amounts of melena and a modest amount of blood returning from his nasogastric tube. He is hemodynamically unstable. You transfuse blood, platelets and plasma as appropriate, and start an intravenous proton pump inhibitor. Endoscopy cannot be performed until the following day. You have to decide whether to treat the patient empirically with intravenous octreotide. You know it has a role in certain types of gastrointestinal (GI) bleeding but you are uncertain if you should be using it when the cause of bleeding is unclear. Your administrator tells you the drug is relatively expensive. Review Pro/con debate: Octreotide has an important role in the treatment of gastrointestinal bleeding of unknown origin? Yaseen Arabi 1 , Bandar Al Knawy 2 , Alan N Barkun 3 and Marc Bardou 4 1 Intensive Care Unit, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia 2 Division of Gastroenterology/Hepatology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia 3 Divisions of Gastroenterology and Clinical Epidemiology, McGill University, and the McGill University Health Centre, Montréal, Québec, Canada 4 Division of Clinical Pharmacology, LPPCE, Faculty of Medicine, Dijon Cedex, France Corresponding author: Alan Barkun, alan.barkun@muhc.mcgill.ca Published: 3 July 2006 Critical Care 2006, 10:218 (doi:10.1186/cc4958) This article is online at http://ccforum.com/content/10/4/218 © 2006 BioMed Central Ltd GI = gastrointestinal; NVUGB = non-variceal upper gastrointestinal bleeding; PPI = proton pump inhibitor; RCT = randomized controlled trial; UGB = upper gastrointestinal bleeding. Pro: Yes, octreotide does have an important role in the treatment of gastrointestinal bleeding of unknown origin Yaseen Arabi and Bandar Al Knawy There is evidence to support the use of octreotide in variceal and non-variceal upper GI bleeding (UGB). As a somatostatin analogue, octreotide binds with endothelial cell somatostatin receptors, inducing strong, rapid and prolonged vaso- constriction [1]. Octreotide reduces portal and variceal pressures as well as splanchnic and portal-systemic collateral blood flows [2]. It also prevents postprandial splanchnic hyperemia in patients with portal hypertension [3] and lowers gastric mucosal blood flow in normal and portal hypertensive stomachs [4]. Octreotide inhibits both acid and pepsin secretion. As a result, it prevents the dissolution of freshly formed clots at the site of bleeding [5]. The use of octreotide as a first, single therapy versus emergency sclerotherapy in bleeding esophageal varices was examined in a Cochrane systematic review of 12 randomized controlled trials (RCTs), including 6 trials of octreotide [6]. Emergency sclerotherapy 9/22/2014 SIMULATION IN CHEMICAL PROCESSES Instructor: Dr Le Dinh Chien Department of Oil Refining and Petrochemistry Faculty of Oil and Gas Hanoi University of Mining and Geology E-mail: chien.dinh.le@bath.edu Instructor: Dr Le Dinh Chien Kiến thức chuyên ngành Tin học chuyên ngành Thiết kế (Designer) Vận hành (Operator) Tư vấn (Consultant) Tiếng Anh Kỹ mềm 9/22/2014 Instructor: Dr Le Dinh Chien • GPP Dinh Cố - Phòng điều hành - Operator • PV Pro – Phòng tư vấn thiết kế - Consultant • PVEP – Dự án Velezuela – Designer • JGC – Process Engineering – Engineer • Cimas – Process Engineering – Engineer Instructor: Dr Le Dinh Chien MỤC ĐÍCH MÔN HỌC  Hiểu vai trò mô phỏng, số phần mềm mô điển hình công nghệ Lọc Hóa dầu  Cách xây dựng toán mô  Nắm rõ bước, tiện ích phần mềm Hysys để thực số toán chuyên ngành cụ thể  Củng cố lại kiến thức chuyên ngành  Giúp sinh viên có kĩ làm việc độc lập theo nhóm 9/22/2014 Instructor: Dr Le Dinh Chien TIÊU CHUẨN ĐÁNH GIÁ - Dự lớp đầy đủ theo quy định (nghỉ không 1/5 số lên lớp) - Thực Task session - Thi cuối học kỳ (vấn đáp/viết + thực hành) - Bài tập lớn Instructor: Dr Le Dinh Chien TÀI LIỆU THAM KHẢO      Advanced Process Modeling using HYSYS (2008) – Aspentech Training Manual Workbook Process Modeling using HYSYS with Refinery Focus (2004) – Aspentech Process Modeling using HYSYS (2004) – Aspentech Simulation Basis - Aspentech Dynamic Modeling - AspenTech 9/22/2014 Instructor: Dr Le Dinh Chien NỘI DUNG MÔN HỌC Chương 1: Giới thiệu mô phần mềm phổ biến mô trình công nghệ hóa học Chương 2: Giới thiệu Aspen Hysys tính 2.1 Thiết lập trình mô với Hysys 2.2 Sử dụng tiện ích Hysys 2.3 Một số mô hình thiết bị Hysys Chương 4: Thực hành: Ứng dụng Aspen Hysys mô số trình công nghệ chế biến dầu khí tự nhiên 4.1 Mô số trình công nghệ chế biến khí tự nhiên 4.2 Mô số trình công nghệ chế biến dầu thô 4.3 Mô số trình công nghệ hóa dầu Instructor: Dr Le Dinh Chien Mối quan hệ với môn học khác Các môn học khác Nội dung môn học TƯD Công nghệ lọc dầu, Công nghệ hóa dầu, Công nghệ chế biến khí - Cách thiết lập trình mô (thu thập tài liệu, lựa chọn công nghệ, ) Hóa Lý Sử dụng tiện ích Hysys Thiết bị phản ứng, Thiết bị công nghệ lọc dầu Nhập thiết bị Hysys 9/22/2014 Instructor: Dr Le Dinh Chien MÔ PHỎNG (SIMULATION) • Mô gì? • Mô làm gì? • Ưu mô gì? • Có kiểu mô gì? • Thực mô tính toán thiết kế công nghệ nào? • Các phần mềm mô phổ biến • Hysys 7.2 Instructor: Dr Le Dinh Chien MÔ PHỎNG (SIMULATION) Quá trình xảy thực tế tập hợp gồm nhiều yếu tố phức tạp: • Các thông số công nghệ (T, P, lưu lượng dòng, ) • Các trình phản ứng hóa học • Các trình truyền nhiệt • Các trình chuyển khối • ………… tính toán cho kết xác tuyệt đối 9/22/2014 Instructor: Dr Le Dinh Chien Các thông số công nghệ Các phản ứng hóa học Quá trình công nghệ Các trình truyền nhiệt Các trình chuyển khối Instructor: Dr Le Dinh Chien MÔ PHỎNG (SIMULATION) • Mô (Simulation) gì? • Thực mô trình thực tế nào? 9/22/2014 Instructor: Dr Le Dinh Chien MÔ PHỎNG Thiết lập Mô hình SỐ Sử dụng Phương pháp SỐ MÔ HÌNH HÓA Trợ giúp MÁY TÍNH Instructor: Dr Le Dinh Chien QUÁ TRÌNH MÔ PHỎNG Mô hình nguyên lý Mô tả toán học Xử lý biểu thức 9/22/2014 Instructor: Dr Le Dinh Chien THIẾT KẾ MÔ PHỎNG Instructor: Dr Le Dinh Chien Xây dựng phần mềm Thiết kế mô HYSYS 9/22/2014 Instructor: Dr Le Dinh Chien Ngôn ngữ lập trình Mã nguồn mở Xây dựng phần mềm Giải toán thực tế Trí tuệ kỹ sư trẻ Kinh phí thấp Instructor: Dr Le Dinh Chien - Quản lý dạng bảng tính, đồ thị - Thích hợp cho quản lý nhân sự, vật tư, kế toán Excel Microsoft Access Visual Basic - Dễ sử dụng, Có khả kết nối, - Khả quản lý khối lượng liệu lớn - Lưu trữ liệu nhiều dạng thức - Tính bảo mật cao - Dễ sử dụng, Có thể hoạt động độc lập kết hợp với ngôn ngữ khác Access, SQL, - File ứng dụng có kích thước nhỏ, dễ cài đặt - Giao diện kiểu Windown Matlab - Ngôn ngữ tính toán, lập trình tuyệt vời cho kỹ sư - Được sử dụng rộng rãi, đặc biệt trường đại học 9/22/2014 Instructor: Bài giảng môn Tin ứng dụng 9/22/2014 Session 3.4 ASPEN HYSYS In báo cáo kết Revise Thiết lập trình sản xuất Toluene từ n-heptane phản ứng dehydro hóa  Component: toluene, n-heptane, hydrogene  Fluid Package: Peng Robinson  Reaction: n-heptane -> Toluene + 4H2 Độ chuyển hóa C0 = 15% “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” BM Lọc Hóa dầu Bài giảng môn Tin ứng dụng 9/22/2014 Print PFD Từ PFD, kích chuột phải vào thiết bị dòng, chọn Show table để đưa bảng thông số cho thiết bị dòng Remove Add biến số cần đưa thông tin Có thể đưa dòng Text vào vị trí cách chọn A công cụ In PFD: •File> chọn Print Print Windows Snapshot •Kích chuột phải vào vùng trống PFD, chọn Print PFD Nếu máy tính không kết nối với máy in, bạn in định dạng file pdf phần mềm hỗ trợ (VD: Pdf factory pro) Dùng chuột để chỉnh lại vị trí thiết bị dòng trước in “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” Print Datasheet RC thiết bị dòng, chọn Print Datasheet (Có thể in file text cách chọn Text to file in file PDF cách dùng pdf factory pro)  “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” BM Lọc Hóa dầu Bài giảng môn Tin ứng dụng 9/22/2014 Report   Cách 1: Tools>Report (Ctrl+R)>Create>Insert Datasheet, chọn đối tượng cần đưa vào Report>Add>Done Cách 2: mở Workbook>RC>chọn Print Datasheet Chọn Print để in Report “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” Databook   Truy cập vào DataBook cách sử dụng tổ hợp phím CTRL D (Tools>Databook) DataBook cung cấp truy cập đến Process Data Tables, Strip Charts, Data Recorder Case Studies Thêm thông số cần nghiên cứu tính chất “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” BM Lọc Hóa dầu Bài giảng môn Tin ứng dụng 9/22/2014 Process Data Tables Process Data Tables cho phép xem xét biến công nghệ Ta mở khung hình để theo dõi liên tục giá trị biến Nhập tên Process Data Table Khi lựa chọn nút View, Process Data Table trình bày “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” Strip Charts Page Strip Charts thiết đặt cụ thể thông qua Strip Charts page Mở StripChart chọn Tên StripChart (lưu lượng biến thay đổi Khung thiết đặt StripChart Kích hoạt vào biến thị StripChart “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” BM Lọc Hóa dầu Bài giảng môn Tin ứng dụng 9/22/2014 The Strip Chart View Mỗi biến có trục tỷ lệ Y, giá trị nhỏ lớn cho biến đặt độc lập Kích chuột phải vào đồ thị lựa chọn Graph Control để truy cập vào khung định dạng X-Axis thời gian Có thể đặt Time Span cho đồ thị trang Overall Chart Properties khung Setup “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% of what we see and hear; 70% of what we discuss; 80% of what we experience; 95% of what we teach others” Khung hình dạng Strip Chart Khung Configuration chứa đựng tabs, tab rõ phận xuất đồ thị General tab thể Để trông thấy trục đồ thị Tab gồm tuỳ chọn định dạng cho curves axes cho stripchart Tuỳ chọn diện mạo đồ thị Mở DataBook Mở khung Logger Setup “We learn …10% of what we read; 20% of what we hear; 30% of what we see; 50% ... upper gastrointestinal bleeding in children CLINICAL GUIDELINES (2011) International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding AASLD... established in children, # 20 % of all episodes of gastrointestinal bleeding in children • The most common causes of UGI in children vary depending upon age • The most common cause of severe UGI bleeding. .. most common cause of severe UGI bleeding in children : Variceal rupture & ulcer bleeding Approach to upper gastrointestinal bleeding in children • The initial evaluation : assessment of hemodynamic