Boerhaave syndrome, first described by the Dutch physician Hermann Boerhaave in 1724, is a life-threatening condition involving spontaneous esophageal perforation from a sudden, forceful increase in intraesophageal pressure against a closed glottis (e.g., intense vomiting, retching, or straining). The most common perforation site is the esophagus’s distal third, particularly along…
As a cardiovascular ICU intensivist, postoperative ileus (POI) is a condition I deal with frequently following laparotomies and even abdominal aorta endovascular repairs with gut dysmotility, inflammation, and neural inhibition all contributing. If conventional “bowel regimen” therapies (ambulation, enemas, etc.) fail, and I’m convinced the pathology is colonic pseudo-obstruction (not a mechanical obstruction), I’ll consider…
Ogilvie’s syndrome is an acute, paralytic ileus of the colon without mechanical obstruction associated with massive right colon dilation. Symptoms can include abdominal distension/pain, constipation, and in more severe situations, leukocytosis with fevers. In line with Laplace’s Law (tension ~ intraluminal pressure * radius), since the cecum has the largest…
The Couinaud classification system divides the liver into eight functionally independent segments, each with a center consisting of a portal vein, hepatic artery branches, and bile duct drainage. The periphery of each segment is where vascular outflow occurs via the hepatic veins. The numbering system begins with the caudate lobe…
Transaminitis refers to an increase in circulating levels of transaminases (ie, AST and ALT) classically indicative of liver injury. Hepatobiliary disease spans a wide breadth of various pathologies and should consider a patient’s physical exam, clinical context, imaging, other labs (GGT, bilirubin, alkaline phosphatase, etc); however, having AST and ALT…
Left ventricular assist devices (LVADs) are gaining more traction in treatment-refractory heart failure primarily as a bridge-to-transplantation or destination therapy. Unfortunately, these patients frequently develop gastrointestinal (GI) bleeds requiring transfusion and endoscopic interventions. But why?
Sandostatin (octreotide) is a subcutaneous, intramuscular, or intravenous analog to somatostatin – a protein hormone secreted throughout the GI tract – which acts via G-protein coupled receptors to inhibit a myriad of other hormones. For example, in the central nervous system, it suppresses the release of prolactin, thyroid stimulating hormone,…
Today was the first day of my last core rotation in medical school – pediatrics! I’ll be spending most of the two months at the largest pediatric hospital in the country – Texas Children’s Hospital. :-) After the routine orientation/badging this morning, the group split into our respective services. For…
C. difficile is a bacteria part of our normal bowel flora, but when certain antibiotics (namely clindamycin) wipe out the other healthy organisms, C. diff’s growth is left unchecked. C. diff colitis is something I saw all the time in February while working on the gastroenterology service at St. Luke’s,…
I’m on the gastroenterology consult service at St. Luke’s Episcopal Hospital (SLEH) for the second month of my internal medicine rotation. Last month, Ben Taub General Hospital (BTGH) provided me with the team-centered, primary caretaker view for the uninsured/homeless/EC population. Now I’m learning about the world of specialized consult services…