Gastrointestinal Method For The Practitioner

Stomach or small intestine exploratory A nasogastric or Dünndarmintubation is used for the relief of the stomach. It is indicated for the treatment of a gastric atony, ileus or obstruction, to eliminate recorded toxins, for the administration of antidotes, or both, for the recovery of gastric contents for analysis (amount of acidity, blood) and for the supply of nutrients. Contraindications include nasopharyngeal or esophageal obstruction serious injuries in the maxillofacial area uncorrected bleeding disorders esophageal varices were earlier regarded as a contraindication, a negative effect is never shown. Several types of probes are available. A Levinson or Salem soft rubber probe for stomach relief, to analyze and rarely used for the short-term diet. Various long and thin intestine probes are used for enteral long-term nutrition (enteral nutrition via probes). For intubation, the patient sits upright or, if he is not able, on the left side in decubitus position. A topical numbing spray given in the nose and pharynx, reduces discomfort. The patient holds his head slightly bent, provided with a lubricant probe is inserted through a nostril, and then pushed back, according to the anatomy of the nasopharynx, downward. When the tip reaches the posterior pharyngeal wall, the patient is asked to drink water through a straw. A strong cough and an air flow in the probe in breathing indicate that the probe was inadvertently placed into the trachea. Aspiration of gastric juice shows the positioning of the probe in the stomach. The location of larger probes can secure, if one instilled 20-30 ml of air and controlled with the stethoscope below the left rib cage the air insufflation. As introduced a nasogastric tube © Elsevier Inc. All Rights Reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video. var model = {videoId: ‘4536776210001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4536807273001_4536776210001-vs.jpg?pubId=3850378299001&videoId=4536776210001’, title: ‘As a nasogastric tube is inserted’ description: ” credits’ © Elsevier Inc. All rights Reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); For smaller, more flexible small intestine probes must be used for reinforcement guidewires or stylet. These probes usually require an x-ray or endoscopic control, when pushed through the pylorus. Complications are rare, they include violations of the nasopharynx with or without bleeding, pulmonary aspiration, traumatic esophageal or gastric bleeding or perforation and very rare intracranial or mediastinal penetration. Rectoscopy and sigmoidoscopy rectoscopy and sigmoidoscopy are used for evaluation of symptoms of the rectum or anus (light rectal bleeding, mucus, protrusions, pain). In addition, the sigmoidoscopy also allows biopsy of intestinal tissue, and the implementation of intervention measures such as hemostasis or intraluminal stent. There are no absolute contraindications, except those that should be considered in a normal endoscopy. In patients with cardiac arrhythmia or recent myocardial ischemia instead gehabter the procedure should be delayed until improvement of comorbidities, otherwise a cardiac monitoring is needed. Due to changes in the guidelines of the American Heart Association, these methods need no longer an endocarditis. As a anoscopy performed © Elsevier Inc. All Rights Reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video. var model = {videoId: ‘4536717375001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4536786429001_4536717375001-vs.jpg?pubId=3850378299001&videoId=4536717375001’, title: ‘As a anoscopy is carried out’, description: ” credits’ © Elsevier Inc. All rights Reserved. This video is personal information. The users to copy, reproduce, license, subscribe, sell, rent or distribution is prohibited by this video ‘, hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); The perianal region and the distal rectum can be examined with a 7 cm long rectoscope, and the rectum and the sigmoid can be examined with either a rigid, 25 cm long or a flexible, 60 cm long Instrument. The flexible sigmoidoscopy is much gentler on the patient and allows photographic documentation and tissue biopsy. It requires considerable manual dexterity, the rectosigmoid connection with the rigid sigmoidoscope painless to pass (at 15 cm). A sigmoidoscopy is carried out after emptying the rectum, intravenous concomitant medication is not usually necessary. The patient is placed in the left lateral position. The rigid sigmoidoscope is inserted gently 3-4 cm behind the anal sphincter, which happened obturator and placed the unit with direct vision. A sigmoidoscope is carried out without preparation. The sigmoidoscope is described in its full length as described above for the rigid sigmoidoscope is inserted, usually with the patient in the left lateral position. Complications are extremely rare when the procedure is performed correctly. Abdominal paracentesis An abdominal paracentesis is performed to obtain ascites for analysis. It is also to eliminate pronounced ascites indexed, causing respiratory discomfort or pain, or for the treatment of chronic ascites. Paracentesis video created by Hospital Procedures Consultants, www.hospitalprocedures.org. var model = {videoId: ‘3903645517001’, playerId ‘SyAEZ6ptl_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_4412127246001_vs-55c8fce0e4b042dbac3ca556-672293879001.jpg?pubId=3850378299001&videoId=3903645517001’ title: ‘paracentesis’, description: ” credits ‘video created by Hospital Procedures Consultants, www.hospitalprocedures.org’ hideCredits: true hideTitle: false, hideDescription: true loadImageUrlWithAjax: true};. var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Absolute contraindications are: serious, uncorrectable coagulation disorders, intestinal obstruction, infection of the abdominal wall. Poor patient cooperation, surgical scars on the punctured area, large intra-abdominal lesions and severe portal hypertension with training of abdominal collaterals are relative contraindications. Whole blood, platelet count and coagulation status be checked before the procedure. After emptying the bladder, the patient sits with around 45-90 ° head up. In patients with obvious and greater ascites a point on the center line between the umbilicus and the pubic bone is determined, and cleaned with an antiseptic solution, and alcohol. Two other potential sites for paracentesis are about 5 cm superior and medial to the anterior superior iliac spine on both sides. In patients with moderate ascites abdominal ultrasound is used for the precise localization of the ascites fluid. The positioning of the patient in the lateral side position with the planned insertion site below also promotes migration of air-filled bowel loops up and away from the point of entry. Using sterile technique the area up to the peritoneum with 1% lidocaine is anesthetized. In a diagnostic paracentesis a 18-gauge needle is inserted at a 50-ml syringe through the peritoneum (which generally produces a dull feeling of pain). Carefully liquid is aspirated, it will be cytologically examined for cell number, protein or amylase or or there is applied a culture if necessary. In therapeutic paracentesis a 14-gauge needle is used on a vacuum suction system and collected up to 8 liters of ascites fluid. The accompanying i.v. infusion of albumin during a large volume paracentesis is recommended in order to avoid significant displacement of the intravascular volume and hypotension after the procedure. Bleeding is the most common complication. Very rarely can leak after puncturing a pronounced ascites at the injection site over time.

Health Life Media Team

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