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[Gastroenterology] IBD(UC+CD), PMC, CCD, IBS, Colon Pulyp, Colon and Rectal Cancer(HNPCC)

Inflammatory Bowel Disease, IBD 發炎性腸道疾病
包含兩大類發炎性大腸炎(Ulcerative Colitis, UC)和克隆氏症(Crohn's Disease, CD)
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Pseudomembranous Colitis, PMC 偽膜性腸炎
Also name: Antibiotic Associated Colitis, Necrotizing Colitis, Clostridium Difficile Colitis(or Diarrhea)

好發族群:住院病人\使用抗生素療程病人\腹瀉or水瀉

常見感染細菌:

診斷工具:(1)內視鏡(2)測體內毒素

Symptom and Sign :
右下腹痛 DDx appendicitis
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Colonic Divertiular Diseasec, CDD （結腸憩室疾病）
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Irritable Bowel Syndrome, IBS大腸激躁症候群
最大特色:不會癌化
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Colon Polyp結腸息肉
依形態:
依良惡:
症狀:大多無症狀
DDx polyposis syndrome(有大腸外症狀)
發現時機:健康檢查(無症狀者)，腸胃道疾病
病因:其他疾病或遺傳性疾病(polyposis syndrome)造成

Polyposis Syndromes遺傳性疾病[少見常考]
Reference:eMedicine: Intestinal Polyposis Syndromes

Syndromes & Genes: familial adenomatous polyposis (FAP)、Gardner syndrome、Turcot’s syndrome、Peutz-Jeghers syndrome、Cowden disease、familial juvenile polyposis、hyperplastic polyposis
Cause:Gene deficiency
病因:基因缺陷

Familial Adenomatous Polyposis, FAP
Also Called: adenomatous polyposis coli, familial polyposis
中文名:家族性腺瘤性息肉
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Colon and Rectal Cancer

Hereditary nonpolyposis colorectal cancer (HNPCC) = Lynch Syndrome
Lynch Syndrome I:單純大腸

考試重點:
Polyposis Syndromes

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外科腸胃道疾病照護

手術前 NPO 手術後 減壓引流管 Decompression - NG decompression  pressure:? - J-P drain - Hemovac drain 引流管 - Foley-sump drain:一般不用負壓引流，採free drainage     臨床經驗，負壓引流無特別情況， 術後照護重點： 1. 適當引流及腸胃道減壓 2. 營養建立：需長期靜脈營養？ 七天以上無法給予腸胃道。                         PPNLP\PPNNP\TPN
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[Phsiology] 溶液滲透度osmolaluty & osmolarity

Osmolarity is a measure of the osmoles of solute per liter of solution, while the osmolality is a measure of the osmoles of solute per kilogram of solvent . from http://en.wikipedia.org/wiki/Osmolarity Plasma osmolality Plasma osmolality is a measure of the concentration of substances such as sodium , chloride , potassium , urea , glucose , and other ions in human blood . It is calculated as the osmoles of solute per kilogram of solvent. Normal osmolality in plasma is about 280 - 303 milli-osmoles per kilogram. It is affected by changes in water content. To calculate plasma osmolarity (osmolality) use the following equation: P osm = 2[Na + ] + [Glucose]/18 + [ BUN ]/2.8 The above equation holds true if the glucose & ureas blood chemistry units are given as: mg/dL. If the units are given as: mmol/l; then the calculated osmolality is given by: P .OSM = 2[NA] + 2[K+] + [Urea] + [Glucose] Osmolality can be measured on an analytical instrument called an Osmometer.
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[Gastroenterology] 消化道疾病與內視鏡手術

本文內容： (1)整個內視鏡之診療 (2)上消化系統內視鏡 A 食道 B 胃 C ERCP (3)大腸鏡 (4)腹腔鏡 (5)小腸鏡 (6)內視鏡超音波EUS (7)出血Hemostasis (a)急性非曲張性出血Acute nonvariceal bleeding(潰瘍性) (b)肝門脈高壓性出血Portal hypertensive bleeding(高壓性) (8)消化道擴張和固定GI tract dilatation and stent insertion (9)Enteral Access (10)ERCP (11)Tumor resection --------------------------------------------------- 上消化系統內視鏡手術 UGI System Endoscopy 定義 Def ：從嘴巴＞食道＞胃＞十二指腸第二段(肝胰壺腹) by Harrison 食道Esophageal Varices GERD Esophageal Varices GERD Los Angeles Classification (1) Grade A, one or more mucosal breaks no longer than 5 mm, none of which extends between the tops of the mucosal folds; (2) Grade B, one or more mucosal breaks more than 5 mm long, none of which extends between the tops of two mucosal folds; (3) Grade C, mucosal breaks that extend between the tops of two or more mucosal folds, but are not circumferential; (4) Grade D, one or more circumferential mucosal breaks. Grade A 單個或多個長度<5mm div="
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