myra lalas pitt. 1. no direct ct evidence of appendicitis. 2. gastric bezoar versus foodstuff within...
TRANSCRIPT
Myra Lalas Pitt
1. NO DIRECT CT EVIDENCE OF
APPENDICITIS.
2. GASTRIC BEZOAR VERSUS
FOODSTUFF WITHIN THE STOMACH.
3. RIGHT-SIDED ADNEXAL CYST WITH FREE
FLUID IN CUL DE SAC CONSISTENT WITH CYST RUPTURE.
4. TRACE AMOUNT OF PERIPORTAL
EDEMA. ULTRASOUND MAY BE
OBTAINED
IF CLINICALLY INDICATED.
5. FECAL MATERIAL THROUGHOUT THE ENTIRE COLON CONSISTENT WITH CONSTIPATION.
Definition Result from the accumulation of foreign
ingested material in the form of masses or concretions
Rare and occurs in <1% of the population
Grow by the continuing intake of food rich in cellulose and other indigestible materials such as hair, cotton, and tissue paper, matted together by protein, mucus, and pectin.
Pathophysiology
Properties of the ingested material and some degree of gastric dysfunction may lead to its formation
Risk Factors:
Previous gastric surgery
Delayed gastric emptying
Signs and Symptoms Phytobezoars: men in their 40s-50s Trichobezoars: women in their 20s Symptoms usually develop insidiously:Abominal painNausea/ vomitingEarly satietyAnorexiaWeight lossGI bleeding
Diagnosis
AXR:
CT Scan
Gastric trichobezoar
Treatment
Depend on their composition, location and size.
Dissolution therapy (cellulase, acetylcystein, papain and Coca Cola)
Endoscopic fragmentation and/or aspiration
Surgery
Endoscopic removal of the yellow-greenish-colored bezoar and normal gastric mucosa.
Gastric bezoar dissolution with oral Coca-Cola® intake
Sara Regaño, Marisol Trugeda, Gonzalo Gutierrez, Susana Menéndez and Gonzalo De las Heras, 05 May 2009
Lavage with Coca-Cola® as a safe and effective treatment for gastric bezoars was first described in 2002
Case of 64 yo F with hypogastric pain & gastric fullness for 3 years; h/o DM type 2 and hyperthyroidism
Meds: Omeprazol®, plus oral antidiabetic agents, and Thirodril
The patient was asked to drink 3 cans of Coca-Cola® per day with every meal (33 cl. 3 times a day) for a month.
The mechanism of Coca-Cola® dissolution is not fully explained.
Phosphoric acid (H3PO4) is responsible for Coke’s pH of 2.6, which is close to the pH of gastric secretions→ acidification of the gastric content may be the way Coca-Cola® acts by disintegrating the bezoar.
The release of carbon dioxide (CO2) bubbles into the gastric lumen and the mucolitic action of sodium bicarbonate (NaHCO3) may also contribute to bezoar dissolution.
References
Azevedo et al. Successful endoscopic resolution of a large gastric
bezoar in a child. World J Gastrointest Endosc. 2011 June 16; 3(6):
129–132.
Regano et al. Gastric bezoar dissolution with oral Coca-Cola®
intake. May 2009 (www.gastrohep.com)
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