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Anemia in cirrhosis:An underestimated entity

World Journal of Clinical Cases 2022年第3期10卷 777-789页

作者： Manish Manrai Saurabh Dawra rajan kapoor Sharad Srivastava Anupam Singh Department of Internal Medicine Armed Forces Medical CollegePune 411040India Department of Medicine and Gastroenterology Command HospitalPune 411040India Department of Medicine Command HospitalKolkata 70027India Department of Gastroenterology Post Graduate Institute of Medical Education and ResearchChandigarh 160012India

Anemia in a patient with cirrhosis is a clinically pertinent but often overlooked clinical *** guidelines highlight the algorithmic approach of managing a patient of cirrhosis presenting with acute variceal hemorrhage but day-to-day management in hospital and out-patient raises multiple dilemmas:Whether anemia is a disease complication or a part of the disease spectrum?Should iron,folic acid,and vitamin B complex supplementation and nutritional advice,suffice in those who can perform tasks of daily living but have persistently low *** does one investigate and manage anemia due to multifactorial etiologies in the same patient:Acute or chronic blood loss because of portal hypertension and bone marrow aplasia secondary to hepatitis B or C viremia?To add to the clinician’s woes the prevalence of anemia increases with increasing disease *** thus aim to critically analyze the various pathophysiological mechanisms complicating anemia in a patient with cirrhosis with an emphasis on the diagnostic flowchart in such patients and proposed management protocols thereafter.

关键词： Anemia Cirrhosis Iron deficiency anemia Macrocytic anemia Normocytic anemia

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Anterior resection for rectal carcinoma-risk factors for anastomotic leaks and strictures

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World Journal of Gastroenterology 2011年第11期17卷 1475-1479页

作者： Ashok Kumar Ram Daga Paari Vijayaragavan Anand Prakash Rajneesh Kumar Singh Anu Behari Vinay K kapoor rajan Saxena Department of Surgical Gastroenterology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow 226014India

AIM:To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection(AR)and its subsequent ***:Retrospective analysis of data from 108 patients with rectal carcinoma who underwent AR or low anterior resection(LAR)to identify the various preoperative,operative,and post operative factors that might have influence on anastomotic leaks and ***:There were 68 males and 40 females with an average of 47 years(range 21-75 years).The median distance of the tumor from the anal verge was 8 cm(range 3-15 cm).Sixty(55.6%)patients underwent handsewn anastomosis and 48(44.4%)were *** median operating time was 3.5 h(range2.0-7.5 h).Sixteen(14.6%)patients had an anastomotic *** these,11 patients required reexploration and five were managed *** anastomotic leak rate was similar in patients with and without diverting stoma(8/60,13.4%with stoma and 8/48;16.7%without stoma).In 15(13.9%)patients,resection margins were positive for ***(17.6%)patients developed anastomotic strictures at a median duration of 8 mo(range 3-20 mo).Among these,15 patients were successfully managed with per-anal *** multivariate analysis,advance age(>60 years)was the only risk factor for anastomotic leak(P=0.004).On the other hand,anastomotic leak(P=0.00),mucin positive tumor(P =0.021),and lower rectal growth(P=0.011)were found as risk factors for the development of an anastomotic ***:Advance age is a risk factor for an anastomotic *** anastomotic leak,a mucin-secreting tumor,and lower rectal growth predispose patients to develop anastomotic strictures.

关键词： Rectal carcinoma Anterior resection Anastomotic leak Stricture

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