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Management of Abortion
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Boerhaave first described the spontaneous rupture of the esophagus in 1724. It typically occurs after forceful emesis. Boerhaave syndrome is a transmural perforation of the esophagus to be distinguished from mallory-weiss syndrome, a nontransmural esophageal tear also associated with vomiting. Because it often is associated with emesis, boerhaave syndrome usually is not truly spontaneous. However, the term is useful for distinguishing it from iatrogenic perforation, which accounts for 85-90% of cases of esophageal rupture.
Diagnosis of boerhaave syndrome can be difficult because often no classic symptoms are present and delays in presentation for medical care are common. Approximately one third of all cases of boerhaave syndrome are clinically atypical. Prompt recognition of this potentially lethal condition is vital to ensure appropriate treatment. Mediastinitis, sepsis, and shock frequently are seen late in the course of illness, which further confuses the diagnostic picture.
See can't-miss gastrointestinal diagnoses, a critical images slideshow, to help diagnose the potentially life-threatening conditions that present with gastrointestinal symptoms.
A reported mortality estimate is approximately 35%, making it the most lethal perforation of the gi tract. The best outcomes are associated with early diagnosis and definitive surgical management within 12 hours of rupture. If intervention is delayed longer than 24 hours, the mortality rate (even with surgical intervention) rises to higher than 50% and to nearly 90% after 48 hours. Left untreated, the mortality rate is close to 100%.
Esophageal rupture in boerhaave syndrome is postulated to be the result of a sudden rise in intraluminal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle to relax. The syndrome commonly is associated with overindulgence in food and/or alcohol. The most common anatomical location of the tear in boerhaave syndrome is at the left posterolateral wall of the lower third of the esophagus, 2-3 cm proximal to the gastroesophageal junction, along the longitudinal wall of the esophagus. The second most common site of rupture is in the subdiaphragmatic or upper thoracic area. [1, 2]
Although likely underreported, the incidence of boerhaave syndrome is relatively rare. A 1980 review by kish cited 300 cases in the literature worldwide.  a 1986 summary by bladergroen et al described 127 cases.  of these, 114 were diagnosed antemortem; the others were diagnosed at autopsy. Overall, boerhaave syndrome accounts for 15% of all cases of traumatic rupture or perforation of the esophagus.
Race-, sex-, and age-related demographics
Cases have been reported in all races and on virtually every continent, affecting males more commonly than females, with ratios ranging from 2: 1 to 5: 1.
Boerhaave syndrome is seen most frequently among patients aged 50-70 years. Reports suggest that 80% of all patients are middle-aged men. However, this condiction has also been described in neonates and in persons older than 90 years. Although no clear explanation exists for this, the least susceptible age group appears to be children aged 1-17 years.
Prognosis is directly contingent on early recognition and appropriate intervention. Early diagnosis of boerhaave syndrome allows prompt surgical repair. Diagnosis and surgery within 24 hours carry a 75% survival rate. This drops to approximately 50% after a 24-hour delay and approximately 10% after 48 hours.
The mortality rate is high. Esophageal perforation is the most lethal perforation of the gi tract. Survival is contingent largely upon early recognition and appropriate surgical intervention.
Overall, the mortality rate is approximately 30%. Mortality is usually due to subsequent infection, including mediastinitis, pneumonitis, pericarditis, or empyema.
Patients who undergo surgical repair within 24 hours of injury have a 70-75% chance of survival. This falls to 35-50% if surgery is delayed longer than 24 hours and to approximately 10% if delayed longer than 48 hours.
Cases of patients surviving without surgery exist but are rare enough to warrant case reports in the medical literature.
Esophageal rupture may lead to the development of septicemia, pneumomediastinum, mediastinitis, massive pleural effusion, empyema, pneumomediastinum, or subcutaneous emphysema.
If the esophageal rupture extends directly into the pleura, hydropneumothorax is expected. In adults, this occurs more commonly on the left side of the pleura. In neonates, esophageal rupture usually occurs on the right side.
After esophageal rupture, free air enters the mediastinum and also may spread to the adjacent structures, resulting in mediastinal abscess or superimposed secondary infection.
Other complications include acute respiratory distress syndrome, pneumomediastinum, pneumothorax, and hydrothorax.
What is the main problem for continues bleeding after 5 days periods? And now it's spotting. For about 2 months daily. Also in tym of periods, Normal 5 days continuous bleeding occurred for about two months and after that some time daily spotting or bleeding of fresh blood. What is it?
I had sex last night with ma wife after two month 4 days of baby delivery (delivery date is 6 feb 2016), I am afraid that is there any chance to get pregnant, because I dont know it was safe day or unsafe and bleeding cycle stopped on 16 to 18th march 2016, please help me.
Sir I have 1 month pregnant and test for the confirm and get the result positive but my health is not sport so I want to cancel the praganancplease help me.
My wife aged 51 is not interested in sexual life, avoiding, complain pain in vagina due to dryness, sometimes and more frequently complaining heap pain, after getting hot massage she relaxed, possible remedies and cause of above problems.
I have been experiencing sticky opaque cervical mucus since yesterday. I have a 35 day cycle and I gt my periods on d 16th of may. Hw do I knw wen il ovulate. Im realy anxious to conceive.
I'm 26 years old I have married my wife is pregnant now we used I pill but it has not worked now what to do next as we are leaving in different cities because of our profession we are not ready to hv children nw only so please suggest us something thank you.
My wife is no interest in sex at any time .I asked her what is the problem but she say no problem .so what I do.
What should we do if amniotic fluid level is 2.5 mm, and due date for delivery is 31.11.16. She feels no labor pain yet.
In my last scan Doctor found an ovarian cyst. But after using tablets, when I go to scan today, they told the cyst is removed and there is no problem. Now I want to conceive, is it the right time to conceive? Or any problem happened? Can I use any medicines?
I have unprotected sex last to last week my cycle date is 23 of every month this month still I have not got periods please suggest me I ate, lots of papaya and boil eggs but no use.
Dr. I am 23 year old I got married in april 2015 we are trying to conceive every time we expect but fail to. Every month my wife menses late for 15 to 20 days month after month irregular menses .now she detected with pcos .medication is on and exercise also .but sometime I feel that is there any wrong with my fertility or my wife irregular menses making negative us to conceive .please guide me .regards.
Dear doctor i'm suffering from period problem since more time, please tell that after period why bleeding is not stop properly. Always bleeding as like brown red colors. Please reply. i'm very thankful for your this kindness work.
I ws pregnant but in 12 th week ie 1april ultrasound got to knw baby had no heartbeat n growth so I had my d&c on 2 april 2016. I want to what all precautions I need to take nw nd fr how long. Nd aftr d&c how many days bed rest is required?
Endometriosis is a common gynecological disorder where the tissue lining of the uterus grows outside the uterine cavity. Endometriosis is caused most commonly by menstrual blood flowing back in the Fallopian tubes, instead of leaving the body. This endometrial tissue may then leak into the abdomen through a surgical scar or cut in the uterine lining, leading to endometriosis.
Here are five things you should know about this condition:
It is hard to diagnose
The first roadblock to diagnosing endometriosis is that though it is a very common condition, there is a lack of knowledge about it. The classic symptoms include heavy periods, painful bowel movements and urination, depression, fatigue and pain all over the body. The only way to correctly diagnose endometriosis is through a laparoscopy or keyhole surgery.
Endometriosis is not equal to infertility
One of the myths surrounding endometriosis is that it causes infertility, however, this is not true. When treated properly, endometriosis does not affect your fertility, and it is still safe for you to have children. At the same time,you should also know that being pregnant does not cure the condition.
It can reduce your sex drive
One of the symptoms of endometriosis is chronic pain all over the body. This, coupled with fatigue and depression can reduce your sex drive drastically. Additionally, the act of intercourse itself also becomes painful for women suffering from endometriosis. This pain can be managed with the use of pain relievers, or by experimenting with positions, which is most comfortable for you.
Some women have a higher risk of endometriosis
The exact cause that triggers the endometriosis is still unknown. However, certain factors are said to raise the risk of endometriosis, such as:
1, Genetics: Endometriosis may be passed genetically from generation to generation.
2. Pelvic infections: Scarring of the uterine walls via infections or surgeries can give the menstrual blood that falls back to the Fallopian tubes a way out of the uterine cavity, and hence, lead to endometriosis.
3. Short Menstrual cycles: Women with menstrual cycles that are shorter than 27 days, or those who have periods that last longer than 7 days are more susceptible to endometriosis than others. However, myths that suggest delaying pregnancy as one of the causes of endometriosis are false.
There is no known cure
The treatment for endometriosis addresses its various symptoms as there is no known cure for the disease itself. Even a hysterectomy will not cure this disease unless it includes the removal of your ovaries as well. Over the counter pain medication may help deal with the muscle aches, while hormonal treatments that slow down the production of estrogen can help with the painful menses. Light exercises such as walking and swimming can also help deal with the discomfort of endometriosis.
Dear sir My wife is 3 and half month pregnant. She is loosing weight due to excess vomiting. She can not even drink water a lot. What to do Thanks.
1. Loaded with vitamins and minerals
The juice comes loaded with a bevy of vitamins, minerals and antioxidants essential for our body. The only thing that doesn't find presence in aloe vera is vitamin d. Aloe vera juice is easily available in the market. You can start by consuming it plain and then graduate to trying it with other juices like amla, giloy, tulsi, and karela.
2. Fights digestive disorders
Daily consumption of aloe vera juice is believed to fight and cure a range of digestive disorders including poor digestion, constipation, acidity and gas. It is also beneficial in boosting appetite and keeping a check on weight gain.
3. Flushes our toxins from the body
Aloe vera juice consumption flushes out toxins from the body. Drinking it early in the morning will help you in many ways, right from curing digestive issues to cleaning the system.
4. Balances hormonal problems
The juice is often used in many other herbal tonics pivotal in curing hormonal issues, as well as pancreas and spleen related disorders.
5. Excellent for hair and skin
Aloe vera juice helps maintain smooth, radiant skin and promotes hair growth. Its topical application can relieve from superficial burns and scars. It can be used as a moisturising agent for the skin as well as the scalp.
6. Boosts immunity
The health benefiting properties of aloe vera juice also boosts the body's immunity, especially when teamed with amla, tulsi, and giloy juice - an ideal concoction to battle the change in season.
How to use
Aloe vera juice should ideally be consumed on an empty stomach. 20ml should be mixed with a glass of water. You can even try mixing equal quantities of aloe vera juice with tulsi (holy basil), amla (indian gooseberry), and giloy (heart-leaved moonseed) juice.
40/60 ml of karela (bitter gourd) juice can be mixed with 20ml of aloe vera juice along with a glass of water. Karela juice is excellent for diabetes and cholesterol, combining it with aloe vera juice doubles the power of the individual potions.