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.
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.
The answer is unfortunately. Yes!
Meningitis, sometimes referred as spinal meningitis, is an inflammation of the membranes surrounding the brain and spinal cord. Usually caused by a viral infection, but it can also be caused by a bacterial or fungal infection.
Among pediatric patients admitted for treatment of sinusitis, 3.2% were found to have an intracranial complication. Infection of the sphenoid sinuses, however, merits concern. These thin-walled sinuses develop late in childhood, and their deep location places them adjacent to the dura mater and other critical structures.
Sphenoid sinusitis is identified in approximately 3% of cases of acute sinusitis, typically in the context of pansinusitis. Significant development of the sphenoid sinuses does not begin until age 4 to 6 years, thus, sphenoid sinusitis is restricted.
Viral infection causes most cases of spinal meningitis. Viral meningitis is usually mild and heals without treatment. Bacterial meningitis is more severe and requires treatment with antibiotics. Streptococcus pneumoniae and neisseria meningitidis are strains of bacteria that cause pneumococcus and meningococcus meningitis respectively.
It can be life threatening condition owing to its proximity to brain and spinal cord and infective media is the fluid surrounding them.
• Lumbur puncture – csf examination (cell count, glucose, proteins) and culture
The chest cavity within the ribs is a very vital area of your body. There are multiple vital organs within this area and if there are any problems with any of these, then one of the ways to perform surgery in this area is with the help of thoracotomy.
What is thoracotomy?
Thoracotomy is the opening up of the chest cavity for the doctors to allow access to the vital organs within the region such as:
In this procedure, the doctors make a medium to large incision on the side of the chest which may extend much further up the back depending on how far the doctor needs access too. However, in certain cases, the doctors may extend the incision to the front of the chest and even remove ribs to allow access. Thoracotomy is a major and invasive surgery. It is a fairly common surgery but carries risks because of it being such an invasive surgery.
When is thoracotomy performed?
Some of the indications where thoracotomy is performed would be –
Risks of Thoracotomy
Aftercare is fairly complicated with this procedure and will take some time to heal completely.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Tuberculosis (TB) is one of most deadly diseases know globally. It is an infectious disease occurring in many developing and developed countries as well. However, more patients can be seen coming from developing nations. According to WHO (World Health Organisation), 9 million people suffer from TB in a year. Tuberculosis is one of the diseases leading to deaths among women aged between 15 to 40 years.
The main cause of TB is a bacterium called Mycobacterium tuberculosis. It is an infectious disease that is also contagious. However, tuberculosis can be of two varying types:
Some of the signs and symptoms of active TB are:
There are other types of TB occurring among people that have many more symptoms:
These were some of the symptoms associated with various types of Tuberculosis. However, its diagnosis may range of doing a skin test to blood tests to x-rays to sputum tests. Along with this doctors use a stethoscope to listen to the sounds of lungs.
What you need to keep in mind is that TB affects other parts of the body as well. If you are having tuberculosis in your kidneys, then it results in loss of blood through urine. So you need to observant and report to your doctor accordingly.
As TB is a contagious disease, its treatments require certain medications which have to be consumed for a period of 6 months. For effective results and better recovery, doctors advise patients to complete the full course of medications.
Gall Bladder Stone
Courtesy -Dr.Kumar Parth (MBBS; MNAMS; FMAS; FAIS; FACRSI (Colo-Rectal Surgery) DNB; FSGE (Surgical Gastroenterology)
(Consultant Surgical Gastroenterologist), firstname.lastname@example.org, www.drparthgastro.com
Definition: Presence of stones in the gallbladder is referred to as cholelithiasis.
Composition of Gall Bladder Stone:
Cholesterol Stone: Found in western world, causes accounted to diet rich in cholesterol.
Pigmented stone: generally found in diseases related to blood disorder
Mixed stone: Contains Calcium, magnesium, sodium phosphate ( most common type found in Asian population (India).
Indications for Surgery:
Asymptomatic or Silent gall stone requiring surgery in special circumstances are:
Treatment: Surgery - Laparoscopic Cholecystectomy (Key Hole Surgery) is Gold standard worldwide.
Gallbladder removal is one of the most commonly performed surgical procedures. Gallbladder removal surgery is usually performed with minimally invasive techniques and the medical name for this procedure is Laparoscopic Cholecystectomy or Laparoscopic Gallbladder Removal.
The gallbladder is a pear-shaped organ that rests beneath the right side of the liver. Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine. Removal of the gallbladder is not associated with any impairment of digestion in most people.
What Causes Gallbladder Problems?
It is uncertain why some people form gallstones but risk factors include being female, prior pregnancy, age over 40 years and being overweight. Gallstones are also more common as you get older and some people may have a family history of gallstones. There is no known means to prevent gallstones.
These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever. If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.
Gallstones do not go away on their own. Some can be temporarily managed by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed. Treatments to break up or dissolve gallstones are largely unsuccessful.
Surgical removal of the gallbladder is the time-honored and safest treatment of gallbladder disease.
Complications of Gallstones
Solution if any complication occures:
In case the gallstones slip into bile duct, the doctor will opt an additional procedures called Endoscopic Retrograde Cholangiopancreatography (ERCP). In this procedure, the doctors perform endoscopic removal of the stones with or without placement of a stent.
The doctors may also opt for a surgery such as bile duct exploration (which can be done laparoscopically) to remove the stones.
What are the Advantages of Performing Laparoscopic Gallbladder Removal?
Are you the right Candidate?
Although there are many advantages to laparoscopic gallbladder removal (cholecystectomy), the procedure may not be appropriate for some patients who have severe complicated gallbladder disease or previous upper abdominal surgery. A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal (cholecystectomy) is an appropriate procedure for you.
Tb is a disease which in humans is usually caused by bacteria called mycobacterium tuberculosis (m. Tuberculosis). Tb is an abbreviation of the word tuberculosis and is how people often refer to the disease.
Bovine tb is a disease caused by similar bacteria called mycobacterium bovis (m. Bovis). Bovine tb mainly affects cattle but can also affect humans.
Just a few years ago it was believed that tb was an old disease, and that it was no longer a problem in humans. But now because of such issues as drug resistance and hiv, it has become a major problem again.
Globally, more than 1 in 3 individuals is infected with tb. According to the who, there were 8.8 million incident cases of tb worldwide in 2010, with 1.1 million deaths from tb among hiv-negative persons and an additional 0.35 million deaths from hiv-associated tb. In 2009, almost 10 million children were orphaned as a result of parental deaths caused by tb.
Overall, the who noted the following:
1. Active tb
Active tb is an illness in which the tb bacteria are rapidly multiplying and invading different organs of the body. The typical symptoms of active tb variably include cough, phlegm, chest pain, weakness, weight loss, fever, chills and sweating at night. A person with active pulmonary tb disease may spread tb to others by airborne transmission of infectious particles coughed into the air.
If you are diagnosed with an active tb disease, be prepared to give a careful, detailed history of every person with whom you have had contact. Since the active form may be contagious, these people will need to be tested, as well.
Multi-drug treatment is employed to treat active tb disease. Depending on state or local public health regulations, you may be asked to take your antibiotics under the supervision of your physician or other healthcare professional. This program is called “directly observed therapy” and is designed to prevent abandonment or erratic treatment, which may result in “failure” with continued risk of transmission or acquired resistance of the bacteria to the medications, including the infamous multi-drug resistant tb (mdr-tb).
2. Miliary tb
Miliary tb is a rare form of active disease that occurs when tb bacteria find their way into the bloodstream. In this form, the bacteria quickly spread all over the body in tiny nodules and affect multiple organs at once. This form of tb can be rapidly fatal.
￼Types of tb
1. Cavitary tb
Cavitary tb involves the upper lobes of the lung. The bacteria cause progressive lung destruction by forming cavities, or enlarged air spaces. This type of tb occurs in reactivation disease. The upper lobes of the lung are affected because they are highly oxygenated (an environment in which m. Tuberculosis thrives). Cavitary tb can, rarely, occur soon after primary infection.
Symptoms include productive cough, night sweats, fever, weight loss, and weakness. There may be hemoptysis (coughing up blood). Patients with cavitary tb are highly contagious. Occasionally, disease spreads into the pleural space and causes tb empyema (pus in the pleural fluid).
2. Latent tb infection
Latent tb occurs when a person has the tb bacteria within their body, but the bacteria are present in very small numbers. They are kept under control by the body’s immune system and do not cause any symptoms.
People with latent tb do not feel sick and are not infectious. They cannot pass the bacteria on to other people. In addition they will usually have a normal chest x-ray and a negative sputum test. It is often only known that someone has latent tb because they have had a test, such as the tb skin test.
You are at risk of tb infection if you are around people with active tb disease who are coughing, which releases bacteria into the air. The risk of infection increases for intravenous drug users, healthcare workers, and people who live or work in a homeless shelter, migrant farm camp, prison or jail, or nursing home.
Most people who are infected with the bacteria that cause tb do not develop active disease. The following factors increase the risk that latent disease will develop into active disease:
The mycobacterium tuberculosis bacterium causes tb. It is spread through the air when a person with tb (whose lungs are affected) coughs, sneezes, spits, laughs, or talks.
￼Causes of tuberculosis
Although tuberculosis (tb) is most frequently associated with symptoms involving the lungs—because the disease most often affects the lungs—it can affect any organ of the body. The disease can cause a variety of symptoms. If you have symptoms, your doctor will want to know when they began.
People with latent tb infection (an infection without active disease) have no symptoms.
The usual symptoms of tb include:
The symptoms may be mild and may not seem particularly worrisome to the patient. In other people, the symptoms become chronic and severe.
Other symptoms of active tb disease depend on where in the body the bacteria are growing. If active tb disease is in the lungs (pulmonary tb), the symptoms may include a bad cough, pain in the chest, and coughing up blood. If active tb is outside the lungs (for example, the kidney, spine, brain, or lymph nodes), it is called extrapulmonary tb and has other symptoms, depending on which organs are affected. For example, tuberculosis in the spine may cause back pain or stiffness.
Diagnosis and test
Types of tb test
There are a range of tests to show if you have tb, such as a sputum test, a culture test and x-rays.
A chest x-ray can show damage in your lungs, but you might need further tests to prove you have tb, such as sputum and culture tests or scans.
A lab will use a microscope to look at any sputum (phlegm) that you cough up. If there are tb germs in your sputum, you have tuberculosis of the lungs or throat (pulmonary tb). This test also helps doctors to understand how infectious you may be.
If it is thought that you have tb, but not in your lungs or throat, the doctor may take a biopsy to test for tb. This is a small sample of tissue or fluid taken from the area where the tb is thought to be.
This test uses your sputum or tissue sample to grow any tb bacteria that may be there. It tells doctors how infectious you are and also whether your tb is resistant to any antibiotics. This helps ensure they put you on a combination of drugs that will cure you. As tb culture grows slowly, it may take up to eight weeks to get some of the results.
Treatment and medications
Treatment for active tb
If you have this form of the disease, you’ll need to take a number of antibiotics for 6 to 9 months. These four medications are most commonly used to treat it:
Your doctor may order a test that shows which antibiotics will kill the tb strain. Based on the results, you’ll take three or four medications for 2 months. Afterward, you’ll take two medications for 4 to 7 months.
You’ll probably start to feel better after a few weeks of treatment. But only a doctor can tell you if you’re still contagious. If you’re not, you may be able to go back to your daily routine.
Treatment of latent tb
The treatment of latent tb is considered by many people to be an important part of tb prevention.
It is not recommended that everyone with latent tb infection (ltbi) should have tb treatment. Rather it is recommended that certain “target” groups should receive treatment. The main “target” groups considered by the world health organisation (who) to be most at risk from progressing from latent to active tb include people in low tb burden countries:
Who have certain clinical conditions, or conditions which compromise their immune system, such as people with diabetes, and people with chronic renal failure.
In high tb burden countries the populations that are most strongly recommended for the treatment of latent tb infection are people living with hiv, and children under five who are household contacts of pulmonary tb cases.
Treatment for miliary tb
If you test positive for latent tb infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.
Protect your family and friends
In countries where tuberculosis is more common, infants often are vaccinated with bacillus calmette-guerin (bcg) vaccine because it can prevent severe tuberculosis in children. The bcg vaccine isn’t recommended for general use in the united states because it isn’t very effective in adults. Dozens of new tb vaccines are in various stages of development and testing.