Podcasts about octreotide

In this episode, we review the high-yield topic of ⁠Octreotide⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠from the Gastrointestinal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

In this episode, we review the high-yield topic of⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Octreotide⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Gastrointestinal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbull --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

Obtain IV Access – get two large bore IVs (18g or larger) Resuscitate – un-crossmatched blood at first, don't forget type and screen! Medicate – Give Pantoprazole always, Octreotide and Ceftriaxone if hx liver disease, reverse anticoagulation if indicated Imaging – Upright CXR to assess for perforation, CTA if concerned for lower GIB Consult – […]

Show notes at pharmacyjoe.com/episode795. In this episode, I’ll discuss when octreotide can be discontinued in patients with variceal bleeding. The post 795: When can octreotide be discontinued in patients with variceal bleeding? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode795. In this episode, I’ll discuss when octreotide can be discontinued in patients with variceal bleeding. The post 795: When can octreotide be discontinued in patients with variceal bleeding? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode779. In this episode, I'll discuss when to use octreotide for upper GI bleeding. The post 779: When to use octreotide for upper GI bleeding appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode779. In this episode, I ll discuss when to use octreotide for upper GI bleeding. The post 779: When to use octreotide for upper GI bleeding appeared first on Pharmacy Joe.

Back with returning guest Dr. Elliot Tapper (@ebtapper), gastroenterologist, transplant hepatologist, and director of the cirrhosis program at the University of Michigan in Ann Arbor, to talk about critical GI bleeding. Takeaway lessons Consider the Glasgow-Blatchford score to stratify risk and need for admission, GI consultation, etc. Octreotide (or terlipressin) is indicated in every cirrhotic … Continue reading "Episode 38: GI bleeding with Elliot Tapper"

In today's VETgirl online veterinary CE podcast, we interview Dr. Ryan Gouptil and Dr. Megan Davis, DACVECC on the use of percutaneous biliary drainage and octreotide (injectable milk thistle) for dogs with Amanita mushroom poisoning. In a recent publication entitled Clinical recovery of 5 dogs from amatoxin mushroom poisoning using an adapted Santa Cruz protocol for people, the co-authors review the dangers of mushroom, general approach to poisoning, how Amanita mushroom toxicity needs to be rapidly recognized and treated, and how to implement percutaneous biliary draining and the use of octretide (called the Santa Cruz method in human medicine) to help increase survival.

In which Grace and Eddie discuss spooky topics such as Minnesota tubes, varices, and ghost ships. Here is a picture of a Minnesota tube: shorturl.at/dqvA9 Errata: 1. Paloma, in Spanish, means pigeon or dove. 2. Octreotide is usually a 50 mcg bolus followed by 50 mcg/hr gtt 3. Grace mentions fibrinogen replacement — the most ideal way to do this is probably cryoprecipitate, which is more concentrated than FFP. 4. Tornadoes form when warm, humid air collides with cold, dry air. This results in an updraft, which will rotate in the right conditions. The updraft will draw in warm air and water droplets to form a funnel cloud, which spookily descends from the sky and, upon touching the ground, becomes a tornado. Disclaimer: this podcast is purely educational and is not medical advice.

Show notes at pharmacyjoe.com/episode431. In this episode, I’ll discuss when octreotide can be discontinued in patients with variceal bleeding. The post 431: When can octreotide be discontinued in patients with variceal bleeding? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode409. In this episode, I’ll discuss octreotide’s role in treating variceal bleeding. The post 409: How does octreotide help in variceal bleeding? appeared first on Pharmacy Joe.

#Scienza, #clinica, #Assobiotech, #CRO, #RegulatoryAffairsDay, #Brexit, #Equita, #CRA, #Renepolicistico, #MolMed, #PPD, #farmaceutico, #Psoriasi, #MedPace, #IQVIA, #Clintec, #terapieinnovative.PharmaPills - Pillole dal farmaceutico: Novità, Curiosità e Lavoro dal mondo del farmaceutico. A cura di Stefano Lagravinese.In questa puntata parliamo di:Assobiotech, CRO, Regulatory affairs day, Brexit, Rene policistico, Psoriasi moderata-grave.Aziende: MolMed, PPD, MedPace, Clintec, PRA Health Sciences, KCR, ICON, IQVIA, PSI, Parexel, Covance.Persone: Riccardo Palmisano (MolMed), Franco Locatelli (Ospedale pediatrico Bambino Gesù), Giuseppe Remuzzi (Istituto di Ricerche Farmacologiche Mario Negri IRCCS), Giampiero Girolomoni (Clinica Dermatologica Università di Verona).Nuove terapie: Octreotide, Brodalumab.Patologie: Rene policistico, Psoriasi moderata-grave.Lavoro: Clinical Project Manager (Milano), Pharmacovigilance Quality Analyst (Milano), CRA (Roma).Il mercoledì alle h 12.00 su Spreaker.com e iTunes.Seguici su: www.telegram.me/pharmapillswww.facebook.com/pharmapills/

#Scienza, #clinica, #Assobiotech, #CRO, #RegulatoryAffairsDay, #Brexit, #Equita, #CRA, #Renepolicistico, #MolMed, #PPD, #farmaceutico, #Psoriasi, #MedPace, #IQVIA, #Clintec, #terapieinnovative.PharmaPills - Pillole dal farmaceutico: Novità, Curiosità e Lavoro dal mondo del farmaceutico. A cura di Stefano Lagravinese.In questa puntata parliamo di:Assobiotech, CRO, Regulatory affairs day, Brexit, Rene policistico, Psoriasi moderata-grave.Aziende: MolMed, PPD, MedPace, Clintec, PRA Health Sciences, KCR, ICON, IQVIA, PSI, Parexel, Covance.Persone: Riccardo Palmisano (MolMed), Franco Locatelli (Ospedale pediatrico Bambino Gesù), Giuseppe Remuzzi (Istituto di Ricerche Farmacologiche Mario Negri IRCCS), Giampiero Girolomoni (Clinica Dermatologica Università di Verona).Nuove terapie: Octreotide, Brodalumab.Patologie: Rene policistico, Psoriasi moderata-grave.Lavoro: Clinical Project Manager (Milano), Pharmacovigilance Quality Analyst (Milano), CRA (Roma).Il mercoledì alle h 12.00 su Spreaker.com e iTunes.Seguici su: www.telegram.me/pharmapillswww.facebook.com/pharmapills/

Author: Jared Scott, MD Educational Pearls:   Beta-blockers can mask the effects of hypoglycemia Prolonged/refractory hypoglycemia should raise a suspicion for sulfonylurea (or other oral hypoglycemic) overdose Interventions to reverse hypoglycemia include feeding the patient, IV dextrose, glucagon Octreotide can be used as an antidote with sulfonylurea ingestion  Editor’s note: Here is an interesting case report on using steroids for severe hypogylcemia caused by insulin overdose. Perhaps another treatment modality to keep in your back pocket? References Alsahli M, Gerich JE. Hypoglycemia. Endocrinol Metab Clin North Am. 2013 Dec;42(4):657-76. doi: 10.1016/j.ecl.2013.07.002. Review. PubMed PMID: 24286945. Moore C, Woollard M. Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial.Emerg Med J. 2005 Jul;22(7):512-5. PubMed PMID: 15983093; PubMed Central PMCID: PMC1726850. Fasano CJ, O'Malley G, Dominici P, Aguilera E, Latta DR. Comparison of octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med. 2008 Apr;51(4):400-6. Epub 2007 Aug 30. PubMed PMID: 17764782. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

In this episode, I ll discuss when to use octreotide for upper GI bleeding. Show notes at pharmacyjoe.com/episode320. The post 320: When to use octreotide for upper GI bleeding appeared first on Pharmacy Joe.

This episode features Professor David Currow (University of Technology Sydney, Ultimo, NSW, Australia. Wolfson Palliative Care Research Centre, University of Hull, Hull, UK). This transnational online survey aimed to determine the impact of a phase III randomised controlled trial on palliative care clinicians’ self-reported practice change.  The orginal study in question described the use of octreotide in the management of inoperable malignant bowel obstruction. This survey was distributed in 2016, 2 years after the first publication of the study in a peer-reviewed journal.The results demonstrated that out of 106 respondents, 52 (49.1%) indicated modified practice (60.9% of those who had previously prescribed octreotide in this setting). In those who reported practice change, most frequently octreotide was now used when other therapies failed. The results suggest that there is a cohort of ‘early adopters’ within palliative care practice as new evidence becomes available. Full paper available from: http://journals.sagepub.com/doi/abs/10.1177/0269216318778460?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: anwosu@liverpool.ac.uk

In Part 2 of our two part podcast on GI Bleed Emergencies Anand Swaminathan and Salim Rezaie kick off with a discussion on the evidence for benefit of various medications in ED patients with upper GI bleed. PPIs, somatostatin analogues such as Octreotide, antibiotic prophylaxis and prokinetics have varying degrees of benefit, and we should know which ones to prioritize. We then discuss the usefulness of the Glasgow-Blatchford and Rockall scores for risk stratification and disposition of patient with upper GI bleeds and hit it home with putting it all together in a practical algorithm. Enjoy! The post Episode 102 GI Bleed Emergencies Part 2 appeared first on Emergency Medicine Cases.

Blood in the vomit. Blood in the stool. Blood in the diaper. How far do I go in my investigation? What do I really have to worry about?   The differential diagnosis of GI bleeding in children is broad. (Here is the complete differential diagnosis) In the ED, we can simplify by categorizing by age and appearance.     Neonates GI bleeding in the neonate (less than one month of age) is serious until proven otherwise. Well appearing? If this in obvious anal fissure, then no further work-up is necessary.  Counsel on proper feeding and follow-up. Evaluate for potential swallowed maternal blood by examining mother with a chaperone, then perform the Apt test. Consider allergic proctocolitis if the child is well.  Counsel the breastfeeding mother on diet modification.  If formula fed, the child should feed through thus until the primary care physician decides whether to start the sticky process of changing up formulas. If unclear, consider a complete blood count and/or further work-up and admission if unwell. Ill Appearing? The three most dangerous diagnoses in the neonate are necrotizing enterocolitis, malrotation with volvulus, and inherited coagulopathy.  It is important to note that 15% of necrotizing enterocolitis occurs in full-term babies; malrotation can present simply in shock, without initial overt bleed.  Inherited conditions may not be known to the family early on, as they have not yet heard back from the neonatal screening done at birth. Pitfalls in the neonate and infant Genitourinary bleeding; hematuria; or uric acid crystals: the classic fake out here is the orange or pink stained diaper – that is actually residue from deposits of uric acid crystals in the urine, an almost always benign phenomenon in which the concentrated crystals oxidize and stain the diaper, frightening the parents. Think -- pink stain, without clot:   Infants and Young Children Well appearing? Through the first year to age 5, things like infectious colitis and gastritis are common. Ill appearing? Think about intussusception, cryptic liver disease, or esophageal bleeding. Check the skin – is that a dark purple palpable rash on the buttocks? Think Henoch-Schoenlein purpura. Focus: Meckel's Diverticulum Meckel’s diverticulum is the most common congenital malformation of the GI tract, and the most common cause of GI bleeding in the toddler.  It is a remnant of the omphalomesenteric tract – it came from a long tube that once connected the yolk sac to the lumen of the midgut.  A stranded island of gastric tissue secretes acid in the intestine, where it doesn’t belong.  Sometimes these islands never cause much trouble. When it does present itself, a Meckel’s diverticulum usually follows the rule of twos: Presents by age 2 Affects 2% of the population Often 2 inches in length May include 2 types of mucosa Found within 2 feet of the ileocecal valve. Not actively bleeding: technetium-99 pertechnate scintigram (Meckel’s scan). Actively bleeding: radio-labeled red blood-cell scan (resuscitate and call your surgeons!) Pitfalls in the infant and young child Epistaxis; food-related misadventures   Older Child and Adolescent Well appearing? Mallory-Weiss tears after forceful vomiting; trivial hemoptysis after viral symptoms; pill esophagitis in the child is just learning to swallow medications.  Always consider foreign body ingestion. Ill Appearing? Varices from cryptic liver disease; hemorrhagic gastritis; vascular malformation, such as a Dieulafoy lesion, where a tortuous small artery ends just superficial to the gastric mucosa, and can erode through and erupt. Focus: Inflammatory Bowel Disease Approximately a quarter of patients with inflammatory bowel disease (IBD) -- both Ulcerative Colitis and Crohn disease – will present by age 20.  Children and adolescents may present with the classic symptoms of IBD: abdominal pain, weight loss, bloody diarrhea, but many present atypically with isolated signs like poor growth, anemia, or delayed puberty. You may also suspect IBD in the child with other extra-intestinal symptoms like oral ulcers, clubbing, erythema nodosum, jaundice, or hepatomegaly. On history and physical examination, you may get one of three cardinal presentations Fatigue, history of anemia, in a stable child who comes to the ED with bloody diarrhea Chronic diarrhea, chronic abdominal pain, and poor weight gain or weight loss A fulminant presentation, with severe abdominal pain, frankly bloody stools, tenesmus, fever, leukocytosis, and hypoalbuminemia. On exam, look for general appearance, glossitis from B2 deficiency, hair loss and brittle nails form protein loss, purpura (from vitamin C and vitamin K deficiencies).  Look for evidence of episcleritis or uveitis.  Listen for rubs as in pericarditis.  Do a good abdominal exam, especially looking for hepatomegaly. Perirectal skin tags are not uncommon. Children with IBD may form urinary calculi form oxalate crystal deposition. Do a thorough skin and neurologic exam. Treatment for both ulcerative colitis and Crohn’s disease is similar. Induction therapy: children with mild disease get aminosalicylates; those with moderate disease get steroids; and those with severe disease get cyclosporine. Maintenance regimens to prevent relapse include aminosalicylates, mercaptopurine, and azathioprine. Surgical treatments for refractory colitis include an ileal pouch and anal anastomosis – also called a J pouch, a type of neorectum created surgically by folding loops of ileum back on themselves and stitching them together to create a larger rectal reservoir where the rectum once was.  A neorectum allows the child to have voluntary control of his stools again. Stabilizing the Pediatric GI Bleed Life-threatening GI bleeding in children is, thankfully, rare, but we have to be prepared. Give blood for compensated shock, prepare for massive transfusion if giving more than 40 mL/kg total blood products. Differing Etiologies: adults and children The reasons for upper GI bleed in adults are vastly different from those of children.  In adults, mostly the life-threats are due to liver disease, varices, or hemorrhagic gastritis. In children, critical upper GI bleed is often secondary to critical illness (hemorrhagic gastritis or stress ulcer), or vascular malformation.  Critical lower gastrointestinal bleeding may be from Meckel's diverticulum or other congenital angiodysplasia. Endoscopy Get your patient urgent endoscopy as soon as possible after arrival if there is active bleeding. Otherwise, according to the Belgian guidelines, stable children may have endoscopy within the first 24 hours of hospitalization. The reported efficacy of endoscopy for controlling upper GI bleeding in children is approximately 90%. Miscellaneous Nasogastric tube? No routine role (unreliable to rule out or stratify upper GI bleed). Proton pump inhibitor? No good data, but no major common contraindications. Octreotide, vasopressin, broad-spectrum antibiotics?  May use adult data to extrapolate in the proper etiologic context. General Advice for the Brisk GI Bleed in Children This is a rare, but potentially life threatening situation, so anticipate how the child can decline, and get your team assembled: your pediatric intensivist, gastroenterologist, and surgeon – especially if we can’t ge the upper GI bleed to abate with endoscopy. The sooner you activate the team, the better. Summary The broad differential diagnosis may be paralyzing, and frustrating, since much of it we cannot discern in the ED. Consider actionable, high-yield etiologies based on age and appearance. Neonates Well appearing?  Think rectal fissure, maternal blood, or allergic proctocolitis Ill appearing?  Think necrotizing enterocolitis, malrotation, or an inherited coagulaopathy. Infants, and Young Children Well appearing? Think infectious colitis and gastritis. Ill appearing? Think intussusception and Meckel’s diverticulum. Older Children and Adolescents Well appearing?  Think Mallory Weiss tear from vomiting, or gastritis Ill appearing?  Think metabolic, cryptic liver disease, or inflammatory bowel disease. For everyone – a careful history and a good physical exam will point you tto the etiology, or risk-stratify for further outpatient evaluation and management. References Bozic MA, Puri K, Molleston JP. Screening and Prophylaxis for Varices in Children with Liver Disease. Curr Gastroenterol Rep. 2015 Jul;17(7):27. Chaïbou M, Tucci M, Dugas MA, Farrell CA, Proulx F, Lacroix J. Clinically significant upper gastrointestinal bleeding acquired in a pediatric intensive care unit: a prospective study. Pediatrics. 1998 Oct;102(4 Pt 1):933-8. Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E, Macken E, Penaloza A, Piessevaux H, Stéphenne X, Van Biervliet S, Laterre PF. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta Gastroenterol Belg. 2011 Mar;74(1):45-66. Garcia-Tsao G, Bosch J. Varices and Variceal Hemorrhage in Cirrhosis: A New View of an Old Problem. Clin Gastroenterol Hepatol. 2015 Nov;13(12):2109-17. Kaya A, Toyran M, Civelek E, Misirlioglu E, Kirsaclioglu C, Kocabas CN. Characteristics and Prognosis of Allergic Proctocolitis in Infants. J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):69-73. Lacroix J, Nadeau D, Laberge S, Gauthier M, Lapierre G, Farrell CA. Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit. Crit Care Med. 1992 Jan;20(1):35-42. Osman D, Djibré M, Da Silva D, Goulenok C. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care. 2012 Nov 9;2(1):46. Owensby S et al. Diagnosis and Management of Upper Gastrointestinal Bleeding in Children. J Am Board Fam Med. 2015; 28(1):134-145. Rosen MJ et al. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr. 2015 Nov;169(11):1053-60. Rufo PA, Bousvaros A. Current therapy of inflammatory bowel disease in children. Paediatr Drugs. 2006;8(5):279-302. Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? JAMA. 2012 Mar 14;307(10):1072-9. Thomson MA, Leton N, Belsha D. Acute upper gastrointestinal bleeding in childhood: development of the Sheffield scoring system to predict need for endoscopic therapy. J Pediatr Gastroenterol Nutr. 2015 May;60(5):632-6. This post and podcast are dedicated to Carlo D'Apuzzo, MD  for his creativity, innovation, and dedication to the highest standards of emergency care.  Le tue pillole sono buona medicina. Grazie, Carlo per tutto quello che fai per il mondo #FOAMed.   GI Bleeding in Children Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

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Die Akromegalie stellt ein vielschichtiges Krankheitsbild dar, das meist durch ein Wachstumshormon produzierendes Hypophysenadenom ausgelöst wird. Durch die verschiedenen Wirkungen des Wachstumshormons im Körper treten über die Zeit unter anderem ödematöse Schwellungen der Weichteile und Wachstum des peripheren Skeletts auf, Symptome, die der Erkrankung ihren Namen gaben. Die Lebenserwartung der Patienten ist deutlich reduziert, weil durch die Wirkung des Wachstumshormons an den inneren Organen, insbesondere dem Herz krankhafte Veränderungen auftreten, außerdem bedroht das durch Verdrängung wachsende Hypophysenadenom die umgebende Hypophyse und kann die umliegenden Hirn- und Nervenstrukturen und deren Funktionen beeinträchtigen. Therapeutisch ist die operative Entfernung des Hypophysenadenoms die Therapie der ersten Wahl. Ist eine Operation nicht möglich oder nicht ausreichend erfolgreich, stehen medikamentöse Therapien oder auch zusätzlich eine Radiatio zur Verfügung.Medikamentös haben sich neben Dopaminagonisten und Wachstumshormonrezeptorblockern vor allem Somatostatinanaloga in der Therapie der Akromegalie bewährt. Neben dem seit bald 20 Jahren auf dem Markt befindlichen Octreotide, hat sich inzwischen auch Lanreotide etabliert. Die neuere Entwicklung sucht nach Somatostatinanaloga, die der physiologischen Wirkung des Somatostatins näher kommen, verbunden mit der Hoffnung, dadurch eine noch bessere Reduktion der Wachstumshormonsekretion zu erreichen, eine Stabilisierung oder besser eine Reduzierung der Tumorgröße stellt hier ein wichtiges weiteres Ziel dar. Pasireotide (SOM230) ist ein neues Somatostatinanalogon, das sich durch seine Rezeptoraffinität von Octreotide und Lanreotide unterscheidet und sich mehr der des Somatostatins nähert. In der vorliegenden Arbeit wurde bei acht Patienten mit Akromegalie die Verträglichkeit und Wirksamkeit der medikamentösen Therapie mit Somatostatinanaloga untersucht. Dabei wurde bei fünf Patienten im Rahmen einer bis zu neun Monate umfassenden Dosisintervallstudie untersucht, ob bei kontrollierter Krankheitsaktivität unter Lanreotide Autogel® einmal im Monat s.c. appliziert, eine Intervallverlängerung vorgenommen werden kann und so sowohl Behandlungskosten gespart werden können, als auch die Behandlung für den Patienten angenehmer gestaltet werden kann, ohne dass die therapeutische Wirkung beeinträchtigt wird. In einer weiteren Studie, die ein Jahr Beobachtungszeitraum umfasste, wurde bei drei Patienten untersucht, ob die Therapie mit Pasireotide LAR i.m. einmal monatlich therapeutisch vergleichbar ist mit der s.c. Applikation von Pasireotide 600 μg zweimal täglich. Dabei stand vor allem die Wirksamkeit und Verträglichkeit des Depotpräparates im Mittelpunkt. Neben Fragebögen für die Patienten, um die Akzeptanz der Therapie und subjektive Veränderungen zu ermitteln, wurden als Sicherheits- und Kontrolluntersuchungen regelmäßig die relevanten Laborwerte erhoben, Kontrollprofile und Stimulationstests erstellt und Abdomen-Sonographien durchgeführt. Es stellte sich heraus, dass Lanreotide Autogel® eine wirksame Alternative zu Octreotide LAR darstellt, weil es zum einen eine mindestens vergleichbare, wenn nicht bessere Kontrolle der Akromegalie ermöglicht, bei gut kontrollierten Patienten aber darüber hinaus eine Intervallverlängerung ermöglicht, die sowohl für den Patienten angenehmer ist, aber auch deutlich die Behandlungskosten senken kann. Diese Ergebnisse stehen in Übereinstimmung mit der veröffentlichten Literatur. In der Studie mit Pasireotide LAR ließ sich festhalten, dass die Darreichungsform als monatliche i.m. Injektion von den Patienten als sehr positiv erlebt wurde. Sowohl die Sicherstellung der Complience als auch die deutliche Besserung der Einstellung der Akromegalie während der ersten acht Monate sprechen deutlich für Pasireotide LAR. Dabei wurde Pasireotide LAR von den Patienten gut vertragen, Symptome der Akromegalie bildeten sich deutlich zurück, aber es zeigte sich eine Verschlechterung der Blutzuckerwerte. Der in der Literatur erhoffte Zuwachs an Wirksamkeit konnte nur teilweise bestätigt werden. Insgesamt konnte gezeigt werden, dass mit Lanreotide Autogel® und Pasireotide LAR zwei wirksame und gut verträgliche Somatostatinanaloga zur Behandlung der Akromegalie zur Verfügung stehen. Die Behandlung mit Pasireotide LAR sollte aber an einem größeren Patientenkollektiv und über einen längeren Zeitraum weiter untersucht werden.

The synthetic hexapeptide GH-releasing peptide (GHRP; His-D-Trp-Ala-Trp-D-Phe-Lys-NH2) specifically stimulates GH secretion in humans in vivo and in animals in vitro and in vivo via a still unknown receptor and mechanism. To determine the effect of GHRP on human somatotroph cells in vitro, we stimulated cell cultures derived from 12 different human somatotroph adenomas with GHRP alone and in combination with GH-releasing hormone (GHRH), TRH, and the somatostatin analog octreotide. GH secretion of all 12 adenoma cultures could be stimulated with GHRP, whereas GHRH was active only in 6 adenoma cultures. In GHRH-responsive cell cultures, simultaneous application of GHRH and GHRP had an additive effect on GH secretion. TRH stimulated GH release in 4 of 7 adenoma cultures; in TRH-responsive cell cultures there was also an additive effect of GHRP and TRH on GH secretion. In 5 of 9 adenoma cultures investigated, octreotide inhibited basal GH secretion. In these cell cultures, GHRP-induced GH release was suppressed by octreotide. In 5 of 5 cases, the protein kinase-C inhibitor phloretin partly inhibited GHRP-stimulated GH release, but not basal GH secretion. In summary, GH secretion was stimulated by GHRP in all somatotroph adenomas investigated, indicating that its unknown receptor and signaling pathway are expressed more consistently in somatotroph adenoma cells than those for GHRH, TRH, and somatostatin. Our data give further evidence that GHRP-stimulated GH secretion is mediated by a receptor different from that for GHRH or TRH, respectively, and that protein kinase-C is involved in the signal transduction pathway. Because human somatotroph adenoma cell cultures respond differently to various neuropeptides (GHRH, TRH, somatostatin, and others), they provide a model for further investigation of the mechanism of action of GHRP-induced GH secretion.