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The microcirculation of the gastrointestinal tract is under the control of both myogenic and metabolic regulatory systems. The myogenic mechanism contributes to basal vascular tone and the regulation of transmural pressure, while the metabolic mechanism is responsible for maintaining an appropriate balance between O2 demand and O2 delivery. In the postprandial state, hydrolytic products of food digestion elicit a hyperemia, which serves to meet the increased O2 demand of nutrient assimilation. Metabolically linked factors (e.g., tissue pO2, adenosine) are primarily responsible for this functional hyperemia. The fenestrated capillaries of the gastrointestinal mucosa are relatively permeable to small hydrolytic products of food digestion (e.g., glucose), yet restrict the transcapillary movement of larger molecules (e.g., albumin). This allows for the absorption of hydrolytic products of food digestion without compromising the oncotic pressure gradient governing transcapillary fluid movement and edema formation. The gastrointestinal microcirculation is also an important component of the mucosal defense system whose function is to prevent (and rapidly repair) inadvertent epithelial injury by potentially noxious constituents of chyme. Two pathological conditions in which the gastrointestinal circulation plays an important role are ischemia/reperfusion and chronic portal hypertension. Ischemia/reperfusion results in mucosal edema and disruption of the epithelium due, in part, to an inflammatory response (e.g., increase in capillary permeability to macromolecules and neutrophil infiltration). Chronic portal hypertension results in an increase in gastrointestinal blood flow due to an imbalance in vasodilator and vasoconstrictor influences on the microcirculation. Table of Contents: Introduction / Anatomy / Regulation of Vascular Tone and Oxygenation / Extrinsic Vasoregulation: Neural and Humoral / Postprandial Hyperemia / Transcapillary Solute Exchange / Transcapillary Fluid Exchange / Interaction of Capillary and Interstitial Forces / Gastrointestinal Circulation and Mucosal Defense / Gastrointestinal Circulation and Mucosal Pathology I: Ischemia/Reperfusion / Gastrointestinal Circulation and Mucosal Pathology II: Chronic Portal Hypertension / Summary and Conclusions / References / Author Biography
This book provides a comprehensive account on individually rare, but collectively frequent diseases of the liver. In the first part, conditions such as hepatic vascular malformations, ischemic cholangiopathy, hepatic artery occlusion, sinusoidal conditions and Budd-Chiari syndrome are discussed among others. The second part examines the causes of vascular liver disease namely, coagulation disorders, neoplasm disorders, non-malignant blood disorders, systemic diseases and toxins, among others. The unique expertise of the authors, who are all members of the Vascular Liver Disease Disorders Group, an independent network of researchers with a common interest in Vascular Liver Diseases, are merged for an optimal pragmatic and individualized approach. This book is of interest to a broad range of experts, such as hepatologists, internists, radiologists and angiologists.
To-the-point information on more than 1000 diseases and disorders surgeons are most likely to encounter The leading single-source surgery book for house-staff, students, practitioners, and surgeons A Doody's Core Title for 2011! "This is an excellent source of updated, authoritative, and concise information on diseases encountered in general surgery and the surgical subspecialties of otolaryngology, urology, gynecology, orthopedics, plastic and reconstructive surgery, and pediatrics....This is a wonderful resource for all levels of surgical practitioners as well as nonsurgical practitioners. In my experience, it has provided me with a framework to prepare for both oral and written boards. 3 Stars."--Doody's Review Service Authoritative, concise, and completely up-to-date, CURRENT Diagnosis & Treatment Surgery features: Wide-ranging coverage that encompasses general surgery and all the important subspecialties including otolaryngology, urology, gynecology, orthopedics, plastic and reconstructive surgery, and pediatrics References linked to recent journal articles Logical quick-find organization made even more accessible by a comprehensive index More than 600 informative photographs and illustrations Detailed treatment algorithms NEW CD-ROM with content from Quick Answers: Surgery to speed diagnosis of symptoms and signs NEW Chapter on Training, Communication, Professionalism, and Systems-Based Practice Completely rewritten chapters on Wound Healing, Anesthesia, Otolaryngology/Head & Neck Surgery, The Heart, Neurosurgery, Gynecology, and Orthopedics
This book is an up-to-date, technically detailed yet easy-to-read reference book on current clinical applications of MDCT in small animals. It has been designed to serve as the reference book for all MDCT-users, such as veterinary radiologists, imaging technicians, oncologists, surgeons, and non-radiologist clinicians. Individual chapters on novel clinically important topics include applications in endocrinology, oncology, trauma, and cardiovascular CT, as well as sections on organ-specific pathologies and their CT characteristics. The book will also cover main domains of CT, such as thorax and the trauma imaging. Anatomy, clinical aspects, pathology, and CT signs are integrated to provide the reader with the basis for interpretation of MDCT findings. Many excellent 2D multiplanar and 3D figures illustrating typical CT findings of various conditions will serve as a clinical reference for the reader.
Although pediatric surgery is a distinct and evolving specialty, it still remains an integral part of most general surgical and paediatric medical practice. Nevertheless, surgery in children does differ from adult practice in various fundamental ways, and there are key physiological and anatomical differences that constantly need underlining. Progress and improvement in outcome has also been rapid but it is sometimes difficult for practitioners to keep themselves up-to-date with the usual surgical or paediatric text books. This book will give a concise overview of all important topics and is designed to provide information in order to recognise the common surgical conditions; namely typical symptoms and signs, investigation and then treatment management. It will also provide an anatomical and physiological background to aid understanding, in addition to emphasising logical, and where possible, evidence-based practice by the use of flow charts, tables and algorithms. Authored by an international range of leading contributors, this is the first book of its kind to offer comprehensive coverage to this topic in a quick reference, pocket-book format.
This practical, comprehensive anatomy book arms FRCA candidates with detailed, robust anatomical knowledge via a question-based approach.
The Hepatic circulation is unique among vascular beds. The most obvious unique features include the dual vascular supply; the mechanism of intrinsic regulation of the hepatic artery (the hepatic arterial buffer response); the fact that portal blood flow, supplying two thirds of liver blood flow, is not controlled directly by the liver; the fact that 20% of the cardiac output rushes through the most vascularized organ in the body, driven by a pressure gradient of only a few millimeters of mercury; the extremely distensible capacitance and venous resistance sites; the unidirectional acinar blood flow that regulates parenchymal cell metabolic specialization; and the high concentration of macrophagic (Kupffer) cells filtering the blood. The liver is the only organ reported to have regional blood flow monitored by the autonomic nervous system. This mechanism, when dysfunctional, accounts for the hepatorenal syndrome and offers a mechanistic therapeutic target to treat this syndrome. The trigger for liver regeneration is dependent on hepatic hemodynamics so that chronic liver blood flow regulates liver cell mass. In severe liver disease, the whole body circulation is reorganized, by forming portacaval shunts, to accommodate the increased intrahepatic venous resistance. These shunts protect the venous drainage of the splanchnic organs but lead to loss of major regulatory roles of the liver. The development of knowledge of the hepatic vasculature is presented from a historical perspective with modern concepts summarized based on the perspective of the author's four decades of devotion to this most marvelous of organs. Table of Contents: Acknowledgements / Historical Perspectives / Overview / Fluid Exchange / Capacitance / Resistance in the Hepatic Artery / Resistance in the Venous System / Fetal and Neonatal Hepatic Circulation / In Vivo Pharmacodynamic Approaches / Nitric Oxide / Adenosine / Hepatic Nerves / Hepatic Circulation and Toxicology / Hepatorenal Syndrome / Integrative Hepatic Response to Hemorrhage / Blood Flow Regulation of Hepatocyte Proliferation / Multiple Mechanisms Maintaining a Constant Hepatic Blood Flow to Liver Mass Ratio / Pathopharmacology and Repurposing Drugs as a Research Strategy / References
Portal hypertension is a relatively common condition, the complications of which are frequently life threatening. Patients with portal hypertension represent an important por tion of the daily clinical work of abdominal radiologists, gastroenterologists and abdominal surgeons. During the past two decades the development of new radiological devices and of new percutaneous image-guided treatment methods has resulted in fundamental changes in the clinical management of patients with portal hypertension. During the same period tremen dous progress was achieved in the visualization of the numerous morphological and func tional changes observed in patients with portal hypertension, due to the clinical introduc tion of the new cross-sectional imaging methods: ultrasonography, computed tomography and magnetic resonance imaging. I am very grateful to Prof. Plinio Rossi, an internationally recognized leader in the field of interventional radiology, for accepting the challenging task of compiling and presenting in a structured way the numerous facts and data that have become available during the past few years in this rapidly developing field. The editor has been inspired and successful in his selection of the impressive group of international experts that has contributed to many chapters of this volume.