The pathophysiology of pancreatitis.

The pancreas is an exocrine and endocrine gland that is required for normal digestion and metabolism of proteins, carbohydrates, and fats. Acute pancreatitis (AP) is an inflammatory process of the pancreas that involves peripancreatic tissues and remote organs. Mild AP occurs in 80% of patients requiring hospitalization and severe AP occurs in the other 20%. Chronic pancreatitis (CP) is an inflammatory disorder that causes anatomic changes, including infiltration of chronic inflammatory cells and fibrosis of the pancreas. This review discusses biochemical and histologic features of pancreatic injury in AP and CP and some of the important clinical sequelae associated with these abnormalities.     

Placenta increta; conservative management – a successful outcome. Case report and literature review

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and Doppler assessment, followed by interval manual removal of placenta.     

Management of a traumatic gastric ulcer with a low-profile gastrostomy tube.

Since the advent of percutaneous endoscopic gastrostomy (PEG) tubes in 1980, they have become the device of choice for providing long-term enteral nutrition. Despite their overall safety, a number of complications can occur after PEG placement. Bleeding is usually a minor complication associated with PEG placement that occurs soon after the procedure and is most often caused by puncture of an abdominal wall vessel. More severe bleeding can occur when a branch of one of the gastric arteries is punctured. There are only a few case reports of traumatic gastric ulceration secondary to the internal bolster of a PEG. The internal bolsters are either balloons or dome shaped, and are 1.5-2.0 cm in height. We report a case in which a patient developed hemorrhage from a gastric ulcer induced by a balloon-type PEG tube that was resolved only after replacement with a tube manufactured with a low-profile internal bolster that was only 0.3 mm in height. The protruding tip of a balloon-type gastrostomy tube was believed to have caused traumatic injury to the gastric mucosa in our patient, causing ulceration. Usually, removal of the tube and placement in a different location may solve the problem. However, we believe that the PEG tube fashioned with a low-profile internal bumper is a safer option.