Shadowing Practice: HCC 1475-27 Band ligator - Learn English Speaking with Video

Elige un modo de práctica

Cada modo abre una sala de práctica a pantalla completa.

161 oraciones

Si las oraciones son demasiado cortas o largas, haz clic en Editar para ajustarlas.

Greetings.

Let us learn about band ligator.

Band ligator is like putting a ligature

and here you can see the application of band ligator to ligate esophageal varices to prevent bleeding as well as treat bleeding.

In addition to esophageal variceal bleeding control,

band ligator has also been used in the control of arterial bleeding.

Here is an example of band ligation of diverticular bleeding.

It has also been used for management of dulofoy bleeding as well.

another application of band ligation is in resection of flat lesions

here is an example of band ligation followed by resection of

Barrett's mucosa band ligation EMR has also been used to manage rectal carcinoids so among all the different uses,

band ligation of varices is used quite often in practice.

And before we learn about band ligation of varices,

let us take some time to learn about how varices form and thereby you can understand better how to use band ligation.

Here is a normal anatomy of the portal venous system.

Portal vane drains blood from the gastrointestinal tract and also portal vane drains blood from the spleen.

So let us look at the blood flow.

So here is a splenic vane that is draining blood from the spleen

and the splenic vane also drains blood from the left portion of the colon

and that dumps blood via the inferior mesentric vein.

So the splinic vein goes and joins the superior mesentric vein to form the portal vein.

And the portal vein, like any vein, once it goes into the liver it branches becomes capillaries

and supplies the liver cells

and then from the liver hepatic veins start draining the liver

and then they enter the inferior vena cava and the inferior vena cava goes into the right atrium

Two systems of veins are very important in esophageal varices, and these are right and left gastric veins,

which drain into the portal vein.

So we have learned about portal venous system, and let us take a little bit of a deep dive

into the liver lobule to understand the flow of blood from the portal vein to the hepatic vein.

So here is a liver lobule.

It's a normal liver lobule.

You have portal triads consisting of portal vein, hepatic artery, and hepatic ducts.

The blood flow from the portal vein reaches the central vein via a bunch of sinusoids.

the flow of blood from the portal vein goes to the central vein from the central vein

it goes into the hepatic vein branches and finally the hepatic veins and the inferior vena cava

in cirrhosis of the liver the liver lobular architecture is destroyed

and there is resistance to the flow of blood from the portal vein to the central vein

and there is also development of communications between the veins

and the arteries a portal vein portal venous system

and hepatic arterial system and these disturbances increase the pressure in the portal venous system

and increase in pressure in the portal vein lead to the development of varices

So, let us look at the anatomy of the esophageal varices in a little more detail.

So, here is the lower esophagus and let us look at it in magnification.

And as you can see here,

the venous anatomy, understanding the venous anatomy of the GE junction and lower esophageal segment of the esophagus is critical.

So you have, with portal hypertension, the adventitial veins become bigger, the perforator veins become bigger,

and the deep venous plexus inside the esophageal wall,

especially in the submucosa, become bigger, and they develop as varices.

The perforators are maximum closer to the GE junction.

Hence you see large varices developing at the GE junction.

And as you go up the esophagus from the distal esophagus to mid to proximal esophagus, the size of the veins become smaller.

learning this anatomy of especially the importance of the perforator veins the distribution of the perforator veins

and the density of the perforator veins closer to the

G -E junction is very important for endoscopists larger perforator veins

denser amount of perforator veins in the lower esophagus allows the

esophageal varices in the lower esophagus to become very big and

once the veins become very big they're at high risk for bleeding.

So here is large esophageal varices and as the veins become larger sometimes they become,

the wall becomes thinner

and you could see the blood in the vein as a red red whale spots

or red whale signs and these are signs of increased risk for bleeding.

These large esophageal varices with red whale signs can rupture

and cause vomiting of blood otherwise known as hematemesis

or the blood can go down the GI tract

and the patient can present with either melena that is dark black stool or

if there's a lot of bleeding at one time to the point of shock

they can even pass bright red blood per rectum otherwise known as hematochagia

and these setbacks could be prevented by using band ligation of the esophageal varices they prevent bleeding

they're also useful in treating active bleeding and prevent re -bleeding

so now let us learn about how do you set up a band ligator a band ligator set

there are several different types of band ligators for this example i'm going to use one

that we have been using routinely in our lab

And here is a band ligator.

This is the control handle.

And then you have a loading catheter.

And then you have a trip

wire with band ligators attached to the cap and an irrigation adapter.

so let us learn about band ligator first this is a control handle

and as you can see here there are two marks a two -way mark

and a firing mark

if the band ligator is in a two -way position it is allows us to set up the band ligator

because the band ligator can, the wheel can move in both clockwise and anticlockwise direction,

makes it favorable for setting up the band ligator,

and also allows us to introduce the endoscope because it doesn't make the tip stiff.

So that is having the band ligator in a two -wheel position

if you press the band ligator against the control handle on the the head against the control handle

it goes into firing position when it is in firing position it only moves in the clockwise direction

allows the bands to be deployed so so the key is when you want to set up the band ligator

keep the knob in a two -way position and this allows the loading of the device so

So I'm repeating it because it's very important to understand the concept of two -way position and firing position.

You take the handle and insert into the biopsy port.

And once you insert into the biopsy port, next you take in the irrigation adapter

and puncture the seal with the irrigation adapter and that allows you to insert the loading catheter into the channel easily.

So you push the loading catheter down the biopsy channel

and you push it until the loading catheter comes out of the endoscope.

And once it comes out,

you take the trigger card attached to the band ligator and attach it to the loading catheter.

And once you attach it, you remove the loading catheter and the trigger cord through the channel.

And once you have the trigger cord out, you load the trigger cord into the notch on the device

100

and anchor the knot onto the groove and rotate the knob clockwise to wrap the trigger cord around the device.

101

By this time, you could attach the panligator cap to the distal tip of the endoscope.

102

One thing that is important is to make sure the trigger cord is not in the middle of the view.

103

So you could rotate the cap to align the trigger cords to be in line with the biopsy channel

104

so that is very important so as so that

105

when you go down with the scope you have a beautiful view although view with the cap is limited

106

so you have the endoscope with the cap

107

and bands attached to the distal end and the band ligator handle is at the biopsy port.

108

So before you introduce the scope,

109

you want to keep the band ligator handle in the two -way position.

110

This is very important.

111

If you put it in the two -way position and you move your up -down knob, the tip of the scope will move easily

112

because the trigger card can move forwards

113

and backwards without restriction on the other hand

114

if you try to do this thing in the firing position

115

and want to introduce the endoscope first of all the scope becomes stiff

116

and it is dangerous

117

it is dangerous to insert the endoscope into the mouth with the band ligators set up in the firing position

118

I've heard about cases where somebody accidentally put a band into the pharynx

119

or into the vuvula because they introduced the band ligator into the mouth in the firing position

120

so important step

121

when as an endoscopy assistant gives the scope to the endoscopist

122

keep the band ligator set up in the two -way position not in the firing position

123

so once the endoscope endoscopist pushes the scope down the esophagus to the ge junction

124

then he will put the band ligator in firing position before he fires the bands.

125

So we have the scope and coming to the GE junction in firing position,

126

the band ligator in firing position and you rotate in clockwise direction and the band gets released.

127

And that's how bands are placed

128

and it is important to start placing the bands as close to the G -junction as possible.

129

I preferably start putting it at the Z -line or the squamous corner junction, at the G -junction, I should put it.

130

And then I focus my next bands in the lower esophagus, in the lower...

131

five centimeters.

132

That's where most of the perforators are there, providing large amounts of blood supply and feeding those veins to form.

133

There's no point in putting bands in the middle third or upper esophagus.

134

So variceal banding, if you're planning to do to prevent bleeding after seeing large varices or varices with the Red Veil Science,

135

the American Society for Liver Diseases, American Association for Liver Diseases,

136

recommends banding at two to eight week interval until varices are completely obliterated.

137

If a patient presents with bleeding and you control the bleeding with banding, then at one to four week interval,

138

until the varices are completely obliterated.

139

So what are the side effects of banding?

140

It's important to share with the patient

141

that they may have some chest discomfort for a few days and they may have some difficulty swallowing for a few days.

142

Rarely bands can fall off prematurely and can cause bleeding.

143

That is very rare.

144

Patients who undergo band ligation are typically advised to be on liquids for the first day

145

or so and recommended to take proton pump inhibitors also to allow the band ligation ulcers to heal faster.

146

So we covered band ligation of varices

147

and let us look at other applications of band ligation

148

that is band ligation EMR in patients with Barrett's esophagus in this case

149

you again you use a multiband ligator although you see in the image a single band

150

and people may decide to put the band straight

151

or some people may do a little bit of injection

152

and then put a band followed by snare resection

153

and extend the amount of resection that need to be done by applying more bands

154

and repeating the steps band ligation can also be used for

155

treating bleeding from different arterial sources either a Mallory Weiss tear bleed or

156

dulofy ulcer bleed dulofy bleed

157

or diverticular bleed these are these are these users have been reported in different cases

158

but the approved indication is mostly for varicell banding

159

so here is a band ligation of a diverticular bleeding

160

so you go in you suck the diverticulum and place the band

161

and the diverticulum gets inverted and the band catches on the bleeding vessel I hope this is useful thank you

Descargar app

Todo lo que necesitas para hablar con fluidez

Pronunciación con IAEvalúa cada oración

Práctica de IPADomina cada sonido

VocabularioConstruye tu banco de palabras

Juego de vocabularioAprende mientras juegas

Escanea el QR

Download on theApp Store Get it onGoogle Play

FOR YOU

Recomendar Video

109 oraciones

Hospital-Acquired Infections (HAIs) and Hand Hygiene - Fundamentals of Nursing | @LevelUpRN

Daily ConversationUniversity Students

72 oraciones

SVINutes: Cerebral Venous Sinus Anatomy

Daily ConversationUniversity Students

Vocabulario y notas de pronunciación para esta lección

Esta lección de conversación se basa en el vídeo “HCC 1475-27 Band ligator”. Las palabras que más se repiten: band, vein, ligator, bleeding, varices. Este vídeo tiene 161 frases y 2053 palabras para practicar shadowing. La parte hablada dura 18:24. El hablante mantiene un ritmo constante de unas 112 palabras por minuto, cómodo para el shadowing. Solo el 74 % de las palabras está entre las 3.000 más comunes del inglés, por lo que el vocabulario es exigente.

Vocabulario clave de este vídeo

15 palabras del vídeo que vale la pena aprender, con su pronunciación y significado:

Palabra	Pronunciación	Significado
vein sustantivo	/veɪn/	vena
bleed verbo	/ˈbliːd/	desangrar
portal sustantivo	/ˈpɔːɹtl̩/	portada, portal
junction sustantivo	/ˈd͡ʒʌŋkʃən/	juntamiento
trigger sustantivo	/ˈtɹɪɡɚ/	gatillo, perrillo
scope sustantivo	/skəʊp/	ámbito, rubro
drain sustantivo	/dɹiːn/	desagüe, drenaje
cord sustantivo	/ˈkoɹd/	cuerda, cordón
attach verbo	/əˈtæt͡ʃ/	adjuntar, atachar
anatomy sustantivo	/əˈnætəmi/	anatomía
insert verbo	/ɪnˈsɝt/	insertar, enserir
inferior adjetivo	/ɪnˈfɪɹ.i.ɚ/	inferior, malmatado
introduce verbo	/ˌɪntɹəˈdus/	presentar
whale sustantivo	/ˈweɪl/	ballena
irrigation sustantivo	/ˌɪɹəˈɡeɪʃən/	riego, irrigación

Phrasal verbs que vas a escuchar

Palabra	Pronunciación	Significado
come out verbo	/ˌkʌm ˈaʊt/	revelarse, salir a la luz
fall off verbo		caer
go up verbo		subir

Gramática en este vídeo

Las estructuras que más usa el hablante, con las palabras exactas del vídeo:

Estructura	En el vídeo
Voz pasiva be + participio pasado — importa lo que ocurre, no quién lo hace	been used · is used · is destroyed
Present perfect have/has + participio pasado — una acción pasada que sigue importando ahora	has also been · have learned · I've heard

Pronunciación a tener en cuenta

El hablante usa 7 contracciones y formas reducidas, como I'm, they're, doesn't. Dilas en su forma corta, tal como las oyes.

Los sonidos de “th”: thin /ˈθɪn/, thereby /ðɛɹˈbaɪ/, catheter /ˈkæθɪtɚ/
Los sonidos de “sh” y “zh”: junction /ˈd͡ʒʌŋkʃən/, irrigation /ˌɪɹəˈɡeɪʃən/, shock /ʃɔk/, indication /ɪndɪˈkeɪʃən/, injection /ɪnˈd͡ʒɛk.ʃən/
Palabras largas — cuida el acento: anatomy /əˈnætəmi/, inferior /ɪnˈfɪɹ.i.ɚ/, irrigation /ˌɪɹəˈɡeɪʃən/, superior /sʊˈpɪɹ.i.ɚ/, architecture /ˈɑː.kɪˌtɛk.t͡ʃə/

Sonidos difíciles para hispanohablantes:

s + consonante al inicio — sin añadir una “e” delante: scope /skəʊp/, stiff /stɪf/, swallow /ˈswɑ.loʊ/, stool /stuːl/, spleen /spliːn/
/v/ — no es /b/: los dientes tocan el labio inferior: vein /veɪn/, interval /ˈɪntɚvəl/, vessel /ˈvɛsəl/, dive /daɪv/, advise /ədˈvaɪz/
/z/ — sonora, no /s/: advise /ədˈvaɪz/, clockwise /ˈklɒkwaɪz/, anticlockwise /ˌæn.tɪˈklɑkˌwaɪz/, mucosa /mjuˈkoʊzə/

Cómo practicar con este vídeo

Escucha el vídeo entero una vez sin hablar y anota las palabras que no conoces.
Haz shadowing frase por frase a velocidad normal, repitiendo cada una hasta que tu ritmo coincida con el del hablante.
Grábate y compara con el original, prestando atención a palabras como vein, bleed, portal.

¿Qué es la Técnica de Shadowing?

Shadowing es una técnica de aprendizaje de idiomas respaldada por la ciencia, desarrollada originalmente para la formación de intérpretes profesionales y popularizada por el políglota Dr. Alexander Arguelles. El método es simple pero poderoso: escuchas audio en inglés nativo y lo repites en voz alta de inmediato, como una sombra que sigue al hablante con solo 1-2 segundos de retraso. A diferencia de la escucha pasiva o los ejercicios de gramática, el shadowing obliga a tu cerebro y músculos de la boca a procesar y reproducir simultáneamente patrones de habla reales. Las investigaciones muestran que mejora significativamente la precisión de la pronunciación, la entonación, el ritmo, el habla conectada, la comprensión auditiva y la fluidez al hablar, convirtiéndola en una de las metodologías más efectivas para la preparación del IELTS Speaking y la comunicación en inglés en el mundo real.

Técnica de shadowing: lee la guía completa paso a paso →

Shadowing Practice: HCC 1475-27 Band ligator - Learn English Speaking with Video

Elige un modo de práctica

Descargar app

Surgical Anatomy 2 (Spleen)

BGP Overview

Retinal Artery Occlusion vs. Retinal Vein Occlusion

Introduction to HPLC - Lecture 1: HPLC Basics

Hypertrophic Cardiomyopathy (HCM): Managing Symptoms

How Shear Deflection Impacts Deep and Composite Beams.

Lesson Eight: Placement of the Orchestra, Leonard Slatkin's Conducting School

Understanding Cervical Ectropion / Cervical Erosion

The Composition and Function of Blood

Scoliosis: How to medically classify scoliosis (the Lenke System for AIS)