Hemorrhoides
•
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This document discusses hemorrhoidal disease, including definitions, incidence, pathogenesis, classification, symptoms, and treatment options. It defines hemorrhoids as dilated vascular channels located in three constant locations in the anus. Hemorrhoidal disease is manifested by prolapse, bleeding, and itching. Treatment options discussed include sclerosing injections, infrared photocoagulation, rubber band ligation, and hemorrhoidectomy. The preferences for treatment are outlined based on the degree of hemorrhoids.
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Anorectal disorders
Anorectal Disorders including :
Anal canal & Rectum Anatomy
Haemorrhoids
Fissure in Ano
Pilonidal Sinus
Fistula in Ano
Rectal Prolapse
Hemorrhoids
Please find the power point on Hemorrhoids. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Femoral Hernia
Femoral hernias occur when abdominal contents protrude through the femoral ring into the femoral canal. They are more common in elderly women and often present without a visible lump. Half of patients are unaware of the hernia prior to strangulation. Treatment involves surgical repair via open or laparoscopic surgery to reduce hernia contents and reinforce the femoral ring with sutures or mesh. Complications are higher if the hernia is incarcerated or strangulated at time of emergency surgery. With elective repair, prognosis is generally good with low recurrence rates.
Thrombosed External Hemorrhoid
1) Thrombosed external hemorrhoid is a painful swelling at the anal opening caused by a blood clot forming in an external hemorrhoid.
2) It is usually caused by factors that increase pressure in the abdomen like pregnancy, constipation from poor diet or lack of exercise, or prolonged sitting or standing.
3) Symptoms include a bluish swollen lump near the anus that is painful. Seeking treatment is important to address pain and rule out other potential issues. Maintaining a high fiber diet and drinking plenty of water can help prevent hemorrhoids.
Hemorrhoidectomy/ operative surgery
This document discusses various procedures for treating hemorrhoids, including Barron's banding, open and closed hemorrhoidectomy, stapled hemorrhoidectomy, and transanal hemorrhoidal dearterialization (THD). Barron's banding is used for first and second degree hemorrhoids as an office procedure under local anesthesia. Open hemorrhoidectomy involves making a V-cut to dissect and remove third degree hemorrhoids, while closed hemorrhoidectomy uses an elliptical incision and ligation. Stapled hemorrhoidectomy uses a circular stapler to remove hemorrhoidal tissue. THD involves identifying and ligating the hemorrhoidal arteries through the anus to reduce blood
Sigmoid volvulus/ Generalised abdominal pain
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Lower GI - Bleed
This PPT is for the MBBS - Students mainly to know the causes, types and their association with defecation.
Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management Options
Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management Options
Patricia L. Raymond MD FACG, Rx For Sanity
There seem to be many options to manage our patients' hemorrhoids: hemorrhoidectomy, banding, sclerotherapy, laser photocoagulation, topical medications. Which option is the best for your patient? The physiology and management of the bitter end of the gastrointestinal tract.
Objectives: The participant will…
Distinguish between internal and external hemorrhoids, review the anorectal anatomy and understand the grading system for internal hemorrhoids.
Categorize the differential diagnosis of hemorrhoids, including proctalgia fugax, anal fissure, perianal crohns disease, anal cancer, condyloma, skin tags and rectal prolapse
Examine specific medical, endoscopic, office, and surgical treatment options for hemorrhoids and their stated efficacy
Recommended
Anorectal disorders
Anorectal Disorders including :
Anal canal & Rectum Anatomy
Haemorrhoids
Fissure in Ano
Pilonidal Sinus
Fistula in Ano
Rectal Prolapse
Hemorrhoids
Please find the power point on Hemorrhoids. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Femoral Hernia
Femoral hernias occur when abdominal contents protrude through the femoral ring into the femoral canal. They are more common in elderly women and often present without a visible lump. Half of patients are unaware of the hernia prior to strangulation. Treatment involves surgical repair via open or laparoscopic surgery to reduce hernia contents and reinforce the femoral ring with sutures or mesh. Complications are higher if the hernia is incarcerated or strangulated at time of emergency surgery. With elective repair, prognosis is generally good with low recurrence rates.
Thrombosed External Hemorrhoid
1) Thrombosed external hemorrhoid is a painful swelling at the anal opening caused by a blood clot forming in an external hemorrhoid.
2) It is usually caused by factors that increase pressure in the abdomen like pregnancy, constipation from poor diet or lack of exercise, or prolonged sitting or standing.
3) Symptoms include a bluish swollen lump near the anus that is painful. Seeking treatment is important to address pain and rule out other potential issues. Maintaining a high fiber diet and drinking plenty of water can help prevent hemorrhoids.
Hemorrhoidectomy/ operative surgery
This document discusses various procedures for treating hemorrhoids, including Barron's banding, open and closed hemorrhoidectomy, stapled hemorrhoidectomy, and transanal hemorrhoidal dearterialization (THD). Barron's banding is used for first and second degree hemorrhoids as an office procedure under local anesthesia. Open hemorrhoidectomy involves making a V-cut to dissect and remove third degree hemorrhoids, while closed hemorrhoidectomy uses an elliptical incision and ligation. Stapled hemorrhoidectomy uses a circular stapler to remove hemorrhoidal tissue. THD involves identifying and ligating the hemorrhoidal arteries through the anus to reduce blood
Sigmoid volvulus/ Generalised abdominal pain
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Lower GI - Bleed
This PPT is for the MBBS - Students mainly to know the causes, types and their association with defecation.
Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management Options
Kiss Your Hemorrhoids Goodbye: Surgical and Non-Surgical Management Options
Patricia L. Raymond MD FACG, Rx For Sanity
There seem to be many options to manage our patients' hemorrhoids: hemorrhoidectomy, banding, sclerotherapy, laser photocoagulation, topical medications. Which option is the best for your patient? The physiology and management of the bitter end of the gastrointestinal tract.
Objectives: The participant will…
Distinguish between internal and external hemorrhoids, review the anorectal anatomy and understand the grading system for internal hemorrhoids.
Categorize the differential diagnosis of hemorrhoids, including proctalgia fugax, anal fissure, perianal crohns disease, anal cancer, condyloma, skin tags and rectal prolapse
Examine specific medical, endoscopic, office, and surgical treatment options for hemorrhoids and their stated efficacy
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This document provides information on the management of inguinal hernias. It discusses the historical development of hernia repair techniques from the 15th century to modern methods. Investigation methods such as ultrasound, CT, MRI, and herniography are outlined. Surgical techniques for hernia repair including herniotomy, herniorrhaphy, hernioplasty, and laparoscopic repair are described in detail. Post-operative complications of open and laparoscopic hernia repair are also reviewed. The conclusion states that laparoscopic and Lichtenstein open mesh repairs have good long-term results and low recurrence rates compared to other open hernia repair techniques.
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This document discusses fistula-in-ano, which is an abnormal connection between two epithelial surfaces that usually communicates an infected anal gland to a secondary opening in perianal skin. Cryptoglandular disease is responsible for 90% of cases. Fistulae are classified as simple or complex depending on sphincter involvement. Clinical examination can often diagnose the condition, while radiological exams like endoanal ultrasound and MRI may help in complex cases. The document reviews the causes, symptoms, classifications, and diagnostic evaluations of fistula-in-ano.
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1) Inguinal hernias are common, with approximately 700,000 repairs performed annually in the US, mostly occurring in males.
2) There are two main types of inguinal hernias - indirect and direct. Indirect hernias are congenital while direct hernias are acquired lesions that occur through the posterior inguinal wall.
3) Common surgical repair options include the Lichtenstein tension-free repair using mesh, the Shouldice repair with overlapping tissue layers, and laparoscopic repairs like TAPP and TEP which utilize a mesh placed laparoscopically.
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This document outlines the steps in an open appendectomy procedure. It begins with a description of surgical anatomy including variations such as ectopic or absent appendix. It then discusses pre-operative preparation, incision sites, and identification of the appendix. The key steps are: delivering the cecum into the wound, identifying the appendix base, applying clamps and removing the appendix from tip to base while ligating vessels. The appendix is then ligated and the stump may be cauterized before closing tissue layers and applying dressings. Variations for complicated cases are also noted.
Haemorrhoids- Dr. Vijayalakshmi
Anesthetize the area with lidocaine gel
Surgeon: Insert anoscope and identify hemorrhoid
Procedure
Surgeon: Inject sclerosant into hemorrhoid using a fine needle
Post
Surgeon: Apply petroleum jelly to area
Instructions: Expect swelling and discomfort for a few days. Take stool softeners. Hemorrhoid will slough off in 1-2 weeks.
Follow up: As needed if symptoms persist beyond 2 weeks
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This document discusses anorectal abscesses and fistula in ano. It begins by defining anorectal abscesses as infections of soft tissues around the anal canal that form abscess cavities, often coinciding with fistula in ano. The peak incidence is in the third and fourth decades of life, affecting males more often. Causes include infection of anal glands, injury, Crohn's disease, and tuberculosis. Pathophysiology involves infection of anal glands leading to abscess formation in intersphincteric spaces. Abscesses are classified based on their location such as perianal, ischiorectal, or pelvirectal. Treatment involves incision and drainage. Fistula in ano results from
Haemorrhoids and its Management: How can Ayurveda have the upper hand...
Haemorrhoids are the pathological enlargement of the vascular cushions present in submucosal layer of anal canal which otherwise act as a hermetic seal in maintaining the continence. Ayurveda aim at to treat the hemorrhoids at the basic pathological level and offers a wide range of treatment options ranging from medical management to the use of parasurgical as well as surgical measures.
Anal Fissure
Fissure in ano is an elongated ulcer in the lower anal canal, most commonly located in the midline posteriorly. It is caused by pressure from hard stool during bowel movements tearing the anal tissues. It can also be caused by inflammation or ischemia. An acute fissure is a deep tear in the anal skin, while a chronic fissure has inflamed, indurated edges and scar tissue at the base. Symptoms include pain with defecation and sometimes bleeding. Treatment aims to relax the internal sphincter and includes topical nitrates, dilatation, and lateral sphincterotomy. Squamous cell carcinoma of the anus can be caused by radiation, HPV, or inflammation. It presents
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The document discusses splenic trauma, including anatomy, mechanisms of injury, signs and symptoms, diagnostic modalities, grading systems, and treatment approaches. It notes that non-operative management is the preferred treatment for hemodynamically stable patients, regardless of injury grade. Operative management may be required for hemodynamic instability, failure of non-operative management, or high-grade injuries involving major vessels. Splenectomy is performed as a last resort, and vaccination and antibiotic prophylaxis are important after splenectomy to prevent infection.
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This document discusses hernias, including their anatomy, types, causes, diagnosis, and treatment options. It provides details on the layers of the abdominal wall and inguinal canal. There are two main types of hernias - indirect and direct. Treatment options include open repair techniques like Shouldice repair as well as laparoscopic techniques like TAPP and TEP which involve placing a mesh to reinforce the abdominal wall. Complications of hernia repair can include recurrence, chronic pain, infection, and injury to surrounding structures.
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This document discusses various anorectal disorders including hemorrhoids, anal fissures, and rectal foreign bodies. It provides detailed information on the anatomy, etiology, clinical presentation, differential diagnosis, evaluation, and management of these conditions. For hemorrhoids, it describes the grading system and covers treatment approaches like lifestyle changes, medications, non-surgical procedures like band ligation, and surgical hemorrhoidectomy if needed. For anal fissures, it discusses the pathogenesis and focuses on medical management using topical agents to help healing. Rectal foreign bodies are also reviewed, highlighting careful history and imaging for diagnosis and the need for manual extraction or surgery in some cases.
Anorectal fistula
1) Anorectal fistulas are abnormal connections between the anal canal and perianal skin that usually form after an anorectal abscess bursts spontaneously.
2) Park's classification system categorizes fistulas as intersphincteric, transphincteric, suprasphincteric, or extrasphincteric based on their path through the anal sphincter muscles.
3) Treatment options include fistulotomy, seton placement, advancement flaps, fibrin plugs, and the LIFT procedure. The goal is to drain infection and eradicate the fistula tract while preserving sphincter function and avoiding recurrence.
Perianal abscess
This document provides information about perianal abscesses including their etiology, pathogenesis, classification, clinical presentation, investigations, and management. Anorectal abscesses are infections of the soft tissues around the anus that form abscess cavities. They commonly originate from infections of anal glands. Abscesses are usually drained surgically with antibiotics added for immunosuppressed individuals. The type of drainage depends on the abscess classification. While some advocate primary fistulotomy, others prefer delayed fistulotomy after initial incision and drainage to avoid unnecessary procedures.
Obstructed & stragulated hernia1
Strangulated inguinal hernias occur when herniated tissue becomes trapped within the hernia sac, cutting off blood flow. This can lead to tissue death. Symptoms include swelling, pain, and signs of bowel obstruction. Diagnosis is usually made through surgical exploration, which may involve bowel resection. While tension-free mesh repairs have been successfully used in strangulated hernias, non-mesh techniques are generally preferred due to the risk of mesh infection in contaminated fields. Proper surgical technique and mesh choice can help reduce infection risks for tension-free repairs in strangulated hernias.
Rectal bleeding
This document provides information on differential diagnosis and evaluation of rectal bleeding. It discusses common causes such as hemorrhoids, anal fissures, and colorectal cancers. It describes approaches to history taking, physical examination, and investigations including proctoscopy, sigmoidoscopy, colonoscopy, and imaging. Key signs and symptoms of conditions causing rectal bleeding are summarized.
Haemorrhoid
- Haemorrhoids are swollen veins in the anal canal. Common symptoms include bleeding, pain, itching, and protrusion of tissue from the anus.
- Causes include straining during bowel movements, prolonged sitting, obesity, and pregnancy. Risk increases with age.
- Treatment options range from lifestyle and diet changes to minimally invasive procedures like rubber band ligation, infrared coagulation, and sclerotherapy. More severe cases may require excisional haemorrhoidectomy or stapled haemorrhoidopexy.
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1. The document discusses various potential causes of a mass in the right iliac fossa, including appendicitis, appendicular abscess, carcinoid tumors of the appendix, mucoceles, adenocarcinoma, tuberculosis, Crohn's disease, carcinoma of the caecum, actinomycosis, amoebiasis, mesenteric cysts, intussusception, iliopsoas abscess, retroperitoneal tumors, aneurysms, and more rare causes.
2. Diagnostic tools mentioned include ultrasound, CT, colonoscopy, and biopsy. Treatment depends on the underlying cause but may include antibiotics, surgery, chemotherapy, and ATT.
3
Hemorrhoids-
HEMORRHOIDS IS A COMPLEX DISEASE WITH COMPLEX MANAGEMENT.THIS POWERPOINT AIMS TO RESOLVE THIS COMPLEXITY IN THE MOST CONVENIENT WAY
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1) Carotid Doppler ultrasound is used to evaluate the carotid arteries for stenosis or occlusion. It involves using grayscale, color Doppler, and spectral Doppler to examine the anatomy and flow of the carotid arteries.
2) A normal carotid Doppler ultrasound will show triphasic waveforms within the carotid arteries with velocities under 125 cm/sec. The intima-media thickness should be less than 0.8-0.9mm.
3) Carotid artery disease is most commonly caused by atherosclerosis which can be evaluated using Doppler ultrasound parameters like peak systolic velocity, end diastolic velocity, and ICA/CCA velocity ratios to grade the severity of stenosis.
Mri anatomy of knee Dr. Muhammad Bin Zulfiqar
This presentation is the first series of the MR imaging of Knee.
In this presentation MRI anatomy has been discussed. As we all know good knowledge of medical imaging three dimensional anatomy is key for good reporting.
Hope we all get benifitted.
Suggestions are most welcome
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Inguinal hernia repair
This document provides information on the management of inguinal hernias. It discusses the historical development of hernia repair techniques from the 15th century to modern methods. Investigation methods such as ultrasound, CT, MRI, and herniography are outlined. Surgical techniques for hernia repair including herniotomy, herniorrhaphy, hernioplasty, and laparoscopic repair are described in detail. Post-operative complications of open and laparoscopic hernia repair are also reviewed. The conclusion states that laparoscopic and Lichtenstein open mesh repairs have good long-term results and low recurrence rates compared to other open hernia repair techniques.
Fistula in-ano
This document discusses fistula-in-ano, which is an abnormal connection between two epithelial surfaces that usually communicates an infected anal gland to a secondary opening in perianal skin. Cryptoglandular disease is responsible for 90% of cases. Fistulae are classified as simple or complex depending on sphincter involvement. Clinical examination can often diagnose the condition, while radiological exams like endoanal ultrasound and MRI may help in complex cases. The document reviews the causes, symptoms, classifications, and diagnostic evaluations of fistula-in-ano.
Inguinal hernia
1) Inguinal hernias are common, with approximately 700,000 repairs performed annually in the US, mostly occurring in males.
2) There are two main types of inguinal hernias - indirect and direct. Indirect hernias are congenital while direct hernias are acquired lesions that occur through the posterior inguinal wall.
3) Common surgical repair options include the Lichtenstein tension-free repair using mesh, the Shouldice repair with overlapping tissue layers, and laparoscopic repairs like TAPP and TEP which utilize a mesh placed laparoscopically.
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1) The document provides information on the evaluation and management of bleeding per rectum (BPR). It discusses the history, physical exam, differential diagnoses, investigations and treatment options for common causes of BPR.
2) Common causes of BPR include hemorrhoids, anal fissures, colorectal polyps, inflammatory bowel disease, diverticular disease, and colorectal cancers. The history can help determine if the bleeding is from distal or proximal lesions.
3) Physical exam involves digital rectal exam to feel for masses or other abnormalities. Initial investigations include labs, endoscopy, and imaging. Treatment depends on the underlying cause but may include medications, procedures like banding or surgery.
Operative steps in open appendicectomy
This document outlines the steps in an open appendectomy procedure. It begins with a description of surgical anatomy including variations such as ectopic or absent appendix. It then discusses pre-operative preparation, incision sites, and identification of the appendix. The key steps are: delivering the cecum into the wound, identifying the appendix base, applying clamps and removing the appendix from tip to base while ligating vessels. The appendix is then ligated and the stump may be cauterized before closing tissue layers and applying dressings. Variations for complicated cases are also noted.
Haemorrhoids- Dr. Vijayalakshmi
Anesthetize the area with lidocaine gel
Surgeon: Insert anoscope and identify hemorrhoid
Procedure
Surgeon: Inject sclerosant into hemorrhoid using a fine needle
Post
Surgeon: Apply petroleum jelly to area
Instructions: Expect swelling and discomfort for a few days. Take stool softeners. Hemorrhoid will slough off in 1-2 weeks.
Follow up: As needed if symptoms persist beyond 2 weeks
Anorectal abscess & Anal fistulae
This document discusses anorectal abscesses and fistula in ano. It begins by defining anorectal abscesses as infections of soft tissues around the anal canal that form abscess cavities, often coinciding with fistula in ano. The peak incidence is in the third and fourth decades of life, affecting males more often. Causes include infection of anal glands, injury, Crohn's disease, and tuberculosis. Pathophysiology involves infection of anal glands leading to abscess formation in intersphincteric spaces. Abscesses are classified based on their location such as perianal, ischiorectal, or pelvirectal. Treatment involves incision and drainage. Fistula in ano results from
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Haemorrhoids are the pathological enlargement of the vascular cushions present in submucosal layer of anal canal which otherwise act as a hermetic seal in maintaining the continence. Ayurveda aim at to treat the hemorrhoids at the basic pathological level and offers a wide range of treatment options ranging from medical management to the use of parasurgical as well as surgical measures.
Anal Fissure
Fissure in ano is an elongated ulcer in the lower anal canal, most commonly located in the midline posteriorly. It is caused by pressure from hard stool during bowel movements tearing the anal tissues. It can also be caused by inflammation or ischemia. An acute fissure is a deep tear in the anal skin, while a chronic fissure has inflamed, indurated edges and scar tissue at the base. Symptoms include pain with defecation and sometimes bleeding. Treatment aims to relax the internal sphincter and includes topical nitrates, dilatation, and lateral sphincterotomy. Squamous cell carcinoma of the anus can be caused by radiation, HPV, or inflammation. It presents
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This document discusses hernias, including their anatomy, types, causes, diagnosis, and treatment options. It provides details on the layers of the abdominal wall and inguinal canal. There are two main types of hernias - indirect and direct. Treatment options include open repair techniques like Shouldice repair as well as laparoscopic techniques like TAPP and TEP which involve placing a mesh to reinforce the abdominal wall. Complications of hernia repair can include recurrence, chronic pain, infection, and injury to surrounding structures.
Anorectal Disorders
This document discusses various anorectal disorders including hemorrhoids, anal fissures, and rectal foreign bodies. It provides detailed information on the anatomy, etiology, clinical presentation, differential diagnosis, evaluation, and management of these conditions. For hemorrhoids, it describes the grading system and covers treatment approaches like lifestyle changes, medications, non-surgical procedures like band ligation, and surgical hemorrhoidectomy if needed. For anal fissures, it discusses the pathogenesis and focuses on medical management using topical agents to help healing. Rectal foreign bodies are also reviewed, highlighting careful history and imaging for diagnosis and the need for manual extraction or surgery in some cases.
Anorectal fistula
1) Anorectal fistulas are abnormal connections between the anal canal and perianal skin that usually form after an anorectal abscess bursts spontaneously.
2) Park's classification system categorizes fistulas as intersphincteric, transphincteric, suprasphincteric, or extrasphincteric based on their path through the anal sphincter muscles.
3) Treatment options include fistulotomy, seton placement, advancement flaps, fibrin plugs, and the LIFT procedure. The goal is to drain infection and eradicate the fistula tract while preserving sphincter function and avoiding recurrence.
Perianal abscess
This document provides information about perianal abscesses including their etiology, pathogenesis, classification, clinical presentation, investigations, and management. Anorectal abscesses are infections of the soft tissues around the anus that form abscess cavities. They commonly originate from infections of anal glands. Abscesses are usually drained surgically with antibiotics added for immunosuppressed individuals. The type of drainage depends on the abscess classification. While some advocate primary fistulotomy, others prefer delayed fistulotomy after initial incision and drainage to avoid unnecessary procedures.
Obstructed & stragulated hernia1
Strangulated inguinal hernias occur when herniated tissue becomes trapped within the hernia sac, cutting off blood flow. This can lead to tissue death. Symptoms include swelling, pain, and signs of bowel obstruction. Diagnosis is usually made through surgical exploration, which may involve bowel resection. While tension-free mesh repairs have been successfully used in strangulated hernias, non-mesh techniques are generally preferred due to the risk of mesh infection in contaminated fields. Proper surgical technique and mesh choice can help reduce infection risks for tension-free repairs in strangulated hernias.
Rectal bleeding
This document provides information on differential diagnosis and evaluation of rectal bleeding. It discusses common causes such as hemorrhoids, anal fissures, and colorectal cancers. It describes approaches to history taking, physical examination, and investigations including proctoscopy, sigmoidoscopy, colonoscopy, and imaging. Key signs and symptoms of conditions causing rectal bleeding are summarized.
Haemorrhoid
- Haemorrhoids are swollen veins in the anal canal. Common symptoms include bleeding, pain, itching, and protrusion of tissue from the anus.
- Causes include straining during bowel movements, prolonged sitting, obesity, and pregnancy. Risk increases with age.
- Treatment options range from lifestyle and diet changes to minimally invasive procedures like rubber band ligation, infrared coagulation, and sclerotherapy. More severe cases may require excisional haemorrhoidectomy or stapled haemorrhoidopexy.
Rif mass
1. The document discusses various potential causes of a mass in the right iliac fossa, including appendicitis, appendicular abscess, carcinoid tumors of the appendix, mucoceles, adenocarcinoma, tuberculosis, Crohn's disease, carcinoma of the caecum, actinomycosis, amoebiasis, mesenteric cysts, intussusception, iliopsoas abscess, retroperitoneal tumors, aneurysms, and more rare causes.
2. Diagnostic tools mentioned include ultrasound, CT, colonoscopy, and biopsy. Treatment depends on the underlying cause but may include antibiotics, surgery, chemotherapy, and ATT.
3
Hemorrhoids-
HEMORRHOIDS IS A COMPLEX DISEASE WITH COMPLEX MANAGEMENT.THIS POWERPOINT AIMS TO RESOLVE THIS COMPLEXITY IN THE MOST CONVENIENT WAY
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2) A normal carotid Doppler ultrasound will show triphasic waveforms within the carotid arteries with velocities under 125 cm/sec. The intima-media thickness should be less than 0.8-0.9mm.
3) Carotid artery disease is most commonly caused by atherosclerosis which can be evaluated using Doppler ultrasound parameters like peak systolic velocity, end diastolic velocity, and ICA/CCA velocity ratios to grade the severity of stenosis.
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This document discusses the classification of esophageal motility disorders based on manometric features. It describes the normal esophageal motility test and features. It then covers various motility disorders including achalasia, atypical LES relaxation disorders, diffuse esophageal spasm, hypercontraction disorders like nutcracker esophagus and isolated hypertensive LES, and ineffective esophageal motility. For each disorder, it provides the manometric criteria for diagnosis and differentiates them based on features of LES relaxation, wave progression, distal wave amplitude. It concludes by discussing the therapeutic implications of this classification system.
Prostate Biopsy--New Emerging Trends, Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss about the
Anatomy of Prostate
Technique of Transrectal US
Carcinoma Prostate and
Different modes of prostatic biopsy.
Doppler of the portal system
This document discusses the Doppler ultrasound assessment of the portal venous system. It begins with an overview of the sonographic and Doppler evaluation of the portal system's anatomy and normal circulation. It then covers the assessment of specific vessels like the portal vein, hepatic veins, and hepatic artery through grayscale ultrasound and Doppler evaluation. Key aspects like normal vessel diameters, waveforms, and flow direction are defined. The document concludes by outlining the important Doppler assessment techniques and parameters used to evaluate the portal system.
16 High Resolution Computed Tomography of Interstitial and Occupational Lung ...
16 High Resolution Computed Tomography of Interstitial and Occupational Lung ...Dr. Muhammad Bin Zulfiqar
This presentation is collection of images from chapter 16 of Grainger and Allison.
Inthis we will discuss the ILD.
This is only for educational purposes.21 non ischaemic acquired Dr.Muhammad Bin Zulfiqar
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 21 with caption in this presentation.
In my opinion it will be very benificial to have this in your android.
Doppler us of liver made simple Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss normal doppler parameters in portal and hepatic veins and hepatic artery. We will discuss the pathologies regarding hepatic, and portal veins and hepatic artery.
we will discuss Role of sonography in TIPS evaluation.
we will discuss the role of Doppler in post op follow up of hepatic transplant.
Role of medical imaging in management of arteriovenous fistula Dr. Muhammad B...
Role of medical imaging in management of arteriovenous fistula Dr. Muhammad B...Dr. Muhammad Bin Zulfiqar
This presentation is very helpful for vascular sergeons, interventional radiologists and sonographers that how to map Vasculature before construction of AV fistula for hemodialysis, how to check its patency, how to check its proper functioning ,to comment on its failure and decide when to reintervene.Doppler ultrasound of carotid arteries
This document discusses Doppler ultrasound of carotid arteries. It begins with the anatomy of carotid arteries and then discusses normal Doppler ultrasound findings of the carotid arteries including flow patterns and spectral waveforms. It describes various pathologies that can cause carotid artery disease such as atherosclerosis and other non-atherosclerotic diseases. It also discusses how diseases outside the carotid arteries can affect them. The document provides detailed information on ultrasound techniques for evaluating the carotid arteries and interpreting ultrasound findings for plaque characterization and grading stenosis.
Arterio-Portal Fistula Syndrome (APFS)
This case report describes a 60-year-old female patient presenting with abdominal pain, vomiting, diarrhea and ascites. Clinical exams and laboratory tests revealed signs of portal hypertension. Imaging studies including ultrasound and arteriography identified a splenic arterio-venous fistula causing blood to shunt from the splenic artery directly into the splenic vein, bypassing the liver and overloading the portal system. The patient underwent splenectomy and ligation of the splenic vein, with postoperative anticoagulation. Arterio-portal fistula syndrome is a rare condition where an abnormal connection forms between one or more arteries and the portal vein, causing portal hypertension. Treatment depends on the location and size of the fistula but
Renal artery aneurysm
A 23-year-old man was admitted to the emergency department with severe abdominal pain. Ultrasound showed a large cystic mass in his right renal pelvis. Further imaging with color Doppler ultrasound revealed the mass was communicating with and receiving a jet of blood from the right renal artery, indicating a renal artery aneurysm. The diagnosis of a threatened ruptured right renal artery aneurysm was made. An urgent nephrectomy was required to remove the aneurysm and stabilize the patient.
Helicobacter pylori & Nobel Prize in medicine & physiology
The discovery of H. pylori and its role in peptic ulcer disease was a collaborative effort between clinicians and scientists at Royal Perth Hospital in Western Australia in the early 1980s. Robin Warren, a pathologist, first observed the bacteria in gastric biopsies. Barry Marshall, an intern, helped cultivate H. pylori from a patient's biopsy, fulfilling Koch's postulates. Together with contributions from electron microscopists, microbiologists, and other specialists, they were ultimately able to characterize the bacteria and its association with gastritis and peptic ulcers. For their seminal work, Warren and Marshall received the 2005 Nobel Prize in Physiology or Medicine.
Vascular access
This document discusses vascular access for hemodialysis and a programmatic approach. It covers the multidisciplinary care team involved, background on chronic kidney disease and end stage renal disease in the US, and options for vascular access at initiation of dialysis. The document reviews guidelines promoting arteriovenous fistulas over catheters, quality standards, and complications associated with different access types. It also discusses strategies for a systems approach to access management, including timing of access creation and cannulation, monitoring access, and interventions for access issues.
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21 non ischaemic acquired Dr.Muhammad Bin Zulfiqar
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Authored by Dr. James Shpich, MD. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2016, Midland Country Club, Midland, MI.
Management of lower limb varicose veins
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The document discusses the venous system and varicose veins. It describes the anatomy and function of veins, noting they return blood to the heart and help regulate body temperature. Varicose veins are dilated, tortuous veins above 4mm in diameter. Evaluation involves history, exam including tests like Trendelenburg-Brodie, and imaging like ultrasound Doppler. Treatment options include compression stockings, sclerotherapy, surgery such as vein stripping or ligation, and newer minimally invasive procedures. Complications can include thrombophlebitis, hemorrhage, skin changes if left untreated.
CA VULVA.pptx
Vulvar cancer is a rare malignancy that represents less than 1% of cancers in women. It occurs most commonly in two age groups - younger women who smoke and are HPV-positive, and older women who may have epithelial dystrophies as risk factors. Lymphatic drainage is primarily to the superficial inguinal lymph nodes, with potential spread to deep femoral and pelvic nodes. Positive lymph nodes, particularly those over 5mm or with extracapsular spread, are the strongest prognostic factors and reduce 5-year survival by 50%. Surgical margins of at least 8mm are also important to reduce the risk of local recurrence after resection. Radiation may help reduce recurrence risk when margins are close. Distant metastases generally occur
dvt-good.ppt
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually of the legs. Risk factors include prolonged bed rest, surgery, cancer, and inherited or acquired disorders of coagulation. Virchow's triad describes the factors involved - venous stasis, endothelial injury, and hypercoagulability. Clinical features include leg pain and swelling. Diagnosis involves D-dimer testing, ultrasound, or venography. Treatment is anticoagulation with heparin or low molecular weight heparin followed by warfarin to prevent pulmonary embolism and post-thrombotic syndrome.
Haemorrhoids
Lecture on haemorrhoids for medical students. Encompasses basic sciences, classifications, principles and tips of management of this very common yet potentially complicated disorder.
Complications of Sinusitis (1).pptx
Orbital, intracranial, and bony complications are the main categories of sinusitis complications. Orbital complications are most common, occurring through direct extension or impaired venous drainage. Imaging like CT and MRI help identify complications. Treatment involves antibiotics, drainage of abscesses or involved sinuses, and sometimes surgery. Complications can range from mild preseptal cellulitis to life-threatening intracranial infections like cavernous sinus thrombosis, meningitis, or brain abscesses if not properly treated.
CSF rhinorrhoea
A 52-year-old female presented with a clear watery nasal discharge that worsened with bending over or coughing. Clinical tests and imaging found a CSF leak from the right cribriform plate, likely caused by increased intracranial pressure eroding the bone. CSF leaks can be managed conservatively or surgically via an endoscopic approach, which has high success rates and minimal morbidity compared to intracranial or extracranial approaches.
Deep Venous Thrombosis (DVT)
This is my presentation for my placement purpose. I am uploading it because it may help someone like me... Thank You.
EndoTHeF - Endovascular Treatment of Hemorrhoids with Foam - UIP Boston, 2013
These slides, presented during the 2013 UIP Congress in Boston, show a new painless treatment of hemorrhoids
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This document provides information about haemorrhoids (also known as piles), including:
1. Haemorrhoids are varicosities of the veins in the anal canal that are common, affecting around 25% of adults. Risk factors include constipation, pregnancy, liver disease, and heredity.
2. There are four grades of internal haemorrhoids based on the degree of prolapse. Symptoms include rectal bleeding, pain, itching, and swelling. Diagnosis involves examination and sometimes proctoscopy.
3. Treatment options range from conservative measures like diet changes to invasive procedures like rubber band ligation, injection sclerotherapy, and various surgical haemorrhoidectomy
3.Anorectal diseases.pptx
This document provides an overview of common anorectal diseases including hemorrhoids, anal fissure, and anorectal abscesses. It discusses the anatomy, risk factors, types, clinical features, and treatment options for each condition. Key points include that hemorrhoids are normal cushions in the anal canal that only require treatment if symptomatic, anal fissures are tears in the anoderm that cause pain with bowel movements, and anorectal abscesses form from infected anal glands that can spread along different anatomic planes requiring surgical drainage.
Varicose vein AB
Varicose veins are dilated, twisted veins most often found in the legs that result from defective valves in the veins or intrinsic weakness of the vein walls. Risk factors include pregnancy, age, gender, heredity, obesity, prolonged standing, and prior injury or surgery. Symptoms include heavy, achy legs, skin discoloration, and leg swelling. Diagnosis involves physical examination and imaging tests like ultrasound or MRI. Treatment options include compression stockings, sclerotherapy, laser or radiofrequency ablation, and surgical stripping for severe cases. Nursing care focuses on leg elevation, exercise, skin care, and health education to prevent complications like skin ulcers, blood clots, or deep vein thrombosis.
Vascular access for haemodialysis prof. ahmed halawa
Vascular access for haemodialysis requires either an autogenous arteriovenous fistula, a PTFE graft, or a tunnelled line. A good fistula has adequate size, blood flow, and low complication rates. Formation of an arteriovenous fistula involves connecting an artery such as the radial or brachial to a vein like the cephalic or basilic. Complications include steal syndrome, aneurysms, pseudoaneurysms, venous hypertension, and infection. Steal syndrome is treated with distal reconstruction and interval ligation. Buttonhole and rope-ladder techniques are used for cannulating fistulas and have benefits over traditional needle cannulation.
Deep Vein Thrombosis – A Case for Early Intervention
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Presentation by Dr. Hiranya A. Rajasinghe from Naples, Florida.
Gangrene & amputation
1) Gangrene is defined as macroscopic necrosis of tissues, and can be dry, wet, or gas gangrene. Dry gangrene is caused by reduced blood flow and progresses slowly, while wet gangrene develops rapidly due to blocked blood flow and favors bacterial growth. Gas gangrene is caused by Clostridium bacteria.
2) Amputation involves surgically removing a body extremity and is indicated for conditions like gangrene, trauma, tumors, and vascular insufficiency. The goals are to remove all infected tissue, achieve wound healing, and provide a stump that can accommodate a prosthesis.
3) Factors in determining the amputation level include the zone of injury, adequate tissue margins, circulation
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Vascular ulcers presented to the department of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria as resident postgraduate presentation
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Vascular ulcers presented as part of surgery resident postgraduate seminar to the department of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
Varicose Veins
This document discusses varicose veins, including definitions, anatomy, causes, symptoms, examination techniques, and treatment options. Some key points:
- Varicose veins are dilated, tortuous veins, usually in the legs, caused by incompetent valves that allow blood to flow in the wrong direction.
- Annual incidence is about 2% and lifetime prevalence is around 40%, being more common in women.
- Symptoms can include pain, swelling, heaviness, and skin changes like pigmentation.
- Examination involves inspection, palpation, auscultation, and Doppler ultrasound to map veins and locate sites of reflux.
- Treatment options include conservative compression therapy, sclerotherapy
Vein Grand R Ounds5 19 2011
Varicose veins and superficial venous insufficiency are conditions caused by abnormal blood flow in the veins leading to damage. Risk factors include family history, age, obesity, prolonged standing, and prior deep vein thrombosis. Treatment options include conservative compression therapy, sclerotherapy to destroy veins chemically, and newer minimally invasive techniques like endovenous laser ablation which uses laser heat to close veins. While varicose veins cannot be cured, many treatment options have high success rates in closing veins and relieving symptoms with few complications. Ongoing management focuses on preventing recurrence through lifestyle changes and compression therapy.
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EndoTHeF - Endovascular Treatment of Hemorrhoids with Foam - UIP Boston, 2013
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Diagnosis of sliding hiatal hernia
High resolution manometry (HRM) is the most accurate non-invasive test for diagnosing sliding hiatal hernia. HRM can classify hiatal hernias as no hernia, small (1-2 cm separation), or large (>2 cm separation) based on the distance between the lower esophageal sphincter and crural diaphragm pressure zones. A study found HRM had 94% sensitivity and 91% specificity for diagnosing hiatal hernia compared to open surgical assessment, outperforming barium swallow radiography and upper endoscopy. HRM is concluded to be the best test for accurately diagnosing and classifying the size of sliding hiatal hernias.
Ultrasound of thyroid nodules
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Ultrasound of carpal tunnel syndrome
Thank you for providing the detailed scanning technique. Let's move our discussion to the ultrasound features seen in carpal tunnel syndrome.
Assessment of liver fibrosis by us elastography
Liver fibrosis assessment techniques such as ultrasound elastography were discussed. Liver biopsy is currently the gold standard for fibrosis staging but has limitations like sampling error and invasiveness. Transient elastography is a validated method for noninvasive fibrosis assessment that provides a reliable result with 10 valid measurements where the interquartile range is less than 30% of the median. Normal liver stiffness values are below 5 kPa while values above 12.5 kPa indicate cirrhosis. Factors like acute hepatitis, congestive heart failure, and obesity can affect elastography results. ARFI and shear wave elastography are alternative ultrasound methods for evaluating liver fibrosis in a noninvasive manner.
Doppler ultrasound of visceral arteries
Doppler ultrasound of different diseases of visceral arteries including arterial stenosis and occlusion, arterial aneurysm, artrial pseudoaneurysm, arterio-venous fistula, artrial dissection, and abdominal vascular compression syndromes
Ultrasound of groin & anterior abdominal wall hernias
ultrasound of different groin and anterior abdominal wall hernias with ultrasound features of differential diagnosis
Extended focus assessment with sonography for trauma
The document discusses extended focused assessment with sonography for trauma (E-FAST), an ultrasound technique used to rapidly detect fluid in body cavities resulting from trauma. It describes the indications, views, techniques, findings and advantages of E-FAST. Key points include that E-FAST can detect blood or fluid in the abdomen, chest or heart within 3-5 minutes without radiation. It is a useful first-line tool to identify life-threatening bleeding but does not replace definitive diagnostic tests if findings are uncertain or positive. E-FAST examination involves six standard views of the abdomen, chest and heart and can be repeated as needed at the bedside to dynamically monitor trauma patients.
Acute appendicitis - Ultrasound first
1. The document discusses ultrasound techniques for diagnosing acute appendicitis, including visualizing the normal appendix and primary and secondary signs of inflammation.
2. Primary ultrasound signs of acute appendicitis include an appendix diameter over 6mm, a target sign of hypoechoic center with hyper- and hypoechoic rings, tenderness over the appendix, lack of compressibility, and increased vascularity of the wall.
3. Secondary ultrasound signs include free fluid around the appendix, abscess formation, thickening of surrounding tissues, and signs of small bowel obstruction.
Carotid intima-media thickness
1) Carotid intima-media thickness (CIMT) measurement is used to assess subclinical atherosclerosis and predict cardiovascular risk. It involves ultrasound imaging of the carotid arteries.
2) Standardized protocols have been developed for measuring CIMT at specific locations in the carotid arteries. Automated methods have good correlation with manual measurements.
3) Higher CIMT is associated with increasing age. Baseline and progression of CIMT over time can predict future cardiovascular events independent of traditional risk factors. However, other emerging risk markers may provide better prediction than CIMT alone.
Esophageal pH monitoring in pediatrics
This document summarizes esophageal pH monitoring techniques in pediatrics, including 24-hour pH monitoring, wireless pH monitoring, and pH-impedance monitoring. It describes the indications, methodology, analysis, and normal values for each technique. Key points include that 24-hour pH monitoring is the standard but wireless and pH-impedance monitoring can provide additional information. A normal composite score on 24-hour pH monitoring is less than 11.99 using the Boix-Ochoa scale. pH-impedance monitoring allows detection of acid and non-acid reflux and differentiation of liquid versus gas contents.
JNET classification of colo rectal polyps
This document discusses the JNET classification of colorectal polyps based on narrow-band imaging (NBI) endoscopy. It provides a brief history of NBI development and discusses the need for a new universal polyp classification system. The Japan NBI Expert Team (JNET) developed a novel 4-type classification system in 2014 using magnifying NBI endoscopy and considering both vessel and surface patterns. Type 1 correlates with hyperplastic/sessile serrated polyps, type 2A with low-grade dysplasia, type 2B can range from low-grade dysplasia to deep submucosal invasion, and type 3 correlates with deep submucosal invasion. A validation study found high accuracy
Types of clinical studies
This document discusses different types of clinical studies used in evidence-based medicine, including case reports/series, ecological studies, cross-sectional studies, case-control studies, cohort studies, randomized clinical trials, systematic reviews, and meta-analyses. It provides details on study designs, strengths and limitations, and how to interpret results including risk ratios, odds ratios, confidence intervals, and p-values. Key concepts covered include biases, confounding factors, prevalence versus incidence, and how study size influences precision.
MCQs in evidence based practice
Yes, the results are statistically significant since the confidence interval does not cross 1. The results are also precise since the confidence interval is narrow. There is no information given to determine if there is publication bias.
Understanding scientific peer review
This document discusses the history and process of scientific peer review. It begins by outlining some of the earliest documented uses of peer review in the 9th century by Ishaq bin Ali Al-Rahawi and in the 18th century by the Royal Society of London. It then describes how peer review evolved in the early 1900s in scientific journals and was facilitated by the introduction of photocopiers. The document outlines different peer review systems and their advantages and disadvantages. It also discusses ways to improve peer review, including the roles of authors, editors, reviewers, and publishers. Overall, the document provides a high-level overview of the development and current state of scientific peer review.
Normal & abnormal swallows in chicago classification version 3.0
(1) This document discusses the technical aspects and metrics used in Chicago Classification version 3.0 for analyzing high resolution manometry studies of swallowing. It includes definitions for the different types of esophagogastric junction morphology, measurements of esophageal contraction vigor and pattern, and thresholds for classifying swallows as normal or abnormal.
(2) Key metrics discussed include integrated relaxation pressure for analyzing esophagogastric junction relaxation, distal contractile integral for measuring contraction vigor, and distal latency for evaluating premature contractions.
(3) The document provides illustrations and examples of how to identify landmarks like the contractile deceleration point and measure these various metrics to characterize swallows according to the Chicago Classification.
Indications, examination protocol & results of conventional anorectal manometry
This document discusses conventional anorectal manometry (ARM), including the equipment, examination protocol, normal values, and interpretations. ARM involves using catheters to measure pressures in the anal canal and rectum at rest and during maneuvers like squeezing, coughing, and simulated defecation. It provides normal ranges for metrics like anal canal resting pressure, squeeze pressure, and the presence of the rectoanal inhibitory reflex. Interpretations of atypical results are discussed to aid in diagnosing conditions like fecal incontinence, Hirschsprung's disease, and dyssynergia.
Endoanal ultrasound in anal diseases
Endoanal ultrasound can be used to evaluate several anal diseases:
(1) It can identify anal sphincter lesions such as defects from obstetrical trauma, surgery, or accidental injury. Defects involve disruption of the internal and/or external anal sphincters and ultrasound can determine the extent and muscles involved.
(2) It is useful for evaluating perianal fistulas by identifying their tracts.
(3) Anal canal tumors like carcinoma can be imaged with endoanal ultrasound.
(4) It can also assess miscellaneous anal conditions including endometriosis and hemorrhoidal prolapse.
Endorectal ultrasound in rectal diseases
ERUS can be used to stage rectal tumors by assessing tumor depth (T staging), nodal status (N staging), and distance to circumferential resection margins. It has high sensitivity and specificity for T1-3 staging but is less accurate for T4 tumors and nodal metastases. ERUS is useful for evaluating submucosal invasion depth and predicting tumors amenable to endoscopic resection. Limitations include difficulty distinguishing post-treatment changes from residual tumor. ERUS provides complementary information to MRI for locoregional staging of rectal cancers.
Esophageal motility disorders in Chicago classification v3.0
Description of esophageal motility disorders according to criteria of Chicago classification version 3.0 by high resolution manometry
Ultrasound & doppler ultrasound in liver transplantation
1) Doppler ultrasound is useful for detecting vascular complications following liver transplantation such as hepatic artery thrombosis, stenosis, and pseudoaneurysm as well as portal vein stenosis and thrombosis.
2) Reversible Doppler findings in the immediate postoperative period include elevated hepatic artery velocities and pulsatile portal vein flow that typically resolve within a few days.
3) Biliary cast syndrome is a rare but serious complication characterized by hard casts within the biliary ducts that can cause strictures, dilatation, and abscesses, often requiring surgery or endoscopic removal. Doppler ultrasound may demonstrate associated hepatic artery stenosis.
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Ultrasound of groin & anterior abdominal wall hernias
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Normal & abnormal swallows in chicago classification version 3.0
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Indications, examination protocol & results of conventional anorectal manometry
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
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Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
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TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
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Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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Hemorrhoides
- 2. Definitions • Hemorrhoids Dillated vascular channel in 3 constant locations Normal part of human anatomy • Hemorroidal Disease Manifeted by prolapse, bleeding, & itching • Internal hemorrhoids Originate above dentate line Covered with transitional mucosa • External hemorrhoids Located close to the verge Covered with transitional mucosa
- 3. Usual sites of internal hemorrhoids Knee-chest position Left lateral Right posterior Right anterior
- 4. Incidence of hemorrhoidal disease • Exact incidence is not known • 10 - 25 % of adult population thought to be affected
- 5. Pathogenesis of hemorrhoids Normal vascular cushions present at birth Downward pressure during defecation Muscle fibers that anchor cushions attenuated Hemorrhoids: slide, congested, bleed, prolapse High resting anal pressure (unclear?)
- 6. Classification of internal hemorrhoids • First degree Project a short way into the anal canal The only symptom is bleeding • Second degree Prolapse during defecation Return spontaneously • Third degree Must be returned manually • Fourth degree Hemorrhoids are irreducible
- 7. Symptoms of hemorrhoids Intermittent symptoms • Painless bleeding Seen on toilet tissue Dripping into toilet at end of defecation Accumulate in rectum with dark blood or clots • Prolapsed hemorrhoids Blood & mucus stain patient’s underwear Mucus against anal skin lead to itching
- 8. Third degree internal hemorrhoids
- 9. Forth degree internal hemorrhoids
- 11. Anal & rectal palpation
- 13. Internal hemorroids Seen with the proctoscope
- 15. Prolapse of 3 mains hemorrhoidal piles
- 16. External hemorroids (skin tags)
- 19. Treatment of internal hemorrhoids Reduce downward pressure Diet Bulk agents Veinotonic agents Avoid prolonged sitting at stool Fix cushions to sphincter Sclerosing injections Rubber band ligation Cryotherapy Photocoagulation: infrared - laser Electrocoagulation: bipolar - heater probe Excise hemorrhoids Hemorrhoidectomy
- 20. Preferences for treatment of hemorrhoids Degree or Grade Treatment 1 Sclerosing injections Infrared coagulation 2 Infrared coagulation Rubber band ligation 3 Rubber band ligation 4 Hemorrhoidectomy
- 23. Sites of sclerosing injections 1 Superficial 2 Good (submucosa) 3 Deep (intramuscular)
- 24. Sclerosing injections • Substances 1 ml is sufficient to create raise area Phenol 5 % – Quinine Chlorhydrate & urea 5% • Number of injections 2 injections per week 4 – 6 injections in total • Results Success in 75 % of first & second degree
- 26. Infrared photocoagulation • Coagulation proximal to internal hemorrhoids • Applied for 1.5 sec in 2 – 3 sites • Success in 75 % of 1st & sd degree • Rare complications
- 29. Number of bands in one session Disagreement • 1 band by session Many authorities believe that severity of pain & risk of complictions are less • 2 – 3 bands by session Safe & effective at one setting • 8 – 10 bands in one session
- 30. Retroflexed endoscopic multiple band ligation Extensive ligations of internal hemorrhoids & normal rectal mucosa immediately proximal to internal hemorrhoids weeks after8 – 10 elastic bands in one session Before band ligation Gastrointest Endosc 2004 ; 59 : 380 – 4 .
- 31. Rubber band ligation is probably the most common fixation method in use worldwide today
- 32. Rubber band ligation Complications Pain Moderate 5 - 85% – analgesic Severe near dentate line – ablation Bleeding Minimal 1 – 15 % Severe: 0.5 - 2% – Transfusion – suture Cellutitis Severe complication (50% mortality) 15 cases reported between 1980 – 1988 Anaerobic – Gram negative bacteria Early symptoms: anorectal pain & urinary troubles Early treatment ameliorate prognosis (antibiotics) Dysuria & urine retention
- 36. Edematous external hemorroidal thrombosis
- 37. Sebaceous cyst Not painful After puncture
- 38. Thrombosed hemorrhoidal prolapse Acute hemorrhoidal disease
- 39. Treatment of acute hemorrhoidal disease Medical Direct injection of 9 ml bupivacaine 0.25% + 1 ml hyaluronidase Gentle massage followed by reduction of the mass NSAIDs parenterally Surgical Emergency hemorrhoidectomy occasionally
- 40. Only about 10% of patients should undergo operation
- 41. Thank You