The Thoracic Ventricle

The Thoracic Ventricle
II– MDCT angiography of the thoracic aorta:
At the point when an acute aortic syndrome (AAS) is suspected (owing either to clinical
manifestations or to chest radiographic findings), non enhanced CT is usually done first to search a
high–attenuation acute intramural hematoma (IMH). The contrast–enhanced scanning, which take
after is the key part of the CT examination. The right timing of the entry of contrast material in the
aorta is basic to picture quality. Approaches to accomplishing this incorporate a ' 'timing bolus ' ' or a
' ' bolus tracking technique ' ' (Kazerooni et al, 2009).
Technical procedures: Previously, ECG gating has fundamentally been retrospective gating with
which information are gathered over the whole cardiac cycle. This allows review of aortic valve
morphologic features on static images at end systole and end diastole, measurement of aortic valve
surface area and the review of valve leaflet motion in cine mode. Inadequate coaptation of the valve
leaflets relates to regurgitation, and a confined opening relates to stenosis (Gilkeson et al., 2006).
Additionally, the more up to date prospective triggering technique gathers CT information just at a
specified point or cluster of points in the heart cycle, decreasing the time the CT beam is on to a
fraction of what it was with retrospective gating, thus considerably decreasing the radiation dose
(Shuman et al., 2008).
The development of MSCT with more than 16 detector rows has enabled
... Get more on HelpWriting.net ...

The Treatment Of An Abdominal Aortic Aneurysm ( Aaa )
An aneurysm is permanent, excessive dilation of a blood vessel. It can occur in the aorta and other
blood vessels; the most common location for an aneurysm is in the abdominal section of the aorta
(Humphrey and Taylor [88] from ITL biomechanics thesis). There are a couple of definitions of an
abdominal aortic aneurysm (AAA): one is a local dilation in the aorta whereby the diameter of a
dilated artery is more than 50% larger than the original diameter [1]. Another definition is when the
external AAA diameter exceeds 30mm [3].
In most cases, an AAA usually remains asymptomatic until rupture. The most common symptom of
a ruptured AAA is acute pain in the abdomen and hemodynamic shock. Ruptured AAAs have high
mortality rate; 78% – 94% of ruptured aneurysms lead to death. [1.1o] Since the mortality rate is
high for ruptured AAAs, the most promising practice for improving clinical outcomes are early
diagnosis and careful management.
The main treatment option for AAA is to eliminate the aneurysm wall from the systemic pressure to
prevent further bulging of the AAA, using a vascular graft. In open surgery, a graft is sealed to the
healthy part of the aorta by transabdominal surgery. Open surgery has a 30–day mortality rate of
around 5% [greenhalgh et al 2004 from T] Endovascular aneurysm repair (EVAR) is an alternative
treatment option to open surgery, it is a minimal invasive surgery whereby a stent graft is placed in
the AAA through a small incision in the groin area. It has a

Aortic Aneurysm Research Paper
Aortic Aneurysm
1. Basic definition of the disease – Source: "Aortic Aneurysm." MedlinePlus. U.S. National Library
of Medicine, 28 Sept. 2016. Web. 13 Oct. 2016. .
There are two types of aortic aneurysms – thoracic and abdominal. Both can be inherited as
autosomal dominant heart diseases. Thoracic aortic aneurysms (TAA) occur in the part of the aorta
running through the chest area, while abdominal aortic aneurysms (AAA) occur in the part of the
aorta running through the abdomen. The aorta is the main blood vessel, or artery, that transports
blood from the heart to the rest of the body. Aneurysms in the aorta are a bulges in the blood vessel
walls that cause various health problems.
2. Cause – Source: "Familial TAAD." Genetics Home Reference. ... Show more content on
Helpwriting.net ...
The treatments are usually all very effective as they serve the purpose of eliminating tumors and
preserving vision.
6. Prognosis – Source: "Retinoblastoma." AAPOS.org. American Association for Pediatric
Ophthalmology and Strabismus, 1 June 2016. Web. 12 Oct. 2016. .
What is the life expectancy?
The life expectancy of affected individuals depends on their stage of retinoblastoma and whether
they were diagnosed early enough to receive treatment. Like other cancers, lifespan can be reduced
if patients develop second–stage tumors and are not treated quickly enough. Most often, death
caused by retinoblastoma is rare because patients are usually diagnosed as children can receive
treatments that are very effective.
What is the quality of life?
Living with retinoblastoma can be difficult, both physically and emotionally. Children affected by
retinoblastoma may experience poor vision and eye pain as well as rapid involuntary eye movement.
These symptoms can be very uncomfortable for a young child. Further, the frequent treatments such
as chemotherapy can be inconvenient, and affected children often have lower self esteem as a result
of their

Essay on Marfan Syndrome: The Case of Joey Jones
Case Report #1
Joey Jones, a 14–year–old African American child who just seems too tall, is referred to genetic
clinic. A physical exam revealed the following parameters and features: Height = 6 ft, 4 in Weight =
125 lb Head circumference = 54 cm Arm span = 85 in Upper and lower limbs: Joint laxity and
arachnodactyly Chest: Pectus excavatum Heart: Soft systolic murmur at the apex Abdomen: Soft, no
hepatosplenomegaly, no masses
An ophthalmologic evaluation showed ectopia lentis and myopia. A cardiologic examination
revealed a MVP.
His father was 6 feet, 8 inches tall and died suddenly last year in this 30s. An autopsy showed
ruptured aortic aneurysm. A paternal aunt is tall and myopic. Joey's younger brother is also quite tall
... Show more content on Helpwriting.net ...
The presence of an FBN1 mutation that is associated with cardiovascular disease will confirm the
diagnosis of this condition in the patient.
The tests available for this condition are:
1. FBN1 mutation scanning/ Sequence analysis – this test detects sequence variants and has a
mutation detection frequency of 70 – 93%.
2. Complementary DNA sequence analysis – This test detects sequence variants and has a mutation
detection frequency of 70 – 93%.
3. Deletion/duplication analysis – This test detects exonic and whole gene deletions. The mutation
detection frequency for this test is unknown.
The preferred method of testing for this condition is Sequence analysis of FBN1.
Some laboratories that offer this testing are:
1. Mayo Clinic: This laboratory offers FBN1 full sequence analysis.
[http://www.mayomedicallaboratories.com/test–catalog/Overview/89308]
2. ARUP laboratories: This laboratory offers FBN1 sequence analysis as well as
Deletion/Duplication analysis. [http://ltd.aruplab.com/Tests/Pub/2005584]
3. Quest diagnostics: This laboratory offers FBN1 full gene sequence analysis.
[http://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=29635&labCode=QDV]
4. Greenwood Genetic Center: This laboratory offers FBN1 sequence analysis.
[http://www.ggc.org/diagnostic/tests–costs/test–finder/marfan–syndrome–fbn1–sequencing.html]
GENETIC COUNSELING:

Essay on Reflective Nursing Case Study
Case Study One
In this case study I will use Gibbs (1988) model of reflection to write a personal account of an
abdominal examination carried out in general practice under the supervision of my mentor, utilising
the skills taught during the module thus far.
What happened
During morning routine sick parade I was presented with a 21 year old male soldier experiencing
severe acute, non specific, abdominal pain. Under the supervision of the medical officer (MO) I
proceeded to carry out a full assessment and abdominal examination, using Byrne and Long's (1976)
model to structure the consultation. I requested the patients' consent before conducting the
examination, as is essential before commencement of any medical procedure, be it a ... Show more
content on Helpwriting.net ...
Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation,
and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute
abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with
abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects
of the physical examination and had to be prompted by the MO. Although with more practice such
incidence would be reduced.
Analysis
I was happy that I managed to rule out any distinct causes of the abdominal pain by performing the
examination to collect data, analyse it, and use the results to make an appropriate decision (Schon,
1984). However, had I performed the examination without assistance I may not have gained all the
information required to confirm diagnosis, as I did forget some aspects.
Conclusion
The MO seemed happy with my diagnosis and care plan, though he did highlight the importance of
practicing the physical examination skills in order to become a more competent practitioner. Overall
I feel gaining knowledge and skills in translating a patients' history and physical examination
results, has enabled me to become more confident in making a diagnosis and has improved my
decision making skills.
Action Plan
In order to become a more capable and effective practitioner I must continue to

Cell Sheet Adhesion Of Porcine Heart Tissue After Transplant
Time Course Of cell Sheet Adhesion to Porcine Heart Tissue after Transplant
Opposed to performing heart transplants after a myocardial infarction, cell sheets can be attached to
the existing cardiac muscle in order to repair the damaged tissue, sticking the sheet to the heart
without sutures. The researcher's extracted bone marrow from a pig, washed away all red blood cells
with a solution, and used reverse transcription so RNA makes cDNA. These cells were placed in a
petri dish until the cells floated to the top of the culture, they were then placed in a different culture
set at 37 degrees Celsius where two more cell layers were added on top of them. The cell sheets
were placed on 5 different pig hearts on the left ventricle either basal or apical side up, after 15–
60min the sheets and heart tissue underneath were removed for analysis under a scanning electron
microscope. The basal side adhered to the heart tissue better than the apical side, showing a solid
connection with the heart tissue about 30 minutes after being inserted. During open heart surgery,
the chest should remain open at least 30 minutes after inserting the cell sheet in order to confirm it
has properly stuck to the heart tissue. This study is significant because it demonstrates progress
toward effectively using cell sheets to treat the heart after myocardial infarction.
6–Month Aortic Valve Implantation of an Off the Shelf Tissue Engineered Valve in Sheep
Decellularized engineered tissue was used to make

Understanding The Pathophysiology Of Sepsis
This leads us to the next step in the pathophysiology of Sepsis. Stage 2 of sepsis, which is when
SIRS plus the confirmation of an infection has been made. At this stage, the patient's body has been
continuously fighting something in their body and it is starting to have an effect on the patient. Signs
and symptoms of sepsis are often nonspecific and include the following: Fever, chills, or rigors,
Confusion, Anxiety, Difficulty breathing, Fatigue, malaise, Nausea and vomiting. It is important to
identify any potential source of infection. Localizing signs and symptoms referable to organ systems
may provide useful clues to the etiology of sepsis and are as follows: Head and neck infections:
Severe headache, neck stiffness, altered mental

Essay about Abdominal Aortic Aneurysm
The cardiovascular system is the most important system in our body. This system is what keeps us
alive. Beating on average 30 billion times a year, our heart is never able to stop and take a break.
With every beat of our heart, the cardiovascular system moves blood, gases, nutrients, and hormones
throughout the intricate vasculature of our bodies. An adult body contains over 60,000 miles of
vessels, which can wrap around the world two and a half times. The vessel branching off of the heart
is largest artery in our body and is known as the aorta. The aorta supplies oxygenated blood to our
body. The aorta runs along the midline of our body and has many other vessels that stem from it to
deliver the blood to a specific location. The ... Show more content on Helpwriting.net ...
Elastic tissue is very strong. The adventitia is the outermost layer. It is made of collagen and
nourishes the wall with vasa vasorum.
An aneurysm is a widening or ballooning of a vessel. It is caused by weakness in the aortic wall. In
the aortic wall, the media is mostly affected because it is the thickest. There are instances where
dilation of the wall can occur, but to the outermost layer and this is not a typical aneurysm. It is
known as a false aneurysm or a pseudoaneurysm. When the outermost layer is dilated, often times
the inner or medial wall will rupture, but the outer wall will still be intact. The extracellular matrix
proteins degenerate and the inflammatory T cells are present. The collagen and elastin dissolve and
disintegrate which will lead to an expansion of the aortic wall. If the pressure in the vessel is too
great, the aortic wall will rupture. An abdominal aortic aneurysm is a ballooning or dilating of the
abdominal aorta. An aneurysm is diagnosed when the diameter of the vessel is greater than 50% of
its original diameter. The aorta is normally two centimeters in diameter at the level or the renal
arteries. An aneurysm is named based off of their location, size and shape. An aneurysm will affect
how the vessel is shaped, therefore causing the blood flow to alter. When an aneurysm is
symmetrical on both sides of the aortic wall it is called fusiform; but if only one side of the wall is
dilated, it is saccular. Aneurysms

Abdominal Aortic Aneurysm Research Paper
An abdominal aortic aneurysm (AAA) is an area in the lower part of the aorta that becomes
enlarged.1 The aorta is usually about the width of a garden hose,1 but when it dilates 1.5 times the
diameter of its normal width (commonly about 3 cm) it is then termed a AAA.2 Although an
aneurysm can occur along any part of the aorta, it is termed "abdominal" along any segment below
the diaphragm.3 An aneurysm above the level of the diaphragm is termed "thoracic."1 The most
common location for a AAA to occur is the infrarenal segment,2 therefore it is common practice to
restrict the term AAA to that portion of the aorta.3 There are two types of AAA, bulging and
dissecting.1,3 Bulging (or ballooning) aneurysms can be either fusiform or saccular.4 Most
aneurysms are fusiform since the whole artery is affected, but in more rare cases can be saccular.3
An aortic dissection occurs when the inner layer of the aorta tears and perfusion of blood ... Show
more content on Helpwriting.net ...
Risk factors for an AAA include: age of 65 years old, smoking, atherosclerosis, male gender, and
family history.1,2,3,4 The three most powerful predictors are age, smoking and male gender, and
smoking accounts for 78% of the excess prevalence of AAA.2 Gene defects with some of the
connective tissue disorders associated with AAA have been identified in chromosome 11 and 15,4
but genetic background paired with environmental factors is a more likely cause of AAA than
genetics alone.3 Family members are four times more at risk for an AAA if a parent, adult child, or
sibling has had an AAA4 (15–19% in relatives, compared to 1–3% in unrelated cases).3 Additional
risk factors that are seen in individuals with an aortic dissection include: hypertension, pre–existing
aortic aneurysms, an aortic valve defect, aortic coarctation, certain genetic diseases (Turner's
syndrome, Marfan syndrome, Ehlers–Danlos syndrome, and Loeys–Dietz syndrome), and
inflammation or infection (giant cell arteritis, syphilis, and sexually transmitted

Human Abdomen and Correct Answers Essay
* Question 1
2 out of 2 points | | | Which sound is normal to elicit when percussing in the seventh right intercostal
space at the midclavicular line over the liver?Answer | | | | | Selected Answer: | Dullness | Correct
Answer: | Dullness | Response Feedback: | The liver is located in the right upper quadrant and would
elicit a dull percussion note. | | | | | * Question 2
2 out of 2 points | | | Which structure is located in the left lower quadrant of the abdomen?Answer | |
| | | Selected Answer: | Sigmoid colon | Correct Answer: | Sigmoid colon | Response Feedback: | The
sigmoid colon is located in the left lower quadrant of the abdomen. | | | | | * Question 3
2 ... Show more content on Helpwriting.net ...
| Response Feedback: | Normally, one may see the pulsations from the aorta beneath the skin in the
epigastric area, particularly in thin persons with good muscle wall relaxation. | | | | | * Question 10
2 out of 2 points | | | A patient has hypoactive bowel sounds. The nurse knows that a potential cause
of hypoactive bowel sounds is:Answer | | | | | Selected Answer: | peritonitis. | Correct Answer: |
peritonitis. | Response Feedback: | Diminished or absent bowel sounds signal decreased motility
from inflammation as seen with peritonitis, with paralytic ileus after abdominal surgery, or with late
bowel obstruction. | | | | | * Question 11
2 out of 2 points | | | The main reason auscultation precedes percussion and palpation of the abdomen
is to:Answer | | | | | Selected Answer: | prevent distortion of bowel sounds that might occur after
percussion and palpation. | Correct Answer: | prevent distortion of bowel sounds that might occur
after percussion and palpation. | Response Feedback: | This is done because percussion and
palpation can increase peristalsis, which would give a false interpretation of bowel sounds. | | | | | *
Question 12
2 out of 2 points | | | The nurse is listening to bowel sounds. Which of the following is true of bowel
sounds?Answer | | | | | Selected Answer: | They are usually high–pitched, gurgling, irregular sounds. |
Correct Answer: | They

Vulvar Case Paper
13. A 25–year–old female presents to your clinic for evaluation of a mass in the vulvar area. This
has been present for the last 1 week and tender to touch, there is no fever and no chills. Upon exam,
you noticed that there is a medially protruding mass in the introitus area around a radius of 1.5 cm
and tender to touch with some induration around the area. You advised the patient that the most
likely diagnoses in this case are: A. Vulvar Neoplasm B. Nabothian Cyst C. Bartholin Cyst D.
Genital Herpes E. Varicella Answer: C Explanation: Answer A is incorrect due to the acute
presentation of the lesion and the presence of induration and tenderness with touch makes the
possibility of vulvar neoplasm unlikely. Answer B is incorrect as Nabothian

Four Body Cavities
The topic I will be discussing about is the body cavities, it is a space which is considered our insides
that contains our organs and fluids. We as humans have four body cavities (1) the cranial, (2) the
thoracic, (3) the abdominal and (4) the pelvic cavity, they all contain one or more of our organs.
Now let's get more depth with the cavities individually, let's start with the cranial cavity, it is inside
the cranium its what protects the brain and its soft tissue, the cranial cavity is surrounded in a thin
layer of cells. The thoracic or chest cavity houses the oesophagus, aorta, lungs, heart, and trachea, it
is also subdivided into small sections the pleural is where each lung is and the mediastinum it
surrounds the heart, veins, and arteries.

Chalazion Research Paper
Chalazion A chalazion is a swelling or lump on the eyelid. CAUSES This condition may be caused
by: Long–lasting (chronic) inflammation of the eyelid glands. A blocked oil gland in the eyelid.
SYMPTOMS Symptoms of this condition include: A swelling on the eyelid. The swelling may
spread to areas around the eye. A hard lump on the eyelid. This lump may make it hard to see out of
the eye. DIAGNOSIS This condition is diagnosed with an examination of the eye. TREATMENT
This condition is treated by applying a warm compress to the eyelid. If there is no improvement
after two days, it may be treated with: Surgery. Medicine injected into the chalazion. Medicine
applied to the eye. HOME CARE INSTRUCTIONS

Acute Appendicitis Case Study
The common cause of acute abdomen is acute appendicitis and the reason for abdominal surgeries.
Its diagnosis is still a big challenge because of many other condition similar to the acute appendicitis
like renal colic, colitis, adenitis etc. Primary imaging modality for the acute abdominal pain in
pediatric age group is a plain x–rays of the abdomen, followed by ultrasound. Further imaging
depends on the results of these studies (17) . The normal appendix could be visualized with graded–
compression sonography, and need to be differentiate between normal and abnormal appendix
(21,23,24,25). Although CT– scan has more accuracy in diagnosis and management of acute
appendicitis. Ct scan is preferably done in obese patients and in those with marked abdominal
tenderness who cannot tolerate the graded–compression technique. , but due to high ionizing
radiation and risk of cancer especially in pediatric age group most clinicians prefer U/S as a first line
of investigation to avoid unnecessary radiation. Unfortunately, its poor sensitivity in comparison to
CT does not allow it to be utilized as a good "rule out" diagnostic tool, if the ultrasound result is not
positive for ... Show more content on Helpwriting.net ...
While the range of reported accuracy (82% to 96%) for US in children has been acceptable, the
sensitivity (44% to 100%) and the specificity (47% to 99%) have varied considerably; also, the
visualization rates vary widely in the published literature, from a low of 22% to a high of 98% (6).
From 98 patients that had appendicitis, ultrasound results were in favor of appendicitis in 63 patients
(64.3%) and were suspicious for appendicitis in 14 patients (14.3%). Twenty One patients had
normal study (21.4%) (

Abdominal Adhesion Report
How to Eliminate Abdominal Adhesions (Scar Tissue Banding)
When groups of internal scar tissue band together, the result is an abdominal adhesion. While most
people believe that internal scar tissue is formed after surgery, there is no hard–and–fast rule for the
formation of the initial scar tissue itself. Scar tissue is what develops when the body is trying to heal
itself after infections, bleeding, bodily injuries, inflammatory diseases, chronic intestinal conditions,
physical trauma, and radiation treatments, as well as after surgical procedures.
The problem with an adhesion is that it ties two organs or two serous membranes together that
should not be connected under healthy conditions. Sometimes the adhesion forms within weeks of
scar tissue banding, and sometimes it may develop years later, long after the ... Show more content
on Helpwriting.net ...
In the event that the scar tissue wraps around a major organ, blood flow may be reduced or even cut
off. This situation would require immediate surgical attention. Only intestinal blockages can be seen
on X–rays or Ultrasounds. If you are experiencing abdominal pain, cramps, and vomiting, your
Victorville General Surgeon may need to perform a minimal invasive exploratory procedure to
confirm an adhesion.
ADHESION REMOVAL SURGERY
There are two minimally invasive techniques used for exploration and removal of abdominal
adhesions. Your surgeon will determine the best technique based on where the adhesions are located
and how large they are. Both operations are performed as an out–patient process. You will be given
either a local or general anesthetic to ensure that you are comfortable and pain–free during the
procedure. Both procedures will require about two hours for completion. You will need to have
someone available to drive you home from the clinic or hospital.
Laparoscopy

Personal Narrative: My Husband
September 9, 2013 was a really hard day for me,The interns and I sitting at dinner 6:30 p.m. saw on
the New York times that there was a train crash. We all scrubbed in and got ready for all of the
ambulance' to show up. When they got to KU Medical Hospital I felt a big rush in my body. I felt
like I had to help everyone in need. I got a pregnant lady on a gurney and rushed her into an O.R.
she could barely even talk she was in such shock. I turn around and something caught my eye, a
man and a woman stuck together on a pole going through their torso. The Chief calls me over and
says "Gray I need you over here, take them to an O.R and find Bailee"
As I rushed them over to the O.R. I saw Isabelle fill in my spot with the pregnant lady. I found
Bailee and she told me to ask them questions to keep them focused on not leaving ... Show more
content on Helpwriting.net ...
Andrew is in his early 50's and Vonnie in her 20's. I asked them if either had a husband or wife they
needed to call, and they both said they called in the ambulance. I asked them if they knew how the
train crashed and Vonnie said some dumb redneck was racing the train and it hit his vehicle. Andrew
laughed then he commented that it hurt to laugh, Bailee said that she was sorry and that they are
trying to figure everything out as soon as possible. Bailee asks me to find out the medical
information. I found that Vonnie has the pole going through her abdominal aorta, the largest blood
vessel in the abdomen. Then I found that the pole is inline with Andrew's inferior vena cava, the
largest vein in the body it runs along the abdominal aorta. Dr. Shepard came over to me and Dr.
Bailee and he said we can't remove or else they will both bleed out. The chief suggested that we
move one of the patients not the pole. A lot of the doctors helping thought we should remove Vonnie
from the pole because the for survival is slim for her because of the damage to her aorta so moving

Aortic Aneurysm: A Case Study
The aorta is the largest artery in the body, responsible for providing oxygen to the entire body. An
aortic aneurysm occurs when an artery wall of the aorta weakens. The weakening then causes the
wall of the aorta to expand and bulge out (United States National Library of Medicine, 2014).
Dilation of at least one and a half times the normal diameter of the aorta is qualification for an
aneurysm (Novaro, 2014). Nearly 50,000 deaths in the United States annually can be attributed to a
thoracic aortic aneurysm (McLarty, A. J., Bishawi, M., Yelika, S. B., Shroyer, A. L., & Romeiser, J,
2015). Although the aorta runs from the heart through the abdomen, the section that runs through the
chest is the thoracic aorta. Three specific areas susceptible to development of an aneurysm include
the ascending aorta, aortic arch, and descending aorta (Elefterides, J., Sang, A., Kuzmik, G., &
Hornick, M, 2015).
Risk factors for the development of a thoracic aortic aneurysm include; hypertension, high
cholesterol, smoking, obesity, family history, and older age (United States National Library of
Medicine, 2014). Atherosclerosis or hardening of the arteries is especially prevalent in patients with
descending aortic aneurysms. In a study by ... Show more content on Helpwriting.net ...
Z., Halperin, J. L., Marin, M. L., Stewart, A. S., Eagle, K. A., & Fuster, V, 2014). Hypertension
leads to tremendous stress on the aortic wall and can ultimately lead to aortic dissection. Research
has also demonstrated a possible family connection in the diagnosis of thoracic aortic aneurysm. In a
study by the Journal of the American College of Cardiology, twenty one percent of thoracic aortic
aneurysms individuals have a relative with a known aneurysm. These same individuals
demonstrated higher aorta growth rate and were diagnosed at an earlier age (Elefteriades & Farkas,

Rt Interposition Graft
Aortic arch angiogram: shows right aortic arch with the following branching pattern (from proximal
to distal): left common carotid, right common carotid, right subclavian artery. The origin of left
subclavian (with anomalous origin) was not seen as it was ligated previously. However, the distal
portion is filled with diluted contrats likely through a retrograde flow through the left vertebral
artery. Patent Rt MAPCA with no intimal ingrowth was seen in the previously placed stent at the
origin of Rt MAPCA. Dilated tortus RIMA which is likely profusion the right upper lung lobe
(aortopulmonary collaterals) left BT shunt is wide patent (connected left common carotid artery to
the interposition graft) with good caliber with mild narrowing at its insertion in the interposition
graft. ... Show more content on Helpwriting.net ...
Bt shunt and the RPA–homograft connection).
Right pulmonary artery has normal arborization, capillary and levophase. Except in the atelectatic
area of the right upper lobe where the distal branches seem to be crowded as expected.
Left lung is whitened out. However, patent flow was seen in the LPA though the flow it is
diminished in the area corresponding to left upper lobe. Normal levophase was identified with
possible single common left pulmonary vein.
Selected injection at the origin of the Rt MPACA shows good flow in the RPA with relatively
decreased contrast density at the right upper lobe likely related to negative contrast wash out from
the competitive flow from the previously described AP collaterals.
LT. BT shunt angiogram, showed similar finding to what has been described in eth first injection
LT. BT shunt angiogram after balloon angioplasty showed significant improving in the diameter and
flow of the ballooned areas. However, a flap was seen in the homograft lumen (attached to the
inferior luminal aspect of the graft) with no evidence of

Doppler Ultrasound
Diagnosis of many acute abdominal conditions relies on a good history and physical examination
supplemented by relevant laboratory tests and the appropriate use of radiological investigations(4,5).
There is no single radiological test that is uniformly effective in identifying the cause of acute
abdominal pain. Various factors, including age, sex, habitus, and the suspected clinical diagnosis,
determine the choice of radiological investigation(6).
Owing to the risks posed by the radiation associated with tests such as computed tomography and
scintigraphy, ultrasound has grown in popularity as an easy and quick way of imaging the abdomen.
This has led to a considerable increase in the number of such scans being performed for acute
abdominal ... Show more content on Helpwriting.net ...
Whereas in diagnosing acute appendicitis, it is less accurate than clinical diagnosis. In diagnosing
retroperitoneal conditions, the sensitivity and specificity is almost same for clinical and USG
diagnosis(9).
US can provide useful information for about 56% of patients with acute abdominal pain, and as
reported by several authors who claim that US is considerably helpful in making the correct
diagnosis, in the initial evaluation of the patients with acute abdominal pain(10).
Color and Power Doppler imaging supplement the information provided by gray–scale imaging,
with increased vascularity visualized in a number of inflammatory, infectious or neoplastic diseases.
For example hyperemia, both of the bowel wall and adjacent mesentery, is a marker of disease
activity in inflammatory bowel disease. Ultrasound can provide useful information for about 52% of
patients with acute abdominal pain, and as reported by several authors who claim that US is
considerably helpful in making the correct diagnosis, in the initial evaluation of the patients with
acute abdominal

Aortic Insufficiency Lab Report
Introduction
Aortic insufficiency is a condition where the aortic valve does not close all the way. The aortic valve
is a gate–like structure that is located between the lower left chamber of the heart (left ventricle) and
the blood vessel that leads away from the heart (aorta). The aortic valve opens when the left
ventricle squeezes to pump blood into the aorta, and it closes when the left ventricle relaxes.
In aortic insufficiency, blood in the aorta leaks through the aortic valve after it has closed. As a
result, the heart works harder to pump the same amount of blood through the valve as it would if the
valve closed tightly. When left untreated, aortic insufficiency causes enlargement and weakening of
the left ventricle. When this happens, ... Show more content on Helpwriting.net ...
MRI.
Electrocardiography. This is a test that records the electrical impulses of the heart.
Angiography. This is a test that produces images of arteries in your body. You may need aortic
angiography or CT angiography. In aortic angiography, a dye flows to your heart through a soft,
flexible tube (catheter) while X–rays are taken. CT angiography uses a CT scanner and MRI in
addition to the catheter, dye, and X–rays.
How is this treated?
Treatment depends on how severe the aortic insufficiency is, the problems it is causing, and your
symptoms.
Observation. If the aortic insufficiency is mild, no treatment may be needed. However, you will
need to have the condition checked regularly to make sure it is not getting worse or causing serious
problems.
Surgery. If the aortic insufficiency becomes severe, you may need surgery to repair or replace the
valve. Surgery is usually recommended if the left ventricle enlarges beyond a certain point. If aortic
insufficiency occurs suddenly, surgery may be needed immediately.
Medicines. Some medicines may help the heart work more efficiently.
Follow these instructions at home:
Keep all follow–up visits as directed by your health care provider. You may need to have tests done
regularly to monitor your condition and how well your heart is pumping

Systemic Lupus Erythematosus
CS was first described by Dr. David G Cogan in 1945 as a non–syphilitic interstitial keratitis with
vestibuloauditory symptoms (1). CS is rare, with fewer than 250 reported cases in the literature, and
is mostly described in young adult Caucasian patients of both sexes (2). CS is an extremely rare
disorder in Arabic and Middle Eastern countries(3). The novelty of this study is represented by
being the first case reported within Jordanian population that is 7 million people.
The classical form of ocular involvement in CS is characterized by the interstitial keratitis, but also,
iritis or uveitis, scleritis or episcleritis, and conjunctivitis have been also described, and the atypical
CS exists in the absence of interstitial keratitis (2). Some systemic manifestations have been
reported in association with CS, including vasculitis of the aorta leading to aortic aneurysm and/or
aortic valve regurgitation, fever, arthralgia (or arthritis), lymphadenopathy, splenomegaly, skin rash,
and peripheral or central nervous system involvement (2, 4).
The ocular involvement in CS usually gives a good response to topical corticosteroids therapy,
while, systemic corticosteroids are reserved for unresponsive cases or those with posterior uveitis, it
was reported that poor long term ophthalmologic outcomes due to CS are unusual in contrast to
vestibuloauditory affection(4).
Deafness is the most common serious outcome of CS and systemic corticosteroid therapy is
warranted as soon as

Jonathan Larson Essay
Jonathan Larson
January 21. The time is around 6:45 pm. Writer, composer Jonathan
Larson was sitting in the very last few rows listening as cast he had chosen for his "about to
be" Broadway musical, "Rent" went through one of the final dress rehearsals in
The New York Theater Workshop. He and the Director of "Rent"
Michael Grief began to sing one of the songs form the show when Larson began to feel a pain in his
chest. The pain worsened. Larson (being the compulsive worrier and hypochondriac close friends
and relatives knew him as) turned to an actor and said,"You better call 911. Think I'm having a
heart attack."
Lagon was rushed to the Emergency Room of New York's Cabrini Medical
Center. ... Show more content on Helpwriting.net ...
Evening. Brian Carmody found his roommate in bed, short of breath and mumbling in a low voice.
The only food he could seemingly stomach was Jell–O and some tapioca pudding.
January 23. Afternoon. Jonathan called his father in Albuquerque complaining of chest and lower
back pains and a small degree temperature. His father felt it was nothing serious.
Evening. His condition worsens. The chest pains are again excruciating.
He decides to return to the hospital. Carmody again a member of the staff says the hospital could not
attain the records form Larson's visit two days earlier.
Instead, he is taken by way of cab to St. Vincent's, a closer hospital. When he arrived, Larson rated
his pain as being seven out of a possible 10. A nurse classified his case as "urgent".
After some examination, he was told this was no more than a virus (due to flu–like symptoms) and it
would pass.
January 25. It has been a long, hard, nerve–racking day for Larson. He has just returned to his
downtown Manhattan apartment on Greenwich Avenue from the final dress rehearsal before the
preview of his On–Broadway musical "Rent".
Perhaps he was trying to relax with some nice, hot tea, or perhaps it was just to heat up some
remedy he had picked up from a stage hand in passing through the cloud of hectic activity which
consumed him that day. Larson collapsed there, in front of the stove that day, dead, and was later

discovered by Mr. Carmody.
Dead. After six years

Marfan's Syndrome Essay
Marfan's syndrome is a rare hereditary disorder of the body's connective tissue. The phenotypic
traits include being tall, abnormally long stretched limbs and in the most severe cases the aorta can
be prone to rupture and retinal detachment can occur [1]. Seventy five percent of cases for this
multisystem disorder are genetic and inherited in an autosomal dominant fashion (a child can inherit
it from just one parent): 25% are sporadic where neither parent has the syndrome [2]. Its prevalence
is 1/5000 and of these affected individuals each has a 50% chance of passing on the mutated gene to
their offspring [3]. Marfan's syndrome is caused by mutations in the fibrillin–1 gene (FBN1) located
on chromosome 15q21.1 [4]. Fibrillin is a large glycoprotein ... Show more content on
Helpwriting.net ...
Two thirds (approximately 66%) of Marfan's syndrome sufferers experience problems in the
cardiovascular system and have mitral valve prolapse; where blood may flow back from the
ventricles into the atrium in a process called mitral valve regurgitation. This may require valve
repair or valve replacement. If cardiac arrhythmias occurs – where the heartbeat becomes irregular –
there is the risk of sudden death [2]. Thoracic aortic aneurysm is also prevalent in Marfan's
syndrome sufferers. This is a condition caused by the widening of the aorta due to weakness in the
walls of the vessel. Aneurysm can lead to rupture itself or to aortic dissection where the aorta wall
tears thus allowing blood to flow between the layers of the blood vessel walls. It can result in
rupture or in a decrease in blood flow to the organs. This situation is very dangerous and is most
likely to require heart surgery or aortic replacement

Superior Mesenteric Artery Syndrome Analysis
Superior Mesenteric Artery Syndrome
Education is Key
Superior mesenteric artery syndrome is a rare disease that is caused by many different factors, but
the focus of this paper will be how compression from a body cast or spinal injury causes superior
mesenteric artery syndrome. The injuries sustained can lead to a compressed area in the superior
mesenteric artery and the abdominal aorta, which in return will lead to an obstructed duodenum.
Education is key; if the symptoms are recognized early, then early interventions can prevent severe
complications. The safety concern with superior mesenteric artery syndrome is the inability to
absorb nutrients. This can become a life–threatening condition if nutritional needs are not met in a
timely manner ... Show more content on Helpwriting.net ...
Education needs to be directed to not only the patients and their families, but to HCP as well.
According to Dr. A.Run Pal Singh (2015), prevention and prompt treatment of cast syndrome is key
and knowledge of the nursing staff is essential in prevention. Knowing the early signs and
symptoms, as well as diagnostic tests, will not only shorten the disease process, but allow for
immediate treatment to prevent any further complications. Patients compliance to treatment is the
key to their health. This assignment has taught us what superior mesenteric artery syndrome was, as
well as how to provide adequate education to the patients, families, and all HCP.
References
Cheever, K., & Hinkle, J., Brunner & Suddarth's Textbook of Medical– Surgical Nursing pg. 1141–
1146. Wolters Kluwer.
Gebhart, T. (2015). Superior Mesenteric Artery Syndrome [Abstract]. Gastroenterology Nursing,
38(3), 189–193.
Karrer, F. M. (n.d.). Superior Mesenteric Artery Syndrome Follow–up. Retrieved February 18, 2017,
from http://emedicine.medscape.com/article/932220–followup
Ranschaert, E. (n.d.). Superior mesenteric artery syndrome | Radiology Reference Article. Retrieved
February 18, 2017, from https://radiopaedia.org/articles/superior–mesenteric–artery–syndrome.
Singh, D. A., About Dr Arun Pal SinghArun Pal Singh D. P. (2015, December 11).

Symptoms And Symptoms Of Viral Gastroenteritis
Assessment
E.L. is a 36 year old female who has presented with a chief complaint of vomiting, diarrhea,
abdominal cramping and sharp adnominal pain rated 7/10. The patient is a geriatric nurse and states
that she was in close contact with patients who had similar symptoms. The patient denies taking any
medication, denies allergies, reports childhood illnesses gastrointestinal amoebas, and is up to date
with vaccinations. Family history indicates that the patient is at increased risk for developing heart
disease. The patient denies any previous or current tobacco use and reports drinking alcohol socially.
The patient is married with 4 children and denies that immediate family members have or are
displaying any similar symptoms.
Subjective ... Show more content on Helpwriting.net ...
Differential diagnoses important to consider are appendicitis and irritable bowel syndrome.
Appendicitis is an acute inflammation of the appendix and is often missed by clinicians (Cox &
Sovak, 2015). In this case, appendicitis is unlikely as the patient does not display signs and
symptoms indicative of appendicitis. During the physical exam the McBurney's point, Rovsing's
sign, Obturator, and Psoas all yielded negative results. Also, E.L. is complaining of pain to the
hypogastric area and denies pain specifically located in the right lower quadrant or rebound
tenderness. These findings do not support a diagnosis of appendicitis. Irritable bowel syndrome
(IBS) is a motility disorder of the gastrointestinal tract causing intermittent nausea, abdominal pain
relieved by defecation, abdominal distension, flatulence, and diarrhea (Goolsby & Grubbs, 2015).
Although E.L. has several of these symptoms, a diagnosis of IBS is unlikely for many reasons. The
patient's symptoms are attributed to contact with an infectious person indicating an acute illness.
This makes IBS less likely because, IBS is characterized as a reoccurring illnesses with relapses.
IBS is also unlikely since the symptoms are often triggered by meals and in this case the patient
attributes symptoms to being in close contact with individuals displaying the same symptoms. Also,
the patient denies eating

How An Abdominal Aortic Aneurysm?
Introduction
This essay will discuss how an abdominal aortic aneurysm occurs, who are at risk of developing
one, how the body responds as well as the clinical presentations of the signs and symptoms. It will
also give an explanation of how the clinical presentations relates to the pathogenesis of abdominal
aortic aneurysms as well as how it affects homeostatic mechanisms.
Before those subjects it is necessary to understand what an abdominal aortic aneurysm is. An
abdominal aortic aneurysm is an augmented area of the lower aorta, most commonly occurring in
the portion of the aorta below the renal artery origin and iliac bifurcation.
How the chosen condition has occurred
(pathogenesis)
The aorta is the main blood vessel that supplies blood to the pelvis, abdomen and the legs,
According to Rahimi, MD Facs's Abdmonial Aortic Aneurysm: Practice Essentials, Background,
anatomy [22] After the age of 50, the normal diameter of the aorta is between 1.5 a. This
information was a concurred in Schaub, G's document. Schaub, G states in the document 'abdominal
aortic aneurysm– american family physician' [25] "an aneurysm is a permanent focal dilation of an
artery 1.5 times the normal diameter in size."
According to Macsweeney et al the pathogenesis of abdominal aortic aneurysm includes numerous
factors acting over time. However, the destruction of elastin in the aortic wall is one of the key
events that shifts the load produced by blood pressure on to collagen. This is

Abdominal Aortic Aneurysm Essay
Definition
An AAA (abdominal aortic aneurysm) is defined as enlargement of at least 3 cm of the abdominal
aorta. The majority of abdominal aortic aneurysms begins below the renal arteries and ends above
the iliac arteries. The exact cause of (AAAs) is unknown. However, it is thought to be due to a
degenerative process of the abdominal aorta caused by atherosclerosis. Artherosclerosis represents a
response to vessel wall injury caused by inflammation, genetically regulated defects in collagen and
fibrillin, increased protease activity within the arterial wall, and mechanical factors (Stoelting p.
143).
Pathophysiology
The abdominal aorta consists of three distinct tissue layers including: the intima, media, and
adventicia. There is ... Show more content on Helpwriting.net ...
There is an increase in the concentration of proteolytic enzymes compared to their inhibitors in the
abdominal aorta as age progresses. It is also thought that metalloproteinases (MMPs) may be a
factor in the development of AAAs (Stoelting p. 143). There is an increase in expression and activity
of MMPs in people with AAAs. MMPs are present in normal aortic tissue and are responsible for
vessel remodeling. These proteinases are secreted into the extracellular matrix of AAAs by aortic
smooth muscle cells and macrophages. Increased MMP activity favors the degradation of collagen
and elastin in aneurysmal tissue (Laake).
Signs and Symptoms
Patients with ruptured AAAs present in many different ways. The most common manifestation of
rupture is back pain with a pulsatile abdominal mass and hypotension. Additional symptoms may
include syncope, flank mass, groin pain, or paralysis (Dalman and White). Unstable patients with a
suspected ruptured abdominal aortic aneurysm need immediate operation and control of the
proximal aorta without preoperative confirmatory testing or optional volume resuscitation
(Stoelting, p. 144).
Anesthesia Management
Surgical intervention is presently the only effective method of treating AAAs. The risk of surgical
repair is outweighed by the risk of aneurysm rupture or aneurysm related death. Patients

Aneurysm Essay
Introduction
Despite considerable advances in surgical treatment, the ruptured human abdominal aortic aneurysm
(AAA) is still associated with a mortality rate of 65–85% [1, 2] . A diameter is currently the only
reliable determinant of the imminent rupture of an AAA and patients exceeding 5.5 cm generally
undergo surgical or endovascular intervention [2, 3] . However, the outcome of rupture is poor with
less than half of the patients being delivered to the hospital alive [1, 4] . It is well known that
inflammation and proteolytic degradation markedly contributes to the formation and rupture of an
AAA [5, 6] . During inflammation, the aortic wall is weakened by loss of smooth muscle cells
(SMCs) and destruction of the extracellular ... Show more content on Helpwriting.net ...
Hence, another study described increased expression of ADAM–17, also known as TACE (TNF– –
converting enzyme), in human AAA [18] . Especially in the transition zone, high levels of ADAM–
17 and TNF– have been detected , implementing a certain role in the development of AAA.
Therefore, the aim of the present study was to conduct an expression analysis of ADAMs with
proteolytic function [19] such as ADAMs 8, 9, 10, 12, 15 and 17, and their tissue inhibitors of
metalloprotease (TIMP)–1 and TIMP– 3 [20] in human AAA by quantitative PCR. The localisation
of the corresponding ADAMs was determined by means of immunohistochemistry.
Discussion
The development of AAA is closely associated with alternation of connective tissue in the aortic
wall, especially fragmentation of elastic fibres and collagen degradation through various proteolytic
enzymes, particularly MMPs [8, 9, 22] . Some promising drugs inhibiting MMPs have already been
shown to be successful in experimental models [23] . However, no positive results have been
observed in clinical trials. This phenomenon may be based on the fact that MMPs are not the only
proteinases able to degrade connective tissue. There is a plethora of proteolytic enzymes belonging
to the family of metalloproteinases such as ADAMs with multiple biological roles including cell–
matrix interaction, zymogen activation (shedding) and cell adhesion. These

Genetics Synthesis: Marfan Syndrome Essay
Marfan Syndrome
Marfan Syndrome is an autosomal dominant disorder mainly caused by defects in the gene FBN1
that codes for the protein fibrillin. Approximately 1 in 5,000 people are affected. Cardinal features
involve the ocular, musculoskeletal, and cardiovascular systems. There is a high degree of
variability of this disorder, sometimes presenting itself at birth or later in childhood or adulthood.
On one end of the spectrum is severe neonatal presentation with rapidly progressive disease, while
on the other end isolated phenotypic features may be the only presenting signs. Life expectancy,
with proper management, approximates to that of the general population.
Growth, Development & Musculoskeletal attributes: excessive ... Show more content on
Helpwriting.net ...
Cardiovascular attributes: Major source of morbidity and mortality, dilation of the aorta, aortic valve
insufficiency, predisposition for aortic tear and rupture, mitral valve prolapse with or without
regurgitation, tricuspid valve prolapse, and enlargement of the proximal pulmonary artery.
Participation in contact sports, competitive sports and isometric exercise should be restricted.
Decongestants, caffeine, psychostimulants all should be avoided or used with caution and be
approved first by a cardiologist. Bacterial prophylaxis prior to dental procedures expected to
contaminate the bloodstream is needed.
Pulmonary attributes: spontaneous pneumothorax, reduced pulmonary reserve and sleep apnea.
Skin attributes: 2/3 of people with marfan syndrome develop stretch marks often across the lower
back and the inguinal and axillary regions due to rapid growth. Stretch marks are typically
perpendicular to the axes of growth. Higher risk for hernias due to the defect in connective tissue.
Neurological attributes: stretching of the dural sac in the dependent lumbosacral region, resulting in
dural ectasia. This can lead to bony erosion and nerve entrapment, postural hypotension and low–
pressure headaches. In severe cases, spinal shunting and/or medications are necessary.
Reproductive attributes: pregnancy in women with marfan syndrome increases the risk of aortic
rupture or dissection, higher rates of

Governing Aortic Pressure
Governing Physiology
In order to provide as accurate a test as possible, care must be taken to model our system after
human physiologic conditions. There are many variables at play near the aortic valve we must
consider when making our tester. The most obvious physiology we have to model is pressure. A
successful heart valve must be one that can reliably handle the pressures found in the body. Average
blood pressure for a healthy adult male when measured with a cuff is 80/120 mmHg where two
numbers are given for minimum and maximum pressures. However, pressure measured with a cuff
is different than aortic pressure5. At max pressure, the difference can by as by as much as 20 mmHG
for systole5. This is due to the higher elasticity of the aorta. We ust keep that in mind if hoping to
get accurate pressure found at an aortic valve. Minimum pressures ... Show more content on
Helpwriting.net ...
The pump "Siphon–Mate 35–109PC Transfer Pump for Liquid" can pump 0.12L of liquid per
stroke, and has a outer diameter of 1"8. In order to create a flow rate of 0.233L/s with this pump,
one has to pump one full stroke in: 0.12L / (0.233L/s) = 0.51s. This means one must do a full pump
about twice per second to test whether the heart valve can withstand the maximum flow rate through
aorta. According to the product description, this pump is "a combination displacement lift pump and
siphon pump with valves suitable for transferring fuel."8 So the pump itself contains a valve that
prevents backflow.
Tubing: To house the heart valves, 1" inner diameter braided vinyl tubing was used. The tubing fit
well into the PVC T–junctions and are approximately equal in size to a human aorta.
Assembly and iterations
The main parts and components of this project have remained relatively constant. We divided work
among our members setting up the pump, a housing for the heart valve, and a way to measure

A Brief Note On Mrs. Lawson Boice Essay
CC
Mrs. Lawson Boice is a 69–year–old female here today for a followup.
HPI
The patient was last seen in the office in February. Please see that note for complete details. She has
several issues she would like to discuss today. She tells me that she has really been under a lot of
stress of late. She had been caring for her sister, who has uterine cancer. In addition, her husband 's
brother recently died, and there have been issues regarding a property they co–owned. She sold her
house in New York and is now renting a house here in Portsmouth. She feels all that she has been
doing is moving and cleaning. She feels that she is a little bit settled, however and is hoping that she
can get back to her normal regimen. She has not been walking as much as typical, and she would
like to lose a couple of pounds and plans to get back into that, as well as her physical therapy
exercises that she has been doing for her neuropathy.
The patient has been diagnosed with bilateral peripheral neuropathy. She has been seeing Kishori
Somyreddy, MD. Dr. Somyreddy recommended physical therapy, which she is not sure it helped
with the neuropathy, but she does think it helps with her chronic back pain and she is feeling better
from that standpoint. She has not been able to stick with the physical therapy exercises as much of
late, but does plan on getting back to that now that she is settled and feeling less stress with all that
she needs to do.
Since the patient has a decided to

Benjamin Engelhart Essay
EMERGENCY SERVICES ADMISSION REPORT
Patient Name: Benjamin Engelhart
Patient ID: 112592
DOB 10/5/–––– AGE: 46 SEX: Male
Date of Admission 11/14/––––
Emergency Room Physician: Alex McClure, MD
Admitting Diagnosis: Acute Appendicitis
HISTORY OF PRESENT ILLNESS: This 46–year old gentleman with past medical history
significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the
emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a
generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the
right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around
6am, but he now ... Show more content on Helpwriting.net ...
Date of Procedure: 11/14/––––
HISTORY: Right lower quadrant pain. No previous studies.
Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys,
pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared
thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the
abdomen appeared unremarkable. No free air was seen.
Pelvis: Good–quality, non– contrasted, actual CT examination of the pelvis with coronal
reconstructions. The prostate seminal vesicles and urinary bladder appeared WNL. The bowels seen
on the study appeared WNL, except for inflammatory changes of the appendix, and cecum
consistent with acute appendicitis. .All the structures of the pelvis appeared intact with evidence of
bilateral hip degenerative changes.
IMPRESSION: 1. Findings consistent with acute appendicitis.
2. Degenerative changes of the hips.
_________________________
Paula Reddy, MD Radiology
PR:ld
D: 11/14/––––
T: 11/14/–––– OPERATIVE REPORT
PATIENT NAME: Benjamin Engelhart
Patient ID: 112592 DOB: 10/5/–––– AGE: 46 SEX: Male

Date of Admission: 11/14/––––
Date of Procedure: 11/14/––––
Admitting Physician: Bernard Kester, MD General Surgery
Surgeon: Bernard Kester, MD General Surgery
Assistant: Jason Wagner, PA–C Surgical Assistant
Circulating Nurse: Jimmy Dale Jett, RN
Preoperative

An Aortic Dissection
Introduction
The aorta is a three–layered structure composed of the inner layer being the intima, middle layer
being the media, and the outer layer being the adventitia. An aortic dissection (AD) starts when a
tear forms in the intimal layer of the aorta. Due to the high–pressure environment within the aorta,
blood is forced into the tear causing the intimal layer to separate/dissect from the medial layer of the
aorta. This separation will cause a new chamber to form between the intima and the media called a
false lumen (FL). Patients with this condition will experience a variety of symptoms that may be
similar to that of other conditions. There are several risk factors associated with AD; however, the
exact cause is unknown.
A chest x–ray is usually the first type of imaging ordered when a patient arrives with chest pain or
complaints. In the case of an AD, a chest x–ray will typically display a widening of the aorta;
however, an x–ray will not be able to diagnose an AD. If an AD is suspected after the initial x–ray,
several advanced modalities can be used to diagnose this condition. For a definite diagnosis a
transesophageal echocardiogram (TEE), CT chest with contrast, or a MRA is needed.1 Upon
arriving in a radiology department, the technologist's ability to acquire a good history may be the
best tool in order to expedite the process in diagnosing an AD.
Review of Literature Although the exact cause of an AD is unknown, many risk factors have been

Essophageal Foreign Bodies Essay
Esophageal foreign bodies are a fairly common emergency in dogs. They are a life–threatening type
of obstruction and immediate veterinary attention is necessary for the best outcome. The esophagus
is a thin sheet of muscle located within the thorax that connects the mouth to the stomach and aids in
pushing food and water down into the stomach. Esophageal foreign bodies are seen more often in
dogs than in cats. Symptoms of an esophageal foreign body include but are not limited to the
following: exaggerated swallowing, drooling, pawing at the mouth and/or neck, vomiting, anorexia,
gagging, coughing, and agitation. These foreign bodies seem to have a tendency to get lodged in two
locations in the esophagus: near the base of the heart or in the ... Show more content on
Helpwriting.net ...
Sometimes surgical foreign body removal is necessary. Quick endoscopic retrieval generally results
in a lesser degree of damage to the esophagus. Damage to the esophagus is variable based on the
size, shape, and texture of the foreign body, as well as the duration of time at which the foreign body
is in the esophagus. The longer the foreign body stays in the esophagus, the more pressure necrosis
(i.e., cell death) it causes to the thin muscular wall of the esophagus. Stricture formation is a
common complication post removal of esophageal foreign bodies. Strictures form when the
damaged tissue of the esophagus forms excessive scar tissue. The tightening of scar tissue is so great
that it prevents the passing of food through the esophagus. Stricture formation can be later addressed
by a balloon device inserted into the area to gradually stretch the tissue. Endoscopic foreign body
removal also has the benefit of being able to visualize the damage or lack thereof to the esophagus.
By visualizing the damage to the esophagus, a decision can be made as to whether or not the patient
will need a PEG (percutaneous endoscopic gastrotomy) tube installed. An esophageal foreign body
can result in severe complications such

Aortic Stenosis Research Paper
Aortic stenosis is the narrowing down of the opening of the aortic heart valve, this is a common
valvular disease in the modern world. The aortic stenosis is classified into two types, congenital and
acquired. In congenital aortic stenosis, it is often observed that the malformation of a bicuspid valve
instead of a natural tricuspid valve. The leaflets are fused to create a bicuspid structure. While in
acquired stenosis, there is narrowing down of the valve opening due to calcification which usually
starts from the roots and extends to the end of the opening creating a stiffened and narrowed opening
as shown in Figure 7 [22]. This calcification process formed over the course of decades of unhealthy
diet, smoking, obesity and other cardio vascular ... Show more content on Helpwriting.net ...
50 percent of patients with severe aortic stenosis wouldn't serve the nominal two year life
expectancy in respect to those with Aortic valve replacement[28]. Hence, emphasis on the study of
aortic stenosis and its progression is of decisive significance [23].
Classifications of aortic stenosis is often based on factors that include its opening area and the
pressure related to it. These are often derived from the echocardiography recordings the change in
the relation between the mean opening areas to the pressure gradients provides insights about the
severity of the disease in terms of its effect on the left ventricle increased load.
Aortic stenosis progression is generally classified into the

Nursing Diagnostic Essay
Diagnostic testing performed on the patient was done in relation to presenting chief complaints of
acute abdominal pain and severe shortness of breath. Upon admission, patient was immediately
ordered various forms of diagnostic testing. These tests included CT scan of the abdomen without
contrast and two portable x–rays of the kidney, ureters, and bladder (KUB). The CT scan of the
abdomen was ordered for evaluation of abdominal discomfort on February 5, 2016. An abdominal
CT scan is a noninvasive radiographic procedure used to diagnose pathologic conditions in the
abdominal cavity. The CT image results from passing X–rays through the abdominal organs at
different angles (Pagana & Pagana, 2010). As different organs have different tissue densities, each
density is given a numeric value in which these areas turn a shade of gray (Pagana & Pagana, 2010).
It with this shading that CT scans can be visualized and read. The use of contrast can help enhance
the images, but for this particular study no contrast was used. The results of the CT scan showed
various findings. The liver was in correct ... Show more content on Helpwriting.net ...
A nursing diagnosis is obtained during the initial assessment and acts as an outline for the nurse to
follow in terms of how to provide appropriate prioritized care. Prioritization of care is placed in
order of patient's immediate survival and demand for safety. For these reason, nursing diagnoses are
organized in importance by looking at "airway, breathing, and circulation" (Herdman, 2016).
Interventions are also dependent on a nursing diagnosis. The selection as to which intervention will
be implemented is based upon the patient's current health status. If the patient's airway, breathing, or
circulation is compromised, the nursing diagnosis related to that condition will be treated

Hillcrest Medical Case 2
RADIOLOGY REPORT
Patient Name: Benjamin Engelhart
Patient ID: 112592 DOB: 10/05/ Age: 46 Sex: M
CT Scan No: 10–790031
Ordering Physician: Alex McClure, MD
Procedure: CT scan of abdomen and pelvis without contrast.
Date of Procedure: 11/14/2012
HISTORY: RLQ pain, no previous studies.
ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals,
kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study
appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of
the abdomen appeared unremarkable. No free air was seen.
PELVIS: Good quality, non contrasted actual CT examination of the pelvis with coronal
reconstructions. ... Show more content on Helpwriting.net ...
He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very
small bowel movement earlier this morning that was not normal for him. He has not passes has the
morning. 'he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ
without radiation at this point. He has never had a colonoscopy.
PAST MEDICAL HISTORY: Significant for arthritis of bilateral hips seen by Dr. Hersch.
PAST SURGICAL HISTORY: Negative
MEDICATIONS: Piroxicam for degenerative joint disease of bilateral hips
ALLERGIES: No known drug allergies
SOCIAL HISTORY: Patient admits alcohol ingestion nightly and on weekends. Denies tobacco use
and illicit drug us. He is married.
FAMILY HISTORY: No history of cancer or inflammatory bowel disease in his family.
REVIEW OF SYSTEMS;;12 point ROS was preformed and is negative except noted in above HIP,
PMH and PSH. Careful attention was paid to endocrine, integumentary, pulmonary, renal and
neurological exam
PHYSICAL EXAMINATION: Vital Signs. TEMPERATURE: 101.0, Blood Pressure– 127/179,
Heart Rate–129, Respirations– 185, Weight–215. Situations 96% on room air. Pain Scale– 8/10.
HEENT–Normal cephalic, atrumatic pupils equally round and reactive to light. Extra ocular motions
intact. ORAL: Shows oral pharynx clear but slightly dry mucosal membranes. TMS: Clear. NECK:
Supple, No thrangegally or JVD. No cervical, subclavicular, axilarry or lingual lymphinalpathy.

Epilepsy: A Case Study
Rationale: Fast alpha variant is a rare benign activity seen in EEG with an incidence of <1% in the
general population.1 It appears as a fast rhythmic activity (16–20 Hz) during the awake state with
twice the frequency of waking background alpha frequency. It is thought to be a benign variant of
unknown clinical significance and does not predict an increased convulsive tendency. High
incidence of the fast alpha variant has been reported in patients with psychoneurosis and idiopathic
generalized epilepsy.2 We present a case of idiopathic generalized absence epilepsy where fast alpha
rhythm potentiate epileptiform discharges and clinical seizures. Methods: Retrospective chart review
Results: A 20–year–old female with a known diagnosis of idiopathic generalized childhood absence
epilepsy (CAE) was admitted to our epilepsy monitoring unit for prolonged video EEG to
characterize the events of staring and medication efficaciousness. She was diagnosed with CAE at
age of 7 years and failed multiple seizure medications. Most recently she is taking lamotrigine. Her
EEG showed a background of 8–9 Hz alpha frequency with frequent periods of a rhythmic posterior
predominant fast beta frequency of 16–20 Hz lasting 2–4 seconds, consistent with the fast alpha
variant. No change in clinical activity was noted during these intervals. Interictally occasional burst
of high amplitude right frontal and generalized frontal predominant 3 Hz spike and polyspike wave
discharges were noted. Interestingly fast alpha variant if lasting ≥ 3 seconds, was followed by right
frontal and generalized 3 Hz spike and wave discharges. Clinically during these intervals, patient
had eye blinking, consistent with ... Show more content on Helpwriting.net ...
Fast alpha variant, though benign if present longer than 3 seconds can potentiate intrinsic
epileptogenesis and induce clinical

Abdominal Aortic Aneurysm Essay
Pathophysiology Behind Abdominal Aortic Aneurysms
The abdominal aorta supplies oxygenated blood to the abdomen, pelvis and legs. An abdominal
aortic aneurysm arises when a weakened area of the arterial wall within the abdomen becomes very
large and begins to distend outward; therefore, creating an increased susceptibility to rupture under
high pressure (Eagleton, 2012). The majority or abdominal aortic aneurysms are located inferior to
the kidneys and in order to be considered an abdominal aortic aneurysm, the local dilation must be
1.5 times its normal aortic diameter or greater than 3cm in diameter (Sun, 2012). There are two main
types of abdominal aortic aneurysms, both acquired and congenital. Predisposing factors associated
with acquired ... Show more content on Helpwriting.net ...
Wang and Tao (2015) explain that advanced technology will help diagnose these cases earlier. With
the help of improved operative skills and conservative treatment, hope to decrease the mortality rate
looks promising for future cases (Wang & Tao, 2015).
Signs and Symptoms
Aneurysms can develop slowly often with no symptoms, but symptoms may arise quickly upon
rapid expansion. With an abdominal aortic aneurysm, patients typically exhibit abdominal pain,
tachycardia, presence of a palpable, pulsatile abdominal mass, a bruit heard over the abdominal
aortic aneurysm, severe dyspnea, lower extremity edema, and elevated central venous pressure
(Kotsikoris et al., 2012). People may also experience pain near the back, abdomen, or flank, usually
signs impending rupture.

The Thoracic Ventricle

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The Thoracic Ventricle