1) Abdominal paracentesis is a procedure where a needle is inserted into the peritoneal cavity to remove ascitic fluid. It can be performed for diagnostic purposes to obtain a small fluid sample for testing or therapeutically to remove over 5 liters of fluid.
2) The optimal site for paracentesis is the left lower quadrant of the abdomen to access the thicker abdominal wall and larger fluid pool. Ultrasound guidance can be used.
3) After marking the skin and administering local anesthesia using the "Z-track" technique, the needle is slowly inserted while aspirating to check for blood. Fluid flow indicates proper needle placement in the peritoneal cavity.
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Colonoscopy is a procedure used to see
inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers,
and abnormal growths. The procedure is used to look for early signs of
colorectal cancer and can help doctors diagnose unexplained changes in bowel
habits, abdominal pain, bleeding from the anus, and weight loss.
NIDDK
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung.
The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura.
The space between these two areas is called the pleural space.
This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.
Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.
IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection
Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis
ications
It is a procedure where small piece of liver tissue is removed and examined to Confirm clinical diagnosis, and assess the severity, and progression treatment response of the disease.
Colonoscopy is a procedure used to see
inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers,
and abnormal growths. The procedure is used to look for early signs of
colorectal cancer and can help doctors diagnose unexplained changes in bowel
habits, abdominal pain, bleeding from the anus, and weight loss.
NIDDK
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung.
The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura.
The space between these two areas is called the pleural space.
This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.
Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.
IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection
Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis
ications
It is a procedure where small piece of liver tissue is removed and examined to Confirm clinical diagnosis, and assess the severity, and progression treatment response of the disease.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Abdominal paracentesis, also known as an abdominal tap or ascitic tap, is a medical procedure in which a needle is inserted into the abdominal cavity to remove excess fluid that has accumulated in the peritoneal space. This procedure is typically performed to diagnose the cause of abdominal fluid accumulation (ascites) or to provide symptomatic relief for patients with large amounts of fluid in their abdomen
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Surgical Site Infections, pathophysiology, and prevention.pptx
Abdominal paracentesis
1.
2. Abdominal paracentesis is a bed side clinical
procedure in which needle is inserted into
peritoneal cavity nd ascitic fluid is removed.
TYPES:-1)diagnostic small quantity of fluid is
removed for testing.
2) therapeutic:>5 litres of fluid is removed to
reduce intraabdominal pressure and
relieve the asso. Symptms like dyspnoea,
abdmnl pain nd early satiety.
3. For evaluation of new onset ascites.
Testing of ascitic fluid.
For evaluation of pt with ascitis who has
signs of clinical deterioration like
fever,abd.pain,hepatic
encephalopathy,decreased renal function n
metabolic acidosis.
Paracentesis can identify unexpected
diagnosis such as chylous, hemorrhagic or
esinophilic ascites useful to know etiology n
antibiotic susceptibility.
4. Pt with DIC – risk is decreased by
administering platelets or FFPs.
Primary fibrinolysis(pt with 3 dimensional
bruises) treat with aminocaproic acid or IV
tranexamic acid.
Massive ileus with bowel distension.
Near the surgical scar bcoz scars are asso.
With tethering of bowel to abd.wall n will
cause bowel perforation.
Infections
5. Abnormal coagulation studies like increased
INR n Thrombocytopenia are not
contraindications.
70% pts with Ascites have abnormal PT but risk
of bleeding is low.
Pt who bleed had renal failure suggesting
qualitative platelet dysfunction asso. With
renal failure. Here desmopressin may be
used before paracentesis in pts with cirrhosis
and renal failure.
6. Explain the procedure & Obtain Consent
No fasting before Procedure
EQUIPMENT & STAFF
Clinician & Assistant
Bottles should be labelled for tests prior
doing paracentesis
Bacterial culture is done in pts with SBP
7. DIAGNOSTIC: 1.5 Inch, 22 Gauge needle
For Obese :3.5 Inch, 22 Gauge spinal needle
THERAPEUTIC: 15/ 16 Gauge needle to
speed up the removal.
KIMBERLY – CLARK QUICK TAP
PARACENTESIS TRAY CONTAINS
CADWELL NEEDLE which has a sharp inner
trocar & blunt outer metal cannula with side
holes to permit withdrawal of fluid if end hole
is occluded by bowel/ Omentum
8. Mostly Supine
Head may be elevated
Knee elbow position for removal of minimal fluid
in dependent area
SITE
Lt lower Quadrant (Dullness on percussion)
3cm medial & 2cm above the ant. Sup. Iliac
spine
Not near umbilicus bcoz of presence of
collateral vessels
Surgical scars & visible veins should be
avoided.
9.
10. Abd. Wall is thinner.
Pool of fluid is more.
Pt can be rolled easily to left for drainage.
WHY NOT RIGHT???
Appedicectomy scar, caecum filled with gas in
pts taking lactulose.
Care must be taken not to injure inferior
epigastic artery which bleeds massively &
which is located near pubic tubercle
11. Mark the site as “X” & positions 12, 3, 6, 9 a
few centimeters from “X”
Sterilise with Iodine or Chlorhexidine
Solution starting from X using widening
circular motions.
12. Anaesthetise using 3- 5 ml of 1% Lignocaine
Solution in a “Z” track technique.
Needle used for it is 1.5inch which is sufficiently
long.
Choose the site & pass the needle tangentially,
raising a wheal with Lignocaine.
“Z” track creates a non linear pathway b/n
Skin& Ascitic fluid & minimise the chance of
leakage.
13.
14. With one hand pull the abdominal wall n with
other hand operate the syringe. Hand on the
abd.wall should not be removed untill the
needle enters the fluid.
Insert the needle n syringe 5mm deep
pull the plunger back with each advancement
to see if any blood is aspirated.
then inject the lignocaine sol.
Cont. the same procedure until the needle enters
fluid.
15. Aspiration should be intermittent not
continuous.
Cont. may pull the bowel or omentum onto
needle tip,occluding the tip.
Yellow color fluid indicates needle is in the
peritoneal cavity.
NEEDLE INSERTION:
Needle is inserted along anesthetised
pathway after nick is given with 11 no. blade.
Fliud should drip from the hub of the needle.
Larger the nick greater the post paracentesis
leak.
16. Ultrasound guidance cab be used to guide
the procedure.
During laproscopy parietal peritoneum may
form tenting over needle n fluid doesn’t
come.
Operator cant see this n may mis interpret as
DRY TAP.
Rotating the needle for 90 degrees or more
will pierce the peritoneum n help the
drainage.
17. Small amount of fluid may be difficult to drain
bcoz omentum/bowel may block the end of
needle. So multi hole needles are helpful.
Misconception of poor flow is LOCULATION.
True loculation is seen in peritoneal
carcinomatosis with malignant adhesions or
bowel rupture with surgical peritonitis.
Loculation never occur in cirrhosis or heart
failure with ascites or SBP.
18. Stable needle n depth of penetration of
needle are crucial for successful
paracentesis.
TESTING
25 ml fluid is enough for cell count,diff
count,chemical testing n bacterial culture.
In TB 50ml for cytology
50ml for smear n culture.
19. It is removal of >5 lit of fluid.
In refractory ascites,removal of as much fluid as
possible with sod.restricted diet n diuretics will
extend the interval to next paracentesis.
REMOVAL OF NEEDLE:
Needle is removed with one rapid smooth
withdrawal motion.
Distract the pt by asking him to cough
bcoz cough will prevent pain sensation.
20.
21. Ascitic fluid leak:
-improper Z track
-using large bore needle
-large skin nick
Rx: keep ostomy bag over nick.
Bleeding:
-artery or vein
In inferior epigastric bleed fig. of 8 suture is
placed surrounding the needle site.
22. Rarely laprotomy is needed to control
bleeding in pts with renal failure n
hyperfibrinolysis.
Bowel perforation
Infections
Catheter residue broken into adb.wall.