Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
**Download to see my lecture notes!!**
Learn about the pathophysiology, clinical signs and symptoms, diagnosis and managment of the hernias of the groin- femoral and inguinal. Surgical approach is mentioned and common complications.
**Download to see my lecture notes!!**
Learn about the pathophysiology, clinical signs and symptoms, diagnosis and managment of the hernias of the groin- femoral and inguinal. Surgical approach is mentioned and common complications.
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral.
HERNIA isA hernia is a medical condition characterized by the protrusion of a...tekalignpawulose09
A hernia is a medical condition characterized by the protrusion of an organ or tissue through an abnormal opening in the muscle wall that typically holds it in place
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.
Follow us on: Pinterest
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. Approach to abdominal wall
hernia by : younis zainal khaleel
kufa college of medicine .. Medical student .. Stager
2. Topics of presentation
• 1 . All types of abdominal wall
hernia other than inguinal and
femoral (previously discussed ).
• 2 . Divarication of the rectus
abdominis and incisional hernia .
6. Umbilical hernia
Many different condition represent
umbilical hernia , they differ by each
other in there pathophysiology and
age of incidence .
1- Omphalocele & gastrochisis ( at
birth)
2-Umbilical hernia of infants and
children
3- acquired umbilical hernia (adult and
older)
*
7. omphalocele
Omphalocele and gastrochisis.
-1: 6000 births
Gastroschisis: It is the congenital anomaly
characterized by a defect in the anterior wall through
which the abdominal contents freely fall.
Omphalocele: It is a congenital birth defect that
involves the umbilical cord itself, and the organs
remain enclosed in the visceral peritoneum.
-There is some debate as to whether gastroschisis
represents a separate entity or is simply an
Omphalocele with ruptured membranes, but the
debate of little importance because the same
principles of treatments.
8. Pathophysiology of omphalocele
An omphalocele is caused by error in the embryonic
development
↓
Normal development there are 3 distinct portions formed
– foregut, midgut & hindgut
↓
At early fetal life much of midgut is temporarily
herniated outside the abdomen at the umbilicus
↓
The midgut later re-enters the abdomen and opening of
abdominal wall is closed
↓
*Failure for the midgut to return and re-enter the
abdomen
↓
Omphalocele is formed
9. • Management of omphalocele
• Small defects : may be closed primarily soon after
birth
• Large defect : a more substantial problem and four
techniques have been described:
* non-operative therapy,
* skin flap closure,
*staged closure and
* primary closure.
omphalocele
12. Pathophysiology of congenital
umbilical hernia
During development of fetus
A small opening is present in the abdominal muscles, so that
the umbilical cord can pass through, connecting mother
to baby.
Usually the abdominal opening closes.
(After birth) Sometimes these muscles do not meet- creating
a small opening.
A loop of intestine can move into the opening between
abdominal muscle and cause and hernia.
13. age : usually at birth , but may not be noticed until umbilical
cord has separated & healed or it stay so small and not noticed
until it enlarged months later.
Symptoms : usually Symptomless, but mother anxiety is
common , intestinal obstruction is extremely rare.
Signs :
_ Have a classical conical shape or hemispherical .
_ size ( range from 0.5_10cm) .
They reduce spontaneously when the child lies down and
become tense when the child cries.
Cough impulse:expansile cough impulse is invariably present.
Composition : are soft, compressible and easy to reduce,
They usually contain bowel and so may be resonant to
percussion
Congenital umbilical hernia
14. • Natural history :The vast majority of
congenital umbilical hernia disappear
spontaneously during the first few years of life
(up to 2 year), It is difficult to believe that a
large defect will close over in an active child,
but this is the usual
course of events.
Congenital umbilical hernia
15. umbilical hernia
Treatment of infantile umbilical hernia
Conservative treatment
indicated ↓ 2 years; Just reassurance of the
parents, as 95% of hernias will disappear
spontaneously and rarely strangulate .
Surgical : If persists at 2 years of age or older it
is unlikely to resolve and herniorrhaphy is
indicated.
17. UMBILICAL HERNIA IN ADULTS
A true umbilical hernia comes through the
umbilical scar. It is not common in adults
and usually secondary to raised intra-
abdominal pressure. but the common causes
of an acquired umbilical hernia are pregnancy
and ascites. The local physical signs of the
hernia are identical to those described for the
congenital variety.
20. Paraumbilical hernia
• is a protrusion through the linea alba,
• 1. just above (supraumbilical hernia)
• 2. just below the umbilicus (infraumbilical)
hernia)
21. • M:F 1:5 therefore its common in woman who are
*overweight
*ages of 35 and 50
*repeated pregnancy .
• Symptoms : The commonest symptoms are
discomfort and a swelling
• some time they present complaining of pain or
discomfort around the umbilicus, made worse by
prolonged standing or strenuous exercise , and if its
large one cause a dragging pain because of its weight
.
• Strangulation is common , but the usual contents in
this case are extraperitoneal fat or omentum, so even
strangulation occur, the bowel is not obstructed.
Paraumbilical hernia
22. Paraumbilical hernia
General examination The patient is quite likely
to be obese and may have other herniae and
generalized abdominal wall laxity.
Shape :classically make the umbilicus crescent
shape if its so near the umbilicus but not in obese
pt and in large one .
Composition The lump is firm as it usually contains
omentum. If it contains bowel, it is soft and
resonant to percussion.
If the hernia can be reduced, the firm fibrous edge of
the defect in the linea alba is easy to feel. It may
vary in size from a few millimetres in diameter to a
defect big enough to admit your hand.
26. Epigastric hernia
• occurs through the linea alba anywhere between the
xiphoid process and the umbilicus, usually midway
between these structures.
• Its usually as a protrusion of extraperitoneal fat that
why called (fatty hernia of the linea alba) , The
mouth of the hernia is rarely large enough to permit a
portion of hollow viscus to enter it; consequently, either
the sac is empty or it contains a small portion of
greater omentum.
27. Pathophysiology
it is more likely a result of a weakened linea alba due to
abnormal decussation of the fibres of the aponeurosis
That why an epigastric hernia is the direct result of a
sudden strain tearing of the interlacing fibres of the linea
alba.
and the patients are often manual workers between 30 and
45 years of age.
Epigastric hernia
28. Clinical features
• Symptomless
• Painful (attacks of local pain, worse on physical
exertion, and tenderness to touch and light clothing)
• Referred pain The pain is often associated with
eating, so the patient calls it ‘indigestion’ and makes a self-
diagnosis of peptic ulceration.
• A likely explanation for this is Referred pain that the fatty
hernia is ‘nipped’ by the linea alba on leaning forward in the
sitting position adopted at the dining table.
Epigastric hernia
29. • On examination
_feel firm, don't usually have a cough
impulse
_cannot be reduced.
_sometimes impossible to distinguish
them from lipoma
_ only the typical position suggesting
the correct diagnosis
Epigastric hernia
32. Spigelian hernia
• hernia occurring at the level of the arcuate line
• The sac, lie beneath the internal oblique muscle, where
it is virtually impalpable it advances through that
muscle and spreads out like a mushroom between the
internal and external oblique muscles and gives rise to
a more evident swelling.
33. Spigelian hernia
Clinically
So rare , usually over 50 years of age, equal in M &
F .
Typically, a soft, reducible mass will be encountered
lateral to the rectus muscle and below the umbilicus
Dx : By US , CT . Treatment : need operation
37. Obturator hernia
which passes through the obturator canal,
women : men 6:1.
Most patients are over 60 years of age.
The swelling is liable to be overlooked because it is covered
by the pectineus muscle
38. It seldom causes a definite swelling, but if the limb is
flexed, abducted and rotated outwards, the hernia
sometimes becomes more apparent.
but can cause intestinal obstruction with nausea &
vomiting.
And the presentation usually as a strangulated hernia , In
more than 50% of cases of strangulated obturator hernia,
pain is referred along the obturator nerve by its geniculate
branch to the knee.
On vaginal or rectal examination the hernia can
sometimes be felt as a tender swelling in the region of the
obturator foramen.
Treatment
Operation is indicated
Obturator hernia
39. Gluteal and sciatic hernias
• A gluteal hernia passes through the greater
sciatic foramen
• A sciatic hernia passes through the lesser
sciatic foramen.
40. Presentation : sciatica , local pain , swelling .
Differential diagnosis must be made between these
conditions and:
• a lipoma under the gluteus maximus;
• a tuberculous abscess;
• a gluteal aneurysm.
All doubtful swellings in this
situation should be explored by
operation.
Gluteal and sciatic hernias
41. • An abdominal incisional hernia is a
hernia through an acquired scar in
the abdominal wall, caused by a
previous surgical operation or
injury.
• Scar tissue stretches progressively
if subjected to constant stress.
Incisional hernia
42. Incisional hernia
occurs most often in
• obese individuals
• postoperative abdominal distension .
• Postoperative infection or haematoma .
• operations for peritonitis because, as a rule, the
wound becomes infected.
• There may be a history of factors likely to weaken
the abdominal musculature, such as chronic
cough or steroid therapy.
Weakness Often the event passes unnoticed if the
skin wound remains intact after the stitches have
been removed.
43. Clinical presentation
may occur through
1. a small portion at the lower end or frequently as a diffuse
bulging
Symptoms : The commonest symptoms are a lump and pain.
Intestinal obstruction can occur, causing distension,
colic, vomiting, constipation and severe pain in the
lump.
Those through a lower abdominal scar, usually increases
steadily in size and more and more of its contents become
irreducible .
Nevertheless, most cases of incisional hernia are
asymptomatic and broad-necked and do not need
treatment Therefore they are rarely strangulate.
Incisional hernia
44. Examination
The common findings are a lump with
an expansile cough impulse, beneath
an old scar.
Incisional hernia are not
unusual irreducible,
the defect being plugged with
adherent omentum.
Incisional hernia
45. Incisional hernia
Treatment
1.Palliative : An abdominal belt is sometimes
satisfactory, especially in cases of a hernia through an
upper abdominal incision.
2.Operation
Postoperative care
* nil by mouth and intravenous fluids until bowels have functioned
*Early ambulation and gentle physical exercise to be encouraged.
*patient should not resume strenuous exercise for several weeks.
Result of operation (recurrence )
Without mesh .. 30_50% , With mesh .. 10%
46. This is separation of the rectus abdominis muscles
with extenuation of the linea alba, from xiphisternum
to umbilicus and occasionally below.
Divarication of the rectus
abdominis
47. Divarication of the rectus
abdominis
① in children may be seen in the first few
years.
_The condition usually improves and eventually
disappears as the child grows.
The only clinical concern is the cosmetic
disfigurement,
as strangulation is impossible.
48. Divarication of the
rectus abdominis
② in adults,
in women during and immediately after childbirth. There
may be a wide separation of the muscles, with stretched
overlying abdominal skin.
As abdominal tone recovers, the defect closesbut may
become permanent after multiple pregnancies.
2 way to examine :
1.. Make the recti to relax :the patient lying supine The
examiner may be able to push a hand into the abdominal
cavity .
2.. Make the recti fully tense :ask the patient to raise the
head and legs together or other way to tense the recti ,
The thinned-out linea alba then bulges, producing a
visible swelling.
49. • Treatment
• An abdominal belt is all that is
required. As there is no risk of
strangulated intestinal contents.
Divarication of the rectus
abdominis