This document discusses acquired intestinal ileus, which can be paralytic or mechanical in nature. Paralytic ileus is caused by medications, surgery, infection, or other insults and results in paralysis of intestinal movement. Mechanical obstruction can be caused by hernias, adhesions, tumors or other structural issues that physically block intestinal contents. Symptoms include abdominal pain, distension and inability to pass gas or stool. Diagnosis involves physical exam, imaging and labs. Treatment focuses on restoring bowel motility with decompression, fluids and electrolyte replacement. The document also discusses specific causes like intussusception, adhesions and their signs, symptoms, diagnosis and management.
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
This presentation explains in detail the definition, pathophysiology, signs & symptoms, management, and prognosis of intestinal obstruction, ileus, and volvulus.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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.
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
4. Causes of paralytic ileusCauses of paralytic ileus
• Medications, especially narcotics
• Intraperitoneal infection
• Mesenteric ischemia Injury to the
abdominal blood supply
• Complications of intra-abdominal surgery
• Kidney or thoracic disease
• Metabolic disturbances (such as decreased
potassium levels)
• Cranial and cerebral injuries
8. Treatment of paralytic ileusTreatment of paralytic ileus
• Para-nephral and pre-sacral novocaine nerve
blocks
• Gastric lavage and intestinal intubation
• Stimulation of intestinal peristalsis
• IV fluids and electrolytes,
• a minimal amount of sedatives,
• adequate serum K level (> 4 mEq/L [> 4 mmol/L])
• Sometimes colonic ileus can be relieved by
colonoscopic decompression; rarely cecostomy is
required. Ileus persisting > 1 wk probably has a
mechanical obstructive cause, and laparotomy
should be considered.
9. The mechanical causes of intestinalThe mechanical causes of intestinal
obstructionobstruction
• Hernias
• Postoperative adhesions or scar tissue
• Impacted feces (stool)
• Gallstones
• Tumors
• Granulomatous processes (abnormal tissue
growth)
• Intussusception
• Volvulus
• Foreign bodies
10. Obstruction of the small bowelObstruction of the small bowel
• Abdominal cramps around the
umbilicus or in the epigastrium;
• Vomiting starts early
• Obstipation occurs with complete
obstruction, but diarrhea may be
present with partial obstruction.
• Strangulating obstruction occurs in
nearly 25% of cases and can progress to
gangrene in as little as 6 h
11. Obstruction of the large bowelObstruction of the large bowel
• Symptoms usually develop more gradually
• increasing constipation
• abdominal distention
• vomiting (not usually)
• lower abdominal cramps
• unproductive of feces
• distended abdomen
• there is no tenderness
• the rectum is usually empty
12. X-ray examinationX-ray examination
• Sign of reversed cups of Kloiber: shows
position of air-filled loops of bowel and
horizontal levels of the fluid below gas
• Presence of shady fields of the large
bowel
• If peritonitis has developed, we can see
free gas under the liver, because bowel is
damaged
13.
14. Adhesive Intestinal ObstructionAdhesive Intestinal Obstruction
The incidence of postoperative adhesive obstruction
after laparotomy is about
2%. The procedures which have highest risk for
adhesive McBurney’s point in pediatric
patients are:
1. subtotal colectomy,
2. resection of symptomatic Meckel’s diverticulum,
3. Ladd’s procedure, and
4. nephrectomy.
15. EtiologyEtiology
The causes of postoperative McBurney’s point
include adhesions, intussusception,hernia, and
tumor. Adhesions are fibrous bands of tissue that
form between loops of bowel or between the
bowel and the abdominal wall after
intraabdominal inflammation. Obstruction
occurs when the bowel is “caught” within one of
these
fibrous bands in a kinked or twisted position,
twists around an adhesive band, or herniates
between a band and another fixed structure
within the abdomen.
16. Clinical PresentationClinical Presentation
• cramping abdominal pain,
• distension, and vomiting.(bilious or even
feculent).
• Inspection of the abdomen may reveal obvious
dilated loops of bowel and distension.
• fever, tachycardia, decreased blood pressure,
abdominal tenderness and leukocytosis.
18. TreatmentTreatment
•isotonic saline solutions,
•nasogastric decompression,
• correction of electrolyte abnormalities,
• IV antibiotics,
Indications for operation include obstipation for 24 hours,
continued abdominal pain with fever and tachycardia, decreased
blood pressure, increasing abdominal tenderness, and
leukocytosis despite adequate resuscitation and medical
treatment.The abdomen is opened through a previous incision, if
present, and midline, if not. The cecum is identified and the
collapsed ileum is followed proximally until dilated bowel and
the point of obstruction is identified. The offending adhesive
bands are disrupted and the abdomen is closed. Laparoscopic
lysis of adhesions is another option and may allow a shorter
postoperative recovery and hospital stay. Postoperatively,
nasogastric decompression and intravenous fluids are
continueduntil return of bowel function and the volume of gastric
aspirate decreases.
19. Intussusception is a
process in which a segment of
intestine invaginates into the
adjoining intestinal lumen,
causing a bowel obstruction.
intussuscipiens
intussusceptum
20. FrequencyFrequency.. Intussusception is theIntussusception is the
predominate cause of intestinal obstructionpredominate cause of intestinal obstruction
in persons aged 3 months to 6 years. Thein persons aged 3 months to 6 years. The
estimated incidence is 1-4 per 1000 liveestimated incidence is 1-4 per 1000 live
births.births.
SexSex.. Overall, the male-to-female ratio isOverall, the male-to-female ratio is
approximately 3:1.approximately 3:1.
21. EtiologyEtiology
•Intussusception is most commonly idiopathic and no anatomic
lead point can be identified. Several viral gastrointestinal
pathogens (rotavirus, reovirus, echovirus) may cause hypertrophy
of the Peyer’s patches of the terminal ileum which may potentiate
bowel intussusception.
•A recognizable, anatomic lesion acting as a lead point is only
found in 2-12% of all pediatric cases. The most commonly
encountered anatomic lead point is a Meckel’s diverticulum. Other
anatomic lead points include polyps, ectopic pancreatic or gastric
rests, lymphoma, lymphosarcoma, enterogenic cyst, hamartomas
(i.e., Peutz-Jeghers syndrome), submucosal hematomas (i.e.,
Henoch-Schonlein purpura), inverted appendiceal stumps, and
anastomotic suture lines. Children with cystic fibrosis are at
increased risk of intussusception possibly due to thickened
inspissated stool.
•Postoperative intussusception accounts for 1.5-6% of all
pediatric cases of intussusception.
22. Pathology/PathophysiologyPathology/Pathophysiology
1.The intussusception begins at or near the ileocaecal valve without
local anatomical lesion to cause it
2.The mesenteric vassels are drawn between the layers of the
intussusception and compressed.
3.The sligth interference with lymphatic and venous drainage results
in edema and an increase of tissue pressure
4.Venulus and capillaries became great engorged and bloody edema
fluid drips into the lumen
5.The mucosal cells swell into goblet cells and discharge mucus,
which, mixing in the lumen with the bloody transsudate, forms the
‘current-jelly’ stool
6. Edema increases until venous inflow is completely obstructed
7. As arterial continues to pump in, tissue pressure rises until it is
higher then arterial pressure, and gangrene results
8. Gangrene appears in the outer coat of the intussuseption and
progresses back to the neck of the intussusception
9. Rarely the invagination is damaged
23. ClassificationClassification
• Colic-involving segments of large intestine
• Enteric-involving the small intestine only
• Ileocecal-ileocecal prolapses into cecum
drawing the ileum along with it
• Ileocolic-the ileum prolapses through the
ileocecal valve into the colon
28. Clinical Presentation
1. vomiting (85%)-initially, vomiting is nonbilious and
reflexive, but when the intestinal obstruction occurs,
vomiting becomes bilious.
2. abdominal pain (83%)-pain is colicky, severe, and
intermittent.
3. passage of blood or bloody mucous per rectum (53%).
4. a palpable abdominal mass
5. lethargy.
6. diarrhea.
The classic triad of pain, vomiting, and bloody mucous
stools (“red current jelly”) is present in only one third of
infants with intussusception. Diarrhea may be present in 10-
20% of patients.
29. Physical:Physical:
• Usually, the abdomen is soft and nontender early, but it
eventually becomes distended and tender.
• A vertically oriented mass may be palpable in the right
upper quadrant. Ruch’s symtom: Appering of the pain and
screams during the palpation of intussusception mass
under abdominal wall. Dance’s symptom: in ileocaecal
invagination aconcave right lateral area of abdomen is
palpable
• Currant jelly stools are observed in only 50% of cases.
• Most patients (75%) without obviously bloody stools have
stools that test positive for occult blood.
• Fever is a late finding and is suggestive of enteric sepsis.
31. Diagnostic studies:Diagnostic studies:
• Laboratory investigation usually is not helpful in
the evaluation of patients with intussusception.
Leukocytosis can be an indication of gangrene if
the process is advanced. Dehydration is
depicted by electrolyte imbalances.
• X-ray examination: barium enema or
pneumoirigography
• Sonography
• CT
35. Air contrast enema showsAir contrast enema shows
intussusception in the cecum.intussusception in the cecum.
36. Air enema showing the intussusception is in theAir enema showing the intussusception is in the
splenic flexure (arrow).splenic flexure (arrow).
37. Barium enema shows intussusceptionBarium enema shows intussusception
in the descending colon.in the descending colon.
38. CT scan reveals the classic ying-yangCT scan reveals the classic ying-yang
sign of an intussusceptum inside ansign of an intussusceptum inside an
intussuscipiens.intussuscipiens.
39. UltrasoundUltrasound
• The typical appearance is described
variously as a "target sign" a doughnut
sign, pseudokidney, or a sandwich sign.
• Colour Doppler has been used to assess
bowel viability and as a prognostic sign
that reduction will be successful
40. Abdominal sonograph reveals the classicAbdominal sonograph reveals the classic
target sign of an intussusceptum inside antarget sign of an intussusceptum inside an
intussuscipiens.intussuscipiens.
41. Intussusception.
(A) Longitudinal sonogram of a
child with the typical clinical
presentation of intussusception.
This is a longitudinal sonogram
through the intussusception.
There are multiple lymph nodes
(arrows) in the intussusception.
(B) Transverse sonogram of the
intussusception showing the
multiple lymph nodes (arrows)
within the intussusception. If
lymph nodes are seen within an
intussusceptum it has been
reported that it is more difficult to
reduce the intussusception.
42. (C) Transverse sonogram
of an intussusception
showing the color flow within
the intussusceptum. This
indicates that the
intussusception is still viable.
When no color flow is seen
on Doppler, suspicion must
be raised that the
intussusception is no longer
viable and the risk of
perforation is high.
45. Enema ReductionEnema Reduction
• Personal comfort level is probably the best
contrast selection criterion
• All have similar rates of reduction (75-85%)
and perforation (1-2%)
• End point - free reflux into small bowel and
reduction of mass
• Often see edema of ileocecal valve
• Main goal is to prevent unnecessary open
reduction, select patients who need
resection
46. Non-operative reduction of theNon-operative reduction of the
intussusceptionintussusception
Richardson balloon for pneumoirigography
47. Principles of barium enema reductionPrinciples of barium enema reduction
1. Perform nasogastric suction: administer 4 fluids or
blood and antibiotics
2. Insert ungreased Foley catheter in rectum, distend
ballon and pull down against levator. Strap in place
3. Wrap legs
4. Let barium run from height of 30 cm in above table
5. X-ray intermittently
6. Stop if barium column is stationary and its
unchanging for 10 min
7. Reduction
48. ReductionReduction is marked by:is marked by:
• free from of barium meal into small
bowel
• expulsion of feces and air with the barium
• disappearing of intussusception mass
• response of child-clinical improvement of
the patient, who may fall into a natural
sleep
52. In severe cases:In severe cases:
• Intestinal resection
• Placement of ileotransversal anastomosis
• Ileostoma and caecostoma placement
53. BIBLIOGRAPHYBIBLIOGRAPHY
• Abasiyanik A, Dasci Z, Yosunkaya A, et al: Laparoscopic-assisted pneumatic
reduction of intussusception. J Pediatr Surg 1997 Aug; 32(8): 1147-8[Medline].
• Barr LL: Sonography in the infant with acute abdominal symptoms. Semin Ultrasound
CT MR 1994 Aug; 15(4): 275-89[Medline].
• Boehm R, Till H: Recurrent intussusceptions in an infant that were terminated by
laparoscopic ileocolonic pexie. Surg Endosc 2003 May; 17(5): 831-2[Medline].
• Chang HG, Smith PF, Ackelsberg J, et al: Intussusception, rotavirus diarrhea, and
rotavirus vaccine use among children in New York State. Pediatrics 2001 Jul; 108(1):
54-60[Medline].
• Collins DL, Pinckney LE, Miller KE, et al: Hydrostatic reduction of ileocolic
intussusception: a second attempt in the operating room with general anesthesia. J
Pediatr 1989 Aug; 115(2): 204-7[Medline].
• Cull DL, Rosario V, Lally KP, et al: Surgical implications of Henoch-Schonlein
purpura. J Pediatr Surg 1990 Jul; 25(7): 741-3[Medline].
• Dennison WM, Shaker M: Intussusception in infancy and childhood. Br J Surg 1970
Sep; 57(9): 679-84[Medline].
• DiFiore JW: Intussusception. Semin Pediatr Surg 1999 Nov; 8(4): 214-20[Medline].
• Doody DP: Intussusception. In: Oldham KT, Colombani PM, Foglia RP, eds. Surgery
of Infants and Children: Scientific Principles and Practice. Lippincott-Raven; 1997:
1241-8.
• Ein SH, Stephens CA: Intussusception: 354 cases in 10 years. J Pediatr Surg 1971
Feb; 6(1): 16-27[Medline].
• Eklof OA, Johanson L, Lohr G: Childhood intussusception: hydrostatic reducibility and
incidence of leading points in different age groups. Pediatr Radiol 1980 Nov; 10(2):
83-6[Medline].