The document discusses considerations for elderly surgical patients. Older patients represent a growing demographic undergoing more procedures. While age alone is a poor indicator of health, the aging process involves physiological changes that reduce cardiac, pulmonary, renal and other organ reserves. Careful preoperative evaluation of functional status is important to assess risks. Perioperative strategies aim to support compromised systems and avoid stressors that can precipitate complications in elderly patients.
Prof. M.C.Bansal discusses physiological changes in coagulation during pregnancy that result in a hypercoagulable state and increased risk of venous thrombosis. Several coagulation factors are increased while others like protein S are decreased. Inherited and acquired bleeding disorders may also develop or be exacerbated during pregnancy. Careful screening and management is required for safe delivery.
This case presentation describes a 24-year-old woman who presented with complaints of amenorrhea for 21+ weeks, per vaginal bleeding for two days, and passage of grape-like substances for one day. Her medical history and examination findings were presented. Initial diagnosis of a molar pregnancy was made based on her history and ultrasound findings. She underwent suction and evacuation surgery, which confirmed the diagnosis of a molar pregnancy based on histopathology. She was discharged with advice for follow up, contraception, and monitoring of beta hCG levels. The case discussion then provides an overview of gestational trophoblastic diseases including classification, etiology, pathogenesis, clinical features and management of hydatidiform mole.
This document discusses the management of post-partum hypertension. It outlines who is at risk, when to treat elevated blood pressure, how to treat through medication choices, and how to follow up with patients. Treatment involves using anti-hypertensive drugs like hydralazine, labetalol, and nifedipine to effectively lower blood pressure without side effects while allowing for breastfeeding. Patients should be followed closely in the first two weeks after delivery by checking blood pressure every other day and adjusting medications accordingly.
This document provides an overview of abruption placenta, including:
1. Couvelaire uterus, which is a severe form associated with massive bleeding into the uterine muscles.
2. Pathological changes in other organs like the liver, kidneys, and blood.
3. A clinical classification system grading abruption from mild to severe.
4. Clinical features that depend on the degree and speed of placental separation.
5. Ultrasonography and differential diagnosis with conditions like placenta previa.
Complications are more severe for concealed abruption, and can include maternal hemorrhage, shock, and death as well as high rates of fetal death from anoxia.
Face presentation occurs when the fetal chin presents at the pelvic inlet. The mentum engages in either a right or left oblique diameter. While mentoanterior positions often rotate anteriorly and deliver vaginally, mentoposterior positions have a 25% chance of persisting or rotating posteriorly, requiring cesarean section. Brow presentation involves the fetal forehead presenting and is not suitable for vaginal delivery due to the large engaging diameter. It usually converts to vertex or face but if persistent requires cesarean section.
1) Hypertensive disorders complicate 5-10% of pregnancies and are a leading cause of maternal mortality. They include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension.
2) Preeclampsia is defined as new hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to endothelial dysfunction and multi-organ involvement.
3) Women with signs of severe preeclampsia such as severe headaches, visual disturbances, abdominal pain, thrombocytopenia, or impaired liver or kidney function require delivery, usually between 34-37 weeks of gestation. Strict maternal and fetal monitoring is necessary for management.
The document describes how to use a partograph to monitor labor progress. A partograph should be used for all women admitted to the labor ward. It monitors cervical dilation, fetal heart rate, contractions, amniotic fluid, and any oxytocin administered. Lines on the partograph indicate when action should be taken if progress is too slow, such as artificial rupture of membranes, oxytocin augmentation, correcting malposition, or cesarean section. The partograph is an important tool for safely monitoring labor.
Prof. M.C.Bansal discusses physiological changes in coagulation during pregnancy that result in a hypercoagulable state and increased risk of venous thrombosis. Several coagulation factors are increased while others like protein S are decreased. Inherited and acquired bleeding disorders may also develop or be exacerbated during pregnancy. Careful screening and management is required for safe delivery.
This case presentation describes a 24-year-old woman who presented with complaints of amenorrhea for 21+ weeks, per vaginal bleeding for two days, and passage of grape-like substances for one day. Her medical history and examination findings were presented. Initial diagnosis of a molar pregnancy was made based on her history and ultrasound findings. She underwent suction and evacuation surgery, which confirmed the diagnosis of a molar pregnancy based on histopathology. She was discharged with advice for follow up, contraception, and monitoring of beta hCG levels. The case discussion then provides an overview of gestational trophoblastic diseases including classification, etiology, pathogenesis, clinical features and management of hydatidiform mole.
This document discusses the management of post-partum hypertension. It outlines who is at risk, when to treat elevated blood pressure, how to treat through medication choices, and how to follow up with patients. Treatment involves using anti-hypertensive drugs like hydralazine, labetalol, and nifedipine to effectively lower blood pressure without side effects while allowing for breastfeeding. Patients should be followed closely in the first two weeks after delivery by checking blood pressure every other day and adjusting medications accordingly.
This document provides an overview of abruption placenta, including:
1. Couvelaire uterus, which is a severe form associated with massive bleeding into the uterine muscles.
2. Pathological changes in other organs like the liver, kidneys, and blood.
3. A clinical classification system grading abruption from mild to severe.
4. Clinical features that depend on the degree and speed of placental separation.
5. Ultrasonography and differential diagnosis with conditions like placenta previa.
Complications are more severe for concealed abruption, and can include maternal hemorrhage, shock, and death as well as high rates of fetal death from anoxia.
Face presentation occurs when the fetal chin presents at the pelvic inlet. The mentum engages in either a right or left oblique diameter. While mentoanterior positions often rotate anteriorly and deliver vaginally, mentoposterior positions have a 25% chance of persisting or rotating posteriorly, requiring cesarean section. Brow presentation involves the fetal forehead presenting and is not suitable for vaginal delivery due to the large engaging diameter. It usually converts to vertex or face but if persistent requires cesarean section.
1) Hypertensive disorders complicate 5-10% of pregnancies and are a leading cause of maternal mortality. They include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension.
2) Preeclampsia is defined as new hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to endothelial dysfunction and multi-organ involvement.
3) Women with signs of severe preeclampsia such as severe headaches, visual disturbances, abdominal pain, thrombocytopenia, or impaired liver or kidney function require delivery, usually between 34-37 weeks of gestation. Strict maternal and fetal monitoring is necessary for management.
The document describes how to use a partograph to monitor labor progress. A partograph should be used for all women admitted to the labor ward. It monitors cervical dilation, fetal heart rate, contractions, amniotic fluid, and any oxytocin administered. Lines on the partograph indicate when action should be taken if progress is too slow, such as artificial rupture of membranes, oxytocin augmentation, correcting malposition, or cesarean section. The partograph is an important tool for safely monitoring labor.
Prediction and prevention of preeclampsiapratham98
This document discusses various screening tests and potential biochemical markers for predicting preeclampsia (PE). It notes that PE is a two-stage disorder involving inadequate invasion of spiral arteries into the myometrium in stage one, followed by an oxidatively stressed placenta releasing anti-angiogenic factors in stage two. Several biochemical markers are mentioned as showing potential for predicting PE, either alone or in combination with ultrasound measures, including placental growth factor, soluble fms-like tyrosine kinase-1, soluble endoglin, PAPP-A, and inhibin A. The document provides details on studies investigating the sensitivity and specificity of these and other markers for PE prediction.
This document discusses the differential diagnosis and management of breast lumps. The triple test of clinical breast examination, diagnostic mammography, and fine needle aspiration biopsy is recommended to evaluate breast lumps. Clinical breast examination involves visual inspection and palpation techniques to evaluate the breasts. Mammography is useful for screening and diagnosis but has limitations depending on a patient's age. Fine needle aspiration biopsy provides diagnostic information but has a small false negative rate. Ultrasound can help differentiate cysts from solid masses and guide procedures. Core needle or excisional biopsy may be used when needed for a definitive diagnosis or treatment.
(1) Abnormal progress of labour can include prolonged labour, obstructed labour, or abnormal uterine contractions. Prolonged labour is defined as poor cervical dilation or delayed fetal descent. Obstructed labour occurs when there is a mechanical obstruction preventing delivery.
(2) Factors that can contribute to abnormal labour include uterine dysfunction, fetal issues like large size or malpositioning, and maternal factors like pelvic abnormalities. Complications of prolonged labour include maternal exhaustion and increased C-section rates, as well as risks to the fetus like distress and infection.
(3) Abnormal labour is monitored using a partogram to track cervical dilation, fetal position and heart rate. Management depends on the specific issue,
The document discusses strategies for safely reducing the rate of primary cesarean deliveries. It finds that the most common indications for primary c-sections are labor dystocia, abnormal fetal heart rate tracings, fetal malpresentation, multiple gestation, and suspected macrosomia. Safe reduction of c-section rates will require different approaches tailored to each of these indications. Some strategies discussed include revising the definition of labor dystocia, improving interpretation of fetal heart rate monitoring, increasing access to support during labor, attempting external cephalic version for breech babies, and allowing trial of labor for some twin pregnancies. The document emphasizes using evidence-based guidelines and a multifaceted approach at the organizational and regional levels,
This document discusses trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section for women with a prior cesarean delivery. It notes that 60-80% of women who attempt TOLAC will have a successful vaginal birth. The risks of TOLAC include uterine rupture, failed trial of labor requiring emergency cesarean, and slightly increased risk of complications for the baby. The risks of elective repeat cesarean include increased risks for placenta problems and complications in future pregnancies. The document provides an overview of the risks, benefits, and success rates to help women decide which option is safest for their individual situation.
A 25-year-old woman presented with irregular vaginal bleeding following evacuation of a molar pregnancy 6 weeks prior. On examination, she was anemic and her uterus was enlarged to 16 weeks size. Ultrasound and beta-hCG levels confirmed incomplete evacuation of molar tissue. She underwent a second suction and evacuation procedure where a large amount of molar tissue was removed. She was advised follow up monitoring of beta-hCG levels and contraceptive use, and warned to report any symptoms like bleeding or vision changes during recovery.
This document discusses preterm prelabour rupture of membranes (PPROM), which complicates 2% of pregnancies but is associated with 40% of preterm deliveries and can result in neonatal morbidity and mortality. It is diagnosed through maternal history and sterile speculum exam. Ultrasound may help confirm but a normal fluid index does not rule it out. Women should be observed for signs of chorioamnionitis every 4-6 hours. The document outlines antibiotic, corticosteroid and tocolytic treatment and discusses the timing of delivery for managing PPROM.
This document discusses hypertension in pregnancy, including gestational hypertension. It defines gestational hypertension as blood pressure of 140/90 or higher after 20 weeks of pregnancy without proteinuria, with blood pressure returning to normal within 12 weeks postpartum. It notes that early onset of gestational hypertension and higher blood pressure are risk factors for progression to preeclampsia. Treatment for gestational hypertension focuses on monitoring and controlling severe high blood pressure, with delivery occurring between 37-38 weeks.
This document discusses hypertensive disorders in pregnancy. It defines various types of hypertensive disorders including pregnancy-induced hypertension, pre-eclampsia, eclampsia, and chronic hypertension. It provides details on the pathophysiology, risk factors, clinical features, investigations, management, and complications of pre-eclampsia and eclampsia. Common antihypertensive drugs used for treatment are also mentioned.
Hypertensive disorders of pregnancy (HDP) are among the top 3 causes of maternal mortality, responsible for 10-15% of deaths. The new classification of HDP defines it as hypertension in pregnancy and removes eclampsia from the major classification. Prediction of preeclampsia is important because the risk of recurrence can be as high as 35% and it is associated with maternal and neonatal complications. However, current screening tests are not reliable enough for clinical use as they lack specificity and predictive value. Treatment aims to control blood pressure and prevent complications like eclampsia.
Obstructed labor occurs when the fetus cannot pass through the birth canal due to mechanical problems, resulting in prolonged and obstructed delivery. Signs of obstructed labor include exhaustion, anxiety, tachycardia, dehydration, foul breath, and scanty urine in the mother. Physical examination shows a tender, tonic uterus, full bladder, bandl's ring, edematous vulva, dry vagina, poorly applied cervix, and meconium draining. Complications for the fetus include asphyxia, hemorrhage, pneumonia, sepsis, facial injuries, and convulsions. Investigations like ultrasound, CT scan, and MRI are used to assess fetal and pelvic anatomy.
This document discusses caesarean section (CS), including the different types (primary vs repeat), rising CS rates due to various factors, and indications for CS. It also covers the details of lower segment CS vs classical CS, including techniques, risks, and benefits. Complications of CS and measures to reduce unnecessary CS are also mentioned.
This document discusses the case of a 25-year-old pregnant woman with beta thalassemia major. She is 38 weeks pregnant with her third child. She has a history of beta thalassemia major diagnosed at age 15 and requires regular blood transfusions. Her current pregnancy has been uncomplicated except for mild anemia and IUGR. She is scheduled for a C-section due to her condition and late gestation. The document then provides details on beta thalassemia, its effects on pregnancy, recommended prenatal care and management during pregnancy for women with this condition.
Locally advanced breast cancer refers to stage IIIA and IIIB breast cancer where the cancer has spread locally but not to distant sites. It is typically treated with a multi-pronged approach including neoadjuvant chemotherapy to shrink the tumor followed by surgery if possible. Post-operatively, patients receive adjuvant chemotherapy, radiation therapy, and hormone therapy if the cancer is hormone receptor positive. The goal of neoadjuvant chemotherapy is to downstage the tumor to allow for breast conserving surgery rather than mastectomy in some cases. Prognosis depends on response to neoadjuvant chemotherapy and surgical margins. Inflammatory breast cancer, a rare but aggressive form of locally advanced disease, has a poorer prognosis despite intensive treatment
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
This case study describes a 37-year-old female patient who presented with a breast mass. Diagnostic tests performed included a mammogram, biopsy, and right modified radical mastectomy which revealed invasive ductal carcinoma. The management plan for this patient includes neoadjuvant chemotherapy, followed by surgical therapy such as modified radical mastectomy and adjuvant radiation therapy. Adjuvant chemotherapy or hormone therapy may also be recommended depending on risk factors. Regular follow-up exams are important to monitor for potential recurrence.
The document discusses polyhydramnios, a condition where there is excess amniotic fluid in the amniotic sac during pregnancy. It occurs in about 1% of pregnancies and is typically diagnosed when the amniotic fluid index is greater than 24 cm. The document outlines causes of polyhydramnios like diabetes, twin-twin transfusion syndrome, and fetal abnormalities. It also discusses symptoms, diagnosis via ultrasound, and potential management strategies like monitoring, inducing early labor, or draining excess fluid in severe cases. The goal is to monitor the condition and prevent complications for the health of the mother and baby.
1) Thyroid nodules are common findings that require evaluation to determine if they are malignant or benign.
2) Evaluation involves patient history, physical exam, laboratory tests like TSH, ultrasound of the thyroid, and fine needle aspiration biopsy of suspicious nodules.
3) Most nodules are benign but ultrasound and biopsy help determine the small percentage that require surgical removal due to cancer risk.
Acs0006 Risk Stratification, Preoperative Testing, And Operative Planningmedbookonline
This document discusses risk stratification, preoperative testing, and operative planning. It outlines tools for assessing surgical risk such as the American Society of Anesthesiologists physical status classification system. Factors that affect cardiac risk are identified, such as smoking, alcohol abuse, and previous cardiovascular disease. Guidelines for preoperative testing are presented, noting the need for selective testing. The importance of identifying clinical risk factors and optimizing modifiable factors is discussed.
Pre operative cardiac assessment dr sadany-1Hossam atef
This document discusses perioperative cardiac risk assessment and management. It covers pre-operative evaluation of patient risk factors and conditions, classification of surgical procedures by urgency, predictors of perioperative cardiac complications, and recommendations for testing and treatment based on patient risk profile and functional capacity. The goal is to stratify patient risk and determine optimal management to reduce complications during surgery and recovery.
Prediction and prevention of preeclampsiapratham98
This document discusses various screening tests and potential biochemical markers for predicting preeclampsia (PE). It notes that PE is a two-stage disorder involving inadequate invasion of spiral arteries into the myometrium in stage one, followed by an oxidatively stressed placenta releasing anti-angiogenic factors in stage two. Several biochemical markers are mentioned as showing potential for predicting PE, either alone or in combination with ultrasound measures, including placental growth factor, soluble fms-like tyrosine kinase-1, soluble endoglin, PAPP-A, and inhibin A. The document provides details on studies investigating the sensitivity and specificity of these and other markers for PE prediction.
This document discusses the differential diagnosis and management of breast lumps. The triple test of clinical breast examination, diagnostic mammography, and fine needle aspiration biopsy is recommended to evaluate breast lumps. Clinical breast examination involves visual inspection and palpation techniques to evaluate the breasts. Mammography is useful for screening and diagnosis but has limitations depending on a patient's age. Fine needle aspiration biopsy provides diagnostic information but has a small false negative rate. Ultrasound can help differentiate cysts from solid masses and guide procedures. Core needle or excisional biopsy may be used when needed for a definitive diagnosis or treatment.
(1) Abnormal progress of labour can include prolonged labour, obstructed labour, or abnormal uterine contractions. Prolonged labour is defined as poor cervical dilation or delayed fetal descent. Obstructed labour occurs when there is a mechanical obstruction preventing delivery.
(2) Factors that can contribute to abnormal labour include uterine dysfunction, fetal issues like large size or malpositioning, and maternal factors like pelvic abnormalities. Complications of prolonged labour include maternal exhaustion and increased C-section rates, as well as risks to the fetus like distress and infection.
(3) Abnormal labour is monitored using a partogram to track cervical dilation, fetal position and heart rate. Management depends on the specific issue,
The document discusses strategies for safely reducing the rate of primary cesarean deliveries. It finds that the most common indications for primary c-sections are labor dystocia, abnormal fetal heart rate tracings, fetal malpresentation, multiple gestation, and suspected macrosomia. Safe reduction of c-section rates will require different approaches tailored to each of these indications. Some strategies discussed include revising the definition of labor dystocia, improving interpretation of fetal heart rate monitoring, increasing access to support during labor, attempting external cephalic version for breech babies, and allowing trial of labor for some twin pregnancies. The document emphasizes using evidence-based guidelines and a multifaceted approach at the organizational and regional levels,
This document discusses trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section for women with a prior cesarean delivery. It notes that 60-80% of women who attempt TOLAC will have a successful vaginal birth. The risks of TOLAC include uterine rupture, failed trial of labor requiring emergency cesarean, and slightly increased risk of complications for the baby. The risks of elective repeat cesarean include increased risks for placenta problems and complications in future pregnancies. The document provides an overview of the risks, benefits, and success rates to help women decide which option is safest for their individual situation.
A 25-year-old woman presented with irregular vaginal bleeding following evacuation of a molar pregnancy 6 weeks prior. On examination, she was anemic and her uterus was enlarged to 16 weeks size. Ultrasound and beta-hCG levels confirmed incomplete evacuation of molar tissue. She underwent a second suction and evacuation procedure where a large amount of molar tissue was removed. She was advised follow up monitoring of beta-hCG levels and contraceptive use, and warned to report any symptoms like bleeding or vision changes during recovery.
This document discusses preterm prelabour rupture of membranes (PPROM), which complicates 2% of pregnancies but is associated with 40% of preterm deliveries and can result in neonatal morbidity and mortality. It is diagnosed through maternal history and sterile speculum exam. Ultrasound may help confirm but a normal fluid index does not rule it out. Women should be observed for signs of chorioamnionitis every 4-6 hours. The document outlines antibiotic, corticosteroid and tocolytic treatment and discusses the timing of delivery for managing PPROM.
This document discusses hypertension in pregnancy, including gestational hypertension. It defines gestational hypertension as blood pressure of 140/90 or higher after 20 weeks of pregnancy without proteinuria, with blood pressure returning to normal within 12 weeks postpartum. It notes that early onset of gestational hypertension and higher blood pressure are risk factors for progression to preeclampsia. Treatment for gestational hypertension focuses on monitoring and controlling severe high blood pressure, with delivery occurring between 37-38 weeks.
This document discusses hypertensive disorders in pregnancy. It defines various types of hypertensive disorders including pregnancy-induced hypertension, pre-eclampsia, eclampsia, and chronic hypertension. It provides details on the pathophysiology, risk factors, clinical features, investigations, management, and complications of pre-eclampsia and eclampsia. Common antihypertensive drugs used for treatment are also mentioned.
Hypertensive disorders of pregnancy (HDP) are among the top 3 causes of maternal mortality, responsible for 10-15% of deaths. The new classification of HDP defines it as hypertension in pregnancy and removes eclampsia from the major classification. Prediction of preeclampsia is important because the risk of recurrence can be as high as 35% and it is associated with maternal and neonatal complications. However, current screening tests are not reliable enough for clinical use as they lack specificity and predictive value. Treatment aims to control blood pressure and prevent complications like eclampsia.
Obstructed labor occurs when the fetus cannot pass through the birth canal due to mechanical problems, resulting in prolonged and obstructed delivery. Signs of obstructed labor include exhaustion, anxiety, tachycardia, dehydration, foul breath, and scanty urine in the mother. Physical examination shows a tender, tonic uterus, full bladder, bandl's ring, edematous vulva, dry vagina, poorly applied cervix, and meconium draining. Complications for the fetus include asphyxia, hemorrhage, pneumonia, sepsis, facial injuries, and convulsions. Investigations like ultrasound, CT scan, and MRI are used to assess fetal and pelvic anatomy.
This document discusses caesarean section (CS), including the different types (primary vs repeat), rising CS rates due to various factors, and indications for CS. It also covers the details of lower segment CS vs classical CS, including techniques, risks, and benefits. Complications of CS and measures to reduce unnecessary CS are also mentioned.
This document discusses the case of a 25-year-old pregnant woman with beta thalassemia major. She is 38 weeks pregnant with her third child. She has a history of beta thalassemia major diagnosed at age 15 and requires regular blood transfusions. Her current pregnancy has been uncomplicated except for mild anemia and IUGR. She is scheduled for a C-section due to her condition and late gestation. The document then provides details on beta thalassemia, its effects on pregnancy, recommended prenatal care and management during pregnancy for women with this condition.
Locally advanced breast cancer refers to stage IIIA and IIIB breast cancer where the cancer has spread locally but not to distant sites. It is typically treated with a multi-pronged approach including neoadjuvant chemotherapy to shrink the tumor followed by surgery if possible. Post-operatively, patients receive adjuvant chemotherapy, radiation therapy, and hormone therapy if the cancer is hormone receptor positive. The goal of neoadjuvant chemotherapy is to downstage the tumor to allow for breast conserving surgery rather than mastectomy in some cases. Prognosis depends on response to neoadjuvant chemotherapy and surgical margins. Inflammatory breast cancer, a rare but aggressive form of locally advanced disease, has a poorer prognosis despite intensive treatment
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
This case study describes a 37-year-old female patient who presented with a breast mass. Diagnostic tests performed included a mammogram, biopsy, and right modified radical mastectomy which revealed invasive ductal carcinoma. The management plan for this patient includes neoadjuvant chemotherapy, followed by surgical therapy such as modified radical mastectomy and adjuvant radiation therapy. Adjuvant chemotherapy or hormone therapy may also be recommended depending on risk factors. Regular follow-up exams are important to monitor for potential recurrence.
The document discusses polyhydramnios, a condition where there is excess amniotic fluid in the amniotic sac during pregnancy. It occurs in about 1% of pregnancies and is typically diagnosed when the amniotic fluid index is greater than 24 cm. The document outlines causes of polyhydramnios like diabetes, twin-twin transfusion syndrome, and fetal abnormalities. It also discusses symptoms, diagnosis via ultrasound, and potential management strategies like monitoring, inducing early labor, or draining excess fluid in severe cases. The goal is to monitor the condition and prevent complications for the health of the mother and baby.
1) Thyroid nodules are common findings that require evaluation to determine if they are malignant or benign.
2) Evaluation involves patient history, physical exam, laboratory tests like TSH, ultrasound of the thyroid, and fine needle aspiration biopsy of suspicious nodules.
3) Most nodules are benign but ultrasound and biopsy help determine the small percentage that require surgical removal due to cancer risk.
Acs0006 Risk Stratification, Preoperative Testing, And Operative Planningmedbookonline
This document discusses risk stratification, preoperative testing, and operative planning. It outlines tools for assessing surgical risk such as the American Society of Anesthesiologists physical status classification system. Factors that affect cardiac risk are identified, such as smoking, alcohol abuse, and previous cardiovascular disease. Guidelines for preoperative testing are presented, noting the need for selective testing. The importance of identifying clinical risk factors and optimizing modifiable factors is discussed.
Pre operative cardiac assessment dr sadany-1Hossam atef
This document discusses perioperative cardiac risk assessment and management. It covers pre-operative evaluation of patient risk factors and conditions, classification of surgical procedures by urgency, predictors of perioperative cardiac complications, and recommendations for testing and treatment based on patient risk profile and functional capacity. The goal is to stratify patient risk and determine optimal management to reduce complications during surgery and recovery.
ACC AHA Guidelines on Perioperative Cardiac AssesementMenaga Vasudewan
The ACC/AHA guidelines provide recommendations for preoperative cardiac risk assessment and perioperative management of noncardiac surgery patients. The guidelines classify patients into different risk levels based on 5 factors, including coronary history, prior cardiac testing, comorbidities, functional status, and surgery risk. They provide a 9 step algorithm to determine which patients need further cardiac testing or optimization of medical therapy prior to surgery based on their risk level. The guidelines aim to identify patients at high risk for cardiac complications from surgery and make recommendations to reduce surgical risk and improve outcomes.
Perioperative cardiac assessment for non-cardiac surgeryAnor Abidin
Non-cardiac surgery represents an opportunity to assess patients' short-term and long-term cardiac risk and treat any significant cardiac diseases or risks. The referring physician should inform patients of the evaluation results and implications for their prognosis. Further, physicians should avoid stating a patient is "cleared for surgery" and instead focus on perioperative cardiac optimization and management of risks.
This document discusses mitral valve disease and treatment options such as surgical repair/replacement and the MitraClip procedure. Some key points:
- Mitral regurgitation (MR) is the most common valve problem and increases in prevalence with age. Left untreated, MR can lead to heart failure and death.
- Surgical treatment has traditionally been the only option to reliably reduce MR, but many patients are considered too high-risk for surgery.
- The MitraClip procedure is a minimally invasive treatment that fills this gap for inoperable patients by using a clip to repair the mitral valve and reduce MR without open heart surgery.
- Clinical trials show the MitraClip procedure reduces MR
The document discusses guidelines for pre-operative cardiac evaluation to identify patients at risk of peri-operative complications and determine the need for interventions. It outlines goals of evaluating a patient's history, physical exam, and tests to determine cardiac risk. Non-invasive tests include ECG, stress testing, and echocardiogram. Surgical risk is stratified as high, moderate, low. Guidelines provide a framework to screen patients. The evaluation involves assessing risk factors, functional capacity, surgical risk to categorize patients and guide management through anesthesia, medical optimization, or possible revascularization.
Preop evaluation of cardiac patient postd=ed for non cardiac surgery Rajesh Munigial
This document discusses pre-operative evaluation and preparation of cardiac patients for non-cardiac surgeries. It outlines that patients with coronary artery disease undergoing non-cardiac surgery are at increased risk of complications. A thorough pre-operative evaluation including history, physical exam, diagnostic tests, and knowledge of the planned surgery is important to assess risk factors and develop a management plan. Tests like ECG, stress testing, echocardiogram and in some cases angiography help evaluate cardiac status. Medical optimization including management of angina, heart failure, diabetes, etc. can help reduce perioperative risk. Timing of surgery depends on the clinical status and risk of delay. Intraoperative management focuses on preventing ischemia.
This document discusses mitral valve disease and treatment options. It provides information on:
- Mitral regurgitation (MR), the most common type of heart valve disease, which occurs when the mitral valve does not close properly.
- Treatment options for MR including open-heart surgery, minimally invasive surgery, robotic surgery, and the MitraClip procedure. MitraClip offers a less invasive alternative for high-risk surgical patients.
- Guidelines for referral for mitral valve repair/replacement, focusing on patients with moderate-severe or severe MR who are at high-risk for open-heart surgery.
- The large population of MR patients who are not surgical candidates, representing an unmet
Non cardiac surgery in cardiac patients moTamer Taha
This document discusses guidelines for evaluating and managing cardiac risk in patients undergoing non-cardiac surgery. It outlines factors that increase surgical risk like prolonged stress and changes in thrombotic factors. Complication rates are reported to be 7-11% with 0.8-1.5% mortality depending on precautions. Up to 42% of complications are cardiac related. It provides recommendations on pre-operative testing and risk stratification using indices. Risk reduction strategies discussed include use of beta-blockers, statins, and revascularization. Perioperative management of antiplatelets and anticoagulants is also covered.
Perioperative myocardial infarction is a common cause of morbidity and mortality in patients undergoing noncardiac surgery. It can occur through acute coronary syndrome or prolonged myocardial ischemia in patients with stable coronary artery disease. Diagnosis is difficult as symptoms often do not present in anesthetized patients. Risk is determined by patient clinical factors, exercise capacity, and surgery risk. Management may include beta blockers, statins, aspirin, and evaluating need for revascularization based on standard criteria.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced myocardial blood flow associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities, determine significance of angiographic findings, and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and known or suspected congestive heart failure.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
Dr. Brijesh Savidhan discusses strategies for evaluating cardiac risk in patients undergoing non-cardiac surgery. The goals are to identify patients at risk, evaluate the severity of underlying heart disease, and stratify surgical risk. A thorough history, physical exam, electrocardiogram, and assessment of functional capacity are recommended. For higher-risk patients, stress testing and evaluation of left ventricular function may be considered to guide management and minimize perioperative complications. Overall, a multidisciplinary approach is important to optimize cardiac status, determine the safest location and timing of surgery, and develop an anesthesia plan tailored to each patient's cardiac condition.
The document discusses the role of cardiopulmonary exercise testing (CPET) before, during, and after left ventricular assist device (LVAD) implantation for advanced heart failure. CPET is useful diagnostically and prognostically before LVAD implantation to help determine candidacy. It can also help guide cardiac rehabilitation and monitor recovery after LVAD implantation. CPET values are important criteria used to select candidates for LVAD and heart transplantation.
Coronary heart disease is best addressed by a comprehensive approach aimed at halting atherosclerotic disease and reducing the risk of thrombosis. Unfortunately, our success in optimal risk factor modification in patients with stable CHD remains poor: only 41% of patients achieved all basic goals in the recent ISCHEMIA trial, with success rates likely even lower outside the rigorous clinical trial context. A greater focus on achieving prevention goals in patients with CHD will have a substantial impact on patient outcome and rates of hospitalization and more resources and incentives should be allocated for improved secondary prevention.
The ISCHEMIA trial suggests that even selected, high-risk patients with extensive ischemic burden do not benefit from revascularization barring unacceptable angina despite OMT. As ISCHEMIA excluded patients with unacceptable angina, advanced heart failure, and those with unprotected left main disease, our evaluation may be geared to identify such patients for consideration of revascularization alongside an initial strategy of OMT.
Atherosclerosis is a systemic disease of the arterial circulation, with focal areas of more severe manifestation. From an imaging standpoint, the paradigm of ischemia testing may have come to an end. Recent evidence from COURAGE, PROMISE, SCOT-HEART, and ISCHEMIA has demonstrated that functional testing for inducible myocardial ischemia is inferior to anatomic assessment for risk stratifying and managing patients with suspected or known CHD. Consistent with a large body of evidence, risk from CHD is mediated by the extent of atherosclerotic disease burden and not by the extent of inducible ischemia. Given that 55% of patients had nonobstructive CHD by CT in PROMISE, which was associated with 77% of cardiovascular deaths and myocardial infarctions at follow-up, there is immense opportunity to impact the disease at an earlier stage in a very large population of patients with occult CHD.
This document discusses sudden cardiac death (SCD) in young athletes. SCD is the leading cause of death in exercising young athletes, with estimates of incidence ranging from 1 in a million to as high as 1 in 3,000 for some athlete populations. SCD often results from structural heart abnormalities that may be detected through pre-participation physicals. Pre-participation cardiovascular screening evaluates large athlete populations before participation to reduce the risk of SCD. The document goes on to discuss recommendations and components of pre-participation cardiovascular screening examinations.
Diastolic heart failure occurs when a patient exhibits signs and symptoms of heart failure but has a normal left ventricular ejection fraction over 45%. It accounts for approximately 40-60% of heart failure cases. The main causes are hypertension and coronary artery disease. Diagnosis involves clinical signs and echocardiographic evidence of abnormal diastolic function with normal systolic function. Management focuses on controlling blood pressure, heart rate, and congestion with diuretics, along with revascularization for underlying coronary artery disease.
Diastolic heart failure occurs when a patient exhibits signs and symptoms of heart failure but has a normal left ventricular ejection fraction over 45%. It accounts for approximately 40-60% of heart failure cases. The main causes are hypertension and coronary artery disease. Diagnosis involves clinical signs and echocardiographic evidence of abnormal diastolic function with normal systolic function. Management focuses on controlling blood pressure, heart rate, and congestion with diuretics, along with revascularization for underlying coronary artery disease.
Similar to Acs0901 The Elderly Surgical Patient (20)
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.