This document provides an overview of acute abdominal pain, including classifications, causes, symptoms, diagnostic tests, and treatment considerations. It describes three types of abdominal pain - visceral, parietal, and referred - and covers common intra-abdominal etiologies like appendicitis, cholecystitis, small bowel obstruction, and ischemic bowel. It also discusses extra-abdominal, toxic, metabolic, and neurogenic causes of abdominal pain and emphasizes the importance of thorough history taking and physical exam in diagnosing the source.
Physical exam of an acute surgical abdomen. Using detailed descriptions of pain along with onset and physical exam tests including peritoneal signs and more advanced physical exam maneuvers in order to formulate a diagnosis and severity of illness.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
Physical exam of an acute surgical abdomen. Using detailed descriptions of pain along with onset and physical exam tests including peritoneal signs and more advanced physical exam maneuvers in order to formulate a diagnosis and severity of illness.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
Dr. Guy Nicastri, Associate Professor of Surgery and Family Medicine at the Warren Alpert School of Medicine at Brown University takes us through some of the pearls of the Acute Abdomen Examination in the Adult
In this PPT presentation I try to teach many causes of Abdominal pain in various quadrants of the abdomen. Since it is individual case based teaching i concentrate only in the essential minimum an undergraduate medical student should know and you will have immersive learning experience.
lower GIT bleeding: is bleeding from a source distal to the ligament of Treitz (duodenojejunal junction), presented as
Hematochezia is blood passed with stool from the anus,
Melena is black, tarry stool produced by the oxidation of heme by intestinal flora; as little as 50 mL of blood may result in melena, and it may persist for 3 to 5 days following resolution of the bleed.
Maroon-colored stool is associated with rapidly bleeding small bowel lesions in which the transit of blood is too fast for complete oxidation.
Currant-jelly stool is associated with ischemic small bowel or proximal colonic lesions such as may be seen in intussusception.
Upper GIT bleeding: is bleeding from a source proximal to the ligament of Treitz (duodenojejunal junction).
Discussion included the definition of bleeding per rectum, it's types according to child age groups, it's presentation, how to diagnose each type and how to treat.
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
Acute appendicitis is the acute inflammation of the appendix, typically due to an obstruction of the appendiceal lumen. It is the most common cause of acute abdomen requiring emergency surgical intervention in both children and adults.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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.
4. Visceral Pain
O Usually caused by stretching of fibers
innervating the walls or capsules of hollow
or solid organs, respectively.
5. Parietal Pain
O Caused by irritation of fibers that innervate
the parietal peritoneum, usually the
portion covering the anterior abdominal
wall.
O Can be localized to the dermatome
superficial to the site of the painful
stimulus
6. Referred pain
O Felt at a location distant from the diseased
organ
O Usually ipsilateral to the involved organ
8. Pain Attributes
O P – precipitating (aggravating) / palliating
(alleviating) factors
O Q – quality
O R – radiation
O S – severity
O T – timing / duration / onset
9. Physical Exam
O INSPECTION – distention, scars, masses
O AUSCULTATION – normal / increased
bowel sounds, hyperactive / obstructive
bowel sounds
O PALPATION – tenderness, voluntary
guarding
O PELVIC EXAM – women of reproductive
age
O RECTAL EXAM – stool color, +/- blood,
tenderness
11. Treatment
O HYPOTENSION
O Isotonic crystalloid
O Vasoconstrictors (dopamine,
norepinephrine)
O Pump failure : Dobutamine
O ANALGESIC
O Opioids, NSAIDs
O ANTI-EMETIC
O Metoclopramide
O ANTIBIOTICS
12. Disposition
O Indication for admission:
O Appear ill
O Elderly or immunocompromised
O With unclear diagnosis
O With reasonably unexcluded potential causes of
abdominal pain
O Intractable pain or vomiting
O Acute or chronically altered mental status
O Inability to follow discharge or follow-up
instructions
O Lacking social supports
O Alcohol or other drug use
15. Appendicitis
O Clinical features
with predictive
value
O RLQ pain
O Pain migration
from the
periumbilical
area to RLQ
O Rigidity
O Pain before
vomiting
O Positive psoas
sign
17. Biliary Tract Disease
O Most ommon
diagnosis in ED
patients ≥50 years
old
O Steady post-
prandial upper
abdominal pain that
radiates to the
upper back
18. Biliary Tract Disease
O ULTRASOUND is better in the
identification of Cholecystitis than in the
detection of Common duct obstruction
O Cholescintigraphy (radionuclide
scanning)
O MR Cholangiography
19. Small Bowel Obstruction
O Central issues:
O Diagnosis of the
primary disorder, and
O Early detection of
secondary
strangulation or
ischemia
O Historical features
1. Previous
abdominal
surgery
2. Intermittent/colick
y pain
O PE findings
1. Abdominal
distention
2. Abnormal BS
20. Small Bowel Obstruction
O Ischemic bowel sec to
strangulation
O Extremely difficult to
detect clinically or
with plain
radiography
O CT
O Useful in altering the
likelihood of
ischemia
21. Acute Pancreatitis
O 80% caused by alcohol
or gallstones
O Steady and severe pain
that extends well
beyond the upper
abdomen to cause
generalized tenderness
O Resides deep in the
belly and extends into
the retroperitoneum
22. Acute Pancreatitis
O Serum lipase – begun to replace amylase
as the preferred ED screening test for
suspected acute pancreatitis
O Accuracy of serum lipase in the diagnosis
of acute pancreatitis is inversely related to
the time elapsed between symptom onset
and presentation
23. Acute Pancreatitis
O Double contrast
helical CT
O MR
cholangiopancreato
graphy (MRCP)
O ALT >150 U/L
(including
alcoholics)
O Increased risk of
biliary pancreatitis
24. Diverticulitis
O Pain confined to LLQ (<1/4 of cases)
O Pain in lower half of abdomen (1/3 of
cases)
O Generalized tenderness
O Elderly
27. Renal Colic
O Pain: unilateral
flank, abrupt
onset, colicky, radiates
to groin/testicle/labia
O Non-contrast helical CT
O Doppler UTZ +
elevation of “renal
resistive index” in one
kidney relative to the
other may identify stone
in ipsilateral ureter
28. Renal Colic
O Older patients: exclusion of an abdominal
aortic aneurysm (AAA)
O (+) Anterior abd tenderness – impacted
stone at the ureterovesical junction
29. Acute Urinary Retention
O ACUTE URETHRAL OBSTRUCTION
O Another most common GU cause of abd
pain
O Distended bladder
O Insertion of urethral catheter – dx & tx
31. Acute Pelvic Inflammatory
Disease
O Abnormal vaginal discharge
O Only PE finding assoc with laparoscopic
PID
O Transvaginal sonography
O Positive: thickened tubal wall
O Transvaginal power doppler
O Positive: hyperemia + tubal inflammation
32. Ectopic Pregnancy
O Pain may be absent at earlier stage with a
sentinel complaint of only vaginal bleeding
O ANY WOMAN OF CHILDBEARING AGE
WHO PRESENTS TO ED W/ ABD PAIN
OR ABNORMAL VAGINAL BLEEDING
SHOULD RECEIVE A QUALITATIVE
PREGNANCY TEST AS A SCREENING
MEASURE.
35. Abdominal Aortic Aneurysm
O Tend to enlarge, become aneurysmal over
years
O Triad:
HYPOTENTION, ABDOMINAL/BACK
PAIN, PULSATILE ABDOMINAL MASS
O Absence of abd pain – compatible with a
contained leak extending to
retroperitoneum
38. Mesenteric Ischemia
O Distinctions made among 4 major forms
1. Embolic is abrupt; MVT is most indolent
2. NOMI accompanied by low-flow
state, typically due to cardiac disease
3. MVT may be more amenable to non-
invasive diagnosis with CT; in younger
px; lower mortality; tx w/ immediate
anticoag
4. Arteriography w/ papaverine infusion –
impt in px w/ splanchnic vasoconstriction
39. Ischemic colitis
O A disease of older patients
O Diffuse or lower abdominal visceral pain
O Accompanied by diarrhea, often mixed
with blood
O Rectal sparring
O Segmental portions of the mucosa and
submucosa slough
41. Cardiopulmonary
O Pain of the upper half of the abdomen
(with or without tenderness)
O Chest film
O Epigastric pain + age grp CAD is
prevalent
O Cardiac history
O ECG
42. Abdominal wall
O Pain originating from the abdominal wall
may be confused with visceral pain
because superficial innervation from the
lower thoracic roots enter the spinal cord
via the same dorsal horn as the deeper
visceral afferents
O Carnett’s sign / sit-up test
O (+) abdominal wall syndrome
43. Hernias
O Defect through which intraabdominal
contents protrude, often
intermittently, during transient increases in
intraabdominal pressure
O Uncomplicated
O Asymptomatic or at worst, aching &
uncomfortable
O Significant pain: incarcerated or
strangulated
44. Hernias
O Inguinal – most common
O Femoral hernias – women
O Sonography of the abdominal wall
45. Toxic
O Infectious agents
irritate GI tract –
crampy
O Concomitant vomiting
or diarrhea
O Poisoning
O Overdose
O Opioid withdrawal
O Peritoneal tenderness
O Infarction
O Penetration
O Perforation
46. Metabolic
O Anion-gap metabolic acidoses (DKA,
AKA)
O Gastric distention
O Paralytic ileus
O If acidosis is resistant to standard
treatment, or pain persists after
normalization of pH, intraabdominal
disease should be suspected
48. Neurogenic
O Dysesthetic sensation
O “hover” sign
O Radicular problems
O Zosteriform radiculopathy
O Dysesthesia outlining a dermatome on either
side of the involved root
O Lancinating, ticlike bouts of shooting pain or
continuous burning
O Vesicles
49. NSAP
O Diagnosis of exclusion
O Nausea – most common symptom after
abdominal pain
O Mid-epigastric and lower half of the
abdomen
O Lab test usually normal / mild leukocytosis