The document discusses acute appendicitis. It describes the anatomy of the appendix and explains that appendicitis is usually caused by obstruction of the appendix lumen by a fecalith. The clinical features of appendicitis include pain that initially starts around the umbilicus and later localizes to the right lower quadrant, along with nausea, vomiting, fever and tenderness at McBurney's point. Diagnosis is often made through ultrasound or CT scan. Treatment involves surgical removal of the appendix (appendicectomy) through an open or laparoscopic approach.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
Inguinal and femoral hernia:
A hernia is a protusion of a viscus or a part of viscus through and abnormal opening in the walls of its containing cavity. Details of inguinal hernia and few slides on other types of hernia.
Appendicitis is characterized by inflammation of the appendix. it is most common abdominal emergency encountered in children. most common symptom is pain., vomiting and low - grade fever. Here, nurses play an important role in managing the problem before the doctor arrives. so read this out and it will help you in the future.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
Inguinal and femoral hernia:
A hernia is a protusion of a viscus or a part of viscus through and abnormal opening in the walls of its containing cavity. Details of inguinal hernia and few slides on other types of hernia.
Appendicitis is characterized by inflammation of the appendix. it is most common abdominal emergency encountered in children. most common symptom is pain., vomiting and low - grade fever. Here, nurses play an important role in managing the problem before the doctor arrives. so read this out and it will help you in the future.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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!
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
2. Anatomy
Located at the terminal end of caecum, 2 cm below the
ileocaecal junction.
Length is about 5-10 cm .Diameter of appendix is 3-8 mm and
diameter of lumen is 1-3 mm.
Parts of appendix : base ,body and tip
The mesentery attached to the appendix is known as
mesoappendix which contains appendicular vessels.
Mesoappendix doesn’t extend up to the tip of appendix so in
obstructive type of appendicitis the commonest site of
gangrene is the tip(the least vascular area).
3. • Appendix is supplied by appendicular artery which is a
branch of ileocolic artery. The appendicular artery is an
end artery.
• The base of the apppendix is usually located at the
MacBurney’s point.
• Opening of appendix into the caecum is guarded by valve
of Geralch.
• Most common position of appendix is retrocaecal (78%)
next is pelvic (21%).
5. Acute appendicitis
Etiology
Common in young males and whites races
Low fibre diet
Viral infection can cause mucosal oedema and
inflammation which later gets infected by bacteria
30% chances in first degree relatives
Obstruction of lumen by faecoliths(most common),
stricture, foreignbody and roundworm may cause
obstructive appendicitis.
Adhesion and kinking
Distal colonic obstruction
Abuse of purgatives
6. • Organisms are E.coli, enterococci, streptococci,
anaerobic streptococci , Cl.welchii
• Pseudoappendicitis is appendicitis due to acute ileitis due
to yersinia infection.
Pathogenesis
Non obstructive appendicitis: acute inflammation of the
mucus membrane with secondary infection. It may lead to
resolution ,fibrosis ,recurrent appendicitis or eventual
obstructive appendicitis.
7. Obstructive appendicitis :
• luminal obstruction by faecoliths, FB, Carcinoma,lymphoid
hyperplasia ,pinworm
• Mucus and inflammatory fluid collects inside the lumen
and increased intraluminal pressure
• Blockage of lymphatic and venous drainage resulting in
increased oedema of mucosa and wall
• Mucosal ulceration and ischemia, bacterial translocation.
If thrombosis of appendicular artery-ischaemic necrosis –
gangrene of appendix and then perforation at the tip or
base=peritonitis
8. • After perforation-localization at greater omentum and
dilated ileum occurs-with suppuration and
pus=appendicular abscess
• In severe acute appendicitis, localization at G. omentum
and dilated ileum occurs without pus formation =
appendicular mass
• Acute appendicitis with blockage at the opening of lumen-
mucus collects inside the lumen resulting in enlargement
of appendix = Mucocele of appendix
9. Types of appendicitis
1. Acute non-obstructive appendicitis
2. Acute obstructive appendicitis
3. Recurrent appendicitis: repeated attacks of non-
obstructive
4. Subacute appendicitis
5. Stump appendicitis: due to retained stump of appendix
after lap appendicitomy
11. • Pain:visceral pain around the umbilicus d/t distension of
appendix later after few hours somatic pain in RIF d/t
irritation of parietal peritoneum d/t inflamed appendix
• Vomiting d/t reflex pylorospasm
• Constipation/diarrhoea
• Fever, tachycardia, fetor oris
• Urinary frequency
Tenderness and rebound tenderness at McBurney’s point
in RIF
P/R examination tenderness in the right side of rectum
Hyperaesthesia in Sherren’s triangle( ASIS ,umbilicus and
pubic symphisis )
12. Clinical signs in appendicitis
Rovsing’s sign
On pressing the LIF ,pain occurs in the RIF d/t shift of
bowel loops which irritated the parietal peritoneum.
Blumberg’s sign(release sign)
pain upon removal of pressure rather than application of
pressure to the abdomen.
Cope psoas sign(hyperextension) and obturator
sign(internal rotation) of the right hip causing pain in the
RIF d/t irritation of the psoas muscle and obturator
internus muscle respectively.
Baldwing’s test: when legs are lifted off with knee
extended, pain complains pain while pressing over the
flanks.
14. In children
1) Meckel’s diverticulum
2) Acute colitis
3) Intussusception
4) Roundworm colic
5) Lobar pneumonia
6) Acute iliac lymphadenitis
In females
1. Ruptured ectopic gestation
2. Mittelschmerz rupture of ovarian follicle
3. Ovarian cyst torsion
4. Salpingo-oophoritis
15. Investigations
• U/S to rule out stones, cyst, pancreatitis, ectopic
pregnancy and confirm appendicular abscess or mass.
• USG findings: size of appendix >6mm ,hyperechoic
thickened appendix wall >2mm- target sign, appendicolith,
interruption of submucosal continuity, periappendicular
fluid.
• Total leucocyte count is increased.
• Contrast CT scan
• C-reactive protein, MRI
• Plain X-ray: to R/O duodenal ulcer perforation, intestinal
obstruction and ureteric stone
16.
17.
18. Treatment
• Surgery : Appendicectomy
• Approaches
• Grid iron incision at (incision perpendicular to
the McBurney’s point)
• Rutherford Morison incision
• Lanz crease(centering at McBurney’s point)
• Right lower paramedian incision or
• Lower midline incision
• Laparoscopic approach
• Fowler-weir approach
McBurney’s point is the lateral 1/3 and
medial 2/3 of imaginary line joining ASIS
and umbilicus.
19.
20. Open appendectomy
G.A is given.
Mark McBurney’s point and grid-iron incision is given.
Skin is incised. Subcutaneous tissue and superficial
fascia (camper’s and scarpa’s) are cut using cautery.
A nick is given to external oblique aponeurosis.it is
opened in the line of incision and the incised free margins
are lifted up using artery forceps.
Internal oblique and tranversus muscle are split in the line
of fibres.(retracted to reach the peritoneum)
Peritoneum is held at 2 places by mosquito forceps.nick is
given between two forceps.
Peritoneal cavity entered.
21. Caecum is identified by the presence of taenia coli and
ileocaecal junction. Appendix is held by Babcock’s
forceps.
Window is made in the mesoappendix with the help of
curved artery forceps. Mesoappendix and appendicular
artery is ligated using vicryl 2-0
Junction of caecum with appendicular base is identified.
Now the appendix is crushed with straight clamp about 3-
5mm away from the caecum. Reapplied again
Base of the appendix is double ligated using vicryl 2-0.
appendix is cut distal to the suture ligature and removed.
Stump is cleaned with antiseptics and exposed portion is
cauterized.
Internal oblique, T. abdominus and peritoneum closed
with vicryl 1-0. gut preserved. E.O.A is closed vicryl 1-0
continuous
22. Complications after appendicectomy
A. Reactionary haemorrhage d/t slipping of ligature of
appendicular artery
B. Paralytic ileus
C. Residual abscess
D. Pylephlebitis
E. Adhesion, kinking and intestinal obstruction
F. Right inguinal hernia
G. wound sepsis
H. Faecal fistula