This document provides an overview of acute cholecystitis. It defines cholecystitis as inflammation of the gallbladder, usually resulting from gallstones obstructing the cystic duct. It discusses the epidemiology, relevant anatomy, etiology, pathogenesis, clinical presentation, investigations, treatment and complications of acute cholecystitis. The standard treatment is initially conservative management followed by delayed cholecystectomy once the inflammation has subsided.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Please find the power point on Carcinoma of rectum. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
A quick review of the various benign pathologic conditions of Gallbladder,intended primarily for the Undergraduate students; Based on Bailey & Love's Short Practise of Surgery latest edition.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Please find the power point on Carcinoma of rectum. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
A quick review of the various benign pathologic conditions of Gallbladder,intended primarily for the Undergraduate students; Based on Bailey & Love's Short Practise of Surgery latest edition.
Complicated diverticular disease
Diverticulitis is the most usual clinical complication of
diverticular disease, affecting 10–25% of patients with
diverticular.
The process by which diverticulitis arises has been likened to that of appendicitis, with a diverticulum becoming obstructed by inspissated stool in its neck.
This faecalith abrades the mucosa of the sac, causing inflammation and expansion of usual bacterial flora, with
diminished venous outflow and localised ischaemia.
Bacteria may breach the mucosa and extend the process
through the full wall thickness, ultimately leading to
perforation.
etiology ,classifications of gall stones & causes,risk factors,presentations, clinical examinations ,investigations including radiological (role of ERCP and MRCP ) and serological ,treatment including surgical and non surgical ,post cholecystectomy syndrome and its management ,Iindicatrions for cholecystectomy and cholecystotomy & when to perform ,complications of gall stones ,preventions of gall stone disease
gall stone disease, etiology , pathogenesis , risk factors ,types of gall stones,clinical feature, diagnosis , medical and surgical treatment of gall stones , prevention of gall stones
tutorials in surgery, surgery training curriculum, residency in surgery, surgical education, principles of surgery, operative surgery, surgical anatomy, pathology and radiology, research methodology, surgery mcqs, surgery essay writing, part 1 exams, part 2 fellowship exams.
resident doctors. medical officers and house officers
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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3. Cholecystitis is the inflammation of the gall bladder.
Calculus cholecystitis results from obstruction by gall stone and is the
commonest cause of cholecystitis.
• EPIDEMIOLOGY
(Fat, Fair, Female, Fertile, at Fourty)
90% of patient with acute cholecystitis is associated with calculus
obstruction. Cholelithiasis is common in western countries. 10% of
adult white hours gall stones . 60% of patients are women. It afflicts
more than 20million Americans annually. Most are silent. Only 20%
develop acute cholecystitis
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Pear shape organ
that lie at the
underside of the liver
between the right
and left lobe
7.5-12cm long
Capacity about 25-
30ml
Cystic duct is 3cm in
length, 1-3mm in
diametre
CHD 2.5cm
CBD 7.5cm
8. • Three factors are important in the formation of gall stones
• Metabolic ; reduction of bile salt cholesterol ratio below 13:1 e.g
avitaminosis A or excessive gallbladder absorption in ifection
• Infection; streptococci, E.coli, salmonella, Cl. welchi
• Bile stasis; stasis enable gall stone to grow
• Types of stone;
• Cholesterol (20%)
• Pigment (5%)
• Mixed (75%)
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9. • Cholesterol stones:
• Obesity, age <50
• Estrogens: female, multiparity, OCPs
• Commer in western/ developed countries
• Terminal ileal resection or disease (Crohn’s Disease)
• Impaired gallbladder emptying: starvation, DM type 1
• Rapid weight loss: rapid cholesterol mobilization and biliary stasis
• Inborn error of bile salt metabolism
• hyperlipidemia
• Pigment stones :
• Commoner in Asia and Africa
• More in rural than urban area
• Chronic (contains calcium bilirubinate):
• Cirrhosis
• Chronic hemolysis
• Biliary stasis (strictures, dilation, biliary infection)
10. • When stone becomes impacted in the cystic duct the gall
bladder becomes inflamed(chemical and bacterial
inflammation). The mucous membrane is swollen and the wall
thickened. The event may now take several turns
the mucous membrane may become lifted away from the sides of the
stone wedged in the neck of the gall bladder, so that the muco-
purulent content of the bladder drain into the common bile duct. The
attack is then temporarily arrested.
Impaction may persist leading to empyema of the gall bladder.
May perforate (rare- due thickening of wall from recurrent cholecytitis,
seen diabetic and elderly)
Gangrene of the gall bladder- interference to blood supply
Empyema and inflammatory mass
Mirzzi syndrome
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11. stones
obstruction to
bile outflow
inflammation of gall bladder wall due to
phospholipases from the mucosa hydrolyzes biliary
lecithin to lysolecithin (toxic to the mucosa)
disrupt normal
protective
glycoprotein layer
exposed the mucosal
epithelium to the direct
detergent action of bile salts
Superimposed bactrial
infection
Distended gall
bladder
Prostaglandin
released
Mucosal and
mural
inflammation
Increase
intraluminal
pressure
Compromise
mucosal blood
flow
12. • HISTORY
• Pain
• Epigastric
• Right hypochondrial
• Sudden onset
• Associated with fatty meals
• Nausea and vomiting
• Fever
• Jaundice +/-
• Transient
• Usually sets in 2nd or 3rd day of the illness
• Marked or persistent in choledocholithiasis
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13. • PHISICAL SIGNS
• Pyrexia
• Tenderness, rebound tenderness and guarding or rigidity are
found in the right hypochondrium.
• Omental phlegmon- mass gallbladder and omentum, at the
right hypochodrium, as pain subside. It may turn out to be an
empyema or carcinoma especially in the elderly.
• Positive Murphy’s sign
• Positive Boas sign; tenderness over the 9th- 11th right ribs
posteriorly
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14. • Abdominal Uss;
• Calculi cast acostic shadow (80-90%)
• Thickening wall mucosa
• Distended gall bladder with serosal oedema (halo sign)
• Pericystic collection of fluid
• Plain X-ray
• Opacity (10-20%)
• Gas seen in gall bladder or biliary passage ; suggests infection by
anaerobes or passage of stone into the duodenum
• Full blood count ; leucocytosis
• LFT; slight elevation of serum transaminase, elevataed
alkaline phosphatase, bilirubin
• Elevated serum amylase
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15. • The general accepted practice is non-operative
management in the acute phase followed by
cholecystectomy. (interval or delayed cholecystectomy
6 weeks after inflammation has subsided)
• Argument ;
• Majority of patients settle on conservative measures
• Dissection of inflammed area could lead to spread of infection
• With inflammation there is anatomical anomalies with risks of error
• Patient with high risk of perforation are frequently
identifiable(diabetic and aged)
However, in recent years, early operation is increasingly
offered. Following conservative measures, patient is
operated as elective in the next available operation list in
few days.
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16. • REST THE INFLAMMED GALLBLADDER
• NPO, N-G tube aspiration
• IV fluids
• Anticholinergic drugs; propantheline 15mg i.m 8hourly or atropine
0.6mg i.m 8hourly for more rapid action
• SEDATION + analgesia
• Pethidine 100mg i.m
• NSAID suppresses pain from tension within the biliary system
• ANTIBIOTICS
• Broad spectrum and bactericidal. Third generation
cephalosporines are agent of choice
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17. 1. Signs of incipient perforation; temperature and pulse
not improving in 24-36hours. Pain and tenderness
persist across the abdomen.
2. Spreading gangrene of the gallbladder with redness and
oedema of the overlying skin
3. Presence of inflammatory mass in the right
hypochondrium
4. Mucocele
5. Detection of gas in the extrabiliary system
6. Detection of intestinal obstruction
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18. • Cholecystectomy
The gall bladder and cystic duct are removed by
transection and dissection of the cystic duct close to the
common bile duct
Types; Open or laparoscopic
Principles;
• Adequate exposure
• Exclude concomitant pathology of neighboring structures-
preliminary laparotomy
• Defining anatomy
• Adequate hemostasis
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19. Newer, fewer post op complication, shorter hospital stay
Absolute contraindications
• I. Sepsis including cholangitis
• 2. Diffuse peritonitis
• 3. Bleeding diathesis.
Relative contraindications
• I. Previous upper abdominal surgery
• 2. Acute cholecystitis
• 3. Choledocholithiasis
• 4. Gallstone pancreatitis
• 5. Co-existent carcinoma, diverticular and
• inflammatory bowel disease
• 6. Cirrhosis
• 7. Significant anaesthetic risks
• 8. Minor bleeding disorder (eg. aspirin intake)
• 9. Pregnancy
• 10. Obesity.
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21. • Cholecystostomy
The fundus of the gall bladder is opened and stone
removed with a forceps self retaining catheter place and
exteriorised via a separate wound. Elective
cholecystectomy the performed in 3-6 weeks
• Unfit – severely ill
• Elderly
• Empyema
• Persistent and progressive symptoms
. Better option as chances of injury to adjacent structures is higher
in emergency cholecystectomy
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22. • Iatrogenic bile duct injury
• Post op bile leak
• Haemorrhage
• Retained stone
• Post cholecystectomy syndrome
• Inadvertent bowel injury
• Subcutaneous emphysema
• Anaesthetic complication
24. • Overall reported mortality of acute cholecystitis is 2-3%
with much higher figures (10%) in patient over 70. This is
largely due to incidental cardiorespiratory disease and
complication.
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25. • Steven M. strasberg, MD; acute calculus cholecystitis. The
new England jornal of Medicine 2008; 358:2804-11
• E.A Badoe et al, “Principles and Practice of surgery including
pathology in the tropics” 4th edition, Assembly of God
Literature Center ltd, 2009
• Bailey and Love’s “Short Practice of Surgery” 26th edition
CRC press Taylor and Francis group. 2013
• www.slideshare .net
• www.wikepedia .org
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Editor's Notes
Bilesalt and lecithine keeps cholestherol in soluble state
Moynihan aphorism “a gallstone is a tombstone erected to the organism within it”
PIGMENT STONE:
Hemolytic anemias and infections of the biliary tract → increased unconjugated bilirubin in the biliary tree → form precipitates : insoluble calcium bilirubinate salts.
CHOLESTEROL STONE:
when bile is supersaturated with cholesterol, with GB hyopomotility, it precipitates. Mucus hypersecretion trap crystals aggregating into stone.
The major complications are bile duct injury (1%), bile
leak with biliary peritonitis (4 %), bleeding (3%), perforation
Of a viscus (0.3%) and retained stones.
About 90% of patients having successful laparoscopic
cholecystectomy leave hospital within 24h andover 91 % return
to full normal activity in one week