lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
Rightly diagnosed is half cured so thorough examination of the patient is very much essential for the diagnosis and management of udara roga. Here an attempt made to understand udara roga in parlance with modern science which will be helpful for treating the patient at right time.
Portal Hypertension in pediatric populationPrabinPaudyal3
PORTAL HYPERTENSION
OUTLINE:
Definition
Causes
Pathogenesis
Clinical features
Investigations
Management
Complications
Prognosis
Approach
Definition:
Defined as:
Portal Pressure > 10-12 mm Hg, with diameter >10mm Or
Hepatic Venous Pressure Gradient > 4 mm Hg
increased portal resistance or increased portal venous blood flow
major cause of morbidity and mortality in chronic liver diseases
Portal Vein:
Causes of Portal HTN:
Extrahepatic/Pre-hepatic
Hepatic
Pre-Sinusoidal
Sinusoidal
Post-Sinusoidal
Post-hepatic
A. Extra-hepatic:
Portal Vein Thrombosis- Most common
Neonates: Omphalitis, Umbilical Vein Catheterization, Dehydration, Sepsis
Older Children: Intra-abdominal infections e.g., Appendicitis, IBD, PSC
Hypercoagulable states: Deficiencies of factor V Leiden, protein C, S
Blunt Abdominal Trauma
Portal vein agenesis, atresia, stenosis
Splenic vein thrombosis
Biliary tract disease
Extrahepatic biliary atresia
Choledochal cyst
B. Intra-hepatic:
C. Post-hepatic:
Budd-Chiari Syndrome
IVC Webs
Chronic Constrictive Pericarditis
Pathogenesis And Consequence of Portal HTN
Portosystemic collaterals:
Sites:
Lower part of esophagus
Lower part of rectum
Around Umbilicus
Clinical Features:
Bleeding:
Most common presentation
risk of first bleed in cirrhosis is 22%
rises to 38% in with known varices >5-yr period
Pattern of bleeding
Hematemesis/Malena: Most common
worsened by Stress / Intercurrent illness
Size of varices → Bleeding
Splenomegaly:
2nd Most common presentation
asymptomatic or associated with cytopenia
Ascites:
Seen in 7-21% patients
Less common but important manifestations
Portal Hypertensive Biliopathy
Growth Failure
Hepatopulmonary Syndrome
Porto-pulmonary HTN
Caput Medusae:
Abnormal, dilated venous network on anterior abdominal wall, radiating from the umbilicus
Not seen in extra-hepatic portal HTN
Seen in intra-hepatic portal HTN
Continuous murmur between umbilicus and lower sternum
Cruveilhier-Baumgarten Murmur
Investigations
USG with Doppler
portal vein diameter > 10 mm
hepatic diseases, masses, presence of varices and ascites
ascertain pattern of flow
Reversal of portal blood flow (Hepatofugal flow) - Associated with bleeding varices
Cavernous transformation of the portal vein in EHPVO
Increased thickness of lesser omentum
CECT and MRA: Needed in selective cases
Selective Arteriography: When surgical decompression is being planned
GIT Endoscopy: Most reliable to detect varices
Other investigations:
CBC
LFT
Barium swallow
Portal angiogram
Percutaneous intrasplenic measurement of portal pressure
Venography
A. Emergency Management of Bleeding Varices
1st Step (Initial resuscitation):
airway protection
Obtain I/V Access
Restoration of IV volume: fluid and BT
PRBC: Target Hb: 7-9 g/dL
Correction of coagulopathy: vitamin K, FFP/PC
NG
Delivering Micro-Credentials in Technical and Vocational Education and TrainingAG2 Design
Explore how micro-credentials are transforming Technical and Vocational Education and Training (TVET) with this comprehensive slide deck. Discover what micro-credentials are, their importance in TVET, the advantages they offer, and the insights from industry experts. Additionally, learn about the top software applications available for creating and managing micro-credentials. This presentation also includes valuable resources and a discussion on the future of these specialised certifications.
For more detailed information on delivering micro-credentials in TVET, visit this https://tvettrainer.com/delivering-micro-credentials-in-tvet/
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2. Definition
-Ascites is of greek derivation(askos)
which refers to bag or sack
-The word describes pathological fluid
accumulation in peritoneal cavity
5. Pathophysiology
• Under filling theory
primarily there is inappropriate
sequestration of fluid within the splanchnic
vascular bed as a consequence of portal
hypertension (PHT) that produces
decrease in effective circulating blood
volume. This activates the plasma rennin,
aldosterone, and sympathetic nervous
system, resulting in renal sodium and
water retention
6. Overflow theory
primary abnormality is
inappropriate
renal retention of sodium and water in the
absence of volume depletion. Basis of this
theory is that patients with cirrhosis have
intravascular hypervolemia rather than
hypovolemia
7. Peripheral arterial vasodilatation
• The major factor of ascites formation
is splanchnic vasodilation.
• Cirrhosis causes increased hepatic
resistance to portal flow that results in
PHT and shunting of blood to the syst
emiccirculation.
• Local production of vasodilators, mainly
nitric oxide due to PHT results in
splnchnic and peripheral arterial
vasodilatation. This leads to decrease in
effective arterial blood volume (EABV)
8. Pathogenic mechanism
• Increased hydrostatic pressure
• Decreased colloid osmotic pressure
• Increased permeability of peritoneal
capillaries
• Leakage of fluid into peritoneal cavity
• Misc.
20. Risk factors
•
•
•
•
•
•
Chronic viral hepatitis
Intravenous drug use
Sexual promiscuity
Transfusions
Tattos
Habitation or origination from endemic
hepatitis
25. Imaging studies
• Chest and abdominal films
-elevation of diaphragm
-nonspecific signs
-hellmer sign
-obliteration of hepatic angle
-dogs ear/mickey mouse sign
-med displacement of cecum &
ascending colon & lat displacement of
properitoneal line
26. • USG
-site for paracentesis
-100ml fluid
-uncomplicated ascites
homogenous ,freely mobile, anechioc
collection in peritoneal cavity,deep
acoustic enhancement
-massive ascites
small bowel loops-polycyclic,lollypop
like arcuate app.
27. -coarse internal echoes(blood)
-fine internal echoes(chyle)
-multiple septa(TB,pseudomyxoma
peritonei)
-loculated /atypical fluid distribution
-matting or clumping bowel loops
-thickening of interface betn fluid & adjacent
structure
28.
29. • Upper GI endoscopy
-oesophageal/fundal varices
CT/MRI
-rt perihepatic space,morrisons
pouch,douglas pouch
-malignant ascites
prop fluid in lesser & greater sac
-benign ascites
fluid in greater sac
41. Peritoneovenous shunt
• A peritoneovenous
shunt (also
called Denver shunt)
is a shunt which
drains peritoneal fluid
from the peritoneum
into veins, usually
the
internal jugular vein or
the
superior vena cava
42. Portocaval shunt
• A portacaval
shunt (or portal caval
shunt) is a treatment for
high blood pressure in the
liver. A connection is
made between the
portal vein, which
supplies 75% of the liver's
blood, and the
inferior vena cava, the
vein that drains blood
from the lower two-thirds
of the body.
44. Refractory ascitis
• Fluid load that is non responsive to
restriction of dietary sodium to
88mmol/day and maximal dose diuretic
therapy in absence of ingestion of
prostaglandin inhibitors(NSAID)
• Management
serial large volume paracentesis
100ml/kg at a time
iv albumin 6-8g/lit
