Surgical management of gastroesophageal reflux disease (GERD) and hiatal hernia is an approach used when conservative treatments fail to provide adequate relief or in cases where complications arise. GERD is a condition characterized by the backward flow of stomach acid and contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and chest pain. Hiatal hernia, on the other hand, occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity.
The surgical treatment of GERD and hiatal hernia aims to reinforce the lower esophageal sphincter (LES) and repair the anatomical defect in the diaphragm. This is typically achieved through a procedure called fundoplication, which involves wrapping a portion of the upper stomach (fundus) around the lower esophagus to create a new valve-like mechanism. This reinforces the LES and helps prevent the backflow of stomach acid into the esophagus.
There are different surgical techniques available for fundoplication, including open surgery and minimally invasive procedures such as laparoscopic or robotic-assisted surgery. Laparoscopic surgery involves making small incisions in the abdomen and using specialized instruments and a tiny camera to perform the procedure. Robotic-assisted surgery utilizes robotic arms controlled by the surgeon to perform precise movements during the operation.
The advantages of minimally invasive techniques over traditional open surgery include smaller incisions, reduced postoperative pain, faster recovery, and shorter hospital stays. However, the choice of surgical approach depends on various factors, including the patient's overall health, the size of the hiatal hernia, and the surgeon's expertise.
Surgical management of GERD and hiatal hernia can provide long-term relief from symptoms and improve the quality of life for many patients. However, as with any surgery, there are potential risks and complications involved, such as infection, bleeding, difficulty swallowing, and gas-related discomfort. It is important for patients to discuss the potential benefits and risks with their healthcare provider and undergo a thorough evaluation before considering surgical intervention.
Overall, surgical management plays a crucial role in the treatment of GERD and hiatal hernia, particularly for individuals who do not respond well to medication or lifestyle modifications. It offers an effective solution to restore the normal functioning of the lower esophageal sphincter and repair the anatomical defect, providing relief from symptoms and reducing the risk of complications associated with these conditions.
Presentation; Discussion of Herd Behaviour is Erroneous Human Decision Making; PROACT Decision Making Tool; 30 Point Multi-Dimensional assessment tool; Selection of the Best Bariatric Surgey; Discussion of the Lack of Risk of Gastric Cancer and the Billroth II
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.
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the latest guidelines ACR and EULAR, Ahmed Yehia Ismaeel, MD Beni-Suef University
ACR EULAR CLASSIFICATION CRITERIA FOR GOUT
EULAR 2023 Guidelines on gout imaging
ACR guideline recommendations for gout management
SOAP NotePatient Initials RA Pt. Encounter Number .docxpbilly1
SOAP Note
Patient Initials: RA Pt. Encounter Number: 1
Date: 10/1/20 Age: 23 Sex: female
Allergies: NKA Advanced Directives: none
SUBJECTIVE
CC: “I have been having heavy periods for 4-5 months now. I feel tired and dizzy most days”
HPI: 23-year-old came to the clinic today complaining of heavy menstrual periods happening for the past 4 to 5 months. Accompanying the heavy flow, patient states that she has moderate cramps. Pt describes the pain as stabbing and its 3 out of the 0-10 scale. Patient does not take any medications for the pain. The pain is decreased by applying warm compresses to the lower abdominal area. In addition, patient complains of feeling dizziness and tiredness most of the times.
Current Medications: none
PMH Medication Intolerances: NONE Chronic Illnesses/Major traumas: NONE Screening Hx/Immunizations Hx: Vaccinations up to date, most recent pap smear 12/19 – negative Hospitalizations/Surgeries: None
Family History:Father: Alive, No medical history Mother: Alive, Htn
Social History: Patient is a full-time college student and part time employee at Publix as cashier. Pt lives at home with parents and denies having had a sexual partner for the past year. Patient denies the use of cigars, alcohol, or illegal drugs.
ROS
GeneralDenies recent weight loss, fever, change in appetite or headaches. She denies chills or night sweats. CardiovascularDenies palpitations, chest pain, orthopnea, and claudication. Reports episodes of hypotension.
SkinDenies bruising, skin rash, or discoloration. Denies changes in moles or skin breakdown. RespiratoryDenies shortness of breath, abnormal sputum, cough, or wheezing.
EyesDenies pain, redness, loss of vision, double or blurred vision GastrointestinalDenies abdominal pain, decreased appetite, nausea, or vomiting. Denies food intolerances and changes in stool
EarsDenies ear pain, ear infections, or tinnitus Genitourinary/GynecologicalDenies dysuria, flank pain, and hematuria. Denies abnormal vaginal discharge or itching. Denies STI history. Reports heavy menstrual periods lasting 5 to 6 days, associated with cramping; every 28 days. OBSTETRIC/GYNECOLOGICAL Hx:Menarche: 11 years LMP: 09/15/20 G 0 T 0 P 0 A 0 L 0 Birth Control/Type: NoneMenopause: no Sexually Active: yes STD Hx: None
Nose/Mouth/ThroatDenies nasal pain, congestion, epistaxis, or postnasal drip. Denies pain in mouth, bleeding gums, or dry mouth. Denies pain in throat, hoarseness, difficulty or painful swallowing. MusculoskeletalDenies muscle pain or joint pain. Denies limited range of motion
BreastDenies breast tenderness, discharge, redness, or lumps. NeurologicalDenies headache, dizziness, seizures, or memory loss.
Heme/Lymph/EndoPt denies bruising PsychiatricDenies mood changes, irritability, or changes in concentration. Denies hav.
Surgical management of gastroesophageal reflux disease (GERD) and hiatal hernia is an approach used when conservative treatments fail to provide adequate relief or in cases where complications arise. GERD is a condition characterized by the backward flow of stomach acid and contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and chest pain. Hiatal hernia, on the other hand, occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity.
The surgical treatment of GERD and hiatal hernia aims to reinforce the lower esophageal sphincter (LES) and repair the anatomical defect in the diaphragm. This is typically achieved through a procedure called fundoplication, which involves wrapping a portion of the upper stomach (fundus) around the lower esophagus to create a new valve-like mechanism. This reinforces the LES and helps prevent the backflow of stomach acid into the esophagus.
There are different surgical techniques available for fundoplication, including open surgery and minimally invasive procedures such as laparoscopic or robotic-assisted surgery. Laparoscopic surgery involves making small incisions in the abdomen and using specialized instruments and a tiny camera to perform the procedure. Robotic-assisted surgery utilizes robotic arms controlled by the surgeon to perform precise movements during the operation.
The advantages of minimally invasive techniques over traditional open surgery include smaller incisions, reduced postoperative pain, faster recovery, and shorter hospital stays. However, the choice of surgical approach depends on various factors, including the patient's overall health, the size of the hiatal hernia, and the surgeon's expertise.
Surgical management of GERD and hiatal hernia can provide long-term relief from symptoms and improve the quality of life for many patients. However, as with any surgery, there are potential risks and complications involved, such as infection, bleeding, difficulty swallowing, and gas-related discomfort. It is important for patients to discuss the potential benefits and risks with their healthcare provider and undergo a thorough evaluation before considering surgical intervention.
Overall, surgical management plays a crucial role in the treatment of GERD and hiatal hernia, particularly for individuals who do not respond well to medication or lifestyle modifications. It offers an effective solution to restore the normal functioning of the lower esophageal sphincter and repair the anatomical defect, providing relief from symptoms and reducing the risk of complications associated with these conditions.
Presentation; Discussion of Herd Behaviour is Erroneous Human Decision Making; PROACT Decision Making Tool; 30 Point Multi-Dimensional assessment tool; Selection of the Best Bariatric Surgey; Discussion of the Lack of Risk of Gastric Cancer and the Billroth II
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.
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the latest guidelines ACR and EULAR, Ahmed Yehia Ismaeel, MD Beni-Suef University
ACR EULAR CLASSIFICATION CRITERIA FOR GOUT
EULAR 2023 Guidelines on gout imaging
ACR guideline recommendations for gout management
SOAP NotePatient Initials RA Pt. Encounter Number .docxpbilly1
SOAP Note
Patient Initials: RA Pt. Encounter Number: 1
Date: 10/1/20 Age: 23 Sex: female
Allergies: NKA Advanced Directives: none
SUBJECTIVE
CC: “I have been having heavy periods for 4-5 months now. I feel tired and dizzy most days”
HPI: 23-year-old came to the clinic today complaining of heavy menstrual periods happening for the past 4 to 5 months. Accompanying the heavy flow, patient states that she has moderate cramps. Pt describes the pain as stabbing and its 3 out of the 0-10 scale. Patient does not take any medications for the pain. The pain is decreased by applying warm compresses to the lower abdominal area. In addition, patient complains of feeling dizziness and tiredness most of the times.
Current Medications: none
PMH Medication Intolerances: NONE Chronic Illnesses/Major traumas: NONE Screening Hx/Immunizations Hx: Vaccinations up to date, most recent pap smear 12/19 – negative Hospitalizations/Surgeries: None
Family History:Father: Alive, No medical history Mother: Alive, Htn
Social History: Patient is a full-time college student and part time employee at Publix as cashier. Pt lives at home with parents and denies having had a sexual partner for the past year. Patient denies the use of cigars, alcohol, or illegal drugs.
ROS
GeneralDenies recent weight loss, fever, change in appetite or headaches. She denies chills or night sweats. CardiovascularDenies palpitations, chest pain, orthopnea, and claudication. Reports episodes of hypotension.
SkinDenies bruising, skin rash, or discoloration. Denies changes in moles or skin breakdown. RespiratoryDenies shortness of breath, abnormal sputum, cough, or wheezing.
EyesDenies pain, redness, loss of vision, double or blurred vision GastrointestinalDenies abdominal pain, decreased appetite, nausea, or vomiting. Denies food intolerances and changes in stool
EarsDenies ear pain, ear infections, or tinnitus Genitourinary/GynecologicalDenies dysuria, flank pain, and hematuria. Denies abnormal vaginal discharge or itching. Denies STI history. Reports heavy menstrual periods lasting 5 to 6 days, associated with cramping; every 28 days. OBSTETRIC/GYNECOLOGICAL Hx:Menarche: 11 years LMP: 09/15/20 G 0 T 0 P 0 A 0 L 0 Birth Control/Type: NoneMenopause: no Sexually Active: yes STD Hx: None
Nose/Mouth/ThroatDenies nasal pain, congestion, epistaxis, or postnasal drip. Denies pain in mouth, bleeding gums, or dry mouth. Denies pain in throat, hoarseness, difficulty or painful swallowing. MusculoskeletalDenies muscle pain or joint pain. Denies limited range of motion
BreastDenies breast tenderness, discharge, redness, or lumps. NeurologicalDenies headache, dizziness, seizures, or memory loss.
Heme/Lymph/EndoPt denies bruising PsychiatricDenies mood changes, irritability, or changes in concentration. Denies hav.
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263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
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.
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
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
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
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
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
2. OVERVIEW
O Introduction
O What are FB ?
O Where FB are lodged?
O Who are at risk ?
O Clinical features
O Investigtions
O Management
O MCQs
O References
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 2
3. INTRODUCTION
O FBs of GIT are not so dangerous as air
way foreign bodies.
O very common problem among children
and elderly
O 80-90 % pass harmlessly
O 10–20% will require endoscopic
intervention
O < 1% will require surgery
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 3
4. WHAT ?
O Coin (45%)
O Fish bone (12%)
O Sharp (8%)
(nails, pins,blades )
O batteries. Keys, small toys
O Food bolus impactions
O Tooth brush : eating disorders
O Dentures partial , Teeth –artificial or natural
O Meat or chicken bone
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 4
5. WHO?
O Pediatric patients (80%)
AGE: 6 months - 4 years.
O Psychiatric patients
O Patients with underlying GI disorders
(malignancy,strictures,achalasia)
O Edentulous elderly patients
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 5
6. WHERE in GIT ?
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 6
9. HISTORY
O Did you witness the child ingesting a foreign
body?
O Did the child report to you that he/she ingested a
foreign body?
O Do you know what the foreign body is? (size,
shape, identity)
O Do you know when the child ingested the foreign
body?
O Have you found the foreign body in the
stool/vomitus already?
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 9
10. O Does the child have any other medical
illnesses or have had previous surgery?
O Does the child have :
Fever, abdominal pain, or vomiting?
Stools? If so, how many times, what
color?
Difficulty breathing ?
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 10
11. CLINICAL FEATURES
Esophageal foreign body symptoms
O Dysphagia
O Food refusal, weight loss
O Drooling, gagging
O Emesis/hematemesis
O Foreign body sensation
O Chest pain, sore throat
O Noisey breathing, difficulty breathing, cough,
O Unexplained fever
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 11
12. Stomach/lower GI tract foreign bodies
O Abdominal distention
O Abdominal pain
O vomiting
O Hematochezia
O Unexplained fever
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 12
13. PHYSICAL EXAMINATION
O Usually unremarkable
O Oral cavity/oropharynx/Neck :
• Drooling or pooling of secretions
• Impacted FB : hypopharynx
• Crepitus ,swelling : neck
O Per Abdomen: tenderness, rigidity,distention
(perforation/ obstruction)
O Chest : wheeze , stridor
3/15/2018
APPROACH TO FOREIGN BODY INGESTION 13
15. 2.Neck /Chest/Abdominal Radiography
O Initial Investigation of choice
O Most ingested foreign bodies are radiopaque
(60%)
Determines :
O Presence
O Type
O location of the foreign body.
O Identifying possible complications
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APPROACH TO FOREIGN BODY INGESTION 15
19. 3.Metal detectors:
• Identification of metallic FB
• Aluminum FB - often radiolucent.
• look for progresssion of metallic FB in
GIT
4.Endoscopy:
O diagnostic and therapeutic
O Radiolucent FB
5. CT- Scan :
• Non metallic ,radiolucent FB
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20. MANAGEMENT
O Site
O Size
O Type
O Duration
O Complications
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APPROACH TO FOREIGN BODY INGESTION 20
21. Removed immediately:
O Batteries in esophagus
O Length> 10cm
O Any object
Child: >1cm X 3cm
Adult: > 2cm X 5 cm
O Symptomatic, f/o perforation
O Esophageal FB (> 24 hrs at presentation)
O Sharp ,pointed FB
O Batteries remaining in the stomach (> 48 h )
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22. Conservative management
(wait and watch )
O Coins in the esophagus : 12–24 Hrs
O Any asymptomatic blunt object : 1week
Child: <1cm X 3cm
Adult: < 2cm X 5 cm
O Asymptomatic Disk batteries and
cylindrical batteries in stomach : upto 48
Hrs.
O Progression ; serial xrays , metal detector
O laxatives to increase GI motility
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APPROACH TO FOREIGN BODY INGESTION 22
23. Methods of removal
1.Endoscopy
O Procedure of choice
O Minimally invasive
O Success rate: 90-100%
O Can retrive FB up to 2nd part of duodenum
(FB beyond that often passes spontaneously)
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24. 2. Surgical
A. Cervical esophagostomy
B. Thoracotomy
C. laparotomy
INDICATIONS:
O Evidence of perforation, hemorrhage, fistula
formation, obstruction.
O FB fail to progress (lie beyond stomach)
O FB not retrieved endoscopically.
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25. MCQs
1.Which is the most common FB in
esophagus
A. Button batteries
B. Coin
C. Fish bone
D. chicken bone
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26. 2. Where is the FB ?
AP: sagittal (end on) Lat: coronal (face )
oesophagus
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26
27. REFERENCES
O Current opinion in pediatrics ;Foreign bodies in GIT
O African Journal of Emergency Medicine Volume 5,
Issue 4 December 2015, Pages 176-180;
Investigation and management of foreign body
ingestion in children at a major paediatric trauma unit
in South Africa
O Conners GP, Hadley JA. Esophageal coin with an
unusual radiographic appearance. Pediatric Emerg
Car. 2005;21:667-669.
O Raney LH, Losek JD. Child with esophageal coin and
atypical radiograph. J Emerg Med 2008;34:63-66
O Srilakshmi Narra, MD and Firas H. Al-Kawas MD;
The Importance of Preparation and Innovation in the
Endoscopic Management of Esophageal Foreign
Bodies
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