1. Ascites is an accumulation of fluid in the peritoneal cavity, most commonly caused by cirrhosis of the liver.
2. Diagnosis involves physical exam findings, ultrasound imaging, and analysis of ascitic fluid. A serum ascites albumin gradient (SAAG) can help determine if ascites is caused by portal hypertension.
3. Initial treatment involves sodium restriction, diuretics like spironolactone and furosemide, and therapeutic paracentesis if needed. Refractory ascites may require transjugular intrahepatic portosystemic shunt or liver transplantation.
Acute cholangitis is an infection of the bile ducts caused by obstruction and bacterial overgrowth. It presents with fever, jaundice, and right upper quadrant pain (Charcot's triad). Obstruction leads to increased pressure and bacterial growth in the bile ducts. Diagnosis involves blood tests, imaging like ultrasound or CT, and testing bile if drained. Treatment is antibiotics, hydration, and relieving obstruction endoscopically or surgically. Antibiotics are continued until obstruction is fully resolved to prevent recurrence.
This document provides an overview of acute gastrointestinal bleeding. It defines upper gastrointestinal bleeding and discusses its causes, including variceal and non-variceal sources. Signs and symptoms are outlined. The approach involves taking a thorough history and physical exam. Key lab tests include CBC, LFTs, coagulation panels and endoscopy. Treatment depends on the bleeding source, and may include endoscopic methods, radiological embolization, surgery, or medications like PPIs and vasoactive drugs. Complications are also reviewed.
Oliguria is a low urine output defined as less than 1 mL/kg/hr in infants, less than 0.5 mL/kg/hr in children, and less than 300 mL daily in adults. It indicates an underlying disorder and can lead to acute renal failure if left untreated. Anuria is even less urine output at less than 50 mL/day. Causes of oliguria and anuria include pre-renal (low blood volume), renal (kidney damage), and post-renal (urinary tract obstruction). Evaluation and management depends on determining the cause through history, physical exam, urinalysis, and blood tests to guide volume replacement or other interventions to prevent further kidney injury.
The document discusses pancreatitis, including its anatomy, physiology, classification, signs and symptoms, diagnosis, and management. It addresses both acute and chronic pancreatitis. Acute pancreatitis is commonly caused by gallstones or alcohol and can be mild, moderately severe, or severe based on organ dysfunction. It presents with abdominal pain and elevated pancreatic enzymes. Chronic pancreatitis is usually due to alcohol abuse and causes pain, digestive issues, and diabetes over time. Management involves treating the underlying cause, supportive care, and surgery for complications.
This document provides information on ascites including its definition, causes, diagnosis, and management. Ascites is defined as the accumulation of free fluid in the peritoneal cavity, most often caused by liver cirrhosis (75% of cases), malignancy, or heart failure. Diagnosis involves history, physical exam finding shifting dullness or fluid wave, and abdominal ultrasound or paracentesis. Initial ascites management consists of sodium restriction, diuretics, and large volume paracentesis for refractory ascites.
1. Ascites is an accumulation of fluid in the peritoneal cavity, most commonly caused by cirrhosis of the liver.
2. Diagnosis involves physical exam findings, ultrasound imaging, and analysis of ascitic fluid. A serum ascites albumin gradient (SAAG) can help determine if ascites is caused by portal hypertension.
3. Initial treatment involves sodium restriction, diuretics like spironolactone and furosemide, and therapeutic paracentesis if needed. Refractory ascites may require transjugular intrahepatic portosystemic shunt or liver transplantation.
Acute cholangitis is an infection of the bile ducts caused by obstruction and bacterial overgrowth. It presents with fever, jaundice, and right upper quadrant pain (Charcot's triad). Obstruction leads to increased pressure and bacterial growth in the bile ducts. Diagnosis involves blood tests, imaging like ultrasound or CT, and testing bile if drained. Treatment is antibiotics, hydration, and relieving obstruction endoscopically or surgically. Antibiotics are continued until obstruction is fully resolved to prevent recurrence.
This document provides an overview of acute gastrointestinal bleeding. It defines upper gastrointestinal bleeding and discusses its causes, including variceal and non-variceal sources. Signs and symptoms are outlined. The approach involves taking a thorough history and physical exam. Key lab tests include CBC, LFTs, coagulation panels and endoscopy. Treatment depends on the bleeding source, and may include endoscopic methods, radiological embolization, surgery, or medications like PPIs and vasoactive drugs. Complications are also reviewed.
Oliguria is a low urine output defined as less than 1 mL/kg/hr in infants, less than 0.5 mL/kg/hr in children, and less than 300 mL daily in adults. It indicates an underlying disorder and can lead to acute renal failure if left untreated. Anuria is even less urine output at less than 50 mL/day. Causes of oliguria and anuria include pre-renal (low blood volume), renal (kidney damage), and post-renal (urinary tract obstruction). Evaluation and management depends on determining the cause through history, physical exam, urinalysis, and blood tests to guide volume replacement or other interventions to prevent further kidney injury.
The document discusses pancreatitis, including its anatomy, physiology, classification, signs and symptoms, diagnosis, and management. It addresses both acute and chronic pancreatitis. Acute pancreatitis is commonly caused by gallstones or alcohol and can be mild, moderately severe, or severe based on organ dysfunction. It presents with abdominal pain and elevated pancreatic enzymes. Chronic pancreatitis is usually due to alcohol abuse and causes pain, digestive issues, and diabetes over time. Management involves treating the underlying cause, supportive care, and surgery for complications.
This document provides information on ascites including its definition, causes, diagnosis, and management. Ascites is defined as the accumulation of free fluid in the peritoneal cavity, most often caused by liver cirrhosis (75% of cases), malignancy, or heart failure. Diagnosis involves history, physical exam finding shifting dullness or fluid wave, and abdominal ultrasound or paracentesis. Initial ascites management consists of sodium restriction, diuretics, and large volume paracentesis for refractory ascites.
This document provides an overview of ascites, including its definition as fluid collection in the peritoneal cavity. It discusses the epidemiology, classification, etiology, pathophysiology, workup, and treatment of ascites. The epidemiology section notes mortality rates and differences between sexes. Classification divides ascites into four grades based on severity. Etiology categorizes ascites as transudative or exudative based on albumin levels. Workup involves history, exam, labs, imaging and diagnostic paracentesis. Treatment options include dietary changes, diuretics, paracentesis, TIPS procedure, and liver transplant.
Liver abscesses can be pyogenic (caused by bacteria), amoebic (caused by Entamoeba histolytica), or fungal. Pyogenic liver abscesses are most commonly located in the right lobe due to blood flow patterns and are usually caused by gram-negative bacteria like E. coli. Patients present with fever, right upper quadrant pain, hepatomegaly, and diarrhea in some cases of amoebic abscess. Diagnosis involves blood tests, imaging like CT or ultrasound, and abscess fluid culture. Treatment is drainage of pus combined with antibiotics, usually percutaneous catheter drainage guided by imaging. For amoebic abscess, metronidazole is usually
Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid in people with liver cirrhosis and ascites. It is defined by a positive ascitic fluid culture with ≥250 PMN cells/mm3 in the absence of an intra-abdominal source. Risk factors include low ascitic fluid protein and prior SBP. Translocation of gut bacteria through the intestinal wall and lymphatics is a main mechanism. Treatment involves antibiotics like cefotaxime for 5-7 days. Prognosis depends on clinical stability, though prophylaxis may be considered for high risk patients.
The document discusses acute kidney injury (AKI), including its causes, diagnosis, and management. It provides details on prerenal, intrinsic, and postrenal forms of AKI. For prerenal AKI, management focuses on correcting the underlying cause, such as volume depletion, and restoring intravascular volume through fluid resuscitation. For intrinsic AKI, identifying and removing nephrotoxic agents is important. Dialysis may be needed for severe AKI with fluid/electrolyte imbalance or uremia.
This document provides an overview of cholecystitis, including:
1. It defines cholecystitis as the inflammatory condition of the gallbladder and describes the types of acute cholecystitis.
2. It outlines the clinical features of acute cholecystitis including symptoms like colicky pain and signs like Murphy's sign.
3. It discusses the treatment options for acute cholecystitis which include conservative treatment, early cholecystectomy, or emergency cholecystostomy depending on the severity of the case.
Fissure in ano is an elongated ulcer in the lower anal canal, most commonly located in the midline posteriorly. It is caused by pressure from hard stool during bowel movements tearing the anal tissues. It can also be caused by inflammation or ischemia. An acute fissure is a deep tear in the anal skin, while a chronic fissure has inflamed, indurated edges and scar tissue at the base. Symptoms include pain with defecation and sometimes bleeding. Treatment aims to relax the internal sphincter and includes topical nitrates, dilatation, and lateral sphincterotomy. Squamous cell carcinoma of the anus can be caused by radiation, HPV, or inflammation. It presents
Hepatic Encephalopathy -Pathophysiology,Evaluation And ManagementSantosh Narayankar
Hepatic encephalopathy is a brain dysfunction caused by liver disease or portosystemic shunting. It presents as a wide range of neurological or psychiatric abnormalities from mild alterations to coma. The prevalence is 30-40% in those with cirrhosis and risk of first episode is 5-25% within 5 years of cirrhosis diagnosis. Recurrence risk after an initial episode is 40% within 1 year. Ammonia, systemic inflammation, manganese, genetics, and oxidative stress may all contribute to pathogenesis. Diagnosis involves clinical exam and testing like serum ammonia levels or neuropsychological tests on phone apps. Management involves treating precipitating factors, lactulose, antibiotics like rifaximin, and
Renal colic is a type of intense pain that occurs when a urinary stone becomes lodged in the kidney or ureter. Symptoms include waves of pain in the flank, groin, or lower abdomen, as well as nausea, vomiting, blood in the urine, and difficulty urinating. Risk factors include dehydration, a high-vitamin D diet, family history of kidney stones, and urinary tract infections. Treatment depends on the size of the stone but may include shock wave lithotripsy to break up the stone, ureteroscopy to remove it, or percutaneous nephrolithotomy for large stones. Preventing dehydration and limiting foods high in oxalate can
The document provides information on acute abdomen including its definition, epidemiology, physiology, differential diagnosis by location, history and physical examination findings, important investigations, management principles, and criteria for surgical consultation. Acute abdomen is defined as sudden severe abdominal pain lasting less than 24 hours that often requires urgent diagnosis and some causes need surgical treatment. The differential diagnosis considers location of pain and includes conditions like appendicitis, diverticulitis, bowel obstruction, pancreatitis and others. Key aspects of evaluation involve history, physical exam, labs, imaging and identifying high-risk patients who may require emergent surgery.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
Peritonitis is inflammation of the peritoneum lining the abdominal cavity that can be caused by bacterial infection, chemicals, or trauma. The peritoneum has a parietal layer lining the abdominal wall and a visceral layer surrounding organs. Peritonitis can be primary (from spontaneous bacterial infection), secondary (from a perforated organ), or tertiary (persistent infection after treatment). Common causes are perforated ulcers or appendicitis. Patients experience abdominal pain and tenderness along with fever. Diagnosis involves blood tests and imaging scans. Treatment requires antibiotics, source control through surgery if needed, and organ support. Complications can include sepsis, multiple organ dysfunction, and death if not properly managed.
Acute pancreatitis is a condition where pancreatic enzymes leak into the pancreas and cause its auto-digestion. Common causes include gallstones, alcohol use, and idiopathic factors. Patients present with epigastric pain radiating to the back that is exacerbated by eating or lying down. Lab tests show elevated pancreatic enzymes and imaging shows changes to the pancreas. Treatment is supportive with NPO, IV fluids, pain control and monitoring for complications like necrosis, pseudocysts, shock and respiratory failure. Severe cases may require ERCP, surgery or drainage procedures.
There are three major forms of liver abscess classified by etiology: pyogenic liver abscess which accounts for 80% of cases, amoebic liver abscess due to E. histolytica accounting for 10% of cases, and fungal abscess accounting for less than 10% of cases. Risk factors include traveling to infection-common areas, older age, medical conditions, medications, alcohol, and poor nutrition. Symptoms include abdominal pain, cough, fatigue, fever, nausea and vomiting, loss of appetite, and jaundice. Diagnosis involves blood tests, imaging, and procedures to drain fluid from the liver. Treatment depends on the cause but may include medications, needle aspiration, catheter drainage, or
This document summarizes the clinical presentation, signs, radiographic findings, and management of hydrocarbon poisoning from inhalation or ingestion. The initial symptoms are respiratory in nature and include choking, coughing, and vomiting. Chest X-rays typically show perihilar or lobar densities within a few hours that can persist for days. Treatment is supportive, with attention to respiratory symptoms, and antibiotics may be used if bacterial pneumonia develops. Prevention efforts include storing kerosene out of children's reach and clearly labeling containers.
A hiatal hernia occurs when part of the stomach pushes through an opening in the diaphragm and into the chest cavity. There are two main types - a sliding hernia, where the stomach slides up during increased abdominal pressure and back down when pressure is relieved, and a paraesophageal hernia where part of the stomach remains stuck in the chest. Tests like chest x-rays, barium swallows, and endoscopy can diagnose hiatal hernias. Treatment may involve antacids, proton pump inhibitors, or surgery to repair the diaphragm if symptoms are severe.
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
This document discusses hepatomegaly (enlargement of the liver). It begins by describing the normal anatomy and functions of the liver. It then discusses the various mechanisms that can cause hepatomegaly, including increased cell size/number, inflammation, infiltration, increased vascular/biliary space, and idiopathic causes. The main causes of hepatomegaly are listed as infective, congestive, degenerative/infiltrative, storage disorders, neoplasia, and toxins. The document concludes by describing the clinical presentation and examination findings of hepatomegaly.
1. The document discusses gastrointestinal bleeding, describing its various presentations including hematemesis, melena, hematochezia, occult blood in stools, and chronic blood loss/anemia.
2. Upper GI bleeding occurs above the ligament of Treitz and can cause hematemesis or melena, while lower GI bleeding occurs below and causes melena and hematochezia but no hematemesis.
3. Common causes of upper GI bleeding include peptic ulcer disease, gastritis, and esophageal varices, while common causes of lower GI bleeding include hemorrhoids, diverticulosis, and polyps.
1. Cirrhosis is the most common cause of ascites, accounting for 85% of cases. Other causes include malignancy, tuberculosis, cardiac disease, and nephrotic syndrome.
2. Analysis of ascitic fluid can help determine the cause of ascites. A serum ascites albumin gradient (SAAG) ≥1.1 g/dL suggests portal hypertension while a SAAG <1.1 g/dL suggests a non-cirrhotic cause like malignancy or tuberculosis.
3. Gross appearance, cell count, SAAG, and biochemical properties of ascitic fluid provide clues to diagnose conditions like chylous ascites, spontaneous bacterial peritonitis, or biliary perforation
This document provides an overview of ascites, including its definition as fluid collection in the peritoneal cavity. It discusses the epidemiology, classification, etiology, pathophysiology, workup, and treatment of ascites. The epidemiology section notes mortality rates and differences between sexes. Classification divides ascites into four grades based on severity. Etiology categorizes ascites as transudative or exudative based on albumin levels. Workup involves history, exam, labs, imaging and diagnostic paracentesis. Treatment options include dietary changes, diuretics, paracentesis, TIPS procedure, and liver transplant.
Liver abscesses can be pyogenic (caused by bacteria), amoebic (caused by Entamoeba histolytica), or fungal. Pyogenic liver abscesses are most commonly located in the right lobe due to blood flow patterns and are usually caused by gram-negative bacteria like E. coli. Patients present with fever, right upper quadrant pain, hepatomegaly, and diarrhea in some cases of amoebic abscess. Diagnosis involves blood tests, imaging like CT or ultrasound, and abscess fluid culture. Treatment is drainage of pus combined with antibiotics, usually percutaneous catheter drainage guided by imaging. For amoebic abscess, metronidazole is usually
Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid in people with liver cirrhosis and ascites. It is defined by a positive ascitic fluid culture with ≥250 PMN cells/mm3 in the absence of an intra-abdominal source. Risk factors include low ascitic fluid protein and prior SBP. Translocation of gut bacteria through the intestinal wall and lymphatics is a main mechanism. Treatment involves antibiotics like cefotaxime for 5-7 days. Prognosis depends on clinical stability, though prophylaxis may be considered for high risk patients.
The document discusses acute kidney injury (AKI), including its causes, diagnosis, and management. It provides details on prerenal, intrinsic, and postrenal forms of AKI. For prerenal AKI, management focuses on correcting the underlying cause, such as volume depletion, and restoring intravascular volume through fluid resuscitation. For intrinsic AKI, identifying and removing nephrotoxic agents is important. Dialysis may be needed for severe AKI with fluid/electrolyte imbalance or uremia.
This document provides an overview of cholecystitis, including:
1. It defines cholecystitis as the inflammatory condition of the gallbladder and describes the types of acute cholecystitis.
2. It outlines the clinical features of acute cholecystitis including symptoms like colicky pain and signs like Murphy's sign.
3. It discusses the treatment options for acute cholecystitis which include conservative treatment, early cholecystectomy, or emergency cholecystostomy depending on the severity of the case.
Fissure in ano is an elongated ulcer in the lower anal canal, most commonly located in the midline posteriorly. It is caused by pressure from hard stool during bowel movements tearing the anal tissues. It can also be caused by inflammation or ischemia. An acute fissure is a deep tear in the anal skin, while a chronic fissure has inflamed, indurated edges and scar tissue at the base. Symptoms include pain with defecation and sometimes bleeding. Treatment aims to relax the internal sphincter and includes topical nitrates, dilatation, and lateral sphincterotomy. Squamous cell carcinoma of the anus can be caused by radiation, HPV, or inflammation. It presents
Hepatic Encephalopathy -Pathophysiology,Evaluation And ManagementSantosh Narayankar
Hepatic encephalopathy is a brain dysfunction caused by liver disease or portosystemic shunting. It presents as a wide range of neurological or psychiatric abnormalities from mild alterations to coma. The prevalence is 30-40% in those with cirrhosis and risk of first episode is 5-25% within 5 years of cirrhosis diagnosis. Recurrence risk after an initial episode is 40% within 1 year. Ammonia, systemic inflammation, manganese, genetics, and oxidative stress may all contribute to pathogenesis. Diagnosis involves clinical exam and testing like serum ammonia levels or neuropsychological tests on phone apps. Management involves treating precipitating factors, lactulose, antibiotics like rifaximin, and
Renal colic is a type of intense pain that occurs when a urinary stone becomes lodged in the kidney or ureter. Symptoms include waves of pain in the flank, groin, or lower abdomen, as well as nausea, vomiting, blood in the urine, and difficulty urinating. Risk factors include dehydration, a high-vitamin D diet, family history of kidney stones, and urinary tract infections. Treatment depends on the size of the stone but may include shock wave lithotripsy to break up the stone, ureteroscopy to remove it, or percutaneous nephrolithotomy for large stones. Preventing dehydration and limiting foods high in oxalate can
The document provides information on acute abdomen including its definition, epidemiology, physiology, differential diagnosis by location, history and physical examination findings, important investigations, management principles, and criteria for surgical consultation. Acute abdomen is defined as sudden severe abdominal pain lasting less than 24 hours that often requires urgent diagnosis and some causes need surgical treatment. The differential diagnosis considers location of pain and includes conditions like appendicitis, diverticulitis, bowel obstruction, pancreatitis and others. Key aspects of evaluation involve history, physical exam, labs, imaging and identifying high-risk patients who may require emergent surgery.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
Peritonitis is inflammation of the peritoneum lining the abdominal cavity that can be caused by bacterial infection, chemicals, or trauma. The peritoneum has a parietal layer lining the abdominal wall and a visceral layer surrounding organs. Peritonitis can be primary (from spontaneous bacterial infection), secondary (from a perforated organ), or tertiary (persistent infection after treatment). Common causes are perforated ulcers or appendicitis. Patients experience abdominal pain and tenderness along with fever. Diagnosis involves blood tests and imaging scans. Treatment requires antibiotics, source control through surgery if needed, and organ support. Complications can include sepsis, multiple organ dysfunction, and death if not properly managed.
Acute pancreatitis is a condition where pancreatic enzymes leak into the pancreas and cause its auto-digestion. Common causes include gallstones, alcohol use, and idiopathic factors. Patients present with epigastric pain radiating to the back that is exacerbated by eating or lying down. Lab tests show elevated pancreatic enzymes and imaging shows changes to the pancreas. Treatment is supportive with NPO, IV fluids, pain control and monitoring for complications like necrosis, pseudocysts, shock and respiratory failure. Severe cases may require ERCP, surgery or drainage procedures.
There are three major forms of liver abscess classified by etiology: pyogenic liver abscess which accounts for 80% of cases, amoebic liver abscess due to E. histolytica accounting for 10% of cases, and fungal abscess accounting for less than 10% of cases. Risk factors include traveling to infection-common areas, older age, medical conditions, medications, alcohol, and poor nutrition. Symptoms include abdominal pain, cough, fatigue, fever, nausea and vomiting, loss of appetite, and jaundice. Diagnosis involves blood tests, imaging, and procedures to drain fluid from the liver. Treatment depends on the cause but may include medications, needle aspiration, catheter drainage, or
This document summarizes the clinical presentation, signs, radiographic findings, and management of hydrocarbon poisoning from inhalation or ingestion. The initial symptoms are respiratory in nature and include choking, coughing, and vomiting. Chest X-rays typically show perihilar or lobar densities within a few hours that can persist for days. Treatment is supportive, with attention to respiratory symptoms, and antibiotics may be used if bacterial pneumonia develops. Prevention efforts include storing kerosene out of children's reach and clearly labeling containers.
A hiatal hernia occurs when part of the stomach pushes through an opening in the diaphragm and into the chest cavity. There are two main types - a sliding hernia, where the stomach slides up during increased abdominal pressure and back down when pressure is relieved, and a paraesophageal hernia where part of the stomach remains stuck in the chest. Tests like chest x-rays, barium swallows, and endoscopy can diagnose hiatal hernias. Treatment may involve antacids, proton pump inhibitors, or surgery to repair the diaphragm if symptoms are severe.
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
This document discusses hepatomegaly (enlargement of the liver). It begins by describing the normal anatomy and functions of the liver. It then discusses the various mechanisms that can cause hepatomegaly, including increased cell size/number, inflammation, infiltration, increased vascular/biliary space, and idiopathic causes. The main causes of hepatomegaly are listed as infective, congestive, degenerative/infiltrative, storage disorders, neoplasia, and toxins. The document concludes by describing the clinical presentation and examination findings of hepatomegaly.
1. The document discusses gastrointestinal bleeding, describing its various presentations including hematemesis, melena, hematochezia, occult blood in stools, and chronic blood loss/anemia.
2. Upper GI bleeding occurs above the ligament of Treitz and can cause hematemesis or melena, while lower GI bleeding occurs below and causes melena and hematochezia but no hematemesis.
3. Common causes of upper GI bleeding include peptic ulcer disease, gastritis, and esophageal varices, while common causes of lower GI bleeding include hemorrhoids, diverticulosis, and polyps.
1. Cirrhosis is the most common cause of ascites, accounting for 85% of cases. Other causes include malignancy, tuberculosis, cardiac disease, and nephrotic syndrome.
2. Analysis of ascitic fluid can help determine the cause of ascites. A serum ascites albumin gradient (SAAG) ≥1.1 g/dL suggests portal hypertension while a SAAG <1.1 g/dL suggests a non-cirrhotic cause like malignancy or tuberculosis.
3. Gross appearance, cell count, SAAG, and biochemical properties of ascitic fluid provide clues to diagnose conditions like chylous ascites, spontaneous bacterial peritonitis, or biliary perforation
1. The patient, a 48-year-old otherwise healthy woman, presented with microscopic hematuria on a routine urinalysis.
2. Microscopic hematuria is defined as more than 3 red blood cells per high-power field on urinalysis.
3. Evaluation of the patient with hematuria includes urine analysis, urine culture if indicated by presence of white blood cells, renal ultrasound or CT urogram, cystoscopy if lower urinary tract is suspected, and further testing depending on initial findings.
This document provides information about jaundice and obstruction of the biliary tract. It begins with an overview of the causes of yellow discoloration of the skin and mucous membranes, which is caused by bilirubin accumulation. It then describes the breakdown of red blood cells and how bilirubin is processed and excreted. The document outlines various causes of obstructive jaundice including gallstones, strictures, tumors, and external compression. Investigation methods and treatment approaches for different biliary obstructions are also summarized.
Chronic liver disease for intense learningoneplus9rns
This document describes a case of a 56-year-old male patient presenting with abdominal distension, leg swelling, and jaundice. Laboratory tests reveal anemia, low platelet count, elevated liver enzymes and bilirubin, prolonged INR, and low albumin consistent with cirrhosis. The document then reviews the various causes, presentations, complications, and management of chronic liver disease and cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, and hepatocellular carcinoma.
Cirrhosis is the most common cause of ascites, which is an accumulation of fluid in the abdominal cavity. Ascites occurs due to increased portal pressure and sodium retention as a result of vasodilation and reduced arterial blood flow in cirrhosis. Diagnosis involves abdominal examination, ultrasound, and diagnostic paracentesis of ascitic fluid. Treatment involves restricting sodium and fluid intake, diuretics, and repeated paracentesis. Refractory ascites is difficult to manage and may require transjugular intrahepatic portosystemic shunt placement or liver transplantation.
INVESTIGATIONS OF A PATIENT WITH OBSTRUCTIVE JAUNDICE -LETS GODr.Manojit Sarkar
Routine tests like liver function tests, urine analysis, and hematological investigations are used to determine if a patient's symptoms suggest obstructive jaundice. Imaging tests like ultrasound, MRCP, ERCP, and CT scan help locate the cause by visualizing the biliary tree and detecting any dilations, masses, or other abnormalities. ERCP can both diagnose the specific cause by visualizing structures and performing biopsies and also treat certain conditions like gallstones through procedures such as sphincterotomy and stent placement. The combination of biochemical and imaging tests aims to determine if the jaundice has an obstructive etiology, identify suspected causes like cancer or gallstones, and assess if the patient is a surgical candidate.
1. Ascites is an accumulation of fluid in the peritoneal cavity that can occur due to conditions like cirrhosis, heart failure, and cancer.
2. Diagnosis involves physical exam findings like flank bulging and shifting dullness as well as paracentesis to analyze fluid characteristics.
3. Treatment depends on the cause, with high SAAG ascites from cirrhosis treated initially with salt restriction and diuretics while malignant ascites may require drainage or shunt procedures.
Hematuria in children can be detected by urinary dipstick or microscopic examination. Common causes include glomerular disease, hypercalciuria, and nutcracker syndrome. Evaluation depends on whether hematuria is isolated, accompanied by proteinuria, or symptomatic. For isolated hematuria, follow-up includes urine culture and screening for hypercalciuria if persistent. Hematuria with proteinuria warrants further testing including serum creatinine. Symptomatic hematuria evaluation includes history, physical exam, and urinalysis to determine glomerular vs extraglomerular cause. Renal biopsy is considered if hematuria is substantial or progressive.
Cirrhosis is the most common cause of ascites, accounting for 81% of cases. The accumulation of ascitic fluid in cirrhosis is caused by splanchnic vasodilation leading to portal hypertension and hyperdynamic circulation. Initial management involves sodium-restricted diet and diuretics. Refractory ascites is treated with serial therapeutic paracentesis, TIPS, or liver transplantation. Complications include spontaneous bacterial peritonitis and hepatorenal syndrome.
Malignant ascites, an abnormal accumulation of fluid in the abdominal cavity, is commonly associated with cancers like ovarian cancer, gastrointestinal cancers, and breast cancer. It develops due to mechanical obstruction of lymphatic drainage by tumors and increased vascular permeability caused by cytokines. Diagnosis involves abdominal ultrasound or CT scan followed by diagnostic paracentesis of the fluid to examine for malignant cells. Treatment options include dietary salt restriction, diuretics, repeated paracentesis, indwelling catheters, peritoneovenous shunting, and intraperitoneal chemotherapy.
This document discusses ascites, which is an accumulation of fluid in the peritoneal cavity. It defines ascites and lists its main causes as increased hydrostatic pressure, decreased colloid osmotic pressure, increased permeability of capillaries, and leakage of fluid. The document describes the pathophysiology and classification of ascites as transudative or exudative. It outlines the clinical signs and diagnostic workup of ascites including abdominal examination, imaging, and analysis of ascitic fluid. Treatment approaches include dietary changes, diuretics, therapeutic paracentesis, TIPS procedure, and liver transplantation.
This document discusses hematuria, or the presence of blood in the urine. Evaluation is warranted when hematuria is present, as it can be a sign of medical or urological issues. An initial workup includes a medical history, physical exam, urine analysis, and urine microscopy. Further imaging with ultrasound, CT scan, or cystoscopy may be used to investigate the urinary tract for causes like cancer, stones, infections, or structural abnormalities. For high risk patients, especially those older than 40 or with a history of smoking, a cystoscopy and urine cytology are recommended to screen for bladder cancer. Most cases of asymptomatic microscopic hematuria remain unexplained despite a full urological evaluation.
Frequency of hyponatraemia and its influence on liver cirrhosis related compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more frequent hepatic encephalopathy and cirrhosis complications like hepatorenal syndrome and spontaneous bacterial peritonitis during their hospital stay compared to patients with normal sodium levels. The study concluded that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
Frequency Of Hyponatraemia And Its Influence On Liver Cirrhosis Related Compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more frequent hepatic encephalopathy and cirrhosis complications like hepatorenal syndrome and spontaneous bacterial peritonitis during their hospital stay compared to patients with normal sodium levels. The study concluded that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
Frequency of hyponatraemia and its influence on liver cirrhosis related compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more complications like hepatic encephalopathy. Even mild hyponatremia with sodium levels between 131-135 mEq/L increased the risk of cirrhosis complications compared to patients with normal sodium levels. The study concludes that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
The document discusses the proximal splenorenal shunt procedure for patients with liver cirrhosis and portal hypertension combined with hypersplenism. The procedure involves creating a shunt from the splenic vein to the left renal vein to decompress the portal system. It is indicated for select patients as an alternative to other procedures to prevent variceal bleeding while removing the spleen. However, it carries risks of hepatic encephalopathy, worsening liver function, and is not suitable for future transplantation. The authors' experience with 17 patients who underwent this procedure is presented, along with postoperative outcomes.
Este documento presenta un compendio del examen mental elaborado por Fredy Ivan Sucari Callohuanca. El compendio describe en detalle diferentes aspectos del estado mental como la apariencia general, conducta, afectividad, discurso, sensopercepción y clasifica variaciones cualitativas y cuantitativas de cada aspecto. El autor busca proveer una guía concisa pero completa para realizar evaluaciones psiquiátricas.
Este documento proporciona una descripción general del linfoma no Hodgkin (LNH). Define el LNH como un grupo heterogéneo de proliferaciones malignas del sistema linfático. Describe las presentaciones clínicas más comunes como la linfadenopatía y los síntomas B, y explica que los linfomas indolentes tienen un curso más crónico mientras que los agresivos son más agudos. Finalmente, resume los pasos clave en la evaluación y clasificación del LNH, incluyendo la biopsia, pruebas de laboratorio, estud
La Unión Europea ha acordado un embargo petrolero contra Rusia en respuesta a su invasión de Ucrania. El embargo prohibirá la mayoría de las importaciones de petróleo ruso a la UE a partir de finales de año. Algunos países como Hungría aún dependen en gran medida del petróleo ruso, por lo que se les ha concedido una exención temporal al embargo.
Este documento describe el hiperaldosteronismo primario, un síndrome causado por la hiperproducción autónoma de aldosterona. Sus síntomas principales incluyen hipertensión, bajos niveles de potasio, debilidad muscular y edemas. El diagnóstico se basa en niveles elevados de aldosterona en plasma y una relación PAC/PRA mayor a 20:1, y se confirma mediante una prueba de carga oral de NaCl que mantiene los niveles de aldosterona elevados.
Irritable bowel syndrome (IBS) is a chronic functional disorder characterized by abdominal pain and changes in bowel habits without any underlying structural abnormality. The ROME IV criteria are used to diagnose IBS based on recurrent abdominal pain associated with changes in stool frequency or appearance. IBS is very common, affecting up to 21% of the population, and is more prevalent in women. While the exact cause is unknown, factors like altered gut motility, microbiome changes, and visceral hypersensitivity are thought to play a role. Evaluation focuses on excluding other potential causes through medical history, examination, and initial lab tests and imaging only if indicated.
This document discusses upper gastrointestinal bleeding, which is bleeding that occurs proximal to the ligament of Treitz. It lists various potential causes of upper GI bleeding, including gastric ulcers, esophageal varices, esophagitis, and gastric erosions. Clinical features are outlined, with hematochezia being the most severe sign. Endoscopy is the most accurate diagnostic test. Treatment involves stabilizing the patient, administering IV PPIs, performing endoscopy to locate the bleeding site and provide therapeutic intervention such as epinephrine injection. Peptic ulcer bleeding has a low mortality unless rebleeding occurs, while esophageal variceal bleeding has high rebleeding and mortality rates.
Es una inflamación del estómago, caracterizado por hallazgos anormales como eritema, erosión y hemorragias subepiteliales. Subdividida en erosiva, no erosiva, y otros tipos especificos de gastritis.
Inflammatory bowel disease (IBD) describes Crohn's disease and ulcerative colitis, which are idiopathic disorders of the bowel associated with diarrhea, bleeding, weight loss, fever, and abdominal pain. IBD is diagnosed through endoscopy and sometimes barium studies. Treatment involves anti-inflammatory medications such as mesalamine for maintenance, with steroids used for acute exacerbations. The causes of IBD are not fully known but are thought to involve an interplay between host genetics and the gut microbiota.
Colorectal cancer is the third most common cancer globally, with over 1.4 million new cases annually. Risk factors include hereditary conditions, inflammatory bowel disease, diet, obesity, and age over 50. Common symptoms vary based on tumor location, and include blood in stool, changes in bowel habits, and abdominal pain or mass. Diagnosis involves physical exam, imaging, and biopsy. Treatment options range from surgery alone for early stages to surgery and chemotherapy for more advanced stages.
La sepsis es un síndrome (conjunto de signos y síntomas) que es provocado por una reacción exagerada del organismo frente a alguna infección.
Esta revisión es hasta 2018 06.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Ascitis -
1. Ascitis
DEFINITION
Ascites refers to a pathologic accumulation of
fluid in the peritoneal cavity, most commonly
caused by liver cirrhosis.
SYNONYMS
Fluid in peritoneal cavity
Hydroperitoneum
Hydroperitonia
Hydrops abdominis
EPIDEMIOLOGY & DEMOGRAPHICS
Ascites is the most common complication of cirrhosis
and signifies decompensation of chronic
liver disease. Ascites occurs in 60% of individuals
with cirrhosis within ten years of diagnosis.
Cirrhosis is the cause of 75% of cases of ascites.
Other causes include intraperitoneal malignancy,
heart failure, tuberculosis, pancreatitis, nephrotic
syndrome, and Budd-Chiari syndrome.
2. CLINICAL PRESENTATION
Important information to elicit within history:
1. History of viral hepatitis
2. Alcoholism
3. Intravenous drug use, intranasal cocaine use
4. Sexual history (i.e., men who have sex with men)
5. History of transfusions, tattoos, piercings, imprisonment
6. Symptoms suggestive of peritoneal malignancy (e.g., weight loss, pain, palpable masses,
rectal/vaginal bleeding)
7. Other liver disease symptoms (e.g., increasing abdominal girth, jaundice, pruritis,
confusion, pedal edema)
8. Cardiac symptoms (e.g., pedal edema, shortness of breath, orthopnea, chest pains)
3. Important physical exam findings:
1. Bulging flanks (can be present in obesity)
2. Flank dullness to percussion
3. Fluid wave on abdominal exam
4. Lower extremity edema
5. Shifting dullness on abdominal exam
6. Physical signs associated with liver cirrhosis: spider angiomas,
jaundice, loss of body hair, skeletal muscle wasting (sarcopenia),
Dupuytren’s contracture, bruising, palmar erythema, gynecomastia,
testicular atrophy, rectal varices, and caput medusae
5. Diagnóstico:
LABORATORY TESTS
• Initial evaluation should always include:
1. Diagnostic paracentesis. Laboratory tests on this fluid should include a cell count, cytology, albumin, total protein,
culture, and Gram stain. A serum-ascites albumin gradient (SAAG) should be calculated in all patients.
a. If the SAAG is greater than 1.1, the cause of ascites can be attributed to portal hypertension.
b. If SAAG is less than 1.1, a non-portal hypertension etiology of ascites must be sought. Optional tests on
paracentesis fluid include amylase, LDH, acid-fast bacilli, and glucose levels.
c. Causes of ascites in the normal or diseased peritoneum by SAAG are summarized in Table 1.
d. Fig. 2 illustrates an algorithm for the approach to the differential diagnosis of ascites.
2. AST, ALT, total and direct bilirubin, albumin, alkaline phosphatase, GGTP
3. CBC, coagulation studies
4. Electrolytes, BUN, creatinine
IMAGING STUDIES
• Abdominal ultrasound (Fig. 3) is the most sensitive measure for detecting ascitic fluid; a CT or MRI scan is a viable
alternative. Doppler studies of portal and hepatic veins should be added to rule out vascular etiology.
• Endoscopy of the upper GI tract to evaluate for esophageal varices if ascites is secondary to portal hypertension.
6.
7. Diagnóstico:
LABORATORY TESTS
• Initial evaluation should always include:
1. Diagnostic paracentesis. Laboratory tests on this fluid should include a cell count, cytology, albumin, total protein,
culture, and Gram stain. A serum-ascites albumin gradient (SAAG) should be calculated in all patients.
a. If the SAAG is greater than 1.1, the cause of ascites can be attributed to portal hypertension.
b. If SAAG is less than 1.1, a non-portal hypertension etiology of ascites must be sought. Optional tests on
paracentesis fluid include amylase, LDH, acid-fast bacilli, and glucose levels.
c. Causes of ascites in the normal or diseased peritoneum by SAAG are summarized in Table 1.
d. Fig. 2 illustrates an algorithm for the approach to the differential diagnosis of ascites.
2. AST, ALT, total and direct bilirubin, albumin, alkaline phosphatase, GGTP
3. CBC, coagulation studies
4. Electrolytes, BUN, creatinine
IMAGING STUDIES
• Abdominal ultrasound (Fig. 3) is the most sensitive measure for detecting ascitic fluid; a CT or MRI scan is a viable
alternative. Doppler studies of portal and hepatic veins should be added to rule out vascular etiology.
• Endoscopy of the upper GI tract to evaluate for esophageal varices if ascites is secondary to portal hypertension.
8.
9. Ascites, ultrasound.
Ultrasound is useful for detection of
ascites. Simple fluids such as ascites
are excellent sound transmission
media, reflecting almost no sound
waves. As a consequence, they
appear quite hypoechoic (black) on
ultrasound. This view of the right
lower quadrant shows loops of
bowel surrounded by fluid. During
the ultrasound, the bowel loops
would be seen to undergo peristalsis
and drift back and forth in the ascitic
fluid with patient movement.
Ultrasound cannot distinguish the
composition of the fluid; ascites,
liquid blood, liquid bile, urine, and
infectious fluids have a similar
appearance, with a few exceptions.
Blood may coagulate and form
septations within the fluid
collection. Infectious fluids also
frequently form loculated fluid
collections that may be recognized
on ultrasound, although the exact
composition cannot be determined.
10.
11.
12.
13.
14.
15. Gastrointestinal malignancies
Unfortunately, clinical symptoms appear most often at the late stages
of disease and therefore are associated with poor patient survival.
Some tumors induce diffuse dissemination of the tumor cells into the
peritoneal cavity.
The appearance of peritoneal carcinomatosis (PCA) is associated with
tumor progression and an unfavorable outcome (survival ranging from
weeks to months), with ascites and bowel obstruction as the main
symptoms.
Expression of MicroRNAs in the Ascites of Patients With Peritoneal Carcinomatosis and Peritonitis
Diagnostic
is based on imaging of PCA and
cytological evaluation of ascites
followed by an invasive approach such
as laparoscopy or laparotomy.
Computed tomography and magnetic
resonance imaging deliver the most
reliable results for the nodal type of
PCA and pre-dominantly in advanced
stages of disease.
cytology remains the gold standard that allows
for the definitive diagnosis with high specificity,
although the sensitivity is only approximately
40% to 60%
16. Expression of MicroRNAs in the Ascites of Patients With Peritoneal Carcinomatosis and Peritonitis
patients with cirrosis
and ascites may
develop spontaneous
bacterial peritonitis
(SBP), which occurs in
10% to 30% of cases.
limited progress in the
development of alternative
molecular-based methods for the
diagnosis of PCA and SBP.
MicroRNAs (miRNAs)
small, endogenous, non-coding RNA molecules
miRNA is a consequence of the complex
transcription and RNA processing.
During this process, miRNA binds to Argonaute proteins and
controls the gene expression as the RNA-induced silencing complex (RISC).
various body fluids such as blood, urine, feces,
cerebrospinal fluid, etc.
17. Department of Gastroenterology, Hepatology and Infectious Diseases
at Otto-von-Guericke-University
in Magdeburg,
Germany.
45 patients
The ascites samples (approximately 25 mL) were collected from patients with various conditions during
diagnostic or therapeutic paracentesis.
1. 15 patients with PCA (detection of neoplastic cells in cytology);
2. 15 patients with sponatenous and secondary bacterial peritonitis (SBP) (polymorphonuclear
leukocytes count [PMN] 250 cells/mm3 and/or positive bacterial culture); and
3. 15 patients with ascites due to portal hypertension without complications (no SBP/PCA) (negative
cytology, PMNs 250 cells/mm3 , and negative bacterial culture).
18.
19. miRNAs en ascítis
Análisis por reacción de cadena de transcriptasa reversa y polimerasa en forma cuantitativa
The results of the current study demonstrate that miRNAs can be easily isolated from ascites samples.
Hipertensión portal
Sobre expresado
miR-21
miR-186
miR-222
miR-483
infraexpresado
miR-266
Peritonitis bact. Espont.
“Sobre expresado”
miR-223
Carcinomatosis peritoneal
^^ Sobre expresado
miR-21
miR-186