A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
This is a small booklet in an outline format to assist undergraduate medical students to aid in writing case write ups. This mainly contains how to elicit symptoms and signs.
Case Study on Intrauterine Growth RestrictionAbhineet Dey
A clinically based study of a case of Intrauterine Growth Restriction (IUGR) or Foetal Growth Restriction (FGR).
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
42: Liza Hazarika
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
This is a small booklet in an outline format to assist undergraduate medical students to aid in writing case write ups. This mainly contains how to elicit symptoms and signs.
Case Study on Intrauterine Growth RestrictionAbhineet Dey
A clinically based study of a case of Intrauterine Growth Restriction (IUGR) or Foetal Growth Restriction (FGR).
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
42: Liza Hazarika
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
A FEASIBILITY STUDY OF REMOTE MONITORING OF CAPD PATIENT’S BLOOD PRESSURE AND
BLOOD GLUCOSE MEASUREMENTS VIA THE INTERNET. G. Pylypchuk, P. Jacobson, C. McAllister
University of Saskatchewan, St. Paul’s Hospital, Saskatoon, Saskatchewan. Regina, Saskatchewan
The purpose of this study was to determine the feasibility of remotely monitoring blood pressure (BP) and
glucose measurements in a cohort of diabetic patients receiving continuous ambulatory peritoneal
dialysis (CAPD).
Digital Health - Hypertension Case StudySatnam Bains
For Digital Health to be effective, we need more than technology. We need the right service re-design from a clinical perspective, and support for patients to improve their health literacy, and achievable goals to facilitate long term behaviour change. Only then can we enter into the realm and much sought after nirvana of preventative health. This presentation was created by the CEO of Health Fabric and a set of clinicians to share their knowledge around a case study around hypertension management.
Varicose veins:A never ending problem if mistreated!KETAN VAGHOLKAR
Varicose veins is one of the most distressing disorders affecting the lower limbs. It is commonly seen in individuals who stand for prolonged hours thus causing immense pain and discomfort. These days it is also found in individuals who sit for prolonged periods as seen in computer professionals. Proper treatment based on good understanding of the pathophysiology underlying the disease is pivitol for a successful outcome. the presentation outlines the approach to the problem for practitioners
CHOLELITHIASIS, NEPHROLITHIASIS SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPH...Jack Frost
CHOLELITHIASIS, NEPHROLITHIASIS
SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPHROSIS
This presentation contains real names of persons involve of this particular study. This names should not be copied or rewritten. Used the data of this study as basis only. All rights reserved 2009.
My memorable case! AN UNANTICIPATED CARDIAC ARREST & UNUSUAL POST-RESUSCITATI...Prof. Mridul Panditrao
ABSTRACT
A case report of a primigravida, who was admitted with severe pregnancy induced hypertension
(BP 160/122 mmHg) and twin pregnancy, is presented here. Antihypertensive therapy was
initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies,
intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered
cardiac arrest. Cardio pulmonary resucitation (CPR) was started and within 3 minutes, she was
successfully resuscitated. The patient initially showed peculiar psychological changes and with
passage of time, certain psycho-behavioural patterns emerged which could be attributed to near
death experiences, as described in this case report.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Congenital Anomalies of the Kidney & Urinary TractAbhineet Dey
Congenital anomalies of the kidney and urinary tract (CAKUT) represent a broad range of disorders that result from developmental abnormalities of the lower urinary tract, urinary collecting system, disrupted embryonic migration of the kidney(s), or abnormal renal parenchymal development.
Despite significant variation in phenotype and clinical implications, CAKUT shares a common genetic basis and molecular signaling that affect kidney development.
Diagnostics in Inflammatory Bowel Disease (IBD): UltrasoundAbhineet Dey
Intestinal ultrasound has a good accuracy in the diagnosis of Crohn's disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses.
Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn's disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery.
Similarly to Crohn's disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy.
Short-term data also evidence the role of intestinal ultrasound in evaluating therapy response, with ultrasound changes observed after 2 weeks of treatment and significant improvement after 12 weeks of follow-up in ulcerative colitis.
The term acute abdomen defines a clinical syndrome characterized by the sudden onset of severe abdominal pain requiring emergency medical or surgical treatment.
It is one of the most frequent reasons for presentation of an adult to the emergency department, ranging from 4% to 10% of admissions.
A prompt and accurate diagnosis is essential to minimize morbidity and mortality in these patients.
The differential diagnosis includes a spectrum of infectious, inflammatory, ischemic, obstructive, hemorrhagic, and neoplastic disorders.
The acute abdomen can also reflect extra-abdominal conditions, including cardiac, pulmonary, endocrine, or metabolic disorders.
Beyond LFT - A Radiologist’s Guide to the Liver Blood TestsAbhineet Dey
Abnormal liver blood test results are often the first indicator of hepatobiliary disease and a common indication for abdominal imaging with US, CT, or MRI.
Most of the disease entities can be categorized into hepatocellular or cholestatic patterns, with characteristic traits on liver blood tests. Each pattern has a specific differential, which can help narrow the differential diagnosis when combined with the clinical history and imaging findings.
Overall, integrating liver blood test patterns with imaging findings can help the radiologist accurately diagnose hepatobiliary disease, especially in cases where imaging findings may not allow differentiation between different entities.
Imaging of the Biliary System and its DisordersAbhineet Dey
Clinical data such as history, physical examination, and laboratory tests are useful in identifying patients with biliary obstruction and biliary sources of infection. However, if intervention is planned, noninvasive imaging is needed to confirm the presence, location, and extent of the disease process.
Currently, the most commonly available and used noninvasive modalities are ultrasound (US), computed tomography (CT), magnetic resonance (MR), and nuclear medicine hepatobiliary scintigraphy (HIDA).
Imaging plays a key role in the diagnosis of diseases of the trachea, bronchi and small airways. The technical advances relating to CT, and in particular the ability to rapidly acquire a volume of data with multidetector CT, has revolutionised the investigation of patients with suspected airway disease.
Tracheal abnormalities can be due to intrinsic or extrinsic causes and may be focal, multifocal or diffuse. CT is now the investigation of choice for suspected bronchiectasis. Asthma remains a clinical diagnosis, but advances in CT technology now allow quantitative assessment of the bronchial wall and this is providing insights into the nature of airway remodelling that occurs in asthma.
Small airways (for practical purposes the bronchioles) are numerous and thus clinical tests are insensitive in detecting disease. This has increased the role and importance of CT in identifying either of the two main categories of small airway disease—constrictive bronchiolitis and exudative bronchiolitis.
Sarcoidosis from head to toe: What the radiologist needs to knowAbhineet Dey
Sarcoidosis is a multisystem granulomatous disorder characterized by development of noncaseating granulomas in various organs.
Clinical features are often nonspecific, and imaging is essential to diagnosis.
Abnormalities may be seen on chest radiographs in more than 90% of patients with thoracic sarcoidosis. Symmetric hilar and mediastinal adenopathy and pulmonary micronodules in a perilymphatic distribution are characteristic features of sarcoidosis. Irreversible pulmonary fibrosis may be seen in 25% of patients with the disease.
Although sarcoidosis commonly involves the lungs, it can affect virtually any organ in the body.
Computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography/CT (PET/CT) are useful in the diagnosis of extrapulmonary sarcoidosis, but imaging features may overlap with those of other conditions.
Familiarity with the spectrum of multimodality imaging findings of sarcoidosis can help to suggest the diagnosis and guide appropriate management.
This presentation aims to give a foundational knowledge in the art of radiological interpretation of the chest radiograph.
It includes some of the important anatomical structures visible on a chest X-ray along with technical aspects regarding image aquisition in correlation with lateral views and cross-sectional imaging to give a more complete sense of the structures in view.
Journal presentation: Brink, J. A., & Hricak, H. (2023). Radiology 2040. Radiology, 306(1), 69–72. https://doi.org/10.1148/radiol.222594
This editorial describes a variety of anticipated changes in the science and practice of radiology, some of which will appear almost inevitably and some of which the imaging community will only be able to achieve through vision and intense determination.
Immediate or Type I hypersensitivity is a rapid immunological reaction occurring in a previously sensitized individual that is triggered by the binding of an antigen to IgE antibody on the surface of mast cells.
Amyloidosis is a condition associated with a number of inherited and inflammatory disorders in which extracellular deposits of fibrillar proteins are responsible for tissue damange and functional compromise. (Robbins Basic Pathology, 9th Edition)
The following slideshow deals with the classification of Amyloidosis:
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The 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
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
1. Case Presentation on
Varicose Veins &
Venous UlcerModerator
Dr Jamaluddin Ahmed,
Asst. Professor, Dept. of Surgery,
Gauhati Medical College & Hospital
Presented by:
Students of 8th semester
Roll no. 29, 30, 31, 32, 33, 34, 35
4. Patient Particulars
• Name: Uttam Kalita
• Age: 66 years
• Sex: Male
• Religion: Hinduism
• Address: Palashbari, P.O-& P.S-Palashbari, Dist-Kamrup
Phone no.: +91-9435035598
• Occupation: Daily wage worker in a rice-mill
• Date of Admission: 9-03-2017
• Date of Examination: 16-03-2017
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
5. Chief Complaint
• On and off pain in the left leg for 30 years.
• Recurring ulcers in the left leg for 27 years.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
6. History of Present Illness
• The patient complains of pain in the lower left leg for 30 years. The
pain was gradual in onset and progressive in nature. The pain was
dragging in nature and it worsens when the patient stands for a long
time and is relieved when he lies down. There is no radiation of the
pain. The pain is more towards the end of the day. The patient is
said to have taken medication for the pain, but it didn’t get relieved.
• The patient also presents with an ulcer in the left leg for 27 years
which occurred spontaneously. It was gradual in onset and
progressive in nature. At first it was small in size and gradually
increased in size as time progressed. There is no history of trauma.
There was pain around the ulcer and discharge from the ulcer. The
discharge was sero-purulent in nature, scanty in amount, and non
foul-smelling. There is darkening and thickening of the skin around
the ulcer. There is no associated fever or any other significant
findings.
• The patient also complains of another ulcer over the lateral aspect
of the lower limb, which started 5 years ago and was gradual in
onset, progressive in nature with associated pain around the ulcer
and no discharge or bleeding.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
7. History of Present Illness (Contd.)
• There is no associated swelling of the left leg. Patient also
complains of itching. There is no complaint of night-cramps.
• There is no history of constipation, chronic cough or swelling of
the abdomen. Pain abdomen and fever are absent.
• Patient’s appetite is normal, bladder and bowel habits are
regular and sleep in normal. There is no history of weight loss.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
8. Past History
• There is no history of similar illnesses in the past. There is no
history of hypertension, diabetes or any other serious illnesses
in the past.
• There is no history of previous surgeries in the past.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
9. Personal History
• The patient takes average rice-based non-veg Assamese diet,
consisting of three major meals a day and two minor meals.
• He is a non-smoker, non-alcoholic but chews tobacco for the
last 20 years.
• The patient is a daily wage worker in a rice-mill.
His occupation requires him to stand for prolonged periods of time.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
10. Family History
• There is no history of similar diseases in the family. All other
members are enjoying good health.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
11. Socio-economic History
• The patient belongs to a low socio-economic group with an
income of Rs. 4000 per month.
• He lives in a pucca house, drinks unfiltered water from the tube-
well and uses sanitary latrine.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
12. Medication History
• The patient took medication for the pain in the leg which he
couldn’t specify. He also took medication for gastritis for more
than 5 years.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
13. Immunisation History
• BCG scar is absent.
• The patient could not recall taking any other vaccinations.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
14. Allergic History
• Patient is not allergic to any known contactant, ingestant or
inhalant.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
16. • Appearance: Patient looks well
• Decubitus: Of choice
• Build: Average
• Weight: 63kg
• Height: 175cm
• Nutrition: Fair
• Hair and skin: Hair is normal in
colour and texture. Skin in the
left lower leg is
hyperpigmented and
thickened.
• Dehydration: Absent
• Icterus: Absent
• Pallor: Absent
• Cyanosis: Absent
• Teeth and gums: Stained
• Tongue: Moist and smooth
papillae
• Neck vein: Not engorged
• Neck glands: Not palpable
• Clubbing: Absent
• Koilonychia: Absent
• Oedema: Absent
• Skeletal deformities: Absent
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
17. Vitals
• Respiratory rate: 18/min.
Regular in rhythm, and abdomino-thoracic type.
• Blood pressure: 110/70 mm Hg in right upper arm in supine
position.
• Pulse: 84 beats/min.
Regular in rhythm, normo-volumic, normal arterial wall condition with
normal character.
No radio-radial and radio-femoral delay found.
All other peripheral pulses are bilaterally and symmetrically palpable.
• Temperature: 98⁰F
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
19. Inspection
• Patient is examined in standing position.
• Long, tortuous and dilated veins are seen extending from above
the medial malleolus to above the knee.
• Localised swellings are seen on the antero-medial aspect of the
left leg along the course of the long saphenous vein.
• Skin of the lower left leg is hyperpigmented and thickened.
• There is eczema over the medial malleolus.
• The toes are hyperpigmented.
• There is no impulse on coughing at the saphenous opening.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
20. Inspection (Contd.)
Lower left leg (Medial Aspect) Lower left leg (Lateral Aspect)
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
21. Inspection (Contd.)
• There are two ulcers present on the
lower left leg. One is above the
medial malleolus with scab over the
ulcer, and another ulcer above the
lateral malleolus.
• Size:
Medial malleolus: 11x7cm (apprx)
Lateral malleolus: 4x2cm (apprx)
• Shape:
Medial malleolus: Irregular
Lateral malleolus: Vertically oval
• Margins: Irregular, with a sloping
edge (Both ulcers)
• Floors: Covered with scab.
• No discharge or bleeding present.
• Surrounding area: Hyperpigmented.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
22. Palpation
• Tenderness: Not present
• Sloping edge is felt in both ulcers, with an irregular margin with no
indurations in both ulcers.
• Base: Formed of muscle and bone.
• Depth:
6mm on the medial side
2mm on the lateral side
• The ulcer does not bleed on touch.
• The ulcer is not fixed to deeper structures.
• There is no raised temperatures and tenderness in the surrounding
skin. Mobility is present and it is not fixed to the deeper structures.
No loss of sensation or motor deficit is present.
• Dorsalis pedis artery is palpable.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
23. Palpation (Contd.)
• VARICOSE VEIN EXAMINATION
Dilated and tortuous vein is seen on the medial aspect of the left leg. So
the vein involved is long saphenous vein.
• Test for Varicose Vein
1. Brodie Tredelenburg’s Test I
On releasing the tourniquet immediately after standing the veins didn’t fill from
above. So, the test is negative.
2. Brodie Tredelenburg’s Test II
The tourniquet was tied for 2-3 minutes. There was gradual filling of the
superficial veins. So, the test is positive. This shows the perforators are
incompetent.
3. Three Tourniquet Test
All the three below knee perforators are involved.
4. Modified Perthes Test
Distention of superficial veins seen with no pain while walking with tourniquet in
place. The test is negative, suggesting no DVT.
5. Morrisey’s Test
Cough impulse at saphenous opening is absent.
6. Fegan’s test
The sites of the perforators are marked
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
24. Palpation (Contd.)
• Lymph Node Examination
The vertical chain of inguinal lymph nodes is enlarged in the left leg.
• Other limb examination:
There is no varicosity or venous ulcer seen.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
26. A. Central Nervous System
• Higher mental functions
Patient is conscious, alert and cooperative.
Patient is oriented to time, place and person.
His speech is normal and memory is intact.
• Cranial nerves are intact.
• Motor system is normal.
• Reflexes and jerks are normal.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
27. B. Respiratory System
• Inspection:
Shape and size of chest is normal.
Movement of chest is bilaterally symmetrical.
• Palpation:
Trachea is in the midline.
Chest expansion is normal.
Vocal fremitus is bilaterally symmetrical and normal.
• Percussion:
Lung field is uniformly resonant in all areas.
• Auscultation:
Normal vesicular breath sounds are heard and no additional
sounds are heard.
Vocal resonance is normal on both sides.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
28. C. Cardiovascular System
• Inspection:
Precordium is normal.
No bulging or visible pulsations are seen.
• Palpation:
Apex breath is felt in the 5th intercostal space just medial to
the mid-clavicular line.
• Auscultation:
1st and 2nd heart sounds are heard normally.
No additional heart sounds are heard.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
29. D. Gastrointestinal System
INSPECTION:
• Shape of the abdomen is neither flat nor distended
• Umbilicus is on midline and inverted
• No visible scar or pulsation or peristalsis
• No engorged vein seen
• Hernia sites are normal
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
30. D. Gastrointestinal System (Contd.)
PAPATION:
• On superficial palpation, no local rise of temperature, no
tenderness
• On deep palpation, all the quadrants are normal
• Liver is not palpable
• Spleen is not palpable
• Kidneys are bimanually palpable
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
31. Provisional
Diagnosis
Our patient, Uttam Kalita, a 66 year old male is provisionally
diagnosed to be a case of venous ulcers due to varicose vein as a
result of below-knee perforator incompetence in the left limb
with a normal right limb.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
32. Differential Diagnosis
D/D for Venous Ulcer
• Ischemic Ulcer
• Diabetic Ulcer
• Rheumatoid Ulcer
• Traumatic Ulcer
• Neuropathic Ulcer
• Neoplastic Ulcer
D/D for Varicose Vein
• AV Malformation
• Renal and Cardiac Disease
• Hepatic Causes
• Vasculitis
• Chronic infection like
Tuberculosis, Syphilis, etc.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
36. C. Additional Tests
• Chest X-Ray
• Left lower leg X-Ray
• ECG
• Culture Sensitivity
• Biopsy of the ulcer edge
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
37. Final Diagnosis
Our patient, Uttam Kalita, a 66 year old male is diagnosed to be a
case of venous ulcers due to varicose vein as a result of below-
knee perforator incompetence in the left limb with a normal right
limb.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
38. Management
Varicose veins is to be treated first followed by treatment for
venous ulcers.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
39. Treatment for Venous Ulcer
• Bisgaard Method
To reduce edema, increase venous drainage, so as to promote ulcer
healing.
It consist of:
1. Elevation
2. Massage of the indurated area and whole calf
3. Passive and active exercise.
• Care of the ulcer by regular cleaning with povidone iodine +
H2O2
• Dressing with EUSOL
• Antibiotics depending on culture sensitivity.
• Skin graft after ulcer granulates.
Dept.ofSurgery,GauhatiMedicalCollege&Hospital
40. Specific Treatment for Varicose Vein
• CONSERVATIVE TREATMENT
Elastic Crepe Bandage
Elevation of limb
Unna Boots
Pneumatic Compression method
• DRUG THERAPY
Calcium dobesylate 500mg BD
Diosmine 450mg BD
• SURGICAL TREATMENT
Sub fascial ligation of below-knee perforators
Dept.ofSurgery,GauhatiMedicalCollege&Hospital