This patient presented with a one year history of recurrent right upper abdominal pain. Imaging showed gallstones. The diagnosis was chronic cholecystitis. The patient would undergo a laparoscopic cholecystectomy. Key decisions included whether to explore the common bile duct based on preoperative imaging and intraoperative findings. Proper placement of mops was important to safely expose Calot's triangle during the procedure.
A 4-year-old girl presented with abdominal distension and mild constipation. Imaging studies revealed a large fluid collection in her abdomen. A paracentesis was performed and fluid analysis showed characteristics of a lymphatic cyst. During an exploratory laparotomy, a large multicystic mass was discovered originating from the omentum. The mass was surgically removed. Histopathological examination confirmed it was an omental cyst. The girl recovered well after surgery. Omental cysts are rare congenital lesions that can present in both children and adults with non-specific abdominal symptoms. Complete surgical excision is the treatment of choice.
The presentation is about a patient who is having Situs Inversus Totalis and is also suffering from multiple gall bladder stones. Patient's physician have decided to undergo cholecystectomy.
Sources are already mentioned in the presentation.
Hope the presentation helps to gain some information.
This document discusses appendicitis, including its causes, symptoms, diagnosis, and treatment. The appendix is a small pouch connected to the cecum in the digestive system. Appendicitis occurs when the appendix becomes blocked and infected, causing swelling. Common symptoms include abdominal pain localized to the lower right side, nausea, loss of appetite, and fever. Doctors use physical exams, blood tests, imaging like CT scans, and ultrasounds to diagnose appendicitis and rule out other potential causes of abdominal pain. Untreated appendicitis can lead to a burst appendix, so surgical removal of the inflamed appendix (appendectomy) is usually required to treat appendicitis.
Annular pancreas is an uncommon condition in adults.
The ring formation generally originates from the failure of
normal clockwise rotation of ventral pancreas. First
described by Tiedmann in 1818, its incidence is
1:20,000 population. It has bimodal presentation i.e is seen
either in Infants or in 4th & 5th decade of life.
A 14-year-old boy presented with a neck swelling. Physical exam revealed a mobile, fluid-filled lump below the hyoid bone that moved on swallowing. Ultrasound was determined to be the single most appropriate investigation, as it is the first-line imaging to distinguish fluid-filled cysts and visualize the mass and surrounding tissues. Ultrasound can confirm the diagnosis of a thyroglossal cyst in most cases without the need for biopsy or other invasive tests.
Initially in my lectures you can see that I have talked about Approach to Pain in abdomen, now we will learn what imaging should be done and why as per case to case basis. CT or USG or X-ray !!
This document provides an overview of chronic pancreatitis, including its pathophysiology, etiology, clinical features, diagnosis, and management. It discusses how chronic pancreatitis represents a continuous inflammatory and fibrosing process of the pancreas resulting in permanent dysfunction. The main causes are alcohol use and genetic factors. Patients present with abdominal pain in 95% of cases and can develop weight loss, steatorrhea, and diabetes. Diagnosis involves tests of pancreatic function and imaging tests looking for features like calcification. Treatment focuses on pain control, managing maldigestion with pancreatic enzyme replacement, and addressing complications like pseudocysts and stenosis.
The document discusses various diagnostic procedures used in gastrointestinal (GIT) diseases. It describes structural tests like imaging techniques (X-rays, ultrasound, CT, MRI, endoscopy), functional tests (motility tests, pH monitoring, malabsorption tests), tests for infections like Helicobacter pylori, blood tests, and stool tests. Key diagnostic procedures mentioned include upper and lower endoscopy, capsule endoscopy, ERCP, EUS, biopsy, and hydrogen breath testing.
A 4-year-old girl presented with abdominal distension and mild constipation. Imaging studies revealed a large fluid collection in her abdomen. A paracentesis was performed and fluid analysis showed characteristics of a lymphatic cyst. During an exploratory laparotomy, a large multicystic mass was discovered originating from the omentum. The mass was surgically removed. Histopathological examination confirmed it was an omental cyst. The girl recovered well after surgery. Omental cysts are rare congenital lesions that can present in both children and adults with non-specific abdominal symptoms. Complete surgical excision is the treatment of choice.
The presentation is about a patient who is having Situs Inversus Totalis and is also suffering from multiple gall bladder stones. Patient's physician have decided to undergo cholecystectomy.
Sources are already mentioned in the presentation.
Hope the presentation helps to gain some information.
This document discusses appendicitis, including its causes, symptoms, diagnosis, and treatment. The appendix is a small pouch connected to the cecum in the digestive system. Appendicitis occurs when the appendix becomes blocked and infected, causing swelling. Common symptoms include abdominal pain localized to the lower right side, nausea, loss of appetite, and fever. Doctors use physical exams, blood tests, imaging like CT scans, and ultrasounds to diagnose appendicitis and rule out other potential causes of abdominal pain. Untreated appendicitis can lead to a burst appendix, so surgical removal of the inflamed appendix (appendectomy) is usually required to treat appendicitis.
Annular pancreas is an uncommon condition in adults.
The ring formation generally originates from the failure of
normal clockwise rotation of ventral pancreas. First
described by Tiedmann in 1818, its incidence is
1:20,000 population. It has bimodal presentation i.e is seen
either in Infants or in 4th & 5th decade of life.
A 14-year-old boy presented with a neck swelling. Physical exam revealed a mobile, fluid-filled lump below the hyoid bone that moved on swallowing. Ultrasound was determined to be the single most appropriate investigation, as it is the first-line imaging to distinguish fluid-filled cysts and visualize the mass and surrounding tissues. Ultrasound can confirm the diagnosis of a thyroglossal cyst in most cases without the need for biopsy or other invasive tests.
Initially in my lectures you can see that I have talked about Approach to Pain in abdomen, now we will learn what imaging should be done and why as per case to case basis. CT or USG or X-ray !!
This document provides an overview of chronic pancreatitis, including its pathophysiology, etiology, clinical features, diagnosis, and management. It discusses how chronic pancreatitis represents a continuous inflammatory and fibrosing process of the pancreas resulting in permanent dysfunction. The main causes are alcohol use and genetic factors. Patients present with abdominal pain in 95% of cases and can develop weight loss, steatorrhea, and diabetes. Diagnosis involves tests of pancreatic function and imaging tests looking for features like calcification. Treatment focuses on pain control, managing maldigestion with pancreatic enzyme replacement, and addressing complications like pseudocysts and stenosis.
The document discusses various diagnostic procedures used in gastrointestinal (GIT) diseases. It describes structural tests like imaging techniques (X-rays, ultrasound, CT, MRI, endoscopy), functional tests (motility tests, pH monitoring, malabsorption tests), tests for infections like Helicobacter pylori, blood tests, and stool tests. Key diagnostic procedures mentioned include upper and lower endoscopy, capsule endoscopy, ERCP, EUS, biopsy, and hydrogen breath testing.
Tasleem Akhtar, a 50-year old female, presented with post-prandial vomiting, abdominal pain, and constipation. Imaging showed signs of intestinal obstruction. She underwent exploratory laparotomy, which found a stricture in the sigmoid colon due to a hard mass. A segment of the sigmoid colon was resected along with the mass. Histopathology revealed colorectal cancer. She was diagnosed with colorectal cancer affecting the sigmoid colon.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Augu...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Nephrolithiasis
- Infected Iliac Aneurysm
- Pancreatic Masses
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
A 70-year-old man presented with vague abdominal pain following treatment for stage III colon cancer. Imaging showed no evidence of recurrence but his CEA level was rising. Review of his initial PET scan in light of a subsequent scan found a lesion that was initially missed due to its location near the bowel.
A 70-year-old white male presented with a history of stage III colon cancer and recent abdominal pain. Imaging showed no evidence of recurrent or metastatic disease. Due to a rising CEA level, the physician recommended a follow up PET scan, which ultimately revealed a focal area of uptake indicating cancer that was initially missed on the first PET scan. This case highlights the difficulty of distinguishing pathological from physiological uptake on PET alone without comparison to recent CT images.
1. Chronic pancreatitis represents a continuous inflammatory process of the pancreas resulting in permanent endocrine and exocrine dysfunction.
2. Chronic pancreatitis most commonly presents with abdominal pain in 95% of cases, along with weight loss, steatorrhea, and diabetes mellitus in some cases.
3. Diagnosis involves tests of pancreatic function like secretin stimulation tests and fecal elastase, as well as imaging with CT, MRI, and ERCP to detect features like pancreatic enlargement, calcifications, and ductal abnormalities.
The document provides an overview of the classification, pathophysiology, diagnosis, and management of abdominal trauma. It discusses the primary and secondary surveys, various imaging modalities including FAST ultrasound, CT scan, and DPL, and treatments for different types and severities of injuries. Management may involve nonoperative approaches like observation for mild injuries or surgery for more severe injuries, hemorrhage, or failed nonoperative management. Specific injuries to organs like the spleen are also addressed.
The document discusses the assessment, investigations, and treatment of intestinal obstruction. It provides details on the history, physical examination, and various tests used to diagnose the cause of obstruction including blood tests, imaging like x-rays and CT scans. It then outlines supportive care measures and describes specific surgical treatments for different types of intestinal obstructions like resection of gangrenous bowel or hernia repair with bowel resection if needed.
A 40-year-old male presented to the emergency department with acute abdominal pain and distension after eating a heavy meal two days prior. Imaging showed massive gastric dilatation. Conservative management failed, so the patient underwent surgery. In surgery, the stomach was found to be hugely distended with thinned walls but no perforation. A gastrojejunostomy was performed to decompress the stomach. The patient recovered well post-operatively.
This document contains 24 multiple choice questions related to anatomy, diagnosis, and treatment of gallbladder and bile duct disorders. The questions cover topics like gallbladder anatomy, investigations for gallstones, management of cholecystitis, gallbladder polyps, and risk factors for cholangiocarcinoma. The correct answers are not provided.
Nuclear medicine in biliary tract disordersRamin Sadeghi
The document summarizes nuclear medicine techniques for evaluating various biliary tract disorders. Cholescintigraphy using radiotracers can help diagnose acute cholecystitis, functional gallbladder disorders, and gallstone ileus. It evaluates gallbladder ejection fraction to identify sphincter of Oddi dysfunction and determine surgical candidacy for patients with functional gallbladder disorders. Biliary leaks after surgery are also detectable on hepatobiliary scans.
This document discusses the management of abdominal trauma. It begins with classifications for abdominal injuries and describes the pathophysiology of blunt and penetrating trauma. The primary and secondary surveys are outlined, including important physical exam findings. Diagnostic imaging options are presented, such as FAST ultrasound, CT scans, and DPL. Specific injuries to organs like the spleen are discussed. Management approaches for both blunt and penetrating trauma are covered, including options for non-operative management versus laparotomy. Damage control resuscitation principles and abdominal compartment syndrome are also mentioned.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Febr...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Pneumatosis intestinalis
- Gallstone ileus
- Cecal perforation
This document discusses Hirschsprung's disease, a congenital disorder causing bowel obstruction. It begins with an introduction stating it affects 1 in 5,000-8,000 births and is caused by absence of ganglion cells in the colon. Embryology and clinical presentation are then described. The document further classifies Hirschsprung's disease and discusses various imaging modalities used in diagnosis such as radiography, ultrasound, CT scan, and biopsy. Differential diagnosis and treatment involving temporary colostomy followed by definitive surgery are also outlined.
1. The document discusses the use of ultrasound imaging techniques for diagnosing bowel pathology in cases of acute abdomen. It outlines normal ultrasound appearances of the bowel and key signs of various diseases.
2. Dynamic ultrasound techniques like assessing peristalsis, compressibility, and the valsalva maneuver can provide additional diagnostic information. Focused scanning with high-frequency probes can aid in evaluating superficial lesions.
3. Ultrasound has benefits as a first-line imaging method due to its availability, low cost, and lack of radiation or contrast agents. With experience in ultrasound appearances of the bowel and careful technique, it can effectively evaluate abdominal complaints and guide management.
Esophagogastroduodenoscopy (EGD) is an endoscopic examination of the esophagus, stomach, and duodenum used for both diagnostic and therapeutic purposes. It allows visualization of these areas as well as obtaining biopsies. Common indications include unexplained anemia, gastrointestinal bleeding, and dyspepsia. Potential complications are rare at 1 in 1000 and include aspiration pneumonia, bleeding, and perforation. Limitations include inability to fully examine gastrointestinal function or areas beyond the duodenum. Contraindications include recent heart issues or hypotension. Capsule endoscopy allows noninvasive imaging of the small intestine by using a swallowed capsule with a camera.
The patient is a 45-year-old female presenting with sudden abdominal pain for 3 hours in her epigastric and right upper quadrant areas. She reports one episode of vomiting and a subjective fever. Her vital signs show elevated blood pressure, heart rate, and temperature. Physical exam reveals tenderness in the epigastric and right upper quadrants. Based on her history and exam findings, she is suspected to have acute cholecystitis.
The document provides an overview of esophageal disorders, including their symptoms, diagnosis, and management. Key points include:
- Dysphagia can be caused by obstructive lesions like cancer/strictures or motility disorders. Diagnosis involves barium swallow, endoscopy, and manometry.
- Odynophagia can be due to conditions like GERD, infections, pill esophagitis, or radiation esophagitis.
- Barrett's esophagus develops in some with longstanding GERD and requires surveillance due to cancer risk.
- H. pylori testing is recommended if treating, for persistent dyspepsia, or lymphoma risk. Endoscopy is considered
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
Basic principles of ultrasound.
Terms used in ultrasound.
Advantages of ultrasound.
Definition of acute abdomen.
Differential Diagnosis.
Abdominal ultrasound technique.
USG findings in most common pathologies.
Conclusion.
Tasleem Akhtar, a 50-year old female, presented with post-prandial vomiting, abdominal pain, and constipation. Imaging showed signs of intestinal obstruction. She underwent exploratory laparotomy, which found a stricture in the sigmoid colon due to a hard mass. A segment of the sigmoid colon was resected along with the mass. Histopathology revealed colorectal cancer. She was diagnosed with colorectal cancer affecting the sigmoid colon.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Augu...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Nephrolithiasis
- Infected Iliac Aneurysm
- Pancreatic Masses
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
A 70-year-old man presented with vague abdominal pain following treatment for stage III colon cancer. Imaging showed no evidence of recurrence but his CEA level was rising. Review of his initial PET scan in light of a subsequent scan found a lesion that was initially missed due to its location near the bowel.
A 70-year-old white male presented with a history of stage III colon cancer and recent abdominal pain. Imaging showed no evidence of recurrent or metastatic disease. Due to a rising CEA level, the physician recommended a follow up PET scan, which ultimately revealed a focal area of uptake indicating cancer that was initially missed on the first PET scan. This case highlights the difficulty of distinguishing pathological from physiological uptake on PET alone without comparison to recent CT images.
1. Chronic pancreatitis represents a continuous inflammatory process of the pancreas resulting in permanent endocrine and exocrine dysfunction.
2. Chronic pancreatitis most commonly presents with abdominal pain in 95% of cases, along with weight loss, steatorrhea, and diabetes mellitus in some cases.
3. Diagnosis involves tests of pancreatic function like secretin stimulation tests and fecal elastase, as well as imaging with CT, MRI, and ERCP to detect features like pancreatic enlargement, calcifications, and ductal abnormalities.
The document provides an overview of the classification, pathophysiology, diagnosis, and management of abdominal trauma. It discusses the primary and secondary surveys, various imaging modalities including FAST ultrasound, CT scan, and DPL, and treatments for different types and severities of injuries. Management may involve nonoperative approaches like observation for mild injuries or surgery for more severe injuries, hemorrhage, or failed nonoperative management. Specific injuries to organs like the spleen are also addressed.
The document discusses the assessment, investigations, and treatment of intestinal obstruction. It provides details on the history, physical examination, and various tests used to diagnose the cause of obstruction including blood tests, imaging like x-rays and CT scans. It then outlines supportive care measures and describes specific surgical treatments for different types of intestinal obstructions like resection of gangrenous bowel or hernia repair with bowel resection if needed.
A 40-year-old male presented to the emergency department with acute abdominal pain and distension after eating a heavy meal two days prior. Imaging showed massive gastric dilatation. Conservative management failed, so the patient underwent surgery. In surgery, the stomach was found to be hugely distended with thinned walls but no perforation. A gastrojejunostomy was performed to decompress the stomach. The patient recovered well post-operatively.
This document contains 24 multiple choice questions related to anatomy, diagnosis, and treatment of gallbladder and bile duct disorders. The questions cover topics like gallbladder anatomy, investigations for gallstones, management of cholecystitis, gallbladder polyps, and risk factors for cholangiocarcinoma. The correct answers are not provided.
Nuclear medicine in biliary tract disordersRamin Sadeghi
The document summarizes nuclear medicine techniques for evaluating various biliary tract disorders. Cholescintigraphy using radiotracers can help diagnose acute cholecystitis, functional gallbladder disorders, and gallstone ileus. It evaluates gallbladder ejection fraction to identify sphincter of Oddi dysfunction and determine surgical candidacy for patients with functional gallbladder disorders. Biliary leaks after surgery are also detectable on hepatobiliary scans.
This document discusses the management of abdominal trauma. It begins with classifications for abdominal injuries and describes the pathophysiology of blunt and penetrating trauma. The primary and secondary surveys are outlined, including important physical exam findings. Diagnostic imaging options are presented, such as FAST ultrasound, CT scans, and DPL. Specific injuries to organs like the spleen are discussed. Management approaches for both blunt and penetrating trauma are covered, including options for non-operative management versus laparotomy. Damage control resuscitation principles and abdominal compartment syndrome are also mentioned.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Febr...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Pneumatosis intestinalis
- Gallstone ileus
- Cecal perforation
This document discusses Hirschsprung's disease, a congenital disorder causing bowel obstruction. It begins with an introduction stating it affects 1 in 5,000-8,000 births and is caused by absence of ganglion cells in the colon. Embryology and clinical presentation are then described. The document further classifies Hirschsprung's disease and discusses various imaging modalities used in diagnosis such as radiography, ultrasound, CT scan, and biopsy. Differential diagnosis and treatment involving temporary colostomy followed by definitive surgery are also outlined.
1. The document discusses the use of ultrasound imaging techniques for diagnosing bowel pathology in cases of acute abdomen. It outlines normal ultrasound appearances of the bowel and key signs of various diseases.
2. Dynamic ultrasound techniques like assessing peristalsis, compressibility, and the valsalva maneuver can provide additional diagnostic information. Focused scanning with high-frequency probes can aid in evaluating superficial lesions.
3. Ultrasound has benefits as a first-line imaging method due to its availability, low cost, and lack of radiation or contrast agents. With experience in ultrasound appearances of the bowel and careful technique, it can effectively evaluate abdominal complaints and guide management.
Esophagogastroduodenoscopy (EGD) is an endoscopic examination of the esophagus, stomach, and duodenum used for both diagnostic and therapeutic purposes. It allows visualization of these areas as well as obtaining biopsies. Common indications include unexplained anemia, gastrointestinal bleeding, and dyspepsia. Potential complications are rare at 1 in 1000 and include aspiration pneumonia, bleeding, and perforation. Limitations include inability to fully examine gastrointestinal function or areas beyond the duodenum. Contraindications include recent heart issues or hypotension. Capsule endoscopy allows noninvasive imaging of the small intestine by using a swallowed capsule with a camera.
The patient is a 45-year-old female presenting with sudden abdominal pain for 3 hours in her epigastric and right upper quadrant areas. She reports one episode of vomiting and a subjective fever. Her vital signs show elevated blood pressure, heart rate, and temperature. Physical exam reveals tenderness in the epigastric and right upper quadrants. Based on her history and exam findings, she is suspected to have acute cholecystitis.
The document provides an overview of esophageal disorders, including their symptoms, diagnosis, and management. Key points include:
- Dysphagia can be caused by obstructive lesions like cancer/strictures or motility disorders. Diagnosis involves barium swallow, endoscopy, and manometry.
- Odynophagia can be due to conditions like GERD, infections, pill esophagitis, or radiation esophagitis.
- Barrett's esophagus develops in some with longstanding GERD and requires surveillance due to cancer risk.
- H. pylori testing is recommended if treating, for persistent dyspepsia, or lymphoma risk. Endoscopy is considered
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
Basic principles of ultrasound.
Terms used in ultrasound.
Advantages of ultrasound.
Definition of acute abdomen.
Differential Diagnosis.
Abdominal ultrasound technique.
USG findings in most common pathologies.
Conclusion.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Article: https://pecb.com/article
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A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
1. CASE OF CHRONICCHOLECYSTITIS
QWhatis your case?(Summaryofacase of chroniccholecystitis)
Ans. This 35-year-oldladypresented with history ofrecurrent attack ofpain in right upper half of abdomen for last 1yeat.
The pain startedin theright upper half of the abdomen l year back, which was sudden in onset. The pain was colicky in
nature, severeinintensityandwas relieved by analgesics. The pain radiatedto the backofthe right side ofthe chest and right
2. 102
SECTION 1: Surgical Long Cases
shoulder region. Patient has similar attacks of pain for last lyearinitially at an interval of 3-4 months, but for
lastl month
patient is having dullaching constantpainin right upper half of abdomen. Patient complains of heart
burn,acidity,,Alatulenc,
and sensation offullness after meals for thesame duration. Bowel and bladder habits are normal. There are no
significan,
symptoms suggestive of any systemic disease. There are no significant past family or personal history.
On examination: On general survey patient is conscious and cooperative, no jaundice, anemia, pulse 86 beats/
min. On
abdominal examination, oninspection, the shape and contour of the abdomenis normal. Umbilicus is normal
Abdomen
is moving normally with respiration, no visible peristalsis, no pulsatile movement and skin of the abdomen iss
normal.
palpationthe abdomen has a normal soft elasticfeel. There is nosuperficial or deep tenderness in abdomen. Liver;
spleen are not palpable. No other mass is palpable. On percussion the abdomen is normally tympanitic and there is d
fluidin abdomen. (On auscultation normal bowel sounds are heard. External genitalia are normal. Per rectal and
per vaginal,
examination is not done. Systemicexamination is normal.
Q.What isyourdiagnosis?
Ans. This is a case ofchronic cholecystitis.
(Incase of mucoceleofgallbladder, the history and examination part is the same as chronic cholecystitis, except
abdominal examination on inspection there is aglobular intra-abdominal lump in the right hypochondriac and right lu
region moving up and dowm with respiration. On palpation alump is palpable in the said region, which is intra-abdomi
moving upand down withrespiration, nontender,surface issmooth,lowermargin, medialandlateralmarginsarepalpail.
but the upper margin is passing deep to the costal margin, it is tense cystic in feel. Liver and spleen are not palpable.
QHowwillyou demonstrate Murphy'ssign?
Ans. See abdomen examination (Figs. 3.15A and B, Page No. 70).
Q.When doyoufind Murphy'ssignispositive?
Ans. Murphy'ssignispositive in acute cholecystitis. In chronic cholecystitis Murphy's sign is not positive.
Q.Whatare the other possibilities in this patient?
Ans.
o Chronicduodenal ulcer
$ Chronic gastric ulcer
" Chronicpancreatitis
" Recurrent appendicitis
" Hiatus hernia
" Right-sided renal calculus
" Chronic pyelonephritis.
Q. How will you managethis patient?
Ans. Iwould like to confirm my diagnosis bydoing aUSG ofupper abdomen.
QHow ultrasonography helps in diagnosis ofbiliarytract disease?
Ans. Ultrasonography is areliable investigation for evaluation ofbiliary tract disease.
" Gallbladder:
» Size ofthe gallbladder whether gallbladderis normal sized, contracted or distended
Walls of the gallbladder--normal wall thickness or any thickening of wall
» Intraluminal calculi-intraluminalcalculi may be seen as aechogenic shadow in the gallbladder lumen withDou
anterior and posterior acoustic shadow. Any associated mass in gallbladder mnay be seen.
Common bile duct: The upper end of common bile duct may be seen and its diameter may be measured. Any
intraluminal
o Liver: Liver mnay be seen well and any solid or cysticlesion intheliver may be ascertained. Any dilatation oftheintrahepati
calculi in the bile duct lumen may be seen. However, stone at lower end of bile duct may sometimes be missedl onUSG.
biliary radicles may be seen well.
e Pancreas: The pancreas may be seen and any mass in relation to the pancreas may be seen wel. The diameter
of
the
pancreatic duct may be measured. Any calculus in the pancreatic duct or parenchymal calcification may
beseen.The
arenchymal echotexture may be seen clearly and chronic or acute pancreatitis may be diagnosed.
0. IfUSGshowsstone in gallbladderwhat elsewould you like to do?
Ans. If USG shows stone in gallbladder and common bile duct is normal and there is no history of jaundice
or
cholangits
hen no further investigation is required to confirm diagnosis of gallstone disease.
We would like to dosome more investigation toassess fitness of the patient for general anesthesia.
Complete hemogram: Hb%, TLC, DLCand ESR
3. " Biood for sugar, urea and creatinine
" Liver function test
" Urine for routine examination
" Chest X-ray (posteroanterior view)
" FCG.
0.When will youconsiderdoing an ERCPon MRCP in patient with gallstone disease?
Ans. Ulrasonographyis not always reliable for evaluation of bile duct as it is difficultto studythelower part ofthe bile duct
due tooverlapping bowel gas shadow. So evaluation ofCBD may need to be done in following situations:
" Ifthere is history of jaundice or the patient is having jaundice
Ifthere is suspicion of stonein the common bile duct on USG examination
"IfLFT shows elevation of serumenzymes--ALT, AST and alkaline phosphatase
USGshows dilatation of commonbile duct
* Patient presenting with acute cholecystitis has higher incidence ofCBD stones and hence needs evaluation.
o WhataretheadvantagesanddisadvantagesofMRCPforevaluationofbileduct?
Ans. Magnetic resonance cholangiopancreatography (MRCP) is anewer modality of investigation and it provides virtual
reconstructionofthe whole biliary tree from the slices of MRIofthe hepatobiliary tree and can give verygood picture of the
entire biliarytree. It is anoninvasive investigation,no radiation exposure, no dye is required. The biliary tract dilatation, any
obstruction due to stone or growth may be ascertained.
The limitation ofMRCP is that it has only diagnostic value as no intervention is possible.
Whataretheadvantagesand disadvantagesofERCP?
Ans.Theadvantage of ERCPistherapeuticinterventionlikesphincterotomyandstoneextractionorbiliarystentingis possibie.
Bile aspirated may be used for exfoliative cytology. Biopsyfrom periampullary lesion or brush cytology from the bile duct
mavbe taken.
QHow willyou treatthis patient?
Thisisan invasiveinvestigation. Itrequiresintroduction ofagastroduodenoscope, cannulationofbileand pancreaticduct
and injection ofadye. There is chance ofpostprocedure cholangitis or pancreatitis, which may be life-threatening.
Ans.
Ans. I willtreat this patientbycholecystectomy. Iwould prefer to do laparoscopic cholecystectomy.
Q
Whydoyoupreferlaparoscopiccholecystectomy?
" Laparoscopiccholecystectomyhas been established as gold standard for the treatmentofgallstone diseases
» Surgery is safe in the hands ofa trained surgeon
» Less pain, less hospital stays
» Cosmetic
» EarBy return to work is possible
> More acceptance by the patient.
Whileyoutakeconsentforlaparoscopiccholecystectomywhatconsentshouldbetaken?
Describethesteps of laparoscopiccholecystectomy?
Ans.
Ans. Informed consent ís to be taken. Patient should be explained that if laparoscopic procedure is not safe it may need
Conversion to open cholecystectomy.
Ans. SeeOperative SurgerySection, Page No. 801, Chapter 22.
Whataretheindsionsforopen cholecystectomy?
CHAPTER3: Abdomen
. Right subcostal incision (Kocher's incision)
Right upper paramedianincision
3. Midline incision
Mayo Robson'sincision. Right paramedianwith extension to midline
Upper abdominaltransverse incision (Fig. 3.34).
Wheredoyouplacemopsduringopencholecystectormy?
Ans.Duringopencholecystectomyafteropeningthe peritoneum and confirmation
of diagnosis,three mops are placed properlytoexposethegallbladder area..One mop
103
colon downward. (1) Another mop isinserted to retract the transverse colonand
tirtitFiit
4 3
splacedin the hepatorenal pouch of Morrisontoretract the hepatic flexure of the Fig. 3.34: Incisions for open cholecystec-
tomy (See text for 1, 2, 3, 4, 5).