This document discusses various causes of acute abdominal pain, including non-specific abdominal pain (34%), acute appendicitis (28%), acute cholecystitis (10%), small bowel obstruction (4%), perforated peptic ulcer (3%), pancreatitis (3%), and diverticular disease (2%). It describes the pathophysiology of visceral, parietal, and referred pain. It provides details on localized pain patterns from various abdominal organs and conditions. It also outlines the important history, physical exam findings, and initial investigations for evaluating a patient with acute abdominal pain.
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
This topic is very important for an MBBS Students as it is one of the common cases a Medical Officer will come across during their Surgical Postings. Moreover it is always a Debate in treating the patient either an Physician or a Surgeon...Always it is one of the Devastating conditions of abdomen...
Information about Diverticular disease by Dr Dhaval Mangukiya.
Details of Diverticular disease, Differential Diagnosis, CT Scan Protocol, Point to look in CT, Options, Indications for Elective Surgery, Exploraion, Primary Resection, Opinion, Management etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Learn about the management of a patient with an acute abdomen in the emergency room settings. Clinical scenarios are included. The emphasis of this presentation is the surgical patient.
This topic is very important for an MBBS Students as it is one of the common cases a Medical Officer will come across during their Surgical Postings. Moreover it is always a Debate in treating the patient either an Physician or a Surgeon...Always it is one of the Devastating conditions of abdomen...
Information about Diverticular disease by Dr Dhaval Mangukiya.
Details of Diverticular disease, Differential Diagnosis, CT Scan Protocol, Point to look in CT, Options, Indications for Elective Surgery, Exploraion, Primary Resection, Opinion, Management etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Learn about the management of a patient with an acute abdomen in the emergency room settings. Clinical scenarios are included. The emphasis of this presentation is the surgical patient.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
3. Introduction
• > 1000 causes exist
– Non Specific AP (34%)
– Acute appendicitis (28%)
– Acute cholecystitis (10%)
– Small Bowel Obstruction (4%)
– Perforated PU (3%)
– Pancreatitis (3%)
– Diverticular disease (2%)
– Others (13%)
4. Pathophysiology
• Visceral pain
– Distention, inflammation or ischemia in hollow
viscous & solid organs
– Localization depends on the embryologic origin
of the organ:
• Foregut to epigastrium
• Midgut to umbilicus
• Hindgut to the hypogastric region
5. Pathophysiology
• Parietal pain : is localized to the
dermatome above the site of the stimulus.
• Referred pain: produces symptoms, not
signs e.g. tenderness
19. Systemic Examination
Abdomen:
• Inspection
- Scaphoid or flat in peptic ulcer
- Distended in ascites or intestinal
obstruction
- Visible peristalsis in a thin or malnourished
patient (with obstruction)
20. Systemic Examination
Palpation
• Check for Hernia sites
• Tenderness
• Rebound tenderness
• Guarding- involuntary spasm of muscles
during palpation
• Rigidity- when abdominal muscles are tense
& board-like indicates peritonitis.
21. Systemic Examination
• Local Right Iliac Fossa tenderness:
– Acute appendicitis
– Acute Salpingitis
• Low grade, poorly localized tenderness:
– Intestinal Obstruction
• Tenderness out of proportion to examination:
– Mesenteric Ischemia
– Acute Pancreatitis
• Flank Tenderness:
– Perinephric Abscess
– Retrocaecal Appendicitis
22. Important Signs
Sign Finding Association
Cullen's sign Bluish periumbilical
discoloration
Retroperitoneal
haemorrhage
Kehr's sign Severe left shoulder pain Splenic rupture
Ectopic pregnancy
rupture
McBurney‘s Tenderness located 2/3 distance from
anterior iliac spine to umbilicus on right side Appendicitis
Murphy's sign Abrupt interruption of inspiration on palpation
of right upper quadrant
Acute cholecystitis
Iliopsoas sign Hyperextension of right hip causing abdominal
pain
Appendicitis
Obturator's sign Internal rotation of flexed right hip causing
abdominal pain
Appendicitis
Grey-Turner's Discoloration of the flank Retroperitoneal
haemorrhage
Chandelier sign Manipulation of cervix causes patient to lift
buttocks off table
Pelvic inflammatory
disease
Rovsing's sign Right lower quadrant pain with palpation of
the left lower quadrant
Appendicitis
32. Laparoscopy
• Early diagnostic laparoscopy may result in:
– accurate,
– prompt,
– efficient management of AAP
• Reduces the rate of unnecessary laparotomy
• Increases the diagnostic accuracy
• May be a key to solving the diagnostic
dilemma of NSAP.
33. MCQs: 1
A 35 yr old male came to emergency room with
acute abdominal pain, abdominal distension and
vomiting for 3 days. Examination revealed presence
of tachycardia, dehydration, abdominal rigidity and
rebound tenderness. Best initial management would
be
1.IV fluids CT scan
2.IV fluids X ray abdomen
3.Directly CT scan
4.Only USG examination
34. MCQs: 2
A 40 yr old female had severe pain in RUQ
with radiation to back and vomiting for 6 hrs.
Examination revealed mild tenderness in
RUQ. Best initial investigation would be
1.X ray chest
2.X ray abdomen
3.CT scan
4.USG examination
35. MCQs: 3
A 65 yr old male with a history of thinning of
urinary stream, and intermittency woke up in
morning with lower abdominal pain and inability
to pass urine. Examination showed suprapubic
distension. Per rectal examination is likely to
show:
1.Carcinoma prostate
2.Carcinoma rectum
3.BPH
4.PR examination is not useful in this case.
36. MCQs: 4
• A woman 35 years of age comes to the
emergency department with symptoms of
pain in abdomen and bilious vomiting but no
distension of abdomen. Abdominal X ray
showed no air fluid level. Diagnosis is:
1.Ca rectum
2.Duodenal obstruction
3.Adynamic ileus
4.Pseudoobstruction
37. MCQ 5
• A patient underwent right hemicolectomy for
cecal mass. On POD 7, he developed
abdominal distension and bilious vomiting with
↑bowel sounds. X ray abdomen showed
multiple air fluid levels. No h/o fever. What is the
most probable cause?
1.Paralytic ileus
2.Anastomotic dehiscence
3.Adhesive obstruction
4.pseudoobstruction
38. MCQ 6
• Pain in rt shoulder in acute cholecystitis
is
1.Shifting pain
2.Referred pain
3.Indicates poor prognosis
4.Not related to gallbladder
39. MCQ7
• Acute pain in epigastrium radiating to back
after an alcohol binge in a 45 yr male with
severe vomiting: true is
1.Serum lipase in less helpful than serum amylase in
making correct diagnosis
2.Serum lipase is more helpful than serum amylase in
making correct diagnosis after 5 days
3.Serum amylase is never helpful in such cases
4.C reactive protein is not helpful in acute pancreatitis
40. MCQ 8
Grey turner sign is seen in
1.Acute cholecystitis
2.Acute appendicitis
3.Acute pancreatitis
4.Acute hepatitis
41. MCQ 9
In duodenal ulcer perforation
1.Erect x ray chest is not helpful in detecting air
under diaphragm
2.Supine x ray is better than erect x ray
abdomen
3.Air under diaphragm is not seen in all cases
4.X ray chest is not helpful in making correct
diagnosis
42. MCQ10
• x ray abdomen shown is
diagnostic of
1.Acute pancreatitis
2.Acute appendicitis
3.Acute small intestinal
obstruction
4.Acute cholecystitis
