Perforated peptic ulcers commonly occur in middle-aged patients, often due to smoking and NSAID use. Symptoms include sudden severe abdominal pain. Diagnosis involves chest X-ray showing free air or CT scan. Treatment is surgical closure of the perforation along with antibiotics. Upper GI bleeding treatment involves resuscitation, diagnosis via endoscopy, and treatment of the bleeding source, such as ulcers. Gastric outlet obstruction is usually due to peptic ulcer disease or gastric cancer, causing non-bilious vomiting, weight loss, and metabolic abnormalities like hypochloremic alkalosis. Treatment involves rehydration, gastric decompression, investigation of the cause, and sometimes surgical gastroenterostomy.
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
collected from multiple general surgery references (2016) like bailey's and loves short practice of surgery , Schwartzs Principles of Surgery, 10th Edition , Schwartzs Principles of Surgery, 10th Edition and Matary's GIT surgery .
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days.
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days. The clinical ex-...
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days. The clinical ex-...
We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes
of abdominal pain who had a three-day cessation of materials and gas for three days. The clinical examination on admission showed a slightly distended abdomen, an empty rectal bulb with digital rectal
examination. The biological assessment was without abnormality, the radiography of the abdomen
without preparation showed central hydro-aeric levels of the hail-like type with a gaseous crescent
inter hepato-diaphragmatic. The abdominal CT objectified a pneumoperitoneum with aerobilia, an
upper digestive distension with probable proximal digestive volvulus. The patient was admitted to
the block and an exploratory laparotomy was performed which revealed the presence of a gas cyst in
several places in the small intestine with distension of the latter upstream of a large mass of benign
appearance. Taking a segment of the jejunum. We carried out an anastomosis resection of the small
intestine carrying out the mass which we sent to the pathological anatomy laboratory and the result
of which returned in favor of intestinal cystic pneumatosis. The postoperative suites were simple with
good evolution and resumption of transit at end of the third day
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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 simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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Complications of-peptic-ulcer
1. Complications of peptic ulceration
The common complications of peptic ulcer are:
1- Perforation.
2-Bleeding.
3-Pyloric stenosis.
2. Perforated peptic ulcer
Epidemiology
Despite the use of antiulcer agents and eradication therapy, the incidence of perforated
peptic ulcer has changed little.
Most patients are middle aged, with a ratio more in men than women.
Smoking and NSAIDs appear to be responsible for most of these perforations.
Clinical features
The patient, who may have a history of peptic ulceration, develops sudden-onset,
severe, generalized abdominal pain as a result of the irritant effect of gastric acid
on the peritoneum.
Although the contents of an acid are relatively low in bacterial load, bacterial
peritonitis supervenes over a few hours, usually accompanied by a deterioration in
the patient’s condition Initially, the patient may be shocked with a tachycardia but a
pyrexia is not usually observed until some hours after the event.
The abdomen exhibits a board-like rigidity and the patient can not move because of
the pain. The abdomen does not move with respiration. Patients with this form of
presentation need an operation, without which they will deteriorate with a septic
peritonitis.
3. Sometimes perforations will seal as a result of the inflammatory response and
adhesion within the abdominal cavity, and so the perforation may be self-limiting. All
of these factors may combine to make the diagnosis of perforated peptic ulcer.
The most common site of perforation is the anterior aspect of the duodenum.
However, the anterior or incisural gastric ulcer may perforate and, in addition, gastric
ulcers may perforate into the lesser sac, which can be particularly difficult to diagnose.
These patients may not have obvious peritonitis.
Investigations
An erect plain chest radiograph will reveal free gas under the diaphragm in most of
the cases.
But CT imaging is more accurate .
All patients should have serum amylase levels tested, as distinguishing between peptic
ulcer perforation and pancreatitis can be difficult. Measuring the serum amylase,
however, may not remove the diagnostic difficulty; it can be elevate following
perforation of a peptic ulcer although, fortunately, the levels are not usually as high as
the levels commonly seen in acute pancreatitis. Several other investigations are
useful if doubt remains.
A CT scan will normally be diagnostic in both conditions.
6. Treatment
1.The patient should be admitted to the hospital
2. Resuscitation ,an IV line and intravenous fluid.
3.Naso gastric tube put.
3.Analgesia should not be with held for fear of removing the signs of an intraabdominal
problem.
4.Following resuscitation, the treatment is principally surgical.
Laparotomy is performed, usually through an upper midline or right upper paramedian
incision if the diagnosis of perforated peptic ulcer can be made with confidence. This is
not always possible and, hence, it may be better to place a small incision around the
umbilicus to localize the perforation with more certainty.
Alternatively, laparoscopy may be used. The most important component of the
operation is a thorough peritoneal toilet to remove all of the fluid and food debris. If
the perforation is in the duodenum it can usually be closed by several well-placed
sutures. It is common to place an omental patch over the perforation in the hope of
enhancing the chances of the leak sealing.
Gastric ulcers should, if possible, be excised and closed, and sent for histopathology so
that malignancy can be excluded.
Occasionally, a patient is seen who has a massive duodenal or gastric perforation such
that simple closure is impossible; in these patients, partial gastrectomy is a useful
operation. All patients should be treated with systemic antibiotics. The stomach should
be kept empty postoperatively by nasogastric and gastric anti-secretory agents are
commenced to promote healing in the residual ulcer.
7. HAEMATEMESIS AND MELAENA
Upper gastrointestinal hemorrhage remains a major medical problem. Despite
improvements in diagnosis and the proliferation in treatment modalities
An in hospital mortality still can be expected.
Causes of upper gastrointestinal bleeding
1.Ulcers : Oesophageal ,Gastric and Duodenal
2.Erosions: Oesophageal ,Gastric and Duodenal
3.Mallory–Weiss tear (syndrome)
4.Oesophageal varices
5.Tumour (mainly gastric)
6.Vascular lesions, e.g. Dieulafoy’s disease
8. Whatever the cause, the principles of management are identical. The patient
should be first resuscitated and then investigated urgently to determine the cause
of the bleeding. Only then should definitive treatment be instituted. For any
significant gastrointestinal bleed,
1-Intravenous access should be established and Blood should be cross-matched
and the patient transfused as clinically indicated
2-For severe bleeding, central venous pressure monitoring should be set up
3-Bladder catheterization performed.
As a general rule, most gastrointestinal bleeding will stop, but there are some
cases when this is not. In these circumstances, resuscitation, diagnosis and
treatment should be carried out in quick succession. There are occasions when
life-saving manoeuvres have to be undertaken without the benefit of an absolute
diagnosis. For instance, in patients with known oesophageal varices and
uncontrollable bleeding, a Sengstaken–Blakemore tube may be inserted before an
endoscopy has been carried out.
The most important current causes of this are liver disease. In this circumstance,
the coagulopathy should be corrected, if possible, with freshfrozen plasma.
Upper gastrointestinal endoscopy should be carried out by an experienced
operator as soon as practicable after the patient has been stabilised. In patients in
whom the bleeding is relatively mild, endoscopy may be carried out on the
morning after admission. In all cases of severe bleeding it should be carried out
immediately
9. GASTRIC OUTLET OBSTRUCTION
The two common causes of gastric outlet obstruction are:
1-pyloric stenosis secondary to peptic ulceration.
2- gastric cancer(prepyloric tumor).
Clinical features
*There is usually a long history of peptic ulcer disease.
*pain: the pain may become unremitting but in other cases it may largely disappear.
*Vomiting: The vomitus is totally lacking in bile(nonbilious). Very often it is possible to
recognise foods taken several days previously.
*The patient commonly loses weight, and appears unwell and dehydrated.
On examination it may be possible to see the distended stomach and a succussion
splash may be audible on shaking the patient’s abdomen.
Metabolic effects The vomiting of hydrochloric acid results in hypochloraemic alkalosis
but, initially, sodium and potassium levels may be relatively normal. However, as
dehydration progresses, more profound metabolic abnormalities arise. Initially, the
urine has a low chloride and high bicarbonate content, reflecting the primary metabolic
abnormality. This bicarbonate is excreted along with sodium and so, the patient
becomes progressively hyponatraemic and more dehydrated,a phase of sodium
retention follows and potassium and hydrogen are excreted in preference. This results
in the urine becoming paradoxically acidic and hypokalaemia .Alkalosis leads to a
lowering of the circulating ionised calcium, and tetany can occur
10.
11.
12. Management
1-The patient should be rehydrated with intravenous isotonic saline with potassium
supplementation.
2-If the patient is anaemic it should be corrected.
3-The stomach should be emptied using a wide-bore gastric tube.
4-This then allows investigation of the patient with endoscopy and contrast
radiology. Biopsy of the area around the pylorus is essential to exclude malignancy.
5-The patient should also have an anti-secretory agent.
6- severe cases are treated surgically, usually with a gastroenterostomy.
Endoscopic treatment with balloon dilatation has been practised and may be most
useful in early cases. However, this treatment is not devoid of problems. Dilating
the duodenal stenosis may result in perforation, and the dilatation may have to be
performed several times and may not be successful in the long term.