This document discusses gallstones, including their types, prevalence, etiology, and pathogenesis. It notes that gallstones form when bile components like cholesterol and bilirubin crystallize in the gallbladder. There are three main types: mixed, cholesterol, and pigmented. Factors that contribute to cholesterol gallstone formation include genetics, sex/estrogen levels, obesity, diabetes, and impaired gallbladder function. The formation involves an altered bile composition, cholesterol crystal nucleation, mucus hypersecretion, and gallbladder hypomotility.
Surgical Anatomy of the Liver : Ηepatectomies - Dimitris P. KorkolisDimitris P. Korkolis
- The liver is the largest gland in the body and has a wide variety of functions
- Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
- It is exocrine(bile) & endocrine organ(Albumin , prothrombin & fibrinogen)
Function of the liver :
- Secretion of bile & bile salt
- Metabolism of carbohydrate, fat and protein
- Formation of heparin & anticoagulant substances
- Detoxication
- Storage of glycogen and vitamins
- Activation of vita .D
CASE PRESENTATION ONCIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC EN...Akhil Joseph
A DETAIL CASE PRESENTATION ON CIRRHOSIS OF LIVER WITH PORTAL HYPERTENSION, HEPATIC ENCEPHALOPATHY AND GRADE II OESOPHAGEAL VARICES WITH CONGESTIVE GASTROPATHY. LIVER CIRRHOSIS AND ALL ITS COMPLICATION IN A PATIENT.
This presentation serves to review all the available non-operative treatment options for gall stone disease. It was presented in January 2020 to the HepatoPancreaticoBiliary Surgery Unit, Division of General Surgery, ABUTH Zaria, Nigeria
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June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
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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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NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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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
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
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
2. • Gallstones. The gallstone types and
Prevalence
• Etiology
• Pathogenesis
3. Epidemiology
• One of most common abdominal organs requiring
surgery
• Over 95% of biliary tract disease is attributable to
cholelithiasis (gallstones)
• Population prevalence 5-20% of which majority
(70-80%) remain asymptomatic
• 1-4% develop symptoms each year
4. It is estimated that more than 20 million persons in the
United States have gallstones, totaling some 25 to
50 tons in weight!
6. Gallstones are pieces of hard solid
matter in the gallbladder. They form
when the components of bile—
including cholesterol and bilirubin
— precipitate out of solution and
form crystals, much as sugar may
collect in the bottom of a syrup jar.
10. Pigment GS
Location: GB, ducts
Major constituents: bilirubin pigment polymer
Consistency: hard
Radio-opaque: 60%
Associations:
infection: rare
other diseases: cirrhosis and hemolysis
Location: ducts
Major constituents: calcium bilirubinate
Consistency: soft, friable
Radio-opaque: 0%
Associations:
infection: usual
other diseases: chronic partial biliary obstruction
11.
12. RESULTS:
23 %of cholesterol stones and 68%of pigment stones contained
bacteria (P < 0.0001). Stone culture correlated with scanning electron
microscopy results. Pigment stone bacteria were more often present in
bile and blood.
Cholesterol stone bacteria caused more severe infections (19%)than
sterile stones (0%),but less than pigment stone bacteria (57%)(P <
0.0001). Serum and bile from patients with cholesterol stone bacteria
had less bacterial-specific immunoglobulin G. Cholesterol stone bacteria
produced more slime. Pigment stone bacteria were more often killed by
a patient's serum. Tumor necrosis factor-alpha production of the groups
was similar
14. (1) Altered composition of hepatic bile. The bile must be
upersaturated with cholesterol;
(2) Cholesterol nucleation in the bile is accelerated;
(3) Hypersecretion of mucus in the gallbladder traps the nucleated
crystals, leading to their aggregation into stones.
(4)Impaired gallbladder function . Hypomotility of the gallbladder
promotes nucleation;
Cholesterol gallstone formation involves four
simultaneous conditions :
18. Genetics
The variant is known as D19H, and
it is estimated that it may
contribute 8% to 11% of the risk for
the formation of cholesterol
gallstones. (The odds ratios are 2-3
for heterozygous carriers of D19H,
and 7 for homozygous carriers).
Individuals with the D19H variant
absorb less, but synthesize more,
cholesterol, suggesting that HMG-
CoA inhibitors (statins) may
decrease the risk of gallstone
formation in these individuals.
19. “Fat, Female, Forty, Fertile”
•Sex and oestrogens
•GSs are twice as common in women as in
men, and this is particularly so before the age
of 50.
• The incidence is higher in multiparous than in
nulliparous women.
•Women on long - term oral contraceptives
have a twofold increased incidence of GB
disease over controls.
•Postmenopausal women taking oestrogen -
containing drugs have a significant increase
frequency (around 1.8 times) of GB disease. In
men given oestrogen for prostatic carcinoma
the bile becomes saturated with cholesterol
and GSs may form.
20. •Obesity
50% of markedly obese patients
have gallstones at surgery
• Age
There is a steady increase in
gallstone prevalence with
advancing years, probably due to
the increased cholesterol content
in bile. By age 75, around 20% of
men and 35% of women in some
Western countries have GSs.
•Rapid weight loss
21. Diabetes mellitus
•Obesity
•“a diabetic neurogenic
gallbladder”
•Insulin-tolerance
Diabetics have a higher prevalence of gallstones (or a history of
cholecystectomy) than non - diabetics, particularly females (42 versus 23%).
22. On the basis of their studies in LIRKO mice, which have selective insulin resistance in the
liver, Biddinger et al.2 propose two mechanisms that underlie predisposition to
gallstone formation in individuals with the metabolic syndrome.
First, LIRKO mice show reduced formation of bile acids.
Second, the absence of hepatic insulin signaling in these mice increases the
transcriptional activity of FoxO1, through inhibition of Akt-mediated phosphorylation. As
a result, ABCG5/ABCG8 expression is induced.
Katie Ris-Vicari
23. • Biliary protein concentration is increased in
lithogenic bile. Proteins that accelerate
nucleation (pronucleators) include GBGB mucinmucin
and IgIgGG. Cholesterol GSs have bilirubin at their
centre, and a protein pigment complex might
provide the surface for nucleation of
cholesterol crystals from GB bile.
• Factors that slow nucleation (inhibitors)
include apolipoprotein A1apolipoprotein A1 and A2A2 and a 120 -
kDa glycoproteinglycoprotein. Ursodeoxycholic acidUrsodeoxycholic acid, as
well as decreasing cholesterol saturation, also
prolongs the nucleating time.
• AspirinAspirin reduces mucus biosynthesis by GB
mucosa which explains why this drug and other
non - steroidal anti - inflammatory drugs inhibit
GS formation.
2. Nucleation of cholesterol crystals
and 3. Hypersecretion of mucus
24. 4. Impaired gallbladder function
Gallbladder contraction is under
cholinergic and hormonal control.
Cholecystokinin (CCK),Cholecystokinin (CCK), derived from the
intestine, contracts and empties the
gallbladder and increases mucosal fluid
secretion with dilution of gallbladder
contents. AtropineAtropine reduces the
contractile response of the gallbladder to
CCK. Other hormones found to have an
influence on the gallbladder include
motilinmotilin (stimulatory) and somatostatinsomatostatin
(inhibitory).
Immune processes and inflammationImmune processes and inflammation in the
gallbladder also appear to effect
contraction and promote the production
of pronucleators.