This document provides information on the history, examination, and investigations for acute pancreatitis.
The history section outlines common symptoms including upper abdominal pain that intensifies and radiates to the back. Examination may reveal signs of dehydration as well as abdominal tenderness and guarding.
Laboratory investigations for acute pancreatitis include pancreatic enzymes, liver enzymes, electrolytes, blood glucose, and C-reactive protein. Imaging options are abdominal ultrasound, CT scan, and MRI, with CT being the standard choice to assess severity and complications using the CT severity index. Ultrasound can identify gallstones as a common cause.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
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.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
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.
Physical exam of an acute surgical abdomen. Using detailed descriptions of pain along with onset and physical exam tests including peritoneal signs and more advanced physical exam maneuvers in order to formulate a diagnosis and severity of illness.
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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
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
2. ①HISTORY
• Abdominal pain
– Site: upper abdomen
– Acute onset
– Gradually intensifies in severity
– Duration: varies
– Radiates to the back
– Worsening when drinking alcohol or eating heavy
meal
– Relieve sometimes by sitting upright or leaning
forward
– Associated with nausea, vomiting, anorexia, fever
3. Don’t forget to ask..
• History of previous biliary colic
• History of alcohol consumption
• Any recent operative or other invasive
procedures (e.g. ERCP)
• Any intake of certain medications
• Any viral infection
• Family history of hypertriglyceridemia
5. Abdominal examination
• Abdominal tenderness
• Muscular guarding
(guarding tends to be
more pronounced in the
upper abdomen) and
distention.
• Bowel sounds are often
diminished or absent
because of gastric and
transverse colonic ileus.
6. Uncommon physical findings
• Cullen’s sign: bluish
discoloration around the
umbilicus resulting from
hemoperitoneum
• Grey-Turner’s sign : reddish-
brown discoloration along the
flanks resulting from
retroperitoneal blood
dissecting along tissue planes.
• Erythematous skin nodules :
focal subcutaneous fat
necrosis(size not more than 1
cm, and the site is on extensor
skin surfaces)
• Polyarthritis
7. ③INVESTIGATIONS
LABORATORY
• CBC
– Anemia(hgic), leukocytosis (inflammation, infection)
• Liver enzymes
– ALT if increases more that 150 U/L probably dto
gallstones
• Serum electrolytes, BUN, creatinine
– Low Ca2+
• Blood glucose, cholesterol, triglycerides
– Blood glucose high dto B-cell injury
• ABG
– respiratory distress
9. • Pancreatic enzymes (serum amylase and
lipase)
– Serum amylase sensitivity of 81-95% but not
specific for pancreatitis
– Serum lipase more preferred dto its improved
sensitivity esp in alcohol-induced pancreatitis, and
its prolonged elevation
– Rise 2-4 times the upper limit of normal is
recommended for dx
– Neither is useful in monitoring or predicting the
severity the episode of acute pancreatitis
10.
11. • Serum C-Reactive Protein: best marker for
severity
• Trypsinogen and elastase have no significant
advantage over amylase or lipase
12.
13. IMAGING IN ACUTE PANCREATITIS
Role:
• To clarify the diagnosis when the clinical picture is
confusing
• Help in determine the possible causes
• Assess severity (Balthazar score)
• Determine prognosis
• Detecting complications
14. 1. Abdominal Ultrasound
• Indicated early in acute pancreatitis
– Pros
• Inexpensive
• Excellent for identifying gallbladder pathology
• Technique of choice of detecting gallstones (Most common
cause of pancreatitis!)
• Evaluate bile‐duct dilation
• May visualize masses and follow up of pseudocyst
– Cons
• Not optimal for pancreas; retroperitoneal location easily
obscured by bowel gas distension
• Less sensitive for stones in distal CBD
• Limited in early assessment of pancreatitis
15. 2. Abdominal X-ray
• Limited role in acute pancreatitis
• Poor visualization of the pancreas and retroperitoneum
• Most common radiologic signs associated with acute
pancreatitis include:
– Free air in the abdomen, indicating a perforated viscus
– The colon cut-off sign, and sentinel loop sign, both
indicating inflammatory process damaging peripancreatic
structures
17. SENTINEL LOOP SIGN
Mildly dilated, gas-filled segment of small bowel
with or without air fluid level
18. 3. Contrast-Enhanced CT
• Standard imaging of choice
– Pros
• Aid in diagnosis and staging of pancreatitis
• Evaluate complications
• Evaluate common bile duct for stones or other obstructions
• Assess severity of acute pancreatitis (CT Severity Index)
– Cons
• limited in patients who are allergic to intravenous (IV)
contrast or have renal insufficiency.
20. 3. MRI
• Increasingly used in diagnosis and management of acute
pancreatitis
– Pros
• alternative in situations in which CECT is contraindicated
• Non‐invasive and no use of IV contrast
• Ability to delineate pancreatic and bile ducts (detect
choledocholithiasis missed on U/S )
• Greater sensitivity than CT in detecting mild pancreatitis
– Cons
• Expensive
• Less readily available in non‐tertiary medical centers
Editor's Notes
Point 3… until it reaches constant ache
Point 4 … usually lasts more than a day
Point 6.. ‘fatty dyspepsia’
All of these obtain from complaint & its analysis
In severe acute pancreatitis, often the patient is pale, diaphoretic and listless
Tachypnea occur in ARDS
These findings are associated with severe necrotizing pancreatitis
Routine ix
Ix for the organs affected.. Serum amylase, lipase, n so on
CT severity index (CTSI) based on findings from a CT scan with intravenous contrast to assess the degree of pancreatic inflammation, necrosis and complications in patients with acute pancreatitis. The severity of computed tomography findings correlated with clinical prognosis. CTSI includes grading of pancreatitis (A-E) and the extent of pancreatic necrosis. The CTSI was added to the traditional balthazar score in the 1990 by the same author.
CTSI
The CTSI is determined on the basis of the sum of the scores obtained in balthazar score and those obtained in the evaluation of glandular necrosis percent.
0-3: AP mild
4-6: AP moderate
7-10: AP severe
CTSI
Grading of pancreatitis
A: normal pancreas: 0
B: enlargement of pancreas: 1
C: inflammatory changes in pancreas and peripancreatic fat: 2
D: ill defined single fluid collection: 3
E: two or more poorly defined fluid collections: 4
Pancreatic necrosis
none: 0
less than/equal to 30%: 2
>30-50%: 4
>50%: 6
The maximum score that can be obtained is 10.
Rise within hours of pancreatic injury. A threshold 2-4 times the upper limit of normal