This document provides an overview of the anatomy of the large intestine, including its dimensions, blood supply, lymphatic drainage, peritoneal relations, and positions of the appendix. Key sections include descriptions of the divisions of the large intestine (cecum, ascending colon, transverse colon, descending colon, and sigmoid colon), relationships with surrounding structures like the mesentery and peritoneum, common vascular variations, and lymphatic drainage pathways. References are provided for additional information.
Management Post Op Leaks
1. First Prevent Leaks
2. Categorize: Early Leaks vs Late Leaks
3. Simple Management Protocol
In short:
Management Post Op Leaks
1. First Prevent Leaks
2. Categorize: Early Leaks vs Late Leaks
3. Simple Management Protocol
Simple Leak Management Protocol
Leak found 24-48hr
= No Diagnostic Tests
= Immediate Exploration
= Usually Simple Suture Repair
Fear Leak: Suspect a Leak in Every Case
Leak found 24-48hr
= No Diagnostic Tests
No WBC
No CAT Scan
No Chest XRay
If patient does not feel well reexplore early
= Immediate Exploration
Expect many negative explorations when you begin
= Usually Simple Suture Repair
Leak Found More than 72 hours
Categorize:
1. Acute peritonitis, sepsis, leak NOT contained
= Take down GJ (1 Staple Firing) 5-10 min
= Gastro-Gastrostomy (5-10 min)
= Get Out (Drain and ABx)
2. Stable patient, not septic, leak contained
= Conservative:
ABx, Drainage and Feeding
Management Post Op Leaks
1. First Prevent Leaks
2. Categorize: Early Leaks vs Late Leaks
3. Simple Management Protocol
In short:
Management Post Op Leaks
1. First Prevent Leaks
2. Categorize: Early Leaks vs Late Leaks
3. Simple Management Protocol
Simple Leak Management Protocol
Leak found 24-48hr
= No Diagnostic Tests
= Immediate Exploration
= Usually Simple Suture Repair
Fear Leak: Suspect a Leak in Every Case
Leak found 24-48hr
= No Diagnostic Tests
No WBC
No CAT Scan
No Chest XRay
If patient does not feel well reexplore early
= Immediate Exploration
Expect many negative explorations when you begin
= Usually Simple Suture Repair
Leak Found More than 72 hours
Categorize:
1. Acute peritonitis, sepsis, leak NOT contained
= Take down GJ (1 Staple Firing) 5-10 min
= Gastro-Gastrostomy (5-10 min)
= Get Out (Drain and ABx)
2. Stable patient, not septic, leak contained
= Conservative:
ABx, Drainage and Feeding
CT angiography based Study of Variations in Coeliac Trunk and its surgical im...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Assessment and management of anterior vaginal wall defects presents a unique surgical challenge and is the most common site of initial prolapse in women and the most common site of recurrence.
State of the Art Consensus Conference on Prevention of Bile Duct Injury Durin...JosephDAguanno2
Strategies for Minimizing Bile Duct Injuries during cholecystectomy are founded in a Patient Safety Mindset, ensuring proper clearing of the surgical field, careful identification of cystic structures, and confidence in surgical technique.
Iatrogenic Ureteral Injuries in Non – Urological Surgeries: An Institutional ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
CT angiography based Study of Variations in Coeliac Trunk and its surgical im...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Assessment and management of anterior vaginal wall defects presents a unique surgical challenge and is the most common site of initial prolapse in women and the most common site of recurrence.
State of the Art Consensus Conference on Prevention of Bile Duct Injury Durin...JosephDAguanno2
Strategies for Minimizing Bile Duct Injuries during cholecystectomy are founded in a Patient Safety Mindset, ensuring proper clearing of the surgical field, careful identification of cystic structures, and confidence in surgical technique.
Iatrogenic Ureteral Injuries in Non – Urological Surgeries: An Institutional ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
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.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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.
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.
1. Clinical Anatomy of the
Large Intestine
Handout download:
http://www.oucom.ohiou.edu/dbms-witmer/gs-rpac.htm
23 January 2007
Lawrence M. Witmer, PhD
Professor of Anatomy
Department of Biomedical Sciences
College of Osteopathic Medicine
Ohio University
Athens, Ohio 45701 witmerL@ohio.edu
6. Dimensions
cecum
5 cm
ascending
colon
10 cm
transverse colon
50 cm
descending
colon
10 cm
sigmoid colon
50 cm
anal canal
4 cm
rectum
15 cm
5 cm
6
cm
8
cm
5
cm
5
cm
4 cm
widest:
likely
site for
perforation
narrowest: likely
site for obstruction
8. Paraduodenal fossae:
1) Superior & 2) Inferior
fossae of Trietz
3)Mesentericoparietal
fossa of Waldeyer
4)Intermesocolic fossa
of Brooke
5)Paraduodenal fossa
of Landzert
Skandalakis’ Surgical Anatomy 2004
SMA
Internal Hernia
Right
Paraduodenal
Hernia
hernial
sac
Peritoneal Relations
9. free taenia
cecum
Skandalakis’ Surgical Anatomy 2004
appendix
mesoappendix
superior ileocecal
internal hernia
(a pericecal hernia;
6-13% of all internal hernias)
Peritoneal Relations
superior &
inferior
ileocecal
fossa
10. Position
Nonapp-
endicitis
1
Appen
dicitis
5
Total %
A Preileal 6 4
G
E
C
D
B
A
anterior
B Postileal 7 3 10 8 F
C Subileal 11 8 19 15
D Pelvic 14 11 25 19
E Subcecal 9 5 14 11
F Paracecal 4 9 13 10
G Retrocecal 18 24 42 33
post.
Appendix
Position
Skandalakis’ Surgical Anatomy 2004
data from O’Connor & Reed (1994)
Peritoneal Relations
11. Moore’s Developing Human 1988
• Elongation of gut tube
• Herniation into umbilical cord
• Counterclockwise rotations
Peritoneal Relations
12. Moore’s Developing Human 1988
• Retraction & return of gut
• Final counterclockwise rotation
• Descent of cecum
• Fixation to posterior abdominal wall
Peritoneal Relations
14. Peritoneal Relations
Skandalakis’ Surgical Anatomy 2004
Fixation of cecum
asc col
mesent
ileum
cecum
pelvic brim
Type I 11.2% Ia 8.3% Type Ib 22.7%
appendix
Type II 9.7% IIa 7.3% III 11.3% III 5.7%
areas of fixation shown in black
Type IV 17.3% V 4.7% VI 2.7%
16. Skandalakis’ Surgical Anatomy 2004
m. colic a.
r. colic a.
marginal a.
ileocolic a.
cecal a.
appendicular
a.
ileal a.
SMA IMA
sup. rectal a.
RCA-Ileocolic
anastomosis
absent 5%
Vasculature
Anastomosis
• poor 32%
• absent 7%
acc. left colic
a. (~ 40%)
marginal a.
l. colic a.
sigmoid aa.
18. Skandalakis’ Surgical Anatomy 2004
Nodes N
A Ileocolic 29
B Right colic 11.1
C Midcolic 22.4
D Left colic 25.2
E Sigmoid &
rectal
32.8
Lymphatic Drainage
mesenteric nodes
l. lumbar
mesocolic
paracolic
epicolic
nodes
B
A
C
D
E
20. References
• Gourley, E. J. and S. A. Gering. 2005. The meandering mesenteric
artery: a historical review and surgical implications. Diseases of the
Colon and Rectum 48(5):996-1000.
• Mathieu, D. and A. Luciani. 2004. Internal abdominal herniations.
American Journal of Roentgenology 183:397-404.
• Moore, K. L. 1988. The Developing Human. Clinically Oriented
Embryology, 4th Ed. Lippincott, Williams & Wilkins, Baltimore.
• Moore, K. L. and A. F. Dalley. 2006. Clinically Oriented Anatomy,
5th Ed. Lippincott, Williams & Wilkins, Baltimore.
• O'Connor, C. E. and W. P. Reed 1994. In vivo location of the human
vermiform appendix. Clinical Anatomy 7:139-142.
• Skandalakis, J. E., G. L. Colborn, T. A. Weidman, R. S. Foster, A.
N. Kingsnorth, L. J. Skandalakis, N. P. Skandalakis, P. Mirilas
(Editors). 2004. Surgical Anatomy: The Embryologic And Anatomic
Basis Of Modern Surgery. McGraw-Hill, New York.
