This document provides information on dysphagia (difficulty swallowing). It begins by defining dysphagia and describing the swallowing mechanism. The clinical presentation of dysphagia is then outlined. Dysphagia can be graded on a scale of 1 to 6 based on severity. The document discusses the main causes/etiologies of dysphagia as being neurological, mechanical/obstructive issues. Evaluation involves history, examination, imaging like barium swallow and endoscopy. Management depends on the underlying cause and may include lifestyle changes, medications, endoscopic procedures like dilation, stenting, or surgery.
Definition
Type of Hernia
risk factor
pathophysiology
diagnostic procedure
physical assessment
management for hernia
Nursing Diagnosis
Health Education
Definition
Type of Hernia
risk factor
pathophysiology
diagnostic procedure
physical assessment
management for hernia
Nursing Diagnosis
Health Education
Gastritis is a condition in which the stomach
lining—known as the mucosa—is inflamed. The stomach lining contains special
cells that produce acid and enzymes, which help break down food for digestion,
and mucus, which protects the stomach lining from acid. When the stomach lining
is inflamed, it produces less acid, enzymes, and mucus.
Gastritis may be acute or chronic. Sudden,
severe inflammation of the stomach lining is called acute gastritis. Inflammation
that lasts for a long time is called chronic gastritis. If chronic gastritis is
not treated, it may last for years or even a lifetime.
Erosive gastritis is a type of gastritis that
often does not cause significant inflammation but can wear away the stomach
lining. Erosive gastritis can cause bleeding, erosions, or ulcers. Erosive
gastritis may be acute or chronic.
The relationship between gastritis and
symptoms is not clear. The term gastritis refers specifically to abnormal
inflammation in the stomach lining. People who have gastritis may experience
pain or discomfort in the upper abdomen, but many people with gastritis do not
have any symptoms.
The term gastritis is sometimes mistakenly
used to describe any symptoms of pain or discomfort in the upper abdomen. Many
diseases and disorders can cause these symptoms. Most people who have upper
abdominal symptoms do not have gastritis.
Gastroesophageal reflux disease in children.Indian Society of Pediatric Gast...Vijitha A S
Gastroesophageal reflux disease in children.Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN) 2022 update
DR VIJITHA A S
Breast surgery for Metastatic Breast Cancer : Cochrane Analysis Kundan Singh
Breast surgery plus systemic treatment may improve local PFS when compared to systemic treatment alone (HR 0.22, 95% CI 0.08 to 0.57; 2 studies; 607 women; I2 = 43%; low quality evidence)
The group receiving breast surgery plus systemic treatment probably had a shorter time
to distant PFS compared to the group receiving systemic treatment alone (HR 1.42, 95%CI 1.08 to 1.86; 1 study; 350 women; moderate-quality evidence)
Advantages of Cervicofial flaps :
Operative time is short.
It causes minimum deviations in relations to important structures around cheek.
reduce surgical risk in high risk patients like old age, diabetic patients, un-controlled hypertension
It can provide excellent skin colour and texture match.
Study of the distribution and determinants of
health-related states or events in specified populations and the application of this study to control health problems.
John M. Last, Dictionary of Epidemiology
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
Evaluation of POSSUM scoring system in patients with perforation peritonitis ...Kundan Singh
Background: Continuous audit of clinical practice is an essential part of making improvements in medicine and
enhancing patient care. Recently, physiological and operative severity score for the enumeration of mortality and
morbidity (POSSUM) scores has been developed, which would help to identify those patients who are at increased
risk of developing complications and deaths. This scoring system is based on 12 physiological characteristics of
patient and 6 characteristics of the surgery performed.
Methods: This study was done in Department of surgery at Patna medical college, Patna, Bihar, India from April
2014 to October 2015 on 100 patients. Physiological variables were collected prior to induction of anesthesia and
operative variable collected during operation chi-square test was used for expected and actual mortality differences.
Results: In present study 100 patients of peritonitis due to different cause of intestinal perforation were studied.
Comparison of observed and POSSUM predicted mortality and morbidity rates were done. Observed to expect
mortality and morbidity ratio was 1.005 and 1.001 respectively and there was no statistically significant difference
between the predicted and observed values.
Conclusions: This study confirms and validates the findings of previous work that POSSUM is an accurate and
reliable tool for estimating in-hospital mortality.
multilobed spleen : A case report
The spleen plays multiple supporting roles in the body. It is a vital organ for the functioning
of immune system. It acts as a filter for blood as part of the immune system. Old red blood
cells are recycled in the spleen, and platelets and white blood cells are stored there. It can
have a wide range of congenital anomalies including its shape, location, number, and size.
Although most of these anomalies are congenital, there are also acquired types. Multilobed
spleen is one of such condition. It is most commonly detected during abdominal surgeries.
Since they are bigger in size than the normal spleen, they are more pre disposed to trauma. In
this case report we have presented such a case of multi lobed spleen, which was detected
incidentally during exploratory laprotomy for blunt trauma abdomen with hemoperitoneum
A retrospective study of outcome of intraoperative gallbladder perforation du...Kundan Singh
Abstract:
Background: During laparoscopic cholecystectomy, gallbladder perforation with leakage of bile and/or gallstones into the abdominal cavity occurs frequently while gallbladder is being dissected from liver bed or while extracting it through the port site. In this retrospective study we have studied the case files of the patients who underwent laproscopic cholecystectomy and had intraoperative gallbladder perforation and had studied its effect on outcome of the surgery.
Material & method: This is a retrospective done at patna medical college and hospital in January 2016 in which the patients records of 310 patients of laproscopic cholecystectomy from January 2015 to December 2015 were studied. The incidence of perforation, duration of operation and the post-operative complications were noted and the data obtained was analysed
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
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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.
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
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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.
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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!
3. DYSPHAGIA
• The word dysphagia is derived from the Greek
phagia (to eat) and dys (with difficulty).
• Eating becomes unenjoyful.
• It refers to the sensation of food being
obstructed in the food passage anywhere
from the mouth to the stomach.
• The basic impairment behind dysphagia are
1)neurological
2)mechanical / obstructive
4. SWALLOW MECHANISM
• The act of swallowing requires the passage for food and drink from the
mouth into the stomach.
• From mouth to hypopharynx covers 1/3rd of passage (distance) while
2/3rd is covered by the esophagus .
• The swallowing center in brain stem is located in the floor of fourth
ventricle and adjacent regions of medulla. From here it is connected
to cerebral cortex, vomiting and respiratory centre.
• All these areas works in coordinated manner to provides voluntary as
well the involuantary control of swallowing.
• An adult swallow approximately 580 times daily and the act goes on
unconsciously .
• Swallowing phase
– Oro-Pharyngeal phase( voluntary phase)
– Esophageal phase( involuntary phase)
7. Esophageal Phase
• Food bolus is propelled through the esophagus
by an involuntary wave of contraction mediated
by the enteric nervous system.
• Pressure gradient speeds the movement of food
from the hypopharynx into the esophagus when
the cricopharyngeus muscle relaxes.
• The primary peristaltic contraction which is
initiated by a swallowing , moves down the
esophagus at the rate of 2 to 4 cm/s and reaches
the distal esophagus about 9 seconds .
• This duration varies from 8 to 20 seconds
8. Clinical presentation
• Pain and difficulty in swallowing.
• Sensation of food being stuck into throat or chest.
• Coughing or gagging while swallowing.
• Nasal regurgitation
• Dysarthria
• Nasal speech because of associated muscle
weaknesses
• Frequent burning sensation in chest.
• Having food or stomach acid back up into the throat.
• Unexpectedly losing weight.
9. FUNCTIONAL GRADES OF DYSPHAGIA
There are 6 grades of dysphagia
• GRADE 1 : Complains of dysphagia but still
eating normally
• GRADE 2 : Requires liquid with Meals
• GRADE 3 : able to take semisolid ,but unable
to take any solids
• GRADE 4 : able to swallow liquids only
• GRADE 5 : unable to swallow liquid, but able
to swallow saliva
• GRADE 6 : unable to swallow saliva also
10. Etiology
Dyspahgia has been classified broadly into
two types on the basis of site.
Oropharyngeal Esophageal
11. Abnormalities Causing
Oropharyngeal Dysphagia
• Inability to initiate the act of swallowing.
Etiology
(1) Neuromuscular Diseases
• Central nervous system (CNS)
• Cerebral vascular accident involving the brain stem.
• Parkinson disease
• Wilson disease
• Multiple sclerosis
• Brain stem tumor
• Peripheral nervous system
• poliomyelitis
• Peripheral neuropathies (e.g. diphtheria, tetanus rabies, diabetes mellitus)
• Motor end plate
• Myasthenia gravis
13. CONTINUED.........................
5) Disorders of the Upper Esophageal Sphincter (UES)
It is related to the abnormal UES relaxation or opening
• Incomplete relaxation
cricopharyngeal achalasia
oculopharyngeal muscular dystrophy
• Inadequate opening
cricopharyngeal bar
Zenker diverticulum
• Delayed relaxation
familial dysautonomia
14. Esophageal Dysphagia
Patients usually complains of feeling of food getting stuck several
seconds after swalloing and will point towards the suprasternal
notch or behind the sternum.
ETIOLOGY
1) Neuromuscular (Motility) Disorders
• Most common
– Achalasia
– Diffuse esophageal spasm
• Other motility abnormalities
– Nutcracker esophagus
– Hypertensive lower esophageal sphincter
– motility disorders secondary to
Scleroderma
collagen disorders
Chagas disease
15. CONTINUED ........
(2) Mechanical or obstructive
i) Esophagitis:dysphagia is due to mucuosal edema or benign
stricture
• Gastroesophageal reflux disease (GERD)
• Infectious esophagitis HIV , H. pylori, Herpes, Candidiasis
• Medication-induced esophagitis NSAIDs , quinidine,
potassium, vitamins (B. complex), Iron sulphate
• Radiation treatment
• Caustic injury
ii) Disorders of wall
Esophageal stricture
Zenker diverticulum
Epiphrenic diverticula
17. Associated symptoms and possible etiologies
Condition Diagnosis to consider
Difficulty in initiating swallow Oropharyngeal dysphagia
Food sticks after swallow in chest Esophageal dysphagia
Progressive dysphagia Neuro muscular dysphagia, carcinoma
Sudden dysphagia Foreign body, esophagitis
Intermittent dysphagia Rings and webs, Diffuse esophageal spasm,
Nutcracker esophagus
Cough: Early in swallow
Late in swallow
Neuromuscular dysphagia
Obstructive dysphagia
Weight loss: In elder patient
With regurgitation
Carcinoma
Achalasia
Pain after swallowing Esophagitis
Dysphagia related to: solid foods only
Solid and liquid both
Obstructive dysphagia
Neuromuscular dysphagia
Regurgitation of old food and halitosis Zenkers diverticulum
Dysphagia relieved with repeated swallow Achalasia
29. 24-Hour Ambulatory pH Monitoring
• The most direct method of measuring
increased REFLUX (esophageal exposure
to gastric juice ) is by an indwelling pH
electrode, or more recently via a radio-
telemetric pH monitoring capsule that
can be clipped to the esophageal mucosa.
30.
31. Endoscopic ultrasound
tumor confined to the
esophageal wall
an advanced esophageal carcinoma
penetrating through all layers
Used for dysphagia due to
carcinoma esophagus
for T , N staging
Biopsy can also be taken
33. TREATMENT
• Life style modification
• Drug therapy
• Therapeutic endoscopy
• Dilation
• Stentings
• Chemo-radiation
• Surgery
34. LIFE STYLE MODIFICATION
• These include
– avoidance of precipitating foods(fatty foods,
alcohol, caffeine)
– Oral hygine
– avoidance of recumbency postprandially
– elevation of the head of the bed
– smoking cessation
– weight reduction.
35. • Inflammatory lesion
Antibiotics
Antifungal
Incision & Drainage – for abscess
Neuromuscular dysphagia
Maintenance of oral hygine
Chew well
Semisolid /liquid diet
Eat small meals more frequently
Thermal tactile stimulation
For grade 4-6 dysphagia – cricomyotomy
39. Stents
• Self expanding metal stents
• Indication –
grade 4 -6 dysphagia in ca esophagus ( not resectable )
Types - covered , uncovered stents
Complication - stent blockage , stent migration , erosion
Blockage can be removed by coring using laser or cryo
ablation
Non-covered stents
Stent in situStent delivery system
40. Chemo-radiation
• Indications
Grade 1-3 dysphagia in case of ca
esophagus ( neo adjuvent )
Grade 4-6 dysphagia in case of ca
esophagus ( palliative )
Cisplatin+5FU + 60Gy radiation over 8 weeks