ENDOSCOPY.pptx
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This document discusses endoscopy procedures performed at St. Mary's hospital and some challenges. It notes that the main indications for endoscopy are dyspepsia and the main findings are normal or gastritis. Some sample patient requests and challenges are presented, as well as what clinicians prefer to see in endoscopy reports versus things they do not like. Recommendations include the judicious use of endoscopy and contextual interpretation of results. Questions are also posed about relying solely on endoscopy to investigate abdominal pain and handling unexpected findings.
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Urine retention can be acute or chronic. Acute retention occurs suddenly with pain, while chronic retention develops insidiously with lower urinary tract symptoms. Causes include nervous system issues, medications, local obstructions like prostate enlargement, strictures, or tumors. Evaluation involves history, exam of the abdomen and genitals, urinalysis, ultrasound or other imaging. Management of acute retention is per urethral or suprapubic catheterization along with treating infection. Definitive care targets the underlying cause, such as surgery for strictures or tumors.
Transplantation MB6.pptx
This document provides an overview of transplantation surgery principles. It defines key terms like transplantation, graft types, and alloantigens. It discusses indications for common organ transplants like kidney, liver, heart and lungs. It also covers the immunological basis for graft rejection, focusing on the role of the major histocompatibility complex and human leukocyte antigens in triggering rejection. Finally, it summarizes strategies for tissue matching between donors and recipients, principles of immunosuppressive therapy to prevent rejection, potential complications of transplantation, and methods for organ donation and preservation.
Surg onco MB6.pptx
This lecture covers surgical oncology, including the epidemiology, definitions, biology, etiology, screening, diagnosis, staging, treatment, and palliation of cancer. The objectives are discussed including carcinogenesis, the work-up process involving screening, diagnosis and staging of cancer, as well as treatment options and palliative care. Treatment may involve surgery, chemotherapy, radiation therapy, hormone therapy, targeted therapy, or immunotherapy depending on the cancer type and stage. The goal of treatment is cure through wide resection of the tumor and draining lymph nodes when possible or palliation to relieve symptoms for advanced or metastatic disease.
Ca Prostate MB6.pptx
Prostate cancer is the most common cancer in men. It arises from the prostate gland and is dependent on androgens like testosterone for growth. Risk factors include increased age, family history, and race. Screening involves a digital rectal exam and PSA blood test. Biopsy confirms diagnosis. Staging uses the TNM system and Gleason score. Treatment options include active surveillance for low risk disease, surgery, radiation, hormone therapy, chemotherapy, and palliation depending on age, risk level, and whether the cancer has spread. The goal is cure of localized disease or palliation of symptoms from advanced disease.
breast.pptx
This document provides an overview of benign and malignant breast conditions. It begins with the anatomy of the breast and a classification of benign and malignant diseases. It then discusses various benign conditions such as fibrocystic disease, fibroadenomas, cysts and infections. Malignant conditions covered include ductal and lobular carcinomas. Risk factors, staging, investigations, management and prognosis of breast cancer are also summarized. The document aims to cover objectives related to the anatomy, classification, benign disease and cancer of the breast.
Arterial dse MB6.pptx
This document provides an overview of arterial vaso-occlusive disease. It discusses the surgical anatomy, physiology, epidemiology, etiology, work-up, treatment, and scope of diseases. Specific topics covered include arterial trauma, aneurysmal disease, the pathology and causes of vaso-occlusive disease, clinical presentation, classification systems, clinical evaluation, investigations, differential diagnosis, and treatment options such as angioplasty, stenting, grafting, thrombectomy, and amputation. The objectives are to review the anatomy, functions, screening, diagnosis, staging, and management of various arterial diseases involving occlusion.
EARLY MANAGEMENT OF BURNS.ppt
This document discusses the early management of thermal burns. It covers the pathophysiology of burns including coagulative necrosis, zones of injury, and fluid loss. Evaluation involves assessing the extent of the burn using charts and formulas as well as depth. Resuscitation involves fluid therapy using formulas like Parkland to replace fluid loss. Other ancillary measures include tetanus prophylaxis, escharotomy, analgesia, and nutrition starting within 24 hours with a feeding goal of 25 kcal/kg/day. Early excision and grafting within 3-5 days is recommended to prevent infection and reduce the metabolic demand.
SURGICAL MANAGEMENT OF WOUNDS.pptx
This document discusses the surgical management of wounds. It outlines the fundamentals of wound healing, including the types of wounds and factors that can hinder healing like poor vascularity, infection, and nutrition. It then describes the basic TIME principles of wound care - debriding unviable tissue, controlling infection, maintaining moisture, and advancing wound edges. Specific techniques are provided for tissue control, infection control, moisture control, and edge management to promote wound healing.
ppt empyema.pptx
This document discusses a patient diagnosed with pulmonary tuberculosis (PTB) with right pleural effusion who was not improving after 5 weeks of treatment. On examination, the patient had reduced right lung movement and dullness on percussion. The document then summarizes pleural effusion, its causes, diagnostic indicators, stages of organization, and treatment options which include aspiration for stage 1, chest tube for stage 2, thoracotomy for stage 3, and pleurodesis for recurrent effusion.
GERD surg.pptx
This document discusses surgical approaches for treating GERD. It outlines the pathophysiology of GERD and indications for surgery. The principles of anti-reflux surgery involve restoring the intra-abdominal esophagus length, increasing the angle of His, and reducing the esophageal opening diameter. Surgical approaches include laparoscopic, open transthoracic, and transabdominal procedures. Common procedures discussed are Nissen's fundoplication, Belsey Mark IV, Toupet, and Hill's procedure. Laparoscopic surgery is now the standard approach due to its benefits over open surgeries.
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The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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ENDOSCOPY.pptx
- 1. ENDOSCOPIST-CLINICIAN; MENDING THE BROKEN LINK A St. Mary’s perspective Dr Makanga
- 2. Where are we currently? • 140 scopes per month • Main indication = dyspepsia • Main source of patients = OPD • 2-4 colonoscopies per week • Main diagnosis = Normal finding Makanga et al; The Annals of African Surgery, July 2014, Volume 11, Issue 2, Page 35-39
- 3. Fig 1. Main findings of UGIEs done Makanga et al; An Afr Surg, July 2014, Vol 11, Issue 2, Page 35-39
- 4. Table 1. Morbidity proportion in Elementaita n = 1878
- 5. Author & year n Normal Gastritis DU GU Esophageal tumor Gastric tumor Misallek 1991 4000 30 11 22 NR 4 5 Ayuo* 1994 45 60 NR 20 8.9 NR NR Ogwang 2003 307 29 19 18 0.01 0.02 0.01 Lodenyo 2005 768 11 25.8 7.8 1.3 8.5 4.5 Chagaluka 2009 441 24 10 1.4 NR 28 1.4 Makanga 2013 6110 35 26 10 5 6.9** 1.7 Table 2. Comparison with other studies **Both esophageal and gastroesophageal junction tumors
- 6. Sampled requests… • Non-specific abdominal pain • FB sensation; do laryngoscopy and OGD • On-off heartburn ?GERD* • Chronic headache and backache…and incidental epigastric pain/tenderness • Self request “I have been told I have ulcers” Harrison's Principles of Internal Medicine, 18th Edition
- 7. If your only tool is a hammer, all problems look like nails… Author unknown
- 8. Sampled challenges… • Food – full stomach • Poorly prepared patient/incomplete exam • Uncooperative patient/declines OGD • Very sick patient (near comatose), psychiatric, CP, halo jacket, neck contracture • Young child < 5 years
- 9. The SAGES Manual Fundamentals of Laparoscopy, Thoracoscopy, and GI Endoscopy, Second Edition
- 10. What clinicians like to hear • Specific and definite diagnosis • Diagnosis in keeping with clinical presentation • Precise description of location, grading and size of lesion* • Recommendation of way forward
- 11. What clinicians don’t like to hear • Mild gastritis • Whitish patches on esophagus ? Candidiasis • Non-specific mucosal changes • Suspicious nodule/lesion • Vascular lesion – not biopsied • 2 tumors (or long tumor >10 cm) • Normal – clinically correlate
- 12. All of us would like to see this…
- 13. Grade 2 varices Esophageal tumor Candidiasis GERD (LA 3)
- 14. Erosions Chronic GU Malignant GU ‘Gastritis’
- 15. Duodenal ulcer
- 16. But we see this… sometimes…
- 19. Questions • What supports the use of OGD primarily for epigastric pain? • Can you rely on a test that is endoluminal to investigate an entire abdomen? • Are you prepared for margin of error for a wrong endoscopic diagnosis? • Or an unsatisfactory finding? • How will you handle a surprise finding?
- 20. Recommendations • Referral for OGD if dyspepsia fails to resolve within 2 weeks of PPI* • Judicious use of OGD – No broad spectrums • Contextual interpretation of results • Liaison with endoscopist if findings are unsatisfactory • Role of repeat OGD after Rx period • Endoscopist to correlate notes and patient? Harrison's Principles of Internal Medicine, 18th Edition
- 21. Questions, comments, additions and discussions… Thank you…