Femoral hernias occur when abdominal contents protrude through the femoral ring into the femoral canal. They are more common in females, the elderly, and those who have given birth. Patients often present with groin pain or a lump that is usually irreducible. Treatment involves surgical repair through an open or laparoscopic approach to reduce hernia contents and reinforce the femoral ring with sutures or mesh. Prognosis is generally good, but risks of complications are higher for emergent repairs of incarcerated hernias.
This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study.
Ureteric injury in Gyenec Surgery, Serious complication of gynecologic surgery
Significant morbidity and long-term sequelae
Uncommon in benign gynecologic surgery
Vaginal hysterectomy has the lowest rate of ureteral injury
Laparoscopic hysterectomy has the highestThe ureters are the muscular ,thick walled narrow tubes(Right and Left)
Each measures 25-30 cm in length and extends from renal pelvis to its entry in the bladder.The ureter are located retroperitonealy and run from the renal pelvic to urinary bladder.
First part –Enter the pelvis by crossing the common iliac vessel from lateral to medial aspect at their bifurcation just medial to ovarian vessel and run downwards along with greater sciatic notch & reaches ischial spine.
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Fracture classification, xray, complication, reduction method, surgery, cast, vascular injury, nerve injury, all the Undergraduate students should know is included
Spinal stenosis is a degenrative spine disorder in which the AP and transverse diameter are decreased causing neural compression and symptoms of chronic & acute nerve compression
This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study.
Ureteric injury in Gyenec Surgery, Serious complication of gynecologic surgery
Significant morbidity and long-term sequelae
Uncommon in benign gynecologic surgery
Vaginal hysterectomy has the lowest rate of ureteral injury
Laparoscopic hysterectomy has the highestThe ureters are the muscular ,thick walled narrow tubes(Right and Left)
Each measures 25-30 cm in length and extends from renal pelvis to its entry in the bladder.The ureter are located retroperitonealy and run from the renal pelvic to urinary bladder.
First part –Enter the pelvis by crossing the common iliac vessel from lateral to medial aspect at their bifurcation just medial to ovarian vessel and run downwards along with greater sciatic notch & reaches ischial spine.
Supracondylar humerus fracture & complication for MBBS studentsYash Oza
Fracture classification, xray, complication, reduction method, surgery, cast, vascular injury, nerve injury, all the Undergraduate students should know is included
Spinal stenosis is a degenrative spine disorder in which the AP and transverse diameter are decreased causing neural compression and symptoms of chronic & acute nerve compression
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
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Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
2. Femoral Hernia
A femoral hernia is the protrusion of a viscus
from the abdominal or pelvic cavity, through
the femoral ring into the femoral canal.
The (peritoneal) hernia sac may contain pre-
peritoneal fat, omentum, small bowel, or
other structures.
4. incidence
• uncommon
• F>M
• more common in parous
• > 65 years
• 3% of all hernias
• 7% of groin hernia
• nearly 5000 / year in UK
5. presenting symptoms
• Only 50% of patients are aware of
the hernia before strangulation.
• Around 60% present in the
emergency situation
• 49% were emergency repairs and
48% waiting list repairs.
non-acute
non-acute acute - emergency
acute - emergency
7. presenting symptoms
non-acute
non-acute
• pain or discomfort in groin
• groin lump
• mild pain exacerbated by bending or
lifting
• small lump (may be no lump)
• mild tenderness
• usually not reducible
10. difficulties with diagnosis
• 1/3of patients do not complain of
symptoms directly attributable to a
hernia
• a groin lump is not always present.
• obese
• elderly - other diagnoses
13. differential diagnosis
inguinal hernia
inguinal hernia
ABOVE and MEDIAL
ABOVE and MEDIAL
to pubic tubercle
to pubic tubercle
femoral hernia
femoral hernia
BELOW and LATERAL
BELOW and LATERAL
to pubic tubercle
to pubic tubercle
pubic tubercle
pubic tubercle
femoral –v- inguinal
femoral –v- inguinal
hernia
hernia
14. FEMORAL INGUINAL
Sex Female male
Age Elderly > 65 years Younger - all ages
children rare common
Males 1 20
Females 1 5
Cough impulse Often absent Usually present
Reducibility Usually not Often is
Shape Globular Pear shaped
Elective Presentation (of
groin hernia) in Male
1%
Elective Presentation (of
groin hernia) in Female
20%
Present persistent intermittent
Strangulation @ 3 mths 22% 3%
Strangulation @21 mths 45% 4.5%
15. investigations
• clinical examination
–experienced clinician can usually distinguish
between Femoral and Inguinal hernia
• always examine the groin in patients
–with intestinal obstruction
–with abdominal pain
17. treatment
• Surgical Repair
• Open Surgery or Laparoscopic Surgery
• General Anaesthetic
• Local Anaesthetic and/or Regional Anaesthetic
18. treatment
• Surgical Repair
– Dissection of the sac
– Inspection / reduction of the contents
– Ligation of the sac
– Closure of Femoral Ring
• Approximation of the inguinal and pectineal ligaments
• Mesh patch
19. Surgical Repair
• Open Surgery
• Classically 3 approaches:-
– Lockwood’s infra-inguinal approach
– Lotheissen‘s trans-inguinal approach
– McEvedy’s high approach
– ischaemic bowel – high approach
20. treatment
• Surgical Repair
• Open Surgery or Laparoscopic Surgery
– bladder may be involved in medial part of hernia
sac
– Repair suturing the inguinal ligament to the
pectineal ligament non-absorbable sutures
– avoid any pressure on the femoral vein
21. treatment
Local Anaesthetic
• The iliohypogastric and ilioinguinal nerves (T12 and
L1) supply the lower abdomen. They are blocked by
an injection of local anaesthetic between internal
and external oblique muscles just medial to the
anterior superior iliac spine.
• The genitofemoral nerve (L1,2) supplies inguinal cord
structures and the anterior scrotum via its genital
branch and supplies the skin and subcutaneous
tissues of the femoral triangle via the femoral
branch.
22. treatment
LA or Regional Anaesthetic -Advantages
• With a careful technique, local anaesthesia causes
minimal physiological disturbance
• patients with cardiovascular or respiratory disease
• The absence of postoperative sedation or drowsiness
allows early ambulation and diminishes the
requirement for recovery facilities.
• provides postoperative analgesia for up to four hours
• When adrenaline is mixed with the local anaesthetic
(normally in a dilution of 1:200,000) useful
vasoconstriction is produced resulting in a relatively
bloodless field.
23. treatment
LA or Regional Anaesthetic –Disadvantages
• must be carried out gently.
• Although pain sensation is usually blocked by the
anaesthetic, traction on certain tissues, particularly
the peritoneum, is uncomfortable.
• Larger hernias, particularly those with incarcerated
bowel may prove unsuitable for local anaesthesia.
• Some sedation during the operation may be required
for anxious patients which loses some of the benefits
of avoiding general anaesthesia. Patients who are
excessively nervous may be unsuitable for surgery
under local anaesthesia.
24. treatment
• pre-operative consent - risks/complications
• Wound haematoma
• Wound infection
• when using ‘mesh’ antibiotics are usually given during the operation
• lymph (fluid) may collect under the wound and need to be drained off.
• Nerve damage - several nerves cross the operative field in hernia surgery.
• Some patients develop chronic pain after hernia surgery, probably due to
the pressure from the mesh on the nerves (occurs in about 2% of hernia
repairs).
• Recurrence of the hernia - fortunately recurrence after hernia repair
should be rare (1-5%).
25. treatment
presenting as an emergency
• increased morbidity and mortality
• increased rates of bowel resection
• increased complications
• wound infection
• cardiovascular and respiratory complications
• mortality X20 if bowel resection required (cf
elective repair without bowel resection)
26. prognosis
• The mortality for elective hernia repair is:
• 0.1% below the age of 60
• 0.2% between 60 and 69
• 1.6% between 70 and 79
• 3.3% over the age of 80
• The risk for emergency repair of a
strangulated hernia is 10 times higher and
many patients are 80 years or over.
The overall operative mortality for
strangulated hernia is 10%: