Fundoscopy in pih
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This document discusses fundal changes seen in pre-eclampsia and the use of fundoscopy to monitor patients. Fundoscopy allows visualization of hypertensive changes in the retina, which runs parallel to severity of pre-eclampsia. Normal findings include uniform caliber arteries with smooth course and branching at obtuse angles. Hypertensive changes include vasospasm seen as narrowing, straightening and acute branching, vasosclerosis seen as Salus' sign and Gunn's sign, and retinopathy seen as exudates, hemorrhages, edema, hard exudates and retinal detachment. The Keith-Wagener-Barker and American Ophthalmological Association gradings of retin
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Total anomalous pulmonary venous connection
Total anomalous pulmonary venous connection (TAPVC) is the fifth most common cause of cyanotic congenital heart disease, where the pulmonary veins drain anomalously into the right atrium or its tributaries instead of the left atrium. It was first described in 1798. There are four main types based on the drainage site: supracardiac, cardiac, infracardiac, and mixed. Unobstructed TAPVC allows mixing of pulmonary and systemic venous blood, while obstructed types lead to pulmonary venous hypertension. Surgical repair is usually required in the neonatal period to redirect the pulmonary veins to the left atrium.
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Total anomalous pulmonary venous connection
Total anomalous pulmonary venous connection (TAPVC) is the fifth most common cause of cyanotic congenital heart disease, where the pulmonary veins drain anomalously into the right atrium or its tributaries instead of the left atrium. It was first described in 1798. There are four main types based on the drainage site: supracardiac, cardiac, infracardiac, and mixed. Unobstructed TAPVC allows mixing of pulmonary and systemic venous blood, while obstructed types lead to pulmonary venous hypertension. Surgical repair is usually required in the neonatal period to redirect the pulmonary veins to the left atrium.
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TGA is a complex congenital heart disease.Understanding the anatomy,physiology,surgery and anaesthetic management is very important for patient's better outcome.This ppt explains all these points in detail.
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Tricuspid atresia and transposition of the great vessels are congenital heart defects that require complex anesthetic management. For tricuspid atresia, blood cannot flow from the right atrium to the right ventricle, causing cyanosis. For transposition of the great vessels, the aorta arises from the right ventricle and pulmonary artery from the left ventricle, separating systemic and pulmonary circulation. Surgical procedures like shunts, banding, or arterial switch procedures are required. Anesthesia goals include maintaining hemodynamics like cardiac output and low pulmonary vascular resistance while avoiding hypotension, fluid overload, or arrhythmias.
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This document discusses the embryology, anatomy, clinical presentation, evaluation, and surgical treatment of pulmonary atresia with ventricular septal defect (PA-VSD). Some key points:
- PA-VSD is characterized by atresia of the pulmonary artery and a ventricular septal defect, with pulmonary blood flow derived from collateral arteries.
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- Surgical repair aims to connect as many lung segments as possible to right ventricular outflow during infancy to avoid pulmonary vascular changes, with the ultimate goal of complete repair closing all defects and incorporating
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Transposition of the great arteries (TGA) is a congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, causing parallel instead of serial circulation. TGA accounts for 5-7% of congenital heart diseases and has an annual incidence of 20-30 per 100,000 live births. Without treatment, TGA is incompatible with long-term survival due to lack of oxygen supply. Initial treatment involves prostaglandin E1 to maintain ductal patency and increase pulmonary blood flow. Later procedures include the Rastelli operation or arterial switch operation to correct the defect.
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This case study describes the repair of total anomalous pulmonary venous connection (TAPVC) in a 50-day-old baby. TAPVC is a congenital heart defect where the pulmonary veins do not connect normally to the left atrium. The baby underwent surgery to reroute the pulmonary veins and close an atrial septal defect. In the postoperative period, the baby developed pulmonary arterial hypertension crisis, which was treated with reintubation, vasoactive drugs, and sildenafil infusion through a pulmonary artery catheter. The baby's condition gradually improved and was extubated again after 48 hours of ventilation support.
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This document provides information on total anomalous pulmonary venous connection (TAPVC), including its definition, history, classification, embryology, pathophysiology, clinical manifestations, and findings. TAPVC is an anomaly where the pulmonary veins do not connect to the left atrium and instead connect directly to systemic veins. It can be classified based on the site of connection and presence of obstruction. Clinical presentation depends on whether there is pulmonary venous obstruction, ranging from asymptomatic to respiratory distress and death in infants.
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1) The document discusses total anomalous pulmonary venous return (TAPVR), partial anomalous pulmonary venous drainage (PAPVD), and their classification and features.
2) TAPVR occurs when pulmonary veins drain anomalously into the systemic venous system rather than the left atrium. It is classified by the drainage site and carries a risk of heart failure without surgery.
3) PAPVD involves anomalous drainage of one or more pulmonary veins rather than all veins. It can cause left-to-right shunting depending on factors like atrial septal defects.
4) CT and surgery play roles in diagnosis and treatment. CT defines venous anatomy and rules out obstructions, while surgery redirects venous drainage to
D tga, echo & hemodynamic features of
1) Complete transposition of the great arteries (d-TGA) is a congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, causing ventriculoarterial discordance.
2) In d-TGA, the systemic and pulmonary circulations are arranged in parallel rather than in series, requiring blood flow between the circuits through connections like an atrial or ventricular septal defect.
3) Echocardiography is useful for diagnosing d-TGA by demonstrating the aorta originating from the right ventricle and pulmonary artery from the left ventricle, as well as identifying the origins of the coronary arteries.
Asd
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echo cardiography Of ASD
View of ASD in ECHO
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A 30-year-old female was found to have total anomalous pulmonary venous return (TAPVR) of the supracardiac type on imaging studies. In this rare condition, the pulmonary veins drain abnormally into the superior vena cava rather than the left atrium. CT imaging showed a looped vascular trunk formed by the united pulmonary veins that drained into the superior vena cava. The patient's condition was similar to a case report of a 24-year-old man who presented with cerebral abscesses secondary to non-obstructive supracardiac TAPVR. TAPVR can be of different types depending on the path of the anomalous venous drainage.
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TAPVC defines the anomaly in which the pulmonary veins have no connection with the left atrium. Rather, the pulmonary veins connect directly to one of the systemic veins (TAPVC) or drain in to right atrium.
A PFO or ASD is present essentially in those who survive after birth
When pulmonary veins drain anomalously into the right atrium either because of complete absence of the interatrial septum or malattachment of the septum primum , then it is known as total anomalous pulmonary venous drainage.
When some or all of the pulmonary veins drain anomalously in to RA or its tributaries without being abnormally connected, the terms partially anomalous pulmonary venous drainage (PAPVD) or totally anomalous pulmonary venous drainage (TAPVD) with normal pulmonary venous connections are used.
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This document discusses the embryology, classification, incidence, and pathophysiology of total anomalous pulmonary venous return (TAPVR). It can be summarized as follows:
1. TAPVR occurs due to failure of the pulmonary veins to connect normally to the left atrium, instead connecting abnormally to veins draining into the right atrium.
2. It is classified based on the pathway of drainage, with the most common types being supracardiac (50%) and cardiac (25%).
3. TAPVR has an incidence of 1.5-2% of all congenital heart defects and carries a risk of pulmonary hypertension and heart failure due to obligatory right-to-left shunt
Asd new
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- Small ASDs may close spontaneously but larger defects can cause volume overload of the right heart and pulmonary arteries over time if left unrepaired. Echocardiography is the primary imaging test used to diagnose ASDs and estimate shunt size.
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Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare congenital heart defect where the pulmonary valve is blocked, preventing blood flow to the lungs. It is characterized by an underdeveloped right ventricle and connections between the right ventricle and coronary arteries. Newborns present with cyanosis and rely on a patent ductus arteriosus for pulmonary blood flow. Without intervention, most infants will die within the first few months of life. Treatment involves surgical procedures like the Blalock-Taussig shunt, bidirectional Glenn procedure, and Fontan operation to redirect blood flow to the lungs without using the right ventricle.
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This document provides information about atrial septal defects (ASD). It discusses the different types of ASDs including ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. It covers the pathophysiology, clinical presentation, investigations including echocardiography and ECG findings, and management including device closure or surgery. Long term outcomes are also summarized such as the potential for spontaneous closure in small defects or complications in adults if left untreated, including congestive heart failure, pulmonary hypertension, and atrial arrhythmias.
Sutton 7 transposition of the great arteries
The document discusses congenital heart disease, specifically transposition of the great arteries (TGA). TGA is a serious defect where the two main arteries leaving the heart (the aorta and pulmonary artery) are switched, or transposed. It occurs in about 1 in 4,000-5,000 births. Babies with TGA appear blue and have trouble breathing due to the lack of oxygen in their blood. Imaging like chest x-rays can help diagnose TGA by showing the reversed positioning of the heart arteries. The long term outcomes of TGA require medical management with prostaglandins or surgical repairs like arterial switches.
Total Anomalous Pulmonary Venous Connection
This document provides information on total anomalous pulmonary venous connection (TAPVC), including:
1. TAPVC is a congenital heart defect where the pulmonary veins do not connect normally to the left atrium and instead connect to the right atrium or its tributaries.
2. There are four main types of anomalous pulmonary vein connections: supracardiac, cardiac, infracardiac, and mixed.
3. Untreated TAPVC can lead to pulmonary overcirculation, congestion, and pulmonary hypertension due to mixing of oxygenated and deoxygenated blood. Surgical repair is usually recommended.
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This document discusses hemodynamic principles and waveform analysis from cardiac catheterization. It provides an overview of normal and abnormal pressure waveforms from the right atrium, pulmonary artery, left ventricle, and aorta. Key points include how respiration and different disease states can impact pressure tracings. The document also outlines the components and uses of the Swan-Ganz catheter for measuring pressures in the right heart and pulmonary circulation.
Transposition of the great arteries
Transposition of the great arteries is a serious but rare heart defect present at birth (congenital), in which the two main arteries leaving the heart are reversed (transposed). The condition is also called dextro-transposition of the great arteries.
Patent Ductus Arteriosus
This infant is a 5 day old 25 week preemie with worsening respiratory distress requiring increased oxygen and ventilator support. On exam, the infant has a systolic murmur and signs of increased cardiac output including bounding pulses. An echocardiogram is needed to confirm a diagnosis of a hemodynamically significant patent ductus arteriosus (PDA), which could be contributing to the respiratory distress. Treatment options for a large PDA include supportive care, medications like indomethacin or ibuprofen to close the ductus, or surgery.
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Tricuspid atresia is a congenital heart defect where the tricuspid valve is absent or not formed, preventing communication between the right atrium and right ventricle. It occurs in approximately 0.06 per 1000 live births with no gender predominance. The condition ranges in severity from complete absence of the tricuspid valve to stenosis. Early presentation includes severe cyanosis, hypoxemia, and acidosis in infants with low pulmonary blood flow, while those with higher flow present with heart failure symptoms later in infancy. Echocardiography can identify the absent tricuspid valve and associated defects. Without surgical intervention, few infants survive beyond 6 months, but current treatments including shunts and the
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Pulmonary atresia with intact ventricular septum (PAIVS) is a congenital heart defect where the pulmonary valve is blocked, preventing blood flow from the right ventricle to the lungs. It occurs in 1-3% of congenital heart diseases. Surgical interventions for PAIVS have improved, with 5-year survival rates now around 80%. Treatment depends on factors like the size of the tricuspid valve and whether the coronary arteries depend on blood flow from the right ventricle. Options include biventricular repair, univentricular repair, or transplantation.
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Transposition of great arteries
Transposition of the great arteries (TGA) is a congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, causing parallel instead of serial circulation. TGA accounts for 5-7% of congenital heart diseases and has an annual incidence of 20-30 per 100,000 live births. Without treatment, TGA is incompatible with long-term survival due to lack of oxygen supply. Initial treatment involves prostaglandin E1 to maintain ductal patency and increase pulmonary blood flow. Later procedures include the Rastelli operation or arterial switch operation to correct the defect.
TAPVC A CASE STUDY
This case study describes the repair of total anomalous pulmonary venous connection (TAPVC) in a 50-day-old baby. TAPVC is a congenital heart defect where the pulmonary veins do not connect normally to the left atrium. The baby underwent surgery to reroute the pulmonary veins and close an atrial septal defect. In the postoperative period, the baby developed pulmonary arterial hypertension crisis, which was treated with reintubation, vasoactive drugs, and sildenafil infusion through a pulmonary artery catheter. The baby's condition gradually improved and was extubated again after 48 hours of ventilation support.
Total anomalous pulmonary venous connection
This document provides information on total anomalous pulmonary venous connection (TAPVC), including its definition, history, classification, embryology, pathophysiology, clinical manifestations, and findings. TAPVC is an anomaly where the pulmonary veins do not connect to the left atrium and instead connect directly to systemic veins. It can be classified based on the site of connection and presence of obstruction. Clinical presentation depends on whether there is pulmonary venous obstruction, ranging from asymptomatic to respiratory distress and death in infants.
Anomalous pulmonary venous drainage total & partial CT role
1) The document discusses total anomalous pulmonary venous return (TAPVR), partial anomalous pulmonary venous drainage (PAPVD), and their classification and features.
2) TAPVR occurs when pulmonary veins drain anomalously into the systemic venous system rather than the left atrium. It is classified by the drainage site and carries a risk of heart failure without surgery.
3) PAPVD involves anomalous drainage of one or more pulmonary veins rather than all veins. It can cause left-to-right shunting depending on factors like atrial septal defects.
4) CT and surgery play roles in diagnosis and treatment. CT defines venous anatomy and rules out obstructions, while surgery redirects venous drainage to
D tga, echo & hemodynamic features of
1) Complete transposition of the great arteries (d-TGA) is a congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, causing ventriculoarterial discordance.
2) In d-TGA, the systemic and pulmonary circulations are arranged in parallel rather than in series, requiring blood flow between the circuits through connections like an atrial or ventricular septal defect.
3) Echocardiography is useful for diagnosing d-TGA by demonstrating the aorta originating from the right ventricle and pulmonary artery from the left ventricle, as well as identifying the origins of the coronary arteries.
Asd
Atrial Septal Defect
Types :- Ostium secdum, Ostium Premium
echo cardiography Of ASD
View of ASD in ECHO
total anomalous pulmonary venous return
A 30-year-old female was found to have total anomalous pulmonary venous return (TAPVR) of the supracardiac type on imaging studies. In this rare condition, the pulmonary veins drain abnormally into the superior vena cava rather than the left atrium. CT imaging showed a looped vascular trunk formed by the united pulmonary veins that drained into the superior vena cava. The patient's condition was similar to a case report of a 24-year-old man who presented with cerebral abscesses secondary to non-obstructive supracardiac TAPVR. TAPVR can be of different types depending on the path of the anomalous venous drainage.
TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION (TAPVC)
TAPVC defines the anomaly in which the pulmonary veins have no connection with the left atrium. Rather, the pulmonary veins connect directly to one of the systemic veins (TAPVC) or drain in to right atrium.
A PFO or ASD is present essentially in those who survive after birth
When pulmonary veins drain anomalously into the right atrium either because of complete absence of the interatrial septum or malattachment of the septum primum , then it is known as total anomalous pulmonary venous drainage.
When some or all of the pulmonary veins drain anomalously in to RA or its tributaries without being abnormally connected, the terms partially anomalous pulmonary venous drainage (PAPVD) or totally anomalous pulmonary venous drainage (TAPVD) with normal pulmonary venous connections are used.
Classification and pathophysiology of tapvc
This document discusses the embryology, classification, incidence, and pathophysiology of total anomalous pulmonary venous return (TAPVR). It can be summarized as follows:
1. TAPVR occurs due to failure of the pulmonary veins to connect normally to the left atrium, instead connecting abnormally to veins draining into the right atrium.
2. It is classified based on the pathway of drainage, with the most common types being supracardiac (50%) and cardiac (25%).
3. TAPVR has an incidence of 1.5-2% of all congenital heart defects and carries a risk of pulmonary hypertension and heart failure due to obligatory right-to-left shunt
Asd new
- Atrial septal defects (ASDs) are holes in the atrial septum that allow blood to shunt from the left atrium to the right atrium.
- There are several types of ASDs including primum, secundum, sinus venosus, and patent foramen ovale. Secundum ASDs are the most common, making up 70% of cases.
- Small ASDs may close spontaneously but larger defects can cause volume overload of the right heart and pulmonary arteries over time if left unrepaired. Echocardiography is the primary imaging test used to diagnose ASDs and estimate shunt size.
PA/IVS - Dr. Julius King Kwedhi
Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare congenital heart defect where the pulmonary valve is blocked, preventing blood flow to the lungs. It is characterized by an underdeveloped right ventricle and connections between the right ventricle and coronary arteries. Newborns present with cyanosis and rely on a patent ductus arteriosus for pulmonary blood flow. Without intervention, most infants will die within the first few months of life. Treatment involves surgical procedures like the Blalock-Taussig shunt, bidirectional Glenn procedure, and Fontan operation to redirect blood flow to the lungs without using the right ventricle.
seminar ASD
This document provides information about atrial septal defects (ASD). It discusses the different types of ASDs including ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. It covers the pathophysiology, clinical presentation, investigations including echocardiography and ECG findings, and management including device closure or surgery. Long term outcomes are also summarized such as the potential for spontaneous closure in small defects or complications in adults if left untreated, including congestive heart failure, pulmonary hypertension, and atrial arrhythmias.
Sutton 7 transposition of the great arteries
The document discusses congenital heart disease, specifically transposition of the great arteries (TGA). TGA is a serious defect where the two main arteries leaving the heart (the aorta and pulmonary artery) are switched, or transposed. It occurs in about 1 in 4,000-5,000 births. Babies with TGA appear blue and have trouble breathing due to the lack of oxygen in their blood. Imaging like chest x-rays can help diagnose TGA by showing the reversed positioning of the heart arteries. The long term outcomes of TGA require medical management with prostaglandins or surgical repairs like arterial switches.
Total Anomalous Pulmonary Venous Connection
This document provides information on total anomalous pulmonary venous connection (TAPVC), including:
1. TAPVC is a congenital heart defect where the pulmonary veins do not connect normally to the left atrium and instead connect to the right atrium or its tributaries.
2. There are four main types of anomalous pulmonary vein connections: supracardiac, cardiac, infracardiac, and mixed.
3. Untreated TAPVC can lead to pulmonary overcirculation, congestion, and pulmonary hypertension due to mixing of oxygenated and deoxygenated blood. Surgical repair is usually recommended.
Hemodynamic
This document discusses hemodynamic principles and waveform analysis from cardiac catheterization. It provides an overview of normal and abnormal pressure waveforms from the right atrium, pulmonary artery, left ventricle, and aorta. Key points include how respiration and different disease states can impact pressure tracings. The document also outlines the components and uses of the Swan-Ganz catheter for measuring pressures in the right heart and pulmonary circulation.
Transposition of the great arteries
Transposition of the great arteries is a serious but rare heart defect present at birth (congenital), in which the two main arteries leaving the heart are reversed (transposed). The condition is also called dextro-transposition of the great arteries.
Patent Ductus Arteriosus
This infant is a 5 day old 25 week preemie with worsening respiratory distress requiring increased oxygen and ventilator support. On exam, the infant has a systolic murmur and signs of increased cardiac output including bounding pulses. An echocardiogram is needed to confirm a diagnosis of a hemodynamically significant patent ductus arteriosus (PDA), which could be contributing to the respiratory distress. Treatment options for a large PDA include supportive care, medications like indomethacin or ibuprofen to close the ductus, or surgery.
Tricuspid atresia
Tricuspid atresia is a congenital heart defect where the tricuspid valve is absent or not formed, preventing communication between the right atrium and right ventricle. It occurs in approximately 0.06 per 1000 live births with no gender predominance. The condition ranges in severity from complete absence of the tricuspid valve to stenosis. Early presentation includes severe cyanosis, hypoxemia, and acidosis in infants with low pulmonary blood flow, while those with higher flow present with heart failure symptoms later in infancy. Echocardiography can identify the absent tricuspid valve and associated defects. Without surgical intervention, few infants survive beyond 6 months, but current treatments including shunts and the
Pulmonary atresia with intact ventricular septum
Pulmonary atresia with intact ventricular septum (PAIVS) is a congenital heart defect where the pulmonary valve is blocked, preventing blood flow from the right ventricle to the lungs. It occurs in 1-3% of congenital heart diseases. Surgical interventions for PAIVS have improved, with 5-year survival rates now around 80%. Treatment depends on factors like the size of the tricuspid valve and whether the coronary arteries depend on blood flow from the right ventricle. Options include biventricular repair, univentricular repair, or transplantation.
Tricuspid atresia in pediatrics
Tricuspid atresia is a congenital heart defect where the tricuspid valve is absent or closed, preventing blood flow from the right atrium to the right ventricle. This causes the right ventricle to be underdeveloped and the pulmonary artery to be narrow. To survive, babies with tricuspid atresia rely on openings between the atria (ASD) or ventricles (VSD) and/or a patent ductus arteriosus to provide pulmonary blood flow. Treatment depends on the amount of pulmonary blood flow, and may involve procedures like shunts, pulmonary artery banding, or ultimately the Fontan procedure. Complications can include arrhythmias, ventricular dysfunction,
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Anomalous pulmonary venous drainage total & partial CT role
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TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION (TAPVC)
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The document discusses varicose veins, which are distended and dilated veins caused by blood pooling in the legs. It describes the venous system and explains that varicose veins occur due to defects in valves that normally prevent backflow of blood. Symptoms include heaviness, pain, swelling, and skin discoloration or ulcers. Treatment options addressed are compression therapy, sclerotherapy, and surgical procedures like vein stripping to remove damaged veins.
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This document discusses imaging in bowel ischemia. It provides an overview of the anatomy of the splanchnic circulation and mesenteric arteries/veins. It then covers the pathophysiology, causes, clinical features, and imaging findings of both acute and chronic mesenteric ischemia. For imaging, it discusses the role of plain radiography, ultrasound and Doppler, CT, angiography, and MRI. It provides examples of imaging findings for different types of mesenteric ischemia and highlights how each modality can help in diagnosis.
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Varicose veins are dilated, tortuous, elongated superficial
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ANESTHESIA FOR CONGENITAL HEART DISEASES
This document provides an overview of congenital heart disease (CHD). It begins with learning objectives related to heart anatomy, embryology, circulation changes at birth, CHD classification and pathophysiology. Key concepts covered include shunting, single ventricle physiology, and factors that influence pulmonary and systemic vascular resistance. Specific defects discussed in detail include ventricular septal defects, atrial septal defects, tetralogy of Fallot, transposition of the great arteries, and hypoplastic left heart syndrome. Surgical and anesthetic management considerations are also reviewed.
Colour doppler friend of fetus
This document discusses the use of color Doppler ultrasound in obstetrics. It begins with an introduction to color Doppler and how it can identify blood flow directions based on changes in sound wave frequency. It then describes how color Doppler is useful for studying fetal circulation patterns and the three main arterial-venous shunts in the fetus. The rest of the document discusses various clinical applications of color Doppler in high-risk pregnancies, including assessing fetal well-being, detecting growth restriction, anemia, anomalies, and predicting preeclampsia. Specific fetal and placental vessels that can be evaluated with Doppler to monitor the fetus are also outlined.
Imaging in Portal hypertension
This presentation is prepared by Dr Parikha Rampal, Senior Resident, Department of Radiology, ABVIMS & Dr RML Hospital, New Delhi
Portal Hypertension Surgical MANagement.pptx
Portal hypertension can be treated with shunt operations to lower portal pressure and reduce variceal bleeding by shunting blood away from the liver. Selective shunts like the distal splenorenal shunt are preferred as they do not divert all blood flow and have a lower risk of hepatic encephalopathy. Non-selective shunts effectively lower pressure but carry higher risks of encephalopathy. Investigation with angiography and ultrasound is needed before surgery to assess anatomy. Complications include bleeding, shunt thrombosis and encephalopathy.
Hemodynamic Pressure Monitoring
This document discusses hemodynamic pressure monitoring, including indirect and invasive arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter placement and measurements. It provides details on:
- Methods for continuously monitoring arterial blood pressure, heart rate, and circulatory function during anesthesia
- Techniques for indirect and direct arterial pressure measurement
- Components, calibration, and placement of arterial pressure monitoring catheters
- Measurements obtained from central venous and pulmonary artery catheters like cardiac output, pressures, and oxygen saturation
- Potential complications of pulmonary artery catheter placement
ascites
This document discusses ascites, which is free fluid in the abdominal cavity. It describes the pathophysiology of ascites, which can be due to increased hydrostatic pressure (e.g. in cirrhosis), increased osmotic pressure, or impaired fluid resorption. The diagnosis involves history of increased abdominal size and physical exam findings like shifting dullness. Imaging studies like ultrasound can detect small amounts of fluid. Treatment involves dietary sodium restriction, diuretics, and paracentesis for symptomatic relief. Surgical options include shunt procedures for refractory ascites.
collaterals in PHTN.pptx
The document discusses collateral pathways that develop in portal hypertension. It describes:
1. Normal portosystemic anastomoses that exist and how portal hypertension causes increased flow through these pathways.
2. How collateral pathways open up when blood flow is obstructed in the portal vein, flowing from high to low pressure areas.
3. The various collateral pathways that can develop, including esophageal varices, gastric varices, and other ectopic varices.
4. Factors that determine whether collateral circulation develops in a hepatofugal (away from liver) or hepatopetal (toward liver) direction depending on where the obstruction occurs.
collaterals in PHTN.pptx
This document discusses collateral pathways that develop in portal hypertension. It begins by explaining how portosystemic collateral veins normally exist but increase in flow with portal hypertension. It then discusses the different directions collateral flow can take depending on where the obstruction is located.
The document proceeds to describe various normal and abnormal portosystemic anastomoses, including those connecting the esophagus, stomach, duodenum and other organs. It explains the afferents and efferents of different varices that can form. Images are also included showing various collateral pathways visible on imaging. In summary, the document provides a detailed overview of the venous drainage patterns and collateral vessels that can develop in response to portal hypertension.
Mitral stenosis Clinical manifestation & echocardiography assessment
This document discusses mitral stenosis, including its etiology, pathophysiology, clinical manifestations, and echocardiography assessment. It begins by covering the main causes of mitral stenosis such as rheumatic fever. It then describes the pathophysiology involving obstruction of blood flow across the mitral valve and subsequent effects. The clinical manifestations involve symptoms related to reduced cardiac output and right heart failure as well as physical exam findings. Echocardiography is key for assessing the severity of mitral stenosis using measurements of the mitral valve area and gradients as well as estimating pulmonary artery pressures.
Varicose veins and management 1
This document provides information on varicose veins and their management. It discusses the anatomy of veins in the lower extremities, including superficial, deep and perforator veins. It describes the pathogenesis of varicose veins which involves valve incompetence and reflux of blood. Clinical features include pain, heaviness, cramps and complications like ulcers. Investigations include Doppler ultrasound, duplex scan and venography. Management involves conservative measures like compression stockings as well as invasive options like sclerotherapy and surgery. Sclerotherapy involves injecting sclerosing agents into veins to cause scarring and closure.
Varicose veins and management 1
This document provides information on varicose veins and their management. It discusses the anatomy of veins in the lower extremities, including superficial, deep and perforator veins. It describes the pathogenesis of varicose veins which involves valve incompetence and reflux of blood. Clinical features include pain, heaviness, cramps and complications like ulcers. Investigations include Doppler ultrasound, duplex scan and venography. Management involves conservative measures like compression stockings as well as invasive options like sclerotherapy and surgery. Sclerotherapy involves injecting sclerosing agents into veins to cause scarring and closure.
Color doppler in fetal hypoxia
Color Doppler ultrasound is an indispensable tool for assessing fetal growth restriction and hypoxia. It allows identification of fetuses at risk for damage or death in utero by examining blood flow in key vessels like the umbilical artery, middle cerebral artery, and uterine arteries. Abnormal Doppler readings in these vessels can indicate placental insufficiency or redistribution of blood flow due to fetal hypoxia. Together with 2D ultrasound, color Doppler improves outcomes by aiding management decisions around timing and mode of delivery.
criss cross heart.pptx
This document discusses criss-cross heart, a rare congenital heart defect where the ventricles are rotated such that the atria drain into the contra-laterally located ventricles. It provides details on the etiology, diagnosis using echocardiography, associated anomalies, differential diagnosis, and surgical treatment options. It also presents two case reports, with one involving a 12-day old newborn who underwent arterial switch operation, and another involving a 12-year-old girl who underwent Fontan surgery. MRI images are shown demonstrating variants of criss-cross heart. The conclusion notes this may be the first reported case of criss-cross heart with double outlet right ventricle and pulmonary atresia that
Congenital heart disease
This document discusses congenital heart diseases. It begins by describing the fetal circulation and how it changes after birth. It then discusses the epidemiology and types of congenital heart diseases, including acyanotic lesions like atrial and ventricular septal defects which cause left-to-right shunts, and cyanotic lesions like transposition of the great arteries and tetralogy of Fallot which cause right-to-left shunts. For each type of lesion, the document discusses physical exam findings, natural history, and management approaches. The goal is to provide an overview of congenital heart diseases, their presentations, and treatment options.
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Anatomy, Physiology & Classification of Varicose Veins
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Intrauterine fetal demise
This document summarizes the case of a 36-week pregnant primigravida woman who presented with absent fetal movements for 2 days and was diagnosed with intrauterine fetal demise. Her antenatal period was otherwise uneventful. Evaluation of the stillborn fetus, placenta, and maternal factors found no anomalies or risks except for acute chorioamnionitis seen on placental histopathology. A thorough evaluation was conducted including autopsy, cultures, and genetic testing to investigate the cause, though it remained undetermined.
Embryology of genitourinary system
The urogenital system develops from the intermediate mesoderm. In early development, the genital ridges form the gonads and reproductive ducts, while the nephrogenic cords form the urinary system. In females, the gonads become ovaries and the paramesonephric ducts form the uterus, fallopian tubes, and upper vagina. The mesonephric ducts give rise to the ureters, bladder trigone, and posterior urethra. Under the influence of estrogen, the genital tubercle develops into the clitoris and genital swellings form the labia majora and minora.
HIV in pregnancy
Drug interactions and overlapping toxicities between ART and other medications require expertise to determine the optimal treatment regimen. Involving an HIV specialist helps ensure the regimen is both effective against HIV and safe for the pregnant woman and developing fetus.
Ureter and bladder
This document discusses the anatomy and surgical risks related to the ureter. It describes the course, blood supply, innervation and identification of the ureter. It also outlines the types of operative ureteral injuries that can occur during gynecologic surgery, including crushing, ligation, transection, angulation and ischemia. The most common sites of injury are near the pelvic brim during hysterectomy when attempting hemostasis. Laparoscopic injuries typically result from thermal damage to the ureter. Surgical procedures like hysterectomy, adnexectomy, incontinence surgery and radical trachelectomy carry risks of ureteral injury.
CVS AND RESPIRATORY PHYSIOLOGY IN PREGNANCY
Pregnancy causes significant physiological changes to the cardiovascular, respiratory, and urinary systems. The cardiovascular system undergoes remodeling to support the increased blood volume and cardiac output required to meet metabolic demands. The respiratory system experiences alkalosis due to progesterone-induced hyperventilation. Kidney function is elevated as glomerular filtration rate increases up to 50% by the second trimester to accommodate increased plasma volume.
Azoospermia case
This document presents the case of a 26-year-old woman and her 30-year-old husband who have been unable to conceive after 3 years of marriage. Evaluation found the woman has polycystic ovarian syndrome and irregular menstrual cycles. The man was found to have obstructive azoospermia, with no sperm found on multiple semen analyses. Both partners underwent further testing and examination, and the diagnosis was primary infertility due to female and male factors - her PCOS and his obstructive azoospermia.
medical termination of pregnancy
- The document discusses various topics related to medical termination of pregnancy (MTP) and abortions under Indian law.
- The MTP Act was passed in 1971 and amended in 2002 and 2021 to further enable access to safe abortion services in India up to certain gestational limits.
- The act legalizes abortion and protects medical practitioners providing abortion, while also de-criminalizing women seeking abortions.
- Abortions are only permitted for conditions and within gestational limits specified by the act and must be done by approved medical practitioners at approved facilities.
contraception
The document discusses various methods of family planning and contraception. It provides information on natural family planning methods like calendar/rhythm methods and cervical mucus monitoring. It also discusses barrier methods like condoms and diaphragms, as well as hormonal birth control pills, implants, IUDs, hormone injections, and permanent sterilization methods. Emergency contraception options are also mentioned. The document aims to educate people about different contraceptive choices and empower them to choose methods that meet their family planning goals.
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Fundoscopy in pih
- 2. FUNDOSCOPY IN PIH RETINA Mirror to the cardiovascular system of the body FUNDOSCOPY Visualization of hypertensive changes PIH Retinal changes run parallel with the severity of hypertension hence that of pre-eclampsia
- 3. PROCEDURE ONE DROP EVERY 10 MINUTES THREE TIMES FUNDOSCOPY AFTER ONE HOUR BEFORE FOUR HOURS
- 4. SYSTEMIC HTN VASOSPASM VASOSCLEROSIS RETINOPATHY
- 5. NORMAL FUNDUS Uniform Caliber Smooth sinuous course Branch at obtuse angle
- 6. VASOSPASM NARROWING STRAIGHTENING ACUTEANGLED BRANCHING A-V RATIO 1:3
- 7. VASOSCLEROSIS SALU’S SIGN Deflection in the course of the vein at the Arterio-venous crossing
- 8. VASOSCLEROSIS GUNN’S SIGN Concealment of the vein beneath the artery at the Arterio-venous crossing
- 9. RETINOPATHY SOFT EXUDATES RETINAL HEMORRHAGES RETINAL EDEMA HARD EXUDATES RETINAL DETACHMENT
- 10. RETINOPATHY Occulsion of precapillary arteriole Capillary nonperfusion Localised axoplasmic stasis Compact yellowish white fluffy lesions Cotton wool spots SOFT EXUDATES
- 11. RETINOPATHY Fibrinoid necrosis in the vessel wall Located in the Nerve fibre layer of retina Bright red flamed shaped hemorrhage FLAME SHAPED HAEMORRGHAGES
- 12. RETINOPATHY Increased capillary Permeability Retinal edema Precipitation of lipids Discrete dense yellow lesions Macular star HARD EXUDATES MACULAR STAR
- 13. RETINAL DETACHMENT Accumulation of Serous fluid between Retinal pigment epithelium and Neurosensory retina LOCALISED RETINAL DETACHMENT
- 16. KEITH- WAGENE R- BARKER 1939 FEATURES K-W-R GRADING SURVIVAL Narrowing of the retinal arteries I EXCELLENT A-V CHANGES SALU’S SIGN AND GUNN’S SIGN II GOOD RETINOPATHY SOFT EXUDATES FLAME HAEMORRHAGES HARD EXUDATES RETINAL EDEMA/RETINALDetachment III POOR DISC EDEMA IV VERY POOR
- 17. AMERICAN OPHTHALMOLOGICAL SOCEITY K-W-R GRADING AOA GRADING FEATURES O Normal fundus I I II Focal Narrowing Diffuse generalised narrowing II III III RETINOPATHY SOFT EXUDATES/FLAME HAEMORRHAGES RETINAL EDEMA/RETINAL DETACHMENT IV IV DISC EDEMA
- 18. IMPLICATION FEATURES PREGNANCY NORMAL FUNDUS CONTINUE FOCAL NARROWING DIFFUSE NARROWING RETINOPATHY SOFT EXUDATES FLAME HAEMORRHAGES HARD EXUDATES RETINAL EDEMA/RD TERMINATE DISC EDEMA
- 20. PROGNOSIS
- 21. THANKYOU