This document discusses hepatic encephalopathy, which is a potentially reversible disturbance in brain function caused by liver disease or portal-systemic shunting. It defines and classifies hepatic encephalopathy, discusses potential precipitating factors, describes methods of grading its severity including the West Haven criteria, and outlines treatment approaches including reducing nitrogenous toxins from the gut, improving extra-intestinal ammonia elimination, and counteracting abnormalities in central neurotransmission.
basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
Please leave a comment if you like it..
basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
Please leave a comment if you like it..
Hepatic encephalopathy is a brain dysfunction caused by liver insufficiency, and/or portosystemic shunt; it manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma.
Its a common disorder in liver cirrhosis
dr Mohammed Hussien ( assistant Lecturer of Gastroenterologist and Hepatology at Kaferelsheik University Egypy) illusterating one of Major complication of Cirrhosis --H.E
Clinical Toxicology by dr.tayyaba rphpptBIANOOR123
Toxicology is a scientific discipline, overlapping with biology, chemistry, pharmacology, and medicine, that involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating exposures to toxins and toxicants.
alcohol perturbs the balance between excitatory and inhibitory influences in the brain, resulting in Anxiolysis. An increased reaction time, diminished fine motor control, impulsivity, and impaired judgement be come evident when the concentionof alcohol in the blood is 20-30mg/dl.
More than 50% of persons are grossly intoxicated by a conc. Of 150mg/dl.
The defintion of intoxication varies by country.
Alcohol can be measured in saliva, urine,sweat,and blood, level in exheled air remains the primary method of assessing the level of intoxication.
Ethanol (CH 3 CH 2 OH) is a water-soluble alcohol that rapidly crosses cell membranes.
Absorption of ethanol occurs via the gastrointestinal system, primarily in the stomach (70 percent) and duodenum (25 percent), with a small amount absorbed by the remaining intestine .
When the stomach is empty, peak blood ethanol levels are reached between 30 and 90 minutes after ingestion.
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
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
2. Definition
Potentially reversible disturbance in central
nervous system function secondary to hepatic
insufficiency or portal-systemicshunting.
This broad definition reflects a spectrum of
neurologic manifestations, ranging from subtle
alterations in neuropsychological tests to
appearance of deep coma, brain edema, and
intracranial hypertension.
3. Classification:
a. Encephalopathy associated with acute
liver failure (type A, for acute).
b. Encephalopathy associated with portal-
systemic bypass and no intrinsic
hepatocellular disease (type B, for By-
pass).
c. Encephalopathy associated with cirrhosis
and portal hypertension and/or portal-
systemic shunts (type C, for cirrhosis).
4. Subgroups:
We can divide type C further into:
c.1. Episodic HE. Subdivided into
precipitated and spontaneous, depending
on the presence of precipitating factors.
``Recurrent encephalopathy'‘ refers to the
occurrence of at least two episodes of
episodic HE within 1 year.
5. c.2. Persistent HE. Includes cognitive deficits that
impact negatively on social and occupational
functioning, and is subdivided into mild and severe.
Treatment-dependent persistent HE is a subgroup
in which overt symptoms develop promptly after
discontinuing medication.
c.3. Minimal HE. Refers to abnormalities of cognition,
affection/emotion, behavior, or bioregulation that
are not usually detected by regular clinical
examination; diagnosis requires specific
neuropsychological and neurophysiological tests.
10. Grading
The two most useful and
recommended methods of grading
HE are based on clinical findings.
The West Haven criteria are a
semiquantitative classification that
groups HE in four stages, covering
the whole spectrum of HE except
minimal HE.
11. Thus, stage I includes trivial lack of
awareness, euphoria, anxiety, shortened
attention span, and impairment of skills
such as addition or subtraction;
stage II is characterized by lethargy, time
disorientation, obvious personality
change, and inappropriate behavior;
12. stage III includes somnolence to
semistupor but responsiveness to
stimuli, confusion, gross
disorientation, and bizarre
behavior; and
Stage IV is coma and no response
to noxious stimuli.
13. The Glasgow coma scale, initially developed for
patients with neurotrauma, is less subject to
observer variability, but its use has not been
validated in metabolic encephalopathies.
It measures the response to eye opening, verbal
behavior, and motor responsiveness, and
quantifies neurologic impairment in a continuous
numerical scale.
It is mainly useful for evaluation of advanced
stages of HE.
14. The portal-systemic encephalopathy index,
which combines assessment of mental state,
arterial ammonia, electroencephalography,
number connection test, and estimation of
degree of asterixis, is another method that has
been extensively used to grade HE.
However, a consensus has been recently
reached indicating that it is not adequate for
clinical followup evaluation and it is not
recommended for clinical trials.
15. Flapping Tremors
Clinical Presentation
Infrequent at this stage
Alert, euphoric, occasionally depression
Poor concentration, slow mentation and
affect, reversed sleep rhythm
Grade 1
(prodrome)
Easily elicited
Drowsiness, lethargic, inappropriate
behavior, disorientation
Grade 2
(impending
Coma)
Usually present
Stuporous but easily rousable, marked
confusion, incoherent speech
Grade 3
(Early Coma)
Usually absent
Coma, unresponsive but may respond to
painful stimulus
Grade 4
(Deep Coma)
16. Treatment
A) General Measures:
1. Special nursing staff to avoid harm.
2. Adequate hydration and nutrition during period
of altered mental state.
3. Identification and removal of precipitating
factors.
4. Early diagnosis and management of infection,
GI hemorrhage, renal impairment, electrolyte,
constipation….etc
5. Intubation in stage III or IV
17. Treatment
A) General Measures:
1. Special nursing staff to avoid harm.
2. Adequate hydration and nutrition during period
of altered mental state.
3. Identification and removal of precipitating
factors.
4. Early diagnosis and management of infection,
GI hemorrhage, renal impairment, electrolyte,
constipation….etc
5. Intubation in stage III or IV
18. Treatment
B) Reduction of Nitrogenous Load from the Gut:
1. Prolonged periods of dietary protein restriction
should be avoided.
2. Preferably from vegetable and dairy sources
rather than animal protein.
3. Nonabsorbable disaccharides, such as lactulose
and lactitol, remain the first-line pharmacological
treatment of HE.
4. Lactitol and lactulose enemas have been also
shown effective.
19. 5. Antibiotics as they reduce ammonia-producing
bacteria in the colon:
- Neomycin
- Metronidazole
- Also, vancomycin or rifaximin
20. C) Improvement of Extraintestinal Elimination of
Ammonia:
1. Zinc is a cofactor in all enzymes of the urea cycle,
thus administration of zinc acetate to improve
ureagenesis may be specially indicated in patients
with associated malnutrition
2. Ornithine-aspartate provides substrates for the
urea cycle in the liver as well as for the synthesis
of glutamine via transamination.
21. D) Counteracting Abnormalities of Central
Neurotransmission:
1. Intravenous administration of flumazenil (esp. if
benzodiazepine ingestion is suspected).
2. Bromocriptine to correct abnormalities of
dopaminergic neurotransmission, it is indicated
only for the treatment of chronic encephalopathy.
3. Administration of intravenous and oral solutions of
branched-chain amino acids (???).
22. E) Manipulation of Splanchnic Circulation:
In HE caused by congenital portal-systemic shunts
and in those patients with severe HE after
placement of a transjugular intrahepatic
portosystemic stent shunt.
Occlusion or reduction of the shunt via surgery or
via interventional radiology should be considered.
This may be also an option in selected patients with
cirrhosis and large spontaneous portal-systemic
shunts, if they present with recurrent episodes of
HE without precipitating factors.