Cirrhosis is a diffuse process characterized by liver necrosis & fibrosis and conversion of normal liver architecture into structurally abnormal nodules that lack normal lobular organization
Presentation about Inflammatory Bowel Disease (IBD), focused on pathologic diagnosis with a short introduction containing incidence, etiology and pathogenesis.
Cirrhosis is a diffuse process characterized by liver necrosis & fibrosis and conversion of normal liver architecture into structurally abnormal nodules that lack normal lobular organization
Presentation about Inflammatory Bowel Disease (IBD), focused on pathologic diagnosis with a short introduction containing incidence, etiology and pathogenesis.
This is a lecture note for 5th-semester MBBS students. Lecture notes on hepatology, liver disease, and liver abscess. Introduction to a liver abscess, pyogenic liver abscess, causes, approach and management of liver abscess.
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.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
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.
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
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
2. DEFINITION
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by
many forms of liver diseases and conditions, such as hepatitis and
chronic alcoholism. The liver carries out several necessary
functions, including detoxifying harmful substances in your body,
cleaning your blood and making vital nutrients.
3. CAUSE OF CIRRHOSIS
Alcohol (acetaldyhyde)
Chronic viral hepatitis (hepatitis B, C)
Nonalcoholic steatohepatitis (obesity)
Biliary cirrhosis
Cardiac cirrhosis (Right heart failure)
4. CAUSE OF CIRRHOSIS
Inherited metabolic liver disease
Hemochromatosis (iron metabolism > hepatic iron deposition)
Wilson’s disease (fail to excrete copper > hepatic copper
deposition)
ɑ1 Antitrypsin deficiency (abnormal folding protein > fail to
secrete from liver)
Cystic fibrosis
Cryptogenic cirrhosis
5.
6. SIGN & SYMPTOM
Non-specific Specific
right upper quadrant
abdominal pain
ascites
fever edema
nausea upper GI hemorrhage
vomiting jaundice
diarrhea encephalopathy
anorexia
malaise
7. PHYSICAL EXAMINATION
Liver & Spleen enlarged
Liver edge firm and nodular
Palmar erythema
Spider angiomas
Digital clubbing
Scleral icterus
(yellowish coloration of the eyes)
9. LABORATORY
Anemic (from GI bleeding)
Malnutrition
Platelet count often reduce
Total bilirubin can be normal or elevated
ALT, AST are typically elevated
10. CHILD-PUGH-TURCOTTE (CPT)
Using to determine disease severity in cirrhosis
Based on the presence of ascites and hepatic encephalopathy,
serum bilirubin, albumin, and clotting.
15. DEFINITION
Peritonitis is an inflammation of the
peritoneum, the tissue that lines the inner wall
of the abdomen and covers and supports
most of your abdominal organs.
17. PRIMARY SPONTANEOUS PERITONITIS
Spontaneous Bacterial Peritonitis (SBP) is development of a
bacterial infection in the peritoneum (Ascites)
SBP occurs in both children and adults and is a well-known and
ominous complication in patients with cirrhosis.
SBP can occur as a complication of any disease state that
produces the clinical syndrome of ascites, such as heart failure
and Budd-Chiari syndrome.
18. Three fourths of spontaneous bacterial peritonitis infections have been
caused by gram-negative aerobic bacilli organisms (Escherichia coli,
Klebsiella spp.). The remainder has been due to aerobic gram-positive
organisms (Streptococcal species)
Risk Factor
Cirrhosis
Kidney failure getting peritoneal dialysis
19. SECONDARY PERITONITIS
Usually develops when an injury or infection in the abdominal cavity allows
infectious organisms into the peritoneum.
Secondary peritonitis has several major causes.
Bacteria may enter the peritoneum through a hole (perforation) in an of the
organ digestive tract. The hole may be caused by a ruptured appendix,
stomach ulcer, or perforated colon. It may also come from an injury, such as a
gunshot or knife wound.
Bile or chemicals released by the pancreas may leak into the abdominal
cavity. This may be caused by sudden swelling and inflammation of the
pancreas.
20.
21. SYMPTOMS OF PERITONITIS
The first symptoms of peritonitis are typically poor appetite and nausea and a dull abdominal ache
that quickly turns into persistent, severe abdominal pain, which is worsened by any movement.
Other signs and symptoms related to peritonitis may include:
Abdominal tenderness or distention
Chills
Fever
Fluid in the abdomen
Not passing any urine, or passing significantly less urine than usual
Difficulty passing gas or having a bowel movement
Vomiting
22. COMPLICATION
A bloodstream infection (bacteremia).
Sequestration of fluid and electrolytes, as revealed by decreased
central venous pressure, may cause electrolyte disturbances, as
well as significant hypovolemia, possibly leading to shock and
acute renal failure.
An infection throughout your body (sepsis). Sepsis is a rapidly
progressing, life-threatening condition that can cause shock and
organ failure.
23. DIAGNOSIS
Blood and urine tests
Imaging studies such as X-rays and computerized tomography
(CT) scans
Exploratory surgery
Paracentesis, a procedure in which fluid from the abdominal cavity
is withdrawn through a thin needle and checked for infection.
24. TREATMENT
Antibiotics : Given a course of antibiotic medication to fight the
infection and prevent it from spreading. The type and duration of
your antibiotic therapy depend on the severity of your condition (If
SBP, use third generation cephalosporin)
Surgery : Surgical treatment is often necessary to remove infected
tissue, treat the underlying cause of the infection, and prevent the
infection from spreading, especially if peritonitis is due to a
ruptured appendix, stomach or colon.
27. DEFINITIONS
the development of severe acute liver injury with
- encephalopathy
- Impaired synthetic function (INR of ≥1.5)
chronic liver failure varies between reports, a commonly used
cutoff is an illness duration of <26 weeks.
28. EPIDEMIOLOGY
In the United States, the US Acute Liver Failure Study Group collected data
on 1147 cases of acute liver failure from 23 sites between 1998 and 2007 .
The most common causes of acute liver failure were
acetaminophen overdose (46 percent)
Indeterminate (14 percent)
Idiosyncratic drug reactions (12 percent)
Hepatitis B virus (7 percent)
Hepatitis A virus (3 percent).
30. PATHOPHYSIOLOGY
He development of cerebral edema is the major cause of morbidity
and mortality in patients with acute liver failure.
The etiology of this intracranial hypertension (ICH) is not fully
understood, but it is considered to be multifactorial.
31. PATHOPHYSIOLOGY
Briefly, hyperammonemia may be involved in the development of
cerebral edema. Brain edema is thought to be both cytotoxic and
vasogenic in origin.
Multisystem organ failure
Hyperdynamic circulatory state that mimics sepsis (low systemic
vascular resistance);
32. PATHOPHYSIOLOGY
Ref: Aquaporin and blood brain barrier. Bonomini F, Francesca B, Rezzani R - Curr Neuropharmacol (2010)
CYTOTOXICD EDEMA AND VASOGENIC EDEMA
34. DIAGNOSIS
Determining the cause of acute liver failure
- History
- Physical examination
- Laboratory evaluation,
- Imaging studies
- Liver biopsy.
35. DIFFERENTIAL DIAGNOSIS:
Acute Decompensation of Cirrhosis
Alcoholic Hepatitis With Underlying Cirrhosis
Autoimmune Hepatitis
Eclampsia
Multiple Organ Dysfunction Syndrome in Sepsis
Preeclampsia
36. CLINICAL MANIFESTRATION
In addition to hepatic encephalopathy, abnormal liver blood tests,
and an INR ≥1.5 (all of which are required for the diagnosis), may
include
Jaundice
Hepatomegaly
Right upper quadrant tenderness
Thrombocytopenia
37. TREATMENT:
Multiple medications may be necessary in patients with acute liver
failure because of the wide variety of complications that may
develop from fulminant hepatic failure.
38. PREVENTION
Reduce your risk of acute liver failure by
Taking care of your liver, for example
Follow instructions on medications
Tell your doctor about all your medicines
Drink alcohol in moderation
Avoid risky behavior and getting vaccination.
