Cirrhosis is severe scarring of the liver caused by prolonged exposure to toxins like alcohol or viral infections. It involves the loss of liver cells and irreversible scarring, disrupting the structure and function of the liver. Common causes include alcoholism, hepatitis viruses, toxins, and biliary obstructions. Symptoms range from fatigue and jaundice to complications like ascites, bleeding disorders, and hepatic encephalopathy. Treatment involves managing symptoms, dietary changes, medications to prevent complications, and sometimes surgery or liver transplantation.
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
Hepatic encephalopathy is one of the deadly complication of liver diseases, occurs due to profound liver failure and from accumulation of ammonia and other toxic metabolites in blood.
Hepatic coma is advanced stage of hepatic encephalopathy.
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.
Hepatic encephalopathy is one of the deadly complication of liver diseases, occurs due to profound liver failure and from accumulation of ammonia and other toxic metabolites in blood.
Hepatic coma is advanced stage of hepatic encephalopathy.
MEANING
Sudden and often temporary loss of kidney function.
DEFINITION
Acute renal failure (ARF) is an abrupt and sudden reduction in renal function resulting in the inability to excrete metabolic wastes and maintain proper fluid & electrolyte balance.
• It usually associated with oliguria (less than 500ml/day), no oliguria (greater than 800ml/day) or anuria (less than 50ml/day).
• BUN &creatinine values are elevated.
Etiology
ARF can be further divided into pre-renal, intra renal and post renal etiologies.
1) Pre- Renal causes
Are those that decrease effective blood flow to the kidney and cause a decrease in the glomerular filtration rate (GFR). Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function.
Volume depletion resulting from:
• Hemorrhage
• Renal losses (diuretics, osmotic diuresis)
• Gastrointestinal losses (vomiting, diarrhea, nasogastric suction)
Impaired cardiac efficiency resulting from:
• Myocardia infraction
• Heart failure
• Dysrhythmias
• Cardiogenic shock
Vasodilation resulting from:
• Sepsis
• Anaphylaxis
• Antihypertensive medications or other medications that cause vasodilation.
2) Intrarenal causes
Refers to disease processes which directly damage the kidney itself. It can be due to one or more of the kidney’s structures including the glomeruli, kidney tubules or the interstitium.
Prolonged renal ischemia resulting from:
• Pigment nephropathy (associated with the breakdown of blood cells containing pigments that in turn occlude kidney structures)
• Myoglobinuria (trauma, crush injuries, burns)
• Hemoglobinreuria (transfusion reaction, hemolytic anemia)
Nephrotoxic agents such as:
• Aminoglycoside antibiotics (gentamycin, tobramycin)
• Radiopaque contrast agents
• Heavy metals (lead, mercury)
• Solvents and chemicals (ethylene glycol, carbon tetrachloride, arsenic)
• NSAIDS
• ACE inhibitors
Infections processes such as:
• Acute pyelonephritis
• Acute glomerulonephritis
3) Post renal causes
Refers to mechanical obstruction of urinary outflow, between the kidney and the urethral meatus, which includes urethral and bladder neck obstruction due to:
Calculi formation
Benign prostatic hyperplasia
Tumors
Strictures
Trauma (to back, pelvis or perineum)
Blood clots
Pathophysiology
The kidneys receive approximately one fourth of cardiac output; therefore, they are very sensitive to alteration in perfusion. Most cases of ARF are caused by ischemia episode. The pathophysiology of ARF is not completely understood.
PrerenalARF, is the result of impaired blood flow that leads to hypo perfusion of the kidney which causes decreased oxygen delivery that leads to hypoxemia and ischemia due to damage the kidney and glomerular filtration rate (GFR) decreases that leads to electrolyte imbalance and increased tubular reabsorption of sodium and water.
Intrarenal ARF is the result of actual parenchymal damage to the glomeruli or kidney
Medical Surgical Nursing - I
UNIT: IV -Nursing Management of Patients With Disorder of Digestive System "Cirrhosis of liver"
the topic covers
- the stages, Pathophysiology and clinical manifestation of Cirrhosis of liver
- diagnostic evaluation and complication of Cirrhosis of liver
- medical, surgical and nursing management of patient with Cirrhosis of liver
INTRODUCTION
Cancer is a general term used to refer to a condition where the body’s cells begin to grow and reproduce in an uncontrollable way. Lung cancers are the fourth most common cancer reported in the Indian males.
DEFINITION
Lung carcinoma is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body.
CAUSES
The most common causes of fracture include,
I. Tobacco smoke
Tobacco use is responsible for more than one of every six deaths. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer.
II. Secondhand smoke
Passive smoking has been identified as a possible cause of lung cancer in nonsmokers. People who are involuntarily exposed to tobacco smoke in a closed environment (house, automobile, and building) have an increased risk of lung cancer when compared with unexposed nonsmokers.
III. Environmental and occupational exposure
Various carcinogens have been identified in the atmosphere, including motor vehicle emissions and pollutants fromrefineries and manufacturing plants. High levels of radon have been associated with the development of lung cancer, especially when combined with cigarette smoking. Chronic exposure to industrial carcinogens, such as arsenic, asbestos, mustard gas, chromates, coke oven fumes, nickel, oil, and radiation has been associated with the development of lung cancer.
IV. Genetics
Some familial predisposition to lung cancer seems apparent, because the incidence of lung cancer in close relatives of patients with lung cancer appears to be two to three times that in the general population regardless of smoking status.
TYPES OF LUNG CANCER:
1. Small cell lung carcinoma
• Accounts for 15%-25% of lung cancers
• It is most malignant form
• Tends to spread early via lymphatic and bloodstream
• Is frequently associated with endocrine disturbances
• Predominantly central and can cause bronchial obstruction and pneumonia.
2. Non-small cell lung carcinoma
Is further classified by cell type,
Adenocarcinoma
• Most common type
• Accounts for approximately 30%-40% of lung cancers
• More common in women
• Often gas no clinical manifestations until widespread metastasis is present
• Usually begins in mucous glandular tissue, is most commonly located in peripheral portions of lungs.
Squamous cell carcinoma
• Second most common type of lung cancer
• Accounts for 30%-35% of lung cancers
• Is more common in men
• Arises from the bronchial epithelium of the lungs or bronchus, slow-growing cancer that usually begins in the bronchial tubes.
Large cell carcinoma
• The least common form
• Accounts for 5%-15% of lung cancers
• Composed of large sized cells that are anaplastic and often arise in the bronchi, commonly causes cavitation
• Is highly metastatic via lymphatic and blood.
STAGING OF NON-SMALL CELL LUNG C
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
2. INTRODUCTION
LIVER CIRRHOSIS is the severe scarring of liver and poor function at last stage of
chronic liver disease scarring is most often Caused by prolonged exposure in toxins.
E.g., alcohol or viral infection, scarring leads to altered liver functions.
5. DEFINITION
CIRRHOSIS IS COMPLICATION OF LIVER DISEASE WHICH INVOLVES LOSS OF
LIVER CELLS AND IRREVERSIBLE SCARING OF LIVER CELLS. IT IS A CHRONIC
DISEASE CHJARACVTERIZED BY REPLACEMENT OR DEGENRATIVE CHANGES IN
NORMAL LIVER CELLS. TISSUE WITH DIFFUSE FIBROSIS AND NODULES THAT
DISTURBS THE STRUCTUREVAND FUNCTION OF LIVER. ALSO SCAR FORMATION.
OCCURS DUE TO DESTROYED HEPATOCYES.
6. TYPES
POST NECROTIC CIRRHOSIS
DUE TO SEVERE INFLAMMATION AND MASSIVE NECROSIS OF HEPATOCYTES
CELLS.
ALCOHOLIC CIRRHOSIS
IT OCCURS DUE TO EXCESSIVE INTAKE OF ALCOHOL THAT LEADS TO
ACCUMULATION OF FAT IN LIVER
BILIARY CIRRHOSIS
DUE TO BILIARY OBSTRUCTION FOR LONG TIME AND CHOLESTATSIS (STOPPAGE
OF FLOW OR GROWTH)
CARDIAC CIRRHOSIS
MAIN CAUSE OF THIS TYPE OF CIRRHOSIS IS RIGHT SIDE CONGESTIVE HEART FAILURE.
8. CLINICAL MANIFESTATIONS/ SIGNS AND SYMPTOMS
EARLY SYMPTOMS DUE TO INFLAMMATION :
- FEVER
- PAIN
- ANOREXIA
- FATIGUE
- NAUSEA
OTHER SYMPTOMS ARE :
- ODEMA
- FOUL SMELL
- YELLOWISH SKIN
- HEPATIC ENCEPHALOPATHY
- LOSS OF SENSORY FUNCTION
- DIFFICULTY IN BREATHING
- INCREASED SERUM NH3 ( AMMONIA ) LEVEL.
- ASCITES
- HYPOALBUMINEMIA
- ABDOMINAL DISTENSION
- INCREASED ABDOMINAL GIRTH
- SPIDER ANGIOMA
9. CONTINUED SIGNS AND SYMPTOMS
IF BILIARY OBSTRUCTION :
- ABSENCE OF UROBILINOGEN IN DIGESTIVE TRACT
- INCREASE SERUM BILIRUBIN LEVEL SO APPEAR DARK COLOUR URINE
- JAUNDICE DUE TO ACCUMULATION OF BILIRUBIN UNDER SKIN.
HORMONAL OBSTRUCTION :
REDUCE ANDROGEN AND ESTROGEN WHICH PRODUCE ABNORMAL MENSES.
- AMENORRHOEA
- LOSS OF BODY HAIR
- GYNECOMASTIA (UPPER SWELLING ON BREAST IN MEN)
BLEEDING DISORDERS :
REDUCE ABSORPTION OF VITAMIN K AND REDUCE SYNTHESIS OF PROTHROMBIN
10. PATHOPHYSIOLOGY
DUE TO ANY CAUSE LIKE ( ALCOHOL ABUSE, MALNUITRITION, INFECTION, DRUGS OR BILIARY
OBSTRUCTION)
DESTRUCTION OF HEPATOCYTES
FIBROSIS / SCAR FORMATION
OBSTRUCTION OF BLOOD FLOW
INCREASE PRESSURE IN VENOUS AND SINUSOIDAL CHANNELS
FATTY INFILTRATION FIBROSIS/ SCARRING
PORTAL HYPERTENSION
11. DIAGNOSTIC EVALUATION
LIVER FUNCTION TEST (LFT)
ASPIRATEW AMINOTRANSFERASE
ALT – ALANINE TRANSFERASE
LDH – LACTATE DEHYDROGENASE
USG – FOR HEPAṬOMEGALY
WBC – (FOR DETERMINATION OF INFECTION )
RBC – (ANEMIA)
LIVER BIOPSY – FNAC (FINE NEEDLE ASPIRATION CYTOLOGY)
SERUM EXAMINATION –
- INCREASE SGOT/SGPT LEVEL
- LOW PROTEIN
- INCRTEASE BILIRUBIN LEVEL RAISED
ABDOMINAL PARACENTESIS ( FOR DETERMINE PUS CELLS BACTERIAL INFECTION OR PROTEIN
COMPONENT IN ACCUMULATED FLUYID
13. MANAGEMENT
MEDICAL MANAGEMENT
MEDICAL M,ANAGEMENT IS BASED ON PRESENTING SYMPTOMS.
- ANTACIDS
- ANTIEMETICS
- VITAMINS AND NUTRITIONAL SUPPLEMENT
- BALANCED DIET
- POTASSIUM SPARRING DIURETICS (FOR ASCITES.) E.G., SPIRONOLACTONE.
- AVOIDANCE OF ALCOHOL
14. DIETARY MANGEMENT
PROVIDE HIGH CALORIE DIET AND LOW LIQUID DIET (800 – 1000 ml/dl )
IN HEPATIC COMA, GIVE LOW PROTEIN AND LOW SODIUM DIET.
PROVIDE ALBUMIN CONTAINING FOOD.
VITAMIN A,D,E,K INCLUDED WITH DIET OF THE PATIENT.
15. SURGICAL MANAGEMENT
PORTAL- CAVAL SHUNT (PORTA CAVAL ANASTOMOSIS)
SPLENORENAL SHUNT (SPLEENORENAL ANASTOMOSIS)
- A SURGICAL TECHNIQUE IN WHICH SPLEEN VEIN IS JOINED TO THE LEFT RENAL
VEIN. (MOSTLY FOR TREATIONG PORTAL HYPERTENSION).
LIVER TRANSPLANTATION
16. NURSING DIAGNOSIS WITH NURSING
MANAGEMENT
ACTIVITY INTOLERANCE RELATED TO FATIGUE AND DISCOMFORT.
Interventions:
-Nurse should encourage patient to take proper rest and need to ambulation.
-Instruct the patient to elevate legs to mobilize edema and ascites
-Encourage for active and passive exercises to patient to promote muscle strength.
-instruct to take nutritional and proper calorific diet to maintain energy level of
patient.
17. Contd...
RISK OF INJURY RELATED TO COAGULOPATHY
Interventions:
-Assess sign of bleeding, observe stools and vomiting for colour,consistency.
-Instruct to avoid or limit activities if sign of bleeding show.
-Administer vitamin K as prescribed.
-Nurse should teach risk preventive measures e.g.,
- #Maintain safe environment
- #Gentle blowing of nose
- #Use of soft toothbrush
-Encourage patient to intake of foods with high vitamin C content.
-Nurse should use small gauze needles for injections and maintain pressure over
puncture site until bleeding stops.
18. Contd...
IMPAIRED SKIN INTEGRITY RELATED TO JAUNDICE.
Interventions:
-Assess and document degree of jaundice of skin and sclera.
-Promote adequate nutrition.
-Assess dietary intake and nutritional status. Encourage the client to adhere to a high
carbohydrate diet with protein intake consistent with that recommended for hepatic
encephalopathy.
-Assess for adequate hydration.
-Instruct patient to keep the incision site or wound site dry for five to seven days and to report
any signs and symptoms of redness pain and drainage if available.
-Encourage physical activity as permitted.
-Teach client importance of skin integrity and its care.
19. Contd...
KNOWLEDGE DEFICIT RELATED TO DISEASE CONDITION.
Interventions:
-Nurse should review underlying cause, disease process and prognosis to the patient.
-Discuss with patient about medication regimen, schedule and possible side effect.
-Instruct to avoid foods cause gastric irritations, eg., chocolate, spicy food, whole grains, raw
vegetables.
-Discuss and identify stress situations and how to avoid them, investigate job related issues.
-Discuss avoidance of NSAIDS, forceful bleeding of nose, straining for Bowel movement,to
reduces risk of bleeding in case of coagulopathy.
-Instruct to eat frequent small meals.
-Provide information for patient to plan for return to usual routine with untoward incidents.
-Nurse should recommend gradual resumption of daily usual activities, and take proper rest
to prevent fatigue and increase feeling of well-being.
20. THANKYOU FOR YOUR ACTIVE LISTENING
AND ATTENTION..
IF ANY QUERY REGARDING THE TOPIC
KINDLY ASK….
The End.