Hydatid cyst of the liver, also known as echinococcosis, is caused by the larval stage of the Echinococcus tapeworm. Humans can become infected by ingesting tapeworm eggs from infected animal feces. The parasite then develops into a hydatid cyst in the liver or lungs. A hydatid cyst grows slowly and can reach a large size, sometimes replacing an entire liver lobe. It consists of an outer layer (ectocyst) and inner layer (endocyst) that produces cyst fluid and daughter cysts. Rupture of the cyst can lead to spread of the parasite within the abdomen or chest. Imaging such as ultrasound and CT are important for diagnosis and show cyst
Hydatid cyst of the liver is very rare problem in the urban population of INDIA. However, we must know the disease its presentation, the review of literature for the same and its management with current updates.
Hydatid cyst disease of the liver الدكتور طارق المنيزل Tariq Al munaizel
A comprehensive lecture about the hydatid cyst disease of the liver including the parasite life cycle, infection, clinical presentation, complications, diagnosis , medical and surgical treatment.
Gastric Perforation From Peptic Ulcer Disease - A Review of the Surgical Trea...Joseph A. Di Como MD
A PowerPoint presentation reviewing gastric perforation for peptic ulcer disease and a review of the surgical treatment options. Intended for medical professionals and students.
Surgical management of hepatic hydatid diseaseKETAN VAGHOLKAR
Hydatidosis is strictly a zoonosis. Humans are an accidental host. The disease is endemic in rural agricultural areas. However if acquired by humans, it can cause extensive spread affecting a wide range of organs with predilection for the liver. Managing such cases requires a sound fundamental knowledge of the parasite and its pathogenicity. It is essential that surgeons who deal with such cases have a good working knowledge of the disease. The approaches to hepatic hydatids with respect to the principles of surgical treatment are presented in this article.
A concise revision on the pathology and current management of liver hepatic cysts and abscesses. Being a copy of seminar presentation I for the HepatoPancreaticoBiliary Unit of the Division of General Surgery, Ahmadu Belllo University Teaching Hospital, Zaria.
Hydatid cyst of the liver is very rare problem in the urban population of INDIA. However, we must know the disease its presentation, the review of literature for the same and its management with current updates.
Hydatid cyst disease of the liver الدكتور طارق المنيزل Tariq Al munaizel
A comprehensive lecture about the hydatid cyst disease of the liver including the parasite life cycle, infection, clinical presentation, complications, diagnosis , medical and surgical treatment.
Gastric Perforation From Peptic Ulcer Disease - A Review of the Surgical Trea...Joseph A. Di Como MD
A PowerPoint presentation reviewing gastric perforation for peptic ulcer disease and a review of the surgical treatment options. Intended for medical professionals and students.
Surgical management of hepatic hydatid diseaseKETAN VAGHOLKAR
Hydatidosis is strictly a zoonosis. Humans are an accidental host. The disease is endemic in rural agricultural areas. However if acquired by humans, it can cause extensive spread affecting a wide range of organs with predilection for the liver. Managing such cases requires a sound fundamental knowledge of the parasite and its pathogenicity. It is essential that surgeons who deal with such cases have a good working knowledge of the disease. The approaches to hepatic hydatids with respect to the principles of surgical treatment are presented in this article.
A concise revision on the pathology and current management of liver hepatic cysts and abscesses. Being a copy of seminar presentation I for the HepatoPancreaticoBiliary Unit of the Division of General Surgery, Ahmadu Belllo University Teaching Hospital, Zaria.
Hamster - Bacterial, Viral, Mycotic, Parasitic and Non infectious diseasesRakshith K, DVM
There are approximately 25 different hamster species worldwide.
In labs: Syrian or golden hamster (Mesocricetus auratus) and Chinese or gray hamster (Cricetulus griseus)
Hamsters possess buccal pouches, which extend dorsolaterally from the oral cavity on either side of the shoulder region.
Bacterial diseases: Proliferative ileitis, Clostridial diseases, Tyzzers disease, Salmonellosis, Campylobacter jejuni, Escherichia coli, Yersiniosis, Respiratory disease, Mastitis, Abscess, Mycotic infection, Viral diseases, Parasitic diseases and Non infectious diseases.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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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
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
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- 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
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
3. Echinococcosis (hydatidosis, hydatid
disease)
• Zoonosis
• Organism- larval (metacestode) stages of cestodes (flat worms)
• genus -Echinococcus
• family -Taeniidae
• Definitve host-carnivores
• animals are both intermediate and definitive hosts
• Humans are the accidental intermediate host (dead end)
4. • The first North American case was observed in
1808 and published in 1822. The true nature of
the disease was not known until the second
half of the 19th century.
5. • There are three known forms of echinococcosis in humans:
• (i) cystic echinococcosis (hydatid disease) caused by
Echinococcus granulosus,
• (ii) alveolar echinococcosis (alveolar hydatid disease) caused
by Echinococcus multilocularis, and
• (iii) polycystic echinococcosis caused by Echinococcus vogeli
or Echinococcus oligarthus
6.
7. Humans are an accidental, intermediate host and become infected when they
accidentally ingest eggs of the tapeworm
• The eggs hatch in the duodenum, and the released oncosphere penetrates
the mucosa and reaches a blood vessel
• most frequently settles in the liver and lungs
• the parasite develops its larval stage, the hydatid cyst, the clinical
presentation of E. granulosus
• The cyst is a chronic, well-localized, and adapted space-occupying
affliction that is not affected by the functional status of the host
8.
9.
10. Pathology
• By 21 days becomes visible with with naked eye
• Host tissue response- ecases parasite in fibous tissue
• Parasite responds by forming inert chitinous material
• 5 month- pericyst Avascular
Spaces within contains BV, Bile
ducts
integral part of both the liver
and the parasite
Difficult to remove
from liver
11. • Parasite can be separated by ectocyst
• H. cyst
– Unilocular
– Increases size about 1 to 1.5mm/month
– Fluid is under pressure
– Liters of fluid
Pathology
12. The fully developed wall of the cyst consists of
two layers
Ectocyst (laminated membrane)
• is a cuticular chitinous
structure without nuclei
• never grows thicker than 5
mm, regardless of cyst size.
Endocyst (germinative )
• microscopic dimensions
• responsible for the
production of the
– crystal-clear hydatid fluid
– ectocyst
– brood capsules
– scoleces
– the daughter cysts
Pathology
14. • Daughter cyst formation is considered a defense reaction Endogenic
vesiculation
• Daughter cysts are true replicas of the mother cyst.
• The presence of daughter cysts is a problem for chemotherapy,
protoscolicide activity, and the standard PAIR procedure
Ectogenic vesiculation of E. granulosus is infrequent.
• It occurs when there is a small rupture or defect in the ectocyst and the
endocyst passes through
Pathology
15. • Hydatid fluid is antigenic
• This antigenicity is rarely of great clinical significance
• Allergic reactions range from skin rash to a frank anaphylactic
reaction
• The antigenicity of hydatid fluid is the basis of serodiagnostics
Pathology
16. Clinical Presentation of Liver Hydatid
Cysts
• depend on the site, size, number, vitality, and stage of
development of the cyst.
• Simple, uncomplicated liver hydatid cysts usually
asymptomatic or present with nonspecific symptoms
• Complicated liver hydatid cysts cause specific symptoms and
signs
18. Suppuration and Secondary Bacterial
Infection
• most frequent cause of infection is a cystobiliary
communication
• Clinically presents at pyogenic liver abscess
• An infected hydatid cyst undergoes structural changes and the
parasite dies
• incidence in the literature ranges from 11.0% to 27.1
19. Pressure Effects
• grow in the direction of the least resistance
• Pressure effects appear sooner or later
• symptoms result from direct pressure or distortion of
neighboring structures or viscera.
• An enlarging cyst
– atrophy of surrounding hepatocytes
– fibrosis
– compensatory hypertrophy of the remaining liver parenchyma
– replaces an entire liver lobe
20. • Serious consequence of cyst enlargement
Rupture
• Three types of cyst rupture have been addressed:
– obscure
– free
– communicant rupture
21. Obscure (Internal) Rupture
Injury or penetration of bile between pericyst and ectocyst
Ruptue of ectocyst
Protoscolesces occupies spaces
Develops 100s of daughter cyst
Unilocular multilocular
22. Such multilocular cyst when surgically opened
No ectocyst
Floating 100s of daughter cyst
Within yellow fluid of gelatin like amorphous mass inside
pericyst
Obscure Rupture
23.
24. Clinical significance of multivesicular cysts
• host is exposed to hydatid antigens in the hydatid fluid
• cyst is bacteriologically sterile
• cyst contents cannot be easily aspirated and needs to be
scooped out
• the cyst must be treated as viable and infective
• bile stained cyst contents mandates a meticulous search for
CBC
Obscure Rupture
25. Not all multivesicular cysts have bile-stained fluid,
and not all
cysts with bile-stained fluid have active communications with the
bile ducts
Obscure Rupture
27. Free Rupture
In free rupture, the hydatid contents disseminates throughout the
peritoneal or pleural cavity
28. Intraperitoneal Rupture
• Hydatid cyst grows in the direction of the least resistance
• superficial portion of the pericyst is stretched, thinned out
• cyst irregularly shaped, fibrous whitish structure
protruding from normal liver parenchyma
• Cysts reaching the anterior and inferior part of the liver
continue to grow, protruding into the abdominal cavity
• high intracystic pressure causes rupture
of both univesicular and multivesicular
cysts
29. Clinical presentations of intraperitoneal rupture
• (i) In acute symptomatic rupture,
– peritoneal irritation and acute abdominal symptoms occur
– The incidence is about 1% to 4%.
• (ii) In anaphylactic shock
– rupture precipitates severe circulatory collapse, which
may be fatal mask the abdominal manifestations
• (iii) In silent rupture, the patient presents with disseminated
abdominal hydatidosis, unaware when the rupture occurred
30. (iv) Herniation of the laminated membrane occurs through the adventitial
pericyst
The herniating membrane does not actually burst and therefore no spillage
of hydatid debris occurs
The initial liver cyst remains small
although the
herniated, extrahepatic portion of the cyst can attain a volume of several
liters
– This condition mimics ascites, and attempts at percutaneous aspiration
can lead to allergic manifestations
Intraperitoneal Rupture
31. • Intraperitoneal rupture is a life-threatening complication that
results in secondary echinococcosis
• •Multiple cysts develop throughout the peritoneal cavity
causing
– intestinal obstruction,
– gross abdominal distention,
– ascites,
– and cachexia several years after the rupture.
• This is the secondary, smaller life cycle for the parasite,
occurring only in the intermediate host.
Intraperitoneal Rupture
32. Intrathoracic Rupture
• Elevated hemidiaphragm and a sterile sympathetic pleural effusion can
be the first signs of liver hydatid disease
• Upward extension of a subdiaphragmatic cyst is usually asymptomatic,
although it can cause dry cough, dyspnea, chest pain, and toxemia
• The pleura and adherent basal lung segments often become inflamed
and indurated
• Frank intrapleural rupture with empyema (hydatopiothorax) is rare
• pneumonitis or lung abscess
33. • The hydatid cyst may erode into a bronchiole and the contents
can be evacuated
• Rupture into bronchiole daughter cysts in the sputum
• Ocassionally a bronchobiliary fistula will arise
Expectoration of bile-tinged sputum
• The incidence of diaphragmatic or transdiaphragmatic
thoracic involvement by hydatid cysts in the dome of the liver
ranges from 0.6% to 16%
Intrathoracic Rupture
34. Communicant Rupture
Hydatid cysts can rupture into physiologic
channels (e.g., biliary, blood vessels) or
adjacent organs (e.g., digestive tract)
35.
36. • In silent rupture, bile leaks from eroded small ducts into the
cyst, causing
– endogenic vesiculation
– suppuration
– eventually death of the parasite
• Such cysts are filled with bile-stained detritus, although no
visible bile duct communications can be seen.
• Probably 80% to 90% of hydatid cyst bile duct ruptures are of
the silent type.
Communicant Rupture
37. • A triad of symptoms characterizes rupture into the bile ducts:
I. biliary colic
II. partial intermittent or complete ductal obstruction with
cholangitis and jaundice
III. germinative membranes in the feces.
Communicant Rupture
38. • The rapid discharge of the cyst contents into a major bile duct or
body cavity can lead to the sudden absorption of the hydatid antigen
in a sensitized patient, resulting in anaphylaxis.
• More frequently, pruritus or urticarial rash is the major external
manifestation.
Episodes of asthma have been reported.
Communicant Rupture
39. Organ Imaging in the Diagnosis and Treatment
of Hydatid Disease
•X-ray
• Limited value
• In endemic areas, elevation of the right hemidiaphragm in an
otherwise healthy, asymptomatic patient is highly indicative of
liver hydatidosis
• Sometimes streaklike or round calcification of a senile hydatid
cyst.
40.
41. Ultrasound Imaging
• readily available and easy to master
• comparatively cheap, noninvasive, enables
interventional procedures
42. • Pathognomonic US diagnostic features are
I. unmistakable daughter cysts (rosettes•) within the main cyst
cavity
II. detachment of the membrane of the cyst (double-contoured
membrane)
III. agglomeration of daughter cysts in the dependent portion of a
hydatid cyst
IV. calcification of the cyst wall
Ultrasound Imaging
43. • Based on US signs, Hassen Gharbi in 1981 classified liver
hydatid cysts into five types
I. pure fluid collection
II. fluid collection with a split wall
III. fluid collection with septa
IV. heterogeneous appearance, and
V. reflecting thick walls
– Gharbi cyst types II and III as well as type V calcified cysts
are characteristic for liver cystic hydatid disease.
Ultrasound Imaging
46. 1/3rd sterile 2/3rd fertile
½ secndry cyst
Wait and watch
Further differential
diagnosis
Chemotherapy
Surgery
PAIR
Chemotherapy
Active cysts (type CL, CE 1, CE 2)
No cyst wall
Hydatid sand
rossette
Management options
47. living protoscoleces can exist
and
all treatment options should be considered
Irregular wavy nature of
fluid level produced by
collapsed hydatid
membrane floating on top
of residual hydatid fluid
Degenerating (transitional state) cysts (type CE 3)
49. CT Scan
• CT yields the most accurate information regarding the number,
position, and cyst characteristics as well as the extent of intra-
abdominal disease.
• Discontinuity of the cyst wall in the vicinity of bile ducts is
highly suggestive of CBC
50. ERCP
• ERCP has little value in asymptomatic patients and
should be avoided
• Indications for endoscopic papillotomy in the
preoperative period are
1. when US, CT, or ERCP detect hydatid material in the
CBD
2. when cholangitis has been a feature of the clinical
presentation, regardless whether a CBC is detected
51. indications for endoscopic papillotomy in the
postoperative period are
1. hydatid material in the CBD
2. a biliary fistula lasting longer than 3 weeks
3. high-output biliary fistula (more than 1,000 mL per 24 hours)
4. Jaundice
5. short stricture obstructing the papilla
Critical use of ERCP and papillotomy in patients with CBC has reduced
mortality and in-hospital stay
52. References
• Mastery of surgery
• Sabiston text book of surgery
• Schwartz text book of surgery
53. Next presentation on..
• Medical Management
• Minimally Invasive techniques (PAIR)
• Various Surgical Modalities of management