Strangulated intestinal obstruction is a relatively common type of acute abdomen and requires urgent surgical treatment. The causes of strangulated intestinal obstruction are many including primary volvulus, hernias, adhesions, bands, and intussusceptions.
Strangulated intestinal obstruction is a relatively common type of acute abdomen and requires urgent surgical treatment. The causes of strangulated intestinal obstruction are many including primary volvulus, hernias, adhesions, bands, and intussusceptions.
These presentation is related to biliary disorders. it is simple and concise presentation and provide all information about the biliary disease. i hope this presentation fulfill your requirements and should be useful.
Elimination is the expulsion of waste products from the body through the skin ,lungs, kidneys and rectum Urinary elimination is the removal of waste products from the body through the urinary system(urine)
Fármacos usados na psiquiatria com interesse mesicoBasilio4
Falar de psicofármacos é falar das drogas usadas no sentido de melhorar todas as alterações psiquiatra , neste óptica é imperioso que todo o psiquiatra conheça dessas drogas pois são imperioso em todas as intervenções do dia pois dia ,está palestra fornece um resumo dessas drogas para o proficional assim como estudante. Para melhor compreender esse fármacos recomendamos para visitar as referências bibliograficaa acima mensionada
These presentation is related to biliary disorders. it is simple and concise presentation and provide all information about the biliary disease. i hope this presentation fulfill your requirements and should be useful.
Elimination is the expulsion of waste products from the body through the skin ,lungs, kidneys and rectum Urinary elimination is the removal of waste products from the body through the urinary system(urine)
Fármacos usados na psiquiatria com interesse mesicoBasilio4
Falar de psicofármacos é falar das drogas usadas no sentido de melhorar todas as alterações psiquiatra , neste óptica é imperioso que todo o psiquiatra conheça dessas drogas pois são imperioso em todas as intervenções do dia pois dia ,está palestra fornece um resumo dessas drogas para o proficional assim como estudante. Para melhor compreender esse fármacos recomendamos para visitar as referências bibliograficaa acima mensionada
está palestra é útil para que quer perceber melhor sobre fibrose endomiocardica ,está é uma patologia muito comum aqui em África e ainda há escacez de informações sobre a causa apenas é associado com o consumo da mandioca
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
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.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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.
6. Cherry stones
Enteroliths:
an intestinal calculus formed of layers of
minerals salts surrounding a nucleus of
some hard body suche as a swallod fruit
stone or otehr indigestibl substance
15. ADYNAMIC ILEUS
Factors implicated
in the development
and persistence of
ileus
• Neurogenic: spinal cord lesione or injury
retroperitoneal process
ureteral colic
Parkinson’s disease
• Metabolic: hypokalemia
uremia
Ca⁺⁺, Mg⁺⁺ imbalance
hipothyroidism
diabetic coma or ketoacidosis
• Pharmacologic: opiates
neuroletic medications
anticholinergics
calcium channel blockers
• Infectius: peritonitis
pneumonia
tetanus
bacterial overgrowth of bowel
herpes zoster
• Laparotomy
CAUSES
16. Pathophysiology
• Intestinal gas accumulation
• Intraluminal fluid accumulation
• Intestinal flora alteration
• Changes in intestinal blood flow
• Changes in intestinal motility: mechanical ileus , at first increase of intestinal and
contractile activity; later progressive decrease of
peristatic activity
adynamic ileus, from the beginning progressive
deacrease of peristaltic activity
INTESTINAL OCCLUSION
17. • bacterial endotoxins ↑ fluid intraluminally
• ↑ secretory stimulation of the intestinal mucosa
• ↓ absorptive activity of the intestinal mucosa
• ↑ intraluminal distention and pressure
• ↓ myolectrical function of the gut
• Electrolyte imbalance : ↓ Natremia
↓ Cloremia
↓ Kalaemia
promote decrease of peristaltic activity
atony of the wall
Funcional obstruction
18. Clinical presentation
• ABDOMINAL PAIN
• VOMITING
• OBSTIPATION (inability to pass gas o stool)
• ABDOMINAL DISTENSION
• DEHYDRATION
INTESTINAL OCCLUSION
19. ABDOMINAL PAIN
Mechanical ileus
Adynamic ileus
At first
Intermittent
Colicky
Intense
Related to peristalsis*
After
Continuous with fresh outbreak
Gradual disappearance
(progressive decrease
of peristaltic activity)
* Intestinal motility increase to propel luminal contents
Less intense and
vague
severe evolution
20. VOMITING:
Present in mechanical and adynamic ileus
Mechanical ileus
Obstruction in proximal small bowel : early and bilious
Obstruction in distal small bowel and colon: late and progressively feculent
Vomiting is earlier in higher obstruction, late in distally obstruction
21. OBSTIPATION
(inability to pass gas o stool)
Mechanical ileus
Total retention of gas and stools.
Total or partial retencion of gas and
stool for emptying dowenstream of
the obsturction
Adynamic ileus
22. ABDOMINAL SIGNS
Abdominal distention.
Absent peristaltic sounds
(silent abdomen).
Hyperresonance to percussion.
Adynamic
tinkling bowel sounds
silent abdomen
severe situation
Mechanical ileus
Abdominal distention.
Hyperresonance to percussion.
23. Abdominal examination should be undertaken, with
careful inspection of the entire abdomen and inguino-
femoral region for signs of either surgical scars or
hernia.
Digital rectal examination may
reveal an anal or rectal tumor or
impacted feces
Never forget
31. Ogilvie’s Syndrome
(acute colonic pseudo-obstruction)
It is a clinical entity in which signs and symptoms of bowel
obstruction are present without an actual mechanical obstruction
Symptoms: abdominal distension
pain
nausea and vomiting
obstipation
or
50% flatus or diarrhea
peritonitis, if perforated only (luminal diameter of colon > 10 -12 cm)
At first non operative treatment: nasogstric tube
correction of fluid and electrolyte imbalances
rectal tube
Neostigmina administration
Usually resolves in more than 75% of cases
May occur in hospitalized patient
with severe illness , after surgery
or in metabolic imbalance
32. Mechanical intestinal obstruction
TREATMENT
• Nasogastric tube: decompression
• Intravenous fluid : isotonic saline solution, lactated Ringer’s
+ potassium chloride if needed
• Urine moritoring : Foley catheter
• Central venosus assessment : in severe dehydration
• Broad-spectrum antibiotics
Non operative management
Operative management
Vigilant management of fluid and electrolyte status
33. Abdominal disconfort, distention, constipation
Steady pain Colic
Absent bowel sounds Active bowel sounds
X-ray nonspecific X-ray, air-fluid levels
Suspect adynamic ileus Suspect mechanical obstruction
(mechanical ileus)
Especting observation
Intravenous fluids, nasogstric tube, serial evalustions
Improvement No change Deterioration
Clamp tube Not tolerated Colic
White blood cells
Mass
Tenderness
Tolerated, passes flatus Continued expectant
and stool management
Nasogastric tube removed Gradual Non resolution Laparotomy
Diet advanced evolution
34. Bibliography
• http://www.radiologytutorials.com/main.cgi?tut=/main.cgi&frame=main&tt=1&t=135&s=2
• Lazar J. Greenfield, Micheal W. Muholland, Keith T. Oldham, Gerald B. Zelenock, Keith D. Lillemoe ,
SURGERY, Scientific principles and practice, third edition, Lippincott Williams & Wilkins Ed. 2001,
Philadelphia, USA
• C. M.Townsend, R. D. Beauchemp, B. M. Evers, K. L. Mattox, Sabiston Textbook of surgery, 18th Ed., 2008-
Philadelphia
• https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-20351460
• https://www.researchgate.net/figure/Surgical-findings-in-a-patient-with-gallstone-ileus-A-An-impacted-
gallstone-was-found_fig2_291421810
• https://www.pedsradiology.com/Historyanswer.aspx?qid=47&fid=1
• https://medical-dictionary.thefreedictionary.com/enterolith
• https://www.everydayhealth.com/crohns-disease/symptoms/dealing-with-strictures-in-crohns-disease/
• https://viverepiusani.it/cosa-bisogna-sapere-sul-cancro-al-colon/
• https://www.unmedicopertutti.it/cancro_colon.htm
• https://pmj.bmj.com/content/75/887/559
• http://www.gastrosurgery.co.uk/intestinal-adhesions-treatment-london/
• I. lópez blasco, S. Paz Maya, D. Soriano Mena, J. P. Ruiz
• Gutierrez, A. Llanes Rivada, D. Dualde-Beltrán, R. Dosdá-Muñoz,J. Palmero; Valencia/ES, How to diagnose a
bezoar: imaging findings in CT, European Society of Radiology – electronic presentation
• Merck Manual - https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-
and-surgical-gastroenterology/intestinal-obstruction