Intussusceptions in adults
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Intussusceptions occur when one segment of the gastrointestinal tract telescopes inside an adjacent segment. While rare in adults, intussusceptions account for 5% of bowel obstructions and have an identifiable underlying disorder in 90% of cases. Symptoms include abdominal pain, nausea, vomiting and bleeding, while diagnostic tools include abdominal CT, x-rays and ultrasound. Treatment involves surgical resection of the involved segment. Prognosis depends on the cause, with mortality rates varying from 8.7% for benign lesions to 52.4% for malignant cases.
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Intususseption in adults
1. The patient presented with multiple jejuno-jejunal intussusceptions that were reduced laparoscopically. No lesion was identified.
2. Differential diagnoses include small bowel tumors, Meckel's diverticulum, Crohn's disease, or metastatic lesions. Further imaging with MRI or capsule endoscopy is recommended to rule out small bowel polyps before resection.
3. Transient intussusception can occur in conditions that alter GI motility like Crohn's disease or celiac disease. Aggressive resection should be avoided to prevent short bowel syndrome.
omphalocele and gastroschisis
This document discusses the embryology, diagnosis, and treatment of two congenital abdominal wall defects: gastroschisis and omphalocele.
Gastroschisis results from a failure of the lateral body folds to migrate, causing intestines to protrude through an abdominal wall defect to the right of the umbilicus. Prenatal ultrasound can diagnose it by 20 weeks. Treatment involves either primary closure or staged closure using a silo.
Omphalocele occurs when organs fail to return to the abdominal cavity during development, causing them to remain in the umbilical cord. It can involve liver and intestines protruding in a sac. Treatment options depend on size and may include immediate or staged
Intussusception in adults
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
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Intussusception in adults
Adult intussusception is rare, accounting for 1% of small bowel obstructions. It is usually caused by an underlying pathological lead point like a tumor. CT imaging is the most sensitive test for diagnosis and can identify potential lead points. Presenting symptoms are nonspecific like abdominal pain but complications from delay in diagnosis or treatment include bowel ischemia, perforation and sepsis. Surgical intervention is usually required for definitive treatment and pathology diagnosis given the high incidence of malignancy as the lead point.
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Intussusception
This document provides information on intussusception in children. It discusses that intussusception is the telescoping of one segment of intestine into another and is most common in children under 1 year old. It can be idiopathic or have a pathological lead point such as Meckel's diverticulum. Diagnosis is usually made clinically or with ultrasound or contrast enema. Treatment involves non-operative reduction with hydrostatic or pneumatic enema, which has a high success rate. Surgery is needed if reduction fails or there are complications like perforation. Prognosis is generally excellent with prompt treatment.
Intussusception
A 30-year-old female presented with acute left abdominal pain and nausea. Imaging showed an intussusception, which is when a segment of bowel invaginates into another segment, often causing obstruction. Intussusception is most common in children under 2 years old and is frequently idiopathic, while in adults it is often due to an underlying cause like tumors. Computed tomography is the most accurate way to diagnose intussusception based on its characteristic appearance.
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Intususseption in adults
1. The patient presented with multiple jejuno-jejunal intussusceptions that were reduced laparoscopically. No lesion was identified.
2. Differential diagnoses include small bowel tumors, Meckel's diverticulum, Crohn's disease, or metastatic lesions. Further imaging with MRI or capsule endoscopy is recommended to rule out small bowel polyps before resection.
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This document discusses the embryology, diagnosis, and treatment of two congenital abdominal wall defects: gastroschisis and omphalocele.
Gastroschisis results from a failure of the lateral body folds to migrate, causing intestines to protrude through an abdominal wall defect to the right of the umbilicus. Prenatal ultrasound can diagnose it by 20 weeks. Treatment involves either primary closure or staged closure using a silo.
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Intussusception in adults
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
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Intussusception in adults
Adult intussusception is rare, accounting for 1% of small bowel obstructions. It is usually caused by an underlying pathological lead point like a tumor. CT imaging is the most sensitive test for diagnosis and can identify potential lead points. Presenting symptoms are nonspecific like abdominal pain but complications from delay in diagnosis or treatment include bowel ischemia, perforation and sepsis. Surgical intervention is usually required for definitive treatment and pathology diagnosis given the high incidence of malignancy as the lead point.
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This document discusses tumors of the appendix. It outlines different types of appendix tumors including mucocele, primary adenocarcinoma, cystadenocarcinoma, and carcinoid tumors. Mucocele occurs when the appendix lumen becomes blocked, causing a fluid-filled cyst. Ruptured mucocele or adenocarcinoma can lead to pseudomyxoma peritonei, where mucus accumulates in the abdominal cavity. Carcinoid tumors are the most common appendix tumors but are generally not aggressive. Management depends on tumor type but often involves surgical removal of the appendix or part of the colon.
Intussusception
This document provides information on intussusception in children. It discusses that intussusception is the telescoping of one segment of intestine into another and is most common in children under 1 year old. It can be idiopathic or have a pathological lead point such as Meckel's diverticulum. Diagnosis is usually made clinically or with ultrasound or contrast enema. Treatment involves non-operative reduction with hydrostatic or pneumatic enema, which has a high success rate. Surgery is needed if reduction fails or there are complications like perforation. Prognosis is generally excellent with prompt treatment.
Intussusception
A 30-year-old female presented with acute left abdominal pain and nausea. Imaging showed an intussusception, which is when a segment of bowel invaginates into another segment, often causing obstruction. Intussusception is most common in children under 2 years old and is frequently idiopathic, while in adults it is often due to an underlying cause like tumors. Computed tomography is the most accurate way to diagnose intussusception based on its characteristic appearance.
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Intussusception
Intussusception is the telescoping of one segment of the intestine into another. It occurs more commonly in children between 6 months and 2 years of age and is often caused by viral gastroenteritis leading to mucosal edema and lymphoid hyperplasia. In adults, intussusception usually has an identifiable anatomical lead point such as a tumor, polyp, ulcer, or Meckel's diverticulum. Symptoms include abdominal pain, vomiting, and bloody stools. Diagnosis can be made using imaging studies like ultrasound, X-ray, or barium enema which may show signs like a target or meniscus.
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2. They are classified into 5 types based on location and extent of dilation.
3. Presentation varies from jaundice and abdominal mass in children to pain and cholangitis in older patients.
4. Investigation involves ultrasound, CT, MRCP and cholangiography to determine type and rule out complications.
5. Treatment is complete excision of the cysts and biliary tree with Roux-en-Y hepaticojejunostomy, except for type III which can be managed endoscopically.
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Intussusception is the telescoping of one part of the intestine into another part and is most common in children under 2 years old. The classic presentation includes intermittent abdominal pain, a sausage-shaped abdominal mass, and currant jelly stools. Ultrasound is the preferred diagnostic method and shows a target or "doughnut" sign. Treatment involves rehydration and antibiotics if infected. Non-operative reduction using hydrostatic or pneumatic pressure is usually attempted first but surgery may be needed if reduction fails or there are signs of perforation or necrosis. With prompt diagnosis and treatment, mortality from intussusception is less than 1%.
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Intussusception is the telescoping of the proximal bowel inside the distal bowel. It is a common cause of bowel obstruction in infants and toddlers. The classic presenting symptoms are known as the "triad" - crying, currant jelly stools, and a palpable abdominal mass. Ultrasound is the primary diagnostic tool, showing target or doughnut signs. Treatment involves hydrostatic or pneumatic reduction of the intussusception non-operatively. If this fails or signs of perforation are present, surgical reduction or resection is required.
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Intussusception is the most common acute abdominal disorder of early childhood. In this lecture, we describe the manifests of Intussusception, the diagnosis, and the treatment of this disease.
Intussusception
Intussusception is the telescoping of one segment of the intestine into another. It occurs more commonly in children between 6 months and 2 years of age and is often caused by viral gastroenteritis leading to mucosal edema and lymphoid hyperplasia. In adults, intussusception usually has an identifiable anatomical lead point such as a tumor, polyp, ulcer, or Meckel's diverticulum. Symptoms include abdominal pain, vomiting, and bloody stools. Diagnosis can be made using imaging studies like ultrasound, X-ray, or barium enema which may show signs like a target or meniscus.
Choledochal cyst
1. Choledochal cysts are abnormal dilations of the bile ducts that are more common in Asia and women.
2. They are classified into 5 types based on location and extent of dilation.
3. Presentation varies from jaundice and abdominal mass in children to pain and cholangitis in older patients.
4. Investigation involves ultrasound, CT, MRCP and cholangiography to determine type and rule out complications.
5. Treatment is complete excision of the cysts and biliary tree with Roux-en-Y hepaticojejunostomy, except for type III which can be managed endoscopically.
Stoma
An intestinal stoma is an artificial opening in the abdominal wall that connects the intestinal tract to the outside of the body. There are different types of stomas including ileostomies, colostomies, and urostomies. Ileostomies divert small intestine contents and have a liquid effluent that is discharged continuously. Colostomies divert large intestine contents and have solid, intermittent effluent. Stomas can be temporary or permanent depending on the clinical situation and are constructed in different ways including as an end stoma or loop stoma. Proper stoma care and use of appliances is important for managing stomas.
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Intussusception is the telescoping of one part of the intestine into another part and is most common in children under 2 years old. The classic presentation includes intermittent abdominal pain, a sausage-shaped abdominal mass, and currant jelly stools. Ultrasound is the preferred diagnostic method and shows a target or "doughnut" sign. Treatment involves rehydration and antibiotics if infected. Non-operative reduction using hydrostatic or pneumatic pressure is usually attempted first but surgery may be needed if reduction fails or there are signs of perforation or necrosis. With prompt diagnosis and treatment, mortality from intussusception is less than 1%.
GASTRIC OUTLET OBSTRUCTION
Gastric outlet obstruction is caused by benign or malignant diseases that obstruct gastric emptying. Common benign causes include peptic ulcer disease while pancreatic cancer is a frequent malignant cause. Patients experience nausea, vomiting and weight loss. Diagnosis involves distinguishing functional from mechanical causes and identifying the underlying etiology. Treatment focuses on rehydration and correcting metabolic abnormalities as well as addressing the mechanical obstruction through endoscopic or surgical interventions.
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This document discusses different types of intestinal atresia, which is a complete blockage in the intestine. It describes pyloric, duodenal, jejunoileal, and colonic atresia. Pyloric atresia involves an obstruction at the stomach-duodenum junction. Duodenal atresia occurs in 1 in 2,500 births and often involves other abnormalities. Jejunoileal atresia can be classified into different types depending on the location and severity of the blockage. Colonic atresia is rare and may involve dilation of the colon. Diagnosis is often made through prenatal ultrasound or abdominal x-ray. Treatment involves surgery to remove blockages and re
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This document provides an overview of splenic injuries, including epidemiology, anatomy, evaluation, management, and guidelines. Key points include:
- The spleen is the most commonly injured organ in blunt abdominal trauma. Evaluation involves clinical exam, hematology tests, ultrasound, and CT scan to grade injuries.
- Management depends on hemodynamic stability and injury grade. Options include non-operative management with observation or angioembolization, or splenectomy/splenorrhaphy during surgery.
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Intussusception is the telescoping of the proximal bowel inside the distal bowel. It is a common cause of bowel obstruction in infants and toddlers. The classic presenting symptoms are known as the "triad" - crying, currant jelly stools, and a palpable abdominal mass. Ultrasound is the primary diagnostic tool, showing target or doughnut signs. Treatment involves hydrostatic or pneumatic reduction of the intussusception non-operatively. If this fails or signs of perforation are present, surgical reduction or resection is required.
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Gastric outlet obstruction (GOO) is caused by any disease process that mechanically impedes gastric emptying. Common benign causes include peptic ulcer disease and gastric polyps, while pancreatic cancer is the most common malignant cause. GOO presents with non-bilious vomiting, weight loss, and dehydration. Management involves resuscitation with IV fluids and correcting metabolic abnormalities, then treating the underlying cause surgically if medical management fails or for palliation of malignant obstructions. Diagnosis in resource-limited areas relies on clinical exam findings, while challenges include limited imaging and laboratory resources.
Testicular torsion/ Torsion of testes
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
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This document discusses rectal prolapse and various surgical treatments. It provides details on:
1) Types of rectal prolapse including full thickness, mucosal, and internal prolapse.
2) Common anatomical abnormalities that can cause rectal prolapse like a deep pouch of Douglas or lax muscles.
3) Investigations used to evaluate rectal prolapse like imaging, sigmoidoscopy, and manometry.
4) Goals of treatment include controlling the prolapse, restoring bowel function and continence, and preventing recurrence.
5) Numerous surgical procedures are described ranging from perineal to abdominal approaches, with recurrence rates varying from 0-38% depending on the
Choledochal cyst
Choledochal cyst is a rare congenital dilatation of the bile duct that occurs in 1 in 100,000 people. It is more common in Asian populations and women. The pathogenesis is typically due to an anomalous pancreaticobiliary junction, where the pancreatic and biliary ducts fuse before entering the duodenum. This allows pancreatic secretions to reflux into the bile duct and cause inflammation and cystic degeneration. Choledochal cysts are classified into 5 types based on their location and extent. Patients typically present with jaundice, right upper quadrant pain, or a palpable mass. Investigations include ultrasound, CT, MRCP and ERCP to establish the diagnosis and classification. Complications include
Gastric Outlet Obstruction (GOO)
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ENTEROCUTANEOUS FISTULA
Management of enterocutaneous fistulas involves several phases:
1) Recognition and stabilization including resuscitation, controlling sepsis and drainage, nutrition support, and skin care.
2) Investigation using fistulograms and CT scans to define the fistula anatomy and underlying pathology.
3) Decision on management which depends on factors predicting spontaneous closure like output, nutrition status and bowel health.
4) Definitive surgery including bowel resection and anastomosis if needed, otherwise a staged approach with bypass.
5) Post-surgical recovery focusing on preventing recurrent fistula and hernia.
Mesenteric ischemia
Mesenteric ischemia is a condition with reduced blood flow to the intestines that can be fatal if not treated. It can be acute or chronic and involve both the arterial and venous circulation. Diagnosis involves imaging tests like CT scans to identify arterial blockages or venous clots. Treatment aims to resuscitate the patient, treat any underlying causes, and restore blood flow surgically or via endovascular methods if possible. Unviable intestines will also be resected. Despite advances, mesenteric ischemia remains challenging to diagnose and treat due to its complexity and non-specific symptoms.
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The document discusses types of intestinal stomas including classifications based on duration, anatomical location, and reconstruction. It covers indications for stoma creation, principles of stoma formation including challenges, common complications, and dietary advice for ostomates. Stoma appliances and management of various stoma-related complications are also described.
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1. Small bowel neoplasms are rare, comprising about 1-2% of gastrointestinal tumors. The most common benign tumors are leiomyomas, adenomas, and gastrointestinal stromal tumors (GISTs), while the most common malignant tumor is adenocarcinoma.
2. Risk factors for small bowel tumors include Crohn's disease, familial polyposis syndromes, and Peutz-Jeghers syndrome. Diagnosis is often difficult but can involve imaging like CT, capsule endoscopy, or surgical exploration.
3. Treatment depends on whether the tumor is benign or malignant and its size and location. Resection is often curative for localized benign and malignant tumors, while
Intussusception
Intussusception is a condition where one part of the bowel slides into the next, blocking fluid and food passage and cutting off blood supply. It most commonly affects children under 2 years old. Symptoms include abdominal pain, vomiting, and bloody stools. Diagnosis is usually via ultrasound or enema x-ray. Treatment involves nonsurgical reduction via air or liquid enema or surgical reduction if complications are present. With treatment, prognosis is excellent though recurrence or complications can sometimes occur.
Tumors of intestine
The document discusses tumors of the small and large intestines. It classifies intestinal tumors and provides details on various benign and malignant tumor types. The most common tumors are epithelial tumors, with colorectal cancer representing 70% of all gastrointestinal malignancies. Adenomas are precursors to most colorectal cancers. Risk factors include inflammatory bowel disease, familial polyposis, and diet. Prognosis and treatment depend on tumor stage and characteristics.
Small Intestine Ii
The small intestine is responsible for digestion and absorption of nutrients. It has three parts - duodenum, jejunum, and ileum. Common surgical conditions of the small intestine include small bowel obstruction, infections, inflammation, tumors, and diverticula. Mechanical obstruction from adhesions is the most common cause of small bowel obstruction. Strangulated obstruction can lead to ischemia and necrosis if not treated promptly.
Tumor small intestine
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
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Genital tuberculosis- a view
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This document provides information on acute abdominal pain in children, including:
1. It classifies abdominal pain by age group and lists common emergent and nonemergent causes for different age ranges from newborns to adolescents.
2. It describes important considerations for evaluating abdominal pain in children such as history, physical exam including genital exam, imaging options, and pain management.
3. It provides more detailed information on evaluating and managing some specific conditions that can cause abdominal pain in children like intussusception, appendicitis, constipation, and nonspecific viral syndromes.
GI obstructive condition -Intussusception.pptx
Intussusception is the telescoping of the proximal bowel into the distal bowel. It is most common in children under 2 years old, with the majority of cases being idiopathic. The classic triad of symptoms includes intermittent abdominal pain, a sausage-shaped abdominal mass, and bloody stools, though this triad is present in less than 15% of cases. Ultrasound is the preferred diagnostic tool, showing a target or doughnut-shaped mass. Treatment involves rehydration and stabilization, with non-operative reduction via hydrostatic or pneumatic enema being first-line for stable patients without evidence of perforation. Surgery is pursued if non-operative reduction fails or if there are signs of
intussusception.pptx
Intussusception is the telescoping of the proximal bowel into the distal bowel. It is most common in children under 2 years old and presents with intermittent abdominal pain, a palpable abdominal mass ("sausage-shaped"), and bloody stools. Ultrasound is the primary diagnostic tool, showing a target or doughnut sign. Treatment involves rehydration, antibiotics if infected, and non-operative reduction initially with air or barium enema. Surgery is needed if reduction fails or there is perforation with resection and anastomosis. Complications can include necrosis, perforation, sepsis but mortality is low (less than 1%) with prompt diagnosis and treatment.
Appendicitis
This document discusses appendicitis, including its signs, symptoms, diagnostic tests, differential diagnosis, and treatment options. Appendicitis has a 7% lifetime risk and commonly affects people aged 10-30. Diagnosis involves physical exam findings like the Dunphy sign as well as imaging like CT scans or ultrasounds to identify an enlarged appendix. Treatment is typically open or laparoscopic appendectomy, with laparoscopic offering benefits like shorter recovery for uncomplicated cases. Chronic appendicitis presents with long-term localized pain but fewer systemic symptoms.
Ectopic Pregnancy - Obstetrical & Gynaecological Nursing
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Acute appendicitis __
1. Abdominal pain is the primary symptom of acute appendicitis, which typically begins in the lower abdomen and migrates to the right lower quadrant. Diagnosis is based on clinical signs and symptoms, and may be supplemented by imaging or bloodwork.
2. Treatment for acute appendicitis is surgical removal of the appendix, either through open appendectomy or laparoscopic appendectomy. Antibiotic administration before and after surgery can help prevent surgical site infections.
3. The differential diagnosis of right lower quadrant pain includes conditions like mesenteric adenitis, pelvic inflammatory disease, ovarian cysts, and intestinal illnesses. Timely diagnosis and treatment are important to prevent complications from appendiceal rupture
Anomalies of the Gastrointestinal Tract and Anterior Abdominal.ppt
suatu materi tentang kelainan anatomi sistem pencernan yg berhubungan dengan obstertri dan ginekologi. termasuk lambung, usus halus, usus besar, rektum dan anus. Dapat berguna untuk penapisan sebelum bayi lahir. Diharapkan dengan materi ini dapat meningkatkan pengetahuan mahasiswa dalam ilmu yang berkaitan dengan Gastrointestinal terpadu. digunakan pada masyarakat umum dan sekitarnya.
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Mullerian anomalies
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Hirschsprung's Disease and management.ppt
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Crohn's disease
Crohn's disease is a chronic inflammatory bowel disease of unknown cause characterized by focal, asymmetrical, transmural inflammation that may affect any part of the gastrointestinal tract. Symptoms include diarrhea, abdominal pain, weight loss, and systemic symptoms. Diagnosis is confirmed through clinical evaluation, blood tests, endoscopy, imaging, and biopsy showing inflammation but not infection. Differential diagnoses include ulcerative colitis, infectious gastroenteritis, and other intestinal conditions.
Exeter Surgical Society: Paediatric surgery
This document discusses several pediatric gastrointestinal conditions:
- Testicular torsion presents with severe testicular or abdominal pain and requires surgical fixation following reduction to prevent recurrence.
- Exomphalos involves intestinal loops protruding in a sac through an abdominal wall defect, with prognosis depending on associated anomalies.
- Gastroschisis has intestines protruding without a sac and fewer associated anomalies.
- Pyloric stenosis causes projectile vomiting in infants around 6 weeks and is treated surgically.
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2) While lumbar sympathectomy increases skin blood flow, it does not significantly increase true nutritional blood flow in skeletal muscle. There is no physiological basis for its use in intermittent claudication.
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Malignant Melanoma
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Journal club oesophageal motility disorders and manometry
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Hepatocellular carcinoma indications for surgery
HCC is the most common primary liver cancer and is often diagnosed at an advanced stage making surgery difficult. Treatment depends on tumor stage and liver function. The Child-Turcotte-Pugh classification and MELD score evaluate liver function. Future liver remnant volume must be sufficient post-surgery. Hepatic resection is only recommended for early stage HCC meeting Milan criteria with a normal liver. Liver transplantation allows for the widest resection margins but is reserved for select patients.
Occult Ca Oral cavity
FDG-PET and PET/CT are useful tools for detecting unknown primary tumors in patients presenting with cervical lymph node metastases. A review of studies found that FDG-PET detected the primary tumor in 24.5-51% of cases where conventional workup was negative. Identifying the primary tumor allows for targeted therapy and improves prognosis by avoiding wide-field irradiation. One study noted FDG-PET findings changed treatment management in 25% of cases with unknown primary tumors.
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haemorrhagic shock
Shock, including hemorrhagic shock, results from inadequate tissue perfusion leading to hypoxia and cellular dysfunction. Hemorrhagic shock specifically is caused by hypovolemia from blood or fluid loss, leading to decreased blood pressure and organ ischemia. It can be classified based on severity of blood loss and signs/symptoms, and treatment involves controlling bleeding, rapid fluid resuscitation, and treating complications like multiple organ failure and coagulopathy that can result from severe or prolonged shock.
Pain
This document defines pain and describes the physiology of pain. It states that pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is transmitted via nociceptors and travels along afferent nerve fibers to the spinal cord. The gate control theory proposes that pain transmission can be modulated by interactions between pain fibers and touch fibers at the spinal cord. Chronic pain may involve different nerve fibers and neurotransmitters than acute pain. Various brain regions are also involved in pain perception and modulation.
Asepsis and antisepsis
Proper aseptic technique and administration of antimicrobial prophylaxis are essential for preventing surgical site infections. The document discusses the history and evolution of aseptic techniques, including the use of sterile instruments and dressings. It provides detailed steps for surgical hand scrubbing and gloving using aseptic technique. The timing and appropriate selection of antimicrobial agents for prophylaxis is important to reduce infection risks according to several studies discussed.
Lower gi bleed
Lower gastrointestinal bleeding can have various causes like diverticulosis, angiodysplasia, inflammation, and cancers. A thorough history, physical exam, and initial tests like colonoscopy are important to determine the source and severity of bleeding. Colonoscopy allows for both diagnosis and potential treatment but often requires bowel prep, while angiography and CT angiography can localize active bleeding but lack therapeutic options. Together, these diagnostic tests aim to safely identify the cause and guide appropriate clinical management of lower GI bleeding.
Evolution of surgery in colorectal cancer
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Open Vs Laparoscopic cholecystectomy
This document summarizes information on gallbladder removal surgery (cholecystectomy). It discusses the history and types of cholecystectomy procedures, including open and laparoscopic techniques. Key points include that laparoscopic cholecystectomy has become the gold standard treatment for gallstone disease since the 1990s as it is associated with less pain, smaller incisions, shorter hospital stays and faster recovery compared to open cholecystectomy. However, laparoscopic approaches may be more technically challenging and carry a higher risk of bile duct injuries.
Spleenomegaly & hypersplenism etiology pathogenesis and surgical management
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Institutinal Deliveries in PHCs
The document discusses strategies to promote institutional deliveries, specifically in Primary Health Centres (PHCs). It outlines the benefits of institutional deliveries including access to skilled birth attendants, equipment, treatment of complications, and neonatal care. PHCs are promoted as they are nearby, well-equipped to handle normal deliveries, and have no financial constraints. Community awareness is raised through various IEC activities by frontline workers. Antenatal checkups, immunizations, and identification of high-risk mothers are emphasized. PHCs aim to be open 24/7 with trained staff, drugs, and equipment to handle deliveries and referrals.
How to improve vasectomies in primary health centres
This document discusses how to improve vasectomy procedures in primary health centres. It defines vasectomy and explains its advantages over tubectomy, such as being an easier technique with a shorter procedure time, smaller incisions, and less bleeding and postoperative care required. It promotes non-scalpel vasectomy, which uses a very small incision and no sutures. The document addresses common misbeliefs in communities and strategies for motivation, such as government incentives. It provides guidance on postoperative care and shares vasectomy statistics from recent years.
Benign gastric outlet obstruction
Benign gastric outlet obstruction can result from various benign conditions that cause mechanical impediment to gastric emptying. Peptic ulcer disease, particularly chronic ulcers, was previously a leading cause but has declined with treatment of Helicobacter pylori and use of proton pump inhibitors. Other benign causes include corrosive injury, certain drugs like NSAIDs, and inflammatory conditions of the stomach or duodenum. Patients present with epigastric pain, nausea, vomiting, and weight loss. Diagnosis involves imaging tests and endoscopy. Treatment depends on the underlying cause but may include endoscopic balloon dilation, surgery such as vagotomy and gastrojejunostomy, or management of the underlying disease in cases of inflammation. Complications can
Omentum – anatomy, pathological conditions and surgical importance
The omentum is a fold of tissue that hangs down from the stomach and extends over other abdominal organs. It has important functions like immunity, absorbing edema, and limiting spread of infection. The greater omentum develops from the dorsal mesogastrium and extends from the stomach to the transverse colon. The lesser omentum connects the stomach and duodenum to the liver. Pathologies of the omentum include cysts, torsion, and tumors. Clinically, the omentum helps drain collections, access the retroperitoneum surgically, and forms adhesions useful for patching perforations.
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Intussusceptions in adults
- 2. Intussusceptions occur when one segment of the gastrointestinal tract (intussusceptum) telescopes into the lumen of an adjacent distal segment of the gastrointest-inal tract (intussuscipiens).
- 3. Very rare in adults Accounts for 5% of all intussusecptions 1% of bowel obstructions In 90% cases definitive underlying disorder can be identified Mean average age 54.5 yrs male-to-female ratio is 1:1.3 In 65% of cases – neoplasms Malignant tumors are more common in colon Bening tumours in small intestine
- 4. Diagnostic challenge Patients presents with present with nonspecific symptoms Has chronic indolent course until bowel ischemia occurs
- 5. Symptoms › Abdominal pain (71-100%)- with guarding only in 50% cases › Nausea and vomiting (40-60%) › Bleeding per rectum (4-33%)- more in colonic types › Abdominal masses are palpable (<10%)
- 6. Types › ileo-colic, › ileo-ileo-colic, › colo-colic and › small bowel intussusception (jejuno-jejunal and ileo-ileal) › Gastroduodenal and coloanal intussusceptions are extremely rare
- 7. Common lead points Small intestine › Benign neoplasms, › Meckel’s diverticuli, › Appendix › Adhesions › Malignant lesions (25%) large bowel › Malignant lesions (50%)
- 8. Investigation Abdominal CT › complex sausage-shaped soft tissue mass with an eccentric area of fat density contained within, which represents the mesenteric fat. Plain abdominal x-rays Ultrasound
- 9. Treatment Always surgical in adults Resection of involved segment and anastmosis
- 10. Prognosis › Good usually depends on cause Mortality › 8.7% for the benign lesions to 52.4% for the malignant variety