The pancreas, located in the upper abdomen, has endocrine as well as exocrine functions .
The secretion of pancreatic enzymes into the gastrointestinal tract through the pancreatic duct represents its exocrine function.
The secretion of insulin, glucagon, and somatostatin directly into the bloodstream represents its endocrine function.
Pancreatitis (inflammation of the pancreas) is a serious disorder. The most basic classification system used to describe or categorize the various stages and forms of pancreatitis divides the disorder into acute or chronic forms.
Acute pancreatitis can be a medical emergency associated with a high risk for life-threatening complications and mortality, whereas chronic pancreatitis often goes undetected until 80% to 90% of the exocrine and endocrine tissue is destroyed.
Acute pancreatitis does not usually lead to chronic pancreatitis unless complications develop.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
Cholelithiasis (calculi or gallstones) usually form in the gallbladder from the solid constituents of bile and vary greatly in size, shape and composition.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs and symptoms include abdominal pain, vomiting, bloating and not passing gas.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
Cholelithiasis (calculi or gallstones) usually form in the gallbladder from the solid constituents of bile and vary greatly in size, shape and composition.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs and symptoms include abdominal pain, vomiting, bloating and not passing gas.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Bell’s palsy
Trigeminal Neuralgia ( Tic Douloreux)
Cranial & spinal neuropathies
Bell’s palsy (facial paralysis) is due to unilateral inflammation of the ( CN VII Facial nerve) seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side.
Polices for intensive care units / critical care units ANILKUMAR BR
What is a Policy?
A Policy is a statement, verbal, written or implied, of those principles and rules that are set by Board of Directors as guidelines on organizations actions.
There should be written polices for the intensive care units or critical care units which will guide the personnel working there.
The polices making body, there should be representation from administrative team, medical team and the nursing team.
ADMISSION POLICES: This should specify whether the patients can be admitted directly to CCU /ICU or through the casualty department.
There should be polices regarding the admission of medico-legal cases.
RESUSCIATION EQUIPMENTS IN INTENSISIVE CARE UNITSANILKUMAR BR
Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation devices, and other life support equipment .
They are designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure thereby requiring 24-hour care and monitoring.
Intensive care unit equipment includes
Patient monitoring devices
Life support and emergency resuscitation devices, and
Diagnostic devices.
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
Infection control protocols in intensive care unitsANILKUMAR BR
Hospital acquired infections (HAIs) are common in intensive care unit (ICU) patient and are associated with increased morbidity and mortality.
The main reason being severity of illness, interruption of normal defense mechanism (e.g. mechanical ventilation), malnutrition & inability to ambulate make it more susceptible to multi drug resistant organism (MDRO).
The most frequent mode of transmission is Contact transmission, this may be direct or indirect other modes include droplet transmission, airborne transmission, common vehicle such as ventilator etc.
Abnormal development or deformities of the ear anatomy can cause a range of complications, from cosmetic issues to hearing and development problems.
An estimated 6 to 45 percent of children are born with some sort of congenital ear deformity.
Normally, the pleural space contains a small amount of fluid (5 to 15 mL), which acts as a lubricant that allows the pleural surfaces to move without friction.
But if fluid builds up from either increased production or inadequate removal pleural effusion results.
Pleural effusion B/L or unilateral (parapneumonic process)
Refers to any significant collection of fluid within pleural space.
Any imbalance in formation, absorption lead accumulation of pleural fluid. Common condition:
CHF
Bacterial pneumonia
Malignancy(chest tumor)
Pulmonary embolism
Pleura effusion is a condition refers to a collection of fluid in the pleural space. It is almost secondary to other conditions.
Hearing is one of our primary modes of communication. 360 million people worldwide have disabling hearing loss.
Hearing loss may result from genetic causes, complications at birth, certain infectious diseases, chronic ear infections, the use of particular drugs, exposure to excessive noise and ageing.
Hearing loss may be mild, moderate, severe or profound.
It can affect one ear or both ears, and leads to difficulty in hearing conversational speech or loud sounds. it may occur in one or both ear.
CONDUCTIVE HEARING LOSS (CHL)
SENSORINEURAL HEARING LOSS (SHL)
MIXED HEARING LOSS (MHL)
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
Prostate cancer or tumor is the most common cancer in men other than non-melanoma skin cancer.
The majority (more than 75%) of cases occur in men over age 65.
Prostate cancer is a malignant tumor of the prostate gland.
Nursing management of patients with oncological conditionsANILKUMAR BR
Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells.
Cancer is caused by external factors and internal factors which may act together to initiate or promote carcinogenesis.
External Factors - chemicals, radiation, viruses, and lifestyle.
Internal Factors – hormones, immune condition, and inherited mutations.
Oncology branch of medicine deals with etiology, diagnosis, treatment and prevention of cancer.
Onco - is a Greek word meaning tumor .
A group of eye disorders, glaucoma is characterized by high intraocular pressure (IOP) that damages the optic nerve.
Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States.
Glaucoma may occur as primary or congenital disease or secondary to other causes, such as injury, infection, surgery, or prolonged use of topical corticosteroids.
Primary glaucoma has mainly two forms :
1. Open angle glaucoma ( chronic, simple, or wide angle glaucoma)
2. Angle –closure glaucoma( Acute or narrow angle glaucoma)
Angle –closure glaucoma occurs suddenly and may cause permanent or irreversible vision loss in 48 to 72 hours.
An inflammation of the conjunctiva commonly known as pink eye. Conjunctivitis is usually acute condition and self- limiting.
Conjunctivitis may be unilateral or bilateral.
It may also be chronic, possibly indicating degenerative changes or damage from repeated attacks.
It transmitted by contaminated towels, wash cloths, or the client own hands and it usually spreads very rapidly from one eye to otCommon causes are
Bacterial
Viral and chlamydial infection
Less common causes
Allergy
Parasitic disease and fungal infection
Occupational irritants
her eye.
Nursing assessment and management of patients with hepatic disordersANILKUMAR BR
Liver or Hepatic disorders are common and may result from a virus or exposure to toxic substances such as alcohol.
Another liver disorder is cancer: hepatocellular carcinoma is a highly malignant tumor that is difficult to treat and often fatal.
Liver function is complex, and liver dysfunction affects all body systems.
For this reason, the nurse must understand how the liver functions and must have expert assessment and clinical management skills to care for patients undergoing complex diagnostic and treatment procedures.
The liver plays additional roles in detoxification of chemicals and synthesis and storage of important nutrients and The liver is especially important in the regulation of glucose and protein metabolism .
Ototoxicity is, quite simply, ear poisoning (oto = ear, toxicity = poisoning), which results from exposure to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve (the nerve sending balance and hearing information from the inner ear to the brain).
Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Pneumonitis is a more general term that describes the inflammatory process in the lung tissue that may predispose and Pneumonia is an inflammation of the lung parenchyma that is caused by a microbial agent.
place the patient at risk for microbial invasion.
Pneumonia is classified into four: community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
Nurses are primarily involved in the administration of medication across various settings. Nurses are also involved in both dispensing and preparation of medication. Research on medical administration errors (MAEs) shows an error rate of 60%, 34 mainly in the form of wrong time, wrong rate, or wrong dose.
There are many ways to prevent medication errors and one way of which is understanding the 10 “rights” of drug administration:
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung.
The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura.
The space between these two areas is called the pleural space.
This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.
Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.
IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection
Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis
ications
Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes. Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia.
Nephrotic syndrome is a primary glomerular disease characterized by the following:
Marked increase in protein in the urine (proteinuria)
Decrease in albumin in the blood (hypoalbuminemia)
Edema (The swelling (edema), can be most noticeable on the face, around the eyes, around the feet and ankles, and in the belly area (or the abdomen).
High serum cholesterol and low-density lipoproteins (hyperlipidemia)
Nephrotic syndrome is a clinical disorder characterized by marked increase of protein in the urine ( proteinuria ), decrease in albumin in the blood (hypoalbuminemia ),edema, & excess lipids in the blood ( hyperlipidemia )
Pathophysiology
Nephrotic syndrome can occur with almost any intrinsic renal disease or systemic disease that affects the glomerulus.
Although generally considered a disorder of childhood, nephrotic syndrome does occur in adults, including the elderly. Causes include:
Chronic glomerulonephritis
Diabetes mellitus with intercapillary glomerulosclerosis
Amyloidosis of the kidney
Systemic lupus erythematosus
Multiple myeloma and renal vein thrombosis.
NSAIDs
Pre eclampsia
Urinary diversion procedures are performed to divert urine from the bladder to a new exit site, usually through a surgically created opening (stoma) in the skin.
These procedures are primarily performed when a bladder tumor necessitates removal of the entire bladder (cystectomy).
Urinary diversion has also been used in managing pelvic malignancy, birth defects, strictures, trauma to ureters and urethra, neurogenic bladder, chronic infection causing severe ureteral and renal damage, and intractable interstitial cystitis and as a last resort in managing incontinence.
There are two categories of urinary diversion:
1. Cutaneous urinary diversion : in which urine drains through an opening created in the abdominal wall and skin.
2. Continent urinary diversion : in which a portion of the intestine is used to create a new reservoir for urine.
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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.
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.
4. THE PANCREAS
•The pancreas, located in the upper abdomen, has
endocrine as well as exocrine functions .
•The secretion of pancreatic enzymes into the
gastrointestinal tract through the pancreatic duct
represents its exocrine function.
•The secretion of insulin, glucagon, and somatostatin
directly into the bloodstream represents its endocrine
function.
5. Exocrine Pancreas
• The secretions of the exocrine pancreas are digestive
enzymes high in protein content and an electrolyte-rich
fluid.
• The secretions are very alkaline because of their high
concentration of sodium bicarbonate and are capable of
neutralizing the highly acid gastric juice that enters the
duodenum.
• The enzyme secretions include amylase, which aids in the
digestion of carbohydrates; trypsin, which aids in the
digestion of proteins; and lipase, which aids in the digestion
of fats.
6. Endocrine Pancreas
• The islets of Langerhans, the endocrine part of the
pancreas, are collections of cells embedded in the
pancreatic tissue.
• They are composed of alpha, beta, and delta cells.
• The hormone produced by the beta cells is called
insulin; the alpha cells secrete glucagon and the
delta cells secrete somatostatin.
7. PANCREATIC DISORDERS
•Pancreatitis (inflammation of the pancreas) is a serious
disorder. The most basic classification system used to
describe or categorize the various stages and forms of
pancreatitis divides the disorder into acute or chronic forms.
•Acute pancreatitis can be a medical emergency associated
with a high risk for life-threatening complications and
mortality, whereas chronic pancreatitis often goes
undetected until 80% to 90% of the exocrine and endocrine
tissue is destroyed.
•Acute pancreatitis does not usually lead to chronic
pancreatitis unless complications develop.
8. PANCREATIC DISORDERS
Although the mechanisms causing pancreatic
inflammation are unknown, pancreatitis is
commonly described as auto digestion of the
pancreas.
Generally, it is believed that the pancreatic duct
becomes obstructed, accompanied by hyper
secretion of the exocrine enzymes of the pancreas.
9. ACUTE PANCREATITIS
• Acute pancreatitis is an inflammation of the
pancreas, ranging from mild edema to extensive
hemorrhage, resulting from various insults to the
pancreas. (Mild acute pancreatitis is characterized by
edema and in-flammation confined to the pancreas)
• It is defined by a discrete episode of abdominal pain
and serum enzymes elevations. The structure and
function of the pancreas usually return to normal
after an acute attack.
12. Pathophysiology and Etiology
1. Excessive alcohol consumption is the most common cause
in the United States.
2. Also commonly caused by biliary tract disease, such as
cholelithiasis, acute and chronic cholecystitis.
3. Less common causes are bacterial or viral infection, blunt
abdominal trauma, peptic ulcer disease, ischemic vascular
disease, hyperlipidemia, hypercalcemia; the use of
corticosteroids, thiazide diuretics, and oral contraceptives;
surgery on or near the pancreas or after instrumentation of
the pancreatic duct by ERCP; tumors of the pancreas or
ampulla; and a low incidence of hereditary pancreatitis.
13. Pathophysiology and Etiology
4. Mortality is high (10%) because of shock, anoxia,
hypotension, or multiple organ dysfunction.
5. Attacks may resolve in complete recovery, may recur
without permanent damage, or may progress to chronic
pancreatitis.
6. Auto digestion of all or part of the pancreas is involved,
but the exact mechanism is not completely understood.
14. Clinical Manifestations
(Depends on severity of pancreatic damage)
1. Severe abdominal pain is the major symptom of
pancreatitis. Pain is frequently acute in onset,
occurring 24 to 48 hours after a very heavy meal or
alcohol ingestion ( Abdominal pain and tenderness
and back pain result from irritation and edema of
the inflamed pancreas that stimulate the nerve
endings).
2. Nausea and vomiting.
3. Fever.
16. Clinical Manifestations
(Depends on severity of pancreatic damage)
1. Hypotension is typical and reflects hypovolemia and shock caused by the
loss of large amounts of protein-rich fluid into the tissues and peritoneal
cavity.
2. Respiratory distress and hypoxia are common, and the patient may
develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and
abnormal blood gas values ( ABGs).
3. Myocardial depression, hypocalcaemia, hyperglycemia, and
disseminated intravascular coagulopathy (DIC) may also occur with
acute pancreatitis.
17. Purplish discoloration of the flanks (Turner's sign) or of the
periumbilical area (Cullen's sign) occurs in extensive
hemorrhagic necrosis of the pancreas.
18. Assessment and Diagnostic Findings
1. The diagnosis of acute pancreatitis is based on a
history of abdominal pain, the presence of known risk
factors, physical examination findings, and diagnostic
findings.
2. Serum amylase and lipase levels are used in making
the diagnosis of acute pancreatitis. In 90% of the
cases, serum amylase and lipase levels usually rise in
excess of three times their normal upper limit within
24 hours.
19. Assessment and Diagnostic Findings
•Abdominal X-ray to detect an ileus or isolated loop of small
bowel overlying pancreas.
•CT scan is the most definitive study for determining
pancreatic changes.
•Chest X-ray for detection of pulmonary complications.
Pleural effusions are common, especially on the left, but
may be bilateral.
20. Medical Management client with acute pancreatitis
• Management of the patient with acute pancreatitis is directed toward
relieving symptoms and preventing or treating complications.
• All oral intake (NPO) is withheld to inhibit pancreatic stimulation and
secretion of pancreatic enzymes.
• Parenteral nutrition is usually an important part of therapy, particularly in
debilitated patients, because of the extreme metabolic stress associated with
acute pancreatitis.
• Nasogastric suction may be used to relieve nausea and vomiting.
• Restoration of circulating blood volume with I.V. crystalloid or colloid
solutions or blood products.
• Maintenance of adequate oxygenation reduced by pain, anxiety, acidosis,
abdominal pressure, or pleural effusions.
21. POSTACUTE MANAGEMENT
•Antacids may be used when acute pancreatitis begins to
resolve. Oral feedings low in fat and protein are initiated
gradually.
•Caffeine and alcohol are eliminated from the diet. If the
episode of pancreatitis occurred during treatment with
thiazide diuretics, corticosteroids, or oral contraceptives,
these medications are discontinued.
•Follow-up of the patient may include ultrasound, x-ray
studies, or ERCP to determine whether the pancreatitis is
resolving and to assess for abscesses and pseudocysts.
22. PAIN MANAGEMENT
•Adequate pain medication is essential during the course of
acute pancreatitis to provide sufficient pain relief and
minimize restlessness, which may stimulate pancreatic
secretion further.
•Antiemetic agents may be prescribed to prevent vomiting.
•Electrolyte replacements as needed.
•Regular insulin to treat hyperglycemia.
•Antibiotic therapy for documented infection or sepsis.
23. COMPLICATIONS
1. Fluid and electrolyte disturbances
2. Necrosis of the pancreas
3. Shock and multiple organ dysfunction
4. Hemorrhage with hypovolemic shock.
5. Acute renal failure
6. Pancreatic ascites, abscess, or pseudocyst.
24. NURSING PROCESS: THE PATIENT WITH ACUTE
PANCREATITIS
• Assessment
1. Obtain history of gallbladder disease, alcohol use, or
precipitating factors.
2. Assess GI distress, including nausea and vomiting, diarrhea,
and passage of stools containing fat.
3. Assess characteristics of abdominal pain.
4. It also is important to assess the patient’s nutritional and fluid
status and history of gallbladder attacks and alcohol use.
5. Assess respiratory rate and pattern and breath sounds.
25. NURSING PROCESS: THE PATIENT WITH ACUTE
PANCREATITIS
• Assessment
5. The nurse assesses the emotional and psychological status of
the patient and family and their coping, because they are often
anxious about the severity of the symptoms and the acuity of
illness.
26. NURSING DIAGNOSIS
1. Acute pain related to inflammation, edema, distention of the
pancreas, and peritoneal irritation.
2. Ineffective breathing pattern related to severe pain,
pulmonary infiltrates, pleural effusion, atelectasis, and
elevated diaphragm.
3. Imbalanced nutrition, less than body requirements, related
to reduced food intake and increased metabolic demands.
4. Impaired skin integrity related to poor nutritional status, bed
rest, and multiple drains and surgical wound.
28. Pancreatitis
Nursing Interventions
P- Pain: Morphine or Dilaudid
A- Antispasmodic drugs- motility
N- NPO/NGT suction- pancreas to rest, TPN
C- Calcium, hypocalcemia, replace Ca
R- Replace F/E- NG losses and fluid shift
E- Endocrine & Enzymes
A- Antibiotics- with fever
S- Steroids- corticosteroids during acute attacks
28
29. Patient Education and Health Maintenance
1. Instruct patient to gradually resume a low-fat diet.
2. Instruct patient to increase activity gradually, providing for
daily rest periods.
3. Reinforce information about disease process and precipitating
factors. Stress that subsequent bouts of acute pancreatitis may
destroy the pancreas, cause additional complications, and lead to
chronic pancreatitis.
4. If pancreatitis is a result of alcohol abuse, the patient needs to
be reminded of the importance of eliminating all alcohol; advise
about Alcoholics Anonymous or other substance abuse
counseling.
32. CHRONIC PANCREATITIS
• Chronic pancreatitis is defined as the persistence of
pancreatic cellular damage after acute inflammation
and decreased pancreatic endocrine and exocrine
function. Or
• Chronic pancreatitis is an inflammatory disorder
characterized by progressive anatomic and
functional destruction of the pancreas.
33. Pathophysiology and Etiology
1. Alcohol consumption in Western societies and malnutrition worldwide are
the major causes of chronic pancreatitis. Excessive and prolonged
consumption of alcohol accounts for approximately 70% of the cases.
2. The incidence of pancreatitis is 50 times greater in alcoholics than in the
nondrinking population.
3. Long-term alcohol consumption causes hypersecretion of protein in
pancreatic secretions, resulting in protein plugs and calculi within the
pancreatic ducts.
4. Alcohol also has a direct toxic effect on the cells of the pancreas. Damage
to these cells is more likely to occur and to be more severe in patients
whose diets are poor in protein content and either very high or very low in
fat.
34. Clinical Manifestations
1. Chronic pancreatitis is characterized by recurring
attacks of severe upper abdominal and back pain,
accompanied by vomiting. (Some patients experience
continuous severe pain; others have a dull, nagging
constant pain).
2. Weight loss is a major problem in chronic
pancreatitis: more than 75% of patients experience
significant weight loss, usually caused by decreased
dietary intake secondary to anorexia or fear that eating
will precipitate another attack.
35. Clinical Manifestations
1. The stools become frequent, frothy, and foul-
smelling because of impaired fat digestion, which
results in stools with a high fat content. This is
referred to as “steatorrhea”
2. Diabetes mellitus
36. Assessment and Diagnostic Findings
1. ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is the
most useful study in the diagnosis of chronic pancreatitis. It provides
detail about the anatomy of the pancreas and the pancreatic and
biliary ducts.
38. ERCP (Endoscopic Retrograde Cholangio-
Pancreatography)
• It is also helpful in obtaining tissue for analysis and
differentiating pancreatitis from other conditions,
such as carcinoma.
39. Other diagnostic investigations
• Various imaging procedures, including:
1. Magnetic resonance imaging ( MRI)
2. Computed tomography ( CT-SCAN) and ultrasound, have been
useful in the diagnostic evaluation of patients with suspected
pancreatic disorders.
3. A glucose tolerance test ( GTT) evaluates pancreatic islet cell
function, information necessary for making decisions about
surgical resection of the pancreas.
4. An abnormal glucose tolerance test indicative of diabetes may
be present
40. Medical Management
The management of chronic pancreatitis depends on
its probable cause in each patient.
Treatment is directed toward preventing and
managing acute attacks, relieving pain and
discomfort, and managing exocrine and endocrine
insufficiency of pancreatitis.
41. Medical Management
1. Pain management.
2. Correction of nutritional deficiencies.
3. Pancreatic enzyme replacement.
4. Treatment of diabetes mellitus.
5. Endoscopic placement of pancreatic stent allowing free
flow of pancreatic juices through distorted and
irregular/narrowed pancreatic duct.
6. Diabetes mellitus resulting from dysfunction of the
pancreatic islet cells is treated with diet, insulin, or oral
antidiabetic agents.
42. Surgical Management
Surgery is generally carried out to relieve abdominal pain and
discomfort, restore drainage of pancreatic secretions, and
reduce the frequency of acute attacks of pancreatitis.
The surgery performed depends on the anatomic and
functional abnormalities of the pancreas, including the
location of disease within the pancreas, diabetes, exocrine
insufficiency, biliary stenosis, and pseudocysts of the pancreas.
The Care is similar to the patient undergoing abdominal
surgery.
43. Pancreaticojejunostomy
• Pancreaticojejunostomy (also referred to as Roux-en-Y) with a side-to-
side anastomosis or joining of the pancreatic duct to the jejunum
allows drainage of the pancreatic secretions into the jejunum.
44. •Autotransplantation or implantation of the
patient’s pancreatic islet cells has been
attempted to preserve the endocrine function of
the pancreas in patients who have undergone
total pancreatectomy.
• Resection of part of pancreas (Whipple procedure,
distal pancreatectomy) or removal of entire pancreas
(total pancreatectomy).
46. Pancreatic pseudocyst
• A pancreatic pseudocyst is a circumscribed collection of fluid rich
in pancreatic enzymes, blood, and necrotic tissue, typically located
in the lesser sac of the abdomen.
47. Nursing Assessment
• Assess level of abdominal pain.
• Assess nutritional status.
• Assess for steatorrhea and malabsorption.
• Assess for signs and symptoms of diabetes mellitus.
• Assess current level of alcohol intake and motivation
and resources available to abstain from drinking such
as Alcoholics Anonymous.
• Provide pre and post operative nursing care
48.
49.
50. • Cancer of the pancreas may arise in the head (70%) or body and tail
(30%) of the pancreas. Adenocarcinoma of the cells that line the
ducts of the pancreas is the most common (80%) type.
• Pancreatic cancer is the fourth-leading cause of cancer deaths in the
United States because 90% of tumors are not resectable at the time
of diagnosis.
• Usually occurs between ages 60 and 80, but can be found in younger
patients.
51. Pathophysiology and Etiology
•Cigarette smoking, exposure to industrial chemicals or
toxins in the environment, and a diet high in fat, meat, or
both are associated with pancreatic cancer, although their
role is not completely clear.
• The risk for pancreatic cancer increases as the extent of
cigarette smoking increases. Diabetes mellitus, chronic
pancreatitis, and hereditary pancreatitis are also
associated with pancreatic cancer.
•The pancreas can also be the site of metastasis from other
primary tumors.
52. Pathophysiology and Etiology
• Cancer may arise in any portion of the pancreas (in
the head, the body, or the tail); clinical manifestations
vary depending on the location of the lesion and
whether functioning, insulin secreting pancreatic islet
cells are involved.
• Approximately 75% of pancreatic cancers originate in
the head of the pancreas and give rise to a distinctive
clinical picture.
53.
54. Clinical Manifestations
• Pain, jaundice, or both are present in more than 90%
of patients pancreatic cancer with and, along with
weight loss, are considered classic signs of pancreatic
carcinoma.
• However, they often do not appear until the disease
is far advanced esp. III or IV stage of pancreatic
cancer.
55. Clinical Manifestations
•Other signs include rapid, profound, and progressive
weight loss as well as vague upper or mid abdominal
pain or discomfort that is unrelated to any
gastrointestinal function and is often difficult to
describe.
• Anorexia, nausea, vomiting, and weakness may occur.
• Biliary obstruction produces jaundice, dark tea-colored
urine, clay-colored stools, and pruritus.
• Depression and lethargy may be present.
•Insulin deficiency: glycosuria, hyperglycemia, and
abnormal glucose tolerance.
56. Assessment and Diagnostic Findings
• Magnetic resonance imaging (MRI) and Computed tomography
(CT-SCAN) are used to identify the presence of pancreatic tumors.
• ERCP is also used in the diagnosis of pancreatic carcinoma. (Cells
obtained during ERCP are sent to the laboratory for examination).
• Liver function tests (LFT) elevated; coagulation studies may be
prolonged.
• Percutaneous fine-needle aspiration or biopsy through
ultrasonography or CT scan guidance to determine malignancy.
• Percutaneous transhepatic cholangiography is another procedure
that may be performed to identify obstructions of the biliary tract
by a pancreatic tumor.
57. Medical Management
• If the tumor is resectable and localized (typically
tumors in the head of the pancreas), the surgical
procedure to remove it is usually extensive.
• However, definitive surgical treatment (ie, total
excision of the lesion) is often not possible because of
the extensive growth when the tumor is finally
diagnosed and because of the probable widespread
metastases (especially to the liver, lungs, and bones).
58. • If the patient undergoes surgery, intraoperative radiation therapy
(IORT) may be used to deliver a high dose of radiation to the tumor
with minimal injury to other tissues.
59. • Before extensive surgery can be performed, a fairly long period of
preparation is often necessary because the patient’s nutritional
and physical condition is often quite compromised.
• Various liver and pancreatic function studies are performed.
• A diet high in protein along with pancreatic enzymes is often
prescribed.
• Preoperative preparation includes adequate hydration, correction
of prothrombin deficiency with vitamin K, and treatment of
anemia to minimize postoperative complications.
• Parenteral nutrition and blood component therapy are frequently
required.
60. Pancreaticoduodenectomy. (Whipple procedure )
• Is the removal of the head of the pancreas, distal portion of the
common bile duct including the gallbladder, duodenum, and the distal
stomach with anastomosis of the remaining pancreas, stomach, and
common bile duct to the jejunum (If the gallbladder is present, it is
also removed.
64. • Palliative bypass of the bile duct
(choledochojejunostomy or cholecystojejunostomy)or
stomach (gastrojejunostomy) for unresectable tumors
of the pancreas.
65. Other Measures
• Chemotherapy may be used in combination with radiation therapy as
neoadjuvant therapy before surgery to shrink tumors.
• Radiation therapy may be used alone.
• Endoscopic or percutaneous stent placement for relief of biliary
obstruction (usually for patients near end of life).
• Endoscopic stent for relief of duodenal obstruction (usually for
patients near end of life).
66. Nursing Management
1. Preoperatively and postoperatively, nursing care is directed toward
promoting patient comfort, preventing complications, and assisting the
patient to return to and maintain as normal and comfortable a life as
possible.
2. The nurse closely monitors the patient in the intensive care unit after
surgery; the patient will have multiple intravenous and arterial lines in
place for fluid and blood replacement as well as for monitoring arterial
pressures, and is on a mechanical ventilator in the immediate
postoperative period.
3. It is important to give careful attention to changes in vital signs, arterial
blood gases and pressures, pulse oximetry, laboratory values, and urine
output.
4. The nurse must also consider the patient’s compromised nutritional status
and risk for bleeding.
Editor's Notes
C- Calcium- monitor levels and look for clinical signs, replace as needed.
R- Replace Fand E- NG losses plus- fluid shifts into peritoneum. TPN if NPO over 7-10 days
3.
Medications administered
Pancreatic enzymes: pancreatic and panrelipase take with meals for fat and protein digestion
Education: take ac or c meals, swallow wihout chewing to minimize oral irritation, mix powder forms in applesauce or fruit e in protein containing foods. Wipe lips to avoid skin irritation
Anticholinergics,glucagon,histamine inhibitors- all decreas vagal stimulation, decrease GI motility and inhibit pancreatic secretions
E- Endocrine- control of hyperglycemia- insulin, glucagon, calcitonin and somatastatin sometimes used.
Other interventions may include heparin, peritoneal dialysis to remove toxic substancesand peritoneal tap for fluid collection which impairs resp. dynamicsno oral intake to inhibit pancreatic stimulation
Anticholinergics- atropine (Bentyl)
Vitamin supplements
Pancreatic enzymes: pancreatic and panrelipase take with meals for fat and protein digestion
Monitor blood glucose levels and administer insulin as needed
Monitor hydration levels orthostatic blood pressure,
I&O, lab values, weights
morphine sulfate is not used: can cause spasms in the pancreas(spincter of Oddi)
Medications administered
Pancreatic enzymes: pancreatic and panrelipase take with meals for fat and protein digestion
Education: take ac or c meals, swallow wihout chewing to minimize oral irritation, mix powder forms in applesauce or fruit e in protein containing foods. Wipe lips to avoid skin irritation
Anticholinergics,glucagon,histamine inhibitors- all decreas vagal stimulation, decrease GI motility and inhibit pancreatic secretions