Peritonitis is an inflammation of the peritoneum lining the abdominal cavity that can be caused by infection or non-infectious processes. There are two main types - primary peritonitis caused by infection spreading from the blood or lymph nodes, and secondary peritonitis caused by infection entering through the GI or biliary tract. Symptoms include abdominal pain and tenderness, fever, nausea, and vomiting. Treatment involves antibiotics, intravenous fluids, and sometimes surgery to drain and cleanse the peritoneum if infection is present. Complications can include electrolyte imbalances, organ dysfunction, sepsis, and formation of scar tissue.
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
Peritonitis is among the most common surgical cases. getting familiarized with it for early proper diagnostic and management is the key to reduce morbidity and mortality. In this power point i have analysed important anatomy, causes, investigation and how to manage it as medical personal covers all the necessary things you will require to know about peritonitis
Kindly like, save and share if you find the material useful
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
Peritonitis is among the most common surgical cases. getting familiarized with it for early proper diagnostic and management is the key to reduce morbidity and mortality. In this power point i have analysed important anatomy, causes, investigation and how to manage it as medical personal covers all the necessary things you will require to know about peritonitis
Kindly like, save and share if you find the material useful
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
1. Peritonitis
Definition:
Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the
abdominal cavity. Peritonitis may be localized or generalized, and may result from
infection and from a non-infectious process.
Peritonitis is an inflammation (irritation) of the peritoneum, the thin tissue that lines the
inner wall of the abdomen and covers most of the abdominal organs.
Types Or Classification of peritonitis
1- Infected peritonitis (localized or generalized infected peritonitis) or non-infected
peritonitis.
2- Primary or secondary peritonitis.
Major types
Primary : The spread of an infection.
People who have an accumulation of fluid in their abdomen (ascites).
The fluid that accumulates create a good environment for the growth of bacteria.
Secondary : The entry of bacteria or enzymes into the peritoneum.
Ulcer, appendix and a ruptured diverticulum.
An intestine to burs or injury.
• Primary peritonitis is caused by the spread of an infection from the blood and lymph nodes
to the peritoneum.
• Secondary peritonitis is the more common type of peritonitis, happens when the infection
comes into the peritoneum from the gastrointestinal or biliary tract.
Risk Factors
• Liver disease (cirrhosis)
• Fluid in the abdomen
• Weakened immune system
• Pelvic inflammatory disease
Risk factors for secondary peritonitis include:
• Appendicitis (inflammation of the appendix)
• Stomach ulcers, Twisted intestine, Pancreatitis
• Inflammatory bowel disease, Injury caused by an operation.
• Peritoneal dialysis, Trauma.
Causative organisms
• pyogenic bacteria - E. coli
• Aerobic and anaerobic - streptococci staphylococci
Causes
I- Infected peritonitis:
Generalized Infected peritonitis:
1. Perforation of part of the gastrointestinal tract is the most common cause of peritonitis.
This includes:
2. • Perforation of the distal oesophagus.
• perforation of the stomach as peptic ulcer, gastric carcinoma
• perforation of the duodenum (peptic ulcer)
• perforation of the remaining intestine (e.g., appendicitis, inflammatory bowel disease,
intestinal infarction, intestinal strangulation, colorectal carcinoma).
• Or perforation of the gall bladder (cholecystitis).
• Other possible reasons for perforation include abdominal trauma, ingestion of a sharp
foreign body, perforation by an endoscope or catheter.
2. Disruption of the peritoneum, even in the absence of perforation of a hollow viscus,
may also cause infection by letting micro-organism into the peritoneal cavity.
Examples include trauma, surgical wound, continuous ambulatory peritoneal dialysis, and
intra-peritoneal chemotherapy.
3. Direct entry through an operative or traumatic wound.
4. Intra-peritoneal dialysis predisposes to peritoneal infection5. Though blood spread in
cases of septicaemia and pyaemia but is rare.
Systemic or localized infections (such as tuberculosis) may rarely have a peritoneal
localisation.
II-Non-infected peritonitis:
1- Leakage of sterile body fluids into the peritoneum, such as blood, gastric juice (e.g.,
peptic ulcer, gastric carcinoma), bile (e.g., liver), urine (pelvic trauma), pancreatic juice
(pancreatitis).
Note: While these body fluids are sterile at first, they frequently become infected once they
leak out of their organ, leading to infectious peritonitis within 24 to 48 hours.
2- Sterile abdominal surgery under normal circumstances, causes localized or minimal
generalized peritonitis through a foreign body reaction and/or fibrotic adhesions.
Pathophysiology
• In normal conditions, the peritoneum appears greyish and glistening. It becomes dull 2–4
hours after the onset of peritonitis, initially with serous or slightly turbid fluid.
• Peritonitis is caused by leakage of contents from abdominal organs into the abdominal
cavity, usually as a result of inflammation, infection, ischemia, trauma, or tumor
perforation.
• Bacterial proliferation occurs.
• Edema of the tissues results and exudation of fluid develops in a short time.
• Fluid in the peritoneal cavity becomes turbid with increasing amounts of protein, white
blood cells, cellular debris, and blood. The immediate response of the intestinal tract is
hypermotility, followed by paralytic ileus with an accumulation of air and fluid in the
bowel.
• Later on, the exudate becomes creamy and suppurative. It may be spread to the whole
peritoneum.
Nursing process:
Assessment
Signs and symptoms of peritonitis:
3. • Symptoms depend on the location and extent of the inflammation.
• Abdominal pain and tenderness. At first, a diffuse type of pain is felt. The pain tends to
become constant, localized, and more intense near the site of the inflammation.
• Diffuse abdominal rigidity, Swelling and tenderness in the abdomen with pain ranging
from dull aches to severe, sharp pain is often present, especially in generalized peritonitis.
• Fever and chills, loss of appetite, thirst, nausea and vomiting.
• Reduced urine output
• Not being able to pass gas or stool
• Sinus tachycardia
• Development of paralytic ileus (i.e., intestinal paralysis), which also causes nausea,
vomiting and.
• Abdominal distension
• Auscultation reveals absent of bowel sound due to paralytic ileus
• In neglected cases the patient will present by sunken eyes
Diagnostic parameters:
• A diagnosis of peritonitis is based on the clinical manifestations.
• Blood picture for leukocytosis.
• Hypokalemia, hypernatremia, and acidosis may be present, but they are not specific
findings.
• Abdominal X-rays may reveal dilated, edematous intestines,
• Computed tomography (CT or CAT scanning) may be useful in differentiating causes of
abdominal pain.
• In patients with ascites, a diagnosis of peritonitis is made via paracentesis.
• Culture of the peritoneal fluid can determine the microorganism responsible and
determine their sensibility to antimicrobial agents.
Nursing diagnosis:
• Abdominal pain.
• Fluid volume deficit.
• Alteration in tissue perfusion
Nursing intervention:
1- Monitor and document the severity, consistency, location and other characteristics of
pain.
2- The patient is placed on the side with knees flexed; this position decreases tension on
the abdominal organs and maximize comfort.
3- Accurate recording of all intake and output and central venous pressure assists in
calculating fluid replacement.
4- Monitor the quantity and quality of output from nasogastric tube.
5- Maintain intravenous therapy.
6- Monitor the patient for signs and symptoms of shock.
7- Monitor the patients bowel sounds by assessing for flatus or bowel movement.
8- Monitor the patients mental, cardiac, and pulmonary status.
9- Monitor Signs that indicate that peritonitis is subsiding include a decrease in
temperature and pulse rate, softening of the abdomen, return of peristaltic sounds,
passing of flatus, and bowel movements.
10- Increases fluid and food intake gradually and reduces parenteral fluids as prescribed.
4. Medical Treatment of peritonitis:
•General supportive measures such as intravenous rehydration and correction of electrolyte
disturbances.
• Antibiotics are usually administered intravenously, but they may also be infused directly
into the peritoneum.
Surgical treatment:
Laparotomy is needed to perform a full exploration and lavage of the peritoneum.
Preoperative preparation:
• A nasogastric tube is inserted to deflate the stomach and bowels and to prevent vomiting
during induction of anesthesia.
• Intravenous fluids as saline or ringer solution are administered to correct the hypovolemia.
• Antibiotics: a combination of ampicillin, an aminoglycoside and metroniazol can cover
all aerobic and anaerobic organisms.
• Analgesics are given for pain relieve.
• Foley catheter is inserted to check the urine output and the adequacy of fluid replacement.
Post operative care:
• Continuous antibiotic treatment.
• Drains are inserted during the surgical procedure, and the nurse must observe and record
the character of the drainage post-operatively.
• Care must be taken when moving and turning the patient to prevent the drains from being
dislodged.
• Prepare the patient and family for discharge by teaching him to care for the incision and
drains if he will be sent home with the drains.
Complications
• Sequestration of fluid and electrolytes, as revealed by decreased central venous pressure,
may cause electrolytes disturbances.
• Hypovolemia, leading to shock and acute renal failure.
• A peritoneal abscess.
• Sepsis may develop, so blood cultures should be obtained.
• The fluid may push on the diaphragm, causing splinting and subsequent breathing
difficulties.
• Formation of fibrous tissue in the peritoneum.
• Adult respiratory distress syndrome.