This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
Ultrasound Physics Made easy - By Dr Chandni WadhwaniChandni Wadhwani
History of ultrasound, Principle of Ultrasound.
Ultrasound wave and its interactions
Ultrasound machine and its parts, Image display, Artifacts and their clinical importance
what is Doppler ultrasound, Elastography and Recent advances in field of ultrasound.
Safety issues in ultrasound.
Venography is a radiological procedure for the evaluation of the veins by the help of intravenous radiological contrast media. It is also known as phlebography. Contrast venography is the gold standard for judging diagnostic imaging methods for deep venous thrombosis; although, because of its cost, invasiveness, the increased sensitivity of sonography to demonstrate pathology and other limitations this test is rarely performed.
Ultrasound Physics Made easy - By Dr Chandni WadhwaniChandni Wadhwani
History of ultrasound, Principle of Ultrasound.
Ultrasound wave and its interactions
Ultrasound machine and its parts, Image display, Artifacts and their clinical importance
what is Doppler ultrasound, Elastography and Recent advances in field of ultrasound.
Safety issues in ultrasound.
Venography is a radiological procedure for the evaluation of the veins by the help of intravenous radiological contrast media. It is also known as phlebography. Contrast venography is the gold standard for judging diagnostic imaging methods for deep venous thrombosis; although, because of its cost, invasiveness, the increased sensitivity of sonography to demonstrate pathology and other limitations this test is rarely performed.
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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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
2. Special procedures of biliary system
1. PTC
2. PTBD
3. ERCP
4. T tube cholangiography
3. Anatomy of biliary system
• Organs associated with biliary system
1. Liver
2. Gallbladder
• Ducts associated with biliary system
1. Right & left hepatic duct.
2. Common hepatic duct: 3cm.
3. Cystic duct: 3 to 4 cm.
4. Bile duct : 8cm.
4. Liver
• Large, solid, wedge shaped gland situated in right
upper quadrant of the abdominal cavity.
• Location- whole right hypochondrium, greater part
of epigastrium & extended into left
hypochondrium.
• Divided into right & left lobes by ;
• the attachment of falciform ligament anteriorly &
superiorly.
• By fissure for ligamentum teres inferiorly.
• By fissure for ligamentum venosum posteriorly.
• Caudate lobe is situated on posterior surface &
quadrate lobe on inferior surface.
5.
6. Porta hepatis
• Deep, transverse fissure about 5cm long.
• Situated on inferior surface of right lobe.
• Between caudate lobe above & quadrate lobe below.
• Portal vein, hepatic artery & hepatic nerve plexus enter
through porta hepatis.
• Right & left hepatic duct and few lymphatic leaves
from it.
7. Gall bladder
• It is pear shaped sac, situated in a fossa on
inferior surface of right lobes of liver.
• Fossa for gall bladder extends from right end
of porta hepatis to the inferior border of liver.
• 7- 10 cm long , 3cm broad at its widest part.
• 30 – 50ml in capacity.
• • It acts as reservoir of bile.
• Absorption of water & concentration of bile
8.
9. Cystic Duct
• About 3 – 4cm long.
• Runs downward, backward &
to the left, ends by joining
common hepatic duct at acute
angle to form Bile duct.
• Its mucous membrane form 5-
12 crescentic fold, arranged
spirally, form spiral valve of
Heister (not true value).
10. Bile Duct
• Formed by union of cystic & common hepatic duct near porta hepatis.
• 8cm long, diameter about 6mm.
Course
• Runs downward & backward.
• First in the free margin of lesser omentum – supraduodenal part.
• Behind the 1st part of duodenum - retroduodenal part.
• Lastly embedded in the head of pancreas - infraduodenal part.
• Comes contact with pancreatic duct & accompanies it through the wall of
duodenum - intraduodenal part.
• 2 duct unite to form hepatopancreatic ampulla of vater.
11. Sphincter related to Bile & Pancreatic Duct
i. Sphincter of choledochus:
• Surrounds terminal part of bile duct.
• Always present.
• Keeps lower ends of bile duct closed.
• Bile formed in liver keeps accumulating in gall bladder & also
undergoes considerable concentration.
ii. Sphincter pancreaticus
• Present around terminal part of pancreatic duct.
• Less developed not always present.
iii. Sphincter of Oddi
Controls the flow of bile from liver and pancreas into first part of
duodenum
14. Patient preparations for biliary
examination
• NPO 4 to 6 hours prior to the procedure
• Serology test should be done.
• Haemoglobin prothrombin time and platelets
count is essential for PTC and PTBD
• Premedication including analgesics and
antibiotics
• Patient should be hydrated via IV fluids for
PTC and PTBD
16. Equipments and contrast media
• Fluoroscopic unit
• Chiba needle (22G, 18 cm long)
• Antiseptic solution and sterile gloves and
gauges
• Lignocaine 3% (inj.)
• Contrast media = LOCM 150mgI/ml (20 to 60
mL)
17. Technique
• Patient lie supine on the Fluoroscopy table.
• Best to puncture liver in cranial position as possible.
However it is best to avoid traversing the pleura and it is
essential not to puncture the lungs as the pleural reflection
are much deeper.
• The Skin, intercoastal muscle and liver capsule are
infiltrated with lidocaine, after which 3mm skin incision
is made.
• Under US observation ,during suspended respiration the
chiba needle is inserted into liver but once it is within the
liver parenchyma, patient is allowed shallow respiration.
• Once the needle is inserted the stellate is withdrawn . If
the bile drips from the hub of needle , it indicates that a
duct has been entered .
18. • Injection of CM into bile ducts is recognized by
slow flow of CM.
• Injection of CM outside the bile ducts must be
minimum because it tends to obscure the region
of interest, may be painful and can cause pseudo
obstruction of Intrahepatic bile duct.
• If intrahepatic duct seems to be dilated , bile
should be aspirated and sent for microbiological
examination.
• Contrast media is injected to fill the duct system.
• The needle is withdrawn , care should be taken
not to over fill an obstructed dust system ,
because septic shock may be precipitated
21. Aftercare
• Pulse and BP should be checked half hourly
for 6 hours
• Antibiotic Prophylaxis
• Observe signs and symptoms of peritonitis and
intraperitoneal hemorrhage
23. PTBD
• Percutaneous Transhepatic biliary drainage is a
therapeutic procedure that involves sterile
cannulation of periphery biliary radicle after
percutaneous puncture followed by imaging
guide wires and catheter manipulation
• Placement of External or Internal Stent or tube
completes the procedure
24. Indications
• Decompress Obstructed
Biliary tree.
• Dilate Biliary Strictures.
• Remove the Bile duct stones
when ERCP is contradicted
or fails.
• Divert Bile from Bile duct
leak and stent bile duct
defect.
• Treatment of Acute Biliary
Sepsis
Contraindications
• Bleeding tendency
• Biliary tract sepsis
• Pregnancy
• Hepatitis
• Hyatid diseases
• Massive ascitis
• Multiple biliary obstructions
25. Equipments and contrast media
1. Fluoroscopic unit
2. Chiba needle 18G, 25cm
3. Dilators
4. Guide wire ( J Tipped stiff)
5. Pigtail catheter (12 to 14 Fr)
6. inj. Xylocaine 4%
7. Sterile gloves
8. Disposable syringe
9. Contrast media= LOCM 200 mgI/mL (20 to 60
mL)
26. Technique
• Initial procedure is similar to PTC. It is performed
at first.
• A duct in the right lobe of liver is chosen that has
a horizontal or caudal course to porta hepatis.
• Chiba needle is introduced following
percutaneous puncture through an intercoastal
space in mid axillary line.
• Upon successful puncture, guide wire is inserted
via sheath towards obstruction
27. • The sheath of the needle is removed and
dilator is used to dilate the path of the catheter
• The catheter is then pushed through the
stricture and sited with its side holes above and
below stricture for internal drainage
• For external drainage catheter is connected to a
connector and to a urobag
• Suture is applied to maintain catheter insitu
and elastoplast is applied
28.
29. Aftercare
• As per PTC
• Antibiotics for at least 3 days
• An external drainage catheter should be
regularly flushed via normal saline and
exchanged at 3 months interval
30. Complications
• As per PTC
• Sepsis
• Dislodgement of catheters
• Blockage of catheters
• Perforation of bile ducts
31. ERCP
• ERCP is an combined endoscopic and
fluoroscopic procedure in which an upper
endoscope is led to the 2nd part of the duodenum
making it possible for passage of other tools via
duodenal papilla into the biliary and pancreatic
ducts
Advantages over PTC
• ability to visualize and biopsy of ampullary
lesions
• Greater therapeutic potential
32. Indications
• Investigation of extrahepatic
biliary obstruction
• Post cholecystectomy
syndrome
• Pancreatic diseases
• Investigation of diffuse
biliary tree
Contraindications
• Oesophageal obstructions;
varices; pyloric stenosis
• Previous gastric surgery
• Acute pancreatitis
• Pancreatic pseudocyst
• Severe cardiorespiratory
diseases
33. Equipments and contrast media
1. Side viewing endoscope
2. Polythene catheters
3. Fluoroscopic unit
Contrast media
• For pancreas LOCM 240 mgI/ml
• For bile duct LOCM 150 mgI/ml
34. Technique
• Pharynx is anaesthetized with 4% xylocaine spray and
patient is given 5 mg diazepam until sedated
• Patient lies on left side and endoscope is introduced.
When Ampulla of Vater is located; patient is turned
prone
• A polythene catheter prefilled with contrast is inserted
into ampulla
• A small test injection of contrast under fluoroscopic
control is made is determine position of cannula
• Pancreatic duct is cannulated first and then bile duct
and filled with contrast (over filling is avoided)
35. Filming
• Preliminary film ( prone and LAO) to check for
opaque gallstone and pancreatic calculi
• For pancreas= prone
both posterior obliques
• For bile ducts
I. Early filling films
• Prone ( erect and posterior obliques)
• Supine (erect and both obliques)
• Trendelenburg to fill intrahepatic duct
II. Films following removal of endoscope
III. Delayed films to assess GB and emptying of bile
ducts
36. Aftercare
• Nil orally till sensation has reached to pharnyx
• Pulse; temperature; blood pressure half hourly
for 6 hrs
• Serum/ urinary amylase if pancreatitis
suspected
38. T tube cholangiography
• T tube cholangiograms are fluoroscopic study
performed in the setting of hepatobiliary diseases
• T tube is a special type of tube kept at common
bile duct at the time of surgery (e.g.
cholecystectomy) and retrieval of common bile
duct stones
• Is generally performed at 10th day of surgery and
imaging of biliary tree is done via contrast study
via the tube
39. Indications
• To exclude biliary tract
calculi when operative
cholangiography wasn’t
performed or operative result
is unsatisfactory
• Assessment of biliary leaks
following biliary surgery
Contraindications
• None
40. Equipments and contrast media
• Fluoroscopy unit
• Sterile gloves
• Disposable syringe
Contrast media
• HOCM or LOCM 150 mgI/ml (20 to 30 mL)
41. Technique
• The examination is performed on or about the
tenth postoperative day, prior to pulling out the T
tube
• Patient lies supine on xray table
• The drainage tube is clamped off near to the
patient and cleaned with antiseptic
• 23 G needle, extension tube and 20 ml syringe are
assembled and filled with contrast media
• Needle is inserted into tubing between patient and
clamp and injection is made under fluoroscopic
control depending on duct filling
