Reproductive tract fistulae are abnormal communications between the urinary tract and/or gastrointestinal system and the reproductive tract. They are most commonly caused by prolonged obstructed labor without access to emergency obstetric care. The document defines and classifies reproductive tract fistulae, outlines their epidemiology and risk factors, pathogenesis, clinical manifestations, diagnosis, and management including surgical repair as well as prevention through improved access to emergency obstetric care and changing socio-cultural practices.
This document provides an overview of vesico-vaginal fistula (VVF), including its prevalence globally and in Nigeria, historical perspectives, causes, classifications, management approaches, prevention strategies, and VVF centers in Nigeria. It discusses that VVF is most common in Asia and Sub-Saharan Africa, with an estimated 50,000-100,000 new cases annually. Nigeria accounts for 40% of global VVF cases. The document outlines classifications of VVF based on anatomy, severity, and size. Surgical repair is the primary management approach and can be performed vaginally or abdominally depending on the fistula. Post-operative care and prevention strategies aimed at reducing poverty, illiteracy and harmful practices are also
- The Triple-P procedure is a three step conservative treatment to prevent significant hemorrhage and peripartum hysterectomy involving obstetricians, anesthetists and interventional radiologists.
- A sequence of conservative measures should be attempted before resorting to hysterectomy to control uterine hemorrhage. If one measure does not succeed, the next should be swiftly instituted.
- Indecisiveness in treating hemorrhage can lead to potentially fatal excessive bleeding, while delay also increases blood loss and risks from complications like coagulopathy. Timing of hysterectomy is critical to outcome - it should be neither too early nor too late.
The document describes a case discussion of a 12-year-old female patient who presented with lower abdominal pain and urinary retention and was diagnosed with an imperforate hymen after examination found a bulging hymenal membrane and imaging showed hematocolpos. The case discussion covers the patient's presentation, diagnosis, management via hymenotomy, and final diagnosis of acute urinary retention related to an imperforate hymen. Key details on the embryology, presentation, diagnosis and management of imperforate hymen are also reviewed.
Obstructed labour occurs when progress of labour stops due to mechanical factors despite adequate uterine contractions. It is a leading cause of maternal and fetal morbidity and mortality worldwide. Risk factors include cephalopelvic disproportion, malnutrition, osteomalacia, teenage pregnancy and macrosomia. Prolonged obstructed labour can result in uterine rupture, obstetric fistula, maternal death and stillbirth. Treatment involves relieving obstruction through caesarean section if fetus is alive or craniotomy/caesarean if not. Prevention strategies include good antenatal care, early referral and use of a partograph during labour.
Obstetric fistula is an abnormal connection between the vagina and bladder or rectum caused by prolonged obstructed labor without timely medical intervention. Nigeria accounts for 40% of global fistula cases with around 20,000 new cases annually. Risk factors include poverty, early marriage, and lack of access to emergency obstetric care. Clinical presentation includes urinary or fecal incontinence. Treatment involves surgical repair once inflammation subsides, while prevention focuses on girl child education, empowerment, antenatal care, and emergency obstetric services.
This document discusses genital tract fistulas, specifically defining them as abnormal communications between epithelial surfaces of the urinary and genital tracts. It classifies and describes different types of genital fistulas including genitourinary, intestinogenital, and skin-genital fistulas. The majority of the document focuses on vesicovaginal fistulas, discussing their causes, presentations, evaluations, and treatments. Prevention strategies are also outlined for obstetric and radiation-induced fistulas as well as surgical prevention techniques.
This document provides information on various gynecological surgical procedures including:
- Hysterectomy - removal of the uterus, described are abdominal and vaginal hysterectomy approaches.
- Myomectomy - removal of uterine fibroids, leaving the uterus intact to preserve fertility.
- Dilation and curettage (D&C) - dilating the cervix and scraping the uterine lining, used diagnostically and therapeutically.
- Anterior and posterior colporrhaphy - procedures to repair vaginal wall defects and prolapse.
- Fothergill's operation - vaginal procedure to correct uterine prolapse while preserving the uterus.
Pre-operative, intra-operative and
Obstetric fistula is an abnormal opening between the reproductive tract (usually the vagina) and the urinary tract (frequently the bladder) or alimentary tract (usually the rectum) or both. Obstetric fistula typically develops after several days of prolonged or obstructed labour.
This document provides an overview of vesico-vaginal fistula (VVF), including its prevalence globally and in Nigeria, historical perspectives, causes, classifications, management approaches, prevention strategies, and VVF centers in Nigeria. It discusses that VVF is most common in Asia and Sub-Saharan Africa, with an estimated 50,000-100,000 new cases annually. Nigeria accounts for 40% of global VVF cases. The document outlines classifications of VVF based on anatomy, severity, and size. Surgical repair is the primary management approach and can be performed vaginally or abdominally depending on the fistula. Post-operative care and prevention strategies aimed at reducing poverty, illiteracy and harmful practices are also
- The Triple-P procedure is a three step conservative treatment to prevent significant hemorrhage and peripartum hysterectomy involving obstetricians, anesthetists and interventional radiologists.
- A sequence of conservative measures should be attempted before resorting to hysterectomy to control uterine hemorrhage. If one measure does not succeed, the next should be swiftly instituted.
- Indecisiveness in treating hemorrhage can lead to potentially fatal excessive bleeding, while delay also increases blood loss and risks from complications like coagulopathy. Timing of hysterectomy is critical to outcome - it should be neither too early nor too late.
The document describes a case discussion of a 12-year-old female patient who presented with lower abdominal pain and urinary retention and was diagnosed with an imperforate hymen after examination found a bulging hymenal membrane and imaging showed hematocolpos. The case discussion covers the patient's presentation, diagnosis, management via hymenotomy, and final diagnosis of acute urinary retention related to an imperforate hymen. Key details on the embryology, presentation, diagnosis and management of imperforate hymen are also reviewed.
Obstructed labour occurs when progress of labour stops due to mechanical factors despite adequate uterine contractions. It is a leading cause of maternal and fetal morbidity and mortality worldwide. Risk factors include cephalopelvic disproportion, malnutrition, osteomalacia, teenage pregnancy and macrosomia. Prolonged obstructed labour can result in uterine rupture, obstetric fistula, maternal death and stillbirth. Treatment involves relieving obstruction through caesarean section if fetus is alive or craniotomy/caesarean if not. Prevention strategies include good antenatal care, early referral and use of a partograph during labour.
Obstetric fistula is an abnormal connection between the vagina and bladder or rectum caused by prolonged obstructed labor without timely medical intervention. Nigeria accounts for 40% of global fistula cases with around 20,000 new cases annually. Risk factors include poverty, early marriage, and lack of access to emergency obstetric care. Clinical presentation includes urinary or fecal incontinence. Treatment involves surgical repair once inflammation subsides, while prevention focuses on girl child education, empowerment, antenatal care, and emergency obstetric services.
This document discusses genital tract fistulas, specifically defining them as abnormal communications between epithelial surfaces of the urinary and genital tracts. It classifies and describes different types of genital fistulas including genitourinary, intestinogenital, and skin-genital fistulas. The majority of the document focuses on vesicovaginal fistulas, discussing their causes, presentations, evaluations, and treatments. Prevention strategies are also outlined for obstetric and radiation-induced fistulas as well as surgical prevention techniques.
This document provides information on various gynecological surgical procedures including:
- Hysterectomy - removal of the uterus, described are abdominal and vaginal hysterectomy approaches.
- Myomectomy - removal of uterine fibroids, leaving the uterus intact to preserve fertility.
- Dilation and curettage (D&C) - dilating the cervix and scraping the uterine lining, used diagnostically and therapeutically.
- Anterior and posterior colporrhaphy - procedures to repair vaginal wall defects and prolapse.
- Fothergill's operation - vaginal procedure to correct uterine prolapse while preserving the uterus.
Pre-operative, intra-operative and
Obstetric fistula is an abnormal opening between the reproductive tract (usually the vagina) and the urinary tract (frequently the bladder) or alimentary tract (usually the rectum) or both. Obstetric fistula typically develops after several days of prolonged or obstructed labour.
This document discusses the principles of management of vesico-vaginal fistula (VVF). It begins with definitions and classifications of different types of fistulas. The main causes of VVF are discussed as obstructed labor and other obstetric complications. Clinical features include continuous urinary leakage. Surgical repair is the main treatment and involves excising scar tissue and closing the fistula in layers without tension. Factors like adequate drainage, preventing infection, and good surgical technique impact repair success.
This document discusses obstetric fistulas, which occur when tissue dies off between a woman's vagina and bladder or rectum due to prolonged, obstructed childbirth without medical care. Key points include:
- Obstetric fistulas most often affect young, poor, rural women in developing countries who lack access to emergency obstetric care.
- The main causes are prolonged obstructed labor from factors like pelvic abnormalities, early marriage, and childbirth.
- Symptoms include continuous urinary or fecal incontinence. Diagnosis involves physical exams and dye tests.
- Management involves surgery to repair the fistula, along with catheterization and antibiotics. Prevention focuses on increasing
The document discusses peripartum hysterectomy, including its definition, history, incidence and trends, risk factors, types, indications, complications, and techniques. A key point is that a sequence of conservative measures should be attempted before hysterectomy to control uterine hemorrhage, as indecisiveness can lead to fatal excessive bleeding. The "Triple-P procedure" is also summarized as a three-step conservative approach involving obstetric, anesthesia and interventional radiology teams to prevent hemorrhage and need for hysterectomy in high-risk cases.
The urinary bladder develops from the urogenital sinus in weeks 4-7 of development. The bladder absorbs parts of the mesonephric ducts, forming the trigone. The ureters enter the bladder at the base of the trigone. Prenatally, the bladder appears elliptical and anechoic on ultrasound by 13 weeks. Postnatally, urachal anomalies including patent urachus, umbilical-urachus sinus, urachal cyst, and vesicourachal diverticulum can occur and may require surgical excision.
Vaginal myomectomy is a surgical procedure to remove uterine fibroids through the vagina. It is most commonly used for posterior or anterior fibroids that are accessible through the vaginal route. Key eligibility criteria for the vaginal approach include adequate vaginal capacity, uterine mobility, and moderate uterine size. Potential advantages over other routes include shorter recovery time and fewer postoperative adhesions. However, the technique requires skill and appropriate patient selection to minimize risks of complications like infection, hematoma or bowel injury. Further research is still needed to directly compare outcomes of vaginal myomectomy to other minimally invasive approaches.
Micturating cystourethrogram (MCU) involves filling the bladder with contrast material and imaging the lower urinary tract during voiding. It can detect vesicoureteral reflux (VUR), bladder abnormalities, and congenital anomalies. The procedure involves catheterizing the bladder and instilling contrast based on the patient's age or weight. Imaging is done during filling and voiding to identify any reflux or blockages. Complications can include infection, contrast reaction, or trauma from catheterization. MCU is useful for evaluating VUR, recurrent urinary tract infections, genitourinary anomalies, and postoperative issues.
Abdominal wall defects like gastroschisis and omphalocele can cause significant morbidity. Gastroschisis is a defect of the abdominal wall to the right of the umbilical cord through which the intestine and sometimes other organs protrude without a sac. Omphalocele features herniated organs covered by a sac through a defect at the umbilical cord. Management involves prenatal diagnosis, stabilization after birth, and surgical repair. Outcomes have improved but intestinal complications remain challenges, and associated anomalies are common in omphalocele.
An obstetric fistula is an abnormal connection between the vagina and bladder or rectum, usually caused by prolonged labor without prompt medical care. Symptoms include constant urinary or fecal incontinence. Management involves initial catheterization followed by surgical repair once tissues have healed, usually 3 months later. Surgical techniques depend on the location and complexity of the fistula. Post-operative care focuses on drainage and preventing infection to allow healing.
Long term medical morbidities following lower spinal surgery in childrenGopakumar Hariharan
The presentation provides an overview of medical morbidities following lower spinal surgery in children. The discussion is build upon a postoperative case scenario, however the information could be extrapolated to other lower spinal pathologies.
Prune belly syndrome is a rare congenital condition characterized by abdominal muscle deficiency, undescended testes, and urinary tract abnormalities. It results from abnormal development of the abdominal wall and urinary tract during fetal development. Affected individuals present with a wrinkled, floppy abdominal wall and urinary tract defects ranging from kidney abnormalities to urethral issues. Management involves surgical reconstruction of the urinary tract, abdominal wall, and testes to improve symptoms and quality of life. Long term care focuses on urinary tract infections, renal function, and fertility issues related to the condition.
This document provides an overview of anorectal malformations (ARM). It discusses the embryology, classification, associated anomalies, and management of various ARM defects. Primary repair is generally preferred over colostomy for lower defects when the newborn has no serious associated anomalies. The definitive repair technique is posterior sagittal anorectoplasty (PSARP). Postoperative care involves careful monitoring and dilation. While many patients achieve good bowel control, complications can include incontinence and strictures. Prognosis depends on the specific defect and presence of other anomalies.
The document discusses different types of urogenital fistulas including their causes, presentations, diagnoses, and surgical repair techniques. It describes vesicovaginal, urethrovaginal, and ureterovaginal fistulas in detail, outlining their etiologies from obstetric trauma or surgery and treatments including surgical repairs via vaginal or abdominal approaches. Prevention strategies to avoid fistula formation during childbirth or gynecological procedures are also provided.
new new TEGENE,JIMMA, ETHIOPIAN CONGENITAL ABDOMINAL WALL DEFECTtgbk100
1) Abdominal wall defects occur due to interruptions in the normal development of the lateral body wall folds during embryogenesis.
2) The two most common abdominal wall defects are gastroschisis, which is a defect to the right of the umbilicus through which the intestines protrude, and omphalocele, where the intestines are covered by a sac protruding through the umbilical ring.
3) Factors that influence the management and prognosis of abdominal wall defects include the presence of other anomalies, degree of intestinal damage, and optimal timing of delivery.
Placenta accreta is an abnormal placental implantation where the placenta attaches too deeply into the uterine wall. It has become more common, occurring in about 1 in 2,500 deliveries now. There are three types - accreta attaches to the uterus, increta invades the muscle, and percreta invades all the way through the uterine wall. Risk factors include placenta previa, prior C-sections, advanced maternal age, and uterine surgeries. Ultrasound can help diagnose by showing abnormal tissue interfaces and blood flow. Treatment depends on severity but may include attempting manual removal of the placenta, leaving it in place to detach naturally over time, or hyster
Treatment and causes of female infertility.pptxDrdimple2
Treatment and etiology of Infertility in current scenario.
this presentation is based on what are the passible causes of infertility /subfertility in males and females.
what is the current trend of infertility across the globe.
and what could be the possible treatment and management strategies for a couple to get pregnant.
Urinary tract infections (UTIs) are common, especially in females and young children. UTIs are caused by bacterial invasion of the urinary tract and result in inflammation. Common symptoms include fever, urinary urgency, and abdominal pain. UTIs are usually treated with antibiotics like trimethoprim-sulfamethoxazole or fluoroquinolones. Severe or recurrent UTIs may require imaging and long-term preventative management to address risk factors and complications like renal scarring.
At the end of presentation, the participants should be able to understand the following:
Definition of Cerclage
Types of cerclage
Indications
Pre operative Preparations
Removal of Cerclage
Laparoscopy can be performed safely during pregnancy to treat certain conditions like appendicitis and gallbladder disease. While it offers advantages over open surgery like faster recovery, there are also risks to the mother and fetus. Laparoscopy is considered safe in the first and early second trimester, but risks of complications increase in the late second and third trimester due to the enlarged uterus. As such, expertise is important and open surgery may be preferable if laparoscopic skills are lacking. With proper precautions and multidisciplinary care, laparoscopy can effectively treat several acute abdominal conditions during pregnancy while avoiding additional risks compared to open techniques.
1) Placenta accreta spectrum disorders occur when the placenta invades and is inseparable from the uterine wall, posing risks of heavy bleeding. The incidence has increased 10-fold in recent decades due to rising c-sections.
2) Risk factors include placenta previa, prior c-sections, and other uterine surgeries. Early diagnosis using ultrasound and MRI is important for management planning.
3) Management involves a multidisciplinary approach, with the goal of minimizing blood loss through techniques like arterial embolization and hysterectomy if needed. Conservative management is sometimes attempted but carries risks if failed.
Fractures are breaks in the bone that can range from minor cracks to complete breaks. They are often caused by direct impact or force on the bone. The document outlines the types of fractures, signs and symptoms, and principles for managing fractures in the field. Key priorities for treatment include controlling bleeding, immobilizing the fracture, and rapidly evacuating casualties with potential head or spinal injuries.
This document discusses chemotherapy for helminth infections. It describes the life cycles of various parasitic worms (helminths) that infect humans, including nematodes, cestodes, and trematodes. It provides details on the most common anthelmintic drugs used to treat different helminth infections, such as albendazole, mebendazole, praziquantel, and ivermectin. The document focuses on how these drugs act locally or systemically to eliminate worms from the gastrointestinal tract or other tissues and organs.
This document discusses the principles of management of vesico-vaginal fistula (VVF). It begins with definitions and classifications of different types of fistulas. The main causes of VVF are discussed as obstructed labor and other obstetric complications. Clinical features include continuous urinary leakage. Surgical repair is the main treatment and involves excising scar tissue and closing the fistula in layers without tension. Factors like adequate drainage, preventing infection, and good surgical technique impact repair success.
This document discusses obstetric fistulas, which occur when tissue dies off between a woman's vagina and bladder or rectum due to prolonged, obstructed childbirth without medical care. Key points include:
- Obstetric fistulas most often affect young, poor, rural women in developing countries who lack access to emergency obstetric care.
- The main causes are prolonged obstructed labor from factors like pelvic abnormalities, early marriage, and childbirth.
- Symptoms include continuous urinary or fecal incontinence. Diagnosis involves physical exams and dye tests.
- Management involves surgery to repair the fistula, along with catheterization and antibiotics. Prevention focuses on increasing
The document discusses peripartum hysterectomy, including its definition, history, incidence and trends, risk factors, types, indications, complications, and techniques. A key point is that a sequence of conservative measures should be attempted before hysterectomy to control uterine hemorrhage, as indecisiveness can lead to fatal excessive bleeding. The "Triple-P procedure" is also summarized as a three-step conservative approach involving obstetric, anesthesia and interventional radiology teams to prevent hemorrhage and need for hysterectomy in high-risk cases.
The urinary bladder develops from the urogenital sinus in weeks 4-7 of development. The bladder absorbs parts of the mesonephric ducts, forming the trigone. The ureters enter the bladder at the base of the trigone. Prenatally, the bladder appears elliptical and anechoic on ultrasound by 13 weeks. Postnatally, urachal anomalies including patent urachus, umbilical-urachus sinus, urachal cyst, and vesicourachal diverticulum can occur and may require surgical excision.
Vaginal myomectomy is a surgical procedure to remove uterine fibroids through the vagina. It is most commonly used for posterior or anterior fibroids that are accessible through the vaginal route. Key eligibility criteria for the vaginal approach include adequate vaginal capacity, uterine mobility, and moderate uterine size. Potential advantages over other routes include shorter recovery time and fewer postoperative adhesions. However, the technique requires skill and appropriate patient selection to minimize risks of complications like infection, hematoma or bowel injury. Further research is still needed to directly compare outcomes of vaginal myomectomy to other minimally invasive approaches.
Micturating cystourethrogram (MCU) involves filling the bladder with contrast material and imaging the lower urinary tract during voiding. It can detect vesicoureteral reflux (VUR), bladder abnormalities, and congenital anomalies. The procedure involves catheterizing the bladder and instilling contrast based on the patient's age or weight. Imaging is done during filling and voiding to identify any reflux or blockages. Complications can include infection, contrast reaction, or trauma from catheterization. MCU is useful for evaluating VUR, recurrent urinary tract infections, genitourinary anomalies, and postoperative issues.
Abdominal wall defects like gastroschisis and omphalocele can cause significant morbidity. Gastroschisis is a defect of the abdominal wall to the right of the umbilical cord through which the intestine and sometimes other organs protrude without a sac. Omphalocele features herniated organs covered by a sac through a defect at the umbilical cord. Management involves prenatal diagnosis, stabilization after birth, and surgical repair. Outcomes have improved but intestinal complications remain challenges, and associated anomalies are common in omphalocele.
An obstetric fistula is an abnormal connection between the vagina and bladder or rectum, usually caused by prolonged labor without prompt medical care. Symptoms include constant urinary or fecal incontinence. Management involves initial catheterization followed by surgical repair once tissues have healed, usually 3 months later. Surgical techniques depend on the location and complexity of the fistula. Post-operative care focuses on drainage and preventing infection to allow healing.
Long term medical morbidities following lower spinal surgery in childrenGopakumar Hariharan
The presentation provides an overview of medical morbidities following lower spinal surgery in children. The discussion is build upon a postoperative case scenario, however the information could be extrapolated to other lower spinal pathologies.
Prune belly syndrome is a rare congenital condition characterized by abdominal muscle deficiency, undescended testes, and urinary tract abnormalities. It results from abnormal development of the abdominal wall and urinary tract during fetal development. Affected individuals present with a wrinkled, floppy abdominal wall and urinary tract defects ranging from kidney abnormalities to urethral issues. Management involves surgical reconstruction of the urinary tract, abdominal wall, and testes to improve symptoms and quality of life. Long term care focuses on urinary tract infections, renal function, and fertility issues related to the condition.
This document provides an overview of anorectal malformations (ARM). It discusses the embryology, classification, associated anomalies, and management of various ARM defects. Primary repair is generally preferred over colostomy for lower defects when the newborn has no serious associated anomalies. The definitive repair technique is posterior sagittal anorectoplasty (PSARP). Postoperative care involves careful monitoring and dilation. While many patients achieve good bowel control, complications can include incontinence and strictures. Prognosis depends on the specific defect and presence of other anomalies.
The document discusses different types of urogenital fistulas including their causes, presentations, diagnoses, and surgical repair techniques. It describes vesicovaginal, urethrovaginal, and ureterovaginal fistulas in detail, outlining their etiologies from obstetric trauma or surgery and treatments including surgical repairs via vaginal or abdominal approaches. Prevention strategies to avoid fistula formation during childbirth or gynecological procedures are also provided.
new new TEGENE,JIMMA, ETHIOPIAN CONGENITAL ABDOMINAL WALL DEFECTtgbk100
1) Abdominal wall defects occur due to interruptions in the normal development of the lateral body wall folds during embryogenesis.
2) The two most common abdominal wall defects are gastroschisis, which is a defect to the right of the umbilicus through which the intestines protrude, and omphalocele, where the intestines are covered by a sac protruding through the umbilical ring.
3) Factors that influence the management and prognosis of abdominal wall defects include the presence of other anomalies, degree of intestinal damage, and optimal timing of delivery.
Placenta accreta is an abnormal placental implantation where the placenta attaches too deeply into the uterine wall. It has become more common, occurring in about 1 in 2,500 deliveries now. There are three types - accreta attaches to the uterus, increta invades the muscle, and percreta invades all the way through the uterine wall. Risk factors include placenta previa, prior C-sections, advanced maternal age, and uterine surgeries. Ultrasound can help diagnose by showing abnormal tissue interfaces and blood flow. Treatment depends on severity but may include attempting manual removal of the placenta, leaving it in place to detach naturally over time, or hyster
Treatment and causes of female infertility.pptxDrdimple2
Treatment and etiology of Infertility in current scenario.
this presentation is based on what are the passible causes of infertility /subfertility in males and females.
what is the current trend of infertility across the globe.
and what could be the possible treatment and management strategies for a couple to get pregnant.
Urinary tract infections (UTIs) are common, especially in females and young children. UTIs are caused by bacterial invasion of the urinary tract and result in inflammation. Common symptoms include fever, urinary urgency, and abdominal pain. UTIs are usually treated with antibiotics like trimethoprim-sulfamethoxazole or fluoroquinolones. Severe or recurrent UTIs may require imaging and long-term preventative management to address risk factors and complications like renal scarring.
At the end of presentation, the participants should be able to understand the following:
Definition of Cerclage
Types of cerclage
Indications
Pre operative Preparations
Removal of Cerclage
Laparoscopy can be performed safely during pregnancy to treat certain conditions like appendicitis and gallbladder disease. While it offers advantages over open surgery like faster recovery, there are also risks to the mother and fetus. Laparoscopy is considered safe in the first and early second trimester, but risks of complications increase in the late second and third trimester due to the enlarged uterus. As such, expertise is important and open surgery may be preferable if laparoscopic skills are lacking. With proper precautions and multidisciplinary care, laparoscopy can effectively treat several acute abdominal conditions during pregnancy while avoiding additional risks compared to open techniques.
1) Placenta accreta spectrum disorders occur when the placenta invades and is inseparable from the uterine wall, posing risks of heavy bleeding. The incidence has increased 10-fold in recent decades due to rising c-sections.
2) Risk factors include placenta previa, prior c-sections, and other uterine surgeries. Early diagnosis using ultrasound and MRI is important for management planning.
3) Management involves a multidisciplinary approach, with the goal of minimizing blood loss through techniques like arterial embolization and hysterectomy if needed. Conservative management is sometimes attempted but carries risks if failed.
Fractures are breaks in the bone that can range from minor cracks to complete breaks. They are often caused by direct impact or force on the bone. The document outlines the types of fractures, signs and symptoms, and principles for managing fractures in the field. Key priorities for treatment include controlling bleeding, immobilizing the fracture, and rapidly evacuating casualties with potential head or spinal injuries.
This document discusses chemotherapy for helminth infections. It describes the life cycles of various parasitic worms (helminths) that infect humans, including nematodes, cestodes, and trematodes. It provides details on the most common anthelmintic drugs used to treat different helminth infections, such as albendazole, mebendazole, praziquantel, and ivermectin. The document focuses on how these drugs act locally or systemically to eliminate worms from the gastrointestinal tract or other tissues and organs.
This document provides an overview of several important human protozoal infections, including their causative agents, transmission, clinical manifestations, diagnosis, and treatment. It discusses amoebiasis, giardiasis, trichomoniasis, toxoplasmosis, cryptosporidiosis, leishmaniasis, trypanosomiasis, babesiosis, and microsporidiosis. For each infection, it outlines the protozoan parasite involved, how humans become infected, the diseases that can result, how the infection is diagnosed, and the drugs used for treatment. Key drugs discussed include metronidazole, tinidazole, nitazoxanide, chloroquine
The document discusses acute coronary syndrome (ACS), which includes STEMI, NSTEMI, and unstable angina representing varying degrees of coronary artery occlusion. A 12-lead ECG within 10 minutes of arrival is central to diagnosis and risk stratification. STEMI shows ST elevation and elevated enzymes, while NSTEMI shows ST depression/T-wave inversion and elevated enzymes. The primary goals are early reperfusion for STEMI patients via fibrinolysis within 30 minutes or PCI within 90 minutes. Treatment involves oxygen, aspirin, nitroglycerin, morphine and reperfusion therapies like fibrinolytics or PCI, with important timelines to maximize outcomes for ACS patients.
The document provides information on injuries to the musculoskeletal system, including fractures, dislocations, sprains, strains, and compartment syndrome. It discusses signs and symptoms of various injuries, mechanisms of injury, classifications of fractures, assessment of injury severity, emergency medical care including splinting, and complications from orthopedic injuries. Key points covered include the importance of stabilizing injuries before transport, controlling bleeding, preventing further injury, and reducing pain.
Spinal injuries are common, with over 200,000 living with spinal cord injuries in the US. Proper immobilization and treatment can minimize further damage. Immobilization with a rigid cervical collar, backboard, and straps is effective for safe transport while limiting movement. Controversial methylprednisolone therapy may provide benefit if administered within 8 hours of acute spinal cord injury. Communication between emergency staff is important to classify patients and ensure prompt evaluation and treatment for spinal injuries.
Human anatomy is the study of the structures of the normal human body. It is divided into three disciplines: gross anatomy studies the body and parts visible to the naked eye, histology studies cell and tissue structure under a microscope, and embryology studies human development before birth. Common anatomical terms come from Latin and Greek roots and prefixes, such as "intra-" meaning inside and "peri-" meaning around. Anatomy provides definitions for structures like tissues, cells, canals, and meatus, as well as suffixes like "-genesis" denoting development.
This document provides an introduction to physiology and covers several topics including the volume and composition of body fluids, cell membranes, transport across membranes, resting membrane potential, action potentials, and synaptic and neuromuscular transmission. The major intracellular and extracellular fluid compartments are described along with the mechanisms maintaining solute concentration gradients. Key concepts regarding the generation and propagation of action potentials and neurotransmission at chemical synapses are also summarized.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. Reproductive Tract Fistulae
Learning Objectives
At the end of the lesson you should be able to:
• Define reproductive tract fistulae
• Classify reproductive tract fistulae
• Outline the clinical features of reproductive tract
fistulae
• Apply the acquired knowledge to diagnose
reproductive tract fistulae
• Apply the acquired knowledge to manage
reproductive tract fistulae
5/9/2023 2
Dr.Otara A
3. Definition
The presence of a communication between
the urinary tract and / or the
gastrointestinal system and the
reproductive tract
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4. Epidemiology
• Prevalence data on obstetric fistula are not available for most
settings in the developing world.
• Most studies are largely hospital based and therefore cannot be fully
indicative of the magnitude of the problem
• In 1989, WHO estimated that more than 2 million girls and women
around the world had this condition, with an additional 50,000 to
100,000 new cases occurring each year.
• Mabeya et al. Kapenguria, 2004
– The prevalence of obstetric fistula was 1 per 1000 women.
– Age; range 15-46, a mean of 22.8 ( SD +/-6.6) and a median of 20
– 55%of the women were primigravida
– 59% percent had no formal education
– 72% had no occupation.
– 56% were still married at admission and
– 75% had prolonged labor
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5. Epidemiology
• Obstetric fistula is a health condition caused by an interplay of
numerous physical, socio-cultural, political and economic factors of
women.
– The physical factors; obstructed labour, accidental surgery,
injury related to pregnancy and crude attempts at induced
abortion.
– Traditional surgical procedures employed during pregnancy
and labour that lead to obstetric fistula, haemorrhage and
sepsis e.g. include female genital mutilation(FGM) and Gishiri
cut (practised in Nigeria) .
– Socio-cultural factors; early marriage, health seeking
behaviour and availability and utilization of essential obstetric
care services.
– Malnutrition leading to the stunting of the pelvis.
– Illiteracy; determines what kind of medical help is sought, high-
risk pregnancies and unwanted pregnancies
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6. Pathogenesis
• Obstetric fistulae are a result of prolonged
and obstructed labour.
• The anterior vaginal wall and the bladder
become compressed between the fetal
skull and the maternal pubic symphysis,
resulting in pressure necrosis, which gives
rise to obstetric fistula
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7. Classification
• According to aetiology
• According to site
• According to anatomic location
• According to involvement of the sphincter/
closing mechanism ( 5cm from external
urethral meatus)
• According to size of fistuale
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8. Classification
Aetiology
• Obstetrical with reference to:
– Urinary system
– Gastrointestinal system
• Surgical; iatrogenic
• Infections; LGV, TB
• Post-radiotherapy
• Congenital
• Post-traumatic, rape
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9. Classification
Site
• Vesico-vaginal fistulae( VVF)
• Recto-vaginal fistulae (RVF)
• Urethro-vaginal fistula
• Uretero-vaginal fistulae
• Vesico-utero-vaginal fistula
• Vault fistula( after hysterectomy)
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10. Classification
Anatomic location
VVF
Type I: Not involving closing mechanism
Type II: Involving the closing mechanism
A Not involving (sub) total urethra
a Without circumferential defect
b With circumferential defect
B Involving (sub) total urethra
a Without circumferential defect
b With circumferential defect
Type III: Miscellaneous, e.g. ureteric
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11. Classification
Anatomic location
RVF
1. Proximal fistula
a) Without rectum stricture
b) With rectum stricture
c) With circumferential defect( very seldom)
2. Distal fistula
a) Without sphincter ani involvement
b) With sphincter ani involvement
3. Miscellaneous, e.g. ileouterine fistulas( after
instrumental abortion)
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13. Clinical manifestations
• Obstetric fistula is the single most
dramatic aftermath of neglected childbirth
resulting in; social, physical and
psychological effects
• Psychological; most of fistula patients are
ostracized by relatives and divorced by
their husbands
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14. Clinical manifestations
• Uncontrollable urinary or fecal incontinence
• Secondary ammenorhea
• Pain
• Vulval excoriation
• Ammoniacal smell
• Infection; urinary tract infection, vaginitis
• Possible future inability to carry a child even
after repair of fistula.
• A low child survival rate has been shown to be
related to obstetric fistula
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15. Diagnosis
History
• Events of delivery; low parity, difficult or
prolonged labour
• Type of incontinence
• Seek other causes
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16. Diagnosis
Physical examination
• Vaginal inspection- visual, Sims speculum
– site, size, number, fibrosis
• Dye test
• Examination under anesthesia
• IVU if uretero-vaginal fistula is suspected
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17. Management
• Perineal care is important and makes the patient
more comfortable and tolerant of delayed
closure.
• Frequent pad changes are required to minimize
inflammation, edema, and vulvar irritation.
• Incontinence products designed for the larger
volume associated with drainage of urine and
the low viscosity of urine.
• Zinc oxide ointment or a cream containing
lanolin may be especially helpful in the treatment
of perineal and vulvar dermatitis and
excoriations.
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18. Management
• Antibiotics incase of infections, cystitis,
vaginitis and perineal dermatitis
• Bladder catheterization
• Perineal care
• Counselling
• Surgical repair
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19. Management
Surgical Repair
• The timing of repair remains controversial.
• 3 to 6 months after the inciting event or the last
attempt at repair. The delay allows the
inflammatory or necrotic fistula margins that are
thought to be responsible for surgical failure to
resolve.
• This interim period of waiting is often very
distressing for the patient
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20. Management
Surgical Repair
• A successful repair is gauged by whether the
woman is continent of urine
• The operation could be by vaginal,
transperitoneal or transvesical approach.
• Most repairs are vaginally under regional
anaesthetic
• Repairs are generally successful- more than
90%, depending on the extent of damage and
duration of condition
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23. Massive loss of tissue
• Urethra
• Bladder neck
• Absence of vagina
• Circumferential loss
of rectum
• Anal sphincter
rupture
• Cervix fibrotic
Lost tissue
fibrosis
cloaca
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24. Urethra and continence
– Reconstruction with residual tissues have
high rate of failures
– Tabularization of bladder neck
– Flap from anterior bladder wall
– Vaginally
– Abdominally
» Vesicostomy
» Tanagho neo-urethra
» Naude neo-urethra
» Anterior bladder flap
» With and without slings
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25. Complete loss of the
bladder wall functionality
• Augmentation cystoplasty gives :
• Better volumes
• Low pressure
• Better continence
• Neo bladder
• Ilieal conduit
• Continent bladder
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26. Complete loss of the
bladder wall functionality
Neo-bladder
• Uretero-sigmoidostomy
–Classic ( pyelonephritis, acidosis)
–Mainz Pouch II ( less common
complication)
–Sigmoid bladder with colo-anal pull
through (more difficult)
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27. Rectum
Colostomy
Small fistulas can be corrected easily
with 2 layers
Colostomy can be closed 2-3 months
later
In big fistula posterior perineo-plasty is
advisable
Colo – anal anastomose is sometimes
necessary
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28. Vaginoplasty
• Free grafts
• Skin
• Bucal mucosa
• Labia minor flaps
• Skin flaps
• Muscular and fascia flaps
• Bladder
• Colon transposition
– Cecum
– Sigmoid
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29. Indications for a neo-vagina
If intercourse is not possible in a
satisfactory way
• Complex fistula
• Multiple surgeries
• Fibrosis
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30. Complete pelvic
reconstruction
1. Anal sphincter and rectum
2. Select bowel segment ( sigmoid,
cecum, ileum) and do reconstruction
3. Vagina repair or neo vagina
4. Augmentation cystoplasty
5. Ureters reimplantation
6. Urethra reimplantation
7. Sling
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31. Prevention
• Change in the status of women.
– adequate nutrition in childhood
– access to primary education
– eradication of harmful traditional practices like female genital
mutilation
– raising the age of marriage
– Avoid early child bearing.
• Essential obstetrical care; prevention of obstructed
labour, consistent and correct use of the Partograph
• An indwelling catheter for continous bladder drainage for
6 weeks in obstructed labour or fistulae less than 2cm
• Community mobilization; awareness , IEC,BCC.
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