This case presentation summarizes a 26-year-old male patient with a parumbilical hernia. The patient reported an abdominal swelling for 18 years that increased in size and caused pain over the past 4-5 months. On examination, a 3x4 cm oval, reducible swelling was found in the supraumbilical region. Investigations confirmed the diagnosis of a parumbilical hernia. The patient was diagnosed with a parumbilical hernia with an omentocele and divergence of the recti muscles. The management plan is primarily surgical to close the defect either primarily or with mesh placement.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
This is a small booklet in an outline format to assist undergraduate medical students to aid in writing case write ups. This mainly contains how to elicit symptoms and signs.
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
This is a small booklet in an outline format to assist undergraduate medical students to aid in writing case write ups. This mainly contains how to elicit symptoms and signs.
Long case examination done during MBBS and MD examination. Neurology case is mostly the long case. History, general examination , systemic examination, provisional diagnosis, investigation and final diagnosis are the sequential steps. Neurology examinations includes higher mental function, cranial nerve examination, motor and sensory system examination, cerebellar signs, gait, peripheral nerves, spine and skull and peripheral nerve examination.
FIBROUS-DYSPLASIA-
CASE-PRESENTATION-At-Shaheed-Suhrawardy-Medical-College-Hospital-Dhaka-Bangladesh (1).pptx is queued for conversion. Meanwhile you can add details and save.
CPC held at Frontier Medical College on Acute Pancreatitis
Prepared by Quratulain Nasir,Zeeshan Ghias Khan,Ummair Munawar,Parsa Bashir,Kanwal Shehzadi,Urfa Mir and Zeeshan Ahmed
Similar to Surgery case presentation on anterior abdominal wall hernia (20)
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
7. HISTORY OF PRESENT ILLNESS
The patient complains of a lump in the abdomen along the
midline just above the umbilicus which he first noticed when he
was 8-9 years of age and ignored it. It resembled a marble then.
Suddenly 4-5 months back, he felt pain in the umbilical region
along the midline when he noticed that the lump had then rapidly
increased to the size of a betel-nut. It becomes prominent on
coughing or straining such as on strenous exercise and reduces
spontaneously on lying down on the bed.
The pain is an intermittent dull-ache, moderate in intensity,
aggravated on straining and relieved on leaning forward. There is
no radiation of the pain.
8. HISTORY OF PRESENT ILLNESS
There is no vomiting, no yellowish discolouration of eyes or
urine, no chronic cough or constipation or abdominal
distension.
The bowel, bladder habits are normal, sleep is normal and
the appetite is good. There is no loss of weight.
The patient was referred to GMCH from a CRPF hospital
and after the necessary investigations, he has been called for
surgery at a later date.
9. HISTORY OF PAST ILLNESS
The patient has no history of similar swelling in the past,
elsewhere in the body.
The patient has no history of respiratory problems such as
asthma, cardiac ailments, tuberculosis, diabetes, hypertension,
malaria or any surgical history in the past.
10. PERSONAL HISTORY
The patient is a non-vegetarian and consumes an average
Assamese diet. He does not consume any intoxicants.
11. FAMILY HISTORY
The patient’s family presents with no similar complaints.
No disease runs in the family.
12. SOCIOECONOMIC HISTORY
The patient lives in a pucca house in a 3 membered nuclear
family with his parents and a younger brother.
He is the sole earning member with a monthly income of Rs
18000 and a per capita income of Rs 6000. They use LPG
cylinder as the fuel source for cooking.
They consume tubewell water after filtration.
13. DRUG AND ALLERGY HISTORY
There is no routine consumption of any drug.
There is no history of allergy to any known contactant,
ingestant or inhalant.
16. • Consciousness- The patient is alert and conscious
• Orientation- Well oriented to time, place and person
• Appearance and Facies- Normal
• Decubitus- Of choice
• Build- Average
• Nutrition- Good
• Gait- Normal
• Pallor- Absent
• Icterus- Absent
• Cyanosis-Absent
• Clubbing- Absent
• Dehydration -Absent
• Neck Veins- Not engorged
• Lymph nodes- Not palpable
• Edema- Absent
• Hair ,skin and nails- Normal
• Oral Cavity- Oral hygiene is maintained, no features of malnutrition, no dental caries,
gums , tongue is moist with normal papillae
17. VITALS
• PULSE-
1. Rate- 84 beats/ min
2. Rhythm- regular
3. Character- normal
4. Volume- normovolumic
5. Radioradial or Radiofemoral delay- Absent
6. All peripheral pulses- Palpable
7.Elasticity of arterial wall- present
• BLOOD PRESSURE- 120/72 mm Hg in left arm taken in supine position
• RESPIRATORY RATE- 18/ min, regular, abdominothoracic.
• TEMPERATURE- 98˚F
19. CENTRAL NERVOUS SYSTEM
a) Higher function: The patient is alert, conscious, cooperative and well oriented to time,
place and person.
b) Cranial Nerves: Functions of all the cranial nerves are intact.
c) Motor system: Tone, power and bulk of muscles of all four limbs are normal.
Coordination is normal. No abnormality detected. All the superficial and deep
reflexes are intact.
d) Sensory and autonomic functions are normal.
20. CARDIOVASCULAR SYSTEM
a) Inspection: Precordium is normal. No visible pulsations or engorged veins seen. No
scar is seen.
b) Palpation: Apex beat is palpable just medial to mid-clavicular line in the left 5th
intercostal space. It is normal in character.
c) Auscultation: Heart sounds are normal. No added sounds heard.
21. RESPIRATORY SYSTEM
a) Inspection: Shape and symmetry of chest is normal and symmetrical. Respiratory
movements are bilaterally symmetrical. Respiratory rate is 18/minute and regular in
rhythm. No deformity detected.
b) Palpation: Trachea is in midline. Chest expansion is normal and bilaterally
symmetrical on both sides. Vocal fremitus is bilaterally symmetrical and normal.
c) Percussion: Lung field is uniformly resonant in all the areas. No abnormality
detected.
d) Auscultation: Normal breath sounds are heard in all the areas. Vocal resonance is
normal and bilaterally symmetrical in all the areas. No added sounds heard.
23. INSPECTION
a) Shape and contour of abdomen – Normal.
b) Umbilicus – Inverted, midline in position and midway
between the xiphisternum and pubic symphysis.
c) Skin over the abdomen – No scar, abnormal pigmentation
or engorged veins seen.
d) Movement of abdomen with respiration – All regions are
moving normally with respiration.
e) Any visible peristalsis – None.
f) Any visible pulsations – None.
24.
25.
26. INSPECTION
g) Prominent divaricated edges of both recti along with visi
ble mass is seen.
Site – present in the supraumbilical region along the
midline.
Shape – oval in shape.
Surface – Smooth.
Margins – Well defined.
‘Leg rising test’ and ‘Head rising test’ – the visible
swelling becomes more prominent, hence it is a PARIETAL
SWELLING.
Cough Impulse Test – Expansile impulse on cough is
present.
Any ulceration or skin changes over the defect – None.
27. INSPECTION
h) Inspection of other hernia sites – No swelling and no
expansile impulse on coughing is seen.
i) Inspection of external genitalia – Normal.
28. SUPERFICIAL PALPATION
a) Temperature – No local rise of temperature.
b) Superficial tenderness – Tenderness is present in the umbilical region
over the area of the defect as well as in the midline.
No tenderness present in any of the other areas.
c) Feel of abdomen – Soft and elastic.
d) Any muscle guarding and rigidity – None.
e) Palpation of swelling :-
Site and extent – midline in position just over the umbilicus.
Size – 3x4 cm.
Shape – Oval.
Surface – Smooth.
Margin – Well-defined.
Reducibility of swelling – Swelling is reducible.
Cough impulse test – Positive.
Consistency – Soft, doughy feel on knee elbow position.
Pulsation – none.
Compressibility of swelling – Not compressible on knee elbow
position.
Fluctuation – Absent on knee elbow position.
29. DEEP PALPATION
a) Tenderness – tenderness present only over the defect and in midline, no
tenderness over any of the other areas.
b) Palpation of liver – Not palpable.
c) Palpation of spleen – Not palpable.
d) Palpation of kidneys – Not palpable.
30. PERCUSSION
a) General percussion note over the abdomen – Tympanitic.
b) Percussion note over the swelling – Dull.
c) Shifting dullness – Absent.
d) Fluid thrill – Absent.
e) Liver span – 12.5 cm, upper border in the right 5th
intercostal space.
34. Our patient Karthik Rajbongshi, 26 years old Male is
provisionally diagnosed to be a case of PARAUMBILICAL
HERNIA IN THE SUPRAUMBILICAL REGION OF THE
ABDOMEN, PROBABLY AN OMENTOCELE WITH
DIVERICATION OF RECTI.
40. SERUM SAMPLE
- Hepatitis B Virus (HBsAg TEST) NON REACTIVE
- Hepatitis c Virus (Anti-HCV antibody test) NON REACTIVE
- HIV NON REACTIVE
- Serum TSH 2.02mIU/L
41. RADIOLOGY
X-Ray Chest PA View
-Both the lung fields do not reveal any active parenchymal lesions.
-Trachea is normal in position.
-Hilar shadows are normal.
-Cardiothoracic ratio is normal.Great vessels are within normal limits.
-CP angles are clear and acute.
-Both domes of diaphragm are normal in position and contour.
-Bony thorax is intact.
42. RADIOLOGY
Ultrasonography:
Report is currently not available but according to the consulting doctors who have gone through
thepreviousreports,thereissomedefectintheanteriorabdominalwallwithherniation.
44. “Our patient Karthik Rajbongshi, 26 years old Male is finally
diagnosed to be a case of PARAUMBILICAL HERNIA IN
THE SUPRAUMBILICAL REGION OF THE ABDOMEN
WITH AN OMENTOCELE WITH DIVERICATION OF
RECTI.”
46. THE MANAGEMENT IS PRIMARILY
SURGICAL
1. Primary Closure Of The Defect- An infraumbilical incision is made encircling its lower
half. Sac is dissected circumferentially and is released of from the umbilicus ande
subcutaneous tissue. Sac is opened ; contents are reduced ;excess part is excised up to the
umbilical ring. Defect is closed with interupted nonabsorbable suture.
2. Mayo's Operation- Through a transverse elliptical incision sac is identified and
dissected . Herniotomy is done. Double breasting of the defect in the rectus sheath is
done by interrupted non-absorbable suture.
47. THE MANAGEMENT IS PRIMARILY
SURGICAL
3. Open Dual PTFE and Polypropylene Mesh Placement-
Umbilical hernia is dissected similarly through subumbilical
incision. Redundant sac is excised. Peritoneum is closed. A
special composite mesh containing wider PTFE on the inner
side with little smaller polypropylene mesh on the outer aspect
is used.
4. Laparascopic Umbilical Hernia Repair- It is similar to
any ventral hernia , done under GA. It is usually done for large
umbilical hernia.