This document provides guidance and advice to a surgical trainee beginning their first day on call. It emphasizes being prepared with up-to-date patient information and bloodwork. It discusses appropriately evaluating and managing common acute surgical conditions like appendicitis and pancreatitis. Guidance is provided on consenting for procedures and communicating effectively with referral sources. The overall message is to focus on the basics of patient care and know when to escalate concerns, as the document aims to equip the trainee for typical issues that may arise on their first day on call.
SYMPTOMS & SIGNS IN GIT PROBLEMS
• Dear Viewers
• Greetings from “ Surgical Educator”
• I am uploading a PPT presentation on symptoms and signs in GI problems
• What are the questions you have to ask the patients for each problem in GIT is explained
• How to examine and elicit various signs in abdomen is also explained
• I hope this PPT presentation will be very useful to you
• You can watch all my surgery teaching videocasts in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
SYMPTOMS & SIGNS IN GIT PROBLEMS
• Dear Viewers
• Greetings from “ Surgical Educator”
• I am uploading a PPT presentation on symptoms and signs in GI problems
• What are the questions you have to ask the patients for each problem in GIT is explained
• How to examine and elicit various signs in abdomen is also explained
• I hope this PPT presentation will be very useful to you
• You can watch all my surgery teaching videocasts in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
Gallstones are small, pebble-like substances that develop in the
gallbladder. The gallbladder is a small, pear-shaped sac located below
your liver in the right upper abdomen. Gallstones form when liquid
stored in the gallbladder hardens into pieces of stone-like material.
The liquid—called bile—helps the body digest fats. Bile is made in the
liver, then stored in the gallbladder until the body needs it. The
gallbladder contracts and pushes the bile into a tube—called the common
bile duct—that carries it to the small intestine, where it helps with
digestion.
Bile contains water, cholesterol, fats, bile salts, proteins, and
bilirubin—a waste product.
Bile salts break up fat, and bilirubin gives bile and stool a
yellowish-brown color. If the liquid bile contains too much cholesterol,
bile salts, or bilirubin, it can harden into gallstones.
The two types of gallstones are cholesterol stones and pigment
stones. Cholesterol stones are usually yellow-green and are made
primarily of hardened cholesterol. They account for about 80 percent of
gallstones. Pigment stones are small, dark stones made of bilirubin.
Gallstones can be as small as a grain of sand or as large as a golf
ball. The gallbladder can develop just one large stone, hundreds of tiny
stones, or a combination of the two.
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
Gallstones are small, pebble-like substances that develop in the
gallbladder. The gallbladder is a small, pear-shaped sac located below
your liver in the right upper abdomen. Gallstones form when liquid
stored in the gallbladder hardens into pieces of stone-like material.
The liquid—called bile—helps the body digest fats. Bile is made in the
liver, then stored in the gallbladder until the body needs it. The
gallbladder contracts and pushes the bile into a tube—called the common
bile duct—that carries it to the small intestine, where it helps with
digestion.
Bile contains water, cholesterol, fats, bile salts, proteins, and
bilirubin—a waste product.
Bile salts break up fat, and bilirubin gives bile and stool a
yellowish-brown color. If the liquid bile contains too much cholesterol,
bile salts, or bilirubin, it can harden into gallstones.
The two types of gallstones are cholesterol stones and pigment
stones. Cholesterol stones are usually yellow-green and are made
primarily of hardened cholesterol. They account for about 80 percent of
gallstones. Pigment stones are small, dark stones made of bilirubin.
Gallstones can be as small as a grain of sand or as large as a golf
ball. The gallbladder can develop just one large stone, hundreds of tiny
stones, or a combination of the two.
emergencies in patient with abdominal pain to be ruled out first that might save the patients life , with ther clinical minute diagnosis and management in the ER then and there.
Avoiding errors in diagnosing abdominal painDr Varun Patel
Diagnosing Abdominal pain is Emergency department is a tough task. This presentation covers all possible causes of Abdominal pain. As an Emergency Physician you need to look through all these causes of Abdominal Pain in order to not miss a diagnosis.
CE Title: Gastrointestinal Bleeding Scintigraphy: Changing the Paradigm
Presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging, held in Denver, CO on Tuesday, June 13, 2017, 8:00 AM–9:30 AM
Educational Objectives
Upon completion of this activity, the participant will be able to:
1. Interpret GIBS images, planar and SPECT/CT.
2. Compare GIBS with available diagnostic tests used in GI bleeding, including GIB-CTA, endoscopy, etc.
3. Implement the best practice technique for GIBS, based on the revised SNMMI guideline document.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
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.
Follow us on: Pinterest
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
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
3. The basics
• Fast paced - theatre by 8.30
• Your job is to know your patients as if they’re your
babies.
• Up to date list
• Bloods available. Any recent images loaded.
• Do the basics well and these can be sweet jobs. Theatre
/ clinic / audit / skysports.
4. Surgeons ask for help
• Often frustrating but usually comes from a genuine wish for
the best for their patients (…and they’re
figures/reputation/private work….)
• Rule 1: Every referral (and imaging request) must have a
clinical question. If you don’t know the question don’t start
writing the form. Ask your F2’s, CT’s, we remember!
5. Surgeons ask for help
• Rule 2. Phone referrals – arm
yourself.
Success = Not having to get out of seat.
Fail = Get out of seat on 3 occasions to get
notes, then drug chart, then obs chart…
• Have a plan. SBAR
Situation and what you want / clinical question
Background – have the notes to hand
Assessment – what has changed? Obs, fluid balance, drug chart to hand
Request – restate what you need and offer get started with bloods,
Ix etc before they arrive.
6. You’re on call.
First day. 08:10.
Over to you…
Dear Surgical on call.
Please see Bob Smith (25yrs) who is new to the area. He has a
lot of abdominal pain and I world appreciate your opinion
and further management.
Kind regards
7. Case 1 - Appendicitis
• Nice and easy. Not much for you to do.
• Bloods.
• If young and classical case NO XRAY’s. Any other
imaging?
• In a girl she’s always pregnant until you know otherwise.
• Analgesia. NBM.
• Role for antibiotics?
8. Busy morning. Another waiting
• What do you want to know?
• Differentials?
• Looks rough.
Dear Surgical house officer.
Thanks for seeing Jim (52yrs). He’s not quite right. I think it’s
his belly. He’s in quite often because of the alcohol but
usually pleasant enough.
Kind regards
AAA
Pancreatitis
Biliary disease
Peforated Duodenal Ulcer
9. Busy morning. Another waiting
• What are you going to do?
Dear Surgical house officer.
Thanks for seeing Jim (52yrs). He’s not quite right. I think it’s
his belly. He’s in quite often because of the alcohol but
usually pleasant enough.
Kind regards
ABC’s
Big cannulas – FBC, U&E, LFT’s, CRP, Amylase, G&S/Crossmatch ± ABG
Hartmann’s, O2
Examine
Erect CXR (air under diaphragm) & Abdo XR (obstruction)
Pain relief. Monitor urine output. NBM.
Escalate at any stage if unwell – it’s your first day remember!
10. Case 2 - Outcomes
1. HR126, BP100/50, RR22, T37.6C, XR’s normal, WBC
13.2, ALT70, Bili40, ALP300, Amylase1800
Pancreatitis. These can get nasty. Usually need lots of fluid but
beware ARDS (acute respiratory distress syndrome).
The boss: “How worry should I be”
Any ideas?
1 – Observations & general condition
2 – Severity scoring P a02
A ge
N eutrophils (WBC)
C alcium
R enal (Urea)
E nzymes (LDH)
A lbumin
S ugar
<8
>55
>15
<2
>16
>600
<32
>10
So need to
have had
these
bloods &
ABG
≥3 = Severe
Usually HDU/ITU
11. Case 2 - Outcomes
2. Obs stable, Tender epigastric & RUQ, XR’s normal, WBC
15.0, CRP 130, LFT’s normal, Amylase normal. Old USS showed
gallstones.
Acute cholecystitis
But what’s the difference between biliary colic/acute
cholecystitis/ascending cholangitis?
12. Biliary colic
Pain following impaction of gallstone in
gallbladder neck or cystic duct
Epigastric / RUQ pain
Lasting a few hours & N/V
Preceded by fatty meals
WBC & LFT’s normal
Analgesia, USS abdo
If USS shows gallstones delayed
laparoscopic cholecystectomy
Acute Cholecystitis
Inflammation of the gallblader usually following
obstruction of cystic duct by a gallstone
Epigastric / RUQ pain
Lasting a few hours & N/V
↑WBC, LFT’s may be mildly elevated
Murphy’s positive
Analgesia, IVI, IV antibiotics, USS abdo
If USS shows gallstones usually laparoscopic
cholecystectomy – hot/delayed (72hr)
Ascending Cholangitis
Biliary system infection due to a stone in the common bile duct
Charcot’s triad: Abdo pain (RUQ), Jaundice (↑Bili), Fever
Reynolds’ pentad: Charcot’s + septic shock, confusion
In reality these are not always present but the diagnosis is suspected if biliary type
history & septic.
↑WBC & obstructive LFT’s (↑↑bili & ↑↑ALP, ↑ALT)
Murphy’s negative
SEPSIS 6! Initial ultrasound. If some diagnostic doubt MRCP to assess
for CBD stone, if not proceed to ERCP. Delayed lap chole.
13. You were about to go to lunch….
• He’s all yours…
Dear Surgical team.
Good afternoon. Thanks for reviewing Mr Humphries (78yrs)
who’s noticed he’s been getting up to pass urine requently at
night. I started an anticholinergic but this doesn’t seem to
have helped and he seems to have suprapubic pain this
morning.
I’m out of ideas, Thanks
14. I could bloody well kiss you doc.
• Retention - >500ml
• If you can feel a bladder & they can’t wee – catheterise.
• If you’re not sure it probably is but easy to bladder scan most
places.
• Catheter hints:
o Plenty of instillagel
o Hold penis firmly & stetch – straightens urethra
o Bigger catheters get past big prostates easier – 16Fr
o Elbow (Koude) catheters are a godsend if they’re available
• To make you popular with the urologists as well:
o Document how much has drained in 5mins.
o Document if there is blood initially – decompression haematuria
o Check renal function – high pressure/low pressure
15. Consent – to do or not to do?
• GMC: “It is always best for the person actually treating the
patient to seek the patient’s consent. However, you may seek
consent on behalf of colleagues if you are capable of
performing the procedure in question, or if you have been
specially trained to seek consent for that procedure.
• In reality you shouldn’t be consenting for operations.
• You may however be expected to consent for OGD’s &
colonoscopies / flexible sigmoidoscopies
16. The principles
• Check demographics
• State name of procedure
• Explain briefly what it involves
• General anaesthetic / local anaesthetic / sedation
• Check allergy status & if on anti-coagulants
• Benefits – diagnostic vs therapeutic – upper GI bleed
• Risks
OGD
Bleeding – especially if biopsy
Infection – small risk of pneumonia
Perforation - 1 in 9000
Damage to teeth
Colonoscopy / Flexi Sig
Failure – poor bowel prep / not
tolerated
Bleeding – 1/150
Perforation – 1/1500
17. Summary
• Know your patients and be organised. Anything else is a
bonus.
• Arm yourself and SBAR with referrals.
• Stick to your ABC’s with any unwell patient and escalate
– we all need help with sick patients!
• Familiarise with the ‘first hour plan’ for a few conditions –
that’s all you’re expected to manage!
