1. Surgical illness during pregnancy requires careful consideration of risks to both the mother and fetus.
2. The second trimester is generally safest for elective surgery due to lower risks of teratogenesis, miscarriage, and preterm delivery.
3. Emergency surgery may be required at any time in pregnancy to stabilize the mother, with close monitoring of the fetus thereafter.
Cervical cancer is usually a squamous cell carcinoma; less often, it is an adenocarcinoma. The cause of most cervical cancers is human papillomavirus infection. Cervical neoplasia is often asymptomatic; the first symptom of cervical cancer is usually irregular, often postcoital vaginal bleeding. Diagnosis is by a cervical Papanicolaou test and biopsy. Staging is clinical, combined with imaging and pathology results when available. Treatment usually involves surgical resection for early-stage disease or radiation therapy plus chemotherapy for locally advanced disease. If the cancer has widely metastasized, chemotherapy is often used alone.
Cervical cancer is usually a squamous cell carcinoma; less often, it is an adenocarcinoma. The cause of most cervical cancers is human papillomavirus infection. Cervical neoplasia is often asymptomatic; the first symptom of cervical cancer is usually irregular, often postcoital vaginal bleeding. Diagnosis is by a cervical Papanicolaou test and biopsy. Staging is clinical, combined with imaging and pathology results when available. Treatment usually involves surgical resection for early-stage disease or radiation therapy plus chemotherapy for locally advanced disease. If the cancer has widely metastasized, chemotherapy is often used alone.
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. If left untreated, the tumor can spread to other parts of the body. This is called metastatic ovarian cancer.
The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone.
Ovarian cancer often goes undetected until it has spread within the pelvis and stomach. At this late stage, ovarian cancer is more difficult to treat and can be fatal.
Ovarian cancer often has no symptoms in the early stages. Later stages are associated with symptoms, but they can be non-specific, such as loss of appetite and weight loss.
Blood test to measure cancer antigen 125 (CA-125) levels. This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
Biopsy. This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.
Surgery and chemotherapy are generally used to treat ovarian cancer.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
Prostate cancer or tumor is the most common cancer in men other than non-melanoma skin cancer.
The majority (more than 75%) of cases occur in men over age 65.
Risk factors for prostate cancer including increasing age, the incidence of prostate cancer increase rapidly after the age of 50 years. And more than 70% cases occur in men older than 65 year of age.
Nursing assessment and management of patients with hepatic disordersANILKUMAR BR
Liver or Hepatic disorders are common and may result from a virus or exposure to toxic substances such as alcohol.
Another liver disorder is cancer: hepatocellular carcinoma is a highly malignant tumor that is difficult to treat and often fatal.
Liver function is complex, and liver dysfunction affects all body systems.
For this reason, the nurse must understand how the liver functions and must have expert assessment and clinical management skills to care for patients undergoing complex diagnostic and treatment procedures.
The liver plays additional roles in detoxification of chemicals and synthesis and storage of important nutrients and The liver is especially important in the regulation of glucose and protein metabolism .
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. If left untreated, the tumor can spread to other parts of the body. This is called metastatic ovarian cancer.
The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone.
Ovarian cancer often goes undetected until it has spread within the pelvis and stomach. At this late stage, ovarian cancer is more difficult to treat and can be fatal.
Ovarian cancer often has no symptoms in the early stages. Later stages are associated with symptoms, but they can be non-specific, such as loss of appetite and weight loss.
Blood test to measure cancer antigen 125 (CA-125) levels. This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
Biopsy. This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.
Surgery and chemotherapy are generally used to treat ovarian cancer.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
Prostate cancer or tumor is the most common cancer in men other than non-melanoma skin cancer.
The majority (more than 75%) of cases occur in men over age 65.
Risk factors for prostate cancer including increasing age, the incidence of prostate cancer increase rapidly after the age of 50 years. And more than 70% cases occur in men older than 65 year of age.
Nursing assessment and management of patients with hepatic disordersANILKUMAR BR
Liver or Hepatic disorders are common and may result from a virus or exposure to toxic substances such as alcohol.
Another liver disorder is cancer: hepatocellular carcinoma is a highly malignant tumor that is difficult to treat and often fatal.
Liver function is complex, and liver dysfunction affects all body systems.
For this reason, the nurse must understand how the liver functions and must have expert assessment and clinical management skills to care for patients undergoing complex diagnostic and treatment procedures.
The liver plays additional roles in detoxification of chemicals and synthesis and storage of important nutrients and The liver is especially important in the regulation of glucose and protein metabolism .
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy. Miscarriages can happen for a variety of medical reasons, many of which aren't within a person's control.
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
How libraries can support authors with open access requirements for UKRI fund...
Surgical illness's
1. Surgical illness during pregnancy
By;
Dr Syeda Sumaiya(2019-2022)
Pg scholar dept of OBG
NIUM, Bengaluru-91.
Under the guidance of;
Prof Wajeeha Begum
HOD dept
of OBG NIUM,
Bengaluru-91.
2. Principles of general surgery during pregnancy:
• „
Try to avoid major elective surgery, specially abdominal, till delivery.
• Second trimester is the safest time for surgery as the risks of
teratogenesis, miscarriage and preterm delivery are lowest.
• Diagnosis of acute abdomen is difficult in pregnant state.
• „Emergency surgery has to be done at any time during pregnancy.
• Laparoscopic surgery can be performed safely during pregnancy.
3. • Use of non-ionizing imaging procedures, e.g. USG, MRI is
preferred to minimize fetal irradiation.
• Imaging of abdominal organs is difficult in pregnancy due to the
presence of gravid uterus.
• Management of pregnant woman with trauma should always be to
stabilize the mother first, with evaluation of the fetus thereafter.
• Operation should be done preferably by a senior surgeon with an
expert anesthetist. An obstetrician should remain as a standby. „
Minimal handling of the uterus should be done.
4. • „Postoperatively, the patient is to be given pain relief for 48 hours.
Use of tocolytics may be helpful
• Close observation is mandatory for evidences of miscarriage or
preterm labor.
• „In majority of cases, taken all the precautions, the risk of adverse
perinatal outcome is low. However, risk of surgery must be balanced
against the complications of the underlying pathology that need
surgery.
5. ACUTE APPENDICITIS
• Acute appendicitis is the most common acute surgical condition of the
abdomen, it might be obstructive or nonobstructive variety
• Symptoms include:
• Pain abdomen, initial typical pain is diffuse and dull and is situated in
the umbilical or lower epigastric region. Gradually the pain is localised
in the right lower quadrant at or near McBurney’s point.
• Anorexia and nausea
murphy’s triad
Pain Vomiting temperature
6. In pregnancy;
• Incidence is about 1 in 1,000 pregnancies. It is the commonest
nongynecological cause of acute abdomen requiring surgery.
Diagnosis is difficult in pregnancy due to
(a) Nausea and vomiting common in normal pregnancy are also the
common symptoms of appendicitis
(b) Leukocytosis is common in normal pregnancy
7. (c) Appendix moves upwards and outwards as the uterus enlarges. So
pain and tenderness may not be located in the right iliac fossa (Mc
Burney’s point)
(d) Diagnosis is often confused with disturbed ectopic pregnancy,
pyelonephritis, twisted ovarian cyst, abruptio placenta and red
degeneration of a fibroid, preterm labor.
Effect of appendicitis on pregnancy;
may lead to miscarriage, preterm delivery, increased perinatal
mortality and maternal mortality.
8. Effect of pregnancy on appendicitis is adverse because of
(a) late diagnosis
(b) failure of localization due to displacement of the position and as
such
(c) peritonitis is more common, specially, in last trimester.
9. • The risks of maternal and fetal mortality from appendicitis in
pregnancy is high specially when associated with perforations.
Ultrasonography is commonly done.
• Appendiceal mural thickening, peri appendiceal fluid and a non
compressible tubal structure (6 mm or more) are suggestive.
• MRI may be used when ultrasound is inconclusive.
10. TRAUMA IN PREGNANCY
• Trauma in pregnancy may be due to blunt trauma, motor vehicle
accident, fall or following domestic violence.
• Placental abruption is the common complication following minor as
well as major abdominal trauma.
• Common types of penetrating trauma in pregnant women are due to
road traffic accidents, gunshot or stab wounds.
• Maternal death rates in penetrating trauma is two-thirds lower than
in the non-gravid women. It is due to protective effects of the uterus
to other abdominal organs. Fetal death is high (70%).
11. ACUTE PANCREATITIS:
Acute pancreatitis means acute inflammation superimposed on a
normal gland .
Symptoms include;
• Pain abdomen frequently located in the midepigastrium often radiates
to the back or flanks.
• Repeated vomiting with nausea.
12. • It is difficult to diagnose during pregnancy because of the
physiological increase of amylase value during the second and last
trimester.
• Serum amylase is elevated to 1000 IU/L or more, serum calcium is
usually low.
• Ultrasound is of diagnostic value.
• Preterm labor is more common.
• Once the diagnosis is made, the treatment should be conservative
rather than surgical. Medical management includes IV fluids, gastric
acid suppression, analgesia and nasogastric suction.
13. SYMPTOMATIC CHOLELITHIASIS:
• Incidence is about 1 in 2,000 pregnancies.
• It is the second most common nongynecological condition that needs
surgery during pregnancy.
• Initial management is conservative.
• Elective endocystectomy is done in the second trimester or
puerperium.
14. • Deterioration of clinical condition despite medical therapy or
recurrent biliary colic needs cholecystectomy regardless of trimester.
• Laparoscopic cholecystectomy can be done in the second trimester of
pregnancy safely.
15. PEPTIC ULCER:
• It is rare during pregnancy to appear for the first time.
• The course of the disease is unpredictable.
• Perforation and hemorrhage are uncommon during pregnancy.
• Infection with Helicobacter pylori plays an important part in the
pathogenesis.
• TREATMENT: Directed to inhibit acid production (H2 blocker),
acid neutralization (antacids) and eradication of H. pylori infection
(antibiotic).
16. LAPAROSCOPY IN PREGNANCY
• Laparoscopic surgery can be performed safely during pregnancy.
• Second trimester is the best time.
• Fetal risks and preterm labor are less as the uterine manipulation and
the use of narcotics are less.
17. Guidelines of laparoscopic surgery during pregnancy (SAGES,
2008)
1. Obstetric consultation is essential for preoperative and
postoperative management.
2. Diagnostic laparoscopy is safe and effective when done in a well
selected case. Laparoscopy can be done safely during any trimester
of pregnancy.
3. Gastric emptying time is prolonged in pregnancy. Risk of
aspiration during anesthesia could be reduced using antacid, and H2
blocker beforehand.
18. 4. Patient should be in the left lateral decubitus with minimum reverse
Trendelenburg
5. Open technique (Hasson) for entering the abdominal cavity to be
used. Veress needle may be avoided.
6. Antithrombotic prophylaxis are: use of pneumatic compression
devices (intraoperative as well as postoperative) and early
postoperative ambulation.
19. 7. CO2 pneumoperitoneum is maintained at 12–15 mm Hg, keeping
intraperitoneal pressure minimum.
8. Maternal end tidal CO2 should be maintained at 25–30 mm Hg
(capnography) to minimize maternal and fetal acidosis.
9. Fetal monitoring is to be continued and pneumoperitoneum is to
be released if fetal distress arises.
10. Operative time should be minimum as possible.
20. ACUTE PAIN IN ABDOMEN DURING
PREGNANCY
• Some amount of abdominal pain is common during pregnancy.
• One should be very careful to distinguish the pathological variety
from the physiological one.
• A meticulous history coupled with systematic and thorough
examinations (general, abdominal and vaginal) are mandatory to
arrive at a diagnosis on the real state of affairs.
• Many a times a delay in the diagnosis of a nongestational cause
terminates fatally.
21. • Consultation with a surgeon or a physician should be done whenever
felt necessary.
• Laboratory tests, ultrasonography and X-ray are helpful diagnostic
parameters.
• However, their limitations and restrictions in pregnancy should be
borne in mind.
• The physician should be conscious of the entity of disturbed tubal
pregnancy in early months and rupture of the uterus, in the later
months while dealing with acute abdomen in pregnancy.
22. early late medical surgical gynaecological
• Abortion
• Disturbed ectopic
• Hydatidiform
mole
• Acute
polyhydramnios
• Abruptio
placentae
Preterm
labour pains
• Rupture
uterus
• Polyhydramni
os
• Acute
fulminating
preeclampsia
• Eclampsia
• HELLP
syndrome
• Torsion of the
uterus
• Pyelitis
• Pyelonephritis
• Pneumonia
• Cystitis
• Hepatitis
• Acute fatty
liver
• Peptic ulcer
• Acute
appendicitis
• Intestinal or
gastric
perforation
• Intestinal
obstruction
• Volvulus
• Rectus sheath
hematoma
• Cholecystitis
• Choledocholithi
asis
• Biliary colic
• Renal or
ureteric calculi
• Malignant
disease
• torsion of
ovarian cyst
• Red
degeneration of
fibroid
• Retention of
urine due to
retroverted
gravid uterus
impacted
fibroid or
ovarian tumor
obstetrical nonobstetrical
