This document provides information on obstructive jaundice in infants. It discusses the various causes of obstructive jaundice including biliary atresia, choledochal cysts, and inspissated bile. Biliary atresia is the most common cause requiring surgery and involves blockage of the bile ducts. It is typically treated with the Kasai procedure to reconnect bile flow or liver transplantation. Choledochal cysts are rare congenital cysts of the bile duct that can cause obstruction. Inspissated bile occurs when thickened bile blocks the ducts in newborns. The document outlines presentations, investigations, and treatments for different types of obstructive jaundice in infants.
Nuclear medicine in biliary tract disordersRamin Sadeghi
In this presentation, application of nuclear medicine in biliary tract disorders is explained including cholecystitis, sphicter of Oddi dysfunction, neonatal cholestasis, biliary leak, etc.
Nuclear medicine in biliary tract disordersRamin Sadeghi
In this presentation, application of nuclear medicine in biliary tract disorders is explained including cholecystitis, sphicter of Oddi dysfunction, neonatal cholestasis, biliary leak, etc.
The surgical causes for jaundice in children- both in neonates and infants- are Biliary atresia, Choledochal cyst, Biliary hypoplasia, Inspissated bile syndrome, and spontaneous perforation of CBD. How to Diagnose & Treat all these causes.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
The surgical causes for jaundice in children- both in neonates and infants- are Biliary atresia, Choledochal cyst, Biliary hypoplasia, Inspissated bile syndrome, and spontaneous perforation of CBD. How to Diagnose & Treat all these causes.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Dear Viewers,
Greetings from “ Surgical Educator”
Today I have uploaded a video on one of the congenital causes for obstructive jaundice- Biliary Atresia. In this episode, I am discussing about the etiology, types, clinical features, investigations, treatment and surgical outcome of Biliary Atresia. I hope you will enjoy the video. You can watch all my surgical teaching video casts in the following link: surgicaleducator.blogspot.com.
Hepatic cysts are abnormal fluid-filled spaces in the hepatic parenchyma and biliary tree
They are categorized into 3 main types:
fibrocystic diseases of the liver
cystadenomas and cystadenocarcinomas
and hydatid cysts
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- 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.
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
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
2. Yellowish discoloration of the skin, mucous
membranes, and sclerae of the eyes
Hyperbilirubinemia
Deposition of bile salts in these tissues
Causes of jaundice can be classified into pre-
hepatic, hepatic or post hepatic.
3. Jaundice in the first few weeks of life
categorised into
Hematologic,
Enzymatic/metabolic,
Infectious and
Obstructive
4.
5. Bile
Fluid made by the liver
Two main functions:
1. Carrying toxins and waste products out of
the body
2. Helping the body digest fats and absorb the
fat-soluble vitamins A, D, E, and K
6. • Bile becomes trapped, builds up, and
damages the liver. The damage leads to
scarring, loss of liver tissue, and cirrhosis
• Cirrhosis, portal hypertension, liver failure,
and death
• Deficiency of vitamin A,D,E,K – clotting factor
deficiency – bleeding disorder
10. Neonatal cholestasis is defined as prolonged
elevation of serum levels of conjugated
bilirubin beyond the first 14 days of life.
11. • Biliary atresia
• Choledochal cyst
• Gallstones or biliary sludge
• Alagille syndrome
• Inspissated bile
• Cystic fibrosis
• Neonatal sclerosing cholangitis
• Congenital hepatic fibrosis/Caroli’s disease
• Intrahepatic hypoplasia
• spontaneous perforation of the bile duct
12. Obstructive jaundice in infancy
surgical challenge
Short time between the appearance of the
jaundice and the optimal time for surgical
intervention
between 4 and 6 weeks
13. Biliary atresia: most common cause of
obstructive jaundice
requiring operation in children
Choledochal cyst: 2nd most common cause
15. Rare
1:18,000 infants
More common in
Females
Premature babies,
Children of Asian or African American
heritage
16. • Multiple causes: none proven yet
• Not an inherited disease
• Some are:
1. Viral or bacterial infection after birth
cytomegalovirus, retrovirus, or rotavirus
2. Immune system problem
when the immune system attacks the
liver
or bile ducts for unknown reasons
3. Genetic mutation
4. Problem during liver and bile duct
development in the womb
17. 1. Fetal(syndromic) : appears while the baby is in
the womb
• known as the embryonic type
• associated congenital anomalies such as an
interrupted inferior vena cava, preduodenal
portal vein, intestinal malrotation, situs inversus,
cardiac defects, and polysplenia.
• In this variety, which accounts for 10% to 20% of
all
2.Perinatal(Nonsyndromic):
more common
become evident at 2 to 4 weeks after birth
18. • Type I:
occlusion of common bile duct;
• type IIa
obliteration of common hepatic duct;
• type Iib:
obliteration of common bile duct, hepatic and
cystic ducts, with cystic dilatation of ducts at the
porta hepatis and no gallbladder involvement;
• type III:
obliteration of common, hepatic, and cystic
ducts without anastomosable ducts at porta
hepatis.
19.
20. The biliary system originates from the hepatic
diverticulum of the foregut at 4 weeks’
gestation.
This differentiates into cranial and caudal
components, which give rise to the
intrahepatic and extrahepatic bile ducts,
respectively.
21.
22. • Jaundice
• Dark urine
• Gray stools
From a lack of bilirubin reaching the
intestines
• Slow weight gain and growth
• Hepatomegaly
23. Routine Examinations
Color of stool
Consistency of the liver
Conventional liver function tests, including
test for γ-glutamyl transpeptidase
Coagulation times (PT, aPTT)
24. Special biochemical studies
Hepatitis A, B, C serologic studies
TORCH titers
α1-Antitrypsin level
Serum lipoprotein-X
Serum bile acid
25. The goals of imaging are:
To confirm the presence of an extra-hepatic
obstruction
To determine the level of the obstruction
To identify the specific cause of the
obstruction
To provide complementary information
relating to the underlying diagnosis
26. Confirmation of patency of extrahepatic bile
ducts
Duodenal fluid aspiration
Ultrasonography
Hepatobiliary scintigraphy
Endoscopic retrograde
cholangiopancreatography
Near-infrared reflectance spectroscopy
27. Other:
Needle biopsy of the liver for histopathologic
studies
Laparoscopy
Surgical cholangiography
28. Biliary atresia is treated by
surgery- Kasai procedure or
a liver transplant
Kasai opretaion- Named after the surgeon
Morio Kasai
This procedure is most effective in infants
younger than 3 months old
As they usually haven’t yet developed
permanent liver damage
29. Surgeon removes the infant’s damaged bile
ducts and brings up a loop of intestine to
replace them.
As a result, bile flows straight to the small
intestine
32. No bile drainage (10%)
Bile drainage (90%)
1/3 Fail- severe liver disease
1/3 indeterminate- moderate liver
disease
1/3 “Cured”- minimal liver disease
33. Liver Transplant
Liver transplantation is the definitive
treatment for biliary atresia
Survival rate after surgery has increased
dramatically in recent years
36. A choledochal cyst is a rare congenital
swelling of the hepatic or bile duct .
These cysts can be intrahepatic, meaning that
they occur in the part of the duct located
inside of the liver.
They can also be extrahepatic, meaning part
of the bile duct that is located outside the
liver.
37. Frequently include an anomalous junction of
the pancreatic duct and CBD
(pancreaticobiliary malunion [PBMU])
Intrahepatic bile duct dilatation with or
without downstream stenosis
Varying degrees of hepatic fibrosis
38.
39. • Congenital weakness of the bile duct wall, a
primary abnormality of proliferation during
embryologic ductal development, and
congenital obstruction have been postulated
• In 1969, the “long common channel theory”
was Proposed:
PBMU allows reflux of pancreatic enzymes
into the CBD, which leads to disruption of the
duct walls
40. Pancreaticobiliary ductal junction has been
demonstrated to be outside the duodenal wall
before the eighth week of gestation and then
migrates normally toward the duodenal
lumen.
Thus, PBMU may persist as a result of arrest
in this migration.
42. • Type I:
Classic cyst type characterized by cystic
dilatation of the common bile duct; most
common, comprising 50–85% of all biliary cysts;
subdivided into
IA -cystic
IB -saccular
IC -fusiform
• Type II:
Simple diverticulum of the extrahepatic biliary
tree, comprising less than 5% of all cysts; located
proximal to the duodenum
• Type III:
Cystic dilatation of the intraduodenal portion
of the extra hepatic common bile duct; also
known as a choledochocele; comprise
approximately 5%
43. • Type IV:
Involve multiple cysts of the intrahepatic and
extrahepatic biliary tree
subdivided into
type IVA: Both intrahepatic and extrahepatic
cysts
Second most common type 30–40%
Type IVB: multiple extrahepatic cysts without
intrahepatic involvement
• Type V :
Isolated intrahepatic biliary cystic disease
Known as Caroli's disease
Associated with periportal fibrosis or cirrhosis
Multilobar or confined to a single lobe
44.
45. The classic triad
Pain, jaundice, and abdominal mass.
Conjugated bilirubin (80%),
Failure to thrive
Intermittent jaundice and recurrent
cholangitis
pancreatitis
46. • Raised white blood cell count, (increased immature
neutrophils in patients with cholangitis).
• Abnormal LFTs - cholestasis.
• Serum amylase and lipase concentrations may be
increased in the presence of pancreatitis.
• Serum amylase concentrations also may be elevated
in biliary obstruction and cholangitis.
• Abdominal ultrasonography
• Technetium 99m Tc hepatobiliary iminodiacetic acid
(HIDA) scan is often used and is particularly useful for
showing continuity with bile ducts and diagnosis of
cyst rupture
• Abdominal CT scan and MRI help to delineate the
anatomy of the lesion and of the surrounding
structures
• Percutaneous transhepatic cholangiography (PTC) or
endoscopic retrograde cholangiopancreatography
(ERCP)
47. • If a patient presents with pancreatitis or
cholangitis,
treated supportively prior to definitive
operative management
• Radical excision of the cyst with
reconstruction of the biliary tract using a
Roux-en-Y loop of jejunum.
• Complete resection of the cyst is important
because of the association with the
development of cholangiocarcinoma.
48.
49. • Ascending cholangitis
• Intrahepatic bile duct stones
• Intrapancreatic terminal choledochus calculi
• Pancreatic duct calculus
• Stones in the blind pouch of the end-to-side
Roux-en-Y hepaticojejunostomy
• Bowel obstruction
• Cholangiocarcinoma
• Liver dysfunction
• Pancreatitis
50. • Inspissated bile within the distal common bile
duct may cause obstructive jaundice in newborns
• Due to haemolysis, diuretic therapy, parenteral
nutrition, prematurity, or cystic fibrosis.
• Inspissated bile plug syndrome difficult to
distinguish from biliary atresia.
• In both conditions-
jaundice and acholic stools, conjugated
hyperbilirubinaemia, and no biliary excretion on
a radionuclide scan.
• USG reveals dilated proximal bile ducts and
inspissated bile.
51. • Exceptionally small but grossly visible and
radiographically patent extrahepatic biliary
duct system
• Neonatal hepatitis,α1-antitrypsin deficiency,
intrahepatic biliary atresia, Alagille syndrome,
and
• Non cannot be improved by surgical
maneuvers. The prognosis is highly variable
and depends on the primary disease.
52. • Genetic disorder
• Inherited in an autosomal dominant pattern,
and its estimated prevalence is 1 in every
100,000 live births
• Typical features: peculiar facies with a high,
prominent forehead and deep-set eyes,
chronic cholestasis, butterfly-like vertebral
arch defects, and heart disease (usually
peripheral pulmonary stenosis)
• respond to supportive measures such as
treatment with ursodeoxycholic acid and
phenobarbital.
• May need liver transplantation as well
53. Jaundice beyod the age of 14 days need
meticulous investigation and obstructive
causes to be ruled out.
Obstructive jaundice, timely intervention can
save a great hazard of liver failure and need
of liver transplantation.