Ultrasonography is useful for evaluating the normal ovary and detecting abnormalities. A normal ovary appears hypoechoic and contains multiple small follicles. During ovulation, a corpus luteum forms which appears as a solid or cystic structure. Polycystic ovary syndrome is diagnosed based on the number of follicles present. Ultrasonography can also detect cysts, masses, ectopic pregnancies and other ovarian pathologies. It is an important tool for assessing ovarian function and guiding fertility treatments.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
In this presentation we will discuss
First trimester US especially TVS is an integral part for confirmation of intrauterine pregnancy and to rule out ectopic pregnancy.
First trimester US helps us in suggesting conceptus viability.
First trimester US especially TVS is very efficient in approaching and evaluating the cause of vaginal bleeding.
This the second lecture of a series of 3 lectures and deals with the endometrium as it appears during various phases of the menstural cycle, polyps, menopausal bleeding, tamoxifen endometrium, saline sonohysterography etc
Various diseases related to organ in pediatric pelvis of females and males, their imaging features on various modalities such as radiograph, and ultrasound.
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
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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
- 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
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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
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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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2. Normal ovary
Technique
1. F.B., LS of the uterus, TS, slide the probe
towards the fundus. Confirm the ovarian vessels
entering laterally.
LS of the ovary: confirm: ovary is anterior to the
ureter & internal iliac artery.
2. Turn the patient obliquely & scan the opposite
ovary through the F.B., Reduce the gain
ABOUBAKR ELNASHAR
3. Problems:
1. Ovary is not obvious:
use the blood vessels to lead you to the ovary.
2. After hysterectomy:
follow the internal iliac vessels into the pelvis.
3. Postmenopause
4. Gas filled loops:
tipping the head down, erect & oblique erect position
Get ut in transverse plane, put it in middle of screen
Follow the br lig
Push ovary downwards
ABOUBAKR ELNASHAR
4. Position
Extremely variable.
TS:
lateral to the AV uterus
lateral & superior to the RV uterus.
In NP:
bounded by
oblitrated umbilical a. anteriorly
ureter & the internal iliac a. posteriorly
external iliac v superiorly.
Ovarian vessels may or may not be visualized at the
superior aspect of the ovary.ABOUBAKR ELNASHAR
5. Echogenecity
Hypoechoic as compared to the uterus
{ multiple follicle in the cortex}.
Follicles:
Do not exceed 25 mm
round or ovoid, sharply marginated & anechoic.
Medulla & capsule:
higher echogenecity.
ABOUBAKR ELNASHAR
8. Volume
= L X WX T X 0.52
0.5 cm3Prepubertal
5 cm3Reproductive years
2.5X2.2X2 cm.
Diameter >3.5 cm is abnormal
2.5 cm3Postmenopausal
ABOUBAKR ELNASHAR
9. Ovarian size and appearance at
different ages
AppearanceSizeAge
Follicles <10 mm1 mlNeonate
Follicles < 5 mm<1.0 ml<2 y
Follicles <10 mm<2.5 mlPrepubertal
Follicles present9.8 ± 5.8 mlPostpuberty
No follicles› 4 mlPostmenopause ABOUBAKR ELNASHAR
10. Mean ovarian volume
<3 cm3: poor response to HMG
very high cancellation rate during IVF
(Lass et al, 1997)
Mean maximum ovarian diameter
measured in the largest sagittal plane
good estimation of ovarian volume
>3.5 cm: increase risk of OHSS
<2 cm: decreased ovarian reserveABOUBAKR ELNASHAR
11. AFC: Resting follicles.
Total number of follicles 2–8mm
counted in both ovaries
A threshold of 5 AF (2-5 mm) have the lowest error rate
for the prediction of poor response (Bancsi et al.,2004)
ABOUBAKR ELNASHAR
12. Batista et al. 2012
ovarian response prediction index (ORPI)
multiplying the AMH(ng/ml) level by the number of
antral follicles (2–9 mm),and the result was divided
by the age (years) of the patient.
ABOUBAKR ELNASHAR
14. Early in the menstrual cycle. No medications being given.
9 antral follicles.
The ovary has normal volume (30X18mm).
Expect a normal response to injectable FSH.
ABOUBAKR ELNASHAR
15. only 1 antral, other ovary had only 2 antrals
Ovarian volume: low
D3 FSH: normal
Attempts to stimulate ovaries for IVF were not successful
ABOUBAKR ELNASHAR
16. At the beginning of a menstrual cycle, irregular periods, No
medications being given.
Antral follicles:16 are seen in this image. Ovary had a total of 35
antrals (only 1 plane is shown). This is PCO with a high antral
Ovarian volume= 37 X19.5mm
"high responder" to injectable FSH drugs.
ABOUBAKR ELNASHAR
17. POF.
Only the stroma of the ovary is identified.
A very few follicles of less than 1 mm on the inferior aspect of
the ovary.
ABOUBAKR ELNASHAR
18. Diagnosis of Spontaneous Ovulation
1. Mature F. (contain mature oocyte) = 17 – 25 mm
(Inner dimensions)
2. Deflation of the mature follicle
3. Intra peritoneal fluid
-Normal: 1-3 ml
-With ovulation: 4- 5 ml
4. CL: 4-8 days after ovulation
• Irregular thick wall .
• Hypoechoic
• May contain internal echos (hge.)
• 15 mm
ABOUBAKR ELNASHAR
20. Atretic follicle of preovulatory diameter. thin follicle walls and sharp
transition at the fluid-follicle wall interface. The shape of the large
atretic follicle is compromised by small peripheral follicles.ABOUBAKR ELNASHAR
21. Corpus albicans
resulting from regression of a luteal structure from a
previous cycle.
hyperechoic structures within the ovary and they may
occasionally appear to be more pronounced owing to the
presence of surrounding follicles.
ABOUBAKR ELNASHAR
22. Early Corpus Luteum. The site of
rupture of the dominant follicle
soon after ovulation appears as a
collapsed cystic structure (arrow)
Corpus Luteum–Hypoechoic Solid
Appearance. The corpus luteum
appears as a hypoechoic solid mass
(arrow) on the right ovary (o) onABOUBAKR ELNASHAR
23. Corpus Luteum–Thick-Walled Cyst
Appearance. Transvaginal scan
shows an anechoic ovarian cyst
(between calipers, +, x) with
moderately thick walls.
Corpus Luteum–Thin-Walled Cyst
Appearance. This corpus luteum
(arrow, between cursors, +, x) has a
thin wall and contains anechoic fluid.
ABOUBAKR ELNASHAR
24. Corpus hemorrhagicum
thick walls of peripheral luteal tissue and a central
hemorrhagic clot with an interspersed fibrin network.
ABOUBAKR ELNASHAR
25. Failure of ovulation and development of “cystic” follicle.
The follicle typically grows larger than the mean preovulatory
follicle diameter of 23 mm, thin atretic follicle walls and small
flecks of particulate matter are frequently seen in the lumen or
aggregated at the side of the structure.ABOUBAKR ELNASHAR
26. Hemorrhagic anovulatory follicle.
Extravasated blood and an interspersed fibrin network are
observed within the lumen. The walls of this structure are thin,
echoic, and do not have the appearance of luteal tissue.
ABOUBAKR ELNASHAR
28. Endometrioma. Sagittal TVS
an ovarian mass with multiple fine internal echoes (arrows) and
several hyperechoic mural foci (arrowheads).
ABOUBAKR ELNASHAR
29. Ovarian endometrioma (A, B).
The structure is hypoechoic and exhibits low amplitude
uniformly distributed echotexture in the cavities of the
cysts. ABOUBAKR ELNASHAR
30. PCO: Rotterdam, 2004
At least one of the following
12 or more follicles in each ovary measuring 2 to
9 mm in diameter or
Ovarian volume >10 cm3.
Only one ovary meeting these criteria is
sufficient for diagnosis.
The follicle distribution & increase in stromal
echogenecity & volume are not required for
diagnosis.
Absence of mature follicle
ABOUBAKR ELNASHAR
32. Technical recommendation
1. Regularly menstruating females should be scanned
between days 3-5
Oligo-/ amenorrhoeic should be scanned either at
random or between days 3-5 after progesterone –
induced bleeding
2. If there is evidence of a dominant follicle >10 mm or a
corpus luteum, the scan should be repeated the next
cycle.
3. Ovarian volume= 0.5X length X width X thickness
ABOUBAKR ELNASHAR
34. Subtypes of PCO: The images exhibit quite different appearances
in the size and distribution of follicles. A recent corpus luteum is
clearly visible in the ovary in panel (D).
ABOUBAKR ELNASHAR
38. Hyperstimulated ovary
Multiple follicles & cysts of different sizes & shapes
(Cogwheel)
Ascites
Follicular cysts
few mm to 10 cm.
Thin walled, unilocular & hypoechoic
ABOUBAKR ELNASHAR
43. Corpus luteum cyst
Similar to follicular cyst but hemorrhage is frequent & internal
echoes appear.
Difficult to be DD from ectopic pregnancy.
If ruptured: fluid in DP
Para ovarian cyst
Similar to functional cysts but may reach 15-20 cm
ABOUBAKR ELNASHAR
46. Dermoid cyst
Cystic mass containing a cone of solid tissue with highly
echogenic focus & posterior shadowing
Endometrioma
Cystic, mixed or solid. If cystic, difficult to dd from any
other cyst. Commonly low level echoes evently
distributed. 1-20 cm
ABOUBAKR ELNASHAR
47. Endometrioma
Hyperechoic wall foci
(in 35%)
Cysts With Low-level Echoes
Hemorrhagic
cyst
Lacelike
internal
echoes (in
40%)
Teratoma
Regional bright
echoes
(in 97%)
ABOUBAKR ELNASHAR