Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
TURP step by step operative urology series
for more resources:
www.uronotes2012.blogspot.com
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Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Long segment urethral strictures with a very narrow lumen pose an immense challenges for buccal mucosa augmentation urethroplasty.
Larger discrepancy in size of the graft and the native urethral plate makes it difficult to place the sutures and also makes the graft vulnerable to contracture and fibrosis.
Increasing the width of the urethral plate by a vertical midline mucosal incision and applying an additional inlay buccal mucosal graft may lessen the discrepancy and help in improving the adequacy of the urethral lumen.
Other option to deal with these kind of strictures is dorsal onlay and ventral inlay.
Spongiofibrosis is never full thickness except in traumatic injury ( straddle injury/blunt trauma)
Partial thickness Spongiofibrosis and scarred mucosa can be removed completely and replaced by buccal mucosa.
Lithotomy position
Epidural + general anesthesia.
Vertical perineal incision. Mobilization of bulbar urethra
Dorsal ( one side kulkarni’s technique)or ventral urethrotomy
Vertical midline incision or complete removal of scarred urethral plate with removal of thin layer of spongiofibrosis.
Inlay and onlay grafting done
Urethra closed over 16 fr
Results were analysed on the basis of pre and post operative uroflowmetry.
Any kind of instrumentation was considered as failure.
Mean follow up 630 days.
22 patients have significant better flow rate after surgery
One patient developed ring stricture near proximal anastomosis and managed by urethral dilatation.
One patient developed abscess followed by urine leak and was managed conservatively with indwelling catheter and antibiotics.
Combined urethroplasty avoid complete transection of urethra.
It widens the native urethral plate in an anatomical manner
Reduces the disparity between urethral plate and onlay buccal mucosa.
improves the success rate of long and very narrow bulbar urethra strictures
TURP step by step operative urology series
for more resources:
www.uronotes2012.blogspot.com
enter your mail & press follow us by mail to receive our daily feeds
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Long segment urethral strictures with a very narrow lumen pose an immense challenges for buccal mucosa augmentation urethroplasty.
Larger discrepancy in size of the graft and the native urethral plate makes it difficult to place the sutures and also makes the graft vulnerable to contracture and fibrosis.
Increasing the width of the urethral plate by a vertical midline mucosal incision and applying an additional inlay buccal mucosal graft may lessen the discrepancy and help in improving the adequacy of the urethral lumen.
Other option to deal with these kind of strictures is dorsal onlay and ventral inlay.
Spongiofibrosis is never full thickness except in traumatic injury ( straddle injury/blunt trauma)
Partial thickness Spongiofibrosis and scarred mucosa can be removed completely and replaced by buccal mucosa.
Lithotomy position
Epidural + general anesthesia.
Vertical perineal incision. Mobilization of bulbar urethra
Dorsal ( one side kulkarni’s technique)or ventral urethrotomy
Vertical midline incision or complete removal of scarred urethral plate with removal of thin layer of spongiofibrosis.
Inlay and onlay grafting done
Urethra closed over 16 fr
Results were analysed on the basis of pre and post operative uroflowmetry.
Any kind of instrumentation was considered as failure.
Mean follow up 630 days.
22 patients have significant better flow rate after surgery
One patient developed ring stricture near proximal anastomosis and managed by urethral dilatation.
One patient developed abscess followed by urine leak and was managed conservatively with indwelling catheter and antibiotics.
Combined urethroplasty avoid complete transection of urethra.
It widens the native urethral plate in an anatomical manner
Reduces the disparity between urethral plate and onlay buccal mucosa.
improves the success rate of long and very narrow bulbar urethra strictures
Sometimes Urinary Bladder has to be removed for Bladder Cancer. After this some methods are used for passage of urine, and this is known as Urinary Diversion. This includes Ileal Conduit and Neobladder.
this power point presentation is made ideally according to criteria of ppt. with opener , energizes , bibliography ans much more criteria are followed.thank you..
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
● Abdominal Wall Hematoma
● Walled Off Necrosis Of The Pancreas
● Acute Aortic Thrombosis
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
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
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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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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
2. INTRODUCTION
• URINARY DIVERSION
Diversion of urinary pathway from its natural
path
Types:
• Temporary/Permanent
• External /Internal
• Continent / Incontinent
• Definitive/Palliative
• Orthotopic / Heterotopic
3. HISTORY
• First attempted urinary diversion by Simon in
1852
• Ureterosigmoidostomy is the oldest
• Zaayer in 1911 started ileal conduit and it was
gold standard through 1990’s
• 1950 (Bricker): eastablish ileal conduit as first
choice
4. • In 1979, Camey and Le Duc reported their
pioneer othrotopic neobladder
• Kock and associates reintroduced continent
cutaneous diversion in 1982
6. GOAL OF URINARY DIVERSION
• To provide the best local cancer control.
• To reduce potential range of complications.
• To guarantee the best quality of life for the
patient.
7. PREFERABLE DIVERSION
• Continent reservior connected to urethra
• Ileal segments (lower pressure peaks and ease
of surgical handling)
8. PRINCIPLE OF URINARY DIVERSION
• A reservoir in which to store urine in low
pressure
• A conduit through which the urine is conducted
to the surface
• A continence mechanism
9. BLADDER RESERVOIR
• Able to retent 500-1000ml of fluid
• Maintenance of low pressure after filling
• Elimination of intermittant pressure spikes
• True continence
• Ease of catheterization and emptying
• Prevention of reflux
11. NON CONTINENT DIVESION
• NON CONTINENT DIVERSION involve a wide
stoma and an external appliance to collect the
urine.
TYPE
1.Ileal Conduit
2.Colonic Conduit
3.Jejunal Conduit
12. CONTINENT URINARY DIVERSION
• Heterotopic Continent Diversion
It’s a catheterizable stoma on the abdominal wall to
empty an intra abdominal neobladder
TYPE
1. Right Colonic Pouches
The Indiana Pouch , The Florida Pouch
The Miami Pouch ,The Penn Pouch
2. Ileal Pouches
The Kock Pouch
The Mainz Pouch
13. CONTINENT URINARY DIVERSION
• Orthotopic Continent Diversion
It creates a pelvic neobladder that is anastomosed
to urethra
TYPE
1.Studder neobladder
2.Hautmann neobladder
3. Mainz neobladder
14. PRINCIPLE OF ANASTOMOSIS
• Adequate exposure
• Ensure good blood supply
• Control spillage
• Accurate apposition of serosa to serosa
• Ensure tight
• Realignment of the mesentery
20. Indications For Permanent Diversion
• After radical cystectomy in a case of muscle invasive
bladder tumor, along with radical prostatectomy
• Neurogenic bladder dysfunction due to congenital or
acquired disorders in case of neural tube defect and
spinal cord injury.
• Severe idiopathic detrusor overactivity
• Chronic inflammatory conditions like interstitial cystitis,
Tuberculosis, schistosomiasis and post radiation bladder
contraction
21. • As a palliative diversion in case of irremovable
obstruction in the bladder & distal to bladder
• Severe hemorrhagic cystitis
• Ectopic vesicle
• Incurable vesico- vagina fistula
22. SELECTION OF TYPE OF DIVERSION
• Age/ Survival rate
• Co morbidities
• Oncological Extent of disease
• Renal and Hepatic functional status
• Bowel condition
• Patient’s preferences
• Available expertise
• Mental status
27. ILEAL CONDUIT
• 10-12cm ileal segment isolated 20cm proximal to
IC valve
• Short straight conduit without kinking
• Continuity of small bowel re-established
• Mesenteric window closed
• Ileum in isoperistaltic fashion
28. • Isolated segment flushed with warm saline till
return of clear fluid
• Left ureter brought beneath the sigmoid
mesocolon (inferior to IMA)
• Ureteroenteric anastomosis
29.
30. ILEAL CONDUIT
• After single J ureteral stent is placed in both ureter
• Distal end of ileal segment fashioned as end
ileostomy in RLQ
• A Rutzen bag/ stoma bag can be applied to the
stoma on the fifth or sixth postoperative day with
complete comfort for the patient
31. ILEAL CONDUIT
• ADVANTAGES
Technically simple surgery
Few complication
No bladder retaining
No nocturnal incontinence
Dwayne Tun Soong Chang Published in Urology annals 2015, DOI:10.4103/0974-7796.148553
32. ILEAL CONDUIT
• DISADVANTAGES
Risk of stomal complication eg: parastomal
hernia or stenosis
Urinary incontinance
Increased long term expenses of stoma care
Dwayne Tun Soong Chang Published in Urology annals 2015, DOI:10.4103/0974-7796.148553
33. COLONIC CONDUIT
• Indication
1. Extensive pelvic irradiation
2. When the middle and distal ureter are
absent.
• Containdication
1. Inflammatory large bowel disease
2. Severe chronic diarrhoea
35. INDIANA POUCH
• A segment of terminal ileum approximately 10
cm in length along with the entire right colon is
isolated.
• An appendectomy is performed, and the
appendiceal fat pad obscuring the inferior margin
of the ileocecal junction is removed by cautery.
• The entire right colon is opened along its
antimesenteric border.
36. INDIANA POUCH
• Interrupted Lembert sutures are taken over a
short distance (3 to 4 cm) in two rows for the
double imbrication of the ileocecal valve.
• Application of opposing Lembert sutures on
each side of the terminal ileum
• Excess ileum can be tapered by stapling
technique.
37.
38. INDIANA POUCH
• ADVANTAGES
Potential for normal or near normal urinary
continence
No nocturnal incontinence
No need for a stoma bag
The small stoma can be easily covered with
bandage that is less effect on physical image vs
ileal conduit
Dwayne Tun Soong Chang Published in Urology annals 2015, DOI:10.4103/0974-7796.148553
39. INDIANA POUCH
• DISADVANTAGES
Technically more difficult procedure
Complication associated with intermittent
catherization
Potential complications from urinary waste
product reabsorption
Risk of stomal complication eg: parastomal hernia
or stenosis
40. Neobladder
• The clinical goal of most neobladders is to
– allow volitional voiding 4 - 6 times per day
– capacity range of 400 to 500 mL of urine at low
pressures (>15 cm H2O)
• Two important criteria
– No compromise of oncological outcomes by
reconstruction at the urethroenteric anastomosis
– Rhabdosphincter mechanism must remain intact
to provide continent
41. Types of Neobladder
• Camey I & II
• Hautman
• Kock
• Mainz
• T-Pouch, Florida, UCLA, S pouch, Le bag
• Studer (most common)
42. STUDER NEOBLADDER
• Designated segments of terminal ileum for
construction of neobladder.
• Note that the distal mesenteric division is made
between the ileocolic and terminal branches of
the superior mesenteric artery, which extends
into the avascular plane of the mesentery.
• In addition, a small window of mesentery and a
5-cm segment of proximal small bowel are
discarded to allow mobility to the pouch and
small bowel anastomosis.
47. Metabolic Problems
• Electrolyte Abnormalities
• Abnormal drug metabolism
• Osteomalacia and growth retardation
• Infections
• Formation of renal and reservoir calculi
• Renal deterioration
• Development of urothelial or intestinal cancer
48. Metabolic Problems
• Due to continued solute transport by interposed
segment
• The factors that influence
– Segment of bowel used
– Surface area of the bowel
– The amount of time the urine is exposed
– The concentration of solutes in the urine
– Renal function
– The pH of the fluid
49.
50. • stomach: a hypochloremic hypokalemic metabolic
alkalosis may occur
• jejunum – hyponatremia, hyperkalemia, and
metabolic acidosis occur.
• ileum or colon – hyperchloremic metabolic acidosis
ensues.
• Other electrolyte abnormalities – hypokalemia,
hypomagnesemia, hypocalcemia, hyperammonemia,
and elevated blood urea nitrogen and creatinine.
51. Infection
• An increased incidence of bacteriuria, bacteremia,
and septic episodes occurs in patients with bowel
interposition
• Incidence : 10% to 17% with colon and ileal
conduits
• Patients with continent diversions also have a
significant incidence of bacteriuria and septic
episodes
52. Stones
• Most are infection stone
• Structural or metabolic cause
• Major risk: hyperchloremic metabolic acidosis
• Colon conduits : 3% to 4%
• Ileal conduits : 10% to 12%
• Continent cecal reservoirs : 20%
53. Short bowel and nutritional problem
• Significant loss of ileum
Vit B12 malabsorption : megaloblastic
anemia
Malabsorption of bile salts: diarrhea
Malabsorption of fat: fatty diarrhea
