This document discusses the role of ultrasound in evaluating gallbladder pathologies. It begins by covering normal gallbladder anatomy and variants. Key pathological findings that can be identified on ultrasound include gallstones, sludge, cholecystitis, polyps, gallbladder cancer, and bile duct stones. Specific ultrasound findings that help characterize these various conditions are presented. The document also reviews ultrasound evaluation of the biliary tract, including assessment of the bile ducts and conditions like Mirizzi syndrome.
Ultrasound detection of colonic polyps Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of USG in the diagnosis of Colonic polyps with charecterization.
Ultrasound detection of colonic polyps Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of USG in the diagnosis of Colonic polyps with charecterization.
A brief overview of Imaging of urinary bladder and urethra for medical students and residents with commonly encountered benign and neoplastic conditions of lower urinary tract.
A brief overview of Imaging of urinary bladder and urethra for medical students and residents with commonly encountered benign and neoplastic conditions of lower urinary tract.
Rapid review of radiology text book, abdominal imaging, contrast imaging, CT , plain x ray, IVU , power point of abdominal pathological cases and description of diagnosis , differential diagnosis of diagnosis
inflammatory bowel disease is a diagnosis of exclusion and it has two form known as crohn's disease which can affect all GI tract from ''gum to bum'' with skip lesion and the formation of cobblestones. ulcerative colitis affect only the colon and also causes proctitis and toxic megacolon. both of the disease has extraGI symptoms like sclerosing cholangitis, uveitis, ankylosing spondylitis,conjunctivitis, liver cirrhosis, pyoderma gangrenosum, arthropathy and althralgia, etc .
The lecture overviews the different situations where cholecystitis can be fatal,if not accurately diagnosed.Different types of dangerous cholecystitis are illustrated with their imaging findings.
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
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
7. NORMAL APPERANCE OF GB
Normal Gallbladder is seen as a sonolucent pear shaped
structure with slim wall (2 mm or so). Best seen with overnight
fasting or at least 4-5 hours fasting. It is seen usually at the
inferior aspect of the liver right lobe.
8. The main hepatic fissure appears as an echogenic
line that extends from the neck of the gallbladder to
the portal vein and serves as a landmark.
The complex of the gallbladder, main hepatic fissure,
and portal vein (in the short-axis) has the
appearance of an exclamation point
08/03/14
12. NORMAL VARIANTS
Phrygian cap
Figure (A) A folded gallbladder is
difficult to examine with the patient
supine.
(B) Turning the patient, right side
raised, unfolds the gallbladder,
enabling the lumen to be satisfactorily
examined.
The gallbladder may be ‘folded’ (the so-
called Phrygian cap).
17. Sludge is identified on ultrasound as slightly hyperechoic material forming a
meniscus within the gallbladder lumen.
Sludge may be a precursor to gallstones and has been related to pathology
such as acute cholecystitis and acute pancreatitis
08/03/14
18. 08/03/14
DD
ECHOGENIC LESIONS
IN GALL BLADDER
DD
MOBILE OR POSTERIOR
SHADOWING
•STONES
•SLUDGE
FIXED
•POLYP
•ADHESIVE STONE
•SLOW MOVING TUMEFACTIVE
SLUDGE
21. CALCULUS CHOLECYSTITIS VS ACALCULUS
Acute cholecystitis refers to the acute inflammation of the
gallbladder . It is the primary complication of cholelithiasis
90 to 95% of cases are due to calculous obstruction of the gallbladder
neck or cystic duct.
Most sensitive US finding :
1. Presence Of Cholelithiasis
2. Sonographic Murphy Sign.
3. Gallbladder Wall Thickening (>3mm)
4. Pericholecystic fluid.
Other less specific imaging findings include gallbladder distension(>4
cm) and sludge.
99m
Tc-HIDA scintigraphy
HIDA cholescintigraphy in acute cholecystitis will demonstrate
nonvisualization of the gallbladder.
22. Figure: Acute cholecystitis: (A) TS of an oedematous, thickened gallbladder wall
with a stone. (B) LS with a thickened wall (arrows). Stones and debris are present.
(C) and (D) TS and LS demonstrating pericholecystic fluid.
23. Sonographic Murphy’s sign
08/03/14
Sonographic Murphy’s sign is positive when the point of maximal tenderness is
identified in the right upper quadrant while the gallbladder is identified on the
ultrasound monitor.
Differential diagnosis of acute cholecystitis
choledocholithiasis
pancreatitis
peptic ulcer disease
acute hepatitis
24. Complications
gangrenous cholecystitis
emphysematous cholecystitis
gallbladder perforation
pericholecystic abscess
cholecystoenteric fistula
liver abscess
Gangrenous and emphysematous cholecystitis - serious complications of acute
cholecystitis that may be identified with ultrasound by the presence of air within
the gallbladder wall or lumen . Air on ultrasound is represented by “comet-
tail” artifacts.
Gallbladder perforation may also be diagnosed by ultrasound. Findings of
perforation include significant amounts of pericholecystic fluid that may contain
echogenic material which may be walled off from the rest of the abdomen.
25. Gallbladder gangrene/mucosal sloughing. Longitudinal
ultrasound of a patient who had acute cholecystitis
secondary to stone (arrow) impacted in the
gallbladder neck. Note the intraluminal membranes
(arrowheads) that are associated with gangrene of
the gallbladder.
28. When the gallbladder is entirely filled with stones, a wall echo shadow
(WES) sign is seen
The WES triad is another sign of chronic cholecystitis; here the WES
stands for Wall (of the GB), Echo (of the calculus) and Shadow
(caused by the stones).
29. ACALCULUS CHOLECYSTITIS
Acute acalculous cholecystitis (AAC) refers
development of cholecystitis either in a gallbladder without
gallstones or in a gallbladder with gallstones where the
stones are not the contribuatry factor to the development
of cholecystitis .
AETIOLOGY
It usually occurs in critically ill or
injured patients.
30. Figure :(A) Acalculous cholecystitis. The gallbladder wall is markedly thickened
and tender on scanning.
(B) Gravity-dependent sludge with a thick, oedematous wall. No stones were
present.
31. PORCELAIN GB
A porcelain gallbladder refers to extensive calcium
encrustation of the gallbladder wall.
The term porcelain gallbladder has been used to
emphasize the blue discoloration and brittle
consistency of the gallbladder wall at surgery
Association between porcelain gallbladder and
gallbladder adenocarcinoma- 22-30 % .
Cholecystectomy routinely performed when a
porcelain gallbladder is identified.
32. Porcelain gallbladder. (A) Sagittal imageof the gallbladder shows a densely
echogenic anterior wall (arrow) with a sharp shadow that obliterates the
gallbladder lumen and posterior wall. (B) Transverse ultrasound of the
gallbladder in the same patient. The anterior wall is bright, but, without enough
reflection or attenuation to eliminate visualization of the lumen and posterior wall
(arrow), which is also echogenic and casts a posterior acoustic shadow.
34. GB POLYPS
Gallbladder polyps are outgrowths of the gallbladder mucosal wall.
Do not cast an acoustic shadow.
Remain fixed on turning the patient ;so distinguishable from stones
Majority are not neoplastic but are hyperplastic or represent lipid
deposits(cholesterolosis).
Gallbladder (GB) polyps are incidentally detected in approximately
4%–7% of patients who undergo ultrasonography
36. GB polyps are soft tissue masses attached to the wall of the gallbladder and
differentiated from gallstones by their lack of mobility and shadowing
38. INCREASE RISK OF MALIGNANCY IN
POLYP
Diameters > 10 mm
Sessile Polyps
Single Polyps
Polyps With Adjacent Wall Thickening Or Invasion
Increased Patient Age
Size Of At Least 10 mm Is The Most Well-established
predictor of malignancy
40. CARCINOMA GB
Gall bladder carcinoma is the most common biliary
tract cancer.
Delayed presentation and early spread of tumor
make it one of the lethal tumors with poor prognosis.
41. RISK FACTOR FOR CA GB
Gallstones
History of chronic cholecystitis
Porcelain gallbladder.
Choledochal cysts,
Anomalous pancreaticobiliary duct junctions
Gallbladder polyps > 1 cm in size.
Peak incidence in the 6th
-7th
decades of life
3-5 times more predominant in females
42. USG FINDINGS IN CA GB
A Mass Completely Occupying Or Replacing The Gallbladder
Lumen
Focal Or Diffuse Asymmetric Gallbladder Wall Thickening
An Intraluminal Polypoid Lesion.
Invasion of adjacent liver parenchyma
Hepatic metastasis
Periportal/ peripancreatic lymphadenopathy
Sonographically : Heterogeneous, Predominantly Hypoechoic
Tumor Fills Much Or All of the gallbladder lumen.
44. 08/03/14
The normal gallbladder wall measures less than 4 mm. the gallbladder wall is measured at the
most narrow point of the anterior wall in the short-axis. Care must be taken to not measure the
wall at an oblique angle
THICKENING OF GALL BLADDER
WALL
DD
FOCAL
ADENOMYOMATOSIS
GALL BLADDER CANCER
DIFFUSE
ACUTE CHOLECYSTITIS
CHRONIC CHOLECYSTITIS
XANTHOGRANULOMATOUS
CHOLECYSTTIS
ADENOMYOMATOSIS
GB WALL EDEMA
GB CANCER
OTHERS-
ASCITIS,CHF,HYPOALBUMINEMIA
48. 08/03/14
BILE DUCTS
Sonographically, the CBD appears as an anechoic tubular
structure in the main portal triad, anterior to and following the
course of the main portal vein
Conventionally, the upper limit of normal for the common bile
duct as measured by ultrasound is considered to be 6 mm.
Biliary duct obstruction: caused by stones, pancreatic
pathology (e.g. mass), or stricture is detected measuring a
CBD larger than 6-7 mm.
2000 Am. Coll. of Gastroenterology
50. The Mirizzi Syndrome
Form of obstructive jaundice-described by
Mirizzi.
Caused by a stone or stones impacted in the
neck of the gallbladder or the cystic duct, such
that the common hepatic duct is narrowed.
Rare complication of gallstones-occurs in about
0.1% to 0.7% of patients with cholelitiasis.
52. Figure: Mirizzi syndrome: a large stone in the
neck of the gallbladder (arrow) is compressing the bile duct,
causing intrahepatic duct dilatation. The lower end of the CBD
remains normal in calibre.
53. COMPONENTS OF MS
There must be 4 components for the syndrome to occur:
1. Anatomy- placing the cystic duct parallel to the common
hepatic duct
2. Impaction of a stone in the cystic dust or gallbladder neck
3. Obstruction of the common hepatic duct from the stone
itself, or from the resultant inflammatory response
4. Intermittent or constant jaundice occasionally causing
cholangitis, and with longstanding obstruction, biliary
cirrhosis
55. INTRAHEPATIC VS EXTRAHEPATIC CALCULUS
•Caroli's disease is characterized by congenital
segmental dilation of the intrahepatic bile ducts producing
primary intrahepatic gallstones.
•Secondary intrahepatic gall stone formation occurs due to
chronic obstruction of CBD and CHD
•It's believed that most patients suffering a chronic illness
have excessive amounts of gallstones in the liver.
• Gallstones found in gallbladder tend to be hardened and
relatively large while stones found in liver tends to be soft
and noncalcified
•Intrahepatic Gallstones cause liver congestion and elevted
liver enzymes
56. Primary intrahepatic stones exclusively involving the
intrahepatic biliary tree-related to chronic parasitic infestation of
the biliary tree- (ascariasis )
Mixed intrahepatic stone- Associated with extrahepatic lithiasis
Secondary intrahepatic stones related to ananatomical
condition precipitating stasis or infection
TYPES OF INTRAHEPATIC CALCULUS
59. KLATSKIN TUMOUR
A Klatskin tumour is a term that was traditionally given
to a hilar cholangiocarcinoma (occuring at the
bifurcation of the common hepatic duct).
Typically, these tumours are
Small In Size
Poorly Differentiated
Exhibit Aggressive Biologic Behaviour
And tend to obstruct the intrahepatic bile ducts
25% of all cholangiocarcinoma
61. ULTRASOUND FINDINGS
Presence of a hilar mass with obstruction
Increased echogenicity relative to surrounding
liver ~79%
Reduced echogenicity ~ 19 %
Mixed echogenicity ~ 2 %
Segmental dilatation or nonunion of R and L ducts
Polypoid intraluminal masses,
Nodular smooth masses with mural thickening.
Should do doppler, as this is helpful to assess
Vascular invasion (unresectable)
62. Figure : Cholangiocarcinoma. (A) Irregular mass at the porta,
causing biliary obstruction—a Klatskin tumour.
(B) MRI of the same patient, confirming the mass at the porta.
KLATSKIN TUMOUR
64. 08/03/14
THICKENING OF BILE DUCT WALL
FOCAL STRICTURE
•BACTERIAL CHOLANGITIS
•CHOLANGIOCARCINOMA
•CHOLEDOCAL CYSTS
•METASTASIS
•BENIGN STRICTURE
NO STRICTURE
•POLYPOID CANCER
•STONES
•PERIAMPULLARY CANCER
•SENILE CHANGE
•POSTCHOLECYSTECTOMY
DILATATION
•CHOLEDOCHAL CYST
•ASCARIASIS
65. 08/03/14
Pearls and Pitfalls
The gallbladder is a mobile organ; remember to change patient positioning
and/or probe placement to find the organ of interest.
Distinguish gallstones from polyps and septations or folds by always scanning
through the whole organ and in both longitudinal and transverse planes.
During the biliary exam, use color Doppler to help distinguish nonvascular from
vascular structures.
Ultrasound findings must be interpreted in the context of the clinical
presentation; findings suggestive of acute cholecystitis (e.g., gallstone or
thickened wall) may be present in patients in a nondiseased state.
The common bile duct can be dilated in the absence of pathology in older
patients and postcholecystectomy patients.
Measure the anterior wall of the gallbladder. The posterior wall may appear
artificially thickened because of acoustic enhancement or artifact from bowel
gas.