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Possible causes include a combination of biological, psychological, and social sources of distress. Increasingly, research suggests these factors may cause changes in brain function, including altered activity of certain neural circuits in the brain. The persistent feeling of sadness or loss of interest that characterizes major depression can lead to a range of behavioral and physical symptoms. These may include changes in sleep, appetite, energy level, concentration, daily behavior, or self-esteem. Depression can also be associated with thoughts of suicide. The mainstay of treatment is usually medication, talk therapy, or a combination of the two. Increasingly, research suggests these treatments may normalize brain changes associated with depression.
A 30 YEAR WOMEN WITH INTRACTABLE BILIARY COLIC
CASE REPORT: This 30 year women developed severe pain right upper quadrant for last 10 days. She sought many consultations and was given intravenous analgesics both (nonnarcortic and narcotic). Pain did not subside and she sought my consultation. Examination revealed her to be in agony with severe upper abdominal pain. General physical examination was otherwise unremarkable. Abdominal examination revealed mild tenderness in right hypochondrium with doubtful Murphy's sign. Urgent abdominal ultrasound showed a linear structure in bile ducts making slow writhing movements. The structure had an anechoic tube (alimentary canal) inside suggestive of a large Ascarid. Urgent ERCP was performed and bile duct and pancreatic duct cannulated selectively. Pancreatic duct was normal. Bile ducts contained a long linear filling defect extending from lower end of common bile duct to right intrahepatic duct (see image gallery for ERCP plate). A basket was introduced in the duct (see video clip) and the linear structure was engaged with soft closure and extracted out of the bile duct. Accompanying the basket was a 25 cm thick highly motile Ascarid. To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain. A relook cholangiogram showed no more structures in the duct. She was given antihelmintic therapy and passed hundreds of worms with the feces. The worms recovered form stools were both male and female population and varied in length and size. However the lone worm recovered form bile ducts was the longest and the thickest male worm. The phenomenal behavior of this ubiquitous infection remains unexplained.
Care for Your Knee After Knee Replacement Surgery
In this video, Dr. Mark Hammerberg, provides details on two important activities to help during recovery from knee replacement surgery.
Denver Health's Orthopedics department offers many different types of treatments to help you, including surgical and non-surgical options. To find out if surgery is right for you, visit DenverHealth.org/Orthopedics or call 303-602-1590 to make an appointment.
The spleen is an organ in the upper far left part of the abdomen, to the left of the stomach. The spleen varies in size and shape between people, but it’s commonly fist-shaped, purple, and about 4 inches long. Because the spleen is protected by the rib cage, you can’t easily feel it unless it’s abnormally enlarged. The spleen plays multiple supporting roles in the body. It acts as a filter for blood as part of the immune system. Old red blood cells are recycled in the spleen, and platelets and white blood cells are stored there. The spleen also helps fight certain kinds of bacteria that cause pneumonia and meningitis.
Ankle and Foot Clinical Examination - Clinical Skills - Dr Gill
When it comes to joints of the body, the ankle is one of the joints most commonly injured. This is vitally important to be able to effectively examine a patient who is complaining of pain in the ankle and foot.
In this video we will perform a demonstration of the ankle and foot examination.
Examination of the foot, and the ankle joint, follows the standard orthopaedic approach of look, feel, move.
There is a connected video to the foot and ankle examination, on the causes of carpal tunnel syndrome - here
https://youtu.be/aXx6NfBWDSs
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Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.
However during OSCE assessments. Different medical schools, nursing colleges, and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.
The examination demonstrated here is derived from Macleod's Clinical Examination - a recognized standard textbook for clinical skills.
#footpain #clinicalexamination #DrGill
Dr. Ebraheim’s educational animated video describing the anatomy and associated injuries of the knee joint.
Disrupted quadriceps
•Patient is unable to actively extend the knee.
The most common cause of ACL ruptures:
•Traumatic force being applied during twisting motion.
•Side stepping or landing from a jump.
Patient complains of:
•Immediate pain
•Knee giving way
•Swelling
Aspiration of the knee
•If aspiration of the knee joint shows evidence of blood within the joint there is 75-80% chance of ACL and meniscal injury.
Lachamn’s test- ACL knee exam
•Knee is flexed at 30 degrees.
•ACL tear of the knee is identified by pulling on the tibia and examining the frontward motion of the lower leg in comparison to the upper leg.
Radiological exam – ACL
•MRI of the knee joint shows bone lesions or bruising associated with tears of the ACL. Injury is found in the typical location; middle of the femoral condyle and posterior part of the tibia laterally.
Posterior cruciate ligament tear (PCL)
•Common cause of injury is a bent knee hitting a dashboard in a car accident.
Tibial Sag Test –PCL knee exam
Quadriceps active test-PCL knee exam
•The examiner stabilizes the leg of the patient and then the patient is asked to actively contract the quadriceps muscle.
•The tibia is seen actively reduced from the posterior subluxed position.
Lachman’s test-PCL knee exam
•Knee is bent 20-30 degrees.
•The posterior drawer test is carried out while the patient is in a supine position and the knee is flexed to 90 degrees.
•The amount of translation of the tibia relative to the femur is observed.
The dial test is performed while the patient is in the supine or prone position and both knees are in 90 and 30 degrees of flexion. More than 10 degrees of external rotation indicates significant injury.
Common meniscal tears
Symptoms include
•Knee pain
•Pain with straightening the knee
•Swelling
•Locking
•Weakness
To understand high blood cholesterol (ko-LES-ter-ol), it helps to learn about cholesterol. Cholesterol is a waxy, fat-like substance that’s found in all cells of the body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. However, cholesterol also is found in some of the foods you eat. Cholesterol travels through your bloodstream in small packages called lipoproteins (lip-o-PRO-teens). These packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important. LDL cholesterol sometimes is called “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. (Arteries are blood vessels that carry blood from your heart to your body.) HDL cholesterol sometimes is called “good” cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Your liver removes the cholesterol from your body.
Overweight does not necessarily equal unhealthy. There are actually plenty of overweight people who are in excellent health (1). Conversely, many normal weight people have the metabolic problems associated with obesity (2). That’s because the fat under the skin is actually not that big of a problem (at least not from a health standpoint, it’s more of a cosmetic problem). It’s the fat in the abdominal cavity, the belly fat, that causes the biggest issues (3). If you have a lot of excess fat around your waistline, even if you’re not very heavy, then you should take some steps to get rid of it. Belly fat is usually estimated by measuring the circumference around your waist. This can easily be done at home with a simple tape measure. Anything above 40 inches (102 cm) in men and 35 inches (88 cm) in women, is known as abdominal obesity. There are actually a few proven strategies that have been shown to target the fat in the belly area more than other areas of the body.
Cholecystectomy means removal of the gallbladder. The most common reasons
your doctor might recommend a cholecystectomy are biliary colic, cholecystitis,
choledocolithiasis, or gallstone pancreatitis. Biliary colic, also known as symptomatic
cholelithiasis, is caused by gallstones, which are hardened deposits of bile. Gallstones are
common in the general population, and gallstones alone are not a reason for gallbladder
removal if they do not cause symptoms. However, sometimes gallstones can get caught at the
neck of the gallbladder, causing pain when the gallbladder contracts against them trying to
release its bile, especially after a fatty meal. With biliary colic, the pain typically resolves within
an hour or so. Occasionally, a stone or some other blockage may prevent the gallbladder from
emptying over a long period of time, causing an increase in pressure and trapped fluid within the
gallbladder. This can cause inflammation and infection of the gallbladder, which we call
cholecystitis. Choledocholithiasis is when there are one or more stones in the bile ducts, which
can cause back up of bile into the liver, and depending on the location of the stones, could
cause pancreatitis, which is inflammation of the pancreas. Other reasons for gallbladder
removal, though less common, are gallbladder polyps and cancer. All of these are reasons for
gallbladder removal.