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 To recover the worm, endoscope was withdrawn along with the basket and the friendly catch. While the endoscope was being withdrawn and the basket was in the duodenum with the worm out of bile duct, patient indicated of relief of abdominal pain.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.

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.

Infant Airway Obstruction and how to deal with

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

Catheters and Long Lines are introduced in Neonates to administer fluid and Total Parentral Nutrition. The proceedure is not easy to perform and is prone to get infections.
Strict Aseptic technique is mandatory

Hip Examination

Stress-relaxation is a well-established mechanism for laboratory skin stretching, with limited clinical application in conventional suturing techniques due to the inherent, concomitant induction of ischemia, necrosis and subsequent suture failure. Skin defects that cannot be primarily closed are a common difficulty during reconstructive surgery. The TopClosure tension-relief system (TRS) is a novel device for wound closure closure, providing secured attachment to the skin through a wide area of attachment, in an adjustable manner, enabling primary closure of medium to large skin defects. The aim of this study was to evaluate the efficiency of the TopClosure TRS as a substitute for skin grafting and flaps for primary closure of large soft tissue defects by stress-relaxation. We present three demonstrative cases requiring resection of large to huge tumors customarily requiring closure by skin graft or flaps. TRS was applied during surgery serving as a tension-relief platform for tension sutures, to enable primary skin-defect closure by cycling of stress-relaxation, and following surgery as skin-secure system until complete wound closure. All skin defects ranging from 7 to 26 cm in width were manipulated by the TRS through stress-relaxation, without undermining of skin, enabling primary skin closure and eliminating the need for skin grafts and flaps. Immediate wound closure ranged 26 to 135 min. TRS was applied for 3 to 4 weeks. Complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced and wound aesthetics were improved. In this case series we present a novel technology that enables the utilization of the viscoelastic properties of the skin to an extreme level, extending the limits of primary wound closure by the stress-relaxation principle. This is achieved via a simple device application that may aid immediate primary wound closure and downgrade the complexity of surgical procedures for a wide range of applications on a global scale.

Arthritis occurs when the cartilage breaks down explains Dr. Derek Papp, Sports Medicine Physician with Miami Orthopedics & Sports Medicine Institute. This it’s a very common knee injury such as the damage of the cartilage and meniscus tear.
ACL tears is another common injury especially in sports like soccer or Australian football, the specialist explains.

A nonsurgical method of treating a ganglion is to drain the fluid from (aspirate) the ganglion sac. Your doctor can do this in the office using the following procedure: The ganglion area is cleaned with an antiseptic solution. A local anesthetic is injected into the ganglion area to numb the area. When the area is numb, the ganglion sac is punctured with a sterile needle. The fluid is drawn out of the ganglion sac. The ganglion collapses. A bandage and, in some cases, a splint are used for a few days to limit movement and prevent the ganglion sac from filling again. Treating a ganglion by draining the fluid with a needle may not work because the ganglion sac remains intact and can fill again, causing the ganglion to return. For this reason, your doctor may puncture the sac with the needle 3 or 4 times so the sac will collapse completely. Even then, the ganglion is likely to come back.

Watch that video to know How To Firm And Lift Your Sagging Chest Naturally

Psoriatic arthritis is a chronic arthritis. In some people, it is mild, with just occasional flare ups. In other people, it is continuous and can cause joint damage if it is not treated. Early diagnosis is important to avoid damage to joints. Psoriatic arthritis typically occurs in people with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis. Psoriatic arthritis typically affects the large joints, especially those of the lower extremities, distal joints of the fingers and toes, and also can affect the back and sacroiliac joints of the pelvis. For most people, appropriate treatments will relieve pain, protect the joints, and maintain mobility. Physical activity helps maintain joint movement. Psoriatic arthritis is sometimes misdiagnosed as gout, rheumatoid arthritis or osteoarthritis. - See more at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis#sthash.VsBTUw76.dpuf

This is video 1 of 2 on diabetic ketoacidosis (pathophysiology and signs of diabetic ketoacidosis / DKA):

The hepatic portal system is the system of veins comprising the hepatic portal vein and its tributaries. It is responsible for directing blood from the region of the gastrointestinal tract between the esophagus and rectum and also includes venous drainage from the supplementary organs such as the spleen and pancreas.

Patient 65-year-old of age who comes to the medical consultation with pain moderated pain in the right hypochondrium of “several years of evolution” but that it increased one week ago. Also, she shows pain in the umbilical region of “many years of evolution”, that is supported according to the patient - in a constant way.rnTo the examination, we observe an umbilical hernia, apparently divided into two parts. The hernia of the external region measures 25.1 centimeters x 18.0 centimeters and the one that occupies the average region measures 12.0 centimeters x 10.0 centimeters.rnPatient who comes to the medical consultation with moderated pain in the right hypochondrium of one year of evolution but it increased one week ago after eat duck.rnIn the ultrasound scan of the region of the right hypochondrium (patient came having breakfast, that is to say, without previous preparation ) we can observe the liver of 123.8 millimeters high, as well as the porta vein with a diameter of 7.3 millimeters.rnOn having observed the Gallbladder, we think that a side wall is increased in 2.7 mm (hyperechogenic) with several “echogenics points” in the interior (”Biliary Mud”).

The measurements of the gallbladder were: 39.0 x 17.4 millimeters.rnWe can appreciates an echogenic image in the interior that it would make think about stone. The stones are identified as echogenic foci casting acoustic shadowing but but this image did not appear and a re-evaluation is decided in 15 days.

Acalculous cholecystopathy which means disease or condition of the gallbladder without the presence of gallstones. You might also call it functional gallbladder disorder or impaired gallbladder emptying. Some causes may be chronic inflammation, a problem with the smooth muscles of the gallbladder or the muscle of the Sphincter of Oddi being too tight.

REMEMBER:
Umbilical hernia is a congenital malformation, especially common in infants of African descent, and more frequent in boys. An Acquired umbilical hernia directly results from increased intra-abdominal pressure and are most commonly seen in obese individuals.
Presentation:A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 5 years. Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissued is inversely correlated with risk of strangulation (i.e. narrow base is more likely to strangulate).
Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus.
Differential diagnosisrnImportantly this type of hernia must be distinguished from a paraumbilical hernia which occurs in adults and involves a defect in the midline near to the umbilicus, and from omphalocele.

USMLE Step 2 CS - Numbness Weakness This is just preview video. To get full access please visit our website : www.usmletutoring.com

USMLE Step 2 CS - Wrist Pain This is just preview video. To get full access please visit our website : www.usmletutoring.com

Superior capsule reconstruction (SCR) is a promising alternative treatment for irreparable posterosuperior rotator cuff tears (Figure 1). It utilizes a graft from the superior glenoid to the greater tuberosity to stabilize the humeral head. In a study by Mihata and colleagues of 23 patients who underwent SCR with a fascia lata autograft at a minimum of 2 years follow-up, the American Shoulder and Elbow Surgeons (ASES) score improved significantly from 23.5 preoperatively to 92.9. Postoperative MRI showed 83% of patients had intact reconstructions with no progression of muscle atrophy.

The only sure way to prevent genital warts is to not have sex. But everyone wants sex, so here is how to have safe sex if you are living with Genital Warts.

Throat Endoscopy: This video shows the vocal cords while singing

Neurological Examination