In cases when the presentation is unclear, ultrasonography is the imaging methodology of choice. The characteristic finding is the presence of a "target sign". Ultrasonography is not required in patients with obvious clinical diagnosis (as seen in this patient). Such patients can proceed directly to treatment with diagnostic and therapeutic air (pneumatic) or water-soluble (hydrostatic contrast) enema.

The most reliable clinical sign to detect ascites is checking for bilateral flank dullness. If a patient with ascites is lying supine, fluid accumulates in the flank regions, leading to dullness on percussion. At the same time, the air-filled bowel loops are forced upwards by the free fluid due to buoyancy, resulting in tympanitic percussion. To locate specifically where dullness shifts to tympany, or the air-fluid level, percussion should be performed from the sides towards the middle. To confirm that the dullness is caused by ascites, ask the patient to switch to a lateral decubitus position. If ascites is present, the air-filled bowel loops will shift accordingly and remain at the surface of the fluid. As a result, the air-fluid level will shift as well. This is known as shifting dullness.

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This patient presented to the ER for umbilical pain and had a history of umbilical hernia. He was concerned about the possibility of incarceration of the hernia.

In this video we explain how the clinical exam helps to differentiate a simple painful hernia from an incarcerated one.

***Thanks to the patient for sharing his history and exam with YouTube world***

Suspect that a patient has a subphrenic abscess if he deteriorates, or recovers and then deteriorates, between the 14th and the 21st day after a laparotomy, with a low, slowly increasing, swinging fever, sweating, and a tachycardia. This, and a leucocytosis, show that he has ''pus somewhere', which is making him anorexic, wasted, and ultimately cachectic. If he has no sign of a wound infection, a rectal examination is negative, and his abdomen is soft and relaxed, the pus is probably under his diaphragm. The pus might be between his diaphragm and his liver, in (1) his right or (2) his left subphrenic space, or under his liver in (3) his right or (4) his left subhepatic space in his lesser sac. He may have pus in more than one of these spaces. Explore him on the suspicion that he might have a subphrenic abscess. Exploration is not a major operation; the difficulty is knowing where to explore, so refer him if you can. If you cannot refer him, explore him yourself. If you fail to find pus, you have done him no harm; missing a subphrenic abscess is far worse. If it is anterior, you can drain it by going under his costal margin anteriorly. If it is posterior, you can go through the bed of his 12th rib posteriorly.

After the diagnosis of primary melanoma of pectoral region had been established, the patient was referred to lymphoscintigraphy with gamma camera (techencium; nanno colloid). Two hours after the administration of the contrast medium, the operation commenced. During the operation the primary tumor wa...s excised, and the sentinel node was detected with the use of gamma probe and also excised.

Watch that Huge Stomach Tumor Removal Medical Surgery

Here's how female-to-male gender reassignment surgery works.

Watch that Full Human Body Decay Process Video

extracorporeal shockwave lithotripsy is used to treat kidney stones

Ascites, the collection of fluid within the peritoneal space is caused due to a variety of causes including cirrhosis, cardiac causes, sinusoidal obstruction syndrome, tubercular peritonitis and pancreatitis, amongst others. Most commonly, the cause of ascots may be cirrhosis , which in turn, is most frequently causes by alcohol use, hepatitis C and non-alcoholic steatohepatitis. At the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. Both low SAAG and high SAAG ascites have been dealt with in some depth, with a brief overview of the management of these conditions

Watch that video of a Bodybuilder's Colon Contains 10 lbs Meat Worms

Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications. Some people refer to AF as a quivering heart. An estimated 2.7 million Americans are living with AF.

watch that Enema Insertion Medical Procedure

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth. Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Female Catheter Insertion

The Talizi Hair Transplantation Clinic offers hair restoration through a painless hair transplantation procedure and guarantees a natural result for an affordable price. 6000 grafts at one session. Hair transplantation surgery combining seamless Follicular Unit Extraction FUE method and Strip Version.

A silent heart attack is a heart attack that has few, if any, symptoms. You may have never had any symptoms to warn you that you've developed a heart problem, such as chest pain or shortness of breath. Having diabetes or prediabetes puts you at increased risk for heart disease and stroke. You can lower your risk by keeping your blood glucose (also called blood sugar), blood pressure, and blood cholesterol close to the recommended target numbersthe levels suggested by diabetes experts for good health. (

Over one million Americans have the sexually transmitted virus, HIV, which can lead to the deadly disease known as AIDS.
HIV can be transmitted in the sexual fluids, blood or breast milk of an infected person. HIV prevention therefore involves a wide range of activities including prevention of mother-to-child transmission, needle exchanges and harm reduction for injecting drug users, and precautions for health care workers.