Basic Abdominal Clinical Exam

For a full Surgical Airway Techniques resource: https://bit.ly/2rb9Nud
Video courtesy of Gauri Mankekar, MBBS, MS, PhD

Most babies will move into delivery position a few weeks prior to birth, with the head moving closer to the birth canal. When this fails to happen, the baby’s buttocks and/or feet will be positioned to be delivered first. This is referred to as “breech presentation.”

Microsurgical bipolar cautery tonsillectomy compares favorably with traditional techniques in terms of intraoperative bleeding, postoperative pain, otalgia, and hemorrhage. This technique combines the hemostatic advantage of cautery dissection, the excellent visualization achieved by a microscope, and, with the use of a video, greatly improves the physician's ability to teach how to perform a tonsillectomy.

Care must be taken to prevent stenosis at the anastomotic site. If the diameter of the anastomosis is less than 2 cm, the anastomosis should be taken down and resected. A classic end-to-end anastomosis should be performed to ensure adequate diameter to the intestine. If the posterior wall of the colon has been preserved, care should be taken to close the colostomy prior to opening the peritoneal cavity. This will reduce intraperitoneal contamination from the stoma site. Copious irrigation of the wound should be made prior to primary closure. If gross contamination has occurred, delayed closure of the wound should be considered.

A vaginoplasty is a surgical procedure that tightens the vagina. This is done by removing excess vaginal lining and tightening the surrounding soft tissues and muscles. During delivery of a baby the vagina and surrounding tissues and muscles become stretched. After delivery the vagina may return to a more “normal” size, but it often fails to return to its’ pre pregnancy diameter. Generally, the more vaginal deliveries, the worse the condition gets. Many women will complain of decreased sensation and sexual satisfaction during intercourse. Commonly this is due to a lack of friction. Often their partner may notice a change although he may say nothing. Kegel exercises are often recommended but rarely succeed in restoring vaginal tightness.

Do you think you have a hernia?
What are hernias?
The hernias we address in this http://DoctorsExpressHartsdale.com Medical Minute are inguinal, or groin, hernias. More common in men than women, an inguinal hernia can occur when part of the small intestine protrudes through a weakness or tear in the area between your abdomen and your thigh- or your groin. It's possible for anyone to get an inguinal hernia, but it is more commonly found in males.

Hernias form a bulge and can be accompanied by pain. Men have an approximate 26% lifetime risk of having hernia at some point in their life, where as women have a much lower chance of one- only about 3% of women will experience a hernia at some point in their life. There are other types of hernias, such as abdominal, or "hiatal" hernias but groin hernias outnumber abdominal hernias by about 3 to 1.

What causes a hernia?
The cause of a hernia is not always known, but hernias are often the result of weak spots in the abdominal wall. Weaknesses can be due to congenital defects (present at birth) or formed later in life. Some risk factors for inguinal hernia include:
• fluid or pressure in the abdomen
• heavy lifting
• straining during urination or bowel movements
• obesity
• chronic cough
• pregnancy

Hernias often form in people with weakened abdominal muscles or in those who do a lot of heavy lifting or straining, which is why we see it quite often in young men. Physiology plays a part: men have testicles and scrotum which descend through the inguinal canal-much larger in men than in women. That is part of the reason men tend to be more susceptible to hernias than women.

Symptoms of hernia

Symptoms of inguinal hernia usually include a bulge in the groin area and pain, pressure, or aching at the bulge—especially when lifting, bending, or coughing. These symptoms usually subside during rest periods. Men may also experience swelling around the testicles.


Screening and Diagnosis of Hernias
If you are having abdominal pain or pelvic bulge and pain, you want to see physician, and he or she will do an exam. They will use their finger, to see if you have a bulge in your scrotum or on your groin and they'll see if its reducible or not. If the exam doesn't give them the answer, they can then perform an ultrasound, an inexpensive test that can tell you the same day whether a hernia is present.


What to do if you think you have a hernia
Most of the time hernias do not cause problems. People often live with hernias their entire life without them becoming aggravated or painful. When they do cause pain though, there is concern that complications may have arisen. Most common hernias are what we call reducible; you can take your finger or you can lie down in bed and due to the effects of gravity, the bulge in the groin will actually disappear, which means the intestinal contents actually go back into the abdominal cavity or to the correct location. If it's not reducible by lying down or using a finger or having a physician trying to reduce it, then there are concerns about complications such as strangulation, or incarceration occurring. If those concerns are there, then you need to see a surgeon, and there may be a need for surgery.

How to Treat a Hernia
As stated earlier, hernias can often be watched for years without being treated. If however, they are causing pain, we generally refer you to a surgeon who can do a very simple laparoscopic surgery.

If you suspect a hernia, but have not been diagnosed, you should see your doctor, and of course, we are happy to see you here at Doctors Express

Circumcision Video 3D

This is a video of a carpal tunnel release surgery

Plastination pioneer Gunther Von Hagens gives us a view inside the bodies of 2 people who have died of cancer.

Primary biliary cirrhosis, sometimes called PBC, is a disease in which the bile ducts in your liver are slowly destroyed. Bile, a fluid produced in your liver, plays a role in digesting food and helps rid your body of worn-out red blood cells, cholesterol and toxins. When bile ducts are damaged, as in primary biliary cirrhosis, harmful substances can build up in your liver and sometimes lead to irreversible scarring of liver tissue (cirrhosis). Primary biliary cirrhosis is considered an autoimmune disease, in which the body turns against its own cells. Researchers think it is triggered by a combination of genetic and environmental factors. Primary biliary cirrhosis usually develops slowly and medication can slow its progression, especially if treatment begins early.

Hydatid cysts in retroperitoneal region in transit to the thorax

This animation demonstrates how a unilateral complete cleft lip repair is performed. This video is meant for educational purposes for patients and families. There are many ways to fix a complete cleft lip, but the technique shown here is the most common known as the Millard Rotation Advancement Repair.

Medical Female Breast Exam

Ultrasound Guided Intravenous Peripheral Line Placement

Watch that video to know the Female Genital Infections Causes and treatments.

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Watch that A Big Size Fibroadenoma Removal Under Local Anesthesia

This video illustrates several forms of catatonia including waxy flexibility, forced grasping, opposition, negativism and aversion.

How to start a peripheral IV in the dorsum of the hand: clinical nursing skill technique.

Starting an IV (intravenous catheter) can be an intimidating experience for nurses, especially nursing students and new nurses. However, nurses will perform IV insertions often, so this is an important nursing skill to learn.

Before starting an IV, always follow the protocols of your facility, as well as manufacturer's instructions for any supplies used.

In this video, Nurse Sarah demonstrates how to start a peripheral IV in the dorsum of the hand. Prior to inserting the IV, you'll want to do the following:

-Gather supplies
-Perform hand hygiene
-Prepare supplies (including priming the saline flush, removing air from extension tubing, opening packages, completing labels, and any other steps required by your facility.
-Locate a suitable vein
-Perform hand hygiene
-Don gloves


If the patient has a lot of hair, you might want to use clippers to trim the hairs prior to starting the IV. You may also apply a tourniquet to help veins move near the surface of the skin.


Next, you'll want to clean the site using the cleaner that came in the IV start kit, such as ChloraPrep.


Once the site has dried completely, you can insert the IV. Stabilize the vein with your non-dominant hand, and insert the IV's needle into the vein, watching carefully for blood return (or a blood flash) in the chamber. Advance the IV around 2mm more to ensure the plastic cannula is in the vein, then thread the cannula into the vein and press the needle safety button.

Notes: https://www.registerednursern.....com/how-to-start-an-
IV Video Series: https://www.youtube.com/watch?v=MbG_1-_mnoo&list=PLQrdx7rRsKfXr6kruqEpIovf66sxo0gxh



This video also demonstrates how to flush the IV using the push-pause method, how to secure the IV using the Tegaderm dressing that came with the IV start kit, considerations of the different cap types and the clamp sequence, and more.



For more information, watch the complete tutorial.

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