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Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Extended
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017
AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri
DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.
ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.
How to perform a Thyroid Gland Examination - Clinical Skills Revision
The thyroid examination is one of the first sessions of the clinical skills block for medical students at Warwick Medical School - largely as it touches lightly on to other clinical areas, such as the cardiac examination, and the peripheral neurological examination making it an excellent starting point for building further knowledge
This is a clinical examination of the thyroid gland is performed by Dr James Gill following the approach in Macleod’s Clinical examination.
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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 evaluation - you should concentrate on THEIR marks schemes for your assessments.
The examination demonstrated here is derived from Macleods Clinical Examination - a recognised standard textbook for clinical skills.
Some people may experience an ASMR effect from watching this medical clinical examination
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Join the Amoeba Sisters a they explore different muscle tissues and then focus on the sliding filament theory in skeletal muscle! This video also briefly talks about muscle naming, some vocabulary (such as agonists and antagonists) before focusing on the sliding filament model. Video also mentions general roles of tropomyosin and troponin.
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Table of Contents:
00:00 Intro
0:39 Muscle Tissue Types
1:58 Muscle Characteristics
2:33 Skeletal Muscle Naming and Arrangement
3:26 Actin Myosin and Sarcomere
4:32 Sliding Filament Model
6:55 Tropomyosin an Troponin
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Factual References:
Betts, J. Gordon, et al. “10.3 Muscle Fiber Contraction and Relaxation - Anatomy and Physiology 2e | OpenStax.” Openstax.org, 20 Apr. 2022, openstax.org/books/anatomy-and-physiology-2e/pages/10-3-muscle-fiber-contraction-and-relaxation.
Urry, Lisa A, et al. Campbell Biology. 11th ed., New York, Ny, Pearson Education, Inc, 2017.
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Further Reading Recommendations:
What about I and A bands? What actually initiates the power stroke? How does calcium get released and from where? Remember, there is a lot more detail! We recommend this page from Openstax to learn more:
https://openstax.org/books/bio....logy-2e/pages/38-4-m
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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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A subdural hematoma is most often the result of a severe head injury. This type of subdural hematoma is among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury and may lead to death. Subdural hematomas can also occur after a minor head injury. The amount of bleeding is smaller and occurs more slowly. This type of subdural hematoma is often seen in older adults. These may go unnoticed for many days to weeks, and are called chronic subdural hematomas. With any subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In older adults, the veins are often already stretched because of brain shrinkage (atrophy) and are more easily injured.
This cancer development medical video is devoted to elaborating the basics of cancer growth. We used advanced medical animation techniques to display such a complicated process.
What is happening in cancer development medical video
The fundamental abnormality described in the cancer development medical video is the nonstop unregulated multiplication of cancer cells. Being uncontrollable by body’s signals that regulate normal cell behavior; cancerous cells divide and grow populating neighboring normal tissues or even spread throughout the body. The overall lack of growth control acquired by cancer cells is due to the accumulated abnormalities in numerous cell regulatory mechanisms and is considered in some aspects of cell behavior that differs them from their healthy counterparts. The interaction of these cells is shown in our previous medical animation video.
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Diabetic ketoacidosis is an acute complication of uncontrolled hyperglycaemia characterised by high anion gap metabolic acidosis, dehydration and other metabolic abnormalities. Upto half of patients with Type 1 diabetes mellitus may have DKA. The incidence in T2DM is also rising. Precipitants include acute illness such as myocardial infarction, trauma and infection. Paitents of diabetic ketoacidosis may present with vomiting, pain abdomen and lethargy. Mental obtundation may also be present. Management of diabetic ketoacidosis revolves around administration of IV normal saline, insulin, replacement of potassium with frequent monitoring of sugars and electrolytes.
In this compilation, Barnsley Hospital is facing a very busy day with a high number of patients being treated, the doctors and nurses face some of their toughest shifts when they treat critical patients and rare illnesses as well as making tough decisions.
⌚️Timecodes:
00:00 Season 2 Episode 1
08:56 Season 4 Episode 1
16:53 Season 3 Episode 10
30:36 Season 3 Episode 13
37:45 Season 2 Episode 9
46:51 Season 1 Episode 2
52:52 Season 1 Episode 3
58:02 Season 2 Episode 2
01:09:39 Season 2 Episode 11
01:18:37 Season 2 episode 12
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About Casualty 24/7:
Casualty 24/7 shows how the doors of Barnsley A&E department are open every hour, of every day. They allow a peek inside their medical emergency teams, and how they deal with critical situations revolving around people's lives and illnesses. The team are close-knit and exchange typical Yorkshire humour to get them through their often long and tough days.
Watch our playlists:
🔵 Season 1 Full Episodes | Casualty 24/7:
https://www.youtube.com/playli....st?list=PLWrY8x74oDM
🔵 Season 2 Full Episodes | Casualty 24/7:
https://www.youtube.com/playli....st?list=PLWrY8x74oDM
🔵 Season 3 Full Episodes | Casualty 24/7:
https://www.youtube.com/playli....st?list=PLWrY8x74oDM
🔵 Season 4 Full Episodes | Casualty 24/7:
https://www.youtube.com/playli....st?list=PLWrY8x74oDM
🔵 Compilation Videos of Casualty 24/7:
https://www.youtube.com/playli....st?list=PLWrY8x74oDM
#SeriousIllness #Casualty247 #EmergencyServices #AandE #BHNFT #OurFutureSouthYorkshire
It depends upon which ligament is injured. If it is medial collateral ligament you feel pain when you walk ,sit and stand and you will be liming as well. If it is anterior cruciate ligament you feel pain when you walk on uneven ground.