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A surgeon begins the PPH stapled hemorrhoidectomy by inserting a circular anal dilator and obturator into the anal canal and then securing the dilator in place with four sutures. The surgeon then inserts a PPH anoscope into the obturator. Next, he places a circumferential purse-string suture of 2-0 Monocryl on a UR-6 needle 4 cm proximal to the dentate line. The surgeon opens a PPH stapler and places its anvil across the purse string. The stapler is then closed and fired; it is held closed for two minutes to improve hemostasis. Prior to firing the stapler in a female patient, the surgeon places a gloved finger in the vagina to ensure the vaginal mucosa and rectal-vaginal septum are not trapped within the jaws of the closed stapler. The surgeon then opens and removes the stapler.
A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks. A PNS usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odor. A PNS is a condition that mostly affects men and is also common in young adults. It’s also more common in people who sit a lot, like cab drivers.
A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. In the United States, almost one in three women has their babies this way. Some C-sections are planned, but many are done when unexpected problems happen during delivery. Reasons for a C-section may include
By 5 weeks' gestational age, the wolffian (ie, mesonephric) and the müllerian (ie, paramesonephric) ducts have formed from intermediate mesoderm. In the absence of testosterone and müllerian inhibitory substance, the mesonephric ducts regress and the paramesonephric ducts continue to form the female reproductive structures with fusion of the distal portions of the paramesonephric ducts to give rise to the uterine fundus, the cervix, and the upper vagina. These developmental changes are genetically controlled in large part by a series of complex transcriptional signaling pathways including Wnt signaling, Hox genes, and many others. In a female fetus, the wolffian duct disappears except for nonfunctional vestiges. The müllerian duct is lined by a columnar epithelium. This includes the entire cervix and upper vagina to the vaginal plate (ie, sinovaginal bulb). Through a process of squamous metaplasia, the vagina and a variable portion of the ectocervix become covered with squamous epithelium. This process is complete by the fifth month of pregnancy.
If a patient comes to you with a painful, throbbing, swollen, red face (a ''fat face'), perhaps with fever, trismus and lymphadenitis, he is probably suffering from an acute dental or oral infection, most probably an alveolar abscess. He may have: (1) An alveolar abscess begins as an infection in the bone around a non-vital infected tooth. He has severe pain, which becomes less as pus is released into more superficial tissues and his face starts to swell. After 36 hours of cellulitis he usually has a fluctuant abscess which needs draining. If drainage is delayed, the pus in his abscess discharges spontaneously through a sinus (26-8) in his gum or face, which may become chronic. First, control infection with antibiotics, and then drain the abscess, either by incising it where it is pointing, or by removing the infected tooth, which acts as a cork to prevent the pus escaping, or by doing both these things. If you remove a tooth before you have controlled the infection with antibiotics, and while his face is still severely swollen, you may spread the infection; your task will also be more difficult. (2) A periodontal abscess at the side of a tooth, caused by spread from an infected gum. (3) A pericoronal abscess caused by infection of the gum over the crown of an unerupted and impacted tooth, usually a lower third molar (''an infected wisdom tooth'). Often, an abscess does not form, and the gum round the tooth is merely inflamed.
A nose job (technically called a rhinoplasty) is surgery on the nose to change its shape or improve its function. It can be done for medical reasons -- such as to correct breathing problems related to the nose or correct disfigurement resulting from trauma or birth defects. It can also be done for cosmetic reasons, which will change the nose's shape and appearance.
The examination room should be quiet, warm and well lit. After you have finished interviewing the patient, provide them with a gown (a.k.a. "Johnny") and leave the room (or draw a separating curtain) while they change. Instruct them to remove all of their clothing (except for briefs) and put on the gown so that the opening is in the rear. Occasionally, patient's will end up using them as ponchos, capes or in other creative ways. While this may make for a more attractive ensemble it will also, unfortunately, interfere with your ability to perform an examination! Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated. Observation: Before diving in, take a minute or so to look at the patient in their entirety, making your observations, if possible, from an out-of-the way perch. Does the patient seem anxious, in pain, upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient. Temperature: This is generally obtained using an oral thermometer that provides a digital reading when the sensor is placed under the patient's tongue. As most exam rooms do not have thermometers, it is not necessary to repeat this measurement unless, of course, the recorded value seems discordant with the patient's clinical condition (e.g. they feel hot but reportedly have no fever or vice versa). Depending on the bias of a particular institution, temperature is measured in either Celcius or Farenheit, with a fever defined as greater than 38-38.5 C or 101-101.5 F. Rectal temperatures, which most closely reflect internal or core values, are approximately 1 degree F higher than those obtained orally. Respiratory Rate: Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4. Try to do this as surreptitiously as possible so that the patient does not consciously alter their rate of breathing. This can be done by observing the rise and fall of the patient's hospital gown while you appear to be taking their pulse. Normal is between 12 and 20. In general, this measurement offers no relevant information for the routine examination. However, particularly in the setting of cardio-pulmonary illness, it can be a very reliable marker of disease activity. Pulse: This can be measured at any place where there is a large artery (e.g. carotid, femoral, or simply by listening over the heart), though for the sake of convenience it is generally done by palpating the radial impulse. You may find it helpful to feel both radial arteries simultaneously, doubling the sensory input and helping to insure the accuracy of your measurements. Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.
This video: Sickle cell anemia is an inherited form of anemia which is a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout your body. Normally, your red blood cells are flexible and round, moving easily through your blood vessels. In sickle cell anemia, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. There's no cure for most people with sickle cell anemia. However, treatments can relieve pain and help prevent further problems associated with sickle cell anemia.
The best way to prevent hepatitis A is through vaccination with the hepatitis A vaccine. Vaccination is recommended for all children age 12 months or older, for travelers to certain countries, and for people at high risk for infection with the virus. The hepatitis A vaccine is given as two shots, six months apart.
Lip augmentation is a cosmetic procedure that can give you fuller, plumper lips. These days, an injectable dermal filler is the most commonly used method of lip augmentation. There are many types of dermal fillers that can be injected in your lips and around your mouth.
When is endoscopy used? Endoscopes were first developed to look at parts of the body that couldn’t be seen any other way. This is still a common reason to use them, but endoscopy now has many other uses too. It’s often used in the prevention, early detection, diagnosis, staging, and treatment of cancer. To prevent and screen for cancer Some types of endoscopes are used to look for cancer in people who have no symptoms. For example, colonoscopy (KO-lun-AH-skuh-pee) and sigmoidoscopy (SIG-moid-AH-skuh-pee) are used to screen for colon and rectal cancer. These procedures can also help prevent cancer because they let doctors find and remove polyps (growths) that might become cancer if left alone. To find cancer early Endoscopy can sometimes be used to find cancer early, before it has had a chance to grow or spread. Looking for causes of symptoms When people go to the doctor with certain symptoms, endoscopy can sometimes be used to help find a cause. For instance: Laryngoscopy to look at the vocal cords in people with long-term hoarseness Upper endoscopy in people having trouble swallowing Colonoscopy in people with anemia (low red blood cell counts) with an unknown cause Colonoscopy in people with blood in their stool Looking at problems found on imaging tests Imaging tests such as x-rays and CT scans can sometimes show physical changes within the body. But these tests may only give information about the size, shape, and location of the problem. Doctors use endoscopes to see more details, like color and surface texture, when trying to find out what’s going on. Newer methods of endoscopy that include high magnification are being tested to find out whether they are more useful in detecting cancer and other abnormal cells on the inner surfaces of the body. To diagnose and find out the stage (extent) of cancer To get a tissue sample Going one step further, most types of endoscopes have tools on the end that the doctor can use to take out small tissue samples. This procedure is called a biopsy (BY-op-see). Samples can be taken from suspicious areas and then looked at under a microscope or tested in other ways to see if cancer is there. A biopsy is usually the best way to find out if a growth or change is cancer or something else. Getting a closer look In some cases endoscopes are used to help find out how far a cancer has spread. Thoracoscopy (THOR-uh-KAHS -kuh-pee) and laparoscopy (LAP-uh-RAHS-kuh-pee) can be very useful in finding out if cancer has spread into the thorax (chest) or abdomen (belly). The surgeon can look into these places making only a small incision (cut) in the skin.
Blood clots form in an already-narrowed artery and block the flow of oxygen-rich blood to the heart muscle. When taken during a heart attack, aspirin slows clotting and decreases the size of the blood clot that is forming. After a heart attack. Aspirin can help prevent a second heart attack.
Your egg usually lives for just 12 to 24 hours, but sperm will live inside you for anything from a few hours to seven days, with one to three days the optimum time. ... But because a small number of sperm are long-living, having sex up to six days before ovulation can also result in pregnancy.
The most common position of the uterus is anteverted (cervix angles forward) and anteflexed (body is flexed forward). The position of the uterus in the adult is liable to considerable variation, depending chiefly on the condition of the bladder and rectum. Adnexa: In gynecology, the appendages of the uterus, namely the ovaries, the Fallopian tubes, and the ligaments that hold the uterus in place.
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