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Gallstone ileus is an important, though infrequent, cause of mechanical bowel obstruction, affecting older adult patients who often have other significant medical conditions. It is caused by impaction of a gallstone in the ileum after being passed through a biliary-enteric fistula. The diagnosis is often delayed since symptoms may be intermittent and investigations fail to identify the cause of the obstruction. The mainstay of treatment is removal of the obstructing stone after resuscitating the patient. Gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.
Hyponatremia is defined as a serum sodium of less than 135 Meq per litre and occurs in upto 22 % of hospitalised patients. The causes of hyponatremia may be understood based on the pre-existing volume status of the patient which may either be hypovolemic, euvolemic or hypervolemic hyponatremia. This presentation discusses in detail, the causes of these underlying conditions. Also mentioned are the clinical features and management options and therapeutic sodium targets in patients with hyponatremia. Drugs such as demeclocycline and vaptans (Tolvaptan, Conivaptan) are also mentioned as management options which may be used on a case to case basis. Finally, the all important targets of sodium correction over 24 hours are also mentioned, along with a practical formula for calculation of sodium deficit which is explained with an example.
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
Kneecap dislocation Email this page to a friend Print Facebook Twitter Google+ Kneecap dislocation occurs when the triangle-shaped bone covering the knee (patella) moves or slides out of place. The problem usually occurs toward the outside of the leg. Causes Kneecap (patella) dislocation is often seen in women. It usually occurs after a sudden change in direction when your leg is planted. This puts your kneecap under stress.
Cholangitis Email this page to a friend Email this page to a friend Facebook Twitter Google+ Cholangitis is an infection of the bile ducts, the tubes that carry bile from the liver to the gallbladder and intestines. Bile is a liquid made by the liver that helps digest food. Causes Cholangitis is most often caused by bacteria. This can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver. Risk factors include a previous history of gallstones, sclerosing cholangitis, HIV, narrowing of the common bile duct, and rarely, travel to countries where you might catch a worm or parasite infection. Symptoms The following symptoms may occur: Pain on the upper right side or upper middle part of the abdomen. It may also be felt in the back or below the right shoulder blade. The pain may come and go and feel sharp, cramp-like, or dull. Fever and chills. Dark urine and clay-colored stools. Nausea and vomiting. Yellowing of the skin (jaundice), which may come and go.
6 987 24 MORE How Does Anesthesia Work? Credit: itsmejust | Shutterstock If you’ve ever had surgery, unless you are super tough, you’ve gone through it with the benefit of anesthetics. But, how do these body-numbing elixirs work? Prior to the invention of anesthesia in the mid-1800s, surgeons had to hack off limbs, sew up wounds and remove mysterious growths with nothing to dull the patient's pain but opium or booze. While these drugs may have numbed the patient, they didn’t always completely block the pain, or erase the memory of it. Since then, doctors have gotten much better at putting us out with drug combinations that ease pain, relax muscles and, in some cases, put us in a deep state of hypnosis that gives us temporary amnesia. Today, there are two primary types of anesthesia drugs: those that knockout the whole body (general) and those that only numb things up locally.
Radiosurgery: Radiosurgery devices, such as the CyberKnife Robotic Radiosurgery System, offer patients a new option for the treatment of lung cancer. The CyberKnife® System is used to treat lung cancer patients who cannot tolerate surgery, have an inoperable tumor, or are seeking an alternative to surgery.
Emphysema, also known as COPD, is a chronic condition with multiple factors that impact survival and life expectancy. Stages of COPD are generally defined using the GOLD criteria (Global Initiative for Chronic Obstructive Lung Disease). It has four levels or stages: mild - or Stage 1.
minimally invasive procedure is the new gold standard for hemorrhoidectomy, according to American and European experts in the field. The procedure, known as PPH (procedure for prolapse and hemorrhoids) stapled hemorrhoidectomy, combines hemorrhoidal devascularization and repositioning to return the veins to the anal canal. “This year, this is the revolutionary new procedure in the United States,” Gary Hoffman, MD, clinical faculty member in general and colorectal surgery, Cedars-Sinai Medical Center, Los Angeles, told General Surgery News after moderating a live PPH telesurgery at the 2003 annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons.
A new well designed randomized study has suggested that long term baby aspirin usage may aid in fight against cancer. The suggested mechanism is that cancers induce inflammatory responses so the anti-inflammatory mechanism of prostaglandins inhibitors may cease the progress of many cancers. There are some concerns about the study because despite the well-designed randomized study; the study didn't include a satisfying number of female participants. The study was also conducted on esophageal, colorectal and lung cancers.
Join Rhinoplasty Specialist Dr. Paul Nassif, a world-renowned expert in revision rhinoplasty, in the operating room as he performs a Columella Strut Placement. His practice, Spalding Drive Cosmetic Surgery & Dermatology, is located in Beverly Hills, CA.
Video Produced by SPORE Medical