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Alimentary Tract Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ryan Lamm, Arturo J. Rios-Diaz, Priyadarshini Koduri, Francesco Palazzo
Symptoms suggestive of acute cholecystitis are similar in the pregnant and non-pregnant state. Common signs and symptoms include constant right upper quadrant pain or tenderness, fever, tachycardia, leukocytosis, anorexia, nausea, vomiting, and inability to tolerate oral intake. Jaundice and signs consistent with peritonitis may also be present. In women with superimposed bacterial infection, sepsis may also be apparent.
Examination of the abdominal system
Published in Tracy Lapworth, Deborah Cook, Clinical Assessment, 2022
You may be able to palpate the right kidney in a slim patient:Place the left hand underneath the patient in the right loin at the twelfth ribPlace the right hand in the right upper quadrant above lateral and parallel to the rectus muscleAsk the patient to take a deep breath and, at the peak of inspiration, press your hands together in a duckbill fashion and try to capture the kidney between the two handsIf the kidney is palpable, describe its size, shape and any tenderness
Malrotation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Simon Blackburn, Joseph I. Curry, Bhanumathi Lakshminarayanan
Once access to the abdomen is established, the diagnosis is confirmed by identifying the position of the duodenojejunal flexure and the ileocecal junction. The volvulus is reduced. The right colon is then reflected to the patient’s left to expose the duodenum. At this point, careful division of the attachments between the duodenum and colon proceeds to reveal the superior mesenteric artery. The duodenum is then straightened by division of its right lateral attachments. The small bowel can then be brought to the right of the abdomen by gentle manipulation into the right upper quadrant, progressing from the duodenal end to the ileocecal junction. Peritoneal attachments restricting this are divided as they are encountered. This rewards the operator with a view of the small bowel mesentery with the small bowel on the right of the image and the colon to the left. Final division of the attachments between the small bowel and colon establishes a non-rotated position. Appendectomy can then proceed if desired.
Inhibiting L1CAM Reverses Cisplatin Resistance of Triple Negative Breast Cancer Cells by Blocking AKT Signaling Pathway
Published in Cancer Investigation, 2022
Lu-Yao Zhang, Zhi-Xin Shen, Lu Guo
Cells in each group were digested by 0.25% trypsin (PYG0107, Wuhan Boster Biological Technology, Ltd., China), collected, centrifuged, and washed with cold PBS buffer three times. The supernatant was discarded after centrifugation and cell apoptosis was detected by following instructions of the Annexin-V-FITC apoptosis detection kit (K201-100, Biovision, USA). Before the staining assay, cells were suspended, placed at room temperature for 15 min, and reacted with 1 mL HEPES buffer. FITC and PI fluorescence was detected using a 515 and 629 nm passband filter, respectively with the excitation wavelength 488 nm, and cell apoptosis can be evaluated subsequently. The experiment was performed three times independently. In the scatter diagram of flow cytometry, the right lower quadrant indicated early apoptotic cells, right upper quadrant late apoptotic cells, left upper quadrant mechanically damaged or necrotic cells, and left lower quadrant living cells. Apoptosis rate was calculated with the formula: Apoptosis rate (%) = Percentage of early apoptotic cells + Percentage of late apoptotic cells.
Perforation of the excluded segment without pneumoperitoneum following Roux-en-Y gastric bypass surgery: case report and literature review
Published in Acta Chirurgica Belgica, 2021
Maxime Peetermans, Jana Vellemans, Guido Jutten, Pieter D’hooge, Peter Delvaux, Frederik Huysentruyt, Anneleen Van Hootegem, Jos Callens, Olivier Peetermans
Diagnosis and treatment in RYGB patients is challenging, since their altered anatomy hinders diagnostic and therapeutic interventions. Conventional signs of hollow organ perforation, such as pneumoperitoneum and extravasation of orally administered contrast, are often absent. The absence of a pneumoperitoneum can be explained by the lack of free air in the excluded stomach. When reviewing the literature, a pneumoperitoneum was established in 12 of 48 patients [10,12,14,16,19,20,22–24,28–30], half of whom were patients with a duodenal perforation [10,12,14,16,19,20]. In most of these cases, pneumoperitoneum was only revealed on abdominal CT. Only in three patients, pneumoperitoneum was demonstrated on abdominal radiography [10,29,30]. In one patient the perforation was accompanied by a gastrogastric fistula, which evidently leads to free abdominal air [16]. Extravasation of orally administered contrast is also absent since it does not reach the perforated excluded segment. However, after percutaneously introducing contrast in the excluded stomach, Charuzi et al. [10] were able to demonstrate extravasation of contrast on abdominal radiography. Ultrasound and/or CT scan are useful for investigating such patients and will also contribute to the identification of other causes of acute right upper quadrant pain. As in the case we present, free peritoneal fluid is often the only abnormality that can be identified on CT scan.
Adrenal infarction in the immediate postnatal period†
Published in Journal of Obstetrics and Gynaecology, 2019
Thomas Keith Cunningham, Slavyana Maydanovych, Hannah Draper, Georgios Antoniades, Jane Allen
Approximately 2 hours after delivery she reported severe right upper quadrant pain radiating into her back. On physical examination, the patient appeared to be distressed and was writhing in the bed. The abdominal palpation demonstrated that there was a soft abdomen with right upper quadrant and right renal angle tenderness. There was no fundal tenderness on uterine palpation. Her blood pressure (BP) became significantly raised with 139/111 in her right arm and 158/131 in her left. Her pulse remained at 80 bpm with normal character, and there was no radio-radial delay; her respiratory rate was elevated at 20 bpm and she was apyrexial throughout. Her clean catch urine elicited +1 protein. In the acute period she was managed with an IV of morphine and an IV of paracetamol for the pain, 200 mg of oral labetalol for BP control and was commenced on an IV of magnesium sulphate until pre-eclampsia could be excluded. Blood was drawn for a full blood count; the liver enzymes, urea and electrolytes, coagulation profile and the urine:protein:creatinine ratio was examined. A differential diagnosis at this time was included; it was a capsular liver haematoma secondary to pre-eclampsia, renal colic, a bowel infarction, cholelithiasis/pancreatitis, a dissecting aorta or a thrombotic event.