Test Paper 5
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
A 58-year-old inpatient, admitted 10 days before for an acute exacerbation of chronic obstructive pulmonary disease, develops profuse watery diarrhoea and severe cramp-like abdominal pain. Abdominal X-ray is unremarkable, but CT demonstrates circumferential wall thickening of the rectum extending to the mid-transverse colon, an ‘accordion sign’ in the sigmoid colon, pericolonic fat stranding and ascites. What is the most likely diagnosis? Radiation enteritisIschaemic colitisDiverticulitisAmoebiasisClostridium difficile colitis
Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
In boys, congenital inguinal hernias are related to descent of the testis through the layers of the abdominal wall (Figure 24.1). The gonad starts intra-abdominally at the level of the kidney and reaches the internal ring at about 15–20 weeks’ gestation primarily under the influence of insulin-like hormone 3 (INSL3) produced by testicular Leydig cells. Thereafter, led by the shortening gubernaculum, it passes through the internal ring under the influence of local calcitonin gene-related peptide (CGRP) released from the genitofemoral nerve and under the influence of testosterone. It drags with it a diverticulum of peritoneum on its anteromedial surface referred to as the “processus vaginalis.” This normally fuses in >90% of full-term infants, obliterating the entrance to the canal, but failure of obliteration may result in a variety of inguinoscrotal anomalies, including an indirect inguinal hernia, a communicating hydrocele, hydrocele of the canal and a hydrocele of the tunica vaginalis. There are a number of obvious predisposing factors, particularly prematurity, but others include anterior abdominal wall defects (gastroschisis, exomphalos, and cloacal exstrophy), and conditions characterized by excess intraperitoneal fluid (e.g. ascites and ventriculoperitoneal shunts).
Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Clinical examination of obese people should be directed to identifying associated comorbid conditions (Table 11.17) and clinical features of disorders causing secondary obesity (see Table 11.15). Obesity may present with symptoms of these comorbid conditions. An assessment of the mental state should be included; morbidly obese people have higher rates of anxiety and depression. Breathlessness may be due to the increased work associated with walking with an increased mechanical weight load and compounded by lack of physical fitness. Consider other causes of breathlessness, including obesity hypoventilation syndrome. Body temperature regulation is more difficult in the obese because of the insulating effect of fat causing problematic sweating. Ascites may present as ‘obesity’ and should be considered as a differential diagnosis in people with an increasing waist size.
Noninvasive imaging assessment of portal hypertension: where are we now and where does the future lie?
Published in Expert Review of Molecular Diagnostics, 2021
Shang Wan, Xijiao Liu, Hanyu Jiang, Zhongzhao Teng, Bin Song
Liver stiffness quantified by ultrasound transient elastography has been used primarily to determine liver cirrhosis. It can be used to evaluate pathological changes in the liver parenchyma due to the progression of chronic fibrosis [3]. Ultrasound transient elastography has been well-demonstrated to be associated with CSPH with satisfactory diagnostic accuracy against HVPG measurement [5]. The Baveno VI recommendation stated that transient elastography can be used as an alternative for identifying patients’ requirement of endoscopic screening if liver stiffness <20 kPa and platelet count ≥150 × 103/mm3 does not require endoscopic screening in esophageal varices patients [5]. However, the robustness of transient elastography might be affected by patients’ individual physical conditions, such as obesity and ascites. A novel parameter of spleen stiffness has been proposed recently and has shown promising capability for identifying CSPH, with a better diagnostic performance than liver stiffness [6]. However, it cannot be measured using traditional transient elastography or in patients without splenomegaly; thus, this noninvasive parameter of spleen stiffness is not recommended in general clinical applications. Magnetic resonance elastography (MRE) is another alternative method for measuring liver and spleen stiffness. It is also correlated with CSPH, with encouraging diagnostic performance [7].
Knowledge of enhanced recovery after surgery and influencing factors among abdominal surgical nurses: a multi-center cross-sectional study
Published in Contemporary Nurse, 2022
Bing Xue, Huidan Yu, Xianwu Luo
A guideline suggested that prophylactic abdominal drainage should be omitted after major abdominal surgery (Melloul et al., 2016), but the results found that only half of the nurses agreed with this. Contrary to the traditional way is a contributory factor in nurses’ reluctance to adopt ERAS practices (Seow-En et al., 2021). Though the abandonment of abdominal drainage after abdominal surgery is safe and effective, and it will not increase the incidence of postoperative complications, especially abdominal infection and ascites exudation (Brustia et al., 2021). This indicates that the concept of ERAS has not been systematically introduced in China, and some perioperative treatment measures of ERAS may have been implemented in clinical practice. However, due to the lack of systematic and professional theoretical knowledge training, nurses lack profound understanding of knowledge, resulting in a low correct response rate of some items(Wang & Li, 2018).
Diagnostic Performance of SGA, PG-SGA and MUST for Malnutrition Assessment in Adult Cancer Patients: A Systematic Literature Review and Hierarchical Bayesian Meta-Analysis
Published in Nutrition and Cancer, 2022
Rena Nakyeyune, Xiaoli Ruan, Yi Shen, Yi Shao, Chen Niu, Zhaoping Zang, Fen Liu
The Subjective Global Assessment (SGA) is a method that assesses nutritional status based on a patient’s history and physical examination. The history component shows the patient’s weight change, presence of gastrointestinal symptoms (anorexia, diarrhea, nausea, vomiting), functional capacity plus disease and its relation to nutritional requirements. The physical examination evaluates the loss of subcutaneous fat, ankle edema, sacral edema, muscle wasting and ascites. Patients are rated as well nourished (SGA-A), moderately malnourished (SGA-B) or severely malnourished (SGA-C) (11, 12).
Related Knowledge Centers
- Cirrhosis
- Shortness of Breath
- Spontaneous Bacterial Peritonitis
- Abdomen
- Peritoneal Cavity
- Tuberculosis
- Cancer
- Pancreatitis
- Heart Failure
- Shortness of Breath
- Budd–Chiari Syndrome