Hernia: An anatomical curse!

•

15 recomendaciones•3,681 vistas

Hernia is one of the commonest surgical disorder due to weakness in the anatomical structures of the region.Understanding the anatomical aspects is therefore pivitol in successfull treatment of this potentially dangerous condition. The presentation provides a road map for understanding and treating hernias.

Salud y medicina Empresariales

HERNIA

by
Dr. Ketan Vagholkar.
MS, DNB, MRCS, FACS
Professor of Surgery
&
Consultant Surgeon

Surgical Anatomy Of Anterior
Abdominal Wall
n Fascias
n Rectus Sheath
n Abdominal Muscles
n Inguinal Canal

Inguinal Canal
n Boundaries & Contents n External ring is a triangular
n Anteriorly-External oblique aperture in the aponeurosis
aponeurosis &internal oblique of the external oblique.It is
laterally 1.25 cms above the pubic
n Posteriorly-Transversalis fascia tubercle.
and conjoined tendon
n Superiorly-Conjoined tendon n Deep ring is a U shaped
n Inferiorly-Inguinal ligament opening in the transversalis
n Contents
fascia.It lies 1.25 cms above
n In males-spermatic cord and the mid inguinal point.
Ilioinguinl nerne.
n In Females-round ligament
and Ilioinguinal nerve

Natural Mechanisms Preventing
Hernia
n Obliquity of the canal
n Internal oblique muscle opposite the deep ring
n Shutter action of the arched fibres of internal
oblique and transversus abdominis
n Plugging action of the spermatic cord due to
contraction of the cremaster muscle
n Sliding valve action of the U shaped internal ring

Definition of Hernia
n Hernia is defined as an
abnormal protrusion of
viscus or part of viscus
through a normal or
abnormal opening in the wall
of the cavity containing it.
n Classification depending on
the anatomical site of the
hernia. (Inguinal, femoral,
epigastric etc.)
n Incidence: Inguinal-
73%,Femoral-
17%&Umbilical-8.5%)

Pathology
n Composition n Contents
n Sac- Diverticulum of n Intestine-enterocele
peritoneum and consists n Omentum-omentocele or
of mouth, neck, body and epiplocele
fundus. The diameter of n Meckel’s diverticulum-
the neck determines the Littre’s hernia
outcome.
n Circumference of bowel-
n Coverings well Richter’s hernia
amalgamated hence
indistinguishable. n W loop of intestine-
Maydl’s hernia

Natural history
n Reducible
n Irreducible
n Obstructed
n Strangulated
n Inflammed

Clinical Evaluation
n History
n Chief complaints (odp)
n Complications

n Etiology

n Treatment taken

n Inference from history

Clinical Evaluation
n Physical examination.
n Inspection-site,impulse
n Palpation-
n Getting above
n Impulse on coughing
n Reducibility-Taxis
n Deep ring occlusion test
n Invagination test
n Tone-Inspection/palpation
n Other systems

Clinical Diagnosis
n Site, side, complicated or not, direct or indirect
inguinal hernia
n Status of tone
n Possible etiological factor

Investigations
n Haematological
n CBC
n Blood sugar (fasting &
postprandial)
n BUN, creatinine, Electrolytes
n Urine examination

n Ultrasound of Abd.
n ECG
n CXR

Principles of repair
n Herniotomy for an indirect sac
n Identify
n Dissect

n Open

n Reduce the contents

n Transect

n Twist, tansfix, ligate & excise the redundant portion

n Slit open the distal sac

Principles of repair
n Herniotomy for direct sac
n Identify
n Dissect around the neck

n Purse string suture

n Invert the sac and tighten the purse string

n Direct sac never to be opened

Principles of repair
n Special cases
n Pantaloon hernia
n Sliding hernia

n Strangulated hernia

Principles of repair
n Herniorrhaphy
n Selection of patients
n Principles (anatomic considerations)
n Types
n Bassini’s
n Shouldice
n Lichtenstein Repair(T abd to Ing Lig with relaxing
incision& Ext obl behind the cord)
n Other types (Ogilvie’s, Lyttle’s ,skeletonization of cord
etc.)

Principles of repair
n Hernioplasty (Open approach)
n Patient selection
n Types
n Mesh plasty

n Darning

n Material used
n Endogenous

n Exogenous

n Requirements of a mesh

Meshplasty
nLaparoscopic Approach
TAPP
TEPP

Surgical Aftercare
n Avoid straining
n Avoid heavy work
n Bowel function
n Urinary system
n Care to be taken for at least 3 months after
surgery

Complications
n Intraoperative
n Post operative
n Infection
n Neurological complications

n Recurrence
n Types
n True
n False

Más contenido relacionado

La actualidad más candente

Gastrojejunostomy

medbookonline

Modified radical mastectomy

Jaideep Pradeep

Inguinal hernia ppt

Viswa Kumar

Undescended testis

GAURAV NAHAR

Abdomen layers & surgical incisions

Dr.Abhishek Reddy K

Splenectomy

Bashir BnYunus

Carcinoma rectum (Rectal Cancer)

Dr Vandana Singh Kushwaha

EXTENDED TOTALLY EXTRA-PERITONEAL REPAIR {eTEP}

Dr Jasbeer Singh

VENTRAL HERNIA

Selvaraj Balasubramani

Varicocele

Abino David

Burst abdomen

Aung Ko Thet

Benign breast disease

Jyotindra Singh

Incisional hernia

Rana Singh

Hydrocele

sonia dagar

CONGENITAL HERNIA AND HYDROCELE

Dr.Manish Kumar

Breast surgery

Faisal Azmi

Principle of laparoscopic surgery

thaannush

Laparoscopy Basics, Principles, Instrumentation, Indication

Anil Haripriya

Blunt abdominal trauma

Anne Odaro

Retroperitoneal mass

Kundan Singh

La actualidad más candente (20)

Gastrojejunostomy

Modified radical mastectomy

Inguinal hernia ppt

Undescended testis

Abdomen layers & surgical incisions

Splenectomy

Carcinoma rectum (Rectal Cancer)

EXTENDED TOTALLY EXTRA-PERITONEAL REPAIR {eTEP}

VENTRAL HERNIA

Varicocele

Burst abdomen

Benign breast disease

Incisional hernia

Hydrocele

CONGENITAL HERNIA AND HYDROCELE

Breast surgery

Principle of laparoscopic surgery

Laparoscopy Basics, Principles, Instrumentation, Indication

Blunt abdominal trauma

Retroperitoneal mass

Destacado

Ventral hernias

Lalityaswarna Pethakamsetty

Hernia

Bashir BnYunus

Inguinal hernia examination

Mohamed Mourad

Femoral hernia - Groin swellings

Selvaraj Balasubramani

Abdominal hernias by dr. nitin

Hernia

Hernia

Inguinal hernia

Destacado (8)

Ventral hernias

Hernia

Inguinal hernia examination

Femoral hernia - Groin swellings

Abdominal hernias by dr. nitin

Hernia

Inguinal hernia

Similar a Hernia: An anatomical curse!

Inguinal hernia

Loveleen Garg

The larynx, commonly known as the voice box, is a cartilaginous structure located in the neck, connecting the pharynx (throat) to the trachea (windpipe). It plays a crucial role in phonation (production of sound) and protecting the lower respiratory tract. Disorders of the larynx can impact speech and swallowing. Conditions such as laryngitis, vocal cord nodules, or laryngeal cancer can affect the structure and function of the larynx. Voice changes, difficulty swallowing, and respiratory compromise are common symptoms associated with laryngeal disorders.

RESP 03 larynx anatomy medical respiratory .pdf

AHMED ASHOUR

Inguinal hernia

karrar adil

inguinoscrotal surical conditions-lituli.pptx

SirajudheenSRJ

hernia (1).pptx

jharnaverma2

Open hernial repair

Rajesh Rayidi

Dr mia oncology conference 1 1-2013

Tariq Mohammed

Seminar on scrotal swelling

Abuneder Ababu

M132 Module 05 Coding Assignment 1. Case Study #1 PREOPERATIVE DIAGNOSIS: Tertiary hyperparathyroidism. POSTOPERATIVE DIAGNOSIS: Tertiary hyperparathyroidism. OPERATION PERFORMED: Subtotal parathyroidectomy. ANESTHESIA: General. Fifteen mL of 0.5% Marcaine with epinephrine for local anesthesia. DESCRIPTION OF OPERATION: The patient was intubated with the nerve monitor endotracheal tube. A shoulder roll was placed and the neck was prepped and draped in the usual manner. A transverse cervical incision was made, and local anesthesia was infiltrated prior to the incision and as we finished the closure. The initial incision was deep and beyond platysma. Crossing anterior jugular vein branches were doubly ligated with 2-0 silk ties and divided. The superior subplatysmal flap was brought to the thyroid notch and the inferior flap to the sternal notch. Strap muscles were divided at the midline and separated. The right strap muscles were lifted off the right thyroid gland and mobilized slowly the right thyroid gland medially. The nerve at the base of the neck was identified. There were two inferior thyroid artery branches that were ligated with 2-0 silk ties and divided. Middle thyroid vein was ligated with 2-0 silk tie and divided. The thyroid gland was mobilized medially. The right upper parathyroid gland was found at the mid aspect of the posterior thyroid gland. It was intrathyroidal. It was slowly removed from the thyroid gland, clipped the feeding vessels and the right upper parathyroid gland was totally excised. The nerve was noted to be functional at the end of this excision. The superior vascular bundle was doubly ligated with 2-0 silk ties and divided allowing for further mobilization of the gland medially. We were unable to find a parathyroid gland at that level. We then subsequently freed the lower pole of the thyroid gland and we started identifying the thymus tissue and pulled it out of the chest. There was a right neck lymph node that was submitted for frozen section and this was benign. We then identified a right lower parathyroid gland. I clipped the distal half and this was confirmed to be parathyroid tissue. The proximal half of the parathyroid gland was left intact. The left strap muscles were lifted off the left thyroid gland. The middle thyroid vein was ligated with 3-0 silk ties and divided and the thyroid gland was then mobilized medially. The nerve was found at the base of the neck and traced towards the larynx. The left upper parathyroid gland was identified, found to be posterior to the mid aspect of the thyroid gland, and it measured 1.5 x 0.8 cm. We freed it from the nerve and from the thyroid gland and this was confirmed to be parathyroid tissue. The small vascular pedicles were clipped and the left upper parathyroid gland removed. The nerve was noted to be functional at this point. We ligated the superior thyroid vascular pedicle. This was done with 2-0 silk ties x2 and with a 3-0 silk suture ligature. We ...

M132 Module 05 Coding Assignment1. Case Study #1PREOPERATI.docx

infantsuk

Hernia by momen

Momen Ali Khan

Hernia and herniorrhaphy

Adams Inusah

Puj obstruction

Dipali Tagg

Hernia Lecture notes.pptx

DramoyoGeofrey

Anus and rectum absite

KevinClimaco

04 genital prolapse isam

Abdominal hernias

Hernia

Femoral hernia

Appendicitis and Hernia.pptx

Marjorie Grecia

Anorectal malformation ppt 5

RamanUppal3

Similar a Hernia: An anatomical curse! (20)

Inguinal hernia

RESP 03 larynx anatomy medical respiratory .pdf

Inguinal hernia

inguinoscrotal surical conditions-lituli.pptx

hernia (1).pptx

Open hernial repair

Dr mia oncology conference 1 1-2013

Seminar on scrotal swelling

M132 Module 05 Coding Assignment1. Case Study #1PREOPERATI.docx

Hernia by momen

Hernia and herniorrhaphy

Puj obstruction

Hernia Lecture notes.pptx

Anus and rectum absite

04 genital prolapse isam

Abdominal hernias

Hernia

Femoral hernia

Appendicitis and Hernia.pptx

Anorectal malformation ppt 5

Más de KETAN VAGHOLKAR

Meckel’s diverticulum in a hernia sac is designated as a Littre’s hernia. It is an uncommon type of hernia. The diagnosis is invariably made at the time of surgery. Resection anastomosis of the adjacent segment of the small bowel with the diverticulum is a contentious issue. A case of Littre’s hernia is reported. A case of Littre’s hernia in a 17-year-old boy is reported to highlight the diagnostic and therapeutic issues confronting the attending surgeon. A short segment resection anastomosis of the small bowel along with the Meckel’s diverticulum was done. A herniorrhaphy was done with no complications. The diagnostic challenges, the dilemma of selecting the best option for removing Meckel’s diverticulum, and the choice of hernia repair are discussed. Littre’s hernia is invariably diagnosed intraoperatively. A short segment resection anastomosis of the adjacent small bowel and Meckel’s diverticulum prevents complications arising due to the diverticulum. A herniorrhaphy for a young patient and the use of an absorbable mesh for other age groups is advisable.

LITTRE’S HERNIA: A SURGICAL DILEMMA

KETAN VAGHOLKAR

Post-traumatic wounds especially after run over accidents are difficult to manage. The vascularity and regenerative potential of the tissues is severely compromised. Surgical intervention is of limited value. A conservative approach with concomitant hyperbaric oxygen therapy (HBOT) serves as a great salvage in such cases. A case of post-traumatic forefoot gangrene in a 27-year-old laborer is presented to highlight and create an awareness of the potential benefit of HBOT in salvage of distal parts of the lower extremity where the blood supply is severely compromised.

Hyperbaric oxygen therapy a boon for complex post traumatic wounds

KETAN VAGHOLKAR

Deep vein thrombosis (DVT) usually affects the deep vein of the legs, though it may also occur in the veins of the arms, mesenteric and cerebral veins. Venous thromboembolism can cause sudden pulmonary embolism with instantaneous death. In patients who have developed deep vein thrombosis there is likelihood of recurrent thrombosis and post thrombotic syndrome. Deep venous thrombosis is preventable in majority of the cases. Understanding the etiopathogenesis, clinical presentation, evaluation and management is essential for both prevention and management thereby reducing the morbidity and mortality associated with the disease.

Deep Vein Thrombosis

KETAN VAGHOLKAR

Background: Fluid collection in a femoral hernia sac designated as a femorocele is an extremely uncommon surgical condition. Till date 9 cases of unilateral femorocele and one case of bilateral femorocele have been reported in English literature. Objective: Thus making the case presented the second case of bilateral femorocele in English literature. Case report: A case of bilateral femorocele in a patient suffering from rheumatic heat disease who had undergone dual valvular replacement with ascites due to cardiac cirrhosis is presented to highlight the surgical challenges in management of such a rare case. Discussion: Pathophysiology, clinical features, investigations and managemeny of femorocele are discussed. Conclusion: Contrast enhanced CT scan of the abdomen and scrotum is diagnostic. Open surgery in the form of dissection of sac with high ligation followed by obliteration of femoral ring is therapeutic. There is no scope of laparoscopy in such a case.

Bilateral Secondary Femorocele in a Case of Ascites Due to Cardiac Cirrhosis ...

KETAN VAGHOLKAR

Sliding inguinal hernia continues to be the most challenging hernia to treat. Both diagnosis and treatment pose a dilemma to the attending surgeon. Understanding the pathological anatomy of the sliding inguinal hernia is essential for optimal choice of surgical procedure without causing damage to the involved viscera. A case of sliding inguinal hernia is presented to highlight the diagnostic and technical challenges for repair of sliding hernia. Majority of sliding hernias are diagnosed at the time of surgery. Sigmoid colon is a commonest content in a left sided sliding hernia. Bevan’s technique is best suited to deal with the sac followed by Lichtenstein tension-free mesh repair.

Sliding hernia.pdf

KETAN VAGHOLKAR

Gallbladder carcinoma is fifth most common gastrointestinal malignancy. Main indication for cholecystectomy is gallstone disease. Majority of gallbladder carcinomas are diagnosed during the course of histopathological evaluation of specimens obtained at cholecystectomy. Accomplishing radical cholecystectomy is advisable in these patients. Technically difficult gallbladder dissection during the course of laparoscopic surgery should raise a high suspicion of malignancy. Specimen retrieval bags should be used in all cases to avoid external spillage of bile giving rise to port side metastasis. A good outcome depends on prompt diagnosis and radical surgical resection. It is essential for a general surgeon to be aware of predisposing factors, pathology, patterns of presentation, and surgical options in gallbladder carcinoma.

Carcinoma of the gall bladder.pdf

KETAN VAGHOLKAR

Fournier’s gangrene is a severe necrotizing fasciitis affecting the scrotum, perianal and perineal region. Development of this condition after inguinal hernia repair is extremely rare. A 54-year-old diabetic male patient who had undergone right inguinal hernia repair in a private clinic presented with severe necrotizing infection of the scrotum, predominantly of the right side. He was referred to our surgical unit. Initial resuscitation followed by broad spectrum antibiotic therapy and aggressive debridement of necrotic tissue followed by closure of scrotum was performed with excellent outcome. The purpose of presenting this case is to create awareness about this complication after hernia repair surgery especially in cases with comorbidities like diabetes mellitus.

Fournier’s gangrene of the scrotum after inguinal hernia repair: case report

KETAN VAGHOLKAR

Hydrocele of the Canal of Nuck (HCN) is a rare condition seen in adult females. Diagnosis of HCN poses a great challenge to the attending surgeon. There are various variants of embryological abnormality of the processes vaginalis manifesting in different forms. Understanding the embryological development of the processes vaginalis and the gubernaculum in female is therefore essential for determining the best surgical option for treating these rare cases.

Hydrocele of Canal of Nuck.pdf

KETAN VAGHOLKAR

Carbuncle is a confluent folliculitis that is infection affecting multiple hair follicles leading to multiple sinuses discharging pus. It is commonly seen on the back of immuno-compromised patients. Admission to hospital with aggressive treatment, both systemic and locally is necessary. Optimisation of co-morbidities such as diabetes, adequate hydration, and antibiotics and are mainstay of initial treatment. Surgical intervention in the form of debridement and desloughing followed by wound care is the next line of management. Patient education at the time of discharge is necessary for prevention of recurrence.

Carbuncle: A challenging infective lesion

KETAN VAGHOLKAR

Cases of self-inserted foreign bodies into the lower urinary tract are uncommon. They are associated with a mental illness called polyembolokoilomania. The site, size and nature of the foreign body determines both the symptomatology and complications. A case of self-inserted needle into the penile urethra by a 15-year-old boy is presented. A plain X-ray of the pelvis revealed the needle. The needle was successfully removed by cystoscopy. Plane X-ray imaging and CT scan are essential to locate the site, size, and nature of the foreign body. Endoscopic approach is preferred in majority cases. Psychiatric counselling in the post-operative period is required to prevent further episodes of reinsertion of such foreign bodies.

Foreign body in the male urethra: case report

KETAN VAGHOLKAR

Introduction: Morel-Lavalleé lesion is an uncommon closed degloving injury usually affecting the lower extremity. Although these lesions have been documented in literature, yet there is no standard treatment algorithm for the same. A case of Morel-Lavallée lesion following blunt injury to the thigh is therefore presented to highlight the diagnostic and therapeutic challenges in managing such lesions. The aim of presenting the case is to create awareness of clinical presentation, diagnosis, and management of Morel-Lavallée lesions, especially in the setting of polytrauma patients. Case Report: A case of Morel-Lavallée lesion in a 32-year-old male with history of a blunt injury to the right thigh caused by a partial run over accident is presented. A magnetic resonance imaging (MRI) was done to confirm the diagnosis. A limited open approach for evacuating the fluid in the lesion was performed followed by irrigation of the cavity with a combination of 3% hypertonic saline and hydrogen peroxide in order to induce fibrosis to obliterate the dead space. This was followed by continuous negative suction accompanied with a pressure bandage. Conclusion: A high index of suspicion is necessary especially in cases of severe blunt injuries to the extremities. MRI is essential for early diagnosis of Morel-Lavallée lesions. A limited open approach is a safe and effective option for treatment. The use of 3% hypertonic saline along with hydrogen peroxide irrigation of the cavity to induce sclerosis is a novel method for treating the condition.

Morel-Lavallée Lesion: Uncommon Injury often Missed

KETAN VAGHOLKAR

Background: The development of a pseudocyst after mesh repair of an incisional hernia is a rare complication. Both diagnosis and management pose a great challenge to the attending surgeon. Therefore, the need to report such an uncommon complication and its management in order to create awareness of this distinct though rare entity. Case report: A pseudocyst formation following an onlay mesh repair of an incisional hernia is reported. Contrast-enhanced CT scan was diagnostic. It revealed a well-formed cyst with no communication with the peritoneal cavity. Complete excision of the cyst was curative. Conclusion: Pseudocyst formation is a rare complication following mesh repair. Contrast-enhanced CT scan is essential for confirming the diagnosis. Complete surgical resection of the cyst is the mainstay of surgical treatment.

ABDOMINAL WALL PSEUDOCYST COMPLICATING INCISIONAL HERNIA REPAIR

KETAN VAGHOLKAR

Background: Traumatic lumbar hernia is due to shearing of bony insertions of the muscle in the lumbar region. In recurrent cases, there is more attenuation of muscles. This makes fixation of the mesh extremely difficult. Hence, the need to develop a new technique. Case report: A 27-year-old male presented with a recurrent post-traumatic right- sided lumbar hernia. He had a severe two wheeler accident. Following the accident he had undergone various surgical interventions for a fractured pelvis with a deglowing injury involving the right gluteal region and upper thigh. He had also developed a post-traumatic lumbar hernia for which he had undergone open mesh repair. Subsequently he developed recurrence of the post traumatic right-sided lumbar hernia. After complete investigation he underwent open mesh repair for the recurrent post traumatic lumbar hernia. The defect was wide and was devoid of healthy surrounding muscles. The mesh was fixed to the ileal bone with bone anchors and to the twelfth rib with trans-osseous fiber sutures passed through holes drilled in the twelfth rib. Flaps were created from the remnant surrounding attenuated muscles. They were double-breasted to cover the mesh. Postoperative outcome was excellent with no recurrence for the last six months. Discussion: The various anatomical and technical considerations of bone fixation of the mesh for hernia repair are discussed. Conclusion: Bone fixation of the mesh with bone anchors is a viable option especially in cases where there is severe attenuation of adjacent muscles for mesh fixation.

Novel Technique for Mesh Fixation to the Bone in Recurrent Post Traumatic Lum...

KETAN VAGHOLKAR

Background: Acute calculous cholecystitis is one of the commonest biliary tract emergencies. The advent of laparoscopic cholecystectomy has changed the treatment approach from conservative to emergency surgical intervention. As a result, emergency laparoscopic cholecystectomy is emerging as the standard of care. Therefore, the needs to evaluate the various factors that determine the procedure’s safety. Aims: The study aims to evaluate the efficacy and safety of laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and methods: Consecutive patients who underwent laparoscopic cholecystectomy for acute calculous cholecystitis over a 2-year-old period were studied prospectively. Results: 75 patients were evaluated. The mean age was 49.48 years. Majority presented with right hypochondriac pain. 22 patients had hypertension. 26 had diabetes and 6 patients had both hypertension and diabetes. In 61 patients the mean duration of surgery was less than 60 minutes. 5 patients needed conversion to an open procedure. 10 patients developed complications. Mean hospital stay was 4.34 days. Conclusion: Early emergency laparoscopic cholecystectomy is a safe and viable option for treating acute calculous cholecystitis

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS (STUDY OF 75 CA...

KETAN VAGHOLKAR

Lipoma is one of the most common soft tissue tumor arising from the mesenchyme. It is slow growing, encapsulated, and usually benign in nature. Tumors over the back, shoulder, and neck region have a high propensity to assume large size thereby getting redefined as a giant lipoma when they exceed 10 cm in width or weigh more than 1000 grams. MRI is the investigation of choice for evaluating giant lipomas. Fine needle aspiration cytology (FNAC) or frozen section may be pertinent in suspected cases of liposarcoma. Complete surgical incision is the treatment of choice. A case of a giant lipoma on the back of a 64-year-old lady is presented with a view to revisit conceptual understanding of the clinical evaluation, investigation, and management of giant lipomas.

Giant lipoma over the back

KETAN VAGHOLKAR

Background: Appendicectomy is one of the common procedures performed by a general surgeon. However, the advent of laparoscopic appendicectomy has reduced the number of open appendicectomies performed. Therefore there is a need to study the advantages of the laparoscopic approach over the traditional open approach. Aims: The study aimed to compare laparoscopic appendicectomy with open appendicectomy based on various intraoperative and postoperative parameters Materials and methods: 50 patients undergoing interval appendicectomy were randomised into two groups. Group A comprised 25 patients who underwent laparoscopic appendicectomy and group B comprised 25 patients who underwent open appendicectomy. Results: Confirmation of diagnosis and evaluation of intraoperative findings was easier in group A patients. In addition, early commencement of feeds with early bowel movements, reduced need for postoperative analgesia due to less pain, lesser complications and shorter duration of hospital stay was observed in group A patients. Conclusion: Laparoscopic appendicectomy has better outcomes rendering it a preferable procedure for appendicectomy.

LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)

KETAN VAGHOLKAR

Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical intervention for complications is the mainstay of treatment.

ABDOMINAL TUBERCULOSIS (STUDY OF 50 CASES)

KETAN VAGHOLKAR

Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed by clinical and radiological investigations were included in the study and studied prospectively. On admission to the hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented in an advanced stage developed complications. The majority of patients were males. The interval between the onset of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process, were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication. Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.

PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...

KETAN VAGHOLKAR

Background: Skin approximation is a very important step in a surgical operation. The quality of skin approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications. Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation). The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation) had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction. Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.

COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...

KETAN VAGHOLKAR

Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively. Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60 years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B. The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic requirement, early commencement of oral feeds, and shorter duration of hospitalization

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...

KETAN VAGHOLKAR

Más de KETAN VAGHOLKAR (20)

LITTRE’S HERNIA: A SURGICAL DILEMMA

Hyperbaric oxygen therapy a boon for complex post traumatic wounds

Deep Vein Thrombosis

Bilateral Secondary Femorocele in a Case of Ascites Due to Cardiac Cirrhosis ...

Sliding hernia.pdf

Carcinoma of the gall bladder.pdf

Fournier’s gangrene of the scrotum after inguinal hernia repair: case report

Hydrocele of Canal of Nuck.pdf

Carbuncle: A challenging infective lesion

Foreign body in the male urethra: case report

Morel-Lavallée Lesion: Uncommon Injury often Missed

ABDOMINAL WALL PSEUDOCYST COMPLICATING INCISIONAL HERNIA REPAIR

Novel Technique for Mesh Fixation to the Bone in Recurrent Post Traumatic Lum...

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS (STUDY OF 75 CA...

Giant lipoma over the back

LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)

ABDOMINAL TUBERCULOSIS (STUDY OF 50 CASES)

PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...

COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...

Último

In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.

Circulatory Shock, types and stages, compensatory mechanisms

MedicoseAcademics

Exclusive Call Girls Bangalore {7304373326} ❤️VVIP MALTI Call Girls in Bangalore Karnataka Booking Details Are here: just visit website: https://girlsinbangalore.com #Call Girl In Bangalore, #Bangalorecallgirls #CallgirlserviceBangalore, #CallgirlsinBangalore 07-May-2024( Mj) Click On WhatsApp Chat +91-7304373326 Bangalore Escorts Make You Feel Like Royalty Bangalore Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Exclusive Call Girls Bangalore {7304373326} ❤️VVIP POOJA Call Girls in Bangal...

Sheetaleventcompany

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8630512678 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Lucknow Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In Lucknow Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 8630512678 !! Thank you for Visiting.

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

soniyagrag336

Call Girls Service In Kolkata ❤️🍑 9xx000xx09 👄🫦Independent Escort Service Kolkata West Bengal WhatsApp Chat: ☎️ +91-9xx000xx09 Call Girl Near Me, Kolkata Call Girls, Kolkata Call Girl Booking Details Are here: just visit website: https://hotbabe24.com #Call Girl In Kolkata, #Kolkatacallgirls #CallgirlserviceKolkata, #CallgirlsinKolkata Website on rent : mailto:indiancallgirl4rent@gmail.com Call Girls Kolkata offer you everything from intimate moments to wild nights - be it intimate or wild. Their girls are always prepared to meet all your needs and desires so you're assured a memorable experience with them. Beautiful Babes are sure to turn heads wherever they go, captivating men with their seductive personalities and captivating looks - not to mention their sensually alluring bodies that are sure to satisfy all your naughty fantasies, from blowjobs to anal massages; not forgetting BDSM and orgies as well. Show them some appreciation when the time is right. Call Girl Kolkata that their clients can be very demanding. To maintain their reputation and gain more clients, these sexy call girls always work tirelessly to provide exceptional service that ensures each customer's happiness - so much so that many men seek them out to have an unforgettable experience with Passionate about providing erotic pleasure for their clients - fulfilling all sexy fantasies while offering role play services such as BDSM. ★OUR BEST SERVICES: - FOR BOOKING ★ A-Level (5-star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob) ★ Spending time in my rooms ★ BJ (Blowjob Without a Condom) ★. Extra ball (Have ride many times) ☛ ☛ ☛ ✔✔ secure✔✔ 100% safe WHATSAPP CALL ME💥✨✨⭐⭐⚡💦💦💨🔥💫💫 Their services range from erotic encounters and movie dates to in-call and out-call services, making this option available 24/7. Available for services including NSA, threesomes and foursomes sessions as well as massage services and casual foreplay - they even provide real girlfriend experience. Find one online or visit local women's clubs, hotels or restaurants. Hiring a Kolkata call girl for an evening or day out can be the perfect addition to your social gathering or office event, or you could arrange for her to visit your home or hotel room. Not only are these women gorgeous, they're intelligent as well, with great senses of humor - sure to please and leave you wanting more. If you want a cheap escort in Kolkata, look for someone who is either a student or works part time so that she will always be available when you need her. In addition to this, look for housewives as this ensures they have stable lives that can keep you satisfied for extended periods. These beautiful ladies will capture your attention at first sight with stunning eyes and full, seductive lips; not to mention a seductive personality that makes you want to spend more time with them; moreover they are discreet enough to meet up anywhere nearby! Hiring a call girl in Kolkata can be done through either

Kolkata Call Girls Service ❤️🍑 9xx000xx09 👄🫦 Independent Escort Service Kolka...

Sheetaleventcompany

Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now CALL WATTSAPP 6378878445 THE MOST BEAUTIFUL INDEPENDENT ESCORT CALL GIRL SERVICE, Chennai WE ARE PROVIDING GENUINE CALL GIRL SERVICE I AM A a NATURAL BRUNETTES, SLIM BODY, NATURAL LONG HAIR AND ALL TYPE OF HAIR IS A NATURAL BRUNETTE IN THE MOST BEAUTIFUL INDEPENDENT ESCORT GIRL I AM A NATURAL BRUNETTE WITH ROOM AND HOTEL AND A NATURAL BRUNETTE WITH A BODY MADE FOR SIN AND ALL TYPE OF ME ALL THE TIME I SEND YOU A HAIR, VERY SOCIABLE AND FUNNY, READY TO ENTERTAIN TO ENTERTAIN U AND MAKE FORGET ABOUT TO GET ENTERTAIN U AND MAKE FORGET#v08 ABOUT ALL THE PROBLEMS. LET'S HAVE A WONDERFUL TIME TOGETHER AND FORGET ABOUT EVERYTHING ALL TYPE SERVICE ENJOYMENT SAFE AND SECURE IN CALL OUT CALL HOME AND HOTEL ANYTIME AVAILABLE AND ALL TYPE SERVICE ENJOYMENT

Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now

tanudubay92

Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available Easy & Fast Booking Procedure Of Kathua Escorts Call girls are ready and waiting to provide the quality essentialness that will help ease away life's tensions Kathua Escorts are regular companions of elite gentlemen and can take them places they could only dream of visiting. These ladies take great care in maintaining themselves to look appealing; visiting salons and spas regularly keeps them looking their best; their portfolios can be found online via an escort’s agency website. EXCITING OPTIONS AVAILABLE AT OUR INDEPENDENT ESCORTS Candlelight dinner Evening date Night clubs or parties Hotels or your flats Business trip Business party Stripping party Kathua Escort Service are adept at performing wild anal sex, deep throat sex and cum eating - perfect for satisfying all your sexual needs and playing any game imaginable. Affordable professional assistants are readily available and ready to assist with any situation - be it romantic date or solo night. Their beautiful appearances and striking personalities will leave you speechless, while they can accompany you to restaurants or bars where their presence will surely leave an impression.

Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available

Dipal Arora

❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh BEST Call Girls in CHANDIGARH Escort Service provide Cute Nice sweet and Sexy Models in beautiful CHANDIGARH city cash in hand to hand call girl in CHANDIGARH and CHANDIGARH escorts. HOT & SEXY MODELS // COLLEGE GIRLS IN CHANDIGARH AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ 100% SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE Profiles Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & 24x7 :: 3 * 5 *7 *Star Hotel Service .In Call & Out call Services : ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without a Condom)Chandigarh Call Girls

❤️Chandigarh Escorts Service☎️9814379184☎️ Call Girl service in Chandigarh☎️ ...

Sheetaleventcompany

Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...

Cara Menggugurkan Kandungan 087776558899

Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Available 24*7 Book Chat On WhatsApp: +91-📞 7427069034 📞 Book A Meeting Now With Our Call Girls Chennai Call Girls Chennai are available for any special event from birthday parties to romantic dinners, and provide an unforgettable experience that will have you wanting more. Their seductive presence will leave you wanting more; these air hostesses escorts are guaranteed to get your kink on and provide hours of sexual fun - they will become your personal fantasy girl; making every event that much better. They truly stand out as some of the finest professionals available; their services cannot be rivalled. Call Now :- 📞 7427069034 📞 Independent Call Girls Chennai dance will leave #N06 you breathless with breathtaking performances that'll take away all your worries while making you feel like royalty - they're sure to leave an impactful impression that leaves you feeling empowered. From providing you with a romantic date night full of excitement and sex to just hanging out and talking, they're there for whatever it is you require. Listening attentively as you share stories or telling theirs, these ladies provide great conversation as well as delicious dinner or beverages to remember the experience by. Just one encounter with Call girls in Chennai will have you calling back for more. They're sure to transform any party into an unforgettable night of fun and adventure - you won't be the only one smitten. Don't miss this chance; arrange your next date with an exotic Foreign Escort today. Chennai offers many beautiful call girls Not only are they enjoyable companions, but travelling is something they truly love to do and will happily go on weekend tours with you. Additionally, businessmen can hire one of these young ladies as an escort during business trips. ★OUR BEST SERVICES: - FOR BOOKING ★ A-Level (5-star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob) ★ Spending time in my rooms ★ BJ (Blowjob Without a Condom) ★ COF (Come on Face) ★ Completion ★ (Oral to completion) noncovered ★ Special Massage ★ O-Level (Oral) ★ Blow Job; ★ Oral fun uncovered) ★ COB (Come on Body) ★. Extra ball (Have ride many times) ☛ ☛ ☛ ✔✔ secure✔✔ 100% safe

Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...

amritaverma53

Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 Neha Thakur Call Mrs Naina Ji +91-6378878445 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in bangalore Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In bangalore Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 6378878445 !! Thank you for Visiting.

Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...

gragneelam30

❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amritsar Call Girls Service ☎️ Call Girls In Amritsar ❤️Amritsar Escort Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amritsar Call Girls Service ☎️ Call Girls In Amritsar BEST Call Girls in Amritsar Escort Service provide Cute Nice sweet and Sexy Models in beautiful Amritsar city cash in hand to hand call girl in Amritsar and Amritsar escorts. HOT & SEXY MODELS // COLLEGE GIRLS IN Amritsar AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ 100% SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE Profiles Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & 24x7 :: 3 * 5 *7 *Star Hotel Service .In Call & Out call Services : ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without a Condom)Amritsar Call Girls

❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...

Sheetaleventcompany

Call 8250092165 Patna Call Girls ₹4.5k Cash Payment With Room Delivery ★ CALL US High Class Luxury and Premium Escorts ServiCe We Provide Well Educated, Royal Class Female, High-Class Escorts Offering a Top High-Class Escorts Service In the & Several Nearby All Places Of . ★ Get The High Profile, Bollywood Queens , Well Educated , Good Looking , Full Cooperative Model Services. You Can See Me at My Comfortable Hotels or I Can Visit You In hotel Our Service Available IN All SERVICE, 3/4/5 STAR HOTEL , In Call /Out Call Services.24 hrs ,$P13 ★ To Enjoy With Hot and Sexy Girls . ★ We Are Providing :- • Models • Vip Models • Russian Models • Foreigner Models • TV Actress and Celebrities • Receptionist • Air Hostess • Call Center Working Girls/Women • Hi-Tech Co. Girls/Women • Housewife • Collage Going Girls. • Travelling Escorts. • Ramp-Models • Foreigner And Many More.. Incall & Outcall Available… • INDEPENDENT GIRLS / HOUSE WIFES ★ I Guarantee You To Have An Unforgettable Experience With Me.A Curvy Body, long Hair and Silky Smooth Skin. She Is an Independent Escorts Model Will Give You More Pleasure & Full Satisfaction. Call Now Seema:- 8250092165

Call 8250092165 Patna Call Girls ₹4.5k Cash Payment With Room Delivery

Jyoti singh

Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...

Sheetaleventcompany

tongue disease lecture Dr Assadawy legacy

DrMohamed Assadawy

Low Rate Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalore Karnataka Booking Details Are here: just visit website: https://girlsinbangalore.com #Call Girl In Bangalore, #Bangalorecallgirls #CallgirlserviceBangalore, #CallgirlsinBangalore 11-May-2024( Mj) Click On WhatsApp Chat +91-9179660964 Bangalore Escorts Make You Feel Like Royalty Bangalore Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Low Cost Call Girls Bangalore {9179660964} ❤️VVIP NISHA Call Girls in Bangalo...

Sheetaleventcompany

These are simplified slides discussing the regulation of cardiac output and venous return. Learning objectives: 1. Comprehend the determinants of cardiac output and factors affecting cardiac output 2. Comprehend the factors affecting stroke volume and heart rate and total peripheral resistance 3. Identify the factors regulating venous return 4. Discuss the causes of high and low output cardiac failure 5. Enlist the functions of veins and recognise the significance of venous reservoirs Study Resources: 1. Chapter 20, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 30 and 32, Ganong’s Review of Medical Physiology, 26th edition 3. Chapter 10, Human Physiology by Lauralee Sherwood, 9th edition 4. Physiology, Cardiac Output - StatPearls https://www.ncbi.nlm.nih.gov/books/NBK470455/

Cardiac Output, Venous Return, and Their Regulation

MedicoseAcademics

Pune Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Pune No💰Advance Cash On Delivery Service Booking Details Are here: just visit website: https://hotbabe24.com #Call Girl In Pune, #Punecallgirls #CallgirlservicePune, #CallgirlsinPune Website on rent : mailto:indiancallgirl4rent@gmail.com "Call Girls Pune VIP Call Girls Service Pune.. Booking Open Now We Are Providing Safe & Secure High Class girl women sucking men Services Affordable Rate 100% Satisfaction, Unlimited Enjoyment. Any Time for Model/ women seeking men in royal call girl High class luxury and premium call girl agency. ✔️High class luxury and premium escorts agency We Provide Well Educated, Royal Class Female, High-class Escorts agency offering a top high class escort service in the royal Escorts ✔️ Get High Profile queens , Well Educated , Good Looking , Full Cooperative Model Services. you can see me at my comfortable Hotels or I can visit you in hotel Our Service Available IN All Services 3/5/7 Star Hotels, In call /Out call Service 24/7.. ✔️ All Meetings We Provide Hottest Female With Me Are Safe And Consensual With Most Limits Respected Complete Satisfaction Guaranteed...Service Available In:- 24/7 3 * 5 *7 *Star Hotel Service In. In Call Out call service Avilable also. ✔️ I guarantee you to have an unforgettable experience with me A curvy body, long hair and silky smooth skin. She is an independent royal Escorts/Women Seeking Men model will give you more pleasure & Full satisfaction. ✔️ I am very sensual and flirtatious with charming personality! I love to laugh and my bright smile is ever Present. ,Hotel & Home Services CALL PLZZ ✔️Available Near All 3* 4* 5* 7* Hotels Of I Want Only Hotel Name , Guest Name , Room No. Only For Confirmation.✔️ Nandani... agency...⭐⭐⭐⭐⭐ VIP...Service ✣ ✤ ✥ ✦ TIME WASTERS AND BARGAINERS ARE PLEASE EXCUSE, WE RESPECT YOUR SAFETY AND PRIVACY AND EXPECT TH WHATSAPP: 9xx000xx09 CALL ME" 9xx000xx09

Pune Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Pune No💰Adva...

Sheetaleventcompany

ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx

Swetaba Besh

Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available WhatsApp Chat : +91-8854095900 Get More Information About Mussoorie Escorts Service Mussoorie Escorts offer their services to their clients at any time of day or night - including sex, travel and tours. Contact them via telephone or the internet. Hire an escort as your movie partner, date or party companion - they're sure to exceed all your expectations. Girls available 24/7 make for great companions who offer sensual body massages and drinks/food service during your time together. Find one who fits with your personality or budget - these girls have you covered.

Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available

Janvi Singh

Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8005736733 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Kolkata Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In Kolkata C010524HD Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 8005736733 !! Thank you for Visiting.

Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...

Namrata Singh

Hernia: An anatomical curse!

1. HERNIA by Dr. Ketan Vagholkar. MS, DNB, MRCS, FACS Professor of Surgery & Consultant Surgeon

2. Surgical Anatomy Of Anterior Abdominal Wall n Fascias n Rectus Sheath n Abdominal Muscles n Inguinal Canal

3. Inguinal Canal n Boundaries & Contents n External ring is a triangular n Anteriorly-External oblique aperture in the aponeurosis aponeurosis &internal oblique of the external oblique.It is laterally 1.25 cms above the pubic n Posteriorly-Transversalis fascia tubercle. and conjoined tendon n Superiorly-Conjoined tendon n Deep ring is a U shaped n Inferiorly-Inguinal ligament opening in the transversalis n Contents fascia.It lies 1.25 cms above n In males-spermatic cord and the mid inguinal point. Ilioinguinl nerne. n In Females-round ligament and Ilioinguinal nerve

4. Natural Mechanisms Preventing Hernia n Obliquity of the canal n Internal oblique muscle opposite the deep ring n Shutter action of the arched fibres of internal oblique and transversus abdominis n Plugging action of the spermatic cord due to contraction of the cremaster muscle n Sliding valve action of the U shaped internal ring

5. Definition of Hernia n Hernia is defined as an abnormal protrusion of viscus or part of viscus through a normal or abnormal opening in the wall of the cavity containing it. n Classification depending on the anatomical site of the hernia. (Inguinal, femoral, epigastric etc.) n Incidence: Inguinal- 73%,Femoral- 17%&Umbilical-8.5%)

6. Pathology n Composition n Contents n Sac- Diverticulum of n Intestine-enterocele peritoneum and consists n Omentum-omentocele or of mouth, neck, body and epiplocele fundus. The diameter of n Meckel’s diverticulum- the neck determines the Littre’s hernia outcome. n Circumference of bowel- n Coverings well Richter’s hernia amalgamated hence indistinguishable. n W loop of intestine- Maydl’s hernia

7. Natural history n Reducible n Irreducible n Obstructed n Strangulated n Inflammed

8. Clinical features of inguinal hernias

9. Direct inguinal hernia

10. Morbid Anatomy

11. Clinical Features

12. Clinical Features

13. Clinical Evaluation n History n Chief complaints (odp) n Complications n Etiology n Treatment taken n Inference from history

14. Clinical Evaluation n Physical examination. n Inspection-site,impulse n Palpation- n Getting above n Impulse on coughing n Reducibility-Taxis n Deep ring occlusion test n Invagination test n Tone-Inspection/palpation n Other systems

15. Clinical Diagnosis n Site, side, complicated or not, direct or indirect inguinal hernia n Status of tone n Possible etiological factor

16. Investigations n Haematological n CBC n Blood sugar (fasting & postprandial) n BUN, creatinine, Electrolytes n Urine examination n Ultrasound of Abd. n ECG n CXR

17. Principles of repair n Herniotomy for an indirect sac n Identify n Dissect n Open n Reduce the contents n Transect n Twist, tansfix, ligate & excise the redundant portion n Slit open the distal sac

18. Principles of repair n Herniotomy for direct sac n Identify n Dissect around the neck n Purse string suture n Invert the sac and tighten the purse string n Direct sac never to be opened

19. Principles of repair n Special cases n Pantaloon hernia n Sliding hernia n Strangulated hernia

20. Principles of repair n Herniorrhaphy n Selection of patients n Principles (anatomic considerations) n Types n Bassini’s n Shouldice n Lichtenstein Repair(T abd to Ing Lig with relaxing incision& Ext obl behind the cord) n Other types (Ogilvie’s, Lyttle’s ,skeletonization of cord etc.)

21. Principles of repair n Hernioplasty (Open approach) n Patient selection n Types n Mesh plasty n Darning n Material used n Endogenous n Exogenous n Requirements of a mesh

22. Requirements of a mesh

23. Mechanism of action

24. Meshplasty nLaparoscopic Approach TAPP TEPP

25. Surgical Aftercare n Avoid straining n Avoid heavy work n Bowel function n Urinary system n Care to be taken for at least 3 months after surgery

26. Complications n Intraoperative n Post operative n Infection n Neurological complications n Recurrence n Types n True n False

Hernia: An anatomical curse!

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Destacado

Destacado (8)

Similar a Hernia: An anatomical curse!

Similar a Hernia: An anatomical curse! (20)

Más de KETAN VAGHOLKAR

Más de KETAN VAGHOLKAR (20)

Último

Último (20)

Hernia: An anatomical curse!