Friday, February 17, 2017
Thursday, February 16, 2017
what is the mesentery
what is neme of this colon segmoid colon it is colon decending here colon transversum whatis it ?it is stomach what is it ?it is falciform ligament and aterior free border of falciformligament present what ligamentum terus hepaticus and what is th name of this ligament it is ligamentum coronarium hepatis and free border of coronary ligament ligamentum triangularesinister and the same ligament of the right side here continuation of ligamentum coronariumhepatis and free border of this coronary ligament on the right side has name ligamentum triangularedexter ok topography of peritonium cavity we know three flour or storey upper flourit is space between diaphragm sperioirly and transverse colon together mesocolon transversuminferiorly all of this space it is sperioir
storey middle storey it is space between transvercecolon and true pelvis and inferioir storey it is cavitus of true pelvis in upper storeynecessary to know three bursa bursa hepatica it from right side of falciform ligament everythingon right side bursa hepatica and on the left side bursa pregastrica it occupied left lobeof the liver and it is in front from stomach that is why bursa pregastrica in front fromstomach that is two bursa more difficult it is bursa which is present behind of stomachand behind of laser omentum what is laser omentum that is two ligaments peritonium fromliver goto stomach and all of this space which occupy peritonium has name ligamentum hepatogastricumand here it is ligamentum hepatoduodenale and two ligament hepatogastricum and hepatoduodinaletogher form leser omentum and bursa behind
of laser omentum behind of stomach has namebursa omentalis impossible to see this bursa in living man because from large cavity ofstomach peritonium go to transverse colon and fuse with transverse colon it is largecavity of stomach and transverse colon fuse togher five layer of peritonium and form ligamentligamentum gastrocolocum that is why impossible to see bursa omentalis only we can put fingerinto the openingand name of this opening it is foramen epiploicum it opening behinnd ofwhich ligament hepatoduodenale we can put pincert in time of operation we can put fingerinto bursa omentalis and if necessary to perform operation on poterioir wall of the stomachnecessary to cut ligament between stomach and transverse colon ligamentumgastrocolicumand after that we can open bursa omentalis
and perform operation in posterioir wall ofstomach or operation on pancrease is it clear it is place where we can cut it is ligamentof stomach and colon ligamentum gastrocolicum and after operation it is necessary to restore this ligament three burse bursa hepatica bursa pregastrica andbursa omentalis and necessary to know wall of this bursa omentalis and walls of thisopening foramen epiploicum forexample anterioir wall it is ligamentum hepatodeodenale superioirwall caudate lobe lobus caudatus of the liver posterior wall it is peritonium which comefrom liver kidney and form it is ligamentum hepatorenalis that is inferior wall speriorpart of dueodenum that is walls of foramen epiploica nextmiddle storey of abdominal cavityit is has two lateral canal canalis lateralis
dexter between colon ascending and abdominalwall and canalis lateralis sinister between colon descending and abdominal wall two lateralcanal right and left oneof this canal is closed sperioirly and not communicate with sperioirstorey do u remember becayse on the left side we have ligament which form pocket for spleenand name of this ligament ligamentum phrenicocolicum and this ligament it closed left lateral canaland right lateral canal communicate with superioir storey of abdominal cavity now space undethe colon all of this space what is it small intestine and mesenterium of small intestineattach it is from it start from upper left side and go downward and to the right andthis root of mesenterium separete space under the colon into two sinuses here it is sinusmesentricum sinister and here it is sinus
mesentricum dexter clear and last moment itis some pockets or resesus of dueodenum necessary to know resesus of dueodenum two resesus resesus dueodenalis superior or another name resesus dueodenaljejunalis superiorand resesus dueodinualjejunalis inferior next resesus inplace where ilium into secum andabove of ilium resesus iliocecalis superior and resesus iliocecalis inferior next resesusbehind the cecum it is resesus retrocecalis and last resesus in loop of sigmoid colonresesus intersigmoids that is all about middle storey and inferior storey that is space oftrue pelvis and here it necessary to know to two excavasu in female and one excavasuin male that is female corpse that is why
here it is uterus and between uterus and rectumthis space it is excavasu rectouterinum and here excavasu vesicouterinum and in male excavasurectovesicalis that is all
what is panniculitis
systemic lupus erythematosus, abbreviatedas sle. this is a systemic disease, which means thatit can affect the whole body systemically. the brain, skin, heart, lungs, kidneys, joints,the immune system, the vascular system, and the list goes on. lupus means wolf. erythematosus means reddening of the skin. why did i show a red butterfly? because a very typical sign of sle is a butterflyshaped reddening of the skin. the way i remember this disease, is to imaginea wolf that attacks a woman, and why a woman?
because 9 out 10 patients are women. so the wolf bites the face of the woman causinga butterfly shaped erythema on her face. then the wolf continues to bite all her organsone by one, because this disease is a systemic disease, which means that it can affect allthe organs systemically. of course this disease has nothing to do witha wolf. but sle is an autoimmune disease, which meansthat this woman called emma have an immune system that attacks her own body, insteadof only attacking bacterias, viruses and parasites. so emma have an immune system that acts asa wolf inside her.
i will show you how we can find out if emmareally has sle by diagnosing her. and then we will look at what type of medicationswe can give her. i want you to remember at least one thingfrom this presentation. that is systemic lupus international collaboratingclinics, abbreviated as slicc. slicc is a criterion that can help in thediagnosis of sle. slicc contains clinical criteria, immunologiccriteria and biopsy criteria. we need more than 4 criteria with at least1 clinical and 1 immunologic. or we need 1 biopsy criteria and 1 immunologiccriteria.
so what does these 3 words mean? clinical, immunologic and biopsy? the synonym for clinic, is hospital. so clinical criteria stand for the symptoms,signs and lab values of a patient in the hospital. immunology deals with the immune system thatprotects you from bacterias, viruses, and immunologic criteria are usually lab teststhat detect any problem with the immune system. biopsy means that a doctor cuts out a pieceof an organ. for example, a small piece of kidney can becut out, and then the doctor puts this piece of kidney in a microscope and looks for diseases.
clinical criteria can be divided into alopecia,which means hairloss. skin problemsulcers heart diseaseslung diseases kidney problemsjoint pain problems with the nervous systemand blood diseases. skin problems can be grouped under the namecutaneous lupus erythematosus. we can divide these skin diseases into acutesubacute and chronic, based on the timing of the diseases. acute diseases are usually those that happensuddenly with a short duration.
chronic diseases are ongoing for a long time. whereas subacute means those diseases thatare not yet chronic but has passed the acute phase. a way to remember these timing are to memorize2 numbers. 1 and 3. why? because the duration of acute diseases areusually less than 1 month, subacute are 1 to 3 months, and chronic are more than 3 monthsin duration. so which are the acute type of skin problems?
butterfly erythema, which is a reddening ofthe face in a butterfly shape. it usually affects the cheeks or also calledmalar region, and therefore it is sometimes called malar erythema. it does not affect the nasolabial region. there can also be bullous lesions which areblisters that can be a mix of small grouped vesicles to large tense bullae. bullae are elevating the skin and are filledwith fluid. toxic epidermal necrolysis-like sle, is adetachment of the epidermis, the upperlayer of the skin, resulting in exfoliation, meaningthat the upperlayer just falls off.
this is very dangerous, because the skin isthe organ that protects against infections. so if you loose a large part of your skin,then sepsis can happen, which means that bacterias easily invade your vascular system, sincethere is no skin to protect you. this can lead to something called septic shock,which can lead to death. maculopapular rash is another acute sign. macules are flat spots up to 1 cm, and papulesare bumps up to 1 cm. maculopapular is a combination between maculesand papules. photosensitivity can also be seen which meansthat the skin is much more sensitive to sunlight than normally.
this can cause cause solar urticaria, whichis a vascular reaction of the skin that cause pathches. patches are flat lesions like macules, butthey are bigger than 1 cm. so one difference between macules and patchesis the size. macules are less than 1 cm, whereas patchesare more than 1 cm. so the acute cutaneous lupus erythematosuscan be divided into 5 lesions: butterfly shaped erythema, bullous lesions, toxic epidermalnecrolysis, maculopapular rashes, and photosensitive solar urticarias. subacute cutaneous lupus erythematosus canbe divided into 2 types.
one is annular polycyclic lesions. the word polycyclic refers to more than 1ring structures that can be seen in chemistry for example. the word annular also refers to a ring-shapedstructure. so annular polycyclic lesions are ring-shapedskin lesions that usually occur on sun-exposed areas of the skin. nonindurated psoriaform is the other typeof subacute skin lesions. psoriaform means that it looks like psoriasis. nonindurated means that it is not hardas psoriasis.
subacute can be divided into annular polycyclicand nonindurated psoriaform lesions chronic skin lesions are chilblain lupus,that affects toes, fingers, nose, and ears during cold weather. these are painful, bright red nodules. nodules means a swelling of the skin thatis up to 1 cm diameter. discoid rash can also be seen. discoid refers to the disc shape of theselesions. we can divide discoid into classical type. discoid lesions can be divided into localized,which means that discoid lesions appear above
the neck,and generalized, which means that discoid lesions can appear both above and below theneck. lichen planus is an inflammatory disease thatcan affect the skin and oral mucosa. here we see a picture of whitish lichen planuson the oral mucosa. the word lichen means tree-moss as you cansee here on the picture. so this disease is looking like a tree mossbut with a whitish color. in sle patients this happen, that a discoidlesion is seen together with lichen planus. verrucous lesions or also called hypertrophiclesions are skin that hypertrophies, which means that the skin cells increase in numberand cause these hard wartlike lesions, especially
on extensor arms. mucosal lesions can affect the mucosal membranearound the teeth, the tongue, and hardpalate panniculitis or also called profundus, isan inflammation and destruction of the subcutaneous fat. tumidus lesions are pinkish urticarial non-scarringplaques usually in sun-exposed areas. plaques are elevation of the skin similarto papule, but they differ in size. so plaques are more than 1 cm in diameter,whereas papules are less than 1 cm. the chronic skin lesion are chilblain, discoid,discoid with lichen planus, hypertrophic, mucosal, panniculitis, and tumidus.
ulcers can appear on the mucosal membrane,on for example the hardpalate, buccal region, on the tongue, and on the nasal septum. inflammation can affect the heart causingpericarditis. here we see a normal normal heart on the upperpicture, and a reddish heart on the lower picture. inflammation is causing redness, pain, heat,swelling and loss of function. the heart wall rub against each other causinga typical pericardial rub sound that one can hear with a stethoscope. here we see a man having a painful pericarditispericardial effusion can also happen, which
means that fluid accumulates around the heartcausing a typical waterbottle-shaped heart on x-ray. as i mentioned, pericardial rub sounds canbe heard with a stethoscope. inflammation can also affect the lungs. so similar to the heart, there will be inflammation,pain, pleural friction rub sounds, and pleural effusionhere we can see the pleural effusion that have accumulated between the 2 layers of thelungs. this is how pleural friction rub sounds like. imagine walking on snow when you hear thissound.
we need to collect urine to find kidney problems. more than 500 mg of protein in the urine duringa 24 hour period can be seen in sle patients. this is called proteinuria, meaning proteinin the urine, which is not normal. we can also find red blood cell casts in theurine by analyzing the urine in a microscope. these casts are formed by red blood cellsthat stick together. blood in the urine is not normal. it suggest that something is wrong with thekidney. synovitis is inflammation of the synovialmembrane of the joints. polyarthritis can be seen in sle.
poly stands for that more than 1 joint isaffected. arthritis is inflammation of joint. so more than 1 joint will be inflamed causingpain. the nervous system can also be affected bysle. seizures can happen, which are hyperexcitationof neurons in the brain, sometimes leading to muscle contractions. psychosis and acute confusional state, alsocalled delirium can happen. psychosis and delirium patients usually sufferfrom hallucinations. neuropathies can be seen in sle.
neuropathy means neurons that are diseased. the neurons can be in the cranial part, peripheralpart, in the spinal cord which is then called myelitis, or single nerves can be damagedwhich is then called mononeuropathy, mono standing for single. or multiple single nerves in different areasof the body can be damaged, which is then called multiple mononeuropathy. what can we see in the blood? with a microscope we can distinguish differentblood cells. here is a picture showing the blood cells.
the blood cells originate from one cell calledmultipotential hematopoetic stem cell. this cell can produce myeloid cells, and lymphoidcells. the myeloid cells can produce erythrocytes,also called red blood cells. but in sle hemolytic anemia can be seen, whichmeans that the erythrocytes can damaged and therefore anemia will happen, which meansthat not enough oxygen is transported to the tissues. the myeloid cells can also produce megakaryocytes,that can further produce thrombocytes, also called platelets. but in sle the number of thrombocytes canbe reduced, and we call this thrombocytopenia.
penia stands for less of something, inthis case we have a penia of thrombocytes, so thrombocytopenia. the symptom of thrombocytopenia is usuallypetechiae which are small purplish spots on the skin. leukopenia can happen in sle which is a reducednumber of leukocytes, which are white blood cells, with neutrophils being the most commonwhite blood cell. lymphopenia can also be seen, which are reducednumber of lymphocytes. so the clinical criteria were alopecia, skinlesions, ulcers, diseases of the heart, lungs, kidneys, joints, nervous system and the blood.
the immunologic criteria are related to autoantibodies,meaning that the antibodies of the immune system attacks itself, instead of only attackingbacterias etc. here we have a cell, with its nucleus, containingchromosomes that contain dna. in sle, the antibodies attack your own nuclearproteins, for example your own dna, or rna binding proteins called smith proteins. so in sle we check for antinuclear antibodylevels, abbreviated as ana. we also check anti-smith and anti-double strandeddna. another immunologic criteria is direct coombstest. here we mix the patients blood together witha coombs reagent, and if red blood cells agglutinate,
meaning they stick together, then we havea positive test result. the complement system helps or complementsthe antibodies to fight infections. in sle we can see a low number of these complementproteins. the complement proteins are numbered c1 toc9, and it is the c3 and c4 complement proteins that are low in sle. ch50 stands for the total complement activity,which is also low in sle. an increased number of antiphospholipid antibodiescan be measured in sle. these antibodies bind to proteins like beta2 glycoprotein 1 on the phospholipid cell membrane.
the function of the beta 2 glycoprotein 1is to prevent phospholipid membrane to activate the thrombosis cascade. we know that thrombosis can cause death. so therefore it is very important to checkthe antiphospolipid antibody level. it is especially important in pregnant women,because these antibodies can cause spontaneous abortion and late fetal death. except antiphospholipid antibodies, sle flarescan also cause fetal death. sle fluctuate between flares and remissions. a flare is a very active disease with manysymptoms, whereas a remission is an inactive
state with few symptoms. during pregnancy, the mother should be monitoredfor any sle flares since these can lead to fetal death. so if a woman wants a child, then pregnancyshould be timed for when sle is in remission for at least 6 months. furthermore, anti-ro antibodies should bemeasured, because if anti-ro is detected, then doctors should warn mothers that thereare risks of the fetus getting a neonatal lupus or even a severe congenital heart blockwhich means the death of the fetus. so it is very important to monitor the fetalheart in this case, with for example an echocardiograph
and a 24-hour holter monitor. lets turn now to the biopsy criteria. here we need a biopsy of the kidney, whichwill show that there is inflammation, called nephritis. but it is not enough with a biopsy, we needan immunologic criteria as well, for example antinuclear antibodies, or anti-double-strandeddna. now lets see how we can treat sle patients. the first thing that we have to do is to removeany type of medication that can cause sle-like symptoms.
these are for example hydralazine, procainamide,and isoniazid. non-steroidal anti-inflammatory drugs arevery useful in sle patients, especially in controling arthralgias, which means painfuljoints. here we can use naproxen, ibuprofen, and diclofenac. antimalarial medications also help jointsproblems, but also skin problems, and they reduces the sle flares. the typical sle medication is hydroxychloroquine,but there are alternative like chloroquine and quinacrine. hydroxychloroquine can in rare cases causeretinal problems, skeletal muscle problems
and cardiac problems. so it is important that the eyes are examinedyearly. corticosteroids are usually the first linetreatment in acute severe sle. we typically begin by giving intravenous methylprednisolonefor 3 days and then we maintain the therapy with prednisone. disease-modifying antirheumatic drugs arealso very important. we can use azathioprine, methotrexate, mycophenolatemofetil, cyclophosphamide together with mesna, and in very severe cases intravenous immunoglobulin. it is well known that corticosteroid use fora long time can cause osteoporosis, which
means bone weakening. therefore it is important to consider givingcalcium, vitamin d, and bisphosphonate. so to conclude, we can say that emma has sle,which is a systemic autoimmune disease, that affects her whole body systemically. the brain, skin, heart, lungs, kidneys, joints,the immune system, and the vascular system. the typical butterfly-shaped erythema canbe seen in sle patients. thank you very much for listening!
Wednesday, February 15, 2017
what is mesentery
this is the most hated topic in anatomyever. the abdominal blood supply. don't worry this is animated anatomy andwe're going to make it simple for you. this here is the superior mesentericartery and this here is the inferior mesenteric artery. now let's start by explaining thesuperior one. and we're not going to follow the arteries, we're going tofollow the digestive tract here and we're going to actually explain whereeach part gets its blood from. so let's bring our digestive tract and we cannotsee much, can we? that's why i will remove the jejunum andi'm going to remove the ilium as well.
i will remove this part of the colin andstomach so we can see the superior mesenteric artery hiding right here. now the superior mesenteric artery gives away immediately one branch here andthat is the inferior pancreaticoduodenenal artery theanterior one and the posterior one as well, it gives bood to both of thesearteries. now you can see this little artery hereand that is the middle colic artery. but i said that we're not going to do that.we're going to follow digestive tract and we're going to explain each part andwhere it gets this bath from and we're going to come to that part. so this overhere is the set of jejunal arteries and
down there you have the set of ilealarteries. then you have here the marginal artery of colon. you can see howlong it goes. and you know what, let's just remove the testicular arteriesbecause they're making this more complicated and this is by the wayalready too complicated. let's remove the lumbar arteries as wellnow it all looks a little bit more simple, right? we have the the superior mesentericartery then the jejunal arteries, then the ileal arteries, then the marginalartery of colon and then we have this artery here. it's the ileocolic artery and it has the superior branch
of ileocolic artery and the ileal branch of the ileocolic artery. now weget to this part here, and that is the right colic artery. and then we get thislittle buddy here and that is the middle colic artery. so remember we have theright colic archery and then the middle colic artery. so now let's explain thissecond really important artery and that is the inferior mesenteric artery. theinferior mesenteric artery has here the left colic artery, and remember we talkedabout the middle colic artery and the right colic artery. furthermore the inferior mesentericartery separates here into sigmoid
artery and the superior rectal artery.so you have here the superior rectal artery and this is the sigmoid artery.i'd like to point out that this part right here is not modeled exactly andour inferior mesenteric artery is not supposed to go through the externaliliac artery. that's just not correct, but doesn't matter, furthermore i wouldn't say that ouraorta is so huge it's a little bit smaller artery, though it's still verybig.
what is mesenteritis
let's check out some email today. dear bevvan,i need your help. my husband and i married for better or worse and he is willing to helpme, but i just can't stand it. i wonder if this email is for me. oh here it is. i havem.s. that's multiple sclerosis and i can't get the toilet paper you know where by myselfanymore. do you have any answers. well actually, i think i do. hygiene aftertoileting is something that most adults in america would like to have handled, privately,discreetly, and independently and it is among one of the most challenging activities bothphysically and emotionally for many people with disabilities. people who have normalhand and arm function can only imagine how complicated and difficult handling toiletpaper and getting it to the right perianal
spot can be after toileting. so while thereare several good pieces of adaptive equipment to handle toilet paper, i would like to suggestthat you consider an attachable bidet as a substitute for toilet paper. now an attachable bidet can help a personwith a disability with hygiene after toileting by allowing them to do that activity independentlythrough the touch of a button. if a caregiver is still needed that provides a degree ofseparation that adds to that comfort level between caregiver and person being cared forduring a private activity. bidets are also gaining popularity with seniors who don'thave disabilities for a couple of reasons. there are some normal anal sphincter changesthat may occur with aging and older women
are more susceptible to bladder and vaginalinfections. so the super cleaning power of an attachable bidet is an advantage, becauseit makes cleaning easier and reduces risk of health issues from not totally perfectcleaning. so an attachable bidet has many, many advantages. now i'm still learning aboutbidets, but i have five features that i'd love to share with you. things you can consider.the first is that while in america we consider toilet paper clean, people all over the worldare using bidets quite joyfully and gleefully. some people use them for religious reasons,others are using them because they are friendlier to the environment and others are using thembecause quite frankly they clean better than toilet paper. now, you may or may not wantto run your own personal test on that one,
but i'd like for you to accept that thereis an alternative to toilet paper. tidbit number two, there are several types of bidets.people who have been to europe may be more familiar with the separate stand alone bidet,which can be used for soaking or may have jets. there is an attachable bidet that replacesthe toilet seat on an existing toilet. there is an attachable toilet bidet that fits betweenthe toilet seat and the toilet and then there are portable bidets. now, i'm typically recommendingthe attachable bidet so the toilet seat bidet, because you don't have to have extra roomfor a separate plumbing fixture and because people who have difficulty transferring canjust sit in one place and take care of everything. third thing. you need to consider size andthe functions that you need when you're out
shopping for a bidet. if you have a roundtoilet or an elongated toilet you need a bidet that fits that shape. there are also manyimportant features. the things i think about most are how you control. where are the buttonslocated. are they separate, are they right or left. how big are they? whether you addhot air to dry or not is an important question to ask yourself. i would urge you to do thedrying feature, and the third is how many wands do you have. some of the systems i likebest have two separate water jets. one is for feminine cleansing the other is for analcleansing and then they have air, as well. so you think about all of these differentfeatures you need when you're out there shopping for this device. the fourth thing that youwant to consider is whether or not you need
other adaptive equipment when using the bidet.you can use some of your other assistive equipment like grab bars, whether they're floor to ceilingor mounted on the wall. we've used different types of toilet safety equipment with bidetsand you can use risers with bidets. you can use the type of riser that fits under thetoilet and you can use the type of riser that fits between the toilet and the toilet seat.you can't use the kind of riser that fits on top of the toilet seat with a bidet, butyou can keep things like height and balance supports with a bidet. and the fifth and finalthing that i want to offer is that you should prepare for a bidet. it doesn't take much.it uses the existing water supply from your toilet so that's a no-brainer. when i'm workingwith people that re remodeling their bathroom.
even if they have no trouble at all handlingtoilet paper or getting toilet seated, i suggest they add that outlet down low. that makesit easier to add the bidet in the future. you can add it and plug it in to any outletthat's within a certain distance of the bidet, but if you're using that outlet already forlike curling irons and hair dryers and recharging your toothbrush, you don't want to be tryingto plug the bidet in there as well. so preparing for that while remodeling by just adding aprotected outlet near the toilet will prepare you for the wonderful world of bidets. soshare the news and share the video. there is an alternative to toilet paper.
what is mesenteric fat
learning b vitamins doesn't involve understandingany concepts-- just regurgitating keywords. here's a mnemonic: it's like finding a one-night stand at a bar. first: you drink a beer, then see who you'dlike to f#ck. you don't need anything,b4 your pants cause a burning groin, and copayments for a bloody child birth. or:my beer see f#ckdon't need b4cause pants
live fireco blood my beer means thiamine beri. beer for alcoholicmalnutrition. dry beriberi is paralytic atrophy (a dry wit).wet beriberi is cardiac failure/edema (heart pumps wet stuff). see fock means “c fâ€c for cheilosis (lip inflammation) and corneal vascularization f for fad and fmn from riboflavin (2atp) don't need means 3ds: diarrhea, dermatitis,and dementia. need means nad from niacin (3 atp)
b4 means: don't worry about b4. cause pants means co-a and pantothenate. live fire means liver (alt + ast) and pyremeans pyridoxine. co blood means cobalamin: big anemia. my beer, see f#ck, don't need, be4, causepants, live fire, co blood. this mnemonic organization is convoluted,but it's still easier than arbitrary keyword association.now go get drunk! helphippo: help your hippocampus.
