pediagenosis: science
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Showing posts with label science. Show all posts
Showing posts with label science. Show all posts

Sunday, November 10, 2019

Arteries and Veins of Perineum and Uterus Anatomy

Arteries and Veins of Perineum and Uterus Anatomy


Arteries and Veins of Perineum and Uterus Anatomy
Round ligament, Tubal, Ovarian, Uterine vessels, Ureter, Vaginal branches of uterine artery, Vaginal artery, Levator ani muscle, Perineal membrane, Internal pudendal artery, Perineal artery, Superficial perineal space, Superficial perineal (Colles’) fascia, Posterior labial artery, Ischiocavernosus muscle, Bulbospongiosus muscle, Superficial perineal space, Perineal membrane, Perineal artery, Superficial transverse perineal muscle, Perineal artery, Internal pudendal artery in pudendal canal (Alcock’s), Inferior rectal artery, External anal sphincter muscle.
Arteries of Pelvis: Female Anatomy

Arteries of Pelvis: Female Anatomy


Arteries of Pelvis: Female Anatomy
Median sacral artery, Iliolumbar artery, Lateral sacral arteries, Superior gluteal artery, Piriformis muscle, Inferior gluteal artery, Internal pudendal artery, Coccygeus muscle, Sacrotuberous ligament, Obturator fascia (of obturator internus muscle), Internal pudendal artery in pudendal canal (Alcock’s), Levator ani muscle (cut edge), Internal iliac artery, Posterior division, Anterior division, External iliac artery, Obturator artery, Umbilical artery (patent part), Middle rectal artery, Uterine artery, Vaginal artery, Accessory obturator artery, Superior vesical arteries, 

Friday, November 8, 2019

Abdominal Pain

Abdominal Pain


Abdominal Pain
The abdominal cavity contains the organs that digest food, filter blood and enable reproduction, any of which may give rise to abdominal pain. As with chest pain, patients presenting with a ‘textbook’ collection of symptoms are the exception rather than the rule.
Tibia, Ankle and Foot Injuries

Tibia, Ankle and Foot Injuries


Tibia, Ankle and Foot Injuries
History
Mechanism of injury
High-energy injuries commonly result from axial loading, direct blows or crush injuries, e.g. falls or jumps, motor vehicle accidents. Tibial shaft injuries are severe, and risk neurovascular injury and compartment syndrome.
Back Pain, Hip And Knee Injuries

Back Pain, Hip And Knee Injuries


Back Pain, Hip And Knee Injuries
Back pain
Lumbar back pain is a common presentation to the Emergency Department, and can be very challenging to manage. Patients may arrive at the Emergency Department with an agenda that includes hospital admission for analgesia and rehabilitation. This is not practical or desirable: after exclusion of significant pathology, early mobilisation is the most effective treatment. Back pain may also be caused by hip disease and retroperitoneal organs, e.g. aorta, pancreas.
Shoulder And Elbow Injuries

Shoulder And Elbow Injuries


Shoulder And Elbow Injuries
The extreme mobility of the shoulder joint, which relies on soft tissues – muscles, ligaments and cartilage – for stability, comes at a price. The shoulder is relatively unstable, and prone to stiffness if not used. There is a wide range of injury patterns, which change according to the age of the patient.
Wrist And Forearm Injuries

Wrist And Forearm Injuries


Wrist And Forearm Injuries
Injuries to the wrist and forearm are common, often resulting from a fall onto an outstretched hand (FOOSH). It can be difficult to distinguish subtle fractures from soft tissue injury on clinical history and examination alone, so X-ray is usually necessary.

Thursday, November 7, 2019

Dorsum of Foot: Deep Dissection Anatomy

Dorsum of Foot: Deep Dissection Anatomy


Dorsum of Foot: Deep Dissection Anatomy
Superficial fibular nerve (cut), Fibularis longus tendon, Fibularis brevis muscle and tendon, Extensor digitorum longus muscle and tendon, Fibula, Perforating branch of fibular artery, Anterior lateral malleolar artery, Lateral malleolus, Lateral branch of deep fibular nerve (to muscles of dorsal region of foot) and lateral tarsal artery, Fibularis longus tendon (cut), Extensor digitorum brevis and extensor hallucis brevis muscles (cut), Fibularis brevis tendon (cut), 
Muscles of Dorsum of Foot: Superficial Dissection Anatomy

Muscles of Dorsum of Foot: Superficial Dissection Anatomy


Muscles of Dorsum of Foot: Superficial Dissection Anatomy
Superficial fibular nerve (cut), Fibularis brevis muscle, Fibularis longus tendon, Extensor digitorum longus muscle and tendon, Superior extensor retinaculum, Fibula, Perforating branch of fibular artery, Lateral malleolus and anterior lateral malleolar artery, Inferior extensor retinaculum, Lateral tarsal artery and lateral branch of deep fibular nerve (to muscles of dorsum of foot), Fibularis (peroneus) brevis tendon, Fibularis tertius tendon, 
Tendon Sheaths of Ankle Anatomy

Tendon Sheaths of Ankle Anatomy


Tendon Sheaths of Ankle Anatomy
Soleus muscle, Fibularis longus muscle, Fibularis brevis muscle, Calcaneal (Achilles) tendon, Common tendinous sheath of fibularis longus and brevis muscles, Subcutaneous calcaneal bursa (Subtendinous) bursa of calcaneal tendon, Superior and, Inferior fibular retinacula, Calcaneus, Extensor digitorum brevis muscle, Abductor digiti minimi muscle, Lateral view, Extensor digitorum longus muscle, Superior extensor retinaculum, 
Ligaments and Tendons of Foot: Plantar View Anatomy

Ligaments and Tendons of Foot: Plantar View Anatomy


Ligaments and Tendons of Foot: Plantar View Anatomy
Flexor digitorum longus tendon to 2nd toe (cut), Flexor digitorum brevis tendon to 2nd toe (cut), 4th distal phalanx, 4th middle phalanx, Deep transverse metatarsal ligaments, 5th proximal phalanx, 4th lumbrical tendon (cut), Abductor digiti minimi and flexor digiti minimi brevis tendons (cut), Plantar ligaments (plates), Interosseous muscles (cut), 5th metatarsal bone, Plantar metatarsal ligaments, Tuberosity of 5th metatarsal bone, Fibularis (peroneus) brevis tendon, 

Tuesday, November 5, 2019

Gastrointestinal Hormones

Gastrointestinal Hormones


Gastrointestinal Hormones
Clinical background
Neuroendocrine tumours of the gastrointestinal system are rare tumours that usually present with manifestations related to the actions of the peptide that they secrete. Functioning neuroendocrine tumours include: the pancreatic tumours insulinomas (insulin secreting), VIPomas (vasoactive intestinal polypeptide), glucagonomas (glucagon), gastrinomas (gastrin) and somatostatinomas (somatostatin) and the small bowel tumours carcinoids (5HIAA), gastrinomas (gastrin) and somatostatinomas (somatostatin). Pancreatic tumours may form part of the MEN 1 syndrome and sometimes secrete a number of other hormones including ACTH (presenting as Cushing’s syndrome), GHRH (causing acromegaly), and PTHrP (presenting with hypercalcaemia). Patients with insulinomas present with hypoglycaemic symptoms; those with gastrinomas have complex peptic ulcer disease with diarrhoea; VIPomas cause diarrhoea, acid–base disturbances and glucose intolerance and an erythematous rash; glucagonomas cause a typical necrolytic skin lesion associated with glucose intolerance, bowel disturbance, neuropsychiatric problems and venous thrombosis; and somatostatinomas present with steatorrhoea, gallstones and diabetes. Carcinoid tumours are the most common of the group, presenting with flushing, diarrhoea, bronchospasm, arthropathy and cardiac complications. All these tumours are extremely rare and require specialist management by multidisciplinary teams of endocrinologists, surgeons, radiologists and oncologists.
Glucagon

Glucagon


Glucagon
Clinical background
Hypoglycaemia is an important complication of insulin therapy in patients with diabetes. At the onset of the disease most patients recognize the symptoms (Fig. 42d) and are able to take remedial action, but ‘hypoglycaemia awareness’ decreases with the dura- tion of insulin treatment so that after 20 years of diabetes up to a half of patients may have lost their awareness of the symptoms. Severe hypoglycaemia, requiring the assistance of another person for treatment, is an important cause of morbidity and mortality in insulin treated diabetics. Family members, friends or school staff should be educated in recognition of the symp- toms and how to treat it. Early symptoms can be treated with oral carbohydrate; if the patient is unable to swallow intramuscular glucagon is helpful as is buccal glucose gel. Patients and their relatives can be trained to administer intramuscular glucagon. If there is evidence of impaired consciousness medical advice should be sought and the patient treated with intravenous glucose.
Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus


Type 2 Diabetes Mellitus
Clinical background
Type 2 diabetes mellitus is a disease that is becoming more common in association with the increase in obesity in the population. The overall UK prevalence is around 2% of the population, rising with age, and is higher in certain ethnic groups including African–Caribbeans (around 5%) and South Asians (>10%). Diagnosis of diabetes depends on the demonstration of a raised non-fasting blood glucose of greater than 11 mmol/L. If there is doubt, a fasting sample should obtained. The guidelines for the diagnosis of DM are shown in Table 41.1. Impaired glucose tolerance is an important condition with a high risk of developing Type 2 DM and an increased risk of macrovascular disease compared to the normal population.
Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus


Type 1 Diabetes Mellitus
Clinical scenario
Miss GT was a 22-year-old woman with Type 1 diabetes mellitus (DM) since the age of 13. Initially she had been well controlled, but over the last year she had attended her local Accident and Emergency Department on several occasions with hypoglycaemic episodes. For the few days prior to this admission she had felt unwell – she developed an upper respiratory tract infection but despite monitoring her blood sugar more often and taking her insulin, she had started vomiting 8 hours prior to admission. By the time she arrived in the Accident and Emergency Department she was drowsy and had vomited on several further occasions. Her temperature was elevated, she demonstrated prolonged expiration in breathing (Kussmaul’s respiration), there was a smell of acetone on her breath and she appeared to be dehydrated and unwell. Her blood glucose was 24 mmol/L and she had both glycosuria and 3+ ketonuria on urinalysis. Blood gases were done immediately and showed a metabolic acidosis with pH 7.2, HCO3 14 mmol/L, PO2 12 kPa, PCO2 3.4 kPa. A diagnosis of diabetic ketoacidosis was made and routine therapy commenced, with IV fluids, potassium and insulin, according to local protocols.
Insulin Action

Insulin Action


Insulin Action
Clinical scenario
Mrs PC, a 45-year-old woman, was referred to her GP having been found to have a raised random blood glucose measurement at an insurance medical examination. On questioning she admit- ted to feeling increasingly tired recently and her weight had increased over the preceding year. She smoked 15 cigarettes a day. Her mother and maternal grandfather had Type 2 diabetes. On examination she was obese (body mass index 34 kg/m2). Blood pressure was 160/90 and there was an absent posterior tibial pulse at the right ankle. The rest of the examination was normal. Subsequent investigations revealed a fasting blood glucose of12.2 mmol/L, HbA1c 9.2%, cholesterol 7.4 mmol/L, normal renal function, glycosuria of 3+ on dipstix urine testing. She was strongly advised to stop smoking and treatment was commenced with antihypertensives and lipid-lowering agents. She was seen by the specialist nurse and dietician and advised about monitoring her blood glucose and about diet and exercise. Initially, her progress was slow but she eventually started to lose weight after the introduction of the drug metformin. This was accompanied by improved glycaemic control.
Cross Section of Hand: Axial View Anatomy

Cross Section of Hand: Axial View Anatomy


Cross Section of Hand: Axial View Anatomy
Flexor pollicis longus tendon 1st dorsal interosseous muscle, Interosseous muscle, Interosseous muscle, Interosseous muscle 1st lumbrical muscle, Adductor pollicis muscle 2nd lumbrical muscle, 4th lumbrical muscle, 3rd lumbrical muscle, Metacarpal 2, head, Metacarpal 3, Metacarpal 4, Metacarpal 5, head, Extensor digitorum tendon, Extensor digitorum tendon, Extensor digitorum tendon and extensor expansion, Extensor digitorum tendon, Extensor indicis tendon, Proximal phalanx 1, Flexor digitorum profundus tendons, Hypothenar muscles, Flexor digitorum profundus tendons Flexor digitorum superficialis tendons, Flexor digitorum superficialis tendons.

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