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قال رسول الله(ص):

(( من سلک طریقا یطلب فیه علما سلک الله به طریقا الی الجنة ))

کسی که راه کسب علم را پیش گیرد خداوند او را به راهی
هدایت می کند که او را به بهشت می رساند


 

 

موضوعات

علمی

سرگرمی

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پیوند ها

بچه های پزشکی 88 کازرون

دانشجویان مهر 87 کازرون

anatomy

bia2doctor

ایران موزیک

اطلس آناتومی

سینوهه در دانشگاه

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اصطلاحات پزشکی

بازار نو

سرگرمی های با حال

جدید ترین مطالب علمی

سیب پزشکی

سرگرمی-پزشکی

 

مطالب اخير

small bowel obstruction

Sigmoid Volvulus

بیماری نادر

Gallstone

Appendicitis

دلایل ریزش مو

صداهای تنفسی...

آب مرواريد(كاتاراكت)

اثرات سیگار بر لوزالمعده

 
 

امكانات جانبي

 


small bowel obstruction

·         General considerations

o       Small bowel obstruction, as the term is used here, is due to physical and organic changes which produce mechanical obstruction to the passage of the bowel contents somewhere in the small bowel

o       The bowel proximal to the point of obstruction dilates with swallowed air and secreted fluid,

§         Vomiting may release some of the proximal bowel contents and reduce the amount of proximal dilation

o       The bowel hyperperistalses

o       Bowel distal to the point of obstruction (i.e. colon and sometimes distal small bowel) empties over time

o       Strangulation of the bowel may result from vascular compromise of the affected loops and is a cause of increased mortality

·         Causes

o       Overwhelmingly, the most common cause of a mechanical small bowel obstruction are adhesions related to prior surgery (60%)

§         The most common prior surgeries associated with a subsequent SBO include appendectomy, colorectal surgery and gynecologic surgery

§         Bowel may become kinked under an adhesion

§         The obstruction is frequently partial or intermittent

o       Hernias

§         Most often femoral or inguinal

o       Intussusception

o       Volvulus

o       Tumor, either primary or metastatic

o       Wall lesions such as leiomyomas or strictures

o       Crohn’s disease

o       Foreign bodies

o       Gallstones

§         Such as in gallstone ileus (which is actually a mechanical obstruction, usually at the ileocecal valve)

·         Clinical findings

o       Abdominal pain and distension

§         Most marked in patients with distal SBO although its onset in distal obstructions is later in the course of the disease than in proximal obstruction

§         Typically colicky in nature and progressively worsening over time

o       Nausea

o       Vomiting

§         An earlier sign of a proximal than a distal obstruction

§         Fluid and electrolyte imbalances from vomiting increase mortality

o       Constipation

o       History of prior abdominal or pelvic surgery

o       Bowel sounds are hyperactive and high-pitched

§         Absence of bowel sounds may indicate bowel ischemia or peritonitis

·         Imaging findings

o       Conventional radiography is the study of first choice

§         Loops proximal to the point of obstruction will become dilated and fluid-filled

·         Usually greater than 2.5-3 cm in size

§         Differential height of air-fluid levels in the same loop of small bowel no longer considered reliable sign of mechanical SBO

§         Absence of, or disproportionately smaller amount of, gas in the colon, especially the rectosigmoid

§         Loops of small bowel may arrange themselves in a step-ladder configuration from the left upper to the right lower quadrant in a distal SBO

§         Mostly fluid-filled loops of bowel may demonstrate a string-of-beads sign caused by the small  amount of visible air in those loops

 



Small Bowel Obstruction. Supine view of the abdomen (left) shows several dilated loops of small bowel
in the upper abdomen. The small bowel is disproportionately dilated compared the the large bowel
which is collapsed. The upright view (right) demonstrates multiple air-fluid levels in the dilated loops
in a typical configuration of a small bowel obstruction. The patient had previous bowel surgery.

 



ادامه مطلب

چهارشنبه بیست و پنجم دی 1392 |

 

Sigmoid Volvulus


General Considerations

  • Twisting of loop of intestine around its mesenteric attachment site may occur at various sites in the GI tract
    • Most commonly: sigmoid & cecum
    • Rarely: stomach, small intestine, transverse colon
    • Results in partial or complete obstruction
    • May also compromise bowel circulation resulting in ischemia
  • Sigmoid volvulus most common form of GI tract volvulus
    • Accounts for up to 8% of all intestinal obstructions
  • Most common in elderly persons (often neurologically impaired)
  • Patients almost always have a history of chronic constipation

Pathophysiology

  • Redundant sigmoid colon that has a narrow mesenteric attachment to posterior abdominal wall allows close approximation of 2 limbs of sigmoid colon à twisting of sigmoid colon around mesenteric axis
  • Other predisposing factors
    • Chronic constipation
    • High-roughage diet (may cause a long, redundant sigmoid colon)
    • Roundworm infestation
    • Megacolon (often due to Chagas dz)
  • 20-25% mortality rate
  • Peak age > 50 yrs.
    • Second largest group à children
  • Torsion usually counterclockwise ranging from 180 – 540 degrees
  • Luminal obstruction generally @ 180 degrees
  • Venous occlusion generally @ 360 degrees à gangrene & perforation
  • Signs and symptoms
    • May present as abdominal emergency
      • Acute distension
      • Colicky pain (often LLQ)
      • Failure to pass flatus or stool (constipation is prevailing feature)
      • Vomiting is late sign
    • Distention may compromise respiratory & cardiac function
    • May also present with surprisingly few signs and symptoms in bedridden and debilitated
  • Physical examination
    • Tympanitic abdomen
    • Abdominal distention
    • +/- palpable mass

Diagnosis

  • Abdominal plain films usually diagnostic
    • Inverted U-shaped appearance of distended sigmoid loop
      • Largest  and most dilated loops of bowel are seen with volvulus
    • Loss of haustra
    • Coffee-bean sign à midline crease corresponding to mesenteric root in a greatly distended sigmoid
    • Bird’s-beak or bird-of-prey sign à seen on barium enema as it encounters the volvulated loop
  • CT scan useful in assessing mural wall ischemia

Differential Diagnosis

  • Large bowel obstruction due to other causes à sigmoid colon CA
  • Giant sigmoid diverticulum
  • Pseudo-obstruction
  • Colonic ischemia
  • Perforation
  • Sepsis

Treatment

  • Laparoscopic de-rotation or laparotomy +/- bowel resection
  • De-rotation & decompression by barium enema or with rectal tube, colonoscope, or sigmoidoscope if no signs of bowel ischemia or perforation
  • Cecopexy à suture fixation of bowel to parietal peritoneum may prevent recurrence
  • Recurrence rate after decompression alone à 50%

Sigmoid volvulus


Sigmoid Volvulus.
Dilated loop of sigmoid colon has a "coffee-bean" shape and
the wall between the two volvulated loops of sigmoid (black arrow) "points" towards the right upper quadrant.
There is a considerable amount of stool in the colon from chronic constipation.

جمعه بیستم دی 1392 |

 

بیماری نادر

بیماری نادر به شماری از بیماری‌ها گفته می‌شود که دارای فراوانی کمتر از ۵ نفر در ده هزار نفر است. این شیوع

کم باعث شده‌است که تشخیص این بیماری‌ها، به سختی امکان پذیر باشد. تاکنون بین پنج تا هشت هزار بیماری

نادر در جهان شناسایی شده‌است. بیماری نادر به بیماری گفته می‌شود که شیوع آن بسیار کم است و دامنه‌ای

بین ۱ به ۱۰۰۰ و ۱ به ۲۰۰۰۰۰ را دربرمی‌گیرد. درحال حاضر تخمین زده می‌شود که بین ۵۰۰۰ تا ۸۰۰۰ نوع

بیماری نادر وجود دارد که بعلت اینکه تعداد افرادی که به هریک از گونه‌های بیماری‌های نادر مبتلا می‌شوند بسیار

کم هستند برای همین برای مثال مجموع تمام مبتلایان به بیماریهای نادر در فرانسه برابر است با مبتلایان به

بیماری سرطان


بیشترین درصد بیماری‌های نادر (حدود ۸۰%) ریشه ژنتیکی دارند.[۲] و به این ترتیب افراد مبتلا به بیماری‌های نادر

 معمولا تا آخر عمر تحت تاثیر عوارض بیماری‌ها هستند. حتی اگر بعضی عوارض تنها در بعضی سطوح خاص

پیشرفت بیماری بروز بکنند. وگاهی بیماری‌های نادر مادرزادی درصد مرگ و میر این دسته از بیماران را در سنین ۵

سالگی به ۳۰% درمیان تمام بیماران مبتلا به بیماری نادر رسانده‌است.

بیماری‌های نادر را به بیماری‌های یتیم نیز می‌شناسند و آن به این دلیل است که هیچ روش درمانی موثری وجود

ندارد و تمام تجویزها و راه‌های درمانی بکارگرفته شده بیشتر در جهت کاستن علائم و عوارض بیماری‌های نادر است.


در تعریف بیماری‌های یتیم بیماری‌های شایع تری نیز قرار می‌گیرند که درواقع هیچ درمانی برای آنها یافت

نشده‌است. مانند بیماری زوال عقل یا آلزایمر. این گونه بیماری‌ها بدون اینکه بیماری نادر شناخته شوند جز

بیماری‌های یتیم بحساب می‌آیند.

طبق تخمین بنیاد بیماری‌های نادر اروپا به جز ۸۰ درصد این بیماری‌ها که خاستگاه ژنتیکی دارد و بقیه آنها نتیجه

 گونه‌ای از عفونت‌ها و حساسیت‌ها است

 


ادامه مطلب

شنبه دوم شهریور 1392 |

 

Gallstone


Gallstones form in the gallbladder, a small organ located under the liver. The gallbladder aids in the digestive process by storing bile and secreting it into the small intestine when food enters. Bile is a fluid produced by the liver and is made up of several substances, including cholesterol, bilirubin, and bile salts.

What Are Gallstones?

Gallstones are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.

The two main types of gallstones are:

  • Cholesterol stones: Usually yellow-green in color, approximately 80% of gallstones are cholesterol stones.
  • Pigment stones: These stones are smaller and darker and are made up of bilirubin.

What Causes Gallstones?

Several factors may come together to create gallstones, including:

  • Genetics
  • Body weight
  • Decreased motility (movement) of the gallbladder
  • Diet

Gallstones can form when there is an imbalance in the substances that make up bile. For instance, cholesterol stones may develop as a result of too much cholesterol in the bile. Another cause may be the inability of the gallbladder to empty properly.

Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease in which scar tissue replaces healthy liver tissue) or blood diseases such as sickle cell anemia.

What Are the Risk Factors for Gallstones?

Risk factors for getting gallstones include:

  • Genetics. If other people in your family have had gallstones, you are at increased risk of developing gallstones.
  • Obesity. This is one of the biggest risk factors. Obesity can cause a rise in cholesterol and can also keep the gallbladder from emptying completely.
  • Estrogen. Estrogen can increase cholesterol and reduce gallbladder motility. Women who are pregnant or who take birth control pills or hormone replacement therapy have higher levels of estrogen and may be more likely to develop gallstones.
  • Ethnic background. Certain ethnic groups, including Native Americans and Mexican-Americans, are more likely to develop gallstones.
  • Gender and age. Gallstones are more common among women and older people.
  • Cholesterol drugs. Some cholesterol-lowering drugs increase the amount of cholesterol in bile, which may increase the chances of developing cholesterol stones.
  • Diabetes. People with diabetes tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.
  • Rapid weight loss. If a person loses weight too quickly, his or her liver secretes extra cholesterol, which may lead to gallstones. Also, fasting may cause the gallbladder to contract less.

What Are the Symptoms of Gallstones?

Gallstones often don't cause symptoms. Those that don't are called "silent stones." A person usually learns he or she has gallstones while being examined for another illness.

When symptoms do appear, they may include:

  • Pain in the upper abdomen and upper back. The pain may last for several hours.
  • Nausea
  • Vomiting
  • Other gastrointestinal problems, including bloating, indigestion and heartburn, and gas

 


ادامه مطلب

سه شنبه بیست و دوم مرداد 1392 |

 

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