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Surgery Presentation

Transcript: Surgery: ET's presentation to hopsital Renee Duvenage 25/06/2013 Past Medical History: * 4 months Post partum- vaginal birth * L Carpal tunnel release Family history: * Father: AMI (3rd decade) Medications: * nil * NKDA Social History: * Non Smoker * Non Drinker * Lives at home with husband and child Differentials Provisional Diagnosis: GORD Peptic Ulcer Differential Diagnosis: Pancreatitis Cholecystitis AAA Investigations Management Biliary Colic Acute Cholangitis Chronic Cholangitis Anatomy: Can you name all the structures Management: Categories: 1: Incidental : requires no managment 2: Biliary symptoms, Gallstones (U/S), no complications 3: Atypical Symptoms, Gallstones (U/S) 4: Biliary symptoms without Gallstones (U/S) Complications Outcome Definitions and Classification Examination Further History Findings Thank you Imaging U/S: multiple small mobile calculi, mildly distended, positive sonographraphic Murphy's sign. CBD was not dilated (4.6 mm). Fatty liver changes identified. Presentation FBC: Leukocytosis LFT: All mildly elevated Abdominal pain S: Epigastric O: 2/7 C: Crescendo-descrendo, Never fully remitting R: Radiating to back and up to jaw. A: Alleviated by vomiting, associated with nausea, anorexia, T: At night, after dinner E: Exacerbated by food S: ranging from 3-8/10 Observation: appears comfortable at rest, bandages over laprascopic incisions present, IV cannula in situ, and is obese. Palpation: demonstrated a tender RUQ, and Positive Murphy's sign, AA difficult to palpate Auscultation: Bowel sounds present, no respiratory findings, HSDNM Percussion: Liver 14cm, no acites Blood Work Vital Signs: * Heart Rate: 74 bpm * Blood Pressure: 131/88 mmHg * Respiratory Rate: 22 bpm * Temperature: 37.7 C PC

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Transcript: Wisdom does not flow like water Plato’s Critique of Pederasty Pederasty Background Symposium Pederasty My Project Pausanias' Speech Pausanias' Speech Two Aphrodites Uranian Heavenly Pandemos Common Text Text Pictures Pictures "Here, Socrates, lie down alongside me, so that by my touching you, I too may enjoy the piece of wisdom that just occurred to you while you were in the porch. It is plain that you found it and have it, for otherwise you would not have come away beforehand." Agathon and Socrates “It would be a good thing, Agathon, if wisdom were the sort of thing that flows from the fuller of us into the emptier, just by our touching one another, as the water in wine cups flows through a wool thread from the fuller to the emptier. For if wisdom too is like that, then I set a high price on my being placed alongside you, for I believe I shall be filled from you with much fair wisdom. My own may turn out to be a sorry sort of wisdom, or disputable like a dream; but your own is brilliant and capable of much development, since it has flashed out so intensely from you while you are young; and yesterday it became conspicuous among more than thirty thousand Greek witnesses." "You are outrageous, Socrates," Agathon said. "A little later you and I will go to court about our wisdom, with Dionysus as judge, but now first attend to dinner." how water flows Principle at play When they do engage in a contest about love Timeline YEAR Alcibiades' Speech Socrates, he claims, is like “those silenuses that sit in the shops of herm sculptors, the ones that craftsman make holding reed pipes or flutes; and if they are split in two and opened up they show they have images of gods within.” (215b) Alcibiades' Speech You, in my opinion,' I said, 'have proved to be the only deserving lover of mine; and it seems to me that you hesitate to mention it to me. Now I am in this state: I believe it is very foolish not to gratify you in this or anything else of mine—my wealth or my friends—that you need; for nothing is more important to d me than that I become the best possible; and I believe that, as far as I am concerned, there is no one more competent than you to be a fellow helper to me in this. So I should be far more ashamed before men of good sense for not gratifying a man like you than I should be before the many and senseless for gratifying you.' Seduction Scene 'Really, my dear Alcibiades, you're no sucker if what you say about me is really true and there is some power in me e through which you could become better. You must see, you know, an impossible beauty in me, a beauty very different from the fairness of form in yourself. So if, in observing my beauty, you are trying to get a share in it and to exchange beauty for beauty, you are intending to get far the better deal. For you are trying to acquire the truth of beautiful things in exchange for the seeming and opinion of beautiful things; and you really have in mind to exchange "gold for bronze." But blessed one do consider better: Without your being aware of it—I may be nothing. Thought, you know, begins to have keen eyesight when the sight of the eyes starts to decline from its peak; and you are still far from that.' Conclusion conclusion If Socrates were to have sex with Alcibiades, he would perpetuate: 1) the idea that people can make each other wise. impact: prevent Alcibiades from realizing his ignorance about wisdom 2) Alcibiades belief that his physical attractiveness is the most important thing about him impact: the belief could harm Alcibiades as he begins to decline from his physical peak, when “Thought begins to have keen eyesight.” (219a) 3) Socrates would be no better than the sophists who cannot acknowledge the ways in which they are ignorant, and thus, risk self-deception. Advantages Advantages to my account: -Fits with the well-known picture of a Socrates who: 1) proclaims his own ignorance. 2) critiques the Sophists for i. both not acknowledging what they do not know ii. exchanging money for wisdom -Makes explicit the way Plato critiques the customs of his time -Throws into question a vision of Socrates as someone who consistently denies bodily urges -Makes clear that the container model is supposed to function in opposition to the image of pregnancy and birth. Accounts of “Plato’s Appropriation of Reproduction” run these two images together.

Surgery presentation

Transcript: Ductal Adenocarcinoma Surgical treatment? Both procedures provide adequate pain relief and quality of life after long-term follow-up with no differences regarding exocrine and endocrine function. However, short-term results favor the organ-sparing procedure.* Puestow procedure Duval US CT ERCP Pathological types Insulinoma Glucagonoma Gastrinoma Somatostatinoma VIPoma Prognosis Laparoscopic Treatment Open Abdominal pain Nausea, Vomiting Epigastric tenderness Tachycardia, Hypotension Fever Paralytic ileus Ecchymoses CT US Epidemiology teroids P A N C R E A S Distal pancreatectomy Whipple's procedure Subtotal pancreatectomy Total pancreatectomy Complications Pseudocyst Infected necrosis Abscess GI bleeding Thrombosis Analgesics Celiac plexus block Pancreatic enzyme supplements Fat-soluble vitamins Insulin may be needed Diet; No alcohol, low fat Clinical symptoms Surgical Management ge >55 Whipple's procedure Symptoms Puestow procedure Treatment G E T S M A S H E D <2% of all malignancies. Usually appears in elderly. Severe Pancreatitis Distal Pancreatectomy Pathophysiology Diagnosis RCP Causes Whipple's prcedure ugar, glucose >10 mmol/L Pseudocyst Pancreaticoenteric fistulas Diabetes Mellitus Malabsorption Pancreas carcinoma THANK YOU FOR YOUR ATTENTION yperlipidemia, hypercalcemia Minimally invasive - necrosectomy through small incision in skin or stomach Conventional - necrosectomy with simple drainage Closed - necrosectomy with closed continuous postoperative lavage Open - necrosectomy with planned staged reoperations utoimmune (PAN) Resectional rauma Nasogastic tube Nothing PO 60% pancreatic head 25% body 15% tail Surgery Presentation Diagnosis Distal pancreatectomy Cullen Sign rugs Surgical Thrombophlebitis migrans Hypercalcemia Portal hypertension Splenic vein thrombosis Hemorrhagic Treatment nzymes, LDH > 600 U/L, ASAT > 200 U/L Tumor < 3cm and no metastases No survival benefit in non-curative resections Post-op morbidity is high Symptoms Mild Alcohol eutrophilia, WBC > 15 Cholestatic jaundice CA 19-9 Diffuse scarring and strictures in the pancreatic duct Exocrine & endocrine insufficiency Drainage Resection with extended drainage Acute Complications Partial Fluids Blood tests corpion venom Pancreatitis Acute Pancreatitis Extended drainage Endoscopic or percutaneous stent insertion Bypass for duodenal obstructions Pain relief (opiates or radiotherapy) Celiac plexus infiltration Pain relief PPI H2 blocker * GET SMASHED! allstones Painless obstructive jaundice Courvoisier's sign Epigastric pain which radiates to the back and relieved by sitting forward Anorexia Diabetes mellitus Acute pancreatitis Surgical management of chronic pancreatitis: Imaging Risk factors Microvascular leakage Necrosis of fat by lipase SIRS Proteolytic destruction of parenchyma Destruction of blood vessels with hemorrhage Supportive of Severe Pancreatitis Pancreatic rest Shock with MODS ARDS Renal failure DIC Sepsis Hypocalcemia Pancreatic Tumors (Pancreatoduodenectomy) aO2 <8 kPa (<60 mmHg) thanol Symptomatic Rumpfs Diagnosis Late Secretin stimulation test Imaging (US, CT, XR, ERCP) Fecal elastase Amylase & lipase usually normal Complete Fluid resuscitation Respiratory care Cardiovascular care Pain relief Parenteral feeding Treatment of infection Chronic Frey's procedure Hans Beger's Pathology Partington-Rochelle procedure 12% Mortality Managed on surgical wards although surgery is not often involved Severe Blood tests PANCREAS! Early Symptoms of Mild Pancreatitis Surgical Mean survival 6 months 5-year survival <2% Imaging Medical Palliative Acute necrotizing Grey-Turner Sign Etiology Cystic fibrosis Hemochromatosis Hyperlipidemia Hyperparathyroidism by Eivind W. Aabel umps Clinical enal function, Urea > 16 mmol/L Others Smoking Alcohol Carcinogens Diabetes Chronic pancreatitis High fat diet Partington-Rochelle Bapat lbumin <32 g/L Location alcium <2 mmol/L Mid-epigastric pain Jaundice Weight loss Steatorrhea Tenderness Mass Diabetic symptoms Amylase & Lipase >3x Treatment

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