Grazie
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Topics: 13
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Angel23
You rock!  Oh my gosh you are studying so hard, for sure your 99 is coming soon, Keep it up!
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| angel23
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Topics: 42
Posts: 980
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done with ostetrics
now feeing a lott sleepy ..
will sleep for an hour n then come back
 
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| angel23
Forum Guru
Topics: 42
Posts: 980
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hey grazie!!
welcome to the ck world!!
hws ur pregnancy going on?hws the little one ?
i havnt even completed my first read and hav so many targets to complete
in btw did u start a journal for ck?
i think u should be quick coz u will make ck world too interesting
take care
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| angel23
Forum Guru
Topics: 42
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ok got up....had lunch...
n now all set for study.....now i l do a block of psychiatry....with explanations...
see ya after i complete block
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| angel23
Forum Guru
Topics: 42
Posts: 980
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O God give me strength
havnt even completed first reading n this task on my head
cant extend qbank.....done with 40%.....how i l complete?
but i will do
no use of weeping now....hav to do qbank....
from mon.onwards i l start with read of kaplan lecture notes +notes i made from qbank
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Hey Angel,
About my pregnancy, actually the reason I am here is because..
You know, I have been preparing for my CS but unfortunately I didn't count with my special pregnancy physiology  , I thought I was gonna be able to manage my body until later in the pregnancy like other friends I have, but my bladder won first and I am not able to hold it for more than 20min and with that record forget it! , I am not taking my CS until after my little one comes, hopefully and with God's help by the end of september 
I am now in the process of collecting current CK material; I have heard about the new Kaplan CK Notes  but I also heard that the main difference is in Pediatrics, so I will try to check it with some friends from kaplan, but I am not taking the live lectures this time, anyway I plan to use the DVD's and Kaplan CK Notes from 2007, we'll see.
I may be pretty soon swimming into CK stuff like you buddy  , I really get very motivated by your posts, you are being so consistent, Keep it up Angel 
See you around.
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| angel23
Forum Guru
Topics: 42
Posts: 980
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thanks grazie for dropping!!
we l be waiting for u to start ur journal....
i love reading your journal...even wen i was done ith cs i kept on reading your journal coz it was damn interesting!!very nice
take care
see ya around
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| angel23
Forum Guru
Topics: 42
Posts: 980
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hey journal....good morning!!
so yday i completed obstetrics and a block of psychiatry n some notes of surgery
so today i l complete 2 blocks of surgery with explanations....ths will cover surgery
then i l do left over 2 blocks of psychiatry + 15 ques of epi +their explanations
so i start with a block of suregery and will report after completing it
see ya later
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| angel23
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i m done with 1 block of surgery ....
now will write down explanations
and then return back to 2nd block of surgey so see ya in 2 hours with explanations +block of surgery
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| angel23
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Topics: 42
Posts: 980
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Ranson criteria is a clinical prediction rule for predicting the severity of acute pancreatitis.
Parameters used:
At admission:
age in years >55years
white blood cell count > 16000/mcL
blood glucose > 11 mmol/L (>200 mg/dL)
serum AST > 250 IU/L
serum LDH > 350 IU/L
After 48 hours:
Calcium (serium calcium < 2.0 mmol/L (<8.0 mg/dL)
Haematocrit fall > 10%
Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
Base deficit > 4Meq/L
Sequestration of fluids > 6L
The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.
Interpretation
If the score >=3, severe pancreatitis likely.
If the score < 3, severe pancreatitis is unlikely
Or
Score 0 to 2 : 2% mortality
Score 3 to 4 : 15% mortality
Score 5 to 6 : 40% mortality
Score 7 to 8 : 100% mortality
Mnemonic for Memorizing Ranson's Criteria
At admission: "GA LAW" (Glucose, Age, LDH, AST, WBC count)
At 48 hours: "C Hobbs" (ie. Calvin and Hobbs): (Calcium, Hematocrit, O2, BUN, Base deficit, Sequestration)
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| angel23
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Gastric dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine, the jejunum, fills too quickly with undigested food from the stomach. "Early" dumping begins during or right after a meal. Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness and fatigue. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types.
It is speculated that "early" dumping is associated with difficulty digesting fats while "late" dumping is associated with carbohydrates.
In addition, people with this syndrome often suffer from low blood sugar, or hypoglycemia, because the rapid "dumping" of food triggers the pancreas to release excessive amounts of insulin into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia".
Dumping syndrome is most common in patients with certain types of stomach surgery, such as a gastrectomy or gastric bypass surgery, that allow the stomach to empty rapidly. Dumping syndrome can also occur as a result of complications after a cholecystectomy (gallbladder removal).
Patients with Zollinger-Ellison syndrome, a rare disorder involving extreme peptic ulcer disease and gastrin-secreting tumors in the pancreas, may also have dumping syndrome.
Dumping is also common for esophageal cancer patients who have had an esophagectomy; surgery to remove the cancerous portion of their esophagus. The stomach is pulled into the chest and attached to what remains of the esophagus, leaving a short digestive tract. Both early and late dumping syndrome can occur in the same patient.
Finally, patients with connective tissue conditions such as Ehlers-Danlos syndrome can experience "late" dumping as a result of decreased motility.
Two ways of determining if a patient has dumping syndrome include Barium fluoroscopy and radionuclide scintigraphy.
In the first procedure, a contrast of barium-labeled medium is ingested, and x-ray images are taken; early dumping can be easily recognized by premature emptying of the contrast medium from the stomach.
The second method, scintigraphy (or radionuclide scanning), involves a similar procedure in which a labeled medium containing 99mTc (or other radionuclide) colloid or chelate is ingested. The 99mTc isotope decays in the stomach, and the gamma photons emitted are detected by a gamma camera; the radioactivity of the area of interest (the stomach) can then be plotted against time on a graph. Patients with dumping syndrome generally exhibit steep drops in their activity plots, corresponding to abnormally rapid emptying of gastric contents into the duodenum.
Treatment
Dumping syndrome is largely avoidable by avoiding certain foods which are likely to cause it, therefore having a balanced diet is important. Treatment includes changes in eating habits and medication. People who have gastric dumping syndrome need to eat several small meals a day that are low in carbohydrates, especially omitting simple sugars (candy, desserts, ice cream), and should drink liquids between meals, not with them. People with severe cases take medicine such as cholestyramine or proton pump inhibitors (such as pantoprazole) to slow their digestion.
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| angel23
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Afferent loop syndrome (ALS) is a purely mechanical complication that infrequently occurs following construction of a gastrojejunostomy. Creation of an anastomosis between the stomach and jejunum leaves a segment of small bowel, most commonly consisting of duodenum and proximal jejunum, lying upstream from the gastrojejunostomy. This limb of intestine conducts bile, pancreatic juices, and other proximal intestinal secretions toward the gastrojejunostomy and is thus termed the afferent loop.
Acute ALS
Acute ALS is caused by complete obstruction of the afferent loop. Patients with acute ALS typically present with a sudden onset of epigastric and/or right or left upper quadrant abdominal pain, with associated nausea and vomiting.
With acute ALS, the vomitus is not bilious because the biliary and pancreatic secretions remain trapped in the obstructed bowel loop. If the afferent loop is not decompressed, the patient becomes acutely ill and can subsequently develop peritonitis and shock if intestinal perforation or infarction ensues.
Chronic ALS
Chronic ALS is caused by partial obstruction of the afferent loop. Approximately 10-20 minutes to an hour postprandially, the patient experiences abdominal fullness and epigastric pain. These symptoms usually last from several minutes to an hour, although they occasionally last as long as several days.
Projectile bilious vomiting is a classic manifestation of ALS with partial obstruction. The distended afferent loop decompresses forcefully, providing rapid relief of symptoms. Note that the vomitus usually contains no food because it has progressed along the unobstructed efferent limb. Vomiting may occur after each meal or only occasionally.16 Also, symptoms in the immediate postprandial period may be minimized if the patient assumes a recumbent position.
Prolonged chronic ALS with stasis and bacterial overgrowth can be further complicated by steatorrhea, diarrhea, and vitamin B-12 deficiency anemia. These effects are primarily due to bacterial deconjugation of bile salts. The aforementioned factors, in addition to bypassing the duodenum and proximal jejunum, can result in iron deficiency anemia.
Physical
Physical examination can reveal one or more of the following findings:
An ill-defined mass in the right upper abdominal quadrant
Localized midepigastric or right upper abdominal quadrant tenderness
Peritonitis and/or a rigid abdomen if necrosis or perforation of the bowel wall has occurred
Jaundice
Signs of pancreatitis (eg, upper abdominal pain radiating to the flank or back
Surgery is indicated in most cases of ALS
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| angel23
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Short bowel syndrome (SBS, also short gut syndrome or simply short gut) is a malabsorption disorder caused by the surgical removal of the small intestine, or rarely due to the complete dysfunction of a large segment of bowel. Most cases are acquired, although some children are born with a congenital short bowel. It usually does not The symptoms of short bowel syndrome can include:
Abdominal pain
Diarrhea and steatorrhea (oily or sticky stool, which can be particularly foul-odored)
Fluid retention
Weight loss and malnutrition
Fatigue
Patients with short bowel syndrome may have complications caused by malabsorption of vitamins and minerals, such as deficiencies in vitamins A, D, E, K, and B12, calcium, magnesium, iron, folic acid, and zinc. These may appear as anemia, hyperkeratosis (scaling of the skin), easy bruising, muscle spasms, poor blood clotting, and bone pain.
Causes
Short bowel syndrome in adults is usually caused by surgery for:
Crohn's disease, an inflammatory disorder of the digestive tract
Volvulus, a spontaneous twisting of the small intestine that cuts off the blood supply and leads to tissue death
Tumors of the small intestine
Injury or trauma to the small intestine
Necrotizing enterocolitis (premature newborn)
Bypass surgery to treat obesity, a now uncommonly performed surgical procedure
Surgery to remove diseases or damaged portion of the small intestine
develop unless a person has lost more than two thirds of their small intestine
Symptoms of short bowel syndrome are usually addressed by prescription medicine. These include:
Anti-diarrheal medicine (e.g. loperamide, codeine)
Vitamin and mineral supplements
H2 blocker and proton pump inhibitors to reduce stomach acid
Lactase supplement (to improve the bloating and diarrhoea associated with lactose intolerance)
Surgery, including intestinal lengthening, tapering, and organ transplant.
Parenteral nutrition (PN or TPN - nutrition administered via intravenous line).
Nutrition administered via gastrostomy tube
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| angel23
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hey journal!!
i m back....
done with 1 block with explanations
and half 2nd block of surgery since morning
then slept
and now i started with infections in IM ....146 ques
so doing 1st block
see ya later after doing block with explanations
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| angel23
Forum Guru
Topics: 42
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O God give me strength to work hard!!
i m feeling deadly sleepy....slept for half an hour
now i m up n will hav coffee
n wont see my journal till i complete 2 blocks of infections
wasted so much of time since morning ....
tomorrow wont stay home....will go to library for sure
ok so now back to studies
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| tia
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Topics: 50
Posts: 1,190
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hey angle123
how r u??
good luck study well
tc
tia
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| angel23
Forum Guru
Topics: 42
Posts: 980
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good morning dear journal!!
i have to do a lottt today
i l stick to my chair n not move......
now first i l be writing explanations of rheumatology and come back....
see ya journal
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Angel,
You keep strong all the way, I really admire your hard work, keep it up Doc, you will rock this exam. Enjoy your study day
Grazie.
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| angel23
Forum Guru
Topics: 42
Posts: 980
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ok now done with rheumatology...
then started doing emergency med.
so i intend to complete emergency med today and one block of surgery so tht i finish off with surgery
so i l be done with obs, gyne surgery, rheumato, skin ,emergency med
thursday:do GIT ,endo ,neuro ,preventive and radio explanations
friday : psychiatry and peds left overs ....haem.
sat. last day of qbank):cardio ,explanations of infectious,pulmonology+nephro
God give me strength to do all this in time plzzzzzzzzzzz!!
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| angel23
Forum Guru
Topics: 42
Posts: 980
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ok now enough n get back to work
still hav 2 blocks of emergency med to go
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