Living will form (Medical humour)
LIVING WILL FORM
______ a Martini ______ a Margarita ____ a Scotch and soda ______ a Bloody Mary ______ a Gin and Tonic _______ a Cuppa ______ a Steak ______ Lobster or crab legs ______ the remote control ______ a bowl of ice cream ______ the sports page______ sex ______ or chocolate, it should be presumed that I won’t ever get any better.
When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes, and call it a day. At this point, it is time to call the Scots Highlander Bagpipe Band to come do their thing at my funeral and ask all of my friends to raise their glasses to toast the good times we have had.
Idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis is scarring or thickening of the lungs without a known cause.
Theories of Etiology:
There are genetic markers of susceptibility for the genetics and pathogenesis of familial IPF.
- A central repository of DNA samples and lung biopsies of patients with familial IPF would be useful and may provide the genetic material for defining this important subset of patients with IPF.
Environmental factors contributing to the pathogenesis of IPF.
- Case control studies with matched, well-defined cases of IPF to define environmental associations would be informative.
DNA viruses in the pathogenesis of IPF.
Pathogenesis:
Inflammatory and parenchymal cells affect fibroblasts. Fibroblasts also alter inflammatory and parenchymal cells. Stimulation of fibroblasts causes fibrosis of the lung tissue.
“In the normal lung, the interstitium of the alveolar wall is thin and the number of fibroblasts is limited. Most fibroblasts and collagen fibers occur along blood vessels and conducting airways. The balance of fibrogenic and antifibrogenic factors must be toward suppression of fibroblast proliferation and matrix production. However, we know little about the antifibrogenic factors that are present in the normal lung.”
Symptoms:
- chest pain
- cough, usually dry
- Decreased exercise tolerance
- dyspnea, upon exertion or in progressive cases also at rest)Diagnostics:
- broncoscopy with transbronchial lung biopsy
- chest CT
- chest x-ray
- SpO2, blood oxygen level
- pulmonary function tests
- Lung tissue biopsy
Treatment and management:
- There is no cure.
- corticosteroids and cytotoxic drugs may help reduce swelling (inflammation) in some cases
- supplemental oxygen
- lung physiotherapy to maintain exercise tolerance
- lung transplant in severe advanced cases
Whipple procedure
A surgical procedure to treat cancer involving on the head of the pancreas, malignant tumors involving the common bile duct, duodenal papilla, or duodenum near the pancreas.
Pancreaticoduodenectomy:
en bloc removal of the distal segment (antrum) of the stomach; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the gallbladder.
The head of the pancreas and the duodenum share the same arterial blood supply (the gastroduodenal artery). These arteries run through the head of the pancreas, so that both organs must be removed if the single blood supply is severed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum, resulting in tissue necrosis.
Timeline:
1898 – procedure was originally described by Alessandro Codivilla, an Italian surgeon.
1909 – The first resection for a periampullary cancer was performed by Walther Kausch, a German surgeon.
1935 – improved version of the surgery performed by Allen Whipple, an American surgeon.
There after called the Whipple procedure.
Koch Pouch
The Kock Pouch is an example of a continent ileostomy, so called because the contents of the small intestine stay within the body until the patient decides to empty it. The Kock pouch consists of a reservoir constructed from the small intestine, and a nipple valve which keeps the contents of the reservoir inside the body, and permits entry of an external catheter to drain the pouch when desired.
The catheter is a simple hollow plastic tube. It is inserted about 5 inches into the stoma, and the contents of the reservoir come out on their own. Immediately after surgery the pouch is emptied about every three hours, because the reservoir is small. But following the surgery it grows in size until it can be emptied only 3 or 4 times a day, approximately 2 months after surgery. In the absence of late night meals, it is rare to have to get up at night to empty. This is in contrast to some of the alternative surgeries such as the J pouch, where night time emptyings are generally necessary. In between emptyings, the stoma is covered with a piece of gauze to absorb the mucus coming from it. The stoma is typically about 1/2 inch in diameter.
http://alumnus.caltech.edu/~pls/kock/
Application:
Total Proctocolectomy with Koch Pouch
This operation involves complete removal of the colon and rectum with the creation of a continent ileostomy. It is similar to that of the Brooke ileostomy, but here a pouch is created inside the abdominal wall with a continent ileostomy. This operation is rarely performed, but can be considered in selected cases in which transanal reconstruction is not a good option.
 |
| Figure 14. Technique for total proctocolectomy with Koch pouch (front and side view) |
Belladonna & opium suppository
Use:
typically to treat moderate to severe pain from spasms of the urinary tract.
It contains 2 medications, belladonna and opium.
Belladonna helps to decrease the spasms. Opium is a narcotic medication that helps to relieve pain.
A note on belladonna and its uses:
Belladonna produces many effects in the body, including relief from spasms of the gastrointestinal tract (stomach and intestines), the bladder, and the biliary tract. This is helpful in controlling conditions such as colitis, spastic bladder, diverticulitis, infant colic, renal and biliary colic, peptic ulcer, and irritable bowel syndrome.
Belladonna also reduces the secretions of many organs, thereby helping to control conditions such as excessive stomach acid production.
Belladonna is used to treat the rigidity, tremor, excessive salivation, and sweating caused by Parkinson’s disease.
Belladonna also is used to treat motion sickness, nausea, vomiting, abdominal cramping associated with menstruation, and to reduce nighttime urination.
Side effects:
- Nausea
- vomiting
- constipation
- blurred vision
- increased eye discomfort in bright light
- lightheadedness
- dizziness
- drowsiness
- dysuria
Procedure:
lubricate supp
Insert the suppository, pointed end first, with your finger until it passes the muscular sphincter of the rectum, about 1/2 to 1 inch in infants and 1 inch in adults. (If not inserted past this sphincter, the suppository may pop out.)
Intrauterine insemination (IUI)
With infertility rates on the rise in seemingly healthy young couples, intrauterine insemination or IUI is becoming more popular. It could be seen as a step in fertility treatments between hormone therapy and invitro fertilization, IVF.
Intrauterine insemination (IUI) is a form of assisted contraception. it is a procedure in which washed, prepared sperm is introduced into the uterus at the time of ovulation. This procedure is often combined with fertility drugs to increase chances of contraception.
Sperm wash protocol
Sperm wash methods:
Simple Sperm Wash
The simple sperm wash technique is the most basic way of washing and preparing sperm for IUI. Semen is diluted in a test tube, with a special solution of antibiotics and protein supplements. It is then placed in a centrifuge, a machine that spins around at extremely high speeds.
As the sperm mixture is spun, sperm cells fall to the bottom of the test tube, producing a mass of dense, highly active sperm. These sperm can then be removed from the test tube and used in IUI. A simple sperm wash takes about 20 to 40 minutes.
Sperm Swim-Up
Semen is placed in a test tube; in some cases, it is previously washed and centrifuged.
A culture medium is carefully placed on top of the semen. The medium is a hospitable environment for the sperm, and healthy sperm will swim up into it. Slow and immotile sperm are left behind, along with most debris in the semen.
The test tube is let stand an hour or so; in some cases it is placed at an angle, and/or in an incubator where past that time the top layer is collected for use.
Finally, the portion retained for use may be washed and centrifuged again.
Density Gradient Sperm Wash (Percoll)
The density gradient sperm wash is one of the most popular sperm washing methods. This is because it also works to separate dead sperm cells, white blood cells, and other waste products from the sperm.
A test tube is filled with multiple layers of liquids of different densities. Semen is then placed on the top layer of liquid and the test tube is spun in a centrifuge. After it is spun, active, healthy sperm will make their way, to the very bottom layer of the liquid in the test tube, while debris and dead sperm will get caught in the top two layers.
These layers can be siphoned off, in order to remove the active sperm from the test tube. This sperm is then used in the IUI procedure. Density gradient sperm washes take approximately 60 minutes.
This procedure is often called just the “Percoll method”, because Percoll was so often used as the density medium, but other density media are now used.
http://www.fertilitycrete.gr/fertility-treatments/sperm-swim-up-percoll
Ketamine and bladder dysfunction
Findings are show a link between the recreational use of ketamine 3 or more times a week and bladder problems that can linger more than a year after its use.
Symptoms:
Associated bladder dysfunction includes:
- urinary frequency
- urinary urgency
- epigastric pain
The recreational use of ketamine reduces bladder capacity to about 200 mls.
Normal bladder capacity is 400-500ml
The bladder capacity has been shown to recover gradually after a year of abstaining from ketamine abuse.
Prognosis:
In extreme cases of chronic ketamine abuse bladder fibrosis has been shown to set in, reducing bladder capacity to less than 50mls with little recovery when ketamine use stops.
Treatment and Management:
- Stopping ketamine use
- Bladder reconstructive surgery
The medical post. Canadianhealthcarenetworks.ca
Kleine-Levin Syndrome or KLS (also known as Sleeping Beauty Syndrome)
a neurological disorder characterized by recurring periods of excessive amounts of sleeping and eating.
Manifestations:
- Hypersomnia, patients may spend 18 hours a day asleep.
- altered mental state during the episode.
- difficult to arouse from this sleep
- irritability
- aggressive when prevented from sleeping.
- Cognitive impairment
- confusion
- Amnesia for the event
- Hallucination
- Delusions or experience a dream-like state
- changes in eating behavior during episodes, exhibiting megaphagia little discrimination in consumption of excessive amounts of food.
Endoscopic retrograde cholangiopancreatography (ERCP)
a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on X-rays.
ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons.
Diagnostic
Fluoroscopic image of common bile ductstone seen at the time of ERCP. The stone is impacted in the distal common bile duct. A nasobiliary tube has been inserted.
Fluoroscopic image showing dilatation of the pancreatic duct during ERCP investigation. Endoscope is visible.
- Obstructive jaundice - This may be due to several causes
- Chronic pancreatitis - a now controversial indication due to widespread availability of safer diagnostic modalities including endoscopic ultrasound, high-resolution CT, and MRI/MRCP
- Gallstones with dilated bile ducts on ultrasonography
- Bile duct tumors
- Suspected injury to bile ducts either as a result of trauma or iatrogenic
- Sphincter of Oddi dysfunction
- Pancreatic tumors no longer represent a valid diagnostic indication for ERCP unless they cause bile duct obstruction and jaundice. Endoscopic ultrasound represents a safer and more accurate diagnostic alternative
Therapeutic
- Any of the above when the following may become necessary
- Endoscopic sphincterotomy (both of the biliary and the pancreatic sphincters)
- Removal of stones
- Insertion of stent(s)
- Dilation of strictures (e.g. primary sclerosing cholangitis, anastomotic strictures after liver transplantation)
Procedure
- The patient is sedated or anaesthetized. Then a flexible camera (endoscope) is inserted through the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of Vater (the opening of the common bile duct and pancreatic duct) exists. The sphincter of Oddi is a muscular valve that controls the opening of the ampulla. The region can be directly visualized with the endoscopic camera while various procedures are performed.
Coudé catheter
Like the standard straight Foley catheter, the Coudé catheter is retained by means of a balloon at the tip which is inflated with saline. The balloons typically come in two different sizes: 5 cc and 30 cc. A Coudé catheter is designed with a curved tip that makes it easier to pass through the curvature of the prostatic urethra.
