Dr Darshan Sn
Dr Darshan Sn
in General
My iz♡
My iz♡
in General
Trachealization” of the Esophagus
Trachealization” of the Esophagus
A 32-year-old man presented to the emergency department with difficulty swallowing oral secretions and the feeling that food was stuck in his throat after he ate a pizza roll. The patient reported that similar episodes had occurred previously, but in each instance the feeling resolved spontaneously, and he did not seek medical care. At the time of presentation, the patient was drooling. Upper endoscopy revealed impacted food material (Panel A) and prominent mucosal rings extending 20 cm from the incisors to the level of the gastroesophageal junction, with two discrete areas of narrowing and associated linear furrows (Panel B). Biopsy specimens were obtained, and esophagitis was observed, with more than 40 eosinophils per high-power field (Fig. S1 in the Supplementary Appendix). An endoscopic finding of fixed esophageal rings, or “trachealization,” is suggestive of eosinophilic esophagitis, although a definitive diagnosis is made on the basis of clinical presentation, histologic findings, and the exclusion of other causes of esophageal eosinophilia, such as proton-pump inhibitor–responsive esophageal eosinophilia. The patient was treated with an 8-week course of omeprazole, but there was no symptom resolution or histologic improvement on repeat endoscopic biopsies, which confirmed the diagnosis of eosinophilic esophagitis. He was started on an 8-week course of both swallowed fluticasone and a six-food elimination diet (elimination of the six most commonly identified types of allergenic food — wheat, milk, soy, nuts, eggs, and seafood). No additional endoscopies were performed after completion of treatment with fluticasone and the elimination diet. At a 1-year follow-up visit, the patient reported no further symptoms of food impaction.
Makuo chukwu
Makuo chukwu
in Case Study
Trauma!!!
Trauma!!!
A twenty-three-year old male patient was brought to our emergency service by an ambulance. Trauma mechanism reported by the paramedic team indicated that the patient was seated in the driver seat without his seatbelt on, and he had crushed his face to the steering wheel during the accident. After the initial examination, it was noted that the patient’s bilateral orbitas; maxillary, zygomatic and nasal bone structures were not observed. The patient was conscious, breathing spontaneously in tripod position and he had tachypnea. He had midfacial bleeding  due to maxillofacial trauma.  He was cooperated and oriented but vocal and ocular responses were suboptimal due to damages. Vital signs were: blood pressure 160/90 mmHg, heart rate 110,  respiratory rate 22 and fingertip saturation 99%.(Figure1, figure 2, Figure 3) On his primary survey, his  hemorrhage control was maintained with aspiration. Oxygen saturation was normal while sitting but he was not able to keep his airway open in supine position.  After stabilization of the patient, urgent plastic surgery was planned. Because of his severe facial fractures, surgical airway (tracheostomy) placement was performed accompanied by a otolaryngologist. On his secondary survey, other system examinations were normal. In his cranial computed tomography (CT) imaging there was neither damage in brain parenchyma; nor hemorrhage or hematoma on epidural, subdural or subarachoidal spaces. Lateral, superior, medial and inferior walls of bilateral orbitas and bilateral multiple zygomatic arch fractures were detected. Right bulbus oculi was not in its cavity, left bulbus oculi was displaced  antero-superiorly. The relationship between the left temporomandibular joint was absent. After performing cranial imaging, the patient was referred to Plastic and Reconstructive Surgery for  operation.
REV MED
REV MED
in Learning Materials
Pancreas
Pancreas
𝐓𝐡𝐞 🍇 𝐨𝐟 𝐭𝐡𝐞 𝐛𝐨𝐝𝐲, 𝐭𝐡𝐞 𝐏𝐚𝐧𝐜𝐫𝐞𝐚𝐬! ⤵️⁣⁣⁣⁣ ⁣⁣⁣ ✅ 𝐎𝐯𝐞𝐫𝐯𝐢𝐞𝐰 ⁣⁣⁣⁣ ⁣⁣⁣⁣ It is an organ sitting behind the stomach at about 6-8 inches long. The right side of the Pancreas is its widest part and is referred to as the head. It is cradled by the duodenum (1st part of small intestine). It moves upwards from right to left as the body of the Pancreas and ends at the spleen as the tail of the Pancreas.  ⁣⁣⁣⁣ ✅ 𝟐 𝐆𝐥𝐚𝐧𝐝𝐬 𝐨𝐟 𝐏𝐚𝐧𝐜𝐫𝐞𝐚𝐬⁣⁣⁣⁣ ⁣⁣⁣⁣ Exocrine: about 95% consists of this tissue. secretes digestive enzymes into the pancreatic duct. ⁣⁣⁣⁣ ⁣⁣⁣⁣ Endocrine: about 5% secretes hormones such as insulin into the blood stream, with its cells known as Islets of Langerhans. It regulates the body’s sugar levels.  ⁣⁣⁣⁣ ✅ 𝐃𝐢𝐬𝐞𝐚𝐬𝐞𝐬 𝐨𝐟 𝐏𝐚𝐧𝐜𝐫𝐞𝐚𝐬⁣⁣⁣⁣ ⁣⁣⁣⁣ Pancreatitis: inflammation and damage by its own digestive chemicals. Pancreas swells and tissue cells die. ⁣⁣⁣⁣ ⁣⁣⁣⁣ Pancreatic pseudocyst: with conditions of pancreatitis, a fluid filled cavity can form, referred to as a pseudocyst. ⁣⁣⁣⁣ ⁣⁣⁣⁣ Diabetes type 1: Disruption in the body’s immune system causes damage and destruction to the pancreas’ insulin-producing cells.  ⁣⁣⁣⁣ Diabetes type 2: Pancreas loses ability to provide adequate release of insulin. Body continues to become resistant to insulin and blood sugar peaks. ⁣⁣⁣⁣ ⁣⁣⁣⁣⁣ 🎥 𝐋𝐞𝐚𝐫𝐧 𝐀𝐧𝐚𝐭𝐨𝐦𝐲 𝐰𝐢𝐭𝐡 𝐨𝐮𝐫 𝐞𝐚𝐬𝐲 𝐚𝐧𝐝 𝐪𝐮𝐢𝐜𝐤 𝐯𝐢𝐝𝐞𝐨𝐬. 𝐂𝐥𝐢𝐜𝐤 𝐭𝐡𝐞 𝐥𝐢𝐧𝐤 𝐢𝐧 𝐛𝐢𝐨 𝐚𝐧𝐝 𝐠𝐞𝐭 𝐬𝐭𝐚𝐫𝐭𝐞𝐝 𝐍𝐎𝗪! 𝐒𝐮𝐩𝐩𝐨𝐫𝐭 𝐮𝐬 𝐛𝐲 𝐬𝐮𝐛𝐬𝐜𝐫𝐢𝐛𝐢𝐧𝐠 😊⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣ Instagram: @rev.med⁣⁣⁣⁣⁣
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