RTA with severe abdominal pain should not be taken lightly. There may be liver , spleen or other intraabdominal visceral injury . Get an urgent ultrasonography of abdomen and X- Ray abdomen standing for gas under right dome of diaphragm to exclude visceral perforation and liver or splenic injury. Monitor B.P , pulse , urine output after Foley's catheterization. Start with NPO , RT suction , IV fluids and Ultrasonography suggests hemoperitoneum.arrange blood and prepare for exploratory laparotomy
Go for BP and pulse X ray abd erect Per abd palpation USG fast scan IV fluids Foleys catherization IV antibiotics Pain killers If nothing comes in X ray , fast scan , per bad palpation patient can be discharged with conservative treatment and muscle relaxants.
First Stabilise pt.if Hemodynamicaly unstable. Looks Blunt Injury Abdomen. USG/CT ABD.N GET OTHER INVSTIGATIOND N XRAY ABD. MANAGEMENT WILL BE DECIDED AFTER WORK UP. YOU MAY NEED TO TAP TOR/O HEMOPERITONEUM. POST INVESTIGATIONS FINDINGS TO ADVICE.
Check vital single puls BP.oirentatipn Start I v fluids Keep.nothing by mouth Iv meropenum Iv metrogyl Do.cbc usg and See haemoperitoneum Injury to lbr.kidney intestine Spleen X Ryan chest Plan BT LAPROTOMY sos
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45/F presented to ER with c/o Right upper & lower quadrant severe abdominal pain since 12.30 midnight a/w vomiting - 6 episodes h/o right flank pain radiating to lower abdomen. h/o palpitation+ no h/o fever/decreased urine output / burning micturition. ECG done showed this changes diagnosis and treatment?Dr. Nelson Jd2 Likes17 Answers
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THE COVID-19 SYMPTOMS WE DID NOT KNOW ABOUT As the pandemic spreads around the world, doctors are beginning to scope the coronavirus’s damage. Seen initially as a cause of viral pneumonia during the chaos of an explosion of cases in China, it’s now emerging as an enigmatic pathogen capable of harming the body in a myriad of unexpected, and sometimes lethal, ways. Clinical manifestations range from common cold-like symptoms and bronchitis to more severe disease such as pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. The illness may occur as a direct result of viral infection, as well as the body’s response to it. Here’s a snapshot of some of the symptoms Covid-19 causes, including some you might not have heard about. Blood Fever and inflammation may disrupt blood vessels, rendering blood cells more prone to clumping while interfering with the body’s ability to dissolve clots. That may trigger a clotting cascade that can lead to blood-vessel blockages in tissues and organs throughout the body. Life-threatening clots in the arteries of the lung, known as pulmonary emboli, may occur even after symptoms of the infection have resolved. Damaged blood vessels may become leaky and prone to bleeding. In children, inflammation of veins and arteries triggered by excessive immune activation may cause an illness similar to Kawasaki disease, an inflammatory disorder. Brain Dysfunction in the lining of blood vessels and associated bleeding and clotting disorders may cause strokes and bleeding in the brain. Patients may also experience headache, dizziness, confusion, impaired consciousness, poor motor control, delirium and hallucinations. Eyes Red, puffy eyes, sometimes referred to as pink eye, may result from infection in the conjunctiva, the tissue that lines the inside of the eyelids and covers the white part of the eye. Gastrointestinal tract Infection of cells lining the digestive tract may cause diarrhea, nausea, vomiting and abdominal pain. Blood-vessel blockages caused by abnormal clotting have been found to damage the bowel, requiring emergency surgery and resection. Hands Prickling or burning sensation in the hands and limbs may indicate Guillain-Barré syndrome, a rare nervous-system disorder that may be triggered by aberrant immune responses to viral infection. Other symptoms of the syndrome include poor coordination, muscle weakness and temporary paralysis. Heart Cardiac injury, sometimes leading to irregular heartbeat, heart failure, and cardiac arrest, may occur as a result of excess strain, inflammation of the heart muscle and coronary artery, blood clots, and overwhelming multi-organ illness. Infection, fever, and inflammation in people with existing heart-vessel blockages may cause their fatty plaques to break off, blocking or stopping blood flow in organs and tissues. Limbs Obstructions in large blood vessels may cause insufficient flow, or acute ischemia, in the limbs. Severe vascular complications can be lethal. At least one reported cases resulted in lower limb amputation. Liver Liver dysfunction may occur as a direct result of the viral infection, or more likely because of immune-mediated, systemic inflammation and circulatory blockages cutting blood flow to the organ. Lungs The virus targets the epithelial cells that line and protect the respiratory tract as well as the walls of the tiny grape-like air sacs, or alveoli, through which gas exchange occurs to oxygenate the blood. Damage to alveoli and inflammation in the lungs can cause pneumonia, characterized by chest pain and shortness of breath. In severe cases, the lack of oxygen can trigger acute respiratory distress syndrome, leading to multi-organ-system failure. Kidneys Acute kidney injury may result from clots and impaired blood supply, or as a direct result of infection. Nose and tongue While the virus can cause the sneezing and runny nose typical of a common cold, it can also disrupt the olfactory system, causing an abrupt full or partial loss of the sense of smell known as anosmia. Taste may also become distorted in a condition known as dyguesia. Skin Hive-like rashes, small red dots and purplish discolorations on the legs and abdomen are part of a complex category of so-called paraviral dermatoses that may result from the body’s immune response to the virus or from benign, superficial blood-vessel damage beneath the skin. Toes Purple rashes that resemble chickenpox, measles or chilblains may appear on the feet, especially of children and younger adults.Dr. Prashant Ved16 Likes18 Answers
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According to the World Health Organization , waterborne diseases account for an estimated 3.6% of the total DALY (disability- adjusted life year) global burden of disease , and cause about 1.5 million human deaths annually. The World Health Organization estimates that 58% of that burden, or 842,000 deaths per year, is attributable to a lack of safe drinking water supply, sanitation and hygiene (summarized as WASH ).  Overview The term waterborne disease is reserved largely for infections that predominantly are transmitted through contact with or consumption of infected water. Trivially, many infections may be transmitted by microbes or parasites that accidentally, possibly as a result of exceptional circumstances, have entered the water, but the fact that there might be an occasional freak infection need not mean that it is useful to categorise the resulting disease as "waterborne". Nor is it common practice to refer to diseases such as malaria as "waterborne" just because mosquitoes have aquatic phases in their life cycles, or because treating the water they inhabit happens to be an effective strategy in control of the mosquitoes that are the vectors . Microorganisms causing diseases that characteristically are waterborne prominently include protozoa and bacteria , many of which are intestinal parasites , or invade the tissues or circulatory system through walls of the digestive tract. Various other waterborne diseases are caused by viruses . (In spite of philosophical difficulties associated with defining viruses as " organisms ", it is practical and convenient to regard them as microorganisms in this connection.) Yet other important classes of water- borne diseases are caused by metazoan parasites. Typical examples include certain Nematoda , that is to say "roundworms". As an example of water-borne Nematode infections, one important waterborne nematodal disease is Dracunculiasis . It is acquired by swallowing water in which certain copepoda occur that act as vectors for the Nematoda. Anyone swallowing a copepod that happens to be infected with Nematode larvae in the genus Dracunculus , becomes liable to infection. The larvae cause guinea worm disease .  Another class of waterbornemetazoan pathogens are certain members of the Schistosomatidae , a family of blood flukes . They usually infect victims that make skin contact with the water.  Blood flukes are pathogens that cause Schistosomiasis of various forms, more or less seriously affecting hundreds of millions of people worldwide.  Long before modern studies had established the germ theory of disease , or any advanced understanding of the nature of water as a vehicle for transmitting disease, traditional beliefs had cautioned against the consumption of water, rather favouring processed beverages such as beer , wine and tea . For example, in the camel caravans that crossed Central Asia along the Silk Road , the explorer Owen Lattimore noted, "The reason we drank so much tea was because of the bad water. Water alone, unboiled, is never drunk. There is a superstition that it causes blisters on the feet."  Socioeconomic impact Waterborne diseases can have a significant impact on the economy, locally as well as internationally. People who are infected by a waterborne disease are usually confronted with related costs and not seldom with a huge financial burden. This is especially the case in less developed countries. The financial losses are mostly caused by e.g. costs for medical treatment and medication, costs for transport, special food, and by the loss of manpower. Many families must even sell their land to pay for treatment in a proper hospital. On average, a family spends about 10% of the monthly households income per person infected.  Infections by type of pathogen Protozoan Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Amoebiasis (hand-to-mouth) Protozoan ( Entamoeba histolytica ) (Cyst-like appearance) Sewage , non- treated drinking water , flies in water supply, saliva transfer (if the other person has the disease) Abdominal discomfort, fatigue , weight loss, diarrhea , bloating , fever Cryptosporidiosis (oral) Protozoan ( Cryptosporidium parvum ) Collects on water filters and membranes that cannot be disinfected , animal manure , seasonalrunoff of water. Flu-like symptoms , watery diarrhea, loss of appetite, substantial loss of weight, bloating , increased gas, nausea Cyclosporiasis Protozoan parasite ( Cyclospora cayetanensis ) Sewage , non- treated drinking water cramps , nausea, vomiting , muscle aches, fever, and fatigue Giardiasis (fecal- oral) (hand-to- mouth) Protozoan ( Giardia lamblia ) Most common intestinal parasite Untreated water, poor disinfection, pipe breaks, leaks, groundwater contamination, campgrounds where humans and wildlife use same source of water. Beavers and muskrats createponds that act as reservoirsfor Giardia. Diarrhea, abdominal discomfort, bloating , and flatulence Microsporidiosis Protozoan phylum ( Microsporidia ), but closely related to fungi Encephalitozoon intestinalis has been detected in groundwater , the origin of drinking water  Diarrhea and wasting in immunocompromised individuals. Bacterial Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Botulism Clostridium botulinum Bacteria can enter an open wound from contaminated water sources. Can enter the gastrointestinal tract through consumption of contaminated drinking water or (more commonly) food Dry mouth, blurred and/or double vision , difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea . Death is usually caused by respiratory failure . Campylobacteriosis Most commonly caused by Campylobacter jejuni Drinking water contaminated with feces Produces dysentery like symptoms along with a high fever . Usually lasts 2–10 days. Cholera Spread by the bacterium Vibrio cholerae Drinking water contaminated with the bacterium In severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhea, nausea , cramps , nosebleed , rapid pulse , vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 12–18 hours. E. coli Infection Certain strains of Escherichia coli (commonly E. coli ) Water contaminated with the bacteria Mostly diarrhea. Can cause death in immunocompromised individuals, the very young, and the elderly due to dehydration from prolonged illness. M. marinum infection Mycobacterium marinum Naturally occurs in water, most cases from exposure in swimming poolsor more frequently aquariums ; rare infection since it mostly infects immunocompromised individuals Symptoms include lesions typically located on the elbows, knees, and feet (from swimming pools ) or lesions on the hands ( aquariums ). Lesions may be painless or painful. Dysentery Caused by a number of species in the genera Shigella and Salmonella with the most common being Shigella dysenteriae Water contaminated with the bacterium Frequent passage of feces with blood and/ or mucus and in some cases vomiting of blood. Legionellosis(two distinct forms: Legionnaires' disease and Pontiac fever) Caused by bacteria belonging to genus Legionella (90% of cases caused by Legionella pneumophila ) Legionella is a very common organism that reproduces to high numbers in warm water;  but only causes severe disease when aerosolized.  Pontiac fever produces milder symptoms resembling acute influenza without pneumonia . Legionnaires' disease has severe symptoms such as fever , chills , pneumonia (with cough that sometimes produces sputum ), ataxia , anorexia , muscle aches, malaiseand occasionally diarrhea and vomiting Leptospirosis Caused by bacterium of genus Leptospira Water contaminated by the animal urine carrying the bacteria Begins with flu-like symptoms then resolves. The second phase then occurs involving meningitis , liver damage (causes jaundice ), and renal failure Otitis Externa (swimmer's ear) Caused by a number of bacterial and fungal species. Swimming in water contaminated by the responsible pathogens Ear canal swells, causing pain and tenderness to the touch Salmonellosis Caused by many bacteria of genus Salmonella Drinking water contaminated with the bacteria. More common as a food borne illness . Symptoms include diarrhea , fever , vomiting, and abdominal cramps Typhoid fever Salmonella typhi Ingestion of water contaminated with feces of an infected person Characterized by sustained fever up to 40 °C (104 °F), profusesweating ; diarrhea may occur. Symptoms progress to delirium , and the spleen and liver enlarge if untreated. In this case it can last up to four weeks and cause death. Some people with typhoid fever develop a rash called "rose spots", small red spots on the abdomen and chest. Vibrio Illness Vibrio vulnificus , Vibrio alginolyticus , and Vibrio parahaemolyticus Can enter wounds from contaminated water. Also acquired by drinking contaminated water or eating undercooked oysters . Symptoms include abdominal tenderness, agitation, bloody stools, chills, confusion, difficulty paying attention (attention deficit), delirium, fluctuating mood, hallucination, nosebleeds, severe fatigue, slow, sluggish, lethargic feeling, weakness.  Viral Disease and Transmission Viral Agent Sources of Agent in Water Supply General Symptoms SARS(Severe Acute Respiratory Syndrome) Coronavirus Manifests itself in improperly treated water Symptoms include fever , myalgia , lethargy , gastrointestinal symptoms , cough , and sore throat Hepatitis A Hepatitis A virus (HAV) Can manifest itself in water (and food) Symptoms are only acute (no chronic stage to the virus) and include Fatigue , fever, abdominal pain, nausea, diarrhea, weight loss, itching, jaundice and depression . Poliomyelitis (Polio) Poliovirus Enters water through the feces of infected individuals 90-95% of patients show no symptoms, 4-8% have minor symptoms (comparatively) with delirium , headache , fever , and occasional seizures , and spastic paralysis , 1% have symptoms of non- paralytic aseptic meningitis . The rest have serious symptoms resulting in paralysisor death Polyomavirus infection Two of Polyomavirus : JC virus and BK virus Very widespread, can manifest itself in water, ~80% of the population has antibodies to Polyomavirus BK virus produces a mild respiratory infection and can infect the kidneys of immunosuppressed transplantpatients. JC virus infects the respiratory system , kidneys or can cause progressive multifocal leukoencephalopathy in the brain (which is fatal).  Algal Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Desmodesmus infection desmodesmusDr. Tapan Kumar Sau10 Likes14 Answers
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Female 48 yrs with abdominal pain and fullness... what is line of investigation and treatment?Dr. Gaurav Chhaya1 Like9 Answers
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A25-year-old, woman presents for evaluation of abdominal pain. The patient describes her pain as having been present for the past 3 days. The pain is described as constant, exacerbated by movements& associated with subjective fevers and chills. She denies any recent changes in bowel habits, urinary symptoms, or menses. Her last menstrual period was 6 days ago. The physical examination reveals temperature of 38.4°C (101.1°F), pulse rate of 110 beats per minute, blood pressure of 112/70 mm Hg, and respiratory rate of 18 breaths per minute. Her skin is nonicteric. Cardiopulmonary examination is unremarkable. The abdomen is mildly distended and tender in both right & left lower quadrants. Involuntary guarding and localized rebound tenderness are noted in the right lower quadrant. The pelvic examination reveals no cervical discharge; cervical motion tenderness and right adnexal tenderness are present. The rectal examination reveals no masses or tenderness. Laboratory studies reveal white blood cell count (WBC) of 14,000 cells/mm3, a normal hemoglobin, and a normal hematocrit. The urinalysis reveals 3 to 5 WBC/high-power field (HPF), few bacteria, and trace ketones. What are the most likely diagnoses? How can you confirm the diagnosis?Dr. Rajendra Rai0 Like7 Answers