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3 082
Most suitable diagnostic test where a woman wishes to know fetal karyotype as early in the pregnancy as possible.
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A 28-year-old woman who has had an emergency Caesarean section in labour for fetal distress. She had a DVT in a previous pregnancy.
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32-year-old woman presented to the delivery suite.She was 28 weeks pregnant in her second pregnancy.Ultrasound scan at 12 weeks had confirmed a twin pregnancy.She was admitted complaining of bleeding per vaginum; this was bright red in nature and painless
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🔴Paralytic ileus 🔴
Intestinal obstruction can be broadly divided into mechanical and paralytic obstruction (also known as paralytic ileus). A paralytic ileus occurs when the intestines are in a complete state of atony. Clinical features include abdominal distension, absolute constipation, vomiting and the absence of intestinal motility (thus bowel sounds are absent). Due to the lack of intestinal movement, colicky abdominal pain is not a feature, unlike what is seen in mechanical obstruction. Postoperative abdominal surgery, peritonitis, trauma, acute pancreatitis, potassium deficiency, uraemia, anticholinergic and antidiarrhoeal drugs are some of the frequent causes of a paralytic ileus.
🌻Causes of mechanical obstruction can be divided into:
• Luminal (e.g. faecal impaction, foreign body, intussusceptions, large polyps)
• Intramural (e.g. congential intestinal atresia, Crohn’s colitis, tumours, strictures)
• Extraluminal (e.g. volvulus, adhesions, strangulated hernia, extrinsic compression also known as a ‘mass effect’)
🌼A gallstone ileus can be classified as a form of luminal intestinal obstruction. This occurs when a large gallstone (usually >2.5 cm) erodes through the gallbladder wall and passes into the duodenum, through a cholecysto-duodenal fistula, which is formed due to the chronic inflammatory environment of the eroding gallstone. The stone may then go on to obstruct the terminal ileum at the ileocaecal junction.
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🔓You see a 55-year-old woman in the emergency department, who was admitted with central colicky abdominal pain and multiple episodes of vomiting. She last opened her bowels 4 hours ago. On examination she appears dehydrated and is in pain. The abdomen is generally tender and slightly distended. Bowel sounds are increased. You suspect a bowel obstruction and decide to order some investigations. What is the most valuable initial investigation that will support your suspected diagnosis?
🔏 Plain film radiograph of the abdomen This patient has symptoms and signs consistent with small bowel obstruction . The four cardinal features of small bowel obstruction are:
• Vomiting (occurs early in small bowel obstruction)
• Colicky pain (in small bowel obstruction the pain is periumbilical)
• Absolute constipation (not passing faeces or flatus)
• Abdominal distension
Absolute constipation may not always be a feature if the site of obstruction is high up and is usually a late sign of small bowel obstruction.
The abdominal plain film radiograph is a valuable tool and should be the first line imaging investigation in confirming the diagnosis of small bowel obstruction. Barium follow-through, colonoscopy (if mechanical obstruction is suspected, but it carries the risk of perforation) and CT scan are all helpful investigations and can be performed after the initial plain abdominal film is obtained. Upper gastrointestinal endoscopy is not usually helpful in diagnosing small bowel obstruction
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🔘 57-year-old man presents with acute colicky pain in the suprapubic area. He has been constipated over the last 2 days and has been feeling bloated. He feels nauseous, but he has not vomited. On examination of the abdomen you notice marked abdominal distension, and increased bowel sounds. What is the most likely diagnosis?
🔏large bowel obstruction : Pain is usually colicky in nature and is felt commonly in the suprapubic area rather than the central area of the abdomen, which is experienced in small bowel obstruction. Vomiting is usually a late sign in large bowel obstruction, but an early sign in small bowel obstruction. Absolute constipation (not passing faeces or flatus) is an early feature of large bowel obstruction, due to the lower site of obstruction, and a late feature of small bowel obstruction. Abdominal distension is marked in large bowel obstruction and may be absent or slight in small bowel obstruction depending on the level of obstruction in the small bowel.
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👺 Schizophrenia 👺
🔵Paranoid schizophrenia is marked by hallucinations and delusions and relative preservation of affect and cognitive functions. Delusions are usually grandiose or persecutory or both, organized around a central coherent theme. Hallucinations, usually auditory, are frequent and related to the delusional theme. Anxiety, anger, argumentativeness, and aloofness are often present. Paranoid schizophrenia tends to develop later in life and it is associated with a better prognosis
🔵 Residual schizophrenia : there is a clear progression from an active psychotic phase to a chronic negative phase. The negative phase comprises of psychomotor retardation, affective blunting, reduced motivation, reduced speech output, and a decline in social functioning.
🌼Both simple and residual schizophrenia ar similar in that they are marked by a negative phase, but residual schizophrenia is always preceded by an active psychotic phase while simple schizophrenia does not.
🔴 Simple schizophrenia : is an uncommon and controversial subtype of schizophrenia, which is characterised by at least a 1 year history of progressive development of negative symptoms (apathy, blunting of affect, lack of initiative and drive), gradual changes in social behaviour, and social withdrawal. There is no evidence of preceding acute psychotic symptoms.
🔵 Hebephrenic schizophrenia : characterised by changes in affect (flattening or incongruity of affect), thought disorder, and behaviour that is aimless or disjointed. Individuals tend to become socially isolated and tend to develop prominent negative symptoms. This type of schizophrenia is usually diagnosed in adolescents or young people.
⚪Schizoaffective disorder :comprises symptoms that meet some diagnostic criteria for both an affective disorder (depression, mania, mixed type) and schizophrenia. The symptoms must occur simultaneously and in approximately equal proportions.
⚫Catatonic schizophrenia is dominated by psychomotor disturbances, which may fluctuate between extremes of excitement and hyperkinesis to stupor and mutism. Catatonic behaviours such as automatic obedience and posturing are also seen.
🔴 Schizophreniform disorder : differ from chronic schizophrenia only in the duration of the symptoms and the fact that the impaired social or occupational functioning associated with chronic schizophrenia is not required to diagnose schizophreniform disorder. As with schizophrenia, schizophreniform disorder is characterized by the presence of delusions, hallucinations, disorganized thoughts and speech, and the presence of negative symptoms. The total duration of the illness, including prodromal and residual phases, is at least one month and less than six months.
🔵 disorganized type: are disorganized speech and behavior, flat or inappropriate affect, great functional impairment, and inability to perform basic activities such as showering or preparing meals. Grimacing, silly and odd behavior, and mannerisms are common. Hallucinations and delusions, if present, are fragmented and not organized in a coherent theme. This subtype is associated with poor premorbid functions, early insidious onset, and a progressive course without remissions.
🔴Undifferentiated schizophrenia is a condition that meets the general diagnostic criteria for schizophrenia, but does not fit with one particular subtype. For example, a patient may exhibit thought withdrawal but have no other behavioural symptoms to specify the type of schizophrenia.
⚫ Schizotypal disorder is classified as a schizophrenic illness in ICD-10, but belongs to personality disorder in DSM-IV. It is thought to be related to schizophrenia in that the incidence is higher in relatives of patients with schizophrenia. It is similar to schizophrenia but lacks the hallucinations and delusions. Characteristics seen are ideas of references, odd beliefs, eccentric appearance and speech, inappropriate affect, suspiciousness, and social anxiety.
