#ectopic spleen

[jcmicr]

Spontaneous Rupture of Wandering Spleen: Case Report by Mina Alvandipour in Journal of Clinical and Medical Images, Case Reports

Abstract

Keywords: Spleen; wandering spleen; ectopic spleen; splenic rupture.

Introduction

A wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2% [1]. wandering spleen is caused by either extreme laxity or absence of the normal ligaments that anchor the spleen to the left upper quadrant. Gravity also plays a role by allowing the spleen to descend into the lower abdomen attached by its vascular pedicle [2]. Symptoms depend on the degree of torsion and range from chronic abdominal pain in mild torsion to acute pain in severe torsion and infarction. Accurate clinical diagnosis is difficult because of the rarity of the condition and non-specific symptoms. Radiological evaluation includes usage of ultrasound, Doppler, abdominal CT or MRI depending upon availability or preference [3]. A wandering spleen can be either congenital or acquired. In the congenital condition the ligaments fail to develop properly, whereas in the acquired form the hormonal effects of pregnancy and abdominal wall laxity are proposed as determining factors .However, the precise etiology of the wandering spleen is not known [1]. We present a spontaneous rupture of a wandering spleen with severe torsion and infarction and abdominal pain without any history of trauma.

Case Report

A 25 years old female present to emergency unit with 2 week history of progressive abdominal pain, recurrent constipation ,vomiting and loss of appetite. There was no history of melena, fever, and hematochezia and weight loss. On examination there was periumbilical and epigastria tenderness and a firm and tender mass in the right side of the abdomen without muscle guarding and rebound tenderness. The vital sign and laboratory results were all within the normal ranges, except decreased hematocrit (hemoglobin-8.4). The plain abdominal radiograph was un-remarkable while abdominal ultrasonography with color Doppler showed absence of spleen in its normal location in the left upper abdomen. Also it detects a heterogeneous hypoechoic capsulated mass with diameter of 175mm in right lower abdomen. Other organs of the abdomen were normal. Abdominal pelvic CT scan with and without contrast was recommended and findings was Absence of the spleen in its normal position in the left hypochondrium, and presence of large diameter mass (splenomegaly)in the right sub hepatic area(Wandering spleen) . Other organs of the abdomen were normal. Contrast-enhanced computed tomography (CECT) of the abdomen revealed whirlpool sign near the umbilicus. The splenic parenchyma showed abnormal enhanced areas, suggestive of splenic torsion and infarction.

A final diagnosis was wandering spleen with torsion of the vascular pedicle and infarction. The patient underwent a total splenectomy. During the laparotomy, an enlarged and infarcted mass was seen in right side of abdomen. The characteristic “whirlsign” can be seen in the area of the splenic vascular pedicle, indicative of torsion. Histological examination confirmed total infraction of the wandering spleen. The postoperative course was uneventful, and the patient was discharged on the 4th day after the operation.

Discussion

A wandering spleen is a rare but well-known entity. The incidence is < 0.2%. It is more common in females than males between the second to fourth decade of life and children [4]. Splenic weight >500 g in more than 8 out of 10 cases [5]. Interestingly, it has been reported that one out of three cases of wandering spleen appears in children bellow the age of 10 years old [7].

Wandering is characterized by splenic hyper mobility that results from elongation or mal-development of its suspensory ligaments. It is also known as aberrant, floating, displaced, prolapsed, ptotic, dislocated or dystopic spleen. Ectopic spleen, splenosis and accessory spleens are separate clinical entities and must be distinguished from it [5]. If the pedicle is twisted in the course of movement of the spleen, blood supply may be interrupted or blocked, resulting in severe damage to the blood vessels .Acute splenic torsion compromises venous outflow, which causes congestion and impairment of arterial inflow. Pain is originated from the splenic capsular stretching with rapid splenic enlargement and localized peritonitis [6]. Etiology is congenital or acquired. In case of congenital anomaly, a failure occur in fusion of the dorsal mesogastrium with the posterior abdominal wall during the second month of embryogenesis. Acquired risk factors that predispose to wandering spleen include pregnancy, trauma and splenomegaly [7]. Splenic torsion is usually clockwise. Complications of splenic torsion include: gangrene, abscess formation, local peritonitis, intestinal obstruction and necrosis of the pancreatic tail, which can lead to recurrent acute pancreatitis [8].

Wondering spleen had nonspecific symptoms such as abdominal pain that make diagnosis extremely challenging. As a result, radiologists play a major role in the diagnosis of this condition and its complications. Torsion may occur acutely and present with infarction or peritonitis. Chronic intermittent torsion can lead to pain, splenomegaly, and functional splenectomy. Contrast-enhanced computed tomography (CT) is the best imaging tool to make this diagnosis, although ultrasound may be used as well. Imaging findings on CT include identification of a spleen in an abnormal location, or with an abnormal orientation in the left upper quadrant. Often the wandering spleen is identified as a “comma” shaped mass in abdomen, with no normal left upper quadrant spleen [9].

Laboratory investigations are non-specific. Thrombocytopenia, through a mechanism of spleen enlargement secondary to compression of the splenic pedicle is rarely found [7]. The clinical presentation of wandering spleen is variable; it is either asymptomatic or noted incidentally during physical and radiographic examination or presents as acute abdomen due to torsion with subsequent infarction. The most common presentation is a mass with non-specific abdominal symptoms or intermittent abdominal discomfort due to congestion resulting from torsion and spontaneous detorsion [10]. Today, the only recommended treatment for wandering spleen is operation [7]. Splenectomy is indicated for infracted spleen and sometimes for huge splenomegaly precluding splenopexy. Splenopexy is the choice of treatment if the spleen is not infarcted [6]. Splenic preservation is highly recommended for young patients—those under one year of age up to those in their thirties—who are at particular risk for overwhelming post-splenectomy sepsis [10]. This should be appropriately followed up by the prophylactic vaccines against post-splenectomy sepsis syndrome. Ideally they should be administered before surgery; however, in emergencies this is not always possible [1].

Conclusion

In this case, splenectomy was done due to spleen infarction. Laparotomy was done in this case because of low experience at laparoscopy splenectomy. This report highlights the investigations and management necessary for a patient who presents with an ischaemic torted wandering spleen.

Acknowledgement: None.

Conflict of Interest: None.

Funds: None.

For more details : https://jcmimagescasereports.org/author-guidelines/ 

[noodlebutts]

Ahhhh venting my spleen on anti abortion ppl by just talking about women dying because they didnt have access. The only woman said that it is totally possible to carry an ectopic pregnancy

[allthingsvetmed]

WEEK FOUR

This week, I am going to be breaking down the ECG shown above from our patient from week three.

To jog your memory, we have a young small breed dog with no prior medical history presenting for a bilateral deciduous canine removal, as well as a bilateral maxillary third incisor removal. 

This patient was pre-medicated with Buprenorphine at a 0.02mg/kg IM dose, Dexmedetomidine 5mcg/kg IM and Meloxicam 0.95mg SQ. After we placed the intravenous catheter, she was induced with 4mg/kg of Propofol and maintained under general anesthesia at 1.5% Isoflurane inhalant. 

The deciduous canines were extracted with no issues, but once we began working on extracting the maxillary incisors we noticed that she was developing a heart block. 

A heart block, otherwise known as an “AV Block”, means that the impulse normally generated from the atria to the ventricles is being disrupted somehow. There can be many cause of AV block from ischemia to mitral valve insufficiency, excessive vagal tone, and drugs with parasympathomimetic effects. 

There are many different kinds of heart block, all requiring different methods of treatment. First degree AV block is seen by prolonged p-r intervals with a normal QRS complex. There are many things that are associated with first degree av block. Normally, we do not always have to treat first degree av block, it is best to find the underlying cause of the block to appropriately treat the issue. 

There are two types of second degree AV block. First is, 2nd degree AV block Mobitz type 1. This is classified on an ECG by progressive prolongation of P to QRS waves, then a dropped QRS complex. Some causes of 2nd degree av block mobitz type 1 is AV node disorders or increased vagal tone. Treatment of mobitz type 1 would be done only if the patient is hemodynamically unstable (decreased blood pressure and heart rate). The increased vagal tone is possibly caused by general anesthesia, so it may be helpful to lower the patient’s anesthetic depth if you are seeing this dysrhythmia. 

For second degree AV block mobitz type two, you will see many P waves with no corresponding QRS complexes. This can be a more serious dysthymia, because it has the possibility of becoming third degree AV block. The cause of this dysthymia is an abnormality within the bundle of HIS. Treatment is warranted, especially is the QRS complexes are becoming wider. We would treat with anticholinergics, isoproterenol, or a pacemaker. Sometimes this can also be due to increased vagal tone, which can be arising from many different issues.  

Finally for third degree AV block, on the ECG we would see P waves with escape QRS beats from ectopic foci. All the P and QRS waves are uncoordinated and random. This can be caused by a congenital deformity within the heart, an abnormality within the heart itself or an electrolyte imbalance. This rhythm should be treated as soon as possible with either isoproterenol, a pacemaker, or epinephrine if cardiac arrest is impending. 

In our patient, we took into account that we were in the middle of extracting her maxillary incisors and that she was under general anesthesia. We deemed that the patient was showing signs of seconds degree AV block mobitz type 1. After finding this block, we took into account that her blood pressure, mucous membranes and capillary refill time and heart rate were stable and that this block was most likely due to increased vagal tone. The vagal tone may have been increased from the increased ocular pressure that was occurring from the doctor while the maxillary teeth were being extracted. 

The vagus nerve is cranial nerve 10 and it originates in the medulla. It innervates many parts of the body and is mostly apart of the parasympathetic nervous system. The parasympathetic nervous system is the part of the autonomic nervous system which tells the body to “rest and digest”.  It innervates the heart, lungs, stomach, spleen, kidneys, small and large intestines. When the vagus nerve is stimulated, this induces the parasympathetic nervous system to kick on and bradycardia, increased gut motility, miosis, decreased blood pressure, increased secretions and more can be seen.

After identifying this arrhythmia, we chose to monitor for any decline in her hemodynamics. The procedure was smooth from here on out and her blocks resolved when the teeth were extracted. 

[kaushal555]

Ultrasound Scan Booking:

Ultrasound Scan Booking:A Comprehensive Guide

Understanding Ultrasound Scans

An ultrasound scan, often referred to as a sonogram, is a non-invasive imaging technique that uses high-frequency sound waves to create real-time images of internal organs and structures. It's a safe and painless procedure widely used in medical diagnosis and monitoring. Ultrasound scans are employed for various purposes, including:

Obstetrics and Gynecology: Monitoring fetal development, assessing placental function, and diagnosing conditions like ectopic pregnancy.

Abdominal Imaging: Examining the liver, gallbladder, pancreas, kidneys, and spleen.

Cardiovascular System: Evaluating heart structure and function.

Musculoskeletal System: Assessing soft tissues, tendons, and muscles.

Other Applications: Guiding biopsies, detecting blood clots, and evaluating thyroid and breast conditions.

Why Book an Ultrasound Scan?

There are numerous reasons to consider an ultrasound scan. Some common scenarios include:

Pregnancy: Regular ultrasound scans are essential for monitoring fetal growth, development, and well-being.

Abdominal Pain: Ultrasound can help identify the cause of abdominal discomfort or pain.

Urinary Tract Issues: It can diagnose kidney stones, infections, or other urinary tract problems.

Heart Problems: Ultrasound of the heart (echocardiogram) can assess heart function and structure.

Blood Vessel Issues: Ultrasound can detect blood clots, narrowed arteries, or other vascular abnormalities.

Benefits of Ultrasound Scans

Ultrasound scans offer several advantages:

Non-invasive: No needles or ionizing radiation is involved.

Safe: Considered safe for both adults and unborn babies.

Painless: The procedure is generally comfortable.

Real-time Imaging: Provides immediate results and allows for dynamic assessment.

Versatile: Can be used to examine various organs and structures.

Cost-effective: Compared to other imaging modalities, ultrasound is often more affordable.

How to Book an Ultrasound Scan

Booking an ultrasound scan is typically a straightforward process. Here's a general outline of the steps involved:

Consult Your Doctor: Discuss the need for an ultrasound scan with your healthcare provider. They will determine the type of scan required and provide a referral if necessary.

Choose a Facility: Research and select a reputable ultrasound clinic or hospital. Consider factors such as location, experience, and available services.

Make an Appointment: Contact the chosen facility to schedule an appointment for the ultrasound scan. Be prepared to provide your personal information, medical history, and insurance details.

Prepare for the Scan: Follow any specific instructions provided by the facility, such as fasting or drinking fluids beforehand.

Arrive on Time: Arrive at the scheduled appointment time to avoid delays.

Understand the Results: After the scan, discuss the findings with your doctor to understand the implications.

Tips for a Smooth Ultrasound Experience

To ensure a comfortable and informative ultrasound experience, consider the following tips:

Communicate with Your Technician: Feel free to ask questions about the procedure and express any concerns.

Relax: Try to stay calm and relaxed during the scan, as tension can affect the image quality.

Bring a Support Person: If you feel anxious, bring a friend or family member for support.

Follow Instructions: Carefully follow the instructions provided by the ultrasound technician.

Conclusion

Ultrasound scans are valuable diagnostic tools that provide essential information about your health.  Ultrasound scan Booking is a simple process that can be easily managed with the guidance of your healthcare provider. By understanding the benefits and steps involved, you can confidently schedule and undergo an ultrasound scan when needed.

Ready to book your ultrasound scan? Contact [Your Clinic/Hospital Name] today to schedule an appointment. Our experienced team is dedicated to providing accurate and compassionate care.

[centrelotusdiagnostic]

What is General Ultrasound Imaging?

Ultrasound imaging, also known as sonography, is a non-invasive diagnostic technique that uses high-frequency sound waves to create images of the inside of the body. It is widely used in the medical field to visualize muscles, tendons, blood vessels, and internal organs to diagnose various conditions and guide treatments. At Lotus Imaging & Diagnostic Centre in Vaishali Nagar, Jaipur, we offer advanced ultrasound services performed by experienced professionals to ensure accurate and reliable results.

How Does Ultrasound Imaging Work?

Ultrasound imaging employs a device called a transducer, which emits sound waves that penetrate the body. When these sound waves hit a boundary between different tissues, they bounce back and are captured by the transducer. These returning echoes are then converted into real-time images by a computer, allowing healthcare providers to see inside the body without making an incision.

Applications of General Ultrasound Imaging

1. Abdominal Ultrasound

Abdominal ultrasound is used to examine organs such as the liver, gallbladder, spleen, pancreas, and kidneys. It can help diagnose conditions like gallstones, liver disease, and abdominal pain causes.

2. Pelvic Ultrasound

Pelvic ultrasound is often used to evaluate the reproductive organs in women, including the uterus and ovaries. It is commonly used in pregnancy to monitor fetal development, detect ectopic pregnancies, and diagnose conditions like ovarian cysts and uterine fibroids.

3. Thyroid Ultrasound

Thyroid ultrasound helps in assessing the thyroid gland for conditions such as goiters, nodules, and cancer. It is a crucial tool for the early detection and management of thyroid-related issues.

4. Musculoskeletal Ultrasound

This type of ultrasound is used to visualize muscles, tendons, ligaments, and joints. It is particularly useful in diagnosing sports injuries, tendonitis, and joint inflammation.

5. Vascular Ultrasound

Vascular ultrasound, including Doppler studies, evaluates blood flow in the arteries and veins. It helps diagnose conditions such as deep vein thrombosis, varicose veins, and arterial blockages.

Benefits of General Ultrasound Imaging

Non-Invasive and Painless

One of the most significant advantages of ultrasound imaging is that it is non-invasive and painless. Patients can undergo the procedure without discomfort and without the need for anesthesia or recovery time.

No Radiation Exposure

Unlike other imaging techniques such as X-rays or CT scans, ultrasound does not use ionizing radiation. This makes it safer, especially for pregnant women and young children.

Real-Time Imaging

Ultrasound provides real-time imaging, which is particularly beneficial for procedures that require dynamic observation, such as guiding needle biopsies or monitoring fetal development during pregnancy.

Why Choose Lotus Imaging & Diagnostic Centre in Vaishali Nagar, Jaipur?

At Lotus Imaging & Diagnostic Centre, we pride ourselves on offering state-of-the-art ultrasound imaging services. Our center in Vaishali Nagar, Jaipur, is equipped with the latest ultrasound technology and staffed by highly trained radiologists and technicians. Here’s why you should choose us for your ultrasound needs:

Expertise: Our team consists of experienced professionals who are dedicated to providing accurate and detailed diagnostic results.

Advanced Technology: We use cutting-edge ultrasound machines to ensure high-quality images and reliable diagnoses.

Patient-Centered Care: We prioritize patient comfort and satisfaction, ensuring a pleasant experience from start to finish.

Comprehensive Services: We offer a wide range of ultrasound services to meet the diverse needs of our patients.

Conclusion

General ultrasound imaging is a versatile and valuable diagnostic tool that plays a crucial role in modern medicine. Whether you need an abdominal scan, a pregnancy check-up, or a musculoskeletal evaluation, ultrasound provides a safe, effective, and non-invasive method for obtaining detailed images of the body’s internal structures. At Lotus Imaging & Diagnostic Centre in Vaishali Nagar, Jaipur, we are committed to delivering top-notch ultrasound services to help you achieve optimal health and well-being.

[drnishamangal]

What conditions can be treated by a Laparoscopic Surgeon?

Laparoscopic surgery, also known as minimally invasive surgery, can be used to treat a variety of conditions across different medical specialties. Some common conditions that can be treated by a laparoscopic surgeon include:

Gallbladder diseases, such as gallstones or inflammation of the gallbladder (cholecystitis).

Appendicitis, where the appendix becomes inflamed and requires removal.

Hernias, including inguinal, umbilical, and hiatal hernias.

Gastroesophageal reflux disease (GERD), often treated with laparoscopic fundoplication.

Endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus.

Ovarian cysts or tumors.

Uterine fibroids, noncancerous growths in the uterus.

Ectopic pregnancies, where the embryo implants outside the uterus.

Colon conditions such as diverticulitis or colorectal cancer.

Kidney conditions, including kidney stones or tumors.

Pancreatic conditions, such as pancreatitis or pancreatic cysts.

Obesity, through procedures like laparoscopic gastric bypass or sleeve gastrectomy.

Liver conditions, such as cysts or tumors.

Splenic conditions, such as splenomegaly (enlarged spleen) or splenic cysts.

These are just some examples, and the range of conditions that can be treated with laparoscopic surgery continues to expand as technology advances and surgeons gain more experience with minimally invasive techniques. Always consult with a medical professional for specific information and advice regarding your condition and treatment options.

[alsafwa-radiology-center-sharjah]

Innovative Imaging: Alsafwa's State-of-the-Art Ultrasound Scan Center in Sharjah, UAE

In the ever-evolving landscape of medical diagnostics, precision and accuracy are paramount. At Alsafwa's Ultrasound Scan Center in Sharjah, UAE, we pride ourselves on pioneering innovative imaging solutions that deliver unparalleled insights into the human body. From early detection of medical conditions to monitoring fetal development during pregnancy, our state-of-the-art ultrasound technology sets the standard for excellence in diagnostic imaging.

Unmatched Precision with Advanced Technology

At Alsafwa, we understand the importance of investing in cutting-edge technology to provide our patients with the highest level of care. Our ultrasound scan center is equipped with the latest ultrasound machines featuring advanced imaging capabilities, including high-resolution imaging, 3D/4D imaging, and Doppler ultrasound. These technologies enable our skilled radiologists to obtain detailed images of internal organs, tissues, and blood flow, allowing for accurate diagnosis and treatment planning.

Comprehensive Diagnostic Services

Whether you require a routine ultrasound examination or a specialized diagnostic procedure, Alsafwa's Ultrasound Scan Center offers a wide range of services to meet your needs. Our experienced team of radiologists and technologists performs a variety of ultrasound scans, including:

Abdominal Ultrasound: Used to visualize the organs within the abdomen, such as the liver, gallbladder, kidneys, pancreas, and spleen, abdominal ultrasound is a non-invasive imaging technique that helps diagnose conditions such as gallstones, kidney stones, and liver disease.

Pelvic Ultrasound: Pelvic ultrasound is commonly used to evaluate the reproductive organs in both men and women, including the uterus, ovaries, and prostate gland. It is instrumental in diagnosing conditions such as ovarian cysts, uterine fibroids, and prostate enlargement.

Obstetric Ultrasound: Obstetric ultrasound plays a crucial role in monitoring fetal development during pregnancy, allowing expectant parents to see their baby's growth and development in real-time. It can also detect potential complications such as ectopic pregnancy, placental abnormalities, and fetal anomalies.

Vascular Ultrasound: Vascular ultrasound is used to assess blood flow and detect abnormalities in the blood vessels, including blockages, narrowing, and blood clots. It is commonly used to diagnose conditions such as deep vein thrombosis (DVT), peripheral artery disease (PAD), and carotid artery stenosis.

Patient-Centered Care

At Alsafwa's Ultrasound Scan Center, we prioritize the comfort and well-being of our patients above all else. From the moment you step through our doors, you will be greeted by our friendly and compassionate staff who are dedicated to providing you with a positive experience. Our modern and inviting facility is designed to ensure your comfort and privacy throughout your visit, and our team is always available to address any questions or concerns you may have.

Conclusion

Innovation is at the heart of everything we do at Alsafwa's Ultrasound Scan Center in Sharjah, UAE. With state-of-the-art technology, comprehensive diagnostic services, and patient-centered care, we are committed to delivering the highest standard of imaging excellence to our patients. Whether you require a routine ultrasound examination or specialized diagnostic imaging, you can trust Alsafwa to provide you with the precision, accuracy, and compassionate care you deserve. Schedule your appointment with Alsafwa's Ultrasound Scan Center today and experience the future of diagnostic imaging.

[modernscan33]

Ultrasound Scan In Annanagar

Ultrasound Scan, Purpose and Uses

Ultrasound is best used to learn about conditions involving soft tissue, such as organs, glands, and blood vessels. Diagnostic ultrasound is used if you have signs or symptoms of a problem, and ultrasound can help diagnose or rule out possible causes. For example, instructions for some biopsy procedures.

Ultrasound Scan

The Ultrasound scan produces real-time images of the inside of the body using sound waves. It is painless and non-invasive. Ultrasound works differently from X-rays in that and does not use radiation. An ultrasound scan is performed by sending high-frequency sound waves aimed at the part of the body being examined. The sound waves emitted by a transducer detects the reflected echo. Reflected sound waves (echoes) create images that can be recorded on a computer monitor.

Purpose of ultrasound scan

Ultrasound uses high-frequency sound waves to create images of structures inside a person's body. Doctors often use ultrasound to study the development of a person's fetus (fetus), abdominal and pelvic organs, muscles and tendons, or heart and blood vessels.

Observe the uterus and ovaries during pregnancy and monitor the health of the developing baby

Diagnosis of gallbladder disease

Assess blood flow

Needle guide for biopsy or tumor treatment

Check for breast lumps

Thyroid check

Check for genital and prostate problems

If your doctor recommends ultrasound scan, trust and get it done at 𝐌𝐨𝐝𝐞𝐫𝐧𝐋𝐚𝐛&𝐗-𝐑𝐚𝐲𝐬, a reputed ultrasound scan in AnnaNagar Chennai for accurate, reliable, and affordable diagnostic services near you.

The 3 main types of ultrasound scan are:

external ultrasound – the probe moves over the skin.

internal ultrasound – the probe is inserted inside of the body.

Endoscopic ultrasound – the probe is attached to a long, thin, flexible tube (endoscope) and inserted deeper into the body.

Uses of Ultrasound Scan

Pregnancy – Ultrasound imaging has different uses during pregnancy. Early on, they can be used to determine the due date, detect the presence of twins or other multiples, and rule out ectopic pregnancy.

Diagnosis - Doctors use ultrasound imaging to diagnose a number of conditions that affect the body's organs and soft tissues, including the heart and blood vessels, liver, gallbladder, spleen, pancreas, bladder, kidneys, eyes,uterus, ovaries, thyroid, and testicles.

Use in medical procedures - Ultrasound images can help doctors perform procedures such as needle biopsies, which require the doctor to remove tissue from a very specific area inside the body for testing.

Therapeutic applications - Ultrasound is sometimes used to detect and treat soft tissue damage.

Book your appointment at the best centre for ultrasound scan in AnnaNagar!

[meetyourbabyca]

The Value of Ultrasound in Pregnancy

      An Ultrasound for Pregnancy near Me is a crucial tool for assessing the development and well-being of the foetus. During Pregnancy Ultrasound near Meare essential for monitoring the baby’s growth and ensuring a smooth pregnancy.

Ultrasound uses high-frequency sound waves to examine the uterus from outside the body. The infant then reflects them, and the computer interprets the echoes as visual data. That way, you can see the baby’s progress as they grow. Ultrasound Scan near Mehas been used safely and effectively throughout pregnancy for over 40 years.The following is revealed by an ultrasound performed in the first trimester of pregnancy:

The real number of weeks for a pregnancy

You may better prepare for your child’s birth by knowing the exact date of your due date and by giving your pregnant body the external assistance it needs, such as the necessary medication and nutrition.

The baby’s heartbeat

Hearing the baby’s heartbeat from inside the mother’s womb is a moving experience. Doctors can also tell a lot about a baby’s health based on the rhythm and frequency of their heartbeats.

Ruled out an ectopic pregnancy

When a pregnancy implants in a location other than the uterus, it is called an ectopic pregnancy. Both the mother and the unborn child are in grave danger. Ultrasound is the only method of diagnosis.

To know how many fetuses

First-trimester Booking Ultrasound Onlinecertify to doctors the correct number of embryos or foetuses developing inside the womb.

Figure out the risk of Down’s syndrome

Infants born with Down syndrome face significant cognitive and physical challenges. An3d Ultrasound Babyperformed in the first trimester of pregnancy can detect it. As soon as a diagnosis is made, treatment can begin.

The Positive Effects of Ultrasound on Pregnancy

Ultrasound is the gold standard in obstetric diagnostics. It’s easy, harmless, produces visible outcomes right away, and is generally considered safe. Evidence-based research has backed up some of the benefits touted in the literature, such as pinpointing a pregnancy’s due date. Some have been deemed clinically effective despite weaker objective evidence. There is always the chance of making a wrong diagnosis or experiencing unintended side effects whenever a medical procedure is performed.

Principal Ideas:

Ultrasounds performed most commonly in the second trimester employ high-frequency sound waves to produce images of the foetus, placenta, and uterus.

An ultrasound can help with various diagnostic procedures, including confirming the pregnancy and gestational age, screening for multiple pregnancies, detecting congenital anomalies, and identifying placental abnormalities; monitoring foetal position, growth, and amniotic fluid levels; and assisting with other tests.

Transvaginal ultrasound, Baby 3d Ultrasound, 4d Ultrasound near Me , and foetal echocardiography are all examples of the various ultrasounds available.

Conclusion

There is no discomfort or risk involved in getting an ultrasound, and the results are usually accurate. The abdominal aorta and its major branches, the eyes, the liver, gallbladder, spleen, thyroid and parathyroid glands, the scrotum (testicles), the brain in infants, the hips in infants, and the spine in infants are just some of the internal organs that can be examined with ultrasound.

[jcmicr]

 Spontaneous Rupture of Wandering Spleen: Case Report by Mina Alvandipour in Journal of Clinical and Medical Images, Case Reports 

Abstract

Keywords: Spleen; wandering spleen; ectopic spleen; splenic rupture.

Introduction

A wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2% [1]. wandering spleen is caused by either extreme laxity or absence of the normal ligaments that anchor the spleen to the left upper quadrant. Gravity also plays a role by allowing the spleen to descend into the lower abdomen attached by its vascular pedicle [2]. Symptoms depend on the degree of torsion and range from chronic abdominal pain in mild torsion to acute pain in severe torsion and infarction. Accurate clinical diagnosis is difficult because of the rarity of the condition and non-specific symptoms. Radiological evaluation includes usage of ultrasound, Doppler, abdominal CT or MRI depending upon availability or preference [3]. A wandering spleen can be either congenital or acquired. In the congenital condition the ligaments fail to develop properly, whereas in the acquired form the hormonal effects of pregnancy and abdominal wall laxity are proposed as determining factors .However, the precise etiology of the wandering spleen is not known [1]. We present a spontaneous rupture of a wandering spleen with severe torsion and infarction and abdominal pain without any history of trauma.

Case Report

A 25 years old female present to emergency unit with 2 week history of progressive abdominal pain, recurrent constipation ,vomiting and loss of appetite. There was no history of melena, fever, and hematochezia and weight loss. On examination there was periumbilical and epigastria tenderness and a firm and tender mass in the right side of the abdomen without muscle guarding and rebound tenderness. The vital sign and laboratory results were all within the normal ranges, except decreased hematocrit (hemoglobin-8.4). The plain abdominal radiograph was un-remarkable while abdominal ultrasonography with color Doppler showed absence of spleen in its normal location in the left upper abdomen. Also it detects a heterogeneous hypoechoic capsulated mass with diameter of 175mm in right lower abdomen. Other organs of the abdomen were normal. Abdominal pelvic CT scan with and without contrast was recommended and findings was Absence of the spleen in its normal position in the left hypochondrium, and presence of large diameter mass (splenomegaly)in the right sub hepatic area(Wandering spleen) . Other organs of the abdomen were normal. Contrast-enhanced computed tomography (CECT) of the abdomen revealed whirlpool sign near the umbilicus. The splenic parenchyma showed abnormal enhanced areas, suggestive of splenic torsion and infarction.

A final diagnosis was wandering spleen with torsion of the vascular pedicle and infarction. The patient underwent a total splenectomy. During the laparotomy, an enlarged and infarcted mass was seen in right side of abdomen. The characteristic “whirlsign” can be seen in the area of the splenic vascular pedicle, indicative of torsion. Histological examination confirmed total infraction of the wandering spleen. The postoperative course was uneventful, and the patient was discharged on the 4th day after the operation.

Discussion

A wandering spleen is a rare but well-known entity. The incidence is < 0.2%. It is more common in females than males between the second to fourth decade of life and children [4]. Splenic weight >500 g in more than 8 out of 10 cases [5]. Interestingly, it has been reported that one out of three cases of wandering spleen appears in children bellow the age of 10 years old [7].

Wandering is characterized by splenic hyper mobility that results from elongation or mal-development of its suspensory ligaments. It is also known as aberrant, floating, displaced, prolapsed, ptotic, dislocated or dystopic spleen. Ectopic spleen, splenosis and accessory spleens are separate clinical entities and must be distinguished from it [5]. If the pedicle is twisted in the course of movement of the spleen, blood supply may be interrupted or blocked, resulting in severe damage to the blood vessels .Acute splenic torsion compromises venous outflow, which causes congestion and impairment of arterial inflow. Pain is originated from the splenic capsular stretching with rapid splenic enlargement and localized peritonitis [6]. Etiology is congenital or acquired. In case of congenital anomaly, a failure occur in fusion of the dorsal mesogastrium with the posterior abdominal wall during the second month of embryogenesis. Acquired risk factors that predispose to wandering spleen include pregnancy, trauma and splenomegaly [7]. Splenic torsion is usually clockwise. Complications of splenic torsion include: gangrene, abscess formation, local peritonitis, intestinal obstruction and necrosis of the pancreatic tail, which can lead to recurrent acute pancreatitis [8].

Wondering spleen had nonspecific symptoms such as abdominal pain that make diagnosis extremely challenging. As a result, radiologists play a major role in the diagnosis of this condition and its complications. Torsion may occur acutely and present with infarction or peritonitis. Chronic intermittent torsion can lead to pain, splenomegaly, and functional splenectomy. Contrast-enhanced computed tomography (CT) is the best imaging tool to make this diagnosis, although ultrasound may be used as well. Imaging findings on CT include identification of a spleen in an abnormal location, or with an abnormal orientation in the left upper quadrant. Often the wandering spleen is identified as a “comma” shaped mass in abdomen, with no normal left upper quadrant spleen [9].

Laboratory investigations are non-specific. Thrombocytopenia, through a mechanism of spleen enlargement secondary to compression of the splenic pedicle is rarely found [7]. The clinical presentation of wandering spleen is variable; it is either asymptomatic or noted incidentally during physical and radiographic examination or presents as acute abdomen due to torsion with subsequent infarction. The most common presentation is a mass with non-specific abdominal symptoms or intermittent abdominal discomfort due to congestion resulting from torsion and spontaneous detorsion [10]. Today, the only recommended treatment for wandering spleen is operation [7]. Splenectomy is indicated for infracted spleen and sometimes for huge splenomegaly precluding splenopexy. Splenopexy is the choice of treatment if the spleen is not infarcted [6]. Splenic preservation is highly recommended for young patients—those under one year of age up to those in their thirties—who are at particular risk for overwhelming post-splenectomy sepsis [10]. This should be appropriately followed up by the prophylactic vaccines against post-splenectomy sepsis syndrome. Ideally they should be administered before surgery; however, in emergencies this is not always possible [1].

Conclusion

In this case, splenectomy was done due to spleen infarction. Laparotomy was done in this case because of low experience at laparoscopy splenectomy. This report highlights the investigations and management necessary for a patient who presents with an ischaemic torted wandering spleen.

Acknowledgement: None.

Conflict of Interest: None.

Funds: None.

For more details : https://jcmimagescasereports.org/author-guidelines/ 

[cranquis]

TSK: Xiphoid process metastasis

Patient with self-admitted anxiety: While you’re feeling my stomach, can you please check if the lump on my left side is still there?

Cranquis: *palpates left flank, finds deep hard pointed well-defined mass with slight mobility* This?

Patient: Oh no, yeah, that’s it, oh I’m scared to ask... what is...?

Cranquis: Well, I have bad news and good news. The bad news is that you probably have another one on your right side just like it. The good news is, they’re your 12th ribs and they’ve been there all your life.

[fighterkimburgess]

i got this really good Connor Rhodes request!!! It will used Liv’s idea that the reader is a trauma and pediatric surgeon. Connor keeps asking you out but you say no as you are playing hard to get. Until Connor gets attacked by a patient while you are in surgery and once you see for yourself he is okay, you say yes.

So this kind of went off the rails and turned into a 5+1, but I love it.

Warnings: Canon typical medical stuff, mentions of child abuse and child sexual abuse, pregnancy, ectopic pregnancy, mentions of child death, active shooter scenario, gun injuries.

Words: 3.2k (how is it so long?!?!

Wanna join my taglist?

--

1

“Dinner tonight?” You turned and looked at the new voice who’d asked the question. His scrubs read Connor Rhodes, and you raised an eyebrow.

“Hi, nice to meet you, how are you?” You held out your hand and he shook it.

“Hi, I’m Connor, nice to meet you. Want to get dinner?” He smiled, and you were pretty sure it worked on everyone.

“No thanks, Connor. We should get back to work.” You turned and went to the nurses station, introducing yourself to the charge nurse, Maggie.

It was your first day fully covering the ER for paediatric trauma cases, and you spent most of it stitching up kids to try avoid a scar. You’d greet parents, and then get down on their level to talk and explain exactly what you were going to do. It calmed kids who were afraid, and that was the part of your job you loved.

Halfway through your shift you got called to a trauma room, a family had been t-boned by a drunk driver and there was a six year old who needed to be checked. The other paediatrician was already in there, and you followed her lead until it was obvious it was surgical and you took over with a nod. She needed her spleen removed and some liver lacerations closed, but you were able to give the good news to her parents before going downstairs to tell the other doctor.

She was surprised you sought her out, and held out her hand. “Natalie Manning. I’m looking forward to working with you.”

You spent the rest of the day in the ER, and when Natalie invited you for a drink with the rest of the doctors you agreed without hesitation. As you left you spotted Connor staring at the group of you walking out, but you put it out of your head.

2.

You were staring at the scans, trying to work out what to do. Your patient was barely a teenager, she was pregnant and it was an ectopic pregnancy. And she didn’t know she was pregnant. It was a clusterfuck of epic proportions.

“You ok?” You turned around to see Connor leaning in the door of the doctors lounge.

“Not really? Can I get some advice?” He sat and motioned for you to continue. “Fourteen year old female, brought in for lower right quadrant pain. She’s never menstruated before, unusual but not unheard of. Standard tests run to show a high hCG level.” As your words set in Connor's face darkened. “Ultrasound confirmed ectopic pregnancy. I can get her in for surgery now, but pregnancy means she’s automatically emancipated so I can’t tell her foster parents, and she’s convinced she’s never had sex. I don’t know what to do.”

He looked at you for a moment, his head in his hands. “This is a mess. Is there abuse?”

“Nothing physical. I was thinking about getting someone from psych down, but she needs surgery in the next hour. I’ve called DCFS, but I need her to approve the surgery.”

“You have to tell her. Maybe get Nat in with you too?” You nodded, a small smile on your face.

“Thanks, Connor.”

His plan worked, and the teenager had told you that her foster dad had told her that if she told anyone she’d be out on the streets because nobody would believe her. Your heart broke, but you took her up for immediate surgery, removing the ectopic pregnancy and managing to save the girls Fallopian tubes, so she could have a chance at having a child when she was fully grown. You handed over the necessary samples so CPD could do their job and arrest the bastard, a solemn nod from Upton as she took it from you. You’d had a few drinks with her and liked her, but this was too much.

Finally your shift was over, and you just wanted to go home and crash. As you walked through the doors into the chilly Chicago night you heard Connor call your name.

“How did the surgery go?”

You laughed bitterly. “As well as could be expected. She’s going to make a full physical recovery. But mentally? She’s been in that foster family for three years. They were going to adopt her. Now she’s alone. I bought her a stuffed animal so she wouldn’t be so alone.” You wiped your eyes. Normally working with children was a joy, helping them get better. This though, this hurt your soul.

“Do you want to get a drink? Is it a good idea for you to be alone?” You could hear the concern in his voice, but you couldn’t keep the mask that you were ok up any longer.

“I need to go home alone, Connor. I’ll see you next shift.”

You walked to your car, making it home and collapsing into bed with a sore heart.

3

If you ever decided to go into politics, your entire campaign would be based on seatbelts on school buses. Two buses had collided on a frozen street, and it was hell. You were in and out of ORs, trying to save as many lives as possible. By the time the carnage was complete you’d had to call time of death on three kids. You just kept reminding yourself of the five you’d saved, but it was hard.

When you arrived back into the scrub room Connor was there, his forearms on his legs, sitting in silence. You tried being quiet but he looked up at you, his eyes bloodshot.

“How do you do it?” His question was quiet, and if you hadn’t been so careful to not make noise you would have missed it.

“Do what?” You asked, putting a fresh scrub top on and sitting beside him.

“Kids. I had four kid surgeries today, and two didn’t make it. How do you know when to call it? How do you make yourself?”

You threw your head back and stared at the ceiling, looking at the bad paint job. “Because I have to. Because I remind myself that I’m only one person, and by me even attempting to help - even if I can’t do it - I’m giving them a better chance. If neither of us operated there’d be twelve dead kids today. Instead there’s five, and seven should get to go home to their families. I call that seven lives saved.” You leaned against his shoulder, taking the comfort he gave. He’d become a friend since you’d arrived three months before, his initial cockiness turning to mutual respect when you both realised you were good at your jobs. He’d consulted with you on cases, and vice versa.

“After a day like today, go do something that brings you joy. I’m gonna go home, open a bottle of disturbingly cheap rosé I’ve been drinking since college but love anyway, and sit and have a glass or two while watching a rom com. Whatever makes you happy, do that.” You squeezed his shoulder as you stood, preparing for the rest of your day.

“Do you want to get a coffee after shift?” Connor sounded hopeful, and you hated letting him down.

“I’m sorry. After a day like today I just need to get home. Rain check?” He stood and gave you a brief hug, the two of you walking out the door and pretending everything was fine.

4

You were officially pissed. Natalie had promised she’d meet you at Molly’s, and was now an hour late. You knew she was hooking up with Will Halstead again, and while you were glad they seemed to be working their issues out, you’d have rathered it not be on a night when you really needed girl talk.

Because you thought you might have a crush on your fellow trauma surgeon and had No Idea what to do about it. Instead you slowly sipped the beer in your hands, mulling over what to do. You’d finish the beer, go home, and text Nat that you were happy for her but you seriously needed some girl talk next time you were both free.

“Doc, my brother interrupting your night?” You turned to the voice, seeing Jay standing at the next place on the bar.

“Everyone knows but they think they’re so sneaky, right?” You responded, a small smile on your face. You’d met the detective a few times through work, before going to Will’s to watch a Hawks game and meeting him properly.

“I think he’s afraid of screwing up again. You weren’t around for the disaster that was the two of them dating and getting engaged. It was a mess.”

Jay invited you over to his table, and you chatted with the other members of his unit. It felt so good to spend time with people who knew what your job was like but didn’t actually do it, even if you and Kevin felt like fifth and sixth wheels. After a second beer you said goodbye, determined to get home and relax. You’d just left the front door of Molly’s when Connor came out the patio gate, looking glum.

“Everything ok?” You asked, appreciating the small smile that came over his face when he saw you standing there.

“A little better now. I had to see my sister today. Family’s only good in small doses, you know?” You just nodded, with no family close by you didn’t really know what it was like. “Heading in?”

“Just leaving. I was supposed to meet Nat, but...” you trailed off, rolling your eyes.

“Manstead rides again?” Connor asked, and your confused face made him explain. “Manning and Halstead, Manstead. You’re in the betting pool, right? They were engaged, came pretty close to making it down the aisle. She dated Crockett for a while, some other guys, he dated around, but they always had a thing. I left Chicago for three years and they’re still on and off again.”

“Oh god, it’s like Bennifer?” Connor chuckled at your comparison, the laugh coming from deep within him.

“Exactly. Come on in, I’ll buy you a beer?” You wanted to, you really did. But one more beer would put you firmly over the tipsy line, and you didn’t want to be the topic of gossip in work. As much as you wanted to spend time with Connor.

“I can’t. I need to head home. I’ll see you tomorrow?”

His smile immediately dimmed, his eyes losing their sparkle, but he agreed.

“See you in the morning.”

5

You loved your job, you loved your job, you loved your job. You kept telling yourself that, hoping it would make it true. And normally you did love your job. But you were on hour 21 of a 36 hour shift, and you were exhausted. Doing these shifts as an intern was bad enough, but as an Attending? It was hell. Your body just didn’t metabolise caffeine as well as it used to. But finally it was four am, and you half walked half staggered to Maggie.

“I’m going into the lounge to nap. Wake me if you need me?” She nodded, patting your shoulder.

The couch wasn’t comfy, and wasn’t long enough for you to stretch out on properly, but it was better than a gurney so you lay there. It felt like you’d only blinked, but Connor was shaking you awake, a takeout cup of coffee in his hand.

“Hey, it’s seven. I figured you could do with some decent coffee from Josh down the street.” You sat up, yawning, taking the cup from him. It had two sugars and some cream, and the noise out of your mouth when you sipped it was obscene.

“Sorry, sorry,” you murmured, checking your watch. “Only twelve hours to go. I thought Attendings never had to do triple shifts?”

“Only in regular medicine. You’ve got this!” You downed your coffee before putting the cup in the trash, stretching out your back before taking on the day.

You were only up in surgery three times, and you were grateful for it. People laughed that you were a surgeon who didn’t want to be in the OR, but it was how you worked. You wanted to get your kids healthy, and if you could avoid surgery without causing a big issue, you would.

You’d finally left the last surgery, having to give the news to a wonderful couple that their eldest daughter hadn’t made it. You never made a resident give the news. They could watch you, but you always told them, and held up the parents when they broke. Their daughter had been cycling down the street when a drunk driver ran her over, and despite everything you tried doing to save her you couldn’t.

When you made it back downstairs you didn’t even change, just grabbing your bag to get out. It was seven thirty, you’d been in the hospital for thirty seven hours and all you wanted to do was collapse into your bed.

As you walked out of the hospital you heard your name being called, and you turned to see Connor.

“I heard about your last surgery. You’ve had a hell of a few days, want to go get dinner and I’ll drive you home?” He had a small, hopeful smile, and all you wanted was a hug from him and to spend time with him. But your exhaustion was too much, and you needed to go home.

“I just need sleep, Connor.” His face fell, and you took his hand, squeezing once. “It’s not a never. It’s a not right now. Ask me after our next shift?” His smile came back, and he squeezed back.

“Sure thing. Sweet dreams?” As you walked away you had a small smile on your face, and you realised that you couldn’t wait for him to ask.

+1

Code silver. All staff, code silver.

Your blood ran cold when you heard it. There was an active shooter in the hospital, and you had your hands in a two year old’s abdomen trying to repair trauma from a car accident. You could see your OR team start to shift and worry, and you had to take control.

“Emma, you’re not sterile. Lock the door, and pull down the blinds from the door and the gallery. I need you to make sure nobody can tell we’re in here. David, we’ve got thirty minutes to get this under control. Two-oh vicryl on a curved needle, I can use that to repair the lac.” Your voice was calm, and your staff responded to you. True to what you said, twenty nine minutes later you were putting the last stitch in the toddler’s belly, thankful for the technique Connor had taught you to minimise scarring. Once you’d finished and bandaged the wound everyone got out of their sterile gowns, waiting for the all clear. It was another twenty minutes and the doors unlocked, Jay Halstead popping his head in.

“You’re fine. It’s all in the ER, we’re working on getting eyes in there.” You could see the worry for his brother on his face, and your stomach fell. Your friends were down there. Nat, Will, Ethan. Connor could even be down there.

Connor. Who was going to ask you out today and you were going to say yes. You were going to ask him to go for dinner at a little noodle bar you loved. And hopefully you were going to get to kiss him.

The time passed so slowly, until Jay got the all clear. You heard the call for you over his radio, needing to hear it again.

“Get her! She’s the best trauma surgeon in the hospital who can operate right now.”

The elevator was still out thanks to CFD, so you ran down the stairs, taking them two at a time. You made it into the ER, looking around for everyone. You couldn’t see Ethan or Connor, and Nat pointed you to the hybrid OR. As you arrived in you realised Ethan was keeping pressure on Connor’s abdomen, and you wanted to scream. Instead you went to scrub, as quickly and effectively as you could.

“April, I need a vent and I need you to close the curtains in here. Get me Maggie, and someone from anaesthesiology. I need them right now.” She ran and within two minutes you had everything you needed in the room, just four of you in there with Connor.

You nodded to the anaesthesiologist who you’d never met before, watching as he injected Connor to put him under. You took a deep breath and picked up your clamp, getting Ethan to lift his hands and clamping the artery that had been grazed.

It took longer than it should have for you, but finally the bullet was out and Connor’s artery was repaired. You carefully checked everything, seeing no other issues. If it had been a few millimetres one way he wouldn’t have had any issues. A few the other and he’d have died almost immediately.

You sewed up the bullet hole, knowing there’d be a scar on his stomach and hoping he wouldn’t blame you. Once you were finished you nodded, moving him to a gurney. The elevators were back up and running, so you took your patient up to Recovery, giving a hopeful nod to your friends.

It took three hours for Connor to wake up. Three hours of sitting there with bloody scrubs, unwilling to move in case he woke up alone. You’d had your hands in him. You’d had to save his life. And all you could think while you held his hand waiting for him to wake up was what if you hadn’t done it right. You were used to dealing with children, tiny veins and arteries. Nothing like what an adults were. But you needed to make sure he was ok and you were the only person in the hospital who could have saved him.

You had his hand in yours, running your thumb over the back of his hand. There was a small knot of scar tissue at the base of his index finger, and your thumb kept finding it and rubbing on it.

“Lacrosse accident as a kid.” Your head shot up, seeing Connor’s blue eyes looking at yours. “My finger scar. Broke it when someone brought his stick down on my hand. What happened?”

You smiled, so glad to see him awake and coherent. “There was an active shooter in the ER. You got shot, Ethan kept you alive until I got down. You needed the bullet removed and a graft on your renal artery, but I did it. It’s going to be a recovery, but you’ll be ok.” The tears you’d held back since bringing him upstairs started falling, and you tried wiping your eyes to stop him seeing.

“Don’t cry. I’m ok thanks to you. I don’t want to make you cry.” You looked at him and without thinking reached over to kiss him. His lips froze under yours for a second, but then he was kissing you back. You separated before it got too deep, not wanting to strain his healing body.

“If I’d known it’d get me a kiss I’d have been shot already,” he said, before wincing as he saw your face drop.

“How about this? You promise not to get shot again and you’ll get at least one kiss a day.” You smiled through your tears, just glad he was alive and joking and being so Connor.

“I promise.”

Taglist: @wanniiieeee @underscorejayden @chazubagi @elisafestari @suane007-blog @resanoona​ @sophiatellerrhodes​

[chicago-geniza]

Doctor was talking about my kidneys and spleen and I was like. Well I had an acute kidney injury in 2020 and an ectopic spleen that mysteriously disappeared and my creatinine clearance has been historically wonky. And I've been in persistent metabolic acidosis for at least 3 years. Is This Anything. And she was like. Okay we are ordering a full electrolyte panel, renal function, and various cell levels that look at the spleen & immune system specifically

I've never had a doctor take me so seriously before?????????

Still boggles my mind despite everything I know intellectually that they were just like "well that was weird, must have been your anticonvulsants" when I got an acute kidney injury out of nowhere & my renal function has been, how do you say, fucked ever since

[mcatmemoranda]

Mom's immune system is not exposed to baby's RBCs until delivery. Baby's RBCs can't cross the placenta, nor can mom's WBCs or IgM cross the placenta. After baby is born, mom's immune system can be exposed to baby's RBCs. Mom's phagocytes take up baby's RBCs and show the Rh antigens on baby's blood to mom's adaptive immune system in her lymph nodes.

The next pregnancy, mom will have IgG against Rh and the IgG can cross the placenta. They tag baby's RBCs for destruction and baby's immune system destroys the RBCs. Baby's liver and spleen try to compensate for the hemolysis by making more RBCs-> hepatosplenomegaly. Increased bilirubin from hemolysis-> kernicterus. When baby is born, mom and baby's blood mix, so mom's body has increased immune response to antigens on baby's RBCs.

Establish mom's Rh status at 1st prenatal visit. If mom is Rh+, nothing to do. If mom is Rh-, check the dad's Rh status. If he is Rh-, baby can't have Rh. If dad is unknown, give prophylaxis. Can also get cell free DNA, which tells you baby's Rh status. Cell free DNA is expensive test, so you don't have to do it.

If dad is Rh positive, get mom's Rh Ab titers against RhD. If titer is less than 1:16, check titer q4 weeks. If titers greater than 1:16, screen for anemia in fetus with transcranial doppler at velocity through middle cerebral artery. If there is nor increased velocity, nothing to do. If velocity through the middle cerebral artery I'd increased, and baby is less than 34 weeks, get percutaneous umbilical blood sample (PUBS) and transfuse as needed. So you can give the baby a blood transfusion while he's in utero! You use the umbilical vein to do that. That's so crazy!

If baby is greater than or equal to 34 weeks, no benefit to further gestation. They have higher risk of staying in utero with anemia. So deliver them.

Get blood type and Rh status every pregnancy. Prophylaxis is given if mom is antigen negative and antibody negative (i.e., she is Rh negative and has no anti-Rh antibodies) whose baby is Rh+. Give anti RhD immune globulin. It masks the Rh factor from mom so she can't mount an immune response to it. Do this at week 28 and after any mixing event (delivery, ectopic pregnancy, spontaneous abortion, induced abortion, chorionic villas sampling, amniocentesis, abdominal trauma with bleeding, any vaginal bleeding after 20 weeks).

Other antibodies:

Diego, Duffy (if mom has Abs to these and fetus has these, the fetus dies)

Kell & Kid Abs kill the fetus

Lewis lives

[prapti-hospital]

Laparoscopic surgery in Nashik | Prapti Hospital

Laparoscopic surgery

A minimally invasive surgical procedure utilized in the abdomen and pelvis is called laparoscopic surgery. It employs a laparoscope to see inside your body without fully opening it up. A laparoscope is a thin, telescopic rod with a camera at the end. In contrast to open abdominal surgery, which requires a 6- to 12-inch incision, laparoscopic surgery only requires two to four tiny incisions, each no larger than half an inch. The others are for the surgical tools, and one is for the camera. Keyhole surgery is another name for minimally invasive surgery that alludes to these tiny incisions.

What surgeries are performed laparoscopically?

removal of polyps, stones, fibroid, and cysts.

Excision of small tumors.

Biopsies.

Reversing and ligating the tubes.

Removing ectopic pregnancies.

surgery for endometriosis.

surgery for vaginal and urethral reconstruction.

Orchiopexy (testicle correction surgery).

Rectopexy (rectal prolapse repair).

surgery to treat a hernia.

Surgery for esophageal anti-reflux (fundoplication).

Surgery to remove the stomach.

For gallstones, cholecystectomy (gallbladder removal).

Appendectomy (removal of the appendix) for appendicitis.

Colectomy (bowel resection surgery).

abdominal and urethral resection (rectum removal).

Cystectomy (bladder removal).

Prostatectomy (prostrate removal).

Adrenalectomy (adrenal gland removal).

Nephrectomy (kidney removal).

Splenectomy (spleen removal).

Radical removal of the ureter (for transitional cell cancer).

Pancreaticoduodenectomy,  often known as the Whipple procedure.

Gastrostomy  (stomach removal).

Liver removal.

Can laparoscopic surgery be used in other parts of the body outside the abdomen and pelvis?

Many parts of the body are operated on using minimally invasive surgical methods. The technique may be identical outside of the abdominal and pelvic regions, but it goes by a different name. Through a keyhole incision in the chest, a surgeon may inspect your lungs using a thoracoscope. An arthroscopy may be used by a surgeon near the knee. Although the scopes have different names depending on what area of the body they are examining, they are all variations of the same thing.

Is laparoscopic surgery major surgery?

Major surgery and small surgery don't have any definite definitions that are well-established. They are frequently used by medical professionals to set expectations for the recovery duration and to compare how complicated and/or dangerous they believe one operation is relative to another. Depending on the type of operation you're talking about and how comprehensive it is, you can get a variety of responses if you ask them about laparoscopic surgery

There is no clear distinction between major surgery and minor surgery that is well-established. Medical personnel typically use them to compare how complicated and/or dangerous they think one procedure is compared to another and to set expectations for the length of recovery. You may get a range of responses if you inquire about laparoscopic surgery, depending on the kind of procedure you're discussing and how thorough it is.

On the other hand, laparoscopic procedures involve the removal of organs, and if you assume that any organ removal requires significant surgery, you are not mistaken. No matter how they are performed, these operations have inherent hazards that include bleeding, injury to surrounding organs, internal scarring, and others. The recuperation durations will be shortened and made easier with the laparoscopic procedure, but they are also frequent and have excellent success rates.

How safe is laparoscopic surgery?

There are less dangers and it is at least as safe as open surgery. Reduced bleeding, infection, and postoperative problems such wound separation and incisional hernia are all benefits of smaller wounds. Reduced direct touch between the surgeon and patient during laparoscopic surgery lowers the possibility of any microbial transmission. Additionally, it cuts down on post-operative recovery time, which lowers the dangers of protracted bed rest, like blood clots.

How common is laparoscopic surgery?

According to research, about 13 million laparoscopic procedures are carried out annually throughout the world. Over the following five years, it is predicted that these numbers will increase by 1%.

How should I prepare for my laparoscopic surgery?

You'll need to be ready for this in a few different ways because general anesthesia is typically used for laparoscopic surgeries. Prior to surgery, you should not eat or drink anything for roughly eight hours. This is done to stop anesthesia-related motion sickness. Additionally, you should make arrangements for transportation home after the treatment. Even while you'll probably be able to return home that day, the anesthesia may have left you feeling hazy. More detailed instructions regarding your drugs may be provided by your doctor.

What happens before the procedure?

When you get to the hospital, a nurse will take your vital signs to make sure you're healthy enough for surgery while you change into a hospital gown. Before the procedure, individuals could occasionally have additional testing, such a blood test or imaging of the surgical site

You will enter the surgical room after the testing is complete. To give you fluids and an aesthetic, an IV (intravenous) line will be inserted into a vein in your arm or hand. You'll be put to sleep and have your muscles paralyzed, along with any pain. Additionally, a breathing tube will be inserted in your throat to maintain the openness of your airway.

What happens during the procedure?

A little incision close to your belly button or pelvic bone marks the beginning of the procedure. Carbon dioxide gas is pumped into your abdominal or pelvic cavities through this first incision. Trocars, which are small surgical tubes used in laparoscopic surgery; serve as ports for surgical tools. Your abdomen or pelvis will be inflated with gas when the surgeon inserts the first trocar and threads the gas tube through it. By separating your abdominal wall from your organs, you can more easily see your organs on the television monitor.

The surgeon will take out the gas tube after filling the cavity and insert the laparoscope through the trocar. Real-time video images of the surgical site will be projected onto the video monitor by the laparoscope. The additional surgical equipment will be positioned according to this. They may make one or more keyhole incisions and insert trocars there, depending on the operation.

A surgical drain may be inserted into the cavity during various procedures to remove extra fluids, such as those from inflammation. Through a little tube, the liquids will drain. The tube may need to stay in your body to continue draining fluids for a while after the procedure depending on your condition. Following surgery, everything else will be stitched up. The incisions won't be closed until the gas has been released from your body. Before removing your breathing tube and IV, your surgical team will make sure that your vital signs are stable.

What happens after the procedure?

During various procedures, a surgical drain may be introduced into the cavity to drain additional fluids, such as those from inflammation. The liquids will drain through a little tube. Depending on your condition, the tube may need to remain in your body to continue draining fluids for some time after the treatment. Everything else will be sutured after the procedure.

Depending on your specific surgery and how your body heals, you might be able to go home the same day or you might need to stay overnight. You'll receive instructions from your medical team on how to take care of yourself once you get home. This covers nutrition recommendations, especially if you have abdominal surgery, as well as wound care and drain care, if applicable. Before you depart, you will also arrange a follow-up appointment to assess your recovery and, if necessary, have the fluid drain removed.